bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Patient Perceptions Towards Direct Primary Care: A Focus Group Study
Authors: Tou Leila C. , Jeyakumar Shereen J. , Siddiqui Taha A. , Ravi Srekar , Prakash Nirmala
Published: August 2022

Direct primary care (DPC) is a growing model of care that is suggested as an alternative to traditional fee-for-service healthcare. Patient-reported experiences of DPC can provide unique insight into the impact of joining the model and inform quality improvement. The purpose of this study was to investigate patient perceptions of DPC. Thirty-one participants were initially recruited for the study and completed a survey assessing patient demographics. Of the 31 participants, 10 went on to complete the focus group interviews. Qualitative analysis of focus group transcripts identified common themes and subthemes. Focus group findings were stratified into 4 themes including quality of care, access to care, affordability, physician qualities, and reasons for choosing DPC. The top positive subthemes were good communication, joining DPC due to poor past healthcare experiences, and physician personability. The most common negative subthemes were difficulty referring to specialists outside the practice, poor communication, and poor access to medications. All findings were presented and discussed with the investigated clinic to facilitate improvements in healthcare delivery.
What limits Muslim communities’ access to nature? Barriers and opportunities in the United Kingdom
Authors: Edwards Rachael C , Larson Brendon MH , Burdsey Daniel
Published: August 2022

Recreation in protected areas can greatly contribute to health and wellbeing, but there exist significant demographic disparities in protected area use across Europe and North America. Minority ethnic groups, in particular, are often underrepresented in protected areas due to a variety of cultural, economic, and discriminatory barriers. Muslims are one of the fastest growing minority ethnic communities in Western countries but have received little study in the context of protected areas. More research is therefore needed to understand protected area exclusion as experienced by Muslim communities. Through 14 in-depth interviews with Muslim community leaders in the United Kingdom, we explored the socio-cultural barriers and opportunities that contribute to the accessibility of protected areas for Muslims. As the majority of our participants were women, this study addresses the underrepresentation of diverse female voices in research on Muslims and leisure and foregrounds Muslim women as agents in their recreational lives. We found that a wide variety of factors can inhibit access, cumulatively resulting in several layers of exclusion. Primary barriers included a lack of inclusive imagery, insufficient facilities for social gathering, prior instances of discrimination, the perceived whiteness of protected areas, and unfamiliarity with these spaces. Several barriers related to the wilderness ideology that is embedded across many aspects of protected area marketing, design, and management as it does not embrace collectivist aspects of Muslim cultures. The level of “naturalness” associated with protected areas, however, did not emerge as a barrier. We also identified many opportunities, including the stewardship role of humans depicted within Islam. Lastly, we discuss the management implications for protected areas that emerge from our results. This research demonstrates that to foster a sense of belonging for Muslim communities, protected area managers must consider many socio-cultural dimensions of accessibility, holistically engage with Muslim communities, and embrace diverse worldviews relating to the human–nature relationship.
Measure of Frontal Morphology in Sagittal Craniosynostosis: The Frontal Bossing Index
Authors: Bins Griffin P. , Cull Deborah , Layton Ryan G. , Powell Rhyann B. , Nearine Jake , Meegalla Nuwan T. , Patel Kamlesh B. , Runyan Christopher M.
Published: August 2022

Background:

Frontal bossing is a prominent forehead feature common in sagittal craniosynostosis (SC). Assessment of severity of frontal bossing is limited by the use of serial CT imaging or complex computer programing. Three-dimensional measurements of cranial surface morphology provide a radiation-free alternative for assessing cranial shape. This study describes the creation of a frontal bossing index (FBI), a novel tool using surface morphology to assess the frontal severity in patients with SC.

Methods:

Surface imaging from CT scans or 3D photographs of 359 individuals with sagittal craniosynostosis and 224 normocephalic individuals were compared to identify differences in frontal morphology. Cartesian grids were created on each individual’s surface mesh using equidistant axial and sagittal planes yielding 33 unique points of intersection on the forehead. Area under the curve (AUC) analyses were performed to identify frontal points with the greatest discrepancy between groups.

Results:

All points in the SC population had significantly greater protrusion than corresponding points in the control group. The largest differences were located in the superior lateral regions. Combining the superior- and lateral-most points gave the maximal AUC (0.9707) and was therefore selected to generate the frontal bossing index (FBI). The FBI distinguished between the 2 groups with a sensitivity of 93.5% and specificity of 92.9%.

Conclusions:

The frontal bossing index is a useful tool for evaluating the severity of the frontal region in patients with SC, comparing outcomes of differing surgical techniques, and tracking frontal changes in individuals over time, without the need for radiation.
Preventive Health Screening for Women at Risk for Cardiovascular Disease: Targeting Women 40 to 64 Years of Age
Authors: Bloom Isaiah W. , Evans Kevin D. , Brady Austin N. , Stigall-Weikle A. Nicole
Published: August 2022

Objective:

The Centers for Disease Control and Prevention (CDC) has documented that the leading cause of death in the United States is cardiovascular disease (CVD). Specifically, CVD is responsible for the death of one out of every five women in the United States. Therefore, the research question was, “What specific diagnostic tests, including a novel approach to detecting abdominal aortic calcifications (AAC), could be added to screening women for CVD?”

