bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic criteria for retained products of conception—A scoping review
Authors: Hamel Charlotte C. , van Wessel Steffi , Carnegy Alasdair , Coppus Sjors F. P. J. , Snijders Marc P. M. L. , Clark Justin , Emanuel Mark H.
Published: July 2021

Introduction

Numerous studies have been performed assessing optimal treatment regimens for evacuating (retained) products of conception from the uterus, but standardized criteria for diagnosing retained products of conception (RPOC) are still lacking. We aim to provide an overview of diagnostic criteria in current literature, used to diagnose RPOC after induced first‐trimester abortion or early pregnancy loss.

Material and methods

Pubmed, EMBASE, and the Cochrane library were searched systematically up until March 2020 for English articles reporting on induced abortion or early pregnancy loss. Articles not specifying diagnostic criteria used to assess completeness of treatment were excluded, as were conference abstracts, expert opinions, reviews, and case reports. Four elements of diagnostic criteria were described: diagnostic tools, parameters used within these tools, applied cut‐off values, and timing of follow up. Additionally, a meta‐analysis was performed assessing diagnostic qualities of the most often applied diagnostic tool and parameter.

Results

The search strategy yielded 1233 unique articles, of which 248 were included, with a total of 339 517 participants. In the 79 included randomized controlled trials, six diagnostic tools to assess RPOC were identified, combined in 14 ways, with 55 different cut‐off values. In 169 observational studies, seven diagnostic tools were identified, used in 28 combinations, applying 89 different cut‐off values. Transvaginal ultrasonographic measurement of endometrial thickness with a cut‐off value of at least 15 mm indicating RPOC, was used most frequently. In the timing of follow‐up there was great variation, with 55 and 107 different combinations in randomized controlled trials and observational studies, respectively. Assessment of treatment success was scheduled most often around 2 weeks after treatment. Diagnostic qualities of endometrial thickness of 15 mm or more was not adequately assessed.

Conclusions

There is wide variation in the way RPOC are assessed, and the criteria used to define RPOC following induced abortion and early pregnancy loss; ultrasonographic measurement of endometrial thickness, with a cut‐off of 15 mm or more 2 weeks after primary treatment is the most widely used diagnostic approach. A meta‐analysis on diagnostic accuracy of endometrial thickness of 15 mm or more did not lead to solid results. These findings can be a first step to develop a workable standard of establishing RPOC after induced abortion or early pregnancy loss.
Vulnerabilities of the Rural Poor in India during pandemic COVID‐19: Social Work perspective for designing sustainable emergency response
Authors: Bhadra Subhasis
Published: July 2021

Poor are vulnerable, frail, battered, marginalized, voiceless, and victim of multiple social circumstances. The complex vulnerable existence always made them suffer and become double victims of any disaster, be it natural, human‐made, or biological like pandemic COVID‐19. Poverty in India is an outfall of a number of complex social realities, historical past, and present doldrums. Restrictions due to lockdown and a shrinking economy, the job market as the immediate impact caused a number of survival crises for the rural families. The situation of rural poor becomes even more aggravated, as the reverse migration and influx of population increased the consumption and demand for jobs that actually the rural livelihood sector can provide. While the pre‐existing vulnerabilities of the poor are exposed in the pandemic, the government's response toward them showed its restricted efficiency. The pandemic COVID‐19 has taken human‐life hostage and effective sustainable strategies to manage the crisis of the poor vulnerable section were essential for long‐term resolution. Thus, the professional challenge ahead is designing a sustainable strategy of working in such pandemic situations that social workers are professionally skilled to handle similar challenges.
Characteristics of patients receiving extended treatment after incident venous thromboembolism
Authors: Albertsen Ida Ehlers , Jensen Martin , Abdelgawwad Khaled , Søgaard Mette , Larsen Torben Bjerregaard , Nielsen Peter Brønnum
Published: July 2021

Given high recurrence risk after venous thromboembolism (VTE), guidelines recommend extended dose rivaroxaban (10 mg OD) or apixaban (2.5 mg BID) to be considered after 6 months of initial treatment. This study aimed to provide insight into clinical practice regarding the use of extended preventive treatment and to describe duration of the initial treatment.

Linkage of nationwide health registers identified all in‐ and outpatients with VTE from April 2017 through 2018. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated adjusting for other VTE‐related factors.

The study included 6030 patients with VTE. Among rivaroxaban users, 2.2% (n = 113) received the extended 10‐mg dose after mean 9.4 (SD 3.1) months of standard treatment. For apixaban, 4.7% (n = 40) received extended 2.5‐mg dose after mean 8.0 months (SD 3.9). After adjustments, incident pulmonary embolism (HR 1.81 95% CI 1.12;2.91) and trauma/fracture (HR 1.42 95% CI 0.46;4.43) were associated with switching to extended dose, whereas patients with unprovoked VTE were less likely to receive the extended dose (HR 0.68 95% CI 0.30;1.55).

