bluuebunny/crossref_metadata_2025 huggingface dataset:
Pituitary tumor apoplexy associated with extrapontine myelinolysis during pregnancy
Authors: Ye Wenfeng , Huang Wenjie , Chen Linlin , Yao Changfang , Sheng Shiying , Liu Zhengyu , Xue Chunyan , Xing Wei
Published: March 2021

Rationale:

Pituitary tumor apoplexy (PTA) is a rare clinical syndrome which requires urgent diagnosis and treatment due to its life-threatening consequences. Management of undiagnosed pituitary tumor before pregnancy is a problem during pregnancy.

Patient concerns:

We reported a case with PTA which was not diagnosed before pregnancy presenting with vomiting associated with hyponatremia during the third trimester. After supplying the sodium the patient presented with dysarthria and hemiplegia.

Diagnoses:

MRI examination showed PTA accompanied with extrapontine myelinolysis (EPM).

Interventions:

The patient was given hydrocortisone according to the symptoms gradually to taper off dose, at the same times oral levothyroxine therapy (25μg/day) was given.

Outcomes:

The patient delivered a healthy baby via cesarean section at hospital at 38 + 1 week of gestation. We performed MRI examination regularly and the tumor regressed significantly 8 months postpartum.

Lessons:

We reported a case as PTA associated with EPM. Headache during pregnancy is often nonspecific, so careful medical history inquiry is very important.
Health-related quality of life among survivors in minority area 2 years after Jiuzhaigou earthquake
Authors: Zhang Xi , Gao Yuyang , Dai Xuemei , Zhou Jing , Yan Liuqing , Hou Furang , Yuan Ping , Wen Jin
Published: March 2021

To investigate the health-related quality of life (HRQoL) and related factors, the symptoms of posttraumatic stress disorder (PTSD) among earthquake survivors in minority area 2 years after Jiuzhaigou earthquake.

Two years after the Jiuzhaigou earthquake, a cross-sectional survey was conducted by a multi-stage sampling approach. HRQoL was measured by the short form 12 (SF-12), PTSD was measured by the PTSD Check List-Civilian Version (PCL-C), and social support was measured by the Multidimensional Scale of Perceived Social Support. Descriptive statistics, t-tests, ANOVA and multiple linear regression analysis were used for data analysis.

Of the 561 participants, the mean scores on the physical component summary (PCS) and mental component summary (MCS) were 46.36 ± 12.79 and 55.03 ± 8.73, and 5.73% reported the symptoms of PTSD. Lower PCS and MCS after an earthquake were associated with elderly age, physical illness, and low level of social support (P < .05). Meanwhile, PTSD was significantly associated with MCS.

These findings showed that physical disease and psychological symptoms can adversely affect the HRQoL of survivors. Moreover, providing higher social support to survivors should be considered as a way to improve the HRQoL outcomes of survivors.
To assess the effective and safety of compound glutamine entersoluble capsules in irritable bowel syndrome
Authors: Zhang Yong , Liu Ru , Wang Jin , Yan Shuguang , Guo Zhiqing
Published: March 2021

Background:

Irritable bowel syndrome (IBS) is one the common medical condition of functional GI disorder (FGD) characterized by bowel-related symptoms without other organic gastrointestinal (GI) disease. Compound Glutamine Entersoluble Capsules(CGEC),a compound preparation in which each capsule contains 120 mg L-glutamine, 50 mg ginseng, 50 mg licorice, 50 mg Atractylodes macrocephala and 50 mg Poria cocos, have been reported the efficacy of CGEC for patients with IBS in improving the clinical symptoms and quality of patients’ life. However, there is no a systematic review related to CGEC for IBS to this day. In this study, we will systematically evaluate the effectiveness and safety of CGEC in the treatment of IBS-D with a meta-analysis method, so as to provide a solid evidence for clinical practice.

Methods:

In this study, a literature search was performed by using the Chinese and English databases, which include PubMed, Embase, MEDLINE, Cochrane Library Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI) database, Wanfang Data Knowledge Service Platform, the VIP information resource integration service platform (cqvip), China Biology Medicine Disc (Sino Med),and the Chinese Clinical Trial Registry (ChiCTR), to find the related literature of CGEC in the treatment of IBS published from the inception date of each predefined database upto January 2021. The evaluation of the risk of bias for eligible studies will be performed by two investigators. Data synthesis will be performed by RevMan 5.4 software. Heterogeneity between studies can be assessed by a heterogeneity X2 test. The degree of heterogeneity among multiple included studies can be measured by I2. The stability of systematic review or meta-analysis outcomes will be evaluated by Sensitivity analysis. Reporting bias will be evaluated by funnel plot. Finally, The Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess the quality of evidence obtained.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusion:

Whether it is the effectiveness and safety of CGEC in the treatment of IBS will be judged in the result of this systematic review.
A single-arm, open-label, intervention study to investigate the improvement of glucose tolerance after administration of the 5-aminolevulinic acid (5-ALA) in the patients with mitochondrial diabetes mellitus
Authors: Nakamura Yuta , Haraguchi Ai , Shigeno Riyoko , Ito Ayako , Horie Ichiro , Kawakami Atsushi , Abiru Norio
Published: March 2021

Background:

