bluuebunny/crossref_metadata_2025 huggingface dataset:
Preloaded injectors used in a clinical study: videographic assessment and laboratory analysis of injector nozzle damage
Authors: Khoramnia Ramin , Yildirim Timur M. , Weindler Jan , Naujokaitis Tadas , Dzhambazova Mariyana , Auffarth Gerd U.
Published: January 2021

Purpose:

To evaluate quality and duration of implantation of 2 preloaded intraocular lens (IOL) injectors and assess postimplantation damage.

Setting:

The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.

Design:

Prospective, randomized, comparative study with laboratory investigation.

Methods:

Implantation videos and postuse injectors from 60 paired eyes of 30 bilateral cataract patients were included. Patient eyes were randomly assigned for implantation with 2 different preloaded injectors: the AutonoMe with a Clareon IOL (Alcon Laboratories, Inc.) and the iSert with a Vivinex IOL (Hoya Corp.). Videos were reviewed for events during the implantation procedure, and the duration of each step of implantation. Injector nozzles were examined under light and scanning electron microscopy. Damage was graded and correlated with the IOL power. Three months postoperatively IOLs were assessed for material changes.

Results:

IOL delivery was without any critical events in 60 of the 60 eyes. The implantation took 56 seconds with the AutonoMe and 44 seconds with the iSert (P < .05). Most AutonoMe injectors (29; 97%) showed no damage or slight deformation. In most of the iSert injectors (25; 80%), short or extended cracks were present, and damage lengths correlated with the IOL power. All IOLs were free of material changes, including glistenings, 3 months postoperatively.

Conclusions:

Both preloaded IOL injectors allowed a safe and convenient IOL delivery. Implantation of the Clareon IOL took, on average, slightly longer than that of the Vivinex IOL, mostly due to a slower IOL unfolding. The AutonoMe showed less nozzle tip damage than that of the iSert.
Comparative evaluation of once-daily and twice-daily dosing of topical bromfenac 0.09%: aqueous pharmacokinetics and clinical efficacy study
Authors: Titiyal Jeewan S. , Thangavel Rajeswari , Kaur Manpreet , Venkatesh Pradeep , Velpandian T. , Sinha Rajesh
Published: January 2021

Purpose:

To evaluate aqueous pharmacokinetics of topical bromfenac 0.09% and compare clinical outcomes of once- and twice-daily dosing in phacoemulsification.

Setting:

Dr. R.P. Center for Ophthalmic Sciences, AIIMS, New Delhi, India.

Design:

Prospective interventional study.

Methods:

In phase I, single-drop aqueous pharmacokinetics of topical bromfenac was estimated at 15 minutes, 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours, and 24 hours using liquid chromatography mass spectrometry in 60 eyes. In phase II, 45 eyes undergoing phacoemulsification were enrolled: group I (control, n = 15), group II (once-daily bromfenac, n = 14), and group III (twice-daily bromfenac, n = 16). Intraoperative pupillary miosis, postoperative anterior chamber (AC) flare, Summed Ocular Inflammation Score (SOIS), central macular thickness (CMT), and pain scores were assessed. Follow-up was performed at 1 day, 7 days, 28 days, and 90 days postoperatively.

Results:

Half-life of topical bromfenac was 3.6 hours, mean residence time 5.5 hours, and peak concentration (63.73 ng/mL) achieved after 2 hours. Aqueous concentration was more than inhibitory concentration (IC50) at 12 hours but not at 24 hours. Cumulative effect was observed with repeated dosing with aqueous levels more than IC50 in once-daily and twice-daily groups at 5 days. Significant intraoperative miosis was observed in group I. Pain score, AC flare, and SOIS were significantly more in group I (P < .001) and comparable in groups II and III at all timepoints. CMT was comparable in all groups; no case developed cystoid macular edema.

Conclusions:

Single-dose topical bromfenac did not maintain therapeutic aqueous concentration over 24 hours; however, cumulative effect was observed with repeated dosing. Clinical efficacy of once-daily and twice-daily dosing was comparable.
The effects of long-term menstrual pain on pain empathy in women with primary dysmenorrhea
Authors: Mu Junya , Wang Qiming , Dun Wanghuan , Yang Jing , Wang Ke , Zhang Ming , Liu Jixin
Published: January 2021

Primary dysmenorrhea (PDM) is not only a painful experience but also affects the psychological and affective states of women. Neuroimaging studies have revealed shared neural substrates for somatic and empathic pains in healthy subjects. However, little is known about the relationship between pain intensity and pain empathy in pain disorders. The cyclic nature of PDM makes it a unique model for investigating this issue during a patients' pain phase. To study how long-term pain modulates empathy for pain, T1-weighted magnetic resonance imaging scans were obtained in 39 PDM patients and 41 matched female healthy controls during menstruation. Subjects viewed static visual stimuli of the limbs submitted to painful and nonpainful stimulation to solicit empathy. The visual analogue scale for pain intensity and the Interpersonal Reactivity Index for empathic ability were also obtained. We found that women with PDM exhibited higher pain empathy compared with controls. The anterior insula and brain regions related to sensory discrimination with decreased gray matter volumes were not only shared but also acted as a mediator between pain intensity and pain empathy in PDM patients. In addition, the general linear modeling analysis revealed that long-term pain experience was a more important factor to pain empathy compared with pain intensity. This indicated that long-term pain may cause maladaptive brain structural plasticity, which may further affect psychological adjustment to bring patients more vivid pain when they witness suffering and distress in others.
A proteome signature for acute incisional pain in dorsal root ganglia of mice
Authors: Pogatzki-Zahn Esther M. , Gomez-Varela David , Erdmann Gerrit , Kaschube Katharina , Segelcke Daniel , Schmidt Manuela
Published: January 2021

