bluuebunny/crossref_metadata_2025 huggingface dataset:
Trimethylamine-N-Oxide and Precursors as Novel Potential Biomarkers for Anxiety Disorder
Authors: Le Juan , Peng Rui , Li Yan
Published: June 2021

Background

Anxiety disorder (AD) is closely related to changes in the composition of the gut microbiota, and changes in gut microbiota abundance affect the synthesis of trimethylamine N-oxide (TMAO).

Objective

To explore whether TMAO is related to and serves as a potential biomarker for the diagnosis of AD.

Methods

The concentrations of TMAO, choline, and betaine were analyzed in 60 patients with AD and 60 control individuals using a liquid chromatography–tandem mass spectrometry (LC-MS/MS) method.

Results

Compared with controls, TMAO was significantly reduced in patients with AD. Logistic regression analysis demonstrated that decreased TMAO concentrations were associated with an increased risk of AD. The multiplication of TMAO and its precursors (choline and betaine) produced the best AUC for the diagnosis of AD (AUC = 0.847; 95% CI, 0.780–0.914; P <.001).

Conclusion

The decrease of TMAO concentration is related to the increase of anxiety disorder. TMAO and precursors could be identified as novel potential biomarkers for the diagnosis of AD.
Growing Better, Not Going Faster: World War I, Holy Land Mania, and Transnational Exchange in the Works of Abraham Mitrie Rihbany
Authors: Eltahawy Nora
Published: June 2021

This article analyzes the three works published by Arab American theologian and author Abraham Mitrie Rihbany during and in the aftermath of World War I: Militant America and Jesus Christ (1917), America Save the Near East (1918), and Wise Men from the East and from the West (1922). The political climate in which Rihbany wrote the works saw the American public grappling with two issues of particular relevance to the steadily growing Arab American community. Where the global front was concerned, debates on the merits of abandoning isolationist policies, which focused near exclusively on the situation in Europe, left Americans oblivious to the ongoing conflict between the Ottoman Empire and its Arab subjects. On the domestic front, rising levels of xenophobia and the lasting legacy of The Naturalization Act divided legal and public opinion on Arabs’ eligibility for citizenship. Situating Rihbany’s attempts to address both of these problems against the backdrop of his upbringing in Greater Syria, this article reveals how Rihbany called on his training in the cosmopolitan era of the Nahda in order to guide the American public toward a more expansive model of transnationalism capable of encompassing both Arabs and Arab Americans in its fold.
Mandatory HPV Vaccination; Opportunity to Save Lives, Improve Readiness and Cut Costs
Authors: Sitler Collin A , Weir Larissa F , Keyser Erin A , Casablanca Yovanni , Hope Erica
Published: June 2021

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the U.S. military and accounts for more healthcare visits than the next two most common STIs combined. Human papillomavirus is preventable with a safe, effective, prophylactic vaccine that has been available since 2006, yet vaccination rates remain low. The vaccine is approved for females and males aged 9-45 years for prevention of HPV-related dysplasia and cancers. Although it is recommended by the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunization Practices (ACIP), it is not part of the U.S. military’s mandatory vaccine list. Human papillomavirus does not just affect female service members—male service members have a higher reported seropositive rate than their civilian counterparts and can develop oropharyngeal, anal, or penile cancers as sequelae of HPV. Oropharyngeal cancer, more common in males, is the fastest growing and most prevalent HPV-related cancer in the USA. Several countries, such as Australia and Sweden, have successfully implemented mandatory vaccine programs and have seen rates of HPV-related diseases, including cancer, decline significantly. Some models project that cervical cancer, which is the fifth-most common cancer in active duty women, will be eliminated in the next 20 years as a result of mandatory vaccination programs. Between higher seropositive rates and lack of widespread vaccination, HPV dysplasia and cancer result in lost work time, decreased force readiness, negative monetary implications, and even separation from service. With more than half of the 1.3 million service members in the catch-up vaccination age range of less than 26 years of age, we are poised to have a profound impact through mandatory active duty service member vaccination. Although multiple strategies for improving vaccination rates have been proposed, mandatory vaccination would be in line with current joint service policy that requires all ACIP-recommended vaccines. It is time to update the joint service guidelines and add HPV vaccine to the list of mandatory vaccines.
How much water was delivered from the asteroid belt to the Earth after its formation?
Authors: Martin Rebecca G , Livio Mario
Published: June 2021

The Earth contains between 1 and 10 oceans of water, including water within the mantle, where 1 ocean is the mass of water on the Earth’s surface today. With N-body simulations, we consider how much water could have been delivered from the asteroid belt to the Earth after its formation. Asteroids are delivered from unstable regions near resonances with the giant planets. We compare the relative impact efficiencies from the ν6 resonance, the 2:1 mean motion resonance with Jupiter and the outer asteroid belt. The ν6 resonance provides the largest supply of asteroids to the Earth, with about $2{{\ \rm per\ cent}}$ of asteroids from that region colliding with the Earth. Asteroids located in mean motion resonances with Jupiter and in the outer asteroid belt have negligible Earth-collision probabilities. The maximum number of Earth collisions occurs if the asteroids in the primordial asteroid belt are first moved into the ν6 resonance location (through asteroid–asteroid interactions or otherwise) before their eccentricity is excited sufficiently for Earth collision. A maximum of about eight oceans of water may be delivered to the Earth. Thus, if the Earth contains 10 or more oceans of water, the Earth likely formed with a significant fraction of this water.
Structure specific DNA recognition by the SLX1–SLX4 endonuclease complex
Authors: Xu Xiang , Wang Mingzhu , Sun Jixue , Yu Zhenyu , Li Guohong , Yang Na , Xu Rui-Ming
Published: June 2021

