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COVID-19 is associated with increased risk for cognitive decline but very little is known regarding the neural mechanisms of this risk. We enrolled 49 adults (55% female, mean age = 30.7 ± 8.7), 25 with and 24 without a history of COVID-19 infection. We administered standardized tests of cognitive function and acquired brain connectivity data using MRI. The COVID-19 group demonstrated significantly lower cognitive function (W = 475, p

This survey study assesses the rate at which US academic medical centers have adopted evidenced-based guidelines for the management of COVID-19 into practice.

BackgroundTreatment of multidrug-resistant tuberculosis requires long-term therapy with a combination of multiple second-line drugs. These drugs are associated with numerous adverse events that can cause severe morbidity, such as deafness, and in some instances can lead to death. Our aim was to estimate the absolute and relative frequency of adverse events associated with different tuberculosis drugs to provide useful information for clinicians and tuberculosis programmes in selecting optimal treatment regimens.MethodsWe did a meta-analysis using individual-level patient data that were obtained from studies that reported adverse events that resulted in permanent discontinuation of anti-tuberculosis medications. We used a database created for our previous meta-analysis of multidrug-resistant tuberculosis treatment and outcomes, for which we did a systematic review of literature published between Jan 1, 2009, and Aug 31, 2015 (updated April 15, 2016), and requested individual patient-level information from authors. We also considered for this analysis studies contributing patient-level data in response to a public call made by WHO in 2018. Meta-analysis for proportions and arm-based network meta-analysis were done to estimate the incidence of adverse events for each tuberculosis drug.Findings58 studies were identified, including 50 studies from the updated individual patient data meta-analysis for multidrug-resistant tuberculosis treatment. 35 of these studies, with 9178 patients, were included in our analysis. Using meta-analysis of proportions, drugs with low risks of adverse event occurrence leading to permanent discontinuation included levofloxacin (1·3% [95% CI 0·3-5·0]), moxifloxacin (2·9% [1·6-5·0]), bedaquiline (1·7% [0·7-4·2]), and clofazimine (1·6% [0·5-5·3]). Relatively high incidence of adverse events leading to permanent discontinuation was seen with three second-line injectable drugs (amikacin: 10·2% [6·3-16·0]; kanamycin: 7·5% [4·6-11·9]; capreomycin: 8·2% [6·3-10·7]), aminosalicylic acid (11·6% [7·1-18·3]), and linezolid (14·1% [9·9-19·6]). Risk of bias in selection of studies was judged to be low because there were no important differences between included and excluded studies. Variability between studies was significant for most outcomes analysed.InterpretationFluoroquinolones, clofazimine, and bedaquiline had the lowest incidence of adverse events leading to permanent drug discontinuation, whereas second-line injectable drugs, aminosalicylic acid, and linezolid had the highest incidence. These results suggest that close monitoring of adverse events is important for patients being treated for multidrug-resistant tuberculosis. Our results also underscore the urgent need for safer and better-tolerated drugs to reduce morbidity from treatment itself for patients with multidrug-resistant tuberculosis.FundingCanadian Institutes of Health Research, Centers for Disease Control and Prevention (USA), American Thoracic Society, European Respiratory Society, and Infectious Diseases Society of America.

