bluuebunny/crossref_metadata_2025 huggingface dataset:
OTHR-13. IMPACT the brain: improving metastatic breast cancer patient access to coordinated treatment
Authors: Grogan Nicole , Pierce-Gjeldum Donna , Swartz Leigh , Verbal Kait , Merajver Sofia , Friese Christopher , Kiyota Ayano , Heth Jason , Leung Denise , Smith Sean , Gabel Nicolette , Kim Michelle , Morikawa Aki
Published: August 2021

Central nervous system (CNS) metastases are associated with decreased survival and quality of life for patients with metastatic breast cancer (MBC). Multi-disciplinary care can optimize outcomes. This project aims to improve access to coordinated care for patients with MBC and CNS metastases.

Patients with MBC and CNS metastases are referred and offered to enroll in our care coordination program. A team consisting of specialists (breast medical oncology, breast cancer genetics, radiation oncology, neurosurgery, neuro-oncology, physical medicine and rehabilitation (PM&R), neuropsychology, and palliative care) supports a dedicated program coordinator who provides navigation, education, specialty referral, and clinical trial screening. A unique intake form developed for the program creates personalized, coordinated, and expedited referrals. Patient-reported outcomes and caregiver burden assessments are collected.

Since May 2020, 43 patients were referred and a total of 40 patients (93%) were enrolled – 2 (5%) declined due to perceived burden of participation and 1 (2%) died before enrollment. 85% of patients were Caucasian (n = 34) and 15% were non-Caucasian (n=6). Median time to program intake was 1 day (range: 0–8 days). Of the 43 patients referred, 17 (40%) consented to research studies in the metastatic setting. 11 were for an interventional trial (65%), while 9 consents were for non-interventional studies (53%). In addition to the initially referred specialty, 56 referrals were made across 7 sub-specialties; 37 patients (66%) were subsequently seen by a sub-specialist, most commonly radiation oncology (n = 9), neuro-oncology (n=8), PM&R (n=8), and neuropsychology (n=8).

Implementation of a care coordination program for patients with MBC and CNS metastases is feasible. Further, it allows for improved access to care across sub-specialties and supports participation in clinical research for a group of cancer patients historically underrepresented in research studies.

Funding: National Comprehensive Cancer Network Oncology Research Program from financial support provided by Pfizer.
Effect of brown seaweed on plasma glucose in healthy, at-risk, and type 2 diabetic individuals: systematic review and meta-analysis
Authors: Vaughan Kate , Ranawana Viren , Cooper David , Aceves-Martins Magaly
Published: August 2021

Context

Sustained hyperglycemia triggers chronic disease, including type 2 diabetes. A considerable volume of research has explored the effects of brown seaweed on plasma glucose control, but equivocal findings have been reported.

Objective

A systematic review and meta-analysis was conducted to assess the evidence from human randomized controlled trials (RCTs) on the effects of brown seaweed on plasma glucose in healthy, at-risk, and individuals with type 2 diabetes.

Data Sources

MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched for reports published between 2000 and 2020.

Data Extraction

Population, intervention, comparator, outcome, and study design data were extracted.

Data Analysis

Eighteen RCTs met our inclusion criteria. The reported results varied across and between populations. Meta-analyses showed a significant effect, favoring the intervention group for both fasting (mean difference –4.6 [95% CI –7.88, –1.33]) and postprandial (mean difference –7.1 [95% CI –7.4, –6.9]) plasma glucose.

Conclusion

Brown seaweed and its extracts show potential for preventing and managing hyperglycemia. Our meta-analysis confirms that brown seaweed positively affects plasma glucose homeostasis, with particularly promising postprandial plasma glucose effects. However, further research is needed because no high-quality RCT was identified. Species-specific and dose–response research is also required.

Systematic Review Registration

PROSPERO registration no. CRD42020187849.
Data-driven dynamics of phytoplankton blooms in a reaction–diffusion NPZ model
Authors: Cowall Seth T , Oliver Matthew J , Cook L Pamela
Published: August 2021

The causes of seasonal phytoplankton blooms in the ocean are a debated topic. The disturbance-recovery hypothesis posits that blooms are initiated when seasonally changing light and mixing conditions disrupt attractive equilibrium states in the predator–prey relationship between zooplankton and phytoplankton, leading to an accumulation in phytoplankton biomass. This paper follows up on this notion with a nutrient-phytoplankton-zooplankton (NPZ) model incorporating diffusion and depth-dependent coefficients in which we explore the nature of these attractive states. The reaction–diffusion NPZ model, incorporated with seasonal solar radiation and mixed layer depth data, simulates blooms with better timing than a related ordinary differential equations model but still leaves room for further modeling and improvement. The results of the data-driven, reaction–diffusion model aid in understanding the driving forces of the simulated phytoplankton blooms. The results also reveal a significant influence on the vertical structure of plankton concentration by the attenuation of light with depth in the ocean. Models that accurately simulate blooms tend to share characteristics of the reaction–diffusion model in this paper. The dynamics described in this paper could be a key mechanism that seasonally disrupts the ecological balance between phytoplankton and zooplankton and facilitates a high-latitude marine phytoplankton bloom.
Error-Manipulation Gait Training for Veterans With Nontraumatic Lower Limb Amputation: A Randomized Controlled Trial Protocol
Authors: Kline Paul W , So Noel , Fields Thomas , Juarez-Colunga Elizabeth , Christiansen Cory L
Published: August 2021

Objective

he purpose of this study will be to determine the efficacy of error-manipulation gait training (error-augmentation or error-correction) to improve step length symmetry and secondary health outcomes in veterans with unilateral nontraumatic transtibial amputation (TTA).

