bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolutionary systems biology reveals patterns of rice adaptation to drought-prone agro-ecosystems
Authors: Groen Simon C , Joly-Lopez Zoé , Platts Adrian E , Natividad Mignon , Fresquez Zoë , Mauck William M , Quintana Marinell R , Cabral Carlo Leo U , Torres Rolando O , Satija Rahul , Purugganan Michael D , Henry Amelia
Published: November 2021

Rice (Oryza sativa) was domesticated around 10,000 years ago and has developed into a staple for half of humanity. The crop evolved and is currently grown in stably wet and intermittently dry agro-ecosystems, but patterns of adaptation to differences in water availability remain poorly understood. While previous field studies have evaluated plant developmental adaptations to water deficit, adaptive variation in functional and hydraulic components, particularly in relation to gene expression, has received less attention. Here, we take an evolutionary systems biology approach to characterize adaptive drought resistance traits across roots and shoots. We find that rice harbors heritable variation in molecular, physiological, and morphological traits that is linked to higher fitness under drought. We identify modules of co-expressed genes that are associated with adaptive drought avoidance and tolerance mechanisms. These expression modules showed evidence of polygenic adaptation in rice subgroups harboring accessions that evolved in drought-prone agro-ecosystems. Fitness-linked expression patterns allowed us to identify the drought-adaptive nature of optimizing photosynthesis and interactions with arbuscular mycorrhizal fungi. Taken together, our study provides an unprecedented, integrative view of rice adaptation to water-limited field conditions.
Beam optics for the compensation of third-order structure resonances
Authors: Yasui Takaaki , Igarashi Susumu , Sato Yoichi , Koseki Tadashi
Published: November 2021

The third-order structure resonance due to sextupole magnetic fields was compensated in the Japan Proton Accelerator Research Complex main ring synchrotron using new beam optics. In the present optics, the third-order structure resonance νx − 2νy = −21 was so strong that the working point was limited. The new optics cancels the resonance by adjusting the phase advances in the arc sections. The resonance compensation was verified by aperture survey simulations and further demonstrated by three types of experiment. First, transverse coupling measurements were performed. The coupling was observed only for the optics without the compensation. This was also verified with the tracking simulation. Second, beam losses were measured using the current and new optics. The measured beam losses were noticeably reduced at the tunes around the resonance using the new optics. The beam loss reduction was also verified with the space charge tracking simulation. Third, Fourier analyses of the transverse dipole oscillations were conducted for both optics. Fourier spectra derived from the resonances were observed, and their peaks were clearly suppressed with the new optics. This was also consistent with the results of the space charge simulations.
The Effect of Mat Pilates Training Combined With Aerobic Exercise Versus Mat Pilates Training Alone on Blood Pressure in Women With Hypertension: A Randomized Controlled Trial
Authors: da Silva Almeida Isabella , de Souza Andrade Letícia , de Sousa Alessandra Martins Melo , Junior Gerson Cipriano , Turri-Silva Natália , Cunha Nascimento Dahan da , Mota Yomara Lima , Durigan João Luiz Quagliotti
Published: November 2021

Objective

The purpose of this study was to determine the effects of mat Pilates (MP) versus MP plus aerobic exercise (AE) compared with the effects of no intervention on ambulatory blood pressure (BP) in women with hypertension.

Methods

This 3-arm, parallel-group randomized clinical trial assessed 60 women who had hypertension and were 30 to 59 years old. The intervention lasted 16 weeks, and the participants were allocated into 3 groups: MP only (MP group), MP with alternating bouts of AE on a treadmill (MP + AE group), and control group (CG) with no exercises. Primary outcomes were the effects of the interventions on ambulatory BP assessed in the 24-hour, awake, and asleep periods of analysis.

Results

A 2-way analysis of variance did not reveal statistically significant differences in between-group comparisons in the 24-hour period of analysis for systolic BP (CG vs MP = 3.3 [95% CI = −7.1 to 13.8]; MP vs MP + AE = 0.7 [95% CI = −4 to 5.4]; CG vs MP + AE = 4.0 [95% CI = −5.2 to 13.4]), diastolic BP (CG vs MP = 2.2 [95% CI = −5.6 to 10.0]; MP vs MP + AE = 1.1 [95% CI = −4.3 to 6.5]; CG vs MP + AE = 3.3 [95% CI = −3.8 to 10.4]), and heart rate (CG vs MP = 3.4 [95% CI = −2 to 8.8]; MP vs MP + AE = 2.0 [95% CI = −3.4 to 7.5]; CG vs MP + AE = 5.4 [95% CI = −0.8 to 11.8]). The awake and asleep periods of analyses also showed similar behavior and did not reveal statistically significant between-group differences. Furthermore, in the responsiveness analysis based on the minimal clinically important difference, no differences were observed between groups.

Conclusion

The magnitudes of the decrease in systolic BP during the 24-hour period of analysis were −3 and −5.48 mm Hg for the MP and MP + AE groups, without differences for responsiveness between groups. The results suggest that MP supplemented with AE or not may be an alternative adjuvant treatment for women who have hypertension and are using antihypertension medication.

