bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing quality of life between patients undergoing trans-areola endoscopic thyroid surgery and trans-oral endoscopic thyroid surgery
Authors: Shen Shuang , Hu Xiaochi , Qu Rui , Guo Youming , Luo Libo , Chen Xin
Published: June 2021

Background

Compared with conventional open surgery, endoscopic thyroidectomy via the oral vestibular approach (ETVOA) and endoscopic thyroidectomy via the areola approach (ETAA) avoided scarring of the skin, which may help patients achieve a better quality of life (QOL). However, the benefit of the QOL from this technique has not been adequately investigated, therefore this study compared the QOL outcomes between ETVOA and ETAA.

Methods

131 patients were enrolled in this study. ETAA surgery and ETVOA surgery were performed in 74 patients and 57 patients, respectively. These patients were followed up at 2 weeks, 4 weeks, and 8 weeks, and their QOL was evaluated using a thyroid surgery-specific questionnaire and a short-form health survey (SF-36).

Results

There were no differences in clinical characteristics such as gender, age, body mass index (BMI), and tumor size between the two groups. The volume of intraoperative blood loss, cost of hospitalization, and complications between the two procedures showed no differences. Compared with ETAA, ETVOA has a longer operation time, no drainage, and shorter hospital stay. In the QOL questionnaire, several parameters in ETVOA were better. The satisfaction scores of patients undergoing ETVOA were higher. In addition, the cosmetic satisfaction in patients who received ETOVA was significantly better than that of patients who underwent ETAA. The degree of neck movement disorder in patients with ETVOA was milder. Patients who received ETVOA had higher score on the SF-36.

Conclusions

The trans-oral endoscopic approach can acquire better cosmetic results and achieved high-level QOL.
The effect of multimodal comprehensive care methodology training on oral health care professionals’ empathy for patients with dementia
Authors: Kobayashi Masaki , Ito Mio , Iwasa Yasuyuki , Motohashi Yoshiko , Edahiro Ayako , Shirobe Maki , Hirano Hirohiko , Gineste Yves , Honda Miwako
Published: June 2021

Background

The prevalence of oral diseases in people with dementia has increased, and patients with dementia have worse oral health than people without dementia. However, in the provision of oral care, these patients often exhibit care-resistant behaviours. Empathy is important for health care professionals who provide dental care for people with dementia. A study was conducted to assess whether a multimodal comprehensive care methodology training programme, Humanitude™, was associated with an improvement in empathy for people with dementia among oral health care professionals.

Methods

This research was a pre-post prospective study. A total of 45 dentists and dental hygienists participated in a 7-h multimodal comprehensive care methodology training programme. Participants’ empathy for their patients was evaluated with the Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) before the training and 1 month after the training (primary outcome). Each participant listed 3 patients with poor oral health due to the refusal of usual oral care or dental treatment from his or her clinical practice. The oral health of the 3 care-resistant patients listed by each participant was evaluated by the Oral Health Assessment Tool (OHAT) before the training and 1 month after the training (secondary outcome).

Results

The post-training response rate was 87% (21 dentists and 18 dental hygienists). From pre-training to post-training, the multimodal comprehensive care methodology training significantly increased the mean empathy score (from 113.97 to 122.95, P < 0.05, effect size = 0.9). Regardless of gender, profession and years of clinical experience, all post-training subgroup scores were higher than the pre-training subgroup scores. The tongue, natural teeth, and oral hygiene scores of patients with dementia who resisted usual oral care or dental treatment, as assessed by the OHAT, were significantly improved compared with those before the training.

Conclusions

The multimodal comprehensive care methodology training was associated with an improvement in oral health professionals’ empathy for patients with dementia. These findings suggest that randomized controlled trials with large sample sizes will be needed.

Trial registration

UMIN Clinical Trials Registry (UMIN-CTR), UMIN000041687. Registered 4 September 2020 – Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047586
A systematic review of natural language processing applied to radiology reports
Authors: Casey Arlene , Davidson Emma , Poon Michael , Dong Hang , Duma Daniel , Grivas Andreas , Grover Claire , Suárez-Paniagua Víctor , Tobin Richard , Whiteley William , Wu Honghan , Alex Beatrice
Published: June 2021

Background

Natural language processing (NLP) has a significant role in advancing healthcare and has been found to be key in extracting structured information from radiology reports. Understanding recent developments in NLP application to radiology is of significance but recent reviews on this are limited. This study systematically assesses and quantifies recent literature in NLP applied to radiology reports.

Methods

We conduct an automated literature search yielding 4836 results using automated filtering, metadata enriching steps and citation search combined with manual review. Our analysis is based on 21 variables including radiology characteristics, NLP methodology, performance, study, and clinical application characteristics.

Results

We present a comprehensive analysis of the 164 publications retrieved with publications in 2019 almost triple those in 2015. Each publication is categorised into one of 6 clinical application categories. Deep learning use increases in the period but conventional machine learning approaches are still prevalent. Deep learning remains challenged when data is scarce and there is little evidence of adoption into clinical practice. Despite 17% of studies reporting greater than 0.85 F1 scores, it is hard to comparatively evaluate these approaches given that most of them use different datasets. Only 14 studies made their data and 15 their code available with 10 externally validating results.

