bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of a Cognitively Challenging Agility Boot Camp Program on Balance and Gait in People With Parkinson’s Disease: Does Freezing of Gait Status Matter?
Authors: Shah Vrutangkumar V. , Vitorio Rodrigo , Hasegawa Naoya , Carlson-Kuhta Patricia , Nutt John G. , King Laurie A. , Mancini Martina , Horak Fay B.
Published: August 2022

Background and Aim:

Individuals with Parkinson’s disease (PD) with and without freezing of Gait (FoG) may respond differently to exercise interventions for several reasons, including disease duration. This study aimed to determine whether both people with and without FoG benefit from the Agility Boot Camp with Cognitive Challenges (ABC-C) program.

Methods:

This secondary analysis of our ABC-C trial included 86 PD subjects: 44 without FoG (PD−FoG) and 42 with FoG (PD + FoG). We collected measures of standing sway balance, anticipatory postural adjustments, postural responses, and a 2-minute walk with and without a cognitive task. Two-way repeated analysis of variance, with disease duration as covariate, was used to investigate the effects of ABC-C program. Effect sizes were calculated using standardized response mean (SRM) for PD−FoG and PD + FoG, separately.

Results:

The ABC-C program was effective in improving gait performance in both PD−FoG and PD + FoG, even after controlling for disease duration. Specifically, dual-task gait speed ( P < .0001), dual-cost stride length ( P = .012), and these single-task measures: arm range of motion ( P < .0001), toe-off angle ( P = .005), gait cycle duration variability ( P = .019), trunk coronal range of motion ( P = .042), and stance time ( P = .046) improved in both PD−FoG and PD + FoG. There was no interaction effect between time (before and after exercise) and group (PD−FoG/PD + FoG) in all 24 objective measures of balance and gait. Dual-task gait speed improved the most in PD + FoG (SRM = 1.01), whereas single-task arm range of motion improved the most in PD−FoG (SRM = 1.01).

Conclusion:

The ABC-C program was similarly effective in improving gait (and not balance) performance in both PD−FoG and PD + FoG.
Predictors of Anal High-Risk HPV Infection Across Time in a Cohort of Young Adult Sexual Minority Men and Transgender Women in New York City, 2015–2020
Authors: LoSchiavo Caleb , D’Avanzo Paul A. , Emmert Connor , Krause Kristen D. , Ompad Danielle C. , Kapadia Farzana , Halkitis Perry N.
Published: August 2022

Cisgender sexual minority men (SMM) and transgender women are disproportionately vulnerable to HPV-related anal cancer, but little is known about longitudinal predictors of high-risk human papillomavirus (hrHPV) infection in this population. As such, this analysis aims to identify factors associated with incident anal hrHPV infection in a diverse cohort of young SMM and transgender women. This study of HPV infection, nested within a larger cohort study, took place between October 2015 and January 2020. Participants completed a brief computer survey assessing HPV symptomatology, risk, and prevention alongside multi-site testing, in addition to biannual cohort study assessments. In the analytic sample of 137 participants, 31.6% tested positive for an anal hrHPV infection, with 27.0% and 29.9% testing positive for incident anal hrHPV infections at Visits 2 and 3, respectively. When adjusting for time between study visits, participants had significantly greater odds of incident anal hrHPV at Visit 2 if they had a concurrent HSV infection (AOR = 5.08 [1.43, 18.00]). At Visit 3, participants had significantly greater odds of incident anal hrHPV infection if they reported a greater number of sex partners in the previous month (AOR = 1.25 [1.03, 1.51]). Prevalence of cancer-causing HPV at baseline was high and many participants tested positive for additional types of anal hrHPV at subsequent visits. Risk for newly detected anal hrHPV infection was significantly associated with biological and behavioral factors. Our findings strongly indicate a need for programs to increase uptake of HPV vaccination and provide HPV-related health education for sexual and gender minorities.
A review of component-in-the-loop: Cyber-physical experiments for rapid system development and integration
Authors: Fagcang Haesul , Stobart Richard , Steffen Thomas
Published: August 2022

To meet rising demands in performance and emissions compliance, companies are driven to develop systems of ever-increasing complexity. In-the-loop methods use a hybrid approach combining a physical subsystem with a virtual subsystem in real-time that can make product development processes faster and cheaper, enabling physical subsystems to be tested in real-world conditions while they are immersed in virtual environment simulation. These techniques evolved from being used solely in controller development with only the embedded controller placed as hardware-in-the-loop (HIL), to being a more holistic technique for system synthesis, capable of both component- and system-level studies. This paper delves into the development of the latter form, henceforth referred to as ‘component-in-the-loop’ or CIL. It provides a literature review of the growing uses of the technique in automotive development, giving a general implementation guidance in system architecture, methodology and control system structure. Furthermore, it suggests the need to clarify terminologies related to in-the-loop methods for a more efficient taxonomy. Definitions are proposed where deemed appropriate. In the age of search engines, this should facilitate knowledge transfer within and across disciplines. Finally, it highlights the key challenges in constructing such systems while discussing attempted solutions. CIL has reached a state of maturity where it is ready for wider adoption and continued technological progress will only push its potential further.
Herbal Sources of Magnesium as a Promising Multifaceted Intervention for the Management of COVID-19
Authors: Amin Mohammed Namiq , Bahoosh Saba Rahimi , Eftekhari Mahdieh , Hosseinzadeh Leila
Published: August 2022

