bluuebunny/crossref_metadata_2025 huggingface dataset:
AMYLASE DEPLETION SIGNIFICANTLY IMPROVES THE MALDI-TOF PROFILE OF SALIVA – APPLICATION TO COVID-19 DIAGNOSTICS
Authors: LaCasse Zane , Chivte Prajkta , Kress Kari , Seethi Venkata Devesh R. , Bland Joshua , Alhoori Hamed , Kadkol Shrihari S. , Gaillard Elizabeth R.
Published: April 2023

Human saliva contains a plethora of proteins whose presence and concentration can be monitored for diagnosis and progression of disease. Saliva has been extensively probed for the diagnosis of several systemic and infectious diseases because of the ease with which it can be collected. However, amylase, the most abundant protein found in saliva can obscure the detection of low-abundance proteins by MALDI-ToF MS (matrix-assisted laser desorption/ionization-time of flight mass spectrometry) and diminish the diagnostic utility of this specimen type. In the present study, we used a device to deplete salivary amylase from water-gargle samples through affinity adsorption. After depletion, profiling of the saliva proteome was performed by MALDI-ToF MS on gargle samples from subjects whose COVID-19 (coronavirus disease 2019) status was confirmed by NP (nasopharyngeal) swab RT-qPCR (reverse transcription polymerase chain reaction). Amylase depletion led to the enhancement of signal intensities of various peaks as well as the detection of previously unobserved peaks in the MALDI-ToF spectra. The overall specificity and sensitivity after amylase depletion was 100% and 85.17% respectively for detecting COVID-19. Our simple, rapid and inexpensive technique to deplete salivary amylase can be used to unmask spectral diversity in saliva by MALDI-ToF MS, reveal low-abundant proteins and aid in the establishment of novel biomarkers for diseases.
Malaria surveillance reveals parasite relatedness, signatures of selection, and correlates of transmission across Senegal
Authors: Schaffner Stephen F. , Badiane Aida , Khorgade Akanksha , Ndiop Medoune , Gomis Jules , Wong Wesley , Ndiaye Yaye Die , Diedhiou Younouss , Thwing Julie , Seck Mame Cheikh , Early Angela , Sy Mouhamad , Deme Awa , Diallo Mamadou Alpha , Sy Ngayo , Sene Aita , Ndiaye Tolla , Sow Djiby , Dieye Baba , Ndiaye Ibrahima Mbaye , Gaye Amy , Ndiaye Aliou , Battle Katherine E. , Proctor Joshua L. , Bever Caitlin , Fall Fatou Ba , Diallo Ibrahima , Gaye Seynabou , Sene Doudou , Hartl Daniel L. , Wirth Dyann F. , MacInnis Bronwyn , Ndiaye Daouda , Volkman Sarah K.
Published: April 2023

Parasite genetic surveillance has the potential to play an important role in malaria control. We describe here an analysis of data from the first year of an ongoing, nationwide program of genetic surveillance ofPlasmodium falciparumparasites in Senegal, intended to provide actionable information for malaria control efforts. Looking for a good proxy for local malaria incidence, we found that the best predictor was the proportion of polygenomic infections (those with multiple genetically distinct parasites), although that relationship broke down in very low incidence settings (r = 0.77 overall). The proportion of closely related parasites in a site was more weakly correlated (r= -0.44) with incidence while the local genetic diversity was uninformative. Study of related parasites indicated their potential for discriminating local transmission patterns: two nearby study areas had similarly high fractions of relatives, but one area was dominated by clones and the other by outcrossed relatives. Throughout the country, 58% of related parasites proved to belong to a single network of relatives, within which parasites were enriched for shared haplotypes at known and suspected drug resistance loci as well as at one novel locus, reflective of ongoing selection pressure.
Acceptability of Breast Milk Donor Banking: A qualitative study among Health Workers in Greater Accra Regional Hospital, Ghana
Authors: Tende Fred Kafui , Nwameme Adanna Uloaku , Tabong Philip Teg-Nefaah
Published: April 2023

Despite the compelling evidence demonstrating the immediate and long-term health advantages of prompt breastfeeding beginning, not all newborns are breastfed exclusively for a variety of reasons. As a result, the World Health Organization has made new recommendations for the adoption of breastmilk donor banks to make sure that children receive breastmilk when mothers are unable to produce it. In order to better understand how health professionals at the Greater Accra Regional Hospital, who would be leading the charge in putting this policy into practice, perceive and accept the practice of storing breastmilk, this study was conducted. At the Greater Accra Regional Hospital, 18 healthcare professionals were chosen using maximum variation purposive sampling procedures. They were made up of eleven midwives, a medical officer, six nurses, and two nutritionists and all participants were interviewed face to face using a semi structured interview guide. Data was transcribed verbatim and was analyzed using thematic analysis. Participants in the study admitted that they would be open to using or contributing to a bank of breastmilk. Participants also said that if safety precautions are taken, they would urge their customers to give breastmilk and recommend breastmilk from a breastmilk bank to them when the situation calls for it. Health professionals recommended that education be provided prior to the installation of breast milk donor banking to lessen or eliminate any misconceptions people may have about it. The concept of breastmilk donor banking was fairly accepted among health workers. Misconceptions about the safety of breast milk was the main concern. The results emphasize the necessity of greater stakeholder engagement and education prior to the implementation of this policy in order to boost acceptance and uptake.
Granular analysis reveals smart insufflation to be operationally more efficient and financially net positive compared to traditional insufflation for laparoscopic surgery
Authors: Abbas Aazad , Saleh Imran , Hoit Graeme , Park Sam , Whyne Cari , Toor Jay
Published: April 2023

Introduction

Smart insufflation (SI) techniques relying on valve and membrane-free insufflation are increasing in usage. Although considerable literature exists demonstrating the benefits of SI on procedural ease and patient outcomes, there remains a paucity describing the financial impact of these devices. The purpose of this study was to determine the financial and efficiency impact of these devices on the operating room (OR) and inpatient wards of a hospital.

