scholarly journals Rapid implementation of a cohort for the study of post-acute sequelae of SARS-CoV-2 infection/COVID-19

2021 ◽  
Author(s):  
Michael J. Peluso ◽  
J. Daniel Kelly ◽  
Scott Lu ◽  
Sarah A. Goldberg ◽  
Michelle C. Davidson ◽  
...  
Keyword(s):  
San Francisco ◽  
Acute Phase ◽  
Medical Center ◽  
Population Level ◽  
Physical Symptoms ◽  
Post Traumatic Stress ◽  
Early Recovery ◽  
History Of ◽  
And Performance ◽  
Late Recovery

ABSTRACTBACKGROUNDAs the coronavirus disease 2019 (COVID-19) pandemic continues and millions remain vulnerable to infection with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), attention has turned to characterizing post-acute sequelae of SARS-CoV-2 infection (PASC).METHODSFrom April 21 to December 31, 2020, we assembled a cohort of consecutive volunteers who a) had documented history of SARS-CoV-2 RNA-positivity; b) were ≥ 2 weeks past onset of COVID-19 symptoms or, if asymptomatic, first test for SARS-CoV-2; and c) were able to travel to our site in San Francisco. Participants learned about the study by being identified on medical center-based registries and being notified or by responding to advertisements. At 4-month intervals, we asked participants about physical symptoms that were new or worse compared to the period prior to COVID-19, mental health symptoms and quality of life. We described 4 time periods: 1) acute illness (0-3 weeks), 2) early recovery (3-10 weeks), 3) late recovery 1 (12-20 weeks), and 4) late recovery 2 (28-36 weeks). Blood and oral specimens were collected at each visit.RESULTSWe have, to date, enrolled 179 adults. During acute SARS-CoV-2 infection, 10 had been asymptomatic, 125 symptomatic but not hospitalized, and 44 symptomatic and hospitalized. In the acute phase, the most common symptoms were fatigue, fever, myalgia, cough and anosmia/dysgeusia. During the post-acute phase, fatigue, shortness of breath, concentration problems, headaches, trouble sleeping and anosmia/dysgeusia were the most commonly reported symptoms, but a variety of others were endorsed by at least some participants. Some experienced symptoms of depression, anxiety, and post-traumatic stress, as well as difficulties with ambulation and performance of usual activities. The median visual analogue scale value rating of general health was lower at 4 and 8 months (80, interquartile range [IQR]: 70-90; and 80, IQR 75-90) compared to prior to COVID-19 (85; IQR 75-90). Biospecimens were collected at nearly 600 participant-visits.CONCLUSIONAmong a cohort of participants enrolled in the post-acute phase of SARS-CoV-2 infection, we found many with persistent physical symptoms through 8 months following onset of COVID-19 with an impact on self-rated overall health. The presence of participants with and without symptoms and ample biological specimens will facilitate study of PASC pathogenesis. Similar evaluations in a population-representative sample will be needed to estimate the population-level prevalence of PASC.

scholarly journals Managing the Patient With Pulmonary Arterial Hypertension and Methamphetamine Use: A Practical Perspective for the Clinician

2018 ◽  
Vol 17 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Nimaljeet Tarango ◽  
Andrea Gergay Baird
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
San Francisco ◽  
Medical Center ◽  
The United States ◽  
Methamphetamine Abuse ◽  
Methamphetamine Use ◽  
Personal Experiences ◽  
History Of ◽  
Pulmonary Arterial

Pulmonary arterial hypertension (PAH) is a serious, chronic, progressive cardiopulmonary disease. PAH is associated with several concomitant conditions, as well as drugs and toxins.12 Methamphetamine abuse is likely associated with the development of PAH.3 Methamphetamine abuse is epidemic in the United States and abroad, with rates of new users escalating since 2012. There are over 100,000 new users annually as young as 12 years old. Treating a patient with a history of methamphetamine abuse poses many challenges for a clinician, including nonadherence, therapeutic treatment selection, complex psychosocial issues, and relapse or continued drug abuse. Patients with methamphetamine-associated PAH (Meth-APAH) have higher mortality rates when compared to idiopathic PAH.3 Having a better understanding of the complexities of addiction and working with a multidisciplinary team that includes a social worker to provide care and counseling to these patients can improve their trajectory. In this article, we will offer insight and background into methamphetamine abuse and addiction, as well as discuss a practical approach for clinicians in treating a patient with Meth-APAH, based on the literature, as well as our personal experiences at University of California, San Francisco Medical Center.

