bluuebunny/crossref_metadata_2025 huggingface dataset:
Who Engaged in Home-Based Arts Activities During the COVID-19 Pandemic? A Cross-Sectional Analysis of Data From 4,731 Adults in the United States
Authors: Bone Jessica K. , Wan Mak Hei , Sonke Jill K. , Fluharty Meg E. , Lee Jenny B. , Kolenic Anthony J. , Radunovich Heidi , Cohen Randy , Fancourt Daisy
Published: September 2022

Arts engagement is a health-related behavior that may be influenced by social inequalities. While the COVID-19 pandemic provided new opportunities for some people to engage in the arts, it might have created barriers for others. We aimed to examine whether there was social patterning in home-based arts engagement during the pandemic in the United States, and whether predictors of engagement differed according to the type of arts activity. We included 4,731 adults who participated in the United States COVID-19 Social Study between April and July 2020. Three types of home-based arts engagement were considered: reading for pleasure, arts or crafts activities, and digital arts activities. Using logistic regression models, we tested cross-sectional associations between a broad range of demographic, socioeconomic, psychosocial, and health-related factors as well as adverse events and worries during lockdown and each type of arts engagement. The factors most strongly associated with all three types of arts engagement were social support, social network size, age, race/ethnicity, keyworker status, and experiencing physical or psychological abuse during the pandemic. However, most socioeconomic and health-related factors were not associated with arts engagement, including household income and mental and physical health problems. Overall, our findings indicate that the social gradient in arts engagement was reduced in the first 4 months of the COVID-19 pandemic in the United States. Given the health benefits of arts engagement, the potential diversification of arts audiences during the pandemic is promising for both population-level health and wellbeing and the future of the arts and cultural sector.
Development of a Brief Measure for Multi-Tiered Systems of Support Sustainability
Authors: Bahr Michael W. , Edwin Mary , Long Kara A.
Published: September 2022

This study focused on the development of the Multi-Tiered Systems of Support–Sustainability Scale (MTSS-SS). Review of the literature identified factors associated with sustainability for multi-tiered systems of support (MTSS), and it indicated few sustainability measures currently exist for practitioners and researchers to incorporate into MTSS program evaluation. This study endeavored to create a brief measure of MTSS sustainability that could be used for evaluation in research and practice by school interventionists. Study participants included a national sample of 598 school counselors and school psychologists who worked as interventionists in schools using MTSS. This group completed the 10-item MTSS-SS. Outcomes from content validity ratings, principal axis factoring, internal consistency reliability analyses, and construct validity with known groups indicated the MTSS-SS possessed initial evidence of psychometric adequacy when used by interventionists from the disciplines of school counseling or school psychology. Discussion focuses on the use of the MTSS-SS, need for further development, and study limitations.
Evolution of WIfI: Expansion of WIfI Notation After Intervention
Authors: Blanchette Virginie , Fernando Malindu E. , Shin Laura , Rowe Vincent L. , Ziegler Kenneth R. , Armstrong David G.
Published: September 2022

Nearly a decade ago, the Society for Vascular Surgery (SVS)'s wound, ischemia, and foot Infection (WIfI) classification was first developed to help assess overall limb threat. However, managing conditions such as diabetic foot ulcer and chronic limb-threatening ischemia can be complex. For instance, certain investigative findings might initially be pending such as the level of ischemia or extent of infection before the final classification is established. In addition, wounds evolve rapidly, and the current classification does not allow for tracking their progression over time during treatment. Therefore, we propose a supplemental consistent notation for scoring WifI re-assessment during treatment of a threatened limb inspired by the cancer staging before and after neoadjuvant treatment classification system. Thus, we describe the re-scoring system and how to use it. Our suggestion supports a coherent method to longitudinally communicate characteristics of a threatened limb. This has potential to support high quality interdisciplinary, patient-centered care and enhance the use of this classification in research. Further work is required to validate this modification of a common language of risk.
EEG Dynamics of Locomotion and Balancing: Solution to Neuro-Rehabilitation
Authors: Khajuria Aayushi , Sharma Richa , Joshi Deepak
Published: September 2022

The past decade has witnessed tremendous growth in analyzing the cortical representation of human locomotion and balance using Electroencephalography (EEG). With the advanced developments in miniaturized electronics, wireless brain recording systems have been developed for mobile recordings, such as in locomotion. In this review, the cortical dynamics during locomotion are presented with extensive focus on motor imagery, and employing the treadmill as a tool for performing different locomotion tasks. Further, the studies that examine the cortical dynamics during balancing, focusing on two types of balancing tasks, ie, static and dynamic, with the challenges in sensory inputs and cognition (dual-task), are presented. Moreover, the current literature demonstrates the advancements in signal processing methods to detect and remove the artifacts from EEG signals. Prior studies show the electrocortical sources in the anterior cingulate, posterior parietal, and sensorimotor cortex was found to be activated during locomotion. The event-related potential has been observed to increase in the fronto-central region for a wide range of balance tasks. The advanced knowledge of cortical dynamics during mobility can benefit various application areas such as neuroprosthetics and gait/balance rehabilitation. This review will be beneficial for the development of neuroprostheses, and rehabilitation devices for patients suffering from movement or neurological disorders.
Assessing Responsiveness of the Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire
Authors: Saggaf Moaath M. , Roy Mélissa , Antflek Daniel , Borkhoff Cory M. , Baltzer Heather
Published: September 2022

Background:

This study aimed to assess the responsiveness of the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire after corticosteroid injections and operative management for trapeziometacarpal osteoarthritis (TMC-OA).

