bluuebunny/crossref_metadata_2025 huggingface dataset:
Content comparison of neck pain outcome measures using the international classification of functioning, disability and health
Authors: Tiwari Devashish , Clock Christopher , Gore Shweta , Alsalaheen Bara
Published: November 2021

The purpose of this study was to compare the content covered by existing neck pain measures based on the linkage to the International Classification of Functioning, Disability and Health (ICF) framework to examine the extent to which the existing measures represent ICF categories and to identify content gaps in existing measures that would inform further research. Ten commonly used measures were identified, and their content was linked to ICF categories using established coding systems. Two clinical experts reviewed every measure independently and identified the central meaningful concepts from individual items of each measure. A total of 177 concepts were identified from 193 items across 10 measures. Body functions were the most represented category across measures (23–64%). The representation of activities ranged from 14 to 61% whereas the representation of participation ranged from 6 to 31% across measures. The ProFitMap-Neck was the only measure that addressed the environmental factors. The ProFit-Map neck captured a majority of concepts from body structures and function and the neck outcome score captured maximum concepts from the activities and participation categories. A combination of ProFit-Map neck and Neck Outcome Score can be used with caution to obtain a more comprehensive assessment of the impact of neck pain on function, activities and participation.
Nurses' Perceptions of Recommended Fall Prevention Strategies
Authors: Garcia Amanda , Bjarnadottir Ragnhildur (Raga) I. , Keenan Gail M. , Macieira Tamara G. R.
Published: November 2021

Background:

Limited studies have synthesized evidence on nurses' perceptions of recommended fall prevention strategies and potential differences between those and the practiced strategies.

Purpose:

To synthesize evidence about nurses' perceptions of recommended fall prevention strategies for hospitalized adults.

Methods:

Using PubMed, 50 records underwent abstract and full-text screening, and 10 studies were retained. Narrative synthesis was conducted to identify common themes across studies. Quality assessment was not performed.

Results:

Nurses are aware of effective fall prevention strategies but identified unit-level barriers and facilitators to implementing these in their practice. Unit culture and policies, educational offerings, nursing interventions, and style of communication and collaboration were seen to influence fall prevention.

Conclusions:

Nurses recognize falls as a multifactorial issue suggesting that prevention efforts be tailored to the unit and involve all employees. We recommend that future research emphasize identifying and understanding the combination of factors that produce successful unit-level fall prevention strategies.
Racial Disparities in Care Interactions and Clinical Outcomes in Black Versus White Nursing Home Residents With Dementia
Authors: Resnick Barbara , Van Haitsma Kimberly , Kolanowski Ann , Galik Elizabeth , Boltz Marie , Ellis Jeanette , Behrens Liza , Eshraghi Karen
Published: November 2021

Background:

With the increase in Black nursing home residents, racial and ethnic disparities in quality of care have been raised.

Purpose:

The purpose of this study was to evaluate racial disparities in care and outcomes over 12 months.

Methods:

This was a secondary data analysis using data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia study. A total of 553 residents, 24% Black residents and 76% White residents, from 55 nursing homes were included.

Results:

Differences favoring Black resident were noted in agitation, quality of life, inclusion of person-centered care approaches in care plans, and fewer falls and hospitalizations. Differences in quality-of-care interactions favored White residents. There were no differences in depression, resistiveness to care, function, pain, or transfers to the emergency department.

Conclusions:

Disparities in clinical outcomes were small and generally favored Black versus White residents except for quality-of-care interactions.
Self-assessment of Rationing and Quality of Nursing Care
Authors: Witczak Izabela , Kołtuniuk Aleksandra , Rypicz Łukasz , Panczyk Mariusz , Grzebieluch Wojciech , Młynarska Agnieszka , Uchmanowicz Izabella
Published: November 2021

Background:

Nursing care rationing has been a widespread problem in everyday nursing practice for many years.

Purpose:

The aim of this research study was to assess the prevalence of care rationing among nurses working in Poland.

Methods:

The study was conducted among a population of 1310 nurses. To examine the dependencies between the sociodemographics and unfinished nursing care, the Polish adaptation of the Perceived Implicit Rationing of Nursing Care questionnaire and an investigator-developed questionnaire were used.

Results:

The mean level of missed care was 1.16 (SD = 0.7). The significant predictors of care rationing were associated with the quality of patient care (βstd = −.43, P < .001) and general work satisfaction (βstd = −.15, P < .001).

Conclusions:

Job satisfaction and the quality of nursing care should be constantly monitored as these factors are significantly associated with the levels of care rationing.
Stigma, Uncertainty, and Coping at the Time of COVID-19 Pandemic Amid Health Care Professionals
Authors: Ayoub Doaa R. , Gohar Sherif M. , Khalil Mohamed A. , Abdel-Hamid Hoda M. , Mostafa El-Makawi Shirin
Published: November 2021

