bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrated Meditation and Exercise Therapy: A Randomized Controlled Pilot of a Combined Nonpharmacological Intervention Focused on Reducing Disability and Pain in Patients with Chronic Low Back Pain
Authors: Polaski Anna M , Phelps Amy L , Smith Thomas J , Helm Eric R , Morone Natalia E , Szucs Kimberly A , Kostek Matthew C , Kolber Benedict J
Published: October 2020

Objective

This pilot trial examined the effects of a combined intervention of mindfulness meditation followed by aerobic walking exercise compared with a control condition in chronic low back pain patients. We hypothesized that meditation before exercise would reduce disability, pain, and anxiety by increasing mindfulness prior to physical activity compared with an audiobook control group.

Participants

Thirty-eight adults completed either meditation and exercise treatment (MedExT) (n=18) or an audiobook control condition (n=20).

Setting

Duquesne University Exercise Physiology Laboratory.

Design

A pilot, assessor-blinded, randomized controlled trial.

Methods

Over a 4-week period, participants in the MedExT group performed 12–17 minutes of guided meditation followed by 30 minutes of moderate-intensity walking exercise 5 days per week. Measures of disability, pain, mindfulness, and anxiety were taken at baseline and postintervention. Pain perception measurements were taken daily.

Results

Compared with the control group, we observed larger improvements in disability in the MedExT intervention, although the changes were modest and not statistically significant (mean between-group difference, –1.24; 95% confidence interval [CI], –3.1 to 0.6). For secondary outcome measures, MedExT increased mindfulness (within-group) from pre-intervention to postintervention (P=0.0141). Additionally, mean ratings of low back pain intensity and unpleasantness significantly improved with time for the MedExT group compared with that of the control group, respectively (intensity P=0.0008; unpleasantness P=0.0022).

Conclusion

. Overall, 4 weeks of MedExT produced suggestive between-group trends for disability, significant between-group differences for measures of pain, and significant within-group increases in mindfulness.
Health news sharing is reflected in distributed reward-related brain activity
Authors: Doré B P , Scholz C , Baek E C , Falk E B
Published: October 2020

Neuroimaging has identified individual brain regions, but not yet whole-brain patterns, that correlate with the population impact of health messaging. We used neuroimaging to measure whole-brain responses to health news articles across two studies. Beyond activity in core reward value-related regions (ventral striatum, ventromedial prefrontal cortex), our approach leveraged whole-brain responses to each article, quantifying expression of a distributed pattern meta-analytically associated with reward valuation. The results indicated that expression of this whole-brain pattern was associated with population-level sharing of these articles beyond previously identified brain regions and self-report variables. Further, the efficacy of the meta-analytic pattern was not reducible to patterns within core reward value-related regions but rather depended on larger-scale patterns. Overall, this work shows that a reward-related pattern of whole-brain activity is related to health information sharing, advancing neuroscience models of the mechanisms underlying the spread of health information through a population.
A Cautionary Note on the Use of Genotype Callers in Phylogenomics
Authors: Duchen Pablo , Salamin Nicolas
Published: October 2020

Next-generation-sequencing genotype callers are commonly used in studies to call variants from newly sequenced species. However, due to the current availability of genomic resources, it is still common practice to use only one reference genome for a given genus, or even one reference for an entire clade of a higher taxon. The problem with traditional genotype callers, such as the one from GATK, is that they are optimized for variant calling at the population level. However, when these callers are used at the phylogenetic level, the consequences for downstream analyses can be substantial. Here, we performed simulations to compare the performance between the genotype callers of GATK and ATLAS, and present their differences at various phylogenetic scales. We show that the genotype caller of GATK substantially underestimates the number of variants at the phylogenetic level, but not at the population level. We also found that the accuracy of heterozygote calls declines with increasing distance to the reference genome. We quantified this decline and found that it is very sharp in GATK, while ATLAS maintains high accuracy even at moderately divergent species from the reference. We further suggest that efforts should be taken towards acquiring more reference genomes per species, before pursuing high-scale phylogenomic studies. [ATLAS; efficiency of SNP calling; GATK; heterozygote calling; next-generation sequencing; reference genome; variant calling.]
A systematic review and meta-analysis of interventions to reduce sedentary behavior among older adults
Authors: Chase Jo-Ana D , Otmanowski Jennifer , Rowland Sheri , Cooper Pamela S
Published: October 2020

