bluuebunny/crossref_metadata_2025 huggingface dataset:
Treating spondyloarthritis early: does it matter? Results from a systematic literature review
Authors: Capelusnik Dafne , Benavent Diego , van der Heijde Désirée , Landewé Robert , Poddubnyy Denis , van Tubergen Astrid , Falzon Louise , Navarro-Compán Victoria , Ramiro Sofia
Published: September 2022

Objective

To summarize evidence on the relationship between early treatment (definition based on symptom/disease duration or radiographic damage) and treatment clinical response in patients with SpA.

Methods

A systematic literature review was conducted in studies on SpA patients treated with NSAIDs or biological/targeted synthetic DMARDs addressing the impact of symptom/disease duration or presence of radiographic damage on treatment response assessed by any disease activity outcome. For categorical outcomes, relative risk, relative risk ratio and number needed to treat were calculated, and for continuous outcomes, differences in differences, to compare groups stratified based on symptom/disease duration or the presence of radiographic damage.

Results

From the 8769 articles retrieved, 25 were included and 2 added by hand-search, all in axial SpA (axSpA), most of them with low risk of bias. Twenty-one studies compared groups based on symptom duration (n = 6) or disease duration (n = 15) and seven studies based on absence/presence of radiographic damage (two studies used two comparisons). When early axSpA was defined by symptom duration (<5 years) in randomized controlled trials, early treatment was associated with better outcomes in patients with non-radiographic axSpA [n = 2, ASAS40 relative risk ratio 5.24 (95% CI 1.12, 24.41) and 1.52 (0.60, 3.87)] but not in radiographic axSpA (n = 1) [ASAS20 0.96 (0.53–1.73)]. When early axSpA was defined based on disease duration or radiographic damage, no differences were found between groups.

Conclusion

Evidence towards better outcomes in early axSpA is very limited and restricted to non-radiographic axSpA and <5 years symptom duration. When early axSpA is defined based on disease duration or radiographic damage, no differences in response to treatment are found.
Effects of feeding variable levels of mycotoxins with or without a mitigation strategy on growth performance, gut permeability, and oxidative biomarkers in nursery pigs
Authors: Wilson Victoria C , Ramirez Shelby M , Murugesan Ganapathi Raj , Hofstetter Ursula , Kerr Brian J
Published: September 2022

The objectives were to determine how high levels (> 2.5 mg/kg diet) of deoxynivalenol (DON), in conjunction with other naturally occurring mycotoxins (MTX) would impact growth, intestinal integrity, and oxidative status, with or without a mitigation strategy, in nursery pigs. One-hundred and five pigs (5.5 ± 0.52 kg) were randomly allotted to 35 pens and fed dietary treatments for 45 d. Treatments were factorially arranged with the inclusion of MTX being low (L-MTX; < 1 mg/kg diet) or high (H-MTX; > 2.5 mg/kg diet) in combination with no mitigation strategy or the inclusion of a mitigation strategy (Biofix® Plus, BPL; 1.5 mg/kg diet). There was no interaction between MTX level and BPL inclusion on average daily gain (ADG) or gain to feed ratio (GF), (P > 0.10). Compared to pigs fed diets containing L-MTX, feeding pigs diets containing H-MTX decreased ADG and GF (P < 0.05). The addition of BPL had no effect on ADG (P > 0.10), but improved GF (P = 0.09). There was an interaction between MTX and BPL on average daily feed intake (ADFI), where the addition of BPL had no effect on ADFI of pigs fed L-MTX diets but improved ADFI of pigs fed H-MTX diets (P = 0.09). An interaction was detected between MTX and BPL on protein oxidation as measured by plasma protein carbonyls (PC, P = 0.01), where the inclusion of BPL decreased plasma PC in pigs fed H-MTX diets to a greater extent than pigs fed the L-MTX diets. There was no interaction between MTX and BPL, or an effect of MTX or BPL on DNA damage as measured by 8-hydroxy-2ʹdexoxyguanosine (P > 0.10). There was no interaction between MTX and BPL, or a BPL effect on lipid damage as measured by thiobarbituic acid reactive substances (TBARS, P > 0.10), but pigs fed diets containing H-MTX exhibited lower concentrations of plasma TBARS (P = 0.07) compared to pigs fed L-MTX diets. There was no interaction between MTX and BPL, or an effect of MTX or BPL on plasma lactulose and mannitol ratio as a measure of intestinal permeability (P > 0.10). In conclusion, feeding H-MTX decreased ADG and GF, decreased plasma TBARS, but did not affect plasma 8-hydroxy-2ʹdexoxyguanosine or plasma LM ratio. The inclusion of a mitigation strategy improved ADFI when pigs were fed H-MTX diets and improved GF regardless of MTX level. Addition of a mitigation strategy also reduced plasma protein damage but did not affect indicators of DNA or lipid damage or affect gastrointestinal integrity.
Respiration-timing-dependent changes in activation of neural substrates during cognitive processes
Authors: Nakamura Nozomu H , Fukunaga Masaki , Yamamoto Tetsuya , Sadato Norihiro , Oku Yoshitaka
Published: September 2022

