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BACKGROUND:Patients with IBD report increased gastrointestinal symptoms, including diarrhea, abdominal pain, and nausea following COVID-19 diagnosis. While there has been a great amount of research assessing outcomes of COVID-19 in patients with IBD, little is known about the effects of COVID-19 on IBD disease activity. We aimed to explore IBD related outcomes in a cohort of IBD patients affected by COVID-19.METHODS:We performed a retrospective case series of patients with IBD who were diagnosed with COVID-19 and seen in a single tertiary care referral center from March 2020 to March 2021 after IRB approval. We compared patients who were in stable remission up to 90 days prior to the COVID-19 diagnosis to those who were not in remission during the same time frame. COVID-19 diagnosis was made based on a combination of symptoms and positive rapid antigen and/or PCR test. Disease activity was estimated based on routinely measured clinical disease severity indices documented in office visit notes, including partial Mayo score for ulcerative colitis (UC) or Harvey-Bradshaw Index for Crohn's disease (CD) and/or endoscopic scoring documented in procedure notes including Mayo endoscopic subscore for UC or simple endoscopic score for CD documented in the procedure notes. For the primary outcome, we assessed IBD related outcomes by determining the need for escalation of immunosuppressive maintenance therapy, and/or need for IBD related hospitalization/surgery within 3 months after diagnosis of COVID-19. For the secondary outcome, COVID-19 related outcomes were assessed including need for hospitalization, ICU stay, use of COVID-19 related therapy such as monoclonal antibodies, and death. Continuous variables were compared between groups using student t test. Categorical variables were compared using Chi-square test.RESULTS:We identified 57 eligible patients. At the time of COVID-19 diagnosis, 30 (52.6%) were in remission, 0 (0%) had mild disease, 23 (40.3%) had moderate disease activity, and 4 (7.0%) had severe disease activity. No patients discontinued maintenance medications for more than 14 days due to COVID-19 diagnosis. No differences in age, gender, race, body max index, and combordities were noted between those not in remission versus those who were in remission (p>0.05). Patients who were not in remission were more likely to be on steroids at the time of COVID-19 diagnosis (47% vs 0%, p =0.00001) including budesonide and prednisone. Patients who were not in remission were more likely to be on biologics at the time of COVID-19 diagnosis (96.3%% vs 73.3%, p =0.03). Patients in remission had overall low rates of needing escalation in immunosuppressive maintenance therapy and IBD related hospitalization/surgery (6.7% and 0%, respectively). Patients who were not in remission were more likely to require escalation in immunosuppressive maintenance therapy (44.4% vs 6.7%, p 0.0015) and IBD related hospitalization/surgery compared to those in remission (18.5% vs 0.0%, p=0.02). No differences in COVID-19 related outcomes including need for hospitalization, ICU stay, use of COVID-19 related therapy such as monoclonal antibodies, and death were noted between the two groups (p>0.05).CONCLUSION:Our study suggests minimal impact of COVID-19 on IBD related outcomes in patients in remission. Patients who were not in remission did have worse IBD related outcomes compared to those in remission, however, the findings could reflect the natural history of IBD related disease rather than being related to COVID-19. COVID-19 related outcomes were no different in those who were not in remission versus those who were in remission. Future larger scale studies are warranted to study the findings further.