Mitochondrial diabetes mellitus (MDM) is characterized by maternal inheritance, progressive neurosensory deafness, insulin secretory disorder, and progressive microvascular complications. Mitochondria are critical organelles that provide energy in the form of adenosine triphosphate (ATP). An impairment of ATP production in pancreatic β cells is regarded as the main cause of the insulin secretory disorder in patients with MDM, and these patients require insulin replacement therapy early after the diagnosis. The amino acid 5-aminolevulinic acid (5-ALA), a precursor of heme metabolites, is a non-proteinogenic δ amino acid synthesized in mitochondria. An addition of ferrous iron to 5-ALA enhances heme biosynthesis and increases ATP production through an upregulation of the respiratory complex. Several studies have reported that the administration of 5-ALA and ferrous iron to existing treatment improved the glycemic control in both patients with prediabetes and those with type 2 diabetes mellitus. The additional administration of 5-ALA and ferrous iron to MDM patients on insulin therapy may improve their insulin secretory capacity and glycemic control by improving their mitochondrial function. The findings of this study are expected to provide new treatment options for MDM and improve the patients’ glycemic control and prognosis.

Methods/design:

This study is a single-arm, open-label pilot intervention study using clinical endpoints to investigate the effects of treatment with 5-ALA plus sodium ferrous citrate (SFC) to patients with MDM on their glucose tolerance. A total of 5 patients with MDM will be administered 5-ALA/SFC (200 mg/d) for 24 weeks. We will perform a 75-g oral glucose tolerance test before and at 24 weeks after the start of this 5-ALA/SFC treatment to evaluate glucose-dependent insulin responses.

Discussion:

To the best of our knowledge, this study will be the first assessment of the effects of 5-ALA/SFC in patients with MDM. This study will obtain an evidence regarding the effectiveness and safety of 5-ALA/SFC for patients with MDM.

Trial registration:

This study was registered with the University Hospital Medical Information Network (UMIN000040581) on July 1, 2020 and with the Japan Registry of Clinical Trials (jRCTs071200025) on August 3, 2020.
Effects of aerobic exercise on TC, HDL-C, LDL-C and TG in patients with hyperlipidemia
Authors: Zhao Shaoping , Zhong Jiao , Sun Caihong , Zhang Junping
Published: March 2021

Background:

With the development of the social level and the improvement of living standards, people's dietary structure changes in the direction of high blood fat, high sugar and high fever, which leads to the occurrence of many diseases.Long-term increase in blood lipids can easily cause cholesterol to invade the walls of large blood vessels, deposit and accumulate, and promote the proliferation of smooth muscle cells and fibroblasts in the arterial intima, leading to coronary heart disease and atherosclerosis (AS) and other cardiovascular and cerebrovascular diseases.

Methods:

Electronic databases including Google Scholar, PubMed, Web of Science(WOS), the Cochrane Library, EMBASE and VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang. These databases will be searched to identify randomized controlled trials published January 1, 1980, and January 20, 2021. Language is limited with English and Chinese. We will use the standards provided in Cochrane Handbook 5.3.0 for quality assessment and risk assessment, and use Revman 5.3 software for meta-analysis. The primary outcomes are mainly evaluated by total cholesterol and triglyceride.

Conclusion:

The results of this study can provide a beneficial basis for the improvement of total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, and triglyceride in patients with hyperlipidemia.
Statin/ezetimibe combination therapy vs statin monotherapy for carotid atherosclerotic plaque inflammation
Authors: Oh Minyoung , Kim Hyunji , Shin Eon Woo , Sung Changhwan , Kim Do-Hoon , Moon Dae Hyuk , Lee Ji Sung , Lee Pil Hyung , Lee Seung-Whan , Lee Cheol Whan
Published: March 2021

It remains uncertain whether statin/ezetimibe combination therapy serves as a useful and equivalent alternative to statin monotherapy for reducing atherosclerotic plaque inflammation. The aim of the present study was to compare the effects of statin/ezetimibe combination therapy and statin monotherapy on carotid atherosclerotic plaque inflammation using 18F-fluorodeoxyglucose (18FDG) positron emission tomography (PET)/computed tomography (CT) imaging. Data were pooled from 2 clinical trials that used serial 18FDG PET/CT examination to investigate the effects of cholesterol-lowering therapy on carotid atherosclerotic plaque inflammation. The primary outcome was the percent change in the target-to-background ratio (TBR) of the index vessel in the most diseased segment (MDS) at 6-month follow-up. Baseline characteristics were largely similar between the 2 groups. At the 6-month follow-up, the MDS TBR of the index vessel significantly decreased in both groups. The percent change in the MDS TBR of the index vessel (primary outcome) did not differ significantly between the 2 groups (−8.41 ± 15.9% vs −8.08 ± 17.0%, respectively, P = .936). Likewise, the percent change in the whole vessel TBR of the index vessel did not differ significantly between the 2 groups. There were significant decreases in total and LDL cholesterol levels in both groups at follow-up (P < .001). There were no significant correlations between the percent changes in MDS TBR of the index vessel, changes in the lipid, and high-sensitive C-reactive protein levels. The reduction in carotid atherosclerotic plaque inflammation by statin/ezetimibe combination therapy was equivalent to that by the statin monotherapy.
Chinese herbal compounds containing scorpion in the treatment of epilepsy
Authors: Rong Ping , Fu Qianfang , Zhang Xilian , Liu Xuan , Yang Jie , Wang Xin , Wang Shuai , Liu Hui , Ma Rong , Nie Lianghui , Ma Rong
Published: March 2021

Background:

Epilepsy is 1 of the common neurodevelopmental diseases. It can affect about 0.5% to 1.0% of the population regardless of their race and social class. Despite the development of a wide range of treatments, there remaining about one-third of patients still experience seizures. Chinese herbal compounds containing scorpion (CHCCS) have shown an outstanding curative effect on nerve protection and epilepsy. But there's no study to assess its clinical efficacy and safety.

