bluuebunny/crossref_metadata_2025_split huggingface dataset:
M196. CLINICAL CORRELATES OF SUBJECTIVE QUALITY OF LIFE IN ADULT PATIENTS WITH EARLY PSYCHOSIS IN HONG KONG
Authors: Tze Kwan Kam Candice , Chun Lau Fu , Ting Liu Tsz , Sau Man Wong Corine , Ming Hui Lai , Wa Chan Kit , Ming Lee Ho , Nam Suen Yi , Chen Eric , Chung Chang Wing 
Published: May 2020

Abstract

Background
Subjective quality of life (SQoL) is an important outcome domain in patients with early psychosis. In an attempt to better understand and maximize SQoL of early psychosis patients, an increasing number of research has been conducted to investigate factors associated with SQoL. Nonetheless, most previous studies focused on younger patients with early psychosis. In this study, the correlates of SQoL in adult patients who had completed 3-year specialized early intervention service for first-episode psychosis (FEP) in Hong Kong were investigated.

Methods
In total, one hundred and one Chinese patients aged 26–55 years who completed 3-year specialized early intervention service for psychosis in Hong Kong were recruited. Assessments on illness onset (DUP), clinical (PANSS, BNSS, SUMD), intrinsic motivation (by items in Quality of Life Scale, QLS), functional (SOFAS), antipsychotic-induced parkinsonism features (Simpson-Angus Scale, SAS) were conducted. SQoL was evaluated by Chinese version SF-12 which consist of physical and mental components for analysis.

Results
Correlation analyses showed that SF12 physical health score was correlated with PANSS depression component (p&lt;0.001), QLS intrinsic motivation score (p=0.001) and SAS score (p&lt;0.05) while SF12 mental health score was correlated with PANSS depression score (p&lt;0.001), QLS intrinsic motivation score (p&lt;0.05) and SAS score (p&lt;0.05). Multiple linear regression analyses further revealed that lower PANSS depression score (p&lt;0.001) and higher intrinsic motivation (measured by QLS, p&lt;0.05) were independently associated with better physical SQoL, while lower PANSS depression score (p&lt;0.001) and lower SAS side-effect score (p&lt;0.05) were independently related to better mental SQoL.

Discussion
Our results are consistent with the literature which indicates that SQoL is significantly related to depressive symptoms. In addition, patients with higher intrinsic motivation and less antipsychotic-induced extrapyramidal side-effect have better SQoL. Further analysis on the longitudinal data will clarify variables predictive of SQoL at follow-up.
S129. REHOSPITALIZATION RATE IN PEOPLE WITH FIRST-EPISODE PSYCHOSIS IN THE CZECH REPUBLIC: A REGISTER-BASED STUDY
Authors: Kondrátová Lucie , Mladá Karolína 
Published: May 2020

Abstract

Background
Rehospitalization in a year after the first discharge for psychotic disorder is routinely considered as a principal health care outcome. However, there is a lack of data about the rehospitalization rate of people with first-episode psychosis in Central and Eastern Europe where the psychiatric care is predominantly based on inpatient care.

Methods
Data from nationwide register of inpatient hospitalizations were analysed. A retrospective analysis of first-ever admitted patients with psychosis (F2 according to ICD-10) in 2014 and younger than 60 years of age was conducted. Descriptive statistics aiming to identify the rehospitalization rate were performed.

Results
1 963 patients with psychosis who were first admitted to psychiatric hospitalization in 2014 and discharged between 2014 and 2016 were identified. Of those, 480 (24,5 %) were readmitted in the first year after the first discharge. 101 (21,0%) of those were readmitted within 14 days, 144 (30,0%) within a month and 241 (50,2%) within a 3-month period after the first discharge. An average time between the first discharge and readmission was 124 days, the mean age of those readmitted was 33 years at the time of first admission.

