bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating Genomic Screening into Primary Care: Provider Experiences Caring for Latino Patients at a Community-Based Health Center
Authors: Srinivasan Tarika , Sutton Erica J. , Beck Annika T. , Cuellar Idali , Hernandez Valentina , Pacyna Joel E. , Shaibi Gabriel Q. , Kullo Iftikhar J. , Lindor Noralane M. , Singh Davinder , Sharp Richard R.
Published: March 2021

Introduction:

Minority communities have had limited access to advances in genomic medicine. Mayo Clinic and Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, Arizona, partnered to assess the feasibility of offering genomic screening to Latino patients receiving care at a community-based health center. We examined primary care provider (PCP) experiences reporting genomic screening results and integrating those results into patient care.

Methods:

We conducted open-ended, semi-structured interviews with PCPs and other members of the health care team charged with supporting patients who received positive genomic screening results. Interviews were recorded, transcribed, and analyzed thematically.

Results:

Of the 500 patients who pursued genomic screening, 10 received results indicating a genetic variant that warranted clinical management. PCPs felt genomic screening was valuable to patients and their families, and that genomic research should strive to include underrepresented minorities. Providers identified multiple challenges integrating genomic sequencing into patient care, including difficulties maintaining patient contact over time; arranging follow-up medical care; and managing results in an environment with limited genetics expertise. Providers also reflected on the ethics of offering genomic sequencing to patients who may not be able to pursue diagnostic testing or follow-up care due to financial constraints.

Conclusions:

Our results highlight the potential benefits and challenges of bringing advances in precision medicine to community-based health centers serving under-resourced populations. By proactively considering patient support needs, and identifying financial assistance programs and patient-referral mechanisms to support patients who may need specialized medical care, PCPs and other health care providers can help to ensure that precision medicine lives up to its full potential as a tool for improving patient care.
Maternal Self-rated Capability Status and Its Association with Under-Five Children Morbidity
Authors: Akintunde Tosin Yinka , Chen Shaojun , Ibrahim Elhakim , Tassang Angwi Enow
Published: March 2021

Background:

Under-five morbidity is a significant public health concern in developing countries, and maternal intervention remains vital to achieving under-five optimal health.

Objective:

The study examined the influence of maternal self-rated capability status (SCS) on under-five morbidity in Ibadan North Local Government Area (LGA), Oyo State, Nigeria.

Methods:

The study interviewed 683 nursing mothers surveyed from 20 primary healthcare centers (PHCs) from 13th to 27th September 2018 in the LGA of study. We employed logistic regression models to examine the association of 4 domains of maternal SCS on under-five morbidity incidence controlling for the potential confounding effects of maternal, child, and household sociodemographic attributes.

Results:

Under-five children of mothers with poor status in the knowledge of child morbidity, experience-informed action, child morbidity exposure, and childcare vulnerability domains are, respectively, 497%, 323%, 400%, and 318% more likely to be at risk of morbidity than their peers born to mothers with good status. In addition, the odds of morbidity were lower for children born to women with more than 1 under-five children (AOR: 0.49, 95% CI: 0.27, 0.88), while the odds were higher for those from households that are food-insecure (AOR: 3.16, 95% CI: 1.31, 7.65) and dispose of wastes within the compound (AOR: 2.67, 95% CI: 1.31, 5.45) relative to children in the comparative categories.

Conclusion:

Our findings revealed the significance of maternal SCS as a crucial pathway for understanding and reducing under-five morbidity. Community interventions should prioritize empowering nursing mothers with prevention and care information necessary to reduce the under-five morbidity burden at the community level.
Physical Aggression Is Associated With More Effective Postdecisional Processing of Social Threat
Authors: Brennan Grace M. , Baskin-Sommers Arielle
Published: March 2021

Physically aggressive individuals are more likely to decide that others are threatening. Yet no research has examined how physically aggressive individuals’ social decisions unfold in real time. Seventy-five incarcerated men completed a task in which they identified the emotions in faces displaying anger (i.e., threat) and happiness (i.e., nonthreat) at low, moderate, or high ambiguity. Participants then rated their confidence in their decisions either immediately or after a delay, and changes in confidence provided an index of postdecisional processing. Physical aggression was associated with stronger differentiation of threatening and nonthreatening faces under moderate ambiguity. Moreover, physical aggression was associated with steeper decreases in confidence over time following decisions that threatening faces were nonthreatening, indicating more extensive postdecisional processing. This pattern of postdecisional processing mediated the association between physical aggression and angry rumination. Findings suggest a role for postdecisional processing in the maintenance of threat-based social decisions in physical aggression.
Weightbearing Protocols After Posterolateral Corner Reconstruction: A Systematic Review
Authors: Morris Brandon L. , Poppe Tanner , Kim Kenneth , Barnds Brandon , Schroeppel Paul , Mullen Scott , Tarakemeh Armin , Bechtold Megan , Vopat Bryan G.
Published: March 2021

Background:

Multiligamentous knee injuries with a posterolateral corner injury represent a devastating insult to the knee.

