bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 Pandemic and Beyond: Considerations and Costs of Telehealth Exercise Programs for Older Adults With Functional Impairments Living at Home—Lessons Learned From a Pilot Case Study
Authors: Middleton Addie , Simpson Kit N , Bettger Janet Prvu , Bowden Mark G
Published: April 2020

Objective

The purpose of this study was to describe the process and cost of delivering a physical therapist–guided synchronous telehealth exercise program appropriate for older adults with functional limitations. Such programs may help alleviate some of the detrimental impacts of social distancing and quarantine on older adults at-risk of decline.

Methods

Data were derived from the feasibility arm of a parent study, which piloted the telehealth program for 36 sessions with 1 participant. The steps involved in each phase (ie, development, delivery) were documented, along with participant and program provider considerations for each step. Time-driven activity-based costing was used to track all costs over the course of the study. Costs were categorized as program development or delivery and estimated per session and per participant.

Results

A list of the steps and the participant and provider considerations involved in developing and delivering a synchronous telehealth exercise program for older adults with functional impairments was developed. Resources used, fixed and variable costs, per-session cost estimates, and total cost per person were reported. Two potential measures of the “value proposition” of this type of intervention were also reported. Per-session cost of $158 appeared to be a feasible business case, especially if the physical therapist to trained assistant personnel mix could be improved.

Conclusions

The findings provide insight into the process and costs of developing and delivering telehealth exercise programs for older adults with functional impairments. The information presented may provide a “blue print” for developing and implementing new telehealth programs or for transitioning in-person services to telehealth delivery during periods of social distancing and quarantine.

Impact

As movement experts, physical therapists are uniquely positioned to play an important role in the current COVID-19 pandemic and to help individuals who are at risk of functional decline during periods of social distancing and quarantine. Lessons learned from this study’s experience can provide guidance on the process and cost of developing and delivering a telehealth exercise program for older adults with functional impairments. The findings also can inform new telehealth programs, as well as assist in transitioning in-person care to a telehealth format in response to the COVID-19 pandemic.
When Dead Bodies Talk: Colonial and Ritual Autopsies in French-Ruled Africa (1918–1945)
Authors: Ginio Ruth
Published: April 2020

This article examines the practice of autopsies in French-ruled West Africa in the interwar era. It contributes to the discussion of medical knowledge and its employment in the colonies and raises a set of questions regarding the administration’s motives for performing autopsies and the African responses to this practice. In order to answer these questions, I briefly examine the practice of autopsies in France and move to the colonies to look at the problematic ways in which they were performed under colonial conditions. I then delve into local practices of ritual autopsies that also aim to explain death, but in different ways. Finally, I demonstrate what the differences and similarities between practices of colonial and ritual autopsies can teach us about the idea of the Civilising Mission and its perception by African colonial subjects.
Swiss foundation law reform: profound game-changer or a case of “never change a winning formula”?
Authors: Studen Goran
Published: May 2020

In the words of the dramatist George Bernard Shaw: “Progress is impossible without change, and those who cannot change their minds cannot change anything.” While Swiss foundation law has undergone changes since 1912, these have been rather modest compared to the substantial overhauls of Swiss corporate or family law in the same period. Nevertheless, the question remains: Does Switzerland really need to reform its foundation law? While the sector is currently debating the pros and cons of a parliamentary initiative that could bring substantial changes, this article aims to systematize the various proposals from a practical perspective.
Measuring Employment: Experimental Evidence from Urban Ghana
Authors: Heath Rachel , Mansuri Ghazala , Rijkers Bob , Seitz William , Sharma Dhiraj
Published: May 2020

Using a randomized survey experiment in urban Ghana, this paper demonstrates that the length of the reference period and the interview modality (in-person or over the phone) affect how people respond in labor surveys, with impacts varying markedly by job type. Survey participants report significantly more self-employment spells when the reference period is shorter than the traditional one week, with the impacts concentrated among those in home-based and mobile self-employment. In contrast, the reference period has no impact on the incidence of wage-employment. The wage-employed do report working fewer days and hours when confronted with a shorter reference period. Finally, interviews conducted on the phone yield lower estimates of employment, hours worked, and days worked among the self-employed who are working from home or a mobile location as compared to in-person interviews.
Prevalence of Yellow Leaf Disease (YLD) and its Associated Areca Palm Velarivirus 1 (APV1) in Betel Palm (Areca catechu) Plantations in Hainan, China
Authors: Wang Hongxing , Zhao Ruibai , Zhang Huaiwen , Cao Xianmei , Li Zhaotong , Zhang Ze , Zhai Jinling , Huang Xi
Published: April 2020

Yellow leaf disease (YLD) is an economically important disease affecting betel palm in several countries, the cause of which remains unclear despite associations with putative agents, including phytoplasmas. In this study, we screened the potential casual agents associated with YLD in Hainan, China using next-generation sequencing and revealed the association of areca palm velarivirus 1 (APV1) with the YLD-affected palm. The complete genome of the APV1-WNY isolate was determined to be 17,546 nucleotides in length, approximately 1.5 kb longer than the previously reported APV1_HN genome. Transmission electron microscopy showed that APV1 particles are flexuous and filamentous, a typical morphology of species in the Closteroviridae family. Comparison of symptomatic and symptomless tree populations showed a strong association between APV1 and YLD. APV1 was detected in Pseudococcus sp. mealybugs sampled from YLD-affected trees in many locations, suggesting that mealybugs are a potential transmission vector for APV1. Although further studies are needed to confirm a causal relationship, these results provide timely information for the prevention and management of YLD associated with APV1.
Posterior Direct Reduction of Lateral Atlantoaxial Joints for Rigid Pediatric Atlantoaxial Subluxation
Authors: Yamagata Toru , Nishijima Shugo , Kou Saya , Naito Kentaro , Nagm Alhusain , Ishibashi Kenichi , Ohata Kenji , Takami Toshihiro
Published: April 2020

Study Design.

