Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa

Ninety subjects with DSM-III-R anorexia nervosa were randomly allocated to four treatment options, one inpatient, two outpatient, and one comprising an assessment interview only. Twenty were thus offered a package of outpatient individual and family psychotherapy. At 2-year follow-up, 12 of the 20 were classed as well, or very nearly well, according to operationally defined criteria. Statistically significant improvements over time were obtained for weight, mean body mass index (BMI), and also for psychological, sexual, and socioeconomic adjustments. Weight and BMI changes were significantly better than for the assessment only group, some of whom had received extensive treatment elsewhere. The style of the outpatient therapy and compliance with it are described in some detail and prognostic indicators for the treated and untreated groups presented. Lower weights at presentation and vomiting were associated with poorer outcome, although age and length of history were not. © 1994 by John Wiley & Sons, Inc.     

Treatment of stiff-man syndrome with intravenous immune globulin

Objective. To evaluate the efficacy of intravenous immune globulin (IVIG) in the treatment of stiff-man syndrome (SMS). Methods. An open, unblinded study of 3 patients with active disease and/or disease refractory to treatment with diazepam and/or corticosteroids. Results. All 3 bedridden patients improved substantially shortly after infusion with IVIG and regained function. Conclusion. IVIG may be useful for the treatment of SMS.     

Increased sanitization potency of hydrogen peroxide with synergistic O3 and intense pulsed light for non-woven polypropylene

Supplies of respiratory masks have recently become a concern due to the onset of the SARS-CoV-2 pandemic. Sanitization and reuse of masks can alleviate high mask consumption and production stresses. In the present work, improved sanitization potency of vaporous hydrogen peroxide (VHP) treatment of resilient bacterial spores while retaining polymeric filter performance was explored. A batch fumigation chamber with hydrogen peroxide (H₂O₂) vapor and ozone (O₃) is featured, followed by intense pulsed light (IPL) flash treatments. A resilient bacterial indicator, Geobacillus stearothermophilus (G. stearothermophilus), was utilized to compare the efficacy of various H₂O₂ concentrations in combination with O₃ and IPL. It was found that exposure to 30 minutes of 4.01 L min⁻¹ 0.03% H₂O₂ aqueous vapor and 3 g h⁻¹ O₃ followed by 10 IPL flashes per side completely inactivated G. stearothermophilus. The xenon sourced IPL irradiation was found to synergistically enhance radical production and strengthen the complementary biocidal interaction of H₂O₂ with O₃. Due to the synergistic effects, H₂O₂ was able to sanitize at a diluted concentration of 0.03% H₂O₂. The physical properties, such as surface potential, tensile strength, hydrophobicity, and filtration efficiency of >300 nm saline water aerosol of fibrous polypropylene (PP) sheets, were maintained. In addition, no residue of sanitizers was detected, thus confirming the biosafety and applicability of this method to disposable masks. Performance was benchmarked and compared with commercially available processes. The synergistic regime was found to achieve sterilization of G. stearothermophilus at drastically reduced H₂O₂ concentrations and in ambient conditions relative to commercial methods.

By introducing synergistic elements to the VHP processes, potent sanitization of polymeric filters is achieved at low H₂O₂ concentrations.     

Bonding diversity in rock salt-type tellurides: examining the interdependence between chemical bonding and materials properties

Future technologies are in need of solid-state materials showing the desired chemical and physical properties, and designing such materials requires a proper understanding of their electronic structures. In this context, recent research on chalcogenides, which were classified as ‘incipient metals’ and included phase-change data storage materials as well as thermoelectrics, revealed a remarkable electronic behavior and possible state (dubbed ‘metavalency’) proposed for the frontier between entire electron localization and delocalization. Because the members of the family of the polar intermetallics vary widely in their properties as well as electronic structures, one may wonder if the aforementioned electronic characteristics are also achieved for certain polar intermetallics. To answer this question, we have employed quantum-chemical tools to examine the electronic structures of the rock salt-type YTe and SnTe belonging to the families of the polar intermetallics and incipient metals, respectively. To justify these classifications and argue as to why an application of the Zintl–Klemm concept (frequently employed to relate the structural features of tellurides to their electronic structures) could be misleading for YTe and SnTe, the electronic structures of YTe and SnTe were first compared to that of the rock salt-type SrTe. In addition, we carried out a Gedankenexperiment by subsequently modifying the chemical composition from YTe to SnTe, and, by doing so, we shed new light on the interdependence between chemical bonding and materials properties. Gradual changes in the former do not necessarily translate into the latter which may undergo discontinuous modifications.