Impact

Sixteen weeks of MP training reduced ambulatory BP in women who had hypertension. The MP + AE group displayed a BP reduction similar to that of the MP group. A reduction in ambulatory BP can decrease the risk of cardiovascular disease.
Perceived Factors of Influence on the Implementation of a Multidimensional Project to Improve Patients’ Movement Behavior During Hospitalization: A Qualitative Study
Authors: Bor Petra , van Delft Lotte , Valkenet Karin , Veenhof Cindy
Published: November 2021

Objective

The aim of this study was to explore perceived factors of influence on the implementation of Hospital in Motion, a multidimensional and multidisciplinary implementation project to improve inpatients’ movement behavior.

Methods

This qualitative study was conducted on 4 wards. Per ward, a tailored action plan was implemented consisting of multiple tools and interventions to stimulate the integration of inpatient physical activity in usual care processes. After implementation, semi-structured interviews were performed with health care professionals and patients to explore perceived factors of influence on the implementation of the Hospital in Motion project. A content analysis was performed using the framework of the Medical Research Council for complex interventions as guidance for the identification of categories and themes.

Results

In total, 16 interviews were conducted with health care professionals and 12 with patients. The results were categorized into the 3 key components of the Medical Research Council framework: implementation, mechanisms of impact, and context. An important factor of influence within the theme “implementation” was the iterative and multidisciplinary approach. Within the theme “mechanisms of impact,” continuous attention and the interaction of multiple interventions, tailored to the target group and targeting multiple dimensions (individual, inter-professional, community and society), were perceived as important. Within the theme “context,” the intrinsic motivation and inter-professional, community and societal culture towards physical activity was perceived to be of influence.

Conclusion

Impact can be achieved and maintained by creating continuous attention to inpatient physical activity and by the interaction between different interventions and dimensions during implementation. To maintain enough focus, the amount of activities at one time should be limited.

Impact

To improve inpatients’ movement behavior, implementation project teams should be multidisciplinary and should implement a small set of tailored interventions that target multiple dimensions. Intermediate evaluation of the implementation process, strategies, and interventions is recommended.
Predictors of self-harm and suicide in LGBT youth: The role of gender, socio-economic status, bullying and school experience
Authors: Jadva V , Guasp A , Bradlow J H , Bower-Brown S , Foley S
Published: November 2021

Background

Lesbian, gay and bisexual (LGB) young people’s increased risk of self-harm, suicidal attempts and suicide compared with heterosexual youth is well established. The current study sought to examine whether these findings also apply to the trans (T) population and which factors act as additional risk or protective factors.

Methods

In a national cross-sectional survey, 3713 LGBT adolescents, aged 11–19 years, reported on their own history of self-harm, suicidal ideation and suicide attempts, as well as their experiences of school and homophobic, biphobic and transphobic bullying. Logistic regressions tested the association between risk and protective factors on self-harm, suicidal ideation and suicide attempts.

Results

A high proportion of the sample reported self-harm (65.3%), suicidal ideation (73.8%) and suicide attempts (25.7%). Demographic risk factors included identifying as female, non-binary or trans and being from a low-income background. Bullying and online bullying were associated with an increased risk for each outcome, and positive school experience was associated with a reduced risk for each outcome.

Conclusions

Consistent with minority stress theory, the study found high rates of mental health problems within LGBT youth. Interventions focused on improving young people’s experiences in schools appear useful targets to help improve mental health outcomes.
Years of life lost (YLL) associated with COVID-19 deaths in Khorasan-RAZAVI province, Iran
Authors: Yousefi Mehdi , Fazaeli Somayeh , Mohammad-pour Saeed
Published: November 2021

Background

The number of deaths among people with coronavirus disease 2019 (COVID-19) does not show the true impact of the disease on communities. Therefore, this study aimed to calculate years of life lost (YLL) due to premature death in patients with COVID-19.

Methods

We performed a descriptive cross-sectional study based on data from one of the largest provinces of Iran, in the period 13 February 2020 to 17 May 2021. We used WHO proposed guidelines for the calculation of the burden of diseases to calculate the YLL among patients with COVID-19, taking into consideration gender in different age groups.

Results

Findings showed that 13 628 deaths were due to COVID-19 with associated 249 309 YLL. The study reported higher mortality among men (1222 cases) in the age group over 85 years than in women (840) of the same age group. The minimum number of YLL for men was 1749 in the 5–9 years age group and that for women was 1551 years in the 14–10 years age group.

Conclusion

The high number of deaths due to COVID-19 has led to high YLL due to premature death. The provision of adequate health care and appropriate policies will bring about a decrease in YLL due to COVID-19.
Rituximab for interstitial pneumonia with autoimmune features at two medical centres
Authors: D’Silva Kristin M , Ventura Iazsmin Bauer , Bolster Marcy B , Castelino Flavia V , Sharma Amita , Little Brent P , Adegunsoye Ayodeji , Strek Mary E , Choi Hyon , Montesi Sydney B
Published: November 2021

Objectives

Many patients with interstitial lung disease (ILD) have autoimmune manifestations but do not meet criteria for a systemic rheumatic disease. A subset meets criteria for interstitial pneumonia with autoimmune features (IPAF) and have ILD requiring therapy. We conducted a multicentre observational study to examine the use of rituximab (RTX) in IPAF.