After surgery, acute pain is still managed insufficiently and may lead to short-term and long-term complications including chronic postsurgical pain and an increased prescription of opioids. Thus, identifying new targets specifically implicated in postoperative pain is of utmost importance to develop effective and nonaddictive analgesics. Here, we used an integrated and multimethod workflow to reveal unprecedented insights into proteome dynamics in dorsal root ganglia (DRG) of mice after plantar incision (INC). Based on a detailed characterization of INC-associated pain-related behavior profiles, including a novel paradigm for nonevoked pain, we performed quantitative mass-spectrometry–based proteomics in DRG 1 day after INC. Our data revealed a hitherto unknown INC-regulated protein signature in DRG with changes in distinct proteins and cellular signaling pathways. In particular, we show the differential regulation of 44 protein candidates, many of which are annotated with pathways related to immune and inflammatory responses such as MAPK/extracellular signal-regulated kinases signaling. Subsequent orthogonal assays comprised multiplex Western blotting, bioinformatic protein network analysis, and immunolabeling in independent mouse cohorts to validate (1) the INC-induced regulation of immune/inflammatory pathways and (2) the high priority candidate Annexin A1. Taken together, our results propose novel potential targets in the context of incision and, therefore, represent a highly valuable resource for further mechanistic and translational studies of postoperative pain.
Assessing outcome in postoperative pain trials: are we missing the point? A systematic review of pain-related outcome domains reported in studies early after total knee arthroplasty
Authors: Bigalke Stephan , Maeßen Timo V. , Schnabel Kathrin , Kaiser Ulrike , Segelcke Daniel , Meyer-Frießem Christine H. , Liedgens Hiltrud , Macháček Philipp A. , Zahn Peter K. , Pogatzki-Zahn Esther M.
Published: January 2021

The management of acute postoperative pain remains suboptimal. Systematic reviews and Cochrane analysis can assist with collating evidence about treatment efficacy, but the results are limited in part by heterogeneity of endpoints in clinical trials. In addition, the chosen endpoints may not be entirely clinically relevant. To investigate the endpoints assessed in perioperative pain trials, we performed a systematic literature review on outcome domains assessing effectiveness of acute pain interventions in trials after total knee arthroplasty. We followed the Cochrane recommendations for systematic reviews, searching PubMed, Cochrane, and Embase, resulting in the screening of 1590 potentially eligible studies. After final inclusion of 295 studies, we identified 11 outcome domains and 45 subdomains/descriptors with the domain “pain”/“pain intensity” most commonly assessed (98.3%), followed by “analgesic consumption” (88.8%) and “side effects” (75.3%). By contrast, “physical function” (53.5%), “satisfaction” (28.8%), and “psychological function” (11.9%) were given much less consideration. The combinations of outcome domains were inhomogeneous throughout the studies, regardless of the type of pain management investigated. In conclusion, we found that there was high variability in outcome domains and inhomogeneous combinations, as well as inconsistent subdomain descriptions and utilization in trials comparing for effectiveness of pain interventions after total knee arthroplasty. This points towards the need for harmonizing outcome domains, eg, by consenting on a core outcome set of domains which are relevant for both stakeholders and patients. Such a core outcome set should include at least 3 domains from 3 different health core areas such as pain intensity, physical function, and one psychological domain.
Assessment of Inter- and Intra-Rater Reliability of Tablet-Based Software to Measure Cochlear Duct Length
Authors: Cooperman Shayna P. , Aaron Ksenia A. , Fouad Ayman , Tran Emma , Blevins Nikolas H. , Fitzgerald Matthew B.
Published: January 2021

Objective:

The objective of this study is to build upon previous work validating a tablet-based software to measure cochlear duct length (CDL). Here, we do so by greatly expanding the number of cochleae (n = 166) analyzed, and examined whether computed tomography (CT) slice thickness influences reliability of CDL measurements.

Study Design:

Retrospective chart review study.

Setting:

Tertiary referral center.

Patients:

Eighty-three adult cochlear implant recipients were included in the study. Both cochleae were measured for each patient (n = 166).

Interventions:

Three raters analyzed the scans of 166 cochleae at 2 different time points. Each rater individually identified anatomical landmarks that delineated the basal turn diameter and width. These coordinates were applied to the elliptic approximation method (ECA) to estimate CDL. The effect of CT scan slice thickness on the measurements was explored.

Main Outcome Measures:

The primary outcome measure is the strength of the inter- and intra-rater reliability.

Results:

The mean CDL measured was 32.84 ± 2.03 mm, with a range of 29.03 to 38.07 mm. We observed no significant relationship between slice thickness and CDL measurement (F1,164 = 3.04; p = 0.08). The mean absolute difference in CDL estimations between raters was 1.76 ± 1.24 mm and within raters was 0.263 ± 0.200 mm. The intra-class correlation coefficient (ICC) between raters was 0.54 and ranged from 0.63 to 0.83 within raters.

