IV magnesium sulfate reduced asthma exacerbations in pediatric population

A recent study by Dominika Ambrożej explored the effectiveness of intravenous magnesium sulfate (IV-MgSO4) as a secondary treatment for acute asthma exacerbations in children. Asthma is the most prevalent chronic disease affecting children worldwide that poses a significant healthcare burden by prompting the urgent need for reliable secondary therapies. The key findings were published in the journal of Paediatric Respiratory Reviews.

This meta-analysis evaluated data from randomized clinical trials to assess the efficacy and safety of IV-MgSO4 in managing acute asthma exacerbations in children. The primary outcomes focused on hospitalization rates, length of hospital stay and changes in severity scores, while the secondary outcomes included measures such as peak expiratory flow rate (PEFR), hospital re-admission rates and adverse effects.

The findings from the analysis encompassed a total of eleven studies that revealed that administration of IV-MgSO4 to children experiencing acute asthma exacerbations showed a sizeable reduction in the risk of hospitalization by indicating its potential as a valuable secondary treatment option. In comparison to standard therapies, IV-MgSO4 demonstrated an improvement in lung function, as evidenced by an increase in PEFR in select studies.

The analysis highlighted the rarity of adverse effects associated with IV-MgSO4 by further underscoring its potential as a safe intervention for pediatric asthma management. This study also noted the need for additional well-designed research to further elucidate the efficacy and safety profile of IV-MgSO4.

This significant advancement in asthma management offers hope for millions of children with this condition globally. By providing clinicians with valuable insights into an effective secondary treatment option, this research suggests the potential to enhance the quality of care and reduce the healthcare burden associated with childhood asthma exacerbations.

Source:

Ambrożej, D., Adamiec, A., Forno, E., Orzołek, I., Feleszko, W., & Castro-Rodriguez, J. A. (2024). Intravenous magnesium sulfate for asthma exacerbations in children: Systematic review with meta-analysis. In Paediatric Respiratory Reviews. Elsevier BV. https://doi.org/10.1016/j.prrv.2024.01.003

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Excessive Daytime Sleep during Infancy may predict poor working memory at school age

The maturation of sleep patterns during early life plays a crucial role in cognitive development. Understanding the relationship between daytime sleep duration (DSD) in infancy and cognitive outcomes in later childhood is essential for identifying potential markers of cognitive health.

A recent study aims to analyze the association between DSD during infancy and cognitive development at 6 and 10 years of age. This study was published in the Journal Of Clinical Sleep Medicine by Jianfei Lin and colleagues. Daytime sleep duration in infancy is considered an indicator of sleep maturation and is closely linked to cognitive development. However, the long-term implications of excessive daytime sleep during infancy on cognitive function in school-aged children remain unclear.

The study included 262 mothers and their newborns from the Shanghai Sleep Birth Cohort Study, with follow-ups spanning from 42 days to 10 years. Sleep parameters were assessed using parent-report questionnaires at each follow-up, while cognitive development was evaluated using the Wechsler Intelligence Scale for Children, 4th edition at 6 and 10 years.

The key findings of the study were:

  • Two distinct trajectories of DSD during early childhood were identified: “typical DSD” (66.7%) and “infancy excessive DSD” (33.3%).

  • Children in the “infancy excessive DSD” trajectory exhibited significantly lower working memory scores compared to those in the “typical DSD” trajectory at 6 years (Mean difference=5.90, 95% CI [1.83, 9.96], p=0.005) and 10 years (Mean difference=4.37, 95% CI [0.26, 8.48], p=0.037).

  • Additional analysis in a relatively homogeneous sample consistently showed correlations between DSD trajectories and working memory performance.

  • No consistent significant differences were found in other domains of cognitive development.

Excessive daytime sleep during infancy may serve as an early indicator for poor working memory in school-aged children. These findings underscore the importance of monitoring sleep patterns during infancy and their potential impact on long-term cognitive development. Further research is needed to elucidate the underlying mechanisms and explore interventions to support cognitive health in children with excessive DSD during infancy.

