bluuebunny/crossref_metadata_2025 huggingface dataset:
Apixaban Level and Its Influence on Immunosuppression and Graft Outcome in Kidney Transplant Recipients With Atrial Fibrillation
Authors: Green Hefziba , Rahamimov Ruth , Spectre Galia , Rozen-Zvi Benaya , Fuchs Shmuel , Avni Shiri , Nissan Ran
Published: December 2020

Background:

Currently, there is limited information on the level of apixaban in kidney transplant (KT) patients with atrial fibrillation and the influence of apixaban therapy on the level of immunosuppression and graft function.

Methods:

This was a cross-sectional prospective study of 19 KT patients treated with apixaban. The levels of apixaban were measured using a chromogenic assay calibrated for apixaban and compared with those predicted by the manufacturer. Mean immunosuppression trough levels before and after apixaban treatment initiation were calculated using 3 consecutive measurements. Apixaban levels were compared with a historical control group comprising of 20 nontransplant patients with atrial fibrillation who were treated with the standard 5-mg bid apixaban dosage.

Results:

All KT patients should have been treated with the standard 5-mg bid apixaban dosage according to the clinical parameters; however, 7 were inappropriately treated with a reduced dosage (2.5-mg bid). There was no significant difference in apixaban level between KT patients treated with the 5-mg bid dosage and nontransplant patients. No KT patient administered the standard dose had out-of-range levels. Peak GM level was significantly lower in KT patients administered an inappropriately reduced dose (P = 0.05). Two patients had below-range peak levels. Apixaban treatment initiation had minimal influence on the level of immunosuppression. Furthermore, it had no adverse impact on graft function.

Conclusions:

Similar to nontransplant patients, KT patients administered the standard 5-mg bid dosage had apixaban levels that were well within the recommended manufacturers' expected ranges. In addition, this dosage had minimal influence on immunosuppression and no effect on graft function.
Incidence and Outcomes of Suprachoroidal Hemorrhage Following Aurolab Aqueous Drainage Implant in Adult and Pediatric Glaucoma
Authors: Wijesinghe Hiruni K. , Puthuran George V. , Gedde Steven J. , Pradhan Chinmayee , Uduman Mohammed S. , Krishnadas Subbaiah R. , Kannan Naresh B. , Robin Alan L. , Palmberg Paul
Published: December 2020

Précis:

Postoperative suprachoroidal hemorrhage (PSCH) is an infrequent but devastating complication after nonvalved aqueous drainage implant surgery and demonstrated a bimodal distribution. The final outcomes of either conservative management or surgical drainage of the hemorrhage remained poor.

Purpose:

The aim was to report the incidence and outcomes of eyes developing PSCH after undergoing Aurolab aqueous drainage implant (AADI) surgery for adult and pediatric refractory glaucomas.

Materials and Methods:

In this retrospective series, case files of all patients who underwent AADI between May 2012 and December 2019 were retrieved from an electronic database. A PSCH was defined as the presence of hemorrhagic choroidal detachment, confirmed by ultrasound B scan, occurring in a closed system in the postoperative period.

Results:

Of the 986 eyes that underwent AADI during the study period, 7 (0.7%), developed PSCH (95% confidence interval=0.3-1.6%). There were no differences in the preoperative parameters between those with and without PSCH. Of these, 4 were seen in pediatric eyes (4/288, 1.4%) and 3 in adult eyes (3/698, 0.4%) (P<0.01). Four eyes (57%) had PSCH in the immediate postoperative period (ie, between 24 and 48 h of AADI surgery), while the remaining 3 had onset ranging from 6 to 7 weeks after surgery. Anatomic risk factors were present in all eyes including hypotony (n=4), myopia (n=3), microcornea (n=2), microphthalmos (n=1), postvitrectomy (n=1), and staphyloma (n=1). Visual acuity improved in only 1 (14%) eye while 3 (43%) eyes developed phthisis bulbi, all in the pediatric age group.

Conclusions:

PSCH is a rare complication following AADI and is seen in <1% eyes. The incidence is higher in the pediatric age group. Visual and anatomic outcomes are dismal following PSCH with globe salvage possible in only about half these eyes.
Clozapine Response in Schizophrenia and Hematological Changes
Authors: Blackman Graham , Lisshammar Jenny E.L. , Zafar Rayyan , Pollak Thomas A. , Pritchard Megan , Cullen Alexis E. , Rogers Jonathan , Carter Ben , Griffiths Kira , Nour Matthew , David Anthony S. , McGuire Philip , Stewart Robert , MacCabe James
Published: December 2020

Background

Clozapine is the only effective medication for treatment-resistant schizophrenia; however, its mechanism of action remains unclear. The present study explored whether its effectiveness is related to changes in hematological measures after clozapine initiation.

Methods

Patients with treatment-resistant schizophrenia commenced on clozapine between January 2007 and December 2014 by the United Kingdom’s largest mental health trust were identified from electronic patient records. Hematological data from these patients were obtained from a monitoring registry. White blood cell, neutrophil, and platelet count were assessed at baseline and during the early phase of clozapine treatment. Clozapine response at 3 months was defined as “much,” or “very much” improved on the seven-point Clinical Global Impression—Improvement (CGI-I) subscale.