Conclusions:

This software produces reliable measurements of CDL between and within raters, regardless of CT scan thickness.
Surgical Outcomes With Cochlear Implantation in Patients With Enlarged Cochlear Aperture: A Systematic Review
Authors: Wong Kevin , Bahethi Rohini R. , Weitzman Rachel E. , Schwam Zachary G. , Wanna George B.
Published: January 2021

Objective:

Evaluate surgical outcomes in patients with enlarged cochlear aperture (ECA) after cochlear implantation.

Databases Reviewed:

PubMed, EMBASE, and Scopus.

Methods:

A systematic review was performed using standardized methodology. Studies were included if they included subjects with ECA who underwent cochlear implantation. Exclusion criteria included non-English articles, abstracts, letters/commentaries, case reports, and reviews. Bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool.

Results:

Out of 1,688 identified articles, 7 articles representing 23 subjects with ECA were included. Publication rates increased between the period of study from 2009 to 2018. Four studies were level 4 evidence and three studies were level 3 evidence. In total, 20 subjects underwent cochlear implantation. Cerebrospinal fluid gushers were encountered in the majority of cases that reported complications (16/17, 94.1%); one patient developed postoperative meningitis, and another experienced postimplantation facial nerve stimulation. No study provided measurements on cochlear aperture size or defined size criteria used to identify ECA. Four studies recognized X-linked deafness to be associated with ECA, and the most common mutation was in POU3F4 gene.

Conclusion:

An association exists between ECA and cerebrospinal fluid gusher, underscoring the importance of reviewing preoperative imaging. Size criteria are not well defined, and there is a paucity of data with respect to normative measurements. Many cases of ECA may give a genetic link. Although level of evidence of current studies remains modest, ECA reports have increased and will likely continue to expand with advancements in imaging and genetic testing.
The Skull Vibration-induced Nystagmus Test (SVINT) for Vestibular Disorders: A Systematic Review
Authors: Waissbluth Sofia , Sepúlveda Valeria
Published: January 2021

Objective:

To determine the specificity and sensitivity of the skull vibration-induced nystagmus test (SVINT) for detecting vestibular hypofunction.

Databases Reviewed:

The Cochrane Library, MEDLINE, PubMed, EMBASE, and SciELO.

Methods:

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases were searched using a comprehensive search strategy including the terms “Vibration-induced nystagmus” or “SVINT” or “skull vibration-induced nystagmus test” or “skull vibration-induced nystagmus” from inception to May 2020.

Results:

A total of 79 articles were identified, and 16 studies met the inclusion criteria. The methodology for performing the SVINT and determining positivity is varied. Most authors refer to reproducibility, sustained response, ending with withdrawal of stimulus, nondirection changing, and response in more than one point of stimulation, as necessary for a positive test. Only seven studies included a slow phase velocity of 2 degrees/s or 2.5 degrees/s as a criterion. Most studies employed 100 Hz stimulus for 10 seconds, while longer duration is suggested for pediatric patients. For partial and total unilateral vestibular loss, positivity varied from 58 to 60%, and 93 to 100%, respectively. Sensitivity ranged from 50 to 100%, and specificity from 62 to 100%. Importantly, the SVINT may decrease with time but does not usually disappear, hence, can provide information of past/compensated vestibular events.

Conclusions:

The SVINT can be used in pediatric and adult patients. It provides information regarding unilateral vestibular loss, acute, or compensated. It is a quick, safe, and noninvasive test, and is complementary to the dynamic vestibular and positional tests.
Reimbursement Matters
Authors: Lee Simon J. Craddock , Murphy Caitlin C. , Gerber David E. , Geiger Ann M. , Halm Ethan , Nair Rasmi G. , Cox John V. , Tiro Jasmin A. , Skinner Celette S.
Published: January 2021

Background:

Accrual to cancer clinical trials is suboptimal. Few data exist regarding whether financial reimbursement might increase accruals.

Objective:

The objective of this study was to assess perceptions about reimbursement to overcome barriers to trial accrual.

Research Design:

This was a cross-sectional survey.

Subjects:

Oncologists identified from the American Medical Association Physician Masterfile.

Measures:

We report descriptive statistics, associations of physician characteristics with perceptions of reimbursement, domains, and subthemes of free-text comments.

Results:

Respondents (n=1030) were mostly medical oncologists (59.4%), ages 35–54 (67%), and male (75%). Overall, 30% reported discussing trials with >25% of patients. Barriers perceived were administrative/regulatory, physician/staff time, and eligibility criteria. National Cancer Institute cooperative group participants and practice owners were more likely to endorse higher reimbursement. Respondents indicated targeted reimbursement would help improve infrastructure, but also noted potential ethical problems with reimbursement for discussion (40.7%) and accrual (85.9%). Free-text comments addressed reimbursement sources, recipients, and concerns about the real and apparent conflict of interest.

Conclusions:

Though concerns about a potential conflict of interest remain paramount and must be addressed in any new system of reimbursement, oncologists believe reimbursement to enhance infrastructure could help overcome barriers to trial accrual.
Incident and Prevalent HIV Infections Attributed to Sexual Transmission in the United States, 2018
Authors: Johnson Anna Satcher , Song Ruiguang
Published: January 2021

Background

The Ending the HIV Epidemic: A Plan for America initiative aims to reduce new infections by 2030. Routine assessment of incident and prevalent HIV by transmission risk is essential for monitoring the impact of national, state, and local efforts to end the HIV epidemic.