The coronavirus-disease 2019 (COVID-19) was announced as a global pandemic by the World Health Organization (WHO), and it affected all human groups. Severe COVID-19 is characterized by cytokine storms, which can lead to multiorgan failure and death, although fever and cough are the most typical symptoms of mild COVID-19. Plant-based diets provide a 73% lower risk of moderate-to-severe COVID-19. Additionally, the association between low levels of some micronutrients and the adverse clinical consequences of COVID-19 has been demonstrated. So, nutritional therapy can become part of patient care for the survival of this life-threatening disease (COVID-19) also short-term recovery. Magnesium as an essential micronutrient due to its anti-inflammatory and beneficial effects can effectively prevent COVID-19 pandemic by playing a role in the treatment of comorbidities such as diabetes and cardiovascular disorders as major risk factors for mortality. Sufficient magnesium to stay healthy is provided by a proper daily diet, and there is usually no need to take magnesium supplements. Considering that almost half of the dietary magnesium comes from fruits, vegetables, nuts, and grains, it seems necessary to pay attention to the consumption of edible plants containing sufficient magnesium as part of the diet to prevent severe COVID-19. In this study, we have described the beneficial effects of sufficient magnesium levels to control COVID-19 and the importance of plant-based magnesium-rich diets. Additionally, we have listed some edible magnesium-rich plants.
Intermediate to Long-Term Follow-up of the Salto Talaris Fixed-Bearing Total Ankle Prosthesis
Authors: Vesely Bryanna D. , King Matthew A. , Scott Aaron T.
Published: August 2022

Background

Total ankle arthroplasty (TAA) remains a viable option for recalcitrant, end-stage ankle arthritis. Among the various Food and Drug Administration (FDA)-approved prosthetic options is the fixed-bearing Salto Talaris implant. The aim of the present study was to evaluate the intermediate to long-term clinical outcomes and radiographic complications following implantation of the Salto Talaris TAA.

Methods

Nineteen Salto Talaris total ankle implants were included in the present retrospective study. Medical records were reviewed to determine pre- and postoperative visual analog scale (VAS) pain scores, and both medical records and radiographs were utilized to assess for complications. Telephone interviews were then conducted to assess for overall patient satisfaction.

Results

At a mean follow of 6.9 years (range, 3.5-12 years), there was a 21% complication rate according to the classification system described by Glazebrook et al. The reoperation rate was low at 10.5%, and there was 100% survivorship of the total ankle implant. The average pain decreased from 9.1 (range, 7-10) preoperatively to 2.6 (range, 0-10) postoperatively. Patients reported a 95% satisfaction rate, and 16% of patients reported using a brace postoperatively.

Conclusion

The Salto Talaris arthroplasty was associated with low complication and reoperation rates, and a high survivorship at intermediate to long-term follow-up.

Levels of Evidence:

4
Utility of Post-Splinting Conventional Radiographs in Adult Patients With Ankle Fractures Presenting to the Emergency Department
Authors: Walraven Lucia Francisca Joseph , Ridderikhof Milan Lennaert , Schepers Tim
Published: August 2022

Background:

Post-splinting radiographs are often performed in patients with ankle fractures to identify displacement that potentially occurs during splinting. The objective of this study was to investigate the significance of post-splinting conventional radiographs, with an emphasis on stable ankle fractures, not requiring reduction.

Methods:

A retrospective study in which all adult patients presenting with ankle fractures to the emergency department of a level 1 trauma center were included. The primary outcome was frequency of displacement at post-splinting radiographs. Secondary outcome was the rate of successful reduction attempts.

Results:

A total of 225 patients were included and the majority had a Supination-External Rotation (SER) type 2 or Weber B ankle fracture. One hundred fifty patients (mainly SER 2 fractures [68%] or Weber B [89%] fractures), were treated with a splint without fracture reduction. Post-splinting radiographs in these patients, as well as in all patients with a Supination-Adduction (SA) type 1 and 2 fractures, did not show loss of alignment.

Conclusion:

Post-splinting radiographs are probably not necessary in any SA and SER type 2 or Weber A/B ankle fractures without medical clear space widening or need for reduction as no loss of alignment occurred when applying a splint.

Level of Evidence:

IV—Case Series
Knee Cartilage and Subchondral Bone Evaluations by Magnetic Resonance Imaging Correlate with Histological Biomarkers in an Osteoarthritis Rabbit Model
Authors: Sifre Vicente , Ten-Esteve Amadeo , Serra C. Iván , Soler Carme , Alberich-Bayarri Ángel , Segarra Sergi , Martí-Bonmatí Luis
Published: August 2022

Objective

To evaluate pathological changes in cartilage and subchondral bone MRI biomarkers in a rabbit model of osteoarthritis (OA) and correlate these with histological variations.

Design

Transection of the anterior cruciate ligament was performed on the right knee of eighteen 12-week-old New Zealand white rabbits to induce OA. 3-Tesla MR images were obtained from 18 healthy control knees (left) and 18 knees with OA (right). Imaging biomarkers included volume, thickness, T1 and T2* cartilage parametric maps, and several subchondral bone features: bone volume to total volume ratio, trabecular thickness, trabecular spacing, trabecular number (TbN), 2D and 3D fractal dimensions, and quality of trabecular score (QTS). Microscopic analysis of the lateral femoral condyles was set as the ground truth.

