bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing Epidemiology of Bacterial Meningitis Since Introduction of Conjugate Vaccines: 3 Decades of National Meningitis Surveillance in The Netherlands
Authors: Koelman Diederik L H , van Kassel Merel N , Bijlsma Merijn W , Brouwer Matthijs C , van de Beek Diederik , van der Ende Arie
Published: November 2020

Background

The epidemiology of acute bacterial meningitis has changed substantially since the introduction of conjugate vaccines.

Methods

We analyzed nationwide surveillance data of all cerebrospinal fluid isolates received by the Netherlands Reference Laboratory for Bacterial Meningitis in the Netherlands. We assessed the impact of conjugate vaccines on incidence (defined as episodes per 100 000 population per year) and for different age groups using incidence rate ratios (IRRs), comparing incidence before and after conjugate vaccine introduction.

Results

We analyzed 17 393 episodes, of which 5960 episodes (34%) occurred in preschool children (aged 3 months to 4 years). Overall, bacterial meningitis incidence decreased from 6.37 to 1.58 between 1989–1993 and 2014–2019 (IRR, 0.25 [95% confidence interval {CI}, .23–.26]; P < .001). This decrease was most pronounced in preschool and school-aged children (5–15 years); IRR, 0.10 [95% CI, .09–.12] and 0.08 [95% CI, .06–.10]; both P < .001. The incidence was highest in young infants (<90 days) due to a high incidence of group B Streptococcus and Escherichia coli meningitis (42.48 and 19.49, respectively). Conjugate vaccines effectively reduced the incidence of Haemophilus influenzae type b, Neisseria meningitidis serogroup C, and 10 pneumococcal serotypes (IRRs, .02–.04; P < .001). At the end of the observed period, Streptococcus pneumoniae caused the majority of meningitis cases (829/1616 [51%]), mostly in older adults (aged 45–64 years) and elderly adults (aged ≥65 years; incidence of 1.06 and 1.54, respectively).

Conclusions

Conjugate vaccines reduced the burden of bacterial meningitis, especially in children. The efforts for new measures to prevent bacterial meningitis should be focused on neonates and elderly, as the residual rate of disease is still high in these age groups.
Extrinsic tricuspid valve compression due to an aortic aneurysm causing significant right to left shunt via a patent foramen ovale: a case report
Authors: Ahmed Rizwan
Published: November 2020

Background

Aortic aneurysms are known to cause compression of adjacent structures including the tracheobronchial tree, oesophagus, and recurrent laryngeal nerve. Extremely rarely, they can lead to compression of the tricuspid valve (TV) annulus. We describe a case where aortic aneurysm caused TV annulus compression and persistent right-to-left shunt through a patent foramen ovale (PFO).

Case summary

A 75-year-old female was admitted with headache and dizziness. On examination, she had persistent arterial desaturation with oxygen levels reduced to 69% at rest whilst breathing ambient air. Complete blood count demonstrated polycythaemia (Hb 174 g/L). Right to left cardiac shunt was suspected after significant lung and haematologic pathology was excluded. Transoesophageal echocardiography demonstrated a trileaflet aortic valve with an ascending aorta aneurysm and a stretched PFO with persistent right to left shunt across it. The ascending aortic aneurysm was observed coursing superior to and compressing the TV annulus. Invasive haemodynamic data demonstrated prominent ‘a’ waves in the right atrium, low RV (12/1 mmHg), and pulmonary artery pressures (14/6 mmHg), reduced cardiac output and significant right to left shunt with Qp:Qs 0.6. Computed tomography (CT) angiogram demonstrated a 5 cm fusiform ascending aorta aneurysm that coursed anteriorly causing TV annulus compression.

Discussion

Tricuspid valve inflow obstruction associated with a right to left shunt across PFO can be an extremely rare complication of aortic aneurysm. This may result in persistent arterial hypoxaemia and secondary polycythaemia.
Production of methylmercury by methanogens in mercury contaminated estuarine sediments
Authors: Wang Yuwei , Roth Spencer , Schaefer Jeffra K , Reinfelder John R , Yee Nathan
Published: November 2020

Anaerobic bacteria are known to produce neurotoxic methylmercury [MeHg] when elemental mercury [Hg(0)] is provided as the sole mercury source. In this study, we examined the formation of MeHg in anaerobic incubations of sediment collected from the San Jacinto River estuary (Texas, USA) amended with aqueous Hg(0) to investigate the microbial communities involved in the conversion of Hg(0) to MeHg. The results show that the addition of the methanogen inhibitor 2-bromoethanesulfonate (BES) significantly decreased MeHg production. The mercury methylation gene, hgcA, was detected in these sediments using archaeal specific primers, and 16S rRNA sequencing showed that a member of the Methanosarcinaceae family of methanogens was active. These results suggest that methanogenic archaea play an underappreciated role in the production of MeHg in estuarine sediments contaminated with Hg(0).
Elimination of GlnKAmtB affects serine biosynthesis and improves growth and stress tolerance of Escherichia coli under nutrient-rich conditions
Authors: Frare Romina , Stritzler Margarita , Pascuan Cecilia , Liebrenz Karen , Galindo-Sotomonte Luisa , Soto Gabriela , Nikel Pablo Iván , Ayub Nicolás
Published: November 2020