Methods

This will be a 3-arm, parallel, assessor-blinded, randomized controlled trial, with baseline, postintervention, and 3-month follow-up assessments in a VA Geriatric Research Education and Clinical Center. Participants are 54 US military veterans ranging in age from 50 to 85 years with a unilateral transtibial nontraumatic amputation. Participants will be randomized into 1 of 3 groups: error-augmentation training (EAT), error-correction training (ECT), or supervised walking (CTL). Each group will complete 8 split-belt treadmill walking training sessions of 25 minutes each over 4 weeks. The EAT group will walk with belts moving at asymmetrical speeds. The ECT group will walk to the cadence of a metronome and the split belts moving at symmetrical speeds. The CTL group will walk with symmetrical belt speeds and without feedback. Step length symmetry is the primary outcome and will be assessed using an asymmetry index during overground walking. Secondary outcomes include lower extremity joint work during treadmill walking, 6-Minute Walk Test performance, daily step count, participant-perceived disability, and residual-limb integumentary health. Outcomes will be assessed at preintervention, 1-week postintervention (primary endpoint), and 13 weeks postintervention.

Impact

This study protocol focuses on an understudied area of rehabilitation for patients with nontraumatic unilateral TTA who have high levels of spatiotemporal gait asymmetry and mobility impairment. The results of this study will inform future implementation of clinical gait training interventions to improve spatiotemporal gait symmetry and long-term health and disability outcomes in patients with nontraumatic unilateral TTA.
Redefining public health and sustainable economy: Covid-19 from pandemic to endemic
Authors: Deguma Jabin J , Capuno Reylan G , Manguilimotan Ramil P , Padillo Gengen G , Deguma Melona C
Published: August 2021

With the recent claim that the maintenance of population immunity will not depend on continued vaccinations but on the endemic presence of the virus, the proper understanding of the value of public health allows us to configure human living conditions as it thrives in a world where the novel Corona Virus Disease in 2019 (Covid-19) becomes endemic. World leaders and economic managers need to redefine public health not just as a means that enables economic productivity but as a substantially primordial goal—an end that every functional society must achieve via living an economically sustainable lifestyle. This paper argues that economic and societal sustainability thus must be framed and delimited within the human ecological boundary—a crucial viewpoint that could sustain public health amid a Covid-19 endemic world while preventing another viral pandemic from occurring.
Whitefly-Mediated Transmission and Subsequent Acquisition of Highly Similar and Naturally Occurring Tomato Yellow Leaf Curl Virus Variants
Authors: Marchant Wendy G. , Gautam Saurabh , Dutta Bhabesh , Srinivasan Rajagopalbabu
Published: August 2021

Begomoviruses are whitefly-transmitted viruses that infect many agricultural crops. Numerous reports exist on individual host plants harboring two or more begomoviruses. Mixed infection allows recombination events to occur among begomoviruses. However, very few studies have examined mixed infection of different isolates/variants/strains of a Begomovirus species in hosts. In this study, the frequency of mixed infection of tomato yellow leaf curl virus (TYLCV) variants in field-grown tomato was evaluated. At least 60% of symptomatic field samples were infected with more than one TYLCV variant. These variants differed by a few nucleotides and amino acids, resembling a quasispecies. Subsequently, in the greenhouse, single and mixed infection of two TYLCV variants (variant #2 and variant #4) that shared 99.5% nucleotide identity and differed by a few amino acids was examined. Plant–virus variant–whitefly interactions including transmission of one and/or two variants, variants’ concentrations, competition between variants in inoculated tomato plants, and whitefly acquisition of one and/or two variants were assessed. Whiteflies transmitted both variants to tomato plants at similar frequencies; however, the accumulation of variant #4 was greater than that of variant #2 in tomato plants. Despite differences in variants’ accumulation in inoculated tomato plants, whiteflies acquired variant #2 and variant #4 at similar frequencies. Also, whiteflies acquired greater amounts of TYLCV from singly infected plants than from mixed-infected plants. These results demonstrated that even highly similar TYLCV variants could differentially influence component (whitefly–variant–plant) interactions.
TCF19 and p53 regulate transcription of TIGAR and SCO2 in HCC for mitochondrial energy metabolism and stress adaptation
Authors: Mondal Payel , Gadad Shrikanth S. , Adhikari Swagata , Ramos Enrique I. , Sen Sabyasachi , Prasad Parash , Das Chandrima
Published: August 2021

