bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in Uterine Cancer Mortality in the United States
Authors: Somasegar Sahana , Bashi Aya , Lang Susan M. , Liao Cheng-I , Johnson Caitlin , Darcy Kathleen M. , Tian Chunqiao , Kapp Daniel S. , Chan John K.
Published: September 2023

OBJECTIVE:

To analyze mortality trends in uterine cancer in the United States over 50 years with an emphasis on age and race and ethnicity.

METHODS:

Data on uterine cancer deaths from 1969 to 2018 were obtained from the National Center for Health Statistics. Trends were examined by age and race and ethnicity after adjustment for the hysterectomy rate and pregnancy.

RESULTS:

Uterine cancer mortality decreased between 1969 and 1997 (from 6.03 to 4.00/100,000) but increased between 1997 and 2018 (from 4.00 to 5.02/100,000). From 2001 to 2018, mortality rates increased by 1.25-fold across all age groups. In 2018, the mortality rate from uterine cancer for patients aged 70 years or older and 60–69 years was sixfold and threefold higher, respectively, than in younger patients (aged 50–59 years) (54.87/100,000 vs 27.80/100,000 vs 8.70/100,000). The mortality rate for non-Hispanic Black women was 2.2-fold higher than for non-Hispanic White, Hispanic, and non-Hispanic Asian or Pacific Islander women (17.6/100,000 vs 7.82/100,000, 6.54/100,000, and 4.24/100,000, respectively). On an intersection analysis of age and race, non-Hispanic Black women aged older than 60 years had a threefold higher mortality rate than non-Hispanic White women (72/100,000 vs 24/100,000). A notable finding was that young non-Hispanic Black and Hispanic women (30–39 years) had the highest annual increases in mortality at 3.3% and 3.8% per year compared with 2.2% in non-Hispanic White women.

CONCLUSION:

Since 2001, the uterine cancer mortality rate has increased across all four racial and ethnic groups examined, with the highest increase seen among non-Hispanic Black women. The largest increase in mortality was observed among younger non-Hispanic Black and Hispanic women.
Why Causation Matters
Authors: Mayne Gabriella , Buckley Ayisha , Ghidei Luwam
Published: September 2023

Although it is tempting to construe the correlation between Black “race” and higher rates of preterm birth as causal, this logic is flawed. Worse, the continued use of Black “race” as a risk factor for preterm birth is actively harmful. Using Black “race” as a risk factor suggests a causal relationship that does not exist and, critically, obscures what actually causes Black patients to be more vulnerable to poorer maternal and infant outcomes: anti-Black racism. Failing to name anti-Black racism as the root cause of Black patients' vulnerability conceals key pathways and tempts us to construe Black “race” as immutably related to higher rates of preterm birth. The result is that we overlook two highly treatable pathways—chronic stress and implicit bias—through which anti-Black racism negatively contributes to birth. Thus, clinicians may underuse important tools to reduce stress from racism and discrimination while missing opportunities to address implicit bias within their practices and institutions. Fortunately, researchers, physicians, clinicians, and medical staff can positively affect Black maternal and infant health by shifting our causal paradigm. By eliminating the use of Black “race” as a risk factor and naming anti-Black racism as the root cause of Black patients' vulnerability, we can practice anti-racist maternity care and take a critical step toward achieving birth equity.
The Power of Language in Hospital Care for Pregnant and Birthing People
Authors: Barcelona Veronica , Horton Rose L. , Rivlin Katherine , Harkins Sarah , Green Coretta , Robinson Kenya , Aubey Janice J. , Holman Anita , Goffman Dena , Haley Shaconna , Topaz Maxim
Published: September 2023

Language is commonly defined as the principal method of human communication made up of words and conveyed by writing, speech, or nonverbal expression. In the context of clinical care, language has power and meaning and reflects priorities, beliefs, values, and culture. Stigmatizing language can communicate unintended meanings that perpetuate socially constructed power dynamics and result in bias. This bias may harm pregnant and birthing people by centering positions of power and privilege and by reflecting cultural priorities in the United States, including judgments of demographic and reproductive health characteristics. This commentary builds on relationship-centered care and reproductive justice frameworks to analyze the role and use of language in pregnancy and birth care in the United States, particularly regarding people with marginalized identities. We describe the use of language in written documentation, verbal communication, and behaviors associated with caring for pregnant people. We also present recommendations for change, including alternative language at the individual, clinician, hospital, health systems, and policy levels. We define birth as the emergence of a new individual from the body of its parent, no matter what intervention or pathology may be involved. Thus, we propose a cultural shift in hospital-based care for birthing people that centers the birthing person and reconceptualizes all births as physiologic events, approached with a spirit of care, partnership, and support.
A Rubric to Center Equity in Obstetrics and Gynecology Research
Authors: Batman Samantha , Rivlin Katherine , Robinson Whitney , Brown Oluwateniola , Carter Ebony B. , Lindo Edwin
Published: September 2023

