bluuebunny/crossref_metadata_2025 huggingface dataset:
Anxiety in Paediatric Patients Diagnosed with COVID-19 and the Affecting Factors
Authors: Solmaz Abdullah , Karataş Hülya , Ercan Tuğba Meliha Fatma , Erat Tuğba , Solmaz Filiz , Kandemir Hasan
Published: February 2022

Objective

Children may be greatly affected by events that increase stress in individuals in general and are reported as the vulnerable groups during the coronavirus disease-19 (COVID-19) pandemic. But most of the studies in the literature investigating the mental effects of the pandemic on children were conducted with healthy children and limited study has evaluated the effect on children diagnosed with COVID-19. The aim of this study is to determine the anxiety level in paediatric patients diagnosed with COVID-19 and the affecting factors.

Methods

This descriptive study was conducted with 292 children aged 8–18 years who were diagnosed with COVID-19. Data were collected using the Descriptive Characteristics Questionnaire and the Screen for Child Anxiety Related Emotional Disorders (SCARED). Interviews were held by phone.

Results

Males were 51.4% of participants, the mean age was 16.04 ± 1.93. 84.1% of them had a chronic disease; the transmission source was family/relatives/friends for 41.1%. By social isolation, 49.3% were affected and 33.2% were affected by disease symptoms the most in this process. The most common symptoms were headache (61.6%), and asthenia (59.9%). Mean anxiety scale score was 25.5 ± 14.37. The effect of gender, number of symptoms and transmission source on anxiety score was significant (p < 0.05).

Conclusion

Paediatric patients diagnosed with COVID-19 were found to have high anxiety levels. It is recommended to re-evaluate the duration of children’s social participation and support the management of COVID-19 symptoms that affect their anxiety level.
CE: Assessing Movement-Evoked Pain
Authors: Booker Staja , Arnstein Paul , van Boekel Rianne
Published: February 2022

One of the most common and nuanced tasks that nurses perform is pain assessment, particularly in acute postoperative settings where frequent reassessments are needed. Most assessments are limited to obtaining a pain intensity score with little attention paid to the conditions necessitating the assessment or the factors contributing to the pain. Pain is frequently assessed during rest, but seldom during periods of movement or activity, which is a crucial omission given that acute postoperative movement-evoked pain (MEP) is intense and a common barrier to healing and restoration of function. In addition to physical limitations, MEP can impede cognitive, emotional, and social functioning in ways that can contribute to chronic pain, mood disorders, and disability. Professional and regulatory standards are moving away from a focus on pain intensity to an emphasis on its context, impact on function, and associated distress. Thus, there are many driving forces compelling nurses to integrate MEP assessments into practice to expedite the restoration of biopsychosocial functioning in postoperative patients. The authors discuss the clinical significance of a MEP assessment as well as protocols and tools for completing such assessments.
Medical Aid in Dying: What Every Nurse Needs to Know
Authors: Roy Kaveri
Published: February 2022

The number of U.S. states legalizing medical aid in dying for patients with terminal diseases and survival prognoses of six months or less is increasing. At press time, 10 states and the District of Columbia have legalized such aid. But because terminal illnesses without clear prognoses are not covered under these laws, some patients are forced to seek medical aid in dying outside the country.

The nurse's role regarding aid in dying is poorly defined, and must be clarified. Currently, nurses and other providers have many misconceptions and fears about providing patients and families with the relevant education. Nurses need to have accurate knowledge and understanding of aid in dying, so they can advocate for those requesting this option; ensure equitable access; and provide them with guidance, support, and resources. An interdisciplinary approach is essential.

This article provides background information on aid in dying in the United States, discusses the nurse's role, offers an illustrative case report, and addresses nursing implications.
Supporting Self-isolation for COVID-19 With “Risk Mitigation” Prescribing and Housing Supports for People Who Use Drugs: A Case Report
Authors: Hong Ran Ha , Brar Rupinder , Fairbairn Nadia
Published: February 2022

Background

Self-isolation is critical in preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. However, people who use drugs face significant barriers in adhering to the regulations. As a response, several supportive measures have been introduced in British Columbia, including temporary housing access and “risk mitigation” prescribing, in which health care providers prescribe pharmaceutical alternatives to the unregulated drug supply to prevent withdrawal and reduce overdose risk.

Case summary

We present a case of a 39-year-old male with a history of polysubstance use and frequent overdoses, who had tested positive for SARS-CoV-2 and was able to successfully self-isolate. “Risk mitigation” prescribing, supportive housing, and harm reduction services were initiated for his self-isolation and connection to community outreach teams for ongoing support.

Discussion

This case illustrates how “risk mitigation” prescribing supported patient’s self-isolation, reduced his illicit drug use, and offered an opportunity for healthcare engagement. Access to safer alternatives to the toxic drug supply should continue beyond COVID-19 pandemic to address the persistent issues of contaminated drug supply and the overdose crisis in North America.
Long-Term Outcomes of Multiligament Knee Injuries
Authors: Zhang Tina , Shasti Keyan , Dubina Andrew , Schneider Matheus B. , Aneizi Ali , Packer Jonathan D. , O'Toole Robert V. , Sciadini Marcus F. , Henn R. Frank
Published: February 2022

Objective:

To characterize long-term outcomes of multiligament knee injuries (MLKIs) using patient-reported outcome measures, physical examination, and knee radiographs.