The SLX1–SLX4 structure-specific endonuclease complex is involved in processing diverse DNA damage intermediates, including resolution of Holliday junctions, collapse of stalled replication forks and removal of DNA flaps. The nuclease subunit SLX1 is inactive on its own, but become activated upon binding to SLX4 via its conserved C-terminal domain (CCD). Yet, how the SLX1–SLX4 complex recognizes specific DNA structure and chooses cleavage sites remains unknown. Here we show, through a combination of structural, biochemical and computational analyses, that the SAP domain of SLX4 is critical for efficient and accurate processing of 5′-flap DNA. It binds the minor groove of DNA about one turn away from the flap junction, and the 5′-flap is implicated in binding the core domain of SLX1. This binding mode accounts for specific recognition of 5′-flap DNA and specification of cleavage site by the SLX1–SLX4 complex.
Multiethnic Prediction of Nicotine Biomarkers and Association With Nicotine Dependence
Authors: Bergen Andrew W , McMahan Christopher S , McGee Stephen , Ervin Carolyn M , Tindle Hilary A , Le Marchand Loïc , Murphy Sharon E , Stram Daniel O , Patel Yesha M , Park Sungshim L , Baurley James W
Published: June 2021

Introduction

The nicotine metabolite ratio and nicotine equivalents are measures of metabolism rate and intake. Genome-wide prediction of these nicotine biomarkers in multiethnic samples will enable tobacco-related biomarker, behavioral, and exposure research in studies without measured biomarkers.

Aims and Methods

We screened genetic variants genome-wide using marginal scans and applied statistical learning algorithms on top-ranked genetic variants, age, ethnicity and sex, and, in additional modeling, cigarettes per day (CPD), (in additional modeling) to build prediction models for the urinary nicotine metabolite ratio (uNMR) and creatinine-standardized total nicotine equivalents (TNE) in 2239 current cigarette smokers in five ethnic groups. We predicted these nicotine biomarkers using model ensembles and evaluated external validity using dependence measures in 1864 treatment-seeking smokers in two ethnic groups.

Results

The genomic regions with the most selected and included variants for measured biomarkers were chr19q13.2 (uNMR, without and with CPD) and chr15q25.1 and chr10q25.3 (TNE, without and with CPD). We observed ensemble correlations between measured and predicted biomarker values for the uNMR and TNE without (with CPD) of 0.67 (0.68) and 0.65 (0.72) in the training sample. We observed inconsistency in penalized regression models of TNE (with CPD) with fewer variants at chr15q25.1 selected and included. In treatment-seeking smokers, predicted uNMR (without CPD) was significantly associated with CPD and predicted TNE (without CPD) with CPD, time-to-first-cigarette, and Fagerström total score.

Conclusions

Nicotine metabolites, genome-wide data, and statistical learning approaches developed novel robust predictive models for urinary nicotine biomarkers in multiple ethnic groups. Predicted biomarker associations helped define genetically influenced components of nicotine dependence.

Implications

We demonstrate development of robust models and multiethnic prediction of the uNMR and TNE using statistical and machine learning approaches. Variants included in trained models for nicotine biomarkers include top-ranked variants in multiethnic genome-wide studies of smoking behavior, nicotine metabolites, and related disease. Association of the two predicted nicotine biomarkers with Fagerström Test for Nicotine Dependence items supports models of nicotine biomarkers as predictors of physical dependence and nicotine exposure. Predicted nicotine biomarkers may facilitate tobacco-related disease and treatment research in samples with genomic data and limited nicotine metabolite or tobacco exposure data.
Post-severe Acute Respiratory Syndrome Coronavirus 2 Monoclonal Antibody Treatment Hospitalizations as a Sentinel for Emergence of Viral Variants in New York City
Authors: Cowman Kelsie , Guo Yi , Pirofski Liise-anne , Wong David , Bao Hongkai , Chen Victor , Hopkins Una , Andrews Erin , Hamel Joseph , Keller Marla , Bellin Eran , Thota Raja , Davis Patricia , Rodriguez Edwin Torres , Suthar Pooja , Allen Lauren , Rossi James , Haviland Adam , Orner Erika , Szymczak Wendy , Shujauddin Sadahf , McCarthy James , Binder Barbara , Pushparaj Vanitha , Bard Linda , Pierino Vincent Frank , Alsina Leslie , Esses David , McCaskie Alicia , Campbell Caron , Madzura Tabitha , Wollowitz Andrew , Basset Kelly , White Deborah , Ruiz Rafael , Sosnowski Frank , Nori Priya
Published: June 2021

We partnered with the US Department of Health and Human Services to treat high-risk, nonadmitted coronavirus disease 2019 (COVID-19) patients with bamlanivimab in the Bronx, New York per Emergency Use Authorization criteria. Increasing posttreatment hospitalizations were observed monthly between December 2020 and March 2021 in parallel to the emergence of severe acute respiratory syndrome coronavirus 2 variants in New York City.
Do Acupuncture Services Reduce Subsequent Utilization of Opioids and Surgical Interventions Compared to Noninvasive Therapies among Patients with Pain Conditions?
Authors: Pham Timothy , Ma Qinli , Agiro Abiy , Bukowiec Julie , Flannery Terry
Published: June 2021

Objective

To compare prescribed opioid use and invasive surgical interventions between patients using acupuncture and those using non-steroidal anti-inflammatory drugs (NSAIDs)/physical therapy (PT).