Results

In the total sample (n = 188), clozapine initiation was associated with a significant transient increase (peaking in weeks 3 to 4) in white blood cell, neutrophil, and platelet count (P < 0.001). There were 112 (59.6%) patients that responded to treatment; however, none of the hematological factors assessed at baseline, nor changes in these factors, were directly associated with treatment response.

Implications

Clozapine treatment is associated with transient hematological changes during the first month of treatment; however, there was no evidence that these were related to the therapeutic response.
Covert Dyskinesia With Aripiprazole
Authors: Gomaa Hassaan , Mahgoub Yassir , Francis Andrew
Published: December 2020

Background

Tardive dyskinesia (TD) is an involuntary movement disorder most commonly involving the tongue, lips, and face and less commonly the trunk and limbs. Although TD is historically associated with conventional antipsychotics, it still occurs with newer agents. Covert dyskinesia (CD), a form of TD, occurs after the discontinuation of antipsychotics, and it differs from other withdrawal emergent dyskinesia by its persistence for more than 8 to 12 weeks after discontinuation of dopamine receptor-blocking agents. Although initially reported in the 1960s with conventional antipsychotics, multiple recent reports describe several cases in association with aripiprazole (APZ).

Methods

We used PubMed and the Google Scholar for CD reports during the past 20 years. We also report a recent case ofCD.

Results

We identified 11 case reports of CD. Six were related to APZ, 3 to risperidone, 1 to amisulpride, and 1 to haloperidol. Our patient was an 81-year-old woman with a history of major depressive disorder who was admitted for worsening depression. Before hospitalization, she had been on APZ 5 mg/d for 2 years, but it was discontinued 4 months prior, and then she developed repetitive involuntary movements in her tongue, lips, and jaw 2 months after APZ discontinuation. The Abnormal Involuntary Movement Scale score was 5. Reinstating APZ a few months later led to disappearance of movements.

Conclusions

Literature to date suggests that APZ is the atypical antipsychotic most commonly reported with CD. A possible risk might be APZ's unique mechanism of action and its association with akathisia. Following up patients with serial Abnormal Involuntary Movement Scale after antipsychotic discontinuation is recommended.
Evaluation of the Esophagogastric Junction on High Resolution Manometry
Authors: Rogers Benjamin D. , Gyawali C. Prakash
Published: December 2020

The esophagogastric junction (EGJ) is a complex barrier between the thoracic and abdominal luminal gut compartments, comprised primarily of the lower esophageal sphincter (LES) and crural diaphragm. Although closed at rest, the EGJ relaxes to allow antegrade bolus transit and retrograde venting of air. Abnormal relaxation is the hallmark of achalasia spectrum disorders, while increased frequency of transient lower esophageal sphincter relaxations and/or EGJ disruption are seen in gastroesophageal reflux disease. High resolution manometry (HRM) is the modern day gold standard for assessment of EGJ morphology and function, with better performance characteristics compared with endoscopy and barium esophagography. Conventional LES metrics defining EGJ function include resting LES pressure as well as postswallow residual pressures. Newer HRM-based metrics include EGJ contractile integral, which measures static barrier function at rest, and EGJ morphology, which characterizes the relationship between LES and crural diaphragm. Provocative maneuvers assess dynamic EGJ function during physiological or pharmacologic stress. The most useful of these maneuvers, the rapid drink challenge, assesses for latent obstruction, while multiple rapid swallows evaluate adequacy of deglutitive inhibition. Amyl nitrate and cholecystokinin administration can segregate motor from structural obstruction. Newer provocative tests (straight leg raise maneuver, abdominal compression) and novel diagnostic tools (functional lumen imaging probe) complement HRM evaluation of the EGJ. Although current HRM metrics and maneuvers show promise in identifying clinically relevant EGJ abnormalities, future investigations evaluating management outcomes will improve segregation of normal from abnormal EGJ morphology and function.
Quality Analysis of Online Patient Resources for Hepatocellular Carcinoma
Authors: Li Jim (Zhang Hao) , McLeod Jane , Ingledew Paris-Ann
Published: December 2020

Goal:

This study aims to evaluate the quality of online hepatocellular carcinoma (primary liver cancer) resources by using a validated tool to determine the strengths and limitations of hepatocellular carcinoma Web sites designed for patient education.

Background:

In recent years, online health information-seeking behavior has become more prevalent. Meanwhile, hepatocellular carcinoma incidence rates have also increased. However, there is currently limited literature assessing the quality of online hepatocellular carcinoma information.

Materials and Methods:

The term “hepatocellular carcinoma” was searched using the search engine Google and the meta-search engines Dogpile and Yippy. A validated rating tool was used to assign quality scores to 100 Web sites based on the domains of Web site affiliation, accountability, interactivity, structure and organization, readability, and content quality. Overall quality scores were tallied for all Web sites.

Results:

Noncommercial hepatocellular carcinoma Web sites received significantly higher overall quality scores compared with their commercial counterparts. Overall, 30% of the Web sites identified their author(s), 42% cited sources, and 33% were updated within the past 2 years. The majority of Web sites utilized at least 1 interactive feature and 4 structural tools. Average readability was at a grade 11.8 level using the Flesch-Kincaid grading system, which is significantly higher than the recommended grade 6 level. Definition and treatment were the most commonly covered topics, while prevention and prognosis were the least commonly covered.