Methods

A discrete event simulation model representing a typical mid-sized North American hospital comparing SI to TI was generated. The National Surgical Quality Improvement (NSQIP) database from 2015 to 2019 was used to populate the model with data supplemented from literature. Outcomes included length of stay (LOS), duration of surgery (DOS), annual procedure volume, profit, return on investment (ROI), and gross profit margin (GPM).

Results

The operational parameters demonstrating favorability of SI to TI were DOS and LOS. DOS savings were 10-32 minutes/case while LOS savings were 0-3 days/case. Implementation of an SI led to an increase in annual throughput of 148 cases (12%). LOS decreased by 189 days (19%). This resulted in an increase in net profit of $104,675 per annum. The ROI of SI over TI device was >1000%.

Conclusion

Despite the initial financial investment being greater, the implementation of SI offsets these expenses and yields significant financial benefits. Our study demonstrates the financial benefits of SI over TI and illustrates how granular operational and financial analysis of technologies are essential to aid in sound healthcare procurement decision making.
Intra-urban inequalities in modern family planning use in Uganda’s urban settings: the role of place of residence, socio-economic, family, and individual factors
Authors: Kananura Rornald Muhumuza , Birabwa Catherine , Wasswa Ronald , Ssanyu Jacquellyn Nambi , Muluya Kharim Mwebaza , Namutamba Sara , Kyangwa Moses , Kizito Felix , Kakaire Othman , Mugahi Richard , Waiswa Peter
Published: April 2023

Evidence of how intra-urban inequalities could steer the use of modern family planning (mFP) services remains elusive. In this study, we examined the role of residence, socio-economic, family, and individual factors in shaping access to mFP use in Iganga Municipality and Jinja city, in central eastern Uganda.

We used cross-sectional household survey data that were collected between November-December 2021 from 1023 women aged 15-49 years. We used logistic regression to assess the factors associated with mFP use and Stata user written command –iop, to assess the inequality in mFP due to different factors. We considered unfair circumstances as socio-economic status (wealth quartile, education level, and working level), place of residence, age, religion affiliation, and authority. The time of sexual intercourse was considered as fair circumstance.

Overall mFP use was estimated at 48.8%, with close to 60% using long-term acting reversible methods. Overall, 24% of all heterogeneity in modern FP use was due to the observed circumstances and 18% was due to differential in unfair circumstances. An increase in age was inversely associated with mFP use [adjusted Odds Ratio (aOR) [95% Confidence Interval (95%CI)] =0.976[0.966-0.986]), while an increase in parity was positively associated with mFP use (aOR [95%CI]=1.404[1.249-1.578]). Compared to mainland non-slum and landing site residents, mainland slum residents were two-fold (aOR[95%CI]=2.065[1.735-2.458]) and three-fold (aOR[95%CI]=2.631[1.96-3.531]) more likely to use mFP, respectively. Whereas the odds of using mFP increased with the wealth status (Middle: aOR[95%CI]=1.832[1.52-2.209] and Better: aOR[95%CI]=5.276[4.082-6.819]), an interaction between the place of residence and wealth index showed that wealth index mattered only in non-slum mainland areas. Women with secondary or higher level of education and whose decisions to use mFP were independent of other authorities were more likely to use mFP. Lastly, there were region affiliation and type of work differential in the use of mFP.

In conclusion, about one-fifth of all heterogeneity in mFP use was due to differentials in unfair circumstances. The findings highlight the need for intervention that are tailored to the different groups of urban residents. For instance, the package of interventions should consider the places of work and places of residences regardless of socioeconomic status.
Improvement in drug prescription skills in medical students through in-person and remote simulated interviews
Authors: Malca C Michan , Siccha S Christian , Cardenas F Ernesto , Placencia M Maritza
Published: April 2023

Introduction

Development of drug prescription skills poses critical challenges in medical education. This study determined the effects of simulated interviews on the improvement of drug prescription skills among medical students in 2020.

Methodology

This was a quantitative, cross-sectional, analytical, quasi-experimental study of simulated interviews for improving rational drug prescription skills in medical students. Baseline, pre-, and post-intervention assessments of prescription skills were performed using an expert-validated instrument constructed from the WHO Good Prescribing Guide. Three simulated interviews with different simulated patients were conducted in two groups: in-person in the first batch and remotely in the second batch due to mandatory social distancing during the Covid-19 pandemics. Friedman, Dunn-Bonferroni, and Wilcoxon tests were used, considering a significance of levelp<.05 and standardized mean difference (Hedges g); data were analyzed using Excel 2016 and SPSS 28.

Results

Fifty-four students completed the required assessments; in-person 28 and remotely 26. The total score for pharmacological prescription skills increased significantly from pre- to post-intervention measurements, from 12.72 +/-2.94 to 15.44 +/-2.50, respectively (p<.0001) (g: 0.996), and the increase from baseline to post-intervention scores for drug prescription knowledge was 5.39 +/-3.67, 11.28 +/-3.50, respectively (p<.01).

