Driving in Early-Stage Alzheimer’s Disease: An Integrative Review of the Literature

One of the most difficult decisions for individuals with Alzheimer’s disease (AD) is when to stop driving. Because driving is a fundamental activity linked to socialization, independent functioning, and wellbeing, making the decision to stop driving is not easy. Cognitive decline in older adults can lead to getting lost while driving, difficulty detecting and avoiding hazards, as well as increased errors while driving due to compromised judgment and difficulty in making decisions. The purpose of the current literature review was to synthesize evidence regarding how individuals with early-stage AD, their families, and providers make determinations about driving safety, interventions to increase driving safety, and methods to assist cessation and coping for individuals with early-stage AD. The evidence shows that changes in driving ability start early and progress throughout the trajectory of AD. Some individuals with mild cognitive impairment or early-stage AD may be safe to drive for a period of time. Support groups aimed at helping with the transition have been shown to be helpful for individuals who stop driving. Research and practice must support interventions to help individuals maintain safety while driving, as well as cope with driving cessation

Reoperative brachial plexus neurolysis after previous anatomically complete supraclavicular decompression for neurogenic thoracic outlet syndrome: A 10-year single-center case series

BACKGROUND: Optimal management of recurrent neurogenic thoracic outlet syndrome (NTOS) remains a considerable challenge. OBJECTIVE: To assess the safety and effectiveness of reoperative brachial plexus neurolysis in patients with recurrent NTOS. METHODS: From 2009 to 2019, 85 patients underwent reoperative supraclavicular brachial plexus neurolysis for recurrent NTOS after a previous anatomically complete supraclavicular decompression. Data from a prospectively maintained database were analyzed retrospectively. RESULTS: The mean patient age at reoperation was 36.9 ± 1.3 (range 15-64) years, 75% were female, and the interval after previous primary operation was 2.5 ± 0.2 years. Intervening injury had precipitated recurrent NTOS in 14 patients (16%), and the mean Disability of the Arm, Shoulder, and Hand (QuickDASH) score before reoperation was 65.2 ± 2.6, reflecting substantial disability. Operative findings consisted of dense fibrous scar tissue surrounding/encasing the brachial plexus. Compared with the previous primary operations, reoperations had a shorter operative time (198 ± 4 vs 161 ± 5 minutes, P \u3c .01) and hospital stay (4.4 ± 0.2 vs 3.6 ± 0.1 days, P \u3c .01), but there were no significant differences in the frequency of prolonged hospitalization (7.1% vs 4.7%), early reoperation (3.5% vs 1.2%), or 30-day hospital readmission (8.2% vs 7.1%). During a median follow-up of 4.8 years, QuickDASH scores improved by 23.3 ± 2.6 (34.2% ± 3.6%; P \u3c .01) and patient-rated outcomes were excellent in 24%, good in 42%, fair in 26%, and poor in 8%. CONCLUSION: Reoperative supraclavicular brachial plexus neurolysis is technically challenging but safe and effective treatment for recurrent NTOS, with significant improvements in symptoms and function. Diminishing perineural scar tissue development and avoiding secondary injury would likely decrease the need for reoperations

Fourteen-Year Trends in the Use of Psychotropic Medications, Opioids, and Other Sedatives Among Institutionalized Older People in Helsinki, Finland

