bluuebunny/crossref_metadata_2025 huggingface dataset:
Sleepiness is a signal to go to bed: data and model simulations
Authors: Shochat Tamar , Santhi Nayantara , Herer Paula , Dijk Derk-Jan , Skeldon Anne C
Published: May 2021

Study Objectives

Assess the validity of a subjective measure of sleepiness as an indicator of sleep drive by quantifying associations between intraindividual variation in evening sleepiness and bedtime, sleep duration, and next morning and subsequent evening sleepiness, in young adults.

Methods

Sleep timing and sleepiness were assessed in 19 students in late autumn and late spring on a total of 771 days. Karolinska Sleepiness Scales (KSS) were completed at half-hourly intervals at fixed clock times starting 4 h prior to participants’ habitual bedtime, and in the morning. Associations between sleepiness and sleep timing were evaluated by mixed model and nonparametric approaches and simulated with a mathematical model for the homeostatic and circadian regulation of sleepiness.

Results

Intraindividual variation in evening sleepiness was very large, covering four or five points on the 9-point KSS scale, and was significantly associated with subsequent sleep timing. On average, a one point higher KSS value was followed by 20 min earlier bedtime, which led to 11 min longer sleep, which correlated with lower sleepiness next morning and the following evening. Associations between sleepiness and sleep timing were stronger in early compared to late sleepers. Model simulations indicated that the directions of associations between sleepiness and sleep timing are in accordance with their homeostatic and circadian regulation, even though much of the variance in evening sleepiness and details of its time course remain unexplained by the model.

Conclusion

Subjective sleepiness is a valid indicator of the drive for sleep which, if acted upon, can reduce insufficient sleep.
Pathway engineering for high-yield production of lutein in Escherichia coli
Authors: Takemura Miho , Kubo Akiko , Watanabe Asuka , Sakuno Hanayo , Minobe Yuka , Sahara Takehiko , Murata Masahiro , Araki Michihiro , Harada Hisashi , Terada Yoshinobu , Yaoi Katsuro , Ohdan Kohji , Misawa Norihiko
Published: May 2021

Lutein is an industrially important carotenoid pigment, which is essential for photoprotection and photosynthesis in plants. Lutein is crucial for maintaining human health due to its protective ability from ocular diseases. However, its pathway engineering research has scarcely been performed for microbial production using heterologous hosts, such as Escherichia coli, since the engineering of multiple genes is required. These genes, which include tricky key carotenoid biosynthesis genes typically derived from plants, encode two sorts of cyclases (lycopene ε- and β-cyclase) and cytochrome P450 CYP97C. In this study, upstream genes effective for the increase in carotenoid amounts, such as isopentenyl diphosphate isomerase (IDI) gene, were integrated into the E. coli JM101 (DE3) genome. The most efficient set of the key genes (MpLCYe, MpLCYb and MpCYP97C) was selected from among the corresponding genes derived from various plant (or bacterial) species using E. coli that had accumulated carotenoid substrates. Furthermore, to optimize the production of lutein in E. coli, we introduced several sorts of plasmids that contained some of the multiple genes into the genome-inserted strain and compared lutein productivity. Finally, we achieved 11 mg/l as lutein yield using a mini jar. Here, the high-yield production of lutein was successfully performed using E. coli through approaches of pathway engineering. The findings obtained here should be a base reference for substantial lutein production with microorganisms in the future.
Quality Performance of a Transfer Center Reduces Interhospital Transfer and Direct Admission-Related ED Evaluations
Authors: Pagali Sandeep , Kocher Jean-Pierre , Coons Trevor , King Kassie , Hansel Stephanie , Van Brunt Nathan , Smith Cydni , Williams Amy , Newman Jamie
Published: May 2021

Transfer centers play a vital role in the efficient triage of hospital admission requests that generate outside the emergency department (ED) of the given facility. This cohort study includes all the calls processed through the transfer center requesting an admission to Mayo Clinic, Rochester, from January 2016 to December 2018. More than 116,000 transfer request calls were processed. Of these, about 65% (75,000) were accepted for ED evaluation or direct admission. Of the 75,000 patients, >50% were accepted as direct admits. Among patients accepted for direct admission, a trend toward reduced utilization of ED reevaluation at the receiving facility was noted from 2016 to 2018. A temporal trend of overall reduced ED utilization reflects the adeptness of the transfer center. An effective transfer center promotes value-based care, optimizes the workflow in a hospital, and augments hospital administrative decisions to allocate resources.
L5 Partial Pedicle Subtraction Osteotomy in High Pelvic Incidence Patients: A New Way to Manage Lordosis
Authors: Grobost Pierre , Chevillotte Thomas , Schlösser Tom , Silvestre Clément , Roussouly Pierre
Published: May 2021

Introduction:

Numerous corrective osteotomy techniques have been reported in lumbar area. Owing to mechanical difficulties and reputation of higher neurological risk, L5 pedicle subtraction osteotomy (PSO) has been poorly used and described. Until now, there was no reported specific method of PSO in L5 to manage the shape of the lordosis with respect of local anatomy. The objective of this study was to describe a new partial PSO technique in L5 to manage the lower arc of lordosis in high pelvic incidence patients with fixed sagittal imbalance.

Materials and Methods:

We describe, here, the surgical technique for a partial PSO at L5 level and the associated technique of instrumentation and correction of lordosis.