Stigma and uncertainty are noticed in global pandemics. Their impacts on health care providers tend to persist notably during and after the outbreaks. Our objective was to assess stigma, uncertainty, and coping among health care providers through an online survey using the Discrimination and Stigma Scale Version 12 (DISC-12) modified version to assess stigma related to treating COVID-19, the Intolerance of Uncertainty Scale, and the Brief Resilient Coping Scale (BRCS). Of the respondents (n = 65), 63.1% treated patients with COVID-19, and 21.5% worked in isolation hospitals. Physicians who treated patients with COVID-19 had significantly higher scores in all DISC subscales: unfair treatment (8.73 ± 6.39, p = 0.001), stopping self from doing things (2.05 ± 1.41, p = 0.019), overcoming stigma (1.17 ± 0.80, p = 0.035), and positive treatment (1.90 ± 1.65, p = 0.005). Unfair treatment was negatively correlated with BRCS (r = −0.279, p = 0.024). On the other hand, physicians who did not treat patients with COVID-19 had significantly higher BRCS scores. We concluded that frontline physicians experienced greater stigma associated with lower resilient coping strategies.
Author Diversity on Clinical Practice Guideline Committees
Authors: Verduzco-Gutierrez Monica , Katz Nicole B. , Fleming Talya K. , Silver Emily M. , Hunter Tracey L. , El Sayed Nuha , Escalon Miguel X. , Lorello Gianni R. , Silver Julie K.
Published: November 2021

Reports have demonstrated that women overall and women physicians, in particular, are underrepresented as authors of clinical practice guidelines. This analysis used publicly available information to explore the diversity of rehabilitation-related clinical practice guideline authors by gender, race, and ethnicity. Primary analysis identified authors’ gender, race, ethnicity, and visible minority status. Two sets were analyzed: (1) clinical practice guidelines by Department of Veterans Affairs (VA) categorized as “Rehabilitation” or “Pain” (n = 7; VA clinical practice guidelines) and (2) a set (n = 10) published in the United States (US) from 2019 to 2021 that were selected because of low numbers of inclusion at less than 20% women authors. Key findings include that among physician authors, both the VA and US clinical practice guidelines underrepresented women (15 [24.2%] and 27 [16.7%], respectively) and those coded as a racial or ethnic minority were particularly underrepresented. Notably, women authors overall were equally represented (92 [50.0%]) in the VA clinical practice guidelines. The US clinical practice guidelines had women authors who were underrepresented (36 [19.0%]). Secondary analysis of the entire set of VA clinical practice guidelines (n = 21) found gaps in diversity-related content. Clinical practice guidelines have far-reaching health and economic impacts, and addressing disparities in the diversity of author teams and/or gaps in diversity-related content is of paramount importance.
Implant Placement With Graftless Sinus Floor Elevation via the Lateral Approach: A Case Series With 4 Years Post-Loading Radiographical Outcomes and Implant Survival Rate
Authors: Menassa Gabriel , Kassir Abdel Rahman , Landi Luca , Naaman Nada Bou Abboud , Chakar Carole
Published: November 2021

The purpose of the present study was to evaluate the radiographical outcomes, survival rate, and amount of bone formation around implants placed during graftless lateral sinus lift approach (GLSLA). Five patients (6 sinus augmentations) were consecutively treated with GLSLA. After Schneiderian membrane elevation and implant insertion, only blood clot was left to fill the new sinus compartment. After 4 months of healing, implants were functionally loaded. in all cases, samples were taken for biopsy at the time of second-stage surgery. The radiographical marginal bone variations and apical bone gain were assessed using cone beam— computed tomography taken 4 months after the surgery (at crown insertion) and after 4 years of loading. A total of 14 implants were placed in a mean initial residual bone height of 3.1 mm (range 1.64 mm). No failure was recorded, and all the implants were successfully loaded yielding a 100% survival rate. Vital bone formation was 33% according to the histomorphometry data. Four years after loading the mean radiographic bone remodeling was 1.3 mm. The mean ridge height was 7.6 mm and the mean apical bone gain amounted for 3.8mm. Within the limitations of this study, the placement of dental implants in conjunction with GLSLA seems to be feasible and accompanied by high implant survival rate.
Ultrasonic Imaging Investigation of Tongue Movement Patterns of Cleft-Related Lateralized and Palatalized Misarticulation
Authors: Zhu Mengxian , Li Sheng , Zhou Guangchao , Wang Binbing , Jiang Chenghui , Shi Xinghui
Published: November 2021

Objectives:

To explore the tongue movement patterns on Mandarin speaking children with repaired cleft palate with lateralized and palatalized misarticulation (LPM) using ultrasound imaging technique.

Methods:

A group of 20 subjects who were diagnosed with speech sound disorder after cleft palate repairment, and another group of 18 children with LPM were recruited. A group of 20 typical children were recruited as the control group. The ultrasonography was used to collect the articulation pattern of the 8 single vowels that are /a/, /o/, / ɘ/, /i/, /u/, /y/, /ɨ/, /ʉ/ in Mandarin Chinese. Various ultrasonic tongue parameters were analyzed from both sagittal and coronal planes.

Results:

Compared with the control group, coronal height of peak point, coronal tongue dorsum constraint index, sagittal peak point offset distance, sagittal distance between tongue tip and peak point, and sagittal tongue dorsum constraint index of /ɘ/,/i/, /y/ and /ɨ/ were significantly smaller in the cleft-related lateralized and palatalized group (CLP) and noncleft-related lateralized and palatalized group (NLP) (P 
< 0.05). Compared with the noncleft-related later- alized and palatalized group and control group, sagittal peak point offset distance of the vowels /ɘ/ and /i/ was significant smaller in the cleft-related lateralized and palatalized group group (P < 0.05).