Results

When healthy and osteoarthritic knees were compared, significant differences were seen in the T1 and T2* values of the femur and tibia cartilage and in the subchondral bone volume to total volume, TbN, and QTS of both the lateral and medial aspects of the femur and tibia. Histological findings revealed significant osteoarthritic changes between healthy and osteoarthritic knees in stain, structure, chondrocyte density, total score, and subchondral bone biomarker levels. A positive correlation was found between histological staining, structure, chondrocyte density, and total score variables in T1 and T2* cartilage biomarkers. A negative correlation was observed between histological subchondral bone variables and magnetic resonance D2D and QTS biomarkers.

Conclusion

Quantification of several cartilage and subchondral bone imaging biomarkers in a rabbit model of OA allows the detection of significant changes, which are correlated with histological findings.
Radiation modification and characterization of polyvinyl alcohol/starch/citric acid/glycerol bioblend film
Authors: Abdel-Ghaffar Ashraf M , Ali Hussein E
Published: August 2022

Blend films of polyvinyl alcohol (PVA) with starch (St) were obtained by casting method. The effect of different contents of glycerol (Glyc) and citric acid (CA) was investigated. The successful preparations of different compositions were shown by FTIR analysis. The bioblend film of PVA/St/CA/Glyc with a composition of (2:1:1/10 vol %) was selected due to its water resistance, higher mechanical properties, and good thermal stability than other prepared bioblend films. Further improvements were obtained by irradiation with gamma rays at a dose of 10 kGy, where the water resistance was highly reduced and the tensile strength strongly improved. The thermal stability increased with the increasing of irradiation doses up to 30 kGy. The modified thermal and mechanical properties of the selected film either non-irradiated or irradiated were compared with widely used commercially packaging films such as LDPE and PP films. Compared to commercially packaging films, the selected PVA/St bioblend film has higher tensile properties, good and closely thermal properties either non-irradiated or irradiated one. Hence, the study showed the development of modified PVA/St bioblend film, which can be used in many fields such as the packaging industry.
What possibly affects nighttime heart rate? Conclusions from N-of-1 observational data
Authors: Matias Igor , Daza Eric J. , Wac Katarzyna
Published: August 2022

Background

Heart rate (HR), especially at nighttime, is an important biomarker for cardiovascular health. It is known to be influenced by overall physical fitness, as well as daily life physical or psychological stressors like exercise, insufficient sleep, excess alcohol, certain foods, socialization, or air travel causing physiological arousal of the body. However, the exact mechanisms by which these stressors affect nighttime HR are unclear and may be highly idiographic (i.e. individual-specific). A single-case or “ n-of-1” observational study (N1OS) is useful in exploring such suggested effects by examining each subject's exposure to both stressors and baseline conditions, thereby characterizing suggested effects specific to that individual.

Objective

Our objective was to test and generate individual-specific N1OS hypotheses of the suggested effects of daily life stressors on nighttime HR. As an N1OS, this study provides conclusions for each participant, thus not requiring a representative population.

Methods

We studied three healthy, nonathlete individuals, collecting the data for up to four years. Additionally, we evaluated model-twin randomization (MoTR), a novel Monte Carlo method facilitating the discovery of personalized interventions on stressors in daily life.

Results

We found that physical activity can increase the nighttime heart rate amplitude, whereas there were no strong conclusions about its suggested effect on total sleep time. Self-reported states such as exercise, yoga, and stress were associated with increased (for the first two) and decreased (last one) average nighttime heart rate.

Conclusions

This study implemented the MoTR method evaluating the suggested effects of daily stressors on nighttime heart rate, sleep time, and physical activity in an individualized way: via the N-of-1 approach. A Python implementation of MoTR is freely available.
From Oblivion to Reappearance: A Multi-Faceted Evaluation of the Sustainability of Folk Music in Yunnan Province of China
Authors: Kuang Jia , He Lan
Published: August 2022

The Southwestern Chinese province of Yunnan is the home to a plethora of traditional music, folk songs, and ethnic musical instruments with 24 local folk music items included in the national intangible cultural heritage list and extended list. In this article, the authors intend to delve into the issue of Yunnan folk music protection from the perspective of cultural sustainability theory. With an in-depth qualitative analysis of the data on the protection of 24 folk music items of Yunnan, the achievement, impact, and challenges of the current safeguarding efforts are revealed. The findings suggest that: 1. Government agencies at all levels have a dominant influence on the protection effort. 2. The local community, musicians, culture bearers, troupes, clubs, and social organizations form the “brick and mortar” of the folk music sustainability system. 3. The current reappearance or resurface of certain folk music items is a significant step toward truly reviving the folk music items in the future.
Fluid Intake and Hydration Status Among North Carolina Farmworkers: A Mixed Methods Study
Authors: Mizelle Elizabeth , Larson Kim L. , Bolin Linda P. , Kearney Gregory D.
Published: August 2022

Background:

Agricultural workers are disproportionately at risk for heat-related morbidity and mortality. The purpose of this study was to explore how sociocultural and occupational factors, and environmental heat stress influenced fluid intake and hydration status among Latino farmworkers working in eastern North Carolina.