Methods

Patients from Mass General Brigham (MGB) and University of Chicago Medicine (UCM) were included if they were ≥18 years old, met the 2015 classification criteria for IPAF and were treated with RTX. Clinical improvement was defined as improvement in four out of four domains at 1 year after RTX initiation: documented clinician global assessment; oxygen requirement; need for respiratory-related hospitalization; and survival.

Results

At MGB, 36 IPAF patients (mean age 61 years, 44% female) were treated with RTX. At 1 year, 18 (50%) were clinically improved, 12 (33%) were stable, and 6 (17%) died from progressive respiratory failure. At UCM, 14 IPAF patients (mean age 53 years, 71% female) were treated with RTX. At 1 year, eight (57%) were improved, two (14%) were stable, three (21%) died from progressive respiratory failure, and one (7%) was lost to follow-up. Two patients experienced minor infusion reactions, and two patients discontinued therapy owing to adverse events (infections).

Conclusion

In patients with IPAF treated with RTX at two medical centres, the majority (40 [80%]) demonstrated improvement/stability at 1 year. These findings call for prospective studies, including randomized clinical trials, to determine the risks, benefits and cost effectiveness of RTX in IPAF.
The effects of disease activity, inflammation, depression and cognitive fatigue on resting state fMRI in systemic lupus erythematosus
Authors: Barraclough Michelle , McKie Shane , Parker Ben , Elliott Rebecca , Bruce Ian N
Published: November 2021

Objectives

Cognitive dysfunction (CD) and depression are interlinked comorbidities of SLE. They may be the result of altered brain mechanisms. This study aimed to examine SLE effects on functional connectivity (FC) within the default mode network (DMN) using resting state fMRI, and how depression may impact this.

Methods

Demographic, clinical and psychiatric data were collected from 19 SLE-active, 23 SLE-stable and 30 healthy controls (HC) participants. A T2*-weighted rsfMR scan was acquired and analysed using independent component analysis. Group z-scores for nodes associated with the DMN were tested. Significant nodes were entered into a factor analysis. The combined factor was used in correlations with factors of interest. Significant variables were used in a mediation analysis.

Results

14 DMN nodes were defined using independent component analysis. In five nodes, the SLE groups had significantly reduced FC compared with the HC group (P < 0.01). Factor analysis generated one factor that only depression score correlated with for both the HC group (rs = −0.510) and SLE groups combined (rs = −0.390). Mediation analysis revealed depression score accounted for 22% of the altered FC in the DMN. Disease state accounted for the remaining 78%.

Conclusions

Altered FC was evident in DMN nodes for SLE groups irrespective of disease activity. Depression accounts for some of this effect but SLE directly accounted for more. Further studies are needed to assess if these changes may be a precursor to CD in SLE. If so, rs-fMRI could be an early marker for CD in SLE and help in future CD in SLE treatment trials.
Resting-state functional brain connectivity for human mentalizing: biobehavioral mechanisms of theory of mind in multiple sclerosis
Authors: Isernia Sara , Pirastru Alice , Massaro Davide , Rovaris Marco , Marchetti Antonella , Baglio Francesca
Published: November 2021

Although neural hubs of mentalizing are acknowledged, the brain mechanisms underlying mentalizing deficit, characterizing different neurological conditions, are still a matter of debate. To investigate the neural underpinning of theory of mind (ToM) deficit in multiple sclerosis (MS), a region of interest (ROI)-based resting-state fMRI study was proposed. In total, 37 MS patients (23 females, mean age = 54.08 ± 11.37 years, median Expanded Disability Status Scale = 6.00) underwent an MRI and a neuro-psychosocial examination and were compared with 20 sex-age-education matched healthy subjects. A neuroanatomical ToM model was constructed deriving 11 bilateral ROIs and then between and within-functional connectivity (FCs) were assessed to test for group differences. Correlation with psychosocial scores was also investigated. Lower ToM performance was registered for MS both in cognitive and affective ToM, significantly associated with processing speed. A disconnection between limbic–paralimbic network and prefrontal execution loops was observed. A trend of aberrant intrinsic connectivity in MS within the anterior cingulate cortex (ACC) was also reported. Finally, a correlation between cognitive ToM and intrinsic FC was detected in ACC and dorsal striatum, belonging to the limbic–paralimbic network, likely explaining the behavioral deficit in MS. The results suggest that aberrant intrinsic and extrinsic connectivity constitutes a crucial neural mechanism underlying ToM deficit in MS.
Machine Learning Identifies Digital Phenotyping Measures Most Relevant to Negative Symptoms in Psychotic Disorders: Implications for Clinical Trials
Authors: Narkhede Sayli M , Luther Lauren , Raugh Ian M , Knippenberg Anna R , Esfahlani Farnaz Zamani , Sayama Hiroki , Cohen Alex S , Kirkpatrick Brian , Strauss Gregory P
Published: November 2021

Background

Digital phenotyping has been proposed as a novel assessment tool for clinical trials targeting negative symptoms in psychotic disorders (PDs). However, it is unclear which digital phenotyping measurements are most appropriate for this purpose.

Aims

Machine learning was used to address this gap in the literature and determine whether: (1) diagnostic status could be classified from digital phenotyping measures relevant to negative symptoms and (2) the 5 negative symptom domains (anhedonia, avolition, asociality, alogia, and blunted affect) were differentially classified by active and passive digital phenotyping variables.

