bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypoalbuminaemia, Not Biologic Exposure, Is Associated with Postoperative Complications in Crohn’s Disease Patients Undergoing Ileocolic Resection
Authors: Shah Ravi S , Bachour Salam , Jia Xue , Holubar Stefan D , Hull Tracy L , Achkar Jean-Paul , Philpott Jessica , Qazi Taha , Rieder Florian , Cohen Benjamin L , Regueiro Miguel D , Lightner Amy L , Click Benjamin H
Published: December 2020

Background

There are limited data on the postoperative outcomes in Crohn’s disease patients exposed to preoperative ustekinumab or vedolizumab. We hypothesised that preoperative biologic use in Crohn’s disease is not associated with postoperative complications after ileocolic resection.

Methods

Crohn’s disease patients who underwent ileocolic resection over 2009–2019 were identified at a large regional health system. Preoperative biologic use within 12 weeks of surgery was categorised as no biologic, anti-tumour necrosis factor, vedolizumab, or ustekinumab. The primary endpoint was 90-day intra-abdominal septic complication. Risk factors included preoperative medical therapies, demographics, disease characteristics, laboratory values, and surgical approach. Regression models assessed the association of biologic use with intra-abdominal septic complication.

Results

A total of 815 Crohn’s disease patients who underwent an ileocolic resection were included [62% no biologic, 31.4% anti-tumour necrosis factor, 3.9% vedolizumab, 2.6% ustekinumab]. Primary anastomosis was performed in 85.9% of patients [side-to-side 48.8%, end-to-side 26%, end-to-end 25%] in primarily a stapled [77.2%] manner. Minimally invasive approach was used in 41.4%. The 90-day postoperative intra-abdominal sepsis rate of 810 patients was 12%, abscess rate was 9.6%, and anastomotic leak rate was 3.2%. Multivariable regression modelling controlling for confounding variables demonstrated that preoperative biologic use with anti-tumour necrosis factor [p = 0.21], vedolizumab [p = 0.17], or ustekinumab [p = 0.52] was not significantly associated with intra-abdominal septic complication. Preoperative albumin < 3.5 g/dl was independently associated with intra-abdominal septic complication (odds ratio [OR] 1.76 [1.03, 3.01]).

Conclusions

In Crohn’s disease patients undergoing ileocolic resection, preoperative biologics are not associated with 90-day postoperative intra-abdominal septic complication. Preoperative biologic exposure should not delay necessary surgery.
Combined aerobic/resistance/inspiratory muscle training as the ‘optimum’ exercise programme for patients with chronic heart failure: ARISTOS-HF randomized clinical trial
Authors: Laoutaris Ioannis D , Piotrowicz Ewa , Kallistratos Manolis S , Dritsas Athanasios , Dimaki Niki , Miliopoulos Dimitris , Andriopoulou Maria , Manolis Athanasios J , Volterrani Maurizio , Piepoli Massimo F , Coats Andrew J S , Adamopoulos Stamatis ,   ARISTOS-HF trial (Aerobic, Resistance, InSpiratory Training OutcomeS in Heart Failure) Investigators
Published: December 2020

Aims

An ‘optimum’ universally agreed exercise programme for heart failure (HF) patients has not been found. ARISTOS-HF randomized clinical trial evaluates whether combined aerobic training (AT)/resistance training (RT)/inspiratory muscle training (IMT) (ARIS) is superior to AT/RT, AT/IMT or AT in improving aerobic capacity, left ventricular dimensions, and secondary functional outcomes.

Methods and results

Eighty-eight patients of New York Heart Association II–III, left ventricular ejection fraction  ≤ 35% were randomized to an ARIS, AT/RT, AT/IMT, or AT group, exercising 3 times/week, 180 min/week for 12 weeks. Pre- and post-training, peakVO2 was evaluated with cardiopulmonary exercise testing, left ventricular dimensions using echocardiography, walking distance with the 6-min walk test (6MWT), quality of life by the Minnesota Living with HF Questionnaire (MLwHFQ), while a programme preference survey (PPS) was used. Seventy-four patients of [mean 95% (confidence interval, CI)] age 66.1 (64.3–67.9) years and peakVO2 17.3 (16.4–18.2) mL/kg/min were finally analysed. Between-group analysis showed a trend for increased peakVO2 (mL/kg/min) [mean contrasts (95% CI)] in the ARIS group [ARIS vs. AT/RT 1.71 (0.163–3.25)(.), vs. AT/IMT 1.50 (0.0152–2.99)(.), vs. AT 1.38 (−0.142 to 2.9)(.)], additional benefits in circulatory power (mL/kg/min⋅mmHg) [ARIS vs. AT/RT 376 (60.7–690)*, vs. AT/IMT 423 (121–725)*, vs. AT 345 (35.4–656)*], left ventricular end-systolic diameter (mm) [ARIS vs. AT/RT −2.11 (−3.65 to (−0.561))*, vs. AT −2.47 (−4.01 to (−0.929))**], 6MWT (m) [ARIS vs. AT/IMT 45.6 (18.3–72.9)**, vs. AT 55.2 (27.6–82.7)****], MLwHFQ [ARIS vs. AT/RT −7.79 (−11 to (−4.62))****, vs. AT −8.96 (−12.1 to (−5.84))****], and in PPS score [mean (95% CI)] [ARIS, 4.8 (4.7–5) vs. AT, 4.4 (4.2–4.7)*] [(.) P ≤ 0.1; *P ≤ 0.05; **P ≤ 0.01; ***P ≤ 0.001; ****P ≤ 0.0001].