Less than 3% of patients with incident VTE received extended treatment after initial standard treatment. Even though international guidelines suggest that the risk–benefit balance is in favour of extended VTE treatment, this was yet to be translated into clinical practice as of 2018. Studies using contemporary data are warranted to investigate routine clinical practice of extended treatment for VTE recurrence.
Perceptions of women and partners on labor and birth positions: A meta‐synthesis
Authors: Shorey Shefaly , Chan Valerie , Lalor Joan Gabrielle
Published: July 2021

Background

The risks and benefits of different birthing positions are commonly studied, but both paternal and maternal preferences and experiences of different birth positions are not examined. Therefore, this systematic review aims to explore the perceptions of women and their partners on birthing positions during the first and second stage of labor, so that maternity health care practitioners can provide better quality patient‐centered care.

Methods

Six databases were searched from each database's inception through November 2020. Qualitative or mixed‐methods studies exploring perceptions of women and/or their partners on birthing positions were included in the review. Key information and findings of the studies were extracted; qualitative data were meta‐summarized, then meta‐synthesized using thematic analysis.

Results

Seven studies were included, and four themes emerged: (a) Influences on choice and preference; (b) mixed experiences from “pain” to “more in control”; (c) impact on postpartum health; and (d) ways to empower couples in their choice.

Conclusions

Women's preferences for birthing positions were influenced by a myriad of personal and socio‐cultural beliefs and traditions. Findings suggest a need for health care practitioners to build better rapport and provide more culturally relevant informational support to both women and their birthing partners, so they are better able to make informed decisions on their preferred birthing position.
Trade unions and the well‐being of workers
Authors: Blanchflower David G. , Bryson Alex , Green Colin
Published: July 2021

Using data on nearly 2 million respondents from the United States and Europe, we show the partial correlation between union membership and employee job satisfaction is positive and statistically significant. This runs counter to findings in the seminal work of Freeman and Borjas in the 1970s. For the United States, we show the association between union membership and job satisfaction switched from negative to positive in the 2000s. Cohorts with positive union effects over time come to dominate those with negative effects. The negative association between membership and job satisfaction is apparent in cohorts born before the 1960s but turns positive for those born between the 1960s and 1990s. Analyses for Europe since the 2000s confirm the positive association between union membership and worker well‐being is apparent elsewhere. Panel estimates for the United Kingdom also find a positive relation between union membership and job satisfaction. A positive union association with other aspects of worker well‐being including life satisfaction, happiness and trust is apparent in cross‐sectional data for Europe. Union members are also less likely to be stressed, worried, depressed, sad or lonely. The findings have important implications for our understanding of trade unionism.
A randomized trial investigating clinical outcomes and stent‐related symptoms after placement of a complete intra‐ureteric stent on a string versus conventional stent placement
Authors: Shah Milap , Pillai Sunil , Chawla Arun , de la Rosette Jean J. M. C. H. , Laguna Pilar , Jayadeva Reddy Suraj , Taori Ravi , Hegde Padmaraj , Mummalaneni Sitaram
Published: July 2021

Objective

To compare stent‐related symptoms (SRS) associated with conventional ureteric JJ stent (CUS) placement and SRS associated with placement of a modified complete intra‐ureteric stent (CIUS) with extraction suture, designed to minimize SRS, using the validated Ureteral Stent Symptom Questionnaire (USSQ).

Materials and Methods

We randomized 124 patients who had undergone uncomplicated ureteroscopic lithotripsy into a CIUS and a CUS placement group. USSQ scores were evaluated on postoperative days 1 and 7 (just before stent removal) and 4 weeks after stent removal (control values). Pain scores on a visual analogue scale (VAS) after stent removal were also recorded. Subdomain analysis of all SRS and stent‐related complications were also compared.

Results

No significant intergroup differences were found in the domain scores for urinary symptoms (P = 0.74), pain (P = 0.32), general health (P = 0.27), work (P = 0.24), or additional problems (P = 0.29). However, a statistically significant difference was noted in VAS scores (P = 0.015). Analysis of subdomains of USSQ item scores showed the CIUS group had significantly better scores for urge incontinence (1.21 vs 1.00; P ≤ 0.001), discomfort on voiding (2.07 vs 1.50; P ≤ 0.001), difficulties with respect to light physical activity (1.131 vs 1.00; P ≤ 0.001), fatigue (1.84 vs 1.57; P = 0.002), feeling comfortable (3.68 vs 3.16; P = 0.003), need for extra help (1.96 vs 1.00; P ≤ 0.001), and change in duration of work (4.27 vs 1.86; P ≤ 0.001). However, the patients in the CIUS group were sexually inactive for the time during which the stent was indwelling (mean: 7.34 days). There was no difference in complication rates between the two groups.

Conclusion

The use of a CIUS with strings after Ureteroscopy decreases SRS.
Effects of music, dance and drama therapies for people with an intellectual disability: A scoping review
Authors: Mino‐Roy Jordan , St‐Jean Juliette , Lemus‐Folgar Oliverio , Caron Katherine , Constant‐Nolett Ozalée , Després Jean‐Philippe , Gauthier‐Boudreault Camille
Published: July 2021

Accessible summary

There are different forms of arts therapy including music, dance and drama therapies.

Music, dance and drama can help people with an intellectual disability to improve their wellbeing.

To encourage the inclusion of music, dance and drama therapies in different services, it is important to look at their effects on people with an intellectual disability.

Music, dance and drama help with self‐esteem, social skills, expression and management of emotions.