Methods

Participants included 52 outpatients with a PD and 55 healthy controls (CN) who completed 6 days of active (ecological momentary assessment surveys) and passive (geolocation, accelerometry) digital phenotyping data along with clinical ratings of negative symptoms.

Results

Machine learning algorithms classifying the presence of a PD diagnosis yielded 80% accuracy for cross-validation in H2O AutoML and 79% test accuracy in the Recursive Feature Elimination with Cross Validation feature selection model. Models classifying the presence vs absence of clinically significant elevations on each of the 5 negative symptom domains ranged in test accuracy from 73% to 91%. A few active and passive features were highly predictive of all 5 negative symptom domains; however, there were also unique predictors for each domain.

Conclusions

These findings suggest that negative symptoms can be modeled from digital phenotyping data recorded in situ. Implications for selecting the most appropriate digital phenotyping variables for use as outcome measures in clinical trials targeting negative symptoms are discussed.
Education and training policies for research integrity: Insights from a focus group study
Authors: Labib Krishma , Evans Natalie , Roje Rea , Kavouras Panagiotis , Reyes Elizondo Andrea , Kaltenbrunner Wolfgang , Buljan Ivan , Ravn Tine , Widdershoven Guy , Bouter Lex , Charitidis Costas , Sørensen Mads P , Tijdink Joeri
Published: November 2021

Education is important for fostering research integrity (RI). Although RI training is increasingly provided, there is little knowledge on how research stakeholders view institutional RI education and training policies. Following a constructivist approach, we present insights about research stakeholders’ views and experiences regarding how research institutions can develop and implement RI education and training policies. We conducted thirty focus groups, engaging 147 participants in eight European countries. Using a mixed deductive-inductive thematic analysis, we identified five themes: (1) RI education should be available to all; (2) education and training approaches and goals should be tailored; (3) motivating trainees is essential; (4) both formal and informal educational formats are necessary; and (5) institutions should take into account various individual, institutional, and system-of-science factors when implementing RI education. Our findings suggest that institutions should make RI education attractive for all and tailor training to disciplinary-specific contexts.
Deconstructing impact: A framework for impact evaluation in grant applications
Authors: Ma Lai , Agnew Rachael
Published: November 2021

Impact assessments in grant applications can be biased, random, or inconsistent. One reason is that there is not a framework to assist the review process. To develop fair and transparent evaluative criteria, it is necessary to understand what kinds of outcome and impact can reasonably be achieved and expected. Using content analysis, 100 UK Research Excellence Framework (REF) 2014 impact case studies were analysed based on the definition of the output, outcome, and impact in the logic model. The analysis shows that (1) outcomes and medium-term impacts, not long-term impacts, are reported in the case studies, (2) impacts can be categorised as use and experience based, and (3) there is a need to recognise the creation and co-creation of impacts. A framework for impact evaluation in grant applications has been developed. In this framework, the criteria for evaluating impact statements focus on process-oriented impacts and that ‘impacts’ can be outputs, outcomes, and medium-term impacts.
New concepts for the pathogenesis and management of aspirin-exacerbated respiratory disease
Authors: Sehanobish Esha , Asad Mohammad , Jerschow Elina
Published: November 2021

Purpose of review

The purpose of this review is to provide a comprehensive summary of the current understanding of the pathogenesis of aspirin-exacerbated respiratory disease (AERD), and an update on its management.

Recent findings

Elevated levels of 15-oxo-eicosatetraenoic acid (15-Oxo-ETE), a newly described metabolite of arachidonic acid, have been identified in nasal polyps of AERD patients. In nasal polyps, activated basophils, and interleukin-5 -receptor-α-positive IL-5Rα+ plasma cells are associated with more severe nasal polyposis in AERD. Alveolar monocyte-derived macrophages and their persistent proinflammatory activation were suggested as putative factors contributing to AERD. Although not AERD-specific, three biological agents are now available for the management of both nasal polyposis and asthma.

A newly downstream product of 15-lipoxygenase, 15-Oxo-ETE, was recently found to be significantly elevated in nasal polyps from AERD patients. This eicosanoid metabolite likely originates from an interplay between epithelial cells and mast cells. Nasal polyp basophils, IL-5Rα+ plasma cells, and alveolar macrophages were identified as important contributors to inflammation in AERD. Besides traditional aspirin desensitization and treatment for AERD management, several biologics for treatment of asthma are available, including three that have been approved for nasal polyposis. These biologic agents show variable rates of success in controlling AERD symptoms.
Use of Bedside Entertainment and Relaxation Theater (BERT) to Reduce Fear and Anxiety Associated With Outpatient Procedures in Pediatric Orthopaedics
Authors: Richey Ann E. , Khoury Michael , Segovia Nicole A. , Hastings Katherine G. , Caruso Thomas J. , Frick Steven , Rodriguez Samuel
Published: November 2021

Background:

The aim of the present study was to evaluate the effectiveness of the Bedside Entertainment and Relaxation Theater (BERT) on fear, anxiety, and pain outcomes in pediatric orthopaedic patients associated with cast removal and/or pin removal in the outpatient clinic setting.

Methods:

A total of 66 pediatric patients between the ages of 2 and 6 undergoing clinic procedures were recruited for this study and randomized into the control group or the intervention (BERT) group. Patients in the control group received standard of care during the cast room procedure; patients in the BERT group were given headphones and watched a movie on a projector during the procedure. Fear, anxiety, and pain were measured before and after the procedure. Procedures included cast removal, pin removal, or a combination of the 2.