Discussion

Our results suggest that the implementation of pre-briefing and debriefing strategies in remote and in-person clinical interviews with simulated patients significantly improved drug prescription skills and pharmacological knowledge among medical students. The logical sequence of the WHO Guide for Good Prescribing may have facilitated debriefing, knowledge acquisition, and transfer to various clinical contexts.
Theraputic Effects of Brain-Computer Interface on Motor Recovery of Stroke Patients: A Meta-analysis
Authors: Guo Zhiwei , Gao Qiang , Jiang Yi , Jiang Hanhong , Jiang Ning
Published: April 2023

Background

Previous clinical studies have demonstrated the effects of brain-computer interface (BCI) on the motor recovery of stroke patients. The aim of this study was to evaluate the therapeutic effects of BCI on improving motor functions of stroke patients.

Methods

We conducted a meta-analysis on randomized controlled trials (RCTs) on BCI training for post-stroke motor rehabilitation. Relevant publications were identified from the databases of PubMed, Embase, ScienceDirect, and Cochrane Library. The standardized mean difference (SMD) with 95% confidence intervals (CI) were calculated as the pooled effect size of the motor outcome.

Results

Thirty-five of the 43 candidate articles involving 749 participants were included in this meta-analysis. Overall, both the significant immediate effect size of 0.53 and long-lasting effect size of 0.26 were found for motor outcome measured by Fugl-Meyer Assessment. A further subgroup-analysis observed larger therapeutic effects on lower-limb than upper-limb. A subgroup-analysis also indicated that stroke patients may gain better functional outcome in the subacute phase than in the chronic phase. Superior effect of BCI training was also detected for distal function of upper-limb over proximal function. BCI training combined with functional electrical stimulation (FES) was more effective than BCI combined with robot. No significant effect was found in other combined interventional methods, especially the use of transcranial direct current stimulation, which cannot potentiate the effects of BCI training. In addition, subgroup-analysis also indicated a greater effect for longer durations of intervention. And the dosage between 15 min and 180 min was found to be optimal.

Conclusions

BCI has significant immediate and long-lasting effects on improving motor function of both upper-limb and lower-limb of stroke patients. Superior therapeutic could be delivered to patients in the subacute phase and clearer benefits are evident in distal functions of upper extremity. When combined with FES, BCI seems to be more effective than when combined with robot and other external devices. Longer durations of intervention could provide better effects. But bigger is not always better for weekly dosage.
Electroacupuncture on Modifying Inflammatory Levels of Cytokines and Metabolites in Stroke Patients
Authors: Sandra Arriagada Rios , Fang Liao Yi , Lee Yu Chen , Lu Ming-Kuei , Tsai Sheng-Ta , Eyal Ben-Arie , Ho Wen-Chao
Published: April 2023

Introduction

The use of electroacupuncture (EA) in post-ischemic stroke and rehabilitation has been the subject of numerous studies; however, the effect of EA on cholesterol metabolites has not been thoroughly investigated. The inflammatory response in stroke has been associated with serum cholesterol, low HDL-Cc, and high LDL-Cc levels, and early intervention has been linked to improved post-stroke rehabilitation. This study aimed to assess the impact of EA on early ischemic stroke as a modulator of total cholesterol, HDL-c, and LDL-c in the blood, its anti-inflammatory effect, and its effect on pain and stroke scales in patients in the first few days after the onset of stroke.

Data Access Statement

The datasets generated during the current study are available from the corresponding author on reasonable request

Material and Method

A total of 90 patients with acute ischemic stroke and a first-time diagnosis of stroke will be randomized into one of three groups: an EA group, a sham EA group, and a sensory control group. All patients will receive the interventions three times a week for a total of six sessions over two weeks. Outcome measurements will include blood tests for total cholesterol, triglycerides, HDL with HDL-c cholesterol, LDL and LDL-c cholesterol, along with Visual Analog Scale (VAS), National Institutes of Health Stroke Scale (NIHSS), and Barthel Index (BI).

Expected Outcome

This study will help determine the effect of EA on ischemic stroke recovery, focusing on metabolic changes in patients with early stage stroke. EA treatment might modify risk indices (HDL-c), maintain or control (LDL-c), and generate localized reperfusion of the vascular areas involved in stroke.

Discussion

This randomized controlled trial will determine the ability of EA to support early stroke ischemic injury and neuro-endothelium damage, which could lead to a faster stroke recovery in stroke scales, and reveal whether the mechanism of EA is associated with a reduced inflammatory process via modulation of the levels of total cholesterol, HDL-c, LDL-c, and triglycerides. The results of this study will be of significant value in the treatment of ischemic stroke and could lead to more effective and personalized stroke rehabilitation therapies.

Trial registry

registered study protocol onwww.clinicaltrial.gov(NCT05734976)
Bivalent COVID-19 booster vaccines induce cross-reactive but not BA.5-specific antibodies in polyclonal serum
Authors: Carreño Juan Manuel , Singh Gagandeep , Abbad Anass , Yellin Temima , Srivastava Komal , Gleason Charles ,   PVI study group, van Bakel Harm , Simon Viviana , Krammer Florian
Published: April 2023

