bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Pediatricians, Pediatric Associations, and Academic Departments in Ensuring Optimal Early Childhood Development Globally: Position Paper of the International Pediatric Association
Authors: Uchitel Julie , Alden Errol , Bhutta Zulfiqar A. , Cavallera Vanessa , Lucas Jane , Oberklaid Frank , Patterson Janna , Raghavan Chemba , Richter Linda , Rikard Blaire , Russell Robert Ross , Mikati Mohamad A.
Published: August 2022

Early childhood (birth–8 years), particularly the first 3 years, is the most critical time in development because of the highly sensitive developing brain. Providing appropriate developmental care (i.e., nurturing care, as defined by the World Health Organization [WHO]) during early childhood is key to ensuring a child's holistic development. Pediatricians are expected to play a critical role in supporting early childhood development (ECD) through providing developmental services such as developmental monitoring, anticipatory guidance, screening, and referral to medical and/or community-based services when delay is identified. Pediatricians are also expected to serve as advocates within their clinics and communities for improved delivery of ECD services, such as advocating for increasing funding for ECD initiatives, increasing insurance coverage of ECD services, and working to increase other pediatricians' awareness of the principles of ECD and how to deliver developmental services. However, this does not always occur. Typically, pediatricians' training and practice emphasizes treating disease rather than enhancing ECD. Pediatricians are further hindered by a lack of uniformity across nations in guidelines for developmental monitoring and screening. In this article, we present the vision of the International Pediatric Association (IPA) of the roles that pediatricians, academic departments, medical training programs, and pediatric associations should fulfill to help support ECD, including raising ECD to higher levels of priority in routine pediatric care. First, we present the challenges that face these goals in supporting ECD. We then propose, with supportive literature, strategies and resources to overcome these challenges in collaboration with local and international stakeholders, including the IPA, the WHO, UNICEF, and the World Bank.
Precision Medicine and Sickle Cell Disease
Authors: El Hoss Sara , El Nemer Wassim , Rees David C.
Published: August 2022

Sickle cell disease (SCD) is characterized by variable clinical outcomes, with some patients suffering life-threatening complications during childhood, and others living relatively symptom-free into old age. Because of this variability, there is an important potential role for precision medicine, in which particular different treatments are selected for different groups of patients. However, the application of precision medicine in SCD is limited by difficulties in identifying different prognostic groups and the small number of available treatments. The main genetic determinant of outcomes in SCD is the underlying β-globin genotype, with sickle cell anemia (HbSS) and hemoglobin SC disease (HbSC) forming the 2 major forms of the disease in most populations of African origin. Although there are clear differences in clinical outcomes between these conditions, treatments approaches are very similar, with little evidence on how to treat HbSC in particular. Other genomic information, such as the co-inheritance of α-thalassemia, or high fetal hemoglobin (HbF) levels, is of some prognostic value but insufficient to determine treatments. Precision medicine is further limited by the fact that the 2 main drugs used in SCD, penicillin and hydroxyurea, are currently recommended for all patients. Newer treatments, such as crizanlizumab and voxelotor, raise the possibility that groups will emerge who respond best to particular drugs or combinations. Perhaps the best current example of precision medicine in SCD is the selective use of blood transfusions as primary stroke prevention in children with evidence of cerebral vasculopathy. More precise treatments may emerge as we understand more about the pathology of SCD, including problems with erythropoiesis.
Prevalence and Risk Factors of Glaucoma Among Chinese People From the China Health and Retirement Longitudinal Study
Authors: Sun Junran , Li Tong , Zhao Xiaohuan , Lu Bing , Chen Jieqiong , Liu Wenjia , Zhou Minwen , Sun Xiaodong
Published: August 2022

Précis:

This study demonstrated the prevalence of self-reported glaucoma and its strong association with preexisting systemic chronic diseases in China using the baseline data from China Health and Retirement Longitudinal Study (CHARLS), a nationwide population-based cohort.

Purpose:

The purpose of this study is to estimate the prevalence of self-reported glaucoma and its risk factors using data from the CHARLS.

Materials and Methods:

Data on age, sex, area of residence, education, marital status, health-related behaviors, and preexisting comorbidities for this cross-sectional study were retrieved from the CHARLS for 17,713 subjects who completed a questionnaire between June 2011 and March 2012. The prevalence of glaucoma was estimated, and a multivariate weighted analysis was performed to estimate the odds ratios (ORs) of its risk factors.

Results:

Of 16,599 respondents (93.7%) who answered questions regarding glaucoma and their history of systemic chronic diseases, 314 (1.89%) reported having glaucoma before the index date. Qinghai and Beijing had the highest prevalence of glaucoma in China. Glaucoma was significantly associated with hypertension [OR: 1.362; 95% confidence interval (CI), 1.801–2.470], diabetes (OR: 2.597; 95% CI, 1.661–10.207), dyslipidemia (OR: 1.757; 95% CI, 1.157–3.650), lung disease (OR: 2.098; 95% CI, 1.674–6.527), stroke (OR: 5.278; 95% CI, 1.094–25.462), heart disease (OR: 1.893; 95% CI, 1.237–3.363), and health-related behaviors such as smoking and alcohol consumption after adjusting for age, sex, area, education, marital status, and medical insurance.