The Steering Committee for the Obstetrics & Gynecology special edition titled “Racism in Reproductive Health: Lighting a Path to Health Equity” formed a working group to create an equity rubric. The goal was to provide a tool to help researchers systematically center health equity as they conceptualize, design, analyze, interpret, and evaluate research in obstetrics and gynecology. This commentary reviews the rationale, iterative process, and literature guiding the creation of the equity rubric.
Structural Racism and Adverse Pregnancy Outcomes Through the Lens of the Maternal Microbiome
Authors: Hadley Megan , Oppong Akosua Yeboaa , Coleman Jenell , Powell Anna Maya
Published: September 2023

Microbiome science offers a glimpse into personalized medicine by characterizing health and disease states according to an individual's microbial signatures. Without a critical examination of the use of race as a variable, microbiome studies may be susceptible to the same pitfalls as other areas of science grounded in racist biology. We will examine the use of race as a biological variable in pregnancy-related microbiome research. Emerging data from studies that investigate the intestinal microbiome in pregnancy suggest strong influence of a poor diet on adverse pregnancy outcomes. Differences in the vaginal microbiome implicated in adverse pregnancy outcomes are frequently attributed to race. We review evidence that links systemic racism to pregnancy health outcome differences with a focus on the vaginal and intestinal microbiomes as well as diet. We also review how structural racism ultimately contributes to inequitable access to healthy food and higher risk environmental exposures among pregnant people of lower socioeconomic status and exacerbates common pregnancy comorbidities.
To Bury or Not to Bury the K-wires After Fixation of Both Bone Forearm Fractures in Patients Younger Than 11 Years Old: A Randomized Controlled Trial
Authors: Khaled Mohamed , Fadle Amr A. , Hassan Ahmed A.A. , Khalifa Ahmed A. , Nabil Andrew , Hafez Abdelkhaleak , Abol Oyoun Nariman
Published: September 2023

Purpose:

The primary objective was to compare the re-fracture incidence of both radius and ulna fracture in 2 groups treated using intramedullary Kirschner wires (K-wires) where the wires were exposed in group I and buried in group II. The secondary objective was to compare the final functional outcomes and complications incidence.

Methods:

Between March 2019 and February 2021, 60 pediatric patients with unstable radius and ulna fractures amenable to surgical intervention using intramedullary K-wires were randomized into group I (K-wires were exposed above the skin by 2 cm) or group II (K-wires were buried under the skin). In group I, K-wires were removed in the outpatient clinic, while in group II, they were removed under general anesthesia as a day-case procedure. Functional outcome per Price criteria was reported at 1-year follow-up.

Results:

Included patients had a mean age of 7.6 years (range: 5 to 10 y). The mean operative time was significantly higher in group II (32.33±7.51 vs. 36.77±8.70 min, P=0.03), with no difference regarding intraoperative x-ray exposure (43.12±15.52 vs. 41.6±11.96 s, P=0.67). Fracture union was achieved after a mean of 44±2.6 days in group I and 43±1.87 days in group II, with no difference between both groups (P=0.34). One patient had re-fracture in group I and no patients in group II; however, the difference was insignificant (P=0.12). Infection occurred in 2 patients in each group. All patients reported excellent scores per Price criteria and achieved full wrist and elbow range of motion compared with the contralateral noninjured side.

Conclusions:

Exposed implants are a safe option when dealing with forearm fractures in patients younger than 11 years old, with the added advantage of fewer hospital admissions. Furthermore, it had a similar complication rate and functional outcomes compared with buried implants.

Clinical Trial Registration:

ClinicalTrials.gov, NCT03906929.

Level of Evidence:

Level II.
Group Versus Individual Rehabilitation in Lung Transplantation: A Retrospective Noninferiority Assessment
Authors: Byrd Rebecca , Breslin Rachel , Wang Peijin , Peskoe Sarah , Chow Shein-Chung , Lowers Sean , Snyder Laurie D. , Pastva Amy M.
Published: September 2023

Purpose:

Pulmonary rehabilitation both before and after lung transplant is associated with improved functional exercise capacity and physical quality of life. There is wide variation in rehabilitation program provision. This study's aim was to compare the effects of group versus individual rehabilitation.

Methods:

Individuals who completed pre- and/or posttransplant outpatient rehabilitation at a single, academic, medical center between March 2019 and March 2021 were included in this study. Noninferiority analysis was used to assess differences in change in 6-minute walk distance (6MWD) between group and individual rehabilitation. Multivariable linear regression models examined 6MWD, Short Physical Performance Battery (SPPB), Ferrans and Powers Quality of Life Index Pulmonary Version (QLI), Center for Epidemiological Studies-Depression Scale (CESD), and San Diego Shortness of Breath Questionnaire (SOBQ).

Results:

Preoperatively, 93 patients completed group and 81 completed individual rehabilitation. Postoperatively, 110 completed group and 105 completed individual rehabilitation. Individual rehabilitation was noninferior to group rehabilitation (α = 0.05). In addition, there was no significant difference in changes in 6MWD, SPPB, QLI, CESD, or SOBQ, between cohorts pre- and postoperatively (all P > .25).

