bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacologic and psychological interventions for depression treatment in patients with kidney disease
Authors: Gregg L. Parker , Hedayati S. Susan
Published: July 2020

Purpose of review

It remains controversial whether existing therapies, including pharmacologic and psychological interventions, are effective for treatment of depression in patients with chronic kidney disease (CKD) and end-stage kidney disease.

Recent findings

Most studies of depression treatment were underpowered or uncontrolled. The CKD Antidepressant Sertraline Trial showed no benefit of a serotonin-selective reuptake inhibitor (SSRI), sertraline, over double-blind matched placebo for the treatment of depressive symptoms in patients with nondialysis CKD. A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression showed improvement in depressive symptoms from baseline in both groups and a marginal benefit of sertraline over CBT that was of unclear clinical significance, given the lack of an active control group. SSRIs are associated with poor tolerability in clinical trials and serious adverse outcomes in large retrospective studies.

Although the data do not support unlimited use of SSRIs in patients with CKD or end-stage kidney disease, it is reasonable to initiate a cautious trial of sertraline while closely monitoring for depressive symptom improvement and adverse effects. CBT is a low-risk, possibly effective intervention to treat major depressive disorder in patients with kidney disease who have access to such treatments.
Tubular effects of sodium–glucose cotransporter 2 inhibitors: intended and unintended consequences
Authors: Dominguez Rieg Jessica A. , Xue Jianxiang , Rieg Timo
Published: July 2020

Purpose of review

Sodium–glucose cotransporter 2 (SGLT2) inhibitors are antihyperglycemic drugs that act by inhibiting renal sodium–glucose cotransport. Here we present new insights into ‘off target’, or indirect, effects of SGLT2 inhibitors.

Recent findings

SGLT2 inhibition causes an acute increase in urinary glucose excretion. In addition to lowering blood glucose, there are several other effects that contribute to the overall beneficial renal and cardiovascular effects. Reabsorption of about 66% of sodium is accomplished in the proximal tubule and dependent on the sodium–hydrogen exchanger isoform 3 (NHE3). SGLT2 colocalizes with NHE3, and high glucose levels reduce NHE3 activity. The proximal tubule is also responsible for the majority of phosphate (Pi) reabsorption. SGLT2 inhibition is associated with increases in plasma Pi, fibroblast growth factor 23 and parathyroid hormone levels in nondiabetics and type 2 diabetes mellitus. Studies in humans identified a urate-lowering effect by SGLT2 inhibition which is possibly mediated by urate transporter 1 (URAT1) and/or glucose transporter member 9 in the proximal tubule. Of note, magnesium levels were also found to increase under SGLT2 inhibition, an effect that was preserved in nondiabetic patients with hypomagnesemia.

Cardiorenal effects of SGLT2 inhibition might involve, in addition to direct effects on glucose homeostasis, effects on NHE3, phosphate, urate, and magnesium homeostasis.
Estimating the Direct Medical Costs and Productivity Loss of Outpatient Chlamydia and Gonorrhea Treatment
Authors: Kumar Sagar , Chesson Harrell , Gift Thomas L.
Published: July 2020

We used 2016–2017 administrative claims data to calculate the direct medical cost and productivity loss per diagnosed case of chlamydia and gonorrhea treatment. In 2018 US dollars, the direct cost per diagnosed case was $151 for chlamydia (n = 9180) and $85 for gonorrhea (n = 3048); productivity loss was $206 (n = 31) and $246 (n = 7), respectively, among those missing work seeking care.
Identifying Adolescent Girls and Young Women at High Risk for HIV Acquisition: A Risk Assessment Tool From the Girl Power-Malawi Study
Authors: Rosenberg Nora E. , Kudowa Evaristar , Price Joan T. , Pettifor Audrey , Bekker Linda-Gail , Hosseinipour Mina C. , Chagomerana Maganizo
Published: July 2020

Background

Prioritizing HIV prevention for adolescent girls and young women (AGYW) at high risk for HIV acquisition in sub-Saharan Africa (typically considered ≥3 per 100 person-years [PYs]) is urgently needed, but identifying these AGYW is challenging. We sought to assess and, if needed, enhance a risk assessment tool from the VOICE trial for identifying AGYW at high risk for HIV in Lilongwe, Malawi.

Methods

A multisite prospective cohort study was conducted among sexually active AGYW 15 to 24 years old at 4 health centers in 2016 to 2017. The VOICE tool was first applied and then updated by excluding variables that were not predictive and adding variables that were. Incidence rates (IRs), incidence rate ratios, 95% confidence intervals (CIs), area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated.

Results

Seven hundred ninety-five participants experienced 14 seroconversions for 672 PYs (IR, 2.08 per 100 PYs; 95% CI, 1.23–3.52). The VOICE tool had moderate predictive ability (AUC, 0.64; 95% CI, 0.52–0.75). Maintaining 2 variables (genital ulcers and vaginal discharge), removing 5 sociodemographic variables, and adding 2 variables (ever pregnant and >5-year male-female age gap) enhanced performance (AUC, 0.79; 95% CI, 0.69–0.89). Thirty-five percent had a score of 0, 41% had a score of 1 to 2, and 24% had a score >3. A score >1 resulted in 100% sensitivity, 35.9% specificity, and an IR of 3.25 per 100 PYs. A score >3 resulted in 64.3% sensitivity, 76.8% specificity, and an IR of 5.89 per 100 PYs.

