Clinical Factors, Management, and Outcomes of Patients Under 18 Years Old With Central Nervous System Tumors: Single-center Experience in Peru.

Few reports on clinical factors, treatment, and survival in children and adolescents with Central nervous system tumors in low-income and middle-income countries in Latin America exist. We retrospectively reviewed such data in all cases of patients younger than 18 years with brain tumors diagnosed in a single tertiary care center in Peru from 2007 through 2017. Variables were analyzed for association with overall survival and event-free survival by using the Kaplan-Meier method and the Cox hazards ratio regression. Seventy-five patients' data were analyzed (40 boys, 35 girls; mean age=7.7 y). The main clinical symptoms were headache, vomiting, difficulty walking, and visual disturbances. The most frequent clinical signs were hydrocephalus, cerebellar signs, visual abnormalities, and focal motor signs. The median time to diagnosis was 12 weeks. Tumor resection was performed in 68 patients, and 37 patients received postoperative radiotherapy. The most frequent histologic subtypes were low-grade gliomas and medulloblastomas. Overall survival rates at 1 and 5 years of disease were 78% (CI 95%, 0.67 to 0.86) and 74% (CI 95%, 0.62 to 0.82), respectively, and the 5-year event-free survival rate was 62% (CI 95%, 0.47 to 0.73). Although diagnosis occurred late in our cohort, the survival rate was higher than that in other Latin American countries.

Forecasting Hospitalizations Due to COVID-19 in South Dakota, USA.

Anticipating the number of hospital beds needed for patients with COVID-19 remains a challenge. Early efforts to predict hospital bed needs focused on deriving predictions from SIR models, largely at the level of countries, provinces, or states. In the USA, these models rely on data reported by state health agencies. However, predicting disease and hospitalization dynamics at the state level is complicated by geographic variation in disease parameters. In addition, it is difficult to make forecasts early in a pandemic due to minimal data. Bayesian approaches that allow models to be specified with informed prior information from areas that have already completed a disease curve can serve as prior estimates for areas that are beginning their curve. Here, a Bayesian non-linear regression (Weibull function) was used to forecast cumulative and active COVID-19 hospitalizations for SD, USA, based on data available up to 2020-07-22. As expected, early forecasts were dominated by prior information, which was derived from New York City. Importantly, hospitalization trends differed within South Dakota due to early peaks in an urban area, followed by later peaks in rural areas of the state. Combining these trends led to altered forecasts with relevant policy implications. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s41666-021-00094-8.

Elderly Medication Adherence Intervention Using the My Interventional Drug-Eluting Stent Educational App: Multisite Randomized Feasibility Trial.

BACKGROUND: A lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin. OBJECTIVE: This study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial. METHODS: Potential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants' blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants' group membership. The primary outcome was a feasibility analysis of recruitment and retention. RESULTS: The mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients' reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found. CONCLUSIONS: Elderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education. TRIAL REGISTRATION: ClinicalTrials.gov NCT04439864; https://clinicaltrials.gov/ct2/show/NCT04439864.

IL-12 Signaling Contributes to the Reprogramming of Neonatal CD8+ T Cells.

Neonates are highly susceptible to intracellular pathogens, leading to high morbidity and mortality rates. CD8+ T lymphocytes are responsible for the elimination of infected cells. Understanding the response of these cells to normal and high stimulatory conditions is important to propose better treatments and vaccine formulations for neonates. We have previously shown that human neonatal CD8+ T cells overexpress innate inflammatory genes and have a low expression of cytotoxic and cell signaling genes. To investigate the activation potential of these cells, we evaluated the transcriptome of human neonatal and adult naïve CD8+ T cells after TCR/CD28 signals ± IL-12. We found that in neonatal cells, IL-12 signals contribute to the adult-like expression of genes associated with cell-signaling, T-cell cytokines, metabolism, and cell division. Additionally, IL-12 signals contributed to the downregulation of the neutrophil signature transcription factor CEBPE and other immaturity related genes. To validate the transcriptome results, we evaluated the expression of a series of genes by RT-qPCR and the promoter methylation status on independent samples. We found that in agreement with the transcriptome, IL-12 signals contributed to the chromatin closure of neutrophil-like genes and the opening of cytotoxicity genes, suggesting that IL-12 signals contribute to the epigenetic reprogramming of neonatal lymphocytes. Furthermore, high expression of some inflammatory genes was observed in naïve and stimulated neonatal cells, in agreement with the high inflammatory profile of neonates to infections. Altogether our results point to an important contribution of IL-12 signals to the reprogramming of the neonatal CD8+ T cells.

