bluuebunny/crossref_metadata_2025 huggingface dataset:
Simplifying Bony Midface Reconstruction with Patient-specific Titanium Plates
Authors: Palines Patrick A. , Ferrer James R. , Yoo Aran , St. Hilaire, Hugo , Stalder Mark W.
Published: April 2021

Virtual surgical planning and patient-specific osteosynthesis plates provide reconstructive surgeons with the ability to proceed with facial reconstruction of expanding complexity. Moreover, these advances have been shown to reduce the energy, effort, and operating time while helping guide the surgeon toward anatomically correct results. The currently available literature regarding custom-milled plates pertains mostly to reconstructive surgery of the mandible. This small 3-patient series illustrates the use of patient-specific titanium plating to simplify complex reconstruction of the midface. Composite defects requiring multiple bony and soft tissue segments are difficult to reconstruct intraoperatively without prior planning. Custom plates and associated cutting guides based on patient-specific anatomy allow for a more streamlined, stepwise protocol for assembly of intricate constructs. Custom-manufactured hardware will precisely fit bony contours and minimize additional manipulation of both the bone and plate, maximally preserving internal strength and allowing for improved stability, dental occlusion, and spatial positioning. In addition to these mechanical benefits, the ease of mind and overall cost reduction through a reduction in procedural time are significant advantages offered by pre-designed plates. We hope that this series illustrates the value of custom-printed plates for midface reconstruction.
Symptoms of Depression and Anxiety in Patients With Type 2 Diabetes in a Canadian Outpatient Cardiac Rehabilitation Program
Authors: Moran Chelsea , Flynn Michelle , Campbell Tavis , Rouleau Codie , Arena Ross , Chirico Daniele , Aggarwal Sandeep , Laddu Deepika
Published: April 2021

Purpose:

The objective of this study was to determine whether type 2 diabetes status is associated with an increased likelihood of depressed mood and anxiety in patients attending cardiac rehabilitation (CR) and to explore predictors of depression and anxiety after CR completion in patients with diabetes.

Methods:

A retrospective analysis was conducted in patients who completed a 12-wk CR program between 2002 and 2016. Patients were classified as reporting normal-to-mild or moderate-to-severe symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). Logistic regression models were used to compare predictors of depression and anxiety prior to CR enrollment and investigate predictors of post-CR HADS scores among a subset of patients with diabetes.

Results:

Data from 6746 patients (mean age 61 ± 11 yr, 18% female, 18% with diabetes) were analyzed. After controlling for known predictors of depression, patients with diabetes were not more likely to report moderate-to-severe levels of depression prior to or after completing CR. In patients with diabetes, younger age predicted moderate-to-severe depression post-CR (OR = 0.95: 95% CI, 0.93-0.98). Patients with diabetes were also more likely to report moderate-to-severe levels of anxiety after completing CR (OR = 1.45: 95% CI, 1.02-2.07). Younger age (OR = 0.93: 95% CI, 0.88-0.97) and smoking status (OR = 3.3: 95% CI, 1.15-7.06) predicted moderate-to-severe post-CR anxiety in patients with diabetes.

Conclusions:

Patients with diabetes, particularly younger patients who currently smoke or recently quit, are more likely to report having anxiety following CR. These patients may therefore require additional management of anxiety symptoms during CR. Larger studies of CR patients with diabetes and more variable depression and anxiety levels are needed.
Therapeutic Inefficacy and Proarrhythmic Nature of Metoprolol Succinate and Carvedilol Therapy in Patients With Idiopathic, Frequent, Monomorphic Premature Ventricular Contractions
Authors: Turan Oguzhan Ekrem , Aydin Mehmet , Odabasi Ahmet Yener , Inc Mustafa , Payzin Serdar , Hasdemir Can
Published: April 2021

Background:

Antiarrhythmic drugs remain the first-line therapy for treatment of idiopathic ventricular arrhythmias.

Study Question:

The aim of this study was to assess the therapeutic efficacy of extended-release metoprolol succinate (MetS) and carvedilol for idiopathic, frequent, monomorphic premature ventricular contractions (PVCs).

Study Design:

Study population consisted of 114 consecutive patients: 71 received MetS and 43 received carvedilol.

Measures and Outcomes:

All patients underwent 24-hour Holter monitoring at baseline and during drug therapy. PVC-burden response to drug therapy was categorized as “good” (≥80% reduction), “poor” (either <80% reduction or ≤50% increase), and “proarrhythmic” responses (>50% increase) based on change in PVC burden compared with baseline.

Results:

Most common presenting symptom was palpitations (65.8%), followed by coincidental discovery (29%). The mean MetS and carvedilol dosages were 65.57 ± 30.67 mg/d and 23.66 ± 4.26 mg/d, respectively. “Good,” “poor,” and “proarrhythmic” responses were observed in 11.3% and 16.3%, 63.4% and 67.4%, and 25.3% and 16.3% of patients treated with MetS and carvedilol, respectively. In patients with relatively high (≥16%) PVC burden, the sum of “poor”/“proarrhythmic” response was observed in 95.5% and 86.4% of patients treated with MetS and carvedilol, respectively. “Proarrhythmic” response was observed in 21.9% of the patients, particularly in the presence of relatively lower (≤10%) baseline PVC burden. Patients with “good” response during beta-blocker therapy had higher baseline daily average intrinsic total heart beats compared with patients with “poor”/“proarrhythmic” response combined (96,437 ± 26,488 vs. 86,635 ± 15,028, P = 0.047, respectively). Side effects and intolerance were observed in 5.6% and 18.6% of patients treated with MetS and carvedilol, respectively.

