bluuebunny/crossref_metadata_2025 huggingface dataset:
Pipelle Endometrial Sampling With a Full Bladder Compared With Standard Care
Authors: Hashim Erwina , Hong Jesrine , Woo Yin Ling , Hamdan Mukhri , Tan Peng Chiong
Published: May 2024

OBJECTIVE:

To compare insertion failure rates for Pipelle endometrial sampling with a full bladder compared with the standard process (not taking into account bladder status) without cervical manipulation.

METHODS:

A single-masked randomized trial was conducted in a single tertiary care center from July 2021 to January 2022. Two hundred fourteen participants aged 18 years or older who were scheduled for outpatient Pipelle endometrial sampling were randomized: 107 each to having a full bladder (by oral water intake) or standard process (without delayed sampling and bladder status not taken into account). Women with known cervical stenosis, gynecologic malignancy, uterine anomalies, leiomyoma distorting the uterine cavity, acute cervicitis, urge bladder dysfunction, intense anxiety, need for anesthesia or analgesic before the procedure, positive pregnancy test, or previous failed office endometrial sampling were excluded. The primary outcome was the insertion failure rate of endometrial sampling at first attempt. Secondary outcomes were pain during procedure, satisfaction score, analgesia use, procedure duration, and need for cervical manipulation. Factoring in a baseline insertion failure rate of 30.0%, relative risk of 0.45, α of 0.05, 80.0% power, and a dropout rate of 10.0%, we needed 107 participants in each arm.

RESULTS:

The insertion failure rate was significantly lower in the full bladder group compared with standard process: 25 of 107 (23.4%) compared with 45 of 107 (42.1%) (relative risk 0.56, 95% CI, 0.37–0.84; number needed to treat to benefit 6.0, 95% CI, 3.20–15.70). Pain score (median) during the procedure (interquartile range) was 4 (3–6) compared with 5 (3–8) (P=.004); patient satisfaction score was 8 (7–9) compared with 7 (4–8) (P<.001); and mean±SD procedure duration was 3.0±2.4 compared with 4.7±2.9 minutes (P<.001) for the full bladder and standard process arm, respectively. Other secondary outcomes of cervical laceration, analgesia use, and adequacy of endometrial tissue for histopathologic assessment were not significantly different between groups.

CONCLUSION:

Pipelle endometrial sampling with a full bladder reduces the initial insertion failure rate, procedure-related pain, and duration of sampling and increases patient satisfaction compared with the standard process.

CLINICAL TRIAL REGISTRATION:

ISRCTN, ISRCTN33938192.
Frailty Is More Predictive of Mortality than Age in Patients With Hip Fractures
Authors: Sagona Abigail , Ortega Carlos A. , Wang Liqin , Brameier Devon T. , Selzer Faith , Zhou Li , von Keudell Arvind
Published: May 2024

OBJECTIVES:

To investigate the association between the Comprehensive Geriatric Assessment-based Frailty Index and adverse outcomes in older adult patients undergoing hip fracture surgery.

METHODS:

Design:

Retrospective cohort study.

Setting:

Academic Level 1 Trauma Center.

Patients:

All patients aged 65 or older who underwent surgical repair of a hip fracture between May 2018 and August 2020 were identified through institutional database review.

Outcome Measures and Comparisons:

Data including demographics, FI, injury presentation, and hospital course were collected. Patients were grouped by FI as nonfrail (FI < 0.21), frail (0.21 ≤ FI < 0.45), and severely frail (FI > 0.45). Adverse outcomes of these groups were compared using Kaplan Meier survival analysis. Risk factors for 1-year rehospitalization and 2-year mortality were evaluated using Cox hazard regression.

RESULTS:

Three hundred sixteen patients were included, with 62 nonfrail, 185 frail, and 69 severely frail patients. The total population was on average 83.8 years old, predominantly white (88.0%), and majority female (69.9%) with an average FI of 0.33 (SD: 0.14). The nonfrail cohort was on average 78.8 years old, 93.6% white, and 80.7% female; the frail cohort was on average 84.5 years old, 92.4% white, and 71.9% female; and the severely frail cohort was on average 86.4 years old, 71.0% white, and 55.1% female. Rate of 1-year readmission increased with frailty level, with a rate of 38% in nonfrail patients, 55.6% in frail patients, and 74.2% in severely frail patients (P = 0.001). The same pattern was seen in 2-year mortality rates, with a rate of 2.8% in nonfrail patients, 36.7% in frail patients, and 77.5% in severely frail patients (P < 0.0001). Being classified as frail or severely frail exhibited greater association with mortality within 2 years than age, with hazard ratio of 17.81 for frail patients and 56.81 for severely frail patients compared with 1.19 per 5 years of age.

CONCLUSIONS:

Increased frailty as measured by the Frailty Index is significantly associated with increased 2-year mortality and 1-year hospital readmission rates after hip fracture surgery. Degree of frailty predicts mortality more strongly than age alone. Assessing frailty with the Frailty Index can identify higher-risk surgical candidates, facilitate clinical decision making, and guide discussions about goals of care with family members, surgeons, and geriatricians.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
CD28-expressing δ T cells are increased in perivascular adipose tissue of hypertensive mice and in subcutaneous adipose tissue of obese humans
Authors: Berillo Olga , Comeau Kevin , Caillon Antoine , Leclerc Séverine , Shokoples Brandon G. , Mahmoud Ahmad U.M. , Andelfinger Gregor , Paradis Pierre , Schiffrin Ernesto L.
Published: May 2024

Objectives:

γδ T-lymphocytes play a role in angiotensin II (AngII)-induced hypertension, vascular injury and T-cell infiltration in perivascular adipose tissue (PVAT) in mice. Mesenteric arteries of hypertensive mice and subcutaneous arteries from obese humans present similar remodeling. We hypothesized that γδ T-cell subtypes in mesenteric vessels with PVAT (MV/PVAT) from hypertensive mice and subcutaneous adipose tissue (SAT) from obese humans, who are prone to develop hypertension, would be similar.

