The Impact of Relapses on Pain and Quality of Life in Patients with Multiple Sclerosis Treated with Corticosteroids

Background: We assessed the prevalence and risks associated with pain during and after a multiple sclerosis (MS) relapse, and the impact of pain on quality of life (QoL), in MS patients. // Methods: 117 patients suffering an acute MS relapse were evaluated with clinician- and patient-reported outcomes, including the expanded disability status scale (EDSS), Multiple Sclerosis Impact Scale (MSIS-29), and MS Walking scale-12 (MSWS-12). Relapse-related pain was assessed via the short-form 36 (SF-36) questionnaire upon first visit (relapse onset) and at 6 weeks after treatment with intravenous methylprednisolone (follow-up visit). // Results: Pain was present in 80% of patients at relapse onset. Patients with pain were more impaired physically (higher mean scores on MSIS-29phys and MSWS-12 and lower mean scores on SF-36 role physical, physical, and vitality scales) at relapse and six weeks after. In total, 74% of patients with MS relapse reported a poorer QoL due to pain. A lower psychological well-being was correlated with greater pain (MSIS29psy score). An increased number of prior relapses was a predictor of more pain at relapse onset. // Conclusions: Pain was common at the time of MS relapse and improved, but was still significant, six weeks after treatment with corticosteroids. Further studies are required to better understand relapse-related pain

The Disparate Impact of an Underfunded, Patchwork Indigent Defense System on Mississippi’s African Americans: The Civil Rights Case for Establishing a Statewide, Fully Funded Public Defender System

A fundamental principal of our nation\u27s criminal justice system is that regardless of financial status, whether wealthy or destitute, every accused person is entitled to the effective assistance of counsel. Despite over a decade of calls for reform by state courts, Mississippi is one of the few states that fail to meet its obligation to provide funding for attorneys representing the indigent criminally accused. As a result, Mississippi\u27s counties have shouldered the responsibility of paying court-appointed counsel without financial contribution from the state. The state\u27s eighty-two counties vary widely in wealth and resources. Some counties are able to provide reasonably adequate funding for indigent defense services, and even feature full-time, fully staffed public defender offices. Others, however, have maintained under-funded, part-time, court-appointed counsel systems. The resulting patchwork system of indigent defense practically ensures geographic disparities in the quality of counsel provided to poor Mississippians. Alternatively, a defendant\u27s access to counsel or decent advocacy varies widely depending on the county in which he is charged. African Americans in Mississippi, as throughout the nation, are disproportionately among the poor and the criminally accused. Therefore, the state\u27s failure to fund attorneys for the indigent accused acutely affects African Americans. The effects of the absence of meaningful advocacy for poor defendants reverberates widely and impacts African American families, neighborhoods, and communities

Taxonomy Visualization in Support of the Semi-Automatic Validation and Optimization of Organizational Schemas

Never before in history, mankind had access to and produced so much data, information, knowledge, and expertise as today. To organize, access, and manage these highly valuable assets effectively, we use taxonomies, classification hierarchies, ontologies, and controlled vocabularies among others. We create directory structures for our files. We use organizational hierarchies to structure our work environment. However, the design and continuous update of these organizational schemas that potentially have thousands of class nodes to organize millions of entities is challenging for any human being. The Taxonomy Visualization and Validation (TV) tool introduced in this paper supports the semi-automatic validation and optimization of organizational schemas such as file directories, classification hierarchies, taxonomies, or any other structure imposed on a data set as a means of organization, structuring, and naming. By showing the “goodness of fit” of a schema and the potentially millions of entities it organizes, the TV eases the identification and reclassification of misclassified information entities, the identification of classes that grew over-proportionally, the evaluation of the size and homogeneity of existing classes, the examination of the “well-formedness” of an organizational schema, etc. The TV is exemplarily applied to display the United States Patent and Trademark Office patent classification, which organizes more than three million patents into about 160,000 distinct patent classes. The paper concludes with a discussion and an outlook to future work

