bluuebunny/crossref_metadata_2025 huggingface dataset:
909. Clinical features and management of a human monkeypox outbreak: a retrospective observational study in Harlem New York
Authors: Shaw Raphael , Schliep Tjark , Sivaplan Vel , Bratu simona , Mannheimer Sharon , Dowie Donna , Sayegh Mark , Hajihossainlou Behnam , Dickerson Erika , Sinsmyr Guerline
Published: November 2023

Background

In this paper, we report the descriptive, epidemiological, virologic and clinical features of the response to the investigational antiviral Tecovirimat, during the last Human Monkeypox outbreak in New City.

Methods

This is a retrospective observational study, based on data obtained from a convenient sample of patients evaluated for monkeypox infection at Harlem Hospital Infectious Diseases Clinic, from June 30th 2022 to September 1st 2022. Outbreak analysis was completed using grid-like/mapping approach to evaluate the distribution of the lesions. Statistical analysis was conducted using binary logistic and Chi-square analysis.

Mapping of lesions

Results

44 patients were included in the study 16 (36%) patients were immunocompromised with HIV with an absolute CD4 count ranging from 22 to 1048. Of the 44 patients, 30 (68%) were prescribed oral tecovirimat. Follow up showed that 13(43.3%) and 3 (3%) patients who received tecovirimat had complete resolution of symptoms at 7 days and 14 days respectively. 4 (9%) patients were lost to follow up and 2 (4.5%) were hospitalized for worsening symptoms. Overall medication was well tolerated with no reported events that were felt to be related to the medication.

Symptoms grid mapping showed a higher prevalence of lesions at the genital and rectal area, highly significant in the treatment group.

We were not able to establish a significant statistical correlation between HIV status/CD4 count and resolution of symptoms. However statistical analysis showed a significant positive correlation between treatment with Tecovirimat and resolution of symptoms at 14 days (P = 0.047).

Conclusion

The results published in the abstract are mostly descriptive of the sample and the general management including the use of Tecovirimat.

Most patients who received tecovirimat had a complete resolution of symptoms n= (53%) at 14 days. It is not clear whether this difference was attributable to the efficacy of the treatment versus the natural course of disease. Indeed, several patients in the non-treatment group were lost to follow up.

Further studies are needed to define the effect of severe immunosuppression and the efficacy of available antiviral drugs on the course of disease.

Disclosures

All Authors: No reported disclosures
910. Herpes Zoster in Children: A Literature Review
Authors: Simpson Chris , Dilley Anne , Viscidi Emma
Published: November 2023

Background

Herpes zoster (HZ), known as shingles, is caused by reactivation of the varicella zoster virus (VZV) and is characterized by a painful and/or itchy vesicular rash. The incidence of HZ in adults is approximately 4-10 per 1,000 person-years (PY). While the condition occurs mostly in older adults, it can develop in childhood after primary infection or rarely varicella vaccination (VV). The contemporary burden of HZ in children, and the impact of VV policies on incidence rates (IRs), are not well described.

Methods

A systematic literature search was conducted to identify studies reporting the incidence of HZ among pediatric populations (< 20 or < 18 years of age). A search of peer-reviewed literature published from 2010 onward in the PubMed and EMBASE databases was conducted of studies published through January 31st, 2023. While reviewing potentially relevant papers, reference lists were explored to discover additional peer-reviewed articles and reports. Publications were eligible for inclusion if they reported estimates of the IR of medically-attended HZ in nationally-representative samples of pediatric patients, using clearly stated and defensible methods.

Results

Sixteen publications meeting criteria were identified. IRs increased with age, from a median of 0.15 per 1,000 PYs in < 1 year old to 1.88 per 1,000 PYs in 15-19 years of age. In 3 countries with long-standing VV programs, IRs were 0.38 per 1,000 PY in the US, 0.82 per 1,000 PY in Canada, and 1.2 per 1,000 PY in Germany. In countries without widespread VV, incidence was higher, ranging from 0.8 per 1,000 PY in Norway to 2.5 per 1,000 PY in the Netherlands. The median hospitalization rate in children across 5 studies was 2.0 per 100,000 per year (range: 0.4 to 3.7). Immunocompromised (IC) children are at higher risk for HZ; in two studies that compared HZ in IC and non-IC children, the incidence rate ratios were 5.7 and 8.6. Post-herpetic neuralgia, the largest contributor to the HZ health burden, is much less likely to develop in children.

Conclusion

Based on a contemporary literature review, the incidence of HZ was lower in the children than in adults and HZ IRs were lower in countries with routine childhood VV. The incidence in children increased with age and is higher in the immunocompromised.

Disclosures

Chris Simpson, MSPH, Epidemiologic Research & Methods: Advisor/Consultant Anne Dilley, PhD, Epidemiologic Research & Methods: Advisor/Consultant Emma Viscidi, PhD, MHS, Moderna: Employee|Moderna: Stocks/Bonds
918. Identification of novel druggable host targets for Middle East respiratory syndrome coronavirus using a quantitative phosphoproteomics approach
Authors: Chan Jasper F W , Hu Bingjie , Chik Kenn K H , Yuan Shuofeng , Chu Hin
Published: November 2023

Background

Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory disease and extrapulmonary complications with a high mortality rate. The molecular mechanisms of MERS remain incompletely understood. Phosphoproteomics identifies proteins containing a phosphate group as posttranslational modification and allows rapid analysis of entire phosphorylation-based signaling networks. It has been increasingly used to study virus-host interactions and identify potential host-targeting treatments.