BackgroundTreatment outcomes for multidrug-resistant tuberculosis remain poor. We aimed to estimate the association of treatment success and death with the use of individual drugs, and the optimal number and duration of treatment with those drugs in patients with multidrug-resistant tuberculosis.MethodsIn this individual patient data meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library to identify potentially eligible observational and experimental studies published between Jan 1, 2009, and April 30, 2016. We also searched reference lists from all systematic reviews of treatment of multidrug-resistant tuberculosis published since 2009. To be eligible, studies had to report original results, with end of treatment outcomes (treatment completion [success], failure, or relapse) in cohorts of at least 25 adults (aged >18 years). We used anonymised individual patient data from eligible studies, provided by study investigators, regarding clinical characteristics, treatment, and outcomes. Using propensity score-matched generalised mixed effects logistic, or linear regression, we calculated adjusted odds ratios and adjusted risk differences for success or death during treatment, for specific drugs currently used to treat multidrug-resistant tuberculosis, as well as the number of drugs used and treatment duration.FindingsOf 12 030 patients from 25 countries in 50 studies, 7346 (61%) had treatment success, 1017 (8%) had failure or relapse, and 1729 (14%) died. Compared with failure or relapse, treatment success was positively associated with the use of linezolid (adjusted risk difference 0·15, 95% CI 0·11 to 0·18), levofloxacin (0·15, 0·13 to 0·18), carbapenems (0·14, 0·06 to 0·21), moxifloxacin (0·11, 0·08 to 0·14), bedaquiline (0·10, 0·05 to 0·14), and clofazimine (0·06, 0·01 to 0·10). There was a significant association between reduced mortality and use of linezolid (-0·20, -0·23 to -0·16), levofloxacin (-0·06, -0·09 to -0·04), moxifloxacin (-0·07, -0·10 to -0·04), or bedaquiline (-0·14, -0·19 to -0·10). Compared with regimens without any injectable drug, amikacin provided modest benefits, but kanamycin and capreomycin were associated with worse outcomes. The remaining drugs were associated with slight or no improvements in outcomes. Treatment outcomes were significantly worse for most drugs if they were used despite in-vitro resistance. The optimal number of effective drugs seemed to be five in the initial phase, and four in the continuation phase. In these adjusted analyses, heterogeneity, based on a simulated I2 method, was high for approximately half the estimates for specific drugs, although relatively low for number of drugs and durations analyses.InterpretationAlthough inferences are limited by the observational nature of these data, treatment outcomes were significantly better with use of linezolid, later generation fluoroquinolones, bedaquiline, clofazimine, and carbapenems for treatment of multidrug-resistant tuberculosis. These findings emphasise the need for trials to ascertain the optimal combination and duration of these drugs for treatment of this condition.FundingAmerican Thoracic Society, Canadian Institutes of Health Research, US Centers for Disease Control and Prevention, European Respiratory Society, Infectious Diseases Society of America.

We describe the construction and initial demonstration of a new instructional tool called ROXI (Research Opportunity through eXperimental Instruction). The system interfaces a series of electronic sensors to control software via the Arduino platform. The sensors have been designed to enable low-cost data collection in laboratory courses. Data are collected by a computer and can be displayed or plotted in nearly real time, allowing chemistry to come to life. In addition, student data can be analyzed by the computer automatically and used to provide feedback to assess whether students are analyzing experimental results correctly. Because the computer and software are able to perform all computations and data analysis independently of the student, the software can assess the accuracy of student calculations and even assign grades based upon performance. In addition, since measurement data are logged and plotted, it is possible for the software to assist in assembling laboratory report files that students can print and submit. We envision that the feedback provided to students regarding the accuracy of computations and queries at the conclusion of the experiment can improve laboratory instruction by forcing students to revise or reinforce their mental models at the time of instruction. While this work describes only an initial implementation of the concept, the ROXI platform may ultimately be a powerful mechanism to improve laboratory instruction or serve for administering distance learning laboratory courses.

Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population. • A subgroup reports persistent or de novo disordered eating after bariatric surgery. • This review synthesizes the literature on disordered eating measures post-surgery. • Limited support for eating disorder measures in the bariatric field exists. [ABSTRACT FROM AUTHOR]