Conclusions:

The ultrasound images on the children with cleft palate showed a midline elevation of the tongue and a significant apical constriction. The children with LPM showed a midline elevation at the coronal plane and anterior movement of the tongue high point at the sagittal plane. The apical vowels were more informative and accurate in indicating the features of LPM than other vowels.
Management of Palatal Fistula Using Superficial Circumflex Iliac Artery Perforator Flap With Intraoral Anastomosis and Supermicrosurgery Techniques
Authors: Zhang Guohao , Zhu Hongping , Zheng Lei
Published: November 2021

Postoperative palatal fistula following primary cleft palate repair, especially wide and recurrent defects, presents significant challenges to management. When the fistula is surrounded by limited and scarred regional tissues, vascularized free flaps are recommended. The authors propose a novel method to repair a wide and recurrent palatal fistula resulting in excellent aesthetics and minor donor-site complications. The superficial circumflex iliac artery perforator flap was transferred with the application of intraoral anastomosis and supermicrosurgery techniques for palatal fistula closure.
Hard Tissue Preservation and Recovery in Minimally Invasive Alveolar Surgery Using Three-Dimensional Printing Guide Plate
Authors: Tang Xiaopeng , Lai Qingguo , Xue Runqi , Ci Jiangbo
Published: November 2021

Background:

For completely impacted teeth, it is of great significance to locate teeth accurately, preserve hard tissue and recovering the height of alveolar ridge. This can be effectively solved by the digital three-dimensional printing guide technology.

Methods:

Ten patients with completely impacted tooth were selected in this experiment. After cone-beam computed tomography scan, the dicom formal computed tomography data was analyzed for threedimensional reconstruction by mimics 17.0 software. Then determining the surgical plan and making surgical guide plate. Threedimensional printing guide plate assisted piezosurgery was used to remove bone and extract impacted teeth. After that, the removed bone cap was back to the original position. Cone-beam computed tomography was used for each operated patients after 1 week and 6 months.

Result:

The surgical guide plates can locate teeth accurately and the surgery time was reduced for all patients. A week later, all patients healed well and removed the stitches on time. Cone-beam computed tomography showed that the retention of bone caps was good and there was no displacement. All patients showed a normal parameter of pain. Six months later, cone-beam computed tomography showed good bone formation in the extraction area, which filled with new bones completely. The recovery of bone outline and height of alveolar crest at the surgical site were basically consistent with those before the operation.

Conclusions:

Three-dimensional printing guide plates combining with fenestration and bone-cap restoration can locate impacted teeth accurately, reduce the extraction volume of bone, shorten surgery time, and alleviate complications. This was conducive to preserve and restore hard tissue and had great prospective.
Clinical Manifestations in Patients Wearing Ocular Prostheses
Authors: Kim Joohyun , Yoon Sumin , Lee Hyunkyu , Lee Hwa , Baek Sehyun
Published: November 2021

Purpose:

This study aimed to assess upper and lower eyelid shapes and changes in patients wearing ocular prostheses.

Methods:

The authors retrospectively reviewed the clinical records of patients wearing ocular prostheses. Clinical manifestations, including superior sulcus deepening, ptosis, upper and lower eyelid entropion, upper and lower eyelid ectropion, upper and lower eyelid retraction, and upper and lower eyelid socket contracture were investigated.

Results:

For those patients who underwent evisceration, the most common clinical manifestations of the eyelid were superior sulcus deepening and ptosis (35%, respectively), whereas lower eyelid entropion and lower eyelid retraction were the second most common manifestations (25%, respectively). Among those patients who underwent enucleation, the most common eyelid changes were lower eyelid entropion (45.5%), and ptosis and lower eyelid socket contracture were the second most common alterations (36.4%, respectively). Finally, superior sulcus deepening, upper eyelid entropion, and lower eyelid retraction occurred in 27.3% of patients, respectively.

Conclusions:

Upper eyelid ptosis, superior sulcus deepening, and lower eyelid entropion and retraction were the most common clinical manifestations in patients wearing ocular prostheses. When following up with patients with ocular prostheses, it is important to check these eyelid changes and consider making appropriate corrections.
Analyses of Youtube Videos on Botox Treatment of Gummy Smile
Authors: Yagiz Ozlem , Yavuz Günay Yapici , Keskinruzgar Aydin , Acibadem Elif
Published: November 2021

Objective:

The purpose of this study was to determine the content quality and accuracy of the YouTube videos about the Botox application during gummy smile treatment and to analyze the efficacy of these videos in informing the healthcare professionals and the patients.

Materials and Methods:

The first 200 videos resulting from the search on YouTube by using the keywords “gummy smile/Botox,” which were determined by Google Trends, were evaluated in the study. One hundred fourteen out of these 200 videos were included in the study. The videos were calculated using these descriptive features. A content scale consisting of 8 categories was used to determine the content levels of the videos and the video information and quality index scale was used to determine the quality level.

Results:

The most mentioned subjects in the videos were “Description” of the gummy smile and Botox treatment (71.9%), “Advantage” of Botox treatment (51.8%), “Procedure” (48.2%), and “Prognosis” (47.4%). The “Contraindication” was mentioned rarely (2.6%). A statistically significant difference was found between the videos with different content levels in terms of Description, Advantage, indication, Procedure, Complication, Prognosis, and Cost. Likewise, there was a statistically significant difference between videos in distinct content level groups in terms of video information and quality index total score.

