bluuebunny/crossref_metadata_2025 huggingface dataset:
Naja atra venom-spit ophthalmia in Taiwan: An epidemiological survey from 1990 to 2016
Authors: Tsai Tsung-Han , Lin Chun-Chi , Mao Yan-Chiao , Hung Chia-Lien , Yang Yi-Chiang , Yang Chen-Chang , Jeng Mei-Jy
Published: November 2019

Background:

Venomous snakebites are common during hot seasons in Taiwan. However, rarely is venom spat directly into the subject’s eyes, causing eye injury. Despite being uncommon, analytical data regarding venom-spit ophthalmia in Taiwan have been lacking. This study thus aimed to conduct an epidemiological survey on Naja atra venom-spit ophthalmia in Taiwan during the past decades to improve future care of such patients.

Methods:

Registered records of cases with snake venom injuries at the Taiwan National Poison Control Center from 1990 to 2016 were retrospectively reviewed, enrolling those with records of cobra venom-spit eye injuries and excluding exotic species. Demographic data, clinical symptoms, snake species, ocular conditions, management, and outcomes were recorded and analyzed.

Results:

A total of 39 cases suffering from Naja atra venom-spit ophthalmia were enrolled. The overall incidence rate was 1.6 cases per million people from 1990 to 2016. Among the included cases, most were unilaterally injured (82%), male (95%), aged 18 to 59 years (90%), injured during catching (51%), and injured in spring and summer (92%). Ocular symptoms occurred in 90% of the cases, majority of which included ocular pain (90%) and redness (85%). Conjunctivitis (67%) and corneal injury (59%) of involved eyes were common. Immediate water irrigations were done in all cases, most of whom received further topical eye drops, including antibiotics, corticosteroids, and vasoconstrictors. Although topical or intravenous antivenoms were administered in 11 cases, no obviously superior outcome was observed. Most cases (77%) were symptom free after the acute stage.

Conclusion:

Although Naja atra venom-spit ophthalmia in Taiwan is uncommon, the risk for transient ocular symptoms and corneal/conjunctival injury does exists. Prompt ocular irrigation and professional ophthalmic care after envenomation help prevent serious ocular sequelae. Moreover, superior outcomes were not achieved with the use of antivenom. Nonetheless, further studies are required to clarify the role antivenoms play in venom-spit ophthalmia.
Exploring HIV-Related Stigma as a Determinant of Engagement in HIV Care by African American Women
Authors: McCoy Katryna , Lipira Lauren , Kemp Christopher G. , Nevin Paul E. , Huh David , M. Turan Janet , Mugavero Michael J. , Cohn Susan E. , Bahk Mieoak , Simoni Jane M. , Andrasik Michele P. , Rao Deepa
Published: November 2019

Engagement in HIV care reduces HIV-related health disparities that persist across racial/ethnic and gender lines; yet, African American (AA) women face multiple challenges to remaining engaged in care, including HIV-related stigma. We analyzed longitudinal data from 239 participants in the Unity Health Study to estimate associations between HIV-related stigma and engagement in care among AA women linked to HIV care. In adjusted Poisson regression analyses, engagement in care was not associated with HIV-related stigma but was associated with older age (incidence rate ratio [IRR] = 1.01, 95% confidence interval [CI] = [1.00–1.01], p = .01), higher levels of education (IRR = 1.18, 95% CI = [1.02–1.35], p = .03), and higher levels of social support (IRR = 1.05, 95% CI = [1.01–1.09], p = .04). Our findings suggest the need for targeted interventions to enhance engagement in care and to incorporate social support into health promotion programming for AA women living with HIV.
Physical Activity and Cognitive Health Among People Living With HIV: An Integrative Review
Authors: Winston Nadia , Swanson Barbara , Capuano Ana W. , Fogg Louis F. , Barnes Lisa L.
Published: November 2019

The purpose of our review was to analyze evidence related to physical activity (PA) and cognitive health in people living with HIV (PLWH), appraise psychometric characteristics of study measures, and calculate effect sizes. A computerized database search of the literature published between 1996 and 2017 was examined for correlational and observational studies that included a sample of PLWH, measured PA, and measured cognitive health. Seven articles met the sampling criteria. Of which, six studies used a cross-sectional design; one used a longitudinal design. All but one found significant positive associations between PA and cognitive health in PLWH. Four studies showed a moderate to high effect for PA on cognitive function (Cohen's d values = 0.45–0.58). None reported sample-specific reliability and validity estimates for PA and cognitive health instruments. PA is a modifiable factor that may delay the onset of cognitive impairment and decline among PLWH.
Direct, Absenteeism, and Disability Cost Burden of Obesity Among Privately Insured Employees
Authors: Ramasamy Abhilasha , Laliberté François , Aktavoukian Shoghag A. , Lejeune Dominique , DerSarkissian Maral , Cavanaugh Cristi , Smolarz B. Gabriel , Ganguly Rahul , Duh Mei Sheng
Published: November 2019

Objective:

To compare obesity-related costs of employees of the healthcare industry versus other major US industries.

Methods:

Employees with obesity versus without were identified using the Optum Health Reporting and Insights employer claims database (January, 2010 to March, 2017). Employees working in healthcare with obesity were compared with employees of other industries with obesity for absenteeism/disability and direct cost differences. Multivariate models estimated the association between industries and high costs compared with the healthcare industry.

Results:

Obesity-related absenteeism/disability and direct costs were higher in several US industries compared with the healthcare industry (adjusted cost differences of $–1220 to $5630). Employees of the government/education/religious services industry (GERS) with obesity (BMI of 30 or greater) had significantly higher odds of direct costs at the 80th percentile and above (odds ratio vs healthcare industry = 2.20; P < 0.05).

