The mental health of Australians bereaved during the first two years of the COVID-19 pandemic: a latent class analysis.

BACKGROUND: The COVID-19 pandemic disrupted many areas of life, including culturally accepted practices at end-of-life care, funeral rites, and access to social, community, and professional support. This survey investigated the mental health outcomes of Australians bereaved during this time to determine how these factors might have impacted bereavement outcomes. METHODS: An online survey indexing pandemic and bereavement experiences, levels of grief, depression, anxiety, and health, work, and social impairment. Latent class analysis (LCA) was used to identify groups of individuals who shared similar symptom patterns. Multinomial regressions identified pandemic-related, loss-related, and sociodemographic correlates of class membership. RESULTS: 1911 Australian adults completed the survey. The LCA identified four classes: low symptoms (46.8%), grief (17.3%), depression/anxiety (17.7%), and grief/depression/anxiety (18.2%). The latter group reported the highest levels of health, work, and social impairment. The death of a child or partner and an inability to care for the deceased due to COVID-19 public health measures were correlated with grief symptoms (with or without depression and anxiety). Preparedness for the person's death and levels of pandemic-related loneliness and social isolation differentiated all four classes. Unemployment was associated with depression/anxiety (with or without grief). CONCLUSIONS: COVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society into the foreseeable future. These lessons learned must inform policymakers and healthcare professionals to improve bereavement care and ensure preparedness during and following future predicted pandemics to prevent negative impacts.

Management and cleanup of legacy radium-contaminated sites in the United States.

The hazards associated with radium-containing materials were largely unknown when they were first introduced into household and other products over a century ago. Radium was also originally thought to have beneficial health properties, leading to confusion amongst the public about the safety of radium in household products and food items. When the adverse health effects associated with radium were discovered and became well known, radium products became unpopular and were prohibited in some countries. In the United States, after the hazards associated with radium became known, radium was first regulated by individual states in the late 1920s and early 1930s. Later, the US Nuclear Regulatory Commission (NRC) was given a role in the regulation of discrete sources of radium with the passage of the Energy Policy Act of 2005. After passage of the Act, the NRC began to systematically identify sites around the country where radium was used and reached out to site owners to determine whether existing radium contamination could pose a risk to public health and safety and the environment. The NRC devised a graded approach in response to its new regulatory responsibilities to address potential public health and safety issues at legacy radium sites. By September 2019, the NRC had dispositioned all the sites that were identified as having potential contamination from historical radium within its regulatory purview in non-Agreement States. The staff worked with site owners and federal, state and local officials, as needed, to properly disposition the sites to ensure that each site either meets the applicable criteria for unrestricted use or has controls in place to limit access during remediation so that no site poses an unacceptable risk to public health and safety and the environment.

The diagnostic value of 14-3-3η protein levels in patients with rheumatoid arthritis.

14-3-3η may represent a useful diagnostic biomarker for rheumatoid arthritis (RA). We assessed the prevalence and serum levels of 14-3-3η in patients with RA and in patients with other rheumatic diseases. Serum levels of 14-3-3η were measured in 96 patients with RA, in 101 patients with other rheumatic diseases, and in 66 healthy subjects. All of the sera samples were evaluated by JOINT stat 14-3-3η ELISA test kits (Augurex Life Sciences Corp.). Median (IQR) 14-3-3η levels were significantly higher in the early RA group [0.25 ng/ml (0.075-3.11)] and in patients with established RA [0.15 ng/ml (0.08-1.26)] than in healthy subjects [0 ng/ml (0-0)] and disease controls: SLE [0.01 ng/ml (0-0.055)], AS [0.05 ng/ml (0-0.255)], and PsA [0.01 ng/ml (0-0.065)]. The prevalence of 14-3-3η positivity in patients with early RA was 58%, significantly higher than that in disease controls and healthy subjects (p < 0.001). In patients with established RA, this prevalence was 43%, and it was significantly higher than that in patients with other rheumatic diseases and healthy subjects (p < 0.05), excluding the AS group (p = 0.054). In the early RA cohort, the positivity for 14-3-3η, RF, and anti-CCP was 58%, 67%, and 71%, respectively. Eighty-two percent of the patients in this cohort were positive for at least one of these biomarkers. The concentration of 14-3-3η protein may be used to distinguish between patients with early RA and patients with other rheumatic diseases.

