bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience-Based Co-Design to Develop an Injury Prevention Intervention in Skilled Nursing Facilities
Authors: McConnell Eleanor , Berry Sarah , Hecker Emily , Herndon Laurie , Colon-Emeric Cathleen
Published: December 2020

Experience-based co-design (EBCD) improves clinical effectiveness and safety by incorporating end-user perspectives in the design of clinical interventions. To refine a centralized, multi-component fall-related injury prevention service (IPS) to be tested in skilled nursing facilities (SNFs) in a pragmatic trial, we employed a modified EBCD process. We first conducted in-depth interviews with SNF residents, family members, and staff (n = 28; three facilities in two states) regarding their experiences in falls prevention. We then engaged these and other stakeholders from multiple institutions (n=4) in a day-long co-design workshop with our interdisciplinary research team. Building upon themes drawn from the analysis of interviews, we targeted three intervention components that were refined during the workshop: de-prescribing process, osteoporosis treatment, and educational videoconferences. Key outcomes from the ECBD process included development of strategies to ensure that: (1) residents, families, and SNF staff are involved in communication about residents identified as high risk for fall-related injury, and in related treatment decisions; (2) approaches to monitoring for unintended consequences from the injury prevention plan are clearly understood by direct care staff and are compatible with existing workflow; (3) treatment plan risks and benefits are presented in a manner easily understood by stakeholders; and (4) staff education conferences build trust with the IPS nurse and provide direct care staff with support and advice about challenging cases. EBCD is a feasible approach to strengthen intervention development in SNFs and can lead to testable new ideas for protocol refinement to address diverse stakeholder perspectives.
Differences in Characteristics Associated With Mobility in Older Dwellers of a Hillside Residential Community
Authors: Nitanai Ryoichi , Ogino Ryogo , Umemoto Daisuke , Matsumura Yu , Sakurai Rika , Hosogaya Kazutate , Endo Takaaki , Goto Jun
Published: December 2020

In a super-ageing society, sustaining outings as an elderly person is necessary for maintaining good health and preventing frailty and social isolation. Avoiding driving cars and walking due to ageing are among factors that deter the elderly from going out. However, the characteristics associated with mobility on foot and by car in actual outings of the elderly have not been examined. To explore these characteristics, we conducted interviews with 23 elderly participants living in a suburban hillside residential community in Japan, and investigated the destinations, routes, and means of all their outings for a certain week. Then, spatial analysis was conducted to identify differences in behavioral characteristics associated with mobility on foot and by car/taxi among three age groups: 70–79, 80–84, and 85+. Consequently, two inclinations were identified. First, the older the group, the smaller the area of the outing on foot due to difficulties in walking on slopes for a long duration with luggage. Second, the use of a car/taxi varies among the three groups. While the 70–79 age group used cars/taxis for district-to-district trips, the 80–84 age group rarely used them, and further, the 85+ age group mainly travelled by them one-way or made back-and-forth trips. To summarize, for older suburban dwellers in a hillside residential community, mobility on foot is lowered by physical and mental weakness and the landscape. Therefore, even though mobility increases by using cars/taxis, willingness for outing has changed with ageing, and thus, they make limited use of opportunities.
Confirmatory Factor Analysis of the Perceived Stress Scale-10 Across Age Groups
Authors: Intrieri Robert , Goodwin Paige
Published: December 2020

The Perceived Stress Scale-10 (PSS; Cohen et al, 1983) was developed to measure subjective elements of stress. Most measures focus on objective characteristics of stress (e. g., frequency of occurrence) and specific situations that produce stress (e. g., divorce) but ignore the cognitive appraisal associated with stressful stimuli. The PSS-10 assesses the interplay between stressor and appraisal-mediated coping ability. Factor analytic studies provide support for two factors: perceived helplessness and perceived self-efficacy (see Roberti et al. 2006). The current study presents data from 591 people across three groups: 221 young adults (mean age 19.31, SD = 1.21), 283 middle-age adults (mean age 48.27, SD = 5.14), and 109 older adults (mean age 72.95, SD = 7.22). An ordinal confirmatory factor analysis (CFA) using robust weighted least squares (WLSMV) evaluated invariance across age groups. Results showed CFI/TLI values of .964/.953, 965/.960, and .964/.969 for Configural (CI), Metric (MI), and Scalar (SI) models. The RMSEA for CI, MI, and SI models was .086, .081, and .071. Based upon recommendations of Cheung and Rensvold (2002), Sass (2011), and Chen (2007), a cutoff of ΔCFI ≥ 0.01 was established as evidence of invariance. The ΔCFI between CI and MI models was < .01 so analysis continued with the SI test. Once again, ΔCFI between MI and SI models was < 0.01 which did not justify rejection of the null hypothesis. Based on these analyses, PSS-10 scores are valid across multiple age groups. Further, results support the multidimensional nature of the PSS-10.
eMental Health Literacy and the Relationship to Barriers to Mental Health Care
Authors: Root Eve , Caskie Grace
Published: December 2020