Conclusions:

Relative to the healthcare industry, employees of other industries, especially GERS, incurred higher obesity-related costs.
Number of Previous Absences Is a Predictor of Sustained Attendance After Return-to-Work in Workers With Absence due to Common Mental Disorders
Authors: Mishima Masayoshi , Adachi Hiroyoshi , Mishima Chieko
Published: November 2019

Objective:

This study evaluated the relationship of the number of previous episodes due to common mental disorders (CMDs) with long-term outcomes and sustainability of attendance after return-to-work (RTW).

Methods:

Participants were assigned to the following three groups: workers having one (Group 1), two (Group 2), and three or more (Group 3) previous episodes. Outcomes were a recurrent absence and the sustainability rate of attendance after RTW.

Results:

The sustainability rate in Group 1 was significantly higher than that in Group 3 throughout the observation period. The sustainability rates for Group 2 were significantly higher than for Group 3 at 30 and 36 months.

Conclusions:

The number of previous episodes was shown to affect sustainability of attendance after RTW due to CMDs, indicating that repeated previous absences are a significant prognostic factor.
A Call to Follow-Up: Results Regarding Trauma Clinic Follow-Up Patterns
Authors: Trevino Colleen M. , Cooros James C. , Chesney Samantha A. , deRoon-Cassini Terri , Carver Thomas W. , Milia David Joseph
Published: November 2019

The objective of this study was to assess the current practice pattern regarding posthospitalization follow-up of trauma patients among the members of the Eastern Association for the Surgery of Trauma (EAST). An anonymous online multiple-choice survey of EAST members in 2016 was conducted. Ten questions relating to the follow-up care of injured patients were presented to the Active, Senior, and Associate members of EAST. Data were screened for quantitative concerns prior to analysis. Of the 1,610 members surveyed, 289 responded (18%). Approximately 52% of respondents stated that their institution has a dedicated trauma follow-up clinic where most injured patients are seen after discharge. Less than 20% reported that nontrauma multidisciplinary providers are present in clinics. Most (89.5%) reported that follow-up is a single visit, unless a patient has long-standing issues. Only 3 respondents stated that patients are regularly seen 3+ months out from injury, and a significant minority (17.7%) acknowledged no set follow-up timeline. Only 3.6% of participants indicated that they have a psychologist embedded in the trauma team, and 11.5% reported that no system is currently in place to manage mental health. Despite more than 20 years of literature highlighting the long-term physical and mental health sequelae after trauma, these survey results demonstrate that there is a lack of standardized and multidisciplinary follow-up. Given the improvement in outcomes with the identification and treatment of these sequelae, greater attention should be paid to functional recovery, social and psychological well-being, and chronic pain.
A Systematic Review of Barriers and Facilitators for Concussion Reporting Behavior Among Student Athletes
Authors: Clark Ricketta , Stanfill Ansley Grimes
Published: November 2019

Despite increasing attention to concussion safety, many young athletes still do not report concussion-like symptoms to athletic staff. This systematic review was conducted to identify barriers and facilitators to reporting of concussions by high school and collegiate athletes. The review was conducted using PubMed, SCOPUS, CINAHL Complete, and Cochrane Library. Original research articles were deemed eligible if they contained either qualitative or quantitative data on barriers and facilitators of high school and collegiate athletes self-reporting concussion symptoms to athletic staff. For those articles that met inclusion criteria, both authors critically read each article, summarized reasons given by the authors, and then categorized this information into a barrier or a facilitator of concussion-reporting behavior. Of the 878 articles returned, 24 articles met inclusion criteria. Major facilitators were female sex and younger age. Major barriers were a fear of losing current or future playing time, a misconception that concussive injury is not serious, a fear of letting one's team down, and a lack of knowledge of concussion signs and symptoms. Future interventions should address these issues, incorporate primary and secondary prevention strategies, and emphasize the long-term risks of playing while concussed.
Inappropriate Use of Aztreonam
Authors: Steiner Ryan , King Madeline , Byrne Dana , Rose Lucia
Published: November 2019

Background:

Aztreonam is not a preferred empiric antibiotic because of variable susceptibilities compared with alternative agents. In addition, it has no Gram-positive activity, necessitating coadministration with vancomycin when used empirically, and is more costly when compared with other Gram-negative active agents. Aztreonam is often given to patients with a reported penicillin allergy without further investigation into the reaction or other relevant allergy information.

Study Question:

How frequently is aztreonam being used inappropriately?

Study Design:

We conducted a retrospective chart review at an academic medical center to assess the appropriateness of our aztreonam use.

Measures and Outcomes:

Our primary outcome was frequency of appropriate aztreonam use, based on a true IgE-mediated allergy reported for each patient. We evaluated whether the patients had tolerated a beta-lactam in the past, and what the reported allergic reaction was.

Results:

We included 165 patients and found that 46.7% of our aztreonam use was inappropriate, based on previous use of a beta-lactam, or no documentation of an IgE-mediated response. Of the patients with a documented beta-lactam allergy, 63 (38.2%) patients had no allergy manifestation listed, and 37 (22.4%) patients had a non–IgE-mediated allergy manifestation. Of the total population, 61 (37%) patients had tolerated a beta-lactam in the past.

