bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiences of U.S. Nurses Compared With Nonnurses in the First Year of COVID-19
Authors: Chen-Lim Mei Lin , McCabe Margaret A. , Xu Haolin , Thomas Laine E. , Forrest Christopher B. , Birnbaum Shira , Webb Laura E. , O’Brien Emily C.
Published: July 2022

Background

Nursing professional organizations and media sources indicated early in the pandemic that the physical and psychological effects of COVID-19 might be distinct and possibly greater in nurses than in other types of healthcare workers (HCWs).

Objectives

Based on survey data collected in Healthcare Worker Exposure Response and Outcomes (HERO), a national registry of U.S. HCWs, this study compared the self-reported experiences of nurses with other HCWs during the first 13 months of the pandemic.

Methods

Nurse responses were compared to responses of nonnurse HCWs in terms of viral exposure, testing and infection, access to personal protective equipment (PPE), burnout, and well-being. Logistic regression models were used to examine associations between nurse and nonnurse roles for the binary end points of viral testing and test positivity for COVID-19. We also examined differences by race/ethnicity and high-risk versus low-risk practice settings.

Results

Of 24,343 HCWs in the registry, one third self-identified as nurses. Nurses were more likely than other HCWs to report exposure to SARS-CoV-2, problems accessing PPE, and decreased personal well-being, including burnout, feeling tired, stress, trouble sleeping, and worry. In adjusted models, nurses were more likely than nonnurse HCWs to report viral testing and test positivity for COVID-19 infection. Nurses in high-risk settings were more likely to report viral exposure and symptoms related to well-being; nurses in low-risk settings were more likely to report viral testing and test positivity. Black or Hispanic nurses were most likely to report test positivity.

Discussion

Differences were identified between nurses and nonnurse HCWs in access to PPE, physical and mental well-being measures, and likelihood of reporting exposure and infection. Among nurses, testing and infection differed based on race and ethnicity, and type of work setting. Our findings suggest further research and policy are needed to elucidate and address social and occupational disparities.
MUM1/IRF4 is Highly Expressed in Dermatopathic Lymphadenopathy
Authors: Garces Sofia , Rudzki Zbigniew , Yin C. Cameron , Miranda Roberto N. , Medina Ana M. , Sriganeshan Vathany , Cuglievan Branko , Li Shaoying , Xu Jie , Jelloul Fatima , Khoury Joseph D. , Thakral Beenu , Tang Guilin , Garces Juan C. , Medeiros L. Jeffrey
Published: July 2022

Dermatopathic lymphadenopathy (DL) is a distinctive type of lymph node hyperplasia that typically occurs in the setting of chronic dermatologic diseases. DL generally self-resolves following disappearance of the underlying skin stimulus and does not require any specific therapy. We recently observed multiple myeloma oncogene 1/interferon regulatory factor 4 (MUM1/IRF4) expression in a case of DL using immunohistochemical methods. The goal of this study was to systematically assess DL cases for MUM1/IRF4 expression and to survey other histiocytic and Langerhans cell lesions. We particularly focused on Langerhans cell histiocytosis (LCH) because the differential diagnosis of DL versus LCH in lymph nodes can be challenging. We identified high expression of MUM1/IRF4 in all 22 cases of DL tested. Specifically, MUM1/IRF4+ dendritic cells comprised 50% to 90% (median, 80%) of all dendritic cells in the paracortex of dermatopathic lymph nodes, always showing moderate or strong intensity. Among 10 DL cases stained for MUM1/IRF4 and langerin/CD207 using dual immunohistochemistry, MUM1/IRF4+ and langerin+ Langerhans cells represented 5% to 60% (median, 30%) of paracortical dendritic cells. MUM1/IRF4 was also positive in reactive Langerhans cells in skin biopsy specimens of all cases of spongiotic dermatitis (n=10) and normal skin (n=15), and was negative in all cases of LCH (n=24), Rosai-Dorfman disease (n=10), follicular dendritic cell sarcoma (n=5) and histiocytic sarcoma (n=4). In aggregate, our findings support the utility of MUM1/IRF4 to highlight the dendritic cells of DL and to distinguish DL from other histiocytic and Langerhans cells lesions.
Reliability of Using a Smartphone Application to Objectify Skull Deformation
Authors: Meijer Sofie , Suir Imke , Maissan Francois , Nuysink Jacqueline
Published: July 2022

Purpose:

To establish intrarater and interrater reliability of photographs made in a newly developed smartphone app to determine the severity of infantile skull deformation by taking a cranial photograph of an infant's head.

Methods:

Using the app, 1 pediatric physical therapist and 2 pediatric physical therapy master students photographed heads of 30 infants aged up to 12 months receiving treatment for asymmetric or delayed motor development. Modified Cranial Vault Asymmetry Index and Cranial Index determined the severity of skull deformation.

Results:

Intrarater reliability was excellent both for mCVAI and CI, with an ICC(3,1) = 0.97, and ICC(3,1) = 0.98, respectively. Interrater reliability with an ICC(2,1) = 0.97 for the mCVAI, and ICC(2,1) = 0.99 for the CI was excellent too.

Conclusion:

The reliability of the Skully Care App proved to be excellent when used by pediatric physical therapists.