Reference:

Lin, J., Jiang, Y., Xiao, X., Zhu, Q., Wang, G., Lin, Q., & Jiang, F. Daytime sleep duration during infancy as an indicator for cognitive development at school age: a prospective cohort study. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine,2024. https://doi.org/10.5664/jcsm.11062

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Foot Care may Prevent Diabetes related Amputations among diabetes patients with Kidney Failure on dialysis: JAMA

A recent retrospective cohort study published in the Journal of American Medical Association highlight the critical importance of foot and ankle care for patients with kidney failure who are at risk of diabetes-related foot ulcers (DFUs). The patients who received foot and ankle care from podiatrists in the three months preceding a DFU diagnosis experienced significantly better outcomes when compared to those who did not. Among the nearly 15,000 adult patients analyzed, 18.4% received podiatric care prior to their DFU diagnosis.

The study analyzed data from 2016 to 2019 and found that patients who had received podiatric care were older, more likely to be male and had more comorbidities than those who hadn’t. However, they expressed a lower likelihood of death and/or major amputation, as well as a reduced likelihood of major amputation alone. Over a mean follow-up period of 13.5 months, 70% of patients with podiatric care experienced death and/or major amputation when compared to 74% in the non-podiatric group. The survival probabilities at 36 months were notably higher among those who received foot and ankle care.

The multivariate regression analysis further reinforced the association between foot and ankle care and reduced the likelihood of adverse outcomes. The patients who received such care were associated with an 11% lower likelihood of death and/or amputation, and a 9% lower likelihood of major amputation.

These findings underline the importance of proactive foot care in reducing the risk of diabetes-related amputations among patients with kidney failure. With diabetes being a common comorbidity in individuals undergoing dialysis to ensure regular foot and ankle care by podiatrists could significantly improve the outcomes and quality of life of patient.

Source:

Tan, T.-W., Caldwell, B., Zhang, Y., Kshirsagar, O., Cotter, D. J., & Brewer, T. W. (2024). Foot and Ankle Care by Podiatrists and Amputations in Patients With Diabetes and Kidney Failure. In JAMA Network Open (Vol. 7, Issue 3, p. e240801). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.0801

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Interventions like mindfulness and CBT effective treatment options for non-physical symptoms of menopause: Study

Interventions such as mindfulness and cognitive behavioural therapy (CBT), could be an effective treatment option for menopause-related mood symptoms, memory and concentration problems, finds a new study by UCL researchers.

The research, published in the Journal of Affective Disorders, is the most up-to-date study of its kind, providing a meta-analysis of 30 studies involving 3,501 women who were going through the menopause in 14 countries, including the UK, USA, Iran, Australia, and China.

Lead author, Professor Aimee Spector (UCL Psychology & Language Sciences), said: “Women can spend a notable number of years in their lives dealing with a range of menopausal symptoms, such as hot flushes, mood changes and brain fog. These symptoms can have a great impact on women’s wellbeing and quality of life.

“Menopause management is now a prioritised topic in public health. However, most studies of menopause symptom management focus on hormonal replacement therapy and physiological symptoms. This restricts treatment options for women who are concerned about the risks of hormone replacement therapy and overlooks the wellbeing of women with non-physiological symptoms, such as brain fog and mood problems, which are highly prevalent.”

The studies that were analysed examined the effects of several different kinds of therapies on mood, cognition and quality of life.

Ten studies explored the impact of CBT-based interventions on menopausal symptoms, while nine provided Mindfulness-Based Interventions (MBI) and the remaining eleven studies encompassed Acceptance and Commitment Therapy (ACT), group counselling, marital support, health promotion coaching, and emotional freedom techniques.

The CBT-based interventions included educating women about the psychological symptoms of the menopause, alongside cognitive and behavioural strategies, relaxation techniques, and symptom monitoring.

Meanwhile, MBI-based therapies promoted a focus on the present experiences of women and a non-judgemental understanding of symptoms.

Symptoms were measured using standardised, internationally recognised self-report instruments, including the Patient Health Questionnaire PHQ-9 (which considers factors such as a lack of interest in doing things, issues with sleep, and feelings of low mood) and the GAD7 questionnaire (which asks how often a person feels worried, on edge or unable to relax).

The researchers found that women showed statistically significant improvements in anxiety and depression following CBT and MBI when compared to no or alternative treatments. This equates to small to medium changes in everyday life.

CBT and group-based psychosocial interventions were also effective in reducing memory and concentration difficulties.

All psychosocial interventions were effective in improving quality of life, regardless of their type.

