Author: "Akerman A" / Topic: business - Searchworks@Jio Institute Digital Library Search Results

699 results on '"Akerman A"'

1. Initial stay times for uncompensable occupational heat stress in young and older men: a preliminary assessment

Author: Sean R. Notley, Ashley P. Akerman, and Glen P. Kenny
Subjects: Nutrition and Dietetics, Physiology, business.industry, Physiology (medical), Endocrinology, Diabetes and Metabolism, Medicine, General Medicine, Core temperature, business, Heat stress, Demography
Abstract: During uncompensable occupational heat stress, heat-mitigation controls are required to prevent core temperature exceeding recommended limits (≥38 °C). However, the initial stay time before employing controls remained unknown. We estimated these times for moderate-intensity work at 26, 28, 30, and 32 °C wet-bulb globe temperatures (WBGT) in 50 young (18–30 years) and older (50–70 years), non-heat acclimatized men. Initial stay time was 111 min at 26 °C WBGT and declined exponentially to 44 min at 32 °C WBGT. Novelty: We provide estimates of the moderate-intensity work duration before heat-mitigation is required in wet-bulb globe temperatures between 26–32 °C for young and older, non-heat acclimatized men.
Published: 2022

2. Cost-minimization analysis of teledermatology versus conventional care in the Brazilian National Health System

Author: Marina Morgado Garcia, Rogério Renato Silva, Ligia Fonseca Spinel, Igor da Costa Borysow, Ramon Gonçalves Pereira, Augusto Afonso Guerra Junior, Daniel Holthausen Nunes, Marco Akerman, Pamela Santos Azevedo, Maria Cristina Marino Calvo, Patrícia Caroline Iacabo Correia Gomes, Francisco de Assis Acurcio, and Juliana Alvares-Teodoro
Subjects: National health, Service (business), Teledermatology, Health economics, Primary Health Care, business.industry, Cost-Benefit Analysis, Health Policy, Decision tree, Health services research, Dermatology, Telehealth, medicine.disease, Cost-minimization analysis, Humans, Medicine, Medical emergency, business, Referral and Consultation, Brazil, health care economics and organizations
Abstract: Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients’ access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.
Published: 2021

3. Institutional Usage of Ferric Pyrophosphate Citrate (FPC) Delivered Via Dialysate in Reducing Erythropoiesis Stimulating Agents (ESAs) and IV Iron Cost

Author: Naveed Masani, Shan Wang, Louis Dellafera, Brian Malone, Meredith Akerman, Paula Dutka, and Lameesa Dhanani
Subjects: Pharmacology, Nephrology, medicine.medical_specialty, business.industry, Pharmacy, Dialysis patients, Multiple factors, Original Research Articles, Internal medicine, medicine, Iron deficient, FERRIC PYROPHOSPHATE CITRATE, Erythropoiesis, Pharmacology (medical), Hemoglobin, business
Abstract: Dialysis patients are often iron deficient due to a multiple factors. Ferric pyrophosphate citrate is a complex iron salt that can be given via dialysate allowing maintenance of hemoglobin (Hgb) concentration and iron balance while reducing the need for IV iron. The purpose of this study is to perform a cost evaluation of FPC and the effect it has on lowering the dose/use of ESAs and IV iron therapy. This study reviewed the same 100 hemodialysis patient’s charts before and after the use of FPC. The data points that were collected and analyzed are as follows: hemoglobin, ferritin levels, average weekly ESA dosing, and IV iron replacement therapy dose. Out of 100 patients, there was no statistical difference in the average hemoglobin, ferritin, and iron saturation levels observed in the patients before and after FPC use. The average weekly dose of darbepoetin alfa per patient was 52.74 μg before the FPC group compared to 39.27 μg in the post FPC group ( P
Published: 2021

4. Cannabis, anesthesia and acute postoperative pain: known and unknown

Author: Michael Akerman, Rob White, Rohan Jotwani, Roniel Weinberg, and Evgeny Bulat
Subjects: Analgesics, Pain, Postoperative, biology, business.industry, General Medicine, Research needs, Perioperative, Cannabis use, Affect (psychology), biology.organism_classification, Anesthesia, Anesthetic, medicine, Humans, Acute postoperative pain, Cannabis, business, Acute pain, Anesthetics, medicine.drug
Abstract: Tweetable abstract Cannabis use may significantly affect anesthetic, perioperative and acute pain management care; but research needs to be standardized, expanded and more inclusive.
Published: 2021

5. Heat Tolerance and Occupational Heat Exposure Limits in Older Men with and without Type 2 Diabetes or Hypertension

Author: Pierre Boulay, Andreas D. Flouris, Brian J. Friesen, Emma McCourt, Sean R. Notley, Martin P. Poirier, Marcel Ruzicka, Glen P. Kenny, Ashley P. Akerman, and Ronald J. Sigal
Subjects: medicine.medical_specialty, business.industry, Wet-bulb globe temperature, Physical Therapy, Sports Therapy and Rehabilitation, Type 2 diabetes, Core temperature, medicine.disease, Heat tolerance, Internal medicine, Heart rate, Metabolic rate, Cardiology, medicine, Orthopedics and Sports Medicine, Heart rate reserve, Cardiovascular strain, business
Abstract: Purpose To mitigate rises in core temperature >1°C, the American Conference of Governmental Industrial Hygienists (ACGIH) recommends upper limits for heat stress (action limit values [ALV]), defined by wet-bulb globe temperature (WBGT) and a worker's metabolic rate. However, these limits are based on data from young men and are assumed to be suitable for all workers, irrespective of age or health status. We therefore explored the effect of aging, type 2 diabetes (T2D), and hypertension (HTN) on tolerance to prolonged, moderate-intensity work above and below these limits. Methods Core temperature and heart rate were assessed in healthy, heat unacclimatized young (18-30 yr, n = 13) and older (50-70 yr) men (n = 14) and heat unacclimatized older men with T2D (n = 10) or HTN (n = 13) during moderate-intensity (metabolic rate: 200 W·m-2) walking for 180 min (or until termination) in environments above (28°C and 32°C WBGT) and below (16°C and 24°C WBGT) the ALV for continuous work at this intensity (25°C WBGT). Results Work tolerance in the 32°C WBGT was shorter in men with T2D (median [IQR]; 109 [91-173] min; P = 0.041) and HTN (120 [65-170] min; P = 0.010) compared with healthy older men (180 [133-180] min). However, aging, T2D, and HTN did not significantly influence (i) core temperature or heart rate reserve, irrespective of WBGT; (ii) the probability that core temperature exceeded recommended limits (>1°C) under the ALV; and (iii) work duration before core temperature exceeded recommended limits (>1°C) above the ALV. Conclusion These findings demonstrate that T2D and HTN attenuate tolerance to uncompensable heat stress (32°C WBGT); however, these chronic diseases do not significantly impact thermal and cardiovascular strain, or the validity of ACIGH recommendations during moderate-intensity work.
Published: 2021

6. Seasonal variation of respiratory viral infections: a comparative study between children with cancer undergoing chemotherapy and children without cancer

Author: Chana L Glasser, Asif Noor, Mark E. Weinblatt, Shahidul Islam, Tal Dror, and Meredith Akerman
Subjects: Adult, Male, medicine.medical_specialty, Neutropenia, Adolescent, Rhinovirus, medicine.drug_class, medicine.medical_treatment, Antibiotics, Antineoplastic Agents, medicine.disease_cause, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Internal medicine, Influenza, Human, Epidemiology, medicine, Humans, Child, Respiratory Tract Infections, Enterovirus, Retrospective Studies, Chemotherapy, business.industry, Immunoglobulins, Intravenous, Infant, Cancer, Retrospective cohort study, Hematology, Emergency department, medicine.disease, Anti-Bacterial Agents, Coronavirus, Hospitalization, Oncology, Virus Diseases, Child, Preschool, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, Respiratory virus, Female, Seasons, business, 030215 immunology
Abstract: Respiratory viral infections (RVIs) affect children year-round, with seasonal-specific patterns. Pediatric oncology patients are uniquely vulnerable to infection, but whether this predisposes them to different patterns of RVIs than healthy children is unknown. There is also limited data on the impact of RVIs on cancer patients. We conducted a retrospective study of children ages 1-21 with cancer presenting to the clinic and emergency department (ED) and a randomly selected subset of patients without cancer presenting to the ED who had positive nasopharyngeal viral polymerase chain reactions at our institution from 2014 to 2019. Sixty-seven cancer patients (206 RVI episodes) and 225 pediatric non-cancer patients (237 RVI episodes) were included. Human rhino/enterovirus (HRE) was the most common infection in both groups in the spring, summer, and fall. In the winter, the most common RVI was influenza in cancer patients verses respiratory syncytial virus in non-cancer patients. On age-adjusted analysis, the likelihood of detecting coronavirus in the winter, HRE in the spring and fall, and parainfluenza in the summer was significantly greater in cancer patients (OR = 2.60, 2.52, 5.73, 3.59 respectively). Among cancer RVI episodes, 50% received parenteral antibiotics, 22% were severely neutropenic, 22% had chemotherapy delays for a median of six days, 16% were hospitalized, and 6% received intravenous immunoglobulin. We conclude that there are differences in the seasonal patterns of RVIs between children with and without cancer. RVIs also cause significant morbidity in children with cancer.
Published: 2021

7. Exercise-heat tolerance in middle-aged-to-older men with type 2 diabetes

Author: Ashley P. Akerman, Sean R. Notley, Ronald J. Sigal, Andreas D. Flouris, Brian J. Friesen, Pierre Boulay, and Glen P. Kenny
Subjects: medicine.medical_specialty, business.industry, Endocrinology, Diabetes and Metabolism, General Medicine, Type 2 diabetes, 030204 cardiovascular system & hematology, Thermoregulation, medicine.disease, Heat tolerance, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Internal medicine, Diabetes mellitus, Internal Medicine, Medicine, 030212 general & internal medicine, business
Published: 2021

8. Challenging Ethical Scenarios in the Surgical Treatment of Erectile Dysfunction: A Survey of High-Volume Penile Prosthesis Surgeons

Author: Brad Figler, Elizabeth Sonntag, Charan S Mohan, Mark Ehlers, Jason P. Akerman, R. Matthew Coward, and Solomon Hayon
Subjects: Response rate (survey), medicine.medical_specialty, business.industry, Urology, media_common.quotation_subject, Sex offender, medicine.medical_treatment, education, Beneficence, 030232 urology & nephrology, MEDLINE, Penile prosthesis, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Erectile dysfunction, 030220 oncology & carcinogenesis, Medicine, Justice (ethics), business, Intensive care medicine, Autonomy, media_common
Abstract: OBJECTIVE To investigate how surgeons approach ethically challenging scenarios that arise in penile prosthesis surgery and identify patient-related factors that impact their approach. METHODS A survey was distributed to the Society for Urologic Prosthetic Surgeons membership consisting of 6 ethically challenging scenarios: an HIV+ patient, a patient with cognitive disability, a registered sex offender, a nonverbal patient, a litigious patient, and an uncontrolled diabetic patient whose insurance will lapse soon. Additional clinical information was provided to assess how the likelihood to offer surgery might change. The primary outcome was the likelihood of offering surgery in each scenario. RESULTS The response rate was 15.6% (n = 29). When compared to the baseline patient, respondents had a lower likelihood of offering surgery in all scenarios except the HIV+ patient, with the lowest likelihood of offering surgery to a sex offender (P CONCLUSION Ethical principles, including respect for autonomy, nonmaleficence, beneficence, and justice, are appropriately applied by urological prosthetic surgeons when ethical challenges arise. While the likelihood of offering penile prosthesis surgery is decreased with most ethical dilemmas, specific clinical factors often augment decision-making.
Published: 2021

9. 1540‐nm fractional erbium: Glass laser is a safe and effective modality for nonablative facial rejuvenation

Author: Emmilia Hodak, Moshe Lapidoth, Daniel Mimouni, Assi Levi, Lehavit Akerman, Efrat Solomon-Cohen, and Dan Slodownik
Subjects: Erythema, Facial rejuvenation, Dentistry, chemistry.chemical_element, Lasers, Solid-State, Dermatology, Erbium, 030207 dermatology & venereal diseases, 03 medical and health sciences, Glass laser, Laser treatments, 0302 clinical medicine, Patient satisfaction, Ablative case, Humans, Rejuvenation, Medicine, Retrospective Studies, Modality (human–computer interaction), business.industry, Skin Aging, Treatment Outcome, chemistry, Face, 030220 oncology & carcinogenesis, Laser Therapy, medicine.symptom, business
Abstract: Background Laser treatments for facial rejuvenation are common, with ablative modalities being of more common use for this indication. Efficient nonablative modalities are of rising demand. Aim Our aim was to determine the safety and efficacy of high-fluence, nonablative 1540-nm fractional Erbium:glass laser for facial rejuvenation. Patients and methods A retrospective study of patients treated with 3-4 treatments using the 1540-nm fractional Erbium:glass laser for facial rejuvenation, using 2500-3000 mJ/stacked pulses (51-61 mJ per pixel). Patients were followed-up for 3 months following their last treatment. Before and after photos were independently blindly evaluated by 2 dermatologists, who graded them using a scale from 0 (exacerbation) to 4 (76%-100% improvement) for 2 different facial regions (frontal face region and lateral canthal region). Pain perception and adverse effects as well as patient satisfaction were documented throughout the study. Results Sixteen patients completed both treatment and follow-up period. At the 3-months posttreatment follow-up visit, moderate-to-significant improvement in rhytids appearance (mean grade of improvement: 2.93 for frontal face and 3 for lateral canthal region) was observed. Patients' satisfaction was high (4.25). Patients reported mild and transient erythema posttreatment with no other adverse effects. Conclusion The high-fluence 1540-nm fractional Erbium:glass laser is a safe and effective nonablative modality for facial rejuvenation.
Published: 2021

