bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tips for successful deep enteroscopy
Authors: Lo Simon K. , Paski Shirley , Liu Quin 
Published: July 2021

Purpose of review
The aim of this study was to provide practical tips to readers on how to perform deep enteroscopy efficiently.

Recent findings
Deep enteroscopy has revolutionized the diagnosis and management of small intestinal conditions in recent years. They are extremely valuable, but may be technically challenging to perform, regardless if it is double balloon enteroscopy, single balloon enteroscopy or spiral enteroscopy. The common issues to these procedures are repetitive motion, extended procedure duration and physical exertion during scope advancement. These situations may in turn lead to a variety of ergonomic issues that need to be addressed accordingly to prevent occupational injuries to the endoscopists and their assistants. Depending on the clinical indications, the technical approach and execution of these procedures may be carried out differently. Some guiding principles may be applied to make performing these procedures more smoothly, effectively and deeply.

Summary
Careful planning and skilful manipulations are essential to performing an efficient and stress-free deep enteroscopy. There are many simple ways to improve on the ergonomics and performance of these procedures.
Topical Review: Understanding Vision Impairment and Sports Performance through a Look at Paralympic Classification
Authors: Chun Robert , Creese Marieke , Massof Robert W. 
Published: July 2021

SIGNIFICANCE: To provide meaningful competition that is equitable for Paralympic athletes, classification systems are vital to determine which athletes are eligible to compete in adapted forms of sports and to group athletes for competition. Our discussion has important implications to inform how we should approach visual function assessment in sports performance.
Sport participation positively benefits individuals with low vision. In particular, adapted sports exist to provide people with visual disabilities an avenue for participating in recreational activity. High-performance low-vision athletes can participate in Paralympic sports but need to be properly classified based on the severity of their vision impairment. The model for Paralympic classification was initiated by Sir Ludwig Guttmann in 1952 in a rehabilitation clinic for soldiers with spinal cord injuries. Today, the International Paralympic Committee mandates that international sports federations develop evidence-based sport-specific classification systems to ensure that eligible disabled athletes have an opportunity for meaningful competition. With the current classification system, only visual acuity and visual field measures are considered to determine an athlete's eligibility to compete, leaving room to expand our understanding of visual function requirements for individual sports. In this topical review, we discuss the origins of Paralympic sports, limitations of current classification methods, and requirements toward achieving evidence-based sport-specific evaluation systems.
Athletes Demonstrate Superior Dynamic Visual Acuity
Authors: Yee Alan , Thompson Benjamin , Irving Elizabeth , Dalton Kristine 
Published: July 2021

SIGNIFICANCE
Athletes exhibit better dynamic visual acuity (DVA) compared with nonathletes, whereas action video game players (VGPs) perform more similarly to controls despite having similar static visual acuity and refractive errors. The differences in DVA between groups were not related to differences in static visual acuity, refractive error, or smooth pursuit gain.

PURPOSE
The purpose of the study was to examine whether athletes and VGPs have superior DVA than controls (nonathletes, nongamers).

METHODS
Forty-six participants (15 athletes, 11 VGPs, 20 controls) aged 21.7 years (standard deviation, 2.8 years) were recruited. Participants were emmetropic with equivalent monocular and binocular static visual acuity between groups. Dynamic visual acuity was assessed using predictable (horizontal) and unpredictable (random) motion targets at velocities of 5, 10, 20, and 30°/s. Smooth pursuit eye movements were assessed using a horizontal motion step-ramp stimulus at the same speeds. This study was pre-registered with the Center for Open Science (https://osf.io/eu7qc).

RESULTS
At 30°/s, there were significant main effects of group (F = 4.762, P = .01) and motion type (F = 9.538, P = .004). Tukey post hoc analysis for groups indicated that athletes performed better than did the control group (t = −2.919, P < .02). An omnibus (group × motion type × speed) repeated measures ANOVA showed a main effect of speed (F = 110.137, P < .001) and a speed × motion-type interaction (F = 27.825, P < .001). Dynamic visual acuity decreased as speed increased, and the slope of the change was greater for random than for horizontal motion. Smooth pursuit gains were not significantly different between groups (P > .05).

