bluuebunny/crossref_metadata_2025 huggingface dataset:
Quasar photometric redshifts from incomplete data using deep learning
Authors: Curran S J
Published: March 2022

Forthcoming astronomical surveys are expected to detect new sources in such large numbers that measuring their spectroscopic redshift measurements will not be practical. Thus, there is much interest in using machine learning to yield the redshift from the photometry of each object. We are particularly interested in radio sources (quasars) detected with the Square Kilometre Array and have found Deep Learning, trained upon a large optically selected sample of quasi-stellar objects, to be effective in the prediction of the redshifts in three external samples of radio-selected sources. However, the requirement of nine different magnitudes, from the near-infrared, optical, and ultra-violet bands, has the effect of significantly reducing the number of sources for which redshifts can be predicted. Here, we explore the possibility of using machine learning to impute the missing features. We find that for the training sample simple imputation is sufficient, particularly replacing the missing magnitude with the maximum for that band, thus presuming that the non-detection is at the sensitivity limit. For the test samples, however, this does not perform as well as multivariate imputation, which suggests that many of the missing magnitudes are not limits, but have indeed not been observed. From extensive testing of the models, we suggest that the imputation is best restricted to two missing values per source. Where the sources overlap on the sky, in the worst case, this increases the fraction of sources for which redshifts can be estimated from 46 per cent to 80 per cent, with >90 per cent being reached for the other samples.
[18F]-fluoromisonidazole (FMISO) PET/MRI hypoxic fraction distinguishes neuroinflammatory pseudoprogression from recurrent glioblastoma in patients treated with pembrolizumab
Authors: Barajas Ramon F , Ambady Prakash , Link Jeanne , Krohn Kenneth A , Raslan Ahmed , Mallak Nadine , Woltjer Randy , Muldoon Leslie , Neuwelt Edward A
Published: March 2022

Response assessment after immunotherapy remains a major challenge in glioblastoma due to an expected increased incidence of pseudoprogression. Gadolinium-enhanced magnetic resonance imaging (MRI) is the standard for monitoring therapeutic response, however, is markedly limited in characterizing pseudoprogression. Given that hypoxia is an important defining feature of glioblastoma regrowth, we hypothesized that [18F]-fluoromisonidazole (FMISO) positron emission tomography (PET) could provide an additional physiological measure for the diagnosis of immunotherapeutic failure. Six patients with newly diagnosed glioblastoma who had previously received maximal safe resection followed by Stupp protocol CRT concurrent with pembrolizumab immunotherapy were recruited for FMISO PET and Gd-MRI at the time of presumed progression. The hypoxic fraction was defined as the ratio of hypoxic volume to T1-weighted gadolinium-enhancing volume. Four patients diagnosed with pseudoprogression demonstrated a mean hypoxic fraction of 9.8 ± 10%. Two with recurrent tumor demonstrated a mean hypoxic fraction of 131 ± 66%. Our results, supported by histopathology, suggest that the noninvasive assessment of hypoxic fraction by FMISO PET/MRI is clinically feasible and may serve as a biologically specific metric of therapeutic failure.
Sex-Dependent Effects of Inhaled Nicotine on the Gut Microbiome
Authors: Whitehead Anna K , Meyers Margaret C , Taylor Christopher M , Luo Meng , Dowd Scot E , Yue Xinping , Byerley Lauri O
Published: March 2022

Introduction

The impact of nicotine, the addictive component of both traditional cigarettes and e-cigarettes, on many physiological processes remains poorly understood. To date, there have been few investigations into the impact of nicotine on the gut microbiome, and these studies utilized oral administration rather than inhalation. This study aimed to establish if inhaled nicotine alters the gut microbiome and the effect of sex as a biological variable.

Methods

Female (n = 8 air; n = 10 nicotine) and male (n = 10 air; n = 10 nicotine) C57BL6/J mice were exposed to air (control) or nicotine vapor (12 hour/day) for 13 weeks. A fecal sample was collected from each mouse at the time of sacrifice, and the gut microbiome was analyzed by 16S rRNA gene sequencing. QIIME2, PICRUSt, and STAMP were used to detect gut bacterial differences and functional metabolic pathways.

Results

Sex-specific differences were observed in both alpha and beta diversities in the absence of nicotine. While nicotine alters microbial community structure in both male and female mice as revealed by the beta diversity metric, nicotine significantly reduced alpha diversity only in female mice. A total of 42 bacterial taxa from phylum to species were found to be significantly different among the treatment groups. Finally, analysis for functional genes revealed significant differences in twelve metabolic pathways in female mice and ten in male mice exposed to nicotine compared to air controls.

Conclusions

Nicotine inhalation alters the gut microbiome and reduces bacterial diversity in a sex-specific manner, which may contribute to the overall adverse health impact of nicotine.

Implications

The gut microbiota plays a fundamental role in the well-being of the host, and traditional cigarette smoking has been shown to affect the gut microbiome. The effects of nicotine alone, however, remain largely uncharacterized. Our study demonstrates that nicotine inhalation alters the gut microbiome in a sex-specific manner, which may contribute to the adverse health consequences of inhaled nicotine. This study points to the importance of more detailed investigations into the influence of inhaled nicotine on the gut microbiota.
Increased Risk of Herpes Zoster in Adults ≥50 Years Old Diagnosed With COVID-19 in the United States
Authors: Bhavsar Amit , Lonnet Germain , Wang Chengbin , Chatzikonstantinidou Konstantina , Parikh Raunak , Brabant Yves , Servotte Nathalie , Shi Meng , Widenmaier Robyn , Aris Emmanuel
Published: March 2022

Background

Case reports have described herpes zoster (HZ) in patients with coronavirus disease 2019 (COVID-19). However, this constitutes low-quality evidence for an association. We therefore performed a retrospective cohort study to assess the risk of developing HZ following a COVID-19 diagnosis.