Results:

Patients in the BERT group reported less fear and anxiety overall after the procedure than patients in the control group (P=0.009, 0.015). Adjusting for procedure type (ie, pin removal), patients in the BERT group reported a 0.67 point decrease (95% confidence interval: 0.04, 1.30) on the fear scale after the procedure (P=0.039) and a 1.81 point decrease (95% confidence interval: 0.04, 3.59) on the anxiety scale associated with the procedure (P=0.045), compared with the control group. Patients and caregivers reported high satisfaction with BERT.

Conclusion:

This randomized, controlled trial demonstrates an evidence-based distraction tool that can be implemented across medical centers for pediatric patients undergoing office based orthopaedic procedures. BERT can be used to reduce fear and anxiety associated with these procedures, and increase patient and parent satisfaction.

Level of Evidence:

Level I.
Ambient temperature and stillbirth risks in northern Sweden, 1880–1950
Authors: Karlsson Lena , Junkka Johan , Lundevaller Erling Häggström , Schumann Barbara
Published: November 2021

Background:

Climate vulnerability of the unborn can contribute to adverse birth outcomes, in particular, but it is still not well understood. We investigated the association between ambient temperature and stillbirth risk among a historical population in northern Sweden (1880–1950).

Methods:

We used digitized parish records and daily temperature data from the study region covering coastal and inland communities some 600 km north of Stockholm, Sweden. The data included 141,880 births, and 3,217 stillbirths, corresponding to a stillbirth rate of 22.7 (1880–1950). The association between lagged temperature (0–7 days before birth) and stillbirths was estimated using a time-stratified case-crossover design. Incidence risk ratios (IRR) with 95% confidence intervals were computed, and stratified by season and sex.

Results:

We observed that the stillbirth risk increased both at low and high temperatures during the extended summer season (April to September), at −10°C, and the IRR was 2.3 (CI 1.28, 4.00) compared to the minimum mortality temperature of +15°C. No clear effect of temperature during the extended winter season (October to March) was found. Climate vulnerability was greater among the male fetus compared to the female counterparts.

Conclusion:

In this subarctic setting before and during industrialization, both heat and cold during the warmer season increased the stillbirth risk. Urbanization and socio-economic development might have contributed to an uneven decline in climate vulnerability of the unborn.
The Impact of Adjuvant Radiotherapy on Immediate Implant-based Breast Reconstruction Surgical and Satisfaction Outcomes: A Systematic Review and Meta-analysis
Authors: Zugasti Ania , Hontanilla Bernardo
Published: November 2021

Background:

Adjuvant radiotherapy could be a necessary step in the oncological treatment for breast cancer. However, radiotherapy may have negative effects on implant-based immediate breast reconstruction. The aim of this study was to determine the impact of adjuvant radiation therapy on surgical results and patient-reported satisfaction outcomes in women undergoing immediate implant-based breast reconstruction.

Methods:

A systematic search in PubMed was conducted on September 2019 and updated on April 2021. The risk of bias of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Form for Observational Studies. RevMan 5 was used for statistical analysis. We obtained relative risks to determine the complication incidence and mean differences for 2-year BREAST-Q scores.

Results:

Fourteen studies were included. A total of 11,958 implant-based immediate reconstructions were performed, 2311 received postmastectomy radiation therapy, and 9647 were considered as control group. Surgical complications, reoperation rates, and reconstruction failure were significantly higher among irradiated breasts. Significantly lower BREAST-Q scores were reported by irradiated women receiving radiotherapy.

Conclusions:

This systematic review and meta-analysis combines reconstruction complication rates with aesthetic and patient-reported satisfaction outcomes. Adjuvant radiotherapy is consistently associated with greater complication rates and poorer aesthetic and satisfaction outcomes. The magnitude of association is significantly lower when the reconstruction is based on autologous tissues.
Office-Based Rapid Diagnosis and Management of External Ophthalmomyiasis Via Smartphone-Aided Innovative Tools in an Under-Resourced Setting
Authors: Chandrakanth Prithvi , Gosalia Hirika , Verghese Shishir , Menon C.K. Sunitha , Rammohan Ram , Narendran Kalpana , Narendran Venkatapathy
Published: November 2021

Purpose:

To evaluate the use of smartphone-based innovative tools named Anterior segment photography with intraocular lens (ASPI) and smartphone based intraocular lens microscope (IOLSCOPE) to demonstrate, treat, and diagnose the patients of ophthalmomyiasis caused by Oestrus ovis.

Methods:

A retrospective interventional case series of six patients infested with O. ovis presenting in a rural health center with symptoms of burning, itching, watering, and foreign body sensation diagnosed with ophthalmomyiasis. Diagnosis and treatment were performed using an innovative imaging technique that is, an optical system formed by intraocular lens (IOL) and smartphone.

Results:

The smartphone-based ASPI clearly detected and removed the moving larvae from the ocular surface, followed by microbiological diagnosis of O.ovis larvae with the help of an IOLSCOPE.