Methods:

This longitudinal cohort study included patients with TMC-OA who underwent treatment (corticosteroid injection or surgery). Measurements occurred at baseline and follow-up time points: 6 weeks, 3 months, 6 months, and 1 year. Patient measures were collected electronically using a data repository platform. The TASD is a validated psychometric patient-administered scale. We examined responsiveness by correlating the TASD scores with another known effective indicator of change (shortened Disabilities of the Arm, Shoulder, and Hand [QuickDASH]). Repeated score measurements over time were analyzed using analysis of variance, and correlations between questionnaires were reported with repeated measures correlation and Pearson correlation coefficients.

Results:

The nonsurgical cohort undergoing corticosteroid injections included 31 (66%) women and 16 (34%) men, and the surgical cohort included 29 (71%) women and 12 (29%) men. Both the QuickDASH and the TASD captured a statistically significant improvement in symptom burden postoperatively ( P < .0001 for both questionnaires), whereas no statistical significance was noted after corticosteroid injections ( P = .45 and P = .34, respectively). There was a strong correlation between QuickDASH and TASD questionnaires ( r = 0.87, P < .0001).

Conclusions:

The TASD is a promising TMC-OA–specific questionnaire to capture responsiveness following treatment, particularly following surgery. The responsiveness of TASD was demonstrated in the TMC-OA cohort. Further research is needed to define a minimal clinically important difference.
Localization of the Median Nerve and Flexor Pollicis Longus at the Carpal Tunnel Inlet in Patients With and Without Carpal Tunnel Syndrome Using Ultrasound
Authors: Lee Hannah H. , Lynch Kevin J. , Kohls Morgan R. , Fowler John R.
Published: September 2022

Background:

Current illustrations of the carpal tunnel vary greatly. The relative positions of the components such as the median nerve and flexor pollicis longus (FPL) tendon seem often arbitrarily chosen. The purpose of this study was to determine the locations of the median nerve and FPL in the carpal tunnel using ultrasound (US) and to determine whether the position of the median nerve changes in carpal tunnel syndrome (CTS).

Method:

Patients with and without CTS underwent US examination of the wrist. A 4 × 10 grid was fitted to each saved cross-sectional image. The center points of the median nerve and FPL were identified, and their horizontal and vertical coordinates were recorded.

Results:

The median nerve was identified in 115 wrists (average x = 0.70, y = 0.82), and FPL was identified in 90 wrists (average x = 0.86, y = 0.59). A scatter plot was created by stacking all US images to demonstrate the average positions of the median nerve and FPL. There were 97 wrists without CTS (No CTS) and 17 wrists with CTS. There was a significant difference in the vertical position of the median nerve between No CTS and CTS wrists ( P = .0006).

Conclusions:

The locations of the median nerve and FPL within the carpal tunnel were determined using US of 115 wrists, and a heat map was created to illustrate these locations. The median nerve was found to be more superficial in the setting of CTS.
An open approach to a ruptured common iliac artery aneurysm with resultant ilio-iliac arteriovenous fistula
Authors: Lim Eric TA , Khanafer Adib
Published: September 2022

Objective

Presentations of a spontaneous ilio-iliac arteriovenous fistula are considered a rare occurrence and warrant urgent intervention. They are usually a result following trauma, previous surgery or uncommonly from a ruptured aneurysm.

Method

We describe a case of a patient presenting with general malaise who examined to have a pulsatile abdominal mass with an associated bruit. He was found to have an ilio-iliac arteriovenous fistula secondary to a ruptured iliac aneurysm that was treated successfully with open surgical repair.

Result

The patient was brought forward for open surgical repair due to haemodynamic instability as well as likely predicted difficulties with endovascular repair. Intra-operatively, his sigmoid colon was adherent to the aneurysm prompting the need for a Hartmann’s procedure to allow for better visualisation of the aneurysm. A combination of external digital compression and Prolene suture was used to close the arteriovenous fistula.

Conclusion

Open surgical repair of an ilio-iliac arteriovenous fistula secondary to a ruptured iliac aneurysm appears to be safe and feasible approach. The advancement of medical technology does open up the possibility of an endovascular approach; however, in a small subset of patients, open repair would appear to be better.
Evaluating group-sequential non-inferiority clinical trials following interim stopping: The HIV Prevention Trials Network 083 trial
Authors: Hanscom Brett S , Donnell Deborah J , Fleming Thomas R , Hughes James P , McCauley Marybeth , Grinsztejn Beatriz , Landovitz Raphael J , Emerson Scott S
Published: September 2022

Background/Aims:

The HIV Prevention Trials Network 083 trial was a group-sequential non-inferiority trial designed to compare HIV incidence under a novel experimental regimen for HIV prevention, long-acting injectable cabotegravir, with an active-control regimen of daily oral tenofovir disoproxil fumarate/emtricitabine (brand name Truvada). In March of 2020, just as the trial had completed enrollment, the COVID-19 pandemic threatened to prevent trial participants from attending study visits and obtaining study medication, motivating the study team to update the interim monitoring plan. The Data and Safety Monitoring Board subsequently stopped the trial at the first interim review due to strong early evidence of efficacy.

