bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Relationship Between Endogenous Pain Modulation, Pain Intensity, and Depression in Patients Using Opioids for Chronic Low Back Pain
Authors: Lazaridou Asimina , Paschali Myrella , Zgierska Aleksandra E. , Garland Eric L. , Edwards Robert R.
Published: September 2022

Introduction:

Endogenous pain modulatory processes appear to play an important role in shaping pain-related outcomes, but we know relatively little about the influence of psychosocial factors on those pain modulatory processes. The primary objective of this study was to explore associations between endogenous pain modulation (ie, conditioned pain modulation, CPM; temporal summation, TS), chronic pain, and negative affective factors (ie, depression, anxiety symptoms) in a sample of participants with chronic low back pain (CLBP) treated with long-term daily opioids.

Methods:

Adults with opioid-treated CLBP (N=107) completed questionnaires assessing pain, pain symptoms, and psychological measures. CPM and TS were evaluated as predictors of pain intensity ratings (Brief Pain Inventory), with depression scores (Hospital Anxiety and Depression Scale, depression subscale) examined as potential moderators of those associations.

Results:

Moderation analyses demonstrated associations between CPM and back pain intensity ratings, moderated by depression symptom scores (B=−0.002, SE=0.0008, P<0.01) when controlling for daily opioid dose, with participants with higher depression scores showing a relatively stronger link between lower CPM and increased pain intensity ratings. Significant associations were observed between depression, pain intensity, and CPM-derived outcomes.

Conclusion:

Our findings suggest that reduced pain-inhibitory capacity is associated with elevated self-reported pain intensity in adults with opioid-treated CLBP, particularly among those with higher severity of depression symptoms.
Temporal trend in mortality of cardiovascular diseases and its contribution to life expectancy increase in China, 2013 to 2018
Authors: Xia Xue , Cai Yue , Cui Xiang , Wu Ruixian , Liu Fangchao , Huang Keyong , Yang Xueli , Lu Xiangfeng , Wu Shiyong , Gu Dongfeng
Published: September 2022

Backgrounds:

Cardiovascular disease (CVD) remains the leading cause of deaths nationwide. However, little is understood about its temporal trend and corresponding influence on longevity improvements. We aimed to describe the updated tendency in CVD mortality and to quantify its impact on life expectancy (LE) increase in China.

Methods:

All-cause mortality rates were calculated with population sizes from the National Bureau of Statistics and death counts from the National Health Commission. We estimated CVD mortality rates by allocating age- and sex-based mortality envelopes to each CVD subtype based on its proportion derived from the Disease Surveillance Points system. The probability of CVD premature deaths and LE were calculated with life tables and we adopted Arriaga's method to quantitate age- and cause-specific contributions to LE gains.

Results:

During 2013 to 2018, the age-standardized mortality rate of CVD decreased from 289.69 (95% confidence interval [CI]: 289.03, 290.35)/100,000 to 272.37 (95%CI: 271.81, 272.94)/100,000, along with a decline in probability of CVD premature deaths from 9.05% (95%CI: 9.02%, 9.09%) to 8.13% (95%CI: 8.10%, 8.16%). The gap in CVD mortality across sexes expanded with more remarkable declines in females, especially for those aged 15 to 64 years. Among major subtypes, the probability of premature deaths from hemorrhage stroke declined fastest, while improvements of ischemic stroke and ischemic heart disease were limited, and there was an increase in stroke sequelae. LE in China reached 77.04 (95%CI: 76.96, 77.12) years in 2018 with an increase of 1.38 years from 2013. Of the total LE gains, 21.15% (0.29 years) were attributed to reductions of CVD mortality in the overall population, mostly driven by those aged >65 years.

Conclusions:

The general process in reducing CVD mortality has contributed to longevity improvements in China. More attention should be paid to prevention and control of atherosclerotic CVD and stroke sequelae, especially for the elderly. Working-age males also deserve additional attention due to inadequate improvements.
Chinese registry of rheumatoid arthritis (CREDIT) V: sex impacts rheumatoid arthritis in Chinese patients
Authors: Jiang Nan , Li Qin , Li Hongbin , Fang Yongfei , Wu Lijun , Duan Xinwang , Xu Jian , Zhao Cheng , Jiang Zhenyu , Wang Yanhong , Wang Qian , Leng Xiaomei , Li Mengtao , Tian Xinping , Zeng Xiaofeng
Published: September 2022

Background:

The impact of sex on the clinical manifestations of rheumatoid arthritis (RA) were diversely reported in the literature. The Chinese Registry of rhEumatoiD arthrITis provides a platform for the investigation of this issue in Chinese patients.

Methods:

Demographic and clinical parameters were collected from all enrolled patients with RA and from patients with early RA (disease duration ≤6 months). The differences in data regarding disease activity, comorbidities, and medications for RA were compared between men and women. The proportions of patients who achieved remission and low disease activity were compared at enrollment and during 3-, 6-, and 12-month follow-up visits.