Conclusions:

MetS and carvedilol for idiopathic, frequent, monomorphic PVCs are frequently inefficient. Therapeutic efficacy decreases further in patients with relatively high (≥16%) PVC burden. Relatively higher baseline daily intrinsic total heart beats may be used to predict “good” response before beta-blocker therapy.
Diagnosis, Management, and Challenges in Synchronous Bilateral Wilms Tumor in a Horseshoe Kidney: A Case Report
Authors: Arslantaş Esra , Çelebi Süleyman , Ayçiçek Ali , Doğan Sumeyra , Bayram Cengiz
Published: April 2021

Horseshoe kidney (HK) refers to a congenital malformation that results from fusion of both the kidneys at one pole, and is the most common renal fusion defect with an incidence of 1 in 400 to 600 individuals. Synchronous bilateral development of Wilms tumor (WT) in an HK is extremely rare. Here, we present a case of synchronous bilateral WT in an HK in an 18-month-old girl. The patient received 12 weeks of preoperative chemotherapy followed by 2-step surgical resection including nephron-sparing surgery (NSS) in both kidneys and left nephrectomy because of positive surgical margin and adjuvant chemotherapy. The patient is still in remission and asymptomatic 6 months after the completion of treatment. In this report, we discuss the treatment modalities of synchronous bilaterally located WT in HK. We conclude that successful outcomes can be obtained with preoperative chemotherapy and NSS in such cases even in the presence of advanced disease and complex anatomic conditions. In addition, the deepest tumor point can be reached during NSS, but total nephrectomy should be considered regarding the possibility of microscopic residue.
A 10-Year-old Girl With Late Acute Lymphoblastic Leukemia Recurrence Diagnosed With COVID-19 and Treated With Remdesivir
Authors: Gadzińska Justyna , Kuchar Ernest , Matysiak Michał , Wanke-Rytt Monika , Kloc Malgorzata , Kubiak Jacek Z.
Published: April 2021

Patients with hemato-oncologic diseases are particularly vulnerable to severe infections. Adult patients with blood cancers infected with SARS-CoV-2 had poorer treatment outcomes and higher mortality than patients with COVID-19 without burden. However, in pediatric patients with hemato-oncologic diseases the course of COVID-19 is milder than in adults in the same group of patients. In this report, we describe the case of our patient with acute lymphoblastic leukemia infected with SARS-CoV-2 and treated with remdesivir. We also review the existing literature of pediatric patients who have been diagnosed with both hemato-oncologic diseases and COVID-19.
Access to support for Australian cancer caregivers: in-depth qualitative interviews exploring barriers and preferences for support
Authors: Taylor Jo , Fradgley Elizabeth A. , Clinton-McHarg Tara , Byrnes Emma , Paul Christine L.
Published: April 2021

Introduction:

Caregivers are critical to patient-centered care and can benefit from supportive care interventions such as counseling. However, the barriers to supportive care for caregivers are poorly understood. This Australian study explores caregivers’ experiences when accessing care to support their own wellbeing.

Method:

Semi-structured telephone interviews were conducted with a diverse sample of distressed caregivers who contacted the Cancer Council New South Wales and Victoria helpline. Grounded theory framework informed the generation of themes with data analyzed by two independent coders.

Results:

Caregivers (n = 14) included: partners (n = 8), parents (n = 3), child (n = 1), sibling (n = 1), and friend (n = 1). Two major themes emerged. First, caregivers face multiple barriers when accessing supportive care including: deprioritization of their needs; limited opportunity to express needs; poor availability; lack of time and lack of local services. Secondly, caregivers preferred the delivery of support to be: via face-to-face or telephone; separate to patient; and to occur while the patient receives treatment.

Conclusions:

Tailored pathways for new and existing services that are flexible and accessible are important in supporting caregiver's wellbeing. Caregivers must be encouraged to acknowledge and discuss their own needs.
Barriers to communicating a cancer diagnosis to patients in a low- to middle-income context
Authors: Henry Melissa , Nichols Sharon , Hwang Jennie M. , Nichols Scott D. , Odiyo Philip , Watson Maggie , Alias Ali , Parker Patricia A. , Kissane David , Asuzu Chioma , Lounsbury David W.
Published: April 2021

Objective.

The aim of this study was to understand the needs and experiences of oncology professionals involved in communicating a diagnosis to adult and pediatric cancer patients in the low-middle income (LMI) context of Kenya, with a focus on identifying barriers and facilitators.

Methods.

A World Café focus group methodology was conducted and comprised 19 discussion groups of approximately 6 participants (n = 114 professionals). Thematic analysis was used to clarify barriers and facilitators of professional–patient communication.

Results.

Participants reported several obstacles that hinder communication between cancer patients and healthcare professionals in Kenya, including: patient-related barriers (ie, lack of terminology, health literacy), culture-related barriers (ie, cultural and religious beliefs about cancer, beliefs about children), and physician- and system-related barriers (ie, limited communication skills, organizational barriers). Communication facilitators included: the central role of family and cultural traditions, and the caring attitude of physicians when disclosing diagnosis and treatment procedures.

Conclusions.