Conclusions:

The quality of online hepatocellular carcinoma information is highly variable. Health care professionals should be aware of its limitations and be proactive in guiding patients to reliable resources.
Qualitative sonographic assessment of transmural ileal inflammation in Crohn’s disease: a comparison with MRI activity score
Authors: Livne Moran , Amitai Michal Mariene , Klang Eyal , Ben Horin Shomron , Ungar Bella , Levartovsky Asaf , Kopylov Uri , Carter Dan
Published: December 2020

Background

Intestinal ultrasound (IUS) is an accurate tool for monitoring Crohn’s disease. To date, there is no clinically used validated quantitative ultrasonographic score for assessing disease activity. For magnetic resonance enterography (MRE), the magnetic resonance index of activity (MaRIA) is most used. The goal of this study was to devise a new quantitative IUS score for assessing Crohn’s disease inflammation, by using a partial MaRIA score as a reference.

Methods

This was a retrospective cohort study. The study cohort included patients with Crohn’s disease followed between January 2016 and December 2018. Inclusion criteria were age >18 and <3 months between MRE and IUS. Linear/logistic regression was performed for the correlation of ultrasonographic parameters with MaRIA score. Ultrasonograpic features included: bowel wall thickness, disrupted bowel wall stratification, mesenteric fat proliferation, presence of lymph nodes, hypervascularity present on color Doppler flow, and the presence of complications (strictures, inflammatory mass, and fistula).

Results

Forty-two patients were included. A stepwise multiple regression model was constructed to predict MaRIA score using ultrasound features. Two variables were found to be independently significant: terminal ileum (TI) thickness (r = 0.68, P = 0.001) and mesenteric fat proliferation (r = 0.45, P = 0.019). A model was constructed as follows: MaRIA = 7 + 2.5 * TI US thickness (mm) + 7 * US fat proliferation (0 = no, 1 = yes). This model has an R
2 of 0.51 for explaining the variability in the results.

Conclusions

IUS measurements are significantly correlated with MaRIA score in the terminal ileum and a simple computational model can be constructed.
Deamidated Gliadin Antibodies: Do They Add to Tissue Transglutaminase-IgA Assay in Screening for Celiac Disease?
Authors: Abdulrahim Ashraf , Fagih Mosa , Troncone Riccardo , Bashir Muhammed Salman , Asery Ali , Alruwaithi Muhanad , Al-Jurayyan Abdullah N. , Al-Alallah Ibrahim , Al-Hussaini Abdulrahman
Published: December 2020

Objectives:

Use of deamidated gliadin peptide (DGP) test kits as adjunctive to tissue-transglutaminase-IgA (TTG-IgA) for the diagnosis of celiac disease (CD) has been a controversial issue. The objectives of our study were to evaluate the diagnostic performance of DGP antibodies compared with TTG-IgA and to evaluate the correlation between DGP-antibody titers and degree of enteropathy.

Methods:

We included children who underwent endoscopy and biopsies because of positivity of any of the serology tests in the “celiac profile” (TTG-IgA, DGP-IgA, and DGP-IgG) from 2012 to 2019. We divided children into clinically suspected cases of CD (group 1) and asymptomatic cases screened as they were from a high-risk group (group 2).

Results:

Group 1 constituted 52 children and group 2 included 81 children (76 type-1 diabetes [T1D]). The sensitivity and positive-predictive value (PPV) of DGP-IgG in group 1 (90%, 98%) and group 2 (91%, 85.5%) were comparable with TTG-IgA (98%, 92% in group 1; 100%, 80% in group 2). By adding DGP-IgG to TTG-IgA, the performance of TTG-IgA has improved marginally in group 1 (sensitivity 100%, PPV 92.3%). All cases with DGP-IgG titer 2 times ULN in group 1, and >4 times ULN in group 2 had villous atrophy. All T1D patients with TTG IgA >10 times ULN had villous atrophy.

Conclusions:

DGP-IgG assay did not add to the performance of TTG-IgA. DGP-IgG titer correlated with enteropathy. The diagnosis of CD can be made in asymptomatic T1D child with TTG-IgA titer >10 times ULN and positive endomyseal antibodies.
Epithelioid Inflammatory Myofibroblastic Sarcoma Presenting as Gastrointestinal Bleed: Case Report and Literature Review
Authors: Giannaki Alexandra , Doganis Dimitrios , Giamarelou Panagiota , Konidari Anastasia
Published: December 2020

