bluuebunny/crossref_metadata_2025 huggingface dataset:
Genomic epidemiology, antimicrobial resistance and virulence factors of Enterobacter cloacae complex causing potential community-onset bloodstream infections in a tertiary care hospital of Nepal
Authors: Manandhar Sulochana , Nguyen Quynh , Nguyen Thi Nguyen To , Pham Duy Thanh , Rabaa Maia A. , Dongol Sabina , Basnyat Buddha , Dixit Sameer M. , Baker Stephen , Karkey Abhilasha
Published: April 2022

Objectives

Community-onset bloodstream infections (BSIs) caused by carbapenemase-producing Enterobacter cloacae complex (ECC) species are increasing internationally. This observation suggests that ECC are emerging pathogens, requiring for detailed understanding on their genomic epidemiology including transmission dynamics and antimicrobial resistance profiles.

Patients and methods

We performed WGS on 79 Enterobacter spp. isolated from the patients with clinically significant BSIs and admitted to emergency department of a major tertiary hospital in Nepal between April 2016 and October 2017.

Results

We identified 5 species and 13 STs of ECC. Enterobacter xiangfangensis ST171, one of the globally emerging carbapenem resistant ECC clones with epidemic potential, was the most prevalent (42%). Phylogenetic analysis showed a large (>19 400 SNPs) core genome SNP distance across major STs, which was minimal (<30 SNPs) among the isolates of each prevalent ST, suggesting the relatively recent importation of major STs followed by local clonal expansions. Genomic evidence for resistance to all major antimicrobial classes except for colistin and macrolides was detected. A limited number of isolates also carried blaNDM-1 (n = 2) and blaOXA-48 (n = 1) carbapenemase genes. Virulence factors encoding siderophores (24%), T6SSD (25%) and fimbriae (54%) were detected.

Conclusions

Our study highlighted that MDR ECC clones are important pathogens of BSIs in community. Though of low prevalence, carbapenem resistance observed in our ECC isolates raised concern about further community dissemination, underscoring the need for community surveillance to identify MDR ECC clones with epidemic potential.
Optimal Time-Consistent Government Debt Maturity, Fiscal Policy, and Default
Authors: Kiiashko Sergii
Published: April 2022

I develop a tractable model to study the optimal debt maturity structure and fiscal policy in an environment with incomplete markets, lack of commitment, and opportunity to default by the government. I show that the Lucas and Stokey time-consistency result can be extended to environments with an opportunity of outright default. The maturity is used to resolve the time-consistency problem. I show that if both risk-free interest rates and risk premiums can be manipulated, then the optimal maturity structure tends to have a decaying profile: The government issues debt at all maturity dates, but the distribution of payments over time is skewed toward the short end. The model allows for numerical characterization of the optimal maturity structure of debt with an arbitrarily large number of maturities. Debt maturity data across countries are consistent with model predictions.
Effect of Different Wheat-Based Diets and Corn Meal Addition on Development Parameters ofEphestia kuehniella(Zeller, 1879) (Lepidoptera: Pyralidae)
Authors: Parra L M , Garcia A G , Alves G R , Magro S R , Parra J R P
Published: April 2022

The expansion of Integrated Pest Management (IPM), including biological control, has had several positive consequences for the agricultural environment and participants in the production chain. To enable successful operation and applications of biological control, production of insects used for rearing natural enemies (parasitoids and predators) must be optimized to reduce time and costs and improve production both qualitatively and quantitatively. The present study evaluated the effect of wheat varieties, the main component of artificial diets for Ephestia kuehniella, on the reproductive performance and biological parameters of this flour moth, which is used for mass production of Trichogramma spp. (Hymenoptera: Trichogrammatidae) and other parasitoids and predators. Four varieties of wheat were compared: BRS 327, BRS Marcante, BRS Parrudo, and KBR, with and without the addition of corn E. kuehniella reared on 97% BRS 327 wheat flour + 3% nutritional yeast had the best biological parameters and substitution of corn for about half of the wheat increased the number of eggs per female.
Current practice of pharmacological treatment for hyperactive delirium in terminally ill cancer patients: results of a nationwide survey of Japanese palliative care physicians and liaison psychiatrists
Authors: Matsuda Yoshinobu , Morita Tatsuya , Oya Kiyofumi , Tagami Keita , Naito Akemi Shirado , Kashiwagi Hideyuki , Otani Hiroyuki
Published: April 2022

Objective

The objective of this survey was to identify areas where doctors have divergent practices in pharmacological treatment for hyperactive delirium in terminally ill patients with cancer.

Methods

We conducted a survey of Japanese palliative care physicians and liaison psychiatrists. Inquiries were made regarding: (i) choice of drug class in the first-line treatment, (ii) administration methods of the first-line antipsychotic treatment, (iii) starting dose of antipsychotics in the first line treatment and maximum dose of antipsychotics in refractory delirium, and (iv) choice of treatment when the first-line haloperidol treatment failed. Respondents used a five-point Likert scale.

Results

Regarding choice of drug class in the first-line treatment, more doctors reported that they ‘frequently’ or ‘very frequently’ use antipsychotics only than antipsychotics and benzodiazepine (oral: 73.4 vs. 12.2%; injection: 61.3 vs. 11.6%, respectively). Regarding administration methods of the first-line antipsychotic treatment, the percentage of doctors who reported that they used antipsychotics as needed and around the clock were 55.4 and 68.8% (oral), 49.2 and 45.4% (injection), respectively. There were different opinions on the maximum dose of antipsychotics in refractory delirium. Regarding the choice of treatment when the first-line haloperidol treatment failed, the percentage of doctors who reported that they increased the dose of haloperidol, used haloperidol and benzodiazepines, and switched to chlorpromazine were 47.0, 32.1 and 16.4%, respectively.

