bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal signal and the phylodynamic threshold of SARS-CoV-2
Authors: Duchene Sebastian , Featherstone Leo , Haritopoulou-Sinanidou Melina , Rambaut Andrew , Lemey Philippe , Baele Guy
Published: August 2020

The ongoing SARS-CoV-2 outbreak marks the first time that large amounts of genome sequence data have been generated and made publicly available in near real time. Early analyses of these data revealed low sequence variation, a finding that is consistent with a recently emerging outbreak, but which raises the question of whether such data are sufficiently informative for phylogenetic inferences of evolutionary rates and time scales. The phylodynamic threshold is a key concept that refers to the point in time at which sufficient molecular evolutionary change has accumulated in available genome samples to obtain robust phylodynamic estimates. For example, before the phylodynamic threshold is reached, genomic variation is so low that even large amounts of genome sequences may be insufficient to estimate the virus’s evolutionary rate and the time scale of an outbreak. We collected genome sequences of SARS-CoV-2 from public databases at eight different points in time and conducted a range of tests of temporal signal to determine if and when the phylodynamic threshold was reached, and the range of inferences that could be reliably drawn from these data. Our results indicate that by 2 February 2020, estimates of evolutionary rates and time scales had become possible. Analyses of subsequent data sets, that included between 47 and 122 genomes, converged at an evolutionary rate of about 1.1 × 10−3 subs/site/year and a time of origin of around late November 2019. Our study provides guidelines to assess the phylodynamic threshold and demonstrates that establishing this threshold constitutes a fundamental step for understanding the power and limitations of early data in outbreak genome surveillance.
Calonectria pseudonaviculata Conidia Dispersal and Implications for Boxwood Blight Management
Authors: LaMondia James A. , Maurer Katja
Published: August 2020

We investigated Calonectria pseudonaviculata conidial dispersal from sporulating lesions on boxwood leaves and sporulating cultures on half-strength PDA (1/2 PDA). Botrytis cinerea-infected blossoms were used as a control. Dispersal of C. pseudonaviculata or Botrytis conidia was confirmed by capture using an Allergenco air sampler at 15 liters/min and by microscopic observation of conidia and C. pseudonaviculata growth on 15-cm-diameter 1/2 PDA Petri dishes. C. pseudonaviculata conidia were not dispersed by either dry or moist air currents directed at conidia and conidiophores from 2 mm away at air speeds of 19.8 m/s for 10 min or by a fine mist with water droplets (mean diameter 20 µm) with air speeds of 1.7 m/s. C. pseudonaviculata spores were dispersed by splash of water droplets at air speeds of 9.0 to 19.8 m/s. C. pseudonaviculata conidia released from phialides by water could not be wind dispersed after the water had evaporated. Secondary water dispersal was reduced because conidia strongly adhered to a surface after drying. Boxwood leaves dropped from heights of 15, 33, or 66 cm landed with more than 60% of leaves facing abaxial surface up. The cupped shape of most boxwood leaves may result in the abaxial surface with sporulation facing up. That orientation may also aid in retention of water films to wet and release conidia for splash dispersal. This is consistent with observations of increased disease severity in lower boxwood canopies and reinforces suggestions for best management practices including mulching and pruning lower branches to reduce the incidence and severity of disease.
Anaphylaxis and alternative medicine: an unexpected association
Authors: Diaz Sandra Gonzalez , Furci Fabiana , Olivieri Bianca , Ansotegui Ignacio J.
Published: August 2020

Purpose of review

The present review aims to evaluate the use of complementary medicine among patients with allergic disorders, highlighting the risk of adverse reactions, which are often not considered and referred by patients to specialists.

Recent findings

Complementary medicine is often used in clinical practice and preferred by patients as it is considered a natural therapy compared to traditional medicine. This choice is because of various cultural and socioeconomics aspects.

The use of complementary medicine and its adverse reactions, often as severe as anaphylaxis, is frequently reported in atopic patients, in which a cross reactivity between the natural herbs used and the pollen to which they are sensitized is possible.

Therefore, a personalized approach in atopic patients before the use of natural products is crucial to prevent any adverse reactions.
Psychometric Testing of the Turkish Version of the Technology Informatics Guiding Educational Reform–Based Assessment of Nursing Informatics Competencies Tool
Authors: Kaynar Nur Sema , Secginli Selda , West Karen
Published: August 2020

Nursing informatics competencies are vital to benefit from information technologies to improve patient outcomes. It is essential to use a reliable and valid instrument for evaluating competencies. The Technology Informatics Guiding Educational Reform–Based Assessment of Nursing Informatics Competencies Tool is a valid and reliable tool used to evaluate nursing informatics competencies in nurses who primarily speak English. This cross-sectional research aimed to evaluate the psychometric properties of a Turkish version of the instrument. Data were collected from 518 nurses working in two university hospitals in Istanbul, Turkey. The tool was translated into Turkish, validated by professional experts, back-translated, and analyzed. Thirty nurses completed the tool twice for test-retest reliability. A four-factor structure identified in exploratory factor analysis (73.64% of the total variance with all items loaded >0.40 [0.44–0.88] for each factor). Cronbach's α reliability coefficients of the subsets were .98 for basic computer skills, .97 for clinical information management, and .98 for information literacy. The total item correlations for subsets were between 0.57 and 0.84. The Turkish version of the Technology Informatics Guiding Educational Reform–Based Assessment of Nursing Informatics Competencies demonstrated sufficient reliability and validity for assessing nursing informatics competencies within Turkish culture.
Pediatric Provider Experiences with Implementation of Routine Mental Health Screening
Authors: Godoy Leandra , Gordon Sara , Druskin Lindsay , Long Melissa , Kelly Katherine Patterson , Beers Lee
Published: August 2020

Objective:

Despite the utility of universal screening, most pediatric providers rarely use mental health (MH) screening tools. As such, provider descriptions of their experiences with universal screening are limited. The goal of this study was to describe barriers to, and facilitators of, universal MH screening implementation, the perceived impact of such screening, impressions of a screening-focused quality improvement (QI) Learning Collaborative, and lessons learned.