Association between specimen length and diagnostic yield of temporal artery biopsy.

OBJECTIVES: Temporal artery biopsy (TAB) is performed in patients suspected of giant cell arteritis (GCA). Inadequate TAB specimen length is considered a possible explanation for a negative biopsy in patients with GCA. We investigated the association between specimen length and diagnostic yield of TAB. METHOD: We conducted a retrospective analysis of 240 patients who underwent TAB in a single hospital between 2000 and 2015. Patients were diagnosed with GCA based on positive TAB or, when TAB was negative, on clinical grounds that fulfilled the American College of Rheumatology (ACR) 1990 criteria. Baseline clinical and laboratory features and TAB length were obtained from medical records. Among patients diagnosed with GCA, the rate of TAB positivity was calculated according to biopsy length (< 5, 5-9, 10-14, and ≥ 20 mm). RESULTS: Out of 240 patients, 88 were diagnosed with GCA: 62 had a positive TAB and 26 were diagnosed based on clinical grounds despite a negative TAB. Among those who were diagnosed with GCA, the length of the TAB specimen was similar in those with a positive and a negative TAB (1.13 ± 1.68 mm vs. 1.15 ± 0.61 mm, respectively, p = 0.928). The TAB positivity rate was similar among all ranges of biopsy length [< 5 mm: 7/10 (70%); 5-9 mm: 22/31 (71%); 10-14 mm: 11/16 (69%); 15-19 mm: 11/16 (69%); ≥ 20 mm: 11/15 (73%, p = ns] and was similar to the overall biopsy positivity rate. CONCLUSIONS: Specimen length is not associated with diagnostic yield of TAB.

Is temporal artery biopsy essential in all cases of suspected giant cell arteritis?

OBJECTIVES: Temporal artery biopsy (TAB) is performed in cases of suspected giant cell arteritis (GCA), and is the gold-standard for diagnosis of the disease. Current American College of Rheumatology (ACR) classification criteria may aid in the diagnosis of GCA. We aimed to assess whether TAB is essential in all cases of suspected GCA, or whether ACR criteria can replace the need for this procedure in some cases. METHODS: Retrospective analysis of 216 patients who underwent TAB in a single hospital between 2000 and 2013. Pre-TAB and post-TAB ACR criteria were calculated. Sensitivity and specificity of ACR criteria for the diagnosis of GCA were assessed. RESULTS: Overall, 55 patients had histological evidence of GCA.Out of 161 patients with negative TAB findings, 34 were diagnosed with GCA, and 127 were not diagnosed with GCA. Sensitivity of TAB for the diagnosis of GCA was 61.7%. Sensitivity and specificity of ACR criteria for diagnosis of GCA before performing TAB were 68.5% and 58%, respectively. Sensitivity and specificity of ACR criteria after performing TAB biopsy were 89.8% and 64.5%, respectively. CONCLUSIONS: Temporal artery biopsy should be performed in the majority of patients with suspected GCA, and may be obviated only in patients with a pre-TAB ACR score of ≤ 1. In all other cases, when GCA is suspected, ACR criteria should not be a substitute to TAB, as they are not highly specific.

El estudio A1chieve: un estudio observacional, de no intervención en pacientes con diabetes tipo 2 que inician o cambian a un tratamiento con análogos de insulina: datos de la población argentina / The A1chieve study: An observational non-interventional study of patients with type 2 diabetes initiating or changing to insulin analogue therapy: data from the Argentinean population