Sedentary behavior (SB) is associated with numerous negative health outcomes, independent of physical activity behavior. Older adults are the most sedentary population in the United States. Understanding the effects and characteristics of existing interventions to reduce SB can inform practice, future research, and public health initiatives to improve older adults’ health. We conducted a systematic review and meta-analysis to examine existing SB intervention research among older adults and quantitatively synthesize intervention effects. Comprehensive searches were conducted to identify studies testing interventions to reduce SB time among adults at least 60 years old. Data on study design, intervention content and delivery, and participant characteristics were extracted from eligible studies. Standardized mean difference effect sizes (Cohen’s d) were synthesized using a random-effects model for two-group pretest–posttest design studies. Twenty-two reports describing 17 distinct studies were included in the narrative synthesis, with eight studies included in the meta-analysis (k = 8; n = 1,024). Most interventions were theory-driven and employed multiple strategies, including education, self-monitoring, and goal setting. Although SB interventions significantly reduced total sedentary time, the overall effect was small (d = −0.25, 95% confidence interval [−0.50, 0.00], p = .05). Studies were significantly heterogeneous (Q = 22.34, p < .01); however, the small number of comparisons prevented moderator analyses. Practitioners should employ diverse SB-specific strategies to encourage older adults to reduce time spent sedentary. To develop public health programs targeting SB in older adults, future research should include measures of time spent in specific SB and duration/number of breaks in sedentary time and investigate SB intervention effects on health outcomes.
A systematic review of stigma in sexual and gender minority health interventions
Authors: Layland Eric K , Carter Joseph A , Perry Nicholas S , Cienfuegos-Szalay Jorge , Nelson Kimberly M , Bonner Courtney Peasant , Rendina H Jonathon
Published: October 2020

Stigma against sexual and gender minorities is a major driver of health disparities. Psychological and behavioral interventions that do not address the stigma experienced by sexual and gender minorities may be less efficacious. We conducted a systematic review of existing psychological and behavioral health interventions for sexual and gender minorities to investigate how interventions target sexual and gender minority stigma and consider how stigma could affect intervention efficacy. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Eligible studies were peer reviewed and published in English between January 2003 and July 2019 and reported empirical results of behavioral or psychological interventions implemented among sexual and gender minorities. All interventions addressed stigma. We identified 37 eligible interventions. Most interventions targeted sexual minority men. Interventions were frequently developed or adapted for implementation among sexual and gender minorities and addressed multiple levels and types of stigma. Interventions most frequently targeted proximal stressors, including internalized and anticipated stigma. HIV and mental health were the most commonly targeted health outcomes. A limited number of studies investigated the moderating or mediating effects of stigma on intervention efficacy. The application of an intersectional framework was frequently absent and rarely amounted to addressing sources of stigma beyond sexual and gender minority identities. A growing number of interventions address sexual and gender minority stigma in an effort to prevent deleterious health effects. Future research is needed to assess whether stigma modifies the effectiveness of existing psychological and behavioral interventions among sexual and gender minorities. Further, the application of intersectional frameworks is needed to more comprehensively intervene on multiple, intersecting sources of stigma faced by the diverse sexual and gender minority community.
Soil nutrient availability alters tree carbon allocation dynamics during drought
Authors: Schönbeck Leonie , Li Mai-He , Lehmann Marco M , Rigling Andreas , Schaub Marcus , Hoch Günter , Kahmen Ansgar , Gessler Arthur
Published: October 2020

Drought alters allocation patterns of carbon (C) and nutrients in trees and eventually impairs tree functioning. Elevated soil nutrient availability might alter the response of trees to drought. We hypothesize that increased soil nutrient availability stimulates root metabolism and C allocation to belowground tissues under drought stress. To test this hypothesis, we subjected 3-year-old Pinus sylvestris L. saplings in open-top chambers during two subsequent years to drought using three different water treatments (100, 20 and 0% plant available water in the soil) and two soil nutrient regimes (ambient and nitrogen-phosphorus-potassium (N-P-K) fertilization corresponding to 5 g N m−2 year−1) and released drought thereafter. We conducted a 15N and 13C labeling experiment during the peak of the first-year drought by injecting 15N labeled fertilizer in the soil and exposing the tree canopies to 13C labeled CO2. The abundance of the N and C isotopes in the roots, stem and needles was assessed during the following year. Carbon uptake was slightly lower in drought-stressed trees, and extreme drought inhibited largely the N uptake and transport. Carbon allocation to belowground tissues was decreased under drought, but not in combination with fertilization. Our results indicate a potential positive feedback loop, where fertilization improved the metabolism and functioning of the roots, stimulating C allocation to belowground tissues. This way, soil nutrients compensated for drought-induced loss of root functioning, mitigating drought stress of trees.
Multi-analysis of sheath senescence provides new insights into bamboo shoot development at the fast growth stage
Authors: Chen Ming , Ju Ye , Ahmad Zishan , Yin Zengfang , Ding Yulong , Que Feng , Yan Jijun , Chu Jinfang , Wei Qiang
Published: October 2020

Sheath senescence is an important part of bamboo shoot development during the fast growth stage. However, no information has been reported about this distinctive process until now. Using multiple approaches, we found that sheath senescence is a complex process that occurs sequentially with chloroplast corruption, chlorophyll degradation and water loss. Reactive oxygen species (ROS), salicylic acid and abscisic acid also accumulate in the senescing sheath. Transcriptome analysis showed that NAC and WRKY transcription factors, such as NAC2 and WRKY75, as well as their possible downstream target genes, such as those involved in ROS production, proteolysis and nutrition recycling, constitute the gene network of the bamboo sheath senescence process. Furthermore, the initiation of sheath senescence might be triggered by hexokinase genes, such as HXK6, which is localized to the mitochondrion and could promote leaf senescence when overexpressed in Arabidopsis. Sheath senescence occurs after the growth decrease of the internodes, which provides assimilates. The slowing of internode growth possibly results in sugar accumulation, such as glucose, in the sheath, which finally upregulates hexokinase genes and initiates sheath senescence. These findings reveal that sheath senescence is a multilevel regulation process and has a close link to the corresponding internode growth, which provides new insights into the shoot development of bamboo during the fast growth stage.
PCR-RFLP for Detection of Fusarium graminearum Genotypes with Resistance to Phenamacril
Authors: Li Jiao-Sheng , Wu Luo-Yu , Zhang Hui , Song Xiu-Shi , Wang Jian-Xin , Zhou Ming-Guo , Hou Yi-Ping
Published: October 2020