We previously showed that cognitive performance declines when the retrieval process spans an expiratory-to-inspiratory (EI) phase transition (an onset of inspiration). To identify the neural underpinning of this phenomenon, we conducted functional magnetic resonance imaging (fMRI) while participants performed a delayed matching-to-sample (DMTS) recognition memory task with a short delay. Respiration during the task was monitored using a nasal cannula. Behavioral data replicated the decline in memory performance specific to the EI transition during the retrieval process, while an extensive array of frontoparietal regions were activated during the encoding, delay, and retrieval processes of the task. Within these regions, when the retrieval process spanned the EI transition, activation was reduced in the anterior cluster of the right temporoparietal junction (TPJa, compared to cases when the retrieval process spanned the inspiratory-to-expiratory phase transition) and the left and right middle frontal gyrus, dorsomedial prefrontal cortex, and somatosensory areas (compared to cases when the retrieval process did not span any phase transition). These results in task-related activity may represent respiratory interference specifically in information manipulation rather than memory storage. Our findings demonstrate a cortical-level effect of respiratory phases on cognitive processes and highlight the importance of the timing of breathing for successful performance.
Exploring the Usefulness of Theory-Guided Reflection During the COVID-19 Pandemic
Authors: Sitzman Kathleen , Carpenter Tristin , Cherry Kim , Craven Ileen
Published: September 2022

During 2 massive open online course sessions in 2020-2021, learners shared lived experiences during the coronavirus disease-2019 (COVID-19) pandemic within a framework of theory-guided online discussion. We analyzed 211 COVID-19-related learner narratives from online discussion boards. Themes included sharing concerns and strategies related to patients separated from loved ones, honoring strengths in self and colleagues, valuing shared support among work colleagues, realizing the importance of self-care, voicing concerns about working conditions, and recognizing the impact of theory-guided shared reflection. Themes reflected personal knowing and attributes related to the American Association of Colleges of Nursing Essentials for Nursing Education. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A56.
Limited Hip Flexion and Internal Rotation Resulting From Early Hip Impingement Conflict on Anterior Metaphysis of Patients With Untreated Severe SCFE Using 3D Modelling
Authors: Lerch Till D. , Kim Young-Jo , Kiapour Ata M. , Zwingelstein Sébastien , Steppacher Simon D. , Tannast Moritz , Siebenrock Klaus A. , Novais Eduardo N.
Published: September 2022

Introduction:

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescent patients that can result in complex 3 dimensional (3D)-deformity and hip preservation surgery (eg, in situ pinning or proximal femoral osteotomy) is often performed. But there is little information about location of impingement.

Purpose/Questions: The purpose of this study was to evaluate (1) impingement-free hip flexion and internal rotation (IR), (2) frequency of impingement in early flexion (30 to 60 degrees), and (3) location of acetabular and femoral impingement in IR in 90 degrees of flexion (IRF-90 degrees) and in maximal flexion for patients with untreated severe SCFE using preoperative 3D-computed tomography (CT) for impingement simulation.

Methods:

A retrospective study involving 3D-CT scans of 18 patients (21 hips) with untreated severe SCFE (slip angle>60 degrees) was performed. Preoperative CT scans were used for bone segmentation of preoperative patient-specific 3D models. Three patients (15%) had bilateral SCFE. Mean age was 13±2 (10 to 16) years and 67% were male patients (86% unstable slip, 81% chronic slip). The contralateral hips of 15 patients with unilateral SCFE were evaluated (control group). Validated software was used for 3D impingement simulation (equidistant method).

Results:

(1) Impingement-free flexion (46±32 degrees) and IRF-90 degrees (−17±18 degrees) were significantly (P<0.001) decreased in untreated severe SCFE patients compared with contralateral side (122±9 and 36±11 degrees).

(2) Frequency of impingement was significantly (P<0.001) higher in 30 and 60 degrees flexion (48% and 71%) of patients with severe SCFE compared with control group (0%).

(3) Acetabular impingement conflict was located anterior-superior (SCFE patients), mostly 12 o’clock (50%) in IRF-90 degrees (70% on 2 o’clock for maximal flexion). Femoral impingement was located on anterior-superior to anterior-inferior femoral metaphysis (between 2 and 6 o’clock, 40% on 3 o’clock and 40% on 5 o’clock) in IRF-90 degrees and on anterior metaphysis (40% on 3 o’clock) in maximal flexion and frequency was significantly (P<0.001) different compared with control group.

Conclusion:

Severe SCFE patients have limited hip flexion and IR due to early hip impingement using patient-specific preoperative 3D models. Because of the large variety of hip motion, individual evaluation is recommended to plan the osseous correction for severe SCFE patients.

Level of Evidence:

Level III.
Surgical Site Infection After Posterior Stabilization of the Spine – When do we Have to Remove the Implants?
Authors: Prost Max , Röckner Melanie Elisabeth , Flüh Greta , Windolf Joachim , Konieczny Markus Rafael
Published: September 2022

Study Design:

Retrospective data analysis.

Objection:

The primary objective of this investigation was to analyze if treatment of Postoperative surgical site infections (PSSI) after posterior stabilization of the spine (PS) without radiological signs of screw loosening (RSL) shows a sufficient success rate without implant removal and if there was any difference between early and late PSSI.

Summary of Background Data:

PSSI after PS are usually treated by implant removal and reinstrumentation if loosening of one of more screws is detected. There is presently no conclusive data that shows the success rate of the treatment of PSSI after PS without implant removal if no RSL are perceived.

