Holistic AI analysis of hybrid cardiac perfusion images for mortality prediction.

Background: While low-dose computed tomography scans are traditionally used for attenuation correction in hybrid myocardial perfusion imaging (MPI), they also contain additional anatomic and pathologic information not utilized in clinical assessment. We seek to uncover the full potential of these scans utilizing a holistic artificial intelligence (AI)-driven image framework for image assessment. Methods: Patients with SPECT/CT MPI from 4 REFINE SPECT registry sites were studied. A multi-structure model segmented 33 structures and quantified 15 radiomics features for each on CT attenuation correction (CTAC) scans. Coronary artery calcium and epicardial adipose tissue scores were obtained from separate deep-learning models. Normal standard quantitative MPI features were derived by clinical software. Extreme Gradient Boosting derived all-cause mortality risk scores from SPECT, CT, stress test, and clinical features utilizing a 10-fold cross-validation regimen to separate training from testing data. The performance of the models for the prediction of all-cause mortality was evaluated using area under the receiver-operating characteristic curves (AUCs). Results: Of 10,480 patients, 5,745 (54.8%) were male, and median age was 65 (interquartile range [IQR] 57-73) years. During the median follow-up of 2.9 years (1.6-4.0), 651 (6.2%) patients died. The AUC for mortality prediction of the model (combining CTAC, MPI, and clinical data) was 0.80 (95% confidence interval [0.74-0.87]), which was higher than that of an AI CTAC model (0.78 [0.71-0.85]), and AI hybrid model (0.79 [0.72-0.86]) incorporating CTAC and MPI data (p<0.001 for all). Conclusion: In patients with normal perfusion, the comprehensive model (0.76 [0.65-0.86]) had significantly better performance than the AI CTAC (0.72 [0.61-0.83]) and AI hybrid (0.73 [0.62-0.84]) models (p<0.001, for all).CTAC significantly enhances AI risk stratification with MPI SPECT/CT beyond its primary role - attenuation correction. A comprehensive multimodality approach can significantly improve mortality prediction compared to MPI information alone in patients undergoing cardiac SPECT/CT.

Predictors of Psychological Distress Among Rural Family/Friend Caregivers of People Living With Dementia in the United States: Consequences of the COVID-19 Pandemic.

OBJECTIVES: Caregivers of persons living with dementia in rural United States are a vulnerable population. During the coronavirus disease 2019 (COVID-19) pandemic, rural communities experienced heightened disparities in social services, healthcare, suicides, and mortality. Guided by the Caregiving Stress Process Model, this study examines the relationship between the stressors and resources of rural caregivers of persons living with dementia and their experience of depression, stress, and COVID-19. METHODS: One hundred and fifty-two rural caregivers of persons living with dementia completed an online survey, March 1, 2021-April 30, 2022. Analyses used baseline responses to validated scales and an open-ended question, "How has COVID impacted your life as a caregiver?" Dependent variables were depressive symptoms and stress. Bivariate and hierarchical linear regression analyses examined associations of stressors and resources with depressive symptoms and stress. Thematic analysis examined open-ended question responses. RESULTS: Among examined stressors, high care burden (b = 1.94, p < .05) and loneliness (b = 0.76, p < .0001) were positively associated with depressive symptoms. Loneliness (b = 0.24, p < .05) and ≥41 hr spent caregiving per week (reference 10-20 hr; b = 0.99, p < .05) were associated with stress. Among examined resources, self-efficacy for caregiving (b = -0.21, p < .05) was inversely associated with stress. Qualitative results confirmed quantitative results and identified additional pandemic-related themes in stressors and resources. DISCUSSION: We found that caregiver burden, loneliness, and caregiving hours were associated with greater psychological distress among rural caregivers of persons living with dementia during the pandemic, whereas self-efficacy for caregiving was protective. Rural caregivers need increased support to address care burdens and enhance psychological resources for caregiving. CLINICAL TRIAL REGISTRATION NUMBER: NCT04428112.