Methods:

Mice were infused with AngII for 14 days. MV/PVAT T-cells were used for single-cell RNA-sequencing (scRNA-seq). scRNA-seq data (GSE155960) of SAT CD45+ cells from three lean and three obese women were downloaded from the Gene Expression Omnibus database.

Results:

δ T-cell subclustering identified six δ T-cell subtypes. AngII increased T-cell receptor δ variable 4 (Trdv4)+ γδ T-effector memory cells and Cd28
high δ TEM-cells, changes confirmed by flow cytometry. δ T-cell subclustering identified nine δ T-cell subtypes in human SAT. CD28 expressing δ T-cell subclustering demonstrated similar δ T-cell subpopulations in murine MV/PVAT and human SAT. Cd28
+ γδ NKTEM and Cd28
high δ TEM-cells increased in MV/PVAT from hypertensive mice and CD28
high δ TEM-cells in SAT from obese women compared to the lean women.

Conclusion:

Similar CD28+ δ T-cells were identified in murine MV/PVAT and human SAT. CD28high δ TEM-cells increased in MV/PVAT in hypertensive mice and in SAT from humans with obesity, a prehypertensive condition. CD28+ δ T-lymphocytes could have a pathogenic role in human hypertension associated with obesity, and could be a potential target for therapy.
Prevalence of dyslipidemia among persons with type 2 diabetes in Africa: a systematic review and meta-analysis
Authors: Ekpor Emmanuel , Addo-Mensah Dorothy , Akyirem Samuel
Published: May 2024

Background:

Dyslipidemia is an established cardiovascular risk factor in persons with type 2 diabetes (T2D), yet the extent to which these conditions co-occur in Africa is unknown. This systematic review and meta-analysis aimed to determine the prevalence of dyslipidemia among persons with T2D in Africa.

Methods:

Medline, Embase, Global Health, Scopus, and Web of Science were searched on 5 December 2023. This review adhered to the PRISMA guidelines and was prospectively registered on PROSPERO. The prevalence data for dyslipidemia was pooled through a random-effects meta-analysis. The authors assessed heterogeneity and publication bias using I

2
statistics and Egger’s test, respectively.

Results:

Our search identified 8035 records, of which 60 articles involving 20 034 individuals with T2D were included in this review. The pooled prevalence of dyslipidemia recorded 38.6% (95% CI: 34.1–43.4) for high TC (≥ 5.2 mmol/l), 52.7% (95% CI: 44.2–61.1) for high low-density lipoprotein cholesterol (LDL-C) (≥ 2.6 mmol/l), 43.5% (95% CI: 37.1–50.0) for low high-density lipoprotein cholesterol (HDL-C) (< 1.0 mmol/l in men and less than 1.3 mmol/l in women), and 37.4% (95% CI: 32.2–42.9) for high triglycerides (TG) (≥ 1.7 mmol/l). Subgroup analysis based on gender indicated a notably higher prevalence of dyslipidemia among females compared to males.

Conclusion:

Dyslipidemia is prevalent among persons with T2D in Africa. This highlights the need for early screening, diagnosis, and management of dyslipidemia to mitigate the risk of cardiovascular complications in this population.
Microengineered neuronal networks: enhancing brain-machine interfaces
Authors: Kantawala Burhan , Emir Hamitoglu Ali , Nohra Lea , Abdullahi Yusuf Hassan , Jonathan Isaac Kirumira , Shariff Sanobar , Nazir Abubakar , Soju Kevin , Yenkoyan Konstantin , Wojtara Magda , Uwishema Olivier
Published: May 2024

The brain–machine interface (BMI), a crucial conduit between the human brain and computers, holds transformative potential for various applications in neuroscience. This manuscript explores the role of micro-engineered neuronal networks (MNNs) in advancing BMI technologies and their therapeutic applications. As the interdisciplinary collaboration intensifies, the need for innovative and user-friendly BMI technologies becomes paramount. A comprehensive literature review sourced from reputable databases (PubMed Central, Medline, EBSCOhost, and Google Scholar) aided in the foundation of the manuscript, emphasizing the pivotal role of MNNs. This study aims to synthesize and analyze the diverse facets of MNNs in the context of BMI technologies, contributing insights into neural processes, technological advancements, therapeutic potentials, and ethical considerations surrounding BMIs. MNNs, exemplified by dual-mode neural microelectrodes, offer a controlled platform for understanding complex neural processes. Through case studies, we showcase the pivotal role of MNNs in BMI innovation, addressing challenges, and paving the way for therapeutic applications. The integration of MNNs with BMI technologies marks a revolutionary stride in neuroscience, refining brain–computer interactions and offering therapeutic avenues for neurological disorders. Challenges, ethical considerations, and future trends in BMI research necessitate a balanced approach, leveraging interdisciplinary collaboration to ensure responsible and ethical advancements. Embracing the potential of MNNs is paramount for the betterment of individuals with neurological conditions and the broader community.
Amyand’s hernia: a case of right inguinoscrotal hernia with appendiceal content
Authors: Khandelwal Shreya , Kaur Alamjeet , Singh Shashi , Ghosh Aneek
Published: May 2024

Introduction:

Amyand’s hernia, a rare condition where the appendix becomes lodged in the inguinal canal, poses diagnostic challenges due to its varied clinical presentations and lack of distinctive radiological features. This case underscores the importance of early detection and comprehensive diagnostic evaluation.