Conclusions:

Individual rehabilitation seems to be an acceptable alternative to group rehabilitation for lung transplant candidates and recipients.
Severe Alprazolam Withdrawal With Delirium and Psychosis
Authors: Conaty Oisín , Doherty Anne M. , Lally John
Published: September 2023

In our report, and review of the literature, we present an important clinical lesson for the recognition and treatment of alprazolam withdrawal with complicated delirium and psychosis, and present a strong case for future treatment algorithms. Our case is unique due to the severity of behavioral disturbance associated with acute psychosis secondary to alprazolam withdrawal and the significant quantity of alprazolam consumed. The use of high cumulative doses of longer-acting benzodiazepines resulted in rapid improvement in symptoms with full resolution of psychosis. Within 4 days of treatment in hospital, delirium and psychosis had fully resolved. Detoxification continued in the community and the patient was followed up in clinic for monitoring of mental state. There was no recurrence of psychotic symptoms.
Physician Assistant Student Preceptors and Point-of-Care Ultrasound: Perceptions and Readiness to Teach
Authors: Breunig Michael , Kingsley Ryan , Fischer Karen , Huckabee Michael
Published: September 2023

Purpose

Point-of-care ultrasound (POCUS) inclusion in medical education is increasing, and understanding of clinical educators' perceptions and use patterns is needed. The purpose of this research project was to explore current use, interest, knowledge, perceptions, and readiness to teach POCUS from the perspectives of clinical preceptors for physician assistant (PA) students.

Methods

A survey research study was completed on previously identified preceptors. Descriptive statistics outlined the frequencies of responses. Bivariate analysis with Chi-Square or Fischer Exact Testing was used to identify statistically significant differences between groupings.

Results

Most preceptors (87.1%) believe POCUS adds clinical value, but a minority received POCUS training (37%), are familiarity with its use (37.4%), and currently use POCUS (23.4%). Two-thirds (66.1%) of preceptors stated they would allow PA students to practice POCUS skills on clinical rotation; however, few (31%) felt comfortable with this and even fewer (22.6%) felt comfortable findings on POCUS into their clinical decision making.

Conclusions

Despite support of incorporation of POCUS into PA education, clinical preceptors' readiness to teach POCUS on clinical rotations is limited. This study shows that preceptors are neither comfortable with student use nor incorporating student findings into clinical decision making. A lack of sufficient clinical preceptors to support POCUS education has not been previously reported. PA programs attempting to incorporate POCUS into their curricula will need to be intentional providing opportunities to continue POCUS on clinical rotations.
Severity assessment to guide empiric antibiotic therapy for cholangitis in children after Kasai portoenterostomy: a multicenter prospective randomized control trial in China
Authors: Wang Pei , Zhang Hong-yi , Yang Jixin , Zhu Tianqi , Wu Xiaojuan , Yi Bin , Sun Xiaoyi , Wang Bin , Wang Tao , Tang Weibing , Xie Hua , Tou Jinfa , Han Yijiang , Liu Xiang , Zhan Jianghua , Liu Yuanmei , Li Yingchao , Lv Zhibao , Lu Li , Zhao Baohong , Fu Tingliang , Wu Dianming , Bai Jianxi , Li Wanfu , Yang Heying , Zhang Guofeng , Ren Hongxia , Feng Jiexiong
Published: September 2023

Background:

Cholangitis is common in patients with biliary atresia following Kasai portoenterostomy (KPE). The prompt use of empiric antibiotics is essential due to the lack of identified microorganisms. The authors aimed to validate a severity grading system to guide empiric antibiotic therapy in the management of post-KPE cholangitis.

Materials and methods:

This multicenter, prospective, randomized, open-label study recruited patients with post-KPE cholangitis and was conducted from January 2018 to December 2019. On admission, patients were categorized into mild, moderate, and severe cholangitis according to the severity grading system. Patients in the mild cholangitis group were randomized to receive cefoperazone sodium tazobactam sodium (CSTS) or meropenem (MEPM). Patients with severe cholangitis were randomized to treatment with MEPM or a combination of MEPM plus immunoglobulin (MEPM+IVIG). Patients with moderate cholangitis received MEPM.

Results:

The primary endpoint was duration of fever (DOF). Secondary outcomes included blood culture, length of hospital stay, incidence of recurrent cholangitis, jaundice clearance rate, and native liver survival (NLS). For mild cholangitis, DOF, and length of hospital stay were similar between those treated with CSTS or MEPM (all P>0.05). In addition, no significant difference in recurrence rate, jaundice clearance rate, and NLS was observed between patients treated with CSTS and MEPM at 1-month, 3-month, and 6-month follow-up. In patients with moderate cholangitis, the DOF was 36.00 (interquartile range: 24.00–48.00) h. In severe cholangitis, compared with MEPM, MEPM+IVIG decreased DOF and improved liver function by reducing alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and direct bilirubin at 1-month follow-up. However, recurrence rate, jaundice clearance rate, and NLS did not differ significantly between MEPM+IVIG and MEPM at 1-month, 3-month, and 6-month follow-up.