The data indicate the potential need to adapt communication guidelines to the Kenyan context to disseminate skills training in a culturally relevant way. Also of importance may be to embed parallel public health strategies and health care structural changes to facilitate disclosure and mitigate any unintended negative effects such as stigma and social isolation.
Weighing In on the Controversy: Preoperative Imaging in Unicoronal Craniosynostosis Leads to Strategic Changes in Surgical Care
Authors: Ulma Raquel M. , Ranganathan Kavitha L. , Vercler Christian J. , Garton Hugh J. L. , Maher Cormac O. , Muraszko Karin M. , Buchman Steven R.
Published: April 2021

Background:

Clinical findings in children with unilateral coronal craniosynostosis are characteristic, and therefore clinicians have questioned the need for confirmatory imaging. Preoperative computed tomographic imaging is a powerful tool for diagnosing associated anomalies that can alter treatment management and surgical planning. The authors’ aim was to determine whether and how routine preoperative imaging affected treatment management in unilateral coronal craniosynostosis patients within their institution.

Methods:

A retrospective, single-center review of all patients who underwent cranial vault remodeling for unilateral coronal craniosynostosis between 2006 and 2014 was performed. Patient data included demographics, age at computed tomographic scan, age at surgery, results of the radiographic evaluation, and modification of treatment following radiologic examination.

Results:

Of 194 patients diagnosed with single-suture craniosynostosis, 29 were diagnosed with unilateral coronal craniosynostosis. Additional radiographic anomalies were found in 19 unilateral coronal craniosynostosis patients (65.5 percent). These included severe deviation of the anterior superior sagittal sinus [n = 12 (41.4 percent)], Chiari I malformation [n = 1 (3.4 percent)], and benign external hydrocephalus [n = 2 (6.9 percent)]. The radiographic anomalies resulted in a change in management for 48.3 percent of patients. Specifically, alteration in frontal craniotomy design occurred in 12 patients (41.4 percent), and two patients (6.9 percent) required further radiographic studies.

Conclusions:

Although clinical findings in children with unilateral coronal craniosynostosis are prototypical, preoperative computed tomographic imaging is still of great consequence and continues to play an important role in surgical management. Preoperative imaging enabled surgeons to alter surgical management and avoid inadvertent complications such as damage to a deviated superior sagittal sinus. Imaging findings of Chiari malformation and hydrocephalus also permitted judicious follow-up.

CLINICAL QUESTIONS/LEVEL OF EVIDENCE:

Therapeutic, IV.
A Qualitative Study of Patient Protection against Postoperative Opioid Addiction: A Thematic Analysis of Self-Agency
Authors: Cho Hoyune E. , Billig Jessica I. , Byrnes Mary E. , Nasser Jacob S. , Kocheril Alex P. , Haase Steven C. , Waljee Jennifer F. , Chung Kevin C.
Published: April 2021

Background:

Opioids are commonly used following outpatient surgery. However, we understand little about patients’ perspectives and how patients decide on postoperative opioid use. This study seeks to investigate aspects of patients’ thought processes that most impact their decisions.

Methods:

The authors conducted semistructured interviews with 30 adults undergoing minor elective hand surgery at one tertiary hospital. Narratives were content-coded to arrive at the authors’ thematic analysis. The authors incorporated Bandura’s concept of self-agency to interpret the data and develop a conceptual framework that best explained the implicit theory within participants’ responses.

Results:

The authors found six themes under two domains of self-agency. Participants actively sought out protective mechanisms supporting their decision on opioid use, but sometimes did so unconsciously. They would avoid opioids postoperatively because they were “tough” and wanted to evade the risk of addiction as “good citizens.” They conveyed a nuanced safety against addiction because they were “not the kind” to become addicted and because they trusted the surgeons’ prescribing. However, participants felt discouraged by the stigma associated with opioids. Both intentionally and unintentionally, participants integrated a strong sense of self in their decision-making processes.

Conclusions:

A robust understanding of how patients choose to take opioids for postoperative pain control is imperative to develop patient-centered strategies to treat the opioid epidemic. Effective opioid-reduction policies should consider patients as active agents who negotiate various internal and external influences in their decision-making processes. Surgeons must incorporate patients’ individual goals and perspectives regarding postoperative opioid use to minimize opioid-related harm after surgery.
Quantitative Analysis of the Lifting Effect of Facial Soft-Tissue Filler Injections
Authors: Haidar Rami , Freytag, M.D. David L. , Frank Konstantin , Rudolph Christina , Hamade, B.Sc. Hassan , Schenck Thilo L. , Green Jeremy B. , Giunta Riccardo E. , Gotkin Robert H. , Cotofana Sebastian
Published: April 2021

Background:

Although injectable soft-tissue fillers are frequently used for facial rejuvenation, there is a dearth of objective data evaluating the tissue-lifting effects. Current practices for efficacy evaluation include some subjectivity. This study seeks to evaluate the lifting effects of facial soft-tissue fillers in a quantifiable, objective setting.

Methods:

Twenty fresh hemifaces obtained from 10 Caucasian body donors (seven women and three men) with a mean age of 83.5 ± 6.8 years and a mean body mass index of 25.3 ± 4.3 kg/m2 were injected with soft-tissue fillers following a predefined treatment algorithm. Three-dimensional surface scanning procedures were performed to assess postinjection effects.

