Neurologic Manifestations of Long COVID Differ Based on Acute COVID-19 Severity.

OBJECTIVE: To characterize neurologic manifestations in post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients. METHODS: Prospective study of the first 100 consecutive PNP and 500 NNP patients evaluated at a Neuro-COVID-19 clinic between 5/2020 and 8/2021. RESULTS: PNP were older than NNP patients (mean 53.9 vs 44.9 y; p < 0.0001) with a higher prevalence of pre-existing comorbidities. An average 6.8 months from onset, the main neurologic symptoms were "brain fog" (81.2%), headache (70.3%), and dizziness (49.5%) with only anosmia, dysgeusia and myalgias being more frequent in the NNP compared to the PNP group (59 vs 39%, 57.6 vs 39% and 50.4 vs 33%, all p < 0.003). Moreover, 85.8% of patients experienced fatigue. PNP more frequently had an abnormal neurologic exam than NNP patients (62.2 vs 37%, p < 0.0001). Both groups had impaired quality of life in cognitive, fatigue, sleep, anxiety, and depression domains. PNP patients performed worse on processing speed, attention, and working memory tasks than NNP patients (T-score 41.5 vs 55, 42.5 vs 47 and 45.5 vs 49, all p < 0.001) and a US normative population. NNP patients had lower results in attention task only. Subjective impression of cognitive ability correlated with cognitive test results in NNP but not in PNP patients. INTERPRETATION: PNP and NNP patients both experience persistent neurologic symptoms affecting their quality of life. However, they harbor significant differences in demographics, comorbidities, neurologic symptoms and findings, as well as pattern of cognitive dysfunction. Such differences suggest distinct etiologies of Neuro-PASC in these populations warranting targeted interventions. ANN NEUROL 2023;94:146-159.

Mothers, milk and mourning: The meanings of breast milk after loss of an infant.

Breast milk is a highly valued substance, immunologically and nutritionally, which also signifies maternal care and love for the infant. This intersection of biological and cultural qualities confers breast milk with complex meanings, which necessarily shape the experience of breastfeeding. Our research, investigating the experience of lactation after the loss of an infant, casts a novel light on these meanings. This article analyses the experience of 17 Australian bereaved mothers and 114 health professionals charged with their care. We find that while all the mothers found post-loss lactation emotionally painful, many also found redemptive meaning in their milk-production, as a bond with the lost child, as confirmation of their maternal competence and as a life giving substance that they could donate to other needy infants. These complex meanings and positive connotations were at odds with hospital cultures that regard post-loss lactation as valueless and best dealt with through medical suppression, despite the more complex insights of individual health-care professions.

Transforming entomology to adapt to global concerns: 2021 student debates.

The 2021 Student Debates of the Entomological Society of America (ESA) were held at the Annual Meeting in Denver, CO. The event was organized by the Student Debates Subcommittee (SDS) of the Student Affairs Committee (SAC). The theme of the 2021 Student Debates was "Transforming Entomology to Adapt to Global Concerns", with 3 topics. Each topic had an unbiased introduction and 2 teams. The debate topics were (i) Nonnative insect introduction is an ethical approach for counteracting proliferation and overpopulation of consumers, (ii) What is the best technology to control undesirable insect pests in urban and agricultural settings? and (iii) Compared to other solutions, like plant-based diets, insect farming is the best method to address rising human global food and nutrient supply demands. Unbiased introduction speakers and teams had approximately 6 months to prepare for their presentations.

Seeing what works: identifying and enhancing successful interprofessional collaboration between pathology and surgery.

Utilising frozen section technologies, Mayo Clinic has one of the lowest reoperation rates for breast lumpectomy in the United States. The research reported on sought to understand the successful teamwork between the Breast Surgery Team and the Frozen Section Laboratory at Mayo Clinic. Researchers worked collaboratively with healthcare staff from breast surgery and the frozen section pathology laboratory to identify communication styles and strategies that contribute to the timely and accurate intraoperative evaluation of breast cancer specimens. Using the video-reflexive ethnography (VRE) methodology underpinned by a positive theoretical approach to researching quality and safety in healthcare, the researchers video-recorded the communications associated with specimen resections in surgery and the subsequent pathology diagnoses. Then, 57 staff from the breast surgery and frozen section laboratory teams attended video-reflexivity sessions to collaboratively analyse their communication practices and identify opportunities to optimize interprofessional communication. In this article, we focus on how the flexible, interdisciplinary, and cross-hierarchical communication within the frozen section laboratory supports a rapid and accurate intraoperative evaluation and communication, previously conceptualized by staff as being performed in a linear fashion. Moreover, we detail how the VRE methodology led surgeons and pathologists to implement new strategies and optimize their interprofessional communication.