Conclusions:

Aztreonam should be avoided, except in the case of a true IgE-mediated allergic reaction. Our goal was to reduce the inappropriate use of aztreonam at our institution by one or more of the following: educating providers, reviewing aztreonam orders, requiring answering of order questions, or requiring an indication for use. Penicillin skin testing and desensitization are options as well.
Direct bilirubin level is an independent risk factor for atrial fibrillation in thyrotoxic patients receiving radioactive iodine therapy
Authors: Sun Danyang , Li Wei , Zheng Wei , Tan Jian , Zhang Guizhi
Published: November 2019

Objectives

This study aimed to indicate the risk factors of atrial fibrillation (AF) in thyrotoxic patients receiving radioactive iodine (RAI) therapy after antithyroid drug and other medication.

Methods

This study was a retrospective cohort study. Thyrotoxic patients were divided into two groups, with or without AF. Clinical features were retrospectively analyzed. Univariate and multivariate analyses of data from thyrotoxic patients were performed to evaluate the probability of AF.

Results

The following clinical factors were found to be correlated with AF: age, gender, duration of hyperthyroidism, coronary artery disease, hypertension, and levels of platelets, creatinine, uric acid (UA), and certain liver enzymes. According to the multiple logistic regression model, age and levels of UA, direct bilirubin (DBIL), and gamma-glutamyl transpeptidase (GGT) were important risk factors for predicting AF. ROC analysis showed that DBIL levels were predictive of AF, with a specificity of 0.813, a sensitivity of 0.767, and an area under the curve of 0.8515 (P < 0.001).

Conclusion

Older age and levels of UA, DBIL, and GGT influenced the occurrence of AF in thyrotoxic patients receiving RAI. DBIL level was an important factor in predicting AF in patients with hyperthyroidism. Thus, thyrotoxic patients who have the above-mentioned risk factors should undergo routine pulse palpation should be considered for active antithyroid drug therapy.
Post-stroke dysphagia rehabilitation in the old and oldest old: outcome and relevance for discharge home
Authors: Castagna Alberto , Ferrara Lucia , Asnaghi Emanuela , Colombo Valeria , Rega Vincenzo , Fiorini Gianfrancesco
Published: November 2019

We assessed the outcome of dysphagia rehabilitation in all the 139 patients with post-stroke dysphagia admitted to our Neurorehabilitation Unit during 2 years (2017 and 2018), divided into two groups: old (aged 65–84 years) and oldest-old (aged 85 or above). We studied which factors predicted dysphagia improvement in the two groups. The potential association of improvement with type of discharge was also evaluated. On admission, ‘old’ patients had more frequently aphasia (P = 0.02) and less frequently dysarthria (P = 0.03); ‘oldest old’ had more severe pressure ulcers (P = 0.008), higher levels of c reacting protein (P = 0.01) and more heart problems (P = 0.004). None of these factors was associated with the outcome of dysphagia. We found no difference between the two groups in the severity of dysphagia, as measured with Dysphagia Outcome and Severity Scale on admission and discharge, but due to minor differences, the degree of improvement was higher in the ‘old’ group (P = 0.02). The number of patients discharged with improved swallowing was also comparable. Cognitive impairment had a negative predicting role in the ‘old’ group (odds ratio 0.270, 95% confidence interval 0.101–0.725, P = 0.007). Norton Scale score predicted dysphagia improvement in the ‘oldest old’ group (odds ratio 1.611, 95% confidence interval 1.102–2.355, P = 0.007). Dysphagia improvement was associated with discharge home in general (P = 0.011) and in the ‘old’ group (P = 0.04). Our data, though preliminary, could give a contribution to implement patient-specific rehabilitation strategies; these could increase swallowing improvement in post-stroke dysphagia.
Physical Symptom Cluster Subgroups in Chronic Kidney Disease
Authors: Lockwood Mark B. , Lash James P. , Pauls Heather , Chung Seon Yoon , Samra Manpreet , Ryan Catherine , Park Chang , DeVon Holli , Bronas Ulf G.
Published: November 2019

Background

Symptom burden associated with chronic kidney disease can be debilitating, with a negative effect on patient health-related quality of life. Latent class clustering analysis is an innovative tool for classifying patient symptom experience.

Objectives

The aim of the study was to identify subgroups of patients at greatest risk for high symptom burden, which may facilitate development of patient-centered symptom management interventions.

Methods

In this cross-sectional analysis, baseline data were analyzed from 3,921 adults enrolled in the Chronic Renal Insufficiency Cohort Study from 2003 to 2008. Latent class cluster modeling using 11 items on the Kidney Disease Quality of Life symptom profile was employed to identify patient subgroups based on similar observed physical symptom response patterns. Multinomial logistic regression models were estimated with demographic variables, lifestyle and clinical variables, and self-reported measures (Kidney Disease Quality of Life physical and mental component summaries and the Beck Depression Inventory).

Results

Three symptom-based subgroups were identified, differing in severity (low symptom, moderate symptom, and high symptom). After adjusting for other variables in multinomial logistic regression, membership in the high-symptom subgroup was less likely for non-Hispanic Blacks and men. Other factors associated with membership in the high-symptom subgroup included lower estimated glomerular filtration rate, history of cardiac/cardiovascular disease, higher Beck Depression Inventory scores, and lower Kidney Disease Quality of Life physical and mental component summaries.

Discussion

Three symptom subgroups of patients were identified among patients with mild-to-moderate chronic kidney disease. Several demographic and clinical variables predicted membership in subgroups. Further research is needed to determine if symptom subgroups are stable over time and can be used to predict healthcare utilization and clinical outcomes.
Patient Ethnicity and Pediatric Visits to the Emergency Department for Fever
Authors: Shapiro Daniel J. , Fine Andrew M.
Published: November 2019

Objectives

Previous research has identified ethnic differences in parents' beliefs about fever, but whether patient ethnicity is associated with health care use for fever is uncertain. Our objectives were to describe the national rate of pediatric visits to the emergency department (ED) for fever and to determine whether there is variation in this rate by patient ethnicity.