Conclusions:

In patients with post-KPE cholangitis, MEPM is not superior to CSTS for the treatment of mild cholangitis. However, MEPM+IVIG treatment was associated with better short-term clinical outcomes in patients with severe cholangitis.
Neoadjuvant docetaxel, oxaliplatin plus capecitabine versus oxaliplatin plus capecitabine phase III randomized controlled clinical trial for patients with locally advanced gastric adenocarcinoma: long-term results of a randomised controlled trial
Authors: Tian Yuan , Yang Peigang , Guo Honghai , Liu Yang , Zhang Ze , Ding Pingan , Zheng Tao , Deng Huiyan , Ma Wenqian , Li Yong , Fan Liqiao , Zhang Zhidong , Wang Dong , Zhao Xuefeng , Tan Bibo , Liu Yu , Zhao Qun
Published: September 2023

Background:

Neoadjuvant chemotherapy with docetaxel, oxaliplatin, and capecitabine (DOX regimen) is rarely used in Eastern countries and its efficacy and safety in advanced gastric cancer have not been reported. In this open-label, randomized, controlled trial, the authors aimed to assess the clinical efficacy of neoadjuvant chemotherapy using the DOX and oxaliplatin plus capecitabine (XELOX) regimens, in comparison to surgery alone.

Materials and methods:

Three hundred patients younger than 60 years with potentially resectable advanced gastric cancer (cT3-4, Nany, M0) were enrolled in this randomized controlled clinical trial between November 2014 and June 2018. The primary endpoint of the study was the pathological complete response (pCR) rate. Secondary endpoints included 3-year overall survival (OS), 3-year disease-free survival.

Results:

In total, 280 patients (93 in the DOX group, 92 in the XELOX group, and 95 in the surgery group) were included in the per-protocol analysis. The DOX group demonstrated a significantly higher pCR rate compared to the XELOX group (16.1 vs. 4.3%, P=0.008). For patients with intestinal type, the DOX group exhibited significantly higher rates of both pCR and major pathological response compared to the XELOX group (P=0.007, P<0.001). The 3-year OS rates of the DOX group, the XELOX group and the surgery group were 56.9, 44.6, and 34.7%, respectively. The 3-year disease-free survival rates were 45.2, 40.2, and 28.4%, respectively. The neoadjuvant DOX regimen demonstrated a significant improvement in the 3-year OS of patients compared to the neoadjuvant XELOX regimen (P=0.037).

Conclusion:

The neoadjuvant DOX regimen has shown the potential to increase the pCR rate and improve the prognosis of patients with advanced gastric cancer who are under 60 years old.
Traumatic spinal injury-related hospitalizations in the United States, 2016–2019: a retrospective study
Authors: Sun Jiuxiao , Yuan Wenjian , Zheng Ruiyuan , Zhang Chi , Guan Bin , Ding Jiaming , Chen Zhuo , Sun Qingyu , Fu Runhan , Chen Lingxiao , Zhou Hengxing , Feng Shiqing
Published: September 2023

Background:

Traumatic spinal injury (TSI) is associated with significant fatality and social burden; however, the epidemiology and treatment of patients with TSI in the US remain unclear.

Materials and methods:

An adult population was selected from the National Inpatient Sample database from 2016 to 2019. TSI incidence was calculated and TSI-related hospitalizations were divided into operative and nonoperative groups according to the treatments received. TSIs were classified as fracture, dislocation, internal organ injury, nerve root injury, or sprain injuries based on their nature. The annual percentage change (APC) was calculated to identify trends. In-hospital deaths were utilized to evaluate the prognosis of different TSIs.

Results:

Overall, 95 047 adult patients were hospitalized with TSI in the US from 2016 to 2019, with an incidence rate of 48.4 per 100 000 persons in 2019 (95% CI: 46.2–50.6). The total incidence increased with an APC of 1.5% (95% CI: 0.1–3%) from 2016 to 2019. Operative TSI treatment was more common than nonoperative (32.8 vs. 3.8; 95% CI: 32.3–33.2 vs. 3.6–4%). The number of operations increased from 37 555 (95% CI: 34 674–40 436) to 40 460 (95% CI: 37 372–43 548); however, the operative rate only increased for internal organ injury (i.e. spinal cord injury [SCI])-related hospitalizations (APC, 3.6%; 95% CI: 2.8–4.4%). In-hospital mortality was highest among SCI-related hospitalizations, recorded at 3.9% (95% CI: 2.9–5%) and 28% (95% CI: 17.9–38.2%) in the operative and nonoperative groups, respectively.

Conclusions:

The estimated incidence of TSI in US adults increased from 2016 to 2019. The number of operations increased; however, the proportion of operations performed on TSI-related hospitalizations did not significantly change. In 2019, SCI was the highest associated mortality TSI, regardless of operative or nonoperative treatment.
Implications of climate change on acute kidney injury
Authors: Freidin Natalie , Hayes Eily , Struthers Sarah A.
Published: September 2023

Purpose of review

Climate change is an active and growing threat to human health. This review examines the evidence linking climate change to kidney diseases, with a focus on acute kidney injury (AKI).

Recent findings

A growing body of evidence documents the adverse impact of various environmental and occupational exposures on kidney health. Extreme heat exposure increases the risk for AKI in vulnerable populations, particularly outdoor workers. These effects are being seen in both developed and developing nations, impacting equatorial as well as more northern climates. Climate change is also increasing the risk of water-borne and vector-borne infections, which are important causes of AKI in tropical regions. Due to overlapping environmental and social risk factors, populations in low-income and middle-income countries are likely to be disproportionately affected by climate-related health impacts, including heightened risk for kidney diseases.

