bluuebunny/crossref_metadata_2025 huggingface dataset:
Wearing Time for Lower-Limb Orthoses in Users with Pathological Gait Due to Neurological Disorder—Influences of Orthotic Concepts
Authors: Schwarze Martin , Wendy Stephanie , Kaib Thomas , Alimusaj Merkur , Weichold Claudia , Putz Cornelia , Wolf Sebastian I. , Block Julia
Published: June 2020

Introduction

Lower-limb orthoses are usually part of conservative therapy in patients with pathological gait due to neurological disorders. A modular design, defined as a detachable combination of different orthotic designs, offers the possibility to adapt orthosis functionality to individual needs. Currently, however, knowledge about the actual impact of modularity on wearing times is limited. The aim of the present study was therefore to examine the wearing time of modular and nonmodular orthoses to determine whether there are differences between the different orthotic concepts of the lower limb on weekdays and weekends and whether modularity affects wearing time.

Material and Methods

In this prospective clinical study, 53 patients with neurological gait disorder were included. All wore modular or nonmodular orthoses in one of these three groups: dynamic ankle-foot orthoses (DAFOs), ankle-foot orthoses (AFOs), and knee-ankle-foot orthoses (KAFOs). Wearing time was recorded by temperature sensors for 3 months. Data analysis included both descriptive and further parametric statistical testing (t-test for dependent and independent samples) as well as Pearson correlations. A univariate analysis of variance was used when comparing multiple groups.

Results

Participants wore DAFOs and AFOs, but not KAFOs, significantly longer on weekdays. Wearing time correlated significantly between weekdays and weekends for all groups. There is no significant difference in the mean daily wearing time between the groups. Modularity influenced the wearing time only for the DAFO/AFO combination.

Conclusion

Orthotic design and anatomic height affect the average daily wearing time. A change in wearing behavior between weekdays and weekends and influences by modularity can be found solely in DAFOs and AFOs.
Evaluation of the Impact of Handoff Based on the SBAR Technique on Quality of Nursing Care
Authors: Abbaszade Ali , Assarroudi Abdolghader , Armat Mohammad Reza , Stewart Jacqueline J. , Rakhshani Mohammad Hassan , Sefidi Narges , Sahebkar Mohammad
Published: June 2020

Background:

Effective communication, including the complete and accurate transfer of information and the prevention of misrepresentation and misinterpretation of patient-centered data during handoff, can enhance the quality of patient care and safety.

Purpose:

This study was aimed at evaluating the impact of bedside handoff using the Situation, Background, Assessment, Recommendation (SBAR) technique, on the quality of nursing care.

Methods:

The Quality Patient Care Scale (QUALPACS) was completed by the patient while nurses performed a verbal bedside shift handoff and after receiving education on the purpose and proper use of the SBAR communication tool.

Results:

The mean age of subjects was 51.29 ± 8.02 years. We found a significant increase in the mean score of QUALPACS dimensions, namely psychosocial (P < .001), physical (P < .001), and communication (P < .001) after SBAR implementation.

Conclusions:

Findings suggest that using the SBAR handoff technique increases the quality of nursing care in all QUALPACS dimensions.
Nurse Educators Establish and Evaluate Community Coalition to Promote Statewide Advance Care Planning Through RE-AIM
Authors: Kupershmidt Sabina , Fischbach Cheryl , Hegge Helene , AbouSamra Haifa , Penisten Linda , Dieter Carla
Published: June 2020

The purpose of this quality improvement project was to evaluate a statewide initiative promoting Advance Care Planning (ACP) to educate and support multidisciplinary ACP educators and provide tools to start ACP conversations in a predominantly rural state of the Upper Midwest. Individual objectives were to (1) motivate people of different professions and backgrounds to support the vision and (2) implement a system to educate and maintain a pipeline of ACP educators in appropriate methodologies to enable ACP in distant communities. The Advance Care Planning: Quality Conversations coalition was formed in 2015 to improve health care across the life span. The Reach-Effectiveness-Adoption-Implementation-Maintenance framework was applied to evaluate the project. Outcome variables were measured before, during, and after program implementation through service statistics and a questionnaire. Participation in the coalition's membership team between September 2015 and September 2019 ranged from 18 to 36 with a median of 27 and mode of 27. At least 20 different professions were represented. The coalition provided funds for educating 9 ACP instructors and 180 facilitators according to the Respecting Choices–First Steps ACP program. The coalition's mission has generated sustained interest for 4 years. Key elements and obstacles to implementing a statewide coalition were identified.
The Noninvasive Fetal Electrocardiogram During Labor: A Review of the Literature
Authors: Lempersz Carlijn , Noben Lore , de Vries Bart , van Laar Judith O. E. H. , Westerhuis Michelle E. M. H. , Oei S. Guid
Published: June 2020

Importance

The introduction of the cardiotocogram (CTG) during labor has not been found to improve neonatal outcome. The search for a more reliable, less invasive, and patient-friendly technique is ongoing. The noninvasive fetal electrocardiogram (NI-fECG) has been proposed as one such alternative.

Objectives

The aim of this study was to review the literature on the performance of NI-fECG for fetal monitoring during labor. Following the PRISMA guidelines, a systematic search in MEDLINE, EMBASE, and Cochrane Library was performed. Studies involving original research investigating the performance of NI-fECG during labor were included. Animal studies and articles in languages other than English, Dutch, or German were excluded. The QUADAS-2 checklist was used for quality assessment. A descriptive analysis of the results is provided.

