bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gaps in the Use of Long-Acting Opioids Within Intervals of Consecutive Days Among Cancer Outpatients Using Electronic Pill Caps
Authors: Meghani Salimah H , Persico Amelia L , Fudin Jeffrey , Knafl George J 
Published: July 2020

Abstract

Objective
This study describes individual cancer patients’ nonuse of extended-release or long-acting (ER/LA) opioids, including periods of gap between opioid doses taken.

Design
Secondary analysis of a three-month observational study of prescribed ER/LA opioids monitored using electronic pill caps.

Setting
Two outpatient oncology clinics of a large health system in the Mid-Atlantic region.

Participants
Inclusion was based on self-identified African Americans and whites, at least 18 years old, diagnosed with solid tumors or multiple myeloma. For the current analysis, the additional inclusion criterion was prescription of an oral ER/LA opioid for cancer pain to be taken around the clock.

Methods
The electronic monitoring period for each study participant was partitioned into intervals of days between days with one or more openings (using medication event monitoring systems) representing rates of ER/LA opioid nonuse over consecutive days and over time.

Results
Of the sample (N = 109), two-thirds of the cancer patients had some nonuse of prescribed ER/LA opioids, with one in four having nonuse during 31.5–87.5% of their electronic-monitoring periods. Nonuse over periods of five or more, six or more, and seven or more consecutive days occurred for 37.6%, 34.9%, and 30.3% of the participants, respectively.

Conclusions
About one in three ambulatory cancer patients in this study had substantial gaps between days of ER/LA opioid use, potentially resulting in risk of overdose depending upon the prescribed ER/LA opioid type, dose, and length of the time the opioid was stopped and resumed at the previous dose. This phenomenon has received little to no attention in the opioid safety discourse.
Is it me? The impact of patient–physician interactions on lupus patients’ psychological well-being, cognition and health-care-seeking behaviour
Authors: Sloan Melanie , Naughton Felix , Harwood Rupert , Lever Elliott , D’Cruz David , Sutton Stephen , Walia Chanpreet , Howard Paul , Gordon Caroline 
Published: July 2020

Abstract

Objective
The aim was to explore the impact of patient–physician interactions, pre- and post-diagnosis, on lupus and UCTD patients’ psychological well-being, cognition and health-care-seeking behaviour.

Methods
Participants were purposively sampled from the 233 responses to a survey on patient experiences of medical support. Twenty-one semi-structured interviews were conducted and themes generated using thematic analysis.

Results
The study identified six principal themes: (i) the impact of the diagnostic journey; (ii) the influence of key physician(s) on patient trust and security, with most participants reporting at least one positive medical relationship; (iii) disparities in patient–physician priorities, with patients desiring more support with quality-of-life concerns; (iv) persisting insecurity and distrust, which was prevalent and largely influenced by previous and anticipated disproportionate (often perceived as dismissive) physician responses to symptoms and experiences of widespread inadequate physician knowledge of systemic autoimmune diseases; (v) changes to health-care-seeking behaviours, such as curtailing help-seeking or under-reporting symptoms; and (vi) empowerment, including shared medical decision-making and knowledge acquisition, which can mitigate insecurity and improve care.

Conclusion
Negative medical interactions pre- and post-diagnosis can cause a loss of self-confidence and a loss of confidence and trust in the medical profession. This insecurity can persist even in subsequent positive medical relationships and should be addressed. Key physicians implementing empowering and security-inducing strategies, including being available in times of health crises and validating patient-reported symptoms, might lead to more trusting medical relationships and positive health-care-seeking behaviour.
Systemic vascular distensibility relates to exercise capacity in connective tissue disease
Authors: Singh Inderjit , Oliveira Rudolf K F , Naeije Robert , Oldham William M , Faria-Urbina Mariana , Waxman Aaron B , Systrom David M 
Published: July 2020

Abstract

Objective
Exercise intolerance is a common clinical manifestation of CTD. Frequently, CTD patients have associated cardio-pulmonary disease, including pulmonary hypertension or heart failure that impairs aerobic exercise capacity (pVO2). The contribution of the systemic micro-vasculature to reduced exercise capacity in CTD patients without cardiopulmonary disease has not been fully described. In this study, we sought to examine the role of systemic vascular distensibility, α in reducing exercise capacity (i.e. pVO2) in CTD patients.