Nitrogen is a most important nutrient resource for Escherichia coli and other bacteria that harbor the glnKamtB operon, a high-affinity ammonium uptake system highly interconnected with cellular metabolism. Although this system confers an advantage to bacteria when growing under nitrogen-limiting conditions, little is known about the impact of these genes on microbial fitness under nutrient-rich conditions. Here, the genetically tractable E. coli BW25113 strain and its glnKamtB-null mutant (JW0441) were used to analyze the impact of GlnK-AmtB on growth rates and oxidative stress tolerance. Strain JW0441 showed a shorter initial lag phase, higher growth rate, higher citrate synthase activity, higher oxidative stress tolerance and lower expression of serA than strain BW25113 under nutrient-rich conditions, suggesting a fitness cost to increase metabolic plasticity associated with serine metabolism. The overexpression of serA in strain JW0441 resulted in a decreased growth rate and stress tolerance in nutrient-rich conditions similar to that of strain BW25113, suggesting that the negative influence on bacterial fitness imposed by GlnK-AmtB can be traced to the control of serine biosynthesis. Finally, we discuss the potential applications of glnKamtB mutants in bioproduction processes.
Surgical Management of Chronic Subdural Hematoma in Older Adults: A Systematic Review
Authors: Shlobin Nathan A , Kedda Jayanidhi , Wishart Danielle , Garcia Roxanna M , Rosseau Gail
Published: November 2020

Background

Chronic subdural hematoma (cSDH) is a form of intracranial hemorrhage common in older adults. Optimal treatment remains controversial. We conducted a systematic review to identify surgical thresholds, characterize outcomes, and delineate critical considerations in the surgical management of older adults in order to summarize the evidence supporting the best contemporary management of cSDH.

Methods

A systematic review exploring surgical management of cSDH among individuals aged 65 years and older was conducting by searching the PubMed, Embase, and Scopus databases for articles in English. Abstracts from articles were read and selected for full-text review according to a priori criteria. Relevant full-text articles were analyzed for bibliographic data, aim, study design, population, interventions, and outcomes.

Results

Of 1473 resultant articles, 21 were included. Surgery rationale was case-by-case for symptomatic patients with cSDH. Surgery was superior to conservative management and promoted equivalent neurologic outcomes and rates of complications. Recurrence and reoperation rates in older adults were similar to younger individuals. Some studies reported higher mortality rates for older adults, while others reported no difference. Anticoagulation or antiplatelet agent use did not seem to be associated with poorer outcomes in older adults.

Conclusions

Surgery for cSDH in older adults leads to favorable neurologic outcomes without increased risk of overall complications, recurrence, or reoperation compared to younger patients. However, older adults may be at increased risk for mortality after surgery. It is important to determine use of anticoagulant or antiplatelet agents in older adults to optimally manage patients with cSDH.
Discontinuity of Straightening in Anti-Holomorphic Dynamics: II
Authors: Inou Hiroyuki , Mukherjee Sabyasachi
Published: November 2020

In [21], Milnor found Tricorn-like sets in the parameter space of real cubic polynomials. We give a rigorous definition of these Tricorn-like sets as suitable renormalization loci and show that the dynamically natural straightening map from such a Tricorn-like set to the original Tricorn is discontinuous. We also prove some rigidity theorems for polynomial parabolic germs, which state that one can recover unicritical holomorphic and anti-holomorphic polynomials from their parabolic germs.
M-regular Decompositions for Pushforwards of Pluricanonical Bundles of Pairs to Abelian Varieties
Authors: Jiang Zhi
Published: November 2020

We extend the so-called Chen–Jiang decompositions for pushforwards of pluricanonical bundles to abelian varieties to the setting of klt pairs. We also provide a geometric application of this decomposition.
The context and influences of safety: An exploration of social networks, actions, and behaviour
Authors: Wailling J O , Long Janet C , Stolarek Iwona
Published: November 2020

Background

Safety systems are socio-cultural in nature, characterized by people, their relationships to one another and to the whole. This study aimed to (i) map the social networks of New Zealand’s quality improvement and safety leaders, (ii) illuminate influential characteristics and behaviours of key network players and (iii) make recommendations regarding how networks might be optimized.

Methods

Instrumental case study was done using mixed methods. Purposeful sampling was applied to collect survey data from delegates at two national safety and quality forums (n = 85). Social network questions asked respondents who influenced their safety work. Key network players were identified and invited to participate in a semi-structured interview (n = 7).

Results

Key players described safety systems in humanistic terms. Safety influence was determined to be a responsive relational process. Adaptive leaders broker relationships between multiple perspectives and contexts, which is essential for safe healthcare.

Conclusion

Influential safety approaches appreciate the human contribution to safety. Designing the health system to adapt and respond to the needs of people, teams and communities, rather than the unilateral needs of the system, is essential. Adaptive leadership will assist in achieving these aims and will likely be embraced by New Zealand health professionals.
Use of biochar by sheep: impacts on diet selection, digestibility, and performance
Authors: McAvoy Darren J , Burritt Beth , Villalba Juan J
Published: November 2020