Phenamacril is a cyanoacrylate fungicide that provides excellent control of Fusarium head blight (FHB) or wheat scab, which is caused predominantly by Fusarium graminearum and F. asiaticum. Previous studies revealed that codon mutations of the myosin-5 gene of Fusarium spp. conferred resistance to phenamacril in in vitro lab experiments. In this study, PCR restriction fragment length polymorphism (RFLP) was developed to detect three common mutations (A135T, GCC to ACC at codon 135; S217L, TCA to TTA at codon 217; and E420K, GAA to AAA at codon 420) in F. graminearum induced by fungicide domestication in vitro. PCR products of 841 bp (for mutation of A135T), 802 bp (for mutation of S217L), or 1,649 bp (for mutation of E420K) in the myosin-5 gene were amplified by appropriate primer pairs. Restriction enzyme KpnI, TasI, or DraI was used to distinguish phenamacril-sensitive and -resistant strains with mutation genotypes of A135T, S217L, and E420K, respectively. KpnI digested the 841-bp PCR products of phenamacril-resistant strains with codon mutation A135T into two fragments of 256 and 585 bp. In contrast, KpnI did not digest the PCR products of sensitive strains. TasI digested the 802-bp PCR products of phenamacril-resistant strains with codon mutation S217L into three fragments of 461, 287, and 54 bp. In contrast, TasI digestion of the 802-bp PCR products of phenamacril-sensitive strains resulted in only two fragments of 515 and 287 bp. DraI digested the 1,649-bp PCR products of phenamacril-resistant strains with codon mutation E420K into two fragments of 932 and 717 bp, while the PCR products of phenamacril-sensitive strains was not digested. The three genotypes of resistance mutations were determined by analyzing electrophoresis patterns of the digestion fragments of PCR products. The PCR-RFLP method was evaluated on 48 phenamacril-resistant strains induced by fungicide domestication in vitro and compared with the conventional method (mycelial growth on fungicide-amended agar). The accuracy of the PCR-RFLP method for detecting the three mutation genotypes of F. graminearum resistant to phenamacril was 95.12% compared with conventional method. Bioinformatics analysis revealed that the PCR-RFLP method could also be used to detect the codon mutations of A135T and E420K in F. asiaticum.
Pyrimethanil Sensitivity and Resistance Mechanisms in Penicillium digitatum
Authors: Zhang Yuchao , Fu Yanping , Luo Chaoxi , Zhu Fuxing
Published: October 2020

Pyrimethanil is an anilinopyrimidine (AP) fungicide that is highly effective in controlling green mold caused by Penicillium digitatum but has not yet been registered in China to control postharvest diseases of citrus. In this study, baseline sensitivity of P. digitatum to pyrimethanil was established based on the effective concentrations for 50% inhibition (EC50) values of 127 isolates collected from five major citrus-growing regions of China. The distribution of these EC50 values was unimodal but with a long right tail. The mean ± SD EC50 value was 0.137 ± 0.046 μg/ml, and the minimum and maximum were 0.073 and 0.436 μg/ml, respectively. Pyrimethanil in potato dextrose agar (PDA) at 0.20 μg/ml decreased methionine production in the mycelia by 21.6% and reduced the activity of cell wall-degrading enzymes cellulase and pectinase by 9.1 and 32.8%, respectively. Twelve pyrimethanil-resistant mutants were obtained by consecutive subculturing of 12 arbitrarily selected sensitive isolates on pyrimethanil-amended PDA for four generations, and the resistance factors ranged from 69 to 3,421. There was no cross-resistance between pyrimethanil and prochloraz (r = 0.377, P = 0.123). Compared with their parental isolates, pyrimethanil-resistant mutants had reduced pathogenicity to citrus fruit but higher tolerance to hydrogen peroxide. No differences were detected in tolerance to NaCl, CaCl2, Congo red, or sodium dodecyl sulfate. The exogenous addition of methionine into PDA partially alleviated pyrimethanil toxicity to the sensitive isolates but had no significant effect on toxicity to the resistant mutants. Sequencing of cystathionine γ-synthase encoding genes CGS1 and CGS2, the potential target genes for pyrimethanil, showed that there was no nucleotide mutation in the coding region of CGS of the pyrimethanil-resistant mutants. However, the relative expression of CGS1 and CGS2 of the pyrimethanil-resistant mutants was reduced by 42.5 and 57.4%, respectively. These results have important implications for applications of pyrimethanil to control P. digitatum and for understanding the modes of action and resistance mechanisms of pyrimethanil.
Genome Sequence Resource of ‘Candidatus Liberibacter asiaticus’ Strain Myan16 from Myanmar
Authors: Zheng Yongqin , Guo Jun , Deng Xiaoling , Zheng Zheng
Published: October 2020

