bluuebunny/crossref_metadata_2025 huggingface dataset:
The effectiveness of interventions to prevent loneliness and social isolation in the community-dwelling and old population: an overview of systematic reviews and meta-analysis
Authors: Grillich Ludwig , Titscher Viktoria , Klingenstein Pauline , Kostial Eva , Emprechtinger Robert , Klerings Irma , Sommer Isolde , Nikitin Jana , Laireiter Anton-Rupert
Published: March 2023

Background

Loneliness and social isolation have comparable health effects to widely acknowledged and established risk factors. Although old people are particularly affected, the effectiveness of interventions to prevent and/or mitigate social isolation and loneliness in the community-dwelling older adults is unclear. The aim of this review of reviews was to pool the findings of systematic reviews (SRs) addressing the question of effectiveness.

Methods

Ovid MEDLINE®, Health Evidence, Epistemonikos and Global Health (EBSCO) were searched from January 2017 to November 2021. Two reviewers independently assessed each SR in two consecutive steps based on previously defined eligibility criteria and appraised the methodological quality using a measurement tool to assess SRs 2, AMSTAR 2. One author extracted data from both SRs and eligible studies; another checked this. We conducted meta-analyses to pool the study results. We report the results of the random-effects and common-effect models.

Results

We identified five SRs containing a total of 30 eligible studies, 16 with a low or moderate risk of bias. Our random-effects meta-analysis indicates an overall SMD effect of 0.63 [95% confidence interval (CI): −0.10 to 1.36] for loneliness and was unable to detect an overall effect of the interventions on social support [SMD: 0.00; 95% CI: −0.11 to 0.12].

Discussion

The results show interventions can potentially reduce loneliness in the non-institutionalized, community-dwelling and older population living at home. As confidence in the evidence is low, rigorous evaluation is recommended.

Registration

International Prospective Register of SRs (PROSPERO): Registration number: CRD42021255625
An improved assembly of the pearl millet reference genome using Oxford Nanopore long reads and optical mapping
Authors: Salson Marine , Orjuela Julie , Mariac Cédric , Zekraouï Leïla , Couderc Marie , Arribat Sandrine , Rodde Nathalie , Faye Adama , Kane Ndjido A , Tranchant-Dubreuil Christine , Vigouroux Yves , Berthouly-Salazar Cécile
Published: March 2023

Pearl millet (Pennisetum glaucum (L.)) R. Br. syn. Cenchrus americanus (L.) Morrone) is an important crop in South Asia and sub-Saharan Africa which contributes to ensuring food security. Its genome has an estimated size of 1.76 Gb and displays a high level of repetitiveness above 80%. A first assembly was previously obtained for the Tift 23D2B1-P1-P5 cultivar genotype using short-read sequencing technologies. This assembly is, however, incomplete and fragmented with around 200 Mb unplaced on chromosomes. We report here an improved quality assembly of the pearl millet Tift 23D2B1-P1-P5 cultivar genotype obtained with an approach combining Oxford Nanopore long reads and Bionano Genomics optical maps. This strategy allowed us to add around 200 Mb at the chromosome-level assembly. Moreover, we strongly improved continuity in the order of the contigs and scaffolds within the chromosomes, particularly in the centromeric regions. Notably, we added more than 100 Mb around the centromeric region on chromosome 7. This new assembly also displayed a higher gene completeness with a complete BUSCO score of 98.4% using the Poales database. This more complete and higher quality assembly of the Tift 23D2B1-P1-P5 genotype now available to the community will help in the development of research on the role of structural variants and more broadly in genomics studies and the breeding of pearl millet.
Genomics, Population Divergence, and Historical Demography of the World's Largest and Endangered Butterfly, The Queen Alexandra's Birdwing
Authors: Reboud Eliette L , Nabholz Benoit , Chevalier Emmanuelle , Tilak Marie-ka , Bito Darren , Condamine Fabien L
Published: March 2023

The world's largest butterfly is the microendemic Papua New Guinean Ornithoptera alexandrae. Despite years of conservation efforts to protect its habitat and breed this up-to-28-cm butterfly, this species still figures as endangered in the IUCN Red List and is only known from two allopatric populations occupying a total of only ∼140 km². Here we aim at assembling reference genomes for this species to investigate its genomic diversity, historical demography and determine whether the population is structured, which could provide guidance for conservation programs attempting to (inter)breed the two populations. Using a combination of long and short DNA reads and RNA sequencing, we assembled six reference genomes of the tribe Troidini, with four annotated genomes of O. alexandrae and two genomes of related species Ornithoptera priamus and Troides oblongomaculatus. We estimated the genomic diversity of the three species, and we proposed scenarios for the historical population demography using two polymorphism-based methods taking into account the characteristics of low-polymorphic invertebrates. Indeed, chromosome-scale assemblies reveal very low levels of nuclear heterozygosity across Troidini, which appears to be exceptionally low for O. alexandrae (lower than 0.01%). Demographic analyses demonstrate low and steadily declining Ne throughout O. alexandrae history, with a divergence into two distinct populations about 10,000 years ago. These results suggest that O. alexandrae distribution has been microendemic for a long time. It should also make local conservation programs aware of the genomic divergence of the two populations, which should not be ignored if any attempt is made to cross the two populations.
The Kaiser’s Silver: German Nationalism and the 1913 Nationalspende for Christian Mission
Authors: Best Jeremy
Published: March 2023