Conclusions

Doctors have divergent practices in administration methods of the first-line antipsychotic treatment, maximum dose of antipsychotics, and choice of treatment when the first-line haloperidol treatment failed. Further studies are needed to determine the optimal treatment.
Subsequent Primary Cancer Risk Among 5-Year Survivors of Adolescent and Young Adult Cancers
Authors: Sung Hyuna , Siegel Rebecca L , Hyun Noorie , Miller Kimberly D , Yabroff K Robin , Jemal Ahmedin
Published: April 2022

Background

A comprehensive examination of the incidence and mortality of subsequent primary cancers (SPCs) among adolescent and young adult (AYA) cancer survivors in the United States is lacking.

Methods

Cancer incidence and mortality among 170 404 cancer survivors of 5 or more years who were aged 15-39 years at first primary cancer diagnosis during 1975-2013 in 9 Surveillance, Epidemiology, and End Results registries were compared with those in the general population using standardized incidence ratio (SIR), absolute excess incidence (AEI), standardized mortality ratio (SMR), and absolute excess mortality (AEM).

Results

During a mean follow-up of 14.6 years, 13 420 SPC cases and 5008 SPC deaths occurred among survivors (excluding the same site as index cancer), corresponding to 25% higher incidence (95% confidence interval [CI] = 1.23 to 1.27, AEI = 10.8 per 10 000) and 84% higher mortality (95% CI = 1.79 to 1.89, AEM = 9.2 per 10 000) than that in the general population. Overall, SPC risk was statistically significantly higher for 20 of 29 index cancers for incidence and 26 for mortality, with the highest SIR among female Hodgkin lymphoma survivors (SIR = 3.05, 95% CI = 2.88 to 3.24, AEI = 73.0 per 10 000) and the highest SMR among small intestine cancer survivors (SMR = 6.97, 95% CI = 4.80 to 9.79, AEM = 64.1 per 10 000). Type-specific SPC risks varied substantially by index cancers; however, SPCs of the female breast, lung, and colorectum combined constituted 36% of all SPC cases and 39% of all SPC deaths, with lung cancer alone representing 11% and 24% of all cases and deaths, respectively.

Conclusion

AYA cancer survivors are almost twice as likely to die from a new primary cancer as the general population, highlighting the need for primary care clinicians to prioritize cancer prevention and targeted surveillance strategies in these individuals.
Combining a small urinary catheter with an endo mini-retractor: a novel technique for laparoscopic selective vascular control
Authors: Luvira Vor , Junyavoraluk Apichaya , Tipwaratorn Theerawee
Published: April 2022

The Pringle maneuver using a urinary catheter has been described and proven to be one of the best methods for laparoscopic intracorporeal vascular control. Selective vascular control provides many advantages over total inflow occlusion by the Pringle maneuver. However, laparoscopic selective vascular control by urinary catheter has not been described. We, herein, describe laparoscopic selective vascular control using a combined small urinary catheter with an endo mini-retractor, which inserted in a new way, named ‘The J-shaped Loop’. This method makes the instrument more compact so we can selectively control the vascular pedicle. When selective vascular occlusion is desired, the loop is tightened and the tension is held just by the catheter itself. This novel technique is simple, safe, effective and reproducible, and, therefore, can be used as a good alternative to other intracorporeal techniques for laparoscopic liver resection.
The Milky Way tomography with APOGEE: intrinsic density distribution and structure of mono-abundance populations
Authors: Lian Jianhui , Zasowski Gail , Mackereth Ted , Imig Julie , Holtzman Jon A , Beaton Rachael L , Bird Jonathan C , Cunha Katia , Fernández-Trincado José G , Horta Danny , Lane Richard R , Masters Karen L , Nitschelm Christian , Roman-Lopes A
Published: April 2022

The spatial distribution of mono-abundance populations (MAPs, selected in [Fe/H] and [Mg/Fe]) reflect the chemical and structural evolution in a galaxy and impose strong constraints on galaxy formation models. In this paper, we use APOGEE data to derive the intrinsic density distribution of MAPs in the Milky Way, after carefully considering the survey selection function. We find that a single exponential profile is not a sufficient description of the Milky Way’s disc. Both the individual MAPs and the integrated disc exhibit a broken radial density distribution; densities are relatively constant with radius in the inner Galaxy and rapidly decrease beyond the break radius. We fit the intrinsic density distribution as a function of radius and vertical height with a 2D density model that considers both a broken radial profile and radial variation of scale height (i.e. flaring). There is a large variety of structural parameters between different MAPs, indicative of strong structure evolution of the Milky Way. One surprising result is that high-α MAPs show the strongest flaring. The young, solar-abundance MAPs present the shortest scale height and least flaring, suggesting recent and ongoing star formation confined to the disc plane. Finally we derive the intrinsic density distribution and corresponding structural parameters of the chemically defined thin and thick discs. The chemical thick and thin discs have local surface mass densities of 5.62 ± 0.08 and 15.69 ± 0.32 M⊙pc−2, respectively, suggesting a massive thick disc with a local surface mass density ratio between thick to thin disc of 36 per cent.
Testing feedback from star clusters in simulations of the Milky Way formation
Authors: Brown Gillen , Gnedin Oleg Y
Published: April 2022