Results:

A total of 11,564 patients were enrolled, 83.6% of whom were female. In all the enrolled patients and patients with early RA, C-reactive protein (CRP, 12.0 vs. 6.7 mg/L), pain visual analogue scale (4.8 vs. 4.5), patient's and physician's global assessment (4.9 vs. 4.5 and 4.9 vs. 4.5), 28-joint disease activity score using DAS28-CRP (4.3 vs. 4.0) simplified disease activity index (21.9 vs. 19.9), and clinical disease activity index (19.3 vs. 18.0) were significantly higher in men than in women. Additionally, the swollen joint count/tender joint count and DAS28 using erythrocyte sedimentation rate were higher in male patients than in female patients with early RA. More female patients with early RA reached the treatment target at baseline than male patients (23.4% vs. 18.2%, assessed by CDAI). At 3 months, 6 months, and 12 months, the proportion of remission and treatment target achievement was similar in both sexes. Coronary artery disease (CAD) and stroke were more frequent in men than in women.

Conclusions:

In Chinese patients with RA, men were found to have more active disease, as well as more cases of CAD and stroke. Therefore, sex should be carefully considered during the personalization of RA treatment.
Transplant outcomes of 100 cases of living-donor ABO-incompatible kidney transplantation
Authors: Yin Saifu , Tan Qiling , Yang Youmin , Zhang Fan , Song Turun , Fan Yu , Huang Zhongli , Lin Tao , Wang Xianding
Published: September 2022

Background:

Although ABO-incompatible (ABOi) kidney transplantation (KT) has been performed successfully, a standard preconditioning regimen has not been established. Based on the initial antidonor ABO antibody titers, an individualized preconditioning regimen is developed, and this study explored the efficacy and safety of the regimen.

Methods:

From September 1, 2014, to September 1, 2020, we performed 1668 consecutive living-donor KTs, including 100 ABOi and 1568 ABO-compatible (ABOc) KTs. ABOi KT recipients (KTRs) with a lower antibody titer (≤1:8) were administered oral immunosuppressive drugs (OIs) before KT, while patients with a medium titer (1:16) received OIs plus antibody-removal therapy (plasma exchange/double-filtration plasmapheresis), patients with a higher titer (≥1:32) were in addition received rituximab (Rit). Competing risk analyses were conducted to estimate the cumulative incidence of infection, acute rejection (AR), graft loss, and patient death.

Results:

After propensity score analyses, 100 ABOi KTRs and 200 matched ABOc KTRs were selected. There were no significant differences in graft and patient survival between the ABOi and ABOc groups (P = 0.787, P = 0.386, respectively). After using the individualized preconditioning regimen, ABOi KTRs showed a similar cumulative incidence of AR (10.0% υs. 10.5%, P = 0.346). Among the ABOi KTRs, the Rit-free group had a similar cumulative incidence of AR (P = 0.714) compared to that of the Rit-treated group. Multivariate competing risk analyses revealed that a Rit-free regimen reduced the risk of infection (HR: 0.31; 95% CI: 0.12–0.78, P = 0.013). Notably, antibody titer rebound was more common in ABOi KTRs receiving a Rit-free preconditioning regimen (P = 0.013) than those receiving Rit. ABOi KTRs with antibody titer rebound had a 2.72-fold risk of AR (HR: 2.72, 95% CI: 1.01–7.31, P = 0.048). ABOi KTRs had similar serum creatinine and estimated glomerular filtration rate compared to those of ABOc KTRs after the first year.

Conclusions:

An individualized preconditioning regimen can achieve comparable graft and patient survival rates in ABOi KT with ABOc KT. Rit-free preconditioning effectively prevented AR without increasing the risk of infectious events in those with lower initial titers; however, antibody titer rebound should be monitored.
Child Media Use During COVID-19: Associations with Contextual and Social-Emotional Factors
Authors: Munzer Tiffany , Torres Chioma , Domoff Sarah E. , Levitt Kimberley J. , McCaffery Harlan , Schaller Alexandria , Radesky Jenny S.
Published: September 2022

Objective:

The aim of this study was to test associations between (1) contextual factors and types of digital media use and (2) types of digital media use and children's social-emotional and sleep outcomes during COVID-19.

Methods:

In February to March 2021, 303 parents of elementary schoolers participated in this cross-sectional survey gathering information on demographics, child school format, contextual factors, duration of types of digital media use, social-emotional outcomes, and sleep. Multivariable regressions examined associations outlined in the objective, adjusting for school format, only child, race/ethnicity, and parental stress, depressive symptoms, education, and material hardship.

Results:

Children were aged 5 years to younger than 11 years and spent approximately 4 hours on screen media daily. In multivariable analyses, remote school format; greater material hardship; Black, Indigenous, and people of color child race/ethnicity; lower parenting stress; and parent depressive symptoms were associated with longer duration of various digital media. Longer daily duration of streaming video and video chat were associated with higher prosocial scores, while console games, mobile apps/games, and video-sharing platforms were associated with greater problematic media use (PMU) (defined as interfering with adaptive functioning). More time on mobile apps/games, video-sharing platforms, and video streaming was linked with shorter sleep.

