Discharge Disposition and Loss of Independence Among Survivors of COVID-19 Admitted to Intensive Care: Results From the SCCM Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS).

OBJECTIVES: To describe incidence and risk factors of loss of previous independent living through nonhome discharge or discharge home with health assistance in survivors of intensive care unit (ICU) admission for coronavirus disease 2019 (COVID-19). DESIGN: Multicenter observational study including patients admitted to the ICU from January 2020 till June 30, 2021. HYPOTHESIS: We hypothesized that there is a high risk of nonhome discharge in patients surviving ICU admission due to COVID-19. SETTING: Data were included from 306 hospitals in 28 countries participating in the SCCM Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 registry. PATIENTS: Previously independently living adult ICU survivors of COVID-19. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was nonhome discharge. Secondary outcome was the requirement of health assistance among patients who were discharged home. Out of 10 820 patients, 7101 (66%) were discharged alive; 3791 (53%) of these survivors lost their previous independent living status, out of those 2071 (29%) through nonhome discharge, and 1720 (24%) through discharge home requiring health assistance. In adjusted analyses, loss of independence on discharge among survivors was predicted by patient age ≥ 65 years (adjusted odds ratio [aOR] 2.78, 95% confidence interval [CI] 2.47-3.14, P < .0001), former and current smoking status (aOR 1.25, 95% CI 1.08-1.46, P = .003 and 1.60 (95% CI 1.18-2.16), P = .003, respectively), substance use disorder (aOR 1.52, 95% CI 1.12-2.06, P = .007), requirement for mechanical ventilation (aOR 4.17, 95% CI 3.69-4.71, P < .0001), prone positioning (aOR 1.19, 95% CI 1.03-1.38, P = .02), and requirement for extracorporeal membrane oxygenation (aOR 2.28, 95% CI 1.55-3.34, P < .0001). CONCLUSIONS: More than half of ICU survivors hospitalized for COVID-19 are unable to return to independent living status, thereby imposing a significant secondary strain on health care systems worldwide.

Evaluation of the self-directed format of Walk With Ease in patients with systemic lupus erythematosus: the Walk-SLE Pilot Study.

OBJECTIVE: To conduct a proof-of-concept pilot evaluation of the self-directed format of Walk With Ease (WWE), a 6-week walking program developed for adults with arthritis, in patients with systemic lupus erythematosus (SLE). METHODS: This was a single arm, 6-week pre- and post-evaluation of the self-directed WWE program to assess feasibility, tolerability, safety, acceptability, and effectiveness. Adult patients with physician-diagnosed SLE were recruited to participate during regularly scheduled visits to an academic rheumatology clinic. Self-reported outcomes of pain, stiffness, and fatigue were assessed by visual analog scales (VAS) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-fatigue) scale at baseline and at completion of the 6-week program. Patients also completed a satisfaction survey at the end of the program. Multivariate linear regression models were used to calculate mean changes between baseline and 6-week follow-up scores, adjusting for covariates. Mean change scores were used to estimate effect sizes (ES). RESULTS: At 6 weeks, 48 of the 75 recruited participants completed the WWE program. Participants experienced modest improvements in stiffness and fatigue (ES = 0.12 and ES = 0.23, respectively, for VAS scores; ES = 0.16 for FACIT-fatigue score) following the intervention. The majority of participants reported satisfaction with the program (98%) and benefitted from the workbook (96%). CONCLUSIONS: The self-directed format of WWE appears to reduce stiffness and fatigue in patients with SLE. It also seems to be a feasible and acceptable exercise program to patients with SLE. Larger studies are needed to confirm these findings.

Treatment as Prevention for Hepatitis C (TraP Hep C) - a nationwide elimination programme in Iceland using direct-acting antiviral agents.

A nationwide programme for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. By providing universal access to direct-acting antiviral agents to the entire patient population, the two key aims of the project were to (i) offer a cure to patients and thus reduce the long-term sequelae of chronic hepatitis C, and (ii) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. An important part of the programme is that vast majority of cases will be treated within 36 months from the launch of the project, during 2016-2018. Emphasis is placed on early case finding and treatment of patients at high risk for transmitting HCV, that is people who inject drugs (PWID), as well as patients with advanced liver disease. In addition to treatment scale-up, the project also entails intensification of harm reduction efforts, improved access to diagnostic tests, as well as educational campaigns to curtail spread, facilitate early detection and improve linkage to care. With these efforts, Iceland is anticipated to achieve the WHO hepatitis C elimination goals well before 2030. This article describes the background and organization of this project. Clinical trial number: NCT02647879.

