bluuebunny/crossref_metadata_2025 huggingface dataset:
Recovery From Mobility Limitation in Middle-Aged African Americans: The Jackson Heart Study
Authors: Odden Michelle C , Sims Kendra D , Thorpe Roland J , Sims Mario , Dhamoon Mandip , Min Yuan-I , Correa Adolfo
Published: October 2020

Background

Despite evidence that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery.

Method

Participants from the Jackson Heart Study underwent 3 in-person exams from 2000 to 2013. Mobility limitations were assessed over this period by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the year following an incident event. Candidate predictor variables were assessed in logistic regression models, including sociodemographic, psychosocial, and health measures. Inverse probability weights were used to address missing data in the outcome.

Results

Among 4526 participants (mean [SD] age = 54.5 (12.8) years) without a mobility limitation at baseline, 1445 (32%) had an incident mobility limitation over 12 years of follow-up, and 709 (49%) reported recovery from mobility limitation by 1 year later. Low income and daily discrimination were associated with a lower likelihood of recovery even after adjustment for covariates. In adjusted models, greater comorbidity was associated with a lower likelihood of recovering (p-value for trend = .05). History of heart failure and cancer were associated with a lower likelihood of recovering from mobility limitation (OR: 0.52, 95% CI: 0.29, 0.94 and OR: 0.74, 95% CI: 0.55, 1.00). Adiposity, smoking status, and physical activity were not associated with recovery from mobility limitation.

Conclusion

Half of incident mobility limitations in this population of middle-aged African Americans were transient. Adverse sociodemographic factors and comorbidities were associated with lower likelihood of recovery.
Retooling the Health Care Workforce for an Aging America: A Current Perspective
Authors: Foley Kevin T , Luz Clare C
Published: October 2020

A 2008 Institute of Medicine (IoM) report outlined a vision for health care and a workforce capable of addressing health and extended care needs of our aging population. It highlighted dramatic shortages necessitating bold action and outlined recommendations aimed at building a sizable and qualified workforce. This study updates report findings and progress made on its recommendations. Through review of publicly accessible, internet-based literature and government and professional organization websites, current workforce data and recent policy changes are compared to the report’s statistics and recommendations. Direct comparisons are limited by changing definitions, context, and data collection and analyses methods. Future workforce-need projections are estimated using reports from various sources. Inability to forecast medical advances, socioeconomic changes, and world events affects the accuracy of these projections. Nonetheless, clear conclusions emerge despite such limitations. Progress toward fulfilling the IoM goals is variable and insufficient. The current and projected numbers for all geriatric health providers remain inadequate compared to estimated 2030 demand. Challenges in meeting estimated needs persist essentially unchanged. The 2008 IoM framework and recommendations remain relevant and constitute an important roadmap to complete unfinished goals. Initial findings from this update provide a platform for developing practice and policy reforms.
Reforming WTO Conflict Management: Why and How to Improve the Use of ‘Specific Trade Concerns’
Authors: Wolfe Robert
Published: October 2020

With its dispute settlement system in peril, the role of the World Trade Organization in mitigating commercial conflict is more important than ever, but its working practices need reform. The Sanitary and Phytosanitary Measures and Technical Barriers to Trade committees have developed a mechanism for members to raise ‘specific trade concerns’ about the laws, regulations, and practices of their trading partners, both proposed and already implemented. These specific trade concerns can mitigate sources of friction and help avoid recourse to formal dispute settlement. This article assesses experience with specific trade concerns and analyzes suggestions for reform of the process and its extension to all World Trade Organization committees. The important World Trade Organization reform question is whether procedural changes in Geneva can make specific trade concerns more effective for all members while facilitating enhanced participation by members who do not now make full use of the possibilities that such procedures offer.
In a flash of time: knowledge resources that enable professional cross-boundary work
Authors: Cross David , Swart Juani
Published: October 2020

In this paper, we highlight the networked context of the professions. In particular, we indicate that neo-classical professionals tend to work across organizational boundaries in project teams, often to meet the needs of clients and the wider society. However, little is known about the resources that professionals draw on to meet immediate, fast paced, client demands in project network organizations (PNOs). We pinpoint how knowledge resources, human, social and organizational capital enable professionals to produce outputs at a fast pace/tempo. Temporality emerged as an unexpected but key issue in our empirical research and we explore this further here. First, we put forward how professional work organization(s) has changed by focusing on the boundaries of organizations, and how this is often temporary and project-driven. Second, we use the specific lens of knowledge resources which are drawn upon to enable networked working and ask the question: which knowledge resources enable professionals to work at a fast pace within networks? Third, appreciative of the vast literature on temporary and networked organizations in professional work, our focus is beyond a single profession or organization, and hence, we build upon the prior research on PNOs. We do this by drawing on empirical data of a humanitarian aid project networked organization (HN) that upscales across its network at high speed, often within days, to generate funds for humanitarian disasters in order to save lives.
r-mode instability of neutron stars in Low-mass X-ray binaries: effects of Fermi surface depletion and superfluidity of dense matter
Authors: Dong J M
Published: October 2020