10. A combination of 1064 nm Q‐switched fractional ND‐YAG laser with a nonfractional microsecond pulsed technology has a synergistic effect for nonablative facial rejuvenation

Author: Assi Levi, Efrat Solomon-Cohen, Moshe Lapidoth, Lehavit Akerman, Daniel Hilewitz, and Eran Sharon
Subjects: Adult, Technology, genetic structures, Facial rejuvenation, Lasers, Solid-State, Dermatology, law.invention, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, law, Ablative case, Humans, Rejuvenation, Medicine, Facial erythema, Wrinkle, Aged, Retrospective Studies, business.industry, Middle Aged, Laser, Skin Aging, Microsecond, Treatment Outcome, 030220 oncology & carcinogenesis, Nd:YAG laser, Female, medicine.symptom, business, Biomedical engineering
Abstract: Background Non-ablative fractionated lasers for facial rejuvenation are increasingly preferred over ablative lasers due to their minimal downtime and fewer adverse events. The synergistic effect of the Q-switched fractional (QSF) 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, in combination with the non-fractional microsecond pulsed technology has yet to be fully evaluated. Aim Our objective was to determine the safety and efficacy of this combination treatment for skin rejuvenation. Methods Patients who underwent treatment using the QSF-Nd:YAG laser, followed by the non-fractional microsecond pulsed Nd:YAG were evaluated retrospectively using a novel 3D imaging modality for degree of facial erythema, wrinkles surface area, and wrinkle depth. Pain perception, adverse effects, and patient satisfaction were assessed at the 2-month post-treatment follow-up visit, graded on a scale of 1- 5 (1 = not satisfied, 5 = very satisfied). Results Ten female patients' ages 44-67 (mean 55 years) completed both treatment and follow-up period, with an overall mild improvement in facial erythema and wrinkle surface area (mean improvement of 18% and 19.5% accordingly), as well as a mild improvement in overall wrinkle depth. Pain and adverse effects were mild and transient. Patients' satisfaction was high. Conclusion The combination of the QSF-Nd:YAG laser and non-fractional microsecond pulsed technology, using a single Nd:YAG 1064 nm laser platform, was found safe and effective as a non-ablative modality for facial rejuvenation, as demonstrated by a novel 3D imaging modality.
Published: 2021

11. Myths and methodologies: Reliability of forearm cutaneous vasodilatation measured using laser‐Doppler flowmetry during whole‐body passive heating

Author: Mohamed R. Gemae, Glen P. Kenny, Gregory W. McGarr, Maura M. Rutherford, Sean R. Notley, Ashley P. Akerman, Robert D. Meade, and Madison D. Schmidt
Subjects: Adult, Male, medicine.medical_specialty, Mean arterial pressure, Hot Temperature, Physiology, Intraclass correlation, Coefficient of variation, 030204 cardiovascular system & hematology, Heating, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Consistency (statistics), Physiology (medical), Internal medicine, Laser-Doppler Flowmetry, medicine, Humans, Reliability (statistics), Skin, Reproducibility, Nutrition and Dietetics, business.industry, Reproducibility of Results, General Medicine, Repeatability, Laser Doppler velocimetry, Vasodilation, Forearm, Regional Blood Flow, Cardiology, business, 030217 neurology & neurosurgery
Abstract: Laser-Doppler flowmetry (LDF) is commonly used to assess cutaneous vasodilatation responses, but its reliability (i.e. consistency) during whole-body passive heating is unknown. We therefore assessed the reliability of LDF-derived indices of cutaneous vasodilatation during incremental whole-body heating. Fourteen young men (age: 24 (SD 5) years) completed three identical trials, each separated by 1 week. During each trial, a water-perfused suit was used to raise and clamp oesophageal temperature at 0.6°C (low-heat strain; LHS) and 1.2°C (moderate-heat strain; MHS) above baseline. LDF-derived skin blood flow (SkBF) was measured at three dorsal mid-forearm sites, with local skin temperature clamped at 34°C. Data were expressed as absolute cutaneous vascular conductance (CVCabs ; SkBF/mean arterial pressure) and normalised to maximal conductance (%CVCmax ) achieved via simultaneous local skin heating to 44°C and increasing oesophageal temperature to 1.8°C above baseline. Between-day reliability was characterised as measurement consistency across trials, while within-day reliability was characterised as measurement consistency across adjacent skin sites during each trial. Between- and within-day absolute reliability (coefficient of variation) generally improved with increasing heat strain, changing from poor (>25%) at baseline, poor-to-moderate (15-34%) at LHS, and moderate (10-25%) at MHS. Generally, these estimates were more consistent when expressed as %CVCmax . Conversely, relative reliability was mostly acceptable (intraclass correlation coefficient ≥0.70) during LHS and when data were expressed as CVCabs . These findings indicate that the consistency of LDF-derived CVC estimates during heat stress depends on the level of heat strain and method of data expression, which should be considered when designing and interpreting experiments.
Published: 2020

12. Regional variation in the reliability of sweat rate measured via the ventilated capsule technique during passive heating

Author: Maura M. Rutherford, Sean R. Notley, Glen P. Kenny, Madison D. Schmidt, Robert D. Meade, and Ashley P. Akerman
Subjects: Male, Hot Temperature, Physiology, Intraclass correlation, Coefficient of variation, Sweating, 030204 cardiovascular system & hematology, Biceps, Heating, 03 medical and health sciences, 0302 clinical medicine, Forearm, Physiology (medical), Humans, Medicine, Sweat, Reliability (statistics), Skin, Reproducibility, Nutrition and Dietetics, integumentary system, business.industry, Reproducibility of Results, General Medicine, Repeatability, medicine.anatomical_structure, Forehead, business, Nuclear medicine, 030217 neurology & neurosurgery
Abstract: The ventilated capsule technique is widely used to measure time-dependent changes in sweating in humans. However, evaluations of its reliability (consistency) have been restricted to the forearm, despite extensive regional heterogeneity in the sweating response. Given the importance of such information for experimental design, statistical analysis and interpretation, we determined the reliability of local sweat rate at nine sites during whole-body passive (resting) heating. On three separate occasions, a water-perfused suit was used to increase and clamp oesophageal temperature 0.6, 1.2 and 1.8°C above baseline in 14 young men [24 (SD 5) years of age], while sweat rate was measured at the forehead, chest, abdomen, biceps, forearm, hand, quadriceps, calf and foot using ventilated capsules (3.8 cm2 ). Absolute and relative reliability were determined via the coefficient of variation (CV) and intraclass correlation coefficient (ICC), respectively. At low heat strain (0.6°C), almost all sites had acceptable relative reliability (ICC ≥ 0.70) and moderate absolute reliability (CV < 25%). At moderate heat strain (1.2°C), only the abdomen, hand, quadriceps and foot had acceptable relative reliability, whereas the forehead, abdomen, forearm, hand and quadriceps had moderate absolute reliability. At high heat strain (1.8°C), relative reliability was acceptable at the abdomen, quadriceps, calf and foot, whereas the chest, abdomen, forearm, hand, quadriceps, calf and foot had moderate absolute reliability. Our findings indicate that the measurement site and level of heat strain impact the consistency of local sweat rate measured via the ventilated capsule technique, and we demonstrate the possible implications for research design and data interpretation.
Published: 2020

13. Do subtle findings on chest X-ray predict worse outcomes for paediatric asthma?

Author: Meredith Akerman, Melodi Pirzada, Claudia Halaby, and Michael Abeles
Subjects: medicine.medical_specialty, Adolescent, 03 medical and health sciences, 0302 clinical medicine, Adrenal Cortex Hormones, 030225 pediatrics, Internal medicine, medicine, Humans, Outpatient clinic, 030212 general & internal medicine, Child, Retrospective Studies, Asthma, medicine.diagnostic_test, business.industry, X-Rays, Infant, Newborn, Infant, Retrospective cohort study, General Medicine, Emergency department, medicine.disease, Peribronchial Thickening, Chronic cough, Paediatric asthma, Child, Preschool, medicine.symptom, Emergency Service, Hospital, Chest radiograph, business
Abstract: Background Asthma, a common childhood condition, often presents with chronic cough. While evaluating for chronic cough, many specialists obtain a baseline chest radiograph (CR) to assess for other causes. Usually read as ‘normal’, sometimes CRs will reveal evidence of airway inflammation in the form of subtle findings, such as ‘increased interstitial markings’ or ‘peribronchial thickening’. There is sparse literature in the outpatient setting correlating findings on baseline CRs with adverse outcomes such as systemic steroid use, emergency department (ED) visit or hospitalisation. Methods This was a retrospective study of patients seen at our institution's Pediatric Pulmonology outpatient clinic. We reviewed the charts of all new patients aged 0–18 years who presented between January 2015 and December 2017. Patients were included if they were diagnosed with asthma, had a CR after the initial visit and were followed up at least twice. Adverse outcomes include systemic steroid use, ED visit or hospitalisation. Results 130 subjects were included. 89 subjects had clear CRs and 41 subjects had CRs with airway inflammation. Overall events were higher in the airway inflammation group (22.5% vs 46.3%, respectively, p Conclusion This study shows a positive correlation between airway inflammation findings on baseline CR and subsequent ED visits in patients with asthma.
Published: 2020

14. Evaluation of Opioid Overdose Reports in Patients Treated with Extended-Release Naltrexone: Postmarketing Data from 2006 to 2018

Author: Kimberley McKinnell, Maria A. Sullivan, Priya Jain, James Fratantonio, Prashanthi Vunnava, Sarah C. Akerman, Avani Desai, Made Wenten, Gary Bloomgren, Marie A. Liles-Burden, and Rose Marino
Subjects: Narcotic Antagonists, Toxicology, Injections, Intramuscular, 030226 pharmacology & pharmacy, Naltrexone, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Pharmacology (medical), In patient, Original Research Article, 030212 general & internal medicine, Adverse effect, Pharmacology, business.industry, Opioid overdose, Drug Tolerance, Opioid-Related Disorders, medicine.disease, Blockade, Discontinuation, Analgesics, Opioid, Opiate Overdose, Extended release naltrexone, Delayed-Action Preparations, Anesthesia, business, human activities, After treatment, medicine.drug
Abstract: Introduction After treatment with naltrexone extended-release injectable suspension (XR-NTX), a µ-opioid receptor antagonist, opioid tolerance is reduced from pretreatment baseline. Patients may be vulnerable to opioid overdose if they attempt to override the blockade during treatment, at the end of a dosing interval, after missing a dose, or after discontinuing treatment. Objective We analyzed postmarketing data to characterize reporting rates of opioid overdose during treatment with and after discontinuation of XR-NTX. Methods Postmarketing adverse event reports within the XR-NTX safety database, received 2006–2018, for patients treated with XR-NTX for any indication were reviewed for opioid overdose cases. Assessable cases were categorized by timing of the event from the last dose of XR-NTX (latency): ≤28 days (on treatment), 29–56 days, and >56 days from last dose of XR-NTX. Within each latency group, cases were further classified as serious and, of those, cases that had a fatal outcome. Results During the 12-year period, an estimated 495,602 patients received XR-NTX. Opioid overdose was reported in 161 cases; of these, 66 contained sufficient information to determine latency. Reporting rates of opioid overdose per 10,000 patients treated were similar among latency groups: 0.54 for ≤28 days (0.24 fatal), 0.34 for 29–56 days (0.16 fatal), and 0.44 for >56 days (0.40 fatal) from the last dose of XR-NTX. Conclusions Over the 12-year period, the reporting rates of opioid overdose were similar during treatment with or after discontinuation of XR-NTX and
Published: 2020

15. Impact of cesarean delivery due to maternal choice on perinatal outcome in term nulliparous patients with a singleton fetus in a vertex presentation

Author: Eva Hoffmann, Rosanne Vertichio, Genevieve Sicuranza, Meredith Akerman, William S. Vintzileos, and Anthony M. Vintzileos
Subjects: medicine.medical_specialty, Perinatal outcome, Maternal choice, 03 medical and health sciences, Fetus, 0302 clinical medicine, Pregnancy, medicine, Humans, 030212 general & internal medicine, Cesarean delivery, reproductive and urinary physiology, Retrospective Studies, 030219 obstetrics & reproductive medicine, Cesarean Section, Singleton, Obstetrics, business.industry, Infant, Newborn, Parturition, Obstetrics and Gynecology, Vertex (anatomy), female genital diseases and pregnancy complications, medicine.anatomical_structure, Case-Control Studies, Pediatrics, Perinatology and Child Health, Female, Vertex Presentation, business
Abstract: The objectives of our study were to: (1) evaluate the prevalence of cesarean delivery due to maternal request among nulliparous, term, singleton, vertex (NTSV) patients; (2) identify the clinical profile, if any, of these patients; and (3) compare the perinatal outcomes between NTSV patients who requested a cesarean delivery versus patients who did not request cesarean delivery.This was a retrospective case control study performed at a single institution between November 2018 and July 2019. All NTSV patients who had a cesarean delivery due to maternal choice were identified and compared to the next two NTSV patients in labor who delivered vaginally or by medically indicated cesarean delivery following a cesarean delivery by maternal choice. The primary outcome was composite neonatal morbidity. Secondary outcomes were individual components of composite neonatal and maternal morbidity.Of 1138 NTSV patients, 61 (5.4%) patients opted for cesarean delivery by maternal choice. There were significant differences in the demographic/clinical profile between cases and controls including BMI (35.3 kg/mCesarean delivery by maternal choice in NTSV patients is not associated with improved neonatal outcomes; in contrast, it is associated with increased composite maternal morbidity and increased transfusion rate.
Published: 2020