Unique health needs and characteristics of homeless women in Iowa City, Iowa

Context: Homeless individuals have comparatively poorer health, however few gender specific assessments exist. Purpose: This cross-sectional survey of homeless individuals assesses gender-specific health needs. Procedure: 68 Homeless adults were surveyed at a shelter from March to April, 2015 in Iowa City, IA. Descriptive statistics were computed to compare gender-subgroup responses. Main Findings: The study population was predominately male (45, 67.2%), white (37, 54.4%), and averaged 42.35 years old (range 21-74). Males were more likely to be veterans (13, 28.9% vs. 1, 4.5%, p=0.025). Women were more likely to have dependents (9, 47.4% vs. 1, 4%, p=0.001) and access to dental coverage (16, 80% vs. 12, 30.8%, p=0.001). Similar rates of chronic disease, primary care access, and unmet health needs were noted. Conclusions: Homeless women and men have unique needs and would benefit from gender-specific health interventions. Resources for child-care may be important for women who are homeless, while dental health care may be particularly beneficial for men

Using smartwatches to observe changes in activity during recovery from critical illness following COVID-19:a 1 year multi-centre observational study

BACKGROUND: As a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions. OBJECTIVE: We aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this. METHODS: We conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site—the MDT site (n=19)—had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis. RESULTS: Of the 50 participants recruited, 35 (70%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74% (14/19) of smartwatch users uploaded smartwatch data, whereas 68% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup’s mean step count increased more than that of the control group (176% increase vs 42% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71% (10/14) of smartwatch users at the MDT site and 48% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86% (12/14) and 48% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time. CONCLUSIONS: This is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post–critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.12968/ijtr.2020.010

Surviving severe COVID-19: Interviews with patients, informal carers and health professionals

Background:The COVID-19 pandemic has been associated with an unprecedentednumber of critical care survivors. Their experiences through illness and recovery arelikely to be complex, but little is known about how best to support them. This studyaimed to explore experiences of illness and recovery from the perspective of survi-vors, their relatives and professionals involved in their care.Study design:In-depth qualitative interviews were conducted with three stakeholdergroups during the first wave of the pandemic. A total of 23 participants (12 profes-sionals, 6 survivors and 5 relatives) were recruited from 5 acute hospitals in Englandand interviewed by telephone or video call. Data analysis followed the principles ofReflexive Thematic Analysis.Findings:Three themes were generated from their interview data: (1) Deterioratingfast—a downhill journey from symptom onset to critical care; (2) Facing a new virusin a hospital—a remote place; and (3) Returning home as a survivor, maintaining nor-mality and recovering slowly.Conclusions:Our findings highlight challenges in accessing care and communicationbetween patients, hospital staff and relatives. Following hospital discharge, patientsadopted a reframed‘survivor identity’to cope with their experience of illness andslow recovery process. The concept of survivorship in this patient group may be ben-eficial to promote and explore further.Relevance to clinical practice:All efforts should be made to continue to improvecommunication between patients, relatives and health professionals during criticalcare admissions, particularly while hospital visits are restricted. Adapting to life aftercritical illness may be more challenging while health services are restricted by theimpacts of the pandemic. It may be beneficial to promote the concept of survivorship,following admission to critical care due to severe COVID-19

XBP1 governs late events in plasma cell differentiation and is not required for antigen-specific memory B cell development

The unfolded protein response (UPR) is a stress response pathway that is driven by the increased load of unfolded proteins in the endoplasmic reticulum of highly secretory cells such as plasma cells (PCs). X box binding protein 1 (XBP1) is a transcription factor that mediates one branch of the UPR and is crucial for the development of antibody-secreting PCs. PCs represent only one class of terminally differentiated B cells, however, and little is known about the role for XBP1 in the other class: memory B cells. We have developed an XBP1fl/fl CD19+/cre conditional knockout (XBP1CD19) mouse to build upon our current understanding of the function of XBP1 in PC differentiation as well as to explore the role of XBP1 in memory cell development. Using this model, we show that XBP1CD19 mice are protected from disease in an autoantibody-mediated mouse lupus model. We also identify a novel developmental stage at which B cells express the traditional PC marker CD138 (syndecan-1) but have yet to undergo XBP1-dependent functional and morphological differentiation into antibody-secreting cells. Finally, we show that memory B cells develop normally in XBP1CD19 mice, demonstrating that XBP1-mediated functions occur independently of any memory cell lineage commitment