Results:

Two different cases were reviewed retrospectively to illustrate this new technique to manage lordosis. The described technique is feasible either in first intention or in a revision surgery. Radiologic results on lordosis and sagittal balance are exposed.

Conclusion:

A partial resection of the pedicles at L5 is often sufficient to create enough lordosis, maybe more effective than complete L3 and L4 PSO for restoration of sagittal balance and less aggressive than complete L5 PSO.
Integrating an Innovative, Cost-Effective Electronic Documentation System for Undergraduate Nursing Students
Authors: Holland Cindra , Stuber Marlene , Mellon Molly
Published: May 2021

Over the past 15 years, the use of electronic medical record systems in the healthcare setting has grown exponentially. Accurate input of patient data is critical to facilitate safe care and effective communication among all members of the healthcare team. To keep pace with the practice environment, nursing students must have the opportunity to document health-related information in an electronic medical record early in the educational program. The purpose of this project was to create a cost-effective electronic medical record system for undergraduate nursing students to learn appropriate documentation of patient-related findings. Patient-centered care, informatics, and safety were the focus topics from the Quality and Safety Education for Nurses project included in the development of this endeavor. Faculty worked in collaboration with the university's information technology department to develop an innovative electronic medical record to be used in physical assessment, which is the first course in the nursing curriculum. Positive feedback was obtained from students and faculty about the project. It is important to provide students with the opportunity to experience electronic documentation to effectively prepare them for the ever-changing practice environment.
Development of a Web-Based Korean Triage and Acuity Scale Learning Program for Emergency Department Nurses
Authors: Kim Hyo-Jin , Kang Hee-Young , Kim Hae-Ran
Published: May 2021

The Korean Triage and Acuity Scale is a tool developed to classify severity and urgency of emergency department patients, focusing on their symptoms. Considering the importance of the Korean Triage and Acuity Scale, learning for emergency department nurses who perform the Korean Triage and Acuity Scale must be structured to ensure that the knowledge they gain can be applied to various clinical situations of the emergency department. Moreover, Web-based learning is considered appropriate in this situation. This is a methodological research study that was conducted to develop a Web-based Korean Triage and Acuity Scale learning program for emergency department nurses. The learning program was developed using each of the five phases of the “analysis, design, development, implementation, and evaluation” model, that is, analysis, design, development, implementation, and evaluation. The learning program was composed of 22 cases of emergency situations based on the Korean Triage and Acuity Scale teaching material with an approval from the Korean Triage and Acuity Scale committee in the Korean Society of Emergency Medicine. The developed program was delivered in 4-hour sessions over 4 weeks. Emergency department nurses who were given the Web-based Korean Triage and Acuity Scale learning program showed improvement in work-site transfer and reported satisfactory learning. The findings indicate that the Web-based learning program for nurses can be used as an effective tool that is easily accessible and provides multiple learning opportunities.
Automatic Classification of Electronic Nursing Narrative Records Based on Japanese Standard Terminology for Nursing
Authors: Aoki Miwa , Yokota Shinichiroh , Kagawa Rina , Shinohara Emiko , Imai Takeshi , Ohe Kazuhiko
Published: May 2021

In Japan, nursing records are not easily put to secondary use because nursing documentation is not standardized. In recent years, electronic health records have necessitated the creation of Japanese nursing terminology. The purpose of this study was to develop and evaluate an automatic classification system for narrative nursing records using natural language processing technology and machine learning. We collected a week's worth of narrative nursing records from an academic hospital. The authors independently annotated the text data, dividing it into morphemes, the smallest meaningful unit in a language. During preprocessing when creating feature quantities, we used a Japanese tokenizer, MeCab, an open-source morphological parser, and the bag-of-words model. A support vector machine was adopted as a classifier for machine learning. The accuracy was 0.96 and 0.86 on the training set and test set, respectively, and the F value was 0.82. Our findings provide useful information regarding the development of an automatic classification system for Japanese nursing records using nursing terminology and natural language processing techniques.
A Mobile-Assisted Peer Assessment Approach for Evidence-Based Nursing Education
Authors: Hwang Gwo-Jen , Wu Yi-Jung , Chang Ching-Yi
Published: May 2021

Students who learn evidence-based nursing can assist the healthcare team to make proper medical decisions and provide patients with valuable advice, thus optimizing the quality of patient care in specific situations. In clinical work, nursing staff members participate in decision making by searching for relevant empirical nursing literature, a basic ability required to enter clinical practice. In traditional instruction, nursing students are taught the Problem, Intervention, Comparison, and Outcome method to learn to use library resources and gather empirical nursing knowledge for decision making. However, it is a challenge for most students to have sufficient practice to make decisions correctly and to have opportunities to perceive medical cases from diverse perspectives. Therefore, we propose a peer assessment-based Problem, Intervention, Comparison, and Outcome approach to help nursing students locate correct evidence and make appropriate decisions about patient care. We performed an experiment with our approach in a nursing university training program. The experimental results reveal that the subjects learning with the proposed approach show better evidence-based nursing knowledge, learning attitude, and critical thinking ability than those learning with the traditional approach.
Children with Cerebral Palsy and Unmet Need for Care Coordination
Authors: Casseus Myriam , Cheng JenFu
Published: May 2021

Objective:

To examine the physical and functional health of children with cerebral palsy (CP) and determine the prevalence and correlates of unmet need for health care coordination among this population.

