Anti-racist strategies for clinical and translational research: Design, implementation, and lessons learned from a new course.

Translational research should examine racism and bias and improve health equity. We designed and implemented a course for the Master of Science in Clinical Investigation program of the Northwestern University Clinical and Translational Sciences Institute. We describe curriculum development, content, outcomes, and revisions involving 36 students in 2 years of "Anti-Racist Strategies for Clinical and Translational Science." Ninety-six percent of students reported they would recommend the course. Many reported changes in research approaches based on course content. A course designed to teach anti-racist research design is feasible and has a positive short-term impact on learners.

Community Outreach Among Employees of an Academic Children's Hospital.

Ann & Robert H. Lurie Children's Hospital of Chicago, the largest freestanding academic pediatric hospital in Illinois, created the Healthy Communities initiative in 2016 to expand the hospital's mission to improve child health by partnering with local community organizations. Through the Thrive leadership development program, a group of hospital employees developed an action-learning project to understand how employees and physicians might engage with a specific Healthy Communities initiative to increase participation in organization-affiliated community outreach activities. After conducting a literature review and interviews with key stakeholders, the group characterized current employee and physician community outreach activities and interests through an online survey. The 19-item Likert style survey assessed perspectives on key motivations, barriers, and opportunities. A multidisciplinary sample of 564 respondents completed the survey. Although 87% of respondents currently participate in community outreach activities, only 44% participate through the institution. Motivations for participation included helping others less fortunate (70%), giving back to the community (68%), and creating awareness of an initiative (45%). The ideal setting for future participation would not require ongoing commitment (82%), could be done on weekends (69%), and completed with co-workers, friends or family (71%). The ideal types of opportunities for future participation could involve donations (86%), volunteering their skills (79%), and attending fundraisers (73%). Community outreach participation is high among employees and physicians at our institution. Targeting individual motivating factors could increase participation in activities through the institution. These findings guided the Healthy Communities team in organizing and developing opportunities for employees.

Alteplase for Acute Ischemic Stroke after Heparin Reversal with Protamine: A Case Report and Review.

Few patients presenting with acute ischemic stroke (AIS) are eligible for alteplase, especially those receiving ongoing anticoagulation. We describe the first reported case of a patient receiving full-dose intravenous (IV) alteplase for AIS after heparin reversal with protamine. A 73-year-old man presented with AIS. He was treated with IV heparin, tirofiban, loading-dose prasugrel, and aspirin before percutaneous coronary intervention (PCI) for placement of a right coronary artery stent. One hour following PCI, he abruptly developed left hemiparesis and dysphagia. The National Institutes of Health Stroke Scale was 12, and activated partial thromboplastin time (aPTT) was longer than 150 seconds. Head computed tomography (CT) showed no acute pathology, and CT angiogram showed no large-vessel occlusion amenable to mechanical thrombectomy. Repeat aPTT, obtained 45 minutes later, was 110 seconds, at which time protamine 40 mg IV was administered. At 144 minutes from last known well time, full-dose IV alteplase (0.9 mg/kg) was administered. Follow-up head imaging at 25 hours showed right pontine and cerebellar AIS with no evidence of hemorrhage. The patient was discharged to inpatient rehabilitation 2 days later. Modified Rankin Scale at 3 months was 3, improved from 5 at discharge. Given the lack of adverse events associated with IV alteplase in our patient, we advocate cautious evaluation for potential reversal of acutely administered anticoagulation to facilitate alteplase administration in severely disabled patients who are not eligible for mechanical intervention and would have been excluded from definitive AIS treatment.

Reproducibility of ABC/2 method to determine infarct volume and mismatch percentage with CT perfusion.

