bluuebunny/crossref_metadata_2025 huggingface dataset:
Tectonic Descemet Stripping Endothelial Keratoplasty for the Management of Corneal Perforation: A Case Series
Authors: Tourkmani Abdo Karim , Ansari Abdus Samad , Hossain Parwez N. , Konstantopoulos Aristides , Anderson David F.
Published: July 2020

Purpose:

Corneal perforations pose a considerable challenge for ophthalmic surgeons. The aim remains restoring the anatomical integrity of eye while attempting to preserve as much visual function as possible. To our knowledge, we report the first case series of 4 successful tectonic Descemet stripping endothelial keratoplasty (DSEK) grafts completed for acute corneal perforation. In all cases, restoration of globe integrity was achieved. In cases where visual potential remained, deep anterior lamellar keratoplasty over DSEK was offered.

Methods:

Four patients presenting to Royal Gwent Hospital (Newport, Wales) with corneal perforation were included. Etiological origins included exposure keratopathy, corneal hydrops secondary to pellucid marginal degeneration with fistulization-associated aqueous leak, and herpetic keratitis. Patients were treated with initial temporary therapies, including glue patch, the use of bandage contact lenses, amniotic membrane transplant, and antibiotic cover, depending on the size and location of the perforation. Subsequent DSEK was subsequently performed under local anesthesia.

Results:

All patients had successful tectonic grafts (3 DSEKs and 1 hemi-DSEK) up to 4 months postoperatively. In the case involving a hemi-DSEK, the patient underwent 2 refloating attempts of the graft before anchoring suture placement because of repeated graft detachment. Successful graft placement and tectonic globe restoration was confirmed by anterior segment imaging.

Conclusions:

Tectonic DSEK provides corneal surgeons with a new modality of treating corneal perforations. It provides clinicians an additional tool in their armamentarium in complex cases where anterior lamellar or penetrating keratoplasty may be contraindicated or deemed high risk of complications.
A Framework for Developing, Implementing, and Evaluating a Social Determinants of Health Initiative
Authors: Parrill Rachael E.
Published: July 2020

EXECUTIVE SUMMARY

Even while making progress toward improved health outcomes, the United States is facing health disparities, increasing rates of chronic diseases, and rising healthcare costs. Health systems and organizations understand the positive impact that addressing social determinants of health (SDOH) can have on population health outcomes and cost savings, yet barriers exist to SDOH initiatives because of a lack of standardization and a clear framework. This essay proposes six steps for various types of healthcare organizations to take to achieve their unique SDOH goals. The framework provides examples from the SDOH literature for identifying and prioritizing health issues; conducting literature scans; calculating a projected return on investment; and selecting, implementing, and evaluating an SDOH initiative. By applying the evidence base for SDOH in developing and evaluating their efforts, healthcare organizations are better equipped to implement an SDOH initiative that improves health outcomes and decreases healthcare costs.
Cardiovascular Health Risk Behaviors by Occupation in the NYC Labor Force
Authors: Tannis Candace , Chernov Claudia , Perlman Sharon , McKelvey Wendy , Toprani Amita
Published: July 2020

Objective:

We explored associations between occupation and cardiovascular disease (CVD) risk behaviors including: attempted weight loss, physical activity, smoking, and restaurant meal and sugary beverage consumption.

Methods:

We used NYC Health and Nutrition Examination Survey 2013 to 2014 data, and coded free-text, occupational question responses using 2010 US Census Bureau Classification. CVD risk behaviors were compared across occupational categories, using regression to adjust for demographics.

Results:

There were health behavior differences across occupational categories. Construction/transportation/maintenance workers smoked more and were less likely than management to attempt weight loss, service workers were less likely to eat restaurant-prepared meals, sales/office workers were less likely to be physically active (all P < 0.05). Adjusting for demographics, differences in health behaviors were reduced, but remained present.

Conclusions:

Knowledge of occupational disparities may aid chronic disease prevention by identifying populations for targeted interventions.
Propofol Safety in Anticoagulated and Nonanticoagulated Patients During Extracorporeal Membrane Oxygenation
Authors: Bakdach Dana , Akkari Abdelrauof , Gazwi Khaled , Deloso Ferdinand , Tan Darwin , Ibrahim Abdulsalam , Abdussalam Ahmad , Hassan Ibrahim
Published: July 2020

Sedation management during extracorporeal membrane oxygenation(ECMO) is a common challenge encountered by treating intensivists. Data about the safety of propofol use during ECMO has been contradictory. We aimed to investigate associated risks of propofol use on oxygenator lifespan and to explore the effect of propofol use on oxygenator membranes when therapeutic anticoagulation was omitted. Adult respiratory ECMO patients who received propofol were retrospectively compared with those who did not, and outcomes were assessed by means of duration of oxygenator functionality before requiring an exchange, and number of exchanges during propofol use and/or ECMO support. Out of the 63patients included in the analysis, 46%received propofol during ECMO as part of sedation regimen. The use of propofol was not found to be associated with an increased incidence of oxygenator failure when compared with cohorts who did not receive propofol (21% propofol arm vs. 6% control, p = 0.13). When analyzed for anticoagulation omission effects, propofol did not increase the risk of oxygenator failure (p = 0.63). The only predictor that statistically predicted the risk of oxygenator failure was development of heparin-induced thrombocytopenia (HIT) during ECMO. The results of this study further support the previously reported safety of propofol utilization during respiratory ECMO even in the absence of anticoagulation.
Peroral Endoscopic Myotomy Is Safe and Highly Effective Treatment for Advanced Achalasia With Sigmoid Esophagus
Authors: Sanaka Madhusudhan R. , Garg Rajat , Chadalavada Pravallika , Thota Prashanthi N. , Gabbard Scott , Parikh Malav P. , Khoudari George , Murthy Sudish , Raja Siva
Published: July 2020