With regards to the delivery of these interventions, the study suggests that CBT is the most cost-effective option for menopause management – as compared to other forms of therapy, it requires a shorter course of treatment (around 1.5 hours per session and 11.8 hours in total).

Co-author and master’s graduate, Zishi Li (UCL Psychology & Language Sciences), said: “This study provides encouraging evidence to support the use of psychosocial interventions for managing non-physiological menopausal symptoms. This is in line with the NICE Menopause guidelines, updated in 2023 and currently in the consultation phase, which promote CBT as a treatment option.”

Senior author Dr Roopal Desai (UCL Psychology & Language Sciences), said: “GPs and healthcare providers often struggle to know what to offer beyond medical treatment. This research will help give GPs and patients more options.”

In November 2023, NICE drafted updated guideline recommendations to include more treatment choices for menopause symptoms, with evidence showing that CBT could help reduce symptoms such as hot flushes and night sweats, depressive symptoms and problems sleeping.

Consequently, the guidelines stated that CBT should be considered alongside or as an alternative to Hormone Replacement Therapy (HRT).

However, this is the first study to consider other forms and doses of therapy, alongside assessing which type is best for different symptoms.

Experts at UCL have also teamed up with leading women’s health charities to design a new education and support programme for women across the UK experiencing menopause*.

Study limitations

Without individual patient data, the study is unable to consider the best stage of the menopause to deliver interventions.

The research also can’t account for the long-term symptom changes that occur with different types of therapy. For example, some interventions may require longer exposure to show more significant effects, whilst the benefits of others might fade with time.

Reference:

Aimee Spector, Zishi Li, Lexi He, Yasmeen Badawy, Roopal Desai, The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis, Journal of Affective Disorders, https://doi.org/10.1016/j.jad.2024.02.048.

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Inpatient hyperglycemia, regardless of diabetes status, tied to risk of AKI, stroke, and infections: Study

Australia: Inpatient hyperglycemia leads to harmful outcomes for all hospital patients, irrespective of whether they have diabetes, a recent study published in The Journal of Clinical Endocrinology & Metabolism has suggested.

“Hyperglycemia in-hospital raises the risk of healthcare-associated infection (HAI), stroke, and acute kidney injury (AKI),” the researchers reported. “Patients who experienced hyperglycemia without a prior diabetes diagnosis had a greater risk of mortality.”

Hyperglycemia in hospital inpatients without pre-existing diabetes is linked with increased mortality. However, there is no clarity on the independent contribution of hyperglycemia to acute kidney injury, stroke, and healthcare–associated infection. Therefore, Rahul D. Barmanray, The University of Melbourne, Melbourne, Australia, and colleagues aimed to investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes.

For this purpose, the researchers performed Diabetes IN-hospital: Glucose and Outcomes (DINGO), a 26-week (October 2019-March 2020) prospective cohort study. Glucose and clinical data were collected up to the 14th day of admission. Primary stratification was by hyperglycemia, defined as ≥2 random capillary blood glucose (BG) measurements ≥11.1 mmol/L (≥200 mg/dL).

To allow interrogation of causality, propensity weighting for nine clinical characteristics was performed. To maintain the positivity assumption, patients with HbA1c >12.0% were excluded and prehospital treatment was not adjusted for.

The study was set in the Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia. Admissions with at least 2 capillary glucose values and a length of stay >24 hours were eligible, with half randomly sampled. Outcome measures were AKI, HAI, stroke, and mortality.

The study led to the following findings:

  • 45% experienced hyperglycemia in hospital of 2558 included admissions.
  • Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of 9 covariables, contribute to an increased risk of in-hospital HAI (11.3% vs 7.1%, adjusted odds ratio [aOR] 1.03), AKI (10.5% vs 4.2%, aOR 1.07), and stroke (0.9% vs 0.1%, aOR 1.05).

“In hospital inpatients (HbA1c ≤12.0%), regardless of diabetes status and prehospital glycemia, hyperglycemia raises the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia,” the researchers concluded.

