bluuebunny/crossref_metadata_2025 huggingface dataset:
How Do Coronavirus Attitudes Fit into Britain’s Ideological Landscape?
Authors: Mellon Jonathan , Bailey Jack , Prosser Christopher
Published: April 2021

Coronavirus upended British politics in 2020 but where does it fit into the ideological map of party competition? Recent British elections have seen a shift from economic left–right competition between the major parties to competition on the cultural (liberal–authoritarian) dimension, most notably in terms of the issues of immigration and membership of the European Union. Using British Election Study data from June 2020, we find that coronavirus attitudes fall primarily onto the traditional economic left–right dimension, with left-wing voters more willing to make economic sacrifices of various types to reduce infections. However, more draconian coronavirus measures (such as fining or imprisoning those who violate the coronavirus rules) are most supported by voters who score high on authoritarianism. We show that the structure of coronavirus attitudes puts the Conservative government in a difficult position where many steps it takes to reduce infections risk alienating its core economic right-wing vote.
Vascular and nonvascular transmission of systemic reactive oxygen signals during wounding and heat stress
Authors: Zandalinas Sara I , Mittler Ron
Published: April 2021

Sensing of heat, high light (HL), or mechanical injury by a single leaf of a plant results in the activation of different systemic signals that reach systemic tissues within minutes and trigger systemic acquired acclimation (SAA) or systemic wound responses (SWRs), resulting in a heightened state of stress readiness of the entire plant. Among the different signals associated with rapid systemic responses to stress in plants are electric, calcium, and reactive oxygen species (ROS) waves. These signals propagate from the stressed or injured leaf to the rest of the plant through the plant vascular bundles, and trigger SWRs and SAA in systemic tissues. However, whether they can propagate through other cell types, and whether or not they are interlinked, remain open questions. Here we report that in response to wounding or heat stress (HS), but not HL stress, the ROS wave can propagate through mesophyll cells of Arabidopsis (Arabidopsis thaliana). Moreover, we show that ROS production by mesophyll cells during these stresses is sufficient to restore SWR and SAA transcript accumulation in systemic leaves, as well as SAA to HS (but not HL). We further show that propagation of the ROS wave through mesophyll cells could contribute to systemic signal integration during HL and HS stress combination. Our findings reveal that the ROS wave can propagate through tissues other than the vascular bundles of plants, and that different stresses can trigger different types of systemic signals that propagate through different cell layers and induce stress-specific systemic responses.
Prevalence and Impact of Dysmenorrhea Among University Students in Ireland
Authors: Durand Hannah , Monahan Katie , McGuire Brian E
Published: April 2021

Objective

Primary dysmenorrhea (PD), or painful menstruation, is a common gynecological condition that can cause intense pain and functional disability in women of reproductive age. As a nonmalignant condition, PD is relatively understudied and poorly managed. The purpose of this study was to estimate the prevalence and impact of PD among third-level students in Ireland.

Design

A cross-sectional observational design was used.

Methods

Students (n = 892; age range = 18–45 years) completed an online survey on menstrual pain characteristics, pain management strategies, pain interference, and pain catastrophizing.

Results

The prevalence of PD was 91.5% (95% confidence interval = 89.67–93.33). Nonpharmacological management strategies were most popular (95.1%); of these, heat application (79%), rest (60.4%), hot shower/bath (40.9%), and exercise (25.7%) were most common. Perceived effectiveness of these methods varied between participants. Analgesic use was also common (79.5%); of these, paracetamol was most used (60.5%) despite limited perceived effectiveness. Pain catastrophizing was a significant predictor of variance in both pain intensity and pain interference scores such that those with higher pain catastrophizing scores reported more intense pain and greater interference with daily activities and academic demands.

Conclusions

This article presents the first investigation into PD among third-level students in Ireland. Poorly managed menstrual pain may impact functional ability across several domains. Future research should focus on improving menstrual pain management education and support and promoting menstrual health literacy for women affected by PD.
Peripubertal mGluR2/3 Agonist Treatment Prevents Hippocampal Dysfunction and Dopamine System Hyperactivity in Adulthood in MAM Model of Schizophrenia
Authors: Sonnenschein Susan F , Grace Anthony A
Published: April 2021

Pomaglumetad methionil (POM), a group 2 metabotropic glutamate receptor (mGluR2/3) agonist, showed promise as a novel antipsychotic in preclinical research but failed to show efficacy in clinical trials, though it has been suggested that it may be effective in certain patient populations, including early in disease patients. We used the methyazoxymethanol acetate (MAM) rat model of schizophrenia to determine whether POM may prevent the development of dopamine (DA) system dysfunction in a model representative of the hyperdopaminergic state thought to underlie psychosis, compared to control (SAL) rats. MAM and SAL rats were administered either POM (3 mg/kg, i.p.), vehicle (1 ml/kg), or no injection during postnatal day (PD) 31–40. In either late adolescence (PD 47–56) or adulthood (PD 83–96), novel object recognition (NOR) was tested, followed by anesthetized in vivo electrophysiological recordings of VTA DA neuron activity or ventral hippocampal (vHPC) pyramidal neuron activity. MAM rats treated with POM demonstrated increased NOR in adulthood compared to no injection MAM rats, but not compared to vehicle-treated MAM rats. POM-treated MAM rats demonstrated normalized DA neuron population activity and vHPC pyramidal neuron activity compared to vehicle and no injection MAM rats in both late adolescence and adulthood. No significant differences were observed across treatment groups in SAL rats. These results suggest that peripubertal mGluR2/3 agonist administration can prevent the emergence of vHPC pyramidal neuron hyperactivity and increased DA neuron population activity in adult MAM rats.
Household Sanitary Inspection, Mosquito Control and Domestic Hygiene in the Gold Coast [Ghana] from the Late-Nineteenth to the Mid-Twentieth Century
Authors: Amoako-Gyampah Akwasi Kwarteng
Published: April 2021