Methods

Using the National Hospital Ambulatory Medical Care Survey between 2012 and 2015, we estimated the proportion of ED visits with a complaint of fever by patients 0 to 18 years old and compared this proportion across patient ethnicity. We performed multivariable logistic regression controlling for sociodemographic characteristics and visit acuity to determine whether patient ethnicity was independently associated with visits for fever.

Results

Fever was the reason for 19% [95% confidence interval (CI), 18%–20%] of pediatric visits to the ED, and the proportion of visits for fever was highest among Hispanic patients (25%; 95% CI, 23%–27%) and lowest among non-Hispanic white patients (15%; 95% CI, 14%–17%). In multivariable analysis, the adjusted odds of visits for fever were greater for Hispanic patients (odds ratio, 1.56; 95% CI, 1.38–1.83) and non-Hispanic non-black patients of other races (1.34; 95% CI, 1.02–1.77) compared with non-Hispanic white patients.

Conclusions

There is significant ethnic variation in the use of emergency medical services for fever in the United States, and these disparities are not fully explained by differences in the acuity of illness or differences in socioeconomic status. Interventions to empower parents to manage nonurgent pediatric fever should incorporate ethnocultural differences in parents' understanding of fever.
Global status of Toxoplasma gondii infection and associated risk factors in people living with HIV
Authors: Safarpour Hanie , Cevik Muge , Zarean Mehdi , Barac Aleksandra , Hatam-Nahavandi Kareem , Rahimi Mohammad T. , Bannazadeh Baghi Hossein , Koshki Tohid J. , Pagheh Abdol S. , Shahrivar Firooz , Ebrahimi Mina , Ahmadpour Ehsan
Published: November 2019

Objective:

Toxoplasma infection remains as the most common cause of focal brain lesions among people living with HIV (PLHIV) despite the decline in opportunistic infections with the introduction of antiretroviral treatment. This study was conducted to provide a summary of evidence about the seroprevalence of Toxoplasma gondii and prevalence of active T. gondii infection and associated risk factors among PLHIV.

Design:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Scopus, PubMed, Science Direct and EMBASE were searched from 1997 to July 2018. All peer-reviewed original research articles describing T. gondii infection among PLHIV with different diagnostic methods were included.

Methods:

Incoherence and heterogeneity between studies were quantified by I
2 index and Cochran's Q test. Publication and population bias were assessed with funnel plots and Egger's regression asymmetry test. All statistical analyses were performed using StatsDirect.

Results:

In total, 111 studies from 37 countries assessing 66 139 blood samples were included in this study. The pooled prevalence of T. gondii infection among PLHIV was 3.24% by IgM and 26.22% by molecular methods using the random-effects model. Pooled seroprevalence of T. gondii by IgG was 44.22%. There was a relationship between Toxoplasma prevalence and sex, raw meat consumption, contact with cat and knowledge about toxoplasmosis.

Conclusion:

High Toxoplasma seroprevalence among PLHIV observed in this study emphasizes the need for implementing screening and prophylaxis tailored to the local context. Owing to the serious and significant clinical manifestations of the parasite in case of reactivation, early identification of seropositivity for initiating prophylaxis among those with a CD4+ cell count of less than 200 cells/ml is recommended.
Upregulation of IL-32 Isoforms in Virologically Suppressed HIV-Infected Individuals: Potential Role in Persistent Inflammation and Transcription From Stable HIV-1 Reservoirs
Authors: Zaidan Sarah M. , Leyre Louise , Bunet Rémi , Larouche-Anctil Etienne , Turcotte Isabelle , Sylla Mohamed , Chamberland Annie , Chartrand-Lefebvre Carl , Ancuta Petronela , Routy Jean-Pierre , Baril Jean-Guy , Trottier Benoit , MacPherson Paul , Trottier Sylvie , Harris Marianne , Walmsley Sharon , Conway Brian , Wong Alexander , Thomas Réjean , Kaplan Robert C. , Landay Alan L. , Durand Madeleine , Chomont Nicolas , Tremblay Cécile L. , El-Far Mohamed ,   for the Canadian HIV and Aging Cohort Study
Published: November 2019

Background:

Human IL-32 is a polyfunctional cytokine that was initially reported to inhibit HIV-1 infection. However, recent data suggest that IL-32 may enhance HIV-1 replication by activating the HIV-1 primary targets, CD4+ T-cells. Indeed, IL-32 is expressed in multiple isoforms, some of which are proinflammatory, whereas others are anti-inflammatory.

Setting and Methods:

Here, we aimed to determine the relative expression of IL-32 isoforms and to test their inflammatory nature and potential to induce HIV-1 production in latently infected cells from virologically suppressed HIV-infected individuals. IL-32 and other cytokines were quantified from plasma and supernatant of CD4+ T-cells by ELISA. Transcripts of IL-32 isoforms were quantified by qRT-PCR in peripheral blood mononuclear cells. The impact of recombinant human IL-32 isoforms on HIV-1 transcription was assessed in CD4+ T-cells from HIV-1+cART+ individuals by qRT-PCR.