Residence times of groundwater along a flow path in the Great Artesian Basin determined by 81Kr, 36Cl and 4He: Implications for palaeo hydrogeology.

Understanding the age distribution of groundwater can provide information on both the recharge history as well as the geochemical evolution of groundwater flow systems. Of the few candidates available that can be used to date old groundwater, 81Kr shows the most promise because its input function is constant through time and there are less sources and sinks to complicate the dating procedure in comparison to traditional tracers such as 36Cl and 4He. In this paper we use 81Kr in a large groundwater basin to obtain a better understanding of the residence time distribution of an unconfined-confined aquifer system. A suite of environmental tracers along a groundwater flow path in the south-west Great Artesian Basin of Australia have been sampled. All age tracers (85Kr, 39Ar 14C, 81Kr, 36Cl and 4He) display a consistent increase in groundwater age with distance from the recharge area indicating the presence of a connected flow path. Assuming that 81Kr is the most accurate dating technique the 36Cl/Cl systematics was unravelled to reveal information on recharge mechanism and chloride concentration at the time of recharge. Current-day recharge occurs via ephemeral river recharge beneath the Finke River, while diffuse recharge is minor in the young groundwaters. Towards the end of the transect the influence of ephemeral recharge is less while diffuse recharge and the initial chloride concentration at recharge were higher.

Radiation dose reduction in CT of the brain: can advanced noise filtering compensate for loss of image quality?

BACKGROUND: Computed tomography (CT) of the brain is performed with high local doses due to high demands on low contrast resolution. Advanced algorithms for noise reduction might be able to preserve critical image information when reducing radiation dose. PURPOSE: To evaluate the effect of advanced noise filtering on image quality in brain CT acquired with reduced radiation dose. MATERIAL AND METHODS: Thirty patients referred for non-enhanced CT of the brain were examined with two helical protocols: normal dose (ND, CTDI(vol) 57 mGy) and low dose (LD, CTDI(vol) 40 mGy) implying a 30% radiation dose reduction. Images from the LD examinations were also postprocessed with a noise reduction software with non-linear filters (SharpView CT), creating filtered low dose images (FLD) for each patient. The three image stacks for each patient were presented side by side in randomized order. Five radiologists, blinded for dose level and filtering, ranked these three axial image stacks (ND, LD, FLD) as best to poorest (1 to 3) regarding three image quality criteria. Measurements of mean Hounsfield units (HU) and standard deviation (SD) of the HU were calculated for large region of interest in the centrum semiovale as a measure for noise. RESULTS: Ranking results in pooled data showed that the advanced noise filtering significantly improved the image quality in FLD as compared to LD images for all tested criteria. No significant differences in image quality were found between ND examinations and FLD. However, there was a notable inter-reader spread of the ranking. SD values were 15% higher for LD as compared to ND and FLD. CONCLUSION: The advanced noise filtering clearly improves image quality of CT examinations of the brain. This effect can be used to significantly lower radiation dose.

Suppression of Zeeman splitting of the energy levels of exciton-polariton condensates in semiconductor microcavities in an external magnetic field.

A key property of equilibrium exciton-polariton condensates in semiconductor microcavities is the suppression of the Zeeman splitting under a magnetic field. By studying magnetophotoluminescence spectra from a GaAs microcavity, we show experimentally that a similar effect occurs in a nonequilibrium polariton condensate arising from polariton parametric scattering. In this case, the quenching of Zeeman splitting is related to a phase synchronization of spin-up and spin-down polarized polariton condensates caused by a nonlinear coupling via the coherent pump state.

Psychosocial adaptation in female partners of men with prostate cancer.

The objective was to explore the psychosocial adaptation of female partners living with men with a diagnosis of either localized or metastatic prostate cancer. Semi-structured qualitative interviews were conducted with 50 women at two time points (baseline and 6 months later). The interviews examined emotions, experiences, attitudes to sexual and continence issues and treatment decision making. As part of a larger prospective observational study, demographic data and scores for depression and anxiety were collected. Initial analysis demonstrated that the group of 11 women assessed as distressed on the anxiety and depression measures described reduced coping skills and poorer adaptation after 6 months. In contrast, the 39 women in the non-distressed group reported emotional adaptation that fitted the Lazarus and Folkman pattern of coping through appraisal of the impact of the diagnosis on their partner and themselves, appraisal of coping strategies and reappraisal of the situation. A surprise finding was the high level of resilience displayed by majority of these women. Results suggest that a psychosocial intervention could strengthen healthy adaptation and provide better coping skills for distressed couples.

