bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of irrigation on humid heat extremes
Authors: Krakauer Nir Y , Cook Benjamin I , Puma Michael J
Published: June 2020

Most studies of irrigation as an anthropogenic climate forcing focus on its cooling effects. However, irrigation also increases humidity, and so may not ameliorate humid heat and its extremes. We analyzed global climate model results over hot locations and seasons at high temporal resolution to estimate the impact of irrigation on humid heat extremes, quantified as different percentiles of wet-bulb temperature (

T

w

), under contemporary conditions. We found that although irrigation reduced temperature, the median and higher percentiles of

T

w

  on average did not decrease. Increases in

T

w

  percentile values and increases in frequency of dangerous

T

w

  of several days per year due to irrigation were found in some densely populated regions, including the central United States and the Middle East, while the Ganges basin saw reduced

T

w

. Changes in

T

w

  were partly associated with the differential regional impacts of irrigation on moisture transport. These results underline the importance of considering impacts of climate forcings on humidity as well as temperature in evaluating associated effects on heat extremes.
Observations on the Bethe ansatz solutions of the spin-1/2 isotropic anti-ferromagnetic Heisenberg chain: the chiral string conjecture
Authors: Nickel Bernie
Published: June 2020

Calculations of low lying excited states in even length L → ∞ chains begun in 2019 J. Phys. Commun.
3 025007 in the total spin S = 0 sector are here extended to S > 0. Bethe string configurations that were observed to transition from their definition at small L to different ‘apparent’ configurations at large L are now understood to be a manifestation of the approximate chiral symmetry that develops with increasing chain length. It is conjectured that when chiral symmetry is built into the configuration definitions a complete explicit labelling of all low lying excited states by strings is obtained. The structure is of the form of a product of Bethe strings defining left and right chiral states of spin sL and sR and a central complex ‘string’ necessary to bind

s
⃗

L

and

s
⃗

R

into total

S
⃗

.

Rules based on the string content of a state yield its momentum and asymptotic energy, including the amplitude of the leading ln(L) correction.
Nanoemulsions containing oil and aqueous extract of green coffee beans with antioxidant and antimicrobial activities
Authors: Buzanello E B , Pinheiro Machado G T B , Kuhnen S , Mazzarino L , Maraschin M
Published: June 2020

Coffee has bioactive compounds with protective effect against free radicals and antifungal and antibacterial activities that are beneficial to the health skin. This work aims to provide scientific evidence that nanoemulsions developed with oil and green coffee extract have antioxidant and antimicrobial effects. Nanoemulsions were prepared by spontaneous emulsification method using different concentrations of components (oil, extract and tensoactive) in order to optimize the preparation of formulations. The nanoemulsions presented globular morphology, negative charges, monodispersity and size around 200 nm. Two nanoemulsions, namely F7 and F16, presented characteristics of size and concentration of tensoactives more suitable for investigation regarding their antioxidant and antibacterial activities. The later assay was performed against standard strains of Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli at different nanoemulsion concentrations. The formulations proved to be inhibitors of free radicals and showed excelent antibacterial activity, demonstrating their potential for cosmetic and therapeutic applications.
How I Diagnose Primary Cutaneous Marginal Zone Lymphoma
Authors: Gibson Sarah E , Swerdlow Steven H
Published: June 2020

Objectives

Primary cutaneous marginal zone lymphoma (PCMZL) is 1 of the 3 major subtypes of primary cutaneous B-cell lymphoma. The diagnosis of PCMZL may be challenging, as the differential diagnosis includes benign cutaneous lymphoproliferations as well as other primary or secondary cutaneous B-cell or T-cell lymphomas. This review describes our approach to the diagnosis of PCMZL.

Methods

Two cases are presented that illustrate how we diagnose each of the 2 subtypes of PCMZL. The clinicopathologic features of PCMZL and the ways in which these cases can be distinguished from both benign and other neoplastic entities are emphasized.

Results

A definitive diagnosis of PCMZL requires the incorporation of histologic and immunophenotypic features, molecular genetic studies in some cases, and just as importantly, clinical findings. Emerging data suggest that the heavy chain class-switched cases may be more like a clonal chronic lymphoproliferative disorder.

Conclusions

The 2 subtypes of PCMZL create different diagnostic challenges and require the use of a multiparameter approach. Although very indolent, it is important to distinguish PCMZLs from reactive proliferations, because they frequently recur and may require antineoplastic therapies. It is also critical to distinguish PCMZLs from other B- or T-cell lymphomas so that patients are properly evaluated and not overtreated.
Perspectives from the frontline: A pharmacy department’s response to the COVID-19 pandemic
Authors: Collins Curtis D , West Nina , Sudekum David M , Hecht Jason P
Published: June 2020

Purpose

The global coronavirus disease 2019 (COVID-19) pandemic has created unprecedented strains on healthcare systems around the world. Challenges surrounding an overwhelming influx of patients with COVID-19 and changes in care dynamics prompt the need for care models and processes that optimize care in this medically complex patient population. The purpose of this report is to describe our institution’s strategy to deploy pharmacy resources and standardize pharmacy processes to optimize the management of patients with COVID-19.

Methods

This retrospective, descriptive report characterizes documented pharmacy interventions in the acute care of patients admitted for COVID-19 during the period April 1 to April 15, 2020. Patient monitoring, interprofessional communication, and intervention documentation by pharmacy staff was facilitated through the development of a COVID-19–specific care bundle integrated into the electronic medical record.