Discussion
This register-based study confirms the existence of the revolving door phenomenon in people with first-episode psychosis in the Czech Republic. Each rehospitalization is a burden not only for a patient, as each hospitalization significantly worsens the overall prognosis, but for the whole psychiatric care system as well. Considering the rehospitalization rate in people with first-episode psychosis, more attention should be paid to the development of services which have a potential to lower the risk of rehospitalization such as early detection and early intervention services.
S181. ANALYSIS OF THE AMELIORATING EFFECT OF D-SERINE ON GLUN2D DEFICIENT MICE
Authors: Mallien Anne , Herb Anne , Monyer Hannah , Inta Dragos , Gass Peter 
Published: May 2020

Abstract

Background
The glutamate hypothesis of schizophrenia postulates NMDA receptor (NMDAR) hypofunction as a major pathophysiological mechanism based on clinical observations and preclinical evidence. Mice with globally reduced NMDAR expression display hyperlocomotion, sensorimotor gating deficits, cognitive deficits and social withdrawal. NMDARs are tetramers composed of 2 obligatory GluN1 (NR1) and 2 variable GluN2A-D (NR2A-D) subunits. GluN2A and GluN2B are the main cortical NMDAR subunits, but genetic models provided evidence that psychosis-like effects of NMDAR antagonists are mediated by GluN2C/GluN2D subunits. Previous data suggest a role also of the GluN2D subunit in schizophrenia-associated abnormalities [1].

Methods
We aimed to assess a comprehensive behavioural phenotyping of GluN2D deficient mice, including locomotion, affective behaviours and general welfare, but drew special focus on cognitive functions, including spatial learning, short-term and long-term memory, as well as puzzle solving. We further investigated the effect of D-Serine on the GluN2D KO mice. D-Serine is a NMDAR modulator and acts as an agonist at the glycine site. Previous work in clinical trials suggests significant therapeutic effects of D-serine on negative and positive symptoms, cognitive deficits and motor symptoms. We used the chronic application of D-Serin by supplementing it into the drinking water of the subjects.

Results
Preliminary data indicate no effect on locomotor alterations of the GluN2D mice, however a potential improvement in short-term memory and wellbeing-associated parameters. They indicate a role of the GluN2D subunit and a beneficial effect of D-serine on schizophrenia-induced parameters, including physiological, welfare-associated burrowing and cognitive performance in the short term task of the puzzle box test.

Discussion
Our preliminary data indicate a role of the GluN2D subunit in the emergence of cognitive deficits associated with schizophrenia and a potential therapeutic effect of D-serine in alleviating these deficits. Further investigations are planned to further validate these findings.

Reference
S184. IN SILICO PREDICTION OF T-CELL-MEDIATED MOLECULAR MIMICRY IN TOXOPLASMOSIS AND SCHIZOPHRENIA
Authors: Thylur David , Lori Adriana , Avramopoulos Dimitri , Mulle Jennifer , Goes Fernando , Conneely Karen , Pulver Ann , Pearce Brad 
Published: May 2020

Abstract

Background
Exposure to Toxoplasma gondii (TOXO) has been consistently associated with the development of schizophrenia, but the neurobiological mechanism through which this occurs is not well elucidated. Emerging data has broadly implicated the adaptive immune system as a possible pathway from TOXO infection to schizophrenia. In order to explore the hypothesis that crossreactive T cells could help mediate this relationship, we built upon the genetic analysis from our psychiatrically-enriched Ashkenazi Jewish cohort using an in silico approach to predict HLA reactivity to TOXO epitopes, with the aim of identifying host proteins that could be susceptible to T-cell-mediated molecular mimicry.

Methods
We used netMHCpan v4.0 to generate a library of 2182 oligopeptides from the TOXO proteome that were predicted to be strongly antigenic for individuals with HLA-C*04:01, an allele of interest since our analysis indicated that the odds ratio for TOXO infection were in the opposite direction for those with schizophrenia compared to controls. A predicted binding affinity less than 500 nM was used to identify epitopes that were likely to be biologically relevant. Epitopes identified by this approach were compared with human peptides for local sequence similarity using BLAST optimized for short peptide sequences in order to identify host proteins that could mimic TOXO antigens. Ingenuity Pathway Analysis was then used to interpret and synthesize possible biological relationships between predicted autoantigens and schizophrenia.

Results
Our pipeline identified 38 candidate proteins for molecular mimicry at a threshold of P&lt;.05 after correcting for multiple testing. A number of these genes have been strongly linked to schizophrenia through genetic studies, including HSPA9, PSMA4, and ZDHHC5. Pathway and gene ontology analysis revealed that these genes were involved in networks of regulation of gene expression as well as ubiquitination, which participates in antigen presentation.