‘Candidatus Liberibacter asiaticus,’ an uncultured α-proteobacterium, is associated with citrus huanglongbing (HLB, yellow shoot disease), a destructive disease threatening citrus production worldwide. Here, we reported the draft genome sequence of ‘Ca. L. asiaticus’ strain Myan16 from an HLB-affected lime tree in Myitkyina, Kachin State, Myanmar. The strain Myan16 genome is 1,229,102 bp with an average G+C content of 36.4%, along with a circular prophage: P-Myan16-2 (36,303 bp, type 2). This is the first genome sequence of a ‘Ca. L. asiaticus’ strain from Myanmar, which will enrich the current ‘Ca. L. asiaticus’ genome sequence database and facilitate HLB epidemiology research in Asia and world.
A look at sundown syndrome
Authors: Duran Jackie , Julian Marcia K.
Published: October 2020

Management of evening behavioral disturbance in patients with dementia is complex, presenting a growing need for healthcare professionals and family caregivers to be equipped with innovative treatment options.
Use of allergen immunotherapy for treatment of allergic conjunctivitis
Authors: Norris Matthew R. , Khaimov Michelle , Bielory Leonard
Published: October 2020

Purpose of review

The purpose of this article is to provide an overview of the literature pertaining to the use of allergen immunotherapy for treatment of allergic conjunctivitis with an emphasis on recent developments.

Recent findings

Both subcutaneous (SCIT) and sublingual (SLIT) immunotherapy continue to show efficacy in treating allergic conjunctival disease, subcutaneous more than sublingual. Adverse effects of sublingual therapy continue to be reported since the FDA's approval of SLIT tablets in 2014. Initial SLIT studies reported high rates of adherence, while real use reports identify rates of nonadherence/discontinuation ranging between 50 and 80%. Studies in polyallergic patients evaluating the efficacy of SLIT combination therapy report encouraging results.

Both SCIT and SLIT offers improvement in allergic conjunctival symptom scores and decrease medication utilization. Although SCIT has a higher likelihood of systemic reaction, SLIT has a very high rate of mild-to-moderate adverse events – especially in the first month. Cost–benefit analyses tend to favor SCIT (greater efficacy and less impacted by discontinuation rates).
Gender Differences in Emotional Dysregulation and Deliberate Self-harm in Patients With Tramadol Dependence
Authors: Shamseldin Noha , Asal Abdelrahman A. , Enaba Dalia A. , Khalil Mohamed A. , Shaheen Somaya H.
Published: October 2020

Objectives:

Gender differences in substance dependence across many domains including emotional dysregulation and deliberate self-harm (DSH) has not been studied widely. Tramadol dependence is the most one lacking empirical research and evidence regarding these differences; therefore, our aim is to detect gender differences in patients with tramadol dependence as regards emotional dysregulation and DSH.

Materials and Methods:

The study included 30 male and 30 female patients with tramadol dependence [diagnosis was made by Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I)]. Assessment of emotional dysregulation and DSH was done by the Difficulties in Emotion Dysregulation Scale, the Deliberate Self-Harm Inventory—Short Version.

Results:

Female patients are higher in emotional dysregulation and induce DSH more evidently than male patients with tramadol dependence. There was a statistically significant positive correlation between overall emotional dysregulation and overall DSH in both groups.

Conclusion:

The results will be useful in clinical practice for the management of patients with tramadol dependence.
A Comparison of Outcomes for Spinal Trauma Patients at Level I and Level II Centers
Authors: Baron Rebecca B. , Neifert Sean N. , Martini Michael L. , Maragkos George A. , McNeill Ian T. , Lamb Colin , Rasouli Jonathan J. , Caridi John M.
Published: October 2020

Study Design:

Retrospective analysis of a national database.

Objective:

To characterize the spine trauma population, describe trauma center (TC) resources, and compare rates of outcomes between the American College of Surgeons (ACS) level I and level II centers.

Summary of Background Data:

Each year, thousands of patients are treated for spinal trauma in the United States. Although prior analyses have explored postsurgical outcomes for patients with trauma, no study has evaluated these metrics for spinal trauma at level I and level II TCs.

Materials and Methods:

The ACS Trauma Quality Improvement Program was queried for all spinal trauma cases between 2013 and 2015, excluding polytrauma cases, patients discharged within 24 hours, data from TCs without a designated level, and patients transferred for treatment.

Results:

Although there were similar rates of severe spine traumas (Abbreviated Injury Scale≥3) at ACS level I and level II centers (P=0.7), a greater proportion of level I patients required mechanical ventilation upon emergency department arrival (P=0.0002). Patients at level I centers suffered from higher rates of infectious complications, including severe sepsis (0.58% vs. 0.31%, P=0.02) and urinary tract infections (3.26% vs. 2.34%, P=0.0009). Intensive care unit time (1.90 vs. 1.65 days, P=0.005) and overall length of stay (8.37 days vs. 7.44 days, P<0.0001) was higher at level I TCs. Multivariate regression revealed higher adjusted overall complication rates at level II centers (odds ratio, 1.15, 95% confidence interval, 1.06–1.24; P<0.001), but no difference in mortality (odds ratio, 1.18; 95% confidence interval, 0.92–1.52; P>0.10).