Materials and Methods:

All patients who were treated for a PSSI after PS without RSL in a single spine center from 12/2009 to 03/2020 were enrolled in a retrospective analysis. Patients were treated by revision surgery with debridement and irrigation and subsequent antibiotic therapy. Implant removal was performed if the initial treatment did not lead to an improvement in wound healing and normalization of laboratory values. Statistical analysis was performed by Statistical Package for the Social Sciences 25. Descriptive data are given as mean and standard error of mean, a χ2 test was performed.

Results:

Of the 32 enrolled patients, 17 had an early PSSI, 15 a late PSSI. In 71.9% (23/32), the PSSI was treated without implant removal: 12/17 in early PSSI, 11/15 in late PSSI. The difference was not significant (P>0.05). One patient died, all other patients were discharged from the hospital with no remaining laboratory signs of the infection and with closed soft tissues.

Conclusions:

In our group of patients, the success rate of irrigation and debridement without implant removal was 71.9%. In the light of this data, performing at least two irrigations and debridement before implant removal seems to be a valid treatment option in PSSI after PS if there are no RSL in early and late PSSI.
Correction and Maintenance of Cervical Alignment
Authors: Campion Chad , Crawford Charles H. , Glassman Steven D. , Berkay Fehmi , Mkorombindo Tino , Carreon Leah Y.
Published: September 2022

Study Design:

Longitudinal observational comparative cohorts.

Objective:

The objective of this study is to compare 3 and 12-month radiographic sagittal parameters and patient-reported outcomes (PROs) in patients who underwent 3-level ACDF or a hybrid procedure.

Summary of Background Data:

Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), and hybrids (combination ACCF-ACDF) are common procedures used to treat symptomatic cervical spondylosis. Although there is a relative abundance of literature comparing 1-level ACCF versus 2-level ACDF and 2-level ACCF versus 3-level ACDF, detailed comparisons of 3-level ACDF versus hybrid procedures have not been extensively addressed.

Methods:

Patients who underwent a 3-Level ACDF (3L-ACDF, N=47) or 1-Level Corpectomy/1-Level ACDF (Hybrid, N=52) with at least a 12-month post-op data available were identified. Standard demographic, surgical and PROs were collected in addition to preoperative and postoperative radiographic data, including C2 plumb line (C2PL), C2–C7 lordosis (CL), segmental lordosis (SL), and T1 slope (T1S).

Results:

The 2 cohorts were similar in terms of demographics. At 3 months post-op, CL (9.04° vs. −2.12°, P=0.00) and SL (6.06° vs. −2.26°, P=0.003) were significantly greater in the 3L-ACDF group versus the HYBRID group. This significant difference was maintained at 12 months postoperative for CL [(6.62° vs. −0.60°, P=0.015) but not for SL (2.36° vs. −1.09°, P=0.199)]. There were no differences in PROs between the 2 groups before surgery, at 3 months postoperative or 12 months postoperative. Seven patients required revision surgery in the 1-year study period (1 in the 3L-ACDF, and 6 in the Hybrid P<0.001).

Conclusions:

Three level ACDF resulted in greater C2–C7 lordosis and segmental lordosis postoperatively, which was maintained at 1 year for cervical lordosis. While PROs were similar between the groups, patients with hybrid instrumentation required significantly more revision surgeries than those treated with 3-level ACDF.
Developing an Idea into a Research Question
Authors: Stark Michael , Woods Barrett
Published: September 2022

The success of obtaining answers in any research project relies on how well the investigators are able to ask the right question. The PICO (Patient, Intervention, Comparator, Outcomes) approach provides a framework to develop this question utilizing four major elements: Population, Intervention, Comparison, Outcomes. This paper provides a framework for both the young and the experienced surgeon in the use of the PICO approach to construct a clear research question.
Risk Factors and Clinical Outcomes of Candidemia Associated With Severe COVID-19
Authors: Dixit Deepali , Jen Polly , Maxwell Tyler D. , Smoke Steven , McCracken James Andrew , Cardinale-King Maria , Haribhakti Aditi , Patel Purvi , Cani Eris , Choi Seohyun (Claudia) , Jagpal Sugeet , Varughese Tilly , Tatem Luis L. , Bhowmick Tanaya
Published: September 2022

IMPORTANCE:

COVID-19 can cause serious illness requiring multimodal treatment and is associated with secondary infections. Studies have suggested an increased risk of fungal infections, including candidemia following severe COVID-19 though understanding of risk factors and clinical outcomes remains unclear.

OBJECTIVES:

To describe clinical characteristics, outcomes and risk factors of candidemia among patients hospitalized with severe COVID-19.

DESIGN, SETTING, AND PARTICIPANTS:

A multicenter, case-control study of patients with severe COVID-19 was conducted to evaluate risk factors and clinical outcomes in patients who developed candidemia between August 2020 and August 2021.

