bluuebunny/crossref_metadata_2025 huggingface dataset:
Mindful Mentors: Is a Longitudinal Mind–Body Skills Training Pilot Program Feasible for Pediatric Cardiology Staff?
Authors: Freedenberg Vicki A , Jiang JiJi , Cheatham Carla A , Sibinga Erica MS , Powell Cynthia A , Martin Gerard R , Steinhorn David M , Kemper Kathi J
Published: September 2020

Background

Stress and burnout among medical professionals are common and costly, placing professionals, organizations, and patients at risk.

Objectives

To determine feasibility and acceptability of a longitudinal mind–body skills training initiative to help staff decrease stress and burnout, improve well-being, and empower them to utilize basic mindfulness methods with coworkers, patients, and families.

Methods

Prospective cohort, mixed methods approach. Nurses, doctors, technicians, social workers, child life specialists were eligible to participate. The 12-month curriculum consisted of 16 hours of intensive education/practice over 2 days, with training in mindfulness skills, self-compassion, nonviolent communication, overcoming barriers to practice, and mindful listening/speaking, followed by monthly 1 hour booster/debriefing sessions.

Results

A total of 37 staff participated (RN = 18, MD = 5, Technician = 6, Social Worker = 3, Child life = 3, others = 2) in the initial training, and 24 (65%) completed the 3- and 12-month follow-up surveys. Compared with pretraining scores, there were significant improvements 3 to 12 months after the initial training in stress ( P < .0001), distress ( P ≤ .04), anxiety ( P = .01), self-efficacy in providing non-drug therapies ( P < .0001), mindfulness ( P = .002), burnout ( P < .0001), and confidence in providing compassionate care ( P < .0001). In addition, 25 (67%) participants initiated projects incorporating what they learned into staff/patient wellness activities.

Conclusion

This longitudinal pilot program was feasible and was associated with improvements in measures of psychological well-being over the 12-month intervention. The innovative approach of training participants to teach basic techniques to coworkers and other staff can increase the impact of this program beyond any individual participant. Future research will investigate the aspects of implementation and potential effects on patient care and experience.
Do Intraoperative Neurophysiological Changes During Decompressive Surgery for Cervical Myeloradiculopathy Affect Functional Outcome? A Prospective Study
Authors: Akbari Keyur Kantilal , Badikillaya Vigneshwara , Venkatesan Muralidharan , Hegde Sajan K.
Published: September 2020

Study Design:

Prospective cohort.

Objective:

To investigate whether intraoperative neuromonitoring (IONM) positive changes affect functional outcome after surgical intervention for myeloradiculopathy secondary to cervical compressive pathology (cervical compressive myelopathy).

Methods:

Twenty-eight patients who underwent cervical spine surgery with IONM for compressive myeloradiculopathy were enrolled. During surgery motor-evoked potential (MEP) and somatosensory evoked potential (SSEP) at baseline and before and after decompression were documented. A decrease in latency >10% or an increase in amplitude >50% was regarded as a “positive changes.” Patients were divided into subgroups based on IONM changes: group A (those with positive changes) and group B (those with no change or deterioration). Nurick grade and modified Japanese Orthopaedic Association (mJOA) score were evaluated before and after surgery.

Results:

Nine patients (32.1%) showed improvement in MEP. The mean preoperative Nurick grade and mJOA score of group A and B were (2.55 ± 0.83 and 11.11 ± 1.65) and (2.47 ± 0.7 and 11.32 ± 1.24), respectively. The mean postoperative Nurick grade of groups A and B at 6 months was 1.55 ± 0.74 and 1.63 ± 0.46, respectively, and this difference was not significant. The mean postoperative mJOA score of groups A and B at 6 months was 14.3 ± 1.03 and 12.9 ± 0.98, respectively, and this difference was statistically significant ( P = .011). Spearman correlation coefficient showed significant positive correlation between the IONM change and the mJOA score at 6 months postoperatively ( r = 0.47; P = .01).

Conclusion:

Our study shows that impact of positive changes in MEP during IONM reflect in functional improvement at 6 months postoperatively in cervical compressive myelopathy patients.
Physical Examination of the Spine Using Telemedicine: A Systematic Review
Authors: Piche Joshua , Butt Bilal B. , Ahmady Arya , Patel Rakesh , Aleem Ilyas
Published: September 2020

Study Design:

This is a systematic review.

Objective:

To systematically review (1) the reliability of the physical examination of the spine using telehealth as it pertains to spinal pathology and (2) patient satisfaction with the virtual spine physical examination.

Methods:

We searched EMBASE, PubMed, Medline Ovid, and SCOPUS databases from inception until April 2020. Eligible studies included those that reported on performing a virtual spine physical examination. Two reviewers independently assessed all potential studies for eligibility and extracted data. The primary outcome of interest was the reliability of the virtual spine physical exam. Secondary outcomes of interest were patient satisfaction with the virtual encounter.

Results:

A total of 2321 studies were initially screened. After inclusion criteria were applied, 3 studies (88 patients) were included that compared virtual with in-person spine physical examinations. These studies showed acceptable reliability for portions of the low back virtual exam. Patient satisfaction surveys were conducted in 2 of the studies and showed general satisfaction (>80% would recommend).