Reference:

Barmanray, R. D., Kyi, M., Worth, L. J., Colman, P. G., Churilov, L., Fazio, T. N., Rayman, G., Gonzalez, V., Hall, C., & Fourlanos, S. Hyperglycemia in Hospital: An Independent Marker of Infection, Acute Kidney Injury, and Stroke for Hospital Inpatients. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgae051

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Negligence, Deficiency in Service during Choledocholithiasis Treatment: Fortis Hospital, Gastroenterologist Slapped Rs 5 Lakh Compensation

Kangra: Holding Fortis Hospital and its Gastroenterologist guilty of gross negligence, dereliction of duty and deficiency of service while providing treatment for Choledocholithiasis, the District Consumer Disputes Redressal Commission (DCDRC), Kangra recently directed them to pay Rs 5 lakh compensation to the patient.

“The complainant, who had gone to Fortis Hospital during Covid-19 period for the treatment of Choledocholithiasis, was not treated properly and was subjected to another ERCP procedure in the month of August, 2021. Thus, the opposite parties are liable to pay a hefty compensation to the complainant for act of dereliction,” opined the District Consumer Court.

“Accordingly, the complaint is allowed and opposite parties are jointly and severally directed to pay an amount of Rs.5,00,000/- as compensation to the complainant. Apart from this, opposite parties are jointly & severally also directed to pay litigation cost quantified as Rs.20,000/-,” it ordered.

The history of the case goes back to 2020 when the complainant was suffering from abdomen pain and vomiting. After initial treatment, she was diagnosed with Choledocholithiasis. After being checked at Apollo Clinic in Indrapuram, she was referred to the treating doctor- Dr. Bhalla (Gastroenterologist) for ERCB & Stenting treatment.

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts and pancreas. 

After examination in OPD, the complainant was admitted to Fortis Hospital on 15.12.2020 and remained under treatment till 19.12.2020. During the admission period, she was operated and ERCP + EPT with Biliary Stenting was done as per the medical record of the treatment. During her discharge, the complainant was advised to revisit after 5 days and accordingly, the complainant went for the follow-ups. She was examined and was given medicines. However, allegedly, there was no relief from pain.

It was alleged by the complainant that afterwards, during treatment at Amandeep Hospital at Pathankot (Punjab), it was found that the treating doctor at Fortis had extracted amount from the complainant in the name of ERCP, Stenting and even removal of stenting, though she was not operated or treated. Therefore, alleging deficiency in the service on the part of the doctor and hospital, the complainant filed the complaint before the District Consumer Court, Kangra.

On the other hand, the counsel for the hospital and doctor submitted that they complied with the standard medical procedure in the treatment of the ERCP and Stone removal and Biliary Stenting. It was further submitted that there was no negligence or any deficiency in the treatment of the Complainant or any other deficiency while treating the patient.

They further argued that the complainant did not file any medical evidence or expert opinion to establish the allegation that the Stenting procedure was not done by them. The hospital and the doctor claimed that there was no negligence or lack of care because they had given their best effort and also provided the best treatment in every possible way to the Complainant throughout her admission and she was discharged in a stable condition without any complaint.

While considering the matter, the Consumer Court took note of the Discharge Summary that mentioned that Endoscopic Retrograde Cholangiopancreatography (ERCP), stone removal and biliary stenting procedure were done on the complainant. 

The Commission also took note of the submission by Dr. Gurkha, who conducted the subsequent ERCP procedure. The doctor submitted that he had not seen the stent which was placed earlier by Fortis Hospital, so he placed new stent by performing ERCP procedure. He also removed stones after completing ERCP. 90% CBD (Common Bile Duct) was cleared from stones at the time of ERCP on 6.08.2021. Dr. Gurkha on 17.10.2021 removed the stent placed on 06.08.2021 and also cleared remaining 10% of stones from CBD.

He further admitted that the earlier report dated 17.12.2020 of Fortis Hospital was not shown to him. As per Dr. Gurkha, findings of ultrasound showed that there were stones in the bile duct. However, he was no sure that the earlier stent placed by Fortis Hospital was migrated by natural means, but he admitted that stent could migrate through natural means in some cases.

Referring to the statement of Dr. Gurkha, the Consumer Court observed that despite the cross-examination, there was no specific denial made by Fortis Hospital and the doctor that the stones were removed from the Common Bile Duct (CBD) during the second procedure by Dr. Gurkha.

“Meaning thereby the procedure done by the Dr. Gurkha was admitted to be true by the opposite parties,” observed the consumer court, adding that the counsel for Fortis also did not explain the formation of stones within seven months of post-cholecystectomy.