According to the American Psychological Association (2017), one in four individuals who are 65 years and older experience a mental health problem; however, many older adults do not receive the services they need and deserve (Karlin, 2008). The current study utilizes a new concept similar to eHealth Literacy called eMental Health Literacy, defined as the degree to which individuals obtain, process, and understand basic mental health information and services needed to aid their recognition, management, or prevention of mental health issues. The relationship of eMental Health Literacy to perceived barriers to receiving mental health services was examined in a sample of middle-aged and older adults. We hypothesized that higher eMental Health Literacy would predict fewer reported barriers to mental health services. A sample of 243 participants (M=63.33, range=55-80 years) were recruited online through Amazon Mechanical Turk to complete measures assessing eMental Health Literacy (eMHEALS) and mental health barriers (BMHSSS-R). After adding two correlated errors, a structural equation model specifying eMHEALS as a predictor of extrinsic and intrinsic barriers to mental health services achieved good fit (χ2(60)=170.014, p<.001, SRMR=.068, CFI=.944, GFI=.901, TLI=.927, RMSEA=.087). All indicators were significantly related to their latent construct (p<.001). The results indicate higher eMental Health Literacy significantly predicted fewer reported intrinsic and fewer extrinsic barriers to mental health services. These relationships were statistically significant even when examined across differing socioeconomic status and age. These findings indicate eMental Health Literacy may have significant impact on the way individuals in later life navigate through the mental healthcare system.
The Effects of the COVID-19 Pandemic on the Lived Experience of Diverse Older Adults Living Alone With Cognitive Impairment
Authors: Portacolone Elena , Chodos Anna , Halpern Jodi , Covinsky Kenneth E , Keiser Sahru , Fung Jennifer , Rivera Elizabeth , Tran Thi , Bykhovsky Camilla , Johnson Julene K
Published: December 2020

Background and Objectives

Even before the COVID-19 pandemic, older adults with cognitive impairment living alone (an estimated 4.3 million individuals in the United States) were at high risk for negative health outcomes. There is an urgent need to learn how this population is managing during the pandemic.

Research Design and Methods

This is a qualitative study of 24 adults aged 55 and older living alone with cognitive impairment from diverse racial/ethnic backgrounds. Participants’ lived experiences during the pandemic were elicited via 59 ethnographic interviews conducted over the phone either in English, Spanish, or Cantonese. Using a qualitative content analysis approach, interview transcripts were analyzed to identify codes and themes.

Results

Qualitative analysis of transcripts revealed 5 themes: (a) fear generated by the pandemic, (b) distress stemming from feeling extremely isolated, (c) belief in misinformation, (d) strategies for coping during the pandemic, and (e) the importance of access to essential services.

Discussion and Implications

This pandemic put a spotlight on the precarity and unmet needs of older adults living alone with cognitive impairment. Findings underscore the need to expand access to home care aides and mental health services for this population.
Noncoding RNAs as Promising Diagnostic Biomarkers and Therapeutic Targets in Intestinal Fibrosis of Crohn’s Disease: The Path From Bench to Bedside
Authors: Zhou Long-Yuan , Lin Si-Nan , Rieder Florian , Chen Min-Hu , Zhang Sheng-Hong , Mao Ren
Published: December 2020

Fibrosis is a major pathway to organ injury and failure, accounting for more than one-third of deaths worldwide. Intestinal fibrosis causes irreversible and serious clinical complications, such as strictures and obstruction, secondary to a complex pathogenesis. Under the stimulation of profibrotic soluble factors, excessive activation of mesenchymal cells causes extracellular matrix deposition via canonical transforming growth factor-β/Smads signaling or other pathways (eg, epithelial-to-mesenchymal transition and endothelial-to-mesenchymal transition) in intestinal fibrogenesis. In recent studies, the importance of noncoding RNAs (ncRNAs) stands out in fibrotic diseases in that ncRNAs exhibit a remarkable variety of biological functions in modulating the aforementioned fibrogenic responses. In this review, we summarize the role of ncRNAs, including the emerging long ncRNAs and circular RNAs, in intestinal fibrogenesis. Notably, the translational potential of ncRNAs as diagnostic biomarkers and therapeutic targets in the management of intestinal fibrosis is discussed based on clinical trials from fibrotic diseases in other organs. The main points of this review include the following:

• Characteristics of ncRNAs and mechanisms of intestinal fibrogenesis

• Wide participation of ncRNAs (especially the emerging long ncRNAs and circular RNAs) in intestinal fibrosis, including transforming growth factor-β signaling, epithelial-to-mesenchymal transition/endothelial-to-mesenchymal transition, and extracellular matrix remodeling

• Translational potential of ncRNAs in the diagnosis and treatment of intestinal fibrosis based on clinical trials from fibrotic diseases in other organs
Overview of Factors Associated with HIV Viral Load Suppression in Transgender Women
Authors: Goldstein Zil G
Published: December 2020

Background

Transgender women face a significantly higher HIV burden than their cisgender counterparts around the world with worse treatment outcomes in almost all categories.

Content

A mini-review of the available literature discussing HIV risk and factors associated with HIV viral load suppression in transgender women.

This review discusses the disparities transgender women face that contribute to both of these factors including race as well as social determinants of health and how they affect the HIV treatment cascade in this population.
Genetic parameters and purebred–crossbred genetic correlations for growth, meat quality, and carcass traits in pigs
Authors: Esfandyari Hadi , Thekkoot Dinesh , Kemp Robert , Plastow Graham , Dekkers Jack
Published: December 2020