scholarly journals Persistence, Magnitude and Patterns of Post-acute Symptoms and Quality of Life Following Onset of SARS-CoV-2 Infection: Cohort Description and Approaches for Measurement

2021 ◽  
Author(s):  
Michael J Peluso ◽  
J Daniel Kelly ◽  
Scott Lu ◽  
Sarah A Goldberg ◽  
Michelle C Davidson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Acute Phase ◽  
Limited Information ◽  
Physical And Mental Health ◽  
Post Traumatic Stress ◽  
Rigorous Approach ◽  
Symptoms Of Depression ◽  
Visual Analogue Scale Rating ◽  
History Of

Abstract BACKGROUND There is mounting evidence for the presence of post-acute sequelae of SARS-CoV-2 infection (PASC), but there is limited information on the spectrum, magnitude, duration, and patterns of these sequelae as well as their influence on quality of life. METHODS We assembled a cohort of adults with documented history of SARS-CoV-2 RNA-positivity who were ≥ 2 weeks past onset of COVID-19 symptoms or, if asymptomatic, first positive test. At 4-month intervals, we queried physical and mental health symptoms and quality of life. RESULTS Of the first 179 participants enrolled, 10 were asymptomatic during the acute phase of SARS-CoV-2 infection, 125 symptomatic but not hospitalized, and 44 symptomatic and hospitalized. During the post-acute phase, fatigue, shortness of breath, concentration problems, headaches, trouble sleeping and anosmia/dysgeusia were most common through 8 months of observation. Symptoms were typically at least somewhat bothersome and sometimes exhibited a waxing-and-waning course. Some participants experienced symptoms of depression, anxiety, and post-traumatic stress, as well as difficulties with performance of usual activities. The median visual analogue scale rating of general health was lower at 4 and 8 months compared to pre-COVID-19. Two clusters of symptom domains were identified. CONCLUSION Many participants report bothersome symptoms following onset of COVID-19 with variable patterns of persistence and impact on quality of life. The substantial variability suggests the existence of multiple sub-phenotypes of PASC. A rigorous approach to the prospective measurement of symptoms and functional manifestations sets the stage for the next phase of research focusing on the pathophysiologic causes of the various sub-groups of PASC.

The Relationship Between Pain and Depression

1996 ◽  
Vol 168 (S30) ◽  
pp. 101-108 ◽  
Author(s):  
Michael Von Korff ◽  
Gregory Simon
Keyword(s):  
Psychological Distress ◽  
Natural History ◽  
Depressive Disorders ◽  
Psychological Symptoms ◽  
Recovery Phase ◽  
Physical Symptoms ◽  
Early Recovery ◽  
History Of ◽  
Psychological Stressor ◽  
Pain Patients

Empirical results from epidemiological studies on pain–depression comorbidity in primary care and population samples have shown that: (a) pain is as strongly associated with anxiety as with depressive disorders; (b) characteristics that most strongly predict depression are diffuseness of pain and the extent to which pain interferes with activities; (c) certain psychological symptoms (low energy, disturbed sleep, worry) are prominent among pain patients, while others (guilt, loneliness) are not; (d) depression and pain dysfunction are evident early in the natural history of pain, but dysfunction and distress are often transient; and (e) among initially dysfunctional pain patients whose dysfunction is chronic, depression levels do not improve but neither do they increase over time with chronicity alone. These results seem consistent with these mechanisms of pain–depression comorbidity; (1) a trait of susceptibility to both dysphoric physical symptoms (including pain) and psychological symptoms (including depression), and a state of somatosensory amplification in which psychological distress amplifies dysphoric physical sensations (including pain); (2) psychological illness and behavioural dysfunction being interrelated features of a maladaptive response to pain evident early in the natural history of the condition, and often resolving during an early recovery phase; (3) pain constituting a significant physical and psychological stressor that may induce or exacerbate psychological distress. Thus, pain and psychological illness should be viewed as having reciprocal psychological and behavioural effects involving both processes of illness expression and adaption, as well as pain having specific effects on emotional state and behavioural function.

scholarly journals An Etiologic Assessment of ADHD and Trauma.