Methods

Data reported to the National HIV Surveillance System were used to estimate numbers of incident and prevalent HIV infection attributed to sexual transmission in the United States in 2018. The first CD4 result after diagnosis and a CD4 depletion model were used to generate estimates by transmission category, sex at birth, age group, and race/ethnicity.

Results

In 2018, there were an estimated 32,600 (50% confidence interval [CI], 31,800–33,400) incident and 984,000 (50% CI, 977,000–990,900) prevalent HIV infections attributed to sexual transmission in the United States. Male-to-male sexual contact comprised 74.8% and 69.1% of incident and prevalent HIV infections, respectively. Persons aged 25 to 34 years comprised 39.6% (12,900; 50% CI, 12,400–13,400) of incident infections; however, the number of prevalent infections was highest among persons 55 years and older (29.3%; 288,300 [50% CI, 285,600–291,000]). There were racial/ethnic differences in numbers of incident and prevalent infections among both men who have sex with men and persons with HIV attributable to heterosexual contact.

Conclusions

In 2018, most incident sexually transmitted HIV infections occurred in men who have sex with men, and the burden was disproportionate for persons aged 24 to 35 years, and Black/African American and Hispanic/Latino adults and adolescents. Efforts to increase the use of effective biomedical and behavioral prevention methods must be intensified to reach the goal to end the HIV epidemic in the United States.
Estimated Prevalence and Incidence of Disease-Associated Human Papillomavirus Types Among 15- to 59-Year-Olds in the United States
Authors: Lewis Rayleen M. , Laprise Jean-François , Gargano Julia W. , Unger Elizabeth R. , Querec Troy D. , Chesson Harrell W. , Brisson Marc , Markowitz Lauri E.
Published: January 2021

Introduction

Human papillomavirus (HPV) can cause anogenital warts and several types of cancer, including cervical cancers and precancers. We estimated the prevalence, incidence, and number of persons with prevalent and incident HPV infections in the United States in 2018.

Methods

Prevalence and incidence were estimated for infections with any HPV (any of 37 types detected using Linear Array) and disease-associated HPV, 2 types that cause anogenital warts plus 14 types detected by tests used for cervical cancer screening (HPV 6/11/16/18/31/33/35/39/45/51/52/56/58/59/66/68). We used the 2013–2016 National Health and Nutrition Examination Survey to estimate prevalence among 15- to 59-year-olds, overall and by sex. Incidences in 2018 were estimated per 10,000 persons using an individual-based transmission-dynamic type-specific model calibrated to US data. We estimated number of infected persons by applying prevalences and incidences to 2018 US population estimates.

Results

Prevalence of infection with any HPV was 40.0% overall, 41.8% in men, and 38.4% in women; prevalence of infection with disease-associated HPV was 24.2% in men and 19.9% in women. An estimated 23.4 and 19.2 million men and women had a disease-associated HPV type infection in 2018. Incidences of any and disease-associated HPV infection were 1222 and 672 per 10,000 persons; incidence of disease-associated HPV infection was 708 per 10,000 men and 636 per 10,000 women. An estimated 6.9 and 6.1 million men and women had an incident infection with a disease-associated HPV type in 2018.

Conclusions

We document a high HPV burden of infection in the United States in 2018, with 42 million persons infected with disease-associated HPV and 13 million persons acquiring a new infection. Although most infections clear, some disease-associated HPV type infections progress to disease. The HPV burden highlights the need for continued monitoring of HPV-associated cancers, cervical cancer screening, and HPV vaccination to track and prevent disease.
Estimates of the Prevalence and Incidence of Syphilis in the United States, 2018
Authors: Spicknall Ian H. , Kreisel Kristen M. , Weinstock Hillard S.
Published: January 2021

Background

Syphilis is a genital ulcerative disease caused by the bacterium Treponema pallidum that is associated with significant complications if left untreated and can facilitate the transmission and acquisition of HIV infection. The last prevalence and incidence estimates of the burden of syphilis in the United States were for 2008.

Methods

We generate syphilis prevalence and incidence estimates for 2018 among adults aged 14 to 49 years. We fit a simple mathematical model to 2018 case report data to generate 10,000 sets of estimates for age and sex subpopulations and summarize our estimates by their median (50th percentile); uncertainty intervals are characterized by their 25th (Q1) and 75th (Q3) percentiles. We also used our methodology to reestimate 2008 prevalence and incidence estimates.

Results

In 2018, there were an estimated 156,000 (Q1, 132,000; Q3, 184,000) prevalent and 146,000 (Q1, 126,000; Q3, 170,000) incident syphilitic infections in people aged 14 to 49 years. Men accounted for roughly 70% of prevalent infections and more than 80% of incident infections. In both sexes, there were more prevalent and incident infections in 25- to 49-year-olds than 14- to 24-year-olds. Using these methods to reanalyze 2008 data, syphilis prevalence and incidence estimates have increased 164% and 175%, respectively, between 2008 and 2018.