Conclusion:

Lower parenting stress predicted greater digital media use. Greater digital media use during the pandemic may have enabled parents to focus on other needs. Use of media for social connection predicted greater prosocial behaviors. Engagement-prolonging digital media predicted PMU. Pediatric providers may wish to consider family context when addressing digital media use and encourage socially oriented digital media.
INTERNAL LIMITING MEMBRANE PEELING DISTORTS THE RETINAL LAYERS AND INDUCES SCOTOMA FORMATION IN THE PERIFOVEAL TEMPORAL MACULA
Authors: Tao Jiwei , Yang Jinglei , Wu Yubo , Ye Xin , Zhang Yun , Mao Jianbo , Wang Jun , Chen Yiqi , Shen Lijun
Published: September 2022

Purpose:

To determine whether internal limiting membrane peeling damages retinal function in patients with an idiopathic macular hole.

Methods:

Retrospective case series. Forty-five eyes of 45 idiopathic macular hole patients who underwent vitrectomy with internal limiting membrane peeling with a minimum follow-up of 6 months. Each patient received a complete ophthalmological examination. The eyes were examined by microperimetry MP-3 in the central 20° visual field and optical coherence tomography angiography in the central 6 × 6 mm area.

Results:

Six months after the surgery, macular hole closed in each patient. Retinal sensitivity decreased significantly in the perifoveal temporal ETDRS sector (from 24.97 ± 2.67–19.98 ± 5.68 dB, P = 0.001) but not in the other sectors. Six patients (13%) developed 24 scotomas, 62.5% presented in the perifoveal temporal sector. Anatomically, bumps in the outer nuclear layer were discovered concurrent with inner retinal dimples on B-scan images, predominantly (76.8%) in the perifoveal temporal sector, which have not been previously reported. The incidence of outer nuclear layer bumps was significantly higher in patients with scotomas than in those without (83% vs. 18%, P = 0.014).

Conclusion:

Internal limiting membrane peeling induced functional changes specifically in the perifoveal temporal macula. Distortion in the retinal layers is proposed to underly scotomas pathogenesis.
Investigation of the Effect of Sexual Attitudes and Attachment Styles of Spouses of Cancer Patients on Their Psychological Resilience
Authors: Tanriverdi Ayça Merve , Turan Nazan
Published: September 2022

It is pointed out that the attachment styles of spouses are also very important in terms of coping with the psychological problems experienced in illness and sexual satisfaction. The aim of this study is to investigate the effect of sexual attitudes and attachment styles of spouses of cancer patients on their psychological resilience. The research was carried out as a descriptive study based on the relational screening model between January and November 2021. A total of 429 spouses of cancer patients who met the inclusion criteria were included in the study. The data were collected online using the Participant Information Form, which was prepared by the researcher, Resilience Scale for Adults (RSA), Experiences in Close Relationships Scale (ECR-S), and Hendrick Sexual Attitude Scale (BSAS). Data analyses included descriptive statistics, Mann-Whitney U-test, Kruskal-Wallis, and linear regression using the SPSS 25.0 program. Two hundred forty-six women and 183 men were included in the study, and it has been detected that RSA scores of female participants were higher than male participants. In addition, a positive relation between RSA scores and ECR-S scores (r = 0.247) and a negative relation between RSA and BSAS (r = −0.414) were detected (p < 0.05). It was determined that the psychological resilience of spouses of cancer patients was related to sexual attitudes and attachment styles.
Childhood Adversity, Addiction Severity, and Comorbidity Among Patients Receiving Opioid Use Disorder Treatment
Authors: Carr Meagan M. , Ellis Jennifer D. , Saules Karen K. , Ledgerwood David M.
Published: September 2022

Patients in opioid use disorder (OUD) treatment report high rates of childhood adversity, and women experience greater exposure to certain types of childhood adversity (e.g., sexual abuse). Childhood adversity is associated with clinical severity, but the mechanisms explaining this association are not well understood. Participants (N = 171) in opioid agonist treatment completed measures of childhood adversity, emotion regulation, and clinical severity (i.e., addictive behaviors, depression, and anxiety). Women endorsed greater childhood adversity and higher current psychopathology than men. The association between childhood adversity and clinical severity varied as a function of symptom type, although emotion regulation was a strong predictor in all models. Women reported higher levels of anxiety after controlling for covariates, childhood adversity, and emotion dysregulation. Future research should investigate treatment strategies to address emotion dysregulation among patients in OUD treatment, particularly women who may present with greater childhood adversity exposure and anxiety.
Occult Fracture of the Fibula
Authors: Zhang Shuliang , Sheng Hongfeng , Xu Bin , Chen Yangdahao , Lao Yangjun
Published: September 2022

Occult fibula fracture in adults is a fairly rare disease. It is easy to overlook or misdiagnose, resulting in delayed treatment and serious sequelae, as well as medical conflicts. We describe a case of concealed distal fibula fracture. The radiograph revealed no visible abnormalities at first. Finally, the occult fibula fracture was confirmed by magnetic resonance imaging and the patient received timely, correct, and reasonable treatment after diagnosis. This case raises our awareness of occult fibula fractures that are easily missed, and it deserves to be shared.
A Novel Bone Contouring Technique Using Multiple Tangential Shaving for Conservative Management of Craniofacial Fibrous Dysplasia
Authors: Kim Young Chul , Park Hojin , Woo Soo Hyun , Choi Jong Woo
Published: September 2022