In 1913, in honour of the kaiser’s silver jubilee, a group of secular colonial advocates organized a national fundraising campaign to raise money for Germany’s missionary societies. The nationalist motivations of this campaign ran counter to the theological and ideological self-conception of the missionaries, especially the leadership of Germany’s Protestant missions. Despite the ambivalence of the campaign’s declared beneficiaries, the Nationalspende zum Kaisersjubiläum für die christlichen Missionen in den deutschen Kolonien und Schutzgebieten proved to be a definitive success. Organizers mobilized national sentiment and generated a significant infusion of resources into Germany’s mission movement. The Nationalspende’s ulterior motive, drawing the internationalist and independent missions into a secular, nationalist colonial program, was also successful. In the aftermath of the Nationalspende, Germany’s formerly anti-nationalist Protestant mission movement came under new leadership, which began linking the missions more closely to Germany’s secular colonial movement. This article traces the history of the Nationalspende and places it in the context of competition between secular and religious impulses (and their organizational advocates) within Germany’s colonial movement before the First World War.
The Changing Significance of Nationality for the Protection of Civilians in the Hands of a Party to an International Armed Conflict
Authors: Landefeld Sarina
Published: March 2023

The Fourth Geneva Convention provides the main protection regime for civilians in the hands of a party to an international armed conflict. Yet its application is limited to non-nationals, and conditional upon states’ belligerent and legal relations. This article historicises and problematises the so-called nationality requirement for the treatment and protection of civilians. The significance of nationality for international humanitarian law has changed considerably since the late nineteenth century. The complex delineation of civilian protected persons under the Fourth Geneva Convention was, therefore, not inevitable. The article challenges the common perception of the treaty as a humanitarian achievement designed to safeguard innocent and vulnerable civilians. This detailed study of nationality provides insights into the changing perception of civilians as war victims and the role of international humanitarian law in protecting them.
Does Diagnostic Certainty Matter?: Pain-Related Stigma in Adolescents with Juvenile Idiopathic Arthritis
Authors: Wakefield Emily O , Belamkar Vaishali , Sandoval Ashley , Puhl Rebecca M , Edelheit Barbara , Zempsky William T , Rodrigues Hannah A , Litt Mark D
Published: March 2023

Objectives

Childhood chronic pain conditions are common and vulnerable to stigma. Adolescents with chronic primary pain experience diagnostic uncertainty and describe pain-related stigma experiences across multiple social contexts. Juvenile idiopathic arthritis (JIA) is a childhood autoimmune, inflammatory condition with associated chronic pain, but with well-defined diagnostic criteria. The current study examined pain-related stigma experiences in adolescents with JIA.

Methods

Four focus groups of 3–7 adolescents with JIA (N = 16), ages 12–17 (Mage = 15.42, SD = 1.82), and parents (N = 13) were conducted to examine experiences of, and reaction to, pain-related stigma. Patients were recruited from an outpatient pediatric rheumatology clinic. Focus group length ranged from 28 to 99 minutes long. Two coders used directed content analysis resulting in 82.17% inter-rater level of agreement.

Results

Adolescents with JIA described pain-related stigma experiences predominantly from school teachers and peers, and less from medical providers (e.g., school nurses), and family members after a diagnosis. The primary categories that emerged were (1) Felt Stigma, (2) Internalized Stigma, (3) Anticipatory Stigma/Concealment, and (4) Contributions to Pain-Related Stigma. A common experience of pain-related stigma was the perception by others that the adolescent was too young to have arthritis.

Conclusions

In common with adolescents with unexplained chronic pain, our findings indicate that adolescents with JIA experience pain-related stigma in certain social contexts. Diagnostic certainty may contribute to greater support among medical providers and within families. Future research should investigate the impact of pain-related stigma across childhood pain conditions.
Ezetimibe alleviates acetic acid-induced ulcerative colitis in rats: targeting the Akt/NF-κB/STAT3/CXCL10 signaling axis
Authors: Mostafa Rasha E , Abdel-Rahman Rehab F
Published: March 2023

Objective

Ulcerative colitis (UC) is a relapsing inflammatory health state posing significant worldwide problems. Ezetimibe is a cholesterol-lowering drug having anti-inflammatory and pleiotropic properties.

Methods

Twenty-four rats were classified into four groups (n = 6). Group (I) was considered negative control. Acetic acid (AA) was instilled intrarectally in groups (II–IV). Group (II) was considered UC-control. Groups (III and IV) were orally treated with Ezetimibe (5 and 10 mg/kg/day; 14 days).

Key finding

AA installation resulted in severe macroscopic colonic lesions associated with elevations in the relative colon weight, the wet weight/length ratio and oxidative stress markers in the colorectum tissues. UC-control rats showed significantly elevated colorectal tissue CXCL10 and STAT3 gene expression. Akt, phosphorylated Akt, phosphorylated STAT3, TNF-α, IL-6 and NF-κB were expressively upregulated in the UC-control group. AA installation also resulted in significant histopathological alterations in the colorectum tissues of UC-control rats along with increasing the colorectal tissues’ immunohistochemical iNOS expression. Collectively, these data suggest activation of the Akt/NF-κB/STAT3/CXCL10 signaling axis. Ezetimibe treatment significantly ameliorated all the aforementioned parameters.