Method:

We invited primary care clinicians participating in a large-scale QI Learning Collaborative on MH screening (n = 107) to complete postproject interviews. Interviews were transcribed and analyzed using constant comparative qualitative analysis, an inductive, iterative process.

Results:

Eleven interviews were completed and analyzed. Practice sites included academic health centers, a private practice, and a federally qualified health center. Providers described the positive impact of screening (increased identification of MH concerns) and barriers and facilitators of screening at the practice level (clinic and leadership buy-in and electronic medical record integration), the provider level (provider beliefs about the importance of screening), and the patient level (parent literacy). Challenges of linking families with care after screening included lack of adequate referrals, long wait lists, limited bilingual providers, insurance gaps, and inadequate feedback loops. Access to on-site MH clinicians and participation in the Learning Collaborative were described as beneficial.

Conclusion:

Findings elucidate how universal MH screening can be sustainably integrated into real-world primary care settings and may facilitate the uptake of American Academy of Pediatrics recommendations for best practices in screening for MH concerns.
The Urgent Need to Sit Less and Move More During the COVID-19 Pandemic
Authors: Smirmaul Bruno Paula Caraça , Arena Ross
Published: August 2020

The coronavirus disease-2019 (COVID-19) pandemic containment and mitigation strategies may lead to excessive physical inactivity and sedentary behavior, drastically impacting cardiorespiratory fitness and overall health. It is urgent to safely find ways to sit less and move more.
OUTCOMES OF NONCONFLUENT DIODE LASER PANRETINAL PHOTOCOAGULATION FOR AGGRESSIVE POSTERIOR RETINOPATHY OF PREMATURITY AFTER INTRAVITREAL BEVACIZUMAB
Authors: Mammo Danny A. , Rubino Shaina M. , Quiram Polly A.
Published: August 2020

Purpose:

To assess the safety and efficacy of less dense panretinal photocoagulation after intravitreal bevacizumab in aggressive posterior retinopathy of prematurity infants.

Methods:

Retrospective consecutive case series of premature infants diagnosed with aggressive posterior retinopathy of prematurity between August 2012 and November 2015 who received intravitreal bevacizumab with subsequent modified indirect diode laser panretinal photocoagulation for reactivation or incomplete vascularization. Main outcome measures included postprocedural reactivation, retinal detachments, or anterior segment ischemia.

Results:

Sixty-one eyes of 31 premature infants were identified. The average gestational age was 24 ± 2.2 weeks (range 22–27), and the average birth weight was 661.5 ± 167.1 g (range 340.0–930.5 g). The average follow-up was 3.9 ± 1.3 years (range 1.3–5.4 years). At the last follow-up, no patient had experienced postlaser reactivation, retinal detachments, anterior segment ischemia, or other laser complications.

Conclusion:

This study suggests that nonconfluent panretinal photocoagulation for aggressive posterior retinopathy of prematurity infants who have received intravitreal bevacizumab may be safe and effective. This study's strengths include a sizeable sample size, long-term follow-up of nearly 4 years, and consistency in treatment among patients by a single, experienced retinopathy of prematurity specialist.
MICROSTRUCTURAL CHANGES IN CYSTOID MACULAR EDEMA IN RETINITIS PIGMENTOSA AFTER INTRAVITREAL DEXAMETHASONE IMPLANT INJECTION
Authors: Park Un Chul , Park Jung Hyun , Yoon Chang Ki , Yu Hyeong Gon
Published: August 2020

Purpose:

To evaluate microstructural changes in cystoid macular edema in retinitis pigmentosa after intravitreal dexamethasone implant injection.

Methods:

In an extended cohort of a randomized trial of intravitreal dexamethasone implant for the management of retinitis pigmentosa-associated cystoid macular edema, microstructural changes during six months after the treatment were evaluated using spectral-domain optical coherence tomography.

Results:

Forty-two eyes were included, and all had cystoid space in the inner nuclear layer (INL) at baseline. No eyes showed subretinal fluid, and 28.6% showed hyperreflective foci. Among 38 eyes with cystoid space both in the INL and outer nuclear layer/Henle's layer, 13 (34.2%) showed complete resolution and 12 (31.6%) showed cystoid space only in the INL at 2 months after injection, whereas others showed persistent cystoid space in both layers. After complete resolution, cystoid space recurrence was earlier in the INL than in the outer nuclear layer/Henle's layer. Multivariable analysis showed that greater cystoid space area in the INL and outer nuclear layer/Henle's layer, presence of macular leakage, and longer intact external limiting membrane at baseline were associated with greater cystoid space area decrease after the treatment.