Growth, meat quality, and carcass traits are of economic importance in swine breeding. Understanding their genetic basis in purebred (PB) and commercial crossbred (CB) pigs is necessary for a successful breeding program because, although the breeding goal is to improve CB performance, phenotype collection and selection are usually carried out in PB populations housed in biosecure nucleus herds. Thus, the selection is indirect, and the accuracy of selection depends on the genetic correlation between PB and CB performance (rpc). The objectives of this study were to 1) estimate genetic parameters for growth, meat quality, and carcass traits in a PB sire line and related commercial CB pigs and 2) estimate the corresponding genetic correlations between purebred and crossbred performance (rpc). Both objectives were investigated by using pedigree information only (PBLUP) and by combining pedigree and genomic information in a single-step genomic BLUP (ssGBLUP) procedure. Growth rate showed moderate estimates of heritability for both PB and CB based on PBLUP, while estimates were higher in CB based on ssGBLUP. Heritability estimates for meat quality traits were diverse and slightly different based on PB and CB data with both methods. Carcass traits had higher heritability estimates based on PB compared with CB data based on PBLUP and slightly higher estimates for CB data based on ssGBLUP. A wide range of estimates of genetic correlations were obtained among traits within the PB and CB data. In the PB population, estimates of heritabilities and genetic correlations were similar based on PBLUP and ssGBLUP for all traits, while based on the CB data, ssGBLUP resulted in different estimates of genetic parameters with lower SEs. With some exceptions, estimates of rpc were moderate to high. The SE on the rpc estimates was generally large when based on PBLUP due to limited sample size, especially for CBs. In contrast, estimates of rpc based on ssGBLUP were not only more precise but also more consistent among pairs of traits, considering their genetic correlations within the PB and CB data. The wide range of estimates of rpc (less than 0.70 for 7 out of 13 traits) indicates that the use of CB phenotypes recorded on commercial farms, along with genomic information, for selection in the PB population has potential to increase the genetic progress of CB performance.
The Constitutional Right to a Healthy Environment in Indonesia
Authors: Butt Simon , Murharjanti Prayekti
Published: December 2020

Like many other countries, Indonesia has recently put the right to a ‘good and healthy environment’ into its Constitution. Also like many other countries, this right has been underutilised in its courts. This article demonstrates that underutilisation by examining the Constitutional Court cases in which the right has been mentioned. It then offers explanations for what we consider to be a conscious reluctance by lawyers and judges to use the right. Many of the reasons given to explain underutilisation or reluctance in the courts of other countries also help explain the Indonesian experience, including lack of judicial knowledge and difficulties in balancing competing rights. But additional factors are at play in Indonesia, including the political environment in which the Court operates, some of the Court’s decision-making practices, the way the right is worded in the Indonesian Constitution, and the preference of lawyers and judges for basing their arguments on generic constitutional rights rather than specific environmental rights.
mTORC1 promotes TOP mRNA translation through site-specific phosphorylation of LARP1
Authors: Jia Jian-Jun , Lahr Roni M , Solgaard Michael T , Moraes Bruno J , Pointet Roberta , Yang An-Dao , Celucci Giovanna , Graber Tyson E , Hoang Huy-Dung , Niklaus Marius R , Pena Izabella A , Hollensen Anne K , Smith Ewan M , Chaker-Margot Malik , Anton Leonie , Dajadian Christopher , Livingstone Mark , Hearnden Jaclyn , Wang Xu-Dong , Yu Yonghao , Maier Timm , Damgaard Christian K , Berman Andrea J , Alain Tommy , Fonseca Bruno D
Published: December 2020

LARP1 is a key repressor of TOP mRNA translation. It binds the m7Gppp cap moiety and the adjacent 5′TOP motif of TOP mRNAs, thus impeding the assembly of the eIF4F complex on these transcripts. mTORC1 controls TOP mRNA translation via LARP1, but the details of the mechanism are unclear. Herein we elucidate the mechanism by which mTORC1 controls LARP1’s translation repression activity. We demonstrate that mTORC1 phosphorylates LARP1 in vitro and in vivo, activities that are efficiently inhibited by rapamycin and torin1. We uncover 26 rapamycin-sensitive phospho-serine and -threonine residues on LARP1 that are distributed in 7 clusters. Our data show that phosphorylation of a cluster of residues located proximally to the m7Gppp cap-binding DM15 region is particularly sensitive to rapamycin and regulates both the RNA-binding and the translation inhibitory activities of LARP1. Our results unravel a new model of translation control in which the La module (LaMod) and DM15 region of LARP1, both of which can directly interact with TOP mRNA, are differentially regulated: the LaMod remains constitutively bound to PABP (irrespective of the activation status of mTORC1), while the C-terminal DM15 ‘pendular hook’ engages the TOP mRNA 5′-end to repress translation, but only in conditions of mTORC1 inhibition.
Double lock of a potent human therapeutic monoclonal antibody against SARS-CoV-2
Authors: Zhu Ling , Deng Yong-Qiang , Zhang Rong-Rong , Cui Zhen , Sun Chun-Yun , Fan Chang-Fa , Xing Xiaorui , Huang Weijin , Chen Qi , Zhang Na-Na , Ye Qing , Cao Tian-Shu , Wang Nan , Wang Lei , Cao Lei , Wang Huiyu , Kong Desheng , Ma Juan , Luo Chunxia , Zhang Yanjing , Nie Jianhui , Sun Yao , Lv Zhe , Shaw Neil , Li Qianqian , Li Xiao-Feng , Hu Junjie , Xie Liangzhi , Rao Zihe , Wang Youchun , Wang Xiangxi , Qin Cheng-Feng
Published: December 2020

