bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological and work-related factors predicting work engagement in Malaysian employees
Authors: Chan C M H , Wong J E , Wee L H , Jamil N A , Yeap L L L , Swarna Nantha Y , Siau C S
Published: May 2020

Background

Past research on work engagement has focused almost exclusively on either psychological or work-related factors in almost wholly separate literature. There is therefore a need to examine how these factors collectively influence work engagement.

Aims

To determine levels of work engagement and to identify psychological and work-related characteristics predicting work engagement in employees in Malaysia.

Methods

We recruited 5235 employees from 47 public and private organizations in Malaysia who responded to an online health survey. We assessed work engagement with the 9-item Utrecht Work Engagement Scale (UWES-9) and psychological distress using the 6-item Kessler scale. We performed multiple linear regression to determine predictors of work engagement.

Results

Employee mean age was 33.8 years (standard deviation [SD] ± 8.8). The mean work engagement score on the UWES-9 was 3.53 (SD ± 0.94). Eleven of 18 variables on multiple regression predicted work engagement, F(18, 4925) = 69.02, P < 0.001, R2 = 0.201. Factors that predicted higher work engagement were age, marital status, education level, job type, job permanency, longer sleep duration, lower psychological distress and no history of workplace bullying.

Conclusions

Key factors associated with poorer work engagement in Malaysian employees include inadequate sleep, psychological distress and a history of workplace bullying. These are modifiable factors that individuals and employers can target to improve work engagement, ideally tailored according to occupational type.
Clinical Characteristics of Patients Infected With the Novel 2019 Coronavirus (SARS-Cov-2) in Guangzhou, China
Authors: Wang Yaping , Liao Baolin , Guo Yan , Li Feng , Lei Chunliang , Zhang Fuchun , Cai Weiping , Hong Wenxin , Zeng Yu , Qiu Shuang , Wang Jian , Li Yueping , Deng Xilong , Li Jianping , Xiao Guangming , Guo Fengxia , Lai Xunxi , Liang Zhiwei , Wen Xueliang , Li Pinghong , Jiao Qian , Xiang Fangfei , Wang Yong , Ma Chenghui , Xie Zhiwei , Lin Weiyin , Wu Yanrong , Tang Xiaoping , Li Linghua , Guan Yujuan
Published: May 2020

Background

The clinical manifestations and factors associated with the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections outside of Wuhan are not clearly understood.

Methods

All laboratory-confirmed cases with SARS-Cov-2 infection who were hospitalized and monitored in Guangzhou Eighth People’s Hospital were recruited from January 20 to February 10.

Results

A total of 275 patients were included in this study. The median patient age was 49 years, and 63.6% had exposure to Wuhan. The median virus incubation period was 6 days. Fever (70.5%) and dry cough (56.0%) were the most common symptoms. A decreased albumin level was found in 51.3% of patients, lymphopenia in 33.5%, and pneumonia based on chest computed tomography in 86%. Approximately 16% of patients (n = 45) had severe disease, and there were no deaths. Compared with patients with nonsevere disease, those with severe disease were older, had a higher frequency of coexisting conditions and pneumonia, and had a shorter incubation period (all P < .05). There were no differences between patients who likely contacted the virus in Wuhan and those who had no exposure to Wuhan. Multivariate logistic regression analysis indicated that older age, male sex, and decreased albumin level were independently associated with disease severity.

Conclusions

Most of the patients infected with SARS-CoV-2 in Guangzhou, China are not severe cases and patients with older age, male, and decreased albumin level were more likely to develop into severe ones.
MRI Study of Types of Internal Knee Derangements of Traumatic Knee
Authors: Abdelhamied H A , Salama A M , Naguib A M
Published: May 2020

Background

MRI is currently gold standard non-invasive diagnostic imaging modality of choice for nearly all clinical indications concerning the knee. MRI provides excellent visualization of the internal structures of the knee along with soft tissue structures and bone marrow abnormalities (1).

Aim of the work

determine diagnostic role of MRI in studying types of internal knee derangements of the traumatic knee.

Patients and Methods

A cross sectional study of thirty four patient of knee joint trauma who underwent MRI for internal derangement of knee at Radio-diagnosis department of Ain Shams University Hospitals in the period from October 2017 to march 2018.

Results

commonest lesion detected in our study was ACL tear detected in 24 patients.16 patients of with partial ACL tear and 8 patients with complete ACL tear, followed by knee joint effusion medial meniscus tear. Lateral meniscal injuries were less common when compared to medial meniscalinjuries.

Conclusion

MR imaging is the best non-invasive imaging modality for diagnosis of types of internal derangement of knee joint as it provides excellent visualization of the internal structures of the knee, soft tissue structures and, bone marrow abnormalities.

Recommendation

further studies with much more population and correlation with arthroscopy for more accurate results.
Clinical features and outcomes of discharged coronavirus disease 2019 patients: a prospective cohort study
Authors: Wang X , Xu H , Jiang H , Wang L , Lu C , Wei X , Liu J , Xu S
Published: May 2020

Background

Coronavirus disease 2019 (COVID-19) is a global pandemic but the follow-up data of discharged patients was barely described.

Aim

To investigate clinical outcomes, distribution of quarantine locations and the infection status of the contacts of COVID-19 patients after discharge.

Design

A prospective cohort study.