Results

Eight articles were included. Pooled analysis of the results of the separate studies was not possible due to heterogeneity. All studies demonstrate that it is possible to apply NI-fECG during labor. Compared with Doppler ultrasound, NI-fECG performs equal or better in most studies.

Conclusions and Relevance

NI-fECG for fetal monitoring is a promising noninvasive and patient-friendly technique that provides accurate information. Future studies should focus on signal quality throughout labor, with the aim to further optimize technical development of NI-fECG.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning objectives

After completing this activity, the learner should be better able to interpret the performance of both noninvasive fetal electrocardiography and Doppler ultrasound for fetal heart rate monitoring during labor; assess the advantages and disadvantages of monitoring fetal heart rate with the current noninvasive fetal electrocardiogram during labor; and summarize the definitions of the different performance measures.
Single-Cell Analysis of Human Ovarian Cortex Identifies Distinct Cell Populations But No Oogonial Stem Cells
Authors: Wagner Magdalena , Yoshihara Masahito , Douagi Iyadh , Damdimopoulos Anastasios , Panula Sarita , Petropoulos Sophie , Lu Haojiang , Pettersson Karin , Palm Kerstin , Katayama Shintaro , Hovatta Outi , Kere Juha , Lanner Fredrik , Damdimopoulou Pauliina
Published: June 2020

(Abstracted from Nat Commun 2020;11:1147)

In the female fetus, oogonia derived from fetal germ cells (FGCs) form primordial follicles that remain dormant until reactivation in the postnatal ovary. The reserve of primordial follicles in the ovarian cortex determines the fertile lifespan, and its depletion marks the beginning of menopause.
The Role of Levonorgestrel Intra-uterine System in the Management of Adenomyosis: A Systematic Review and Meta-analysis of Prospective Studies
Authors: Abbas Ahmed M. , Samy Ahmed , Atwa Khaled , Ghoneim Hanan M. , Lotfy Mariam , Mohammed Heba Saber , Abdellah Asmaa M. , El Bahie Amira M. , Aboelroose Ahmed A. , El Gedawy Asmaa M. , Mostafa Mona , Elsenity Mohamed A. , Samy Mohammed , Safwat Sarah , Abdelrahman Rehab M. , Salah El Din Adel S. , Badran Esraa , Abdelkader Abdelrahman M. , Abdallah Ameer
Published: June 2020

(Abstracted from Acta Obstet Gynecol Scand 2020;99:571–581)

Adenomyosis is a prevalent disorder characterized by the presence of ectopic endometrial tissues within the myometrium. Its etiology and pathogenesis are unclear.
Low-Dose Aspirin for the Prevention of Preterm Delivery in Nulliparous Women With a Singleton Pregnancy (ASPIRIN): A Randomized, Double-blind, Placebo-Controlled Trial
Authors: Hoffman Matthew K. , Goudar Shivaprasad S. , Kodkany Bhalachandra S. , Metgud Mrityunjay , Somannavar Manjunath , Okitawutshu Jean , Lokangaka Adrien , Tshefu Antoinette , Bose Carl L. , Mwapule Abigail , Mwenechanya Musaku , Chomba Elwyn , Carlo Waldemar A. , Chicuy Javier , Figueroa Lester , Garces Ana , Krebs Nancy F. , Jessani Saleem , Zehra Farnaz , Saleem Sarah , Goldenberg Robert L. , Kurhe Kunal , Das Prabir , Patel Archana , Hibberd Patricia L. , Achieng Emmah , Nyongesa Paul , Esamai Fabian , Liechty Edward A. , Goco Norman , Hemingway-Foday Jennifer , Moore Janet , Nolen Tracy L. , McClure Elizabeth M. , Koso-Thomas Marion , Miodovnik Menachem , Silver R. , Derman Richard J.
Published: June 2020

(Abstracted from Lancet 2020;395:285–293)

Preterm birth, or delivery before 37 weeks, is one of the most common causes of infant mortality. New evidence has shown that women who take low-dose aspirin (81 mg) may be at lower risk of preeclampsia.
The Association of Race, Sex, and Insurance With Transfer From Adult to Pediatric Trauma Centers
Authors: Kulaylat Afif N. , Hollenbeak Christopher S. , Armen Scott B. , Cilley Robert E. , Engbrecht Brett W.
Published: June 2020

Objective

Our objective was to investigate whether racial/ethnic-based or payer-based disparities existed in the transfer practices of pediatric trauma patients from adult trauma center (ATC) to pediatric trauma center (PTC) in Pennsylvania.

Methods

Data on trauma patients aged 14 years or less initially evaluated at level I and II ATC were obtained from the Pennsylvania Trauma Outcome Study (2008–2012) (n = 3446). Generalized estimating equations regression analyses were used to evaluate predictors of subsequent transfer controlling for confounders and clustering. Recent literature has described racial and socioeconomic disparities in outcomes such as mortality after trauma; it is unknown whether these factors also influence the likelihood of subsequent interfacility transfer between ATC and PTC.

Results

Patients identified as nonwhite comprised 36.1% of the study population. Those without insurance comprised 9.9% of the population. There were 2790 patients (77.4%) who were subsequently transferred. Nonwhite race (odds ratio [OR], 4.3), female sex (OR, 1.3), and lack of insurance (OR, 2.3) were associated with interfacility transfer. Additional factors were identified influencing likelihood of transfer (increased odds: younger age, intubated status, cranial, orthopedic, and solid organ injury; decreased odds: operative intervention at the initial trauma center) (P < 0.05 for all).

