Publications by authors named "Alex Rosenberg"
Importance: Recent evolutions in clinical care and remote monitoring suggest that some acute illnesses no longer require intravenous therapy and inpatient hospitalization.
Objective: To describe outcomes of patients receiving care in a new, outpatient, virtual, home-based acute care model called Safer@Home.
Design, Setting, And Participants: This retrospective cohort analysis, conducted from September 1, 2022, through August 31, 2023, included 2466 patients treated at a safety net hospital in Los Angeles County for 10 core illnesses and 24 other acute illnesses for which patients are commonly hospitalized.
Article Synopsis
- Type II interferon gamma (IFNγ) is important for fighting off infections in both mice and humans, but some parasites have ways to block this immune response.
- A specific protein complex called MYR helps these parasites deliver factors that prevent the host's defenses from working properly, especially after getting infected.
- New research found that certain proteins like GRA24 and GRA28 play key roles in stopping the immune response from working, showing how clever these parasites are at avoiding the body's defenses.
Clinicians' experience of barriers and facilitators to care delivery of an extracorporeal cardiopulmonary resuscitation service for out-of-hospital cardiac arrest: a qualitative survey.
Scand J Trauma Resusc Emerg Med
September 2024
Article Synopsis
- Out-of-hospital cardiac arrest (OHCA) survival rates in the UK are low, with less than 10% of patients surviving, but extracorporeal cardiopulmonary resuscitation (ECPR) can enhance survival if administered within an hour.
- A study surveyed clinicians from Thames Valley Air Ambulance and Harefield Hospital to identify barriers and facilitators for implementing an effective ECPR transport system for OHCA patients, gathering responses on technical and non-technical aspects.
- Key themes discovered include the importance of educational programs, teamwork, communication, and standardizing protocols, highlighting the need for collaboration and effective training across both pre-hospital and in-hospital settings.
Article Synopsis
- An implantable left ventricular assist device (LVAD) is used in the UK mainly as a temporary solution for patients awaiting heart transplants or recovery.
- LVADs create a unique hemodynamic state, making standard measurements like blood pressure and pulse difficult to obtain, leading to challenges in patient assessment.
- To address these challenges, UK experts developed specific guidelines for managing emergencies in LVAD patients, aimed at healthcare providers in advanced heart failure centers, ensuring appropriate care during critical situations.
In both mice and humans, Type II interferon-gamma (IFNγ) is crucial for regulation of () infection, during acute or chronic phases. To thwart this defense, secretes protein effectors hindering the hosťs immune response. For example, relies on the MYR translocon complex to deploy soluble dense granule effectors (GRAs) into the host cell cytosol or nucleus.
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- * The study identifies at least five different parasite genes on various chromosomes that influence this susceptibility, especially those related to secretory proteins interacting with host cells.
- * The research uncovers that the difference in how parasite proteins are recognized at the host-pathogen interface is a key factor in determining the effectiveness of autophagy against these pathogens.
Article Synopsis
- The study aimed to see how a special education program could help doctors check for pain, agitation, and delirium (PAD) in patients in intensive care units.
- They included 430 patients from 12 hospitals in four countries and provided 6 weeks of online lessons and hands-on training.
- After one year, the results showed that more patients were getting checked for PAD, especially for delirium and pain, compared to before the training.
Article Synopsis
- The right ventricle (RV) plays a crucial role in critical illness, but its functions and pathologies are less understood compared to the left ventricle, leading to a greater need for study.
- With the rise of point-of-care echocardiography in critical care, there's a growing ability to detect and monitor RV issues in patients earlier than before.
- The article discusses different states of RV injury, highlighting a lack of a universal definition and emphasizing the importance of understanding RV-pulmonary circulation dynamics to improve diagnosis and treatment.
Introduction: induces a strong CD8 T cell response characterized by the secretion of IFNγ that promotes host survival during infection. The initiation of CD8 T cell IFNγ responses differs widely between clonal lineage strains of , in which type I strains are low inducers, while types II and III strains are high inducers. We hypothesized this phenotype is due to a polymorphic "Regulator Of CD8 T cell Response" (ROCTR).
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- Simulation training at the EuroELSO congress allows healthcare professionals to learn team-based skills without risking patient safety.
- The Educational Corner featured 43 sessions focused on advanced ECLS techniques for both adults and children, gaining positive feedback from participants.
- An overwhelming majority (94%) found the training valuable, and 95% would recommend it, indicating that the sessions effectively met educational objectives and could enhance their future practices.
Background: There are limited practical advanced life support algorithms to aid teams in the management of cardiac arrest in patients on extracorporeal membrane oxygenation (ECMO).
Methods: In our specialist tertiary referral centre we developed, by iteration, a novel resuscitation algorithm for ECMO emergencies which we validated through simulation and assessment of our multi-disciplinary team. A Mechanical Life Support course was established to provide theoretical and practical education combined with simulation to consolidate knowledge and confidence in algorithm use.