Materials and Methods:

A prospective cohort of 14 female volunteers, between the ages of 40 and 60 years, were consented to sonography of the aorta, collection of demographic data, as well as contributing biometric data. Each volunteer gave informed consent in compliance with the university’s Institutional Review Board. Volunteers also were provided with a Health Insurance Portability and Accountability Act (HIPAA) release that was signed prior to the collection of any data. All sonographic images were analyzed post-examination and aortic calcifications were graded using a modified scoring system derived from a dual-energy x-ray absorptiometry (DXA)-based grading system.

Results:

In this cohort of 14 females, their AAC category scores ranged from I to IIIB (grades: normal to multiple calcified atheroma). Descriptive statistics demonstrate that it is possible to document AAC on this cohort of women using sonography. Correlational statistics showed a statistically significant association between a volunteer’s posterior aortic-intimal media thickness (a-IMT) and their atherosclerotic cardiovascular disease (ASCVD) 10-year risk score.

Conclusion:

This pilot study suggests the need for further research on screening techniques to determine women’s specific CVD risk in this age group. Although the preliminary results allude to sonographic measures of a-IMT being a possible CVD screening method in the future, more research data are needed.
Identifying and describing subtypes of spontaneous empathic facial expression production in autistic adults
Authors: Quinde-Zlibut Jennifer , Munshi Anabil , Biswas Gautam , Cascio Carissa J.
Published: August 2022

Background

It is unclear whether atypical patterns of facial expression production metrics in autism reflect the dynamic and nuanced nature of facial expressions across people or a true diagnostic difference. Furthermore, the heterogeneity observed across autism symptomatology suggests a need for more adaptive and personalized social skills programs. Towards this goal, it would be useful to have a more concrete and empirical understanding of the different expressiveness profiles within the autistic population and how they differ from neurotypicals.

Methods

We used automated facial coding and an unsupervised clustering approach to limit inter-individual variability in facial expression production that may have otherwise obscured group differences in previous studies, allowing an “apples-to-apples” comparison between autistic and neurotypical adults. Specifically, we applied k-means clustering to identify subtypes of facial expressiveness in an autism group (N = 27) and a neurotypical control group (N = 57) separately. The two most stable clusters from these analyses were then further characterized and compared based on their expressiveness and emotive congruence to emotionally charged stimuli.

Results

Our main finding was that a subset of autistic adults in our sample show heightened spontaneous facial expressions irrespective of image valence. We did not find evidence for greater incongruous (i.e., inappropriate) facial expressions in autism. Finally, we found a negative trend between expressiveness and emotion recognition within the autism group.

Conclusion

The results from our previous study on self-reported empathy and current expressivity findings point to a higher degree of facial expressions recruited for emotional resonance in autism that may not always be adaptive (e.g., experiencing similar emotional resonance regardless of valence). These findings also build on previous work indicating that facial expression intensity is not diminished in autism and suggest the need for intervention programs to focus on emotion recognition and social skills in the context of both negative and positive emotions.
Multidimensional measure of instrumental support in transitional care – design and pilot test of a questionnaire assessing instrumental support among older adults with chronic diseases
Authors: Yang Fengbo , Hua Jianing , Geng Guiling , Cui Min , Yang Wenwen , Geng Zihan
Published: August 2022

Background

Previous studies indicated that poor quantity and quality of instrumental support are one of the main barriers in the application of transitional care. Instrumental support, as one common function of social support, is the provision of financial assistance, material goods, or services. The purpose of our study is to develop an Instrumental Support in Transitional Care Questionnaire (ISTCQ) and use this questionnaire to make an assessment among older adults with chronic diseases.

Methods

The draft questionnaire was examined by 18 experts from different professional fields performing three rounds of content validity testing with the Delphi method. Afterward, we conducted a pilot test recruiting 174 participants as a convenience sample in Nantong, China. The construct validity was confirmed via exploratory factor analysis and reliability was assessed using Cronbach's alpha.

Results

The authority coefficient of experts was 0.74–0.99 and Kendall harmony coefficient W was 0.381. The exploratory factor analysis indicated that the questionnaire can be interpreted by three factors: namely, anticipated support (items 1, 2, 3, 4), received support (items 5, 6, 7, 8) and support satisfaction (items 9, 10, 11, 12). These three factors (eigenvalues > 1 and factor loading > 0.4) explained 69.128% of the total variance. Furthermore, the calculation of Cronbach's alpha and test–retest reliability have shown good reliability among each dimension of the 12-item questionnaire (Cronbach's alpha 0.711–0.827, test–retest reliability 0.704–0.818).

Conclusion

Results from the pilot test demonstrated excellent reliability and validity of ISTCQ through each dimension and as an entire.
Relationship between ventilator bundle compliance and the occurrence of ventilator-associated events: a prospective cohort study
Authors: Hassan Eman Arafa , Elsaman Suad Elsayed abdelmotalb
Published: August 2022

Background

Instead of ventilator-associated pneumonia (VAP), the modern definition of ventilator-associated events (VAEs) has been introduced to identify infectious and noninfectious respiratory complications. Some studies revealed that compliance to the ventilator bundle is associated with decreased occurrence of VAP, but little is known about its association with the decrease of VAEs occurrence.

