bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraocular pressure–lowering medications during pregnancy and risk of neonatal adverse outcomes: a propensity score analysis using a large database
Authors: Hashimoto Yohei , Michihata Nobuaki , Yamana Hayato , Shigemi Daisuke , Morita Kojiro , Matsui Hiroki , Yasunaga Hideo , Aihara Makoto
Published: September 2020

Background/Aims

To investigate the association between exposure to intraocular pressure (IOP)–lowering medications during pregnancy and neonatal adverse outcomes.

Methods

This retrospective, cohort study used the JMDC Claims Database (JMDC, Tokyo, Japan), 2005–2018. We extracted data on pregnant women with glaucoma, including dispensation of (1) any IOP-lowering medications, (2) only prostaglandin analogues (PGs) and 3) only beta-blockers, during the first trimester. We compared frequency of congenital anomalies (CA), preterm birth (PB), low birth weight (LBW) and the composite outcome of these three measures, between the women with and without IOP-lowering medications. We calculated propensity scores (PSs) using logistic regression in which use of IOP-lowering medications was regressed against known confounders (disorders during pregnancy and other chronic comorbidities). We then conducted logistic regression in which neonatal adverse outcomes were regressed against use of IOP-lowering medications with adjustment for the PS.

Results

We identified 826 eligible women, 91 (11%) of whom had received any IOP-lowering medications. CA occurred in 9.9% and 6.4%, PB in 2.2% and 4.5%, LBW in 9.9% and 6.0% and composite outcome in 17.6% and 13.3% of mothers with and without IOP-lowering medications, respectively. After adjustment for PS, IOP-lowering medications were not significantly associated with more frequent CA (adjusted OR (aOR), 1.43; 95% CI, 0.66 to 3.12), PB (aOR, 0.45; 95% CI, 0.10 to 1.97), LBW (aOR, 2.11; 95% CI, 0.98 to 4.57) or composite outcome (aOR, 1.40; 95% CI, 0.78 to 2.53). Results were similar regarding PGs only and beta-blockers only.

Conclusions

IOP-lowering medications during the first trimester were not significantly associated with increase in CA, PB or LBW.
Detection of features associated with neovascular age-related macular degeneration in ethnically distinct data sets by an optical coherence tomography: trained deep learning algorithm
Authors: Rim Tyler Hyungtaek , Lee Aaron Y , Ting Daniel S , Teo Kelvin , Betzler Bjorn Kaijun , Teo Zhen Ling , Yoo Tea Keun , Lee Geunyoung , Kim Youngnam , Lin Andrew C , Kim Seong Eun , Tham Yih Chung , Kim Sung Soo , Cheng Ching-Yu , Wong Tien Yin , Cheung Chui Ming Gemmy
Published: September 2020

Background

The ability of deep learning (DL) algorithms to identify eyes with neovascular age-related macular degeneration (nAMD) from optical coherence tomography (OCT) scans has been previously established. We herewith evaluate the ability of a DL model, showing excellent performance on a Korean data set, to generalse onto an American data set despite ethnic differences. In addition, expert graders were surveyed to verify if the DL model was appropriately identifying lesions indicative of nAMD on the OCT scans.

Methods

Model development data set—12 247 OCT scans from South Korea; external validation data set—91 509 OCT scans from Washington, USA. In both data sets, normal eyes or eyes with nAMD were included. After internal testing, the algorithm was sent to the University of Washington, USA, for external validation. Area under the receiver operating characteristic curve (AUC) and precision–recall curve (AUPRC) were calculated. For model explanation, saliency maps were generated using Guided GradCAM.

Results

On external validation, AUC and AUPRC remained high at 0.952 (95% CI 0.942 to 0.962) and 0.891 (95% CI 0.875 to 0.908) at the individual level. Saliency maps showed that in normal OCT scans, the fovea was the main area of interest; in nAMD OCT scans, the appropriate pathological features were areas of model interest. Survey of 10 retina specialists confirmed this.

Conclusion

Our DL algorithm exhibited high performance for nAMD identification in a Korean population, and generalised well to an ethnically distinct, American population. The model correctly focused on the differences within the macular area to extract features associated with nAMD.
Exploring clinicians’ perspectives on the ‘Obstetric Anal Sphincter Injury Care Bundle’ national quality improvement programme: a qualitative study
Authors: Bidwell Posy , Thakar Ranee , Gurol-Urganci Ipek , Harris James M , Silverton Louise , Hellyer Alexandra , Freeman Robert , Morris Edward , Novis Vivienne , Sevdalis Nick
Published: September 2020

Introduction

Obstetric anal sphincter injuries (OASI) can have severe debilitating consequences to women and health systems. The OASI Care Bundle quality improvement programme was introduced in 16 maternity units across England, Scotland and Wales (January 2017 to March 2018) to address increasing OASI rates.

Objectives

To explore clinicians’ (midwives’ and obstetricians’) perspectives of the OASI Care Bundle with respect to (1) acceptability, (2) feasibility, and (3) sustainability.

Design

A qualitative exploratory study using focus groups methodology.

Setting

A total of 16 focus groups were conducted in 16 maternity units in England, Scotland and Wales where the OASI Care Bundle was implemented. Focus groups took place approximately 3 months following initial implementation of the care bundle in each unit.

