Acute Care Physical and Occupational Therapy Early Intervention Pathway After Transcatheter Aortic Valve Replacement: A Retrospective Study

Purpose: Transcatheter aortic valve replacement (tAVR) has emerged as a less-invasive alternative to traditional surgical aortic valve replacement. The purpose of this study was to examine the effect of a novel clinical pathway with an emphasis on early physical therapy and occupational therapy on patients undergoing tAVR in the acute care setting. Methods: A retrospective study was conducted involving 189 patients who underwent tAVR. The control group (n = 74) included patients who underwent tAVR prior to the implementation of the pathway. The intervention group (n = 115) included patients who underwent tAVR following the implementation of the pathway. Inpatient length of stay and discharge disposition were measured. Results: No differences in demographics or clinical variables were found; for example, mean age was 79.5 ± 11.2 years, with 57% male in the control group versus 81.6 ± 8.4 years and 59% male in the intervention group. Length of stay was significantly lower in the intervention group (control 6.9 ± 5.4 days, intervention 4.8 ± 5.4 days,P = .009) and significantly shorter length of stay postprocedure (control 4.8 ± 2.9 days, intervention 3.5 ± 4.0, P= .015). The incidence of the patient\u27s discharge disposition to home increased from 77% of patients in the control group to 86% of patients in the intervention group but was not statistically significant (P = .118). Conclusions: A clinical pathway specific to patients post-tAVR provided early mobility, targeted education, individualized functional goals, and discharge disposition recommendations. Patients in the intervention group experienced reduced hospital length of stay

Weight Loss and Illness Severity in Adolescents With Atypical Anorexia Nervosa.

BACKGROUND:Lower weight has historically been equated with more severe illness in anorexia nervosa (AN). Reliance on admission weight to guide clinical concern is challenged by the rise in patients with atypical anorexia nervosa (AAN) requiring hospitalization at normal weight. METHODS:We examined weight history and illness severity in 12- to 24-year-olds with AN (n = 66) and AAN (n = 50) in a randomized clinical trial, the Study of Refeeding to Optimize Inpatient Gains (www.clinicaltrials.gov; NCT02488109). Amount of weight loss was the difference between the highest historical percentage median BMI and admission; rate was the amount divided by duration (months). Unpaired t tests compared AAN and AN; multiple variable regressions examined associations between weight history variables and markers of illness severity at admission. Stepwise regression examined the explanatory value of weight and menstrual history on selected markers. RESULTS:Participants were 16.5 ± 2.6 years old, and 91% were of female sex. Groups did not differ by weight history or admission heart rate (HR). Eating Disorder Examination Questionnaire global scores were higher in AAN (mean 3.80 [SD 1.66] vs mean 3.00 [SD 1.66]; P = .02). Independent of admission weight, lower HR (β = -0.492 [confidence interval (CI) -0.883 to -0.100]; P = .01) was associated with faster loss; lower serum phosphorus was associated with a greater amount (β = -0.005 [CI -0.010 to 0.000]; P = .04) and longer duration (β = -0.011 [CI -0.017 to 0.005]; P = .001). Weight and menstrual history explained 28% of the variance in HR and 36% of the variance in serum phosphorus. CONCLUSIONS:Weight history was independently associated with markers of malnutrition in inpatients with restrictive eating disorders across a range of body weights and should be considered when assessing illness severity on hospital admission

The Ursinus Weekly, January 14, 1963

Exam period begins Thursday as semester draws to a close • Psychology Club hears speaker from Graterford • Collegeville plans new street lights along Main Street • Third student concert scheduled next Monday • Record enrollment in Evening School • Student teachers tell experiences at PSEA meeting • Weekly laments lack of newsworthy events • Race for space topic of speaker • Bible Study fellowship to sponsor color film • Ursinus receives $12,500 grant from Phila. church • Dean Rothenberger guest speaker at Lions banquet • Freedom urged by Dolman at conference • Jazz and the white American topic of introductory program on jazz • Alumni may pass fund drive goal • Curriculum changes discussed in chemistry and economics • Editorial: Throwing stones from glass houses • Letters to the editor • Familiar concentration camp image looms forbiddingly even today • Production story of the Weekly • Dean Rothenberger offers advice on how to study for final exams • Father\u27s interest in politics led Pancoast to same field • Greek gleanings • Cagers edge PMC cadets 51-50, then lose to Swarthmore 70-61 • Ability and poise mark Troster • Ken Dean shines in mat displays • Soccermen earn MAC honors • Wrestlers tie Swarthmore 14-14, stun Albright in 19-8 victory • Intramural story • Athletic letters given for soccer & footballhttps://digitalcommons.ursinus.edu/weekly/1285/thumbnail.jp

Erratum: A Case-Control Study of Maternal Polybrominated Diphenyl Ether (PBDE) Exposure and Cryptorchidism in Canadian Populations

[This corrects the article DOI: 10.1289/EHP522.]