Arts therapies could also increase social inclusion and self‐determination.

Background

Arts therapies take different forms, including music, dance and drama therapies. Access to meaningful activities is limited for people with an intellectual disability. Music, dance and drama therapies could be relevant strategies to improve well‐being of people with an intellectual disability. To encourage the inclusion of these modalities in services offered to this population, it is important to look at the effects of music, dance and drama therapies for people with an intellectual disability.

Methods

This scoping review aimed to document the effects of music, dance and drama therapies for people with an intellectual disability.

Findings

72 documents were selected and analysed. Depending on the modality of art therapy, various physical, emotional, cognitive and spiritual benefits were noted. Most of studies presented a limited sample size and had no group control.

Conclusion

The use of arts therapy modalities music, dance and drama shows promise for people with an intellectual disability. The results of this study may contribute to the development of diversified and meaningful activities.
Importance of sex education for a successful transition to life after school: Experiences of high school girls with intellectual disability
Authors: Strnadová Iva , Loblinzk Julie , Danker Joanne
Published: July 2021

Accessible summary

Quality sex education is important for all students. It also helps with a successful transition to life after school.

We talked to 11 Australian high school girls with intellectual disability. We wanted to know what they think about their sex education at school.

The girls told us that they were often not included in Individual Learning Plan meetings. They were also not consulted about what they would like to learn in sex education.

Sex education classes were largely inaccessible for them.

Accessible sex education classes are important to prepare students for life after school.

Background

Students with intellectual disability often do not receive holistic sex education, which is critical for their successful transition to post‐school life, including having an ability to make healthy choices about their sexuality and relationships. The aim of this inclusive research study was to explore the perceptions and experiences of sex education with Australian high school girls with intellectual disability, as they prepare for a transition to post‐school life.

Method

There were 11 high school girls aged 13–20 years who participated in this study. Interviews were conducted and analysed using inductive content analysis.

Findings

The findings indicate that critical topics such as gender and sexual identity, and masturbation are not sufficiently covered in sex education in New South Wales, Australia. The participating girls also highlighted ways in which teachers could make sex education lessons more accessible. Individual Learning Plan meetings, an important platform for transition planning, were attended by less than a third of the girls in this study.

Conclusions

Comprehensive and accessible programmes on sex education for high school girls with intellectual disability are needed to promote successful transition to an autonomous life for these students.
Measuring research excellence amongst economics lecturers in the UK
Authors: McManus Richard , Mumford Karen , Sechel Cristina
Published: July 2021

Using a rich new data source, we explore the selection of economics lecturers into the last UK Research Excellence Framework (REF) exercise. Only some one‐in‐two (54%) of these lecturers were submitted to REF2014; 57% of men and 46% of women. The decision making of institutions is found to be well approximated by a simplified selection approach; focusing on working papers and higher quality journal publications. Our results also reveal sizeable conditional differences in the probability of selection, especially so in departments with higher research rankings. More than half of the variance in selection probability remains unexplained, revealing considerable idiosyncrasies in the management of submissions and uncertainty across the discipline in this research assessment process.
Understanding crowdsourcing projects: A review on the key design elements of a crowdsourcing initiative
Authors: Karachiwalla Rea , Pinkow Felix
Published: July 2021

Crowdsourcing has gained considerable traction over the past decade and has emerged as a powerful tool in the innovation process of organizations. Given its growing significance in practice, a profound understanding of the concept is crucial. The goal of this study is to develop a comprehensive understanding of designing crowdsourcing projects for innovation by identifying and analyzing critical design elements of crowdsourcing contests. Through synthesizing the principles of the social exchange theory and absorptive capacity, this study provides a novel conceptual configuration that accounts for both the attraction of solvers and the ability of the crowdsourcer to capture value from crowdsourcing contests. Therefore, this paper adopts a morphological approach to structure the four dimensions, namely, (i) task, (ii) crowd, (iii) platform and (iv) crowdsourcer, into a conceptual framework to present an integrated overview of the various crowdsourcing design options. The morphological analysis allows the possibility of identifying relevant interdependencies between design elements, based on the goals of the problem to be crowdsourced. In doing so, the paper aims to enrich the extant literature by providing a comprehensive overview of crowdsourcing and to serve as a blueprint for practitioners to make more informed decisions when designing and executing crowdsourcing projects.
Immunotherapy‐responsive brainstem lesion accompanied with anti‐galactocerebroside antibody
Authors: Shiraishi Wataru
Published: July 2021

Background

Brainstem lesions are a diagnostic challenge and clinicians have to differentiate between many diseases including acute disseminated encephalomyelitis, multiple sclerosis (MS), Bickerstaff brainstem encephalitis (BBE) and brain tumors. The anti‐galactocerebroside (Gal‐C) antibody is an anti‐glycolipid antibody that is often detected in autoimmune peripheral neuropathy. However, anti‐Gal‐C antibody is rarely detected in autoimmune central nervous system diseases. Here, we report the case of an anti‐Gal‐C antibody‐positive patient who had a brainstem lesion that mimicked MS and responded to immunotherapy.