Conclusions:

These results suggest that the virtual spine examination may be comparable to the in-person physical examination for low back pain, though there is a significant void in the literature regarding the reliability of the physical examination as it pertains to specific surgical pathology of the spine. Because patients are overall satisfied with virtual spine assessments, validating a virtual physical examination of the spine is an important area that requires further research.
CandiDating Game: An Exercise in Interviewing and Hiring
Authors: Howe David C.
Published: September 2020

This article describes a game show-style classroom exercise that is appropriate for any management-related courses that wish to enrich students’ understanding of a key phase of the hiring process. The activity introduces the importance of job descriptions and job specifications through a semiscripted unstructured interview patterned after a classic television game show. In The CandiDating Game, one student interviews three candidates in front of the class. Through varying the job specifications that each student receives without informing the students or interviewer, the instructor can use this activity to engage the class in a rigorous discussion on the importance of job specifications and the general structure of interviews.
Impact of COVID-19 on Life Experiences of Essential Workers Attending a Dental Testing Facility
Authors: Fontana M. , McCauley L. , Fitzgerald M. , Eckert G.J. , Yanca E. , Eber R.
Published: September 2020

COVID-19 poses a threat to health and well-being.

Objectives:

1) To compare the impact of COVID-19 on the life experiences of essential workers attending a COVID-19 antibody testing clinic at a dental school. 2) To compare responses of dental, non–dental health care, and non–health care essential workers. 3) To assess acceptability/satisfaction of testing done in a dental setting.

Method:

A total of 984 participants completed a self-administered online questionnaire.

Results:

Over 90% were healthy (i.e., not in a high-risk health-related group for COVID-19), did not have COVID-19 symptoms within 30 d, and always/frequently engaged in preventive measures. Fifty-eight percent thought that they had a 0% to 25% chance of having immunity/antibodies to COVID-19. Non–dental health care workers thought that their chance was significantly higher (P < 0.05) than others. Over 70% were sometimes, frequently, or always worried about their friends and loved ones getting COVID-19 and of resulting financial problems. Dental workers were significantly less afraid than non–dental health care and non–health care providers. For all groups, more than half of the respondents stated that the pandemic had a negative (somewhat worse or worse) impact on daily life (59%), interactions with others (65%), stress levels (66%), and enjoyment of life (56%). There were significant differences among all 3 groups regarding the percentage of individuals with a negative impact on job security (dental, 47%; non–dental health care, 34%; non–health care, 31%). However, more than half of the respondents stated that the pandemic had a positive impact (same, somewhat better, or much better) on caring about one another, self-care, and exercise. Knowing the results of an antibody test would decrease the level of stress and anxiety in 67% of respondents. Over 80% found a COVID-19 test received in a dental setting acceptable, were “definitely” satisfied, and would “definitely” recommend it to a friend, family, or coworker.

Conclusions:

These findings support that dental workers are as vulnerable as other essential workers to threats and psychological impacts of COVID-19. They also support the acceptability and satisfaction of testing for a pandemic done in a dental setting.

Knowledge Transfer Statement:

The results of this study highlight the impact that pandemics such as COVID-19 can have on life experiences of essential workers, including dentists. It also highlights a role that dentistry can play within the broader health care system, during and beyond the current pandemic, to help with surveillance efforts of community health. Testing may also help alleviate stress and anxiety associated with these pandemics.
CANOMAD: a neurological monoclonal gammopathy of clinical significance that benefits from B-cell–targeted therapies
Authors: Le Cann Marie , Bouhour Françoise , Viala Karine , Simon Laurence , Tard Céline , Rossi Cédric , Morel Guillaume , Lagrange Emmeline , Magy Laurent , Créange Alain , Michaud Maud , Franques Jérôme , Echaniz-Laguna Andoni , Antoine Jean-Christophe , Baron Marine , Arnulf Bertrand , Puma Angela , Delmont Emilien , Maisonobe Thierry , Leblond Véronique , Roos-Weil Damien
Published: September 2020

CANOMAD (chronic ataxic neuropathy, ophthalmoplegia, immunoglobulin M [IgM] paraprotein, cold agglutinins, and disialosyl antibodies) is a rare syndrome characterized by chronic neuropathy with sensory ataxia, ocular, and/or bulbar motor weakness in the presence of a monoclonal IgM reacting against gangliosides containing disialosyl epitopes. Data regarding associated hematologic malignancies and effective therapies in CANOMAD are scarce. We conducted a French multicenter retrospective study that included 45 patients with serum IgM antibodies reacting against disialosyl epitopes in the context of evocating neurologic symptoms. The main clinical features were sensitive symptoms (ataxia, paresthesia, hypoesthesia; n = 45, 100%), motor weakness (n = 18, 40%), ophthalmoplegia (n = 20, 45%), and bulbar symptoms (n = 6, 13%). Forty-five percent of the cohort had moderate to severe disability (modified Rankin score, 3-5). Cold agglutinins were identified in 15 (34%) patients. Electrophysiologic studies showed a demyelinating or axonal pattern in, respectively, 60% and 27% of cases. All patients had serum monoclonal IgM gammopathy (median, 2.6 g/L; range, 0.1-40 g/L). Overt hematologic malignancies were diagnosed in 16 patients (36%), with the most frequent being Waldenström macroglobulinemia (n = 9, 20%). Forty-one patients (91%) required treatment of CANOMAD. Intravenous immunoglobulins (IVIg) and rituximab-based regimens were the most effective therapies with, respectively, 53% and 52% of partial or better clinical responses. Corticosteroids and immunosuppressive drugs were largely ineffective. Although more studies are warranted to better define the optimal therapeutic sequence, IVIg should be proposed as the standard of care for first-line treatment and rituximab-based regimens for second-line treatment. These compiled data argue for CANOMAD to be included in neurologic monoclonal gammopathy of clinical significance.
Contribution of clonal hematopoiesis to adult-onset hemophagocytic lymphohistiocytosis
Authors: Miller Peter G. , Sperling Adam S. , Gibson Christopher J. , Viswanathan Kaushik , Castellano Cecilia , McConkey Marie , Ceremsak John , Taylor Martin S. , Birndt Sebastian , Perner Florian , Arnason Jon , Agrawal Mridul , Schram Alison M. , Nikiforow Sarah , Pihan German , Hasserjian Robert P. , Aster Jon C. , La Rosée Paul , Morgan Elizabeth A. , Berliner Nancy , Ebert Benjamin L.
Published: September 2020