Receptor recognition and subsequent membrane fusion are essential for the establishment of successful infection by SARS-CoV-2. Halting these steps can cure COVID-19. Here we have identified and characterized a potent human monoclonal antibody, HB27, that blocks SARS-CoV-2 attachment to its cellular receptor at sub-nM concentrations. Remarkably, HB27 can also prevent SARS-CoV-2 membrane fusion. Consequently, a single dose of HB27 conferred effective protection against SARS-CoV-2 in two established mouse models. Rhesus macaques showed no obvious adverse events when administrated with 10 times the effective dose of HB27. Cryo-EM studies on complex of SARS-CoV-2 trimeric S with HB27 Fab reveal that three Fab fragments work synergistically to occlude SARS-CoV-2 from binding to the ACE2 receptor. Binding of the antibody also restrains any further conformational changes of the receptor binding domain, possibly interfering with progression from the prefusion to the postfusion stage. These results suggest that HB27 is a promising candidate for immuno-therapies against COVID-19.
Kosovo
Authors: Judah Tim
Published: December 2020

On February 17, 2008, Kosovo declared its independence, becoming the seventh state to emerge from the break-up of the former Yugoslavia. A tiny country of just two million people, 90% of whom are ethnic Albanians, Kosovo is central - geographically, historically, and politically - to the future of the Western Balkans and, in turn, its potential future within the European Union. But the fate of both Kosovo, condemned by Serbian leaders as a “fake state” and the region as a whole, remains uncertain. In Kosovo: What Everyone Needs to Know, Tim Judah provides a straight-forward guide to the complicated place that is Kosovo. Judah, who has spent years covering the region, offers succinct, penetrating answers to a wide range of questions: Why is Kosovo important? Who are the Albanians? Who are the Serbs? Why is Kosovo so important to Serbs? What role does Kosovo play in the region and in the world? Judah reveals how things stand now and presents the history and geopolitical dynamics that have led to it. The most important of these is the question of the right to self-determination, invoked by the Kosovo Albanians, as opposed to right of territorial integrity invoked by the Serbs. For many Serbs, Kosovo's declaration of independence and subsequent recognition has been traumatic, a savage blow to national pride. Albanians, on the other hand, believe their independence rights an historical wrong: the Serbian conquest (Serbs say “liberation”) of Kosovo in 1912. For anyone wishing to understand both the history and possible future of Kosovo at this pivotal moment in its history, this book offers a wealth of insight and information in a uniquely accessible format.
The Bible
Authors: Coogan Michael
Published: December 2020

The Bible is the most influential book in Western history. As the foundational text of Judaism and Christianity, the Bible has been interpreted and reinterpreted over millennia, utilized to promote a seemingly endless run of theological and political positions. Adherents and detractors alike point to different passages throughout to justify wildly disparate behaviors and beliefs. Translated and retranslated, these texts lead both to unity and intense conflict. Influential books on any topic are typically called “bibles.” What is the Bible? As a text considered sacred by some, its stories and language appear throughout the fine arts and popular culture, from Shakespeare to Saturday Night Live. In Michael Coogan’s eagerly awaited addition to Oxford’s What Everyone Needs to know® series, conflicts and controversies surrounding the world’s bestselling book are addressed in a straightforward Q&A format. This book provides an unbiased look at biblical authority and authorship, the Bible’s influence in Western culture, the disputes over meaning and interpretation, and the state of biblical scholarship today. Brimming with information for the student and the expert alike, The Bible: What Everyone Needs to Know ® is a dependable introduction to a most contentious holy book.
ICU Delirium-Prediction Models: A Systematic Review
Authors: Ruppert Matthew M. , Lipori Jessica , Patel Sandip , Ingersent Elizabeth , Cupka Julie , Ozrazgat-Baslanti Tezcan , Loftus Tyler , Rashidi Parisa , Bihorac Azra
Published: December 2020

Objective:

Summarize performance and development of ICU delirium-prediction models published within the past 5 years.

Data Sources:

Systematic electronic searches were conducted in April 2019 using PubMed, Embase, Cochrane Central, Web of Science, and Cumulative Index to Nursing and Allied Health Literature to identify peer-reviewed studies.

Study Selection:

Eligible studies were published in English during the past 5 years that specifically addressed the development, validation, or recalibration of delirium-prediction models in adult ICU populations.

Data Extraction:

Screened citations were extracted independently by three investigators with a 42% overlap to verify consistency using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies.

Data Synthesis:

Eighteen studies featuring 23 distinct prediction models were included. Model performance varied greatly, as assessed by area under the receiver operating characteristic curve (0.62–0.94), specificity (0.50–0.97), and sensitivity (0.45–0.96). Most models used data collected from a single time point or window to predict the occurrence of delirium at any point during hospital or ICU admission, and lacked mechanisms for providing pragmatic, actionable predictions to clinicians.

Conclusions:

Although most ICU delirium-prediction models have relatively good performance, they have limited applicability to clinical practice. Most models were static, making predictions based on data collected at a single time-point, failing to account for fluctuating conditions during ICU admission. Further research is needed to create clinically relevant dynamic delirium-prediction models that can adapt to changes in individual patient physiology over time and deliver actionable predictions to clinicians.
Association Between ICU-Acquired Hypernatremia and In-Hospital Mortality: Data From the Medical Information Mart for Intensive Care III and the Electronic ICU Collaborative Research Database
Authors: Olsen Markus Harboe , Møller Marcus , Romano Stefano , Andersson Jonas , Mlodzinski Eric , Raines Nathan H. , Sherak Raphael , Jeppesen Anni Nørgaard
Published: December 2020

Objectives:

Describe the relationship between ICU-acquired hypernatremia and in-hospital mortality and investigate the optimal hypernatremia correction rate.