Methods:

Each data of CHCCS in treating epilepsy from related English and Chinese databases will be searched. The primary outcome is the efficacy of the CHCCS on epilepsy. And the secondary outcomes include recurrence rate and side effects. The risk of bias will be assessed, and RevMan5.3 and Stata14.0 will be performed for meta-analysis. Finally, we will assess the level of the resulting evidence.

Results:

The results of the study will be combined with current evidence and published in a peer-reviewed journal.

Conclusions:

This study will specifically investigate the effectiveness and safety of CHCCS in treating epilepsy.

INPLASY registration number:

INPLASY202120056.
Design Considerations for the Development and Implementation of a Medical Respite for Older Adults Experiencing Homelessness in Metro Vancouver
Authors: Canham Sarah L. , Humphries Joe , Danielsen Chris , Small Scott , Bosma Harvey
Published: March 2021

Background:

Older persons with lived or living experience of homelessness (PWLEs) often live with complex physical and/or mental health conditions which are challenged by poor access to health services, especially primary care. To fill the gap in the continuum of care following hospital discharge for PWLEs, medical respite provides health and shelter support for PWLEs who do not have acute care needs that qualify for a stay in a hospital bed, yet are too sick or frail to recover on the streets or in a traditional shelter.

Objective:

This study examines how a medical respite could be designed for older PWLEs in Metro Vancouver, BC.

Research Design:

Using a community-based participatory research approach, in-depth interviews and focus groups were conducted with PWLE (n=15) and service provider (n=11) participants.

Results:

Participants offered rich suggestions about (a) the culture of the medical respite, (b) the physical design of a medical respite, (c) individuals who should be involved in medical respite delivery, (d) services a medical respite should provide, and (e) who the medical respite should serve.

Conclusions:

When designing a medical respite for older PWLEs, considerations include providing an environment where patients can rest, but also feel safe and be surrounded by persons who they trust and who care for them. Developing a medical respite that adheres to the tenets of trauma-informed and patient-centered care acknowledges the mistrust and traumatization that often accompanies homeless patients presenting to health care.
The Effect of Various Supportive Housing Models on ART Adherence Among Persons Living With HIV in Supportive Housing
Authors: Quinn Katherine G. , DiFranceisco Wayne , Spector Antoinette , Bendixen Art , Peters Amanda , Dickson-Gomez Julia
Published: March 2021

Background:

Providing permanent supportive housing to chronically homeless persons living with human immunodeficiency virus (PLH) contributes to improved human immunodeficiency virus (HIV) outcomes, including adherence to antiretroviral therapy (ART). This study seeks to understand whether certain components of housing, namely intensity of case management and specialized HIV housing programs, affects ART adherence for PLH in supportive housing.

Methods:

From 2015 to 2019 we conducted quantitative assessments with 157 PLH in supportive housing at baseline, 6-, 12-, and 18-month postbaseline to identify factors associated with ART adherence. General Estimating Equations for repeated measures were performed to assess bivariate and multivariate measures.

Results:

Two thirds of PLH in supportive housing reported 95% or greater adherence to ART. Multivariate analyses indicate that neither intensity of case management services nor specialized housing for PLH were associated with greater ART adherence. Greater time since diagnosis was positively associated with ART adherence. Greater depressive symptoms and African American race were negatively associated with ART adherence.

Conclusions:

Study findings reveal that although prior research has established the importance of receipt of housing for homeless PLH, the type or intensity of case management services associated with that housing may not be as important as simply being housed. Our results highlight the importance of considering mental health and more recent HIV diagnosis when developing treatment and case management plans to enhance residents’ ART adherence.
Does Housing Improve Health Care Utilization and Costs? A Longitudinal Analysis of Health Administrative Data Linked to a Cohort of Individuals With a History of Homelessness
Authors: Wiens Kathryn , Nisenbaum Rosane , Sucha Ewa , Aubry Tim , Farrell Susan , Palepu Anita , Duhoux Arnaud , Gadermann Anne , Hwang Stephen W.
Published: March 2021

Background:

Individuals who are homeless have complex health care needs, which contribute to the frequent use of health services. In this study, we investigated the relationship between housing and health care utilization among adults with a history of homelessness in Ontario.

Methods:

Survey data from a 4-year prospective cohort study were linked with administrative health records in Ontario. Annual rates of health encounters and mean costs were compared across housing categories (homeless, inconsistently housed, housed), which were based on the percentage of time an individual was housed. Generalized estimating equations were applied to estimate the average annual effect of housing status on health care utilization and costs.