Purpose:

To evaluate multiligamentous knee reconstruction rehabilitation programs and recommend a rehabilitation program based on a review of published outcomes studies.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A MEDLINE (PubMed), OVID, and Embase database search was conducted using the terms “posterolateral corner” and “rehabilitation.” All articles obtained were examined to confirm their rehabilitation programs for multiligamentous knee injuries. These injuries included a posterolateral corner injury plus an isolated anterior or posterior cruciate ligament injury or a combined cruciate injury.

Results:

Ten publications representing 245 patients with multiligamentous knee reconstruction were analyzed. Rehabilitation protocols were divided by weightbearing (WB) status: in 2 studies, patients were non-WB until postoperative 4 weeks (delayed WB; n = 61); 5 studies permitted progressive WB until postoperative 6 weeks (progressive WB; n = 123); and 3 studies allowed WB immediately after surgery (immediate WB; n = 61). No significant difference in outcome scores among the 3 WB groups was found. Arthrofibrosis requiring manipulation under anesthesia was the most common complication (11%) in the delayed WB group, followed by the immediate WB group (3%) and the progressive WB group (0%; P < .01). Overall complication rates were highest in the delayed WB group (44%), followed by the immediate and progressive WB groups (25% and 3%, respectively; P < .00001). The delayed WB group was permitted to return to sport at a mean of 10.5 months from the index procedure; the progressive WB group, at 6.0 months; and the immediate WB group, at 9.0 months ( P < .05).

Conclusion:

This review revealed no significant difference in outcome scores when comparing immediate, progressive, and delayed WB protocols. Time to permitted return to sport was not significantly different among the groups, but there existed a trend toward earlier return in the progressive WB group. Patients in the delayed and immediate WB groups experienced a higher overall complication rate. Progressive WB postoperative protocols may decrease the risk of complications without compromising outcomes; however, more research is needed to identify the optimal postoperative rehabilitation protocol, given the significant data heterogeneity currently available in the literature.
Individual Vulnerability and Organizational Context as Risks for Sexual Harassment among Female Graduate Students
Authors: Sutton Tara E. , Culatta Elizabeth , Boyle Kaitlin M. , Turner Jennifer L.
Published: March 2021

Despite a growing body of work on sexual harassment among college students, little work has examined predictors of sexual harassment specifically among graduate students. This study aims to address this gap in the literature by using data from 490 female graduate students at a large, public university. Based on a feminist routine activity theory approach, both individual vulnerability (lesbian, gay, bisexual, queer, or other sexual identity [LGBQ+], international student status, psychological distress, alcohol use) and organizational context (departmental female ratio, male-dominated field, departmental support) are tested as risk factors for sexual harassment. Moreover, we examine risks for sexual harassment by either a peer or a professor before testing models for peer and faculty member harassment separately. Logistic regression analyses demonstrated that both individual vulnerability and organizational context are related to an increased likelihood of sexual harassment among female graduate students, but patterns of findings vary by type of offender. Policy recommendations are offered, including the need for safe spaces on campus for LGBQ+ and international students and the need for clear consequences for offenders of sexual harassment.
Swipe Up for More: How Our Students Taught Us to Use Social Media in an Academic Health Promotion Department
Authors: Blanchard Rebecca , Webb Summer , Duval Garian I. , Robinson Molly , Lee Joseph G. L. , Russell Kelli
Published: March 2021

Social media is an important tool for academic departments. Yet, with limited resources, many health promotion departments may not have the ability to conduct extensive planning or development of social media plans. This commentary reports the efforts of one undergraduate public health program to improve its social media presence. Faculty and students worked together to develop a social media plan, identify activities to implement the plan, and track social media follower counts on Instagram and Twitter in spring 2020. A logic model planning framework drove the process, and key learnings from efforts are presented. Departmental leaders may want to link students and faculty to generate student-driven content on social media. Leaders should recognize that advance planning is needed to maintain consistency, control account access, and be prepared to deal with problematic comments on social media. Suggested activities are presented in the hope they may inform other departments’ efforts. Department leaders and faculty may find they have much to learn from their students in this area.
Speaking like a scientist: A multiple case study on sketch and speak intervention to improve expository discourse
Authors: Peterson Amy K , Ukrainetz Teresa A , Risueño RJ
Published: March 2021

Purpose

This descriptive multiple case study examined the effects of a contextualized expository strategy intervention on supported and independent note-taking, verbal rehearsal, and reporting skills for three elementary students with language disorders.

Method

Two 9-year-old fourth grade students and one 11-year-old sixth grade student with language disorders participated. The intervention was delivered as sixteen individual 20-minute sessions across nine weeks by the school speech-language pathologist. Students learned to take written and pictographic notes from expository texts and use verbal formulation and rehearsal of individual sentences and whole reports in varied learning contexts. To explore both emergent and independent accomplishments, performance was examined in final intervention session presentations and pre/post intervention testing.

Results

Following the intervention, all three students effectively used notes and verbal rehearsal to prepare and present fluent, organized, accurate, confident oral reports to an audience. From pre- to post-test, the students showed a range of improvements in the quality of notes, use of verbal rehearsal, holistic quality of oral and written reporting, and strategy awareness.