Conclusions

A simple risk assessment tool identified a subset of AGYW in Malawi at high risk for HIV acquisition who may benefit from biomedical HIV prevention.
Single-Dose Azithromycin for Genital Lymphogranuloma Venereum Biovar Chlamydia trachomatis Infection in HIV-Infected Women in South Africa: An Observational Study
Authors: Peters Remco P.H. , Maduna Liteboho , Kock Marleen M. , McIntyre James A. , Klausner Jeffrey D. , Medina-Marino Andrew
Published: July 2020

We conducted an observational study of lymphogranuloma venereum (LGV) biovar Chlamydia trachomatis infection in HIV-infected women in South Africa. The LGV biovar was detected in vaginal specimens of 17 (20%) of 85 women with C. trachomatis infection; 29% were symptomatic. All cases were negative for the LGV biovar after single-dose azithromycin.
Comprehensive Molecular Screening in a Cohort of Young Men Who Have Sex With Men and Transgender Women: Effect of Additive Rectal Specimen Source Collection and Analyte Testing
Authors: Munson Erik , Reynoso Alyssa , Pass Morena , Buehler Kathleen , Ryan Daniel , Clifford Antonia , Morgan Ethan , Mustanski Brian
Published: July 2020

Background

This study's purposes were to characterize detection rates of several sexually transmitted infection (STI) agents and describe the effect additional specimen source and analyte screening has on STI detection within a cohort of young men who have sex with men and transgender women.

Methods

Within a 16-month interval, 1966 encounters involved dual urine and rectal swab submissions assessed by commercial transcription-mediated amplification–based assays for Chlamydia trachomatis and Neisseria gonorrhoeae and by off-label transcription-mediated amplification–based Trichomonas vaginalis and Mycoplasma genitalium testing. Identification of STI carriers used algorithms involving Food and Drug Administration–cleared screening methods, laboratory-modified testing for extraurogenital C. trachomatis and N. gonorrhoeae, and laboratory-developed tests for T. vaginalis and M. genitalium.

Results

Food and Drug Administration–indicated urine C. trachomatis and N. gonorrhoeae screening revealed 39 encounters (2.0%) yielding one or both agents. Via C. trachomatis and N. gonorrhoeae screening that included rectal swab analysis, 264 encounters (13.4%) yielded evidence of either (140 C. trachomatis, 88 N. gonorrhoeae) or both (36 participants) infections. Detection rates for C. trachomatis and N. gonorrhoeae were 1.4% and 0.6% for urine screening and 8.2% and 6.2% for rectal screening, respectively. Off-label screening identified 413 additional encounters with STI (5 T. vaginalis, 396 M. genitalium, 12 with both). Of these identifications, 82.1% were generated from analysis of rectal swabs (4 participants with T. vaginalis, 323 participants with M. genitalium, 12 with both). Overall detection rates of T. vaginalis (0.2% urine, 1.3% rectal) and M. genitalium (9.1% urine, 21.5% rectal) were variable.

Conclusions

Additive analyte testing, including extraurogenital collections, contributes to comprehensive STI screening within a high-risk demographic.
Including Homeless Populations in Disaster Preparedness, Planning, and Response: A Toolkit for Practitioners
Authors: Gin June L. , Levine Cheryl A. , Canavan David , Dobalian Aram
Published: July 2020

Context:

People experiencing homelessness are often the first and most severely affected group during disasters. Nonetheless, communities across the United States have frequently failed to adequately address the needs of homeless populations in disaster planning, response, and recovery. Communities must build multisector collaborative relationships and ensure that homeless service providers are adequately resourced. However, constraints in funding and staffing, combined with a lack of guidance about how to achieve an integrated approach to disaster planning for people experiencing homelessness, have hindered communities' ability to accomplish these goals.

Program:

The US Department of Veterans Affairs, the US Department of Health and Human Services, and the US Department of Housing and Urban Development created an interagency workgroup to identify resources to help communities address the disaster needs of homeless populations. This workgroup created a toolkit to address this gap: Disaster Preparedness to Promote Community Resilience.

This article describes the development of the toolkit. The toolkit is divided into 3 sections:

Section 1 provides guidance to homeless service providers and government entities in identifying collaborative relationships to ensure that services are available to address homeless populations' disaster needs. Section 2 offers nonprofit homeless service providers guidance in creating their disaster response plans. Section 3 aims to ensure that public health officials and health care systems have the capacity to provide health care to homeless populations during disasters.

Implementation:

Efforts are under way to develop a disaster preparedness training manual to assist nonprofit homeless service organizations.

Discussion:

Homeless service providers are vital partners in disaster response. Integrating them into emergency management and ensuring that they are adequately prepared for disasters will effectively enable them to contribute their unique skill sets to community disaster recovery.
Factors Influencing Paretic Upper Limb Use During First 4 Weeks After Stroke
Authors: Chin Lay Fong , Hayward Kathryn S. , Brauer Sandra G.
Published: July 2020

Objective

This study aimed to investigate factors related to paretic upper limb use within the first 4 wks after stroke.