Methods

A prospective cohort research design was used. Data were collected over eight months from May 2019 to February 2020 in five general intensive care units. The researchers assessed the compliance to ventilator care bundle using the Institute for Healthcare Improvement ventilation bundle checklist. Mechanically ventilated patients were prospectively assessed for the occurrence of VAEs using a pre-validated calculator from the Centers for Disease Control and Prevention. All are non-invasive tools and no intervention was done by the authors.

Results

A total of 141 mechanically ventilated patients completed the study. The odds ratio of having VAEs in patients who received ventilator bundle was -1.19 (95% CI, -2.01 to -0.38), a statistically significant effect, Wald χ2(1) = 8.18, p = 0.004.

Conclusion/ implications for practice

Ventilator bundle compliance was associated with a reduced risk for VAEs occurrence. Nurses should comply with the ventilator bundle because it is associated with decreased VAEs occurrence.
Anaesthesia personnels’ perspectives on digital anaesthesia information management systems – a qualitative study
Authors: Leonardsen Ann-Chatrin , Bruun Anne-Marie Gran , Valeberg Berit T.
Published: August 2022

Background

In Norway, the anaesthesia team normally consists of a nurse anaesthetist and an anaesthetist. Digital anesthesia information management systems (AIMS) that collect patient information directly from the anaesthesia workstation, and transmit the data into documentation systems have recently been implemented in Norway. Earlier studies have indicated that implementation of digital AIMS impacts the clinical workflow patterns and distracts the anaesthesia providers. These studies have mainly had a quantitative design and focused on functionality, installation designs, benefits and challenges associated with implementing and using AIMS. Hence, the aim of this study was to qualitatively explore anaesthesia personnel’s perspectives on implementing and using digital AIMS.

Methods

The study had an exploratory and descriptive design. The study was conducted within three non-university hospitals in Southern Norway. Qualitative, individual interviews with nurse anaesthetists (n = 9) and anaesthetists (n = 9) were conducted in the period September to December 2020. Data were analysed using qualitative content analysis according to the recommendations of Graneheim and Lundman.

Results

Four categories were identified: 1) Balance between clinical assessment and monitoring, 2) Vigilance in relation to the patient, 3) The nurse-physician collaboration, and 4) Software issues. Participants described that anaesthesia included a continuous balance between clinical assessment and monitoring. They experienced that the digital AIMS had an impact on their vigilance in relation to the patient during anaesthesia. The digital AIMS affected the nurse-physician collaboration. Moreover, participants emphasised a lack of user participation and aspects of user-friendliness regarding the implementation of digital AIMS.

Conclusion

Digital AIMS impacts vigilance in relation to the patient. Hence, collaboration and acceptance of the mutual responsibility between nurse anaesthetists and anaesthetists for both clinical observation and digital AIMS administration is essential. Anaesthesia personnel should be included in development and implementation processes to facilitate implementation.
“Intention to receive COVID-19 vaccine among healthcare workers: a comparison between two surveys”
Authors: Meysamie Alipasha , Ghasemi Elham , Moshksar Shadi , Askarian Mehrdad
Published: August 2022

Background

Considering the importance of intention to receive COVID-19 vaccine among healthcare workers and its role in maintaining their health and inhibiting the epidemic spread of Covid-19, the present study was done to identify the changes in intention to receive COVID-19 vaccine rate in two different time points and it’s determinants based on the dimensions of the health belief model among healthcare workers in Iran.

Methods

Two cross-sectional surveys performed to investigate COVID-19 vaccination intent and associated factors based on the health belief model. The first conducted on 1244 participants from August 18 to 23, 2020, and the second on 1514 participants from February 5 to April 29, 2021, both using a questionnaire of intent to accept COVID-19 vaccination. The questionnaire distribution platform in both surveys was similarly, WhatsApp and Telegram social and working virtual groups of HCWs. Data were analyzed with SPSS-16 software for descriptive and analytical statistics.

Results

In the first survey, 58.4% (95% CI: 0.55-0.61%) of healthcare workers intended to receive the COVID-19 vaccine, the rate dropped to 45.7% (95% CI: 0.43-0.48%) in the second survey (P < 0.001). The regression analysis indicated six factors that were significantly associated with higher intention to receive COVID-19 vaccine: being a female (OR = 1.84, 95% CI (1.11-3.03)), history of Covid-19 infection (OR = 1.54, 95% CI (1.09-2.18), perceptions of Covid-19 disease (OR = 1.13, 95% CI (1.01-1.28)), perceived benefits of COVID-19 vaccine (OR = 1.34, 95% CI (1.22-1.47)), prosocial norms for COVID-19 vaccination (OR = 1.25, 95% CI (1.21-1.29)), and COVID-19 vaccine safety/cost concerns (OR = 1.25, 95% CI (1.17-1.33)).