Conclusions

Although we assume that a desire for specialized care is the primary reason for transfer of injured children to PTCs, our analysis demonstrates that race, female sex, and lack of insurance are also associated with transfers from ATCs to PTCs for children younger than 15 years in Pennsylvania. Further research is needed to understand the basis of these health care disparities and their impact.
Time to Antibiotic for Pediatric Oncology Patients With Febrile Neutropenia at Regional Emergency Departments
Authors: Wadhwa Aman , Oakley Jamie , Richman Joshua , Bhatia Smita , Kutny Matthew A.
Published: June 2020

Objectives

We compared the time to antibiotic (TTA) for pediatric oncology patients with febrile neutropenia (FN) presenting at regional emergency departments (EDs) with those presenting at a pediatric referral ED, and examined its association with need for aggressive medical care.

Methods

We abstracted data for pediatric oncology patients (age, <21 years) admitted for FN between August 2012 and August 2017 at a single children's hospital and compared the TTA between those referred from a regional ED across the state and those admitted via the referral ED at the children's hospital. Factors associated with delay in antibiotic administration (TTA, >60 minutes) were estimated using generalized linear modeling with generalized estimating equations (GEEs). Delay in antibiotic administration was examined for its association with the need for aggressive medical care (>1 fluid bolus, intensive care unit admission, inotropic or invasive ventilator support) within 24 hours of admission as an exploratory aim.

Results

Three-hundred eighty-nine FN admissions (regional ED, 26.7%; referral ED, 73.3%) occurred in 205 eligible patients. Median TTA was significantly (P < 0.0001) greater among patients presenting at a regional ED (117.5 minutes [range, 9–722 minutes]) vs referral ED (46 minutes [range, 6–378 minutes]). Presentation at regional ED was the only factor associated with delay in antibiotic administration (odds ratio, 9.73; 95% confidence interval, 5.37–17.63; P < 0.0001). Delay in antibiotic administration was not associated with greater need for aggressive medical care (odds ratio, 1.34; 95% confidence interval, 0.55–3.29; P = 0.5).

Conclusions

Pediatric oncology patients with FN presenting to regional EDs have longer TTA as compared with those presenting to a referral ED at a children's hospital.
Cardiovascular Effects of Energy Drinks in the Pediatric Population
Authors: Moussa Mohamad , Hansz Keith , Rasmussen Michaela , Gillman Cassidy , Pollard Casey , Kwak Eunice , Izsak Eugene
Published: June 2020

Consumption of energy drinks in the pediatric population is correlated with more emergency department visits and causes adverse reactions, such as neurological, psychiatric, gastrointestinal, renal, and cardiovascular effects. These cardiovascular complications include increased cardiometabolic risk with high intake of sugar, short-term blood pressure increases and a decrease in cerebral blood flow due to the caffeine content, increased or decreased blood pressure from taurine, unmasked cardiac conditions, such as channelopathies, and atrial and ventral fibrillations. Cardiovascular complications can also arise when energy drinks are mixed with pharmaceutical drugs, such as amiodarone, potent CYP1A2 inhibitors, warfarin, digoxin, or corticosteroids. Combining energy drinks with alcohol also precipitates adverse cardiovascular events, posing a risk to the health of children and adolescents. This review further explores the ingredients in energy drinks and their mechanism of action in causing these cardiovascular complications.
User Testing to Improve Retrieval and Comprehension of Information in Guidelines to Improve Medicines Safety
Authors: Jones Matthew D. , Franklin Bryony Dean , Watson Margaret C. , Raynor DK
Published: June 2020

Objective

The aim of the study was to investigate the effectiveness of user testing for improving healthcare professionals’ retrieval and comprehension of information in medicines guidelines.

Methods

The United Kingdom’s Injectable Medicines Guide was selected as a case study. This gives guidance to nurses on preparing and administering intravenous medicines on hospital wards, in line with standard UK practice. Three rounds of user testing were completed with 10 hospital nurses per round, using the Injectable Medicines Guide for voriconazole and aminophylline. Participants used the guidelines to answer 17 questions related to the administration of these medicines. Answers were scored for “finding” and “understanding” the required information. Semistructured interviews explored participants’ opinions of guideline content, design, and wording, with responses analyzed thematically. The guidelines were revised between rounds.

Results

In round 1, 8 of 17 questions were answered correctly by all participants. Participants had difficulty with dose, dilution, administration rate, and adverse effects questions. Revisions included new subsections and increased calculation support. In round 2, 14 of 17 questions were answered correctly by all participants. Difficulty persisted with dose and administration rate questions and further revisions made. In round 3, 15 of 17 questions were answered correctly by all participants. Across all rounds, participants considered appropriate subheadings and information order as important for fast location of information. Specific, detailed, and practical instructions were perceived as important to improve understandability and usefulness.

Conclusions

Key information in medicines guidelines may not be found and/or understood by healthcare professionals. User testing increased information retrieval and comprehension and could have an important role in improving the safety of medicines use.
Role of Arterial Perfusion in Early Survival of Arterialized Venous Flaps
Authors: Wang Hongshu , Hong Sungmin , Lu Shengdi , Wu Tianyi , Chai Yimin , Wen Gen
Published: June 2020

Background

The arterialized venous flap (AVF) is appropriate as a flap for hand and foot resurfacing meet the aesthetic demands in the same time. However, the inconsistency of survival rate limited its popularization in clinical settings. The purpose of this study was to investigate the role played by the caliber and location of the artery.