Conclusion:

Resolution and recurrence pattern of retinitis pigmentosa-associated cystoid macular edema after dexamethasone treatment showed that the INL is the primary layer of cystic change, and this suggests its pathogenesis is most likely caused by Müller cell dysfunction.
Accelerated Epi-On Versus Standard Epi-Off Corneal Collagen Cross-Linking for Progressive Keratoconus in Pediatric Patients: Five Years of Follow-Up
Authors: Henriquez Maria A. , Hernandez-Sahagun Gustavo , Camargo Jorge , Izquierdo Luis
Published: August 2020

Purpose:

The purpose of this study was to evaluate and compare the 5-year efficacy and safety of accelerated transepithelial (A-epi-on) corneal collagen cross-linking (CXL) with standard CXL (epi-off) in children with progressive keratoconus (KC).

Methods:

This prospective cohort study included 78 eyes of patients aged 18 years old or younger with progressive KC who underwent CXL at the Oftalmosalud Institute of Eyes, Lima, Peru. A-epi-on CXL was performed in 32 eyes (30′ of impregnation/5′ of irradiation at 18 mW/cm2) and epi-off CXL was performed in 46 eyes (30′of impregnation/30′ minutes of irradiation at 3 mW/cm2). Visual acuity, refraction, and the Scheimpflug imaging parameters were evaluated preoperatively and postoperatively at 1 and 5 years.

Results:

The best corrected visual acuity improved to 0.06 logarithm of the minimum angle of resolution (SD: 0.19, P = 0.03) and 0.09 logarithm of the minimum angle of resolution (SD: 0.13, P < 0.001) in the A-epi-on and epi-off groups, respectively. The mean flattening in the mean keratometry was 0.09 diopters (D) (SD: 0.68, P = 0.33) and 3.18 D (SD: 5.17, P < 0.001) in the A-epi-on CXL and Epi-off groups at the 5-year follow-up. Significant differences were found in the change at 1 and 5 years between the groups for cylinder reduction, flat and mean K, and pachymetry (all P < 0.05). The KC progression rate was 9.37% (3/32) in the A-epi-on CXL; no progression was found in the epi-off CXL group at the 5-year follow-up.

Conclusions:

Both procedures halted the progression of KC at the 5-year follow-up; however, epi-off CXL was safer and more effective when compared with A-epi-on CXL.
Sex- and cell-dependent contribution of peripheral high mobility group box 1 and TLR4 in arthritis-induced pain
Authors: Rudjito Resti , Agalave Nilesh M. , Farinotti Alex Bersellini , Lundbäck Peter , Szabo-Pardi Thomas A. , Price Theodore J. , Harris Helena Erlandsson , Burton Michael D. , Svensson Camilla I.
Published: August 2020

Spinal high mobility group box 1 protein (HMGB1) plays crucial roles in arthritis-induced pain; however, the involvement of peripheral HMGB1 has not been examined previously. In this study, we addressed the role of peripheral HMGB1 and explored if sex contributes differentially to nociception in arthritis. We found Hmgb1 expression to be elevated in the ankle joints of male and female mice subjected to collagen antibody-induced arthritis. Blocking the action of peripheral HMGB1, however, only reversed collagen antibody-induced arthritis-mediated hypersensitivity in males. Intra-articular injection of the toll-like receptor (TLR)4-activating, partially reduced disulfide, but not the fully reduced all-thiol, HMGB1 evoked mechanical hypersensitivity in both sexes. A sex-dependent temporal profile in expression of inflammatory factors in the ankle joint was observed in response to intra-articular injection of disulfide HMGB1, with male mice showing a delayed, yet longer-lasting increase in mRNA levels for several of the investigated factors. Intra-articular HMGB1 did not induce cellular infiltration in the ankle joint suggesting its action on tissue resident cells. To further explore possible sex differences in cellular involvement, we used the macrophage inhibitor, minocycline, and mice with specific TLR4 depletion in myeloid cells or nociceptors. We found that inhibition of resident macrophages attenuated HMGB1-induced pain-like behavior only in male mice. Interestingly, although the contribution of TLR4 on myeloid cells to nociception was minimal in females compared to males, TLR4 on nociceptors are important for HMGB1-induced pain in both sexes. Collectively, our work highlights sex- and cellular location-dependent roles of HMGB1 and TLR4 in peripheral pain mechanisms.
Reliability and validity of the severe impairment battery in Taiwanese patients with moderate to severe Alzheimer’s disease
Authors: Huang Mao-Hsuan , Tsai Chia-Fen , Hu Chaur-Jong , Lin Yu-Te , Yang Yuan-Han , Wang Wen-Fu , Lee Wei-Ju , Fuh Jong-Ling
Published: August 2020

Background:

The severe impairment battery (SIB) was developed to evaluate cognitive functions in moderate to severe dementia patients. We aimed to examine the reliability and validity of the Taiwanese version of the SIB (T-SIB) in patients with moderate to severe Alzheimer’s disease (AD).

Methods:

AD patients with clinical dementia rating (CDR) stage 2 (n = 79) or 3 (n = 21) and scores <15 on the Taiwanese version of mini mental state examination (T-MMSE) were recruited from six hospitals in Taiwan. Cronbach’s alpha was used to evaluate the internal consistency of the T-SIB. The CDR and functional assessment staging (FAST) scores were used to assess dementia severity.

Results:

We recruited 100 AD patients (73 women and 27 men; mean T-SIB score, 56.4 ± 24.8). The mean T-SIB total score for patients with CDR 2 and 3 were 60.3 ± 23.3 and 41.2 ± 24.9, respectively. The internal consistency of the T-SIB was 0.96. The T-SIB was moderately correlated with the T-MMSE (Pearson’s correlation coefficient = 0.76). The areas under the curve for discriminating between CDR 2 and CDR 3 were 0.81 (95% CI = 0.91–0.71) and 0.72 (95% CI = 0.84–0.61), respectively. Using a cut-off score of 59, the T-SIB had a sensitivity of 80% and specificity of 61% for discriminating between CDR 2 and CDR 3. Using a cut-off score of 45, the T-SIB had a sensitivity of 83.3% and specificity of 73.1% for discriminating between the FAST stage 7c.