Mosquito control was the focus of many public health interventions in the Gold Coast because during the colonial period, malaria and other mosquito-borne diseases remained a leading cause of European and African morbidity and mortality. Tagging along with theories of racial ecology that portrayed Africans and their surroundings as the nidus of infection, and therefore, perceiving African homes as a source of danger, colonial officials targeted the fight against mosquito at African households and surroundings. Sanitary inspectors were deployed to African households to search, prosecute and fine householders whose environment harboured larvae. By examining the connection between household sanitary inspection, mosquito control and domestic hygiene, this article demonstrates how sanitary inspection was not limited to finding larvae. Instead, it became a tool for checking general cleanliness in African households, and therefore, provided the colonial administration, the means to regulate, and manipulate African habits and practices in the domestic sphere.
Admission ultrasonography as a predictive tool for thrombocytopenia and disease severity in dengue infection
Authors: Donaldson Callum D , de Mel Sanjay , Clarice Choong Shi Hui , Thilakawardana Basuru Uvindu , de Mel Primesh , Shalindi Malka , Samarasinghe U , de Mel Chandima , Chandrasena Lal , Wijesinha Rasanga S , Wijesinha A Nirmala I , Yip Christina , Yap Eng-Soo , Seneviratne Suranjith L , Abeysuriya Visula
Published: April 2021

Background

Ultrasound (US) is an investigation available in many acute care settings. Thrombocytopenia is a well-described complication of dengue infection and has been shown to correlate with disease severity. The purpose of this study was to assess the utility of admission ultrasonography in predicting thrombocytopenia and disease severity in patients infected with dengue virus.

Methods

Data were collected prospectively on 176 patients (male, n=86; female, n=90) admitted to the Nawaloka Hospital, Sri Lanka with dengue infection between December 2016 and August 2018. All patients had an US scan on admission and disease severity was determined using the World Health Organization 2009 classification.

Results

There were 106 (60.2%) cases of dengue with/without warning signs and 70 (39.8%) cases of severe dengue. Patients with an abnormal US on admission were more likely to have severe dengue. Gallbladder wall thickening was the most common US abnormality. Abnormal US findings significantly correlated with more pronounced thrombocytopenia from day 2 of admission.

Conclusions

An abnormal US scan on admission can aid in identification of patients at risk of developing severe dengue and can be used as a novel clinical tool to identify patients at risk of severe thrombocytopenia.
Comparative Genomic Understanding of Gram-Positive Plant Growth-Promoting Leifsonia
Authors: Nordstedt Nathan P. , Roman-Reyna Veronica , Jacobs Jonathan M. , Jones Michelle L.
Published: April 2021

Root-associated bacteria play critical roles in shaping plant health for abiotic and biotic stress tolerance. The Leifsonia genus includes pathogenic and beneficial bacteria but limited research is available comparatively across species regarding their association with plants. We recently identified the plant growth-promoting Leifsonia sp. C5G2 isolated from the rhizosphere of Plectranthus scutellarioides (coleus) that increased stress tolerance and quality of water-stressed greenhouse ornamentals. Using this beneficial strain as a model, we performed comparative genomics with beneficial, commensal, and pathogenic Leifsonia spp. to better understand plant association and growth promotion under abiotic stress. Comparative phylogenetic analyses showed that beneficial and commensal Leifsonia spp. clustered separately from pathogenic Leifsonia xyli subsp. xyli. In addition, the beneficial or commensal strains share biosynthetic gene and orthologous protein clusters that are not shared with known phytopathogens in our analysis. The phytopathogenic Leifsonia strains also share noticeably higher percent homology with plant-associated virulence factors in closely related Clavibacter spp. than the beneficial or commensal strains. Genome analysis supplemented with in vitro assays validated the findings that our model growth-promoting Leifsonia sp. strain C5G2 was highly prolific on diverse carbon sources. This is unlike known fastidious growth behaviors of phytopathogenic Leifsonia spp. Beneficial Leifsonia sp. C5G2 imparts water stress tolerance in plants, and multiple genes were identified in the genomes of beneficial Leifsonia strains that are potentially involved in bacterial osmotic stress and the production of osmoprotectants and vitamin B9. This work sheds light on the diversity of the genus Leifsonia, with a better understanding of potential mechanisms employed by poorly understood beneficial bacteria.
Race Characterization and Molecular Genotyping of Puccinia triticina Populations from Durum Wheat in Russia
Authors: Gultyaeva Elena I. , Shaydayuk Ekaterina L. , Kazartsev Igor A. , Kosman Evsey
Published: April 2021