CONCLUSIONS
Athletes have superior dynamic visual acuity performance compared with controls at 30°/s. This between-group difference cannot be fully explained by differences in smooth pursuit eye movements and therefore may reflect other differences between the groups.
The Uses of Vision Data in Selecting Players for the Major League Baseball Draft
Authors: Kirschen David G. , Laby Daniel M. 
Published: July 2021

SIGNIFICANCE
This report illustrates the potential uses of vision data in helping teams select players during the draft.

PURPOSE
Visual performance has gradually gained recognition in baseball as a tool that can optimize on-field performance. It also may be useful in player development programs that gradually move players toward the major league.

METHODS
Recently, over the past 5 years, vision data from six different major league teams were used by the authors to assess prospective players before the annual Major League Baseball (MLB) draft. One thousand three hundred forty-three vision forms were evaluated representing 759 different players. Their vision data were retrospectively analyzed using a novel grading method to advise teams on the visual readiness of prospects for success in MLB.

RESULTS
On a one (best)-to-six (worst) vision scale, the average vision score was 2.080 ± 1.171. Sixty-eight percent (320/473) of the players with good vision scores were drafted, 66% (185/281) of the players with moderate vision scores were drafted, and only 1 player with a poor vision score was drafted. There was a statistically significant difference in the amount of signing bonus received by draftees with better vision scores compared with those with lower vision scores (P < .003 to P < .001). Draftees with the highest vision scores also received the highest signing bonuses as they entered MLB.

CONCLUSIONS
For both potential draftees and teams, the vision score seems to be a valuable tool in selecting players for the MLB draft. Adding the pre-draft visual assessment score to a team's projection model could help reduce the uncertainty surrounding the player draft and future service to the team.
An Atypical Presentation of Hirayama Disease With Lower Limb Myelopathic Symptoms Only
Authors: Mattson Laura M. , Alomar-Jimenez Walter O. , Hearn Sandra L. 
Published: July 2021

Abstract
Hirayama disease is a rare neuromuscular disease, which classically presents as lower motor neuron weakness and atrophy in the upper limbs and specifically the C7–T1 myotomes. Proposed pathogenesis relates to microcirculatory dysfunction in the territory of the anterior spinal artery caused by epidural venous plexus engorgement with forward displacement of the posterior dura and spinal cord during neck flexion, leading to chronic ischemic changes in the lower cervical anterior horn cells. Diagnosis hinges upon clinical and radiographic findings, and treatment is generally conservative given the self-limited nature of the disease. Here, we present a case with classic radiologic findings of Hirayama disease with lower limb myelopathic findings alone. This case raises the question of whether the pathophysiology leading to focal anterior cervical myelopathy in forward flexion could present along a broader clinical spectrum than previously recognized, from complete asymptomaticity, to classic Hirayama disease with C7–T1 atrophy, to cervical myelopathy with long tract signs.
Contemplative Mental Training Reduces Hair Glucocorticoid Levels in a Randomized Clinical Trial
Authors: Puhlmann Lara M.C. , Vrtička Pascal , Linz Roman , Stalder Tobias , Kirschbaum Clemens , Engert Veronika , Singer Tania 
Published: July 2021

ABSTRACT

Objective
This study aimed to investigate the effect of regular contemplative mental training on endocrine and psychological indices of long-term stress.

Methods
An open-label efficacy trial that comprised three distinct 3-month long modules targeting attention and interoception, socioaffective, or sociocognitive abilities through dyadic exercises and secularized meditation practices was conducted with healthy adults. Participants underwent the training for 3 or 9 months, or were assigned to a retest control cohort. Chronic stress indices were assayed at four time points: pretraining and after 3, 6, and 9 months. The main outcome measures were cortisol (HC) and cortisone (HE) concentration in hair and self-reported long-term stress.