Conclusions:

ACS level I TCs possess larger surgical staff and are more likely to be academic centers. Patients treated at level I centers experience fewer overall complications but have a greater incidence of infectious complications. Mortality rates are not statistically different.
Lumbar Fusion for Spondylolisthesis
Authors: Zhou Shi Guo , Liu Chun Hua , Dai Ke Hui , Lai Yong Xin
Published: October 2020

Study Design:

This was a Bayesian network meta-analysis.

Objective:

We aimed to assess the comparative efficacies of the 5 most commonly used procedures for spondylolisthesis in a Bayesian network meta-analysis.

Summary of Background:

Lumbar fusion procedures are the backbone for the surgical treatment of spondylolisthesis. However, the current evidence has only considered head-to-head comparisons of different fusion procedures and failed to definitively favor one fusion procedure over another.

Materials and Methods:

A Bayesian random-effects model was used, and radiographic fusion and complications were assessed by risk ratio with a corresponding 95% credible interval; Oswestry Disability Index (ODI) scores were assessed by mean difference and 95% credible interval. Furthermore, with respect to each endpoint, ranking probabilities for each fusion procedure were evaluated using the value of the surface under the cumulative ranking curve.

Results:

In all, 12 studies were identified. Significant differences in associated complications were found between minimally invasive transforaminal lumbar interbody fusion (MTLIF) and each of the other 4 fusion procedures. Surface under the cumulative ranking curve results suggested that for the most effective radiographic fusion, open transforaminal lumbar interbody fusion (OTLIF) had the maximum probability of being successful (76.6%), followed by MTLIF (70.4%) and open posterior lumbar interbody fusion (OPLIF, 48.7%). In terms of ODI scores, OTLIF might be the best intervention (70.5%), followed by MTLIF (68.8%) and then OPLIF (44.0%). However, MTLIF is ranked the safest (99.8%) regarding associated complications, followed sequentially by OTLIF (57.1%) and posterolateral fusion (30.1%).

Conclusions:

OTLIF for spondylolisthesis was found to be the more efficient procedure in terms of radiographic fusion and ODI scores. Importantly, MTLIF is most likely to have a lower associated complication rate compared with other fusion procedures.
Cardiovascular Toxicity and Mortality Associated With Adoptive Cell Therapy and Tumor-infiltrating Lymphocytes for Advanced Stage Melanoma
Authors: Fradley Michael G. , Damrongwatanasuk Rongras , Chandrasekhar Sanjay , Alomar Mohammed , Kip Kevin E. , Sarnaik Amod A.
Published: October 2020

Adoptive cellular therapy (ACT) with tumor-infiltrating lymphocytes (TILs) has emerged as an effective treatment option for unresectable stage III/IV metastatic melanoma. Acute toxicities, particularly cardiovascular (CV), can have a significant effect on the completion of therapy. We abstracted information on 43 patients who received ACT-TIL treatment for melanoma at the Moffitt Cancer Center between 2010 and 2016. The Student t tests and χ2 tests were used to compare patient characteristics by presence versus absence of specific CV complications. In this cohort, 32.6% developed hypotension requiring treatment with intravenous fluids and pressors, 14% atrial fibrillation, and 2.3% troponin elevations suggestive of myocardial damage. No patients developed clinical heart failure, and among the patients that underwent echocardiography, there was no significant difference in mean left ventricular ejection fraction before or after therapy (62.9% vs. 63.5%, respectively, P=0.79). There was also no statistically significant difference in survival between those with and without CV complications (overall survival=61.9%, mean: 26.0 mo and progression-free survival=45.2%, mean: 18.1 mo). CV toxicities are common in ACT-TIL protocols; however, survival does not appear to be significantly affected. Further research is needed to define mechanisms and potential prevention strategies to help clinicians manage these complications and mitigate risk.
Provider Perspectives on the Extension for Community Healthcare Outcomes Autism: Transition to Adulthood Program
Authors: Cheak-Zamora Nancy , Farmer Justin G. , Crossman Morgan K. , Malow Beth A. , Mazurek Micah O. , Kuhlthau Karen , Stobbe Gary , Loftin Rachel , Mirza-Agrawal Mavara , Tapia Mark , Hess Amy , Davis Katrina , Sohl Kristin
Published: October 2020

Objective:

Despite their complex health care needs, transition-aged youth diagnosed with autism spectrum disorder (TAY-ASD) receive few transition services and describe difficulty finding adult providers. A 12-week primary care provider (PCP) training was developed to improve the delivery of transition services for TAY-ASD [Extension for Community Healthcare Outcomes (ECHO) Autism: Transition to Adulthood program]. The current study examines the PCPs' perspectives and experiences of the program and application of the training material.

Methods:

This study used a qualitative descriptive framework to explore the experiences and perspectives of 10 PCPs who completed the ECHO Autism: Transition to Adulthood program. Semistructured focus groups, conducted through Zoom videoconferencing, were used to explore these topics.