Conclusion:

T-SIB is a reliable and valid instrument for measuring cognition of severely demented Taiwanese AD patients.
Adjunctive Raloxifene and Isradipine Improve Cognitive Functioning in Patients With Schizophrenia
Authors: Vahdani Bita , Armani Kian Alireza , Esmaeilzadeh Abdolreza , Zenoozian Saeedeh , Yousefi Vida , Mazloomzadeh Saeideh
Published: August 2020

Background

Cognitive impairment is the most important feature of schizophrenia leading to severe functional disability. To identify pathways that improve pathophysiological neurocognition in schizophrenia is a current challenge for the development of goal-directed clinical interventions. In the present study, we investigated the effects of raloxifene (a selective estrogen modulator) and isradipine (a voltage-gated L-type calcium channel blocker) on cognitive deficits in patients with schizophrenia.

Method

We designed a double-blind, randomized, parallel, placebo-controlled trial. We randomized 60 patients with schizophrenia into 3 groups including isradipine 5 mg, raloxifine 60 mg, and placebo for 6 consequent weeks, all in the same shape capsules, 2 times a day, along with treatment as usual. The initial and final results of blood tests, electrocardiograms, and cognitive tests in specific domains, such as attention, processing speed, executive function, and verbal memory were evaluated.

Results

Our findings revealed a remarkable association between adjunctive raloxifene treatment and the alleviation of verbal memory deficits. Isradipine treatment significantly improved the verbal memory and attention dysfunction in some variables of the Stroop test, compared with the placebo. However, no effect was observed in processing speed and executive function deficits.

Conclusions

To the best of our knowledge, this study provides the first evidence that isradipine is a novel therapy option improving verbal memory and attention, both related to its activity in the hippocampus and the cerebellum. Further investigations are necessary to elucidate the mechanisms of action for both drugs in schizophrenia.
Patient Satisfaction With Human Papillomavirus Self-Sampling in a Cohort of Ethnically Diverse and Rural Women in Yunnan Province, China
Authors: Goldstein Andrew , Plafker Benjamin , Stamper Sarah , Goldstein Lena , Lipson Roberta , Bedell Sarah , Wang Jue , Brenner Gal , Goldstein Gail , O'Keefe Karen , O'Keefe Casey , O'Keefe McKenna , O'Keefe Tierney , Goldstein Amelia , Zhao Anna
Published: August 2020

Objective

Rural Yunnan Province is one of the most ethnically, culturally, and religiously diverse regions in China. The majority of its women have never been screened for cervical cancer. It is not known whether women would feel comfortable and ultimately even prefer using a human papillomavirus (HPV) self-swabbing method.

Methods

In a 6-day period, 3,600 women were taught the role of HPV in cervical cancer. They were then given self-swabbing instructions. After obtaining their specimens, 600 women were interviewed about their experience with HPV self-testing. The women were of the Yi, Hui, Dai, and Han ethnicities.

Results

The overwhelming majority of the women surveyed understood the self-sampling instructions (588/600, 98%) and felt comfortable carrying out the self-sampling procedure (584/600, 97%). Significantly more women (389/600, 64.8%) preferred self-sampling to having the provider (211/600, 35.2%) obtain the sample (χ2 = 105.61, p < .05). Women who preferred self-sampling did so primarily because they felt capable of obtaining the specimens (n = 80) or that it was a more convenient way to be tested (n = 79). The medical expertise of the provider (n = 74) and concerns over the accuracy of the test (n = 88) shifted some women's preference toward a provider-obtained sample.

Conclusions

There are 400+ million Chinese women who have never had a cervical cancer screening. Self-testing has the potential to significantly increase the number of women tested. Despite the diversity of the women screened, the majority felt comfortable self-sampling and preferred self-swabbing to provider testing.
Microtechnologies for inner ear drug delivery
Authors: Forouzandeh Farzad , Borkholder David A.
Published: August 2020

Purpose of review

Treatment of auditory dysfunction is dependent on inner ear drug delivery, with microtechnologies playing an increasingly important role in cochlear access and pharmacokinetic profile control. This review examines recent developments in the field for clinical and animal research environments.

Recent findings

Micropump technologies are being developed for dynamic control of flow rates with refillable reservoirs enabling timed delivery of multiple agents for protection or regeneration therapies. These micropumps can be combined with cochlear implants with integral catheters or used independently with cochleostomy or round window membrane (RWM) delivery modalities for therapy development in animal models. Sustained release of steroids with coated cochlear implants remains an active research area with first-time-in-human demonstration of reduced electrode impedances. Advanced coatings containing neurotrophin producing cells have enhanced spiral ganglion neuron survival in animal models, and have proven safe in a human study. Microneedles have emerged for controlled microperforation of the RWM for significant enhancement in permeability, combinable with emerging matrix formulations that optimize biological interaction and drug release kinetics.

Microsystem technologies are providing enhanced and more controlled access to the inner ear for advanced drug delivery approaches, alone and in conjunction with cochlear implants.
Insulin-like growth factor 1: role in the auditory system and therapeutic potential in otology
Authors: Gao Li , Nakagawa Takayuki
Published: August 2020

Purpose of review

Insulin-like growth factor 1 (IGF-1) is a hormone necessary for the development, growth, and maintenance of various organs, and has been used as a therapeutic agent in clinical settings. This review aimed to illustrate its role in the auditory systems and its potential use as a therapeutic in the field of otology.