"Ultimately, mom has the call": Viewing clinical trial decision making among patients with ovarian cancer through the lens of relational autonomy.

OBJECTIVE: This study employs the concept of relational autonomy to understand how relational encounters with family members (FMs) and care providers may shape decisions around ovarian cancer patients' clinical trial (CT) participation. The study also offers unique insights into how FMs view patients' decision making. METHODS: In-depth interviews were conducted with 33 patients with ovarian cancer who had been offered a CT and 39 FMs. Data were inductively analysed using a thematic approach and deductively informed by constructs derived from the theory of relational autonomy (RA). RESULTS: Patients' relationships, experiences and social status were significant resources that shaped their decisions. Patients did not give equal weight to all relationships and created boundaries around whom to include in decision making. Doctors' recommendations and perceived enthusiasm were described as influential in CT decisions. Both patients with ovarian cancer and their FMs maintained that patients have the "final say," indicating an individualistic autonomy. However, maintaining the "final say" in the decision-making process is constitutive of patients' relationships, emphasizing a relational approach to autonomy. FMs support patients' autonomy and they do so particularly when they believe the patient is capable of making the right choices. CONCLUSIONS: Although ethical principles underlying informed consent for CT participation emphasize individual autonomy, greater attention to relational autonomy is warranted for a more comprehensive understanding of CT decision making.

Freezing for love: enacting 'responsible' reproductive citizenship through egg freezing.

The promise of egg freezing for women's fertility preservation entered feminist debate in connection with medical and commercial control over, and emancipation from, biological reproduction restrictions. In this paper we explore how women negotiate and make sense of the decision to freeze their eggs. Our analysis draws on semi-structured interviews with 16 women from the Midwest and East Coast regions of the USA who froze their eggs. Rather than freezing to balance career choices and 'have it all', the women in this cohort were largely 'freezing for love' and in the hope of having their 'own healthy baby'. This finding extends existing feminist scholarship and challenges bioethical concerns about egg freezing by drawing on the voices of women who freeze their eggs. By viewing egg freezing as neither exclusively liberation nor oppression or financial exploitation, this study casts egg freezing as an enactment of 'responsible' reproductive citizenship that 'anticipates coupledom' and reinforces the genetic relatedness of offspring.

Multiple Researcher Roles in Video-Reflexive Ethnography.

Hospital-based video-reflexive ethnography (VRE) is a collaborative visual methodology used by researchers and/or health professionals to understand, interpret, and optimize health professionals' work practices and patients' experiences. For more than a decade, the VRE methodology has spread throughout (research) institutions and hospitals internationally, and VRE has evolved and broadened. Different ways of doing VRE have implications for the role of the researcher. A thorough examination of the consequences for the researcher's position is the central focus of this article. We outline three typical styles of researcher engagement with VRE: clinalyst, affect-as-method, and planned obsolescence. We argue that by examining these different styles of doing VRE research, academic researchers can then critically review and carefully choose which styles of VRE research best meet the needs of their research questions, their field relationships, their disciplinary background, and the expectations of their clinical research collaborators.

A Mixed-Methods Study on the Barriers and Facilitators of Telemedicine for Newborn Resuscitation.

BACKGROUND: Teleneonatology may improve the quality of high-risk newborn resuscitations performed by general providers in community settings. Variables that affect teleneonatology utilization have not been identified. INTRODUCTION: The objective of our mixed-methods study was to understand the barriers and facilitators experienced by local care providers who receive teleneonatology services. MATERIALS AND METHODS: In October 2015, an electronic survey was sent to 349 teleneonatology participants at 6 community hospitals to assess user satisfaction, technology usability and acceptability, and impact on patient care. From December 2015 to June 2016, 49 participants were involved in focus groups and individual interviews to better understand barriers and facilitators of teleneonatology implementation. Qualitative data were analyzed using a thematic approach. RESULTS: Survey response rate was 31.8% (N = 111). Of 93 survey respondents, 88 (94.6%) agreed that teleneonatology was needed at their hospitals, and of 52 participants, 50 (96.2%) believed that teleneonatology consults were helpful. We identified multiple facilitators and barriers to program implementation in education and training, process and work flow, communication, and technology. DISCUSSION: Local care teams believed that teleneonatology was valuable for connection to a remote neonatologist. Successful program implementation may be facilitated by communicating the value of teleneonatology, engaging local stakeholders in program training and education, maintaining supportive professional relationships, and designing simple, highly reliable clinical work flows. CONCLUSIONS: Teleneonatology is viewed as an innovative, valuable service by local care teams. The identified barriers and facilitators to program use should be considered when implementing a teleneonatology program.