Methods:

Here we describe some unique aspects of the trial’s design, monitoring, analysis, and interpretation. We illustrate the importance of computing point estimates, confidence intervals, and p values based on the sampling distribution induced by sequential monitoring.

Results:

Accurate analysis, decision-making and interpretation of trial results rely on pre-specification of a stopping boundary, including the scale on which the stopping rule will be implemented, the specific test statistics to be calculated, and how the boundary will be adjusted if the available information fraction at interim review is different from planned. After appropriate adjustment for the sampling distribution and overrun, the HIV Prevention Trials Network 083 trial provided strong evidence that the experimental regimen was superior to the active control.

Conclusions:

For the HIV Prevention Trials Network 083 trial, the difference between corrected inferential statistics and naive results was quite small—as will often be the case—nevertheless, it is appropriate to report and publish the most accurate and unbiased statistical results.
Destigmatizing Borderline Personality Disorder: A Call to Action for Psychological Science
Authors: Masland Sara R. , Victor Sarah E. , Peters Jessica R. , Fitzpatrick Skye , Dixon-Gordon Katherine L. , Bettis Alexandra H. , Navarre Kellyann M. , Rizvi Shireen L.
Published: September 2022

Despite recognition that borderline personality disorder (BPD) is one of the most stigmatized psychological disorders, destigmatization efforts have thus far focused on the views and actions of clinicians and the general public, neglecting the critical role that psychological science plays in perpetuating or mitigating stigma. This article was catalyzed by recent concerns about how research and editorial processes propagate stigma and thereby fail people with BPD and the scientists who study BPD. We provide a brief overview of the BPD diagnosis and its history. We then review how BPD has been stigmatized in psychological science, the gendered nature of BPD stigma, and the consequences of this stigmatization. Finally, we offer specific recommendations for researchers, reviewers, and editors who wish to use science to advance our understanding of BPD without perpetuating pejorative views of the disorder. These recommendations constitute a call to action to use psychological science in the service of the public good.
Does an experimentally induced self-association elicit affective self-prioritisation?
Authors: Orellana-Corrales Gabriela , Matschke Christina , Schäfer Sarah , Wesslein Ann-Katrin
Published: September 2022

Self-relevant stimuli such as one’s name and face have been demonstrated to influence information processing in both the cognitive and affective domains. It has been observed that recently self-associated stimuli can also influence cognition, but their impact on affect has not been tested yet. In the current study ( N = 107), we test whether recently self-associated stimuli yield an affective bias and compare the size of the effect with that of familiar self-associated stimuli. A Recoding-Free Implicit Association Test (IAT-RF) presenting self-associated, neutral object-associated, positive, and negative stimuli was used with two groups: one which categorised familiar words as self- and neutral object-associated stimuli, and a second which categorised recently self- and neutral object-associated geometric shapes. In both cases, response times were faster for congruent trials, which mapped response keys as “positive/self” and “negative/neutral object,” than for incongruent trials which mapped response keys as “positive/neutral object” and “negative/self.” The size of the effect yielded by familiar and new self-associated stimuli did not differ. This indicates that experimentally induced self-association can immediately yield an affective bias in favour of the self-associated stimulus.
Does fluoxetine reduce apathetic and depressive symptoms after stroke? An analysis of the Efficacy oF Fluoxetine—a randomized Controlled Trial in Stroke trial data set
Authors: Tay Jonathan ,   EFFECTS Trial Collaboration, Mårtensson Björn , Markus Hugh S , Lundström Erik
Published: September 2022

Objective:

Apathy is a common and disabling symptom after stroke with no proven treatments. Selective serotonin reuptake inhibitors are widely used to treat depressive symptoms post-stroke but whether they reduce apathetic symptoms is unknown. We determined the effect of fluoxetine on post-stroke apathy in a post hoc analysis of the EFFECTS (Efficacy oF Fluoxetine—a randomized Controlled Trial in Stroke) trial.

Methods:

EFFECTS enrolled patients ⩾18 years between 2 and 15 days after stroke onset. Participants were randomly assigned to receive oral fluoxetine 20 mg once daily or matching placebo for 6 months. The Montgomery–Åsberg Depression Rating Scale (MADRS) was administered at baseline and 6 months. Individual items on this scale were divided into those reflecting symptoms of apathy and depression. Symptoms were compared between fluoxetine and placebo groups.

Results:

Of 1500 participants enrolled, complete MADRS data were available for 1369. The modified intention-to-treat population included 681 patients in the fluoxetine group and 688 in the placebo group. Confirmatory factor analysis revealed that apathetic, depressive, and anhedonic symptoms were dissociable. Apathy scores increased in both fluoxetine and placebo groups (both p ⩽ 0.00001). In contrast, fluoxetine was associated with a reduction in depressive scores (p = 0.002)

Conclusion:

Post-stroke apathetic and depressive symptoms respond differently to fluoxetine treatment. Our analysis suggests fluoxetine is ineffective in preventing post-stroke apathy.
Natural history of elbow flexion and forearm rotation contractures in obstetric brachial plexus injury
Authors: Hems Tim
Published: September 2022

A prospective database study was undertaken to investigate the severity and progression of elbow and forearm contractures in patients with obstetric brachial plexus injury. One-hundred and fifty-nine patients, who had not undergone nerve repair (mean age 12 years at last follow-up) (56 Narakas Group 1, 66 Group 2, 27 Group 3, 10 Group 4) were studied. Mean fixed flexion of the elbow at last follow-up was 13° for Group 1, 15° for Group 2, 19° for Group 3 and 24° for Group 4. Severe contracture of 30° or more developed in 31 children (mean age 118 months), with poorer active shoulder abduction being a significant risk factor. Onset of contracture was before the age of 5 years but did not increase substantially beyond 12 years. Active and passive pronation and supination tended to decrease with increasing injury severity. Seventeen children developed severe restriction of passive pronation (supination contracture) (mean age 69 months), and 12 developed severe restriction of passive supination at a mean of 137 months.