Methods

Demographics, baseline characteristics of 131 COVID-19 patients discharged from 3 February 2020 to 21 February 2020 in Wuhan, China were collected and analyzed by reviewing the medical records retrospectively. Post-hospitalization data related to clinical outcomes, quarantine locations and close contact history were obtained by following up the patients every week up to 4 weeks.

Results

Fifty-three (40.05%) patients on discharge had cough (29.01%), fatigue (7.63%), expectoration (6.11%), chest tightness (6.11%), dyspnea (3.82%), chest pain (3.05%) and palpitation (1.53%). These symptoms constantly declined in 4 weeks post-discharge. Transient fever recurred in 11 (8.4%) patients. Among the discharged patients, 78 (59.5%) underwent chest CT and 2 (1.53%) showed deterioration. A total of 94 (71.8%) patients received SARS-CoV-2 retest and 8 (6.10%) reported positive. Seven (2.29%) patients were readmitted because of fever or positive SARS-CoV-2 retest. After discharge, 121 (92.37%) and 4 (3.05%) patients were self-quarantined at home or community spots, respectively, after a close contact with 167 persons in total who were free of COVID-19 at the endpoint of study.

Conclusion

The majority of COVID-19 patients after discharge were in the course of recovery. Readmission was required in rare cases due to suspected recurrence of COVID-19. Although no contacted infection observed, appropriate self-quarantine and regular re-examination are necessary, particularly for those who have recurred symptoms.
T117. PROMINENT AND PERSISTENT AUTISTIC TRAITS ARE ASSOCIATED WITH EARLY NON-REMISSION IN FIRST-EPISODE SCHIZOPHRENIA
Authors: Pina-Camacho Laura , Diaz-Caneja Covadonga M , Fraguas David , Boada Leticia , Parellada Mara , Winter-van Rossum Inge , Kahn Rene , Arango Celso
Published: May 2020

Background

Autistic phenotypic profiles in patients with schizophrenia are reportedly associated with poor outcomes, including higher odds of antipsychotic treatment failure. The Positive and Negative Syndrome Scale for Schizophrenia (PANSS) Autism Severity Scale (PAUSS) has been validated as a tool to identify “autistic profiles” in adolescents and adults with schizophrenia. We used the PAUSS (total score and subscores) to quantify autistic symptom load at different time points in a sample of patients with first episode schizophrenia (FES). We sought to investigate whether showing “prominent and persistent” autistic symptom load was associated with not achieving clinical remission at week 4 after the FES.

Methods

We analysed a subsample of FES patients from the OPTiMiSE study that was treated with amisulpride in an open-label design and had completed 4 weeks of follow-up. The selected subsample was composed of 55 individuals (27.3% female, mean age 25.6 (6.2) years) at “high-risk of non-remission” at week 2; i.e. patients with schizophrenia (not schizophreniform nor schizoaffective disorder) that showed prominent and persistent baseline-to-2-week negative symptoms (PNS, using Galderisi et al 2013 definition) and that had not achieved clinical remission at week 2 (using Andreasen criteria).

Results

In the selected subsample, the PAUSS showed acceptable internal consistency at baseline, 2-week, and 4-week visit (all Cronbach’s alpha>0.7). Those with prominent (over the third tertile) and persistent (over the 4-week follow-up) PAUSS total scores, i.e. “autistic FES patients” had, relative to non-autistic FES patients, higher rates of comorbid social phobia (18.2% vs 0%, p= .041), higher PANSS positive, negative and total scores at week 2 and 4 (all p<.01), and a higher proportion of “non-remitters” at week 4 (91.7% vs 51.2%, p=.018). No other differences in demographic or clinical variables were found between both FES groups. Stepwise logistic regression analyses, controlling for potential confounders, revealed that showing a prominent and persistent “autistic phenotype” was associated with not achieving clinical remission at week 4 (B=2.148, OR=8.57, 95% CI= 1.01–73.5, p<0.05).

Discussion

The delineation of “autistic profiles” with the PAUSS in the early stages of schizophrenia might enable early detection of subjects at higher risk of short-term antipsychotic treatment failure. It may also enable to explore the neurobiological underpinnings of particular phenotypic groups within schizophrenia, which might in turn help advance in the understanding of the pathophysiology and aetiology of psychosis.
T135. ABERRANT EXECUTIVE CONTROL AND AUDITORY NETWORKS IN RECENT-ONSET SCHIZOPHRENIA - A GROUP ICA DUAL REGRESSION ANALYSIS
Authors: Lee Jungsun , Joo Sung Woo , Kim Harin , Ho Joo Yeon
Published: May 2020

Background

A great number of studies using resting-state functional MRI (rsfMRI) have been conducted for revealing altered functional connectivity in schizophrenia. Although the default mode network has been predominantly investigated, other resting-state networks (RSNs) can be networks of interest for unveiling the neurobiological basis of schizophrenia. Our study investigated changes in functional connectivity in the nine RSNs in recent-onset schizophrenia.

Methods

We performed a rsfMRI in 46 patients with recent-onset schizophrenia and 22 healthy controls. In the preprocessing steps, independent component analysis (ICA)-based automatic removal of motion artifacts was applied to eliminate motion-related components from an individual-level ICA. Group ICA and dual regression were performed for voxel-wise comparisons between the groups with the non-parametric permutation test using threshold-free cluster enhancement and a corrected-p < 0.05 for multiple comparisons. We used the Positive and Negative Syndrome Scale scores for the correlation analysis of symptom severity with functional connectivity in the patient group.