Recent findings

Previous animal studies have indicated the critical role of IGF-1 in the development and maintenance of the auditory system, especially in the cochlea. A clinical study demonstrated a close relationship between the serum level of IGF-1 and the progression of age-related hearing impairment, suggesting its importance in the maintenance of hearing in humans. More recently, its effect on the regeneration of cochlear synapses has been reported using explant cultures, which could explain the course of hearing recovery in patients who underwent topical IGF-1 application for the treatment of sudden sensorineural hearing loss.

Recent advances in experimental and clinical investigations have revealed the importance of IGF-1 in the maintenance of the auditory function. On the basis of broad targets, its clinical application will expand to the field of otology in the future.
Progress towards xenogenic tolerance
Authors: Duggan Erin M. , Griesemer Adam
Published: August 2020

Purpose of review

To describe the most recent progress towards tolerance in xenotransplantation.

Recent findings

Mixed chimerism and thymic transplantation have been used to promote tolerance in xenotransplantation models. Intra-bone bone marrow transplantation is a recent advance for mixed chimerism, which promotes longer lasting chimerism and early graft function of subsequent organ transplantation. The hybrid thymus, an advancement to the vascularized thymokidney and vascularized thymic lobe, is being developed to allow for both donor and recipient T-cell selection in the chimeric thymus, encouraging tolerance to self and donor while maintaining appropriate immune function. Regulatory T cells show promise to promote tolerance by suppressing effector T cells and by supporting mixed chimerism. Monoclonal antibodies such as anti-CD2 may promote tolerance through suppression of CD2+ effector and memory T cells whereas Tregs, which express lower numbers of CD2, are relatively spared and might be used to promote tolerance.

These findings contribute major advances to tolerance in xenotransplantation. A combination of many of these mechanisms will likely be needed to have long-term tolerance maintained without the use of immunosuppression.
Impact of the Quality of Postpartum Sleep and its Health Determinants on Human Milk Volume
Authors: Carrega Joanna , Lee Shih-Yu , Clark Patricia , Cranford Joan , Lloyd Steven
Published: August 2020

Purpose:

To examine the impact of postpartum sleep disturbance on 24-hour milk volume and breastfeeding during the early postpartum period. Factors associated with postpartum sleep disturbance also were examined.

Study Design and Methods:

A descriptive, correlational design was used. The sample included 29 first-time mothers exclusively breastfeeding healthy, full-term newborns. A home visit was conducted to collect self-report data for sleep, stress, fatigue, depression, and anxiety at 2 weeks postpartum. Infant test weights as an estimate of 24-hour milk volume also were performed. At 1 month, a phone interview was conducted for breastfeeding status. Pearson's correlation and hierarchical regression were used for data analysis.

Results:

All mothers were breastfeeding at 2 weeks and at 1 month postpartum. Most (69.2%) reported significant sleep disturbance. Higher degree of stress was associated with more disturbed sleep (β = .59, p = .001), and sleep disturbance was associated with more symptoms of fatigue (r = .70, p = - .001), depression (r = .58, p = .001), and anxiety (r = .52, p = - .01). Poor sleep quality was the only significant predictor for lower milk volume (β = - .70, p = .02).

Clinical Implications:

Clinically significant sleep disturbance is common during the early postpartum period and may have a negative impact on human milk production and other important maternal health indicators. A better understanding of postpartum sleep disturbance and its impact on breastfeeding and maternal health is needed.
Intraoperative Mother and Baby Skin-to-Skin Contact during Cesarean Birth
Authors: Frederick Anitra , Fry Tena , Clowtis Licia
Published: August 2020

Purpose:

Experts recommend immediate skin-to-skin (SSC) contact for all alert and stable mothers and newborns after birth. Clinicians are working to incorporate immediate (intraoperative) SSC during cesarean birth. The purpose of this systematic review is to describe the state of the science of intraoperative SSC for mother and baby and increase clinician's awareness of its potential benefits and risks.

Study Design and Methods:

A systematic approach was followed throughout the review process. CINAHL, PubMed, and Embase databases were searched using strategies constructed by an academic health sciences librarian. Articles included in the review focused on SSC initiated during cesarean birth.

Results:

Thirteen studies were selected for the mixed-method systematic review. Six prospective studies, four retrospective chart reviews, and three qualitative studies met the inclusion criteria. Maternal stress levels were reduced, whereas comfort, oxytocin, and antioxidant levels increased with intraoperative SSC. Physiologic measures of successful newborn transition showed little difference between newborns held in intraoperative SSC and those who were not. Synthesis of qualitative experiences revealed mothers' intense desire to hold and know their baby immediately after birth.

Clinical Implications:

Intraoperative SSC is a safe, beneficial, and highly desirable practice for mothers and newborns experiencing cesarean birth. Although barriers exist to its implementation, nurses can facilitate and support this practice. Evidence-based, family-centered intraoperative SSC should be offered to all stable mothers and babies according to recommendations and in a manner that promotes safe outcomes, including following current nurse staffing guidelines.
The Efficacy of a Brief Educational Training Session in Point-of-Care Pediatric Hip Ultrasound
Authors: Pade Kathryn H. , Niknam Kian R. , Lobo Viveta E. , Anderson Kenton L.
Published: August 2020

Background

Pediatric limp is a common presenting complaint to emergency departments. Despite this, diagnosis can be difficult in young patients with no history of trauma. Ultrasound can be used to identify a hip effusion, which may be the etiology of limp in pediatric patients. Brief educational training sessions have successfully been used to introduce novice ultrasound users to point-of-care (POC) ultrasound; however, the education of POC hip ultrasound is underexplored, and the efficacy of educational training sessions in this domain remains unknown.