MAIN OUTCOMES AND MEASURES:

Chart review evaluating institutional and patient demographics, clinical and mycological characteristics, concomitant interventions (antibiotics, immunosuppressive agents, parenteral nutrition, degree of oxygen support, mechanical ventilation, surgery), treatment regimens, and outcomes (length of stay and discharge disposition)

RESULTS:

A total of 275 patients were enrolled in the study, including 91 patients with severe COVID-19 and subsequent candidemia and 184 with severe COVID-19 without candidemia. Most patients received antibiotics prior to candidemia episode (93%), while approximately one-quarter of patients received biologic for COVID-19. In-hospital mortality was significantly higher in the cases compared with the controls (68% vs 40%; p < 0.01). Candida albicans was the most common (53%), followed by C. glabrata (19%). Use of central lines, biologic, and paralytics were independent risk factors for candidemia.

CONCLUSIONS AND RELEVANCE:

Candidemia following COVID-19 infection is a concern that requires clinical consideration and patient monitoring. Risk factors for the development of candidemia in the setting of COVID-19 infection are largely consistent with traditional risk factors for candidemia in hospitalized patients.
Fingerprick Microsampling Methods Can Replace Venepuncture for Simultaneous Therapeutic Drug Monitoring of Tacrolimus, Mycophenolic Acid, and Prednisolone Concentrations in Adult Kidney Transplant Patients
Authors: Scuderi Carla , Parker Suzanne , Jacks Margaret , John George T. , McWhinney Brett , Ungerer Jacobus , Mallett Andrew , Healy Helen , Roberts Jason , Staatz Christine
Published: September 2022

Background:

Kidney transplant patients undergo repeated and frequent venepunctures during allograft management. Microsampling methods that use a fingerprick draw of capillary blood, such as dried blood spots (DBS) and volumetric absorptive microsamplers (VAMS), have the potential to reduce the burden and volume of blood loss with venepuncture.

Methods:

This study aimed to examine microsampling approaches for the simultaneous measurement of tacrolimus, mycophenolic acid, mycophenolic acid glucuronide (MPAG), and prednisolone drug concentrations compared with standard venepuncture in adult kidney transplant patients. DBS and VAMS were simultaneously collected with venepuncture samples from 40 adult kidney transplant patients immediately before and 2 hours after immunosuppressant dosing. Method comparison was performed using Passing–Bablok regression, and bias was assessed using Bland–Altman analysis. Drug concentrations measured through microsampling and venepuncture were also compared by estimating the median prediction error (MPE) and median absolute percentage prediction error (MAPE).

Results:

Passing–Bablok regression showed a systematic difference between tacrolimus DBS and venepuncture [slope of 1.06 (1.01–1.13)] and between tacrolimus VAMS and venepuncture [slope of 1.08 (1.03–1.13)]. Tacrolimus values were adjusted for this difference, and the corrected values showed no systematic differences. Moreover, no systematic differences were observed when comparing DBS or VAMS with venepuncture for mycophenolic acid and prednisolone. Tacrolimus (corrected), mycophenolic acid, and prednisolone microsampling values met the MPE and MAPE predefined acceptability limits of <15% when compared with the corresponding venepuncture values. DBS and VAMS, collected in a controlled environment, simultaneously measured multiple immunosuppressants.

Conclusions:

This study demonstrates that accurate results of multiple immunosuppressant concentrations can be generated through the microsampling approach, with a preference for VAMS over DBS.
Listening Effort in Prelingual Cochlear Implant Recipients: Effects of Spectral and Temporal Auditory Processing and Contralateral Acoustic Hearing
Authors: Yüksel Mustafa , Taşdemir İlknur , Çiprut Ayça
Published: September 2022

Objective

Considering the impact of listening effort (LE) on auditory perception, attention, and memory, it is a significant aspect in the daily hearing experiences of cochlear implant (CI) recipients. Reduced spectral and temporal information on an acoustic signal can make listening more difficult; as a result, it is important to understand the relationship between LE and spectral and temporal auditory processing capacities in CI receivers.

Study Design, Setting, and Patients

This study used spectral ripple discrimination and temporal modulation transfer function to evaluate 20 prelingually deafened and early implanted CI recipients. The speech perception in noise test (primary) and the digit recall task (DRT-secondary) were used to assess LE using the dual-task paradigm. To assess the effects of acoustic hearing, contralateral acoustic hearing thresholds between 125 Hz and 8 kHz with a hearing aid were also acquired. To examine the relationship between the research variables, correlation coefficients were generated. Furthermore, the Mann-Whitney U test was used to compare unilateral and bimodal users.

Results

There was a statistically significant correlation between LE and spectral ripple discrimination (r = 0.56; p = 0.011), 125 Hz (r = 0.51; p = 0.020), 250 Hz (r = 0.48; p = 0.030), 500 Hz (r = 0.45; p = 0.045), 1,000 Hz (r = 0.51; p = 0.023), 2000 Hz (r = 0.48; p = 0.031), and 4,000 Hz (r = 0.48; p = 0.031), whereas no statistically significant correlations were observed between temporal modulation transfer function in four frequencies and LE. There was no statistically significant difference between unilateral and bimodal CI recipients (p > 0.05).