Conclusion

ARISTOS-HF trial recommends exercise training for 180 min/week and supports the prescription of the ARIS training regime for HF patients (Clinical Trial Registration: http://www.clinicaltrials.gov. ARISTOS-HF Clinical Trial number, NCT03013270).
Longitudinal Autonomic Nervous System Measures Correlate With Stress and Ulcerative Colitis Disease Activity and Predict Flare
Authors: Hirten Robert P , Danieletto Matteo , Scheel Robert , Shervey Mark , Ji Jiayi , Hu Liangyuan , Sauk Jenny , Chang Lin , Arnrich Bert , Bӧttinger Erwin , Dudley Joel , Keefer Laurie , Sands Bruce E
Published: December 2020

Background

Differences in autonomic nervous system function, measured by heart rate variability (HRV), have been observed between patients with inflammatory bowel disease and healthy control patients and have been associated in cross-sectional studies with systemic inflammation. High HRV has been associated with low stress.

Methods

Patients with ulcerative colitis (UC) were followed for 9 months. Their HRV was measured every 4 weeks using the VitalPatch, and blood was collected at baseline and every 12 weeks assessing cortisol, adrenocorticotropin hormone, interleukin-1β, interleukin-6, tumor necrosis factor-α, and C-reactive protein (CRP). Stool was collected at enrollment and every 6 weeks for fecal calprotectin. Surveys assessing symptoms, stress, resilience, quality of life, anxiety, and depression were longitudinally collected.

Results

Longitudinally evaluated perceived stress was significantly associated with systemic inflammation (CRP, P = 0.03) and UC symptoms (P = 0.02). There was a significant association between HRV and stress (low-frequency to high-frequency power [LFHF], P = 0.04; root mean square of successive differences [RMSSD], P = 0.04). The HRV was associated with UC symptoms (LFHF, P = 0.03), CRP (high frequency, P < 0.001; low frequency, P < 0.001; RMSSD, P < 0.001), and fecal calprotectin (high frequency, P < 0.001; low frequency, P < 0.001; RMSSD, P < 0.001; LFHF, P < 0.001). Significant changes in HRV indices from baseline developed before the identification of a symptomatic or inflammatory flare (P < 0.001).

Conclusions

Longitudinally evaluated HRV was associated with UC symptoms, inflammation, and perceived and physiological measures of stress. Significant changes in HRV were observed before the development of symptomatic or inflammatory flare.
In vitroactivity of the novel antifungal olorofim against dermatophytes and opportunistic moulds includingPenicilliumandTalaromycesspecies
Authors: Singh Ashutosh , Singh Prerna , Meis Jacques F , Chowdhary Anuradha
Published: December 2020

Objectives

Olorofim is a novel antifungal agent with in vitro activity against Aspergillus and other opportunistic moulds. We investigated the in vitro activity of olorofim against a range of filamentous fungi comprising isolates of Aspergillus species, Scedosporium species, Alternaria alternata, dermatophytes, including terbinafine- and multidrug-resistant Trichophyton species, and Penicillium/Talaromyces species originating from patients in North India.

Methods

Antifungal susceptibility of olorofim was tested against 241 mould isolates of Penicillium/Talaromyces species, Trichophyton species, A. fumigatus and cryptic Aspergillus species, Scedosporium species, and Alternaria alternata using CLSI broth microdilution. The comparators were five systemic azoles, amphotericin B, terbinafine, and luliconazole.

Results

Overall, olorofim showed highly potent in vitro activity against dermatophytes and opportunistic moulds (MIC range of 0.004–0.125 mg/L) except for Alternaria alternata. Penicillium, and Talaromyces species and Trichophyton species exhibited a low geometric mean (GM) MIC (GM 0.027 mg/L and 0.015 mg/L, respectively) of olorofim. Importantly, a 2–12 dilution step decrease in in vitro activity of olorofim as compared with azoles was observed against Penicillium and Talaromyces. Notably, olorofim displayed potent in vitro activity against Trichophyton isolates including terbinafine-resistant and azole-resistant Trichophyton mentagrophytes/interdigitale with a modal MIC value of 0.008 mg/L. Further, azole-resistant A. fumigatus isolates harbouring mutations in azole target Cyp51A genes and several cryptic aspergilli displayed low MICs (range 0.004–0.03 mg/L) of olorofim. However, no in vitro activity of olorofim against Alternaria alternata was observed.

Conclusions

The potent in vitro activity of olorofim against drug-resistant dermatophytes and opportunistic moulds is promising, warranting evaluation of the clinical utility of olorofim.
Swayne’s hartebeest (Alcelaphus buselaphus swaynei): home range and activity patterns in Maze National Park, Ethiopia
Authors: Tamrat Misganaw , Atickem Anagaw , Tsegaye Diress , Fashing Peter J , Evangelista Paul , Bekele Afework , Stenseth Nils Chr
Published: December 2020