Results:

All IL-32 isoforms were significantly upregulated in HIV-1+cART+ compared to HIVneg individuals with IL-32β representing the dominantly expressed isoform, mainly in T-cells and NK-cells. At the functional level, although IL-32γ induced typical proinflammatory cytokines (IL-6 and IFN-γ) in TCR-activated CD4+ T-cells, IL-32α showed an anti-inflammatory profile by inducing IL-10 but not IL-6 or IFN-γ. However, IL-32β showed a dual phenotype by inducing both pro- and anti-inflammatory cytokines. Interestingly, consistent with its highly pro-inflammatory nature, IL-32γ, but not IL-32α or IL-32β, induced HIV-1 production in latently infected CD4+ T-cells isolated from combined antiretroviral therapy–treated individuals.

Conclusions:

Our data report on the differential expression of IL-32 isoforms and highlight the potential role of IL-32, particularly the γ isoform, in fueling persistent inflammation and transcription of viral reservoir in HIV-1 infection.
Renal Metastasis From Neuroblastoma Shown on MIBG Imaging
Authors: Wen Zhe , Zhuang Hongming
Published: November 2019

A 6-year-old girl with high-risk neuroblastoma underwent a 123I-MIBG scan to monitor the disease status. In addition to the known lesion in the right retroperitoneal region, there were additional foci of increased activity in the right upper quadrate of the abdomen, which were not typical bowel activity. SPECT/CT images located the activity in the cortex of the lower pole of the right kidney, which was partially calcified. Subsequent biopsy confirmed neuroblastoma metastasis to the right kidney, which is extremely rare.
Isolated Immunoglobulin G4–Related Disease of Nasal Septum and Maxilla
Authors: Rodriguez Fonseca Omar Dario , Suarez Juan Pablo , Dominguez Maria Luz , Fernandez Llana Belen , Vigil Carmen , Martin Noelia , Gonzalez Francisco Manuel
Published: November 2019

Immunoglobulin G4–related disease (IgG4-RD) is a systemic inflammatory condition that can manifest in atypical locations. We present the case of a middle-aged woman presenting with isolated IgG4-RD of left maxilla and nasal septum, confirmed with 18F-FDG PET/CT. She achieved complete metabolic response with multiple pharmacologic treatment, but 1 year later, she experienced local relapse, and FDG PET/CT found new additional lesions in humeral vasculature and lungs. This case illustrates the usefulness of FDG PET/CT for initial evaluation and monitoring of IgG4-RD with unusual nasomaxillary involvement.
Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons
Authors: Kelz Rachel R. , Niknam Bijan A. , Sellers Morgan M. , Sharpe James E. , Rosenbaum Paul R. , Hill Alexander S. , Zhou Hong , Hochman Lauren L. , Bilimoria Karl Y. , Itani Kamal , Romano Patrick S. , Silber Jeffrey H.
Published: November 2019

Objective:

The aim of the study was to address the controversy surrounding the effects of duty hour reform on new surgeon performance, we analyzed patients treated by new surgeons following the transition to independent practice.

Summary Background Data:

In 2003, duty hour reform affected all US surgical training programs. Its impact on the performance of new surgeons remains unstudied.

Methods:

We studied 30-day mortality among 1,483,074 Medicare beneficiaries undergoing general and orthopedic operations between 1999 and 2003 (“traditional“ era) and 2009 and 2013 (“modern” era). The operations were performed by 2762 new surgeons trained before the reform, 2119 new surgeons trained following reform and 15,041 experienced surgeons. We used a difference-in-differences analysis comparing outcomes in matched patients treated by new versus experienced surgeons within each era, controlling for the hospital, operation, and patient risk factors.

Results:

Traditional era odds of 30-day mortality among matched patients treated by new versus experienced surgeons were significantly elevated [odds ratio (OR) 1.13; 95% confidence interval (CI) (1.05, 1.22), P < 0.001). The modern era elevated odds of mortality were not significant [OR 1.06; 95% CI (0.97–1.16), P = 0.239]. Relative performance of new and experienced surgeons with respect to 30-day mortality did not appear to change from the traditional era to the modern era [OR 0.93; 95% CI (0.83–1.05), P = 0.233]. There were statistically significant adverse changes over time in relative performance to experienced surgeons in prolonged length of stay [OR 1.08; 95% CI (1.02–1.15), P = 0.015], anesthesia time [9 min; 95% CI (8–10), P < 0.001], and costs [255USD; 95% CI (2–508), P = 0.049].

Conclusions:

Duty hour reform showed no significant effect on 30-day mortality achieved by new surgeons compared to their more experienced colleagues. Patients of new surgeons, however, trained after duty hour reform displayed some increases in the resources needed for their care.
Inner Deliberations of Surgeons Treating Critically-ill Emergency General Surgery Patients
Authors: Kulkarni Shreyus S. , Briggs Alexandra , Sacks Olivia A. , Rosengart Matthew R. , White Douglas B. , Barnato Amber E. , Peitzman Andrew B. , Mohan Deepika
Published: November 2019

Background:

30% of elderly patients who require emergency general surgery (EGS) die in the year after the operation. Preoperative discussions can determine whether patients receive preference-sensitive care. Theoretically, surgeons frame their conversations after systematically assessing the risks and benefits of management options based on the clinical characteristics of each case. However, little is known about how surgeons actually deliberate about those options.

Objective:

To identify variables that influence surgeons’ assessment of management options for critically-ill EGS patients.

Methods:

We conducted semi-structured interviews with 40 general surgeons in western Pennsylvania who worked in a variety of hospital settings. Interviews explored perioperative decision-making by asking surgeons to think aloud about selected memorable cases and a standardized case vignette of a frail patient with acute mesenteric ischemia. We used constant comparative methods to analyze interview transcripts and inductively developed a framework for the decision-making process.

