Telehealth is here to stay but not without challenges: a consultation of cardiac rehabilitation clinicians during COVID-19 in Victoria, Australia.

AIMS: Delivery of cardiac rehabilitation (CR) was challenged during the pandemic caused by the Coronavirus disease (COVID-19), due to government stay-at-home directives which restricted in-person programmes. The Australian state of Victoria experienced the longest and most severe COVID-19 restrictions and was in lockdown for ∼6 months of 2020. We aimed to explore (i) clinicians' experiences and perceptions and (ii) identify barriers and enablers, for delivering CR during the COVID-19 pandemic. METHODS AND RESULTS: Victorian members of the Australian Cardiovascular Health and Rehabilitation Association (ACRA) were invited to attend an exploratory qualitative online consultation in November 2020. An inductive thematic analysis was undertaken, before deductively applying the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework to identify barriers and enablers for technology adoption in CR. Thirty members participated in a 106-min consultation. Seventeen members who provided demographics represented multiple disciplines (nursing n = 13, exercise physiology n = 3, and physiotherapy n = 1) and geographical settings (metropolitan n = 10, regional n = 4, and rural n = 3). Four main themes were inductively identified: consequences of change; use of technology; capacity; and the way forward. The deductive NASSS analysis demonstrated the main challenges of continuing remotely delivered CR lie with adopters (staff, patients, and carers) and with organizations. CONCLUSION: The COVID-19 pandemic expedited significant changes to CR delivery models. While clinicians are eager to retain technology-enabled delivery in addition to resuming in-person CR, it is now timely to review remote models of care, tools used and plan how they will be integrated with traditional in-person programmes.

MR imaging of cartilage repair surgery of the knee.

Articular cartilage is a complex tissue with unique properties that are essential for normal joint function. Many processes can result in cartilage injury, ranging from acute trauma to degenerative processes. Articular cartilage lacks vascularity, and therefore most chondral defects do not heal spontaneously and may require surgical repair. A variety of cartilage repair techniques have been developed and include bone marrow stimulation (microfracture), osteochondral autograft transfer system (OATS) or osteochondral allograft transplantation, autologous chondrocyte implantation (ACI), matrix-assisted chondrocyte implantation (MACI), and other newer processed allograft cartilage techniques. Although arthroscopy has long been considered as the gold standard for evaluation of cartilage after cartilage repair, magnetic resonance (MR) imaging is a non-invasive method to assess the repair site and can be scored using Magnetic resonance Observation of Cartilage Repair Tissue (MOCART). MR also provides additional evaluation of the subchondral bone and for other potential causes of knee pain or internal derangement. Conventional MR can be used to evaluate the status of cartilage repair and potential complications. Compositional MR sequences can provide supplementary information about the biochemical contents of the reparative tissue. This article reviews the various types of cartilage repair surgeries and their postoperative MR imaging appearances.

Behavioral reactions to novel food odors by intertidal hermit crabs.

Novel food items represent important food resources for generalist scavengers, such as intertidal hermit crabs. For animals that rely heavily on olfaction to mediate foraging, their first encounters with novel food items come from the detection of novel food odors. Although crustaceans have been shown to possess sensory mechanisms for processing novel odors, little is known about the level of stimulus reinforcement needed to maintain behavioral responses to novel food odors upon subsequent exposures. In the context of foraging, reinforcement of a novel food odor comes from feeding on the novel food item after sensory detection of the food item. This study tested the behavioral responses of hermit crabs to a novel food odor over repeated exposures both with and without stimulus reinforcement. The results show that stimulus reinforcement is needed for the animals to maintain their baseline level of behavioral responses to the novel food odors. Animals that were allowed to feed on the novel food item after first exposure (reinforced treatment) maintained strong behavioral reactions to the novel food odor during subsequent exposures. The behavioral reactions of animals that were not allowed to feed on the novel food item after first exposure (unreinforced treatment) rapidly declined.

Psychosocial and nonclinical factors predicting hospital utilization in patients of a chronic disease management program: a prospective observational study.

Psychosocial factors such as marital status (odds ratio, 3.52; 95% confidence interval, 1.43-8.69; P = .006) and nonclinical factors such as outpatient nonattendances (odds ratio, 2.52; 95% confidence interval, 1.22-5.23; P = .013) and referrals made (odds ratio, 1.20; 95% confidence interval, 1.06-1.35; P = .003) predict hospital utilization for patients in a chronic disease management program. Along with optimizing patients' clinical condition by prescribed medical guidelines and supporting patient self-management, addressing psychosocial and nonclinical issues are important in attempting to avoid hospital utilization for people with chronic illnesses.

Aggression and food resource competition between sympatric hermit crab species.

The vertical zonation patterns of intertidal organisms have been topics of interest to marine ecologists for many years, with interspecific food competition being implicated as a contributing factor to intertidal community organization. In this study, we used behavioral bioassays to examine the potential roles that interspecific aggression and food competition have on the structuring of intertidal hermit crab assemblages. We studied two ecologically similar, sympatric hermit crab species, Clibanarius digueti [1] and Paguristes perrieri [2], which occupy adjacent zones within the intertidal region of the Gulf of California. During the search phase of foraging, C. digueti showed higher frequencies of aggressive behaviors than P. perrieri. In competition assays, C. digueti gained increased access to food resources compared to P. perrieri. The results suggest that food competition may play an important role in structuring intertidal hermit crab assemblages, and that the zonation patterns of Gulf of California hermit crab species may be the result of geographical displacement by the dominant food competitor (C. digueti).

Targeting a tumor-specific laminin domain critical for human carcinogenesis.

Laminin-332 is critical for squamous cell carcinoma (SCC) tumorigenesis, but targeting it for cancer therapy has been unachievable due to key role of laminin-332 in promoting tissue integrity. Here, we show that a portion of laminin-332, termed G45, which is proteolytically removed and absent in normal tissues, is prominently expressed in most human SCC tumors and plays an important role in human SCC tumorigenesis. Primary human keratinocytes lacking G45 (DeltaG45) showed alterations of basal receptor organization, impaired matrix deposition, and increased migration. After SCC transformation, the absence of G45 domain in DeltaG45 cells was associated with deficient extracellular signal-regulated kinase and phosphotidylinositol 3-kinase (PI3K) pathway activation, impaired invasion, deficient metalloproteinase activity, and absent tumorgenicity in vivo. Expression of G45 or activated PI3K subunit in DeltaG45 cells reversed these abnormalities. G45 antibody treatment induced SCC tumor apoptosis, decreased SCC tumor proliferation, and markedly impaired human SCC tumorigenesis in vivo without affecting normal tissue adhesion. These results show a remarkable selectivity of expression and function for laminin-332 G45 in human SCC tumorigenesis and implicate it as a specific target for anticancer therapy.

Disseminated cellulitic cryptococcosis in the setting of prednisone monotherapy for pemphigus vulgaris.

Cryptococcal infections are seen mainly in immunocompromised hosts. The cutaneous manifestations of infection can include papules, plaques, nodules, vesicles, ulcers, ecchymosis, and, rarely, cellulitis. Cryptococcal meningitis is a life-threatening complication of this disease. Pemphigus vulgaris is a rare auto-immune blistering disease that can also be life-threatening. Treatment of pemphigus commonly entails both corticosteroids and steroid-sparing agents. We present a case of disseminated cryptococcal infection in a patient with pemphigus vulgaris treated with high dose corticosteroids as monotherapy. This case provides an opportunity to discuss the difficulty of managing two potentially mortal conditions in which the treatment of pemphigus vulgaris may exacerbate the disseminated cryptococcal infection.