Design

Retrospective observational study of administrative claims.

Setting

Large commercial insurance plan.

Subjects

52 346 each treated with either acupuncture or NSAIDs/PT.

Methods

Users of acupuncture and NSAIDs/PT were identified from January 1, 2014, to December 31, 2017. The first date of each service was defined as the index date. Acupuncture patients were 1:1 propensity score matched to the NSAIDs/PT group on baseline characteristics. Outcomes included opioid use, subsequent invasive surgical procedures, healthcare utilization such as hospitalizations or emergency department (ED) visits, and costs. These were assessed in the 12-month period before index date (baseline) and 12-month period following index date (follow-up) using difference-in-difference (DID) analysis. Results for opioid use were stratified by those with and without baseline opioid use.

Results

The acupuncture group had fewer patients initiating opioids post-index both among those with (49.2% vs 56.5%, P < .001) and without (15.9% vs 22.6%, P < .001) baseline opioid use. There was a small increase in invasive surgical procedures with acupuncture (3.1% vs 2.8%, P = .006). A reduction in ED visits was observed with acupuncture (DID −4.6% for all-cause; −3.3% for pain-related, all P < .001). Acupuncture was associated with higher total medical and pharmacy costs (DID +$1331 per patient, P = .006).

Conclusions

Acupuncture showed a modest effect in reducing opioid use and ED visits. More research on acupuncture’s place in emergency care, pain relief, and comparison to other types of non-opioid treatment is needed.
Erasing Indian Country: Urban Native Space and the 1972 Rapid City Flood
Authors: Hausmann Stephen R
Published: June 2021

In June 1972, a flood tore through Rapid City, South Dakota and the surrounding Black Hills, killing at least 238 people, a disproportionate number of them Native people. Many whose lives and homes were destroyed lived in neighborhoods perilously close to the banks of Rapid Creek, including the vestiges of a Native neighborhood known as Osh Kosh Camp. This article asks why those people lived in that place at that time. I argue that White Americans racialized certain spaces, including urban spaces, under the conceptual framework of Indian Country as part of the process of settler colonialism. As a result, the American project of racializing western spaces attempted to erase Native people from Rapid City and its history. Despite this, Native people continued to live and work in the city throughout the twentieth century. After the flood, Native people had less access to recovery funding despite bearing a disproportionate cost from the disaster, and city officials did not take the needs of the city’s Native community into account when planning for Rapid City’s recovery. Despite the goals of White settlers, the attempt at erasing Indian Country failed. The Flood and its aftermath helped galvaniized Native protest and resistance in the Black Hills.
IV Chaucer
Authors: Pitard Derrick , Simon-Jones Lindsey , Twu Krista Sue-Lo
Published: June 2021

This chapter has five sections 1. General; 2. The Canterbury Tales; 3. Troilus and Criseyde; 4. Other Works; 5. Reception. Section 1 is by Krista Sue-Lo Twu; section 2 is by Krista Sue-Lo Twu with additions by Lindsey Simon-Jones; sections 3 and 4 are by Derrick Pitard with additions by Lindsey Simon-Jones; section 5 is by Lindsey Simon-Jones.
CE: Postpartum Depression: A Nurse's Guide
Authors: Alba Barbara Marie
Published: June 2021

Despite extensive research, the etiology behind postpartum depression (PPD) remains a mystery. Experts have theorized about various potential risk factors, including hormonal fluctuations, genetics, prior history of depression, low socioeconomic status, adolescent pregnancy, and certain personality traits. This article provides foundational information about PPD, reviewing the risk factors for and the consequences of this mood disorder. Postpartum blues and postpartum psychosis are briefly discussed for context, although they differ from PPD. Screening and treatment options are explained, and nursing implications for practice are presented.
Unintended Consequences and Workarounds of Electronic Medical Record Implementation in Clinical Nursing Practice
Authors: Lee Seonah , Kang Ji-Soon
Published: June 2021

Nurses have experienced unintended consequences and workarounds associated with health information technology implementation. However, examination of this occurrence is rare. This study aimed to examine the unintended consequences and workarounds produced by the implementation of electronic medical record systems in clinical nursing practice. A total of 143 nurses participated in a survey using statistically tested instruments. The data were analyzed using descriptive statistics and a nonparametric test. The descriptive data were analyzed by meaning. The participants experienced unintended consequences and workarounds related to electronic medical record implementation at moderate or high levels based on the responses to questions scored on 5-point Likert scales. The unintended consequences were closely associated with workarounds. The degree of experience with unintended consequences and the use of workarounds differed significantly according to the level of education, job position, and years in nursing practice. The nursing examples of unintended consequences and workarounds were organized into four categories of unintended consequences. By presenting unintended consequences and workarounds together, this study enhances the understanding of the problems encountered in EMR implementation and the action of nurses. Nurses' needs should be considered as an important resource in developing, redesigning, or purchasing and implementing health information technology in healthcare settings.
Bed-Sharing in the First 6 Months: Associations with Infant-Mother Attachment, Infant Attention, Maternal Bonding, and Sensitivity at 18 Months
Authors: Bilgin Ayten , Wolke Dieter
Published: June 2021

Objective:

The objective of this study was to investigate whether bed-sharing during the first 6 months of life is associated with infant's attachment and behavioral outcomes and mother's bonding and sensitive parenting at 18 months of age.