Results

A total of 1,572 pharmacist interventions were documented in 197 patients who received a total of 15,818 medication days of therapy during the study period. The average number of interventions per patient was 8. The most common interventions were regimen simplification (15.9%), timing and dosing adjustments (15.4%), and antimicrobial therapy and COVID-19 treatment adjustments (15.2%). Patients who were admitted to an intensive care unit care at any point during their hospital stay accounted for 66.7% of all interventions documented.

Conclusion

A pharmacy department’s response to the COVID-19 pandemic was optimized through standardized processes. Pharmacists intervened to address a wide scope of medication-related issues, likely contributing to improved management of COVID-19 patients. Results of our analysis demonstrate the vital role pharmacists play as members of multidisciplinary teams during times of crisis.
A functional–structural model of upland rice root systems reveals the importance of laterals and growing root tips for phosphate uptake from wet and dry soils
Authors: De Bauw Pieterjan , Mai Trung Hieu , Schnepf Andrea , Merckx Roel , Smolders Erik , Vanderborght Jan
Published: June 2020

Background and Aims

Upland rice is often grown where water and phosphorus (P) are limited. To better understand the interaction between water and P availability, functional–structural models that mechanistically represent small-scale nutrient gradients and water dynamics in the rhizosphere are needed.

Methods

Rice was grown in large columns using a P-deficient soil at three P supplies in the topsoil (deficient, sub-optimal and non-limiting) in combination with two water regimes (field capacity vs. drying periods). Root system characteristics, such as nodal root number, lateral types, interbranch distance, root diameters and the distribution of biomass with depth, as well as water and P uptake, were measured. Based on the observed root data, 3-D root systems were reconstructed by calibrating the structural architecure model CRootBox for each scenario. Water flow and P transport in the soil to each of the individual root segments of the generated 3-D root architectures were simulated using a multiscale flow and transport model. Total water and P uptake were then computed by adding up the uptake by all the root segments.

Key Results

Measurements showed that root architecture was significantly affected by the treatments. The moist, high P scenario had 2.8 times the root mass, double the number of nodal roots and more S-type laterals than the dry, low P scenario. Likewise, measured plant P uptake increased >3-fold by increasing P and water supply. However, drying periods reduced P uptake at high but not at low P supply. Simulation results adequately predicted P uptake in all scenarios when the Michaelis–Menten constant (Km) was corrected for diffusion limitation. They showed that the key drivers for P uptake are the different types of laterals (i.e. S- and L-type) and growing root tips. The L-type laterals become more important for overall water and P uptake than the S-type laterals in the dry scenarios. This is true across all the P treatments, but the effect is more pronounced as the P availability decreases.

Conclusions

This functional–structural model can predict the function of specific rice roots in terms of P and water uptake under different P and water supplies, when the structure of the root system is known. A future challenge is to predict how the structure root systems responds to nutrient and water availability.
A-06 Agree to Disagree: Evaluating the Utility of Child and Parent-Reported Symptom Summary Scores on the ImPACT Pediatric
Authors: Bogar K , Schatz P
Published: June 2020

Objective

ImPACT Pediatric is a neurocognitive test used to assess concussion in children ages 5–11. Embedded in the test is a series of yes/no symptom questions, answered by both parents and their child. The purpose of this study was to determine if there was any utility in creating summary scores using child- and parent-reported symptoms, and document agreement between child- and parent-reported symptoms.

Method

De-identified baseline and post-concussion ImPACT Pediatric data were obtained from the lead programmer at ImPACT Applications, Inc, who was blind to the purpose of the study. Number of symptoms endorsed through parent and child self-report was documented by summing individual symptoms endorsed at baseline and within 7 days of concussion. Chi-squared analyses were conducted to evaluate the level of agreement between the four symptoms that appear on both child and parent symptom lists (Headache, Dizziness, Tiredness, and Nausea/Vomiting).

Results

Across the four shared symptoms (Headache, Dizziness, Tiredness, and Nausea/Vomiting), parent- child co-endorsement ranged from 27%–71% at baseline, and 69%–95% post-concussion; Kappa (as a measure of agreement) was weak; .24–.41. Paired-samples T-tests revealed children report significantly more symptoms than their parents at baseline (p < .001) but not post-concussion (p = .14).

Conclusions

Parents and their children are not in agreement with respect to symptom endorsement on the ImPACT Pediatric at baseline, with children endorsing a significantly greater number of total symptoms. While the presence/absence of specific symptoms may be of clinical utility, creating a summary symptom score out of binary symptom data does not appear to be useful.
A-10 Grit Predicts Depression, Anxiety, and Subjective Cognitive Complaints Despite Normal Cognitive Performance in College Athletes
Authors: Crane A , DaCosta A , Webbe F , Logalbo A
Published: June 2020

Objective

Grit is defined as a non-cognitive variable that assesses perseverance and passion for long-term goals (Duckworth, Peterson, Matthews, & Kelly, 2007). Current literature demonstrates a relationship between grit and self-control, self-regulation, depression, and anxiety in collegiate students (Muenks, Wigfield, Yang, & O’Neal, 2017; Akos & Kretchmar, 2017; Salles, et. Al. 2016; Masika Musumar, et al. 2018). However, the relationship between grit and relevant sports neuropsychology variables in college athletes has yet to be explored.

Method

Division II collegiate athletes (n = 453, ages 18–23, mean age = 19.79) underwent annual pre-participation baseline evaluation, which included the 12-item grit scale, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder–7 (GAD-7), Sports Concussion Assessment Tool 5th edition (SCAT-5), and Immediate Post Concussion Assessment and Cognitive Testing (ImPACT).

