No description available.

A man with IgG1 multiple myeloma developed fever, confusion, and progressive muscle weakness resulting in paralysis. Echovirus type 11 was isolated from cerebrospinal fluid, pleura, pleural fluid, and muscle, and muscle biopsy disclosed changes consistent with viral myositis. Immunologic evaluation revealed low serum levels of polyclonal IgG subtypes 1 and 3, reduced blood levels of T-helper/inducer and T-suppressor/cytotoxic cells, and a complement abnormality involving the function of the classical pathway C3 convertase, C4b2a. Therapy with intravenous immunoglobulin was associated with clinical recovery. This is the first reported case of disseminated central nervous system enteroviral infection in an adult with a B-cell malignancy, and in association with a documented complement abnormality. The findings suggest the efficacy of immunotherapy in this disease.

In this issue of Cell Host and Microbe, Lee et al. define the glycan binding specificity of a variant of typhoid toxin produced by a non-typhoidal Salmonellae serotype. The authors elegantly demonstrate that tissue and host specificity of the toxin are related to specific glycan binding characteristics of the toxin.

Background: Despite numerous guidelines on perioperative temperature management, perioperative hypothermia remains common. Prewarming to prevent redistribution hypothermia is supported by evidence, but not widely practiced. We investigate the measurement of preoperative mean body temperature as a potential tool for individualising the practise of prewarming. Methods: We hypothesised that patients who experience intraoperative hypothermia have a lower preoperative mean body temperature. A longitudinal study was conducted in adult patients presenting for ophthalmological surgery under general anaesthesia, to describe the relationship between the incidence of hypothermia within the first hour of anaesthesia and preoperative mean body temperature. Results: Sixty-five patients were enrolled. Twelve participants (18%) presented to the operating theatre hypothermic (core temperature <36.0°C). A further twenty-eight (43%) became hypothermic during the procedure. All hypothermia events occurred within sixty minutes after induction of anaesthesia, and half of the events occurred within nineteen minutes. The difference in preoperative mean body temperature between those with- and without intraoperative hypothermia was only -0.2°C (95% CI -0.4, 0.1). This is neither clinically relevant nor statistically noteworthy. In Cox proportional hazards analysis, BMI and ASA status compounded the observed association between preoperative mean body temperature and the incidence of intraoperative hypothermia. A higher BMI and ASA are associated with a lower incidence of hypothermia. Conclusion: We conclude that intraoperative hypothermia is common and occurs early after induction of anaesthesia. We observed no useful difference in preoperative mean body temperature to help distinguish between patients who become hypothermic and those who do not. Without a useful risk prediction tool, a generic approach to prewarming remains appropriate. Preoperative screening for pre-existing hypothermia should be practiced, even in cases considered as low risk.

No description available.

Introduction: There are similarities in the phenomenology and psychobiology of schizophrenia and methamphetamine psychosis, with evidence of alterations in glutamatergic function in both conditions, and of involvement of inflammatory pathways in schizophrenia and methamphetamine abuse. Few studies have directly compared glutamatergic and inflammatory metabolites in thalamo-cortical circuitry across schizophrenia and methamphetamine-induced psychosis or assessed the relationship between such metabolites and inflammatory markers in either disorder. This study aimed to 1) compare glutamatergic and neuroinflammatory metabolites in thalamo-cortical circuitry in schizophrenia and methamphetamine-induced psychosis, and 2) to investigate associations between glutamatergic metabolites, neuroinflammatory metabolites, and peripheral cytokine levels in both disorders. Methods: One hundred and sixteen participants were recruited – 44 with schizophrenia, 34 with methamphetamine-induced psychosis, and 38 healthy controls. All participants underwent a magnetic resonance imaging scan, which included magnetic resonance spectroscopy with voxels located in the anterior cingulate cortex (ACC) and left thalamus as well as a chemical-shift imaging 2-dimensional slice. Neurometabolites obtained included glutamatergic metabolites (glutamate (Glu), glutamine (Gln) and glutamate plus glutamine (Glx)) and neuroinflammatory metabolites (myo-inositol (mI), n-acetyl-aspartate (NAA), and n-acetyl aspartate plus n-acetyl-aspartyl glutamate (NAA+NAAG)). Absolute metabolite concentrations are reported. Serum cytokine concentrations were measured. For group differences, parametric data were analysed with one-way analysis of variance and nonparametric data analysed with Kruskal Wallis tests, followed by relevant post-hoc tests. Associations were determined using Spearman's rank-order coefficient. Significant associations were followed by comparison of correlations of independent samples. Results: There were no differences between neurometabolites in schizophrenia and healthy controls. The methamphetamine-induced psychotic disorder group had lower relative nacetyl-aspartate plus n-acetyl-aspartyl glutamate in left dorsolateral prefrontal cortex and left frontal white matter, compared to healthy controls. In schizophrenia, positive associations were found between absolute glutamatergic metabolites and absolute inflammatory metabolites in the anterior cingulate cortex (n-acetyl-aspartate with glutamate, lower n-acetylaspartate with n-acetyl-aspartyl glutamate plus glutamate, myo-inositol with glutamate, myoinositol with glutamate plush glutamine). Several positive relationships were found in mI between different brain areas of the thalamo-cortical circuitry in the methamphetamineinduced psychosis group. Conclusion: In schizophrenia, the associations between lower glutamatergic and lower neuroinflammatory metabolites suggest dysfunction in neuronal tissues in the glutamateglutamine cycle within the thalamo-cortical circuit. In methamphetamine-induced psychosis, lower NAA+NAAG/Cr+PCr in the left dorsolateral prefrontal cortex and left frontal white mattersuggest compromised neuronal integrity associated with chronic disease progression. Furthermore, in this group the associations of mI between brain areas in the thalamo-cortical 6 circuit suggest that neuroinflammatory pathways in this circuit are dysfunctional. Taken together, there may be important differences in the neurobiology of schizophrenia and methamphetamine-induced psychosis.