Climate change will adversely impact global kidney health over the course of the century through effects on temperature and risk of endemic infections. Alongside efforts to aggressively reduce carbon emissions, additional research is needed to guide public and environmental health policies aimed at mitigating the impact of climate change on human health.
Something to consider: rapid palatal expansion for treatment of obstructive sleep apnea in pediatric patients
Authors: Ahsan Muhammad , Narala Bhavya , Ednick Mathew , Kier Catherine
Published: September 2023

Purpose of review

This review examines the potential of rapid palatal expansion (RPE) as a treatment for pediatric obstructive sleep apnea (OSA). The focus is on recent findings related to its efficacy, safety, patient selection, timing, appliance options, cost considerations, and long-term outcomes.

Recent findings

Recent studies indicate that RPE can lead to significant improvements in pediatric OSA, with a 70% reduction in the Apnea Hypopnea Index (AHI) and increased oxygen saturation levels. It has been particularly effective in children with small or absent tonsils and has been found to reduce adenoid and tonsil size. Long-term follow-up studies suggest the need for ongoing monitoring, as some patients may experience relapse over time.

RPE shows promise as an additional treatment for pediatric obstructive sleep apnea. It offers improvements in respiratory function and reduced symptoms in certain patients. However, long-term efficacy and safety require further investigation. Comparative studies and patient-reported outcomes are necessary to optimize treatment approaches. Collaboration between orthodontists, sleep specialists, and ear-nose-throat (ENT) specialists may be essential for optimal outcomes in pediatric OSA patients treated with RPE.
Comparing Virtual Simulations to Paper Case Studies in Combination With Manikin-Based Medication Administration Simulations
Authors: Campbell Denise , Wilson Kristi , Turkelson Carman
Published: September 2023

Background:

Medication errors are among the most common preventable adverse events in health care.

Methods:

A quasi-experimental approach with a pre/posttest design was used to explore the effectiveness of an enhanced medication administration simulation bundle that included the use of manikin-based simulation-based experiences (SBEs) in combination with either virtual SBEs (V-SBEs) for deliberate practice (DP) or traditional paper case studies for DP on safe medication administration in undergraduate nursing students.

Results:

Nursing students (n = 101) participated in multiple medication administration–focused SBEs including DP via V-SBEs or DP via traditional paper case studies. Student performance in the medication administration SBEs improved after the third experience. There was no statistically significant difference between the V-SBE groups compared with the traditional paper case study groups across the 3 medication administration–focused SBEs.

Conclusion:

Findings from this study highlight the importance of DP with medication administration for undergraduate nursing students.
Experiences of Undergraduate Male Students in Nursing
Authors: Englund Heather M. , Mott Jason , MacWilliams Brent
Published: September 2023

Background:

Measures to improve gender diversity of the profession have yielded only a modicum of progress.

Purpose:

To investigate the relationship between marginalization and gender minorities in baccalaureate nursing programs in the United States.

Methods:

A descriptive cross-sectional study compared self-reported marginalization in male and female baccalaureate nursing students. The sample was drawn from the American Association of Colleges of Nursing database of US baccalaureate nursing programs, and the Englund Marginality Index (EMI) was used to measure marginalization, along with a demographic survey.

Results:

In the study, 6480 full-time baccalaureate students from a traditional face-to-face nursing program in the United States participated. The results show that male participants had higher EMI scores (mean = 40.0, SD = 9.1) compared with female nursing students (mean = 35.1, SD = 9.0); t
(6478) = 14.9, P < .001.

Conclusions:

Marginalizing behaviors must not be tolerated or promulgated. More needs to be done to better support and integrate men into nursing programs as they bring forth a unique perspective and skill set to the profession.
Moderate to Vigorous Intensity Locomotor Training After Stroke: A Systematic Review and Meta-analysis of Mean Effects and Response Variability
Authors: Boyne Pierce , Miller Allison , Kubalak Owen , Mink Caroline , Reisman Darcy S. , Fulk George
Published: September 2023

Background and Purpose:

This meta-analysis quantified mean effects of moderate to vigorous intensity locomotor training (LTmv) on walking outcomes in subacute and chronic stroke, and the magnitude of variability in LTmv response.

Methods:

Databases were searched for randomized trials comparing LTmv with no intervention, nongait intervention, or low-intensity gait training. Comfortable gait speed (CGS), fastest gait speed (FGS), 6-minute walk test (6MWT), walking activity (steps per day), and adverse effect/event (AE) data were extracted. Pooled estimates were calculated for mean changes, AE relative risks, and the standard deviation of response (SDresponse) to LTmv versus control groups, stratified by study chronicity where possible.

