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Item type: Item , Access status: Open Access , Catatonia in anti-NMDA receptor encephalitis: a case series and approach to improve outcomes with electroconvulsive therapy.(BMJ neurology open, 2024-01) Kraiter, F Gabriela; May, Dakota T; Slauer, Ryan D; Abburi, Nandini; Eckstein, Christopher; Shah, Suma; Komisar, Jonathan R; Feigal, Jacob PBackground
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has been recognised to present with the syndrome of catatonia. In severe cases dysautonomia is representative of malignant catatonia. The treatment with benzodiazepines (BZDs) and electroconvulsive therapy (ECT) may decrease morbidity and mortality in patients presenting with anti-NMDA receptor encephalitis and catatonia.Methods
This is a retrospective case series of eight patients with anti-NMDA receptor encephalitis treated with ECT. We use clinical prediction scores (Clinical Assessment Scale for Autoimmune Encephalitis [CASE] and anti-NMDAR Encephalitis One-Year Functional Status scores) to compare expected outcomes and observed outcomes.Results
CASE scores in our group ranged between 5 and 19, with a mean score of 13.8 (median 15.5). NEOS scores ranged from 2 to 4, with a mean and median of 3. Of the eight patients, six had a favourable modified Rankin Score (0-2) at a follow-up of 8 to 12 months. Patients received an average of 29.9 ECT treatments in total.Conclusions
Based on clinical prediction scores, this cohort had better than expected functional outcomes. We discuss the use of BZDs and ECT in these cases and propose a treatment algorithm for patients who present with catatonic syndrome in anti-NMDA receptor encephalitis.Item type: Item , Access status: Open Access , Conscious of Conscience: Moral Distress as a Trigger for Deeper Reflection on Harm.(The Linacre quarterly, 2025-07) Meza-Venegas, Joyce; Slauer, Ryan; Briscoe, JoshuaThough clinicians aspire to benefit their patients and not harm them, conflict arises when patient and clinician disagree on what constitutes benefit and harm. Here, we report a case in which a patient has strong opinions on which treatments are appropriate for him. The clinician disagrees on the nature of the patient's illness and on the proposed treatments. However, she felt forced to ignore her intuition and conscience, which led to moral distress. This experience inspires her to reflect on her own moral development and the healthcare system around her. One framework that helps make sense of such moral distress is that offered by Curlin and Tollefsen in their 2021 book The Way of Medicine: Ethics and the Healing Profession. There, they distinguish between two contrasting accounts of medicine's purpose. In one, the Provider of Services Model (PSM), health care is a service provided to patients, and clinicians are viewed as technicians. In the other, the Way of Medicine (WoM), clinicians are entrusted to work collaboratively to support and promote their patients' health. In our case, the clinician was stuck in the PSM, which exposed her to moral distress. A framework based on the WoM, on the other hand, protects against moral distress and therefore benefits both patients and clinicians. We argue that a virtue ethics framework can help clinicians facing similar dilemmas better care for themselves and more effectively "do no harm."Item type: Item , Access status: Open Access , Lung transplantation from donation after circulatory death donors over 55 years old: A national analysis of outcomes and utilization(Jhlt Open, 2026-02-01) Alderete, IS; Halpern, SE; Jawitz, OK; Gurses, A; Jiang, H; Date, H; Klapper, J; Hartwig, MG; Patel, KJBackground: Lungs from older donation after circulatory death (DCD) donors are underutilized; however, these organs may represent an opportunity to expand the donor pool. Herein, we evaluated utilization and outcomes of lung transplants using lungs from older DCD donors. Methods: Using national data from 2016 to 2024, we identified all adult DCD donors and corresponding isolated lung transplant recipients. Multivariable logistic regression was used to identify predictors of lung utilization. Kaplan-Meier and Cox proportional hazards methods were used to compare graft survival between recipients of lungs from DCD donors <55 and ≥55 years. Results: Among 10,769 older (age ≥ 55) DCD donors identified, lungs were transplanted from only 302 (2.8%) with significant organ procurement organization- and center-level variation in use. Just one center exceeded 50 transplants using older DCD donors over the study period. Utilization increased over time (7 cases in 2016 vs 111 in 2024; p < 0.001). Ex-vivo lung perfusion (odds ratio 5.93) and higher PaO₂/FiO₂ ratio (odds ratio 1.33 per 50-point increase) were independently associated with transplantation of older DCD donor lungs. One- and three-year graft survival were similar between age groups; older donor age was not associated with increased risk of graft failure in adjusted models. Conclusions: Lungs from older DCD donors remain underutilized despite comparable outcomes. Their use is highly concentrated among a small number of centers and organ procurement organizations, suggesting that local behaviors and infrastructure strongly influence disposition. Broader adoption of ex-vivo lung perfusion and strategic recipient matching may support safe expansion of this untapped donor pool.Item type: Item , Access status: Open Access , Synthesis of single-qutrit circuits from Clifford + R gates(Physical Review A) Gustafson, Erik J; Lamm, Henry; Liu, Diyi; Murairi, Edison M; Zhu, ShuchenItem type: Item , Access status: Open Access , Accelerating the translation of findings from the MoTrPAC study to benefit clinical care: a qualitative analysis.(BMC primary care, 2025-10) Collins-Bennett, Katherine A; Lacci-Reilly, Kandice R; Aguilar, Aylin; Fleg, Jerome L; George, Stephanie M; Houmard, Joseph A; Huffman, Kim M; Johannsen, Neil M; Katz, Daniel H; Narendra, Julia; Radom-Aizik, Shlomit; Sparks, Lauren M; Xia, Ashley; Cooper, Dan MBACKGROUND: The Molecular Transducers of Physical Activity Consortium (MoTrPAC) is a large-scale research study aimed at elucidating the effects of exercise training on the molecular mechanisms underlying the health benefits of exercise and physical activity. To take a first step toward achieving a goal of rapid dissemination, a qualitative analysis among frontline clinicians was conducted to identify the perceived clinical relevance of exercise research, MoTrPAC discoveries, and optimal ways to disseminate these results to key stakeholders. METHODS: A convenience sample of 12 clinicians in internal medicine, family medicine, and emergency medicine agreed to participate in one-on-one interviews. Interviews were conducted over the phone by a member of the Wake Forest Qualitative and Patient-Reported Outcomes (Q-PRO) Shared Resource. Transcripts were stored and coded in ATLAS.ti version 24 software. Two Q-PRO members developed code summaries, which were synthesized into themes and organized using principles of reflexive thematic analysis. RESULTS: Clinicians (n = 12) were predominantly male (n = 7), non-Hispanic White (n = 5), located in California (n = 10), and practiced in a Primary Care/Family Medicine setting (n = 6). Clinicians reported underuse of exercise testing due to provider-level and patient-level barriers. While they valued exercise research, they emphasized the need for clear, practical takeaways and preferred direct dissemination strategies. CONCLUSIONS: These interviews highlighted the variable nature of exercise research dissemination and implementation and are the first steps toward shaping the dissemination of valuable scientific discoveries from the MoTrPAC study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-025-03030-6.