Home range and activity patterns of animals are important elements for wildlife management and conservation practices. We examined seasonal home range and daily activity patterns of the endangered Swayne’s hartebeest (Alcelaphus buselaphus swaynei) in Maze National Park, Ethiopia. We tracked two groups of Swayne’s hartebeests in open grassland for 1 year. Each group’s daily activities (0700–1900 h) and GPS locations were recorded at 15-min intervals on 5 days every month. Activities were grouped into five behavioral categories: feeding, resting, traveling, vigilance, and other. In addition, we carried out nocturnal monitoring during full moon periods to further document movements patterns. We produced 95% and 50% kernel density estimates (KDE) of home range sizes for each group. Home range estimates did not vary across seasons. Feeding and traveling peaked during the early morning and late afternoon, whereas resting occurred most frequently during the midday hours in both seasons. The proportion of time spent feeding was higher during the dry season, whereas a greater proportion of time was spent resting during the wet season. Vigilance behavior occurred consistently throughout the day during both seasons. Time spent feeding and traveling did not vary significantly between seasons. Activity patterns of Swayne’s hartebeests are strongly influenced both by time of day and season, while home range size is less influenced by seasonality and may instead reflect temporal variation in food availability. Our findings will help to inform management strategies and conserve one of the last two extant populations of Swayne’s hartebeests.
How do institutional changes facilitate university-centric networks in Taiwan? The Triple Helix model of innovation view
Authors: Chang Yuan-Chieh , Chen Po-Hsuan , Teng Min-Jun
Published: December 2020

This article investigates how institutional changes facilitate university-centric interactions from the Triple Helix model of innovation perspective. The Triple Helix research framework consists of three cyclical dimensions, namely government institutional changes, the roles, missions, and interactions of universities, and university-centric networks. By developing a triangulation method, the qualitative dataset of the Taiwanese institutional changes includes science and technology, educational, and industrial policies; the quantitative dataset (1986–2015) collects the patents of Taiwanese universities via the US Patent and Trademark Office database. The results reveal that integrated policies systemically facilitate institutional changes that drive the transition of university’s roles and missions, while the university-centric networks have transformed from isolated to loosely-coupled and ultimately, to densely interactive networks. This article concludes that government institutional changes have effectively transformed the roles and interactions of universities with other actors towards entrepreneurial universities, in turn, have facilitated a more interactive Triple Helix model of innovation in Taiwan. Some policy implications are suggested.
Symptom Management Theory
Authors: Mathew Asha , Doorenbos Ardith Z. , Vincent Catherine
Published: December 2020

A detailed analysis of Symptom Management Theory (SMT) along with its extent of use and implications for adults with cancer as demonstrated in 20 oncology research studies is reported. SMT provides useful guidance for adult oncology research and nursing practice. Theory dimension most researched in cancer was symptom experience. Although theory assertions were demonstrated in 80% of the studies, it was used to an adequate extent only in 35% of them. Comparisons between cancer-related clinical outcomes with and without use of SMT, certain theory modifications, and future SMT-based studies involving longitudinal designs in this population are warranted.
3-Methyladenine-enhanced susceptibility to sorafenib in hepatocellular carcinoma cells by inhibiting autophagy
Authors: Zhao Fangfang , Feng Guohe , Zhu Junyao , Su Zhijun , Guo Ruyi , Liu Jiangfu , Zhang Huatang , Zhai Yongzhen
Published: December 2020

As an effective targeted therapy for advanced hepatocellular carcinoma (HCC), sorafenib resistance has been frequently reported in recent years, with the activation of autophagy by cancer cells under drug stress being one of the crucial reasons. Sorafenib treatment could enhance autophagy in HCC cells and autophagy is also considered as an important mechanisms of drug resistance. Therefore, the inhibition of autophagy is a potential way to improve the sensitivity and eliminate drug resistance to restore their efficacy. To determine whether autophagy is involved in sorafenib resistance and investigate its role in the regulation of HepG2 cells’ (an HCC cell line) chemosensitivity to sorafenib, we simultaneously treated HepG2 with sorafenib and 3-Methyladenine (3-MA) (a common autophagy inhibitor). First, by performing cell counting kit 8 cell viability assay, Hoechst 33342 apoptosis staining, and Annexin V-fluorescein isothiocyanate/propidium iodide apoptosis kit detection, we found that both sorafenib and 3-MA effectively inhibitted the proliferative activity of HepG2 cells and induced their apoptosis to a certain extent. This effect was significantly enhanced after these two drugs were combined, which was also confirmed by the increased expression of apoptosis-related proteins. Subsequently, by using AAV-GFP-LC3 transfection methods and transmission electron microscopy, we found that both the number and activity of autophagosomes in HepG2 cells in sorafenib and 3-MA group were significantly reduced, suggesting that autophagy activity was inhibited, and this result was consistent with the expression results of autophagy-related proteins. Therefore, we conclude that 3-MA may attenuate the acquired drug resistance of sorafenib by counteracting its induction of autophagy activity, thus enhancing its sensitivity to advanced HCC therapy.
PHACOVITRECTOMY VERSUS LENS-SPARING VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT REPAIR ACCORDING TO THE SURGICAL EXPERIENCE
Authors: Kim Min Seok , Woo Se Joon , Park Kyu Hyung
Published: December 2020

Purpose:

To compare the efficacy and safety between lens-sparing vitrectomy and phacovitrectomy for primary rhegmatogenous retinal detachment treatment according to surgical experience.

Methods:

We retrospectively reviewed the medical records of 193 patients with primary rhegmatogenous retinal detachment who underwent either lens-sparing vitrectomy (n = 111) or phacovitrectomy (n = 82). Patients were operated by two experienced surgeons or eight vitreoretinal fellows and had a minimum follow-up of 6 months. Anatomical success rate, postoperative complications, and functional outcomes were compared.