Conclusion:

The importance of ASPI and IOLSCOPE for the management of ophthalmomyiasis in peripheral health centers devoid of slitlamp and microscopes has been emphasized here.
Severe Corneal Edema Increases ECL From Grafts After DSAEK—Corneal Edema and ECL After DSAEK
Authors: Gu Shaofeng , Peng Rongmei , Xiao Gege , Hong Jing
Published: November 2021

Objectives:

To determine the relationship between the preoperative degree of corneal edema in the recipient and the endothelial cell density in grafts after Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods:

This retrospective case series enrolled 111 eyes of 107 patients who underwent DSAEK. The preoperative and postoperative central corneal thickness (CCT) was measured by anterior-segment optical coherence tomography. Eyes were divided into three groups according to the preoperative recipient CCT: group A (mild edema): 550 μm<CCT≤750 μm, n=38; group B (moderate edema): 750 μm<CCT≤900 μm, n=51; and group C (severe edema): 900 μm<CCT≤1,500 μm, n=22. The endothelial cell loss (ECL) was calculated by in vivo confocal microscopy and compared at 1, 6, 12, and 24 months after surgery.

Results:

The recipient CCT (all groups combined) was 805.99±132.70 μm preoperatively and decreased to 656.31±105.02 μm at 1 month, decreased to 626.08±81.40 μm at 6 months, and remained stable between 12 (P=0.144) and 24 months (P=0.485) postoperatively. The mean ECL was 27.34±15.43%, 33.56±17.13%, 39.18±16.71%, and 45.87±14.27% at 1, 6, 12, and 24 months, respectively. The percentage of ECL in group C was higher than that in the other 2 groups through the 24-month follow-up. The difference in ECL between groups A and C was significant at 24 months (group A: 42.45±14.47%; group C: 52.49±10.65%; P=0.019).

Conclusions:

The degree of corneal edema in the recipient was associated with implant ECL. Compared with mild and moderate corneal edema, the severe corneal edema may cause greater ECL after DSAEK.
Reinfection and Breakthrough Infection of SARS-CoV-2: An Emerging Challenge That Is Threatening Our World
Authors: Gao Lin , Mu Xiuying , Jiao Yan-Mei , Wang Fu-Sheng
Published: November 2021

The pandemic of coronavirus disease 2019 has threatened humans for more than one and a half years. In particular, viral mutation like delta strain has led to third- or fourth-wave transmission among the countries in Asia, Europe, and North America. Although large-scale vaccination has been carried out in many countries, the incidence of reinfection and vaccine-past breakthrough infection is becoming an emerging challenge to humans worldwide. The related mechanisms underlying the reinfection and breakthrough infection remain unknown. In this review, we summarized the challenge and related reasons for severe acute respiratory syndrome coronavirus 2 reinfection and breakthrough infection. Simultaneously, we addressed some critical contents of the study in future.
Cutaneous Manifestations of HIV/AIDS in the Era of Highly Active Antiretroviral Therapy: Evidence from Bangladesh
Authors: Mowla Mohammad Rafiqul , Manchur Mohammed Abul , Islam A Q M Serajul , Maurer Toby
Published: November 2021

Objective:

Skin diseases are common and striking features of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and may vary considerably by ethnic and geographic regions and by the influence of highly active antiretroviral therapy (HAART). However, little information exists regarding the cutaneous manifestations of patients with HIV/AIDS in Bangladesh. This study was performed to elucidate the spectrum of cutaneous disorders in patients with HIV/AIDS in the era of HAART.

Materials:

This descriptive cross-sectional study was carried out in Chittagong Medical College Hospital, Bangladesh from January 2017 and December 2020. Diagnosed case of HIV/AIDS for HAART therapy and all cases of HIV/AIDS who are already on HAART therapy were included in this study. Descriptive statistical analysis was carried out by using frequencies and percentages.

Results:

Of 40 patients with HIV/AIDS, 22 (55.0%) were male and 18 (45.0%) were female. The patients ranged in age from 8 to 60years, with a mean age of 38 ± 0.966years. Among all age groups, the highest 19 (47.5%) patients were in the 31- to 40-year age group. Most of the patients were migrant workers [22/40 (55.0%)] with low socioeconomic status [32/40 (80.0%)], and the most common transmission mode was heterosexual activity [36/40 (90.0%)]. Most of the patients [32/40 (80.0%)] had mucocutaneous disorders, 30/40 (75.0%) had infective dermatoses, and 21/40 (52.5%) had non-infective inflammatory dermatoses. Eight of forty (20.0%) patients presented with three or more skin disorders. The most common infective dermatoses were fungal infections [15/40 (37.5%)], followed by viral infections [8/40 (20.0%)], bacterial infections [4/40 (10.0%)], and scabies [3/40 (7.5%)]. The most common noninfective dermatosis was generalized pruritus [6/40 (15.0%)], followed by prurigo simplex [4/40 (10.0%)], psoriasis [4/40 (10.0%)], eczema [3/40 (7.5%)], pruritic papular eruption [1/40 (2.5%)], seborrheic dermatitis [1/40 (2.5%)], urticaria [1/40 (2.5%)], and xerosis [1/40 (2.5%)]. Patients treated with HAART had decreased rates of oral candidiasis and herpes simplex but increased rates of drug reactions [19/40 (47.5%)]. The most common drug eruption following HAART was a morbilliform rash [11/40 (27.5%)], and the most common offending agent was nevirapine. The prevalence of mucocutaneous disorders was higher in patients with a CD4 cell count of <200cells/mm3.