Methods

We compared the HZ incidence in ≥50-year-olds diagnosed with COVID-19 vs those never diagnosed with COVID-19. We used data from the US MarketScan Commercial Claims and Encounters and Medicare Supplemental (3/2020–2/2021) and Optum Clinformatics Data Mart (3–12/2020) databases. Individuals with COVID-19 were exact-matched 1:4 to those without COVID-19 by age, sex, presence of HZ risk factors, and health care cost level. Adjusted incidence rate ratios (aIRRs) were estimated by Poisson regression.

Results

A total of 394 677 individuals ≥50 years old with COVID-19 were matched with 1 577 346 individuals without COVID-19. Mean follow-up time after COVID-19 diagnosis and baseline characteristics were balanced between cohorts. Individuals diagnosed with COVID-19 had a 15% higher HZ risk than those without COVID-19 (aIRR, 1.15; 95% CI, 1.07–1.24; P < .001). The increased HZ risk was more pronounced (21%) following COVID-19 hospitalization (aIRR, 1.21; 95% CI, 1.03–1.41; P = .02).

Conclusions

We found that COVID-19 diagnosis in ≥50-year-olds was associated with a significantly increased risk of developing HZ, highlighting the relevance of maintaining HZ vaccination.
Impact of Testing Strategies to Combat a Major Syphilis Outbreak Among Australian Aboriginal and Torres Strait Islander Peoples: A Mathematical Modeling Study
Authors: Hui Ben B , Ward James S , Guy Rebecca , Law Matthew G , Gray Richard T , Regan David G
Published: March 2022

Background

A syphilis outbreak among Australian Aboriginal and Torres Strait Islander people (respectfully referred to as Aboriginal) has resulted in almost 4000 notifications by 2020, with several congenital syphilis cases and infant deaths. Outbreak control efforts became coordinated under a National enhanced test and treat response in 2017. We evaluated the impact of these efforts and of expansion of testing interventions on syphilis prevalence.

Methods

We developed an individual-based mathematical model of infectious syphilis transmission among young heterosexual Aboriginal people aged 15–34 years living in and moving between regional and remote areas, and we assessed the impact of existing and hypothetical outbreak control responses on syphilis prevalence.

Results

The increased testing coverage achieved through the response (from 18% to 39% over 2011–2020) could stabilize the epidemic from 2021. To return to pre-outbreak prevalence (<0.24%) by 2025, testing coverage must reach 60%. The addition of annual community-wide screening, where 30% of youth in communities are tested over 6 weeks, would reduce prevalence to the pre-outbreak level within 4 years. If testing coverage had been scaled-up to 60% at the start of outbreak in mid-2011, the outbreak would have been mitigated.

Conclusions

Our results suggest that to control the syphilis outbreak, the response needs to be delivered to enable the maximum coverage of testing to be reached in the shortest time to reduce the prevalence to pre-outbreak levels. Reduction could be hastened with community-wide screening at similar time periods across all communities together with increases in annual testing coverage.
Tracking metabolites at single-cell resolution reveals metabolic dynamics during plant mitosis
Authors: Okubo-Kurihara Emiko , Ali Ahmed , Hiramoto Mika , Kurihara Yukio , Abouleila Yasmine , Abdelazem Eman Muhammad , Kawai Takayuki , Makita Yuko , Kawashima Mika , Esaki Tsuyoshi , Shimada Hiroaki , Mori Tetsuya , Hirai Masami Yokota , Higaki Takumi , Hasezawa Seiichiro , Shimizu Yoshihiro , Masujima Tsutomu , Matsui Minami
Published: March 2022

One-sentence summary

Analyzing only one cell allows the changes and characteristics of intracellular metabolites during the chromosome segregation process to be precisely captured and mitotic sub-phases to be dissected at the metabolite level.
Use of IMMPACT Recommendations to Explore Pain Phenotypes in People with Knee Osteoarthritis
Authors: Carlesso Lisa C , Feldman Debbie Ehrmann , Vendittoli Pascal-André , LaVoie Frédéric , Choinière Manon , Bolduc Marie-Ève , Fernandes Julio , Newman Nicholas , Sabouret Pierre
Published: March 2022

Objective

Knee osteoarthritis (OA) is a disease of multiple phenotypes of which a chronic pain phenotype (PP) is known. Previous PP studies have focused on one domain of pain and included heterogenous variables. We sought to identify multidimensional PPs using the IMMPACT recommendations and their relationship to clinical outcomes.

Methods

Participants >40 years of age with knee OA having a first-time orthopedic consultation at five university affiliated hospitals in Montreal, Quebec, and Hamilton (Canada) were recruited. Latent profile analysis was used to determine PPs (classes) using variables recommended by IMMPACT. This included pain variability, intensity and qualities, somatization, anxiodepressive symptoms, sleep, fatigue, pain catastrophizing, neuropathic pain, and quantitative sensory tests. We used MANOVA and χ2 tests to assess differences in participant characteristics across the classes and linear and Poisson regression to evaluate the association of classes to outcomes of physical performance tests, self-reported function and provincial healthcare data.