The objective of this study was to determine the influence of biochar obtained from exothermic production of lodgepole pine (Pinus contorta) and quaking aspen (Populus tremuloides) on sheep performance and diet digestibility and on preference for a ration enriched with this carbon-based material. Twenty-four lambs were housed in individual pens and assigned to one of three treatment groups (eight animals per group), where they received: 1) a 60:40 ration of alfalfa:barley (Control), 2) an isoenergetic and isonitrogenous ration with alfalfa, barley, and 2% biochar (BC), and 3) a simultaneous offer of the Control and BC rations (Choice). Lambs were exposed to two consecutive feeding periods (Period 1: 13 d and Period 2: 21 d), representing time intervals where the evolution of intake, animal performance, and rumen parameters were assessed; in vivo digestibility was determined during the last 5 d of the study. Ration intake did not differ among groups of lambs (P > 0.10), although during some days in Period 2, intake was greater for the BC and Choice groups than for the Control group (P < 0.05). Lambs in Choice had a lower preference for BC than for the Control ration (Period 1: P < 0.05; Period 2: P < 0.10), although they incorporated a substantial amount of BC (39 and 40%, for Periods 1 and 2, respectively) into their diets. No differences in body weight gains (ADG) or gain-to-feed ratios were found among groups of animals (P > 0.10), although dry matter digestibility and digestible dry matter intake was greater for lambs in the BC group than for lambs in Control group (P < 0.05). The ruminal concentration of the volatile acid acetate in Period 2 was greater for BC than for Choice (P < 0.05). During the same period, the concentration of valerate and ruminal pH values were greater in BC than in Control (P < 0.05). Thus, the addition of biochar to grain-based diets enhanced diet digestibility and influenced some ruminal parameters in lambs. Nevertheless, these positive effects were not reflected in significant improvements on ADG or feed conversion efficiencies. Lambs offered choices between Control and BC rations formed a diet with concentrations of biochar of ~1.2%, suggesting that these animals would tolerate such levels without reductions in ration palatability.
Efficacy of orthobiologic adjuvants to core decompression for hip preservation in avascular necrosis hip
Authors: Kumar Prasoon , Shetty Vijay D , Dhillon Mandeep Singh
Published: November 2020

Head preserving modalities in avascular necrosis (AVN) hip are variably effective in early stages, and further options that could prevent head distortion and osteoarthritis are needed. Core decompression (CD) is the most commonly used surgery in the early stages of osteonecrosis with variable rates of success. The present review aimed to determine the effectiveness of bone marrow aspirate concentrate (BMAC), platelet-rich plasma (PRP), bone morphogenetic proteins (BMP) or their combination with CD in early stages of AVN hip, prior to collapse of femoral head. Additionally, any newer unexplored modalities were also searched for and ascertained. PubMed and SCOPUS databases were searched for relevant articles in English language describing CD with aforementioned orthobiologics. We analysed a total of 20 studies published between 2011 and 2020. There were 6 retrospective and 14 prospective studies. PRP showed improved survival and functional outcomes; however, with only three studies, there is inconclusive evidence for its routine utilization. BMAC enhances the efficacy of CD which can further be increased by culture and expansion of cells or combining it with PRP to stimulate growth. In conclusion, CD with BMAC works more efficiently than CD alone prior to collapse of femoral head in AVN. However, PRP needs more evidence for extensive application. Addition of PRP to BMAC or culturing the latter could further enhance the potency of CD + BMAC combination. Very limited data is available for the efficacy of BMP-7 and the role of intraosseous bisphosphonates should be evaluated for a cheaper and potential alternative.
Pod indehiscence in common bean is associated with the fine regulation ofPvMYB26
Authors: Di Vittori Valerio , Bitocchi Elena , Rodriguez Monica , Alseekh Saleh , Bellucci Elisa , Nanni Laura , Gioia Tania , Marzario Stefania , Logozzo Giuseppina , Rossato Marzia , De Quattro Concetta , Murgia Maria L , Ferreira Juan José , Campa Ana , Xu Chunming , Fiorani Fabio , Sampathkumar Arun , Fröhlich Anja , Attene Giovanna , Delledonne Massimo , Usadel Björn , Fernie Alisdair R , Rau Domenico , Papa Roberto
Published: November 2020

In legumes, pod shattering occurs when mature pods dehisce along the sutures, and detachment of the valves promotes seed dispersal. In Phaseolus vulgaris (L)., the major locus qPD5.1-Pv for pod indehiscence was identified recently. We developed a BC4/F4 introgression line population and narrowed the major locus down to a 22.5 kb region. Here, gene expression and a parallel histological analysis of dehiscent and indehiscent pods identified an AtMYB26 orthologue as the best candidate for loss of pod shattering, on a genomic region ~11 kb downstream of the highest associated peak. Based on mapping and expression data, we propose early and fine up-regulation of PvMYB26 in dehiscent pods. Detailed histological analysis establishes that pod indehiscence is associated with the lack of a functional abscission layer in the ventral sheath, and that the key anatomical modifications associated with pod shattering in common bean occur early during pod development. We finally propose that loss of pod shattering in legumes resulted from histological convergent evolution and that it is the result of selection at orthologous loci.
EDGE: a new approach to suppressing numerical diffusion in adaptive mesh simulations of galaxy formation
Authors: Pontzen Andrew , Rey Martin P , Cadiou Corentin , Agertz Oscar , Teyssier Romain , Read Justin , Orkney Matthew D A
Published: November 2020

