bluuebunny/crossref_metadata_2025 huggingface dataset:
The Inquiry Cycle and Applied Inquiry Cycle: Integrated Frameworks for Field Studies in the Environmental Sciences
Authors: Feinsinger Peter , Rodríguez Iralys Ventosa , Izquierdo Andrea E , Buzato Silvana
Published: August 2020

Empirical place-based studies remain the research mode of most environmental field scientists. For their own sake and that of synthetic analyses based on them, such studies should follow rigorous, integrated frameworks for formulating, designing, executing, analyzing, interpreting, and reporting investigations. The inquiry cycle and applied inquiry cycle provide such frameworks: research questions complying with strict guidelines, research design following 17 detailed steps, and ordered sequences of reflections on data that begin with possible causes of their general tendencies and exceptions (outliers) and then consider possibilities involving other spatiotemporal scales. The applied inquiry cycle evaluates alternative place-based management guidelines. In these studies, reflection on results can lead to implementing the most promising alternative examined, monitoring the consequences, and engaging in adaptive management. The integration from start to finish and the numerous reality checks of the two frameworks provide field researchers with tools to carry out the best, or least flawed, field investigations possible.
European Society of Cardiology methodology for the development of quality indicators for the quantification of cardiovascular care and outcomes
Authors: Aktaa Suleman , Batra Gorav , Wallentin Lars , Baigent Colin , Erlinge David , James Stefan , Ludman Peter , Maggioni Aldo P , Price Susanna , Weston Clive , Casadei Barbara , Gale Chris P
Published: August 2020

Aims

It is increasingly recognized that tools are required for assessing and benchmarking quality of care in order to improve it. The European Society of Cardiology (ESC) is developing a suite of quality indicators (QIs) to evaluate cardiovascular care and support the delivery of evidence-based care. This paper describes the methodology used for their development.

Methods and results

We propose a four-step process for the development of the ESC QIs. For a specific clinical area with a gap in care delivery, the QI development process includes: (i) the identification of key domains of care by constructing a conceptual framework of care; (ii) the construction of candidate QIs by conducting a systematic review of the literature; (iii) the selection of a final set of QIs by obtaining expert opinions using the modified Delphi method; and (iv) the undertaking of a feasibility assessment by evaluating different ways of defining the QI specifications for the proposed data collection source. For each of the four steps, key methodological areas need to be addressed to inform the implementation process and avoid misinterpretation of the measurement results.

Conclusion

Detailing the methodology for the ESC QIs construction enables healthcare providers to develop valid and feasible metrics to measure and improve the quality of cardiovascular care. As such, high-quality evidence may be translated into clinical practice and the ‘evidence-practice’ gap closed.
Common carotid artery true lumen flow impairment in patients with type A aortic dissection
Authors: Kreibich Maximilian , Desai Nimesh D , Bavaria Joseph E , Szeto Wilson Y , Vallabhajosyula Prashanth , Beyersdorf Friedhelm , Czerny Martin , Siepe Matthias , Rylski Bartosz , Itagaki Ryo , Okamura Homare , Yamaguchi Atsushi , Kimura Naoyuki
Published: August 2020

OBJECTIVES

Our aim was to evaluate clinical and neurological effects of common carotid artery (CCA) true lumen flow impairment or occlusion in patients with type A aortic dissection.

METHODS

Characteristics and imaging data of patients with dissected CCA secondary to acute type A aortic dissection from 3 institutions were analysed. We defined true lumen blood flow as unimpaired when the maximum true lumen diameter exceeded 50% of the complete CCA diameter, as impaired when the true lumen was compressed to ˃50% of the complete lumen, or as occluded.

RESULTS

Out of 440 patients, 207 presented unimpaired CCA flow, 172 impaired CCA flow and CCA occlusion was present in 61 patients. Preoperative shock (P = 0.045) or a neurological deficit (P < 0.001) were least common in patients with unimpaired CCA flow and most common in those with CCA occlusion. Non-cerebral, other-organ malperfusion was common in 37% of all patients, but the incidence was similar (P = 0.69). In patients with CCA occlusion, postoperative stroke (P < 0.001) and in-hospital mortality (0.011) were significantly higher, while the incidences were similar between patients with unimpaired and impaired CCA flow. Mixed-effects logistic regression models showed that CCA flow impairment (P = 0.23) or occlusion (P = 0.55) was not predictive for in-hospital mortality, but CCA occlusion was predictive for in-hospital stroke (odds ratio 2.166, P = 0.023)

CONCLUSIONS

Shock and non-cerebral, other-organ malperfusion are common in patients with CCA dissection. While there is a high risk for stroke in patients with CCA occlusion, CCA flow impairment and occlusion were not predictive for in-hospital mortality. Surgery should not be denied to patients with CCA flow impairment or occlusion.
Bacteria but not fungi respond to soil acidification rapidly and consistently in both a spruce and beech forest
Authors: Choma Michal , Tahovská Karolina , Kaštovská Eva , Bárta Jiří , Růžek Michal , Oulehle Filip
Published: August 2020