Results:

Injections in the medial face [i.e., forehead, medial midface, and perioral (chin and labiomandibular sulcus)] increased the local surface volume by 0.67, 0.56, and 0.87 cc and created local (but not regional) lifting effects of 1.11, 0.11, and 0.74 mm. Injections in the lateral face (temple, lateral midface, and jawline) changed the local surface volume by 0.45, 0.02, and −0.38 cc, and created local lifting effects of 0.57, 0.81, and 0.29 mm, respectively. Lateral face injections, however, created additional regional lifting effects by co-influencing neighboring lateral facial regions, which was not observed for medial face injections.

Conclusions:

This cadaveric study provides evidence that soft-tissue fillers, although typically classified as volumizers, can induce lifting effects of the face. Whereas temporal deep supraperiosteal injections have limited lifting effects, the combined effects of subdermal injections of the temple, lateral midface, and mandibular angle can induce lifting effects of the total lateral face.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Scalp Reconstruction after Mohs Cancer Excision: Lessons Learned from More Than 900 Consecutive Cases
Authors: Harirah Muhammad , Sanniec Kyle , Yates Tyler , Harirah Omar , Thornton James F.
Published: April 2021

Background:

Scalp reconstruction has evolved over time. Given the large surface area, location, and high likelihood of sun exposure, the scalp is particularly prone to sun damage and skin cancer. Resection of scalp cancers often leaves a large defect that can be challenging for reconstruction. The authors present objective data and recommendations based on more than 10 years of consecutive scalp reconstructions performed by the senior author (J.F.T.). In addition, the authors describe each method of reconstruction and delineate an algorithm based on the senior author’s approach and the cases assessed.

Methods:

The authors conducted a retrospective review of patients who underwent scalp reconstruction after Mohs cancer excision over a 10-year period. Each case was evaluated for key patient characteristics, defect location, defect size, defect composition, reconstructive modality, and complications.

Results:

The senior author (J.F.T.) performed 913 scalp reconstruction procedures. Defects most commonly involved the forehead or vertex of the scalp, with a wide range of sizes. A significant majority of the patients’ defects were repaired with the use of adjacent tissue transfer or Integra dermal regeneration templates. There were 94 complications (12.5 percent) noted, ranging from graft loss to cancer recurrence.

Conclusions:

Reconstruction of scalp defects after Mohs cancer excision presents the plastic surgeon with numerous patient and defect preoperative variables to consider. Each defect should be evaluated, and a plan based on composition of the defect and the needs of the patient should be developed. Scalp reconstruction is safe to perform in an outpatient setting, even in elderly patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Self-Rated Health Among Patients With Severe Traumatic Brain Injury and Their Close Relatives: The Role of Posttraumatic Stress Symptoms
Authors: Tsur Noga , Haller Chiara S.
Published: April 2021

Objective

Severe traumatic brain injury (sTBI) is accompanied by significant declines in self-rated health (SRH). Although such deteriorations in SRH are related to various consequences of sTBI, the effect of posttraumatic reactions (i.e., posttraumatic stress [PTS] symptoms) has been tested insufficiently to date, especially among civilians. The present investigation is based on Trajectories of Recovery After Severe Traumatic brain injury—Matters In families (TRAST-MI), a unique study among civilians with sTBI and their families. Previous research revealed that civilian sTBI has effects beyond the injured patient, influencing their close relatives as well. The aim of this study was to assess the association between PTS symptoms and SRH among patients with civilian sTBI and their close relatives.

Methods

Patients with sTBI (assessed by an Abbreviated Injury Scale of the head region score >3) and their close relatives participated in TRAST-MI. One hundred twenty-six patient-relative dyads were assessed at 3, 6, and 12 months after the injury.

Results

Multilevel modeling revealed that patients’ PTS symptoms were associated with consequent SRH (slope = 0.42; p < .001), and relatives’ PTS symptoms were associated with their respective SRH (slope = 0.2; p = .012).

Conclusions

The findings of this study reveal that SRH of both patients with sTBI and their relatives are negatively affected by their own PTS symptoms. These findings underline the understanding that sTBI is not merely a medical trauma but rather a comprehensive psychosocial trauma, which has consequences for the whole family system.
Association Between the Modified Functional Movement Screen Scores, Fear of Falling, and Self-Perceived Balance in Active Older Adults
Authors: Dietze-Hermosa Martin S. , Montalvo Samuel , Gonzalez Matthew P. , Dorgo Sandor
Published: April 2021

Aims:

To determine the association between fear of falling and self-perceived balance with the modified Functional Movement Screen (FMS) and determine whether fear of falling, self-perceived balance, and modified FMS scores differ depending on age group and sex.

Methods:

One hundred and fifty-six active older adults completed a fear of falling and self-perceived balance questionnaire and then the modified FMS.

Results:

Modified FMS scores differed by age group and sex (P < .05). Increasing age was associated with poorer modified FMS scores while females outperformed males on most components of the modified FMS (P < .05). Associations of the modified FMS with age group and sex indicated that better modified FMS scores were associated with decreased fear of falling and greater self-perceived balance.