Design:

Retrospective clinical follow-up.

Methods:

Twenty knees (18 patients) were evaluated at a mean follow-up of 13.1 years (range 11–15 years). The primary outcome measure was the Internal Knee Documentation Committee score. Patients also completed secondary patient-based outcome assessments including Patient-Reported Outcomes Measurement Information System computer adaptive testing, Short Form-36, and Tegner activity score. Sixteen knees (14 patients) also had physical examination and bilateral knee radiographs assessed with the Kellgren-Lawrence score.

Results:

The mean Internal Knee Documentation Committee score was 56 points, which was significantly lower than the age-matched normative value of 77 (P = 0.004) and exceeds the minimum clinically important difference of 12 points. Most secondary outcome scores were worse than normative population values. Posttraumatic arthritis was present in 100% of MLKIs that had radiographs. Comparing operative versus nonoperative management, there were no statistical differences in patient demographics, injury characteristics, physical examination, or imaging, but surgical patients had better Short Form-36 Social Functioning (89 vs. 63, P = 0.02) and Tegner scores (4.5 vs. 2.9, P = 0.05).

Conclusion:

The long-term outcomes of MLKIs are generally poor, and posttraumatic radiographic evidence of arthritis seems to be universal. Operative management of these injuries may improve long-term outcomes. Clinicians should be aware of these results when counseling patients.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Ventilator-Associated Lower Respiratory Tract Bacterial Infections in COVID-19 Compared With Non-COVID-19 Patients*
Authors: Hedberg Pontus , Ternhag Anders , Giske Christian G. , Strålin Kristoffer , Özenci Volkan , Johansson Niclas , Spindler Carl , Hedlund Jonas , Mårtensson Johan , Nauclér Pontus
Published: February 2022

OBJECTIVES:

Ventilator-associated lower respiratory tract infections (VA-LRTIs) are associated with prolonged length of stay and increased mortality. We aimed to investigate the occurrence of bacterial VA-LRTI among mechanically ventilated COVID-19 patients and compare these findings to non-COVID-19 cohorts throughout the first and second wave of the pandemic.

DESIGN:

Retrospective cohort study.

SETTING:

Karolinska University Hospital, Stockholm, Sweden.

PATIENTS:

All patients greater than or equal to 18 years treated with mechanical ventilation between January 1, 2011, and December 31, 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The cohort consisted of 20,223 ICU episodes (479 COVID-19), with a VA-LRTI incidence proportion of 30% (129/426) in COVID-19 and 18% (1,081/5,907) in non-COVID-19 among patients ventilated greater than or equal to 48 hours. The median length of ventilator treatment for COVID-19 patients was 10 days (interquartile range, 5–18 d), which was significantly longer than for all other investigated specific diagnoses. The VA-LRTI incidence rate per 1,000 ventilator days at risk was 31 (95% CI, 26–37) for COVID-19 and 34 (95% CI, 32–36) for non-COVID-19. With COVID-19 as reference, adjusted subdistribution hazard ratios for VA-LRTI was 0.29–0.50 (95% CI, < 1) for influenza, bacterial pneumonia, acute respiratory distress syndrome, and severe sepsis, but 1.38 (95% CI, 1.15–1.65) for specific noninfectious diagnoses. Compared with COVID-19 in the first wave of the pandemic, COVID-19 in the second wave had adjusted subdistribution hazard ratio of 1.85 (95% CI, 1.14–2.99). In early VA-LRTI Staphylococcus aureus was more common and Streptococcus pneumoniae, Haemophilus influenzae, and Escherichia coli less common in COVID-19 patients, while Serratia species was more often identified in late VA-LRTI.

CONCLUSIONS:

COVID-19 is associated with exceptionally long durations of mechanical ventilation treatment and high VA-LRTI occurrence proportions. The incidence rate of VA-LRTI was compared with the pooled non-COVID-19 cohort, however, not increased in COVID-19. Significant differences in the incidence of VA-LRTI occurred between the first and second wave of the COVID-19 pandemic.
Effects of Carbon Fiber Foot Plate on Able-bodied Gait: Pilot Study
Authors: Premprasopchok Yuparat , Sukthomya Sasithon , Petmunee Wareerat , Rayothee Pitchaya , Permpool Kwannate , Eh Saw Naing Naing , Utami Feryanda
Published: February 2022

Introduction

Foot orthoses have injury prevention and human performance benefits. The carbon fiber foot plate (CFFP) is a possible orthotic intervention for preventing foot injury and enhancing sports performance. However, the cost of these devices is generally acceptable for developed settings but might serve as a barrier for use in developing settings. In this study, we aimed to develop an affordable locally custom-made CFFP and evaluate its function along with subjective feedback.

Materials and Methods

Three types of foot plates were designed each with a unique layup and fabric orientation. Carbon fiber preimpregnated with activated resin was used for foot plate fabrication. Three participants were provided with each prototype of the foot plate. Outcome measurements include walking speed (20-m walk test [20MWT]), treadmill jogging energy expenditure, and user feedback.