Conclusion

As a result of the improved signal-to-noise ratio in the auditory environment, CI users with better spectral resolutions and acoustic hearing have a reduced LE. On the other hand, temporal auditory processing, as measured by temporal modulation detection, does not contribute to the LE.
Decreased Intestinal Microbiota Diversity Is Associated With Increased Gastrointestinal Symptoms in Patients With Chronic Pancreatitis
Authors: McEachron Kendall R. , Nalluri Harika , Beilman Gregory J. , Kirchner Varvara A. , Pruett Timothy L. , Freeman Martin L. , Trikudanathan Guru , Staley Christopher , Bellin Melena D.
Published: September 2022

Objectives

Chronic pancreatitis (CP) is characterized by abdominal pain, recurrent hospitalizations, frequent exposure to antibiotics, nutritional deficiencies, and chronic opioid use. Data describing the gut microbial community structure of patients with CP is limited. We aimed to compare gut microbiota of a group of patients with severe CP being considered for total pancreatectomy with islet autotransplantation (TPIAT) with those of healthy controls and to associate these differences with severity of clinical symptoms.

Methods

We collected stool from healthy donors (n = 14) and patients with CP (n = 20) undergoing workup for TPIAT, in addition to clinical metadata and a validated abdominal symptoms severity survey.

Results

Patients with CP had significantly lower alpha diversity than healthy controls (P < 0.001). There was a significantly increased mean relative abundance of Faecalibacterium in healthy controls compared with patients with CP (P = 0.02). Among participants with CP, those with lower alpha diversity reported worse functional abdominal symptoms (P = 0.006).

Conclusions

These findings indicate that changes in gut microbial community structure may contribute to gastrointestinal symptoms and provide basis for future studies on whether enrichment of healthy commensal bacteria such as Faecalibacterium could provide clinically meaningful improvements in outcomes for CP patients undergoing TPIAT.
Identification to Intervention: A Perspective From Parents of Children with Cerebral Palsy
Authors: Wise Nancy J. , Gellasch Patricia A.
Published: September 2022

Background

Early diagnosis of cerebral palsy (CP) promotes early intervention, symptom management, and support for parents. There is little evidence showing whether parents actually receive these benefits.

Objectives

The objectives of this study were to explore and describe the experiences of parents of children with CP, including their journey to diagnosis, access to services and resources, and what they would want other parents or health care providers to know and understand about their experiences.

Methods

Using a qualitative descriptive design, semistructured interviews were conducted from January 2021 to April 2021. A purposive sampling method with a snowball effect was used to recruit parents through therapists, a children’s hospital, a pediatric rehabilitation center, and social media CP support groups. An inductive approach to content analysis was used to categorize the data. ATLAS.ti® was employed to arrange and code data.

Results

Three themes emerged: (a) Something Was Off: I Simply Didn’t Know; (b) Coping With the Unknown: Uncharted Territory; and (c) What We Needed Then and Now: Advocacy, Education, and Research.

Discussion

Parents emphasized a lack of knowledge of developmental milestones and their inability to recognize delays in their children. Health care providers dismissed persistent unexplained symptoms and developmental delays; parents were expected to ‘watch and wait’ for their child to catch up. The CP diagnosis, although delayed, validated their concerns and gut intuitions about their child’s symptoms and connected them to early intervention services and specialty care. Therapists became a lifeline for parents, providing education, answering questions, obtaining adaptive equipment, and offering care management strategies. Parent support groups provided emotional support, lessened parent isolation, and offered realistic hope. Parents reported a need for an earlier diagnosis and earlier access to services, direct and open communication about CP diagnosis, and follow-up phone calls after the diagnosis. They also asked for a tip sheet to guide them after the diagnosis.
Linear Mixed Model Analysis of Polygenic Hazard Score on Verbal Memory Decline in Alzheimer’s Disease
Authors: Wang Kesheng , Xu Chun , Theeke Laurie A. , Xiao Danqing , Luo Xingguang , Xie Changchun
Published: September 2022

Background

Alzheimer’s disease (AD) is a chronic, progressive, degenerative disease characterized by cognitive dysfunction, including verbal memory loss. Studies were lacking in examining the longitudinal effect of polygenic hazard score on the Rey Auditory Verbal Learning Test-Delayed Total (AVDELTOT) score (a common measure of verbal memory). A key step in analyzing longitudinal changes in cognitive measures using a linear mixed model (LMM) is choosing a suitable covariance structure.

Objectives

The study aims to determine the association between the polygenic hazard score and the AVDELTOT score accounting for repeated measures (the covariance structure).

Methods

The AVDELTOT scores were collected at baseline, 12, 24, 36, and 48 months from 283 participants with AD, 347 with cognitive normal, and 846 with mild cognitive impairment in the Alzheimer’s Disease Neuroimaging Initiative. The Bayesian information criterion statistic was used to select the best covariance structure from 10 covariance structures in longitudinal analysis of AVDELTOT scores. The multivariable, LMM was used to investigate the effect of polygenic hazard score status (low vs. medium vs. high) on changes in AVDELTOT scores while adjusted for age, gender, education, APOE-ε4 genotype, and baseline Mini-Mental State Examination (MMSE) score.

Results

One-way analysis of variance revealed significant differences in AVDELTOT scores, MMSE, and polygenic hazard score among AD diagnoses at baseline. Bayesian information criterion favored the compound symmetry covariance structure in the LMM analysis. Using the multivariate LMM, the APOE-ε4 allele and high polygenic hazard score value was significantly associated with AVDELTOT declines. Significant polygenic hazard score status by follow-up visit interactions was discovered.