We introduce a new method to mitigate numerical diffusion in adaptive mesh refinement (AMR) simulations of cosmological galaxy formation, and study its impact on a simulated dwarf galaxy as part of the ‘EDGE’ project. The target galaxy has a maximum circular velocity of $21\, \mathrm{km}\, \mathrm{s}^{-1}$ but evolves in a region that is moving at up to $90\, \mathrm{km}\, \mathrm{s}^{-1}$ relative to the hydrodynamic grid. In the absence of any mitigation, diffusion softens the filaments feeding our galaxy. As a result, gas is unphysically held in the circumgalactic medium around the galaxy for $320\, \mathrm{Myr}$, delaying the onset of star formation until cooling and collapse eventually triggers an initial starburst at z = 9. Using genetic modification, we produce ‘velocity-zeroed’ initial conditions in which the grid-relative streaming is strongly suppressed; by design, the change does not significantly modify the large-scale structure or dark matter accretion history. The resulting simulation recovers a more physical, gradual onset of star formation starting at z = 17. While the final stellar masses are nearly consistent ($4.8 \times 10^6\, \mathrm{M}_{\odot }$ and $4.4\times 10^6\, \mathrm{M}_{\odot }$ for unmodified and velocity-zeroed, respectively), the dynamical and morphological structure of the z = 0 dwarf galaxies are markedly different due to the contrasting histories. Our approach to diffusion suppression is suitable for any AMR zoom cosmological galaxy formation simulations, and is especially recommended for those of small galaxies at high redshift.
FAX-RIC enables robust profiling of dynamic RNP complex formation in multicellular organismsin vivo
Authors: Na Yongwoo , Kim Hyunjoon , Choi Yeon , Shin Sanghee , Jung Jae Hun , Kwon S Chul , Kim V Narry , Kim Jong-Seo
Published: November 2020

RNA–protein interaction is central to post-transcriptional gene regulation. Identification of RNA-binding proteins relies mainly on UV-induced crosslinking (UVX) followed by the enrichment of RNA–protein conjugates and LC-MS/MS analysis. However, UVX has limited applicability in tissues of multicellular organisms due to its low penetration depth. Here, we introduce formaldehyde crosslinking (FAX) as an alternative chemical crosslinking for RNA interactome capture (RIC). Mild FAX captures RNA–protein interaction with high specificity and efficiency in cell culture. Unlike UVX-RIC, FAX-RIC robustly detects proteins that bind to structured RNAs or uracil-poor RNAs (e.g. AGO1, STAU1, UPF1, NCBP2, EIF4E, YTHDF proteins and PABP), broadening the coverage. Applied to Xenopus laevis oocytes and embryos, FAX-RIC provided comprehensive and unbiased RNA interactome, revealing dynamic remodeling of RNA–protein complexes. Notably, translation machinery changes during oocyte-to-embryo transition, for instance, from canonical eIF4E to noncanonical eIF4E3. Furthermore, using Mus musculus liver, we demonstrate that FAX-RIC is applicable to mammalian tissue samples. Taken together, we report that FAX can extend the RNA interactome profiling into multicellular organisms.
Focused Ultrasound Thalamotomy for Refractory Essential Tremor: A Japanese Multicenter Single-Arm Study
Authors: Abe Keiichi , Horisawa Shiro , Yamaguchi Toshio , Hori Hiroki , Yamada Kazumichi , Kondo Kimito , Furukawa Hironori , Kamada Hajime , Kishima Haruhiko , Oshino Satoru , Mochizuki Hideki , Kanemoto Manabu , Hirabayashi Hidehiro , Fukutome Kenji , Ohnishi Hideyuki , Igase Keiji , Matsubara Ichiro , Ohnishi Takanori , Sadamoto Kazuhiko , Taira Takaomi
Published: November 2020

BACKGROUND

Several feasibility studies and a randomized, controlled, multicenter trial have demonstrated the safety and efficacy of unilateral transcranial magnetic resonance-guided focused ultrasound (FUS) lesioning of the ventral intermediate thalamic nucleus in treating essential tremor.

OBJECTIVE

To evaluate the safety and efficacy of FUS thalamotomy in a Japanese patient cohort through a prospective, multicenter, single-arm confirmatory trial.

METHODS

A total of 35 patients with disabling refractory essential tremor underwent unilateral FUS thalamotomy and were followed up for 12 post-treatment months. Safety was measured as the incidence and severity of treatment-related adverse events. Efficacy was measured as the tremor severity and quality of life improvements using the Clinical Rating Scale for Tremor and Questionnaire for Essential Tremor.

RESULTS

The mean skull density ratio (SDR) was 0.47. There was a significant decrease in the mean postural tremor score of the treated hand from baseline to 12 mo by 56.4% (95% CI: 46.7%-66.1%; P < .001), which was maintained at last follow-up. Quality of life improved by 46.3% (mean overall Questionnaire for Essential Tremor score of 17.4 [95% CI: 12.1-22.7]) and there were no severe adverse events. The most frequent adverse event was gait disturbance and all events resolved.

CONCLUSION

Unilateral FUS thalamotomy allowed significant and sustained tremor relief and improved the quality of life with an outstanding safety profile. The observed safety and efficacy of FUS thalamotomy were comparable to those reported in a previous multicenter study with a low SDR, and inclusion of the low SDR group did not affect effectiveness.
Switching to Progressively Reduced Nicotine Content Cigarettes in Smokers With Low Socioeconomic Status: A Double-Blind Randomized Clinical Trial
Authors: Krebs Nicolle M , Zhu Junjia , Wasserman Emily , Kuprewicz Robin , Martinez Diane J , Veldheer Susan , Livelsberger Craig , Modesto Jennifer , Reinhart Lisa , Trushin Neil , Reilly Samantha M , Liao Jason , Fazzi Alyse , Bascom Rebecca , Richie John P , Foulds Jonathan , Horn Kimberly , Muscat Joshua E
Published: November 2020

Introduction

The Food and Drug Administration issued an advanced notice of proposed rulemaking for setting a product standard for nicotine levels in cigarettes, with an emphasis on minimally or non-addicting very low nicotine content (VLNC).