Objective

To evaluate the feasibility and efficacy of using a brief educational training session to teach novice ultrasound users to identify hip anatomy and effusions.

Methods

Medical and physician assistant students were enrolled during an ultrasound education conference. A pretest evaluated prior knowledge, experience, and confidence level regarding POC hip ultrasound. Students attended a brief didactic session and then completed an objective structured assessment of technical skill as well as a posttest.

Results

Twenty-eight students naive to hip ultrasound participated in this study. Levels of training included medical and physician assistant students. Mean test scores increased from the pretest (4.8 of 9, SD = 1.6) to the posttest (7.9 of 9, SD = 0.72) (P < 0.001). Average objective structured assessment of technical skill was 4.6 of 5 (SD, 0.75; 95% confidence interval, 4.3–4.9). After the sessions, confidence levels in identifying landmarks, joint space, and a joint effusion significantly increased (P < 0.001).

Conclusions

Pediatric hip ultrasound knowledge, performance, skills, and confidence improved as demonstrated by novice ultrasound users after a brief educational training session. Our study shows that a brief, targeted educational intervention was a feasible and effective method of introducing pediatric POC hip ultrasound to novices.
Outcomes of Short Versus Long Leg Casts for Childhood Accidental Spiral Tibial CAST Fractures
Authors: MacNeille Rhett , Gockley Allison , Hennrikus William
Published: August 2020

Objective

The objective of the current study was to analyze the outcomes of short versus long leg casts in the treatment of childhood accidental spiral tibial (CAST) fractures.

Methods

A retrospective review was performed of medical records at a single tertiary children's hospital from 2009 to 2014 of children with distal, spiral tibial fractures (CAST fractures). The following points were documented for each patient: sex, laterality of fracture, age at presentation, type of cast, length of time in cast, use of a controlled ankle motion boot after cast removal, suspicion for abuse, and complications including skin irritation, skin breakdown, infection, compartment syndrome, fracture displacement, and gait disturbances.

Results

A total of 21 patients with an age range of 12 to 62 months were found to have CAST fractures as confirmed by x-ray. Fourteen were treated with short leg casts, whereas 7 were treated with long leg casts. Both groups healed with equal outcomes, and there was no documented suspicion for abuse in any case.

Conclusions

A short leg walking cast seems to be an effective and safe method of treatment for CAST fractures and could be considered as potentially preferable to long leg casts because of the added benefits of increased mobility and function. Follow-up to this preliminary study is warranted to better elucidate any differences in benefit between these treatment options, and clinical judgment should be used when considering immobilization options.
Motor Relearning After Hypoglossal-Facial Nerve Anastomosis
Authors: Negley Kelly J. , Rasool Alysha , Byrne Patrick J.
Published: August 2020

Facial paralysis is a clinical condition associated with significant functional and psychosocial morbidity (Facial Plast Surg FPS. 2011;27(4):346–57). The management paradigm for this condition continues to evolve with the use of both surgical and nonsurgical strategies (Facial Plast Surg FPS. 2011;27(4):346–57). Hypoglossal-facial nerve anastomosis is a surgical technique whereby the hypoglossal nerve acts as a donor motor nerve to restore facial muscle reinnervation via movements of the tongue (Plast Reconstr Surg. 1979;63(1):63–72). This case describes a 33-yr-old woman with unilateral facial paralysis who underwent hypoglossal-facial nerve anastomosis and 14 wks of postoperative rehabilitation. This report highlights the details of her rehabilitation regimen including the specific techniques used to enhance motor relearning of facial expression through movement of the tongue.
Adverse childhood experiences and chronic pain among children and adolescents in the United States
Authors: Groenewald Cornelius B. , Murray Caitlin B. , Palermo Tonya M.
Published: August 2020

Objective:

To evaluate the association between adverse childhood experiences (ACEs) and chronic pain during childhood and adolescence.

Methods:

Cross-sectional analysis of the 2016-2017 National Survey of Children's Health, including 48,567 child participants of 6 to 17 years of age. Parents of children reported on 9 ACEs. Chronic pain was defined as parents reporting that their children had “frequent or chronic difficulty with repeated or chronic physical pain, including headache or other back or body pain during the past 12 months.” Multivariate logistic regression analysis adjusted for sociodemographic and health-related factors.

Results:

In this nationally representative sample, 49.8% of children were exposed to one or more ACEs during their lifetime. Children with exposure to 1 or more ACEs had higher rates of chronic pain (8.7%) as compared to those with no reported ACEs (4.8%). In multivariate analysis, children with ACEs had increased odds for chronic pain (adjusted odds ratio [aOR]: 1.6, 95% confidence interval [CI]: 1.3–2.2, for 0 vs 1 ACE and aOR: 2.7, 95% CI: 2.1–3.4 for 0 vs 4+ ACEs). The strongest associations of individually measured ACEs with chronic pain included financial instability (aOR: 1.9, 95% CI: 1.6–2.2), living with a mentally ill adult (aOR: 1.8, 95% CI: 1.5–2.2), and having experienced discrimination based on race (aOR: 1.7, 95% CI: 1.3–2.2).

