bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of disease duration and other characteristics on efficacy outcomes in clinical trials of tocilizumab for rheumatoid arthritis
Authors: Rubbert-Roth Andrea , Aletaha Daniel , Devenport Jenny , Sidiropoulos Paris N , Luder Yves , Edwardes Michael D , Jacobs Johannes W G
Published: April 2020

Objective

To determine the extent to which disease duration, alone or in combination with other baseline clinical and non-clinical factors, explains variations in outcome of tocilizumab initiated in biologic-naïve patients with established RA.

Methods

In this pooled analysis of phase 3 and 4 clinical trials conducted by the sponsor, predictors of response, including demographics, disease characteristics at baseline (start of tocilizumab dosing) and study characteristics (e.g. patient inclusion criteria, tocilizumab dosing regimen) were evaluated. Response was measured as change from baseline to week 24 in Clinical Disease Activity Index (CDAI) and HAQ–Disability Index (HAQ-DI) scores and as the proportions of patients who experienced ≥50% improvement based on ACR criteria (ACR50) and CDAI remission (≤2.8) rates at week 24.

Results

Improvements in all outcomes investigated were observed in patients receiving tocilizumab. Although disease duration was statistically significant in the models, it accounted for <2% of variation in CDAI and HAQ-DI score changes from baseline to week 24; baseline CDAI and HAQ-DI values accounted for 32% and 15% of variations, respectively. Doubling of disease duration reduced the odds of achieving an ACR50 response by only 9%, and each additional 5-year period of disease duration decreased the odds of achieving CDAI remission by only 15%.

Conclusion

RA duration, alone or in combination with other baseline characteristics, had a statistically significant but clinically small effect on the outcomes of tocilizumab initiated in biologic-naïve patients with established RA.
Effect of biologic disease-modifying anti-rheumatic drugs targeting remission in axial spondyloarthritis: systematic review and meta-analysis
Authors: Cruz-Machado Ana Rita , Rodrigues-Manica Santiago , Silva Joana Leite , Alho Irina , Coelho Constança , Duarte Joana , Florêncio Cláudia , Pimentel-Santos Fernando M , Tavares-Costa José , Vieira-Sousa Elsa
Published: April 2020

Objectives

To assess the efficacy of biologic DMARDs (bDMARDs) in achieving Assessment of Spondyloarthritis International Society partial remission (ASAS-PR) and/or Ankylosing Spondylitis Disease Activity Score inactive disease (ASDAS-ID), as remission-like surrogates, in axial SpA (axSpA).

Methods

Data from randomized controlled trials (RCTs), including long-term extensions, were included. A systematic literature review was performed using the MEDLINE database (first search May 2018, updated February 2020) and PICO criteria according to Patients—adults with radiographic or non-radiographic axSpA; Intervention—any bDMARD; Comparator—placebo and/or any different drug; Outcomes—ASAS-PR and/or ASDAS-ID as primary or secondary endpoints. Meta-analysis was performed after assessment of the homogeneity of study designs, populations and outcomes.

Results

After screening 155 references, a total of 22 RCTs and 28 long-term extensions were retrieved. ASAS-PR was the dominant remission-like definition used. Concerning TNF inhibitors, 14/17 RCTs provided evidence of efficacy in reaching remission at different time points: 12, 16, 24 and 28 weeks (ASAS-PR in 16–62% of patients and ASDAS-ID in 24–40% of patients). With a limited number of studies available, IL-17A inhibitors exhibited remission rates of 15–21% for ASAS-PR and 11–16% for ASDAS-ID at week 16. A meta-analysis regarding ASAS-PR was performed considering RCTs with a similar duration (12, 16 or 24 weeks). The relative risk for achieving remission was 3.864 (95% CI 2.937, 5.085).

Conclusion

bDMARDs have a clear impact in axSpA remission evaluated by ASAS-PR. Nevertheless, these data show an unmet need for improved reporting of remission-like outcomes.
ASSESSMENT OF ADULT DIAGNOSTIC REFERENCE LEVELS IN INTRAORAL RADIOGRAPHY IN TAMIL NADU REGION, INDIA
Authors: Jose Amal , Saravana Kumar A , Govindarajan K N , Manimaran P
Published: April 2020

In the present study, incident air kerma has been measured, for six intraoral examinations, for establishing regional adult diagnostic reference levels (DRLs), in intraoral radiography, in Tamil Nadu, India. A total of 131 units, both digital (semiconductor-based) and analog (film-based) radiography systems, were selected for the study. The third quartile values, for the six intraoral examinations selected for the present study, ranged from 1.2 to 2.0 mGy, for the adult settings. The results showed a wide range of patient doses existing across the clinics or hospitals studied. This is the primary study for the establishment of adult intraoral DRL, in Tamil Nadu, one of the major states of the country. Similar studies will be undertaken in other major states across the country to establish national DRLs in intraoral radiography in the country.
Mapping the probability of detecting Burkholderia pseudomallei in rural rice paddy soil based on indicator kriging and spatial soil factor analysis
Authors: Saengnill Wacharapong , Charoenjit Kitsanai , Hrimpeng Karnjana , Jittimanee Jutharat
Published: April 2020

Background

Melioidosis is an infectious disease commonly found in Thailand. This infectious disease is caused by Burkholderia pseudomallei in soil. This study aims to analyze the association between spatial soil factors and B. pseudomallei detection, as well as to map the probability of B. pseudomallei contamination based on indicator kriging in paddy soil.