Conclusion:

Focus on different aspects of the modified FMS may depend on age and sex. There is a small relationship between the modified FMS with fear of falling and self-perceived balance.
Regression Model for the Prediction of Risk of Pelvic Floor Muscle Weakness Among Older Adults
Authors: Karkare Prajakta , Mohapatra Sidhiprada , Nandakumar Girish
Published: April 2021

Pelvic floor muscle (PFM) weakness is a common presentation among older adults, assessment of which is complicated by privacy issues, availability of perineometer, and lack of trained therapists. Several factors seem to influence PFM strength. Hence, this study developed an alternate method using a regression model to determine PFM strength among institutionalized older women using 27 independent variables. A total of 102 participants were assessed for their PFM strength using peritron perineometer. Age, years of menopause, pelvic surgical procedures, strength of hip muscles, and degenerative disc disorders were found to have a significant odds ratio and were included in the regression model (r
2 = 0.484). It may be used as a simple and easy-to-administer method for the evaluation of PFM weakness.
The Effect of Different Exercise Training Types on Functionality in Older Fallers
Authors: Abit Kocaman Ayşe , Kırdı Nuray , Aksoy Songül , Elmas Özgün , Dogu Burcu Balam
Published: April 2021

Background:

Fall is one of the most common geriatric syndromes in the elderly population. It is important to determine the most effective exercise training in elderly individuals who are at risk of falling.

Aim:

To investigate the effects of different exercise trainings on functionality in older fallers.

Method:

A total of 30 older adults, 16 females and 14 males, were enrolled in this randomized controlled trial. The older adults were divided into 3 groups: vestibular exercise (VE), posturography balance exercise (PBE), and square step exercise (SSE) groups. All groups received VE training. Sensory Organization Test (SOT), Adaptation Test (ADT), Fall Efficacy Scale (FES), Montreal Cognitive Assessment (MoCA), Vestibular Disorders Activities of Daily Life Scale (VADL), and the World Health Organization Quality of Life Scale–Older Adults Module (WHOQOL-Old) were administered before and at the end of the 24 training sessions.

Results:

The MoCA and the composite balance score of the SOT were improved in the PBE and SSE groups and the FES in all groups. According to multiple comparison analyses, toes up in the VE and PBE groups, toes down of the ADT in the PBE group, VADL in the PBE and SSE groups, the WHOQOL-Old in all groups significantly improved (P < .010).

Conclusion:

VE training alone is not sufficient for older fallers. A combination of PBE and SSE training, which was applied 3 times a week for 8 weeks, was more effective in improving functionality in older fallers.
The Moderating Role of Pain Self-efficacy in the Relationships Among Caregiver Burden and Care Recipient Pain and Neuropsychiatric Symptoms in a Sample of Persons With Dementia
Authors: Patrick Karlee S. , Martin John T. , Chapman Kimberly R. , Anderson Jason R. , Spitznagel Mary B.
Published: April 2021

Past research suggests relationships among dementia caregiver burden and care recipient pain and neuropsychiatric symptoms, but no prior work has examined the influence of pain self-efficacy on these associations. A sample of 502 dementia caregivers completed an online protocol assessing caregiver burden and care recipient neuropsychiatric symptoms, presence of pain, and pain self-efficacy in this cross-sectional, observational study. The indirect effect of neuropsychiatric symptoms on the relationship between pain and caregiver burden was significant. Pain self-efficacy significantly moderated the effect of pain on neuropsychiatric symptoms (P=0.04) and the direct association between pain and caregiver burden (P=0.004), but did not moderate the indirect effect. Future research should explore how pain influences neuropsychiatric symptoms, and whether improvement in pain self-efficacy in dementia care recipients attenuates the influence of pain on neuropsychiatric symptoms and caregiver burden in other samples.
Disaster preparedness among women with a recent live birth in Hawaii, a cross-sectional study, results from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2016
Authors: Strid Penelope , Fok Carlotta Ching Ting , Zotti Marianne , Shulman Holly B. , Awakuni Jane , House L. Duane , Morrow Brian , Kern Judy , Shim Matthew , Ellington Sascha
Published: April 2021

Objectives

This study examines emergency preparedness behaviors among women with a recent live birth in Hawaii.

Methods

Using the 2016 Hawaii Pregnancy Risk Assessment Monitoring Survey we estimated weighted prevalence of eight preparedness behaviors.

Results

Among 1010 respondents (weighted response rate=56.3%), 79.3% reported at least one preparedness behavior and 11.2% performed all eight behaviors. The prevalence of women with a recent live birth in Hawaii reporting preparedness behaviors includes: 63.0% (95% CI: 58.7-67.1%) having enough supplies at home for at least seven days, 41.3% (95% CI: 37.1-45.6%) having an evacuation plan for their child(ren), 38.7% (95% CI: 34.5, 43.0) having methods to keep in touch, 37.8% (95% CI: 33.7, 42.1) having an emergency meeting place, 36.6% (95% CI: 32.6, 40.9) having an evacuation plan to leave home, 34.9% (95% CI: 30.9, 39.2) having emergencies supplies to take with if they have to leave quickly, 31.8% (95% CI: 27.9, 36.0) having copies of important documents, 31.6% (95% CI: 27.7, 35.8) having practiced what to do.

Conclusion

One in ten women practiced all eight behaviors indicating more awareness efforts are needed among this at-risk population in Hawaii. Hawaii can measure the effect of interventions to increase preparedness by tracking this question over time.

Significance

“What is already known on this subject?”

Preparedness is associated with reduced vulnerability, and postpartum women are considered an at-risk population in the post-disaster period with special clinical needs. One prior study has assessed disaster preparedness among postpartum women.

“What this study adds?”