Participants

A total of 101 clinicians participated, with an average of six per focus group. Participants volunteered to take part and compromised of 37 obstetricians and 64 midwives (including eight students). The majority were female and the mean age was 36.5 years.

Results

Four main themes emerged: ‘Implementation strategies’, ‘Opportunities to use the OASI Care Bundle’, ‘Does current practice need to change?’ and ‘Perceptions of what women want’. Midwives were more likely than obstetricians to report themes alluding to ‘what women want’ and variations in intrapartum perineal protection techniques. Both professional groups reported similar views of other themes, in particular regarding the supporting clinical evidence. Gaps were identified in clinicians’ knowledge and experience of intrapartum perineal management.

Conclusions

Adoption of the OASI Care Bundle was associated with a number of cognitive and interpersonal factors, such as personal values, interprofessional working and how the intervention was launched; which both facilitated and impeded adoption. The ‘what women want’ theme has implications for maternal autonomy and needs further exploration. Our findings can be used by similar initiatives to reduce perineal trauma both nationally and internationally.

Trial registration number

ISCTRN 12143325; https://doi.org/10.1186/ISRCTN12143325.
Association between blood lead level and risk of stroke in Korean adults: a cross-sectional study in the Korea National Health and Nutrition Examination Survey 2008–2013
Authors: Kim Minkyeong , Yun Sang-Moon , Jeong Jihyun , Jo Chulman , Koh Young Ho
Published: September 2020

Objectives

Although lead is a potential risk factor for cardiovascular diseases such as stroke, research on this association in the Korean population remains limited. Therefore, we aimed to investigate the association between lead level and stroke in Korean adults.

Design

A population-based cross-sectional study.

Setting

The Korea National Health and Nutrition Examination Survey 2008–2013, which enrolled a representative sample of the Korean population.

Participants

We excluded participants younger than 20 years, missing weight data, pregnant or lactating, and missing blood lead and stroke data. A total of 11 510 participants were included in this analysis.

Primary and secondary outcome measurement

The participants were classified by blood lead concentration into the low-level (≤2.189 µg/dL, n=5756) and high-level (>2.189 µg/dL, n=5754) groups. The main outcome, stroke, was assessed by information from physician diagnosis, prevalence of stroke or treatment for stroke. The ORs and 95% CIs were calculated to evaluate the association between blood lead level and stroke using multivariate logistic regression analysis.

Results

Although blood lead level was not significantly associated with stroke (OR: 1.30, 95% CI: 0.66–2.58) in the multivariate-adjusted model, in individuals with hypertension, the high-level group was 2.36-fold higher odds of stroke (OR: 2.36, 95% CI: 1.02–5.44) compared to that in the low-level group. No association was observed in individuals with normotension (OR: 0.42, 95% CI: 0.13–1.38, p for interaction=0.007).

Conclusion

The association between blood lead concentration and stroke may be influenced by hypertension status. Our findings suggest the need for closer attention to lead exposure in patients with hypertension.
Prevalence of diabetes and pre-diabetes in Bangladesh: a systematic review and meta-analysis
Authors: Akhtar Sohail , Nasir Jamal Abdul , Sarwar Aqsa , Nasr Nida , Javed Amara , Majeed Rizwana , Salam Muhammad Abdus , Billah Baki
Published: September 2020

Objective

The purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh.

Design

Systematic review and meta-analysis.

Participants

General population of Bangladesh.

Data sources

PubMed, Medline, Embase, Bangladesh Journals Online, Science Direct, Scopus, Cochrane Library and Web of Science were used to search for studies, published between 1st of January 1995 and 31st of August 2019, on the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. Only articles published in the English language articles were considered. Two authors independently selected studies. The quality of the articles was also assessed.

Results

Out of 996 potentially relevant studies, 26 population-based studies, which together involved a total of 80 775 individuals, were included in the meta-analysis. The pooled prevalence of diabetes in the general population was 7.8% (95% CI: 6.4–9.3). In a sample of 56 452 individuals, the pooled prevalence of pre-diabetes was 10.1% (95% CI: 6.7–14.0; 17 studies). The univariable meta-regression analyses showed that the prevalence of diabetes is associated with the factors: the year of study, age of patients and presence of hypertension. The prevalence of diabetes was significantly higher in urban areas compared with rural areas, while there was no significant gender difference.

Conclusions

This meta-analysis suggests a relatively high prevalence of pre-diabetes and diabetes in Bangladesh, with a significant difference between rural and urban areas. The main factors of diabetes include urbanisation, increasing age, hypertension and time period. Further research is needed to identify strategies for early detecting, prevention and treatment of people with diabetes in the population.

PROSPERO registration number

CRD42019148205.
Diagnosis, treatment and management of apathy in Parkinson’s disease: a scoping review
Authors: Mele Bria , Van Shinia , Holroyd-Leduc Jayna , Ismail Zahinoor , Pringsheim Tamara , Goodarzi Zahra
Published: September 2020

Objective

To conduct a scoping review of the literature on apathy in Parkinson’s disease (PD), to better understand how apathy in Parkinson’s disease is diagnosed, treated and managed.