Results:

Surgeons averaged 13 years (standard deviation (SD) 10.4) of experience; 40% specialized in trauma/acute care surgery. Important themes regarding the main topic of “perioperative decision-making” included many considerations beyond the clinical characteristics of cases. Surgeons described the importance of variables ranging from the availability of institutional resources to professional norms. Surgeons often remarked on their desire to achieve individual flow, team efficiency, and concordant expectations of treatment and prognosis with patients.

Conclusions:

This is the first study to explore how surgeons decide among management options for critically-ill EGS patients. Surgeons’ decision-making reflected a broad array of clinical, personal, and institutional variables. Effective interventions to ensure preference-sensitive care for EGS patients must address all of these variables.
Mathematical Analysis of EEG Concordance in Preterm Twin Infants
Authors: Lloyd Rhodri O. , O'Toole John M. , Livingstone Vicki , Filan Peter M. , Boylan Geraldine B.
Published: November 2019

Purpose:

Preterm twins are at higher risk of neurodisability than preterm singletons, with monochorionic–diamniotic (MCDA) twins at higher risk than dichorionic–diamniotic (DCDA) twins. The impact of genetic influences on EEG concordance in preterm twins <32 weeks of gestational age is not established. This study aims to investigate EEG concordance in preterm MCDA and dichorionic–diamniotic twins during maturation.

Methods:

Infants <32 weeks of gestational age had multichannel EEG recordings for up to 72 postnatal hours, with repeat recordings at 32 and 35 weeks of postmenstrual age. Twin pairs had synchronous recordings. Mathematical EEG features were generated to represent EEG power, discontinuity, and symmetry. Intraclass correlations, while controlling for gestational age, estimated similarities within twins.

Results:

EEGs from 10 twin pairs, 4 MCDA and 6 dichorionic–diamniotic pairs, and 10 age-matched singleton pairs were analyzed from a total of 36 preterm infants. For MCDA twins, 17 of 22 mathematical EEG features had significant (>0.6; P < 0.05) intraclass correlations at one or more time points, compared with 2 of 22 features for DCDA twins and 0 of 22 for singleton pairs. For MCDA twins, all 10 features of discontinuity and all four features of symmetry were significant at one or more time-points. Three features of the MCDA twins (spectral power at 3–8 Hz, EEG skewness at 3–15 Hz, and kurtosis at 3–15 Hz) had significant intraclass correlations over all three time points.

Conclusions:

Preterm twin EEG similarities are subtle but clearly evident through mathematical analysis. MCDA twins showed stronger EEG concordance across different postmenstrual ages, thus confirming a strong genetic influence on preterm EEG activity at this early development stage.
Citalopram reduces glutamatergic synaptic transmission in the auditory cortex via activation of 5-HT1A receptors
Authors: Cervantes-Ramírez Víctor , Canto-Bustos Martha , Aguilar-Magaña Diana , Pérez-Padilla Elsy Arlene , Góngora-Alfaro José Luis , Pineda Juan Carlos , Atzori Marco , Salgado Humberto
Published: November 2019

Serotonin modulates cognitive processes and is related to various psychiatric disorders, including major depression. Administration of citalopram reduces the amplitude of auditory evoked potentials in depressed people and animal models, suggesting that 5-HT has an inhibitory role. Here, we characterize the modulation of excitatory post-synaptic currents by application of either 5-HT or agonists of 5-HT1A and 5-HT2 receptors, or by endogenous 5-HT evoked by citalopram on pyramidal neurons from layer II/III of rat auditory cortex. We found that application of 5-HT concentration-dependently reduces excitatory post-synaptic currents amplitude without changing the paired-pulse ratio, suggesting a post-synaptic modulation. We observed that selective agonists of 5-HT1A and 5-HT2 receptors [8-OH-DPAT (10 µM) and DOI (10 µM), respectively] mimic the effect of 5-HT on the excitatory post-synaptic currents. Effect of 5-HT was entirely blocked by co-application of the antagonists NAN-190 (1 µM) and ritanserin (200 nM). Similarly, citalopram application (1 μM) reduced the amplitude of the evoked excitatory post-synaptic currents. Reduction in the magnitude of the excitatory post-synaptic currents by endogenous 5-HT was interpolated in the dose-response curve elicited by exogenous 5-HT, yielding that citalopram raised the extracellular 5-HT concentration to 823 nM. Effect of citalopram was blocked by the previous application of NAN-190 but not ritanserin, indicating that citalopram reduces glutamatergic synaptic transmission via 5-HT1A receptors in layer II/III of the auditory cortex. These results suggest that the local activity of 5-HT contributes to decrease in the basal excitability of the auditory cortex for enhancing the detection of external relevant acoustic signals.
Storage and sensory characteristics according to drying methods of dried oriental melon
Authors: Koo Hansol , Lee Jieon , Jung Hyuna
Published: November 2019

