bluuebunny/crossref_metadata_2025 huggingface dataset:
OSCE Revision for the Final FRCEM
Authors: Goss Rachel , McMaster Emma , Rennie Stephanie
Published: February 2022

The FRCEM OSCE Revision Guide is an excellent resource for trainees who are preparing for their Fellowship of the Royal College of Emergency Medicine (FRCEM) Objective Structured Clinical Examination (OSCE). Written by three UK-trained Emergency Medicine Consultants, this book provides an insight into the preparation required to pass the exam. The FRCEM OSCE has somewhat evolved over recent years, and so the authors explain the structure and format of the current exam. They also provide useful tips on revision strategy, as well as on how to navigate the actual exam. Each element of the OSCE is covered throughout the chapters: history, examination, teaching skills, practical skills and procedures, communication skills, resuscitation scenarios, psychiatry cases, and management scenarios. Each chapter provides numerous OSCE scenarios with instructions for the candidate and clear mark schemes, as well as learning points for the trickier cases. The cases reflect real-life scenarios that are common, yet complex presentations to the emergency department. They are pertinent to the Royal College of Emergency Medicine (RCEM) curriculum and have frequently appeared in previous OSCEs. The cases are often nuanced in such a way as to stretch the candidate to communicate and make decisions at the level of a senior registrar or consultant. The mark schemes are based on best practice and up-to-date national guidance. Overall, this book provides a great structure for successful revision.
Examinations
Authors: Goss Rachel , McMaster Emma , Rennie Stephanie
Published: February 2022

This chapter contains 12 different examination sample cases for the Fellowship of the Royal College of Emergency Medicine (FRCEM) Objective Structured Clinical Examination (OSCE). In this chapter, candidates are provided with the opportunity to go beyond simply examining a patient. Candidates must incorporate slick, focused examination skills, with communication skills, knowledge, and application of up-to-date guidelines, to succinctly explain management of disease to patients. The cases reflect a range of common presentations that are pertinent to the Royal College of Emergency Medicine (RCEM) curriculum and that are seen in real-life emergency departments. Each case contains instructions for the candidate and the patient actor, as well as a sample mark scheme breakdown. Key learning points are highlighted after each case.
Resuscitation Scenarios
Authors: Goss Rachel , McMaster Emma , Rennie Stephanie
Published: February 2022

This chapter contains six different resuscitation scenarios for the Fellowship of the Royal College of Emergency Medicine (FRCEM) Objective Structured Clinical Examination (OSCE). In this chapter, candidates are expected to follow standard life support principles for adults and paediatrics. Candidates must incorporate communication skills, knowledge, and application of up-to-date guidelines to manage the scenarios. This will often be incorporated with another element such as teaching, a practical procedure, and communication with a colleague or relative. The cases reflect a range of common presentations that are pertinent to the Royal College of Emergency Medicine (RCEM) curriculum and that are seen in real-life emergency departments. Each case contains instructions for the candidate and the patient actor, as well as a sample mark scheme breakdown and a mark scheme. Key learning points are highlighted.
Testing cosmic anisotropy with the Ep−Eiso (‘Amati’) correlation of GRBs
Authors: Zhao Dong , Xia Jun-Qing
Published: February 2022

We test the possible cosmic anisotropy in 118 long GRBs with the Ep−Eiso (‘Amati’) correlation by employing the dipole fitting (DF) and hemisphere comparison (HC) methods. The distribution of the GRB sample is nearly homogeneous in the sky. The dipole anisotropy is weak in the dipole-modulated $\rm \Lambda$CDM model and the Finslerian cosmological model. The dipole directions from the GRB sample are consistent with ones given by the Pantheon SNe-Ia sample, but with smaller uncertainties. We also investigate whether the GRB sample can reduce the anisotropic signal from inhomogeneous samples like the Pantheon one. The GRB sample is then combined with the Pantheon one, thus providing an SN-G sample. In the dipole-modulated $\rm \Lambda$CDM model, the dipole direction in the SN-G sample shows a considerable change from the one in the Pantheon sample. The angle between the two directions is 26${_{.}^{\circ}}$78. For the HC method, the result of maximum anisotropy level from the G-SN sample is 0.257 ± 0.060 at 68 per cent confidence level (CL) and the corresponding preferred direction is $(l,b)=(82{_{.}^{\circ}}97^{+52{_{.}^{\circ}}73}_{~-61{_{.}^{\circ}}88}, -15{_{.}^{\circ}}09^{+60{_{.}^{\circ}}09}_{~-13{_{.}^{\circ}}54})$. The statistical significance of the $\rm AL_{max}$ is 1.4σ. The angle between the preferred direction and the one from the Pantheon sample is 44${_{.}^{\circ}}$40. Although the amount of data in the GRB sample is about a tenth of that in the Pantheon sample, the GRB sample can considerably impact the results from the Pantheon sample. Our results show that GRBs have the potential to search for a convincing cosmic anisotropy.
Oblique Alfvén waves in a stellar wind environment with dust particles charged by inelastic collisions and by photoionization
Authors: De Toni L B , Gaelzer R , Ziebell L F
Published: February 2022