Methods:

The sample with complete longitudinal data comprised 178 infants and their caretakers. Bed-sharing was assessed with maternal report at term, 3, 6, and 18 months. Infant attachment was measured at 18 months using the strange situation procedure. Infant behavioral outcomes (i.e., poor attention/hyperactivity and task persistence) were assessed with 2 observational measures at 18 months. Maternal sensitivity was observed at 3 and 18 months, and mothers reported on bonding to their infant at term, 3, and 18 months.

Results:

Bed-sharing was common at term (41.2%), which decreased at 3 months (22.6%) followed by a slight increase at 6 (27.5%) and 18 months of age (31.3%). No associations between bed-sharing during the first 6 months and infant-mother attachment and infant behavioral outcomes at 18 months were found. Similarly, there were no associations between bed-sharing during the first 6 months and maternal bonding and sensitivity at consequent assessment points (i.e., 3 and 18 months).

Conclusion:

Bed-sharing during the first 6 months is not associated with positive or negative outcomes about infant-mother attachment, infant behavior, maternal bonding, or sensitive parenting.
Parental Opinions on Medical Decision-Making in Adolescence: A Case-Based Survey
Authors: Stavleu Debbie C. , Peter de Winter J. , Veenstra Xandra , van Stralen Karlijn J. , De Coninck David , Matthijs Koen , Toelen Jaan
Published: June 2021

Objective:

Patient trust and consent are complex topics for health care workers in pediatrics, specifically when relating to adolescent's legal status. In the context of medical decisions, not much work has been performed to understand the opinion of parents on health care decision-making, especially on confidentiality concerning their adolescent children. The purpose of this research was to assess the parental opinions on these decisions and the influence of different perspectives.

Methods:

We used a case-based methodology to assess parental opinions on fictional medical decisions. A survey was provided to parents in 2 pediatric outpatient departments in Belgium and the Netherlands. The survey contained cases regarding medical care related to confidentiality and consent about which participants gave their opinion.

Results:

In total, 222 surveys were completed. Overall, most parents would allow an adolescent to make his/her own decision (58.6%–70.4%), except in the case of confidentiality on alcohol-related trauma (28.9%). The results show a significant difference in how parents responded when answering from the parental perspective or adolescents' perspective. They granted significantly more authority to the adolescent in the latter view.

Conclusion:

Our study shows that parents who were confronted with cases from an adolescent perspective were significantly more likely to give the patient authority. In addition, the medical issue and context influence how the parents responded. These data provide insight into the parental opinions and could lead to more evidence-based frameworks for shared medical decision-making of adolescents and their parents.
Efficacy and Safety of Evinacumab for the Treatment of Hypercholesterolemia: A Meta-Analysis
Authors: Jin Menglong , Meng Fanhua , Yang Wenwen , Liang Liyan , Wang Hao , Fu Zhenyan
Published: June 2021

Angiopoietin-like protein 3 is essential in lipid metabolism regulation. However, the efficacy and safety of evinacumab (angiopoietin-like protein 3 inhibition drug) for hypercholesterolemia treatment is unknown. In this study, a meta-analysis of randomized controlled trials (RCTs) was conducted to assess the efficacy and safety of evinacumab. RCTs published between January 1, 2000, and November 1, 2020, were obtained from PubMed, Embase, and Cochrane Library. All RCTs evaluating the efficacy and safety of evinacumab were included without language restrictions. Our primary end points included the percent change of low-density lipoprotein cholesterol (LDL-C) from baseline and the incidence of at least one treatment emergent adverse events including nasopharyngitis, influenza-like illness, headache, dizziness, injection-site reaction, increased aspartate aminotransferase, increased alanine aminotransferase, and any other discomfort during treatments. Percentage changes of triglycerides and high-density lipoprotein cholesterol (HDL-C) from baseline indicated secondary end points. A random-effects model was used to assess pooled data if there was moderate to high heterogeneity between studies. Four studies with 5 RCTs (568 participants) were identified. Evinacumab significantly reduced LDL-C [mean difference (MD) −33.123%, 95% confidence interval (CI), −48.639% to −17.606%, P < 0.0001], triglycerides (MD −50.959%, 95% CI, −56.555% to −45.362%, P < 0.0001), and HDL-C (MD −12.773%, 95% CI, −16.359% to −9.186%, P < 0.0001) compared with placebo. The incidence of at least 1 treatment emergent adverse events was not significantly different between evinacumab and placebo groups (relative risk 1.080, 95% CI, 0.901–1.296, P = 0.405). Evinacumab decreased triglycerides, LDL-C, and HDL-C without significant adverse effects, indicating that it can be a therapeutic strategy for hypercholesterolemia.
Impact of Comorbidities and Antiplatelet Regimen on Platelet Reactivity Levels in Patients Undergoing Transcatheter Aortic Valve Implantation
Authors: Trejo-Velasco Blanca , Tello-Montoliu Antonio , Cruz-González Ignacio , Moreno Raul , Baz-Alonso Jose A. , Salvadores Pablo J. , Romaguera Rafael , Molina-Navarro Eduardo , Paredes-Galán Emilio , Fernández-Barbeira Saleta , Ortiz-Saez Alberto , Bastos-Fernandez Guillermo , De Miguel-Castro Antonio , Figueiras-Guzman Adolfo , Iñiguez-Romo Andres , Jimenez-Diaz Victor A.
Published: June 2021