Alteration in glucose homeostasis during cancer metabolism is an important phenomenon. Though several important transcription factors have been well studied in the context of the regulation of metabolic gene expression, the role of epigenetic readers in this regard remains still elusive. Epigenetic reader protein transcription factor 19 (TCF19) has been recently identified as a novel glucose and insulin‐responsive factor that modulates histone posttranslational modifications to regulate glucose homeostasis in hepatocytes. Here we report that TCF19 interacts with a non‐histone, well‐known tumor suppressor protein 53 (p53) and co‐regulates a wide array of metabolic genes. Among these, the p53‐responsive carbohydrate metabolic genes Tp53‐induced glycolysis and apoptosis regulator (TIGAR) and Cytochrome C Oxidase assembly protein 2 (SCO2), which are the key regulators of glycolysis and oxidative phosphorylation respectively, are under direct regulation of TCF19. Remarkably, TCF19 can form different transcription activation/repression complexes which show substantial overlap with that of p53, depending on glucose‐mediated variant stress situations as obtained from IP/MS studies. Interestingly, we observed that TCF19/p53 complexes either have CBP or HDAC1 to epigenetically program the expression of TIGAR and SCO2 genes depending on short‐term high glucose or prolonged high glucose conditions. TCF19 or p53 knockdown significantly altered the cellular lactate production and led to increased extracellular acidification rate. Similarly, OCR and cellular ATP production were reduced and mitochondrial membrane potential was compromised upon depletion of TCF19 or p53. Subsequently, through RNA‐Seq analysis from patients with hepatocellular carcinoma, we observed that TCF19/p53‐mediated metabolic regulation is fundamental for sustenance of cancer cells. Together the study proposes that TCF19/p53 complexes can regulate metabolic gene expression programs responsible for mitochondrial energy homeostasis and stress adaptation.
Professional Values Development Among Jordanian Baccalaureate Nursing Students
Authors: Subih Maha , Al Hadid Lourance , Al Omari Domam , Albana Haya , Shahrour Loai Abu
Published: August 2021

AIM

The aims of the study were to identify professional values among third- and fourth-year baccalaureate nursing students at private and public universities in Jordan and to investigate the demographic variables correlating with professional values.

BACKGROUND

Educational curricula reinforce professional values among nursing students.

METHOD

A cross-sectional design was used; the questionnaire included a demographic variable survey and the Nurses Professional Values Scale-3.

RESULTS

The mean score for the overall value scale was moderate (3.5, SD = 0.4, range 1–5). The caring subscale was the highest (3.9); the professionalism and the activism subscales had the same mean (3.3). Male students, studying in private universities and employed in health care, scored higher (p = .002, .001, and .01, respectively). Study track and age were insignificantly correlated.

CONCLUSION

The development of professional values is associated positively with practice and employment status; clinical experience improved students’ sense of professionalism.
Reversing Rivaroxaban Anticoagulation as Part of a Multimodal Hemostatic Intervention in a Polytrauma Animal Model
Authors: Rayatdoost Farahnaz , Braunschweig Till , Maron Benjamin , Schöchl Herbert , Akman Necib , Rossaint Rolf , Herzog Eva , Heitmeier Stefan , Grottke Oliver
Published: August 2021

Background

Life-threatening bleeding requires prompt reversal of the anticoagulant effects of factor Xa inhibitors. This study investigated the effectiveness of four-factor prothrombin complex concentrate in treating trauma-related hemorrhage with rivaroxaban-anticoagulation in a pig polytrauma model. This study also tested the hypothesis that the combined use of a low dose of prothrombin complex concentrate plus tranexamic acid and fibrinogen concentrate could improve its subtherapeutic effects.

Methods

Trauma (blunt liver injury and bilateral femur fractures) was induced in 48 anesthetized male pigs after 30 min of rivaroxaban infusion (1 mg/kg). Animals in the first part of the study received prothrombin complex concentrate (12.5, 25, and 50 U/kg). In the second part, animals were treated with 12.5 U/kg prothrombin complex concentrate plus tranexamic acid or plus tranexamic acid and fibrinogen concentrate. The primary endpoint was total blood loss postinjury. The secondary endpoints (panel of coagulation parameters and thrombin generation) were monitored for 240 min posttrauma or until death.

Results

The first part of the study showed that blood loss was significantly lower in the 25 U/kg prothrombin complex concentrate (1,541 ± 269 ml) and 50 U/kg prothrombin complex concentrate (1,464 ± 108 ml) compared with control (3,313 ± 634 ml), and 12.5 U/kg prothrombin complex concentrate (2,671 ± 334 ml, all P < 0.0001). In the second part of the study, blood loss was significantly less in the 12.5 U/kg prothrombin complex concentrate plus tranexamic acid and fibrinogen concentrate (1,836 ± 556 ml, P < 0.001) compared with 12.5 U/kg prothrombin complex concentrate plus tranexamic acid (2,910 ± 856 ml), and there were no early deaths in the 25 U/kg prothrombin complex concentrate, 50 U/kg prothrombin complex concentrate, and 12.5 U/kg prothrombin complex concentrate plus tranexamic acid and fibrinogen concentrate groups. Histopathologic analyses postmortem showed no adverse events.

Conclusions

Prothrombin complex concentrate effectively reduced blood loss, restored hemostasis, and balanced thrombin generation. A multimodal hemostatic approach using tranexamic acid plus fibrinogen concentrate enhanced the effect of low doses of prothrombin complex concentrate, potentially reducing the prothrombin complex concentrate doses required for effective bleeding control.

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What We Already Know about This Topic

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“Damage Control” Fixation of Displaced Femoral Neck Fractures in High-Risk Elderly Patients: A Feasibility Case Series
Authors: Konda Sanjit R. , Dedhia Nicket , Rettig Samantha , Davidovitch Roy , Ganta Abhishek , Egol Kenneth A.
Published: August 2021

Objectives:

To assess the outcomes of patients who underwent closed reduction and percutaneous pinning (CRPP) with cannulated screws for treatment of a displaced femoral neck fracture (DFNF) as they were deemed too high risk to undergo hemiarthroplasty (HA).