Results
Of 362 initially randomized individuals, 30 dropped out before study initiation (n = 332; mean [SD] age = 40.7 [9.2] years; 197 women). Hair-based glucocorticoid assays were available from n = 227, and questionnaire data from n = 326. Results from three separate training cohorts (TC1–3) revealed consistent decreases in HC and HE levels over the first three (TC3) to 6 months (TC1 and TC2) of training, with no further reduction at the final 9-month mark (baseline to end of training differences, HC, TC1: t(355) = 2.59, p = .010, contrast estimate (est.) [SE] = 0.35 [0.14]; HC, TC2: t(363) = 4.06, p < .001, est. = 0.48 [0.12]; HC, TC3: t(368) = 3.18, p = .002, est. = 0.41 [0.13]; HE, TC1: t(435) = 3.23, p = .001, est. = 0.45 [0.14]; HE, TC2: t(442) = 2.60, p = .010, est. = 0.33 [0.13]; HE, TC3: t(446) = 4.18, p < .001, est. = 0.57 [0.14]). Training effects on HC increased with individual compliance (practice frequency), and effects on both HC and HE were independent of training content and unrelated to change in self-reported chronic stress. Self-reported stress, and cortisol-to-dehydroepiandrosterone ratios as an exploratory endpoint, were also reduced, albeit less consistently.

Conclusions
Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners’ health.

Trial Registration: ClinicalTrials.gov identifier: NCT01833104.
Cardiovascular Stress Reactivity and Health: Recent Questions and Future Directions
Authors: Whittaker Anna C. , Ginty Annie , Hughes Brian M. , Steptoe Andrew , Lovallo William R. 
Published: July 2021

ABSTRACT

Objective
High cardiovascular reactions to psychological stress are associated with the development of hypertension, systemic atherosclerosis, and cardiovascular disease. However, it has become apparent that low biological stress reactivity also may have serious consequences for health, although less is known about the mechanisms of this. The objectives of this narrative review and opinion article are to summarize and consider where we are now in terms of the usefulness of the reactivity hypothesis and reactivity research, given that both ends of the reactivity spectrum seem to be associated with poor health, and to address some of the key criticisms and future challenges for the research area.

Methods
This review is authored by the members of a panel discussion held at the American Psychosomatic Society meeting in 2019, which included questions such as the following: How do we measure high and low reactivity? Can high reactivity ever indicate better health? Does low or blunted reactivity simply reflect less effort on task challenges? Where does low reactivity originate from, and what is a low reactor?

Results
Cardiovascular (and cortisol) stress reactivity are used as a model to demonstrate an increased understanding of the different individual pathways from stress responses to health/disease and show the challenges of how to understand and best use the reconstruction of the long-standing reactivity hypothesis given recent data.

Conclusions
This discussion elucidates the gaps in knowledge and key research issues that still remain to be addressed in this field, and that systematic reviews and meta-analyses continue to be required.
The School-Ladder Effect: Subjective Socioeconomic Status and Diurnal Cortisol Profile Among Adolescents
Authors: Chen Lihua , Du Hongfei , Zilioli Samuele , Zhao Shan , Nie Yangang , Chi Peilian 
Published: July 2021

ABSTRACT

Objective
Subjective socioeconomic status (SES) is a well-established psychosocial determinant of adolescents’ self-report health. However, whether low subjective SES is associated with stress-related physiological risks (e.g., dysregulations in the hypothalamic-pituitary-adrenal axis activity) remains uncertain. This study examined the impact of subjective SES with different reference groups (i.e., perception of family SES relative to other students in the school versus other people in the city) on adolescents’ diurnal cortisol profiles.

Methods
A sample of 255 adolescents (aged 11–14 years; 53.7% boys) completed a battery of psychological scales, including school-referenced subjective SES and city-referenced subjective SES. Diurnal cortisol was assessed by collecting saliva samples four times a day across two consecutive days. Four cortisol parameters (cortisol at awakening, cortisol awakening response [CAR], cortisol slope, and total cortisol secretion [area under the curve with respect to ground {AUCg}]) were derived.

Results
Higher levels of school-referenced subjective SES were associated with higher cortisol levels at awakening (β = 0.0483, standard error [SE] = 0.0219, p = .028), steeper cortisol slopes (β = −0.0036, SE = 0.0017, p = .034), and higher cortisol AUCg (b = 0.50, SE = 0.24, p = .036), but not with CAR (p = .77), after adjusting for covariates. In contrast, city-referenced subjective SES was not associated with any of the cortisol parameters (cortisol at awakening [p = .90], CAR [p = .74], cortisol slope [p = .84], and cortisol AUCg [p = .68]).