Methods

Seventy-eight soil samples were collected randomly on 22 April 2018 in various paddy fields. Oxidase, Gram staining and monoclonal antibody-based latex agglutination assays were performed to confirm the presence of B. pseudomallei in soil samples. The association between B. pseudomallei detection and spatial soil factors including soil temperature, soil pH, soil texture and soil drainage were analyzed by the Mann–Whitney U test and χ2 test. Subsequently, a semivariogram model and indicator kriging were used to map the probability of B. pseudomallei contamination.

Results

Of the 78 samples, B. pseudomallei was detected in 32 (41.03%). The presence or absence of B. pseudomallei was not significantly associated with spatial soil factors. The semivariogram model showed that the lag distance between positive B. pseudomallei samples was 90.51 m.

Conclusion

The empirical semivariogram and indicator kriging are an alternative option for predicting the spatial distribution of B. pseudomallei in soil.
Sexually dimorphic characters and shared aposematic patterns mislead the morphology-based classification of the Lycini (Coleoptera: Lycidae)
Authors: Kusy Dominik , Motyka Michal , Fusek Lukas , Li Yun , Bocek Matej , Bilkova Renata , Ruskova Michaela , Bocak Ladislav
Published: April 2020

The Lycini (Elateroidea: Lycidae) contains > 400 species placed in four typologically based genera and numerous subgenera. We assembled a mito-ribosomal dataset representing ~100 species from the whole range and recovered a phylogeny rejecting Lycus and Lycostomus as polyphyletic assemblages. The male-specific wide elytra and elytral thorns are identified in unrelated Neolycus and Lycus. The morphological similarity based on sexual dimorphism and aposematic patterns defined terminal clades and misled the genus-rank classification. We delimit Neolycus, Rhyncheros reinst. name (= Thoracocalon syn. nov. = Lyconotus syn. nov.), LipernesLycostomus, Haplolycus and Lycus. Demosis and six subgenera of Lycus are synonymized with Lycus. Celiasis Laporte, 1840 is kept in the classification as a nomen dubium until any specimen is available. The deep lineages are known from the Americas and Asia. Africa was colonized by Lycus and Haplolycus. Each specific aposematic pattern occurs in a limited range, and the similar body shape and coloration evolved in unrelated sympatrically occurring lineages. High intraspecific polymorphism is putatively a result of the adaptation of various populations to local mimetic assemblages. Therefore, the delimitation of many phenotypically diverse species should be investigated.
Identification and Characterization of Two Novel Geminiviruses Associated with Paper Mulberry (Broussonetia papyrifera) Leaf Curl Disease
Authors: Qiu Yuanjian , Zhang Song , Yu Haodong , Xuan Zhiyou , Yang Liu , Zhan Binhui , Murilo Zerbini F. , Cao Mengji
Published: April 2020

Paper mulberry (Broussonetia papyrifera) is a perennial woody plant used as source material for Cai Lun paper making, in traditional Chinese medicine, and as livestock feed. To identify the presence of viruses in paper mulberry plants affected by a disease with leaf curl symptoms, high-throughput sequencing of total RNA was performed. Analysis of transcriptome libraries allowed the reconstruction of two geminivirus-like genomes. Rolling-circle amplification and PCR with back-to-back primers confirmed the presence of two geminiviruses with monopartite genomes in these plants, with the names paper mulberry leaf curl virus 1 and 2 (PMLCV-1 and PMLCV-2) proposed. The genomes of PMLCV-1 (3,056 nt) and PMLCV-2 (3,757 to 3,763 nt) encode six proteins, with the V4 protein of PMLCV-1 and the V3 proteins of both viruses having low similarities to any known protein in databases. Alternative splicing of an intron, akin to that of mastre-, becurto-, capula-, and grabloviruses, was identified by small RNA (sRNA)-seq and RNA-seq reads mapping to PMLCV-1 and PMLCV-2 antisense transcripts. Phylogenetic analyses and pairwise comparisons showed that PMLCV-1 and PMLCV-2 are most closely related to, but distinct from, two unassigned geminiviruses, citrus chlorotic dwarf associated virus and mulberry mosaic dwarf associated virus, suggesting that they are two new members of the family Geminiviridae. Field investigation confirmed the close association of the two viruses with leaf curl symptoms in paper mulberry plants and that coinfection can aggravate the symptoms.
The Duke Hotspotting Initiative: Providing Meaningful Clinical Experiences and Improving Clinical Readiness for First-Year Medical Students
Authors: Bunning Thomas , Goodwin Matthew , Barney Emily , Thakkar Aarti , Clay Alison S.
Published: April 2020

Problem

Many medical schools now incorporate meaningful clinical experiences for first-year medical students (MS1s). However, these clinical placements often fail to teach components of the physician experience, including health care logistics, cost-conscious care, longitudinal patient care, and interaction with an interprofessional team. The Duke Hotspotting Initiative (DHSI) is a student-led elective longitudinal experience for MS1s to serve as a patient’s health care liaison to encourage proactive health management and efficient use of resources.

Approach

DHSI is a combined didactic-clinical experience at Duke University School of Medicine. Students complete a didactic curriculum to develop relevant skills and maintain weekly contact with a patient in Durham, North Carolina, for the duration of the academic year. In their meetings with patients, students help them set and monitor health goals, identify and address barriers to health resources, and efficiently access primary care. Across 2 academic years (2017–2018 and 2018–2019), 54 MS1s were surveyed electronically before and after their participation in DHSI. They were asked about their comfort navigating various patient management scenarios, using communication tools, and assuming clinical responsibilities.