Methods

Arterialized venous flaps were designed on the abdomen of New Zealand rabbits, and the animals were randomized into 3 groups and 2 groups in experiment 1 and 2, respectively. In experiment 1, the artery flow was restricted with vascular staplers of different calibers. In experiment 2, the artery was anastomosed with the afferent vein in the center or at the margin of the flap. Blood perfusion state, water content, epidermal metabolite levels, and flap survival status were observed in both experiments. Furthermore, outcomes of 12 patients received AVF to resurface soft tissue defects in the digits, hands, and feet between January 2016 and February 2018 were analyzed.

Results

In experiment 1, compared with the control group, groups with restricted artery showed poor results regarding blood perfusion state, water content, epidermal metabolite levels, and flap survival status. In experiment 2, group with the afferent vein in the center of the flap showed better results mentioned previously. All the flaps survived uneventfully in this study. Two flaps partially failed (20% of the flap area) because of insufficient perfusion. Generally, larger caliber and center-located vein helped the survival of AVF.

Conclusions

Experimental findings suggested that increased arterial perfusion and center-located vein are beneficial for the survival of AVF. Clinical series proved the findings previously. The problem of inconsistency of AVF can be partially solved by increasing arterial perfusion and dissecting afferent vein into the center of flap, and still, further studies are needed to shed light on the mechanism behind.
Assessment of Opioid-Prescribing Practices in Breast Augmentation
Authors: Crystal Dustin T. , Cuccolo Nicholas G. , Plewinski Michael J. , Ibrahim Ahmed M.S. , Sinkin Jeremy C. , Lin Samuel J. , Agag Richard L. , Lee Bernard T.
Published: June 2020

Background

The United States (US) is in the mid of an opioid epidemic propagated, in part, by prescription opioids. With excess overprescribing documented in a variety of surgical procedures, several societies have recommended opioid-prescribing guidelines. Considering the scope and postoperative pain associated with aesthetic plastic surgery procedures, earnest evaluation into opioid-prescribing practices for breast augmentation was conducted.

Methods

Members of the American Society for Aesthetic Plastic Surgery were electronically surveyed on their opioid-prescribing patterns. The survey was distributed to 1709 plastic surgeons. Descriptive statistics were collated into percentages, deviations, and morphine milligram equivalents (MMEs), when appropriate.

Results

Two hundred twenty-nine American Society for Aesthetic Plastic Surgery members (13.4%) provided responses. A total of 91.2% of respondents prescribe opioids to patients undergoing breast augmentation. The most commonly prescribed agents included oxycodone/acetaminophen (Percocet, 47.0%) and hydrocodone/acetaminophen (Vicodin, 38.3%). On average, 165.3 ± 81.7 MMEs were dispensed (range, 25.0–600.0 MMEs; number tablets, 5–60). Prescribers felt that a lack of phone-in prescribing (52.4%) and the ease of preemptively prescribing opioids (52.4%) propagate opioid overprescribing. A total of 61.3% of respondents reported that they are or may be in favor of developing plastic surgery societal guidelines related to opioid prescribing. These respondents indicated support for guidelines on opioid-sparing pain management strategies (74.2%) and guidelines identifying the type (54.7%), duration of use (69.5%), and number of opioid tablets (61.7%) necessary for procedures.

Conclusions

Considerable variability exists among prescribing patterns after breast augmentation. Societal guidelines aimed at providers and patients may serve a future role in opioid prescribing.
Missile War Injuries of the Craniofacial Region
Authors: Kummoona Raja
Published: June 2020

Many factors govern the nature, severity, and outcome of missile war injuries and associated soft tissue damages. Managements of primary phase and trauma care have improved significantly. Many of these injured victims survived and require immediate care for primary phase management. Secondary phase was achieved by reconstruction of soft tissue by local, regional flaps, and bony defect by bone grafting.

There is no consensus on timing of treatment of bone and soft tissue of missile war injuries.

Currently, in Iraq, anti-government's protestors’ movement for the last 3 months mainly unemployed young people demanding for human rights has resettled in 22,000 people being injured. This includes more than 600 young men who were assassinated by unknown killers through confrontation with security and police men using tear gas canisters and sound bombs. The demonstrators used mini cars (Tuck Tuck) for attacking policemen and security people and used them for transferring injured demonstrators as ambulance to a special tent in the Tahrir Square for receiving first aid.
A Three-Dimensional Study of the Nasolabial Soft Tissue Symmetry in Children With Unilateral Complete Cleft Lip and Palate Using Traditional and Split-Type Nasoalveolar Molding
Authors: Cai Donglin , Zheng Jie , Kuang Wenying , Li Zhelun , Yuan Shiyu , Xiong Hui , Yuan Wenjun
Published: June 2020

Background:

Presurgical nasoalveolar molding (NAM) is the most common preoperative treatment for cleft lip and palate. However, NAM may have some limitations such as requiring high technical sensitivity and frequent visits. To simplify the device, some scholars have changed the traditional NAM into a split-NAM consisting of a alveolar molding plate and a nasal hook. This study compared the shaping effect of split NAM and traditional NAM on nasolabial soft tissue using three-dimensional (3D) measurement.