Methods

MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Central Register of Control Trials and Cochrane Database of Systematic Reviews were searched to 17 May 2017. An updated review was run from 17 May 2017 to 28 January 2019. The grey literature was searched using the CADTH Grey Matters tool. Original peer-reviewed research was included if it included individuals with PD and apathy. Non-original data was only included if it was in the form of meta-analysis. All information regarding diagnosis, treatment and management of PD was extracted. Citation screening and extraction were performed in duplicate.

Results

From 11 375 citations, 362 articles were included in the final review. The majority of included studies focussed on prevalence, with few studies examining treatment. Twenty screening tools for apathy were identified. Fifty per cent of treatment studies were randomised control trials (RCTs). RCTs applied treatment methods including: exercise, mindfulness, rotigotine (Neupro) transdermal patch and rivastigmine (Exelon).

Conclusions

This review identified a large body of literature describing current knowledge on diagnosing, treating and managing apathy in PD. Future research should aim to detect an ideal screening tool for apathy in PD, to identify the best treatment options for apathy and the variety of comorbidities it may present with and finally aim to better understand postoperative apathy in those with deep brain stimulation.
Tailoring anticoagulant treatment of patients with atrial fibrillation using a novel bleeding risk score
Authors: Chu Gordon , Valerio Luca , van der Wall Sake J , Barco Stefano , Konstantinides Stavros , Huisman Menno V , Klok Frederikus A
Published: September 2020

Objectives

Current international guidelines advocate the application of bleeding risk scores only to identify modifiable risk factors, but not to withhold treatment in patients at high risk of bleeding. VTE-BLEED (ActiVe cancer, male with uncontrolled hyperTension, anaEmia, history of BLeeding, agE and rEnal Dysfunction) is a simple bleeding risk score that predicts major bleeding (MB) in patients with venous thromboembolism, but has never been evaluated in patients with atrial fibrillation (AF). We sought to evaluate VTE-BLEED in patients with AF included in the Randomised Evaluation of Long-term anticoagulant therapY (RE-LY) trial, to assess whether score classes (high vs low bleeding risk) interact with the tested dabigatran doses (150 vs 110 mg twice daily), and to investigate whether dose reductions based on this interaction might help to lower the incidence of the composite outcome MB, stroke/systemic embolism or death.

Methods

The score was calculated in the safety population of RE-LY (n=18 040) and recalibrated for AF (AF-adapted VTE-BLEED or AF-BLEED). HRs were calculated to evaluate the score’s predictive accuracy for MB. The risk ratios (RRs) for the composite outcome comparing dabigatran 150 and 110 mg twice daily were calculated for the high-risk group.

Results

AF-BLEED classified 3534 patients (19.6%) at high bleeding risk, characterised by a 2.9-fold to 3.4-fold higher risk of bleeding than low bleeding risk patients, across the treatment arms. High bleeding risk patients randomised to 110 mg twice daily had a lower incidence of the composite outcome than those randomised to 150 mg twice daily, for an RR of 0.52 (95% CI 0.35 to 0.78). Compared with the label criteria for dose reduction, AF-BLEED identified an additional 11% of patients who might have benefited from dose reduction.

Conclusions

AF-BLEED identified patients with AF at high risk of bleeding. Our findings raise the hypothesis that dabigatran 110 mg twice daily might be considered in patients classified as high risk according to the AF-BLEED score. This study provides a basis for future studies to explore safe dose reductions of direct oral anticoagulants in selected patient groups based on bleeding scores.
Prognostic values of L-type amino acid transporter 1 and CD98hc expression in breast cancer
Authors: Ichinoe Masaaki , Mikami Tetuo , Yanagisawa Nobuyuki , Yoshida Tsutomu , Hana Kiyomi , Endou Hitoshi , Okayasu Isao , Sengoku Norihiko , Ogata Hideaki , Saegusa Makoto , Shibuya Kazutoshi , Murakumo Yoshiki
Published: September 2020

Aims

L-type amino acid transporter 1 (LAT1) is a major Na+-independent neutral amino acid transporter, forming a complex with CD98hc. The aim of this study is to investigate the significance of LAT1 and CD98hc in invasive breast cancer.

Methods

LAT1 and CD98hc expression was immunohistochemically assessed in 280 invasive breast cancers and analysed for association with clinicopathological features.

Results

High levels of LAT1 and CD98hc were observed in triple-negative breast cancers (TNBCs) possessing negative immunoreactivity with oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2, compared with non-TNBCs (NTNBCs), and were associated with lymph-node metastasis and higher nuclear grade. The high-LAT1-expression group showed a poor prognosis in NTNBC and TNBC, however, high-CD98hc-expression group showed a poor prognosis only in NTNBC. LAT1 and CD98hc expression could be the prognostic factors in univariate analyses, but not in multivariate analyses. Further, we found that invasive tumour components showed higher LAT1 and CD98hc expression than non-invasive tumour components.