Conclusions

Sketch and Speak shows potential as an expository intervention for students who struggle with academic language learning. The results support further examination of this intervention for supported strategy use by younger students and independent use by older students.
Socio-demographic factors modify awareness, knowledge, and perceived risk of glaucoma in rural and urban residents in Ghana: a population-based survey
Authors: Ocansey Stephen , Abu Emmanuel K. , Abraham Carl Halladay , Owusu-Ansah Andrews , Acheampong Caleb , Mensah Frederick , Darko-Takyi Charles , Ilechie Alex
Published: March 2021

Purpose:

To evaluate the awareness, knowledge and the perception of risks of glaucoma among rural and urban dwellers in Ghana, a high prevalent country, in order to provide information for health promotion planning.

Method:

In a population-based descriptive cross-sectional survey, 1200 adults were selected from household settings, using a two-stage cluster and simple systematic random sampling. Quantitative data collection, using interviewer-administered questionnaire, was employed. Descriptive statistics were performed using chi-square, ordinal univariate, multinomial and multivariate logistic regression models used to calculate odds ratio with 95% confidence interval (CI) to identify predictive factors.

Results:

Overall, only 326 (27.2%, 95% CI = 24.6–29.7) indicated they were aware of glaucoma, whereas 331 (27.6%, 95% CI = 24.6–29.7) had ever undergone an eye screening. Low knowledge was demonstrated in 152 (46.6%, 95% CI = 41.2–52.0) and high knowledge in 99 (30.4%, 95% CI = 25.4–35.4) glaucoma-aware participants. Only 238 (19.8%, 95% CI = 17.6–22.1) of respondents presumed themselves to be at risk of developing glaucoma. Having eye examination (within the last 6 months) was positively associated with knowledge (adjusted odds ratio (AOR) = 1.413; 95% CI = 0.9–1.896) and awareness (AOR = 1.13; 95% CI = 0.938–2.449). Three levels of education (no education (AOR = 0.041; 95% CI = 0.016–0.11), primary (AOR = 0.057; 95% CI = 0.018–0.179), and middle school (AOR = 0.254; 95% CI = 0.127–0.51)) were associated with low knowledge while all levels of education were inversely associated with awareness. Perceived risk of glaucoma was also influenced by area of residence (rural (AOR = 0.344; 95% CI = 0.21–0.57)), being young (18–24 years (AOR = 4.308; 95% CI = 2.36–7.88)) and having previously undergone screening for glaucoma (AOR = 13.200; 95% CI = 5.318–32.764).

Conclusion:

The main modifiers of glaucoma awareness and knowledge were education and previous eye examination, but awareness had additional factor of area of residence. Perceived risk of glaucoma was influenced by being young and living in urban areas.
Validation of the Activity Room: An Ecologically Valid Assessment of Young Children’s Risk-Taking
Authors: Morgan Casie H. , Estep Claire , Morrongiello Barbara A. , Schwebel David C.
Published: March 2021

Physical risk-taking is associated with increased risk of unintentional injury, a global health challenge and the leading cause of death for children in the United States. To assess risk and develop prevention programs, valid tools to assess children’s physical risk-taking are needed. No ecologically valid behavioral measures are widely available. This study describes the development and validation of the “Activity Room” to measure children’s physical risk-taking while presenting low risk of actual injury. Participants were 59 children aged 4 to 6 years old (51% female; 51% non-Hispanic White) and their parents. Children completed two tasks to assess physical risk-taking: (a) vignettes (short stories presenting risk situations) and (b) the “Activity Room” (unsupervised engagement for 5 min in a room with apparatus designed to stimulate potential physical risk-taking). Parents responded to a questionnaire concerning children’s active play behaviors. Correlational analyses evaluated convergent validity of the Activity Room risk-taking outcome. The Activity Room proved feasible; all children engaged eagerly and safely. Convergent validity was demonstrated through two strategies. First, risk-taking in the Activity Room correlated with observed play behaviors, such as climbing and falling. Second, risk-taking in the Activity Room correlated with children’s risk-taking responses in the vignettes and with parent-reported child risk-taking. Results indicate the Activity Room task is a valid technique to assess young children’s risk-taking in an ecologically valid real-world behavioral task. Incorporation of the task as an assessment tool may benefit a range of studies investigating children’s physical risk-taking behavior, risky decision-making, and child injury prevention strategies.
3D printing of a continuous fiber-reinforced composite based on a coaxial Kevlar/PLA filament
Authors: Cersoli Trenton , Yelamanchi Bharat , MacDonald Eric , Carrillo Jose Gonzalo , Cortes Pedro
Published: March 2021

Additive manufacturing has allowed for the production of complex and mass customized geometries, but often at the expense of mechanical performance, a penalty which can be in part mitigated with the fabrication of composite parts. Thermoplastic structures fabricated with material extrusion additive manufacturing stand to be improved in terms of fracture toughness with the integration of continuous fibers. The present research program has investigated the production of a continuously reinforced filament to be used in open-source fused filament fabrication systems. Three different volume fractions of Kevlar fibers were incorporated into a polylactic acid (PLA) thermoplastic filament. It was observed that a 20% fiber volume fraction resulted in a doubling of the tensile strength relative to the unreinforced PLA parts. High-velocity impact tests were also performed on the reinforced printed thermoplastic material, and it was observed that the composite with the highest fiber volume fraction provided an impact energy resistance improved by a factor of four, relative to the plain PLA. The reinforced fibers have shown to restrain the penetration of the projectile at velocities similar to those that perforated the unreinforced PLA. The present work has demonstrated the production of printed composites without the need of modifying the extruding systems of a commercial 3D printer. This approach could represent an alternate and feasible process for producing continuously reinforced 3D-printed thermoplastic parts with utility for high-velocity impact applications.
Mcconnellite, CuCrO2 and ellinaite, CaCr2O4, from varicoloured spurrite marble of the Daba-Siwaqa area, Hatrurim Complex, Jordan
Authors: Galuskina Irina O. , Stachowicz Marcin , Woźniak Krzysztof , Vapnik Yevgeny , Galuskin Evgeny
Published: March 2021

