No abstract

This study provides preliminary evidence of the acceptability of the TIM breathing maneuver in patients with CF and their ability to perform repeated TIM breathing during simulated nebulizer therapy with the I-neb AAD System.

BACKGROUND Emergency department (ED) staff are at-risk of burnout, poor wellbeing and increased stress that can impact patient satisfaction, staff morale and retention. The aim of this survey was to determine level of burnout, stress and satisfaction with current employment role in ED during COVID-19. METHODS A multisite cross-sectional survey captured ED employment data, wellbeing, burnout (Maslach Burnout Inventory), stress (Health Professions Stress Inventory), work environment (WES-10) and Caring for COVID-19 Patients questions. RESULTS The response rate of 44.2% (n = 177) represented all healthcare disciplines. Only 58.8% (n = 104) of participants were happy in their role, satisfaction was low, burnout was high ( M 71.0, SD 17.1) as was level of stress ( M 90.6, SD 16.5). Nurses and allied health staff were more stressed than their medical or support staff colleagues. Participants perceived discriminatory behaviours from friends and family in caring for suspected or infected COVID-19 patients. CONCLUSION ED staff are a vulnerable group. Programs to promote wellbeing, personal resilience, and self-care together with personal and professional growth are needed to build individual capability and a culture of organizational resilience, particularly in the context of the COVID pandemic.

Objective Malformations of cortical development (MCD), including focal cortical dysplasia (FCD), are the most common cause of drug-resistant focal epilepsy in children. Histopathological lesion characterisation demonstrates abnormal cell types and lamination, alterations in myelin (typically co-localised with iron), and sometimes calcification. Quantitative susceptibility mapping (QSM) is an emerging MRI technique that measures tissue magnetic susceptibility (χ) reflecting it's mineral composition. We used QSM to investigate abnormal tissue composition in a group of children with focal epilepsy with comparison to effective transverse relaxation rate (R2*) and Synchrotron radiation X-ray fluorescence (SRXRF) elemental maps. Our primary hypothesis was that reductions in χ would be found in FCD lesions, resulting from alterations in their iron and calcium content. We also evaluated deep grey matter nuclei for changes in χ with age. Methods QSM and R2* maps were calculated for 40 paediatric patients with suspected MCD (18 histologically confirmed) and 17 age-matched controls. Patients’ sub-groups were defined based on concordant electro-clinical or histopathology data. Quantitative investigation of QSM and R2* was performed within lesions, using a surface-based approach with comparison to homologous regions, and within deep brain regions using a voxel-based approach with regional values modelled with age and epilepsy as covariates. Synchrotron radiation X-ray fluorescence (SRXRF) was performed on brain tissue resected from 4 patients to map changes in iron, calcium and zinc and relate them to MRI parameters. Results Compared to fluid‐attenuated inversion recovery (FLAIR) or T1‐weighted imaging, QSM improved lesion conspicuity in 5% of patients. In patients with well-localised lesions, quantitative profiling demonstrated decreased χ, but not R2*, across cortical depth with respect to the homologous regions. Contra-lateral homologous regions additionally exhibited increased χ at 2–3 mm cortical depth that was absent in lesions. The iron decrease measured by the SRXRF in FCDIIb lesions was in agreement with myelin reduction observed by Luxol Fast Blue histochemical staining. SRXRF analysis in two FCDIIb tissue samples showed increased zinc and calcium in one patient, and decreased iron in the brain region exhibiting low χ and high R2* in both patients. QSM revealed expected age-related changes in the striatum nuclei, substantia nigra, sub-thalamic and red nucleus. Conclusion QSM non-invasively revealed cortical/sub-cortical tissue alterations in MCD lesions and in particular that χ changes in FCDIIb lesions were consistent with reduced iron, co-localised with low myelin and increased calcium and zinc content. These findings suggest that measurements of cortical χ could be used to characterise tissue properties non-invasively in epilepsy lesions.