Anthropogenically enhanced atmospheric sulphur (S) and nitrogen (N) deposition has acidified and eutrophied forest ecosystems worldwide. However, both S and N mechanisms have an impact on microbial communities and the consequences for microbially driven soil functioning differ. We conducted a two-forest stand (Norway spruce and European beech) field experiment involving acidification (sulphuric acid addition) and N (ammonium nitrate) loading and their combination. For 4 years, we monitored separate responses of soil microbial communities to the treatments and investigated the relationship to changes in the activity of extracellular enzymes. We observed that acidification selected for acidotolerant and oligotrophic taxa of Acidobacteria and Actinobacteria decreased bacterial community richness and diversity in both stands in parallel, disregarding their original dissimilarities in soil chemistry and composition of microbial communities. The shifts in bacterial community influenced the stoichiometry and magnitude of enzymatic activity. The bacterial response to experimental N addition was much weaker, likely due to historically enhanced N availability. Fungi were not influenced by any treatment during 4-year manipulation. We suggest that in the onset of acidification when fungi remain irresponsive, bacterial reaction might govern the changes in soil enzymatic activity.
Bacteriophytochrome from Magnetospirillum magneticum affects phototactic behavior in response to light
Authors: Chen Haitao , Li Dandan , Cai Yao , Wu Long-Fei , Song Tao
Published: August 2020

Phytochromes are a class of photoreceptors found in plants and in some fungi, cyanobacteria, and photoautotrophic and heterotrophic bacteria. Although phytochromes have been structurally characterized in some bacteria, their biological and ecological roles in magnetotactic bacteria remain unexplored. Here, we describe the biochemical characterization of recombinant bacteriophytochrome (BphP) from magnetotactic bacteria Magnetospirillum magneticum AMB-1 (MmBphP). The recombinant MmBphP displays all the characteristic features, including the property of binding to biliverdin (BV), of a genuine phytochrome. Site-directed mutagenesis identified that cysteine-14 is important for chromophore covalent binding and photoreversibility. Arginine-240 and histidine-246 play key roles in binding to BV. The N-terminal photosensory core domain of MmBphP lacking the C-terminus found in other phytochromes is sufficient to exhibit the characteristic red/far-red-light-induced fast photoreversibility of phytochromes. Moreover, our results showed MmBphP is involved in the phototactic response, suggesting its conservative role as a stress protectant. This finding provided us a better understanding of the physiological function of this group of photoreceptors and photoresponse of magnetotactic bacteria.
Is Exposure to Epidemic Associated With Older Adults’ Health Behavior? Evidence From China’s 2002–2004 SARS Outbreak
Authors: Zou Hong , Wen Sha , Xu Hongwei
Published: August 2020

Objectives

To determine whether exposure to an epidemic is associated with better health behaviors.

Methods

Using nationally representative survey data collected in 2011 and 2014, we identified middle-aged and older Chinese adults whose communities experienced an outbreak of the 2002–2004 severe acute respiratory syndrome (SARS). We estimated logistic models of health behaviors in the years after the SARS epidemic.

Results

Compared to those who lived in communities not hit by the epidemic, respondents who lived in communities with a SARS outbreak in 2002–2004 were more likely to get a physical examination in 2010–2011 and have their blood pressure checked and participate in regular physical exercise in the years following the SARS epidemic. These associations varied by gender and rural–urban residence.

Discussion

Exposure to the SARS epidemic could be positively associated with health behavior among middle-aged and older Chinese adults.
Frequency-dependent spherical-wave nonlinear AVO inversion in elastic media
Authors: Cheng Guangsen , Yin Xingyao , Zong Zhaoyun
Published: August 2020

The plane-wave reflection coefficient (PRC) plays a remarkable role in conventional amplitude variation with offset (AVO) analysis and inversion. Compared with the widely exploited PRC that breaks down at the near- and supercritical incidence angles, the spherical-wave reflection coefficient (SRC) can overcome the influence of wide-angle reflection and give an accurate description of the actual seismic wave reflection phenomenon based on spherical-wave fronts. However, SRC is not widely used in AVO inversion due to its nonlinearity and computational complexity. In our study, the characteristics of frequency–depth-dependent monochromatic SRC are discussed and a novel three-parameter SRC is derived. Compared with the conventional six-parameter SRC, the novel three-parameter SRC improves the stability of spherical-wave AVO inversion. In addition, the concept of SRC within the Fresnel zone is proposed, and the accuracy of SRC within the Fresnel zone in the deep subsurface is tested. Finally, a nonlinear spherical-wave AVO inversion method for elastic media is proposed, which can make full use of all frequency components of wavelet. The robustness of the proposed method is verified by the application on synthetic seismogram with white Gaussian noise. The feasibility and practicability of this method are verified by comparing the spherical-wave AVO inversion results with the filtered well logs at the known well location.
In vitro activation of ovarian cortex and autologous transplantation: A novel approach to primary ovarian insufficiency and diminished ovarian reserve
Authors: Devenutto L , Quintana R , Quintana T
Published: August 2020

BACKGROUND

Primary ovarian insufficiency (POI) and diminished ovarian reserve are two conditions that affect women’s fertility. Oocyte donation remains an option for these patients; however, the development of certain novel technologies, such as in vitro activation of ovarian cortex (IVA), enables the possibility of activating the pool of resting primordial follicles, increasing the chance of pregnancy.