Ultrafast Relaxation of Symmetry-Breaking Photo-Induced Atomic Forces.

We present a first-principles method for the calculation of the temperature-dependent relaxation of symmetry-breaking atomic driving forces in photoexcited systems. We calculate the phonon-assisted decay of the photoexcited force on the low-symmetry E_{g} mode following absorption of an ultrafast pulse in Bi, Sb, and As. The force decay lifetimes for Bi and Sb are of the order of 10 fs and in agreement with recent experiments, demonstrating that electron-phonon scattering is the primary mechanism relaxing the symmetry-breaking forces. Calculations for a range of absorbed photon energies suggest that larger amplitude, symmetry-breaking atomic motion may be induced by choosing a pump photon energy which maximizes the product of the initial E_{g} force and its lifetime. The high-symmetry A_{1g} force undergoes a partial decay to a nonzero constant on similar timescales, which has not yet been measured in experiments. The average imaginary part of the electron self-energy over the photoexcited carrier distribution provides a crude indication of the decay rate of symmetry-breaking forces.

What Happened to Me while I Was in the Hospital? Challenges and Opportunities for Generating Patient-Friendly Hospitalization Summaries.

Comprehending medical information is a challenging task, especially for people who have not received formal medical education. When patients are discharged from the hospital, they are provided with lengthy medical documents that contain intricate terminologies. Studies have shown that if people do not understand the content of their health documents, they will neither look for new information regarding their illness nor will they take actions to prevent or recover from their health issue. In this article, we highlight the need for generating personalized hospital-stay summaries and several research challenges associated with this task. The proposed directions are directly informed by our ongoing work in generating concise and comprehensible hospitalization summaries that are tailored to suit the patient's understanding of medical terminologies and level of engagement in improving their own health. Our preliminary evaluation shows that our summaries effectively present required medical concepts.

Patient-Centered Tablet Application for Improving Medication Adherence after a Drug-Eluting Stent.

BACKGROUND/AIMS: This study's objective was to evaluate a patient-centered educational electronic tablet application, "My Interventional Drug-Eluting Stent Educational App" (MyIDEA) to see if there was an increase in patient knowledge about dual antiplatelet therapy (DAPT) and medication possession ratio (MPR) compared to treatment as usual. METHODS: In a pilot project, 24 elderly (≥50 years old) research participants were recruited after a drug-eluting stent. Eleven were randomized to the control arm and 13 to the interventional arm. All the participants completed psychological and knowledge questionnaires. Adherence was assessed through MPR, which was calculated at 3 months for all participants who were scheduled for second and third follow-up visits. RESULTS: Relative to control, the interventional group had a 10% average increase in MPR. As compared to the interventional group, more patients in the control group had poor adherence (<80% MPR). The psychological data revealed a single imbalance in anxiety between the control and interventional groups. On average, interventional participants spent 21 min using MyIDEA. DISCUSSION: Consumer health informatics has enabled us to engage patients with their health data using novel methods. Consumer health technology needs to focus more on patient knowledge and engagement to improve long-term health. MyIDEA takes a unique approach in targeting DAPT from the onset. CONCLUSION: MyIDEA leverages patient-centered information with clinical care and the electronic health record highlighting the patients' role as a team member in their own health care. The patients think critically about adverse events and how to solve issues before leaving the hospital.