Discussion
Using an in silico approach, we identified 38 human proteins that could be targeted by a crossreactive T cell autoimmune response after exposure to TOXO. Several of these candidate proteins are highly relevant for genetic risk of schizophrenia and participate in molecular pathways that mediate antigen processing. CD8+ T cells contribute to autoimmunity through cytokine release and have been implicated in the relationship between TOXO exposure and schizophrenia. Though these results will need experimental confirmation, we hope that they will spur further research on the role of the adaptive immune system in toxoplasmosis and schizophrenia.
The Dynamics of Brokering in Second Generation Transnationalism
Authors: Gutierrez Armand 
Published: May 2020

Abstract
This study uses the concept of brokerage to explain how the transnational ties of the children of migrants born in the host country, i.e., the second generation, are initiated and sustained. By examining second generation Mexican- and Filipino-Americans, two groups that differ in linguistic proficiency, geographical proximity to the home country, and interpersonal contact with nonmigrants, this study highlights the common role of a broker for both groups. These findings also reveal the ways in which second generation ties can differ. The second generation utilized middleman brokerage, in which a broker is present throughout each connection; and catalyst brokerage, in which a broker facilitates only the initial ties. Overall, these forms of brokerage were shaped by the type of cross-border connection, linguistic proficiency, interpersonal contact, and emotional attachments between nonmigrants and the second generation. While Filipino-Americans in the sample generally required a middleman broker to be present throughout each connection, Mexican-Americans had a greater capacity to eventually engage in dyadic connections. Given the triadic nature of connections, cross-border ties were shaped and limited by the capacities and emotional attachments of those in the ancestral homeland, immigrant brokers, and the second generation.
Highly Hydrophilic Polyurethane Foam Dressing Versus Early Hydrophilic Polyurethane Foam Dressing on Skin Graft Donor Site Healing in Patients with Diabetes: An Exploratory Clinical Trial
Authors: Namgoong Sik , Jung Jae-Eun , Yoon Young-Don , Han Seung-Kyu , Lee Ye-Na , Son Ji-Won 
Published: May 2020

ABSTRACT

OBJECTIVE
To compare the effects of early hydrophilic polyurethane (EHP) foam dressing and highly hydrophilic polyurethane (HHP) foam dressing on wound healing in patients with diabetes.

METHODS
Twenty patients with diabetes with skin graft donor sites on the lateral thigh were enrolled in this study. Each donor site was divided into two equal-sized areas for the application of HHP or EHP foam dressing. The study endpoint was the time required for healing, defined as complete epithelialization of the donor site without discharge. All possible adverse events were also documented.

MAIN RESULTS
Donor site healing was faster in 15 patients on the HHP half and 1 patient on the EHP half. In four patients, healing rates were the same between the HHP and EHP areas. Donor sites treated with HHP and EHP foam dressings healed in 17.2 ± 4.4 and 19.6 ± 3.7 days (P = .007), respectively. During the study period, no adverse event associated with the dressings occurred in either group.

CONCLUSIONS
The HHP foam dressing might provide faster healing than EHP foam dressing for skin graft donor sites in patients with diabetes.
EQual Rubric Evaluation of the Association of American Medical Colleges’ Core Entrustable Professional Activities for Entering Residency
Authors: Meyer Eric G. , Taylor David R. , Uijtdehaage Sebastian , Durning Steven J. 
Published: May 2020

Purpose
To have subject matter experts evaluate the Core Entrustable Professional Activities for Entering Residency (Core EPAs) with the EQual rubric to determine if revisions were required and, if applicable, how to focus revision efforts.

Method
Ten entrustable professional activity (EPA) experts were invited to evaluate the 13 Core EPAs. Experts had a 6-month window (December 2018–May 2019) to complete the evaluation, which contained the complete EQual rubric and 3 additional prompts, one of which—“Do you think this EPA requires revision?”—was limited to a “yes/no” response. Descriptive statistics for overall and domain-specific EQual rubric scores for each of the 13 Core EPAs were calculated. Free-text responses to why and/or how a Core EPA should be revised were summarized for any Core EPA that scored below a cutoff or for which the majority of experts recommended revision.

Results
Six experts completed the evaluation. Most Core EPAs’ (9/13) overall score was above the cutoff, indicating that they align with the key domains of the EPA construct. The remaining 4 Core EPAs (2, 7, 9, and 13) scored below the overall cutoff, suggesting that they may require revision. A majority of experts felt that Core EPAs 6, 7, 9, and 13 required revision. With regard to domain-specific scores, Core EPAs 2, 3, 7, 9, and 13 were below the discrete units of work cutoff; Core EPAs 7, 9, and 13 were below the entrustable, essential, and important tasks of the profession of medicine cutoff; and Core EPA 9 was below the curricular role cutoff.