Outcomes

DHSI offers MS1s a unique immersive opportunity to gain experience applying the clinical skills they will need in their future careers. Based on comparisons of responses from the 48 students (89%) who completed the pre-DHSI survey and 40 students (74%) who completed the post-DHSI survey, there was a significant increase in comfort with communication and patient advising, managing common chronic diseases, using interview skills, and assuming clinical responsibilities.

Next Steps

DHSI continues to expand in both size and scope, with the goal of incorporating team members from other health professions training programs at multiple institutions. Future analysis will investigate the longer-term impact of the program on students’ professional development, objective changes in clinical skills, and outcomes for patients involved with DHSI.
Augmented intelligence in pediatric anesthesia and pediatric critical care
Authors: Görges Matthias , Ansermino J. Mark
Published: April 2020

Purpose of review

Acute care technologies, including novel monitoring devices, big data, increased computing capabilities, machine-learning algorithms and automation, are converging. This enables the application of augmented intelligence for improved outcome predictions, clinical decision-making, and offers unprecedented opportunities to improve patient outcomes, reduce costs, and improve clinician workflow. This article briefly explores recent work in the areas of automation, artificial intelligence and outcome prediction models in pediatric anesthesia and pediatric critical care.

Recent findings

Recent years have yielded little published research into pediatric physiological closed loop control (a type of automation) beyond studies focused on glycemic control for type 1 diabetes. However, there has been a greater range of research in augmented decision-making, leveraging artificial intelligence and machine-learning techniques, in particular, for pediatric ICU outcome prediction.

Most studies focusing on artificial intelligence demonstrate good performance on prediction or classification, whether they use traditional statistical tools or novel machine-learning approaches. Yet the challenges of implementation, user acceptance, ethics and regulation cannot be underestimated. Areas in which there is easy access to routinely labeled data and robust outcomes, such as those collected through national networks and quality improvement programs, are likely to be at the forefront of the adoption of these advances.
Sugammadex and neuromuscular reversal: special focus on neonatal and infant populations
Authors: Grigg Eliot
Published: April 2020

Purpose of review

Sugammadex is a novel selective muscle relaxant binding agent capable of reversing deep neuromuscular blockade from rocuronium or vecuronium. It has not been approved for use in children by the US FDA because of lack of literature regarding pediatric patients.

Recent findings

A series of new studies has reported sugammadex administration to increasingly younger patients ranging in the newborn period. Although the literature in pediatrics is improving, most of the available studies in pediatrics are underpowered, retrospective, and measure too many different variables to draw reliable, collective conclusions.

All available evidence suggests that sugammadex is likely well tolerated and effective and can be dosed similarly to adults in patients 2 years’ old and greater. Sugammadex should be used with caution in patients less than 2 years old.
State of the art in clinical decision support applications in pediatric perioperative medicine
Authors: Wang Ellen , Brenn B. Randall , Matava Clyde T.
Published: April 2020

Purpose of review

The goal of this review is to describe the recent improvements in clinical decision tools applied to the increasingly large and complex datasets in the pediatric ambulatory and inpatient setting.

Recent findings

Clinical decision support has evolved beyond simple static alerts to complex dynamic alerts for: diagnosis, medical decision-making, monitoring of physiological, laboratory, and pharmacologic inputs, and adherence to institutional and national guidelines for both the patient and the healthcare team. Artificial intelligence and machine learning have enabled advances in predicting outcomes, such as sepsis and early deterioration, and assisting in procedural technique.

With more than a decade of electronic medical data generation, clinical decision support tools have begun to evolve into more sophisticated and complex algorithms capable of transforming large datasets into succinct, timely, and pertinent summaries for treatment and management of pediatric patients. Future developments will need to leverage patient-generated health data, integrated device data, and provider-entered data to complete the continuum of patient care and will likely demonstrate improvements in patient outcomes.
Anesthetic considerations for repeat cesarean section
Authors: Ioscovich Alexander , Gozal Yaacov , Shatalin Daniel
Published: April 2020

Purpose of review

The prevalence of cesarean delivery is increasing worldwide despite the advance of Trial of Labor After Cesarean section. In many countries, a history of previous cesarean section is an almost absolute indication for a repeat cesarean section. The purpose of this review was to examine if the perioperative anesthetic management of patients with repeat cesarean section is different from the anesthetic management of patients with primary cesarean section.

Recent findings

This review discusses important topics, such as early diagnosis of cases with a potentially high risk for complications; the need for assessment of patients diagnosed with abnormal placentation; the importance of a multidisciplinary approach that includes interaction of the anesthesiologist, gynaecologist, and invasive radiologist; emphasizing the need for reinforcement of new methods of invasive procedures; management of massive bleeding, use of new technologies, and development of an institutional protocol for management of patients with abnormal placentation.

According to this review, we show that the management of patients with repeat cesarean section without abnormal placentation is almost the same as the management of patients for primary cesarean section. Timely diagnosis of patient with abnormal placentation and multidisciplinary approach is crucial for prevention of morbidity or even mortality.
Fetal anesthesia: intrauterine therapies and immediate postnatal anesthesia for noncardiac surgical interventions
Authors: Nelson Olivia , Simpao Allan F. , Tran Kha M. , Lin Elaina E.
Published: April 2020

Purpose of review

This review describes maternal and fetal anesthetic management for noncardiac fetal surgical procedures, including the management of lower urinary tract obstruction, congenital diaphragmatic hernia (CDH), myelomeningocele, sacrococcygeal teratoma, prenatally anticipated difficult airway and congenital lung lesions.