We present a suite of galaxy formation simulations that directly model star cluster formation and disruption. Starting from a model previously developed by our group, here we introduce several improvements to the prescriptions for cluster formation and feedback, then test these updates using a large suite of cosmological simulations of Milky Way mass galaxies. We perform a differential analysis with the goal of understanding how each of the updates affects star cluster populations. Two key parameters are the momentum boost of supernova feedback fboost and star formation efficiency per free-fall time ϵff. We find that fboost has a strong influence on the galactic star formation rate, with higher values leading to less star formation. The efficiency ϵff does not have a significant impact on the global star formation rate, but dramatically changes cluster properties, with increasing ϵff leading to a higher maximum cluster mass, shorter age spread of stars within clusters, and higher integrated star formation efficiencies. We also explore the redshift evolution of the observable cluster mass function, finding that most massive clusters have formed at high redshift z > 4. Extrapolation of cluster disruption to z = 0 produces good agreement with both the Galactic globular cluster mass function and age–metallicity relation. Our results emphasize the importance of using small-scale properties of galaxies to calibrate subgrid models of star cluster formation and feedback.
DEPCOD: a tool to detect and visualize co-evolution of protein domains
Authors: Ji Fei , Bonilla Gracia , Krykbaev Rustem , Ruvkun Gary , Tabach Yuval , Sadreyev Ruslan I
Published: April 2022

Proteins with similar phylogenetic patterns of conservation or loss across evolutionary taxa are strong candidates to work in the same cellular pathways or engage in physical or functional interactions. Our previously published tools implemented our method of normalized phylogenetic sequence profiling to detect functional associations between non-homologous proteins. However, many proteins consist of multiple protein domains subjected to different selective pressures, so using protein domain as the unit of analysis improves the detection of similar phylogenetic patterns. Here we analyze sequence conservation patterns across the whole tree of life for every protein domain from a set of widely studied organisms. The resulting new interactive webserver, DEPCOD (DEtection of Phylogenetically COrrelated Domains), performs searches with either a selected pre-defined protein domain or a user-supplied sequence as a query to detect other domains from the same organism that have similar conservation patterns. Top similarities on two evolutionary scales (the whole tree of life or eukaryotic genomes) are displayed along with known protein interactions and shared complexes, pathway enrichment among the hits, and detailed visualization of sources of detected similarities. DEPCOD reveals functional relationships between often non-homologous domains that could not be detected using whole-protein sequences. The web server is accessible at http://genetics.mgh.harvard.edu/DEPCOD.
A Daily Assessment Study of Smoking Cessation After a Head and Neck Cancer Diagnosis
Authors: Borger Tia , Shelton Brent J , Valentino Joseph , Ostroff Jamie S , Cummings Kenneth Michael , Studts Jamie L , Carpenter Matthew J , Burris Jessica L
Published: April 2022

Introduction

This intensive longitudinal study describes key events in the process of smoking cessation after a new head and neck cancer (HNC) diagnosis. Prior longitudinal studies show some cancer patients quit, while others continue to smoke, but details about the pattern in which these discrete outcomes arise are scarce. This study is meant to help rectify this gap in the literature.

Aims and Methods

Participants were 42 HNC patients who reported current smoking at enrollment. Participants were recruited from an outpatient oncology clinic and completed a baseline questionnaire prior to begin a 30-day daily assessment.

Results

Few participants (9.52%) achieved 30-day continuous abstinence from smoking. On average, participants reported 9.64 ± 11.93 total days of abstinence. Nearly, all (94.44%, n = 34) participants made at least one quit attempt, with an average of 16.94 ± 11.30 quit attempt days. Fewer participants were able to achieve a 24-hour quit attempt (52.78%, n = 19), with a corresponding average of 5.50 ± 8.69 24-hour days. The median time to first 24-hour quit attempt was 13 days after enrollment. Based on smoking behavioral patterns, participants were categorized into five groups, the most common being “persistent attempters,” which involved unsuccessful quit attempts throughout the study. Only 45% of participants (n = 19) used evidence-based treatment, the most common being cessation medication.

Conclusions

This intensive longitudinal study found that cancer diagnosis can spur a lot of efforts to quit smoking. Unfortunately, this study suggests that many quit attempts are short lived, possibly a result of an absence or insufficient use of evidence-based treatments.

Implications

For adults who are current smokers at the time of cancer diagnosis, there is a high likelihood of persistent cigarette smoking and use of other tobacco products in the weeks and months after a cancer diagnosis. Furthermore, this study shows that while a lot of quit attempts may occur, few are successful, which may be partly attributable to the low use of evidence-based tobacco treatment. Future research with cancer patients should aim to identify predictors of quit attempts and abstinence as well as treatment utilization.
Sinapate Esters Mediate UV-B-Induced Stomatal Closure by Regulating Nitric Oxide, Hydrogen Peroxide, and Malate Accumulation in Arabidopsis thaliana
Authors: Li Weiqiang , Sun Yaru , Li Kun , Tian Hongtao , Jia Jiangtao , Zhang Hongyu , Wang Yaping , Wang Hong , Bi Baodi , Guo Jinggong , Tran Lam-Son Phan , Miao Yuchen
Published: April 2022

