bluuebunny/crossref_metadata_2025 huggingface dataset:
Asystole episodes and bradycardia in patients with end-stage renal disease
Authors: Rautavaara Joonas , Kerola Tuomas , Kaartinen Kati , Vilpakka Mari , Aitkoski Atte , Anttonen Olli , Ahvonen Jani , Koistinen Juhani , Vääräniemi Kati , Miettinen Marja , Ylitalo Antti , Laine Kaisa , Ojanen Seppo , Nieminen Tuomo
Published: January 2021

Background

Knowledge of arrhythmias in patients with end-stage renal disease (ESRD) is mainly based on ambulatory electrocardiography (ECG) studies and observations during haemodialysis (HD). We used insertable cardiac monitors (ICMs) to define the prevalence of arrhythmias, focusing on bradyarrhythmias, in ESRD patients treated with several dialysis modes including home therapies. Moreover, we assessed whether these arrhythmias were detected in baseline or ambulatory ECG recordings.

Methods

Seventy-one patients with a subcutaneous ICM were followed for up to 3 years. Asystole (≥4.0 s) and bradycardia (heart rate <30 bpm for ≥4 beats) episodes, ventricular tachyarrhythmias and atrial fibrillation (AF) were collected and verified visually. A baseline ECG and a 24- to 48-h ambulatory ECG were recorded at recruitment and once a year thereafter.

Results

At recruitment, 44 patients were treated in in-centre HD, 12 in home HD and 15 in peritoneal dialysis. During a median follow-up of 34.4 months, 18 (25.4%) patients had either an asystolic or a bradycardic episode. The median length of each patient’s longest asystole was 6.6 s and that of a bradycardia 13.5 s. Ventricular tachyarrhythmias were detected in 16 (23%) patients, and AF in 34 (51%) patients. In-centre HD and Type II diabetes were significantly more frequent among those with bradyarrhythmias, whereas no bradyarrhythmias were found in home HD. No bradyarrhythmias were evident in baseline or ambulatory ECG recordings.

Conclusions

Remarkably many patients with ESRD had bradycardia or asystolic episodes, but these arrhythmias were not detected by baseline or ambulatory ECG.
Neuroendocrine cells of the prostate: Histology, biological functions, and molecular mechanisms
Authors: Butler William , Huang Jiaoti
Published: January 2021

Prostate cancer (PCa) is a common cause of cancer-related mortality in men worldwide. Although most men are diagnosed with low grade, indolent tumors that are potentially curable, a significant subset develops advanced disease where hormone therapy is required to target the androgen receptor (AR). Despite its initial effect, hormone therapy eventually fails and the tumor progresses to lethal stages even through continued inhibition of AR. This review article focuses on the role of PCa cellular heterogeneity in therapy resistance and disease progression. Although AR-positive luminal-type cells represent the vast majority of PCa cells, there exists a minor component of AR-negative neuroendocrine (NE) cells that are resistant to hormonal therapy and are enriched by the treatment. In addition, it is now well accepted that a significant subset of hormonally treated tumors recur as small cell neuroendocrine carcinoma (SCNC), further highlighting the importance of targeting NE cells in addition to the more abundant luminal-type cancer cells. Although it has been long recognized that NE cells are present in PCa, their underlying function in benign prostate and molecular mechanisms contributing to PCa progression remains poorly understood. In this article, we review the morphology and function of NE cells in benign prostate and PCa as well as underlying molecular mechanisms. In addition, we review the major reported mechanisms for transformation from common adenocarcinoma histology to the highly lethal SCNC, a significant clinical challenge in the management of advanced PCa.
A Thermodynamic Model for the Subsolidus Evolution and Melting of Peridotite
Authors: Tomlinson Emma L , Holland Tim J B
Published: January 2021

We present a structural update to the thermodynamic model for calculating peridotite phase relations and melt compositions at 0·01 to 60 kbar and from 600 °C to the peridotite liquidus in the system K2O–Na2O–CaO–FeO–MgO–Al2O3–SiO2–TiO2–Fe2O3–Cr2O3 (KNCFMASTOCr), based on the model of Holland et al., 2018 [Melting of Peridotites through to Granites: A Simple Thermodynamic Model in the System KNCFMASHTOCr. Journal of Petrology 59, 881–900]. The new model is better able to predict the phase relations and melting of ultramafic rocks, in particular the abundance of orthopyroxene in the residue and the concentration of silica in the melt. In addition, improvements in modelling Cr-spinels mean that the model is now able to reproduce Cr-content of garnet and spinel above and below the solidus without modification to the knorringite free energy. Model calculations indicate that, for peridotite composition KR4003, the spinel to garnet transition intersects the solidus at 22·1–24·8 kbar and orthopyroxene disappears from the solidus at 29·1 kbar. Below the solidus, the model is able to reproduce the abundances and compositions of phases in experimental studies and natural samples spanning a range of compositions, allowing it to be used for investigating subsolidus equilibration during mantle cooling and pressurisation/decompression. The liquid model provides a good fit to experimental data and is able to replicate the position of the solidus and the composition of both melt and residue at and above the solidus for a range of peridotite compositions. The model may, therefore, be used to investigate fractional mantle melting and basalt generation in modern geodynamic regimes, and also to explore equilibrium mantle melting in the early Earth. The model can also be used to explore liquid and residue compositions for melting of non-pyrolitic mantle, for which there is a paucity of experimental data. We demonstrate the scope of the model using two case studies investigating the subsolidus evolution and melting of a silica-rich cratonic peridotite from the Kaapvaal craton.
DYNAMIN-RELATED PROTEIN DRP1A functions with DRP2B in plant growth, flg22-immune responses, and endocytosis
Authors: Ekanayake Gayani , Smith John M , Jones Kody B , Stiers Hayley M , Robinson Samuel J , LaMontagne Erica D , Kostos Paxton H , Cornish Peter V , Bednarek Sebastian Y , Heese Antje
Published: January 2021