Recent findings

Fetal interventions range from minimally invasive fetoscopic procedures to mid-gestation open surgery, to ex-utero intrapartum treatment procedure. Anesthetic management depends on the fetal intervention and patient characteristics. Anesthesia for most minimally invasive procedures can consist of intravenous sedation and local anesthetic infiltration in clinically appropriate maternal patients. Open fetal and ex-utero intrapartum treatment procedures require maternal general anesthesia with volatile anesthetic and other medications to maintain uterine relaxation. Tracheal balloons are a promising therapy for CDH and can be inserted via minimally invasive techniques. Management of the prenatally anticipated difficult airway during delivery and removal of tracheal balloons from patients with CDH during delivery can be clinically dynamic and require flexibility, seamless communication and a high-functioning, multidisciplinary care team.

Maternal and fetal anesthetic management is tailored to the fetal intervention and the underlying health of the fetus and mother.
Unilateral Laminectomy by Endoscopy in Central Lumbar Canal Spinal Stenosis
Authors: Sun Fenglong , Liang Qingchen , Yan Ming , Wang Hongqing , Liu Zuyao , Li Fu , Dong Jie , Liu Tiejun
Published: April 2020

Study Design.

Retrospective study.

Objective.

To evaluate the outcomes and safety of endoscopic laminectomy for central lumbar canal spinal stenosis.

Summary of Background Data..

Spinal endoscopy is mostly used in the treatment of lumbar disc herniation, while endoscopic laminectomy for lumbar spinal stenosis is rarely reported.

Methods.

From January 2016 to June 2017, 38 patients with central lumbar canal spinal stenosis were treated with endoscopic laminectomy. Clinical symptoms were evaluated at 1, 3, 6, and 12 months and the last follow-up after surgery. Functional outcomes were assessed by using the Japanese Orthopedic Association Scores (JOA) and Oswestry Disability Index (ODI). The decompression effect was assessed by using the dural sac cross-sectional area (DSCA). Lumbar stability was evaluated using lumbar range of motion (ROM), ventral intervertebral space height (VH), and dorsal intervertebral space height (DH).

Results.

The mean age of the cases was 60.8 years, the mean operation time was 66.3 minutes, the blood loss was 38.8 mL, and the length of incision was 19.6 mm. The mean time in bed was 22.3 hours, and the mean hospital stay was 8.8 days. JOA scores were improved from 10.9 to 24.1 (P < 0.05), ODI scores were improved from 79.0 to 27.9 (P < 0.05), DSCA was improved from 55.7 to 109.5 mm2 (P < 0.05), ROM scores were improved from 5.6° to 5.7° (P < 0.05), and DH scores were reduced from 6.6 to 6.5 mm (P < 0.05). There was no significant difference in VH before and after operation (P > 0.05). There were no serious complications during the follow-ups.

Conclusion.

Endoscopic laminectomy had the advantage of a wider view, which was effective, safe, and less invasive for lumbar spinal stenosis.

Level of Evidence: 5
Using 6 Degrees of Freedom to Systematically Reduce and Fix Distal Radius Fractures
Authors: Gordon Adam M. , Perez Eric , Goyal Kanu S.
Published: April 2020

Six degrees of freedom (6DOF) refers to the freedom of movement of a rigid body in 3-dimensional space. Specifically, the object can move in 3 translations: up/down, left/right, and in/out, and in 3 rotations: pitch, yaw, and roll. In fracture care, the principle of 6DOF can be applied to each individual fracture fragment to help better understand fracture reduction and alignment. In the instance of a distal radius fracture, the 6DOF concept can be utilized to reduce the articular block in a systematic and controlled fashion. The articular block may be displaced in 3 translations—shortened (proximal/distal axis), dorsally translated (volar/dorsal axis), and radially translated (radial/ulnar axis). The articular block may also be displaced in 3 rotations—dorsally tilted (rotated about the radial/ulnar axis or in the sagittal plane), decreased radial inclination (rotated about the volar/dorsal axis or in the coronal plane), and supinated (rotated about the proximal/distal axis or in the axial plane). We present a surgical technique of open reduction and internal fixation of a distal radius fracture through a volar approach where we address the distal segment’s instability in 6DOF in a stepwise format.
Timing of Onset, Burden, and Postdischarge Mortality of Persistent Critical Illness in Scotland, 2005–2014: A Retrospective, Population-Based, Observational Study
Authors: Shaw Martin , Viglianti Elizabeth M. , McPeake Joanne , Bagshaw Sean M. , Pilcher David , Bellomo Rinaldo , Iwashyna Theodore J. , Quasim Tara
Published: April 2020

Objectives:

We aimed to understand the prevalence, timing of onset, resource use, and long-term outcomes of patients who developed persistent critical illness in a national dataset.

Design:

Retrospective cohort. Using a physiologic risk adjustment model from ICU admission, we examined the relative ability of acute (related to reason for ICU presentation) and antecedent (demographics, comorbidities) characteristics to discriminate hospital mortality models. Persistent critical illness was defined as the point during an ICU stay when, at the population-level, patients’ acute diagnoses and physiologic disturbance are no longer more accurate at discriminating who survives than are baseline demographics and comorbidity. We examined the change across ICU stay in the relative discrimination of those characteristics, and short-term (in-hospital and 30 d after admission) and medium-term (90 d after admission) survival. Finally, we analyzed the changes in the population definition of persistent critical illness over time.

