bluuebunny/crossref_metadata_2025 huggingface dataset:
The Men’s Training Cup Keep Training: a masturbation aid improves intravaginal ejaculatory latency time and Erection Hardness Score in patients who are unable to delay ejaculation
Authors: Shirai Masato , Ishikawa Keisuke , Hiramatsu Ippei , Mizushima Kazuhiko , Tsuru Takamitsu , Kurosawa Makoto , Kure Akimasa , Uesaka Yuka , Nozaki Taiji , Tsujimura Akira
Published: January 2023

Introduction

Premature ejaculation (PE) has negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy. In Japan, no oral drugs or devices are approved or used clinically to treat PE. The Men’s Training Cup Keep Training (MTCK), a masturbation aid, was developed for PE. MTCK offers 5 grades of tightness and strength.

Aim

We aimed to investigate the efficacy of the MTCK in patients who are unable to delay ejaculation.

Methods

Inclusion criteria were 20- to 60-year-old men feeling distressed and frustrated by PE and who had the same sexual partners throughout the study period. Exclusion criteria were neurologic disease and uncontrolled diabetes mellitus, as well as the use of antidepressants, α-blockers, and 5α-reductase inhibitors. The protocol comprised an 8-week training period with the MTCK from level 1 to level 5, with each level used twice before moving to the next level.

Outcome Measures

The main outcome measure was the extension of intravaginal ejaculation latency time (IELT). The secondary outcome measures were score improvements on the Premature Ejaculation Diagnostic Tool, Sexual Health Inventory for Men, Erection Hardness Score, and Difficulty in Performing Sexual Intercourse Questionnaire–5.

Results

We enrolled 37 patients, and after 19 patients withdrew, 18 concluded the study without experiencing any adverse events. The mean patient age was 39.9 years. Geometric IELT after the 8-week training with the MTCK increased significantly (mean ± SE; 232.10 ± 72.16 seconds) vs baseline (103.91 ± 50.61 seconds, P = .006). Mean scores on the Premature Ejaculation Diagnostic Tool, Difficulty in Performing Sexual Intercourse Questionnaire–5, and Erection Hardness Score after 8-week training improved significantly vs the baseline values. The mean score on the Sexual Health Inventory for Men did not improve significantly after the 8-week training, but domain 1 did significantly improve after 8 weeks of MTCK use.

Clinical Implications

The MTCK may be one possible treatment option for patients who are unable to delay ejaculation.

Strengths and Limitations

This is the first study to show that the MTCK is effective for patients who are unable to delay ejaculation. A major limitation is that the present study was not strictly limited to an IELT <3 minutes.

Conclusions

The MTCK may offer benefits not only for delay of ejaculation but also for erectile function.
Early Malignant Melanoma Detection, Especially in Persons with Pigmented Skin
Authors: Jicman Paul Andrei , Smart Hiske , Ayello Elizabeth A. , Sibbald R. Gary
Published: January 2023

Early detection of malignant melanoma is associated with better survival and clinical outcomes. Visual skin inspection is part of melanoma lesion assessment, but clinicians often have difficulty identifying lesions in persons with darker skin tones (eg, Fitzpatrick type 5 [brown] and type 6 [black] skin). There is also a lack of knowledge about the skin sites that are best to evaluate in persons with darkly pigmented skin (eg, the plantar surface of the feet, palms of the hand, and under the nail plate). These limitations can lead to a delay in diagnosis with potentially poor prognostic outcomes. In this article, the authors identify relevant literature to increase awareness for the presence of early signs of malignant melanoma in all skin types. Patient empowerment includes lifestyle adaptations, such as conducting regular skin and foot self-examinations to detect melanoma signs and applying sun protection on feet.

GENERAL PURPOSE

To present a comprehensive gap analysis of podiatric melanoma literature.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Select the appropriate assessment techniques for screening patients, especially those with skin of color, for melanoma.2. Compare and contrast the various types of melanoma.3. Discuss the results of the literature review that offer insight to clinicians screening patients for melanoma.
Impact of Bilateral Quadratus Lumborum Block Using Different Doses of Dexmedetomidine for Postoperative Analgesia in Laparoscopic Myomectomy
Authors: Li Yue , Zhang Le , Jiao Jing , Yu Xinhua , Huang Shaoqiang
Published: January 2023

Objectives:

The optimal dosage of dexmedetomidine (DEX) for postoperative analgesia of quadratus lumborum block (QLB) after laparoscopic myomectomy is not clear. Our study evaluated the analgesic and adverse effects of different doses of locally administered DEX.

Materials and Methods:

Patients underwent laparoscopic myomectomy were enrolled in this randomized controlled trial. Transmuscular bilateral QLB was conducted postoperatively using local anesthetic plus different doses of DEX, as an adjuvant, per side. Numeric rating scales (NRS) of pain score and heart rate (HR) were assessed after performing QLB. Additional analgesics through patient-controlled analgesia pump, recovery time to first flatus, hospital stay, and other outcomes were also compared.

Results:

A total of 150 participants were randomly divided into 3 groups (DEX1 group: 0.1 μg/kg; DEX2 group: 0.3 μg/kg; DEX3 group: 0.5 μg/kg), 50 for each group. Compared with the DEX1 group, NRS pain scores were lower in groups DEX2 and DEX3 (P<0.017) 20 minutes after QLB and the significance lasted for 24 hours. Patients in groups DEX2 and DEX3 needed fewer additional analgesics than the group DEX1 (P<0.017). HR in groups DEX2 and DEX3 was lower than the group DEX1 10 minutes and 20 minutes after QLB, respectively (P<0.017). Sixty minutes after QLB, HR in the DEX3 group was still lower than the other groups. More patients in the DEX3 group were found bradycardia. Satisfaction score of postoperative analgesia was higher in groups DEX2 and DEX3 than the DEX1 group (P<0.017).

