Targeted hepatitis C screening among ex-injection drug users in the community.

BACKGROUND AND AIM: Chronic hepatitis C virus (HCV) infection is one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. It is highly prevalent among injection drug users (IDUs) but is often undiagnosed because they represent an underprivileged group that faces multiple barriers to medical care. Here, we report the results of the New Life New Liver Project, which provides targeted HCV screening and education for ex-IDUs in the community. METHODS: Patients were recruited through the social worker networks and referrals by fellow ex-IDUs, and rapid diagnosis was based on point-of-care anti-HCV testing at rehabilitation centers. RESULTS: From 2009 to 2012, we served 234 subjects. One hundred thirty (56%) subjects were anti-HCV positive. The number needed to screen to detect one patient with positive anti-HCV was 1.8 (95% confidence interval, 1.6-2.0). However, only 69 (53%) HCV patients attended subsequent follow-up at regional hospitals, and 26 (20%) received antiviral therapy. Patients who attended follow-up were older, had higher education level and more active disease as evidenced by higher alanine aminotransferase, HCV RNA, and liver stiffness measurement by transient elastography. CONCLUSIONS: Targeted screening in ex-IDUs is effective in identifying patients with HCV infection in the community. Improvement in the referral system and introduction of interferon-free regimens are needed to increase treatment uptake.

Caregiver descriptions of dystonia in cerebral palsy.

OBJECTIVE: To determine how caregivers describe dystonia in people with cerebral palsy (CP). METHODS: In this prospective cohort study, paper surveys were administered to caregivers between September 7, 2021 and October 28, 2021 during CP Center visits at a large tertiary care center. Caregivers were asked to describe involuntary movements triggered by voluntary movement or triggered by tactile stimulation in the people with CP they cared for. Their CP Center medical provider separately assessed people with CP for dystonia. Movement features described exclusively by caregivers of people with CP and dystonia were determined using conventional content analysis. RESULTS: 113 caregivers responded on behalf of 56 people with and 57 people without dystonia. If caregivers noted that both voluntary movement and tactile stimulation triggered involuntary movements, that had a 92% positive predictive value for a dystonia diagnosis. Movement features exclusively described in people with CP and dystonia included: (1) stiffening, tensing, or tightening (15% of respondents); (2) involvement of the head (10%), torso (5%), or feet (5%); and (3) triggers of stretching (12.5%), excitement (5%), or transfers (5%). INTERPRETATION: In addition to a thorough exam, asking caregivers of people with CP to describe involuntary movements triggered by voluntary movement or tactile stimulation may inform clinical dystonia diagnosis.

Is the Mind Inherently Predicting? Exploring Forward and Backward Looking in Language Processing.

Prediction is one characteristic of the human mind. But what does it mean to say the mind is a "prediction machine" and inherently forward looking as is frequently claimed? In natural languages, many contexts are not easily predictable in a forward fashion. In English, for example, many frequent verbs do not carry unique meaning on their own but instead, rely on another word or words that follow them to become meaningful. Upon reading take a the processor often cannot easily predict walk as the next word. But the system can "look back" and integrate walk more easily when it follows take a (e.g., as opposed to *make|get|have a walk). In the present paper, we provide further evidence for the importance of both forward and backward-looking in language processing. In two self-paced reading tasks and an eye-tracking reading task, we found evidence that adult English native speakers' sensitivity to word forward and backward conditional probability significantly predicted reading times over and above psycholinguistic predictors of reading latencies. We conclude that both forward and backward-looking (prediction and integration) appear to be important characteristics of language processing. Our results thus suggest that it makes just as much sense to call the mind an "integration machine" which is inherently backward 'looking.'

An extended release ciprofloxacin/dexamethasone hydrogel for otitis media.

OBJECTIVE: Otitis media and associated otorrhea are frequent complications following tympanostomy tube insertion; the most common otologic procedure performed in children in the United States. Current treatments include the administration of antibiotic or antibiotic/anti-inflammatory combination drops to the affected ear. Several studies have demonstrated that using an antibiotic/anti-inflammatory combination product is more effective than the use of antibiotics alone. However, administration of any drops through the tympanostomy tube is very difficult in children, and patient compliance can be an issue. Our group has developed a novel combination drug/hydrogel formulation for the treatment of otitis media/otorrhea that releases both ciprofloxacin and dexamethasone over a 2-3 week period. This has the potential to offer significant advantages over current treatments in use in the clinic. METHODS: The release of drugs from the combination hydrogel was validated in vitro over the desired time frame and the activity of the released drugs was monitored via assays to confirm retention of full activity throughout the dissolution period. The safety of the ciprofloxacin/dexamethasone hydrogel and its inactive excipients was evaluated through in vivo otic toxicity studies in guinea pigs, including hearing tests, gross microscopy, and cytocochleogram analysis. RESULTS: Extended release of both drugs was demonstrated in vitro and antibiotic/anti-inflammatory activities were retained. The hydrogel components and its excipients did not cause adverse reactions in animals, demonstrating safety of the hydrogel combination in vivo. CONCLUSION: The studies presented lay the groundwork for extended release middle ear hydrogel formulations that are capable of safely releasing combinations of active pharmaceutical agents over a desired period of time. This would be more advantageous than therapeutics that are currently used in the clinic for the treatment of otitis media/otorrhea associated with tympanostomy tube insertion.