Background and Aims:

In advanced achalasia patients with sigmoid esophagus, peroral endoscopic myotomy (POEM) might be technically challenging and its outcomes are not well known in western population. Hence, our study aims were to assess and compare the safety and efficacy of POEM in achalasia patients with and without sigmoid esophagus.

Materials and Methods:

Medical records of achalasia patients who had POEM at our institution between April 2014 and December 2019 were reviewed. Patients who underwent work-up comprising timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) before POEM along with 2-month post-POEM esophageal pH study, TBE and HREM were included in the final analysis. Patients were categorized as either sigmoid or no sigmoid esophagus based on the morphology of esophagus on TBE as per Japan Esophageal Society guidelines. Treatment success was defined as reduction of post-POEM Eckardt score to ≤3.

Results:

A total of 168 patients (sigmoid esophagus=20; no sigmoid esophagus=148) were included. Esophageal width on TBE at 1 minute was significantly higher in sigmoid esophagus group compared with no sigmoid esophagus group (4.9 vs. 3.0 cm, P<0.001). Procedural outcomes and complications were similar in both groups. At 2-month follow-up, both groups had significant improvement in Eckardt scores, TBE, and HREM parameters. Treatment success was high and similar in both sigmoid and no sigmoid groups (94.4% vs. 93.2%, P=0.84). The rates of gastroesophageal reflux disease were also similar in both groups.

Conclusions:

Our study findings suggest that POEM is safe and highly effective treatment for achalasia patients with sigmoid esophagus similar to those without sigmoid esophagus in western population. POEM should be considered as the treatment of choice in advanced achalasia with sigmoid esophagus.
Chronic inflammation and other changes are significant components of clinically fibrotic strictures in Crohn’s disease: a histological study of resected strictures clinically characterized as noninflamed
Authors: Shivaji Uday N. , Evans Matthew , Critchlow Tamsin , Gui Xianyong , Smith Samuel C.L. , Pinkney Thomas , Iacucci Marietta , Cooney Rachel , Ghosh Subrata , Skordilis Kassiani
Published: July 2020

Background

Strictures related to Crohn’s disease due to fibrosis are a result of an exaggerated tissue remodelling response to inflammation, characterized by accumulation of collagen-rich extracellular matrix produced by mesenchymal cells.

Objectives

The objective of this study was to characterize histological changes seen in resected ‘fibrotic’ strictures to better understand individual components of intestinal stenosis.

Methods

We identified patients undergoing surgery for ileal Crohn’s disease secondary to symptomatic stricturing disease (Montreal B2) using the histopathology database at Queen Elizabeth Hospital in Birmingham, UK, between 2012 and 2017. Phenotypic data were recorded and resection specimens reviewed. Two independent pathologists applied the semiquantitative scoring system previously developed by us to the microscopic images. Data were analyzed using the possible maximum total score (%PMTS).

Results

Forty-eight patients (M = 25) were included. with median disease duration of 7 years (range 0.25–39 years); nearly two-thirds had ileocolonic distribution (L3). In this cohort, despite presurgery diagnosis of noninflamed fibrosis, chronic inflammation was noted to be a prominent component of all strictures. The histological scoring showed presence of several other prominent findings such as muscular hyperplasia and volume expansion.There was statistically significant positive correlation between chronic inflammation and fibrosis and muscular hyperplasia.

Conclusion

The histological features of Crohn’s disease-related strictures show multiple changes in multiple layers and not simply fibrosis. In our cohort, despite the observation prior to surgery that strictures were clinically considered fibrotic, the finding of chronic inflammation as a dominant component at a histological level in the resection is important. The findings might suggest that one of the main drivers of progressive fibrosis is the inflammatory component, which probably is never fully resolved.
Comparative efficacy and safety of high-dose dual therapy, bismuth-based quadruple therapy and non-bismuth quadruple therapies for Helicobacter pylori infection: a network meta-analysis
Authors: Xu Huimei , Wang Wancong , Ma Xueni , Feng Rukun , Su Yujing , Cheng Long , Yang Yifan , Zhang Dekui
Published: July 2020