Methods

A 33 week, two-arm, double-blind randomized trial conducted in Hershey, Pennsylvania, USA and Washington, DC, USA included adult daily cigarette smokers (≥5 cigarettes per day) with less than a college degree, and who had no plans to quit within the next six months. Participants were randomized to either reduced nicotine content (RNC) study cigarettes tapered every three weeks to a final VLNC (0.2 mg/cigarette) for six weeks or to usual nicotine content (UNC) study cigarettes (11.6 mg/cigarette). Outcomes included acceptability of study cigarettes measured by attrition (primary outcome), compliance, reduction in cigarette dependence and tobacco biomarkers, and post-intervention cessation.

Results

The RNC (n = 122) versus UNC (n = 123) group had higher attrition (adjusted Hazard Ratio 3.4; 95% confidence interval [CI] 1.99 to 5.81). At the end of the intervention, cotinine levels were 50% lower in the RNC group (mean group difference −137 ng/mL; 95% CI −172, −102). The RNC group smoked fewer CPD (−4.1; 95% CI −6.44, −1.75) and had lower carbon monoxide levels (−4.0 ppm; 95% CI −7.7, −0.4). Forty seven percent (29/62) of the RNC group were biochemically-confirmed compliant with smoking VLNC cigarettes (mean cotinine = 8.9 ng/ml). At three month follow-up, only compliant VLNC smokers quit with an assisted quit attempt (N = 6/22, 27%).

Conclusions

This study supports a VLNC standard in cigarettes.

Implications

Differential dropout and noncompliance indicate some smokers had difficulty transitioning to cigarettes with reduced nicotine. These smokers will benefit from supplemental nicotine in medicinal or noncombustible tobacco products if a nicotine reduction standard is established. Other smokers successfully transitioned to very low nicotine content cigarettes exclusively and substantially reduced their exposure to nicotine.
ASSESSING THE RISK ASSOCIATED WITH SIMULTANEOUS EXPOSURE TO MOBILE COMMUNICATION SIGNALS WITHIN 900–2500 MHZ IN NIGERIA
Authors: Ayinmode B O , Farai I P
Published: November 2020

In this study, the total exposure due to signals within GSM 900, GSM 1800, CDMA-1900 and 3G-2100 frequency bands at 200 m from the foot of 120, 100 and 80 base station masts in the Nigerian cities of Lagos, Ibadan and Abuja, respectively, was assessed. A calibrated hand-held spectrum analyser was used to measure the level of power (in dBm) of each signal within the mobile frequency bands. The exposure quotient associated with the combine electric field strengths from the various frequency bands in each city was estimated. The maximum value of total electric field strength at each point in Lagos, Ibadan and Abuja was 0.83 V/m, 0.53 V/m and 1.63 V/m, respectively. This study shows that the exposure quotient due to the simultaneous exposure to the four bands of mobile communication signals in each city is far less than one, as recommend by International Commission on Non-Ionizing Radiation Protection.
Lasting effects of cognitive emotion regulation: neural correlates of reinterpretation and distancing
Authors: Hermann Andrea , Neudert Marie K , Schäfer Axel , Zehtner Raphaela I , Fricke Susanne , Seinsche Rosa J , Stark Rudolf
Published: November 2020

Reinterpretation and distancing are two cognitive reappraisal tactics, used to regulate one’s emotions in response to emotion-eliciting stimuli or situations. Relatively less is known about their (differential) lasting effects on emotional responding and related neural correlates. This functional magnetic resonance imaging study investigated 85 healthy females, participating in a 2-day cognitive emotion regulation experiment. On the first day, participants were instructed to passively look at, reinterpret or distance from repeatedly presented aversive pictures. One week later, they were re-exposed to the same stimuli without regulation instruction, in order to assess lasting effects. The main outcome measures comprised ratings of negative feelings and blood-oxygen-level-dependent responses. Lasting effects for reinterpretation compared with looking at aversive pictures during passive re-exposure 1 week later were reflected in stronger activation of the left amygdala, the ventromedial prefrontal cortex (vmPFC) and reduced negative feelings. Neither distancing compared with looking at aversive pictures nor reinterpretation compared with distancing did result in significant effects during re-exposure. These findings indicate that reinterpretation leads to reduced negative feelings 1 week later, which might be mediated by inhibitory vmPFC activation or stronger positive emotions during re-exposure. However, the missing difference compared with distancing questions the specificity of the results and the mechanisms underlying these two cognitive reappraisal tactics.
Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea
Authors: Alessi Cathy A , Fung Constance H , Dzierzewski Joseph M , Fiorentino Lavinia , Stepnowsky Carl , Rodriguez Tapia Juan C , Song Yeonsu , Zeidler Michelle R , Josephson Karen , Mitchell Michael N , Jouldjian Stella , Martin Jennifer L
Published: November 2020

Study Objectives

Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use.

Methods

125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a “sleep coach” (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected.

Results

Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (−3.2 and −1.7), SOL-D (−16.2 and −15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05).

Conclusions

An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA.