16. The acute effect of resistance exercise on limb blood flow

Author: Travis D. Gibbons, James D. Cotter, Andre M. van Rij, Lorenz S Kissling, Ashley P. Akerman, and Kate N. Thomas
Subjects: Adult, Male, medicine.medical_specialty, Brachial Artery, Physiology, Hemodynamics, Blood Pressure, Acute effect, 030204 cardiovascular system & hematology, Health benefits, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), Internal medicine, medicine, Humans, Muscle, Skeletal, Exercise, Nutrition and Dietetics, business.industry, Resistance training, Extremities, Resistance Training, General Medicine, Blood flow, Muscle oxygenation, Adaptation, Physiological, Peripheral, Vasodilation, Blood pressure, Regional Blood Flow, Cardiology, Female, Endothelium, Vascular, Stress, Mechanical, business, Blood Flow Velocity, 030217 neurology & neurosurgery
Abstract: New findings What is the central question of this study? How does resistance exercise affect peripheral haemodynamics in the active and inactive limb? What is the main finding and its importance? Preliminary data indicate that resistance exercise increases flow and shear rate in the active limb transiently. The same exercise has minimal, short-lasting influence on peripheral haemodynamics in the inactive limb, but further research is required to elaborate on resistance exercise-mediated changes in vascular function in active and inactive limbs. Abstract Current evidence indicates that to achieve maximum health benefits, regular resistance exercise should be a key component of structured physical activity. Several studies have revealed that regular resistance exercise may be associated with impaired vascular function, although this finding is inconsistent. Proposed explanations for impairment include substantial increases in blood pressure and increased retrograde blood flow in active limbs promoted by resistance exercise. However, few studies have examined the acute haemodynamics of resistance exercise in active - and even fewer in inactive - limbs. The purpose of this study was to characterise the haemodynamic responses in peripheral arteries in active and inactive limbs in response to resistance exercise using upper and lower limbs. Ten participants (five male, five female) familiar with resistance training performed three sets of 10 isotonic repetitions of right-sided bicep curls or knee extensions on separate days. Blood flow, shear rate and muscle oxygenation in the active and inactive limb, and blood pressure were measured before and for 3 min after each set. Blood flow increased in response to resistance exercise in the active limb (∼8-fold and ∼6-fold for the upper and lower limb respectively), with concurrent significant increases in mean and antegrade shear rate. In the inactive limb, blood flow more than doubled for both upper and lower limb exercise, transiently, with no significant change in retrograde shear rate. These acute blood flow profiles following resistance exercise are not indicative of long-term vessel impairment based on current understanding of blood flow and shear stress patterns.
Published: 2020

17. Impact of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Detection on Breastfeeding Due to Infant Separation at Birth

Author: Alexandra Vinci, Estela Noyola, Stephanie Popofsky, Billy Pak, Asif Noor, Meredith Akerman, Ann Mock, Jill Leavens-Maurer, Maria Lyn Quintos-Alagheband, Nazeeh Hanna, Eileen Magri, Jennifer Lighter, Leonard R. Krilov, Mona Rigaud, and Adam J. Ratner
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Separation (statistics), Breastfeeding, Kaplan-Meier Estimate, Asymptomatic, Article, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, 030225 pediatrics, medicine, Humans, Longitudinal Studies, Pediatrics, Perinatology, and Child Health, 030212 general & internal medicine, Pregnancy Complications, Infectious, Maternal Behavior, Obstetrics, business.industry, Significant difference, Infant, Newborn, COVID-19, Infectious Disease Transmission, Vertical, Expressed breast milk, Hospitalization, Breast Feeding, COVID-19 Nucleic Acid Testing, Infant Care, Pediatrics, Perinatology and Child Health, Female, Observational study, medicine.symptom, business
Abstract: OBJECTIVE: To assess the impact of separation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR)-positive mother-newborn dyads on breastfeeding outcomes. STUDY DESIGN: This observational longitudinal cohort study of mothers with SARS-CoV-2 PCR-and their infants at 3 NYU Langone Health hospitals was conducted between March 25, 2020, and May 30, 2020. Mothers were surveyed by telephone regarding predelivery feeding plans, in-hospital feeding, and home feeding of their neonates. Any change prompted an additional question to determine whether this change was due to coronavirus disease-2019 (COVID-19). RESULTS: Of the 160 mother-newborn dyads, 103 mothers were reached by telephone, and 85 consented to participate. There was no significant difference in the predelivery feeding plan between the separated and unseparated dyads (P = .268). Higher rates of breastfeeding were observed in the unseparated dyads compared with the separated dyads both in the hospital (P
Published: 2020

18. Preclinical studies investigating the neural mechanisms involved in the co‐morbidity of migraine and temporomandibular disorders: the role of CGRP

Author: Simon Akerman and Marcela Romero-Reyes
Subjects: 0301 basic medicine, Calcitonin Gene-Related Peptide, Migraine Disorders, medicine.medical_treatment, Freund's Adjuvant, Inflammation, Calcitonin gene-related peptide, 03 medical and health sciences, 0302 clinical medicine, medicine, Animals, Humans, Pharmacology, business.industry, Antagonist, Temporomandibular Joint Disorders, medicine.disease, Research Papers, Phenotype, Pathophysiology, Rats, Electrophysiology, 030104 developmental biology, Migraine, Morbidity, medicine.symptom, business, Adjuvant, Neuroscience, 030217 neurology & neurosurgery
Abstract: Background and purpose Temporomandibular disorders (TMD) and migraine can be co-morbid. This can be a significant factor in exacerbating and increasing the prevalence of migraine-like symptoms. However, the underlying mechanisms involved are unknown. Our objective was to investigate these neural mechanisms and the role of CGRP as a key modulator in this co-morbidity. Experimental approach We combined experimental approaches using CGRP, which triggers a migraine-like response in patients, with that of masseteric muscle injection of complete Freund's adjuvant (CFA), to model myofascial TMD-like inflammation. Using validated electrophysiological methods to assess each of the above approaches independently or in combination, we examined their effects on the response properties of migraine-like dural-trigeminocervical neurons. Key results Independently, in ~2/3 of animals (rats) each approach caused delayed migraine-like activation and sensitisation of dural-trigeminocervical neurons. The response to masseteric-CFA was attenuated by a selective CGRP receptor antagonist. The combination approach caused a migraine-like neuronal response in all animals tested, with somatosensory-evoked cranial hypersensitivity significantly exacerbated. Conclusion and implications The data demonstrate a neuronal phenotype that translates to the exacerbated clinical co-morbid phenotype, supporting this combination approach as a relevant model to study the mechanisms involved. It provides a pathophysiological rationale for this exacerbated phenotype, strongly implicating the involvement of CGRP. The results provide support for targeting the CGRP pathway as a novel monotherapy approach for treating this co-morbid condition. This has key implications into our understanding of this co-morbid condition, as well as potentially addressing the major unmet need for novel and effective therapeutic approaches.
Published: 2020

19. Impact of uncomplicated controlled hypertension on thermoregulation during exercise-heat stress

Author: Marcel Ruzicka, Sean R. Notley, Ronald J. Sigal, Pierre Boulay, Brian J. Friesen, Ashley P. Akerman, and Glen P. Kenny
Subjects: Healthy behavior, medicine.medical_specialty, business.industry, Skin blood flow, Uncomplicated hypertension, Heat losses, 030204 cardiovascular system & hematology, Core temperature, Thermoregulation, Heat stress, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Internal Medicine, Cardiology, Medicine, 030212 general & internal medicine, business
Abstract: Exercise is promoted for management of hypertension and as a general healthy behavior, but environmental conditions are seldom considered in these recommendations. Hypertension may affect skin blood flow and sweating, two of the primary mechanisms which prevent continued elevations in core temperature by facilitating whole-body heat loss during exercise-heat stress. We show that during incremental exercise-heat stress (in hot-dry conditions), controlled and uncomplicated hypertension is unlikely to exert a meaningful effect on whole-body heat loss in individuals who are already physically active.
Published: 2020

20. Dose–response relationship between local anesthetic volume and hemidiaphragmatic paresis following ultrasound-guided supraclavicular brachial plexus blockade

Author: Kane O. Pryor, Michael Akerman, Hannah Oden-Brunson, David S Wellman, Daniel J. Pak, Virginia Tangel, Hannah X Lin, and Tiffany Tedore
Subjects: medicine.drug_class, Population, Article, medicine, Humans, Anesthetics, Local, Respiratory system, education, Ultrasonography, Interventional, Ultrasonography, Paresis, education.field_of_study, business.industry, Local anesthetic, Ultrasound, Respiratory disease, General Medicine, medicine.disease, Brachial Plexus Block, Anesthesiology and Pain Medicine, Anesthesia, Anesthetic, medicine.symptom, business, Brachial plexus, medicine.drug
Abstract: BackgroundThere is no consensus regarding what volume of local anesthetic should be used to achieve successful supraclavicular block while minimizing hemidiaphragmatic paresis (HDP). This study investigated the dose–response relationship between local anesthetic volume and HDP after ultrasound-guided supraclavicular brachial plexus block.MethodsA dose escalation design was used to define the dose response curve for local anesthetic volume and incidence of HDP in subjects undergoing upper extremity surgery with supraclavicular block as the primary anesthetic. Dosing levels of 5, 10, 15, 20, 25, 30, 35 and 40 mL of local anesthetic were administered in cohorts of three subjects per dose. Diaphragm function was assessed with M-mode ultrasound before and after block. Secondary objectives included assessment of negative inspiratory force (NIF), oxygen saturation, subjective dyspnea and extent of sensory and motor blockade.ResultsTwenty-one subjects completed the study. HDP was present at all doses, with an incidence of 33% at 5 mL to 100% at 30–35 mL. There was a significant decrease in NIF (7.5 cmH2O, IQR (22,0); p=0.01) and oxygen saturation on room air (1%, IQR (2,0); p=0.01) 30 min postblock in subjects experiencing HDP but not in those without HDP. There was no increase in dyspnea in subjects with or without HDP. No subject required respiratory intervention. Motor and sensory block improved with increasing dose, and subjects with HDP exhibited denser blocks than those without (pConclusionsThere is no clinically relevant volume of local anesthetic at which HDP can be avoided when performing a supraclavicular block. In our subject population free of respiratory disease, HDP was well tolerated.Trial registration numberNCT03138577.
Published: 2020

21. Toward prevention of behavioral emergencies in a general hospital insights from a one-year series

Author: Meredith Akerman, Donald A. Brand, Aaron Pinkhasov, Adri Avishai, and Carlos Hallo
Subjects: Adult, Behavior Control, Male, medicine.medical_specialty, Comorbidity, Hospitals, General, Logistic regression, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Cognitive Dysfunction, 030212 general & internal medicine, General hospital, Noncommunicable Diseases, Rapid response team, Aged, Aged, 80 and over, Problem Behavior, Univariate analysis, business.industry, Mental Disorders, Cognition, Middle Aged, medicine.disease, 030227 psychiatry, Substance abuse, Psychiatry and Mental health, Cross-Sectional Studies, Emergency medicine, Delirium, Female, Emergencies, Nervous System Diseases, medicine.symptom, Risk assessment, business, Hospital Rapid Response Team
Abstract: Behavioral emergencies endanger hospital staff and patients. The objective of this study was to identify patient characteristics that could be used to predict and prevent these incidents.We analyzed a one-year consecutive series of behavioral emergencies that triggered the rapid response team at a general hospital, comparing study patients with controls who did not trigger a rapid response. Standard parametric or nonparametric tests, as appropriate, were used to compare the 2 groups in univariate analyses, and multivariable logistic regression analysis was used to identify the best combination of variables for stratifying the risk of such an event.There were 109 behavioral emergencies involving 83 patients. Comparison of patients who did (n = 83) or did not (n = 22,849) trigger a rapid response revealed marked differences between the two groups with respect to age, sex, and the prevalence of psychiatric comorbidities and various conditions that can diminish cognitive function. Substance use disorder was the most frequent principal diagnosis in the study group, accounting for 10.8% (9/83) of study patients vs. 0.6% (132/22849) of controls (p 0.0001). The presence of a condition that can impair cognition (substance intoxication and withdrawal, epilepsy, cerebrovascular disease, traumatic brain injury, delirium, dementia) was associated with a 13-fold increase in the risk of a behavioral disturbance (95% CI, 8 to 22-fold).Brief cognitive assessment of patients susceptible to cognitive impairment, along with diligent prophylaxis and management of substance withdrawal and delirium, may facilitate prevention of behavioral emergencies.
Published: 2020

22. 1064-nm Q-switched fractional Nd:YAG laser is safe and effective for the treatment of post-surgical facial scars