Results:

Over the study period, the proportion of individuals who were housed increased from 37% to 69%. The unadjusted rates of ambulatory care visits, prescription medications, and laboratory tests were highest during person-years spent housed or inconsistently housed and the rate of emergency department visits was lowest during person-years spent housed. Following adjustment, the rate of prescription claims remained higher during person-years spent housed or inconsistently housed compared with the homeless. Rate ratios for other health care encounters were not significant (P>0.05). An interaction between time and housing status was observed for total health care costs; as the percentage of days housed increased, the average costs increased in year 1 and decreased in years 2–4.

Conclusions:

These findings highlight the effects of housing on health care encounters and costs over a 4-year study period. The rate of prescription medications was higher during person-years spent housed or inconsistently housed compared with the homeless. The cost analysis suggests that housing may reduce health care costs over time; however, future work is needed to confirm the reason for the reduction in total costs observed in later years.
Housing Boston’s Chronically Homeless Unsheltered Population
Authors: Roncarati Jill S. , Tiemeier Henning , Tachick Rebecca , VanderWeele Tyler J. , O’Connell James J.
Published: March 2021

Objective:

The long-term outcomes of permanent supportive housing for chronically unsheltered individuals, or rough sleepers, are largely unknown. We therefore assessed housing outcomes for a group of unsheltered individuals who were housed directly from the streets after living outside for decades.

Methods:

Using an open-cohort design, 73 chronically unsheltered individuals were enrolled and housed in permanent supportive housing directly from the streets of Boston from 2005 to 2019. Through descriptive, regression, and survival analysis, we assessed housing retention, housing stability, and predictors of survival.

Results:

Housing retention at ≥1 year was 82% yet fell to 36% at ≥5 years; corresponding Kaplan-Meier estimates for retention were 72% at ≥1, 42.5% at ≥5, and 37.5% at ≥10 years. Nearly half of the cohort (45%) died while housed. The co-occurrence of medical, psychiatric, and substance use disorder, or “trimorbidity,” was common. Moves to a new apartment were also common; 38% were moved 45 times to avoid an eviction. Each subsequent housing relocation increased the risk of a tenant returning to homelessness. Three or more housing relocations substantially increased the risk of death.

Conclusions:

Long-term outcomes for this permanent supportive housing program for chronically unsheltered individuals showed low housing retention and poor survival. Housing stability for this vulnerable population likely requires more robust and flexible and long-term medical and social supports.
Examining Sleep Disturbance Among Sheltered and Unsheltered Transition Age Youth Experiencing Homelessness
Authors: Redline Brian , Semborski Sara , Madden Danielle R. , Rhoades Harmony , Henwood Benjamin F.
Published: March 2021

Background:

The estimated 3.5-million transition age youth (TAY) who experience homelessness in the United States annually are routinely exposed to inadequate sleep environments and other psychosocial risk factors for deficient sleep. Although staying in a shelter versus being unsheltered may facilitate sleep, research suggests that perceived safety wherever one sleeps may be just as important. In this study, which is the first known study to investigate sleep disturbances among TAY experiencing homelessness, we examine associations of sleep disturbances with sheltered status and perceived safety of usual sleep environment.

Methods:

We surveyed TAY (aged 18–25) experiencing homelessness in Los Angeles, CA about their sleep, psychosocial health, and living situations. Participants (n=103; 60% sheltered) self-reported sleep disturbances using the Patient-Reported Outcomes Measurement Information System Sleep Disturbance short form, while individual items assessed sheltered status and perceived safety where they usually slept. Regression analyses examined associations of sheltered status and perceived sleep environment safety with sleep disturbance, adjusting for age, sex, race, self-rated health, depression symptoms, serious mental illness, high-risk drinking, and severe food insecurity.

Results:

Twenty-six percent of participants reported moderate-severe sleep disturbances. Sleep disturbance was not associated with sheltered status, but was positively associated with feeling unsafe in one’s sleep environment, depression symptoms, severe food insecurity, and decreased age.

Conclusions:

Our findings suggest that sleep disturbances among TAY experiencing homelessness are associated more closely with how safe one feels rather than one’s sheltered status. This highlights the importance of providing safe places to live for sheltered and unsheltered TAY.
Trends in Trimorbidity Among Adults Experiencing Homelessness in Minnesota, 2000–2018
Authors: Vickery Katherine D. , Winkelman Tyler N.A. , Ford Becky R. , Busch Andrew , Robertshaw Danielle , Pittman Brian , Gelberg Lillian
Published: March 2021

Background:

Earlier and more severe onset of chronic health conditions contributes to the increased risk of premature death among adults experiencing homelessness. Trimorbidity, a subset of multimorbidity representing overlap of physical health, mental health, and substance use conditions, disproportionately impacts adults experiencing homelessness. We know of no longitudinal data comparing trimorbidity trends among adults experiencing homelessness.

Objective:

To characterize 19-year trimorbidity trends among adults experiencing homelessness.

Research Design:

Repeated longitudinal, statewide survey administered every 3 years.

Subjects:

Adults living throughout Minnesota experiencing homelessness.

Measures:

Reported diagnoses of chronic health conditions within 3 categories: physical health conditions (hypertension, heart disease, asthma, diabetes); mental health conditions (depression, posttraumatic stress disorder, bipolar disorder, schizophrenia/other paranoid, and delusional disorders); and substance use conditions (alcohol and illicit substances).

