Implementation of a novel team-based model of care using expert intensive care unit physiotherapists to supplement critical care surge demand.

Within Victoria, Australia, the emergence of the Delta variant resulted in a significant and rapid increase in case numbers and high demand for intensive care beds statewide. While prior pandemic planning had been undertaken at a state level, the Delta variant necessitated a need for further rapid expansion of intensive care unit (ICU) beds. Our hospital subsequently implemented a Department of Health-designed team-based model of care to support this rapid ICU expansion-where tasks were allocated according to skill and not discipline. Here we report our local experiences as critical care physiotherapists participating in this novel model of care for physiotherapists to support the functioning of the ICU under peak pandemic surge conditions. Our core skill set as ICU-trained physiotherapists, including depth knowledge of the assessment and treatment of critical care patients, and ICU functioning, enabled us to play a contributing role in team-based care. We discuss our reflections and lessons learnt including future directions for clinicians, educators, managers, policymakers, and researchers to refine implementation of this novel model of care and how these lessons could be leveraged in future scenarios where healthcare systems might be significantly strained by future pandemics.

Resolving the polygenic aetiology of a late onset combined immune deficiency caused by NFKB1 haploinsufficiency and modified by PIK3R1 and TNFRSF13B variants.

Genetic variants in PIK3CD, PIK3R1 and NFKB1 cause the primary immune deficiencies, activated PI3Kδ syndrome (APDS) 1, APDS2 and NFκB1 haploinsufficiency, respectively. We have identified a family with known or potentially pathogenic variants NFKB1, TNFRSF13B and PIK3R1. The study's aim was to describe their associated immune and cellular phenotypes and compare with individuals with monogenic disease. NFκB1 pathway function was measured by immunoblotting and PI3Kδ pathway activity by phospho-flow cytometry. p105/p50 expression was absent in two individuals but elevated pS6 only in the index case. Transfection of primary T cells demonstrated increased basal pS6 signalling due to mutant PIK3R1, but not mutant NFKB1 or their wildtype forms. We report on the presence of pathogenic variant NFKB1, with likely modifying variants in TNFRSF13B and PIK3R1 in a family. We describe immune features of both NFκB1 haploinsufficiency and APDS2, and the inhibition of excessive PI3K signalling by rapamycin in vitro.

From Sorcery to Laboratory: Pandemics and Yanyuwa Experiences of Viral Vulnerability.

The COVID-19 pandemic has prompted renewed attention among health professionals, Aboriginal community leaders, and social scientists to the need for culturally responsive preventative health measures and strategies. This article, a collaborative effort, involving Yanyuwa families from the remote community of Borroloola and two anthropologists with whom Yanyuwa have long associations, tracks the story of pandemics from the perspective of Aboriginal people in the Gulf region of northern Australia. It specifically orients the discussion of the current predicament of 'viral vulnerability' in the wake of COVID-19, relative to other pandemics, including the Hong Kong flu in 1969 and the Spanish flu decades earlier in 1919. This discussion highlights that culturally nuanced and prescribed responses to illness and threat of illness have a long history for Yanyuwa. Yanyuwa cultural repertoires have assisted in the process of making sense of massive change, in the form of past pandemics and the onset of sickness, the threat of illness with COVID-19 and the attribution of 'viral vulnerability' to this remote Aboriginal community. The aim is to centralise Yanyuwa voices in this story, as an important step in growing understandings of Aboriginal knowledge of pandemics and culturally relevant and controlled health responses and strategies for communal well-being.

Framing the Opioid Crisis: Do Racial Frames Shape Beliefs of Whites Losing Ground?

CONTEXT: Although research has begun to examine perceptions of being on the losing side of politics, it has been confined to electoral politics. The context of health disparities, and particularly the opioid crisis, offers a case to explore whether frames that emphasize racial disadvantage activate loser perceptions and the political consequences of such beliefs. METHODS: White survey participants (N = 1,549) were randomized into three groups: a control which saw no news article, or one of two treatment groups which saw a news article about the opioid crisis framed to emphasize either the absolute rates of opioid mortality among whites or the comparative rates of opioid mortality among whites compared to blacks. FINDINGS: Among control group participants, perceiving oneself a political loser was unrelated to attitudes about addressing opioids, whereas those who perceived whites to be on the losing side of public health had a less empathetic response to the opioid crisis. The comparative frame led to greater beliefs that whites are on the losing side of public health, whereas the absolute frame led to more empathetic policy opinions. CONCLUSIONS: Perceptions that one's racial group has lost ground in the public health context could have political consequences that future research should explore.