2020 ◽  
pp. 1-16
Keyword(s):  
San Francisco ◽  
School Environment ◽  
Urban School ◽  
Exploratory Research ◽  
Human Beings ◽  
Trauma Symptoms ◽  
Post Traumatic Stress ◽  
History Of ◽  
The Difference ◽  
Secondary Information

Abstract This research focused on recognition the difference between trauma and attention-deficit/hyperactivity disorder (ADHD) among children and youth in an urban school environment. The objective of this exploratory research was to gain a deeper understanding of the current challenges and barriers relating to assessments and treatments of children with a history of trauma and a putative diagnosis of ADHD. This research study reviewed a representative sample of qualitative observations made by clinicians who worked with children in urban school districts in the San Francisco Bay Area in northern California. In addition, we assessed secondary information of hand-written notes from past clinicians who previously worked in these same schools. We utilized reflexivity (researcher’s views/experiences) methods and framed within an evolutionary perspective, specifically the concept of the flight-freeze response to violence; this perspective offers us insight into how we as human beings react and respond to threats and violence in our lives. We concluded that among our sample, a significant portion of those diagnosed with ADHD had past trauma and trauma symptoms, and that there was noticeable overlap of symptoms that could be attributed to either ADHD or post-traumatic stress disorder (PTSD). This screening for trauma is critical for matters relating to the development of effective and appropriate interventions. We believe that conducting past family histories, and specifically conducting assessments of any history of past trauma, may help reduce the likelihood of misdiagnosing and may assist in being able to administer more effective treatments.

Endobronchial Ultrasound in Suspected Non-Malignant Mediastinal Lymphadenopathy

Pneumologie ◽  
2018 ◽  
Vol 72 (08) ◽  
pp. 559-567 ◽  
Author(s):  
L. Eickhoff ◽  
H. Golpon ◽  
P. Zardo ◽  
H. Suhling ◽  
T. Welte ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Malignant Disease ◽  
Medical Center ◽  
Needle Aspiration ◽  
Epithelioid Cell ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Transbronchial Needle Aspiration ◽  
History Of ◽  
And Performance

Abstract Background Endobronchial ultrasound (EBUS) bronchoscopy with transbronchial needle aspiration (TBNA) is a well-established tool in mediastinal staging in lung cancer and gains importance in exploration of non-malignant lymphadenopathy. The aim of this study was to evaluate the role of EBUS-TBNA in suspected non-malignant diseases. Methods A retrospective, single-center, observation analysis of endobronchial ultrasound bronchoscopy procedures was performed in a university medical center between March 2013 and July 2015. All patients with suspected non-malignant mediastinal lymphadenopathy were included. Cytopathological and microbiological results of EBUS were compared to clinical diagnosis 6 months after procedure and performance of EBUS was contrasted to malignant indications. Results During study period, 333 EBUS bronchoscopies in 315 patients with mediastinal lymphadenopathy were performed. 111 out of 315 (35 %) patients had neither primary signs nor history of a malignant disease, categorised as patients with suspected non-malignant disease. 245 lymph nodes were sampled (median size 15 mm [IQR10 – 19]). Preferred station for TBNA was lymph node station 7 (38 %). Cytopathological findings revealed non-specific inflammation (n = 81; 70 %), carcinoma (n = 7; 6 %), epithelioid cell granulomas (n = 20; 17 %). 7 samples (6 %) were non-representative. Microbiologic testing of lymph nodes identified 3 infections (Mycobacteria tuberculosis [n = 2] and Nocardia nova [n = 1]) relevant to antibiotic therapy. Minor adverse events were observed in 9 out of 115 (8 %) patients. Sensitivity of EBUS-TBNA intervention in suspected non-malignant disease was 76 % and specificity 96 %. Conclusions EBUS-TBNA revealed a specific cause for suspected non-malignant lymphadenopathy in one-third of cases and was associated with excellent specificity. Predominant specific causes were granuloma, besides from tumor. In 3 patients pathogen could be isolated by TBNA.