Results

The control group had areas with a significant group difference in activity compared to that of the patient group in which it existed in the left supplementary motor cortex and supramarginal gyrus (the executive control network) and the right postcentral gyrus (the auditory network). There were no significant correlations of symptom severity with the functional connectivity of these regions.

Discussion

The left supplementary motor cortex, supramarginal gyrus, and right postcentral gyrus having areas with a significant group difference may have a role in the pathophysiology of schizophrenia, given their language and auditory information processing functions.
T143. RESTING STATE FMRI BASED MULTILAYER NETWORK CONFIGURATION IN PATIENTS WITH SCHIZOPHRENIA
Authors: Gifford George , Crossley Nicolas , Matthew Kempton , Sarah Morgan , Dazzan Paola , Young Jonathan , McGuire Philip
Published: May 2020

Background

Novel methods for measuring large-scale dynamic brain organisation are needed to provide new biomarkers of schizophrenia. Using a method for modelling dynamic modular organisation, previous evidence suggests higher ‘flexibility’ (switching between multilayer network communities) to be a feature of schizophrenia.

Methods

The current study compared flexibility between 55 patients with schizophrenia and 72 controls (the COBRE Dataset). In addition, novel methods of ‘between resting state network synchronisation’ (BRSNS) and the probability of transition from one community to another were used to further describe group differences in dynamic community structure.

Results

There was significantly higher schizophrenia group flexibility in cerebellar (F (1,124) = 9.33, p (FDR) = 0.017), subcortical (F (1,124) = 13.14, p (FDR) = 0.005), and fronto-parietal task control (F (1,124) = 7.19, p (FDR) = 0.033) resting state networks (RSNs), as well as in the left thalamus (MNI XYZ: -2, -13, 12; F(1, 124) = 17.1, p (FDR) < 0.001) and the right crus I (MNI XYZ: 35, -67, -34; F (1, 124) = 19.65, p (FDR) < 0.001). Flexibility in the left thalamus reflected transitions between communities covering default mode and sensory-somatomotor RSNs. BRSNS scores suggested altered dynamic inter-RSN modular configuration in schizophrenia.

Discussion

This study suggests higher flexibility in a schizophrenia group at an RSN and node level and provides novel methods of exploring dynamic community structure. Mediation of group differences by mean time window correlation did however suggest flexibility to be no better as a schizophrenia biomarker than simpler measures and a range of methodological choices affected results.
M150. RELATIVES EXPERIENCES OF THE EARLY SIGNS ACTION PLAN
Authors: Sjöström Nils , Berg David , Johansson Sofia , Andreasson Eva , Waern Margda
Published: May 2020

Background

In the recent years person-centered methods have been developed to involve relatives in the care of their next of kin. The Early Signs Action Plan (ESAP) was developed to facilitate relatives’ participation in the care of their next of kin in psychiatric outpatient units specialized in the treatment of persons with schizophrenia and similar disorders. The aim was to investigate relatives’ experiences regarding the activation of the action plan for their next of kin.

Methods

The study is a qualitative interview study using a semi-structured interview guide. The interviews were conducted with relatives (N=13) to outpatients whose Early Signs Action Plan had been activated. The interviews were digitally recorded and transcribed verbatim. The material was then analyzed with qualitative content analysis.

Results

ESAP was positively received by the relatives and most of them experienced that they were participating in the planning of the care of their next of kin’s. Participating in the care also implied a feeling of security and awareness about their next of kin’s early warning signs and what to do in case of a relapse.

Relatives also indicated that the ESAP is vulnerable during on call time and during vacation periods. Outdated paths to get in contact with psychiatric services on call time were reported as problematic since this information is crucial for getting in touch with care outside of office hours.

Discussion

ESAP seems to be a useful tool for the involvement of relatives in the care of their next of kin.
M161. NEURAL CHANGES INDUCED BY ELECTROCONVULSIVE THERAPY (ECT) IN SCHIZOPHRENIA PATIENTS: A SYSTEMATIC REVIEW
Authors: Moon Sun-Young , Kim Minah , Oh Sanghoon , Soo Kwon Jun
Published: May 2020

Background

Despite the remarkable progress of antipsychotic drugs, electroconvulsive therapy (ECT) remains a potent treatment option for schizophrenia. However, the underlying neural mechanism of ECT effect on schizophrenia remains unclear. For this reason, we reviewed literature which investigated structural and functional brain changes after ECT in schizophrenia patients.

Methods

We searched the PubMed, EMBASE, Cochrane Reviews database to search for eligible articles. Following medical subject headings (MeSH) terms were used: ECT AND schizophrenia AND (MRI OR MRS OR PET OR SPECT OR NIRS OR DTI).

Results

Thirteen studies were eligible for the reviewing process. Of them, three studies investigated the effect of ECT upon volumetric changes of cerebral regions; 4 studies on the effect of ECT upon functional brain activities; three studies using magnetic resonance spectroscopy (MRS); and another three studies investigating blood flow changes. Medial temporal lobe (MTL) structures seemed to be increased after ECT sessions in schizophrenia patients, as in major depressive disorder (MDD) patients. Insula and left dorsolateral prefrontal cortex (DLFPC) is other potential neural substrates that might be disease specific for ECT induced changes in schizophrenia. Outcomes of functional imaging seemed to vary among studies, with divergent region of interests (ROI). MRS study results suggests the ratio of left prefrontal NAA/Cr might be increase after adequate ECT sessions. Studies investigating effect of ECT upon cerebral blood flow largely varied among studies with mixed results.