Helicobacter pylori (H. pylori) infection is associated with the development of multiple diseases. The eradication rate of H. pylori has gradually decreased, suggesting the need to discover more effective therapies. This study aimed to compare the effectiveness of first-line treatments including high-dose dual therapy (HDDT), bismuth-based quadruple therapy (BQT), sequential therapy (ST), concomitant therapy (CT) and hybrid therapy (HT) by network meta-analysis (NMA). A comprehensive search on PubMed, Embase, Cochrane Library and Web of Science, was performed from their inception to 1 September 2019. A network analysis of randomized controlled trials (RCTs) comparing first-line therapies were carried out using Stata 14.0 and Revman 5.2. Moreover, a sensitivity analysis was conducted by omitting non-Asian studies. Finally, 41 RCTs with 14 119 patients were included. The NMA showed that, in terms of eradication rate, ST for 10 days (ST-10) was significantly lower than CT for 10 or 14 days (CT ≥ 10). Sensitivity analysis among the Asian population showed that ST-10 denoted the lowest effectiveness among the interventions. The ranking results based on probability showed that HDDT ranked first for the eradication rate. As for adverse events, HDDT was significantly less than BQT and CT regardless of duration, while BQT for 14 days represented higher adverse events than ST, HT and CT ≥ 10. HDDT ranked first among the therapies. In conclusion, HDDT for 14 days appeared to be the most optimal first-line therapy for H. pylori among the Asian population with comparable efficacy and compliance but causing fewer adverse events.
Paediatric Patients (Less Than Age of 17 Years) Account for Less Than 1.5% of All Prevalent Inflammatory Bowel Disease Cases
Authors: Burgess Christopher J. , Henderson Paul , Jones Gareth‐Rhys ,   Lothian IBD Registry Group, Lees Charlie W. , Wilson David C.
Published: July 2020

The prevalence of inflammatory bowel disease (IBD) continues to rise globally; however, the true proportion of paediatric IBD patients remains unknown. We conducted an all‐age, multiparameter, population‐based search using capture‐recapture methodology to identify all IBD cases to August 31, 2018 within Lothian, a defined health board and the largest of the 3 within South‐East Scotland. Individual case note validation was performed for all 24,601 possible IBD cases according to internationally recognised diagnostic and age criteria. Of 7035 confirmed point‐prevalent patients, 560 were classified as A1 age phenotype at diagnosis, constituting just 8% of all cases. Ninety‐nine patients were less than 17 years of age on August 31, 2018, constituting only 1.4% of all point‐prevalent cases. These results demonstrate the true contemporary proportion of prevalent paediatric IBD patients is strikingly low, reflecting compounding prevalence in adult practice and the near‐normal life expectancy of this chronic, incurable condition.
Fathers of Children With Congenital Heart Disease: Sources of Stress and Opportunities for Intervention
Authors: Hoffman Michael F. , Karpyn Allison , Christofferson Jennifer , Neely Trent , McWhorter Linda G. , Demianczyk Abigail C. , James, MSLIS Richard , Hafer Jason , Kazak Anne E. , Sood Erica
Published: July 2020

Objectives:

To examine sources of stress for fathers of children with congenital heart disease and opportunities for intervention to prevent or reduce paternal mental health problems.

Design:

Qualitative study using online crowdsourcing, an innovative research methodology to create an online community to serve as a research sample.

Setting:

Yammer, an online social networking site.

Subjects:

Geographically diverse sample of 70 parents (25 fathers and 45 mothers) of young children with congenital heart disease.

Interventions:

Participants joined a private group on Yammer and responded to 37 open-ended study questions over a 6-month period. Qualitative data were coded and analyzed using an iterative process, and themes regarding sources of stress for fathers of children with congenital heart disease and opportunities for intervention were identified.

Measurements and Main Results:

Four broad themes regarding sources of stress for fathers of children with congenital heart disease emerged from the qualitative data from both mothers and fathers: societal expectations for fatherhood and standards of masculinity, balancing work and family responsibilities, feeling overlooked as a partner in care, and lack of father supports. To begin to address these sources of stress, participants recommended that care teams acknowledge and normalize the impact of congenital heart disease on fathers, provide support for balancing work and family responsibilities, recognize and promote father knowledge and engagement, and provide formal and informal supports for fathers of children with congential heart disease.

Conclusions:

Fathers of children with congenital heart disease experience unique sources of stress in the absence of targeted interventions to meet their needs. Care teams play an important role in acknowledging the experiences of fathers and including and engaging fathers in care.
Influence of Early Extubation Location on Outcomes Following Pediatric Cardiac Surgery*
Authors: Rooney Sydney R. , Mastropietro Christopher W. , Benneyworth Brian , Graham Eric M. , Klugman Darren , Costello John , Ghanayem Nancy , Zhang Wenying , Banerjee Mousumi , Gaies Michael
Published: July 2020

Objectives:

Early extubation following pediatric cardiac surgery is common, but debate exists whether location affects outcome, with some centers performing routine early extubations in the operating room (odds ratio) and others in the cardiac ICU. We aimed to define early extubation practice variation across hospitals and assess impact of location on hospital length-of-stay and other outcomes.

Design:

Secondary analysis of the Pediatric Cardiac Critical Care Consortium registry.

Setting:

Twenty-eight Pediatric Cardiac Critical Care Consortium hospitals.

Patients:

Patients undergoing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 1–3 operations between August 2014 and February 2018.

Interventions:

None.