This is the first study to describe a methodology to analyze the eight-part PRAMS emergency preparedness question. Among recently postpartum women in Hawaii, about 80% practiced at least one of eight emergency preparedness measures assessed and about 10% practiced all behaviors.
FutureMS Cohort Profile: A Scottish Multi-Centre Inception Cohort Study of Relapsing-Remitting Multiple Sclerosis
Authors: Kearns P.K.A. , Martin S.J. , Chang J. , Meijboom R. , York E.N. , Chen Y. , Weaver C. , Stenson A. , Hafezi K. , Thomson S. , Freyer E. , Murphy L. , Harroud A. , Foley P. , Hunt D. , McLeod M. , O’Riordan J. , Carod-Artal F.J. , MacDougall N.J.J. , Baranzini S.E. , Waldman A.D. , Connick P. , Chandran S.
Published: April 2021

Multiple sclerosis (MS) is an immune-mediated, neuroinflammatory disease of the central nervous system and in industrialised countries is the most common cause of progressive neurological disability in working age persons. However, there is significant inter-individual heterogeneity in disease activity and response to treatment. Currently, the ability to predict at diagnosis who will have a benign, intermediate, or aggressive disease course is very limited. There is therefore a need for integrated predictive tools to inform individualised treatment decision-making. FutureMS is a nationally representative, prospective observation cohort study comprising of 440 participants with a new diagnosis of relapsing remitting MS living in Scotland between May 2016 and March 2019. Established with the aim of addressing this need for individualised predictive tools, the cohort is designed to combine detailed clinical phenotyping with imaging, genetic and biomarker metrics of disease activity and progression. Recruitment, baseline assessment and follow up at year one is complete and longer term follow up is planned, beginning at five years after first visit. The study aims to explore the pathobiology and determinants of disease heterogeneity in MS. Here we describe the cohort design and present a profile of the participants at baseline and one year of follow up.
Understanding the barriers to pooled SARS-CoV-2 testing in the United States
Authors: Fenichel Eli P. , Gilbert Anna , Gonsalves Gregg , Wyllie Anne L.
Published: April 2021

Pooled testing for SARS-CoV-2 detection is instrumental for increasing test capacity while decreasing test cost, key factors for sustainable, long-term surveillance measures. While numerous pooled approaches have been described, uptake by labs has been limited. We surveyed 90 US labs to understand the barriers to implementing pooled testing.
Mid-Regional pro-Adrenomedullin (MR-proADM), C-Reactive Protein (CRP) and Other Biomarkers in the Early Identification of Disease Progression in COVID-19 Patients in the Acute NHS Setting
Authors: Moore Nathan , Williams Rebecca , Mori Matilde , Bertolusso Beatrice , Vernet Gabrielle , Lynch Jessica , Philipson Peter , Ledgerwood Thomas , Kidd Stephen P. , Thomas Claire , Garcia-Arias Veronica , Young Michelle , Saeed Kordo , Gordon Kirsty , Cortes Nicholas
Published: April 2021

Aims

There is a lack of biomarkers validated for assessing clinical deterioration in COVID-19 patients upon presentation to secondary or tertiary care. This evaluation looked at the potential clinical application of C-Reactive Protein, Procalcitonin, Mid-Regional pro-adrenomedullin (MR-proADM) and White Cell Count to support prediction of clinical outcomes.

Methods

135 patients presenting to Hampshire Hospitals NHS Foundation Trust between April and June 2020 confirmed to have COVID-19 via RT-qPCR were included. Biomarkers from within 24 hours of admission were used to predict disease progression by Cox regression and area under the receiver operating characteristic (AUROC) curves. The endpoints assessed were 30-day all-cause mortality, intubation and ventilation, critical care admission and non-invasive ventilation (NIV) use.

Results

Elevated MR-proADM was shown to have the greatest ability to predict 30-day mortality adjusting for age, cardiovascular, renal and neurological disease. A significant association was also noted between raised MR-proADM and CRP concentrations and the requirement for critical care admission and non-invasive ventilation.

Conclusions

The measurement of MR-proADM and CRP in patients with confirmed COVID-19 infection upon admission shows significant potential to support clinicians in identifying those at increased risk of disease progression and need for higher level care, subsequently enabling prompt escalation in clinical interventions.
Public Perception of COVID-19 Vaccines through Analysis of Twitter Content and Users
Authors: Saleh Sameh N. , McDonald Samuel A. , Basit Mujeeb A. , Kumar Sanat , Arasaratnam Reuben J. , Perl Trish M. , Lehmann Christoph U. , Medford Richard J.
Published: April 2021

Twitter is a robust medium to understand wide-scale, organic public perception about the COVID-19 vaccine. In this cross-sectional observational study, we evaluated 2.4 million English tweets from nearly 1 million user accounts matching keywords ((‘covid*’ OR ‘coronavirus’) AND ‘vaccine’) during vaccine development from Feb 1stthrough Dec 11th, 2020. We applied topic modeling, sentiment and emotion analysis, and demographic inference of users on the COVID-19 vaccine related tweets to provide insight into the evolution of public attitudes. Individuals generated 87.9% (n=834,224) of tweets. Of individuals, men (n=560,824) outnumbered women (n=273,400) by 2:1 and 39.5% (n=329,776) of individuals were ≥ 40 years old. Daily mean sentiment fluctuated congruent with news events, but overall trended positively. Trust, anticipation, and fear were the three most predominant emotions; while fear was the most predominant emotion early in the study period, trust outpaced fear from April 2020 onward. Fear was more prevalent in tweets by individuals (26.3% vs. organizations 19.4%; p<0.001), specifically among women (28.4% vs. males 25.4%; p <0.001). Multiple topics had a monthly trend towards more positive sentiment. Tweets comparing COVID-19 to the influenza vaccine had strongly negative early sentiment but improved over time. Our findings are concerning for COVID-19 vaccine hesitancy, but also identify targets for educational interventions.
Comparison of SARS-CoV-2 serological assays for use in epidemiological surveillance in Scotland
Authors: McDonald Lindsay , Wise Helen , Muecksch Frauke , Poston Daniel , Mavin Sally , Templeton Kate , Furrie Elizabeth , Richardson Claire , McGuire Jaqueline , Jarvis Lisa , Malloy Kristen , McAuley Andrew , Palmateer Norah , Dickson Elizabeth , Hatziioannou Theodora , Bieniasz Paul , Jenks Sara
Published: April 2021