Methods:

A community-informed, mixed methods research study was conducted in partnership with staff at a federally qualified health center. In summer 2020, we recruited Latino farmworkers at migrant camps. Twenty-eight male, migrant farmworkers participated in focus group discussions and 30 completed surveys and provided urine specimens. Wet bulb globe temperatures were measured in fields where workers labored. Content analysis and parametric analyses were performed. Data integration was completed using a meta-matrix.

Results:

Prior to work, 46.7% of farmworkers’ urine specific gravity measurements indicated dehydration, which increased to 100% after work. The farmworkers spent between 2 and 7.5 hours of their day working in conditions above the recommended limits for workplace heat exposure. Farmworkers described exposure to extreme heat and inconsistent occupational policy compliance. Farmworkers expressed the opportunity to drink water but accessibility and poor water quality limited hydration. The integrated data supported congruent findings of extreme heat, few work breaks, and substandard housing.

Conclusion/Application to Practice:

Farmworkers are dehydrated at work, placing them at higher risk for heat-related illness (HRI). By engaging with agricultural stakeholders, occupational health nurses can combine efforts and advocate for effective health and safety work policies to reduce HRIs and deaths among farmworkers. Legislation stipulating cooling and hydration practices would support safer work environments.
‘Imitate or Incubate?’ Evaluating the Current State of University-Based Business Incubators in the United Arab Emirates
Authors: Yasin Naveed , Gilani Sayed Abdul Majid
Published: August 2022

Although there has been extensive research on business incubators (BIs) in the private sector, relatively little is known about university-based business incubators (UBIs) in the context of emerging markets such as the United Arab Emirates (UAE). This study explores the current state of UBIs in the UAE by analysing secondary and primary data obtained through desk-based research and qualitative semi-structured interviews with UBI managers, academics and support staff. Informed by this study comprising nine cases of UBIs in the UAE, the data were collected through Voice over Internet Protocol and telephone during March 2021–February 2022 during the COVID-19 pandemic. Based on the analysis of data using Template Analysis, the findings illustrate that UAE universities’ BIs are relatively young and characterized by eight key themes, which were identified as (a) attracting new students, (b) improving communication skills, (c) curriculum development, (d) extra-curricular development, (e) industry engagement, (f) innovation/spinoffs, (g) research skills and (h) strategic thinking. As per the UAE Vision 2031, UBIs will play a crucial role in innovation and entrepreneurship, and therefore there are implications for academics, entrepreneurs and policymakers.
Effects of Sodium Hyaluronate in the Treatment of Rotator Cuff Lesions: A Systematic Review and Meta-analysis
Authors: Liu Weijun , Lin Bendan , Yao Hongbin , Chen Zhanpeng , Hu Yishan
Published: August 2022

Background:

Rotator cuff pathology is a common cause of pain and shoulder dysfunction. Several nonoperative treatment modalities have been developed for rotator cuff lesions, but their relative efficacy is not well-established.

Purpose/Hypothesis:

The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of sodium hyaluronate (SH) in the treatment of patients with rotator cuff lesions. It was hypothesized that SH would be found to be more effective than other nonoperative regimens.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

We searched various databases to identify eligible studies that evaluated the effects of SH on the pain and shoulder dysfunction attributed to rotator cuff lesions. Outcome measures were pain visual analog scale (VAS) score; Constant score; University of California, Los Angeles (UCLA) score; satisfaction rate; complications; and factors affecting the pain VAS score. Outcomes were reported as weighted mean difference (WMD) or risk ratio.

Results:

A total of 9 studies were identified for data analysis. Compared with patients treated with other nonoperative treatments (controls), those treated with SH had significantly improved pain VAS scores at 1 week (WMD = −0.95; 95% CI, −1.75 to −0.16; P = .019), 2 weeks (WMD = −1.05; 95% CI, −2.07 to −0.03; P = .044), 3 weeks (WMD = −1.49; 95% CI, −2.88 to −0.11; P = .035), and 4 weeks (WMD = −2.12; 95% CI, −4.05 to −0.19; P = .031). The Constant score was significantly improved in the SH group versus controls at 2 weeks (WMD = 3.25; 95% CI, 2.36 to 4.13; P < .001), 3 months (WMD = 20.28; 95% CI, 0.54 to 40.03; P = .044), and 6 months (WMD = 5.58; 95% CI, 0.94 to 10.21; P = .018). The UCLA score and satisfaction rate did not differ significantly between the 2 groups. No complications associated with SH were reported in the included studies. Metaregression analysis showed that, except for study design (coefficient = −1.64; 95% CI, −2.64 to −0.63; P = .002), none of the variables (sample size, tear type, control treatments) significantly predicted the difference in VAS pain score between SH and other treatments.