Objectives: The use of psychotropic drugs in long-term care (LTC) is very common, despite their known adverse effects. The prevalence of opioid use is growing among older adults. This study aimed to investigate trends in the prevalence of psychotropics, opioids, and sedative load in a LTC setting over a 14-year period. We also explored the interaction of psychotropic and opioid use according to residents' dementia status in nursing home (NH) and assisted living facility (ALF) settings. Design: Four cross-sectional studies. Setting: Institutional settings in Helsinki, Finland. Participants: Older residents in NHs in 2003 (n = 1987), 2011 (n = 1576), and 2017 (n = 791) and in ALFs in 2007 (n = 1377), 2011 (n = 1586), and 2017 (n = 1624). Measures: Comparable assessments were conducted among LTC residents at 4 time points over 14 years. The prevalence of regular psychotropics, opioids, and other sedatives and data on demographics and diagnoses were collected from medical records. Results: Disabilities and severity of dementia increased in both settings over time. The prevalence of all psychotropics decreased significantly in NHs (from 81% in 2003 to 61% in 2017), whereas in ALFs there was no similar linear trend (65% in 2007 and 64% in 2017). There was a significant increase in the prevalence of opioids in both settings (30% in NHs and 22% in AFLs in 2017). Residents with dementia used less psychotropics and opioids than those without dementia in both settings and at each time point. Conclusions/Implications: NHs show a favorable trend in psychotropic drug use, but the rates of psychotropic use remain high in both NHs and ALFs. In addition, the rates of opioid use have almost tripled, leading to a high sedative load among LTC residents. Clinicians should carefully consider the risk-to-benefit ratio when prescribing in LTC. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.Peer reviewe

Pseudomonas aeruginosa Elastase Provides an Escape from Phagocytosis by Degrading the Pulmonary Surfactant Protein-A

Pseudomonas aeruginosa is an opportunistic pathogen that causes both acute pneumonitis in immunocompromised patients and chronic lung infections in individuals with cystic fibrosis and other bronchiectasis. Over 75% of clinical isolates of P. aeruginosa secrete elastase B (LasB), an elastolytic metalloproteinase that is encoded by the lasB gene. Previously, in vitro studies have demonstrated that LasB degrades a number of components in both the innate and adaptive immune systems. These include surfactant proteins, antibacterial peptides, cytokines, chemokines and immunoglobulins. However, the contribution of LasB to lung infection by P. aeruginosa and to inactivation of pulmonary innate immunity in vivo needs more clarification. In this study, we examined the mechanisms underlying enhanced clearance of the ΔlasB mutant in mouse lungs. The ΔlasB mutant was attenuated in virulence when compared to the wild-type strain PAO1 during lung infection in SP-A+/+ mice. However, the ΔlasB mutant was as virulent as PAO1 in the lungs of SP-A-/- mice. Detailed analysis showed that the ΔlasB mutant was more susceptible to SP-A-mediated opsonization but not membrane permeabilization. In vitroand in vivo phagocytosis experiments revealed that SP-A augmented the phagocytosis of ΔlasB mutant bacteria more efficiently than the isogenic wild-type PAO1. The ΔlasB mutant was found to have a severely reduced ability to degrade SP-A, consequently making it unable to evade opsonization by the collectin during phagocytosis. These results suggest that P. aeruginosa LasB protects against SP-A-mediated opsonization by degrading the collectin

Interpreting change on the SCAT3 in professional ice hockey players

Objectives: To examine test-retest reliability of the. SCAT3 for two consecutive seasons using a large sample of professional male ice hockey players, and to make recommendations for interpreting change on the test. Design: A cross-sectional descriptive study. Methods: Preseason baseline testing was administered in the beginning of the seasons 2013-2014 and 2014-2015 to 179 professional male hockey players in rink side settings. Results: The test-retest reliabilities of the SCAT3 components were uniformly low. However, the majority of athletes remained grossly within their own individual performance range when two pre-season SCAT3 baseline scores were compared to published normative reference values. Being tested by the same person or a different person did not influence the results. It was uncommon for the Symptom score to worsen by >= 3 points, the Symptom Severity score to worsen by >= 5 points, SAC total score to worsen by >= 3 points, M-BESS total error points to increase by >= 3, or the time to complete Tandem Gait to increase by >= 4s; each occurred in less than 10% of the sample. Conclusions: The SCAT3 has low test-retest reliability. Change scores should be interpreted with caution, and more research is needed to determine the clinical usefulness of the SCAT3 for diagnosing concussion and monitoring recovery. Careful examination of the natural distributions of difference scores provides clinicians with useful information on how to interpret change on the test. (C) 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Relative exposure to microplastics and prey for a pelagic forage fish