Adult-onset hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening disease of immune hyperactivation. Unlike pediatric HLH, adult HLH is rarely driven by germline genetic variants. Although numerous precipitating etiologies have been identified, the reason that HLH occurs in only a subset of individuals and how other factors contribute to the disease remains unknown. We hypothesized that clonal hematopoiesis (CH), a state in which somatic mutations in blood cells cause an expanded population of mutant hematopoietic cells and drive an aberrant inflammatory state, could contribute to adult-onset HLH. In a highly annotated cohort of older adults with HLH we found that CH was more prevalent than in control cohorts. Using the adult-onset HLH mouse model in which repeated treatments of the TLR9 agonist, ODN1826, was delivered to the mouse, we observed that macrophages carrying mutations in Tet2, one of the most commonly mutated genes in CH, have an enhanced inflammatory response to TLR9 agonism. Finally, mice carrying Tet2 mutations in the hematopoietic compartment (a common model for CH) displayed an exaggerated response to TLR9 agonism, including worse splenomegaly and anemia. Our data suggest that CH is more common in individuals with adult-onset HLH and can contribute to the pathophysiology of this disease.
Convalescent plasma therapy for B-cell–depleted patients with protracted COVID-19
Authors: Hueso Thomas , Pouderoux Cécile , Péré Hélène , Beaumont Anne-Lise , Raillon Laure-Anne , Ader Florence , Chatenoud Lucienne , Eshagh Déborah , Szwebel Tali-Anne , Martinot Martin , Camou Fabrice , Crickx Etienne , Michel Marc , Mahevas Matthieu , Boutboul David , Azoulay Elie , Joseph Adrien , Hermine Olivier , Rouzaud Claire , Faguer Stanislas , Petua Philippe , Pommeret Fanny , Clerc Sébastien , Planquette Benjamin , Merabet Fatiha , London Jonathan , Zeller Valérie , Ghez David , Veyer David , Ouedrani Amani , Gallian Pierre , Pacanowski Jérôme , Mékinian Arsène , Garnier Marc , Pirenne France , Tiberghien Pierre , Lacombe Karine
Published: September 2020

Anti-CD20 monoclonal antibodies are widely used for the treatment of hematological malignancies or autoimmune disease but may be responsible for a secondary humoral deficiency. In the context of COVID-19 infection, this may prevent the elicitation of a specific SARS-CoV-2 antibody response. We report a series of 17 consecutive patients with profound B-cell lymphopenia and prolonged COVID-19 symptoms, negative immunoglobulin G (IgG)-IgM SARS-CoV-2 serology, and positive RNAemia measured by digital polymerase chain reaction who were treated with 4 units of COVID-19 convalescent plasma. Within 48 hours of transfusion, all but 1 patient experienced an improvement of clinical symptoms. The inflammatory syndrome abated within a week. Only 1 patient who needed mechanical ventilation for severe COVID-19 disease died of bacterial pneumonia. SARS-CoV-2 RNAemia decreased to below the sensitivity threshold in all 9 evaluated patients. In 3 patients, virus-specific T-cell responses were analyzed using T-cell enzyme-linked immunospot assay before convalescent plasma transfusion. All showed a maintained SARS-CoV-2 T-cell response and poor cross-response to other coronaviruses. No adverse event was reported. Convalescent plasma with anti–SARS-CoV-2 antibodies appears to be a very promising approach in the context of protracted COVID-19 symptoms in patients unable to mount a specific humoral response to SARS-CoV-2.
Optimization of processing parameters for the manufacturing of jute stick binderless particleboard
Authors: Nitu Ireen Parvin , Islam Md Nazrul , Ashaduzzaman Md , Amin Md Khairul , Shams Md Iftekhar
Published: September 2020

This study investigated the effects of processing parameters, namely particle mixing ratios, press temperatures, and time for the manufacturing of jute stick binderless particleboard (JBPB). Different ratios of fine and coarse particles, press temperature (160 to 240 °C) and press time (4 to 10 min) were used for JBPB fabrication with a target density of 0.9 g/cm3. The dimensional stability and mechanical properties of JBPB were determined according to Japanese Industrial Standard JIS A 5908 (2003). The result shows that the most favorable pressing conditions in the manufacturing process were press temperature of 220 °C for 6 min with a mixing ratio of 50:50 (fine: coarse). The modulus of rupture (MOR), modulus of elasticity (MOE), and internal bonding (IB) of JBPB was 16.35 N/mm2, 3872.99 N/mm2, and 1.07 N/mm2, respectively, which met the minimum requirement for type-18 of particleboard JIS A 5908 (2003) except for the value of MOR. The bonding mechanism was analyzed by the chemical changes in the raw materials after the fabrication of JBPBs. The pentosans present in the raw material decreased with the increased press temperatures. In this study, the hemicellulose was decomposed which may accelerate the self-bonding of the JBPB at high temperatures. The thermal gravimetric analysis (TGA) revealed that the JBPB showed good thermal stability with the increase of press temperatures. Fourier transform infrared (FTIR) spectra indicated that the removal of hydroxyl groups which increased the dimensional stability of JBPBs. Hence, it could be concluded that by controlling particle mixing ratio (50:50) at high press temperature with proper press time, high-performance jute stick binderless particleboard could be successfully developed which has a variety of applications.
Phenotypic coupling of sleep and starvation resistance evolves in D. melanogaster
Authors: Sarikaya Didem P. , Cridland Julie , Tarakji Adam , Sheehy Hayley , Davis Sophia , Kochummen Ashley , Hatmaker Ryan , Khan Nossin , Chiu Joanna , Begun David J.
Published: September 2020