Supplemental Digital Content 1. Video Abstract available at: http://links.lww.com/PPT/A399.
Advancing Leadership Training to Address Health Equity and Respond to Public Health Emergencies
Authors: Levis Maria , Ugarte Raisa , Arana Mayela , Ocasio Carolina , Viera Tariz , Ortiz Sofía , Murrman Marita
Published: July 2022

Context:

In 2015, Impactivo developed the Advancing Leadership in Times of Crisis (ALTC) program for the Region 2 Public Health Training Center under a subaward from the Health Resources and Services Administration. Puerto Rico's (PR) government had defaulted on its debt, and public health officials needed tools to face the fiscal crisis. The ALTC has since been adapted for PR's public health emergencies, including the Zika epidemic, category 5 hurricanes, earthquakes, and the Covid-19 pandemic.

Program:

The program incorporates Ron Heifetz's work on Adaptive Leadership and Marshall Ganz's work on community organizing to address the Centers for Disease Control and Prevention's Essential Public Health Services (EPHS) and health equity. The ALTC is a contextualized and modularized training program that has been provided in different modalities in person and online.

Implementation:

The Spanish language program has been carried out with 4 cohorts (totaling 82 graduates). Participants were 80% women and 100% Hispanic, empowering underrepresented groups to achieve change.

Evaluation:

In the immediate postprogram survey, more than 90% strongly agree that their understanding of the subject matter improved, that they were able to identify actions that apply to their work, and that they were confident in their ability to apply it. Follow-up surveys after the COVID-19 pandemic found that 89% of respondents continue to work in public health, 25% were promoted, and 49% felt confident to train others. Participants also reported that ALTC helped them increase their public health tools (91%), expand their network (84%), and strengthen knowledge about the EPHS (90%).

Discussion:

Evidence supports that ALTC is a promising training program to increase leadership skills and EPHS competencies that can be adapted to address contextual health equity and public health emergencies. Future research should explore the expansion of ALTC to other contexts and its impact on population health and health equity.
Public Health Workforce Development During and Beyond the COVID-19 Pandemic: Findings From a Qualitative Training Needs Assessment
Authors: Zemmel Danielle J. , Kulik Phoebe K. G. , Leider Jonathon P. , Power Laura E.
Published: July 2022

Context:

The Region V Public Health Training Center (RVPHTC) serves the public health workforce in Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. An important tool in priority-setting workforce development is the training needs assessment (TNA), which is vital to identifying and addressing the capacity-building needs of the public health workforce.

Program:

In 2021, we conducted semistructured qualitative interviews with key partners in the local, state, and tribal health workforce.

Implementation:

Findings reflect the results of 23 interviews administered from March to May 2021. Questions solicited in-depth input related to key training gaps identified in our 2020 quantitative TNA; the impact of COVID-19 on the public health workforce; general needs, including preferred training modalities; needs by audience type; and the current capacity for public health agencies to support student development.

Evaluation:

Key training needs of the public health workforce identified by the 2021 TNA include the strategic skills domains of (1) resource management; (2) change management; (3) justice, equity, diversity, and inclusion; and (4) effective communication. The first 3 domains were also noted as having the greatest training need in our 2020 quantitative TNA of local health department leadership.

Discussion:

The COVID-19 pandemic highlighted the need for training in effective communication in new ways and the continued need for training support in the skill domains prioritized in the 2020 assessment. Findings demonstrate the need for capacity building around crosscutting skills and the intersection of strategic skill domains if the field is to be prepared for future threats to public health.
The New to Public Health Residency Program Supports Transition to Public Health Practice
Authors: Manske Julianna , Hayes Hannah , Zahner Susan
Published: July 2022

Training and retaining a competent public health workforce are challenging. Residency programs for new and transitioning professionals are effective in other fields but rare in governmental public health. The New to Public Health Residency Program is a residency program for professionals entering public health practice. On the basis of the Foundational Public Health Services model, the program was designed using adult learning principles and best practices from nurse residency programs. Content created by public health experts is delivered over 12 months through online course sessions that include interactive learning activities. Additional program components include monthly synchronous online discussions and support from a mentor. Residents apply their learning through implementation of an evidence-based practice project at their workplace. The program is accredited for continuing professional development contact hours. Agencies with limited resources to support new public health employees may find the New to Public Health Residency Program a vital training resource.
Correlations between community-level HIV preexposure prophylaxis coverage and individual-level sexual behaviors among United States MSM
Authors: Mann Laura M. , Le Guillou Adrien , Goodreau Steven M. , Marcus Julia L. , Sanchez Travis , Weiss Kevin M. , Jenness Samuel M.
Published: July 2022

Objective:

To evaluate if community-level HIV PrEP coverage is correlated with individual sexual behaviors.

Design:

We used demographic, behavioral, and sexual network data from ARTnet, a 2017–2019 study of United States MSM.

Methods:

Multivariable regression models with a Bayesian modeling framework were used to estimate associations between area-level PrEP coverage and seven sexual behavior outcomes [number of total, main, and casual male partners (network degree); count of one-time partnerships; consistent condom use in one-time partnerships; and frequency of casual partnership anal sex (total and condomless)], controlling for individual PrEP use.