Case presentation

We report a 32‐year‐old woman who presented with subacute numbness of the right lower extremities and hemiataxia. Her cerebrospinal fluid examination showed an elevated myelin basic protein level and an oligoclonal band. Brain magnetic resonance imaging showed a T2 high‐intensity lesion from the left brainstem to the cerebellum. She was treated with steroid pulse therapy, but internuclear ophthalmoplegia and left peripheral facial palsy developed. Her brain magnetic resonance imaging showed an enlargement of the brainstem lesion. Therefore, plasma exchange therapy and high‐dose immunoglobulin therapy were administered, and her symptoms eventually ameliorated. First, we diagnosed her with MS and started dimethyl fumarate. After anti‐GM2 and anti‐Gal‐C antibody positivity was revealed, we diagnosed an anti‐Gal‐C antibody‐related brainstem lesion. There have been few reports of anti‐Gal‐C antibody‐positive central nervous system diseases.

Conclusions

The present case highlights that an anti‐Gal‐C positivity can cause brainstem inflammatory lesions, which should be differentiated from acute disseminated encephalomyelitis, Bickerstaff brainstem encephalitis and MS. The patient’s symptoms improved with intense immunotherapy, and antibody measurement led to the discontinuation of unnecessary disease‐modifying drugs.
Distance Wagner tree refinement as a heuristic approach to character‐based initial tree construction
Authors: Wheeler Ward C.
Published: July 2021

The distance Wagner procedure of Farris (American Naturalist, 1972, 106, 645), in its original or random addition sequence form, is a rapid method of tree construction. The original formulation did not allow for refinement of tree hypotheses via common trajectory search operations (e.g. SPR, TBR). Here, the distance Wagner method is extended to allow for refinement of initial trees produced via the four‐point condition (Mathematics and the Archeological and Historical Sciences, Edinburgh University Press, Edinburgh, 1974). The performance of the extended distance Wagner as a heuristic search procedure is evaluated with several unaligned sequences and combined source datasets within the parsimony framework. Distance Wagner both with and without refinement is shown to be a rapid and useful heuristic method to generate initial trees for further, character‐based, analysis.
Difference in absolute lymphocyte count among male and female heart transplant recipients
Authors: Perry Whitney A. , Chow Jennifer K. , Snydman David R.
Published: July 2021

The impact of sex on immune composition in the setting of solid organ transplantation is unknown. Immunocompetent men and women have quantitative differences in multiple markers of immunity, including lymphocyte subsets. Lymphocytes are of particular interest given the routine use of medications targeted at cell‐mediated immunity. The objective of this retrospective cohort study was to compare absolute lymphocyte count (ALC) measurements of male and female heart recipients immediately before, and 1 month after, transplantation. Data was collected on 375 adult recipients (104 female and 271 male) from 2000 to 2018 at a single center. Mean ALC was compared using Student's t‐test. Women had higher mean ALC both at baseline (female 1.6 × 103 cells/μl vs. male 1.3 × 103 cells/μl; P < .001) and at 1 month post‐transplantation (mean 1.2 × 103 cells/μl vs. .8 × 103 cells/μl; P < .001). This finding could have important implications for sex‐based differences in predisposition to rejection or response to infection or vaccination.
eDNA metabarcoding in lakes to quantify influences of landscape features and human activity on aquatic invasive species prevalence and fish community diversity
Authors: Pukk Lilian , Kanefsky Jeannette , Heathman Amanda L. , Weise Ellen M. , Nathan Lucas R. , Herbst Seth J. , Sard Nicholas M. , Scribner Kim T. , Robinson John D.
Published: July 2021

Aim

Our goal was to use eDNA metabarcoding to characterize fish community diversity, detect aquatic invasive species (AIS) and assess how measures of community (or AIS) diversity are influenced by lake physical and environmental covariates, measures of hydrological connectivity and human accessibility.

Location

Michigan, USA.

Methods

eDNA samples collected from 22 lakes were sequenced using two mitochondrial gene regions (12S and 16S rRNA). Metabarcoding data were compared to traditional fisheries survey data for a subset of lakes, and data from all 22 lakes were combined with environmental information to identify significant associations with community diversity and AIS relative abundance.

Results

Occupancy modelling indicated that detection probabilities were generally higher with eDNA than traditional fisheries gear. Measures of connectivity with upstream aquatic habitats were positively associated with both AIS relative abundance and fish species diversity. We also demonstrate the use of spatial interpolation methods to map distributions of species diversity and AIS relative abundance within lakes.

Main conclusions

eDNA metabarcoding methods provided information on the composition and diversity of fish assemblages and the presence of AIS in freshwater lakes that varied greatly in drainage connectivity and anthropogenic development. Our case study identified associations between environmental covariates and fish diversity or AIS relative abundance across lakes. This information is of particular importance given increasing anthropogenic disturbance, invasive species spread and associated declines in aquatic biodiversity. Incorporating eDNA metabarcoding as a supplement to traditional fisheries surveys will permit managers to identify greater numbers of taxa, including early detection of AIS, with less field effort and fish mortality. Further, eDNA methods may more accurately identify physical and biological features that correlate with diversity and abundance and allow agencies to more effectively direct AIS management activities.
Modelling the biodiversity enhancement value of seagrass beds
Authors: McHenry Jennifer , Rassweiler Andrew , Hernan Gema , Uejio Christopher K. , Pau Stephanie , Dubel Alexandra K. , Lester Sarah E.
Published: July 2021

Aim

Seagrass beds are declining globally and are increasingly vulnerable to sea level rise (SLR), which could have consequences for the rich biodiversity they support. Spatial variation in the role of seagrass beds in enhancing biodiversity is poorly resolved, limiting our ability to set priorities for conservation and restoration. We aimed to model the biodiversity enhancement value of seagrass beds.