Conclusions:

A wide range of mucocutaneous disorders is observed in Bangladeshi patients with HIV/AIDS, and HAART has an impact on the spectrum of HIV/AIDS-associated mucocutaneous disorders. Skin and mucocutaneous disorders are seen at every stage of HIV/AIDS and are the initial presentation in most patients in Bangladesh. There is a need for increased attention to the diagnosis and treatment of skin diseases affecting the quality of life of patients with HIV/AIDS.
Fucosyltransferase 2 Mutations Are Associated With a Favorable Clinical Course in Crohn’s Disease
Authors: Battat Robert , Qatomah Abdulrahman , Kopylov Uri , Wyse Jonathan , Cohen Albert , Afif Waqqas , Lakatos Peter L. , Seidman Ernest , Bitton Alain , Bessissow Talat
Published: November 2021

Background:

Fucosyltransferase 2 (FUT2) participates in intestinal antigen secretion and bacterial adherence. FUT2 homozygous nonsense mutations (FUT2M) and subsequent nonsecretor status is associated with Crohn’s disease (CD). The common null allele is rs601338. We assessed the relationship between FUT2M and disease course.

Methods:

In consecutive adult CD outpatients, clinical, biochemical, and genetic data were collected at baseline visits. Patients were longitudinally followed over 5 years. The primary outcome analyzed the relationship between FUT2M and rates of CD patients in persistent steroid-free clinical remission requiring neither surgery, biologics, nor immunomodulators.

Results:

Sixty-two CD patients were recruited. FUT2M homozygotes (rs601338 or any mutation in linkage disequilibrium) were detected in 27% of CD (17/62). Patients with rs601338 mutations had higher rates of the primary outcome (homozygous: 46.6%, heterozygous: 28.0%, wild-type: 5.3%, P=0.02). Similar findings existed for CD patients with homozygous mutations in any single-nucleotide polymorphism for FUT2 (homozygous: 41.2%, heterozygous: 25.9%, wild-type: 5.6%, P=0.04). On multivariable analysis, rs601338 mutation was associated with the primary outcome (odds ratio=3.4, 95% confidence interval: 1.3-8.7, P=0.01), while other parameters were not. Mutation of rs601338 was associated with lower rates of penetrating disease (homozygous: 13.3%, heterozygous: 28.0%, wild-type: 52.6%, P=0.05) and particularly in high-risk patients (homozygous: 0%, heterozygous: 37.5%, wild-type: 83.3%, P=0.01).

Conclusions:

FUT2 mutation status is associated with a favorable clinical course in CD. Further confirmatory studies are needed.
Long-term moderate to severe complications of COVID-19 infection since 2019 to date
Authors: Ata Fateen , Iqbal Phool , Choudry Hassan , Muthanna Bassam , Younas Hafiz Waqas , Tabar Osama Said Abu , Fadah Kahtan , Sharma Rohit , Elazzazy Shereen , Hamad Anas , Omer Nabil E.
Published: November 2021

Objective:

To investigate the long-term complications in patients recovered from coronavirus disease 2019 (COVID-19) infection.

Methods:

We will perform a meta-analysis and will search multiple electronic databases (PubMed, Scopus, Cochrane library) with predefined search terms to identify eligible articles. Eligible studies should report long-term complications of COVID-19 infection worldwide. Case reports, case series, observational studies with cross-sectional or prospective research design, case-control studies, and experimental studies will be included. Study quality will be evaluated by two reviewers independently using the statistical methodology and categories guided by the Cochrane Collaboration Handbook and PRISMA guidelines.

Results:

This study will explore and integrate the evidence available on the long-term complications of COVID-19 infection in various organ systems.

Conclusion:

By acquiring and statistically analyzing the data about these complications, this study will generate an extensive knowledge on the topic for a better management of the post pandemic healthcare related to COVID-19.
Focal myopathy following local glucocorticoid injection
Authors: Yin Zhaoxu , Qin Jiangbo , Guo Junhong , Zhang Wei
Published: November 2021

Introduction:

Few cases of local subcutaneous atrophy after corticosteroid injection have been described previously. Here, we report 2 patients who had weakness of hip extension and atrophy of the gluteus maximus after several intramuscular triamcinolone acetonide injections in the buttocks.

Patient concerns:

A 50-year-old woman presented with hand eczema and received biweekly intramuscular triamcinolone acetonide injections in the gluteus maximus. After 12 weeks, she experienced difficulty getting up from the armchair and walking upstairs, and noted asymptomatic, oval, gently sloped depressions of the bilateral hips around the injection sites. The other patient was a 45-year-old woman with a medical history of allergic rhinitis. One and a half years before admission, she received weekly intramuscular triamcinolone acetonide injections in the gluteus maximus for 4 weeks for seasonal allergic rhinitis allergic attacks. Six months before admission, she noted depressions in the bilateral hips around the injection sites.

Diagnosis:

Physical examination of both patients showed normal muscle strength, except for bilateral hip extension. Magnetic resonance imaging of the thigh revealed atrophy and fatty infiltration of the bilateral gluteus maximus.

Interventions:

The 2 patients started rehabilitation therapy.

Outcomes:

Six months later, their weakness and atrophy remained unchanged.