The question if the bivalent mRNA COVID-19 booster vaccination, containing wild type and BA.5 spike, provides enhanced benefits against BA.5 and similar Omicron subvariants has been widely debated. One concern was an ‘original antigenic sin’-like effect which may redirect immune responses to the bivalent vaccine towards the wild type spike and may blockde novogeneration of BA.5 specific antibodies. Here, we characterized the response to the bivalent vaccine and we performed antibody depletion experiments. Interestingly, when we depleted serum of all antibodies to wild type RBD, we also removed all reactivity to BA.5 RBD. This suggests that all antibodies induced by the bivalent vaccine – at least with the limit of detection of our assay in polyclonal serum - are in fact cross-reactive. This further suggests that, on a serum antibody level, the bivalent vaccine did not induce ade novoresponse to BA.5.
Severity of Prior COVID-19 Infection is Associated with Postoperative Outcomes Following Major Inpatient Surgery
Authors: Verhagen Nathaniel B. , SenthilKumar Gopika , Jaraczewski Taylor , Koerber Nicolas K. , Merrill Jennifer R. , Flitcroft Madelyn A. , Szabo Aniko , Banerjee Anjishnu , Yang Xin , Taylor Bradley W. , Figueroa Castro Carlos E. , Yen Tina W.F. , Clarke Callisia N. , Lauer Kathryn , Pfeifer Kurt J. , Gould Jon C. , Kothari Anai N. ,   N3C Consortium
Published: April 2023

Objective

To determine the association between severity of prior history of SARS-CoV-2 infection and postoperative outcomes following major elective inpatient surgery.

Summary Background Data

Surgical guidelines instituted early in the COVID-19 pandemic recommended delay in surgery up to 8 weeks following an acute SARS-CoV-2 infection. Given that surgical delay can lead to worse medical outcomes, it is unclear if continuation of such stringent policies is necessary and beneficial for all patients, especially those recovering from asymptomatic or mildly symptomatic COVID-19.

Methods

Utilizing the National Covid Cohort Collaborative (N3C), we assessed postoperative outcomes for adults with and without a history of COVID-19 who underwent major elective inpatient surgery between January 2020 and February 2023. COVID-19 severity and time from SARS-CoV-2 infection to surgery were each used as independent variables in multivariable logistic regression models.

Results

This study included 387,030 patients, of which 37,354 (9.7%) had a diagnosis of preoperative COVID-19. History of COVID-19 was found to be an independent risk factor for adverse postoperative outcomes even after a 12-week delay for patients with moderate and severe SARS-CoV-2 infection. Patients with mild COVID-19 did not have an increased risk of adverse postoperative outcomes at any time point. Vaccination decreased the odds of mortality and other complications.

Conclusions

Impact of COVID-19 on postoperative outcomes is dependent on severity of illness, with only moderate and severe disease leading to higher risk of adverse outcomes. Existing wait time policies should be updated to include consideration of COVID-19 disease severity and vaccination status.
Single Ventricle Reconstruction III: Brain Connectome and Neurodevelopmental Outcomes: Design, Recruitment, and Technical Challenges of a Multicenter, Observational Neuroimaging Study
Authors: Schmithorst Vanessa , Ceschin Rafael , Lee Vince , Wallace Julia , Sahel Aurelia , Chenevert Thomas , Parmar Hemant , Berman Jeffrey I. , Vossough Arastoo , Qiu Deqiang , Kadom Nadja , Grant Patricia Ellen , Gagoski Borjan , LaViolette Peter , Maheshwari Mohit , Sleeper Lynn A. , Bellinger David , Ilardi Dawn , O’Neil Sharon , Miller Thomas A. , Detterich Jon , Hill Kevin D. , Atz Andrew M. , Richmond Marc , Cnota James , T.Mahle William , Ghanayem Nancy , Gaynor William , Goldberg Caren S. , Newburger Jane W. , Panigrahy Ashok ,   the Pediatric Heart Network SVRIII Brain Connectome Study Investigators
Published: April 2023

Patients with hypoplastic left heart syndrome who have been palliated with the Fontan procedure are at risk for adverse neurodevelopmental outcomes, lower quality of life, and reduced employability. We describe the methods (including quality assurance and quality control protocols) and challenges of a multi-center observational ancillary study, SVRIII (Single Ventricle Reconstruction Trial) Brain Connectome. Our original goal was to obtain advanced neuroimaging (Diffusion Tensor Imaging and Resting-BOLD) in 140 SVR III participants and 100 healthy controls for brain connectome analyses. Linear regression and mediation statistical methods will be used to analyze associations of brain connectome measures with neurocognitive measures and clinical risk factors. Initial recruitment challenges occurred related to difficulties with: 1) coordinating brain MRI for participants already undergoing extensive testing in the parent study, and 2) recruiting healthy control subjects. The COVID-19 pandemic negatively affected enrollment late in the study. Enrollment challenges were addressed by 1) adding additional study sites, 2) increasing the frequency of meetings with site coordinators and 3) developing additional healthy control recruitment strategies, including using research registries and advertising the study to community-based groups. Technical challenges that emerged early in the study were related to the acquisition, harmonization, and transfer of neuroimages. These hurdles were successfully overcome with protocol modifications and frequent site visits that involved human and synthetic phantoms.