Results:

Primary anatomical success rate was 92.8% (103/111) for lens-sparing vitrectomy and 91.5% (75/82) for phacovitrectomy (P = 0.733). The fellows had lower success rate after phacovitrectomy compared with the experts, but not statistically significant (85% [34/40] vs. 97.6% [41/42], P = 0.054). During phacovitrectomy, one zonulysis case in the experts group and four posterior capsular rupture cases in the fellows group were noted. Cystoid macular edema was found only after phacovitrectomy (12.2% [10/82]), and epiretinal membrane occurred more after phacovitrectomy than after lens-sparing vitrectomy (28% [23/82] vs. 8.1% [9/111], P < 0.001). There was no difference in the occurrence of cystoid macular edema and epiretinal membrane after phacovitrectomy between two surgeon groups (P = 0.514, 0.701, respectively).

Conclusion:

Combined phacoemulsification and vitrectomy has no additional benefit in improving the surgical outcome of primary rhegmatogenous retinal detachment management. Considering the intraoperative and postoperative complications and the relatively low success rate, phacovitrectomy may not be a desirable option in inexperienced surgeons.
MONTHLY INTRAVITREAL INFLIXIMAB IN BEHÇET'S DISEASE ACTIVE POSTERIOR UVEITIS
Authors: Refaat Mohammad , Abdullatif Abdussalam M. , Hamza Mostafa M. , Macky Tamer A. , El-Agha Mohamed-Sameh H. , Ragab Gaafar , Soliman Mahmoud M.
Published: December 2020

Purpose:

To study the safety of extended monthly intravitreal infliximab injections in patients with active posterior uveitis in Behcet's disease.

Methods:

This is a prospective, interventional, noncomparative, open-label, pilot study of 9 monthly intravitreal infliximab injections (1 mg/0.05 mL) for 22 eyes of 16 patients with active posterior uveitis in Behcet's disease. Control of inflammation and visual outcomes were assessed, and ocular complications were monitored during the study period.

Results:

Successful treatment was achieved in 7 eyes (35%), and failure was encountered in 13 eyes (65%). Only seven eyes of six patients (35%) had completed the study and achieved complete resolution of inflammation with improved best-corrected visual acuity and no complications. Failure was either because of inability to control the inflammation in nine eyes (45%) or development of exacerbation of inflammation in four eyes (20%). Four eyes developed severe immunological reaction from the drug after first (n = 1), second (n = 2), and third (n = 1) injections and had to discontinue the injections. Kaplan–Meier survival analysis showed that the mean estimated time to failure was 3.3 ± 0.2 months, and all failed eyes required revision of their systemic immunotherapy to control the ocular inflammation.

Conclusion:

Intravitreal infliximab for active posterior uveitis in Behcet's disease was associated with a high complication rate and failure to control inflammation in most eyes. It should not be considered a substitute to systemic therapy.
BENIGN FOVEAL DEPIGMENTATION: A MULTIMODAL IMAGING INVESTIGATION
Authors: Parodi Maurizio Battaglia , Arrigo Alessandro , Bruschi Elena , Manitto Maria Pia , Martina Elisabetta , Bandello Francesco
Published: December 2020

Purpose:

To describe the multimodal imaging characteristics of benign foveal depigmentation.

Methods:

The study was designed as prospective observational case series. Patients with benign foveal depigmentation were prospectively investigated by means of multimodal imaging, including blue-light and near-infrared fundus autofluorescence, optical coherence tomography (OCT), OCT angiography, color testing, microperimetry, and electrophysiology. The main outcome measures were vessel density and retinal pigment epithelium (RPE)/photoreceptor complex OCT reflectivity.

Results:

Overall, 4 patients were identified, with bilateral and unilateral involvement in 1 case and 3 cases, respectively. Fundus autofluorescence provided variable results, showing more impairment on near-infrared fundus autofluorescence. Structural OCT revealed slight attenuation of the outer retinal bands in the area affected by benign foveal depigmentation, associated with choroidal hypertransmission, whereas enface OCT better delineated the attenuation of the reflectivity signal. The mean reflectivity intensity of RPE/photoreceptor complex was statistically significantly reduced in patients with respect to control subjects in the benign foveal depigmentation area. Optical coherence tomography angiography, color testing, microperimetry, electrooculogram, and electroretinogram findings were normal.

Conclusion:

Benign foveal depigmentation may represent a focal RPE disease. The limited alterations within the RPE band, as visualized on enface OCT and confirmed on near-infrared fundus autofluorescence, suggest an impairment in melanin production or distribution within the RPE cells.
In the time of COVID…
Authors: Taub Leslie-Faith Morritt
Published: December 2020

JAANP Fellow Dr. Leslie-Faith Morritt Taub, NYU Adult-Gerontology Primary Care Program Director, describes the emotional, political, and social impact of COVID-19 on one graduating cohort of nurse practitioner (NP) students at New York University and one incoming cohort of students. Through the lens of a seasoned professor she describes the changes to her teaching methods because she leads these students through the course work and clinical work required to take on the role of the NP in the midst of a global pandemic in the heart of New York City.
Measurement Properties of the Dizziness Handicap Inventory—Children and Adolescents for Children and Adolescents Postconcussion
Authors: Tiwari Devashish , Yorke Amy , Goldberg Allon , Marchetti Gregory F. , Alsalaheen Bara
Published: December 2020

Purpose:

The purpose of this study was to examine and report the construct validity, internal consistency, and item structure of the Dizziness Handicap Inventory—Children and Adolescents (DHI-CA) in postconcussion children and adolescents.