Methods:

A total of 39 patients with unilateral cleft lip and palate (UCLP) were enrolled and divided into 2 groups. 13 patients were treated with split-NAM while the other 26 patients were treated with traditional NAM. 3D images of all patients’ craniofacial soft tissue before and after NAM treatment were recorded and measured by three-dimensional software. Statistical analysis of measurements in both groups was performed using SPSS software.

Results:

After treatment, nasal soft tissue symmetry in the split-NAM group was better improved than that in the NAM group in vertical and anterior-posterior direction, but was worse improved in transverse direction. There was no significant difference in labial soft tissue symmetry between two groups.

Conclusions:

The split NAM can better elevate the alar and nostrils of the cleft side, and have a better forward effect on alar outer edge, nasal base, and nostrils. However, the traditional NAM can better reduce the width of nasal base.
Assessment of Maxillary Sinus Changes After Le Fort I Osteotomy Surgery
Authors: Akbulut Nihat , Kurşun Çakmak Emine Şebnem , Bayrak Seval
Published: June 2020

Objective:

The goal of this retrospective study is to examine the changes of maxillary sinus volume, sinus membrane thickness (SMT) and the distance between the floor of maxillary sinus and ostium after Le Fort I osteotomy.

Methods:

A total of 30 patients who underwent Le Fort I osteotomy were evaluated just before and 1 year after the surgical operation. Linear and volumetric measurements were done via 3D-DOCTOR software on sectional and 3D images.

Results:

Decrease in maxillary sinus volume, increase in SMT and no change in distance between the floor of the maxillary sinus and ostium were detected after surgery. After surgery, SMT was found higher in advancement + impaction group.

Conclusion:

This paper clarified that Le Fort I osteotomy affects the volume and thickness of the maxillary sinuses that may lead to deterioration of the ciliary activity and failure in the drainage which are predisposing factors for sinus pathologies. In maxillary osteotomies of later ages, maxillary sinus examination and follow-up should be performed regularly in order to maintain sinus health.
The Impact of Mental Illness on Postoperative Outcomes Among Medicare Beneficiaries
Authors: Paredes Anghela Z. , Hyer J. Madison , Diaz Adrian , Tsilimigras Diamantis I. , Pawlik Timothy M.
Published: June 2020

Objective:

The aim of this study was to define the prevalence of preexisting mental illness, as well as characterize the impact of a preexisting mental illness diagnosis on postoperative outcomes.

Summary Background Data:

Preoperative surgical evaluation and risk stratification have traditionally centered on optimizing physical health. The influence of mental health on postoperative surgical outcomes has not been investigated.

Methods:

Medicare beneficiaries who underwent elective colectomy, coronary artery bypass grafting, abdominal aortic aneurysm repair, abdominal aortic aneurysm repair, total hip arthroplasty, total knee arthroplasty, and lung resection were identified. Patients were classified as having mental illness using International Classification of Diseases, 9

th

and 10

th

Revisions Procedures codes (ICD9/10CM) codes for anxiety, depression, bipolar disorder, schizophrenia, or other psychotic disorder.

Results:

Among 1,889,032 Medicare beneficiaries who met inclusion criteria 560,744 (n = 29.7%) individuals had an antecedent diagnosis of mental illness. The majority had anxiety and/or depression (91.8%), whereas a smaller subset (8.2%) had a severe mental illness diagnosis. Patients who did and did not have mental illness were comparable relative to age and comorbidities. Patients with preoperative mental illness had a higher chance of surgical complications [anxiety/depression odds ratio (OR) 1.44, 95% confidence interval (CI) 1.42–1.46, severe mental illness OR 1.71, 95%CI 1.66–1.77] and an extended length of stay (anxiety/depression OR 1.45, 95% CI 1.44–1.46, severe mental illness OR 2.34, 95% CI 2.28–2.39). History of anxiety/depression (OR 1.87, 95% CI 1.85–1.90) or severe mental illness (OR 2.86, 95% CI 2.77–2.94) was also associated with higher odds of 30-day readmission. Additionally, individuals with mental illness had a higher prevalence of suicidal ideation within the first year after surgery (no mental illness: 1.88 per 100,000 individuals; anxiety/depression: 51.3 per 100,000 individuals; severe mental illness: 238.9 per 100,000 individuals).

Conclusions:

Three in 10 Medicare beneficiaries had a preexisting mental illness diagnosis, which was strongly associated with worse postoperative outcomes, as well as suicide risk. Surgeons need to optimize mental health assessment and services in the preoperative setting to improve outcomes for this vulnerable population.
Vitamin D Status of Children With Attention-Deficit Hyperactivity Disorder
Authors: Johnson Stephani R. , Zelig Rena , Parker Anna
Published: June 2020

Attention-deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder, but its pathophysiology remains unclear. Vitamin D deficiency may increase risk for ADHD. A review of the literature was conducted to evaluate the vitamin D status of children with ADHD. Most of the evidence suggests that children with ADHD have significantly lower vitamin D levels than children without ADHD. Supplementation may help treat ADHD symptoms, but some investigators concluded that children with ADHD and children without ADHD do not significantly differ in vitamin D levels. However, identifying and treating vitamin D deficiency remains important for this population.
Is Food Insecurity Associated With Iron Deficiency Anemia and Vitamin D Deficiency Among Women of Reproductive Age?
Authors: Kazemi Ali , Ghaemmaghami Hezaveh Seyed Jamal , Nikniaz Leila , Nikniaz Zeinab
Published: June 2020