Sinapate esters, which are induced in plants under ultraviolet-B (UV-B) irradiation, have important roles not only in the protection against UV-B irradiation but also in the regulation of stomatal closure. Here, we speculated that sinapate esters would function in the stomatal closure of Arabidopsis thaliana in response to UV-B. We measured the stomatal aperture size of the wild-type (WT) and bright trichomes 1 (brt1) and sinapoylglucose accumulator 1 (sng1) mutants under UV-B irradiation; the latter two mutants are deficient in the conversion of sinapic acid to sinapoylglucose (SG) and SG to sinapoylmalate (SM), respectively. Both the brt1 and sng1 plants showed smaller stomatal apertures than the WT under normal light and UV-B irradiation conditions. The accumulation of SM and malate were induced by UV-B irradiation in WT and brt1 plants but not in sng1 plants. Consistently, exogenous malate application reduced UV-B-induced stomatal closure in WT, brt1 and sng1 plants. Nonetheless, levels of reactive oxygen species (ROS), nitric oxide (NO) and cytosolic Ca2+ were higher in guard cells of the sng1 mutant than in those of the WT under normal white light and UV-B irradiation, suggesting that disturbance of sinapate metabolism induced the accumulation of these signaling molecules that promote stomatal closure. Unexpectedly, exogenous sinapic acid application prevented stomatal closure of WT, brt1 and sng1 plants. In summary, we hypothesize that SG or other sinapate esters may promote the UV-B-induced malate accumulation and stomatal closure, whereas sinapic acid inhibits the ROS-NO pathway that regulates UV-B-induced cytosolic Ca2+ accumulation and stomatal closure.
Pain Location and Exacerbating Activities Associated with Treatment Success Following Basivertebral Nerve Ablation: An Aggregated Cohort Study of Multicenter Prospective Clinical Trial Data
Authors: McCormick Zachary L , Sperry Beau P , Boody Barret S , Hirsch Joshua A , Conger Aaron , Harper Katrina , Lotz Jeffrey C , Burnham Taylor R
Published: April 2022

Objective

Develop pain location “maps” and investigate the relationship between low back pain (LBP)-exacerbating activities and treatment response to basivertebral nerve radiofrequency ablation (BVN RFA) in patients with clinically suspected vertebral endplate pain (VEP).

Design

Aggregated cohort study of 296 patients treated with BVN RFA at 33 centers in three prospective trials.

Methods

Participant demographics, pain diagrams, and LBP-exacerbating activities were analyzed for predictors using stepwise logistic regression. Treatment success definitions were: (1) ≥50% LBP visual analog scale (VAS), (2) ≥15-point Oswestry Disability Index (ODI), and (3) ≥50% VAS or ≥15-point ODI improvements at 3 months post-BVN RFA.

Results

Midline LBP correlated with BVN RFA treatment success in individuals with clinically-suspected VEP. Duration of pain ≥5 years (OR 2.366), lack of epidural steroid injection within 6 months before BVN RFA (OR 1.800), lack of baseline opioid use (OR 1.965), LBP exacerbation with activity (OR 2.099), and a lack of LBP with spinal extension (OR 1.845) were factors associated with increased odds of treatment success. Regressions areas under the curve (AUCs) were under 70%, indicative of low predictive value.

Conclusions

This study demonstrates that midline LBP correlates with BVN RFA treatment success in individuals with VEP. While none of the regression models demonstrated strong predictive value, the pain location and exacerbating factors identified in this analysis may aid clinicians in identifying patients where VEP should be more strongly suspected. The use of objective imaging biomarkers (Type 1 and/or 2 Modic changes) and a correlating presentation of anterior spinal element pain remain the most useful patient selection factors for BVN RFA.
Ultrasound-Guided Gluteal Fascial Plane Block for the Treatment of Chronic Refractory Greater Trochanteric Pain Syndrome — Technique Description and Anatomical Correlation Study
Authors: Ferreira-Dos-Santos Guilherme , Hurdle Mark Friedrich B , Tran John , Eldrige Jason S , Clendenen Steven R , Agur Anne M R
Published: April 2022

Introduction

Greater trochanteric pain syndrome may often mimic pain generated from other sources. However, it is most commonly caused by gluteus medius and gluteus minimus tendinopathy or tear. The purpose of this technical report was to: 1) describe the ultrasound-guided fascial plane block technique targeting the superior gluteal nerve in the plane between gluteus medius/gluteus minimus to treat moderate-to-severe, chronic, refractory greater trochanteric pain syndrome; 2) anatomically correlate the procedure with cadaveric dissections demonstrating the structures being imaged and the tissues along the needle trajectory; 3) demonstrate the feasibility of the technique with serial dissection of one cadaveric specimen following injection with color dye.

Technique description

The ultrasound-guided fascial plane block targeting the superior gluteal nerve to treat moderate-to-severe, chronic, refractory greater trochanteric pain syndrome has been outlined with supporting ultrasound scans and anatomical dissections. The cadaveric dissections are correlated to the ultrasound scans of a healthy volunteer and provide visualization of the tissues in the needle trajectory. The feasibility study in a cadaveric specimen showed adequate stain of the superior gluteal nerve without spread to the piriformis muscle belly, the sciatic nerve, or the inferior gluteal nerve.