© The Author(s), 2022. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Chavarry, J. M., Law, K. L., Barton, A. D., Bowlin, N. M., Ohman, M. D., & Choy, C. A. Relative exposure to microplastics and prey for a pelagic forage fish. Environmental Research Letters, 17(6), (2022): 064038, https://doi.org/10.1088/1748-9326/ac7060.In the global ocean, more than 380 species are known to ingest microplastics (plastic particles less than 5 mm in size), including mid-trophic forage fishes central to pelagic food webs. Trophic pathways that bioaccumulate microplastics in marine food webs remain unclear. We assess the potential for the trophic transfer of microplastics through forage fishes, which are prey for diverse predators including commercial and protected species. Here, we quantify Northern Anchovy (Engraulis mordax) exposure to microplastics relative to their natural zooplankton prey, across their vertical habitat. Microplastic and zooplankton samples were collected from the California Current Ecosystem in 2006 and 2007. We estimated the abundance of microplastics beyond the sampled size range but within anchovy feeding size ranges using global microplastic size distributions. Depth-integrated microplastics (0–30 m depth) were estimated using a depth decay model, accounting for the effects of wind-driven vertical mixing on buoyant microplastics. In this coastal upwelling biome, the median relative exposure for an anchovy that consumed prey 0.287–5 mm in size was 1 microplastic particle for every 3399 zooplankton individuals. Microplastic exposure varied, peaking within offshore habitats, during the winter, and during the day. Maximum exposure to microplastic particles relative to zooplankton prey was higher for juvenile (1:23) than adult (1:33) anchovy due to growth-associated differences in anchovy feeding. Overall, microplastic particles constituted fewer than 5% of prey-sized items available to anchovy. Microplastic exposure is likely to increase for forage fishes in the global ocean alongside declines in primary productivity, and with increased water column stratification and microplastic pollution.This work originated from the Plastic Awareness Global Initiative (PAGI) international workshop, hosted by the Center for Marine Biodiversity and Conservation (CMBC) at Scripps Institution of Oceanography at the University of California San Diego in 2018, with support from Igor Korneitchouk and the Wilsdorf Mettler Future Foundation. We thank the workshop participants for early discussions and a collaborative meeting space. We thank Kelly Lance for her illustration contributions, and the SIO Communications Office for their support. We thank Miriam Doyle and Ryan Rykaczewski for their assistance in data acquisition, and we thank Penny Dockry and Stuart Sandin of CMBC for administrative and logistical support. Julia Chavarry was supported by the San Diego Fellowship. This paper is a contribution from the California Current Ecosystem Long Term Ecological Research site, supported by the National Science Foundation

Large salp bloom export from the upper ocean and benthic community response in the abyssal northeast Pacific: Day to week resolution

A large bloom of Salpa spp. in the northeastern Pacific during the spring of 2012 resulted in a major deposition of tunics and fecal pellets on the seafloor at ∼ 4000 m depth (Sta. M) over a period of 6 months. Continuous monitoring of this food pulse was recorded using autonomous instruments: sequencing sediment traps, a time‐lapse camera on the seafloor, and a bottom‐transiting vehicle measuring sediment community oxygen consumption (SCOC). These deep‐sea measurements were complemented by sampling of salps in the epipelagic zone by California Cooperative Ocean Fisheries Investigations. The particulate organic carbon (POC) flux increased sharply beginning in early March, reaching a peak of 38 mg C m−2 d−1 in mid‐April at 3400 m depth. Salp detritus started appearing in images of the seafloor taken in March and covered a daily maximum of 98% of the seafloor from late June to early July. Concurrently, the SCOC rose with increased salp deposition, reaching a high of 31 mg C m−2 d−1 in late June. A dominant megafauna species, Peniagone sp. A, increased 7‐fold in density beginning 7 weeks after the peak in salp deposition. Estimated food supply from salp detritus was 97–327% of the SCOC demand integrated over the 6‐month period starting in March 2012. Such large episodic pulses of food sustain abyssal communities over extended periods of time