Myofibroblastic tumor is a mesenchymal neoplasm composed of myofibroblastic spindle cells with inflammatory infiltrate and considered to be of low-malignant potential tumor. Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a variant of myofibroblastic tumor with malignant characteristics; it mainly consists of round-to-epithelioid cells with positive nuclear membrane/perinuclear immunostaining for anaplastic lymphoma kinase (ALK) receptor tyrosine kinase. A gastric EIMS case in a 7-year-old boy is discussed. Our patient presented with severe anemia and melena. Magnetic resonance imaging of the abdomen and pelvis revealed a solid tumor (2.7 × 1.9 × 2.6 cm) at the posterior stomach wall. Upper gastrointestinal endoscopy revealed an irregular, protruding, highly vascular, approximately 2 cm mass close to the gastrooesophageal junction. Endoscopic biopsies were taken for histology; tumor cells were epithelioid with eccentric nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. Immunohistochemistry showed positive staining for desmin, smooth muscle actin, epithelial membrane antigen, cluster of differentiation CD30, and strongly positive staining for ALK. Fluorescence in situ hybridization analysis confirmed the presence of ALK rearrangements. A full-thickness surgical excision of the tumor with clear margins was performed. No adjunct treatment was administered and our patient has remained in full remission at 12 months following the surgery. To the best of our knowledge, this is the first pediatric case of gastric EIMS. Raised awareness and prompt recognition of special histological and immunochemical characteristics of EIMS can lead to accurate diagnosis and targeted therapy.
Interindividual and Intraindividual Variations of Breast Sensitivity Before and After Breast Reduction
Authors: Silhol Thomas , Chaouat Marc , Noel Warren , Mimoun Maurice , Boccara David
Published: December 2020

Background

More than 300,0000 breast plastic surgery procedures are performed annually worldwide, of which more than 100,000 are reduction mammoplasties carried out in the United States. Although most patients tend to be satisfied with the immediate outcomes of this procedure, there is increasing concern among surgeons as well as patients with regard to breast sensibility and the postoperative recovery.

The objectives of this study were to assess the variation in the sensibility in patients undergoing hypertrophic breast surgery by quantification of the impact of various variables and to evaluate its progression from before the surgery to between 3 and 6 months and 1 year postoperatively.

Methods

We carried out a nonrandomized, monocentric, prospective study. All of the patients were examined by the same evaluator using a set of 20 von Frey monofilaments on the day before the surgery and at 3 to 6 months and 1 year postoperatively. The breast skin, areola, and nipple sensibilities were tested. Age, body mass index, tobacco use, and the breast volume were recorded.

Results

We did not find any significant effect of the body mass index, tobacco use, or age on breast sensibility. The nipple and areola complex (NAC) sensibility was inversely correlated with the degree of hypertrophy before the surgery, but this difference disappeared in the postoperative evaluations. After the surgery, the NAC sensibility decreased at the first follow-up at 4.5 months and returned to normal after 1 year.

Conclusions

The inverse relationship between breast volume and sensibility in the preoperative evaluation disappeared after mammaplasty reduction. In the early postoperative period, the sensibility decreased on the NAC but returned to normal after 1 year.
One Pedicled Superficial Temporal Artery Hair-bearing Flap to Reconstruct Three Different Anatomical Areas of the Burnt Face
Authors: Al-Qattan Mohammad M.
Published: December 2020

Reconstruction of the burnt face is a challenge. In men, the best option to hide facial scars and get rid of the grafted facial appearance is to use the superficial temporal artery hair-bearing flap. In the literature, the superficial temporal artery flap hair-bearing flap has been used to reconstruct one facial anatomical area in men such the eyebrows, the beard, or the mustache area. In this communication, the author describes a personal technique that allows the use of one pedicled superficial temporal artery hair-bearing flap to reconstruct both eyebrows and improve the grafted appearance of the upper/lower lips post the release and graft of burn contractures. The technique will be demonstrated by a case presentation.
Breast Implant-Associated Anaplastic Large Cell Lymphoma
Authors: Skelly Alyson , Guo Lifei
Published: December 2020

Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized malignancy of T-lymphocytes that is linked to certain types of textured breast implants. Although rare, the increasing awareness of the disease is resulting in more case reports and heightened anxiety in patients with textured breast implants. This review aims to summarize the available BIA-ALCL data, including the existing theories of etiopathogenesis, the diagnostic work-up for BIA-ALCL patients, BIA-ALCL treatment recommendations, the epidemiologic challenges, and the current opinions surrounding the use of textured breast implants.
Assessing the Readability of Online Patient Education Resources Related to Gynecomastia
Authors: Nnamani Silva Ogonna N. , Ammanuel Simon G. , Segobiano Brett M. , Edwards Caleb S. , Hoffman William Y.
Published: December 2020

Background

The Internet has a plethora of online patient education resources for many symptoms and diseases. National medical governing bodies recommend that patient education materials are written at or below the eighth-grade level, and the literature suggests that health literacy has been linked to increased adherence to treatment regimens and improved outcomes. The primary aim of the study is to assess the readability of online patient materials relating to gynecomastia and ascertain the availability of patient materials in non-English languages.

Methods

The readability of patient education materials relating to gynecomastia for academic-based websites and nonacademic websites was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG). The prevalence of non-English patient education materials was assessed for both academic-based and nonacademic websites.

Results

Fifty-eight documents were collected across academic websites. Overall median values were 10.7 for the FKGL, 47.0 for the FRE, and 11.4 for the SMOG. For the 10 nonacademic institutions, the overall median values were 10.6 for the FKGL, 45.2 for the FRE, and 10.8 for the SMOG. No appreciable differences were observed for readability when stratified by region or source. The prevalence of non-English patient materials was 19.1% across institutions. None of the noninstitutional materials had information in non-English languages.