Measurements and Main Results:

We defined early extubation as extubation less than 6 hours after postoperative admission. Hospitals were categorized based on the proportion of their early extubation patients who underwent an odds ratio extubation. Categories included low- (< 50% of early extubation, n = 12), medium- (50%–90%, n = 8), or high- (> 90%, n = 8) frequency odds ratio early extubation centers. The primary outcome of interest was postoperative hospital length-of-stay. We analyzed 16,594 operations (9,143 early extubation, 55%). Rates of early extubation ranged from 16% to 100% across hospitals. Odds ratio early extubation rates varied from 16% to 99%. Patient characteristics were similar across hospital odds ratio early extubation categories. Early extubation rates paralleled the hospital odds ratio early extubation rates—77% patients underwent early extubation at high-frequency odds ratio extubation centers compared with 39% at low-frequency odds ratio extubation centers (p < 0.001). High- and low-frequency odds ratio early extubation hospitals had similar length-of-stay, cardiac arrest rates, and low mortality. However, high-frequency odds ratio early extubation hospitals used more noninvasive ventilation than low-frequency hospitals (15% vs. 9%; p < 0.01), but had fewer extubation failures (3.6% vs. 4.5%; p = 0.02).

Conclusions:

Considerable variability exists in early extubation practices after low- and moderate-complexity pediatric cardiac surgery. In this patient population, hospital length-of-stay did not differ significantly between centers with different early extubation strategies based on location or frequency.
The COVID-19 Pandemic and Plastic Surgery: Literature Review, Ethical Analysis, and Proposed Guidelines
Authors: Dorfman Robert , Saadat Sean , Gupta Nisha , Roostaeian Jason , Da Lio Andrew
Published: July 2020

Background:

Coronavirus disease 2019 (COVID-19), known as the “coronavirus,” has spread to over 170 countries. In response, many organizations have spoken out and called for cancellation of all elective surgical procedures. This study aimed to provide clear recommendations for plastic surgeons to follow by addressing the following issues: (1) What defines elective surgery, and where does one draw the line between essential versus nonessential services? (2) How does this differ in the hospital versus private practice setting? (3) If called on to operate on a patient with COVID-19, how do plastic surgeons protect themselves and still provide excellent medical care?

Methods:

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review of the literature on plastic surgery in the setting of a pandemic was performed on March 19, 2020. An ethical analysis was conducted using the four principles of medical ethics.

Results:

The initial search yielded 118 articles. Eighteen articles were relevant and included for analysis. Only one editorial article was published in a plastic surgery journal. Accordingly, no peer-reviewed published COVID-19 guidelines exist for plastic surgery. Given that this pandemic may place health care systems under undue stress with an unpredictable trajectory, it is the responsibility of the plastic surgeon to assess and postpone cases whenever possible to properly contribute to adequate resource allocation and patient safety measures.

Conclusions:

This article fills an important gap in the literature by addressing COVID-19 and providing guidelines for upholding ethics and responsible resource allocation. By upholding these standards, plastic surgeons can do their part to help minimize the spread of this virus.
Brief Report: Adiponectin Levels Linked to Subclinical Myocardial Fibrosis in HIV
Authors: Balmaceda Julia B. , Abd-Elmoniem Khaled Z. , Liu Chia Ying , Purdy Julia B. , Ouwerkerk Ronald , Matta Jatin R. , Schenck Jessica K. , Gharib Ahmed M. , Hadigan Colleen
Published: July 2020

Background:

Persons living with HIV (PLWH) are at an increased risk of myocardial dysfunction and metabolic disturbances represent one of several potential contributing factors. Adiponectin is an adipokine that enhances insulin sensitivity with potential cardioprotective effects. We therefore investigated the relationship between myocardial fibrosis, adiponectin, and related metabolic parameters to better understand the pathophysiologic mechanisms of myocardial injury in PLWH.

Methods:

This is a prospective, cross-sectional study of PLWH without known cardiovascular disease (n = 87) and 28 healthy matched controls. Diffuse myocardial fibrosis and epicardial adipose tissue (EAT) were evaluated using cardiac magnetic resonance imaging and cardiac computed tomography.

Results:

Myocardial fibrosis was increased in PLWH and was correlated with adiponectin (r = 0.26, P = 0.004) and EAT (r = −0.42, P < 0.0001). Myocardial fibrosis was not associated with smoking pack years or CD4/CD8 ratio. In multivariate analysis that included body mass index, HIV status (P = 0.04), female sex (P < 0.0001), higher adiponectin (P = 0.046) and lower EAT (P = 0.01) were independently associated with myocardial fibrosis.

Conclusion:

We describe a novel association between serum adiponectin and subclinical intramyocardial fibrosis, as well as a significant inverse relationship between intramyocardial fibrosis and EAT. Adiponectin may represent a target for preventing myocardial injury in the future; however, our findings reflect the complexity of the metabolic interactions of adiponectin and epicardial adipose as factors associated with the myocardial architecture.
Healthcare associated diarrhea, not Clostridioides difficile
Authors: Turner Nicholas A. , Saullo Jennifer L. , Polage Christopher R.
Published: July 2020

Purpose of review

The aim of this article is to review the epidemiology, cause, diagnostic evaluation, and management of healthcare-associated diarrhea (HCAD) with particular attention to current epidemiology and recent developments in diagnostics.

Recent findings

Multiplex polymerase chain reaction gastrointestinal panels allow rapid detection of a wide array of potential enteropathogens but the role, yield, and utility of these tests have not been systematically assessed in patients with HCAD. Recent epidemiologic studies reaffirm that HCAD is predominantly a noninfectious condition most often caused by medications or underlying medical conditions, sometimes Clostridioides difficile, and occasionally viruses. Other infections are rare.