Results

The 20MWT self-selected speed increased for two participants with the CFFP. The maximum average walking speed increased in two participants with CFFP prototype B (8%–11%). Moreover, the average increase of walking speed for prototypes A and C were 2%–2.6% and 4%–4.6%, respectively. The third participant showed a 5% reduction of speed with CFFP prototype B and 3%–5% with prototypes A and B. For all participants, no improvements of energy expenditure were observed with all prototypes compared to without foot plate. Conversely, an increase in energy expenditure was found with all prototypes at all speeds. The subjective feedback in each prototype showed that all participants were satisfied with the CFFP prototype A, but the first participant was identified with metatarsal head pain.

Prototype B also evidenced a consensus among participants with increased comfort compared with prototype A, especially at the metatarsal heads.

Conclusions

The study describes the development and effects of using three types of CFFPs. Although prototypes increased the energy expenditure, prototype B improved walking speed. Prototypes A and B were useful and accepted by all participants. Further exploration is required in a larger heterogeneous sample of able-bodied persons and sport-specific athletes.

Clinical Relevance

The study demonstrates the effect of the CFFP on walking ability, which can better inform the clinician when considering the prescription for patients with foot problems and sports activities.
Association of a telephone triage service for emergency patients with better outcome: a population-based study in Osaka City, Japan
Authors: Katayama Yusuke , Kitamura Tetsuhisa , Nakao Shunichiro , Tanaka Kenta , Himura Hoshi , Deguchi Ryo , Tai Shunsuke , Tsujino Junya , Mizobata Yasumitsu , Shimazu Takeshi , Nakagawa Yuko
Published: February 2022

Objective

Telephone triage service in emergency care has been introduced in many countries, and it is important to determine the effect of telephone triage service on the outcome of emergency patients. The aim of this study was to evaluate the effect of telephone triage service on the outcome of emergency patients using propensity score.

Methods design, settings, and participants

This was a retrospective study with a study period from January 2016 to December 2019. We included all patients transported by ambulances of the Osaka Municipal Fire Department during study period.

Exposure

Telephone triage service.

Outcome measures and analysis

The main outcome of this study was unfavorable outcome following use of the telephone triage service. In this study, unfavorable outcome was defined as patients who were admitted, transferred, or died after care in the emergency department. Propensity scores were calculated using a logistic regression model with 12 variables that were present before the telephone triage service was used or were indicative of the patient’s condition. Data analyses were not only propensity score matching but also a multivariable logistic regression model and regression model with propensity score as a covariate.

Main results

The number of patients eligible for analyses was 707 474. Of these patients, 8008 (1.0%) used the telephone triage services and 699 466 patients (99.0%) did not use it. The number of patients with an unfavorable outcome was 407 568 (57.6%) in the total cohort. Of them, 2305 patients (28.8%) used the telephone triage service and 297 601 patients (42.5%) did not use it. For propensity score matching, 8008 patients were matched from each group. Use of the telephone triage service was inversely associated with unfavorable outcome in a multivariate logistic regression model with propensity score as a covariate [adjusted odds ratio (OR) 0.874; 95% confidence interval (CI), 0.831–0.919] and propensity score matching (crude OR, 0.875; 95% CI, 0.818–0.936).

Conclusions

This study revealed that the use of the telephone triage service in Osaka city, Japan was associated with better outcomes of patients transported by ambulance.
The Prescription Drug User Fee Act
Authors: Mitchell Aaron P. , Trivedi Niti U. , Bach Peter B.
Published: February 2022

Background:

The Prescription Drug User Fee Act (PDUFA) is due for reauthorization in 2022. Beyond creating the user fee program which now generates a majority of the Food and Drug Administration (FDA) Human Drugs Program budget, PDUFA has made numerous additional changes to FDA policy during its 29-year history. FDA’s budgetary dependence on user fees may advantage the industry in negotiating favorable policy changes through PDUFA.

Methods:

The full texts of all prior PDUFA reauthorization bills and all submitted public comments and meeting minutes for the 2022 reauthorization were reviewed. Provisions affecting FDA regulatory authority and processes were identified.

Findings:

PDUFA legislation has instituted a broad range of changes to FDA policy, including evidentiary standards for drug approval, accelerated pathways for approval, industry involvement in FDA decision-making, rules regarding industry information dissemination to providers, and market entry of generic drugs. Negotiations over the 2022 reauthorization suggest that industry priorities include increased application of real-world evidence, regulatory certainty, and increased communication between FDA and industry during the drug application process.

Conclusions:

The need for PDUFA reauthorization every 5 years has created a recurring legislative vehicle through which far-ranging changes to FDA have been enacted, reshaping the agency’s interactions and relationship with the regulated industry. The majority of policy changes enacted through PDUFA legislation have favored industry through decreasing regulatory standards, shortening approval times, and increasing industry involvement in FDA decision-making. FDA’s budgetary dependence on the industry, the urgency of each PDUFA reauthorization’s passage to maintain uninterrupted funding, and the industry’s required participation in PDUFA negotiations may advantage the industry.
Landscape of Pediatric Endoscopic Ultrasound in a United States Tertiary Care Medical Center
Authors: Barakat Monique T. , Cagil Yasemin , Gugig Roberto
Published: February 2022

Background:

Endoscopic ultrasound (EUS) is a commonly used radiation‐sparing procedure in adult patients for diagnostic sampling of gastrointestinal lesions and fluid collections, gastric variceal hemostasis, biliary/pancreatic duct drainage, and endo‐surgical interventions. Integration of EUS in pediatrics is still in its infancy with limited data regarding its use. The present study analyzes utilization, diagnostic and therapeutic roles of pediatric EUS and evolution in these parameters over time.