Methods

Label-free quantitative phosphoproteomics on MERS-CoV-infected lung epithelial Calu-3 cells was performed. A comprehensive siRNA library knockdown screen was then performed for all upregulated phosphoproteins followed by in-silico prediction with Group-based Prediction System 3.0 to identify the top-ranked kinases for further investigations. siRNA knockdown and kinase inhibitor treatment were then performed to validate the biological relevance of the identified host targets in MERS-CoV infection. Human dipeptidyl peptidase 4-knock in (hDPP4-KI) mice were used to evaluate the treatment effects of selected inhibitors.

Results

We identified more than 300 phosphopeptides that showed a change in phosphorylation status. This markedly perturbed host protein phosphorylation profile included many proteins that were involved in various cellular processes. siRNA library knockdown screen of all upregulated phosphoproteins followed by in silico prediction identified the 5 top-ranked kinases for further investigations. Both siRNA knockdown and kinase inhibitor treatment of these kinases resulted in the significant MERS-CoV load reduction in vitro. Treatment of hDPP4-KI mice with selected kinase inhibitors led to improved clinical outcome with significantly higher survival rate, less body weight loss, and lower lung viral burden.

Conclusion

Quantitative phosphoproteomics is a useful platform for identifying host factors involved in MERS-CoV infection. Inhibition of these host factors may be a potential treatment strategy for this highly pathogenic coronavirus infection.

Disclosures

All Authors: No reported disclosures
1136. A Systematic Literature Review of Disparities That May Influence Health Equity in Invasive Meningococcal Disease Prevention in the US
Authors: Begum Shahina , Herrera-Restrepo Oscar , Rolland Catherine , Purushotham Sneha , Hortobagyi Linda , Kocaata Zeki
Published: November 2023

Background

Meningococcal serogroup A, C, W, Y (MenACWY) and B (MenB) vaccines are recommended in the US to prevent invasive meningococcal disease (IMD), a rare but life-threatening disease. Yet the suboptimal uptake of and adherence to these vaccines may relate to inequities for healthcare access. This systematic literature review (SLR) synthesized the US evidence on disparities associated with IMD prevention.

Methods

Embase, MEDLINE and six conferences were searched and handpicked studies included from 01/01/2012 to 23/08/2022. Studies were screened twice against inclusion criteria (Table 1) via a standardised form. Newcastle Ottawa Scale was used for quality assessment. Synthesis findings reported here were from a broader SLR on IMD risk, prevention and control.

Results

The SLR found 26 studies, 14 relevant for prevention (Table 2-3). MenACWY series completion had higher odds for adolescents with a family annual income >$75,000 vs. ≤$30,000. Individuals from families below poverty status (annual income ≤$75,000 in 2021) had lower MenB vaccination coverage rates. MenACWY booster compliance was lower in uninsured vs. insured adolescents. Higher odds for ≥1 dose of MenB vaccine were observed if individuals had Medicaid vs. private insurance. For parents/guardians of ≥1 dependent of 16-19 years old, with some insurance was significantly associated with MenB vaccine initiation vs. no insurance. Adolescents living outside a metropolitan statistical area had lower vaccination coverage with ≥1 MenACWY than adolescents in MSA principal cities. MenB series completion rates were lower in rural vs. urban areas in commercial insured populations. Non-Hispanic Black and Hispanic population were more likely to be vaccinated for MenB compared to non-Hispanic Whites, however one study found the opposite. MenB series completion were lower in the Black versus White Medicaid populations.

Conclusion

Disparities in IMD prevention were reported for race/ethnicity, geographical factors, income/poverty level and health insurance status. Simplification of current recommendation (e.g., combination vaccine with increased convenience and reduced injections in the IMD vaccination schedule) could improve low uptake and adherence in disadvantaged groups.

Disclosures

Shahina Begum, GSK: Employee Oscar Herrera-Restrepo, PhD, GSK: Stocks/Bonds Catherine Rolland, PhD, Evidera: Advisor/Consultant Sneha Purushotham, MSc, Evidera: Advisor/Consultant Linda Hortobagyi, MSc, GSK: Contractor Zeki Kocaata, PhD, GSK: Stocks/Bonds
1137. The Value of Invasive Meningococcal Disease Combination Vaccine – a Qualitative Study of Adolescents and Parents/Caregivers’ Preferences in the US
Authors: Begum Shahina , Cabrera Eliazar Sabater , Hortobagyi Linda , Khera Twinkle , Correa Selene Camargo , Batchelder Laurie , Kocaata Zeki
Published: November 2023

Background

MenACWY and MenB are commonly used vaccines to prevent invasive meningococcal disease (IMD), targeting serogroups A, B, C, W, Y. MenABCWY combination vaccines are under development and could provide increased vaccine coverage of serogroups. This qualitative study aimed to identify concepts affecting preferences in adolescents (Ado) and parents/caregivers (P/C) decision making towards combination vaccine in the US.

Methods

Two focus group discussions (FGD), 90-minutes with Ado (16-23 years) and P/C of adolescents (16-18 years) were conducted (Table 1). Guides were developed based on a targeted literature review to investigate preferences for potential features of a combination vaccine. Participants were presented with IMD and vaccines information. Important/least important factors for decision-making were transcribed in response to open-ended/probes questions. FGDs were coded to apply thematic assessment. Results were synthesized separately by moderator-probed and spontaneously mentioned themes. Percentages were calculated on participant numbers contributing to a theme.