Clinical assessment remains fundamental to the evaluation of HCAD and targeted testing for C. difficile is sufficient in most patients. Multiplex gastrointestinal panels may have a role in immunocompromised patients but more study is needed. Medication-induced diarrhea is common and underappreciated and not limited to antibiotics, laxatives, and enemas.
Infections associated with the new ‘nibs and mabs’ and cellular therapies
Authors: Maus Marcela V. , Lionakis Michail S.
Published: July 2020

Purpose of review

In recent years, we have witnessed a remarkable surge in the clinical development of effective biological and cellular therapies for the treatment of neoplastic and autoimmune disorders. The present review summarizes our understanding of the pathogen-specific infection risk associated with the use of such therapies.

Recent findings

A variety of biologics, in the form of either monoclonal antibodies (Mabs) or small molecule kinase inhibitors (Nibs), are continuously introduced in the clinic for the management of autoimmune and malignant diseases. In addition, cellular therapies such as the infusion of chimeric antigen receptor (CAR) T-cells are becoming increasingly available for patients with treatment-refractory lymphoid malignancies. Some of these biological and cellular interventions exert direct or indirect adverse effects on the induction of protective immune responses against various pathogens, resulting in heightened infection susceptibility.

The introduction of biological and cellular therapies for the treatment of malignant and autoimmune diseases has been associated with increased infection susceptiblity, which varies greatly depending on the specific immunomodulatory therapy, the infecting pathogen and the recipient patient population. A high index of clinical suspicion and efforts aiming at early diagnosis, targeted vaccination or prophylaxis, and prompt initiation of antimicrobial treatment should help improve infection outcomes.
Laboratory-developed test regulation and the immunocompromised patient: uncertainty ahead
Authors: Clark Andrew E. , Levy Jaclyn , Lee Francesca M.
Published: July 2020

Purpose of the review

Laboratory-developed tests (LDTs) are essential for the clinical care of immunocompromised individuals. These patients often require specialized testing not available from commercial manufacturers and are therefore dependent on the laboratory to create, validate, and perform these assays. Recent paradigm-shifting legislation could alter the way that LDTs are operationalized and regulated.

Recent findings

On March 5th, 2020 the Verifying Accurate and Leading-Edge In-Vitro Clinical Tests Development Act (VALID) was introduced in the US Congress. This statute would overhaul existing regulatory framework by unifying the oversight of LDTs and commercial in-vitro diagnostic tests (IVDs) through the FDA. If enacted, LDTs would be subject to regulatory requirements like those found in commercial submissions for market review. Stakeholders continue to discuss the details and scope of the proposed legislation in the setting of the Severe Acute Respiratory Syndrome Coronavirus 2 pandemic, where LDTs are integral to the national COVID-19 response.

Congressional lawmakers have introduced legislation to alter the regulatory framework governing LDTs. Moving forward, a balance must be struck to ensure the availability of safe and accurate testing without delays or overregulation that could be harmful to patients. The downstream implications of how VALID and other legislation will impact laboratories, clinicians, and patients warrant close examination.
Survey of Telehealth Adoption by Neuro-ophthalmologists During the COVID-19 Pandemic: Benefits, Barriers, and Utility
Authors: Moss Heather E. , Lai Kevin E. , Ko Melissa W.
Published: July 2020

Background:

During the COVID-19 pandemic, telehealth modalities have come to prominence as a strategy for providing patient care when in-person care provision opportunities are limited. The degree of adoption by neuro-ophthalmologists has not been quantified.

Methods:

Telehealth utilization pre–COVID-19 and peri–COVID-19 was surveyed among practicing neuro-ophthalmologists in and outside the United States using an online platform. Demographics, perceived benefits, barriers, and utility for different neuro-ophthalmic conditions were collected. Data collection occurred over a 2-week period in May 2020.

Results:

Two hundred eight practicing neuro-ophthalmologists (81.3% United States, 50.2% females, age range <35 to >65, mode 35–44 years) participated in the survey. Utilization of all telehealth modalities increased from pre-COVID to peri-COVID (video visit 3.9%–68.3%, P < 0.0005, remote interpretation of testing 26.7%–32.2%, P = 0.09, online second opinion 7.9%–15.3%, P = 0.001, and interprofessional e-consult 4.4%–18.7%, P < 0.0005, McNemar). The majority selected access, continuity, and patient efficiency of care as benefits and data quality as a barrier. Telehealth was felt to be most helpful for conditions relying on history, external examination, and previously collected ancillary testing and not helpful for conditions requiring funduscopic examination.

Conclusions:

Telehealth modality usage by neuro-ophthalmologists increased during the COVID-19 pandemic. Identified benefits have relevance both during and beyond COVID-19. Further work is needed to address barriers in their current and future states to maintain these modalities as viable care delivery options.
EEG Findings in Coronavirus Disease
Authors: Pilato Madison S. , Urban Alexandra , Alkawadri Rafeed , Barot Niravkumar V. , Castellano James F. , Rajasekaran Vijayalakshmi , Bagić Anto I. , Fong-Isariyawongse Joanna S.
Published: July 2020

Purpose:

Neurologic manifestations of coronavirus disease (COVID-19) such as encephalopathy and seizures have been described. To our knowledge, detailed EEG findings in COVID-19 have not yet been reported. This report adds to the scarce body of evidence.