Setting:

Patients admitted as level 3 to Scottish ICUs between 2005 and 2014.

Patients:

Seventy-two–thousand two-hundred fifty-three adult level 3 ICU admissions in 23 ICUs across Scotland.

Interventions:

None.

Measurements and Main Results:

The onset of persistent critical illness, occurs at an average of 5.0 days (95% CI, 3.9–6.4 d) across this dataset. The crossing point increased across the decade, by an average of 0.36 days (95% CI, 0.22–0.50 d) per year. In this dataset, 24,425 (33.8%) remained in the ICU long enough to meet this greater than 5-day definition of persistent critical illness. The care of such patients involved 72.3% ICU days used by any level 3 patient; 46.5% of all Scottish ICU bed-days were after day 5. Although rates of 30 days after admission survival rose dramatically during the decade under study, these rates were similar for those with shorter or longer ICU stays, as were the rates of 90-day survival among those who survived at least 30 days.

Conclusions:

Persistent critical illness occurred in one in three ICU patients in Scotland. These minority of patients accounted for disproportionate hospital resources but did not have worse 30- or 90-day postadmission survival.
Distinguishing melanophages from tumor in melanoma patients treated with talimogene laherparepvec
Authors: Audrey-Bayan Claire , Trager Megan H. , Gartrell-Corrado Robyn D. , Rizk Emanuelle M. , Pradhan Jaya , Silverman Andrew M. , Lopez Adriana , Marks Douglas K. , Niedt George , Geskin Larisa J. , Saenger Yvonne M.
Published: April 2020

Response to talimogene laherparepvec (T-Vec) is difficult to assess as pigmented macrophages that have ingested melanoma cells (‘melanophages’) persist after injection, mimicking melanoma. We used quantitative immunofluorescence (qIF) to (1) distinguish melanophages from melanoma in biopsies from two patients treated with T-Vec and (2) evaluate the tumor microenvironment pretreatment and posttreatment. Tissues were stained with 4’,6-diamidino-2-phenylindole, cluster of differentiation (CD) 3, CD8, CD68, human leukocyte antigen-DR isotype (HLA-DR), and SRY-Box Transcription Factor 10 (SOX10), and multispectral images were analyzed. Post-T-Vec samples showed melanophages with cytoplasmic costaining of CD68, SOX10, and HLA-DR, without nuclear SOX10 expression. qIF revealed a dense immune infiltrate of CD3+, CD8+, and CD68+ cells in post-T-Vec samples. Melanophages from tumors post-T-Vec stain the nuclear melanoma marker SOX10 in their cytoplasms as compared to melanoma cells that stain nuclear SOX10. This novel finding highlights the phagocytosis of melanoma cell components by macrophages after treatment with T-Vec. qIF may assist pathologists in determining whether lesions treated with immunotherapy contain residual viable melanoma.
The Relative Economy and Drug Overdose Deaths
Authors: Rudolph Kara E. , Kinnard Elizabeth N. , Aguirre Ariadne Rivera , Goin Dana E. , Feelemyer Jonathan , Fink David , Cerda Magdalena
Published: April 2020

Background:

Overdose deaths increased exponentially in the United States to be the leading cause of adult injury deaths, and declining economic opportunity may contribute. To our knowledge, there has been no quantitative research into the impact of relative economic measures on overdose risk. Prior longitudinal studies on impact of socioeconomic conditions used fixed effects approaches that can result in biased estimates in the presence of time-varying confounders.

Methods:

We estimated county-level longitudinal associations between drug overdose deaths and unemployment and labor-force nonparticipation rates by gender and racial/ethnic subgroup using longitudinal g-computation and the clustered bootstrap.

Results:

We find evidence for associations between both overall and relative aspects of unemployment and labor-force nonparticipation and drug overdose mortality; patterns of associations differed, sometime qualitatively, across subgroups. For males across racial-ethnic groups, greater overall and relative unemployment rates were generally associated with greater overdose mortality in both the short and long terms [e.g., for white males, increasing the overall percentage of unemployed adults by 5% points in 2000, 2009, and 2015 is associated with an increase of 3.2 overdose deaths (95% confidence interval [CI] = −2.8, 14) in 2015, and increasing the ratio by 0.5 in 2000, 2009, and 2015 is associated with an increase of 9.1 overdose deaths (95% CI = 1.6, 24)].

Conclusions:

These findings point to important complexity in how the economic and contextual landscape differentially shapes overdose risks, underscoring a need for increased understanding of the mechanisms operating for women and minority groups.
Health Risk Behaviors and Resilience Among Low-Income, Black Primary Care Patients
Authors: Goldstein Ellen , Benton Susan Flowers , Barrett Bruce
Published: April 2020

This study describes an intervention with low-income, Black primary care patients and their experience in changing a health risk behavior. Participant themes, including behavioral coping, personal values, accomplishments and strengths, barriers and strategies, and social support, are understood in relationship to health behavior theories. Two structured interviews were conducted 1 month apart. Content analysis was used to analyze responses from 40 participants. Participants were well equipped with resilience-based coping, self-efficacies, and informal social networks despite economic and social disadvantages. Findings from this study have the potential to improve behavioral health coping and reduce racial inequities in health prevalent for this population.
Frozen embryo transfer and preeclampsia: where is the link?
Authors: Dall’Agnol Henrique , García Velasco Juan A.
Published: April 2020

Purpose of review

Preeclampsia is the leading cause of maternal death and has a higher incidence in patients undergoing assisted reproduction treatments. New studies about the mechanisms by which it is more frequent in this population have emerged. The purpose of this review is to gather current information about the available results on this correlation and its possible physiopathology.