Ovarian cancer patients' and their family members' perspectives on novel vaccine and virotherapy trials.

BACKGROUND/AIMS: Some of the most promising avenues of cancer clinical investigation center on immunotherapeutic approaches. These approaches have provided notable gains in cancer therapeutics with recent Food and Drug Administration approvals of agents of this class in several types of cancers, although gains for ovarian cancer lag behind. This study examined perceptions of therapeutic trials including immunotherapy and virotherapy among ovarian cancer patients and their family members. METHODS: A total of 72 semi-structured qualitative interviews were conducted with 33 patients and 39 family members at two National Cancer Institute-designated comprehensive cancer centers. Eligible patients were diagnosed with epithelial ovarian, primary peritoneal, or fallopian tube carcinoma and had experience with clinical trial conversations; family members were nominated by patients and interviewed separately. Applied thematic analysis was used to understand and interpret the data. RESULTS: More participants were aware of vaccine trials than virus trials, although more than half had heard of at least one of them. Initial reactions to vaccine trials were generally favorable. For many, childhood experience with vaccines lent a familiar frame of reference. Virus trials elicited more negative initial reactions, including the use of adjectives such as "scary" and "dreadful." Viruses seemed contagious or difficult to control. Increased receptivity to these trials occurred in the context of limited therapeutic options and cancer recurrence. Most participants, including those not immediately drawn to these types of trials, indicated openness to learning more. CONCLUSION: Although vaccine and viral trials are both immunologically based therapeutic approaches, patients who are offered these trials may perceive their potential benefit and safety quite differently. There is a need to consider terminology, solicit and address "gut reactions," and provide information that enables patients and their family members to better understand the science behind these trials.

Involving patients in understanding hospital infection control using visual methods.

AIMS AND OBJECTIVES: This paper explores patients' perspectives on infection prevention and control. BACKGROUND: Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front-line clinicians' practices; patients' roles have been less explored. DESIGN: Video-reflexive ethnography. METHODS: Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one-on-one reflexive sessions. FINDINGS: Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency. CONCLUSION: This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care. RELEVANCE TO CLINICAL PRACTICE: This study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self-care behaviour.

Body dirt or liquid gold? How the 'safety' of donated breastmilk is constructed for use in neonatal intensive care.

When mothers of preterm infants are unable to produce sufficient volumes of breastmilk, neonatologists in many Western countries prescribe pasteurized donor breastmilk. Breastmilk has a paradoxical presence in the neonatal intensive care unit while it has therapeutic properties, it also has the potential to transmit disease. National health authorities and local neonatal intensive care unit policies each delimit the safety of donor milk by focusing on the presence or absence of pathogens. It is in this light that breastmilk from the human milk bank is both sought and legitimated to minimize safety concerns. This research uses data arising from an ethnographic study of two human milk banks and two neonatal intensive care units in the United States, and 73 interviews with milk donors, neonatal intensive care unit parents and clinicians. The primary research question framing the study was 'What are the underlying processes and practices that have enabled donor milk to be endorsed as a safe and legitimate feeding option in neonatal intensive care units?' This study is framed using three key principles of Latour's 'new critique', namely, adding to reality rather than debunking it, getting closer to data rather than turning away from fact and creating arenas in which to assemble. As a result, conceptions of donor milk's safety are expanded. This case study of donor milk demonstrates how Latour's new critique can inform science and technology studies approaches to the study of safety in health care.

Providing Lactation Care Following Stillbirth, Neonatal and Infant Death: Learning from Bereaved Parents.

Objective: The study aimed to identify how, from the perspective of bereaved parents, hospital-based health professionals can better meet their lactation care needs. Methods: In-depth interviews were conducted with 17 mothers and 7 fathers bereaved by stillbirth, neonatal death, or older infant death. Participants were recruited from three large hospitals in Eastern Australia including two with human milk banks. Qualitative thematic data analysis identified bereaved parents' lactation experiences, needs, and how parents wanted lactation care to be provided. Results: Participants experienced lactation after infant death as hard and challenging, while at the same time they received limited lactation care. The negative impact of lactation, however, could be mediated by anticipatory guidance, assistance to make sense of lactation, support to make decisions from available lactation and breast milk management options, and support with breast care for as long as required. Bereaved parents explained lactation care was best provided by health professionals they had come to know and trust rather than by a particular professional role. Care should be provided with compassion, in a manner respectful of individual circumstances, inclusive of partners, and supplemented by quality written information. When bereaved parents felt supported to manage their lactation in a manner consistent with their unique needs, lactation for some could have a positive impact on grief. Conclusion: Bereaved parents have demonstrated that comprehensive lactation care is critical to their health and well-being. Such care should be more fully incorporated into hospital-based bereavement care policies and practices.