Author: Lehavit Akerman, Assi Levi, Moshe Lapidoth, Mati Rozenblat, Efrat Solomon-Cohen, and Emmilia Hodak
Subjects: medicine.medical_specialty, Post surgical, business.industry, Scars, 030206 dentistry, Dermatology, Surgery, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, Nd:YAG laser, medicine, Pain perception, medicine.symptom, business, Adverse effect, After treatment
Abstract: Post-surgical facial scars are often associated with unaesthetic outcome. Treatment of these scars using various lasers could be beneficial; however, the use of the Q-switched fractional (QSF) 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has yet to be evaluated for this indication. Our objective was to determine the safety and efficacy of a QSF-Nd:YAG laser for the treatment of post-surgical facial scars. Eleven (5 male, 6 female) patients who underwent facial surgery with significant scarring were treated using the QSF-Nd:YAG laser. Scars were exposed to 600–1200 mJ/stacked pulses (12–24 mJ per pixel), emitted at a rate of 10 Hz for up to 2 passes per treatment session, receiving overall 3–6 treatments. Patient follow-up was 3 months. Scars’ photographs were blindly assessed by two dermatologists, who graded them on a scale of scar severity from 1 to 5 (1 = least severe, 5 = most severe) before and after treatment. A blinded before/after recognition of these photographs was also performed. Patient satisfaction was assessed 3 months post-treatment and graded on a scale of 1–5 (1 = not satisfied, 5 = very satisfied). Pain perception and adverse effects were also evaluated. Patients demonstrated a decrease in scar severity score by a mean of 1.57 points (p = 0.0005). A blinded before/after recognition was correct in 86.5% of the cases. Pain and adverse effects were mild and transient. Patient satisfaction was high (4.2). QSF-Nd:YAG laser is a safe and effective modality for the treatment of post-surgical facial scars.
Published: 2020

23. Differential actions of indomethacin: clinical relevance in headache

Author: Philip R. Holland, Simon Akerman, Peter J. Goadsby, Jan Hoffmann, Anna P. Andreou, and Oliver Summ
Subjects: musculoskeletal diseases, Naproxen, Indomethacin, Stimulation, Ibuprofen, Pharmacology, Nitric oxide, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, 030202 anesthesiology, Primary headache, Medicine, Humans, Paroxysmal Hemicrania, biology, integumentary system, business.industry, organic chemicals, Nonsteroidal anti-inflammatory drugs, Anti-Inflammatory Agents, Non-Steroidal, Headache, Hemicrania continua, Cyclooxygenase inhibitor, Trigeminal, medicine.disease, musculoskeletal system, Anesthesiology and Pain Medicine, Neurology, chemistry, nervous system, biology.protein, Systemic administration, Neurology (clinical), Cyclooxygenase, business, 030217 neurology & neurosurgery, medicine.drug, Research Paper
Abstract: Indomethacin, naproxen, and ibuprofen inhibited nociceptive trigeminocervical neurons activated by stimulation of the dura mater, whereas only indomethacin inhibited responses activated by a nitric oxide donor., Nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, are used routinely in the treatment of primary headache disorders. Indomethacin is unique in its use in the diagnosis and treatment of hemicrania continua and paroxysmal hemicrania. The mechanism of this specific action is not fully understood, although an interaction with nitric oxide (NO) signaling pathways has been suggested. Trigeminovascular neurons were activated by dural electrical stimulation, systemic administration of an NO donor, or local microiontophoresis of L-glutamate. Using electrophysiological techniques, we subsequently recorded the activation of trigeminovascular neurons and their responses to intravenous indomethacin, naproxen, and ibuprofen. Administration of indomethacin (5 mg·kg−1), ibuprofen (30 mg·kg−1), or naproxen (30 mg·kg−1) inhibited dural-evoked firing within the trigeminocervical complex with different temporal profiles. Similarly, both indomethacin and naproxen inhibited L-glutamate-evoked cell firing suggesting a common action. By contrast, only indomethacin was able to inhibit NO-induced firing. The differences in profile of effect of indomethacin may be fundamental to its ability to treat paroxysmal hemicrania and hemicrania continua. The data implicate NO-related signaling as a potential therapeutic approach to these disorders.
Published: 2020

24. Evidence for age‐related differences in heat acclimatisation responsiveness

Author: Martin P. Poirier, Ronald J. Sigal, Glen P. Kenny, Andreas D. Flouris, Sean R. Notley, Ashley P. Akerman, Robert D. Meade, and Pierre Boulay
Subjects: Adult, Male, Hot Temperature, Physiology, Acclimatization, Sweating, Calorimetry, 030204 cardiovascular system & hematology, Thermal energy storage, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Animal science, Physiology (medical), Age related, Humans, Medicine, Relative humidity, Young adult, Exercise, Aged, Nutrition and Dietetics, business.industry, Age Factors, Heat losses, Calorimetry, Indirect, General Medicine, Middle Aged, 13. Climate action, Ageing, Female, Basal Metabolism, Seasons, business, 030217 neurology & neurosurgery, Body Temperature Regulation
Abstract: NEW FINDINGS What is the central question of this study? Repeated heat exposure during the summer months can enhance heat loss in humans (seasonal heat acclimatisation), but does the magnitude of that enhancement differ between young and older adults when assessed during passive heat exposure? What is the main finding and its importance? While seasonal heat acclimatisation enhanced evaporative heat loss (i.e. sweating) in both young and older adults, those improvements led to a greater reduction in body heat storage in older adults. These outcomes indicate that heat acclimatisation may confer greater thermoregulatory benefits with increasing age. ABSTRACT Repeated heat exposure throughout summer can enhance heat loss in humans (seasonal heat acclimatisation), although the effect of ageing on those improvements remains unclear. We therefore sought to assess thermoregulatory function in young and older adults during environmental heat exposure prior to and following seasonal heat acclimatisation, hypothesizing that the magnitude of adaptation would be greater in older relative to young adults. To achieve this, 14 young (19-27 years) and 10 older adults (55-72 years), who resided in a temperate humid-continental climate, completed a 3 h resting heat exposure (44°C, ∼30% relative humidity) in the winter-spring months as part of a larger investigation (pre-acclimatisation), before being re-evaluated using the same heat stress test following the summer months (post-acclimatisation). Whole-body dry and evaporative heat exchange, and metabolic rate were measured throughout using direct and indirect calorimetry (respectively), and used to quantify body heat storage (metabolic rate + dry heat gain - evaporative heat loss). Evaporative heat loss increased in both groups following acclimatisation, but those improvements led to a decrease in body heat storage in older (mean difference (95% CI); 213 (295, 131) kJ; P
Published: 2020

25. From kamishibai card to key card: a family-targeted quality improvement initiative to reduce paediatric central line-associated bloodstream infections

Author: Melissa Grella, Ranjith Kamity, Maria Lyn Quintos-Alagheband, Maureen L. Kim, and Meredith Akerman
Subjects: Catheterization, Central Venous, Cross Infection, Infection Control, Central line, Quality management, business.industry, Health Policy, Audit, medicine.disease, Quality Improvement, Audit process, ATM card, Catheter-Related Infections, Sepsis, Health care, medicine, Humans, Guideline Adherence, Medical emergency, Family engagement, Child, business, Patient education
Abstract: BackgroundCentral line-associated bloodstream infections (CLABSIs) are major contributors to preventable harm in the inpatient paediatric setting. Despite multiple guidelines to reduce CLABSI, sustaining reliable central line maintenance bundle compliance remains elusive. We identified frontline and family engagement as key drivers for this initiative. The baseline CLABSI rate for all our paediatric inpatient units (January 2016–January 2017) was 1.71/1000 central line days with maintenance bundle compliance at 87.9% (monthly range 44%–100%).ObjectiveTo reduce CLABSI by increasing central line maintenance bundle compliance to greater than 90% using kamishibai card (K-card) audits and family ‘key card’ education.MethodsWe transitioned our central line maintenance bundle audits from checklists to directly observed K-card audits. K-cards list the central line maintenance bundle elements to be reviewed with frontline staff. Key cards are cue cards developed using a plain-language summary of CLABSI K-cards and used by frontline staff to educate families. Key cards were distributed to families of children with central lines to simultaneously engage patients, families and frontline staff after a successful implementation of the K-card audit process. A survey was used to obtain feedback from families.ResultsIn the postintervention period (February 2017–December 2019), our CLABSI rate was 0.63/1000 central line days, and maintenance bundle compliance improved to 97.1% (monthly range 86%–100%, pConclusionCombining the key card programme with K-card audits was associated with improved maintenance bundle compliance and a reduction in CLABSI. This programme has the potential for use in multiple healthcare improvement initiatives.
Published: 2020

26. Sperm Extraction in Obstructive Azoospermia

Author: Robert Matthew Coward, Solomon Hayon, and Jason P. Akerman
Subjects: Infertility, endocrine system, Surgical microscope, Assisted reproductive technology, In vitro fertilisation, urogenital system, business.industry, Urology, medicine.medical_treatment, 030232 urology & nephrology, Obstructive azoospermia, Bioinformatics, medicine.disease, Sperm, Intracytoplasmic sperm injection, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Sperm Retrieval, medicine, business, reproductive and urinary physiology
Abstract: For men with obstructive azoospermia, several surgical sperm retrieval techniques can facilitate conception with assisted reproductive technology. The evolution of both percutaneous and open approaches to sperm retrieval has been affected by technological innovations, including the surgical microscope, in vitro fertilization, and intracytoplasmic sperm injection. Further modifications to these procedures are designed to minimize patient morbidity and increase the quality and quantity of sperm samples. Innovative technologies promise to further ameliorate outcomes by selecting the highest quality sperm. Although various approaches to surgical sperm retrieval are now well established, several advancements in sperm selection and optimization are being developed.
Published: 2020

27. Hydrocortisone and bronchopulmonary dysplasia: variables associated with response in premature infants

Author: Stacey Thomas, Igor Khodak, Christie Clauss, Caterina Tiozzo, Meredith Akerman, Nazeeh Hanna, and Valentyna Tack
Subjects: Pediatrics, medicine.medical_specialty, Hydrocortisone, Intrauterine growth restriction, Infant, Premature, Diseases, Chorioamnionitis, Article, 03 medical and health sciences, Route of administration, 0302 clinical medicine, Pregnancy, 030225 pediatrics, medicine, Humans, In patient, 030212 general & internal medicine, Major complication, Dexamethasone, Bronchopulmonary Dysplasia, Retrospective Studies, Respiratory tract diseases, business.industry, Infant, Newborn, Obstetrics and Gynecology, medicine.disease, Bronchopulmonary dysplasia, Pediatrics, Perinatology and Child Health, Female, Drug therapy, business, Infant, Premature, medicine.drug
Abstract: Objective The primary objective was to evaluate hydrocortisone’s efficacy for decreasing respiratory support in premature infants with developing bronchopulmonary dysplasia (BPD). Secondary objectives included assessment of the impact of intrauterine growth restriction (IUGR), maternal history of chorioamnionitis, side effects and route of administration associated with hydrocortisone’s efficacy. Dexamethasone as second-line treatment to decrease respiratory support was reviewed. Methods Retrospective chart review of preterm infants requiring respiratory support receiving hydrocortisone. Results A total of 48 patients were included. Successful extubation was achieved in 50% of intubated patients after hydrocortisone treatment with no major complications. In our small study, history of maternal chorioamnionitis, IUGR or route of administration did not affect the response. Rescue dexamethasone after hydrocortisone therapy was ineffective in the ten patients who failed extubation following hydrocortisone. Conclusion Hydrocortisone is effective in decreasing respiratory support in patients with developing BPD without major complications. Randomized studies are warranted to confirm our findings.
Published: 2020

28. Transition of Patients with Opioid Use Disorder from Buprenorphine to Extended‐Release Naltrexone: A Randomized Clinical Trial Assessing Two Transition Regimens

Author: Antoine Douaihy, Sarah C. Akerman, Danesh Alam, Abigail Zavod, Narinder Nangia, Paolo Mannelli, Bernard L. Silverman, Maria A. Sullivan, and Sandra D. Comer
Subjects: Adult, Male, Narcotic Antagonists, Medicine (miscellaneous), Placebo, Naltrexone, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Naloxone, medicine, Clinical endpoint, Humans, 030212 general & internal medicine, Adverse effect, Dose-Response Relationship, Drug, business.industry, Drug Substitution, Opioid use disorder, Regular Article, medicine.disease, Opioid-Related Disorders, 030227 psychiatry, Buprenorphine, Substance Withdrawal Syndrome, Psychiatry and Mental health, Clinical Psychology, Treatment Outcome, Anesthesia, Delayed-Action Preparations, Female, Drug Monitoring, business, human activities, medicine.drug, Regular Articles
Abstract: Background and objective When patients seek to discontinue buprenorphine (BUP) treatment, monthly injectable extended-release naltrexone (XR-NTX) may help them avoid relapse. The efficacy of low ascending doses of oral NTX vs placebo for patients transitioning from BUP to XR-NTX is evaluated in this study. Methods In a phase 3, hybrid residential/outpatient study, clinically stable participants with opioid use disorder (N = 101), receiving BUP for more than or equal to 3 months and seeking antagonist treatment, were randomized (1:1) to 7 residential days of descending doses of BUP and low ascending doses of oral NTX (NTX/BUP, n = 50) or placebo (PBO-N/BUP, n = 51). Both groups received standing ancillary medications and psychoeducational counseling. Following negative naloxone challenge, participants received XR-NTX (day 8). The primary endpoint was the proportion of participants who received and tolerated XR-NTX. Results There was no statistical difference between groups for participants receiving a first dose of XR-NTX: 68.6% (NTX/BUP) vs 76.0% (PBO-N/BUP; P = .407). The mean number of days with peak Clinical Opiate Withdrawal Scale (COWS) score less than or equal to 12 during the treatment period (days 1-7) was similar for NTX/BUP and PBO-N/BUP groups (5.8 vs 6.3; P = .511). Opioid withdrawal symptoms during XR-NTX induction and post-XR-NTX observation period (days 8-11) were mild and similar between groups (mean peak COWS score: NTX/BUP, 5.1 vs PBO-N/BUP, 5.4; P = .464). Adverse events were mostly mild/moderate. Conclusions and scientific significance Low ascending doses of oral NTX did not increase induction rates onto XR-NTX compared with placebo. The overall rate of successful induction across treatment groups supports a brief BUP taper with standing ancillary medications as a well-tolerated approach for patients seeking transition from BUP to XR-NTX. (Am J Addict 2020;00:00-00).
Published: 2020