Burnout is an emerging topic that has been explored and researched since the 1970s. The concept is not unbeknown to healthcare and becomes a taboo subject interrupting the foundation of clinical practice. Burnout is described to be a state of physical, emotional, and mental exhaustion that consequently results in health-related problems, cynicism, and a negative impact on professional identity (Edwards & Dirette. 2010; Thomas & Lankau, 2009). During times of increased job demands and decreased job resources an employee is faced with circumstances that become altering. Consequently, this impacts the quality of care rendered to clients, negative feelings towards oneself, and impaired judgement. Evidence has identified the positive implications supervisory support has with alleviating symptoms and its response to burnout (Salminen et al., 2017). The Burnout Prevention from Leader to Team Builder is a program whose primary audience members are managers in a rehabilitation setting. The program provides evidence-based interventions to raise awareness of the managers role in burnout prevention, the rise of symptoms and interventions that will support prevention in the clinical setting. Through education, the self-paced online program is comprised of six modules that offer managers tools to adapt evidence-based programs in the clinical setting while addressing the components of burnout.

The Achilles tendon is the largest single tendon in the body and critical for common movements. Achilles tendon injuries are common, with rising levels of incidence in the western world. Current trends indicate that levels of Achilles tendon injuries will continue to rise globally. These are also impactful injuries, often resulting in long term alterations in lives and activities. Particularly devastating are the effects of Achilles tendon injury on athletes. The goal of this thesis is to contextualize these injuries and trends, providing a system of categorization for understanding and classifying Achilles tendon injuries. The normal structure and function of the Achilles tendon is introduced, followed by a discussion of a series of factors that can lead to Achilles tendon injury. Achilles tendon injuries are sorted into a clinically relevant framework and the various treatments and outcomes for these injuries are explored, with an eye towards potential areas of further research. Taken together, these analyses show the importance and prevalence of Achilles tendon injuries, some of the inherent challenges in dealing with these injuries, and also demonstrate the necessity for further study and exploration of Achilles tendon injuries.

The United States’ healthcare system has focused on identifying determinants of negative health outcomes through the standardized assessment of unmet social needs, termed as ‘social risk screenings.’ Prior research has established different health sector stakeholders’ perceptions regarding the acceptability and utility of these screenings, but there is limited evidence regarding the impact of social risk screening on patient health outcomes. Evidence is especially limited on the impact of social risk screening on persons with mental health or cancer diagnoses, despite high levels of reported unmet social needs in these populations. Additionally, an important consideration in the development and use of social risk screens lies in the potential disconnect between the conceptualization of social needs from the provider versus patient perspectives – a disconnect that may be driven by the ‘medicalization’ of the complex contextual factors that shape one’s social determinants of health. The goal of this dissertation is to generate evidence on the experience of clinical providers charged with administering and responding to social risk screenings, how screenings are associated with service use for patients with mental health needs, and patients’ own experiences of and reactions to being asked about social needs and the resultant impacts on the patient-provider interactive relationship. This dissertation contains three chapters that explore the impact of social risk screening on the adult safety net from multiple health sector perspectives. The first study, Patient Navigator and Clinical Team Perceptions on Addressing Unmet Social Needs: Results from a Breast Cancer Patient Navigation Intervention Study, utilizes primary data collection to characterize how patient navigators and clinical teams seek to screen and address unmet social needs for their patients via a social risk screening and referral intervention embedded in breast cancer care sites across Boston, MA. The second study, The Association between Social Needs Screening and Health Care Utilization Among Adults with Mental Health Needs in the Safety-Net, utilizes secondary data analysis of patient electronic health record data to examine the association of social risk screening on healthcare utilization for patients with mental health needs. The third study, Patient Perceptions and Consideration of Unmet Social Needs whilst Accessing Medical Services: A Qualitative Study utilizes primary data collection to understand the ambulatory care patient experience of responding to social risk screens, how patients prioritize different unmet social needs in light of seeking care, and the impact of social risk screening on the patient-provider relationship.

No description available.