Conclusions:

Geographic variation in the prevalence of self-reported glaucoma and its strong association with preexisting systemic chronic diseases were observed, suggesting that in addition to ophthalmological examinations, regular physical examinations are necessary for glaucoma patients, especially in areas of high incidence. Appropriate strategies to improve preventive measures for glaucoma are recommended for the Chinese population.
Outcomes of Kahook Dual Blade Goniotomy for Uveitis Associated Open Angle Glaucoma or Ocular Hypertension
Authors: Miller Victoria J. , Patnaik Jennifer L. , Young Cara E. Capitena , SooHoo Jeffrey R. , Seibold Leonard K. , Kahook Malik Y. , Ertel Monica K. , Palestine Alan G. , Pantcheva Mina B.
Published: August 2022

Précis:

Kahook Dual Blade (KDB) goniotomy can successfully lower intraocular pressure in some patients with uveitis-associated ocular hypertension or glaucoma.

Purpose:

The purpose of this study was to report a case series of patients that underwent KDB goniotomy at a single institution for uveitis-associated ocular hypertension or glaucoma with an open angle.

Methods:

We performed a retrospective chart review of all patients with uveitis-associated ocular hypertension or glaucoma who underwent KDB goniotomy with trabecular meshwork excision alone or in combination with phacoemulsification cataract surgery at a single center between August 2017 and February 2020. The case series included 45 eyes of 37 patients. All eyes developed ocular hypertension refractory to maximum-tolerated medical therapy and required surgical intervention. Two eyes were excluded as they were lost to follow-up before 5 months postoperatively. Surgical success was defined as reaching the goal intraocular pressure or lower for each patient, including ongoing medical therapy.

Results:

At most recent follow-up, 25 (55.6%) of 45 eyes had an intraocular pressure that was at goal. Mean follow-up time was 15.2±12.1 months ranging from 0.5 to 36 months postoperatively, considering that patients were eliminated from the data analysis once they required a second surgery. The mean number of preoperative medications, including oral carbonic anhydrase inhibitors was 3.7±1.2 medications. The mean number of postoperative medications through the last clinic visit was 2.5±1.9 medications for a mean reduction of 1.2±1.6 medications (P-value <0.0001*).

Conclusions:

This larger case series shows that some patients with uveitis-associated ocular hypertension or glaucoma with an open angle may have success with KDB goniotomy.
Peripapillary and Macular Structural and Vascular Parameters in Age-Related Choroidal Atrophy
Authors: Ucgul Atilgan Cemile , Hondur Gozde , Citirik Mehmet
Published: August 2022

Précis:

The macular and peripapillary structural and vascular alterations in elderly patients with age-related choroidal atrophy may mimic glaucomatous degeneration.

Purpose:

To evaluate the peripapillary retinal nerve fiber layer (pRNFL), macular nerve fiber layer (mNFL), ganglion cell layer (mGCL), inner plexiform layer (mIPL) thicknesses, and choroidal vascularity index (CVI) values in patients with age-related choroidal atrophy (ARCA) and to compare with the those of age and sex-matched healthy controls.

Methods:

The cross-sectional, observational study included 95 eyes of 95 patients. The patients were divided into 2 groups according to subfoveal choroidal thickness (sCT) values. Forty eight eyes with sCT<125 µm constituted ARCA group (group 1), and 47 eyes with sCT>125 µm constituted control group (group 2). Peripapillary RNFL, mNFL, mGCL, mIPL, sCT values and fundus autofluorescence images were acquired with spectral domain-optical coherence tomography. Enhanced depth imaging mode spectral domain-optical coherence tomography images were binarized to show the luminal and stromal areas of choroid. CVI (%) was defined as the ratio of the luminal area to the total choroidal area with defined borders.

Results:

The mean age was 78.47±6.07 years in group 1 and 76.95±6.68 years in group 2. The mean, superior and inferior quadrants pRNFL thicknesses were significantly lower in group 1 than in group 2 (P<0.05 for all). The mean mNFL, mGCL, mIPL thickness values were also statistically lower in group 1 than group 2 (P<0.05 for all). The CVI value was 61.29±4.52 in group 1, and 64.81±3.80 in group 2 (P<0.001).

Conclusion:

The patients with ARCA had decreased pRNFL, inner macular layer thickness and CVI values when compared with healthy control eyes. These findings should be considered in the differential diagnosis and the follow up of eyes with glaucoma.
Effect of Aerobic Exercise at Different Intensities on Intraocular Pressure in Young Males
Authors: Alfaqeeh Fatima , Djemai Haidar , Hammad Rami , Hammad Saleh , Noirez Philippe , Dabayebeh Ibrahim M.
Published: August 2022

Précis:

High intensity aerobic exercise significantly reduced intraocular pressure in healthy young male adults.

Objective:

This study sought to determine how aerobic exercise at various intensities affects intraocular pressure (IOP) in young adults.

Design:

A repeated measures design was adopted.

Participants:

A group of 20 volunteers (mean age: 21.24±1.73 y) took part in this study.

Methods:

IOP was measured with a tonometer (iCare TA01i, Icare Finland, Finland). Subjects completed 4 cycle ergometer sessions. During the first session, power was increased by 60 W every 3 minutes until exhaustion, corresponding to peak power. For the 3 following tests, each lasting 25 minutes, subjects exercised at intensities of 50%, 70%, and 85% of peak power, respectively, and measurements were taken every 5 minutes.

Main Outcome Measures:

IOP, as determined using a tonometer, was the primary measure.