Background

One hypothesis for the function of sleep is that it serves as a mechanism to conserve energy. Recent studies have suggested that increased sleep can be an adaptive mechanism to improve survival under food deprivation in Drosophila melanogaster. To test the generality of this hypothesis, we compared sleep and its plastic response to starvation in a temperate and tropical population of Drosophila melanogaster.

Results

We found that flies from the temperate population were more starvation resistant, and hypothesized that they would engage in behaviors that are considered to conserve energy, including increased sleep and reduced movement. Surprisingly, temperate flies slept less and moved more when they were awake compared to tropical flies, both under fed and starved conditions, therefore sleep did not correlate with population-level differences in starvation resistance. In contrast, total sleep and percent change in sleep when starved were strongly positively correlated with starvation resistance within the tropical population, but not within the temperate population. Thus, we observe unexpectedly complex relationships between starvation and sleep that vary both within and across populations. These observations falsify the simple hypothesis of a straightforward relationship between sleep and energy conservation. We also tested the hypothesis that starvation is correlated with metabolic phenotypes by investigating stored lipid and carbohydrate levels, and found that stored metabolites partially contributed towards variation starvation resistance.

Conclusions

Our findings demonstrate that the function of sleep under starvation can rapidly evolve on short timescales and raise new questions about the physiological correlates of sleep and the extent to which variation in sleep is shaped by natural selection.
Effects of propofol and sevoflurane on hepatic blood flow: a randomized controlled trial
Authors: van Limmen Jurgen , Wyffels Piet , Berrevoet Frederik , Vanlander Aude , Coeman Laurent , Wouters Patrick , De Hert Stefan , De Baerdemaeker Luc
Published: September 2020

Background

Maintaining adequate perioperative hepatic blood flow (HBF) supply is essential for preservation of postoperative normal liver function. Propofol and sevoflurane affect arterial and portal HBF. Previous studies have suggested that propofol increases total HBF, primarily by increasing portal HBF, while sevoflurane has only minimal effect on total HBF. Primary objective was to compare the effect of propofol (group P) and sevoflurane (group S) on arterial, portal and total HBF and on the caval and portal vein pressure during major abdominal surgery. The study was performed in patients undergoing pancreaticoduodenectomy because - in contrast to hepatic surgical procedures - this is a standardized surgical procedure without potential anticipated severe hemodynamic disturbances, and it allows direct access to the hepatic blood vessels.

Methods

Patients were randomized according to the type of anesthetic drug used. For both groups, Bispectral Index (BIS) monitoring was used to monitor depth of anesthesia. All patients received goal-directed hemodynamic therapy (GDHT) guided by the transpulmonary thermodilution technique. Hemodynamic data were measured, recorded and guided by Pulsioflex™. Arterial, portal and total HBF were measured directly, using ultrasound transit time flow measurements (TTFM) and were related to hemodynamic variables.

Results

Eighteen patients were included. There was no significant difference between groups in arterial, portal and total HBF. As a result of the GDHT, pre-set hemodynamic targets were obtained in both groups, but MAP was significantly lower in group S (p = 0.01). In order to obtain these pre-set hemodynamic targets, group S necessitated a significantly higher need for vasopressor support (p < 0.01).

Conclusion

Hepatic blood flow was similar under a propofol-based and a sevoflurane-based anesthetic regimen. Related to the application of GDHT, pre-set hemodynamic goals were maintained in both groups, but sevoflurane-anaesthetized patients had a significantly higher need for vasopressor support.

Trial registration

Study protocol number is AGO/2017/002 – EC/2017/0164. EudraCT number is 2017–000071-90.Clin.trail.gov,NCT03772106, Registered 4/12/2018, retrospective registered.
A Mokken scale analysis of the Kessler-6 screening measure among Chinese older population: findings from a national survey
Authors: Zhang Lisong , Li Zhongquan
Published: September 2020

Background

The aging population increases rapidly across the world. Timely and effective screening of their mental-health problems is important to individuals, families, and the whole society. The Kessler-6 screening measure (K6) is a very popular instrument for non-specific psychological distress. However, few studies have focused on the psychometric properties of this instrument in the older population.

Methods

The present study employed Mokken scale analysis to evaluate its dimensionality and structure. This study also used differential item functioning (DIF) to examine whether the same structure existed across sex in a national representative sample of old Chinese people. Data were drawn from a public data set, the 2010 China Family Panel Studies (CFPS2010), and responses from a total of 6450 participants aged 60 years old and above (3136 males and 3314 females) were included in the final analysis.

Results

Mokken scale analysis supported the unidimensional structure of the K6. Differential item functioning (DIF) analysis revealed that two of the six items (“Hopeless” and “Everything was an effort”) were marked for DIF based on the Chi-square. However, their impacts were negligible in terms of McFadden’s pseudo R2.