Results:

There were 19 eligible studies (total N = 1096): 14 in chronic stroke (N = 839) and 5 in subacute stroke (N = 257). Compared with control interventions, LTmv yielded significantly greater increases in CGS (chronic, +0.06 m/s [95% confidence interval (CI), 0.01-0.10]; subacute, +0.16 [0.12-0.19]; subacute vs chronic, P = 0.03), FGS (chronic, +0.07 m/s [0.02-0.13]; subacute, +0.21 [0.01, 0.41]; P = 0.04), and 6MWT (chronic, +33 m [24-42]; subacute, +51 [26-77]; P = 0.054) but not steps/day (+260 [−1159 to 1679]). There were no treatment-related serious AEs among 398 LTmv participants in 14 AE-reporting studies. SDresponse estimates indicated substantial response variability: CGS, 0.11 m/s [0.00-0.15]; FGS, 0.14 m/s [−0.00 to 0.20]; and 6MWT, 41 m [27-51].

Discussion and Conclusions:

LTmv improves mean walking capacity outcomes in subacute and chronic stroke and does not appear to have high risk of serious harm. Response magnitude varies within and between chronicity subgroups, and few studies have tested effects on daily walking activity or non-serious AEs.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A452).
Prevalence Trend of Myopia during the Post–COVID-19 Epidemic Period among Preschoolers: A Prospective School-based Study
Authors: Li Qin , Zhou Wen , Liao Ya , Chen Hongyan , Sun Yanmei , Wang Mei , Wang Xiaojuan , Wang Wei
Published: September 2023

SIGNIFICANCE

Changes in behavior and lifestyle during the post–coronavirus disease 2019 (COVID-19) epidemic may have some impact on myopia rates in preschoolers, and exploring the changes in myopia rates in preschool children may inform the formulation of myopia prevention and control policies.

PURPOSE

This study aimed to investigate the prevalence of myopia in preschool children during the post–COVID-19 epidemic period in Xuzhou, China.

METHODS

A series of cross-sectional school-based studies was conducted. A total of 117,632 preschool children aged 3 to 6 years were subjected to annual vision screening from 2019 to 2021. Spot photo screening was used to record the spherical equivalent refraction for each child and to analyze the prevalence of myopia by age, sex, and region during the post–COVID-19 epidemic period.

RESULTS

A total of 113,979 preschool children were included in the analysis, of whom 60,784 (53.3%) were male and 53,195 (46.7%) were female. For all children, the mean ± standard deviation spherical equivalent refraction in 2019, 2020, and 2021 was +0.32 ± 0.50, +0.34 ± 0.55, and +0.34 ± 0.54 D, respectively (all P < .05), indicative of a very slight hyperopic shift. In all age groups, the change in mean spherical equivalent refraction and its distribution were relatively stable. From 2019 to 2021, the overall prevalence of myopia in preschool children was 3.1, 3.3, and 3.5%, respectively. The rise in myopia rates was minimal. The largest increase in the annual prevalence of myopia was seen among children aged 6 years, at 0.5%, followed by those aged 5 years (0.4%) and aged 3 years (0.4%). The prevalence was higher in boys than girls and in urban versus rural areas.

CONCLUSIONS

During the post–COVID-19 epidemic period, the refractive status of Xuzhou preschool children remained stable.
Pediatric Death After Withdrawal of Life-Sustaining Therapies: A Scoping Review
Authors: Francoeur Conall , Silva Amina , Hornby Laura , Wollny Krista , Lee Laurie A. , Pomeroy Alexandra , Cayouette Florence , Scales Nathan , Weiss Matthew J. , Dhanani Sonny
Published: September 2023

OBJECTIVES:

Evaluate literature on the dying process in children after withdrawal of life sustaining measures (WLSM) in the PICU. We focused on the physiology of dying, prediction of time to death, impact of time to death, and uncertainty of the dying process on families, healthcare workers, and organ donation.

DATA SOURCES:

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and Web of Science.

STUDY SELECTION:

We included studies that discussed the dying process after WLSM in the PICU, with no date or study type restrictions. We excluded studies focused exclusively on adult or neonatal populations, children outside the PICU, or on organ donation or adult/pediatric studies where pediatric data could not be isolated.

DATA EXTRACTION:

Inductive qualitative content analysis was performed.

DATA SYNTHESIS:

Six thousand two hundred twenty-five studies were screened and 24 included. Results were grouped into four categories: dying process, perspectives of healthcare professionals and family, WLSM and organ donation, and recommendations for future research. Few tools exist to predict time to death after WLSM in children. Most deaths after WLSM occur within 1 hour and during this process, healthcare providers must offer support to families regarding logistics, medications, and expectations. Providers describe the unpredictability of the dying process as emotionally challenging and stressful for family members and staff; however, no reports of families discussing the impact of time to death prediction were found. The unpredictability of death after WLSM makes families less likely to pursue donation. Future research priorities include developing death prediction tools of tools, provider and parental decision-making, and interventions to improve end-of-life care.

