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Altres ajuts: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The development of standardized data collection as part of routine clinical care through Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) was developed and implemented at CC, JH, and CEMCAT in partnership with Biogen. Biogen did not have involvement in study design, data analysis or interpretation, or manuscript preparation. People with multiple sclerosis (MS) may be at higher risk for complications from the 2019 coronavirus (COVID-19) pandemic due to use of immunomodulatory disease modifying therapies (DMTs) and greater need for medical services. To evaluate risk factors for COVID-19 susceptibility and describe the pandemic's impact on healthcare delivery. Surveys sent to MS patients at Cleveland Clinic, Johns Hopkins, and Vall d'Hebron-Centre d'Esclerosi Múltiple de Catalunya in April and May 2020 collected information about comorbidities, DMTs, exposures, COVID-19 testing/outcomes, health behaviors, and disruptions to MS care. There were 3028/10,816 responders. Suspected or confirmed COVID-19 cases were more likely to have a known COVID-19 contact (odds ratio (OR): 4.38; 95% confidence interval (CI): 1.04, 18.54). In multivariable-adjusted models, people who were younger, had to work on site, had a lower education level, and resided in socioeconomically disadvantaged areas were less likely to follow social distancing guidelines. 4.4% reported changes to therapy plans, primarily delays in infusions, and 15.5% a disruption to rehabilitative services. Younger people with lower socioeconomic status required to work on site may be at higher exposure risk and are potential targets for educational intervention and work restrictions to limit exposure. Providers should be mindful of potential infusion delays and MS care disruption.

The distribution of hot interstellar medium in early-type galaxies bears the imprint of the various astrophysical processes it underwent during its evolution. The X-ray observations of these galaxies have identified various structural features related to AGN and stellar feedback and environmental effects such as merging and sloshing. In our XMM-Newton Galaxy Atlas (NGA) project, we analyze archival observations of 38 ETGs, utilizing the high sensitivity and large field of view of XMM-Newton to construct spatially resolved 2D spectral maps of the hot gas halos. To illustrate our NGA data products in conjunction with the Chandra Galaxy Atlas (Kim et al. 2019), we describe two distinct galaxies - NGC 4636 and NGC 1550, in detail. We discuss their evolutionary history with a particular focus on the asymmetric distribution of metal-enriched, low-entropy gas caused by sloshing and AGN- driven uplift. We will release the NGA data products to a dedicated website, which users can download to perform further analyses., 19 pages, 6 figures, 2 tables. Accepted for publication in ApJS. The data-products along with the quick look results are here: https://cxc.cfa.harvard.edu/GalaxyAtlas/NGA/v1/

To increase adherence with intensive care unit mobility by developing and implementing a mobility training program that addresses nursing barriers to early mobilisation.An intensive care unit mobility training program was developed, implemented and evaluated with a pre-test, immediate post-test and eight-week post-test. Patient mobility was tracked before and after training.A ten bed cardiac intensive care unit.The training program's efficacy was measured by comparing pre-test, immediate post-test and 8-week post-test scores. Patient mobilisation rates before and after training were compared. Protocol compliance was measured in the post training group.Nursing knowledge increased from pre-test to immediate post-test (p0.0001) and pre-test to 8-week post-test (p0.0001). Mean test scores decreased by seven points from immediate post-test (80±12) to 8-week post-test (73±14). Fear significantly decreased from pre-test to immediate post-test (p=0.03), but not from pre-test to 8-week post-test (p=0.06) or immediate post-test to 8-week post-test (p=0.46). Post training patient mobility rates increased although not significantly (p=0.07). Post training protocol compliance was 78%.The project successfully increased adherence with intensive care unit mobility and indicates that a training program could improve adoption of early mobility.