Conclusions

This ultrasound-guided fascial plane block is a feasible option for blocking the superior gluteal nerve without inadvertent involvement of the sciatic and inferior gluteal nerves. Further randomized controlled clinical trials are necessary to assess the clinical efficacy of the gluteus medius/gluteus minimus fascial plane block to treat moderate-to-severe, chronic, refractory greater trochanteric pain syndrome.
Curved domain-wall fermions
Authors: Aoki Shoto , Fukaya Hidenori
Published: April 2022

We consider fermion systems on a square lattice with a mass term having a curved domain-wall. Like conventional flat domain-wall fermions, massless and chiral edge states appear on the wall. In the cases of S1 and S2 domain-walls embedded into flat hypercubic lattices, we find that these edge modes feel gravity through the induced spin or spinc connections. The gravitational effect is encoded in the Dirac eigenvalue spectrum as a gap from zero. In the standard continuum extrapolation of the square lattice, we find good agreement with the analytic prediction in the continuum theory. We also find that the rotational symmetry of the edge modes is automatically recovered in the continuum limit. Subject Index B38
A case of acquired angioedema
Authors: Zwanziger Arielle D.
Published: April 2022

Acquired angioedema is a rare disorder characterized by nonurticarial angioedema secondary to deficiency or altered activity of C1-esterase inhibitor protein. This article describes a patient whose recurrent angioedema was initially diagnosed as angiotensin-converting enzyme (ACE) inhibitor-induced angioedema. However, after further testing, she was diagnosed with acquired angioedema and subsequently treated with a synthetic bradykinin B2-receptor antagonist.
Updates on the diagnosis and management of celiac disease
Authors: Soltesz Kristina , Mosebach Jessica , Paruch Emily , Covino Jean
Published: April 2022

Celiac disease is a chronic autoimmune enteropathy affecting about 1% of the population. Gluten ingestion triggers an immune response in genetically susceptible patients, resulting in intestinal and extraintestinal disease manifestations. Current recommendations for diagnosis include serology for celiac-specific antibodies to transglutaminase, endomysium, and deamidated gliadin, and IgA serology. New highly accurate point-of-care tests can efficiently screen for celiac disease and improve the diagnostic timeframe. Definitive diagnosis is most commonly made via biopsy of the small bowel showing villous atrophy. A gluten-free diet with micronutrient supplementation is the only recommended treatment for celiac disease. Primary care providers must be able to recognize screening indications, refer patients appropriately, and provide proper patient education and follow-up.
Combination Therapy of High-flow Nasal Cannula and Upper-body Elevation for Postoperative Sleep-disordered Breathing: Randomized Crossover Trial
Authors: Sakaguchi Yuichi , Nozaki-Taguchi Natsuko , Hasegawa Makoto , Ishibashi Katsuhiko , Sato Yasunori , Isono Shiroh
Published: April 2022

Background

The low acceptance rate of continuous positive airway pressure therapy in postoperative patients with untreated obstructive sleep apnea (OSA) indicates the necessity for development of an alternative postoperative airway management strategy. The authors considered whether the combination of high-flow nasal cannula and upper-body elevation could improve postoperative OSA.

Methods

This nonblinded randomized crossover study performed at a single university hospital investigated the effect on a modified apnea hypopnea index, based exclusively on the airflow signal without arterial oxygen saturation criteria (flow-based apnea hypopnea index, primary outcome), of high-flow nasal cannula (20 l · min–1 with 40% oxygen concentration) with and without upper-body elevation in patients with moderate to severe OSA. Preoperative sleep studies were performed at home (control, no head-of-bed elevation) and in hospital (30-degree head-of-bed elevation). On the first and second postoperative nights, high-flow nasal cannula was applied with or without 30-degree head-of-bed elevation, assigned in random order to 23 eligible participants.

Results

Twenty-two of the 23 (96%) accepted high-flow nasal cannula. Four participants resigned from the study. Control flow-based apnea hypopnea index (mean ± SD, 60 ± 12 events · h–1; n = 19) was reduced by 15 (95% CI, 6 to 30) events · h–1 with head-of-bed elevation alone (P = 0.002), 10.9 (95% CI, 1 to 21) events · h–1 with high-flow nasal cannula alone (P = 0.028), and 23 (95% CI, 13 to 32) events · h–1 with combined head-of-bed elevation and high-flow nasal cannula (P < 0.001). Compared to sole high-flow nasal cannula, additional intervention with head-of-bed elevation significantly decreased flow-based apnea hypopnea index by 12 events · h–1 (95% CI, 2 to 21; P = 0.022). High-flow nasal cannula, alone or in combination with head-of-bed elevation, also improved overnight oxygenation. No harmful events were observed.

Conclusions

The combination of high-flow nasal cannula and upper-body elevation reduced OSA severity and nocturnal hypoxemia, suggesting a role for it as an alternate postoperative airway management strategy.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Hearing Impairment in the Extended High Frequencies in Children Despite Clinically Normal Hearing
Authors: Mishra Srikanta K. , Saxena Udit , Rodrigo Hansapani
Published: April 2022

Objectives:

Pediatric hearing impairment, regardless of degree and type, has a detrimental effect on speech perception, cognition, oral language development, academic outcomes, and literacy. Hearing assessment in the clinic is limited to 8 kHz although humans can hear up to 20 kHz. Hearing impairment in the extended high frequencies (EHFs > 8 kHz) can occur despite clinically normal hearing. However, to date, the nature and effects of EHF hearing impairment in children remain unknown. The goals of the present study were to determine the effects of EHF hearing impairment on speech-in-noise recognition in children and to examine whether hearing impairment in the EHFs is associated with altered cochlear functioning in the standard frequencies.