Results:

There was a significant reduction (P<0.05) in IOP of both eyes during the 25 minutes high-intensity (85%) exercise test. There were also significant interactions between exercise durations and intensities. During high-intensity exercise, IOP, blood pressure, blood lactate, and the rating of perceived exertion were significantly related (P<0.01).

Conclusions:

These data show a significant reduction in IOP at high-intensity aerobic exercise, which may have implications for the management of ocular health.
Outcomes of Penetrating Canaloplasty in Childhood Glaucoma
Authors: Le Rongrong , Xie Yanqian , Cheng Huanhuan , Chen Hong , Ye Wenqing , Deng Yuxuan , Gu Juan , Xu Jing , Hu Cheng , Zhang Shaodan , Liang Yuanbo
Published: August 2022

Précis:

Penetrating canaloplasty was safe and effective for the management of refractory childhood glaucoma.

Purpose:

The purpose of this paper is to report the safety and efficacy of penetrating canaloplasty for the management of childhood glaucoma.

Materials and Methods:

This single-center prospective interventional case series enrolled 50 eyes of 32 patients with childhood glaucoma between July 2017 and July 2020. Penetrating canaloplasty to create direct communication between the anterior chamber and tensioning suture-dilated the Schlemm canal was performed through a trabecular meshwork ostium in the affected eyes. Preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, and procedure-related complications were recorded. Qualified and complete success was defined as IOP≥5 and ≤21 mm Hg with or without glaucoma medications, respectively.

Results:

A total of 43 eyes (86.0%) achieved 360 degrees catheterization of Schlemm canal and completed penetrating canaloplasty. The median age at surgery was 5 years (range, 10 d–17 y, mean 6.20±5.46 y). The mean IOP decreased from 33.11±10.89 mm Hg on 2 medications (median, range: 0–5) before surgery to 13.46±4.71 mm Hg on 0 medications (median, range:0–2) postoperatively at 12 months (P<0.001). Complete and qualified success rates were 81.08% and 89.19%, respectively, at the 12-month follow-up. Hyphema (6/43, 13.95%) and a transient shallow anterior chamber with hypotony (5/43, 11.63%) were the most commonly observed early complications.

Conclusion:

Penetrating canaloplasty demonstrated good safety and efficacy in eyes with childhood glaucoma, and may be considered an option for managing refractory childhood glaucoma.
Does Increasing the Severity of Penalties Assessed in Association With the “Zero Tolerance for Head Contact” Policy Translate to a Reduction in Head Impact Rates in Youth Ice Hockey?
Authors: Williamson Rylen A. , Kolstad Ash T. , Nadeau Luc , Goulet Claude , Hagel Brent , Emery Carolyn A.
Published: August 2022

Objective:

The risk of concussion is high in Canadian youth ice hockey. Aiming to reduce this burden, in 2011, Hockey Canada implemented a national “zero tolerance for head contact (HC)” policy mandating the penalization of any player HC. In 2018 to 2020, Hockey Canada further amended this HC policy including stricter enforcement of severe HCs. This study aimed to compare HC rates, head impact location, and HC enforcement prepolicy, postpolicy, and after policy amendments in elite U15 Canadian youth ice hockey.

Design:

This is a prospective cohort study.

Setting:

A collection of events with the video camera located at the highest point near center ice in public ice hockey arenas in Calgary, Alberta.

Participants:

A convenience sample of 10 AA U15 games prepolicy (2008-2009), 8 games postpolicy (2013-2014), and 10 games after policy amendments (2020-2021).

Independent Variables:

An analysis of 3 cohort years regarding the HC-policy implementation and amendments.

Main Outcome Measures:

Using Dartfish video-analysis software, all player contacts and HCs [direct (HC1), indirect (eg, boards, ice) (HC2)] were tagged using validated criteria. Univariate Poisson regression clustering by team-game offset by game length (minutes) was used to estimate incidence rates (IR) and incidence rate ratios (IRR) between cohorts.

Results:

With additional rule modifications, a 30% reduction in HC1s emerged (IRR2013-2020 = 0.70, 95% CI, 0.51-0.95). Since the HC-policy implementation, HC1s decreased by 24% (IRR2008-2020 = 0.76, 95% CI, 0.58-0.99). The proportion of HC1s penalized was similar across cohorts (P2008-2009 = 14.4%; P2013-2014 = 15.5%; P2020-2021 = 16.2%).

Conclusions:

The HC-policy amendments have led to decreased HC1 rates. However, referee enforcement can further boost the HC-policy effectiveness. These findings can help future referee training and potential rule modifications to increase player safety nationally.
The impact of genital lichen sclerosus and lichen planus on quality of life: A review
Authors: Ranum Alison , Pearson David R.
Published: August 2022

Background:

Lichen sclerosus (LS) and lichen planus (LP) are inflammatory diseases that demonstrate genital and extra-genital manifestations. Genital involvement may result in pruritus, sexual dysfunction, pain, and irritation. It is intuitive that the severity of symptoms may result in functional impairment and emotional distress, leading to a reduction in quality of life (QoL).

Objective:

Investigate the current literature on the impact of genital LS and LP on QoL.

Methods:

A literature review was performed using PubMed and results were summarized. Articles published between 1994 and 2020 were screened and reviewed by both the authors.