Methods:

We identified eight COVID-19 positive patients who underwent EEG monitoring in our hospital system.

Results:

EEGs were most commonly ordered for an altered level of consciousness, a nonspecific neurologic manifestation. We observed generalized background slowing in all patients and generalized epileptiform discharges with triphasic morphology in three patients. Focal electrographic seizures were observed in one patient with a history of focal epilepsy and in another patient with no such history. Five of eight patients had a previous diagnosis of epilepsy, suggesting that pre-existing epilepsy can be a potential risk factor for COVID-19–associated neurological manifestations. Five of eight patients who underwent EEG experienced a fatal outcome of infection.

Conclusions:

Our findings underscore previous observations that neurologic manifestations are common in severe cases. COVID-19 patients with epilepsy may have an increased risk of neurological manifestations and abnormal EEG.
Elucidating the basis for permissivity of the MT-4 T-cell line to replication of an HIV-1 mutant lacking the gp41 cytoplasmic tail
Authors: Fernandez Melissa V. , Hoffman Huxley K. , Pezeshkian Nairi , Tedbury Philip R. , van Engelenburg Schuyler B. , Freed Eric O.
Published: July 2020

HIV-1 encodes an envelope glycoprotein (Env) that contains a long cytoplasmic tail (CT) harboring trafficking motifs implicated in Env incorporation into virus particles and viral transmission. In most physiologically relevant cell types, the gp41 CT is required for HIV-1 replication, but in the MT-4 T-cell line the gp41 CT is not required for a spreading infection. To help elucidate the role of the gp41 CT in HIV-1 transmission, in this study we investigated the viral and cellular factors that contribute to the permissivity of MT-4 to gp41 CT truncation. We found that the kinetics of HIV-1 production are faster in MT-4 than in the other T-cell lines tested, but MT-4 express equivalent amounts of HIV-1 proteins on a per-cell basis relative to cells not permissive to CT truncation. MT-4 express higher levels of plasma-membrane-associated Env than non-permissive cells and Env internalization from the plasma membrane is slower compared to another T-cell line, SupT1. Paradoxically, despite the high levels of Env on the surface of MT-4, two-fold less Env is incorporated into virus particles in MT-4 compared to SupT1. Cell-to-cell transmission between co-cultured 293T and MT-4 is higher than in co-cultures of 293T with most other T-cell lines tested, indicating that MT-4 are highly susceptible to this mode of infection. These data help to clarify the long-standing question of how MT-4 cells overcome the requirement for the HIV-1 gp41 CT and support a role for gp41 CT-dependent trafficking in Env incorporation and cell-to-cell transmission in physiologically relevant cell lines.

Importance

The HIV-1 Env cytoplasmic tail (CT) is required for efficient Env incorporation into nascent particles and viral transmission in primary CD4+T cells. The MT-4 T-cell line has been reported to support multiple rounds of infection of HIV-1 encoding a gp41 CT truncation. Uncovering the underlying mechanism of MT-4 T-cell line permissivity to gp41 CT truncation would provide key insights into the role of the gp41 CT in HIV-1 transmission. This study reveals that multiple factors contribute to the unique ability of a gp41 CT truncation mutant to spread in cultures of MT-4 cells. The lack of a requirement for the gp41 CT in MT-4 is associated with the combined effects of rapid HIV-1 protein production, high levels of cell-surface Env expression, and increased susceptibility to cell-to-cell transmission compared to non-permissive cells.
Study of growth, metabolism, and morphology ofAkkermansia muciniphilawith anin vitroadvanced bionic intestinal reactor
Authors: Li Zhi-tao , Hu Guo-ao , Zhu Li , Sun Zheng-long , Yun-Jiang  , Gao Min-jie , Zhan Xiao-bei
Published: July 2020

As a kind of potential probiotic,Akkermansia muciniphilaabundance in human body is directly causally related to obesity, diabetes, inflammation and abnormal metabolism. In this study,A. muciniphiladynamic cultures using five different media were implemented in anin vitrobionic intestinal reactor for the first time instead of the traditional static culture using brain heart infusion broth (BHI) or BHI + porcine mucin (BPM). The biomass under dynamic culture using BPM reached 1.92 g/L, which improved 44.36% compared with the value under static culture using BPM. The biomass under dynamic culture using human mucin (HM) further increased to the highest level of 2.89 g/L. Under dynamic culture using porcine mucin (PM) and HM, the main metabolites were short-chain fatty acids (acetic acid and butyric acid), while using other media, a considerable amount of branched-chain fatty acids (isobutyric and isovaleric acids) were produced. Under dynamic culture Using HM, the cell diameters reached 999 nm, and the outer membrane protein concentration reached the highest level of 26.26 μg/mg. This study provided a preliminary theoretical basis for the development ofA. muciniphilaas the next generation probiotic.
Two Separate, Large Cohorts Reveal Potential Modifiers of Age-Associated Variation in Visual Reaction Time Performance
Authors: Talboom J.S. , Both M.D. De , Naymik M.A. , Schmidt A.M. , Lewis C.R. , Jepsen W.M. , Håberg A.K. , Rundek T. , Levin B.E. , Hoscheidt S. , Bolla Y. , Brinton R.D. , Schork N.J. , Hay M. , Barnes C.A. , Glisky E. , Ryan L. , Huentelman M.J.
Published: July 2020