Results

Lower levels of grit significantly predicted higher scores on the PHQ-9 (R2 = .053, p < .001), GAD-7 (R2 = .026, p = .002), SCAT-5 total symptoms (R2 = .038, p < .001), and ImPACT symptom score (R2 = .016, p = .015). Interestingly, Grit significantly predicted the ImPACT cognitive symptom cluster (R2 = .029, p = .001), but none of the other symptom clusters or cognitive domains. Similarly, Grit significantly predicted the SCAT-5 cognitive (R2 = .04, p < .001) and sleep clusters (R2 = .016, p = .015).

Conclusions

Consistent with literature in non-athletes, grit is related to mood difficulties. Uniquely, athletes with lower levels of grit are consistently reporting more cognitive problems, but these perceived cognitive problems are not substantiated by objective neuropsychological testing.
A-11 Comparison of the PHQ-9 and ImPACT Affective Symptom Cluster Scores in Measuring Depression at Baseline Among College Athletes
Authors: DaCosta A , Grueninger K , Hurt S , Crane A , Webbe F M , LoGalbo A
Published: June 2020

Objective

Previous research has suggested that the affective symptom cluster in ImPACT can be used to screen for mood-related depressive symptoms in college athletes in place of a standalone mood measure (Riegler, Guty & Arnett, 2019). However, examining the clinical utility of a mood measure that additionally assesses for non-affective depression symptoms should be explored.

Method

Division II college athletes (n = 1,209) completed ImPACT and the Patient Health Questionnaire (PHQ-9) at their first annual pre-participation baseline assessment (mean age = 19.28, 37% female). ImPACT symptoms were divided into four symptom clusters: physical, sleep, cognitive, and affective.

Results

Mean affective symptom cluster score was 0.51 while mean PHQ-9 total score was 1.32. Ninety (7.44%) of the 1,209 athletes fell above the cutoff for mild depression on the PHQ-9. The sleep symptom cluster was the best individual predictor of PHQ-9 total score (R2 = .202, p < .001) compared to the affective symptom cluster (R2 = .147, p < .001), physical symptom cluster (R2 = .124, p < .001) and cognitive symptom cluster (R2 = .145, p < .001). The individual ImPACT symptom of “fatigue” accounted for the most individual variance in PHQ-9 total score (R2 = .158, p < .001).

Conclusions

These results suggest there is clinical utility in utilizing a stand-alone mood measure to assess dysphoria that presents in a sleep-related manner as opposed to a purely affective manner.
A-13 Return-to-Learn: Academic Accommodations for Concussion Recovery
Authors: Davis B , Creed K , Keshvnani C , Blueitt D , Garrison C
Published: June 2020

Objective

To evaluate academic accommodations offered to student athletes following a concussive injury.

Method

Participants were identified during regularly scheduled visits to the participating fellowship-trained, board-certified primary care sports medicine physician (D.B.). A total of 127 participants (mean ± SD age, 14.8 ± 1.5 years [range, 12–18 years]) diagnosed with a concussion from December 2018 to October 2019 were surveyed. The participants were provided a questionnaire in which the following information was collected: age at injury, date of injury, locations of treatment, cognitive symptoms experienced, academic accommodations received, implementation of accommodation by educators, and school related problems.

Results

Cognitive symptoms were reported by 117 (92.1%) participants with trouble concentrating (81.2%), and feeling “slow” (78.7%) being the most common. Participants treated at the participating, sports-medicine concussion center had the highest rate of receiving academic accommodations (95.3%), while those also treated at an emergency or acute care center, primary care physician, or pediatrician’s office had significantly lower rates (<5%). Participants reported their accommodations as helpful (94.5%), with extra time (88.2%), and ability to take breaks (80.3%) having the highest frequency of recommendation. While symptomatic, 110 (86.6%) participants reported having difficulty completing school work and tests, 58 (45.7%) reported experiencing anxiety about completing their school work, and 55 (43.3%) reported a decline in their grades.

Conclusions

These data display the high frequency of cognitive symptoms and hindered academic performance associated with concussion recovery. The implementation of academic accommodations was demonstrated to be beneficial; however, not all medical centers are providing accommodations.
A-18 Utility of the Child SCAT-5: Performance Differences Across Assessments in Pediatric Concussion
Authors: Fazio-Sumrok V , Blaney N , Kissinger-Knox A , Eagle S , Kegel N , Trbovich A , Kontos A P
Published: June 2020

Objective

In 2017, the Sport Concussion Assessment Tool-5 Child (Child SCAT-5) was introduced as a tool for clinicians to assess cognitive function and symptoms in children following a concussion (Davis, 2017; Echmendia, 2017); however, there are limited data supporting its use. The purpose of this study was to assess performance on the Child SCAT-5 among concussed pediatric patients (i.e., 5–9 years) across two clinic visits.

Method

Participants included 95 children (42.15% female) aged 5–9 years (7.42 +/− 1.12) who were diagnosed with a concussion within 30 days of injury (8.75 +/− 5.65 days). Patients underwent clinical interview and Child SCAT-5. Paired t-tests were used to compare measures on symptomatology, neurocognitive function, and balance performance between their first two clinical encounters (18.07 +/− 16.05 days).

Results

Analyses revealed significant improvements for immediate memory (p < 0.001) and delayed recall (p = 0.035), as well as improvements in symptom count (p < 0.001), symptom severity (p < 0.001), and back-to-normal rating (p = 0.004). Headaches (85.6%), feeling tired a lot (65.9%), getting tired easily (59.3%), difficulty concentrating (57.1%), and being distracted (54.9%) were the most commonly reported symptoms at patients’ initial clinic visit.