At this outset, the Commission observed,

“So the opposite parties were having ample opportunities but still have not explained the presence/formation of stones in the common bile duct after the procedure carried by the Opposite Party No.2 on 17-12-2020 in the Fortis Hospital Mohali. In our considered opinion procedure notes were not maintained/prepared properly in the Fortis Hospital Mohali. Due diligence required to be adhered while preparing the procedure notes were not as per standard medical practice. Comparing the notes prepared by Dr. Suresh Gurkha and the opposite party No.2, we observe certain specific deviations from standard medical procedure in the procedure notes.”

Referring to relevant medical literature, the Commission noted that the ERCP procedure is performed before cholecystectomy to clear the common bile duct and remove the gallstones and sludge from the common bile duct to avoid having recurrent pain and jaundice after gallbladder surgery (laparoscopic cholecystectomy).

“In our opinion once the gallbladder was already removed then it was not explained by the opposite parties that how the stones were again formed in the Common Bile duct after the clearance of Common bile duct on 17.12.2021. This unexplained reason is not supported by any medical authority/citation. Even in follow up visit no such advisory was given to the complainant,” the consumer court noted at this outset.

The Commission opined that once the Hospital and the doctor claimed to follow standard medical procedure, then the onus is also shifted upon them to prove that as per standard medical protocol or citations, the stone formation can re-occur within 7 months of the clearance of CBD. 

“Even the opposite parties had not mentioned in their reply that the stones in CBD can reoccur within 7 months after removal that too when the gall bladder is removed already. The entire emphasis of the opposite party on the stent which was stated to be placed while performing ERCP procedure on 17-12-2021. If this version of the opposite parties for the argument sake regarding migration of stent is believed to be true, then it can be inferred only that stent so affixed has been migrated through natural means, but as the stones from CBD was removed by Dr. Suresh Gurkha, we are of the opinion that in earlier operation/procedure stones stated to be removed by the Opposite party No.2 were actually not removed either at all or properly,” it noted.

The Commission referred to the Supreme Court order in the case of Mohit Jain vs. M/S Max Super Specialty Hospital & Ors., where the Apex Court laid certain parameters specifying that to bring a successful claim the victim or victim’s family bringing the action must prove all the “four D’s” against the erring doctor/hospital.

Referring to the case concerned, the Commission noted that the complainant proved negligence by Fortis and its doctor by leading a cogent reliable evidence supported by an evidence of an expert Dr. Gurkha that certainly there was dereliction from duty of care caution by the hospital and its doctor.

“The notes even were not maintained as per standard medical procedure by the opposite parties and there is indeed direct cause to the damages (second ERCP procedure). In our considered opinion, it was the duty of the opposite party No.2 to maintain the proper records of the procedure. If some stones had remained inside the common bile duct or there are chances of reoccurrence, it was to be mentioned in the discharge Summary or in the further follow up visits,” it noted.

Therefore, holding Fortis Hospital and its doctor liable, the Consumer court noted, “We are of the opinion that there was gross negligence, dereliction specifically on the part of opposite party No.2 and deficiency in service on the part of the opposite parties,” and slapped Rs 5 lakh compensation and Rs 20,000 legal cost on them.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/beena-vs-fortis-hospital-220224-233503.pdf

Also Read: Sir Ganga Ram Hospital calls compensation order of Delhi Consumer Court surprising

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Panipat Hospital wrongly charges Ayushman Card holder, Consumer Court orders refund, compensation to patient

Panipat: The Panipat bench of the District Consumer Disputes Redressal Commission has held Oscar Super Speciality Hospital & Trauma Centre liable for deficiency in services as it wrongly charged a patient, who held an Aayushman card, for treatment. The bench ordered the hospital to reimburse Rs. 20,615/- to the complainant and compensate him with Rs. 5,000/-, in addition to covering litigation costs of Rs. 5,500/-.

The order was announced in open court on February 12, 2024, by Dr. R.K. Dogra, President, and Dr. Rekha Chaudhary, Member, District Consumer Disputes Redressal Commission, Panipat.

The case involved Singh, who filed a complaint against Oscar Super Speciality Hospital & Trauma Centre, Panipat, for alleged deficiency in service and unfair trade practices.

The complainant holds an Aayushman card, making him eligible for medical treatment across various hospitals. Following an accident on June 18, 2023, the complainant sought treatment at the hospital operated by Oscar Super Speciality Hospital & Trauma Center, purportedly enlisted on the government’s panel.