Case Presentation:

A 30-year-old male presented with a 2-year history of right inguinoscrotal swelling, culminating in agonizing symptoms and irreducible masses over the inguinoscrotal area. Despite the absence of significant medical history, diagnostic imaging confirmed a complete right inguinoscrotal hernia and bilateral hydrocele with internal echoes.

Clinical Discussion:

The case illustrates the difficulties in preoperative diagnosis of Amyand’s hernia, emphasizing the reliance on imaging modalities and clinical assessment. Successful surgical intervention involving appendectomy and hernioplasty highlights the necessity for prompt diagnosis and management.

Conclusion:

This case exemplifies the challenges and complexities associated with Amyand’s hernia, emphasizing the importance of early recognition and comprehensive surgical planning. Moving forward, increased clinical vigilance and awareness are essential to ensure optimal patient outcomes in cases of inguinoscrotal pathology.
The Insidious Enemy of the Liver
Authors: Gökalp Gamze , Nalbant Tuğçe , Bıcılıoğlu Yüksel
Published: May 2024

Acetaminophen poisoning can lead to liver toxicity, potentially resulting in death. We aimed to evaluate cases of acetaminophen poisoning and investigate the impact of early initiation of the only antidote N-AC (N-acetyl cysteine) used and explore whether there are other factors contributing to prognosis prediction.

Methods

This study was designed as a cross-sectional, observational, retrospective study. The variables of the study were paracetamol overdose, demographic information, poisoning mechanisms, clinical, laboratory findings, and clinical progression of the cases. The cases compared in whom treatment was initiated within the first 8 hours after poisoning and those in whom it was not. χ2, t test, and logistic regression analyses were conducted at appropriate facilities.

Results

Three hundred forty-eight cases were included in the study. N-AC treatment was initiated within the first 8 hours after poisoning in 322 cases (92.5%), and 26 cases received N-AC treatment after 8 hours after poisoning. Liver toxicity developed in 6 cases (1.7%), and indications for liver transplantation were met in 36 cases (10.3%). Among the 26 cases for which treatment was not initiated within the first 8 hours, 18 cases (69.2%) had indications for liver transplantation (P < 0.01). It was found that N-AC within the first 8 hours reduced the risk by 43 times (P = 0.02) and being older than 6 years, being admitted to the intensive care unit, and having alanine aminotransferase values above 1000 U/L increased the risk significantly (P = 0.009, P = 0.005, P < 0.001). When a receiver operating characteristic curve was plotted for the 4th-hour blood acetaminophen level to predict liver transplantation, a value of 684.5 μg/mL emerged with 89% sensitivity and 93% specificity (area under the curve, 0.951).

Conclusions

As a result, this study demonstrates the protective effect of early-initiated N-AC therapy on liver toxicity in pediatric acetaminophen poisoning cases. It also highlights a significant impact of gastrointestinal decontamination methods.
Quantifying the impact of contact tracing interview prioritisation strategies on disease transmission
Authors: Wu Logan , Baker Christopher M. , Tierney Nick , Carville Kylie , McVernon Jodie , McCaw James , Golding Nick , Shearer Freya
Published: May 2024

Contact tracing is an important public health measure used to reduce transmission of infectious diseases. Contact tracers typically conduct telephone interviews with cases to identify contacts and direct them to quarantine, with the aim of preventing onward transmission. However, in situations where caseloads exceed the capacity of the public health system, timely interviews may not be feasible for all cases. Here we present a modelling framework for assessing the impact of different case interview prioritisation strategies on disease transmission. Our model is based on Australian contact tracing procedures and informed by contact tracing data on COVID-19 cases notified in Australia from 2020–21. Our results demonstrate that last-in-first-out strategies are more effective at reducing transmission than first-in-first-out strategies or strategies with no explicit prioritisation. To maximise the public health benefit from a given case interview capacity, public health practitioners should consider our findings when designing case interview prioritisation protocols for outbreak response.
Development and validation of a stakeholder-driven, self-contained electronic informed consent platform for trio-based genomic research studies
Authors: Norton Bethany Y , Liu James , Lewis Sara A , Magee Helen , Kruer Tyler N , Dinh Rachael , Bakhtiari Somayeh , Nordlie Sandra H. , Shetty Sheetal , Heim Jennifer , Nishiyama Yumi , Arango Jorge , Johnson Darcy , Seabrooke Lee , Shub Mitchell , Rosenberg Robert , Shusterman Michele , Wisniewski Stephen , Cooper Blair , Rothwell Erin , Fahey Michael C , Shrader M. Wade , Lennon Nancy , Oleszek Joyce , Pierce Wendy , Fleming Hannah , Belthur Mohan , Tinto Jennifer , Noritz Garey , Glader Laurie , Steffan Kelsey , Walker William , Grenard Deborah , Aravamuthan Bhooma , Bjornson Kristie , Joseph Malin , Gross Paul , Kruer Michael C ,   the Cerebral Palsy Research Network.
Published: May 2024