Variability of the Russian population of Puccinia triticina from durum wheat was studied with virulence and simple sequence repeat (SSR) markers. The pathogen was sampled during 2017 to 2019 in all regions with sizable durum wheat (Triticum durum) growing areas from winter (North Caucasus) and spring (Middle Volga, Ural, and West Siberia) wheat. A total of 474 isolates were tested on a set of 20 Lr-gene lines. Molecular genotypes for 105 selected isolates were determined at 11 SSR loci. Variable virulence/avirulence reaction was observed only on three Lr-gene lines, whereas just five SSR loci were polymorphic with two alleles at each. Seven different virulence phenotypes and 11 SSR genotypes were found among 474 and 105 isolates, respectively, indicating a very low variability of the pathogen. One virulence phenotype and three SSR genotypes occurred in all Russian regions. However, two phenotypes were specific to the European regions of Russia (North Caucasus and Middle Volga), while another two were found only in the Asian part of Russia (Ural and West Siberia). Significant differentiation between six populations of P. triticina from durum wheat in the Asian and European (mainly North Caucasus) regions was also shown with numerous metrics and approaches for data with and without clone correction. Relationships among the regional populations of P. triticina from durum wheat established with virulence phenotypes significantly associated with those for SSR genotypes and was similar to the relationships among the regional populations of the pathogen from common wheat.
Purposeful Language Exposure by Neonatal Nurses and Caregivers in the NICU
Authors: Newnam Katherine M. , Muñoz Lauren R.
Published: April 2021

Background:

Preterm infants are at significant risk of neurocognitive deficits including language delay. Extended hospitalization in the neonatal intensive care unit (NICU) causes missed opportunities for language exposure at critical developmental periods of neural pathways for language processing. Healthcare providers (HCPs), particularly nurses, may be instrumental in providing infant-directed speech to improve neurodevelopmental outcomes.

Purpose:

To evaluate current evidence to determine what is known about the characteristics of HCP communication to infants in the NICU.

Search/Strategy:

Four databases and forward searching were used to respond to the clinical question: “What is known about the characteristics of HCP communication to infants in the NICU?” Empiric, primary research studies published in English without date restriction were included.

Findings:

Eight studies, primarily descriptive, were reviewed. Overall, infant-directed speech was rarely provided by HCPs. Language was more often directed to sicker infants, occurred in contexts of procedural pain, and was sometimes combined with touch. Perceptions of language by nurses, infants, and parents as well as inhibitors and benefits of infant-directed speech were reported.

Implications for Practice:

As frontline neonatal providers, nurses can serve as role models of infant-directed speech for parents, helping them gain comfort and understand the importance of speaking to their preterm infants. Nurses can also provide much-needed language nutrition to preterm infants when parents cannot be present.

Implications for Research:

Methods to reduce barriers and support infant-directed speech in the NICU require testing. Predictive modeling using measures of language exposure in the NICU may support differences in neurodevelopmental outcomes.
A Measure of Long-Term Hearing Aid Use Persistence Based on Battery Reordering Data
Authors: Zobay Oliver , Dillard Lauren K. , Naylor Graham , Saunders Gabrielle H.
Published: April 2021

Objective:

We describe the construction of a hearing aid long-term use persistence measure based on battery reorder data. The measure is derived from the notion that hearing aid users keep using their devices for some time after placing a battery order.

Design:

A hearing aid user is defined as persistent at time T if they placed a battery order within a time span W preceding T. We characterize and validate this measure using electronic health records from a large sample of US Veterans.

Results:

We describe how to choose parameters T and W for calculating persistence rates in the patient sample. For validation, the associations of persistence with: (1) the duration over which users received outpatient hearing aid care; (2) self-reported hearing aid use shortly after fitting; and (3) patient age and hearing loss are investigated. In all cases, plausible dependencies are observed.

Conclusions:

We conclude that our persistence measure is viable and hope this will motivate its use in similar studies.
The Demographics and Epidemiology of Infantile, Juvenile, and Adolescent Idiopathic Scoliosis in a Southern California Integrated Health Care System
Authors: Bondar Kevin , Nguyen Annie , Vatani Jasmine , Kessler Jeffrey
Published: April 2021

Study Design.

Prognostic study, Level III.

Objectives.

The aim of this study was to determine the incidence and demographics of idiopathic scoliosis (IS) in a large cohort of children in a Southern California integrated healthcare system, and to identify the demographic or clinical factors associated with the greatest risk of IS.

Summary of Background Data.

Although many authors have reported on the incidence and prevalence of IS in children, there have been few incidence studies in the United States on large, self-contained populations.

Methods.

A retrospective chart analysis was done on diagnosed cases of IS within our integrated health care system in patients under age 18 years during the entire 2013 calendar year. Patient demographics were recorded and the incidence of IS was determined. Odds ratios (ORs) for having IS and for having more severe initial curve magnitudes based on demographics were determined using logistic regression models.

Results.

IS Incidence was 3.9, 28.6, and 393 per 100,000, respectively, for the infantile, juvenile, and adolescent group. The female incidence was more than twice that of males in all age groups. Multivariate logistic regression analysis showed Asians and non-Hispanic Whites had the highest OR of IS (OR 1.54 and 1.32 with 95% confidence interval [CI] 1.33–1.79 and 1.19–1.47). Whites, Blacks, and mixed-race patients had a significantly higher initial curve magnitude than Hispanics; females also had a significantly greater initial curve magnitude than boys (18.1° vs. 16.7°). Underweight patients had a 50% increased OR of IS versus normal weight (95% CI 1.16–1.94) with a progressively decreased OR of IS as weight increased.

Conclusion.