29. A Combined Triple-Wavelength (755nm, 810nm, and 1064nm) Laser Device for Hair Removal: Efficacy and Safety Study

Author: Galili Eran, Akerman Lehavit, Lapidoth Moshe, and Levi Assi
Subjects: Adult, Male, Dentistry, Hair Removal, law.invention, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, law, Photography, Hair removal, Humans, Pain perception, Medicine, Adverse effect, Retrospective Studies, business.industry, Retrospective cohort study, General Medicine, Middle Aged, Laser, Treatment efficacy, Treatment Outcome, Satisfaction rate, Patient Satisfaction, Lasers, Semiconductor, business, Follow-Up Studies, Hair
Abstract: Background Photoepilation by a single-wavelength laser device is being commonly used for hair removal. Whether emitting multiple laser wavelengths to induce hair unit damage would be beneficial is yet to be established. Objective To evaluate the safety and efficacy of hair reduction using a novel simultaneous multi-wavelength laser device. Patients and methods A retrospective cohort study was carried out among adult males. Hairy sites were treated by a simultaneous triple-wavelength (755nm, 810nm and 1064nm) laser device (Soprano Titanium. Caesarea, Israel: Alma Lasers Ltd). Treatment parameters were: fluence of 7-9J/cm2, pulse frequency of 9-10Hz and spot sizes of 2cm2 or 4cm2. Participants underwent up to 6 treatments at 6-8 weeks intervals and were followed for 4-6 months. Clinical photography before and after treatment was documented. Treatment efficacy was assessed using Global Aesthetic Improvement Scale (GAIS; scale of 0 [no improvement] to 4 [excellent improvement; Over 75% hair reduction]) by two independent dermatologists. Participantsr satisfaction was rated on a scale of 1 (not satisfied) to 5 (very satisfied). Pain perception and adverse events were recorded as well. Results A total of 27 treatment sites among 11 participants, with Fitzpatrick skin type III-V, were included. Mean hair reduction was 3.4 out of 4 in the GAIS. Participants' satisfaction rate was high (mean, 4.8). No adverse events were recorded. Conclusion Simultaneous triple-wavelength laser device is a safe and effective hair removal modality. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4735.
Published: 2020

30. PAC1 receptor blockade reduces central nociceptive activity: new approach for primary headache?

Author: Licheng Shi, Bryan D. Moyer, Margarida Martins-Oliveira, Hong Sun, Sonya G. Lehto, Peter J. Goadsby, Simon Akerman, Jan Hoffmann, Dawn Zhu, Weera Supronsinchai, Ruoyuan Yin, Cen Xu, Silke Miller, Judy Wang, and Hantao Liu
Subjects: Monoclonal antibody, Nociception, Cluster headache, PAC1 receptor, Migraine Disorders, Central nervous system, Pharmacology, 03 medical and health sciences, Trigeminal ganglion, 0302 clinical medicine, 030202 anesthesiology, medicine, Animals, Humans, Premovement neuronal activity, Receptor, Migraine, Sumatriptan, business.industry, Trigeminal activation, Headache, medicine.disease, Rats, Ganglion, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Neurology, Pituitary Adenylate Cyclase-Activating Polypeptide, Neurology (clinical), business, 030217 neurology & neurosurgery, Research Paper, Pituitary adenylate cyclase activating peptide, Receptors, Pituitary Adenylate Cyclase-Activating Polypeptide, Type I, medicine.drug
Abstract: PAC1 receptor blockade using a monoclonal antibody inhibits nociceptive neuronal activity in the trigeminocervical complex., Pituitary adenylate cyclase activating polypeptide-38 (PACAP38) may play an important role in primary headaches. Preclinical evidence suggests that PACAP38 modulates trigeminal nociceptive activity mainly through PAC1 receptors while clinical studies report that plasma concentrations of PACAP38 are elevated in spontaneous attacks of cluster headache and migraine and normalize after treatment with sumatriptan. Intravenous infusion of PACAP38 induces migraine-like attacks in migraineurs and cluster-like attacks in cluster headache patients. A rodent-specific PAC1 receptor antibody Ab181 was developed, and its effect on nociceptive neuronal activity in the trigeminocervical complex was investigated in vivo in an electrophysiological model relevant to primary headaches. Ab181 is potent and selective at the rat PAC1 receptor and provides near-maximum target coverage at 10 mg/kg for more than 48 hours. Without affecting spontaneous neuronal activity, Ab181 effectively inhibits stimulus-evoked activity in the trigeminocervical complex. Immunohistochemical analysis revealed its binding in the trigeminal ganglion and sphenopalatine ganglion but not within the central nervous system suggesting a peripheral site of action. The pharmacological approach using a specific PAC1 receptor antibody could provide a novel mechanism with a potential clinical efficacy in the treatment of primary headaches.
Published: 2020

31. The effects of oral feeding while on nasal continuous positive airway pressure (NCPAP) in preterm infants

Author: Ranjith Kamity, Vikramaditya Dumpa, Nazeeh Hanna, Louisa Ferrara, and Meredith Akerman
Subjects: Pediatrics, medicine.medical_specialty, medicine.medical_treatment, Gestational Age, Positive correlation, Article, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, medicine, Humans, 030212 general & internal medicine, Continuous positive airway pressure, Retrospective Studies, Respiratory tract diseases, Continuous Positive Airway Pressure, business.industry, Postmenstrual Age, Infant, Newborn, Obstetrics and Gynecology, Gestational age, Infant, Retrospective cohort study, Paediatrics, Respiratory support, stomatognathic diseases, Outcomes research, Pediatrics, Perinatology and Child Health, Gestation, business, Oral feeding, Infant, Premature
Abstract: Objective To determine whether delaying oral feeding until coming off NCPAP will alter feeding and respiratory-related morbidities in preterm infants. Design In this retrospective pre–post analysis, outcomes were compared in two preterm infant groups (≤32 weeks gestation). Infants in Group 1 were orally fed while on NCPAP, while infants in Group 2 were only allowed oral feedings after ceasing NCPAP. Results Although infants in Group 2 started feeds at a later postmenstrual age (PMA), they reached full oral feeding at a similar PMA compared with Group 1. Interestingly, there was a positive correlation between the duration of oral feeding while on NCPAP and the time spent on respiratory support in Group 1. Conclusions Delayed oral feeding until ceasing NCPAP did not contribute to feeding-related morbidities. We recommend caution when initiating oral feedings in preterm infants on NCPAP without evaluating the safety of the infants and their readiness for oral feedings.
Published: 2020

32. Evaluation of the Imitation Potential of IT Companies Using the Cobb-Douglas Production Function

Author: Elena Akerman, Natalia Chistyakova, Aleksandr Mikhalchuk, and V. V. Spitsyn
Subjects: 050208 finance, media_common.quotation_subject, 05 social sciences, Wage, Factors of production, General Medicine, Cobb–Douglas production function, 0502 economics and business, Fixed asset, Revenue, Production (economics), Business, Imitation, Function (engineering), 050203 business & management, Industrial organization, media_common
Abstract: The relevance of the study has been determined by the acceleration of innovation growth, which encourages companies to use imitation strategies in response to disruptive technological changes.The study used the Cobb-Douglas production function to evaluate the effectiveness of the used production factors of Russian IT companies. A high-quality 3-cluster model of IT companies was built, as well as highly significant two-factor production functions of Cobb-Douglas, which made it possible to identify the contribution of the main factors (wage and fixed assets) to the production volume (revenue) for each cluster.
Published: 2019

33. Meeting people where they are: Instilling familiarity to increase demand in a rural local food market

Author: Sean Akerman and Robin J. Kemkes
Subjects: Sociology and Political Science, Geography, Planning and Development, Business, Development, Marketing, Food market
Published: 2019

34. Cancer associated fibroblasts in pancreatic ductal adenocarcinoma determine response to SLC7A11 inhibition

Author: Mert Erkan, Julia Lee, Marina Pajic, Janet Youkhana, Anouschka Akerman, Nelson Russia, Amber L. Johns, Thomas P. Davis, Thomas R. Cox, Jie Liu, Jessica L. Chitty, Rosa Mistica C. Ignacio, Angela Chou, George Sharbeen, Yordanos F I Setargew, Yi Fang Guan, Andrew D. Campbell, Joshua A. McCarroll, Jeff Holst, Jennifer P. Morton, Nigel Turner, Arafath Kaja Najumudeen, Koroush S. Haghighi, Estrella Gonzales-Aloy, Phoebe A. Phillips, Owen J. Sansom, Paul Timpson, Val Gebski, Chantal Kopecky, Sigrid K. Fey, Minoti V. Apte, Cyrille Boyer, Brooke A. Pereira, David Goldstein, Stephanie Naim, John Kokkinos, Anthony J. Gill, Jorjina Kasparian, Benjamin J McLean, Erkan, Murat Mert (ORCID 0000-0002-2753-0234 & YÖK ID 214689), Sharbeen, G., McCarroll, J. A., Akerman, A., Kopecky, C., Youkhana, J., Kokkinos, J., Holst, J., Boyer, C., Goldstein, D., Timpson, P., Cox, T. R., Pereira, B. A., Chitty, J. L., Fey, S. K., Najumudeen, A. K., Campbell, A. D., Sansom, O. J., Ignacio, R. M. C., Naim, S., Liu, J., Russia, N., Lee, J., Chou, A., Johns, A., Gill, A. J., Gonzales-Aloy, E., Gebski, V., Guan, Y. F., Pajic, M., Turner, N., Apte, M. V., Davis, T. P., Morton, J. P., Haghighi, K. S., Kasparian, J., McLean, B. J., Setargew, Y. F. I., Apgi APCGI, Phillips, P. A., Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM), and School of Medicine
Subjects: 0301 basic medicine, Genetically modified mouse, Cancer Research, Cell type, Stromal cell, Amino Acid Transport System y+, endocrine system diseases, Mice, Nude, Apoptosis, SLC7A11, Mice, 03 medical and health sciences, 0302 clinical medicine, Cancer-Associated Fibroblasts, Stroma, Fibrosis, Tumor Cells, Cultured, Tumor Microenvironment, Animals, Humans, Medicine, Stellate cellscystine, Glutamate antiporter, Growth, Transporter, Metabolism, Cell Proliferation, Mice, Inbred BALB C, biology, business.industry, Cell growth, Antibodies, Monoclonal, Prognosis, medicine.disease, Xenograft Model Antitumor Assays, digestive system diseases, Gene Expression Regulation, Neoplastic, Pancreatic Neoplasms, Survival Rate, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Cancer research, biology.protein, Female, business, Carcinoma, Pancreatic Ductal
Abstract: Cancer-associated fibroblasts (CAF) are major contributors to pancreatic ductal adenocarcinoma (PDAC) progression through protumor signaling and the generation of fibrosis, the latter of which creates a physical barrier to drugs. CAF inhibition is thus an ideal component of any therapeutic approach for PDAC. SLC7A11 is a cystine transporter that has been identified as a potential therapeutic target in PDAC cells. However, no prior study has evaluated the role of SLC7A11 in PDAC tumor stroma and its prognostic significance. Here we show that high expression of SLC7A11 in human PDAC tumor stroma, but not tumor cells, is independently prognostic of poorer overall survival. Orthogonal approaches showed that PDAC-derived CAFs are highly dependent on SLC7A11 for cystine uptake and glutathione synthesis and that SLC7A11 inhibition significantly decreases CAF proliferation, reduces their resistance to oxidative stress, and inhibits their ability to remodel collagen and support PDAC cell growth. Importantly, specific ablation of SLC7A11 from the tumor compartment of transgenic mouse PDAC tumors did not affect tumor growth, suggesting the stroma can substantially influence PDAC tumor response to SLC7A11 inhibition. In a mouse orthotopic PDAC model utilizing human PDAC cells and CAFs, stable knockdown of SLC7A11 was required in both cell types to reduce tumor growth, metastatic spread, and intratumoral fibrosis, demonstrating the importance of targeting SLC7A11 in both compartments. Finally, treatment with a nanoparticle genesilencing drug against SLC7A11, developed by our laboratory, reduced PDAC tumor growth, incidence of metastases, CAF activation, and fibrosis in orthotopic PDAC tumors. Overall, these findings identify an important role of SLC7A11 in PDAC-derived CAFs in supporting tumor growth. Significance: this study demonstrates that SLC7A11 in PDAC stromal cells is important for the tumor-promoting activity of CAFs and validates a clinically translatable nanomedicine for therapeutic SLC7A11 inhibition in PDAC., NHMRC Project Grant; Avner Innovation Grant; NHMRC CDF-I; NHMRC Ideas Grant ; Cancer-Institute NSW ECF/CDFs ; Cancer Institute NSW Innovation Grant; Cancer Institute NSW The Professor Rob Sutherland AO Make a Difference Award; Cancer Australia/Cancer Council; Cancer Australia/Kids Cancer Project; Cure Cancer Australia; Tour de Cure PhD Support Scholarship; Tour de Cure Established Research Grant; Tour de Cure Pioneering Research Grant; UNSW Interlude Grant Scheme; Cancer Research UK Core Funding and Grand Challenge Grants; NHMRC CDF-II; NHMRC Senior Research Fellowship; Suttons, Cancer Council NSW; Avner Grant from PanKind; Australian Pancreatic Cancer Foundation; Translational Cancer Research Network and Australian Postgraduate Award Scholarships; Australian Government Research Training Program Scholarship; UNSW Sydney Scientia PhD Scholarship; Pancreatic Cancer UK Future Leaders Academy; Len Ainsworth Pancreatic Cancer Fellowship
Published: 2021