BACKGROUND:Patients with IBD report increased gastrointestinal symptoms, including diarrhea, abdominal pain, and nausea following COVID-19 diagnosis. While there has been a great amount of research assessing outcomes of COVID-19 in patients with IBD, little is known about the effects of COVID-19 on IBD disease activity. We aimed to explore IBD related outcomes in a cohort of IBD patients affected by COVID-19.METHODS:We performed a retrospective case series of patients with IBD who were diagnosed with COVID-19 and seen in a single tertiary care referral center from March 2020 to March 2021 after IRB approval. We compared patients who were in stable remission up to 90 days prior to the COVID-19 diagnosis to those who were not in remission during the same time frame. COVID-19 diagnosis was made based on a combination of symptoms and positive rapid antigen and/or PCR test. Disease activity was estimated based on routinely measured clinical disease severity indices documented in office visit notes, including partial Mayo score for ulcerative colitis (UC) or Harvey-Bradshaw Index for Crohn's disease (CD) and/or endoscopic scoring documented in procedure notes including Mayo endoscopic subscore for UC or simple endoscopic score for CD documented in the procedure notes. For the primary outcome, we assessed IBD related outcomes by determining the need for escalation of immunosuppressive maintenance therapy, and/or need for IBD related hospitalization/surgery within 3 months after diagnosis of COVID-19. For the secondary outcome, COVID-19 related outcomes were assessed including need for hospitalization, ICU stay, use of COVID-19 related therapy such as monoclonal antibodies, and death. Continuous variables were compared between groups using student t test. Categorical variables were compared using Chi-square test.RESULTS:We identified 57 eligible patients. At the time of COVID-19 diagnosis, 30 (52.6%) were in remission, 0 (0%) had mild disease, 23 (40.3%) had moderate disease activity, and 4 (7.0%) had severe disease activity. No patients discontinued maintenance medications for more than 14 days due to COVID-19 diagnosis. No differences in age, gender, race, body max index, and combordities were noted between those not in remission versus those who were in remission (p>0.05). Patients who were not in remission were more likely to be on steroids at the time of COVID-19 diagnosis (47% vs 0%, p =0.00001) including budesonide and prednisone. Patients who were not in remission were more likely to be on biologics at the time of COVID-19 diagnosis (96.3%% vs 73.3%, p =0.03). Patients in remission had overall low rates of needing escalation in immunosuppressive maintenance therapy and IBD related hospitalization/surgery (6.7% and 0%, respectively). Patients who were not in remission were more likely to require escalation in immunosuppressive maintenance therapy (44.4% vs 6.7%, p 0.0015) and IBD related hospitalization/surgery compared to those in remission (18.5% vs 0.0%, p=0.02). No differences in COVID-19 related outcomes including need for hospitalization, ICU stay, use of COVID-19 related therapy such as monoclonal antibodies, and death were noted between the two groups (p>0.05).CONCLUSION:Our study suggests minimal impact of COVID-19 on IBD related outcomes in patients in remission. Patients who were not in remission did have worse IBD related outcomes compared to those in remission, however, the findings could reflect the natural history of IBD related disease rather than being related to COVID-19. COVID-19 related outcomes were no different in those who were not in remission versus those who were in remission. Future larger scale studies are warranted to study the findings further.

Membrane bioreactor technology (MBR) combines the technologies of activated sludge treatment with microfiltration membranes. Air introduces itself to the system to scour the membranes and drive the biological treatment. A vacuum on the membranes pulls out a high-quality and consistent effluent.

Objective To review and synthesise qualitative literature regarding the psychological outcomes following paediatric burn injuries, and to determine if children and adolescents who experience a burn injury have elevated risk of psychopathology following the injury. Design Systematic review of quantitative and qualitative studies. Data sources Informit health, Medline, Embase, and PsycINFO were searched from January 2010 to December 2020. Data extraction and synthesis Two reviewers screened articles, and one reviewer extracted data (with cross-checking from another reviewer) from the included studies and assessed quality using an established tool. Narrative synthesis was used to synthesise the findings from the quantitative studies, and thematic synthesis was used to synthesise the findings of included qualitative studies. Results Searches yielded 1240 unique titles, with 130 retained for full-text screening. Forty-five studies from 17 countries were included. The psychological outcomes included in the studies were mental health diagnoses, medication for mental illness, depression, anxiety, stress, fear, post-traumatic stress, post-traumatic growth, emotional issues, self-harm, self-esteem, self-concept, stigmatisation, quality of life, level of disability, resilience, coping, and suicidality. Conclusions Our findings highlight paediatric burn patients as a particularly vulnerable population following a burn injury. Studies suggest elevated anxiety and traumatic stress symptoms, and higher rates of psychopathology in the long-term. Further research is recommended to determine the psychological outcomes in the other mental health domains highlighted in this review, as findings were mixed. Clinical care teams responsible for the aftercare of burn patients should involve psychological support for the children and families to improve outcomes.