The nucleon-nucleon correlation between nucleons leads to the Fermi surface depletion measured by a Z-factor in momentum distribution of dense nuclear matter. The roles of the Fermi surface depletion effect (Z-factor effect) and its quenched neutron triplet superfluidity of nuclear matter in viscosity and hence in the gravitational-wave-driven r-mode instability of neutron stars (NSs) are investigated. The bulk viscosity is reduced by both the two effects, especially the superfluid effect at low temperatures which is also able to reduce the inferred core temperature of NSs. Intriguingly, due to the neutron superfluidity, the core temperature of the NSs in known low-mass X-ray binaries (LMXBs) are found to be clearly divided into two groups: high and low temperatures which correspond to NSs with short and long recurrence times for nuclear-powered bursts respectively. Yet, a large number of NSs in these LMXBs are still located in the r-mode instability region. If the density-dependent symmetry energy is stiff enough, the occurence of direct Urca process reduces the inferred core temperature by about one order of magnitude. Accordingly, the contradiction between the predictions and observations is alleviated to some extent, but some NSs are still located inside the unstable region.
Global identification and characterization of tRNA-derived RNA fragment landscapes across human cancers
Authors: Sun Xiwei , Yang Juze , Yu Mengqian , Yao Dongxia , Zhou Liyuan , Li Xufan , Qiu Qiongzi , Lin Weiqiang , Lu Bingjian , Chen Enguo , Wang Ping , Chen Wantao , Tao Sifeng , Xu Haiming , Williams Anna , Liu Yong , Pan Xiaoqing , Cowley Allen W , Lu Weiguo , Liang Mingyu , Liu Pengyuan , Lu Yan
Published: October 2020

Transfer RNA-derived RNA fragments (tRFs) are a class of small non-coding RNAs that are abundant in many organisms, but their role in cancer has not been fully explored. Here, we report a functional genomic landscape of tRFs in 8118 specimens across 15 cancer types from The Cancer Genome Atlas. These tRFs exhibited characteristics of widespread expression, high sequence conservation, cytoplasmic localization, specific patterns of tRNA cleavage and conserved cleavage in tissues. A cross-tumor analysis revealed significant commonality among tRF expression subtypes from distinct tissues of origins, characterized by upregulation of a group of tRFs with similar size and activation of cancer-associated signaling. One of the largest superclusters was composed of 22 nt 3′-tRFs upregulated in 13 cancer types, all of which share the activation of Ras/MAPK, RTK and TSC/mTOR signaling. tRF-based subgrouping provided clinically relevant stratifications and significantly improved outcome prediction by incorporating clinical variables. Additionally, we discovered 11 cancer driver tRFs using an effective approach for accurately exploring cross-tumor and platform trends. As a proof of concept, we performed comprehensive functional assays on a non-microRNA driver tRF, 5′-IleAAT-8-1-L20, and validated its oncogenic roles in lung cancer in vitro and in vivo. Our study also provides a valuable tRF resource for identifying diagnostic and prognostic biomarkers, developing cancer therapy and studying cancer pathogenesis.
Psychometric validity and reliability of the Danish version of the MD Anderson Symptom Inventory Brain Tumor Module
Authors: Piil Karin , Whisenant Meagan , Mendoza Tito , Armstrong Terri , Cleeland Charles , Nordentoft Sara , Williams Loretta A , Jarden Mary
Published: October 2020

Background

The complexity of disease- and treatment-related symptoms causes profound distress and deterioration of health-related quality of life among patients with brain tumors. Currently, there is no Danish validated disease-specific instrument that focuses solely on measures of both neurologic and cancer-related symptoms of patients with brain tumors. The MD Anderson Symptom Inventory Brain Tumor Module (MDASI-BT) is a validated patient self-report questionnaire that measures symptom prevalence, intensity, and interference with daily life. The aim of the present study was to determine the psychometric validity of the Danish translation of the MDASI-BT, and to test its utility in 3 cohorts of Danish patients across the spectrum of the brain cancer disease and treatment trajectory.

Methods

A linguistic validation process was conducted. Danish patients with malignant primary brain tumors were included to establish the psychometric validity and reliability of the Danish MDASI-BT. Cognitive debriefing interviews were conducted to support the psychometric properties.

Results

A total of 120 patients participated in this study. Coefficient αs for the symptom and interference subscales indicate a high level of reliability across all items. Corresponding symptom and interference or functional items and subscales in the MDASI-BT and European Organisation for Research and Treatment of Cancer Brain Tumor Module BN20 were significantly correlated. Cognitive debriefing provided evidence for content validity and questionnaire utility as participants were comfortable answering the questions and had no problem with the understandability or number of questions asked.

Conclusion

The MDASI-BT is a simple, concise symptom assessment tool useful for assessing the symptom severity and interference of Danish-speaking patients with brain cancer.
Bringing New Meaning to the Term “Adaptive Trial”: Challenges of Conducting Clinical Research During the Coronavirus Disease 2019 Pandemic and Implications for Implementation Science
Authors: Branch-Elliman Westyn , Elwy A Rani , Monach Paul
Published: October 2020