Methods
Systemic and pulmonary vascular distensibility, α (%/mmHg) was determined from multipoint systemic pressure-flow plots during invasive cardiopulmonary exercise testing with pulmonary and radial arterial catheters in place in 42 CTD patients without cardiopulmonary disease and compared with 24 age and gender matched normal controls.

Results
During exercise, systemic vascular distensibility, α was reduced in CTD patients compared with controls (0.20 ± 0.12%/mmHg vs 0.30 ± 0.13%/mmHg, P =0.01). The reduced systemic vascular distensibility α, was associated with impaired stroke volume augmentation. On multivariate analysis, systemic vascular distensibility, α was associated with a decreased exercise capacity (pVO2) and decreased systemic oxygen extraction.

Conclusion
Systemic vascular distensibility, α is associated with impaired systemic oxygen extraction and decreased aerobic capacity in patients with CTD without cardiopulmonary disease.
Otological aspects of NLRP3-related autoinflammatory disorder focusing on the responsiveness to anakinra
Authors: Kim Bong Jik , Kim Young Ho , Lee Seungmin , Han Jin Hee , Lee Sang-Yeon , Seong Jeon , Lee Dong-Han , Kim Bonggi , Park Hye-Rim , Carandang Marge , Oh Dooyi , Oh Seung Ha , Kim Joong Gon , Lee Soyoung , Choi Byung Yoon 
Published: July 2020

Abstract

Objectives
Gradually progressive sensorineural hearing loss (SNHL) is a prevalent sensory defect. It is generally untreatable, making rehabilitation by hearing aid or cochlear implantation the only option. However, SNHL as one of the symptoms of the hereditary autoinflammatory systemic disease cryopyrin-associated periodic syndrome, or as the only symptom of the cochlea-specific form (DFNA34), was suggested to respond to IL-1 antagonist (anakinra) therapy, which ameliorates NLRP3 variants-induced over-secretion of IL-1β. We analysed genotypic and phenotypic spectrum of cryopyrin-associated periodic syndrome or DFNA34, specifically focusing on the responsiveness of SNHL to anakinra.

Methods
Seventeen families diagnosed with either cryopyrin-associated periodic syndrome or DFNA34 were recruited. Genotyping and phenotyping including audiogram, MRI findings, and in vitro IL-1β assay were performed.

Results
Our cohort had an etiologic homogeneity of 94.1% to NLRP3 variants and a high de novo occurrence (84.6%). We identified the second DNFA34 pedigree worldwide with a novel NLRP3 variant supported by in vitro analysis. Significant improvement of hearing status against the natural course, showing response to anakinra, was identified in three probands, one of whom used to have severe SNHL. Hearing threshold worse than 60 dB at the start of anakinra and cochlear enhancement on brain MRI seemed to be related with poor audiologic prognosis and responsiveness to anakinra therapy despite stabilized systemic symptoms and inflammatory markers.

Conclusion
We propose a constellation of biomarkers comprising NLRP3 genotypes, hearing status at diagnosis, and cochlear radiological findings as prognostic factors of hearing status after anakinra treatment and possibly as sensitive parameters for treatment dosage adjustment.
High risk of coronary artery aneurysm in Kawasaki disease
Authors: Mossberg Maria , Mohammad Aladdin J , Kahn Fredrik , Segelmark Mårten , Kahn Robin 
Published: July 2020

Abstract

Objective
Kawasaki disease (KD) is a vasculitis of unknown aetiology with a high risk of coronary aneurysms if untreated. Timely treatment with intravenous immunoglobulin decreases the risk for coronary artery aneurysms (CAA). In this study, we set out to elucidate the factors associated with the risk of developing CAA.

Methods
Records of all KD-diagnosed children in Skåne between 2004 and 2014 were collected and clinical and demographic data were compiled. KD is defined according to the revised American Heart Association diagnostic criteria and classified as either complete KD (cKD) or incomplete KD (iKD).

Results
KD was diagnosed in 77 children and CAA was found in 31% (n = 24). Children with CAA were younger compared with children without (median; 20 vs 34 months) and intravenous immunoglobulin treatment within 10 days was less likely to be received (75% vs 91%). In children presenting with iKD, 47% developed CAA compared with 21% in cKD patients. Using multivariate analysis, an association between the risk of CAA with low age in children with iKD was observed.