Conclusions

Present study showed an undesirable rate of intention to receive COVID-19 vaccine among healthcare workers, especially decreasing over the time, emphasize the need of interventions to promote healthcare workers’ intention to receive the vaccine and reduce the spread of COVID-19 disease.
The association between the pre-pregnancy vaginal microbiome and time-to-pregnancy: a Chinese pregnancy-planning cohort study
Authors: Hong Xiang , Zhao Jun , Yin Jiechen , Zhao Fanqi , Wang Wei , Ding Xiaoling , Yu Hong , Ma Xu , Wang Bei
Published: August 2022

Background

Although sexually transmitted infections are regarded as the main cause of tubal infertility, the association between the common vaginal microbiome and female fecundability has yet to be determined. The objective of this study was to find convincing evidence relating to the impact of the vaginal bacterial structure on the fecundability of women planning pregnancy.

Methods

We recruited women who took part in the Free Pre-pregnancy Health Examination Project from 13 June 2018 to 31 October 2018 (n = 89, phase I) and from 1 November 2018 to 30 May 2020 (n = 389, phase II). We collected pre-pregnancy vaginal swabs from each subject; then, we followed up each subject to acquire the pregnancy-planning outcome in 1 year. In phase I, 16S rRNA gene sequencing was performed to investigate the vaginal bacterial content between the pregnancy and non-pregnancy groups. These findings were verified in phase II by applying a quantitative real-time polymerase chain reaction for the measurement of the absolute abundance of specific species. Cox models were used to estimate fecundability ratios (FR) for each vaginal microbiome type.

Results

In phase I, 59.6% (53/89) of women became pregnant within 1 year. The principal coordinate analysis showed that the pre-pregnancy vaginal microbial community structures of the pregnant and non-pregnant groups were significantly different (PERMANOVA test, R2 = 0.025, P = 0.049). The abundance of the genus Lactobacillus in the pregnancy group was higher than that of the non-pregnant group (linear discriminant analysis effect size (LDA) > 4.0). The abundance of the genus Gardnerella in the non-pregnant group was higher than those in the pregnant group (LDA > 4.0). In phase II, female fecundability increased with higher absolute loads of Lactobacillus gasseri (quartile Q4 vs Q1, FR = 1.71, 95%CI 1.02–2.87) but decreased with higher absolute loads of Fannyhessea vaginae (Q4 vs Q1, FR = 0.62, 95%CI 0.38–1.00). Clustering analysis showed that the vaginal microbiome of type D (characterized by a higher abundance of Lactobacillus iners, a lower abundance of Lactobacillus crispatus and Lactobacillus gassri) was associated with a 55% reduction of fecundability (FR = 0.45, 95%CI 0.26–0.76) compared with type A (featuring three Lactobacillus species, low Gardnerella vaginalis and Fannyhessea vaginae abundance).

Conclusions

This cohort study demonstrated an association between the pre-pregnancy vaginal microbiome and female fecundability. A vaginal microbiome characterized by a higher abundance of L. iners and lower abundances of L. crispatus and L. gasseri appeared to be associated with a lower fecundability. Further research now needs to confirm whether manipulation of the vaginal microenvironment might improve human fecundability.
Noradrenergic Add-on Therapy with Extended-Release Guanfacine in Alzheimer’s Disease (NorAD): study protocol for a randomised clinical trial and COVID-19 amendments
Authors: Hoang Karen , Watt Hilary , Golemme Mara , Perry Richard J. , Ritchie Craig , Wilson Danielle , Pickett James , Fox Chris , Howard Robert , Malhotra Paresh A.
Published: August 2022

Background

Guanfacine is a α2A adrenergic receptor agonist approved for treating attention deficit hyperactivity disorder (ADHD). It is thought to act via postsynaptic receptors in the prefrontal cortex, modulating executive functions including the regulation of attention. Attention is affected early in Alzheimer’s disease (AD), and this may relate to pathological changes within the locus coeruleus, the main source of noradrenergic pathways within the brain. Given that cholinergic pathways, also involved in attention, are disrupted in AD, the combination of noradrenergic and cholinergic treatments may have a synergistic effect on symptomatic AD. The primary objective of the NorAD trial is to evaluate the change in cognition with 12 weeks of treatment of extended-release guanfacine (GXR) against a placebo as a combination therapy with cholinesterase inhibitors in participants with mild to moderate Alzheimer’s disease.

Methods/design

NorAD is a 3-month, single-centre, randomised, double-blind, placebo-controlled, phase III trial of extended-release guanfacine (GXR) in participants with mild to moderate Alzheimer’s disease. A total of 160 participants will be randomised to receive either daily guanfacine or placebo in combination with approved cholinesterase treatment for 12 weeks. The primary outcome is the change in cognition, as measured by the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), from baseline to follow-up in the treatment group compared to the placebo group. Secondary outcomes include the change in additional cognitive measures of attention (Tests of Attention: Trails A and B, digit-symbol substitution, Test of Everyday Attention and CANTAB-RVP), neuropsychiatric symptoms (Neuropsychiatric Inventory), caregiver burden (Zarit Burden Interview) and activities of daily living (Alzheimer’s Disease Co-operative Study – Activities of Daily Living Inventory). From July 2020, observation of change following cessation of treatment is also being assessed.

Discussion

There is strong evidence for early noradrenergic dysfunction in Alzheimer’s disease. The NorAD trial aims to determine whether guanfacine, a noradrenergic alpha-2 agonist, improves attention and cognition when used in addition to standard cholinergic treatment.