This study aimed to propose a novel surgical technique, named multiple tangential shaving of bone contour, for the conservative management of craniofacial fibrous dysplasia. We retrospectively reviewed 17 patients who underwent conservative management of craniofacial fibrous dysplasia using multiple tangential shaving technique between July 2005 and December 2020. Demographics, tumor characteristics, and surgery-related factors were investigated. All patients underwent preoperative (T0) and postoperative computed tomography scans taken at least twice within 1 month for immediate assessment (T1) and at least 12 months postoperatively for long-term assessment (T2). Clinical outcomes, including tumor recurrence, perioperative complications, and physician measure of esthetic outcomes (Whitaker score), were investigated. This technique was applied for contouring of the zygomatic-maxillary and calvarial bone for patients aged between 16 and 60 years (mean age: 26 y). The mean±SD tumor volume reduction was 15.5±8.95 cm3, and the postoperative mean±SD tumor growth rate was 5.52±6.26% per year. Satisfactory outcome was obtained in terms of esthetics with a mean±SD Whitaker score of 1.41±0.62. Patients required a mean operation time of 1.67±0.43 hours and a mean number of shaving operations of 1.35±0.61 during the follow-up period. Five of 17 patients required reoperation because of the tumor recurrence (N=4) and to correct new-onset diplopia after surgery (N=1). In conclusion, the multiple tangential shaving technique allows an easy approach for conservative management of craniofacial fibrous dysplasia. An acceptable rate of tumor recurrence and esthetic outcomes can be obtained by selecting the appropriate candidate for a conservative approach.
Perceptions and Experiences of Privacy Among Persons With an Ostomy Receiving Treatment and Care
Authors: Akyüz Elif , Erdemir Firdevs , Uğurlu Ziyafet , Üstündağ Çiğdem
Published: September 2022

PURPOSE:

The aim of this study was to determine ostomy patients' experiences and opinions on protection of privacy during treatment and care.

DESIGN:

Mixed-methods, descriptive correlational study.

SAMPLE AND SETTING:

The study sample comprised 80 patients with an ostomy receiving treatment and care in a university hospital in Turkey.

METHODS:

Data were collected using a form developed by the researchers based on literature review. The survey consisted of statements that examined demographic characteristics, experiences, and opinions of patients with an ostomy.

RESULTS:

For participants, 64.8% (n = 35/54) defined privacy from a physical dimension, 64.1% (n = 25/39) suffered from ostomy-related psychosocial discomfort, 48.7% experienced ostomy-related discomfort mostly during nursing care (n = 19/39), 48.7% (n = 39/80) were uncomfortable when their ostomy was seen by others, Approximately 56.3% (n = 45/80) thought that they disturbed other patients and their families during ostomy care, and 46.3% (n = 37/80) stated that healthcare professionals discussed information about their ostomy when other patients and their families were present. In addition, 21.3% (n = 17/80) opined that the physical conditions of patient rooms failed to provide privacy. Analysis revealed no significant relationship between education levels and reading the Patient Rights Regulation (P = .129). Analysis also found no significant relationships between age (P = .086), marital status (P = .382), educational background (P = .143), hospitalization experience (P = .427), and satisfaction with perceptions of privacy when receiving ostomy care.

CONCLUSION:

Patients with an ostomy reported physical and psychosocial problems concerning privacy, felt uncomfortable about the way information on their ostomy was discussed, and thought that physical conditions were not suitable for ostomy care. We recommend that healthcare professionals be provided with more training on psychosocial problems and privacy for patients with ostomy and that institutional policies and procedures be developed to address patients' problems.
Evaluation of Treatment Differences Between Men and Women Undergoing Ventral Hernia Repair: An Analysis of the Abdominal Core Health Quality Collaborative
Authors: Polcz Monica E , Olson Molly A , Bradley Joel , Broucek Joseph , Duke Meredith C , Prabhu Ajita , Rosen Samantha , Sedrakyan Art , Poulose Benjamin K , Pierce Richard A ,   for the Vanderbilt Hernia Center Research Group
Published: September 2022

BACKGROUND:

Sex is emerging as an important clinical variable associated with surgical outcomes and decision making. However, its relevance in regard to baseline and treatment differences in primary and incisional ventral hernia repair remains unclear.

STUDY DESIGN:

This is a retrospective cohort study using the Abdominal Core Health Quality Collaborative database to identify elective umbilical, epigastric, or incisional hernia repairs. Propensity matching was performed to investigate confounder-adjusted treatment differences between men and women. Treatments of interest included surgical approach (minimally invasive or open), mesh use, mesh type, mesh position, anesthesia type, myofascial release, fascial closure, and fixation use.

RESULTS:

A total of 8,489 umbilical, 1,801 epigastric, and 16,626 incisional hernia repairs were identified. Women undergoing primary ventral hernia repair were younger (umbilical 46.4 vs 54 years, epigastric 48.7 vs 52.7 years), with lower BMI (umbilical 30.4 vs 31.5, epigastric 29.2 vs 31.1), and less likely diabetic (umbilical 9.9% vs 11.4%, epigastric 6.8% vs 8.8%). Women undergoing incisional hernia repair were also younger (mean 57.5 vs 59.1 years), but with higher BMI (33.1 vs 31.5), and more likely diabetic (21.4% vs 19.1%). Propensity-matched analysis included 3,644 umbilical, 1,232 epigastric, and 12,480 incisional hernias. Women with incisional hernia were less likely to undergo an open repair (60.2% vs 63.4%, p < 0.001) and have mesh used (93.8% vs 94.8%, p = 0.02). In umbilical and incisional hernia repairs, women had higher rates of intraperitoneal mesh placement and men had higher rates of preperitoneal and retro-muscular mesh placement.