Although implementation of evidence-based practices takes an average of 17 years, in the context of the global pandemic, coronavirus disease 2019 (COVID-19) interventions were adopted in a greatly compressed time frame. This rapid uptake creates major challenges for conducting COVID-19 clinical research studies, because quickly evolving standards make it difficult to adapt in real time. The rapid dissemination and implementation of COVID-19 interventions is the realization of goals long pursued by the implementation science community. However, the downside of the rapid implementation is that low-quality evidence with little to no scientific vetting may be quickly integrated into clinical care, resulting in lost opportunities to advance our scientific understanding about how to manage infected patients. In the future, novel adaptive designs embedded into electronic health records (Embedded Quantified, Integrated-into-Practice Trial [EQuIPT] designs) that allow for easier and better access to clinical trials may simultaneously improve care and advance healthcare innovations.
Modeling Donor Screening Strategies to Reduce the Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission via Fecal Microbiota Transplantation
Authors: Olesen Scott W , Zaman Amanda , Osman Majdi , Ramakrishna Bharat
Published: October 2020

The potential for transmission of severe acute respiratory syndrome coronavirus 2 shed in stool via fecal microbiota transplantation is not yet known, and the effectiveness of various testing strategies to prevent fecal microbiota transplantation-based transmission has also not yet been quantified. In this study, we use a mathematical model to simulate the utility of different testing strategies.
Safety of Hydroxychloroquine Among Outpatient Clinical Trial Participants for COVID-19
Authors: Lofgren Sarah M , Nicol Melanie R , Bangdiwala Ananta S , Pastick Katelyn A , Okafor Elizabeth C , Skipper Caleb P , Pullen Matthew F , Engen Nicole W , Abassi Mahsa , Williams Darlisha A , Nascene Alanna A , Axelrod Margaret L , Lother Sylvain A , MacKenzie Lauren J , Drobot Glen , Marten Nicole , Cheng Matthew P , Zarychanski Ryan , Schwartz Ilan S , Silverman Michael , Chagla Zain , Kelly Lauren E , McDonald Emily G , Lee Todd C , Hullsiek Kathy H , Boulware David R , Rajasingham Radha
Published: October 2020

Background

Use of hydroxychloroquine in hospitalized patients with coronavirus disease 2019 (COVID-19), especially in combination with azithromycin, has raised safety concerns. Here, we report safety data from 3 outpatient randomized clinical trials.

Methods

We conducted 3 randomized, double-blind, placebo-controlled trials investigating hydroxychloroquine as pre-exposure prophylaxis, postexposure prophylaxis, and early treatment for COVID-19 using an internet-based design. We excluded individuals with contraindications to hydroxychloroquine. We collected side effects and serious adverse events. We report descriptive analyses of our findings.

Results

We enrolled 2795 participants. The median age of research participants (interquartile range) was 40 (34–49) years, and 59% (1633/2767) reported no chronic medical conditions. Overall 2544 (91%) participants reported side effect data, and 748 (29%) reported at least 1 medication side effect. Side effects were reported in 40% with once-daily, 36% with twice-weekly, 31% with once-weekly hydroxychloroquine, compared with 19% with placebo. The most common side effects were upset stomach or nausea (25% with once-daily, 19% with twice-weekly, and 18% with once-weekly hydroxychloroquine, vs 11% for placebo), followed by diarrhea, vomiting, or abdominal pain (23% for once-daily, 17% twice-weekly, and 13% once-weekly hydroxychloroquine, vs 7% for placebo). Two individuals were hospitalized for atrial arrhythmias, 1 on placebo and 1 on twice-weekly hydroxychloroquine. No sudden deaths occurred.

Conclusions

Data from 3 outpatient COVID-19 trials demonstrated that gastrointestinal side effects were common but mild with the use of hydroxychloroquine, while serious side effects were rare. No deaths occurred related to hydroxychloroquine. Randomized clinical trials, in cohorts of healthy outpatients, can safely investigate whether hydroxychloroquine is efficacious for COVID-19.

ClinicalTrials.gov Identifier

NCT04308668 for postexposure prophylaxis and early treatment trials; NCT04328467 for pre-exposure prophylaxis trial.
Cloud–cloud collisions and triggered star formation
Authors: Fukui Yasuo , Habe Asao , Inoue Tsuyoshi , Enokiya Rei , Tachihara Kengo
Published: October 2020

Star formation is a fundamental process for galactic evolution. One issue over the last several decades has been determining whether star formation is induced by external triggers or self-regulated in a closed system. The role of an external trigger, which can effectively collect mass in a small volume, has attracted particular attention in connection with the formation of massive stellar clusters, which in extreme cases may lead to starbursts. Recent observations have revealed massive cluster formation triggered by cloud–cloud collisions in nearby interacting galaxies, including the Magellanic system and the Antennae Galaxies as well as almost all well-known high-mass star-forming regions in the Milky Way, such as RCW 120, M 20, M 42, NGC 6334, etc. Theoretical efforts are going into the foundation for the mass compression that causes massive cluster/star formation. Here, we review the recent progress on cloud–cloud collisions and the triggered star-cluster formation, and discuss future prospects for this area of study.
Interacting with Persons with Disabilities: South African Police Officers’ Knowledge, Experience and Perceived Competence
Authors: Viljoen Erna , Bornman Juan , Tönsing Kerstin M
Published: October 2020