Methods:

We analyzed data from the 2016 to 2018 National Survey of Children's Health (n = 102,341). Bivariate and multivariable analyses were conducted to compare the prevalence of chronic health conditions, functional disabilities, and care coordination among children with and without CP. Multivariable logistic regression models were used to estimate the adjusted odds ratio of comorbid conditions, functional disabilities, and unmet need for care coordination. Associations between select sociodemographic factors and unmet need for care coordination were assessed.

Results:

Children with CP had significantly higher prevalence of all the comorbid conditions and functional disabilities examined. The most prevalent health conditions among children with CP were allergies (34.2%), anxiety (26.5%), and asthma (25.1%). Notably, children with CP had higher odds of autism spectrum disorder (adjusted odds ratio [aOR] = 2.97; 95% confidence interval [CI] 1.40–6.30) and mental health conditions (aOR = 3.65; 95% CI 2.15–6.21). More than half (53.8%) of children with CP had unmet need for care coordination. They also had higher odds of unmet need for care coordination than children without CP (aOR = 2.63; 95% CI 1.69–4.10).

Conclusion:

Children with CP have high prevalence of chronic health conditions and are also more likely to have unmet need for care coordination. Given the complexity of CP, our study supports the need for robust efforts to ensure that all children with CP have effective care coordination.
Global Trends in Telehealth Among Clinicians in Developmental-Behavioral Pediatric Practice: A COVID-19 Snapshot
Authors: Srinivasan Roopa , Wallis Kate E. , Soares Neelkamal
Published: May 2021

Objective:

This study aims to describe the extent of telehealth use by global developmental-behavioral pediatrics (DBP) clinicians and barriers (if any) in adopting telehealth during the coronavirus disease 2019 (COVID-19) pandemic.

Methods:

A survey was disseminated to DBP clinicians through contact with international professional organizations to determine the use of telehealth in DBP care, before and since the beginning of the COVID-19 pandemic. Descriptive statistics and χ2 tests were used for analysis.

Results:

A total of 271 respondents from 38 countries completed the survey. The number of respondents offering telehealth increased from 36% to 88% after the pandemic, with the greatest shift to telehealth among high-income countries (HICs). Among respondents using telehealth, 75.1% were conducting interactive video visits, with HICs using more telehealth modalities embedded in electronic health records. Most patients (98.7%) were at home for the telehealth encounter. Almost half (46.5%) could not include an interpreter in telehealth visits. Barriers reported by telehealth users included concerns about limited patient access to technology (74.3%), home environment distractions (56.5%), preference for in-person care (53.6%), telehealth effectiveness (48.1%), workflow efficiency (42.2%), and cost/reimbursement (32.1%).

Conclusion:

Global DBP clinicians rapidly adopted telehealth and continued to have interprofessional practice while doing so, with the largest adoption occurring in HICs. Provider concerns about effectiveness and patient access to technology emerged as key organizational and patient barriers, respectively. Increased provider confidence in telehealth and its sustained use in the future depends on supportive regulatory policies and availability and use of measures to monitor quality and effectiveness.
Screening for Children's Chronic Health Conditions and Their Strengths and Difficulties in Primary Care
Authors: Stefko Jordan M. , Stolfi Adrienne , Pascoe John M.
Published: May 2021

Objective:

This study explores parents' perceptions of their child's health status and their strengths and difficulties using 2 validated instruments in primary care settings.

Methods:

This cross-sectional study was conducted between February 2018 and October 2019. Parents of children aged 2 to 18 years completed the Children with Special Health Care Needs (CSHCN) screener and the Strengths and Difficulties Questionnaire (SDQ) as well as demographics. The CSHCN uses 5 questions to identify children with chronic health conditions. Three subgroups were created: children with no chronic health condition (NCHC), chronic health condition with no functional limitations (NFLs), and chronic health condition with functional limitations (FLs). Higher SDQ scores indicate higher degrees of a factor. Associations between CSHCN subgroups and SDQ scores, controlling for demographics, were analyzed with multiple linear regressions.

Results:

In total, 970 parents' surveys (87.9% completed surveys) were included in this analysis: 76.4% of respondents were married, 56.4% had an annual household income ≥$50,000%, and 61.7% were employed full time; 53.0% of the index children were males, 72.1% were White, and 61.4% had private insurance. Mean (SD) total SDQ scores across the 3 CSHCN subgroups were significantly different (NCHC, 7.7 [4.8]; NFL, 12.6 [6.6]; FL, 16.0 [6.7], p < 0.001). The mean SDQ prosocial scores were higher in the NCHC subgroup (p < 0.001), as hypothesized. The SDQ means for the 3 subgroups remained significantly different after controlling for demographics.

Conclusion:

Children with FLs had significantly higher total SDQ scores than children in the other 2 subgroups, which may aid clinicians in the early identification of children who would benefit from behavioral health resources.
Modified Antimesenteric Tapering Enteroplasty: An Alternative Technique for the Treatment of Dysfunctional Anastomosis in Patients With Short Bowel
Authors: Cruz Ruy J.
Published: May 2021

INTRODUCTION:

Several techniques have been described to taper the dilated small bowel to improve intestinal motility and decrease complications related to overdilated small bowel, including longitudinal intestinal lengthening and tapering, serial transverse enteroplasty, and spiral intestinal lengthening and tailoring. We propose an alternative technique designed to optimize bowel function and minimize the effects of recurrent small-bowel bacterial overgrowth in patients with short or ultra-short gut syndrome and dysfunctional anastomosis with maintenance of the actual absorptive surface.