Recent findings

Recent publications on the physiopathology of preeclampsia indicate that the corpus luteum is the main source of hormonal production until placental formation and that apart from the secretion of estrogen and progesterone, corpus luteum also produces important substances involved in maternal circulatory adaptation, such as relaxin.

With the recent increasing number of frozen embryos transfer in natural cycles or under hormonal replacement, this adaptive circulatory process may be unbalanced and predispose this population to preeclampsia.

This article provides a review of frozen embryo transfer and available protocols, the highest incidence of gestational hypertensive disorders presented by the infertile population and an overview of the possible impact of the absence of corpus luteum on the genesis of this disease.
Neurodevelopmental Impairment at 1 Year of Age in Infants With Previous Invasive Group B Streptococcal Sepsis and Meningitis
Authors: Nakwa Firdose L. , Lala Sanjay G. , Madhi Shabir A. , Dangor Ziyaad
Published: April 2020

Background:

Invasive group B streptococcal (GBS) disease causes considerable morbidity and mortality in young infants, and 18% of GBS-meningitis survivors have moderate-to-severe neurodevelopmental impairment. However, there is a paucity of data regarding neurologic impairment following GBS sepsis.

Methods:

A case–control study was undertaken in infants at 3 secondary–tertiary hospitals in Johannesburg, South Africa. Neurodevelopmental assessments were done at 1 year of age using the Denver II Developmental screening tool. A case was defined as isolation of GBS from blood or cerebrospinal fluid in infants less than 90  days of age. Three healthy controls (range: 1–6) were matched to maternal age, maternal HIV-infection status, gestational age and timing of enrollment.

Results:

Of 122 invasive GBS cases, 78 (63.9%) had sepsis and 44 (36.1%) meningitis. Twenty-two (18%) invasive GBS cases (17 of 78; 21.8% with sepsis and 5 of 44; 11.4% with meningitis) died during the course of hospitalization, and a further 2 (1.6%; 1 sepsis and 1 meningitis case) died by 1 year of age. Five (1.1%) of 449 controls died by 1 year of age. Of the 45 GBS sepsis cases and 141 matched controls followed through to 1 year of age, 11 (24.4%) cases (3 with moderate-to-severe impairment) and 10 (7.1%) controls had an abnormal Denver score with an adjusted (for gender) odds ratio of 3.51; 95% confidence interval (CI): 1.23–10.04; P = 0.019. Four (20%) of the 20 GBS meningitis cases compared with 1 (1.5%) control had neurologic impairment at 1-year of age (aOR: 8.29; 95% CI: 0.88–78.3; P = 0.065)

Conclusion:

In this setting, invasive GBS disease is associated with a high mortality. Infant survivors of invasive GBS sepsis compared with controls had 3.5-fold greater odds of neurologic impairment by 1 year of age. This corroborates the need for strategies to prevent invasive GBS disease.
Acute Childhood Viral Encephalitis in Southern Brazil
Authors: Valle Daniel Almeida do , Santos Mara Lúcia Schmitz Ferreira , Giamberardino Heloísa Ihle Garcia , Raboni Sonia Mara , Scola Rosana Herminia
Published: April 2020

Background:

Viral meningoencephalitis is highly heterogeneous, varying by geographic location. The aim of this study was to characterize the etiology and reporting the clinical findings and outcome of viral encephalitis in children in southern Brazil.

Methods:

A cross-Sectional study was conducted at Hospital Pequeno Príncipe, Curitiba, Brazil, between January 2013 and December 2017. It included patients younger than 18 years, who fulfilled the criteria: altered mental status as a major criteria and 2 or more minor criteria (1) fever, (2) seizures, (3) focal neurologic findings, (4) central system fluid white cell count of ≥5 cells/mm3, (5) abnormal brain imaging, and/or (6) electroencephalogram abnormalities.

Results:

Viral meningoencephalitis was diagnosed in 270 children, with median age of 2 years (interquartile range: 0–4), The etiology of viral meningoencephalitis was confirmed in 47% of patients. Enterovirus (18%) was the major cause of encephalitis in Southern Brazilian children, and a high prevalence of Epstein-Barr virus (6%) was demonstrated. Most patients presented with fever (81%), followed by vomiting (50%), focal neurologic findings (46%), seizures (31%) and headache (30%). Few abnormalities were detected on electroencephalograms and brain magnetic resonance images. On discharge from hospital, symptoms resolved completely in 87% of children. Sequelae were mainly observed in patients with focal neurologic symptoms (P<0.001), presence of seizures (P<0.001) and electroencephalogram abnormalities (P=0.024).