Trial Registration

ClinicalTrials.gov

Study name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older Veterans

URL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist=

Registration: NCT02027558
Efficacy of commercial products on nursery pig growth performance fed diets with fumonisin contaminated corn
Authors: Rao Zhong-Xing , Tokach Mike D , Dritz Steve S , Woodworth Jason C , DeRouchey Joel M , Goodband Robert D , Calderon Hilda I
Published: November 2020

Two experiments were conducted to determine the efficacy of various commercial products on growth performance of nursery pigs fed diets high in fumonisin. In experiment 1, 350 pigs (241 × 600; DNA, Columbus, NE; initially 9.9 kg) were used with five pigs per pen and 14 replicates per treatment. After weaning, pigs were fed common diets for 21 d before the experiment started. The five dietary treatments consisted of a positive control (low fumonisin), a negative control (60 mg/kg of fumonisin B1 + B2 in complete diet), and the negative control with one of three products (0.3% of Kallsil Dry, Kemin Industries Inc., Des Moines, IA; 0.3% of Feed Aid Wide Spectrum, NutriQuest, Mason City, IA; 0.17% of Biofix Select Pro, Biomin America Inc., Overland Park, KS). Diets were fed in mash form for 14 d and followed with a low fumonisin diet for 13 d. For the 14-d treatment period, pigs fed the positive control diet and Biofix Select Pro had greater (P < 0.05) average daily gain (ADG), average daily feed intake (ADFI), and gain:feed (G:F) compared to those fed the high fumonisin negative control, or high fumonisin diets with Kallsil Dry or Feed Aid Wide Spectrum. Serum sphinganine to sphingosine ratios (SA:SO) were greater (P < 0.05) in all pigs fed high fumonisin diets compared to the positive control. In experiment 2, 300 pigs (241 × 600; DNA; initially 10.4 kg) were used. Procedures were similar to experiment 1 except there were 12 replicate pens per treatment, high fumonisin diets contained 30 mg/kg fumonisin, and experimental diets were fed for 28 d. Similar to experiment 1, pigs fed the positive control diet and treatment with Biofix Select Pro had greater (P < 0.05) ADG and G:F, and lower (P < 0.05) serum SA:SO compared to pigs fed the high fumonisin negative control, or high fumonisin diets with Kallsil Dry or Feed Aid Wide Spectrum. In summary, pigs fed diets containing 60 mg/kg of fumonisin for 14 d or 30 mg/kg of fumonisin for 28 d had poorer ADG and G:F and greater serum SA:SO compared to pigs fed a diet with less than 5 mg/kg of fumonisin. Adding Biofix Select Pro to diets appeared to mitigate the negative effects of high fumonisin concentrations, while Kallsil Dry and Feed Aid Wide Spectrum did not.
A global census of physician assistants and physician associates
Authors: Hooker Roderick S. , Berkowitz Oren
Published: November 2020

The physician assistant or physician associate (PA) profession is being adopted in many countries. At a time of improved communication and international exchange of educational methods, no central repository of PA numbers exists. The authors set out to consolidate basic information on PAs. The purpose of the project was to support efforts underway that include the global development of PAs. The prevalence of PAs in each country was obtained using an informant methodology strategy and supplemented with reports and internet validation. Eighteen countries have a PA (similar healthcare professionals with different titles were not included), for an estimated total of more than 132,000 clinically active PAs and 366 training programs. In most countries, PA expansion was reported as being underway.
FOLLOW-UP ADHERENCE IN PATIENTS WITH NONPROLIFERATIVE DIABETIC RETINOPATHY PRESENTING TO AN OPHTHALMIC EMERGENCY DEPARTMENT
Authors: Watane Arjun , Kalavar Meghana , Vanner Elizabeth A. , Cavuoto Kara , Sridhar Jayanth
Published: November 2020

Purpose:

To determine the rate of follow-up after emergent encounters for nonproliferative diabetic retinopathy and to identify patient or visit characteristics associated with follow-up adherence.

Methods:

A retrospective cohort study of patients presenting to an ophthalmic emergency department with nonproliferative diabetic retinopathy between May 2014 and December 2018 was conducted. Demographic and encounter data were gathered. Adherence to follow-up was defined as a completed encounter within 5 weeks of the recommended follow-up.

Results:

A total of 1,248 patients were included. The overall follow-up rate was 53%. Significantly decreased odds of follow-up adherence were associated with longer physician recommended follow-up intervals (odds ratio: 0.81, P < 0.001), longer interval to scheduled appointment (OR: 0.98, P < 0.001), commercial insurance (OR: 0.76, P = 0.01), and lack of any insurance (OR: 0.57, P < 0.01). Significantly increased odds were associated with a longer emergency department visit duration (OR: 1.002, P = 0.001), farther home distance (1.02, P < 0.01), increased likelihood of living in a higher income area (OR: 1.07, P = 0.04), greater NPDR severity (OR: 1.23, P < 0.01), Medicare (OR: 1.38, P = 0.04), presence of macular edema (OR: 1.66, P < 0.001), and worse vision (OR: 1.73, P < 0.001).

Conclusion:

Patients presenting emergently with non-proliferative diabetic retinopathy are at high risk for follow-up nonadherence. Several patient and encounter characteristics were associated with follow-up adherence.
Repeatability of biometry measured by three devices and its impact on predicted intraocular lens power
Authors: Shetty Naren , Kaweri Luci , Koshy Ann , Shetty Rohit , Nuijts Rudy M.M.A. , Sinha Roy Abhijit
Published: November 2020

Purpose:

To compare the repeatability of ocular biometry measured with the LENSTAR LS 900, IOLMaster 700, and Anterion and its impact on predicted intraocular lens (IOL) power.

Setting:

Tertiary eye-care facility in South India.