Results:

PrEP coverage ranged from 10.3% (Philadelphia) to 38.9% (San Francisco). Total degree was highest in Miami (1.35) and lowest in Denver (0.78), while the count of one-time partners was highest in San Francisco (11.7/year) and lowest in Detroit (1.5/year). Adjusting for individual PrEP use and demographics, community PrEP coverage correlated with total degree [adjusted incidence rate ratio (aIRR) = 1.73; 95% credible interval (CrI), 0.92–3.44], casual degree (aIRR = 2.05; 95% CrI, 0.90–5.07), and count of one-time partnerships (aIRR = 1.90; 95% CrI, 0.46–8.54). Without adjustment for individual PrEP use, these associations strengthened. There were weaker or no associations with consistent condom use in one-time partnerships (aIRR = 1.68; 95% CrI, 0.86–3.35), main degree (aIRR = 1.21; 95% CrI, 0.48–3.20), and frequency of casual partnership condomless anal sex (aIRR = 0.23; 95% CrI, 0.01–3.60).

Conclusion:

Most correlations between community PrEP coverage and sexual behavior were explained by individual PrEP use. However, some residual associations remained after controlling for individual PrEP use, suggesting that PrEP coverage may partially drive community-level differences in sexual behaviors.
Bone Metastasis of Glomus Caroticum Demonstrated on 68Ga-DOTATATE PET/CT
Authors: Kesim Selin , Sen Feyza , Filizoglu Nuh , Ozguven Salih , Erdil Tanju Yusuf
Published: July 2022

A 71-year-old man who was diagnosed with carotid body paraganglioma was referred to 68Ga-DOTATATE PET/CT for primary evaluation, which revealed unknown bony metastasis with intense 68Ga-DOTATATE uptake. Head and neck paragangliomas are rare neuroendocrine tumors, with a 10% of malignancy rate, and identification of metastatic sites is important in staging and prognosis of the disease. We aimed to highlight the impact of 68Ga-DOTATATE PET/CT on patient management, especially for equivocal lesions, as in our case.
Nephroptosis Incidentally Found on 99mTc-DTPA Renal Dynamic Scan
Authors: Wang Keshan , Fan Meiyin , Shao Fuqiang , Hu Fan , Xia Xiaotian
Published: July 2022

Nephroptosis is a significant descent (more than 5 cm or 2 vertebral bodies) of the kidney from supine to the upright position. The incidence of nephroptosis is probably more prevalent than reported, as few patients present with typical symptoms. A 55-year-old woman with intermittent abdominal pain was referred for a 99mTc-DTPA renal dynamic scan. She had a ureteric calculi history. The result showed that the right kidney was significantly lower than the position in the CT scan a week ago. It had been diagnosed as nephroptosis according to these “moving” images. She was considering elective surgery for intervention.
The Onset of Sarcoidosis After COVID-19 Vaccination Revealed by the 18F-FDG PET
Authors: Song Xiangming , Shao Fuqiang , Lan Xiaoli
Published: July 2022

Sarcoidosis is a heterogeneous multisystem disease characterized by noncaseating granulomas. We presented 18F-FDG PET/CT findings of sarcoidosis in a previously healthy 43-year-old man who presented intermittent cough after the third dose of COVID-19 vaccination. 18F-FDG PET/CT showed high uptake of one solitary nodule in the right middle lobe, mediastinal lymph nodes, bilateral hila, and multiple nodules under the right pleura, mimicking the malignancy. Nevertheless, the biopsy confirmed distinct noncaseating granulomas. This case emphasizes the onset of sarcoidosis revealed by 18F-FDG PET/CT after COVID-19 vaccination.
Collaborative Control Method and Experimental Research on Robot-Assisted Craniomaxillofacial Osteotomy Based on the Force Feedback and Optical Navigation
Authors: Wu Jinyang , Hui Wenyu , Niu Jindong , Chen Shihang , Lin Yanping , Luan Nan , Shen Steve Guofang , Zhang Shilei
Published: July 2022

Objective:

Surgical robot has advantages in high accuracy and stability. But during the robot-assisted bone surgery, the lack of force information from surgical area and incapability of intervention from surgeons become the obstacle. The aim of the study is to introduce a collaborative control method based on the force feedback and optical navigation, which may optimally combine the excellent performance of surgical robot with clinical experiences of surgeons.

Materials and Methods:

The CMF ROBOT system was integrated with the force feedback system to ensure the collaborative control. Force-velocity control algorithm based on force feedback was designed for this control method. In the preliminary experimental test, under the collaborative control mode based on force feedback and optical navigation, the craniomaxillofacial surgical robot entered the osteotomy line area according to the preoperative surgical plan, namely, right maxillary Le Fort I osteotomy, left maxillary Le Fort I osteotomy, and genioplasty.

Results:

The force sensor was able to collect and record the resistance data of the cutting process of the robot-assisted craniomaxillofacial osteotomy assisted in real time. The statistical results showed that the repeatability of collaborative control mode was acceptable in bilateral maxillary Le Fort I osteotomies (right, P=0.124>0.05 and left, P=0.183>0.05) and unfavorable in genioplasty (P=0.048<0.05).