Increasingly long and complex informed consents have yielded studies demonstrating comparatively low participantcomprehensionandsatisfactionwith traditional face-to-face approaches. In parallel, interest in electronic consents for clinical and research genomics has steadily increased, yet limited data are available for trio-based genomic discovery studies. We describe the design, development, implementation, and validation of an electronic iConsent application for trio-based genomic research deployed to support genomic studies of cerebral palsy. iConsent development incorporated stakeholder perspectives including researchers, patient advocates, institutional review board members, and genomic data-sharing considerations. The iConsent platform integrated principles derived from prior electronic consenting research and elements of multimedia learning theory. Participant comprehension was assessed in an interactive teachback format. The iConsent application achieved nine of ten proposed desiderata for effective patient-focused electronic consenting for genomic research.

Overall, participants demonstrated highcomprehensionandretentionof key human subjects’ considerations. Enrollees reported high levels ofsatisfactionwith the iConsent, and we found that participantcomprehension, iConsentclarity,privacy protections, andstudy goal explanationswere associated with overallsatisfaction. Although opportunities exist to optimize iConsent, we show that such an approach is feasible, can satisfy multiple stakeholder requirements, and can realize high participantsatisfactionandcomprehensionwhile increasing study reach.
A case-control study evaluating CT signs of xiphoid process associated with xiphodynia
Authors: Ono Ryosuke , Horibata Ken
Published: May 2024

Objectives

To investigate whether CT signs of the xiphoid process, such as xiphisternal angle and evidence of soft tissue compression, are useful for diagnosing xiphodynia.

Design

A case-control study within a cohort.

Setting/Participants

Participants included 1560 individuals who visited a small urban hospital in Japan for chest or abdominal pain between January 2021 and September 2023. Those who underwent CT examinations including the xiphoid process were selected. Nine individuals diagnosed with xiphodynia were assigned to the case group, while 321 individuals diagnosed with other causes of pain were assigned to the control group.

Interventions

The xiphisternal angle, evidence of soft tissue compression anterior to the xiphoid process, anatomical features at the tip of the xiphoid process, and anatomical morphology of the xiphoid process were compared between the two groups.

Results

There was no significant difference in the xiphisternal angle between the two groups. No significant differences were observed in evidence of soft tissue compression anterior to the xiphoid process or anatomical features at the tip of the xiphoid process. New anatomical signs reveal that in approximately 70% of cases, the xiphoid process curves forward and then backward.

Conclusions

The xiphoid process sternal angle is not useful for diagnosing xiphodynia. The curvature of the xiphoid process is frequently observed regardless of the presence of xiphodynia.
Integrating Genetic Ancestry into Clinical Care: Accuracy, Utility, and Stakeholder Views
Authors: Prettyman Jessica , Hoffmann Thomas J , Biswas Sawona , Rajkovic Aleksandar
Published: May 2024

PURPOSE

This study aimed to evaluate the concordance of genetic ancestry reports from different providers, assess the accuracy of genetic ancestry compared to self-identified race and ethnicity (SIRE), and explore patient and provider perspectives on the potential utility and integration of genetic ancestry data into the electronic health record (EHR).

METHODS

Genetic ancestry results from two commercial providers and two 3rd-party analyses were compared for concordance using data from 451 participants in the UCSF 3D Health Study. Genetic ancestry was also compared to SIRE. Surveys were administered to gather perspectives on genetic ancestry testing, its accuracy, and potential integration into the EHR.

RESULTS

The overall mean concordance between the two commercial providers was 58.41%. Ancestry from one provider had the highest concordance with SIRE, ranging from 80.05% to 94.78% across different thresholds. The majority of participants and providers were neutral regarding the integration of genetic ancestry into the EHR.

CONCLUSION

Significant discordance exists between genetic ancestry reports from different providers, highlighting the need for standardization in the calculation of genetic ancestry. While participants and providers acknowledge the potential utility of genetic ancestry in personalized medicine, concerns regarding data privacy, accuracy, and the potential for discrimination must be addressed before integration into the EHR.
Sex-differences in reporting of statin-associated diabetes mellitus to the US Food and Drug Administration
Authors: Kao David P , Martin James , Aquilante Christina , Shalowitz Elise L , Leyba Katarina , Kudron Elizabeth , Reusch Jane EB , Regensteiner Judith G.
Published: May 2024

Objective

Determine whether statin-associated DM is reported more frequently in women than men in post-marketing adverse drug event (ADE) surveillance.

Design

Retrospective pharmacovigilance analysis

Data source

Publicly available FDA Adverse Event Reporting System (FAERS) from January 1997 through December 2023.

Setting

Real-world spontaneously reported ADEs in the United States.

Participants

Community patients reporting statin ADEs during the study period.

Interventions/exposures

Adverse drug event reports that included at least one statin.

Main outcome measures

Proportional reporting ratio to identify increased rates of statin-associated DM events in women and men compared with all other medications, and reporting odds ratio to compare reporting rates in women vs. men.