The Distributed L1 and L2 Language-Learning Environments of Dual Language Learners Across Home and School Settings.

Purpose This study explored the language-learning environments of typically developing dual language learners (DLLs) who learned Cantonese (first language [L1]) at home and English (second language [L2]) in preschool settings through direct and indirect measures. Method Nine typically developing Cantonese-English DLLs participated in this study. Participants' daylong activities were audio-recorded using the digital language processor of the Language ENvironment Analysis system. A manual coding scheme was developed to examine the audio recordings with the focus of the amount of L1 and L2 used by participants, adults, and their peers across home and school settings. In addition, participants' language use was indirectly examined using parent questionnaires, teacher reports, and classroom observations. Results The results of the audio recordings showed that Cantonese was the primary language used at home, and both Cantonese and English were used in school settings, consistent with the parent and teacher reports. Correlation analyses revealed that the amount of L1 used by the participants was associated with the L1 used by their peers: and the amount of L2 used by participants was positively related to the L2 used by adults at home. Conclusions The findings illustrate how parent/teacher reports and daylong audio recordings could complement each other in the investigation of DLLs' language-learning environments.

Schedule-based Family-centered Rounds: A Novel Approach to Achieve High Nursing Attendance and Participation.

INTRODUCTION: Bedside nurse (RN) presence during family-centered rounds (FCR) enhances communication and collaboration for safer, higher-quality care.1-3 At our institution, RN participation in FCR was variable and lower than desired. The content discussed at each bedside during rounds was inconsistent, contributing to the irregular achievement of established FCR checklist items. METHODS: Using a scheduling tool with a prioritization algorithm and set time allotment/patient, we implemented schedule-based family-centered rounds (SBFCR) on a pediatric acute care unit. Primary outcome metrics included RN attendance and participation. We tracked rounding checklist compliance, parent presence on rounds, and adherence to the schedule. Surveys provided information on provider and family satisfaction. Perceived impact on teaching was the balancing measure because the structure discouraged spending extra time at the cost of team tardiness for the next patient. RESULTS: We created a schedule for 95% workweek days, with the rounding order kept for 93%. Mean RN attendance increased from 69% to 87% and participation increased from 48% to 80% with SBFCR (P < 0.001 for each). FCR checklist compliance increased from 60% to 94% (P < 0.001). Families felt more informed and able to attend; their presence at rounds rose from 66% to 85% (P < 0.001). Most faculty and trainees felt SBFCR was efficient and observed increased teaching with SBFCR. CONCLUSIONS: SBFCR provides an organizational framework for increased RN attendance and participation as well as greater family presence during rounds. The system elevated provider satisfaction with rounding without degrading the perceived educational experience.

Prevention of cisplatin-induced hearing loss by extended release fluticasone propionate intracochlear implants.

OBJECTIVE: Cisplatin is a chemotherapeutic drug known to induce hearing loss. Although corticosteroids may help to mitigate the ototoxic side effects of cisplatin, there are complications associated with their systemic and prolonged use. The goal of this study is to test the efficacy of extended-release fluticasone propionate intracochlear implant particles to protect against cisplatin-induced hearing loss. METHODS: We used guinea pigs (n = 9) injected with cisplatin (IP, 12 mg/kg weight). Fluticasone particles were delivered to the cochlear scala tympani through the round window membrane into the right ears of the guinea pigs (left ears being used as a control) two weeks prior to cisplatin administration, and hearing function was evaluated by ABR and DPOAE before implantation, immediately before cisplatin administration, and 2 weeks after the challenge with cisplatin. Data was statistically evaluated using paired t-test analysis. RESULTS: No significant differences were observed in ABR threshold between control and implanted ears on day 14 (23.9 ±â€¯2.3 dB vs. 25.6 ±â€¯1.3 dB, P = 0.524), whereas the significant cisplatin-induced hearing loss in control animals (23.9 ±â€¯2.3 dB at day 14 vs. 40.7 ±â€¯2.5 dB at day 28, P ≤ 0.0001) was prevented in implanted animals (25.6 ±â€¯1.3 dB at day 14 vs. 25.0 ±â€¯3.1 at day 28, P ≥ 0.85). A similar, though not statistically significant, trend was observed in DPOAE responses in untreated ears (7.9 ±â€¯5.8 dB at day14 vs. -0.5 ±â€¯5.3 dB at day 28, P = 0.654) as compared to treatment (11.1 ±â€¯3.4 dB at day 14 vs. 13.6 ±â€¯4.8 dB at day 28, P = 0.733). CONCLUSION: These results suggest that fluticasone intracochlear implants are safe and able to provide effective otoprotection against cisplatin-induced hearing loss in the guinea pig model.