Conclusions:

Enterovirus was the major cause of encephalitis. Etiologic agent of encephalitis seems to be influenced by the local virologic pattern. A poor outcome was identified in patients with seizures, focal neurologic findings and electroencephalogram abnormalities.
Interferon-Gamma Release Assay Testing in Children Younger Than 2 Years in a US-Based Health System
Authors: Gaensbauer James , Young Janine , Harasaki Cara , Aiona Kaylynn , Belknap Robert , Haas Michelle K.
Published: April 2020

Background:

Use of interferon-gamma releasing assays (IGRAs) in children <2 years old may derive many of the same advantages, which have led to preference over tuberculin skin test (TST) in older children, but data are limited. Since 2011, we have tested children <2 years old with Quantiferon-TB Gold/Gold Plus (QFT)) in select clinical scenarios at Denver Health, a health system encompassing a TB clinic, refugee and immigrant screening and primary care.

Methods:

We identified patients <2 years old tested with QFT between February, 2011 and August, 2019. The primary outcome measure was incident cases of TB among tested patients. Test results and in vitro characteristics were analyzed, as were demographic, epidemiologic and clinical outcomes.

Results:

We analyzed 116 QFTs ordered in children age 7–23 months. Two were positive, 3 indeterminate, 3 failed/refused phlebotomy and the remainder (93%) were negative. Mitogen tube results were robust. Thirteen patients were TST-positive: 11 were QFT-negative, 1 QFT-positive and 1 failed phlebotomy. Eight patients received some form of TB medication, including 4 QFT-negative patients who were treated for active TB or latent TB infection based on positive TST or clinical findings. Among QFT-negative patients, including 6 TST-positive, not treated for active TB or latent TB infection, no TB disease has been identified over a median follow-up time of 2.96 years.

Conclusions:

IGRA use was not limited by barriers of phlebotomy, indeterminate result or gamma-interferon production. The risk of missing an infected but IGRA-negative patient can be reduced by treatment of select patients at higher risk. Current recommendations against IGRA use in children <2 years old could be amended to allow careful introduction, particularly among well-appearing BCG-vaccinated patients.
Characteristics and factors associated with intraocular lens tilt and decentration after cataract surgery
Authors: Chen Xiaoyun , Gu Xiaoxun , Wang Wei , Xiao Wei , Jin Guangming , Wang Lanhua , Dai Ye , Zhang Enen , Ruan Xiaoting , Liu Zhenzhen , Luo Lixia , Liu Yizhi
Published: April 2020

Purpose:

To analyze the characteristics and factors associated with intraocular lens (IOL) tilt and decentration after uneventful phacoemulsification with IOL implantation.

Setting:

Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Design:

Cross-sectional study.

Methods:

All patients underwent a general ophthalmologic examination and anterior segment photography. IOL tilt and decentration were measured with a second-generation anterior segment optical coherence tomography (Casia2). Univariate and multivariate regression analyses were performed to assess the association between IOL tilt and decentration with ocular biometric and systemic parameters, and the visual acuity.

Results:

A total of 196 eyes of 196 patients were enrolled in this study. IOLs showed a mean tilt of 4.8 degrees toward the inferotemporal direction, and the mean decentration was 0.21 mm. Both eyes presented a mirror symmetry relationship. Twenty-two eyes (11.22%) had a tilt greater than 7 degrees, and 21 eyes (10.72%) had a decentration more than 0.4 mm. Multivariate regression analysis showed previous pars plana vitrectomy (PPV) and short axial length (AL) were associated with greater IOL tilt (P = .014 and P < .001). In addition, long AL, thicker lens, and less capsulorhexis–IOL overlap were positively correlated with decentration (P < .001, P = .029, and P = .026). Corrected distance visual acuity did not directly correlate with IOL tilt and decentration (P = .417 and P = .550).

Conclusions:

PPV history and short AL were associated with greater IOL tilt, whereas longer AL, thicker lens, and overlarge capsulorhexis contribute to greater decentration. Implantation of toric and multifocal IOLs in these patients should be cautious.
Protecting the Mental Health of Small-to-Medium Enterprise Owners
Authors: Martin Angela , Kilpatrick Michelle , Scott Jenn , Cocker Fiona , Dawkins Sarah , Brough Paula , Sanderson Kristy
Published: April 2020

Objective:

Small-medium enterprises (SMEs) are under-represented in occupational health research. Owner/managers face mental ill-health risks/exacerbating factors including financial stress and long working hours. This study assessed the effectiveness of a workplace mental health and wellbeing intervention specifically for SME owner/managers.

Methods:

Two hundred ninety seven owner/managers of SMEs were recruited and invited to complete a baseline survey assessing their mental health and wellbeing and were then randomly allocated to one of three intervention groups: (1) self-administered, (2) self-administered plus telephone, or (3) an active control condition. After a four-month intervention period they were followed up with a second survey.

Results:

Intention to treat analyses showed a significant decrease in psychological distress for both the active control and the telephone facilitated intervention groups, with the telephone group demonstrating a greater ratio of change.

Conclusion:

The provision of telephone support for self-administered interventions in this context appears warranted.
The Acute Care Confidence Survey: Examination of the Psychometric Properties and Predictors of Performance Among Students in a Large Inpatient Hospital System
Authors: Rosenfeldt Anson B. , Greenwood Kristin , Lubbeck Karoline , Brown Jennifer , Iversen Maura D.
Published: April 2020

Introduction.

The Acute Care Confidence Survey (ACCS) was created as a measure of student self-efficacy for acute care clinical education experiences (CEEs). Initial measures of validity and reliability have been established; however, further psychometric testing is warranted to facilitate academic and clinical adaptation. This study aimed to further investigate the psychometric properties of the ACCS on a population of physical therapist students from diverse educational backgrounds. The study aims were to examine 1) the test–retest reliability of the ACCS, 2) the relationship between the ACCS and student demographic variables including previous acute care exposure, and 3) the relationship between ACCS scores and clinical performance.