Objetivos: el objetivo de este artículo es informar acerca de la seguridad y la efectividad de iniciar o cambiar a un tratamiento con insulinas análogas en la subpoblación argentina del estudio A1chieve. Materiales y métodos: estudio observacional, de no intervención. En la cohorte argentina participaron 607 pacientes con diabetes tipo 2 (DM2), con o sin tratamiento previo con insulina, quienes inciaron un tratamiento con insulina aspártica bifásica 30, insulina detemir o insulina aspártica con o sin antidiabéticos orales (ADOs). Resultados: el grado de control metabólico al inicio del estudio, medido por HbA1c basal (± DE) fue pobre: 9,4 ± 2,1 %. A los 6 meses, se observó una reducción de HbA1c de -1,8 ± 2,1 % en la cohorte completa, y -2,3 ± 2,1% y -1,1 ± 1,8 % para los pacientes sin tratamiento previo con insulina y con tratamiento previo con insulina, respectivamente. En general, la tasa de hipoglucemia se incrementó en aquellos pacientes que recibieron insulina por primera vez, mientras que se observó una disminución en los pacientes que, previamente, recibían otras insulinas. Se observó un incremento del peso corporal (± DE) en los pacientes sin tratamiento previo con insulina (0,8 ± 4,3 kg). Conclusiones: en la población argentina del estudio A1chieve, se observó un control metabólico deficiente. Se logró una mejoría de la HbA1c al iniciar un tratamiento con análogos de insulina, ya sea en pacientes naïve usuarios previos de insulina,siendo una gran oportunidad para lograr amplias mejorías en el autocuidado y en el control metabólico, independientemente del tipo de regimen insulínico utilizado, con buena tolerabilidad y seguridad. Estos hallazgos coinciden con los resultados obtenidos en la cohorte completa del estudio.

Objectives: The aim of this paper is to report the safety and effectiveness of initiating or switching to insulin analogue therapy in the Argentinean subpopulation of the A1chieve study. Materials and methods: Observational, non-interventional study. The Argentinean cohort included 607 patients with type 2 diabetes (T2D), both insulin-naïve and prior insulin users, who initiated treatment with biphasic insulin aspart 30, insulin detemir or insulin aspart ± oral antidiabetic agents. Results: Baseline HbA1c (±SD) was poor: 9.4 ± 2.1 %. At 6 months, a reduction in the HbA1c of -1.8 ± 2.1 % was observed in the entire cohort, and of -2.3 ± 2.1 % and -1.1 ± 1.8 % in insulin-naïve patients and prior insulin users, respectively. Overall, the rate of hypoglycaemia increased in insulin-naïve patients, whereas a reduction was observed in those switching from other insulins. An increase in the body weight (±SD) was noted in insulin-naïve patients (0.8 ± 4.3 kg). Conclusions: Poor glycemic control was observed in the Argentinean population of the A1chieve study. The initiation of insulin analogue therapy showed an improvement in HbA1c, in both insulin-naïve patients and previous insulin users, which was a good opportunity for improvements in self-care and metabolic control, regardless of the type of insulin regimen used, with a good tolerability and safety profile. These findings are consistent with those obtained from the entire A1chieve study cohort.

El estudio A1chieve: un estudio observacional, de no intervención en pacientes con diabetes tipo 2 que inician o cambian a un tratamiento con análogos de insulina: datos de la población argentina / The A1chieve study: An observational non-interventional study of patients with type 2 diabetes initiating or changing to insulin analogue therapy: data from the Argentinean population

Objetivos: el objetivo de este artículo es informar acerca de la seguridad y la efectividad de iniciar o cambiar a un tratamiento con insulinas análogas en la subpoblación argentina del estudio A1chieve. Materiales y métodos: estudio observacional, de no intervención. En la cohorte argentina participaron 607 pacientes con diabetes tipo 2 (DM2), con o sin tratamiento previo con insulina, quienes inciaron un tratamiento con insulina aspártica bifásica 30, insulina detemir o insulina aspártica con o sin antidiabéticos orales (ADOs). Resultados: el grado de control metabólico al inicio del estudio, medido por HbA1c basal (± DE) fue pobre: 9,4 ± 2,1 %. A los 6 meses, se observó una reducción de HbA1c de -1,8 ± 2,1 % en la cohorte completa, y -2,3 ± 2,1% y -1,1 ± 1,8 % para los pacientes sin tratamiento previo con insulina y con tratamiento previo con insulina, respectivamente. En general, la tasa de hipoglucemia se incrementó en aquellos pacientes que recibieron insulina por primera vez, mientras que se observó una disminución en los pacientes que, previamente, recibían otras insulinas. Se observó un incremento del peso corporal (± DE) en los pacientes sin tratamiento previo con insulina (0,8 ± 4,3 kg). Conclusiones: en la población argentina del estudio A1chieve, se observó un control metabólico deficiente. Se logró una mejoría de la HbA1c al iniciar un tratamiento con análogos de insulina, ya sea en pacientes na´ve usuarios previos de insulina,siendo una gran oportunidad para lograr amplias mejorías en el autocuidado y en el control metabólico, independientemente del tipo de regimen insulínico utilizado, con buena tolerabilidad y seguridad. Estos hallazgos coinciden con los resultados obtenidos en la cohorte completa del estudio.(AU)