Results

Thirteen participants were included in FGDs (6 Ado, 7 P/C, 57% P/C with college or lower degree, Table 2). Ado preferred a combination vaccine which provided time saving (100%) and convenience (83%) by reducing the number of injections in the immunization series (100%) and number of visits (100%). P/C considered injection site discomfort (71%) as an important decision factor for a combination vaccine, however Ado considered this as least important (100%). Both groups considered impact on healthcare system and environment as least important for a combination vaccine (55%) (Table 3). Cross-protection against other infectious disease (55%, probed) and spontaneous themes (e.g. duration of protection, effectiveness, side effects and dosing interval) emerged (Table 4). These concepts were considered relevant for combination vaccine decision-making, although could be applicable to IMD vaccination more generally.

Conclusion

The findings suggest vaccine-receivers preferred a combination vaccine covering serogroups A, B, C, W, Y, with simplified schedules (e.g. fewer visits and injections) and potential cross-protection against other infectious diseases.

Disclosures

Shahina Begum, GSK: Employee Eliazar Sabater Cabrera, PhD, GSK: Employee|GSK: Stocks/Bonds Linda Hortobagyi, MSc, GSK: Contractor Twinkle Khera, Mtech, IQVIA: Advisor/Consultant Selene Camargo Correa, PhD, IQVIA: Advisor/Consultant Laurie Batchelder, PhD, IQVIA: Advisor/Consultant Zeki Kocaata, PhD, GSK: Stocks/Bonds
1138. A Scoping Review of the Role of the Provider in HPV Vaccination Dyads Research, 2012-2022
Authors: Clare Alyssa F , Agudelo Claudia L Gaviria , Walker Kimberly
Published: November 2023

Background

Despite the influence of provider recommendation on Human papillomavirus (HPV) vaccine uptake, few studies in the last decade have assessed the provider’s role in impacting parent and adolescent decisions regarding this vaccine. Given the increasing role of shared decision-making in health decisions, we sought to identify studies that assessed the role of the provider in affecting HPV vaccine decisions among parent-adolescent dyads.

Methods

Inclusion criteria: English-written, original studies from 2012-2022 with a sample including a parent and at least one of the parent’s own adolescents, and with a focus on parent-adolescent intentions and decisions about HPV vaccination. Initial retrieval resulted in 256 studies screened, with 14 meeting eligibility, and seven meeting all qualifications for inclusion.

Results

Clinicians were found to be influential in a dyad’s shared decision to vaccinate against HPV, especially when providing a rationale for vaccination (1, 4, 6). The dyad’s intention to speak with a provider was positively correlated with the likelihood of getting vaccinated (r=0.37, p< 0.05) (5). Both dyad members had high confidence in their provider’s ability to answer questions regarding HPV vaccination (3). Each dyad member felt that the HPV vaccine was discussed more than other vaccines (1). One study explored the relationship between provider-obtained information and adolescent risk perceptions. Less knowledge regarding the HPV vaccine was independently associated with females’ perception of less need for safe sexual practices (p< 0.10) (6). Lastly, delay in receiving the final vaccine dose was associated with decreased accessibility for immunization appointments (7).

Conclusion

Providers play a significant role in HPV education, as they continue to serve as an important source of information for parents and adolescents. Each dyad member perceives unique benefits and risks to HPV vaccination. When approaching a dyad, providers should attempt to include both the adolescent and the parent in the discussion. Future directions for this research include exploring if addressing dyad members individually improves HPV vaccine uptake.

Disclosures

All Authors: No reported disclosures
1143. Meningococcal Vaccination Coverage Disparities in the United States: An Analysis with 2016-2021 National Immunization Survey-Teen Data
Authors: Herrera-Restrepo Oscar , Kwiatkowska Marta , Ndegwa Nelson , Poston Sara , Ganz Michael
Published: November 2023

Background

The US Advisory Committee on Immunization Practices recommends meningococcal vaccination against serogroups A, C, W, and Y (MenACWY) for 11–12 year-olds (y/o) with a booster at 16; and against serogroup B (MenB) for 16–23 y/o under shared clinical decision making (SCDM). We used a large US survey to assess vaccination coverage across vaccines, geography and race/ethnicity.

Methods

This was a cross-sectional analysis using 2016-2021 National Immunization Survey-Teen survey data on MenACWY (≥1 dose [d]) in 13 y/o, MenACWY (≥2 d) and MenB (≥1 d) in 17 y/o. Data were collected via phone interviews with provider confirmation. We assessed coverage throughout the calendar year for MenACWY (≥1 d) and MenB (≥1 d) after the interview date, and for MenACWY (≥2 d) at the interview date.

Results

MenACWY coverage (≥1 d) in 13 y/o evolved from 82.71% (2016) to 86.42% (2021). MenACWY coverage (≥1 d) in 13-17 y/o changed from 83.36% (2016) to 89.82% (2021). MenB coverage (≥1 d) in 17 y/o changed from 5.63% (2016) to 34.05% (2021).

Geographic coverage was more variable moving from MenACWY (≥1 d) in 13 y/o (74.44% Pacific region 2016 to 91.00% New England region 2021) to MenACWY (≥2 d) in 17 y/o (21.05% East South Central region 2016 to 75.68% Mid-Atlantic region 2021) and MenB (≥1 d) in 17 y/o (2.34% Pacific region 2016 to 45.29% South Atlantic region 2021). MenACWY coverage (≥1 d) in 13 y/o was consistent across race/ethnicity, while 17 y/o Hispanic had lower MenACWY coverage (≥2 d) in 2021 (50.63%). For MenB (≥1 d) in 17 y/o, coverage varied by race/ethnicity; coverage in Hispanic and Non-Hispanic (NH) Black populations increased from 5.55% and 7.55% to 33.58% and 42.33% over 5 years, respectively. In NH White population, coverage yearly increased from 5.29% to 33.88%, while it only progressed from 5.34% to 27.17% in other NH + Multiple race population.