Methods:

Records of patients 18 years or younger from 2009 to 2020 at our tertiary pediatric care center were retrospectively identified. Patient demographics, symptoms, laboratory studies, EUS indications and interventions, and clinical outcomes of the procedures were analyzed. Statistical analysis was performed using Student t‐test, Pearson's chisquare and Fisher exact tests.

Results:

306 EUS procedures were performed during the study period, for 279 pediatric patients. These included 287 (93.8%) upper EUS and 19 (6.2%) lower EUS. Two hundred and twenty‐nine procedures were diagnostic (74.8%) and 77 were therapeutic (25.2%). EUS indications included evaluation and therapy of the pancreaticobiliary region (231, 75.5%), subepithelial or regional lesion (54, 17.8%), celiac plexus block (19, 6.2%) and hemostasis (14, 4.5%). Diagnostic sampling was performed in 52 of these EUS procedures, with a 96.2% diagnostic yield. 98.7% of therapeutic procedures were technically successful and there were no associated adverse events.

Conclusion:

The diagnostic and therapeutic role for EUS in adults has expanded dramatically, however the role of EUS in pediatrics is not well‐defined. In this, the largest pediatric EUS study to date, our data support the safety and utility of diagnostic and therapeutic EUS in pediatrics.
Randomized Controlled Trial of Interactive Spaced Education to Support Constipation Management by Pediatric Primary Care Providers
Authors: Mallon Daniel , Fei Lin , Farrell Michael , Anderson Jeffrey B. , Klein Melissa
Published: February 2022

Introduction:

Integrating continuing medical education and quality improvement (QI) initiatives is challenging. We aimed to compare one method, Interactive Spaced Education (ISE/QI), with standard (sTD/Qi) education embedded within a constipation management Qi initiative.

Methods:

We conducted a randomized, controlled study to compare ISE/QI and STD/QI education. Pediatric primary care providers (PCPs) were recruited from a network of local private practices. The QI initiative was implemented with all providers before education interventions. ISE/QI participants received questions by email weekly, provided answers, received feedback, and repeated questions over a 4‐month period. The STD/QI group received a Power Point with the same educational content. Pre‐ and post‐surveys evaluated usability, self‐assessed confidence, and practice changes while quizzes evaluated knowledge. Process control charts tracked subsequent visits to gastroenterology (GI).

Results:

Of the 212 eligible PCPs, 101 (48%) enrolled, with 49 PCPs in the ISE/QI arm and 52 in STD/QI education arm. Quiz scores improved in the ISE/QI arm with a strong effect size (Cohen d 1.76). Mean increase in confidence managing difficult cases was higher in the ISE/QI group (1.84 vs 1.21, P = 0.030). ISE/QI participants were more likely to rate the activity better than most online education (odds ratio [OR] 18.1, P < 0.0001) and incorporate practice changes (OR 3.35, P = 0.0152). Visits to GI decreased among the entire population, but the effect on GI visits within each education arm was mixed.

Conclusions:

ISE/QI improved knowledge and confidence managing difficult cases. ISE/QI participants reported higher likelihood to change practice, but no differences were seen in GI referrals.
Ledipasvir‐sofosbuvir in Adolescents With Chronic Hepatitis C and Hematological Malignancies Undergoing Chemotherapy
Authors: El‐Sayed Manal Hamdy , Ebeid Fatma S. Elsayed , Zekri Abdel‐Rahman , Massetto Benedetta , Kersey Kathryn , Zhang Fangqiu , Gaggar Anuj , Elsayed Walaa , El‐Haddad Alaa
Published: February 2022

Objectives:

In children with hematological malignancies, chronic hepatitis C virus (HCV) infection has been associated with more rapid liver disease progression and higher risk of malignancy relapse due to chemotherapy interruption. We evaluated the safety and efficacy of ledipasvir‐sofosbuvir for 12weeks in these patients.

Methods:

In a phase 2, open‐label study, at one site in Egypt, patients ages 12‐<18years with chronic HCV genotype 1 or 4 infection undergoing maintenance chemotherapy for hematological malignancies received ledipasvir‐sofosbuvir (90 mg/400 mg) once daily for 12weeks. The efficacy endpoint was sustained virologic response 12 weeks after treatment (SVR12). Safety was assessed by the incidence of adverse events and clinical and laboratory data, including HCV flares defined as alanine aminotransferase >3‐fold increase from Day 1 and HCV RNA elevation >1 × log10 from Day 1.