"How's your mood": Recorded physician mental health conversations with Chinese and Latino patients in routine primary care visits.

OBJECTIVE: Patient-physician communication patterns may influence discussions around depressive symptoms and contribute to engagement in depression care among racial/ethnic minority adults. We examined patient-physician communication about depressive symptoms during routine primary care visits with Chinese and Latino patients with and without language barriers. METHODS: We examined 17 audio-recorded conversations between primary care physicians and Chinese (N = 7) and Latino (N = 10) patients who discussed mental health during their visit and reported depressive symptoms on a post-visit survey. Conversations (in English, Cantonese, Mandarin, Hoisan-wa, Spanish) were transcribed and translated by bilingual/bicultural research assistants and analyzed using inductive and deductive thematic and discourse analysis. RESULTS: Patients initiated mental health discussion in eleven visits. Physicians demonstrated care in word choice and sometimes avoided openly mentioning depression; this could contribute to miscommunication around symptoms and treatment goals. Interpreters had difficulty finding single words to convey terms used by either patients or physicians. CONCLUSION: Patients and doctors appeared willing to discuss mental health; however, variability in terminology presented challenges in mental health discussions in this culturally and linguistically diverse sample. PRACTICE IMPLICATIONS: Further understanding patient preferred terminology about mental health symptoms and interpreter training in these terms could improve patient-physician communication about depressive symptoms and treatment preferences.

Study protocol for a hybrid effectiveness-implementation trial of the Building Better Caregivers online workshop for rural family/friend caregivers of people living with dementia.

INTRODUCTION: Dementia caregiving is complex and disproportionally burdens caregivers living in rural areas due to fewer resources and formal support systems. There is an immediate need to identify effective, scalable, and accessible online programs to support rural caregivers' well-being. Building Better Caregivers (BBC), a possible solution, is an asynchronous online 6-week, interactive, and skills-building workshop developed for caregivers of persons with dementia. This research aims to assess the effectiveness and implementation of the BBC workshop when delivered among rural dementia caregivers in the United States. METHODS: A hybrid effectiveness and implementation trial applying mixed methods will be conducted in collaboration with local, state, and national partnering organizations. Eligible participants live in a rural area of the United States, give care at least 10 h a week for a family member or friend with dementia, and have internet access. Evaluation is based on the RE-AIM framework. Effectiveness outcomes are assessed using a randomized control trial. Caregivers are randomly assigned to the BBC workshop (intervention) or attention control group. Implementation outcomes are assessed using surveys and debriefing interviews from partnering organizations and participants. The study protocol including the study design, methods of recruitment and assessment, and outcomes are described. CONCLUSION: This is the first known study to evaluate both the effectiveness and implementation of a caregiver support intervention under real-world conditions in rural areas. If successful, this online workshop will be a practical and acceptable approach for promoting the health and well-being of geographically isolated rural dementia caregivers.

Asociación Vacter Limb. Presentación de un caso / Vacter Limb Association. A case Presentation

El VACTERL designa un conjunto de anomalías, cada una de ellas producida por causas distintas, que afecta a varias estructuras del organismo y se debe a un trastorno producido entre la cuarta y la sexta semana del desarrollo embrionario. Es muy raro y sólo se han descrito unos 250 casos en todo el mundo. Se presenta el caso de un recién nacido hijo de madre con diabetes gestacional, gemelar, que muestra malformaciones compatibles con un defecto primario del desarrollo (asociación de malformaciones Vertebrales, Anales, Cardíacas, Traqueo-esofágicas, y de Extremidades), con otros defectos menores asociados (AU)

VACTERL designates a set of anomalies, each one of them produced by different causes, that affect several structures of the organism and is owing to an upset produced between the fourth and sixth week of the embryonic development. It is very rare and only 250 cases have been described throughout the world. The case of new born, son of mother with gestacional diabetes appears, twin, that shows to compatible malformations with a primary defect of VACTERL development (association of Vertebral, anal, cardiovascular, Tracheo-esophageal, and limb, with other smaller associate defects (AU)