Conclusions:

Children and adolescents with ACEs had increased risk for chronic pain, and this association increased in a dose-dependent fashion.
Predictors of Resumption of Menses in Anorexia Nervosa: A 4-Year Longitudinal Study
Authors: Castellini Giovanni , Rossi Eleonora , Cassioli Emanuele , Giardinelli Lisa , Fanelli Alessandra , Fisher Alessandra D. , Vignozzi Linda , Ricca Valdo
Published: August 2020

Objective

Amenorrhea is a disabling medical consequence of anorexia nervosa (AN); therefore, resumption of menses (ROM) represents an important goal in the treatment for these patients. The aim of the present study was to evaluate possible clinical, psychopathological, and biological predictors of ROM, including age, body mass index (BMI), AN subtype, childhood abuse, duration of illness, general and eating disorder (ED)–specific psychopathology, and sex hormones.

Methods

Fifty amenorrheic patients with AN were enrolled. Baseline clinical data and information on childhood abuse were collected. Questionnaires to evaluate general and ED-specific psychopathology were administered, and blood samples were drawn. All patients received treatment as usual and underwent regular follow-up visits for 4 years or until ROM. Time to ROM, BMI at last evaluation, and data regarding diagnostic crossover into bulimia nervosa were collected.

Results

Twenty-nine (58.0%) patients recovered menses. Diagnostic crossover was associated with a higher probability of ROM (odds ratio = 10.3,p= .030). Time-to-event analysis showed that a shorter duration of illness (χ2(1) = 11.00,p= .001), binge-eating/purging subtype (χ2(1) = 7.01,p= .008), and history of childhood abuse (χ2(1) = 4.03,p= .045) were associated with an earlier ROM. Furthermore, higher baseline ED-specific psychopathology was associated with a reduced likelihood for ROM, whereas higher general psychopathology and follicle-stimulating hormone levels predicted an earlier ROM (all,p< .050). Age, BMI, luteinizing hormone, and estrogen hematic levels had no predictive value with respect to ROM.

Conclusions

The present study provides data in support of an integrated model, emphasizing the importance of duration of illness, childhood abuse, and psychopathological characteristics of amenorrheic patients with AN in predicting ROM.
Expected Estimation Errors in Studies of the Cortisol Awakening Response: A Simulation
Authors: Segerstrom Suzanne C. , Boggero Ian A.
Published: August 2020

Objective

Misestimation as a consequence of small sample sizes, small effect sizes, and noisy measurement may be particularly problematic in biomarker studies, the cost of which can adversely affect design decisions. This simulation study used real study designs reported in a meta-analysis of psychosocial correlates of the cortisol awakening response to investigate the probability that the results of these designs would yield misestimates in a cross-sectional study.

Methods

For each of the 212 designs, 100,000 simulated data sets were produced and the percentages of effects that were in the wrong direction and/or that differed by more than 0.10 from the true effect (b = 0.10) were calculated.

Results

As expected, small samples (n < 100) and noisy measurement contributed to higher probability of errors. The average probability of an effect being in the wrong direction was around 20%, with some designs reaching 40%; misestimation probabilities were around 40%, with some designs reaching 80%. This was true for all studies as well as those reporting statistically significant effects.

Conclusion

Results call for better study designs, and this article provides suggestions for how to achieve more accurate estimates.
Acquired decrease of the C3b /C4b receptor (CR1, CD35) and C4d deposits on Erythrocytes from ICU COVID-19 Patients
Authors: Kisserli Aymric , Schneider Nathalie , Audonnet Sandra , Tabary Thierry , Goury Antoine , Cousson Joel , Mahmoudi Rachid , Bani-Sadr Firouze , Kanagaratnam Lukshe , Jolly Damien , Cohen Jacques HM
Published: August 2020

We determined CR1, CD35 the C3b, C4b receptor density, C3b/C3bi and C4d deposits densities on Erythrocytes (E) in 51 COVID-19 patients undergoing O2 therapy or assisted ventilation in ICU units in Rheims France. A clear acquired decrease of CR1 density of E from COVID-19 patients was observed, particularly among fatal cases, and paralleling several severity parameters.

Deposits of C4d largely above values observed in normal individuals, mostly without C3 deposits, have been observed in more than 80% of the patients, reminiscent of the sub endothelial pericapillary deposits in organ transplant rejection, already observed on E in parallel, as well as also observed on E in clinical SLE flares.

Conversely, significant C3 deposits were only observed among ¼ of the patients. The decrease of CR1/E density, and the detection of virus spike, C3 or C4 fragment on E, among COVID-19 patients, are likely to be two aspects of the same phenomenon of immune complexes or complement fragment coated cell debris handling and clearance.

Measurement of C4d deposit on E might represent a way for assessing inflammation and complement activation occurring in organ capillaries. CR1/E decrease might represent a cumulative index of complement activation in COVID-19 patients.

Taken together, these original findings stress on the participation of the complement regulatory proteins in that disease and evidence that E matter in immune mechanisms in COVID-19 patients.

The use of CR1, or CR1-like molecules with the aim of down regulating complement activation and inflammation for therapy should also be considered.

HIGHLIGHTS

Acquired decrease of CR1 on E in COVID-19 patients, particularly among fatal cases, and paralleling several severity parameters.

Large C4d deposits on E in most patients, reminiscent of the pericapillary deposits in organ transplant rejection, already observed on E in parallel, as well as on E from SLE flares.

C4d deposit on E, a possible way for assessing inflammation and complement activation in organ capillaries.

Decreased CR1/E, a possible cumulative index of complement activation in COVID-19 patients.