Our study of a large integrated healthcare system sheds light on the incidence of IS and the ORs based on weight, sex, and ethnicity/race. The overall incidence was lower overall than previously thought.

Level of Evidence: 3
Revision Surgery of Total Lumbar Disk Replacement
Authors: Schmitz Arthur , Collinet Arnaud , Ntilikina Yves , Tigan Leonardo , Charles Yann P. , Steib Jean-Paul
Published: April 2021

Study Design:

This was a retrospective clinical review.

Objective:

The objective of this study was to analyze failure mechanisms after total lumbar disk replacement (TDR) and surgical revision strategies in patients with recurrent low back pain (LBP).

Summary and Background Data:

Several reports indicate that TDR revision surgery carries a major risk and that it should not be recommended. The clinical results of posterior instrumented fusion using the prosthesis like an interbody cage have not been well analyzed.

Materials and Methods:

From 2003 to 2018, 48 patients with recurrent LBP after TDR underwent revision surgery. The average age was 39 years (24–61 y). The mean follow-up was 100.4 months (24.6–207.7 mo). Clinical data, self-assessment of patient satisfaction, and Oswestry Disability Index collected at each clinical control or by phone call for the older files and radiologic assessments were reviewed. The surgical revision strategy included posterior fusion in 41 patients (group A) and TDR removal and anterior fusion in 7 patients (group B), of which 6 patients had an additional posterior fixation.

Results:

Facet joint osteoarthritis was associated with TDR failure in 85%. In 68% the position of the prosthesis was suboptimal. Range of motion was preserved in 25%, limited in extension in 65%, and limited in flexion in 40%. Limited range of motion and facet joint osteoarthritis were significantly related (P=0.0008). The complication rate in group B was 43% including iliac vein laceration. Preoperative and 2-year follow-up Oswestry Disability Index were 25.5 and 22.0, respectively, in group A versus 27.9 and 21.3 in group B.

Conclusions:

Posterior osteoarthritis was the principal cause of recurrent LBP in failed TDR. The anterior approach for revision carried a major vascular risk, whereas a simple posterior instrumented fusion leads to the same clinical results.

Level of Evidence:

Level IV.
The Development of the Postpartum Depression Self-Management Mobile Application “Happy Mother”
Authors: Seo Ji Min , Kim Su-Jeong , Na Hyunjoo , Kim Jin Hee , Lee Hyejin
Published: April 2021

Postpartum depression is the most common mood disorder that occurs after childbirth, rendering it a significant public health problem. Information and communication technologies hold tremendous promise for expanding the reach of quality mental healthcare and closing the treatment gap for depression. In particular, given that mobile applications are inexpensive and provide information systematically, they are suitable as a method of health management that does not require visiting a medical center. The purposes of this study were to document the process of developing a mobile application for the self-management of postpartum depression and to share usability test results. The mobile application “Happy Mother” was developed based on the first five of seven stages in the mobile application development lifecycle model. Components of cognitive behavioral therapy were adopted to guide content development for “Happy Mother.” The usability of the completed mobile application was tested in the following three steps: it increased awareness of mood, promoted self-management, and implemented specific methods a mother can use in her daily life to improve mood, including modifications made based on the results of the usability test.
Short Term Prediction of Preeclampsia
Authors: Sroka Dorota , Verlohren Stefan
Published: April 2021

Preeclampsia (PE), a multisystem disorder in pregnancy, is a main cause of perinatal mortality and is associated with long-term maternal complications. For a long time, PE was defined as the new onset hypertension and proteinuria after 20 weeks’ gestation. It had been shown that this “gold standard definition” is not able to provide a sufficient prediction of PE-related fetal and/or maternal complications. In 2018 the International Society for the Study of Hypertension in Pregnancy recommended a broader definition of the disease. The new definition of the International Society for the Study of Hypertension in Pregnancy ruled out proteinuria as mandatory for the diagnosis of PE. This new definition increases the number of patients diagnosed as preeclamptic by nearly 21%, which is not accompanied by an increased severity of maternal outcomes. Including angiogenic biomarkers, however, has been shown to increase detection of adverse outcomes.

The pathophysiology of PE is complex and not yet completely explained. Advances in prediction and diagnosis have been achieved by discovery and clinical evaluation of biomarkers, especially of placental origin. A broad spectrum of biomarkers has been tested, a few of them have been introduced into the clinical practice as of today. Especially angiogenic biomarkers that are rooted in the pathophysiology of PE have been demonstrated to be important in the prediction and diagnosis of adverse outcomes. At a cut-off value of the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF)-ratio of 85, early-onset PE <34+0  weeks of gestation can accurately be diagnosed with a sensitivity of 89% and a specificity of 97%. The Prediction of short-term outcome in pregnant women with suspected preeclampsia (PROGNOSIS) study has shown that the high negative predictive value (99.3%) of the sFlt-1/PlGF-ratio below 38 in patients with suspected PE rules out the onset of the disease within one week. PROGNOSIS Asia, evaluating the sFlt-1/PlGF-ratio cut-off of 38 in an Asian population, confirmed the excellent accuracy in prediction.