Discussion

Although not as common as other sexually transmitted infections, syphilis should be monitored because of its devastating sequelae. As it continues to increase in frequency, it will be important for future work to continue to track its trajectory and burden.
Genital Mycoplasma, Shigellosis, Zika, Pubic Lice, and Other Sexually Transmitted Infections: Neither Gone Nor Forgotten
Authors: Torrone Elizabeth A. , Lewis Felicia M. T. , Kirkcaldy Robert D. , Bernstein Kyle T. , Ryerson A. Blythe , de Voux Alex , Oliver Sara E. , Quilter Laura A. S. , Weinstock Hillard S.
Published: January 2021

Most estimates of the combined burden and cost of sexually transmitted infections (STIs) in the United States have focused on 8 common STIs with established national surveillance strategies (chlamydia, gonorrhea, syphilis, trichomoniasis, genital herpes, human papillomavirus, and sexually transmitted human immunodeficiency virus and hepatitis B). However, over 30 STIs are primarily sexually transmitted or sexually transmissible. In this article, we review what is known about the burden of “other STIs” in the United States, including those where sexual transmission is not the primary transmission route of infection. Although the combined burden of these other STIs may be substantial, accurately estimating their burden due to sexual transmission is difficult due to diagnostic and surveillance challenges. Developing better estimates will require innovative strategies, such as leveraging existing surveillance systems, partnering with public health and academic researchers outside of the STI field, and developing methodology to estimate the frequency of sexual transmission, particularly for new and emerging STIs.
Estimates of the Prevalence and Incidence of Chlamydia and Gonorrhea Among US Men and Women, 2018
Authors: Kreisel Kristen M. , Weston Emily J. , St. Cyr Sancta B. , Spicknall Ian H.
Published: January 2021

Background

The most recent prevalence and incidence estimates for chlamydia and gonorrhea, the 2 most reported sexually transmitted infections in the United States, were for 2008. We present updated estimates of the number of prevalent and incident chlamydial and gonococcal infections for 2018.

Methods

We estimated chlamydial prevalence directly from the 2015 to 2018 cycles of the National Health and Nutrition Examination Survey and chlamydial incidence using a mathematical model primarily informed by National Health and Nutrition Examination Survey and case report data. Total and antimicrobial-resistant gonococcal prevalence and incidence were estimated using mathematical models primarily informed by case report and Gonococcal Isolate Surveillance Program data. Estimates were calculated for the total population, all women, and all men aged 15 to 39 years, stratified by age group. Primary estimates represent medians and uncertainty intervals represent the 25th (Q1) and 75th (Q3) percentiles of the empirical frequency distributions of prevalence and incidence for each infection.

Results

Among persons aged 15 to 39 years in the United States in 2018, we estimate 2.35 (Q1, 2.20; Q3, 2.51) million prevalent and 3.98 (Q1, 3.77; Q3, 4.22) million incident chlamydial infections, and an estimated 209,000 (Q1, 183,000; Q3, 241,000) prevalent and 1.57 (Q1, 1.44; Q3, 1.72) million incident gonococcal infections. Of all gonococcal infections, there were 107,000 (Q1, 94,000; Q3, 124,000) prevalent and 804,000 (Q1, 738,000; Q3, 883,000) incident infections demonstrating antimicrobial resistance or elevated minimum inhibitory concentrations to selected antibiotics.

Conclusions

Chlamydia and gonorrhea were very common in the United States in 2018. Estimates show that more than 800,000 newly acquired gonococcal infections in 2018 demonstrated resistance or elevated minimum inhibitory concentrations to currently or previously recommended antibiotics.
Incidence and Prevalence of Trichomonas vaginalis Infection Among Persons Aged 15 to 59 Years: United States, 2018
Authors: Lewis Felicia M. T. , Spicknall Ian H. , Flagg Elaine W. , Papp John R. , Kreisel Kristen M.
Published: January 2021

Background

Trichomonas vaginalis (TV) is a sexually transmitted parasite associated with multiple adverse outcomes in women. Estimating TV incidence is challenging because of its largely asymptomatic presentation.

Methods

Per-capita prevalence was estimated using the National Health and Nutrition Examination Survey, 2013 to 2018. Incidence was estimated using ordinary differential equations assuming static incidence at steady state and fit using Bayesian techniques. Model inputs included estimates of proportion of asymptomatic cases, natural clearance, and time to symptomatic treatment seeking. Posterior distributions were drawn, and uncertainty was reported, from 25th (Q1) to 75th (Q3) percentiles. Aggregated measures were estimated by combining component distributions.

Results

Among 15- to 59-year-olds in 2018, the number of prevalent TV infections was 2.6 (Q1, 2.4; Q3, 2.7) million overall, 470,000 (Q1, 414,000; Q3, 530,000) among men, and 2.1 (Q1, 2.0; Q3, 2.2) million among women; the numbers of incident infections were 6.9 (Q1, 6.2; Q3, 7.6) million, 3.3 (Q1, 2.8; Q3, 3.8) million, and 3.5 (Q1, 3.1; Q3, 4.0) million among all persons, men, and women, respectively. Persons aged 15 to 24 years comprised 15.6% and 16.3% of all prevalent and incident infections, respectively; prevalence and incidence in both sexes increased with age. Incidences in both sexes were highly dependent on estimates of natural clearance, which were based on few data.

