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Background Electroencephalography (EEG) findings following cardiovascular collapse in death are uncertain. We aimed to characterize EEG changes immediately preceding and following cardiac death. Methods We retrospectively analyzed EEGs of patients who died from cardiac arrest while undergoing standard EEG monitoring in an intensive care unit. Patients with brain death preceding cardiac death were excluded. Three events during fatal cardiovascular failure were investigated: (1) last recorded QRS complex on electrocardiogram (QRS 0 ), (2) cessation of cerebral blood flow (CBF 0 ) estimated as the time that blood pressure and heart rate dropped below set thresholds, and (3) electrocerebral silence on EEG (EEG 0 ). We evaluated EEG spectral power, coherence, and permutation entropy at these time points. Results Among 19 patients who died while undergoing EEG monitoring, seven (37%) had a comfort-measures-only status and 18 (95%) had a do-not-resuscitate status in place at the time of death. EEG 0 occurred at the time of QRS 0 in five patients and after QRS 0 in two patients (cohort median − 2.0, interquartile range − 8.0 to 0.0), whereas EEG 0 was seen at the time of CBF 0 in six patients and following CBF 0 in 11 patients (cohort median 2.0 min, interquartile range − 1.5 to 6.0). After CBF 0 , full-spectrum log power ( p  < 0.001) and coherence ( p  < 0.001) decreased on EEG, whereas delta ( p  = 0.007) and theta ( p  < 0.001) permutation entropy increased. Conclusions Rarely may patients have transient electrocerebral activity following the last recorded QRS (less than 5 min) and estimated cessation of cerebral blood flow. These results may have implications for discussions around cardiopulmonary resuscitation and organ donation.

Behaviorally unresponsive patients in intensive care units (ICU) are unable to consistently and effectively communicate their most fundamental physical needs. Brain-Computer Interface (BCI) technology has been established in the clinical context, but faces challenges in the critical care environment. Contrary to cue-based BCIs, which allow activation only during pre-determined periods of time, self-paced BCI systems empower patients to interact with others at any time. The study aims to develop a self-paced BCI for patients in the intensive care unit. BCI experiments were conducted in 18 ICU patients and 5 healthy volunteers. The proposed self-paced BCI system analyzes EEG activity from patients while these are asked to control a beeping tone by performing a motor task (i.e., opening and closing a hand). Signal decoding is performed in real time and auditory feedback given via headphones. Performance of the BCI system was judged based on correlation between the optimal and the observed performance. All 5 healthy volunteers were able to successfully perform the BCI task, compared to chance alone (p<0.001). 5 of 14 (36%) conscious ICU patients were able to perform the BCI task. One of these 5 patients was quadriplegic and controlled the BCI system without any hand movements. None of the 4 unconscious patients were able to perform the BCI task. More than one third of conscious ICU patients and all healthy volunteers were able to gain control over the self-paced BCI system. The initial 4 unconscious patients were not. Future studies will focus on studying the ability of behaviorally unresponsive patients with cognitive motor dissociation to control the self-paced BCI system.

Background Prevalence and etiology of unconsciousness are uncertain in hospitalized patients with coronavirus disease 2019 (COVID-19). We tested the hypothesis that increased inflammation in COVID-19 precedes coma, independent of medications, hypotension, and hypoxia. Methods We retrospectively assessed 3203 hospitalized patients with COVID-19 from March 2 through July 30, 2020, in New York City with the Glasgow Coma Scale and systemic inflammatory response syndrome (SIRS) scores. We applied hazard ratio (HR) modeling and mediation analysis to determine the risk of SIRS score elevation to precede coma, accounting for confounders. Results We obtained behavioral assessments in 3203 of 10,797 patients admitted to the hospital who tested positive for SARS-CoV-2. Of those patients, 1054 (32.9%) were comatose, which first developed on median hospital day 2 (interquartile range [IQR] 1–9). During their hospital stay, 1538 (48%) had a SIRS score of 2 or above at least once, and the median maximum SIRS score was 2 (IQR 1–2). A fivefold increased risk of coma (HR 5.05, 95% confidence interval 4.27–5.98) was seen for each day that patients with COVID-19 had elevated SIRS scores, independent of medication effects, hypotension, and hypoxia. The overall mortality in this population was 13.8% ( n  = 441). Coma was associated with death (odds ratio 7.77, 95% confidence interval 6.29–9.65) and increased length of stay (13 days [IQR 11.9–14.1] vs. 11 [IQR 9.6–12.4]), accounting for demographics. Conclusions Disorders of consciousness are common in hospitalized patients with severe COVID-19 and are associated with increased mortality and length of hospitalization. The underlying etiology of disorders of consciousness in this population is uncertain but, in addition to medication effects, may in part be linked to systemic inflammation.