Results

In total, 343 participants were included (mean age 64 years, 64% female). Three classes were identified with increasing pain burden (class3 > class1), characterized by significant differences across most self-report measures and temporal summation, and differed in terms of female sex, younger age, lower optimism and pain self-efficacy. Participants in class2 and class3 had significantly worse self-reported function, stair climb and 40 m walk tests, and higher rates of healthcare usage compared to those in class1.

Conclusions

Three distinct PPs guided by IMMPACT recommendations were identified, predominated by self-report measures and temporal summation. Using this standardized approach may improve PP study variability and comparison.
Daniel versus Jonson: Books, Beasts and Birds
Authors: Pitcher John
Published: March 2022

The dispute between Samuel Daniel and Ben Jonson lasted two decades, until Daniel’s death in 1619. The story is usually told only from Jonson’s perspective. It began c. 1599 with Jonson’s vying with Daniel for the patronage of Lucy, Countess of Bedford. At the accession of James, Jonson presented himself as the decipherer of the court’s images. He was dismissive of Daniel’s learning and lack of sophistication, but it was Daniel who was chosen to write the first masque at court. The dispute became more vehement in 1605–1607. Jonson suggested Daniel was a brainless time-server and a plagiarist, and Daniel identified Jonson as a wolf trying to get under Lady Bedford’s skin (alluding to the goat emblem on the covers of the Countess’s books). This was when Jonson announced his claim to be the Horace of the age—not just in the public theatres (as in Poetaster), but to the elite of the Jacobean court. At this point Daniel was facing a Privy Council enquiry into his play, Philotas, but he survived. His tragicomedy, The Queen’s Arcadia, was successful when the King and court visited Oxford University in 1605, in events to which Jonson was probably not invited. The essay examines what Daniel said about (as he thought) Jonson’s indecorous fictions and his bullying—and how and why Daniel said these things, through allusions to Lady Bedford’s books, to the persona of the less judgemental Horace (i.e., not Jonson’s version) and to his own sickness and withdrawal from the debate.
Negative Symptom Domains in Children and Adolescents at Ultra-High Risk for Psychosis: Association With Real-Life Functioning
Authors: Giordano Giulia Maria , Palumbo Davide , Pontillo Maria , Mucci Armida , Galderisi Silvana , Vicari Stefano
Published: March 2022

Background

Negative symptoms (NS) appear early in subjects at ultra-high risk (UHR) for psychosis and may increase the risk of conversion to psychotic disorders and poor outcome. Contrary to schizophrenia, there is no consensus on the conceptualization and factor structure of NS in UHR subjects. This study aims to explore NS prevalence, factor structure, and impact on the outcome of UHR state in children and adolescents.

Methods

71 UHR were recruited at the Neuropsychiatry Unit of the Hospital Bambino Gesù in Rome. We examined the prevalence of NS of at least moderate severity, the factor structure of NS by Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA), and correlations between extracted factors and functioning. We also evaluated the severity of baseline NS in subjects who converted to psychosis (converters) and in those who did not convert (nonconverters) at 1-year follow-up.

Results

At baseline, all participants showed at least one NS of at least moderate severity. PCA and CFA yielded a two-factor solution: an ‘‘Expressive” and an “Experiential” factor. Only the Experiential factor was associated with functioning. At baseline, severity of NS did not differ between converters (N = 16) and nonconverters (N = 55).

Conclusions

In UHR children and adolescents NS have a high prevalence, a significant impact on functioning, and cluster in two-factors. Replications by independent studies, with state-of-the-art instruments and longer duration of follow-up, are needed to improve the characterization of NS in this population, clarify their impact on the outcome and enhance their early identification, prevention, and treatment.
Inhibitory Effects of Phenazine Compounds and Volatile Organic Compounds Produced by Pseudomonas aurantiaca ST-TJ4 Against Phytophthora cinnamomi
Authors: Zhang Yu , Kong Wei-Liang , Wu Xiao-Qin , Li Pu-Sheng
Published: March 2022

Phytophthora cinnamomi is an important plant pathogen that is widely distributed worldwide and has caused serious ecological damage and significant economic losses in forests and plantations in many countries. The use of plant growth-promoting rhizobacteria is an effective and environmentally friendly strategy for controlling diseases caused by P. cinnamomi. In this study, we investigated the antagonistic mechanism of Pseudomonas aurantiaca ST-TJ4 against P. cinnamomi through different antagonistic approaches, observations of mycelial morphology, study of mycelial metabolism, and identification of antagonistic substances. The results showed that Pseudomonas aurantiaca ST-TJ4 was able to significantly inhibit mycelial growth, causing mycelial deformation and disrupting internal cell structures. Additionally, pathogen cell membranes were damaged by ST-TJ4, and mycelial cell content synthesis was disrupted. Ultraperformance liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry analyses showed that phenazine compounds and 2-undecanone were the main antagonistic components. The ammonia produced by the ST-TJ4 strain also contributed to the inhibition of the growth of P. cinnamomi. In conclusion, our results confirm that Pseudomonas aurantiaca ST-TJ4 can inhibit P. cinnamomi through multiple mechanisms and can be used as a biological control agent for various plant diseases caused by P. cinnamomi.
Amiodarone with or without N-Acetylcysteine for the Prevention of Atrial Fibrillation after Thoracic Surgery: A Double-blind, Randomized Trial
Authors: Amar David , Zhang Hao , Chung Mina K. , Tan Kay See , Desiderio Dawn , Park Bernard J. , Pedoto Alessia , Roistacher Nancy , Isbell James M. , Molena Daniela , Milne Ginger L. , Meyers Bryan F. , Fischer Gregory W. , Rusch Valerie W. , Jones David R.
Published: March 2022

Background

Postoperative atrial fibrillation may identify patients at risk of subsequent atrial fibrillation, with its greater risk of stroke. This study hypothesized that N-acetylcysteine mitigates inflammation and oxidative stress to reduce the incidence of postoperative atrial fibrillation.