Conclusions

Prevalence and incidence of TV are substantial in the United States, particularly among those 25 years or older. Although estimated prevalence is higher in women, estimated incidence is similar in men and women. Data on key parameters of TV infection are limited; future research should focus on clarifying the natural history of TV.
A Recreational Fishing Death Due to a Jumping Spanish Mackerel (Scomberomorus commerson)
Authors: Tiemensma Marianne , Byard Roger W.
Published: January 2021

Commercial or recreational fishing may be associated with a wide range of potentially lethal events. We report the case of a 56-year-old man who died of blunt force chest and abdominal trauma after impact with a large Spanish mackerel (Scomberomorus commerson) that had jumped into his recreational fishing boat. Injuries at autopsy included soft tissue bruising with fractured ribs, a ruptured diaphragm, intestinal and mesenteric contusions, contusion and disruption of the pancreas, and hilar splenic lacerations with a left-sided hemothorax and a hematoperitoneum. The clear temporal association of pain and progressive deterioration leading to cardiac arrest after the impact indicated that lethal injuries had been sustained. A variety of fish and cetacean species are known to jump out of the water sometimes to escape predators. It was reported that a large number of jumping fish being pursued by sharks were observed in the harbor on the day of the reported incident. This case demonstrates that lethal blunt abdominothoracic trauma may be caused by impact with Spanish mackerel, increasing the range of potentially dangerous situations that may be encountered while fishing.
The Relationship Between Earlobe Creases and the Presence, Extent, and Severity of Coronary Artery Atherosclerosis
Authors: French Claire E.V. , Rutherford John David , Goossens Louise , Tiemensma Marianne
Published: January 2021

The association between earlobe crease(s) and coronary artery atherosclerosis has stimulated debate and controversy over the years. Most available published studies have been conducted on living patients. Although these studies offer valuable insight into such associations in patients who exhibit symptoms, no information is available from these studies on the prevalence of earlobe creases among an asymptomatic population. Postmortem studies offer the advantage of including individuals free of symptomatic cardiovascular disease, thus providing an inbuilt control group. The atherosclerotic pathological findings of 1298 individuals who underwent coronial postmortem examination at Wellington Regional Hospital, New Zealand, between 2006 and 2013 were retrospectively studied. Earlobe creases and atherosclerosis involving the coronary arteries were semiquantitatively appraised. The presence of an earlobe crease was found to be significantly associated with coronary artery atherosclerosis.
Psychometric Properties of the Preparedness Assessment for the Transition Home After Stroke Instrument
Authors: Camicia Michelle , Lutz Barbara J. , Joseph Jill G. , Harvath Theresa A. , Drake Christiana M. , Theodore Brian R. , Kim Katherine K.
Published: January 2021

Purpose

The aim of this study was to evaluate psychometric properties of the Preparedness Assessment for the Transition Home After Stroke (PATH-s), a novel instrument to assess stroke caregiver commitment and capacity. The PATH-s instrument can be obtained at www.rehabnurse.org/pathtool.

Design

The design of this study is cross-sectional.

Methods

The PATH-s, the Preparedness for Caregiving Scale (PCS), the Patient Health Questionnaire, the Perceived Stress Scale, and the Global Health Scale were self-reported from a convenience sample of caregiver–stroke survivor dyads (n = 183) during inpatient rehabilitation.

Results

Exploratory factor analysis revealed eight factors underlying the PATH-s structure. The PATH-s Cronbach’s alpha of .90 demonstrated criterion-related validity with the PCS (r = .79, p < .01). Both the PATH-s and the PCS were negatively correlated with the Patient Health Questionnaire (r = −.26 and −.27, respectively; p < .01) and the Perceived Stress Scale (r = −.12 and −.15, respectively; p > .05) and positively correlated with the Global Health Scale (r = −.46 and .46, respectively; p < .01), indicating convergent validity.

Conclusions

The PATH-s demonstrates excellent internal consistency and satisfactory criterion-related and convergent validity.

Clinical Relevance

The PATH-s may be used to assess the risk/needs of caregivers over time.
Supported Communication Video Training for the Nursing Department in an Inpatient Rehabilitation Hospital
Authors: Armour Michelle , Brady Susan , Williamson-Link Kathryn , McGovern Linda , Struchil Kristen
Published: January 2021

Purpose

The aim of this study was to develop a valid educational intervention to improve knowledge and confidence using communication strategies when interacting with a person with aphasia.

Design

A quantitative, nonrandomized pretest/posttest research study was performed.

Methods

Pre- and postcourse assessments were completed with learning participants. This educational intervention was developed using the underlying theoretical concepts of the integrated behavioral model.

Results

Forty-nine new employees from the nursing department participated in this study, with 61% reporting less than 1 year of experience. Pre- to posttraining assessments on the Test of Knowledge of Aphasia improved from 3.7 to 5.8 (p ≤ .0001) for direct knowledge, from 5.5 to 8.2 (p ≤ .0001) for confidence self-efficacy, and from 5.3 to 7.6 (p ≤ .0001) for knowledge self-efficacy.

Conclusion

Results indicated this theory-driven educational training was effective in training employees from the nursing department working in an inpatient rehabilitation environment.

Clinical Relevancy

Improving communication effectiveness is critical for overall quality of care and patient safety.
Older Persons and Nursing Staff’s Perspectives on Continence Care in Rehabilitation
Authors: Hunter Kathleen F. , Dahlke Sherry , Smith Nicholas , Lin Alina , Rajabali Saima , Wagg Adrian
Published: January 2021

Purpose

The aim of the study was to understand continence care in geriatric rehabilitation from the perspectives of older persons and nursing staff.

Design

This is a qualitative descriptive study.

Methods

Ten patients and 10 nursing staff participated in semistructured interviews. Observations of care were recorded in field notes. Content analysis was used to develop themes of patient and nursing staff perspectives.