Conclusions

LAT1 and CD98hc may possess prognostic values in invasive breast cancer. LAT1 may be linked with cancer cell activities and disease progression in breast cancer.
Gene of the month:GTF2I
Authors: Nathany Shrinidhi , Tripathi Rupal , Mehta Anurag
Published: September 2020

TheGTF2Iis a general transcription factor and its mutations have been reported to be recurrent in thymic epithelial tumours and are rare in other malignancies. Apart from thymic epithelial tumours, these mutations have also been reported in a subgroup of T cell lymphomas, angioimmunoblastic T cell lymphomas. Soft tissue angiofibroma has been reported to harbourGTF2I-NCOA2fusion, whereasGTF2Ipartners with Retinoic acid receptor alpha(RARA)in acute promyelocytic leukaemia asGTF2I-RARA.GTF2Ihas also been implicated in immune disorders and two neuropsychiatric genetic disorders, namely autism and Williams-Beuren syndrome. The various structural, biochemical and functional properties ofGTF2Isuggest towards the oncogenic nature of this gene. Studies involving patients are presently few and the availability of biospecimens amenable to molecular diagnostic studies is limited. Future studies involving biospecimens and transformed cell lines shall provide a clear understanding of theGTF2Imechanistic to eventually lead to targeted treatment.
Will it work here? A realist approach to local decisions about implementing interventions evaluated as effective elsewhere
Authors: Bonell Chris , Prost Audrey , Melendez-Torres G J , Davey Calum , Hargreaves James R
Published: September 2020

There is increasing interest in what evidence is needed to inform decisions about transporting interventions evaluated as effective to new settings. There has been less attention to how local decision-makers decide whether to implement such interventions immediately or subject to further evaluation. Using the example of school-based social and emotional learning, we consider this drawing on realist methods. We suggest decisions need to assess existing evaluations not merely in terms of whether the intervention was effective but also: how the intervention was implemented and what contextual factors affected this (drawing on process evaluation); and for whom the intervention was effective and through what mechanisms (drawing on mediation, moderation and qualitative comparative analyses from primary studies and/or systematic reviews). We contribute new insights to local needs assessments, suggesting that these should assess: the potential, capability, contribution and capacity present in the new setting for implementation; and whether similar ‘aetiological mechanisms’ underlie adverse outcomes locally as in previous evaluations. We recommend that where there is uncertainty concerning whether an intervention can feasibly be implemented this indicates the need for piloting of implementation. Where there is uncertainty concerning whether implementation of the intervention will trigger intended mechanisms, this suggests the need for a new effectiveness trial. Where there is uncertainty concerning whether intervention mechanisms, even if triggered, will generate the intended outcomes, this suggests that decision-makers may need to look to other types of intervention as being needed for their setting instead.
Discriminative value of glial fibrillar acidic protein (GFAP) as a diagnostic tool in acute stroke. Individual patient data meta-analysis
Authors: Cabezas Juan Antonio , Bustamante Alejandro , Giannini Nicola , Pecharroman Emilio , Katsanos Aristeidis H , Tsivgoulis Georgios , Rozanski Michal , Audebert Heinrich , Mondello Stefania , Llombart Victor , Montaner Joan
Published: September 2020

Glial fibrillar acidic protein (GFAP) in serum has been evaluated as a promising biomarker to differentiate between intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS). We assessed its value as diagnostic and prognostic tool for ICH through a literature systematic review and individual patient data (IPD) meta-analysis.

We performed a systematic search in PubMed database until November 2018 for publications that evaluated GFAP to differentiate AIS and ICH within 4.5 hours after symptoms onset. Thereafter, we invited authors of selected studies to participate in this work by providing IPD from their cohorts. We used standardized individual subject's data to evaluate the association of GFAP concentrations with stroke subtype, demographics, stroke characteristics and factors related with GFAP measurement.

From 4 selected studies, we collected data of 340 patients (236 AIS and 104 ICH). Standardized GFAP blood levels were significantly elevated in ICH compared with those with AIS (median and IQR: 0.84 (0.781–1.24), 0.79 (0.74–0.81); p<0.0001). In both stroke types, GFAP concentrations correlated with baseline stroke severity (r=0.27, p<0.0001; r=0.36, p<0.001; for AIS and ICH, respectively) but no correlation was found regarding time to sampling. Limited data precluded the evaluation of GFAP levels and functional outcome.

These findings demonstrate substantially different levels of GFAP in the blood of patients with ICH compared with patients with AIS soon after the event, while no association was found with outcome. In summary, GFAP could be a valuable diagnostic tool to assist in medical decision-making and to optimize management of stroke in the acute setting.
Efficacy and safety of first-line avelumab in patients with advanced non-small cell lung cancer: results from a phase Ib cohort of the JAVELIN Solid Tumor study
Authors: Verschraegen Claire F , Jerusalem Guy , McClay Edward F , Iannotti Nicholas , Redfern Charles H , Bennouna Jaafar , Chen Franklin L , Kelly Karen , Mehnert Janice , Morris John C , Taylor Matthew , Spigel David , Wang Ding , Grote Hans Juergen , Zhou Dongli , Munshi Neru , Bajars Marcis , Gulley James L
Published: September 2020

Introduction

Avelumab, an antiprogrammed death ligand-1 antibody, is approved as a monotherapy for treatment of metastatic Merkel cell carcinoma and advanced urothelial carcinoma, and in combination with axitinib for advanced renal cell carcinoma. We report the efficacy and safety of first-line avelumab in advanced non-small cell lung cancer (NSCLC).

Methods

In a phase I expansion cohort of the JAVELIN Solid Tumor trial, patients with treatment-naive, metastatic, or recurrent NSCLC received 10 mg/kg avelumab intravenously every 2 weeks. Endpoints included best overall response, duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety.