Conclusions:

The quality of the YouTube videos about Botox applications in gummy smile treatment was found to be low in general. it is important for the physician who will perform the procedure to explain the procedure to the patients in detail. in addition, YouTube was determinedto be insufficient for accessing high-quality information for students, assistants, and specialist physicians.
Changes in Hyoid Bone Position Before and After Distraction Osteogenesis in Infants With Robin Sequence
Authors: Li Fan , Li Hehong , Hao Jiansuo , Gao Zijun , Wang Hongtao , Chen Yiyang
Published: November 2021

Purpose:

To study the changes of hyoid position in infants with Robin sequence before and after mandibular distraction osteogenesis, and to explore the related factors.

Material and Methods:

Twenty-six infants with Robin sequence underwent bilateral mandibular distraction osteogenesis from May 2016 to April 2020. Three-dimensional computed tomography data of patients before and after surgery were analyzed with Materialise Mimics 17.0. Changes in the three-dimensional position of the hyoid bone were studied.

Results:

The angle between the long axis of the tongue body and hard palate plane, and the angle between the long axis of the tongue body and mandibular plane were significantly decreased after surgery than before surgery. The hyoid bone-cranial base vertical distance, hyoid bone-mental point distance, and hyoid bone - epiglottis distance were significantly increased after surgery. The differences in the above-mentioned data were statistically significant (P < 0.05). Changes in the angle between the long axis of the tongue body and the hyoid bone - mental point line correlated with changes in the position of the hyoid bone relative to the cervical spine (P 
= 0.006). Postoperatively, the hyoid bone moved forward and the increase in the hyoid bone - mental point osseous distance interval (41.28%) was significantly greater than the increase in the hyoid bone-epiglottis distance (18.73%). Differences in the total mandibular length and the hyoid bone - cranial base vertical distance are related to the age at the operation (P < 0.05). The younger the age at the time of surgical intervention, the greater the difference before and after surgery for the same follow-up interval.

Conclusions:

The three-dimensional direction of the hyoid bone changes after the distraction osteogenesis of the mandible, and the hyoid bone moves downward and forward. Because the mandibular length and airway changed, the relative positions of the long axis of the tongue body on the sagittal plane rotated clockwise.
Sentinel Epileptiform Discharges Activating Two Seizure Networks on Intracranial EEG
Authors: Lapalme-Remis Samuel , Payne Eric T. , Brinkmann Benjamin H. , Britton Jeffrey W.
Published: November 2021

Sentinel epileptiform discharges (SEDs) are epileptiform transients preceding the onset of a focal seizure seen on scalp EEG. Despite their potential localizing value, formal study of SED has been limited. The authors report a patient with MRI-negative focal-onset epilepsy whose seizures on scalp and intracranial EEG were always preceded by SED. Although the location and morphology of the SED was invariable, the seizures after the discharge were of two clearly distinct types, each with different semiology and region of spread on intracranial EEG. This suggests that the SED played a role in activating two distinct seizure networks. A right temporal lobectomy with amygdalohippocampectomy was performed. The resection included both the region of the SED as well as the seizure-onset zone of the more common seizure type, achieving seizure freedom at 3 years after surgery. Further research exploring whether the localization of SED is a reliable indicator of the seizure-onset zone could aid surgical planning in patients whose seizures are preceded by SED.
Hairpin structure facilitates multiplex high-fidelity DNA amplification in real-time PCR
Authors: Zhang Kerou , Pinto Alessandro , Cheng Lauren Yuxuan , Song Ping , Dai Peng , Wang Michael , Rodriguez Luis , Weller Cailin , Zhang David Yu
Published: November 2021

Clinically and biologically, it is essential to detect rare DNA-sequence variants for early cancer diagnosis or drug-resistance mutations identification. Some of the common quantitative PCR (qPCR)-based variant detection methods are restricted in the limit of detection (LoD) because the DNA polymerases used have a high polymerase misincorporation rate, thus the detection sensitivity is sometimes unsatisfactory. With the proofreading activity, high-fidelity (HiFi) DNA polymerases have a 50- to 250-fold higher fidelity. However, there are currently no proper probe-based designs as the fluorescence indicator allowing multiplexed HiFi qPCR reactions, thus restricting the application of HiFi DNA polymerases like the variant detection. We presented the Occlusion System, composed of a 5’-overhanged primer with fluorophore modification and a probe with a short-stem hairpin and a 3’ quencher modification. We demonstrated that the Occlusion System allowed multiplexing HiFi qPCR reaction, and it was compatible with the current variant-enrichment method to improve the LoD up to 10-fold. Thus, the Occlusion System satisfactorily functioned as efficient fluorescence indicator in HiFi qPCR reactions and allowed application of HiFi DNA polymerases in variant detection methods to improve detection sensitivity.
Progressive enhancement of kinetic proofreading in T cell antigen discrimination from receptor activation to DAG generation
Authors: Britain Derek , Weiner Orion
Published: November 2021