Conclusions

Automated understanding of clinical narratives of the radiology reports has the potential to enhance the healthcare process and we show that research in this field continues to grow. Reproducibility and explainability of models are important if the domain is to move applications into clinical use. More could be done to share code enabling validation of methods on different institutional data and to reduce heterogeneity in reporting of study properties allowing inter-study comparisons. Our results have significance for researchers in the field providing a systematic synthesis of existing work to build on, identify gaps, opportunities for collaboration and avoid duplication.
The amygdala modulates prepulse inhibition of the auditory startle reflex through excitatory inputs to the caudal pontine reticular nucleus
Authors: Cano Jose Carlos , Huang Wanyun , Fénelon Karine
Published: June 2021

Background

Sensorimotor gating is a fundamental pre-attentive process that is defined as the inhibition of a motor response by a sensory event. Sensorimotor gating, commonly measured using the prepulse inhibition (PPI) of the auditory startle reflex task, is impaired in patients suffering from various neurological and psychiatric disorders. PPI deficits are a hallmark of schizophrenia, and they are often associated with attention and other cognitive impairments. Although the reversal of PPI deficits in animal models is widely used in pre-clinical research for antipsychotic drug screening, the neurotransmitter systems and synaptic mechanisms underlying PPI are still not resolved, even under physiological conditions. Recent evidence ruled out the longstanding hypothesis that PPI is mediated by midbrain cholinergic inputs to the caudal pontine reticular nucleus (PnC). Instead, glutamatergic, glycinergic, and GABAergic inhibitory mechanisms are now suggested to be crucial for PPI, at the PnC level. Since amygdalar dysfunctions alter PPI and are common to pathologies displaying sensorimotor gating deficits, the present study was designed to test that direct projections to the PnC originating from the amygdala contribute to PPI.

Results

Using wild type and transgenic mice expressing eGFP under the control of the glycine transporter type 2 promoter (GlyT2-eGFP mice), we first employed tract-tracing, morphological reconstructions, and immunohistochemical analyses to demonstrate that the central nucleus of the amygdala (CeA) sends glutamatergic inputs lateroventrally to PnC neurons, including GlyT2+ cells. Then, we showed the contribution of the CeA-PnC excitatory synapses to PPI in vivo by demonstrating that optogenetic inhibition of this connection decreases PPI, and optogenetic activation induces partial PPI. Finally, in GlyT2-Cre mice, whole-cell recordings of GlyT2+ PnC neurons in vitro paired with optogenetic stimulation of CeA fibers, as well as photo-inhibition of GlyT2+ PnC neurons in vivo, allowed us to implicate GlyT2+ neurons in the PPI pathway.

Conclusions

Our results uncover a feedforward inhibitory mechanism within the brainstem startle circuit by which amygdalar glutamatergic inputs and GlyT2+ PnC neurons contribute to PPI. We are providing new insights to the clinically relevant theoretical construct of PPI, which is disrupted in various neuropsychiatric and neurological diseases.
Cost utility of fractional exhaled nitric oxide monitoring for the management of children asthma
Authors: Buendía Jefferson Antonio , Acuña-Cordero Ranniery , Rodriguez-Martinez Carlos E.
Published: June 2021

Introduction

Fractional exhaled nitric oxide is a simple, non-invasive measurement of airway inflammation with minimal discomfort to the patient and with results available within a few minutes. This study aimed to evaluate the cost-effectiveness of asthma management using fractional exhaled nitric oxide monitoring in patients between 4 and 18 years of age.

Methods

A Markov model was used to estimate the cost-utility of asthma management using fractional exhaled nitric oxide monitoring versus asthma management without using fractional exhaled nitric oxide monitoring (standard therapy) in patients between 4 and 18 years of age. Cost data were obtained from a retrospective study on asthma from a tertiary center, in Medellin, Colombia, while probabilities of the Markov model and utilities were obtained from the systematic review of published randomized clinical trials. The analysis was carried out from a societal perspective.

Results

The model showed that fractional exhaled nitric oxide monitoring was associated with a lower total cost than standard therapy (US $1333 vs. US $1452 average cost per patient) and higher QALYs (0.93 vs. 0.92 average per patient). The probability that fractional exhaled nitric oxide monitoring provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness-to-pay thresholds.

Conclusion

Asthma management using fractional exhaled nitric oxide monitoring was cost-effective for treating patients between 4 and 18 years of age with mild to moderate allergic asthma. Our study suggests evidence that could be used by decision-makers to improve clinical practice guidelines, but this should be replicated in different clinical settings.
Age influences susceptibility of brain capillary endothelial cells to La Crosse virus infection and cell death
Authors: Basu Rahul , Nair Vinod , Winkler Clayton W. , Woods Tyson A. , Fraser Iain D. C. , Peterson Karin E.
Published: June 2021

Background

A key factor in the development of viral encephalitis is a virus crossing the blood-brain barrier (BBB). We have previously shown that age-related susceptibility of mice to the La Crosse virus (LACV), the leading cause of pediatric arbovirus encephalitis in the USA, was associated with the ability of the virus to cross the BBB. LACV infection in weanling mice (aged around 3 weeks) results in vascular leakage in the olfactory bulb/tract (OB/OT) region of the brain, which is not observed in adult mice aged > 6–8 weeks. Thus, we studied age-specific differences in the response of brain capillary endothelial cells (BCECs) to LACV infection.