Discussion

Despite the treatment effect of ECT in schizophrenia patients, there have been only a handful of studies investigating the biological mechanisms underlying ECT. Of them, the effect of ECT in schizophrenia seemed also to be mediated by structural volume increases in the MTL region (as in MDD), and the insula and left DLPFC might be other potential neural substrates of ECT effect in schizophrenia patients. Future studies are needed to validate the neural mechanisms that underlie the effect of ECT in schizophrenia, which might help to aid in tailoring treatment plans for refractory schizophrenia patients.
M211. NEUROPROTECTIVE EFFECT OF SHI-ZHEN-AN-SHEN-TANG, A CHINESE HERB FORMULA ON MICE EXPOSED TO CUPRIZONE
Authors: Ma Chao , Wu Yan , Chen Pei , Jia Yuan , Yin Dongqing , Ning Yanzhe , Zhu Hong , Li Xue , Liu Xinyao , Sun Zuoli , Jia Hongxiao
Published: May 2020

Background

Our previous study indicated a therapeutic effect of Shi-Zhen-An-Shen-Tang (SZAST), a Chinese herb formula, on schizophrenia, but the related mechanism is unknown(citation). A large body of evidence suggests the important role of white matter of the brain in the pathophysiology of schizophrenia. This study was designed to evaluate the effect of SZAST on schizophrenia with demyelinated mice.

Methods

Male C57BL/6 mice were given mixed cuprizone (CPZ, a copper chelator, 0.2 %, w/w) rodent chow for six successive weeks to induce demyelination. During the last two weeks, mice were given an oral gavage of saline, or SZAST of three different doses (a low dose of 5.5g·kg-1·d-1, a medium dose of 8.24g·kg-1·d-1, or a high dose of 10.98 g·kg-1·d-1), or quetiapine, respectively. Behavioral tests were conducted after the last treatment. Meanwhile, the expression of myelin basic protein (MBP) and neuregulin-1(NRG1) in the brain was tested by immunohistochemistry staining or Western Blot.

Results

Mice exposed to CPZ for six weeks showed obvious schizophrenia-like behaviors, including lower nest-building activity, sensory gating activity, and higher locomotor activity. CPZ-fed mice also displayed a lower myelin density in the corpus callosum, hippocampus, and cerebral cortex and a reduction of MBP and NRG1 protein in the hippocampus compared with controls. Both quetiapine and SZAST significantly alleviated the abnormal schizophrenia-like behaviors and the impairment of myelin sheath in CPZ-fed mice, however, SZAST with medium dose showed better neuroprotective effect than the low dose or the high dose of SZAST. Furthermore, the expression of NRG1protein in the hippocampus was slightly, but not significantly increased in all SZAST-treated and quetiapine-treated groups.

Discussion

These results indicate that the neuroprotective effect of SZAST in demyelinated mice might partially relate to remyelination in the hippocampus in CPZ-fed mice.
S160. ALTERATIONS IN SHORT-RANGE STRUCTURAL CONNECTIVITY ACROSS THE PSYCHOSIS SPECTRUM: FINDINGS FROM THE B-SNIP STUDY
Authors: Ji Ellen , Perus Lisa , Grigis Antoine , Poupon Cyril , Sarrazin Samuel , Guevara Pamela , Guevara Miguel , Mangin Jean-François , Houenou Josselin
Published: May 2020

Background

Schizophrenia (SZ) and bipolar disorder (BD) have been increasingly viewed as psychotic mood disorders along a shared spectrum. Long-range and short-range structural connectivity have been implicated in both disorders, conceptualising them as “disconnection syndromes”. There has been a rise in neuroimaging tools to understand the overlap and boundaries between the two disorders, which has shifted our focus towards appreciating traits in addition to diagnosis. Our recent pilot study examining short-range U-fibers found in superficial white matter (SWM) found shared and distinct traits among people with SZ and BD and we aimed to investigate SWM further using data from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium.

Methods

Using diffusion weighted imaging (DWI), we performed whole brain tractography in 113 people with SZ, 69 people with SA disorder, 49 people with psychotic BD and 77 healthy controls using BrainVISA and Connectomist 2.0. Segmentation and labelling of SWM tracts were performed using a comprehensive U-fiber atlas. ComBat was applied to remove site effects and principle components analysis was performed to identity networks of bundles used for comparative analyses.

Results

Principle component analysis revealed a network comprised of 8 short tracts in frontal, parietal, and temporal regions that had decreased anatomical connectivity in patients, regardless of diagnosis, relative to healthy controls. This network overlaps, in part, regions that differed between patients (SZ and BD) and healthy controls in our recent pilot study. However, we were unable to detect differences between people with SZ, SA disorder and psychotic BD.

Discussion

We demonstrate that short U-fibers are likely vulnerable to pathological processes in psychotic illnesses, encouraging further understanding of their anatomy and function. Our lack of findings between patient groups may reflect a more homogeneous population (three subgroups of psychosis) and may suggest that abnormalities in SWM are less likely due to mood disturbances.
S194. CLOZAPINE AND ELECTROCONVULSIVE THERAPY AUGMENTATION IN ADOLESCENTS WITH TREATMENT-RESISTANT SCHIZOPHRENIA
Authors: Jeong Park Kee , Kim Hyo-Won
Published: May 2020

Background

Early onset schizophrenia is associated unfavorable treatment response and psychosocial outcome. Clozapine or Electroconvulsive Therapy (ECT) have suggested that these therapies may have an important role in treatment in treatment resistant schizophrenia in adolescents. The aim of this study was to compare effectiveness between clozapine and ECT augmentation in adolescents with treatment-resistant schizophrenia.