Methods

In this double-blind, placebo-controlled trial, patients at high risk of postoperative atrial fibrillation scheduled to undergo major thoracic surgery were randomized to N-acetylcysteine plus amiodarone or placebo plus amiodarone. On arrival to the postanesthesia care unit, N-acetylcysteine or placebo intravenous bolus (50 mg/kg) and then continuous infusion (100 mg/kg over the course of 48 h) was administered plus intravenous amiodarone (bolus of 150 mg and then continuous infusion of 2 g over the course of 48 h). The primary outcome was sustained atrial fibrillation longer than 30 s by telemetry (first 72 h) or symptoms requiring intervention and confirmed by electrocardiography within 7 days of surgery. Systemic markers of inflammation (interleukin-6, interleukin-8, tumor necrosis factor α, C-reactive protein) and oxidative stress (F2-isoprostane prostaglandin F2α; isofuran) were assessed immediately after surgery and on postoperative day 2. Patients were telephoned monthly to assess the occurrence of atrial fibrillation in the first year.

Results

Among 154 patients included, postoperative atrial fibrillation occurred in 15 of 78 who received N-acetylcysteine (19%) and 13 of 76 who received placebo (17%; odds ratio, 1.24; 95.1% CI, 0.53 to 2.88; P = 0.615). The trial was stopped at the interim analysis because of futility. Of the 28 patients with postoperative atrial fibrillation, 3 (11%) were discharged in atrial fibrillation. Regardless of treatment at 1 yr, 7 of 28 patients with postoperative atrial fibrillation (25%) had recurrent episodes of atrial fibrillation. Inflammatory and oxidative stress markers were similar between groups.

Conclusions

Dual therapy comprising N-acetylcysteine plus amiodarone did not reduce the incidence of postoperative atrial fibrillation or markers of inflammation and oxidative stress early after major thoracic surgery, compared with amiodarone alone. Recurrent atrial fibrillation episodes are common among patients with postoperative atrial fibrillation within 1 yr of major thoracic surgery.

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An Online, Modular Curriculum Enhances Surgical Education and Improves Learning Outcomes in East, Central, and Southern Africa: A Mixed-Methods Study
Authors: Parker Andrea S. , Steffes Bruce C. , Hill Katherine , Bachheta Niraj , Mangaoang Deirdre , Mwachiro Michael , Torbeck Laura , White Russell E. , Bekele Abebe , Parker Robert K.
Published: March 2022

Objective:

We aimed to determine the impact of a standardized curriculum on learning outcomes for surgical trainees in East, Central, and Southern Africa (ECSA).

Background:

As surgical education expands throughout ECSA, there is a recognized need for a standardized curriculum. We previously described the design of a novel, large-scale, flipped-classroom, surgical curriculum for trainees in ECSA.

Methods:

In January 2020, the first year of curricular content for trainees of the College of Surgeons of ECSA was released, containing 11 monthly thematic topics, each with 2 to 5 weekly modular subtopics. We aimed to evaluate 3 outcomes utilizing data sources incorporated into the curriculum structure. Learner engagement was assessed by the number of trainees completing curriculum topics. User experience was evaluated using quantitative and qualitative feedback responses to embedded surveys for each content week. Curriculum impact on trainee examination performance was assessed by comparing certification examination scores stratified by the number of curricular topics each trainee completed.

Results:

Two hundred seventy-one trainees (96%) in 17 countries accessed at least 1 weekly module. Trainees completed a median of 9 topics (interquartile range: 6–10). The feedback survey response rate was 92% (5742/6233). Quantitative and qualitative responses were positive in overall module value (93.7% + 2.6%), amount of learning experienced (97.9% + 1.4%), confidence in achieving learning objectives (97.1% + 2.4%), and ease of use of the module (77.6% + 5.98%). Topic-related certification examination performance improved significantly with increased completion of thematic topics.

Conclusions:

A standardized surgical curriculum in ECSA demonstrated excellent trainee usage, positive feedback, and improved examination scores.
Design of a Novel Online, Modular, Flipped-classroom Surgical Curriculum for East, Central, and Southern Africa
Authors: Parker Andrea S. , Hill Katherine A. , Steffes Bruce C. , Mangaoang Deirdre , O’Flynn Eric , Bachheta Niraj , Bates Maria F. , Bitta Caesar , Carter Nicholas H. , Davis Richard E. , Dressler Jeremy A. , Eisenhut Deborah A. , Fadipe Akinniyi E. , Kanyi John K. , Kauffmann Rondi M. , Kazal Frances , Kyamanywa Patrick , Lando Justus O. , Many Heath R. , Mbithi Valentine C. , McCoy Amanda J. , Meade Peter C. , Ndegwa Wairimu Y.B. , Nkusi Emmy A. , Ooko Philip B. , Osilli Dixon J.S. , Parker Madison E.D. , Rankeeti Sinkeet , Shafer Katherine , Smith James D. , Snyder David , Sylvester Kimutai R. , Wakeley Michelle E. , Wekesa Marvin K. , Torbeck Laura , White Russell E. , Bekele Abebe , Parker Robert K.
Published: March 2022

Objective:

We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA).