Findings

Three themes were developed: Perceptions of Assessment, Continence Management, and Rehab: The Repair Shop. Patients had limited insight into continence assessment and management by nursing staff. For older persons, incontinence was embarrassing and created dependence; independence in toileting meant gaining control. Staff viewed continence as an important part of rehabilitation nursing but focused on containment and regular toileting, with patients seeing absorbent pads as commonly suggested.

Conclusions

Continence care approaches that engage older persons during rehabilitation are needed.

Clinical Relevance

Restoration of continence through patient-centered care is core to older person rehabilitation.
Influence of Pulse Wave Velocity on Atherosclerosis and Blood Flow Reversal in the Aorta
Authors: Wehrum Thomas , Dragonu Iulius , Strecker Christoph , Hennemuth Anja , Hennig Jürgen , Reinhard Thomas , Harloff Andreas
Published: January 2021

Background:

Aortic stiffness is associated with a higher incidence of cardiovascular events including stroke. The primary aim of this study was to evaluate whether increased pulse wave velocity (PWV), a marker of stiffness, is an independent predictor of aortic atheroma. The secondary aim was to test whether increased PWV reinforces retrograde blood flow from the descending aorta (DAo), a mechanism of stroke.

Methods:

We performed a cross-sectional case-control study with prospective data acquisition. In all, 40 stroke and 60 ophthalmic patients matched for age and cardiovascular risk factors were included. Multicontrast magnetic resonance imaging (MRI) protocol of the aorta tailored to allow a detailed plaque analysis using 3-dimensional (D) T1-weighted bright blood, T2-weighted and proton density-weighted black blood, and hemodynamic assessment using 4D flow MRI was applied. Individual PWV was calculated based on 4D flow MRI data using the time-to-foot of the blood flow waveform. The extent of maximum retrograde blood flow from the proximal DAo into the arch was quantified.

Results:

PWV was higher in stroke patients compared with controls (7.62±2.59 vs. 5.96±2.49 m/s; P=0.005) and in patients with plaques (irrespective of thickness) compared with patients without plaques (7.47±2.89 vs. 5.62±1.89 m/s; P=0.002). Increased PWV was an independent predictor of plaque prevalence and contributed significantly to a predictor model explaining 36.5% (Nagelkerke R2) of the variance in plaque presence. Maximum retrograde flow extent from the proximal DAo was not correlated with PWV.

Conclusions:

Aortic stiffness was higher in stroke patients and associated with a higher prevalence of plaques. Increased PWV was an independent predictor of plaque presence. Accordingly, regional PWV seems to be a valuable biomarker for the assessment and management of aortic atherosclerosis. However, no association was found for increased retrograde flow extent from the DAo.
The Relationship Between Surgeon Gender and Stress During the Covid-19 Pandemic
Authors: Mavroudis Catherine L. , Landau Sarah , Brooks Ezra , Bergmark Regan , Berlin Nicholas L. , Blumenthal Blanche , Cooper Zara , Hwang Eun Kyeong , Lancaster Elizabeth , Waljee Jennifer , Wick Elizabeth , Yeo Heather , Wirtalla Christopher , Kelz Rachel R.
Published: January 2021

Objective:

To investigate the relationship between surgeon gender and stress during the Covid-19 pandemic.

Background:

Although female surgeons face difficulties integrating work and home in the best of times, the Covid-19 pandemic has presented new challenges. The implications for the female surgical workforce are unknown.

Methods:

This cross-sectional, multi-center telephone survey study of surgeons was conducted across 5 academic institutions (May 15–June 5, 2020). The primary outcome was maximum stress level, measured using the validated Stress Numerical Rating Scale-11. Mixed-effects generalized linear models were used to estimate the relationship between surgeon stress level and gender.

Results:

Of 529 surgeons contacted, 337 surgeons responded and 335 surveys were complete (response rate 63.7%). The majority of female respondents were housestaff (58.1%), and the majority of male respondents were faculty (56.8%) (P = 0.008). A greater proportion of male surgeons (50.3%) than female surgeons (36.8%) had children ≤18 years (P = 0.015). The mean maximum stress level for female surgeons was 7.51 (SD 1.49) and for male surgeons was 6.71 (SD 2.15) (P < 0.001). After adjusting for the presence of children and training status, female gender was associated with a significantly higher maximum stress level (P < 0.001).

Conclusions:

Our findings that women experienced more stress than men during the Covid-19 pandemic, regardless of parental status, suggest that there is more to the gendered differences in the stress experience of the pandemic than the added demands of childcare. Deliberate interventions are needed to promote and support the female surgical workforce during the pandemic.
The Role of Personal Accomplishment in General Surgery Resident Well-being
Authors: Khorfan Rhami , Hu Yue-Yung , Agarwal Gaurava , Eng Joshua , Riall Taylor , Choi Jennifer , Are Chandrakanth , Shanafelt Tait , Bilimoria Karl Y. , Cheung Elaine O.
Published: January 2021

Objective:

To investigate the association of personal accomplishment (PA) with the other subscales, assess its association with well-being outcomes, and evaluate drivers of PA by resident level

Background:

Most studies investigating physician burnout focus on the emotional exhaustion (EE) and depersonalization (DP) subscales, neglecting PA. Therefore, the role of PA is not well understood.