Surveillance of influenza in Iceland during the 2009 pandemic.

In a pandemic setting, surveillance is essential to monitor the spread of the disease and assess its impact. Appropriate mitigation and healthcare preparedness strategies depend on fast and accurate epidemic surveillance data. During the 2009 influenza A(H1N1) pandemic, rapid improvements in influenza surveillance were made in Iceland. Here, we describe the improvements made in influenza surveillance during the pandemic , which could also be of great value in outbreaks caused by other pathogens. Following the raised level of pandemic influenza alert in April 2009, influenza surveillance was intensified. A comprehensive automatic surveillance system for influenza-like illness was developed, surveillance of influenza-related deaths was established and laboratory surveillance for influenza was strengthened. School absenteeism reports were also collected and compared with results from the automatic surveillance system. The first case of 2009 pandemic influenza A(H1N1) was diagnosed in Iceland in May 2009, but sustained community transmission was not confirmed until mid-August. The pandemic virus circulated during the summer and early autumn before an abrupt increase in the number of cases was observed in October. There were large outbreaks in elementary schools for children aged 6­15 years throughout the country that peaked in late October. School absenteeism reports from all elementary schools in Iceland gave a similar epidemiological curve as that from data from the healthcare system. Estimates of the proportion of the population infected with the pandemic virus ranged from 10% to 22%. This study shows how the sudden need for improved surveillance in the pandemic led to rapid improvements in data collection in Iceland. This reporting system will be improved upon and expanded to include other notifiable diseases, to ensure accurate and timely collection of epidemiological data.

The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis.

INTRODUCTION: More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. OBJECTIVES: To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. METHODS: We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. RESULTS: The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. CONCLUSIONS: The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population. KEY WORDS: Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.

Measles encephalitis in rodents: defective expression of viral proteins.

Synthesis of measles virus proteins in rodent brains and Vero cell cultures infected with the hamster neurotropic (HNT), and for comparison the LEC strain, was studied by use of monoclonal antibodies against five structural components. In the brains of HNT-infected adult BALB/C mice two proteins, the nucleocapsid (NP) and phosphoprotein (P) were detected. Suckling hamster brains in addition expressed demonstrable hemagglutinin (HA) protein. In cell cultures all structural components except the matrix (M) protein were detected. In contrast, all five proteins were found in LEC strain-infected suckling hamster brains and cell cultures. The restriction in HNT viral replication observed may be caused by a primary defectiveness in M-protein expression, but the possibility that this restriction is secondary to cellular suppression remains to be explored. Minimal inflammation was seen in the brains of HNT-infected adult mice and viral antigen was primarily located in the cerebral cortex. A selective necrosis of the pyramidal cell layer of the hippocampus was observed. This change did not seem to correlate with virus replication.

Non-lethal infection of aminergic reticular core neurons: age-dependent spread of ts mutant vesicular stomatitis virus from the nose.

In order to induce a non-lethal infection restricted to central aminergic neurons projecting to the olfactory bulbs a series of temperature sensitive (ts) and G-protein monoclonal antibody escape mutants of vesicular stomatitis virus (VSV) were instilled into the nasal cavity of mice. In three-week (wk)-old NMRI mice four monoclonal antibody escape mutants caused an extensive infection of the olfactory epithelium and, like a wild type strain, a lethal brain infection after spread along olfactory pathways. Three ts mutant strains showed an attenuated pathogenic potential. Strain G31 caused a lethal infection with a somewhat prolonged course while the strain G11 failed to invade the nervous system. Strain G41 showed minimal invasion of central nervous system in three-wk-old mice and caused a lethal infection in newborn and one-wk-old mice. In contrast, two-wk-old mice survived infection with this mutant, which spread along olfactory pathways and rather selectively affected aminergic reticular core neurons in the diagonal band, the locus ceruleus and the raphe nuclei in the brainstem. Thus, an age-dependent virus infection of the olfactory pathways can cause restricted lesions in the brain providing a model for studies of virus-induced changes in aminergic neurotransmission.

Bcl-2 immunoreactive cells with immature neuronal phenotype exist in the nonepileptic adult human brain.

