Decline in Stroke Presentations During COVID-19 Surge.

BACKGROUND AND PURPOSE: We aimed to investigate the acute stroke presentations during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: The data were obtained from a health system with 19 emergency departments in northeast Ohio in the United States. Baseline period from January 1 to March 8, 2020, was compared with the COVID period from March 9, to April 2, 2020. The variables included were total daily stroke alerts across the hospital emergency departments, thrombolysis, time to presentation, stroke severity, time from door-to-imaging, time from door-to-needle in thrombolysis, and time from door-to-puncture in thrombectomy. The 2 time periods were compared using nonparametric statistics and Poisson regression. RESULTS: Nine hundred two stroke alerts during the period across the emergency departments were analyzed. Total daily stroke alerts decreased from median, 10 (interquartile range, 8-13) during baseline period to median, 8 (interquartile range, 4-10, P=0.001) during COVID period. Time to presentation, stroke severity, and time to treatment were unchanged. COVID period was associated with decrease in stroke alerts with rate ratio of 0.70 (95% CI, 0.60-0.28). Thrombolysis also decreased with rate ratio, 0.52 (95% CI, 0.28-0.97) but thrombectomy remained unchanged rate ratio, 0.93 (95% CI, 0.52-1.62) Conclusions: We observed a significant decrease in acute stroke presentations by ≈30% across emergency departments at the time of surge of COVID-19 cases. This observation could be attributed to true decline in stroke incidence or patients not seeking medical attention for emergencies during the pandemic.

Comparing First Graders' Attitudes and Preferences Toward a Peer Using an iPad(®)-Based Speech-Generating Device and a Non-Electronic AAC System.

This study compared first graders' attitudes toward a peer who used an iPad(®)-based speech-generating device (SGD) versus a non-electronic AAC system, as well as preferences regarding the systems. In all, 115 first graders were randomly assigned to view a video of a peer using either the SGD or the non-electronic system. Participants then completed the Assessment of Attitudes Toward Augmentative and Alternative Communication (AATAAC) and answered preference questions about the systems. Results showed that attitudes toward the peer did not vary significantly as a function of the type of AAC system the peer used. Girls tended to have more positive attitudes than boys toward the peer who used AAC. A majority of participants preferred the SGD for their peer's and for their own use.

Liver allograft antibody-mediated rejection with demonstration of sinusoidal C4d staining and circulating donor-specific antibodies.

The importance of antibody-mediated rejection (AMR) in ABO-compatible liver transplantation is controversial. Here we report a prospective series of liver recipients with a preoperative positive crossmatch. To establish the diagnosis of AMR in liver recipients, the criteria described for kidney allografts were adopted. In approximately 10% of 197 liver transplants, we observed a positive T and B cell flow crossmatch before transplantation. Fifteen of 19 patients converted to negative crossmatches early after transplantation and displayed normal liver function while they were on routine immunosuppression. Four patients maintained positive crossmatches. Three of the 4 met the criteria for AMR and showed evidence of graft dysfunction, the presence of donor-specific antibodies (DSAs), morphological tissue destruction with positive C4d linear staining on the graft sinusoidal endothelium, and improved function with attempts to eliminate DSAs. A persistently positive crossmatch after liver transplantation may lead to early, severe AMR and liver failure. C4d staining in the liver sinusoidal endothelium should alert one to the possibility of AMR. In our experience, patients with a positive crossmatch should have it repeated at 2 weeks and, if it is positive, again at 3 to 5 weeks. Recipients with an unknown preoperative crossmatch who develop early cholestasis of unclear etiology should be crossmatched or tested for the presence of DSAs to evaluate for AMR.

Speech-language pathologist job satisfaction in school versus medical settings.

PURPOSE: The goal of this study was to determine if job satisfaction differs between speech-language pathologists (SLPs) working in school settings and SLPs working in medical settings. METHOD: The Job Satisfaction Survey (JSS) by Spector (1997) was sent via electronic mail to 250 SLPs in each of the 2 settings. Job satisfaction scores were computed from subscale category ratings and were compared between the 2 settings. Subscale category ratings for pay, promotion, supervision, benefits, contingent rewards, operating conditions, coworkers, nature of work, and communication were analyzed for differences between and within settings. Age, caseload size, and years-at-position were analyzed by linear regression to determine whether these factors might predict SLPs' job satisfaction. RESULTS: The survey had a response rate of 19.6% (N = 98 participants). Although SLPs in both settings were generally satisfied with their jobs, SLPs in medical settings had significantly higher total job satisfaction scores. Respondents from both settings had similar satisfaction ratings for subscale categories, with nature of work receiving the highest rating and operating conditions and promotion the lowest. Results of the linear regression analysis for age, caseload size, and years-at-position were not significant. CONCLUSION: Further research should evaluate important aspects of job satisfaction in both settings, especially nature of work operating conditions, and promotion.

Single motor unit activity in levator veli palatini during speech and nonspeech tasks.

OBJECTIVE: This article assesses the control of velar movement by relating observed recruitment patterns of single motor unit activity in levator veli palatini observed during speech and nonspeech tasks in a single subject to intraoral pressure demands. METHODS: Electromyographic activity was recorded from a single motor unit in levator veli palatini during repetitions of "Say (----) again" with selected consonant-vowel-consonant and consonant-vowel syllables, sustained high pressure consonants, and blowing tasks. Single motor unit firing characteristics (e.g., frequency of occurrence, firing frequency) were related to intraoral air pressures recorded during the sustained consonant and blowing tasks. RESULTS: Levator single motor unit activity was always present during the /s/ in "say" and the first and second /s/ in /sis/. Activity was observed less consistently during the production of the /s/ in /sus/, the /p/ in /p Lambda/, and the /g/ in "again." Single motor unit firing frequency ranged from 16.1 Hz to 22 Hz during phrase productions. Recruitment was observed during sustained productions of high-pressure consonants when intraoral pressures exceeded 15 cm H(2)O. Increases in intraoral air pressure were associated with 25% to 85% increases in single motor unit firing frequencies. During nonspeech blowing tasks, single motor unit activity was observed when intraoral air pressure exceeded approximately 12 cm H(2)O. Increases in intraoral air pressure were again associated with increased single motor unit firing rates. CONCLUSIONS: Results showed evidence of both preprogrammed and feedback-controlled responses by levator veli palatini to changes in task intraoral pressure demands.