Summary Background Data:

Surgical education is essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was deemed necessary.

Methods:

We utilized Kern’s 6-step approach to curriculum development to design an online, modular, flipped-classroom surgical curriculum. Steps included global and targeted needs assessments, determination of goals and objectives, the establishment of educational strategies, implementation, and evaluation.

Results:

Global needs assessment identified the development of a standardized curriculum as an essential next step in the growth of surgical education programs in ECSA. Targeted needs assessment of stakeholders found medical knowledge challenges, regulatory requirements, language variance, content gaps, expense and availability of resources, faculty numbers, and content delivery method to be factors to inform curriculum design. Goals emerged to increase uniformity and consistency in training, create contextually relevant material, incorporate best educational practices, reduce faculty burden, and ease content delivery and updates. Educational strategies centered on developing an online, flipped-classroom, modular curriculum emphasizing textual simplicity, multimedia components, and incorporation of active learning strategies. The implementation process involved establishing thematic topics and subtopics, the content of which was authored by regional surgeon educators and edited by content experts. Evaluation was performed by recording participation, soliciting user feedback, and evaluating scores on a certification examination.

Conclusions:

We present the systematic design of a large-scale, context-relevant, data-driven surgical curriculum for the ECSA region.
EVALUATION OF MORNING GLORY SYNDROME BY SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY
Authors: Ohno-Matsui Kyoko , Akiba Masahiro , Ishibashi Tatsuro , Hirakata Akito
Published: March 2022

Purpose:

The purpose of this study was to investigate the deep structural abnormalities in the patients with morning glory syndrome by using swept source optical coherence tomography.

Methods:

The papillary and peripapillary areas of the four eyes (four patients) with morning glory syndrome were examined with a prototype swept source optical coherence tomography system with a center wavelength of 1,050 nm. In particular, the abnormalities of the lamina cribrosa and peripapillary sclera were evaluated.

Results:

The lamina cribrosa was posteriorly displaced in all the four eyes, and the disk area was filled with herniated retinal tissue. A bump-like protrusion near the papillary margin or within the cup area was observed in three eyes. Some tissues were observed to exist between the retina and the sclera surrounding the papillary margin annularly. In one case, swept source optical coherence tomography detected intrascleral adipose tissue in a relatively wide area around the fovea and the optic nerve.

Conclusion:

Swept source optical coherence tomography clearly delineated the papillary and peripapillary abnormalities of morning glory syndrome. Scleral structural abnormalities were present outside the optic nerve as well.
Preventing Potentially Inappropriate Use of Antibiotics Using the World Health Organization AWaRe Tool
Authors: Maria Lis , Thomas Femy , Thomas Maria , Shibuchan Diya , Mathew Meby Susan , Warrier Anup R. , Karunakaran Priya , Xavier Adhin Antony
Published: March 2022

Background

To avert the rise in antimicrobial resistance, the World Health Organization (WHO) introduced the AWaRe (Access, Watch, Reserve) tool to its Essential Medicines List in 2017. In India, only few studies analyzing the antibiotic prescribing pattern according to AWaRe tool were conducted, most of which included data from wholesale databases.

Aim

This study was aimed at analyzing the antibiotic prescriptions in the outpatient (OP) clinic of a quaternary care hospital as per the WHO AWaRe tool.

Method

This observational study collected the details of patients who received at least 1 oral/intravenous antibiotic and visited the OP clinic during August 2018 to August 2019. The data were collected from electronic medical record, and it included patient demographics, department, and name of antibiotics prescribed. The proportion of antibiotic use was measured as per WHO AWaRE tool.

Results

A total of 23,088 antibiotic prescriptions were collected from 58 departments. It was found that 41.32% of antibiotics were from the Access group, whereas 51.01% were from the Watch group and 1.19% from the Reserve group. Amoxicillin-clavulanic acid (Access), azithromycin (Watch), and linezolid (Reserve) were the commonly prescribed antibiotics in the OP department.

Conclusions

Considering the overall use, the Watch group antibiotics were used to a great extent compared with that of the Access antibiotics, which contradicts the recommended WHO AWaRe criteria. This simple and easy-to-apply antibiotic use monitoring tool, “AWaRe,” must be aligned with the local antibiogram to serve the patient best.
When to Use Amisulpride in Adolescents
Authors: Tuncturk Mustafa , Ermis Cagatay , Saglam Yesim , Can Merve , Yuksel Ayse Sena , Akca Dilara , Alarslan Sezen , Atay Ayca , Ciray Remzi Ogulcan , Turan Serkan , Karacetin Gul
Published: March 2022

Purpose/Background

Despite increasing interest in amisulpride, current knowledge about its use in the pediatric population is scarce. This chart review aimed to investigate the use of amisulpride in a naturalistic adolescent population.

