Access to Focal Spasticity Care: A Cross Canada Survey of Physiatrists.

Successful management of focal spasticity requires access to botulinum toxin type A (BoNT-A) injections, physiotherapy, occupational therapy, and orthoses/bracing. To assess the quality of focal spasticity care across Canada, we sent a survey consisting of 22 questions to physiatrists involved in the management of outpatient spasticity. Thirty-four physiatrists from all 10 provinces responded to the survey. Wait time for BoNT-A treatment averaged 12.7 weeks from time of referral across Canada. More than 75% of patients faced barriers to obtaining physical therapy and orthoses. Access to best quality care for spasticity patients across Canada varies widely.

Contrast-enhanced ultrasound (CEUS) of cystic and solid renal lesions: a review.

Incidentally detected renal lesions have traditionally undergone imaging characterization by contrast-enhanced computer tomography (CECT) or magnetic resonance imaging. Contrast-enhanced ultrasound (CEUS) of renal lesions is a relatively novel, but increasingly utilized, diagnostic modality. CEUS has advantages over CECT and MRI including unmatched temporal resolution due to continuous real-time imaging, lack of nephrotoxicity, and potential cost savings. CEUS has been most thoroughly evaluated in workup of complex cystic renal lesions, where it has been proposed as a replacement for CECT. Using CEUS to differentiate benign from malignant solid renal lesions has also been studied, but has proven difficult due to overlapping imaging features. Monitoring minimally invasive treatments of renal masses is an emerging application of CEUS. An additional promising area is quantitative analysis of renal masses using CEUS. This review discusses the scientific literature on renal CEUS, with an emphasis on imaging features differentiating various cystic and solid renal lesions.

MLT-11 is a transient apical extracellular matrix component required for cuticle patterning and function.

Apical extracellular matrices (aECMs) are associated with all epithelia and form a protective layer against biotic and abiotic threats in the environment. Despite their importance, we lack a deep understanding of their structure and dynamics in development and disease. C. elegans molting offers a powerful entry point to understanding developmentally programmed aECM remodeling. A transient matrix is formed in embryos and at the end of each larval stage, presumably to pattern the new cuticle. Focusing on targets of NHR-23, a key transcription factor which drives molting, we identified the Kunitz family protease inhibitor gene mlt-11 as an NHR-23 target. We identified NHR-23-binding sites that are necessary and sufficient for epithelial expression. mlt-11 is necessary to pattern every layer of the adult cuticle, suggesting a broad patterning role prior to the formation of the mature cuticle. MLT-11::mNeonGreen::3xFLAG transiently localized to the aECM in the cuticle and embryo. It was also detected in lining openings to the exterior (vulva, rectum, mouth). Reduction of mlt-11 function disrupted the barrier function of the cuticle. Tissue-specific RNAi suggested mlt-11 activity is primarily necessary in seam cells and we observed alae and seam cell fusion defects upon mlt-11 inactivation. Predicted mlt-11 null mutations caused fully penetrant embryonic lethality and elongation defects suggesting mlt-11 also plays an important role in patterning the embryonic sheath. Finally, we found that mlt-11 inactivation suppressed the blistered cuticle phenotype of mutants of bli-4 mutants, a subtilisin protease gene but did not affect BLI-4::sfGFP expression. These data could suggest that MLT-11 may be necessary to assure proper levels of BLI-4 activity.

Respiratory Therapist-Driven Mechanical Ventilation Protocol Is Associated With Increased Lung Protective Ventilation.

BACKGROUND: Mechanical ventilation is a common life-saving procedure but can lead to serious complications, including ARDS and oxygen toxicity. Nonadherence to lung-protective ventilation guidelines is common. We hypothesized that a respiratory therapist-driven mechanical ventilation bundle could increase adherence to lung-protective ventilation and decrease the incidence of pulmonary complications in the ICU. METHODS: A respiratory therapist-driven protocol was implemented on August 1, 2018, in all adult ICUs of a Midwestern academic tertiary center. The protocol targeted low tidal volume, adequate PEEP, limiting oxygen, adequate breathing frequency, and head of the bed elevation. Adherence to lung-protective guidelines and clinical outcomes were retrospectively observed in adult subjects admitted to the ICU and on ventilation for ≥ 24 h between January 2011 and December 2019. RESULTS: We included 666 subjects; 68.5% were in the pre-intervention group and 31.5% were in the post-intervention group. After adjusting for body mass index and intubation indication, a significant increase in overall adherence to lung-protective ventilation guidelines was observed in the post-intervention period (adjusted odds ratio 2.48, 95% CI 1.73-3.56). Fewer subjects were diagnosed with ARDS in the post-intervention group (adjusted odds ratio 0.22, 95% CI 0.08-0.65) than in the pre-intervention group. There was no difference in the incidence of ventilator-associated pneumonia, ventilator-free days, ICU mortality, or death within 1 month of ICU discharge. CONCLUSIONS: A respiratory therapist-driven protocol increased adherence to lung-protective mechanical ventilation guidelines in the ICU and was associated with decreased ARDS incidence.