Design:

Prospective cohort study.

Setting:

One urban academic medical center.

Patients/Participants:

Sixteen patients treated with CRPP and 32 risk-level–matched patients treated with HA.

Intervention:

CRPP for patients with DFNFs who were deemed too ill to undergo HA. The concept being that CRPP would aid in pain control and facilitate mobilization and if failed, the patient could return electively after medical optimization for conversion to arthroplasty.

Main Outcome Measurements:

Complications, readmissions, mortality, inpatient cost, and functional status.

Results:

The CRPP cohort had a greater incidence of exacerbations of chronic medical conditions or new onset of acute illness and an elevated mean American Society of Anesthesiologist score. There were no differences in discharge location, length of stay, major complication rate, ambulation before discharge, or 90-day readmission rate. Patients undergoing CRPP were less likely to experience minor complications including a significantly decreased incidence of acute blood loss anemia. Three patients (18.7%) in the CRPP cohort underwent conversion to HA or THA. There was no difference in inpatient, 30-day, or 1-year mortality.

Conclusion:

In the acutely ill patients with DFNFs, “damage control” fixation with CRPP can be safely performed in lieu of HA to stabilize the fracture in those unable to tolerate anesthesia or the sequelae of major surgery. Patients should be followed closely to evaluate the need for secondary surgery.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of Levels of Evidence.
Dielectric Blood Coagulometry for the Early Detection of Sepsis-Induced Disseminated Intravascular Coagulation: A Prospective Observational Study
Authors: Takayama Wataru , Endo Akira , Morishita Koji , Otomo Yasuhiro
Published: August 2021

Objectives:

To evaluate the utility of dielectric blood coagulometry for early sepsis–induced disseminated intravascular coagulation diagnosis.

Design:

Single-center, prospective observational study.

Setting:

Patients with sepsis or septic shock at the Tokyo Medical and Dental University Hospital of Medicine between September 2019 and September 2020.

Patients:

The patients were divided into three groups according to the timing of disseminated intravascular coagulation diagnosis based on the Disseminated Intravascular Coagulation score by the Japanese Association for Acute Medicine: 1) no disseminated intravascular coagulation group, 2) late-diagnosed disseminated intravascular coagulation group: not diagnosed with disseminated intravascular coagulation on day 1 but diagnosed within 48 hours after admission, and 3) disseminated intravascular coagulation group: diagnosed with disseminated intravascular coagulation on day 1. The study evaluated 80 patients (no disseminated intravascular coagulation, 31 [38.8%]; late-diagnosed disseminated intravascular coagulation, 34 (42.5%); disseminated intravascular coagulation, 15 [18.8%]).

Measurements and Main Results:

We compared the clinical severity scores and mortality of the groups and assessed the correlation between the dielectric blood coagulometry–derived coagulation marker, thrombin levels, and Disseminated Intravascular Coagulation score using Spearman rank correlation. The mortality rate was 0% (0/31) in the no disseminated intravascular coagulation group, 35.3% (12/34) in the late-diagnosed disseminated intravascular coagulation group, and 33.3% (5/15) in the disseminated intravascular coagulation group. Although the Disseminated Intravascular Coagulation score on day 1 did not reflect disseminated intravascular coagulation in approximately 70% of patients who developed disseminated intravascular coagulation by day 2, dielectric clot strength measured by dielectric blood coagulometry on day 1 strongly correlated with disseminated intravascular coagulation development by day 2 (Spearman ρ = 0.824; p < 0.05) and with thrombin level on day 1 (Spearman ρ = 0.844; p < 0.05).

Conclusions:

Dielectric blood coagulometry can be used to detect early-phase disseminated intravascular coagulation in patients with sepsis and is strongly correlated with thrombin levels. Larger studies are needed to verify our results for developing clinical applications.
Plasma creatine concentration is associated with incident hypertension in a cohort enriched for the presence of high urinary albumin concentration: the Prevention of Renal and Vascular Endstage Disease study
Authors: Post Adrian , Kremer Daan , Swarte J. Casper , Sokooti Sara , Vogelpohl Fabian A. , Groothof Dion , Kema Ido.P. , Garcia Erwin , Connelly Margery A. , Wallimann Theo , Dullaart Robin P.F. , Franssen Casper F.M. , Bakker Stephan J.L.
Published: August 2021

Objective

: Hypertension is a major risk factor for cardiovascular disease, kidney disease, and premature death. Increased levels of creatine kinase are associated with development of hypertension. However, it is unknown if creatine, a substrate of CK, is associated with the development of hypertension. We therefore, aimed to investigate the association between plasma creatine concentration and incident hypertension.

Methods:

We measured fasting plasma creatine concentrations by nuclear magnetic resonance spectroscopy in participants of the population-based PREVEND study. The study outcome was incident hypertension, defined as either a SBP of at least 140 mmHg, a DBP of at least 90 mmHg, or the new usage of antihypertensive drugs. Participants with hypertension at baseline were excluded.