Discussion:

The results suggest that solution of DEX 0.3 μg/kg in ropivacaine 0.25% for QLB is recommended to relieve postoperative pain after laparoscopic myomectomy effectively and safely.
Utilization and Survival Impact of Hypofractionated Radiotherapy in Stage I Non-small Cell Lung Cancer
Authors: Saeed Nadia A. , Jin Lan , Amini Arya , Verma Vivek , Lester-Coll Nataniel H. , Chen Po-Han , Decker Roy H. , Park Henry S.
Published: January 2023

Objectives:

The optimal fractionation schedule in unresected stage I non-small cell lung cancer (NSCLC) unsuitable for stereotactic body radiation therapy is unclear. Given the lack of comparative data regarding nonstereotactic body radiation therapy schemas, we compared overall survival (OS) with hypofractionated radiotherapy (HFRT) versus conventionally fractionated radiotherapy (CFRT) and examined the OS impact of different HFRT doses.

Materials and Methods:

This retrospective analysis included 2159 patients from the National Cancer Database diagnosed with stage I (cT1-2aN0M0) NSCLC between 2008 and 2016. Patients underwent CFRT (70≤BED10 [biologically effective dose] <100 Gy10 in ≥30 fractions), low-dose HFRT (LD-HFRT; 70≤BED10 [assuming α/β=10] <100 Gy10 in 11 to 24 fractions), or high-dose HFRT (HD-HFRT; 100≤BED10 ≤120 Gy10 in 6 to 10 fractions). Patients who received surgery, chemotherapy, or immunotherapy were excluded. We compared CFRT versus all HFRT, and separately CFRT versus LD-HFRT and CFRT versus HD-HFRT. OS was evaluated with the Kaplan-Meier estimator, log-rank test, and Cox regression.

Results:

A total of 63.2% of patients underwent CFRT, 23.5% LD-HFRT, and 13.3% HD-HFRT. OS was significantly longer with HFRT versus CFRT on univariable (28.2 mo [95% CI, 25.6-31.7] vs 26.4 mo [25.0-27.9]; log-rank=0.0025) but not multivariable analysis (MVA; hazard ratio [HR] 0.90; P=0.062). MVA yielded no significant difference in OS between CFRT and LD-HFRT (HR 0.96, P=0.53). OS was significantly longer with HD-HFRT versus CFRT on MVA (HR, 0.75; P=0.003). However, on sensitivity analysis using different multivariable modeling techniques, this did not retain statistical significance (HR, 0.83; P=0.12).

Conclusions:

For stage I NSCLC, HFRT does not show a robust OS benefit compared with CFRT but may be preferred given the convenience and lower costs.
Nicotinamide Mononucleotide Alleviates Angiotensin II-Induced Human Aortic Smooth Muscle Cell Senescence in a Microphysiological Model
Authors: Yin Xiujie , Abudupataer Mieradilijiang , Ming Yang , Xiang Bitao , Lai Hao , Wang Chunsheng , Li Jun , Zhu Kai
Published: January 2023

The occurrence and development of aortic aneurysms are accompanied by senescence of human aortic smooth muscle cells (HASMCs). Because the mechanism of HASMC senescence has not been fully elucidated, the efficacy of various antisenescence treatments varies. Decreased nicotinamide adenine dinucleotide (NAD+) levels are one of the mechanisms of cell senescence, and there is a lack of evidence on whether increasing NAD+ levels could alleviate HASMC senescence and further retard the progression of aortic aneurysms.

We constructed an HASMC-based organ-on-a-chip microphysiological model. RNA sequencing was performed on cell samples from the vehicle control and angiotensin II groups to explore biological differences. We detected cellular senescence markers and NAD+ levels in HASMC-based organ-on-a-chip. Subsequently, we pretreated HASMC using the synthetic precursor of NAD+, nicotinamide mononucleotide, and angiotensin II treatment, and used rhythmic stretching to investigate whether nicotinamide mononucleotide could delay HASMC senescence.

The HASMC-based organ-on-a-chip model can simulate the biomechanical microenvironment of HASMCs in vivo, and the use of angiotensin II in the model replicated senescence in HASMCs. The senescence of HASMCs was accompanied by downregulation of the expression level of nicotinamide phosphoribosyltransferase and NAD+. Pretreatment with nicotinamide mononucleotide significantly increased the NAD+ level and alleviated the senescence of HASMCs, but did not change the expression level of nicotinamide phosphoribosyltransferase.