The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study.

BACKGROUND: In this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates. METHODS: This study employed a qualitative study design using inductive thematic discourse analysis of 'naturally occurring data' in the form of antenatal conversations around resuscitation decisions at the grey zone of viability. The study occurred between February 2017 and June 2018 on a labor and delivery unit within a large Midwestern tertiary care hospital. Participants included 25 mothers who were admitted to the study hospital with anticipated delivery in the grey zone of viability and practicing neonatologists or neonatology fellows who partnered in antenatal consultation. We used a two-stage inductive analytic process to focus on how neonatologists' discourses constructed SDM in antenatal consultations. First, we used a thematic discourse analysis to interpret the recurring patterns of meaning within the transcribed antenatal consultations, and second, we theorized the subsequent effects of these discourses on shaping the context of SDM in antenatal encounters. RESULTS: In this qualitative study, that included discourse analysis of real-time audio conversations in 25 antenatal consults, neonatologists used language that creates projected autonomy through (i) descriptions of fetal physiology (ii) development of the fetus's presence, and (iii) fetal role in decision-making. CONCLUSION: Discourse analysis of real-time audio conversations in antenatal consultations was revelatory of how various discursive patterns brought the fetus into decision-making, thus changing who is considered the key actor in SDM.

Gut microbes and the liver circadian clock partition glucose and lipid metabolism.

Circadian rhythms govern glucose homeostasis, and their dysregulation leads to complex metabolic diseases. Gut microbes exhibit diurnal rhythms that influence host circadian networks and metabolic processes, yet underlying mechanisms remain elusive. Here, we showed hierarchical, bidirectional communication among the liver circadian clock, gut microbes, and glucose homeostasis in mice. To assess this relationship, we utilized mice with liver-specific deletion of the core circadian clock gene Bmal1 via Albumin-cre maintained in either conventional or germ-free housing conditions. The liver clock, but not the forebrain clock, required gut microbes to drive glucose clearance and gluconeogenesis. Liver clock dysfunctionality expanded proportions and abundances of oscillating microbial features by 2-fold relative to that in controls. The liver clock was the primary driver of differential and rhythmic hepatic expression of glucose and fatty acid metabolic pathways. Absent the liver clock, gut microbes provided secondary cues that dampened these rhythms, resulting in reduced lipid fuel utilization relative to carbohydrates. All together, the liver clock transduced signals from gut microbes that were necessary for regulating glucose and lipid metabolism and meeting energy demands over 24 hours.

Dynamic genetic adaptation of Bacteroides thetaiotaomicron during murine gut colonization.

To understand how a bacterium ultimately succeeds or fails in adapting to a new host, it is essential to assess the temporal dynamics of its fitness over the course of colonization. Here, we introduce a human-derived commensal organism, Bacteroides thetaiotaomicron (Bt), into the guts of germ-free mice to determine whether and how the genetic requirements for colonization shift over time. Combining a high-throughput functional genetics assay and transcriptomics, we find that gene usage changes drastically during the first days of colonization, shifting from high expression of amino acid biosynthesis genes to broad upregulation of diverse polysaccharide utilization loci. Within the first week, metabolism becomes centered around utilization of a predominant dietary oligosaccharide, and these changes are largely sustained through 6 weeks of colonization. Spontaneous mutations in wild-type Bt also evolve around this locus. These findings highlight the importance of considering temporal colonization dynamics in developing more effective microbiome-based therapies.

Egg donation for stem cell research: ideas of surplus and deficit in Australian IVF patients' and reproductive donors' accounts.

We report on a study undertaken with an Australian in vitro fertilisation (IVF) clinic to understand IVF patients' and reproductive donors' perceptions of oocyte (egg) donation for stem cell research. Such perspectives are particularly valuable because IVF patients form a major recruitment group for oocyte donation for research, and because patients and donors have direct experience of the medical procedures involved. Similar studies of oocyte donation have been carried out elsewhere in the world, but to date very little social science research has been published that reports on donation for research, as distinct from donation for reproduction. Our respondents expressed a distinct unwillingness to donate viable oocytes for stem cell research. In our analysis we consider a number of factors that explain this unwillingness. These include the labour of oocyte production, the inscrutability of oocytes (the lack of a test to identify degrees of fertility) and the extent to which the oocytes' fertility sets the parameters for all downstream reproductive possibilities. We draw on the science studies literature on affordances to make sense of the social intractability of oocytes, and compare them with the respondents' much greater willingness to donate frozen embryos for human embryonic stem cells research.