Results:

These diseases have been assessed with dermatological assessments, such as the Skindex-29 and the Dermatology Life Quality Index, general health surveys such as the Short Form-12 questionnaire, and mental health instruments including the Beck Depression Inventory, and others; these instruments consistently demonstrate impaired QoL. It follows that treatment may reduce these symptoms. Interventions, such as photodynamic therapy, have demonstrated improvement in the depressive symptoms that impact QoL. Although both females and males experience a reduction in QoL related to these diseases, they experience the symptomatology differently. Through interviewing, male patients were more likely to report no symptoms compared with female patients, while female patients were also more likely to report worse QoL in the work-school domain of the Dermatology Life Quality Index as compared with male patients.

Limitations:

Few studies have addressed the effect of disease severity or treatment on QoL.

Conclusions:

Understanding how genital LS and LP contribute to reduced QoL for patients is critical for health care providers to better prioritize treatment strategies. Future prospective studies should investigate how QoL correlates with disease severity and response to treatment.
Characterization of thrombophilia-related plasmas evaluated by anticoagulants-mediated thrombin and plasmin generation assays
Authors: Hashimoto Naoki , Ogiwara Kenichi , Matsumoto Tomoko , Furukawa Shoko , Takeyama Masahiro , Nogami Keiji
Published: August 2022

Disturbances in the balance between coagulation, anticoagulation and fibrinolysis may lead to thrombosis or haemorrhage. Simultaneous assessments of thrombin and plasmin facilitate overall understandings of pathological haemostasis, especially for thrombophilia. Here, we characterized coagulation–fibrinolysis potentials in plasmas with thrombophilia using anticoagulants-mediated thrombin-plasmin generation assay (T/P-GA). T/P-GA was initiated by adding tissue factor, tissue-type plasminogen activator and anticoagulants [recombinant-thrombomodulin (rTM), activated protein (P)C (APC) and antithrombin (AT)], followed by simultaneous thrombin generation and plasma generation monitoring. Patients’ plasmas with PC-deficiency (PC-def), PS-deficiency (PS-def), AT-deficiency (AT-def), factor VLeiden (FVL) and antiphospholipid syndrome (APS) were evaluated. A ratio of peak-thrombin (or peak-plasmin) with and without anticoagulants was calculated as anticoagulants (+)/anticoagulants (−). First, TG, in rTM-mediated, PC-def, PS-def and FVL showed higher peak-thrombin ratios than the controls, whereas AT-def and APS exhibited no differences from the controls. In APC-mediated, PC-def, PS-def and AT-def showed low peak-thrombin ratios, similar to the controls, but immune-depleted PS-def (<1%) showed the higher ratio than the controls. FVL and APS showed higher peak-thrombin ratios than the controls. In AT-mediated, peak-thrombin ratios in PS-def, PC-def and APS were lower than in controls, but those in AT-def and FVL was not significantly different from the controls. Second, PG, in rTM-mediated, all thrombophilia plasmas showed low peak-plasmin ratios (∼0.5), but no significant difference was observed, relative to the controls. In APC and AT-mediated, peak-plasmin ratios in thrombophilia-related plasmas were similar to the controls (∼1.0). Anticoagulants-mediated T/P-GA may classify thrombin generation characteristics in thrombophilia-related plasmas upon adding anticoagulants.
Comparison of clinical profiles and associated factors for acute myocardial infarction among young and very young patients with coronary artery disease
Authors: Zhang Dongfeng , Zuo Huijuan , Yang Hongxia , Zhang Min , Ge Changjiang , Song Xiantao
Published: August 2022

Background

This study aimed to compare the profiles of young and very young patients with coronary artery disease (CAD) and explore the factors associated with acute myocardial infarction (AMI) based on age.

Methods

Young CAD patients aged between 18 and 44 years diagnosed by angiography were enrolled retrospectively. They were divided into two groups according to age: young CAD was defined as patients aged between 36 and 44 years, and very young CAD was defined as patients aged between 18 and 35 years. Demographic and clinical characteristics of the patients were collected.

Results

In total, 9286 patients were included in the final database. Most were assigned to the young CAD group (86.5%), and 1250 (13.5%) had very young CAD. Most demographic and clinical characteristics of the young and very young patients with CAD differed significantly. The proportion of patients with CAD in the total population increased with age, whereas the incidence of AMI showed a decreasing trend. A previous percutaneous coronary intervention (PCI) was negatively associated with AMI. Dyslipidemia, current smoking, and hyperhomocysteinemia were positively associated with AMI in the overall and young population with CAD.

Conclusions

The clinical profiles and factors associated with AMI in CAD patients of different ages were significantly different. Lifestyle-related factors were significantly associated with AMI in young patients with CAD.
Split-Belt Adaptation and Savings in People With Parkinson Disease
Authors: Thompson Elizabeth D. , Reisman Darcy S.
Published: August 2022

Background and Purpose:

Upper extremity studies suggest that implicit adaptation is less impaired than explicit learning in persons with Parkinson disease (PD). Little work has explored implicit locomotor adaptation and savings in this population, yet implicit locomotor learning is critical for everyday function. This cross-sectional study examined adaptation and savings in individuals with PD during split-belt treadmill walking.

Methods:

Fourteen participants completed the following treadmill protocol: Baseline (6 minutes belts tied), Adaptation (10 minutes split), Washout (10 minutes tied), and Readaptation (10 minutes split). Step length and step symmetry index (SSI) were calculated to determine magnitude and rate of adaptation and savings. Rate was calculated as strides to reach SSI plateau during Adaptation and Readaptation.