Design:

A volunteer sample of 542 participants (4 to 19 years) with clinically normal audiograms were tested. Participants identified with EHF impairment were assigned as cases in a subsequent case-control study. EHF loss was defined as hearing thresholds greater than 20 dB in at least one EHFs (10, 12.5, or 16 kHz). Speech recognition thresholds in multi-talker babble were measured using the digit triplet test. Distortion product otoacoustic emissions (f
2 = 2, 3, 4, and 5 kHz) were measured to assess cochlear functioning.

Results:

Thresholds in the EHFs were as reliable as those in the standard frequency range. Thirty-eight children had EHF hearing impairment regardless of a clinically normal audiogram. A linear mixed-effects model revealed that children with EHF hearing impairment had higher (poorer) mean speech recognition threshold than children with normal EHF sensitivity (estimate = 2.14 dB, 95% CI: 1.36 to 3.92; effect size = small). The overall magnitude of distortion product otoacoustic emissions was lower for children with EHF impairment (estimate = –2.47 dB, 95% CI: –4.60 to –0.73; effect size = medium). In addition, the pure-tone average for standard audiometric frequencies was relatively higher for EHF-impaired children (estimate = 3.68 dB, 95% CI: 2.56 to 4.80; effect size = small).

Conclusions:

Hearing impairment in the EHFs is common in children despite clinically normal hearing and can occur without a history of otitis media. EHF impairment is associated with poorer speech-in-noise recognition and preclinical cochlear deficits in the lower frequencies where hearing thresholds are normal. This study highlights the clinical need to identify EHF impairments in children.
Pragmatic Uncontrolled Study of Specialized Cognitive Behavioral Therapy for Adults With Chronic Tinnitus
Authors: Fuller Thomas E. , van Breukelen Gerard J. P. , Vlaeyen Johan W. S. , Cima Rilana F. F.
Published: April 2022

Objectives:

Tinnitus is the perception of sound without an external source, affecting quality of life that can cause severe distress in approximately 1 to 3% of the population of people with tinnitus. Randomized controlled trials of cognitive behavioral therapy for tinnitus have demonstrated its effectiveness in improving quality of life, but the effects of their implementation on a large scale in routine practice remains unknown. Therefore, the main purpose of this study was to examine the effects of stepped-care cognitive behavioral therapy for tinnitus delivered in a tertiary audiological center of a regional hospital. Second, we wished to examine predictors of favorable outcome.

Design:

Four hundred three adults with chronic tinnitus were enrolled in this prospective observational study (at 3 months, N=334, 8 months, N=261; 12 months, N=214). The primary outcome was health-related quality of life as measured by the Health Utilities Index III (HUI-III) at 12 months. Secondary outcomes were self-reported levels of tinnitus-related distress, disability, affective distress and tinnitus-related negative beliefs and fear. Measures were completed pre-intervention at 3 months, 8 months, and 12 months. Multilevel modeling was used to examine effects and their predictors.

Results:

Younger participants with lower levels of tinnitus distress were more likely to dropout while those with higher tinnitus distress at baseline and quality of life were more likely to receive step 2 of treatment. MLM analyses revealed, with one exception, no relation between any baseline variable and outcome change over time. Most participants’ improvement exceeded minimally clinical important difference criteria for quality of life, tinnitus-related handicap, and tinnitus distress.

Conclusions:

Results from this large pragmatic study complements those from randomized controlled trials of cognitive behavioral therapy for chronic tinnitus distress and supports its implementation under “real-world” conditions.
Factors Related to Activation in Chinese Patients With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Survey Study
Authors: TANG Ting , DOU Bei , ZHA Hui-Xian , TAO Lian-Shan , GU Ze-Juan , LIU Kou-Ying , XIE Wei-Ping
Published: April 2022

Background

Improving patient activation can lead to better health outcomes among patients with chronic obstructive pulmonary disease (COPD). However, no studies have focused on the issue of activation in patients with COPD in China.

Purpose

This study was designed to explore the status of activation in patients with COPD in China and explicate the significant influencing factors.

Methods

One hundred seventy patients with COPD were recruited using a convenience sampling method from eight tertiary and secondary hospitals in Nanjing, China. Sociodemographic, clinical, and patient-reported factor data were collected. Univariate analysis and multivariate linear regression were performed.

Results

Only 10.6% of the patients were identified as activated for self-management. Multivariate linear regression analysis revealed four explanatory elements as significantly associated with patient activation, including social support (β = .463, p < .001), free medical insurance (β = .173, p = .007), smoking status (β = −.195, p = .002), and health status (β = −.139, p = .04).

Conclusions/Implications for Practice

The findings of this study indicate that a minority of patients with COPD are activated for self-management in China. Having a higher level of patient activation was associated with having better social support, having free medical insurance, being a nonsmoker, and having a better health status. Creating a supportive environment, promoting smoking cessation, and improving medical security and health status may be considered as potential strategies to activate patients into better self-management.
Do it “RIGHT”: HeartMate 3 as Destination Therapy Right Ventricular Assist Device in a Patient With Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Hanuna Maja , Kääb Stefan , Hagl Christian , Mueller Cristoph S.
Published: April 2022

Isolated right ventricular failure presents a rare pathology and heart transplantation remains the treatment of choice. Because of the shortage of donor organs, alternative treatment options are required. However, current continuous-flow ventricular assist devices are designed and approved only for left ventricular support and right ventricular implantation usually presents a procedure of last resort. Herein, we present a successful implantation of the HeartMate 3 for isolated right ventricular support as destination therapy in a patient suffering from late-onset arrhythmogenic right ventricular cardiomyopathy.
Setting up a Rescue Extracorporeal Life Support Program
Authors: Blackwood Jaime , Nikitovic Dejana , Spence Tanya , Khaira Gurpreet K. , Brindle Mary E.
Published: April 2022