Trial registration

ClinicalTrials.govNCT03116126. Registered on 14 April 2017

EudraCT: 2016-002598-36
Postoperative fasting is associated with longer ICU stay in oncologic patients undergoing elective surgery
Authors: Fachini Caroline , Alan Claudio Z. , Viana Luciana V.
Published: August 2022

Background

Cancer patients present nutritional and complications risks during the postoperative period. Fasting contributes to surgical catabolic damage. This study evaluates the consequence of fasting time on the surgical outcomes of cancer patients undergoing elective surgeries.

Methods

Prospective cohort, evaluating two categories of patients according to postoperative fasting: less than or greater than 24 h. Outcomes: Hospitalization time, 28-day mortality, ICU stay and infection rates.

Discussion

We included 109 patients (57% men, 60 ± 15 years, BMI: 26 ± 5 kg/m2, SAPS3 43 ± 12), hepatectomy was the most frequent surgery (13.8%), and colon and rectum were the most common neoplasia (18.3%). The ICU stay was longer in postoperative fasting > 24 h (5.5 [4–8.25] vs. 3 [2–5] days, p < 0.001). Fasting > 24 h persisted as a risk factor for longer length of stay (LOS) in the ICU after adjustments. There were no differences in the mortality analysis within 28 days and total hospitalization time between groups. A tendency to experience more infections was observed in patients who fasted > 24 h (34.8% vs. 16.3%, p = 0.057). Onset of diet after the first 24 h postoperatively was a risk factor for longer ICU stay in cancer patients who underwent major surgeries.

Graphical Abstract
Decreased self-reported receiving of social touch and social support predict loneliness in healthy adults
Authors: Araújo Cássia Regina Vieira , Mota Bruna Eugênia Ferreira , Campagnoli Rafaela Ramos , Rocha-Rego Vanessa , Volchan Eliane , Souza Gabriela Guerra Leal
Published: August 2022

Loneliness has emerged as a public health concern. Previous research has reported its deleterious effects on physical and mental health; however, some specific psychophysiological mechanisms in healthy adults remain to be elucidated. The aim of the current study is to investigate whether self-reported social support and social touch (giving and receiving social touch), as well as resting heart rate variability (HRV), are significant negative predictors of loneliness in healthy adults. The study sample consists of 120 healthy students (50% female) with a mean age of 21.85 years old (DP= 2.21). The students were asked to complete a psychiatric screening questionnaire utilizing loneliness, social support, and social touch scales. HRV was derived from an electrocardiographic signal recorded for 15 min, with the participant relaxed in a supine position. Linear regression analyses were conducted to evaluate loneliness as a function of social support, social touch (giving or receiving touch), and resting HRV. The results show that social support (p< 0.001) and social touch, specifically receiving touch (p< 0.002), accounted for a significant proportion of the variance in loneliness. However, neither giving touch nor resting HRV was a significant predictor of loneliness. The current study highlights specific psychosocial factors in healthy adults that should be considered as promising pathways in order to reduce or work toward preventing loneliness, thus promoting better health and well-being.
Extracellular vesicles in idiopathic pulmonary fibrosis: pathogenesis and therapeutics
Authors: Fujita Yu
Published: August 2022

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease that occurs due to increased fibrosis of lung tissue in response to chronic injury of the epithelium. Therapeutic options for IPF remain limited as current therapies only function to decrease disease progression. Recently, extracellular vesicles (EVs), including exosomes and microvesicles, have been recognized as paracrine communicators through the component cargo. The population of cell-specific microRNAs and proteins present in EVs can regulate gene expressions of recipient cells, resulting in modulation of biological activities. EV cargoes reflect cell types and their physiological and pathological status of donor cells. Many current researches have highlighted the functions of EVs on the epithelial phenotype and fibroproliferative response in the pathogenesis of IPF. Furthermore, some native EVs could be used as a cell-free therapeutic approach for IPF as vehicles for drug delivery, given their intrinsic biocompatibility and specific target activity. EV-based therapies have been proposed as a new potential alternative to cell-based approaches. The advantage is that EVs, depending on their source, may be less immunogenic than their parental cells, likely due to a lower abundance of transmembrane proteins such as major histocompatibility complex (MHC) proteins on the surface. In the last decade, mesenchymal stem cell (MSC)-derived EVs have been rapidly developed as therapeutic products ready for clinical trials against various diseases. Considering EV functional complexity and heterogeneity, there is an urgent need to establish refined systemic standards for manufacturing processes and regulatory requirements of these medicines. This review highlights the EV-mediated cellular crosstalk involved in IPF pathogenesis and discusses the potential for EV-based therapeutics as a novel treatment modality for IPF.
Artificial intelligence for prostate MRI: open datasets, available applications, and grand challenges
Authors: Sunoqrot Mohammed R. S. , Saha Anindo , Hosseinzadeh Matin , Elschot Mattijs , Huisman Henkjan
Published: August 2022