The aim of our study is to assess the impact of anemia, chronic kidney disease, and diabetes mellitus on platelet reactivity (PR) in patients with severe aortic stenosis, both at baseline and after transcatheter aortic valve implantation (TAVI). This study is a prespecified subanalysis of the REAC-TAVI prospective, multicenter trial that included patients pretreated with aspirin + clopidogrel before TAVI. PR was measured at baseline and at 5 different time points after TAVI with the VerifyNow assay (Accriva Diagnostics, San Diego, CA), over a 3-month follow-up period. Patients with high PR (HPR) at baseline, before TAVI (n = 48) were randomized to aspirin + clopidogrel or aspirin + ticagrelor for 3 months, whereas those with normal PR (NPR) (n = 20) were continued on aspirin + clopidogrel. A “raiser response” in PR was defined as an increase in PR units >20% of baseline after TAVI. Patients with HPR before TAVI presented concomitant anemia and chronic kidney disease more frequently than their counterparts with NPR. Anemia and higher body mass index were independently associated with HPR to clopidogrel at baseline. Moreover, anemic patients with baseline HPR who were continued on clopidogrel presented higher PR after TAVI than patients with HPR switched to ticagrelor. All patients with baseline NPR presented a “raiser response” after TAVI, which was nonexistent among patients with HPR managed with ticagrelor. In summary, anemia seems as a relevant factor associated with baseline HPR and higher PR after TAVI in patients with baseline HPR randomized to clopidogrel, whereas ticagrelor proved more effective than clopidogrel at attaining sustained reductions in PR during follow-up, regardless of baseline comorbidities.
A Review of Inotropes and Inopressors for Effective Utilization in Patients With Acute Decompensated Heart Failure
Authors: Nandkeolyar Shuktika , Ryu Rachel , Mohammad Adeba , Cordero-Caban Kathia , Abramov Dmitry , Tran Huyentran , Hauschild Chris , Stoletniy Liset , Hilliard Anthony , Sakr Antoine
Published: June 2021

Inotropes and inopressors are often first-line treatment in patients with cardiogenic shock. We summarize the pharmacology, indications, and contraindications of dobutamine, milrinone, dopamine, norepinephrine, epinephrine, and levosimendan. We also review the data on the use of these medications for acute decompensated heart failure and cardiogenic shock in this article.
The Impact of a Baseline Exercise Test on Confidence to Perform Subsequent Incremental Shuttle Walk Tests, Walk at Home, and Manage Breathlessness
Authors: Stenson Amy , Chaplin Emma J. , Houchen-Wolloff Linzy , Singh Sally J.
Published: June 2021

Purpose:

Incremental shuttle walk tests (ISWTs) are routinely conducted as outcome measures in pulmonary rehabilitation (PR) assessments and in clinical trials; however, there is a paucity of data describing the impact of simply conducting an exercise test and the change produced in the perceived ability of the individual to perform exercise subsequently, which may in turn influence therapy and study outcomes.

Methods:

We conducted a prospective observational cohort study at Glenfield Hospital, Leicester, UK (University Hospitals of Leicester NHS Trust). At initial PR assessment, we asked patients pre- and post-practice ISWT to report confidence in three areas (walking at home [Q1], managing breathlessness [Q2], and performing an ISWT [Q3]) based on a visual analog scale (0-10).

Results:

A total of 100 patients with chronic respiratory disease (age 68.0 ± 10.3 yr, male 49%, chronic obstructive pulmonary disease 63%, Medical Research Council 2-5) completed visual analog scale confidence questions pre- and post-practice ISWT. Confidence in all questions improved after a practice ISWT (all P < .01 Wilcoxon signed rank). A statistically significant improvement in ISWT distance was noted (practice ISWT 207.3 ± 132.7 m to second ISWT 227.4 ± 142.0 m, mean difference = 20.1 m). No association was found between changes in confidence and changes between walk 1 and walk 2 (r
2 = [Q1] −0.04, [Q2] −0.09, [Q3] 0.04, P >.05).

Conclusions:

Confidence increased in all areas post-practice ISWT, but this was not related to changes in performance. However, this change may be an important consideration when designing research trials as exercise behaviors (eg, walking at home) may be affected by conducting baseline exercise tests.
Sex and Age Differences in Anxiety and Depression Levels Before and After Aerobic Interval Training in Cardiac Rehabilitation
Authors: O'Neill Carley D. , Vidal-Almela Sol , Terada Tasuku , Kamiya Kentaro , Tulloch Heather E. , Pipe Andrew L. , Reed Jennifer L.
Published: June 2021

Purpose:

The objective of this study was to investigate sex and age differences in anxiety and depression among patients with cardiovascular disease at baseline and following aerobic interval training (AIT)-based cardiac rehabilitation (CR) and secondarily to compare dropout rates between sexes and age groups.