Ligand-induced endocytosis of the immune receptor FLAGELLIN SENSING2 (FLS2) is critical for maintaining its proper abundance in the plasma membrane (PM) to initiate and subsequently down regulate cellular immune responses to bacterial flagellin or flg22-peptide. The molecular components governing PM abundance of FLS2, however, remain mostly unknown. Here, we identified Arabidopsis (Arabidopsis thaliana) DYNAMIN-RELATED PROTEIN1A (DRP1A), a member of a plant-specific family of large dynamin GTPases, as a critical contributor to ligand-induced endocytosis of FLS2 and its physiological roles in flg22-signaling and immunity against Pseudomonas syringae pv. tomato DC3000 bacteria in leaves. Notably, drp1a single mutants displayed similar flg22-defects as those previously reported for mutants in another dynamin-related protein, DRP2B, that was previously shown to colocalize with DRP1A. Our study also uncovered synergistic roles of DRP1A and DRP2B in plant growth and development as drp1a drp2b double mutants exhibited severely stunted roots and cotyledons, as well as defective cell shape, cytokinesis, and seedling lethality. Furthermore, drp1a drp2b double mutants hyperaccumulated FLS2 in the PM prior to flg22-treatment and exhibited a block in ligand-induced endocytosis of FLS2, indicating combinatorial roles for DRP1A and DRP1B in governing PM abundance of FLS2. However, the increased steady-state PM accumulation of FLS2 in drp1a drp2b double mutants did not result in increased flg22 responses. We propose that DRP1A and DRP2B are important for the regulation of PM-associated levels of FLS2 necessary to attain signaling competency to initiate distinct flg22 responses, potentially through modulating the lipid environment in defined PM domains.
‘Bating Filipino’: contactless greeting during the COVID-19 pandemic
Authors: Gopez Jose Ma W , Capulong Harvey Gain M , Galang Joseph Renus F , Gozum Ivan Efreaim A
Published: January 2021

In a recent correspondence, it was explained that cultural values and beliefs must be taken into consideration in flattening the COVID-19 pandemic curve. With this, cultural awareness is suggested as a guide in coming up with more effective health strategies and policies. For this reason, we discussed the intervention made by the Philippine government and how people can make this gesture as a model for other countries in mitigating the spread of the coronavirus.
Sex differences in response to allopurinol and benzbromarone in gout: a retrospective cohort study
Authors: Veenstra Frouwke , Wanten Sophie A C , Verhoef Lise M , ter Stal Minke , Kwok Wing-Yee , van den Hoogen Frank H J , Flendrie Marcel , van Herwaarden Noortje
Published: January 2021

Objective

Owing to lower mean uric acid excretion in women compared with men, uricosuric agents might be preferred in women over xanthine oxidase (XO) inhibitors. We therefore investigated the differences in response to two urate-lowering therapies (ULTs) with different modes of action within and between sexes.

Methods

This retrospective cohort study included patients with a clinical diagnosis of gout who started allopurinol and/or benzbromarone. The successful response to ULT, defined as reaching a serum uric acid (sUA) target of <0.36 mmol/l within 6 months after commencing ULT, was compared between allopurinol and benzbromarone in women and men. Effect modification by sex on differences in response was evaluated.

Results

Allopurinol was started in 255 women and 1045 men, and benzbromarone in 60 women and 205 men. After 6 months, the proportions of women reaching the sUA target were 58.4% and 66.7% for allopurinol and benzbromarone, respectively (difference, −8%; 95% CI: −22%, 5%). The respective proportions in men were 61.0% and 75.6%, respectively (difference, −15%; 95% CI: −21%, −8%). Corrected for confounding, the odds ratio (OR) of reaching the target on benzbromarone vs allopurinol within women was 0.91 (95% CI: 0.47, 1.75), and within men 1.55 (95% CI: 1.04, 2.32). Corrected for confounding, sex was not an effect modifier of the difference in allopurinol and benzbromarone response (OR, 0.59; 95% CI: 0.28, 1.24).

Conclusion

This study did not demonstrate between-sex differences regarding the response to either a uricosuric agent or an XO inhibitor, negating different treatment choices by sex.
Utility of the HandScan in monitoring disease activity and prediction of clinical response in rheumatoid arthritis patients: an explorative study
Authors: Verhoeven Maxime M A , Tekstra Janneke , Marijnissen Anne C A , Meier Anna J L , Westgeest Antonius A A , Lafeber Floris P J G , Jacobs Johannes W G , van Laar Jacob M , Welsing Paco M J
Published: January 2021

Objectives

The aims were to determine the ability of the HandScan [assessing inflammation in hand and wrist joints using optical spectral transmission (OST)] to measure RA disease activity longitudinally, compared with DAS28, and to determine whether short-term (i.e. 1 month) changes in the OST score can predict treatment response at 3 or 6 months.