Design, Setting, Participants, and Measurements:

Observational study including two individual ICU cohorts. We used the Medical Information Mart for Intensive Care III v. 1.4 database consists of all ICU patients admitted to the Beth Israel Deaconess Medical Center in Boston from 2001 to 2012 (n = 46,476). The electronic ICU v. 2.0 database consists of all ICU patients admitted to 208 distinct hospitals across the United States from 2014 to 2015 (n = 200,859). We included all adult patients admitted to an ICU with two consecutive sodium samples within normal range (135–145 mmol/L) and without two consecutive hyponatremic samples (< 135 mmol/L) during the ICU stay.

Results:

Of 23,445 patients identified in Medical Information Mart for Intensive Care III, 9% (n = 2,172) developed hypernatremia during their ICU stay. In electronic ICU, 88,160 patients were identified and 7% (n = 5,790) developed hypernatremia. In both cohorts, patients with hypernatremia had a higher mortality (Medical Information Mart for Intensive Care III: 20% vs 42%; p < 0.01 and electronic ICU: 6% vs 22%; p < 0.01), with hypernatremia increasing the risk of in-hospital mortality (Medical Information Mart for Intensive Care III: odds ratio, 1.15; 95% CI, 1.13–1.17 and electronic ICU: odds ratio, 1.11; 95% CI, 1.10–1.12) and over time using a Cox regression. Rapid sodium correction rate (> 0.5 mmol/L/hr) was associated with an increased in-hospital mortality in both cohorts (Medical Information Mart for Intensive Care III: odds ratio, 1.08; 95% CI, 1.03–1.13 and electronic ICU: odds ratio, 1.10; 95% CI, 1.06–1.13). In the electronic ICU cohort, rapid correction rates were associated with a significant difference in in-hospital mortality, but there was no statistically significant association in the Medical Information Mart for Intensive Care III cohort.

Conclusions:

ICU-acquired hypernatremia is associated with increased in-hospital mortality. Furthermore, a rapid sodium correction rates may be harmful. This suggests it is important to both prevent ICU-acquired hypernatremia and to avoid rapid correction rates if a patient becomes hypernatremic.
Racial Differences in Gastroenteropancreatic Neuroendocrine Tumor Treatment and Survival in the United States
Authors: Kessel Elizabeth , Naparst Monica , Alpert Naomi , Diaz Kelly , Ahn Eugene , Wolin Edward , Taioli Emanuela , Kim Michelle Kang
Published: December 2020

Objectives

The objective of this study was to evaluate racial differences in cancer treatment and survival in gastroenteropancreatic neuroendocrine tumor (GEP-NET) patients.

Methods

Using the Surveillance, Epidemiology, and End Results Registry, we identified patients with GEP-NETs of the stomach, small intestine (SI), colon, rectum, appendix, and pancreas diagnosed between 1973 and 2014. Demographic, cancer, and treatment information were collected and compared using χ2 tests. Multivariable logistic and Cox regression were used to determine disparities in receiving treatment and overall survival.

Results

We identified 19,031 GEP-NET patients: 2839 were non-Hispanic Blacks, 12,832 non-Hispanic Whites, 2098 Hispanics, and 1262 Asians. African Americans and Hispanics with SI and pancreatic NETs were less likely to be treated with surgery (odds ratio, 0.6; 95% confidence interval [CI], 0.46–0.69; odds ratio, 0.71; 95% CI, 0.51–0.99, respectively). African American race was not an independent predictor of survival; there was a strong trend in stomach, SI, and pancreas NETs (hazard ratio [HR], 1.31; 95% CI, 1–1.7; HR, 1.2; 95% CI, 0.99–1.45; HR, 1.22; 95% CI, 1–1.48, respectively).

Conclusions

Our study provides evidence of racial disparities in treatment and survival across GEP-NET primary sites and racial groups. Further studies should be performed to improve our understanding of the reason for these disparities.
Gut Microbiome Profile After Pancreatectomy in Infants With Congenital Hyperinsulinism
Authors: Vajravelu Mary Ellen , Lee Jung-Jin , Mitteer Lauren , Zemel Babette S. , Bittinger Kyle , De León Diva D.
Published: December 2020

Objectives

The objective of this study was to characterize gut microbiome profiles of infants with congenital hyperinsulinism (HI) who underwent near-total or partial pancreatectomy for hypoglycemia management, as compared with healthy controls.

Methods

A prospective observational cohort study was performed. Subjects were infants (0–6 months) with HI who underwent removal of pancreatic tissue for management of intractable hypoglycemia from February 2017 to February 2018 at the Children's Hospital of Philadelphia. Fecal samples were collected postoperatively, on full enteral nutrition. The gut microbiome of HI subjects was analyzed and compared with age-matched samples from healthy infants.

Results

Seven subjects with ≥50% pancreatectomy and 6 with <50% pancreatectomy were included. α (within-sample) diversity was lowest among infants with ≥50% pancreatectomy (richness: false discovery rate, 0.003; Shannon index: false discovery rate, 0.01). β (between-sample) diversity (Bray-Curtis dissimilarity, P = 0.02; Jaccard distance, P = 0.001) differed across groups (≥ or <50% pancreatectomy, controls). Bifidobacteria and Klebsiella species were least abundant among infants with ≥50% pancreatectomy but did not differ between infants with <50% pancreatectomy and historical controls.