Level of evidence: III
Emerging stronger from COVID-19 through arts
Authors: Ong Chong Yau , Wai Ching Deanna Lee
Published: September 2022

Objectives:

To assess art initiatives and programmes communicating health messages and during the COVID-19 pandemic in Malaysia from 2020 to 2021.

Study design:

Qualitative narrative study.

Methods:

Grey literature on COVID-19 art initiatives and programmes in Malaysia was reviewed.

Results:

The art initiatives and efforts in Malaysia to promote health and wellness during the COVID-19 pandemic were compelling and notable. These initiatives can be classified into five major categories, namely performing arts, visual arts, culture, literature and digital art. The main health messages conveyed through these initiatives included public education regarding COVID-19, health precautionary steps recommended for the public, and solidarity in the fight against COVID-19. These art initiatives cultivated positive responses from the public and increased their awareness of COVID-19.

Conclusion:

From the public health perspective, the use of arts to educate and create awareness of COVID-19 in Malaysia were encouraging. The public is made more informed and prepared to face the challenges ahead.
Acromioclavicular joint injuries revisited: Pathoanatomy, pathomechanics, and clinical presentation
Authors: Kibler W Ben , Sciascia Aaron
Published: September 2022

Multiple papers have described aspects of treatment of acromioclavicular (AC) joint injuries. Most have emphasized aspects of surgical treatment, and some papers have addressed non-operative treatment. Few papers have highlighted the specific pathoanatomy of an AC joint injury or have described methods of evaluating the 3-dimensional pathomechanics resulting from the pathoanatomical injury. This paper is based on 3 observations: (1) AC joint injuries exist and present on a spectrum of pathoanatomy; (2) The effect of the pathoanatomy on normal AC joint mechanics to produce pathomechanics is dependent on the extent of the pathoanatomy; and (3) Treatment protocols should be developed to address the specific pathoanatomy to optimize the mechanics. A comprehensive clinical approach emphasizing the evaluation of the extent of the anatomic injury and understanding its mechanical consequences regarding shoulder and arm function is a key in the development of guidelines for developing operative or non-operative treatment protocols and for establishing outcomes of the treatment protocols.
Effects of immersive virtual nature on nature connectedness: A systematic review protocol
Authors: Brambilla Elena , Petersen Evi , Stendal Karen , Sundling Vibeke , MacIntyre Tadhg E , Calogiuri Giovanna
Published: September 2022

Objective

Nature Connectedness, an individual’s cognitive, affective, and behavioral connection with the natural world, has been linked to various health and well-being outcomes. As Nature Connectedness can be elicited and strengthened through direct contact with nature, in the past decade studies have investigated whether similar effects can be achieved through technologies that simulate highly immersive and realistic experiences of nature, such as Immersive Virtual Nature. This protocol describes the methodology for a systematic review that will summarize the existing evidence on the effects of Immersive Virtual Nature on Nature Connectedness in non-clinical populations.

Methods

The review will be conducted following the guidelines of Preferred Reporting Items for Systematic Reviews and MetaAnalyses. Terms such as “immersive virtual environment,” “natural setting*,” and “contact with nature” were searched in Scopus, WebOfScience, GoogleScholar, Medline, and GreenFILE (22–28 November 2021). Papers in English, describing experimental studies, with or without control/comparison, and testing the effects of Immersive Virtual Nature interventions on Nature Connectedness outcomes in non-clinical populations were included. The risk of bias will be assessed using Cochrane’s Risk of Bias 2 for randomized studies, and the Risk Of Bias In Non-randomized Studies - of Interventions. The data synthesis will be performed through meta-analysis, assuming that the Cochrane Consumers and Communication Group guidelines are met.

Conclusion

The findings will be relevant for understanding the potential and challenges of Immersive Virtual Nature as a tool to promote health and well-being in the general population, providing information on the consistency and limitations of the existing literature and recommendations for future research.
Novel Insights into the Etiology, Genetics, and Embryology of Hypoplastic Left Heart Syndrome
Authors: Gabriel George C. , Yagi Hisato , Xu Xinxiu , Lo Cecilia W.
Published: September 2022