Recently, the angiogenic biomarkers have been integrated in multi-marker prediction models. Digital approaches, integrating algorithm-based decision support tools paired with home monitoring devices may be the next step in enhancing predictive accuracy and thus bear the potential to reduce maternal and/or fetal morbidity and mortality and save costs for the payer in parallel. The objective of this review is to provide an overview of current methods for predicting and diagnosing PE.
First Trimester Screening for Preeclampsia: An Asian Perspective
Authors: Moungmaithong Sakita , Wang Xueqin , Tai Angela S.T. , Feng Qiaoli , Sahota Daljit , Leung Tak Yeung , Poon Liona C.
Published: April 2021

Preeclampsia (PE) is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. This disorder has profound short-term and long-term impacts on both the affected woman's and her child's health. Early-onset PE requiring preterm delivery (preterm PE) is of particular importance because it is associated with a higher risk of adverse pregnancy outcomes than term PE. First trimester screening model developed by the Fetal Medicine Foundation (FMF), which uses Bayes-theorem to combine maternal characteristics and medical history together with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor, has been proven to be effective and have superior screening performance to that of traditional risk factor-based approach for the prediction of PE. Identification of high risk pregnant women for preterm PE and giving aspirin prophylaxis before 16th week of gestation would reduce the incidence of preterm PE. In Asia, although the prevalence of PE is slightly lower than the global estimation, early screening and prevention of this life-threatening condition is still crucial. The FMF Bayes-theorem based screening method has been validated in a large-scale prospective Asia-wide study and revealed that the first trimester triple test achieves the highest detection rate, compared with the traditional risk factor-based approaches, and that the screening performance is comparable to the published data from the FMF in East Asian women. However, in order to achieve optimal screening performance, the key is to establish standardized methods for biomarker measurements and regular biomarker quality assessment, as each biomarker is susceptible to inaccurate measurement, thus affecting performance of screening. Furthermore, it is of great importance to emphasize that the optimal preventive effect of aspirin on preterm PE is clearly associated with good compliance to treatment. In conclusion, global implementation of an effective first trimester “screen and prevent” program for preterm PE would provide the opportunity to reduce the risk of both short-term maternal and perinatal morbidity and mortality, with the possibility of intergenerational prevention of future chronic diseases for both the mother and her offspring.
Cardiac Rehabilitation Following Percutaneous Coronary Intervention Is Associated With Superior Psychological Health and Quality of Life in Males but Not in Females
Authors: Terada Tasuku , Vidal-Almela Sol , Tulloch Heather E. , Pipe Andrew L. , Reed Jennifer L.
Published: April 2021

Purpose:

Cardiac rehabilitation (CR) improves psychological health and health-related quality of life (HR-QoL). Yet, available evidence suggests that their degree of improvements following CR may depend on patient sex and the mode of revascularization. We examined the interplay between sex and mode of revascularization on the psychological health and HR-QoL of patients completing CR.

Methods:

We analyzed the longitudinal records of patients who completed a 3-mo outpatient CR program following coronary revascularization. Levels of anxiety and depression were measured by the Hospital Anxiety and Depression Scale and HR-QoL was measured by the Medical Outcomes Study Short Form-36 before and after CR. A two-by-two analysis of covariance (females vs males by coronary artery bypass graft surgery [CABG] vs percutaneous coronary intervention [PCI]) was used to examine the sex-by-revascularization procedure interaction effect on changes in psychological health and HR-QoL.

Results:

Of the 278 participants (age: 65 ± 9 yr) included in the analysis, 191 (69%) underwent PCI and 55 (20%) were females. Following CR, there was a significant sex-by-revascularization procedure interaction effect on anxiety (P = .033) and mental HR-QoL (mental component summary [MCS]; P = .040). Following CABG, females and males showed similar improvements in anxiety (−1.3 ± 3.4 vs −1.1 ± 3.6 points, P = .460) and MCS scores (5.4 ± 8.9 vs 4.5 ± 8.7 points, P = .887); following PCI, females experienced worse anxiety levels and mental component summary scores while males showed improvements (anxiety: +1.0 ± 3.8 vs −1.3 ± 3.8 points, P = .002; MCS: −1.6 ± 9.3 vs + 4.4 ± 8.9 points, P = .008, respectively). There was no interaction effect on depression.

Conclusions:

Continued efforts are required to improve anxiety and mental HR-QoL in females treated with PCI participating in CR.
Long-Term Treatment of Bipolar Disorder with Valproate: Updated Systematic Review and Meta-analyses
Authors: Yee Caitlin S. , Vázquez Gustavo H. , Hawken Emily R. , Biorac Aleksandar , Tondo Leonardo , Baldessarini Ross J.
Published: April 2021

Learning objective

After participating in this activity, learners should be better able to:

• Evaluate the evidence regarding the effectiveness of long-term treatment of bipolar disorder with valproate

Background

Prophylactic treatment is critical for bipolar disorder (BD) patients. Valproate is commonly used for this purpose but lacks regulatory approval and carries appreciable risks.

Methods

Systematic literature searching through June 2020 sought prospective trials lasting ≥12 months with adults diagnosed with BD to support comparisons of risk of new illness episodes with valproate versus placebo or other agents.

