Multidisciplinary Lessons from Palliative Extubations at Home.

Most patients with serious illness prefer to die at home; however, for those requiring ongoing ventilatory support, this preference is often not honored due to the difficulties of arranging a palliative extubation at home. Here we present two cases of successful home palliative extubations, coordinated by a multidisciplinary team including critical care, palliative care, care management, hospice, and emergency medical services (EMS) clinicians. By exploring the operational and regulatory challenges accompanying these cases, we provide a road map for offering mechanically ventilated patients the choice of a death at home and provide truly holistic and patient-centered care.

Responding to the impact of COVID-19 on the mental health and well-being of health workers in LMICs.

The COVID-19 pandemic has worsened mental health among health workers around the world. With a projected global shortage of 10.2 million health workers by 2030, further exacerbated by COVID-19, taking action to support health worker mental health needs to be an integral component of investments to overcome this gap and build resiliency of systems for the future.

Too Hot to Handle: A Case of Esophageal Thermal Injury From Solid Food Ingestion.

Esophageal thermal injury (ETI) is an uncommon occurrence in both children and adults. Therefore, little is known about the diagnosis and clinical course of patients suffering from these injuries. We present the case of an 11-year-old female with macrocephaly capillary malformation syndrome and developmental delay suffering from ETI after ingestion of a piece of hot butternut squash.

Flotation-Restricted Environmental Stimulation Technique: A Proposed Therapy for Improving Performance and Recovery in Special Forces Operators - A Narrative Review.

The flotation-restriction environmental stimulation technique (FR) may have utility as a recovery tool for improving performance in elite competitive athletes and Special Operations Forces Operators (SOs). Studies suggest that FR may ameliorate various neurophysiological disorders and improve performance in recreational and elite athletic populations. We sought to understand whether there is evidence to support the use of FR to enhance physiological and psychological performance parameters in the SO population and to provide postulations as to the mechanisms of action of FR therapy.

Integration of artificial intelligence and precision oncology in Latin America.

Next-generation medicine encompasses different concepts related to healthcare models and technological developments. In Latin America and the Caribbean, healthcare systems are quite different between countries, and cancer control is known to be insufficient and inefficient considering socioeconomically discrepancies. Despite advancements in knowledge about the biology of different oncological diseases, the disease remains a challenge in terms of diagnosis, treatment, and prognosis for clinicians and researchers.

Physiological and Psychological Stressors Affecting Performance, Health, and Recovery in Special Forces Operators: Challenges and Solutions. A Scoping Review.

Introduction: Special Operations Forces (SOF) Operators (SOs) are exposed to high levels of physiological and cognitive stressors early in their career, starting with the rigors of training, combined with years of recurring deployments. Over time, these stressors may degrade SOs' performance, health, and recovery.

Objectives: (1) To evaluate sources identifying and describing physiological and psychological stressors affecting performance, health, and recovery in SOs, and (2) to explore interventions and phenomena of interest, such as the biological mechanisms of overtraining syndrome (OTS).

Universal SARS-CoV-2 Testing of Emergency Department Admissions Increases Emergency Department Length of Stay.

Study Objective: Our institution experienced a change in SARS-CoV-2 testing policy as well as substantial changes in local COVID-19 prevalence, allowing for a unique examination of the relationship between SARS-CoV-2 testing and emergency department (ED) length of stay.

Methods: This was an observational interrupted time series of all patients admitted to an academic health system between March 15, 2020, and September 30, 2020. Given testing limitations from March 15 to April 24, all patients receiving SARS-CoV-2 tests were symptomatic.

Evaluating effects of sex and age on white matter microstructural alterations in alcohol use disorder: A diffusion tensor imaging study.

Background: Alterations in white matter microstructure associated with chronic alcohol use have been demonstrated in previous diffusion tensor imaging (DTI) research. However, there is conflicting evidence as to whether such differences are influenced by an individual's biological sex. The purpose of the present study was to investigate the prevalence of sex differences in the white matter microstructure of the brains of individuals with alcohol use disorder (AUD) and healthy controls.

Utility of Mass SARS-CoV-2 Testing of Asymptomatic Patients Before Ambulatory and Inpatient Preplanned Procedures Requiring Moderate Sedation or General Anesthesia.

This quality improvement study describes the results of a mass preprocedure SARS-CoV-2 testing strategy during a period of high community transmission in Connecticut.

Real-world assessment of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) nasopharyngeal swab testing in a region with a high burden of coronavirus disease 2019 (COVID-19).

Concerns persist regarding possible false-negative results that may compromise COVID-19 containment. Although obtaining a true false-negative rate is infeasible, using real-life observations, the data suggest a possible false-negative rate of ˜2.3%.