However, the hospital officials allegedly demanded monetary compensation for the treatment, even though the complainant presented his Aayushman card. The complaint contends that the hospital officials unlawfully insisted on payments amounting to Rs.15,000/-, Rs.2000/-, Rs.1665.85/-, Rs.800/-, and Rs.4000/- for services such as X-ray and blood tests. He was later treated at Virk Hospital free of cost under the Aayushman card.

Aggrieved, Singh filed a complaint with the District Commission seeking a refund of Rs. 25,000, Rs. 1,00,000 as compensation for mental pain, and Rs. 22,000 as litigation expenses. The hospital was proceeded against ex-parte as they did not appear despite notice.

Upon examination of the complainant’s arguments and documents, two main issues were noted by the Commission. Firstly, determining the legitimacy of the complainant’s claim for Rs.25,000/-, including interest and other related factors; and secondly, defining the appropriate relief to be awarded to the complainant.

The Commission observed that the terms and conditions of the Aayushman Card indicated that the complainant should have received free treatment. However, the hospital, despite explanations, wrongly and illegally collected Rs.20,615/-. Numerous oral requests for a refund were unsuccessful, and the hospital refused any repayment. The circumstances strongly indicate that the hospital incorrectly charged the complainant for treatment, and the complainant is rightfully entitled to reclaim the amount. The hospital, having remained absent, was proceeded against ex parte on September 29, 2023, leaving the complainant’s evidence unchallenged. It noted;

“..as per the terms and conditions of the Aayushman Card free of cost treatment should have been given to the complainant but despite explaining all positions to the respondent, they recovered Rs.20,615/- wrongly and illegally. Despite so many oral requests, the money was demanded back from the respondent but all in vain and lastly refused to make payment of even a single penny. All the circumstances are proving that the respondent has wrongly received the treatment charges from the complainant and complainant is certainly entitled for taking the same back from the respondent.”

Subsequently, the Commission, after considering the arguments presented by the complainant’s counsel and thoroughly reviewing the available records and unrebutted evidence, favoured the complainant and directed Oscar Super Specialty Hospital and Trauma Centre to pay Rs.20,615/- to the complainant within 45 days of the order, along with interest at the rate of 9% per annum from the date of filing the complaint until actual realization. It held;

“…it is ordered the opposite party i.e. Oscar Super Specialty Hospital and Trauma Centre be directed to make the payment of Rs.20,615/- to the complainant within 45 days of this order along-with interest @ 9% per annum from the date of filing of this complaint till its actual realization. Opposite party is further directed to pay Rs.5,000/- as compensation and Rs.5500/- as litigation expenses failing which the complainant will be entitled to recover the whole amount with interest @12% from the date of order till its actual realization.”

“In case, opposite party fails to do so, then the complainant can file the execution petition under section 71 of Consumer Protection Act, 2019 and in that eventuality, the opposite party may also be liable for prosecution under Section 72 of the said Act. Copies of this order be sent to the party free of costs, as per C.C. No. 296-2023 Dariya Singh Versus Oscar Super Speciality Hospital & Trauma Centre 6 rules, and this order be promptly uploaded on the website of this Commission. File be consigned to the record room after due compliance.”

To view the original order, click on the link below:

https://medicaldialogues.in/pdf_upload/judgement2024-02-12-232617.pdf

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The cost of Prop. 1: Newsom’s plan to transform California’s mental health system

If approved by voters on Tuesday, Gov. Gavin Newsom’s ballot measure to overhaul the state’s mental health services system and sell bonds to finance more than 10,000 treatment beds across California could cost the state up to $14 billion.

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Study finds the timing of CSF biomarker divergence for Alzheimer disease, normal cognition varies

Cerebrospinal fluid (CSF) and other biomarkers differ for individuals with Alzheimer disease and cognitively normal controls, with the estimated times of divergence varying from 18 to six years before diagnosis, according to a study published in the Feb. 22 issue of the New England Journal of Medicine.

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COVID-19 rapid tests still work against new variants—researchers keep ‘testing the tests,’ and they pass

By September 2020, just six months after COVID-19 triggered shutdowns across the U.S., it was clear that SARS-CoV-2, the virus that causes COVID-19, had mutated from its original form.

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