Methods

To examine mechanisms of LACV-induced BBB breakdown and infection of the CNS, we analyzed BCECs directly isolated from weanling and adult mice as well as established a model where these cells were infected in vitro and cultured for a short period to determine susceptibility to virus infection and cell death. Additionally, we utilized correlative light electron microscopy (CLEM) to examine whether changes in cell morphology and function were also observed in BCECs in vivo.

Results

BCECs from weanling, but not adult mice, had detectable infection after several days in culture when taken ex vivo from infected mice suggesting that these cells could be infected in vitro. Further analysis of BCECs from uninfected mice, infected in vitro, showed that weanling BCECs were more susceptible to virus infection than adult BCECs, with higher levels of infected cells, released virus as well as cytopathic effects (CPE) and cell death. Although direct LACV infection is not detected in the weanling BCECs, CLEM analysis of brain tissue from weanling mice indicated that LACV infection induced significant cerebrovascular damage which allowed virus-sized particles to enter the brain parenchyma.

Conclusions

These findings indicate that BCECs isolated from adult and weanling mice have differential viral load, infectivity, and susceptibility to LACV. These age-related differences in susceptibility may strongly influence LACV-induced BBB leakage and neurovascular damage allowing virus invasion of the CNS and the development of neurological disease.
Hidden Markov Model based stride segmentation on unsupervised free-living gait data in Parkinson’s disease patients
Authors: Roth Nils , Küderle Arne , Ullrich Martin , Gladow Till , Marxreiter Franz , Klucken Jochen , Eskofier Bjoern M. , Kluge Felix
Published: June 2021

Background

To objectively assess a patient’s gait, a robust identification of stride borders is one of the first steps in inertial sensor-based mobile gait analysis pipelines. While many different methods for stride segmentation have been presented in the literature, an out-of-lab evaluation of respective algorithms on free-living gait is still missing.

Method

To address this issue, we present a comprehensive free-living evaluation dataset, including 146.574 semi-automatic labeled strides of 28 Parkinson’s Disease patients. This dataset was used to evaluate the segmentation performance of a new Hidden Markov Model (HMM) based stride segmentation approach compared to an available dynamic time warping (DTW) based method.

Results

The proposed HMM achieved a mean F1-score of 92.1% and outperformed the DTW approach significantly. Further analysis revealed a dependency of segmentation performance to the number of strides within respective walking bouts. Shorter bouts ($$< 30$$

<
30

strides) resulted in worse performance, which could be related to more heterogeneous gait and an increased diversity of different stride types in short free-living walking bouts. In contrast, the HMM reached F1-scores of more than 96.2% for longer bouts ($$> 50$$

>
50

strides). Furthermore, we showed that an HMM, which was trained on at-lab data only, could be transferred to a free-living context with a negligible decrease in performance.

Conclusion

The generalizability of the proposed HMM is a promising feature, as fully labeled free-living training data might not be available for many applications. To the best of our knowledge, this is the first evaluation of stride segmentation performance on a large scale free-living dataset. Our proposed HMM-based approach was able to address the increased complexity of free-living gait data, and thus will help to enable a robust assessment of stride parameters in future free-living gait analysis applications.
Genome sequences of human cytomegalovirus strain TB40/E variants propagated in fibroblasts and epithelial cells
Authors: Al Qaffas Ahmed , Camiolo Salvatore , Vo Mai , Aguiar Alexis , Ourahmane Amine , Sorono Myrna , Davison Andrew J. , McVoy Michael A. , Hertel Laura
Published: June 2021

The advent of whole genome sequencing has revealed that common laboratory strains of human cytomegalovirus (HCMV) have major genetic deficiencies resulting from serial passage in fibroblasts. In particular, tropism for epithelial and endothelial cells is lost due to mutations disrupting genes UL128, UL130, or UL131A, which encode subunits of a virion-associated pentameric complex (PC) important for viral entry into these cells but not for entry into fibroblasts. The endothelial cell-adapted strain TB40/E has a relatively intact genome and has emerged as a laboratory strain that closely resembles wild-type virus. However, several heterogeneous TB40/E stocks and cloned variants exist that display a range of sequence and tropism properties. Here, we report the use of PacBio sequencing to elucidate the genetic changes that occurred, both at the consensus level and within subpopulations, upon passaging a TB40/E stock on ARPE-19 epithelial cells. The long-read data also facilitated examination of the linkage between mutations. Consistent with inefficient ARPE-19 cell entry, at least 83% of viral genomes present before adaptation contained changes impacting PC subunits. In contrast, and consistent with the importance of the PC for entry into endothelial and epithelial cells, genomes after adaptation lacked these or additional mutations impacting PC subunits. The sequence data also revealed six single noncoding substitutions in the inverted repeat regions, single nonsynonymous substitutions in genes UL26, UL69, US28, and UL122, and a frameshift truncating gene UL141. Among the changes affecting protein-coding regions, only the one in UL122 was strongly selected. This change, resulting in a D390H substitution in the encoded protein IE2, has been previously implicated in rendering another viral protein, UL84, essential for viral replication in fibroblasts. This finding suggests that IE2, and perhaps its interactions with UL84, have important functions unique to HCMV replication in epithelial cells.
Treatment adherence in tyrosinemia type 1 patients
Authors: González-Lamuño Domingo , Sánchez-Pintos Paula , Andrade Fernando , Couce María L. , Aldámiz-Echevarría Luís
Published: June 2021