Location

Florida Gulf Coast, USA.

Methods

We used generalized additive mixed models (GAMMs) to describe the distribution, total cover and species composition of seagrass beds and to estimate their effects on spatial patterns of faunal species richness under three scenarios. Specifically, we: (a) quantified the biodiversity enhancement value of current seagrass beds, (b) inferred the biodiversity value of potential restoration areas and (c) projected potential changes in the distribution and biodiversity enhancement value of seagrass beds due to SLR using low (+0.50 m) and high (+1.0 m) SLR forecasts for 2100.

Results

Current seagrass beds supported 43%–64% more species than unvegetated habitats, even when accounting for spatial variability in predicted faunal richness due to other environmental, seascape, temporal and geographic factors. Seagrass restoration in potential habitats would also increase biodiversity in the near‐term (i.e., 43%–45% above unvegetated levels). However, model projections indicate that SLR could result in significant losses of current seagrass beds and potential restoration areas, causing contracted distributions and lower seagrass cover. Overall, these changes could result in significant reductions in the enhancement value provided by seagrasses. Although, there could also be many suitable locations for seagrasses by 2100, with some having either comparable or potentially increased enhancement value.

Main conclusions

Our findings highlight the importance of considering spatial variation in biodiversity benefits when planning for seagrass conservation and restoration and when managing the impacts of SLR.
Randomized trial comparing the 25G and 22G Franseen needles in endoscopic ultrasound‐guided tissue acquisition from solid pancreatic masses for adequate histological assessment
Authors: Tomoda Takeshi , Kato Hironari , Fujii Yuuki , Yamazaki Tatsuhiro , Matsumoto Kazuyuki , Horiguchi Shigeru , Tsutsumi Koichiro , Inoue Hirofumi , Tanaka Takehiro , Mitsuhashi Toshiharu , Okada Hiroyuki
Published: July 2021

Background

The effects of the Franseen needle size in endoscopic ultrasound‐guided fine‐needle biopsy (EUS‐FNB) of solid pancreatic masses remain unclear. This study aimed to compare 25G and 22G Franseen needles in terms of adequate tissue acquisition from solid pancreatic masses.

Methods

In this single‐center, crossover, randomized noninferiority trial, eligible patients underwent EUS‐FNB with both 25G and 22G Franseen needles in a randomized order between November 2018 and August 2020. Tissue specimens from each pass were separately evaluated based on the cellularity scoring system. The primary outcome was the proportion of acquired specimens allowing adequate histological assessment (cellularity score ≥3). A –15% noninferiority margin was assumed.

Results

Data from 88 patients were analyzed, which showed malignant and benign lesions in 84 (95.5%) and four (4.5%) patients, respectively. Of the 88 specimens, 62 (70.5%) and 69 (78.4%) acquired using 25G and 22G needles, respectively, allowed adequate histological assessment.

The adjusted proportion difference was –6.6% (95% confidence interval –8.8% to –4.5%), indicating noninferiority of the 25G Franseen needle (P < 0.001). The diagnostic accuracies of the 25G and 22G needles were 86.4% and 89.8%, respectively, with no significant difference (P = 0.180). Adverse events occurred in one patient.

Conclusions

The 25G Franseen needle showed a noninferior adequate tissue acquisition and similar diagnostic performance compared to that of the 22G Franseen needle. However, a 15% noninferiority margin was high for clinical use; thus, further consideration is needed (Clinical Trial Registry no. UMIN000034596).
Managing adverse events after endoscopic ultrasound‐guided drainage of the biliary tract and pancreatic fluid collections: Narrative review (with video)
Authors: Funari Mateus Pereira , Ribeiro Igor Braga , Lera dos Santos Marcos Eduardo , Matuguma Sergio Eiji , de Moura Eduardo Guimarães Hourneaux
Published: July 2021

Endoscopic ultrasound (EUS)‐guided therapeutic procedures have become increasingly common in clinical practice. The development of EUS‐guided fine needle aspiration cytology led to the concept of interventional EUS. However, it carries a considerable risk of adverse events (AEs), which occur in approximately 23% of the procedures performed for the drainage of pancreatic fluid collections and 2.5–37.0% of those performed for drainage of the biliary tract. Although the vast majority of AEs occurring after EUS‐guided drainage are mild, a deep understanding of such events is necessary for their appropriate management. Because EUS‐guided drainage is a novel procedure, there have been few studies of the topic. To our knowledge, this is the first narrative review that focuses on the management and resolution of AEs occurring after EUS‐guided drainage of pancreatic fluid collections or the biliary tract. We also include an explanatory video.
The SARS‐CoV‐2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi‐centre study of the first COVID‐19 wave
Authors: McGlacken‐Byrne Sinéad M. , Drew Samantha E. V. , Turner Kelly , Peters Catherine , Amin Rakesh
Published: July 2021

Objective

Children are usually mildly affected by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2, COVID‐19). However, the pandemic has caused collateral damage to those with non‐COVID‐19 diseases. We aimed to determine the impact of the COVID‐19 pandemic on the presentation of newly diagnosed childhood onset type 1 diabetes.