Clinical case series.

Objective.

To present a surgical technique and results of posterior direct reduction of lateral atlantoaxial joints for rigid pediatric atlantoaxial subluxation (AAS) using a fulcrum lever technique.

Summary of Background Data.

The surgical treatment of pediatric rigid AAS is still technically challenging. Several factors contribute to the surgical difficulty, such as small vertebrae, incomplete bone formation, dysplasia, the difficulty of reduction and external fixation are considered as a surgical daunting challenge. Herein, the surgical technique of posterior direct reduction of lateral atlantoaxial joints for rigid pediatric AAS using a fulcrum lever technique is presented.

Methods.

This retrospective study included 10 pediatric patients with rigid AAS who underwent posterior direct reduction of bilateral C1/2 facet joints via a fulcrum lever technique. The indication for surgery was the presence of neurological symptoms and spinal cord atrophy with an intramedullary high signal at the C1 level on T2-weighted magnetic resonance (MR) images. The surgical procedure consisted of three steps: (1) opening and distraction of the C1/2 facet joints and placement of tricortical bone as a spacer and fulcrum; (2) placement of C1 and C2 screws; and finally, (3) compression between the C1 posterior arch and C2 lamina and constructing C1/2 fusion. All patients underwent the neurological and radiological evaluations before and after surgery.

Results.

Eight of 10 patients demonstrated genetic disorders, either Down syndrome or chondrodysplasia punctate. Besides, all cases documented congenital anomaly of the odontoid process. Bilateral C1 lateral mass screws were successfully placed in all cases. No evidence of postoperative neurovascular complications. Radiological evaluation showed the corrections and bony fusions of C1/2 facet joint in all cases.

Conclusion.

The fulcrum lever technique for rigid pediatric AAS can be one of the effective surgical solutions to this challenging pediatric spinal disorder.

Level of Evidence: 4
Prevalence of Ossification of Posterior Longitudinal Ligament in Patients With Degenerative Cervical Myelopathy
Authors: Liao Xinyuan , Jin Zhenxiong , Shi Lei , Zhao Yin , Zhou Shengyuan , Chen Deyu , Tang Dezhi , Yang Lili , Chen Xiongsheng
Published: April 2020

Study Design.

A cross-sectional study.

Objective.

The aim of this study was to investigate the prevalence of ossification of posterior longitudinal ligament (OPLL) in patients with degenerative cervical myelopathy (DCM).

Summary of Background Data.

OPLL of the cervical spine is one of the main entities of DCM in Asian populations. However, few studies have reported the prevalence of cervical OPLL in DCM patients.

Methods.

A total of 7210 DCM patients (4546 males and 2664 females; mean age: 54 years) who underwent cervical spine three-dimensional computed tomography (3D-CT) at the Shanghai Changzheng Hospital between January 2012 and December 2016 were included in this study. Demographic data including age, sex, height, body weight, body mass index (BMI), concomitant diabetes mellitus (DM), and hypertension were recorded. The imaging diagnosis criterion for OPLL was thickness >2 mm on axial imaging.

Results.

The overall prevalence of OPLL in the 7210 DCM patients was 18.22%, including 19.73% in males and 15.65% in females, with a significant difference between the two groups (P < 0.001). The prevalence of OPLL in DM and hypertensive patients was significantly higher than that in non-DM and normotensive patients (24.16% vs. 18.76% and 22.26% vs. 17.91%, both P < 0.001). Comparison by age and BMI showed that the prevalence of OPLL was the highest in the 70- to 79-year age group (21.91%) and obesity group (26.51%), respectively.

Conclusion.

This CT-based study revealed that the overall prevalence of OPLL in DCM patients was 18.22%. Furthermore, old age, male sex, comorbid hypertension or DM, and high BMI were risk factors for cervical OPLL. Given its high prevalence, CT examination is suggested to identify possible OPLL in DCM patients.

Level of Evidence: 2
Fluid Accumulation in Critically Ill Children*
Authors: Alobaidi Rashid , Basu Rajit K. , DeCaen Allan , Joffe Ari R. , Lequier Laurance , Pannu Neesh , Bagshaw Sean M.
Published: April 2020

Objectives:

To describe the characteristics of fluid accumulation in critically ill children and evaluate the association between the degree, timing, duration, and rate of fluid accumulation and patient outcomes.

Design:

Retrospective cohort study.

Setting:

PICUs in Alberta, Canada.

Patients:

All children admitted to PICU in Alberta, Canada, between January 1, 2015, and December 31, 2015.

Interventions:

None.