A common attribute of two rare natural chromium-bearing oxides: mcconnellite, CuCrO2, discovered more than 40 years ago in Guyana, and a new mineral ellinaite, CaCr2O4, described from two localities (Brazil and Israel) recently, is that these minerals are poorly studied due to their rarity and small size. Mcconnellite and ellinaite in the present study were found in varicoloured marbles of the pyrometamorphic Hatrurim Complex in the Tulul Al Hammam area, Daba-Siwaqa, Jordan. Structural data obtained for ellinaite (Pnma, a = 9.0875(2), b = 2.9698(1), c = 10.6270(3) Å and V = 286.80(2) Å3), with an empirical formula (Сa1.00Sr0.01)Σ1.01(Cr3+1.79Al0.07Ca0.04Fe3+0.04 Ti4+0.03Mg0.03)Σ2.00O4, is similar to the structural data of synthetic analogue β-CaCr2O4 but differs significantly from the data obtained for ellinaite from Brazil and Israel despite the fact that all the natural phases have a similar composition. Single-crystal X-ray diffraction data for mcconnellite from Jordan (R

$\bar{3}$

m, a = b = 2.9756(1) and c = 17.124(1) Å) with composition (Cu0.98Ca0.03Sr0.01)Σ1.02(Cr3+0.90Al0.05 Fe3+0.03)Σ0.98O2, is the first determination of a natural Cu-delafossite-type structure. This paper also presents the results of a single-crystal Raman study for mcconnellite and ellinaite, which indicates that the spectral features of these minerals is dependent on crystal orientation.
Incidence of skin hyperpigmentation in Black patients receiving treatment with immunomodulatory drugs
Authors: Milrod Charles J. , Blevins Frances , Hughes David , Lerner Adam , Sarosiek Shayna , Sanchorawala Vaishali , Sloan J. Mark
Published: March 2021

In a retrospective single-center review of patients with myeloma treated with the immunomodulatory drug thalidomide, lenalidomide, or pomalidomide, the authors report that marked hyperpigmentation occurred in 40% of Black patients, compared with 3.5% of White patients. Since only 2% of the participants in the original pivotal trial of lenalidomide were Black, this unexpectedly high rate was not previously recognized.
Climatic influence on tree wood anatomy: a review
Authors: Pandey Sudip
Published: March 2021

Wood anatomical traits of xylem are the characteristics of tree rings at cellular and subcellular scales providing important insights on structural features and their linkage to the environment. Therefore, studying the relationship between anatomical traits and environmental changes not only provide physiological explanations, but also provide a new vision of studying the adaptation process and response strategies of tree growth to climate. In this paper, I review and synthesize literature on the influence of climatic parameters on wood anatomy from the different geographical regions using recent (2015–2020) published articles on the topic. This paper discusses the relationship between the anatomical features of angiosperm and gymnosperm xylem with climatic factors. Based on the literature, I then purpose to explore the temporal and spatial variations in the anatomical characteristics of xylem tree rings with environmental changes. Also, more studies can be conducted to assess the synergetic and antagonistic effects among different tree-ring proxies and to determine the specific roles and contributions of major climatic factors during different periods of tree-ring formation.
Triazoloacridone C-1305 impairs XBP1 splicing by acting as a potential IRE1α endoribonuclease inhibitor
Authors: Bartoszewska Sylwia , Króliczewski Jarosław , Crossman David K. , Pogorzelska Aneta , Bagiński Maciej , Collawn James F. , Bartoszewski Rafal
Published: March 2021

Inositol requiring enzyme 1 alpha (IRE1α) is one of three signaling sensors in the unfolding protein response (UPR) that alleviates endoplasmic reticulum (ER) stress in cells and functions to promote cell survival. During conditions of irrevocable stress, proapoptotic gene expression is induced to promote cell death. One of the three signaling stressors, IRE1α is an serine/threonine-protein kinase/endoribonuclease (RNase) that promotes nonconventional splicing of XBP1 mRNA that is translated to spliced XBP1 (XBP1s), an active prosurvival transcription factor. Interestingly, elevated IRE1α and XBP1s are both associated with poor cancer survival and drug resistance. In this study, we used next-generation sequencing analyses to demonstrate that triazoloacridone C-1305, a microtubule stabilizing agent that also has topoisomerase II inhibitory activity, dramatically decreases XBP1s mRNA levels and protein production during ER stress conditions, suggesting that C-1305 does this by decreasing IRE1α’s endonuclease activity.
Evolution in Sinocyclocheilus cavefish is marked by rate shifts, reversals, and origin of novel traits
Authors: Mao Ting-Ru , Liu Ye-Wei , Meegaskumbura Madhava , Yang Jian , Ellepola Gajaba , Senevirathne Gayani , Fu Cheng-Hai , Gross Joshua B. , Pie Marcio R.
Published: March 2021

Background

Natural model systems are indispensable for exploring adaptations in response to environmental pressures.Sinocyclocheilusof China, the most diverse cavefish clade in the world (75 species), provide unique opportunities to understand recurrent evolution of stereotypic traits (such as eye loss and sensory expansion) in the context of a deep and diverse phylogenetic group. However, they remain poorly understood in terms of their morphological evolution. Therefore, we explore key patterns of morphological evolution, habitat utilization and geographic distribution in these fishes.