Methods

We retrospectively reviewed the electronic medical records of 27 adolescents with treatment-resistant schizophrenia (age 15.6±1.4 years; 16 boys, 59.3%) who were treated with clozapine or clozapine plus ECT. Effectiveness was measured with the Clinical Global Impressions–Severity (CGI-S) and/or Clinical Global Impressions–Improvement (CGI-I) scales at baseline, and after 2, 4 and 8 weeks. Treatment response was defined as a CGI-S < 3 or CGI-I < 3.

Results

The 21 adolescents treated with clozapine alone (age 15.5±1.2 years; 14 boys, 66.7%), and six adolescents treated with clozapine plus ECT (age 16.0±2.1 years; 2 boys, 33.3%) were compared their treatment effectiveness. The 13 adolescents (61.0%) in clozapine alone group and four adolescents (66.7%) in clozapine plus ECT group met the treatment response criterion. Three (50.0%) of adolescents with clozapine plus ECT group experienced mild post ictal confusion and two (9.5%) of adolescents with clozapine alone group experienced mild reduction of WBC and ANC.

Discussion

Our results suggest that clozapine and ECT augmentation could be one of safe and effective treatment in adolescents with treatment-resistant schizophrenia.
S208. COMPARISON OF MEDICATION PREFERENCE FOR LONG-ACTING INJECTABLE VERSUS ORAL ANTIPSYCHOTICS IN PATIENTS WITH SCHIZOPHRENIA: ANALYSIS OF A PATIENT-REPORTED QUESTIONNAIRE FROM A DOUBLE-BLIND RANDOMIZED CONTROLLED STUDY
Authors: Blackwood Clifton , Sanga Panna , Nuamah Isaac , Keenan Alexander , Singh Arun , Mathews Maju , Gopal Srihari
Published: May 2020

Background

There is limited information on patient’s perspective on choice of long-acting injectable (LAIs) or oral antipsychotic pills used in the management of schizophrenia. Assessing factors that determine patients’ preferences for LAI or oral antipsychotics could help understand their expectations from the treatment and reduce potential barriers to LAI use in schizophrenia.

Methods

Post-hoc analyses were conducted from a double-blind, randomized, non-inferiority study (NCT01515423) of 3-monthly vs 1-monthly paliperidone palmitate in patients with schizophrenia. Data from the Medication Preference Questionnaire, administered to patients on day 1 (baseline; open-label stabilization phase), were used. The questionnaire includes 4 sets of items: (1) reasons for general treatment preference based on goals/outcomes and preference for LAI vs pills based on (2) personal experience (3) injection-site (4) dosing frequency. A logistic regression analysis was performed to assess the effect of baseline variables on preference for LAIs or pills.

Results

Patients who preferred LAIs identified these outcomes as important: “I feel more healthy” (57%), “I can get back to my favorite activities” (56%), “I don’t have to think about taking my medicines” (54%). Most common reasons for medication preference (LAI vs pills) were: “LAIs/pills are easier for me” (67% vs 18%), “more in control/don’t have to think about taking medicine” (64% vs 14%), “less pain/sudden symptoms” (38% vs 18%) and “less embarrassed” (0% vs 46%). Majority of patients (59%) preferred deltoid over gluteal injections: (reasons: faster administration [63%], easier [51%], less embarrassing [44%]). 50% of patients preferred 3-monthly over 1-monthly (38%) or every day (3%) dosing (reasons: fewer injections [96%], fewer injections are less painful [84%], fewer doctor visits [80%]). In the logistic regression analysis (n=1402), 77% of patients preferred LAI over pills and culture and race appeared to play a role in this preference.

Discussion

Patient empowerment and quality-of-life-related goals were important for patients who preferred LAI antipsychotics and when given an option, patients preferred less-frequent, quarterly injections over monthly injections and daily oral medications.
The Dreem Headband compared to polysomnography for electroencephalographic signal acquisition and sleep staging
Authors: Arnal Pierrick J , Thorey Valentin , Debellemaniere Eden , Ballard Michael E , Bou Hernandez Albert , Guillot Antoine , Jourde Hugo , Harris Mason , Guillard Mathias , Van Beers Pascal , Chennaoui Mounir , Sauvet Fabien
Published: May 2020

Study Objectives

The development of ambulatory technologies capable of monitoring brain activity during sleep longitudinally is critical for advancing sleep science. The aim of this study was to assess the signal acquisition and the performance of the automatic sleep staging algorithms of a reduced-montage dry-electroencephalographic (EEG) device (Dreem headband, DH) compared to the gold-standard polysomnography (PSG) scored by five sleep experts.

Methods

A total of 25 subjects who completed an overnight sleep study at a sleep center while wearing both a PSG and the DH simultaneously have been included in the analysis. We assessed (1) similarity of measured EEG brain waves between the DH and the PSG; (2) the heart rate, breathing frequency, and respiration rate variability (RRV) agreement between the DH and the PSG; and (3) the performance of the DH’s automatic sleep staging according to American Academy of Sleep Medicine guidelines versus PSG sleep experts manual scoring.