Measurements and Main Results:

A total of 1,017 patients were included. Fluid overload % increased from median (interquartile range) 1.58% (0.23–3.56%; n = 1,017) on day 1 to 16.42% (7.53–27.34%; n = 111) on day 10 among those remaining in PICU. The proportion of patients (95% CI) with peak fluid overload % greater than 10% and greater than 20% was 32.7% (29.8–35.7%) and 9.1% (7.4–11.1%), respectively. Thirty-two children died (3.1%) in PICU. Peak fluid overload % was associated with greater PICU mortality (odds ratio, 1.05; 95% CI, 1.02–1.09; p = 0.001). Greater peak fluid overload % was associated with Major Adverse Kidney Events within 30 days (odds ratio, 1.05; 95% CI, 1.02–1.08; p = 0.001), length of mechanical ventilation (B coefficient, 0.66; 95% CI, 0.54–0.77; p < 0.001), and length of PICU stay (B coefficient, 0.52; 95% CI, 0.46–0.58; p < 0.001). The rate of fluid accumulation was associated with PICU mortality (odds ratio, 1.15; 95% CI, 1.01–1.31; p = 0.04), Major Adverse Kidney Events within 30 days (odds ratio, 1.16; 95% CI, 1.03–1.30; p = 0.02), length of mechanical ventilation (B coefficient, 0.80; 95% CI, 0.24–1.36; p = 0.005), and length of PICU stay (B coefficient, 0.38; 95% CI, 0.11–0.66; p = 0.007).

Conclusions:

Fluid accumulation occurs commonly during PICU course and is associated with considerable mortality and morbidity. These findings highlight the need for the development and evaluation of interventional strategies to mitigate the potential harm associated with fluid accumulation.
Acute Physiology and Chronic Health Evaluation II Score as a Predictor of Hospital Mortality in Patients of Coronavirus Disease 2019
Authors: Zou Xiaojing , Li Shusheng , Fang Minghao , Hu Ming , Bian Yi , Ling Jianmin , Yu Shanshan , Jing Liang , Li Donghui , Huang Jiao
Published: April 2020

Objectives:

Coronavirus disease 2019 has emerged as a major global health threat with a great number of deaths in China. We aimed to assess the association between Acute Physiology and Chronic Health Evaluation II score and hospital mortality in patients with coronavirus disease 2019, and to compare the predictive ability of Acute Physiology and Chronic Health Evaluation II score, with Sequential Organ Failure Assessment score and Confusion, Urea, Respiratory rate, Blood pressure, Age 65 (CURB65) score.

Design:

Retrospective observational cohort.

Setting:

Tongji Hospital in Wuhan, China.

Subjects:

Confirmed patients with coronavirus disease 2019 hospitalized in the ICU of Tongji hospital from January 10, 2020, to February 10, 2020.

Interventions:

None.

Measurements and Main Results:

Of 178 potentially eligible patients with symptoms of coronavirus disease 2019, 23 patients (12.92%) were diagnosed as suspected cases, and one patient (0.56%) suffered from cardiac arrest immediately after admission. Ultimately, 154 patients were enrolled in the analysis and 52 patients (33.77%) died. Mean Acute Physiology and Chronic Health Evaluation II score (23.23 ± 6.05) was much higher in deaths compared with the mean Acute Physiology and Chronic Health Evaluation II score of 10.87 ± 4.40 in survivors (p < 0.001). Acute Physiology and Chronic Health Evaluation II score was independently associated with hospital mortality (adjusted hazard ratio, 1.07; 95% CI, 1.01–1.13). In predicting hospital mortality, Acute Physiology and Chronic Health Evaluation II score demonstrated better discriminative ability (area under the curve, 0.966; 95% CI, 0.942–0.990) than Sequential Organ Failure Assessment score (area under the curve, 0.867; 95% CI, 0.808–0.926) and CURB65 score (area under the curve, 0.844; 95% CI, 0.784–0.905). Based on the cut-off value of 17, Acute Physiology and Chronic Health Evaluation II score could predict the death of patients with coronavirus disease 2019 with a sensitivity of 96.15% and a specificity of 86.27%. Kaplan-Meier analysis showed that the survivor probability of patients with coronavirus disease 2019 with Acute Physiology and Chronic Health Evaluation II score less than 17 was notably higher than that of patients with Acute Physiology and Chronic Health Evaluation II score greater than or equal to 17 (p < 0.001).

Conclusions:

Acute Physiology and Chronic Health Evaluation II score was an effective clinical tool to predict hospital mortality in patients with coronavirus disease 2019 compared with Sequential Organ Failure Assessment score and CURB65 score. Acute Physiology and Chronic Health Evaluation II score greater than or equal to 17 serves as an early warning indicator of death and may provide guidance to make further clinical decisions.
Best Local Flaps for Lower Extremity Reconstruction
Authors: AlMugaren Faris M. , Pak Changsik John , Suh Hyunsuk Peter , Hong Joon Pio
Published: April 2020

The ideal reconstruction of lower limb defects should replace like with like and minimize morbidity to the donor site, achieving the best possible esthetic and functional outcome. The goal is to obtain stable healing and to resume daily life in an efficient manner. Although the classical local flaps such as gastrocnemius, soleus muscle flap, and the reverse sural flap have allowed to achieve those goals, perforator flaps are now added on to the armamentarium in lower extremity reconstruction using local flaps. A perforator-based local flap, such as a propeller or keystone flap, has made reconstruction efficient while further reducing donor-site morbidity. This article aims to provide a useful review of the best available local flaps for lower limb defects.
Development of Feasible Methods to Image the Eyelid Margin Using In Vivo Confocal Microscopy
Authors: Zhou Nanyu , Edwards Katie , Colorado Luisa H. , Schmid Katrina L.
Published: April 2020

Purpose:

To develop a feasible method to image eyelid margin structures using in vivo confocal microscopy (IVCM) for use in clinical research. Second, to assess the association between IVCM and meibography images.