CONCLUSIONS:

Small but statistically significant treatment differences in operative approach, mesh use, and mesh position exist between men and women undergoing ventral hernia repair. It remains unknown whether these treatment differences result in differing clinical outcomes.
Assessing the Impacts of COVID-19 and Social Isolation on Mental Health in the United States of America
Authors: Fulk Alexander , Saenz-Escarcega Raul , Kobayashi Hiroko , Maposa Innocent , Agusto Folashade
Published: September 2022

The COVID-19 pandemic has had a devastating impact on the world at large with over 500 million cases and over 6 million deaths reported thus far. Of those, over 85 million cases and 1 million deaths have occurred in the United States of America. The mental health of the general population has been impacted by several aspects of the pandemic including lockdowns, media sensationalism, social isolation, and spread of the disease. In this paper, we examine the effect that social isolation and COVID-19 infection and related death had on the prevalence of anxiety and depression in the general population of the USA in a state-by-state multiple time-series analysis. Vector Error Correction Models are estimated and we subsequently evaluated the coefficients of the estimated models and calculated their impulse response functions for further interpretation. We found that variables related to COVID-19 overall led to increase in both anxiety and depression across the studied period, while variables related to social isolation had a varied effect depending on the state being considered.
SDG5 ‘Gender Equality’ and the COVID-19 pandemic: a rapid assessment of health system responses in selected upper-middle and high-income countries
Authors: Kuhlmann Ellen , Lotta Gabriela , Fernandez Michelle , Herten-Crabb Asha , Fehr Leonie Mac , Maple Jaimie-Lee , Paina Ligia , Wenham Clare , Willis Karen
Published: September 2022

The COVID-19 pandemic disrupted healthcare and societies, exacerbating existing inequalities for women and girls across every sphere. Our study explores health system responses to gender equality goals during the COVID-19 pandemic and inclusion in future policies. We apply a qualitative comparative approach, drawing on secondary sources and expert information; material was collected from March to July 2022. Australia, Brazil, Germany, the United Kingdom and USA were selected, reflecting upper-middle and high-income countries with established public health and gender policies but different types of healthcare systems and epidemiological and geo-political conditions. Three sub-goals of SDG 5 were analysed: maternity care and reproductive health, gender-based violence, and gender equality and women’s leadership. We found similar trends across countries. Pandemic policies strongly cut into women’s health, constrained prevention and support services and weakened reproductive rights, while essential maternity care services were kept open. Intersecting gender inequalities were reinforced, sexual violence increased and women’s leadership was weak. All healthcare systems failed to protect women’s health and essential public health targets. Yet there were relevant differences in the responses to increased violence and reproductive rights, ranging from some support measures in Australia to an abortion ban in the US. Our study highlights a need for revising pandemic policies through a feminist lens.
Development and Validation of the Cannabis Exposure in Pregnancy Tool (CEPT)
Authors: Chaput Kathleen H. , McMorris Carly A. , Metcalfe Amy , Ringham Catherine , Wood Stephen , McNeil Deborah , Konschuh Shaelen , Sycuro Laura , McDonald Sheila W.
Published: September 2022

Background

Evidence of associations between prenatal cannabis use (PCU) and maternal and infant health outcomes remains conflicting amid broad legalization of cannabis across Canada and 40 American states. A critical limitation of existing evidence lies in the non-standardized and crude measurement of PCU, resulting in high risk of misclassification bias. We developed a standardized tool to comprehensively measure prenatal cannabis use in pregnant populations for research purposes.

Methods

We conducted a patient-oriented tool development and validation study using a bias-minimizing process. Following an environmental scan and critical appraisal of existing prenatal substance use tools, we recruited pregnant participants via targeted social media advertising and obstetric clinics in Alberta, Canada. We conducted individual in-depth interviews and cognitive interviewing in separate sub-samples, to develop and refine our tool. We assessed convergent and discriminant validity internal consistency and 3-month test-retest reliability, and validated the tool externally against urine THC bioassay.

Results

254 pregnant women participated. The 9-item Cannabis Exposure in Pregnancy Tool (CEPT) had excellent discriminant (Cohen’s kappa=-0.27-0.15) and convergent (Cohen’s kappa=0.72-1.0) validity; as well as high internal consistency (Chronbach’s alpha = 0.92), and very good test-retest reliability (weighted Kappa=0.92, 95% C.I. [0.86-0.97]). The CEPT is valid against urine THC bioassay (sensitivity=100%, specificity=77%).