Our study provides a complementary research platform between traditional cell culture and animal experiments to explore HASMC senescence in aortic aneurysms. Furthermore, it provides evidence for NAD+ boosting therapy in the clinical treatment of aortic aneurysms.
Understanding the concurrent and predictive relations between child-led emotion regulation behaviors and pain during vaccination in toddlerhood
Authors: Gennis Hannah G. , Flora David B. , Norton Lucas , McMurtry C. Meghan , Merlano Tatiana Espinosa , Zaghi Ameer , Flanders Daniel , Weinberg Eitan , Savlov Deena , Garfield Hartley , Pillai Riddell Rebecca R.
Published: January 2023

The purpose of this study was to further our understanding of early childhood pain-related distress regulation. Concurrent and predictive relations between child-led emotion regulation (ER) behaviors and pain-related distress during vaccination were examined at 2 different ages using autoregressive cross-lagged path analyses. Toddlers were video-recorded at the 12- and 18-month routine vaccination appointments (12-month-old [N = 163]; 18-month-old [N = 149]). At 1, 2, and 3 minutes postneedle, videos were coded for 3 clusters of child-led ER behaviors (disengagement of attention, parent-focused behaviors, and physical self-soothing) and pain-related distress. The concurrent and predictive relations between child-led ER behaviors and pain-related distress behaviors were assessed using 6 models (3 emotion regulation behaviors by 2 ages). At 18 months, disengagement of attention was significantly negatively related to pain-related distress at 1 minute postneedle, and pain-related distress at 1 minute postneedle was significantly related to less disengagement of attention at 2 minutes postneedle. Parent-focused behaviors had significant positive relations with pain-related distress at both ages, with stronger magnitudes at 18 months. Physical self-soothing was significantly related to less pain-related distress at both ages. Taken together, these findings suggest that disengagement of attention and physical self-soothing may serve more of a regulatory function during toddlerhood, whereas parent-focused behaviors may serve more of a function of gaining parent support for regulation. This study is the first to assess these relations during routine vaccination in toddlerhood and suggests that toddlers in the second year of life are beginning to play a bigger role in their own regulation from painful procedures than earlier in infancy.
Impact of medications on outcomes in patients with acute myocardial infarction and chronic obstructive pulmonary disease: A nationwide cohort study
Authors: Chiang Cheng-Hung , Jiang You-Cheng , Hung Wan-Ting , Kuo Shu-Hung , Hsia Kai , Wang Chia-Lin , Fu Yun-Ju , Lin Kun-Chang , Lin Su-Chiang , Cheng Chin-Chang , Huang Wei-Chun
Published: January 2023

Background:

Various inhaled bronchodilators have been associated with cardiovascular safety concerns. This study aimed to investigate the long-term impact of chronic obstructive pulmonary disease (COPD) and the safety of COPD medications in patients after their first acute myocardial infarction (AMI).

Methods:

This nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database. Patients hospitalized between 2000 and 2012 with a primary diagnosis of first AMI were included and divided into three cohorts (AMI, ST-elevation myocardial infarction [STEMI], and non-STEMI [NSTEMI]). Each cohort was propensity score matched (1:1) with patients without COPD. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) with 95% CIs.

Results:

A total of 186 112 patients with AMI were enrolled, and COPD was diagnosed in 13 065 (7%) patients. Kaplan-Meier curves showed that patients with COPD had a higher mortality risk than those without COPD in all cohorts (AMI, STEMI, and NSTEMI). The HR of mortality in AMI, STEMI, and NSTEMI patients with COPD was 1.12 (95% CI, 1.09-1.14), 1.20 (95% CI, 1.14-1.25), and 1.07 (95% CI, 1.04-1.10), respectively. Short-acting inhaled bronchodilators and corticosteroids increased mortality risk in all three cohorts. However, long-acting inhaled bronchodilators reduced mortality risk in patients with AMI (long-acting beta-agonist [LABA]: HR, 0.87; 95% CI, 0.81-0.94; long-acting muscarinic antagonist [LAMA]: HR, 0.82; 95% CI, 0.69-0.96) and NSTEMI (LABA: HR, 0.89; 95% CI, 0.83-0.97; LAMA: HR, 0.80; 95% CI, 0.68-0.96).

Conclusion:

This study demonstrated that AMI patients with COPD had higher mortality rates than those without COPD. Using inhaled short-acting bronchodilators and corticosteroids reduced survival, whereas long-acting bronchodilators provided survival benefits in AMI and NSTEMI patients. Therefore, appropriate COPD medication for acute AMI is crucial.
The prognostic value of fear-avoidance beliefs on postoperative pain and dysfunction for lumbar degenerative disk disease: a meta-analysis
Authors: Zhao Zhenni , Li Jiawei , Zhang Rui , Feng Yun , He Yanyan , Sun Zhiling
Published: January 2023

The study aimed to explore the prognostic value of fear-avoidance beliefs (FABs) on postoperative pain and back-specific function for patients with lumbar degenerative disk disease (LDDD). FABs have been proven to be a predictorof pain and disability for patients with low back pain. However, whether FABs are a predictor of surgical outcomes for LDDD is a matter of debate. PubMed, Cochrane library, EMBASE, and EBSCO were searched for eligible cohort studies or secondary analyses of randomized controlled trials. Fixed-effect meta-analysis models were used to estimate odds ratios (OR) because of absent or low heterogeneity (I² < 50%). Subgroup analyses were conducted according to different follow-up durations. Forest plots were used for graphical representation. Six studies with a total of 829 participants were included in the meta-analyses. Risk of bias was high for three studies and moderate for the other three studies. For patients with LDDD, meta-analyses showed that FABs were a predictor of postoperative pain intensity [OR 2.88; 95% confidence interval (CI), 2.76–3.00] and back-specific function (OR 3.13; 95% CI, 3.02–3.24). Patients with FABs are less likely to report improvement in pain (OR 2.56; 95% CI, 1.73–3.86) and function (OR 2.81; 95% CI, 2.57–3.07). In conclusion, FABs were a predictor of postoperative pain and back-specific function for patients with LDDD. This prognostic value is sustained for a long period after surgery (>12 months). Clinicians are advised to initiate targeted interventions for patients with FABs at different stages after surgery. Due to the limited number and low quality of included studies, the results of this meta-analysis should be interpreted with caution.
A Case Manager-Led Pneumonia Care Bundle in a Subacute Rehabilitation Facility
Authors: Granata Deborah , Kendra Moira , Chiu Stephanie H.
Published: January 2023

Purpose of the Study:

To evaluate the relationship between a case manager-led pneumonia care bundle at skilled nursing facilities (SNFs) and 30-day hospital readmissions for pneumonia.