Conclusion

This is the first study to elucidate the modulatory actions of Ezetimibe against oxidative stress and inflammation associated with AA-induced UC in rats. Ezetimibe treatment mitigates UC via downregulation of the Akt/NF-κB/STAT3/CXCL10 signaling axis.
Mental health of diplomatic personnel: scoping review
Authors: Brooks S K , Patel D , Greenberg N
Published: March 2023

Background

Diplomatic personnel frequently relocate as part of their roles, requiring them to adapt to various cultural and political conditions; many are also at risk of experiencing trauma from being deployed to high-threat postings. With diplomatic personnel having to balance the usual pressures of their work with the uncertainties of COVID-19 in recent years, it is particularly important now to understand how to protect their mental health.

Aims

To synthesize existing literature on the well-being of diplomatic personnel to improve understanding of how to protect their mental health.

Methods

A scoping review was carried out to explore what is already known about the well-being of staff working in diplomatic roles. Four databases were searched and reference lists, as well as one key journal, were hand-searched.

Results

Fifteen relevant publications were included. There was little consensus as to how the psychological well-being of diplomatic personnel compares to other populations or which factors predict well-being. Diplomats’ psychological responses to traumatic experiences appeared similar to those of other trauma-exposed occupational groups.

Conclusions

Further research is needed to better understand the well-being of diplomatic personnel, particularly those not deployed to high-threat posts.
Inspect: a decision helping tool for in-situ probe selection in D&D activities
Authors: Aspe Frédéric , Houzelot Amaury , Amgarou Khalil , Idoeta Raquel , Herranz Margarita
Published: March 2023

In the context of the INSIDER European project, the suitability of existing methodologies for in-situ measurements under constraint environments in nuclear facilities following a decommissioning and dismantling (D&D) process was analysed. Firstly, an analysis of the different methodologies for in-situ measurements was made along with a study of the different types of constrained environments that could appear in the D&D process as well as their expected level of impact on the measurement methodologies. Based on this analysis, a decision-helping tool for the selection of the suitable in-situ equipment/detector to be used in nuclear facilities for the different phases in any D&D process has been developed, depending on the constrained environment. This tool is named INSPECT, acronym for In-Situ Probe SelECtion Tool. The software is therefore potentially of use to those working in radiological characterization with in-situ instrumentation in any radiological or nuclear D&D process.
CADORmed: a tool for internal dose assessment
Authors: Landry Bernard , Breustedt Bastian , Castellani Carlo Maria , Lopez Maria Antonia , Sierra Inmaculada , Navarro Juan Francisco , Roberts Gareth
Published: March 2023

CADORmed is a free bespoke Excel® tool for committed effective dose assessment using latest dose coefficients from ICRP OIR publications. The field of application of CADORmed is special monitoring, and it is not available for the dose assessment of chronic exposure. Calculations are made according to EURADOS guidelines and principles (EURADOS report 2013-1). The Chi-squared test for the goodness of fit is made with a scattering factor for type A and type B errors according to the EURADOS report. The Intake is calculated with the maximum likelihood method. Measurements that are below the detection limit are incorporated by the use of an allocated value equal to one-half or one-quarter of the detection limit. The Identification of rogue data can easily be achieved. Advanced options may also be used: mixed ingestion and inhalation, mixture of default absorption types, correction for DTPA treatment, calculation with a new intake and adjustment when the date of intake are unknown. The validation of the tool has been included in the work plan of EURADOS WG 7. The validation plan has been defined and the validation tests completed. All changes are traced in a Quality Assurance document.
Radiation monitoring after experimental dirty bomb explosion
Authors: Kozlovska Michaela , Sybkova Hana , Otahal Petr PS
Published: March 2023

Experiments simulating radioactive dirty bomb explosions in an urban area were performed at the National Institute of NBC Protection (SUJCHBO v.v.i.), Czech Republic. A solution containing 99mTc radionuclide was dispersed by an explosion on an open-air model of a square covered with filters. Subsequently, spectra of gamma rays originating in contaminated filters were measured by a hand-held NaI(Tl) spectrometer and laboratory HPGe spectrometers. The ambient dose equivalent rate at measuring vessels was set as well. Self-made standards had been prepared by dripping a defined amount of 99mTc solution uniformly on the filters to set the 99mTc surface contamination of measured samples. The urban area model’s radioactive contamination map was set using previously determined filters’ locations. The defined amount of 99mTc solution was dripped non-homogenously on some filters to estimate the impact of non-homogenous filters’ coverage by radioactive aerosol’ particles.
Intercomparison study of sensitivities from commercial OSL readers and a newly developed OSL reader
Authors: de Lazzari Rodrigo , Souza Edgar H , Zanetti Susan Y , Viana Emilson R , Malthez Anna LMC
Published: March 2023

In this study, we compared the sensitivities of a newly designed OSL system with two commercial systems, performing OSL readouts of Al2O3:C irradiated with doses ranging from mGy to a few Gy. It is our first prototype, and we used a cluster of three blue LEDs (5 W each and approximately wavelength 450 nm) for the optical stimulation in the modes continuous wave (CW-OSL) and pulsed (POSL). The detection window used a bandpass filter, allowing the detection of OSL signal with a wavelength shorter than 360 nm. For detection, we have a photodetector module with a photomultiplier tube. We compared the readouts with commercial readers, respecting each reader’s different characteristics, which present different wavelengths for optical stimuli (blue and green, respectively) in CW-OSL and POSL modes. The obtained results concluded that the developed reader could be applied for OSL readouts of detectors exposed to a few hundred of mGy in POSL mode and high doses (up to a few Gy) in CW-OSL mode.
Radiosurgery dosimetry using CaSO4:Eu OSLD film—a feasibility study
Authors: Gasparian Patricia BR , Malthez Anna LMC , Torquato Michele , Campos Leticia L
Published: March 2023