Police officers increasingly come into contact with persons with various disabilities in their line of duty. This study aimed to determine police officers’ knowledge, experience, and perceived competence in interacting with persons with disabilities by using questionnaires (n = 98). Participants spanned different genders, age groups, educational levels, ranks, and years of experience. Results showed fair knowledge of the different disability types, despite no prior training. This was attributed to 52% of participants with a family member with a disability and 39% who had previously come into contact with various disability types in their line of duty. Knowledge was poor in identifying specific characteristics of various disabilities. Regarding experience, police officers reported that they most frequently encountered persons with physical disabilities. Perceived competence in interacting with persons with disabilities in the course of policing varied from high to low. A need for training related to disabilities was expressed by 94% of participants.
Identification and Pathogenicity of Diplodia, Neofusicoccum, Cadophora, and Diaporthe Species Associated with Cordon Dieback in Kiwifruit cultivar Hayward in Central Chile
Authors: Díaz Gonzalo A. , Zoffoli Juan Pablo , Ferrada Enrique E. , Lolas Mauricio
Published: October 2020

Dieback symptoms associated with fungal trunk pathogens cause significant economic losses for farmers of kiwifruit and other woody fruit trees worldwide. This study represents the first attempt to identify and characterize the fungal trunk pathogens associated with cordon dieback disease of kiwifruit in central Chile. Field surveys were conducted throughout the main kiwifruit-growing regions in central Chile to determine the incidence and characterize the fungal trunk pathogens associated with cordon dieback of kiwifruit cultivar Hayward through morphological, molecular, and pathogenicity studies. A total of 250 cordon samples were collected and isolations were performed on 2% acidified potato dextrose agar (APDA) plus antibiotics and Igepal. The incidence of kiwifruit cordon dieback ranged between 5% and 85% in all surveyed areas in central Chile. A total of 246 isolates were isolated and identified using culture and morphological features belonging to three fungal taxa: Diaporthaceae spp. (Diaporthe ambigua and D. australafricana; n = 133 isolates); Botryosphaeriaceae spp. (Diplodia seriata and Neofusicoccum parvum; n = 89 isolates); and Ploettnerulaceae spp. (Cadophora luteo-olivacea and C. malorum; n = 24 isolates). These were identified using phylogenetics studies of the internal transcribed spacer (ITS) region (ITS1-5.8S-ITS2) of the rDNA, part of the β-tubulin gene (tub2), and part of the translation elongation factor 1-α gene (tef1-α). Isolates of N. parvum and D. seriata were the most virulent, causing internal brown lesions and dieback symptoms in attached green shoots, attached lignified canes, and young inoculated kiwifruits. This report is the first to describe D. seriata and C. luteo-olivacea associated with kiwifruit cordon dieback in Chile. It presents the first description of N. parvum causing kiwifruit dieback worldwide.
Does the Preoperative Depression Affect Clinical Outcomes in Adults With Following Lumbar Fusion?
Authors: Zhou Yuanxing , Deng Jianlong , Yang Ming , Chang Yvang , Zhang Yu , Xu Gang , Wang Bo , Li Zhonghai
Published: October 2020

Study Design:

This was a retrospective cohort review.

Objective:

The objective of this study was to analyze depression using Beck Depression Inventory (BDI) and Hamilton Depression Scale (HAMD-24), and to correlate with clinical outcomes and improvement in adults with following lumbar fusion.

Summary of Background Data:

Psychological factors such as depression are found to influence outcomes and improvement following spinal surgery. It is still unclear whether there are differences during screening for depression by different implementations to predict outcomes for spine surgery.

Materials and Methods:

Between July 2016 and May 2018, patients with degenerative lumbar disease, who underwent lumbar fusion were enrolled in this study. The patient’s characteristics, preoperative BDI and HAMD-24 score, and preoperative and postoperative outcomes were collected, respectively. Depressed patients were identified by a score of BDI≥15 or HAMD-24>20, respectively. Preoperative and postoperative outcome scores, absolute changes, and recovery ratios of disability and pain were compared within and between groups. Finally, univariate and multiple linear regression analyses was performed to reveal the relationship between preoperative depressive states and outcomes and improvement.

Results:

A total of 125 patients were eligible in the study, with 113 (90.4%) patients without depressive symptoms and 12 (9.6%) depressed patients by BDI, and 97 (77.6%) patients without depressive symptoms and 28 (22.4%) depressed patients by HAMD-24. Both higher BDI and HAMD-24 group was found to have significant worse preoperative and postoperative outcomes as well as less recovery ratios than the patients without depressive symptoms. Univariate and multiple linear regression analyses suggested that preoperative depression might be a potential predictor of worse surgical outcomes.

Conclusions:

Depressive symptoms might lead to smaller magnitude of improvement. Moreover, both preoperative BDI and HAMD-24 score was a negative predictor of postoperative outcomes and can be regarded as a candidate to screen for depression preoperatively.
Persistent postoperative opioid use in Europe
Authors: Sitter Taalke , Forget Patrice
Published: October 2020

BACKGROUND

In the United States, postoperative opioid prescriptions have been implicated in the so-called ‘opioid epidemic’. In Europe, the extent of overprescribing or misuse of opioids is not known.

OBJECTIVES

To describe the proportion of persistent postoperative opioid use in adults (>18 years) in European countries.

DESIGN

Systematic review of the published data.

DATA SOURCES

We searched the electronic literature databases MEDLINE (Ovid), Embase (Ovid), PubMed/MEDLINE and Scopus.

ELIGIBILITY CRITERIA

Studies describing opioid use in adult patients (>18 years) at least 3 months after surgery.