Results

Included were 13 reports involving 9240 subjects treated for an average of 29.1 months (range, 12–124) in 21 trials: 9 were blinded, randomized trials (RCTs) of valproate versus placebo (n = 3), lithium (5), or olanzapine (1); 2 were unblinded RCTs versus lithium (1) or quetiapine (1); and 10 were open-label trials versus lithium (5), quetiapine (2), carbamazepine (1), lamotrigine (1), or olanzapine (1). Random-effects meta-analysis found valproate superior to placebo in 3 trials (odds ratio [OR] = 0.42 [95% confidence level (CI), 0.30–0.60]; p < .0001). In 11 trials, protective effects with valproate and lithium were similar (OR = 1.20 [CI, 0.81–1.79]; p = .36), as well in 5 comparisons versus antipsychotics quetiapine and olanzapine (OR = 0.96 [CI, 0.66–1.40]; p = .84), and 2 versus other mood-stabilizing anticonvulsants (carbamazepine and lamotrigine) (OR = 1.30 [CI, 0.75–2.26]; p = .34). Valproate was nonsignificantly more effective versus new mania than depression (χ2 = 3.03; p = .08).

Conclusions

Valproate was more effective than placebo in preventing new BD episodes of mania or depression, and not significantly different from lithium, second-generation antipsychotics, or other anticonvulsants. Overall benefits were nonsignificantly greater versus mania than bipolar depression.
Developmental Cysts of the Orbit With Mixed Conjunctival and Cutaneous Epithelial Phenotypes
Authors: Vahdani Kaveh , Thaung Caroline , Tay Eugene , Rose Geoffrey E.
Published: April 2021

Aim:

To describe the characteristics of patients presenting with congenital orbital cysts containing epithelia of both cutaneous phenotype—that is, epidermis with or without keratin, and at least one dermal structure (sweat gland or pilosebaceous unit)—and conjunctival phenotype (with goblet cells); these cysts with mixed lining are termed “dermo-conjunctival” cysts.

Patients and methods:

Review of clinical records for patients having dermo-conjunctival cysts that were treated between 1997 and 2017; patients with cysts of solely conjunctival or solely cutaneous origin were omitted. Data recorded included gender, age at presentation, laterality, orbital location, ophthalmic features, surgical and radiological data, and light microscopic findings.

Results:

Of 241 patients with congenital orbital cysts, 22 (9%) contained both cutaneous and conjunctival epithelium; unlike the relatively common congenital cysts lined with solely cutaneous epithelia, these dermo-conjunctival cysts typically occupied the superonasal or nasal quadrants of the orbit (p < 0.000001). Fifteen (68%) of the 22 patients were male, and the group presented at a median age of 22 years (range 8–51 years), with symptoms for a median duration of 5 years (range 1 month–33 years). Fourteen (64%) had noted an orbital mass, 3 (14%) had inflammatory pain, and 1/22 (4%) had reduced acuity. Globe displacement was axial in 7 patients (32%) and nonaxial in 13 (59%), and ocular motility was restricted in 4/22 (18%). Of 17 patients with imaging, 9 (53%) had bone expansion, and the cyst was intimately related to the trochlea in 10 (59%). By definition, all cysts contained conjunctival epithelium with goblet cells: hair shafts were present in 13/22 (59%) specimens, sebaceous units in 18 (82%), sweat glands in 6 (27%), and keratinized epithelium was present in 8 (36%). Fourteen (63%) of cysts had mild chronic inflammation within the cyst wall, and granulomas were present in 8 (36%).

Conclusion:

Congenital dermo-conjunctival orbital cysts are rare and favor a medial location—this suggesting an origin from sequestered caruncular tissues, the only postseptal source of both dermal and conjunctival structures. Unlike pure cutaneous cysts that typically present as superficial masses in childhood, dermo-conjunctival cysts are often postseptal and present in adults.
Efficacy of toric intraocular lens and prevention of axis misalignment by optic capture in pediatric cataract surgery
Authors: Tachibana Kuniko , Maeda Naoyuki , Abe Kosuke , Kusaka Shunji
Published: April 2021

Purpose:

To compare the outcomes of intraocular lens (IOL) implantation using toric (T)-IOL and nontoric (N)-IOL in pediatric cataract patients with astigmatism and to examine the effect of optic capture (OC) on the axis misalignment (AM) of the T-IOLs.

Setting:

Department of Ophthalmology, Kindai University Hospital, Osaka, Japan.

Design:

Interventional, comparative case study.

Methods:

Consecutive pediatric patients implanted with T-IOLs or N-IOLs were retrospectively reviewed. In the T-IOL group, the preoperative and postoperative corrected distance visual acuity (CDVA) and AM were compared in patients with and without OC.

Results:

The T-IOL group included 14 eyes of 11 patients, whereas the N-IOL group included 22 eyes of 15 patients. One year postoperatively, the mean ocular cylinder (1.38 ± 0.80 diopters [D]) was significantly smaller than the mean corneal cylinder (3.33 ± 1.24 D) in the T-IOL group (P = .00012, Wilcoxon signed-rank test). The mean preoperative and 1-year postoperative CDVA (logMAR) were 0.57 and 0.003 (T-IOL) and 0.71 and 0.09 (N-IOL), respectively. The AM at 1 week and 1 year postoperatively was 2.6 ± 3.7 degrees and 4.4 ± 3.1 degrees for the OC group, and 13.3 ± 8.8 degrees and 18.5 ± 14.8 degrees, for the non-OC group, respectively. The AM was significantly smaller in the OC group than that in the non-OC group (P = .009, Mann-Whitney U test) at postoperative 1 week.