Conclusion

Meningococcal vaccination disparities persist across vaccines, ages, geography, and race/ethnicity (MenB only). Disparities increase with age, and with SCDM- versus routinely- recommended vaccines (MenB vs. MenACWY). Top performing states show that better coverage is possible (∼70% MenB coverage in North Dakota vs. 34% nationally in 2021), pointing at the need to reduce access barriers to vaccination, e.g., via simplified vaccine recommendations/schedules.

Disclosures

Oscar Herrera-Restrepo, PhD, GSK: Stocks/Bonds Sara Poston, PharmD, GSK: Stocks/Bonds
1150. Invasive meningococcal disease vaccination – a targeted literature review of adolescents and parents/caregivers’ preferences
Authors: Begum Shahina , Cabrera Eliazar Sabater , Herrera-Restrepo Oscar , Khera Twinkle , Botha Willings , Batchelder Laurie , Kocaata Zeki
Published: November 2023

Background

Invasive meningococcal disease (IMD) serogroups A, B, C, W, Y are commonly prevented by MenACWY and MenB vaccines. MenABCWY candidate vaccines could potentially provide benefits as less injections, simplified schedules, and increased uptake. However, there is limited insight on factors influencing preferences for IMD vaccines/vaccination (Vax). This targeted literature review synthesized evidence of factors influencing IMD Vax preferences in 16–23-year-old adolescents/young adults (Ado/YA) and parents/caregivers (P/CG) of 16-18 year-old adolescents.

Methods

PubMed and Google Scholar were searched globally to identify publications on IMD Vax attitudes and preferences (Table 1). Studies were restricted to English and published between 2005-2022. Data were extracted and synthesized from full text reviews to list IMD Vax preference attributes.

Results

From the 77 abstracts screened, 19 publications were extracted (Table 2) and 17 relevant for Ado/YA and P/CG. Knowledge of disease severity (20% of Ado/YA articles) and vaccine (29% of P/CG articles) were the most reported factors influencing Vax preference. Severity of disease increased Vax preference for both groups (14%), while low disease awareness limited P/CGs’ willingness to vaccinate children (14% of P/CG articles). Some Ado/YA preferred fewer injections in the immunization series due to reduced injection site discomforts (13%). P/CG preferred less injections due to less time and less physician visits, as it may reduce vaccine preparation/injection/administration and indirect costs associated with parental work loss (7%). However, their concerns over injection-related pain were a Vax barrier (14%). IMD vaccine effectiveness was recognized by Ado/YA (13%). Longer duration of protection was important for P/CG (14%), whilst herd immunity and direct protection was preferred in Ado/YA (13%).

Conclusion

Findings highlight IMD Vax characteristics as key considerations among Ado/YA and P/CG when making Vax decisions. To improve vaccination coverage and protection, the evidence supports preferences for vaccinations offering benefits such as fewer injections. Trade-offs between factors relevant for a IMD combination vaccine need further research.

Disclosures

Shahina Begum, GSK: Employee Eliazar Sabater Cabrera, PhD, GSK: Employee|GSK: Stocks/Bonds Oscar Herrera-Restrepo, PhD, GSK: Stocks/Bonds Twinkle Khera, Mtech, IQVIA: Advisor/Consultant Willings Botha, PhD, IQVIA: Advisor/Consultant Laurie Batchelder, PhD, IQVIA: Advisor/Consultant Zeki Kocaata, PhD, GSK: Stocks/Bonds
Turnover intentions of police officers: Influence of burnout, supervisor support, and job satisfaction
Authors: Nonis Sarath , Hester Kim , McDaniel Karen , Philhours Melodie
Published: November 2023

Public service employees are often those in front-line positions, and face stress due to their boundary spanning job requirements. During the Covid 19 pandemic, additional strain was felt by these front-line workers as they were required to continue close contact with others. For police officers, stress may lead to psychological effects such as burnout, lower levels of job satisfaction, and higher levels of turnover intentions. Additionally, some occupational groups such as policing are at a higher risk of developing mental health problems. This is becoming increasingly important for many cities and their police department budgets, as increasing labor costs for staffing and turnover has become a major concern. This study seeks to better understand how these specific factors influence turnover intentions for police officers in a mid-size suburban US police department, how organizations can help address mental health, and make practical suggestions on how to impact these staffing decisions.
Senktide blocks aberrant RTN3 interactome to retard memory decline and tau pathology in social isolated Alzheimer’s disease mice
Authors: Huang He-Zhou , Ai Wen-Qing , Wei Na , Zhu Ling-Shuang , Liu Zhi-Qiang , Zhou Chao-Wen , Deng Man-Fei , Zhang Wen-Tao , Zhang Jia-Chen , Yang Chun-Qing , Hu Ya-Zhuo , Han Zhi-Tao , Zhang Hong-Hong , Jia Jian-Jun , Wang Jing , Liu Fang-Fang , Li Ke , Xu Qi , Yuan Mei , Man Hengye , Guo Ziyuan , Lu Youming , Shu Kai , Zhu Ling-Qiang , Liu Dan
Published: November 2023