Results:

Of the 19 adolescents enrolled and treated, median age was 14 years (range 12–17), 84% (16/19) were male, and all had HCV genotype 4 and were HCV treatment naive. All patients completed treatment and achieved SVR12 (19/19, 100%, 95% confidence interval, 82–100). Common adverse events were pyrexia (5/19, 26%), diarrhea (4/19, 21%), and headache (4/19, 21%). Three patients experienced serious adverse events of pneumonia (two patients), and osteoarthritis and diarrhea (one patient); none were considered related to study drug. No patient experienced HCV flares.

Conclusions:

Ledipasvir‐sofosbuvir was well‐tolerated and efficacious in adolescents with chronic HCV genotype 4 and leukemia undergoing maintenance chemotherapy. These data support the use of this interferon and ribavirin‐free regimen in adolescents with hematological malignancies.
Simplified Magnetic Resonance Index of Activity Is Useful for Terminal Ileal but not Colonic Disease in Pediatric Crohn Disease
Authors: Lepus Chelsea A. , Moote Douglas J. , Bao Shanshan , Mosha Maua H. , Hyams Jeffrey S.
Published: February 2022

Background:

Ileocolonoscopy (IC) detects mucosal inflammation and magnetic resonance enterography (MRE) detects transmural inflammation in Crohn disease (CD). We aimed to evaluate the relationship between the simplified magnetic resonance index of activity (MARIAs) and measures of inflammation by IC in children with newly diagnosed CD.

Methods:

Retrospective review of 140 patients 6–18 years of age with CD who had baseline IC and MRE within 5 weeks of diagnosis. MARIAs was calculated for each intestinal segment (terminal ileum [TI], ascending colon, transverse colon, descending colon, sigmoid colon, rectum), defined as (1 × thickness > 3 mm) + (1 × edema) + (1 × fat stranding) + (2 × ulcers). Sensitivity and specificity were derived using receiver operating characteristic (ROC) curves to compare MARIAs to IC findings.

Results:

Using IC as the reference standard, the cutoff MARIAs ≥1 identified TI segments with active inflammation with 84% sensitivity, 73% specificity, 85% positive predictive value (PPV), 70% negative predictive value (NPV), and area under the curve (AUC) 0.782 (95% confidence interval [CI] 0.689–0.876). The cutoff MARIAs ≥2 identified TI segments with severe lesions with 87% sensitivity, 76% specificity, 87% PPV, 76% NPV, and AUC 0.814 (95% CI 0.712–0.916). There was poor sensitivity for all colonic segments.

Conclusion:

The MARIAs is feasible and accurate in reflecting disease activity in the TI, but not in the colon, in children with newly diagnosed CD. Although the MARIAs may be useful for monitoring TI disease activity over time, full assessment continues to require both IC and MRE.
Nurse-Led Telephonic Palliative Care
Authors: Yamarik Rebecca L. , Tan Audrey , Brody Abraham A. , Curtis Jennifer , Chiu Laraine , Bouillon-Minois Jean-Baptiste , Grudzen Corita R.
Published: February 2022

Americans near the end of life experience high rates of nonbeneficial, burdensome, and preventable hospital-based care. If patients' goals of care are unknown or unclear, they have higher rates of hospitalization at the end of life. The demand for palliative care has grown exponentially because of its impact on quality of life, symptom burden, and resource use, requiring the development of new palliative care models. Nurses' holistic outlook and patient-centered focus make them ideal to deliver telephonic palliative care. This article discusses 4 cases delivered by a nurse-led telephonic palliative care program, a part of the Emergency Medicine Palliative Care Access project, which is a randomized controlled trial comparing outpatient palliative care with nurse-led telephonic case management after an emergency department visit. Telephonic nurses discuss patients' goals, fears, hopes, and concerns regarding their illness and its trajectory that inform decisions for future interventions and treatments. In addition, they share this information with the patients' surrogate decision-makers and clinicians to facilitate care coordination and symptom management. For seriously ill patients, nurses' abilities and expertise, as well as the difficulties of providing care through in-person models of palliative care delivery, make a nurse-led telephonic model an optimal option.
Experiences With COVID-19
Authors: Prokop Jackie , Reid Catherine , Palmateer Brandon
Published: February 2022

Background

Millions of Americans have tested positive for COVID-19. The illness has a range of clinical symptoms with varying degrees of symptom severity; there is limited research about the lived experience of having COVID-19.

Objective

The study aim was to understand the lived experience of having COVID-19, provide detail on the length and severity of symptoms as well as coping mechanisms of those with the illness, and identify issues individuals face when accessing healthcare.

Methods

This phenomenological qualitative study included semistructured interviews of 45 people ages 18 years and older living in the United States who tested positive for COVID-19. Inductive content analysis was employed for subjective interpretation of the text through a systematic coding classification to identify themes for analysis and conclusions.

Results

This study details a variety of symptom presentations of individuals who tested positive for COVID-19 as well as mental health concerns related to fear and living with COVID-19.

Discussion

Individuals expressed varying emotions when finding they tested positive for COVID-19. Many conveyed fear of having COVID-19 and indicated it was a traumatic experience. This fear is an important clinical finding that policymakers and providers should consider when treating acute and chronic COVID-19 patients. Finally, many participants, commonly referred to as “long haulers,” experienced ongoing and lingering symptoms highlighting an area in need of further research.
Case Report: Acute Corneal Hydrops despite Accelerated Transepithelial Corneal Cross-linking
Authors: Meyer Jay J. , Gokul Akilesh
Published: February 2022

SIGNIFICANCE

Corneal cross-linking is a well-established treatment to reduce or halt the progression of keratoconus. This case demonstrates that acute corneal hydrops may develop several years after corneal cross-linking even despite apparent treatment effect with corneal flattening, and patients should be monitored accordingly.