Trial registration number

ClinicalTrials.govRegistration Number:NCT02692443
Multimodal analysis of methylomics and fragmentomics in plasma cell-free DNA for multi-cancer early detection and localization
Authors: Nguyen Van Thien Chi , Nguyen Trong Hieu , Doan Nhu Nhat Tan , Pham Thi Mong Quynh , Nguyen Giang Thi Huong , Nguyen Thanh Dat , Tran Thuy Thi Thu , Vo Duy Long , Phan Thanh Hai , Jasmine Thanh Xuan , Nguyen Van Chu , Nguyen Huu Thinh , Nguyen Trieu Vu , Nguyen Thi Hue Hanh , Huynh Le Anh Khoa , Tran Trung Hieu , Dang Quang Thong , Doan Thuy Nguyen , Tran Anh Minh , Nguyen Viet Hai , Nguyen Vu Tuan Anh , Ho Le Minh Quoc , Tran Quang Dat , Pham Thi Thu Thuy , Ho Tan Dat , Nguyen Bao Toan , Nguyen Thanh Nhan Vo , Nguyen Thanh Dang , Phu Dung Thai Bieu , Phan Boi Hoan Huu , Vo Thi Loan , Nai Thi Huong Thoang , Tran Thuy Trang , Truong My Hoang , Tran Ngan Chau , Le Trung Kien , Tran Thanh Huong Thi , Duong Minh Long , Bach Hoai Phuong Thi , Kim Van Vu , Pham The Anh , Tran Duc Huy , Le Trinh Ngoc An , Pham Truong Vinh Ngoc , Le Minh Triet , Vo Dac Ho , Tran Thi Minh Thu , Nguyen Minh Nguyen , Van Thi Tuong Vi , Nguyen Anh Nhu , Tran Thi Trang , Tran Vu Uyen , Le Minh Phong , Do Thi Thanh , Phan Thi Van , Nguyen Luu Hong Dang , Nguyen Duy Sinh , Cao Van Thinh , Do Thanh Thuy Thi , Truong Dinh Kiet , Tang Hung Sang , Giang Hoa , Nguyen Hoai Nghia , Phan Minh Duy , Tran Le Son
Published: April 2023

Despite their promise, circulating tumor DNA (ctDNA)-based assays for multi-cancer early detection face challenges in test performance, due mostly to the limited abundance of ctDNA and its inherent variability. To address these challenges, published assays to date demanded a very high-depth sequencing, resulting in an elevated price of test. Herein, we developed a multimodal assay called SPOT-MAS (Screening for the Presence Of Tumor by Methylation And Size) to simultaneously profile methylomics, fragmentomics, copy number, and end motifs in a single workflow using targeted and shallow genome-wide sequencing (∼0.55X) of cell-free DNA. We applied SPOT-MAS to 738 nonmetastatic patients with breast, colorectal, gastric, lung and liver cancer, and 1,550 healthy controls. We then employed machine learning to extract multiple cancer and tissue-specific signatures for detecting and locating cancer. SPOT-MAS successfully detected the five cancer types with a sensitivity of 72.4% at 97.0% specificity. The sensitivities for detecting early-stage cancers were 62.3% and 73.9% for stage I and II, respectively, increasing to 88.3% for nonmetastatic stage IIIA. For tumor-of-origin, our assay achieved an accuracy of 0.7. Our study demonstrates comparable performance to other ctDNA-based assays while requiring significantly lower sequencing depth, making it economically feasible for population-wide screening.
A country-wide health policy in Chile for deaf adults using cochlear implants: analysis of health determinants and social impacts
Authors: Bustos-Rubilar Mario , Kyle Fiona , Luna Eliazar , Allel Kasim , Hormazabal Ximena , Tapia-Mora Daniel , Mahon Merle
Published: April 2023

Background

Post-lingual deafness represents a critical challenge for adults’ well-being with substantial public health burdens. One treatment of choice has been cochlear implants (CI) for people with severe to profound hearing loss (HL). Since 2018, Chile has implemented a high-cost policy to cover CI treatment, the “Ley Ricarte Soto” (LRS) health policy. However, wide variability exists in the use of this device. To date, no study has been published on policy evaluation in Chile or other Latin American countries.

Objectives

This study aimed to evaluate the impact of the LRS policy on the treatment success and labour market inclusion among deaf or hard of hearing (DHH) adults using CI. We examined and characterised outcomes based on self-reports about treatment success and occupation status between 2018 and 2020.

Design

We performed a prospective study using hospital clinical records and an online questionnaire with 76 DHH adults aged >15 who had received CIs since the introduction of the LRS policy in 2018. Using univariate and multivariate regression models, we investigated the relationship between demographic, audiological, and social determinants of health and outcomes, including treatment success for social inclusion (International Outcome inventory for Hearing Aids and CIs assessment: IOI-HA) for social inclusion and occupation status for labour market inclusion.

Results

Our study showed elevated levels of treatment success in most of the seven sub-scores of the IOI-HA assessment. Similarly, around 70% of participants maintained or improved their occupations after receiving their CI. We found a significant positive association between treatment success and market inclusion. Participants diagnosed at younger ages had better results than older participants in both outcomes (P=0.078 and P= 0.011, respectively). Regarding social determinants of health, finding suggested participants with high social health insurance and a shorter commute time to the clinic (p=0.070 and p=0.086, respectively) had better results in treatment success. For labour market inclusion, participants with high education levels and better pre-CI occupation (p=0.069 and p=0.021, respectively) had better post-CI occupation status, and findings suggested an impact of high education levels.

Conclusions

In evaluating the LRS policy for providing CIs for DHH adults in Chile, we found positive effects relating to treatment success and occupation status. Our study supports the importance of age at diagnosis and social determinants of health, which should be assessed by integrating public services and bringing them near each beneficiary. Although evidence-based guidelines for candidate selection given by the LRS policy might contribute to good results, these parameters could limit the policy access to people who do not meet the requirements of the guidelines due to social inequalities.
Maternal pre-pregnancy body mass index and risk of preterm birth: a collaboration using large routine health datasets
Authors: Cornish RP , Magnus MC , Urhoj SK , Santorelli G , Smithers LG , Odd D , Fraser A , Håberg SE , Nybo Andersen A-M , Birnie K , Lynch JW , Tilling K , Lawlor DA
Published: April 2023

Importance

Preterm birth (PTB), is a leading cause of child morbidity and mortality. Objective: To examine the associations of maternal pre-pregnant body mass index (BMI) with any PTB, spontaneous (SPTB) and medically indicated PTB (MPTB).