Methods:

IVCM was performed on the central upper eyelid margin of 13 healthy participants (31 ± 5 years). Overall morphology montages (1600 × 1600 μm) were created of 3 participants. Single frames (400 × 400 μm) of 10 participants were imaged to determine the feasibility of measuring eyelid features. Meibography was performed with EASYTEARview+ in the same 10 participants. ImageJ software was used to quantify image structures.

Results:

In the montages, structures of rete ridges, meibomian gland openings, and the lid wiper region were observed. The maximum possible montage size, using multiple single frames, was approximately 5200 × 1500 × 150 μm in the X, Y, and Z directions, respectively. The mean number, density, area, perimeter, and shortest and longest diameters of rete ridges of the 9 nonoverlapped frames were 12 ± 2/frame, 73 ± 5/mm2, 2504 ± 403 μm2, 250 ± 33 μm, 40 ± 6 μm, and 84 ± 13 μm, respectively. Sampling analysis determined at least 5 nonoverlapped frames were necessary to accurately represent the parameters of the ridges. The mean areas of 3 meibomian openings were 785 ± 784 μm2, 1036 ± 963 μm2, 950 ± 1071 μm2, 848 ± 954 μm2, 737 ± 831 μm2, 735 ± 743 μm2, and from 30 μm to 130 μm at 20-μm depth intervals, respectively. No significant association between IVCM and meibography parameters (P = 0.53) was found.

Conclusions:

Imaging rete ridges with IVCM should include at least 5 nonoverlapping single frames in the upper eyelid margin. At least 3 openings imaged between 30 and 130 μm at 20-μm depth intervals are recommended to determine the opening area.
Longitudinal evaluation of posterior corneal power by anterior segment optical coherence tomography 18 months following photorefractive keratectomy
Authors: Latifi Golshan , Jabbarvand Mahmoud , Davoodabadi Mahmood , Abdi Parisa , Mohammadi S.Saeed
Published: April 2020

Purpose:

To investigate the change in anterior, posterior, and net corneal power more than 18 months after photorefractive keratectomy (PRK) by RTVue anterior segment optical coherence tomography (OCT).

Setting:

Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Design:

Prospective observational study.

Methods:

PRK was performed using Technolas TENEO 317 laser platform. Anterior, posterior, and net corneal power was measured by the RTVue-XR anterior segment OCT system with the Pachymetry + Cpwr scan pattern at baseline and months 1, 3, 6, 12, 18, and more than 18 (up to 27) after PRK.

Results:

Three hundred twenty-six eyes of 163 patients (61 men [37.4%], 102 women [62.6%]; mean age 29.71 years; range 18.5 to 46.5 years) were enrolled in this study. Mean preoperative spherical equivalent was −3.15 ± 1.50 diopter (D) (range −8.37 to −0.62 D). The mean change in net corneal power was 3.052 D, 3.281 D, 3.324 D, 3.114 D, 3.446 D, and 3.972 D at months 1, 3, 6, 12, 18, and more than 18 postoperatively compared with baseline, respectively (P < .001 for all comparisons). The mean change in posterior corneal power at postoperative visits compared with baseline was not statistically significant (P > .1) except for 1 month postoperatively, which increased by 0.13 D (P < .001). Changes in posterior corneal power were not correlated with any of the preoperative clinical and Scheimpflug variables.

Conclusions:

Posterior corneal power did not change for more than 18 months after PRK, except for an early small increase at 1 month postoperatively.
Excisional goniotomy vs trabecular microbypass stent implantation: a prospective randomized clinical trial in eyes with mild to moderate open-angle glaucoma
Authors: Falkenberry Suzanne , Singh Inder Paul , Crane Charles J. , Haider Mohammed Ali , Morgan Michael G. , Grenier Christopher P. , Brubaker Jacob W. , Balasubramani Goundappa K. , Dorairaj Syril
Published: April 2020

Purpose:

To compare reduction in intraocular pressure (IOP) and IOP-lowering medication in eyes undergoing excisional goniotomy with Kahook Dual Blade (KDB) vs iStent microbypass implantation, both combined with phacoemulsification, in eyes with mild to moderate open-angle glaucoma (OAG).

Setting:

Nine practices in the United States.

Design:

Prospective, randomized, active-controlled, parallel-group clinical trial.

Methods:

Eyes were randomized to KDB-Phaco or iStent-Phaco group. Demographics, corrected distance visual acuity, IOP, IOP-lowering medications, and adverse events were collected at baseline and at day 1, week 1, and months 1, 3, 6, and 12 postoperatively. The primary outcome measure was the proportion of eyes at 12 months with IOP reduction of 20% or greater or IOP medication reduction of 1 or more compared with baseline.

Results:

For this study, 164 eyes of 164 patients were analyzed (82 in each group). Mean IOP was reduced at 12 months compared with baseline from 18.5 (standard of error 0.4) to 15.4 (0.4) mm Hg in the KDB-Phaco group and from 18.5 (0.3) to 16.1 (0.4) mm Hg in the iStent-Phaco group (P = .24). Mean IOP-lowering medications were reduced from 1.3 (0.1) to 0.3 (0.1) in the KDB-Phaco group and from 1.4 (0.1) to 0.4 (0.1) in the iStent-Phaco group (P = .17). Among study completers, the primary outcome was attained in 74 (93.7%) of 79 patients of KDB-Phaco eyes and 65 (83.3%) of 78 patients of iStent-Phaco eyes (P = .04). Both procedures had similar safety profiles.