Conclusions:

The patients in this case report had weakness and atrophy secondary to the use of triamcinolone acetonide. Glucocorticoid-induced myopathy chiefly affects limb-girdle muscles, the focal form of which needs to be recognized.
A Comparison of Home Health Utilization, Outcomes, and Cost Between Medicare Advantage and Traditional Medicare
Authors: Casebeer Adrianne W. , Ronning David , Schwartz Richard , Long Charron , Bhattacharya Rituparna , Uribe Claudia , Brown Courtney R. , Cameron Joy , Painter Phil , Sharma Anup , Spitale Sandy , Powers Brian , Stemple Chuck , Shrank William
Published: November 2021

Background:

Home health use is rising rapidly in the United States as the population ages, the prevalence of chronic disease increases, and older Americans express their desire to age at home. Enrollment in Medicare Advantage (MA) plans rather than Traditional Medicare (TM) has grown as well, from 13% of total Medicare enrollment in 2004 to 39% in 2020. Despite these shifts, little is known about outcomes and costs following home health in MA as compared with TM.

Objective:

The objective of this study was to measure the association of MA enrollment with outcomes and costs for patients using home health.

Design:

This was a retrospective cohort study.

Participants:

Patients enrolled in plans offered by 1 large, national MA organization and patients enrolled in TM, with at least 1 home health visit between January 1, 2017, and June 30, 2018.

Exposure:

MA enrollment.

Main Measures:

We compared the intensity of home health services and types of care delivered. The main outcome measures were hospitalization, the proportion of days in the home, and total allowed costs during the 180-day period following the first qualifying home health visit during the study period.

Key Results:

Among patients who used home health, our models demonstrated enrollment in MA was associated with 14%, and 6% decreased odds of 60- and 180-day hospitalization, respectively, a 12.8% and 14.7% decrease in medical costs exclusive and inclusive of home health costs, respectively, and a 0.27% increase in the proportion of days at home during the 180-day follow-up, equivalent to an additional half-day at home. There were few differences in home health care delivered for MA and TM [mean number of visits in the first episode of care (17.1 vs. 17.3) and mean visits per week (3.2 vs. 3.3)]. The mean number of visits by visit type and percent of patients with each type was similar between MA and TM as well.

Conclusions:

Compared with enrollment in TM, enrollment in MA was associated with improved patient-centered outcomes and lower cost and utilization, despite few differences in the way home health was delivered. These findings might be explained by structural components of MA that encourage better care management, but further investigation is needed to clarify the mechanisms by which MA enrollment may lead to higher value home health care.
Kidney dysfunction requiring dialysis is a heterogeneous syndrome: we should treat it like one
Authors: Murea Mariana , Flythe Jennifer E. , Anjay Rastogi , Emaad Abdel-Rahman M. , Gupta Nupur , Kovach Cassandra , Vachharajani Tushar J. , Kalantar-Zadeh Kamyar , Casino Francesco G. , Basile Carlo
Published: November 2021

Purpose of review

Advanced kidney failure requiring dialysis, commonly labeled end-stage kidney disease or chronic kidney disease stage 5D, is a heterogeneous syndrome –a key reason that may explain why: treating advanced kidney dysfunction is challenging and many clinical trials involving patients on dialysis have failed, thus far. Treatment with dialytic techniques – of which maintenance thrice-weekly hemodialysis is most commonly used – is broadly named kidney ‘replacement’ therapy, a term that casts the perception of a priori abandonment of intrinsic kidney function and subsumes patients into a single, homogeneous group.

Recent findings

Patients with advanced kidney failure necessitating dialytic therapy may have ongoing endogenous kidney function, and differ in their clinical manifestations and needs. Different terminology, for example, kidney dysfunction requiring dialysis (KDRD) with stages of progressive severity could better capture the range of phenotypes of patients who require kidney ‘assistance’ therapy.

Classifying patients with KDRD based on objective, quantitative levels of endogenous kidney function, as well as patient-reported symptoms and quality of life, would facilitate hemodialysis prescriptions tailored to level of kidney dysfunction, clinical needs, and personal priorities. Such classification would encourage clinicians to move toward personalized, physiological, and adaptive approach to hemodialysis therapy.
Continuing Education for Home Care Nurses
Authors: Pavloff Michelle , Labrecque Mary Ellen
Published: November 2021

With the wide range of clinical skills and responsibilities that home care nurses (HCNs) are expected to perform, it is important they are supported with access to relevant continuing nursing education (CNE) to perform their job safely and effectively. An integrative literature review was conducted to explore the current evidence on CNE for HCNs. Medline and CINAHL were searched and 13 articles that met the criteria were reviewed. The analysis identified three themes: (1) learning strategies (simulation, virtual gaming, elearning, traditional learning); (2) challenges (staffing, time, access, skill) and opportunities (incentive to stay employed, decreased burnout); and (3) learning needs (palliative, patient and family needs, older adults and dementia, acute nursing skills). Nurses who provide care to patients in their homes have very complex roles and responsibilities. In order to keep patients and nurses safe, standards of education for HCNs, beyond their basic education program, must be developed. These educational standards must be designed to address the complex medical needs of patients while making the educational opportunities accessible and value-added. Improving the CNE experience for HCNs has the potential to increase patient safety, improve care outcomes, increase nurse competence, improve retention, and decrease nurse burnout.