Results

We constructed phylogenies and categorized 49 species based on eye-related condition (Blind, Micro-eyed, and Normal-eyed), habitat types (Troglobitic—cave-restricted; Troglophilic—cave-associated; Surface—outside caves) and existence of horns. Geometric-morphometric analyses show Normal-eyed morphs with fusiform shapes segregating from Blind/Micro-eyed deeper bodied morphs along the first principal-component axis; second axis accounts for shape complexity related to horns. The body shapes showed a significant association with eye-related condition and horn, but not habitat types. Ancestral reconstructions suggest at least three independent origins of Blind morphs, each with different levels of modification in relation to their ancestral Normal-eyed morphs;Sinocyclocheilusare also pre-adapted for cave dwelling. Our geophylogeny shows an east-to-west diversification spanning Pliocene and Pleistocene, with early-diversifying Troglobitic species dominating subterranean habitats of karstic plains whereas predominantly Surface forms inhabit hills to the west. Evolutionary rates analyses suggest that lineages leading to Blind morphs were characterized by significant rate shifts, such as a slowdown in body size evolution and a 5–20 fold increase in rate of eye regression, possibly explained by limited resource availability. Body size and eye size have undergone reversals, but not horns, a trait entailing considerable time to form.

Conclusions

Sinocyclocheilusoccupied cave habitats in response to drying associated with aridification of China during late Miocene and the Pliocene. The prominent cave-adaptations (eye-regression, horn-evolution) occur in clades associated with the extensive subterranean cave system in Guangxi and Guizhou provinces. Integration of morphology, phylogeny, rate analyses, molecular-dating and distribution show not only several remarkable patterns of evolution, but also interesting exceptions to these patterns signifying the diversification ofSinocyclocheilusas an invaluable model system to explore evolutionary novelty.
Mapping and characterization QTLs for phenological traits in seven pedigree-connected peach families
Authors: Rawandoozi Zena J. , Hartmann Timothy P. , Carpenedo Silvia , Gasic Ksenija , da Silva Linge Cassia , Cai Lichun , Van de Weg Eric , Byrne David H.
Published: March 2021

Background

Environmental adaptation and expanding harvest seasons are primary goals of most peach [Prunus persica(L.) Batsch] breeding programs. Breeding perennial crops is a challenging task due to their long breeding cycles and large tree size. Pedigree-based analysis using pedigreed families followed by haplotype construction creates a platform for QTL and marker identification, validation, and the use of marker-assisted selection in breeding programs.

Results

Phenotypic data of seven F1low to medium chill full-sib families were collected over 2 years at two locations and genotyped using the 9 K SNP Illumina array. Three QTLs were discovered for bloom date (BD) and mapped on linkage group 1 (LG1) (172–182 cM), LG4 (48–54 cM), and LG7 (62–70 cM), explaining 17–54%, 11–55%, and 11–18% of the phenotypic variance, respectively. The QTL for ripening date (RD) and fruit development period (FDP) on LG4 was co-localized at the central part of LG4 (40–46 cM) and explained between 40 and 75% of the phenotypic variance. Haplotype analyses revealed SNP haplotypes and predictive SNP marker(s) associated with desired QTL alleles and the presence of multiple functional alleles with different effects for a single locus for RD and FDP.

Conclusions

A multiple pedigree-linked families approach validated major QTLs for the three key phenological traits which were reported in previous studies across diverse materials, geographical distributions, and QTL mapping methods. Haplotype characterization of these genomic regions differentiates this study from the previous QTL studies. Our results will provide the peach breeder with the haplotypes for three BD QTLs and one RD/FDP QTL to create predictive DNA-based molecular marker tests to select parents and/or seedlings that have desired QTL alleles and cull unwanted genotypes in early seedling stages.
Insight into the epidemiology of infective endocarditis in Portugal: a contemporary nationwide study from 2010 to 2018
Authors: Sousa Catarina , Nogueira Paulo , Pinto Fausto J.
Published: March 2021

Background

Nationwide hospital admissions data series have contributed to a reliable assessment of the changing epidemiology of infective endocarditis, even though conclusions are not uniform. We sought to use a recent populational series to describe the temporal trends on the incidence of infective endocarditis, its clinical characteristics and outcome results, in Portugal.

Methods

A nationwide retrospective temporal trend study on the incidence and clinical characterization of patients hospitalized with infective endocarditis, between 2010 and 2018.

