The Safety of Maternal and Fetal MRI at 3 T.

OBJECTIVE. The purpose of this study was to evaluate the effects of clinical 3-T MRI during pregnancy on fetal growth and neonatal hearing in neonates at low risk of congenital hearing impairment or of brain or chromosomal abnormalities. MATERIALS AND METHODS. This single-center retrospective case-control study included consecutively born healthy neonates exposed in utero to 3-T MR during MRI for maternal or fetal indications and born between January 2008 and March 2015. Each exposed neonate was randomly matched 1:2 by birth date to healthy control neonates who had not been exposed to MR. Infant birth weights were compared by unpaired t test. Hearing impairment between groups was compared by Fisher exact test. RESULTS. There was no significant difference in mean birth weight between the MR-exposed (3398 g) and control (3510 g) neonates (p = 0.06). There was no significant difference in prevalence of hearing impairment (p = 0.55) between the MR-exposed (0% [0/81]) and control (1.8% [3/162]) groups. CONCLUSION. This study showed no adverse effects with regard to neonatal hearing or fetal growth in healthy neonates who were variably exposed to 3-T MR in utero during MRI for various clinical maternal or fetal indications at any gestational age.

Shipboard Global Health Engagement Missions: Essential Lessons for Military Healthcare Personnel.

INTRODUCTION: Global health engagement missions are conducted to improve and protect the health of populations worldwide. Recognizing the strong link between health and security, the Armed Forces have increased the number of global health engagement missions over the last decade to support force health protection, medical readiness, enhance interoperability, improve host nation capacity building, combat global health threats (i.e., emerging infectious diseases), support humanitarian assistance and disaster relief efforts, as well as build trust and deepen professional medical relationships worldwide. These missions additionally support the US Global Health Security Agenda, US National Security Strategy, US National Defense Strategy and National Military Strategy.Although global health engagement missions are conducted by armed forces with numerous military units and geographical locations, military healthcare personnel assigned to US Naval hospital ships also perform a wide range of these missions. These missions comprise some of the largest global health engagement missions conducted, encompassing hundreds of subject matter expert exchanges, community health exchanges, medical symposiums, and side-by-side partnered healthcare in countries around the world. Military healthcare personnel who have completed past missions possess valuable knowledge related to ship-based global health engagement missions. Capturing and transferring this knowledge to future deployed personnel is important for future successful missions, but has remained a significant challenge. The purpose of this study was to capture and examine first-person accounts of experiential learning among active duty physicians, nurses, and hospital corpsmen who had participated in recent hospital ship-based global heath engagement missions. MATERIALS AND METHODS: We used the interpretive, ethnographic method of interviewing and data analysis described by Benner. Interviews elicited detailed, narrative examples of experiences from military health care personnel who had participated in previous global health engagement missions aboard hospital ships (N = 141). Our approach to gaining meaning from these narratives was guided by three central strategies: (1) identify paradigm cases, (2) identify themes within and across participant narratives of meaningful patterns, and (3) identify exemplars to represent common patterns of meaning and common situations. Additionally, we collected demographic information. RESULTS: Our findings provide firsthand descriptions of five essential elements to prepare military healthcare personnel for shipboard global health engagement missions. These essential elements are mission clarity, preparedness, experiential knowledge, lessons learned, and flexibility/adaptability. CONCLUSIONS: Widespread dissemination of the lessons learned from military global health engagement missions is crucial to shaping forces that operate effectively in a rapidly changing global environment. Sharing lessons learned increases efficiency, adaptability, and agility, while decreasing variance in processes and the need to relearn mission-specific lessons.

Species-specific clinical characteristics of human coronavirus infection among otherwise healthy adolescents and adults.

Human coronavirus (HCoV) is a known cause of influenza-like illness (ILI). In a multisite, observational, longitudinal study of ILI among otherwise healthy adolescents and adults, 12% of subjects were PCR-positive for HCoV. The distribution of species was as follows: HCoV-OC43 (34%), HCoV-229E (28%), HCoV-NL63 (22%), and HCoV-HKU1 (16%). We did not observe species-specific differences in the clinical characteristics of HCoV infection, with the exception of HCoV-HKU1, for which the severity of gastrointestinal symptoms trended higher on the fourth day of illness.

Mantram Repetition Program Decreases Insomnia Among Homeless Women: A Pilot Study.

The current pre-/posttest pilot study recruited homeless women from "safe" car parks and transitional housing to evaluate the use of mantram in regard to insomnia. At baseline, study participants completed measures of cognitive function, depression, and the Insomnia Severity Index (ISI). In 40 minutes, women were taught three skills of the Mantram Repetition Program (MRP) in the natural environment: (a) silently repeating a mantram several times, several times per day; (b) repeating the mantram slowly every night before sleep; and (c) focusing full attention on the mantram during repetitions. One week later, participants completed a second ISI. Of the 29 women recruited, 83% completed 1-week follow up. After 1 week, 88% were using their mantram daily and one half were using it prior to sleep. Insomnia severity significantly decreased (p = 0.03), with a mean difference of 2.36 (SD = 4.75). The practice of MRP, an intervention that is portable and easy to teach, shows significant promise in decreasing insomnia in this unique population.

Differential performance of Alzheimer's and vascular dementia patients on a brief battery of neuropsychological tests.

The purpose of this article was to examine the differences in neuropsychological test performance between groups with Alzheimer's and vascular dementia. Patients included in this study were those diagnosed with Alzheimer's Disease (AD) or Vascular Dementia (VAD) through a series of neuroradiological tests that included at a minimum a CT or MRI scan and a SPECT scan. Of the 113 AD patients, the average age was 80.08 (SD = 5.91) years and average education was 12.85 (SD = 2.88). Of the 109 VAD patients, average age was 78.67 (SD = 5.35) and average education was 13.10 (SD = 2.65). Tests included selected subtests of the WAIS-R, Word Fluency, Rey Figure, Boston Naming Test, Math, Reading, and subtests from the WMS-R. Five tests showed significant differences in favor of the VAD group: Information, Similarities, Picture Completion, WRAT Mathematics, and the Boston Naming Test. Both groups did well on Reading, while both did poorly on the Rey and Word Fluency. Although both groups did poorly on memory measures, the VAD patients showed better performance. Overall, the two groups did not differ significantly on the more complex tests, but did differ on more basic tests and all the memory tests. This pattern of similar score on complex tests and different scores on basic tests demonstrates the theory that both types of dementia affected higher, more complex skills. Differences between the groups were only apparent when basic skills were compared and were not reflected in more complex and neuropsychologically "sensitive" tests.