Conclusion:

The feasibility of robot-assisted craniomaxillofacial osteotomy under the collaborative control method based on the force feedback and optical navigation was proved in some extent. The outcome of this research may improve the flexibility and safety of surgical robot to meet the demand of craniomaxillofacial osteotomy.
The Lateral Orbital Thickening and the Lateral Brow Thickening: A New Choice for the Lower Eyelid Suspension
Authors: Huang Cheng , Huang Xing , Jin Rui , Sun Di , Lu Lin , Wang Xi , Yang Jun , Gu Chuan , Luo Xusong
Published: July 2022

This study aimed to evaluate the effectiveness and safety of a double-suspension technique using the lateral orbital thickening (LOT) and the lateral brow thickening (LBT) in patients with lower eyelid defects. A total of 5 cadavers (4 males and 1 female) ranging in age from 50 to 78 years was subjected to observe the distribution of the orbicularis retaining ligament (ORL) and its characteristics. The ORL is a closed-loop structure that forms the LBT outside the supraorbital rim and forms the LOT in the lateral canthal region. A total of 17 patients (12 females and 5 males) with an average age of 12.3 years who underwent the ORL-assisted lower eyelid reconstruction were included in this retrospective study. After the ORL was completely released on the infraorbital rim for reducing down traction, the subocularis oculi fat and the orbicularis oculi were fixed to the LBT and the LOT for increasing the upward traction. The lower eyelid defects in 17 patients were reduced in different degrees. The defects were closed directly in 3 patients and were resurfaced by skin graft or flap in the other 14 patients. Physicians and patients were all satisfied with the final cosmetic results. Thus, the ORL is a rigid and restrictive internal connected structure, and the ORL-assisted technique decreases the defect size and reconstructs vertical force balance. The LOT and the LBT are strong and safe enough as new fixation choices for lower eyelid suspension.
Trends in Pediatric Head and Facial Trauma During the COVID-19 Pandemic
Authors: Dagi Alexander F. , Parry Gareth J. , Labow Brian I. , Taghinia Amir H.
Published: July 2022

Introduction:

The effect of physical-distancing policies and school closures on pediatric health has been a topic of major concern in the United States during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to assess the immediate impact of these public policies on patterns of head and facial trauma in the pediatric population.

Materials and Method:

The Pediatric Health Information System (PHIS) was queried to identify patient encounters at 46 children’s hospitals across the United States in 2016–2020. Encounters were included if resultant in ICD-10 diagnosis for head or facial trauma in a child under 18 between April 1 and June 30 in 2020 (first COVID-19 school closures) and during the same period in the previous 4 years (for comparison).

Results:

A total of 170,832 patient encounters for pediatric head and facial trauma were recorded during the study period, including 28,030 (16.4%) in 2020 and 142,802 (83.6%) in 2016–2019. Patient encounters declined significantly in 2020 among children of all age groups relative to previous years. Relative reductions were greatest in children aged 11 to 17 (middle/high school) and 6 to 10 (elementary school), at −34.6% (95% confidence interval: −23.6%, −44%; P<0.001) and −27.7% (95% confidence interval: −18.4%, −36%; P<0.001). Variation in relative reductions by race/ethnicity, sex, and rural/urban status were not statistically significant.

Conclusions:

Physical-distancing policies and school closures at the start of the COVID-19 pandemic correlated with significant reductions in pediatric head and facial trauma patient encounters. As in-person activities resume, reductions in head and facial trauma during the pandemic may indicate a range of possible preventable injuries in the future.
Three-Dimensional Measurement of the Temporomandibular Joint in Pruzansky-Kaban Type IIa Hemifacial Microsomia
Authors: Shu Kai-Yi , Liu Wei , Zhao Jiu-Li , Zhang Zhi-Yong , Xu Xi , Shan Ba-Ga , Tang Xiao-Jun
Published: July 2022

Objective:

This observational retrospective cross-sectional study aimed to investigate the morphological characteristics of the temporomandibular joint (TMJ) in type IIa hemifacial microsomia (HFM).

Methods:

We recruited 88 patients with unilateral type IIa HFM. Data relating to the length, distance, and angle of the TMJ, were measured on 3-dimensional models created by the analysis of computed tomography data. Normality analysis was performed by using the Shapiro-Wilk test. Data were compared with the paired t test and Wilcoxon signed-rank test.

Results:

The height, long axis, and short axis of the affected condyle were significantly shorter than the unaffected side (P<0.001); the ratios were 0.41±0.15, 0.75±0.20, and 0.95±0.24, respectively. The spaces between the condyle and the glenoid fossa were significantly larger in affected TMJs (P<0.001). The ratio between the ipsilateral and contralateral anterior space in the sagittal plane was 4.62±2.59; this was significantly different than the ratio of inner space (1.50±1.70), superior space (1.70±0.97), and lateral space (1.28±0.62) in the coronal plane (P<0.001) and the ratio of superior space (1.43±1.05) and posterior space (1.47±0.98) in the sagittal plane (P<0.001); there were no statistical differences between the 5 spaces (P>0.05). The breadth and depth of the glenoid fossa were significantly shorter in affected TMJs (P<0.001), the ratio of the breadth in the affected and unaffected glenoid fossa was between 0.5 and 1 and the depth of the affected glenoid fossa was almost half of that on the unaffected side. The ratio between the ipsilateral and contralateral height of the condyle was significantly different when compared with the length of the mandibular ramus (P<0.001). The ratio between the ipsilateral height of the condyle and the length of the mandibular ramus was significantly different when compared with that of the contralateral side (P<0.001). The height of the affected condyle were significantly different (P=0.005) among different ages.

