Faculty Bibliography

Background: Schizophrenia studies suggest aberrant alpha (8-12Hz), and few studies in clinical high risk (CHR) individuals for psychosis suggested the same. Here, we comprehensively evaluated alpha in CHR, accounting for the region and lower vs. higher alpha sub-bands, using new approaches developed by Corcoran et al. (2018), investigated its clinical relevance in CHR.
Method(s): Resting-state EEG recordings (60-channel, 5-min, eyes closed) were obtained on 27 CHR (14 males) and 21 healthy controls (HC; 10 males). Symptom severity assessed using the Structured Interview for Psychosis-Risk Syndromes. Power in lower (A1: IAF-2Hz) and higher (A2: IAF+2Hz) alpha sub-bands was estimated using a standardized assessment of alpha center of gravity, in frontal, central, and parietal channels clusters. Data analyzed using repeated-measures ANOVA and Spearman correlations between EEG features and clinical symptoms.
Result(s): Across all participants, power in A1 power was greater than in A2 power (p<0.001). Compared with HC, CHR had Moreover, significantly greater A1 power in frontal (p=.024) and parietal (p=.0325), but not in central (p=.2985) clusters, A1 observed in CHR compared to HC. However, A2 power in A2 was comparable between the two groups CHR and HC (p>.05). Lastly, A1 power (across all clusters) was negatively correlated with negative symptom severity (p<.05).
Conclusion(s): Results show that examination of constituent alpha bands, referenced to IAF, may reveal clinically relevant effects which otherwise are obscured in canonical alpha bands. Our finding of association of increased alpha with negative symptoms in CHR may be consistent with alpha being associated with "idling", inhibition and gating, and reduced long-range connectivity. Supported By: K01DA043615 ( MAP). R01MH107558 (CMC) Keywords: EEG, Clinical High Risk for Psychosis, Alpha, Resting-State, Schizophrenia
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INTRODUCTION: Hospitals experienced substantial stress during the COVID-19 pandemic-threats to standard operations- but it is not well known how this stress manifested at individual hospitals. We aimed to understand patterns of hospital stress over time, where stress was located within hospitals, and correlations between individual stress measures.
METHOD(S): We conducted a weekly hospital stress survey from November 2020 through May 2021 among site leaders from the SCCM Discovery Severe Acute Respiratory Infection - Preparedness (SARI-PREP) multicenter prospective cohort study. The survey assessed hospital stress ordinally and also assessed ED and ICU stress and deviations from standard operating procedures. Pairwise comparisons of strain measures were calculated by Pearson's correlation coefficients (r).
RESULT(S): Eight hospitals across three health systems in New York, California, and Washington contributed 190 hospital-weeks of data. Sites reported unavailability of some hospital resources resulting in potentially avoidable patient harm during 3.5% of hospital-weeks (with at least one such week at four hospitals); alterations in care processes and/or staffing which were fully compensated for during 57.9% of weeks; and no stress during 38.6% of weeks. During one December 2020 week, hospital stress, ICU stress, and care deviations were all present at 100% of reporting sites. The most common care deviations were increased hospital staffing (39.5%) and cancelling elective surgeries (18.6%). Hospital stress and care deviations were highly correlated (r = 0.81, p < 0.0001). Stress was more common in ICUs (72.4%) than EDs (14.3%), and ICU and ED stress were not correlated (r = 0.19, p = 0.05). While ED stress rose and abated earlier, ICU stress and care deviations persisted (range 2-13 weeks longer) as local case rates declined.
CONCLUSION(S): Hospital stress during the pandemic varied in degree and type both within and among hospitals over time. Care deviations were common but potentially avoidable patient harm was rare. Systematic national assessments of hospital stress, both during and between pandemics, could inform more rapid, proactive public health responses to novel threats. Areas for further study include impacts from persistent low-level stress and longer-term consequences for hospitals and their communities

OBJECTIVES: We designed a prospective cohort study to systematically study patients with severe acute respiratory infection (SARI) and improve hospital preparedness (SARI-PREP). The goal of this project is to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with SARI clinical outcomes and severity.
METHOD(S): In collaboration with the Society of Critical Care Medicine Discovery Research Network and the National Emerging Special Pathogen Training and Education Center (NETEC), SARIPREP is an ongoing, prospective, observational, multi-center cohort study of hospitalized patients with respiratory viral infections. We collected patient demographics, signs, symptoms, and medications; microbiology, imaging, and other diagnostics; mechanical ventilation, hospital procedures, and other interventions; and clinical outcomes. Hospital leadership completed a weekly hospital stress survey. Respiratory, blood, and urine biospecimens were collected from patients on days 0, 3, 7-14 after study enrollment and at hospital discharge. MEASUREMENTS AND MAIN RESULTS: SARI-PREP enrollment began on April 4, 2020 and currently includes 674 patients. Here we report results from the first 400 patients: 216 are from the University of Washington Hospitals, Seattle WA, 142 from New York University, New York NY and 42 from University of Southern California, Los Angeles, CA. Almost all tested positive for SARS-CoV-2 infection (n=397), whereas 3 patients tested positive for an alternative viral pathogen. The mean (+/-SD) age of the patients was 57+/-16 years; 72% were men, 62% were White, 14% were Asian, 12% were Black, and 31% were Hispanic. Most of the patients were admitted to the intensive care unit (96%). The median (interquartile range) hospital length of stay was 22 (9-46) days. Rates of invasive mechanical ventilation (72%) and renal replacement therapy (19%) were common and the rate of hospital mortality was 35%.
CONCLUSION(S): Initial SARI-PREP analysis indicates enrollment of a diverse population of hospitalized patients primarily with SARSCoV-2 infection. The demographics and clinical outcomes of our cohort mirror other large critically ill cohorts of COVID-19 patients. Results of a concomitant, weekly, hospital stress assessment are reported separately

BACKGROUND:Giant cell tumor of tendon sheath (GCTTS), also known as localized nodular tenosynovitis, is a benign neoplasm that occurs principally on the digits. The cytomorphologic features of this lesion on fine needle aspiration (FNA) have not been fully characterized. CASES/METHODS:In case 1, a 23-year-old female presented with a circumscribed soft tissue swelling in the left second toe. In case 2, a 16-year-old female presented with a tender swelling at the base of the right great toe. FNA smears in both instances were highly cellular, with mononuclear cells predominating and interspersed binucleated and multinucleated osteoclastlike giant cells along with hemosiderin-laden macrophages. CONCLUSION/CONCLUSIONS:When interpreted along with clinical data, the diagnosis of GCTTS can usually be made with certainty using FNA cytology.

OBJECTIVE:To determine interobserver and intraobserver variability of AgNOR quantitation in neoplastic lesions of the breast. STUDY DESIGN/METHODS:Forty-five cases, 20 benign and 25 malignant lesions, were included in the study. Counts were performed on one slide from each case within a pre-marked area of about 1 cm2 in a standardized manner by two observers blind to the histopathologic diagnosis and independent of each other and repeated after two weeks. Interobserver and intraobserver agreement was assessed using the Bland-Altman method. RESULTS:Our results showed small mean interobserver and intraobserver differences but wide limits of agreement. CONCLUSION/CONCLUSIONS:Observer variation in AgNOR counts is too high for the method to be of any diagnostic or prognostic relevance.