Conclusions

The K6 demonstrates adequate psychometric properties in the old Chinese population. The sum of all six items can be used as an indicator of non-specific psychological distress. Differences in the indicator across sex should be considered as a real difference in psychological distress between the female and the male.
Genotypic characterisation and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from patients of different hospitals and medical centres in Poland
Authors: Brzozowski Marcin , Krukowska Żaneta , Galant Katarzyna , Jursa-Kulesza Joanna , Kosik-Bogacka Danuta
Published: September 2020

Background

Pseudomonas aeruginosa is a Gram-negative bacteria responsible for infections in immunocompromised patients and is one of the most common causes of nosocomial infections particularly in intensive care and burn units. We aimed to investigate the population structure of P. aeruginosa strains isolated from patients at different hospital wards. Methods: We analysed the possible presence of P. aeruginosa epidemic or endemic strains in hospitals of the selected region. A genotyping analysis was performed for P. aeruginosa isolates (n = 202) collected from patients of eleven hospitals in north-western Poland. Collections of P. aeruginosa were genotyped using pulsed-field gel electrophoresis (PFGE). Phenotypic screening for antibiotic susceptibility was performed for the common antimicrobial agents.

Results

Pseudomonas aeruginosa isolates were distributed among 116 different pulsotype groups. We identified 30 groups of clonally related strains, each containing from 2 to 17 isolates and typed the obtained 13 unique patterns, designated as A, D, E, J, K, M, N, Ó, P, T, X, AC, AD, and AH. The two largest clusters, D and E, contained 17 and 13 isolates, respectively. Strains of these groups were continuously isolated from patients at intensive care units and burn units, indicating transmission of these strains.

Conclusions

In this study, we demonstrate the clonal relatedness of P. aeruginosa strains and their constant exchange in hospitals over a period of 15 months. The obtained results indicate a predominantly non-clonal structure of P. aeruginosa.
Evaluation of toxoplasmosis in pregnant women using dot-immunogold-silver staining with recombinant Toxoplasma gondii peroxiredoxin protein
Authors: Liu Zhuan-zhuan , Li Xue-yan , Fu Lin-lin , Yuan Fei , Tang Ren-xian , Liu Yi-sheng , Zheng Kui-yang
Published: September 2020

Background

Toxoplasma gondii infection endangers human health and affects animal husbandry. Serological detection is the main method used for epidemiological investigations and diagnosis of toxoplasmosis. The key to effective diagnosis of toxoplasmosis is the use of a standardized antigen and a specific and sensitive detection method. Peroxiredoxin is an antigenic protein and vaccine candidate antigen of T. gondii that has not yet been exploited for diagnostic application.

Methods

In this study, recombinant T. gondii peroxiredoxin protein (rTgPrx) was prepared and used in dot-immunogold-silver staining (Dot-IGSS) to detect IgG antibodies in serum from mice and pregnant women. The rTgPrx-Dot-IGSS method was established and optimized using mouse serum. Furthermore, serum samples from pregnant women were analyzed by rTgPrx-Dot-IGSS.

Results

Forty serum samples from mice infected with T. gondii and twenty negative serum samples were analyzed. The sensitivity and specificity of rTgPrx-Dot-IGSS were 97.5 and 100%, respectively, equivalent to those of a commercial ELISA kit for anti-Toxoplasma IgG antibody. Furthermore, 540 serum samples from pregnant women were screened with a commercial ELISA kit. Eighty-three positive and 60 negative serum samples were analyzed by rTgPrx-Dot-IGSS. The positive rate was 95.18%, comparable to that obtained with the commercial ELISA kit.

Conclusions

The Dot-IGSS method with rTgPrx as an antigen might be useful for diagnosing T. gondii infection in individuals.
Case report: Mononeuritis multiplex in the course of dengue fever
Authors: Ho Jun Yang , Liew Yee Kent , Loh Jiashen , Sohil Pothiawala
Published: September 2020

Background

Dengue fever usually presents as a self-limiting acute febrile illness with worsening thrombocytopenia, with a small minority of patients developing hemorrhagic or life-threatening complications. Organ specific manifestations like myocarditis, acalculous cholecystitis, encephalitis has been described but are uncommon presentations. Even more rarely, such manifestations are the presenting complaint of Dengue fever. In this case report, we highlight a case of Dengue fever where unrelated neuropathies were the presenting complaint.

Case presentation

An elderly man presents with 1 day of diplopia and left foot drop, associated with 2 days history of fever. A decreasing white cell count (WBC) and platelet on the 2nd day of admission prompted Dengue virus to be tested and a positive NS-1 antigen was detected, confirming the diagnosis of Dengue fever. He was treated with supportive treatment with a short duration of intravenous fluids recovered uneventfully and was discharged 6 days after admission with almost full resolution of diplopia and partial resolution of left foot drop. Left foot drop recovered completely 2 weeks later.

Conclusion

Neurological manifestations can be the presenting symptoms in Dengue fever, a diagnosis which should be borne in mind when such symptoms present in patients from endemic areas or in returning travellers from these areas.
Dynamic-related protein 1 inhibitor eases epileptic seizures and can regulate equilibrative nucleoside transporter 1 expression
Authors: Luo Zhong , Wang Jing , Tang Shirong , Zheng Yongsu , Zhou Xuejiao , Tian Fei , Xu Zucai
Published: September 2020

Background

Dynamic-related protein 1 (Drp1) is a key protein involved in the regulation of mitochondrial fission, and it could affect the dynamic balance of mitochondria and appears to be protective against neuronal injury in epileptic seizures. Equilibrative nucleoside transporter 1 (ENT1) is expressed and functional in the mitochondrial membrane that equilibrates adenosine concentration across membranes. Whether Drp1 participates in the pathogenesis of epileptic seizures via regulating function of ENT1 remains unclear.