Conclusion
The risk of CAA development is disturbingly high in young children with iKD. This highlights the importance of rapid intense treatment and vigilance in infants, who are the most difficult to diagnose, in order to reduce the frequency of CAA.
Laser speckle contrast analysis predicts major vascular complications and mortality of patients with systemic sclerosis
Authors: Gigante Antonietta , Villa Annalisa , Rosato Edoardo 
Published: July 2020

Abstract

Objectives
The aim of study was to evaluate peripheral blood perfusion and the proximal-distal gradient (PDG) of the hands as biomarkers of SSc major vascular complications (digital ulcers, pulmonary arterial hypertension, scleroderma renal crisis) and mortality by laser speckle contrast analysis.

Methods
In this retrospective observational study, 176 SSc patients [158 female, median age 53 (51–57) years] and 142 healthy controls [115 female, median age 53 (48–55) years] were enrolled. Clinical data were collected at baseline and annually through 5 years of follow-up. Hand dorsum perfusion images were divided into three regions of interest (ROI): ROI1 included the second, third, and fourth fingers distal to the proximal interphalangeal finger joint; ROI2 included the area between the proximal interphalangeal finger joint and the metacarpophalangeal joint; ROI3 included the hand dorsum. PDG was identified when the perfusion mean difference between ROI1 and ROI2 was &gt;30 perfusion units.

Results
Median peripheral blood perfusion was significantly lower for SSc patients than healthy controls. PDG was present in 51.5% of SSc patients and in 98.6% of healthy controls. Using the final multivariate model, nailfold videocapillaroscopy (NVC) pattern [hazard ratio (HR) 0.065 (0.015–0.283), P &lt;0.0001] and PDG [HR 0.376 (0.194–0.727), P &lt;0.01] were found to be risk factors for major vascular complications. By multivariate analysis, age [HR 1.051 (1.014–1.088), P &lt;0.01), NVC pattern [HR 0.001 (0.000–3.111), P &gt;0.05], and PDG [HR 0.207 (0.073–0.589), P &lt;0.01] were found to be risk factors for 5-year SSc mortality.

Conclusion
PDG predicts major vascular complication and 5-year mortality of SSc patients.
Long-Term Outcomes of Infants with Congenital Zika Virus Infection in Ecuador: A Retrospective Longitudinal Study
Authors: García-Boyano Miguel , García-Segovia Roberto , Fernández-Menéndez Amanda , Pérez Yamila , Bustamante-Amador Jorge , Layana-Coronel Marianella , Caballero-Caballero José Manuel , Rodríguez-Izquierdo Concepción , Chávez-Solórzano Nelly , Solís-Montiel Dalton , Miño-León Greta 
Published: July 2020

Abstract

Background
Few congenital Zika syndrome (CZS) cases have been notified in Ecuador and, to our knowledge, there are no significant published studies dealing with their clinical evolution. We present a detailed clinical characterization of 21 children with congenital Zika virus (ZIKV) infection born in Ecuador who were followed up until September 2019.

Methods
We did a retrospective longitudinal study of children attended by the infectious disease specialists of Francisco Icaza Bustamante Children’s Hospital (Guayaquil) due to congenital ZIKV infection suspicion. The inclusion criteria consisted of laboratory confirmed diagnosis of congenital ZIKV infection.

Results
Sixteen of these 21 cases of congenital ZIKV infection showed clinical, neuroimaging and laboratory findings strongly suggestive of CZS and 5 children showed laboratory findings compatible with congenital ZIKV infection without congenital manifestations associated to CZS. All children with CZS showed neurodevelopmental delay, spasticity and hyperreflexia during follow-up, whereas the majority of them (14/15) experienced recurrent epileptic seizures and dysphagia (12/13). Two CZS cases died during follow-up. Visual evoked potential and hearing screening with acoustically evoked auditory brainstem response were abnormal in 50% and 37.5% of CZS cases, respectively. Congenital ZIKV infection without findings consistent with CZS at birth was not clinically relevant at 23 months of age in the five cases of our cohort.