CONCLUSIONS:

The dying process in children is poorly understood and understudied. This knowledge gap leaves families in a vulnerable position and the clinical team without the necessary tools to support patients, families, or themselves. Improving time to death prediction after WLSM may improve care provision and enable identification of potential organ donors.
A Cost-Effective, Three-Dimensionally Printed Simulation Model Facilitates Learning of Bilobed and Banner Flaps for Mohs Nasal Reconstruction: A Pilot Study
Authors: Lerner Julia L. , Vishwanath Neel , Borrelli Mimi R. , Rao Vinay , Crozier Joseph , Woo Albert S.
Published: September 2023

Flap design for Mohs reconstruction is a complex 3-dimensional process. Simulation offers trainees the chance to practice techniques safely before performing them in the operating room. To aid in teaching, the authors developed a high-fidelity, cost-effective model of the face using three-dimensional printing to simulate flap reconstruction after Mohs surgery. A model face was sculpted digitally to include skin, bone, and cartilage. Negative molds were printed and used to cast silicone, representing external skin. The cartilage and bone models were combined to create a single three-dimensionally printed base. Surgical residents practiced performing banner and bilobed flaps on the simulation model, and improvement was assessed using boards-style pretests and posttests assessing flap design on clinical photographs. Medical students were randomized to complete a similar practice session with the model or a reading on the topic, after which they completed the same assessment. Participants also completed a questionnaire about the model’s didactic and monetary value. Residents showed significant improvement after use of the model (banner flap: P = 0.002, bilobed flap: P = 0.04). Medical students who used the model scored significantly higher than those assigned to train by reading (P = 0.001). Subjective comfort with flap design and execution increased after practice with the model (P = 0.001). The cost of materials for each model was $2.50; participants reported willingness to pay $24.36 (mean) for this tool. This accessible model was superior to traditional teaching materials for Mohs reconstruction, and aided the comfort and proficiency of trainees.
Validation of Photoplethysmography Using a Mobile Phone Application for the Assessment of Heart Rate Variability in the Context of Heart Rate Variability–Biofeedback
Authors: van Dijk Willeke , Huizink Anja C. , Oosterman Mirjam , Lemmers-Jansen Imke L.J. , de Vente Wieke
Published: September 2023

Objective

Heart rate variability–biofeedback (HRV-BF) is an effective intervention to reduce stress and anxiety and requires accurate measures of real-time HRV. HRV can be measured through photoplethysmography (PPG) using the camera of a mobile phone. No studies have directly compared HRV-BF supported through PPG against classical electrocardiogram (ECG). The current study aimed to validate PPG HRV measurements during HRV-BF against ECG.

Methods

Fifty-seven healthy participants (70% women) with a mean (standard deviation) age of 26.70 (9.86) years received HRV-BF in the laboratory. Participants filled out questionnaires and performed five times a 5-minute diaphragmatic breathing exercise at different paces (range, ~6.5 to ~4.5 breaths/min). Four HRV indices obtained through PPG, using the Happitech software development kit, and ECG, using the validated NeXus apparatus, were calculated and compared: RMSSD, pNN50, LFpower, and HFpower. Resonance frequency (i.e., optimal breathing pace) was also compared between methods.

Results

All intraclass correlation coefficient values of the five different breathing paces were “near perfect” (>0.90) for all HRV indices: lnRMSSD, lnpNN50, lnLFpower, and lnHFpower. All Bland-Altman analyses (with just three incidental exceptions) showed good interchangeability of PPG- and ECG-derived HRV indices. No systematic evidence for proportional bias was found for any of the HRV indices. In addition, correspondence in resonance frequency detection was good with 76.6% agreement between PPG and ECG.

Conclusions

PPG is a potentially reliable and valid method for the assessment of HRV. PPG is a promising replacement of ECG assessment to measure resonance frequency during HRV-BF.
Association Between Estradiol and Human Aggression: A Systematic Review and Meta-Analysis
Authors: Wang Yalan , Wang Haifang , Cai Jianzheng , Yu Weixia , Zhang Yingying , Zhang Ying , Tang Zhaofang
Published: September 2023

Objective

Although several studies have examined the association between estradiol and human aggression, a consistent understanding of their correlation has yet to be established. This study aimed to investigate this relationship comprehensively.

Methods

We systematically searched five English databases (PubMed, Web of Science, EMBASE, Cochrane Library, and CINAHL) from their inception to June 5, 2023. Two authors independently screened publications and extracted data based on predefined inclusion and exclusion criteria. Statistical analyses were performed using Review Manager 5.4, and a random-effects model was used to pool the data.

Results

We identified 14 eligible studies comprising data from 1820 participants that met the inclusion criteria. This meta-analysis indicated a positive correlation between estradiol and human aggression, albeit a weak one. The pooled Fisher z value was 0.16 (95% confidence interval = 0.05–0.26; I
2 = 73%, p<.00001). Furthermore, we found that participants’ sex and age, the measures of aggression, and the literature quality might be sources of heterogeneity.

Conclusions

Human aggression exhibited a weak positive correlation with estradiol concentration, whereas this relationship was influenced by participants’ sex and age, the measure of aggression used, and the quality assessment of the literature. Gaining a better understanding of the association between estradiol and aggression could aid in the identification of populations prone to aggression.
Current drug treatment of myasthenia gravis
Authors: Vanoli Fiammetta , Mantegazza Renato
Published: September 2023

Purpose of review

Myasthenia Gravis (MG) is a rare neurological disorder affecting the neuromuscular junction. Clinical hallmarks are fatigability and weakness affecting the extraocular, axial, limb and/or respiratory muscles. Despite immunosuppressive treatment, mainly based on corticosteroids and nonsteroidal immunosuppressants, the burden of MG is still significant, both in terms of inadequate disease control and burdensome side effects. Driven by such limits, the past years have been characterized by an escalation of MG drug development, with novel molecules which now focuses on having a more targeted effect, with a higher safety and efficacy profile.