Methods

Participants visited the outpatient clinic before the start of (additional) RA medication and 1, 3 and 6 months thereafter. Disease activity was monitored at each visit with the HandScan and DAS28 in parallel. A mixed effects model with DAS28 as the outcome variable with a random intercept at patient level, visit month and DAS28 one visit earlier was used to evaluate whether changes in the OST score are related to changes in DAS28. Binary logistic regression was used to test the predictive value of short-term changes in the OST score together with the baseline OST score for achievement of treatment response (EULAR or ACR criteria). All models were adjusted for RA stage (early or established).

Results

In total, 64 RA patients were included. One unit change in OST score was found to be related to an average DAS28 change of 0.03 (95% CI: 0.01, 0.06, P = 0.03). When adding OST score as a variable in the longitudinal model, the ability of the model to estimate DAS28 (i.e. explained variance) increased by 2%, to 59%. Neither baseline OST score nor short-term change in OST score was predictive for treatment response at 3 or 6 months.

Conclusion

A longitudinal association of OST score with DAS28 exists, although explained variance is low. The predictive ability of short-term changes in HandScan for treatment response is limited.
Plasticity of the xylem vulnerability to embolism in Populus tremula x alba relies on pit quantity properties rather than on pit structure
Authors: Lemaire Cédric , Quilichini Yann , Brunel-Michac Nicole , Santini Jérémie , Berti Liliane , Cartailler Julien , Conchon Pierre , Badel Éric , Herbette Stéphane
Published: January 2021

Knowledge on variations of drought resistance traits are needed to predict the potential of trees to acclimate to coming severe drought events. Xylem vulnerability to embolism is a key parameter related to such droughts, and its phenotypic variability relies mainly on environmental plasticity. We investigated the structural determinants controlling the plasticity of vulnerability to embolism, focusing on the key elements involved in the air bubble entry in vessels, especially the intervessel pits. Poplar saplings (Populus tremula x alba (Aiton) Sm., 1804) grown in contrasted water availability or light exposure exhibited differences in the vulnerability to embolism (P50) in a range of 0.76 MPa. We then characterized the structural changes in features related to pit quantity and pit structure, from the pit ultrastructure to the organization of xylem vessels, using different microscopy techniques (transmission electron microscopy, scanning electron microscopy, light microscopy). A multispectral combination of X-ray microtomography and light microscopy analysis allowed measuring the vulnerability of each single vessel and testing some of the relationships between structural traits and vulnerability to embolism inside the xylem. The pit ultrastructure did not change, whereas the vessel dimensions increased with the vulnerability to embolism and the grouping index and fraction of intervessel cell wall both decreased with the vulnerability to embolism. These findings hold when comparing between trees or between the vessels inside the xylem of an individual tree. These results evidenced that plasticity of vulnerability to embolism in hybrid poplar occurs through changes in the pit quantity properties such as pit area and vessel grouping rather than changes on the pit structure.
Is there any association between body mass index and severity of dengue infection?
Authors: Zulkipli Mohd Syis , Rampal Sanjay , Bulgiba Awang , Peramalah Devi , Jamil Nor'Ashikin , See Lucy Lum Chai , Zaki Rafdzah Ahmad , Omar Sharifah Faridah Syed , Dahlui Maznah
Published: January 2021

Background

Dengue, an acute infectious disease caused by a flavivirus, is a threat to global health. There is sparse evidence exploring obesity and the development of more severe dengue cases in adults. With increasing prevalence of obesity in areas with a high risk of dengue infection, obesity may increase the burden and mortality related to dengue infection. Our study aimed to determine the association between obesity and the development of more severe dengue infection in primary healthcare settings and whether these associations were modified by dengue fever phase.

Methods

A cohort study was conducted among laboratory-confirmed dengue patients aged >18 y in the central region of Peninsular Malaysia from May 2016 to November 2017. We collected demographic, clinical history, physical examination and laboratory examination information using a standardized form. Dengue severity (DS) was defined as either dengue with warning signs or severe dengue. Participants underwent daily follow-up, during which we recorded their vital signs, warning signs and full blood count results. Incidence of DS was modeled using mixed-effects logistic regression. Changes in platelet count and hematocrit were modeled using mixed-effects linear regression. The final multivariable models were adjusted for age, gender, ethnicity and previous dengue infection.

Results

A total of 173 patients were enrolled and followed up. The mean body mass index (BMI) was 37.4±13.75 kg/m2. The majority of patients were Malay (65.9%), followed by Chinese (17.3%), Indian (12.7%) and other ethnic groups (4.1%). A total of 90 patients (52.0%) were male while 36 patients (20.8%) had a previous history of dengue infection. BMI was significantly associated with DS (adjusted OR=1.17; 95% CI 1.04 to 1.34) and hematocrit (%) (aβ=0.09; 95% CI 0.01 to 0.16), but not with platelet count (x103/µL) (aβ=−0.01; 95% CI −0.84 to 0.81). In the dose response analysis, we found that as BMI increases, the odds of DS, hematocrit levels and platelet levels increase during the first phase of dengue fever.