Cross-Sectional Analysis of Patient-Centered Language Use in Journals Publishing Research Focused on Heart Failure.

PURPOSE: Detrimental effects of using non-patient-centered language (nPCL) have been reported for diabetes, mental illness, and obesity, and both the American Medical Association (AMA) and International Committee of Medical Journal Editors (ICMJE) recommend using patient-centered language in medical literature. Heart failure is a common yet stigmatized disease, and nPCL may further propagate stigma. This study analyzed current use of nPCL in journals focused on heart failure research and also examined whether the journals steer authors to adhere to AMA or ICMJE guidelines regarding nPCL. METHODS: Following systematic search of PubMed for heart failure-related articles published from May 1, 2018, to April 30, 2020, cross-sectional analysis was performed. Each selected article was inspected for an array of nPCL terms and frequency of nPCL usage. Chi-squared tests and multivariable logistic regressions were used to assess relationships between study characteristics and nPCL use. RESULTS: Of the 195 articles fully analyzed, 108 (55.4%) contained a nPCL term, the most frequently used being "heart failure patient" (78.7%), "burden" (23.1%), and "suffer" (15.7%). Use of nPCL was disproportionately more common in original research articles (63.5%) and less common in case reports (18.2%). Articles that did not detail any treatment or intervention used the most nPCL (71.1%). No statistically significant association was found between a journal's impact factor and its adherence to AMA or ICMJE recommendations. CONCLUSIONS: nPCL is widely used in publications reporting on heart failure. We encourage authors and journals to reduce nPCL to help decrease the stigma patients with this disease often encounter.

The presence of sensational language describing stem cell therapies in news articles: a cross-sectional analysis.

Aim: News articles and their use of sensational language have the potential to influence health behaviors and decisions, thus the purpose of this study was to evaluate the use of sensational language (i.e., superlatives) describing stem cell therapies in public news articles. Materials & methods: In this study, we conducted a Google News search for news articles using superlatives to exaggerate the efficacy of stem cell therapies. Results: Our analysis included 262 news articles from 193 news outlets using 714 unique superlatives to describe stem cells. Health on the Net's Code of Conduct certification was applied to determine credibility of each site. Conclusion: These results demonstrate the need for improving news reporting surrounding stem cell research and therapies.

Biosynthesis of Orthogonal Molecules Using Ferredoxin and Ferredoxin-NADP+ Reductase Systems Enables Genetically Encoded PhyB Optogenetics.

Transplanting metabolic reactions from one species into another has many uses as a research tool with applications ranging from optogenetics to crop production. Ferredoxin (Fd), the enzyme that most often supplies electrons to these reactions, is often overlooked when transplanting enzymes from one species to another because most cells already contain endogenous Fd. However, we have shown that the production of chromophores used in Phytochrome B (PhyB) optogenetics is greatly enhanced in mammalian cells by expressing bacterial and plant Fds with ferredoxin-NADP+ reductases (FNR). We delineated the rate limiting factors and found that the main metabolic precursor, heme, was not the primary limiting factor for producing either the cyanobacterial or plant chromophores, phycocyanobilin or phytochromobilin, respectively. In fact, Fd is limiting, followed by Fd+FNR and finally heme. Using these findings, we optimized the PCB production system and combined it with a tissue penetrating red/far-red sensing PhyB optogenetic gene switch in animal cells. We further characterized this system in several mammalian cell lines using red and far-red light. Importantly, we found that the light-switchable gene system remains active for several hours upon illumination, even with a short light pulse, and requires very small amounts of light for maximal activation. Boosting chromophore production by matching metabolic pathways with specific ferredoxin systems will enable the unparalleled use of the many PhyB optogenetic tools and has broader implications for optimizing synthetic metabolic pathways.

Mobile apps for mood tracking: an analysis of features and user reviews.

Many mood tracking apps are available on smartphone app stores, but little is known about their features and their users' experiences. To investigate commercially available mood tracking apps, we conducted an in-depth feature analysis of 32 apps, and performed a qualitative analysis of a set of user reviews. Informed by a widely adopted personal informatics framework, we conducted a feature analysis to investigate how these apps support four stages of selftracking: preparation, collection, reflection, and action; and found that mood tracking apps offer many features for the collection and reflection stages, but lack adequate support for the preparation and action stages. Through the qualitative analysis of user reviews, we found that users utilize mood tracking to learn about their mood patterns, improve their mood, and self-manage their mental illnesses. In this paper, we present our findings and discuss implications for mobile apps designed to enhance emotional wellness.