Methods

This was a cross‐sectional study conducted over a 1‐year period. We compared the severity of presentation of new‐onset type 1 diabetes in children under the age of 18 presenting to the multi‐centre North Central London diabetes network before (1 July 2019 to 22 March 2020) and during (23 March 2020 to 30 June 2020) the first wave of the COVID‐19 pandemic in the United Kingdom.

Results

Over the 1‐year study period, a total of 30 children presented with new‐onset type 1 diabetes during the pre‐pandemic period and 17 presented during the first COVID‐19 wave. Children presented more frequently in diabetic ketoacidosis (DKA) during the first COVID‐19 wave compared with pre‐pandemic (pre‐pandemic: mild 13%, moderate 6.7%, severe 10%; first COVID‐19 wave: mild 5.9%, moderate 24%, severe 47%; p = 0.002). During the first COVID‐19 wave, DKA presentations in children with a family history of type 1 diabetes were fewer compared to those without a family history (33.3% vs. 100.0%; p = 0.006). Children presenting in severe DKA pre‐pandemic were younger than those not in severe DKA (3.9 years vs. 12.2 years, p < 0.001) but this difference was not significant during the first COVID‐19 wave (10.1 years vs. 11.2 years, p = 0.568). Presenting HbA1c measurement was higher in those presenting during the first COVID‐19 wave (13.0 ± 1.7 vs. 10.4 ± 3.2%; 119 ± 19 vs. 90 ± 35 mmol/mol; p = 0.008).

Conclusion

The COVID‐19 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes. Whatever the context, young people with suspected new‐onset type 1 diabetes should be referred for urgent clinical review.
Validation of non‐formal and informal learning to support disadvantaged learners: Alternative assessments
Authors: Looney Janet , Santibañez Barbara
Published: July 2021

The European Union has set the goal to make lifelong learning a reality for more people through the creation of flexible pathways to improve access to higher levels of education and employment. Validation of non‐formal and informal learning (VNFIL), which is intended to make learning from everyday work and life visible, is an important means to this goal. Nevertheless, in many countries take‐up of VNFIL remains low among disadvantaged groups. While a variety of factors, such as outreach and accessibility of VNFIL, may affect take‐up, the VNFIL approach and quality of assessment are important factors. This article describes alternative VNFIL assessment approaches identified in Innoval (2016–2018), an Erasmus+ project focused on supporting and empowering disadvantaged learners as they pursue further education, employment and/or certification.
Risk of infection according to the gamma globulin level in the 100 days following allogeneic stem cell transplantations
Authors: Lacombe Valentin , Nunes Gomes Christopher , Robin Jean‐Baptiste , Thépot Sylvain , François Sylvie , Cottin Laurane , Ugo Valérie , Dieu Xavier , Abgueguen Pierre , Daniel Valérie , Giltat Aurélien , Hunault Mathilde , Riou Jérémie , Orvain Corentin , Schmidt Aline
Published: July 2021

Background

Immunoglobulin replacement therapy is recommended in case of severe hypogammaglobulinemia after allogeneic hematopoietic stem cell transplantation (allo‐HSCT). However, the supposed increased risk of infection in case of hypogammaglobulinemia has not been confirmed in allo‐HSCT. In this study, we assessed the relationship between the gamma globulin level and the risk of infection during the 100 days following the allo‐HSCT.

Methods

We gathered the weekly laboratory tests from day 7 to day 100 of 76 allograft patients, giving a total of 1 044 tests. 130 infections were documented clinically, by imaging, or microbiologically.

Results

Average gamma globulin levels between D‐7 and D100 did not differ between patients with or without infection (642 ± 232 and 671 ± 246 mg/dL, respectively, P = .65). Gamma globulin level <400 mg/dl was not associated with the occurrence of infection between the test studied and the next one (aOR 1.33 [0.84‐2.15], P = .24). The gamma globulin level was not predictive of bacterial or fungal infections (AUC 0.54 [95%CI: 0.47‐0.61]) nor of viral reactivations (AUC 0.51 [95%CI: 0.43‐0.60]).

Conclusions

This confirmed that the humoral deficiency is a minor part of the immune deficiency in the 100 days post‐transplant. This questions the relevance of the indications of immunoglobulin substitution during this period.
The role of maternally transferred antibodies in maternal performance in red deer
Authors: Gauzere Julie , Walling Craig A. , Pick Joel L. , Watt Kathryn , Jack Penny , Morris Alison , Morris Sean , Pemberton Josephine M.
Published: July 2021