Recent studies demonstrated that optically stimulated luminescence (OSL) systems allow the evaluation of doses for 2D mapping in a relatively fast and simple way and results show submillimeter resolution. This work presents, for the first time, an optically stimulated luminescence dosemeter (OSLD) in the form of film made with CaSO4:Eu particles embedded in a silicone elastomer matrix. The OSLD film was produced using a low-cost and relatively simple methodology. This film is reusable and the signal can be satisfactorily bleached using blue LEDs. The main dosimetric properties were evaluated using TL/OSL Risø reader with blue stimulation and Hoya U-340 filter. Investigation shows repeatability within 3% when measuring with the same film sample. Regarding the OSLD film homogeneity, nearly 12% sensitivity change was observed within the 5 × 5 cm2 produced film. Additionally, the dose response curve shows linearity from 5 to 25 Gy. Fading of the OSL signal is relatively high, about 50% in the first week and then is stable. Nevertheless, a 3 × 3 cm2 OSLD film was successfully used to map dose distribution in radiosurgery (6 MV photon beam). This work demonstrates the feasibility of 2D dosimetry using reusable OSLD films based on CaSO4:Eu.
Engaging Stakeholders to Adapt an Evidence-Based Family Healthy Weight Program
Authors: Darling Katherine E , Hayes Jacqueline F , Evans E Whitney , Sanchez Irene , Chachra Jessica , Grenga Andrea , Elwy A Rani , Jelalian Elissa
Published: March 2023

Childhood obesity is associated with negative physical and psychosocial outcomes, especially for children from low-income backgrounds. It is critical to adapt evidence-based family healthy weight programs to meet the needs of this population. The Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions was used to describe the process of using qualitative data from community and intervention stakeholders, children with overweight or obesity from low-income backgrounds, and caregivers to guide adaptations to the JOIN for ME pediatric weight management intervention. Qualitative interviews were conducted with key community and intervention stakeholders (e.g., nurse care managers, prior JOIN for ME coaches; N = 21). Focus groups were conducted in both Spanish and English with children with overweight or obesity from low-income backgrounds (N = 35) and caregivers of children with overweight or obesity from low-income backgrounds (N = 71). Qualitative data analysis informed modifications including content adaptations to simplify and tailor materials, contextual adaptations to improve intervention engagement and framing, resource awareness, and modality of delivery, training adaptations, and implementation/scale-up activities to increase connections with community partners. The process of engaging multiple stakeholder perspectives to tailor an existing intervention can provide a model for future researchers to improve the potential disseminability of an intervention.
Urinary L-Type Fatty Acid-Binding Protein Predicts Oxygen Demand of COVID-19 in Initially Mild Cases
Authors: Katagiri Daisuke , Asai Yusuke , Ohmagari Norio , Ishikane Masahiro , Hikida Sayaka , Iwamoto Noriko , Nagashima Maki , Suzuki Minami , Takano Hideki , Takasaki Jin , Hojo Masayuki , Sugiyama Haruhito , Tokunaga Katsushi , Miyashita Yoshihiro , Omata Masao , Ohata Keiichi , Bliden Kevin P. , Tantry Udaya S. , Dahlen Jeffrey R. , Sugaya Takeshi , Gurbel Paul A. , Noiri Eisei
Published: March 2023

IMPORTANCE:

Early detection of illness trajectory in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients is crucial for patients and healthcare workers. An effective, noninvasive approach, with simple measurement for decision-making, is necessary in a pandemic to discriminate between high- and low-risk patients, even though both groups may exhibit mild symptoms in the beginning.

OBJECTIVES:

To predict COVID-19 disease severity within 10 days, distinguishing cases that will progress to moderate or severe versus mild, patient urinary L-type fatty acid-binding protein (L-FABP) was assayed within 4 days of receiving a diagnosis. The study also examined whether L-FABP point of care (POC) test is helpful in risk screening.

DESIGN:

Symptomatic subjects who tested positive for SARS-CoV-2 and were hospitalized were prospectively enrolled at the National Center for Global Health and Medicine (NCGM), Yamanashi Prefectural Central Hospital (YPCH), and Sinai Hospital in Maryland. The outcome of each case was evaluated 7 days after admission and the diagnostic performance of L-FABP was assessed.

SETTING AND PARTICIPANTS:

Subjects were treated for COVID-19 at public healthcare centers in Japan from January 31, 2020, to January 31, 2021, to NCGM, YPCH, and at Sinai Hospital in Baltimore, MD, during the same period.

MAIN OUTCOMES AND MEASURES:

The primary outcome was to determine whether urinary L-FABP within 48 hours of admission can predict the patient’s severity of COVID-19 1 week later. We obtained demographic data, information on clinical symptoms, radiographic images, and laboratory data.

RESULTS:

Diagnostic performance was assessed using receiver operating characteristic analysis. Of the 224 participants in the study, 173 initially had a mild form of COVID-19. The area under the curve (AUC) for a severe outcome was 93.5%. L-FABP POC risk prediction of a severe outcome had an AUC of 88.9%.