Conclusions

Infants with HI who underwent ≥50% pancreatectomy differed from age-matched infants in gut microbiome profile, whereas those with <50% pancreatectomy more closely resembled control profiles. The durability of this difference should be investigated.
Age-Related Differences in the Prognosis of Pancreatic Cancer According to Perioperative Systemic Therapy
Authors: Sonohara Fuminori , Yamada Suguru , Kurimoto Keisuke , Inokawa Yoshikuni , Takami Hideki , Hayashi Masamichi , Shimizu Dai , Hattori Norifumi , Kanda Mitsuro , Tanaka Chie , Nakayama Goro , Koike Masahiko , Fujii Tsutomu , Kodera Yasuhiro
Published: December 2020

Objectives

In this study, we retrospectively assessed the feasibility and prognostic efficacy of perioperative chemo(radio)therapy for pancreatic cancer (PC) patients according to age.

Methods

A total of 556 consecutive patients who underwent curative-intent pancreatectomy for PC between 2000 and 2018 were enrolled.

Results

Of the 556 patients who underwent resection, 95 (17%) were elderly (age, ≥75 years). Postoperative complications did not significantly differ between the 2 age groups, and postoperative prognoses were also similar (recurrence-free survival [RFS], P = 0.68; overall survival [OS], P = 0.28). In this cohort, 103 patients (19%) underwent preoperative chemo(radio)therapy, and 417 (77%) underwent postoperative chemotherapy. Perioperative therapy was found to be significantly beneficial for younger patients (preoperative therapy: RFS, P = 0.006; OS, P < 0.001; postoperative therapy: RFS, P < 0.001; OS, P < 0.001). Conversely, no significant survival benefit of perioperative therapy was found for the elderly (preoperative therapy: RFS, P = 0.28; OS, P = 0.44; postoperative therapy: RFS, P = 0.77; OS, P = 0.08).

Conclusions

This study demonstrated that, although perioperative therapy is feasible for selected elderly patients with PC, this approach might not be as beneficial as it is for younger PC patients.
Risk of Venous Thromboembolism in Acute Necrotizing Pancreatitis
Authors: Ahmad Dina S. , Mansoor Emad , Alikhan Muhammed M. , Rana Mariam Nadeem , Panhwar Muhammad Siyab , Wong Richard C.K. , Smith Zachary L.
Published: December 2020

Objectives

Studies on the incidence of venous thromboembolism (VTE) in acute pancreatitis (AP) are scarce. We conducted a large database study to evaluate this relationship.

Methods

Data were extracted from a large electronic health record (Explorys; IBM Watson Health, Armonk, NY). We identified patients with AP in 2018 and 2019, analyzing VTE incidence at 30 days after diagnosis of AP. Univariate and multivariate analyses were performed to identify risk factors associated with VTE.

Results

A total of 25,620 cases of acute necrotizing pancreatitis (ANP) and 155,800 cases of acute nonnecrotizing pancreatitis (ANNP) were identified. The incidence of VTE was 7.1% for ANP, compared with 2.8% in ANNP (P < 0.001). On multivariate analysis, ANP conferred significantly greater odds of VTE (adjusted odds ratio, 2.78; 95% confidence interval, 2.73–2.84; P < 0.001), independent of other variables. In those with ANP, the presence of VTE was associated with a significantly higher mortality (23.5% vs 15.9%, P < 0.001).

Conclusions

Acute necrotizing pancreatitis carries near 2.5-fold risk of VTE, and a 3-fold risk of PE, compared with those with ANNP. Venous thromboembolism development in ANP is associated with higher mortality.
Prognostic Impact of Time to Surgery in Patients With Resectable Pancreatic Ductal Adenocarcinoma
Authors: Joliat Gaëtan-Romain , Labgaa Ismail , Gilgien Jérôme , Demartines Nicolas
Published: December 2020

Objectives

Some studies suggested the importance of performing pancreatoduodenectomy expeditiously in resectable pancreatic ductal adenocarcinoma (PDAC). This study aimed to assess the prognostic value of time to surgery in patients undergoing pancreatoduodenectomy for PDAC.

Methods

All PDAC patients who underwent upfront pancreatoduodenectomy were collected (2000–2015). Diagnosis date was the computed tomography scan date where a suspicious pancreatic head lesion was observed. Survival analyses were performed using Kaplan-Meier method. Cox model was used to find predictive factors of survival.

Results

A total of 192 patients underwent pancreatoduodenectomy. The median time to surgery was 27 days (interquartile range, 17–40 days). The best dichotomous threshold for 24-month overall survival (OS) was 30 days. The median OS was similar between groups with time to surgery of fewer than 30 days and time to surgery of 30 days or more (25 vs 21 months, P = 0.609). Similar results were found for median recurrence-free survivals (19 vs 15 months, P = 0.561). On Cox regressions, time to surgery was not associated with shorter OS. Only lymph node invasion and adjuvant chemotherapy were independent OS predictors (hazard ratio, 2.610, P = 0.006, and hazard ratio, 2.042, P = 0.001).

Conclusions

Delaying surgery 30 days or more after diagnostic computed tomography scan was not associated with poorer OS and recurrence-free survival. Moreover, time to surgery was not prognostic of OS.
Prevalence of Myocardial Infarction in Patients With Chronic Pancreatitis
Authors: Khan Danyal , Abureesh Mohammad , Alkhayyat Motasem , Sadiq Waleed , Alshami Mohammad , Munir Abdullah B. , Karam Boutros , Deeb Liliane , Lafferty James
Published: December 2020

Objective

We conducted this study to ascertain whether chronic inflammation secondary to chronic pancreatitis (CP) has any association with myocardial infarction(MI).