This cross-sectional study assessed the association between household food insecurity (HFI) and anemia, iron deficiency, and vitamin D deficiency among women of reproductive age. The HFI status was assessed using a short form of the Household Food Security Scale questionnaire, and the serum ferritin, hemoglobin, and vitamin D levels were measured using the ELISA method. About 67.3% of the population was food insecure. There was a positive association between HFI and anemia (2.57; 95% CI, 1.02-7.17). However, the association between HFI and serum vitamin D and iron deficiency was not statistically significant. Further prospective research is needed to confirm these observations.
The epidemiological status, environmental and genetic factors in the etiology of Keshan disease
Authors: Yan Chao , Luo Rong , Li Feng , Liu Mingjiang , Li Jinshu , Hua Wei , Li Xiaoping
Published: June 2020

Keshan disease (KD) is an endemic cardiomyopathy with myocardial lesions for which the precise etiology has not been determined. It was named after the location where it was first identified: Keshan County in China. KD is mainly distributed in a selenium-deficient zone from northeast to southwest China. In recent years, the incidence and prevalence of KD have significantly decreased. Meanwhile, more knowledge was accumulated about the etiology of KD and recent data indicated that genetic factor was involved. In this review, we will first update an overview of the epidemiological status and the environmental and genetic factors involved in this disease.
Association between dehydroepiandrosterone levels and cardiovascular risk in public sector health workers in a Peruvian region
Authors: Rojas Ricardo J. , Chávez-Sosa Janett V. , Gutierrez-Ajalcriña Rosmery , Huancahuire-Vega Salomón
Published: June 2020

Alterations in dehydroepiandrosterone sulfate (DHEAS) levels have been shown to affect the cardiovascular system. This study examined the associations between DHEAS levels and cardiovascular risk in workers of a public hospital in Lima, Peru. The analytical cross-sectional study was conducted at the Hospital de Huaycán, Peru. The cardiovascular risk was assessed in health workers using the Framingham score and categorized into high and low cardiovascular risk groups, and then the DHEAS levels of both groups were compared. Two hundred ninety-six health workers were studied, 67.2% showed low cardiovascular risk, 22.3% intermediate and 10.5% high. DHEAS levels were lower in the high cardiovascular risk group (2156.9 vs 2814.6 ng/mL; P < 0.05) and showed negative association (prevalence rate ratio 0.14, 95% IC 0.04–0.53; P < 0.05) in multivariable analysis (P < 0.05). DHEAS, glycosylated hemoglobin, pulse pressure and mean arterial pressure show an independent association with high cardiovascular risk in a group of health workers. Additional variables should be considered for cardiovascular risk assessment.
Lessons from studies with murine cytomegalovirus that could lead to a safe live attenuated vaccine for human cytomegalovirus
Authors: Sweet Clive
Published: June 2020

Studies with a murine cytomegalovirus mutant tsm5 suggested two possible approaches to producing a live attenuated human cytomegalovirus vaccine. One approach would be to use a combination of five to six mutants where an attenuating mutation in the gene of one mutant is compensated by the wild-type version in a second mutant, which in turn has a mutation in a different gene compensated by the wild-type version in a third mutant, etc. Important genes in this approach could include those involved in DNA replication. The importance of the carboxy terminase of the primase gene (M70/UL70) for its function suggested a second approach where some of the natural codons in this region could be substituted with synonymous non-preferred (minor) codons that would reduce the replication fitness of the mutant.
Pontibacter mangrovi sp. nov., isolated from mangrove sediment
Authors: Mo kun-lian , Wang Ling , Wu Qing-juan , Ye Lin , Liu Xing-di , Hu Yong-hua , Huang Hui-qin
Published: June 2020

A Gram-stain-negative, short-rod-shaped and pink-pigmented bacterial strain (HB172049T) was isolated from mangrove sediment. Cells grew at 10–45 °C (optimum, 30 °C), pH 6.0–9.0 (optimum, pH 7.0) and with 0.5–9.0 % (w/v) NaCl (optimum, 2–5 %). Analysis of the 16S rRNA gene sequence revealed that the isolate had highest sequence similarities to

Pontibacter mucosus

DSM 100162T (96.5 %) and

Pontibacter korlensis

X14-1T (96.5 %). The values of average nucleotide identity, average amino acid identity and digital DNA–DNA hybridization between the isolate and its close neighbours were, respectively, less than 80.1, 81.7 and 23.2 %. Chemotaxonomic analysis indicated that the sole respiratory quinone was MK-7 and the predominant cellular fatty acids were summed feature 4 and iso-C15 : 0 (42.2 and 24.6 %, respectively). The major polar lipids consisted of phosphatidylethanolamine, diphosphatidylglycerol, phosphatidylglycerol, one unidentified glycolipid, one unidentified phospholipid, one unidentified aminophospholipid and two unidentified polar lipids. The genomic DNA G+C content was 52.6 mol%. Based on polyphasic taxonomic characterization, it is proposed that strain HB172049T belongs to the genus

Pontibacter

and represents a novel species, for which the name Pontibacter mangrovi sp. nov. is proposed. The type strain is HB172049T (=CGMCC 1.16729T=JCM 33333T).
The quality of condition suggestions and urgency advice provided by the Ada symptom assessment app assessed with independently generated vignettes optimized for Australia
Authors: Gilbert Stephen , Upadhyay Shubhanan , Novorol Claire , Wicks Paul
Published: June 2020