Conclusions
The Core EPAs represent a promising initial framework of EPAs for undergraduate medical education. Some Core EPAs might benefit from revision. The process of improving the Core EPAs must continue if they are to standardize outcomes for medical school graduates.
MD–PhD Program Graduates’ Engagement in Research: Results of a National Study
Authors: Andriole Dorothy A. , Grbic Douglas , Yellin Jodi , McKinney Ross 
Published: May 2020

Purpose
To determine if specialty, among other professional development and demographic variables, predicted MD–PhD program graduates’ research engagement.

Method
The authors merged the 2015 Association of American Medical Colleges (AAMC) National MD–PhD Program Outcomes Survey database with selected data from the AAMC Student Records System, Graduation Questionnaire, and Graduate Medical Education (GME) Track Resident Survey. At the person level, they tested variables of interest for independent associations with MD–PhD graduates’ research engagement using chi-square, Pearson correlations, and analysis of variance tests and logistic and linear regressions.

Results
Of 3,297 MD–PhD graduates from 1991–2010 who were no longer in GME training in 2015, 78.0% (2,572/3,297) reported research engagement. In models controlling for several variables, a neurology (vs internal medicine; adjusted odds ratio [AOR]: 2.48; 95% confidence interval [CI]: 1.60–3.86) or pathology (vs internal medicine; AOR: 1.89; 95% CI: 1.33–2.68) specialty, full-time faculty/research scientist career intention at graduation (vs all other career intentions; AOR: 3.04; 95% CI: 2.16–4.28), and ≥ 1 year of GME research (vs no GME research year[s]; AOR: 2.45; 95% CI: 1.96–3.06) predicted a greater likelihood of research engagement. Among graduates engaged in research, the mean percentage of research time was 49.9% (standard deviation 30.1%). Participation in ≥ 1 year of GME research (beta [β] coefficient: 7.99, P < .001) predicted a higher percentage of research time, whereas a radiation oncology (β: −28.70), diagnostic radiology (β: −32.92), or surgery (β: −29.61) specialty, among others, predicted a lower percentage of research time (each P < .001 vs internal medicine).

Conclusions
Most MD–PhD graduates were engaged in research, but the extent of their engagement varied substantially among specialties. Across specialties, participation in research during GME may be one factor that sustains MD–PhD graduates’ subsequent early- to midcareer research engagement.
Patient and Parent Decision-Making in the Setting of Chemotherapy-Induced Sensorineural Hearing Loss
Authors: Schulz Ginny L. , Hayashi Susan , Spence Anne , Lieu Judith , King Allison , Hayashi Robert J. , Mohrmann Caroline 
Published: May 2020

Objectives:
Children with malignancies may be exposed to ototoxic therapies resulting in sensorineural hearing loss (SNHL). There is no consensus as to when intervention with amplification is necessary due to a variety of factors such as disease status, speech and language development, perceived difficulty with communication, and limitations of technology to fit these challenging losses. The decision to proceed with amplification after cancer can be difficult for patients and families. The purpose of this study is (1) to understand the decision-making (DM) process of childhood cancer survivors (CCSs) with SNHL and their parents and (2) to identify their decisional needs.

Design:
Semi-structured interviews guided by the Ottawa’s decision support framework were recorded and transcribed verbatim. Inclusion criteria were CCSs ages 8 to 30 years old with a Chang grade >1b SNHL and off-therapy; parents of this group were also eligible. Patients with active disease were excluded. Prompts inquired of sources of decisional conflict, role in DM, and DM behaviors. Inductive content analysis of the narrative qualitative data was used.

Results:
Seven parents of CCSs and 6 CCSs participated. Themes in the CCS group included: (1) making sense of ototoxic SNHL; (2) desiring personalized education and treatment of SNHL; (3) playing an active role in the joint DM process; and (4) accepting hearing aids requires time and effort. The parent group shared the first and last theme with the CCS group and had two unique themes: (1) needing experts to respect the individual’s journey to SNHL acceptance and (2) moving past the cancer experience to acceptance. Parents more often framed their DM within the context of already experiencing the trauma of cancer, whereas CCSs did not. One parent said, “You see all the rubble and you’ve lived through the devastation of the storm, but now you got to figure out what’s broken.” CCSs expressed bodily concerns regarding amplification, such as discomfort to the ear and difficulty in adjusting to the volume. The following needs were identified: early, re-enforced education regarding late effects risks; open communication among providers, CCSs, and parents; and audiogram result interpretations in patient- and parent-friendly language.