Conclusion:

The present meta-analysis demonstrated that SH was effective in treating patients with rotator cuff lesions.
Considerations of Family Functioning and Clinical Interventions
Authors: Wallace Paige M. , Sterns Harvey L.
Published: August 2022

Levels of family functioning are an important consideration in determining appropriate clinical and educational intervention approaches for families and older adults. Theoretical and applied approaches are reviewed with the emphasis on specific interventions that support different levels of family functioning and caregiving. Additionally, different dynamics within the family and their relations with aging family members are examined. This paper updates and expands discussions on levels of family functioning considerations by Sterns et al. using Blocher’s theory of level of human effectiveness. Further levels of family functioning include the theories developed by Bowen’s family systems theory. A present-day consideration is important for counseling, case management, caregiving, and treatment planning to assist families and their aging family member.
Gender, Race, and Intersectionality in Campaign Cash to the U.S. Congress, 1990 to 2014
Authors: Zhang Yongjun , Heerwig Jennifer
Published: August 2022

This data visualization presents trends and patterns in gender, race, and their intersection in campaign donations to U.S. congressional candidates by American corporate leaders during the 1990–2014 election cycles. On the basis of a new longitudinal database, this visualization shows consistent gender and racial disparities in corporate leaders’ propensity to donate and in their partisan preferences. Throughout the series, the authors find that women are less likely to contribute to congressional campaigns than men in U.S. corporate leadership. Conditional on contributing, women are overall more likely to donate to Democrats than men. In addition to a consistent gender gap in partisan preferences, we find that women of color are the most Democratic leaning, compared with their white counterparts. This latter finding implies a role for intersectionality in explaining the political behavior of these leaders.
Surgeon Volume Impacts Outcomes Following Ankle Fracture Repair
Authors: Deemer Alexa R. , Drake Jack H. , Littlefield Connor P. , Egol Kenneth A.
Published: August 2022

Background:

The purpose of this study was to determine the impact of surgeon volume on outcomes following ankle fracture fixation.

Methods:

Over 7 years, 362 patients who met inclusion criteria (>18 years with rotational ankle fractures) were identified and treated by orthopaedic surgeons at several hospitals within an academic medical center and were retrospectively reviewed. Surgeons that completed less than 24 ankle fixations per year (<90th percentile) during the study period were classified as low-volume (LV) and surgeons completing 24 or more ankle fixations per year (>90th percentile) were classified as high-volume (HV). Chart review was conducted to gather data regarding perioperative, radiographic, inpatient, and long-term outcome data (average 12-month follow-up).

Results:

One hundred thirty-four patients (37.0%) were treated by LV surgeons and 228 (63.0%) were treated by HV surgeons. Although both cohorts had a similar breakdown of fracture patterns ( P = .638), the LV cohort had a greater incidence of open fractures ( P = .024). No differences were found regarding wait time to surgery, surgery duration, and LOS. Radiographically, more patients in the HV cohort achieved anatomic mortise after surgery (96.5% vs 89.6%, P = .008). Patients in the LV cohort took longer to heal radiographically (4.27 ± 2.4 months vs 5.59 ± 2.9 months, P < .001), and also had higher rates of reoperation and hardware removal ( P < .05). Lastly, all cost variables were lower for high-volume surgeons ( P < .05).

Conclusion:

In this single-center study, we found that patients treated by LV surgeons took 30% longer to heal radiographically and had greater reoperation rates than those treated by HV surgeons. Additionally, patients treated by high-volume surgeons had more anatomic postoperative radiographic ankle mortise reductions and was less cost-effective than when performed by high-volume surgeons.

Level of Evidence:

Level III, retrospective comparative study.
Hemophagocytic Syndrome in a Patient with HIV and Histoplasmosis: A not so Rare Correlation
Authors: Freire Monique , Carvalho Viviane , Spener Renata , da Silva Christiane Rodrigues , da Silva Neto João Ricardo , Carlos Ferreira Luiz , Nogueira Paulo Afonso
Published: August 2022

Hemophagocytic lymphohistiocytosis (HLH) is a disorder that occurs due to unsuitable monocyte activation in a variety of infections. In human immunodeficiency virus (HIV) infections, patients with advanced immunossupression associated with opportunistic infections are at increased risk of developing HLH. We describe a clinical case of a 33-year-old male student diagnosed with HIV who was hospitalized for investigation of asthenia and dyspnea, accompanied by adynamia, decreased motor force in the left leg, dysphagia, and dysfluency. His general condition was regular, he was pale, feverish, and had normal cardiac and pulmonary auscultation. Physical examination revealed ulcerated lesions in the perianal region and hepatosplenomegaly without palpable lymph node enlargement. Laboratory parameters showed pancytopenia, a slight increase in liver function accompanied by high lactate dehydrogenase, and hiperferritinemia. The initial diagnosis was disseminated histoplasmosis, thus amphotericin B deoxycholate was empirically prescribed while waiting on myeloculture and blood cultures for fungi and mycobacteria. Other clinical procedures were blood transfusion, resumption of antiretroviral therapy (ART) and secondary prophylaxis. Myeloculture blood cultures of fungi and mycobacteria were negative. Patient evolved well in relation to the initial complaints and showed partial clinical and laboratory improvement. However, 23 days after hospitalization, he developed a febrile episode accompanied by chills and a convulsive crisis. The patient was transferred to the intensive unit care and developed septic shock and respiratory failure. He died 25 days after the onset of the condition. After the postmortem examination, histopathology revealed countless rounded fungal structures compatible with Histoplasma sp., which were observed in the peripancreatic lymph node, liver, and spleen, in addition to hemophagocytosis in the splenic parenchyma. We thus conclude that when the patient met criteria for HLH, such as fever, hepatosplenomegaly, hiperferritinemia, and pancytopenia, the evolution was fast due to the aggressive and rapidly fatal nature of HLH, despite anti-fungal and corticoid treatment. Therefore, this case report reinforces the need to consider hemophagocytic syndrome in patients with HIV and disseminated histoplasmosis, especially where histoplasmosis is highly endemic, in order for the treatment be started early when there is high clinical suspicion.
Diagnostic agreement among experts assessing adults presenting with possible cystic fibrosis: need for improvement and implications for patient care
Authors: Franciosi Alessandro N. , Tanzler April , Goodwin Jodi , Wilcox Pearce G. , Solomon George M. , Faro Albert , McElvaney Noel G. , Downey Damian G. , Quon Bradley S.
Published: August 2022