Results

The mean percentage error between the EEG signals acquired by the DH and those from the PSG for the monitoring of α was 15 ± 3.5%, 16 ± 4.3% for β, 16 ± 6.1% for λ, and 10 ± 1.4% for θ frequencies during sleep. The mean absolute error for heart rate, breathing frequency, and RRV was 1.2 ± 0.5 bpm, 0.3 ± 0.2 cpm, and 3.2 ± 0.6%, respectively. Automatic sleep staging reached an overall accuracy of 83.5 ± 6.4% (F1 score: 83.8 ± 6.3) for the DH to be compared with an average of 86.4 ± 8.0% (F1 score: 86.3 ± 7.4) for the 5 sleep experts.

Conclusions

These results demonstrate the capacity of the DH to both monitor sleep-related physiological signals and process them accurately into sleep stages. This device paves the way for, large-scale, longitudinal sleep studies.

Clinical Trial Registration

NCT03725943.
Evolution of dependoparvoviruses across geological timescales—implications for design of AAV-based gene therapy vectors
Authors: Hildebrandt Evin , Penzes Judit J , Gifford Robert J , Agbandje-Mckenna Mavis , Kotin Robert M
Published: May 2020

Endogenous viral elements (EVEs) are genetic remnants of viruses that have integrated into host genomes millions of years ago and retained as heritable elements passed on to offspring until present-day. As a result, EVEs provide an opportunity to analyse the genomes of extinct viruses utilizing these genomic viral fossils to study evolution of viruses over large timescales. Analysis of sequences from near full-length EVEs of dependoparvoviral origin identified within three mammalian taxa, Whippomorpha (whales and hippos), Vespertilionidae (smooth-nosed bats), and Lagomorpha (rabbits, hares, and pikas), indicates that distinct ancestral dependoparvovirus species integrated into these host genomes approximately 77 to 23 million years ago. These ancestral viruses are unique relative to modern adeno-associated viruses (AAVs), and distinct from extant species of genus Dependoparvovirus. These EVE sequences show characteristics previously unseen in modern, mammalian AAVs, but instead appear more similar to the more primitive, autonomously replicating and pathogenic waterfowl dependoparvoviruses. Phylogeny reconstruction suggests that the whippomorph EVE orthologue derives from exogenous ancestors of autonomous and highly pathogenic dependoparvovirus lineages, believed to have uniquely co-evolved with waterfowl birds to present date. In contrast, ancestors of the two other mammalian orthologues (Lagomorpha and Vespertilionidae) likely shared the same lineage as all other known mammalian exogenous AAVs. Comparative in silico analysis of the EVE genomes revealed remarkable overall conservation of AAV rep and cap genes, despite millions of years of integration within the host germline. Modelling these proteins identified unexpected variety, even between orthologues, in previously defined capsid viral protein (VP) variable regions, especially in those related to the three- and fivefold symmetry axes of the capsid. Moreover, the normally well-conserved phospholipase A2 domain of the predicted minor VP1 also exhibited a high degree of sequence variance. These findings may indicate unique biological properties for these virus ‘fossils’ relative to extant dependoparvoviruses and suggest key regions to explore within capsid sequences that may confer novel properties for engineered gene therapy vectors based on paleovirology data.
Exogenous Calcium Improved Resistance to Botryosphaeria dothidea by Increasing Autophagy Activity and Salicylic Acid Level in Pear
Authors: Sun Xun , Pan Bisheng , Wang Yun , Xu Wenyu , Zhang Shaoling
Published: May 2020

Pear ring rot, caused by Botryosphaeria dothidea, is one of the most serious diseases in pear. Calcium (Ca2+) was reported to play a key role in the plant defense response. Here, we found that exogenous calcium could enhance resistance to B. dothidea in pear leaves. Less H2O2 and O2− but more activated reactive oxygen species scavenge enzymes accumulated in calcium-treated leaves than in H2O-treated leaves. Moreover, the increased level of more ascorbic acid-glutathione was maintained by Ca2+ treatment under pathogen infection. The expression of core autophagy-related genes and autophagosome formations were enhanced in Ca2+-treated leaves. Silencing of PbrATG5 in Pyrus betulaefolia conferred sensitivity to inoculation, which was only slightly recovered by Ca2+ treatment. Moreover, the salicylic acid (SA) level and SA-related gene expression were induced more strongly by B. dothidea in Ca2+-treated leaves than in H2O-treated leaves. Taken together, these results demonstrated that exogenous Ca2+ enhanced resistance to B. dothidea by increasing autophagic activity and SA accumulation. Our findings reveal a new mechanism of Ca2+ in increasing the tolerance of pear to B. dothidea infection.
Adapted Crusting Technique in Children with Peristomal Lesions: A Case Series
Authors: Santos Monteiro Ana Cristina , Barbosa Maia dos Santos Maria Lucia , Souza Marcia Aparecida , Caires de Oliveira Achili Ferreira Juliana
Published: May 2020

OBJECTIVE

To describe the care of pediatric patients who had a gastrostomy and developed peristomal lesions and received a systematic single adapted crusting technique in a pediatric ICU in a tertiary Brazilian hospital.

METHODS

An analysis of six cases presenting traumatic, noninfectious peristomal lesions with ostium enlargement resulting in gastric residual leaks. All six patients received the same treatment over 7 to 15 days.

RESULTS

Lesion improvement was observed in all patients after 48 hours and considered attributable to the standard treatment recommended by ostomy professionals.