Conclusions

The readability of patient education materials related to gynecomastia is at higher levels than recommended by national organizations. There are limited non-English patient education materials. Future efforts should focus on improving the readability and accessibility of patient materials.
Videofluoroscopic Findings as Predictors of Velopharyngeal Insufficiency After Orthognathic Surgery in Patients With Cleft Lip and Palate
Authors: Yao Chuan-Fong , Bhandari Kishor , Lee Min-Chao , Chen Philip Kuo-Ting , Lu Ting-Chen
Published: December 2020

Background

Midface retrusion is a common problem in patients with cleft lip and palate owing to the lack of adequate growth of the maxilla. Midface advancement surgery is a definite treatment for midface retrusion; however, the subsequent oropharyngeal airway changes might result in velopharyngeal insufficiency (VPI) in affected patients. Determining the predictors of VPI beforehand and modifying the surgical procedure would be beneficial.

Materials and Methods

A retrospective review of 42 patients with cleft lip and palate who underwent orthognathic surgery from 2013 to 2014 was performed. A total of 25 patients met the inclusion criteria and had undergone complete pre- and postsurgery videofluoroscopy, nasopharyngoscopy (NPS), and speech assessment. We compared 2 groups of patients, those who showed NPS finding changes of more than 0.1 (8 patients) and those without changes (17 patients), by measuring the distances of the contact point to the tip of the velum, gap size at maximum closure (MC) and rest, contact area length, lateral wall closure rate, closure velocity, and 2 angles (from the velum to the hard palate and genu) at MC and rest. The amount of maxillary advancement was also recorded.

Results

Among the 8 patients with NPS finding changes, 3 underwent Furlow palatoplasty for VPI. No significant difference was found in the amount of maxillary advancement between the groups (5.8 vs 5.7 mm). Significant differences were found in the preoperative gap size at MC and angle at the genu at MC (P = 0.035 and .012). These could be considered as the predictors before surgery. After surgery, a significant difference was found in the contact area, lateral wall closure rate, and gap size at MC (P = 0.005, 0.018, and 0.01).

Conclusion

Videofluoroscopy is a relatively applicable method of determining dynamic changes in the velum function. By performing videofluoroscopy before midface advancement surgery in patients with cleft lip and palate, we may predict the risk of VPI and consider alternative surgical strategies.
The Referential Montage Inadequately Localizes Corticocortical Evoked Potentials in Stereoelectroencephalography
Authors: Dickey Adam S. , Alwaki Abdulrahman , Kheder Ammar , Willie Jon T. , Drane Daniel L. , Pedersen Nigel P.
Published: December 2020

Purpose:

Corticocortical evoked potentials (CCEPs) resulting from single pulse electrical stimulation are increasingly used to understand seizure networks, as well as normal brain connectivity. However, we observed that when using depth electrodes, traditional measures of CCEPs amplitude using a referential montage can be falsely localizing, often to white matter.

Methods:

We pooled 27 linear electrode arrays targeting the amygdala, hippocampus, or cingulate cortex from eight participants. Using postoperative imaging, we classified contacts as being in gray matter, white matter, or bordering each and measured the amplitude using the root-mean-squared deviation from baseline in a referential, common average, bipolar, or Laplacian montage.

Results:

Of 27 electrode contacts, 25 (93%) had a significantly higher mean amplitude when in gray matter than in white matter using a Laplacian montage, which was significantly more than the 12 of 27 electrodes (44%) when using a referential montage (P = 0.0003, Fisher exact test). The area under the curve for a receiver operating characteristic classifying contacts as gray or white matter was significantly higher for either the Laplacian (0.79) or the bipolar (0.72) montage when compared with either the common average (0.56) or the referential (0.51) montage (P ≤ 0.005, bootstrap).

Conclusions:

Both the Laplacian and bipolar montages were superior to the common average or referential montage in localizing CCEPs to gray matter. These montages may be more appropriate for interpreting CCEPs when using depth electrodes than the referential montage, which has typically been used in prior studies of CCEPs with subdural grids.
Electroencephalographic Seizures in Emergency Department Patients After Treatment for Convulsive Status Epilepticus
Authors: Zehtabchi Shahriar , Silbergleit Robert , Chamberlain James M. , Shinnar Shlomo , Elm Jordan J. , Underwood Ellen , Rosenthal Eric S. , Bleck Thomas P. , Kapur Jaideep
Published: December 2020

Purpose:

It is unknown how often and how early EEG is obtained in patients presenting with status epilepticus. The Established Status Epilepticus Treatment Trial enrolled patients with benzodiazepine-refractory seizures and randomized participants to fosphenytoin, levetiracetam, or valproate. The use of early EEG, including frequency of electrographic seizures, was determined in Established Status Epilepticus Treatment Trial participants.

Methods:

Secondary analysis of 475 enrollments at 58 hospitals to determine the frequency of EEG performed within 24 hours of presentation. The EEG type, the prevalence of electrographic seizures, and characteristics associated with obtaining early EEG were recorded. Chi-square and Wilcoxon rank-sum tests were calculated as appropriate for univariate and bivariate comparisons. Odds ratios are reported with 95% confidence intervals.

