Ferrets as Models for Viral Respiratory Disease.

Domestic ferrets (Mustela putorius furo) have been used in biomedical research to study influenza viruses since the early 20th century. Ferrets have continued to gain importance for the study of viral respiratory disease due to their disease susceptibility and anatomic similarities to humans. Here we review features of ferret biology and management that should be considered when planning to work with this species, particularly in models of respiratory disease. We specifically discuss biosafety and husbandry, clinical and pathologic assessments, and anesthetic considerations for ferrets with respiratory disease and systemic illness. These considerations are important for animal welfare, fidelity of the model to human disease, and ensuring accuracy and reproducibility of acquired data. Finally, we briefly review the use of ferrets to study respiratory diseases by discussing their respiratory anatomy and 2 frequently studied viral respiratory diseases, influenza and coronavirus disease 2019 (COVID-19).

Diabetes distress in a Medicaid sample: The role of psychosocial and health-related factors.

AIMS: Diabetes-related distress can negatively affect disease management leading to worse complications, especially among marginalized populations. Prior studies mostly focus on distress' impact on diabetes outcomes, with few examining distress predictors. The current study examined the impact of social needs on distress on its own and after controlling for other socio-demographic, psychosocial, and health factors. METHODS: Adult Medicaid beneficiaries with type 2 diabetes and a recent HbA1c test documented in claims data (<120 days) were recruited for a 12-month social needs intervention trial. Baseline survey data assessed diabetes distress, social needs, psychosocial factors and health factors. Descriptive statistics were obtained, and bivariate and multivariable logistic regression analyses were used to identify predictors of moderate to severe distress. RESULTS: Bivariate analyses revealed social needs, stress, depression, comorbidity and comorbidity burden, poor self-rated health, insulin use, a self-reported HbA1c ≥ 9.0, and difficulty remembering to take diabetes medications were all positively associated with greater odds of diabetes distress; greater social support, diabetes self-efficacy, and age were negatively associated. Four variables remained significant in the multivariate model: depression, diabetes self-efficacy, self-reported HbA1c ≥ 9.0, and younger age. CONCLUSIONS: Targeted distress screening efforts might prioritize people with HbA1c values >9.0, greater depression, and worse diabetes self-efficacy.

Social Needs Are Associated With Greater Anticipated Needs During an Emergency and Desire for Help in Emergency Preparedness Planning.

OBJECTIVE: Most emergency preparedness planning seeks to identify vulnerable population subgroups; however, focusing on chronic conditions alone may ignore other important characteristics such as location and poverty. Social needs were examined as correlates of anticipated needs and desire for assistance during an emergency. METHODS: A retrospective, secondary analysis was conducted using assessments of 8280 adult Medicaid beneficiaries in Louisiana, linked with medical (n = 7936) and pharmacy claims (n = 7473). RESULTS: The sample was 73% female; 47% Black; 34% White; mean age 41 y. Many had at least 1 chronic condition (75.9%), prescription (90.3%), and social need (45.2%). Across assessments, many reported food (40%), housing (34%), and transportation (33%) needs. However, far more people anticipated social needs during an emergency than in the next month. Having social needs increased the odds of anticipating any need (odds ratio [OR] = 1.5, 1.44-1.56) and desire for assistance during an emergency, even after controlling for significant covariates including older age, race, geographic region, Medicaid plan type, and prescriptions. Chronic conditions were significantly correlated with all anticipated needs in bivariate analyses, but only modestly associated (OR = 1.03, 1.01-1.06) with anticipated medication needs in multivariable analyses. CONCLUSIONS: Identifying individuals with social needs, independent of their chronic disease status, will benefit emergency preparedness outreach efforts.

Similarities and differences in concepts of mental life among adults and children in five cultures.

How do concepts of mental life vary across cultures? By asking simple questions about humans, animals and other entities - for example, 'Do beetles get hungry? Remember things? Feel love?' - we reconstructed concepts of mental life from the bottom up among adults (N = 711) and children (ages 6-12 years, N = 693) in the USA, Ghana, Thailand, China and Vanuatu. This revealed a cross-cultural and developmental continuity: in all sites, among both adults and children, cognitive abilities travelled separately from bodily sensations, suggesting that a mind-body distinction is common across diverse cultures and present by middle childhood. Yet there were substantial cultural and developmental differences in the status of social-emotional abilities - as part of the body, part of the mind or a third category unto themselves. Such differences may have far-reaching social consequences, whereas the similarities identify aspects of human understanding that may be universal.