Methods:

Participants were younger (≤44 yr), middle-aged (45-64 yr), and older adults (≥65 yr). The AIT protocol consisted of: 4 × 4-min of high-intensity work periods at 85-95% peak heart rate (HR) interspersed with 3 min of lower-intensity intervals at 60-70% peak HR, twice weekly for 10 wk. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale at baseline and following CR.

Results:

At baseline, of 164 participants (32% female), 14 (35% female) were younger, 110 (33% female) were middle-aged, and 40 (30% female) were older. Older adults reported lower anxiety levels versus younger (4.4 ± 2.6 vs 7.8 ± 3.4 points, P = .008) and middle-aged adults (4.4 ± 2.6 vs 6.1 ± 3.6 points, P = .05). Baseline depression levels did not differ between age groups (P = .749). All age groups experienced a reduction in anxiety (younger =−2.67; middle-aged =−1.40; older =−0.85) and depression (younger =−1.50; middle-aged =−0.83; older =−0.70) levels following CR. Differences in dropout rates were observed between age groups (χ2[1] = 13.4, P = .001). Within each age group, 43% (female n = 2, male n = 4) of younger, 10% (female n = 8, male n = 3) of middle-aged, and 2.5% (female n = 0, male n = 1) of older participants dropped out.

Conclusions:

Younger and middle-aged adults experience higher levels of anxiety upon entry into CR compared with older adults. Cardiac rehabilitation was associated with significant reductions in anxiety and depression severity, yet dropout rates were highest among younger adults.
Effect of Strength Versus Strength and Endurance Upper Limb Exercise Training in Patients With Chronic Obstructive Pulmonary Disease
Authors: Karagiannis Christos , Savva Christos , Korakakis Vasileios , Adamide Tonia , Georgiou Andreas , Matheou Ioanna , Prodromou Aleka , Xanthos Theodoros
Published: June 2021

Purpose:

Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR.

Methods:

Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale.

Results:

Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (P = .02) with reduced perception of fatigue (P = .03) compared with patients in the strength group.

Conclusions:

In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.
Clinical outcomes of a monofocal intraocular lens with enhanced intermediate function compared with an extended depth-of-focus intraocular lens
Authors: Lee Jae Hyuck , Moon Su Young , Chung Ho Seok , Park So Young , Lee Hun , Kim Jae Yong , Tchah Hungwon
Published: June 2021

Purpose:

To compare clinical outcomes of a new monofocal intraocular lens (IOL) with enhanced intermediate function and an extended depth-of-focus (EDoF) IOL.

Setting:

Asan Medical Center, Seoul, Korea.

Design:

Nonrandomized prospective comparative case series.

Methods:

Patients presenting for cataract surgery and meeting all inclusion and exclusion criteria were implanted with a new monofocal IOL with enhanced intermediate function (Tecnis Eyhance ICB00) or an EDoF IOL (Tecnis Symfony ZXR00) bilaterally. Uncorrected (UDVA), uncorrected intermediate (UIVA), uncorrected near (UNVA), and corrected distance visual acuity (CDVA), defocus curves, and contrast sensitivity were compared after 3 months. Patients were administered questionnaires regarding visual symptoms, spectacle independence, overall satisfaction, and lens recommendations.

Results:

24 patients (48 eyes) were enrolled in the Eyhance group and 20 patients (40 eyes) in the Symfony group. Monocular and binocular UDVA, UIVA, and CDVA were similar in the 2 groups. Monocular UNVA and spectacle independence for near distance were better in the Symfony group, whereas binocular UNVA did not differ significantly in the 2 groups. Contrast sensitivity, glare and halo, satisfaction, and recommendation rates were similar in the 2 groups. Although some dissatisfaction and severe glare and halo were reported in the Symfony group, none of these was reported in the Eyhance group.

Conclusions:

Bilateral implantation of the Eyhance ICB00 IOL provided comparable clinical performances as bilateral implantation of the Symfony ZXR00 IOL. Binocular UNVA was similar, although spectacle independence was higher in the Symfony group, but this was at the expense of more glare and halos.
Influence of anterior capsulorhexis shape, centration, size, and location on intraocular lens position: finite element model
Authors: Rossi Tommaso , Ceccacci Andrea , Testa Gabriel , Ruggiero Andrew , Bonora Nicola , D'Agostino Isabella , Telani Serena , Ripandelli Guido
Published: June 2021

Purpose:

To evaluate the influence of anterior capsulorhexis shape, dimension, and eccentricity on intraocular lens (IOL) position.

Setting:

Laboratory investigation.

Design:

Computational model.

Methods:

A finite element model of the human crystalline lens capsule and zonule was created and the anterior capsule opened to simulate centered and decentered circular and elliptic rhexis. The model calculated capsular bag stress, IOL rotation, tilt, decentration, and vaulting, related to both capsular landmarks (absolute) and a reference IOL position defined as that obtained with a 5.0 mm circular and centered rhexis.