OBJECTIVE AND RATIONALE

Here, we review the main pathways (PI3K and Hippo signaling) that govern the activation of primordial follicles and its application through the development of culture systems that support ovarian cortex for autologous transplantation. We also review the available data from case reports regarding outcomes of pregnancy and live birth rates with IVA.

SEARCH METHODS

A PubMed search was conducted using the PubMed-NCBI database to identify literature pertinent to the pathways involved in the activation of primordial follicles and the outcomes of IVA techniques from 2013 to the present.

OUTCOMES

Women with POI have around a 5% chance of spontaneous pregnancy. Recently, novel techniques involving the activation of primordial follicles through molecular pathways have been developed, thus increasing the odds of these patients. More recently, the introduction of a drug-free IVA technique has shown to increase the number of antral follicles with successful oocyte maturation after gonadotropin treatment, reaching pregnancy rates over 30%, either through spontaneous conception or by the implementation of assisted reproductive technology.

LIMITATIONS

The evidence of this review is based on a few small series, so data should be interpreted with caution, and only randomized controlled trials could estimate the real magnitude and success of the procedure.

REASONS FOR CAUTION

IVA technique remains an experimental strategy, with limited available data and the requirement of invasive procedures. Moreover, possible carcinogenic effects not yet determined after transplantation require special caution.

WIDER IMPLICATIONS

In view of the results achieved, IVA could provide a promising option for the preservation of fertility in some cancer patients and prepuberal girls where the only alternative is tissue cryopreservation.

STUDY FUNDING/COMPETING INTERESTS

The authors received no specific funding for this work and declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Yield of Random Biopsies During Colonoscopies in Inflammatory Bowel Disease Patients Undergoing Dysplasia Surveillance
Authors: Hu Anne B , Burke Kristin E , Kochar Bharati , Ananthakrishnan Ashwin N
Published: August 2020

Background

The development of chromoendoscopy (CE) and high definition endoscopy (HDE) has improved detection of subtle colonic dysplasia in patients with inflammatory bowel diseases (IBDs). The role of random biopsies for dysplasia surveillance is unclear.

Methods

We reviewed patients with IBD who underwent a CE or HDE colonoscopy and had colonic dysplasia detected. Detection of dysplasia was classified as either visible or random and graded as low grade dysplasia (LGD), high grade dysplasia (HGD), or indefinite for dysplasia. Multivariable regression adjusted for relevant confounders examined the predictors of dysplasia detectable on random biopsies alone.

Results

The study included 300 patients (203 ulcerative colitis, 97 Crohn’s disease with colonic involvement) contributing 442 colonoscopies; the mean disease duration was 24.5 years; 7.2% had primary sclerosing cholangitis (PSC). Three hundred sixty-two colonoscopies (82%) had only visible dysplasia, 52 (12%) had only random dysplasia, and 28 (6%) had both visible and random dysplasia. Longer disease duration (odds ratio, 1.04; 95% CI, 1.01–1.07), active inflammation (odds ratio, 2.89; 95% CI, 1.26–6.67), and concomitant PSC (odds ratio, 3.66; 95% CI, 1.21–11.08) were associated with detecting dysplasia on random biopsies compared with visible lesions. Patients with random dysplasia (21%) or both random and visible dysplasia (21%) were more likely to undergo surgical resection compared with those with only visible dysplasia (5%; P < 0.001) and have subsequent development of colorectal cancer (15%, 7%, 1%, respectively; P < 0.0001).

Conclusion

Nearly one fifth of dysplasia detected in patients with IBD was found on random biopsies. Patients with high risk characteristics may benefit from continuing the practice of random biopsies during surveillance examinations.
Improvement in Ulcerative Colitis by Administration of Benralizumab for Comorbid Refractory Bronchial Asthma: A Novel Clinical Observation
Authors: Sugimoto Ken , Fujita Shoya , Miyazu Takahiro , Ishida Natsuki , Tani Shinya , Yamade Mihoko , Hamaya Yasushi , Iwaizumi Moriya , Furuta Takahisa , Osawa Satoshi
Published: August 2020

We present a case of ulcerative colitis improved through benralizumab, which binds to the eosinophil IL-5 receptor and the Fcy receptor on natural killer cells, inducing antibody-dependent cell-mediated cytotoxicity, causing apoptosis, and directly removing eosinophils, in treating comorbid refractory bronchial asthma.
Reductions of Some Two-Dimensional Crystalline Representations via Kisin Modules
Authors: Bergdall John , Levin Brandon
Published: August 2020

We determine rational Kisin modules associated with 2-dimensional, irreducible, crystalline representations of $\textrm{Gal}(\overline{{\mathbb{Q}}}_p/{\mathbb{Q}}_p)$ of Hodge–Tate weights $0, k-1$. If the slope is larger than $\lfloor \frac{k-1}{p} \rfloor $, we further identify an integral Kisin module, which we use to calculate the semisimple reduction of the Galois representation. In that range, we find that the reduction is constant, thereby improving on a theorem of Berger, Li, and Zhu.
Emergent Flexibility in Institutional Development: How International Rules Really Change
Authors: Búzás Zoltán I , Graham Erin R
Published: August 2020