Objectives: To investigate the quality of condition suggestion and urgency advice provided by the Ada symptom assessment application and to compare it to published literature evaluation of free website and mobile symptom assessment applications accessible in Australia.
Design: The application was tested with 48 independently created medical condition vignettes using an externally developed methodology.
Main outcome measures: Correct condition suggestion (provided in first, the top three or top ten condition suggestion results); correct level of urgency advice (appropriate urgency category recommended).
Results: The correct condition suggestion was listed first in 65% of vignettes, and included among the first three results in 83% of vignettes. Urgency advice was exactly matching the vignette gold standard in 63% of cases, including about 67% of emergency and urgent cases and 57% of less serious case vignettes.
Conclusions: This study provides an analysis of the performance of one of the most used symptom assessment applications in Australia, the Ada app, which had not previously been evaluated in the literature in an Australia specific context. The app's accuracy of condition suggestion and its provision of appropriate urgency advice is higher than of other symptom assessment apps evaluated in this context in the literature. We strive for continual improvement to ensure the most appropriate local advice on conditions and care.
Trends in mortality of alcoholic liver disease among adults in the United States, 1999-2017
Authors: Ryu Emily , Xia Harry H. , Guo Grace L , Zhang Lanjing
Published: June 2020

Some subtypes of alcoholic liver disease (ALD) recently had increasing prevalence or mortality. Prevalence of alcoholic fatty liver disease was increased. Mortality of alcoholic hepatitis and cirrhosis also had upward trends. However, trends in ALD- mortality and related factors are unclear. We therefore examined trends in age-standardized ALD-mortality among U.S. adults by factors using multivariable piecewise log-linear models. We collected mortality-data (age-standardized for the 2000 U.S. standard population) from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database (CDC WONDER), using the Multiple Cause of Death Data to identify all ALD deaths in the United States for 1999-2017. We identified 296,194 deaths of ALD during 1999-2017. Trends in multivariable-adjusted, age-standardized mortality did not differ by sex, race, age or urbanization. The age-standardized mortality ratios of male/female, White/non-White and Metropolitan/Non-Metropolitan were 2.346, 1.657 and 0.851 in 2017, respectively. Strikingly, our multivariable model showed that subjects of 65+ years had the highest and the fastest growing mortality in the 3 age-groups. These findings highlight the continuation of health disparities in ALD, particularly in elderly subjects. Further works are warranted to validate and delineate the associated factors.
Rapid SARS-CoV-2 testing in primary material based on a novel multiplex LAMP assay
Authors: Schermer Bernhard , Fabretti Francesca , Damagnez Maximilian , Di Cristanziano Veronica , Heger Eva , Arjune Sita , Tanner Nathan A. , Imhof Thomas , Koch Manuel , Ladha Alim , Joung Julia , Gootenberg Jonathan S. , Abudayyeh Omar O. , Burst Volker , Zhang Feng , Klein Florian , Benzing Thomas , Müller Roman-U.
Published: June 2020

Background

Rapid and extensive testing of large parts of the population and specific subgroups is crucial for proper management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and decision-making in times of a pandemic outbreak. However, point-of-care (POC) testing in places such as emergency units, outpatient clinics, airport security points or the entrance of any public building is a major challenge. The need for thermal cycling and nucleic acid isolation hampers the use of standard PCR-based methods for this purpose.

Methods

To avoid these obstacles, we tested PCR-independent methods for the detection of SARS-CoV-2 RNA from primary material (nasopharyngeal swabs) including loop-mediated isothermal amplification (LAMP) and specific high-sensitivity enzymatic reporter unlocking (SHERLOCK).

Results

Whilst specificity of standard LAMP assays appears to be satisfactory, sensitivity does not reach the current gold-standard quantitative real-time polymerase chain reaction (qPCR) assays yet. We describe a novel multiplexed LAMP approach and validate its sensitivity on primary samples. This approach allows for fast and reliable identification of infected individuals. Primer optimization and multiplexing helps to increase sensitivity significantly. In addition, we directly compare and combine our novel LAMP assays with SHERLOCK.

Conclusion

In summary, this approach reveals one-step multiplexed LAMP assays as a prime-option for the development of easy and cheap POC test kits.
Validation of a new approach for distinguishing anesthetized from awake state in patients using Directed Transfer Function applied to raw EEG
Authors: Juel Bjørn E. , Romundstad Luis , Storm Johan F. , Larsson Pål G.
Published: June 2020

Aim

In a previous study, we found that the state of wakefulness in patients undergoing general anesthesia with propofol can effectively be monitored with high temporal resolution using an automatic measure of connectivity based on the Directed Transfer Function (DTF) calculated from short segments of electroencephalography (EEG) time-series. The study described here was designed to test whether the same measure can be used to monitor the state of the patients also during sevoflurane anesthesia.

Methods

Twenty-five channel EEG recordings were collected from 8 patients undergoing surgical anesthesia with sevoflurane. The EEG data were segmented into one second epochs and labeled as awake or anesthetized in accordance with the clinician’s judgement, and the sensor space directed connectivity was quantified for every epoch using the DTF. The resulting DTF derived connectivity parameters were compared to corresponding parameters from our previous study using permutation statistics. A data driven classification algorithm was then employed to objectively classify the individual 1-second epochs as coming from awake or anesthetized state, using a leave-one-out cross-validation approach. The classifications were made for every epoch using the median DTF parameters across the five preceding 1-second EEG epochs.