Methods.

A total of 66 students completing their acute care CEE in a large hospital system were recruited. Sixty students from 14 different Doctor of Physical Therapy programs had complete data sets and were used for the final analysis. On the first day of their CEE, the students completed the ACCS along with a demographic questionnaire including items about academic preparation. Students completed the ACCS a second time within 1 week to determine the test–retest reliability. The midterm Clinical Performance Instrument (CPI) scores were used to measure the CEE performance. Descriptive statistics characterized the sample. A Pearson correlation coefficient was used to determine the test–retest reliability. The associations between ACCS scores and demographic characteristics and CPI scores were computed using Chi squared tests, t tests, and correlation coefficients.

Results.

The test–retest reliability of the ACCS was 0.83 (P < .0001). The correlation between total ACCS score and midterm CPI score was 0.32 (P < .01); low to moderate correlations were found between the mobility, instruct, and judgment subscales of the ACCS and midterm CPI scores (r = 0.26, 0.30, 0.44, respectively, P < .05). There were low but significant associations between ACCS scores and the number of previous CEEs (first, middle, and terminal; r = 0.33; P < .01), number of weeks of completed full-time CEEs (r = 0.37; P < .003), and number of acute care exposure hours (r = 0.28, P = .02). Having taken a didactic course specifically dedicated to acute care significantly impacted the judgment subscale of the ACCS (P = .005).

Discussion.

Previous exposure to the acute care setting and CEE experiences, regardless of setting, had a positive impact on the ACCS scores. The low to moderate correlations reported between the ACCS and student performance measured by the CPI indicate that self-efficacy alone may not be sufficient to predict the student performance.

Conclusion.

These data indicate that the ACCS is a reliable measure of student preparedness. Further examination on the utility of the ACCS is warranted.
The Physiological and Psychological Effects of the First Year of an Entry-Level Physical Therapist Education Program on Students
Authors: Douris Peter C. , D'Agostino Nick A. , Mathew Seena K. , Anderson Robert P. , Bauman Kevin M. , Tiangtham Sattha A. , Greco Tom , Pizow Adam , Hall Cheryl A.
Published: April 2020

Introduction/Review of Literature.

Physical therapy students anecdotally report the adverse physiological and psychological effects of attending an entry-level physical therapist education program. Previous research on medical students has demonstrated significant negative changes in health and physical fitness during the course of medical school.

Purpose.

The purpose of this study was to quantify the changes in anthropometric parameters, fitness, exercise, stress, sleep, and quality of life in students during their first year of an entry-level physical therapist education program.

Subjects.

Thirty-eight first-year Doctor of Physical Therapy students at the New York Institute of Technology.

Methods.

The design was a prospective longitudinal cohort study. The outcome measures were assessed during the first 3 semesters of the first academic school year.

Results.

Significant changes in aerobic fitness were documented from the beginning to the end of the first year, with V̇o
2max decreasing from 40.8 to 35.5 mL/kg/min. Exercise levels decreased significantly when comparing the fall semester to the summer and winter semesters. Stress levels showed a significant increase, whereas hours of sleep, global quality of sleep, and quality of life decreased significantly, as students progressed through each semester.

Discussion and Conclusion.

The results are based on a cohort of students belonging to a single physical therapist education program and may not be broadly generalizable. These findings suggest that stress management programs and wellness resources ought to be offered while enrolled in a physical therapist education program.
Cervical Stratified Mucin-Producing Intraepithelial Lesion: A Systematic Review of Diagnosis and Management
Authors: Wolf Jennifer L. , Billingsley Caroline C. , Kendler Ady , Jackson Amanda L.
Published: April 2020

Objectives

The aims of the study were to synthesize reported associations of stratified mucin-producing intraepithelial lesion (SMILE) of the cervix with other dysplasia lesions and immunohistochemical (IHC) stains, compare expected patterns of IHC staining to other lesions in the differential diagnosis, and assess follow-up pathology.

Methods

This systematic review includes all case reports and case series of cervical lesions consistent with SMILE based on the histologic diagnosis described in the original case series. MEDLINE, EMBASE, and Cochrane Database were searched through June 2019. Immunohistochemical analysis, concurrent lesions, and pathology on follow-up were compiled for comparison. Weighted averages of concurrent lesions were calculated.

Results

Nine case reports and case series were included, published between 2000 and 2019. Of 9 studies, 6 and 5 studies reported strong, diffuse staining of p16 and increased expression of Ki-67, respectively. Stratified mucin-producing intraepithelial lesion is associated with human papillomavirus, especially type 18. The weighted average risk of concurrent high-grade squamous intraepithelial lesion was 79% (range = 33%–93%), adenocarcinoma in situ 39% (2.9%–92%), adenocarcinoma 5% (1%–25%), and squamous cell carcinoma 6% (0%–11%). Patients underwent follow-up ranging from repeat Pap to radical hysterectomy, with pathology on follow-up infrequently and irregularly reported.

Conclusions

Stratified mucin-producing intraepithelial lesion is a rare lesion with a paucity of research on necessary cytology and IHC stains for diagnosis, but p16 and Ki-67 IHC stains can be performed to rule out benign lesions. The lesion is associated with high risk of concurrent high-grade squamous intraepithelial lesion, adenocarcinoma in situ, and invasive carcinoma, but studies on the risk of pursuing fertility-preserving management are needed.