Primary Practice Settings:

The primary practice settings included patients hospitalized with pneumonia at 2 community hospitals between October 2018 and June 2019 and who were subsequently transferred to an SNF.

Methodology and Sample:

A retrospective cohort study was completed comparing patients in the preintervention cohort who received pneumonia standard of care versus patients in the postintervention cohort who received a case manager-led evidence-based pneumonia care bundle at an SNF. From October 2018 to June 2019, patients admitted with pneumonia to 2 community hospitals in Northwest New Jersey were enrolled in the preintervention cohort. Patients admitted with pneumonia from January 2020 to June 2021 were enrolled in the postintervention group. The primary outcome was to reduce 30-day readmission rates for all patients discharged from the hospital to an SNF with pneumonia.

Results:

Ninety-nine patients were enrolled in the preintervention cohort and 34 patients were enrolled in the postinterventions cohort. Thirty-day readmission rates were lower in the postintervention cohort (24.2% vs. 17.7%). This reduction in readmission rates was clinically significant, demonstrating a 27% reduction for all patients discharged from the hospital to an SNF with pneumonia.

Implications for Case Management Practice:

Individualized pneumonia self-management education can be easily implemented in SNFs to improve quality-of-care outcomes for patients. Our health care system collaborates with several SNFs to decrease 30-day hospital readmission. The pneumonia care bundle includes specific measures to improve the transition of care for patients with pneumonia by decreasing the variability of patient care after discharge from the hospital to an SNF. It was hypothesized that to decrease readmissions from the SNFs, we needed to address the quality of care provided by the SNFs by using a 2-prong approach; education of SNF staff on the pneumonia care bundle, and in-person weekly follow-up visits in the SNF until discharge from the SNF to the patient's home.
The Inflation Reduction Act (IRA): What Case Managers Should Monitor
Authors: Powell Suzanne K.
Published: January 2023

Although this Editorial discusses the Inflation Reduction Act (IRA), it will focus on the health provisions only. Many issues can change between the writing of this Editorial and its publication, but here are some nuances of the law that case managers should watch.
Comparison of five different risk scores to predict incident type 2 diabetes in the Swiss HIV cohort study
Authors: Blondet Fanny , Kraege Vanessa , Cavassini Matthias , Damas Fernandez José , Vollenweider Peter , Wandeler Gilles , Hoffman Matthias , Calmy Alexandra , Stoeckle Marcel , Bernasconi Enos , Hasse Barbara , Marques-Vidal Pedro , Méan Marie
Published: January 2023

Objective:

People with HIV (PWH) have a higher risk of type 2 diabetes (T2D) than HIV-negative individuals. In the general population, diabetes risk scores are used to identify persons at risk of developing T2D, but little is known regarding their performance in PWH.

Design:

Assessment of the capacity of five diabetes risk scores to predict T2D in PWH.

Methods:

A prospective study including all Swiss HIV cohort study (SHCS) participants followed between 2009 and 2019. Five diabetes risk scores were assessed: FINDRISC versions 1 and 2, Balkau, Swiss Diabetes Association (SDA), and Kraege.

Results:

Three thousand eight hundred fifty-three T2D-free PWH (78.5% men, 39.9 ± 11.3 years) were included. After a median follow-up of 4.8 years (interquartile range 2.2–7.8), 62 participants (1.6%) developed T2D, corresponding to an incidence rate of 3.18 per 1000 person-years (95% confidence interval = 2.47–4.08). Participants who developed T2D were older (48.7 ± 12.4 vs. 39.8 ± 11.2 years), more likely to be obese (22.6% vs. 7.4%), abdominally obese (9.7% vs. 1.5%), and to have a family history of diabetes (32.3% vs. 19.1%) than those without T2D. The AUC for incident T2D ranged between 0.72 (Kraege 16) and 0.81 (SDA, FINDRISC2 and Balkau). Sensitivity ranged between 3.2% (Balkau) and 67.7% (FINDRISC1) and specificity between 80.9% (FINDRISC1) and 98.3% (Balkau). Positive predictive values of all scores were below 20%, while negative predictive values were above 98%.