Design

Sixty inpatients within 4 wks of first-time stroke were stratified by severity defined by Fugl-Meyer Upper Limb scores: severe = 0–22, moderate = 23–50, and mild = 51–66. All wore a wrist accelerometer on the paretic upper limb (24 hrs). Factors investigated were the following measures: upper limb motor impairment; mobility; balance; functional independence; sensory impairment; cognitive function; social factors; environmental restriction; and knowledge. Individual and multivariate quantile regression analyses were performed.

Results

Upper limb motor impairment, mobility, balance, functional independence, self-efficacy, and knowing how to use the paretic upper limb were significantly related to upper limb use across the three impairment groups (pseudo R
2 = 0.079–0.492, P < 0.02). Multivariate regression showed the only significant factor in moderate and mild group was Fugl-Meyer Upper Limb score (moderate pseudo R
2 = 0.55, mild pseudo R
2 = 0.54, P < 0.001). For the severe group, Fugl-Meyer upper limb score and step count were significant (severe pseudo R
2 = 0.47, P ≤ 0.030).

Conclusions

Upper limb motor impairment is significantly associated with paretic upper limb use across three impairment groups and step count with the severe group. Strategies to improve upper limb motor impairment and increase mobility may be required to increase upper limb use.
Dorsal Root Ganglion Stimulation for Treatment of Chemotherapy-Induced Neuropathy
Authors: Grabnar Maria , Kim Chong
Published: July 2020

Chemotherapy-induced neuropathy has limited treatment options, and conventional medications used to treat neuropathic pain often do not provide adequate pain relief for patients with a history of cancer. Neuromodulation such as dorsal root ganglion stimulation remains a treatment that has been studied for chronic painful conditions such as low back pain, pelvic pain, complex regional pain syndrome, and phantom limb pain. Dorsal root ganglion stimulation has been presented for treatment of chemotherapy-induced neuropathy, but with limited duration of follow-up. We present a case of pain resolution after placement of a dorsal root ganglion stimulation for persistent chemotherapy-induced neuropathy. Our patient developed burning pain and allodynia in both feet 3 mos into her chemotherapy regimen, with worsened symptoms after cessation of chemotherapy. After failure of conservative pharmacotherapies, a 7-day dorsal root ganglion stimulation trial was implanted, resulting in 100% pain relief. A dorsal root ganglion stimulation was then implanted permanently, and our patient reported continued resolution of symptoms at evaluation 3 yrs after placement. To the author’s knowledge, this is the first case of sustained relief with dorsal root ganglion stimulation placement for chemotherapy-induced neuropathy and presents a treatment option that warrants further investigation.
Incorporating Value-Based Care Into Oncology
Authors: Seymour Erlene K. , de Souza Jonas A. , Fendrick A. Mark
Published: July 2020

Value-based care within insurance design utilizes evidence-based medicine as a means of defining high-value versus low-value diagnostics and treatments. The goals of value-based care are to shift spending and coverage toward high-value care and reduce the use of low-value practices. Within oncology, several value-based methods have been proposed and implemented. We review value-based care being used within oncology, including defining the value of oncology drugs through frameworks, clinical care pathways, alternative payment models including the Oncology Care Model, value-based insurance design, and reducing low-value care including the Choosing Wisely initiatives.
Molecular Classification of Large B-Cell Non-Hodgkin Lymphoma
Authors: Bojarczuk Kamil , Wienand Kirsty , Chapuy Bjoern
Published: July 2020

Large B-cell lymphomas (LBCLs) represent a frequent but clinically and morphologically heterogeneous group of tumors. Technological advances over the last 2 decades prompted the development of new classification schemas to sharpen diagnoses, dissect molecular heterogeneity, and identify rational treatment targets. Despite increased molecular understanding of these lymphomas, the clinical perspectives of patients largely remain unchanged. Recently finished comprehensive genomic studies discovered genetically defined LBCL subtypes that predict outcome, provide insight into lymphomagenesis, and suggest rational therapies with the hope of generating patient-tailored treatments with increased perspective for patients in greatest need. Here, we summarize notable examples of how high-throughput technologies aided in better molecular understanding of LBCLs and provided examples of rationally designed targeted treatments.
Time to Treat Financial Toxicity for Patients
Authors: Collyar Deborah E.
Published: July 2020

Modern medical costs fall beyond most peoples' ability to pay and cause severe adverse effects that impact patients and families. It is time to team up with all stakeholders to provide solutions to systemic issues that thwart oncology's true goal to help patients survive their care and their cancer. Patients need realistic approaches that include (1) access to affordable treatments, (2) accountability and oversight toward patient costs and results in research, and (3) cost-effective drug supply once commercialized. Physicians play a critical role helping patients develop a plan that fits each person's medical, financial, and life situation.
Power Failures During Surgery: A 2000–2019 Review of Reported Events in the Veterans Health Administration
Authors: Soncrant Christina , Mills Peter D. , Zubkoff Lisa , Neily Julia , Mazzia Lisa , Warner Lisa J. , Gunnar William
Published: July 2020

Objectives

The frequency and impact of power failure on surgical care over time in a large integrated healthcare system such as the Veterans Health Administration (VHA) is unknown. Reducing the likelihood of harm related to these rare but potential catastrophic events is imperative to ensuring patient safety and high-quality surgical care. This study provides analysis and description of reported power failures during surgery (January 2000–March 2019), in the VHA and their impact.