Bcl-2, a cell death suppressor protein, is expressed during brain development but is largely down-regulated in the adult central nervous system. We previously reported strong expression of bcl-2 in small, "oligodendrocyte-like" cells (OLC) found in glioneuronal hamartias. These hamartias are microscopic cell rests found in temporal lobe resections from patients with intractable epilepsy and are considered a form of cerebral microdysgenesis. However, a causative relationship between these rests and seizures is not clear. We now report the identification, lineage characterization, and postnatal ontogeny of hamartia-like cell rests in temporal lobes of nonepileptic humans. Postmortem temporal lobes from 28 patients without history of neurologic disease (mean age = 53 years; range = 20 to 83 years) were studied. Microscopic cellular aggregates containing immature-appearing, bcl-2-immunoreactive cells (BIC) (identical to OLC) were observed in 23 of 28 (82%) temporal lobes from nonepileptic individuals. BIC were strongly immunoreactive for neuronal-specific class III beta tubulin, neuronal nuclear antigen, and MAP-2, but were consistently negative for neurofilament proteins and Ki67. Such cells were localized to subventricular regions of the caudal amygdala and often extended into the adjacent subcortical white matter and periamygdaloid cortex. BIC became less abundant with advancing age. These findings suggest that hamartia-like rests containing immature postmitotic neurons are normally present in the human brain and that glioneuronal hamartias may not always represent a maldevelopmental lesion associated with epilepsy.

Vitamin B6 status of the hospitalized aged.

Nutritional status of vitamin B6 was investigated in two groups of 102 hospitalized aged. Vitamin B6 intake was estimated. Erythrocyte glutamic-pyruvic transaminase stimulation in vitro with pyridoxal phosphate and SGOT were studied as the biochemical criteria of vitamin B6 status: 18.6% of the subjects consumed less than 0.66 mg of vitamin B6 per day; 28.4% showed a percentage stimulation in vitro with pyridoxal phosphate of more than 15%. There was no significant correlation between basal erythrocyte glutamic-pyruvic transaminase activity and dietary protein, dietary vitamin B6 dietary vitamin B6/100 g of protein, SGOT, hemoglobin, mean corpuscular volume, and iron. All the biochemical parameters used for evaluating vitamin B6 status appeared higher in females, but no statistical difference between male and female groups was noted. Only SGOT levels of female subjects reflected their vitamin B6 status. A large individual variation of vitamin B6 requirement was indicated in both groups studied. Supplements with 2.5 mg of vitamin B6 to deficient subjects caused an increase in transaminase levels, though females showed a higher response. A higher recommended allowance of vitamin B6 for the aged male and female subjects was considered desirable.

Nutritional status of institutionalized and noninstitutionalized aged in Belfast, Northern Ireland.

A multifaceted analysis of the nutritional status of 196 subjects, aged over 65, institutionalized in hospitals, residential accomodation, and sheltered dwellings and of noninstituionalized subjects was untaken. Subjects of hospital and home, with or without multivitamin supplementation, were grouped separately. The study comprised of 3-day weighed dietary record, biochemical determinations, and clinical examination. The energy intake of females of hospitals and sheltered dwellings was comparatively low. Dietary nutrients most lacking were potassium, magnesium, vitamin D, and vitamin B6. Calcium and vitamin A intake were adequate. Clinical deficiency was rare. Subclinical deficiency was highly prevalent and the deficiency incidence was: anemia 18.6%, ascorbic acid 29.2%, thiamin 13.8%, riboflavin 7.1%, vitamin B6 42.3%, and vitamin D 47.0%. Some kind of mineral or vitamin deficiency was observed biochemically in 91.3% of the nonmultivitamin supplemented group and 64.3% of the multivitamin supplemented group. Regular intake of multivitamin raised the blood levels of riboflavin and ascorbic acid to normal in all, but failed to raise the thiamin and vitamin B6 levels to the normal acceptable levels in 2.9 and 20% of the subjects, respectively. Suggestions are made concerning possibly higher recommended allowance.

Zinc and copper nutriture of women taking oral contraceptive agents.

A cross-sectional and follow-up study of young women taking oral contraceptive agents revealed a marked increase in serum copper levels. This increase was significant after the taking of oral contraceptive agents for 3 months. No significant effect of oral contraceptive agents on serum zinc and hair levels or copper were observed. There was no correlation between duration of oral contraceptive agent therapy and zinc or copper concentrations in serum or hair. Serum and hair concentration of zinc or copper were also not significantly correlated.