Conclusions

The findings from this study indicate that the Child SCAT-5 is useful for identifying common symptoms in pediatric patients tracking symptom improvement across clinic visits. The measure was also useful in identifying improvements in neurocognitive functioning in this population, particularly memory performance. Further research should focus on how the Child SCAT-5 and other pediatric-specific measures can assess and track improvement in clinical outcomes for this at-risk population.
A-23 Mental Health Outcomes of Elite Athletes Following Sport Related Concussion
Authors: Hoyle C , Mrazik M , Naidu D
Published: June 2020

Objective

Investigation of anxiety and depression symptoms at baseline and following sport related concussion in a population of professional and collegiate football players.

Method

A quasi-experimental prospective longitudinal design was implemented. Participants included 198 Canadian Football League and University of Alberta varsity football players at baseline. Additionally, this study tracked 13 concussed athletes, 12 orthopaedic control athletes, and 15 healthy control athletes over approximately a 2 month period. Statistical analysis included an ANOVA and repeated measures ANOVA to identify differences in mental health at baseline as well as after injury at 3 time points (24-48 hours post injury, asymptomatic, and 1 month post return to play).

Results

At baseline, players who had a history of 1 or more concussions reported a greater number of anxiety and depression symptoms in comparison to players who did not have a history of concussion (F(2, 197) = 66.75, (p =.000)). At the group level, there were no differences in anxiety and depression symptoms between players who sustained a concussion, orthoepic injury, or no injury across the four time points measured (depression (F(3, 58) = 1.05, (p =.404); anxiety (F(3, 58) = 1.65, (p =.151)). However, individuals who sustained a concussion displayed significant changes in symptoms of anxiety (F(3, 12) = 9.004, (p =.000)) and depression (F(3, 12) = 11.396, (p =.000)) over time. Specifically, concussed players reported an increase in anxiety related symptoms between baseline report and 24-48 hours post injury (p = .042), a decrease between 24-48 hours and 1 month post return to play (p = .002) and a decrease between asymptomatic and 1 month post return to play (p = .036) time points. Additionally, players who sustained a concussion reported a significant increase in depressive symptoms between 24-48 hours post injury and 1 month post return to play (p = .029) and a decrease between asymptomatic and 1 month post return to play (p = .014) time points. This change over time was not found in the orthopaedic injury (depression (F(3, 11) = 2.467, (p =.14); anxiety (F(3, 11) = 2.242, (p =.15)) or healthy control groups (depression; (F(3, 14) = 2.177, (p =.17); anxiety; F(3, 14) = 1.435, (p =.30)).

Conclusions

Results from this study suggest that a history of concussion impacts baseline self-report of anxiety and depression symptoms. Furthermore, players who sustained a concussion experienced subtle increases in anxiety and depressive symptoms in the short term and not in the long term. Players with who sustained an orthopaedic injury and healthy players did not show these changes in anxiety and depression symptom report. It appears that in this small sample concussion produced unique outcomes related to mental health functioning in the short term.
A-30 Symptom Count Versus Symptom Severity: Which is a Better Predictor of Time to Recovery?
Authors: Pardini J , Pardini D , Sterling J , Docherty M , Mattis J
Published: June 2020

Objective

Evaluation of self-reported symptoms is a key component of concussion management. This study examined whether symptom count, a more parsimonious method to gather symptom information, would predict recovery better than symptom severity.

Method

Participants were 1267 (39.3% female) adolescents ages 10–18 (M = 14.7, SD = 1.8) who were evaluated and diagnosed with a concussion by a physician within 10 days of injury. At their initial visit, participants completed the ImPACT computerized test and the included post-concussion symptom scale. The primary outcome was number of weeks (M = 3.2, SD = 1.8) until participants were cleared to return to play by the treating physician based on a standardized protocol.

Results

Symptom count and symptom severity were highly correlated (r = .89, p < .001). When examined in separate linear regression models, both symptom count (β = .28, p < .001) and symptom severity (β = .25, p < .001) predicted weeks until return to play after controlling for age, gender, prior history of concussion, and neurocognitive test performance. However, when symptom count and severity were both included in the same regression model, symptom count continued to predict weeks to recovery (β = .31, p < .001) and the effect of symptom severity was reduced to non-significance (β = −.03, p = .64).

Conclusions

Symptom count at initial clinic visit predicted recovery time, eliminating the predictive power of symptom severity when both were entered in the same regression model. Thus, symptom count may be a more robust and more parsimonious assessment than traditional severity ratings, which may save clinic time and allow for additional multimodal assessments.
A-32 Acute Concussive Symptom Profiles in Adolescents and Young Adults with History of Depression and Anxiety
Authors: Presley C , Meredith-Duliba T , Tarkenton T , Stokes M , Miller S , Bell K , Batjer H , Cullum C M
Published: June 2020

Objective

The aims of this study are (1) to examine the clinical symptom profiles of individuals with depression and/or anxiety history following a concussion and (2) to compare profile differences across groups.

Method

Participants aged 12-25 (n=129, mean=15.6) with premorbid diagnoses of depression (n=24), anxiety (n=50), or depression+anxiety (n=55) were evaluated within 21 days after sustaining a concussion as part of the North Texas Concussion Registry (ConTex) using the Post-Concussion Symptom Scale (PCSS). Following the model described by Kontos and Collins (2014), symptom clusters were derived from the PCSS to create six domains (cognitive/fatigue, vestibular, ocular, posttraumatic migraine, anxiety/mood, cervical). ANOVAs with Tukey’s post-hoc tests were conducted to compare domain symptom severity and total symptom severity across groups.