Conclusions
Our findings highlight the importance of the reference group for subjective SES and provide a further understanding of socioeconomic disparities in adolescents’ stress physiology.
Offering a choice of daily and event-driven preexposure prophylaxis for men who have sex with men in the Netherlands: a cost-effectiveness analysis
Authors: van Hoek Albert Jan , Reitsema Maarten , Xiridou Maria , van Sighem Ard , van Benthem Birgit , Wallinga Jacco , van Duijnhoven Yvonne , van der Loeff Maarten Schim , Prins Maria , Hoornenborg Elske 
Published: July 2021

Objectives:
To assess the cost-effectiveness of a preexposure prophylaxis (PrEP) programme offering a choice of daily and event-driven PrEP for men who have sex with men (MSM) in the Netherlands.

Methods:
We used an agent-based transmission model and an economic model to simulate a programme offering only daily PrEP and a programme offering daily and event-driven PrEP. Use of PrEP medication and preference for daily versus event-driven PrEP were estimated from the Amsterdam PrEP Demonstration Project (AMPrEP). We calculated costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICER), over 2018–2027. An ICER less than €20 000 per QALY gained was considered cost-effective.

Results:
Using AMPrEP data, we estimated that 27% of PrEP users chose event-driven PrEP with a median of 12 pills per month; daily PrEP users used a median of 30 pills per month. With PrEP, 3740 HIV infections were averted and 1482 QALYs were gained over 2018–2027, compared to the scenario without PrEP. The probability of the PrEP programme being cost-effective (compared to not having a PrEP programme) increased from 91% with daily PrEP to 94% with a choice of daily and event-driven PrEP. The probability of being cost-saving increased from 42% with only daily PrEP to 48% with choice of daily and event-driven PrEP.

Conclusions:
A daily PrEP programme for MSM would be cost-effective. Providing a choice of daily and event-driven PrEP can result in savings and is more likely to be cost-effective and cost-saving, compared to a programme offering only daily PrEP.
Perceived HIV Acquisition Risk and Low Uptake of PrEP Among a Cohort of Transgender Women With PrEP Indication in the Eastern and Southern United States
Authors: Malone Jowanna , Reisner Sari L. , Cooney Erin E. , Poteat Tonia , Cannon Christopher M. , Schneider Jason S. , Radix Asa , Mayer Kenneth H. , Haw J. Sonya , Althoff Keri N. , Wawrzyniak Andrew J. , Beyrer Chris , Wirtz Andrea L. ,   For the American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group
Published: July 2021

Introduction:
Preexposure prophylaxis (PrEP) is effective in preventing HIV among adherent users. However, PrEP uptake among transgender women is low, and current prescribing guidelines from the Centers for Disease Control and Prevention (CDC) are not specific to transgender women. Self-perceived risk of HIV among those who are PrEP-indicated is not well understood.

Methods:
This cross-sectional analysis included 1293 transgender women screened at baseline from March 2018 to May 2020 for a multisite, prospective cohort study. We compared the prevalence of PrEP indication using current CDC prescribing criteria versus transgender women–specific criteria developed by study investigators with community input. We identified factors associated with study-specific PrEP indication and factors associated with self-perceived low to no HIV risk among those who were PrEP-indicated. We also calculated descriptive statistics to depict the PrEP care continuum.

Results:
PrEP indication prevalence using transgender women–specific criteria was 47% (611), 155 more than who were identified using the CDC criteria. Eighty-three percent were aware of PrEP, among whom 38% had ever used PrEP. Among PrEP ever users, 63% were using PrEP at the time of the study. There were 66% of current PrEP users who reported 100% adherence within the previous 7 days. Among those who were PrEP-indicated, 13% were using and adherent to PrEP at the time of the study. More than half (55%) of PrEP-indicated participants had low or no self-perceived HIV risk.