The characteristics of Alfvén waves propagating in a direction oblique to the ambient magnetic field in a stellar wind environment are discussed. A kinetic formulation for a magnetized dusty plasma is adopted considering Maxwellian distributions of electrons and ions, and immobile dust particles electrically charged by absorption of plasma particles and by photoionization. The dispersion relation is numerically solved and the results are compared with situations previously studied where dust particles were not charged by photoionization, which is an important process in a stellar wind of a relatively hot star. We show that the presence of dust causes the shear Alfvén waves to present a region of wavenumber values with zero frequency and that the minimum wavelength for which the mode becomes dispersive again is roughly proportional to the radiation intensity to which the dust grains are exposed. The damping rates of both shear and compressional Alfvén waves are observed to decrease with increasing radiation flux, for the parameters considered. For the particular case where both modes present a region with null real frequency when the radiation flux is absent or weak, it is shown that when the radiation flux is sufficiently strong, the photoionization mechanism may cause this region to get smaller or even to vanish, for compressional Alfvén waves. In that case, the compressional Alfvén waves present non-zero frequency for all wavenumber values, while the shear Alfvén waves still present null frequency in a certain interval of wavenumber values, which gets smaller with the presence of radiation.
A simple preparation protocol for shipping and storage of tissue sections for laser ablation-inductively coupled plasma-mass spectrometry imaging
Authors: Buchholz Rebecca , Krossa Sebastian , Andersen Maria K , Holtkamp Michael , Sperling Michael , Karst Uwe , Tessem May-Britt
Published: February 2022

A rapid and cost-efficient tissue preparation protocol for laser ablation-inductively coupled plasma-mass spectrometry imaging (LA–ICP–MSI) has been developed within this study as an alternative to the current gold standard using fresh-frozen samples or other preparation techniques such as formalin fixation (FFix) and formalin-fixed paraffin-embedding (FFPE). Samples were vacuum dried at room temperature (RT) and stored in sealed vacuum containers for storage and shipping between collaborating parties. We compared our new protocol to established methods using prostate tissue sections investigating typical endogenous elements such as zinc, iron, and phosphorous with LA–ICP–MSI. The new protocol yielded comparable imaging results as fresh-frozen sections. FFPE sections were also tested due to the wide use and availability of FFPE tissue. However, the FFPE protocol and the FFix alone led to massive washout of the target elements on the sections tested in this work. Therefore, our new protocol presents an easy and rapid alternative for tissue preservation with comparable results to fresh-frozen sections for LA–ICP–MSI. It overcomes washout risks of commonly used tissue fixation techniques and does not require expensive and potentially unstable and time-critical shipping of frozen material on dry ice. Additionally, this protocol is likely applicable for several bioimaging approaches, as the dry condition may act comparable to other dehydrating fixatives, such as acetone or methanol, preventing degradation while avoiding washout effects.
Characterization of the nickel-inserting cyclometallase LarC from Moorella thermoacetica and identification of a cytidinylylated reaction intermediate
Authors: Turmo Aiko , Hu Jian , Hausinger Robert P
Published: February 2022

LarC catalyzes the CTP-dependent insertion of nickel ion into pyridinium-3,5-bisthiocarboxylic acid mononucleotide (P2TMN), the final biosynthetic step for generating the nickel-pincer nucleotide (NPN) enzyme cofactor. In this study, we characterized a LarC homolog from Moorella thermoacetica (LarCMt) and characterized selected properties of the protein. We ruled out the hypothesis that enzyme inhibition by its product pyrophosphate accounts for its apparent single-turnover activity. Most notably, we identified a cytidinylylated-substrate intermediate that is formed during the reaction of LarCMt. Selected LarCMt variants with substitutions at the predicted CTP-binding site retained substantial amounts of activity, but exhibited greatly reduced levels of the CMP-P2TMN intermediate. In contrast, enhanced amounts of the CMP-P2TMN intermediate were generated when using LarCMt from cells grown on medium without supplemental nickel. On the basis of these results, we propose a functional role for CTP in the unprecedented nickel-insertase reaction during NPN biosynthesis.
Injectable hybrid inorganic nanoscaffold as rapid stem cell assembly template for cartilage repair
Authors: Wang Shenqiang , Yang Letao , Cai Bolei , Liu Fuwei , Hou Yannan , Zheng Hua , Cheng Fang , Zhang Hepeng , Wang Le , Wang Xiaoyi , Lv Qianxin , Kong Liang , Lee Ki-Bum , Zhang Qiuyu
Published: February 2022