My Interventional Drug-Eluting Stent Educational App (MyIDEA): Patient-Centered Design Methodology.

BACKGROUND: Patient adherence to medication regimens is critical in most chronic disease treatment plans. This study uses a patient-centered tablet app, "My Interventional Drug-Eluting Stent Educational App (MyIDEA)." This is an educational program designed to improve patient medication adherence. OBJECTIVE: Our goal is to describe the design, methodology, limitations, and results of the MyIDEA tablet app. We created a mobile technology-based patient education app to improve dual antiplatelet therapy adherence in patients who underwent a percutaneous coronary intervention and received a drug-eluting stent. METHODS: Patient advisers were involved in the development process of MyIDEA from the initial wireframe to the final launch of the product. The program was restructured and redesigned based on the patient advisers' suggestions as well as those from multidisciplinary team members. To accommodate those with low health literacy, we modified the language and employed attractive color schemes to improve ease of use. We assumed that the target patient population may have little to no experience with electronic tablets, and therefore, we designed the interface to be as intuitive as possible. RESULTS: The MyIDEA app has been successfully deployed to a low-health-literate elderly patient population in the hospital setting. A total of 6 patients have interacted with MyIDEA for an average of 17.6 minutes/session. CONCLUSIONS: Including patient advisers in the early phases of a mobile patient education development process is critical. A number of changes in text order, language, and color schemes occurred to improve ease of use. The MyIDEA program has been successfully deployed to a low-health-literate elderly patient population. Leveraging patient advisers throughout the development process helps to ensure implementation success.

Uniqueness of limit cycles and multiple attractors in a Gause-type predator-prey model with nonmonotonic functional response and Allee effect on prey.

The main purpose of this work is to analyze a Gause type predator-prey model in which two ecological phenomena are considered: the Allee effect affecting the prey growth function and the formation of group defence by prey in order to avoid the predation. We prove the existence of a separatrix curves in the phase plane, determined by the stable manifold of the equilibrium point associated to the Allee effect, implying that the solutions are highly sensitive to the initial conditions. Trajectories starting at one side of this separatrix curve have the equilibrium point (0,0) as their ω-limit, while trajectories starting at the other side will approach to one of the following three attractors: a stable limit cycle, a stable coexistence point or the stable equilibrium point (K,0) in which the predators disappear and prey attains their carrying capacity. We obtain conditions on the parameter values for the existence of one or two positive hyperbolic equilibrium points and the existence of a limit cycle surrounding one of them. Both ecological processes under study, namely the nonmonotonic functional response and the Allee effect on prey, exert a strong influence on the system dynamics, resulting in multiple domains of attraction. Using Liapunov quantities we demonstrate the uniqueness of limit cycle, which constitutes one of the main differences with the model where the Allee effect is not considered. Computer simulations are also given in support of the conclusions.

Topological plasticity increases robustness of mutualistic networks.

1. Earlier studies used static models to evaluate the responses of mutualistic networks to external perturbations. Two classes of dynamics can be distinguished in ecological networks; population dynamics, represented mainly by changes in species abundances, and topological dynamics, represented by changes in the architecture of the web. 2. In this study, we model the temporal evolution of three empirical plant-pollination networks incorporating both population and topological dynamics. We test the hypothesis that topological plasticity, realized through the ability of animals to rewire their connections after depletion of host abundances, enhances tolerance of mutualistic networks to species loss. We also compared the performance of various rewiring rules in affecting robustness. 3. The results show that topological plasticity markedly increased the robustness of mutualistic networks. Our analyses also revealed that network robustness reached maximum levels when animals with less host plant availability were more likely to rewire. Also, preferential attachment to richer host plants, that is, to plants exhibiting higher abundance and few exploiters, enhances robustness more than other rewiring alternatives. 4. Our results highlight the potential role of topological plasticity in the robustness of mutualistic networks to species extinctions and suggest some plausible mechanisms by which the decisions of foragers may shape the collective dynamics of plant-pollinator systems.