Hypoplastic left heart syndrome (HLHS) is a relatively rare severe congenital heart defect (CHD) closely linked to other left ventricular outflow tract (LVOT) lesions including bicuspid aortic valve (BAV), one of the most common heart defects. While HLHS, BAV, and other LVOT lesions have a strong genetic underpinning, their genetic etiology remains poorly understood. Findings from a large-scale mouse mutagenesis screen showed HLHS has a multigenic etiology and is genetically heterogenous, explaining difficulties in identifying the genetic causes of HLHS. In Ohia mice, HLHS shows incomplete penetrance. Some mice exhibited small LV with normal aorta, and others a normal LV with hypoplastic aorta, indicating the LV hypoplasia is not hemodynamically driven. In Ohia mutants, HLHS was found to have a digenic modular construction, with mutation in a chromatin modifier causing the small LV phenotype and mutation in Pcdha9 causing the aorta/aortic valve hypoplasia. The Pcdha9 mutation alone can cause BAV, and in the human genome two common deletion copy number variants spanning PCDHA7-10 are associated with BAV. Hence the digenic etiology of HLHS can account for the close association of HLHS, a rare CHD, with BAV, one of the most common CHD. Functional analysis of Ohia HLHS heart tissue showed severe mitochondrial dysfunction in the small LV, while the normal size RV is also affected but milder, suggesting possible role in vulnerability of surgically palliated HLHS patients to heart failure. These findings suggest insights into the genetics of HLHS may yield new therapies for improving outcome for patients with HLHS.
Hypoplastic Left Ventricle: Hypoplastic Left Heart Complex
Authors: Tchervenkov Christo I. , Tang Richard , Jacobs Jeffrey P.
Published: September 2022

Hypoplastic left heart syndrome (HLHS) without intrinsic valvar stenosis or atresia is synonymous with the term hypoplastic left heart complex (HLHC) and is defined as a cardiac malformation at the milder end of the spectrum of HLHS with normally aligned great arteries without a common atrioventricular junction, characterized by underdevelopment of the left heart with significant hypoplasia of the left ventricle and hypoplasia of the aortic or mitral valve, or both valves, in the absence of intrinsic valvar stenosis or atresia, and with hypoplasia of the ascending aorta and aortic arch. This article describes the definitions, nomenclature, and classification of HLHC; the indications and contraindications for biventricular repair of HLHC; the surgical treatment of HLHC; and the associated outcomes.
Moderators of the Association Between Co-Rumination and Depressive Symptoms in Emerging Adult Friendships
Authors: Hazel Lori , Barker Erin T , De France Kalee , Stack Dale M
Published: September 2022

Co-rumination, or perseverating about problems aloud with another individual, is an emotion regulation strategy enacted within relationships. Despite its association with depressive symptoms, co-rumination may benefit friendships. For example, the independent emotion regulation tendencies of each individual in the dyad may interact with co-rumination to exacerbate or protect against its negative effects on depressive experiences. This interaction might be particularly important during the transition from late adolescence to young adulthood when friendships are in flux and emotion regulation capacity is increasing. Therefore, the current study assessed whether emerging adult friends’ tendencies to enact rumination and reappraisal moderated the association between co-rumination and depressive symptoms. Path analyses revealed that the extent to which a co-ruminating individuals experienced depressive symptoms depended on the extent to which their friend reappraised: a positive, linear association between co-rumination and depressive symptoms emerged only for target participants whose friend was low in reappraisal use.
Open Debridement Alone Versus Open Debridement With Tendon Repair for Lateral Epicondylitis: A Comparison of Complications and 5-Year Reoperation Rates From a Large Insurance Database
Authors: Moran Jay , Gillinov Stephen M. , Schneble Christopher A. , Jimenez Andrew E. , Vaswani Ravi , Mathew Joshua I. , Manzi Joseph E. , Nicholson Allen D. , Blaine Theodore A. , Altchek David W. , Gulotta Lawrence V. , Dines Joshua S.
Published: September 2022

Background:

Open debridement (OD) of the extensor carpi radialis brevis tendon, both with and without repair to the lateral epicondyle, are effective treatments for recalcitrant lateral epicondylitis. However, few comparative studies exist within the literature.

Purpose:

To (1) compare the 5-year reoperation rates of patients who underwent OD alone versus OD with tendon repair (ODR) and (2) identify the 90-day adverse event rates, total same-day reimbursement amounts, and national usage trends for these 2 procedures from 2010 to 2019.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The PearlDiver MUExtr database was reviewed for patients diagnosed with lateral epicondylitis who underwent OD alone and ODR or reattachment between January 2010 and December 2019. These patients were stratified into 2 cohorts: the OD cohort and ODR cohort. The 5-year reoperation rates were assessed and compared, and the incidence of 90-day postoperative complications and risk factors were identified. The number of ODs and ODRs performed each year and the mean same-day reimbursement amounts (in US$) for both procedures were assessed.

Results:

Overall, 41,932 lateral epicondylitis patients who underwent debridement were identified, with 17,139 OD patients and 24,793 ODR patients. There were no significant changes in the proportion of OD versus ODR procedures performed during the study period ( P = .18). A significantly higher incidence of hematoma was seen after OD compared with ODR (0.19% vs 0.12%; P = .04), but ODR had a significantly lower 5-year reoperation rate than OD (2.8% vs 3.9%; P = .006), with an absolute risk reduction of 1.1% and a number needed to treat of 91. Finally, ODR ($1683.17 ± $12.15) had a higher mean same-day reimbursement than OD ($1479.05 ± $15.78) ( P = .001).