TECHNIQUE:

The dilated side-to-side anastomosis is identified, and the mesentery leaves from both the proximal and distal small-bowel loops are separated by using blunt dissection. The previous anastomosis is divided longitudinally with a GI stapler. Once the small-bowel transection is completed, 2 separate blind loops of intestine are created, each one with half the circumference of the dilated side-to-side anastomosis. The antimesenteric stapled line is then reinforced with an outer layer of running suture. The blind loops of the tapered small bowel are then trimmed and anastomosed in an end-to-end isoperistaltic fashion in 2 layers.

RESULTS:

There were no postoperative complications. The length of the tapering ranged from 10 to 23 cm, corresponding to approximately 16% (range, 13%–20%) of the remaining small-bowel length. Three of 4 patients presented significant improvement of their symptoms and were able to have their parenteral support discontinued.

CONCLUSIONS:

Modified antimesenteric tapering enteroplasty is an alternative technique to improve intestinal motility and treat patients with short-bowel syndrome and dysfunctional side-to-side anastomosis without the need for further small-bowel resection. This bowel-sparing technique represents a valuable option in the armamentarium of the surgeon who manages patients with intestinal failure.
Posterior-First Two-Stage Approach to En Bloc Resection of Locally Recurrent Rectal Cancer Involving the Pelvic Sidewall
Authors: Sakata Shinichiro , Karim S. Mohammed , Mathis Kellie L. , Kelley Scott R. , Rose Peter S. , Dozois Eric J.
Published: May 2021

INTRODUCTION:

Using standard anterior-only or anterior then posterior approaches can make an R0 resection difficult to achieve in patients with pelvic sidewall recurrences because of confined working spaces and poor visibility.

TECHNIQUE:

Given the limitations of standard approaches, we have used a novel posterior-first then anterior 2-stage approach allowing us to widely expose and secure deep margins and control vessels under direct visualization.

RESULTS:

We present a technical note describing this approach in patients with recurrent rectal cancer involving the pelvic sidewall with extrapelvic extension.

CONCLUSION:

The posterior-first approach may assist in achieving a higher number of R0 resections in patients with locally recurrent rectal cancer involving the pelvic sidewall.
Current Pharmacological Management of Aortic Aneurysm
Authors: Xiang Bitao , Zhu Shichao , Li Jun , Lai Hao , Wang Chunsheng , Zhu Kai
Published: May 2021

Aortic aneurysm (AA) remains one of the primary causes of death worldwide. Of the major treatments, prophylactic operative repair is used for AA to avoid potential aortic dissection or rupture. To halt the development of AA and alleviate its progression into aortic dissection, pharmacological treatment has been investigated for years. Currently, β-adrenergic blocking agents, losartan, irbesartan, angiotensin-converting-enzyme inhibitors, statins, antiplatelet agents, doxycycline, and metformin have been investigated as potential candidates for preventing AA progression. However, the paradox between preclinical successes and clinical failures still exists, with no medical therapy currently available for ideally negating the disease progression. This review describes the current drugs used for pharmacological management of AA and their individual potential mechanisms. Preclinical models for drug screening and evaluation are also discussed to gain a better understanding of the underlying pathophysiology and ultimately find new therapeutic targets for AA.
Is Autonomic Nervous System Involved in the Epileptogenesis in Preterm Neonates?
Authors: Falsaperla Raffaele , Vitaliti Giovanna , Mailo Janette , Corsello Giovanni , Ruggieri Martino
Published: May 2021

Autonomic nervous system dysfunction has been described with focal and generalized epileptic seizures; occurring during their ictal, interictal, or postictal states. International League Against Epilepsy Seizure Classification Manual defines autonomic seizures as a distinct alteration of autonomic nervous system function involving cardiovascular, pupillary, gastrointestinal, sudomotor, vasomotor, and thermoregulatory functions. Autonomic seizures represent a great challenge for neonatologists and neurophysiologists; and distinguishing between ictal and non-ictal autonomic changes in neonates is rarely straightforward, especially in the premature ones. To avoid overdiagnosis and overtreatment, International League Against Epilepsy and the American Clinical Neurophysiology Society currently require electrographic correlation for any seizure diagnosis, including preterm neonates. There is very little scientific evidence about the pathophysiology of autonomic seizures. The data reporting on their incidence, clinical features, and diagnostic pathway is also insufficient. In this paper, we hypothesize that in the developing brain of preterm neonates, seizures involving deeper autonomic networks and subcortical structures might not propagate sufficiently to the cortex, and therefore the association of the seizures with specific ictal electrographic changes on surface electroencephalogram might be lacking. We propose considering autonomic seizures in the differential diagnosis of unexplained autonomic changes in neonates, especially preterm neonates, even in the absence of clear initial electrographic correlation. Unexplained autonomic changes could therefore be thought of as a “seizure alarm” in this population.
Determination of Free Valproic Acid Concentration in 569 Clinical Samples by LC-MS/MS After Hollow Fiber Centrifugal Ultrafiltration Treatment
Authors: Wu Xikun , Li Haoran , Dong Weichong , Yang Xiuling , Jin Yiran , Gong Ying , Zhang Zhiqing , Liu Xiujv
Published: May 2021

Objective:

To perform therapeutic drug monitoring of total and free plasma valproic acid (VPA) concentrations in clinical samples and to analyze the related factors.