No abstract

Objective Malformations of cortical development (MCD), including focal cortical dysplasia (FCD), are the most common cause of drug-resistant focal epilepsy in children. Histopathological lesion characterisation demonstrates abnormal cell types and lamination, alterations in myelin (typically co-localised with iron), and sometimes calcification. Quantitative susceptibility mapping (QSM) is an emerging MRI technique that measures tissue magnetic susceptibility (χ) reflecting its mineral composition. We used QSM to investigate abnormal tissue composition in a group of children with focal epilepsy with comparison to effective transverse relaxation rate (R2*) and Synchrotron radiation X-ray fluorescence (SRXRF) elemental maps. Our primary hypothesis was that reductions in χ would be found in FCD lesions, resulting from alterations in their iron and calcium content. We also evaluated deep grey matter nuclei for changes in χ with age. Methods QSM (χ) and R2* maps were calculated for 40 paediatric patients with suspected FCD (18 histologically confirmed) and 17 age-matched controls. Patients sub-groups were defined based on concordant electro-clinical or histopathology data. Quantitative investigation of QSM and R2* were performed within lesions, using a surface-based approach with comparison to homologous regions, and globally within deep brain regions using a voxel-based approach with regional values modelled with age and epilepsy as covariates. Synchrotron radiation X-ray fluorescence (SRXRF) was performed on brain tissue resected from 4 patients to map changes in iron, calcium and zinc and relate them to MRI parameters. Results Compared to fluid‐attenuated inversion recovery (FLAIR) or T1‐weighted imaging, QSM improved lesion conspicuity in 5% of patients. In patients with well-localised and confirmed FCDIIb lesions, quantitative profiling demonstrated decreased χ, but not R2*, across cortical depth with respect to the homologous regions. Contra-lateral homologous regions additionally exhibited increased χ at 2-3mm cortical depth that was absent in lesions. The iron decrease measured by the SRXRF in FCDIIb lesions was in agreement with myelin reduction observed by Luxol Fast Blue histochemical staining. SRXRF analysis in two FCDIIb tissue samples showed increased zinc and calcium, and decreased iron in the brain region exhibiting low χ and high R2*. QSM revealed expected age-related changes in the striatum nuclei, substantia nigra, sub-thalamic and red nucleus, but these changes were not altered in epilepsy. Conclusion QSM non-invasively revealed cortical/sub-cortical tissue alterations in MCD lesions and in particular that χ changes in FCDIIb lesions were consistent with reduced iron, co-localised with low myelin and increased calcium and zinc content. Theses findings suggests that the measurements of cortical χ measurements could be used to detect and delineate epilepsy lesions.

Act 1940 and subsequent Parliamentary resolutions. 2 Where the use of such force is (i) reasonable and (ii) necessary in the exercise of the power to remove that person to the place where they are living: see e.g. Health Protection (Coronavirus, Restrictions) (England) Regulations 2020, reg. 8(3)(b) and (4). 3 See e.g. Health Protection (Coronavirus, Restrictions) (England) Regulations 2020, reg. 5. 4 See e.g. ibid., reg. 8( 9), ( 10) and (4). 5 Cf the powers in s. 51 and Sch. 21 (powers relating to potentially infectious persons) and s. 52 and Sch. 22 (powers to issue directions relating to events, gatherings and premises) to what is now the Coronavirus Act 2020 (c.7), which provisions came into force on 25 March 2020, the date of Royal Assent (see s. 87(1) of the 2020 Act).

Intravenous administration of platelet activating factor, Paf (600 ng kg−1 h−1) to ventilated anaesthetised guinea‐pigs induced bronchial hyperresponsiveness to i.v. acetylcholine. Pretreatment of ventilated, anaesthetised guinea‐pigs with the β‐adrenoceptor antagonist, propranolol, or the non‐steroidal anti‐inflammatory drug, indomethacin, induced bronchial hyperresponsiveness to i.v. histamine. Paf‐induced bronchial hyperresponsiveness was significantly attenuated by pretreatment with three different Paf antagonists, CV‐3988, BN 52021 and WEB 2086. Pretreatment of guinea‐pigs with CV‐3988, BN 52021 or WEB 2086 at doses inhibiting Paf‐induced bronchial hyperresponsiveness, had no significant effect on propranolol or indomethacin‐induced bronchial hyperresponsiveness. It is suggested that bronchial hyperresponsiveness induced by propranolol or indomethacin is not secondary to Paf release in the guinea‐pig.