One of the most traumatic injuries a child can experience is a severe burn. Despite improvements in medical treatments which have led to better physical outcomes and reduced mortality rates for paediatric burns patients, the psychological impact associated with experiencing such a traumatic injury has mostly been overlooked. This is concerning given the high incidence of psychopathology amongst paediatric burn survivors. This project will aim to pilot test and evaluate a co-designed trauma-focused intervention to support resilience and promote positive mental health in children and adolescents who have sustained an acute burn injury. Our first objective is to collect pilot data to evaluate the efficacy of the intervention and to inform the design of future trauma-focussed interventions. Our second objective is to collect pilot data to determine the appropriateness of the developed intervention by investigating the changes in mental health indicators pre- and post-intervention. This will inform the design of future interventions. This pilot intervention study will recruit 40 children aged between 6-17 years who have sustained an acute burn injury and their respective caregivers. These participants will have attended the Stan Perron Centre of Excellence for Childhood Burns at Perth Children's Hospital. Participants will attend a 45-minute weekly or fortnightly session for six weeks that involves building skills around information gathering, managing reactions (behaviours and thoughts), identifying, and bolstering coping skills, problem solving and preventing setbacks. The potential effects and feasibility of our intervention will be assessed through a range of age-appropriate screening measures which will assess social behaviours, personal qualities, mental health and/or resilience. Assessments will be administered at baseline, immediately post-intervention, at 6- and 12-months post-intervention. The results of this study will lay the foundation for an evidence-based, trauma-informed approach to clinical care for paediatric burn survivors and their families in Western Australia. This will have important implications for the design of future support offered to children with and beyond burn injuries, and other medical trauma populations.

Background Advances in medicine have improved the chances of survival following burn injuries, however, psychosocial outcomes have not seen the same improvement, and burn injuries can be distressing for both the child or young person, negatively affecting their wellbeing. Pediatric burn patients are at a higher risk of developing psychopathology compared to the general population. In order to promote resilience and prevent psychopathology post-burn injury for pediatric burn patients, it is crucial to understand the experience of children and young people after a burn. This study aimed to understand the psychosocial impact that a pediatric burn has as perceived by the pediatric burn patient. Methods Seven pediatric burn patients were interviewed from the Perth Metropolitan area on average 3.1 years after their injury. All participants had been admitted to hospital for their acute injury and stayed for a median length of 2 days in hospital. Interviews with pediatric patients took place online, and the patients were asked about their mental health, coping strategies, changes to lifestyle and supports following their burn injury. The interviews were transcribed and then thematically analysed using an inductive approach. Results Three overarching themes were developed from the interviews: burn-specific impact on the child or young person (including appearance concerns, family factors, and lifestyle factors), the psychological impact (including positive and negative impact on mental health), and factors supporting the recovery journey (including coping strategies and support services). The participants in our study highlighted issues they faced during recovery, the positive and negative impacts of the injury and recovery process and provided suggestions for future opportunities to bolster resilience and promote growth for pediatric burn patients who may face similar challenges in the future. Conclusion Factors that improve the mental health and wellbeing of pediatric burn patients should be promoted, such as mental health and social supports, the promotion of adaptive coping mechanisms, and meeting the needs of the family unit as a whole. Ultimately, the implementation of trauma-focused, family centred interventions is crucial for the psychosocial recovery of pediatric burn survivors.

Recent cognitive, genetic, and histological studies have highlighted significant overlap between psychotic bipolar disorder and schizophrenia. Specifically, both bipolar disorder and schizophrenia are characterized by interneuron dysfunction within the hippocampus, an essential structure for relational memory. Relational memory impairments are a common feature of schizophrenia, but have yet to be investigated in psychotic bipolar disorder. Here, we tested the hypothesis that psychotic bipolar disorder is characterized by relational memory deficits. We used a transitive inference (TI) paradigm, previously employed to quantify relational memory deficits in schizophrenia, to assess relational memory performance in 17 patients with psychotic bipolar disorder and 22 demographically matched control participants. Functional magnetic resonance imaging was used to examine hippocampal activity during recognition memory in patients and controls. Hippocampal volumes were assessed by manual segmentation. In contrast to our hypothesis, we found similar TI performance, hippocampal volume, and hippocampal recruitment during recognition memory in both groups. Both psychotic bipolar disorder patients and controls exhibited a positive correlation between hippocampal volume and relational memory performance. These data indicate that relational memory impairments are not a shared feature of non-affective and affective psychosis.