Conclusions:

Both procedures lowered both IOP and the need for IOP-lowering medications effectively and safely in eyes with mild to moderate OAG and cataract. Significantly, more KDB-Phaco eyes than iStent-Phaco eyes met the primary outcome of 20% or greater IOP reduction or 1 or more medication reduction at 12 months.
Preoperative Vascular Planning of Free Flaps: Comparative Study of Computed Tomographic Angiography, Color Doppler Ultrasonography, and Hand-Held Doppler
Authors: González Martínez Jesús , Torres Pérez Asia , Gijón Vega María , Nuñez-Villaveiran Teresa
Published: April 2020

Background:

Preoperative planning of microsurgical perforator free flaps continues to be a discussion topic among microsurgeons. The purpose of this study was to compare the ability of three methods of preoperative vascular mapping—hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography—to detect perforators and their concordance with surgical findings.

Methods:

A prospective study was performed to evaluate the sensitivity, specificity, and accuracy of hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography to detect free flap perforators. Each patient undergoing a free flap reconstruction was studied preoperatively with the three methods, and the results were compared to the intraoperative findings.

Results:

Fifty-three patients undergoing autologous tissue reconstruction were included. Most reconstructions (71.7 percent) were performed with anterolateral thigh flaps. The positive predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 100 percent; hand-held Doppler imaging, 88.6 percent) and negative predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 94.3 percent; hand-held Doppler imaging, 90.5 percent) rates were significantly different between methods. The high resolution of the color Doppler ultrasonography probe provided a direct vision of the vasculature arborization and efficiently detected vessels with diameters of less than 0.5 mm. The sensitivity, specificity, and accuracy of color Doppler ultrasonography were greater than those of both computed tomographic angiography and hand-held Doppler imaging. There was 100 percent concordance between color Doppler ultrasonography perforators and the surgical findings.

Conclusions:

Color Doppler ultrasonography provides a reproducible, harmless, and accurate way to visualize vascular anatomy. It has a high correlation with the surgical findings, signifying advantages over hand-held Doppler and computed tomographic angiography in sensitivity, specificity, and accuracy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, II.
Comparison of the Pedicled Latissimus Dorsi Flap with Immediate Fat Transfer versus Abdominally Based Free Tissue Transfer for Breast Reconstruction
Authors: Black Cara K. , Zolper Elizabeth G. , Economides James M. , Abadeer Andrew , Fan Kenneth L. , Song David H.
Published: April 2020

Background:

Abdominally based free tissue transfer (FTT) and latissimus dorsi and immediate fat transfer (LIFT) procedures are both fully autologous options for breast reconstruction. The former is specialized and requires comfort with microsurgical technique, whereas LIFT combines a common set of techniques familiar to all plastic surgeons. Comparing the two methods for clinical effectiveness and complications for equivalency in outcomes may help elucidate and enhance patient decision-making.

Methods:

A retrospective review of a prospectively maintained database between March of 2017 and July of 2018 was performed to compare the LIFTs and FTTs performed by the senior surgeon. Outcomes of interest included postoperative complications, flap success, and follow-up revision and fat-grafting procedures.

Results:

Sixty-five breasts were reconstructed by FTT; and 31 breasts were reconstructed with LIFT. Demographics were similar (p > 0.05). LIFT had a shorter length of operation time (343 ± 128 minutes versus 49 ± 137 minutes) (p < 0.0001) and a shorter length of stay (1.65 ± 0.85 days versus 3.83 ± 1.65 days) (p < 0.001). FTTs had a shorter time until drain removal (13.3 ± 4.3 days versus 24.0 ± 11.2 days) (p < 0.0001). The number of major (requiring operation) and minor complications were not statistically different (i.e., FTTs, 20.0 percent major and 27.7 percent minor; LIFT, 12.9 percent major and 19.35 percent minor) (p > 0.05). The need for revisions (FTTs, 0.80 ± 0.71; LIFT, 0.87 ± 0.71) and fat grafting (FTTs, 41.54 percent; LIFT, 58.8 percent) was not statistically different (p > 0.05).

Conclusions:

Both the LIFT and abdominally based FTT have similar outcomes and complication rates. However, LIFT may be preferred in patients who require shorter operation times. The LIFT may be the fully autologous breast reconstruction of choice for nonmicrosurgeons.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
eHealth Interventions for Solid Organ Transplant Recipients: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Tang James , James Laura , Howell Martin , Tong Allison , Wong Germaine
Published: April 2020

Background.

Lack of support for self-management may contribute to adverse health outcomes. eHealth has the potential to support self-management, but evidence in solid organ transplantation remains unclear. This review aims to evaluate the benefits and harms of eHealth interventions to support self-management in solid organ transplant recipients.

Methods.

We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases for randomized trials of eHealth interventions in solid organ transplant recipients. We calculated the risk ratios or standardized mean difference of outcomes, and summary estimates were determined using random-effects models. The Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluations were used to assess trial quality.

Results.

Twenty-one trials from 6 countries involving 2114 participants were included. Compared with standard care, eHealth interventions improved medication adherence (risk ratio, 1.34; CI, 1.12-2.56; I2 = 75%) and self-monitoring behavior (risk ratio, 2.58; CI, 1.56-4.27; I2 = 0%) up to 12 mo posttransplant. The treatment effects were largely consistent across different subgroups except for intervention functionality and mode of delivery. The effects on other outcomes were uncertain. Nine trials reported harms. The overall risk of bias was considered high or unclear, and the quality of evidence was low to very low for all outcomes.