Design

A meta-analysis of eight population-based datasets.

Setting

Three UK datasets, two USA datasets, and one each from South Australia, Norway and Denmark, with different characteristics and sources of bias.

Participants

All pregnancies resulting in a live birth or stillbirth after 24 completed gestational weeks.

Exposure

Maternal pre-or early pregnancy BMI derived from self-reported or measured weight and height between 12 months pre-pregnancy and 15 weeks gestation.

Main Outcome(s) and Measures(s)

Any PTB (delivery <37 completed weeks), SPTB and medically indicated PTB. Fractional polynomial multivariable logistic regression was applied to eight datasets from different high-income countries and time periods. The results were combined using a random effects meta-analysis.

Results

We found non-linear associations between pre-pregnant BMI and all three outcomes, across all datasets. The adjusted risk of any PTB and MPTB was elevated at both low and high BMIs, whereas the risk of SPTB was increased at lower levels of BMI but remained low or increased only slightly with higher BMI. In the meta-analysed data, the lowest risk of any PTB was at a BMI of 24.5 kg/m2(95% confidence interval: 23.1, 30.3), with a value of 21.3 kg/m2(20.8, 21.9) for MPTB; for SPTB, the risk remained roughly constant above a BMI of around 25-30 kg/m2.

Conclusions and Relevance

Consistency of findings across different populations, despite differences between them in the time period covered, BMI distribution, missing data and control for key confounders, highlight the importance of promoting pre-conception BMI between 21 to 30 kg/m2 to prevent MPTB and SPTB
Reliability and Validity of self-reported Vascular Risk Factors in a Multi-Ethnic Community Based Study of Aging and Dementia
Authors: Lee Annie J. , Sanchez Didi , Reyes-Dumeyer Dolly , Brickman Adam M. , Lantigua Rafael A. , Vardarajan Badri N. , Mayeux Richard
Published: April 2023

INTRODUCTION

The reliability and validity of self-reported cardiovascular and cerebrovascular risk factors remains inconsistent in aging research.

METHODS

We assessed the reliability, validity, sensitivity, specificity, and percent agreement of self-reported hypertension, diabetes, and heart disease, in comparison with direct measures of blood pressure, hemoglobin A1c (HbA1c), and medication use in 1870 participants in a multiethic study of aging and dementia.

RESULTS

Reliability of self-reported for hypertension, diabetes, and heart disease was excellent. Agreement between self-reports and clinical measures was moderate for hypertension (kappa: 0.58), good for diabetes (kappa: 0.76-0.79), and moderate for heart disease (kappa: 0.45) differing slightly by age, sex, education, and race/ethnic group. Sensitivity and specificity for hypertension was 88.6%-78.1%, for diabetes was 87.7%-92.0% (HbA1c>6.5%) or 92.7%-92.8% (HbA1c>7%), and for heart disease was 85.8%-75.5%.

DISCUSSION

Self-reported history of hypertension, diabetes, and heart disease are reliable and valid compared to direct measurements or medication use.
Understanding transmission risk and predicting environmental suitability for Mayaro Virus in the Americas
Authors: Celone Michael , Beeman Sean , Han Barbara A. , Potter Alexander M. , Pecor David B. , Okech Bernard , Pollett Simon
Published: April 2023

Background

Mayaro virus (MAYV) is a mosquito-borneAlphavirusthat is widespread in South America. MAYV infection often presents with non-specific febrile symptoms but may progress to debilitating chronic arthritis or arthralgia. Despite the pandemic threat of MAYV, its true distribution remains unknown. The objective of this study was to clarify the geographic distribution of MAYV using an established risk mapping framework. This consisted of generating evidence consensus scores for MAYV presence, modeling the potential distribution of MAYV across the Americas, and estimating at-risk population residing in areas suitable for MAYV transmission.

Methods

We compiled a georeferenced compendium of MAYV occurrence in humans, animals, and arthropods. Based on an established evidence consensus framework, we integrated multiple information sources to assess the total evidence supporting ongoing transmission of MAYV within each country in our study region. We then developed high resolution maps of the disease’s estimated distribution using a boosted regression tree approach. Models were developed using ten climatic and environmental covariates that are related to the MAYV transmission cycle. Using the output of our boosted regression tree models, we estimated the total population living in regions suitable for MAYV transmission.

Findings

The evidence consensus scores revealed high or very high evidence of MAYV transmission in Brazil (especially the states of Mato Grosso and Goiás), Venezuela, Peru, Trinidad and Tobago, Colombia, Bolivia, and French Guiana. According to the boosted regression tree models, a substantial region of South America is suitable for MAYV transmission, including north and central Brazil, French Guiana, and Suriname. Some regions (e.g., Guyana) with low or moderate evidence of transmission were identified as highly suitable for MAYV. We estimate that approximately 77 million people in the Americas live in areas that may be suitable for MAYV transmission, including 43·4 million people in Brazil. Our results can assist public health authorities in prioritizing high-risk areas for vector control, human disease surveillance and ecological studies.