Results

The DTF derived connectivity parameters showed a significant difference between the awake and sevoflurane-induced general anesthesia at the group level (p<0.05). In contrast, the DTF parameters were not significantly different when comparing sevoflurane and propofol data neither in the awake nor in anesthetized state (p>0.05 for both comparisons). The classification algorithm reached a maximum accuracy of 96.8% (SE=0.63%). Optimizing the algorithm for simultaneously having high sensitivity and specificity in classification reduced the accuracy to 95.1% (SE=0.96%), with sensitivity of 98.4% (SE=0.80%) and specificity of 94.8% (SE=0.10%).

Conclusion

These findings indicate that the DTF changes in a similar manner when humans undergo general anesthesia caused by two distinct anesthetic agents with different molecular mechanisms of action. This seems to support the idea that brain connectivity is related to the level of consciousness in humans, although further studies are needed to clarify whether our results may be contaminated by confounding factors.
Covid19 infection spread in Greece: Ensemble forecasting models with statistically calibrated parameters and stochastic noise
Authors: Politis Georgios D. , Hadjileontiadis Leontios
Published: June 2020

Following the outbreak of the novel coronavirus SARS-Cov2 in Europe and the subsequent failure of national healthcare systems to sufficiently respond to the fast spread of the pandemic, extensive statistical analysis and accurate forecasting of the epidemic in local communities is of primary importance in order to better organize the social and healthcare interventions and determine the epidemiological characteristics of the disease. For this purpose, a novel combination of Monte Carlo simulations, wavelet analysis and least squares optimization is applied to a known basis of SEIR compartmental models, resulting in the development of a novel class of stochastic epidemiological models with promising short and medium-range forecasting performance. The models are calibrated with the epidemiological data of Greece, while data from Switzerland and Germany are used as a supplementary background. The developed models are capable of estimating parameters of primary importance such as the reproduction number and the real magnitude of the infection in Greece. A clear demonstration of how the social distancing interventions managed to promptly restrict the epidemic growth in the country is included. The stochastic models are also able to generate robust 30-day and 60-day forecast scenarios in terms of new cases, deaths, active cases and recoveries.
Deep Learning Improves Pre-Surgical White Matter Visualization in Glioma Patients
Authors: Panesar Sandip S , Nath Vishwesh , Pathak Sudhir K , Schneider Walter , Landman Bennett A. , Iv Michael , Anthony Diana , Jansen Tatiana , Abhinav Kumar , Fernandez-Miranda Juan
Published: June 2020

Background

Diffusion tensor imaging (DTI) is a commonly utilized pre-surgical tractography technique. Despite widespread use, DTI suffers from several critical limitations. These include an inability to replicate crossing fibers and a low angular-resolution, affecting quality of results. More advanced, non-tensor methods have been devised to address DTI’s shortcomings, but they remain clinically underutilized due to lack of awareness, logistical and cost factors.

Objective

Nath et al. (2020) described a method of transforming DTI data into non-tensor high-resolution data, suitable for tractography, using a deep learning technique. This study aims to apply this technique to real-life tumor cases.

Methods

The deep learning model utilizes a residual convolutional neural network architecture to yield a spherical harmonic representation of the diffusion-weighted MR signal. The model was trained using normal subject data. DTI data from clinical cases were utilized for testing: Subject 1 had a right-sided anaplastic oligodendroglioma. Subject 2 had a right-sided glioblastoma. We conducted deterministic fiber tractography on both the DTI data and the post-processed deep learning algorithm datasets.

Results

Generally, all tracts generated using the deep learning algorithm dataset were qualitatively and quantitatively (in terms of tract volume) superior than those created with DTI data. This was true for both test cases.

Conclusions

We successfully utilized a deep learning technique to convert standard DTI data into data capable of high-angular resolution tractography. This method dispenses with specialized hardware or dedicated acquisition protocols. It presents an economical and logistically feasible method for increasing access to high definition tractography imaging clinically.
Fuzzy logic assisted COVID 19 safety assessment of dental care
Authors: Adwibowo Andrio
Published: June 2020

Uncertainty is significant when assessing a risk of certain health care facility conditions especially the facility that prone to the COVID 19 risk. One solution to deal with an uncertainty in health situation assessment is through fuzzy inference system. For that reason, this study aims to develop fuzzy assisted system to assess the safety of dental care related to the sets of patient and environmental conditions. The fuzzy system allows assessment based on the patient’s body temperature, travel history, dental care ventilation rate, and disinfection frequency. The fuzzy system incorporates several steps including fuzzification, fuzzy regulation, and defuzzification. As a result of this study, the fuzzy system is able to assess and identify the risk of dental care according to the patient’s health status and hygiene conditions of dental care as well. To conclude, fuzzy system used in this study has offered the advantage of assessing at any situation as for patient and environmental factor predicts the safety of dental care.
Reproducing the long term predictions from Imperial College CovidSim Report 9
Authors: Rice Ken , Wynne Ben , Martin Victoria , Ackland Graeme
Published: June 2020

1

We present calculations using the CovidSim code which implements the Imperial College individual-based model of the COVID epidemic. Using the parameterization assumed in March 2020, we reproduce the predictions presented to inform UK government policy in March 2020. We find that CovidSim would have given a good forecast of the subsequent data if a higher initial value of R0 had been assumed. We then investigate further the whole trajectory of the epidemic, presenting results not previously published. We find that while prompt interventions are highly effective at reducing peak ICU demand, none of the proposed mitigation strategies reduces the predicted total number of deaths below 200,000. Surprisingly, some interventions such as school closures were predicted to increase the projected total number of deaths.