How do formal international institutions change and adjust to new circumstances? The conventional wisdom in international relations, outlined by rational design, is that the answer lies in designed flexibility, which allows states to adjust agreements. Drawing on rich but disparate literatures across subfields of political science—especially constructivism and historical institutionalism—we propose an alternative, which we call “emergent flexibility.” Emergent flexibility is a property of international institutions that is not intentionally crafted by rule-makers when a rule is formally established, but is subsequently discovered, activated, and accessed by creative rule-users in ways unintended by designers. Rich case studies trace how rule-users have accessed emergent flexibility through the legal interpretive strategy of subsequent practice to change rigid rules of the UN Charter and the European Convention on Human Rights. A key implication of emergent flexibility is that, contrary to rational design expectations, international institutions designed to be rigid can adjust to unforeseen circumstances even in the absence of formal redesign, allowing cooperation to continue. The broadening of flexibility from designed to emergent reveals the politics of flexibility between formal design moments, provides a more nuanced notion of intentionality, and equips us to better address fundamental positive and normative questions of institutional development.
Toxicological Investigations in a Death Involving 2,5-Dimethoxy-4-Chloamphetamine (DOC) Performed on an Exhumed Body
Authors: Aknouche Frédéric , Ameline Alice , Kernalleguen Angeline , Arbouche Nadia , Maruejouls Christophe , Kintz Pascal
Published: August 2020

During a party in another country, several adults sniffed a powder presented as being lysergic acid diethylamide (LSD). The next morning, two subjects, including a French citizen, were found dead. After a body examination that concluded that the death was due to respiratory and cardiac collapses, the French citizen’s corpse was returned to France and buried. Four years later, the body was exhumed, and an autopsy that did not reveal traumatic injury was performed. During the autopsy, biological specimens were collected. A comprehensive toxicological screening, followed by confirmation using ultra high performance liquid chromatography tandem mass spectrometry (UHPLC-MS-MS) revealed the presence of 2,5-dimethoxy-4-chloamphetamine (DOC) in all specimens: liver (99 ng/g), spleen (28 ng/g), bone (14 ng/g), lung (15 ng/g) and pubic hair (32 pg/mg). No other drug, including pharmaceuticals and drugs of abuse were identified, but the circumstances of specimen collection can influence drug stability. Literature survey about DOC stability in biological material did not contribute in interpretation as there is no data dealing with storage for about 4 years before quantitative analysis. A stability study was performed at the laboratory. Blank blood was spiked with DOC at 1 mg/L, stored at + 4°C and −20°C and regularly tested over 6 months. The percentages of concentration remaining from the initial concentration of DOC stored for 6 months at + 4°C and −20°C were 53% and 59%, respectively. To characterize the metabolite(s) of DOC, the drug was incubated with a pool of human hepatic microsomes and the cofactors required to ensure the functioning of the main phase I enzymes. The incubation media were analyzed by liquid chromatography (LC) coupled to high-resolution mass spectrometry (MS), and the results showed hydroxy-DOC. However, the hydroxy-metabolite was not identified in the liver or spleen of the subject. Although the French pathologist considered that it was more likely than not a toxic death, it is difficult to attribute the death to DOC alone, as it was impossible to test for ethanol and other chemically instable drugs. This case presents original data, which can be useful to increase the knowledge in designer drug toxicity.
Crowdsourced Photographs as an Effective Method for Large-Scale Passive Tick Surveillance
Authors: Kopsco Heather L , Xu Guang , Luo Chu-Yuan , Rich Stephen M , Mather Thomas N
Published: August 2020

As tick vector ranges expand and the number of tickborne disease cases rise, physicians, veterinarians, and the public are faced with diagnostic, treatment, and prevention challenges. Traditional methods of active surveillance (e.g., flagging) can be time-consuming, spatially limited, and costly, while passive surveillance can broadly monitor tick distributions and infection rates. However, laboratory testing can require service fees in addition to mailing and processing time, which can put a tick-bite victim outside the window of potential prophylactic options or under unnecessary antibiotic administration. We performed a retrospective analysis of a national photograph-based crowdsourced tick surveillance system to determine the accuracy of identifying ticks by photograph when compared to those same ticks identified by microscopy and molecular methods at a tick testing laboratory. Ticks identified by photograph were correct to species with an overall accuracy of 96.7% (CI: 0.9522, 0.9781; P < 0.001), while identification accuracy for Ixodes scapularis Say (Ixodida: Ixodidae), Amblyomma americanum Linnaeus (Ixodida: Ixodidae), and Dermacentor variabilis Say (Ixodida: Ixodidae), three ticks of medical importance, was 98.2% (Cohen’s kappa [κ] = 0.9575; 95% CI: 0.9698, 0.9897), 98.8% (κ = 0.9466, 95% CI: 0.9776, 0.9941), and 98.8% (κ = 0.9515, 95% CI: 0.9776, 0.9941), respectively. Fitted generalized linear models revealed that tick species and stage were the most significant predictive factors that contributed to correct photograph-based tick identifications. Neither engorgement, season, nor location of submission affected identification ability. These results provide strong support for the utility of photograph-based tick surveillance as a tool for risk assessment and monitoring among commonly encountered ticks of medical concern.
A Liquid Biopsy to Assess Brain Tumor Recurrence: Presence of Circulating Mo-MDSC and CD14+ VNN2+ Myeloid Cells as Biomarkers That Distinguish Brain Metastasis From Radiation Necrosis Following Stereotactic Radiosurgery
Authors: Soler David C , Kerstetter-Fogle Amber , Elder Theresa , Raghavan Alankrita , Barnholtz-Sloan Jill S , Cooper Kevin D , McCormick Thomas S , Sloan Andrew E
Published: August 2020