Methods:

The total VPA concentration in plasma was determined by ultrahigh-performance liquid chromatography with precolumn derivatization with α-bromoacetophenone, and the free VPA concentration was determined by liquid chromatography-tandem mass spectrometry after the plasma was treated by hollow fiber centrifugal ultrafiltration. Regression analysis was performed to examine the associations between free plasma VPA, total plasma VPA, and the plasma protein binding rate. The impact of individual situations, outpatient or inpatient factors, and drug combinations on VPA concentrations were examined.

Results:

Of the 569 clinical samples, 268 were inpatients and 301 were outpatients, and the total VPA concentration in 138 cases (24.2%) was lower than the effective treatment concentration range; the total and free VPA concentrations in outpatient samples were 11.0% and 26.1% higher than those of inpatients, respectively. There was no linear relationship between the free and total VPA concentrations. The relationship equation between the plasma protein binding rate and free VPA concentrations was as follows: Y = 0.0255X2 − 1.1357X + 97.429 (r = 0.8011). The total and free VPA concentrations were significantly decreased after the coadministration of phenobarbital (83.7% and 64.3% of the control group, P < 0.05) or carbapenem antibiotics (32.0% and 32.7% of the control group, P < 0.05).

Conclusions:

The total VPA concentrations in patients with epilepsy at our hospital was lower than the effective treatment concentration range, which was inadequate for epilepsy control; the total VPA concentrations of outpatients were higher than those of inpatients; as phenobarbital affects VPA metabolism, therapeutic drug monitoring is recommended. Carbapenem antibiotic coadministration with VPA should be avoided because carbapenem antibiotics can lead to the failure of VPA antiepileptic treatment.
Transcatheter mitral valve replacement: an update
Authors: Aoun Joe , Reardon Michael J. , Goel Sachin S.
Published: May 2021

Purpose of review

A significant number of patients with mitral valve disease are at high to prohibitive risk for surgical repair or replacement. Transcatheter mitral valve interventions have evolved over the last few years. We review the recent growing evidence on transcatheter mitral valve replacement (TMVR).

Recent findings

Tendyne is the first TMVR device commercially approved in Europe. All TMVR systems remain under investigation in the United States. Several early studies have reported the feasibility and safety outcomes for TMVR implanted via transapical or transseptal approach. TMVR using balloon expandable valve for degenerated bioprosthetic valves, surgical rings and mitral annular calcification appears feasible in selected patients.

Early experience with TMVR systems is promising. Larger ongoing studies will help understand longer term outcomes and offer insights into patient selection.
Comparison of Cardiorespiratory Fitness in Black or African American Versus Caucasian Patients With Heart Failure
Authors: Canada Justin M. , Park Tae Shik , Ravindra Krishna , Chiabrando Juan G. , Del Buono Marco Giuseppe , van Wezenbeek Jessie , Trankle Cory R. , Kadariya Dinesh , Keen Larry , Carbone Salvatore , Billingsley Hayley , Wohlford George F. , Arena Ross , Van Tassell Benjamin W. , Abbate Antonio
Published: May 2021

Purpose:

Cardiopulmonary exercise testing (CPX) is a well-established assessment with important insight into prognosis and therapeutic efficacy in patients with heart failure (HF). Prior studies have identified several clinical differences between Black or African American (B-AA) and Caucasian patients with HF. Differences in key CPX responses between these two groups require further investigation.

Methods:

Using a database consisting of subjects with symptomatic HF who had undergone CPX for inclusion in various prospective randomized clinical trials, we identified 198 (n = 94 [47%] B-AA; n = 105 [53%] Caucasian) patients with a qualifying baseline CPX. Significant univariate predictors of peak oxygen uptake (V˙o
2peak) were included in a multivariate linear regression model.

Results:

When compared with Caucasian patients, B-AA were younger (mean ± SD = 54.8 ± 10.0 vs 57.9 ± 9.6 yr, P = .03), had higher C-reactive protein (CRP) (median [IQR] = 4.9 [2.3, 8.8] vs 1.9 [0.6, 5.5] mg/L, P < .0001), lower hemoglobin (13.0 ± 1.8 vs 13.8 ± 1.6 g/dL, P = .003), and lower left ventricular ejection fraction (LVEF) (40 [32, 51] vs 53 [43, 59]%, P < .00010). During CPX, B-AA patients also had lower V˙o
2peak (14.6 ± 3.9 vs 17.6 ± 4.8 mL·kg−1·min−1, P < .0001). No differences were observed between B-AA and Caucasian in the minute ventilation/carbon dioxide production (V˙e/V˙co
2) slope (P = .14). The difference in V˙o
2peak between B-AA and Caucasian was largely attenuated after adjusting for age, body mass index, CRP, N-terminal pro-brain natriuretic peptide, hemoglobin, LVEF, and peak HR (14.1: 95% CI, 13.2-14.9 vs 15.6: 95% CI, 14.4-16.8 mL·kg−1·min−1, P = .053).