Conclusion

Higher BMI and higher hematocrit levels were associated with higher odds of DS. Among those with high BMI, the development of DS was observed during phase one of dengue fever instead of during phase two. These novel results could be used by clinicians to help them risk-stratify dengue patients for closer monitoring and subsequent prevention of severe dengue complications.
Efficacy of PRECICE Nail in Treatment of Adult Patients With Posttraumatic Femoral Leg Length Discrepancy
Authors: Brinker Mark R. , Amirian Aslan , O'Connor Daniel P. , Laughlin Mitzi S.
Published: January 2021

Posttraumatic, limb length discrepancy in adults is a challenge to treat, and multiple treatment protocols over the years have shown varying levels of success and complications. Before the introduction of the PRECICE nail in 2011, our preferred method of limb lengthening used an Ilizarov or Taylor Spatial frame. To assess the PRECICE nail, we evaluated the accuracy and complications during treatment in a series of skeletally mature patients with posttraumatic femoral limb length discrepancy. The surgical technique along with a case series of 8 patients are described in detail. On average, the target lengthening for the PRECICE nail was 44 mm, and all patients achieved lengthening within 2 mm and complete bony consolidation. The only observed complication in our series was a broken screw 1 year after the patient started weight-bearing. The PRECICE nail demonstrated promising results and was useful for bone regeneration and consolidation without the need for additional procedures. The rate of complications was low compared with previous methods, making this device an excellent treatment option.
Prevalence and Factors Associated with Pelvic Girdle Pain During Pregnancy in Australian Women
Authors: Ceprnja Dragana , Chipchase Lucinda , Fahey Paul , Liamputtong Pranee , Gupta Amitabh
Published: January 2021

Study Design.

Cross-sectional study conducted between December 2017 and October 2019.

Objective.

To determine the prevalence and risk factors associated with pregnancy-related pelvic girdle pain (PPGP) in Australia.

Summary of Background Data.

PPGP is a common condition worldwide yet the prevalence and associated risk factors are not known in Australia.

Methods.

A random sample of pregnant women (N = 780) of (mean [SD]) 31 (5) years of age between 14 and 38 weeks gestation attending ante-natal care in a tertiary referral hospital in Sydney, Australia was conducted. The main outcome measure was point-prevalence of PPGP as classified by recommended guidelines including a physical examination. A number of potential risk factors, including socio-demographic characteristics, country of birth, ethnicity, history of low back pain (LBP) and PPGP, family history of PPGP, occupational factors, and physical activity were investigated with logistic regression.

Results.

The point-prevalence of PPGP in a random sample of 780 Australian women was 44% with the odds of having PPGP increasing with each additional week of gestation (odds ratio [OR]) (OR 1.02). Increasing parity (P = 0.03, OR 1.15), country of birth (P = 0.03), and greater duration of time spent standing (P = 0.009, OR 1.06) were associated with PPGP. The strongest predictors of PPGP were previous LBP and/or PPGP both pregnancy (P < 0.001, OR 4.35) and not pregnancy related (P < 0.001, OR 2.24), and a family history of PPGP (P < 0.001, OR 3.76).

Conclusion.

The prevalence of PPGP in Australian women was high with almost half the sample classified with PPGP, matching data reported worldwide. The identified risk factors associated with PPGP can be included in routine ante-natal care to screen women and identify those at risk of this common and disabling condition.

Level of Evidence: 1
Inter-rater Reliability of the Modified Japanese Orthopedic Association Score in Degenerative Cervical Myelopathy
Authors: Martin Allan R. , Jentzsch Thorsten , Wilson Jamie R.F. , Moghaddamjou Ali , Jiang Fan , Rienmueller Anna , Badhiwala Jetan H. , Akbar Muhammad A. , Nater Anick , Oitment Colby , Ganau Mario , Massicotte Eric M. , Fehlings Michael G.
Published: January 2021

Study Design.

Prospective cross-sectional blinded-assessor cohort study.

Objective.

The aim of this study was to determine the inter-rater reliability of the modified Japanese Orthopaedic Association (mJOA) score in a large cohort of degenerative cervical myelopathy (DCM) patients.

Summary of Background Data.

The mJOA score is widely accepted as the primary outcome measure in DCM; it has been utilized in clinical practice guidelines and directly influences treatment recommendations, but its reliability has not been established.

Methods.

A refined version of the mJOA was administered to DCM patients by two or more blinded clinicians. Inter-rater reliability was measured using intraclass correlation coefficient (ICC), agreement, and mean difference for mJOA total score and subscores. Data were also analyzed with analysis of variance for differences by mJOA severity (mild: 15–17, moderate: 12–14, severe: <12), assessor, assessment order, previous surgery, age, and sex.

Results.

One hundred fifty-four DCM patients underwent 322 mJOA assessments (183 paired assessments). ICC was 0.88 for total mJOA, 0.79 for upper extremity (UE) motor, 0.84 for lower extremity (LE) motor, 0.63 for UE sensation, and 0.78 for urinary function subscores. Paired assessments were identical across all four subscores in 25%. The mean difference in mJOA was 0.93 points between assessors, and this differed by severity (mild: 0.68, moderate: 1.24, severe: 0.87, P = 0.001). Differences of ≥ 2 points occurred in 19%. Disagreement between mild and moderate severity occurred in 12% of patients. Other variables did not demonstrate significant relationships with mJOA scores.

Conclusion.

The inter-rater reliability of total mJOA and its subscores is good, except for UE sensory function (moderate). However, the vast majority of assessments differed between observers, indicating that this measure should be interpreted carefully, particularly when near the threshold between severity categories, or when a patient is reassessed for deterioration. Further efforts to educate clinicians on administration and to refine the UE sensory subscore may enhance the reliability of this tool.