Results:

A total of 278 of 475 patients (58%) in the Established Status Epilepticus Treatment Trial cohort underwent EEG within 24 hours (median time to EEG: 5 hours [interquartile range: 3–10]). Electrographic seizure prevalence was 14% (95% confidence interval, 10%–19%; 39/278) in the entire cohort and 13% (95% confidence interval, 7%–21%) in the subgroup of patients meeting the primary outcome of the Established Status Epilepticus Treatment Trial (clinical treatment success within 60 minutes of randomization). Among subjects diagnosed with electrographic seizures (39), 15 (38%; 95% confidence interval, 25%–54%) had no clinical correlate on the video EEG recording.

Conclusions:

Electrographic seizures may occur in patients who stop seizing clinically after treatment of convulsive status epilepticus. Clinical correlates might not be present during electrographic seizures. These findings support early initiation of EEG recordings in patients suffering from convulsive status epilepticus, including those with clinical evidence of treatment success.
Structural analysis of the chicken FANCM–MHF complex and its stability
Authors: Ito Sho , Nishino Tatsuya
Published: December 2020

FANCM is involved in eukaryotic DNA-damage recognition and activates the Fanconi anemia (FA) pathway through complex formation. MHF is one of the FANCM-associating components and contains a histone-fold DNA-binding domain. Loss of the FANCM–MHF interaction compromises the activation of the FA pathway, resulting in chromosomal instability. Thus, formation of the FANCM–MHF complex is important for function, but its nature largely remains elusive. Here, the aim was to reveal the molecular and structural basis for the stability of the FANCM–MHF complex. A recombinant tripartite complex containing chicken FANCM (MHF interaction region), MHF1 and MHF2 was expressed and purified. The purified tripartite complex was crystallized under various conditions and three different crystals were obtained from similar crystallization conditions. Unexpectedly, structure determination revealed that one of the crystals contained the FANCM–MHF complex but that the other two contained the MHF complex without FANCM. How FANCM dissociates from MHF was further investigated and it was found that the presence of 2-methyl-2,4-pentanediol (MPD) and an oxidative environment may have promoted its release. However, under these conditions MHF retained its complexed form. FANCM–MHF interaction involves a mixture of hydrophobic/hydrophilic interactions, and chicken FANCM contains several nonconserved cysteines within this region which may lead to aggregation with other FANCM–MHF molecules. These results indicate an unexpected nature of the FANCM–MHF complex and the data can be used to improve the stability of the complex for biochemical and structural analyses.
Antecedents of pro-environmental behavior of supply chain managers: an empirical study
Authors: Rasheed Ayesha , Aslam Haris , Rashid Kamran
Published: December 2020

Purpose

Supply chain (SC) managers influence firms in incorporating green behavior throughout the value chain in functions such as purchasing, production, distribution and transportation. In this study, we aim to understand the antecedents of pro-environmental behavior (PEB) in SC managers.

Design/methodology/approach

We develop a research model hypothesizing a direct role of SC managers' private green behaviors, subjective norms, personal and organizational barriers as factors influencing the manager's pro-environmental intentions. We also analyze the impact of these intentions on actual behavior. We surveyed managers working in the SC of manufacturing firms in a developing country and tested the research model using structural equation modeling.

Findings

Our results indicate that SC managers' personal barriers significantly influence intentions to act pro-environmentally and these intentions then predict their actual behavior. However, SC managers' private green behaviors do not spill over to their workplace. Furthermore, the study shows that organizational-level barriers and subjective norms may reverse green intentions.

Originality/value

This study contributes to the research literature by identifying the role of organizational, personal and social factors in modifying the SC managers' intentions. It provides useful insights into how these factors affect the behavior of SC managers. Thus, we extend prior work in the area of PEB to the SC environment.
War by other means at the extractive frontier: the violence of reconstruction in ‘post‐war’ Peru
Authors: Sarmiento Barletti Juan Pablo
Published: December 2020

This article examines the meeting of local and national reconstruction priorities in the wake of Peru's internal war (officially, 1980‐2000). I focus on the impact of the state's extractivism‐led agenda on indigenous Asháninka people's projects of remaking themselves into Asháninka sanori (‘real Asháninka people’). Taking an Asháninka sanori‐centred analysis of their experience of war and post‐war violence, I propose an approach to understanding the impact of mainstream reconstruction efforts on survivors that centres on the latter's articulations of personhood. This approach, possible through ethnographic engagement, sets anthropology at the forefront of the necessary rethinking of mainstream reconstruction interventions to foster approaches that are supportive of survivors’ priorities. The article explores a continuum of violence through war and extractivism that is undoing the networks of relations through which a group of survivors constitute themselves as people and communities and set their aspirations for the future.
Development, implementation and evaluation of a process to recognise and reduce aggression and violence in an Australian emergency department
Authors: Senz Ainslie , Ilarda Elisa , Klim Sharon , Kelly Anne‐Maree
Published: December 2020

Objective

In 2018, we developed and implemented a novel approach to recognition and response to occupational violence and aggression (OVA). It included routine use of the Brøset Violence Checklist for all ED patients integrated with a score‐based notification and response framework. The present study evaluated the impact of the new process on staff knowledge, perceptions and confidence regarding OVA in ED and the rate of security events related to OVA.

Methods

The present study was conducted in a metropolitan hospital ED in Australia. Evaluation was by online before and after survey of nursing staff, point prevalence study of risk classification and comparison of OVA‐related events involving security in the year before implementation and the year after the programme was embedded.