Conclusions:

We found that hypoplasia was more severe in terms of the height of the condyle than the long axis and short axis of the condyle. The degree of condyle deformity was more severe than the mandible. And the affected condyle still had growth potential in the vertical direction with age.
Prenatal Ultrasound Parameters of Twins With Sagittal Suture Craniosynostosis Question Mechanical Constraint as the Leading Cause
Authors: Cinca Kevin P. , de Planque Catherine A. , Peters Nina C.J. , Versnel Sarah L. , Mathijssen Irene M.J.
Published: July 2022

Background:

Multiple pregnancy is a known predisposing factor for sagittal suture synostosis, and intrauterine constraint has been suggested as a potential cause. This study evaluates prenatal images of single and multiple pregnancies of children with sagittal suture synostosis to assess the possible pathogenesis.

Materials and Methods:

Prenatal ultrasound data of scaphocephaly twins treated at Erasmus MC was retrieved retrospectively. The head circumference, cephalic index (CI), and biparietal diameter (BPD) were analyzed. Data were compared with the nonaffected sibling, singletons with scaphocephaly, and to general fetal growth reference values.

Results:

Data of 8 twin pregnancies with 10 cases of scaphocephaly was gathered. For the head circumference no difference was found between affected fetuses and reference values throughout pregnancy. For the BPD a reduced growth was found, compared with control values. The growth curve for the CI of the affected twins is lower from the start and declines over time. When comparing affected fetuses to nonaffected fetuses, the same differences for the BPD and CI were found as compared with controls. No differences in growth parameters were found between the nonaffected siblings and reference values, nor between the affected scaphocephaly twins and singletons with scaphocephaly.

Conclusions:

Scaphocephaly in twin pregnancy develops early on in pregnancy, similar to singleton pregnancy, making the theory of constraint as a cause less likely. The development of scaphocephaly in twins is likely to be attributed to the same disturbed developmental processes in suture development as in singletons, and not to mechanical constraint.
The Effect of Orthognathic Surgery on the Hourglass Appearance of the Neck
Authors: Gulsever Serap , Suzen Muazzez , Uckan Sina
Published: July 2022

In frontal view, the transition from the upper aspect of the neck to the inferior border of the mandible has a subtle hourglass appearance. The aim of this study was to evaluate the effect of the orthognathic surgery on the hourglass appearance of the neck in patients with Class II dentofacial deformity. Twenty-six patients with Class II dentofacial deformity who underwent bilateral sagittal split osteotomy alone or in combination with Le Fort I osteotomy and/or genioplasty were included in this study. The width of the most upper part, the width of the narrowest part, the length of the upper part, the height of the upper part, the depth, and the angle of the hourglass were measured on frontal facial photographs obtained preoperatively and at sixth months postoperatively. The decrease in the width of the narrowest part (P=0.012) and the right (P<0.001) and left (P<0.001) angles of the hourglass were statistically significant. Also, increase in the right (P=0.036) and the left (P=0.004) depths of the hourglass were statistically significant. Orthognathic surgery procedures performed to correct Class II dentofacial deformity positively affects the hourglass appearance of the neck, therefore neck esthetics should also be considered in the preoperative evaluation of facial esthetics.
Alternative Randomized Trial Designs in Surgery
Authors: Augustinus Simone , van Goor Iris W.J.M. , Berkhof Johannes , Daamen Lois A. , Groot Koerkamp Bas , Mackay Tara M. , Molenaar I.Q , van Santvoort Hjalmar C. , Verkooijen Helena M. , van de Ven Peter M. , Besselink Marc G.
Published: July 2022

Introduction:

Randomized controlled trials (RCTs) yield the highest level of evidence but are notoriously difficult to perform in surgery. Surgical RCTs may be hampered by slow accrual, the surgical learning curve, and lack of financial support. Alternative RCT designs such as stepped-wedge randomized controlled trials (SW-RCTs), registry-based randomized controlled trials (RB-RCTs), and trials-within-cohorts (TwiCs) may overcome several of these difficulties. This review provides an overview of alternative RCT designs used in surgical research.

Methods:

We systematically searched PubMed, EMBASE, and Cochrane Central for surgical SW-RCTs, RB-RCTs, and TwiCs. A surgical RCT was defined as a randomized trial that studied interventions in patients undergoing general surgery, regardless of the affiliation of the corresponding author. Exponential regression analysis was performed to assess time trends.

Results:

Overall, 41 surgical RCTs using alternative designs were identified, including 17 published final RCT reports and 24 published protocols of ongoing RCTs. These included 25 SW-RCTs (61%), 13 RB-RCTs (32%), and 3 TwiCs (7%). Most of these RCTs were performed in Europe (63%) and within gastrointestinal/oncological surgery (41%). The total number of RCTs using alternative designs exponentially increased over the last 7 years (P<0.01), with 95% (n=39/41) of the total number published within this time frame. The most reported reasons for using alternative RCT designs were avoidance of contamination for SW-RCTs and generalizability of the trial population for RB-RCTs and TwiCs.

Conclusions:

Alternative RCT designs are increasingly used in surgical research, mostly in Europe and within gastrointestinal/oncological surgery. When adequately used, these alternative designs may overcome several difficulties associated with surgical RCTs.
Examining the Role of Aging Perceptions in Subjective Cognitive Decline
Authors: Chapman Silvia , Weiss David , Broulíková Hana M. , Sunderaraman Preeti , Barker Megan S. , Joyce Jillian L. , Azar Martina , McKeague Ian , Kriesl William C. , Cosentino Stephanie
Published: July 2022

Objective:

While subjective cognitive decline (SCD) is gaining ground as a “preclinical” risk state for Alzheimer disease, its utility depends on our understanding of the factors linked to SCD. Rarely examined sociocultural factors including perceptions of aging may relate to the subjective experience of cognitive aging. Identifying such associations will help to refine the utility of SCD as an early marker of AD while setting the stage for addressing modifiable factors contributing to SCD.