BACKGROUND

Brain metastases (BM) are the most common type of brain tumor malignancy in the US. They are also the most common indication for stereotactic radiosurgery (SRS). However, the incidence of both local recurrence and radiation necrosis (RN) is increasing as treatments improve. MRI imagery often fails to differentiate BM from RN; thus, patients must often undergo surgical biopsy or resection to obtain a definitive diagnosis.

OBJECTIVE

To hypothesize that a marker of immunosuppression might serve as a surrogate marker to differentiate patients with active vs inactive cancer—including RN.

METHODS

We thus purified and quantified Monocytic Myeloid-Derived Suppressor Cells (Mo-MDSC) by flow cytometry in patients proven by biopsy to represent BM or RN.

RESULTS

We report the utility of the previously reported HLA-Dr-Vnn2 Index or DVI to discriminate recurrent BM from RN using peripheral blood. The presence of CD14+ HLA-DRneg/low Mo-MDSC is significantly increased in the peripheral blood of patients with brain metastasis recurrence compared to RN (Average 61.5% vs 7%, n = 10 and n = 12, respectively, P < .0001). In contrast, expression of VNN2 on circulating CD14+ monocytes is decreased in BM patients compared to patients with RN (5.5% vs 26.5%, n = 10 and n = 12, respectively, P = .0008). In patients with biopsy confirmed recurrence of brain metastasis, the average DVI was 11.65, whereas the average DVI for RN patients was consistently <1 (Avg. of 0.17).

CONCLUSION

These results suggest that DVI could be a useful diagnostic tool to differentiate recurrent BM from RN using a minimally invasive blood sample.
Dietetic intervention for adult outpatients with an eating disorder: a systematic review and assessment of evidence quality
Authors: McMaster Caitlin M , Fong Mackenzie , Franklin Janet , Hart Susan
Published: August 2020

Context

Eating disorders (EDs) are complex mental illnesses that require medical, psychological, and dietetic intervention to assist patients achieve recovery.

Objective

Available evidence was reviewed regarding dietetic intervention for adult outpatients with an ED and the quality of this evidence was assessed.

Data sources

Systematic literature searches were conducted using 5 databases (MEDLINE, PreMEDLINE, EMBASE, CINAHL, PsycINFO) for studies comparing adults with an ED receiving a dietetic intervention with those receiving a psychological intervention alone, those receiving a combined dietetic and psychological intervention, or a control group.

Data extraction

Literature searches returned 3078 results, with 10 articles reporting on 9 randomized controlled trials meeting the inclusion criteria. The quality of evidence was assessed using the Cochrane Risk-of-Bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Data analysis

GRADE assessments for studies involving individuals with anorexia nervosa indicated very low quality of evidence for outcomes including weight, ED psychopathology and ED behaviors , and no studies measured nutritional changes. For studies conducted with participants with bulimia nervosa or binge eating disorder, only 1 study included a group receiving combined evidence-based psychological and dietetic intervention. A combined intervention produced moderate-quality evidence for lower attrition, greater abstinence from ED behaviors, and more meals eaten per week in comparison with a stand-alone psychological or dietetic intervention.

Conclusions

There is currently limited evidence to sufficiently assess the impact of incorporating dietetic interventions into outpatient treatment for adults with an ED; however, available evidence supports clinical practice guidelines that dietetic intervention should not be delivered as a stand-alone treatment. Additional methodologically sound studies in larger samples are required to fully inform dietetic treatment in EDs and incorporation of such interventions as part of a multidisciplinary treatment approach.
Diagnostic Infectious Diseases Testing Outside Clinics: A Global Systematic Review and Meta-analysis
Authors: Kpokiri Eneyi E , Marley Gifty , Tang Weiming , Fongwen Noah , Wu Dan , Berendes Sima , Ambil Bhavana , Loveday Sarah-Jane , Sampath Ranga , Walker Jennifer S , Matovu Joseph K B , Boehme Catharina , Pai Nitika Pant , Tucker Joseph D
Published: August 2020

Background

Most people around the world do not have access to facility-based diagnostic testing, and the gap in availability of diagnostic tests is a major public health challenge. Self-testing, self-sampling, and institutional testing outside conventional clinical settings are transforming infectious disease diagnostic testing in a wide range of low- and middle-income countries (LMICs). We examined the delivery models of infectious disease diagnostic testing outside clinics to assess the impact on test uptake and linkage to care.

Methods

We conducted a systematic review and meta-analysis, searching 6 databases and including original research manuscripts comparing testing outside clinics with conventional testing. The main outcomes were test uptake and linkage to care, delivery models, and adverse outcomes. Data from studies with similar interventions and outcomes within thematic areas of interest were pooled, and the quality of evidence was assessed using GRADE. This study was registered in PROSPERO (CRD42019140828).