Background

Increasing awareness of milder presentations of cystic fibrosis (CF) and greater interest in non-CF bronchiectasis are likely to lead to more CF screening by respiratory clinicians. As a result, adults who may not strictly fulfil CF diagnostic criteria yet display evidence of abnormal CF transmembrane conductance regulator (CFTR) function are being identified. The degree of agreement on diagnosis and care needs in these cases between CF clinicians remains unknown, and has implications for patient care, including access to CFTR modulator therapies.

Methods

We surveyed adult CF physicians in Canada, the USA, the UK and Ireland, and presented them with anonymised vignettes of adult patients referred for assessment of possible CF. Diagnostic inter-rater agreement over diagnosis, ease of classifying cases and appropriate follow-up was assessed using Krippendorff's reliability coefficient (α).

Results

Agreement over diagnosis (α=0.282), ease of classification (α= −0.01) and recommended follow-up (α=0.054) was weak. Clinician experience (>10 and 5–10 yearsversus<5 years) and location (UK and IrelandversusCanada) were associated with higher odds of recommending further testing compared with selecting a formal diagnosis (respectively, OR 2.87; p=0.022, OR 3.74; p=0.013 and OR 3.16; p=0.007). A modified standard of care was recommended in 28.7% of cases labelled as CF. 70% of respondents agreed with the statement that “Accurate distinction between CF and CFTR-related disorder has become significantly more pertinent with the advent of highly effective CFTR modulators”.

Conclusions

Our results demonstrate low diagnostic concordance among CF specialists assessing cases of possible adult CF and highlight an area in need of improvement.
Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings
Authors: Hutchinson Ann , Allgar Victoria , Cohen Judith , Currow David C. , Griffin Susan , Hart Simon , Hird Kelly , Hodge Andrew , Mason Suzanne , Northgraves Matthew , Reeve Joanne , Swan Flavia , Johnson Miriam J.
Published: August 2022

Introduction

One-fifth of emergency department presentations by ambulance are due to acute-on-chronic breathlessness. We explored the feasibility of an evaluation-phase, cluster randomised controlled trial (cRCT) of the effectiveness and cost-effectiveness of a paramedic-administered, non-pharmacological breathlessness intervention for people with acute-on-chronic breathlessness at ambulance call-out (BREATHE) regarding breathlessness intensity and conveyance to hospital.

Methods

This mixed-methods, feasibility cRCT (ISRCTN80330546) randomised paramedics to usual care or intervention plus usual care. Retrospective patient consent to use call-out data (primary end-point) and prospective patient/carer consent for follow-up was sought. Potential primary outcomes included breathlessness intensity (numerical rating scale) and conveyance. Follow-up included: interviews with patients/carers and questionnaires at 14 days, 1 and 6 months; paramedic focus groups and surveys.

Results

Recruitment was during COVID-19, with high demands on paramedics and fewer call-outs by eligible patients. We enrolled 29 paramedics; nine withdrew. Randomisation/trial procedures were acceptable. Paramedics recruited 13 patients, not meeting recruitment target (n=36); eight patients and three carers were followed-up. Data quality was good but insufficient for future sample size estimation. The intervention did not extend call-out time, was delivered with fidelity and was acceptable to patients, carers and paramedics. There were no repeat call-outs within 48 h. All trained paramedics strongly recommended BREATHE as a highly relevant, simple intervention.

Conclusion

Patient recruitment to target was not feasible during the pandemic. Training and intervention were acceptable and delivered with fidelity. Results include valuable information on recruitment, consent, attrition and data collection that will inform the design and delivery of a definitive trial.
Sustained population decline of rodents is linked to accelerated climate warming and human disturbance
Authors: Wan Xinru , Yan Chuan , Wang Zhenyu , Zhang Zhibin
Published: August 2022

Background

During the past three decades, sustained population decline or disappearance of cycles in small rodents have been observed. Both anthropogenic disturbance and climate warming are likely to be potential drivers of population decline, but quantitative analysis on their distinct effects is still lacking.

Results

Using time series monitoring of 115 populations (80 populations from 18 known rodent species, 35 mixed populations from unknown species) from 1980 in China (spanning 20–33 yrs), we analyzed association of human disturbances and climate warming with population dynamics of these rodent species. We found 54 of 115 populations showed a decreasing trend since 1980, and 16 of 115 showed an increasing trend. Human disturbances and climate warming showed significant positive associations with the population declines of most rodent species, and the population declines were more pronounced in habitats with more intensified human disturbance such as cities and farmlands or in high-latitude regions which experienced more increase of temperature.