Methods:

A retrospective chart review was conducted for 132 participants. Data were extracted on the DHI-CA, Sports Concussion Assessment Tool-III symptom inventory, and Vestibulo-ocular Motor Screening. The DHI-CA was examined for validity, internal consistency, and factor structure.

Results:

The DHI-CA had fair convergent validity (r
s = 0.30-0.40), but discriminant validity findings were inconclusive. The functional subscale demonstrated least consistent loadings and 4 items had cross-loading. Reliability analysis indicated possible item redundancy given that the overall Cronbach α was higher than the subscales.

Conclusion:

Despite demonstrating convergent validity, structural inconsistencies and possible item redundancy warrant further exploration and restructuring of the DHI-CA. Caution is recommended while making clinical decisions based on the DHI-CA results alone.

Video Abstract:

For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A303.
Test of Infant Motor Performance for Infants in Brazil: Unidimensional Model, Item Difficulty, and Motor Function
Authors: dos Santos Chiquetti Eloá Maria , Valentini Nadia Cristina
Published: December 2020

Background:

There is a need for appropriate tests to identify developmental delays early in life.

Objective:

This study investigates the Test of Infant Motor Performance (TIMP) unidimensional model and its ability to explain variance in items response, hierarchic order of the items, levels of difficulty, and the extent to which the items were appropriate to distinguish different levels of function for infants in Brazil.

Methods:

Six hundred fifty-five infants were assessed. Families provided sociodemographic information.

Results:

Appropriate items reliability (0.99), infit (mean = 0.99; SD = 0.46), outfit (mean = 1.34; SD = 1.58), and point-biserial correlations (−0.36 to 0.92) were obtained. The model explains 74.3% of the variance, and 76.2% of the items had adequate factor relationship.

Conclusion:

The TIMP measures a single construct, has items with different levels of difficulty, and is sensitive to detect differences in the performance of distinct groups for infants in Brazil.
Data-Driven Reopening of Urban Public Education Through Chicago's Tracking of COVID-19 School Transmission
Authors: Fricchione Marielle J. , Seo Jennifer Y. , Arwady M. Allison
Published: December 2020

Reopening in-person education in public schools during the coronavirus 2019 (COVID-19) pandemic requires careful risk-benefit analysis, with no current established metrics. Equity concerns in urban public schools such as decreased enrollment among largely Black and Latinx prekindergarten and special needs public school students already disproportionately impacted by the pandemic itself have added urgency to Chicago Department of Public Health's analysis of COVID-19 transmission. Close tracking within a large school system revealed a lower attack rate for students and staff participating in in-person learning than for the community overall. By combining local data from a large urban private school system with national and international data on maintaining in-person learning during COVID-19 surges, Chicago believes in-person public education poses a low risk of transmission when the operational burden imposed by the second wave has subsided.
Rapid Improvement Project: Improving Caregivers’ Understanding of Safety Recommendations for Neurosurgical Devices
Authors: Anokwute Miracle C. , Seibold Dianne , Jea Andrew , Ackerman Laurie L. , Raskin Jeffrey S.
Published: December 2020

Introduction:

There has been a proliferation in the development of indwelling neuromodulatory devices with varied safety recommendations, making it difficult for providers to remain up-to-date. This deficit presents an opportunity for significant improvement in patient safety.

Methods:

We performed a search for monopolar electrocautery and magnetic resonance imaging safety recommendations for several indwelling neuromodulatory devices. We developed a questionnaire followed by an educational compendium and a posttest for 50 care providers.

Results:

Overall, there was a poor performance on the pretest (mean 39%, SD 19%) but significant improvement on the posttest (mean 71%, SD 16%), P < 0.0001. We placed the educational compendium that included all manufacturer recommendations in the operating room for easy reference. A 2.4 times decrease in the case start times of vagus nerve stimulator cases is evidence of its effectiveness.

Conclusions:

The authors highlight the lack of knowledge about manufacturer safety recommendations for indwelling neurosurgical devices, which led to the creation of operating room supplements and educational devices.
Using Quality Improvement Methodology to Standardize Doppler Acquisition in a Pediatric Cardiology Echocardiography Laboratory
Authors: Hahn Eunice , Taylor Michael , Duncan Nikki , Statile Angela , Brown James , Hill Garick , Statile Christopher
Published: December 2020

Introduction:

In echocardiography, the Doppler principle allows the measurement of tissue velocities. Using the Bernoulli equation, velocities are translated to estimated pressure differences, which dictate the timing of cardiac interventions. Our echocardiography laboratory demonstrated variability in the Doppler interrogation of heart valves, leading to difficulties in comparison over time and study accuracy. To align with previously published quality metrics in echocardiography, our laboratory used quality improvement methodology to achieve measurable improvement in Doppler acquisition.

Methods:

We developed a standardized protocol for Doppler acquisition and translated it to a 20-point scoring system. We established a baseline over 4 months via random assessment of 2 first-time, normal studies per day. Interventions included standardizing the process for acquisition, education, visual tracking, and individual feedback.

