Trace-Forward Investigation of Mice in Response to Lymphocytic Choriomeningitis Virus Outbreak

During follow-up of a 2012 US outbreak of lymphocytic choriomeningitis virus (LCMV), we conducted a trace-forward investigation. LCMV-infected feeder mice originating from a US rodent breeding facility had been distributed to >500 locations in 21 states. All mice from the facility were euthanized, and no additional persons tested positive for LCMV infection.     

Feasibility and usability of measuring receipt of sealants in 2 states

BackgroundThe authors examined the reliability and validity of the Dental Quality Alliance childhood sealant measure under actual use conditions in Texas and Florida. The 2 states provide care for almost 20% of children in Medicaid nationally.MethodsThe authors used dental claims data to examine the reliability of the caries risk assessment component of the measure. They examined validity using a 3-year look-back period to identify children who were inaccurately included in the measure denominator as sealant eligible when they were not owing to already sealed, missing, or restored teeth.ResultsThe children identified at elevated risk varied between the states, with 85% at elevated risk in Texas and 39% in Florida in 2017. Different methods can be used to calculate risk, raising questions about reliability. In Texas, 31% of children included in the denominator were not eligible to receive sealants owing to already sealed, missing, or restored teeth. The magnitude of the underestimation increased with age, so by the time children were 9 years old, 40% were not measure eligible yet included in the denominator. Similar results were observed for Florida.ConclusionsThe authors propose eliminating the caries risk assessment requirement and incorporating a 3-year look-back period to identify already sealed, missing, or restored molars.Practical ImplicationsThe reliability and validity of the sealant measure needs to be enhanced. Measure misspecification in which children are not correctly identified as needing sealants can contribute to inaccurate development of quality improvement goals, performance improvement projects, or pay-for-quality programs.     

Right ventricular strain in patients with pulmonary embolism and syncope

Journal of Thrombosis and Thrombolysis - Patients with acute pulmonary embolism (PE) can present with various clinical manifestations including syncope. The mechanism of syncope in PE is not fully...     

Neurocognitive functioning among people accessing an addiction neuropsychology clinic with and without a history of offending behaviour

Effectiveness of interventions for violent behaviour may be undermined by the presence of neurocognitive impairment, which is known to be common among alcohol and other drug (AOD) users and violent offenders. The current study aimed to examine whether the cognitive functioning of individuals with AOD histories presenting to a specialist addiction neuropsychology service differed according to their offending history (i.e. non-offending, non-violent offending and violent offending), using a retrospective case file audit design. Data were extracted from 190 clients. Tests assessed a breadth of cognitive domains. Violent offenders demonstrated the lowest premorbid IQ out of the three groups, and a significantly higher proportion of violent offenders presented with impaired divided attention and impaired cognitive inhibition compared to non-violent offenders. Rates of impairment across groups were well beyond those expected within the general population. Delivery of both AOD and violence interventions should be adapted to accommodate individuals’ cognitive difficulties.Key words: alcohol and drug use, cognitive functioning, cognitive impairment, intervention, neurocognitive impairment, neuropsychology, offender, rehabilitation, treatment, violence