Methods:

The study consisted of N=136 participants (68% female; 73% White; 22% Black race, agemean=74.72; educationmean=16.01). Questionnaires assessed SCD, depressive symptoms, and age perceptions (essentialist aging beliefs, subjective age, age group identification, and explicit/implicit age stereotypes). Cognitive functioning was measured with a semantic interference and learning task.

Results:

SCD was correlated with essentialist aging beliefs, age identification, and depressive symptoms [r

range
=0.18 to 0.22, P
range=0.009 to 0.02, confidence interval (CI)range=0.00-0.39]. Essentialist aging beliefs were correlated with subjective age and age group identification (r
range=0.22 to 0.42, P

range
<0.001 to 0.003, CIrange=0.08-0.57). Both age group identification and essentialism were correlated with depressive symptoms (r
range=0.22, P
range=0.009 to 0.01, CIrange=0.04-0.39). In the adjusted regression model including depressive symptoms, age perceptions, and SCD, only SCD was associated with cognition (b=−0.31, P<0.001).

Conclusion:

Although correlated with SCD, perceptions of aging do not explain the relationship between SCD and performance on a sensitive cognitive test among older adults.
Association of Being Accompanied at Medical Consultation and Having Memory Complaints With Cognitive Impairment in Elderly Brazilian Outpatients
Authors: Cerveira Maria Otilia , Silva-da-Silva Edla , Borelli Wyllians Vendramini , Castilhos Raphael Machado , Chaves Márcia L.F.
Published: July 2022

Background:

The usefulness of both the presence of a companion at the medical consultation and patient’s cognitive complaints as selection strategies for performing a dementia evaluation is still unclear.

Objectives:

To estimate the association of elderly patients being accompanied during medical visits and patient’s memory complaint with objective cognitive impairment.

Methods:

We included elderly outpatients awaiting medical consultations in 3 non-neurological medical specialties. Demographic and Mini-Mental State Examination were collected. Patients’ memory complaints were evaluated with a single question to both patients and companions.

Results:

Five hundred ninety-three elderly patients were included in the study with 64.6% female and median (interquartile range) age 73 (68-78), 4 (2-6) years of education. Of these, 242 patients were accompanied and 62.6% presented memory complaints. The median (interquartile range) Mini-Mental State Examination scores were significantly lower in patients accompanied and in those with memory complaints. In a logistic regression model, age, education, memory complaint, and presence of companion were associated with cognitive impairment. In the model including only accompanied patients, only age and companion memory complaints were associated with objective cognitive impairment.

Conclusions:

The presence of a companion during a clinical consultation and patients’ memory complaints are both synergistically associated with objective cognitive impairment.
How 2- and 4-year-old children coordinate social interactions with peers
Authors: Rossano Federico , Terwilliger Jack , Bangerter Adrian , Genty Emilie , Heesen Raphaela , Zuberbühler Klaus
Published: July 2022

The Interaction Engine Hypothesis postulates that humans have a unique ability and motivation for social interaction. A crucial juncture in the ontogeny of the interaction engine could be around 2–4 years of age, but observational studies of children in natural contexts are limited. These data appear critical also for comparison with non-human primates. Here, we report on focal observations on 31 children aged 2- and 4-years old in four preschools (10 h per child). Children interact with a wide range of partners, many infrequently, but with one or two close friends. Four-year olds engage in cooperative social interactions more often than 2-year olds and fight less than 2-year olds. Conversations and playing with objects are the most frequent social interaction types in both age groups. Children engage in social interactions with peers frequently (on average 13 distinct social interactions per hour) and briefly (28 s on average) and shorter than those of great apes in comparable studies. Their social interactions feature entry and exit phases about two-thirds of the time, less frequently than great apes. The results support the Interaction Engine Hypothesis, as young children manifest a remarkable motivation and ability for fast-paced interactions with multiple partners.

This article is part of the theme issue ‘Revisiting the human ‘interaction engine’: comparative approaches to social action coordination’.
GTDB-Tk v2: memory friendly classification with the Genome Taxonomy Database
Authors: Chaumeil Pierre-Alain , Mussig Aaron J. , Hugenholtz Philip , Parks Donovan H.
Published: July 2022

The Genome Taxonomy Database (GTDB) and associated taxonomic classification toolkit (GTDB-Tk) have been widely adopted by the microbiology community. However, the growing size of the GTDB bacterial reference tree has resulted in GTDB-Tk requiring substantial amounts of memory (~320 GB) which limits its adoption and ease of use. Here we present an update to GTDB-Tk that uses a divide-and-conquer approach where user genomes are initially placed into a bacterial reference tree with family-level representatives followed by placement into an appropriate class-level subtree comprising species representatives. This substantially reduces the memory requirements of GTDB-Tk while having minimal impact on classification.

Availability

GTDB-Tk is implemented in Python and licenced under the GNU General Public Licence v3.0. Source code and documentation are available at: https://github.com/ecogenomics/gtdbtk.