Conclusion:

Our study shows that the performance of conventional diabetes risk scores in PWH is promising, especially for Balkau and FINDRISC2, which showed good discriminatory power. These scores may help identify patients at a low risk of T2D in whom careful assessment of modifiable T2D risk factors can be spared.
Do mitochondria use efflux pumps to protect their ribosomes from antibiotics?
Authors: Islam Md Deen , Harrison Brian D. , Li Judy J.-Y. , McLoughlin Austein G. , Court Deborah A.
Published: January 2023

Fungal environments are rich in natural and engineered antimicrobials, and this, combined with the fact that fungal genomes are rich in coding sequences for transporters, suggests that fungi are an intriguing group in which to search for evidence of antimicrobial efflux pumps in mitochondria. Herein, the range of protective mechanisms used by fungi against antimicrobials is introduced, and it is hypothesized, based on the susceptibility of mitochondrial and bacterial ribosomes to the same antibiotics, that mitochondria might also contain pumps that efflux antibiotics from these organelles. Preliminary evidence of ethidium bromide efflux is presented and several candidate efflux pumps are identified in fungal mitochondrial proteomes.
Coronary artery calcium mass measurement based on integrated intensity and volume fraction techniques
Authors: Black Dale , Xiao Xingshuo , Molloi Sabee
Published: January 2023

Purpose

Agatston scoring does not detect all the calcium present in computed tomography scans of the heart. A technique that removes the need for thresholding and quantifies calcium mass more accurately and reproducibly is needed.

Approach

Integrated intensity and volume fraction techniques were evaluated for accurate quantification of calcium mass. Integrated intensity calcium mass, volume fraction calcium mass, Agatston scoring and spatially weighted calcium scoring were compared to known calcium mass in simulated and physical phantoms. The simulation was created to match a 320-slice CT scanner. Fat rings were added to the simulated phantoms, which resulted in small (30×20 cm2), medium (35×25 cm2), and large (40×30 cm2) phantoms. Three calcification inserts of different diameters and hydroxyapatite densities were placed within the phantoms. All the calcium mass measurements were repeated across different beam energies, patient sizes, insert sizes, and densities. Physical phantom images from a previously reported study were then used to evaluate the accuracy and reproducibility of the techniques.

Results

Both integrated intensity calcium mass and volume fraction calcium mass yielded lower root mean squared error (RMSE) and deviation (RMSD) values than Agatston scoring in all the measurements in the simulated phantoms. Specifically, integrated calcium mass (RMSE: 0.50 mg, RMSD: 0.49 mg) and volume fraction calcium mass (RMSE: 0.59 mg, RMSD: 0.58 mg) were more accurate for the low-density calcium measurements than Agatston scoring (RMSE: 3.5 mg, RMSD: 2.2 mg). Similarly, integrated calcium mass (9.72%) and volume fraction calcium mass (10.19%) had fewer false-negative (CAC=0) measurements than Agatston scoring (38.89%).

Conclusion

The integrated calcium mass and volume fraction calcium mass techniques can potentially improve risk stratification for patients undergoing calcium scoring and further improve risk assessment compared to Agatston scoring.
Neck pain service utilization and costs: association with number of visits of chiropractic manipulation, active care, manual therapy, or acupuncture. A retrospective cohort study
Authors: Elton David , Zhang Meng
Published: January 2023

Background

Neck pain (NP) clinical practice guidelines (CPG) generally emphasize natural history, self-care, and non-pharmaceutical therapies. For non-pharmaceutical therapies provided for NP, like chiropractic manipulative treatment (CMT), active care (AC), manual therapy (MT), or acupuncture, little is known about the dose/response relationship with use of other services and total cost. The purpose of this retrospective cohort study of individuals with NP was to examine the dose response association between the number of visits of CMT, AC, MT, or acupuncture, the exposure to pharmaceutical, imaging, and interventional services, and total episode cost.

Methods

Episode of care was used to analyze a national sample of individuals 18 years and older with a single episode of non-surgical NP occurring in 2017-2019 and initially contacting a chiropractor (DC), physical therapist (PT), or licensed acupuncturist (LAc). The number of visits of CMT, AC, MT, or acupuncture were the primary independent variables. Rate and timing of use of 13 types of health care services and total episode cost were the primary dependent measures.

Results

A total of 91,805 continuously insured individuals initially contacted a DC, PT, or LAc for a single episode of non-surgical NP. These individuals initially contacted 19,387 different DCs, 1,828 PTs and 1,153 LAcs. There were $39,150,944 in total expenditures. The most common number of visits was 1 to 3 for CMT (47.8% of episodes), AC (31.8%), and MT (35.0%), and 4 to 6 for acupuncture (27.5%). Different levels of utilization intensity of CMT, AC, MT, and acupuncture were generally not associated with statistically or clinically meaningful differences in exposure to pharmaceutical, imaging, or interventional services. Total episode cost increased with higher numbers of visits of CMT, AC, MT, and acupuncture with CMT associated with the lowest median total episode code at each level of visit utilization.

Conclusions

For individuals with non-surgical NP initially contacting a DC, PT or LAc, 1 to 3 visits of CMT, AC, or MT, and 4 to 6 visits of acupuncture were the most common levels of utilization. A higher number of visits of CMT, AC, MT or acupuncture was associated with significantly higher total cost, without clinically or statistically meaningful differences in exposure to pharmaceutical, imaging, or interventional services. CMT was associated with the lowest total episode cost at each level of utilization. Higher visit counts of CMT, AC, MT, or acupuncture may have been associated with unmeasured clinical benefits and warrants further study.
How effective were Australian Quarantine Stations in mitigating transmission aboard ships during the influenza pandemic of 1918-19?
Authors: Alahakoon Punya , Taylor Peter G. , McCaw James M.
Published: January 2023

The influenza pandemic of 1918-19 was the most devastating pandemic of the 20th century. It killed an estimated 50–100 million people worldwide. In late 1918, when the severity of the disease was apparent, the Australian Quarantine Service was established. Vessels returning from overseas and inter-state were intercepted, and people were examined for signs of illness and quarantined. Some of these vessels carried the infection throughout their voyage and cases were prevalent by the time the ship arrived at a Quarantine Station. We study four outbreaks that took place on board theMedic, Boonah, Devon, andManukain late 1918. These ships had returned from overseas and some of them were carrying troops that served in the First World War. By analysing these outbreaks under a stochastic Bayesian hierarchical modeling framework, we estimate the transmission rates among crew and passengers aboard these ships. Furthermore, we ask whether the removal of infectious, convalescent, and healthy individuals after arriving at a Quarantine Station in Australia was an effective public health response.