The number of people in prisons in Australia has increased by 25% between 2013 and 2018 (Australian Bureau of Statistics, 2019b), which is 2.6 times greater than the increase in the Australian population over that same period (9.6%; Australian Bureau of Statistics, 2019a). Of the prisoners released during 2015–2016, 43.7% returned to prison within two years (Justice & Regulation, 2018). This high rate of recidivism is despite the availability of programmes and psychological interventions during incarceration, community corrections orders or parole, and include those addressing alcohol and other drug (AOD) use and offending behaviour (Heseltine et al., 2011). However, the prevalence of AOD use remains a significant issue for the criminal justice system (Casey & Day, 2014), and is often associated with violent offending (Voce & Sullivan, 2019). For example, in 2018, 79% of police detainees across Australia who produced a positive urinalysis for drugs had committed a violent offence, and almost half of the sample (43%) attributed their violent offending to their AOD use (particularly alcohol and methamphetamine; Voce & Sullivan, 2019), which is consistent with international data (Bahr et al., 2012).AOD use and violent behaviour have been consistently associated with neurocognitive impairment (Boles & Miotto, 2003; Cadet & Bisagno, 2015; Crowe et al., 2020; Potvin et al., 2018; Potvin et al., 2014; Stavro et al., 2013). Neurocognitive impairment is an important factor to consider when selecting appropriate behaviour change interventions as it can affect people’s ability to make changes, and may limit engagement in, and response to, intervention (Rupp et al., 2012). Specifically, violent offenders have been found to have specific impairments in inhibitory control, emotional processing and divided attention (Bell & Polaschek, 2017; Bergvall et al., 2001; Yang & Raine, 2009), as well as more broad patterns of executive dysfunction (Broomhall, 2005; Hancock et al., 2010). These are similar impairments to those experienced by individuals with AOD use disorders, which also include aspects of executive functioning such as planning, use of environmental feedback, response inhibition, working memory and goal selection, in addition to learning and memory (Bates et al., 2002; Pitel et al., 2009). These skills are necessary for a successful response to interventions commonly used for aggression/violence, such as cognitive behaviour therapy (CBT), or motivational enhancement (Blume & Marlatt, 2009; Rupp et al., 2012).Importantly, neurocognitive impairments can persist for weeks or months after the cessation of AOD use, in some cases only returning to a normal range after lengthy periods (i.e. 12 or more months) of abstinence (Stavro et al., 2013), while in other cases deficits may persist (Crowe et al., 2020; Crowe & Stranks, 2018). Furthermore, populations with AOD use disorders often present with high rates of comorbid risk factors for cognitive impairment including educational disadvantage, trauma, mental health and head injury (Gooden et al., 2020; Jackson et al., 2011; Morisano et al., 2014).Given that cognitive impairment can be present in both AOD use disorder (Bates et al., 2002, 2013) and violent offending populations (Rosell & Siever, 2015), violent offenders with severe AOD use disorders may be more vulnerable to experiencing higher rates of, or more severe, cognitive impairment. This in turn may limit their ability to access or engage in treatment programmes. Furthermore, there is a risk that these impairments may go undetected or be underestimated despite their impact on intervention outcomes (Bernardin et al., 2014). As such, characterising the nature of these impairments and determining whether individuals in this group present with differing levels of cognitive impairment is the first step in ensuring these weaknesses can be considered and treatment programmes adequately adapted.This study aimed to explore and contrast the neuropsychological performance of (a) those with no offending history, (b) those with a history of non-violent offending and (c) those with a history of violent offending, who presented to a state-wide addiction neuropsychology service in Melbourne, Victoria, Australia. Specifically, we compared both mean scores and the proportion with scores in the impaired range across three groups defined by their history of offending behaviour. Based on existing literature, we predicted that violent offenders would demonstrate poor performance on tests of executive control (inhibition, divided attention and working memory) relative to that of non-violent offenders and non-offenders. Additionally, we aimed to determine the rates at which these groups differed from the normal range on domains of cognitive functioning and explore any differences between groups.     

Effects of denervation and immobilisation during development upon [3H]ouabain binding by slow- and fast-twitch muscle of the rat

The effect of innervation and of muscle inactivity upon the normal production of Na+-K+-ATPase sites, assayed by [3H]ouabain binding, in muscle surface membranes has been determined for the rat. In both slow-twitch soleus (SOL) and fast-twitch extensor digitorum longus (EDL) muscles a large increase was found to occur in [3H]ouabain binding per unit weight of muscle over the first 3 weeks of life. Interruptions of development, brought about by fixation of muscles at different lengths at 5 days of age, had no significant effect upon [3H]ouabain binding by EDL. In contrast, fixation led to a decrease in binding in SOL. When fixed in a shortened position profound morphological changes occurred, although these were not apparent when SOL was fixed in a stretched position. Denervation of SOL at 5 days of age significantly reduced the age related increase in the density of [3H]ouabain binding, whilst denervation of EDL had little effect. It was concluded that normal development of SOL is dependent upon innervation and possibly the resulting muscle activity, whereas development of EDL was relatively independent of innervation.     