Objectives: The aim of this paper is to report the safety and effectiveness of initiating or switching to insulin analogue therapy in the Argentinean subpopulation of the A1chieve study. Materials and methods: Observational, non-interventional study. The Argentinean cohort included 607 patients with type 2 diabetes (T2D), both insulin-na´ve and prior insulin users, who initiated treatment with biphasic insulin aspart 30, insulin detemir or insulin aspart ± oral antidiabetic agents. Results: Baseline HbA1c (±SD) was poor: 9.4 ± 2.1 %. At 6 months, a reduction in the HbA1c of -1.8 ± 2.1 % was observed in the entire cohort, and of -2.3 ± 2.1 % and -1.1 ± 1.8 % in insulin-na´ve patients and prior insulin users, respectively. Overall, the rate of hypoglycaemia increased in insulin-na´ve patients, whereas a reduction was observed in those switching from other insulins. An increase in the body weight (±SD) was noted in insulin-na´ve patients (0.8 ± 4.3 kg). Conclusions: Poor glycemic control was observed in the Argentinean population of the A1chieve study. The initiation of insulin analogue therapy showed an improvement in HbA1c, in both insulin-na´ve patients and previous insulin users, which was a good opportunity for improvements in self-care and metabolic control, regardless of the type of insulin regimen used, with a good tolerability and safety profile. These findings are consistent with those obtained from the entire A1chieve study cohort.(AU)

Sequential IV/PO moxifloxacin treatment of patients with severe community-acquired pneumonia.

BACKGROUND: IV/PO moxifloxacin was evaluated in the treatment of hospitalized patients with severe community-acquired pneumonia (CAP). METHODS: Data were pooled from two prospective, randomized studies. In the multinational study, patients received 7-14 days IV/PO moxifloxacin 400 mg QD or IV/ PO amoxicillin clavulanate 1200/625 mg TID +/- IV/PO clarithromycin 500 mg BID. In the North American study, patients received 7-14 days IV/PO moxifloxacin 400 mg QD, IV/ PO alatrofloxacin/trovafloxacin 200 mg QD, or IV/PO levofloxacin 500 mg QD. The primary endpoint was clinical success at the test-to-cure visit. Severe CAP was defined according to the 1993 ATS criteria. RESULTS: In the clinically valid population, clinical success rates were 88% (167/190) for moxifloxacin- and 83% (155/186) for comparator-treated patients (95% CI = -1.9%, 12.2%). Corresponding clinical success rates for the microbiologically valid population were 87% (59/68) and 84% (54/64), respectively (95% CI = 8.6%, 15.0%). A switch from IV to PO therapy was made by day 5 of therapy for 73% of moxifloxacin- vs. 60% of comparator-treated patients (P < 0.01). Clinical success rates were similar in a retrospective analysis using the revised 2001 ATS definition of severe CAP. Mortality rates were 6% (15/241) and 10% (24/238) in the moxifloxacin and comparator treatment groups, respectively. The incidence of drug-related adverse events was similar in both treatment groups. CONCLUSION: Sequential IV/PO moxifloxacin 400 mg QD is as safe and effective as other fluoroquinolones and a beta-lactam/macrolide combination for treating hospitalized patients with severe CAP.

Photon antibunching in the fluorescence of a single dye molecule embedded in a thin polymer film.