Conclusions:

Directly measured V˙o
2peak was significantly lower in B-AA than in Caucasians with HF. This is largely explained by differences in clinical characteristics, whereas no significant differences were observed in the V˙e/V˙co
2 slope.
Association Between Daily Steps at Moderate Cadence and Vascular Outcomes in Patients With Claudication
Authors: Gardner Andrew W. , Montgomery Polly S. , Wang Ming , Shen Biyi
Published: May 2021

Purpose:

We determined whether patients with peripheral artery disease (PAD) and claudication grouped according to tertiles of community-based daily steps taken at a moderate cadence had differences in vascular function and biomarkers and whether group differences in vascular function and biomarkers persisted after adjusting for demographic variables, comorbid conditions, and severity of PAD.

Methods:

Two hundred sixty-three patients were evaluated for 1 wk on steps taken at a moderate cadence (exceeding 60 steps/min), and patients were placed into low (group 1), intermediate (group 2), and high (group 3) tertiles.

Results:

Ankle/brachial index (ABI) at 1 min after exercise (mean ± SD) was significantly higher in groups 2 and 3 than in group 1 in unadjusted (P < .01) and adjusted (P < .01) analyses (group 1: 0.34 ± 0.25; group 2: 0.38 ± 0.27; and group 3: 0.44 ± 0.28). Exercise time to reach the minimum calf muscle oxygen saturation (StO2) value during treadmill exercise was significantly longer in groups 2 and 3 than in group 1 in unadjusted (P < .01) and adjusted (P < .01) analyses (group 1: 127 ± 127 sec; group 2: 251 ± 266 sec; and group 3: 310 ± 323 sec). Fibrinogen was significantly lower in group 3 than in group 1 in unadjusted (P = .02) and adjusted (P = .05) analyses (group 1: 3.5 ± 1.2 g/L; group 2: 3.6 ± 1.5 g/L; and group 3: 3.0 ± 1.1 g/L).

Conclusions:

Compared with patients with claudication in the lowest tertile of community-based daily steps taken at a moderate cadence, patients in the second and third tertiles had better calf muscle StO2 and ABI values during and immediately after exercise. Second, the most active group had lower fibrinogen levels than the least active group.
First Report of SARS-CoV-2 Detection in Cerebrospinal Fluid in a Child With Guillain-Barré Syndrome
Authors: Araújo Naiana Mota , Ferreira Lis Campos , Dantas Débora Paraíso , Silva Denison Santos , dos Santos Cliomar Alves , Cipolotti Rosana , Martins-Filho Paulo Ricardo
Published: May 2021

Underlying mechanisms on the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and neurologic complications are still poorly understood. Cases of Guillain-Barré Syndrome (GBS) have been linked to the SARS-CoV-2 infection as the result of dysregulated immune response with damage in neuronal tissues. In the current report, we present the first pediatric case of GBS with detection of SARS-CoV-2 in the cerebrospinal fluid (CFS). This unique case of COVID-19-associated GBS with detection of SARS-CoV-2 RNA in the CSF indicates direct viral involvement inducing peripheral nerve inflammation.
The Longest Infectious Virus Shedding in a Child Infected With the G614 Strain of SARS-CoV-2
Authors: Sahbudak Bal Zumrut , Ozkul Aykut , Bilen Melis , Kurugol Zafer , Ozkinay Ferda
Published: May 2021

COVID-19 spread globally and caused over 97 million cases with more than 2 million deaths. There is still ongoing discussion on the duration of infectious interval SARS-CoV-2 infection. Symptomatic children had longer virus shedding and there are some reports of prolonged infectious virus shedding in adults particularly patients having an immunocompromised status. A missense mutation, D614G, in the spike protein of SARS-CoV-2, which has emerged as a predominant clade in Europe and is spreading worldwide that can result in higher viral loads in patients. Herein, we described the longest infectious virus shedding in a previously healthy child infected with SARS-CoV-2 expressing spike D614G substitution.
Piloting the Feasibility and Preliminary Impact of Adding Birth HIV Polymerase Chain Reaction Testing to the Early Infant Diagnosis Guidelines in Kenya
Authors: Finocchario-Kessler Sarah , Wexler Catherine , Brown Melinda , Goggin Kathy , Lwembe Raphael , Nazir Niaman , Gautney Brad , Khamadi Samoel , Babu Shadrack , Muchoki Elizabeth , Maosa Nicodemus , Mabachi Natabhona , Kamau Yvonne , Maloba May
Published: May 2021

Background:

In Kenya, standard early infant diagnosis (EID) with polymerase chain reaction (PCR) testing at 6-week postnatal achieves early treatment initiation (<12 weeks) in <20% of HIV+ infants. Kenya’s new early infant diagnosis guidelines tentatively proposed adding PCR testing at birth, pending results from pilot studies.

Methods:

We piloted birth testing at 4 Kenyan hospitals between November 2017 and November 2018. Eligible HIV-exposed infants were offered both point-of-care and PCR HIV testing at birth (window 0 to <4 weeks) and 6 weeks (window 4–12 weeks). We report the: proportion of infants tested at birth, 6-week, and both birth and 6-week testing; median infant age at results; seropositivity and antiretroviral therapy initiation.