Methods

In the present study, we used pilocarpine to induce status epilepticus (SE) in rats, and we used mitochondrial division inhibitor 1 (Mdivi-1), a selective inhibitor to Drp1, to suppress mitochondrial fission in pilocarpine-induced SE model. Mdivi-1administered by intraperitoneal injection before SE induction, and the latency to firstepileptic seizure and the number of epileptic seizures was thereafter observed. The distribution of Drp1 was detected by immunofluorescence, and the expression patterns of Drp1 and ENT1 were detected by Western blot. Furthermore, the mitochondrial ultrastructure of neurons in the hippocampal CA1 region was observed by transmission electron microscopy.

Results

We found that Drp1 was expressed mainly in neurons and Drp1 expression was significantly upregulated in the hippocampal and temporal neocortex tissues at 6 h and 24 h after induction of SE. Mitochondrial fission inhibitor 1 attenuated epileptic seizures after induction of SE, reduced mitochondrial damage and ENT1 expression.

Conclusions

These data indicate that Drp1 is upregulated in hippocampus and temporal neocortex after pilocarpine-induced SE and the inhibition of Drp1 may lead to potential therapeutic target for SE by regulating ENT1 after pilocarpine-induced SE.
Optic nerve sheath diameter change in prediction of malignant cerebral edema in ischemic stroke: an observational study
Authors: Lee Seong-Joon , Choi Mun Hee , Lee Sung Eun , Park Ji Hyun , Park Bumhee , Lee Jin Soo , Hong Ji Man
Published: September 2020

Background

In acute large anterior circulation infarct patients with large core volume, we evaluated the role of optic nerve sheath diameter (ONSD) change rates in prediction of malignant progression.

Methods

We performed a retrospective observational study including patients with anterior circulation acute ischemic stroke with large ischemic cores from January 2010 to October 2017. Primary outcome was defined as undergoing decompressive surgery or death due to severe cerebral edema, and termed malignant progression. Patients were divided into malignant progressors and nonprogressors. Malignant progression was divided into early progression that occurred before D1 CT, and late progression that occurred afterwards. Retrospective analysis of changes in mean ONSD/eyeball transverse diameter (ETD) ratio, and midline shifting (MLS) were evaluated on serial computed tomography (CT). Through analysis of CT at baseline, postprocedure, and at D1, the predictive ability of time based change in ONSD/ETD ratio in predicting malignant progression was evaluated.

Results

A total of 58 patients were included. Nineteen (32.8%) were classified as malignant; 12 early, and 7 late progressions. In analysis of CTpostprocedure, A 1 mm/hr. rate of change in MLS during the CTbaseline-CTpostproceduretime phase lead to a 6.7 fold increased odds of early malignant progression (p < 0.05). For ONSD/ETD, 1%/hr. change lead to a 1.6 fold increased odds, but this association was trending (p = 0.249). In the CTD1, 1%/day change of ONSD/ETD in the CTbaseline-CTD1time phase lead to a 1.4 fold increased odds of late malignant progression (p = 0.021) while 1 mm/day rate of change in MLS lead to a 1.5 fold increased odds (p = 0.014).

Conclusions

The rate of ONSD/ETD changes compared to baseline at D1 CT can be a predictor of late malignant progression along with MLS. ONSD/ETD change rates evaluated at postprocedure did not predict early malignant progression.
Identifying fear of childbirth in a UK population: qualitative examination of the clarity and acceptability of existing measurement tools in a small UK sample
Authors: Slade P. , Balling K. , Sheen K. , Houghton G.
Published: September 2020

Background

Fear of childbirth is related to but not synonymous with general anxiety, and represents a superior predictor for maternal and infant outcomes. There is a need to improve the identification and provision of support for women experiencing high fear of childbirth. However it is uncertain as to whether existing measurement tools have appropriate content validity (i.e. cover the relevant domains within the construct), practical utility, and whether they are acceptable for use with a UK population. This study aimed to (1) identify the utility and acceptability of existing measures of fear of childbirth (FOC) with a small UK sample and (2) map the content of existing measures to the key concepts of fear of childbirth established by previous research.

Methods

Ten pregnant women; five with high and five with low fear of childbirth participated in a cognitive interview covering four most commonly used measures of fear of childbirth: 1. The Wijma Delivery Expectancy Questionnaire (WDEQ A), 2. The Oxford Worries about Labour Scale (OWLS), 3. The Slade-Pais Expectations of Childbirth Scale – fear subscale (SPECS) and 4. The Fear of Birth scale (FOBS). Each measure was also reviewed by participants for ease and clarity of understanding and acceptability. The measures were then reviewed against the key domains identified in the fear of childbirth literature to ascertain the adequacy of content validity of each measure. Interviews were analysed using thematic analysis for each scale item.

Results

All measures except the FOBS, included items that either women did not understand or, if where there was understanding the meanings were inconsistent across women. All measures demonstrated limited acceptability and content validity for the specific construct of FOC. Therefore, none of the measurement tools currently used within the UK met criteria for understanding, acceptability and content validity for measurement of FOC.