PIP: It is well known that OC (oral contraception) may provoke changes in metal metabolism. This study examines the effects of OC use in serum and hair level of both zinc and copper. The study involved a control group of 24 women, aged 18-20, who had never been on OC; a cross-sectional experimental group of 33 women, aged 18-23, who had been using combined OC for at least 3 months; a follow-up experimental group of 12 women, aged 18-22, who were about to start OC treatment for the first time, and who were examined again at 3 and at 6 months. Blood samples and hair samples were collected and analyzed with the Vir and Love method. Mean serum copper concentration was significantly higher in OC users; hair copper values were also higher, but the difference was not a significant one. Mean serum zinc levels were slightly lower, and hair zinc levels slightly higher in OC users; differences between users and nonusers, however, were not significant. No significant correlation was found between duration of OC treatment and serum and hair metal values. In the follow-up experimental group mean serum copper level increased at 3 months of OC treatment, and mean hair copper values decreased; there were no significant differences at 3 and at 6 months. Mean serum zinc concentration and mean hair zinc concentration also decreased in the control group, but the decline was not significant. No significant correlation was found between serum and hair concentration of zinc or copper in the control or in the experimental group. These findings are consistent with others reported in the published literature. The biological significance of the rise in serum copper levels, and of the slight alteration in serum zinc level after OC use is still not known.

Serum and hair concentrations of copper during pregnancy.

Serum and hair concentration of copper were measured in 28 nonpregnant women and 60 pregnant women at 20 to 22 wk gestation (2nd trimester), 36 to 37 wk gestation (3rd trimester), and 3 days postpartum. The serum copper concentration in pregnant women was approximately twice (1.71 to 1.79 micrograms/ml) the normal nonpregnant values (0.98 micrograms/ml). These high levels persisted throughout pregnancy and early postpartum. The mean concentration of serum copper in maternal serum was about five times those in umbilical cord blood (0.33 microgram/ml) and a strong relationship was noted between maternal and cord copper concentration. Hair copper levels were similar in pregnant and nonpregnant subjects. No significant relationship was noted between serum and hair copper concentrations. Serum copper levels were higher and hair copper concentration was lower in primigravida. Previous history of oral contraceptive usage and alcohol intake during pregnancy had no effect on serum or hair copper levels. The effect of smoking was not consistent and showed a significant lowering effect on serum copper values only in the 2nd trimester. The 3rd trimester levels of hair copper and serum copper demonstrated a significant correlation with neonatal weight and head circumference, respectively. Further studies are indicated to understand the implication of such changes in copper metabolism.

Riboflavin status during pregnancy.

The riboflavin status of 20 nonpregnant and 60 pregnant women (in the 2nd trimester, 3rd trimester, and early postpartum) was determined by the erythrocyte glutathione reductase activation test. None of the nonpregnant subjects but 26 pregnant subjects (21.7% in the 2nd trimester, 20.8% in the 3rd trimester, and 29.6% in early postpartum) had an activity coefficient greater than 1.20, indicative of biochemical deficiency of riboflavin. The deficiency developed at any of the three stages of pregnancy under study. Follow-up of individual cases revealed no progressive deterioration in riboflavin nutriture with advancement of pregnancy. The mean intake of riboflavin was higher than the recommended intake and revealed a significant negative correlation with activity coefficient values at the 3rd trimester. No significant correlation of riboflavin status with the outcome of pregnancy was noted. The effect of numbers of previous pregnancies, history of oral contraceptive usage, smoking, and alcohol showed no consistent effect on the percentage incidence of deficiency at all the three periods.

Zinc concentration in hair and serum of pregnant women in Belfast.

Serum and hair levels of zinc were estimated in 28 nonpregnant women and 60 pregnant women at 20 to 22 wk of gestation (2nd trimester), 36 to 37 wk of gestation (3rd trimester), and 3 days postpartum. The mean serum zinc concentration was significantly lower in pregnant subjects compared to the nonpregnant and showed a continuous significant decline with increasing duration of pregnancy. Mean hair concentration in the various stages of study of pregnant women and nonpregnant subjects were comparable. However, a progressive decrease in hair zinc concentration was noted with advancing pregnancy; the decline between 2nd and 3rd trimester was statistically significant. Mean serum zinc concentration in umbilical cord blood was approximately twice that in maternal blood. Smoking had no effect on zinc concentration, while the effect of alcohol and parity was inconsistent. Oral contraceptive usage before conception appeared to lower hair zinc concentration and increase serum zinc concentration during pregnancy. Two subjects had spontaneous abortion and these had serum zinc in the lower range and hair zinc values in the higher range. The remaining 58 subjects gave birth to normal neonates weighing 2500 to 4500 g. The study revealed that zinc nutrition of the majority of the expectant mothers was adequate for normal growth and development of fetus. The possible cause and implication of observed changes in zinc metabolism are discussed.