Results:

The percentage of studies with a score of 16 or higher preintervention was 17%. The median score was 13.4. In total, we analyzed 407 studies, 173 pre- and 234 postintervention. Over a 4-month intervention period, the median score improved to 18.1, with 85% of studies achieving a score of 16 or higher. Special cause variation occurred after protocol distribution, education, and feedback.

Conclusions:

Our initiative demonstrated significant improvement in the Doppler interrogation of cardiac structures using a measurable scoring system and a concrete goal of incorporating 20 areas of Doppler assessment in normal studies. Our next step is to spread this assessment to abnormal studies, thus developing consistency in evaluating all studies throughout the laboratory.
Constructions of HIV Risk Among a Diverse Sample of HIV-Negative Young Men Who Have Sex With Men Who Are Repeat Testers
Authors: Felner Jennifer K. , Mittal Maria L. , Hoenigl Martin , Amico K. Rivet , Grelotti David J. , Eanes Alex , Hess Kristen , Crawford Jessica , Smith Laramie R.
Published: December 2020

Introduction:

To end the HIV epidemic, HIV prevention and pre-exposure prophylaxis (PrEP) promotion efforts must reach young men who have sex with men (YMSM) at greatest risk for HIV. This study qualitatively explored whether common metrics used by clinicians, scientists, and public health officials to objectively assess HIV risk align with how YMSM conceptualize their risk for HIV and the factors that shape YMSM's risk perceptions.

Methods:

Interviews with a racially/ethnically diverse sample of HIV-negative YMSM (ages 19–24 years, 60% Latinx; n = 20) examined conceptualizations of HIV risk within the context of repeat HIV testing. Iterative, applied thematic analysis examined how participants conceptualized and constructed their HIV risk, and compared participants' descriptions of their risk with a validated quantitative assessment of HIV risk that reliably predicts HIV seroconversion in this group.

Results:

Objective quantitative assessments of HIV risk poorly aligned with participants' perceived HIV risk. Participants described their current risk in relative terms (relative to past risk and relative to friends'/peers' risk) and described age/developmental stage and changes in knowledge about HIV prevention as key factors in risk changes over time. Other factors included substance use and trust/mistrust in sexual partners and scientific advances in HIV prevention (eg, U = U and PrEP). Factors that influenced participants' perceived HIV risk were similar regardless of objective risk assessment.

Conclusions:

Quantitative assessments of risk may poorly align with risk perception among YMSM. Although objective metrics can effectively target YMSM at greatest risk for HIV transmission, interventions to improve prevention behaviors and PrEP uptake may be more effective when tailored to bridge the disconnection between objective HIV risk assessments and YMSM's constructions of risk.
Diagnostic Accuracy of Point-of-care Tests Used to Detect Arterial Disease in Diabetes
Authors: Normahani Pasha , Poushpas Sepideh , Alaa Mays , Bravis Vassiliki , Sounderajah Viknesh , Aslam Mohammed , Jaffer Usman
Published: December 2020

Objective:

We compared the diagnostic performance of a novel point-of-care duplex ultrasound test (podiatry ankle duplex scan; PAD-scan) against commonly used bedside tests for the detection of PAD in diabetes.

Background:

PAD is a major risk factor for diabetic foot ulceration and amputation. Its diagnosis is fundamental though challenging. Although a variety of bedside tests are available, there is no agreement as to which is the most useful. PAD-scan may be advantageous over current tests as it allows for vessel visualization and more accurate arterial waveform assessment. However, its accuracy has not been previously evaluated.

Methods:

From March to October 2019, we recruited 305 patients from 2 diabetic foot clinics. The diagnostic performance of ankle-brachial pressure index, toe-brachial pressure index, transcutaneous pressure of oxygen, pulse palpation, and ankle waveform assessment using PAD-scan and Doppler devices (audible and visual waveform assessment) were assessed. The reference test was a full lower limb duplex ultrasound.

Results:

Based on the reference test, 202 (66.2%) patients had evidence of PAD. PAD-scan had a significantly higher sensitivity [95%, confidence interval (CI) 90%–97%) as compared to all other tests. Particularly low sensitivities were seen with pulse palpation (43%, CI 36%–50%) and transcutaneous pressure of oxygen (31%, CI 24%–38%). PAD-scan had a lower specificity (77%, CI 67%–84%) compared to toe-brachial pressure index (86%, CI 78%–93%; P < 0.001), but not statistically different when compared to all other tests.

Conclusions:

PAD-scan has superior diagnostic utility and is a valid first line investigation.
Simulating Retarded SEIRS model for COVID-19: will the second epidemic happen?
Authors: Mohammad Hamid Pour
Published: December 2020

In this paper, we want to simulate the COVID-19 epidemic according to the Retarded SEIRS model. One of the main questions in the human mind is whether the COVID-19 epidemic will happen again. Therefore, a criterion must be set for the occurrence or non-occurrence of the disease. With the Retarded SEIRS model and this criterion, we can predict whether the Covid-19 will re-emerge. So far, a large number of researches that have been presented in scientific groups or communities have been based on the SIR or SEIR model. But we assume that each recovered individual is immune to the disease for a limited time, and then will be susceptible again. As we know, this assumption was also true for SARS.
Longitudinal variability in mortality predicts Covid-19 deaths
Authors: Lundberg Jon O. , Zeberg Hugo
Published: December 2020

Within Europe, death rates due to covid-19 vary greatly, with some countries being hardly hit while others to date are almost unaffected. It would be of interest to pinpoint the factors that determine a country’s susceptibility to a pandemic such as covid-19.