Results

A total of 18,294,814 ADEs were reported during the study period. Among statin-associated ADEs, 14,897/519,209 (2.9%) reports mentioned DM in women compared with 7,412/489,453 (1.5%) in men, which were both significantly higher than background (0.6%). Statins were primary-or secondary-suspected cause of the ADE significantly more often in women than men (59.8 vs. 28.7%), and reporting rates were disproportionately higher in women than in men for all statins. (reporting odds ratio 1.9 [95% CI 1.9-2.0]). The largest difference in reporting of statin-associated DM between women and women was observed with atorvastatin.

Conclusions

Analysis post-marketing spontaneous ADE reports demonstrated a higher reporting rate of DM-associated with statin use compared to other medications with a significantly higher reporting rate in women compared to men. Future studies should consider mechanisms of statin-associated DM moderated by sex.
Feature Selection Using Lasso Regression Enhances Deep Learning Model Performance For Diagnosis Of Lung Cancer from Transcriptomic Data
Authors: Guha Souvik
Published: May 2024

Cancer is a genetic disease where gene mutations are pivotal in disease initiation and pathophysiology. The gene expression profile follows a specific pattern exclusive to each cancer which can be utilized for early and accurate diagnosis. Microarray techniques have emerged as powerful tools capable of simultaneously capturing the expression profiles of thousands of genes. However, because of the high dimensionality of the produced transcriptome data, analysis of the resulting datasets is challenging. Recent advancements in Artificial Intelligence (AI) techniques like Machine Learning (ML) and Deep Learning can be instrumental in efficiently processing these high-dimensional datasets. LASSO-regression is a ML technique that can help to rank the features which could help in feature selection leading to dimensionality reduction. Deep Learning is one of the most sophisticated ML techniques that can process high-dimensional data owing to the presence of more number of hidden layers in its neural network. We designed a Deep Neural Network (DNN) classifier model fused with a LASSO-based significant feature extractor for classifying the gene expression dataset containing a total of 51 samples of which 24 samples are of lung cancer patients and the remaining 27 samples are of normal individuals. A LASSO regression model was implemented to identify the genes that played a significant role in the classification. These significant gene expressions were then fed into a convergent Deep Neural Architecture. The classifier was trained with 70% data and the rest 30% was used for validation. The proposed classifier proved to provide better classification as compared to LASSO regression and DNN used individually. The two classes were classified with an average accuracy of 96.25%, average precision of 99.67%, average specificity of 99.45% and average sensitivity of 91.73% measured over thirty independent assessments. In some cases, the model was able to obtain a classification accuracy of 100%. This could open the path to early and better diagnosis of cancers from transcriptome data.
Muscle Contraction is Essential for Tendon Healing and Muscle Function Recovery after Achilles Tendon Rupture and Surgical Repair
Authors: Yoneno Moe , Minegishi Yuki , Takahashi Haruna , Takahata Kei , Miyamoto Himari , Usami Yuna , Kokubun Takanori
Published: May 2024

Incomplete tendon healing and postponed muscle weakness after Achilles tendon rupture and surgical repair lead to poor performance in patient activities. Although the effectiveness of postoperative early functional rehabilitation has been proven, the priority and each effect of specific methods in early rehabilitation remain unclear. We hypothesized early muscle contraction exercises without joint motion would promote tendon healing and prevent calf muscle atrophy; in contrast, early static stretching after surgical repair would not contribute to tendon healing and induce calf muscle atrophy. C57Bl/6 mice underwent Achilles tendon rupture and suture repair, followed by different methods of post-surgery interventions: a non-exercise group, a Static stretching group, and an Electrical muscle stimulation group. 3 and 5 weeks after surgery, we assessed ex vivo tendon mechanical properties, collagen fiber alignment, and histological muscle properties. Electrical Muscle Stimulation restored the recovery of tendon mechanical properties and muscle strength more quickly than Static stretching. Static stretching had no additional effect on them compared to the non-exercise. Our results suggested that calf muscle contraction was essential as a post-surgery early functional rehabilitation to load tensile forces on tendons and improve Achilles tendon healing. Additionally, early muscle contractions naturally promote restoring muscle function after the rupture, but further research is needed to optimize muscle contraction protocols.

Statement of Clinical Significance

This study shows the importance of selecting appropriate exercise modalities to resolve imperfections in tendon healing and muscle recovery. The establishment of proper rehabilitation is expected to improve post-surgery outcomes.

Study Design

A controlled laboratory study.
Towards accesible brain-tumor classification at the point of care: Nanopore methylation sequencing from Formalin-Fixed Paraffin-Embedded (FFPE) pathology samples
Authors: Feinberg-Gorenshtein Galina , Grunwald Assaf , Vermeulen Carlo , Mark Nurit Gal , Maman Lena Shinderman , Shihrur Keren , Hameiri-Grossman Michal , Michaeli Orly , Fichman Suzanna , Natan Abraham , Siegal Tali , Yust-Katz Shlomit , Weiss Hanna , Levi-Barda Adva , Konen Osnat , Kershenovich Amir , de Ridder Jeroen , Toledano Helen , Birger Yehudit , Izraeli Shai , Ebenstein Yuval
Published: May 2024