Methods

Data were collected from a commercial database (Explorys, Inc, IBM Watson, Ohio). Adults with the diagnosis of “chronic pancreatitis,” based on Systematized Nomenclature of Medicine–Clinical Terms, were included in the CP group, and the rest of the patients were included in the non-CP group. The prevalence of MI was compared in both groups, and statistical multivariate model was performed.

Results

A total of 28,842,210 patients were included in the study. The overall prevalence of MI was 14.22% in the CP group as compared with 3.23% in the non-CP group (P < 0.0001). In the multivariate analysis, the odds ratio (OR) for MI in CP group was 1.453 (95% confidence interval, 1.418–1.488, P < 0.0001). Hypertension was a strong predictor for MI in the CP group with an OR of 3.2 (95% confidence interval, 3.0–3.5), followed by chronic kidney disease, older than 65 years, dyslipidemia, diabetes mellitus, obesity, alcohol abuse, smoking, White race, and male sex.

Conclusions

This study showed that CP is associated with comorbidities, which can increase the prevalence and OR of MI.
Videocapillaroscopic Findings in Patients With Systemic Lupus Erythematosus With or Without Jaccoud Arthropathy
Authors: Pimenta da Fonseca Emanuela , Lins Carolina Freitas , de Sá Ribeiro Daniel Lima , Santos Willer Gonçalves Dourado , Rosa Genevievi , Machicado Viviane , Pedreira Ana Luiza , Souza Anna Paula Mota Duque , Baleeiro Carla , dos Santos Ferreira Luana Grazielle , de Oliveira Isabela Silva , da Silva João Paulo Cotrim Gama , Atta Ajax Merces , Santiago Mittermayer Barreto
Published: December 2020

Background/Objective

Systemic lupus erythematosus (SLE) is an autoimmune disease that can present changes in blood vessels, which can be evaluated by periungual nailfold videocapillaroscopy (VCP). This technique is important for the diagnosis of systemic sclerosis and to identify individuals with Raynaud phenomenon at higher risk of developing systemic sclerosis. This study aims to describe the videocapillaroscopic profile of a series of SLE patients and to investigate if the VCP pattern is different among those with Jaccoud arthropathy (JA) compared with those without.

Methods

Between September 2014 and March 2015, the patients in this study underwent VCP, clinical evaluation, and laboratory tests. The capillaroscopic patterns were defined as minor, major, and scleroderma (SD). The presence of capillaroscopic findings, such as elongated capillaries, tortuosity, ectasia, prominent venous plexus, neoangiogenesis, hemorrhage, and megacapillaries, were also observed. Associations were calculated using the χ2, Fisher exact, or Student t test.

Results

In a population of 113 females with SLE (67 without JA and 46 with JA), at least 1 alteration was observed in VCP in 89.40% of them, among which “nonspecific changes” were the most prevalent. Minor changes were seen in 39 (58.2%) and 26 (56.5%), major changes in 21 (31.3%) and 11 (23.9%), and SD pattern in 2 (3.0%) and 3 (6.5%), in the patients without and with JA, respectively (p > 0.05).

Conclusions

The majority of patients with SLE demonstrated changes in the VCP examination, but this tool did not allow discrimination between those with or without JA.
Drug Survival of Biologic Therapy in Elderly Patients With Rheumatoid Arthritis Compared With Nonelderly Patients
Authors: Jung Seung Min , Lee Sang-Won , Song Jason Jungsik , Park Sung-Hwan , Park Yong-Beom
Published: December 2020

Objective

Although the proportion of elderly patients with rheumatoid arthritis (RA) is increasing, the persistency of biologic therapy in elderly patients requires additional investigation. This study evaluated the drug survival of biologic therapy and associated factors in elderly compared with nonelderly patients.

Methods

This longitudinal observational study included RA patients who were enrolled in the Korean College of Rheumatology Biologics Registry (NCT01965132, started from January 1, 2013) between 2013 and 2015. We compared the retention rate of biologic therapy between elderly (age ≥70 years) and nonelderly (age <70 years) patients, and investigated the causes and predictors of biologic withdrawal in both groups.

Results

Of 682 patients, 122 were aged 70 years or older. The retention rate of biologic therapy at 24 months was 57.8% and 46.5% in nonelderly and elderly patients, respectively (p = 0.027). Biologic withdrawal due to adverse events and inefficacy within 24 months was not significantly different between the 2 groups, although adverse events were more common in elderly patients (20.6% vs 12.8%, p = 0.360). Drug withdrawal due to patient refusal was more common in elderly patients (9.8% vs 1.8%, p < 0.001). In elderly patients, biologic withdrawal was associated with current smoking and older age at disease onset, whereas the use of tumor necrosis factor inhibitors, nonuse of methotrexate, and combination of corticosteroid were important in nonelderly patients.

Conclusions

Elderly RA patients are more likely to discontinue biologic agents within 24 months. To increase the retention rate of biologic therapy, rheumatologists should consider patient characteristics before and during biologic therapy.
MRI Features Associated With the Detection of Microbial Pathogens by CT-Guided Biopsy in Septic Spondylodiscitis
Authors: Chotard Emilie , Jacquier Hervé , Bart Géraldine , Richette Pascal , Rioux Christophe , Joly Véronique , Goossens Julia , Palazzo Elisabeth , Forien Marine , Jelin Germain , Yazdanpanah Yazdan , Dieudé Philippe , Le Goff Benoît , Ottaviani Sébastien
Published: December 2020

Objective

The aim of this study was to assess the magnetic resonance imaging (MRI) features associated with microbial pathogen detection by computed tomography (CT)–guided biopsy in patients with suspected septic spondylodiscitis.