Methods

This quality improvement study describes patient safety adverse events related to power failure in the operating room reported by 63 VHA medical centers from the approximately 137 VHAs with a surgical program. Power failure events during surgery reported to the VHA National Center for Patient Safety are analyzed.

Results

The authors identify 20 root cause analyses and 135 safety reports. Most events 36.1% (n = 56) resulted from generator delay, equipment reboot delay 21.9% (n = 34), and equipment backup power failure 13.5% (n = 21). Root causes include issues with backup batteries or equipment, engineering and clinical staff communication, standardized procedures for testing power, backup power delay, electrical circuit issues, documentation, and training. Patient harm occurred in 18% (n = 28) and 3.9% (n = 6) as major or catastrophic.

Conclusions

Power failure during surgery is associated with major or catastrophic patient harm, though rare. Staff preoccupation with failure, disaster preparedness, and focus on communication has the potential to minimize or avoid patient harm.
Preserving 2 decades of healthcare gains for Africa in the coronavirus disease 2019 era
Authors: Pastakia Sonak D. , Braitstein Paula , Galárraga Omar , Genberg Becky , Said Jamil , Vedanthan Rajesh , Wachira Juddy , Hogan Joseph W.
Published: July 2020

As coronavirus disease 2019 (Covid-19) restrictions upend the community bonds that have enabled African communities to thrive in the face of numerous challenges, it is vital that the gains made in community-based healthcare are preserved by adapting our approaches. Instead of reversing the many gains made through locally driven development partnerships with international funding agencies for other viral diseases like HIV, we must use this opportunity to adapt the many lessons learned to address the burden of Covid-19. Programs like the Academic Model Providing Access to Healthcare are currently leveraging widely available technologies in Africa to prevent patients from experiencing significant interruptions in care as the healthcare system adjusts to the challenges presented by Covid-19. These approaches are designed to preserve social contact while incorporating physical distancing. The gains and successes made through approaches like group-based medical care must not only continue but can help expand upon the extraordinary success of programs like President's Emergency Plan for AIDS Relief.
Monocyte activation and gut barrier dysfunction in South African youth on antiretroviral therapy and their associations with endothelial dysfunction
Authors: Dirajlal-Fargo Sahera , Yu Jiao , Albar Zainab , Sattar Abdus , Mahtab Sana , Jao Jennifer , Myer Landon , Zar Heather J. , McComsey Grace A.
Published: July 2020

Background:

There is evidence for endothelial dysfunction in youth living with perinatally acquired HIV (YLPHIV). However, little data exist on its mechanisms.

Methods:

YLPHIV and age-matched HIV-uninfected (HIV−) youth enrolled in the Cape Town Adolescent Antiretroviral Cohort in South Africa between 9 and 14 years of age were included. YLPHIV were on antiretroviral therapy more than 6 months with viral load less than 400 copies/ml at baseline and 24 months. Serum biomarkers of systemic inflammation, monocyte activation, intestinal integrity, and oxidized LDL-cholesterol were measured at baseline and after 24 months. Endothelial function was measured at 24 months using reactive hyperemic index (RHI); endothelial dysfunction was defined as RHI less than 1.35. Spearman correlation coefficient and quantile regression were used to examine associations between RHI and different biomarkers.

Results:

We included 266 YLPHIV and 69 HIV− participants. At baseline, median (Q1, Q3) age was 12 (11, 13) years and 53% were females. YLPHIV had poorer endothelial function compared with HIV− youth (RHI = 1.36 vs. 1.52, P < 0.01). At baseline and 24 months, YLPHIV had higher markers of monocyte activation (soluble CD14), gut barrier dysfunction (intestinal fatty acid binding protein) and oxidized LDL-cholesterol (P ≤ 0.04) compared with HIV− youth. Among YLPHIV, soluble CD14 remained associated with endothelial dysfunction after adjusting for age, sex, Tanner stage, and antiretroviral therapy duration (β: −0.05, P = 0.01).

Conclusion:

Despite viral suppression, South African YLPHIV have poor endothelial function and persistent evidence of monocyte activation and gut barrier dysfunction compared with HIV− youth. The long-term clinical significance of gut integrity and monocyte activation needs to be further assessed in YLPHIV.
Tenofovir resistance in early and long-term treated patients on first-line antiretroviral therapy in eight low-income and middle-income countries
Authors: Inzaule Seth C. , Jordan Michael R. , Cournil Amandine , Girón-Callejas Amalia , Avila-Rios Santiango , Mulenga Lloyd , Ssemwanga Deogratius , Asio Juliet , Diop-Ndiaye Halimatou , Niasse-Traore Fatou , Nhan Do T. , Dat Vu Q. , Aghokeng Avelin F. , Billong Serge , Cham Fatim , Doherty Meg , Bertagnolio Silvia
Published: July 2020

Objective:

We aimed to assess the frequency of tenofovir (TDF) resistance in people failing tenofovir/lamivudine or emtricitabine (XTC)/nonnucleotide reverse-transcriptase inhibitor-based first-line antiretroviral treatment (ART) using data from 15 nationally representative surveys of HIV drug resistance conducted between 2014 and 2018 in Cameroon, Guatemala, Honduras, Nicaragua, Senegal, Uganda, Vietnam and Zambia.