Results:

Final sample included 624 mother-infant pairs. Mean maternal age was 30.4 years, 73.2% enrolled during antenatal care and 89.9% had hospital deliveries. Among the 590 mother–infants pairs enrolled before 4 weeks postnatal, 452 (76.6%) completed birth testing before 4 weeks, with 360 (79.6%) testing within 2 weeks, and 178 (39.4%) before hospital discharge (0–2 days). Mothers were notified of birth PCR results at a median infant age of 5.4 weeks. Among all 624 enrolled infants, 575 (92.1%) were tested during the 6-week window; 417 (66.8%) received testing at both birth and 6-weeks; and 207 received incomplete testing (93.3% only 1 PCR and 6.7% no PCR). Four infants were diagnosed with HIV, and 3 infants were initiated on antiretroviral therapy early, before 12 weeks of age.

Conclusions:

Uptake of PCR testing at birth was high and a majority of infants received repeat testing at 6 weeks of age.
Epidemiology of Pediatric Meningitis in South Korea From 2010 to 2018: A Population-based Retrospective Cohort Study
Authors: Kim Bit Gyeol , Jang Min Sik , Kim Jihye
Published: May 2021

Background:

Studies evaluating the epidemiology of pediatric meningitis are limited in our region. This study aimed to describe recent trends in the incidence of pediatric meningitis.

Methods:

We estimated national trends in hospitalization rates for pediatric meningitis (<18 years) by analyzing data from the Health Insurance Review and Assessment database between 2010 and 2018. Meningitis cases were identified based on International Classification of Diseases, Tenth Revision (ICD-10) codes and hospitalization rates were calculated.

Results:

In this national population-based study, a total of 119,644 hospitalizations and 58 deaths due to pediatric meningitis were identified. The hospitalization rates of pediatric bacterial meningitis have declined by 50.0%, from 3.4 per 100,000 in 2010 to 1.7 per 100,000 in 2018. The mortality rates for bacterial and viral meningitis were 2.0% and 0.002%, respectively. Despite the decreased annual incidence of bacterial meningitis, its mortality rate did not change significantly during the study period. The only risk factor identified for mortality in bacterial meningitis patients among age group, sex, region of residence, and season was age below 1 year (P < 0.001). As children under 1 year have a high-mortality rate (4.2%), patients in this age group require close monitoring. The reasons behind indistinct seasonal patterns of bacterial meningitis warrant further investigation.

Conclusions:

Childhood bacterial meningitis has shown a significant decline in incidence from 2010 to 2018. In contrast, viral meningitis has not shown a trend over time. Knowledge of these changes may aid clinicians in the decision-making process and management of meningitis patients.
Factors Contributing to Late Cancellation and No-Show for Otolaryngologic Surgery: A Prospective Study
Authors: Kaplon Adam W. , Lindemann Timothy Logan , Patel Punam A. , Soliman Ahmed M.S.
Published: May 2021

Purpose:

Late cancellations and no-shows for surgery place a burden on patients, healthcare providers, and the health system. We aim to identify risk factors contributing to this phenomenon.

Methods:

Patients who did not arrive for, or canceled within 24 hours of, their surgical appointment between January 2019 and 2020 were identified. Controls were matched by date, procedure, and gender. Demographic information was obtained by phone interview and chart review. Chi-square and Student t-test analyses were used to predict risk factors for cancellation.

Results:

Thirty-one patients were identified, of whom 21 completed phone interviews. Age, gender, race, language, marital status, and smoking status were not significantly different. Study patients reported more transportation challenges (33.3% vs. 4.8%, p = .01) yet lived closer to the hospital (4.53 miles vs. 14.05 miles, p = .01). Study patients lived in lower income zip codes ($48,145 vs. $63,406, p = .02) and more commonly had Medicaid as their primary insurance (70.9% vs. 38.7%, p = .04). Most commonly, no reason was given for cancellation (22.6%) followed by personal reasons (16.1%) and surgery reconsideration (16.1%).

Conclusions:

Transportation trouble and lower income are significant risk factors for surgery late cancellation. Prior no-show must also be considered. A targeted pilot program may help prevent late cancellations.
Relationship Between Various Coronary Artery Disease Risk Factors in Firefighters
Authors: Ras Jaron , Leach Lloyd
Published: May 2021

Objective:

To determine the correlation between the various coronary artery disease risk factors in firefighters.

Methods:

The study used a quantitative, cross-sectional, and correlational study design. A total of 124 full-time firefighters were conveniently recruited to participate. Research procedures were based on the ACSM guidelines.

Results:

Significances were found between age and body mass index (BMI) (r = 0.42, P < 0.001), age and waist circumference (WC) (r = 0.52, P < 0.001), BMI and WC (r = 0.88, P < 0.001), BMI and diastolic blood pressure (DBP) (r = 0.48, P < 0.001), between WC and DBP (r = 0.48, P < 0.001) and between gender and cigarette smoking (χ
2[1] = 5.66, P = 0.017).

Conclusion:

There were significant strong relationships between BMI, SBP, DBP, dyslipidemia, and increasing age, especially in male firefighters. Reducing key risk factors should be emphasized.
Changes in Job Control and Perceptions of General Health
Authors: Taouk Yamna , Spittal Matthew John , Disney George , LaMontagne Anthony Daniel
Published: May 2021

Objective:

This longitudinal study of Australian workers explores a possible causal relationship between job control and general health.