To identify individual differences and potential factors influencing age-related cognitive decline and disease, we created MindCrowd. MindCrowd is a cross-sectional web-based assessment of simple visual (sv) reaction time (RT, index of processing speed) and paired-associate learning (PAL, index of verbal episodic memory). svRT and PAL results were combined with 22 survey questions. Analysis of MindCrowd’s svRT data revealed education and reported stroke as potential modifiers of changes in processing speed and memory from younger to older ages (ntotal=75,666,nwomen= 47,700,nmen= 27,966; ages 18-85 years old, mean (M)Age= 46.54, standard deviation(SD)Age= 18.40). To complement this work, we evaluated complex recognition reaction time (cvrRT) in the UK Biobank cohort (ntotal=158,249nwomen= 89,333nmen= 68,916; ages 40-70 years old,MAge= 55.81,SDAge= 7.72). Similarities between the UK Biobank and MindCrowd were assessed using a subset of the MindCrowd cohort. Labeled UKBb MindCrowd (ntotal=39,795,nwomen= 29,640,nmen= 10,155; ages 40-70 years old,MAge= 56.59,SDAge= 8.16), this subset was carefully selected to mirror the UK Biobank. An identical linear model (LM) was used to assess both cohorts. The LM revealed similarities between MindCrowd and the UK Biobank across most results, despite obvious cohort differences (e.g., US vs. the UK). Notable divergent findings from the UK Biobank included (1) a first-degree family history of Alzheimer’s disease (FHAD) was associated with longer RTs in only. (2) Compared to being a man with more education, being a woman was associated with longer cvrRT length differences observed from younger to older ages. Divergent results from UKBb MindCrowd include more education and reported smoking. More education was associated with shorter and smoking longer cvrRTs differences observed from younger to older ages. Collected with our prior work, MindCrowd is beginning to reveal the intricate network connecting processing speed, memory, and cognition to healthy and pathological brain aging.
Effects of Weather and Season on Human Brain Volume
Authors: Book Gregory A. , Meda Shashwath A. , Janssen Ronald , Dager Alecia D. , Poppe Andrew , Stevens Michael C. , Assaf Michal , Glahn David , Pearlson Godfrey D.
Published: July 2020

We present an exploratory cross-sectional analysis of the effect of season and weather on Freesurfer-derived brain volumes from a sample of 3,279 healthy individuals collected on two MRI scanners in Hartford, CT, USA over a 15 year period. Weather and seasonal effects were analyzed using a single linear regression model with age, sex, motion, scan sequence, time-of-day, month of the year, and the deviation from average barometric pressure, air temperature, and humidity, as covariates. FDR correction for multiple comparisons was applied to groups of non-overlapping ROIs. Significant negative relationships were found between the left- and right-cerebellum cortex and pressure (t = −2.25, p = 0.049; t = −2.771, p = 0.017). Significant positive relationships were found between left- and right-cerebellum cortex and white matter between the comparisons of January/June and January/September. Significant negative relationships were found between several subcortical ROIs for the summer months compared to January. An opposing effect was observed between the supra- and infra-tentorium, with opposite effect directions in winter and summer. Cohen’s d effect sizes from monthly comparisons were similar to those reported in recent psychiatric big-data publications, raising the possibility that seasonal changes and weather may be confounds in large cohort studies. Additionally, changes in brain volume due to natural environmental variation have not been reported before and may have implications for weather-related and seasonal ailments.
Growth Differentiation Factor-15 as a candidate biomarker in gynecologic malignancies: A meta-analysis
Authors: Roy Dipayan , Modi Anupama , Khokhar Manoj , Goyal Manu , Sharma Shailja , Purohit Purvi , Setia Puneet , Facciorusso Antonio , Sharma Praveen
Published: July 2020

Growth Differentiation Factor-15 (GDF-15), though emerged as a novel marker in gynecological cancers, is yet to be recognized in clinical diagnostics. Eligible studies were sorted from multiple online databases, namely PubMed, Cochrane, ClinicalTrials.gov, Google Scholar, Web of Science, Embase, Scopus, LILACS, OpenGrey. From six studies, histopathologically diagnosed cases without prior treatment, and with diagnostic accuracy data for GDF-15 in gynecological cancers, were included. Our meta-analysis shows that GDF-15 has pooled diagnostic odds ratio of 12.74 at 80.5% sensitivity and 74.1% specificity, and an AUC of 0.84. Hence, GDF-15 is a potential marker to differentiate gynecological malignancy from non-malignant tumors.
Rapid Systematic Review Exploring Historical and Present Day National and International Governance during Pandemics
Authors: Lowry Elizabeth , Taddese Henock , Bowman Leigh R.
Published: July 2020

Introduction

Pandemics have plagued mankind since records began, and while non-communicable disease pandemics are more common in high-income nations, infectious disease pandemics continue to affect all countries worldwide. To mitigate impact, national pandemic preparedness and response policies remain crucial. And in response to emerging pathogens of pandemic potential, public health policies must be both dynamic and adaptive. Yet, this process of policy change and adaptation remains opaque. Accordingly, this rapid systematic review will synthesise and analyse evaluative policy literature to develop a roadmap of policy changes that have occurred after each pandemic event, throughout both the 20th and 21st Century, in order to better inform future policy development.