Results

Overall, 156 patients were enrolled and treated. Median duration of follow-up was 18.6 months (range, 15 to 23 months). The objective response rate was 19.9% (95% CI, 13.9 to 27.0), including complete response in 3 (1.9%) and partial response in 28 (17.9%). Median DOR was 12.0 months (95% CI, 6.9 to not estimable). Median PFS was 4.0 months (95% CI, 2.7 to 5.4) and the 6-month PFS rate was 38.5% (95% CI, 30.7 to 46.3). Median OS was 14.1 months (95% CI, 11.3 to 16.9) and the 12-month OS rate was 56.6% (95% CI, 48.2 to 64.1). Treatment-related adverse events (TRAEs) occurred in 107 patients (68.6%), including grade ≥3 TRAEs in 19 (12.2%). Immune-related adverse events and infusion-related reactions occurred in 31 (19.9%) and 40 patients (25.6%), respectively. No treatment-related deaths occurred.

Conclusion

Avelumab showed antitumor activity with a tolerable safety profile as a first-line treatment in patients with advanced NSCLC. These data support further investigation of avelumab in the phase III JAVELIN Lung 100 study.

Trial registration details

ClinicalTrials.gov NCT01772004; registered January 21, 2013.
Immunity passports, fundamental rights and public health hazards: a reply to Brownet al
Authors: de Miguel Beriain Iñigo , Rueda Jon
Published: September 2020

In their recent article, Brownet alanalyse several ethical aspects around immunity passports and put forward some recommendations for implementing them. Although they offer a comprehensive perspective, they overlook two essential aspects. First, while the authors consider the possibility that immunological passports may appear to discriminate against those who do not possess them, the opposite viewpoint of immune people is underdeveloped. We argue that if a person has been tested positive for and recovered from COVID-19, becoming immune to it, she cannot be considered a hazard to public health and, therefore, the curtailment of her fundamental rights (eg, the right to freedom of movement) is not legitimate. Second, they omit that vaccine distribution will create similar problems related to immunity-based licenses. Vaccine certificates will de facto generate a sort of immunity passport. In the next phases of the pandemic, different immunity statuses will be at stake, because the need to identify who can spread COVID-19 is unavoidable. If a person does not pose a threat to public health because she cannot spread the infection, then her right to freedom of movement should be respected, regardless of how she acquired that immunity.
Associations between physical and psychosocial work environment factors and sickness absence incidence depend on the lengths of the sickness absence episodes: a prospective study of 27 678 Danish employees
Authors: Thorsen Sannie Vester , Flyvholm Mari-Ann , Pedersen Jacob , Bültmann Ute , Andersen Lars L , Bjorner Jakob Bue
Published: September 2020

Objectives

This study examined if the association between work environment factors and sickness absence (SA) depended on the inclusion or exclusion of short-term SA episodes.

Methods

We linked the ‘Work Environment and Health in Denmark’ survey with the ‘Danish Register of Work Absences’ (n=27 678). Using covariate adjusted Cox regression, we examined the associations between work environment factors and SA by changing the cut-off points for the length of the SA episodes, for example, episodes ≥1 day, ≥6 days and ≥21 days. We examined three physical work environment factors: ‘Back bend or twisted’, ‘Lifting or carrying’, ‘Wet hands’ and three psychosocial work environment factors: ‘Poor influence’, ‘Role conflicts’ and ‘Bullying’.

Results

‘Back bend or twisted’ and ‘Lifting or carrying’ had small significant HRs for SA episodes ≥1 day and large and highly significant HRs for SA episodes ≥6 days and ≥21 days. ‘Wet hands’ had small significant HRs for SA episodes ≥1 day for both sexes and large and highly significant HR for ≥6 days for women. HRs of all three psychosocial factors were highly significant for SA episodes ≥1 day and ≥6 days for both sexes, and ‘Poor influence’ and ‘Role conflicts’ were significant for SA episodes ≥21 days for women.

Conclusions

The physical work factors had higher associations with SA when SA episodes of 1–5 days were excluded and focus was on SA episodes ≥6 days. The psychosocial work factors were strongly associated with SA both with and without SA episodes of 1–5 days included in the analyses.
Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine
Authors: Bassareo Pier Paolo , Melis Maria Rosaria , Marras Silvia , Calcaterra Giuseppe
Published: September 2020

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece—the cradle of medicine—to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.
No radiographic sacroiliitis progression was observed in patients with early spondyloarthritis at 6 years: results of the Esperanza multicentric prospective cohort
Authors: Fernández-Carballido Cristina , Tornero Carolina , Castro-Villegas M Carmen , Galindez Eva , García-Llorente José Francisco , García-Vivar María Luz , Joven-Ibáñez Beatriz , Juanola Xavier , Urrego-Laurín Claudia , López-Medina Clementina , Almodovar Raquel , Martínez-Alberola Nieves , Ruiz-Jimeno Teresa , de Miguel Eugenio
Published: September 2020

Objective

To estimate the 6-year radiographic progression of sacroiliitis in patients with early spondyloarthritis (SpA).

Patients and methods

Sacroiliac joint (SIJ) radiographs (baseline and 6 years) of 94 patients with recent-onset SpA from the Esperanza cohort were scored, blindly and in a random order, by nine readers. The modified New York criteria were used to define the presence of sacroiliitis. As the gold standard for radiographic (r) sacroiliitis, the categorical opinion of at least five readers was used. Progression was defined as the shift from non-radiographic (nr) to r-sacroiliitis.

