Yoga for Adults with Intellectual and Developmental Disabilities: A Pilot Study

Intellectual and developmental disabilities (IDD) include diagnoses such as autism spectrum disorder (ASD), Down syndrome (DS), and fragile X syndrome (FXS). Generally, individuals with IDD have an increased risk of experiencing poor functional fitness compared to adults without IDD, which can lead to an increased rate of health deterioration and reduced ability to complete activities of daily living. Functional fitness might be positively impacted by yoga, which is an ancient mind-body practice that that synchronously uses controlled breath practices, mindfulness, and physical postures. Yoga has generally been demonstrated to be effective for improving functional fitness for adults, both with and without disability. Little research, however, has been done regarding yoga for individuals with IDD. This single-arm pilot study measured pre and post test functional fitness after a yoga intervention delivered for 60-minutes twice a week for six weeks in a special population recreation center for people with IDD. Eligible individuals completed a battery of functional fitness physical performance measures. A team of yoga teachers and a yoga therapist developed a standardized intervention protocol to promote improving muscular strength and balance. Each yoga session included a standardized progression of postures, breath work, and guided meditation, and affirmations called “mantras” (e.g. I am strong, I am loved). Multiple modifications were offered for engaging in postures including participating from a chair. Each session ended with a four-minute relaxation pose. Pre- and posttest scores were compared using a Wilcoxon Signed Rank test and were further examined with a percent change calculation (Time 1-Time 2/Time 1 * 100). Nine participants assented and completed pre and post-testing. There was a significant improvement in three of the six functional fitness measures. This intervention study indicates positive outcomes to promote functional fitness among individuals with IDD. The preliminary significant results indicate that a yoga intervention may have the potential to enhance functional fitness in people with IDD

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Productive Partnerships: Nurturing collaborations to attain meaningful and best practice programming – examples from rural Georgia.

Georgia Department of Public Health Injury Prevention Program creates conversations and collaborations for a healthy Georgia. The latest work is through a CDC grant designed to bring public health into the fold of dementia work. This grant addresses systems change and leverages resources to fortify Georgia’s dementia infrastructure. This is accomplished through a dynamic network of partnerships guided by the state plan. The program prioritizes work at the grassroots level. Community programs contain rich and multifaceted networks that host broad ranges of ongoing, meaningful engagement activities designed to improve the supports and services for people living with dementia. Collaboration begins with localized partner perspective, then incorporates evidence-based, data driven program building. The work engages various partnership levels to expand understanding of organizational dementia capacity, reach, and funding potential. It avoids duplication of efforts and enhances synergy in cooperative activities centered on long-term plans for increasing annual wellness visits, dementia risk reduction, early diagnosis, prevention and management of comorbidities, and reducing avoidable hospitalizations. For example, the University of Georgia Cognitive Aging Research and Education (CARE) initiative formed community advisory boards in 11 rural Georgia communities to inform programming needs around dementia education, diagnosis, and support services. These advisory boards guide activities, like community forums, where community members and experts gather and learn from each other in community spaces and developing brain health education tailored to their unique needs. Thoughtful partnership development, support, and guidance also increases capacity and highlights paths to quality care for people living with dementia, their care partners, professionals, and communities. Employing systems approaches brokers cohesiveness. This includes unifying quarterly meetings, conversations, and supports for wellness opportunities. It is through these wellness opportunities that the program pursues early diagnosis, chronic disease management, assessment of burden and gaps, stigma reduction, and emphasizes rural health

A <i>Saccharomyces cerevisiae</i> model and screen to define the functional consequences of oncogenic histone missense mutations

AbstractSomatic missense mutations in histone genes turn these essential proteins into oncohistones, which can drive oncogenesis. Understanding how missense mutations alter histone function is challenging in mammals as mutations occur in a single histone gene. For example, described oncohistone mutations predominantly occur in the histone H3.

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Venous Thromboembolism Risk and Prophylaxis in the Acute Care Hospital Setting (ENDORSE Survey) Findings in Surgical Patients

Objective: To evaluate venous thromboembolism (VTE) risk in patients who underwent a major operation, including the use of, and factors influencing, American College of Chest Physicians-recommended types of VTE prophylaxis

Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients The ENDORSE Global Survey

Limited data are available regarding the risk for venous thromboembolism (VIE) and VIE prophylaxis use in hospitalised medically ill patients. We analysed data from the global ENDORSE survey to evaluate VTE risk and prophylaxis use in this population according to diagnosis, baseline characteristics, and country. Data on patient characteristics, VIE risk, and prophylaxis use were abstracted from hospital charts. VTE risk and prophylaxis use were evaluated according to the 2004 American College of Chest Physicians (ACCP) guidelines. Multivariable analysis was performed to identify factors associated with use of ACCP-recommended prophylaxis. Data were evaluated for 37,356 hospitalised medical patients across 32 countries. VIE risk varied according to medical diagnosis, from 31.2% of patients with gastrointestinal/hepatobiliary diseases to 100% of patients with acute heart failure, active noninfectious respiratory disease, or pulmonary infection (global rate, 41.5%). Among those at risk for VTE, ACCP-recommended prophylaxis was used in 24.4% haemorrhagic stroke patients and 40-45% of cardiopulmonary disease patients (global rate, 39.5%). Large differences in prophylaxis use were observed among countries. Markers of disease severity, including central venous catheters, mechanical ventilation, and admission to intensive care units, were strongly associated with use of ACCP-recommended prophylaxis. In conclusion, VIE risk varies according to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease severity rather than medical diagnosis. These data support the necessity to improve implementation of available guidelines for evaluating VIE risk and providing prophylaxis to hospitalised medical patients