Interpretation

The CEPT is a novel, valid and reliable measure of frequency, timing, dose, and mode of PCU, in a contemporary sample of pregnant women. Using CEPT (compared to non-standardized tools) can improve measurement accuracy, and thus the quality of PCU and maternal and child health research.
Work-Related Injuries in the Australian Education Sector: A Retrospective Cohort Study
Authors: Al Afreed Fatimah M , Lane Tyler J , Gray Shannon E
Published: September 2022

Introduction

Educators are exposed to several work-related hazards. Evidence suggests musculoskeletal pain, psychological distress, and student-inflicted violence-related injuries are common. However, there is little evidence on the burden of workplace injury among Australian educators.

Aim

To compare incidence of injury claims and duration of compensated time off work between educators and non-educators, and associated factors.

Methods

Retrospective cohort study of 1,559,676 Australian workers’ compensation claims, including 84,915 educator claims, lodged between July 2009 to June 2015, from the National Dataset for Compensation-based Statistics. Cases were included if aged 18+ years and working in the education sector less than 100 hours per week. Negative binomial regression models estimated the relative risk of making a compensation claim and survival analyses calculated disability duration within educators by sex, age, injury type and mechanism, socioeconomic area, remoteness, and jurisdiction.

Results

Compared to non-educators, educators had lower rates of injury claims and shorter disability durations. However, educators had a higher rate of claims for mental health conditions and assault, with the highest risk being among those in special education and education aides. Among educators, injury claim rates were highest among special educators, education aides, and secondary educators.

Discussion and Conclusion

Though surveys indicate Australians in the education sector have higher incidences of work-related injuries, this study found lower incidence of injury claims and shorter disability durations than others. Educators’ injury-reporting and absenteeism behaviors may be constrained by ethical, social, and administrative attitudes. Educators had higher rates of claims for mental health and assault-related injury, particularly special educators, and education aides, which suggests a need for targeted prevention efforts.
Analysis of CNN features with multiple machine learning classifiers in diagnosis of monkeypox from digital skin images
Authors: Kumar Vidit
Published: September 2022

Concerns about public health have been heightened by the rapid spread of monkeypox to more than 90 countries. To contain the spread, AI assisted diagnosis system can play an important role. In this study, different deep CNN models with multiple machine learning classifiers are investigated for monkeypox disease diagnosis using skin images. For this, bottleneck features of three CNN models i.e. AlexNet, GoogleNet and Vgg16Net are exploited with multiple machine learning classifiers such as SVM, KNN, Naïve Bayes, Decision Tree and Random Forest. Results shows that with Vgg16Net features, Naïve Bayes classifier gives highest accuracy of 91.11%.
Development of reference ranges of vital signs in UK children: comparison with international centiles
Authors: Taylor Nicky , Wark Petra A , Coad Jane , Prayle Andrew , Manning Joseph C.
Published: September 2022

Background

Children and Young People (CYP) with acute illness require routine assessment of their physiological observations. There is no agreement as to what the standard reference ranges of vital signs in children and young people are. Existing reference ranges of vital signs that are currently used in clinical practice are minimally supported by empirical evidence. They are also sometimes conflicting.

Methods

We conducted a cross-sectional study using 66356 admission episodes to analyze routinely collected age-specific respiratory rate, heart rate, and blood pressure observations of CYP aged 0-19 years old at hospital discharge. Quantile regression with Restricted Cubic Splines was used to model age-specific centiles. These were then compared with standard reference ranges and literature.

Results

New centile charts for vital signs are presented. Advanced Paediatric Life Support (APLS, 6th Ed.) reference ranges for respiratory rate and blood pressure poorly aligned to the centiles derived in this study although the centiles for heart rate align well. Variance was also demonstrated between the study centiles and those from the clinical papers, with the greatest differences seen in the upper centiles. Similarly, in comparison with APLS reference ranges, heart rate showed best alignment.

Conclusions

This is the first-time physiological observations of CYP in a UK Children’s hospital have been described and centile charts developed. Current widely used reference ranges especially those for Heart Rate and Respiratory Rate are not fit for purpose when evaluating whether the vital signs of a child are normal or otherwise.
A general theory for infectious disease dynamics
Authors: Carbone Giuseppe , De Vincenzo Ilario
Published: September 2022

We present a general theory of infection spreading, which directly follows from conservation laws and takes as inputs the probability density functions of latent times. The derivation of the theory substantially differs from Kermack and McKendrick (1927) argument, which instead was based on the concept of removal rates. We demonstrate the formal equivalence of the two approaches, but our theory provides a clear interpretation of the kernels of the integro-differential equations governing the infection spreading in terms of survival function of the latent times distributions. This aspect was never captured before. Real distributions of latent times can be, then, employed, thus overcoming the limitations of standard SIR, SEIR and other similar models, which implicitly make use of exponential or exponential-related distributions. SIR and SEIR-type models are, in fact, a subclass of the theory here presented. We show that beside the infection rateν, the joint probability density functionpEI(τ, τ1) of latent times in the exposed and infectious compartments governs the infection spreading. Assuming that the number of infected individuals is negligible compare to the entire population, we were able to study the stability of the dynamical system and provide the general solution of equations in terms characteristic functions of the probability distribution of latent times. We present asymptotic solutions for the caseR0= 1 and demonstrate that the moments of the latent times distribution govern the rate of disease spreading in this case. The present theory is employed to simulate the diffusion of COVID-19 infection in Italy during the first 120 days. The estimated value of the basic reproduction number isR0≈ 3.5, in very good agreement with existing data.
The clinical pharmacology of tafenoquine in the radical cure of Plasmodium vivax malaria: an individual patient data meta-analysis
Authors: Watson James A , Commons Robert J , Tarning Joel , Simpson Julie A , Cuentas Alejandro Llanos , Lacerda Marcus VG , Green Justin A , Koh Gavin CKW , Chu Cindy S , H Nosten François , Price Ric N , Day Nicholas PJ , White Nicholas J
Published: September 2022

Background

Tafenoquine is a newly licensed antimalarial drug for the radical cure of Plasmodium vivax malaria. The mechanism of action and the optimal dosing - a balance between haemolytic risk and radical cure efficacy - are uncertain.