Results

One percent of patients were assessed as high violence risk with a further 4% at moderate risk. The introduction of the Brøset Violence Checklist increased documentation of violence risk assessment. It also improved staff perception of organisational support and awareness of behaviours associated with the risk of violence. There was a statistically significant reduction in unplanned OVA‐related security responses (relative risk 0.75, 95% confidence interval 0.62–0.89). There was also a statistically significant shift to proactive management through early detection and intervention (relative risk 2.22, 95% confidence interval 1.85–2.66).

Conclusion

A process including routine OVA risk assessment and a notification and response framework reduced unplanned security events due to OVA and increased staff confidence in recognition and management of OVA. This approach may be suitable for use more broadly in ED.
Waist circumference‐to‐height ratio and body mass index for obesity classification in Irish children
Authors: Mitchell Lachlan , Bel‐Serrat Silvia , Heinen Mirjam , Mehegan John , Murrin Celine , O’Brien Sarah , Stanley Isobel , Kelleher Cecily
Published: December 2020

Aim

Waist circumference‐to‐height ratio (WHt) has been proposed as an alternative measure to BMI due to its focus on central weight distribution and its basic threshold for increased cardiometabolic risk. This study aimed to compare prevalence of overweight including obesity using BMI and WHt, and assess 10‐year trends of WHt prevalence, in a representative sample of Irish children.

Methods

Children measured during rounds 2–5 of the Childhood Obesity Surveillance Initiative (n = 20037) were classified as healthy weight or overweight including obesity (International Obesity Task Force age and sex BMI cut‐offs), and low or high WHt (WHt ≥ 0.5). Differences in prevalence of BMI and WHt classifications were determined for round five in younger (<9 years) and older (≥9 years) children. The prevalence of high WHt was assessed across rounds.

Results

Differences in prevalence between overweight including obesity and high WHt were apparent in younger (BMI: 16.7%, WHt: 8.9%; p < .001) and older (BMI: 21.3%, WHt: 12.1%; p < .001) children. An inverse trend for prevalence of high WHt was identified across rounds (p < .001).

Conclusion

BMI overestimates overweight including obesity prevalence compared to WHt. Given its ease of use, consideration of the WHt as an additional measure in childhood surveillance and screening is warranted.
Causal inference in high dimensions: A marriage between Bayesian modeling and good frequentist properties
Authors: Antonelli Joseph , Papadogeorgou Georgia , Dominici Francesca
Published: December 2020

We introduce a framework for estimating causal effects of binary and continuous treatments in high dimensions. We show how posterior distributions of treatment and outcome models can be used together with doubly robust estimators. We propose an approach to uncertainty quantification for the doubly robust estimator, which utilizes posterior distributions of model parameters and (1) results in good frequentist properties in small samples, (2) is based on a single run of a Markov chain Monte Carlo (MCMC) algorithm, and (3) improves over frequentist measures of uncertainty which rely on asymptotic properties. We consider a flexible framework for modeling the treatment and outcome processes within the Bayesian paradigm that reduces model dependence, accommodates nonlinearity, and achieves dimension reduction of the covariate space. We illustrate the ability of the proposed approach to flexibly estimate causal effects in high dimensions and appropriately quantify uncertainty. We show that our proposed variance estimation strategy is consistent when both models are correctly specified, and we see empirically that it performs well in finite samples and under model misspecification. Finally, we estimate the effect of continuous environmental exposures on cholesterol and triglyceride levels.
Caregiver experiences of developmental screening
Authors: Traube Dorian E. , Palmer Molina Abigail , Taylor Amanda , Kemner Allison , Shah Lindsey , Rau Angela
Published: December 2020

Background

The American Academy of Pediatrics (AAP) has called for a universal system of developmental screening and surveillance to enhance early detection and intervention for children. While the need and potential impact of universal screening is well documented, recent reports show that screening rates have not reached expected goals and gaps remain in terms of effective follow‐up and referral to early intervention (EI) services. Few studies have explored parent and child experiences of developmental screening, which would aid researchers, practitioners and policymakers in improving early detection and referral to EI. The purpose of this qualitative study was to understand the experiences of caregivers and children who received developmental screening across different service sectors, including the type of screening received, location of screening, experiences during the screening process and the follow‐up interventions received following screening.

Methods

Individual interviews were conducted with 31 caregivers. A descriptive qualitative design allowed for the exploration of caregiver experiences with developmental screening. Thematic analysis was utilized to categorize caregiver reflections prior to, during and following developmental screening events.

Results

Analysis revealed five themes that described caregivers' experiences with screening and assessment for their child: (1) parent's goals of screening; (2) screening preparation and support; (3) parent/child response to screening; (4) result reporting and follow‐up; (5) overall satisfaction with screening process. Each theme was composed of several subthemes.

Conclusions

Caregivers see the importance of developmental screening, caregivers and children respond well to screening delivered by various providers in multiple settings and caregivers find the information gleaned from screening events important in planning for their child's developmental trajectory. Key places where improvements can be made to further bolster parental engagement and satisfaction include screening preparation and follow‐up.
Caries experience among adults in core Sámi areas of Northern Norway
Authors: Bongo Ann‐Kristine Sara , Brustad Magritt , Jönsson Birgitta
Published: December 2020

Objectives

Dental caries is a major oral health problem among indigenous people worldwide, but knowledge on this issue among the indigenous Sámi people in Norway is scarce. The aim of the study was to describe dental caries experience in an adult population in core Sámi areas of Northern Norway and to assess the corresponding associations with socio‐demographic, socioeconomic and oral health‐related behavioural factors.