Future technologies are in need of solid-state materials showing the desired chemical and physical properties, and designing such materials requires a proper understanding of their electronic structures.     

Intercostal nerve blockade with liposomal bupivacaine reduces length of stay after video assisted thoracic surgery (VATS) lobectomy

BackgroundIntercostal nerve blockade (INB) for thoracic surgery analgesia has gained popularity in practice, but evidence demonstrating its efficacy remains sparse and inconsistent. We investigated the effect of INB with standard bupivacaine (SB) with epinephrine versus liposomal bupivacaine (LB) versus a mixed solution of the two on postoperative pain control and outcomes in video assisted thoracoscopic lobectomy patients.MethodsSince 2014, our practice has shifted from using INBs with SB with epinephrine, to LB, to a mix of the two as the central component of multimodal analgesia after video assisted thoracoscopic surgery. The blocks are performed in a standardized fashion under thoracoscopic visualization consecutively from two rib spaces above to two below the outermost incisions. We retrospectively compared all minimally invasive lobectomies performed at our institution between January 2014 and July 2018 by type of local anesthetic used for INB. We examined median length of stay (LOS), opioid utilization, and subjective pain scores [0–10].ResultsOut of 302 minimally invasive lobectomy patients, 34 received SB with epinephrine, 222 received LB alone, and 46 received the mixed solution. LOS was almost a full day shorter in the LB group than in the SB group (34.8 vs. 56.5 hours, P=0.01). There was nearly 25% lower median total morphine equivalent utilization in the mixed solution cohort compared to the LB cohort (−7.1 mg, P=0.02). Additionally, IV morphine equivalent utilization was over 50% lower in the mixed solution group than in the SB with epinephrine group (−10.0 mg, P=0.03).ConclusionsOur study is by far the largest (N=302) to compare types of local anesthetic used for INB within a uniform case population. The reductions in LOS and opiate utilization observed in our study among patients receiving LB-based formulations were both statistically and clinically significant.     

Early chains of transmission of COVID-19 in France,January to March 2020

IntroductionSARS-CoV-2, the virus that causes COVID-19, has spread rapidly worldwide. In January 2020, a surveillance system was implemented in France for early detection of cases and their contacts to help limit secondary transmissions.AimTo use contact-tracing data collected during the initial phase of the COVID-19 pandemic to better characterise SARS-CoV-2 transmission.MethodsWe analysed data collected during contact tracing and retrospective epidemiological investigations in France from 24 January to 30 March 2020. We assessed the secondary clinical attack rate and characterised the risk of a contact becoming a case. We described chains of transmission and estimated key parameters of spread.ResultsDuring the study period, 6,082 contacts of 735 confirmed cases were traced. The overall secondary clinical attack rate was 4.1% (95% confidence interval (CI): 3.6–4.6), increasing with age of index case and contact. Compared with co-workers/friends, family contacts were at higher risk of becoming cases (adjusted odds ratio (AOR): 2.1, 95% CI: 1.4–3.0) and nosocomial contacts were at lower risk (AOR: 0.3, 95% CI: 0.1–0.7). Of 328 infector/infectee pairs, 49% were family members. The distribution of secondary cases was highly over-dispersed: 80% of secondary cases were caused by 10% of cases. The mean serial interval was 5.1 days (interquartile range (IQR): 2–8 days) in contact tracing pairs, where late transmission events may be censored, and 6.8 (3–8) days in pairs investigated retrospectively.ConclusionThis study increases knowledge of SARS-CoV-2 transmission, including the importance of superspreading events during the onset of the pandemic.