Methods:

Prevalence of nucleoside reverse-transcriptase inhibitor resistance among participants with virological nonsuppression (viral load ≥1000 copies/ml) who had received TDF-based ART for 12–24 months (early ART group) and at least 40 months (long-term ART group) was assessed using Sanger sequencing and resistance was interpreted using the Stanford HIVdb algorithm. For each group, we estimated a pooled prevalence using random effect meta-analysis.

Results:

Of 4677 participants enrolled in the surveys, 640 (13.7%) had virological nonsuppression, 431 (67.3%) were successfully genotyped and were included in the analysis; of those, 60.3% (260) were participants in the early ART group. Overall, 39.1, 57.9, 38.5 and 3.6% patients in the early ART group and 42.9, 69.3, 42.9 and 10.0% patients on long-term ART had resistance to TDF, XTC, TDF + XTC and TDF + XTC + zidovudine, respectively. Overall, tenofovir resistance was mainly due to K65R or K70E/G/N/A/S/T/Y115F mutations (79%) but also due to thymidine analogue mutations (21%) which arise from exposure to thymidine analogues but causing cross-resistance to TDF.

Conclusion:

Dual resistance to TDF + XTC occurred in more than 40% of the people with viral nonsuppression receiving tenofovir-based first-line ART, supporting WHO recommendation to optimize the nucleoside backbone in second-line treatment and cautioning against single drug substitutions in people with unsuppressed viral load.
Antiretroviral drug concentrations in brain tissue of adult decedents
Authors: Ferrara Micol , Bumpus Namandjé N. , Ma Qing , Ellis Ronald J. , Soontornniyomkij Virawudh , Fields Jerel A. , Bharti Ajay , Achim Cristian L. , Moore David J. , Letendre Scott L.
Published: July 2020

Objective:

Determine concentrations of antiretroviral therapy (ART) drugs in the human brain.

Design:

Cohort study of persons with HIV who consented to antemortem assessment and postmortem autopsy.

Methods:

Eleven persons with HIV who were taking ART at the time of death and had detectable concentrations of at least one ART drug in intracardiac aspirate at autopsy were evaluated. Autopsies were performed within 24 h of death and brain tissue was stored at −80 °C. Concentrations of 11 ART drugs were measured in three brain regions (globus pallidus, cortical gray matter, white matter) by HPLC tandem mass spectrometry with a lower limit of quantification of 25 ng/ml.

Results:

Participants were mostly men (82%) with a mean age of 40.4 years. Drug concentrations in brain tissue were highly variable and exceeded published concentrations in cerebrospinal fluid for several drugs, including for tenofovir, efavirenz, and lopinavir. Drug concentrations correlated most strongly between cortical gray matter and globus pallidus (rho = 0.70) but less well between globus pallidus and white matter (rho = 0.43). Combining all drugs and brain regions (n = 89), higher drug concentrations in brain were associated with longer estimated duration of HIV infection (P = 0.015), lower HIV RNA in plasma (P = 0.0001), lower nadir CD4+ T-cell count (P = 0.053), and worse neurocognitive performance (P = 0.017).

Conclusion:

This is the first analysis of ART drug concentrations in human brain tissue. Concentrations of several drugs in this analysis were similar to published concentrations in cerebrospinal fluid but others exceeded published concentrations. The association between higher drug concentrations in the brain and worse neurocognitive performance may indicate ART neurotoxicity.
No HIV-1 molecular evolution on long-term antiretroviral therapy initiated during primary HIV-1 infection
Authors: Abdi Basma , Nguyen Thuy , Brouillet Sophie , Desire Nathalie , Sayon Sophie , Wirden Marc , Jary Aude , Achaz Guillaume , Assoumou Lambert , Palich Romain , Simon Anne , Tubiana Roland , Valantin Marc-Antoine , Katlama Christine , Calvez Vincent , Marcelin Anne-Geneviève , Soulie Cathia
Published: July 2020

Objective:

Most studies about HIV-1 molecular evolution have shown the lack of viral evolution on effective antiretroviral therapy (ART), although controversial results have been documented. We therefore aimed to look for evidence of HIV-1 evolution in patients who initiated ART at the time of primary HIV-1 infection (PHI).

Design:

We included retrospectively 20 patients diagnosed at PHI, treated at the time of acute infection and with subsequent effective long-term suppressive ART (HIV viral load <20 copies/ml during at least 5 years without any blips).

Methods:

Longitudinal blood samples were deep sequenced using Illumina Miseq. Drug-resistance-associated mutations were retained at 2% cutoff and interpreted using the latest Agence Nationale de Recherches sur le Sida et les Hépatites Virales resistance algorithm. Viral evolution was established when temporal structure on maximum-likelihood phylogenetic tree and significant change over time of HIV-1 genetic diversity measured as the average pairwise distance was observed.

Results:

Emergences or disappearances of drug-resistance-associated mutations were detected in the blood cells during follow-up despite sustained virological control. In all patients, tree topologies showed an absence of segregation between sequences and blood viral populations from all time-points were intermingled. Comparison of the average pairwise distance showed the absence of significant viral diversity at the time of primary infection and afterwards during 5 years of full virological control under ART.