Results:

Three overarching categories were identified: (1) beneficial and influential aspects of the ECHO, (2) perceived challenges, and (3) suggestions for improvements and adjustments. Overall, participants found the program highly beneficial, describing an increased sense of community and comprehensive recommendations from a multidisciplinary team. Challenges included difficulties participating in the program during clinical hours and difficulties meeting the educational needs of participants with a wide range of previous experience caring for TAY-ASD. Recommendations included embedding the location-specific material into the program to account for regional differences and the use of an online platform for participants to ask questions and discuss issues outside of the regular sessions.

Conclusion:

The study results can inform the development and implementation of new virtual PCP trainings and future ECHOs, including the revision and broad implementation of the ongoing ECHO Autism: Transition to Adulthood program.
Delivering pediatric cardiac care in sub-Saharan Africa: a model for the developing countries
Authors: Ansong Annette K. , Yao Nana-Akyaa , Fynn-Thompson Francis , Edwin Frank
Published: October 2020

Purpose of review

It is projected that by 2050, around 40% of all births, and about 40% of all children, will be in Africa, up from about 10% in 1950. Consequently, this trend will cause an increase in noncommunicable diseases in children, such as congenital and rheumatic heart diseases. The current state of pediatric cardiac care in sub-Saharan Africa is dire with some countries without cardiac surgical services at all. The purpose of this review is to highlight those components needed to build a sustainable model for a pediatric cardiac care center in sub-Saharan Africa.

Recent findings

Review of the literature reveals that capacity-building for pediatric cardiac care in sub-Saharan Africa can be a challenging entity. Several factors must come into play to lay the foundation for a successful cardiac program. Key among them are early diagnosis of heart disease, human resources, financing cardiac care, and political commitment.

The burgeoning pediatric population in sub-Saharan African lends itself to an increase in the incidence of pediatric heart disease. The need for sustainable, patient-centered cardiac centers is pressing. Establishing such pediatric cardiac care models will require the essential components of early diagnosis, increasing human resources, financing cardiac care, and political commitment.

Video abstract

http://links.lww.com/HCO/A59.
Transcatheter mitral valve repair and replacement: the next frontier of transcatheter valve intervention
Authors: Kang Jimmy J.H. , Bozso Sabin J. , El-Andari Ryaan , Adams Corey , Nagendran Jeevan
Published: October 2020

Purpose of review

We summarize the recent developments in transcatheter mitral valve repair (TMVr) and replacement (TMVR), discuss determinants of MitraClip outcomes in various mitral regurgitation causes, and highlight newly emerging devices and randomized trials.

Recent findings

The discordant results published in the two recent randomized trials for MitraClip, the COAPT and the MITRA-FR trial have led to the emergence of a new conceptual framework such as the proportionate versus disproportionate mitral regurgitation and hemodynamics assessment tools like the real-time continuous left atrial pressure monitoring. Learning curve and volume-outcome analyses and studies examining the MitraClip usage in patients with degenerative mitral regurgitation are recent developments that have influenced MitraClip regulation and coverage. Several trials for TMVr devices that take an alternative approach to the edge-to-edge repair are underway and advancements in the TMVR technologies are continuing to progress to fill the unmet needs of treating high surgical risk patients whose complex valve anatomy make TMVr unfeasible.

Evidence supports careful analysis of the valve area and left ventricular function in addition to the left atrial hemodynamics will improve the MitraClip outcome. Operator experience plays a greater effect when achieving excellent results with 1+ or less residual mitral regurgitation whereas surgical MVr volume did not influence TMVr outcome. Interventions on the complex primary mitral regurgitation remain under the surgical domain, but MITRA high risk (HR) and REPAIR mitral regurgitation trials are underway to evaluate the role of MitraClip in high to intermediate surgical risk patients with primary mitral regurgitation. Despite the slow developments in TMVR, the results of the early trials of its devices are promising.
Dematiaceous Fungal Colonization of the Bandage Contact Lens in a Patient Lost to Follow-up During the COVID-19 Crisis
Authors: Srirampur Arjun , Mansoori Tarannum , Kola Pravalika , Kalwad Anupama , Reddy Ashok Kumar
Published: October 2020

We report a rare case of dematiaceous fungus colonization in the therapeutic bandage contact lens (BCL), in an eye with peripheral ulcerative keratitis. Bandage contact lens removal and appropriate treatment resulted in improvement of the visual acuity and prevented the spread of fungus to the underlying ocular structures. Microbiological evaluation of the BCL showed dematiaceous fungal filaments, and the fungus was identified as Bipolaris species. In patients with pigmented plaque-like lesions, with BCL in situ, dematiaceous fungus on the undersurface of the BCL should be kept in mind. Patient education regarding the importance of frequent BCL replacement, proper ocular hygiene, and timely follow-up should be emphasized.
Clinical Characteristics and Outcome Analysis of 94 Children With Brain Abscess in Beijing: A Single-center Retrospective Study
Authors: Dou Zhen-Zhen , Guo Ling-Yun , Liu Lin-Lin , Li Mu-Han , Hu Hui-Li , Hu Bing , Guo Xin , Chen Tian-Ming , Chen He-Ying , Ge Ming , Qian Su-Yun , Zheng Hu-Yong , Li Jiu-Wei , Zhang Wei-Hua , Hei Ming-Yan , Liu Gang
Published: October 2020

Background:

There are limit studies about pediatric brain abscess in China. The aim of this study was to analyze clinical characteristics and outcomes of pediatric brain abscess in recent years in China.