Sea Urchins and Circuses: The Modernist Natural Histories of Jean Painlevé and Alexander Calder

2018 ◽  
Vol 13 (2) ◽  
pp. 187-211
Author(s):  
Patricia E. Chu
Keyword(s):  
New Media ◽  
Sea Urchins ◽  
Life Sciences ◽  
Three Dimensional ◽  
Machine Age ◽  
Avant Garde ◽  
History Of ◽  
And Performance ◽  
The One ◽  
Natural Historian

The Paris avant-garde milieu from which both Cirque Calder/Calder's Circus and Painlevé’s early films emerged was a cultural intersection of art and the twentieth-century life sciences. In turning to the style of current scientific journals, the Paris surrealists can be understood as engaging the (life) sciences not simply as a provider of normative categories of materiality to be dismissed, but as a companion in apprehending the “reality” of a world beneath the surface just as real as the one visible to the naked eye. I will focus in this essay on two modernist practices in new media in the context of the history of the life sciences: Jean Painlevé’s (1902–1989) science films and Alexander Calder's (1898–1976) work in three-dimensional moving art and performance—the Circus. In analyzing Painlevé’s work, I discuss it as exemplary of a moment when life sciences and avant-garde technical methods and philosophies created each other rather than being classified as separate categories of epistemological work. In moving from Painlevé’s films to Alexander Calder's Circus, Painlevé’s cinematography remains at the forefront; I use his film of one of Calder's performances of the Circus, a collaboration the men had taken two decades to complete. Painlevé’s depiction allows us to see the elements of Calder's work that mark it as akin to Painlevé’s own interest in a modern experimental organicism as central to the so-called machine-age. Calder's work can be understood as similarly developing an avant-garde practice along the line between the bestiary of the natural historian and the bestiary of the modern life scientist.

Craft Beer's Unlikely Alchemist

2019 ◽  
Vol 19 (4) ◽  
pp. 78-90
Author(s):  
Theresa McCulla
Keyword(s):  
San Francisco ◽  
Assembly Line ◽  
The United States ◽  
Risk Tolerance ◽  
Small Scale ◽  
Intellectual Curiosity ◽  
Brewing Industry ◽  
Washing Machine ◽  
Craft Beer ◽  
History Of

In 1965, Frederick (Fritz) Maytag III began a decades-long revitalization of Anchor Brewing Company in San Francisco, California. This was an unexpected venture from an unlikely brewer; for generations, Maytag's family had run the Maytag Washing Machine Company in Iowa and he had no training in brewing. Yet Maytag's career at Anchor initiated a phenomenal wave of growth in the American brewing industry that came to be known as the microbrewing—now “craft beer”—revolution. To understand Maytag's path, this article draws on original oral histories and artifacts that Maytag donated to the Smithsonian Institution's National Museum of American History via the American Brewing History Initiative, a project to document the history of brewing in the United States. The objects and reflections that Maytag shared with the museum revealed a surprising link between the birth of microbrewing and the strategies and culture of mass manufacturing. Even if the hallmarks of microbrewing—a small-scale, artisan approach to making beer—began as a backlash against the mass-produced system of large breweries, they relied on Maytag's early, intimate connections to the assembly-line world of the Maytag Company and the alchemy of intellectual curiosity, socioeconomic privilege, and risk tolerance with which his history equipped him.

History of the Security Analysts of San Francisco

1960 ◽  
Vol 16 (1) ◽  
pp. 69-71
Author(s):  
William M. Bennett
Keyword(s):  
San Francisco ◽  
Security Analysts ◽  
History Of
Sign in / Sign up

Export Citation Format

Share Document