Results:

We included 3135 participants (46% men) aged 49 ± 10 years. Mean plasma creatine concentrations were 36.2 ± 17.5 μmol/l, with higher concentrations in women than in men (42.2 ± 17.6 versus 29.2 ± 17.6 μmol/l; P < 0.001). During a median of 7.1 [interquartile range: 3.6–7.6] years of follow-up, 927 participants developed incident hypertension. Higher plasma creatine concentrations were associated with an increased risk of incident hypertension [HR per doubling of plasma creatine: 1.21 (95% confidence interval: 1.10–1.34); P < 0.001], which remained significant after adjustment for potential confounders. Sex-stratified analyses demonstrated higher plasma creatine that was independently associated with an increased risk of incident hypertension in men [hazard ratio: 1.26 (95% CI 1.11–1.44); P < 0.001], but not in women (hazard ratio: 1.13 (95% CI 0.96–1.33); P = 0.14]. Causal pathway analyses demonstrate that the association was not explained by sodium or protein intake.

Conclusion:

Higher plasma creatine is associated with an increased risk of hypertension in men. Future studies are warranted to determine the underlying mechanisms.
Predictive Factors for Resolution of Dematiaceous Fungal Keratitis
Authors: Chaudhary Simmy , Kate Anahita , Bagga Bhupesh , Mohamed Ashik , Sharma Savitri
Published: August 2021

Purpose:

To ascertain the clinicomicrobiological correlation and evaluate the prognostic factors associated with medical resolution in cases of Curvularia, Alternaria, and Scedosporium keratitis.

Methods:

A retrospective review of clinical and microbiological records of culture-proven cases of Curvularia, Alternaria, and Scedosporium keratitis from 2017 to 2019 was performed. Multivariate logistic regression analyses were performed to assess the predictive factors for medical resolution.

Results:

There were a total of 79 eyes of 79 patients. Among these, there were 56 (70.8%), 15 (18.9%), and 8 (10.1%) patients with Curvularia, Scedosporium, and Alternaria keratitis, respectively. Clinical resolution with medical treatment was achieved in 46 of 56 (82.1%) patients with Curvularia keratitis, 8 of 15 (53.3%) patients with Scedosporium, and 7 of 8 (87.5%) patients with Alternaria keratitis. In comparison between Curvularia and Scedosporium, macroscopic pigmentation [18/56 (32.1%)] of anterior stromal plaque-like infiltrate [20/56 (35.7%)] was clinically more in cases with Curvularia, whereas larger diameter of the infiltrate, P = 0.002, posterior stromal infiltrate (40%), P = 0.03, and hypopyon, P = 0.009, were more common with Scedosporium. Multivariate logistic regression analysis, by backward elimination, showed that maximum dimension of the infiltrate (P = 0.01; odds ratio = 0.52, 95% confidence interval, 0.31–0.86) and presence of a hypopyon (P = 0.02; odds ratio = 0.12, 95% confidence interval, 0.02–0.71) were significant factors that were not favoring medical resolution.

Conclusions:

Larger size of the infiltrate, posterior stromal involvement, and presence of a hypopyon are poor prognostic indicators among all 3 species. Variation in species is not a predictor of clinical resolution.
Anterior Segment OCT in Primary Angle Closure Disease Compared With Normal Subjects With Similar Shallow Anterior Chamber
Authors: Xie Qinghong , Ma Ping , Patlidanon Jutima , Saifee Murtaza , Yonamine Sean , Yu Yinxi , Ying Gui-Shuang , Yang Yangfan , Li Shuning , Han Ying
Published: August 2021

Précis:

Compared with normal subjects with similar shallow anterior chamber depth (ACD), patients with primary angle closure disease (PACD) had narrower angle structures measured by swept-source optical coherence tomography (SS-OCT) at 250 μm from scleral spur (very root of iris), especially along oblique and vertical axis.

Purpose:

To examine anterior segment structures in normal subjects whose ACD was shallow on slit-lamp examination but did not meet the diagnostic criteria of PACD, and to compare them with PACD patients with similar ACD.

Materials and Methods:

Patients were recruited from glaucoma clinic at Zhongshan Ophthalmic Center. A total of 40 eyes from 29 PACD patients and 40 eyes from 34 normal subjects received full ophthalmic examination and CASIA SS-1000 OCT tests. PACD eyes and control eyes were 1:1 matched for ACD at 0 degree of scan. Generalized linear model that accounted for inter-eye correlation was used to compare differences between the 2 groups for intraocular pressure and SS-OCT parameters. P-values were adjusted for multiple comparisons using the Bonferroni method.

Results:

The PACD and control groups had similar age, but the PACD group had a significantly higher intraocular pressure (18.4 vs. 14.0 mm Hg, P=0.005). Angle parameters, representative of angle area, such as angle recess area and trabecular iris space area measured at 250 μm along axes of 90, 135, 225, and 315 degrees were significantly smaller in PACD group than those of control group (adjusted P<0.05), while most of angle parameters at 500 and 750 μm, volume parameters, and anterior chamber parameters, were similar (adjusted P>0.05).

Conclusions:

In PACD patients compared with normal subjects with similar anterior chamber shallowing, OCT findings measured at the iris root 250 μm from the scleral spur, especially in the oblique and vertical axes, including angle recess area and trabecular iris space area, may match gonioscopic findings more closely and provide further insight into mechanisms of PACD.
Closure of Anchor Businesses Reduced COVID-19 Transmission During the Early Months of the Pandemic
Authors: McHugh Megan , Tian Yao , Maechling Claude R. , Farley Diane , Holl Jane L.
Published: August 2021

Objectives:

To investigate the relationship between the closure of “anchor businesses” – manufacturing plants and distribution centers employing >1000 workers – and the daily, county-level COVID-19 rate between March 1, 2020 and May 31, 2020.