Conclusions:

T-IOL implantation is effective in correcting astigmatism in pediatric cataract patients with astigmatism, and the OC technique is likely to achieve lower AM of the T-IOL.
Basketball vs. Hockey—The Changing Face of Sport-Related Injuries in Canada
Authors: Axelrod Daniel , Ziegler Teresa , Pincus Daniel , Widdifield Jessica , Marks Paul , Paterson Michael , Wasserstein David
Published: April 2021

Objective:

To characterize and compare the incidence of basketball-related, soccer-related, and hockey-related injuries over a 10-year period.

Design:

Cohort analysis of sport-related injuries using multiple Ontario healthcare databases.

Setting:

Emergency department visits in Ontario, Canada.

Patients:

Any patient who sustained musculoskeletal injuries sustained while playing basketball, soccer, or hockey between 2006 and 2017 were identified.

Assessment of Risk Factors:

Sport of injury, age, sex, rurality index, marginalization status, and comorbidity score.

Main Outcome Measures:

Annual Incidence Density Rates of injury were calculated for each sport, and significance of trends was analyzed by assessing overlap of 95% confidence intervals.

Results:

One lakhs eighty five thousand eighty hundred sixty-eight patients (median age: 16 years, interquartile range 13-26) received treatment for sport-related injuries (basketball = 55 468; soccer = 67 021; and hockey = 63 379). The incidence of basketball-related and soccer-related injuries increased from 3.4 (3.3-3.5) to 5.6 (5.5-5.7) and 4.4 (4.3-4.5) to 4.9 (4.8-5) per 10 000 person years, respectively, whereas the incidence of hockey-related injuries decreased from 4.7 (4.6-4.8) to 3.7 (3.6-3.8). Patients with basketball injuries were more marginalized (3.01 ± 0.74) compared with patients with soccer and hockey injuries (2.90 ± 0.75 and 2.72 ± 0.69, respectively).

Conclusions:

Accurate regional epidemiologic information regarding sports injuries can be used to guide policy development for municipal planning and sport program development. The trends and demographic patterns described highlight general and sport-specific injury patterns in Ontario. Populations with the highest incidence of injury, most notably adolescents and men older than 50, may represent an appropriate population for injury risk prevention.
Adiposity as a Risk Factor for Sport Injury in Youth: A Systematic Review
Authors: Toomey Clodagh M. , Whittaker Jackie L. , Richmond Sarah A. , Owoeye Oluwatoyosi B. , Patton Declan A. , Emery Carolyn A.
Published: April 2021

Objective:

To determine whether high or low adiposity is associated with youth sport-related injury.

Data Sources:

Ten electronic databases were searched to identify prospective studies examining the association between adiposity [body mass index (BMI) or body fat] and a future time-loss or medical attention sport-related musculoskeletal injury or concussion in youth aged 20 years and younger. Two independent raters assessed the quality (Downs and Black criteria) and risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Random-effects meta-analyses were used to calculate pooled odds ratio [95% confidence interval (CI)] of injury.

Main Results:

Of 11 424 potentially relevant records, 38 articles were included with 17 eligible for meta-analyses. In qualitative synthesis, no clear association was identified between adiposity and any sport injury; however, 16/22 studies identified high adiposity as a significant risk factor for lower-extremity injury. Meta-analyses revealed higher BMI in youth with any sport-related injury and lower BMI in youth who developed a bone stress injury (BSI) compared with noninjured controls. The pooled OR (95% CI) examining the association of BMI and injury risk (excluding bone injury) was 1.18 (95% CI: 1.03-1.34). A major source of bias in included articles was inconsistent adjustment for age, sex, and physical activity participation.

Conclusions:

Level 2b evidence suggests that high BMI is associated with greater risk of youth sport injury, particularly lower-extremity injury and excluding BSI or fracture. Although pooled mean differences were low, anthropometric risk of injury seems to be dependent on type and site of injury in youth sport.
Comfort Level of Current Physical Therapist Students in Addressing Sexual Issues With Patients
Authors: Dockter Mary , Ulmer Emma , Wulf Cailey , Gunderson Morgan , Bornhorst Jordan , Joneson Alissa , Abraham Karen , Reisch Rebecca
Published: April 2021

Background:

Scarce evidence has been found on factors that determine physical therapist (PT) students' comfort level in addressing sexual issues with patients. Determining influential factors and barriers may help educators adjust their curriculum to better prepare students.

Objectives:

To identify the comfort level of PT students in addressing sexual issues with patients, demographic factors that impact the students' comfort level, and barriers to PT students addressing sexual issues with patients.

Study Design:

A cross-sectional survey design.

Methods:

A survey was sent to current PT students enrolled at 3 Doctorate of Physical Therapy (DPT) programs. The survey consisted of demographic and scenario questions related to the students' comfort level in addressing sexual issues. Wilcoxon signed rank tests were performed to compare the differences in the comfort levels for male and female students. A χ2 analysis was performed to determine which demographic factors were significantly (P < .05) associated with the respondent's comfort level.

Results:

First-, second-, and third-year students (N = 106) completed the survey and represented programs from diverse geographic locations and religious affiliations. Less than half (41.5%) agreed that they had the necessary skills to address sexual issues, and only 23.58% of respondents were likely to initiate discussion. While students were most comfortable addressing issues with their own gender, collectively there was increased comfort level with conversations with females. Main barriers included lack of experience and knowledge, fear of patient misunderstanding, and patient comfort level.