Recent findings

As the pathogenic mechanism of MG are slowly being unravelled, new potential targets for treatments are being considered. This has led since 2017 to the Food and Drug Administration (FDA)-approval of three new drugs that either act by blocking the complement system (i.e., eculizumab and ravulizumab) or by blocking the neonatal Fc receptor thus preventing immunoglobulin recycling and reducing imunoglobulin G (IgG) antibodies (i.e., efgartigimod). Other drugs, with similar mechanism of action, are currently under review for approval.

The repertoire of available and developmental therapies for MG is rapidly expanding, finally responding to the unmet need of a more targeted and effective therapeutic approach in MG.
Complex evolutionary history of photosynthesis in Bradyrhizobium
Authors: Avontuur Juanita R. , Wilken P. Markus , Palmer Marike , Coetzee Martin P. A. , Stępkowski Tomasz , Venter Stephanus N. , Steenkamp Emma T.
Published: September 2023

Bradyrhizobium

comprises a diverse group of bacteria with various lifestyles. Although best known for their nodule-based nitrogen-fixation in symbiosis with legumes, a select group of bradyrhizobia are also capable of photosynthesis. This ability seems to be rare among rhizobia, and its origin and evolution in these bacteria remain a subject of substantial debate. Therefore, our aim here was to investigate the distribution and evolution of photosynthesis in

Bradyrhizobium

using comparative genomics and representative genomes from closely related taxa in the families Nitrobacteraceae, Methylobacteriaceae, Boseaceae and Paracoccaceae. We identified photosynthesis gene clusters (PGCs) in 25 genomes belonging to three different

Bradyrhizobium

lineages, notably the so-called Photosynthetic,

B. japonicum

and

B. elkanii

supergroups. Also, two different PGC architectures were observed. One of these, PGC1, was present in genomes from the Photosynthetic supergroup and in three genomes from a species in the

B. japonicum

supergroup. The second cluster, PGC2, was also present in some strains from the

B. japonicum

supergroup, as well as in those from the

B. elkanii

supergroup. PGC2 was largely syntenic to the cluster found in

Rhodopseudomonas palustris

and

Tardiphaga

. Bayesian ancestral state reconstruction unambiguously showed that the ancestor of

Bradyrhizobium

lacked a PGC and that it was acquired horizontally by various lineages. Maximum-likelihood phylogenetic analyses of individual photosynthesis genes also suggested multiple acquisitions through horizontal gene transfer, followed by vertical inheritance and gene losses within the different lineages. Overall, our findings add to the existing body of knowledge on

Bradyrhizobium

’s evolution and provide a meaningful basis from which to explore how these PGCs and the photosynthesis itself impact the physiology and ecology of these bacteria.
What do women want to see in a personalized breast cancer risk report? A qualitative study of Asian women of two countries
Authors: Aldila Fatma , Fiona Ng FJ , Audrienna Jessica , Lynn Lim SJ , Tang Shannon , Tanu Sabrina Gabriel , Fernandez Eric Aria , Agatha Faustina Audrey , Wijaya Marco , Sormin Stevany Tiurma Br , Sani Levana , Irwanto Astrid , Haryono Samuel J. , Li Jingmei , Chan Alexandre , Hartman Mikael
Published: September 2023

Introduction

A breast cancer risk assessment tool using Polygenic Risk Score (PRS) of 313 single nucleotide polymorphisms and a risk prediction algorithm from the Gail Model had been established and validated for Asian populations. However, effective ways for delivering personalized risk information have not been fully explored yet. Through facilitated focus group discussions, we assessed the preferences of women from two Asian countries regarding the presentation of risk results, the level of detail provided for explanations, and recommendations for follow-up actions.

Methods

We conducted ten focus group discussions between July and October 2022 with thirty-two Asian women above the age of 25. The discussions aimed to evaluate the views and perceptions of women in Indonesia and Singapore in relation to personalized breast cancer risk assessment. All participants received either a detailed high-risk or low-risk mock report and were assigned to either high-risk result or low-risk result focus group based on the report they had randomly received. All focus group discussion content was then thematically analyzed.

Results

Participants indicated a preference for a comprehensive report that included follow-up steps and information for managing their breast cancer risk. Additionally, they highlighted the need for visuals without colors that project intimidation as well as a summary on the first page of the report to support interpretations. In the context of the report’s content, participants preferred personalized recommendations for risk reduction, and communication styles could be enhanced through the use of simplified language. Furthermore, we found out that Singaporeans receiving low-risk results were less likely to seek additional physician follow-ups compared to Indonesians, due to their greater breast cancer prevention awareness. Finally, participants found the report useful and would like to see similar reports on other diseases in the future.

Conclusion

Overall, most patients prefer a test report to strike a balance between content and complexity. The study also highlighted the importance of the psychological impact of patients receiving their test reports, which is greatly influenced by the patients’ degree of understanding and interpretation of the reports. Lastly, as most patients would likely increase their engagement with their physicians upon receiving their test results, future studies could be extended to physicians who are directly involved in the patient care delivery of breast cancer prevention.