Cartilage injuries are often devastating and most cannot be cured because of the intrinsically low regenerative capacity of cartilage tissues. Although stem-cell therapy has shown enormous potential for cartilage repair, the therapeutic outcome has been restricted by low survival rates and poor chondrocyte differentiation in vivo. Here, we report an injectable hybrid inorganic (IHI) nanoscaffold that facilitates fast assembly, enhances survival and regulates chondrogenic differentiation of stem cells. IHI nanoscaffolds that strongly bind to extracellular matrix (ECM) proteins assemble stem cells through synergistic 3D cell–cell and cell–matrix interactions, creating a favorable physical microenvironment for stem-cell survival and differentiation in vitro and in vivo. Additionally, chondrogenic factors can be loaded into nanoscaffolds with a high capacity, which allows deep, homogenous drug delivery into assembled 3D stem-cell-derived tissues for effective control over the soluble microenvironment of stem cells. The developed IHI nanoscaffolds that assemble with stem cells are injectable. They also scavenge reactive oxygen species and timely biodegrade for proper integration into injured cartilage tissues. Implantation of stem-cell-assembled IHI nanoscaffolds into injured cartilage results in accelerated tissue regeneration and functional recovery. By establishing our IHI nanoscaffold-templated 3D stem-cell assembly method, we provide a promising approach to better overcoming the inhibitory microenvironment associated with cartilage injuries and to advance current stem-cell-based tissue engineering.
Long-term Outcomes and Recovery of Patients who Survived COVID-19: LUNG INJURY COVID-19 Study
Authors: Vargas Centanaro Gianna , Calle Rubio Myriam , Álvarez-Sala Walther José Luis , Martinez-Sagasti Fernando , Albuja Hidalgo Andrea , Herranz Hernández Rafael , Rodríguez Hermosa Juan Luis
Published: February 2022

Background

LUNG INJURY COVID-19 (clinicaltrials.gov NCT 21/399-E) is a registry-based prospective observational cohort study to evaluate long-term outcomes and recovery 12 months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection according to severity.

Methods

Three hundred five coronavirus disease 2019 (COVID-19) survivors were included (moderate, 162; severe, 143). Twelve months after SARS-CoV-2 infection, there was resolution of respiratory symptoms (37.9% in severe vs 27.3% in moderate pneumonia; P = .089).

Results

Exertional dyspnea was present (20% in severe vs 18.4% in moderate; P = .810). Abnormalities on chest radiology imaging were detected more often in severe COVID-19 infection vs moderate infection (29% vs 8.8%; P < .001). Pulmonary function testing (forced spirometry or diffusion) performed at 12 months of mean follow-up according to protocol detected anomalies in 31.4% of patients with severe COVID-19 courses and in 27.7% of moderate patients. Risk factors associated with diffusion impairment at 12 months were age (odds ratio [OR], 1.05; 95% CI, 1.01–1.10; P = .008), forced expiratory volume in 1 second predicted at follow-up (OR, 0.96; 95% CI, 0.93–0.99; P = .017), and dyspnea score at follow-up (OR, 3.16; 95% CI, 1.43–6.97; P = .004). Computed tomography (CT) scans performed at 12 months of mean follow-up showed evidence of fibrosis in almost half of patients with severe COVID-19 courses, who underwent CT according to protocol.

Conclusions

At 12 months from infection onset, most patients refer to symptoms, particularly muscle weakness and dyspnea, and almost one-third of patients with severe COVID-19 pneumonia had impaired pulmonary diffusion and abnormalities on chest radiology imaging. These results emphasize the importance of systematic follow-up after severe COVID-19, with appropriate management of pulmonary sequelae.
Pentatricopeptide repeat protein CNS1 regulates maize mitochondrial complex III assembly and seed development
Authors: Ma Shuai , Yang Wenzhu , Liu Xiaoqing , Li Suzhen , Li Ye , Zhu Jiameng , Zhang Chunyi , Lu Xiaoduo , Zhou Xiaojin , Chen Rumei
Published: February 2022

Mitochondrial function relies on the assembly of electron transport chain complexes, which requires coordination between proteins encoded by the mitochondrion and those of the nucleus. Here, we cloned a maize (Zea mays) cytochrome c maturation FN stabilizer1 (CNS1) and found it encodes a pentatricopeptide repeat (PPR) protein. Members of the PPR family are widely distributed in plants and are associated with RNA metabolism in organelles. P-type PPR proteins play essential roles in stabilizing the 3′-end of RNA in mitochondria; whether a similar process exists for stabilizing the 5′-terminus of mitochondrial RNA remains unclear. The kernels of cns1 exhibited arrested embryo and endosperm development, whereas neither conventional splicing deficiency nor RNA editing difference in mitochondrial genes was observed. Instead, most of the ccmFN transcripts isolated from cns1 mutant plants were 5′-truncated and therefore lacked the start codon. Biochemical and molecular data demonstrated that CNS1 is a P-type PPR protein encoded by nuclear DNA and that it localizes to the mitochondrion. Also, one binding site of CNS1 located upstream of the start codon in the ccmFN transcript. Moreover, abnormal mitochondrial morphology and dramatic upregulation of alternative oxidase genes were observed in the mutant. Together, these results indicate that CNS1 is essential for reaching a suitable level of intact ccmFN transcripts through binding to the 5′-UTR of the RNAs and maintaining 5′-integrity, which is crucial for sustaining mitochondrial complex III function to ensure mitochondrial biogenesis and seed development in maize.
Ruxolitinib inhibits IFNγ-stimulated Sjögren’s salivary gland MSC HLA-DR expression and chemokine-dependent T cell migration
Authors: McCoy Sara S , Parker Maxwell , Gurevic Ilya , Das Rahul , Pennati Andrea , Galipeau Jacques
Published: February 2022

Objectives

Sjögren’s disease (SjD) is a systemic autoimmune disease characterized by focal lymphocytic infiltrate of salivary glands (SGs) and high SG IFNγ, both of which are associated with elevated lymphoma risk. IFNγ is also biologically relevant to mesenchymal stromal cells (MSCs), a SG resident cell with unique niche regenerative and immunoregulatory capacities. In contrast to the role of IFNγ in SjD, IFNγ promotes an anti-inflammatory MSC phenotype in other diseases. The objective of this study was to define the immunobiology of IFNγ-exposed SG-MSCs with and without the JAK1 & 2 inhibitor, ruxolitinib.