Author Summary

The influenza pandemic of 1918-19 was one of the deadliest pandemics in history. In Australia, when it was apparent that the virus was severe, a quarantine service was established to intercept and quarantine ships that returned from overseas and travelled interstate. In this study, we look at the records of outbreaks on board theMedic, Boonah, Devon, andManuka. Some of the ships carried surviving troops from the First World War, and infections were prevalent when they arrived at a quarantine station. Infectious, convalescent, and healthy individuals on board were moved to the quarantine station for treatment or isolation. We model the outbreaks on the four ships using stochastic epidemic models and estimate the model parameters within a hierarchical framework. Furthermore, we investigate whether the removal of individuals with various disease states was an effective intervention measure from a public health perspective.
Redistribution and activation of CD16brightCD56dimNK cell subset to fight against Omicron subvariant BA.2 after COVID-19 vaccination
Authors: Liu Yang , Peng Huiyun , Xiang Tianxin , Xu Fei , Jiang Yuhuan , Zhong Lipeng , Peng Yanqi , Le Aiping , Zhang Wei
Published: January 2023

With the alarming surge in COVID-19 cases globally, vaccination must be prioritised to achieve herd immunity. Immune dysfunction is detected in the majority of patients with COVID-19; however, it remains unclear whether the immune responses elicited by COVID-19 vaccination function against the Omicron subvariant BA.2. Of the 508 Omicron BA.2-infected patients enrolled, 102 were unvaccinated controls and 406 were vaccinated. Despite the presence of clinical symptoms in both groups, vaccination led to a significant decline in nausea or vomiting, abdominal pain, headache, pulmonary infection, overall clinical symptoms, and a moderate rise in body temperature. Omicron BA.2-infected individuals were also characterised by a mild increase in both serum pro- and anti-inflammatory cytokine levels after vaccination. There were no significant differences or trend changes between T and B lymphocyte subsets; however, a significant expansion of NK lymphocytes in COVID-19-vaccinated patients was observed. Moreover, the most effective CD16brightCD56dimsubsets of NK cells showed increased functional capacities, as evidenced by a significantly greater IFN-γ secretion and stronger cytotoxic potential in Omicron BA.2-infected patients after vaccination. Collectively, these results suggest that COVID-19 vaccination interventions promote the redistribution and activation of CD16brightCD56dimNK cell subsets against viral infections, and could facilitate the clinical management of Omicron BA.2-infected patients.
Online randomised trials with children: A scoping review
Authors: Lepage Simone , Conway Aislinn , Goodson Noah , Wicks Paul , Flight Laura , Devane Declan
Published: January 2023

Background

Paediatric trials must contend with many challenges that adult trials face but often bring additional obstacles. Decentralised trials, where some or all trial methods occur away from a centralised location, are a promising strategy to help meet these challenges. This scoping review aims to (a) identify what methods and tools have been used to create and conduct entirely online-decentralised trials with children and (b) determine the gaps in the knowledge in this field. This review will describe the methods used in these trials to identify their facilitators and the gaps in the knowledge.

Methods

The methods were informed by guidance from the Joanna Briggs Institute and the PRISMA extension for scoping reviews. We systematically searched MEDLINE, CENTRAL, CINAHL, and Embase databases, trial registries, pre-print servers, and the internet. We included randomised and quasi-randomised trials conducted entirely online with participants under 18 published in English. A risk of bias assessment was completed for all included studies.

Results

Twenty-one trials met our inclusion criteria. The average age of participants was 14.6 years. Social media was the most common method of online recruitment. Most trials employed an external host website to store and protect their data. Duration of trials ranged from single-session interventions up to ten weeks. Fourteen trials compensated participants. Eight trials involved children in their trial design process; none reported compensation for this. Most trials had a low risk of bias in “random sequence generation”, “selective reporting”, and “other”. Most trials had a high risk of bias in “blinding participants and personnel”, “blinding of outcome assessment”, and “incomplete outcome data”. “Allocation concealment” was unclear in most studies.

Conclusions

There was a lack of transparent reporting of the recruitment, randomisation, and retention methods used in many of the trials included in this review. Patient and public involvement (PPI) was not common, and the compensation of PPI partners was not reported in any study. Consent methods and protection against fraudulent entries to trials were creative and thoroughly discussed by some trials and not addressed by others. More work and thorough reporting of how these trials are conducted is needed to increase their reproducibility and quality.

Ethics and Dissemination

Ethical approval was not necessary since all data sources used are publicly available.
Accuracy of Smartphone-based Vital Monitoring Using Remote Photoplethysmography Technology Enabled WellFie application
Authors: Rajan Sujata , Sivapuram Madhava Sai , Kumar Shiv Shankar , Podder Vivek
Published: January 2023

Background

Remote health monitoring technologies gained interest in the context of COVID-19 pandemic with potential for contactless monitoring of clinical patient status. Here, we examined whether vital parameters can be determined in a contactless manner using a novel smartphone-based technology called remote photoplethysmography (rPPG) and compared with comparable certified medical devices.