Conclusion:

PT students lack comfort in addressing sexual issues due to multiple barriers. Demographic information, including geological location and religious background, was not significantly associated with comfort level (see the Video, Supplemental Digital Content 1, which summarizes this study available at: http://links.lww.com/JWHPT/A44).
Markers of Quality Care for Newly Diagnosed People With Epilepsy on Medicaid
Authors: Bensken Wyatt P. , Navale Suparna M. , Andrew Angeline S. , Jobst Barbara C. , Sajatovic Martha , Koroukian Siran M.
Published: April 2021

Background:

For newly diagnosed people with epilepsy (PWE), proper treatment is important to improve outcomes, yet limited data exist on markers of quality care.

Objective:

Examine markers of quality care for newly diagnosed PWE.

Methods:

Using Medicaid claims data (2010–2014) for 15 states we identified adults 18–64 years of age diagnosed with incident epilepsy in 2012 or 2013. We built 5 sequential logistic regression models to evaluate: (1) seeing a neurologist; (2) diagnostic evaluation; (3) antiepileptic medication adherence; (4) serum drug levels checked; and (5) being in the top quartile of number of negative health events (NHEs). We adjusted for demographics, comorbidities, county-level factors, and the outcomes from all prior models.

Results:

Of 25,663 PWE, 37.3% saw a neurologist, with decreased odds for those of older age, those residing in counties with low-density of neurologists, and certain race/ethnicities; about 57% of PWE received at least 1 diagnostic test; and nearly 62% of PWE were adherent to their medication. The most common comorbidities were hypertension (37.1%) and psychoses (26.9%). PWE with comorbidities had higher odds of seeing a neurologist and to have NHEs. Substance use disorders were negatively associated with medication adherence and positively associated with high NHEs.

Conclusions:

There are notable differences in demographics among people with incident epilepsy who do or do not see a neurologist. Differences in NHEs persist, even after controlling for neurologist care and diagnostic evaluation. Continued attention to these disparities and comorbidities is needed in the evaluation of newly diagnosed PWE.
Comparison of treatment response assessed by 18F-FDG PET/CT with the histopathological response using tumor regression grading on surgically resected specimen following neoadjuvant chemotherapy in squamous cell carcinoma of esophagus
Authors: Kumar Naveen , Deo Suryanarayana , Bhoriwal Sandeep , Sharma Atul , Pramanik Raja , Kumar Rakesh , Das Prasenjit , Arora Saurabh , Kumar Sunil
Published: April 2021

Background

For the response assessment after chemotherapy, gold standard is always the histopathological response. However, metabolic response can also guide further treatment. Herein, this study aimed to evaluate metabolic response assessment to neoadjuvant chemotherapy in squamous cell carcinoma esophagus using PET response criteria in solid tumors (PERCIST) criteria with taking histopathological response by tumor regression grading as the standard method.

Methods

Total fifty-seven patients with squamous cell carcinoma esophagus were enrolled between April 2017 to December 2018 for this prospective study. All patients were undergone for baseline PET scan before going for neoadjuvant chemotherapy. Repeat PET scan was done after neoadjuvant chemotherapy. Operable patients were taken for surgery. Final histological response was assessed by Mandard grading. Three metabolic tools [maximum standardized uptake value (SUVmax), tumor regression grading, PERCIST] were compared.

Results

The mean SULpeak of the primary lesion was 11.7 ± 5.5 (median, 10.2, range 5.5–31.8). The average percentage change (%Δ) in SUVmax was 42.9 ± 26.3. On histopathology, 5 (13.1%) patients showed complete pathological response, whereas grade II, III, IV and V in 8 (21.1%), 12 (31.6%), 10 (26.3%) and 3 (7.8%) respectively. On comparison of PERCIST with Mandard grading, agreement analysis showed that there was moderate agreement (k, 0.48). %ΔSUV peak change showed a strong correlation with %ΔSUVmax (P = 0.01) and percentage tumor to liver ratio change (P = 0.01). On comparison, these metabolic response tools showed a weak agreement (k, 0.28 with tumor to liver ratio, k, 0.38 with SUVmax).

Conclusion

After neoadjuvant chemotherapy, 18F-fluorodeoxyglucose PET/CT can help to assess the response and guide the treatment. However, a larger study is warranted to evaluate their correlation with pathological response.
Assessing parent–child interaction in infant deafness
Authors: Curtin Martina , Herman Ros , Cruice Madeline , Morgan Gary
Published: April 2021

Purpose of review

To highlight the importance of parent–child interaction (PCI) in infant deafness and address the lack of robust assessment tools in clinical practice.

Recent findings

Most deaf babies are born to hearing parents with little experience in deafness. Deafness can reduce access to spoken language. Despite advancements in amplification technology, deaf children still present with delays in attention and communication skills at the start of nursery. Research reports that hearing parents of deaf infants can be more directive during interaction, spend less time following the child's focus of attention, and have more difficulty achieving successful turn-taking in conversation. Much research tells us that these factors impact on the quality and quantity of PCI. Good PCI, in all infants, but especially so in deafness, is a strong predictor of child language outcomes. Teachers of the Deaf and Speech and Language Therapists are the first professionals to support families in the home. For these professionals, having an objective way of assessing PCI would greatly assist and standardise their practice. However, to date, there are no deaf-specific assessments to observe and appraise a parent's communication behaviours when interacting with their deaf child.

Intervention studies with families of deaf children have shown success in improving parental sensitivity and facilitative language techniques. An observational assessment in parent–deaf child interaction would ensure that communication interventions are appropriately targeted on the individual family's needs.