Methods:

We conducted a comparative, interrupted time series analysis of publicly available county-level data. Our main variable of interest was closure, indicating whether one or more of the anchor businesses within the county experienced a full or partial closure of at least 22 days (main analysis) or at least 1 day (sensitivity analyses).

Results:

Closure of an anchor business was associated with 142 fewer positive COVID-19 tests per 100,000 population over a 40-day period. Even short-term and partial closures were associated with reduced spread.

Conclusions:

Temporary closure of anchor businesses appears to have slowed, but not completely contained, the spread of COVID-19.
Movement Impairments in Women With and Without Urinary Urgency/Frequency
Authors: Erbes Nicole A. , Foster Stefanie Nicole , Harris-Hayes Marcie , Spitznagle Theresa M.
Published: August 2021

Objectives:

To (1) examine the relationship between spine, hip, and pelvis movement patterns and urinary urgency and frequency; (2) report the prevalence of pelvic girdle and hip joint impairments among women with and without urinary urgency and frequency; and (3) report the most common movement impairments observed in women with and without urinary urgency and frequency.

Methods:

Women age 18 to 60 years with urinary urgency and frequency were matched 1:1 to women without based on age, body mass index, and vaginal parity. Participants completed primary movement tests of the hip, pelvis, and spine. Additional clinical tests included Stork test, side-lying position, pubic symphysis palpation, flexion-abduction-external rotation, flexion-adduction-internal rotation, and seated hip internal and external rotation. Urge symptoms were monitored before and during each test. Movement patterns and positioning of the thoracic and lumbar spine, pelvis, and hips were observed. Secondary tests to correct a movement or positional impairment were performed if an impairment was noted or if symptoms were provoked during the primary test.

Results:

Forty-two women completed testing. More participants with urinary urgency and frequency (1) demonstrated impairments during forward bend, single-leg stance, side-lying, and Stork tests; (2) reported urgency provocation during forward bend, flexion-adduction-internal rotation test, pubic symphysis palpation, and hip internal rotation; and (3) reported symptom relief with side-lying position secondary test; and secondary tests of the thoracic, lumbar, and hip regions compared with those without.

Conclusion:

Musculoskeletal impairments may be associated with urinary urgency and frequency and should therefore be considered when determining management options for these patients.
Caffeine Consumption Habits, Sleep Quality, Sleep Quantity, and Perceived Stress of Undergraduate Nursing Students
Authors: Higbee Mykin R. , Gipson Christine S. , El-Saidi Mohammed
Published: August 2021

Background:

Consumption of energy drinks is prevalent among college students and has increased over the last decade. There is inadequate research about the energy drink consumption habits of prelicensure nursing students.

Purpose:

This study determined if there were differences in sleep quality, sleep quantity, and perceived stress levels in nursing students who consume energy drinks compared with those who consume other sources of caffeine and those who abstain.

Methods:

A comparative study design was used. Participants (n = 272) from universities in 2 regions of the United States answered questions about sleep, perceived stress, caffeine, and energy drink consumption.

Results:

Nursing students at both universities who consumed energy drinks reported poorer sleep quality, fewer sleep hours, and higher levels of perceived stress than caffeine-only consumers and non-caffeine consumers.

Conclusions:

Prelicensure nursing students may be unaware of the relationships among energy drink consumption, sleep quality, sleep quantity, and perceived stress levels.
Enhancing the Prelicensure Clinical Learning Experience
Authors: Donovan Laureen M. , Strunk Julie A. , Lam Christina , Argenbright Christine , Robinson Jamie , Leisen Melissa , Puffenbarger Nancy
Published: August 2021

Background:

Studies of the clinical learning environment document the importance of the student's clinical learning process.

Purpose:

The aim of this study was to gather information on students' perceptions of their learning in the clinical environment.

Methods:

A mixed-method strategy was used to explore nursing students' (N = 194) perceptions of their clinical learning experiences. Data were collected using the Clinical Learning Environment Inventory (CLEI) survey and open-ended questions.

Results:

The results showed that significant CLEI factors were affordances and engagement, student-centeredness, valuing nurses' work, and fostering workplace learning and that these factors were important to prelicensure nursing students' learning in the clinical environment. In addition, the thematic concepts that enhanced their learning were clinical faculty who exhibited strong communication, encouraged and challenged learners, and were readily available.

Conclusions:

Clinical faculty in the clinical environment must be competent and able to support the prelicensure nursing student learner.
Individuals With Parkinson Disease Are Adherent to a High-Intensity Community-Based Cycling Exercise Program
Authors: Rosenfeldt Anson B. , Miller Koop Mandy , Penko Amanda L. , Alberts Jay L.
Published: August 2021

Background and Purpose:

Parkinson disease is a progressive neurological disorder with no known cure or proven method of slowing progression. High-intensity, laboratory-based aerobic exercise interventions are currently being pursued as candidates for altering disease progression. The aim of this project was to evaluate the translation of a laboratory-based intervention to the community by monitoring exercise adherence (eg, attendance) and intensity (eg, heart rate [HR] and cadence) in 5 established Pedaling for Parkinson's exercise classes. A secondary aim was to determine the impact of disease severity and demographics variables on exercise adherence.

