African swine fever risk and plant-based feed ingredients: Canada's approach to risk management of imported feed products

As a result of unprecedented spread of African swine fever (ASF) since 2018, Canada has taken additional steps to prevent introduction of the virus. While the role of plant-based feed in the transmission of ASF is not completely understood, it was identified that no mitigation measures were in place to address this uncertain risk. A risk analysis process was conducted with collaboration between government and industry, including an assessment of the costs and benefits of various risk mitigation options. Using existing legislative tools, requirements must now be met before the importation of plant-based feed ingredients of concern is permitted. Even with an uncertain risk, countries such as Canada that would suffer severe consequences should ASF be introduced, need to consider appropriate, risk-based mitigation measures.     

Containing SARS-CoV-2 in hospitals facing finite PPE,limited testing,and physical space variability: Navigating resource constrained enhanced traffic control bundling

The COVID-19 outbreak has led to a focus by public health practitioners and scholars on ways to limit spread while facing unprecedented challenges and resource constraints. Recent COVID-19-specific enhanced Traffic Control Bundling (eTCB) recommendations provide a cogent framework for managing patient care pathways and reducing health care worker (HCW) and patient exposure to SARS-CoV-2. eTCB has been applied broadly and has proven to be effective in limiting fomite and droplet transmissions in hospitals and between hospitals and the surrounding community. At the same time, resource constrained conditions involving limited personal protective equipment (PPE), low testing availability, and variability in physical space can require modifications in the way hospitals implement eTCB. While eTCB has come to be viewed as a standard of practice, COVID-19 related resource constraints often require hospital implementation teams to customize eTCB solutions. We provide and describe a cross-functional, collaborative on-the-ground adaptive application of eTCB initially piloted at two hospitals and subsequently reproduced at 16 additional hospitals and health systems in the US to date. By effectively facilitating eTCB deployment, hospital leaders and practitioners can establish clearer ‘zones of risk’ and related protective practices that prevent transmission to HCWs and patients. We outline key insights and recommendations gained from recent implementation under the aforementioned constraints and a cross-functional team process that can be utilized by hospitals to most effectively adapt eTCB under resource constraints.     

Abnormal synchrony of resting state networks in premanifest and symptomatic Huntington disease: the IMAGE-HD study

Background

Functional neural impairments have been documented in people with symptomatic Huntington disease (symp-HD) and in premanifest gene carriers (pre-HD). This study aimed to characterize synchrony in resting state cerebral networks in both pre-HD and symp-HD populations and to determine its association with disease burden and neurocognitive functions.

Methods

We acquired functional magnetic resonance imaging (fMRI) data from pre-HD, symp-HD and healthy control participants. The fMRI data were analyzed using multisubject independent component analysis and dual regression. We compared networks of interest among the groups using a nonparametric permutation method and correcting for multiple comparisons.

Results

Our study included 25 people in the pre-HD, 23 in the symp-HD and 18 in the healthy control groups. Compared with the control group, the pre-HD group showed decreased synchrony in the sensorimotor and dorsal attention networks; decreased level of synchrony in the sensorimotor network was associated with poorer motor performance. Compared with the control group, the symp-HD group showed widespread reduction in synchrony in the dorsal attention network, which was associated with poorer cognitive performance. The posterior putamen and superior parietal cortex were functionally disconnected from the frontal executive network in the symp-HD compared with control and pre-HD groups. Furthermore, the left frontoparietal network showed areas of increased synchrony in the symp-HD compared with the pre-HD group.

Limitations

We could not directly correct for influence of autonomic changes (e.g., heart rate) and respiration on resting state synchronization.

Conclusion

Our findings suggest that aberrant synchrony in the sensorimotor and dorsal attention networks may serve as an early signature of neural change in pre-HD individuals. The altered synchrony in dorsal attention, frontoparietal and corticostriatal networks may contribute to the development of clinical symptoms in people with Huntington disease.     

Lumbar lordosis and pelvic inclination in adults with chronic low back pain

BACKGROUND AND PURPOSE: The causes of lumbopelvic imbalances in standing have been widely accepted by physical therapists, but there is a lack of scientific evidence available to support them. We examined the association between 9 variables and pelvic inclination and lumbar lordosis during relaxed standing. SUBJECTS: Thirty men and 30 women with chronic low back pain (CLBP) for at least 4 months were examined (mean age=54.9 years, SD=9, range=40.4-69.8). METHODS: Multiple linear regression modeling was used to assess the association of pelvic inclination and the magnitude of lumbar lordosis in standing with age, sex, body mass index (BMI), Oswestry Back Pain Disability Questionnaire (ODQ) scores, physical activity level, hip flexor muscle length, abdominal muscle force, and range of motion (ROM) for lumbar flexion and extension. RESULTS: In women, age, BMI, and ODQ scores were associated univariately and multivariately with pelvic inclination. In men, lumbar extension ROM was related univariately to pelvic inclination; age, lumbar extension ROM, and ODQ scores were associated multivariately. Lumbar lordosis was associated univariately with only lumbar extension ROM for women and men. A weak correlation was found between angle of pelvic inclination and magnitude of lumbar lordosis in standing (r=. 31 for women, r=.37 for men). CONCLUSION AND DISCUSSION: The odds ratio of having CLBP is increased if the score on the double-leg lowering test for abdominal muscles exceeds 50 degrees for men and 60 degrees for women. In patients with CLBP, the magnitude of the lumbar lordosis and pelvic inclination in standing is not associated with the force production of the abdominal muscles.     