Artificial intelligence (AI) for prostate magnetic resonance imaging (MRI) is starting to play a clinical role for prostate cancer (PCa) patients. AI-assisted reading is feasible, allowing workflow reduction. A total of 3,369 multi-vendor prostate MRI cases are available in open datasets, acquired from 2003 to 2021 in Europe or USA at 3 T (n = 3,018; 89.6%) or 1.5 T (n = 296; 8.8%), 346 cases scanned with endorectal coil (10.3%), 3,023 (89.7%) with phased-array surface coils; 412 collected for anatomical segmentation tasks, 3,096 for PCa detection/classification; for 2,240 cases lesions delineation is available and 56 cases have matching histopathologic images; for 2,620 cases the PSA level is provided; the total size of all open datasets amounts to approximately 253 GB. Of note, quality of annotations provided per dataset highly differ and attention must be paid when using these datasets (e.g., data overlap). Seven grand challenges and commercial applications from eleven vendors are here considered. Few small studies provided prospective validation. More work is needed, in particular validation on large-scale multi-institutional, well-curated public datasets to test general applicability. Moreover, AI needs to be explored for clinical stages other than detection/characterization (e.g., follow-up, prognosis, interventions, and focal treatment).
Diagnostic value of hybrid FDG-PET/MR imaging of chronic osteomyelitis
Authors: Hulsen Dennis Jan Willem , Mitea Cristina , Arts Jacobus J. , Loeffen Daan , Geurts Jan
Published: August 2022

Background

Magnetic resonance imaging (MRI) and 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) Positron Emission Tomography, paired with Computed Tomography (PET/CT) are commonly used modalities in the complicated diagnostic work-up of osteomyelitis. PET/MRI is a relatively novel hybrid modality with suggested applications in bone infection imaging, based on expert opinion and previous qualitative research. 18F-FDG PET/MRI has the advantages of reduced radiation dose, more soft tissue information, and is deemed more valuable for surgical planning compared to 18F-FDG PET/CT. The goal of this study is to quantitatively assess the diagnostic value of hybrid 18F-FDG PET/MRI for chronic osteomyelitis.

Methods

A retrospective analysis was performed by a nuclear medicine physician and radiologist on 36 patients with 18F-FDG PET/MRI scans for suspected osteomyelitis. Sensitivity, specificity, and accuracy were determined with the clinical assessment by the orthopaedic surgeon (based on subsequent intraoperative microbiology or long-term follow-up) as the ground truth. Standardized uptake values (SUV) were measured and analysed by means of receiver operating characteristics (ROC).

Results

This first study to quantitatively report the diagnostic value of 18F-FDG PET/MRI yielded a sensitivity, specificity, and accuracy of 78%, 100%, and 86% respectively. Area under the ROC curve was .736, .755, and .769 for the SUVmax, target to background ratio, and SUVmax_ratio respectively. These results are in the same range and not statistically different compared to diagnostic value for 18F-FDG PET/CT imaging of osteomyelitis in literature.

Conclusions

Based on the aforementioned advantages of 18F-FDG PET/MRI and the diagnostic value reported here, the authors propose 18F-FDG PET/MRI as an alternative to 18F-FDG PET/CT in osteomyelitis diagnosis, if available.
“Blocked broken heart syndrome”: an unusual case of a complete atrioventricular block complicating a Takotsubo cardiomyopathy
Authors: Briosa A. , Santos J. , Gomes A. C. , Simões O. , Miranda R. , Almeida S. , Brandão L. , Pereira H.
Published: August 2022

Background

Complete heart block is considered a unique and rare complication of Takotsubo cardiomyopathy, an otherwise self-resolving disease. When this occurs, there is a double clinical dilemma: first to find out which triggered the other and second, to decide whether or not to implant a permanent pacemaker.

Case presentation

We present a case of a 77 years-old female patient, with previous medical history of arterial hypertension, diabetes mellitus, dyslipidemia and bifascicular block known since 2013. She came to the emergency department after recurrent syncopal episodes. At admission a complete heart block was diagnosed, and it was implanted a single chamber temporary pacemaker. The patient remained in disproportional acute decompensated heart failure despite pacemaker implantation. She denied chest pain although referring an episode of self-limiting chest pain 2 days before, after an argument with the family. Blood analysis showed an important rise in NTproBNP and troponin levels. Transthoracic echocardiogram showed a dilated left ventricle with akinesia of apical and mid segments, hyperkinesia of basal segments and severely depressed left ventricle ejection fraction. Coronary angiography showed no significant lesions and the diagnosis of Takotsubo cardiomyopathy was suspected. During the following days, she recovered her own intrinsic rhythm. Electrocardiogram evolved with deep T-wave inversion and prolonged QT interval and transthoracic echocardiogram showed resolution of the previous alterations. Despite complete reversion of rhythm alteration, it was decided to implant a permanent pacemaker.

Conclusions

We describe a rare, life-threatening and often underdiagnosed complication of the stress cardiomyopathy. Furthermore, we performed a literature revision of this rare complication and discussed the therapeutic challenge encountered in such patients.
Two decades of implantable cardioverter defibrillator implantation and follow-up at a South African referral centre: trends, indications and long-term outcomes in a resource-limited setting
Authors: Mkoko Philasande , Solomon Kayla , Chin Ashley
Published: August 2022

Background

More than two-thirds of cardiovascular deaths occur in low- and middle-income countries. Sudden cardiac deaths (SCD) from ventricular arrhythmias are an important cause of cardiovascular deaths. Implantable cardioverter defibrillators (ICD) are an important therapeutic strategy for detecting and terminating ventricular arrhythmias in patients at risk of SCD. The profile of patients treated with ICDs in South Africa is unknown. Further, with changing lines of evidence, the implantation trends are undetermined. The objectives of this study were to determine the profile of ICD recipients and implantation trends in a South African quaternary hospital.