Maternal effects are ubiquitous. Yet, the pathways through which maternal effects occur in wild mammals remain largely unknown. We hypothesise that maternal immune transfer is a key mechanism by which mothers can affect their offspring fitness, and that individual variation in maternally derived antibodies mainly depends on a mother's characteristics and the environmental conditions she experiences. To test this, we assayed six colostrum‐derived antibodies in the plasma of 1447 neonates in a wild red deer population. Neonatal antibody levels were mainly affected by maternal genes, environmental variation and costs of prior reproductive investment. We found consistent heterogeneity in maternal performance across traits, with mothers producing the heaviest calves also having calves with more antibodies. Unexpectedly, antibody levels were not associated with calf survival. We provide a unique example of how evolutionary theory on maternal effects can be used to gain insight into the causes of maternal effects in wild populations.
Clinical and radiological characteristics of older‐adult‐onset Alexander disease
Authors: Yoshida Tomokatsu , Mizuta Ikuko , Yasuda Rei , Mizuno Toshiki
Published: July 2021

Background

Alexander disease (ALXDRD) affects a wide range of ages from infancy to adulthood. However, only a few cases involving patients with older‐adult onset over 65 years of age have been reported. In contrast, regarding in‐house data, 10.6% of 85 cases with the identification of GFAP mutations demonstrated older‐adult onset. This discrepancy may be due to poor awareness of such cases.

Methods

The subjects included 9 older‐adult‐onset cases, with an onset age of 65 years or older. We characterized older‐adult‐onset ALXDRD by assessing neurological findings and several magnetic resonance imaging (MRI) parameters.

Results

The age at onset, mean age at diagnosis, and mean period from onset to diagnosis were 68.2 years, 70.4 years, and 2.2 years, respectively. The main neurological features at diagnosis included pyramidal signs with muscle weakness and/or cerebellar ataxia. Two‐thirds of cases were dependent, and the dependence was significantly correlated with a longer period from onset to diagnosis. Quantitative MRI evaluation for brainstem atrophy demonstrated distinctive morphological features of bulbospinal ALXDRD. The corpus callosum index tended to be negatively correlated with the period from onset to diagnosis.

Conclusions

Although neurological and MRI findings of older‐adult‐onset ALXDRD patients showed typical features of bulbospinal ALXDRD, their disease progression was more severe than that in younger‐adult‐onset ALXDRD, and patients developed dependence within 2 years from onset. Cerebral white matter damage tended to progress in proportion to the duration of illness. Our case study may help to advance understanding of the clinical spectrum of ALXDRD.
Acute thalamic damage as a prognostic biomarker for post‐traumatic epileptogenesis
Authors: Manninen Eppu , Chary Karthik , Lapinlampi Niina , Andrade Pedro , Paananen Tomi , Sierra Alejandra , Tohka Jussi , Gröhn Olli , Pitkänen Asla
Published: July 2021

Objective

To identify magnetic resonance imaging (MRI) biomarkers for post‐traumatic epilepsy.

Methods

The EPITARGET (Targets and biomarkers for antiepileptogenesis, epitarget.eu) animal cohort completing T2 relaxation and diffusion tensor MRI follow‐up and 1‐month‐long video‐electroencephalography monitoring included 98 male Sprague‐Dawley rats with traumatic brain injury and 18 controls. T2 imaging was performed on day (D) 2, D7, and D21 and diffusion tensor imaging (DTI) on D7 and D21 using a 7‐Tesla Bruker PharmaScan MRI scanner. The mean and standard deviation (SD) of the T2 relaxation rate, multiple diffusivity measures, and diffusion anisotropy at each time‐point within the ventroposterolateral and ventroposteromedial thalamus were used as predictor variables in multi‐variable logistic regression models to distinguish rats with and without epilepsy.

Results

Twenty‐nine percent (28/98) of the rats with traumatic brain injury (TBI) developed epilepsy. The best‐performing logistic regression model utilized the D2 and D7 T2 relaxation time as well as the D7 diffusion tensor data. The model distinguished rats with and without epilepsy (Bonferroni‐corrected p‐value < .001) with a cross‐validated concordance statistic of 0.74 (95% confidence interval [CI] 0.60–0.84). In a cross‐validated classification test, the model exhibited 54% sensitivity and 91% specificity, enriching the epilepsy rate within the study population from the expected 29% to 71%. A model using the D2 T2 data only resulted in a 73% enriched epilepsy rate (regression p‐value .007, cross‐validated concordance 0.70, 95% CI 0.56–0.80, sensitivity 29%, specificity 96%).

Significance

An MRI parameter set reporting on acute and subacute neuropathologic changes common to experimental and human TBI presents a diagnostic biomarker for post‐traumatic epileptogenesis. Significant enrichment of the study population was achieved even when using a single time‐point measurement, producing an expected epilepsy rate of 73%.
Understanding cardiovascular disease in older adults with epilepsy
Authors: Husein Nafisa , Josephson Colin B. , Keezer Mark R.
Published: July 2021

Objective

This study was undertaken to investigate the distribution of social, lifestyle/behavior, and chronic disease risk factors for cardiovascular disease (CVD) in people with epilepsy as compared to the general population. We also measured the cross‐sectional association between epilepsy and CVD in older adults, with and without adjustments for a history of stroke.

Methods

We analyzed data for 44 817 participants in the Canadian Longitudinal Study on Aging, including 751 individuals with a lifetime history of epilepsy. We modeled associations using ordinal and binomial logistic regression, as well as log‐binomial regression, with multiple imputation for missing data. We measured the attributable fraction of CVD burden due to stroke.