Body appreciation and internalized weight bias have consistently been associated with eating behaviors. However, research has yet to examine the role of these variables among presurgical bariatric patients. The present study sought to assess the relationships between body appreciation and weight bias internalization, binge eating, disinhibited eating, and symptoms of depression and anxiety among a sample of presurgical bariatric patients. The study also sought to examine the extent to which body appreciation and weight bias internalization account for unique variance in disordered eating even when controlling for depression and anxiety. Academic medical center in the United States. Data were collected on body appreciation, weight bias internalization, eating behaviors, depression, and anxiety as part of a standard presurgical psychological evaluation for bariatric surgery (n = 319). Pearson correlations were used to assess relationships between all study variables. Multiple regressions were conducted to assess the roles of body appreciation and weight bias internalization on disordered eating. Significant associations were found between low levels of body appreciation and high levels of weight bias internalization, disordered eating, and symptoms of depression and anxiety. Results indicated that body appreciation and weight bias internalization each significantly accounted for unique variance in symptoms of binge eating and disinhibited eating. Depressive symptoms were also statistically significant in all analyses. Findings indicate the importance of conducting future positive body image research, as well as continuing to examine weight-related constructs, such as internalized weight bias, among bariatric surgery patients. • Low body appreciation was associated with high binge and disinhibited eating • Low body appreciation was associated with high symptoms of depression and anxiety • Body appreciation accounted for unique variance in disordered eating • Weight bias internalization accounted for unique variance in disordered eating [ABSTRACT FROM AUTHOR]

Disparities in obesity care and bariatric surgery persist among patients of diverse identities. However, little is known about sexual minority (SM) bariatric patients. This study sought to describe, in a preliminary fashion, sexual orientation variables of outness, self-esteem, and perceived discrimination among a sample of SM patients pursuing bariatric surgery. The study also sought to compare SM and heterosexual bariatric candidates on measures of eating behaviors, anxiety, and depression. Academic medical center in the United States. Data were collected as part of a standard psychological evaluation for surgical clearance between May 1, 2018 and December 31, 2019. Data included demographic characteristics, sexual orientation variables, eating behaviors, anxiety, and depression. Descriptive statistics were included to present findings among SM patients. One-way analyses of covariance were conducted to assess differences between SM and heterosexual patients. A total of 633 patients were evaluated (38 SM and 595 heterosexual). SM patients had high outness scores with high self-esteem and minimal perceived discrimination. SM patients endorsed lower cognitive restraint, higher disinhibition, and increased hunger compared with heterosexual patients (P <.05). SM patients also reported significantly more symptoms of anxiety and depression compared with heterosexual patients (P <.05). Findings provide preliminary evidence toward the importance of assessing for sexual orientation among bariatric patients. Future research is warranted to assess the unique role of sexual orientation, as well as explore causal links between sexual orientation, eating behaviors, and mental health among bariatric patients pre- and post surgery. [ABSTRACT FROM AUTHOR]

Following bariatric surgery, an explicit dietary regimen is required to facilitate and maintain successful weight loss. Without adequate access to healthy foods, weight maintenance can be hindered. Examine influence degree of food access has on Appalachian bariatric surgery patient weight loss outcomes. Appalachian University hospital, United States. A retrospective chart review was used to examine the influence of food accessibility on weight loss outcomes in an Appalachian bariatric surgery patient population at a large tertiary hospital in West Virginia between 2013 and 2017. Demographic characteristics, health and family history, and 1-year surgery outcomes were collected. A state-specific food accessibility score was calculated for each patient address using the geographic information system. Patients were assigned a food access ranking score (FARS) between 0 (low food access) and 4 (high food access) based on criteria of quantity, quality, income, and vehicle access. Patients (n = 369) were predominately married (60.5%), white (92.4%), female (77.8%), and underwent laparoscopic Roux-en-Y gastric bypass surgery (75.9%), with a mean age of 45 years. Most patients had low FARS (M = 1.67 ±.73; 72.6%). Nonwhite patients (P =.03) with a preoperative diagnosis of depression (P =.02) or without a family history of obesity (P =.01) were found to be in the lower FARS categories. FARS was not indicative of weight loss post surgery (P >.05). Food accessibility in West Virginia was not associated with bariatric surgery weight outcomes at 1-year post operation. Lower food access was associated with nonwhite race/ethnicity, diagnosed depression at baseline, and no family history of obesity. Future studies should include more extended follow-up data collection and mixed-method approaches to capture perceptions of food access and its impact on the patients' postoperative journey. [ABSTRACT FROM AUTHOR]