Promoting Older Adult Physical Activity Throughout Care Transitions Using an Interprofessional Approach.

The nurse practitioner plays a key role in monitoring and improving physical activity and function of older adults. Physical activity is an essential component of care management for all older adults, even those who are frail with multimorbidities. All physical activity, no matter how small, has the potential to impact functional independence and quality of life. Partnering with the older adult and caregivers along with interprofessional providers, such as a physical therapist or occupational therapist and community-based resources, facilitates the development of successful goals and plans and the implementation of activities to promote physical activity across the continuum of care.

Prognosis of Good syndrome: mortality and morbidity of thymoma associated immunodeficiency in perspective.

Good syndrome (GS) or thymoma-associated immunodeficiency, is a rare condition that has only been studied in retrospective case series. General consensus was that GS has a worse prognosis than other humoral immunodeficiencies. In this study, physicians of GS patients completed two questionnaires with a two year interval with data on 47 patients, 499 patient years in total. Results on epidemiology, disease characteristics, and outcome are presented. Mean age at diagnosis was 60years and median follow-up from onset of symptoms was 9years. There was a high frequency of respiratory tract infections due to encapsulated bacteria. Median survival was 14years. Survival was reduced compared to age-matched population controls (5-year survival: 82% versus 95%, p=0.008). In this cohort survival was not associated with gender (HR 0.9, 95% CI 0.3-3.0), autoimmune diseases (HR 2.9, 95% CI 0.8-10.1) or immunosuppressive use (HR 0.3, 95% CI: 0.1-1.2).

Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens.

Rapid diagnosis and treatment of infectious meningitis and encephalitis are critical to minimize morbidity and mortality. Comprehensive testing of cerebrospinal fluid (CSF) often includes Gram stain, culture, antigen detection, and molecular methods, paired with chemical and cellular analyses. These methods may lack sensitivity or specificity, can take several days, and require significant volume for complete analysis. The FilmArray Meningitis/Encephalitis (ME) Panel is a multiplexed in vitro diagnostic test for the simultaneous, rapid (∼1-h) detection of 14 pathogens directly from CSF specimens: Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus agalactiae, cytomegalovirus, enterovirus, herpes simplex virus 1 and 2, human herpesvirus 6, human parechovirus, varicella-zoster virus, and Cryptococcus neoformans/Cryptococcus gattii We describe a multicenter evaluation of 1,560 prospectively collected CSF specimens with performance compared to culture (bacterial analytes) and PCR (all other analytes). The FilmArray ME Panel demonstrated a sensitivity or positive percentage of agreement of 100% for 9 of 14 analytes. Enterovirus and human herpesvirus type 6 had agreements of 95.7% and 85.7%, and L. monocytogenes and N. meningitidis were not observed in the study. For S. agalactiae, there was a single false-positive and false-negative result each, for a sensitivity and specificity of 0 and 99.9%, respectively. The specificity or negative percentage of agreement was 99.2% or greater for all other analytes. The FilmArray ME Panel is a sensitive and specific test to aid in diagnosis of ME. With use of this comprehensive and rapid test, improved patient outcomes and antimicrobial stewardship are anticipated.

Identification of a novel mutation in MAGT1 and progressive multifocal leucoencephalopathy in a 58-year-old man with XMEN disease.

XMEN disease (X-linked immunodeficiency with Magnesium defect, Epstein-Barr virus infection and Neoplasia) is a novel primary immune deficiency caused by mutations in MAGT1 and characterised by chronic infection with Epstein-Barr virus (EBV), EBV-driven lymphoma, CD4 T-cell lymphopenia, and dysgammaglobulinemia [1]. Functional studies have demonstrated roles for magnesium as a second messenger in T-cell receptor signalling [1], and for NKG2D expression and consequently NK- and CD8 T-cell cytotoxicity [2]. 7 patients have been described in the literature; the oldest died at 45 years and was diagnosed posthumously [1-3]. We present the case of a 58-year-old Caucasian gentleman with a novel mutation in MAGT1 with the aim of adding to the phenotype of this newly described disease by detailing his clinical course over more than 20 years.

