Patients with stroke while hospitalized experience important delays in symptom recognition. This study aims to describe the overall management of an in-hospital stroke population and how it compares with an out-of-hospital community-onset stroke population.

In this retrospective observational study, we included consecutive patients with in-hospital and out-of-hospital strokes (both ischemic and hemorrhagic) over a period of one year treated at a comprehensive stroke center. Demographic and clinical data were extracted, and patient groups were compared with regard to stroke treatment time metrics.

A total of 362 patients diagnosed with acute stroke were included, of whom 38 (10.5%) had in-hospital and 324 (89.5%) had out-of-hospital strokes. The median delay to stroke recognition (time between the last time seen well and first time seen symptomatic) was significantly longer in in-hospital compared to out-of-hospital strokes (77.5 [0–334.8] vs. 0 [0–138.5] min, p = 0.04). The median time interval from stroke code activation to the arrival of the stroke team at the bedside was significantly shorter in in-hospital versus out-of-hospital cases (10 [6–15] vs. 15 [8–24.8] min, p = 0.01). In-hospital strokes were less likely to receive thrombolysis (12.8% vs. 45.4%, p < 0.01) with significantly higher mortality (18.2% versus 2.6%, p < 0.01) and longer overall median hospital stay (3 [1–7] vs. 12 days [7–23], p < 0.01) compared to out-of-hospital strokes.

This study showed significant delays in stroke symptom recognition and stroke code activation for in-hospital stroke patients despite comparable overall stroke time metrics. Development of in-hospital stroke protocols and systematic staff training on stroke symptom recognition should be implemented to improve care for hospitalized patients.

We aim to analyze the efficacy and safety of TMS on cognition in mild cognitive impairment (MCI), Alzheimer’s disease (AD), AD-related dementias, and nondementia conditions with comorbid cognitive impairment.

Systematic review, Meta-Analysis

We searched MEDLINE, Embase, Cochrane database, APA PsycINFO, Web of Science, and Scopus from January 1, 2000, to February 9, 2023.

RCTs, open-label, and case series studies reporting cognitive outcomes following TMS intervention were included.

Cognitive and safety outcomes were measured. Cochrane Risk of Bias for RCTs and MINORS (Methodological Index for Non-Randomized Studies) criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42022326423).

The systematic review included 143 studies (n = 5,800 participants) worldwide, encompassing 94 RCTs, 43 open-label prospective, 3 open-label retrospective, and 3 case series. The meta-analysis included 25 RCTs in MCI and AD. Collectively, these studies provide evidence of improved global and specific cognitive measures with TMS across diagnostic groups. Only 2 studies (among 143) reported 4 adverse events of seizures: 3 were deemed TMS unrelated and another resolved with coil repositioning. Meta-analysis showed large effect sizes on global cognition (Mini-Mental State Examination (SMD = 0.80 [0.26, 1.33], p = 0.003), Montreal Cognitive Assessment (SMD = 0.85 [0.26, 1.44], p = 0.005), Alzheimer’s Disease Assessment Scale–Cognitive Subscale (SMD = −0.96 [−1.32, −0.60], p < 0.001)) in MCI and AD, although with significant heterogeneity.

The reviewed studies provide favorable evidence of improved cognition with TMS across all groups with cognitive impairment. TMS was safe and well tolerated with infrequent serious adverse events.

Nightclubs are entertainment and hospitality venues historically vulnerable to terrorist attacks. This study identified and characterized terrorist attacks targeting nightclubs and discotheques documented in the Global Terrorism Database (GTD) over a 50-y period.

A search of the Global Terrorism Database (GTD) was conducted from 1970 to 2019. Precoded variables for target type “business” and target subtype “entertainment/cultural/stadium/casino” were used to identify attacks potentially involving nightclubs. Nightclub venues were specifically identified using the search terms “club,” “nightclub,” and “discotheque.” Two authors manually reviewed each entry to confirm the appropriateness for inclusion. Descriptive statistics were performed using R (3.6.1).

A total of 114 terrorist attacks targeting nightclub venues were identified from January 1, 1970, through December 31, 2019. Seventy-four (64.9%) attacks involved nightclubs, while forty (35.1%) attacks involved discotheques. A bombing or explosion was involved in 84 (73.7%) attacks, followed by armed assault in 14 (12.3%) attacks. The highest number of attacks occurred in Western Europe and Sub-Saharan Africa. In total, 284 persons died, and 1175 persons were wounded in attacks against nightclub venues.

While terrorist attacks against nightclub venues are infrequent, the risk for mass casualties and injuries can be significant, mainly when explosives and armed assaults are used.

Most students in MD-PhD programs take a leave of absence from medical school to complete PhD training, which promotes a natural loss of clinical skills and knowledge and could negatively impact a student’s long-term clinical knowledge. To address this concern, clinical refresher courses in the final year of PhD training have traditionally been used; however, effectiveness of such courses versus a longitudinal clinical course spanning all PhD training years is unclear.

The University of Alabama at Birmingham MD-PhD Program implemented a comprehensive continuing clinical education (CCE) course spanning PhD training years that features three course components: (1) clinical skills; (2) clinical knowledge; and (3) specialty exposure activities. To evaluate course effectiveness, data from an anonymous student survey completed at the end of each semester were analyzed.

Five hundred and ninety-seven surveys were completed by MD-PhD students from fall 2014 to 2022. Survey responses indicated that the majority of students found the course helpful to: maintain clinical skills and knowledge (544/597, 91% and 559/597, 94%; respectively), gain exposure to clinical specialties (568/597, 95%), and prepare them for responsibilities during clinical clerkships. During semesters following lockdowns from the COVID-19 pandemic, there were significant drops in students’ perceived preparedness.

Positive student survey feedback and improved preparedness to return to clinic after development of the course suggests the CCE course is a useful approach to maintain clinical knowledge during research training.

Sports venues foster community and support local economies. Due to their capacity to host hundreds to thousands of spectators, sports venues are vulnerable to becoming targets of terrorism. Types of venues targeted, regional trends, and methods of attack employed world-wide have not been well-described.

A search of the Global Terrorism Database (GTD) was conducted from 1970 through the end of 2019. Pre-coded variables for target type “business” and target subtype “entertainment/cultural/stadium/casino” were used to identify attacks involving venues where sports events might be viewed by spectators as part of an audience. Sports venues were specifically identified using the search terms “sport,” “stadium,” ”arena,” and “ring,” as well as mention of any specific sport. Two authors then manually reviewed each entry for specific information to confirm appropriateness for inclusion, selecting preferentially for attacks against venues where watching a sports event was the primary focus for the majority of the attendees. Descriptive statistics were performed using R (3.6.1).

Seventy-four (74) terrorist attacks targeting sports venues were identified from January 1, 1970 through December 31, 2019. Thirty-three (33) attacks, or 44.6% of attacks, involved soccer stadiums or soccer venues, while 33.8% of attacks (25 attacks) involved unspecified sports venues. A bombing or explosion was the most frequent method of attack employed, comprising 87.8% of attacks. The highest number of attacks occurred in the Middle East & North Africa. In total, 213 persons died and 699 more were wounded in attacks against sports venues.

Although terrorist attacks against sports venues are uncommon, they carry the risk of mass casualties, especially when explosives are used. A greater understanding of the threat posed by terrorist attacks against sports venues can aid emergency preparedness planning and future medical responses.