CONCLUSIONS AND RELEVANCE:

Urinary L-FABP can predict patient risk of COVID-19 illness severity. L-FABP POC is implementable for patient management. (ClinicalTrials.gov number, NCT04681040).
Dermabrasion Versus Microneedling in Transplantation of Autologous Noncultured Melanocyte–Keratinocyte Cell Suspension in Patients With Vitiligo
Authors: Hasan Mohamed S. , Almohsen Abdelraouf M. , Nasr Muhammad I. , Rageh Mahmoud A.
Published: March 2023

BACKGROUND

Autologous noncultured melanocyte–keratinocyte transplantation is one of the procedures used to treat stable vitiligo with varying reported results. Recipient site preparation is one of the variables that could affect repigmentation outcomes.

OBJECTIVE

To assess the effectiveness of transplanting autologous melanocyte–keratinocyte suspension in patients with stable vitiligo and to compare recipient site preparation using dermabrasion versus microneedling.

METHODS

From March 2020 to September 2022, this randomized comparative study included 40 patients with 40 stable vitiligo lesions managed by suspension transplants of melanocytes. Patients were divided into 2 groups: group A, where the recipient site was prepared using dermabrasion, and group B, which was done by microneedling. The assessment was performed 3 months after the treatment based on the degree of repigmentation (excellent, ≥90%; good, 50%–89%; fair, 20%–49%; and poor response, <20%).

RESULTS

Both modalities resulted in effective repigmentation, but the dermabrasion group showed a statistically significant improvement and a satisfactory repigmentation rate.

CONCLUSION

Autologous melanocyte transplantation is a safe and effective treatment method for stable vitiligo lesions that have not responded to other therapies. When compared with microneedling, dermabrasion produced better outcomes for recipient site preparation.
Benefits of Cardiac Rehabilitation in Cardio-Renal Patients With Heart Failure With Reduced Ejection Fraction
Authors: Mroué Ahmad , Roueff Stéphane , Vanorio-Vega Isabella , Lazareth Hélène , Kovalska Oksana , Flahault Adrien , Tuppin Philippe , Thervet Eric , Iliou Marie-Christine
Published: March 2023

Purpose:

Chronic kidney disease (CKD) is common in heart failure (HF). Chronic kidney disease often worsens the prognosis and impairs the management of patients with HF. Chronic kidney disease is frequently accompanied by sarcopenia, which limits the benefits of cardiac rehabilitation (CR). The aim of this study was to evaluate the impact of CR on cardiorespiratory fitness in HF patients with reduced ejection fraction (HFrEF) according to the CKD stage.

Methods:

We conducted a retrospective study including 567 consecutive patients with HFrEF, who underwent a 4-wk CR program, and who were evaluated by cardiorespiratory exercise test before and after the program. Patients were stratified according to their estimated glomerular filtration rate (eGFR). We performed multivariate analysis looking for factors associated with an improvement of 10% in peak oxygen uptake (V˙o
2peak).

Results:

Thirty-eight percent of patients had eGFR <60 mL/min/1.73m². With decreasing eGFR, we observed deterioration in V˙o
2peak, first ventilatory threshold (VT1) and workload and an increase in brain natriuretic peptide levels at baseline. After CR, there was an improvement in V˙O
2peak (15.3 vs 17.8 mL/kg/min, P < .001), VT1 (10.5 vs 12.4 mL/kg/min, P < .001), workload (77 vs 94 W, P < .001), and brain natriuretic peptide (688 vs 488 pg/mL, P < .001). These improvements were statistically significant for all stages of CKD. In a multivariate analysis predicting factors associated with V˙o
2peak improvement, renal function did not interfere with results.

Conclusions:

Cardiac rehabilitation is beneficial in patients with HFrEF with CKD regardless of CKD stage. The presence of CKD should not prevent the prescription of CR in patients with HFrEF.
VALSALVA RETINOPATHY
Authors: Rohowetz Landon J. , Patel Veshesh , Sridhar Jayanth , Yannuzzi Nicolas A.
Published: March 2023

Purpose:

To report the clinical presentation and outcomes in patients with Valsalva retinopathy.

Methods:

This was a retrospective case series of patients diagnosed with Valsalva retinopathy between June 1, 2010, and May 31, 2020. Clinical notes, operative reports, fundus photography, and optical coherence tomography images were reviewed.

Results:

This study comprised 58 eyes of 58 patients. The most common causes were lifting (34.4%), vomiting (20.6%), straining (20.6%), and coughing (17.2%). Mean best-corrected visual acuity at diagnosis was 20/163. The most frequently involved vitreoretinal compartment was the subhyaloid space (42.3%) followed by the intraretinal (32.7%), intravitreal (23.1%), and subretinal (13.4%) spaces. Mean best-corrected visual acuity of all patients was 20/59 at 3 months, 20/48 at 6 months, and 20/22 at 1 year. Mean time to clearance of hemorrhage on clinical examination was 99.0 ± 18.7 days in patients who underwent observation and 4.5 ± 3.5 days after surgery in patients who received pars plana vitrectomy.

Conclusion:

Valsalva retinopathy is generally associated with a favorable visual prognosis. Most eyes perform well with observation although pars plana vitrectomy may be indicated in patients requiring rapid resolution of hemorrhage.
Predictability of the Phenylephrine Test in Congenital Ptosis: Ten Years of Experience
Authors: Akella Sruti S. , Srivatsan Sudarshan , Kravets Sasha , Setabutr Pete
Published: March 2023

Purpose:

To assess the predictability of phenylephrine testing for congenital ptosis and review outcomes of Müller’s Muscle-conjunctival resection (MMCR) for congenital ptosis across ten years of follow-up.