Conclusions.

eHealth interventions may improve medication adherence and self-monitoring behavior in the short term, but high-quality intervention studies are needed to determine whether eHealth will improve long-term patient-relevant outcomes.
Optical Coherence Tomography Findings in the Junctional Scotoma of Traquair
Authors: Harish Bindiganavile Shruthi , Bhat Nita , Adesina Ore-Ofeoluwatomi , Lee Andrew G.
Published: April 2020

A 43-year-old woman presented with a right-sided visual field defect in the right eye. The visual acuity was normal and there was a right relative afferent pupillary defect. Formal visual field testing revealed a junctional scotoma of Traquair. The fundus examination showed optic atrophy in the right eye and optical coherence tomography demonstrated unilateral band atrophy. Neuroimaging revealed a sellar and suprasellar cystic pituitary adenoma for which she underwent a transsphenoidal drainage. We demonstrate the clinical and radiographic features of the junctional scotoma of Traquair and describe the differentiating features vs the junctional scotoma.
Genome-Wide Meta-Analysis Validates a Role for S1PR1 in Microtubule Targeting Agent-Induced Sensory Peripheral Neuropathy
Authors: Chua Katherina C. , Xiong Chenling , Ho Carol , Mushiroda Taisei , Jiang Chen , Mulkey Flora , Lai Dongbing , Schneider Bryan P. , Rashkin Sara R. , Witte John S. , Friedman Paula N. , Ratain Mark J. , McLeod Howard L. , Rugo Hope S. , Shulman Lawrence N. , Kubo Michiaki , Owzar Kouros , Kroetz Deanna L.
Published: April 2020

Microtubule targeting agents (MTAs) are anticancer therapies commonly prescribed for breast cancer and other solid tumors. Sensory peripheral neuropathy (PN) is the major dose-limiting toxicity for MTAs and can limit clinical efficacy. The current pharmacogenomic study aimed to identify genetic variations that explain patient susceptibility and drive mechanisms underlying development of MTA-induced PN. A meta-analysis of genome-wide association studies (GWAS) from two clinical cohorts treated with MTAs (CALGB 40502 and CALGB 40101) was conducted using a Cox regression model with cumulative dose to first instance of grade 2 or higher PN. Summary statistics from a GWAS of European subjects (n = 469) in CALGB 40502 that estimated cause-specific risk of PN were meta-analyzed with those from a previously published GWAS of European ancestry (n = 855) from CALGB 40101 that estimated the risk of PN. Novel single nucleotide polymorphisms in an enhancer region downstream of sphingosine-1-phosphate receptor 1 (S1PR1 encoding S1PR1; e.g., rs74497159, βCALGB40101 per allele log hazard ratio (95% CI) = 0.591 (0.254 - 0.928), βCALGB40502 per allele log hazard ratio (95% CI) = 0.693 (0.334 - 1.053); PMETA = 3.62×10−7) were the most highly ranked associations based on P-values with risk of developing grade 2 and higher PN. In silico functional analysis identified multiple regulatory elements and potential enhancer activity for S1PR1 within this genomic region. Inhibition of S1PR1 function in iPSC-derived human sensory neurons shows partial protection against paclitaxel-induced neurite damage. These pharmacogenetic findings further support ongoing clinical evaluations to target S1PR1 as a therapeutic strategy for prevention and/or treatment of MTA-induced neuropathy.
Increased travel times to United States SARS-CoV-2 testing sites: a spatial modeling study
Authors: Rader Benjamin , Astley Christina M. , Sy Karla Therese L. , Sewalk Kara , Hswen Yulin , Brownstein John S. , Kraemer Moritz U.G.
Published: April 2020

Importance

Access to testing is key to a successful response to the COVID-19 pandemic.

Objective

To determine the geographic accessibility to SARS-CoV-2 testing sites in the United States, as quantified by travel time.

Design

Cross-sectional analysis of SARS-CoV-2 testing sites as of April 7, 2020 in relation to travel time.

Setting

United States COVID-19 pandemic.

Participants

The United States, including the 48 contiguous states and the District of Columbia.

Exposures

Population density, percent minority, percent uninsured, and median income by county from the 2018 American Community Survey demographic data.

Main Outcome

SARS-CoV-2 testing sites identified in two national databases (Carbon Health and CodersAgainstCovid), geocoded by address. Median county 1 km2 gridded friction surface of travel times, as a measure of geographic accessibility to SARS-CoV-2 testing sites.

Results

6,236 unique SARS-CoV-2 testing sites in 3,108 United States counties were identified. Thirty percent of the U.S. population live in a county (N = 1,920) with a median travel time over 20 minutes. This was geographically heterogeneous; 86% of the Mountain division population versus 5% of the Middle Atlantic population lived in counties with median travel times over 20 min. Generalized Linear Models showed population density, percent minority, percent uninsured and median income were predictors of median travel time to testing sites. For example, higher percent uninsured was associated with longer travel time (β = 0.41 min/percent, 95% confidence interval 0.3-0.53, p = 1.2×10−12), adjusting for population density.

Conclusions and Relevance

Geographic accessibility to SARS-Cov-2 testing sites is reduced in counties with lower population density and higher percent of minority and uninsured, which are also risk factors for worse healthcare access and outcomes. Geographic barriers to SARS-Cov-2 testing may exacerbate health inequalities and bias county-specific transmission estimates. Geographic accessibility should be considered when planning the location of future testing sites and interpreting epidemiological data.

Key Points

SARS-CoV-2 testing sites are distributed unevenly in the US geography and population.

Median county-level travel time to SARS-CoV-2 testing sites is longer in less densely populated areas, and in areas with a higher percentage of minority or uninsured populations.