Sporadic or late-onset Alzheimer’s disease (LOAD) accounts for more than 95% of Alzheimer’s disease (AD) cases without any family history. Although genome-wide association studies have identified associated risk genes and loci for LOAD, numerous studies suggest that many adverse environmental factors, such as social isolation, are associated with an increased risk of dementia. However, the underlying mechanisms of social isolation in AD progression remain elusive. In the current study, we found that 7 days of social isolation could trigger pattern separation impairments and presynaptic abnormalities of the mossy fibre-CA3 circuit in AD mice. We also revealed that social isolation disrupted histone acetylation and resulted in the downregulation of 2 dentate gyrus (DG)-enriched miRNAs, which simultaneously target reticulon 3 (RTN3), an endoplasmic reticulum protein that aggregates in presynaptic regions to disturb the formation of functional mossy fibre boutons (MFBs) by recruiting multiple mitochondrial and vesicle-related proteins. Interestingly, the aggregation of RTN3 also recruits the PP2A B subunits to suppress PP2A activity and induce tau hyperphosphorylation, which, in turn, further elevates RTN3 and forms a vicious cycle. Finally, using an artificial intelligence-assisted molecular docking approach, we determined that senktide, a selective agonist of neurokinin3 receptors (NK3R), could reduce the binding of RTN3 with its partners. Moreover, application of senktide in vivo effectively restored DG circuit disorders in socially isolated AD mice. Taken together, our findings not only demonstrate the epigenetic regulatory mechanism underlying mossy fibre synaptic disorders orchestrated by social isolation and tau pathology but also reveal a novel potential therapeutic strategy for AD.
An international multicentre analysis of current prescribing practices and shared decision-making in psoriatic arthritis
Authors: Watson Lily , Coyle Conor , Whately-Smith Caroline , Brooke Melanie , Kiltz Uta , Lubrano Ennio , Queiro Rubén , Trigos David , Brandt-Juergens Jan , Choy Ernest , D’Angelo Salvatore , Delle Sedie Andrea , Dernis Emmanuelle , Guis Sandrine , Helliwell Philip , Ho Pauline , Hueber Axel J , Joven Beatriz , Koehm Michaela , Montilla Carlos , Packham Jon , Pinto Tasende José Antonio , Ramirez Garcia Felipe Julio , Ruyssen-Witrand Adeline , Scrivo Rossana , Twigg Sarah , Soubrier Martin , Wirth Théo , Gossec Laure , Coates Laura C
Published: November 2023

Objectives

Shared decision-making (SDM) is advocated to improve patient outcomes in PsA. We analysed current prescribing practices and the extent of SDM in PsA across Europe.

Methods

The ASSIST study was a cross-sectional observational study of PsA patients ≥18 years of age attending face-to-face appointments between July 2021 and March 2022. Patient demographics, current treatment and treatment decisions were recorded. SDM was measured by the clinician’s effort to collaborate (CollaboRATE questionnaire) and patient communication confidence (PEPPI-5 tool).

Results

A total of 503 patients were included from 24 centres across the UK, France, Germany, Italy and Spain. Physician- and patient-reported measures of disease activity were highest in the UK. Conventional synthetic DMARDs constituted a higher percentage of current PsA treatment in the UK than continental Europe (66.4% vs 44.9%), which differed from biologic DMARDs (36.4% vs 64.4%). Implementing treatment escalation was most common in the UK. CollaboRATE and PEPPI-5 scores were high across centres. Of 31 patients with low CollaboRATE scores (<4.5), no patients with low PsAID-12 scores (<5) had treatment escalation. However, of 465 patients with CollaboRATE scores ≥4.5, 59 patients with low PsAID-12 scores received treatment escalation.

Conclusions

Higher rates of treatment escalation seen in the UK may be explained by higher disease activity and a younger cohort. High levels of collaboration in face-to-face PsA consultations suggests effective implementation of the SDM approach. Our data indicate that in patients with mild disease activity, only those with higher perceived collaboration underwent treatment escalation. Prospective studies should examine the impact of SDM on PsA patient outcomes.

Trial registration

clinicaltrials.gov, NCT05171270.
Weight loss maintenance following an augmented intervention for early slow weight loss responders: An adaptive trial
Authors: Miller Carla K , Nagaraja Haikady N , Fujita Kentaro , Cheavens Jennifer S , Focht Brian C
Published: November 2023

Early slow weight loss during treatment is associated with less weight loss overall. The impact of an augmented intervention designed for early slow weight loss responders compared with a standard diabetes prevention intervention was evaluated following 12 months of treatment and 6 months of no contact. The impact of standard vs. augmented intervention sequences on weight and glycemia also was determined. Adults were ≥21 years old with overweight or obesity and prediabetes (n = 174). Slow responders were stratified to augmented treatment if they failed to achieve >2.5% weight loss (%WL) at Week 5. Matched within-sex pairs of participants were created based on %WL at Month 5 following the intensive intervention phase, and each person within the pair was randomly assigned to treatment for Months 5–12 during the extended intervention phase. Both 12-month interventions included a ≥7%WL goal. Mean 12-month %WL was 5.29% (95% CI: 4.27%–6.31%; P < .0001) and 18-month %WL was 3.34% (95% CI: 2.01%–4.66%; P < .0001) overall. %WL was greater for the standard (9.55%) than the augmented (4.0%) intervention (P = .0001); no differences occurred in weight regain between early and slow responders (P = .9476). No differences occurred in mean %WL at 12 months between the standard and augmented groups after controlling for %WL at Week 5 and sex (P = .23) nor in the change in glycemia (all P > .05). WL following the first month of treatment predicted 12- and 18-month WL success regardless of intervention sequence; however, even early slow responders achieved significant WL during treatment. Further research is needed to support effective WL maintenance for people with prediabetes.
Tailored Indications for Different Neurotoxins
Authors: Sezgin Billur
Published: November 2023