Results:

A total of 25,552 surveys were completed by adults at 3-year intervals in a total of 7 waves. Participants reported increasing frequency and duration of homelessness, and more nights slept outside/in a car. 77.3% of adults experiencing homelessness in 2018 had one or more chronic health condition in any domain. From 2000 to 2018, bimorbidity and trimorbidity surpassed morbidity within a single domain. This was driven by increases in mental health conditions. In 2018, 31.7% of participants reported bimorbidity and 16.3% of adults reported trimorbidity.

Conclusions:

Adults experiencing homelessness bear a substantial and growing burden of bimorbidity and trimorbidity. Ensuring accessible, high quality care that includes robust services that can address all 3 categories of health is critical. Such care is best delivered in combination with affordable supportive housing.
Individualized Placement and Support Supported Employment for Justice-involved Homeless and Unemployed Veterans
Authors: LePage James P. , Martin William Blake , Crawford April M. , Rock Avery , Parish Johnson Julie A. , Washington Edward L.
Published: March 2021

Background:

Homelessness is a significant issue affecting the general US population. Two subsets of the population overrepresented in the US homeless population are justice involved individuals and Veterans. However, relatively little research has addressed alleviating homelessness in justice-involved Veterans (JIV). One direction for addressing homelessness in this population is facilitating employment.

Objective:

This study examined differences in housing and employment outcomes between homeless JIV enrolled in 2 different vocational rehabilitation conditions.

Methods:

This study evaluates vocational outcomes of Veterans experiencing homelessness enrolled in a larger US Department of Veterans Affairs-funded study. Participants were randomized into 2 groups: those who participated in a job search group, the About Face Vocational Program (AFVP) and those who received AFVP plus Individualized Placement and Support, Supported Employment (AFVP+IPS-SE).

Results:

Participants who received supported employment plus group were significantly more likely to secure employment compared with group alone. This significant difference was also found in individuals who identified as chronically homeless. Furthermore, participants who secured employment were significantly more likely to exit homelessness and secure housing, suggesting group membership had an indirect effect on housing status though improved employment outcomes.

Conclusions:

Vocational rehabilitation groups combined with supported employment is appropriate and effective for homeless, JIV seeking employment and may also improve downstream housing outcomes.
Investigating Sleep Disturbance and Its Correlates Among Formerly Homeless Adults in Permanent Supportive Housing
Authors: Henwood Benjamin F. , Rhoades Harmony , Dzubur Eldin , Madden Danielle R. , Redline Brian , Brown Rebecca T.
Published: March 2021

Background:

Adults experiencing homelessness have a high burden of sleep disturbance, which may be reduced by accessing permanent supportive housing.

Objectives:

To assess sleep disturbances and their correlates, including demographics, activity level, health status, age-related health issues (eg, functionality and cognitive impairment), substance use, and homelessness history in a sample of permanent supportive housing (PSH) tenants.

Research Design:

Cross-sectional survey design.

Subjects:

A total of 237 formerly homeless adults between 45 and 80 years old.

Measures:

The Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance short form was used to measure sleep disturbance.

Results:

Twenty-eight percent of our sample had PROMIS scores indicative of a moderate or severe sleep disturbance. Functional impairment, pain, and mental health comorbidities were associated with increased sleep disturbance in multivariable linear regression analyses. The number of years a person experienced homelessness was inversely associated with sleep disturbance.

Conclusions:

This study supports the need to screen for sleep disturbances among PSH tenants. The findings suggest that supportive services in PSH may need to include integrated physical and behavioral health care, pain management, and interventions designed to address activities of daily livings to improve tenant sleep. They also suggest that improved sleep may help reduce PSH tenant pain, impairment, and mental health symptoms among PSH tenants.
Financial Strain, Mental Illness, and Homelessness
Authors: Elbogen Eric B. , Lanier Megan , Wagner Henry R. , Tsai Jack
Published: March 2021

Background:

Research indicates that adults with severe mental illness have lower income and employment than adults without severe mental illness. Further, mental illness has been identified as a risk factor for homelessness. However, little research has investigated the interrelationships between financial strain, mental illness, and homelessness. It is unknown whether or to what extent financial strain mediates the association between mental illness and subsequent homelessness.

Methods:

This study examined financial strain and severe mental illness (psychotic, bipolar, and depressive disorders in the past 12 months) as predictors of subsequent homelessness and financial strain as a mediator of the link between severe mental illness and homelessness by analyzing data from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (n=34,653).

Results:

χ2 and multivariable analyses revealed that financial crises and debt, lower income, unemployment, and past homelessness at wave 1 each significantly predicted subsequent homelessness between waves 1 and 2. For participants with and without severe mental illness, risk of homelessness between waves 1 and 2 increased as a function of the number of financial strain variables at wave 1. Mediation analyses showed a direct effect of severe mental illness on future homelessness as well as an indirect effect via greater financial strain, which accounted for 39% of the link between mental illness and homelessness.

Conclusions:

The findings showing that financial strain mediated the association between severe mental illness and homelessness support assessment of financial well-being in the context of treatment of mental illness and homeless service programs. The results suggest that individuals experiencing homelessness who have severe mental illness may benefit from assistance increasing financial literacy, improving money management, and achieving financial well-being.
Hard-to-Reach Populations and Administrative Health Data
Authors: Hossain Rahat , Dai Jia Hong , Jamani Shaila , Ma Zechen , Dvorani Erind , Graves Erin , Burcul Ivana , Strobel Stephenson
Published: March 2021

Background:

Intervention studies with vulnerable groups in the emergency department (ED) suffer from lower quality and an absence of administrative health data. We used administrative health data to identify and describe people experiencing homelessness who access EDs, characterize patterns of ED use relative to the general population, and apply findings to inform the design of a peer support program.