Methods

We enrolled a total of 150 normotensive adults in this comparative cross-sectional validation study. We used an advanced machine learning algorithm in the WellFie application to create computational models that predict reference systolic, diastolic blood pressure (BP), heart rate (HR), and respiratory rate (RR) from facial blood flow data. This study compared the predictive accuracy of smartphone-based, rPPG-enabled WellFie application with comparable certified medical devices.

Results

When compared with reference standards, on average our models predicted systolic blood pressure (BP) with an accuracy of 93.94%, diastolic BP with an accuracy of 92.95%, HR with an accuracy of 97.34%, RR with accuracy of 84.44%. For the WellFie application, the relative mean absolute percentage error (RMAPE) for HR was 2.66%, for RR was 15.66%, for systolic BP was 6.06%, and for diastolic BP was 7.05%.

Conclusion

Our results on normotensive adults demonstrates that rPPG technology-enabled Wellfie application can determine BP, HR, RR in normotensive participants with an accuracy that is comparable to clinical standards. WellFie smartphone application based on rPPG technology offers a convenient contactless video-based remote solution that could be used in any modern smartphone.
Health-related hope and reduced distress associated with fluid and dietary restrictions in advanced chronic kidney disease and dialysis: a cohort study
Authors: Kurita Noriaki , Wakita Takafumi , Fujimoto Shino , Yanagi Mai , Koitabashi Kenichiro , Yazawa Masahiko , Suzuki Tomo , Kawarazaki Hiroo , Ishibashi Yoshitaka , Shibagaki Yugo
Published: January 2023

Rationale & Objective

In chronic kidney disease (CKD), the durability of patient adherence to fluid and dietary restrictions may depend on the degree to which they have hope that they will enjoy life. However, few studies have examined the long-term role of health-related hope (HR-Hope) on distress from fluid and dietary restrictions.

Study Design Prospective cohort study.

Setting & Participants

A total of 444 non-dialysis stage 3-5 patients and stage 5D patients attending one of five Japanese nephrology centers.

Exposure

An 18-item HR-Hope scale with a score ranging from 0 to 100.

Outcomes

Two-item measures of restrictions on fluid and dietary intake from the Japanese version of the Kidney Disease Quality of Life Short Form, Version 1.3, with each score ranging from 0 to 100.

Analytical Approach

Multivariate linear mixed models were used to estimate the association of baseline HR-Hope with distress from fluid and dietary restrictions at baseline and follow-up.

Results

The mean age of participants was 67 years, 31.1% were female, and 124, 98, and 222 had non-dialysis CKD, peritoneal dialysis, and hemodialysis, respectively. Baseline HR-Hope buffered the growing distress from fluid restriction after one year (−18.01 pts [95% CI, -28.24 to -7.79]) per 10-pt increase, 2.59 pts [95% CI, 1.05 to 4.13]. The distress from fluid restriction at 2 years did not differ from baseline. Baseline HR-Hope buffered the growing distress from dietary restriction after one year (−12.4 pts [95% CI, -22.68 to -2.12]) per 10-pt increase, 1.96 pts (95% CI, 0.34 to 3.57). The distress from dietary restriction at 2 years did not differ from baseline.

Limitations

Use of self-reported measures as proxies for adherence.

Conclusions

Our study shows that HR-Hope, regardless of depression, can potentially mitigate the long-term distress from fluid and dietary restrictions in patients with a wide range of CKD severities.
Porosity-permeability tensor relationship of closely and randomly packed fibrous biomaterials and biological tissues: Application to the brain white matter
Authors: Yuan Tian , Shen Li , Dini Daniele
Published: January 2023

The constitutive model for the porosity-permeability relationship is a powerful tool to estimate and design the transport properties of porous materials, and has thus attracted a significant number of attention for the advancement of composite materials. However, in comparison with engineering composite materials, biomaterials, especially natural and artificial tissues, have more complex micro-structures such as high anisotropy, high randomness of cell/fibre dimensions and very low porosity. Consequently, these properties of the biomaterial make the porosity-permeability relationship more difficult to obtain than traditional composites. To fill this gap, we start the mathematical derivation from the fundamental brain white matter (WM) formed by nerve fibres. This is augmented by a numerical characterisation and experimental validations to obtain an anisotropic permeability tensor of the brain WM as a function of the tissue porosity. Moreover, we propose an anisotropic poroelastic model enhanced by the newly defined porosity-permeability tensor relationship which precisely captures the tissue’s macro-scale permeability changes due to the micro-structural deformation in an infusion scenario. The constitutive model, the theories and protocols established in this study will both provide improved design strategies to tailor the transport properties of fibrous biomaterials and enable the non-invasive characterisation of the transport properties of biological tissues. This will lead to the provision of better patient-specific medical treatments, such as drug delivery.
White matter network organization predicts memory decline after epilepsy surgery
Authors: Stasenko Alena , Kaestner Erik , Arienzo Donatello , Schadler Adam J. , Helm Jonathan L. , Shih Jerry , Ben-Haim Sharona , McDonald Carrie R.
Published: January 2023

Withdrawal Statement

The authors have withdrawn their manuscript owing to a substantial change in data analysis and findings/conclusions. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
Benchmarking Algorithms for Gene Set Scoring of Single-cell ATAC-seq Data
Authors: Wang Xi , Lian Qiwei , Dong Haoyu , Xu Shuo , Su Yaru , Wu Xiaohui
Published: January 2023