We identified 10 386 de-duplicated citations, and 76 studies were included. Data from 18 studies were pooled in meta-analyses. Studies focused on HIV (48 studies), chlamydia (8 studies), and multiple diseases (20 studies). HIV self-testing increased test uptake compared with facility-based testing (9 studies: pooled odds ratio [OR], 2.59; 95% CI, 1.06–6.29; moderate quality). Self-sampling for sexually transmitted infections increased test uptake compared with facility-based testing (7 studies: pooled OR, 1.74; 95% CI, 0.97–3.12; moderate quality).

Conclusions.  Testing outside of clinics increased test uptake without significant adverse outcomes. These testing approaches provide an opportunity to expand access and empower patients. Further implementation research, scale-up of effective service delivery models, and policies in LMIC settings are needed.
Imaging of Lyme Neuroborreliosis: A Pictorial Review
Authors: Garkowski Adam , Łebkowska Urszula , Kubas Bożena , Garkowska Ewa , Rutka Katarzyna , Gawarecka Elwira , Zajkowska Joanna
Published: August 2020

Lyme neuroborreliosis is a common feature of Borrelia burgdorferi infection (as a neurological manifestation occurring in 10%–15% of all Lyme disease cases) and may involve any part of the nervous system, and its coverings, but usually manifests as lymphocytic meningitis, cranial neuritis, and/or radiculoneuritis. This review describes the imaging findings in Lyme neuroborreliosis: the focal point is on the manifestations of involvement visible on brain and spine imaging.
2 Systemic glucocorticoids and bradycardia in critically ill children: a retrospective study
Authors: Maltais-Bilodeau Camille , Frenette Maryse , Morissette Geneviève , Bailey Dennis , Cloutier Karine , Laberge Camille , Simonyan David
Published: August 2020

Background

Glucocorticoids are widely used in the pediatric population. They are associated with numerous side effects including repercussions on the cardiovascular system. The impact on heart rate is not well known, but bradycardia has been reported, mostly with high doses.

Objectives

We described the occurrence of bradycardias and the variation of heart rate in critically ill children receiving glucocorticoids.

Design/Methods

We conducted a retrospective study including 1 month old to 18 year old children admitted to the Pediatric Intensive Care Unit between 2014 and 2017, who received a glucocorticoid dose equivalent to 1 to 15 mg/kg/day of prednisone. We collected data on exposition to glucocorticoids, heart rate before, during and after the exposition, and interventions from the medical staff in response to bradycardia. The primary outcome was the occurrence of bradycardia and the secondary outcomes were the magnitude of heart rate variation and the clinical management of bradycardias.

Results

We included 92 admissions (85 patients). The median dose of glucocorticoid used was 2.80 mg/kg/day of prednisone (2.08—3.80). We found 70 cases (76%) with at least one bradycardia. Before treatment, all patients had a mean heart rate higher than the 5th percentile for age. During exposition to glucocorticoids, 8 patients (10%, n = 83) had a median heart rate ≤ 5th percentile. We noted 46 cases of bradycardia (50%) that led to an intervention from the medical staff, but no patient had a major event associated to bradycardia. We found a significant association between bradycardia and age (estimate -0.136, 95% CI -0.207—-0.065, p < 0.001), glucocorticoid dose (estimate 4.820, 95% CI 2.048—7.592, p < 0.001) and intravenous administration (estimate 8.709, 95% CI 1.893—15.524, p = 0.012).

Conclusion

In our study, most children hospitalized at the intensive care unit receiving standard doses of glucocorticoid experienced bradycardia. The majority of episodes led to an intervention from the medical staff. Presence of bradycardia was associated with younger age, higher dose and IV administration of glucocorticoids.
8 Positive Distraction Entertainment System (PDES) in Paediatric Population Undergoing Day Surgery
Authors: Chang Michael , Fernandes Alicia , Frankel Alexandra
Published: August 2020

Background

Patients undergoing procedures at hospitals may experience anxiety and such anxiety can be heightened in pediatric populations. Anxiety can invoke a physical and mental stress response leading to poorer health outcomes and in children these outcomes include: resistance to treatment, nightmares, longer recovery periods, lowered pain thresholds and separation anxiety (Biddis, 2014; Manyande 2015; Aydın 2017).

Objectives

This study aimed to test whether a virtual reality intervention is feasible, beneficial and effective in reducing anxiety prior to surgery in the pediatric population of Scarborough Health Network.

Design/Methods

Virtual Reality (VR) is a computer technology that simulates a user’s physical presence in a virtual or imaginary environment. ‘Bubble Bloom’, an underwater fishing game where participants launch bubbles to catch colourful fish, is the VR game that the children are administered in a two phased research design to explore whether the VR intervention was a beneficial tool in reducing anxiety in our pediatric population. Phase 1 was a trial phase in which participants (n=20) were administered the condensed version of the State Trait Anxiety Scale before and after the intervention to determine if anxiety levels had been reduced. Participants were also administered an experience survey to explore patient satisfaction, headset comfort, and virtual reality satisfaction.