Contact

p.chaumeil@uq.edu.au or donovan.parks@gmail.com
Psychological Resilience in Adolescence as a function of Genetic Risk for Major Depressive Disorder and Alzheimer’s Disease
Authors: Petrican Raluca , Fornito Alex
Published: July 2022

Major Depressive Disorder (MDD) and Alzheimer’s Disease (AD) are two pathologies linked to prior stress exposure and altered neurodevelopmental trajectories. As a putative antecedent to AD, MDD could be key to understanding the neurobiological changes that precede the clinical onset of AD by decades. To test this hypothesis, we used longitudinal data from the Adolescent Brain and Cognitive Development study (Ntotal = 980, 470 females) and investigated overlapping connectomic, transcriptomic, and chemoarchitectural correlates of adjustment to stressors (i.e., resilience) among adolescents at genetic risk for AD and MDD, respectively. The potential for perinatal adversity to directly and/or indirectly, via accelerated biological ageing, foster resilience (i.e., “inoculation” effects) was also probed. We identified two distinguishable neurodevelopmental profiles predictive of resilience among MDD-vulnerable adolescents. One profile, expressed among the fastest developing youth, overlapped with areas of greater dopamine receptor density and reflected the maturational refinement of the inhibitory control architecture. The second profile distinguished resilient MDD-prone youth from psychologically vulnerable adolescents genetically predisposed towards AD. This profile, associated with elevated GABA, relative to glutamate, receptor density, captured the longitudinal refinement and increasing context specificity of incentive-related brain activations. Its transcriptomic signature implied that poorer resilience among AD-prone youth may be associated with greater expression of MDD-relevant genes. Our findings are compatible with the proposed role of MDD as a precursor to AD and underscore the pivotal contribution of incentive processing to this relationship. They further speak to the key neuromodulatory role of DA-gonadal hormone interactions in fostering resilience in adolescence.

Significance Statement

Environmental stressors can substantially alter brain maturation and incur lifelong costs. Using longitudinal data, we characterise two developmental profiles correlated with positive adjustment to environmental challenges (i.e., resilience) among adolescents at genetic risk for two stress-related conditions, Alzheimer’s Disease (AD) and Major Depressive Disorder (MDD), respectively. One dopamine-related profile typified the fastest developing MDD-prone adolescents and reflected the neural maturation of the inhibitory control architecture. The second profile, neurochemically linked to excitation/inhibition balance, indicated the developmental refinement of motivational pathways, distinguishing resilient MDD-prone from psychologically vulnerable AD-prone teens. Its transcriptomic signature supported the posited role of MDD as an antecedent to AD. Our results unveil candidate neurobiological mechanisms supporting lifespan resilience against both psychiatric and neurological conditions linked to stress exposure.
Active safety surveillance of COVID-19 mRNA vaccines in children aged 5-15 years in Australia
Authors: Wood Nicholas , Lopez Laura K , Glover Catherine , Leeb Alan , Cashman Patrick , Deng Lucy , Macartney Kristine
Published: July 2022

AusVaxSafety (Australia’s active safety surveillance system) used SMS/email delivered surveys to actively solicit the short-term (within first 3 days after vaccination) adverse event profile of mRNA COVID-19 vaccines in children (aged 5–15 years) by age, dose, brand and pre-existing comorbidity.

392,268 survey responses for children aged 5–15 who received a COVID-19 vaccine between July 2021–May 2022 (211,994 following BNT162b2 10mcg in children aged 5–11 years, 173,329 following BNT162b2 30mcg and 6,945 following mRNA-1273 100mcg in adolescents aged 12–15 years) were analysed.

Adverse event rates were higher following dose 2 and 3 compared to dose 1 after all vaccines and highest following dose 2 of mRNA-1273 in 12–15 years. Fever was low in the youngest children (5 years old, any dose; 1,090/26,181 (4%)). Medical review rates remained low (0.3% overall) and impact on daily activities was also low (7% overall). No self-reported cases of myocarditis or pericarditis were identified.

Ongoing active safety surveillance of lower dose mRNA vaccines in children under 5 years old is required to better understand safety as the vaccines roll out into this population age-group.
Operant Conditioning of Rectus Femoris H-Reflexes: A Proof-of-Concept with Implications for Post-Stroke Quadriceps Hyperreflexia
Authors: Kim Kyoungsoon , Akbas Tunc , Lee Robert , Manella Kathleen , Sulzer James
Published: July 2022