Background In 2024 in the United States there is an attack on diversity, equity, and inclusion initiatives within education. Politics notwithstanding, medical school curricula that are current and structured to train the next generation of physicians to adhere to our profession’s highest values of fairness, humanity, and scientific excellence are of utmost importance to health care quality and innovation worldwide. Whereas the number of anti-racism, diversity, equity, and inclusion (ARDEI) curricular innovations have increased, there is a dearth of published longitudinal health equity curriculum models. In this article, we describe our school’s curricular mapping process toward the longitudinal integration of ARDEI learning objectives across 4 years and ultimately creation of an ARDEI medical education program objective (MEPO) domain. Methods Medical students and curricular faculty leaders developed 10 anti-racism learning objectives to create an ARDEI MEPO domain encompassing three ARDEI learning objectives. Results A pilot survey indicates that medical students who have experienced this curriculum are aware of the longitudinal nature of the ARDEI curriculum and endorse its effectiveness. Conclusions A longitudinal health equity and justice curriculum with well-defined anti-racist objectives that is (a) based within a supportive learning environment, (b) bolstered by trusted, structured avenues for student feedback and (c) amended with iterative revisions is a promising model to ensure that medical students are equipped to effectively address health inequities and deliver the highest quality of care for all patients.

Understanding variables associated with coronavirus disease 2019 (COVID‐19) vaccine confidence and hesitancy may inform strategies to improve vaccine uptake in clinical settings such as the emergency department (ED). We aim to identify factors contributing to COVID‐19 vaccine acceptance and to assess patient attitudes surrounding offering COVID‐19 vaccines in the ED. We conducted a survey of a convenience sample of patients and patient visitors over the age 18 years, who were native English or Spanish speakers. The survey was conducted from March through August 2021 at 3 EDs in New York City. The survey was administered via an electronic format, and participants provided verbal consent. Our sample size was 377. Individuals with post‐graduate degrees viewed vaccines positively (Prevalence Ratio [PR], 1.63; 95% Confidence Interval [CI], 1.07–2.47).  Of the various high‐risk medical conditions associated with adverse COVID‐19 infection outcomes, diabetes was the only condition associated with more positive views of vaccines (PR, 1.37; CI, 1.17–1.59). Of all participants, 71.21% stated that they believed offering a COVID‐19 vaccine in the ED was a good idea. Of unvaccinated participants, 21.80% stated they would get vaccinated if it were offered to them in the ED. EDs can serve as a safety net for vulnerable populations and can act as an access point for vaccination.

Recovery trajectories of clinically unresponsive patients with acute brain injury are largely uncertain. Brain activation in the absence of a behavioural response to spoken motor commands can be detected by EEG, also known as cognitive-motor dissociation. We aimed to explore the role of cognitive-motor dissociation in predicting time to recovery in patients with acute brain injury. In this observational cohort study, we prospectively studied two independent cohorts of clinically unresponsive patients (aged ≥18 years) with acute brain injury. Machine learning was applied to EEG recordings to diagnose cognitive-motor dissociation by detecting brain activation in response to verbal commands. Survival statistics and shift analyses were applied to the data to identify an association between cognitive-motor dissociation and time to and magnitude of recovery. The prediction accuracy of the model that was built using the derivation cohort was assessed using the validation cohort. Functional outcomes of all patients were assessed with the Glasgow Outcome Scale–Extended (GOS-E) at hospital discharge and at 3, 6, and 12 months after injury. Patients who underwent withdrawal of life-sustaining therapies were censored, and death was treated as a competing risk. Between July 1, 2014, and Sept 30, 2021, we screened 598 patients with acute brain injury and included 193 (32%) patients, of whom 100 were in the derivation cohort and 93 were in the validation cohort. At 12 months, 28 (15%) of 193 unresponsive patients had a GOS-E score of 4 or above. Cognitive-motor dissociation was seen in 27 (14%) patients and was an independent predictor of shorter time to good recovery (hazard ratio 5·6 [95% CI 2·5–12·5]), as was underlying traumatic brain injury or subdural haematoma (4·4 [1·4–14·0]), a Glasgow Coma Scale score on admission of greater than or equal to 8 (2·2 [1·0–4·7]), and younger age (1·0 [1·0–1·1]). Among patients discharged home or to a rehabilitation setting, those diagnosed with cognitive-motor dissociation consistently had higher scores on GOS-E indicating better functional recovery compared with those without cognitive-motor dissociation, which was seen as early as 3 months after the injury (odds ratio 4·5 [95% CI 2·0–33·6]). Recovery trajectories of clinically unresponsive patients diagnosed with cognitive-motor dissociation early after brain injury are distinctly different from those without cognitive-motor dissociation. A diagnosis of cognitive-motor dissociation could inform the counselling of families of clinically unresponsive patients, and it could help clinicians to identify patients who will benefit from rehabilitation. US National Institutes of Health.