Geologic Interpretation of Data Sets Collected by Planetary Analog Geology Traverses and by Standard Geologic Field Mapping

Geologic maps integrate the distributions, contacts, and compositions of rock and sediment bodies as a means to interpret local to regional formative histories. Applying terrestrial mapping techniques to other planets is challenging because data is collected primarily by orbiting instruments, with infrequent, spatiallylimited in situ human and robotic exploration. Although geologic maps developed using remote data sets and limited "Apollo-style" field access likely contain inaccuracies, the magnitude, type, and occurrence of these are only marginally understood. This project evaluates the interpretative and cartographic accuracy of both field- and remote-based mapping approaches by comparing two 1:24,000 scale geologic maps of the San Francisco Volcanic Field (SFVF), north-central Arizona. The first map is based on traditional field mapping techniques, while the second is based on remote data sets, augmented with limited field observations collected during NASA Desert Research & Technology Studies (RATS) 2010 exercises. The RATS mission used Apollo-style methods not only for pre-mission traverse planning but also to conduct geologic sampling as part of science operation tests. Cross-comparison demonstrates that the Apollo-style map identifies many of the same rock units and determines a similar broad history as the field-based map. However, field mapping techniques allow markedly improved discrimination of map units, particularly unconsolidated surficial deposits, and recognize a more complex eruptive history than was possible using Apollo-style data. Further, the distribution of unconsolidated surface units was more obvious in the remote sensing data to the field team after conducting the fieldwork. The study raises questions about the most effective approach to balancing mission costs with the rate of knowledge capture, suggesting that there is an inflection point in the "knowledge capture curve" beyond which additional resource investment yields progressively smaller gains in geologic knowledge

Associations between diffusion MRI microstructure and cerebrospinal fluid markers of Alzheimer's disease pathology and neurodegeneration along the Alzheimer's disease continuum

INTRODUCTION: White matter (WM) degeneration is a critical component of early Alzheimer's disease (AD) pathophysiology. Diffusion-weighted imaging (DWI) models, including diffusion tensor imaging (DTI), neurite orientation dispersion and density imaging (NODDI), and mean apparent propagator MRI (MAP-MRI), have the potential to identify early neurodegenerative WM changes associated with AD. METHODS: We imaged 213 (198 cognitively unimpaired) aging adults with DWI and used tract-based spatial statistics to compare 15 DWI metrics of WM microstructure to 9 cerebrospinal fluid (CSF) markers of AD pathology and neurodegeneration treated as continuous variables. RESULTS: We found widespread WM injury in AD, as indexed by robust associations between DWI metrics and CSF biomarkers. MAP-MRI had more spatially diffuse relationships with Aβ42/40 and pTau, compared with NODDI and DTI. DISCUSSION: Our results suggest that WM degeneration may be more pervasive in AD than is commonly appreciated and that innovative DWI models such as MAP-MRI may provide clinically viable biomarkers of AD-related neurodegeneration in the earliest stages of AD progression

Composition, Development, and Function of Uterine Innate Lymphoid Cells.

Innate lymphoid cells (ILCs), including NK cells, contribute to barrier immunity and tissue homeostasis. In addition to the role of uterine NK cells in placentation and fetal growth, other uterine ILCs (uILCs) are likely to play roles in uterine physiology and pathology. In this article, we report on the composition of uILCs in the endometrium during the luteal phase and in the decidua during early pregnancy. Whereas nonkiller uILC1s and uILC2s are barely detectable in mouse and not detected in humans, a sizeable population of uILC3s is found in human endometrium and decidua, which are mostly NCR(+) and partially overlap with previously described IL-22-producing uterine NK cells. Development of mouse uILC3 is Nfil3 independent, suggesting unique features of uILCs. Indeed, although the cytokine production profile of mouse uILCs recapitulates that described in other tissues, IL-5, IL-17, and IL-22 are constitutively produced by uILC2s and uILC3s. This study lays the foundation to understand how ILCs function in the specialized uterine mucosa, both in tissue homeostasis and barrier immunity and during pregnancy.Work supported by grants from the Wellcome Trust, the Medical Research Council, the British Heart Foundation and the Leukaemia & Lymphoma Research to FC. EB is the recipient of a Centre for Trophoblast Research Graduate Studentship. SB is the recipient of a Marie Curie FP7 Fellowship.This is the final version of the article. It first appeared from the American Association of Immunologists via http://dx.doi.org/10.4049/​jimmunol.150068

Dupilumab is very effective in a large cohort of difficult-to-treat adult atopic dermatitis patients:First clinical and biomarker results from the BioDay registry

Introduction: Dupilumab has recently been approved for the treatment of moderate to severe atopic dermatitis (AD) in adults. Daily practice data on dupilumab treatment are scarce. Objective: To study the effect of 16-week treatment with dupilumab on clinical response and serum biomarkers in adult patients with moderate-severe AD in daily practice. Methods: Data were extracted from the BioDay registry, a prospective multicenter registry. Sixteen-week clinical effectiveness of dupilumab was expressed as number of patients achieving EASI-50 (Eczema Area and Severity Index) or EASI-75, as well as patient-reported outcomes measures (Patient-Oriented Eczema Measure, Dermatology Life Quality Index, Numeric Rating Scale pruritus). Twenty-one biomarkers were measured in patients treated with dupilumab without concomitant use of oral immunosuppressive drugs at five different time points (baseline, 4, 8, 12, and 16 weeks). Results: In total, 138 patients treated with dupilumab in daily practice were included. This cohort consisted of patients with very difficult-to-treat AD, including 84 (61%) patients who failed treatment on ≥2 immunosuppressive drugs. At week 16, the mean percent change in EASI score was 73%. The EASI-50 and EASI-75 were achieved by 114 (86%) and 82 (62%) patients after 16 weeks of treatment. The most reported side effect was conjunctivitis, occurring in 47 (34%) patients. During dupilumab treatment, disease severity-related serum biomarkers (TARC, PARC, periostin, and IL-22), eotaxin-1, and eotaxin-3 significantly decreased. Conclusion: Treatment with dupilumab significantly improved disease severity and decreased severity-related serum biomarkers in patients with very difficult-to-treat AD in a daily practice setting