Background

While therapeutic advances have significantly improved the prognosis of patients with hereditary tyrosinemia type 1 (HT1), adherence to dietary and pharmacological treatments is essential for an optimal clinical outcome. Poor treatment adherence is well documented among patients with chronic diseases, but data from HT1 patients are scarce. This study evaluated pharmacological and dietary adherence in HT1 patients both directly, by quantifying blood levels nitisinone (NTBC) levels and metabolic biomarkers of HT1 [tyrosine (Tyr), phenylalanine (Phe), and succinylacetone]; and indirectly, by analyzing NTBC prescriptions from hospital pharmacies and via clinical interviews including the Haynes–Sackett (or self-compliance) test and the adapted Battle test of patient knowledge of the disease.

Results

This observational study analyzed data collected over 4 years from 69 HT1 patients (7 adults and 62 children; age range, 7 months–35 years) who were treated with NTBC and a low-Tyr, low-Phe diet. Adherence to both pharmacological and, in particular, dietary treatment was poor. Annual data showed that NTBC levels were lower than recommended in more than one third of patients, and that initial Tyr levels were high (> 400 µM) in 54.2–64.4% of patients and exceeded 750 µM in 25.8% of them. Remarkably, annual normalization of NTBC levels was observed in 29.4–57.9% of patients for whom serial NTBC determinations were performed. Poor adherence to dietary treatment was more refractory to positive reinforcement: 36.2% of patients in the group who underwent multiple analyses per year maintained high Tyr levels during the entire study period, and, when considering each of the years individually this percentage ranged from 75 to 100% of them. Indirect methods revealed percentages of non-adherent patients of 7.3 and 15.9% (adapted Battle and Haynes tests, respectively).

Conclusions

Despite initially poor adherence to pharmacological and especially dietary treatment among HT1 patients, positive reinforcement at medical consultations resulted in a marked improvement in NTBC levels, indicating the importance of systematic positive reinforcement at medical visits.
Prophylactic ankle supports effects on time to stabilization, perceived stability and ground reaction force during lateral landing in female collegiate athletes with chronic ankle instability
Authors: Yalfani Ali , Raeisi Zahra
Published: June 2021

Background

This study was designed to investigate effects of Kinesiotape (KT) with closed basket weave method and lace-up braces (LB) on the vertical time to stabilization, peak vertical ground reaction force (PvGRF), and time to PvGRF as well as perceived stability during lateral landing of participants with chronic ankle instability before and after fatigue.

Methods

Thirty female college athletes with chronic ankle instability of three conditions (control, KT, and LB) performed lateral landing from a 30 cm high step on the plantar pressure platform pre and post fatigue.

Results

The pre-test findings on the rearfoot, of LB indicated negatively increased the PvGRF force (F2,58=3.63, P = 0.04) and decreased the time to PvGRF (F2,58=4.67, P = 0.01). The Bonferroni post-hoc testing revealed LB condition increased the PvGRF than the control (P = 0.002) and KT (P = 0.038). Also, the post-hoc testing showed LB condition decreased the time to PvGRF force than the control (P = 0.05) and KT (P = 0.01). The LB negatively prolonged vertical time to stabilization in the forefoot (F2,58=6.74, P = 0.002) and rearfoot (F2,58=6.13, P = 0.004) after fatigue. The post-hoc testing revealed LB condition generated a slower vertical time to stabilization than the control and KT conditions (P ≤ 0.05). The use of KT had no positive effects as elevated the PvGRF in the forefoot post fatigue (F2,58=7.11, P = 0.002). The post-hoc test uncovered that KT augmented the PvGRF than control (P = 0.01) and LB (P < 0.001). On the other hand, using KT had psychological effects at pre-fatigue which resulting significantly greater in perceived stability compared to other conditions (F2,58=9.65, P < 0.001). The post-hoc test showed that using KT increased perceived stability than LB (P = 0.004) and control (P < 0.001). Moreover, perceived stability improved significantly in KT and LB compared to the control condition at the post-fatigue (P ≤ 0.001).

Conclusions

Despite the positive psychological impact of the prophylactic ankle supports, there were no positive effect on the vertical time to stabilization, PvGRF, and time to PvGRF. Further studies are needed to distinguish the psychological and actual effects of prophylactic ankle supports on athletes with chronic ankle instability.
How are emotional distress and reassurance expressed in medical consultations for people with long-term conditions who were unable to receive curative treatment? A pilot observational study with huntington’s disease and prostate cancer
Authors: Anderson Niall C. , Zhou Yuefang , Humphris Gerry
Published: June 2021

Objective

It is unclear whether how people with long-term conditions express distress, and how clinicians respond, influences perceptions of consultation outcomes. The pilot study examined emotional distress and reassurance in consultations with people whose long-term conditions (at the time of consultations) were treated using active surveillance or symptom management (as no curative treatment was suitable).