Conclusions

Our results indicate that the large-scale sustained population decline of small mammals in various ecosystems driven by the rapid increase of both climate warming and human disturbance is likely a signal of ecosystem dysfunction or transition. There is an urgent need to assess the risks of accelerated climate warming and human disturbance imposes on our ecosystems.
Genomic characteristics of two most widely used BCG vaccine strains: Danish 1331 and Pasteur 1173P2
Authors: Asadian Mahla , Hassanzadeh Seyed Mehdi , Safarchi Azadeh , Douraghi Masoumeh
Published: August 2022

Background

Bacillus Calmette–Guérin (BCG) refers to a group of vaccine strains with unique genetic characteristics. BCG is the only available vaccine for preventing tuberculosis (TB). Genetic and biochemical variations among the BCG vaccine strains have been considered as one of the significant parameters affecting the variable protective efficacy of the vaccine against pulmonary tuberculosis. To track genetic variations, here two vaccine strains (Danish 1331 and Pasteur 1173P2) popularly used according to the BCG World Atlas were subjected to a comparative analysis against the Mycobacterium tuberculosis H37Rv, Mycobacterium bovis AF2122/97, and Mycobacterium tuberculosis variant bovis BCG str. Pasteur 1173P2 reference genomes. Besides, the presence or absence of the experimentally verified human T cell epitopes was examined.

Results

Only two variants were identified in BCG Danish 1331 that have not been reported previously in any BCG strains with the complete submitted genome yet. Furthermore, we identified a DU1-like 14,577 bp region in BCG Danish 1331; The duplication which was previously seemed to be exclusive to the BCG Pasteur. We also found that 35% of the T cell epitopes are absent from both strains, and epitope sequences are more conserved than the rest of the genome.

Conclusions

We provided a comprehensive catalog of single nucleotide polymorphisms (SNPs) and short insertions and deletions (indels) in BCG Danish 1331 and BCG Pasteur 1173P2. These findings may help determine the effect of genetic variations on the variable protective efficacy of BCG vaccine strains.
Results and lessons from dual extraction of DNA and RNA from formalin-fixed paraffin-embedded breast tumor tissues for a large Cancer epidemiologic study
Authors: Ondracek Rochelle Payne , Chen Jianhong , Marosy Beth , Szewczyk Sirinapa , Medico Leonard , Mohan Amrutha Sherly , Nair Priya , Pratt Rachel , Roh Janise M. , Khoury Thaer , Carpten John , Kushi Lawrence H. , Palmer Julie R. , Doheny Kim , Davis Warren , Higgins Michael J. , Yao Song , Ambrosone Christine B.
Published: August 2022

Background

The use of archived formalin-fixed paraffin-embedded (FFPE) tumor tissues has become a common practice in clinical and epidemiologic genetic research. Simultaneous extraction of DNA and RNA from FFPE tissues is appealing but can be practically challenging. Here we report our results and lessons learned from processing FFPE breast tumor tissues for a large epidemiologic study.

Methods

Qiagen AllPrep DNA/RNA FFPE kit was adapted for dual extraction using tissue punches or sections from breast tumor tissues. The yield was quantified using Qubit and fragmentation analysis by Agilent Bioanalyzer. A subset of the DNA samples were used for genome-wide DNA methylation assays and RNA samples for sequencing. The QC metrices and performance of the assays were analyzed with pre-analytical variables.

Results

A total of 1859 FFPE breast tumor tissues were processed. We found it critical to adjust proteinase K digestion time based on tissue volume to achieve balanced yields of DNA and RNA. Tissue punches taken from tumor-enriched regions provided the most reliable output. A median of 1475 ng DNA and 1786 ng RNA per sample was generated. The median DNA integrity number (DIN) was 3.8 and median DV200 for RNA was 33.2. Of 1294 DNA samples used in DNA methylation assays, 97% passed quality check by qPCR and 92% generated data deemed high quality. Of the 130 RNA samples with DV200 ≥ 20% used in RNA-sequencing, all but 5 generated usable transcriptomic data with a mapping rate ≥ 60%.

Conclusions

Dual DNA/RNA purification using Qiagen AllPrep FFPE extraction protocol is feasible for clinical and epidemiologic studies. We recommend tissue punches as a reliable source material and fine tuning of proteinase K digestion time based on tissue volume.

Impact

Our protocol and recommendations may be adapted by future studies for successful extraction of archived tumor tissues.
Characteristics and clinical outcomes of patients presenting with advanced HIV disease in the “treat all” era: a retrospective cohort study from rural Rwanda
Authors: Musengimana Gentille , Umugisha Jean Paul , Habinshuti Placide , Anderson Todd , Mukesharurema Geraldine , Remera Eric , Ndahimana Jean D’Amour , Barnhart Dale A.
Published: August 2022

Background

In 2016 Rwanda adopted “treat all” where all patients with HIV are immediately eligible for ART regardless of disease progression. Despite widespread availability of treatment, it is unknown whether presentation with advanced HIV persists.

Methods

We conducted a retrospective cohort among patients aged ≥ 15 who enrolled in care between July 2016 and July 2018 in three rural Rwandan districts. We estimated the prevalence of advanced HIV, defined as presenting with CD4 count < 200 cells/mm3 or WHO stage 3 or 4, and compared baseline characteristics of patients with and without advanced HIV. We compared cumulative incidences and time to events using Chi squared tests and Cox proportional hazards models, respectively, for (a) viral load tests; (b) viral suppression; (c) death; and (d) treatment failure (a composite of death, lost to follow up, or virologic failure).