Conclusion:

Both OD and ODR had low complication rates. The 5-year reoperation rates were low for both procedures, but they were significantly higher for OD. Over the 10-year study period, there were no significant changes in the relative percentages of OD versus ODR performed. ODR had a significantly higher mean same-day reimbursement.
Use of Automated Infrared Pupillometry to Predict Delirium in the Intensive Care Unit: A Prospective Observational Study
Authors: Okamoto Saiko , Ishizawa Mihoko , Inoue Satoki , Sakuramoto Hideaki
Published: September 2022

Introduction

Delirium is an acute state of brain dysfunction prevalent among critically ill patients. Disturbances in the sympathetic neurons, including cholinergic neurons, have been reported to cause delirium by upsetting the balance of neurotransmitter synthesis, release, and inactivation. The cholinergic system mediates pupillary constriction as a response to light stimulation, and this reflex can be measured using automated infrared pupillometry (AIP). The relationship between delirium and AIP parameters has been examined. The Confusion Assessment Method for the Intensive Care Unit (CAM ICU) and the Intensive Care Unit Delirium Screening Checklist (ICDSC) are used for assessing delirium. However, that between the ICDSC score and AIP parameters remains unclear.

Objective

To examine the relationship between AIP parameters and the various categories of delirium as defined by the ICDSC score (delirium, subsyndromal delirium, no delirium).

Methods

This prospective observational study included patients aged ≥18 years admitted to the intensive care unit (ICU) from May 2018 to September 2018. ICU patients were classified into delirium, subsyndromal delirium, and no delirium groups according to the ICDSC score during ICU stay. The pupillary light reflex was assessed in both eyes immediately after admission using AIP with a portable infrared pupillometer. Logistic regression analyses were used to estimate the odds ratio to examine the relationship between the severity of delirium as assessed by the ICDSC score and the AIP parameters.

Results

In total 133 patients were included in the study. Based on the ICDSC scores, 41.4% of patients had no delirium, 40.6% had subsyndromal delirium, and 18% had delirium. Dilation velocity (DV) measured by AIP was significantly different among the delirium, subsyndromal delirium, and no delirium groups. Post-hoc comparisons showed that DV was significantly slower in the delirium group than in the no delirium group but was not significantly different between the subsyndromal delirium and no delirium groups. After adjusting for patients’ sex and age at enrollment, DV was shown to be independently associated with delirium.

Conclusion

This study suggests that the use of AIP at ICU admission may improve the identification of patients at a high risk of developing delirium.
Migraine phenotype differentially modulates the attentional network: A cross sectional observation study
Authors: Bonsu Angela N , Britton Zelie , Asif Zara , Sharif Mishaal , Kaski Diego , Kheradmand Amir , Bronstein Adolfo M , Arshad Qadeer
Published: September 2022

Background:

Signs of distinct brain dysfunction in patients where migraine intersects with vertigo (i.e. vestibular migraine (VM)), remain elusive. As migraine and vertigo can both independently modulate attentional processes, here we seek the utility of the attentional network to functionally differentiate patients.

Methods:

We used the Attentional Network Task (ANT) to elucidate three separate functional networks: Alerting, orienting and resolving conflict. 120 participants had to attend to the direction of a target visual stimulus, while other parameters were simultaneously manipulated. Reaction times across the networks were assessed in, (i) 30 healthy controls, (ii) 30 VM patients, (iii) 30 patients with migraine without vertigo, and (iv) 30 patients with benign paroxysmal positional vertigo (BPPV) but no migraine.

Results:

Patients with VM (mean = 737.1 ms, SEM = 28), migraine (mean = 735.3 ms, SEM = 36.4), and BPPV (mean = 720.3 ms SEM = 24.3) all exhibited significantly delayed ANT reaction times compared to healthy controls (mean = 661.3 ms, SEM = 23.4). Specific attentional network deficits were observed for resolving conflict in VM, alerting in migraine and orienting in BPPV.

Conclusion:

VM patients displayed deficits in executive function characterized by an inability to focus attentional resources and suppress peripheral distractors, whereas migraineurs without vertigo exhibited changes in the alerting network that reflects hypervigilance.
Perioperative diagnosis and impact of acquired von Willebrand syndrome in infants with congenital heart disease
Authors: Icheva Vanya , Ebert Johanna , Budde Ulrich , Wiegand Gesa , Schober Sarah , Engel Juliane , Kumpf Matthias , Jaschonek Karl , Neunhoeffer Felix , Michel Jörg , Schlensak Christian , Hofbeck Michael , Magunia Harry
Published: September 2022

Acquired von Willebrand syndrome (aVWS) has been reported in patients with congenital heart diseases associated with shear stress caused by significant blood flow gradients. Its etiology and impact on intraoperative bleeding during pediatric cardiac surgery have not been systematically studied. This single-center, prospective, observational study investigated appropriate diagnostic tools of aVWS compared with multimer analysis as diagnostic criterion standard and aimed to clarify the role of aVWS in intraoperative hemorrhage. A total of 65 newborns and infants aged 0 to 12 months scheduled for cardiac surgery at our tertiary referral center from March 2018 to July 2019 were included in the analysis. The glycoprotein Ib M assay (GPIbM)/von Willebrand factor antigen (VWF:Ag) ratio provided the best predictability of aVWS (area under the receiver operating characteristic curve [AUC], 0.81 [95% CI, 0.75-0.86]), followed by VWF collagen binding assay/VWF:Ag ratio (AUC, 0.70 [0.63-0.77]) and peak systolic echocardiographic gradients (AUC, 0.69 [0.62-0.76]). A cutoff value of 0.83 was proposed for the GPIbM/VWF:Ag ratio. Intraoperative high-molecular-weight multimer ratios were inversely correlated with cardiopulmonary bypass (CPB) time (r = −0.57) and aortic cross-clamp time (r = −0.54). Patients with intraoperative aVWS received significantly more fresh frozen plasma (P = .016) and fibrinogen concentrate (P = .011) than those without. The amounts of other administered blood components and chest closure times did not differ significantly. CPB appears to trigger aVWS in pediatric cardiac surgery. The GPIbM/VWF:Ag ratio is a reliable test that can be included in routine intraoperative laboratory workup. Our data provide the basis for further studies in larger patient cohorts to achieve definitive clarification of the effects of aVWS and its potential treatment on intraoperative bleeding.
Uncoupling of platelet granule release and integrin activation suggests GPIIb/IIIa as a therapeutic target in COVID-19
Authors: Weiss Lukas J. , Drayss Maria , Manukjan Georgi , Zeitlhöfler Maximilian , Kleiss Judith , Weigel Mathis , Herrmann Johannes , Mott Kristina , Beck Sarah , Burkard Philipp , Lâm Thiên-Trí , Althaus Karina , Bakchoul Tamam , Frantz Stefan , Meybohm Patrick , Nieswandt Bernhard , Weismann Dirk , Schulze Harald
Published: September 2022

