Do not forget about transplant patients during disasters.

PURPOSE OF REVIEW: The frequency of natural disasters and man-made conflicts has risen significantly in the past two decades, coinciding with an increase in kidney transplant recipients globally. This review addresses the critical need for disaster preparedness to mitigate the severe impacts on this vulnerable patient cohort. RECENT FINDINGS: Kidney transplant recipients are highly dependent on robust healthcare infrastructures for ongoing care, including specialized medical staff, advanced diagnostics, and a consistent supply of immunosuppressive medications. Disasters disrupt these essential services, leading to increased risks of organ rejection, infections, and other medical complications. Strategies at various levels, from government to individual patients, can help maintain care continuity during such crises. SUMMARY: Effective disaster preparedness plans involving strategic medication stockpiling, emergency communication systems, and patient education are crucial to support kidney transplant recipients. By implementing these measures, healthcare systems can better protect the health and well being of transplant patients during and after disasters.

Development of a rapid lateral flow assay for detection of anti-coccidioidal antibodies.

Coccidioides spp. are dimorphic fungi that are capable of infecting human and non-human mammals and can cause diverse manifestations of coccidioidomycosis or Valley fever (VF). In combination with clinical symptoms and radiographic findings, antibody-based diagnostic tests are often used to diagnose and monitor patients with VF. Chitinase 1 (CTS1) has previously been identified as the seroreactive antigen used in these diagnostic assays to detect anticoccidial IgG. Here, an indirect enzyme-linked immunosorbent assay to detect IgG to CTS1 demonstrated 165 of 178 (92.7%) patients with a positive result by immunodiffusion (ID) and/or complement fixation (CF) had antibodies to the single antigen CTS1. We then developed a rapid antibody lateral flow assay (LFA) to detect anti-CTS1 antibodies. Out of 143 samples tested, the LFA showed 92.9% positive percent agreement [95% confidence interval (CI), 84.3%-96.9%] and 97.7% negative percent agreement (95% CI, 87.9%-99.6%) with ID and CF assays. Serum or plasma from canines, macaques, and dolphins was also tested by the CTS1 LFA. Test line densities of the CTS1 LFA correlated in a linear manner with the reported CF and ID titers for human and non-human samples, respectively. This 10-min point-of-care test for the rapid detection of anti-coccidioidal antibodies could help to inform healthcare providers in real-time, potentially improving the efficiency of healthcare delivery.

Oral-Ocular Synkinesis in a 21-Year Old Female Head Trauma Patient Following Facial Nerve Decompression Surgery.

ABSTRACT: Facial synkinesis can happen as a negative event following the recovery of facial nerve paralysis. In this case report, five months after right facial nerve decompression surgery following right sided head trauma, a 21-year-old female patient developed oral-ocular synkinesis. During her attempt to voluntarily smile, she experienced uncontrolled winking of her right eye. Exercise therapy was used as a treatment modality which largely improved her facial nerve function and decreased her synkinesis. As a treatment modality, exercise therapy was used which saw a great improvement in both her facial nerve function and decreased her synkinesis.

Neuroscience and Education Colleagues Collaborate to Design and Assess Effective Brain Outreach for Preschoolers.

Neuroscience outreach efforts are currently aimed at older elementary or high school children and have not traditionally assessed effectiveness. Additionally, programs are often initiated by either neuroscientists or educators alone, with few combined instances of these groups working together. Considering the wide range of benefits that accompany interdisciplinary collaborations for outreach, this study sought to develop a neuroscience curriculum for preschool students via collaborations between neuroscience and education departments. Six neuroscience lessons addressing various functions of the brain were taught to preschool students in consecutive weeks. The first lesson was given to the entire class, after which a baseline pre-assessment was performed. Students were then divided into groups, after which only half of the class received further neuroscience instruction. A post-assessment measured for increases in neuroscience knowledge in the students. Results showed that students who received the neuroscience lessons had a greater understanding of content-specific material compared to the group who did not receive neuroscience lessons. The undergraduates involved also reported great benefits from participation in this program. This work addresses the gap in interdisciplinary science programming targeting young elementary aged students, and also provides a framework for improved design and assessment of such programs to continue to better scientific outreach efforts.