Results

The majority of the CVD risk factors were significantly more prevalent in people with epilepsy as compared to the general population without epilepsy, independent of age and sex. After adjusting for a history of stroke, people with epilepsy had a significantly higher prevalence of heart disease (prevalence ratio [PR] = 1.27, 95% confidence interval [CI] = 1.02–1.57) and peripheral vascular disease (PR = 1.88, 95% CI = 1.50–2.36). Stroke accounted for 36% (95% CI = 19.85–48.76) of the increased prevalence of any CVD among people with epilepsy, similar to the 32% (95% CI = 27.82–36.25) among people without epilepsy. After adjustment for all other CVD risk factors, peripheral vascular disease remained significantly more prevalent (PR = 1.65, 95% CI = 1.28–2.12) in people with epilepsy as compared to those without.

Significance

CVD risk factors are more prevalent in people with epilepsy, independent of age and sex, and the association between epilepsy and CVD is independent of the association between epilepsy and stroke. The association between peripheral vascular disease and epilepsy may differ from the associations with other types of CVD. These findings are important steps in more comprehensively understanding the origins of CVD in people with epilepsy.
Predicting postoperative epilepsy surgery satisfaction in adults using the 19‐item Epilepsy Surgery Satisfaction Questionnaire and machine learning
Authors: Josephson Colin B. , Engbers Jordan D. T. , Sajobi Tolulope T. , Wahby Sandra , Lawal Oluwaseyi A. , Keezer Mark R. , Nguyen Dang K. , Malmgren Kristina , Atkinson Mark J. , Hader Walter J. , Macrodimitris Sophia , Patten Scott B. , Pillay Neelan , Sharma Ruby , Singh Shaily , Starreveld Yves , Wiebe Samuel
Published: July 2021

Objective

The 19‐item Epilepsy Surgery Satisfaction Questionnaire (ESSQ‐19) is a validated and reliable post hoc means of assessing patient satisfaction with epilepsy surgery. Prediction models building on these data can be used to counsel patients.

Methods

The ESSQ‐19 was derived and validated on 229 patients recruited from Canada and Sweden. We isolated 201 (88%) patients with complete clinical data for this analysis. These patients were adults (≥18 years old) who underwent epilepsy surgery 1 year or more prior to answering the questionnaire. We extracted each patient’s ESSQ‐19 score (scale is 0–100; 100 represents complete satisfaction) and relevant clinical variables that were standardized prior to the analysis. We used machine learning (linear kernel support vector regression [SVR]) to predict satisfaction and assessed performance using the R2 calculated following threefold cross‐validation. Model parameters were ranked to infer the importance of each clinical variable to overall satisfaction with epilepsy surgery.

Results

Median age was 41 years (interquartile range [IQR] = 32–53), and 116 (57%) were female. Median ESSQ‐19 global score was 68 (IQR = 59–75), and median time from surgery was 5.4 years (IQR = 2.0–8.9). Linear kernel SVR performed well following threefold cross‐validation, with an R2 of .44 (95% confidence interval = .36–.52). Increasing satisfaction was associated with postoperative self‐perceived quality of life, seizure freedom, and reductions in antiseizure medications. Self‐perceived epilepsy disability, age, and increasing frequency of seizures that impair awareness were associated with reduced satisfaction.

Significance

Machine learning applied postoperatively to the ESSQ‐19 can be used to predict surgical satisfaction. This algorithm, once externally validated, can be used in clinical settings by fixing immutable clinical characteristics and adjusting hypothesized postoperative variables, to counsel patients at an individual level on how satisfied they will be with differing surgical outcomes.
Clinical phenotypes within nonconvulsive status epilepticus
Authors: Lattanzi Simona , Giovannini Giada , Brigo Francesco , Orlandi Niccolò , Trinka Eugen , Meletti Stefano
Published: July 2021

The study aimed to identify distinct phenotypes within nonconvulsive status epilepticus (NCSE). Consecutive episodes of NCSE in patients at least 14 years old were included. The level of consciousness was assessed through the Glasgow Coma Scale (GCS). Etiology of NCSE was defined as symptomatic (acute, remote, progressive) or unknown. Electroencephalographic (EEG) recordings were searched for lateralized periodic discharges (LPDs), generalized sharply and/or triphasic periodic potentials (GPDs), and spontaneous burst suppression (BS). According to treatment response, NCSE was classified as responsive, refractory, or superrefractory. Average linkage hierarchical cluster analysis was performed with Pearson correlation as similarity measure. Two hundred twenty‐nine episodes of NCSE were included. Three clusters were identified. The first cluster linked GCS score 3–8, presence of spontaneous BS on EEG, acute symptomatic etiology, and treatment superrefractoriness. The second cluster gathered GCS score 9–12, presence of LPDs or GPDs on EEG, unknown etiology, and treatment refractoriness. The third cluster associated GCS score 13–15, absence of LPDs, GPDs, and spontaneous BS on EEG, and progressive and remote symptomatic etiology with treatment responsiveness. Phenotyping the heterogeneity of NCSE into electroclinical clusters can contribute to understanding correlations between pathologic and clinical domains, assessing the intrinsic severity of NCSE episodes, and estimating the likelihood of treatment responsiveness.