Oxford Nanopore Technology (ONT) based methylation sequencing is increasingly recognized for its rapid and accurate classification of brain tumors. A process that is crucial for optimal patient treatment. However, widespread clinical utility is currently limited by the need for fresh-frozen biopsies and not the standard-of-care formalin-fixed, paraffin-embedded (FFPE) samples. Our study explores the impact of FFPE on DNA methylation and presents a developed and validated protocol for ONT-based FFPE tumor classification. We present a practical solution for precise brain tumor diagnoses in routine clinical settings and facilitating timely treatment decisions at the point of care and without interfering with operating room standards.
“Real-time county-aggregated wastewater-based estimates for SARS-CoV-2 effective reproduction numbers”
Authors: Ravuri Sindhu , Burnor Elisabeth , Routledge Isobel , Linton Natalie , Thakur Mugdha , Boehm Alexandria , Wolfe Marlene , Bischel Heather N. , Naughton Colleen C. , Yu Alexander T. , White Lauren A. , León Tomás M.
Published: May 2024

Background

The effective reproduction number (Re) serves as a metric of population-wide, time-varying disease spread. During the COVID-19 pandemic,Rewas primarily estimated from clinical surveillance data streams (Rcc), which have varied in quality and representativeness due to changes in testing volume, test-seeking behavior, and resource constraints. DerivingRefrom alternative data sources such as wastewater could inform future public health responses.

Objectives

We estimated county-aggregated, sewershed-restricted wastewater-based SARS-CoV-2Re(Rww) from May 1, 2022 to April 30, 2023 for five counties in California of varying population sizes, clinical testing rates, demographics, proportions surveilled by wastewater, and sampling frequencies to validate the reliability ofRwwas a real-time disease surveillance metric.

Methods

We produced both instantaneous and cohort sewershed-restrictedReusing smoothed and deconvolved wastewater concentrations. We then population-weighted and aggregated these sewershed-level estimates to arrive at county-levelRe. Using mean absolute error (MAE), Spearman’s rank correlation (ρ), confusion matrix classification, and cross-correlation analyses, we compared the timing and trajectory of twoRwwmodels to: (1) a publicly available, county-level ensemble ofRccestimates, and (2) a county-aggregated, sewershed-restrictedRcc.

Results

BothRwwmodels demonstrated high concordance with traditionalRccestimates, as indicated by low mean absolute errors (MAE ≤ 0.09), significant positive Spearman correlation (Spearman ρ ≥ 0.66, p < 0.001), and high confusion matrix classification accuracy (≥ 0.81). The relative timings ofRwwandRccwere less clear, with cross-correlation analyses suggesting strong associations for a wide range of temporal lags that varied by county andRwwmodel type.

Discussion

ThisReestimation methodology provides a generalizable, robust, and operationalizable framework for estimating county-levelRww. Our results support the additional use ofRwwas an epidemiological tool for surveillance. Based on this research, we produced publicly availableRwwnowcasts for the California Communicable diseases Assessment Tool (https://calcat.covid19.ca.gov/cacovidmodels/).
Topography and environmental deficiencies are associated with chikungunya virus exposure in urban informal settlements in Brazil
Authors: Travis Catherine , Argibay Hernán , Pellizzaro Maysa , de Oliveira Daiana Santos , Santana Roberta , Almerinda G. Palma Fabiana , Lustosa Ricardo , Souza Fábio Neves , Alzate López Yeimi Alexandra , Reis Mitermayer Galvão , Ko Albert I. , Diggle Peter J. , Begon Michael , Costa Federico , Eyre Max T. , Khalil Hussein
Published: May 2024

Background

Chikungunya virus (CHIKV) is an arbovirus with a significant global public health burden. Delineating the specific contributions of individual behaviour, household structure and the natural and built environment to CHIKV transmission is important for mitigating risk but challenging in urban informal settlements due to their heterogeneous environments. The aim of this study was to quantify variation in CHIKV seroprevalence between and within four urban communities in a large Brazilian city, and identify the respective contributions of individual, household and environmental factors for seropositivity.

Methodology/Principal Findings

A cross-sectional serological survey was conducted in four low-income communities in Salvador, Brazil in 2018 to collect individual, household and CHIKV IgG serology data for 1217 participants. Fine-scale community mapping of high-risk environmental features and remotely sensed environmental data were used to improve characterisation of the microenvironment close to the household. We categorised risk factors into three dimensions - individual, household, and environmental and used binomial mixed-effect models to identify associations with CHIKV seropositivity. CHIKV seroprevalence was 4.8%, 6.1% and 4.3% in three communities and 22.6% in one community which had a distinct topographical profile. The only individual dimension variable associated with seropositivity was male sex (OR 1.67, 95% CI 1.11 - 2.36), but several environmental variables, including living in a house on a steep hillside, at medium to high elevations, and with surface water nearby, were associated with higher seropositivity.

Conclusions/Significance

Our findings indicate that CHIKV exposure risk can vary significantly between nearby communities and at fine spatial scales within communities, and is likely to be driven more strongly by the availability of mosquito breeding sites rather than human exposure patterns. They suggest that environmental deficiencies and topography, a proxy for several environmental processes including the degree of urbanisation and flooding risk, may play an important role in driving risk at both of these scales.
Implementation of a mobile app (iMPAKT) for improving person-centredness in nursing and midwifery practice: Protocol for a multi-methods evaluation study
Authors: O’Connor Sean R , Brown Donna , Cleland Ian , Wilson Valerie , McCance Tanya V
Published: May 2024