Conclusions:
Understanding the DM process from the CCS and parent’s perspectives should be considered when providing counseling for hearing amplification in the setting of cancer-related SNHL. Earlier and consistent delivery of late effects education, open communication regarding risk for SNHL, and improved delivery of audiogram results should be targets for meeting unmet needs. These findings should inform the development of decision aids to reduce decisional conflict in this population.
A dynamic knee extension device improves flexion contracture before total knee arthroplasty: a randomized controlled trial
Authors: Stone Andrea H. , Turcotte Justin J. , Fowler M. Brook , MacDonald James H. , Brassard Marc F. , King Paul J. 
Published: May 2020

Background:
Postoperative flexion contracture (FC) after total knee arthroplasty (TKA) affects gait and causes pain and fatigue, which can result in poor patient outcomes and decreased satisfaction. This study evaluates a dynamic extension brace that may help improve extension and decrease the rate of postoperative FC.

Methods:
This study was a prospective randomized controlled trial of 101 patients with a FC of ≥10 degrees scheduled to undergo TKA. Primary outcome was change in maximal active extension during the perioperative period; secondary outcomes were patient-reported outcomes. Data were collected at enrollment, preoperative appointments, and 2-week postoperative appointments. Chi-squared, t tests and repeated measures analysis of variance (ANOVA) were used to evaluate the results between and within groups.

Results:
Fifty-five patients were in the control group and 46 in the experimental group. The mean FC in the experimental group was significantly worse at enrollment (14.22 degrees vs. 15.76 degrees, P=0.049), but improved by the preoperative appointment (15.76 degrees to 12.52 degrees, P<0.001), while the control group FC remained stable. The experimental group experienced a greater improvement in Knee Society Knee Scores and a smaller decline in Knee Society Function Scores compared with the control group. The experimental group experienced a significant improvement in Knee Injury and Osteoarthritis Outcome Score (KOOS) score through all time points (29.47 degrees to 35.84 degrees to 51.33 degrees, P<0.001), while the control group only had significant improvement from enrollment to postoperative appointment (35.06 degrees to 49.15 degrees, P<0.001).

Conclusions:
Patients with FC that used a dynamic knee extension brace preoperatively had improved extension before surgery and more rapid improvement in outcome measures when compared to patients treated with a standard program alone.

Level of Evidence:
Level I.
Treatment of Displaced Intra-articular Calcaneal Fractures With an Interlocking Nail (C-Nail)
Authors: Veliceasa Bogdan , Filip Alexandru , Pinzaru Roxana , Pertea Mihaela , Ciuntu Bogdan , Alexa Ovidiu 
Published: May 2020

Objectives:
To assess the outcome of the sinus tarsi approach and C-Nail fixation of displaced intra-articular calcaneal fractures (DIACFs).

Design:
Prospective study.

Setting:
University Trauma Department.

Patients:
Sixty-four patients (mean age 44.3 years, 48 men and 16 women) with 75 DIACFs were treated between October 1, 2016 and December 31, 2018.

Intervention:
In all cases, the posterior facet was reduced through the sinus tarsi approach and fixed with one or 2 screws. After reducing all fragments to the articular block, the final fixation was performed percutaneously with C-Nail, locked with 6 screws.

Main Outcome Measurements:
Patients were assessed for restoration of the Böhler angle, complications, and overall fracture reduction. To assess the functional outcome, we used the Mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score and Maryland Foot Score after 12 months.

Results:
The Böhler angle improved from −0.5 degrees preoperatively to 28.6 degrees postoperatively. The articular step-off was reduced from 5.4 mm preoperatively to 0.6 mm postoperatively. The postoperative radiologic calcaneal score was 2.9, on average. Superficial wound edge necrosis was seen in 3 patients (4%) and superficial infection was observed in one (1.3%). After a 1-year follow-up, we recorded a mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score of 90.2 and a mean Maryland Foot Score of 91.2.

Conclusions:
After obtaining an anatomic reduction of the articular surface of the posterior facet with lag screws, the C-Nail represented a viable alternative to plate stabilization in the treatment of DIACFs, combining primary stability with low soft tissue complications.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.