Social Needs, Chronic Conditions, and Health Care Utilization among Medicaid Beneficiaries.

Health care organizations are increasingly assessing patients' social needs (eg, food, utilities, transportation) using various measures and methods. Prior studies have assessed social needs at the point of care and many studies have focused on correlates of 1 specific need (eg, food). This comprehensive study examined multiple social needs and medical and pharmacy claims data. Medicaid beneficiaries in Louisiana (n = 10,275) completed a self-report assessment of 10 social needs during July 2018 to June 2019. Chronic health conditions, unique medications, and health care utilization were coded from claims data. The sample was predominantly female (72%), Black (45%) or White (32%), had a mean age of 42 years, and at least 1 social need (55%). In bivariate analyses, having greater social needs was associated with greater comorbidity across conditions, and each social need was consistently associated with mental health and substance use disorders. In multivariable logistic analyses, having ≥2 social needs was positively associated with emergency department (ED) visits (OR = 1.39, CI = 1.23 - 1.57) and negatively associated with wellness visits (OR = 0.87, CI = 0.77 - 0.98), inpatient visits (OR = 0.87, CI = 0.76 - 0.99), and 30-day rehospitalization (OR = 0.66, CI = 0.50 - 0.87). Findings highlight the greater concomitant risk of social needs, mental health, and substance use. Admission policies may reduce the impact of social needs on hospitalization. Chronic disease management programs offered by health plans may benefit from systematically assessing and addressing social needs outside point-of-care interactions to impact health outcomes and ED utilization. Behavioral health care management programs would benefit from integrating interventions for multiple social needs.

Sensing the presence of gods and spirits across cultures and faiths.

Hearing the voice of God, feeling the presence of the dead, being possessed by a demonic spirit-such events are among the most remarkable human sensory experiences. They change lives and in turn shape history. Why do some people report experiencing such events while others do not? We argue that experiences of spiritual presence are facilitated by cultural models that represent the mind as "porous," or permeable to the world, and by an immersive orientation toward inner life that allows a person to become "absorbed" in experiences. In four studies with over 2,000 participants from many religious traditions in the United States, Ghana, Thailand, China, and Vanuatu, porosity and absorption played distinct roles in determining which people, in which cultural settings, were most likely to report vivid sensory experiences of what they took to be gods and spirits.

Critical Care Considerations in Adult Patients With Influenza-Induced ARDS.

TOPIC: Acute respiratory distress syndrome is a complex respiratory disease that can be induced by influenza virus infection. Critical care providers are uniquely positioned to manage this pathological progression in adult patients through evidence-based practice. CLINICAL RELEVANCE: Influenza and subsequent acute respiratory distress syndrome are associated with extremely high morbidity and mortality in adult patients in the United States. Although evidence-based medical management strategies can alter the clinical trajectory of acute respiratory distress syndrome and improve outcomes, critical care providers do not always implement these measures. PURPOSE: To provide critical care providers with an overview of the pathological progression of influenza-induced acute respiratory distress syndrome and the current evidence-based strategies for management. CONTENT COVERED: This article reviews the epidemiology and pathophysiology associated with influenza-induced acute respiratory distress syndrome, the criteria for diagnosis, and the evidence-based medical management.

Enhanced Recovery after Partial and Radical Nephrectomy Reduces Length of Stay, Opioid Use and Cost.