Objectives Trauma is a leading cause of morbidity and mortality worldwide, with a disproportionate burden of illness in low- and middle- income countries. This study sought to provide a proof-of-concept pilot study to evaluate the feasibility of a trauma registry in the Western Honduras Hospital. Methods A cross-sectional, observation study was performed that included all admitted, transferred, or deceased trauma patients presenting to the Western Honduras Hospital from February 4, 2019 until April 4, 2019. Descriptive statistics were utilized to describe patient demographics and injury characteristics. Results 268 patients were enrolled. The average age was 27.5 years (SD ±21.3). 10% of injuries were due to interpersonal violence. The most common mechanisms of injury were falls (33.6%) and motor vehicle collisions (MVCs) (22.4%). The mean Modified Kampala Trauma Score (M-KTS) was 12 (SD ±1.4). The mortality rate was 1.1% (N = 3). 94.5% of data points were complete. Conclusions A continuous injury surveillance system in the Western Honduras Hospital is feasible and provides valuable information. The data completeness was suboptimal, but the current data collection system may be improved via modifying and utilizing the registry form as both a clinical and data collection instrument.

Aims The aim of the study was to examine ventricular remodelling in patients free of cardiac risk factors, before, and 6 months post-bariatric surgery with the new imaging modality of three-dimensional (3D) strain and the comparison of two surgical techniques: sleeve gastrectomy vs. gastric bypass. Methods and results Fifty-two consecutive patients referred to the Bariatric Services of Imperial College NHS Trust were examined with conventional 2D and 3D strain echocardiography, prior to and 6 months after bariatric surgery. They were all free from cardiac disease. The study cohort's mean age was 44.2 ± 8.7 years and body mass index of 42.4 ± 4.6 g/m2 prior to surgery. Eighteen patients (34.6%) underwent laparoscopic sleeve gastrectomy, and 34 laparoscopic gastric bypass. On 3D speckle tracking, there was significant reverse remodelling post-bariatric surgery [left ventricular (LV) ejection fraction (EF): pre-surgery: 59 ± 8% vs. post-surgery: 67 ± 7%, P < 0.001 and right ventricular (RV) EF: pre-surgery: 60 ± 9% vs. post-surgery: 68 ± 8.2%, P = 0.0001]. Furthermore, there was significant regression of mass (LV mass: pre-surgery: 111 ± 23.5 g vs. post-surgery: 92.8 ± 15.5 g and RV mass: pre-surgery: 95.2 ± 19.8 vs. post-surgery: 67.3 ± 16.3, P < 0.001). RV and LV global strain improved 6 months post-bariatric surgery: global RV strain: pre-surgery −11.7 ± 4 vs. post-surgery −17.52 ± 3.7, P < 0.001; global LV strain: pre-surgery: −20.2 ± 1.7 vs. post-surgery: −26.5 ± 1.86, P < 0.001. Sleeve gastrectomy and gastric bypass had comparable effects. Conclusion Bariatric surgery has an important effect in reverse LV and RV remodelling and it substantially improves RV longitudinal strain.

Background: Investigators aim to publish their research papers in top journals to disseminate their findings to the widest possible audience. Systematic reviews of the literature occupy the highest position in currently proposed hierarchies of evidence. We hypothesized that the number of citations (a measure of scholarly interest) for systematic reviews (or meta-analyses) published in leading orthopaedic journals would be greater than the number of citations for narrative reviews published in the same journals. Methods: We identified fifteen journals that had high Science Citation Index impact factors for the orthopaedic subspecialty and were believed to have a higher yield of studies and reviews of scientific merit and clinical relevance. For the year 2000, six research associates applied methodological criteria to each article in each issue of the fifteen journals to determine whether the article was scientifically sound (rigorous versus nonrigorous). Of the 3916 articles identified, 2331 were original or review articles. We queried the ISI (Institute for Scientific Information) Web of Science database to ascertain, as of March 2003, the number of subsequent citations to each one of the reviews after its original publication in all journals that published both narrative and systematic reviews. Results: Of the 2331 articles published across the fifteen journals in the year 2000, 110 were review articles. Only seventeen (15%) of the 110 reviews met our criteria for systematic reviews with rigor. Rigorous systematic reviews received more than twice the mean number of citations compared with other systematic or narrative reviews (13.8 compared with 6.0, p = 0.008). The rigor of a review was a significant predictor of the number of citations in other orthopaedic journals (p = 0.01). In addition, rigor was significantly associated with the number of citations in nonorthopaedic journals (p = 0.03). Conclusions: Our findings suggest that journal editors and authors can improve the relevance and scholarly interest in their reviews (as shown by the number of citations) by meeting standard guidelines for methodological rigor.