Results:

Mean von Mises stress along the IOL major z-axis was significantly higher than that along the perpendicular x-axis in all cases (P < .001), both at the equator and at the rhexis edge. Stress at the equator was always greater than that at the rhexis edge (P < .001) regardless of the rhexis shape and position. As rhexis eccentricity increased, the stress difference between the z- and x-axes increased. Absolute IOL tilt (range 10−1 to 10−7 degrees), decentration (10−3 to 10−7 mm), rotation (10−2 to 10-3 degrees), and vaulting (10−1 mm) were negligible from an optical standpoint, but all of them were significantly greater for decentered rhexis (both round and elliptic) compared with centered (P < .05).

Conclusions:

Anterior capsulorhexis irregularity and/or eccentricity increase IOL tilt, decentration, rotation, and vaulting in a numerically significant but optically negligible way. Von Mises stress is much greater at the capsular bag equator compared with the rhexis edge and highly asymmetrically distributed in all cases. Stress asymmetry may influence postoperative biologic processes of capsular bag shrinking and further IOL tilting or decentration.
Indoor Air Quality and Environmental Sampling as Support Tools to Detect SARS-CoV-2 in the Healthcare Setting
Authors: Gregorio Paulo Henrique Peitl , Mariani Alessandro Wasum , Brito João Marcelo Lopes Toscano , Santos Bruno José Martini , Pêgo-Fernandes Paulo Manuel
Published: June 2021

Objectives:

To evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread inside the healthcare setting using environmental sampling and indoor air quality (IAQ) parameters.

Methods:

Ward/ICU rooms had IAQ parameters monitored in real-time, including volatile organic compounds and particulate matter. Surface and three air samples with different exposure times were collected in each room and tested for SARS-CoV-2 using quantitative Rt-PCR. Environmental sampling and IAQ data were compared to provide information about viral spread.

Results:

SARS-CoV-2 RNA was detected in 6/10 rooms and 9/30 air samples, which is proportionally higher than previous studies. Sampling time confirmed to be crucial to viral detection. No correlations between IAQ parameters could be associated with positive/negative samples even when aerosol-generating procedures were performed.

Conclusion:

Environmental sampling of SARS-CoV-2 RNA may be used as an indicator of occupational safety. IAQ is also a potential tool but requires further research.
Respiratory Outcomes of Firefighter Exposures in the Fort McMurray Fire
Authors: Cherry Nicola , Barrie James R. , Beach Jeremy , Galarneau Jean-Michel , Mhonde Trish , Wong Eric
Published: June 2021

Objective:

Determine effects on respiratory health of firefighters attending a catastrophic wildfire.

Methods:

Within the Alberta Administrative Health Database, we identified five community-based controls for each firefighter in a cohort of 1234 deployed to the 2016 Fort McMurray fire. Spirometry records were identified and a stratified sample assessed clinically. We estimated PM2.5 particles exposure.

Results:

Firefighters had an increased risk of asthma consultation post-fire (OR new onset asthma = 2.56; 95%CI 1.75 to 3.74). Spirometry showed decreased FEV1 and FVC with increasing exposure. In the clinical assessment, 20% had a positive MCT and 21% BWT. Those with ongoing fire-related symptoms had a higher concurrence of positive MCT and BWT (OR = 4.35; 95%CI 1.11 to 17.12). Lower diffusion capacity related to higher exposure.

Conclusions:

Massive exposures during a wildfire are associated with non-resolving airways damage.
Impact and Management of COVID-19 Among Healthcare Workers in Two Acute Care Hospitals and Two Associated Long-term Care Centres in Barcelona, Spain
Authors: Montero-Moraga Jose Maria , Buron Andrea , Sala Maria , Santia Paula , Lupia Martina , Beltrán Ana , Villar Rocío , Horcajada Juan Pablo , Castells Xavier , Gil Oscar Díaz , León Eduardo Padilla , Serra Consol
Published: June 2021

Objective:

To describe the characteristics of COVID-19-related episodes in healthcare workers (HCW) of two hospitals.

Methods:

Prospective study of HCW with COVID-like symptoms and/or who were close contacts of confirmed COVID-19. The percentage of positive PCRs among those with symptoms was calculated, and symptom's positive predictive value and negative predictive value. The characteristics of contacts were described, as well as the secondary clinical attack rate.

Results:

We registered 1222 episodes of HCW with COVID-like symptoms; 340 (27.8%) had a positive PCR. In 885 episodes, a HCW was a close contact of a confirmed case. In 45.5% of these, the HCW had contact with another HCW. The secondary clinical attack rate of contacts of HCW was 14.5%.

Conclusion:

We found a high prevalence of disease and transmission between HCW during the first wave of the SARS-CoV-2 pandemic.
The Effect of Perceived Gratitude From Others on Work Engagement
Authors: Komase Yu , Watanabe Kazuhiro , Sasaki Natsu , Kawakami Norito
Published: June 2021

Objective:

This study aimed to examine the effect of perceived gratitude from others on work engagement, adjusting for possible confounders: job demands, job resources (supervisor/coworker support), personal resources (resilience), and gratitude trait.

Methods:

This cross-sectional study conducted a secondary analysis of data from previously published research. Work engagement was measured using the Japanese version of the Utrecht Work Engagement Scale. An original one-item questionnaire measured perceived gratitude from others. A hierarchical linear regression analysis was conducted.