Methods

An observational pilot study was conducted involving consultations between people with long-term conditions and their respective clinician. Consultations between three clinicians (two Huntington’s Disease; one Prostate Cancer) and 22 people with long-term conditions (11 Huntington’s Disease; 11 Prostate Cancer) were audio-recorded. Participants also completed an expanded Consultation and Relational Empathy (CARE) Measure. Two researchers coded sessions using Verona Coding Definitions of Emotional Sequences (VR-CoDES/VR-CoDES-P). Code frequencies were calculated, t tests performed between conditions, and Pearson’s correlations performed for associations between CARE responses and clinician utterances.

Results

People with long-term conditions expressed emotional distress on average 4.45 times per session, averaging 1.09 Concern and 3.36 Cue utterances. Clinicians responded with more explicit (2.59) and space-providing (3.36), than non-explicit (1.86) and space-reducing (1.09), responses per session. Clinicians expressed spontaneous reassurance on average 5.18 times per session, averaging 3.77 Cognitive and 1.5 Affective reassurance utterances. Huntington’s Disease consultations featured significantly more 'Cues', 'Concerns' and 'Overall' 'Emotional Distress', and 'Cognitive' and 'Overall' ‘Reassurance'.

Conclusion

Emotional distress was expressed more using hints than explicit concern utterances. Clinicians predominantly explicitly explored distress rather than providing information/advice and provided advice using spontaneous cognitive reassurance. People with Huntington’s Disease expressed more concerns and received more reassurance, indicating different needs between conditions. Future research is required to explore emotional distress and reassurance in a larger sample of participants and long-term condition types, and how the practical implications of these findings may be used to enhance outcomes of consultations.

Trial registration

N/A.
Mindfulness-based stress reduction adapted to pregnant women with psychosocial vulnerabilities—a protocol for a randomized feasibility study in a Danish hospital-based outpatient setting
Authors: Skovbjerg S. , Birk D. , Bruggisser S. , Wolf A. L. A. , Fjorback L.
Published: June 2021

Background

This protocol is for a feasibility study of a mindfulness-based stress reduction (MBSR) program adapted for pregnant women with psychosocial vulnerabilities. The rationale for the study is the need for a wider array of evidence-based options to address prenatal mental health care needs in pregnant women. MBSR is a promising mental health intervention but has not yet been adapted for pregnant women with the aim of addressing prenatal mental health. The purpose is thus to evaluate the feasibility, acceptability, and clinical outcomes of an adapted MBSR program, prenatal MBSR, compared to usual care to inform a randomized controlled trial.

Methods/design

Pregnant women (n = 60) referred to an outpatient clinic at Copenhagen University Hospital, Amager and Hvidovre, Denmark, will be recruited for the study. The design is a single-center feasibility trial, with prenatal MBSR, as an add-on to usual care. The primary outcome is to assess the feasibility of a full-scale randomized controlled trial. The secondary feasibility outcome includes possible effects of the adapted MBSR program estimated by self-report questionnaires measuring stress, anxiety, depression, well-being, decentering, reflective functioning, mindfulness, and compassion. Participants will be randomized in a 1:1 ratio to prenatal MBSR or usual care.

Discussion

The study is part of the Good Start to Family Life study anchored at Copenhagen University Hospital, Amager and Hvidovre, Denmark. Teaching the skills of mindfulness meditation to a psychosocially vulnerable group of pregnant women could prove a viable and non-pharmacological approach to reduce stress, improve mental health, and provide support in the transition to parenthood. The outcomes of the feasibility study will inform the design of a fully powered randomized controlled trial.

Trial registration

ClinicalTrials.gov, NCT04571190. Registered on September 30, 2020
How to objectively assess and observe maladaptive pain behaviors in clinical rehabilitation: a systematic search and review
Authors: Naye Florian , Cachinho Chloé , Tremblay Annie-Pier , Saint-Germain Lavoie Maude , Lepage Gabriel , Larochelle Emma , Labrecque Lorijane , Tousignant-Laflamme Yannick
Published: June 2021

Background

Cognitive-affective factors influence the perception of pain and disability. These factors can lead to pain behaviors (PB) that can persist and become maladaptive. These maladaptive PB will further increase the risk of chronicity or persistence of symptoms and disability. Thus, clinicians must be prepared to recognize maladaptive PB in a clinical context. To date, in the context of assessment in a rehabilitation setting, PB in clinical settings are poorly documented. The main objective of this study was to identify direct observation methods and critically appraise them in order to propose recommendations for practice. As a secondary objective, we explored and extracted the different observable PB that patients could exhibit and that clinicians could observe.

Methods

We conducted a comprehensive review on four databases with a generic search strategy in order to obtain the largest range of PB. For the first objective, a two-step critical appraisal used clinical criteria (from qualitative studies on barriers to implement routine measures) and psychometric criteria (from Brink and Louw critical appraisal tool) to determine which observation methods could be recommended for clinical practice. For the second objective, we extracted PB found in the literature to list potential PB that patients could exhibit, and clinicians could observe.

Results

From the 3362 retrieved studies, 47 met the inclusion criteria for the first objective. The clinical criteria allowed us to select three observation methods. After the psychometric step, two observation methods were retained and recommended for clinical practice: the Behavioral Avoidance Test-Back Pain (BAT-Back) and the Pain Behaviour Scale (PaBS). For the second objective, 107 studies met the inclusion criteria. The extraction of the PB allowed us to list a large range of PB and classify the data in 7 categories of PB.