The use of CR1 or CR1-like molecules for down regulating complement activation for therapy should also be considered.
A novel deep learning-based point-of-care diagnostic method for detecting Plasmodium falciparum with fluorescence digital microscopy
Authors: Holmström O. , Stenman S. , Suutala A. , Moilanen H. , Kücükel H. , Ngasala B. , Mårtensson A. , Mhamilawa L. , Aydin-Schmidt B. , Lundin M. , Diwan V. , Linder N. , Lundin J.
Published: August 2020

Background

Malaria remains a major global health problem with a need for improved field-usable diagnostic tests. We have developed a portable, low-cost digital microscope scanner, capable of both brightfield and fluorescence imaging. Here, we used the instrument to digitize blood smears, and applied deep learning (DL) algorithms to detect Plasmodium falciparum parasites.

Methods

Thin blood smears (n = 125) were collected from patients with microscopy-confirmed P. falciparum infections in rural Tanzania, prior to and after initiation of artemisinin-based combination therapy. The samples were stained using the 4’,6-diamidino-2-phenylindole fluorogen and digitized using the prototype microscope scanner. Two DL algorithms were trained to detect malaria parasites in the samples, and results compared to the visual assessment of both the digitized samples, and the Giemsa-stained thick smears.

Results

Detection of P. falciparum parasites in the digitized thin blood smears was possible both by visual assessment and by DL-based analysis with a strong correlation in results (r = 0.99, p < 0.01). A moderately strong correlation was observed between the DL-based thin smear analysis and the visual thick smear-analysis (r = 0.74, p < 0.01). Low levels of parasites were detected by DL-based analysis on day three following treatment initiation, but a small number of fluorescent signals were detected also in microscopy-negative samples.

Conclusion

Quantification of P. falciparum parasites in DAPI-stained thin smears is feasible using DL-supported, point-of-care digital microscopy, with a high correlation to visual assessment of samples. Fluorescent signals from artefacts in samples with low infection levels represented the main challenge for the digital analysis, thus highlighting the importance of minimizing sample contaminations. The proposed method could support malaria diagnostics and monitoring of treatment response through automated quantification of parasitaemia and is likely to be applicable also for diagnostics of other Plasmodium species and other infectious diseases.
The Status and Risk Factors of COVID-19 Related Suicides in Bangladesh
Authors: Boshra Sadia Noosrat , Islam Mohammad Mohiminul
Published: August 2020

In addition to physical health, the COVID-19 pandemic has affected the global economy and mental health significantly. The economic and social consequence has sparked many psychological mediators. In severe cases, they led to suicidal behavior in individuals like as seen in the 1918-1919 flu pandemic and in the 2003 severe acute respiratory syndrome (SARS) epidemic. Previously, a few articles have been published with regard to COVID-19 suicides in Bangladesh. However, all these articles talked about sporadic cases of suicides with no clear picture of the holistic overview of suicides in Bangladesh. Herein, we looked into all COVID-19 suicide cases from March 01, 2020, to July 31, 2020, as reported in Bangladeshi media. Our study also reports the risk factors contributing to suicidal incidents. Moreover, we also identified the impact of gender, profession, and COVID-19 diagnosis status on committing suicide. This study will shed light on the topic with a clear understanding of the causalities influencing individuals to suicide. Furthermore, it will help the policymakers to take necessary actions to prevent any further suicides.
Post-discharge health status and symptoms in patients with severe COVID-19
Authors: Weerahandi Himali , Hochman Katherine A. , Simon Emma , Blaum Caroline , Chodosh Joshua , Duan Emily , Garry Kira , Kahan Tamara , Karmen-Tuohy Savannah , Karpel Hannah C. , Mendoza Felicia , Prete Alexander M. , Quintana Lindsey , Rutishauser Jennifer , Martinez Leticia Santos , Shah Kanan , Sharma Sneha , Simon Elias , Stirniman Ana , Horwitz Leora I.
Published: August 2020

Background

Little is known about long-term recovery from severe COVID-19 disease. Here, we characterize overall health, physical health and mental health of patients one month after discharge for severe COVID-19.

Methods

This was a prospective single health system observational cohort study of patients ≥18 years hospitalized with laboratory-confirmed COVID-19 disease who required at least 6 liters of oxygen during admission, had intact baseline cognitive and functional status and were discharged alive. Participants were enrolled between 30 and 40 days after discharge. Outcomes were elicited through validated survey instruments: the PROMIS® Dyspnea Characteristics and PROMIS® Global Health-10.

Results

A total of 161 patients (40.6% of eligible) were enrolled; 152 (38.3%) completed the survey. Median age was 62 years (interquartile range [IQR], 50-67); 57 (37%) were female. Overall, 113/152 (74%) participants reported shortness of breath within the prior week (median score 3 out of 10 [IQR 0-5]), vs. 47/152 (31%) pre-COVID-19 infection (0, IQR 0-1), p<0.001. Participants also rated their physical health and mental health as worse in their post-COVID state (43.8, standard deviation 9.3; mental health 47.3, SD 9.3) compared to their pre-COVID state, (54.3, SD 9.3; 54.3, SD 7.8, respectively), both p <0.001. A total of 52/148 (35.1%) patients without pre-COVID oxygen requirements needed home oxygen after hospital discharge; 20/148 (13.5%) reported still using oxygen at time of survey.

Conclusions

Patients with severe COVID-19 disease typically experience sequelae affecting their respiratory status, physical health and mental health for at least several weeks after hospital discharge.