Level of Evidence: 1
Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia
Authors: Dupuis Claire , Bouadma Lila , de Montmollin Etienne , Goldgran-Toledano Dany , Schwebel Carole , Reignier Jean , Neuville Mathilde , Ursino Moreno , Siami Shidasp , Ruckly Stéphane , Alberti Corinne , Mourvillier Bruno , Bailly Sébastien , Grapin Kévin , Laurent Virginie , Buetti Niccolo , Gainnier Marc , Souweine Bertrand , Timsit Jean-François
Published: January 2021

Objectives:

About 5% of patients with coronavirus disease-2019 are admitted to the ICU for acute hypoxemic respiratory failure. Opinions differ on whether invasive mechanical ventilation should be used as first-line therapy over noninvasive oxygen support. The aim of the study was to assess the effect of early invasive mechanical ventilation in coronavirus disease-2019 with acute hypoxemic respiratory failure on day-60 mortality.

Design:

Multicenter prospective French observational study.

Setting:

Eleven ICUs of the French OutcomeRea network.

Patients:

Coronavirus disease-2019 patients with acute hypoxemic respiratory failure (Pao
2/Fio
2 ≤ 300 mm Hg), without shock or neurologic failure on ICU admission, and not referred from another ICU or intermediate care unit were included.

Intervention:

We compared day-60 mortality in patients who were on invasive mechanical ventilation within the first 2 calendar days of the ICU stay (early invasive mechanical ventilation group) and those who were not (nonearly invasive mechanical ventilation group). We used a Cox proportional-hazard model weighted by inverse probability of early invasive mechanical ventilation to determine the risk of death at day 60.

Measurement and Main Results:

The 245 patients included had a median (interquartile range) age of 61 years (52–69 yr), a Simplified Acute Physiology Score II score of 34 mm Hg (26–44 mm Hg), and a Pao
2/Fio
2 of 121 mm Hg (90–174 mm Hg). The rates of ICU-acquired pneumonia, bacteremia, and the ICU length of stay were significantly higher in the early (n = 117 [48%]) than in the nonearly invasive mechanical ventilation group (n = 128 [52%]), p < 0.01. Day-60 mortality was 42.7% and 21.9% in the early and nonearly invasive mechanical ventilation groups, respectively. The weighted model showed that early invasive mechanical ventilation increased the risk for day-60 mortality (weighted hazard ratio =1.74; 95% CI, 1.07–2.83, p=0.03).

Conclusions:

In ICU patients admitted with coronavirus disease-2019-induced acute hypoxemic respiratory failure, early invasive mechanical ventilation was associated with an increased risk of day-60 mortality. This result needs to be confirmed.
Alabama Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (AL-SIGHT): Study Design and Methodology
Authors: Rhodes Lindsay A. , Register Shilpa , Asif Irfan , McGwin Gerald , Saaddine Jinan , Nghiem Van Thi Ha , Owsley Cynthia , Girkin Christopher A.
Published: January 2021

Précis:

This paper presents the methods and protocol of a community-based telemedicine program to identify glaucoma and other eye diseases.

Purpose:

To describe the study rationale and design of the Alabama Screening and Intervention for Glaucoma and eye Health through Telemedicine project.

Methods:

The study will implement and evaluate a telemedicine-based detection strategy for glaucoma, diabetic retinopathy, and other eye diseases in at-risk patients seen at federally qualified health centers located in rural Alabama. The study will compare the effectiveness of the remote use of structural and functional ocular imaging devices to an in-person examination. Study participants will receive a remote ocular assessment consisting of visual acuity, intraocular pressure, visual field testing, and imaging of the retina and optic nerve with spectral-domain optical coherence tomography, and the data will be reviewed by an ophthalmologist and optometrist. It will also compare the effectiveness of financial incentives along with a validated patient education program versus a validated patient education program alone in improving follow-up adherence. Finally, cost and cost-effectiveness analyses will be performed on the telemedicine program compared with standard in-person care using effectiveness measured in numbers of detected eye disease cases.

Conclusions:

The study aims to develop a model eye health system using telemedicine to prevent vision loss and address eye health among underserved and at-risk populations.
Oral Versus Long-Acting Injectable Antipsychotic Treatment for People With Severe Schizophrenia
Authors: Fernández-Miranda Juan J. , Díaz-Fernández Silvia , López-Muñoz Francisco
Published: January 2021

The objective here is to compare the effectiveness of long-acting injectable antipsychotics (LAI-APs) and oral ones (OAPs) in patients with severe (Global Clinical Impression–Severity ≥ 5) schizophrenia (N = 688). A 5-year follow-up study has been conducted in patients undergoing standard treatment in mental health units (MHUs) or on a severe mental illness program (SMIP). A total of 8.7% of the patients on the SMIP discontinued treatment, whereas 43.6% did so in MHUs (p < 0.0001). In both cases, treatment retention was significantly higher in patients on LAI-APs (p < 0.001). Also, hospital admissions were in both cases fewer among those on LAI-APs (p < 0.001). There was a significant link between suicide attempts and OAP treatment (p < 0.01). Given the relationship between the use of LAI-APs versus oral treatments in achieving higher adherence and less relapses and suicide attempts, the use of second-generation antipsychotics LAIs should be considered more suitable for people with severe schizophrenia.
Delirium Triage Screen/Brief Confusion Assessment Method in Adult Orthopaedic and Hematological Patients
Authors: Sederstrom Jane R. , Aliory Christine D. , Hanneman Elaine M. , Buras Matthew R.
Published: January 2021