CONCLUSIONS

The adapted crusting technique was effective in the treatment of children with peristomal lesions. This technique may be beneficial to other patient and organizational outcomes such as improving safety of care, decreasing pain and discomfort, reducing nursing workload and hospital costs, and improving quality of life.
Health disparities in American Indians/Alaska Natives
Authors: Carron Rebecca
Published: May 2020

American Indians/Alaska Natives experience significant health disparities in many areas including metabolic and mental health disorders. The basis for these differences is grounded in the lasting effects of historical trauma. NPs have the opportunity to understand the underlying causes of these disparities and provide health interventions that promote wellness.
Primary care of children with autism spectrum disorder
Authors: Kilmer Michele
Published: May 2020

Pediatric autism spectrum disorder (ASD) consists of multisystem components that primary care providers (PCPs) must address. PCPs improve health outcomes associated with ASD when they administer developmental screening tools and thoroughly assess identified concerns. Pursuing specialty health services early in childhood combined with managing comorbid conditions curtails symptom escalation and disease progression.
Improving SBIRT in a nurse-managed clinic serving homeless patients with substance use disorder
Authors: Kerrins Ryan B. , Hemphill Jean Croce
Published: May 2020

A nurse-managed clinic in Northeast Tennessee that mainly serves unstably housed patients launched a process improvement project to evaluate Screening, Brief Intervention, and Referral to Treatment (SBIRT) implementation and use. These findings could guide future SBIRT efforts among vulnerable groups.
Return to driving after fracture an overview of current recommendations
Authors: Danilkowicz Richard , Tainter David , Gage Mark
Published: May 2020

One of the many important considerations after fracture is determining the time for safe return to driving. Although a seemingly mundane question, patients rely on their ability to drive in order to work, take care of their families, and perform day-to-day tasks, making it an important landmark on their road to recovery. Patients who are currently taking narcotic medications, are wearing restrictive medical devices, or have inadequate fracture healing all pose a potential risk to themselves and others if they operate a motor vehicle. Despite objective data on when a patient physically might be able to perform the tasks required to drive safely, practitioners often provide nonstandardized recommendations largely due to a lack of formal recommendations from any governing body. It is important to adhere to evidence-based practices for the safety of the patient and provider. This review aims to aggregate the literature on return to driving after fracture to provide a succinct overview of the data and recommendations.

Level of Evidence:

Level IV.
Measuring Lateral Screw Protuberance Is a Clinically Accurate Method for Quantifying Femoral Neck Shortening
Authors: Sepehri Aresh , Martinson James , Marchand Lucas S. , Riedel Matthew D. , McAlister Ian P. , O'Hara Nathan N. , Stockton David J. , Slobogean Gerard P.
Published: May 2020

Objectives:

The purpose of this study is to compare the reliability and accuracy of the screw protuberance method (SPM) and overlay method (OM) for measuring femoral neck shortening on anterior–posterior (AP) radiographs. The secondary aim is to investigate the changes in reliability and accuracy with varying femoral rotation.

Methods:

Radio-opaque femur sawbone models were fitted with either 3 cancellous screws or a sliding hip screw implant. Anterior–posterior radiographs were obtained using C-arm fluoroscopy with femoral neck shortening up to 15 mm and with the femoral shaft in 30 degrees of internal rotation to 30 degrees of external rotation (ER). Four observers measured femoral neck shortening at 2 time points. Intraobserver and interobserver reliability were calculated using the intraclass coefficient. Accuracy was analyzed through a Bland–Altman agreement statistic stratified by femoral rotation.

Results:

Both measurement techniques displayed excellent reliability, regardless of femoral rotation or implant. There was a significant difference in femoral neck shortening measurements with rotation for both the OM (P < 0.001) and SPM (P < 0.001). Both methods are accurate within 1 mm of the actual magnitude of shortening from 30-degree internal rotation to 15-degree ER. At 30-degree ER, shortening was underestimated by −2.10 mm using the OM (95% confidence interval, −2.43 to −1.76; P < 0.01) and by −1.64 mm using the SPM (95% confidence interval, −1.83 to −1.45; P < 0.01).

Conclusion:

This study demonstrates that both the OM and SPM are accurate and reliable assessments for femoral neck shortening; however, both methods are sensitive to extreme ER. Given the simplicity of the SPM technique, it may have increased utility for pragmatic research studies.
Inflammatory and Coagulative Considerations for the Management of Orthopaedic Trauma Patients With COVID-19: A Review of the Current Evidence and Our Surgical Experience
Authors: Puzzitiello Richard N. , Pagani Nicholas R. , Moverman Michael A. , Moon Andrew S. , Menendez Mariano E. , Ryan Scott P.
Published: May 2020

Mounting evidence suggests that the pathogenesis of coronavirus disease 2019 (COVID-19) involves a hyperinflammatory response predisposing patients to thromboembolic disease and acute respiratory distress. In the setting of severe blunt trauma, damaged tissues induce a local and systemic inflammatory response through similar pathways to COVID-19. As such, patients with COVID-19 sustaining orthopaedic trauma injuries may have an amplified response to the traumatic insult because of their baseline hyperinflammatory and hypercoagulable states. These patients may have compromised physiological reserve to withstand the insult of surgical intervention before reaching clinical instability. In this article, we review the current evidence regarding pathogenesis of COVID-19 and its implications on the management of orthopaedic trauma patients by discussing a case and the most recent literature.

Level of Evidence:

Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Diabetes Does Not Increase Complications, Length of Stay, or Hospital Costs After Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Narain Ankur S. , Haws Brittany E. , Jenkins Nathaniel W. , Parrish James M. , Block Andrew M. , Lamoutte Eric H. , Karmarkar Sailee S. , Singh Kern
Published: May 2020

Study Design:

Retrospective cohort.