Conclusions:
These findings suggest that further guidance is needed for health care providers in prescribing PrEP to transgender women. Greater uptake and adherence are also needed for optimal effectiveness.
Cerebrovascular Contributions to Neurocognitive Disorders in People Living With HIV
Authors: Gutierrez Jose , Porras Tiffany N. , Yoo-Jeong Moka , Khasiyev Farid , Igwe Kay C. , Laing Krystal K. , Brickman Adam M. , Pavol Marykay , Schnall Rebecca 
Published: July 2021

Background:To investigate a comprehensive array of magnetic resonance imaging (MRI)-based biomarkers of cerebrovascular disease (CVD) in a cohort of people living with HIV (PLWH) and relate these imaging biomarkers to cognition.Settings:Cross-sectional, community-based study.Methods:Participants were PLWH in New York City, aged 50 years or older. They underwent a brain magnetic resonance angiography or MRI to ascertain 7 MRI markers of CVD: silent brain infarcts, dilated perivascular spaces, microhemorrhages, white matter hyperintensity volume, white matter fractional anisotropy and mean diffusivity (measures of white matter integrity), and intracranial large artery stenosis. Participants underwent a battery of neurocognitive tests to obtain individual and global cognitive scores representative of various aspects of cognition.Results:We included 85 participants (mean age 60 ± 6 years, 48% men, 78% non-Hispanic Black), most of them with well-controlled HIV (75% with CD4 cell count > 200 cells/mm3and viral load < 400 copies/mL at or near the time of the MRI scan). Silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity were associated with poorer performance in at least one cognitive domain, but the sum of these 3 MRI markers of CVD was associated with lower working memory (B = −0.213,P= 0.028), list learning (B = −0.275,P= 0.019), and global cognition (B = −0.129,P= 0.007).Conclusions:We identified silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity as exposures that may be modifiable and may, therefore, influence cognitive decline. In addition, these MRI markers of CVD may help in identifying PLWH at higher risk of cognitive decline, which may be more amenable to targeted therapies.
Undisclosed HIV Status to Sex Partners and Its Unintended Consequences in the Era of Undetectable = Untransmittable
Authors: Kalichman Seth C. , Kalichman Moira O. , Eaton Lisa A. 
Published: July 2021

Background:Adherence to antiretroviral therapy (ART) and sustained HIV suppression virtually eliminate HIV transmission, eg, having an undetectable viral load renders HIV untransmittable (U=U). Owing to the greatly reduced likelihood of HIV transmission when viral load is undetectable, we studied one behavioral ramification of adopting a U=U prevention strategy—not disclosing HIV status to sex partners.Setting:Cisgender men recruited through community outreach in the state of Georgia, USA.Methods:We examined HIV status disclosure to sex partners among 345 young (median age = 29 years) men receiving ART. Data were collected using computerized interviews, daily sexual behavior surveys over 28 days, unannounced pill counts for ART adherence, urine tests for drug use and urogenital health, and blood samples for HIV viral load.Results:One in 3 participants (34%) engaged in condomless anal/vaginal intercourse with an HIV-negative/unknown HIV status partner over 28 days. Average ART adherence was 76%, and one in 5 men had detectable HIV viral loads. Men who engaged in condomless sex with undisclosed partners demonstrated significantly less HIV disclosure to family and friends and had fewer enacted stigma experiences. Hierarchical regression models showed that endorsing U=U as a personal HIV prevention strategy predicted undisclosed condomless sex over and above substance use, HIV stigma experiences, disclosure to family and friends, ART adherence, and HIV viral load.Conclusions:Interventions are needed to improve ART adherence and assist men living with HIV in their decisions to disclose HIV status to sex partners.
18F-FDG PET/CT Imaging of Immune Checkpoint Inhibitor–Related “Retroperitoneal Panniculitis”
Authors: Minutoli Fabio , Parisi Silvana , Laudicella Riccardo , Pergolizzi Stefano , Baldari Sergio 
Published: July 2021

Abstract
A 71-year-old woman was operated on for undifferentiated lung adenocarcinoma. Four months after surgery, she developed bone and adrenal metastases. She underwent palliative radiation therapy of left scapula and right iliac bone. Thereafter, she started immune checkpoint inhibitor (ICI) therapy with anti–PD-1 antibodies achieving complete tumor response. Twenty months later, a follow-up 18F-FDG PET/CT confirmed tumor response and revealed high radiotracer accumulation in correspondence of retroperitoneal and subcutaneous fat opacities. The contiguous fasciae were mildly thickened. The temporal relation with ICI therapy together with tumor response and corticosteroids therapy effectiveness led to conclude for ICI-related adverse events.