INTRODUCTION: Enhanced recovery after surgery pathways are multidisciplinary, multimodal approaches to perioperative care that aim to improve patient outcomes. In this study we evaluate the outcomes of the implementation of enhanced recovery after surgery pathways in patients undergoing nephrectomy. METHODS: A retrospective analysis was performed comparing patients who underwent renal surgery before vs after implementation of enhanced recovery after surgery pathways. Data analyzed included length of stay, opioid use, cost and complications before and after the enhanced recovery after surgery protocol was implemented. RESULTS: There were 76 patients in the pre-enhanced recovery after surgery group and 42 in the enhanced recovery after surgery group. Median length of stay in the pre-enhanced vs enhanced recovery after surgery group was 3 days vs 2 days (p <0.005). For open procedures median length of stay was 5 days vs 2 days (p <0.001). For robotic procedures median length of stay decreased from 3 days to 2 days (p <0.001). Median length of stay was lower in the enhanced recovery after surgery group independent of age, sex, body mass index, American Society of Anesthesiologists® score and anesthesia time. Median total morphine equivalents decreased from 4 mg to 0 mg (p <0.005) while median total oxycodone went from 52.5 mg to 8.75 mg (p <0.005). Direct cost per patient decreased from $13,036 pre-enhanced recovery after surgery to $9,779 (p <0.001) in the enhanced recovery after surgery group, representing a 25% decrease. The 30-day readmission rates did not change after implementation of enhanced recovery after surgery protocol, and a National Surgical Quality Improvement Program sampling showed similar rates in complications, although this was not amenable to statistical analysis. CONCLUSIONS: Enhanced recovery after surgery improves the care of patients undergoing renal surgery. It significantly decreased length of stay, opioid use and hospital cost without having a significant effect on complications.

Solvent Treatment of Wet-Spun PEDOT: PSS Fibers for Fiber-Based Wearable pH Sensing.

There is a growing desire for wearable sensors in health applications. Fibers are inherently flexible and as such can be used as the electrodes of flexible sensors. Fiber-based electrodes are an ideal format to allow incorporation into fabrics and clothing and for use in wearable devices. Electrically conducting fibers were produced from a dispersion of poly (3,4-ethylenedioxythiophene)-poly (styrenesulfonate) (PEDOT: PSS). Fibers were wet spun from two PEDOT: PSS sources, in three fiber diameters. The effect of three different chemical treatments on the fibers were investigated and compared. Short 5 min treatment times with dimethyl sulfoxide (DMSO) on 20 µm fibers produced from Clevios PH1000 were found to produce the best overall treatment. Up to a six-fold increase in electrical conductivity was achieved, reaching 800 S cm-1, with no loss of mechanical strength (150 MPa). With a pH-sensitive polyaniline coating, these fibers displayed a Nernstian response across a pH range of 3.0 to 7.0, which covers the physiologically critical pH range for skin. These results provide opportunities for future wearable, fiber-based sensors including real-time, on-body pH sensing to monitor skin disease.

Sex Differences in Resting-State Functional Connectivity of the Cerebellum in Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is more prevalent in males than females, but the underlying neurobiology of this sex bias remains unclear. Given its involvement in ASD, its role in sensorimotor, cognitive, and socio-affective processes, and its developmental sensitivity to sex hormones, the cerebellum is a candidate for understanding this sex difference. The current study used resting-state functional magnetic resonance imaging (fMRI) to investigate sex-dependent differences in cortico-cerebellar organization in ASD. We collected resting-state fMRI scans from 47 females (23 ASD, 24 controls) and 120 males (56 ASD, 65 controls). Using a measure of global functional connectivity (FC), we ran a linear mixed effects analysis to determine whether there was a sex-by-diagnosis interaction in resting-state FC. Subsequent seed-based analyses from the resulting clusters were run to clarify the global connectivity effects. Two clusters in the bilateral cerebellum exhibited a diagnosis-by-sex interaction in global connectivity. These cerebellar clusters further showed a pattern of interaction with regions in the cortex, including bilateral fusiform, middle occipital, middle frontal, and precentral gyri, cingulate cortex, and precuneus. Post hoc tests revealed a pattern of cortico-cerebellar hyperconnectivity in ASD females and a pattern of hypoconnectivity in ASD males. Furthermore, cortico-cerebellar FC in females more closely resembled that of control males than that of control females. These results shed light on the sex-specific pathophysiology of ASD and are indicative of potentially divergent neurodevelopmental trajectories for each sex. This sex-dependent, aberrant cerebellar connectivity in ASD might also underlie some of the motor and/or socio-affective difficulties experienced by members of this population, but the symptomatic correlate(s) of these brain findings remain unknown. Clinical Trial Registration: www.ClinicalTrials.gov, NIH Clinical Study Protocol 10-M-0027 (ZIA MH002920-09) identifier #NCT01031407.

A Switch and Wave of Neuronal Activity in the Cerebral Cortex During the First Second of Conscious Perception.

