Diagnostic Utility of Temporal Muscle Thickness as a Monitoring Tool for Muscle Wasting in Neurocritical Care

Temporalis muscle (TM) atrophy has emerged as a potential biomarker for muscle wasting. However, its diagnostic utility as a monitoring tool in intensive care remains uncertain. Hence, the objective of this study was to evaluate the diagnostic value of sequential ultrasound- and computed tomography (CT)-based measurements of TM thickness (TMT). With a prospective observational design, we included 40 patients without preexisting sarcopenia admitted to a neurointensive care unit. TMT measurements, performed upon admission and serially every 3–4 days, were correlated with rectus femoris muscle thickness (RFT) ultrasound measurements. Interrater reliability was assessed by Bland Altmann plots and intraclass correlation coefficient (ICC). Analysis of variance was performed in subgroups to evaluate differences in the standard error of measurement (SEM). RFT decline was paralleled by ultrasound- as well as CT-based TMT measurements (TMT to RFT: r = 0.746, p < 0.001; CT-based TMT to ultrasound-based RFT: r = 0.609, p < 0.001). ICC was 0.80 [95% CI 0.74, 0.84] for ultrasound-based assessment and 0.90 [95% CI 0.88, 0.92] for CT-based TMT measurements. Analysis of variance for BMI, Heckmatt score, fluid balance, and agitation showed no evidence of measurement errors in these subgroups. This study demonstrates the clinical feasibility and utility of ultrasound- and CT-based TMT measurements for the assessment of muscle wasting

Defining tumor growth in vestibular schwannomas:a volumetric inter-observer variability study in contrast-enhanced T1-weighted MRI

Introduction:For patients with vestibular schwannomas (VS), the need for reliable volumetric tumor monitoring is important. Currently, a volumetric cutoff of 20% increase in tumor volume is widely used to define tumor growth in VS. This study investigates the volumetric limits of agreement (LoA) of VS by an inter-observer study.Methods:This retrospective study included 100 VS patients who underwent contrast-enhanced T1-weighted MRI. Five observers volumetrically annotated the images. Observer agreement and reliability was measured using the LoA, estimated using the limits of agreement with the mean (LOAM) method, and the intraclass correlation coefficient (ICC). Influence of imaging parameters and tumor characteristics were assessed using univariable and multivariable linear regression analysis.Results:The 100 patients had an average median tumor volume of 903 mm3 (IQR: 193-3101). Peritumoral cysts were found in 6 patients. Patients were divided into four volumetric size categories based on tumor volume quartile. The smallest tumor volume quartile showed a LOAM relative to the mean of 26.8%, whereas for the largest tumor volume quartile this figure was found to be 7.3% and when excluding peritumoral cysts: 4.8%. Of all imagingparameters and tumor characteristics, only tumor volume was associated with the LoA (adjusted B=-0.001 [P=0.003]).Conclusion:Agreement limits within volumetric annotation of VS are affected by tumor volume, since the LoA improves with increasing tumor volume. As a result, for tumors larger than 200 mm3, growth can reliably be detected at an earlier stage, compared to the currently widely used cutoff of 20%.

Wait-and-Scan management in sporadic Koos grade 4 vestibular schwannomas:A longitudinal volumetric study

BackgroundVolumetric natural history studies specifically on large vestibular schwannomas (VSs), commonly classified as Koos grade 4, are lacking. The aim of the current study is to present the volumetric tumor evolution in sporadic Koos grade 4 VSs and possible predictors for tumor growth.MethodsVolumetric tumor measurements and tumor evolution patterns from serial MRI studies were analyzed from selected consecutive patients with Koos grade 4 VS undergoing initial wait-and-scan management between January 2001 and July 2020. The significant volumetric threshold was defined as a change in volume of ≥10%.ResultsAmong 215 tumors with a median size (IQR) of 2.7cm3 (1.8-4.2), 147 tumors (68%) demonstrated growth and 75 tumors (35%) demonstrated shrinkage during follow-up. Growth-free survival rates (95% CI) at 1, 2, 5, and 10 years were 55% (48-61), 36% (29-42), 29% (23-36), and 28% (21-34), respectively and did not significantly differ in tumors >20 mm (Chi-square=.40; P-value=.53). Four tumor evolution patterns (% of total) were observed: continued growth (60); initial growth then shrinkage (7); continued shrinkage (27); and stability (5). Good hearing (adjusted HR 2.21, 95% CI 1.48-3.30; P<.001) and peritumoral edema (adjusted HR 2.22, 95% CI 1.18-4.13; P.01) at diagnosis were significantly associated with an increased likelihood of growth.ConclusionsKoos grade 4 VSs show a wide variety in size and growth. Due to variable growth patterns, an initial wait-and-scan strategy with short scan intervals may be an acceptable option in selected tumors, if no significant clinical symptoms of mass effect that warrant treatment are present