Conclusion

Our findings provide the first evidence of the effect of polygenic hazard score status and APOE-ε4 allele on declines in verbal memory in people with AD.
Cognitive Function and Self-Management Behaviors in Older Adults With Type 2 Diabetes
Authors: Kim Min Jung , Bronas Ulf G. , Quinn Laurie , Sharp Lisa K. , Park Chang , Gruss Valerie , Fritschi Cynthia
Published: September 2022

Background

Type 2 diabetes (T2D) is strongly associated with cognitive impairment. Decreased cognitive function could affect daily self-management behaviors critical for people with T2D. Executive function is significant for daily self-management, and decreased subjective cognitive function could be an early indicator of poor daily self-management. However, little is known about whether executive or subjective cognitive function affects daily self-management behaviors in older adults.

Objectives

We investigated the effect of executive function or subjective cognitive function on daily self-management behaviors (diet, glucose management, physical activity, and physician contact) in older adults with T2D.

Methods

We used a cross-sectional, observational design with convenience sampling of 84 adults aged ≥60 years with T2D. Telephone-administered cognitive function tests measured participants’ overall cognitive and executive function levels. Subjective cognitive function, diabetes self-management, and covariates, including demographic information (age, gender, race/ethnicity, and level of education), body mass index, depressive symptoms, and diabetes duration, were assessed using online surveys. Data were analyzed using bivariate correlation and backward stepwise regression.

Results

The mean age of the sample was 68.46 ± 5.41 years. Participants were predominantly female and White, and the majority had normal cognitive function. Controlling for demographics, body mass index, depressive symptoms, and diabetes duration, a decrease in executive function indicated by a greater number of errors made during the telephone-administered Oral Trail Making Test Part B relative to the sample was associated with poorer adherence to physician contact behaviors. Subjective cognitive function was not associated with any self-management behaviors.

Discussion

A reduction in executive function was associated with poorer adherence to physician contact behaviors in older adults with T2D and normal cognitive function; lack of adherence to physician contact behaviors could be an early indicator of declining cognitive function. Difficulties or changes in routine diabetes self-management behaviors should be closely monitored in older adults. Cognitive assessment should be followed when needed.
Report: A Pox Presenting Without Pox
Authors: Karmarkar Ellora , Altwies Eden E. , Desta Russom , Ahmed Alwiya M. , Nick Epiphany , Gozo Maria Amoreth R. , Cogen Anna L. , Uribe Gabriela , Disharoon Steven , Liles W. Conrad , LaCourse Sylvia M.
Published: September 2022

A man with virally suppressed human immunodeficiency virus (HIV) presented with an erythematous, morbilliform rash without pustules in the setting of fever, fatigue, and myalgias after recent travel to Mexico and Puerto Rico. He was diagnosed with nonvariola orthopoxvirus (monkeypox) infection. This case report highlights an atypical presentation in the 2022 outbreak.
Mechanisms of change of a cognitive-existential group intervention for fear of cancer recurrence: mediation analyses of the FORT trial
Authors: Lebel Sophie , Maheu Christine , Tomei Christina , Mutsaers Brittany , Bernstein Lori J. , Courbasson Christine , Ferguson Sarah E. , Harris Cheryl , Jolicoeur Lynne , Lefebvre Monique , Muraca Linda , Ramanakumar Agnihotram V. , Singh Mina , Parrott Julia
Published: September 2022

Background:

Meta-analyses have demonstrated that brief interventions can address fear of cancer recurrence (FCR), but their mechanisms of action are largely unknown. Our goal was to identify the mediators of treatment efficacy of the Fear Of Recurrence Therapy (FORT) intervention using data from a multisite randomized controlled trial targeting FCR. That randomized controlled trial compared a 6-week cognitive-existential group intervention with an active control group.

Methods:

Participants (n = 135) were women diagnosed with stage I-III breast or gynecological cancer who were assessed at 4 time points (pretherapy, post-therapy, 3-month, and 6-month follow-up). The primary outcome, changes in FCR at 6 months, was measured with the Fear of Cancer Recurrence Inventory. We examined 6 mediators based on our theoretical model of FCR: perceived risk of recurrence, uncertainty in illness, intolerance of uncertainty, positive beliefs about worrying, reassurance-seeking, and cognitive avoidance. Changes in the possible mediator variables were simultaneously investigated to predict changes in FCR using Generalized Structural Equation Models with robust variance estimation.

Results:

FORT predicted FCR at 6 months in univariate analyses (β  = −8.93, P = .0001). In the model including the 6 possible mediators, changes in uncertainty in illness (β = −8.72, P < .0001) and cognitive avoidance (β = −8.36, P < .0001) mediated the relationship between treatment and changes in FCR. However, FORT still predicted changes in FCR at 6 months (β = −6.35, P = .02), suggesting partial mediation.

Conclusions:

We identified 2 mechanisms of action that can be incorporated in future interventions. However, other processes that underlie the efficacy of these interventions need to be uncovered.
Toward the development of a model of caregiver-specific fear of cancer recurrence: a systematic review
Authors: Webb Kyra , Sharpe Louise , Butow Phyllis , Dhillon Haryana , Zachariae Robert , Tauber Nina Møller , O'Toole Mia Skytte , Shaw Joanne
Published: September 2022

Background:

Fear of cancer recurrence (FCR) is the most common psychological issue for cancer survivors, and research shows that caregivers are as fearful of the cancer returning as patients. However, there is relatively little research on caregiver FCR. The aim of this systematic review was to provide a metasynthesis of qualitative research to determine (a) whether caregiver FCR was conceptually similar to FCR among survivors, (b) to determine any specific issues that were different for caregivers compared with survivors, and (c) to present a hypothesis-generating model of caregiver FCR to inform future theoretically grounded caregiver-specific FCR research.