Design:

Prospective, observational, cross-sectional study.

Methods:

Eyes diagnosed with cataract had 3 consecutive scans on each biometers. The repeatability was assessed using the within-subject standard deviation (Sw), test-retest repeatability, and coefficient of variation (CoV). The agreement was evaluated with the intraclass correlation (ICC). The IOL power was calculated with the Barrett Universal II formula.

Results:

The study comprised 127 eyes of 76 patients. The repeatability of all parameters for a given device were excellent (ICC >0.9, low CoV and Sw). The agreement of the parameters between the biometers was very good (range from 0.93 to 0.99). The predicted IOL power differed statistically between the devices (P < .05), but the difference was clinically insignificant between the 3 biometers (ICC >0.99 for repeat calculation of IOL power).

Conclusions:

All the biometers included in the study had good to excellent repeatability of biometry parameters. The agreement of the predicted IOL power was excellent between the 3 optical biometers.
Quantification of aerosol generation during cataract surgery
Authors: Noureddin Gelareh S. , Iovieno Alfonso , Eslami Maryam , Weaver Travers , Meadows Howard , Yeung Sonia N.
Published: November 2020

Purpose:

To determine whether phacoemulsification cataract surgery is an aerosol-generating medical procedure (AGMP) and, therefore, to help determine the personal protective equipment required by healthcare providers in the era of the COVID-19.

Setting:

The Surgery, Teaching and Research Wet Lab of the Department of Ophthalmology and Visual Sciences, Faculty of Medicine, UBC.

Design:

Laboratory-based simulation.

Methods:

Phacoemulsification cataract surgery was performed on porcine eyes. At a fixed distance, a DRX Aerosol Monitor 8534 (DustTrak) was used to measure particulate matter (PM) mass fractions for each of 3 particle sizes, PM1, PM2.5, and PM4 (in microns), every 2 seconds during surgery and for 1 minute after. The main outcome measure was an increase in the mass fraction of aerosolized particles of various sizes.

Results:

There was no significant aerosolization of particles during cataract surgery for both the 2.4 and 2.75 mm wound sizes.

Conclusions:

Phacoemulsification cataract surgery was not found to be an AGMP. In the midst of the COVID-19 pandemic, ophthalmologists can continue to use droplet precautions while performing this surgery.
Assessing reasons for decreased primary care access for individuals on prescribed opioids: an audit study
Authors: Lagisetty Pooja , Macleod Colin , Thomas Jennifer , Slat Stephanie , Kehne Adrianne , Heisler Michele , Bohnert Amy S.B. , Bohnert Kipling M.
Published: November 2020

Many primary care clinics are resistant to accept new patients taking prescription opioids for chronic pain. It is unclear how much of this practice is specific to individuals who may be perceived to have aberrant opioid use. This study sought to determine whether clinics are more or less willing to accept and prescribe opioids to patients depending on whether their history is more or less suggestive of aberrant opioid use by conducting an audit survey of primary care clinics in 9 states from May to July 2019. Simulated patients taking opioids for chronic pain called each clinic twice, giving one of 2 scenarios for needing a new provider: their previous physician had either (1) retired or (2) stopped prescribing opioids for unspecified reasons. Clinic willingness to continue prescribing opioids and accept the patient for general primary care were assessed. Of 452 clinics responding to both scenarios (904 calls), 193 (43%) said their providers would not prescribe opioids in either scenario, 146 (32%) said their providers might prescribe in both, and 113 (25%) responded differently to each scenario. Clinics responding differently had greater odds (odds ratio = 1.83 confidence interval [1.23-2.76]) of willingness to prescribe when the previous doctor retired than when the doctor had stopped prescribing. These findings suggest that primary care access is limited for patients taking opioids for chronic pain, and differentially further reduced for patients whose histories are suggestive of aberrant use. This denial of care could lead to unintended harms such as worsened pain or conversion to illicit substances.
Robot-assisted artificial urinary sphincter implantation
Authors: Peyronnet Benoit , Gray Gary , Capon Grégoire , Cornu Jean-Nicolas , Van Der Aa Frank
Published: November 2020

Purpose of review

The aim of the present manuscript was to provide an overview on the current state of robotic artificial urinary sphincter (AUS) implantation in male and female patients.

Recent findings

Over the past few years, several series have been reported, with promising outcomes for the most part. This has contributed to expand the use of bladder neck AUS, especially in female patients, which was, until then, hampered by its perioperative morbidity.

Robotic AUS has been developed to overcome the technical challenge of bladder neck implantation in female patients and in specific male subgroups, especially self-catheterizing neurological patients. All the series of robotic AUS implantation published in the past few years reported much lower rates of cuff erosion and AUS explantation than the historical open cohorts suggesting that the robotic approach might become the standard for female AUS implantation. This less morbid approach along with technological improvement of the AUS device may contribute to make it a more popular option in the treatment of female stress urinary incontinence due to intrinsic sphincter deficiency. There are much less data available on robotic bladder neck AUS implantation in male patients.
A follow-up study shows no new infections caused by patients with repeat positive of COVID-19 in Wuhan
Authors: Wu Xiaomin , Wang Zengmiao , He Zhenyu , Li Yapin , Wu Yating , Wang Huaiji , Liu Yonghong , Hao Fanghua , Tian Huaiyu
Published: November 2020

Background

It has been reported that a few recovered COVID-19 patients could suffer repeat positive, testing positive for the SARS-CoV-2 virus again after they were discharged from hospital. Understanding the epidemiological characteristics of patients with repeat positive is vital in preventing a second wave of COVID-19.