Conclusions

Findings emphasise a need to develop a specific fear of childbirth tool with good clarity which demonstrates appropriate content validity, and that is acceptable in presentation and length for pregnant women in a UK population.
Pulmonary tuberculosis presenting secondary organizing pneumonia with organized polypoid granulation tissue: case series and review of the literature
Authors: Kim Eun Jin , Kim Kyung Chan
Published: September 2020

Background

Secondary organizing pneumonia (SOP) is difficult to distinguish from cryptogenic organizing pneumonia (COP) considering various clinical situations. SOP caused by Mycobacterium tuberculosis is rare; indeed, it has not been reported as a sequela of disseminated tuberculosis.

Methods

From January 2016 to December 2018, we identified six cases of tuberculosis-associated SOP in which Mycobacterium tuberculosis was revealed by microbiological examination; one of the cases was miliary tuberculosis.

Results

Of the six cases, 17% were positive for acid fast bacillus (AFB) stain, but 100% were positive for M. tuberculosis polymerase chain reaction (MTB PCR) and AFB culture. In all cases, transbronchial lung biopsy was performed and organizing pneumonia was confirmed pathologically. All survived after treatment with anti-tuberculosis therapy.

Conclusions

Pulmonary tuberculosis, which shows OP in lung biopsy, is diagnosed through MTB PCR and AFB culture, and the prognosis is thought to be good.
Trueness of 12 intraoral scanners in the full-arch implant impression: a comparative in vitro study
Authors: Mangano Francesco Guido , Admakin Oleg , Bonacina Matteo , Lerner Henriette , Rutkunas Vygandas , Mangano Carlo
Published: September 2020

Background

The literature has not yet validated the use of intraoral scanners (IOSs) for full-arch (FA) implant impression. Hence, the aim of this in vitro study was to assess and compare the trueness of 12 different IOSs in FA implant impression.

Methods

A stone-cast model of a totally edentulous maxilla with 6 implant analogues and scanbodies (SBs) was scanned with a desktop scanner (Freedom UHD®) to capture a reference model (RM), and with 12 IOSs (ITERO ELEMENTS 5D®; PRIMESCAN® and OMNICAM®; CS 3700® and CS 3600®; TRIOS3®; i-500®; EMERALD S® and EMERALD®; VIRTUO VIVO® and DWIO®; RUNEYES QUICKSCAN®). Ten scans were taken using each IOS, and each was compared to the RM, to evaluate trueness. A mesh/mesh method and a nurbs/nurbs method were used to evaluate the overall trueness of the scans; linear and cross distances between the SBs were used to evaluate the local trueness of the scans. The analysis was performed using reverse engineering software (Studio®, Geomagics; Magics®, Materialise). A statistical evaluation was performed.

Results

With the mesh/mesh method, the best results were obtained by CS 3700® (mean error 30.4 μm) followed by ITERO ELEMENTS 5D® (31.4 μm), i-500® (32.2 μm), TRIOS 3® (36.4 μm), CS 3600® (36.5 μm), PRIMESCAN® (38.4 μm), VIRTUO VIVO® (43.8 μm), RUNEYES® (44.4 μm), EMERALD S® (52.9 μm), EMERALD® (76.1 μm), OMNICAM® (79.6 μm) and DWIO® (98.4 μm). With the nurbs/nurbs method, the best results were obtained by ITERO ELEMENTS 5D® (mean error 16.1 μm), followed by PRIMESCAN® (19.3 μm), TRIOS 3® (20.2 μm), i-500® (20.8 μm), CS 3700® (21.9 μm), CS 3600® (24.4 μm), VIRTUO VIVO® (32.0 μm), RUNEYES® (33.9 μm), EMERALD S® (36.8 μm), OMNICAM® (47.0 μm), EMERALD® (51.9 μm) and DWIO® (69.9 μm). Statistically significant differences were found between the IOSs. Linear and cross distances between the SBs (local trueness analysis) confirmed the data that emerged from the overall trueness evaluation.

Conclusions

Different levels of trueness were found among the IOSs evaluated in this study. Further studies are needed to confirm these results.
Reduction of routine use of radiography in patients with ankle fractures leads to lower costs and has no impact on clinical outcome: an economic evaluation
Authors: van Gerven P. , van Dongen J. M. , Rubinstein S. M. , Termaat M. F. , El Moumni M. , Zuidema W. P. , Krijnen P. , Schipper I. B. , van Tulder M. W. ,   on behalf of the WARRIOR study group, van Bodegom-Vos L. , Breederveld R. S. , Derksen R. J. , van Dijkman B. , Goslings J. C. , Hegeman J. H. , Hoogendoorn J. M. , van Kuijk C. , Meylaerts S. A. G. , Rosendaal F. R. , Weil N. L. , Wendt K. W.
Published: September 2020

Background

To evaluate the cost-effectiveness of a reduction in the number of routine radiographs in the follow-up of patients with ankle fractures.

Methods

We performed an economic evaluation alongside the multicentre, randomised WARRIOR trial. Participants were randomised to a reduced imaging follow-up protocol (i.e. radiographs at week 6 and 12 follow-up obtained on clinical indication) or usual care (i.e. routine radiography at weeks 6 and 12). The Olerud & Molander Ankle Score (OMAS) was used to assess ankle function and the EQ-5D-3L was used to estimate Quality-Adjusted Life Years (QALYs). Costs and resource use were assessed using self-reported questionnaires and medical records, and analysed from a societal perspective. Multiple imputation was used for missing data, and data were analysed using seemingly unrelated regression analysis and bootstrapping.