Results

Among 957 patients, 105 (11.0%) presented with advanced HIV. These patients were significantly more likely to have low body mass index, come from Burera district, be older, and be identified through inpatient settings rather than through voluntary or prenatal testing. Patients with advanced HIV had significantly higher risks of death at 12-months (9.5% vs 1.5%, p < 0.001) and 18-months (10.5% vs 1.9%, p < 0.001) and significantly higher risk of treatment failure at 12-months (21.9% vs. 14.2%, p = 0.037). After adjusting for confounders, patients with advanced HIV had still higher rates of death (adjusted Hazard ratio [aHR] = 4.4, 95% CI: 1.9, 10.2, p < 0.001) and treatment failure (aHR = 1.7, 95% CI: 1.1, 2.5, p = 0.017), but no difference in viral load testing (aHR = 1.1, 95% CI: 0.8, 1.5, p = 0.442) or viral suppression (aHR = 1.0, 95% CI: 0.8, 1.4, p = 0.949). When allowing for the hazard ratio to vary over time, patients with advanced HIV experienced elevated rates of treatment failure in the first six of enrollment, but not after nine months.

Conclusion

Presenting with advanced HIV remains common and is still associated with poor patient outcomes. Sensitization of the community to the benefits of early ART initiation, identification of patients with advanced HIV, and holistic support programs for the first 6 months of treatment may be needed to improve outcomes.
Changes in working status after cancer diagnosis and socio-demographic, clinical, work-related, and psychological factors associated with it
Authors: Kang Danbee , Bae Ka Ryeong , Kim Ho Young , Ahn Yeojin , Kim Nayeon , Shim Youngmog , Sohn Tae Sung , Lee Woo Yong , Baek Ji Hyun , Kweon Sun-Seog , Cho Juhee
Published: August 2022

Background

While many studies investigated changes in working status in cancer survivors, most studies have been performed in survivors of breast cancer and few studies evaluated factors associated with changes in the working status of cancer survivors comprehensively. We aimed to evaluate the changes in the working status of cancer survivors after diagnosis and socio-demographic, clinical, work-related and psychological factors associated with it.

Methods

We conducted a cross-sectional survey of adult patients with cancer who were working at the time of diagnosis. A trained interviewer inquired about participants’ current working status, including leave of absence, discontinuing, continuing, and changing work. Sociodemographic, clinical, work-related and psychological factors were measured. Multinomial logistic regression was used to identify factors associated with changes in the working status.

Results

Among the 730 patients, 29%, 18% and 6% were currently on a discontinued working, leave of absence and had changed jobs, respectively. Patients who discontinued working after cancer diagnosis were more likely to be female, have ≥ $3,000 of monthly family income, not be the principal wage earners for their families and be blue-collar workers. In clinical characteristics, advanced-stage cancer and experienced cancer recurrence was associated with leave of absence and discontinued working. In work-related and psychological factors, stress due to insufficient job control (relative risk ratio [RRR] = 2.26), interpersonal conflict (RRR = 1.86), job insecurity (RRR = 2.63), organizational system (RRR = 3.49), and lack of reward (RRR = 11.76), and less meaning to work were more likely to discontinue working after a cancer diagnosis.

Conclusion

Occupational health care professionals and other stakeholders need to openly communicate with patients with cancer about potential barriers during the return-to-work trajectory.
Assessing whether genetic scores explain extra variation in birthweight, when added to clinical and anthropometric measures
Authors: Haulder Maneka , Hughes Alice E. , Beaumont Robin N. , Knight Bridget A. , Hattersley Andrew T. , Shields Beverley M. , Freathy Rachel M.
Published: August 2022

Background

Human birthweight is a complex, multifactorial trait. Maternal characteristics contribute to birthweight variation by influencing the intrauterine environment. Variation explained by genetic effects is also important, but their contributions have not been assessed alongside other key determinants. We aimed to investigate variance in birthweight explained by genetic scores in addition to easily-measurable clinical and anthropometric variables.

Methods

We analysed 549 European-ancestry parent-offspring trios from a UK community-based birth cohort.

We investigated variance explained in birthweight (adjusted for sex and gestational age) in multivariable linear regression models including genetic scores, routinely-measured maternal characteristics, and parental anthropometric variables. We used R-Squared (R2) to estimate variance explained, adjusted R-squared (Adj-R2) to assess improvement in model fit from added predictors, and F-tests to compare nested models.

Results

Maternal and fetal genetic scores together explained 6.0% variance in birthweight. A model containing maternal age, weight, smoking, parity and 28-week fasting glucose explained 21.7% variance. Maternal genetic score explained additional variance when added to maternal characteristics (Adj-R2 = 0.233 vs Adj-R2 = 0.210, p < 0.001). Fetal genetic score improved variance explained (Adj-R2 = 0.264 vs 0.248, p < 0.001) when added to maternal characteristics and parental heights.

Conclusions

Genetic scores account for variance explained in birthweight in addition to easily measurable clinical variables. Parental heights partially capture fetal genotype and its contribution to birthweight, but genetic scores explain additional variance. While the genetic contribution is modest, it is comparable to that of individual clinical characteristics such as parity, which suggests that genetics could be included in tools aiming to predict risk of high or low birthweights.