Methods

SG-MSCs were isolated from SjD and controls human subjects. SG-MSCs were treated with 10 ng/ml IFNγ +/– 1000 nM ruxolitinib. Experimental methods included flow cytometry, RNA-sequencing, chemokine array, ELISA and transwell chemotaxis experiments.

Results

We found that IFNγ promoted expression of SG-MSC immunomodulatory markers, including HLA-DR, and this expression was inhibited by ruxolitinib. We confirmed the differential expression of CXCL9, CXCL10, CXCL11, CCL2 and CCL7, initially identified with RNA sequencing. SG-MSCs promoted CD4+ T cell chemotaxis when pre-stimulated with IFNγ. Ruxolitinib blocks chemotaxis through inhibition of SG-MSC production of CXCL9, CXCL10 and CXCL11.

Conclusions

These findings establish that ruxolitinib inhibits IFNγ-induced expression of SG-MSC immunomodulatory markers and chemokines. Ruxolitinib also reverses IFNγ-induced CD4+ T cell chemotaxis, through inhibition of CXCL9, -10 and -11. Because IFNγ is higher in SjD than control SGs, we have identified SG-MSCs as a plausible pathogenic cell type in SjD. We provide proof of concept supporting further study of ruxolitinib to treat SjD.
Use of Physiologically Based Kinetic Modeling-Facilitated Reverse Dosimetry to PredictIn VivoAcute Toxicity of Tetrodotoxin in Rodents
Authors: Noorlander Annelies , Zhang Mengying , van Ravenzwaay Bennard , Rietjens Ivonne M C M
Published: February 2022

In this study, the ability of a new in vitro/in silico quantitative in vitro–in vivo extrapolation (QIVIVE) methodology was assessed to predict the in vivo neurotoxicity of tetrodotoxin (TTX) in rodents. In vitro concentration–response data of TTX obtained in a multielectrode array assay with primary rat neonatal cortical cells and in an effect study with mouse neuro-2a cells were quantitatively extrapolated into in vivo dose–response data, using newly developed physiologically based kinetic (PBK) models for TTX in rats and mice. Incorporating a kidney compartment accounting for active renal excretion in the PBK models proved to be essential for its performance. To evaluate the predictions, QIVIVE-derived dose–response data were compared with in vivo data on neurotoxicity in rats and mice upon oral and parenteral dosing. The results revealed that for both rats and mice the predicted dose–response data matched the data from available in vivo studies well. It is concluded that PBK modeling-based reserve dosimetry of in vitro TTX effect data can adequately predict the in vivo neurotoxicity of TTX in rodents, providing a novel proof-of-principle for this methodology.
PtaERF194 inhibits plant growth and enhances drought tolerance in poplar
Authors: Wang Shengji , Fan Yan , Du Shuhui , Zhao Kai , Liu Qiang , Yao Wenjing , Zheng Tangchun , Han Youzhi
Published: February 2022

The water deficits limit the growth and development of agricultural and forest organisms. The AP2/ethylene response factor (ERF) family has been identified as one of the largest plant-specific transcription factors (TFs) essential for plant development and stress response. The function of PtaERF194 in growth and drought tolerance was detected in the overexpression (OX) and RNA interference (RNAi) transgenic poplar 717 hybrids (Populus tremula × Populus alba). Plant growth, stem vessels, water-use efficiency (WUE), chlorophyll content and PtaERF194 co-expressed genes were analyzed using morphological, physiological and molecular methods. Overexpression seedlings showed a shorter and smaller phenotype along with smaller and more vessels compared with the wild-type (WT). Physiological indices indicated that OX with low transpiration and stomatal conductance improved the tolerance to drought by enhancing WUE, limiting water loss and maintaining high water potential. A total of 12 differentially expressed genes co-expressed with PtaERF194 were identified, and they worked together to regulate drought tolerance through the abscisic acid signaling and reactive oxygen species scavenging processes. However, RNAi plants showed similar morphology and physiology to WT, suggesting that the function of PtaERF194 was redundant with other ERF TFs. The findings of the current study may shed new light on the positive function of ERF TFs in plant drought stress tolerance.
The Stanford Global Health Media Fellowship: Training the Next Generation of Physician Communicators to Fight Health Misinformation
Authors: Krohn Kristina M. , Yu Gina , Lieber Mark , Barry Michele
Published: February 2022

Problem

The COVID-19 pandemic and the spread of related health misinformation, especially on social media, have highlighted the need for more health care professionals to produce and share accurate health information to improve health and health literacy. Yet, few programs address this problem by training health care professionals in the art of science writing and medical journalism.

Approach

Created in 2011, the Stanford Global Health Media Fellowship aims to train medical students and residents in public communication strategies. Each year, 1 physician-in-training is selected to complete the fellowship, which includes 3 rotations: (1) 1 academic quarter at Stanford’s Graduate Program in Journalism, (2) 3 to 5 months with a national news network (previously NBC and ABC, now CNN), and (3) a placement at an international site. During the year-long program, fellows also complete a capstone project tackling a global health equity issue.