Background:

Minimally invasive procedures have become increasingly popular because they require minimal downtime and are effective for achieving a more youthful appearance. All U.S. Food and Drug Administration–approved neurotoxins are indicated for achieving similar effects, even though they are different in regard to structure, manufacturing technique, and storage requirements. It is agreed upon that each neurotoxin is unique and therefore not interchangeable. The aim of the author is to provide an approach for choosing the optimal toxin in different indications regarding the area of treatment, the age and characteristics of the patient, potential risks, and ultimate goals.

Methods:

As the country that the author practices carries onabotulinum (ONA), prabotulinum (PRA), and abobotulinum (ABO) toxin type-A, one of these three toxins was preferred for each category. ABO toxins were preferred in wide areas due to the broader action halo. Typical examples include hyperhidrosis treatment, wide forehead area, and calf slimming. In areas where very precise and targeted treatment is required, PRA and ONA toxins were preferred to limit potential side effects due to wider diffusion. First-time patients were typically treated with PRA toxins for a softer trial periods where as “repeat” patients were successfully treated with ABO toxins.

Results:

No toxin is superior to the other in terms of producing effects. Yet, small differences in their properties can allow the plastic surgeon to cater to each patient’s needs while yielding the most optimal results.

Conclusions:

This study is meant to serve as a guideline for choosing the ideal toxin in different patient settings and indications.
Useful Respiratory Maneuvers Aiding Left Heart Cardiac Catheterization and Intervention. A Comprehensive Review
Authors: Vakhshoori Mehrbod , Movahed Mohammad Reza
Published: November 2023

Left heart catheterizations, coronary angiography, and coronary interventions are important common cardiac procedures. Performing a successful cardiac catheterization and intervention and proper catheterization and device delivery is not always without difficulties, especially in the context of calcification or vessel tortuosity. Although there are some techniques to overcome these issues, performing respiratory maneuvers (inspiration or expiration) can be simply tried as the first step to increase successful procedures which is underreported and underutilized. The goal of this article is to review current literature regarding useful respiratory maneuvers that can aid left heart cardiac catheterization, coronary angiography, and intervention for a successful procedure.
Pathway for the Diagnosis and Management of Cardiac Amyloidosis
Authors: Herzog Eyal , Leibowitz David , Gatt Moshe E. , Koren Tali , Pollak Arthur
Published: November 2023

The systemic amyloidoses are a broad spectrum of diseases that result from misfolding of proteins that aggregate into amyloid fibrils. In cardiac amyloidosis, amyloid fibrils accumulate in the interstitial space between cardiac myocytes causing cellular injury and impairing compliance. Current data suggest that cardiac amyloidosis is more common than previously thought. Advances in cardiac imaging, diagnostic strategies, and therapies have improved the recognition and treatment of cardiac amyloidosis. A position statement for the diagnosis and treatment of cardiac amyloidosis has been published in 2021 by the European Society of Cardiology and an expert consensus decision pathway was published in 2023 by the American College of Cardiology. These are excellent documents but quite lengthy and complex. For this reason, our team developed a novel and simple pathway to help health care providers diagnose and treat patients with cardiac amyloidosis. Our pathway starts with a section titled “suspicion” in which we provide simple clues or “red flags” that are associated with the cardiac amyloidosis phenotype. It is followed by a section titled “diagnosis,” where we present in a simplified 2 × 2 format the laboratory and imaging tests that must be performed for an accurate diagnosis. In the section titled “treatment,” we describe the 4 pillars in the management of patients with cardiac amyloidosis, which includes the following: heart failure treatments, management of arrhythmias, treatment of significant aortic stenosis, and appropriate selection of disease modifying therapies. Our algorithm ends with our simplified recommendation for follow-up.
Updating a Healthcare System-wide Clinical Pathway for Managing Chest Pain and Acute Coronary Syndromes
Authors: Zilinyi Robert S. , Fertel Baruch S. , Chang Betty C. , Abrukin Liliya , Suh Edward H. , Sayan Osman R. , McCarty Matthew , Stant Jennifer A. , Chuich Taylor , Smyth Emily T. , Neuberg Gerald , Collins Michael B. , Kirtane Ajay J. , Moses Jeffrey , Rabbani LeRoy
Published: November 2023

Clinical pathways are useful tools for conveying and reinforcing best practices to standardize care and optimize patient outcomes across myriad conditions. The NewYork-Presbyterian Healthcare System has utilized a clinical chest pain pathway for more than 20 years to facilitate the timely recognition and management of patients presenting with chest pain syndromes and acute coronary syndromes. This chest pain pathway is regularly updated by an expanding group of key stakeholders, which has extended from the Columbia University Irving Medical Center to encompass the entire regional healthcare system, which includes 8 hospitals. In this 2023 update of the NewYork-Presbyterian clinical chest pain pathway, we present the key changes to the healthcare system-wide clinical chest pain pathway.
Preventive Cardiovascular Care for Hypercholesterolemia in US Emergency Departments: A National Missed Opportunity
Authors: Ashburn Nicklaus P. , Snavely Anna C. , Rikhi Rishi , Shapiro Michael D. , Chado Michael A. , Stopyra Jason P. , Mahler Simon A.
Published: November 2023

Background:

Hypercholesterolemia (HCL) affects nearly half of Emergency Department (ED) patients who present with possible acute coronary syndrome (ACS). However, it is unknown whether US ED providers obtain lipid panels, calculate 10-year atherosclerotic cardiovascular disease (ASCVD) risk, and prescribe cholesterol-lowering medications for these patients.