Results

7574 patients were hospitalized with infective endocarditis from 2010 to 2018 in Portuguese public hospitals. The average length of hospitalization was 29.3 ± 28.7 days, predominantly men (56.9%), and 47.1% had between 60 and 79 years old. The most frequent infectious agents involved were Staphylococcus (16.4%) and Streptococcus (13.6%). During hospitalization, 12.4% of patients underwent heart valve surgery and 20% of the total cohort died. After a 1-year post-discharge follow-up, 13.2% of the total initial cohort had had heart valve surgery and 21.2% in total died. The annual incidence of infective endocarditis was 8.31 per 100,000 habitants, being higher in men (9.96 per 100,000 in males versus 6.82 in females, p < 0.001) and increased with age, peaking at patients 80 years old or older (40.62 per 100,000). In-hospital mortality rate significantly increased during the analyzed period, the strongest independent predictors being ischemic or hemorrhagic stroke, sepsis, and acute renal failure. Younger age and cardiac surgery had a protective effect towards a fatal outcome.

Conclusions

In Portugal, between 2010 and 2018, the incidence of infective endocarditis presented a general growth trend with a deceleration in the most recent years. Also, a significant rate of in-hospital complications, a mildly lower than expected stable surgical rate and a still high and growing mortality rate were noted.
Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis
Authors: Zhang Xiao-Ming , Jiao Jing , Cao Jing , Huo Xiao-Peng , Zhu Chen , Wu Xin-Juan , Xie Xiao-Hua
Published: March 2021

Background

A large number of studies have explored the association between frailty and mortality among COVID-19 patients, with inconsistent results. The aim of this meta-analysis was to synthesize the evidence on this issue.

Methods

Three databases, PubMed, Embase, and Cochrane Library, from inception to 20th January 2021 were searched for relevant literature. The Newcastle–Ottawa Scale (NOS) was used to assess quality bias, and STATA was employed to pool the effect size by a random effects model. Additionally, potential publication bias and sensitivity analyses were performed.

Results

Fifteen studies were included, with a total of 23,944 COVID-19 patients, for quantitative analysis. Overall, the pooled prevalence of frailty was 51% (95% CI: 44–59%). Patients with frailty who were infected with COVID-19 had an increased risk of mortality compared to those without frailty, and the pooled hazard ratio (HR) and odds ratio (OR) were 1.99 (95% CI: 1.66–2.38) and 2.48 (95% CI: 1.78–3.46), respectively. In addition, subgroup analysis based on population showed that the pooled ORs for hospitalized patients in eight studies and nursing home residents in two studies were 2.62 (95% CI: 1.68–4.07) and 2.09 (95% CI: 1.40–3.11), respectively. Subgroup analysis using the frailty assessment tool indicated that this association still existed when using the clinical frailty scale (CFS) (assessed in 6 studies, pooled OR = 2.88, 95% CI: 1.52–5.45; assessed in 5 studies, pooled HR = 1.99, 95% CI: 1.66–2.38) and other frailty tools (assessed in 4 studies, pooled OR = 1.98, 95% CI: 1.81–2.16). In addition, these significant positive associations still existed in the subgroup analysis based on study design and geographic region.

Conclusion

Our study indicates that frailty is an independent predictor of mortality among patients with COVID-19. Thus, frailty could be a prognostic factor for clinicians to stratify high-risk groups and remind doctors and nurses to perform early screening and corresponding interventions urgently needed to reduce mortality rates in patients infected by SARS-CoV-2.
Prevalence of frailty and associated factors among Saudi community-dwelling older adults: a cross-sectional study
Authors: Alqahtani Bader A. , Alenazi Aqeel M. , Alshehri Mohammed M. , Osailan Ahmed M. , Alsubaie Saud F. , Alqahtani Mohammed A.
Published: March 2021

Background

Prevalence of frailty has been previously established in different Western countries; however, the prevalence and the burden of in the aging populations of Saudi Arabia has not been examined. Therefore, the aim of this study was to examine the prevalence of frailty, and associated factors among Saudi older population.

Methods

The study included a total of 486 community-dwelling elderly adults aged 60 years and over living in the Riyadh area. This study took place from August 2019 to June 2020. The prevalence of frailty was determined using the Fried’s frailty phenotype. Association between sociodemographic features and clinical factors and frailty was estimated by Odds Ratio and confidence intervals (OR, IC 95%) using a multinomial logistic regression model.

Results

The overall prevalence of pre-frailty and frailty were 47.3 and 21.4%, respectively. The following factors were associated with being frail: age (OR: 6.92; 95%CI 3.11–15.41); living alone (OR: 2.50; 95%CI: 1.12–5.59); had more chronic conditions (OR: 1.96; 95%CI: 1.16–3.30); and cognitive impairment (OR: 7.07; 95%CI: 3.92–12.74).

Conclusions

The Compared with other populations, the prevalence of frailty and pre-frailty in the Riyadh region of Saudi Arabia was high. The implications of frailty in this population should be discussed in future study.
Knowledge and attitude towards cutaneous leishmaniasis among rural endemic communities in Shara’b district, Taiz, southwestern Yemen
Authors: Alharazi Talal H. , Haouas Najoua , Al-Mekhlafi Hesham M.
Published: March 2021

Background

Cutaneous leishmaniasis (CL), a neglected tropical disease, represents a significant public health problem in many endemic countries including Yemen. The ongoing armed conflict that started in March 2015 has had a negative impact on the entire healthcare system as well as on infectious disease control programmes. Therefore, this cross-sectional study aimed to assess knowledge and attitude towards CL among rural endemic communities in southwestern Yemen.