35. Neonatal diabetes mutations disrupt a chromatin pioneering function that activates the human insulin gene

Author: Sian Ellard, Jorge Ferrer, Javier García-Hurtado, Sarah E. Flanagan, Philippe Ravassard, Miguel A. Maestro, Elisa De Franco, Ildem Akerman, Gerhard Mittler, Andrew T. Hattersley, Lorenzo Piemonti, Vanessa Grau, University of Birmingham [Birmingham], Centre for Genomic Regulation [Barcelona] (CRG), Universitat Pompeu Fabra [Barcelona] (UPF)-Centro Nacional de Analisis Genomico [Barcelona] (CNAG), University of Exeter Medical School, University of Exeter, Max Planck Institute of Immunobiology and Epigenetics (MPI-IE), Max-Planck-Gesellschaft, Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), IRCCS Ospedale San Raffaele [Milan, Italy], Gestionnaire, Hal Sorbonne Université, Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Akerman, I., Maestro, M. A., De Franco, E., Grau, V., Flanagan, S., Garcia-Hurtado, J., Mittler, G., Ravassard, P., Piemonti, L., Ellard, S., Hattersley, A. T., Ferrer, J., and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)
Subjects: 0301 basic medicine, Transcription, Genetic, [SDV]Life Sciences [q-bio], Endocrinology, Diabetes and Metabolism, medicine.disease_cause, Sulfonylurea Receptors, Bioinformatics, Infant, Newborn, Diseases, Mice, 0302 clinical medicine, Endocrinology, Transcription (biology), Insulina, Human insulin, Insulin, Protein Isoforms, Medicine, Biology (General), Promoter Regions, Genetic, health care economics and organizations, Genetics, Mutation, GLIS3, Diabetis, Gene Expression Regulation, Developmental, Chromatin, 3. Good health, Cell biology, [SDV] Life Sciences [q-bio], DNA-Binding Proteins, neonatal diabetes, QH301-705.5, Neonatal diabetes, mouse model, education, MEDLINE, Mice, Transgenic, Biology, General Biochemistry, Genetics and Molecular Biology, Article, Gene product, 03 medical and health sciences, Text mining, Diabetes Mellitus, Animals, Humans, Point Mutation, Transcription factor, Pancreas, Gene, Alleles, regulatory element, HIP, INS promoter, business.industry, Point mutation, Infants nadons -- Malalties, Infant, Newborn, Embryo, Mammalian, Noncoding DNA, Repressor Proteins, 030104 developmental biology, Trans-Activators, business, 030217 neurology & neurosurgery, Function (biology), Genètica
Abstract: Summary Despite the central role of chromosomal context in gene transcription, human noncoding DNA variants are generally studied outside of their genomic location. This limits our understanding of disease-causing regulatory variants. INS promoter mutations cause recessive neonatal diabetes. We show that all INS promoter point mutations in 60 patients disrupt a CC dinucleotide, whereas none affect other elements important for episomal promoter function. To model CC mutations, we humanized an ∼3.1-kb region of the mouse Ins2 gene. This recapitulated developmental chromatin states and cell-specific transcription. A CC mutant allele, however, abrogated active chromatin formation during pancreas development. A search for transcription factors acting through this element revealed that another neonatal diabetes gene product, GLIS3, has a pioneer-like ability to derepress INS chromatin, which is hampered by the CC mutation. Our in vivo analysis, therefore, connects two human genetic defects in an essential mechanism for developmental activation of the INS gene., Graphical abstract, Highlights • Mutations of a CC dinucleotide in the human INS promoter cause neonatal diabetes • We humanized ∼3.1 kb of mouse Ins2 and created a CC mutant version • Humanized Ins2, but not the CC mutant, recapitulates developmental chromatin activation • GLIS3, also mutated in diabetes, activates INS chromatin and requires an intact CC, Mutations in the CC element of the INS promoter or the transcription factor GLIS3 cause neonatal diabetes. Akerman et al. humanize a 3.1-kb region upstream of the mouse Ins2 gene and show that GLIS3 and the CC element form a pioneering mechanism that activates INS chromatin during pancreas development.
Published: 2021

36. Patterns of withdrawal in patients with opioid use disorder (OUD) transitioning from untreated OUD or buprenorphine treatment to extended-release naltrexone

Author: Anna Legedza, Sarah C. Akerman, Maria A. Sullivan, Antoine Douaihy, Paolo Mannelli, and Abigail Zavod
Subjects: medicine.drug_class, Narcotic Antagonists, Medicine (miscellaneous), Partial agonist, Naltrexone, Patient experience, medicine, Opiate Substitution Treatment, Humans, In patient, business.industry, Antagonist, Opioid use disorder, medicine.disease, Opioid-Related Disorders, Buprenorphine, Analgesics, Opioid, Psychiatry and Mental health, Clinical Psychology, Anesthesia, Delayed-Action Preparations, business, Opioid antagonist, medicine.drug
Abstract: BACKGROUND Pharmacologic treatment is recommended for many individuals with opioid use disorder (OUD). For patients who select opioid antagonist treatment, effective management of opioid withdrawal symptoms during transition to antagonist treatment requires consideration of the patient experience. OBJECTIVES To compare patterns of opioid withdrawal between those withdrawing from untreated opioid use and those withdrawing from buprenorphine. METHODS We performed a post hoc, cross-study comparison of the temporal pattern of opioid withdrawal during 1-week induction onto extended-release naltrexone by similar protocols enrolling two participant populations: participants with OUD entering a study with untreated opioid use (N = 378, NCT02537574) or on stable buprenorphine (BUP) treatment (N = 101, NCT02696434). RESULTS The temporal pattern of withdrawal from induction day 1 through day 7 differed between the two participant populations for Clinical Opiate Withdrawal Score (COWS) and Subjective Opiate Withdrawal Score (SOWS): participants with untreated OUD prior to study entry were more likely to experience an earlier relative peak in opioid withdrawal followed by a gradual decline, whereas participants on stable BUP treatment prior to study entry were more likely to experience a relatively later, though still mild, peak opioid withdrawal. The peak COWS was reached at a mean (standard deviation) of 1.9 (1.5) days for participants with untreated OUD and 5.0 (1.5) days for participants on stable BUP. Daily peak cravings were generally higher for participants with untreated OUD than participants on stable BUP. CONCLUSION Awareness of population-specific variations in the patient experience of opioid withdrawal may help clinicians anticipate the expected course of withdrawal.
Published: 2021

37. COVID-19 Vaccine Failure in Chronic Lymphocytic Leukemia and Monoclonal B-Lymphocytosis; Humoral and Cellular Immunity

Author: Vanessa Milogiannakis, Lucinda Wallman, Anthony L. Cunningham, Anouschka Akerman, Catherine Tang, Jane A. Freeman, Juliette Holland, Kartik Naidu, Stuart Turville, Neena Van Bilsen, Gabriela Martins Costa Gomes, Paul Downe, Yanodng Shen, Ann Solterbeck, Asha Soosapilla, Kerrie J Sandgren, Ian Kerridge, and Stephen P. Mulligan
Subjects: Cellular immunity, Lymphocytosis, business.industry, Chronic lymphocytic leukemia, medicine.disease, chemistry.chemical_compound, Immune system, chemistry, Ibrutinib, Immunology, Monoclonal, Medicine, Seroconversion, medicine.symptom, business, Vaccine failure
Abstract: Chronic lymphocytic leukemia (CLL) is associated with immunocompromise and high risk of severe COVID-19 disease and mortality. Monoclonal B-Lymphocytosis (MBL) patients also have immune impairment. We evaluated humoral and cellular immune responses in 181 patients with CLL (160) and MBL (21) to correlate failed seroconversion (pppppp1000AU/mL. In a representative subset of 32 CLL patients, 80% had normal T-cell responses by IFNγ and IL-2 FluoroSpot assay. Failed seroconversion occurred in 36.6%% of treatment-naive patients, 52.9% treatment-naive with reduced IgM, 78.1% on therapy, and 85.7% on ibrutinib. Vaccination failure is very common in CLL, including early-stage disease.6 Key Novel FindingsComparison CLL vs MBL vs normal-45% of CLL and 9.5% of MBL fail to seroconvert with 2 doses of COVID-19 vaccineNeutralization assay-SARS CoV-2 IgG levels COVID-19-specific T-cell function by FluoroSpot IFN-g and IL-2 productionIgG, A, M class and IgG subclass:correlations by univariate and multivariate analysis-IgM (OR 7.29 pCorrelation withtherapy– ICT, targeted therapies, and those on Ig replacementHigh risk of vaccination failure for all CLL, including early-stage disease, and MBLKey PointsCLL and MBL show significantly impaired anti-spike antibody, viral neutralization, with cellular immune response to COVID-19 vaccinationFailure to seroconvert is associated with low IgM, IgG2, IgG3, and recent therapy; many CLL and MBL patients remain COVID-19 vulnerable
Published: 2021

38. Somnotate: An accurate, robust, and flexible sleep stage classifier for the experimentalist

Author: C Blanco-Duque, Guillaumin Mcc., Colin J. Akerman, L B Krone, M C Kahn, Huang Y-G., L Milinski, Brodersen Pjn., Christopher Thomas, Lewis Taylor, Alfonsa H, Sarah J Flaherty, Angus S. Fisk, L E McKillop, T Yamagata, and Vladyslav V. Vyazovskiy
Subjects: Computer science, business.industry, Feature extraction, Inference, Machine learning, computer.software_genre, Linear discriminant analysis, Non-rapid eye movement sleep, Bottleneck, Annotation, Artificial intelligence, Hidden Markov model, business, Classifier (UML), computer
Abstract: Manual sleep stage annotation is a time-consuming but often essential step in the analysis of sleep data. To address this bottleneck we need automated approaches that exhibit high levels of performance, are robust under different experimental conditions, are accessible, and meet the specific needs of sleep scientists. Here we develop an unbiased framework for assessing automated performance against a consensus derived from multiple experienced researchers. We then construct a new sleep stage classifier that combines automated feature extraction using linear discriminant analysis, with inference based on vigilance state-dependent contextual information using a hidden Markov model. This produces annotation accuracies that exceed expert performance on rodent electrophysiological data. We demonstrate that the classifier is robust to errors in the training data, compatible with different recording configurations, and maintains high performance during experimental interventions including sleep deprivation and optogenetic manipulations. Finally, the classifier quantifies and reports its certainty, which can be leveraged to identify ambiguous epochs for further examination. Ambiguous epochs are shown to include unsuccessful transitions between vigilance states, which may offer new insight into the mechanisms underlying sleep-wake dynamics. We call our classifier ‘Somnotate’ and make an implementation available to the neuroscience community.
Published: 2021