Conclusions
Severe neurodevelopmental delay, severe microcephaly, epileptic seizures and dysphagia were present at 2 years of age in most CZS cases of our cohort.
HTLV in South America: Origins of a silent ancient human infection
Authors: Ishak Ricardo , Guimarães Ishak Marluísa de Oliveira , Azevedo Vânia Nakauth , Machado Luiz Fernando Almeida , Vallinoto Izaura Maria Cayres , Queiroz Maria Alice Freitas , Costa Greice de Lemos Cardoso , Guerreiro João Farias , Vallinoto Antonio Carlos Rosário 
Published: July 2020

AbstractThe description of the first human retrovirus, human T-lymphotropic virus 1 (HTLV-1), was soon associated with an aggressive lymphoma and a chronic inflammatory neurodegenerative disease. Later, other associated clinical manifestations were described, affecting diverse target organs in the human body and showing the enormous burden carried by the virus and the associated diseases. The epidemiology of HTLV-1 and HTLV-2 showed that they were largely distributed around the world, although it is possible to locate geographical areas with pockets of low and very high prevalence and incidence. Aboriginal Australians and indigenous peoples of Brazil are examples of the large spread of HTLV-1 and HTLV-2, respectively. The epidemiological link of both situations is their occurrence among isolated, epidemiologically closed or semi-closed communities. The origin of the viruses in South America shows two different branches with distinct timing of entry. HTLV-1 made its probable entrance in a more recent route through the east coast of Brazil at the beginning of the slave trade from the African continent, starting in the 16th century and lasting for more than 350 years. HTLV-2 followed the ancient route of human migration from the Asian continent, crossing the Behring Strait and then splitting in South America as the population became separated by the Andes Mountains. By that time, HTLV-2c probably arose and became isolated among the indigenous populations in the Brazilian Amazon. The study of epidemiologically closed communities of indigenous populations in Brazil allowed tracing the most likely route of entry, the generation of a new molecular subtype (HTLV-2c), the elucidation of the vertical transmission of HTLV-2, the intrafamilial aggregation of cases and the escape and spread of the virus to other areas in Brazil and abroad. Despite the burden and impact of both viruses, they are maintained as silent infections among human populations because 1, health authorities in most South American countries in which national surveillance is poor have little interest in the disease, 2, the information is commonly lost as indigenous groups do not have specific policies for HTLV and other sexually transmitted infections, and 3, health access is not feasible or properly delivered.
Organizational Practices for the Aging Workforce: Development and Validation of the Later Life Workplace Index
Authors: Wilckens Max R , Wöhrmann Anne M , Deller Jürgen , Wang Mo 
Published: July 2020

AbstractThe present three studies focused on the development and validation of a multifaceted measure of organizational practices for the aging workforce, the Later Life Workplace Index (LLWI). The first study developed a comprehensive item pool based on expert interview evidence from Germany and the United States. Two further studies among workers across industries in Germany (N = 609, N = 349) provided psychometric evidence. The LLWI comprises nine distinct domains of organizational practices for the aging workforce, namely an age-friendly organizational climate and leadership style, certain work design characteristics, health management, individual development opportunities, knowledge management, the design of the retirement transition, continued employment opportunities, and health and retirement coverage. The final LLWI consists of 80 items in total. In addition, the studies demonstrated that the LLWI measures correlated with older workers’ work outcomes such as stress level, workability, person-organization fit, and post-retirement work intentions in meaningful ways. Applications for the LLWI in research and practice are discussed.
Cretaceous mantid lacewings with specialized raptorial forelegs illuminate modification of prey capture (Insecta: Neuroptera)
Authors: Shi Chaofan , Yang Qiang , Shih Chungkun , Labandeira Conrad C , Pang Hong , Ren Dong 
Published: July 2020

AbstractThe Mantispidae (Neuroptera), commonly known as mantid lacewings or mantispids, are characterized by raptorial forelegs used by adults for predation. They have a fossil history extending to the Early Jurassic. During the past 180 Myr, the lineage has undergone significant evolutionary transformation, exhibiting an elevated diversity in morphology yet retaining the same overall ground plan. Although raptorial foreleg morphology and capture behaviour are well documented in extant insects, they are poorly known for premodern lineages, attributable to the scarcity and poor preservation of fossils. Here, we report two new genera and species of Mantispidae from mid-Cretaceous Myanmar (Burmese) amber. Both taxa have highly specialized raptorial forelegs and highlight modification of capture strategy in Cretaceous Mantispidae. The foreleg of both species has one major spine that is the same length as the foretibia on the ventral surface of the forefemur, which faces the foretibia with a row of robust setae. The two new amber mantid lacewings provide structural and functional indications that represent an extinct mode of capture strategy. The new findings reveal the presence of a geochronologically rapid diversification of Mantispidae during the Early Cretaceous, thereby illuminating the varied morphologies involved in prey-capture strategies integral to the early evolution of mantispids.
Inhibitory Immune Checkpoint Molecule Expression in Clinical Sepsis Studies: A Systematic Review
Authors: Busch Lindsay M. , Sun Junfeng , Eichacker Peter Q. , Torabi-Parizi Parizad 
Published: July 2020

Objectives:
Checkpoint inhibitors have been proposed for sepsis following reports of increased checkpoint molecule expression in septic patients. To determine whether clinical studies investigating checkpoint molecule expression provide strong evidence supporting trials of checkpoint inhibitors for sepsis.