Methods

Five hundred households in five areas of Shara’b district of Taiz governorate were randomly selected to participate in a quantitative survey. A pretested structured questionnaire was used to collect data on the sociodemographic characteristics of the participants, their knowledge and attitude towards CL and their knowledge on the sand fly vector.

Results

The analysis was conducted on a final sample of 466 individuals (62.7% males and 37.3% females) aged between 18 and 70 years. Among the participants, 21.5% were non-educated while 39.7 and 20.8% had completed secondary school and tertiary education, respectively. Although the participants were aware of CL, about three quarters (77.7%) of them had poor overall knowledge about disease transmission, clinical presentation, treatment, and prevention. Interestingly, approximately half of the participants (49.1%) were able to differentiate sand flies from other flies and mosquitoes. However, only 14.8% of the participants knew about the role of the phlebotomine sand fly in the transmission of CL. Only 36.6% believed that CL can be prevented and 49.6% had a negative attitude towards the disease. Univariate and multivariate analyses showed that age and gender were the significant determinants of knowledge about CL and the sand fly vector among the studied population.

Conclusion

A poor level of knowledge about the different epidemiological aspects of CL was found among rural CL-endemic communities in Taiz. This factor, together with the major collapse of the healthcare infrastructure due to the ongoing civil war in Yemen, may be contributing to the continued endemicity of CL in the governorate. It is therefore recommended that health education on CL transmission and prevention should be provided to the targeted communities.
Impact of 18F-FDG PET/CT, CT and EBUS/TBNA on preoperative mediastinal nodal staging of NSCLC
Authors: Al-Ibraheem Akram , Hirmas Nader , Fanti Stefano , Paez Diana , Abuhijla Fawzi , Al-Rimawi Dalia , Al-Rasheed Ula , Abdeljalil Riad , Hawari Feras , Alrabi Kamal , Mansour Asem
Published: March 2021

Background

Staging of non-small-cell lung cancer (NSCLC) is a multidisciplinary process involving imaging, endoscopic and surgical techniques. This study aims at investigating the diagnostic accuracy of 18F-FDG PET/CT, CT scan, and endobronchial ultrasound/transbronchial needle aspirate (EBUS/TBNA) in preoperative mediastinal lymph nodes (MLNs) staging of NSCLC.

Methods

We identified all patients who were diagnosed with NSCLC at the King Hussein Cancer Center in Amman, Jordan, between July 2011 and December 2017. We collected their relevant clinical, radiological, and histopathological findings. The per-patient analysis was performed on all patients (N = 101) and then on those with histopathological confirmation (N = 57), followed by a per-lymph-node-station basis overall, and then according to distinct N-stage categories.

Results

18F-FDG PET/CT, in comparison to CT, had a better sensitivity (90.5% vs. 75%, p = 0.04) overall and in patients with histopathological confirmation (83.3% vs. 54.6%), and better specificity (60.5% vs. 43.6%, p = 0.01) overall and in patients with histopathological confirmation in MLN staging (60.6% vs. 38.2%). Negative predictive value of mediastinoscopy, EBUS/TBNA, and 18F-FDG PET/CT were (87.1%), (90.91%), and (83.33%) respectively. The overall accuracy was highest for mediastinoscopy (88.6%) and EBUS/TBNA (88.2%), followed by 18F-FDG PET/CT (70.2%). Dividing patients into N1 disease vs. those with N2/N3 disease yielded similar findings. Comparison between 18F-FDG PET/CT and EBUS/TBNA in patients with histopathological confirmation shows 28 correlated true positive and true negative findings with final N-staging. In four patients, 18F-FDG PET/CT detected metastatic MLNs that would have otherwise remained undiscovered by EBUS/TBNA alone. Lymph nodes with a maximal standardized uptake value (SUVmax) more than 3 were significantly more likely to be true-positive.

Conclusion

Multimodality staging of the MLNs in NSCLC is essential to provide accurate staging and the appropriate treatment. 18F-FDG PET/CT has better overall diagnostic utility when compared to the CT scan. The NPV of 18F-FDG PET/CT in MLNs is reliable and comparable to the NPV of EBUS/TBNA. SUVmax of MLNs can help in predicting metastases, but nevertheless, a positive 18F-FDG PET/CT MLNs particularly if such a result would change the treatment plan, should be verified histopathologically.
Exploring factors associated with pain in hemodialysis patients: a multicenter cross‐sectional study from Palestine
Authors: Marzouq Maha K. , Samoudi Aseel F. , Samara Ahmad , Zyoud Sa’ed H. , Al-Jabi Samah W.
Published: March 2021

Background

Chronic kidney disease (CKD) is a rising medical concern around the world. End-stage kidney disease (ESKD) is the last stage of CKD stages that necessitates renal replacement therapy (RRT), such as hemodialysis (HD), which seems to be the most commonly used type. However, patients on HD still suffer from high mortality and morbidity rates compared to those who receive a kidney transplant. Therefore, we aimed in this study to assess the prevalence of pain among ESKD patients on HD, as well as to explore the factors that were associated with this complaint.