Methods:

General surgery residents were surveyed following the 2019 American Board of Surgery In-Training Examination regarding their learning environment. Pearson correlations of PA with EE and DP were assessed. Multivariable logistic regression models assessed the association of PA with attrition, job satisfaction, and suicidality and identified factors associated with PA by PGY.

Results:

Residents from 301 programs were surveyed (85.6% response rate, N = 6956). Overall, 89.4% reported high PA, which varied by PGY-level (PGY1: 91.0%, PGY2/3: 87.7%, PGY4/5: 90.2%; P = 0.02). PA was not significantly correlated with EE (r = –0.01) or DP (r = –0.08). After adjusting for EE and DP, PA was associated with attrition (OR 0.60, 95%CI 0.46–0.78) and job satisfaction (OR 3.04, 95%CI 2.45–3.76) but not suicidality (OR 0.72, 95%CI 0.48–1.09). Although the only factor significantly associated with PA for interns was resident cooperation, time in operating room and clinical autonomy were significantly associated with PA for PGY2/3. For PGY4/5s, PA was associated with time for patient care, resident cooperation, and mentorship.

Conclusion:

PA is a distinct metric of resident well-being, associated with job satisfaction and attrition. Drivers of PA differ by PGY level and may be targets for intervention to promote resident wellness and engagement.
Recent findings on neurofeedback training for auditory hallucinations in schizophrenia
Authors: Hirano Yoji , Tamura Shunsuke
Published: January 2021

Purpose of review

To provide recent evidence on real-time neurofeedback (NFB) training for auditory verbal hallucinations (AVH) in schizophrenia patients.

Recent findings

NFB is a promising technique that allows patients to gain control over their AVH by modulating their own speech-related/language-related networks including superior temporal gyrus (STG) and anterior cingulate cortex (ACC) using fMRI, fNIRS and EEG/MEG. A recent limited number of studies showed that while an EEG-based NFB study failed to regulate auditory-evoked potentials and reduce AVH, downregulation of STG hyperactivity and upregulation of ACC activity with fMRI-based NFB appear to alleviate treatment-resistant AVH in schizophrenia patients. A deeper understanding of AVH and development of more effective methodologies are still needed.

Despite recent innovations in antipsychotics, many schizophrenia patients continue to suffer from treatment-resistant AVH and social dysfunctions. Recent studies suggested that real-time NFB shows promise in enabling patients to gain control over AVH by regulating their own speech-related/language-related networks. Although fMRI-NFB is suitable for regulating localized activity, EEG/MEG-NFB are ideal for regulating the ever-changing AVH. Although there are still many challenges including logistic complexity and burden on patients, we hope that such innovative real-time NFB trainings will help patients to alleviate severe symptoms and improve social functioning.
Bacterial gastroenteritis caused by the putative zoonotic pathogen Campylobacter lanienae: First reported case in Germany
Authors: Fornefett Juliane , Busch Anne , Döpping Sandra , Hotzel Helmut , Rimek Dagmar
Published: January 2021

Foodborne campylobacteriosis is the most common cause of human bacterial enteritis in Germany.

Campylobacter jejuni

and

Campylobacter coli

are the main causative agents for enteric disease, but a number of other species are involved, including rare ones. These rare

Campylobacter

spp. are emerging zoonotic pathogens in humans due to increasing international movement of supplies, livestock and people.

Campylobacter lanienae

was first isolated from healthy abattoir workers in Switzerland and at first its pathogenic potential for humans was considered to be low. Recently, the first case of

Campylobacter lanienae

-associated human enteritis was reported in Canada. Here, we describe a case of mild

Campylobacter lanienae

-associated enteritis with subsequent asymptomatic excretion in a butcher. The isolate is available at the TLV strain collection (no. TP00333/18). This first reported case of human

Campylobacter lanienae

campylobacteriosis in Germany demonstrates the agent’s likely zoonotic pathogenicity.
Are probiotics and prebiotics safe for use during pregnancy and lactation? A systematic review and meta-analysis
Authors: Sheyholislami Hauna , Connor Kristin L.
Published: January 2021

Probiotic and prebiotic products have shown potential health benefits, including for the prevention of adverse pregnancy outcomes. The incidence of adverse effects in pregnant people and their infants associated with probiotic/prebiotic/synbiotic intake, however, remains unclear. The objectives of this study were to evaluate the evidence on adverse effects of maternal probiotic, prebiotic and/or synbiotic supplementation during pregnancy and lactation and interpret the findings to help inform clinical decision-making and care of this population. A systematic review was conducted following PRISMA guidelines. Scientific databases were searched using pre-determined terms, and risk of bias assessments were conducted to determine study quality. Inclusion criteria were English language studies, human studies, access to full-text, and probiotic/prebiotic/synbiotic supplementation to the mother and not the infant. 11/100 eligible studies reported adverse effects and were eligible for inclusion in quantitative analysis, and data were visualised in a GOfER diagram. Probiotic and prebiotic products are safe for use during pregnancy and lactation. One study reported increased risk of vaginal discharge and changes in stool consistency (Relative Risk [95% CI]: 3.67 [1.04, 13.0]) when administeringLactobacillus rhamnosusandL. reuteri. Adverse effects associated with probiotic and prebiotic use do not pose any serious health concerns to mother or infant. Our findings and knowledge translation visualisations provide healthcare professionals and consumers with information to make evidence-informed decisions about the use of pre- and probiotics.