RESULTS

One thousand three hundred and seven studies were found, and 12 studies were included in this review. The rate of opioid use after 3 to 6 months was extracted from the studies and categorised by the type of surgery. Nine studies investigated opioid use after total hip or total knee arthroplasties (THA and TKA) and reported opioid user rates between 7.9 and 41% after 3 months. In all the included studies, a proportion between 2 and 41% of patients were opioid users 3 months after surgery. The level of evidence varied from high to very low.

CONCLUSION

To describe persistent opioid use in relation to specific countries or types of surgery is not possible. Because of the wide ranges observed, we can neither confirm nor rule out a possible public health problem linked to the persistent use of opioids in Europe.

STUDY REGISTRATION

PROSPERO: CRD42019154292.
Effects on cerebral blood flow of position changes, hyperoxia, CO2 partial pressure variations and the Valsalva manoeuvre
Authors: Tercero Javier , Gracia Isabel , Hurtado Paola , de Riva Nicolás , Carrero Enrique , Garcia-Orellana Marta , Belda Isabel , Rios José , Maldonado Felipe , Fàbregas Neus , Valero Ricard
Published: October 2020

BACKGROUND

Maintaining adequate blood pressure to ensure proper cerebral blood flow (CBF) during surgery is challenging. Induced mild hypotension, sitting position or unavoidable intra-operative circumstances such as haemorrhage, added to variations in carbon dioxide and oxygen tensions, may influence perfusion. Several of these circumstances may coincide and it is unclear how these may affect CBF.

OBJECTIVE

To describe the variation in transcranial Doppler and regional cerebral oxygen saturation (rSO2), as a surrogate of CBF, after cardiac preload and gravitational positional changes.

DESIGN

Observational study.

SETTING

Operating room at Hospital Clínic de Barcelona.

VOLUNTEERS

Ten healthy volunteers, white, both sexes.

INTERVENTIONS

Measurements were performed in the supine, sitting and standing positions during hyperoxia, hypocapnia and hypercapnia protocols and after a Valsalva manoeuvre.

MAIN OUTCOME MEASURES

Cardiac index (CI), haemodynamic and respiratory variables, maximal and mean velocities (V
max, V
mean) (transcranial Doppler) and rSO2 were acquired. Results were analysed using a generalised estimating equation technique.

RESULTS

CI increases more than 16% after a preload challenge were not accompanied by differences in rSO2 or V
max − V
mean. With positional changes, V
mean decreased more than 7% (P = 0.042) from the supine to the seated position. Hyperoxia induced a cerebral rSO2 increase more than 6% (P = 0.0001) with decreases in V
max, V
mean and CI values more than 3% (P = 0.001, 0.022 and 0.001) in the supine and standing position. During hypocapnia, CI rose more than 20% from supine to seated and standing (P = 0.0001) with a 4.5% decrease in cerebral rSO2 (P = 0.001) and a decrease of V
max − V
mean more than 24% in all positions (P = 0.001). Hypercapnia increased cerebral rSO2 more than 17% (P = 0.001), V
max − V
mean more than 30% (P = 0.001) with no changes in CI. After a Valsalva manoeuvre, rSO2 decreased more than 3% in the right hemisphere in the upright position (P = 0.001). V
max − V
mean decreased more than 10% (P = 0.001) with no changes in CI.

CONCLUSION

CBF changes in response to cerebral vasoconstriction and vasodilatation were detected with rSO2 and transcranial Doppler in healthy volunteers during cardiac preload and in different body positions. Acute hypercapnia had a greater effect on recorded brain parameters than hypocapnia.
European minimum standards for obstetric analgesia and anaesthesia departments
Authors: Guasch Emilia , Brogly Nicolas , Mercier Frederic J. , Ioscovich Alexander , Weiniger Carolyn F. , Lucas Nuala , Chassard Dominique , Kranke Peter , Whitaker David , Geldner Goetz , Sabelnikovs Olegs , de Robertis Edoardo
Published: October 2020

An important variability of anaesthetic standards of care was discovered in the obstetric departments of many European Union countries. After discussing this issue in various meetings of the European Society of Anaesthesiology (ESA) board and its obstetric subcommittee, European Board of Anaesthesiology of the European Union of Medical Specialists (EBA-UEMS) executive members, ESA obstetric subcommittee members and European experts in obstetric anaesthesiology have participated in the elaboration of this document. This experts’ opinion is focused mainly on obstetric patients and safety concerns in terms of minimum standards of practice. An initial bibliographical search was performed in medical databases and general literature, searching for obstetric anaesthesiology standards to select the most important safety issues. After the initial presentation of the project during EBA-UEMS and ESA obstetric subcommittee meetings, participants were asked to review the document; several rounds of revisions were performed by the experts, to reach a common opinion concerning the topics considered central to patient safety in the obstetric setting. After three rounds of revision, a consensus was reached and is presented in this document, which includes the list of topics considered relevant by the involved areas, and the respective recommendations. These recommendations covered some EBA-UEMS strategic key areas, in addition to several clinical aspects of common obstetric practice.
Consumer wearable technologies to identify and monitor exercise-related arrhythmias in athletes
Authors: Sanchis-Gomar Fabian , Lavie Carl J. , Perez Marco V.
Published: October 2020

Purpose of review

The aim of this study was to synthesize the current evidence supporting and against the use of wearable devices to detect underlying heart conditions in athletes and the most significant limitations.