Methods:

The clinical information of children with brain abscess hospitalized in Beijing Children’s Hospital between January 1, 2007 and December 31, 2016 were retrospectively reviewed.

Results:

Ninety-four children were enrolled in this study. A Streptococcus milleri group (13.8%) was identified as the most common causative organisms, followed by Staphylococcus aureus (6.4%). The overall mortality was 21.6%, with 50.0% of deaths happening in the first week after diagnosis. Long-term outcomes of 74 patients were assessed with Glasgow Outcome Scale–Extended Pediatric Reversion: 50 patients with a score of 1–2 (favorable outcome) and 24 patients with a score of 3–8 (unfavorable outcome). Patients with multiple abscesses (P = 0.029) and intraventricular rupture of brain abscess/hydrocephalus (P = 0.024) had higher risk of unfavorable outcomes.

Conclusions:

Brain abscess is a serious disease with high mortality in children; more aggressive treatments should be considered in the first week of diagnosis because of high risk of death, and for patients with multiple brain abscesses and intraventricular rupture of brain abscess/hydrocephalus because of their higher risk of unfavorable.
Mandibular advancement devices shorten desaturation duration in patients at high risk for obstructive sleep apnea syndrome during intravenous propofol sedation in the decubitus position
Authors: Chang Chi , Hsu Yu-Ting , Ting Chien-Kun , Tsou Mei-Yung , Teng Wei-Nung
Published: October 2020

Background:

The purpose of this study was to determine the efficacy of a mandibular advancement device (MAD) for increasing patient safety during sedated total knee arthroplasty (TKA) and total hip replacement (THR).

Methods:

Forty patients undergoing TKA or THR surgery in the supine or lateral recumbent positions under spinal anesthesia were enrolled. Sedation and oxygenation were administered. The MAD (Sweet Sleep Anti-Snoring Device) was then placed after 15 minutes of observation. SpO2, PetCO2, blood pressure, and respiratory rate were recorded.

Results:

Sedated patients in the decubitus position had higher saturation nadirs, shorter desaturation durations, shorter airway obstruction durations, and fewer rescue events than those in the supine position. In patients at a high risk of obstructive sleep apnea syndrome (OSAS), desaturation duration, obstruction duration, apnea duration, desaturation duration, and rescue events were significantly lower after MAD placement. However, the saturation nadir did not improve after MAD placement.

Conclusion:

The MAD may shorten the duration of desaturation events during spontaneous breathing sedative procedures in the lateral recumbent position but not in the supine position. Breathing patterns did not change from nasal breathing to oral breathing or vice versa between pre- and postplacement of the MAD. Sedation score evaluation affects breathing pattern changes from oral breathing to nasal breathing and vice versa.
Trazodone as an Alternative Treatment for Neuroleptic-Associated Akathisia
Authors: Shams-Alizadeh Narges , Maroufi Azad , Asadi Zahra , Rahmani Khaled , Hassanzadeh Kambiz
Published: October 2020

Background

Akathisia is a distressing extrapyramidal complication that follows the use of antipsychotic medications. Early treatment of neuroleptic-associated akathisia (NAA) is of great importance because it may lead to poor therapeutic response and ultimately treatment noncompliance. Considering the lack of adequate response of some patients to conventional treatments and the assumption that serotonin might be involved in the pathophysiology of the disease in addition to dopaminergic mechanisms, we aimed to evaluate the effectiveness of trazodone as an antidepressant agent with strong antagonistic effects on serotonin receptors in the treatment of akathisia.

Methods

In a double-blind clinical trial, 52 patients receiving antipsychotic medications who were diagnosed to have mild to severe NAA using Barnes Akathisia Rating Scale were treated with trazodone 50 mg daily for 5 days and compared with the placebo control group.

Results

Patients receiving trazodone did not show a significant difference compared with the control group in terms of the severity of akathisia symptoms until the third day of the study. In contrast, at the end of the fifth day, there was a significant improvement in objective (P = 0.01) and subjective (P = 0.001) symptoms of akathisia and the global clinical assessment of akathisia scale (P = 0.001). Moreover, there was no clear difference between trazodone and placebo group in terms of adverse effects.

Conclusions

Considering the antagonistic effect of trazodone on postsynaptic 5-hydroxytryptamine2A receptors as a possible mechanism of efficacy of this agent in the treatment of NAA, this study suggests that trazodone might be an effective and relatively safe drug.
The Effect of Venlafaxine on Electrocardiogram Intervals During Treatment for Depression in Older Adults
Authors: Behlke Lauren M. , Lenze Eric J. , Pham Vy , Miller J. Philip , Smith Timothy W. , Saade Yasmina , Karp Jordan F. , Reynolds Charles F. , Blumberger Daniel M. , Stefan Cristiana , Mulsant Benoit H.
Published: October 2020

Purpose/Background

Venlafaxine is a commonly used antidepressant with both serotonergic and noradrenergic activity. There are concerns that it may prolong the corrected QT interval (QTc), and older adults may be at higher risk for this adverse effect, especially at higher dosages of the medication.