Outcomes

Since 2011, 10 fellows have completed the program, and they have acquired skills in reporting, writing, multimedia, social media, and medical communications. During the news network rotation, they have completed more than 200 medical news pieces and improved the quality of the health information in a myriad of other pieces. Alumni have continued to write and report on medical stories throughout residency, other fellowships, and as practicing physicians. One alumnus is now a medical news producer at CNN.

Next Steps

Expanding high-quality training in medical journalism for physicians through partnerships with journalism schools; communications departments; and local, national, and international journalists can greatly improve physicians’ ability to communicate with the public. It also has the potential to greatly improve the health information the public receives. Educators should consider embedding mass health communications training in medical education curricula and increasing opportunities for physicians to engage with diverse public audiences.
Implementing a Novel Interprofessional Clinical Informatics Curriculum
Authors: Schubert Carolyn , Bruce Ericka , Karl Joyce , Nahikian-Nelms Marcia , Pennyman Natalie , Rizer Milisa , Vrontos Emily , Hebert Courtney
Published: February 2022

A novel interprofessional clinical informatics curriculum was developed, piloted, and implemented, using an academic medical record. Targeted learners included undergraduate, graduate, and professional students across five health science colleges. A team of educators and practitioners representing those five health science colleges was formed in 2016, to design, develop, and refine educational modules covering the essentials of clinical informatics. This innovative curriculum consists of 10 online learning modules and 18 unique imbedded exercises that use standardized patient charts and tailored user views. The exercises allow learners to adopt the role of various providers who document in EMRs. Students are exposed to the unique perspectives of an attending physician, nurse, radiological technician, and health information manager, with the goal of developing knowledge and skills necessary for efficient and effective interprofessional communication within the EMR. The campus-wide clinical informatics curriculum is online, flexible, asynchronous, and well-established within each college, allowing faculty to select and schedule content based on discipline-specific learner and course needs. Program modifications over the past 4 years have correlated with a positive impact on the students' experience.
Perioperative Anticoagulation Management
Authors: Briete Lauren D. , Towers William F. , Bone Rachel , Nair Ranjit , Steck Mackenzie , Cutshall B. Tate , Shah Samarth P.
Published: February 2022

Management of anticoagulation in individuals undergoing operative procedures is a complex situation. Each case should be assessed individually with proper risk assessment, monitoring, and plan for perioperative and postoperative anticoagulation. Clinical evidence for the management of these patients is relatively scarce, and clinicians are often assessing each individual case with minimal guidance. This review provides nurses with a summary of available literature on the assessment, laboratory monitoring, timing of adjusting anticoagulation, and bridging prior to procedures. In addition to general perioperative anticoagulation management, this review discusses perioperative management in special populations and provides a summary on principles when anticoagulation should be resumed following a procedure.
Review of Anticoagulation in Continuous Renal Replacement Therapy
Authors: Roe Neil A. , Wiss Adam L. , Volgas Sarah , Hudson Joanna Q.
Published: February 2022

Continuous renal replacement therapy is an important, yet challenging, treatment of critically ill patients with kidney dysfunction. Clotting within the dialysis filter or circuit leads to time off therapy and impaired delivery of prescribed treatment. Anticoagulation can be used to prevent this complication; however, doing so introduces risk for unintended complications such as bleeding or metabolic derangements in patients who are already critically ill. A thorough understanding of indications, therapeutic options, and monitoring principles is necessary for safe and effective use of this strategy. This review provides clinicians important information regarding when to anticoagulate, differences in pharmacologic agents, recommended doses, routes of drug delivery, and appropriate laboratory monitoring for patients receiving anticoagulation to support continuous renal replacement therapy.
Review of Target-Specific Anticoagulation Reversal Agents
Authors: Smetana Keaton S. , Counts Jacob , Sodhi Angad , May Casey C.
Published: February 2022

Bleeding related to direct oral anticoagulants accounts for nearly half of emergency department visits annually and until recently there were no reversal antidotes available. As there continues to be a shift in prescribing practices away from warfarin, it is essential to have these reversal agents readily available for the treatment of life-threatening bleeds associated with these anticoagulants. In addition, for agents that continue to lack a targeted reversal agent (eg, low-molecular-weight heparin, antiplatelets, and new antithrombotics), it is imperative that research continues to evaluate improved reversal strategies. This review focuses on target-specific anticoagulation reversal agents currently available in the United States (protamine, idarucizumab, and andexanet alfa) and summarizes agents that are in the pipeline for these anticoagulants and antiplatelets.
Smoking During Pregnancy and Risk of Attention-deficit/Hyperactivity Disorder in the Third Generation
Authors: Yim Gyeyoon , Roberts Andrea , Ascherio Alberto , Wypij David , Kioumourtzoglou Marianthi-Anna , Weisskopf and Marc G.
Published: February 2022

Background:

Animal experiments indicate that environmental factors, such as cigarette smoke, can have multigenerational effects through the germline. However, there are little data on multigenerational effects of smoking in humans. We examined the associations between grandmothers’ smoking while pregnant and risk of attention-deficit/hyperactivity disorder (ADHD) in her grandchildren.