Methods/Procedures

Electronic medical records of a tertiary care adolescent inpatient unit were screened between January 2015 and April 2021. Sociodemographic data and all clinical information were collected via data collection forms, and targeted symptoms were obtained from patients' files. Patients with early-onset psychotic disorders (n = 58), bipolar I disorder (n = 29), major depressive disorder (n = 14), and other psychiatric diagnoses (n = 9) were included. Treatment response was defined as a Clinical Global Impression–Improvement of at least much improvement after treatment.

Findings/Results

Median titration rate of amisulpride was 400 mg/wk, and the maximum administered daily dose ranged between 100 and 1200 mg/d. The maximum daily dose and number of previous antipsychotics were higher in the early-onset psychotic disorder group. Persistent positive symptoms and resistance to previous treatments were leading causes for amisulpride treatment. Other indications were also impulsive/disruptive behaviors, antipsychotic adverse effects, depressive symptoms, somatic complaints, and abnormalities in liver function tests. Finally, patients with lower daily treatment doses and more previous antipsychotic trials are less likely to benefit from the treatment.

Implications/Conclusions

Persistent psychotic/mood symptoms, impulsive/disruptive behaviors, and abnormalities in liver function tests were reasons for the amisulpride treatment in adolescents. Randomized placebo-controlled trials are needed to evaluate the efficacy and safety of the treatment in adolescents.
Aripiprazole as First-Line Therapy for Late-Life Depression
Authors: Sonal Akanksha , Srivastava Shrikant
Published: March 2022

Background

Aripiprazole, structurally considered a third-generation antipsychotic agent, is an effective adjuvant strategy for managing treatment-resistant depression. It has been used successfully as an add-on agent in late-life depression (LLD), but there are no controlled trials on its use as first-line therapy, either alone or in combination with an antidepressant.

Methods

This is a case note review of aripiprazole prescribed to outpatients with LLD as a first-line therapy either in combination with an antidepressant or as a monotherapy. The local ethics committee approved the audit. Case notes of subjects with Hamilton Rating Scale for Depression scores of ≥11 and with at least 1 follow-up visit were included in the review. Remission was defined as the first occurrence of achieving a Hamilton Rating Scale for Depression score of <10.

Results

Case notes of 54 subjects (mean age, 68.6 ± 6.9 years) were included, 52 of whom had unipolar depression. Aripiprazole alone was prescribed in 21 subjects, and with an antidepressant in the remaining subjects. The overall remission rate was 59% over 21 weeks, and in the remitted subjects (n = 32), the cumulative remission rate increased from 22% at week 2 to 82% at week 10. No subject discontinued treatment because of poor tolerability or serious adverse events.

Conclusions

Aripiprazole was found to be an effective first-line antidepressant in LLD. The remission rates in the present study were considerably higher than the published literature on antidepressant monotherapy in fresh episodes of LLD. This warrants controlled trials of aripiprazole as a first-line antidepressant for this disease entity.
Interprofessional Pediatric Trauma Resuscitation Simulation
Authors: Dorman Robert James , Ciurzynski Susan M. , Wakeman Derek S.
Published: March 2022

Introduction

Successful resuscitation of pediatric trauma patients requires a team of individuals to come together to provide coordinated, efficient care to the injured child. Lack of specific education in team dynamics and trauma resuscitation skills, combined with a constantly changing membership of pediatric trauma teams, creates barriers to excellence in care delivery. Therefore, it is essential for teams to practice these high-risk, low-volume skills to establish and maintain competency.

Methods

An online educational program consisting of team dynamic training, hospital-specific trauma roles/responsibilities, and exposure to a trauma resuscitation checklist was delivered to 40 interprofessional participants who were representative of the pediatric trauma team. Team members then attended an in-situ simulation of two pediatric trauma resuscitation scenarios.

Results

Forty interprofessional team members participated in the program. Education and simulations were well received by the overwhelming majority of participants, with mean scores for achievement of program objectives ranging from 4.75 to 4.85 based on a Likert scale from 1 to 5. Logistical details such as scheduling, equipment setup and takedown, stakeholder buy-in, and validation for continued program funding were determined to be sustainable in that the overall program was not labor intensive, the scheduling system was user friendly, and the financial impact was minimal.

Discussion

This project provided participants with a baseline of education and the opportunity to practice pediatric trauma resuscitation using simulated scenarios that allowed for assessment of team functioning and clinical performance. The results reinforced the acceptance of interprofessional education and identified subject matter for future educational programs.
Hearing Preservation in Observed Sporadic Vestibular Schwannoma: A Systematic Review
Authors: Khandalavala Karl R. , Saba Elias S. , Kocharyan Armine , Daher Ghazal S. , Lohse Christine M. , Marinelli John P. , Carlson Matthew L.
Published: March 2022

Objective

To characterize the natural history of hearing loss for patients presenting with serviceable hearing (SH) who undergo a wait-and-scan approach for sporadic vestibular schwannoma (VS) using aggregate time-to-event survival analysis.

Study Design

Systematic review.

Setting

Published international English literature, January 1, 2000 to May 31, 2020.

Patients

Patients with sporadic VS entering a wait-and-scan approach with SH at diagnosis.

Interventions

Observation with serial MRI and audiometry.

Results

In total, 3,652 patients from 26 studies were included for analysis. Mean age at diagnosis was 58.8 years (SD, 4.1). Mean follow-up was 49.2 months (SD, 26.5). In total, 755 patients (21%) failed conservative treatment and underwent radiosurgery or microsurgery at the time of last follow-up. The average loss to follow-up was 6.9% (SD, 11.1). A total of 1,674 patients had SH at the time of diagnosis. Survival rates for maintaining SH were 96% at 1 year, 77% at 3 years, 62% at 5 years, and 42% at 10 years following diagnosis.