Delirium in the hospitalized orthopaedic patient is associated with numerous negative outcomes. Assessing for the presence of delirium using an accurate and reliable tool is essential. However, the number of validated screening tools is limited. The purpose of this study was to validate and test the reliability of the Delirium Triage Screening and brief Confusion Assessment Method (DTS/bCAM) to screen for delirium in non-intensive care (ICU) orthopaedic and hematological patients. This was a prospective, observational study. Seventy-six delirium assessments were completed on 19 orthopaedic patients and 10 hematological patients. The clinical nurse performed the DTS/bCAM during every 12-hour shift. Within 2 hours of this assessment, a research investigator performed both the DTS/bCAM and the Confusion Assessment Method (CAM). Each patient had a maximum of three assessments by a research investigator. Interrater reliability for the clinical nurse and the researcher was measured through comparison of positive and negative DTS/bCAM results. Validity was measured by comparing the matched DTS/bCAM and CAM results, both performed by the researcher. The DTS/bCAM and CAM results had 100% agreement. Two patients (7%) screened positive for delirium. Sensitivity of the DTS/bCAM was 100% (95% CI [15.8-100]) and specificity was 100% (95% CI [95.1, 100]). There was 86% agreement (43/50) between the clinical nurse and the researcher for the DTS/bCAM. In adult orthopaedic and hematological patients not receiving intensive care, the DTS/bCAM may be a valid, reliable, and rapid screening tool for delirium.
Development and Validity Testing of a Morning Stiffness Assessment Scale for Patients with Rheumatoid Arthritis
Authors: Oh HyunSoo , Bang SuHyang , Im BoAe , Lee SiWon , Seo WhaSook
Published: January 2021

Morning stiffness is known to exert a significant impact on functional ability, quality of life, and employment status. There is an increasing need for a valid, reliable tool to comprehensively assess morning stiffness. The purpose of this study was to develop and verify a Morning Stiffness Assessment Scale. Items were developed on the basis of a framework of the conceptual attributes of morning stiffness. Validity and reliability tests were conducted on the devised scale. Eighty-five patients with rheumatoid arthritis were included to verify the devised scale. A 10-item Morning Stiffness Assessment Scale was developed. Its content and construct validities were well supported. The scale was found to have good reliability. The devised scale is simple and brief, but it provides a more comprehensive means of evaluation for morning stiffness. We believe this scale offers a clinically useful means of properly assessing morning stiffness and has potential utility for evaluating the effects of morning stiffness treatments.
Development and Testing of the Quality of Life Osteoporosis Scale—Nonvertebral Fractures (QoLOS-NVFX)
Authors: Basilici Zannetti Emanuela , D'Angelo Daniela , Cittadini Noemi , Celi Monica , Pennini Annalisa , Rocco Gennaro , Vellone Ercole , Alvaro Rosaria , Tarantino Umberto
Published: January 2021

The aim of this study was developing and testing a new tool for measuring quality of life (QoL) in patients with osteoporosis who had experienced nonvertebral fractures (NVFXs). Two main phases were carried out. First, the tool was developed based on expert opinion through three focus groups. Second, the tool was tested with exploratory factor analysis and confirmatory factor analysis in a sample of 458 postmenopausal women. The reliability of the developed Quality of Life Osteoporosis Scale—Nonvertebral Fractures (QoLOS-NVFX) was measured using Cronbach's α, maximal reliability (MR), composite reliability (CR), and average variance extracted (AVE). The QoLOS-NVFX resulted in a unidimensional scale with 23 items and showed good reliability, with a Cronbach's α of 0.94, an MR of 0.96, a CR of 0.96, and an AVE of 0.70. The QoLOS-NVFX shows good psychometric properties and can be used to assess the impact of NVFX on QoL in osteoporotic women. Furthermore, it can be easily used in clinical practice and research.
Unnatural Deaths of the Elderly Population of Sri Lanka
Authors: Vadysinghe Amal Nishantha , Senasinghe Prabath , Sivasubramanium Murugupillai , Jayasooriya Pemasiri , Premarathna Bhatiya G. , Rathnayake Rathnayake Mudiyanselage Isuri Saumya D. , Wickramasinghe Wickramasinghe Mudiyanselage Medhani Hasanthika P.
Published: January 2021

As people age, they may become more vulnerable to injury because of frailty, ill health, or dependency on others. Data from medicolegal death investigation including autopsy and statements from cases reported to 3 medicolegal units in Sri Lanka were analyzed in this study under the strict ethical framework. Of the study population, 265 were male and 75 were female. Mean age was 71.14 years. Commonest manner of death was accidental (62.1%) followed by suicide (32.1%) and homicide (5.6%). Commonest types of incidents were road traffic accidents (26.5%), falls (22.6%), and poisoning (21.2%). Among the road traffic accidents, pedestrians (77.9%) were the majority. Poisoning (59.6%) was the commonest method of suicide. The commonest weapons used in homicides were blunt weapons (47.3%). Association with alcohol was seen in more than 10% of suicidal and accidental deaths. More attention should be given to the elderly people who are using the roads while developing policies by the state. Furthermore, it is high time to think about psychological aspect in the elderly care management specially alcohol abuse and suicidal ideation among them.
Virologic response of adolescents living with perinatally acquired HIV receiving antiretroviral therapy in the period of early adolescence (10–14 years) in South Africa
Authors: Nyakato Patience , Schomaker Michael , Sipambo Nosisa , Technau Karl-Günter , Fatti Geoffrey , Rabie Helena , Tanser Frank , Eley Brian , Euvrard Jonathan , Wood Robin , Tsondai Priscilla R. , Yiannoutsos Constantin T. , Cornell Morna , Davies Mary-Ann
Published: January 2021

Background and objectives:

Adolescents living with perinatally acquired HIV (ALPHIV) on antiretroviral therapy (ART) have been noted to have poorer adherence, retention and virologic control compared to adolescents with non-perinatally acquired HIV, children or adults. We aimed to describe and examine factors associated with longitudinal virologic response during early adolescence.