Background: Optimising outcomes for critically ill patients with COVID-19 patients requires early interdisciplinary rehabilitation. As admission numbers soared through the pandemic, the redeployed workforce needed rapid, effective training to deliver these rehabilitation interventions.
Methods: The COVID-19 ICU Remote-Learning Rehab Course (CIRLC-rehab) is a one-day interdisciplinary course developed after the success of CIRLC-acute.
Article Synopsis
- Guidance on managing emergencies for LVAD patients is scarce and inconsistent, increasing the risk of inappropriate responses.
- A new resuscitation algorithm was created and validated through simulations, along with a Mechanical Life Support course aimed at boosting staff confidence and skills.
- After training, staff confidence in handling LVAD situations significantly improved, leading to faster and more effective resuscitation, including reduction in time to restart LVAD function from 49 seconds to about 20 seconds.
Article Synopsis
- Pathogens exploit epigenetic modifications to influence host gene expression, impacting the host's immune response.
- The apicomplexan parasite uses two secreted effectors, TgIST and TgNSM, to manipulate host histone deacetylase activity and interfere with corepressor complexes (NuRD and NCoR/SMRT).
- This parasite serves as an important model for studying how epigenetic changes regulate immune responses, specifically the interferon response, during both acute and chronic stages of infection.
Toxoplasma gondii translocates effector proteins into its host cell to subvert various host pathways. T. gondii effector TgIST blocks the transcription of interferon-stimulated genes to reduce immune defense.
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- The rise of drug-resistant fungal pathogens and the limited antifungal options create significant challenges for treating severe infections.
- Researchers investigated how colistin, an antibiotic, enhances the effectiveness of fluconazole, a commonly used antifungal, especially against resistant strains.
- Colistin improves fluconazole's performance by increasing cell permeability and promoting cell death in fungi, particularly by targeting membranes depleted of ergosterol, which is essential for fungal cell health.
Article Synopsis
- * Mechanical circulatory support (MCS) devices can help stabilize patients, making it possible to delay surgery until their condition improves.
- * This case study focuses on using central venoarterial extracorporeal membrane oxygenation to support a patient with a large VSD, discussing the different types of MCS, their benefits, and drawbacks.
An introduction to mechanical circulatory support in cardiac intensive care.
Br J Hosp Med (Lond)
April 2020
Article Synopsis
- Knowledge about mechanical circulatory support is essential but often lacking among medical professionals, despite its increasing use.
- The article outlines various types of mechanical circulatory support, including intra-aortic balloon pumps, extracorporeal membrane oxygenation, and ventricular assist devices, and their specific applications in different cardiac conditions.
- These devices are effective treatments for conditions like myocardial ischaemia and cardiogenic shock, and they can aid in patient recovery or serve as a bridge to transplants.
Frequency of Thrombocytopenia and Heparin-Induced Thrombocytopenia in Patients Receiving Extracorporeal Membrane Oxygenation Compared With Cardiopulmonary Bypass and the Limited Sensitivity of Pretest Probability Score.
Crit Care Med
May 2020
Objectives: To ascertain: 1) the frequency of thrombocytopenia and heparin-induced thrombocytopenia; 2) positive predictive value of the Pretest Probability Score in identifying heparin-induced thrombocytopenia; and 3) clinical outcome of heparin-induced thrombocytopenia in adult patients receiving venovenous- or venoarterial-extracorporeal membrane oxygenation, compared with cardiopulmonary bypass.
Design: A single-center, retrospective, observational cohort study from January 2016 to April 2018.
Setting: Tertiary referral center for cardiac and respiratory failure.
Article Synopsis
- The Impella devices are short-term mechanical circulatory support (MCS) pumps designed to help patients with acute cardiogenic shock, providing a temporary solution until recovery or further intervention like heart transplant.
- In a study involving 57 patients, various types of Impella were implanted, showing the main reasons for use were related to heart failure conditions and significant improvements in heart and organ function were observed after 24 hours.
- Survival rates differed based on the stage of shock, with 30-day survival at 40% for the most critically ill patients compared to 82.4% for those in less severe stages, indicating timely intervention is crucial for better outcomes.
Evolution of resistance in vitro reveals mechanisms of artemisinin activity in .
Proc Natl Acad Sci U S A
December 2019
Article Synopsis
- Artemisinins are a primary treatment for malaria, but resistance is arising due to mechanisms like mutations in the Kelch13 gene that delay parasite clearance.
- Researchers used a related parasite to study resistance mechanisms, identifying specific mutations in the genome that conferred an advantage in artemisinin's presence.
- Findings indicate that mutations affecting both a serine protease and a protein kinase, along with enhancements in mitochondrial genome, might play crucial roles in artemisinin resistance, signifying mitochondria as a key target for combating resistance.