Thromboembolic events are frequent and life-threating complications of COVID-19 but are also observed in patients with sepsis. Disseminated thrombosis can occur despite anticoagulation, suggesting that platelets play a direct but incompletely understood role. Several studies demonstrated altered platelet function in COVID-19 with some controversial findings, while underlying disease-specific mechanisms remain ill defined. We performed a comprehensive cohort study with 111 patients, comprising 37 with COVID-19, 46 with sepsis, and 28 with infection, compared with control participants. Platelet phenotype and function were assessed under static and flow conditions, revealing unexpected disease-specific differences. From hospital admission onward, platelets in COVID-19 failed to activate the integrin glycoprotein IIb/IIa (GPIIb/IIIa) in response to multiple agonists. Dense granule release was markedly impaired due to virtually missing granules, also demonstrated by whole-mount electron microscopy. By contrast, α-granule marker CD62P exposure was only mildly affected, revealing a subpopulation of PAC-1−/CD62P+ platelets, independently confirmed by automated clustering. This uncoupling of α-granule release was not observed in patients with sepsis, despite a similar disease severity. We found overall unaltered thrombus formation in COVID-19 and sepsis samples under venous shear rates, which was dependent on the presence of tissue factor. Unexpectedly, under arterial shear rates, thrombus formation was virtually abrogated in sepsis, whereas we detected overall normal-sized and stable thrombi in blood from patients with COVID-19. These thrombi were susceptible to subthreshold levels of GPIIb/IIIa blockers, eptifibatide, or tirofiban that had only a minor effect in control participants’ blood. We provide evidence that low-dose GPIIb/IIIa blockade could be a therapeutic approach in COVID-19.
Assessment of the effects of dexmedetomidine on outcomes of traumatic brain injury using propensity score analysis
Authors: Xu Jinbu , Xiao Qing
Published: September 2022

Background

Dexmedetomidine was found to be protective against traumatic brain injury (TBI) in animal studies and safe for use in previous clinical studies, but whether it improves TBI patient survival remains to be determined. We sought to answer this question by analyzing data from the MIMIC clinical database.

Methods

Data for TBI patients from the MIMIC III and MIMIC IV databases were extracted and divided into a dexmedetomidine group and a control group. In the former group, dexmedetomidine was used for sedation, while in the latter, it was not used. Parameters including patient age, the Acute Physiology score III, the Glasgow Coma Scale, other sedatives used, and pupillary response within 24 h were employed in propensity score matching to achieve a balance between groups for further analysis. In-hospital survival and 6-month survival were analyzed by Kaplan–Meier survival analysis and compared by log-rank test. Cox regression was used repeatedly for the univariate analysis, the multivariate analysis, the propensity score-matched analysis, and the inverse probability of treatment weighted analysis of survival data. Meanwhile, the influences of hypotension, bradycardia, infection, and seizure on outcome were also analyzed.

Results

Different types of survival analyses demonstrated the same trend. Dexmedetomidine significantly improved TBI patient survival. It caused no more incidents of hypotension, infection, and seizure. Hypotension was not correlated with in-hospital mortality, but was significantly correlated with 6-month mortality.

Conclusions

Dexmedetomidine may improve the survival of TBI patients. It should be used with careful avoidance of hypotension.
Urinary sodium concentration predicts time to major adverse coronary events and all-cause mortality in men with heart failure over a 28–33-year period: a prospective cohort study
Authors: Ganes Anand , Davis Jessica A. , Virtanen Jyrki K. , Voutilainen Ari , Tuomainen Tomi-Pekka , Atherton John J. , Amerena John , Driscoll Andrea , Hare Dave L. , Wittert Gary , Ruusunen Anu , Marx Wolfgang , Mohebbi Mohammadreza , O’Neil Adrienne
Published: September 2022

Background

Lower urinary sodium concentrations (UNa) may be a biomarker for poor prognosis in chronic heart failure (HF). However, no data exist to determine its prognostic association over the long-term. We investigated whether UNa predicted major adverse coronary events (MACE) and all-cause mortality over 28–33 years.