Design:

A retrospective cohort study

Methods:

We included ALPHIV who initiated ART before age 9.5 years in South African cohorts of the International epidemiology Database to Evaluate AIDS-Southern Africa (IeDEA-SA) collaboration (2004–2016); with viral load (VL) values <400 copies/ml at age 10 years and at least one VL measurement after age 10 years. We used a log-linear quantile mixed model to assess factors associated with elevated (75th quantile) VLs.

Results:

We included 4396 ALPHIV, 50.7% were male, with median (interquartile range) age at ART start of 6.5 (4.5, 8.1) years. Of these, 74.9% were on a non-nucleoside reverse transcriptase inhibitor (NNRTI) at age 10 years. After adjusting for other patient characteristics, the 75th quantile VLs increased with increasing age being 3.13-fold (95% CI 2.66, 3.68) higher at age 14 versus age 10, were 3.25-fold (95% CI 2.81, 3.75) higher for patients on second-line protease-inhibitor and 1.81-fold for second-line NNRTI-based regimens (versus first-line NNRTI-based regimens). There was no difference by sex.

Conclusions:

As adolescents age between 10 and 14 years, they are increasingly likely to experience higher VL values, particularly if receiving second-line protease inhibitor or NNRTI-based regimens, which warrant adherence support interventions.
An Unusual Case of Esophageal Carcinosarcoma on 18F-FDG PET/CT
Authors: Li Chongjiao , Tian Yueli , Chen Jie , Wen Bing , He Yong
Published: January 2021

Carcinosarcoma of the esophagus is a rare malignant neoplasm. Here, we report a case of esophageal carcinosarcoma with lymphatic and pulmonary metastases on 18F-FDG PET/CT in a 64-year-old woman.
Ectopic Pancreatitis in the Gastric Antrum Mimicking Malignancy on FDG PET/CT
Authors: Wang Ling , Li Ling , Fu Liping , Zheng Yumin
Published: January 2021

A 34-year-old man suffered intermittent abdominal pain for 1 month, especially after drinking or eating. Enhancement CT was performed to determine the cause, which detected a soft tissue mass in the gastric antrum, suggestive of possible malignancy. FDG PET/CT scan was undertaken for staging, which showed increased metabolism in the known gastric mass, also suggestive of malignancy. However, this lesion was confirmed as ectopic pancreatitis pathologically.
FDG-Avid Erythema Nodosum Lesions of Behçet Disease Demonstrated on FDG PET/CT
Authors: Kesim Selin , Ozguven Salih , Ones Tunc , Turoglu Halil Turgut , Erdil Tanju Yusuf
Published: January 2021

Behçet disease is a rare multisystemic vasculitis that can affect all sizes and types of blood vessels. Recurrent painful erythematous nodular lesions called erythema nodosum are the most common skin lesions of Behçet disease. Herein, we present 18F-FDG PET/CT images of erythema nodosum lesions in a patient with Behçet disease.
Factors Affecting Implementation of Simulation-Based Education After Faculty Training in a Low-Resource Setting
Authors: Seethamraju Rajasri R. , Stone Kimberly P. , Shepherd Michael
Published: January 2021

Introduction

Simulation instructor training is a recognized key component of health care simulation implementation, including in low-resource settings. PediSTARS India (Pediatric Simulation Training and Research Society) has developed and delivered several instructor training courses and more recently a 3-level faculty development program. However, there is variability in adoption of simulation at workplaces. The goal of this study was to identify factors that influence translation of instructor training into workplace simulation.

Methods

At the conclusion of their faculty development program, participants of the 2018 PediSTARS simulation instructor workshop were invited to participate in a qualitative study with an online questionnaire followed by a semistructured interview. The 3 key questions explored the “enablers,” “barriers,” and “changes needed” at workplaces for simulation-based training. The responses were analyzed and classified into broad themes.

Results

Of the 76 participants of the workshop, 11 were interviewed. The enablers were classified under 3 themes; “management support,” “trained team” and “smart sourcing.” Barriers were “lack of infrastructure,” “lack of time,” and “lack of simulation culture.” The proposed changes were to “raise awareness,” “strengthen systems,” and “curricular integration.”

Conclusions

This study demonstrates the importance of institutional leadership support for simulation-based training and also that new instructors should focus on training teams in the workplace and mapping simulation activities to existing curricula. These results have wide applicability to a variety of health care settings and instructor training programs. Collaboration between organizations for further research about the impact of simulation-based training on patient safety and outcomes is also required.
Mass Training In Situ During COVID-19 Pandemic
Authors: Delamarre Louis , Couarraze Sébastien , Vardon-Bounes Fanny , Marhar Fouad , Fernandes Marilyne , Legendre Muriel , Houze-Cerfon Charles-Henri , Rigal Rachel , Pizzuto Richard , Mathe Olivier , Larcher Claire , Ruiz Jean , Ferré Fabrice , Riu Béatrice , Seguin Thierry , Osinski Diane , Silva Stein , Malavaud Sandra , Georges Bernard , Minville Vincent , Fourcade Olivier , Geeraerts Thomas
Published: January 2021

Introduction

Avoiding coronavirus disease 2019 (COVID-19) work-related infection in frontline healthcare workers is a major challenge. A massive training program was launched in our university hospital for anesthesia/intensive care unit and operating room staff, aiming at upskilling 2249 healthcare workers for COVID-19 patients' management. We hypothesized that such a massive training was feasible in a 2-week time frame and efficient in avoiding sick leaves.