Methods:

Our sample included 105,017 observations (18,574 persons) over 13 annual waves from working age participants with information on job control, general health, and other sociodemographic and health factors. Three complementary longitudinal modeling approaches were used to explore the causal relationship.

Results:

There was a strong stepwise, mostly exposure to outcome, relationship between increasing job control and general health. Cumulative exposure to low job control resulted in increasingly worse general health. Taken together, these findings provide good evidence of a causal relationship between low job control and general health.

Conclusion:

This analysis with improved causal inference over previous research showed that change in job control is strongly associated with change in general health.
Evaluation of the Implementation of a Railway Critical Incident Management and Support Protocol to Help Train Drivers Cope With Accidents and Suicides
Authors: Bardon Cécile , Dargis Luc , Mishara Brian
Published: May 2021

Objective:

Railway accidents and suicides can have severe psychological consequences for train drivers. This study evaluates the implementation of railway critical incident management and support protocols (CIMSP) by employers. It also identifies environmental factors, characteristics of critical incidents, and types of work relations affecting implementation.

Methods:

A longitudinal study was conducted with 74 train drivers. Participants were interviewed 1 week, 1, 3, and 6 months after a critical incident. Correlational analyses were performed to identify factors associated with implementation and satisfaction.

Results:

CIMSP are generally partially applied by employers when a railway incident occurs. Workers’ satisfaction toward implementation of the protocol is moderate. Obstacles to implementation are: geographic isolation, severity of the incident, and poor quality of work relations.

Conclusions:

These obstacles should be addressed in CIMSP design and implementation strategies.
Return to Work After a Disabling Mental Disorder
Authors: Silva-Junior João Silvestre , Martinez Maria Carmen , Griep Rosane Härter , Fischer Frida Marina
Published: May 2021

Objective:

This study aims to analyze factors that influence return to work (RTW) among workers on sickness absence due to mental disorders.

Methods:

A longitudinal study conducted between 2014 and 2017 in São Paulo, Brazil. The 385 participants answered a questionnaire including sociodemographics, habits/lifestyle, job characteristics, and clinical information. Survival analysis was performed to identify factors influencing the RTW.

Results:

Most of participants were females (74.5%), worked in jobs dealing with public (44.2%) and were depressed (52.4%). RTW occurred for 68.3% participants over 1-year follow-up. Mean duration of absence was 163.83 days. The risk profile for remaining absent was heavy smokers, be abstainer, obese, deal with the public, perceived great effort at work, and low self-efficacy.

Conclusions:

These findings can contribute in discussion about disability prevention and interventions to assure mental health care for workers.
Indirect calorimetry in critical illness: a new standard of care?
Authors: De Waele Elisabeth , Jonckheer Joop , Wischmeyer Paul E.
Published: May 2021

Purpose of review

Review recent literature on the role of indirect calorimetry in critical care nutrition management.

Recent findings

Critical illness demands objective, targeted nutritional therapy to prevent adverse effects of underfeeding/over feeding. Thus, all recent societal guidelines recommend indirect calorimetry use to determine energy needs. Very recently, indirect calorimetry technology has finally evolved to allow for accurate, simple, and routine utilization in a wider range of ICU patients. Recent data continues to confirm poor correlation between measured and equation-predicted energy expenditure emphasizing need for indirect calorimetry to be standard of care. This may be particularly true in COVID-19, where significant progressive hypermetabolism and variability in energy expenditure has been shown. Metabolic physiology can change frequently during ICU stay in response to changes in clinical condition or care. Thus, repeated longitudinal indirect calorimetry measures are needed throughout ICU stay to optimize care, with initial data showing improved clinical outcomes when indirect calorimetry targets are utilized.

Personalized ICU care demands objective data to guide therapy. This includes use of indirect calorimetry to determine energy expenditure and guide ICU nutrition therapy. Long-awaited new innovations in indirect calorimetry technology should finally lead to indirect calorimetry to becoming a fundamental component of modern ICU standard of care and clinical research moving forward.
Intraductal Carcinoma of the Prostate: A Guide for the Practicing Pathologist
Authors: Varma Murali
Published: May 2021

Intraductal carcinoma of the prostate gland (IDCP) is characterized by an expansile, architecturally, and cytologically atypical proliferation of prostatic epithelial cells within preexisting prostatic ducts and acini. There has been a wider recognition of IDCP by practicing pathologists since its recognition as a separate category in the World Health Organization (WHO) 2016 classification of tumours of the prostate gland. However, there is also a lack of clarity regarding the diagnosis and reporting of IDCP, which has been compounded by divergent expert recommendations regarding the grading of invasive prostate cancers associated with an intraductal component. The International Society of Urological Pathologists (ISUP) recommends that the IDCP component should be incorporated into the Gleason score, while the Genitourinary Pathology Society (GUPS) recommends excluding it when grading prostate cancer. This review seeks to clarify some of these issues and outline a pragmatic approach to reporting IDCP, particularly in needle biopsies. Diagnostic issues and terminology for lesions falling short of IDCP but exceeding that of high-grade prostatic intraepithelial neoplasia are discussed. The management of patients whose prostate biopsies show only IDCP without an associated invasive component is controversial. Some experts recommend radical therapy, while others recommend prompt repeat biopsy. An alternative clinicopathologic approach that takes into consideration the extent, histomorphology, and location (with respect to a radiologic abnormality) of IDCP, as well as radiologic features, is outlined.