Introducing donor human milk to the NICU: lessons for Australia.

There is an increased use of pasteurised donor human milk (PDHM) in North American neonatal intensive care units (NICU) in order to achieve exclusive human milk (EHM) feeding for preterm infants. Australia, on the other hand, is relatively new to reintroducing PDHM to NICUs. Very little is known about the perception of multidisciplinary NICU teams toward PDHM. This article reports on a survey of 89 NICU clinicians that was implemented during the first weeks of PDHM use in an American NICU, and was repeated 6 months later. Their knowledge and opinions of PDHM in addition to their inclination to recommend its use were evaluated using thematic coding and descriptive statistics. We found that after a 6-month trial, preparedness to recommend PDHM increased to 93%. We found that NICU clinicians' support for PDHM exceeded their knowledge about its risks and benefits and clinicians requested education about various aspects of PDHM. This research in this article aims to assist clinical staff educators as they go about introducing PDHM in NICUs.

Acute caffeine enhances sign-tracking in male Sprague-Dawley rats.

Sign-tracking, as a classically conditioned behavior, is of interest due to its relation to impulsivity and addiction. Caffeine affects the activity of neurotransmitters linked to sign-tracking such as dopamine and acetylcholine. As such, acute caffeine administration may enhance sign-tracking behavior. Caffeine was found to enhance measures of sign-tracking behavior in Sprague-Dawley rats in a sign/goal-tracking procedure. It is suggested that part of caffeine's effects on cognition may be due to its ability to enhance incentive salience in conditioned stimuli.

High-fat diet disrupts REG3γ and gut microbial rhythms promoting metabolic dysfunction.

Gut microbial diurnal oscillations are important diet-dependent drivers of host circadian rhythms and metabolism ensuring optimal energy balance. However, the interplay between diet, microbes, and host factors sustaining intestinal oscillations is complex and poorly understood. Here, using a mouse model, we report the host C-type lectin antimicrobial peptide Reg3γ works with key ileal microbes to orchestrate these interactions in a bidirectional manner and does not correlate with the intestinal core circadian clock. High-fat diet is the primary driver of microbial oscillators that impair host metabolic homeostasis, resulting in arrhythmic host Reg3γ expression that secondarily drives abundance and oscillation of key gut microbes. This illustrates transkingdom coordination of biological rhythms primarily influenced by diet and reciprocal sensor-effector signals between host and microbial components, ultimately driving metabolism. Restoring the gut microbiota's capacity to sense dietary signals mediated by specific host factors such as Reg3γ could be harnessed to improve metabolic dysfunction.

Mapping Hospital-Based Lactation Care Provided to Bereaved Mothers: A Basis for Quality Improvement.

Objective: The study aimed to identify and map the factors that shape the delivery of hospital-based lactation care for bereaved mothers to inform quality improvement initiatives targeting hospital-based lactation care. Methods: Focus groups and interviews were conducted at three large hospitals in Australia with 113 health professionals including obstetricians, neonatologists, midwives, neonatal nurses, lactation consultants, social workers or pastoral care workers, Human Milk Bank (HMB) staff, and perinatal bereavement nurses. Thematic and interactional data analysis identified the nature, scope, and pattern of bereavement lactation care. Results: A bereaved lactation care pathway was generated from health professionals' reports. Bereaved lactation care, if provided, was limited to brief encounters aimed at facilitating lactation suppression. The type of lactation care offered, and any exploration of the variable biopsychosocial significance of lactation after infant death, was conditional on (i) availability of health professionals with suitable awareness, knowledge, capacity, confidence, and comfort to discuss lactation; (ii) hospital culture and mode of suppression primarily practiced; (iii) mother's breast milk being visible to hospital staff; (iv) mother expressing interest in expanded lactation management options; (v) availability of, and eligibility to, donate to a HMB; and (vi) support beyond the hospital setting being facilitated. Conclusion: Mothers should be presented with the full array of lactation management options available after stillbirth or infant death. Inclusion of evidence-based, biopsychosocial and patient-centered approaches to lactation care is urgently required in health professionals' bereavement training and in the policies of hospitals and HMBs.