Results

In total, 246 patients had data available for analysis (reduced imaging = 118; usual care = 128). Fewer radiographs were obtained in the reduced imaging group (median = 4) compared with the usual-care group (median = 5). Functional outcome was comparable in both groups. The difference in QALYs was − 0.008 (95% CI:-0.06 to 0.04) and the difference in OMAS was 0.73 (95% CI:-5.29 to 6.76). Imaging costs were lower in the reduced imaging group (−€48; 95% CI:- €72 to -€25). All other cost categories did not statistically differ between the groups. The probability of the reduced imaging protocol being cost-effectiveness was 0.45 at a wiliness-to-pay of €20,000 per QALY.

Conclusions

Reducing the number of routine follow-up radiographs has a low probability of being cost-effective compared with usual care. Functional outcome, health-related quality of life and societal costs were comparable in both groups, whereas imaging costs were marginally lower in the reduced imaging group. Given this, adherence to a reduced imaging follow-up protocol for those with routine ankle fractures can be followed without sacrificing quality of care, and may result in reduced costs.

Trial registration

The trial was registered on 26-05-2014 in the Netherlands Trial Registry, with reference number NL4477 (www.trialregister.nl/trial/4477).
The evidence gap on gendered impacts of performance-based financing among family physicians for chronic disease care: a systematic review reanalysis in contexts of single-payer universal coverage
Authors: Gupta Neeru , Ayles Holly M.
Published: September 2020

Background

Although pay-for-performance (P4P) among primary care physicians for enhanced chronic disease management is increasingly common, the evidence base is fragmented in terms of socially equitable impacts in achieving the quadruple aim for healthcare improvement: better population health, reduced healthcare costs, and enhanced patient and provider experiences. This study aimed to assess the literature from a systematic review on how P4P for diabetes services impacts on gender equity in patient outcomes and the physician workforce.

Methods

A gender-based analysis was performed of studies retrieved through a systematic search of 10 abstract and citation databases plus grey literature sources for P4P impact assessments in multiple languages over the period January 2000 to April 2018, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study was restricted to single-payer national health systems to minimize the risk of physicians sorting out of health organizations with a strong performance pay component. Two reviewers scored and synthesized the integration of sex and gender in assessing patient- and provider-oriented outcomes as well as the quality of the evidence.

Findings

Of the 2218 identified records, 39 studies covering eight P4P interventions in seven countries were included for analysis. Most (79%) of the studies reported having considered sex/gender in the design, but only 28% presented sex-disaggregated patient data in the results of the P4P assessment models, and none (0%) assessed the interaction of patients’ sex with the policy intervention. Few (15%) of the studies controlled for the provider’s sex, and none (0%) discussed impacts of P4P on the work life of providers from a gender perspective (e.g., pay equity).

Conclusions

There is a dearth of evidence on gender-based outcomes of publicly funded incentivizing physician payment schemes for chronic disease care. As the popularity of P4P to achieve health system goals continues to grow, so does the risk of unintended consequences. There is a critical need for research integrating gender concerns to help inform performance-based health workforce financing policy options in the era of the Sustainable Development Goals.
A whole family-based physical activity promotion intervention: findings from the families reporting every step to health (FRESH) pilot randomised controlled trial
Authors: Guagliano Justin M. , Armitage Sofie M. , Brown Helen Elizabeth , Coombes Emma , Fusco Francesco , Hughes Claire , Jones Andrew P. , Morton Katie L. , van Sluijs Esther M. F.
Published: September 2020

Introduction

This study assessed the feasibility and acceptability of FRESH (Families Reporting Every Step to Health), a theory-based child-led family physical activity (PA) intervention delivered online. We also assessed the preliminary effectiveness of the intervention on outcomes of interest and whether pre-specified criteria were met to progress to a full-scale definitive trial.

Methods

In a three-armed randomised pilot trial, 41 families (with a 7–11-year-old index child) were allocated to a: ‘family’ (FAM), ‘pedometer-only’ (PED), or a no-treatment control (CON) arm. The FAM arm received access to the FRESH website, allowing participants to select step challenges to ‘travel’ to target cities around the world, log their steps, and track progress as families virtually globetrot. FAM and PED arms also received family sets of pedometers. All family members could participate in the evaluation. Physical (e.g., fitness, blood pressure), psychosocial (e.g., social support), behavioural (e.g., objectively-measured PA), and economic (e.g., expenditure for PA) data were collected at baseline, 8- and 52-weeks.

Results

At 8- and 52-weeks, 98 and 88% of families were retained, respectively. Most children liked participating in the study (> 90%) and thought it was fun (> 80%). Compared to the PED (45%) and CON (39%) arms, a higher percentage of children in the FAM (81%) arm reported doing more activities with their family. Adults agreed that FRESH encouraged their family do more PA and made their family more aware of the amount of PA they do. No notable between-group differences were found for childrens’ minutes in moderate-to-vigorous PA. Sizeable changes of 9.4 (95%CI: 0.4, 18.4) and 15.3 (95%CI: 6.0, 24.5) minutes in moderate-to-vigorous PA was found for adults in the FAM group compared to those in the PED or CON groups, respectively. No other notable differences were found.

Conclusion

This study demonstrates feasibility and acceptability of the FRESH intervention. All progression criteria were at least partially satisfied. However, we failed to recruit the target sample size and did not find a signal of effectiveness on PA particularly long-term or in children. Further refinements are required to progress to a full-scale trial.

Trial registration

This study was prospectively registered (ISRCTN12789422) on 16/03/2016.