Methods:

In this retrospective case series, all patients who underwent MMCR for congenital ptosis at a single institution between 2010 and 2020 were identified. Exclusion criteria included patients who had not undergone preoperative testing with 2.5% phenylephrine in the superior fornix; patients who underwent revision surgery; and patients who had a broken suture in the early postoperative period. Demographics, margin-reflex distance 1 (MRD1) values pre- and postphenylephrine, millimeters of tissue resected intraoperatively, and final postoperative MRD1 were recorded.

Results:

A total of 28 patients were included; 19 patients received MMCR and 9 patients received a combined MMCR plus tarsectomy. The amount of tissue resected ranged from 5 to 11 mm. There was no significant difference between median postphenylephrine MRD1 and median final postoperative MRD1 in either surgical group. Neither patient age nor levator function was significantly associated with a change in MRD1 in either group. The addition of a tarsectomy had no bearing on the final MRD1 value.

Conclusions:

MMCR is a viable option for patients with congenital ptosis and moderate levator function with a response to phenylephrine. In these patients, MRD1 after 2.5% phenylephrine testing correlates to the final postoperative MRD1 outcome within 0.5 mm.
Pruritic eruptions in older adults: characterization of a patch test negative cohort
Authors: Sreekantaswamy Shreya , Tully Janell , Botto Nina , Woodruff Carina , Butler Daniel
Published: March 2023

Workup for chronic itch in older adults varies significantly across practices. Patch testing remains an important piece of the workup for chronic pruritic rashes in this population, however, there remains a subset of these patients who test negative. This descriptive study sought to better characterize shared clinical and histopathologic features of patch negative older adults to improve understanding of contributing etiologies for itch in this group.
Evidence-Based Performance Indicators of Positive Inpatient Experiences
Authors: Kemp Elyria , Trivitt Julie , Davis Cassandra
Published: March 2023

Goal:

Patient experiences affect the competitiveness and financial viability of a hospital. The purpose of this research was to ascertain the factors that contribute to positive inpatient experiences by using empirical evidence from national databases and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data.

Methods:

Data were assembled from four publicly available U.S. government datasets. The HCAHPS national survey responses (n = 2,472) were based on four consecutive quarters of patient surveys. Measures of clinical complications obtained from the Centers for Medicare & Medicaid Services were used to assess hospital quality. Social determinants of health were incorporated into the analysis by including data from the Social Vulnerability Index as well as zip code–level information from the Office of Policy Development and Research.

Principal Findings:

The study results show that hospital quietness, nurse communication, and care transition positively affected patient experience ratings and the patient's likelihood to recommend the hospital. In addition, findings show that hospital cleanliness positively influenced patient experience ratings. However, hospital cleanliness had little impact on the likelihood of a patient's recommending the hospital, and staff responsiveness had a negligible impact on both patient experience ratings and the likelihood to recommend the hospital. The results also revealed that hospitals with better clinical outcomes received better patient experience ratings and recommendation scores, whereas hospitals that serve more vulnerable populations received worse patient experience ratings and recommendation scores.

Practical Applications:

Findings from this research demonstrate that managing the physical surroundings by providing a clean and quiet environment, providing relationship-centered care through interactions with medical personnel, and working to engage patients in their health as they transition out of care contributed to positive inpatient experiences.
Occupational Risk Factors for SARS-CoV-2 Seropositivity in Healthcare Workers
Authors: Fazen Louis E. , Abad Queenie-Ann , Smith Richard F. , Santiago Romero , Liu Jian , Wisnewski Adam V. , Redlich Carrie A.
Published: March 2023

Objective

The aim of the study is to evaluate COVID-19 risk factors among healthcare workers (HCWs) before vaccine-induced immunity.

Methods

We conducted a longitudinal cohort study of HCWs (N= 1233) with SARS-CoV-2 immunoglobulin G quantification by ELISA and repeated surveys over 9 months. Risk factors were assessed by multivariable-adjusted logistic regression and Cox proportional hazards models.

Results

SARS-CoV-2 immunoglobulin G was associated with work in internal medicine (odds ratio [OR], 2.77; 95% confidence interval [CI], 1.05–8.26) and role of physician-in-training (OR, 2.55; 95% CI, 1.08–6.43), including interns (OR, 4.22; 95% CI, 1.20–14.00) and resident physicians (OR, 3.14; 95% CI, 1.24–8.33). Odds were lower among staff confident in N95 use (OR, 0.55; 95% CI, 0.31–0.96) and decreased over the follow-up.

Conclusions

Excess COVID-19 risk observed among physicians-in-training early in the COVID-19 pandemic was reduced with improved occupational health interventions before vaccinations.
Role of gastric ultrasound to guide enteral nutrition in the critically ill
Authors: Pérez-Calatayud Ángel Augusto , Carillo-Esper Raul
Published: March 2023

Purpose of review

Early initiation of enteral nutrition (EN) is often not feasible due to the high prevalence of gastrointestinal dysfunction that constitutes one of the leading nonavoidable causes for discontinuing or delaying enteral feeding in critically ill. This review summarizes current evidence on the role of gastric ultrasound as a management and monitoring tool for enteral nutrition in critically ill patients.