Recognition of Streptococcus pseudoporcinus Colonization in Women as a Consequence of Using Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry for Group B Streptococcus Identification.

During a 14-month period of using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for group B streptococcus (GBS) identification, we recovered 32 (1%) Streptococcus pseudoporcinus isolates from 3,276 GBS screening cultures from female genital sources (25 isolates from pregnant women and 7 from nonpregnant women). An additional two S. pseudoporcinus isolates were identified from a urine culture and a posthysterectomy wound culture. These isolates were found to cross-react with three different GBS antigen agglutination kits, PathoDx (Remel) (93%), Prolex (Pro-Lab Diagnostics) (38%), and Streptex (Remel) (53%). New approaches to bacterial identification in routine clinical microbiology laboratories may affect the prevalence of S. pseudoporcinus.

A diagnostic stewardship approach to prevent unnecessary testing of an enteric bacterial molecular panel.

IMPORTANCE: Testing for enteric bacterial pathogens in patients hospitalized for more than 3 days is almost always inappropriate. Our study validates the utility of the 3-day rule and the use of clinical decision support tools to decrease unnecessary testing of enteropathogenic bacteria other than C. difficile. Overriding the restriction was very low yield. Our study highlights the importance of diagnostic stewardship and further refines the criteria for allowing providers to override the restriction while monitoring the impact of the interventions.

Are Republicans and Conservatives More Likely to Believe Conspiracy Theories?

A sizable literature tracing back to Richard Hofstadter's The Paranoid Style (1964) argues that Republicans and conservatives are more likely to believe conspiracy theories than Democrats and liberals. However, the evidence for this proposition is mixed. Since conspiracy theory beliefs are associated with dangerous orientations and behaviors, it is imperative that social scientists better understand the connection between conspiracy theories and political orientations. Employing 20 surveys of Americans from 2012 to 2021 (total n = 37,776), as well as surveys of 20 additional countries spanning six continents (total n = 26,416), we undertake an expansive investigation of the asymmetry thesis. First, we examine the relationship between beliefs in 52 conspiracy theories and both partisanship and ideology in the U.S.; this analysis is buttressed by an examination of beliefs in 11 conspiracy theories across 20 more countries. In our second test, we hold constant the content of the conspiracy theories investigated-manipulating only the partisanship of the theorized villains-to decipher whether those on the left or right are more likely to accuse political out-groups of conspiring. Finally, we inspect correlations between political orientations and the general predisposition to believe in conspiracy theories over the span of a decade. In no instance do we observe systematic evidence of a political asymmetry. Instead, the strength and direction of the relationship between political orientations and conspiricism is dependent on the characteristics of the specific conspiracy beliefs employed by researchers and the socio-political context in which those ideas are considered. Supplementary Information: The online version contains supplementary material available at 10.1007/s11109-022-09812-3.

Dialect effects in speech perception: the role of vowel duration in Parisian French and Swiss French.

The current experiments examined how native Parisian French and native Swiss French listeners use vowel duration in perceiving the /[character: see text]/-/o/ contrast. In both Parisian and Swiss French /ol is longer than /[character: see text]/, but the difference is relatively large in Swiss French and quite small in Parisian French. In Experiment I we found a parallel effect in perception. For native listeners of both dialects, the perceived best exemplars of /o/ were longer than those of /[character: see text]/. However, there was a substantial difference in best-exemplar duration for /[character: see text]/ and /o/ for Swiss French listeners, but only a small difference in best-exemplar duration for Parisian French listeners. In Experiment 2 we found that this precise pattern depended not only on the native dialect of the listeners, but also on whether the stimuli being judged had the detailed acoustic characteristics of the native dialect. These findings indicate that listeners use fine-grained information in the speech signal in a dialect-specific manner when mapping the acoustic signal onto vowel categories of their language.

Candidate name order effects in New Hampshire: Evidence from primaries and from general elections with party column ballots.