Results

There were no demographic differences between groups. A single symptom profile was prominent across each group, with the primary, secondary, and tertiary symptomatic domains being posttraumatic migraine, ocular, and cognitive/fatigue, respectively. Across each domain the depression+anxiety group was most symptomatic, followed in order by the depression and anxiety groups. The depression+anxiety group reported significantly higher anxiety/mood (M=2.0 vs. M=1.3) and cognitive/fatigue (M=2.9 vs M=2.1) symptom severity compared to the anxiety group. Group differences on total symptom severity approached significance (F=2.83, p=.06).

Conclusions

The observed symptom profiles suggest that the acute-concussive response is similar in adolescents and young adults with history of depression and/or anxiety. Multiple premorbid conditions, such as depression and anxiety, appear to magnify overall symptom severity. Further research is warranted to understand the relationship between symptom burden and premorbid mental health factors.
A-33 VOMS Scores Relationship to C3 Logix Trail Scores in Females
Authors: Price A M , Caze T , Knell G , Burkhart S
Published: June 2020

Objective

Burkhart and colleagues (2020) showed that positive screening on the Vestibular Ocular Motor Screening (VOMS) and slower C3 Logix Trails (C3LT) were predictive of protracted recovery in female adolescents. The purpose of this study was to see if there was a relationship between positive screening on the VOMS and slower C3LT times in a similar population.

Method

220 females aged 10–18 were administered the VOMS and C3LT between 2017–2019. We hypothesized that positive screening on the VOMS (i.e. symptom provocation of +2, convergence of > 6 mm) would be related to slower speeds on C3LT A and B. Odds ratios were calculated to estimate the likelihood of screening positive on the VOMS based on C3LT times.

Results

Slower times on C3LT A and B, one to two standard deviations (SD) above the mean, was not related to a positive screening on the VOMS. However, performing a faster C3LT A time, one SD below the mean, was 68% less likely to screen positively on the VOMS (OR = 0.32, 95%CI = 0.16–0.62, p = 0.001) compared to those not 1 SD below the mean.

Conclusions

Though C3LT has a visual scanning component, positive screening on the VOMS was not related to slower processing speeds on the C3LT in females age 10–18.
A-46 Deconstructing Competitiveness: The Effect of Age on Athlete’s Desire to Succeed, Win, and Achieve Goals
Authors: Webber A M , Wong R E , Du Plessis S , Garcia-Barrera M A
Published: June 2020

Objective

Our previous research indicated that athletes scoring high in competitiveness were less likely to report sports-related concussion symptoms and withdraw from the game. The present study examined whether athletes’ desire to succeed (competitiveness motive), win (win orientation), and achieve personal goals (goal orientation) were related to the age of players.

Method

Participants included 161 athletes, ages 14–32 (M = 17.6 years; 33.2% female), recruited from a mid-sized Canadian city participating in low (rowing), moderate (soccer) and high (hockey, rugby, football) contact sports. Confirmatory factor analysis was first used to evaluate the structure of the Sports Orientation Questionnaire. Then, using SEM, athletes’ competitiveness, goal orientation, and win orientation were predicted by age.

Results

High internal consistency was obtained within each factor (.84–.93). The model demonstrated suboptimal fit for this sample (CFI = .84; χ2f/df ratio = 2.02; RMSEA = .087; 90% CI: .077–.097). All factors were significantly related to age, indicating that athletes’ desire to succeed (competitiveness motive; β = .18, p = .009), achieve personal goals (goal orientation; β = .26, p = .007), and win (win orientation; β = .30, p = .000) increases with age.

Conclusion

The small positive association between age and competitiveness, win, and goal orientation indicates that older athletes are more competitive than younger athletes. Given that competitiveness predicts athletes’ intention to report a concussion, clinicians and coaches should pay particular attention to senior athletes who demonstrate high levels of general competitiveness and who are driven by the desire to win and achieve personal goals. Therefore, interventions targeting the barriers to reporting concussions should evaluate subco.
RP-HPLC Method for the Determination and Quantification of Artesunate
Authors: Saeed Muhammad Asad , Ansari Muhammad Tayyab , Ch Bashir Ahmad , Zaman Muhammad
Published: June 2020

A simple, rapid and cost-effective reverse phase high-performance liquid chromatographic (RP-HPLC) method was developed for the quantification of artesunate. C18 Promosil (ODS, 150 × 4.6 mm, 5 μm) column was used as stationary phase to separate the drug. Mobile phase comprised of ethanol: water (65:35) having pH 4.5 was run isocratically at a flow rate of 1 mL/min at 27°C. The method was validated according to ICH guidelines for linearity, precision, accuracy, robustness, specificity, limit of detection (LOD) and limit of quantification (LOQ). The method was found accurate, precise and robust with an average retention time of 4.509 min and 0.5357 %RSD. Good linearity was observed in the concentration range of 2–10 mg/ml with regression coefficient R2 value of 0.9995 and slope value of 369,928. Conclusively, as per ICH norms, the developed method was successfully validated and used for the quantification of artesunate in fast dissolving tablets (FDTs).
Incidence, Etiology, and Severity of Acute Gastroenteritis Among Prospectively Enrolled Patients in 4 Veterans Affairs Hospitals and Outpatient Centers, 2016–2018
Authors: Cardemil Cristina V , Balachandran Neha , Kambhampati Anita , Grytdal Scott , Dahl Rebecca M , Rodriguez-Barradas Maria C , Vargas Blanca , Beenhouwer David O , Evangelista Karen V , Marconi Vincent C , Meagley Kathryn L , Brown Sheldon T , Perea Adrienne , Lucero-Obusan Cynthia , Holodniy Mark , Browne Hannah , Gautam Rashi , Bowen Michael D , Vinjé Jan , Parashar Umesh D , Hall Aron J
Published: June 2020