Recent findings

The ultrasound meal accommodation test, the gastrointestinal and urinary track sonography (GUTS), and other gastric ultrasound protocols used to diagnose and treat gastrointestinal dysfunction in critically ill patients have not changed the outcome. However, this intervention could help clinicians with accurate daily clinical decisions. The dynamic changes in the cross-sectional area (CSA) diameter could help to access gastrointestinal dynamics results immediately, provide a valuable guide to initiate EN, predict feeding intolerance (FI), and aid in following treatment response. More studies are necessary to determine the complete scope and true added clinical value of these tests in critically ill patients.

Using gastric point of care ultrasound (POCUS) is a noninvasive, radiation-free, and inexpensive method. Implementing the ultrasound meal accommodation test in ICU patients might become a step forward to ensure safe early enteral nutrition in critically ill patients.
Physical therapy and nutrition therapy: synergistic, antagonistic, or independent interventions?
Authors: Haines Kimberley J. , Emery Kate L. , Berney Sue C.
Published: March 2023

Purpose of review

Physical therapy and nutrition therapy have predominantly been studied separately in the critically ill, however in clinical practice are often delivered in combination. It is important to understand how these interventions interact. This review will summarize the current science – where they are potentially synergistic, antagonistic, or independent interventions.

Recent findings

Only six studies were identified within the ICU setting that combined physical therapy and nutrition therapy. The majority of these were randomized controlled trials with modest sample sizes. There was an indication of benefit in the preservation of femoral muscle mass and short-term physical quality of life - particularly with high-protein delivery and resistance exercise, in patients who were predominantly mechanically ventilated patients, with an ICU length of stay of approximately 4–7 days (varied across studies). Although these benefits did not extend to other outcomes such as reduced length of ventilation, ICU or hospital admission. No recent trials were identified that combined physical therapy and nutrition therapy in post-ICU settings and is an area that warrants investigation.

The combination of physical therapy and nutrition therapy might be synergistic when evaluated within the ICU setting. However, more careful work is required to understand the physiological challenges in the delivery of these interventions. Combining these interventions in post-ICU settings is currently under-investigated, but may be important to understand any potential benefits to patient longitudinal recovery.
Telemedicine Impact on the Patient–Provider Relationship in Primary Care During the COVID-19 Pandemic
Authors: Andreadis Katerina , Muellers Kimberly , Ancker Jessica S. , Horowitz Carol , Kaushal Rainu , Lin Jenny J.
Published: March 2023

Background:

The COVID-19 pandemic has necessitated a rapid uptake of telemedicine in primary care requiring both patients and providers to learn how to navigate care remotely. This change can impact the patient–provider relationship that often defines care, especially in primary care.

Objective:

This study aims to provide insight into the experiences of patients and providers with telemedicine during the pandemic, and the impact it had on their relationship.

Research Design:

A qualitative study using thematic analysis of semistructured interviews.

Subjects:

Primary care providers (n=21) and adult patients (n=65) with chronic disease across primary care practices in 3 National Patient-centered Clinical Research Network sites in New York City, North Carolina, and Florida.

Measures:

Experiences with telemedicine during the COVID-19 pandemic in primary care. Codes related to the patient–provider relationship were analyzed for this study.

Results:

A recurrent theme was the challenge telemedicine posed on rapport building and alliance. Patients felt that telemedicine affected provider’s attentiveness in varying ways, whereas providers appreciated that telemedicine provided unique insight into patients’ lives and living situations. Finally, both patients and providers described communication challenges.

Conclusions:

Telemedicine has altered structure and process aspects of primary health care such as the physical spaces of encounters, creating a new setting to which both patients and providers must adjust. It is important to recognize the opportunities and limits that this new technology has to help providers maintain the type of one-on-one attention that patients expect and that contributes to relationship building.
Telehealth Use, Care Continuity, and Quality
Authors: Tierney Aaron A. , Payán Denise D. , Brown Timothy T. , Aguilera Adrian , Shortell Stephen M. , Rodriguez Hector P.
Published: March 2023

Background:

Community health centers (CHCs) pivoted to using telehealth to deliver chronic care during the coronavirus COVID-19 pandemic. While care continuity can improve care quality and patients’ experiences, it is unclear whether telehealth supported this relationship.

Objective:

We examine the association of care continuity with diabetes and hypertension care quality in CHCs before and during COVID-19 and the mediating effect of telehealth.

Research Design:

This was a cohort study.

Participants:

Electronic health record data from 166 CHCs with n=20,792 patients with diabetes and/or hypertension with ≥2 encounters/year during 2019 and 2020.

Methods:

Multivariable logistic regression models estimated the association of care continuity (Modified Modified Continuity Index; MMCI) with telehealth use and care processes. Generalized linear regression models estimated the association of MMCI and intermediate outcomes. Formal mediation analyses assessed whether telehealth mediated the association of MMCI with A1c testing during 2020.

Results:

MMCI [2019: odds ratio (OR)=1.98, marginal effect=0.69, z=165.50, P<0.001; 2020: OR=1.50, marginal effect=0.63, z=147.73, P<0.001] and telehealth use (2019: OR=1.50, marginal effect=0.85, z=122.87, P<0.001; 2020: OR=10.00, marginal effect=0.90, z=155.57, P<0.001) were associated with higher odds of A1c testing. MMCI was associated with lower systolic (β=−2.90, P<0.001) and diastolic blood pressure (β=−1.44, P<0.001) in 2020, and lower A1c values (2019: β=−0.57, P=0.007; 2020: β=−0.45, P=0.008) in both years. In 2020, telehealth use mediated 38.7% of the relationship between MMCI and A1c testing.