Methods:

We conducted a serial cross-sectional study using administrative health data to examine ED use by people experiencing homelessness and nonhomeless individuals in the Niagara region of Ontario, Canada from April 1, 2010 to March 31, 2018. Outcomes included number of visits; unique patients; group proportions of Canadian Triage and Acuity Scale (CTAS) scores; time spent in emergency; and time to see an MD. Descriptive statistics were generated with t tests for point estimates and a Mann-Whitney U test for distributional measures.

Results:

We included 1,486,699 ED visits. The number of unique people experiencing homelessness ranged from 91 in 2010 to 344 in 2017, trending higher over the study period compared with nonhomeless patients. Rate of visits increased from 1.7 to 2.8 per person. People experiencing homelessness presented later with higher overall acuity compared with the general population. Time in the ED and time to see an MD were greater among people experiencing homelessness.

Conclusions:

People experiencing homelessness demonstrate increasing visits, worse health, and longer time in the ED when compared with the general population, which may be a burden on both patients and the health care system.
Is Carbapenem-resistant Klebsiella pneumoniae Infection in Pediatric Bone Marrow Transplantation Recipients Inevitably Fatal?
Authors: Komitopoulou Anna , Paisiou Anna , Oikonomopoulou Christina , Kaisari Katerina , Ioannidou Eleni D. , Tzannou Ifigeneia , Sipsas Nikolaos V. , Vessalas George , Peristeri Ioulia , Goussetis Evgenios , Kitra Vasiliki
Published: March 2021

Carbapenem resistance, most notably in Klebsiella pneumonia (KPC), results in infections associated with significant morbidity and mortality. Here we report 2 cases of adolescent patients with KPC infection after high-risk bone marrow transplantation, who eventually succumbed from other causes and review the epidemiology and treatment options for KPC infections in this vulnerable population.
Immune Microenvironment in Gallbladder Adenocarcinomas
Authors: Patil Pallavi A. , Lombardo Kara , Cao Weibiao
Published: March 2021

Programmed death-1 (PD1) expression has not been reported in gallbladder adenocarcinoma. In this study we examined PD1 expression in gallbladder cancer to explore the correlation between PD1 expression and the clinicopathologic parameters. We found that 98% (46/47) cases expressed programmed death-ligand 1 (PD-L1) with 85% cases being PD-L1 3+. PD1+ tumor-infiltrating lymphocytes (TILs) were present in 78.7% cases (37/47). The tumor size was significantly smaller and the stromal CD3+ TILs were significantly higher in tumors with PD1+ TILs than those with PD1− TILs. In the tumors with size of <3 cm, stromal CD3+ TILs >115/HPF or stromal CD8+ TILs >45/HPF were associated with much better survival than those with stromal CD3+ TILs ≤115/HPF or stromal CD8+ TILs ≤45/HPF. In tumors with the size of 3 cm or larger, PD1+ TILs or stromal CD8+ TILs >45/HPF carried a significantly poorer survival than PD1− tumors or stromal CD8+ TILs <=45/HPF. No correlation was identified between PD1 expression and lymphovascular invasion, distant metastasis, pathologic tumor stage or prognostic stage. Multivariate survival analysis showed that tumor TNM stage and age were independent prognostic factors in gallbladder adenocarcinomas. We conclude that gallbladder adenocarcinomas may have high PD-L1 expression and PD1+ TILs. Smaller tumor size and greater amount of stromal CD3+ T cells were found in tumors with PD1+ TILs. In small tumors (<3 cm), high stromal CD3+ TILs or high stromal CD8+ TILs were associated with better survival. However, in large tumors (≥3 cm), PD1+ TILs or high stromal CD8+ TILs carried a poorer survival. Our study implied that immune-based therapy including PD1/PD-L1 checkpoint blockade might be useful in gallbladder adenocarcinomas.
Continuous Prediction of Mortality in the PICU: A Recurrent Neural Network Model in a Single-Center Dataset*
Authors: Aczon Melissa D. , Ledbetter David R. , Laksana Eugene , Ho Long V. , Wetzel Randall C.
Published: March 2021

OBJECTIVES:

Develop, as a proof of concept, a recurrent neural network model using electronic medical records data capable of continuously assessing an individual child’s risk of mortality throughout their ICU stay as a proxy measure of severity of illness.

DESIGN:

Retrospective cohort study.

SETTING:

PICU in a tertiary care academic children’s hospital.