Methods

In this study, the epidemiological and clinical features for 20,280 COVID-19 patients from multiple centers between 31 December 2019 and 4 August 2020 in Wuhan were collected and followed. In addition, the RT-qPCR testing results for 4,079 individuals who had close contact with the patients suffering repeat positive were also obtained.

Results

2,466 (12.16%) of 20,280 patients presented with a repeat positive of SARS-CoV-2 after they were discharged from hospital. 4,079 individuals had close contact with them. The PCR result were negative for the 4,079 individuals.

Conclusions

By a follow-up study in Wuhan, we show the basic characteristics of patients with repeat positive and no new infections caused by patients with repeat positive of COVID-19.
Are pregnant women satisfied with perinatal standards of care during COVID-19 pandemic?
Authors: Ravaldi Claudia , Mosconi Laura , Crescioli Giada , Ricca Valdo , Vannacci Alfredo
Published: November 2020

COVID-19 restrictive measures severely impacted maternity services worldwide, but little is known about the differences in women’s concerns, perception of the modifications of maternity services and childbirth programs at different times during the pandemic. Here we report data from the first COVID-19 wave in Italy, during the 2020 national lockdown (March-April) and soon after lockdown release (May).

1307 pregnant women answered the survey during national lockdown (phase 1) or after restrictive measures were released (phase 2). Women reported a significantly higher COVID-19 concern during phase 1 than during phase 2 (2.34 SD 0.5 vs 2.12 SD 0.5 on a Likert scale 0-3; p<0.001). Several domains of perinatal care were affected during COVID-19 lockdown: while antenatal visits, the use of technology to keep in touch with healthcare professionals, and closeness of caregivers were generally more appreciated (especially during phase 2), women reported the greatest difficulties in receiving clear information on hospitalization, birth plan and partner’s presence at birth.

Italian pregnant women’s worries about the effects of the pandemic on health and their perception of quality in the organization of maternity services improved during lockdown, but they continued to represent a challenge in May, especially regarding organizational aspects of hospitalization and childbirth.
Comprehensive genomic profiling of 30,000 consecutive solid tumors
Authors: Tomlins Scott A. , Hovelson Daniel H. , Suga Jennifer M. , Anderson Daniel M. , Koh Han A. , Dees Elizabeth C. , McNulty Brendan , Burkard Mark E. , Guarino Michael , Khatri Jamil , Safa Malek M. , Matrana Marc R. , Yang Eddy S. , Menter Alex R. , Parsons Benjamin M. , Slim Jennifer N. , Thompson Michael A. , Hwang Leon , Edenfield William J. , Nair Suresh , Onitilo Adedayo , Siegel Robert , Miller Alan , Wassenaar Timothy , Irvin William J. , Schulz William , Padmanabhan Arvinda , Harish Vallathucherry , Gonzalez Anneliese , Mansoor Abdul Hai , Kellum Andrew , Harms Paul , Drewery Stephanie , Falkner Jayson , Fischer Andrew , Hipp Jennifer , Kwiatkowski Kat , de la Vega Lorena Lazo , Mitchell Khalis , Reeder Travis , Siddiqui Javed , Vakil Hana , Johnson D. Bryan , Rhodes Daniel R.
Published: November 2020

Purpose

Tissue-based comprehensive genomic profiling (CGP) is increasingly utilized for treatment selection in patients with advanced solid tumors, however real-world tissue availability may limit widespread implementation. Here we established real-world CGP tissue availability and assessed CGP performance on consecutively received samples.

Patients and Method

Post-hoc, non-prespecified analysis of 32,048 consecutive tumor tissue samples received for StrataNGS, a multiplex PCR based-CGP (PCR-CGP) test, as part of an ongoing observational trial (NCT03061305). Tumor tissue sample characteristics and PCR-CGP performance were assessed across all tested tumor samples, including exception samples not meeting minimum input requirements (<20% tumor content [TC], <2mm2 tumor surface area [TSA], DNA or RNA yield <1ng/ul, or specimen age >5yrs). Tests reporting at least one prioritized alteration or meeting all sequencing QC metrics (and ≥20% TC) were considered successful. For prostate carcinoma and lung adenocarcinoma, tests reporting at least one actionable/informative alteration or those meeting all sequencing QC metrics (and ≥20% TC) were considered actionable.

Results

PCR-CGP was attempted in 31,165 of 32,048 (97.2%) consecutively received solid tumor tissue samples. Among the 31,165 tested samples, 10.7% had low (<20%) tumor content (TC) and 58.4% were small (<25mm2 TSA), highlighting the challenging nature of samples received for CGP. Of the 31,101 samples evaluable for input requirements, 8,079 (26.0%) were exceptions not meeting requirements. However, 94.2% of the 31,101 tested samples were successfully reported, including 80.6% of exception samples. Importantly, 80.6% of 1,344 tested prostate carcinomas and 87.8% of 1,144 tested lung adenocarcinomas yielded results informing treatment selection.

Conclusion

Most real-world tumor tissue samples from patients with advanced cancer desiring CGP are limited, requiring optimized CGP approaches to produce meaningful results. An optimized PCR-CGP test, coupled with an inclusive exception testing policy, delivered reportable results for >94% of samples, potentially expanding the proportion of CGP-testable patients, and thus the impact of biomarker-guided targeted and immunotherapies.