Improved geographic accessibility to testing sites is imperative to manage the COVID-19 pandemic in the United States.
Inferred duration of infectious period of SARS-CoV-2: rapid scoping review and analysis of available evidence for asymptomatic and symptomatic COVID-19 cases
Authors: Byrne Andrew W. , McEvoy David , B. Collins Áine , Hunt Kevin , Casey Miriam , Barber Ann , Butler Francis , Griffin John , Lane Elizabeth A. , McAloon Conor , O’Brien Kirsty , Wall Patrick , Walsh Kieran A. , More Simon J.
Published: April 2020

Objectives

Our objective was to review the literature on the inferred duration of the infectious period of COVID-19, caused by SARS-COV-2 virus, and provide an overview of the variation depending on the methodological approach.

Design

Rapid scoping review. Literature review with fixed search terms, up to 1stApril 2020. Central tendency and variation of the parameter estimates for infectious period in (a) asymptomatic (b) symptomatic cases from (i) virological studies (repeated testing), (ii) tracing studies (iii)modelling studies were gathered. Narrative review of viral dynamics.

Information sources

Search strategies developed and the following searched: PubMed, Google Scholar, MedRxiv, BioRxiv. Additionally, the Health Information Quality Authority (Ireland) viral load synthesis was utilised, which screened literature from PubMed, Embase, ScienceDirect, NHS evidence, Cochrane, medRxiv and bioRxiv, HRB open databases.

Results

There was substantial variation in the estimates, and how infectious period was inferred. One study provided approximate median infectious period for asymptomatic cases of 6.5-9.5 days. Median pre-symptomatic infectious period across studies varied over <1-4 days. Estimated mean time from symptom onset to two negative RT-PCR tests was 13.4 days (95%CI: 10.9-15.8), but was shorter when studies included children or less severe cases. Estimated mean duration from symptom onset to hospital discharge or death (potential maximal infectious period) was 18.1 days (95%CI: 15.1–21.0); time to discharge was on average 4 days shorter than time-to-death. Viral dynamic data and model infectious parameters were often shorter than repeated diagnostic data.

Conclusions

There are limitations of inferring infectiousness from repeated diagnosis, viral loads, and viral replication data alone, and also potential patient recall bias relevant to estimating exposure and symptom onset times. Despite this, available data provides a preliminary evidence base to inform models of central tendency for key parameters, and variation for exploring parameter space and sensitivity analysis. Some current models may be underestimating infectious period.
Evaluation of “stratify and shield” as a policy option for ending the COVID-19 lockdown in the UK
Authors: McKeigue Paul M , Colhoun Helen M
Published: April 2020

Although population-wide lockdowns have been successful in slowing the COVID-19 epidemic, there is a consensus among disease modellers that keeping the load on critical care services within manageable limits will require an adaptive social distancing strategy, alternating cycles of relaxation and reimposition until a vaccine is available. An alternative strategy that has been tentatively proposed is to shield the elderly and others at high risk of severe disease, while allowing immunity to build up in those at low risk until the entire population is protected. We examine the performance required from a classifier that uses information from medical records to assign risk status for a such a stratify-and-shield policy to be effective in limiting mortality when social distancing is relaxed.

We show that under plausible assumptions about the level of immunity required for population-level immunity, the proportion shielded is constrained to be no more than 15% of the population. Under varying assumptions about the infection fatality ratio (from 0.1% to 0.4%) and the performance of the classifier (3 to 4.5 bits of information for discrimination), we calculate the expected number of deaths in the unshielded group. We show that with likely values of the performance of a classifier that uses information from age, sex and medical records, at least 80% of those who would die if unshielded would be allocated to the high-risk shielded group comprising 15% of the population. Although the proportion of deaths that would be prevented by effective shielding does not vary much with the infection fatality ratio, the absolute number of deaths in the unshielded varies from less than 10,000 if the infection fatality rate is 0.1% to more than 50,000 if the infection fatality rate is as high as 0.4%.

For projecting the effect of an optimally applied stratify-and-shield policy, studies now under way should help to resolve key uncertainties: the extent to which infection confers immunity, the prevalence of immunity, the infection fatality ratio, and the performance of a classifier constructed using information from medical records. It is time to give serious consideration to a stratify-and-shield policy that could bring the COVID-19 epidemic to an end in a matter of months while restoring economic activity, avoiding overload of critical care services and limiting mortality.
Using Disability-Adjusted Life Years to assess the burden of road traffic injuries in Nay Pyi Taw, Myanmar
Authors: Thaw Win Ei Ei , Phanprasit Wantanee , Amnatsatsue Kwanjai , Bunnagamchairat Ariya , Bundhamcharoen Kanitta
Published: April 2020

Background

Road traffic injury (RTI) is growing public health problem in Myanmar. In addition, every count in road crush is followed by remarkable burdens in the community. In this study, burden of disease (BOD) approach is used to quantify this hidden problem in the studied area.

Aim/Objective/Purpose

To assess the burden of traffic injuries in Nay Pyi Taw Union Territory, Myanmar

Methods

This cross-sectional study analyzed 16,338 traffic injury victims in injury registry, from 2012 to 2016. The burden was estimated by disability-adjusted life years (DALYs). The analysis was disaggregated by sex, age and type of road users, as well as expressed the rate by per 100,000 population.

Results/Outcomes

It was 60,962 DALYs in total for the studied period, with the rate of 1050.85 per 100,000 population. Although premature death in road crash was only 6.2% in the study, it attributed 87.8% of total burden. Total DALYs contributed by male were three-times higher than female. Nearly half of burden came from the young and productive population of 15-29 years. The highest DALYs rate was seen in the 20-24 years in male and 30-34 years in female. The highest RTI burden was due to motorized two-wheelers, with 69.4% of total DALYs.