Conclusion

In this systematic review, aggregate data from 3,652 patients across 26 studies show consistent patterns in progression of hearing loss during observation for patients with sporadic VS as a function of time. As an easy-toremember conservative benchmark for those presenting with SH at diagnosis: approximately 75% retain SH at 3 years, 60% at 5 years, and 40% at 10 years.
Cochlear Implant Outcomes in CHARGE Syndrome: Updated Perspectives
Authors: Kay-Rivest Emily , McMenomey Sean O. , Jethanamest Daniel , Thomas Roland J. , Shapiro William H. , Waltzman Susan B. , Friedmann David R.
Published: March 2022

Objective

To evaluate outcomes of auditory implants in children with CHARGE syndrome and describe the evolution in management of hearing loss in this complex population.

Methods

A retrospective case review was performed at a tertiary referral center. Children with CHARGE syndrome who received either a cochlear implant (CI) or auditory brainstem implant (ABI) were included. Clinical records, demographic information, CHARGE features, neuroimaging, audiology, hearing rehabilitation interventions, operative notes, and outcomes were reviewed.

Results

Thirteen children with CHARGE syndrome underwent a total of 19 cochlear implants between 2008 and 2020. Among the congenitally deafened children (n = 9), six underwent bilateral implantation (five simultaneous and one sequential). Bilateral implantation was performed even in the presence of diminutive-appearing cochlear nerves. The average age of implantation was 1.1 years, and the mean device use time was 9.4 hours per day. Patients showed improvements in subjective family assessment related to hearing. In this group, two patients use oral communication, five use total communication, and two use sign language exclusively. Among the children with progressive hearing loss, the mean age of hearing deterioration was 4.4 years of age, and the device use time on average was 9.8 hours per day. The highest performer in the cohort was a child who lost hearing in their only hearing ear at age 4 and had normal cochleovestibular anatomy on that side. One child received an auditory brainstem implant at age two after deriving no benefit from a CI and can detect environmental sounds but is currently a nonuser. Over time, we noted that implantation occurred earlier in life and that practice has shifted toward bilateral implantation.

Conclusions

Compared to a previous institutional cohort, children evaluated in this study were often implanted at a younger age and bilaterally with significantly improved outcomes. A CI evaluation should be considered in children with CHARGE syndrome to maximize sensory input and auditory ability.
Barriers to Pediatric Osseointegrated Bone-Conduction Hearing Devices
Authors: Koenigs Maria B. , Behzadpour Hengameh K. , Harrington Chloe B. , Prado Leslie , Gorelik Daniel , Woolman Karen , Rana Md Sohel , Preciado Diego A. , Reilly Brian K.
Published: March 2022

Objective:

To identify social, demographic, and clinical barriers for implantation with Osseointegrated Bone Conduction Devices (OBCD) in pediatric candidates.

Study Design:

Retrospective cohort study of 94 children who met standard OBCD implantation criteria.

Setting:

Tertiary stand-alone children's hospital.

Materials and Methods:

Retrospective chart review comparing demographic (age, race, state of residence, and insurance) and clinical (severity and etiology of hearing loss, medical comorbidities, and early intervention) factors impacting implantation. Members of the existing cohort were then contacted to obtain a better understanding of qualitative factors impacting surgical decision.

Results:

Of the identified 94 surgical candidates, 47 (50%) underwent OBCD implantation. State of residence significantly impacted implantation rates, with children from the District of Columbia and Virginia being less likely to receive an implant than those from Maryland. Private insurance, race, and ethnicity did not impact rate of implantation (OR 2.8 [95% CI 0.78–10]; 1.34 [95% CI 0.44–3.68]; and 1.0 [95% CI 0.42–2.43], respectively). Children with anotia or microtia and children younger than 10 years old were less likely to have an implant (OR 10.6 (95% CI 1.74–65). Thirty-nine children participated in the qualitative portion. Themes that emerged as reasons to forgo implantation included a child's young age, planned reconstruction for microtia or atresia, and overall device functionality and usage. Thirtyseven children (39%) of the cohort declined surgery and currently wear a nonsurgical bone conduction aid regularly.

Conclusion:

Despite known benefits of implantation, only one-half of children who were candidates underwent OBCD. Unlike cochlear implantation, where insurance status is a major risk factor for implantation delay and underperformance, for OBCD, implantation barriers appear to be more multifactorial and include medical, demographic, and social factors.
Postviral Gastroparesis Associated With SARS-CoV-2 Infection in a Pediatric Patient
Authors: Rusch Courtney M. , Molleston Jerome M. , Glasser Matthew F , Don Steven , Kulkarni Sakil S.
Published: March 2022

Postviral gastroparesis has been described in children, but it has not yet been attributed to SARS-CoV-2 infection. Our case report describes a teenager with abdominal pain, early satiety, and vomiting who likely had an asymptomatic SARS-CoV-2 infection 2 months before presentation. Through investigation of epidemiologic links, antibody testing, and clinical course, it is hypothesized that her significant reduction in gastric emptying was due to postviral gastroparesis secondary to SARS-CoV-2. She was treated with supportive care and prokinetic agents. The patient demonstrated symptom resolution and near normalization of gastric emptying by the time of 1 month follow up.
Measles seroprevalence in human immunodeficiency virus-infected adults born in the era of measles vaccination
Authors: Lefebvre Maeva , Secher Solène , Bouchez Sabelline , Vandamme Yves-Marie , Fialaire Pascale , Leautez Sophie , Blanchi Sophie , Michau Christophe , Coste-Burel Marianne , Brunet-Cartier Cécile , Reliquet Véronique , Gregoire Antoine , Raffi François , Allavena Clotilde ,   on behalf of the VIHStaRouge study group∗
Published: March 2022

Objective:

Widespread use of the measles vaccine should lead to the elimination of this disease. Here, we study the seroprevalence of measles in a cohort of adults living with HIV born after the introduction of measles vaccine in France and attempt to identify risk factors for the absence of serum measles antibody.