T cells use kinetic proofreading to discriminate antigens by converting small changes in antigen binding lifetime into large differences in cell activation, but where in the signaling cascade this computation is performed is unknown. Previously, we developed a light-gated immune receptor to probe the role of ligand kinetics in T cell antigen signaling. We found significant kinetic proofreading at the level of the signaling lipid diacylglycerol (DAG) but lacked the ability to determine where the multiple signaling steps required for kinetic discrimination originate in the upstream signaling cascade (Tischer and Weiner, 2019). Here we uncover where kinetic proofreading is executed by adapting our optogenetic system for robust activation of early signaling events. We find the strength of kinetic proofreading progressively increases from Zap70 recruitment to LAT clustering to downstream DAG generation. These data suggest a distributed kinetic proofreading mechanism, with proofreading steps both at the receptor and at downstream signaling events. Leveraging the ability of our system to rapidly disengage ligand binding, we measure slower reset rates for downstream signaling events. Our observations of distributed kinetic proofreading and slowed resetting of downstream steps suggest a basis of cooperativity between multiple active receptors with implications in tissue homeostasis, autoimmunity, and immunotherapy off-target effects.
Addressing medical and social needs to reduce unnecessary health care utilization and costs: a qualitative study
Authors: Liss David T. , Guzman Adriana , Walsh Emily E. , Shaunfield Sara , Brown Tiffany
Published: November 2021

Background

There are few if any well-known approaches to reducing avoidable health care utilization and costs in patients with social needs. This study’s objective was to explore the goals, and approaches to organizing and delivering care, of interventions attempting to reduce avoidable resource use by addressing patients’ medical and social needs.

Methods

Semi-structured interviews were conducted with study investigators about early interventions in the peer-reviewed literature. A template analysis approach was used to review interview transcripts for common themes and create a final code list. Coder dyads separately coded each interview and resolved any discrepancies.

Results

Interviews were conducted with 15 investigators of interventions that delivered a variety of health services and addressed several individual social needs. Participants frequently described their overall goal as meeting patients’ diverse needs to prevent unnecessary acute care utilization. Reported approaches to addressing medical needs included assistance with receipt of primary care and care coordination across settings. Social needs were described as tightly linked with medical needs; addressing social support and housing were perceived as distinct from addressing other social needs. Participants described their overall approach to meeting patients’ needs in terms of establishing connections, partnership, respect, and being adaptable to patients’ priorities.

Conclusions

Findings shed new light on how to simultaneously address medical and social needs. Opportunities for future research include evaluating different approaches to addressing medical needs (primary care versus care coordination), separately evaluating the impacts of housing or social support, and hiring and training procedures to promote trauma-informed, patient-centered care.
A Pilot Randomized Controlled Trial ofde novoBelatacept-Based Immunosuppression in Lung Transplantation
Authors: Huang Howard J. , Schechtman Kenneth , Askar Medhat , Bernadt Cory , Mittler Brigitte , Dore Peter , Witt Chad , Byers Derek , Vazquez-Guillamet Rodrigo , Halverson Laura , Nava Ruben , Puri Varun , Gelman Andrew , Kreisel Daniel , Hachem Ramsey R.
Published: November 2021

The development of donor-specific antibodies (DSA) after lung transplantation is common and results in adverse outcomes. In kidney transplantation, Belatacept has been associated with a lower incidence of DSA, but experience with Belatacept in lung transplantation is limited. We conducted a 2-center pilot randomized controlled trial ofde novoimmunosuppression with Belatacept after lung transplantation to assess the feasibility of conducting a pivotal trial. Twenty-seven participants were randomized to Control (Tacrolimus, Mycophenolate Mofetil, and prednisone, n = 14) or Belatacept-based immunosuppression (Tacrolimus, Belatacept, and prednisone until day 89 followed by Belatacept, Mycophenolate Mofetil, and prednisone, n = 13). All participants were treated with rabbit anti-thymocyte globulin for induction immunosuppression. We permanently stopped randomization and treatment with Belatacept after 3 participants in the Belatacept arm died compared to none in the Control arm. Subsequently, 2 additional participants in the Belatacept arm died for a total of 5 deaths compared to none in the Control arm (log rank p = 0.016). We did not detect a significant difference in DSA development, acute cellular rejection, or infection between the 2 groups. We conclude that this investigational regimen using Belatacept after lung transplantation is associated with significantly increased mortality.
A Remote Digital Memory Composite to Detect Cognitive Impairment in Memory Clinic Samples in Unsupervised Settings using Mobile Devices
Authors: Berron David , Glanz Wenzel , Clark Lindsay , Basche Kristin , Grande Xenia , Güsten Jeremie , Billette Ornella V. , Hempen Ina , Naveed Muhammad Hashim , Diersch Nadine , Butryn Michaela , Spottke Annika , Buerger Katharina , Perneczky Robert , Schneider Anja , Teipel Stefan , Wiltfang Jens , Johnson Sterling , Wagner Michael , Jessen Frank , Düzel Emrah ,   the DELCODE Consortium
Published: November 2021