Recent findings

Although several large studies have been conducted to evaluate the ability of wearables devices to identify atrial fibrillation among the general population, no studies evaluating their ability to detect other exercise-related arrhythmias in athletes are very sparse. Most of the studies or case reports are focused on the wearables’ reliability and accuracy compared with standard ECG. Only small studies evaluating the accuracy of one wearable device in athletes have been carried out to date. Unfortunately, none of them have investigated their ability to detect specific arrhythmias in the athletic population.

Rapidly detecting dangerous arrhythmias in a symptomatic athlete continues to be an elusive goal. The use of smartphone ECG monitors can provide diagnostic data in athletes with symptoms that could represent a helpful instrument. However, many uncertainties remain and need to be addressed and validated in large-scale trials to incorporate these devices into the healthcare system and be part of an athlete's daily monitoring and healthcare.
Impact of Preoperative Lymphopenia on Survival Following Left Ventricular Assist Device Placement
Authors: Stawiarski Kristin , Agboola Olayinka , Park Jiheum , Geirsson Arnar , Jacoby Daniel , Bellumkonda Lavanya , Ahmad Tariq , Chou Josephine , Lee Forrester , Mangi Abeel , Bonde Pramod
Published: October 2020

Lymphopenia has been implicated in poor outcomes in the heart failure population. However, the prognostic implication of lymphopenia in left ventricular assist device (LVAD) patients is unknown. We examine the impact of lymphopenia on all-cause mortality in this population over a 24-month period post-implantation. A total of 170 patients between June 2011 and July 2018 receiving permanent durable LVAD at a single center formed the study population. Criteria for lymphopenia on admission, defined as an absolute lymphocyte count (ALC) <1500 cells/μl, was met in 99 patients. A total of 11 patients were excluded: two with ALC >4800/μl and nine with incomplete data. Survival across groups was compared with a Kaplan-Meier plot and log-rank statistics. The Cox proportional hazard model was used to examine the association between lymphopenia and 24-month all-cause mortality. In the lymphopenia group, mean ALC was 909.6 ± 331.9 versus 2073.6 ± 501.1 in the non-lymphopenic group. Twenty-four-month all-cause mortality was significantly higher in the lymphopenia group (p = 0.009). The lymphopenic patients had worse unadjusted (hazard ratio [HR] = 2.14, confidence interval [CI] = 1.19–3.82; p = 0.01) and adjusted survival (HR = 2.07, CI = 1.13–3.79; p = 0.02). Further clinical investigations are required to assess the utility of continued clinical monitoring of ALC levels beyond LVAD placement.
Hypertension in psoriasis patients: based on office and ambulatory blood pressure measurement
Authors: Abedini Robabeh , Najafi Mohammad-Taghi , Azizpour Arghavan , Nasimi Maryam , Darreshiri Mohammad , Teymourpour Amir
Published: October 2020

Objective

Psoriasis is a chronic inflammatory disorder, which is associated with high risk of metabolic comorbidities. Hypertension (HTN) is among the most common and serious associations. In this study, we aimed to evaluate HTN in psoriatic patients through office and ambulatory blood pressure monitoring (ABPM).

Materials and methods

Forty-nine patients with confirmed diagnosis of psoriasis were enrolled in the study. Office measurement of blood pressure was performed and then holter monitoring was used for 24-h ABPM.

Results

Thirty-six patients (73.4%) had HTN including 13 females (36.1%) and 23 males (63.9%) (P = 0.011). Twelve patients (33.3%) had masked HTN (six females and six males). Office, 24-h, morning, daytime, and nocturnal HTN were present in 49%, 40.8%, 34.7%, 36.7%, and 63.3% of our patients, respectively. The only factor significantly related to morning/daytime/24 h HTN was age, which hypertensive patients had higher age. About 22.4% of patients had metabolic syndrome, which was significantly associated with FBS, weight, waist circumference, and BMI.

Conclusion

Psoriasis is associated with a high rate of HTN. Masked HTN constitutes nearly one-third of hypertensive patients. ABPM increases the accuracy of HTN detection in psoriatic patients.
Evaluation of the relationship between pseudo-hypertension and the parameters of subclinical atherosclerosis
Authors: Karabiyik Ugur , Savas Goktug , Yasan Mustafa , Murat Bucak Halil , Cesur Burak , Cetinkaya Zeki , Topsakal Ramazan , Dogan Ali
Published: October 2020

Background

Methods using for determining the subclinical atherosclerosis have gained growing interest in the recent years. However, the effects of pseudo-hypertension on the parameters of subclinical atherosclerosis are uncertain. We aimed to evaluate the relationship between pseudo-hypertension and subclinical atherosclerosis in individuals diagnosed with pseudo-hypertension.

Methods

A total of 122 patients who underwent radial elective coronary angiography were included in the present study. These patients were divided into two groups based on the difference between invasive and noninvasive blood pressure (BP) measurements: pseudo-hypertension group who had a difference ≥15 mmHg in SBP or ≥10 mmHg in DBP levels between invasive and noninvasive measurements (n = 28), and the other group who did not have any difference as described on these levels (n = 94). In order to evaluate the subclinical atherosclerosis; flow-mediated dilatation (FMD), carotid intima-media thickness (IMT), pulse wave velocity (PWV), and augmentation index were recorded in all patients. Two groups were compared with respect to these parameters.