Design:

In this multi-centre cross-sectional study, adult outpatients born after 1980 were screened for the presence of measles IgG antibody. Demographic and clinical data were obtained from the standardized electronic medical record system. Univariate and multivariate logistic regressions were performed to identify factors associated with the absence of measles antibodies.

Results:

Between April 2019 and April 2020, 648 participants were enrolled. The median age was 33 years, 53.6% were born outside of France, and 74% were considered as socially deprived. Plasma HIV RNA was undetectable in 86% of patients. Among 603 evaluable patients, measles serology was positive in 87.2%. Only 81.8% of the patients with documented vaccination tested positive for measles IgG. Younger age was significantly associated with the absence of measles serum antibodies (P = 0.004 for each 10-year lower), as was birth in France (P < 0.001) and absence of social vulnerability (P = 0.04).

Conclusion:

The current study revealed a low seroprevalence of measles compared with that previously reported in France 6 years earlier and to the expected rate to achieve herd immunity. Checking vaccination record should be systematically carried out in patients living with HIV to fill the immunity gaps.
Clinical Features and Outcomes of Patients with Orbital Schwannoma
Authors: Park Na Ri , Kim Sung Eun , Jung Su-Kyung , Cho Won-Kyung , Paik Ji-Sun , Yang Suk-Woo
Published: March 2022

Purpose:

To report the clinical features, treatment, and outcome of 11 patients with orbital schwannoma in Korean patients.

Methods:

The medical records of 11 orbital schwannoma patients treated between April 2007 and April 2021 were retrospectively reviewed. The demographic data, clinical characteristics, radiological features, and outcomes were reviewed.

Results:

The mean age at the time of diagnosis was 49.00 ± 14.45 years. The most common initial symptom was ocular protrusion (n = 7), and other symptoms were decreased visual acuity (n = 5), restriction of eye movement (n = 4), swelling (n = 3), and pain (n = 2). Locations of tumors were superomedial; followed by the orbital apex and inferolateral. The most common shape seen in our patients was beads like multilobulated appearance; followed by a round, oval, fusiform, and dumbbell shape. MRI of T1-weighted revealed isointense or hypointense, whereas the T2-weighted indicated hyper or isointense lesion. Five patients had optic neuropathy at presentation, and 1 of them showed improved vision after surgery. Complete or incomplete excision was performed for all. Surgical complications include decreased vision and paraesthesia. There has been no recurrence to date.

Conclusions:

Orbital schwannoma is a rare disease and it is difficult to distinguish it from other orbital tumors because the initial symptoms are nonspecific. Differential diagnosis by combining the shape, location, and contrast enhancement findings seen on computed tomography and magnetic resonance imaging can be helpful in surgical treatment. Complete excision gives the best results without recurrence, but if the patient is in an inaccessible location, only surgery to reduce the volume can satisfy the patient without recurrence.
Clinical Application of Three-Dimensional Printing of Polycaprolactone/Beta-Tricalcium Phosphate Implants for Cranial Reconstruction
Authors: Park Hojin , Choi Jong Woo , Jeong Woo Shik
Published: March 2022

Polycaprolactone (PCL) implants are a biodegradable polymeric material with appropriate mechanical strength and durability for use in cranioplasty. They can be manufactured as patient- customized implants using a three-dimensional (3D) printer. Herein, the authors aimed to share our experience in cranioplasty of patients with deformed and asymmetric skulls using PCL/beta- tricalcium phosphate (ß-TCP) implants.

Seven patients underwent cranioplasty using patient-specific PCL/ß-TCP implants. Cranial computed tomography images were converted to a 3D model and mirrored to design a patient-specific implant. Based on the 3D simulation, an implant was 3D printed using PCL/ß-TCP. A 6-month follow-up was conducted with periodic visits and computed tomography scans. Symmetry after surgery and complications were evaluated.

Postoperatively, the soft tissue volumes increased to 15.8 ± 17.2 cm3 and 14.9 ± 15.7 cm3 at 2 weeks and 6 months of follow-up, respectively. The volume change from 2 weeks to 6 months was —4.4 ± 2.5%. Six patients achieved complete symmetry after cranioplasty, whereas 1 patient noticed partial symmetry. The symmetry remained unchanged at 6 months of follow-up. Upon palpation to assess smoothness, 6 patients exhibited a smooth edge interface, whereas 1 patient had a slightly irregular edge.

Based on these findings, 3D-printed PCL/ß-TCP implants are an excellent material for cranioplasty, and a favorable cosmetic outcome can be achieved. Specifically, these novel PCL/ß-TCP implants have good biocompatibility and mechanical strength without any postoperative foreign body reaction.