Wound healing with “spray‐on” autologous skin grafting (ReCell) compared with standard care in patients with large diabetes‐related foot wounds: an open‐label randomised controlled trial

There is an urgent need for interventions that improve healing time, prevent amputations and recurrent ulceration in patients with diabetes‐related foot wounds. In this randomised, open‐label trial, participants were randomised to receive an application of non‐cultured autologous skin cells (“spray‐on” skin; ReCell) or standard care interventions for large (>6 cm²), adequately vascularised wounds. The primary outcome was complete healing at 6 months, determined by assessors blinded to the intervention. Forty‐nine eligible foot wounds in 45 participants were randomised. An evaluable primary outcome was available for all wounds. The median (interquartile range) wound area at baseline was 11.4 (8.8‐17.6) cm². A total of 32 (65.3%) index wounds were completely healed at 6 months, including 16 of 24 (66.7%) in the spray‐on skin group and 16 of 25 (64.0%) in the standard care group (unadjusted OR [95% CI]: 1.13 (0.35‐3.65), P = .845). Lower body mass index (P = .002) and non‐plantar wounds (P = .009) were the only patient‐ or wound‐related factors associated with complete healing at 6 months. Spray‐on skin resulted in high rates of complete healing at 6 months in patients with large diabetes‐related foot wounds, but was not significantly better than standard care (Australian New Zealand Clinical Trials Registry: ACTRN12618000511235).     

Importance of imaging method over imaging modality in noninvasive determination of left ventricular volumes and ejection fraction: assessment by two- and three-dimensional echocardiography and magnetic resonance imaging

OBJECTIVES: This study sought to determine the concordance between biplane and volumetric echocardiography and magnetic resonance imaging (MRI) strategies and their impact on the classification of patients according to left ventricular (LV) ejection fraction (EF) (LVEF). BACKGROUND: Transthoracic echocardiography and MRI are noninvasive imaging modalities well suited for serial evaluation of LV volume and LVEF. Despite the accuracy and reproducibility of volumetric methods, quantitative biplane methods are commonly used, as they minimize both scanning and analysis times. METHODS: Thirty-five adult subjects, including 25 patients with dilated cardiomyopathies, were evaluated by biplane and volumetric (cardiac short-axis stack) cine MRI and by biplane and volumetric (three-dimensional) transthoracic echocardiography. Left ventricular volume, LVEF and LV function categories (LVEF > or =55%, >35% to <55% and < or =35%) were then determined. RESULTS: Biplane echocardiography underestimated LV volume with respect to the other three strategies (p < 0.01). There were no significant differences (p > 0.05) between any of the strategies for quantitative LVEF. Volumetric MRI and volumetric echocardiography differed by a single functional category for 2 patients (8%). Six to 11 patients (24% to 44%) differed when comparing biplane and volumetric methods. Ten patients (40%) changed their functional status when biplane MRI and biplane echocardiography were compared; this comparison also revealed the greatest mean absolute difference in estimates of EF for those subjects whose EF functional category had changed. CONCLUSIONS: Volumetric MRI and volumetric echocardiographic measures of LV volume and LVEF agree well and give similar results when used to stratify patients with dilated cardiomyopathy according to systolic function. Agreement is poor between biplane and volumetric methods and worse between biplane methods, which assigned 40% of patients to different categories according to LVEF. The choice of imaging method (volumetric or biplane) has a greater impact on the results than does the choice of imaging modality (echocardiography or MRI) when measuring LV volume and systolic function.