Methods

We pooled individual data from 1102 patients with acute vivax malaria and 72 healthy volunteers (all with >70% of the population median whole blood glucose-6-phosphate dehydrogenase [G6PD] activity) who were studied in the pre-registration trials of tafenoquine. Plasma tafenoquine concentrations were analysed under a population pharmacokinetic model. A series of Bayesian logistic and Emax dose-response models were fitted to the primary outcome of any P. vivax recurrence within 4 months. Acute vomiting and haemolysis were secondary outcomes. The key exposure variables were: the mg/kg tafenoquine dose; pharmacokinetic summaries of parent compound exposure (AUC[0,∞), Cmax) and metabolism (terminal elimination half-life); and day 7 methaemoglobin concentration (%) as a measure of oxidative activity.

Results

Tafenoquine dose (mg/kg) was a major determinant of recurrence (odds ratio [OR]: 0.70 per mg/kg increase, 95% credible interval [CI]: 0.65-0.75). After adjustment for dose, the tafenoquine terminal elimination half-life (OR: 1.15 per day increase, 95% CI: 1.06-1.25), and the day 7 methaemoglobin concentration (OR: 0.81 per absolute percentage point increase, 95% CI: 0.65 to 0.99), but not the parent compound exposure, were also associated with recurrence. Under the Emax we estimate that the currently recommended 300mg dose in a 60kg adult (≈5mg/kg) results in approximately 70% of the maximal obtainable hypnozoiticidal effect. Increasing the dose to 7.5mg/kg (i.e. 450mg) would result in 90% reduction in the risk of P. vivax recurrence. Tafenoquine was well tolerated. No patients had severe haemolysis. Acute vomiting was not dose-related. In patients with normal G6PD enzyme concentrations, tafenoquine dose was associated with minor post-treatment haemoglobin reductions on days 2 or 3 (0.02 g/dL per mg/kg increase [95% CI: 0.04 to 0.00]).

Conclusions and interpretation

The currently recommended 300mg adult dose for radical cure of vivax malaria has suboptimal efficacy. Increasing to 450mg is predicted to increase radical cure rates substantially. The production of oxidative metabolites is central to tafenoquine’s hypnozoiticidal efficacy. Clinical trials of higher tafenoquine doses are now needed to characterise efficacy, safety and tolerability.
Persistent low-level variants in a subset of HCMV genes are highly predictive of poor outcome in immunocompromised patients with cytomegalovirus infection
Authors: Venturini Cristina , Colston Julia M , Charles Oscar , Best Timothy , Atkinson Claire , Forrest Calum , Williams Charlotte , Rao Kanchan , Worth Austen , Thorburn Doug , Harber Mark , Griffiths Paul , Breuer Judith
Published: September 2022

Human cytomegalovirus (HCMV) is the most common and most serious opportunistic infection after solid organ (SOT) and haematopoietic stem cell transplantation (HSCT). There is considerable interest in using virus sequence data to investigate and monitor viral factors associated with the clinical outcome, including failure to respond to available antiviral therapies.

To assess this, we used target-enrichment to deep-sequence 16 paediatric patients with HSCT, SOT or primary immunodeficiency of whom 9 died with HCMV and 35 infected SOT adult recipients of whom one died with HCMV.

We first showed that samples from both groups have fixed drug-resistance mutations and mixed infections. Deep sequencing also revealed non-fixed resistance mutations in most of the patients who died (6/9). A machine learning approach identified 10 genes with high within-host variability in these patients. These genes formed a viral signature which discriminated patients with HCMV who died from those that survived with high accuracy (AUC=0.96). Lymphocyte numbers for a subset of 17 patients showed no recovery post-transplant of counts in the five who died.

We hypothesise that the viral signature identified in this study may be a useful biomarker for poor response of HCMV to antiviral drug treatment and indirectly for poor T cell function, potentially identifying early, those patients requiring non-pharmacological interventions.
SARS-CoV-2 containment was achievable during the early stage of the pandemic: a retrospective modelling study of the Xinfadi outbreak in Beijing
Authors: Wang Yan , Sun Kaiyuan , Pan Yang , Yi Lan , Huo Da , Wu Yanpeng , Dong Shuaibing , Guo Jinxin , Dou Xiangfeng , Wang Wei , Wu Shuangsheng , Bai Xufang , Yu Hongjie , Wang Quanyi
Published: September 2022