Antithrombotic Treatment in Transcatheter Aortic Valve Implantation Insights for Cerebrovascular and Bleeding Events

Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic alternative for patients with symptomatic aortic stenosis at high or prohibitive surgical risk. However, patients undergoing TAVI are also at high risk for both bleeding and stroke complications, and specific mechanical aspects of the procedure itself can increase the risk of these complications. The mechanisms of periprocedural bleeding complications seem to relate mainly to vascular/access site complications (related to the use of large catheters in a very old and frail elderly population), whereas the pathophysiology of cerebrovascular events remains largely unknown. Further, although mechanical complications, especially the interaction between the valve prosthesis and the native aortic valve, may play a major role in events that occur during TAVI, post-procedural events might also be related to a prothrombotic environment or state generated by the implanted valve, the occurrence of atrial arrhythmias, and associated comorbidities. Antithrombotic therapy in the setting of TAVI has been empirically determined, and unfractionated heparin during the procedure followed by dual antiplatelet therapy with aspirin (indefinitely) and clopidogrel (1 to 6 months) is the most commonly recommended treatment. However, bleeding and cerebrovascular events are common; these may be modifiable with optimization of periprocedural and post-procedural pharmacology. Further, as the field of antiplatelet and anticoagulant therapy evolves, potential drug combinations will multiply, introducing variability in treatment. Randomized trials are the best path forward to determine the balance between the efficacy and risks of antithrombotic treatment in this high risk-population

Relating Sick Building Symptoms to Environmental Conditions and Worker Characteristics

40 pages, 1 article*Relating Sick Building Symptoms to Environmental Conditions and Worker Characteristics* (Ohman, Pamela A.; Eberly, L. E.) 40 page

Comparative Analysis of Patient Characteristics in Cardiogenic Shock Studies: Differences Between Trials and Registries

OBJECTIVES: This study sought to evaluate the differences in cardiogenic shock patient characteristics in trial patients and real-life patients. BACKGROUND: Cardiogenic shock (CS) is a leading cause of mortality in patients presenting with acute myocardial infarction (AMI). However, the enrollment of patients into clinical trials is challenging and may not be representative of real-world patients. METHODS: We performed a systematic review of studies in patients presenting with AMI-related CS and compared patient characteristics of those enrolled into randomized controlled trials (RCTs) with those in registries. RESULTS: We included 14 RCTs (n = 2,154) and 12 registries (n = 133,617). RCTs included more men (73% vs 67.7%, P \u3c 0.001) compared with registries. Patients enrolled in RCTs had fewer comorbidities, including less hypertension (61.6% vs 65.9%, P \u3c 0.001), dyslipidemia (36.4% vs 53.6%, P \u3c 0.001), a history of stroke or transient ischemic attack (7.1% vs 10.7%, P \u3c 0.001), and prior coronary artery bypass graft surgery (5.4% vs 7.5%, P \u3c 0.001). Patients enrolled in RCTs also had lower lactate levels (4.7 ± 2.3 mmol/L vs 5.9 ± 1.9 mmol/L, P \u3c 0.001) and higher mean arterial pressure (73.0 ± 8.8 mm Hg vs 62.5 ± 12.2 mm Hg, P \u3c 0.001). Percutaneous coronary intervention (97.5% vs 58.4%, P \u3c 0.001) and extracorporeal membrane oxygenation (11.6% vs 3.4%, P \u3c 0.001) were used more often in RCTs. The in-hospital mortality (23.9% vs 38.4%, P \u3c 0.001) and 30-day mortality (39.9% vs 45.9%, P \u3c 0.001) were lower in RCT patients. CONCLUSIONS: RCTs in AMI-related CS tend to enroll fewer women and lower-risk patients compared with registries. Patients enrolled in RCTs are more likely to receive aggressive treatment with percutaneous coronary intervention and extracorporeal membrane oxygenation and have lower in-hospital and 30-day mortality