Aggression and violence, posttraumatic stress, and absenteeism among employees in penitentiaries

On the basis of the Labour Conditions Act of 18 March 1999, employers are obliged to take care of their employees’ safety and health, and to pursue a policy aimed at creating the best possible labour conditions. The prevention of aggression towards employees falls under this obligation. In November 2005, the Scientific Research and Documentation Centre (WODC) carried out a large-scale study into the prevalence of aggressive behaviour targeting employees of penitentiaries during their work, which was commissioned by the Judicial Penitentiary Service (DJI) (Bogaerts & Den Hartogh, 2006). One of the remarkable findings of this study was that ‘aggression and violence among employees’ is a frequently occurring phenomenon within the prison system; of the 5,750 responding employees, no less than 641 reported to have fallen victim to one or more forms of aggression and violence among employees in the course of the previous twelve months. In this context, the term ‘aggression and violence among employees’ includes experienced unwanted sexual attention, intimidation, and physical violence. Aggression and violence among employees consists either of incidents between staff members, or of incidents between executive staff members and ordinary staff members. A substantial part of prison personnel is comprised of penitentiary workers (in Dutch, so-called ‘PIW-ers’). In order to improve the safety of penitentiary workers, the Ministry of Social Affairs and Employment, the DJI, and the unions have reached an agreement about a reduction of aggression and violence among employees, laid down in the ‘Arboplus Covenant Judicial Penitentiary Service on the Policy on Absenteeism, Integral Personal Safety, and the Career Perspective of Executive Personnel’2. The goal was for this reduction to be brought about halfway through 20073. To enable itself to successfully act upon the agreement, in addition to many actions and measures, the Sector Directorate of the Prison System asked the WODC to conduct an in-depth study on aggression and violence among employees within the penitentiaries. It was decided to examine only personal factors in this study. Organisational and economic factors and the institutional features of organisations that, without any doubt, play an important role in both the prevention and the occurrence of aggression and violence among employees were not studied. Framing mechanisms, for instance, which occur in every organisation, were not included in the study, the importance of this and other concepts notwithstanding. In his book ’Frame analysis: An essay on the organization of experience’, Goffman writes: “The concept of framing is taken to label schemata of interpretation that allows individuals or groups to locate, perceive, identify, and label events and occurrences, thus rendering meaning, organizing experiences, and guiding actions.” (Goffman, 1974, p. 21) The study ‘Benchmark Penitentiaries’, which will start in the autumn of 2007, will include institutional, organisational, and economic characteristics as well, besides the personal indicators, in order to assess the quality of the penitentiaries. In this way, aggression and violence among employees will not only be linked to personal factors, but will also be related to institutional factors and characteristics specific to the organisation. Another correlation not included in the present study is that between domestic violence (partner violence), violence at work, absenteeism, and the economic costs, even though this correlation is regularly established in the literature (e.g. Reeves & O’Leary-Kelly, 2007; Swanberg, Macke, & Logan, 2007). With this study, the aim of the Judicial Penitentiary Service is to gain insight into the possible effects of aggression and violence among employees and in the factors which are at the roots of it. The DJI is especially interested in absenteeism as a possible effect of aggression and violence among employees, and in the psychosocial factors that play a role. In the present report, we will present the findings of this study. It is set up as follows. In chapter 2, we will examine the potential effects of aggression and violence among employees and the factors at their source, such as can be assumed to exist when we base ourselves on the literature. Next, we will take these findings as the basis for our hypothetical model presented in chapter 3, which will be the starting point for the empirical part of the study. We will also discuss how this model was tested. In chapter 4, we will present de results of this test and we will examine whether it is necessary to break down the model into sub-models. In chapter 5, we will subsequently formulate twelve specific research questions, which deserve further exploration in the researchers’ view, both on the basis of the literature study and of the hypothetical model derived from it. All these questions are in logical keeping with the formulated hypothetical model. Again, we will indicate how these questions were tested. Finally, chapter 6 will provide a summary of the study. In this chapter we will present some conclusions as well