Results

In the 94 SIJ radiographs (baseline and 6 years), 78/94 (83%) pairs of radiographs had not changed from baseline to 6 years. Sacroiliitis was present in 20 patients at baseline (21.3%) and in 18 (19.2%) patients at 6 years; 11 patients had sacroiliitis at both the baseline and final visits; 9 patients changed from baseline r-sacroiliitis to nr-sacroiliitis at 6 years, and 7 changed from baseline nr-sacroiliitis to r-sacroiliitis at 6 years. The mean continuous change score (range: −8 to +8) was 2.80 at baseline and 2.55 at 6 years (mean net progression of −0.25). The reliability of the readers was fair (mean inter-reader kappa of 0.375 (0.146–0.652) and mean agreement of 73.7% (58.7–90%)).

Conclusion

In the early SpA Esperanza cohort, progression from nr-axSpA to r-axSpA over 6 years was not observed, although the SIJ radiographs scoring has limitations to detect low levels of radiographic progression.
Creation and implementation of a novel clinical workflow based on the AAST uniform anatomic severity grading system for emergency general surgery conditions
Authors: Bessoff Kovi E , Choi Jeff , Bereknyei Merrell Sylvia , Nassar Aussama Khalaf , Spain David , Knowlton Lisa Marie
Published: September 2020

Objective

Emergency general surgery (EGS) conditions encompass a variety of diseases treated by acute care surgeons. The heterogeneity of these diseases limits infrastructure to facilitate EGS-specific quality improvement (QI) and research. A uniform anatomic severity grading system for EGS conditions was recently developed to fill this need. We integrated this system into our clinical workflow and examined its impact on research, surgical training, communication, and patient care.

Methods

The grading system was integrated into our clinical workflow in a phased fashion through formal education and a written handbook. A documentation template was also deployed in our electronic medical record to prospectively assign severity scores at the time of patient evaluation. Mixed methods including a quantitative survey and qualitative interviews of trainees and attending surgeons were used to evaluate the impact of the new workflow and to identify obstacles to its adoption.

Results

We identified 2291 patients presenting with EGS conditions during our study period. The most common diagnoses were small bowel obstruction (n=470, 20.5%), acute cholecystitis (n=384, 16.8%), and appendicitis (n=370, 16.1%). A total of 21 qualitative interviews were conducted. Twenty interviewees (95.2%) had a positive impression of the clinical workflow, citing enhanced patient care and research opportunities. Fifteen interviewees (75.0%) reported the severity grading system was a useful framework for clinical management, with five participants (25.0%) indicating the system was useful to facilitate clinical communication. Participants identified solutions to overcome barriers to adoption of the clinical workflow.

Conclusions

The uniform anatomic severity grading system can be readily integrated into a clinical workflow to facilitate prospective data collection for QI and research. The system is perceived as valuable by users. Educational initiatives that focus on increasing familiarity with the system and its benefits will likely improve adoption of the classification system and the clinical workflow that uses it.

Level of evidence

Level III.
Dietary restriction and/or exercise training impairs spermatogenesis in normal rats
Authors: Li Yinlam , Zhang Li , Zheng Xiaoguo , Qian Jianing , Li Yanquan , Xie Chong , Zhang Xuelian , Zhou Yuchuan , Huang Hefeng
Published: September 2020

Dietary restriction and/or exercise has been shown to have multiple benefits for health. However, its effects on reproductive health and the mechanisms by which it regulates reproductive function remain unclear. Here, to evaluate its effects on spermatogenesis and sperm function, rats were divided into 4 groups: ad libitum-fed sedentary control, dietary restriction (DR), exercise training (ET), and dietary restriction plus exercise training (DR+ET) groups. Results indicated that body weight, epididymal fat pad weight, and sperm counts were significantly reduced in the DR, ET, and DR+ET groups. Moreover, sperm motility and capacitation-associated protein tyrosine phosphorylation were suppressed in the DR and DR+ET groups, but not the ET group. Microarray analysis revealed that the number of downregulated genes was higher than that of upregulated genes in the DR and/or ET groups. About half of the downregulated genes are common after exercise training and/or diet restriction. Gene ontology analysis showed that downregulated genes in the DR, ET, and DR+ET groups affected spermatogenesis through overlapping pathways, including glucocorticoid, corticosteroid, extracellular structure organization, and estradiol responses. Our findings suggest that diet restriction and/or exercise training may present potential risks to male reproductive dysfunction by disrupting normal gene expression patterns in the testis.