Results

The median age of the pseudo-hypertension group was 76 years, while the median age of the other group was 63.5 years (P < 0.0001). The incidence of concomitant hypertension was higher in the pseudo-hypertension group as compared to the other group (P < 0.001). There was a significant difference in augmentation index, cardiac output, PWV, FMD, and IMT values between two groups (P = 0.016, P = 0.023, P <0.001, P < 0.001, P < 0.001, respectively).

Conclusions

The present results demonstrated that there was a strong correlation between pseudo-hypertension and the parameters of subclinical atherosclerosis; augmentation index, PWV, FMD, and carotids IMT.
Coronavirus disease-2019: implications for the gastroenterologist
Authors: Bilal Mohammad , Sawhney Mandeep S. , Feuerstein Joseph D.
Published: October 2020

Purpose of review

The COVID-19 pandemic has impacted the practicing gastroenterologist in several ways. Although majority of COVID-19 patients present with respiratory symptoms, gastrointestinal symptoms are also seen. COVID-19 has also disrupted gastrointestinal endoscopy services in numerous ways. There are also concerns regarding the impact of these changes on gastrointestinal cancer screening and management of chronic gastrointestinal diseases. The purpose of this review is to provide an overview of the implications of COVID-19 for the practicing gastroenterologist.

Recent findings

COVID-19 patients can have gastrointestinal symptoms including diarrhea, nausea and vomiting, abdominal pain and anorexia. Separate from the management of COVID-19 patients, there has been a reduction in endoscopy volume worldwide. This has also resulted in reduction/cessation of in-person clinic visits and an increasing use of telemedicine services. In addition, patients with certain chronic diseases like chronic liver disease or inflammatory bowel disease may have worse outcomes during the COVID-19 pandemic.

Gastroenterologists need to rapidly adapt to the challenges being faced and need to make both systems and practice-based changes to the endoscopy unit and outpatient clinic practices. Gastroenterologists should stay up-to-date with the rapidly evolving literature regarding gastrointestinal symptoms in COVID-19 patients as well as its impact on chronic gastrointestinal illnesses.
Plantarflexor strength, gait speed, and step length change in individuals with Parkinson’s disease
Authors: Shearin Staci M. , Medley Ann , Trudelle-Jackson Elaine , Swank Chad , Querry Ross
Published: October 2020

Parkinson’s disease affects the ability to walk often resulting in decreased independence and low quality of life. The purpose of this study was to examine differences in plantarflexor strength (PFS), gait speed, and step length in persons with Parkinson’s disease (PwP) and healthy peers using clinical measures. A secondary purpose was to examine the relationship between these gait components across disease severity. The study was a convenience sample of 71 PwP and 25 community healthy peers. Outcome measures included 10-Meter Walk, step length, and Calf-Raise Senior Test. PwP were separated into mild and moderate impairment groups using the Movement Disorders Society United Parkinson’s Disease Rating Scale Motor Subscale. Between group differences for gait speed (F
2,93 = 24.560, P = 0.000), step length (F
2,93 = 21.93, P = 0.000) and PFS (F
2,93 = 19.49, P < 0.000) were observed. Post hoc testing determined a difference (P < 0.00) in gait speed, step length, and PFS testing between moderate impairment versus healthy peers and mild impairment. A difference (P = 0.045) in step length and a trend towards significance (P = 0.064) for PFS was found between healthy peers and mild impairment group. This study revealed that PwP with mild impairment also have significant changes in step length and trends toward plantarflexor weakness without a significant difference in gait speed. These early changes may warrant early assessment and intervention to prevent decline. This study may bring clinical focus onto the plantarflexor and step length for early comprehensive assessment and treatment of gait and mobility for PwP.
Lessons Learned From a Mental Health Hospital
Authors: Loewenstein Kristy , Saito Ema , Linder Howard
Published: October 2020

Congregate settings such as psychiatric units have an increased risk of disease transmission because of the milieu setting and the inability to isolate patients. Interventions to prevent infection and cross-contamination are discussed including monitoring of patient temperatures, personal protective equipment, remote care, monitoring of human resources, and reinforcement of infection prevention strategies. We discuss the effectiveness of those interventions and the lessons learned, including implications for psychiatric clinical care, during future pandemics or a next wave of COVID-19.
Hospital Costs Following Surgical Complications
Authors: Stokes Sean M. , Scaife Courtney L. , Brooke Benjamin S. , Glasgow Robert E. , Mulvihill Sean J. , Finlayson Samuel R. G. , Varghese Thomas K.
Published: October 2020

Objective:

Surgical complications have substantial impact on healthcare costs. We propose an analysis of the financial impact of postoperative complications.

Summary of Background Data:

Both complications and preoperative patient risk have been shown to increase costs following surgery. The extent of cost increase due to specific complications has not been well described.

Methods:

A single institution's American College of Surgeons National Surgical Quality Improvement Program data was queried from 2012 to 2018 and merged with institutional cost data for each encounter. A mixed effects multivariable generalized linear model was used to estimate the mean relative increase in hospital cost due to each complication, adjusting for patient and procedure-level fixed effects clustered by procedure. Potential savings were calculated based on projected decreases in complication rates and theoretical hospital volume.