Results:

During Early Adaptation and Early Readaptation, SSI was perturbed from Baseline (P < 0.001 and P = 0.002, respectively). Less perturbation in Early Readaptation (P < 0.001) demonstrated savings. In Late Adaptation and Late Readaptation, participants returned to Baseline symmetry (P = 0.026 and P = 0.022, respectively, with adjusted level of significance = 0.007). Adaptation was also seen in reverse asymmetry observed in Early Washout (P = 0.003 vs Baseline). Readaptation rate was faster than in Adaptation (P = 0.015), demonstrating savings.

Discussion and Conclusions:

Individuals with PD showed locomotor adaptation in an implicit sensorimotor adaptation task. They also demonstrated savings, with less perturbation and faster adaptation during the second split-belt exposure. However, performance was variable; some individuals showed minimal adaptation. Variations in learning, savings, and clinical presentation highlight the need to further explore characteristics of individuals with PD most likely to benefit from adaptation-based locomotor training.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A395).
Lessons Learned in Outpatient Physical Therapy for Motor Functional Neurological Disorder
Authors: Maggio Julie , Kyle Kevin , Stephen Christopher D. , Perez David L.
Published: August 2022

Background and Purpose:

Motor functional neurological disorder is a prevalent and costly condition at the intersection of neurology and psychiatry that is diagnosed using positive “rule-in” signs. Physical therapy is a first-line treatment and consensus recommendations exist to guide clinical care. Nonetheless, optimal outpatient treatment of adults with functional motor symptoms requires an expanded physical therapy tool kit to effectively guide care.

Summary of Key Points:

In this article, lessons learned from a physical therapist practicing in a multidisciplinary and interdisciplinary outpatient functional neurological disorder clinic are highlighted. In doing so, we discuss how use of the biopsychosocial model and neuroscience constructs can inform physical therapy interventions. The importance of team-based care and the delivery of physical therapy through video telehealth services are also outlined.

Recommendations for Clinical Practice:

Use of the biopsychosocial formulation to triage clinical challenges and guide longitudinal care, coupled with application of neuroscience to aid intervention selection, allows for patient-centered physical therapy treatment across the spectrum of functional motor symptoms.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A400).
Neurocheck Frequency
Authors: LaBuzetta Jamie Nicole , Kazer Max R. , Kamdar Biren B. , Owens Robert L. , Evans John H. , Stone Lauren , Malhotra Atul
Published: August 2022

Background:

Following acute brain injury, patients in the intensive care unit often undergo hourly or every-other-hour exams (“neurochecks”) to monitor for neurodeterioration. We assessed health care provider attitudes towards neurocheck frequency and evaluated providers’ ideal neurocheck frequency.

Methods:

This was a cross-sectional, online survey distributed in Spring 2021 at a tertiary care academic medical center. Providers from multiple intensive care unit and neuroscience clinical specialties including attending faculty, medical trainees, advanced practice providers, and bedside nurses were invited to participate.

Results:

Among 177 participants, 61 (34%) and 116 (66%) were self-identified as ordering and performing providers, respectively. The survey response rate was 58% among physicians and 51% among bedside nurses with neurological expertise. The most common medical and non-medical reasons for ordering hourly neurochecks were “a specific diagnosis with anticipated course” and “standard of care”, respectively. Compared with ordering providers, performing providers felt guidelines regarding neurocheck frequency (P<0.01) and duration (P<0.01) should be proscriptive. Conversely, ordering providers felt hourly neurochecks were detrimental to patients with acute brain injury (P=0.02) and believed they would not utilize hourly neurochecks if there was another mode of monitoring available (P=0.03). Performing providers identified multiple patient-related factors impacting the difficulty of and their willingness to perform frequent neurochecks, and only 70% of neurochecks were perceived to be performed as ordered. Both ordering and performing providers preferred every-other-hour neurochecks following acute brain injury.

Conclusions:

This survey revealed clinically relevant differences in ordering versus performing provider attitudes about frequent neurochecks. Providers preferred every-other-hour rather than hourly neurochecks.
Development and use of a method based on the anti-N reactivity of longitudinal samples to better estimate SARS-CoV-2 seroprevalence in a vaccinated population
Authors: Bazin Renée , Rochette Samuel , Perreault Josée , Fournier Marie-Josée , Grégoire Yves , Boivin Amélie , Lewin Antoine , Germain Marc , Renaud Christian
Published: August 2022

Background

Emerging evidence suggests that COVID-19 vaccination decreases the sensitivity of anti-nucleocapsid (N) serologies, making them less reliable to assess recently-acquired infections. We therefore developed and tested a new approach based on the ratio of the anti-N absorbance of longitudinal samples to overcome this limitation.

Methods

Previously vaccinated repeat plasma donors provided at least one pre-infection (reference) and one post-infection (test) sample. All samples were tested using an in-house anti-N ELISA. Seropositivity was determined based on the ratio between the anti-N absorbance of the test and reference samples. The ratio approach was tested in a real-world setting during three cross-sectional serosurveys carried out among plasma donors in Québec, Canada.

Results

Using a cut-off ratio of 1.5, the approach had a sensitivity of 95.2% among the 248 previously vaccinated and infected donors compared with 63.3% for the conventional approach. When tested in a real-world setting, the ratio-based approach yielded an adjusted seroprevalence of 27.4% (95% confidence interval [CI]=23.8%-30.9%) at the latest time point considered, compared to 15.1% (95% CI=12.2%-18.0%) for the conventional approach.