Novelty: Dietary restriction and/or exercise can lead to the damage of spermatogenesis as well as sperm maturation. Sperm functional changes are more sensitive to dietary restriction than exercise training. Dietary restriction and exercise impair spermatogenesis through overlapping biological pathways in the testis.
Effects of oral bovine lactoferrin on a mouse model of inflammation associated colon cancer
Authors: Tanaka Hajime , Gunasekaran Sivagami , Saleh Dina Mourad , Alexander William T. , Alexander David B. , Ohara Hirotaka , Tsuda Hiroyuki
Published: September 2020

Patients with ulcerative colitis or colonic Crohn’s disease have a significantly increased risk of developing colorectal cancer. Bovine lactoferrin (bLF) reportedly inhibited the development of colon cancer in rats and mice, and in a placebo controlled trial, ingestion of bLF inhibited the growth of intestinal polyps. In addition, in a case study, a patient with Crohn’s disease was reported to have remained in remission for over 7 years while ingesting 1 g of bLF daily. Thus, bLF has an inhibitory effect on colon carcinogenesis, and it may also promote remission of Crohn’s disease. The purpose of this study was to investigate the effects of bLF in a mouse model of colorectal cancer related to irritable bowel disease (IBD). The mice were divided into 4 groups: (i) no treatment; (ii) treated with bLF only; (iii) treated with azoxymethane plus dextran sulfate sodium (AOM + DSS); and (iv) treated with AOM + DSS + bLF. AOM was used to initiate intestinal cancer, and DSS was used to induce IBD-like inflammation in the intestine of the C57BL/6 mice. At the end of the study, the mice treated with AOM + DSS + bLF had a better fecal score, fewer lesions in the colon, and less weight loss than the mice treated with AOM + DSS without bLF. However, there were no statistically significant differences between the two groups with respect to tumor burden.
When Weblogs Can Be Harmful
Authors: Feldstein Michael
Published: September 2020

If a learning community's particular information-sharing process is flawed, then communications technologies such as weblogs will amplify the misinformation that results from that flawed process.
The Rock Stars of eLearning: An interview with Neil Lasher
Authors: Raymer Rick
Published: September 2020

ELearning's Rock Stars are individuals whose passion and enthusiasm has made a positive impact on the industry. Whether it's using new technologies, or staging an epic event, Neil Lasher is an expert at making impactful learning.
Developing Engaging Content
Authors: Vieira Randhir
Published: September 2020

Companies need training that is not only flexible and affordable, but can be deployed and consumed quickly. Enter eLearning. Trainers have the dual challenge of helping employees meet compliance or other industry requirements and respond to changing customer needs. These pressures mean trainers must create new online courses on the fly while ensuring the content is easily consumable to reinforce rapid learning. By using existing material and frequently measuring feedback, among other ideas, you can transform your online training program into a highly efficient machine for learning and competing.
Putting the Classroom in the Cloud with Virtual Desktops and Bring-Your-Own-Device
Authors: Mills Shawn
Published: September 2020

IT departments in educational environments must constantly balance expenses while implementing new technology to engage learners and empower instructors. Virtual desktop infrastructure (VDI) is one method IT administrators can implement for simplified computer lab management, increased security measures, and to allow students and teachers to work with their mobile devices.
Online and Distance Education Demands Researchers Pick a Topic and Get to Work
Authors: Dolet Nakita
Published: September 2020

Online and distance educations continues to grow as a field, attracting students and educators from various disciplines and cultural backgrounds. Despite, a growing interest in online education, many argue there is a need for deliberate, well-informed research that helps in the continued development of the field. "Online Distance Education: Towards a Research Agenda," edited by Olaf Zawacki-Richter and Terry Anderson, attempts to bring a renewed energy to online and distance education (ODEL) research by inviting a number of experts to discuss issues impacting this sector of education today.
You Think You Know Online Learners? Think Again
Authors: Cross Jill
Published: September 2020

Online learning is a dynamically evolving practice, and many companies operate under outdated assumptions about their audience. InReach, a continuing education solution provider, recently conducted a survey to uncover the wants and preferences of online learners. The findings, which are shared within, can help identify the key factors that make up a successful online program.
The Development of Online Distance Education in Saudi Arabia
Authors: Alturki Uthman T.
Published: September 2020

Today we live in the era of the knowledge revolution, which accelerates scientific discoveries, technological developments, and the spread of knowledge. Perhaps one of the most rapid technological developments is what is happening in the field of communication technology, the Internet, and distance education. These developments have affected all aspects of life and pose new challenges in all areas especially in the field of education. This article provides an overview of the Saudi education system and history of distance education, and also describes the reality of distance learning in Saudi Arabia and the possibility of using it as a solution method to absorb the growing numbers of students who wish to continue their education.
Creating Instruction for Ubiquitous Learners: Three paradigm shifts that are changing the foundations of instructional design
Authors: Stafford Timothy
Published: September 2020

Learning is shifting, but in many ways it is the foundations of learning that are having the most profound effect on contemporary instructional designers. Defining social media, digital literacy and learning, knowing, and expertise are only the tip of the iceberg for the future of learning within digital environments.
Do you Blend? Huntley High School Does
Authors: Garrett Dikkers Amy , Whiteside Aimee L. , Lewis Somer
Published: September 2020

Huntley High School in Huntley, Illinois has recently implemented a blended learning initiative to meet needs of their learners in the 21st century, infusing technology into the school's curriculum and teachers' instructional practices, and preparing students for college and career. Huntley's unique mix of traditional and blended learning provides a variety of ways for students to learn in both elective and core classes. We share Huntley's unique model of blended learning, focusing on four lessons learned.
Expanding the Uses of Blogs in the Classroom
Authors: Lee Yekyung Lisa , Ik Yeo Hwan
Published: September 2020

Blogs are not only tools for self-expression or social interaction among school children. They also have the potential to influence the cognitive processes of learning. The authors detail their experience using blogs at a public elementary school in Korea.
Fungal Volatile Organic Compounds: More Than Just a Funky Smell?
Authors: Inamdar Arati A. , Morath Shannon , Bennett Joan W.
Published: September 2020