PURPOSE

This study aimed to describe a case of continued progression in the form of corneal hydrops despite prior corneal cross-linking and evidence of treatment effect.

CASE REPORT

A 19-year-old woman underwent bilateral accelerated transepithelial corneal cross-linking for progressive keratoconus. At 2 years after the procedure, significant flattening of the central cornea of >3 D was measured in the left eye, indicating a significant treatment response, although continued thinning was noted on tomography. At 3.5 years after the procedure, this eye developed acute corneal hydrops with subsequent corneal scarring necessitating corneal transplantation.

CONCLUSIONS

Patients should continue to be monitored for several years after corneal cross-linking, and retreatment should be considered if there is progressive corneal thinning.
Successive Wave Analysis to Assess Nonresponse Bias in a Statewide Random Sample Testing Study for SARS-CoV-2
Authors: Duszynski Thomas J. , Fadel William , Dixon Brian E. , Yiannoutsos Constantin , Halverson Paul K. , Menachemi Nir
Published: February 2022

Introduction:

Nonresponse bias occurs when participants in a study differ from eligible nonparticipants in ways that can distort study conclusions. The current study uses successive wave analysis, an established but underutilized approach, to assess nonresponse bias in a large-scale SARS-CoV-2 prevalence study. Such an approach makes use of reminders to induce participation among individuals. Based on the response continuum theory, those requiring several reminders to participate are more like nonrespondents than those who participate in a study upon first invitation, thus allowing for an examination of factors affecting participation.

Methods:

Study participants from the Indiana Population Prevalence SARS-CoV-2 Study were divided into 3 groups (eg, waves) based upon the number of reminders that were needed to induce participation. Independent variables were then used to determine whether key demographic characteristics as well as other variables hypothesized to influence study participation differed by wave using chi-square analyses. Specifically, we examined whether race, age, gender, education level, health status, tobacco behaviors, COVID-19–related symptoms, reasons for participating in the study, and SARS-CoV-2 positivity rates differed by wave.

Results:

Respondents included 3658 individuals, including 1495 in wave 1 (40.9%), 1246 in wave 2 (34.1%), and 917 in wave 3 (25%), for an overall participation rate of 23.6%. No significant differences in any examined variables were observed across waves, suggesting similar characteristics among those needing additional reminders compared with early participants.

Conclusions:

Using established techniques, we found no evidence of nonresponse bias in a random sample with a relatively low response rate. A hypothetical additional wave of participants would be unlikely to change original study conclusions. Successive wave analysis is an effective and easy tool that can allow public health researchers to assess, and possibly adjust for, nonresponse in any epidemiological survey that uses reminders to encourage participation.
Disparities in SARS-CoV-2 Testing for Hispanic/Latino Populations: An Analysis of State-Published Demographic Data
Authors: Pond Emily N. , Rutkow Lainie , Blauer Beth , Aliseda Alonso Angel , Bertran de Lis Sara , Nuzzo Jennifer B.
Published: February 2022

Racial and ethnic minorities in the United States have been disproportionately affected by the COVID-19 pandemic, experiencing increased risk of infection, hospitalization, and death. In this study, we sought to examine race- and ethnicity-based differences in SARS-CoV-2 testing. We used publicly available US state dashboards to extract demographic data for COVID-19 cases and tests. Poisson regression models were used to model the effect of race and ethnicity on the number of SARS-CoV-2 tests performed per case. In total, just 8 states reported testing data by race and ethnicity. In regression models, race and ethnicity was a significant predictor of testing rate per case. In all states, Hispanic/Latino patients had a significantly lower testing rate than their non-Hispanic/Latino counterparts, with an incident rate ratio varying from 0.45 to 0.81, depending on the state and referent race category. These results suggest disparities in testing access among Hispanic/Latino individuals, who are already at a disproportionate risk for infection and severe outcomes.
Differentiating Sex and Gender Among Older Men and Women
Authors: Pohrt Anne , Kendel Friederike , Demuth Ilja , Drewelies Johanna , Nauman Tauseef , Behlouli Hassan , Stadler Gertraud , Pilote Louise , Regitz-Zagrosek Vera , Gerstorf Denis
Published: February 2022

Objective

This study aimed to paradigmatically show the development of a gender score that can be used as either an adjustment or a matching variable to separate the effects of gender versus biological sex in a sample of older adults.

Methods

Our sample comprised 1100 participants from the Berlin Aging Study II (52% women, mean [standard deviation] age = 75.6 [3.8] years). The gender score included a multitude of gender-related variables and was constructed via logistic regression. In models of health outcomes, it was used as an adjustment variable in regression analyses as well as a matching variable to match older men and women according to their gender.