PATIENTS/SUBJECTS:

Twelve thousand five hundred sixteen episodes (9,070 children) admitted to the PICU between January 2010 and February 2019, partitioned into training (50%), validation (25%), and test (25%) sets.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

On 2,475 test set episodes lasting greater than or equal to 24 hours in the PICU, the area under the receiver operating characteristic curve of the recurrent neural network’s 12th hour predictions was 0.94 (CI, 0.93–0.95), higher than those of Pediatric Index of Mortality 2 (0.88; CI, [0.85–0.91]; p < 0.02), Pediatric Risk of Mortality III (12th hr) (0.89; CI, [0.86–0.92]; p < 0.05), and Pediatric Logistic Organ Dysfunction day 1 (0.85; [0.81–0.89]; p < 0.002). The recurrent neural network’s discrimination increased with more acquired data and smaller lead time, achieving a 0.99 area under the receiver operating characteristic curve 24 hours prior to discharge. Despite not having diagnostic information, the recurrent neural network performed well across different primary diagnostic categories, generally achieving higher area under the receiver operating characteristic curve for these groups than the other three scores. On 692 test set episodes lasting greater than or equal to 5 days in the PICU, the recurrent neural network area under the receiver operating characteristic curves significantly outperformed their daily Pediatric Logistic Organ Dysfunction counterparts (p < 0.005).

CONCLUSIONS:

The recurrent neural network model can process hundreds of input variables contained in a patient’s electronic medical record and integrate them dynamically as measurements become available. Its high discrimination suggests the recurrent neural network’s potential to provide an accurate, continuous, and real-time assessment of a child in the ICU.
Levetiracetam Versus Phenytoin or Fosphenytoin for Second-Line Treatment of Pediatric Status Epilepticus: A Meta-Analysis
Authors: Klowak Jennifer Ann , Hewitt Mark , Catenacci Vanessa , Duffett Mark , Rochwerg Bram , Jones Kevin , Choong Karen
Published: March 2021

OBJECTIVE:

To synthesize the available evidence examining the efficacy and safety of levetiracetam compared with phenytoin or fosphenytoin in benzodiazepine-refractory pediatric status epilepticus.

Data Sources:

We searched (from inception until April 27, 2020) Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials.

Study Selection:

Two reviewers, independently and in duplicate, screened citations and manuscripts for eligible randomized controlled trials.

Data Extraction and Synthesis:

Independently and in duplicate, we performed data abstraction, risk of bias assessment, and certainty assessment using Grading of Recommendations, Assessment, Development, and Evaluation. We performed meta-analyses using random-effect models or, if insufficient data, presented findings narratively.

Results:

We identified seven randomized controlled trials (n = 1,575). Pooled analysis demonstrated low certainty evidence for no difference of levetiracetam on time to seizure cessation (mean difference, –3.11 min; 95% CI, –6.67 to 0.45), early seizure cessation (relative risk, 1.09, 95% CI, 0.95–1.26), or late seizure cessation (relative risk, 1.05; 95% CI, 0.93–1.18). Adverse event outcomes were limited by low event numbers. We found low certainty evidence for less respiratory depression with levetiracetam (relative risk, 0.28; 95% CI, 0.12–0.69).

Conclusions:

The efficacy of levetiracetam is comparable with phenytoin or fosphenytoin in children with benzodiazepine-refractory status epilepticus (low certainty evidence). Levetiracetam may cause less respiratory depression. Clinicians and guideline developers should weigh safety profiles when choosing between these agents.
Development of a Heart Rate Variability Risk Score to Predict Organ Dysfunction and Death in Critically Ill Children
Authors: Badke Colleen M. , Marsillio Lauren E. , Carroll Michael S. , Weese-Mayer Debra E. , Sanchez-Pinto L. Nelson
Published: March 2021

OBJECTIVES:

Determine whether the Heart Rate Variability Dysfunction score, a novel age-normalized measure of autonomic nervous system dysregulation, is associated with the development of new or progressive multiple organ dysfunction syndrome or death in critically ill children.

DESIGN, SETTING, AND PATIENTS:

This was a retrospective, observational cohort study from 2012 to 2018. Patients admitted to the PICU with at least 12 hours of continuous heart rate data available from bedside monitors during the first 24 hours of admission were included in the analysis.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Heart rate variability was measured using the integer heart rate variability, which is the sd of the heart rate sampled every 1 second over 5 consecutive minutes. The Heart Rate Variability Dysfunction score was derived from age-normalized values of integer heart rate variability and transformed, so that higher scores were indicative of lower integer heart rate variability and a proxy for worsening autonomic nervous system dysregulation. Heart Rate Variability Dysfunction score performance as a predictor of new or progressive multiple organ dysfunction syndrome and 28-day mortality were determined using the area under the receiver operating characteristic curve. Of the 7,223 patients who met inclusion criteria, 346 patients (4.8%) developed new or progressive multiple organ dysfunction syndrome, and 103 (1.4%) died by day 28. For every one-point increase in the median Heart Rate Variability Dysfunction score in the first 24 hours of admission, there was a 25% increase in the odds of new or progressive multiple organ dysfunction syndrome and a 51% increase in the odds of mortality. The median Heart Rate Variability Dysfunction score in the first 24 hours had an area under the receiver operating characteristic curve to discriminate new or progressive multiple organ dysfunction syndrome of 0.67 and to discriminate mortality of 0.80. These results were reproducible in a temporal validation cohort.