Conclusion

This study initiates usefulness of local data from injury registry to calculate the burden of injury. The findings highlight a huge burden of traffic injuries in the community, focusing on the hidden contribution of fatal cases and the vulnerability of young adult, male and motorcyclists in traffic accidents.
Ketamine’s pharmacogenomic network in human brain contains sub-networks associated with glutamate neurotransmission and with neuroplasticity
Authors: Higgins Gerald A. , Handelman Samuel A. , Allyn-Feuer Ari , Ade Alex S. , Burns James S. , Omenn Gilbert S. , Athey Brian D.
Published: April 2020

The pharmacogenomic network responsible for the rapid antidepressant action of ketamine and concomitant adverse events in patients has been poorly defined. Integrative, multi-scale biological data analytics helps explain ketamine’s action. Using a validated computational pipeline, candidate ketamine-response genes and regulatory RNAs from published literature, binding affinity studies, and single nucleotide polymorphisms (SNPs) from genomewide association studies (GWAS), we identified 108 SNPs associated with 110 genes and regulatory RNAs. All of these SNPs are classified as enhancers, and additional chromatin interaction mapping in human neural cell lines and tissue shows enhancer-promoter interactions involving other network members. Pathway analysis and gene set optimization identified three composite sub-networks within the broader ketamine pharmacogenomic network. Expression patterns of ketamine network genes within the postmortem human brain are concordant with ketamine neurocircuitry based on the results of 24 published functional neuroimaging studies. The ketamine pharmacogenomic network is enriched in forebrain regions known to be rapidly activated by ketamine, including cingulate cortex and frontal cortex, and is significantly regulated by ketamine (p=6.26E-33; Fisher’s exact test). The ketamine pharmacogenomic network can be partitioned into distinct enhancer sub-networks associated with: (1) glutamate neurotransmission, chromatin remodeling, smoking behavior, schizophrenia, pain, nausea, vomiting, and post-operative delirium; (2) neuroplasticity, depression, and alcohol consumption; and (3) pharmacokinetics. The component sub-networks explain the diverse action mechanisms of ketamine and its analogs. These results may be useful for optimizing pharmacotherapy in patients diagnosed with depression, pain or related stress disorders.

One Sentence Summary

The ketamine network in the human brain consists of sub-networks associated with glutamate neurotransmission, neuroplasticity, and pharmacokinetics.
Effects of L-DOPA on gene expression in the frontal cortex of rats with unilateral lesion of midbrain dopaminergic neurons
Authors: Radlicka Anna , Kamińska Kinga , Borczyk Malgorzata , Piechota Marcin , Korostyński Michał , Pera Joanna , Lorenc-Koci Elżbieta , Parkitna Jan Rodriguez
Published: April 2020

The development of Parkinson’s disease (PD) causes dysfunction of the frontal cortex, which contributes to hallmark motor symptoms and is regarded as one of the primary causes of the affective and cognitive impairments observed in PD. Treatment with L-DOPA alleviates motor symptoms but has mixed efficacy in restoring normal cognitive functions, which is further complicated by the psychoactive effects of the drug. In this study, we investigated how L-DOPA affects gene expression in the frontal cortex in an animal model of unilateral PD. We performed an RNA-seq analysis of gene expression in the frontal cortex of rats with 6-hydroxydopamine (6-OHDA)-induced unilateral dopaminergic lesion that were treated with L-3,4-dihydroxyphenylalanine (L-DOPA), for 2 weeks. We used analysis of variance to identify differentially expressed genes and found 48 genes with significantly altered transcript abundance after L-DOPA treatment. We also performed a weighted gene coexpression network analysis (WGCNA), which resulted in the detection of 5 modules consisting of genes with similar expression patterns. The analyses led to three primary observations. First, the changes in gene expression induced by L-DOPA were bilateral, although only one hemisphere was lesioned. Second, the changes were not restricted to neurons but also appeared to emerge in immune or endothelial cells. Finally, comparisons with databases of drug-induced gene expression signatures revealed multiple nonspecific effects, which indicates that a part of the observed response is a common pattern activated by multiple types of pharmaceuticals in different target tissues. Taken together, our results identify cellular mechanisms in the frontal cortex that are involved in the response to L-DOPA treatment.
SNP genotyping and population analysis of five indigenous Kazakh sheep breeds
Authors: Pozharskiy Alexandr , Khamzina Aigerim , Gritsenko Dilyara , Khamzina Zhangylsyn , Kassymbekova Shinara , Karimov Nurlybek , Karymsakov Talgat , Tlevlesov Nurlan
Published: April 2020

Sheep husbandry is an important branch of agriculture in Kazakhstan. Modern agrarian and breeding science demands inclusion of molecular genetic and genomic data to supplement traditional methods. Here we used medium-scale SNP genotyping for the first time to determine the population structure of five local sheep breeds in Kazakhstan and their relation to global sheep diversity.

Principal component analysis and model-based structure analysis of general population markers revealed two breed groups. The first group included Akzhayik and Kazak Fine-wool sheep and the second group had Edilbay, Saryarka and Kazakh Semi-coarse wool sheep. High heterogeneity of different populations of Akzhayik and Kazakh Semi-coarse wool sheep was observed. A neighborjoining tree comparing Kazakh sheep data with the dataset generated by the Sheep HapMap project supported a close relationship between Kazakh sheep varieties and ancient domestic sheep ancestors.