Methods

This was a retrospective review of all patients implanted with ICDs at Groote Schuur Hospital from 01 January 1998 to 31 December 2020. A standardised data collection form was used to collect baseline demographic data, information on clinical presentation and ICD follow-up data for the history of ICD shock therapies.

Results

A total of 253 ICDs were implanted; 75% for secondary prevention and 25% for primary prevention. 67.2% of the implanted ICDs were single-chamber ICDs, dual-chamber ICDs were implanted in 12.3% and Cardiac resynchronisation with a defibrillator (CRT-D) in 20.6%. There was an upward trajectory of ICD implantations during the study period. Increasing numbers of dual-chamber devices and CRT-D were implanted over time. ICD recipients had a mean (standard deviation) age of 50 (14) years and were predominantly male (69%). Primary prevention ICD recipients were younger than secondary prevention recipients, with a mean (SD) age of 46 (14) years versus 51 (14) years, p = 0.019. The secondary prevention group presented with ventricular tachycardia in 81%, ventricular fibrillation in 13% and cardiopulmonary resuscitation without documented heart rhythm in 5.3% (10/190). After a median (interquartile range) follow-up of 44 (15; 93) months, there was an overall mortality rate of 16.2%, with no mortality difference between the primary and secondary prevention patient groups.

Conclusion

There is an increase in the annual number of ICDs implanted at a South African referral centre. ICDs are predominantly implanted for secondary prevention. However, over time the number of devices implanted for primary prevention is steadily increased. During follow-up, there was no mortality difference between the primary prevention and the secondary prevention groups.
Wilms tumor 1 gene expression in acute myeloid leukemia: prognostic significance and usefulness in minimal residual disease monitoring—a case–control study
Authors: Donia Hanaa Mahmoud , Elsweify Nada Mahmoud , Farahat Nahla Mohamed , Nadwan Eman Attia
Published: August 2022

Background

Minimal residual disease (MRD), which is characterized as leukemic cells at a level below morphologic detection, has been connected to the risk of relapse in acute myeloid leukemia. In 80–90% of acute myeloid leukemia (AML) patients, the Wilms tumor (WT1) gene is overexpressed at the mRNA level. In our prospective study, a total of 55 patients were enrolled in the study. Group I involved 40 AML patients and group II involved 15 patients healthy controls.WT1gene expression was quantified using quantitative real-time PCR on bone marrow samples from AML patients at initial diagnosis and at day 28 after induction chemotherapy, and compared to 15 healthy controls in group II. Follow up of patients for prognosis evaluation was assessed. IBM SPSS software was used to capture and analyses the data.

Results

At diagnosis, the meanWT1transcript value in AML patients was substantially higher than the expression observed in control patient’s Bone marrow. There was no statistically relevant relationship between the onset of relapse andWT1expression. Patients withWT1overexpression at diagnosis had a shorter overall survival than patients with negativeWT1expression.

Conclusions

Wilms tumor 1 gene expression was found to be significantly higher in AML patients than control cases, overall, our results confirmed the prognostic significance ofWT1overexpression in AML patients. Our findings support the application of MRD in AML patients based on WT1 overexpression.
Seismic inversion for density using a transdimensional approach
Authors: Biswas Reetam , Kumar Dhananjay , Sen Mrinal K.
Published: August 2022

Commercial and low-saturation gas (also called paleoresidual gas [PRG]) show similar strong amplitude signatures on P-wave seismic data. This poses an exploration risk in gas reservoir regions. However, density correlates inversely with gas saturation and can differentiate a zone of full gas saturation from PRG. This can improve the chances of success in terms of predrill prediction of gas saturation. Amplitude-variation-with-offset (AVO) inversion using prestack seismic data is the most commonly used technique that can estimate elastic parameters such as P-wave velocity, S-wave velocity, and density. Out of these three parameters, extracting density from seismic data is the most challenging due to its weak sensitivity to seismic reflection amplitude and the lack of good quality seismic data at far offsets. However, with recent improvements in seismic data acquisition and processing technology, which produces reliable AVO gathers, density estimates have improved. This requires that strong density sensitivity to AVO exists. Note that multiple density models may fit the data equally well. Therefore, quantifying uncertainty is crucial for interpretation and risk assessment. We apply a recently developed stochastic approach based on the Bayesian framework to solve the problem in a transdimensional framework, where the number of model parameters is treated as a variable and estimated along with the elastic properties. We use the reversible jump Hamiltonian Monte Carlo (RJHMC) algorithm to sample models from a variable dimensional model space and obtain a globally optimum model and uncertainty estimates. We use a synthetic and good quality real data set from Columbus Basin in Trinidad, which has a proven gas reservoir, to demonstrate the algorithm. The RJHMC results calibrate well with the logs and show the areal extents of the density anomalies within the 3D volume.
Reviews
Authors: Green William
Published: August 2022