Prevalence of abnormal urine drug tests during COVID-19 pandemic in the cancer patient population: retrospective study.

Background: Opioid misuse is a persistent concern, heightened by the COVID-19 pandemic. This study examines the risk factors contributing to elevated rates of abnormal urine drug tests (UDTs) in the cancer pain patient population during COVID-19. Materials & methods: A retrospective chart review of 500 patient encounters involving UDTs at a comprehensive cancer center. Results: Medication adherence rates increase when UDTs are incorporated into a chronic cancer pain management protocol. Higher positive tests for illicit or nonprescribed substances in patients with specific risk factors: current smokers (tobacco), no active cancer and concurrent benzodiazepine use. Conclusion: This research emphasizes the increased risk of opioid misuse during COVID-19 among cancer pain patients with specific risk factors outlined in the results.

This study looked at how the COVID-19 pandemic has affected opioid use among people with cancer-related pain. The researchers checked the records of 500 patients who had had tests to see if they used opioids correctly. They found that when these tests were part of the treatment plan, patients were more likely to take their medicines correctly. However, they also noticed that certain patients, such as those who smoke, do not have active cancer or are taking another type of medication (i.e., benzodiazepines), are more likely to use opioids or other drugs in ways that deviated from the original intention. This study shows that during the pandemic, which continues to exist, it is even more important to watch how these patients use their painkillers and help them avoid misuse.

Practice Patterns of Physicians who Perform Caudal Epidural Steroid Injections.

Introduction: Caudal epidural steroid injections (ESIs) are commonly employed in the management of low back pain and radiculopathy. Despite their widespread use, practice patterns among physicians performing caudal ESIs can vary significantly. This study aims to identify variability in injection techniques utilized by physicians during caudal ESIs, focusing on steroid use, needle selection, and catheter use. This study also looks at major permanent neurological injuries related to caudal ESIs. Methods: A survey was distributed to a cohort of physicians who regularly perform ESIs. The survey comprised questions regarding the type of needle primarily used, steroid selection, the use of catheters, and major neurological injuries from caudal ESIs. The respondents included a diverse group of pain management physicians from various specialties and practice settings. Results: The results revealed a predominant preference for the use of particulate steroids (72.41%) when performing caudal ESIs. Additionally, physicians primarily prefer to use spinal needles (72.41%) compared to other needle types. A majority of physicians (65.12%) reported that they never use a catheter when performing caudal ESIs to access higher pathology. Finally, all physician responders (100%) reported that they have never caused a permanent neurological injury when performing a caudal ESI. Conclusion: This survey provides initial data among physicians who perform caudal ESIs. Our results demonstrate the majority of physicians favor using particulate steroids and a spinal needle, with fewer opting to use a catheter during these procedures. There were no reported major permanent neurological injuries, demonstrating that caudal ESIs are a safe interventional option for managing lumbosacral pain complaints.

Improving Coccidioidomycosis Testing for Emergency Department Patients With Suspect Community-Acquired Pneumonia: Analysis of Provider Attitudes and the Effect of a Targeted Intervention.

Coccidioidomycosis is a common cause of community-acquired pneumonia in endemic regions. Approximately 20 000 cases of coccidioidomycosis occur annually; however, this statistic is limited by a widespread lack of testing. Here, we analyze emergency medicine provider attitudes toward coccidioidal testing and assess the effect of an intervention to improve testing rates.

COVID-19 Vaccine intent in appalachian patients with multiple sclerosis.