Mobile app-based unsupervised monitoring of cognition holds the promise to facilitate case-finding in clinical care and the individual detection of cognitive impairment in clinical and research settings. In the context of Alzheimer’s disease, this is particularly relevant for patients who seek medical advice due to memory complaints. Here we developed a Remote Digital Memory Composite (RDMC) score from an unsupervised remote and mobile cognitive assessment battery focused on episodic memory and long-term recall and assessed its construct validity, retest reliability and diagnostic accuracy when predicting MCI-grade impairment in a memory clinic sample and healthy controls. A total of 199 study participants were recruited from three cohorts and included as healthy controls (HC; n=97), individuals with subjective cognitive decline (SCD; n= 59) or patients with mild cognitive impairment (MCI; n=43). Study participants performed cognitive assessments in a fully remote and unsupervised setting via a smartphone app for cognitive testing. The derived RDMC score was highly correlated with the PACC5 score across participants and demonstrated good retest reliability. Diagnostic accuracy for discriminating memory impairment from no impairment was high (cross-validated AUC = 0.83, 95% CI [0.66, 0.99]) with a sensitivity of 0.82 and a specificity of 0.71. Our results indicate that unsupervised mobile cognitive assessments in a memory clinic setting using the implementation in the neotiv digital platform results in a good discrimination between cognitively impaired and unimpaired individuals. Thus, it is feasible to complement neuropsychological assessment of episodic memory with unsupervised and remote assessments on mobile devices. This contributes to recent efforts for implementing remotely performed episodic memory assessment for case-finding and monitoring in large research trials and clinical care.
Correcting prevalence estimation for biased sampling with testing errors
Authors: Zhou Lili , Díaz-Pachón Daniel Andrés , Zhao Chen , Rao J. Sunil , Hössjer Ola
Published: November 2021

Sampling for prevalence estimation of infection is subject to bias by both over-sampling of symptomatic individuals and error-prone tests. This results in naïve estimators of prevalence (i.e., proportion of observed infected individuals in the sample) that can be very far from the true proportion of infected. In this work, we present a method of prevalence estimation that reduces both the effect of bias due to testing errors and oversampling of symptomatic individuals, eliminating it altogether in some scenarios. Moreover, this procedure considers stratified errors in which tests have different error rate profiles for symptomatic and asymptomatic individuals. This results in easily implementable algorithms, for which code is provided, that produce better prevalence estimates than other methods (in terms of reducing and/or removing bias), as demonstrated by formal results, simulations, and on COVID-19 data from the Israeli Ministry of Health.
Functional changes of visual cortex in pre- and post- operative intermittent exotropia patients: study protocol for a non-randomized case-control clinical trial
Authors: Guo Yanan , Fu Jing , Hong Jie , Liu Zhaohui , He Xueying
Published: November 2021

Introduction

Intermittent exotropia (IXT) is the most common type of divergent squint. IXT is primarily a cortical neurologic dysfunction disorder, occurring as a result of insufficient maintaining of sensory and motor fusion. Recent reports have demonstrated the relationship between IXT and visual cortical impairment. We plan to assess blood oxygen level-dependent (BOLD)- functional magnetic resonance imaging (fMRI) in IXT patients during the pre-and post-operation follow-ups to evaluate the functional changes of the visual cortex.

Methods and analysis

A total of 90 Chinese subjects will be recruited, and the age is between 18 and 60 years old. The subjects include the Surgical treatment (ST) group (45 IXT subjects who will perform surgery) and the Healthy control (HC) group (45 age - and sex - and education matched healthy volunteers). The assessments include the following aspects: general ophthalmic, optometry, binocular vision test, Newcastle Control Score (NCS), and fMRI. Each subject completes the rest-state BOLD-fMRI, and the sequences include echo planar imaging (EPI) pulse and 3-dimensional brain volume (3D-BRAVO) to acquire high-resolution images. The follow-up schedule is 6 and 12months after the surgery. The primary outcome will be determined by cortex changes in BOLD-fMRI in ST group before and after the surgery. We also compare the HC group with the pre-operation subjects in the ST group. The secondary outcomes are changes of strabismus examinations, binocular visual function examinations, and NCS.

Ethics and dissemination

Ethical approval has been obtained from the Medical Ethics Committee of the Beijing Tongren Hospital. We plan to publish the results of this study in a peer-reviewed journal article.

Trial registration number

ChiCTR2100048852

Strengths and limitations of this study

The present study is advanced which aims to explore the functional changes in the visual cortex in IXT patients before and after surgery through rest-state 3.0T BOLD-fMRI. We also explore the relationships between changes of cortex and ocular examination.

The follow-up comparison between the visual cortex and ophthalmic changes will enrich our understanding of the impairment and plasticity of visual function in IXT patients.

Loss to follow-up of participants is possible after the surgery in this study.

The present study focuses on IXT patients with surgical indications. We did not carry on the study on the different subtypes or the different severity of IXT.
Maternal immune response and placental antibody transfer after COVID-19 vaccination across trimester and platforms
Authors: Atyeo Caroline G. , Shook Lydia L. , Brigida Sara , De Guzman Rose M. , Demidkin Stepan , Muir Cordelia , Akinwunmi Babatunde , Baez Arantxa Medina , McSweeney Erin , Burns Madeleine , Nayak Ruhi , Kumar Maya K. , Patel Chinmay D. , Fialkowski Allison , Cvrk Dana , Goldfarb Ilona T. , Yonker Lael M. , Fasano Alessio , Elovitz Michal A. , Gray Kathryn J. , Alter Galit , Edlow Andrea G.
Published: November 2021