Research in a few U.S. states has shown that candidates listed first on ballots gain extra votes as a result. This study explored name order effects for the first time in New Hampshire, where such effects might be weak or entirely absent because of high political engagement and the use of party column ballots. In general elections (in 2012 and 2016) for federal offices and the governorship and in primaries (in 2000, 2002, and 2004), evidence of primacy effects appeared in 86% of the 84 tests, including the 2016 presidential race, when Donald Trump gained 1.7 percentage points from first listing, and Hillary Clinton gained 1.5 percentage points. Consistent with theoretical predictions, primacy effects were larger in primaries and for major-party candidates in general elections than for non-major-party candidates in general elections, more pronounced in less publicized contests, and stronger in contests without an incumbent running. All of this constitutes evidence of the reliability and generalizability of evidence on candidate name order effects and their moderators.

The first reported cases of meat allergy following tick bites in the UK.

Allergic reactions frequently involve the production of immunoglobulin E (IgE) antibodies to proteins. However, reactions directed against carbohydrate moieties are increasingly being recognised. Tick bites can contribute to the development of immunoglobulin E to the galactose-1,3-galactose (alpha-gal) moiety on tick salivary proteins. These IgE molecules can cross-react with alpha-gal found in red meats, causing Type I IgE-mediated hypersensitivity reactions to these foods. We present three cases of delayed reactions to beef, pork and lamb in patients with prior tick bites and in the presence of a positive-specific IgE to alpha-gal. Patients were advised to avoid red meat consumption and to carry emergency treatment in the form of anti-histamines with or without adrenaline autoinjector devices. This is the first published report of red meat allergy caused by tick bites suffered in the UK.

Characteristics of listener sensitivity to talker-specific phonetic detail.

Previous research shows that listeners are sensitive to talker differences in phonetic properties of speech, including voice-onset-time (VOT) in word-initial voiceless stop consonants, and that learning how a talker produces one voiceless stop transfers to another word with the same voiceless stop [Allen, J. S., and Miller, J. L. (2004). J. Acoust. Soc. Am. 115, 3171-3183]. The present experiments examined whether transfer extends to words that begin with different voiceless stops. During training, listeners heard two talkers produce a given voiceless-initial word (e.g., pain). VOTs were manipulated such that one talker produced the voiceless stop with relatively short VOTs and the other with relatively long VOTs. At test, listeners heard a short- and long-VOT variant of the same word (e.g., pain) or a word beginning with a different voiceless stop (e.g., cane or coal), and were asked to select which of the two VOT variants was most representative of a given talker. In all conditions, which variant was selected at test was in line with listeners' exposure during training, and the effect was equally strong for the novel word and the training word. These findings suggest that accommodating talker-specific phonetic detail does not require exposure to each individual phonetic segment.

CE: Acute Care for Patients with Dementia.

Among adults ages 65 and older, dementia doubles the risk of hospitalization. Roughly one in four hospitalized patients has dementia, and the prevalence of dementia in the United States is rising rapidly. Patients with dementia have significantly higher rates of hospital-acquired complications, including urinary tract infections, pressure injuries, pneumonia, and delirium, which when unrecognized and untreated can accelerate physical and cognitive decline, precipitating nursing home placement and death. The authors discuss the unique needs of patients with dementia who require acute care, highlighting evidence-based strategies for nurses to incorporate into practice.

Improving satisfaction with postoperative pain management for patients with persistent pain: a preoperative pain medicine consultation intervention.

PURPOSE: Preoperative pain medicine consultations with opioid-tolerant patients allow for an accurate medication history, patient involvement in the postoperative plan, and realistic goal setting. The purpose of this quality improvement project was to increase attendance at preoperative pain consultations, thereby increasing patient satisfaction. METHODS: Retrospective chart reviews identified patients who had a preoperative pain consultation ordered from May through July 2016. Patient interviews determined reasons for not attending appointments, involvement in goal setting, engagement in pain management planning, and satisfaction with postoperative pain management. RESULTS: Retrospective chart reviews and interviews were conducted after the intervention (May-July 2017). Scheduling changes increased attendance at preoperative pain consultations by 14 percentage points (50% vs 64%). Those who attended consultations were more involved in goal setting and decisions and were more satisfied. CONCLUSIONS: Preoperative pain consultations with opioid-tolerant patients can increase satisfaction through realistic goal setting and involvement in the pain management plan.