Methods:

Using keywords relating to FCR, caregivers, and cancer, CINAHL, PsycINFO, PubMed, and Embase databases were searched. Qualitative studies reporting on FCR in caregivers published between January 1997 and July 2021 were included.

Results:

Following PRISMA guidelines, 13 articles were included for review and metasynthesis. Overall, there was a paucity of qualitative research exploring caregiver FCR. Metasynthesis revealed 1 theme, uncertainty/fear previously identified among survivors and a theme unique to the caregiver's experience of FCR: caregiver's role as protector. An overarching theme, fear of losing a loved one, explained the relationship between each of the identified themes, acting as a driver of caregiver FCR.

Conclusions:

This review highlighted, that although similarities between survivor and caregiver experiences of FCR exist, key elements that underline caregiver FCR are conceptually different to the fear experienced by cancer survivors. We propose a new model of FCR that incorporates aspects unique to caregivers which requires further investigation. The proposed model provides an important foundation for further research exploring caregiver FCR. Given caregivers with higher FCR experience more caregiver burden, it is essential to better understand their experiences. This will facilitate the development of interventions which effectively support caregivers, enhancing their capacity to support survivors.
Pediatric Patient Insurance Status and Regionalization of Admissions
Authors: Samuels-Kalow Margaret E. , Gao Jingya , Boggs Krislyn M. , Camargo Carlos A. , Zachrison Kori S.
Published: September 2022

Background

Pediatric hospital care is becoming increasingly regionalized, and previous data have suggested that insurance may be associated with transfer. The aims of the study are to describe regionalization of pediatric care and density of the interhospital transfer network and to determine whether these varied by insurance status.

Methods

Using the New York State ED Database and State Inpatient Database from 2016, we identified all pediatric patients and calculated regionalization indices (RI) and network density, overall and stratified by insurance. Regionalization indices are based on the likelihood of a patient completing care at the initial hospital. Network density is the proportion of actual transfers compared with the number of potential hospital transfer connections. Both were calculated using the standard State ED Database/State Inpatient Database transfer definition and in a sensitivity analysis, excluding the disposition code requirement.

Results

We identified 1,595,566 pediatric visits (emergency department [ED] or inpatient) in New York in 2016; 7548 (0.5%) were transferred and 7374 transferred visits had eligible insurance status (Medicaid, private, uninsured). Of the transfers, 24% were from ED to ED with discharge, 28% from ED to ED with admission, 31% from ED to inpatient, 16% from inpatient to inpatient, and 1.2% from inpatient to ED. The overall RI was 0.25 (95% confidence interval [95% CI], 0.20–0.31). The overall weighted RI was 0.09 (95% CI, 0.06–0.12) and was 0.09 (95% CI, 0.06–0.13) for Medicaid-insured patients, 0.08 (95% CI, 0.05–0.11) for privately insured patients, and 0.08 (95% CI, 0.05–0.11) for patients without insurance. The overall network density was 0.018 (95% CI, 0.017–0.020). Network density was higher, and transfer rates were lower, for patients with Medicaid insurance as compared with private insurance.

Conclusions

We found significant regionalization of pediatric emergency care. Although there was not material variation by insurance in regionalization, there was variation in network density and transfer rates. Additional work is needed to understand factors affecting transfer decisions and how these patterns might vary by state.
Integrative biology of persister cell formation: molecular circuitry, phenotypic diversification and fitness effects
Authors: Berkvens Alicia , Chauhan Priyanka , Bruggeman Frank J.
Published: September 2022

Microbial populations often contain persister cells, which reduce the extinction risk upon sudden stresses. Persister cell formation is deeply intertwined with physiology. Due to this complexity, it cannot be satisfactorily understood by focusing only on mechanistic, physiological or evolutionary aspects. In this review, we take an integrative biology perspective to identify common principles of persister cell formation, which might be applicable across evolutionary-distinct microbes. Persister cells probably evolved to cope with a fundamental trade-off between cellular stress and growth tasks, as any biosynthetic resource investment in growth-supporting proteins is at the expense of stress tasks and vice versa. Natural selection probably favours persister cell subpopulation formation over a single-phenotype strategy, where each cell is prepared for growth and stress to a suboptimal extent, since persister cells can withstand harsher environments and their coexistence with growing cells leads to a higher fitness. The formation of coexisting phenotypes requires bistable molecular circuitry. Bistability probably emerges from growth-modulated, positive feedback loops in the cell's growth versus stress control network, involving interactions between sigma factors, guanosine pentaphosphate and toxin–antitoxin (TA) systems. We conclude that persister cell formation is most likely a response to a sudden reduction in growth rate, which can be achieved by antibiotic addition, nutrient starvation, sudden stresses, nutrient transitions or activation of a TA system.
Aspirin and cancer: biological mechanisms and clinical outcomes
Authors: Elwood Peter , Protty Majd , Morgan Gareth , Pickering Janet , Delon Christine , Watkins John
Published: September 2022