Extracorporeal life support (ECLS) is a high-risk, lifesaving medical treatment that is typically limited to centers that can support a comprehensive ECLS program. Rescue programs can bridge the gap in care between ECLS centers and other tertiary pediatric centers without cardiac surgical and comprehensive ECLS support. We describe how our pediatric center without cardiac surgery successfully partnered with an established ECLS center to develop a Rescue ECLS Cannulation Program. This formalized program provides cannulation and stabilization by a specialized team at the presenting hospital before being transported to a partner hospital. This article outlines how we established our unique Rescue ECLS Cannulation program. We outline the planning, development, and implementation of the program and describe the unique aspects contributing to successful implementation including longitudinal training, staged program evolution, and a bundled approach to care. We also describe the patients who we have cannulated since its inception. Rescue ECLS Cannulation Programs provide access to consistent, high-quality, and lifesaving care to critically ill patients at sites without the resources to support a full ECLS program.
Lifting Statewide Mask Mandates and COVID-19 Cases
Authors: Petersen Finn , Errore Anna , Karaca-Mandic Pinar
Published: April 2022

Importance:

As states reopened their economies state and local officials made decisions on policies and restrictions that had an impact on the evolution of the pandemic and the health of the citizens. Some states made the decision to lift mask mandates starting spring 2021. Data-driven methods help evaluate the appropriateness and consequences of such decisions.

Objective:

To investigate the association of lifting the mask mandate with changes in the cumulative coronavirus case rate.

Design:

Synthetic control study design on lifting mask mandate in the state of Iowa implemented on February 7, 2021.

Setting:

Daily state-level data from the COVID-19 Community Profile Report published by the US Department of Health & Human Services, COVIDcast dataset of the Delphi Research Group, and Google Community Mobility Reports.

Exposures and Outcome:

Mask mandate policy lift at the state level. State-day observations of the cumulative case rate measured as the cumulative number of new cases per 100,000 people in the previous 7 days.

Results:

The cumulative case rate in Iowa increased by 20%–30% within 3 weeks of lifting the mask mandate as compared with a synthetic control unit. This association appeared to be related to people, in fact, reducing their mask-wearing habits.

Conclusions:

Lifting the mask mandate in Iowa was associated with an increase in new COVID-19 cases. Caution should be applied when making this type of policy decision before having achieved a more stable control of the pandemic.
Prognostic Value of Pathological Personality Traits for Treatment Outcome in Anxiety and Depressive Disorders
Authors: van Eeden Wessel A. , van Hemert Albert M. , Giltay Erik J. , Spinhoven Philip , de Beurs Edwin , Carlier Ingrid V.E.
Published: April 2022

Previous studies have failed to take baseline severity into account when assessing the effects of pathological personality traits (PPT) on treatment outcome. This study assessed the prognostic value of PPT (Dimensional Assessment of Personality Pathology–Short Form) on treatment outcome (Brief Symptom Inventory [BSI-posttreatment]) among patients with depressive and/or anxiety disorders (N = 5689). Baseline symptom level (BSI-pretreatment) was taken into account as a mediator or moderator variable. Results showed significant effects of PPT on outcome, of which Emotional Dysregulation demonstrated the largest association (β = 0.43, p < 0.001). When including baseline BSI score as a mediator variable, a direct effect (β = 0.11, p < 0.001) remained approximately one-third of the total effect. The effects of Emotional Dysregulation (interaction effect β = 0.061, p < 0.001) and Inhibition (interaction effect β = 0.062, p < 0.001), but not Compulsivity or Dissocial Behavior, were moderated by the baseline symptom level. PPT predicts higher symptom levels, both before and after treatment, but yields relatively small direct effects on symptom decline when the effect of pretreatment severity is taken into account.
Plasma Metabolomic Signature of Early Abuse in Middle-Aged Women
Authors: Huang Tianyi , Zeleznik Oana A. , Roberts Andrea L. , Balasubramanian Raji , Clish Clary B. , Eliassen A. Heather , Rexrode Kathryn M. , Tworoger Shelley S. , Hankinson Susan E. , Koenen Karestan C. , Kubzansky Laura D.
Published: April 2022

Objective

Metabolomic profiling may provide insights into biological mechanisms underlying the strong epidemiologic links observed between early abuse and cardiometabolic disorders in later life.

Methods

We examined the associations between early abuse and midlife plasma metabolites in two nonoverlapping subsamples from the Nurses’ Health Study II, comprising 803 (mean age = 40 years) and 211 women (mean age = 61 years). Liquid chromatography–tandem mass spectrometry assays were used to measure metabolomic profiles, with 283 metabolites consistently measured in both subsamples. Physical and sexual abuse before age 18 years was retrospectively assessed by validated questions integrating type/frequency of abuse. Analyses were conducted in each sample and pooled using meta-analysis, with multiple testing adjustment using the q value approach for controlling the positive false discovery rate.