Conclusions

This article describes a new and highly-sensitive approach that captures a significantly greater proportion of vaccinated individuals with a recent history of SARS-CoV-2 infection.
Extending Healthcare Access via Telemedicine in Public Libraries: A Mixed Methods Study
Authors: DeGuzman Pamela B. , Garth Jennifer , Sanjay Kamya , Compton Rebekah M.
Published: August 2022

Background

Despite the potential for telemedicine in public libraries to expand healthcare access to those living a long distance from care and in broadband poor areas, there are few collaborations between libraries and healthcare providers offering these programs.

Purpose

To explore licensed independent providers’ perspectives (LIPs) on telemedicine in public libraries as a method of improving equitable access to care for populations lacking the ability to connect to a telemedicine video visit from home.

Methods

We used a two-phase explanatory sequential mixed methods design with a quantitative strand followed by a qualitative strand to explore LIPs’ perspective on telemedicine in public libraries. Surveys were analyzed descriptively and to determine group differences. Survey respondents were recruited to participate in interviews, which were analyzed thematically using descriptive content analysis.

Findings

Fifty LIPs responded to the survey, and 12 were interviewed. Respondents were overwhelmingly supportive of telemedicine in public libraires, describing how video visits could help multiple vulnerable populations connect to providers when travel was cost prohibitive. They emphasized how connecting at-risk populations to a video visit instead of a telephone call allowed for a more thorough and accurate assessment. While several LIPs were concerned with privacy, others considered a library to be more private than the home. Interviews revealed how chronic illness management may be the ideal visit type for public library-based telemedicine.

Conclusions

Given the importance of expanding access sites for telemedicine, providers should consider partnering with libraries in their catchment areas where broadband access is sparse, and patients must travel long distances to care. Managing chronic illnesses using telemedicine in public libraries may be an important approach toward reducing health disparities in populations who live long distances from care and do not have home-based internet access.
Geographic barriers to care persist at the community healthcare level: evidence from rural Madagascar
Authors: Evans Michelle V , Andréambeloson Tanjona , Randriamihaja Mauricianot , Ihantamalala Felana , Cordier Laura , Cowley Giovanna , Finnegan Karen , Hanitriniaina Feno , Miller Ann C. , Ralantomalala Lanto Marovavy , Randriamahasoa Andry , Razafinjato Bénédicte , Razanahanitriniaina Emeline , Rakotonanahary Rado JL , Andriamiandra Isaïe Jules , Bonds Matthew H , Garchitorena Andres
Published: August 2022

Geographic distance is a critical barrier to healthcare access, particularly for rural communities with poor transportation infrastructure who rely on non-motorized transportation. There is broad consensus on the importance of community health workers (CHWs) to reduce the effects of geographic isolation on healthcare access. Due to a lack of fine-scale spatial data and individual patient records, little is known about the precise effects of CHWs on removing geographic barriers at this level of the healthcare system. Relying on a high-quality, crowd-sourced dataset that includes all paths and buildings in the area, we explored the impact of geographic distance from CHWs on the use of CHW services for children under 5 years in the rural district of Ifanadiana, southeastern Madagascar from 2018-2021. We then used this analysis to determine key features of an optimal geographic design of the CHW system, specifically optimizing a single CHW location or installing additional CHW sites. We found that consultation rates by CHWs decreased with increasing distance patients travel to the CHW by approximately 28.1% per km. The optimization exercise revealed that the majority of CHW sites (50/80) were already in an optimal location or shared an optimal location with a primary health clinic. Relocating the remaining CHW sites based on a geographic optimum was predicted to increase consultation rates by only 7.4%. On the other hand, adding a second CHW site was predicted to increase consultation rates by 31.5%, with a larger effect in more geographically dispersed catchments. Geographic distance remains a barrier at the level of the CHW, but optimizing CHW site location based on geography alone will not result in large gains in consultation rates. Rather, alternative strategies, such as the creation of additional CHW sites or proactive care, should be considered.
Potential utility of plasma p-tau and NfL as surrogate biomarkers for preventive clinical trials
Authors: Ferreira Pâmela C. L , Ferrari-Souza João Pedro , Tissot Cécile , Bellaver Bruna , Leffa Douglas T. , Lussier Firoza Z. , Povala Guilherme , Therriault Joseph , Benedet Andrea L. , Ashton Nicholas J. , Cohen Ann D. , Lopez Oscar L. , Tudorascu Dana L. , Klunk William E. , Soucy Jean-Paul , Gauthier Serge , Villemagne Victor L. , Zetterberg Henrik , Blennow Kaj , Rosa-Neto Pedro , Zimmer Eduardo R , Karikari Thomas K. , Pascoal Tharick A. ,   Alzheimer’s Disease Neuroimaging Initiative
Published: August 2022

Background

Although longitudinal changes in plasma phosphorylated tau 181 (p-tau181) and neurofilament light (NfL) correlate with Alzheimer’s disease (AD) progression, it is unknown whether these changes can be used to monitor drug effects in preventive clinical trials. Here, we tested the utility of changes in plasma p-tau181 and NfL as surrogate biomarkers for clinical trials focusing on cognitively unimpaired (CU) individuals.