Phase 2, randomized control trial, is currently ongoing with the same measures and VR intervention being administered. In Phase 2, participants are randomized to the control group (regular play activities) or intervention (virtual reality game).

Results

In Phase 1, all participants indicated they enjoyed the experience of the virtual reality intervention. Sixteen of the 20 participants had pre scores that were in the mild to moderate anxiety range (80%). Of these 16 participants, 10 participants’ post scores decreased to the normal or no anxiety range (63%). Additionally, 80% of participants demonstrated a reduction in anxiety post-virtual reality intervention.

Conclusion

Phase 1 results were encouraging with 80% of participants experiencing a reduction in anxiety and all participants enjoying the virtual reality experience.
9 Corticosteroid use in periorbital and orbital cellulitis: A Cochrane systematic review
Authors: Kornelsen Emily , Mahant Sanjay , Parkin Patricia C , Reginald Arun , Shah Samir S , Gill Peter J
Published: August 2020

Background

There is significant variation in the use of corticosteroids for the treatment of periorbital and orbital cellulitis. Corticosteroids may act to reduce inflammation and edema but there are concerns that corticosteroids may lead to immune suppression and worsening infection. Evidence-based recommendations regarding the use of corticosteroids for periorbital and orbital cellulitis are lacking.

Objectives

To assess the effectiveness and safety of corticosteroids in the treatment of periorbital and orbital cellulitis.

Design/Methods

We conducted a detailed search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL Plus, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform for randomized controlled trials (RCTs) of children and adults with periorbital and orbital cellulitis treated with systemic or intranasal corticosteroids. There were no exclusions based on language or publication status. Studies were excluded if they focused exclusively on participants undergoing elective surgery, on post-operative infections, or infections secondary to trauma. Two reviewers independently assessed studies for inclusion, and extracted data in duplicate. Risk of bias was assessed using the Cochrane Collaboration’s domain-based evaluation tool. Data were analyzed according to standard Cochrane methodology.

Results

Of the 7,476 unique results identified, 7,465 records were excluded based on title and abstract screening, and a further 10 records were excluded based on full text review. We identified one small RCT conducted in India with an unclear risk of bias. No other eligible ongoing or completed trials were identified. The small trial of 21 participants 10 years and older compared the use of corticosteroids and antibiotics (n=14), to the use of antibiotics alone for the treatment of orbital cellulitis (n=7). Participants receiving corticosteroids had a shorter length of hospital stay (14.1 ±3.7 vs. 18.4 ±5.9 days, p=0.02) and required antibiotics for a shorter duration (8.6 ±1.3 vs. 11.6 ±4.6 days, p=0.013) compared with the control group. Earlier improvements in fever, pain, periorbital edema, extra ocular motility, conjunctival chemosis, and visual acuity were seen in the corticosteroid group. No major complications of orbital cellulitis or adverse effects of corticosteroids were reported.

Conclusion

There is insufficient evidence to draw conclusions about the use of corticosteroids in the treatment of periorbital and orbital cellulitis. Currently, there is significant variation in how corticosteroids are used in clinical practice and additional high-quality evidence is needed to inform decision making.
10 Mechanical Complications Associated with Central Venous Catheters at a Canadian Tertiary Care Centre
Authors: Moore Kieran , Kulkarni Ketan , Greencorn David , Kuhle Stefan , Langley Joanne
Published: August 2020

Background

The administration of life-saving treatment through central venous catheters (CVC) has significantly improved the quality of life and outcomes for patients, especially for those requiring long-term care. While CVC-associated bacteremia is a standard patient outcome measure, little is known about the incidence of mechanical complications in children. Although common, large data on mechanical complications are scarce and generally limited to specific paediatric populations from modest single center series.

Objectives

To determine the incidence of mechanical complications among paediatric patients with CVCs.

Design/Methods

In this retrospective study we analyzed data from all paediatric patients (0-19 years) who required a CVC between 2001 and 2016 at our health care center, which services patients from regional hospitals in a shared care model. Details on CVC insertions and daily records of catheter function while in hospital have been collected prospectively and stored in a dedicated database. Patient demographics, catheter characteristics, and complications were abstracted from the database. Complications were defined through clinician documentation of CVC mechanical failures such as disconnect, leakage, fracture, and blockage. Complication rates were expressed per 1,000 line days.

Results

A total of 8,747 CVCs were placed in 5,743 patients during the study period for a total of 780,448 line days. Neonatal patients required the most CVC insertions and made up 41% of the cohort studied. Total mechanical complication rates were the highest over the 15-year period in 2001 (12 per 1,000 line days) and lowest in 2013 (3.8 per 1,000 line days). Peripherally inserted central catheters were used in the majority of patients (56%), while port-a-caths made up the vast majority of line days (78%). Mechanical complications occurred more frequently in non-tunneled catheters and were least likely to occur in port-a-caths (43 and 3.1 per 1,000 line days, respectively). Tunneled catheters failed mechanically at a rate of 8.0 per 1,000 line days and the peripherally inserted central catheter complication rate was 17 per 1,000 line days.