Background

Acute gastroenteritis (AGE) burden, etiology, and severity in adults is not well characterized. We implemented a multisite AGE surveillance platform in 4 Veterans Affairs Medical Centers (Atlanta, Georgia; Bronx, New York; Houston, Texas; and Los Angeles, California), collectively serving >320 000 patients annually.

Methods

From 1 July 2016 to 30 June 2018, we actively identified inpatient AGE case patients and non-AGE inpatient controls through prospective screening of admitted patients and passively identified outpatients with AGE through stool samples submitted for clinical diagnostics. We abstracted medical charts and tested stool samples for 22 pathogens by means of multiplex gastrointestinal polymerase chain reaction panel followed by genotyping of norovirus- and rotavirus-positive samples. We determined pathogen-specific prevalence, incidence, and modified Vesikari severity scores.

Results

We enrolled 724 inpatients with AGE, 394 non-AGE inpatient controls, and 506 outpatients with AGE. Clostridioides difficile and norovirus were most frequently detected among inpatients (for AGE case patients vs controls: C. difficile, 18.8% vs 8.4%; norovirus, 5.1% vs 1.5%; P < .01 for both) and outpatients (norovirus, 10.7%; C. difficile, 10.5%). The incidence per 100 000 population was highest among outpatients (AGE, 2715; C. difficile, 285; norovirus, 291) and inpatients ≥65 years old (AGE, 459; C. difficile, 91; norovirus, 26). Clinical severity scores were highest for inpatient norovirus, rotavirus, and Shigella/enteroinvasive Escherichia coli cases. Overall, 12% of inpatients with AGE had intensive care unit stays, and 2% died; 3 deaths were associated with C. difficile and 1 with norovirus. C. difficile and norovirus were detected year-round with a fall/winter predominance.

Conclusions

C. difficile and norovirus were leading AGE pathogens in outpatient and hospitalized US veterans, resulting in severe disease. Clinicians should remain vigilant for bacterial and viral causes of AGE year-round.
Persistent and Emerging Pneumococcal Carriage Serotypes in a Rural Gambian Community After 10 Years of Pneumococcal Conjugate Vaccine Pressure
Authors: Usuf Effua , Bottomley Christian , Gladstone Rebecca , Bojang Ebrima , Jawneh Kaddijatou , Cox Isatou , Jallow Edrissa , Bojang Abdoulie , Greenwood Brian , Adegbola Richard A , Bentley Stephen D , Hill Philip C , Roca Anna
Published: June 2020

Background

The continuing impact of pneumococcal conjugate vaccines (PCVs) in regions with high pneumococcal transmission is threatened by the persistence of vaccine serotypes (VTs) and the emergence of nonvaccine serotypes (NVTs).

Methods

In 2016, we conducted a cross-sectional carriage survey (CSS5) in a community where PCV7 was first introduced in 2006 during a cluster-randomized trial conducted before nationwide introduction of PCV7 (2009) and PCV13 (2011). We estimated prevalence of PCV13 VT and NVT by age and compared these with earlier surveys before (CSS0), during (CSS1-3), and after the trial but before PCV13 (CSS4). Genomic analysis was conducted for the nontypeable pneumococci.

Results

Prevalence of PCV13 VT carriage decreased during the 10 years between CSS0 and CSS5 across all age groups (67.6% to 13.5%, P < .001; 59.8% to 14.4%, P < .001; 43.1% to 17.9%, P < .001; and 24.0% to 5.1%, P < .001, in <2, 2–4, 5–14, and ≥15 years, respectively). However, there was no difference between CSS4 and CSS5 in children ≥2 years and adults (children <2 years, no data). The prevalence of PCV13 NVT increased between CSS0 and CSS5 for children <2 years but decreased in older children and adults. In CSS5, serotypes 3, 6A, and 19F were the most common VT and nontypeable isolates were the most common NVT. Among nontypeable isolates, 73.0% lost the ability to express a capsule. Of these, 70.8% were from a VT background.

Conclusions

The decrease in PCV13 VT that has occurred since the introduction of PCV13 appears to have plateaued. Significant carriage of these serotypes remains in all age groups.
An Analysis of Antibacterial Drug Development Trends in the United States, 1980–2019
Authors: Dheman Nidhi , Mahoney Nicole , Cox Edward M , Farley John J , Amini Thushi , Lanthier Michael L
Published: June 2020