Conscious perception occurs within less than 1 s. To study events on this time scale we used direct electrical recordings from the human cerebral cortex during a conscious visual perception task. Faces were presented at individually titrated visual threshold for 9 subjects while measuring broadband 40-115 Hz gamma power in a total of 1621 intracranial electrodes widely distributed in both hemispheres. Surface maps and k-means clustering analysis showed initial activation of visual cortex for both perceived and non-perceived stimuli. However, only stimuli reported as perceived then elicited a forward-sweeping wave of activity throughout the cerebral cortex accompanied by large-scale network switching. Specifically, a monophasic wave of broadband gamma activation moves through bilateral association cortex at a rate of approximately 150 mm/s and eventually reenters visual cortex for perceived but not for non-perceived stimuli. Meanwhile, the default mode network and the initial visual cortex and higher association cortex networks are switched off for the duration of conscious stimulus processing. Based on these findings, we propose a new "switch-and-wave" model for the processing of consciously perceived stimuli. These findings are important for understanding normal conscious perception and may also shed light on its vulnerability to disruption by brain disorders.

An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital.

AIMS: To determine the incidence of unintended medication discrepancies in paediatric patients at the time of hospital admission; evaluate the process of medicines reconciliation; assess the benefit of medicines reconciliation in preventing clinical harm. METHOD: A 5 month prospective multisite study. Pharmacists at four English hospitals conducted admission medicines reconciliation in children using a standardised data collection form. A discrepancy was defined as a difference between the patient's preadmission medication (PAM), compared with the initial admission medication orders written by the hospital doctor. The discrepancies were classified into intentional and unintentional discrepancies. The unintentional discrepancies were assessed for potential clinical harm by a team of healthcare professionals, which included doctors, pharmacists and nurses. RESULTS: Medicines reconciliation was conducted in 244 children admitted to hospital. 45% (109/244) of the children had at least one unintentional medication discrepancy between the PAM and admission medication order. The overall results indicated that 32% (78/244) of patients had at least one clinically significant unintentional medication discrepancy with potential to cause moderate 20% (50/244) or severe 11% (28/244) harm. No single source of information provided all the relevant details of a patient's medication history. Parents/carers provided the most accurate details of a patient's medication history in 81% of cases. CONCLUSIONS: This study demonstrates that in the absence of medicines reconciliation, children admitted to hospitals across England are at risk of harm from unintended medication discrepancies at the transition of care from the community to hospital. No single source of information provided a reliable medication history.

Do physical abuse, depression, and parental substance use influence patterns of substance use among child welfare involved youth? Substance use misuse.

To date studies have not explored patterns of substance use exclusively among youth in the child welfare system. Consequently, little is known about polysubstance use among child welfare-involved youth. This study aimed to explore whether physical abuse, parental substance use, depression, and demographic characteristics predict distinct patterns of substance use among child welfare-involved youth using latent class analysis (LCA). The sample included 822 11-17 year olds who participated in the National Survey of Child and Adolescent Well-being (NSCAW II) study between March 2008 and September 2009. We found the following three classes: (1) polysubstance use, (2) alcohol and marijuana use, and (3) low use. Older youth and youth who experienced physical abuse were at greater risk of being in the polysubstance use class, while living with a biological parent reduced the likelihood of polysubstance use class membership. Youth in the alcohol and marijuana use class were more likely to be older and depressed. Results from this study illuminate important targets for interventions.

Celebrating the strengths of black youth: increasing self-esteem and implications for prevention.

The purpose of this study was to test the impact of a preventive intervention program, celebrating the strengths of black youth (CSBY), on African American children's self-esteem, racial identity, and parental racial socialization messages. CSBY consisted of 10 in-person group sessions in which small groups of middle school students met two trained group leaders. Parents were invited to attend three of the 10 group sessions. African American children between the ages of 7 and 10 were randomly assigned to either a treatment (TX; n = 33) or waitlist control (WLC; n = 40) group. Pre- and post-measures were completed to capture treatment effects. Analyses revealed that treatment group participants had higher levels of self-esteem post intervention than WLC group participants. In addition, treatment group parents were more likely to communicate egalitarian messages to their children post intervention than WLC parents. The advantages of a cultural heritage, strengths-based preventive intervention for African American youth and suggestions for future research are discussed.