Conclusion:

Despite a slight variation of minority resistance-associated mutation variants, there was no clear evidence of viral evolution during a prolonged period of time in this population of highly controlled adult patients treated at time of PHI.
A High-Fidelity Hybrid Virtual Reality Simulator of Aneurysm Clipping Repair With Brain Sylvian Fissure Exploration for Vascular Neurosurgery Training
Authors: Teodoro-Vite Sergio , Pérez-Lomelí Juan S. , Domínguez-Velasco César F. , Hernández-Valencia Aldo F. , Capurso-García Marino A. , Padilla-Castañeda Miguel A.
Published: July 2020

Introduction

Microsurgery clipping is one of the most challenging surgical interventions in neurosurgery. The opportunities to train residents are scarce, but the need for accumulating practice is mandatory. New simulating tools are needed for skill learning.

Methods

The design, implementation, and assessment of a new hybrid aneurysm clipping simulator are presented. It consists of an ergonomic workstation with a patient head mannequin and a physics-based virtual reality simulation with bimanual haptic feedback. The simulator recreates scenarios of microsurgery from the patient fixation and the exploration of the brain lobes through Sylvian fissure and vascular structures to the aneurysm clipping. Skill metrics were introduced, including monitoring of gestures movements, exerted forces, tissue displacements, and precision in clipping.

Results

Two experimental conditions were tested: (1) simple clipping without brain tissue exploration and (2) clipping the aneurysm with brain Sylvian fissure exploration. Differences in the bimanual gestures were observed between both conditions. The quantitative measurements of tissue displacement of the brain lobes exhibited more tissue retrieval for the surgical gestures of neurosurgeons. Appraisal with questionnaires showed positive scores by neurosurgeons in all items evaluating the usability and realism of the simulator.

Conclusions

The simulator was well accepted and feasible for training purposes. The analysis of the interactions with virtual tissues offers information to establish differential and common patterns between tested groups and thus useful metrics for skill evaluation of practitioners. Future work can lead to other tasks during the intervention and the inclusion of more clinical cases.
A Simulation-Based Prospective Cohort Study on Teaching Best Practices in Firearms Safety
Authors: Ketterer Andrew R. , Lewis Jason J. , Ellis Joshua C. , Hall Matthew M. , Abuhasira Ran , Ullman Edward A. , Dubosh Nicole M.
Published: July 2020

Background

Gun violence in the United States is a significant public health concern. The high rate of weapons carriage by Americans places medical providers at risk for exposure to firearms in the workplace and provides an opportunity for patient safety counseling. Few curricular interventions have been published on teaching firearms safety principles to medical providers. Given the risk of encountering firearms in the workplace and the opportunity to engage patients in firearms safety counseling, providers may benefit from dedicated training on safely handling firearms.

Methods

This was a prospective cohort pilot study of a simulation-based educational intervention for third- and fourth-year medical students enrolled in an emergency medicine subinternship and emergency medicine bootcamp elective. Before undergoing the educational intervention, students completed a preintervention simulation case during which they discovered a model firearm in the patient's belongings and were asked to remove it. Students then received the intervention that included a discussion and demonstration on how to safely remove a firearm in the clinical setting. Two weeks later, the students were presented with a model firearm in a different simulation case, which they needed to remove. During the preintervention and postintervention simulations, students were evaluated on their performance of the critical actions in firearm removal using an 8-item checklist. Students' scores on this checklist were compared.

Results

Fifty-three students participated in the study, 25 of whom completed the postintervention assessment. The median number of correctly performed critical actions preintervention was 5 (interquartile range = 4–6) and postintervention was 7 (interquartile range = 6–8, P < 0.001). Students showed particular improvement in 4 steps: holding the firearm by the grip only, pointing the firearm in a safe direction at all times, removing the firearm from the immediate patient care area and placing it in a safe area, and ensuring that the firearm is monitored and untouched until police or security personnel arrive to secure it.

Conclusions

This educational intervention is the first to formally teach students about the safe handling of firearms found in the clinical care space. This low-cost pilot project is easily transferrable to other training centers for teaching principles of safe firearms handling.
Simulation-Based Mastery Learning of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy
Authors: Kattan Eduardo , De la Fuente Rene , Putz Francisca , Vera Magdalena , Corvetto Marcia , Inzunza Oscar , Achurra Pablo , Inzunza Martin , Munoz-Gama Jorge , Sepulveda Marcos , Galvez Victor , Pavez Nicolas , Retamal Jaime , Bravo Sebastian
Published: July 2020

Introduction

Although simulation-based training has demonstrated improvement of procedural skills and clinical outcomes in different procedures, there are no published training protocols for bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT). The objective of this study was to assess the acquisition of BG-PDT procedural competency with a simulation-based mastery learning training program, and skills transfer into cadaveric models.

Methods

Using a prospective interventional design, 8 trainees naive to the procedure were trained in a simulation-based mastery learning BG-PDT program. Students were assessed using a multimodal approach, including blind global rating scale (GRS) scores of video-recorded executions, total procedural time, and hand-motion tracking–derived parameters. The BG-PDT mastery was defined as proficient tracheostomy (successful procedural performance, with less than 3 puncture attempts, and no complications) with GRS scores higher than 21 points (of 25). After mastery was achieved in the simulator, residents performed 1 BG-PDT execution in a cadaveric model.