Prior to the emergence of the Omicron variant, many cities in China had been able to maintain a “Zero-COVID” policy. They were able to achieve this without blanket city-wide lockdown and through widespread testing and an extensive set of nonpharmaceutical interventions (NPIs), such as mask wearing, contact tracing, and social distancing. We wanted to examine the effectiveness of such a policy in containing SARS-CoV-2 in the early stage of the pandemic. Therefore, we developed a fully stochastic, spatially structured, agent-based model of SARS-CoV-2 ancestral strain and reconstructed the Beijing Xinfadi outbreak through computational simulations. We found that screening for symptoms and among high-risk populations served as methods to discover cryptic community transmission in the early stage of the outbreak. Effective contact tracing could greatly reduce transmission. Targeted community lockdown and temporal mobility restriction could slow down the spatial spread of the virus, with much less of the population being affected. Population-wide mass testing could further improve the speed at which the outbreak is contained. Our analysis suggests that the containment of SARS-CoV-2 ancestral strains was certainly possible. Outbreak suppression and containment at the beginning of the pandemic, before the virus had the opportunity to undergo extensive adaptive evolution with increasing fitness in the human population, could be much more cost-effective in averting the overall pandemic disease burden and socioeconomic cost.
Examining the evidence for Mendelian randomization homogeneity assumption violation using instrument association with exposure variance
Authors: Lyon Matthew S. , Millard Louise A. C. , Smith George Davey , Hartwig Fernando , Gaunt Tom R. , Tilling Kate
Published: September 2022

Background

Estimation of the average causal effect using instrumental variable (IV) analyses requires homogeneity of instrument-exposure and/or exposure-outcome relationships. Previous research explored the validity of homogeneity assumptions by testing IV-exposure interaction effects using a set of effect modifiers. However, this approach requires that modifiers are known and measured but evidence for interaction may also be observed through IV association with exposure variance without knowledge of the modifier.

Methods

We explored the utility of testing for IV-exposure variance effects as evidence against homogeneity through simulation. We also evaluated the approach of removing IVs from Mendelian randomization (MR) analyses that show strong association with exposure variance (hence are likely to have heterogeneous effects). Our methodology was applied to evaluate homogeneity assumptions of LDL, urate and glucose on cardiovascular disease, gout, and type 2 diabetes, respectively.

Results

Under simulation, interaction of IV-exposure and exposure-outcome effects by a single modifier led to bias of the estimated average causal effect (ACE) which could be partially assessed by testing for IV-exposure variance effects. Bias of the ACE attenuated after removing instruments with strong exposure variance effects. In applied analyses, we found no strong evidence of bias from the ACE.

Conclusions

We find no strong evidence against estimating the ACE for LDL, urate and glucose on cardiovascular disease, gout, and type 2 diabetes. These approaches could be used in future MR analyses to gain improved understanding of the causal estimand.

Key messages

Homogeneity of the instrument-exposure and/or exposure-outcome effect is necessary to estimate the average causal effect which is important for developing health interventions

Partial evidence against the homogeneity assumption can be obtained from testing for the instrument-exposure variance effect which may suggest the presence of effect modification

This evidence can be used in two ways: i) as a falsification approach to determine if the homogeneity assumption may be violated. ii) to remove genetic instruments from Mendelian randomization analyses providing an estimate that is closer to the average causal effect

After removing instruments with exposure variance effects, the Mendelian randomization effect of LDL, urate and glucose on coronary heart disease, gout, and type 2 diabetes, respectively showed little difference suggesting no strong evidence against the average causal effect
Exercise prescription and strategies to promote the cross-education of strength: a scoping review
Authors: Voskuil Caleb C. , Andrushko Justin W. , Huddleston Boglarka S. , Farthing Jonathan P. , Carr Joshua C.
Published: September 2022

Objective

To perform a scoping review of the literature on the experimental studies examining the role of resistance training frequency, intensity, the type of training, training volume, and adjuvant therapies on the cross-education of strength.

Study Design

Scoping Review.

Literature Search

The review was preregistered and performed with the search methodology described by the PRISMA extension for scoping reviews. CINAHL, MEDLINE, APA PsycInfo, SPORTDiscus, and Web of Science were systematically searched with grey literature searches and pearling of references thereafter.

Study Selection Criteria

Experiments were included in the review if they performed a unilateral resistance training intervention that directly compared the dose of a training variable on the cross-education response in healthy or clinical populations following a minimum of two weeks of training. Experiments must have reported maximal strength outcomes for the untrained limb.

Data Synthesis

For each experiment, the study population, intervention methods, the dosage of the training variable being studied, and the outcomes for the untrained, contralateral limb were identified and collectively synthesized.

Results

The search returned a total of 911 articles, 56 of which qualified for inclusion. The results show that experimental trials have been conducted on resistance training frequency (n = 4), intensity (n = 7), the type of training (n = 25), training volume (n = 3), and adjuvant therapies (n = 17) on the cross-education of strength.

Conclusions

This review synthesizes the available evidence regarding exercise design and prescription strategies to promote the cross-education of strength. It appears that traditional resistance training frequencies (ie., 2-3d/wk) at high intensities are effective at promoting cross- education. Eccentric muscle actions show additive benefits. There is experimental evidence that neuromodulatory techniques can augment cross-education when layered with unilateral resistance training versus training alone.