Conclusion

Our results allowed us to recommend two observation methods for clinical practice. However, these methods have limitations and are validated only in chronic low back pain populations. With the extraction of PB presented in the literature, we contribute to better prepare clinicians to recognize PB in all patients who are experiencing pain.
Cannabis use frequency, route of administration, and co-use with alcohol among older adults in Washington state
Authors: Subbaraman Meenakshi S. , Kerr William C.
Published: June 2021

Background

The US national surveys and data from legal adult use cannabis states show increases in the prevalence of cannabis use among older adults, though little is known about their manner of cannabis consumption. Here, we examine cannabis use frequency, routes of cannabis administration, and co-use with alcohol, focusing on adults aged 50–64 and ≥65.

Methods

Data come from a general population survey conducted January 2014–October 2016 (N=5492) in Washington state. We first estimate prevalence and trends in cannabis frequency, routes of administration, and co-use with alcohol in gender by age groups (18–29, 30–49, 50–64, ≥ 65). To test associations between cannabis frequency, route of administration, and co-use with alcohol, we then use sample-weighted multinomial regression adjusted for gender, race/ethnicity, marital status, education, employment, and survey year. Sampling weights are used so results better represent the Washington state population. Regressions focus on the 50–64 and ≥65 age groups.

Results

Among men and women 50–64, the prevalence of no cannabis use in the past 12 months decreased significantly (84.2% in 2014 to 75.1% in 2016 for women, 76.8% in 2014 to 62.4% in 2016 for men). Among those who report past-year cannabis use, oral administration and vaping and other routes of administration increased by 70% and 94%, respectively each year. Almost one-third of women aged 50–64 and one-fifth of women aged ≥65 who use cannabis reported daily/near daily use, and more than one-third of men who use cannabis in all age groups reported daily/near daily use, including 41.9% of those ≥65. Among men, the prevalence of edibles, drinks, and other oral forms of cannabis administration went up significantly with age (6.6% among 18–29, 21.5% among ≥65). Vaping and other administration are more strongly related to regular and daily/near daily use than infrequent use among those ≥65. The pattern of associations between cannabis frequency and co-use with alcohol differed for women vs. men.

Conclusions

In a general population representative sample of adults living in a state with legal adult use cannabis, the prevalence of cannabis use increased among those aged 50–64 between 2014 and 2016, the prevalence of daily use is substantial, and oral administration and vaping are increasing.
Patient-related outcomes of patellofemoral arthroplasty: experience of a single center
Authors: Abeysekera W. Y. M. , Schenk W.
Published: June 2021

Purpose

The purpose of this prospective study was to present the experience of a single center on patellofemoral arthroplasty, in terms of patient-related outcomes.

Method

From January 2005 to January 2016, 42 patients with isolated patellofemoral osteoarthritis were treated. The patients were assessed using the Oxford Knee Score preoperatively, and one, five, and eight year(s) after surgery. The data of the patients were analyzed using linear mixed effects models. APvalue of 0.05 was considered statistically significant.

Results

Among 42 patients who underwent patellofemoral arthroplasty, only 25 patients (31 limbs involved) had records up to 5 years. There was a significant clinical improvement of Oxford Knee Score postoperatively (P < 0.05), lowering the score on average by 10.4 ± 1.5 one year after surgery and 8.9 ± 1.9 five years after surgery. This improvement was independent of the types of implants (P > 0.05), gender (P > 0.05), age (P < 0.05), and body mass index (BMI) (P < 0.05).

Conclusion

Patellofemoral arthroplasty can significantly improve the knee function, and this improvement is independent of the type of implant, gender, age, and BMI. However, further studies will need to assess the long-term outcomes of PFA.
Transdisciplinary training: what does it take to address today’s “wicked problems”?
Authors: Yeung Euson , Carlin Leslie , Sandassie Samantha , Jaglal Susan
Published: June 2021

There is a growing need to address today’s “wicked problems” seen in issues such as social justice, global climate crisis and endemic health concerns. Wicked problems are those for which there is no single, clear or optimal solution and thus are amenable to transdisciplinary solutions. Working in a transdisciplinary paradigm is thus seen as an increasingly necessary learned skill, and yet there is a dearth of knowledge on how curriculum centred around transdisciplinarity is perceived by those impacted by such curricula. This study examines the attitudes and responses of Aging Gracefully across Environments using Technology to Support Wellness, Engagement and Long Life NCE Inc.’s (AGE-WELL) stakeholders to the concept and role of transdisciplinarity in a training program intended to equip trainees and research staff from a variety of fields to address the “wicked problem” of aging well in Canada. We conducted 15 in-depth interviews with current AGE-WELL members, trainees as well as researchers and mentors, on the subject of designing the best possible training program. Our data illustrate the complexity of curriculum design and implementation to train for transdisciplinarity. We consider ways in which a shift in culture or ethos in academia may be required to pursue a thoroughly transdisciplinary approach to problem-solving. Short of instituting such a radical culture change as transdisciplinarity, however, strategic and conscientious efforts to integrate multiple and diverse perspectives, to attend carefully to communication and to foreground relationship building may well achieve some of the same goals.
Mental health in the republic of Paraguay
Authors: Aboaja Anne , Wahab Alina , Cao Yang Yang , O'Higgins Marcelo , Torales Julio
Published: June 2021