The iMPAKT App has been developed as a digital tool for implementing and measuring person- centredness in nursing and midwifery practice. Despite its potential usefulness for the collection of person-centred measures, appropriate strategies are required to enhance the implementation of the app. To better understand the factors affecting adoption and maintenance, this protocol describes a multi-methods study to examine the experience of using the iMPAKT App in different contexts and settings. A convergent, multiple-methods approach will be used. Nurses and midwifes working in teams at different study sites in the UK and Australia will use the app during two, six-week cycles of data collection. Qualitative interviews and focus groups, guided by the Consolidated Framework for Implementation Research (CFIR) will be used to explore individual responses, views and experiences around acceptability and engagement with the app, and to examine variations in contexts. Quantitative data will be gathered on the number of person-centred measures recorded during the data collection cycles and using the System Usability Scale. Results will help to develop an understanding of the determinants and processes underpinning successful implementation, and inform further research to develop tailored implementation strategies, aimed at facilitating large scale collection of data on person- centred measures using the iMPAKT App.
Using Generative AI to Simulate Patient History-Taking in a Problem-Based Learning Tutorial: A Mixed-Methods Study
Authors: Mool Allison , Schmid Jacob , Johnston Thomas , Thomas William , Fenner Emma , Lu Kevin , Gandhi Raya , Western Adam , Seabold Brendan , Smith Kodi , Patterson Zachary , Feldt Hannah , Vollmer Daniel , Nallaveettil Roshan , Fanelli Anthony , Schmillen Logan , Tischkau Shelley , Cianciolo Anna T. , Benedict Pinckney , Selinfreund Richard
Published: May 2024

Background

Medical educators who implement problem-based learning (PBL) strive to balance realism and feasibility when simulating patient cases, aiming to stimulate collaborative group discussion, engage students’ clinical reasoning, motivate self-directed learning, and promote the development of actionable scientific understanding. Recent advances in generative artificial intelligence (AI) offer exciting new potential for patient simulation in PBL

Method

This study used a between-groups, mixed-methods approach to (1) form a comprehensive picture of Year 2 medical student interactions with a generative AI-simulated patient in a PBL tutorial, as compared to interactions with multimedia patient case materials; and (2) triangulate on the impact these interactions had on learning. Two groups of students (N = 13) gathered patient history information from a generative AI-enabled, 3D-animated avatar (AI condition). Two other student groups (N = 13) gathered patient history information from a multimedia database using keyword searching (Electronic PBL Module [ePBLM] condition). We used descriptive observation to explore student interactions with both forms of the simulated patient, and we quantitatively compared students’ perceptions of their learning experience and recall of patient history information across conditions.

Results

Students in the AI condition rated their present, AI-augmented PBL learning experience—particularly its clinical accuracy and teamwork aspects—significantly higher than they rated their previous PBL learning experiences using ePBLMs. Recall of patient history information did not differ between conditions. Descriptive observation indicated that the AI avatar presented case content accurately, with an appropriate amount of information provided in response to students’ questions. Students were highly engaged as a group in taking a history from the avatar. However, although students used language suggestive of anthropomorphizing of the AI (e.g., gender pronouns), they appeared to orient to it as an augmented “question bank” for gathering patient history information, using a questioning strategy akin to querying an ePBLM.

Discussion

Optimizing AI implementation to stimulate clinical reasoning and patient communication skills in PBL could include (1) starting early, perhaps in Year 1, before an alternative interactional framework can take hold; (2) orienting students to the AI to help them understand its capabilities; and (3) encouraging “play” with or “discovery learning” of the AI’s capabilities.
Telehealth use for sexual and reproductive health promotion and care during the early phase of COVID-19 pandemic: A descriptive-interpretive qualitative study of healthcare providers’ perspectives and experiences in Western - Central New York State
Authors: Muheriwa-Matemba Sadandaula Rose , Alcena-Stiner Danielle C. , Glazier Alexander , LeBlanc Natalie M.
Published: May 2024

Telehealth emerged as an option for the provision of sexual and reproductive health (SRH) care and promotion during COVID-19 pandemic restrictions. However, studies are limited on the perspectives and experiences of healthcare providers (HCPs) practicing in the Western-Central region of New York State. This qualitative interpretive study explored the perspectives and experiences of HCPs with telehealth use for sexual and reproductive health promotion including counselling, testing, care and treatment for HIV infection and other sexually transmitted infections (STIs), in Western New York State. Ten HCPs participated in semi-structured in-depth interviews from October 2019-February 2021. These providers were predominately white, female, ranged in years of clinical experience (1-30 years). The narratives revealed three major themes: 1) healthcare providers’ perspectives of telehealth use, 2) healthcare providers’ experiences with telehealth use for SRH promotion and care, and 3) determinants of telehealth implementation. Though all providers reported an increase in the use of telehealth, experiences in the delivery of telehealth varied especially for sexual and reproductive health services. Some providers reported having more time to consult with patients because of a decrease in patient load which freed up time to engage with patients. Others reported technological limitations among some patients which impacted care. Strengthening telehealth-based sexual health promotion will serve to address efforts toward ending the HIV epidemic, reducing other STIs, and ensuring consistent access to contraception. To effectively implement telehealth findings, suggest a need to ensure adequate technological resources for patients, and a need to increase HCPs’ comfort to engage patients in sexual health conversations via telehealth.
Plasma p-tau217 in Alzheimer’s disease: Lumipulse and ALZpath SIMOA head-to-head comparison
Authors: Pilotto Andrea , Quaresima Virginia , Trasciatti Chiara , Tolassi Chiara , Bertoli Diego , Mordenti Cristina , Galli Alice , Rizzardi Andrea , Caratozzolo Salvatore , Zancanaro Andrea , Contador José , Hansson Oskar , Palmqvist Sebastian , Santis Giovanni De , Zetterberg Henrik , Blennow Kaj , Brugnoni Duilio , Suárez-Calvet Marc , Ashton Nicholas J , Padovani Alessandro
Published: May 2024

Background

Plasma phosphorylated-tau217 (p-tau217) has been shown to be one of the most accurate diagnostic markers for Alzheimer’s disease (AD). No studies have compared the clinical performance of p-tau217 as assessed by the fully automated Lumipulse and SIMOA ALZpath p-tau217.