Methods

We conducted a multicenter cross-sectional study in the West Bank, Palestine, between August and November 2018. We used questionnaire-based direct interviews with subjects. After reviewing previous studies in the field, we developed our questionnaire and included items on patients’ social, demographic, and clinical characteristics, including dialysis-related data. It also contained the Brief Pain Inventory (BPI) to assess different aspects of pain symptoms. A convenience sampling technique was used to collect data.

Results

Of the 300 participants, 66.3 % reported having chronic pain. HD sessions themselves were the most commonly cited cause for pain (21.6 %). The most commonly cited site of pain was the upper and lower limbs (37.3 %). Paracetamol was the most frequently used pharmacotherapy for pain alleviation. Multiple regression analysis showed that BMI (p = 0.018), gender (p = 0.023), and the number of comorbidities (p < 0.001) were independently associated with pain severity score.

Conclusions

Pain is a highly prevalent symptom among HD patients in Palestine. Subpopulations with higher pain severity include females, patients with higher BMI, and those with multiple comorbidities. Healthcare providers should routinely assess pain in HD patients as it is considered a significant concern. This would involve pain assessment and development of a treatment plan to improve clinical outcomes. The nephrology associations should also push for pain management in HD patients as a clinical and research priority to improve pain-related disability.
Comparing the diagnostic value of Echocardiography In Stroke (CEIS) – results of a prospective observatory cohort study
Authors: Schnieder Marlena , Chebbok Mohammed , Didié Michael , Wolf Frieder , Badr Mostafa , Allam Ibrahim , Bähr Mathias , Hasenfuß Gerd , Liman Jan , Schroeter Marco Robin
Published: March 2021

Background

Echocardiography is one of the main diagnostic tools for the diagnostic workup of stroke and is already well integrated into the clinical workup. However, the value of transthoracic vs. transesophageal echocardiography (TTE/TEE) in stroke patients is still a matter of debate. Aim of this study was to characterize relevant findings of TTE and TEE in the management of stroke patients and to correlate them with subsequent clinical decisions and therapies.

Methods

We evaluated n = 107 patients admitted with an ischemic stroke or transient ischemic attack to our stroke unit of our university medical center. They underwent TTE and TEE examination by different blinded investigators.

Results

Major cardiac risk factors were found in 8 of 98 (8.2%) patients and minor cardiac risk factors for stroke were found in 108 cases. We found a change in therapeutic regime after TTE or TEE in 22 (22.5%) cases, in 5 (5%) cases TEE leads to the change of therapeutic regime, in 4 (4%) TTE and in 13 cases (13.3%) TTE and TEE lead to the same change in therapeutic regime. The major therapy change was the indication to close a patent foramen ovale (PFO) in 9 (9.2%) patients with TTE and in 10 (10.2%) patients with TEE (p = 1.000).

Conclusion

Major finding with clinical impact on therapy change is the detection of PFO. But for the detection of PFO, TTE is non inferior to TEE, implicating that TTE serves as a good screening tool for detection of PFO, especially in young age patients.

Trial registration

The trial was registered and approved prior to inclusion by our local ethics committee (1/3/17).
Design and psychometric evaluation of epilepsy-related apathy scale (E-RAS) in adults with epilepsy: a sequential exploratory mixed methods design
Authors: Shamsalinia Abbas , Moradi Mozhgan , Rad Reza Ebrahimi , Ghadimi Reza , Farahani Mansoureh Ashghali , Masoudi Reza , Rabiei Leili , Ghaffari Fatemeh
Published: March 2021

Background

Apathy in patients with epilepsy is associated with a wide range of consequences that reduce the patient’s ability to perform social functions and participate in self-care and rehabilitation programs. Therefore, apathy is one of the important diagnoses of the healthcare team in the process of caring for epileptic patients and its dimensions need to be examined and recognized. Therefore, appropriate instruments with the sociocultural milieu of each community should be provided to health care providers. The aim of the present study was to design and measure epilepsy–related apathy scale (E-RAS) in adults with epilepsy.

Methods

This study of sequential exploratory mixed methods design was conducted in Iran from April 2019 to December 2019. In the Item generation stage, two inductive (face-to-face and semi-structured interviews with 17 adult epileptic patients) and deductive (literature review) were used. In item reduction, integration of qualitative and literature reviews and scale evaluation were accomplished. For Scale Evaluation, face, content, construct [exploratory factor analysis (EFA) (n = 360) and confirmatory factor analysis (CFA) (n = 200)], convergent and divergent Validity and reliability (internal consistency and stability) were investigated.

Results

The results of EFA showed that E-RAS has four factors, namely, motivation; self-regulatory; cognition and emotional-effective. These four latent factors accounted for a total of 48.351% of the total variance in the E-RAS construct. The results of CFA showed that the 4-factor model of E-RAS has the highest fit with the data. The results of convergent and divergent validity showed that the values of composite reliability (CR) and average variance extracted (AVE) for the four factors were greater than 0.7 and 0.5, respectively, and the value of AVE for each factor was greater than CR. The Cronbach’s alpha coefficient for the whole scale was obtained 0.815. The results of the test-retest showed that there was a significant agreement between the test and retest scores (P < 0.001).

Conclusion

E-RAS is a multidimensional construct consisting of 24 items, and has acceptable validity and reliability for the study of epilepsy-related apathy in adult epileptic patients.