Methods and Analysis

A rapid systematic review will be conducted to assimilate and synthesise both peer-reviewed articles and grey literature that document the then current pandemic preparedness policy, and the subsequent changes to that policy, across high-, middle- and low-income countries. The rapid review will follow the PRISMA guidelines, and the literature search will be performed across five relevant databases, as well as various government websites to scan for grey literature. Articles will be screen against pre-agreed inclusion/ exclusion criteria, and data will be extracted using a pre-defined charting table.

Ethics and Dissemination

All data rely on secondary, publicly available data sources; therefore no ethical clearance is required. Upon completion, the results of this study will be disseminated via the Imperial College London Community and published in an open access, peer-reviewed journal.

Article Summary

Strengths and Limitations of this Study

This systematic review protocol is the first to focus on a longitudinal analysis of pandemic preparedness policy development across low, middle and high income country settings

This protocol and subsequent review benefit from increased transparency, a systematised strategy (PRISMA), and a reduction in the risk of bias, through publication in an open access journal

This review will also capture grey literature - studies published outside peer-reviewed journals

This review protocol and methodology is not as robust as systematic reviews, therefore will lack some of the robustness often associated will classical systematic reviews

Registration Number

Open Science Framework: 10.17605/OSF.IO/VKA39
A laboratory transmission diffraction Laue setup to evaluate single-crystal quality
Authors: Arnaud Alexiane , Guediche Wijdène , Remacha Clément , Romero Edward , Proudhon Henry
Published: July 2020

A scanning laboratory Laue transmission setup is developed to probe extended quasi-monocrystalline samples. Orientation mapping is achieved by controlling the collimation of the incident beam and scanning the position of the specimen. An automated indexing algorithm for transmission Laue patterns is presented, together with a forward simulation model adapted for a laboratory setup. The effect of the main parameters of the system is studied with the aim of achieving exposure times of the order of one second. Applications are presented to probe the orientation of an extended part and detect disoriented regions within the bulk. Finally, the analysis of diffraction spot shapes shows that the misorientation within the illuminated volume can be measured, and a new method is proposed to evaluate its complete mean lattice rotation tensor.
Iterative X-ray spectroscopic ptychography
Authors: Chang Huibin , Rong Ziqin , Enfedaque Pablo , Marchesini Stefano
Published: July 2020

Spectroscopic ptychography is a powerful technique to determine the chemical composition of a sample with high spatial resolution. In spectro-ptychography, a sample is rastered through a focused X-ray beam with varying photon energy so that a series of phaseless diffraction data are recorded. Each chemical component in the material under investigation has a characteristic absorption and phase contrast as a function of photon energy. Using a dictionary formed by the set of contrast functions of each energy for each chemical component, it is possible to obtain the chemical composition of the material from high-resolution multi-spectral images. This paper presents SPA (spectroscopic ptychography with alternating direction method of multipliers), a novel algorithm to iteratively solve the spectroscopic blind ptychography problem. First, a nonlinear spectro-ptychography model based on Poisson maximum likelihood is designed, and then the proposed method is constructed on the basis of fast iterative splitting operators. SPA can be used to retrieve spectral contrast when considering either a known or an incomplete (partially known) dictionary of reference spectra. By coupling the redundancy across different spectral measurements, the proposed algorithm can achieve higher reconstruction quality when compared with standard state-of-the-art two-step methods. It is demonstrated how SPA can recover accurate chemical maps from Poisson-noised measurements, and its enhanced robustness when reconstructing reduced-redundancy ptychography data using large scanning step sizes is shown.
Peer-to-peer evaluations as narcissistic devices: fabricating an entrepreneurial community
Authors: Van den Bussche Penelope , Dambrin Claire
Published: July 2020

Purpose

This paper investigates online evaluation processes on peer-to-peer platforms to highlight how online peer evaluation enacts neoliberal subjects and collectives.

Design/methodology/approach

The paper uses netnography (Kozinets, 2002) to study the online community of Airbnb. It is also based on 18 interviews, mostly with Airbnb users, and quantitative data about reviews.

Findings

Results indicate that peer-to-peer platforms constitute biopolitical infrastructures. They enact and consolidate narcissistic entrepreneurs of the self through evaluation processes and consolidating a for-show community. Specifically, three features make evaluation a powerful neoliberal agent. The object of evaluation shifts from the service to the user's own worth (1). The public nature of the evaluation (2) and symetrical accountability between the evaluator and the evaluatee (3) contribute to excessively positive reviews and this keeps the market fluid.

Social implications

This paper calls for problematization of the idea of sharing in the so-called “sharing economy”. What is shared on peer-to-peer platforms is the comfort of engaging with people like ourselves.

Originality/value

This paper contributes to the literature on online accounting by extending consideration of evaluation beyond the review process. It also stresses that trust in the evaluative infrastructure is fostered by narcissistic relationships between users, who come to use the platform as a mirror. The peer-to-peer context refreshes the our knowledge on evaluation in a corporate context by highlighting phenomena of standardized spontaneity and euphemized evaluation language. This allows evaluation processes to incorporate a market logic without having to fuel competition.