Results:

There were 11,897 patients linked between the 2 databases. The rate of any American College of Surgeons National Surgical Quality Improvement Program complication was 11.7%. The occurrence of any complication resulted in a 1.5-fold mean increase in direct hospital cost [95% confidence interval (CI) 1.49–1.58]. The top 6 most costly complications were postoperative septic shock (4.0-fold, 95% CI 3.58–4.43) renal insufficiency/failure (3.3-fold, 95% CI 2.91–3.65), any respiratory complication (3.1-fold, 95% CI 2.94–3.36), cardiac arrest (3.0-fold, 95% CI 2.64–3.46), myocardial infarction (2.9-fold, 95% CI 2.43–3.42) and mortality within 30 days (2.2-fold, 95% CI 2.01–2.48). Length of stay (6.5 versus 3.2 days, P < 0.01), readmission rate (29.1% vs 3.1%, P < 0.01), and discharge destination outside of home (20.5% vs 2.7%, P < 0.01) were significantly higher in the population who experienced complications.

Conclusions:

Decreasing complication rates through preoperative optimization will improve patient outcomes and lead to substantial cost savings.
Are Volume Pledge Standards Worth the Travel Burden for Major Abdominal Cancer Operations?
Authors: Song Yun , Shannon Adrienne B. , Concors Seth J. , Roses Robert E. , Fraker Douglas L. , DeMatteo Ronald P. , Kelz Rachel R. , Karakousis Giorgos C.
Published: October 2020

Objective:

The study objective is to determine the association between travel distance and surgical volume on outcomes after esophageal, pancreatic, and rectal cancer resections.

Summary of Background Data:

“Take the Volume Pledge” aims to centralize esophagectomies, pancreatectomies, and proctectomies to hospitals meeting minimum volume standards. The impact of travel, and possible care fragmentation, on potential benefits of centralized surgery is not well understood.

Methods:

Using the National Cancer Database (2004–2016), patients who underwent esophageal, pancreatic, or rectal resections at far HVH meeting volume standards versus local intermediate (IVH) and low-volume (LVH) hospitals were identified. Perioperative outcomes and 5-year OS were compared.

Results:

Of 49,454 patients, 17,544 (34.5%) underwent surgery at far HVH, 11,739 (23.7%) at local IVH, and 20,171 (40.8%) at local LVH. The median (interquartilerange) travel distances were 77.1 (51.1–125.4), 13.2 (5.8–27.3), and 7.8 (3.1–15.5) miles to HVH, IVH, and LVH, respectively. By multivariable analysis, LVH was associated with increased 30-day mortality for all resections compared to HVH, but IVH was associated with mortality only for proctectomies [odds ratio 1.90, 95% confidence interval (CI) 1.31–2.75]. Compared to HVH, both IVH (hazard ratio 1.25, 95% CI 1.19–1.31) and LVH (hazard ratio 1.35, 95% CI 1.29–1.42) were associated with decreased 5-year OS.

Conclusions:

Compared to far HVH, 30-day mortality was higher for all resections at LVH, but only for proctectomies at IVH. Five-year OS was consistently worse at local LVH and IVH. Improving long-term outcomes at IVH may provide opportunities for greater access to quality cancer care.
Comparing satisfaction of trauma patients 55 years or older to their caregivers during palliative care: Who faces the burden?
Authors: McGraw Constance , Vogel Rebecca , Redmond Diane , Pekarek Jennifer , Tanner Allen , Lynch Neal , Bar-Or David
Published: October 2020

BACKGROUND

Many studies report on the patient-caregiver relationship during palliative care (PC); however, this relationship has yet to be examined following traumatic injury.

METHODS

This prospective cohort study included trauma patients (≥55 years) and their primary caregivers admitted at two level I trauma centers for 2 years (November 2016 to November 2018), who received PC and who completed satisfaction surveys before discharge; surveys were analyzed by four domains: information giving, availability of care, physical care, and psychosocial care, and by PC assessments: consultations, prognostications, formal family meetings (FFMs), and advanced goals of care discussions. The primary outcome was the percentage of patients and caregivers who were satisfied (defined as ≥80%) and was analyzed using McNemar’s test. Adjusted mixed models identified PC assessments that were associated with satisfaction scores ≥80% for patients and caregivers.

RESULTS

Of the 441-patient and 441-caregiver pairs, caregivers were significantly less satisfied than patients during prognostications (information giving, physical care), FFMs (information giving, physical care), and consultations (physical care), while caregivers were significantly more satisfied than patients during advanced goals of care discussions (availability of care, psychosocial care). After adjustment, significant predictors of caregiver satisfaction (≥80%) included longer patient hospital length of stay (>4 days), caring for a male patient (physical care, availability of care), higher caregiver age (≥55 years; availability of care), and higher patient age (≥65 years; psychosocial care). Conversely, all PC assessments decreased odds of satisfaction for caregivers in every domain except physical care. Significant predictors of higher patient satisfaction included FFMs (for every domain) and PC consultations (psychosocial care), and decreased odds included advanced goals of care discussions and prognostication assessments (information giving, psychosocial care).

CONCLUSIONS

Palliative care increased satisfaction of patients, especially family meetings and consultations, while assessments were predictive of lower caregiver satisfaction, suggesting that caregivers may be experiencing some of the patient burden.

LEVEL OF EVIDENCE

Therapeutic/Care Management, level IV.