39. Critical care admission following elective surgery was not associated with survival benefit

Author: Kahan, Brennan C., Desponia, Koulenti, Kostoula, Arvaniti, Vanessa, Beavis, Douglas, Campbell, Matthew, Chan, Rui, Moreno, Pearse, Rupert M., Scott, Beattie, Pierre-Alain, Clavien, Nicolas, Demartines, Lee, A Fleisher, Mike, Grocott, James, Haddow, Andreas, Hoeft, Peter, Holt, Naomi, Pritchard, Andrew, Rhodes, Duminda, Wijeysundera, Matt, Wilson, Tahania, Ahmed, Kirsty, Everingham, Russell, Hewson, Marta, Januszewska, Rupert, M Pearse, Mandeep-Kaur, Phull, Richard, Halliwell, Mark, Shulman, Paul, Myles, Werner, Schmid, Michael, Hiesmayr, Patrick, Wouters, Stefan de Hert, Suzana, Lobo, Xiangming, Fang, Lars, Rasmussen, Emmanuel, Futier, Matthieu, Biais, Aurélien, Venara, Karem, Slim, Michael, Sander, Despoina, Koulenti, Mathew, Chan, Atul, Kulkarni, Susilo, Chandra, Aida, Tantri, Emad, Geddoa, Muntadhar, Abbas, Giorgio Della Rocca, Datin, Sivasakthi, Marzida, Mansor, Pastor, Luna, Arthur, Bouwman, Wolfgang, Buhre, Tim, Short, Tunde, Osinaike, Ricardo, Matos, Ioana, Grigoras, Mikhail, Kirov, Denis, Protsenko, Bruce, Biccard, Cesar, Aldecoa, Michelle, Chew, Christoph, Hofer, Martin, Hubner, James, Ditai, Tamas, Szakmany, Lee, Fleisher, Marissa, Ferguson, Michael, Macmahon, Ritchie, Cherian, Helen, Currow, Kathirgamanathan, Kanathiban, David, Gillespie, Edward, Pathmanathan, Katherine, Phillips, Jenifer, Reynolds, Joanne, Rowley, Jeanene, Douglas, Ross, Kerridge, Sameer, Garg, Michael, Bennett, Megha, Jain, David, Alcock, Nico, Terblanche, Rochelle, Cotter, Kate, Leslie, Marcelle, Stewart, Nicolette, Zingerle, Antony, Clyde, Oliver, Hambidge, Adam, Rehak, Sharon, Cotterell, Wilson Binh Quan Huynh, Timothy, Mcculloch, Erez, Ben-Menachem, Thomas, Egan, Jennifer, Cope, Paul, Fellinger, Simone, Haselberger, Caroline, Holaubek, Paul, Lichtenegger, Florian, Scherz, Franz, Hoffer, Veronika, Cakova, Andreas, Eichwalder, Norbert, Fischbach, Reinhold, Klug, Elisabeth, Schneider, Martin, Vesely, Reinhart, Wickenhauser, Karl Gernot Grubmueller, Marion, Leitgeb, Friedrich, Lang, Nancy, Toro, Marlene, Bauer, Friedrich, Laengle, Thomas, Mayrhofer, Christian, Buerkle, Karin, Forstner, Reinhard, Germann, Harald, Rinoesl, Elke, Schindler, Ernst, Trampitsch, Gerhard, Fritsch, Christian, Szabo, Jawad, Bidgoli, Hans, Verdoodt, Patrice, Forget, David, Kahn, Fernande, Lois, Mona, Momeni, Caroline, Prégardien, Audrey, Pospiech, Arnaud, Steyaert, Laurent, Veevaete, Dirk De Kegel, Karen De Jongh, Luc, Foubert, Carine, Smitz, Marcel, Vercauteren, Jan, Poelaert, Veerle Van Mossevelde, Jacques, Abeloos, Stefaan, Bouchez, Marc, Coppens, Luc De Baerdemaeker, Isabel, Deblaere, Ann De Bruyne, Stefan De Hert, Kristine, Fonck, Bjorn, Heyse, Tom, Jacobs, Koen, Lapage, Anneliese, Moerman, Martine, Neckebroek, Aliaksandra, Parashchanka, Nathalie, Roels, Nancy Van Den Eynde, Michael, Vandenheuvel, Jurgen Van Limmen, Ann, Vanluchene, Caroline, Vanpeteghem, Piet, Wyffels, Christel, Huygens, Punitha, Vandenbempt, Marc Van de Velde, Dimitri, Dylst, Bruno, Janssen, Evelien, Schreurs, Fábia Berganton Aleixo, Keulle, Candido, Hugo Dias Batista, Mario, Guimarães, Jaqueline, Guizeline, João, Hoffmann, Suzana, M Lobo, Francisco Ricardo Lobo, Vinícius, Nascimento, Katia, Nishiyama, Lucas, Pazetto, Daniela, Souza, Rodrigo Souza Rodrigues, Ana Maria Vilela Dos Santos, Jaquelline, Jardim, Joao, Silva, Paulo do Nascimento Junior, Thalissa Hermínia Baio, Gabriel Isaac Pereira de Castro, Henri Roger Watanabe Oliveira, Cristina Prata Amendola, Gutemberg, Cardoso, Daniela, Ortega, Ana Flavia Brotto, Mirella Cristine De Oliveira, Álvaro, Réa-Neto, Fernando, Dias, Pedro, Azambuja, Marcos Freitas Knibel, Antonio, Martins, William, Almeida, Calim Neder Neto, Maria Angela Tardelli, Eliana, Caser, Marcio, Machado, Crisitiano, Aguzzoli, Sérgio, Baldisserotto, Fernanda Beck Tabajara, Fernanda, Bettega, La Hore Correa Rodrigues Júnior, Julia de Gasperi, Lais, Faina, Marcos Farias Nolasco, Bruna Ferreira da Costa Fischer, Mariana Fosch de Campos Ferreira, Cristina, Hartmann, Marta, Kliemann, Gustavo Luis Hubert Ribeiro, Julia Merladete Fraga, Thiago Motta Netto, Laura Valduga Pozza, Paulo Rafael Wendling, Caroline, Azevedo, Juliana, Garcia, Marcel, Lopes, Bernardo, Maia, Paula, Maselli, Ralph, Melo, Weslley, Mendes, Matheus, Neves, Jacqueline, Ney, Claudio, Piras, Christopher, Applewhaite, Adrienne, Carr, Lorraine, Chow, Kaylene, Duttchen, Julena, Foglia, Michael, Greene, Ashley, Hinther, Kendra, Houston, Thomas Jared McCormick, Jennifer, Mikhayel, Sam, Montasser, Alex, Ragan, Andrew, Suen, Adrianna, Woolsey, Hai Chuan Yu, Duane, Funk, Stephen, Kowalski, Regina, Legaspi, Heather, Mcdonald, Faisal, Siddiqui, Jeremy, Pridham, Bernadette, Rowe, Sonia, Sampson, Barton, Thiessen, Geoff, Zbitnew, Andre, Bernard, Ronald, George, Philip, Jones, Rita, Moor, Naveed, Siddiqui, Alexandra, Wolfer, Diem, Tran, Denyse, Winch, Gary, Dobson, Thomas, Mccormick, Osama, Montasser, Richard, Hall, Leyla, Baghirzada, Si Yuan Dai, Gregory, Hare, Esther, Lee, Uma, Shastri, Albert, Tsui, Anmol, Yagnik, Danielle, Alvares, Stephen, Choi, Heather, Dwyer, Kathrina, Flores, Colin, Mccartney, Priya, Somascanthan, Carroll, Jo, Janneth, Pazmino-Canizares, Noam, Ami, Vincent, Chan, Anahi, Perlas, Ruth, Argue, Katie, Lavis, Kelly, Mayson, Ying, Cao, Hong, Gao, Tingju, Hu, Jie, Lv, Jian, Yang, Yang, Yang, Zhong, Yi, Jing, Zhou, Xiaohua, Zou, Miao, He, Xiaoying, Li, Dihuan, Luo, Haiying, Wang, Tian, Yu, Liyong, Chen, Lijun, Wang, Yunfei, Cai, Zhongming, Cao, Yanling, Li, Jiaxin, Lian, Haiyun, Sun, Sheng, Wang, Zhipeng, Wang, Kenru, Wang, Zhu, Yi, Xindan, Du, Hao, Fan, Yunbin, Fu, Lixia, Huang, Yanming, Huang, Haifang, Hwan, Hong, Luo, Pi-Sheng, Qu, Fan, Tao, Zhen, Wang, Guoxiang, Wang, Shun, Wang, Yan, Zhang, Xiaolin, Zhang, Chao, Chen, Weixing, Wang, Zhengyuan, Liu, Lihua, Fan, Jing, Tang, Yijun, Chen, Yongjie, Chen, Yangyang, Han, Changshun, Huang, Guojin, Liang, Jing, Shen, Jun, Wang, Qiuhong, Yang, Jungang, Zhen, Haidong, Zhou, Junping, Chen, Zhang, Chen, Xiaoyu, Li, Meng, Bo, Haiwang, Ye, Xiaoyan, Zhang, Yanbing, Bi, Jianqiao, Cao, Fengying, Guo, Hong, Lin, Yang, Liu, Meng, Lv, Pengcai, Shi, Xiumei, Song, Chuanyu, Sun, Yongtao, Sun, Yuelan, Wang, Shenhui, Wang, Min, Zhang, Rong, Chen, Jiabao, Hou, Yan, Leng, Qing-Tao, Meng, Qian, Li, Zi-Ying, Shen, Zhong-Yuan, Xia, Rui, Xue, Yuan, Zhang, Zhao, Bo, Xian-Jin, Zhou, Qiang, Chen, Huinan, Guo, Yongqing, Guo, Yuehong, Qi, Zhi, Wang, Jianfeng, Wei, Weiwei, Zhang, Lina, Zheng, Bao, Qi, Yaqiu, Chen, Yijiao, Chen, Yue, Fei, Nianqiang, Hu, Xuming, Hu, Min, Lei, Xiaoqin, Li, Xiaocui, Lv, Fangfang, Miao, Lingling, Ouyang, Qian, Lu, Conyu, Shen, Sun, Yu, Yuting, Wang, Dong, Wang, Chao, Wu, Liyuan, Xu, Jiaqi, Yuan, Lina, Zhang, Huan, Zhang, Yapping, Zhang, Jinning, Zhao, Chong, Zhao, Lei, Zhao, Tianzhao, Zheng, Dachun, Zhou, Haiyan, Zhou, Zhou, Ce, Kaizhi, Lu, Ting, Zhao, Changlin, He, Hong, Chen, Shasha, Chen, Baoli, Cheng, Jie, He, Lin, Jin, Caixia, Li, Hui, Li, Yuanming, Pan, Yugang, Shi, Xiao Hong Wen, Shuijing, Wu, Guohao, Xie, Kai, Zhang, Bing, Zhao, Xianfu, Lu, Feifei, Chen, Qisheng, Liang, Xuewu, Lin, Yunzhi, Ling, Gang, Liu, Jing, Tao, Yang, Lu, Jialong, Zhou, Fumei, Chen, Yunlin, Feng, Benchao, Hou, Jiamei, Lin, Mei, Liu, Foquan, Luo, Xiaoyun, Shi, Yingfen, Xiong, Lin, Xu, Shuangjia, Yang, Qin, Zhang, Huaigen, Zhang, Weihong, Zhao, Weilu, Zhao, Yun, Bai, Linbi, Chen, Sijia, Chen, Qinxue, Dai, Wujun, Geng, Kunyuan, Han, Xin, He, Luping, Huang, Binbin, Ji, Danyun, Jia, Shenhui, Jin, Qianjun, Li, Dongdong, Liang, Shan, Luo, Lulu, Lwang, Yunchang, Mo, Yuanyuan, Pan, Xinyu, Qi, Meizi, Qian, Jinling, Qin, Yelong, Ren, Yiyi, Shi, Junlu, Wang, Junkai, Wang, Leilei, Wang, Junjie, Xie, Yixiu, Yan, Yurui, Yao, Mingxiao, Zhang, Jiashi, Zhao, Xiuxiu, Zhuang, Yanqiu, Ai, Fang, Du, Long, He, Ledan, Huang, Zhisong, Li, Huijuan, Li, Yetong, Li, Liwei, Li, Meng, Su, Yazhuo, Yuan, Enman, Zhang, Jie, Zhang, Shuna, Zhao, Zhenrong, Ji, Ling, Pei, Wang, Li, Chen, Chen, Beibei, Dong, Jing, Li, Ziqiang, Miao, Hongying, Mu, Chao, Qin, Lin, Su, Zhiting, Wen, Keliang, Xie, Yonghao, Yu, Fang, Yuan, Xianwen, Hu, Zhang, Ye, Wangpin, Xiao, Zhipeng, Zhu, Qingqing, Dai, Kaiwen, Fu, Rong, Hu, Xiaolan, Hu, Song, Huang, Yaqi, Li, Yingping, Liang, Shuchun, Yu, Zheng, Guo, Yan, Jing, Tang, Na, Jie, Wu, Dajiang, Yuan, Ruilin, Zhang, Xiaoying, Zhao, Yuhong, Li, Hui-Ping, Bai, Chun-Xiao, Liu, Fei-Fei, Liu, Wei, Ren, Xiu-Li, Wang, Guan-Jie, Xu, Na, Hu, Bo, Li, Yangwen, Ou, Yongzhong, Tang, Shanglong, Yao, Shihai, Zhang, Cui-Cui, Kong, Bei, Liu, Tianlong, Wang, Wei, Xiao, Bo, Lu, Yanfei, Xia, Jiali, Zhou, Fang, Cai, Pushan, Chen, Shuangfei, Hu, Hongfa, Wang, Qiong, Xu, Liu, Hu, Liang, Jing, Bin, Li, Qiang, Liu, Yuejiang, Liu, Xinjian, Lu, Zhen Dan Peng, Xiaodong, Qiu, Quan, Ren, Youliang, Tong, Jin, Wang, Yazhou, Wen, Qiong, Wu, Jiangyan, Xia, Jue, Xie, Xiapei, Xiong, Shixia, Xu, Tianqin, Yang, Hui, Ye, Ning, Yin, Jing, Yuan, Qiuting, Zeng, Baoling, Zhang, Kang, Zheng, Jing, Cang, Shiyu, Chen, 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Strydom, Edwin, Wilberforce-Turton, Rubendraj, R Chetty, Subash, Chirkut, Larissa, Cronje, Kim de Vasconcellos, Nokukhanya, Z Dube, N Sibusiso Gama, Garyth, M Green, Randolph, Green-Thompson, Suman Mewa Kinoo, Prenolin, Kistnasami, Kapil, Maharaj, Manogaran, S Moodley, Sibongile, J Mothae, Ruvashni, Naidoo, Aslam, M, Noorbhai, F, Vivesh, Rughubar, Jenendhiran, Reddy, Avesh, Singh, David, L Skinner, Murray, J Smith, Bhagwan, Singh, Ravi, Misra, Maheshwar, Naidoo, Pireshin, Ramdharee, Yvonne, Selibea, Selina, Sewpersad, Shailendra, Sham, Joseph, D Wessels, Cucu, Africander, Tarek, Bejia, Stephen, P Blakemore, Marisa, Botes, Bimalshakth, Bunwarie, Carlos, B Hernandez, Mohammud, A Jeeraz, Dagmara, A Legutko, Acela, G