Methods:

We conducted a nationwide cross-sectional ED survey from April 18, 2023, to May 12, 2023. An electronic survey assessing current preventive HCL care practices for patients being evaluated for ACS. A convenience sample was obtained by sharing the survey with ED medical directors, chairs, and senior leaders using emergency medicine professional organization listservs and snowball sampling. Responding EDs were categorized as being associated with an academic medical center (AMC) or not (non-AMC).

Results:

During the 4-week study period, 110 EDs (50 AMC and 60 non-AMC EDs) across 39 states responded. Just 1.8% (2/110) stated that their providers obtain a lipid panel on at least half of patients with possible ACS and only one ED (0.9%) responded that its providers calculate 10-year ASCVD risk and prescribe cholesterol medication for the majority of eligible patients. Most reported never obtaining lipid panels (60.9%, 67/110), calculating 10-year ASCVD risk (55.5%, 61/110), or prescribing cholesterol-lowering medications (52.7%, 58/110).

Conclusions:

The vast majority of US ED providers do not provide preventive cardiovascular care for patients presenting with possible ACS. Most ED providers do not evaluate for HCL, calculate ASCVD risk, or prescribe cholesterol-lowering medications for these patients.
Role of immunometabolism during congenital cytomegalovirus infection
Authors: Zwezdaryk Kevin J. , Kaur Amitinder
Published: November 2023

Cytomegalovirus (CMV) is a master manipulator of host metabolic pathways. The impact of CMV metabolic rewiring during congenital CMV on immune function is unknown. CMV infection can directly alter glycolytic and oxidative phosphorylation pathways in infected cells. Recent data suggests CMV may alter metabolism in uninfected neighboring cells. In this mini review, we discuss how CMV infection may impact immune function through metabolic pathways. We discuss how immune cells differ between maternal and decidual compartments and how altered immunometabolism may contribute to congenital infections.
Measuring Emergency Department Staff Perceptions of Causes and Management of Violence
Authors: Ewen Julia , Gaeta Lisa , Fitzgerald Karen A. , Ragione Barbara L. , Feil Deborah A. , Raio Christopher C. , Arrillaga Abenamar , Klein Lauren R. , Eckardt Patricia A.
Published: November 2023

BACKGROUND:

Half of all reported violent incidents in health care settings occur in the emergency department (ED) placing all staff members at risk. However, research typically does not include all ED work groups or validated measures beyond nurses and physicians.

OBJECTIVE:

The aims of this study were to (a) validate an established instrument measuring perceptions of causes of violence and attitudes toward managing violence within an inclusive workforce sample; and (b) explore variation in perceptions, attitudes, and incidence of violence and safety to inform a violence prevention program.

METHODS:

This is an investigator-initiated single-site cross-sectional survey design assessing the psychometric properties of the Management of Aggression and Violence Attitude Scale (MAVAS) within a convenience sample (n = 134). Construct validity was assessed using exploratory factor analysis and reliability was evaluated by the Cronbach's α estimation. Descriptive, correlational, and inferential estimates explored differences in perceptions, attitudes, and incidence of violence and safety.

RESULTS:

Exploratory factor analysis indicated validity of the MAVAS with a seven-factor model. Its internal consistency was satisfactory overall (Cronbach's α= 0.87) and across all subscales (Cronbach's α values = 0.52–0.80). Significant variation in incidence of physical assault, perceptions of safety, and causes of violence was found between work groups.

CONCLUSIONS:

The MAVAS is a valid and reliable tool to measure ED staff members' perceptions of causes of violence and attitudes toward managing violence. In addition, it can inform training according to differences in work group learner needs.
A Fast-Track Respiratory Protocol for High Cervical Spine Injury: A Case Report
Authors: Pan Caixue , Chen Yao , Zhou Yongfang
Published: November 2023

BACKGROUND:

Cervical spinal cord injury can greatly affect pulmonary function, resulting in complications, including respiratory failure with prolonged mechanical ventilation, ultimately leading to increased mortality and high health care costs. Weaning from mechanical ventilation is particularly challenging in patients with complete high spinal cord injury.

CASE PRESENTATION:

We present the case of a 42-year-old man who suffered a complete cervical 5–6 spinal cord injury following a rollover motor vehicle crash and subsequently developed postoperative pneumonia and severe hypoxemic respiratory failure. He received a novel approach to fast-track respiratory care, including early and aggressive secretion clearance management, moderate pressure level of airway pressure release ventilation, timely transition to spontaneous mode, early tracheostomy and humane care, and high-flow oxygenation via tracheotomy after weaning off the ventilator. As a result, the patient experienced significant improvement in pulmonary function and was successfully liberated from the ventilator within a 2-week period.