Many volatile organic compounds (VOCs) associated with industry cause adverse health effects, but less is known about the physiological effects of biologically produced volatiles. This review focuses on the VOCs emitted by fungi, which often have characteristic moldy or “mushroomy” odors. One of the most common fungal VOCs, 1-octen-3-ol, is a semiochemical for many arthropod species and also serves as a developmental hormone for several fungal groups. Other fungal VOCs are flavor components of foods and spirits or are assayed in indirect methods for detecting the presence of mold in stored agricultural produce and water-damaged buildings. Fungal VOCs function as antibiotics as well as defense and plant-growth-promoting agents and have been implicated in a controversial medical condition known as sick building syndrome. In this review, we draw attention to the ubiquity, diversity, and toxicological significance of fungal VOCs as well as some of their ecological roles.
Electrodeposition of Ag/CNT Composite Films from Iodide Plating Baths
Authors: Arai Susumu , Kikuhara Taishi , Shimizu Masahiro , Horita Masaomi
Published: September 2020

Ag/carbon nanotube (CNT) composite films were prepared by electrodeposition from non-cyanide baths. An iodide bath and multiwalled CNTs were used. The stability of the iodide bath under ambient conditions at various pH levels was examined, along with the changes in visual appearance, pH, and triiodide ion (I3
−) concentration. The electrodeposition was conducted under galvanostatic conditions using iodide baths with and without CNTs. The microstructure of the Ag and Ag/CNT composite films was characterized, and the hardness, electrical conductivity, and coefficient of friction of the films were measured. The iodide bath was stable at higher pH levels under ambient conditions. The obtained Ag/CNT composite films exhibited a compact structure, and CNTs were homogeneously distributed in the interior of the deposited Ag matrix. The CNT content in the deposits increased with increasing CNT concentration in the plating bath. The hardness of the Ag/1.2 mass%-CNT composite film was 63.2 HV, which was slightly greater than that of the Ag film (60.4 HV). The resistivity of the composite film was 1.9 μΩ cm, which was slightly higher than that of the pure Ag film (1.8 μΩ cm). The coefficient of friction of the composite film was lower than that of the Ag film.
Reduced allergic lung inflammation and airway responsiveness in mice lacking the cytoskeletal protein gelsolin
Authors: Mikami Maya , Yocum Gene T. , Heller Nicola M. , Emala Charles W.
Published: September 2020

Airway smooth muscle hyperresponsiveness associated with chronic airway inflammation leads to the typical symptoms of asthma including bronchoconstriction and wheezing. Asthma severity is associated with airway inflammation; therefore, reducing airway inflammation is an important therapeutic target. Gelsolin is an actin capping and severing protein that has been reported to be involved in modulation of the inflammatory response. Using mice genetically lacking gelsolin, we evaluated the role of gelsolin in the establishment of house dust mite (HDM) antigen-induced allergic lung inflammation. The genetic absence of gelsolin was found to be protective against HDM sensitization, resulting in reduced lung inflammation, inflammatory cytokines, and Muc5AC protein in bronchoalveolar lavage (BAL) fluid. The number of eosinophils, lymphocytes, and interstitial macrophages in the BAL were increased after HDM sensitization in wild-type mice but were attenuated in gelsolin-null mice. The observed attenuation of inflammation may be partly due to delayed migration of immune cells, because the reduced eosinophils in the BALs from gelsolin-null mice compared with controls occurred despite similar amounts of the chemoattractant eotaxin. Splenic T cells demonstrated similar proliferation rates, but ex vivo alveolar macrophage migration was delayed in gelsolin-null mice. In vivo, the reduced lung inflammation after HDM sensitization in gelsolin-null mice was associated with significantly diminished airway resistance to inhaled methacholine compared with HDM-treated wild-type mice. Our results suggest that modulation of gelsolin expression or function in selective inflammatory cell types that modulate allergic lung inflammation could be a therapeutic approach for asthma.
Selective loss of the GABAAα1 subunit from Purkinje cells is sufficient to induce a tremor phenotype
Authors: Nietz Angela , Krook-Magnuson Chris , Gutierrez Haruna , Klein Julia , Sauve Clarke , Hoff Isaac , Christenson Wick Zoé , Krook-Magnuson Esther
Published: September 2020

Animals with a global knockout of the GABAAα1 subunit show a tremor phenotype reminiscent of essential tremor. Here we show that selective knockout of GABAAα1 from Purkinje cells is sufficient to produce a tremor phenotype, although this tremor is less severe than seen in animals with a global knockout. These findings illustrate that the cerebellum can play a key role in the genesis of the observed tremor phenotype.
Continuous reports of sensed hand position during sensorimotor adaptation
Authors: Tsay Jonathan S. , Parvin Darius E. , Ivry Richard B.
Published: September 2020

Sensorimotor adaptation operates in an obligatory manner. Qualitatively, subjective reports obtained after adaptation demonstrate that, in many conditions, participants are unaware of significant changes in behavior. In the present study, we quantified participants’ sensitivity to these adaptive changes by obtaining reports of hand position on a trial-by-trial basis. The results confirm that participants are largely unaware of adaptation but also reveal the subtle influence of feedback on their subjective experience.