Methods

We evaluated 257 CU older individuals with amyloid-beta (Aβ) positron emission tomography (PET) at baseline, as well as the baseline, up to 24-month plasma p-tau181 and NfL measures. Linear regressions and Cox-proportional hazards tested the associations of change in markers with age and clinical progression, respectively. We estimated the sample size needed to test a 25% drug effect with 80% of power at a 0.05 level on reducing changes in plasma markers.

Results

Longitudinal changes in plasma NfL were associated with age, while changes in plasma p-tau181 with progression to amnestic MCI. Clinical trial using p-tau181 and NfL would require 78% and 63% smaller sample sizes, respectively, for a 24-month than a 12-month follow-up. The use of Aβ positivity for enrichment had a larger impact on reducing the sample size required for trials using p-tau181 (43% reduction) than NfL (17%) as surrogate. Notably, population enrichment with intermediate levels of Aβ, rather than merely Aβ positivity, reduced the sample size by 88% for p-tau181 and 64% for NfL over 12 months, and by 73% for p-tau181 and 59% for NfL over 24 months.

Conclusion

Our results highlighted that changes in plasma NfL could be used as a surrogate for age-related degeneration, while longitudinal changes in plasma p-tau181 were associated with parallel clinical progression. A follow-up duration of 24 months was associated with more stable changes in plasma measures and, consequently, a greater effect size than a follow-up period of 12 months. The enrollment of CU subjects with intermediate levels of Aβ constitutes the alternative with the largest effect size for clinical trials quantifying plasma p-tau181 and NfL over 12 and 24 months.
Alignment of Community Benefit Spending and Initiatives to Improve Community Health: Is There Evidence of Progress?
Authors: Sapirstein Abel , Rao Arthi , Steimle Lauren N.
Published: August 2022

Objectives

We sought to identify changes in non-profit hospitals’ community benefit spending from 2014 to 2019. Secondly, we wanted to find novel predictors of spending in the most recent available data.

Methods

For our longitudinal analysis, we used tax filing data for 1072 hospitals from 2014-2019 and time-based ANOVA. We gathered information about hospital characteristics, the social determinants of health, and hospital partnerships with local communities for 1192 hospitals for the year 2019. We employed multivariate regression to identify significant factors.

Results

Total community benefit spending rose from 8.1% in 2014 to 9.1% of operating expenses in 2019, driven by increased spending on patient care. There was no such increase in spending on activities targeted at improving community health. The presence and strength of partnerships between hospitals and their communities were associated with higher community benefit spending.

Conclusions

We found no evidence of dramatic shifts in community benefit spending from 2014 to 2019. Further, we identified partnerships for population health improvement as an effective, novel predictor of community benefit spending. Supporting partnerships between hospitals and communities may help facilitate strategic investments in community health improvement.
Effects of Long-Term Supplementation of Eggs on Growth, Biochemical Indices, and Microbiota of Rural Thai Primary School Children
Authors: Suta Sophida , Surawit Apinya , Mongkolsucharitkul Pichanun , Pinsawas Bonggochpass , Manosan Thamonwan , Ophakas Suphawan , Pongkunakorn Tanyaporn , Pumeiam Sureeporn , Sranacharoenpong Kitti , Sutheeworapong Sawannee , Phuangsombut Patcha , Khoomrung Sakda , Thaipisuttikul Iyarit , Mayurasakorn Korapat
Published: August 2022

Background

Protein-energy malnutrition is still problematic worldwide. It directly impacts growth and development, especially in children. We investigated the long-term effects of egg supplementation on the growth, biochemical indices, and microbiota of primary school children.

Methods

A randomized controlled cluster study was carried out in six rural schools in Thailand. Participants were randomly assigned into three groups: 1) whole egg (WE) – consuming 10 additional eggs/week [n = 238], 2) protein substitute (PS) - consuming yolk-free egg substitute equivalent to 10 eggs/week [n = 200], and 3) control group (n= 197]). Demographic and biochemical indices, and microbiota composition were measured at weeks 0, 14, and 35.

Findings

635 students (8 to 14 years old) were recruited (51·5% female). At baseline, 17% of the participants were underweight, 18% were stunted, and 13% were wasted. At week 35, compared to the control group, body weight and height increased significantly in WE (3·6 ± 23·5 kg,P<0·001 and 5·1 ± 23·2 cm,P<0·001). No significant differences in weight or height were observed between PS and Control. Prealbumin levels were higher (1·5 ± 8·158·6314 mg/dL,P<0·001) in WE, but not in PS, compared to control. Significant decreases in total cholesterol, triglycerides, and LDL cholesterol were observed in the WE, but not in the PS groups. HDL cholesterol tended to increase in WE (0·7 ± 25·2 mg/dL,ns). Neither the alpha nor beta diversity of the bacterial diversity was significantly different among all groups. After WE supplementation, the overall relative abundance ofBifidobacteriumincreased by 1·28-fold as compared to baseline and the differential abundance analysis also indicated thatLachnospiraincreased significantly andVaribaculumdecreased.

Interpretation

Long-term whole egg supplementation is an effective, feasible and low-cost intervention to reduce protein-energy malnutrition, particularly in low-middle-income countries. Whole egg supplementation improves growth and nutritional biomarkers, and positively impacts gut microbiota without adverse effects on blood cholesterol levels.