Evidence on aspirin and cancer comes from two main sources: (1) the effect of aspirin upon biological mechanisms in cancer, and (2) clinical studies of patients with cancer, some of whom take aspirin. A series of systematic literature searches identified published reports relevant to these two sources. The effects of aspirin upon biological mechanisms involved in cancer initiation and growth appear to generate reasonable expectations of effects upon the progress and mortality of cancer. Clinical evidence on aspirin appears overall to be favourable to the use of aspirin, but evidence from randomized trials is limited, and inconsistent. The main body of evidence comes from meta-analyses of observational studies of patients with a wide range of cancers, about 25% of whom were taking aspirin. Heterogeneity is large but, overall, aspirin is associated with increases in survival and reductions in metastatic spread and vascular complications of different cancers. It is important that evaluations of aspirin used as an adjunct cancer treatment are based upon all the available relevant evidence, and there appears to be a marked harmony between the effects of aspirin upon biological mechanisms and upon the clinical progress of cancer.
Evidence of selection in the uncoupling protein 1 gene region suggests local adaptation to solar irradiance in savannah monkeys (
Chlorocebus
spp.)
Authors: Gagnon Christian M. , Svardal Hannes , Jasinska Anna J. , Danzy Cramer Jennifer , Freimer Nelson B. , Paul Grobler J. , Turner Trudy R. , Schmitt Christopher A.
Published: September 2022

In the last 300 thousand years, the genus
Chlorocebus
expanded from equatorial Africa into the southernmost latitudes of the continent, where colder climate was a probable driver of natural selection. We investigated population-level genetic variation in the mitochondrial uncoupling protein 1 (
UCP1
) gene region—implicated in non-shivering thermogenesis (NST)—in 73 wild savannah monkeys from three taxa representing this southern expansion (
Chlorocebus pygerythrus hilgerti, Chlorocebus cynosuros
and
Chlorocebus pygerythrus pygerythrus
) ranging from Kenya to South Africa. We found 17 single nucleotide polymorphisms with extended haplotype homozygosity consistent with positive selective sweeps, 10 of which show no significant linkage disequilibrium with each other. Phylogenetic generalized least-squares modelling with ecological covariates suggest that most derived allele frequencies are significantly associated with solar irradiance and winter precipitation, rather than overall low temperatures. This selection and association with irradiance is demonstrated by a relatively isolated population in the southern coastal belt of South Africa. We suggest that sunbathing behaviours common to savannah monkeys, in combination with the strength of solar irradiance, may mediate adaptations to thermal stress via NST among savannah monkeys. The variants we discovered all lie in non-coding regions, some with previously documented regulatory functions, calling for further validation and research.
Paternal care regulates the timing, synchrony and success of hatching in a coral reef fish
Authors: Majoris John E. , Francisco Fritz A. , Burns Corinne M. , Brandl Simon J. , Warkentin Karen M. , Buston Peter M.
Published: September 2022

In oviparous species, the timing of hatching is a crucial decision, but for developing embryos, assessing cues that indicate the optimal time to hatch is challenging. In species with pre-hatching parental care, parents can assess environmental conditions and induce their offspring to hatch. We provide the first documentation of parental hatching regulation in a coral reef fish, demonstrating that male neon gobies (
Elacatinus colini
) directly regulate hatching by removing embryos from the clutch and spitting hatchlings into the water column. All male gobies synchronized hatching within 2 h of sunrise, regardless of when eggs were laid. Paternally incubated embryos hatched later in development, more synchronously, and had higher hatching success than artificially incubated embryos that were shaken to provide a vibrational stimulus or not stimulated. Artificially incubated embryos displayed substantial plasticity in hatching times (range: 80–224 h post-fertilization), suggesting that males could respond to environmental heterogeneity by modifying the hatching time of their offspring. Finally, paternally incubated embryos hatched with smaller yolk sacs and larger propulsive areas than artificially incubated embryos, suggesting that paternal effects on hatchling phenotypes may influence larval dispersal and fitness. These findings highlight the complexity of fish parental care behaviour and may have important, and currently unstudied, consequences for fish population dynamics.
Physicochemical properties of novel jelly produced by adding Platycodon grandiflorum concentrates
Authors: Kim Yu Mi , Youn Kwang-Sup
Published: September 2022

We evaluated the physicochemical properties of Platycodon grandiflorums jelly prepared six different concentrate levels to develop the jelly with improved functionality. As the Platycodon grandiflorums concentrate content increased, the moisture content and pH tended to decrease, and soluble solids tended to increase, but no significant variation existed. The L value decreased as the concentration of Platycodon grandiflorums content increased. Conversely, the a and b values tended to increase. Texture profile of the jelly revealed, the strength and hardness increased, but the elasticity and cohesiveness decreased as the content of the Platycodon grandiflorums concentrate increased. The melting rate was lowest in the control jelly, and there was no significant difference in the melting rates between the jelly supplemented with different concentrate levels. The melting temperature was the highest in PG10, and the gelling temperature did not vary significantly among the different added Platycodon grandiflorums concentrate levels. The crude saponin content increased as the concentrate content increased. The ABTS and the DPPH radical scavenging ability both tended to increase as the content increased. Therefore, the jelly preparation improved in functionality by adding Platycodon grandiflorums concentrate, with providing improved textural characteristics and high antioxidant properties.