Methods:

Our study population included 53,653 Nurses’ Health Study II (NHS-II) participants (generation 1 [G1]), their mothers (generation 0 [G0]), and their 120,467 live-born children (generation 2 [G2]). In secondary analyses, we used data from 23,844 mothers of the nurses who were participants in the Nurses’ Mothers’ Cohort Study (NMCS), a substudy of NHS-II.

Results:

The prevalence of G0 smoking during the pregnancy with the G1 nurse was 25%. ADHD was diagnosed in 9,049 (7.5%) of the grandchildren (G2). Grand-maternal smoking during pregnancy was associated with increased odds of ADHD among the grandchildren (adjusted odds ratio [aOR] = 1.2; 95% confidence interval [CI] = 1.1, 1.2), independent of G1 smoking during pregnancy. In the Nurses’ Mothers’ Cohort Study, odds of ADHD increased with increasing cigarettes smoked per day by the grandmother (1–14 cigarettes: aOR = 1.1; 95% CI = 1.0, 1.2; 15+: aOR = 1.2; 95% CI = 1.0, 1.3), compared with nonsmoking grandmothers.

Conclusions:

Grandmother smoking during pregnancy is associated with an increased risk of ADHD among the grandchildren.
Estimation of Relative Vaccine Effectiveness in Influenza: A Systematic Review of Methodology
Authors: McMenamin Martina E. , Bond Helen S. , Sullivan Sheena G. , Cowling Benjamin J.
Published: February 2022

Background:

When new vaccine components or platforms are developed, they will typically need to demonstrate noninferiority or superiority over existing products, resulting in the assessment of relative vaccine effectiveness (rVE). This review aims to identify how rVE evaluation is being performed in studies of influenza to inform a more standardized approach.

Methods:

We conducted a systematic search on PubMed, Google Scholar, and Web of Science for studies reporting rVE comparing vaccine components, dose, or vaccination schedules. We screened titles, abstracts, full texts, and references to identify relevant articles. We extracted information on the study design, relative comparison made, and the definition and statistical approach used to estimate rVE in each study.

Results:

We identified 63 articles assessing rVE in influenza virus. Studies compared multiple vaccine components (n = 38), two or more doses of the same vaccine (n = 17), or vaccination timing or history (n = 9). One study compared a range of vaccine components and doses. Nearly two-thirds of all studies controlled for age, and nearly half for comorbidities, region, and sex. Assessment of 12 studies presenting both absolute and relative effect estimates suggested proportionality in the effects, resulting in implications for the interpretation of rVE effects.

Conclusions:

Approaches to rVE evaluation in practice is highly varied, with improvements in reporting required in many cases. Extensive consideration of methodologic issues relating to rVE is needed, including the stability of estimates and the impact of confounding structure on the validity of rVE estimates.
POLYPOIDAL CHOROIDAL NEOVASCULARIZATION VERSUS TYPE 1 CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION
Authors: Serra Rita , Coscas Florence , Cabral Diogo , Pinna Antonio , Coscas Gabriel
Published: February 2022

Purpose:

To compare quantitative optical coherence tomography angiography parameters between polypoidal choroidal neovascularizations (PCNVs) and Type 1 choroidal neovascularizations (CNVs) in patients with age-related macular degeneration.

Methods:

PCNV and Type 1 CNV lesions were retrospectively recruited in a cohort of patients with age-related macular degeneration. All the patients underwent a comprehensive ophthalmic evaluation, including best-corrected visual acuity, fluorescein and indocyanine green angiography, structural optical coherence tomography (OCT), and optical coherence tomography angiography.

Vascular perfusion density, fractal dimension, and lacunarity were computed by means of fractal analysis of neovascular en face optical coherence tomography angiography slabs.

Results:

Sixty-eight eyes were included in the analysis. Of them, 35 of 68 eyes (51.5%) had PCNV and 33 of 68 (48.5%) had Type 1 CNV. Patients with PCNV were significantly younger (P = 0.0003) and had a higher best-corrected visual acuity (P < 0.0001). The mean vascular perfusion density was 0.83 ± 0.11% in PCNVs and 0.46 ± 0.10% in Type 1 CNVs (P < 0.0001). The mean fractal dimension was 1.44 ± 0.1 in PCNVs and 1.45 ± 0.09 in Type 1 CNVs (P = 0.86) while the mean lacunarity was 2.46 ± 1.03 in PCNVs and 1.86 ± 0.52 in Type 1 CNVs (P = 0.006).

Conclusion:

PCNVs resulted to be more heterogeneous and characterized by higher vascular perfusion density and lacunarity values than Type 1 CNVs. These interesting findings seem to support the idea that PCNVs and Type 1 CNVs are two separate clinical entities. However, future studies based on optical coherence tomography angiography fractal analysis, but also involving other relevant parameters such as demographics, presentation, morphology on multimodal imaging, and response to treatment, are necessary before drawing any definitive conclusions on whether PCNV is a specific clinical entity or a neovascular age-related macular degeneration variant.
INCIDENCE AND RISK FACTORS OF POSTOPERATIVE ENDOPHTHALMITIS AFTER PRIMARY SURGICAL REPAIR COMBINED WITH INTRAOCULAR FOREIGN BODY REMOVAL
Authors: Zhu WENTING , Tian Jingyi , Lu Xiuhai , Gao Xiang , Wei Jianmin , Yuan Gongqiang , Zhang Jingjing
Published: February 2022

Purpose:

To analyze the incidence and risk factors of postoperative endophthalmitis after primary surgical repair and intraocular foreign body (IOFB) removal within 24 hours of injury.