Methods

One hundred and eighty men with chronic HF from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) were included. Baseline data was collected between 1984 and 1989. MACE and all-cause outcomes were obtained using hospital linkage data (1984–2017) with a follow-up of 28–33 years. Cox proportional hazards models were generated using 24-h UNa tertiles at baseline (1 ≤ 173 mmol/day; 2 = 173-229 mmol/day; 3 = 230-491 mmol/day) as a predictor of time-to-MACE outcomes, adjusted for relevant covariates.

Results

Overall, 63% and 83% of participants (n = 114 and n = 150) had a MACE event (median 10 years) and all-cause mortality event (median 19 years), respectively. On multivariable Cox Model, relative to the lowest UNa tertile, no significant difference was noted in MACE outcome for individuals in tertiles 2 and 3 with events rates of 28% (HR:0.72; 95% CI: 0.46–1.12) and 21% (HR 0.79; 95% CI: 0.5–1.25) respectively.. Relative to the lowest UNa tertile, those in tertile 2 and 3 were 39% (HR: 0.61; 95% CIs: 0.41, 0.91) and 10% (HR: 0.90; 95% CIs: 0.62, 1.33) less likely to experience to experience all-cause mortality. The multivariable Cox model had acceptable prediction precision (Harrell's C concordance measure 0.72).

Conclusion

UNa was a significant predictor of all-cause mortality but not MACE outcomes over 28–33 years with 173–229 mmol/day appearing to be the optimal level. UNa may represent an emerging long-term prognostic biomarker that warrants further investigation.
Self-testing for SARS-CoV-2 in São Paulo, Brazil: results of a population-based values and attitudes survey
Authors: Martínez-Pérez Guillermo Z. , Shilton Sonjelle , Saruê Maíra , Cesario Hilton , Banerji Abhik , Batheja Deepshikha , Cunha João Paulo , Baptista Rachel , Schirmer Janine , Ivanova Reipold Eleva , Machado Dias Alvaro
Published: September 2022

Background

Brazil is among the countries in South America where the COVID-19 pandemic has hit the general population hardest. Self-testing for SARS-CoV-2 infection is one of the community-based strategies that could help asymptomatic individuals at-risk of COVID-19, as well as those living in areas that are difficult for health personnel to reach, to know their infectious status and contribute to impeding further transmission of the virus.

Methods

A population-based survey was conducted in November 2021, to assess the acceptability of rapid SARS-CoV-2 antigen self-testing among the population of São Paulo. Survey respondents were approached at more than 400 different street-points that were randomly selected using a five-stage randomization process. A 35-item structured questionnaire was used. Dependent variables for our analyses were the likelihood to use and willingness to pay for self-testing, and the likelihood of taking preventive measures to prevent onward transmission of SARS-CoV-2 following a reactive self-test result. Bivariate and multivariate regression analyses were performed.

Results

Overall, 417 respondents (44.12% female) participated; 19.66% had previously had COVID-19 disease. A minority (9.59%) felt at high-risk of COVID-19. The majority of both females and males (73.91% and 60.09%, respectively) were in favor of the idea of SARS-CoV-2 self-testing. Overall, if self-tests were available, almost half of the sample would be very likely (n = 54, 12.95%) or likely (n = 151, 36.21%) to use one if they felt they needed to. Upon receiving a positive self-test result, the majority of respondents would communicate it (88.49%), request facility-based post-test counseling (98.32%), self-isolate (97.60%), and warn their close contacts (96.64%).

Conclusion

Rapid SARS-CoV-2 antigen self-testing could be an acceptable screening tool in São Paulo. The population would be empowered by having access to a technology that would allow them to test, even if asymptomatic, when traveling, or going to work or school. If there is a surge in the incidence of cases, self-testing could be a good approach for mass case detection by Brazil’s already overstretched Unified Health System.
“Role of kidney function and concentrations of BAFF, sPD-L1 and sCD25 on mortality in hospitalized patients with COVID-19”
Authors: Mansouri Ladan , Sendic Senka , Havervall Sebastian , Thålin Charlotte , Jacobson Stefan H. , Lundahl Joachim
Published: September 2022

Background

Chronic kidney disease (CKD) is a recognized risk factor for severe complications in COVID-19. Our objective was to analyze the association between kidney function / T and B lymphocyte modulatory factors and risk of mortality in COVID-19 patients.

Methods

In-hospital and 30‐day mortality were analyzed in COVID‐19 patients (n = 110). Plasma levels of selected T and B cell modulators were analyzed and correlated to mortality risk. A subgroup of sex- and eGFR-matched COVID-19 patients was compared to CKD patients without infection and healthy subjects.

Results

COVID-19 patients who died in hospital and within 30 days had significantly higher BAFF and sCD25 plasma levels than survivors. In logistic regression models patients with high BAFF, sCD25 and sPD-L1 levels had significantly higher risk of both in-hospital and 30-day mortality while there was no association to eGFR. In the subgroup analysis, a higher level of BAFF, IFN-α, sCD25, sPD-L1 and a lower level of sCD40L was observed in COVID-19 patients compared to the CKD group with corresponding kidney function.

Conclusions

We demonstrate that kidney function and concentrations of BAFF, sCD25 and PD-L1, independent of previously recognized risk factors; age, male gender, and leukocytosis are associated with risk of in-hospital and 30-day mortality in patients with COVID-19. These data indicate the significance of adaptive immune system modulators in COVID-19 and motivate further analysis to identify new potential prognostic and therapeutic approaches.