The availability of three COVID-19 vaccines in the United States provides an unprecedented opportunity to examine how vaccine platforms and timing of vaccination in pregnancy impact maternal and neonatal immunity. Here, we characterized the antibody profile after Ad26.COV2.S, mRNA-1273 or BNT162b2 vaccination in 158 pregnant individuals, and evaluated transplacental antibody transfer by profiling maternal and umbilical cord blood in 175 maternal-neonatal dyads. These analyses revealed lower vaccine-induced functions and Fc-receptor binding after Ad26.COV2.S compared to mRNA vaccination, and subtle advantages in titer and function with mRNA-1273 versus BN162b2. mRNA vaccinees had higher titers and functions against SARS-CoV-2 variants of concern. First and third trimester vaccination resulted in enhanced maternal immune responses relative to second trimester. Higher cord:maternal transfer ratios following first and second trimester vaccination reflect placental compensation for waning maternal titers. These results support vaccination early in pregnancy to maximize maternal protection throughout gestation, without compromising neonatal antibody protection.
A cohort study on the duration of Plasmodium falciparum infections during the dry season in The Gambia
Authors: Collins Katharine A , Ceesay Sukai , Drammeh Sainabou , Jaiteh Fatou K , Guery Marc-Antoine , Lanke Kjerstin , Grignard Lynn , Stone Will , Conway David J , D’Alessandro Umberto , Bousema Teun , Claessens Antoine
Published: November 2021

Background

In areas where Plasmodium falciparum malaria is highly seasonal, a dry season reservoir of blood-stage infection is essential for initiating transmission during the following wet season, bridging transmission seasons several months apart. Understanding infections during the dry season could thus inform approaches for malaria control.

Methods

In The Gambia, a cohort of 42 individuals with qPCR positive P. falciparum infections at the end of the transmission season (December) were followed monthly until the end of the dry season (May) to evaluate the duration of detectable infections. The influence of human host (age, sex, haemoglobin concentration and genotype, and P. falciparum-specific antibodies), and parasitological (parasite density, gametocyte density and genotypic multiplicity of infection) factors was investigated.

Results

A large proportion of individuals infected at the end of the wet season had detectable infections until the end of the dry season (40.0%; 16/40), with the majority of these infections also harbouring gametocytes (81.3%; 13/16). 22 infections were classified as persistent (detectable for at least 3 months), 17 were classified as short-lived (undetectable within 2 months), and 3 were treated (due to symptoms). At the start of the dry season, the majority of persistent infections (82%; 18/22) had parasite densities >10 p/µL compared to only 5.9% (1/17) of short-lived infections. Persistent infections (59%; 13/22) were also more likely to be multi-clonal than short-lived infections (5.9%; 1/17), they were most common in 5 to 15 year old children (63%; 12/19), and were associated with individuals having higher levels of P. falciparum-specific antibodies (p = 0.058).

Conclusions

Asymptomatic persistent dry season infections in The Gambia were multiclonal with higher parasite densities at the beginning of the dry season, mostly occurring in school age children and adults with higher P. falciparum-specific antibodies. Screening and treating asymptomatic, malaria-infected individuals during the dry season may reduce the human reservoir of malaria responsible initiating transmission in the wet-season.
Systematic Review of Cerebral Phenotypes Associated with Monogenic Cerebral Small Vessel Disease
Authors: Whittaker Ed , Thrippleton Sophie , Chong Liza YW , Collins Victoria C , Ferguson Amy C , Henshall David E , Lancastle Emily , Wilkinson Tim , Wilson Blair , Wilson Kirsty , Sudlow Cathie , Wardlaw Joanna , Rannikmäe Kristiina
Published: November 2021

Background

Cerebral small vessel disease (cSVD) is an important cause of stroke and vascular dementia. Most cases are multifactorial, but an emerging minority have a monogenic cause. While NOTCH3 is the best-known gene, several others have been reported. We aimed to summarise the cerebral phenotypes associated with these more recent cSVD genes.

Methods

We performed a systematic review (PROSPERO: CRD42020196720), searching Medline/Embase (conception to July 2020) for any language publications describing COL4A1/2, TREX1, HTRA1, ADA2, or CTSA pathogenic variant carriers. We extracted data about individuals’ characteristics, clinical and vascular radiological cerebral phenotypes. We summarised phenotype frequencies per gene, comparing patterns across genes.

Results

We screened 6,485 publications including 402, and extracted data on 390 COL4A1, 123 TREX1, 44 HTRA1 homozygous, 41 COL4A2, 346 ADA2, 82 HTRA1 heterozygous, and 14 CTSA individuals. Mean age ranged from 15 (ADA2) to 59 years (HTRA1 heterozygotes). Clinical phenotype frequencies varied widely: stroke 9% (TREX1) to 52% (HTRA1 heterozygotes), cognitive features 0% (ADA2) to 64% (HTRA1 homozygotes), psychiatric features 0% (COL4A2; ADA2) to 57% (CTSA). Among individuals with neuroimaging, vascular radiological phenotypes appeared common, ranging from 62% (ADA2) to 100% (HTRA1 homozygotes; CTSA). White matter lesions were the most common pathology, except in ADA2 and COL4A2 cases, where ischaemic and haemorrhagic lesions dominated, respectively.