BACKGROUND: Rural people with Multiple Sclerosis (PwMS) face distinctive challenges in the COVID-19 pandemic. The purpose of this study was to determine the COVID-19 vaccine intent and factors associated with vaccine hesitancy among Appalachian adults with MS. METHOD: We conducted a cross sectional phone and in-person survey of PwMS in a large academic center in West Virginia (WV) from February to May 2021. The study sample consists of 306 adult participants. RESULTS: Among the 306 participants, 104 (33.99%) indicated vaccine hesitancy. Statistically significant factors (p<0.05) associated with vaccine hesitancy compared to those who received or intend to get vaccinated included concerns about vaccine safety, vaccine causing MS relapse, vaccine making MS medication ineffective, vaccine causing other diseases, getting the COVID-19 infection, vaccine fast approval, vaccine ingredients, how well the vaccine works, and its side-effects. Additional factors included prior bad experiences with other vaccines, history of not getting the flu vaccine, and lack of consultation about COVID-19 vaccine with healthcare providers. CONCLUSIONS: Vaccine hesitancy among Appalachian adult PwMS is higher compared to PwMS in the larger United States. Vaccine hesitancy is especially higher among those who are female, younger than 50 years old, and residing in rural areas. Concerns about vaccine safety, perception of infection risks, past vaccine behaviors and consultation with healthcare providers are important factors associated with vaccine intent. Factors influencing vaccine hesitancy in Appalachian PwMS are largely consistent with the general public, however, concerns for interaction between the vaccine and MS are specific to this population and thus could be the focus of further vaccine effort.

Palliative Care: A Survey of Program Benchmarking for Productivity and Compensation.

Background: Palliative Care (PC) encompasses an integrated health care philosophy of care for individuals with serious illnesses and their families. Referrals to palliative care often come from other healthcare clinicians who lack the time and skill required to address the needs of the patient and their caregivers. At its heart, palliative care is individualized to the values, beliefs, and goals of the patient. The process of eliciting values, beliefs, and goals takes time and expertise, and correspondingly, palliative care is labor intensive. To date, there has been no concentrated focus on how to accurately capture the productivity or work of palliative care clinicians. As a result, there is not a universally accepted method of measuring the effort which includes impact, activity, composition, and productivity of a palliative care program. Objective: This paper reviews results obtained during a telephone survey of similar hospital-based palliative care programs on how they measure productivity. Currently, based on the survey, there are two focused methods for benchmarking: work relative value units (wRVU) and consult volume. This paper highlights the variability of wRVUs and the challenge of using them to compare different PC programs. Design: The design was an open-ended question telephone survey. Using the characteristics of our hospital program, the team created a composite of descriptions to consider for comparison. Then, various hospital-based palliative care teams were selected based on publicly reported data through Vizient, a national benchmarking organization. Based on a literature review, an open-ended question survey was created. These questions explored program composition, clinician productivity and performance benchmarks. Data was collected manually and stored in a confidential file. Result: Ninety-four programs were queried that met the following composite: (1) participated in Vizient program and (2) self-reported a hospital-based, inpatient palliative program. Forty-one programs responded to the request to participate. Of these, 32 programs consisted of facilities who had hospitalists who provided palliative care, but there was not a dedicated palliative care team. Nine programs had a dedicated palliative care team with clinicians who only practiced palliative medicine. Inquiry to these programs revealed that within these nine programs-two methods of capturing clinician productivity were used-five sites used a wRVU metric and four sites used a consult volume metric. Conclusion: Preliminary findings support the complexity of benchmarking PC programs against peer institutions with a standard productivity model based on the variability in program composition.

Similar tests of anxiety-like behavior yield different results: comparison of the open field and free exploratory rodent procedures.

Pharmacological agents that treat anxiety disorders are often validated in animal models prior to clinical trials. Yet results suggest little consistency in rodent anxiety-like behavior across tests. The current study examined the relationship between anxiety-like behaviors of male rats in the open field test and free exploratory paradigm. Results indicate most anxiety-like behaviors between tests were not correlated and few correlations existed within tests, despite similarity in testing apparatus, procedures, and quantified behaviors. These results suggest even very similar tests may provide insight into different facets of anxiety and urge caution when translating animal results to the human condition.