This study aims to develop processing and storage conditions for improving the ease of consumption of oriental melon by investigating the changes in its quality and sensory characteristics as a function of the storage period and drying method. Various drying methods were investigated, and the moisture content of the cold air-dried oriental melon was stable from the fifth day. The pH varied significantly during storage (about pH 5-6, p<0.01, 0.001), and the sugar content increased significantly in all treatment groups. The chromaticity, which is indicated by the L value, was highest in freeze-drying, and did not vary significantly after cold air- and freeze-drying, and remained the same during storage. The storage period for freeze-drying was loger (p<0.001), and the various physical properties, such as strength, hardness, chewiness, and brittleness, did not show significant variation from the fifth day of storage. Significant difference in springiness was not observed, and this characteristic was maintained during storage. The total bacterial count was lowest with a value of 4.02 log CFU/g on the first day of the freeze-drying storage but increased upon longer storage. However, significant changes in this parameter in comparison to other treatment groups were not observed. The results indicated that the preferred method of achieving the best sensory characteristics, which included superior aroma and chewiness, was cold air-drying. To prevent changes to the quality characteristics of dried oriental melon, follow-up conditions and procedures, such as the use of hygienic drying environment, storage at 4℃, and vacuum packaging and sterilized packing paper are necessary. The data disclosed in this study will form the basis for further development of conditions for efficient processing of oriental melon and health food using the cold air-drying method for preserving the quality and delivering optimal storage conditions.
Quality characteristics of barley-Makgeolli fermented from yeast Y204 with different fermented agents
Authors: Kim Sun Hee , Mun Ji-Young , Kim Joo-Yeon , Kim So Young , Yeo Soo-Hwan
Published: November 2019

In this study, we compared the quality characteristics of barley-Makgeolli prepared with different nuruk fermentation starters for Saccharomyces cerevisiae Y204 at various temperatures (15, 20 and 25℃) and for different fermentation periods. The pH of the barley-Makgeolli produced by the nuruk of A. oryzae 75-2 (AO) was in the 6.4-4.9 range, which is significantly different to that (3.7-3.3) of the barley-Makgeolli produced using the nuruk of A. luchuensis 74-5 (AL). Barley-Makgeolli exhibited 0.2% acidity when prepared using AO, and 0.8% with AL. The amino-acid content increased on the second day of fermentation and was smoothly maintained to the end of the fermentation period, except when fermented at 25℃. The sugar content of AO Makgeolli was significantly higher than that of AL Makgeolli. Saccharomyces cerevisiae Y204 showed good alcohol fermentation (15-16%) at 25℃ for both AO and AL barley-Makgeolli. The malic acid content of the organic acids increased with increasing fermentation temperature and the citric acid content was the highest in AL barley-Makgeolli when fermented at low temperature. The aroma component patterns of each barley Makgeolli was able to predict the diversity of each flavor pattern on the basis of differences in the AO and AL fermentation groups and temperature. Therefore, barley-Makgeolli produced by Y204 is expected to exhibit superior quality due to the good alcohol producing ability of the Y204 yeast.
Bioactive compounds and antioxidant capacity of domestic citrus cultivar ‘Haryejosaeng’
Authors: Kim Sang Suk , Park Kyung Jin , Yun Su Hyun , Choi Young Hun
Published: November 2019

A new early maturing satsuma mandarin (Citrus unshiu Marc.) ‘Haryejosaeng’ was developed at the Citrus Research Institute, Korea. The present study investigated the variation in total phenolics (TP), flavonoid, and antioxidant activity of fruits of ‘Haryejosaeng’ according to the harvest from September 2018 to December 2018, in Jeju. Colorirmetric methods were employed for the quantitative TP analysis, and the antioxidant activity by in vitro assay methods for DPPH, ABTS, hydroxyl radical, superoxide anion radical, nitric oxide, and hydrogen peroxide. The flavonoid and carotenoid compositions of ‘Haryejosaeng’ were compared with HPLC method. The total phenolics contents, flavonoid, antioxidant activity in both peel and flesh of ‘Haryejosaeng’ decreased during ripening. However, the amounts of β-cryptoxanthin in flesh increased from 0.2 to 1.86 mg/100 g during ripening. The major flavonoids of ‘Haryejosaeng’ extract were narirutin, hesperidin, rutin, nobiletin, and tangeretin. The changes observed for the antioxidant activity of ‘Haryejosaeng’ was correlated with the content of flavonoid and phenolics which can indicate that these compounds may act by capturing free radicals. Therefore, these results suggest that fruits of ‘Haryejosaeng’ are a significant source of antioxidant compounds such as phenolics, flavonoid and β-cryptoxanthin. These finding will allow the determination of appropriate times for harvesting Haryejosaengs containing the highest amount of specific bioactive makers for achieving improved health benefits and functional properties.
Improvement of granule softening and constipation function of Job’s-tears via emzymatization
Authors: Lee You-Seok , Lee Sun-Kyung , Ji Soo-Hyun , Jo Gyeong-Suk , Kang Jeong-Hwa
Published: November 2019

The recent increase in elderly population has contributed to the increasing interest in the foods for the elderly. This research focuses on softening the texture of job’s-tear granules by enzyme treatment and the evaluation of their constipation improvement function via in vivo evaluation using mouse models. After enzyme treatment, the Job’s-tears exhibited a marked softening with a 70% reduction of hardness upon alternating treatment with commercial amylase and protease for 2 hours at 0.1% concentrations. Microstructure analysis with scanning electron microscopy revealed the degree of collapse of the Job’s-tear granules and the level of tissue degradation. Constipation was induced using loperamide, and the relief effect of softened Job’s-tears was determined over three dosage (500, 1,000, 2,000 mg/kg) using the data from the number of feces, and blood tests in the mouse model. The optimum dose of the enzymatized Job’s-tears was determined to be 500 mg/kg (EA500), which effectively improve excretion movement without liver toxicity. Compared with the control group, oral administration of enzymatized Job’s-tear resulted in higher fecal moisture content, higher fecal numbers, and increased length and width of intestinal epithelial cells in the mucous membranes. In conclusion, softened Job’s-tears were successfully produced by enzyme treatment, and their constipation relief function was confirmed in a mouse model. The results of the present investigation are expected to contribute to the development of foods for the elderly.
Production of Compound K using ginsenosides from ginseng leaf by commercial enzyme
Authors: Kim Sang Jin , Park Chang-Su
Published: November 2019