Aim

To evaluate the diagnostic accuracy of Lumipulse and SIMOA plasma p-tau217 assays for AD.

Methods

The study included 392 participants, 162 with AD, 70 with other neurodegenerative diseases (NDD) with CSF biomarkers and 160 healthy controls. Plasma p-tau217 levels were measured using the Lumipulse and ALZpath SIMOA assays. The ability of p-tau217 assessed by both techniques to discriminate AD from NDD and controls was investigated using ROC analyses.

Results

Both techniques showed high internal consistency of p-tau217 with similar correlation with CSF p-tau181 levels. In head-to-head comparison, Lumipulse and SIMOA showed similar diagnostic accuracy for differentiating AD from NDD (area under the curve [AUC] 0.952, 95%CI 0.927–0.978 vs 0.955, 95%CI 0.928–0.982, respectively) and HC (AUC 0.938, 95%CI 0.910-0.966 and 0.937, 95% CI0.907-0.967 for both assays).

Conclusions

This study demonstrated the high precision and diagnostic accuracy of p-tau217 for the clinical diagnosis of Alzheimer’s disease using either fully automated or semi-automated techniques.
Measuring linkage disequilibrium and improvement of pruning and clumping in structured populations
Authors: Bercovich Ulises , Rasmussen Malthe Sebro , Li Zilong , Wiuf Carsten , Albrechtsen Anders
Published: May 2024

Standard measures of linkage disequilibrium (LD) are affected by admixture and population structure, such that loci that are not in LD within each ancestral population appear linked when considered jointly. The influence of population structure on LD can cause problems for downstream analysis methods, in particular those that rely on LD pruning or clumping. To address this issue, we propose a measure of LD that accommodates population structure using the top inferred principal components. We estimate LD from the correlation of geno-type residuals and prove that this LD measure remains unaffected by population structure when analyzing multiple populations jointly, even with admixed individuals. Based on this adjusted measure of LD, we can perform LD pruning to remove the correlation between markers for downstream analysis. Traditional LD pruning is more likely to remove markers with high differences in allele frequencies between populations, which biases measures for genetic differentiation and removes markers that are not in LD in the ancestral populations. Using data from moderately differentiated human populations and highly differentiated giraffe populations we show that traditional LD pruning biasesFSTand PCA but that this can be alleviated with the adjusted LD measure. In addition, we show the adjusted LD leads to better PCA when pruning and that LD clumping retains more sites and the retained sites have stronger associations.
Self-Rehabilitation Strategy for Rural Community-dwelling Stroke Survivors in a Lower-Middle Income Country: A Delphi Study
Authors: Ibrahim Rabi’u , Joseph Conran , Stewart Aimée , Lawal Isa Usman
Published: May 2024

Background

More than half of stroke survivors in LMICs lack access to stroke rehabilitation services. The promotion of self-rehabilitation could be promising in an attempt to address the stroke rehabilitation inadequacies in LMICs. Self-rehabilitation interventions can easily be accepted by many community-dwelling stroke survivors, and therefore, have the potential to drive towards the successful realization of Sustainable Development Goals and other WHO rehabilitation goals. We report a consensus building process that sought to identify which task training is relevant to include in a task-specific self-rehabilitation strategy for the rural community-dwelling stroke survivors.

Methods

We used an iterative two-staged mixed-method consensus-building approach: (1) focus group discussions (n = 5) with rural community-dwelling stroke survivors were conducted to explore personal life experiences in performing daily activities, and the results were used to developed a lists of candidate task trainings that could be included in a task-specific self-rehabilitation intervention model for improving functional ability post-stroke survivors; (2) a three-round Delphi exercise with a panel of stroke rehabilitation experts to establish consensus on the importance/relevance of the developed task trainings. Consensus was pre-defined to be the point where the proportion of items giving a rating of 3 (quite relevant) or 4 (highly relevant) by raters would be ≥ 0.8.

Results

A list of 74 task training was generated from the results of the focus groups and grouped as follows: training for the upper extremity (37); lower extremity training (21); while 7 and 9 task trainings were grouped under the trunk and balance training respectively. A panel of 13 experts in the Delphi reviewed these task trainings and consensus was achieved on keeping 28 task trainings in the first round and an additional 7 in the second round. In the study team’s analysis of open text responses, several areas of debate were identified and some task trainings were modified. The exercise yielded 49 trainings (66% of 74) on which there was consensus (the mean proportion of items giving a rating of 3 or 4 by raters was 0.93) to keep 3 task training groups relating to: upper extremity (27), lower extremity/balance (8), trunk strength (4) and warm up exercises (10).

Conclusions

The study provides a consensus-based view of the features of a task-specific self-rehabilitation training strategy to improve outcomes following a stroke. This self-rehabilitation training strategy can be used as an intervention approach to augment and promote stroke rehabilitation among the rural community-dwelling stroke survivors, especially in SSA.