Methods

We performed a retrospective observational study. Training focused on personal protective equipment donning/doffing and airway management in a COVID-19 simulated patient. The educational models used were in situ procedural and immersive simulation, peer-teaching, and rapid cycle deliberate practice. Self-learning organization principles were used for trainers' management. Ordinary disease quantity in full-time equivalent in March and April 2020 were compared with the same period in 2017, 2018, and 2019.

Results

A total of 1668 healthcare workers were trained (74.2% of the target population) in 99 training sessions over 11 days. The median number of learners per session was 16 (interquartile range = 9–25). In the first 5 days, the median number of people trained per weekday was 311 (interquartile range = 124–385). Sick leaves did not increase in March to April 2020 compared with the same period in the 3 preceding years.

Conclusions

Massive training for COVID-19 patient management in frontline healthcare workers is feasible in a very short time and efficient in limiting the rate of sick leave. This experience could be used in the anticipation of new COVID-19 waves or for rapidly preparing hospital staff for an unexpected major health crisis.
Internet Use in Aphasia
Authors: Menger Fiona , Morris Julie , Salis Christos
Published: January 2021

Purpose:

This article uses an illustrative case example to discuss a means of producing a holistic profile of Internet use for individuals with aphasia.

Methods:

The authors used the International Classification of Functioning, Disability, and Health as a framework to select novel and existing assessments to explore the Internet use and skills of a 74-year-old retired academic with severe aphasia.

Results:

Quantitative and qualitative assessment results revealed that language impairment, nonverbal impairment, nonverbal aspects of cognition, and hemiparesis had an impact on the individual's ability to use the Internet independently for many previous professional activities; however, relevant Personal Factors showed him to have strong goals and motivation to continue to use the Internet for email and gaining information about topics such as sports. Consideration of Environmental Factors provided insight into barriers and facilitators to Internet use and into the skills of people providing support.

Discussion/conclusions:

This approach to profiling Internet use in aphasia may be clinically useful in identifying key factors at work to guide information gathering and decision making with people with aphasia. Implications about SLP preparation and funding policies related to therapeutic priorities also are discussed.
Correlation of Pattern Reversal and Flash Visual Evoked Potential Latencies With Optical Coherence Tomography Measures in Patients With Optic Neuropathy and Patients With Multiple Sclerosis Without Optic Neuropathy
Authors: Moussa Hussein , Sawaya Raja A. , Deeb Rudy , El Ayoubi Nabil
Published: January 2021

Purpose:

The object of the study is to relate the pattern reversal visual evoked potential (PRVEP) and flash VEP (f-VEP) latencies with retinal neurons and their fibers.

Methods:

We studied 104 eyes. Forty-two eyes from patients with optic neuritis (ON), 28 eyes from patients with multiple sclerosis without involvement of the optic nerves (MS–non-ON), and 34 eyes of normal controls.

Results:

Pattern reversal visual evoked potential latency is more delayed in patients with ON than in patients with multiple sclerosis nonON. Flash visual evoked potential (f-VEP) latency was delayed in both categories. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell/inner plexiform layer (GCIPL) thickness was lower in patients with ON and multiple sclerosis non-ON. In patients with ON, f-VEP latencies correlated negatively with pRNFL thickness but not GCIPL thickness. In patients with ON, PRVEP latencies did not correlate with pRNFL thickness but correlate negatively with GCIPL thickness.

Conclusions:

Patients with ON have delayed VEPs and thinner optical coherence tomography values. Flash visual evoked potentials correlate with pRNFL, indicating axonal pathology. PRVEP correlate with GCIPL, indicating ganglion cell pathology. Abnormal PRVEP with preserved normal f-VEP indicate isolated myelin damage. Abnormalities in both PRVEP and f-VEP indicate myelin and axonal damage in the optic nerve. Combining the results of PRVEP, f-VEP, pRNFL, and GCIPL, one can define the location, type, and extent of the lesion in the macula and optic nerve.
Two-sample Mendelian randomization analysis of associations between periodontal disease and risk of colorectal, lung, and pancreatic cancers
Authors: Corlin Laura , Ruan Mengyuan , Tsilidis Konstantinos K. , Bouras Emmanouil , Yu Yau-Hua , Stolzenberg-Solomon Rachael , Klein Alison P. , Risch Harvey A. , Amos Christopher I. , Sakoda Lori C. , Vodička Pavel , Pai Rish K. , Beck James , Platz Elizabeth A. , Michaud Dominique S.
Published: January 2021

Observational studies indicate that periodontal disease may increase the risk of colorectal, lung, and pancreatic cancers. We tested these associations using two-sample Mendelian randomization to emulate a randomized study with observational data. We developed an instrument including single nucleotide polymorphisms with strong genome-wide association study evidence for associations with aggressive and/or advanced periodontal disease. We used this instrument to assess associations with summary-level genetic data for colorectal cancer (n=58,131 cases), lung cancer (n=18,082 cases), and pancreatic cancer (n=9254 cases). The genetic predisposition index for periodontitis was significantly associated with an increased risk of colorectal cancer (p=0.026), colon cancer (p=0.021), proximal colon cancer (p=0.013), and colorectal cancer among females (p=0.039); however, it was not significantly associated with the risk of lung cancer or pancreatic cancer, overall or within most subgroups. Further research should determine whether increased periodontitis prevention and increased cancer surveillance of patients with periodontitis is warranted.