COVID-19 and Intracranial Hemorrhage: A Multicenter Case Series, Systematic Review and Pooled Analysis

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) profoundly impacts hemostasis and microvasculature. In the light of the dilemma between thromboembolic and hemorrhagic complications, in the present paper, we systematically investigate the prevalence, mortality, radiological subtypes, and clinical characteristics of intracranial hemorrhage (ICH) in coronavirus disease (COVID-19) patients. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review of the literature by screening the PubMed database and included patients diagnosed with COVID-19 and concomitant ICH. We performed a pooled analysis, including a prospectively collected cohort of critically ill COVID-19 patients with ICH, as part of the PANDEMIC registry (Pooled Analysis of Neurologic Disorders Manifesting in Intensive Care of COVID-19). Results: Our literature review revealed a total of 217 citations. After the selection process, 79 studies and a total of 477 patients were included. The median age was 58.8 years. A total of 23.3% of patients experienced the critical stage of COVID-19, 62.7% of patients were on anticoagulation and 27.5% of the patients received ECMO. The prevalence of ICH was at 0.85% and the mortality at 52.18%, respectively. Conclusion: ICH in COVID-19 patients is rare, but it has a very poor prognosis. Different subtypes of ICH seen in COVID-19, support the assumption of heterogeneous and multifaceted pathomechanisms contributing to ICH in COVID-19. Further clinical and pathophysiological investigations are warranted to resolve the conflict between thromboembolic and hemorrhagic complications in the future

Characterization of ftsZ Mutations that Render Bacillus subtilis Resistant to MinC

Background: Cell division in Bacillus subtilis occurs precisely at midcell. Positional control of cell division is exerted by two mechanisms: nucleoid occlusion, through Noc, which prevents division through nucleoids, and the Min system, where the combined action of the MinC, D and J proteins prevents formation of the FtsZ ring at cell poles or recently completed division sites. Methodology/Principal Findings: We used a genetic screen to identify mutations in ftsZ that confer resistance to the lethal overexpression of the MinC/MinD division inhibitor. The FtsZ mutants were purified and found to polymerize to a similar or lesser extent as wild type FtsZ, and all mutants displayed reduced GTP hydrolysis activity indicative of a reduced polymerization turnover. We found that even though the mutations conferred in vivo resistance to MinC/D, the purified FtsZ mutants did not display strong resistance to MinC in vitro. Conclusions/Significance: Our results show that in B. subtilis, overproduction of MinC can be countered by mutations that alter FtsZ polymerization dynamics. Even though it would be very likely that the FtsZ mutants found depend on other Z-ring stabilizing proteins such as ZapA, FtsA or SepF, we found this not to be the case. This indicates that the cell division process in B. subtilis is extremely robust.

The psychological science accelerator’s COVID-19 rapid-response dataset

In response to the COVID-19 pandemic, the Psychological Science Accelerator coordinated three large-scale psychological studies to examine the effects of loss-gain framing, cognitive reappraisals, and autonomy framing manipulations on behavioral intentions and affective measures. The data collected (April to October 2020) included specific measures for each experimental study, a general questionnaire examining health prevention behaviors and COVID-19 experience, geographical and cultural context characterization, and demographic information for each participant. Each participant started the study with the same general questions and then was randomized to complete either one longer experiment or two shorter experiments. Data were provided by 73,223 participants with varying completion rates. Participants completed the survey from 111 geopolitical regions in 44 unique languages/dialects. The anonymized dataset described here is provided in both raw and processed formats to facilitate re-use and further analyses. The dataset offers secondary analytic opportunities to explore coping, framing, and self-determination across a diverse, global sample obtained at the onset of the COVID-19 pandemic, which can be merged with other time-sampled or geographic data

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700