We present a longitudinal analysis of investigational new drug applications (INDs) for new, systemic antibacterial drugs under active development between 1980 and 2019, evaluating the characteristics of these investigational drugs and the outcomes of these drug development programs. The number of INDs in active development declined by two-thirds, from 39 active INDs at its peak in 1987 to a low 13 in 2001, with decreased development of new cephalosporin, quinolone, and macrolide drugs and reduced participation from large pharmaceutical firms. Antibacterial drug development activity rebounded substantially from 2002 to 2009, primarily led by involvement of small pharmaceutical companies. As of 31 December 2019, the number of active INDs has declined to an 11-year low, and the number of antibacterial INDs initiated with the US Food and Drug Administration during 2010–2019 was lower than any of the previous 3 decades. Antibacterial drug development programs initiated in the 1980s and 1990s had high success rates, with >40% of INDs obtaining marketing approval, in a median time of about 6 years from IND receipt to approval. For drug development programs initiated between 2000 and 2009, we found that IND-to-approval rates reduced to 23%, with median development times for approved antibacterial drugs increasing to 8.2 years. The majority of INDs in development as of 31 December 2019 come from already established drug classes, most in early stages of development, and few are sponsored by large pharmaceutical companies.
Identification, Management, and Outcomes of Combination Antiretroviral Treatment Failure in Adolescents With Perinatal Human Immunodeficiency Virus Infection in Asia
Authors: Bartlett Adam W , Sudjaritruk Tavitiya , Mohamed Thahira J , Anugulruengkit Suvaporn , Kumarasamy Nagalingeswaran , Phongsamart Wanatpreeya , Ly Penh Sun , Truong Khanh Huu , Van Nguyen Lam , Do Viet Chau , Ounchanum Pradthana , Puthanakit Thanyawee , Chokephaibulkit Kulkanya , Lumbiganon Pagakrong , Kurniati Nia , Nik Yusoff Nik Khairulddin , Wati Dewi Kumara , Sohn Annette H , Kariminia Azar
Published: June 2020

Background

Combination antiretroviral therapy (cART) failure is a major threat to human immunodeficiency virus (HIV) programs, with implications for individual- and population-level outcomes. Adolescents with perinatally acquired HIV infection (PHIVA) should be a focus for treatment failure given their poorer outcomes compared to children and adults.

Methods

Data (2014–2018) from a regional cohort of Asian PHIVA who received at least 6 months of continuous cART were analyzed. Treatment failure was defined according to World Health Organization criteria. Descriptive analyses were used to report treatment failure and subsequent management and evaluate postfailure CD4 count and viral load trends. Kaplan-Meier survival analyses were used to compare the cumulative incidence of death and loss to follow-up (LTFU) by treatment failure status.

Results

A total 3196 PHIVA were included in the analysis with a median follow-up period of 3.0 years, of whom 230 (7.2%) had experienced 292 treatment failure events (161 virologic, 128 immunologic, 11 clinical) at a rate of 3.78 per 100 person-years. Of the 292 treatment failure events, 31 (10.6%) had a subsequent cART switch within 6 months, which resulted in better immunologic and virologic outcomes compared to those who did not switch cART. The 5-year cumulative incidence of death and LTFU following treatment failure was 18.5% compared to 10.1% without treatment failure.

Conclusions

Improved implementation of virologic monitoring is required to realize the benefits of virologic determination of cART failure. There is a need to address issues related to accessibility to subsequent cART regimens, poor adherence limiting scope to switch regimens, and the role of antiretroviral resistance testing.
Coronavirus 2019 and People Living With Human Immunodeficiency Virus: Outcomes for Hospitalized Patients in New York City
Authors: Sigel Keith , Swartz Talia , Golden Eddye , Paranjpe Ishan , Somani Sulaiman , Richter Felix , De Freitas Jessica K , Miotto Riccardo , Zhao Shan , Polak Paz , Mutetwa Tinaye , Factor Stephanie , Mehandru Saurabh , Mullen Michael , Cossarini Francesca , Bottinger Erwin , Fayad Zahi , Merad Miriam , Gnjatic Sacha , Aberg Judith , Charney Alexander , Nadkarni Girish , Glicksberg Benjamin S
Published: June 2020

Background

There are limited data regarding the clinical impact of coronavirus disease 2019 (COVID-19) on people living with human immunodeficiency virus (PLWH). In this study, we compared outcomes for PLWH with COVID-19 to a matched comparison group.

Methods

We identified 88 PLWH hospitalized with laboratory-confirmed COVID-19 in our hospital system in New York City between 12 March and 23 April 2020. We collected data on baseline clinical characteristics, laboratory values, HIV status, treatment, and outcomes from this group and matched comparators (1 PLWH to up to 5 patients by age, sex, race/ethnicity, and calendar week of infection). We compared clinical characteristics and outcomes (death, mechanical ventilation, hospital discharge) for these groups, as well as cumulative incidence of death by HIV status.

Results

Patients did not differ significantly by HIV status by age, sex, or race/ethnicity due to the matching algorithm. PLWH hospitalized with COVID-19 had high proportions of HIV virologic control on antiretroviral therapy. PLWH had greater proportions of smoking (P < .001) and comorbid illness than uninfected comparators. There was no difference in COVID-19 severity on admission by HIV status (P = .15). Poor outcomes for hospitalized PLWH were frequent but similar to proportions in comparators; 18% required mechanical ventilation and 21% died during follow-up (compared with 23% and 20%, respectively). There was similar cumulative incidence of death over time by HIV status (P = .94).