Background

Sero-surveillance of SARS-CoV-2 is crucial to monitoring levels of population exposure and informing public health responses, but may be influenced by variability in performance between available assays.

Methods

Five commercial immunoassays and a neutralising activity assay were used to detect antibodies to SARS-CoV-2 in routine primary care and paediatric samples collected during the first wave of the pandemic in NHS Lothian, Scotland as part of ongoing surveillance efforts. For each assay, sensitivity and specificity was calculated relative to consensus results and neutralising activity. Quantitative correlation was performed between serological and neutralising titres.

Results

Seroprevalence ranged from 3.4-7.3 % in primary care patients and 3-5.9 % in paediatric patients according to different immunoassays. Neutralising activity was detectable in 2.8 % and 1.3 % respectively. Relative assay performance changed depending on comparison to immunoassay consensus versus neutralising activity and qualititative versus quantitative agreement. Cross-reactivity with endemic seasonal coronaviruses was confirmed by neutralising assay in false positives for one immunoassay. Presence of false positives for another assay was found specifically in paediatric but not adult samples.

Conclusions

Five serological assays show variable accuracy when applied to the general population, impacting seroprevalence estimates. Assay performance may also vary in detection of protective neutralising antibody levels. These aspects should be considered in assay selection and interpretation in epidemiological studies.
COVID-19 vaccine hesitancy January-May 2021 among 18-64 year old US adults by employment and occupation
Authors: King Wendy C. , Rubinstein Max , Reinhart Alex , Mejia Robin J.
Published: April 2021

COVID-19 vaccine hesitancy threatens pandemic control efforts. We evaluated vaccine hesitancy in the US by employment status and occupation category during the COVID-19 vaccine rollout. US adults 18-64 years completed an online COVID-19 survey 3,179,174 times from January 6-May 19, 2021. Data was aggregated by month. Survey weights matched the sample to the US population age, gender, and state profile. Weighted percentages and 95% confidence intervals (95%CI) were calculated. Changes in vaccine hesitancy from January-May varied widely by employment status (e.g., -7.8% [95%CI, -8.2--7.5] among those working outside the home, a 26.6% decrease; -13.3% [95%CI, -13.7--13.0] among those not working for pay, a 44.9% decrease), and occupation category (e.g., -15.9% [95%CI, -17.7--14.2] in production, a 39.3% decrease; -1.4% [95%CI, -3.8--1.0] in construction/extraction, a 3.0% decrease). April 20-May 19, 2021, vaccine hesitancy ranged from 7.3% (95%CI, 6.7-7.8) in computer/mathematical professions to 45.2% (95%CI, 43.2-46.8) in construction/extraction. Hesitancy was 9.0% (95%CI, 8.6-9.3) among educators and 14.5% (95%CI, 14.0-15.0) among healthcare practitioners/technicians. While the prevalence of reasons for hesitancy differed by occupation, over half of employed hesitant participants reported concern about side effects (51.7%) and not trusting COVID-19 vaccines (51.3%), whereas only 15.0% didn’t like vaccines in general. Over a third didn’t believe they needed the vaccine, didn’t trust the government, and/or were waiting to see if it was safe. In this massive national survey of adults 18-64 years, vaccine hesitancy varied widely by occupation. Reasons for hesitancy indicate messaging about safety and addressing trust are paramount.
Mild and severe SARS-CoV-2 infection induces respiratory and intestinal microbiome changes in the K18-hACE2 transgenic mouse model
Authors: Seibert Brittany , Joaquín Cáceres C. , Cardenas-Garcia Stivalis , Carnaccini Silvia , Geiger Ginger , Rajao Daniela S. , Ottesen Elizabeth , Perez Daniel R.
Published: April 2021

Transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in millions of deaths and declining economies around the world. K18-hACE2 mice develop disease resembling severe SARS-CoV-2 infection in a virus dose-dependent manner. The relationship between SARS-CoV-2 and the intestinal or respiratory microbiome is not fully understood. In this context, we characterized the cecal and lung microbiome of SARS-CoV-2 challenged K18-hACE2 transgenic mice in the presence or absence of treatment with the Mproinhibitor GC376. Cecum microbiome showed decreased Shannon and Inv Simpson diversity index correlating with SARS-CoV-2 infection dosage and a difference of Bray-Curtis dissimilarity distances among control and infected mice. Bacterial phyla such as Firmicutes, particularly Lachnospiraceae and Oscillospiraceae, were significantly less abundant while Verrucomicrobiota, particularly the family Akkermansiaceae, were increasingly more prevalent during peak infection in mice challenged with a high virus dose. In contrast to the cecal microbiome, the lung microbiome showed similar microbial diversity among the control, low and high challenge virus groups, independent of antiviral treatment. Bacterial phyla in the lungs such as Bacteroidota decreased while Firmicutes and Proteobacteria were significantly enriched in mice challenged with a high dose of SARS-CoV-2. In summary, we identified changes in the cecal and lung microbiome of K18-hACE2 mice with severe clinical signs of SARS-CoV-2 infection.