Funding

This work was financially supported by the Armed Forces Health Surveillance Division—Global Emerging Infections Surveillance (AFHSD-GEIS) under awards P0065_22_WR and P0050_23_WR. The activities undertaken at WRBU were performed in part under a Memorandum of Understanding between the Walter Reed Army Institute of Research (WRAIR) and the Smithsonian Institution, with institutional support provided by both organizations.
Transcutaneous Spinal Cord Stimulation to Reduce Phantom Limb Pain in People with a Transtibial Amputation
Authors: Dalrymple Ashley N , Fisher Lee E , Weber Douglas J
Published: April 2023

Objective

Phantom limb pain (PLP) is debilitating and affects over 70% of people with lower-limb amputation. Other neuropathic pain conditions correspond with increased spinal excitability, which can be measured using reflexes and F-waves. Spinal cord neuromodulation can be used to reduce neuropathic pain in a variety of conditions and may affect spinal excitability, but has not been extensively used for treating phantom limb pain. Here, we propose using a non-invasive neuromodulation method, transcutaneous spinal cord stimulation (tSCS), to reduce PLP and modulate spinal excitability after transtibial amputation.

Approach

We recruited three participants, two males (5- and 9-years post-amputation, traumatic and alcohol-induced neuropathy) and one female (3 months post-amputation, diabetic neuropathy) for this 5-day study. We measured pain using the McGill Pain Questionnaire, visual analog scale, and pain pressure threshold test. We measured spinal reflex and motoneuron excitability using posterior root-muscle (PRM) reflexes and F-waves, respectively. We delivered tSCS for 30 minutes/day for 5 days.

Main Results

After 5 days of tSCS, pain scores decreased by clinically-meaningful amounts for all participants from 34.0±7.0 to 18.3±6.8. Two participants had increased pain pressure thresholds across the residual limb (Day 1: 5.4±1.6 lbf; Day 5: 11.4±1.0 lbf). F-waves had normal latencies but small amplitudes. PRM reflexes had high thresholds (59.5±6.1 µC) and low amplitudes, suggesting that in PLP, the spinal cord is hypoexcitable. After 5 days of tSCS, reflex thresholds decreased significantly (38.6±12.2 µC; p<0.001).

Significance

Overall, limb amputation and PLP may be associated with reduced spinal excitability and tSCS can increase spinal excitability and reduce PLP.
Place Coding in the Human Cochlea
Authors: Walia Amit , Ortmann Amanda J. , Lefler Shannon , Holden Timothy A. , Puram Sidharth V. , Herzog Jacques A. , Buchman Craig A.
Published: April 2023

The cochlea’s capacity to decode sound frequencies is enhanced by a unique structural arrangement along its longitudinal axis, a feature termed ‘tonotopy’ or place coding. Auditory hair cells at the cochlea’s base are activated by high-frequency sounds, while those at the apex respond to lower frequencies. Presently, our understanding of tonotopy primarily hinges on electrophysiological, mechanical, and anatomical studies conducted in animals or human cadavers. However, directin vivomeasurements of tonotopy in humans have been elusive due to the invasive nature of these procedures. This absence of live human data has posed an obstacle in establishing an accurate tonotopic map for patients, potentially limiting advancements in cochlear implant and hearing enhancement technologies. In this study, we conducted acoustically-evoked intracochlear recordings in 50 human subjects using a longitudinal multi-electrode array. These electrophysiological measures, combined with postoperative imaging to accurately locate the electrode contacts allow us to create the firstin vivotonotopic map of the human cochlea. Furthermore, we examined the influences of sound intensity, electrode array presence, and the creation of an artificial third window on the tonotopic map. Our findings reveal a significant disparity between the tonotopic map at daily speech conversational levels and the conventional (i.e., Greenwood) map derived at close-to-threshold levels. Our findings have implications for advancing cochlear implant and hearing augmentation technologies, but also offer novel insights into future investigations into auditory disorders, speech processing, language development, age-related hearing loss, and could potentially inform more effective educational and communication strategies for those with hearing impairments.

Significance Statement

The ability to discriminate sound frequencies, or pitch, is vital for communication and facilitated by a unique arrangement of cells along the cochlear spiral (tonotopic place). While earlier studies have provided insight into frequency selectivity based on animal and human cadaver studies, our understanding of thein vivohuman cochlea remains limited. Our research offers, for the first time,in vivoelectrophysiological evidence from humans, detailing the tonotopic organization of the human cochlea. We demonstrate that the functional arrangement in humans significantly deviates from the conventional Greenwood function, with the operating point of thein vivotonotopic map showing a basal (or frequency downward) shift. This pivotal finding could have far-reaching implications for the study and treatment of auditory disorders.
Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives
Authors: Shahbaz Sumbal , Zakar Rubeena , Howard Natasha
Published: April 2023

Background

Anaesthesia delivery in Pakistan remains limited to conventional intraoperative procedures, with research showing ongoing challenges in quality and resourcing. We aimed to identify systemic challenges in the delivery of quality anaesthesia services for surgical support in Pakistan’s Punjab province.

Methods

This qualitative study included 22 semi-structured interviews with purposively selected anaesthesia system experts in Punjab province, including heads of teaching hospital anaesthesia departments, healthcare commission representatives, and health department officials. We analysed data thematically, using deductive and inductive coding.

Results

We identified three themes of anaesthetist recruitment and retention, quality-of-care and in-service training, and discrepancies between specialities, describing major challenges experienced within the speciality. Findings indicated that workforce shortages and maldistribution, insufficient in-service training and standards, inadequate equipment maintenance, and lack of anaesthesia representation in decision-making compromised anaesthesia provision quality and safety.