Comportamiento de la resistencia antimicrobiana en servicio cerrado de neonatología / Behavior of the antimicrobial resistance in Neonatology Closed Service

La sepsis neonatal es una de las causas más frecuentes de hospitalización en los servicios de neonatología, se mantiene también dentro de las primeras causas de muerte en este periodo de la vida. Se observa los resultados de los cultivos realizados a los recién nacidos que ingresan al servicio. Actualmente se observan nuevos gérmenes que no estaban presentes años atrás en el mapa microbiológico y a lo que es más importante, tanto los gérmenes ya conocidos, como los de nueva aparición en el medio, tienen un incremento de la resistencia a los antimicrobianos, lo que hace que el manejo de la sepsis se haya convertido en un reto para todos los clínicos. Con el objetivo de conocer el estado de la resistencia antimicrobiana en el servicio se realiza el presente trabajo (AU)

Neonatal sepsis is one of the most frequent causes of hospitalization in neonatology service, staying also within the first causes of death in this period of life. If we observe the results of the carried out cultures to new born that enter to our service at the present time we could see that we faced to new germs that were not present some years ago in our microbiological map and which is more important, as much the germs which we are used to, like those of new appearance in means, have an increase of the resistance to the antimicrobial ones, which causes that the sepsis handling has become a challenge for all the clinical ones.With the aim to know the state of the antimicrobial resistance in our service we have carried out this work (AU)

Tipologia y conducta de riesgo de infeccion con el virus de la inmunodeficiencia humana (HIV), de hombres homosexuales de Costa Rica, 1985-1987 / Typology and risk behavior for HIV infection in homosexual men in Costa Rica 1985-1987

Se describe una tipologia de hombres homosexuales en Costa Rica, de acuerdo a informacion obtenida mediante observacion prospectiva cuyo objetivo fue conocer factores de riesgo de infeccion y la ceroconversion al virus de la inmunodeficiencia humana (HIV). Se reconocen cinco tipos de homosexuales, de los cuales se incluyeron en el estudio sin dificultad a tres ( "gays", prostitutos y prisioneros). Existe interacion sexual entre todos los tipos ya sea intra-tipo (por ejemplo, entre "gays" ), o inter-tipo (prostitutos con homosexuales "cripticos " y "cacheros"). Las practicas sexuales identificadas son similares a aquellas descritas en la literatura norteamericana y europea, e incluye conducta riesgosa como el coito anal receptivo,el fellatio con ingestion de semen y el anilingua receptivo e insertivo. La comprension de la tipologia tiene implicaciones en accion en salud publica tendente a disminuir la tasa de diseminacion del HIV entre hombres que practican practicas riesgosas.

Consumo de drogas ilicitas por hombres homosexuales o bisexuales de Costa Rica, 1985-1986 / Consumption of drugs in homosexual and bisexual men of Costa Rica

Este trabajo describe el patron de drogadiccion en tres tipos de hombres homosexuales y bisexuales de Costa Rica: "gays", prostitutos y presos. Una proporcion considerablede hombres de esos tipos consume drogas regularmente. El patron de drogadiccion varia con el tipo de homosexual y con la edad, y esta influenciado por la condicion socioeconomica y la educacion. Se observo el consumo mde carias drogas, aunque hubo preferencia por solo una, o quiza dos. Sin embargo, algunos homosexuales tenian esquemas de drogadiccion complejos, con dos o mas drogas utilizadas a la vez. Marihuana fue la mas utilizada , mientras que ka heroina fue infrecuente. Las prisiones son permeables al trafico de drogas, puesto que los reclusos tienen un serio problelma de drogadiccion. Los presos se drogan tanto como los hombres prostitutos, pero las drogas empleadas no necesariamente son las mismas empleadas por ejemplo por los "gays".