Methods:

A 12-month pragmatic design was utilized to monitor attendance, HR, and cadence during each Pedaling for Parkinson's class session. Over the course of 1 year, approximately 130 sessions were offered. Forty-nine (n = 30 males) persons with mild to moderate Parkinson disease from 5 community fitness facilities participated.

Results:

Out of the approximately 130 cycling sessions offered at each site over 12 months, 37% of the participants attended greater than 2 classes per week (80-130 total sessions), 47% attended 1 to 1.9 classes per week (40-79 total sessions), and less than 17% attended less than 1 class per week (<40 total sessions). Average pedaling cadence was 74.1 ± 9.6 rpms while average percentage of HR maximum was 68.9 ± 12.0%. There were no significant differences between cycling adherence and intensity variables based on disease severity, age, or sex.

Discussion and Conclusions:

Consistent attendance and exercise performance at moderate to high intensities are feasible in the context of a community-based Pedaling for Parkinson's class. Consistency and intensity of aerobic exercise have been proposed as critical features to elicit potential disease modification benefits associated with exercise. Community-based fitness programs that bring laboratory protocols to the “real world” are a feasible intervention to augment current Parkinson disease treatment approaches. See the Supplementary Video, available at: http://links.lww.com/JNPT/A357.
Intramedullary nailing versus external fixation for open tibia fractures in Tanzania: a cost analysis
Authors: Roberts Heather J. , Donnelley Claire A. , Haonga Billy T. , Kramer Erik , Eliezer Edmund N. , Morshed Saam , Shearer David
Published: August 2021

Objectives:

Open tibia fractures pose a clinical and economic burden that is disproportionately borne by low-income countries. A randomized trial conducted by our group showed no difference in infection and nonunion comparing 2 treatments: external fixation (EF) and intramedullary nailing (IMN). Secondary outcomes favored IMN. In the absence of clear clinical superiority, we sought to compare costs between EF and IMN.

Design:

Secondary cost analysis.

Setting:

Single institution in Tanzania.

Patients/Participants:

Adult patients with acute diaphyseal open tibia fractures who participated in a previous randomized controlled trial.

Intervention:

SIGN IMN versus monoplanar EF.

Main Outcome Measurements:

Direct costs of initial surgery and hospitalization and subsequent reoperation: implant, instrumentation, medications, disposable supplies, and personnel costs.

Indirect costs from lost productivity of patient and caregiver.

Societal (total) costs: sum of direct and indirect costs.

All costs were reported in 2018 USD.

Results:

Two hundred eighteen patients were included (110 IMN, 108 EF). From a payer perspective, costs were $365.83 (95% CI: $332.75–405.76) for IMN compared with $331.25 ($301.01–363.14) for EF, whereas from a societal perspective, costs were $2664.59 ($1711.22–3955.25) for IMN and $2560.81 ($1700.54–3715.09) for EF. The largest drivers of cost were reoperation and lost productivity. Accounting for uncertainty in multiple variables, probabilistic sensitivity analysis demonstrated that EF was less costly than IMN from the societal perspective in only 55% of simulations.

Conclusions:

Intramedullary nail fixation compared with external fixation of open tibia fractures in a resource-constrained setting is not associated with increased cost from a societal perspective.
Trends in HIV Care Outcomes Among Adults and Adolescents—33 Jurisdictions, United States, 2014–2018
Authors: Dailey André , Johnson Anna Satcher , Hu Xiaohong , Gant Zanetta , Lyons Shacara Johnson , Adih William
Published: August 2021

Background:

With significant improvements in the diagnosis and treatment of HIV, the number of people with HIV in the United States steadily increases. Monitoring trends in HIV-related care outcomes is needed to inform programs aimed at reducing new HIV infections in the United States.

Setting:

The setting is 33 United States jurisdictions that had mandatory and complete reporting of all levels of CD4 and viral load test results for each year during 2014–2018.

Methods:

Estimated annual percentage change and 95% confidence intervals were calculated to assess trends in stage of disease at time of diagnosis, linkage to HIV medical care within 1 month of HIV diagnosis, and viral suppression within 6 months after HIV diagnosis. Differences in percentages were analyzed by sex, age, race/ethnicity, and transmission category for persons with HIV diagnosed from 2014 to 2018.

Results:

Among 133,477 persons with HIV diagnosed during 2014–2018, the percentage of persons who received a diagnosis classified as stage 0 increased 13.7%, stages 1–2 (early infections) increased 2.9%, stage 3 (AIDS) declined 1.5%, linkage to HIV medical care within 1 month of HIV diagnosis increased 2.3%, and viral suppression within 6 months after HIV diagnosis increased 6.5% per year, on average. Subpopulations and areas that showed the least progress were persons aged 45–54 years, American Indian/Alaska Native persons, Asian persons, Native Hawaiian/other Pacific Islander persons, and rural areas with substantial HIV prevalence, respectively.

Conclusions:

New infections will continue to occur unless improvements are made in implementing the Ending the HIV Epidemic: A Plan for America strategies of diagnosing, treating, and preventing HIV infection.
Effectiveness of Subcostal Transversus Abdominis Plane Block in Subcutaneous Onlay Laparoscopic Approach (SCOLA) Surgery: A Retrospective Observational Study
Authors: Toscano Antonio , Cuccomarino Salvatore , Capuano Paolo , Bonomo Luca D. , Forcella Katia M.R. , Aprà Fabrizio , Jannaci Alberto , Brazzi Luca
Published: August 2021

Background:

Postoperative analgesia in SCOLA (subcutaneous onlay laparoscopic approach) surgery is traditionally based on intravenous opioids. The aim of this retrospective observational study was to evaluate the efficacy of bilateral subcostal transversus abdominis plane (SCTAP) block on postoperative pain relief in the first 48 postoperative hours following SCOLA.