Results

Compared with baseline, in the final training session, residents presented a higher procedural proficiency (0% vs. 100%, P < 0.001), with higher GRS scores [8 (6–8) vs. 25 (24–25), P = 0.01] performed in less time [563 (408–600) vs. 246 (214–267), P = 0.01] and with higher movement economy. Procedural skills were further transferred to the cadaveric model.

Conclusions

Residents successfully acquired BG-PDT procedural skills with a simulation-based mastery learning training program, and skills were effectively transferred to a cadaveric model. This easily replicable program is the first simulation-based BG-PDT training experience reported in the literature, enhancing safe competency acquisition, to further improve patient care.
Use of the Fundamentals of Arthroscopic Surgical Training Workstation for Immediate Objective Feedback During Training Improves Hand-Tied Surgical Knot Proficiency
Authors: Schneider Andrew M. , Davis William , Walsh Daniel , Pedowitz Robert A. , Evans Douglas A.
Published: July 2020

Introduction

In a prior study, we validated the FAST workstation as an objective evaluator of hand-tied surgical knots. The goal of this study was to determine whether guided practice with the FAST workstation could lead to objective improvement in hand-tied surgical knot performance.

Methods

Sixty participants were randomized into 1 of 2 groups: a control group, with access to only the knot-tying station, and a test group, with access to the knot-tying station plus the knot testing station. The study was divided into 3 phases: prepractice, practice, and postpractice. Using the FAST workstation, participants hand-tied 5 knots, 15 knots, and 5 knots using 0 Vicryl suture in the prepractice, practice, and postpractice phases, respectively. Knots for each participant from the prepractice and postpractice phases were collected, tested, and compared.

Results

Within the control group, the average number of prepractice knot successes was 2.63, and the average number of postpractice knot successes was 3.40, which resulted in an improvement of average knot successes of 0.77 (P < 0.01). Within the test group, the average number of prepractice knot successes was 2.40, and the average number of postpractice knot successes was 4.10, which resulted in an improvement of average knot successes of 1.70 (P < 0.01). The difference in average improvement of knot-tying successes (0.93 knots) between the 2 groups was statistically significant (P < 0.01).

Discussion

A knot-tying trainer that provides objective feedback on knot performance may better improve hand-tied surgical knot proficiency compared with one without objective feedback.
Effects of Balance Training on Nonmotor Symptoms in Individuals With Parkinson Disease
Authors: Singh Gurpreet , Jain Tarang K. , Liu Wen , Colgrove Yvonne , Pahwa Rajesh , Lyon Kelly , Sharma Neena
Published: July 2020

Objective:

Evaluate the effects of balance training on nonmotor symptoms associated with Parkinson disease (PD) using Biodex stability system (BSS).

Methods:

Twenty individuals with PD were assigned to either a BSS group (n = 10) or a non-BSS group (n = 10) who performed exercises for 4 weeks. Assessments of depression, fatigue, pain, fear of falling, and quality of life (QOL) were done using standardized measures.

Results:

Fatigue was found to be significantly different within (mean difference: 8 ± 11.5 points; 95% CI, −0.27, 16) as well as between groups (mean difference: 12.6 ± 12.3 points; 95% CI, 23.4, 1.7) for only the BSS group.

Conclusion:

Balance exercise training can decrease fatigue, which may have valuable implications on fear of falling and QOL in individuals with PD.
Epidemiologic, Clinical, and Biological Characteristics of Adult T-cell Leukemia / Lymphoma in Martinique (1983-2013)
Authors: Yves Plumelle , Stephane Michel , Christine Delaunay , Moumouni Kone , Jean-Côme Meniane , Derancourt Christian , Harold Merle , Vincent Molinié , Gérard Panelatti
Published: July 2020

We report one of the largest non-Japanese cohorts of adult T-cell leukemia/lymphoma (ATL). A total of 175 cases were identified in Martinique between 1983 and 2013. The sex ratio was 1.01. The median age was 56 years. The overall incidence rate was 1.16/105inhabitants/year, with a risk 1.29 times higher for men. The distribution of clinical types (acute, lymphoma, and chronic) was 62.9%, 29.1%, and 8%, respectively. Median survival time was 3.06, 8.13, and 45.16 months, respectively, for the acute, lymphoma, and chronic types (p <0.001). Survival was significantly higher for lymphoma type with skin lesions (median 13.96 months versus 6.06, p <0.002) and for the acute type without hypercalcemia (5.1 versus 2.4 months, p <0.01). Symptoms associated with hypercalcemia present in 46.9% of patients and skin lesions in 43.4% were the best-performing clinical signs for the diagnosis of ATL. However, only 16.9% had these manifestations.Strongyloïdes stercoralisinfection was documented in 42.5% of patients. Twenty-three patients had an atypical phenotype, including 14 cases with CD4-CD8- and 4 with CD4+CD8+. Twenty-four patients did not express CD25 with no significant impact on overall survival. The hyperploidy, trisomy of chromosome 3 and rearrangements of chromosome 14 were the most frequent karyotype abnormalities.
Cytochrome OmcS is not essential for long-range electron transport inGeobacter sulfurreducensstrain KN400
Authors: Walker David J. F. , Li Yang , Meier David , Pinches Samantha , Holmes Dawn E. , Smith Jessica A.
Published: July 2020

