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Reduced Venous Blood Oxygen Saturation May Associate with Cognitive Decline in Patients with Multiple Sclerosis
Get PDFIntroduction: Reduced brain oxygen metabolism may be associated with neuronal activity in individuals with Multiple sclerosis (MS). Quantitative susceptibility mapping (QSM), an advanced MRI technique, can measure venous blood oxygen saturation via deoxyhemoglobin levels. It remains unknown whether QSM-derived venous blood susceptibility can be used as an imaging biomarker of neuronal activity in MS. The objective of this study was to investigate the susceptibility of internal cerebral veins (ICVs) in patients with relapsing-remitting MS (RRMS), and their correlations with clinical measures.
Methods: We recruited 18 patients with RRMS and 10 age-matched healthy controls (HC). Participants were scanned on a 3T MRI, generating QSM data. We performed clinical measures, including the paced auditory serial addition test (PASAT), an index of cognitive function. The total lesion load (TLL) and the susceptibility of the ICVs (χicv) were measured through manually delineated regions-of-interest on clinical MRI and QSM images, respectively. We compared the χicv between cohorts using Wilcoxon rank sum test. Linear regression was used to correlate χicv with clinical scores in MS patients.
Results: There were significantly reduced χicv (p = 0.026) in RRMS patients (212.4 ± 30.1 ppb) compared to HCs (239.4 ± 25.9 ppb). The χicv was moderately correlated with PASAT (r = 0.258, p \u3c 0.031) and TLL (r = -0.256, p \u3c 0.032) in MS patients.
Conclusions: This study provides first-of-its-kind evidence that reduced oxygen consumption in deep cerebral regions draining to the ICVs may be associated with cognitive decline in MS patients
Vulnerable Neighborhoods Had Smaller Gains in Health Insurance Coverage During Early Covid-19
Get PDFBackground:
The Covid-19 pandemic has illuminated the inequities that jeopardize health, prompting rapid interventions to promote care access. However, such efforts have had mixed success in eradicating disparities. One focus is the equity of improvements in insured rates.
Methods:
Self-reported health insurance coverage rates among adults aged 18-64 were obtained from the CDC’s PLACES datasets for collection years 2018 and 2021, at the Census Tract level. These data were merged with the CDC’s 2018 Social Vulnerability Index (SVI), which ranks Tracts on 15 measures of social determinants of health. Across Tracts nationally and by state, univariate correlations between Overall SVI and percentage change in uninsured rate from 2018 to 2021 were calculated. Then, national and state-specific multivariate models were created to assess the relationships between all 15 SVI variables and change in uninsured rate.
Results:
Health insurance coverage improved in all states. Nationally and across states, improvements were greater in lower-risk Census Tracts (34% average decrease in uninsured rate in lowest-risk decile nationally, vs. 16% in highest-risk decile, p \u3c 0.0001). Most state-specific multivariate models demonstrated high correlations between SVI variables and change in uninsured rate, with mean Multiple R of 0.74 (0.72 to 0.76 95% CI, F \u3c 0.0001 in all states).
Conclusions:
Nationally and in each state individually, pandemic-era improvements in health insurance access were disproportionately concentrated in lower-risk Census Tracts, which already had lower baseline uninsured rates. Multivariate models using SDOH inputs reliably identified vulnerable neighborhoods with lower health insurance access and smaller improvements in insured rates
Radiofreqency device as an alternative therapy for refractory nasal valve collapse
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Silvers SL, Rosenthal JN, McDuffie CM, Yen DM, Han JK. Temperature-controlled radiofrequency device treatment of the nasal valve for nasal airway obstruction: A randomized controlled trial. Int Forum Allergy Rhinol. 2021 Dec;11(12):1676-1684. http://doi.org/10.1002/alr.22861
for a patient with nasal valve collapse
Buprenorphine for pain management vs. chronic hydrocodone-acetaminophen therapy when comorbidities increase the risk of opioid-related side effects
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Gordon A, Callaghan D, Spink D, et al. Buprenorphine transdermal system in adults with chronic low back pain: a randomized, double-blind, placebo-controlled crossover study, followed by an open-label extension phase. Clin Ther. 2010;32(5):844-860. https://doi.org/10.1016/j.clinthera.2010.04.018
for a patient on long-term opioid therapy with high risk factors for adverse effects
Voyeurs upon History: Stephen Dwoskin, Marc Karlin, and For Memory
No full textThis article discusses the collaboration of Stephen Dwoskin and Marc Karlin, both Jewish filmmakers based in London in the 1970s, drawing in particular on evidence in the Dwoskin archive at the University of Reading that reveals Dwoskin’s hitherto unacknowledged contribution to Karlin’s film For Memory (1984). I demonstrate that this erasure is symptomatic of Dwoskin’s treatment by historians of British film culture, and argue that Dwoskin and Karlin’s collaboration, although it did not come to fruition, is revealing of the two filmmakers’ differing relationships with Britishness and Jewishness, and prompted a new and significant engagement on Dwoskin’s part with questions of diaspora, displacement, and integration
Paternal Origins of Mongolic-Speaking Populations: A Review of Studies from Recent Decades (1999–2019) and Their Implications for Multidisciplinary Research in the Future
No full textThe activities of Mongolic-speaking populations, a large group of people in eastern Eurasia, have important impacts on the history of East Asia and other parts of Eurasia. Most previous genetic research of East Asian populations, including ancient DNA studies, has involved samples from Mongolic-speaking populations or their ancient relatives. This review summarizes frequency data of paternal Y-chromosome haplogroups from all available literature about Mongolic-speaking populations from 1999 to 2019. Fourteen paternal components were identified, and six of them are proposed as major and common components in ancestor groups of Mongolic-speaking populations. The article thoroughly discusses the possible origin, migration patterns, and the roles of these six components in the evolutionary history of Mongolic-speaking populations, as well as implications of present achievements in human genetics for future multidisciplinary research in ethnology, history, archaeology, and linguistics
Racial Disparities in Palliative Care Utilization in the COVID-19 Pandemic
Get PDFBACKGROUND
Palliative care is a vital resource for the critically or terminally ill. It has myriad benefits such as improved quality of life, reduced depressive symptoms, and decreased scarce resource utilization. Self-identified Black/African patients, however, are less likely to utilize advanced care directives or engage in hospice/comfort care measures and are more likely to prefer intensive treatment at the end of life. There is no research, however, on how the COVID-19 pandemic may have affected these trends.
METHODS
A retrospective cohort study of patients who experienced in hospital mortality or in hospital hospice due to COVID-19 between March 2020 – October 2020 was performed within three major hospital systems in two large urban midwestern cities. Data on patient demographics and clinical characteristics, medical treatments received, and outcomes associated with having a palliative care consultation were collected. Bivariate analyses were performed to determine significance, followed by multivariate analysis on variables with a p\u3c0.10.
RESULTS
A total of n=479 patients were studied, 364 identified as Black/African American, 115 as White. Black patients were less likely to receive a palliative care consult (p\u3c0.028, and more likely to undergo cardiopulmonary resuscitation (p\u3c0.0001), intubation (p\u3c0.0307), and acute/chronic dialysis (p\u3c0.0012). There was no difference between the duration of hospitalization or rate of ICU admission.
CONCLUSION
Pre-pandemic data shows that there are established differences in the utilization of palliative services among different racial/ethnic groups. Our study found that this persisted throughout the pandemic. This data provides insight into how the pandemic influenced decision-making and may inform future palliative and critical care practices in future global emergencies