Inhibitory saccadic dysfunction is associated with cerebellar injury in multiple sclerosis

Cognitive dysfunction is common in patients with multiple sclerosis (MS). Saccadic eye movement paradigms such as antisaccades (AS) can sensitively interrogate cognitive function, in particular, the executive and attentional processes of response selection and inhibition. Although we have previously demonstrated significant deficits in the generation of AS in MS patients, the neuropathological changes underlying these deficits were not elucidated. In this study, 24 patients with relapsing–remitting MS underwent testing using an AS paradigm. Rank correlation and multiple regression analyses were subsequently used to determine whether AS errors in these patients were associated with: (i) neurological and radiological abnormalities, as measured by standard clinical techniques, (ii) cognitive dysfunction, and (iii) regionally specific cerebral white and gray‐matter damage. Although AS error rates in MS patients did not correlate with clinical disability (using the Expanded Disability Status Score), T2 lesion load or brain parenchymal fraction, AS error rate did correlate with performance on the Paced Auditory Serial Addition Task and the Symbol Digit Modalities Test, neuropsychological tests commonly used in MS. Further, voxel‐wise regression analyses revealed associations between AS errors and reduced fractional anisotropy throughout most of the cerebellum, and increased mean diffusivity in the cerebellar vermis. Region‐wise regression analyses confirmed that AS errors also correlated with gray‐matter atrophy in the cerebellum right VI subregion. These results support the use of the AS paradigm as a marker for cognitive dysfunction in MS and implicate structural and microstructural changes to the cerebellum as a contributing mechanism for AS deficits in these patients. Hum Brain Mapp 35:2310–2319, 2014. © 2013 Wiley Periodicals, Inc .     

The efficacy and safety of intravenous hydralazine for the treatment of hypertension in the hospitalized child

Background

Intravenous (IV) hydralazine is frequently used for the treatment of elevated blood pressure (BP) in hospitalized children. Its safety and efficacy have not been examined.

Methods

This is a retrospective chart review of IV hydralazine use in hospitalized children (birth to 17 years) over a 3-year period. Demographic data and data on adverse effects (AE), BP, and heart rate (HR) prior to and after each first dose were collected.

Results

The patient cohort comprised 110 children admitted to the hospital during the study period, of whom 77 received the recommended dose. Mean age of the children was 8.5?±?5.4 years; 33 % were male, and 32.5 % were white. Pre-dose systolic and diastolic BP indexes were 1.3 and 1.2, respectively. The median reduction in systolic and diastolic BP was 8.5 and 11.5 %, respectively. Sixteen (21 %) children achieved a 25 % reduction in systolic or diastolic BP, and BP increased in 30 % of patients; 10 % of children had a BP of <95th percentile for age, sex, and height after one dose. Seven (9 %) children had a documented AE. HR increased by a median of 3.5 %. In the multivariable models examining percentage change in systolic and diastolic BP, male gender was significantly associated with a change in systolic BP.

Conclusions

In hospitalized children, IV hydralazine was well tolerated, BP response was variable, and 21 % of the patients achieved a ≥25 % reduction of systolic or diastolic BP. Further studies are needed to compare the safety and efficacy of IV hydralazine to other short-acting antihypertensive agents.     

Problematising risk in stroke rehabilitation

Purpose: Following stroke, re-engagement in personally valued activities requires some experience of risk. Risk, therefore, must be seen as having positive as well as negative aspects in rehabilitation. Our aim was to identify the dominant understanding of risk in stroke rehabilitation and the assumptions underpinning these understandings, determine how these understandings affect research and practise, and if necessary, propose alternate ways to conceptualise risk in research and practise.

Method: Alvesson and Sandberg’s method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives.

Results: Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation.

Conclusions: Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation.

• Implications for rehabilitation

• Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation.

• The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke.

• The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or more severe stroke.

• Viewing individuals affected by stroke as possessing a range of independence and diverse personally valued activities that exist within a network of relations offers wider possibilities for action in rehabilitation.