Conclusion

We provide a novel description of the incidence of mechanical complications in the setting of commonly used CVCs in a large paediatric cohort. Our findings help convey the true frequency of mechanical failures and create a benchmark for mechanical CVC complications in children. Recognizing the mechanical limitations of indwelling catheters will assist clinicians in optimizing catheter choice. Future study is planned to identify risk factors associated with CVC complications.
16 Variability in lumbar punctures and neuroimaging in infants less than 90 days with acute bacterial meningitis at a provincial children’s hospital in Canada
Authors: Bourne Stephanie , Findlay Briar , McLaughlin Thomas , Remington Mia
Published: August 2020

Background

Bacterial meningitis remains a significant cause of morbidity and mortality in infants, necessitating appropriate and timely investigations and treatment. Despite this, there are no current Canadian practice guidelines outlining the recommended management of infants with bacterial meningitis beyond empiric antimicrobial choice. As bacterial meningitis remains one of the most severe infectious diseases managed by general pediatricians, it warrants an attempt at practice standardization.

Objectives

The purpose of this study is to review and identify variation in the timing and frequency of lumbar punctures (LPs) and the use of neuroimaging for the management of bacterial meningitis for infants less than 90 days of age at BC Children’s & Women’s Hospital (BCCWH).

Design/Methods

A retrospective chart review at BCCWH identified confirmed, presumed or possible bacterial meningitis in infants less than 90 days of age over a five-year period (2013-2018). Anonymized data was collected from medical charts, de-identified and stored in REDCap.

Results

Eighty-one patients were included. Fifty-three percent of all patients had a delay in receiving an initial LP. The most common reasons for delays were that the patient was too unstable (42%) or that the first LP attempt was unsuccessful (26%). Forty-six percent of all patients had only one LP while 36% had at least one repeat LP. Most repeat LPs were done within 7 days of diagnosis. Twenty-nine percent of patients had an end of treatment LPs. Of all patients, 80% had neuroimaging. Head ultrasound (US) was the most commonly used imaging modality for both first image (68%) and subsequent images (64%). Seventeen percent of patients received a CT scan and 15% an MRI as their first image. In most cases, there was no clear clinical indication for imaging noted other than a diagnosis of meningitis (44%).

Conclusion

This retrospective study confirms that there is variability in the management of bacterial meningitis with respect to lumbar punctures and neuroimaging in young infants. The findings demonstrate LPs are commonly delayed, and suggest a need to develop clearly defined criteria for evaluating instability before an initial LP. Furthermore, the findings raise concern regarding the common practice of ordering head ultrasound for meningitis, given lower sensitivity in detecting disease complications and therefore disputed clinical utility.
17 Lyme Disease in Eastern Ontario - A Paediatric Centre’s Experience from 2009-2018
Authors: Zahradnik Stephanie , Barrowman Nick , Tsampalieros Anne , Harrison Mary-Ann , Bowes Jennifer , Brophy Jason
Published: August 2020

Background

Lyme disease (LD) is caused by the tick-borne bacterium Borrelia burgdorferi. Over the past ten years, robust local public health data indicates that the incidence of LD has increased significantly in the eastern region of Ontario due to the spread of its vector, the blacklegged tick. As a result, we have seen an increase in the number of cases of LD in children at our tertiary paediatric centre, at all stages of infection. Familiarity with Lyme disease is important as incidence increases. We sought to characterize the cases at our centre.

Objectives

To describe the epidemiology of LD in children at our centre from 2009-2018, as well as the variety of clinical presentations of paediatric LD.

Design/Methods

We completed a retrospective chart review from 2009-2018 of all cases admitted or seen in the Infectious Disease (ID) clinic or the Emergency Department (ED) with a diagnosis of LD. Demographic, clinical and laboratory data were collected, including geographic location where infection occurred and resource utilization. We used descriptive statistics to describe cases and comparative statistics to determine changes in number of cases over time.

Results

There were 171 LD cases managed at our centre during this period. Mean age was 7.4 (SD 4.5) years, 89 (52.0%) were male. The annual number of cases from 2009 - 2018 increased from 1 to 44 and peaked in 2017 (47 cases). The highest number of cases occurred among children <6, the lowest in children ≥11. Most cases occurred in summer (60%), with the fewest in winter months (4%). Stage of LD was not documented in 1 case. Of the remainder, 98 (57.6%) cases were early localized, 41 (25.7%) early disseminated and 31 (19.7%) late disseminated LD.

Early and late disseminated cases occurred more commonly in the summer and accounted for the majority of admissions. These included neurologic Lyme (lymphocytic meningitis [2, 1.2%], polyneuropathy [1, 0.6%], cranial nerve palsy [13, 7.6%]), Lyme carditis (5, 2.9%), and Lyme arthritis (29, 17.0%). There were 133 (77.8%) patients managed in ED, 66 (38.6%) in the ID clinic and 17 (9.9%) in the inpatient ward; median length of stay was 6 (IQR 5, 9) days, with a range of 1 to 30 days. The most common geographic locations of infection acquisition were Ottawa (120 cases, 71.0%) and Kingston (26, 15.4%).

Conclusion

Cases of LD managed at our paediatric centre have increased in keeping with population trends, with all LD stages experienced. Severe cases of meningitis, carditis, and arthritis resulted in hospitalization, with increasing numbers over the study period.