Results:

Hierarchical linear regression showed a significant association between perceived gratitude and work engagement even after controlling for the covariates of occupations, job demands, supervisor support, coworker support, resilience, and gratitude trait (N = 206).

Conclusions:

The association between perceived gratitude and work engagement was independent of job demands, job/personal resources, and gratitude trait, suggesting the direct association.
Contributions of Ergonomics, Psychological Factors, and Sleep Disturbances to Lower Back Pain Among Taiwanese Workers
Authors: Shih Ping , Chu Po-Ching , Liu Li-Wen , Chen Chih-Yong , Guo Yue Leon
Published: June 2021

Objective:

We investigated the contributions of ergonomics, psychological factors, and sleep disturbances to lower back pain (LBP).

Methods:

A nationwide survey of sampled 27,508 (2.6‰) Taiwanese workers was conducted in 2010. Definition of outcome was LBP affecting work performance in the past year. Predictor variables included age, body mass index, ergonomic factors, job control, psychological demands, and sleep disturbances. Mutually adjusted relative risks were examined using general linear models, followed by aPAR.

Results:

18,353 workers were included in the multivariate regression model. The three first significant risk factors to LBP included heavy lifting or awkward posture, sleep disturbances, and high psychological demands (aPAR = 13.5%, 8.7%, 5.7% respectively in men and 6.1%, 11.8%, 5.9% in women).

Conclusions:

In addition to ergonomic exposure, sleep disturbances and high psychological demands significantly contributed to LBP.
Metastatic well-differentiated pancreatic neuroendocrine tumors to the liver: a narrative review of systemic and surgical management
Authors: Vaghaiwalla Tanaz , Memeh Kelvin , Liao Chih-Yi , Keutgen Xavier M.
Published: June 2021

Pancreatic neuroendocrine tumors (PNETs) are a rare group of neoplasms originating from the endocrine pancreas. PNETs are classified as functional or non-functional tumors. PNETs are more often diagnosed at a higher stage with distant metastases or advanced locoregional disease. The majority of individuals with hepatic metastases will ultimately die of liver failure; therefore, the treatment of liver tumor burden is critical to providing a survival impact. While surgical resection remains the only chance of cure for disease confined to the pancreas or for locoregional disease, the treatment of advanced or metastatic PNETs is more complex and often requires a multimodal approach. This review focuses on treatment options for well and moderately differentiated PNETs with metastatic disease to the liver. These include surgery, liver-directed therapies including ablative and intra-arterial therapies, and systemic therapies such as somatostatin analogues, targeted therapies, chemotherapy, and peptide receptor radionuclide therapy. Developing an individualized treatment strategy requires careful assessment of liver tumor burden and predicted biological behavior. Aggressive surgical resection of hepatic metastases secondary to PNET primary tumors is associated with improved survival in multiple retrospective studies. General goals of treatment for metastatic disease include prolonging overall survival and progression free survival, improving quality of life, and control of symptoms.
Notch signaling inhibitor and anti-PD-L1 antibody combination therapies decelerate tumor progression in pancreatic cancer
Authors: Dai Hongmei , Hong Xiafei , Huang Dan , Wu Huanwen , Wang Xianze , Chen Hao , Jiang Rui , Chen Wenyan , Zhao Yupei , Wu Wenming
Published: June 2021

Objective:

Pancreatic cancer (PC) is a highly lethal malignancy with an immunosuppressive environment. Yet, current immune checkpoint inhibitor monotherapies have shown limited efficacy in PC, prompting the need for combination therapies. Herein, we hypothesized that combinations of Notch signaling inhibitor and anti-ligand programmed death-ligand 1 (PD-L1) antibody immunotherapy would show synergistic efficacy.

Methods:

The baseline expression of PD-L1 and HES1 was measured in PC cell lines, single-cell RNA-seq data of PC (GSA: CRA001160), and cBioPortal databases. In an in vitro study, MIA PaCa2 and SW1990 were used to explore the mechanism between Notch signaling and PD-L1. To study the effects in vivo, a subcutaneous tumor model was established using Pan02 cells treated with either anti-PD-L1 monoclonal antibody and/or Notch inhibitor DAPT. The study performed involving human samples was approved by the Ethics Committee of Peking Union Medical College Hospital (approval No. S-K460, approval date: April 23, 2018). Animal studies were approved by the Animal Research Ethics Committee of Peking Union Medical College Hospital (approval No. XHDW-2019-049, approval date: November 28, 2019).

Results:

The Notch signaling inhibitor upregulated PD-L1 expression in PC tumor cells both in vitro and in vivo. Notch effector HES1 knockdown produced PD-L1 upregulation in both MIA PaCa2 and SW1990 cells. Combined DAPT and anti-PD-L1 antibody treatment of Pan02 subcutaneous tumor model resulted in significantly reduced tumor weights compared to that with monotherapy, as well as significantly reduced Ki67 than that in the monotherapy group and control group. Flow cytometry analysis revealed significantly increased CD8+ T cell infiltration in tumors of the combination group compared with those of the monotherapy group.

Conclusion:

Notch signaling blockade might enhance the antitumor effect of anti-PD-L1 therapy in PC.