CONCLUSION:

This case highlights the potential effectiveness of fast-track respiratory care in promoting lung function restoration and expediting liberation from mechanical ventilation in patients with severe hypoxemic respiratory failure following a complete cervical spinal cord injury. However, further research is warranted to validate these findings and expand our understanding in this area.
Establishing excellence: Implementation of an onboarding and continuing education curriculum for pediatric intensive care unit nurse practitioners and physician associates
Authors: Thomas Jenilea K. , Arnold Megan A. , Woodend Kristen R. , Riccioni Mark J. , Rissmiller Brian J.
Published: November 2023

This study describes a novel curriculum for onboarding and clinical education for nurse practitioners and physician associates (NPs and PAs) in the pediatric intensive care unit setting. The objective was to provide details on the initial orientation and continuing education program to ensure the attainment of knowledge and skills needed to care for critically ill patients safely and effectively. A needs assessment was completed, and a knowledge gap identified in five themes: (1) in-depth knowledge on common critical care diagnoses; (2) understanding of pathophysiology; (3) disease management processes; (4) critical thinking; and (5) procedure competency. Using Kern 6-step curriculum and the Kirkpatrick evaluation model, we designed a program for orientation and continuing education for critical care NPs and PAs. Transformative learning theory provided the framework for the program because the cyclical steps of disorienting dilemma, critical reflection, discourse, and action were used repeatedly to transform a new graduate to a competent critical care provider and then into an expert who is able to, in turn, teach others. A total of 31 NPs and 5 PAs completed the 12-week orientation phase. Participants reported that the orientation phase was valuable to their educational advancement and increased critical care knowledge. All participants showed improvement in knowledge, skills, and ability to provide competent patient care.
Transplant selection simulation: Liver transplantation for alcohol-associated hepatitis
Authors: Im Gene Y. , Goel Aparna , Asrani Sumeet , Singal Ashwani K. , Wall Anji , Sherman Courtney B.
Published: November 2023

Liver transplantation (LT) for alcohol-associated hepatitis (AH) remains controversial due to concerns about candidate selection subjectivity, post-LT alcohol relapse, and the potential exacerbation of LT disparities. Our aim was to design, perform, and examine the results of a simulated selection of candidates for LT for AH. Medical histories, psychosocial profiles and scores, and outcomes of 4 simulation candidates were presented and discussed at 2 multidisciplinary societal conferences with real-time polling of participant responses. Candidate psychosocial profiles represented a wide spectrum of alcohol relapse risk. The predictive accuracy of four psychosocial scores, Dallas consensus criteria, sustained alcohol use post-LT, Stanford Integrated Psychosocial Assessment for Transplant, and QuickTrans, were assessed. Overall, 68 providers, mostly academic transplant hepatologists, participated in the simulation. Using a democratic process of selection, a significant majority from both simulations voted to accept the lowest psychosocial risk candidate for LT (72% and 85%) and decline the highest risk candidate (78% and 90%). For the 2 borderline-risk candidates, a narrower majority voted to decline (56% and 65%; 64% and 82%). Two out of 4 patients had post-LT relapse. Predictive accuracies of Dallas, Stanford Integrated Psychosocial Assessment for Transplant, and Quicktrans scores were 50%, while sustained alcohol use post-LT was 25%. The majority of voting outcomes were concordant with post-LT relapse in 3 out of 4 patients. When defining “success” in LT for AH, providers prioritized allograft health and quality of life rather than strict abstinence. In this simulation of LT for AH using a democratic process of selection, we demonstrate its potential as a learning model to evaluate the accuracy of psychosocial scores in predicting post-LT relapse and the concordance of majority voting with post-LT outcomes. Provider definitions of “success” in LT for AH have shifted toward patient-centered outcomes.
Stratification of acute myocardial and endothelial cell injury, salvage index and final infarct size by systematic microRNA profiling in acute ST-elevation myocardial infarction
Authors: Dawkins Sam , Digby Janet E. , Belgard T. Grant , Lee Regent , De Maria Giovanni Luigi , Banning Adrian P. , Kharbanda Rajesh K. ,   Oxford Acute Myocardial Infarction (OxAMI) Study, Mayr Manuel , Choudhury Robin P. , Channon Keith M.
Published: November 2023

Aim

Acute injury and subsequent remodelling responses to ST-segment elevation myocardial infarction (STEMI) are major determinants of clinical outcome. Current imaging and plasma biomarkers provide delayed readouts of myocardial injury and recovery. Here, we sought to systematically characterize all microRNAs (miRs) released during the acute phase of STEMI and relate miR release to magnetic resonance imaging (MRI) findings to predict acute and late responses to STEMI, from a single early blood sample.

Methods and results

miRs were quantified in blood samples obtained from patients after primary PCI (PPCI) for STEMI. Cardiac MRI (cMRI) was performed to quantify myocardial edema, infarct size and salvage index. Regression models were constructed to predict these outcomes measures, which were then tested with a validation cohort. Transcoronary miR release was quantified from paired measurements of coronary artery and coronary sinus samples. A cell culture model was used to identify endothelial cell–derived miRs.

A total of 72 patients undergoing PPCI for acute STEMI underwent miR analysis and cMRI. About >200 miRs were detectable in plasma after STEMI, from which 128 miRs were selected for quantification in all patients. Known myocardial miRs demonstrated a linear correlation with troponin release, and these increased across the transcoronary gradient. We identified novel miRs associated with microvascular injury and myocardial salvage. Regression models were constructed using a training cohort, then tested in a validation cohort, and predicted myocardial oedema, infarct size and salvage index.

Conclusion

Analysis of miR release after STEMI identifies biomarkers that predict both acute and late outcomes after STEMI. A novel miR-based biomarker score enables the estimation of area at risk, late infarct size and salvage index from a single blood sample 6 hours after PPCI, providing a simple and rapid alternative to serial cMRI characterization of STEMI outcome.