Data Sources:
PubMed, EMBASE, Scopus, Web of Science, inception through October 2019.

Study Selection:
Studies comparing checkpoint molecule expression in septic patients versus healthy controls or critically ill nonseptic patients or in sepsis nonsurvivors versus survivors.

Data Extraction:
Two investigators extracted data and evaluated study quality.

Data Synthesis:
Thirty-six studies were retrieved. Across 26 studies, compared with healthy controls, septic patients had significantly (p ≤ 0.05) increased CD4+ lymphocyte programmed death-1 and monocyte programmed death-ligand-1 expression in most studies. Other checkpoint molecule expressions were variable and studied less frequently. Across 11 studies, compared with critically ill nonseptic, septic patients had significantly increased checkpoint molecule expression in three or fewer studies. Septic patients had higher severity of illness scores, comorbidities, and mortality in three studies providing analysis. Across 12 studies, compared with septic survivors, nonsurvivors had significantly increased expression of any checkpoint molecule on any cell type in five or fewer studies. Of all 36 studies, none adjusted for nonseptic covariates reported to increase checkpoint molecule expression.

Conclusions:
Although sepsis may increase some checkpoint molecule expression compared with healthy controls, the data are limited and inconsistent. Further, data from the more informative patient comparisons are potentially confounded by severity of illness. These clinical checkpoint molecule expression studies do not yet provide a strong rationale for trials of checkpoint inhibitor therapy for sepsis.
Full Finger Reperfusion Time Measured by Pulse Oximeter Waveform Analysis in Children
Authors: Nickel Amanda J. , Jiang Shen , Napolitano Natalie , Yehya Nadir , Fitzgerald Julie C. , Bruins Benjamin B. , Lockman Justin L. , Nadkarni Vinay M. , Nishisaki Akira 
Published: July 2020

Objectives:
Capillary refill time is a noninvasive method to assess tissue perfusion to determine shock status. Capillary refill time is defined as the time required to regain skin color after blanching pressure is applied. Although common methods to measure capillary refill time depend on clinicians’ visual assessment, a new approach using a pulse oximeter waveform analysis exists, referred to as full finger reperfusion time. We aim to evaluate reproducibility and validity of the novel full finger reperfusion time measurement using clinicians’ visual capillary refill time assessment as a reference standard.

Design:
Prospective observational study.

Setting:
PICUs and operating suites at a large academic children’s hospital.

Patients:
Ninety-nine children 1–12 years old with various skin color tones.

Interventions:
Each child had 10 measurements, including five full finger reperfusion time and five clinician capillary refill time, alternating second and third digits.

Measurements and Main Results:
Eighteen children had prolonged capillary refill time (> 2 s) and four children with capillary refill time greater than 3 seconds. Four-hundred eighty-five data pairs were analyzed. Intraclass correlation coefficient of full finger reperfusion time within each patient was 0.76 (95% CI, 0.68–0.83), demonstrating good reproducibility. Correlation coefficient between full finger reperfusion time and clinician capillary refill time was moderate: r = 0.37 (p < 0.0001; 95% CI, 0.29–0.44) for the pairs and r = 0.52 (p < 0.0001; 95% CI, 0.36–0.65) for patient average. Bland-Altman plot showed a consistent difference between full finger reperfusion time and clinician capillary refill time (full finger reperfusion time 1.14 s longer). Weak association was found between force and full finger reperfusion time (β = –0.033 ± 0.016; 95% CI, –0.065 to –0.0016; p = 0.04), finger thickness (β = –0.20 ± 0.089; 95% CI, –0.37 to –0.19; p = 0.03), except for color tone (p = 0.31). Finger temperature was associated with full finger reperfusion time (β = –0.18 ± 0.041; 95% CI, –0.26 to –0.0999; p < 0.0001).

Conclusions:
Full finger reperfusion time demonstrated good reproducibility. Full finger reperfusion time showed moderate correlation with clinician capillary refill time. Full finger reperfusion time was 1.14 seconds longer than capillary refill time. Future studies should focus on the clinical value of full finger reperfusion time as a monitoring device for hemodynamics in critically ill children.