Conclusions

Improving anaesthesia provision in Punjab would require increasing physician and non-physician anaesthetist numbers and rotation to peripheral postings, strengthening training quality, and ensuring availability of minimum essential equipment and supplies. To achieve essential anaesthesia provision standards, policy interventions are needed to, for example, balance anaesthesiologist and surgeon numbers, require that anaesthesiology graduates work a few years in-country (e.g. scholarship bonds), ensure in-service training attendance for skills updates, and implement quality assurance standards for equipment and supplies.

HIGHLIGHTS

What is already known on this topic?

Existing research on anaesthesia in lower-income economies focuses on provision discrepancies and capacity measurement of HIC-partnered interventions. However, managerial and frontline challenges that weaken quality anaesthesia provision in countries such as Pakistan, and thus affect global surgery indicators, are largely unexamined.

What this study adds

This study is the first to highlight ongoing challenges within the anaesthesia delivery system in Punjab province as experienced by senior practitioners and health officials, thus contributing to the knowledge base on anaesthesia provision challenges in lower-income economies.

How this study might affect research, practice, or policy

Findings show the urgent need to increase recruitment, retention, and peripheral distribution of physician and non-physician anaesthetists along with developing clear national legislation and practice guidelines for standardised quality of anaesthesia care and raising the public profile of anaesthesia in Pakistan.
Public perceptions of Ebola vaccines and confidence in health services to treat Ebola, malaria, and tuberculosis: Findings from a cross-sectional household survey in Uganda, 2020
Authors: Koyuncu Aybüke , Carter Rosalind J. , Musaazi Joseph , Namageyo-Funa Apophia , Carter Victoria M. , Lamorde Mohammed , Prybylski Dimitri , Apondi Rose , Bakyaita Tabley , Boore Amy L. , Homsy Jaco , Brown Vance R. , Kigozi Joanita , Nabaggala Maria Sarah , Nakate Vivian , Nkurunziza Emmanuel , Stowell Daniel F. , Walwema Richard , Olowo Apollo , Jalloh Mohamed F.
Published: April 2023

Background

Uganda used Ebola vaccines as part of its preparedness and response during the 2018-2020 10thEbola virus disease (EVD) outbreak in neighboring Democratic Republic of the Congo (DRC). We evaluated the public’s perceptions of Ebola vaccines and compared their confidence in health services to treat Ebola versus malaria and tuberculosis as part of a survey on Ebola knowledge, attitudes, and practices (KAP) conducted in March 2020.

Methods

A cross-sectional household survey was implemented in six districts in Uganda using multi-stage cluster sampling to randomly select participants. The districts were purposively selected from districts classified by the government as at high- or low-risk for an EVD outbreak. We describe perceptions of Ebola vaccines and confidence in health services to treat Ebola, tuberculosis, and malaria. Modified Poisson regression modeling was used to identify the demographic correlates of these outcomes.

Results

Among 3,485 respondents, 18% were aware of Ebola vaccines. Of those, 92% agreed that the vaccines were needed to prevent Ebola. Participants aged 15-24 years were 4% more likely to perceive such need compared to those 60 years and older (adjusted prevalence ratio [aPR] 1.04, 95% confidence interval [CI] 1.0-1.08). The perceived need was 5% lower among participants with at least some secondary education compared to uneducated participants (aPR 0.95; 0.92-0.99). Overall, 81% of those aware of the vaccines believed that everyone or most people in their community would get vaccinated if offered, and 94% said they would likely get vaccinated if offered. Confidence in health services to treat Ebola was lower compared to treating malaria or tuberculosis (55% versus 93% and 77%, respectively). However, participants from the EVD high-risk districts were 22% more likely to be confident in health services to treat Ebola compared to those in low-risk districts (aPR: 1.22; 95% CI: 1.08, 1.38).

Conclusion

Our findings suggest that intent to take an Ebola vaccine during an outbreak was strong, but more work needs to be done to increase public awareness of these vaccines. The public’s high confidence in health services to treat other health threats, such as malaria and tuberculosis, offer building blocks for strengthening their confidence in health services to treat EVD in the event of an outbreak.
Life-course neighbourhood deprivation and brain structure in older adults: The Lothian Birth Cohort 1936
Authors: Baranyi Gergő , Buchanan Colin R. , Conole Eleanor L.S. , Backhouse Ellen V. , Maniega Susana Muñoz , Hernandez Maria Valdes , Bastin Mark E. , Wardlaw Joanna , Deary Ian J. , Cox Simon R. , Pearce Jamie
Published: April 2023

Neighbourhood disadvantage may be associated with brain health but the importance at different stages of the life course is poorly understood. Utilizing the Lothian Birth Cohort 1936, we explored the relationship between residential neighbourhood deprivation from birth to late adulthood, and global and regional neuroimaging measures at age 73. We found that residing in disadvantaged neighbourhoods in mid- to late adulthood was associated with smaller total brain (β=-0.06; SE=0.02;n=390) and grey matter volume (β=-0.11; SE=0.03;n=390), thinner cortex (β=-0.15; SE=0.06;n=379), and lower general white matter fractional anisotropy (β=-0.19; SE=0.06;n=388). Regional analysis identified affected focal cortical areas and specific white matter tracts. Among individuals belonging to lower occupational social classes, the brain-neighbourhood associations were stronger, with the impact of neighbourhood deprivation accumulating across the life course. Our findings suggest that living in deprived neighbourhoods is associated with adverse brain morphologies, with occupational social class adding to the vulnerability.