Results

After adjusting for age, race, menopausal status, body size at age 5 years, and childhood socioeconomic indicators, more severe early abuse was consistently associated with five metabolites at midlife (q value < 0.20 in both samples), including lower levels of serotonin and C38:3 phosphatidylethanolamine plasmalogen and higher levels of alanine, proline, and C40:6 phosphatidylethanolamine. Other metabolites potentially associated with early abuse (q value < 0.05 in the meta-analysis) included triglycerides, phosphatidylcholine plasmalogens, bile acids, tyrosine, glutamate, and cotinine. The association between early abuse and midlife metabolomic profiles was partly mediated by adulthood body mass index (32% mediated) and psychosocial distress (13%–26% mediated), but not by other life-style factors.

Conclusions

Early abuse was associated with distinct metabolomic profiles of multiple amino acids and lipids in middle-aged women. Body mass index and psychosocial factors in adulthood may be important intermediates for the observed association.
Role of Dopamine Transporter in the Relationship Between Plasma Cortisol and Cognition
Authors: Yang Kai-Chun , Liu Mu-N , Yang Bang-Hung , Chou Yuan-Hwa
Published: April 2022

Objective

Cortisol is associated with cognition in both healthy individuals and patients with neuropsychiatric disorders. Regarding the effects of cortisol on the dopamine system and the association between dopamine transporter (DAT) and cognition, DAT might be a central target linking cortisol and cognition. This study explored the role of striatal DAT in the cortisol-cognition relationship.

Methods

We recruited 33 patients with carbon monoxide poisoning and 33 age- and sex-matched healthy controls. All participants underwent cognitive assessments of attention, memory, and executive function. Single-photon emission computed tomography with 99mTc-TRODAT was used to determine striatal DAT availability. Plasma cortisol, tumor necrosis factor α, and interleukin-10 levels were measured using enzyme-linked immunosorbent assays.

Results

Compared with healthy controls, patients with carbon monoxide poisoning had lower cognitive performance, bilateral striatal DAT availability, and plasma tumor necrosis factor-α levels and higher cortisol and interleukin-10 levels. In all participants, plasma cortisol level and bilateral striatal DAT availability were negatively and positively related to cognition, respectively, including memory and executive function with β from −0.361 (95% confidence interval [CI] = −0.633 to −0.090) to 0.588 (95% CI = 0.319 to 0.858). Moreover, bilateral striatal DAT mediated the cortisol-cognition relationship with indirect effects from −0.067 (95% CI = −0.179 to −0.001) to −0.135 (95% CI = −0.295 to −0.024). The cytokine levels did not influence the mediation effects.

Conclusions

This is the first study to demonstrate that striatal DAT mediates the cortisol-cognition relationship. Future studies are needed to comprehensively evaluate the role of the dopamine system in cortisol-cognition associations and treatment implications.
Use of Real-Life Safety Data From International Pharmacovigilance Databases to Assess the Importance of Symptoms Associated With Gadolinium Exposure
Authors: Shahid Imran , Joseph Alvin , Lancelot Eric
Published: April 2022

Objective

Recent scientific publications have reported cases of patients who complained from a variety of symptoms after they received a gadolinium-based contrast agent (GBCA). The aim of this study was to appreciate the importance of these clinical manifestations in the overall population by assessing the weight of “symptoms associated with gadolinium exposure” (SAGE) among the bulk of safety experiences reported to major health authorities.

Materials and Methods

Symptoms associated with gadolinium exposure were identified from a review of the scientific literature, and the corresponding preferred terms were searched in each system organ class (SOC) category recorded in the European and North American pharmacovigilance databases EudraVigilance (EV) and FDA Adverse Event Reporting System (FAERS), respectively. The numbers of SAGE per preferred term, and cumulatively per SOC, were recorded and their weights in the overall spectrum of adverse events (AEs) were determined for each GBCA.

Results

The analysis of the selected AEs revealed a significantly higher SAGE weight for gadobenate dimeglumine (EV: 25.83%, FAERS: 32.24%) than for gadoteridol (EV: 15.51%; FAERS: 21.13%) and significantly lower SAGE weights for gadobutrol (EV: 7.75%; FAERS: 13.31%) and gadoterate meglumine (EV: 8.66%; FAERS: 12.99%). A similar ranking was found for most of the SOCs except for “nervous system disorders,” probably owing to a limitation in the methods of data selection. Furthermore, this analysis showed a greater percentage of reports mentioning a decrease in the quality of life of the patients when they were exposed to gadobenate dimeglumine or gadoteridol than to gadobutrol or gadoterate meglumine.

Conclusion

This study showed that SAGE represent a significant percentage of the bulk of AEs reported to the health authorities for each GBCA. It provided real-life arguments suggesting that SAGE may be more prevalent with linear than macrocyclic GBCAs and that gadoteridol may present a higher SAGE risk than the other macrocyclic contrast agents.
Output-weighted sampling for multi-armed bandits with extreme payoffs
Authors: Yang Yibo , Blanchard Antoine , Sapsis Themistoklis , Perdikaris Paris
Published: April 2022

We present a new type of acquisition function for online decision-making in multi-armed and contextual bandit problems with extreme payoffs. Specifically, we model the payoff function as a Gaussian process and formulate a novel type of upper confidence bound acquisition function that guides exploration towards the bandits that are deemed most relevant according to the variability of the observed rewards. This is achieved by computing a tractable likelihood ratio that quantifies the importance of the output relative to the inputs and essentially acts as anattention mechanismthat promotes exploration of extreme rewards. Our formulation is supported by asymptotic zero-regret guarantees, and its performance is demonstrated across several synthetic benchmarks, as well as two realistic examples involving noisy sensor network data. Finally, we provide a JAX library for efficient bandit optimization using Gaussian processes.