BACKGROUND: Our aim is to implement a simple, rapid, and reliable method using computed tomography perfusion imaging and clinical judgment to target patients for reperfusion therapy in the hyper-acute stroke setting. We introduce a novel formula (1-infarct volume [CBV]/penumbra volume [MTT] × 100%) to quantify mismatch percentage. METHODS: Twenty patients with anterior circulation strokes who underwent CT perfusion and received intravenous tissue plasminogen activator (IV tPA) were analyzed retrospectively. Nine blinded viewers determined volume of infarct and ischemic penumbra using the ABC/2 method and also the mismatch percentage. RESULTS: Interrater reliability using the volumetric formula (ABC/2) was very good (intraclass correlation [ICC] = .9440 and ICC = .8510) for hemodynamic parameters infarct (CBV) and penumbra (MTT). ICC coefficient using the mismatch formula (1-MTT/CBV × 100%) was good (ICC of .635). CONCLUSIONS: The ABC/2 method of volume estimation on CT perfusion is a reliable and efficient approach to determine infarct and penumbra volumes. The 1-CBV/MTT × 100% formula produces a mismatch percentage assisting providers in communicating the proportion of salvageable brain and guides therapy in the setting of patients with unclear time of onset with potentially salvageable tissue who can undergo mechanical retrieval or intraarterial thrombolytics.

Clinical and diagnostic features of delayed hypoxic leukoencephalopathy.

Delayed hypoxic leukoencephalopathy is an underrecognized syndrome of delayed demyelination, which is important to consider when delayed onset of neuropsychiatric symptoms follows a hypoxic event. The authors describe clinical and diagnostic features of three such cases, review the pathophysiology of delayed hypoxic leukoencephalopathy, and discuss features which may help distinguish it from toxic leukoencephalopathy.

Self-monitored motives for smoking among college students.

College student smokers (N = 50) were asked to carry electronic diaries for 14 days and record smoking events (n = 1,139). They indicated why they were smoking each cigarette on a checklist of potential motives. Results suggest that a desire to reduce craving (62.8% of occasions) and habit/automatic processes (42.8%) were the most frequent motives. More dependent and daily smokers were especially likely to endorse smoking to reduce craving and for habit/automatic reasons and were less likely to cite coping with negative emotion as a reason for smoking. Dependent and daily smokers were more likely to endorse at least 1 dependence-like motive and were less likely to exclusively attribute smoking to nondependence motives. Self-monitored motives appeared valid, according with conceptually related states, activities, and events in the diary records. Diary-recorded motives were compared with smokers' responses to a retrospective motives questionnaire administered at baseline. The 2 assessment modes produced discrepant estimates of the most influential motivational processes. Questionnaire responses incompletely forecast conceptually similar diary-reported motives. Dependence and daily smoking showed a different pattern of associations with diary-based versus retrospective motives measures.

Dietary cadmium exposure attenuates D-amphetamine-evoked [3H]dopamine release from striatal slices and methamphetamine-induced hyperactivity.

Prolonged exposure to environmentally relevant amounts of CdCl2 results in cadmium accumulation in dopamine-rich brain regions, such as striatum. Exposure to these low levels of cadmium also diminishes cocaine-induced hyperactivity and conditioned reinforcement. The goal of the present study was to assess the effect of cadmium on amphetamine pharmacology. Direct application of cadmium (0.1-100 microM), within the concentrations reported in brain after chronic exposure, to preloaded rat striatal slices did not alter D-amphetamine-evoked [3H]dopamine release. To determine the effect of dietary cadmium exposure on amphetamines, rats received ad libitum access to diet containing CdCl2 (10 or 100 ppm) or to control diet for 30 days and then D-amphetamine-evoked [3H]dopamine release and methamphetamine-induced hyperactivity were measured. Dietary CdCl2 exposure produced a marked increase in cadmium blood and brain levels, approximate to environmental metal exposure. Dietary cadmium exposure was associated with decreased potency of D-amphetamine to evoke [3H]dopamine release. Cadmium-exposed rats were also less sensitive to the locomotor-activating effect of acute methamphetamine (0.3 or 1.0 mg/kg) injection. The present findings demonstrate that the presence of cadmium in brain is not sufficient for the inhibition of D-amphetamine-evoked dopamine release. This suggests that cadmium does not directly interfere with the mechanism of action for amphetamine pharmacology; rather, it suggests that long-term cadmium exposure induces a change in the number and/or function of striatal neurons.