Materials and Methods:

From August 2017 to December 2019, 163 patients were eligible for the analysis. Postoperative analgesia was managed either with an intravenous tramadol continuous infusion (opioid group) or a multimodal opioid-sparing strategy based on bilateral SCTAP block (SCTAP group), according to the anesthesiologist’s postoperative plan. After data collection, 103 patients were assigned post hoc to the SCTAP group and 60 patients to the opioid group. The primary outcome was the evaluation of postoperative pain, considering both the Numeric Rating Scale score and the percentage of patients with uncontrolled pain at 6, 12, 24, or 48 hours. Secondary outcomes were differences in the administration of ketorolac rescue analgesia and incidence of mild adverse effects.

Results:

There were no significant differences in median Numeric Rating Scale at 6, 12, 24, and 48 hours and ketorolac rescue dose consumption in both groups. Five patients (4.85% of a total of 103 patients) referred postoperative nausea and vomiting in the SCTAP group versus 10 patients (16.67% of a total of 60 patients) in the opioid group (P=0.02).

Conclusion:

Analgesia with SCTAP block seems to represent a feasible and efficient strategy for pain management in patients undergoing SCOLA surgery, allowing good quality analgesia, low opioids requirements, and reduced incidence of postoperative nausea and vomiting.
A booster dose is immunogenic and will be needed for older adults who have completed two doses vaccination with CoronaVac: a randomised, double-blind, placebo-controlled, phase 1/2 clinical trial
Authors: Li Minjie , Yang Juan , Wang Lin , Wu Qianhui , Wu Zhiwei , Zheng Wen , Wang Lei , Lu Wanying , Deng Xiaowei , Peng Cheng , Han Bihua , Zhao Yuliang , Yu Hongjie , Yin Weidong
Published: August 2021

Importance

Whether herd immunity through mass vaccination is sufficient to curb SARS-CoV-2 transmission requires an understanding of the duration of vaccine-induced immunity, and the necessity and timing of booster doses. Objective: To evaluate immune persistence of two priming doses of CoronaVac, and immunogenicity and safety of a third dose in healthy adults ≥60 years. Design, setting, and participants: We conducted a vaccine booster study built on a single-center, randomized, double-blind phase 1/2 trial of the two-dose schedule of CoronaVac among healthy adults≥60 years in Hebei, China. We examined neutralizing antibody titres six months or more after the second dose in all participants. We provided a third dose to 303 participants recruited in phase 2 trial to assess their immune responses.

Interventions

Two formulations (3 μg, and 6 μg) were used in phase 1 trial, and an additional formulation of 1.5 μg was used in phase 2 trial. All participants were given two doses 28 days apart and followed up 6 months after the second dose. Participants in phase 2 received a third dose 8 months after the second dose.

Main outcomes and measures

Geometric mean titres (GMT) of neutralizing antibodies to live SARS-CoV-2 and adverse events were assessed at multiple time points following vaccination.

Results

Neutralizing antibody titres dropped below the seropositive cutoff of 8 at 6 months after the primary vaccination in all vaccine groups in the phase 1/2 trial. A third dose given 8 months or more after the second dose significantly increased neutralizing antibody levels. In the 3 μg group (the licensed formulation), GMT increased to 305 [95%CI 215.3-432.0] on day 7 following the third dose, an approximately 7-fold increase compared with the GMT 28 days after the second dose. All solicited adverse reactions reported within 28 days after a booster dose were of grade 1 or 2 severity.

Conclusion and relevance

Neutralizing antibody titres declined substantially six months after two doses of CoronaVac among older adults. A booster dose rapidly induces robust immune responses. This evidence could help policymakers determine the necessity and the timing of a booster dose for older adults.

Trial registration

ClinicalTrials.gov(NCT04383574).
Safety and Immunogenicity of Inactivated SARS-CoV-2 Vaccine in High-Risk Occupational Population: a randomized, parallel, controlled clinical trial
Authors: Feng Yongliang , Chen Jing , Yao Tian , Chang Yue , Li Xiaoqing , Xing Rongqin , Li Hong , Xie Ruixue , Zhang Xiaohong , Wei Zhiyun , Mu Shengcai , Liu Ling , Feng Lizhong , Wang Suping
Published: August 2021

Vaccination is urgently needed to prevent the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we conducted a randomized, parallel, controlled clinical trial for assessment of the immunogenicity and safety of an inactivated SARS-CoV-2 vaccine, aiming to determine an appropriate vaccination interval for high-risk occupational population. Participants were randomly assigned to receive two doses of inactivated SARS-CoV-2 vaccine (4 µg per dose) at an interval of either 14 days, 21 days or 28 days. The primary immunogenicity endpoints were neutralization antibody seroconversion and geometric mean titer (GMT) at 28 days after the second dose. Our results showed that the seroconversion rates (GMT ≥ 16) were all 100% in the three groups and the 0-21 and 0-28 groups elicited significantly higher SARS-CoV-2 neutralizing antibody level. All reported adverse reactions were mild. (Chinese Clinical Trial Registry: ChiCTR2100041705, ChiCTR2100041706)