Hyperreflexia is common after neurological injury such as stroke, yet clinical interventions have had mixed success. Our previous research has shown that hyperreflexia of the rectus femoris (RF) during pre-swing is closely associated with reduced swing phase knee flexion in those with post-stroke Stiff-Knee gait (SKG). Thus, reduction of RF hyperreflexia may improve walking function in those with SKG after stroke. A non-pharmacological and non-surgical procedure for reducing hyperreflexia has emerged based on operant conditioning of spinal reflexes elicited using electrical stimulation of the peripheral nerve, known as an H-reflex. Operant H-reflex conditioning training of the soleus has improved clinical gait function in those with spinal cord injury. It is currently unknown whether operant conditioning can be applied to the RF or those after stroke. This feasibility study trained 7 participants (5 neurologically intact, 2 post-stroke) over a period of 3 months, up to 3 times per week, to down-condition the RF H-reflex using visual feedback. We found an overall decrease in average RF H-reflex amplitude among 7 participants (44% drop, p<0.001, paired t-test), of which the post-stroke individuals contributed (49% drop). We observed a generalized training effect across quadriceps muscles. Post-stroke individuals exhibited improvements in peak knee-flexion velocity, reflex excitability during walking, and clinical measures of spasticity. These aforementioned neuromuscular outcomes provide promising initial results that operant RF H-reflex conditioning is feasible both in healthy and post-stroke individuals. This procedure could provide a targeted alternative to spasticity management and avoid the drawbacks of drugs and surgery.
Novel genomic loci influence patterns of structural covariance in the human brain
Authors: Wen Junhao , Nasrallah Ilya M. , Abdulkadir Ahmed , Satterthwaite Theodore D. , Yang Zhijian , Erus Guray , Robert-Fitzgerald Timothy , Singh Ashish , Sotiras Aristeidis , Boquet-Pujadas Aleix , Mamourian Elizabeth , Doshi Jimit , Cui Yuhan , Srinivasan Dhivya , Skampardoni Ioanna , Chen Jiong , Hwang Gyujoon , Bergman Mark , Bao Jingxuan , Veturi Yogasudha , Zhou Zhen , Yang Shu , Dazzan Paola , Kahn Rene S. , Schnack Hugo G. , Zanetti Marcus V. , Meisenzahl Eva , Busatto Geraldo F. , Crespo-Facorro Benedicto , Pantelis Christos , Wood Stephen J. , Zhuo Chuanjun , Shinohara Russell T. , Gur Ruben C. , Gur Raquel E. , Koutsouleris Nikolaos , Wolf Daniel H. , Saykin Andrew J. , Ritchie Marylyn D. , Shen Li , Thompson Paul M. , Colliot Olivier , Wittfeld Katharina , Grabe Hans J. , Tosun Duygu , Bilgel Murat , An Yang , Marcus Daniel S. , LaMontagne Pamela , Heckbert Susan R. , Austin Thomas R. , Launer Lenore J. , Espeland Mark , Masters Colin L , Maruff Paul , Fripp Jurgen , Johnson Sterling C. , Morris John C. , Albert Marilyn S. , Bryan R. Nick , Resnick Susan M. , Fan Yong , Habes Mohamad , Wolk David , Shou Haochang , Davatzikos Christos ,   the iSTAGING,   the BLSA,   the BIOCARD,   the PHENOM,   the ADNI studies,   the AI4AD consortium
Published: July 2022

Normal and pathologic neurobiological processes influence brain morphology in coordinated ways that give rise to patterns of structural covariance (PSC) across brain regions and individuals during brain aging and diseases. The genetic underpinnings of these patterns remain largely unknown. We apply a stochastic multivariate factorization method to a diverse population of 50,699 individuals (12 studies, 130 sites) and derive data-driven, multi-scale PSCs of regional brain size. PSCs were significantly correlated with 915 genomic loci in the discovery set, 617 of which are novel, and 72% were independently replicated. Key pathways influencing PSCs involve reelin signaling, apoptosis, neurogenesis, and appendage development, while pathways of breast cancer indicate potential interplays between brain metastasis and PSCs associated with neurodegeneration and dementia. Using support vector machines, multi-scale PSCs effectively derive imaging signatures of several brain diseases. Our results elucidate new genetic and biological underpinnings that influence structural covariance patterns in the human brain.

Significance statement

The coordinated patterns of changes in the human brain throughout life, driven by brain development, aging, and diseases, remain largely unexplored regarding their underlying genetic determinants. This study delineates 2003 multi-scale patterns of structural covariance (PSCs) and identifies 617 novel genomic loci, with the mapped genes enriched in biological pathways implicated in reelin signaling, apoptosis, neurogenesis, and appendage development. Overall, the 2003 PSCs provide new genetic insights into understanding human brain morphological changes and demonstrate great potential in predicting various neurologic conditions.
Geographical disparities and differences in medical specialty prescribing of dronabinol in Medicare from 2014 to 2019
Authors: DeSalve Dayna S , McCall Kenneth L , Piper Brian J
Published: July 2022

Purpose

The purpose of our study was to investigate dronabinol prescribing in Medicare from 2014 to 2019 by provider specialty and state.

Methods

Data was collected and analyzed from the Centers for Medicare & Medicaid Services databases from 2014 to 2019. The mean number of prescriptions for each area of practice, each individual year, and for 2014 to 2019 overall for the 50 United States and District of Columbia was determined. The prescriptions were separated by state and the state totals were determined. Individual states with dronabinol prescriptions ≥1.96 standard deviations (SD) from the mean were identified as significant.

Results

The total number of dronabinol prescriptions decreased 9.1% from 2014 to 2019. Dronabinol prescriptions were more concentrated in the eastern United States in 2019 than compared to 2014 [Tennessee (107.2), Kentucky (94.2), and West Virginia (87.6) (>1.96 SD)]. The largest portion of dronabinol prescriptions originated from primary care (1,736) compared to specialty areas of practice (1,233). Internal medicine (789.5), family medicine (608.8), hematology-oncology (343.3), nurse practitioners (337.3), and infectious disease (271.0) had the highest average number of dronabinol prescriptions per year (p<0.05). The areas of practice with the highest ratio of percent dronabinol prescriptions to percent Medicare utilization were infectious disease (15.8), hematology-oncology (12.2), and medical oncology (12.1).

Conclusion

Dronabinol usage declined among Medicare patients and became more concentrated in the eastern United States. Most prescriptions originated from primary care, although after accounting for Medicare patient utilization, the highest ratios originated from infectious disease, hematology-oncology, and medical oncology.