Conclusions

We found no differences in adverse outcomes associated with HIV infection for hospitalized COVID-19 patients compared with a demographically similar patient group.
Comparing Nasopharyngeal and Midturbinate Nasal Swab Testing for the Identification of Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Pinninti Swetha , Trieu Connie , Pati Sunil K , Latting Misty , Cooper Joshua , Seleme Maria C , Boppana Sushma , Arora Nitin , Britt William J , Boppana Suresh B
Published: June 2020

Testing of paired midturbinate (MT) nasal and nasopharyngeal (NP) swabs, collected by trained personnel from 40 patients with coronavirus disease 2019 (COVID-19), showed that more NP (76/95 [80%]) than MT swabs tested positive (61/95 [64%]) (P = .02). Among samples collected a week after study enrollment, fewer MT than NP samples were positive (45% vs 76%; P = .001).
Response to multiple rapid swallows shows impaired inhibitory pathways in distal esophageal spasm patients with and without concomitant esophagogastric junction outflow obstruction
Authors: Hernandez Patricia V , Valdovinos Luis R , Horsley-Silva Jennifer L , Valdovinos Miguel A , Crowell Michael D , Vela Marcelo F
Published: June 2020

Distal esophageal spasm (DES) is a motility disorder characterized by premature contraction of the esophageal body during single swallows. It is thought to be due to impairment of esophageal inhibitory pathways, but studies to support this are limited. The normal response to multiple rapid swallows (MRS) is deglutitive inhibition of the esophageal body during the MRS sequence. Our aim was to compare the response to MRS in DES patients and healthy control subjects. Response to MRS during HRM was evaluated in 19 DES patients (8 with and 11 without concomitant esophagogastric junction outflow obstruction [EGJOO]) and 24 asymptomatic healthy controls. Patients with prior gastroesophageal surgery, peroral endoscopic myotomy, pneumatic dilation, esophageal botulinum toxin injection within 6 months of HRM, opioid medication use, and esophageal stricture were excluded. Response to MRS was evaluated for complete versus impaired inhibition (esophageal body contractility with distal contractile integral [DCI] > 100 mmHg-sec-cm during MRS), presence of post-MRS contraction augmentation (DCI post MRS greater than single swallow mean DCI), and integrated relaxation pressure (IRP). Impaired deglutitive inhibition during MRS was significantly more frequent in DES compared to controls (89% vs. 0%, P < 0.001), and frequency was similar for DES with versus without concomitant EGJOO (100% vs. 82%, P = 0.48). The proportion of subjects with augmentation post MRS was similar for both groups (37% vs. 38%, P = 1.00), but mean DCI post MRS was higher in DES than controls (3360.0 vs. 1238.9, P = 0.009). IRP was lower during MRS compared to single swallows in all patients, and IRP during MRS was normal in 5 of 8 patients with DES and EGJOO. Our study suggests that impaired deglutitive inhibition during MRS is present in the majority of patients with DES regardless of whether they have concomitant EGJOO, and future studies should explore the usefulness of incorporating response to MRS in the diagnosis of DES.
Early experience with a nutrition and survivorship clinic in esophageal cancer
Authors: Murphy Conor F , Fanning Michelle , Raftery Nicola , Elliott Jessie A , Docherty Neil G , Donohoe Claire L , Ravi Narayanasamy , le Roux Carel W , Reynolds John V
Published: June 2020

Improved cure rates in esophageal cancer care have increased focus on health-related quality of life (HRQL) in survivorship. To optimize recovery after esophagectomy, particularly nutritional well-being, a personalized multidisciplinary survivorship clinic was established at this center. Assessments at 6 and 12 months postoperatively include validated European Organization for the Research and Treatment of Cancer (EORTC) symptom and health-related quality of life (HRQL) questionnaires, functional status review, anthropometry, and biochemical screening for micronutrient deficiencies. 75 patients, at a mean age of 63 years, 84% male, 85% with adenocarcinoma, and 73% receiving multimodal therapy were included. Mean preoperative body mass index (BMI) was 27.5 (4.3) kg m −2. 6- and 12-month assessments were completed by 66 (88%) and 37 (93%) recurrence-free patients, respectively. Mean body weight loss at 6 months was 8.5 ± 6.6% and at 12 months 8.8 ± 7.3%. Of the 12-month cohort, micronutrient deficiency was present in 27 (79.4%) preoperatively and 29 (80.6%) after 1 year (P = 0.727), most commonly iron deficiency (preoperative: 16 [43.2%] and postoperative: 17 [45.9%] patients, P = 0.100). 26 (70.3%) of these patients also had clinically significant dumping syndrome persisting to 12 months after surgery. We describe a novel follow-up support structure for esophageal cancer patients in the first year of survivorship. This may serve as an exemplar model with parallel application across oncological care.
Varicella Zoster Virus in Inflammatory Bowel Disease Patients: What Every Gastroenterologist Should Know
Authors: Schreiner Philipp , Mueller Nicolas J , Fehr Jan , Maillard Michel H , Brand Stephan , Michetti Pierre , Schoepfer Alain , Restellini Sophie , Vulliemoz Marianne , Vavricka Stephan R , Juillerat Pascal , Rogler Gerhard , Biedermann Luc
Published: June 2020

Primary varicella zoster virus [VZV] infection results in varicella [chickenpox] and its reactivation results in herpes zoster [HZ; shingles]. Patients with inflammatory bowel disease [IBD] are susceptible to complications of primary VZV infection and have an increased risk of HZ. Concerns of VZV and HZ infection in the IBD population have been highlighted by the emergence of JAK inhibitors and their safety profile in this patient population, as with tofacitinib for the treatment of ulcerative colitis [UC]. The current pipeline of emerging therapies includes novel molecules targeting multiple pathways, including JAK/signal transducer and cytokine signalling pathways, such as JAK/STAT. Hence VZV and HZ will be increasingly relevant for gastroenterologists treating IBD patients in light of these emerging therapies. This review will focus on the epidemiology, disease course, prevention, and management of these two distinct infections in patients with IBD.