Methods

For the last 10-year period, we analyzed the medical records of patients who underwent MRI and CT-guided biopsy for suspected septic spondylodiscitis. Clinical characteristics were recorded. The following MRI features were assessed: edema or contrast enhancement of the intervertebral disc, adjacent vertebrae, epidural and paravertebral space, presence of abscess, and paravertebral edema size. A positive biopsy was defined by pathogen identification on bacterial analysis or the presence of granuloma on histology. Predictors of a positive biopsy were assessed with a logistic regression model.

Results

We examined data for 61 patients (34 [56%] male; mean age, 59.9 ± 18.0 years); for 35 patients (57%), CT-guided biopsy was positive for a pathogen. The 4 MRI findings significantly associated with a positive biopsy were epiduritis, greater than 50% vertebral endplate edema, loss of intradiscal cleft, and abscess. The size of paravertebral edema was greater with a positive than negative biopsy (median, 15.9 [interquartile range, 11.3–21.3] vs 7.3 [4.6–12.9] mm; p = 0.004). On multivariable analysis, epiduritis was the only independent predictor of a positive biopsy (adjusted odds ratio, 7.4 [95% confidence interval, 1.7–31.4]; p = 0.006).

Conclusions

Epiduritis and the size of paravertebral edema on MRI are associated with detection of a microbial pathogen in suspected septic spondylodiscitis. For patients without these MRI signs, the need for further investigations such as enriched or prolonged cultures, a second CT-guided biopsy, or even surgical biopsy need to be discussed.
Predictors of Physical Activity in Patients With Fibromyalgia
Authors: Kaleth Anthony S. , Bigatti Silvia M. , Slaven James E. , Kelly Nicholas , Ang Dennis C.
Published: December 2020

Background/Objective

The aim of this study was to identify psychological factors that influence moderate-vigorous physical activity (MVPA) participation in patients with fibromyalgia.

Methods

In this secondary data analysis, 170 patients received personalized exercise plans and completed baseline and follow-up assessments of self-reported physical activity at weeks 12, 24, and 36. Structural equation modeling was used to examine the predictive strengths of psychological factors (exercise self-efficacy, perceived barriers, and intention) on MVPA participation.

Results

Using a threshold increase in MVPA of 10 or greater metabolic equivalent hours per week (MET h/wk), 3 groups were defined based on subjects who achieved a minimum increase of 10 MET h/wk that was sustained for at least 12 weeks (SUS-PA), achieved an increase of 10 MET h/wk that was not sustained for at least 12 weeks (UNSUS-PA), and did not achieve an increase of 10 MET h/wk (LO-PA). Increases in exercise self-efficacy and intention and reductions in perceived barriers were associated with increased volume of PA, showing the greatest change in the SUS-PA, followed by UNSUS-PA. For the LO-PA group, there was no change in exercise self-efficacy, a decrease in intention, and an increase in barriers. Using path analysis, exercise self-efficacy and perceived barriers were associated with higher volumes of physical activity via greater intention to engage in MVPA.

Conclusions

For patients with fibromyalgia, exercise self-efficacy, perceived barriers, and intention to exercise are important constructs for increasing physical activity. Our findings provide guidance for practitioners who seek to promote physical activity in fibromyalgia and suggestions for researchers aiming to improve prediction models.
Pythons in the Eocene of Europe reveal a much older divergence of the group in sympatry with boas
Authors: Zaher Hussam , Smith Krister T.
Published: December 2020

Extant large constrictors, pythons and boas, have a wholly allopatric distribution that has been interpreted largely in terms of vicariance in Gondwana. Here, we describe a stem pythonid based on complete skeletons from the early-middle Eocene of Messel, Germany. The new species is close in age to the divergence of Pythonidae from North AmericanLoxocemusand corroborates a Laurasian origin and dispersal of pythons. Remarkably, it existed in sympatry with the stem boidEoconstrictor. These occurrences demonstrate that neither dispersal limitation nor strong competitive interactions were decisive in structuring biogeographic patterns early in the history of large, hyper-macrostomatan constrictors and exemplify the synergy between phylogenomic and palaeontological approaches in reconstructing past distributions.
Mobile device location data reveal human mobility response to state-level stay-at-home orders during the COVID-19 pandemic in the USA
Authors: Xiong Chenfeng , Hu Songhua , Yang Mofeng , Younes Hannah , Luo Weiyu , Ghader Sepehr , Zhang Lei
Published: December 2020

One approach to delaying the spread of the novel coronavirus (COVID-19) is to reduce human travel by imposing travel restriction policies. Understanding the actual human mobility response to such policies remains a challenge owing to the lack of an observed and large-scale dataset describing human mobility during the pandemic. This study uses an integrated dataset, consisting of anonymized and privacy-protected location data from over 150 million monthly active samples in the USA, COVID-19 case data and census population information, to uncover mobility changes during COVID-19 and under the stay-at-home state orders in the USA. The study successfully quantifies human mobility responses with three important metrics: daily average number of trips per person; daily average person-miles travelled; and daily percentage of residents staying at home. The data analytics reveal a spontaneous mobility reduction that occurred regardless of government actions and a ‘floor’ phenomenon, where human mobility reached a lower bound and stopped decreasing soon after each state announced the stay-at-home order. A set of longitudinal models is then developed and confirms that the states' stay-at-home policies have only led to about a 5% reduction in average daily human mobility. Lessons learned from the data analytics and longitudinal models offer valuable insights for government actions in preparation for another COVID-19 surge or another virus outbreak in the future.