This study aimed to prepare a valuable minor ginsenoside Compound K, using ginsenosides from ginseng leaf, by-products of ginseng, with a food-grade commercial enzyme Cytolase PCL 5. The total content of major ginsenosides in ginseng leaf extract was 146.9 mg/g and that of the PPD-type ginsenosides such as Rb1, Rb2, Rc, Rd and F2 was 5.7, 11.5, 19.8, 16.4, and 9.8 mg/g, respectively. Cytolase PCL5 showed very efficient enzymatic activity to produce Compound K from the PPD-type gisenosides of ginseng leaf extract. The Cytolase PCL5 exhibited the highest activity at pH 4.5 and 65℃, and the half-lives of the enzyme at 50, 55, 60, 65, 70, and 75℃ were 118, 94, 87, 60, 47, and 8 h, respectively. During Compound K production, the optimal concentrations of PPD-type ginsenosides and enzyme were 10 mg/g and 100 U/ml, respectively. Under optimum conditions, Cytolase PCL5 produced Compound K from PPD-type ginsenosides with a molar yield of over 97% and productivity of 1 mmole/L/h within 10 h. These results suggest that the ginseng leaf is a potential producer of Compound K and Cytolase PCL5 is a very useful enzyme for Compound K production.
Motivational Strategies for Stroke Rehabilitation: A Descriptive Cross-sectional Study
Authors: Oyake Kazuaki , Suzuki Makoto , Otaka Yokei , Tanaka Satoshi
Published: November 2019

Background and Purpose

The addition of motivational strategies to a rehabilitation program is thought to enhance patient adherence and improve outcomes. However, little is known about how rehabilitation professionals motivate stroke patients during rehabilitation. The primary objective of this study was to provide a comprehensive and quantitative list of motivational strategies for stroke rehabilitation. In addition, we aimed to examine (1) whether professionals with more clinical experience used a higher number of motivational strategies, (2) the purpose for using each strategy, and (3) the information considered when choosing strategies.

Methods

This descriptive, cross-sectional study was conducted using a web survey with a random sample of 407 rehabilitation professionals including physicians, nurses, physical therapists, occupational therapists, and speech-language-hearing therapists.

Results

We received data for 362 participants. Fifteen strategies were found to be used by more than 75% of the respondents reported using to motivate their patients. Almost all of the respondents reported that they actively listen to and praise their patients to increase patient adherence to rehabilitation programs. Respondents with more clinical experience tended to use a higher number of motivational strategies (rho = 0.208, p < 0.001). For 11 of the 15 strategies selected by more than 75% of respondents, the highest percentage of respondents reported that they used the strategies to make rehabilitation worthwhile for their patients. The majority of respondents reported that they decide which motivational strategy to use by considering comprehensive information regarding the patient health condition, environmental factors, and personal factors.

Conclusions

The comprehensive list of motivational strategies obtained may be useful for increasing patient adherence to rehabilitation, especially for professionals with less clinical experience. Furthermore, our findings regarding the purpose for using each strategy and the information used to choose strategies might help rehabilitation professionals to utilize the motivational strategy list.
Genomic Epidemiology of Methicillin-Resistant Staphylococcus aureus in Two Cohorts of High-Risk Military Trainees
Authors: Lee Robyn S. , Millar Eugene V. , Callendrello Alanna , English Caroline E. , Elassal Emad M. , Ellis Michael W. , Bennett Jason W. , Hanage William P.
Published: November 2019

Background

MRSA skin and soft tissue infection (SSTI) is a significant cause of morbidity in military trainees. To guide interventions, it is critical we understand the epidemiology of MRSA in this population.

Methods

Two cohorts (‘companies’) of US Army Infantry trainees (N=343) at Fort Benning, GA, USA, were followed during their training cycles (Jun.-Dec. 2015). Trainees had nares, oropharynx, perianal and inguinal areas swabbed for MRSA colonization at five ∼2-4 week intervals, and monitored for SSTI throughout training. Epidemiological data were collected. Isolates were sequenced using Illumina HiSeq and NovaSeq. Single-nucleotide polymorphisms and clusters were identified. Multi-locus sequence type (MLST) and antimicrobial resistance genes were predicted from de novo assemblies.

Results

87 trainees were positive at least once for MRSA (12 had SSTI, 2 without any colonization). Excluding those positive at baseline, 43.7% were colonized within the first month of training. 244/254 samples were successfully sequenced (including all SSTI). ST8 (n=135, 100% of SSTI), ST5 (n=81) and ST87 (n=21) were the most represented. Three main Clusters were identified, largely corresponding to these STs. Sub-analyses within Clusters showed multiple importations of MRSA, with transmission subsequently predominantly within, rather than between, platoons in each company. Over 50% of trainees were colonized only at other anatomical sites; restricting analyses to nares missed substantial transmission.

Conclusions

Serial importations of MRSA into this high-risk setting likely contribute to the ongoing burden of MRSA colonization and infection among military trainees. Sampling multiple anatomical sites is critical for comprehensive characterization of MRSA transmission

US Infantry trainees were followed through training for MRSA skin and soft tissue infection, swabbing for colonization at 2-4 week intervals. Sequencing suggests serial importations of diverse strains on base, followed by transmission mostly within platoons, involving multiple anatomical sites.