Natural Gas, by Michael Bradshaw and Tim Boersma, ISBN 978-0-745-65997-8, 2020, Polity Press, 200 p. Wave Theory of Information, by Massimo Franceschetti, ISBN 978-1-107-02231-7, 2017, Cambridge University Press, 472 p.
Effectiveness of Cricoid and Paratracheal Pressures in Occluding the Upper Esophagus Through Induction of Anesthesia and Videolaryngoscopy: A Randomized, Crossover Study
Authors: Kim Hyerim , Chang Jee-Eun , Won Dongwook , Lee Jung-Man , Kim Tae Kyong , Kim Min Jong , Min Seong-Won , Hwang Jin-Young
Published: August 2022

BACKGROUND:

Maneuvers for preventing passive regurgitation of gastric contents are applied to effectively occlude the esophagus throughout rapid sequence induction and intubation. The aim of this randomized, crossover study was to investigate the effectiveness of cricoid and paratracheal pressures in occluding the esophagus through induction of anesthesia and videolaryngoscopy.

METHODS:

After the induction of anesthesia in 40 adult patients, the location of the esophageal entrance relative to the glottis and location of the upper esophagus relative to the trachea at the low paratracheal region were assessed using an ultrasonography, and the outer diameter of the esophagus was measured on ultrasound before and during application of cricoid and paratracheal pressures of 30 N. Then, videolaryngoscopy was performed with the application of each pressure. During videolaryngoscopy, location of the esophageal entrance relative to the glottis under cricoid pressure was examined on the screen of videolaryngoscope, and the upper esophagus under paratracheal pressure was evaluated using ultrasound. The occlusion rate of the esophagus, and the best laryngeal view using the percentage of glottic opening scoring system were also assessed during videolaryngsocopy. Esophageal occlusion under each pressure was determined by inserting an esophageal stethoscope into the esophagus. If the esophageal stethoscope could not be advanced into the esophagus under the application of each pressure, the esophagus was regarded to be occluded.

RESULTS:

During videolaryngoscopy, esophagus was occluded in 40 of 40 (100%) patients with cricoid pressure and 23 of 40 (58%) patients with paratracheal pressure (difference, 42%; 95% confidence interval, 26–58; P < .001). Both cricoid and paratracheal pressures significantly decreased the diameter of the esophagus compared to no intervention in the anesthetized paralyzed state (P < .001, respectively). Ultrasound revealed that the compressed esophagus by paratracheal pressure in the anesthetized paralyzed state was partially released during videolaryngoscopy in 17 of 40 patients, in whom esophageal occlusion was unsuccessful. The best laryngeal view was not significantly different among the no intervention, cricoid pressure, and paratracheal pressure (77 [29] % vs 79 [30] % vs 76 [31] %, respectively; P = .064).

CONCLUSIONS:

The occlusion of the upper esophagus defined by inability to pass an esophageal stethoscope was more effective with cricoid pressure than with paratracheal pressure during videolaryngoscopy, although both cricoid and paratracheal pressures reduced the diameter of the esophagus on ultrasound in an anesthetized paralyzed state.
Outcomes and Disposition of Patients After Case Cancellation on Day of Surgery for Reasons Attributed to Medical or Anesthetic Care: A Retrospective Cohort Analysis
Authors: Tewfik George L. , Rodriguez-Aponte Carlos , Zhang Kathy , Ezzat Bishoy , Suri Pooja , Chaudhry Faraz
Published: August 2022

BACKGROUND:

Many day-of-surgery cancellations are avoidable, and different strategies are used to prevent these costly adverse events. Despite these past analyses and evaluations of positive interventions, studies have not examined the final disposition of patients whose cases were canceled in this late manner. This study sought to determine whether surgical procedures canceled for medical or anesthetic reasons were ultimately rescheduled, and the time elapsed between cancellation and completion. In addition, the resolution of the underlying issue leading to cancellation was examined.

METHODS:

Two years of surgical case data were reviewed in the electronic health record to isolate all procedures canceled on the intended operative date. These cases were then filtered by the documented reason for cancellation into 2 categories: 1 for cases related to medical or anesthetic care and 1 for unrelated cases. Medical- or anesthetic-related cases were further categorized to better elucidate the underlying reason for cancellation. Cases were then traced to determine if and when the procedure was ultimately completed. If a case was rescheduled, the record was reviewed to determine whether the underlying reason for cancellation was resolved.

RESULTS:

A total of 4472 cases were canceled in the study period with only 20% associated with medical or anesthetic causes. Of these, 72% were rescheduled and 83% of all rescheduled cases resolved the underlying issue before the rescheduled procedure. Nearly half of all cases (47.8%) canceled on the day of surgery for reasons linked to medical and/or anesthetic care were due to acute conditions.

CONCLUSIONS:

Nearly a fifth of cases that are canceled on the date of surgery are never rescheduled and, if they are rescheduled, the delay can be substantial. Although the majority of patients whose procedure are canceled for reasons related to medical or anesthetic care have resolved the underlying issue that led to initial postponement, a significant portion of patients have no change in their status before the ultimate completion of their surgical procedure.