Results

Matching by gender substantially reduced sample size to n = 340. Analyses (either adjusting for gender or matching men and women according to gender) revealed that female sex was independently associated with lower grip strength (B = −14.47, 95% confidence interval [CI] = −15.51 to −13.44), better cognitive performance (B = 3.47, 95% CI = 1.94 to 5.0), higher pulse wave velocity (B = 0.19, 95% CI = 0.06 to 0.31), lower body mass index (B = −0.97, 95% CI = −1.74 to −0.21), and lower rates of metabolic syndrome (odds ratio = 0.53, 95% CI = 0.37 to 0.77). In addition, both sex and gender were independently associated with cognitive performance and depression.

Conclusions

Calculating a gender score allows for the inclusion of a large number of variables, creating parsimonious models that are adaptable to different data sets and alternative gender definitions. Depending on the research question and the sample properties, the gender score can be used as either an adjustment or a matching variable.

Trial Registration: DRKS—Deutsches Register Klinischer Studien (Study ID: DRKS00016157).
Bilateral Mandibular Pseudoarthrosis: A Rare Complication after Orthognathic Surgery
Authors: Sol Izabella , de Castro Rodrigues Cristóvão Marcondes , Meneses-Santos Daniela , de Menezes Henrique Caetano Parreira , Garcia Jose Alberto , da Silva Marcelo Caetano Parreira
Published: February 2022

Orthognathic surgery to treat dentofacial discrepancies has become an increasingly common elective procedure in sur-gical practices. Despite its numerous advantages such as improved aesthetics and masticatory and respiratory function, some complications and unfavorable results can be observed. Pseudoarthrosis after orthognathic surgery is a rare complication and is little reported in the literature. Pseudoarthrosis is characterized by an increasing occlusal worsening associated with bone mobility and pain. Due to the low incidence of pseudoarthrosis, it is necessary to study its involvement to elucidate its etiology and treatment. The aim of this work was to report a clinical case of bilateral mandibular pseudoarthrosis after orthognathic surgery, where multiple interventions and prolonged treatment time were necessary until the case was concluded. The precise diagnosis associated with the choice of the most effective treatment based on the literature proved to be essential for the management of this complication.
An Investigation of the Relationship Between the Second-to-Fourth Digit Ratio and Sagittal Synostosis
Authors: O’Sullivan F. , Bollard S.M. , O’Sullivan G.P. , Coffey P. , Bracken S. , Murray D.J.
Published: February 2022

Background:

The most common presentation of nonsyndromic craniosynostosis is that of the sagittal suture. Amongst this subgroup there is a significant male preponderance. Although the etiology is largely unknown, androgen exposure in utero has been suggested as a contributing factor. The second-to-fourth digit ratio (2D:4D) is a sexually dimorphic trait, reflective of the levels of androgen and estrogen exposure in utero, with a lower 2D:4D ratio associated with higher androgen exposure.

This study aimed to examine the difference in 2D:4D ratio between participants with sagittal synostosis (SS) and gender- matched controls, hypothesizing that alterations in androgen exposure would be reflected in participants’ 2D:4D ratio.

Method:

Participants with nonsyndromic SS and gender-matched controls were prospectively recruited from outpatients clinics. Photographs were taken of the right hand, and 3 independent researchers measured the length of the fingers and 2D:4D ratio, with the mean 2D:4D ratio then calculated.

Results:

Fifty-six participants were recruited to both groups, with 35 males and 21 females in each. The mean age of the study and control groups were 5.6 and 6.3 years, respectively. There was no difference in the 2D:4D ratio between groups overall (P = 0.126). However, males with SS had a significantly higher 2D:4D ratio in comparison to male controls (0.969 ± 0.379 versus 0.950 ± 0.354, P = 0.038).

Conclusions:

Our results suggest that 1 single hormonal pathway is not responsible for suture fusion. Subsequently we consider that an imbalance between testosterone and estrogen signaling may contribute to the development of sagittal craniosynostosis.
A Comparative Study of Analog Preoperative Planning Versus Virtual Preoperative Planning for Mandibular Reconstruction With Fibula Free Flap
Authors: Cedillo Marco , Côrdova Sofia , Larralde Sebastián , Martínez Fabián , Sandoval Fernando , Suntaxi Felipe
Published: February 2022

Mandibular reconstruction is a challenging procedure, especially in cancer patients with defects that are greater than 6 cm. Free vascularized fibular flap is the gold standard treatment in these cases since it allows three-dimensional restoration of the lost segments after ablative surgery in addition to providing the possibility of a subsequent implant-supported rehabilitation improving the functional and aesthetic outcomes of the surgery.

To obtain accurate results, preoperative planning must be done with detail. Approaches for the preoperative planning include both the conventional analog planning and the virtual planning that are valid alternatives in meeting the trans-surgical requirements.

This study makes a comparative analysis of 2 clinical cases with a diagnosis of squamous cell carcinoma that were reconstructed using a vascularized fibular free flap. The first case was planned using the conventional analog method whereas the second case was planned using the virtual planning approach.