Conclusions

There appear to be differences in cerebral manifestations across cSVD genes. Vascular radiological changes were more common than clinical neurological phenotypes, and present in the majority of individuals with reported neuroimaging. However, these results may be affected by age and biases inherent to case reports. In the future, better characterisation of associated phenotypes, as well as insights from population-based studies, should improve our understanding of monogenic cSVD to inform genetic testing, guide clinical management, and help unravel underlying disease mechanisms.
Identifying patient-level risk factors associated with non-β-lactam resistance outcomes in invasive methicillin-resistant Staphylococcus aureus infections in the United States using chain graphs
Authors: Love William J. , Wang Christine A. , Lanzas Cristina
Published: November 2021

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of hospital- and community-acquired infections. MRSA is resistant to many antibiotics, including ß-lactam antibiotics, fluoroquinolones, lincosamides, macrolides, aminoglycosides, tetracyclines, and chloramphenicol. Graphical models such as chain graphs can be used to quantify and visualize the interactions among multiple resistant outcomes and their explanatory variables. In this study, we analyzed MRSA surveillance data collected by the Centers for Disease Control and Prevention (CDC) as part of the Emerging Infections Program (EIP) using chain graphs with the objective of identifying risk factors for individual phenotypic resistance outcomes (reported as minimum inhibitory concentration, MIC) while considering the correlations among themselves. Some phenotypic resistances have low connectivity to other outcomes or predictors (e.g. tetracycline, vancomycin, doxycycline, and rifampin). Levofloxacin was the only resistant associated with healthcare use. Blood culture was the most common predictor of MIC. Patients with positive blood culture had significantly increased MIC to chloramphenicol, erythromycin, gentamicin, lincomycin, and mupirocin, and decreased daptomycin and rifampin MICs. Chain graphs show the unique and common risk factors associated with resistance outcomes.
Impact of Exercise-induced Dehydration on Perceived Exertion During Endurance Exercise: A Systematic Review with Meta-analysis
Authors: Deshayes Thomas A. , Pancrate Timothée , Goulet Eric D.B.
Published: November 2021

Understanding the impact of stressors on the rating of perceived exertion (RPE) is relevant from a performance and exercise adherence/participation standpoint. Athletes and recreationally active individuals dehydrate during exercise. No attempt has been made to systematically determine the impact of exercise-induced dehydration (EID) on RPE. The present meta-analysis aimed to determine the effect of EID on RPE during endurance exercise and examine the moderating effect of potential confounders using a meta-analytical approach. Data analyses were performed on raw RPE values using random-effects models weighted mean effect summaries and meta-regressions with robust standard errors, and with a practical meaningful effect set at 1 point difference between euhydration (EUH) and EID. Only controlled crossover studies measuring RPE with a Borg scale in healthy adults performing ≥ 30 min of continuous endurance exercise while dehydrating or drinking to maintain EUH were included. Sixteen studies were included, representing 147 individuals. Mean body mass loss with EUH was 0.5 ± 0.4%, compared to 2.3 ± 0.5% with EID (range 1.7 to 3.1%). Within an EID of 0.5 to 3% body mass, a maximum difference in RPE of 0.81 points (95% CI: 0.36-1.27) was observed between conditions. A meta-regression revealed that RPE increases by 0.21 points for each 1% increase in EID (95% CI: 0.12-0.31). Humidity, ambient temperature and aerobic capacity did not alter the relationship between EID and RPE. Therefore, the effect of EID on RPE is unlikely to be practically meaningful until a body mass loss of at least 3%.
Fatigue in Incident Peritoneal Dialysis and Mortality: A Real-World Side-by-Side Study in Brazil and the United States
Authors: Guedes Murilo , Wallim Liz , Guetter Camila R , Jiao Yue , Rigodon Vladimir M. , Mysayphonh Chance , Usvyat Len A. , Barretti Pasqual , Kotanko Peter , Larkin John W. , Maddux Franklin W. , Pecoits-Filho Roberto , de Moraes Thyago Proença
Published: November 2021

Background

We tested if fatigue in incident Peritoneal Dialysis associated with an increased risk for mortality, independently from main confounders.

Methods

We conducted a side-by-side study from two of incident PD patients in Brazil and the United States. We used the same code to independently analyze data in both countries during 2004 to 2011. We included data from adults who completed KDQOL-SF vitality subscale within 90 days after starting PD. Vitality score was categorized in four groups: >50 (high vitality), ≥40 to ≤50 (moderate vitality), >35 to <40 (moderate fatigue), ≤35 (high fatigue; reference group). In each country’s cohort, we built four distinct models to estimate the associations between vitality (exposure) and all-cause mortality (outcome): (i) Cox regression model; (ii) competitive risk model accounting for technique failure events; (iii) multilevel survival model of clinic-level clusters; (iv) multivariate regression model with smoothing splines treating vitality as a continuous measure. Analyses were adjusted for age, comorbidities, PD modality, hemoglobin, and albumin. A mixed-effects meta-analysis was used to pool hazard ratios (HRs) from both cohorts to model mortality risk for each 10-unit increase in vitality.

Results

We used data from 4,285 PD patients (Brazil n=1,388 and United States n=2,897). Model estimates showed lower vitality levels within 90 days of starting PD were associated with a higher risk of mortality, which was consistent in Brazil and the United States cohorts. In the multivariate survival model, each 10-unit increase in vitality score was associated with lower risk of all-cause mortality in both cohorts (Brazil HR=0.79 [95%CI 0.70 to 0.90] and United States HR=0.90 [95%CI 0.88 to 0.93], pooled HR=0.86 [95%CI 0.75 to 0.98]). Results for all models provided consistent effect estimates.

Conclusions

Among patients in Brazil and the United States, lower vitality score in the initial months of PD was independently associated with all-cause mortality.