Objective:

To determine if the presence of diabetes mellitus as comorbidity is associated with complications, inpatient length of stay, or direct hospital costs after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:

Very few studies have investigated the effect of diabetes on complications, length of stay, or costs in minimally invasive lumbar surgeries.

Methods:

Patients undergoing primary, single-level MIS TLIF were retrospectively reviewed. Diabetic and nondiabetic patients were propensity matched in a 1:1 manner for age, sex, and comorbidity burden. An association between diabetic status and preoperative demographic or perioperative variables, including inpatient length of stay, was tested for using Student t test or χ2 analysis. Multivariate linear regression was used to test for an association between diabetic status and direct hospital costs.

Results:

After 1:1 propensity matching, 100 patients were included in this analysis. There were no significant differences in age, sex, body mass index, smoking status, or Charlson Comorbidity Index between propensity-matched patients with and without diabetes. In regards to the length of stay, no significant differences existed between diabetic and nondiabetic groups (68.7 vs. 58.3 h, P=0.218). No other significant differences existed in other perioperative variables including operative time, intraoperative blood loss, or complication rate (P≥0.05 for each). Multivariate analysis indicated that diabetic status was not associated with differences in total direct hospital costs (US$20,428 vs. US$20,429, P=0.792) or cost subcategories after MIS TLIF (P≥0.05 for each).

Conclusions:

In this investigation, diabetes was not associated with postoperative complication rates, inpatient length of stay, or direct hospital costs after primary, single-level MIS TLIF. The reduced extent of operative exposure and tissue trauma in MIS TLIF may mitigate the risk of complications in diabetic patients, possibly preventing extensions in hospital stay length and associated hospital costs.
Association of Insurance Status With Treatment and Outcomes in Pediatric Patients With Severe Traumatic Brain Injury
Authors: Porter Austin , Brown Clare C. , Tilford J. Mick , Thomas Kevin , Maxson R. Todd , Sexton Kevin , Karim Saleema , Zohoori Namvar , Rodriguez Analiz
Published: May 2020

Objective:

To determine whether a health insurance disparity exists among pediatric patients with severe traumatic brain injury using the National Trauma Data Bank.

Design:

Retrospective cohort study.

Setting:

National Trauma Data Bank, a dataset containing more than 800 trauma centers in the United States.

Patients:

Pediatric patients (< 18 yr old) with a severe isolated traumatic brain injury were identified in the National Trauma Database (years 2007–2016). Isolated traumatic brain injury was defined as patients with a head Abbreviated Injury Scale score of 3+ and excluded those with another regional Abbreviated Injury Scale of 3+.

Interventions:

None.

Measurement and Main Results:

Procedure codes were used to identify four primary treatment approaches combined into two classifications: craniotomy/craniectomy and external ventricular draining/intracranial pressure monitoring. Diagnostic criteria and procedure codes were used to identify condition at admission, including hypotension, Glasgow Coma Scale, mechanism and intent of injury, and Injury Severity Score. Children were propensity score matched using condition at admission and other characteristics to estimate multivariable logistic regression models to assess the associations among insurance status, treatment, and outcomes. Among the 12,449 identified patients, 91.0% (n = 11,326) had insurance and 9.0% (n = 1,123) were uninsured. Uninsured patients had worse condition at admission with higher rates of hypotension and higher Injury Severity Score, when compared with publicly and privately insured patients. After propensity score matching, having insurance was associated with a 32% (p = 0.001) and 54% (p < 0.001) increase in the odds of cranial procedures and monitor placement, respectively. Insurance coverage was associated with 25% lower odds of inpatient mortality (p < 0.001).

Conclusions:

Compared with insured pediatric patients with a traumatic brain injury, uninsured patients were in worse condition at admission and received fewer interventional procedures with a greater odds of inpatient mortality. Equalizing outcomes for uninsured children following traumatic brain injury requires a greater understanding of the factors that lead to worse condition at admission and policies to address treatment disparities if causality can be identified.
Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review
Authors: Coates Dominiek , Clerke Teena
Published: May 2020

Introduction:

To support the development, implementation, and evaluation of shared decision-making (SDM) training programs, this article maps the relevant evidence in terms of training program design and content as well as evaluation outcomes.

Method:

A systematic scoping review methodology was used. To identify studies, the databases PubMed, Medline, and CINAHL were searched from 2009 to 2019, and reference lists of included studies were examined. After removal of duplicates, 1367 articles were screened for inclusion. To be included, studies were to be published in peer-reviewed journals, and should not merely be descriptive but report on evaluation outcomes. Articles were reviewed for inclusion by both authors, and data were extracted using a purposely designed data charting form implemented using REDCap.

Results:

The review identified 49 studies evaluating 36 unique SDM training programs. There was considerable variation in terms of program design and duration. Most programs included an overview of SDM theories and key competencies, as well as SDM skill development through role plays. Few programs provided training in reflective practice, in identifying and working with patients' individually preferred decision-making style, or in relation to SDM in a context of medical uncertainty or ambiguity. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 randomized controlled trials, showing that training was feasible, well received, and improved participants' knowledge and skills, but was limited in its impact on patients.

Discussion:

Although there is limited capacity to comment on which types of training programs are most effective, overall training was feasible, well received, and improved participants' knowledge and skills.