CONCLUSIONS:

The Heart Rate Variability Dysfunction score, an age-adjusted proxy for autonomic nervous system dysregulation derived from bedside monitor data is independently associated with new or progressive multiple organ dysfunction syndrome and mortality in PICU patients. The Heart Rate Variability Dysfunction score could potentially be used as a single continuous physiologic biomarker or as part of a multivariable prediction model to increase awareness of at-risk patients and augment clinical decision-making.
Kidney injury biomarkers during exposure to tenofovir-based preexposure prophylaxis
Authors: Nickolas Thomas L. , Barasch Jonathan , Mugwanya Kenneth K. , Branch Andrea D. , Heffron Renee , Wanga Valentine , Mugo Nelly R. , Ronald Allan , Celum Connie , Donnell Deborah , Baeten Jared M. , Wyatt Christina M.
Published: March 2021

We previously reported a higher incidence of non-albumin proteinuria and a small but significant decline in estimated glomerular filtration rate (eGFR) among HIV-negative adults randomized to emtricitabine/tenofovir disoproxil fumarate preexposure prophylaxis (FTC/TDF PrEP) versus placebo. In a nested case--control study among participants randomized to FTC/TDF PrEP, established kidney injury biomarkers measured at 12 months were not significantly different between participants who subsequently experienced one of these kidney endpoints and randomly selected controls who did not.
Decreases in markers of monocyte/macrophage activation after hepatitis C eradication in HIV/hepatitis C virus coinfected women
Authors: French Audrey L. , Grennan Dara , Daubert Elizabeth , Seaberg Eric C. , Peters Marion , Augenbraun Michael , Fischl Margaret , Kassaye Seble , Franco Ricardo , Kuniholm Mark , Adimora Adaora A. , Workowski Kimberly , Weber Kathleen M.
Published: March 2021

Objective:

Eradication of hepatitis C virus (HCV) in HIV disease decreases liver and non-liver-related morbidity and mortality. Elevated markers of monocyte/macrophage activation (soluble CD163 and sCD14) are associated with excess non-AIDS morbidity and mortality in HIV. We examined the effect of HCV eradication on these markers in relation to change in hepatic fibrosis.

Design:

A nested substudy within a longitudinal observational cohort

Methods:

We studied 126 HIV/HCV-coinfected women successfully treated for HCV, with undetectable HCV RNA at least 12 weeks after therapy completion. sCD163 and sCD14 were measured in serum collected before and after HCV eradication. Results were correlated with changes in markers of hepatic fibrosis.

Results:

Mean age of participants was 56.3 years, mean CD4+ cell count was 615, and 72% had suppressed HIV RNA. After treatment, sCD163 and sCD14 levels significantly decreased from pre-treatment levels in unadjusted analyses. After adjusting for age, race, hepatic fibrosis status, baseline HCV RNA, CD4 count and HIV RNA status, cigarette smoking, and alcohol use, the decreases in sCD163 and sCD14 remained significant. Decrease in pre-treatment to post-treatment sCD163 were significantly positively correlated with changes in FIB-4 (r = 0.250, P = 0.005) and APRI (r = 0.262, P = 0.003); similarly decrease in sCD14 was significantly positively correlated with changes in FIB-4 (r = 0.333, P = 0.0001) and APRI (r = 0.457, P < 0.0001).

Conclusion:

HCV eradication is associated with significant reductions in monocyte/macrophage activation markers that correlate with reductions in markers of hepatic fibrosis. These findings support broad access to and early initiation of HCV treatment in order to decrease immune activation and improve health in HIV-infected persons.
Normal structural brain development in adolescents treated for perinatally acquired HIV: a longitudinal imaging study
Authors: Van den Hof Malon , Jellema Pien E.J. , ter Haar Anne Marleen , Scherpbier Henriette J. , Schrantee Anouk , Kaiser Antonia , Caan Matthan W.A. , Majoie Charles B.L.M. , Reiss Peter , Wit Ferdinand W.N.M. , Mutsaerts Henk-Jan M.M. , Pajkrt Dasja
Published: March 2021

Objective:

Cross-sectional studies, including one from our NOVICE cohort [Neurological Visual and Cognitive performance in children with treated perinatally acquired HIV (PHIV) compared with matched HIV-negative controls], have revealed that the brains of children with PHIV have lower white matter and grey matter volumes, more white matter hyperintensities (WMH) and poorer white matter integrity. This longitudinal study investigates whether these differences change over time.

Methods:

We approached all NOVICE participants to repeat MRI after 4.6 ± 0.3 years, measuring total white matter and grey matter volume, WMH volume and white matter integrity, obtained by T1-weighted, fluid-attenuated inversion recovery (FLAIR) and diffusion tensor imaging (DTI), respectively. We compared rates of change between groups using multivariable linear mixed effects models, adjusted for sex and age at enrolment. We investigated determinants of developmental deviation, and explored associations with cognitive development.

Results:

Twenty out of 31 (65%) PHIV-positive, and 20 out of 37 (54%) HIV-negative participants underwent follow-up MRI. Groups did not significantly differ in terms of age and sex. Over time, we found no statistically different changes between groups for white matter and WMH volumes, and for white matter integrity (P > 0.1). Total grey matter volume decreased significantly less in PHIV [group∗time 10 ml, 95% confidence interval −1 to 20, P = 0.078], but this difference in rate of change lost statistical significance after additional adjustment for height (group∗time 9 ml, 95% confidence interval −2 to 20, P = 0.112). We found no HIV-associated determinants for potential reduced grey matter pruning, nor associations with cognitive development.

Conclusion:

While using long-term antiretroviral treatment, structural brain development of adolescents growing up with perinatally acquired HIV appears largely normal.