Funding

Agricultural Research Development Agency (ARDA) of Thailand (PRP6105022310, PRP6505030460).
Field assessment of BinaxNOW antigen tests as COVID-19 treatment entry point at a community testing site in San Francisco during evolving omicron surges
Authors: Schrom John , Marquez Carina , Wang Chung-Yu , Saxena Aditi , Mitchell Anthea M. , Ribeiro Salu , Pilarowski Genay , Nakamura Robert , Rojas Susana , Black Douglas , Contreras Oseguera Maria G. , Diaz Edgar Castellanos , Payan Joselin , Rojas Susy , Jones Diane , Tulier-Laiwa Valerie , Zavaleta Aleks , Martinez Jacqueline , Chamie Gabriel , Glaser Carol , Jacobsen Kathy , Petersen Maya , DeRisi Joseph , Havlir Diane
Published: August 2022

Background

COVID-19 oral treatments require initiation within 5 days of symptom onset. Although antigen tests are less sensitive than RT-PCR, rapid results could facilitate entry to treatment. As SARS-CoV-2 variants and host immunity evolve, it is important to characterize the use case for rapid antigen tests for treatment entry.

Methods

We collected anterior nasal swabs for BinaxNOW and RT-PCR testing and clinical data at a walk-up, community site in San Francisco, California between January and June 2022. SARS-CoV-2 genomic sequences were generated from positive samples and classified according to subtype and variant. Monte Carlo simulations were conducted to estimate the expected proportion of SARS-CoV-2 infected persons who would have been diagnosed within 5 days of symptom onset using RT-PCR versus BinaxNOW testing.

Results

Among 25,309 persons tested with BinaxNOW, 2,952 had concomitant RT-PCR. 1321/2952 (44.7%) were SARS-CoV-2 RT-PCR positive. We identified waves of predominant omicron BA.1, BA.2, BA.2.12, BA.4, and BA.5 among 720 sequenced samples. Among 1,321 RT-PCR positive samples, 938/1321 (71%) were detected by BinaxNOW; 95% (774/817) of those with Ct value <30 were detected by BinaxNOW. BinaxNOW detection was consistent over lineages. In analyses to evaluate entry to treatment, BinaxNOW detected 82.7% (410/496, 95% CI: 79-86%) of persons with COVID-19 within 5 days of symptom onset. In comparison, RT-PCR (24-hour turnaround) detected 83.1% (412/496 95% CI: 79-86%) and RT-PCR (48-hour turnaround) detected 66.3% (329/496 95% CI: 62-70%) of persons with COVID-19 within 5 days of symptom onset.

Conclusions

BinaxNOW detected high viral load from anterior nasal swabs consistently across omicron sublineages emerging between January and June of 2022. Simulations support BinaxNOW as an entry point for COVID-19 treatment in a community field setting.
Prevalence and Characterization of Bacteria Present in the Nasopharynx of Outpatients with and without SARS-CoV-2
Authors: Shurko James F. , Mares Chris A. , Page Robert B. , Lopez Kristina , Nguyen Vivian , Vanee Niti , Mishra Pramod K.
Published: August 2022

COVID-19 has emerged as a highly contagious and debilitating disease caused by the SARS-CoV-2 virus and has claimed the lives of over 6.8 million people worldwide. Bacterial co-infections are one of many co-morbidities that have been suggested to impact the outcome of COVID-19 in patients. The primary goal of this study was to assess the prevalence of bacterial co-infections and to describe any trends observed during the height of the COVID-19 pandemic. To do this, we investigated SARS-CoV-2 and bacterial co-infections from outpatient RT-PCR testing in Texas. The results indicateStaphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Moraxella catarrhalis, andHaemophilus influenzaewere the most frequently detected bacterial pathogens in both SARS-CoV-2 positive and SARS-CoV-2 negative patients and that these bacterial pathogens were present in these two patient populations at similar proportions. We also detectedStaphylococcus aureusin a significantly larger proportion of males relative to females and people under 65 years of age relative to those 65 and over. Finally, we found that Hispanics were 75% more likely to be SARS-CoV-2 positive than non-Hispanics. The results suggest that COVID-19 patients may benefit from rapid diagnostic tests for bacterial pathogens and that this information could help delineate targeted antimicrobial therapy.
PHFinder: Assisted detection of point heteroplasmy in Sanger sequencing chromatograms
Authors: Suarez-Menendez Marcos , Rivera-Leon Vania , Robbins Jooke , Bérubé Martine , Palsbøll Per J.
Published: August 2022

Heteroplasmy is the presence of two or more organellar genomes (mitochondrial or plastid DNA) in an organism, tissue, cell or organelle. Heteroplasmy can be detected by visual inspection of Sanger sequencing chromatograms, where it appears as multiple peaks of fluorescence at a single nucleotide position. Visual inspection of chromatograms is both consuming and highly subjective, as heteroplasmy is difficult to differentiate from background noise. Few software solutions are available to automate the detection of point heteroplasmies, and those that are available are typically proprietary, lack customization or are unsuitable for automated heteroplasmy assessment in large datasets.

Here, we present PHFinder, a Python-based, open source tool to assist in the detection of point heteroplasmies in large numbers of Sanger chromatograms. PHFinder automatically identifies point heteroplasmies directly from the chromatogram trace data. The program was tested with Sanger sequencing data from 100 humpback whale (Megaptera novaeangliae) tissue samples with known heteroplasmies.

PHFinder detected most (90%) of the known heteroplasmies thereby greatly reducing the amount of visual inspection required. PHFinder is flexible, enabling explicit specification of key parameters to infer double peaks (i.e., heteroplasmies).