We used scanning confocal microscopy to study the fluorescence from a single terrylene molecule embedded in a thin polymer film of polymethyl methacrylate, at room temperature, with a high signal-to-background ratio. The photon-pair correlation function g((2))(tau) exhibits perfect photon antibunching at tau = 0 and a limit of 1.3, compatible with bunching associated with the molecular triplet state. Application of this molecular system to a triggered single-photon source based on single-molecule fluorescence is investigated.

Evidence-based practice: tap water cleansing of leg ulcers in the community.

To establish and encourage wound management practices based on evidence, a Community Nursing Organization in metropolitan Adelaide began a series of research initiatives in 1997. Based on the results of a wound management survey, and through the processes of participatory action research with clinicians, many wound management practice changes were instigated throughout the Community Nursing Organization. One question remains unanswered: What is the evidence for the use of sterile saline or clean tap water for cleansing of leg ulcers in the community? In this paper we describe a project where we applied the three principles of planning, action and evaluation. Application of these principles enabled clinicians to collaborate in the search for evidence to support or refute tap water cleansing of leg ulcers. To conclude, we report on a pilot research project undertaken to obtain further evidence either to support or refute the use of tap water cleansing for leg ulcers in the community.

Depression, self-esteem, loneliness, and social support among adolescent mothers participating in the new parents project.

The purpose of this pilot study was to examine levels of depression, self-esteem, loneliness, and social support, and the relationships between these variables, among adolescent mothers participating in the New Parents Project (formerly called the Young Parents Project). The sample consisted of 21 adolescent mothers recruited from three primary health care practices in different Midwestern cities. It was found that depression scores were in the high range (CES-DC > 15) for 53% of the participants. Strong, significant relationships were found, except between depression and self-esteem. The implications for enhancement of the New Parents Project, so as to better meet the psychological needs of adolescent mothers, are discussed.

Optical density changes of Gafchromic MD-55 film resulting from laser light exposure at wavelengths of 671 nm and 633 nm.

Laser-based scanners provide a sensitive means for measuring optical density (OD) of Gafchromic films. Such instruments were reviewed in a recent AAPM report (task group 55) which provided recommendations and information on OD measurements (effect of wavelength, temperature, etc.). The present article reports that variable rate scanners and spot densitometers using laser diodes (671 nm) and HeNe lasers (633 nm) can cause polymerization of Gafchromic film. The light induced polymerization depends on light power, wavelength, beam spot size, dwell time, and prior radiation dose of the film. Measurements were made with a custom built scanner that provided accurate control of light power, light polarization, dwell time, and film position in relation to the beam focus. The results demonstrate that lasers operating with powers of 0.1, 0.5, 1.0, and 1.5 mW produce a nonlinear increase in OD of Gafchromic film. The measured change in OD after 1 min of exposure ranges from 0.150 to 0.244 for a laser diode operating at 0.5 and 1.5 mW, respectively. Tables are included that tabulate the increase in OD for laser power, dwell time, and prior dose. Laser light induced polymerization can have a significant impact on dosimetry measurements acquired using these laser-based systems.

Cytokine response to BCG infection in alcohol-fed mice.