Here we present data demonstrating that mortality due to covid-19 in a given country could have been largely predicted even before the pandemic hit Europe, simply by looking at longitudinal variability of all-cause mortality rates in the years preceding the current outbreak. The variability in death rates during the influenza seasons of 2015-2019 correlate to excess mortality caused by covid-19 in 2020 (R2=0.48, p<0.0001). In contrast, we found no correlation between such excess mortality and age, population density, degree of urbanization, latitude, GNP, governmental health spendings or rates of influenza vaccinations.

These data may be of some relevance when discussing the effectiveness of acute measures in order to limit the spread of the disease and ultimately deaths. They suggest that in some European countries there is an intrinsic susceptibility to fatal respiratory viral disease including covid-19; a susceptibility that was evident long before the arrival of the current pandemic.
A unified theory for the computational and mechanistic origins of grid cells
Authors: Sorscher Ben , Mel Gabriel C. , Ocko Samuel A. , Giocomo Lisa , Ganguli Surya
Published: December 2020

The discovery of entorhinal grid cells has generated considerable interest in how and why hexagonal firing fields might mechanistically emerge in a generic manner from neural circuits, and what their computational significance might be. Here we forge an intimate link between the computational problem of path-integration and the existence of hexagonal grids, by demonstrating that such grids arise generically in biologically plausible neural networks trained to path integrate. Moreover, we develop a unifying theory for why hexagonal grids are so ubiquitous in path-integrator circuits. Such trained networks also yield powerful mechanistic hypotheses, exhibiting realistic levels of biological variability not captured by hand-designed models. We furthermore develop methods to analyze the connectome and activity maps of our trained networks to elucidate fundamental mechanisms underlying path integration. These methods provide an instructive roadmap to go from connectomic and physiological measurements to conceptual understanding in a manner that might be generalizable to other settings.
Preventing post-surgical cardiac adhesions with a catechol-functionalized oxime hydrogel
Authors: Fujita Masaki , Policastro Gina M. , Burdick Austin , Lam Hillary T. , Ungerleider Jessica , Braden Rebecca L. , Huang Diane , Osborn Kent , Omens Jeffery H. , Madani Michael M. , Christman Karen L.
Published: December 2020

Post-surgical cardiac adhesions represent a significant problem during routine cardiothoracic procedures. This fibrous tissue can impair heart function and inhibit surgical access in reoperation procedures. Here, we propose a novel hydrogel barrier composed of oxime crosslinked poly(ethylene glycol) (PEG) with the inclusion of a catechol (Cat) group to improve retention on the heart for pericardial adhesion prevention. This three component system is comprised of aldehyde (Ald), aminooxy (AO), and Cat functionalized PEG mixed to form the final gel (Ald-AO-Cat). Ald-AO-Cat has favorable mechanical properties, degradation kinetics, and minimal swelling, as well as superior tissue retention compared to an initial Ald-AO gel formulation. We show that the material is cytocompatible, resists cell adhesion, and led to a reduction in the severity of adhesion in anin vivorat model and a pilot porcine study. The Ald-AO-Cat hydrogel barrier may therefore serve as a promising solution for preventing post-surgical cardiac adhesions.
Humans use minimum cost movements in a whole-body task
Authors: Liu Lijia , Ballard Dana , Hayhoe Mary
Published: December 2020

Humans have elegant bodies that allow gymnastics, piano playing, and tool use, but understanding how they do this in detail is difficult because their musculoskeletal systems are extraordinarily complicated. Nonetheless, common movements like walking and reaching can be stereotypical, and a very large number of studies have shown their movement cost a major factor. In contrast, one might think that general movements are very individuated and intractable, but a recent study has shown that in an arbitrary set of whole-body movements used to trace large-scale closed curves, near-identical posture sequences were chosen across different subjects, both in the average trajectories of the body’s limbs and in the variance within trajectories. The commonalities in that result motivate explanations for its generality. One possibility could be that humans also choose trajectories that are economical in energetic cost. To test this hypothesis, we situate the tracing data within a fifty degree of freedom dynamic model of the human skeleton that allows the computation of movement cost. Comparing the model movement cost data from nominal tracings against various perturbed tracings shows that the latter are more energetically expensive, inferring that the original traces were chosen on the basis of minimum cost.
Multiple adjoining word- and face-selective regions in ventral temporal cortex exhibit distinct dynamics
Authors: Boring Matthew J. , Silson Edward H. , Ward Michael J. , Richardson R. Mark , Fiez Julie A. , Baker Chris I. , Ghuman Avniel Singh
Published: December 2020

The map of category-selectivity in human ventral temporal cortex (VTC) provides organizational constraints to models of object recognition. One important principle is lateral-medial response biases to stimuli that are typically viewed in the center or periphery of the visual field. However, little is known about the relative temporal dynamics and location of regions that respond preferentially to stimulus classes that are centrally viewed, like the face- and word-processing networks. Here, word- and face-selective regions within VTC were mapped using intracranial recordings from 36 patients. Partially overlapping, but also anatomically dissociable patches of face- and word-selectivity were found in VTC. In addition to canonical word-selective regions along the left posterior occipitotemporal sulcus, selectivity was also located medial and anterior to face-selective regions on the fusiform gyrus at the group level and within individual subjects. These regions were replicated using 7 Tesla fMRI in healthy subjects. Left hemisphere word-selective regions preceded right hemisphere responses by 125 ms, potentially reflecting the left hemisphere bias for language; with no hemispheric difference in face-selective response latency. Word-selective regions along the posterior fusiform responded first, then spread medially and laterally, then anteriorally. Face-selective responses were first seen in posterior fusiform regions bilaterally, then proceeded anteriorally from there. For both words and faces, the relative delay between regions was longer than would be predicted by purely feedforward models of visual processing. The distinct time-courses of responses across these regions, and between hemispheres, suggest a complex and dynamic functional circuit supports face and word perception.