Background Systematic reviews summarize all pertinent evidence on a defined health question. They help clinical scientists to direct their research and clinicians to keep updated. Our objective was to determine the extent to which systematic reviews are clustered in a large collection of clinical journals and whether review type (narrative or systematic) affects citation counts. Methods We used hand searches of 170 clinical journals in the fields of general internal medicine, primary medical care, nursing, and mental health to identify review articles (year 2000). We defined 'review' as any full text article that was bannered as a review, overview, or meta-analysis in the title or in a section heading, or that indicated in the text that the intention of the authors was to review or summarize the literature on a particular topic. We obtained citation counts for review articles in the five journals that published the most systematic reviews. Results 11% of the journals concentrated 80% of all systematic reviews. Impact factors were weakly correlated with the publication of systematic reviews (R2 = 0.075, P = 0.0035). There were more citations for systematic reviews (median 26.5, IQR 12 – 56.5) than for narrative reviews (8, 20, P Conclusions A few clinical journals published most systematic reviews. Authors cited systematic reviews more often than narrative reviews, an indirect endorsement of the 'hierarchy of evidence'.

Purpose The aim of this study was to examine left ventricular (LV) echocardiographic indices, 4D volumes and ejection fraction of bariatric patients (BMI >40). Methods Forty-nine consecutive normotensive bariatric patients (31 women (63.2%), 43 Caucasian, mean age: 45.7±9.7 years, BMI ≥40 kg/m 2 ) were examined with 3D and speckle tracking echocardiography pre-bariatric surgery and they were compared with an age-matched group of 30 healthy volunteers. Exclusion criteria were coronary artery disease, cardiomyopathies and arrhythmias. Statistical analysis was performed with SPSS V.14.0 and Medcalc softwares. All indices were indexed to body surface area and heart rate, where appropriate. Results Common comorbidities comprised diabetes mellitus (N=7), fatty liver (N=8), hypertension (N=8) and sleep apnoea (N=12). 2D echocardiography demonstrated dilatation of the left atrium in bariatric patients when compared to healthy volunteers (39.2±1.9 vs 32.3±2.6 mm, p Conclusions Bariatric patients demonstrate increase of LV mass, dilatation of the ventricle and signs of diastolic heart failure with preserved ejection fraction.

IT is quite obvious that one who depends upon a single method in the treatment of malignant disease may not hope to obtain anything but a limited degree of success. Experience has taught us that operative surgery, electrothermic methods, radium, and X-rays are all factors of such importance that none of them can be eliminated from our armamentarium if the maximum of success is to be realized. All of these methods are employed in our institution, either alone or in combination, to meet particular indications; and we have learned from experience that, if it were necessary to eliminate any one of them, we should be seriously handicapped in our work. The status of surgery, radium, and the X-rays is well known, owing to the wide and continuous promulgation of knowledge concerning them in medical schools, and through the writings of capable exponents. Permanent recognition of these methods is assured, since their great value has been demonstrated by numerous critical tests. Knowledge concerning the electrotherm...

Background With the information explosion, the retrieval of the best clinical evidence from large, general purpose, bibliographic databases such as MEDLINE can be difficult. Both researchers conducting systematic reviews and clinicians faced with a patient care question are confronted with the daunting task of searching for the best medical literature in electronic databases. Many have advocated the use of search filters or "hedges" to assist with the searching process. The purpose of this report is to describe the design and methods of a study that set out to develop optimal search strategies for retrieving sound clinical studies of health disorders in large electronics databases. Objective To describe the design and methods of a study that set out to develop optimal search strategies for retrieving sound clinical studies of health disorders in large electronic databases. Design An analytic survey comparing hand searches of 170 journals in the year 2000 with retrievals from MEDLINE, EMBASE, CINAHL, and PsycINFO for candidate search terms and combinations. The sensitivity, specificity, precision, and accuracy of unique search terms and combinations of search terms were calculated. Conclusion A study design modeled after a diagnostic testing procedure with a gold standard (the hand search of the literature) and a test (the search terms) is an effective way of developing, testing, and validating search strategies for use in large electronic databases.