Methods

This cross‐sectional study is based on data from the Dental Health in the North study (2033 participants aged 18‐75 years). A questionnaire was used to collect data on socio‐demographic, socioeconomic and oral health‐related behavioural factors. Clinical examinations were performed by dentists and dental hygienists at Public Dental Service (PDS) clinics in core Sámi areas of Northern Norway.

Results

About 68% (n = 1380) of participants reported Sámi ethnicity, and the mean number of decayed (D), missed (M) and filled (F) teeth (T) was 16.2 (standard deviation [SD] = 6.7). The mean DMFT was 15.7 (SD = 6.7) among Sámi and 17.0 (SD = 6.7) among non‐Sámi. The mean DT among Sámi was 1.0 (SD = 1.6), with a significant, higher prevalence among coastal Sámi (DT = 1.3, SD = 1.8) than inland Sámi (DT = 0.8, SD = 1.5). Living in the coastal region, consumption of sugary soft drinks several times a week or daily, toothbrushing less than daily and irregular dental visits were associated with DT.

Conclusions

Caries experience among adults in core Sámi areas of Northern Norway was common. Dental caries were more common in the coastal than the inland region, with minor differences in caries experience between Sámi and non‐Sámi people within these regions.
Thyroid scintigraphy in the era of fine‐needle aspiration cytology
Authors: Pirola Ilenia , Di Lodovico Elena , Casella Claudio , Pezzaioli Letizia , Facondo Paolo , Ferlin Alberto , Lombardi Davide , Cappelli Carlo
Published: December 2020

Purpose

To evaluate whether thyroid scintigraphy would alter the clinical management of patients referred for fine‐needle aspiration cytology (FNA).

Methods

We reviewed the medical and imaging records of patients referred to our Department between 2016 and 2019. All the patients had to take a serum thyrotropin test administered in our hospital at least two months before the FNA; where the TSH level was ≤1.5 mIU/L, the patients were subjected to a scan and subsequently to FNA, where indicated. We selected only healthy patients with no previous history of thyroid disease, who were not taking any drugs and who had a TSH level of ≤1.5 mIU/L. We excluded patients with multinodular goitre.

Results

A total of 176 patients were analysed. A total of 67/176 patients (38%) showed a serum of TSH ≤ 0.27 mIU/L. Scintigraphy identified a hot nodule in 142 lesions (80.7%), a warm nodule in 8 lesions (4.5%) and a cold nodule in 26 lesions (14.8%). The ROC curve analysis indicated that a TSH value of ≤0.42 mIU/L identified patients with hyperfunctioning nodules with a sensitivity of 65% and a specificity of 77%. All patients with cold and warm nodules were submitted to FNA: 22/26 (85%) and 5/8 (63%) lesions showed suspected malignancy or were compatible with malignancy, respectively.

Conclusion

Speculating on our data, if we had subjected our patients to FNA as indicated by the 2015 ATA guidelines, we would have subjected 117 patients to cytology, from whom 83 had undetected hot nodules. Conversely, by adopting scintigraphy for all patients with TSH ≤ 1.5 mIU/L, 109 patients have avoided FNA. However, our study was performed in a region with a history of mild iodine deficiency. Therefore, we cannot claim that our observation is valid for patients born and living in areas with sufficient iodine uptake. We recommend thyroid scintigraphy for treating single thyroid nodules in euthyroid patients born and living in regions with an iodine deficiency, when TSH levels are below 1.5 mIU/L before FNA.
Marimbondos: systematics, biogeography, and evolution of social behaviour of neotropical swarm‐founding wasps (Hymenoptera: Vespidae: Epiponini)
Authors: Noll Fernando B. , da Silva Marjorie , Soleman Raduan A. , Lopes Rogério B. , Grandinete Yuri C. , Almeida Eduardo A. B. , Wenzel John W. , Carpenter James M.
Published: December 2020

Neotropical swarm‐founding wasps are divided into 19 genera in the tribe Epiponini (Vespidae, Polistinae). They display extensive variation in several colony‐level traits that make them an attractive model system for reconstructing the evolution of social phenotypes, including caste dimorphism and nest architecture. Epiponini has been upheld as a solid monophyletic group in most phylogenetic analyses carried out so far, supported by molecular, morphological and behavioural data. Recent molecular studies, however, propose different relationships among the genera of swarm‐founding wasps. This study is based on the most comprehensive epiponine sampling so far and was analyzed by combining morphological, nesting and molecular data. The resulting phylogenetic hypothesis shows many of the traditional clades but still impacts the way certain behavioural characters, such as nest structure and castes, evolved, and thus requires some re‐interpretations.Angiopolybiaas sister to the remaining Epiponini implies that nest envelopes and a casteless system are plesiomorphic in the tribe. Molecular dating points to an early tribal diversification during the Eocene (c. 55–38 Ma), with the major differentiation of current genera concentrated in the Oligocene/Miocene boundary.