Methods/Procedures

In this secondary analysis of a prospective clinical trial, we measured changes in QTc and other electrocardiogram (ECG) parameters in 169 adults 60 years or older with a major depressive disorder treated acutely with venlafaxine extended release up to 300 mg daily. We examined the relationship of venlafaxine dosage and ECG parameters, as well as the relationship between serum levels of venlafaxine and ECG parameters.

Findings/Results

Venlafaxine exposure was not associated with an increase in QTc. Heart rate increased with venlafaxine treatment, whereas the PR interval shortened, and QRS width did not change significantly. The QTc change from baseline was not associated with venlafaxine dosages or serum concentrations. Age, sex, cardiovascular comorbidities, and depression remission status did not predict changes in QTc with venlafaxine.

Implications/Conclusions

Venlafaxine treatment did not prolong QTc or other ECG parameters, even in high dosages in older depressed adults. These findings indicate that venlafaxine does not significantly affect cardiac conduction in most older patients.
A Tertiary Care-based Complex Care Program
Authors: Hogan Annique K. , Galligan Meghan M. , Stack Noelle J. , Leach Kathryn F. , Aredas Brenna L. , English Rachel , Dye Matthew , Rubin David
Published: October 2020

Objective:

Children with medical complexity (CMC) have significant health care costs, but they also experience substantial unmet health care needs, hospitalizations, and medical errors. Their parents often report psychosocial stressors and poor care satisfaction. Complex care programs can improve the care for CMC. At our tertiary care institution, we developed a consultative complex care program to improve the quality and cost of care for CMC and to improve the experience of care for patients and families.

Methods:

To address the needs of CMC at our institution, we developed the Compass Care Program, a consultative complex care program across inpatient and outpatient settings. Utilization data [hospital admissions per patient month; length of stay per admission; hospital days per patient month; emergency department (ED) visits per patient month; and institutional charges per patient month] and caregiver satisfaction data (obtained via paper survey at outpatient visits) were tracked over the period of participation in the program and compared preenrollment and postenrollment for program participants.

Results:

Participants had significant decreases in hospital admissions per patient month, length of stay per admission, hospital days per patient month, and charges per patient month following enrollment (P<0.01) without a tandem increase in readmissions within 7 days of discharge. There was no statistically significant difference in ED visits. Caregiver satisfaction scores improved in all domains.

Conclusion:

Participation in a consultative complex care program can improve utilization patterns and cost of care for CMC, as well as experience of care for patients and families.
The role of non-HLA antibodies in solid organ transplantation: a complex deliberation
Authors: Jackson Annette M. , Wiebe Chris , Hickey Michelle J.
Published: October 2020

Purpose of review

There is tremendous interest in understanding when, if, and how non-HLA antibodies contribute to allograft injury. Numerous non-HLA target antigens have been identified and sensitization to these targets have been associated with delayed allograft function, rejection, and allograft failure. This review focuses on the clinical utility of HLA antibody testing, highlighting the strengths and limitations of current clinical studies, and the need for defining characteristics to inform non-HLA antibody pathogenicity.

Recent findings

Clinical studies continue to show associations between non-HLA antibodies and rejection and reduced allograft survival across multiple transplanted organ types. The worst clinical outcomes continue to be observed among recipients testing positive for both non-HLA and donor-specific HLA antibodies. Mechanistic insights from both animal and clinical studies support a model in which tissue injury accompanied by an inflammatory environment influence non-HLA antibody formation and pathogenicity.

Immune triggers that lead to non-HLA antibody formation and pathogenicity are complex and poorly understood. The ability of non-HLA antibodies to mediate allograft injury may depend upon their affinity and strength (titer), target specificity, density of the target antigen, and synergy with donor-specific HLA antibodies.
A Pilot Study of Nonpharmacological Interventions for Hospice Patients With Behavioral and Psychological Symptoms in Dementia
Authors: Krauss Beatrice J. , Schlievert Matthew A. , Wagner Bonnie K. , Deutsch Diane D. , Powell Rebecca J.
Published: October 2020

Agitation is a common, treatable symptom that profoundly impacts quality of life and exacerbates caregiver fatigue in the hospice setting for patients with dementia. The objective of this study was to analyze the efficacy of tailored nonpharmacological interventions for mitigation of unwanted behaviors in the population of patients with behavioral and psychological symptoms in dementia while receiving hospice care. The 4-domain Pittsburgh Agitation Scale (PAS; Motor, Verbal, Aggressive, Resistance to Care) was used for multiple baseline and posttest measurements of agitation. Effectiveness of nonpharmacological interventions was evaluated using analysis of variance for repeated measures for the total PAS score. Motor agitation was the presenting problem with highest-rated severity compared with Verbal, Aggression, and Resistance to Care domains. Analysis of variance demonstrated no difference between baseline referral and pretest total PAS measures (P = .8), but a significant drop in total PAS agitation after intervention (P < .001). The best outcomes, however, were with patients receiving both nonpharmacological and standard pharmacological interventions as opposed to nonpharmacological interventions alone (P = .034). For patients with dementia presenting with behavioral and psychological symptoms, selected nonpharmacological interventions provide significant mitigation of agitation.