Mass severe acute respiratory coronavirus 2 (SARS-CoV-2) testing of asymptomatic healthcare personnel.

Mass asymptomatic SARS-CoV-2 nucleic acid amplified testing of healthcare personnel (HCP) was performed at a large tertiary health system. A low period-prevalence of positive HCP was observed. Of those who tested positive, half had mild symptoms in retrospect.

Prevalence of SARS-CoV-2 Among Patients Admitted for Childbirth in Southern Connecticut.

This study describes the prevalence of positive SARS-CoV-2 test results among asymptomatic pregnant women presenting for labor and delivery at Yale New Haven health system hospitals.

A Rare Case of Synchronous Double Cardiac Leiomyosarcoma in the Left Atrium.

Primary cardiac tumors are rare and leiomyosarcoma is an even rarer entity with a reported incidence of <0.25% of all cardiac tumors. We demonstrate the need to include leiomyosarcoma on the differential when presented with an atrial mass on echocardiogram, which may guide intraoperative decision making.

Improving laboratory test utilisation at the multihospital Yale New Haven Health System.

Background: Waste persists in healthcare and negatively impacts patients. Clinicians have direct control over test ordering and ongoing international efforts to improve test utilisation have identified multifaceted approaches as critical to the success of interventions. Prior to 2015, Yale New Haven Health lacked a coherent strategy for laboratory test utilisation management.

Voluntary and involuntary contributions to perceptually guided saccadic choices resolved with millisecond precision.

In the antisaccade task, which is considered a sensitive assay of cognitive function, a salient visual cue appears and the participant must look away from it. This requires sensory, motor-planning, and cognitive neural mechanisms, but what are their unique contributions to performance, and when exactly are they engaged? Here, by manipulating task urgency, we generate a psychophysical curve that tracks the evolution of the saccadic choice process with millisecond precision, and resolve the distinct contributions of reflexive (exogenous) and voluntary (endogenous) perceptual mechanisms to antisaccade performance over time. Both progress extremely rapidly, the former driving the eyes toward the cue early on (∼100 ms after cue onset) and the latter directing them away from the cue ∼40 ms later.

Neural Correlates of Compulsive Alcohol Seeking in Heavy Drinkers.

Background: Compulsive alcohol use, the tendency to continue alcohol seeking and taking despite negative consequences, is a hallmark of alcohol use disorder. Preclinical rodent studies have suggested a role for the medial prefrontal cortex, anterior insula, and nucleus accumbens in compulsive alcohol seeking. It is presently unknown whether these findings translate to humans.

Behavioral Economics and Physician Board Meetings: Opportunity Cost, Regret, and Their Mitigation in Orthopaedic Surgery.

Health care is a business. Health care providers must become familiar with terms such as opportunity costs, the potential loss or gain when one choice is made in lieu of another. The purpose of this study was to calculate the opportunity cost of two orthopaedic surgery society board meetings and discuss these in the context of behavioral economics and regret.

Using System Inflammatory Response Syndrome as an Easy-to-Implement, Sustainable, and Automated Tool for All-Cause Deterioration Among Medical Inpatients.

Objectives: Clinical deterioration detection among adult inpatients is known to be suboptimal, and many electronic health record tools have been developed to help identify these patients. Many of these tools are focused on sepsis spectrum disorders, but the evolution of the definition of sepsis is moving toward increased specificity, which may make automated detection of clinical deterioration from nonsepsis-related conditions less likely. The objectives of this study were to develop and to examine the use of a low-cost, highly sustainable deterioration detection tool based on systemic inflammatory response syndrome (SIRS) criteria.

Characterization of hemocytes from different body fluids of the eastern oyster Crassostrea virginica.

Bivalve hemocytes are involved in a variety of physiological and immunological functions. Circulating hemocytes in the hemolymph represent the main component of the internal self-defense system while hemocytes present in the extrapallial space (between the mantle and the shell) are actively involved in biomineralization and shell formation. This study focused on the characterization of hemocytes from different body fluids of the eastern oyster Crassostrea virginica.

Follicular cell dendritic sarcoma of cervical nodes in a patient with significant WTC exposure.

A patient who worked at the World Trade Center (WTC) site presented with right cervical lymphadenopathy. He underwent right neck dissection. The final pathology showed follicular dendritic cell sarcoma.

Restricting symptoms in the last year of life: a prospective cohort study.

Importance: Freedom from symptoms is an important determinant of a good death, but little is known about symptom occurrence during the last year of life.

Objective: To evaluate the monthly occurrence of physical and psychological symptoms leading to restrictions in daily activities (ie, restricting symptoms) among older persons during the last year of life and to determine the associations of demographic and clinical factors with symptom occurrence.

Design, Setting, And Participants: Prospective cohort study.