The impact of virtual planning and conventional analog planning on preoperative planning time, ischemia period, and total surgical time is analyzed according to the experience obtained in the cases presented. In addition, the authors described the technique used for each planning method along with a literature review in which the results are contrasted and discussed.
Restoration of Facial Bone Defect using Patient-Specific Implant
Authors: Ha Sung-Ho , Choi Jin-Young
Published: February 2022

Facial bone defects can be caused by various causes, such as congenital deformities, iatrogenic results, and trauma. If the size of the bone defect is small, it can be repaired using premanufactured products, but it is not accurate and impossible to restore large bony defect. In the effort to overcome these limitations of premanufac-tured implants, the authors use patient-specific implant (PSI) via computer-aided design/computer-aided manufacturing and 3D printing technologies for facial bone restoration surgery. In this study, the authors use polyetherketoneketone and titanium alloy for implant material among various capable of 3D printing. As a result of analyzing the patients who underwent surgery in this study, PSIs were made in 57 sites for 29 patients. The most common reason for surgery was to improve the patient’s esthetics (14 cases), followed by the improvement of iatrogenic complications and postoperative dissatisfaction (11 cases). Restoration of the congenital bony defect was the least (4 cases). Postoperative complications were occurred in 5 patients (screw loosening in 1 case, postoperative dissatisfaction in 3 cases, and postoperative infection in 1 case). There is no case of rejection after implant insertion, because the authors use polyetherketoneketone and titanium alloy for implant material which are good biocompatibility. By using PSIs via 3D technologies, the authors can overcome the limitations of premanufactured products. Moreover, the authors could get better results. So these cutting edge technologies can improve our surgical procedures and predictability.
Genetic Variants and Haplotypes of TOMM40, APOE, and APOC1 are Related to the Age of Onset of Late-onset Alzheimer Disease in a Colombian Population
Authors: Ortega-Rojas Jenny , Arboleda-Bustos Carlos E. , Guerrero Esneyder , Neira Juan , Arboleda Humberto
Published: February 2022

Background:

The Apolipoprotein E (APOE) gene is the main risk factor for late-onset Alzheimer disease (LOAD). Genetic variants and haplotypes in regions near the APOE locus may be associated with LOAD in the Colombian population.

Objective:

We evaluated frequencies and risk of genetic variants and haplotypes in APOE, TOMM40, and APOC1 promoters, also in putative regulatory enhancer elements (TOMM40 IVS2-4 and TOMM40 IVS6), and in cis-regulatory elements (ME1 and BCR).

Materials and Methods:

Our case-control association study was carried out in 50 patients with LOAD and 50 controls. We determined frequencies and odd ratios for genetic variants and haplotypes.

Results:

We found a significant association between LOAD and genetic variants at the TOMM40 promoter, at TOMM40 IVS2-4 and TOMM40 IVS6 regulatory enhancer elements, and at the APOC1 promoter. Particularly, variants of Poly-T and APOC1 promoter could anticipate the age of onset of LOAD in our population. We identified three risk haplotypes in TOMM40 (ACGGAG, ACGGGG, and ATAGGC) related to LOAD’s age of onset. We also found other risk or protection haplotypes at the TOMM40 and APOE promoters, at TOMM40 IVS2-4, TOMM40 IVS6 regulatory enhancer elements, and at ME1.

Conclusion:

Genetic variants and haplotypes near the APOE locus are related to LOAD risk and accelerated onset of LOAD in the Colombian population.
In Vitro Selection of Remdesivir-Resistant SARS-CoV-2 Demonstrates High Barrier to Resistance
Authors: Checkmahomed Liva , Pont Venice Du , Riola Nicholas C. , Perry Jason K. , Li Jiani , Porter Danielle P. , Boivin Guy
Published: February 2022

In vitro selection of remdesivir-resistant SARS-CoV-2 revealed the emergence of a V166L substitution, located outside of the polymerase active site of the nsp12 protein, after 9 passages. V166L remained the only nsp12 substitution after 17 passages at a final concentration of 10 µM RDV, conferring a 2.3-fold increase in EC50. When V166L was introduced into a recombinant SARS-CoV-2 virus, a 1.5-fold increase in EC50 was observed, indicating a high in vitro barrier to RDV resistance.
Automatic post-processing and merging of multiple spike-sorting analyses with Lussac
Authors: Llobet Victor , Wyngaard Aurélien , Barbour Boris
Published: February 2022

The increasing site counts of multielectrodes used in extracellular recording preclude traditional manual spike-sorting and have led to the development of several new software suites with increased automation. It remains difficult, however, to find parameters enabling optimal processing of signals from all neuronal types simultaneously. Here, we describe a procedure for automatically post-processing and merging the outputs of multiple spike-sorting analyses, enabling the accumulation of results optimised for different activity features. This approach was motivated by and first applied to the analysis of cerebellar activity, in which the complex spikes challenge standard analyses. The core of our modular procedure involves the identification of cluster-fusion candidates and assurance that only fusions that increase a clearly defined cluster-quality metric are performed; important subsidiary steps that have also been automated include spike alignment and duplicate removal. The procedure was validated by recovery of injected spike waveforms. In tests combining analyses from Kilosort and MountainSort, our procedure yielded a 50 % increase in the detected number of Purkinje cell clusters with both simple and complex spikes. A further validation used the synthetic SpikeForest dataset approximating neocortical activity, in which our package also improved performance. Combining multiple analyses therefore offers a general method for improving spike-sorting, and furthermore Lussac reduces manual input and increases the objectivity of analyses.