Methods:

The records of all patients treated surgically for open globe injury and IOFB removal at the Eye Hospital of Shandong First Medical University between January 1, 2015, and June 30, 2020, were retrospectively reviewed. Variables included time from injury to operation, cause of injury, details of surgical repair, and follow-up. The incidence and risk factors of endophthalmitis after IOFB removal were studied.

Results:

During 5 years, 99 patients with IOFB were reviewed. Of these, 19 patients were diagnosed with endophthalmitis on admission, and 5 were suspected of having endophthalmitis during operation. Fifty-four cases had no clinical signs of endophthalmitis on admission and during operation and were treated with operation within 24 hours after the injury. Two patients (2 of 54; 3.70%) developed endophthalmitis after IOFB removal, and the causative agent in both cases was Bacillus cereus.

Conclusion:

The incidence of infectious endophthalmitis after primary surgical repair combined with IOFB removal (≤24 hours) was 3.70% in patients who received a series of standard treatments, and B. cereus infection might be a risk factor.
PANRETINAL PHOTOCOAGULATION VERSUS INTRAVITREAL BEVACIZUMAB VERSUS A PROPOSED MODIFIED COMBINATION THERAPY FOR TREATMENT OF PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Shahraki Toktam , ARABI Amir , Nourinia Ramin , Beheshtizadeh Nazanin Fatemeh , Entezari Morteza , Nikkhah Homayoun , Karimi Saeed , Ramezani Alireza
Published: February 2022

Purpose:

To compare safety and therapeutic effect of three treatment protocols on patients with naive proliferative diabetic retinopathy.

Methods:

A total of 207 eyes with proliferative diabetic retinopathy were randomly divided into three groups: full panretinal photocoagulation group; intravitreal bevacizumab (IVB) group with four monthly IVB injections; and modified combination group with two bimonthly IVB injections and a modified laser therapy. The best-corrected visual acuity and area of neovascularization leakage were compared at 1-year follow-up.

Results:

The difference in final best-corrected visual acuity was not significant between the groups (P = 0.77). The modified combination group had the lowest final leakage area (P = 0.006). The difference in final mean deviation of visual field was not significant between IVB and modified combination groups (mean difference = 0.25, P = 0.23, 95% confidence interval, 0.12–1.38). There was no difference in rate of new-onset diabetic macular edema between IVB and modified combination groups (mean difference = 1.5%, P = 0.31, 95% confidence interval, 1.1–1.88). Mean of total IVB injections were 3.5, 7.4, and 6.2 for panretinal photocoagulation, IVB, and modified combination groups, respectively (P = 0.002). Patients in the IVB group underwent more visits (P = 0.001). In subgroup analysis, the difference in the final leakage area was significant for the eyes with diabetic macular edema (P = 0.005).

Conclusion:

A combination protocol of photocoagulation and IVB can be recommended for proliferative diabetic retinopathy, especially with baseline diabetic macular edema.
ASSESSMENT OF RETINAL MICROVASCULAR ALTERATIONS IN INDIVIDUALS WITH AMNESTIC AND NONAMNESTIC MILD COGNITIVE IMPAIRMENT USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Robbins Cason B. , Akrobetu Dennis , Ma Justin P. , Stinnett Sandra S. , Soundararajan Srinath , Liu Andy J. , Johnson Kim G. , Grewal Dilraj S. , Fekrat Sharon
Published: February 2022

Purpose:

To assess retinal microvascular alterations in individuals with amnestic mild cognitive impairment (MCI) and nonamnestic MCI.

Methods:

One hundred twelve eyes of 59 amnestic MCI participants, 32 eyes of 17 nonamnestic MCI participants, and 111 eyes of 56 controls with normal cognition were included. Optical coherence tomography angiography vessel density and perfusion density in the Early Treatment Diabetic Retinopathy Study 3-mm circle and ring were assessed. Retinal thickness parameters including retinal nerve fiber layer thickness, ganglion cell-inner plexiform layer thickness, central subfield thickness, and subfoveal choroidal thickness were also analyzed. Multivariable generalized estimating equations were used for statistical analysis.

Results:

Perfusion density in the 3-mm inner ring was significantly lower in amnestic MCI patients when compared with nonamnestic MCI participants (0.29 ± 0.03 vs. 0.34 ± 0.09, P = 0.025) and controls with normal cognition (0.29 ± 0.03 vs. 0.39 ± 0.02, P < 0.001), after adjustment for age and sex as covariates. Vessel density, retinal nerve fiber layer thickness, ganglion cell-inner plexiform layer thickness, central subfield thickness, and subfoveal choroidal thickness did not differ among or between diagnostic groups.