Gene set scoring (GSS) has been routinely conducted for gene expression analysis of bulk or single-cell RNA-seq data, which helps to decipher single-cell heterogeneity and cell-type-specific variability by incorporating prior knowledge from functional gene sets. Single-cell assay for transposase accessible chromatin using sequencing (scATAC-seq) is a powerful technique for interrogating single-cell chromatin-based gene regulation, and genes or gene sets with dynamic regulatory potentials can be regarded as cell-type specific markers as if in scRNA-seq. However, there are few GSS tools specifically designed for scATAC-seq, and the applicability and performance of RNA-seq GSS tools on scATAC-seq data remain to be investigated. We systematically benchmarked ten GSS tools, including four bulk RNA-seq tools, five single-cell RNA-seq (scRNA-seq) tools, and one scATAC-seq method. First, using matched scATAC-seq and scRNA-seq datasets, we find that the performance of GSS tools on scATAC-seq data is comparable to that on scRNA-seq, suggesting their applicability to scATAC-seq. Then the performance of different GSS tools were extensively evaluated using up to ten scATAC-seq datasets. Moreover, we evaluated the impact of gene activity conversion, dropout imputation, and gene set collections on the results of GSS. Results show that dropout imputation can significantly promote the performance of almost all GSS tools, while the impact of gene activity conversion methods or gene set collections on GSS performance is more GSS tool or dataset dependent. Finally, we provided practical guidelines for choosing appropriate pre-processing methods and GSS tools in different scenarios.
Improved cognitive-motor processing speed and decreased functional connectivity after high intensity aerobic exercise in individuals with chronic stroke
Authors: Andrushko Justin W. , Rinat Shie , Greeley Brian , Larssen Beverley C. , Jones Christina B. , Rubino Cristina , Denyer Ronan , Ferris Jennifer , Campbell Kristin L. , Neva Jason L. , Boyd Lara A.
Published: January 2023

After stroke, impaired motor performance is linked to an increased demand for cognitive resources. Aerobic exercise improves cognitive function in healthy populations and may be effective in altering cognitive function post-stroke. We sought to determine if high intensity aerobic exercise paired with motor training in individuals with chronic stroke alters cognitive-motor function and functional connectivity between the dorsolateral prefrontal cortex (DLPFC), a key region for cognitive-motor processes, and the sensorimotor network. Twenty-five participants with chronic stroke were randomly assigned to exercise (n = 14; 66 ± 11 years; 4 females), or control (n = 11; 68 ± 8 years; 2 females) groups. Both groups performed five-days of paretic upper limb motor training after either high intensity aerobic exercise (3 intervals of 3 minutes each, total exercise duration of 23-minutes) or watching a documentary (control). Resting-state fMRI, and TMT-A and B were recorded pre- and post-intervention. Both groups showed implicit motor sequence learning (p< .001), but there was no added benefit of exercise (p= .738). Regardless of group, the changes in task score (p= .025), and dwell time (p= .043) were correlated with a decrease in DLPFC-sensorimotor network functional connectivity (p= .024), which is thought to reflect a reduction in the cognitive demand and increased automaticity. The exercise group experienced greater overall cognitive-motor improvements measured with the trail making test part A (TMT-A: task score:p= .012; dwell time:p= .024; movement time:p= .567). Aerobic exercise may improve cognitive-motor processing speed post-stroke.

Significance statement

After stroke, impaired motor performance is linked to an increased demand for cognitive resources. In our work we show that high intensity aerobic exercise paired with an implicit motor learning task improves cognitive-motor processing speed and reduces resting-state functional connectivity between the dorsolateral prefrontal cortex and the sensorimotor network in individuals living with chronic stroke. These data likely reflect a reduction in cognitive resource dependence during a cognitive-motor task after stroke and a shift towards cognitive-motor automaticity.
Sustained Selective Attention in Adolescence: Cognitive Development and Predictors of Distractibility at School
Authors: Hobbiss Michael H. , Lavie Nilli
Published: January 2023

Despite much research into the development of attention in adolescence, mixed results and between-task differences have precluded clear conclusions regarding the relative early- or late-maturation of attention abilities. Moreover, although adolescents constantly face the need to pay attention to their lessons at school, it remains unclear whether laboratory measures of attention can predict their ability to sustain attention focus during school lessons. Here we therefore devised a task that was sensitive to measure both sustained and selective attention and tested whether any of our task measures can predict adolescents’ levels of inattention during their school lessons. 166 adolescents (aged 12-17) and 50 adults performed in our sustained-selective attention task, searching for letter targets, while ignoring salient yet-entirely-irrelevant distractor faces, under different levels of perceptual load-an established determinant of attention in adults. Inattention levels during a just-preceding classroom lesson were measured using our novel self-report classroom-distractibility checklist. The results established that sustained attention (measured with response variability) continued to develop throughout adolescence, across perceptual load levels. In contrast there was an earlier maturation of the effect of perceptual load on selective attention: load modulation of distractor interference was larger in the early adolescence compared to later periods. Both distractor interference and response variability were significant unique predictors of distractibility in the classroom, including when interest in the lesson and cognitive aptitude were controlled for. Overall, the results demonstrate divergence of development of sustained and selective attention in adolescence, and establish both as significant predictors of attention in the important educational setting of school lessons.