Conclusions:

Higher care continuity is associated with telehealth use and A1c testing, and lower A1c and blood pressure. Telehealth use mediates the association of care continuity and A1c testing. Care continuity may facilitate telehealth use and resilient performance on process measures.
Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems
Authors: Rodriguez Hector P.
Published: March 2023

Health care organizations and systems can have a large impact on how extensively telemedicine and virtual visits are used by medical practices and individual clinicians. This supplemental issue of medical care aims to advance evidence about how health care organizations and systems can best support telemedicine and virtual visit implementation. This issue includes 10 empirical studies examining the impact of telemedicine on quality of care, utilization, and/or patient care experiences, of which 6 are studies of Kaiser Permanente patients; 3 are studies of Medicaid, Medicare, and community health center patients; and 1 is a study of PCORnet primary care practices. The Kaiser Permanente studies find that ancillary service orders resulting from telemedicine encounters were not placed as often as in-person encounters for urinary tract infections, neck, and back pain, but there were no significant changes in patient fulfillment of ordered antidepressant medications. Studies focused on diabetes care quality among community health center patients and Medicare and Medicaid beneficiaries highlight that telemedicine helped maintain continuity of primary care and diabetes care quality during the COVID-19 pandemic. The research findings collectively demonstrate high variation in telemedicine implementation across systems and the important role that telemedicine had in maintaining the quality of care and utilization for adults with chronic conditions when in-person care was less accessible.
Spillover Effects of Prenatal Care Coordination on Older Siblings Beyond the Mother-Infant Dyad
Authors: Mallinson David C. , Elwert Felix , Ehrenthal Deborah B.
Published: March 2023

Background:

Pregnancy care coordination increases preventive care receipt for mothers and infants. Whether such services affect other family members’ health care is unknown.

Objective:

To estimate the spillover effect of maternal exposure to Wisconsin Medicaid’s Prenatal Care Coordination (PNCC) program during pregnancy with a younger sibling on the preventive care receipt for an older child.

Research Design:

Gain-score regressions—a sibling fixed effects strategy—estimated spillover effects while controlling for unobserved family-level confounders.

Subjects:

Data came from a longitudinal cohort of linked Wisconsin birth records and Medicaid claims. We sampled 21,332 sibling pairs (one older; one younger) who were born during 2008-2015, who were <4 years apart in age, and whose births were Medicaid-covered. In all, 4773 (22.4%) mothers received PNCC during pregnancy with the younger sibling.

Measures:

The exposure was maternal PNCC receipt during pregnancy with the younger sibling (none; any). The outcome was the older sibling’s number of preventive care visits or preventive care services in the younger sibling’s first year of life.

Results:

Overall, maternal exposure to PNCC during pregnancy with the younger sibling did not affect older siblings’ preventive care. However, among siblings who were 3 to <4 years apart in age, there was a positive spillover on the older sibling’s receipt of care by 0.26 visits (95% CI: 0.11, 0.40 visits) and by 0.34 services (95% CI: 0.12, 0.55 services).

Conclusion:

PNCC may only have spillover effects on siblings’ preventive care in selected subpopulations but not in the broader population of Wisconsin families.
Enhanced Identification of Hispanic Ethnicity Using Clinical Data
Authors: Ochoa-Allemant Pedro , Tate Janet P. , Williams Emily C. , Gordon Kirsha S. , Marconi Vincent C. , Bensley Kara M.K. , Rentsch Christopher T. , Wang Karen H. , Taddei Tamar H. , Justice Amy C. ,   for the VA Family of EHR Cohorts (VACo Family)
Published: March 2023

Background:

Collection of accurate Hispanic ethnicity data is critical to evaluate disparities in health and health care. However, this information is often inconsistently recorded in electronic health record (EHR) data.

Objective:

To enhance capture of Hispanic ethnicity in the Veterans Affairs EHR and compare relative disparities in health and health care.

Methods:

We first developed an algorithm based on surname and country of birth. We then determined sensitivity and specificity using self-reported ethnicity from the 2012 Veterans Aging Cohort Study survey as the reference standard and compared this to the research triangle institute race variable from the Medicare administrative data. Finally, we compared demographic characteristics and age-adjusted and sex-adjusted prevalence of conditions in Hispanic patients among different identification methods in the Veterans Affairs EHR 2018-2019.

Results:

Our algorithm yielded higher sensitivity than either EHR-recorded ethnicity or the research triangle institute race variable. In 2018-2019, Hispanic patients identified by the algorithm were more likely to be older, had a race other than White, and foreign born. The prevalence of conditions was similar between EHR and algorithm ethnicity. Hispanic patients had higher prevalence of diabetes, gastric cancer, chronic liver disease, hepatocellular carcinoma, and human immunodeficiency virus than non-Hispanic White patients. Our approach evidenced significant differences in burden of disease among Hispanic subgroups by nativity status and country of birth.

Conclusions:

We developed and validated an algorithm to supplement Hispanic ethnicity information using clinical data in the largest integrated US health care system. Our approach enabled clearer understanding of demographic characteristics and burden of disease in the Hispanic Veteran population.