Paraguay is a landlocked country in South America. It is a democratic low-middle-income nation, and the Ministry of Public Health and Social Welfare is responsible for its healthcare system. Mental health services receive just 1–2% of healthcare budgets, and there are only 1.6 psychiatrists per 100 000 inhabitants. There are insufficient resources to adequately assess and treat mental disorders in high-risk populations such as children, adolescents and prisoners. Despite several improvements to mental health policies within the past two decades, the nation still lacks a Mental Health Act and specific policies required to optimise the mental health of the population.
Explainable prediction of survival using clinical, molecular, and radiomic profiles in recurrent high-grade glioma patients treated with CAR T-cell therapy.
Authors: Wong Chi Wah , Filippov Aleksandr , Bonjoc Kimberley-Jane C. , Brown Christine , Badie Behnam , Chaudhry Ammar
Published: June 2021

104

Background: High-grade glioma (HGG) is an aggressive heterogeneous primary CNS neoplasm with high recurrence rate and poor survival. Multiple ongoing clinical trials are leveraging targeted molecular and immunologic therapeutics (e.g., pembrolizumab, Chimeric Antigen Receptor [CAR] T-cell therapy) in effort to improve survival. Explainable predictive models have shown value in identifying biomarkers predictive of treatment response as well as informing prognosis. In this study, we developed an explainable machine learning model leveraging clinical, molecular and radiomic (imaging) features to predict overall survival in patients suffering from HGG treated with CAR T-cell therapy. Methods: In this IRB-approved phase 1 clinical trial, 60 patients (39 males, median age = 49) suffering from HGG underwent surgical resection and CAR T-cell therapy1. All patients underwent baseline MRI scans prior to both surgical resection and CAR T-cell administration in the resection cavity. Using contrast-enhanced T1-weighted MRIs, we segmented the enhancing tumor (ET) and generated radiomic features. For predictive modeling, we incorporated the following features: Age, gender, race, ethnicity, histology, tumor grade (WHO), IL-13 receptor alpha 2 (IL-13Rα2) expression (H score), unifocal or multifocal lesions, tumor location (lobe), shape-based radiomics (tumor volume, surface area, and sphericity). We utilized gradient-boosted tree models to classify whether survival is above or below 180 days with two-loop nested cross-validation. For the inner validation loop, we optimized the model with hyper-parameter tuning. For the outer validation loop, we tested the optimal model on the hold-out data and the predictions were used as survival scores (0 – 1). Larger scores imply better predicted survival. For prediction explanations, we adopted the Shapley additive explanation (SHAP) framework. Results: The outer validation loop Area Under the Receiver Operating Characteristic Curve and Area under the Precision-Recall Curve were 0.76 and 0.81, respectively. Among the top five most important features calculated from SHAP; patients with larger tumor surface area, tumor volume and age have reduced survival scores while patients with larger IL-13Rα2 and tumor sphericity have increased survival scores. We stratified the patients into two distinct prognostic sub-groups (30 patients each group) using the survival scores obtained from the outer loop, with a log-rank test p < 0.01. Conclusions: In patients with HGG treated with CAR T-cell therapy, we found that tumor surface area/volume and age are inversely related to survival while increased IL-13Rα2 expression and tumor sphericity were positive predictor of survival. Our model can potentially be used to optimize clinical trial enrollment through more precise patient screening and treatment planning.
Finding the missing millions: Integrating automated viral hepatitis screening in a hospital with care and treatment in a primary care setting.
Authors: Brogden Ruth , Wang Su , Xu Binghong
Published: June 2021

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Background: Rates of hepatocellular carcinoma (HCC) are rising in the US. Patients at Saint Barnabas Medical Cancer Center (SBMC) present with late-stage HCC at higher rates (29%) compared to the national (16%). Chronic Hepatitis C (HCV) and Hepatitis B (HBV) are major drivers of liver cancer, yet screening rates are low. Finding these missing millions is important to reducing rates of HCC. An automated emergency department (ED) viral hepatitis (VH) screening program was initiated in 2018 at SBMC. In January 2020, it was expanded to the inpatient setting and HCV screening was modified from cohort screening (those born in 1945-65) to a one time test for anybody 18 years or over, per updated Centers for Disease Control (CDC) and USPSTF (US Preventive Services Taskforce) recommendations. Methods: The electronic medical record (EMR) was modified to automate screening. HBV testing is triggered by a patient’s country of birth or race, and HCV testing is triggered by age over 18 and no previous testing. The automated HCV (HCV Ab with reflex to HCV RNA) or HBV (HBsAg) lab orders lead to an EMR notification to the nurses of patient eligibility and education is provided to patients. Alerts of positive results are sent to nursing staff, physicians, and the patient navigator (PN). The PN is sent a real-time secure text message and works individually with patients to arrange linkage-to-care (LTC) for evaluation and treatment. Results: From March 2018 - December 2020, 44,002 patients were screened for HCV and 884 (2.0%) were HCVAb+ and 242 (0.55%) HCV RNA+. For HBV, 21,328 patients were screened and 212 (0.99%) were HBsAg+. The expanded screenings accounted for 8,716 (19.8%) of the total HCV screenings. Individuals born outside the 1945-65 birth cohort (younger and older) made up 76.2% of those screened and 41% of the infected. The top 3 countries for HBV screenings were Haiti, Jamaica, and Ecuador. LTC rates, defined as attending first medical appointment or already in care, were 86.8% for HCV and 85.4% for HBV. Of those linked to care, 43 HCV+ patients were seen at a outpatient primary care practice part of SBMC, and of those, 39 initiated HCV cure therapy and 33 were cured (confirmed sustained virologic response at 12 weeks), and 35 HBV+ patients were seen and 6 initiated treatment. Conclusions: This automated program for VH has led to a significant scale up of screening with successful LTC and treatment of patients. Expansion to universal screening of all adults and to the inpatient setting found additional viral hepatitis patients who would have otherwise been missed. In addition to the automated screening, a multidisciplinary team including internists, pharmacists, and patient navigators were part of creating a primary care based program. Integration of viral hepatitis screening and care in a hospital system can be initial steps towards establishing liver cancer prevention program.
A Novel, Likely Pathogenic MAX Germline Variant in a Patient With Unilateral Pheochromocytoma
Authors: Lam-Chung César Ernesto , Rodríguez Larissa López , Vázquez Jazmín Arteaga , Chávarri-Guerra Yanin , Arízaga-Ramírez Rebeca , Antonio Orlando Falcon , De Anda González Jazmín , López-Hernández María Aurelia , Weitzel Jeffrey N , Castillo Danielle , Gómez-Pérez Francisco Javier , Cuevas-Ramos Daniel
Published: June 2021