IMPORTANCE

The COVID-19 pandemic has resulted in millions of deaths. The host’s respiratory and intestinal microbiome can affect directly or indirectly the immune system during viral infections. We characterized the cecal and lung microbiome in a relevant mouse model challenged with a low and high dose of SARS-CoV-2 in the presence or absence of an antiviral Mproinhibitor, GC376. Decreased microbial diversity and taxonomic abundances of the phyla Firmicutes, particularly Lachnospiraceae, correlating with infection dosage was observed in the cecum. In addition, microbes within the family Akkermansiaceae were increasingly more prevalent during peak infection, which is observed in other viral infections. The lung microbiome showed similar microbial diversity to the control, independent of antiviral treatment. Decreased Bacteroidota and increased Firmicutes and Proteobacteria were observed in the lungs in a virus dose-dependent manner. These studies add to a better understanding of the complexities associated with the intestinal microbiome during respiratory infections.
Establishment of a publicly available core genome multilocus sequence typing scheme forClostridium perfringens
Authors: Abdel-Glil Mostafa Y. , Thomas Prasad , Linde Jörg , Jolley Keith A. , Harmsen Dag , Wieler Lothar H. , Neubauer Heinrich , Seyboldt Christian
Published: April 2021

Clostridium perfringensis a spore-forming anaerobic pathogen responsible for a variety of histotoxic and intestinal infections in humans and animals. High-resolution genotyping aiming to identify bacteria at strain level has become increasingly important in modern microbiology to understand pathogen transmission pathways and to tackle infection sources. This study aimed at establishing a publicly available genome-wide multilocus sequence-typing scheme forC. perfringens. 1,431 highly conserved core genes (1.34 megabases; 50% of the reference genome genes) were indexed for a core-genome-based MLST scheme forC. perfringens. As an example, we applied the scheme to 87 poultry and 73 non-poultry strains (total=160). The genotyping results of the 160 genomes were congruent in terms of resolution and tree topology between allele-based and single-nucleotide-polymorphism-based core-genome typing. For the analysis of poultry strains ofC. perfringensconcerning the country of isolation, NetB-toxin gene carriage and clinical disease, we used 60 allelic differences as a clustering threshold. The results showed that poultry strains from a single country formed a cluster (n=17 clusters including 46 strains). Two clusters included six strains from four different countries. These strains werenetB-positive, as were seven strains from Denmark and two strains from Finland, possibly indicating common sources ofnetB-positive strains. In terms of clinical presentation, different clusters of strains were associated with cases of suspected necrotic enteritis. Strains from sick birds grouped with strains from healthy birds or meat samples showing that potentially virulent strains are widespread and that host-related factors contribute significantly to NE. In summary, a publicly available scheme and an allele nomenclature database for genomic typing ofC. perfringenshas been established and can be used for broad-based and standardised epidemiological studies.
Regional atrophy and cognitive decline depend on definition of subjective cognitive decline
Authors: Morrison Cassandra , Dadar Mahsa , Shafiee Neda , Villeneuve Sylvia , Collins D. Louis ,   for Alzheimer’s Disease Neuroimaging Initiative
Published: April 2021

Background

People with subjective cognitive decline (SCD) may be at increased risk for Alzheimer’s disease (AD). However, not all studies have observed this increased risk. Inconsistencies may be related to different methods used to define SCD. The current project examined whether four methods of defining SCD (applied to the same sample) results in different patterns of atrophy and future cognitive decline between cognitively normal older adults with (SCD+) and without SCD (SCD-).

Methods

MRI scans and questionnaire data for 273 cognitively normal older adults from Alzheimer’s Disease Neuroimaging Initiative were examined. To operationalize SCD we used four common methods: Cognitive Change Index (CCI), Everyday Cognition Scale (ECog), ECog + Worry, and Worry only. A previously validated MRI analysis method (SNIPE) was used to measure hippocampal volume and grading. Deformation-based morphometry was performed to examine volume at regions known to be vulnerable to AD. Logistic regressions were completed to determine whether diagnostic method was associated with volume differences between SCD- and SCD+. Linear mixed effects models were performed to examine the relationship between the definitions of SCD and future cognitive decline.

Results

Results varied between the four methods of defining SCD. Left hippocampal grading was lower in SCD+ than SCD-when using the CCI (p=.041) and Worry (p=.021) definitions. The right (p=.008) and left (p=.003) superior temporal regions were smaller in SCD+ than SCD-, but only with the ECog. SCD+ was associated with greater future cognitive decline measured by Alzheimer’s Disease Assessment Scale, but only with the CCI definition. In contrast, only the ECog definition of SCD was associated with future decline on the Montreal Cognitive Assessment.

Conclusion

The current findings suggest that the various methods used to differentiate between SCD- and SCD+ influence whether volume differences and findings of cognitive decline are observed between groups in this retrospective analysis.