Alcoholics have increased susceptibility to infections including tuberculosis. Chronic alcohol treatment impairs host response to bovine mycobacterium infection from BCG. This study assesses the role of four cytokines (TNFalpha, IFNgamma, IL-4, and IL-10) in this impaired response. Twenty male C57BL/6 mice were pair-fed on the Lieber DiCarli control (LCD) or ethanol (LED) diets for 28 days. The LED treated subjects ate ad lib and consumed a mean of 13 g/kg/d of ethanol. After 14 days, based on body weight, subjects were randomly divided into four treatment groups of five each. Ten infected with 2x10(6) colony-forming units (CFU) of BCG by tail-vein. On day 28, the mice were sacrificed. Liver was cultured to determine the mycobacteria CFU/g tissue. Spleens were assayed for the levels of TNFalpha, IFNgamma, IL-4, and IL-10 mRNA relative to mRNA levels for a housekeeping gene using a quantitative reverse transcriptase PCR. Without BCG infection, only the mRNA for IFNgamma was increased by LED treatment, 51% (p = 0.0001). BCG infection significantly increased TNFalpha, IFNgamma, and IL-10 mRNA (p<0.0001). IL-4 mRNA decreased (p = 0.0006). Chronic LED plus BCG infection further increased TNFalpha (p = 0.002) and IFN-gamma (p = 0.04); IL-10 was unchanged, whereas IL-4 was marginally further decreased (p = 0.06). CFU/liver increased with LED (mean +/- SD, 72+/-33x10(5) vs. 39+/-17x10(5); p = 0.004). A significant direct correlation was observed between CFU and TNFalpha, r = 0.70, p = 0.03. In conclusion, BCG infection increases TNFalpha, IFNgamma, & IL-10 and decreases IL-4. CFU numbers correlate with mRNA for TNFalpha, and LED inhibits host containment of BCG infection as measured by liver CFU. This study could not identify cytokine alterations in either Th1- or Th2-type immune responses that might contribute to the impaired host response to the BCG infection.

Juvenile hypothyroidism among two populations exposed to radioiodine.

We found an epidemic of juvenile hypothyroidism among a population of self-defined "downwinders" living near the Hanford nuclear facility located in southeast Washington State. The episode followed massive releases of 131I. Self-reported data on 60 cases of juvenile hypothyroidism (<20 years of age) among a group of 801 Hanford downwinders are presented, as well as data concerning the thyroid status of approximately 160,000 children exposed to radioiodine before 10 years of age as a result of the 26 April 1986 Chernobyl explosion in the former Soviet Union. These children were residents of five regions near Chernobyl. They were examined by standardized screening protocols over a period of 5 years from 1991 to 1996. They are a well-defined group of 10 samples. Fifty-six cases of hypothyroidism were found among boys and 92 among girls. Body burdens of 137Cs have been correlated with hypothyroidism prevalence rates. On the other hand, the group of juvenile (<20 years of age) Hanford downwinders is not a representative sample. Most of the 77 cases of juvenile hypothyroidism in the Hanford group were diagnosed from 1945 to 1970. However, the ratio of reported cases to the county population under 20 years of age is roughly correlated with officially estimated mean levels of cumulative thyroid 131I uptake in these counties, providing evidence that juvenile hypothyroidism was associated with radioiodine exposures. Because even subtle hypothyroidism may be of clinical significance in childhood and can be treated, it may be useful to screen for the condition in populations exposed to radioiodine fallout. Although radiation exposure is associated with hypothyroidism, its excess among fallout-exposed children has not been previously quantified.

Synthesis and biological evaluation of novel cryptophycin analogs with modification in the beta-alanine region.

Structure modification of the beta-alanine region (fragment C) of the potent antimitotic agent cryptophycin was investigated. This includes: (1) introduction of substituents at the previously unsubstituted C7 position of the macrolide ring and (2) replacement of the (2R)-3-amino-2-methyl-propanoic acid (beta-alanine) with various (1)-amino acids to give the corresponding 15-membered unnatural cryptophycin analogs.

Effects on nonlinearity on the estimation of in situ values of acoustic output parameters.

Water can generate extreme waveform distortion compared to tissue, as indicated by the Goldberg number for water, which is 20 times larger than that of tissue at typical diagnostic ultrasound levels. This result was demonstrated by using tofu as a tissue mimicking material. By adjusting transducer voltage drive levels in water to match the peak rarefactional pressures in water to those of waveforms in tofu, a close correspondence was obtained for the peak compressional pressure and time average intensity with depth. A poorer correspondence was found by comparing tofu waveforms with water waveforms that were compensated for broadband attenuation and driven at the same voltage level as tofu. A simplified broadband derating factor, allowing for band-width adjustment, was shown to be more accurate than the standard monochromatic derating. Several new indicators for quantifying the degree of observed nonlinearity are suggested: a field based nonlinearity parameter, a peak pressure ratio pc/pr, and a second harmonic to fundamental frequency spectral ratio. These indicators may have the potential for more consistent characterization of nonlinear relationships among output parameters and drive levels.