Context

Inherited MYC-associated factor X (MAX) gene pathogenic variants (PVs) increase risk for pheochromocytomas (PCCs) and/or paragangliomas (PGLs) in adults and children. There is little clinical experience with such mutations.

Objective

This report highlights an important approach.

Methods

Clinical assessment, including blood chemistry, imaging studies, and genetic testing were performed.

Results

A 38-year-old Hispanic woman was diagnosed with PCC in 2015, treated with adrenalectomy, and referred to endocrinology clinic. Notably, she presented to her primary care physician 3 years earlier complaining of left flank pain, intermittent diaphoresis, and holocranial severe headache. We confirmed severe hypertension (180/100 mm Hg) over multiple antihypertensive regimens. Biochemical and radiological studies workup revealed high plasma metanephrine of 255 pg/mL (normal range, < 65 pg/mL) and plasma normetanephrine of 240 pg/mL (normal range, < 196 pg/mL). A noncontrast computed tomography scan of the abdomen revealed a 4.2 × 4.3 × 4.9-cm, round-shaped and heterogenous contrast enhancement of the left adrenal gland, and a 2-mm nonobstructive left kidney stone. A presumptive diagnosis of secondary hypertension was made. After pharmacological therapy, laparoscopic left adrenalectomy was performed and confirmed the diagnosis of pheochromocytoma. Based on her age, family history, and a high suspicion for genetic etiology, genetic testing was performed that revealed the presence of a novel likely pathogenic variant involving a splice consensus sequence in the MAX gene, designated c0.64-2A > G.

Conclusion

The phenotype of MAX PV-related disease and paraganglioma are highlighted. The novel c0.64-2A > G mutation is reported here and should be considered in the diagnostic workup of similar cases.
Foreign Influence and Domestic Policy
Authors: Aidt Toke S. , Albornoz Facundo , Hauk Esther
Published: June 2021

In an interconnected world, economic and political interests inevitably reach beyond national borders. Since policy choices generate external economic and political costs, foreign state and non-state actors have an interest in influencing policy actions in other sovereign countries to their advantage. Foreign influence is a strategic choice aimed at internalizing these externalities and takes three principal forms: (i) voluntary agreements, (ii) policy interventions based on rewarding or sanctioning the target country to obtain a specific change in policy, and (iii) institution interventions aimed at influencing the political institutions in the target country. We propose a unifying theoretical framework to study when foreign influence is chosen and in which form, and use it to organize and evaluate the new political economics literature on foreign influence along with work in cognate disciplines (JEL D72, D74, F51, F53, P26, P33).
Improving the touchscreen-based food approach-avoidance task: remediated block-order effects and initial findings regarding validity
Authors: van Alebeek Hannah , Kahveci Sercan , Blechert Jens
Published: June 2021

Approach biases to foods may explain why food consumption often diverges from deliberate dietary intentions. Yet, the assessment of behavioural biases with the approach-avoidance tasks (AAT) is often unreliable and validity is partially unclear. The present study continues a series of studies that develop a task based on naturalistic approach and avoidance movements on a touchscreen (hand-AAT). In the hand-AAT, participants are instructed to respond based on the food/non-food distinction, thereby ensuring attention to the stimuli. Yet, this implies the use of instruction switches (i.e., ‘approach food – avoid objects’ to ‘avoid food – approach objects’), which introduce order effects. The present study increased the number of instruction switches to potentially minimize order effects, and re-examined reliability. We additionally included the implicit association task (IAT) and several self-reported eating behaviours to investigate the task’s validity. Results replicated the presence of reliable approach biases to foods irrespective of instruction order. Evidence for validity, however, was mixed: biases correlated positively with external eating, increase in food craving and aggregated image valence ratings but not with desire to eat ratings of the individual images considered within participants or the IAT. We conclude that the hand-AAT can reliably assess approach biases to foods that are relevant to self-reported eating patterns.