The multi-hemec-type cytochrome OmcS, is one of the central components for extracellular electron transport inGeobacter sulfurreducensstrain DL-1, but its role in other microbes, including other strains ofG. sulfurreducensis currently a matter of debate. Therefore, we investigated the function of OmcS inG. sulfurreducensstrain KN400, which is even more effective in extracellular electron transfer than strain DL-1. We found that deletingomcSfrom strain KN400 did not negatively impact the rate of Fe(III) oxide reduction and did not affect the strain’s ability to accept electrons via direct interspecies electron transfer. The OmcS-deficient strain also continued to produce conductive filaments, consistent with the concept that electrically conductive pili are the primary conduit for long-range electron transfer inG. sulfurreducensand closely related species. These findings, coupled with the lack of OmcS homologs in most other microbes capable of extracellular electron transfer, suggest that OmcS is not a common critical component for extracellular electron transfer.
The hidden role of owners' spouses in family firm innovativeness: a dynamic managerial capabilities perspective
Authors: Gerulaitiene Neringa , Pundziene Asta , Vaiciukynaite Egle
Published: July 2020

Purpose

The purpose of this paper is to investigate the effect of the dynamic managerial capabilities (DMC) of the spouse (either working or non-working) of a family firm owner on firm innovativeness. This paper assesses the role of three elements of the DMC of owners' spouses (emotion regulation, conflict resolution and networking capabilities) that are bridged by familiness on family firm innovativeness.

Design/methodology/approach

This paper presents the results of a multiple case study. Twelve cases were selected: six innovative and six non-innovative family firms in Lithuania. The study design enabled a comparison not only of innovative and non-innovative family firms but also of non-working and working spouses of family firm owners.

Findings

The findings show that family firm owners' spouses contribute to firm innovativeness through their DMC in terms of emotion regulation, conflict resolution and networking capabilities.

Research limitations/implications

This research focused on a sample of firms in Lithuania. Future studies should broaden the research to other countries.

Originality/value

This research provides empirical evidence of the hidden role of the DMC of family firm owners' spouses and their contribution to firm innovativeness. This paper extends the application of DMC to family business research.
Board diversity and investment efficiency: evidence from China
Authors: Ullah Irfan , Zeb Aurang , Khan Muhammad Arif , Xiao Wu
Published: July 2020

Purpose

The purpose of this study is to investigate the relationship between board diversity measured as relation-oriented, task-oriented and board overall diversity and firm’s investment efficiency.

Design/methodology/approach

This study estimates four dimensions of board diversity, including age, gender, tenure and education. The four dimensions are further categorized in relation-oriented diversity (i.e. age and gender), task-oriented diversity (i.e. tenure and education) and overall board diversity (relation and task oriented). Panel data analysis is used to examine the board diversity–investment efficiency relationship in Chinese listed firms during the years 2003–2018. The findings of the study are robust to a battery of econometric techniques.

Findings

This study finds relation-oriented, task-oriented and overall diversity of a board curb investment inefficiency by discouraging sub-optimal investment (over- or under-investment). In other words, board diversity improves firms’ investment efficiency.

Practical implications

The results suggest that board diversity plays a significant role in corporate decisions. The findings illustrate that board diversity disciplines the management, reduces agency conflicts and thereby improves corporate governance, resulting in higher investment efficiency.

Originality/value

This study has two important contributions. First, this study extends the prior literature of investment efficiency by considering socio-psychological dimension of the board diversity by constructing relation- and task-oriented diversity. Second, contrary to earlier studies on board diversity, this study takes four facets of board diversity, i.e. age, gender, education and tenure that improve corporate governance mechanism.
Harmony-oriented retail innovations and financial performance
Authors: Alt Mónika Anetta , Berezvai Zombor , Agárdi Irma
Published: July 2020

Purpose

Recently, a growing need for harmony has been observed worldwide. Harmony is a universal value in both Western and Asian countries. This paper aims to study how the concept of harmony is reflected in the innovation of European multinational grocery retailers and how harmony-related innovations affect the financial performance of the retailers.

Design/methodology/approach

The research is based on a multisource database including innovation outcomes and financial performance indicators of 17 European multinational grocery retailers in the period of 2011–2018. In sum, 1,399 innovations were identified by content analysis. The relationship between innovation outcomes and financial performance was measured by panel regression analysis.

Findings

Results indicate that retailers differ in launching harmony-oriented innovations. Moreover, 40% more innovations are related to harmony with people as those related to harmony with nature. Finally, harmony-with-people innovations have a significantly positive effect on retailers' sales growth.

Practical implications

Based on the research findings, retailers can improve their sales growth by launching innovations that focus on harmony in human relationships.

Originality/value

This paper extended the concept of harmony to the field of innovations. First, the research showed how the value of harmony appears in the innovations of multinational retailers. Second, the study differentiated between harmony-with-people and harmony-with-nature innovations. Third, the findings revealed that harmony-oriented innovations contribute to retailers' financial performance.