Conclusion:

Perfusion density was significantly reduced in individuals with amnestic MCI, compared with those with nonamnestic MCI and controls with normal cognition.
Views of Parents of Children With Down Syndrome on Early Intervention Services in Turkey
Authors: Tomris Gozde , Celik Secil , Diken Ibrahim Halil , Akemoğlu Yusuf
Published: February 2022

Perceptions of parents of young children receiving early intervention are important to understand. Parents have valuable opinions on the delivery of early interventions services and can provide critical feedback that can help professionals revise their existing early intervention delivery modalities. In the current study, we examined the perceptions of parents of young children with Down syndrome on early intervention services in Turkey. Specifically, we aimed to understand the parents' views on medical and educational evaluation and diagnosis processes. The study was conducted using a cross-sectional research design, which is one of the survey design methods. Data were collected from a total of 893 parents via an online survey. The results demonstrated that children with Down syndrome were diagnosed within an average of 2.3 months from birth, but the average age for starting education was 10.5 months. The majority of the parents evaluated the process until their children were diagnosed and accessed education services as a rather slow process that proceeded with their own means and efforts. Furthermore, the parents reported that during the diagnosis processes the type of materials, equipment, toys, and settings used were not relevant and time provided was insufficient. Moreover, the majority of the parents reported that the education services presented to them and their children were not sufficient and early intervention services were not provided within a system. As a result, although the legal regulations in Turkey are parallel to those in developed countries and studies in the field have been increasingly gaining momentum, issues such as the absence of an early intervention system model, insufficient cooperation between experts and institutions, and the shortage of expert staff in the field are still present and awaiting a solution.
Improving Language Support for Infants and Toddlers
Authors: Joseph Gail E. , Soderberg Janet , Abbott Robert , Garzon Roxanne , Scott Crista
Published: February 2022

Language skills are vital to children's learning and well-being, and the first 5 years of life are an especially critical time for language acquisition. Research suggests that when early childhood teachers create language-rich environments, children develop stronger receptive and expressive language abilities, especially children from low-income households who are more at risk for language delays. This study investigated the effects of a 10-week professional learning intervention focused on language-based interactions in early care and education settings that serve infants and toddlers on state childcare subsidy. The intervention with childcare providers was titled Filming Interactions to Nurture Development (FIND), which utilized video-based reflective practices to promote positive interactions between providers and children. Using a treatment–control design (control: n = 44; treatment: n = 42), we compared childcare providers' language practices. Provider language use was measured using the Language Environment Analysis (LENA), a wearable digital language processer. Results indicate that, as compared with the control group, FIND participation was associated with increased adult word count and conversational turns in facilities that serve the most vulnerable children. These results suggest the utility of video-based professional learning and automated data collection for supporting providers' positive interactions and improving the quality of infant/toddler programs.
Building a Real-Time Remote Patient Monitoring Patient Safety Program for COVID-19 Patients
Authors: Patel Hemali , Hassell Amy , Cyriacks Brittany , Fisher Brett , Tonelli William , Davis Christopher
Published: February 2022

Coronavirus disease 2019 (COVID-19) pandemic has forced providers to rapidly adopt telehealth tools to reduce staff exposure to ill persons, preserve personal protective equipment, and minimize impact of patient surges on facilities. Remote patient monitoring (RPM) can be used to monitor high-risk patients from their homes and open up hospital bed availability. The authors describe a pilot program to evaluate the impact of RPM in postdischarge monitoring of COVID-19 patients. High-risk patients discharging from the hospital received a wearable vital sign monitoring device to be worn for 8 consecutive days, allowing real-time data transmission to a virtual health center (VHC), which had been established prior to the pandemic, via a smart phone application. The data were monitored 24 hours a day by a VHC tech with built-in escalation protocols to a nurse and/or an attending physician if needed. Eighty patients were enrolled, 48% women with an age range of 19–83 years. Languages included Spanish (49%), English (47%), Burmese (2%), and Swahili (1%). The most common comorbidities included hypertension (48%) and diabetes mellitus (48%). Oxygen was the most common addressed need; 8% requiring new oxygen and 8% benefitting from oxygen-weaning during the RPM time period. Ten percent patients had emergency department (ED) visits and 4% were readmitted within 30 days of discharge. The authors built and deployed an RPM program for postdischarge monitoring of high-risk patients. RPM can be quickly deployed to support COVID-19 patients postdischarge and assist with hospital capacity. RPM can be rapidly and successfully deployed during the COVID 19 pandemic to aid in transitions of care.
Work From Home or Bring Home the Work? Burnout and Procrastination in Brazilian Workers During the COVID-19 Pandemic
Authors: Arenas Daniel Luccas , Viduani Anna , Bassols Ana Margareth Siqueira , Hauck Simone
Published: February 2022

Objective:

To investigate burnout and procrastination in a sample of Brazilian workers during the COVID-19 pandemic according to their current work mode.

Methods:

This cross-sectional study used data from an online survey conducted in 2020: 435 workers were included. The Copenhagen Burnout Inventory and the Irrational Procrastination Scale were used to access burnout and procrastination respectively.

Results:

There was no difference between workers working from home (WFH) and at face-to-face work regarding burnout symptoms. However, the WFH group had higher levels of procrastination. Clinically significant levels of burnout were associated with being female, increased childcare load and living with children under 12years old.

Conclusions:

WFH may have more advantages than disadvantages in ideal conditions. However, work-life imbalances seem to be a key aspect regarding distress among workers WFH, especially in women with small children.