Significance Statement

Representations of visual objects in the human brain have been shown to be organized by several principles, including whether those objects tend to be viewed centrally or peripherally in the visual field. However, it remains unclear how regions that process objects that are viewed centrally, like words and faces, are organized relative to one another. Here, invasive and non-invasive neuroimaging suggests there is a mosaic of regions in ventral temporal cortex that respond selectively to either words or faces. These regions display differences in the strength and timing of their responses, both within and between brain hemispheres, suggesting they play different roles in perception. These results illuminate extended, bilateral, and dynamic brain pathways that support face perception and reading.
Comparison of everting sutures and the lateral tarsal strip with or without everting sutures for involutional lower eyelid entropion: A meta-analysis
Authors: Hwang Gyudeok , Kim Hyo Sin , Lee Jiyoung , Paik Ji-Sun
Published: December 2020

There are three pathophysiologies of involutional entropion, vertical laxity (VL), horizontal laxity (HL), and overriding of the preseptal orbicularis. The effects of methods to correct VL only, HL only, or both VL and HL in patients with involutional entropion were compared using the published results of randomized controlled trials (RCTs).

To find RCT studies that investigated methods to correct involutional entropion, a systematic search was performed from database inception to April 2020 in the Medline, EMBASE, and Cochrane databases. Two independent researchers conducted the literature selection and data extraction. Evaluation of the quality of the reports was performed using the Cochrane Collaboration tool for assessing the risk of bias (ROB 2.0). The data analysis was conducted according to the PRISMA guidelines using Review Manager 5.3.

Two RCT studies were included in this meta-analysis. Surgery for involutional entropion was performed on a total of 109 eyes. Everting sutures (ES) were used on 57 eyes and lateral tarsal strips (LTS) or combined procedures (LTS + ES) were performed on 52 eyes. At the end of the follow-up periods, involutional entropion recurred in 18 eyes (31.6%) in the ES group and three eyes (5.8%) in the LTS +/- ES group. Analysis of the risk ratio showed that the LTS +/- ES method significantly lowered the recurrence rate compared to using ES only (P = 0.007).

Performing LTS +/- ES effectively lowered the recurrence rate of involutional entropion compared to ES alone. However, some patients cannot tolerate more invasive corrections such as LTS. Therefore, sequential procedures, in which ES is performed first and then when entropion recurs LTS +/- ES is performed, or another methods depending upon the degree of HL may be used.
Female Dispersion Is Necessary, But Not Sufficient, For The Evolution of Monogamy in Mammals
Authors: Dunbar R.I.M.
Published: December 2020

Explanations for the evolution of monogamy in mammals typically emphasise one of two possibilities: monogamy evolves when females are overdispersed (such that males cannot defend more than one female at a time) or when males provide a service to the female. However, the first claim has never been directly tested. I test it directly at three levels using data from primates and ungulates. First, I show that the females of monogamous genera do not have territories that are significantly larger, either absolutely or relatively, than those of polygamous genera. Second, using both the Mitani-Rodman and Lowen-Dunbar inequalities, I show that, given their typical day journey lengths, males of most monogamous species could easily defend an area large enough to allow them to monopolise as many as 5-10 females if these ranged solitarily. Finally, I use a model of male mate searching strategies to show that, unlike the males of socially-living polygamous species, the opportunity cost that monogamous males incur is typically more than five times the reproductive success they have by being obligately monogamous. This suggests that the selection pressure dissuading them from pursuing a roving male strategy must be very considerable.
5-Deoxyadenosine Salvage by Promiscuous Enzyme Activity leads to Bioactive Deoxy-Sugar Synthesis inSynechococcus elongatus
Authors: Rapp Johanna , Rath Pascal , Kilian Joachim , Brilisauer Klaus , Grond Stephanie , Forchhammer Karl
Published: December 2020

7-Deoxysedoheptulose is an unusual deoxy-sugar, which acts as antimetabolite of the shikimate pathway thereby exhibiting antimicrobial and herbicidal activity. It is produced by the unicellular cyanobacteriumSynechococcus elongatusPCC 7942, which has a small, stream-lined genome, assumed to be free from gene clusters for secondary metabolite synthesis. In this study, we identified the pathway for the synthesis of 7-deoxysedoheptulose. It originates from 5-deoxyadenosine, a toxic byproduct of radicalS-adenosylmethionine (SAM) enzymes, present in all domains of life. Thereby we identified a novel 5-deoxyadenosine salvage pathway, which first leads to the synthesis and excretion of 5-deoxyribose and subsequently of 7-deoxysedoheptulose. Remarkably, all reaction steps are conducted by promiscuous enzymes. This is a unique example for the synthesis of a bioactive compound without involving a specific gene cluster. This challenges the view on bioactive molecule synthesis by extending the range of possible compounds beyond the options predicted from secondary metabolite gene clusters.