Lopez, Jenine, N De Meyer, Tanaka, Muzenda, Noel, Naidoo, Maryam, Patel, Rao, Pentela, Marina, Junge, Naj, Mansoor, Lana, Rademan, Pawel, Scislowski, Ismail, Seedat, Bianca van den Berg, Doreen van der Merwe, Steyn van Wyk, Komalan, Govender, Darshan, Naicker, Rajesh, Ramjee, 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Patricia, Salgado, Luis, Suarez, Alejandro, Suarez-de-la-Rica, María José Villagrán, José Ignacio Alonso, Estefania, Cabezuelo, Irene, Garcia-Saiz, Olga Lopez Del Moral, Silvia, Martín, Alba Perez Gonzalez, Sherezade Tovar Doncel, Martin Agüero Vera, Francisco José Ávila Sánchez, Beatriz, Castaño, Beatriz Castaño Moreira, Sahely Flores Risco, Daniel Paz Martín, Fernando Pérez Martín, Paloma, Poza, Adela, Ruiz, Wilson Fabio Serna Martínez, Bárbara Vázquez Vicente, Saul Velaz Dominguez, Salvador, Fernández, Alfonso, Munoz-López, Maria Jose Bernat, Arantxa, Mas, Kenneth, Planas, Monir, Jawad, Yousif, Saeed, Annika, Hedin, Helena, Levander, Sandra, Holmström, David, Lönn, Frank, Zoerner, Irene, Åkring, Carl, Widmark, Jan, Zettergren, Victor Aspelund Liljequist, Lena, Nystrom, Suzanne, Odeberg-Wernerman, Anders, Oldner, Patrik, Reje, Sara, Lyckner, Jesper, Sperber, Anne, Adolfsson, Bengt, Klarin, Katrin, Ögren, Jean-Pierre, Barras, Thomas, Bührer, Vasileios, Despotidis, Naeder, Helmy, 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Keulle, Dias Batista, Hugo, Guimarães, Mario, Guizeline, Jaqueline, Hoffmann, João, Lobo, Suzana M., Lobo, Francisco Ricardo, Nascimento, Viníciu, Nishiyama, Katia, Pazetto, Luca, Souza, Daniela, Souza Rodrigues, Rodrigo, Vilela dos Santos, Ana Maria, Jardim, Jaquelline, Silva, Joao, do Nascimento Junior, Paulo, Baio, Thalissa Hermínia, Pereira de Castro, Gabriel Isaac, Watanabe Oliveira, Henri Roger, Amendola, Cristina Prata, Cardoso, Gutemberg, Ortega, Daniela, Brotto, Ana Flavia, De Oliveira, Mirella Cristine, Réa-Neto, Álvaro, Dias, Fernando, Azambuja, Pedro, Knibel, Marcos Freita, Martins, Antonio, Almeida, William, Neto, Calim Neder, Tardelli, Maria Angela, Caser, Eliana, Machado, Marcio, Aguzzoli, Crisitiano, Baldisserotto, Sérgio, Beck Tabajara, Fernanda, Bettega, Fernanda, Rodrigues Júnior, La Hore Correa, de Gasperi, Julia, Faina, Lai, Nolasco, Marcos Faria, da Costa Fischer, Bruna Ferreira, de Campos Ferreira, Mariana Fosch, Hartmann, Cristina, Kliemann, Marta, Ribeiro, Gustavo Luis Hubert, Fraga, Julia Merladete, Netto, Thiago Motta, Pozza, Laura Valduga, Wendling, Paulo Rafael, Azevedo, Caroline, Garcia, Juliana, Lopes, Marcel, Maia, Bernardo, Maselli, Paula, Melo, Ralph, Mendes, Weslley, Neves, Matheu, Ney, Jacqueline, Piras, Claudio, Applewhaite, Christopher, Carr, Adrienne, Chow, Lorraine, Duttchen, Kaylene, Foglia, Julena, Greene, Michael, Hinther, Ashley, Houston, Kendra, McCormick, Thomas Jared, Mikhayel, Jennifer, Montasser, Sam, Ragan, Alex, Suen, Andrew, Woolsey, Adrianna, Yu, Hai Chuan, Funk, Duane, Kowalski, Stephen, Legaspi, Regina, McDonald, Heather, Siddiqui, Faisal, Pridham, Jeremy, Rowe, Bernadette, Sampson, Sonia, Thiessen, Barton, Zbitnew, Geoff, Bernard, Andre, George, Ronald, Jones, Philip, Moor, Rita, Siddiqui, Naveed, Wolfer, Alexandra, Tran, Diem, Winch, Denyse, Dobson, Gary, McCormick, Thoma, Montasser, Osama, Hall, Richard, Baghirzada, Leyla, Dai, Si Yuan, Hare, Gregory, Lee, Esther, Shastri, Uma, Tsui, Albert, Yagnik, 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Edward, Minik, Orsolya, Morgan, Jenna, Musgrave, Anna, Rajanna, Harish, Roberts, Tracey, Adamson, Michael, Jumbe, Sandra, Kendall, Jennie, Muthuswamy, Mohan Babu, Anderson, Charlotte, Cruikshanks, Andrew, Wrench, Ian, Zeidan, Lisa, Ardern, Diane, Harris, Benjamin, Hellstrom, Johanna, Martin, Jane, Thomas, Richard, Varsani, Nimu, Wrey Brown, Caroline, Docherty, Philip, Gillies, Michael, McGregor, Euan, Usher, Helen, Craig, Jayne, Smith, Andrew, Ahmad, Tahania, Bodger, Phoebe, Creary, Thai, Fowler, Alexander, Hewson, Ru, Ijuo, Eke, Jones, Timothy, Kantsedikas, Ilya, Lahiri, Sumitra, McLean, Aaron Lawson, Niebrzegowska, Edyta, Phull, Mandeep, Wang, Difei, Wickboldt, Nadine, Baldwin, Jacqueline, Doyle, Donna, Mcmullan, Sean, Oladapo, Michelle, Owen, Thoma, Williams, Alexandra, Daniel, Hull, Gregory, Peter, Husain, Tauqeer, Kirk-Bayley, Justin, Mathers, Edward, Montague, Laura, White, Stuart, Avis, Joanne, Cook, Tim, Dali-Kemmery, Lola, Kerslake, Ian, Lambourne, Victoria, Pearson, Annabel, Boyd, Christine, Callaghan, Mark, Lawson, Cathy, McCrossan, Roopa, Nesbitt, Vanessa, O’connor, Laura, Scott, Julia, Sinclair, Rhona, Farid, Nahla, Morgese, Ciro, Bhatia, Kailash, Karmarkar, Swati, Ahmed, Jamil, Branagan, Graham, Hutton, Monica, Swain, Andrew, Brookes, Jamie, Cornell, Jonathan, Dolan, Rachael, Hulme, Jonathan, Jansen van Vuuren, Amanda, Jowitt, Tom, Kalashetty, Gunasheela, Lloyd, Fran, Patel, Kiran, Sherwood, Nichola, Brown, Lynne, Chandler, Ben, Deighton, Kerry, Emma, Temlett, Haunch, Kirsty, Cheeseman, Michelle, Dent, Kathy, Garg, Sanjeev, Gray, Carol, Hood, Marion, Jones, Dawn, Juj, Joanne, Rao, Roshan, Walker, Tara, Al Anizi, Mashel, Cheah, Clarissa, Cheing, Yushio, Coutinho, Francisco, Gondo, Prisca, Hadebe, Bernard, Onie Hove, Mazvangu, khader, Ahamed, Krishnachetty, Bobby, Rhodes, Karen, Sokhi, Jagdish, Baker, Katie-Anne, Bertram, Wendy, Looseley, Alex, Mouton, Ronelle, Arnold, Glenn, Arya, Shobhit, Balfoussia, Danai, Baxter, Linden, Harris, Jame, Jones, Craig, 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Gallacher, P., Hill, S., Jaffray, D., Karlakki, S., Kennedy, J., Kiely, N., Lewthwaite, S., Marquis, C., Ockendon, M., Phillips, S., Pickard, S., Richardson, J., Roach, R., Smith, T., Spencer-Jones, R., Steele, N., Steen, J., Van Liefland, M., White, S., Faulds, M., Harris, M., Nicol, S., Pearson, S.A., Chukkambotla, S., Andrew, A., Attrill, E., Campbell, G., Datson, A., Fouracres, A., Graterol, J., Graves, L., Hong, B., Ishimaru, A., Karthikeyan, A., King, H., Lawson, T., Lee, G., Lyons, S., Macalister Hall, A., Mathoulin, S., Mcintyre, E., Mclaughlin, D., Mulcahy, K., Robbins, J., Sung, W., Tayo, A., Trembath, L., Venugopal, S., Wigmore, G., Boereboom, C., Downes, C., Humphries, R., Melbourne, S., Tou, S., Ullah, S., Batchelor, N., Boxall, L., Broomby, R., Deen, T., Hellewell, A., Helliwell, L., Hutchings, M., Hutchins, D., Keenan, S., Mackie, D., Donna, A., Smith, F., Stone, L., Thorpe, K., Wassall, R., Woodgate, A., Baillie, S., Campbell, T., James, S., King, C., Marques de Araujo, D., Martin, D., Morkane, C., Neely, J., Rajendram, R., Burton, M., James, K., Keevil, E., Minik, O., Morgan, J., Musgrave, A., Rajanna, H., Roberts, T., Adamson, M., Jumbe, S., Kendall, J., Muthuswamy, M.B., Cruikshanks, A., Wrench, I., Zeidan, L., Ardern, D., Harris, B., Hellstrom, J., Martin, J., Thomas, R., Varsani, N., Wrey Brown, C., Docherty, P., Gillies, M., McGregor, E., Usher, H., Craig, J., Ahmad, T., Bodger, P., Creary, T., Fowler, A., Ijuo, E., Jones, T., Kantsedikas, I., Lahiri, S., McLean, A.L., Niebrzegowska, E., Phull, M., Wickboldt, N., Baldwin, J., Doyle, D., Mcmullan, S., Oladapo, M., Owen, T., Williams, A., Gregory, P., Husain, T., Kirk-Bayley, J., Mathers, E., Montague, L., Avis, J., Cook, T., Dali-Kemmery, L., Kerslake, I., Lambourne, V., Pearson, A., Boyd, C., Callaghan, M., Lawson, C., McCrossan, R., Nesbitt, V., O'connor, L., Sinclair, R., Farid, N., Morgese, C., Bhatia, K., Karmarkar, S., Ahmed, J., Branagan, G., Hutton, M., Swain, A., Brookes, J., Cornell, J., Dolan, R., Hulme, J., Jansen van Vuuren, A., Jowitt, T., Kalashetty, G., Lloyd, F., Patel, K., Sherwood, N., Brown, L., Chandler, B., Deighton, K., Emma, T., Haunch, K., Cheeseman, M., Dent, K., Gray, C., Hood, M., Jones, D., Juj, J., Rao, R., Walker, T., Al Anizi, M., Cheah, C., Cheing, Y., Coutinho, F., Gondo, P., Hadebe, B., Onie Hove, M., Khader, A., Krishnachetty, B., Rhodes, K., Sokhi, J., Baker, K.A., Bertram, W., Looseley, A., Mouton, R., Arnold, G., Arya, S., Balfoussia, D., Baxter, L., Harris, J., Jones, C., Knaggs, A., Markar, S., Perera, A., Scott, A., Shida, A., Sirha, R., Wright, S., Frost, V., MacGregor, M., Andrews, E., Arrandale, L., Barrett, S., Cifra, E., Cooper, M., Dragnea, D., Elna, C., Maclean, J., Meier, S., Milliken, D., Munns, C., Ratanshi, N., Salvana, A., Watson, A., Ali, H., Critchley, R., Hicks, C., Liddle, A., Pass, M., Ritchie, C., Thomas, C., Too, L., Welsh, S., Gill, T., Johnson, J., Reed, J., Davis, E., Papadopoullos, S., Attwood, C., Biffen, A., Boulton, K., Gray, S., Hay, D., Mills, S., Montgomery, J., Riddell, R., Simpson, J., Bhardwaj, N., Paul, E., Uwubamwen, N., Alexander, M., Arrich, J., Arumugam, S., Blackwood, D., Boggiano, V., Lam Chan, Y., Chatterjee, D., Chhabra, A., Christian, R., Costelloe, H., Coxwell Matthewman, M., Dalton, E., Darko, J., Davari, M., Dave, T., Deacon, M., Deepak, S., Edmond, H., Ellis, J., El-Sayed, A., Eneje, P., English, R., Ewe, R., Foers, W., Franklin, J., Gallego, L., Garrett, E., Goldberg, O., Goss, H., Greaves, R., Harris, R., Hennings, C., Jones, E., Kamali, N., Kokkinos, N., Lewis, C., Lignos, L., Malgapo, E.V., Malik, R., Milne, A., Mulligan, J.P., Nicklin, P., Palipane, N., Parsons, T., Piper, R., Prakash, R., Ramesh, B., Rasip, S., Reading, J., Rela, M., Reyes, A., Robert, S., Rooms, M., Shah, K., Simons, H., Solanki, S., Spowart, E., Stevens, A., Waggett, H., Yassaee, A., Kennedy, A., Scott, S., Somanath, S., Berg, A., Hernandez, M., Nanda, R., Tank, G., Wilson, N., Wilson, D., Al-Soudaine, Y., Baldwin, M., Cornish, J., Davies, Z., Davies, L., Edwards, M., Frewer, N., Gallard, S., Glasbey, J., Harries, R., Hopkins, L., Kim, T., Koompirochana, V., Lawson, S., Lewis, M., Makzal, Z., Scourfield, S., Ahmad, Y., Bates, S., Blackwell, C., Bryant, H., Coulter, S., Cruickshank, R., Daniel, S., Daubeny, T., Golder, K., Hawkins, L., Helen, B., Hinxman, H., Levett, D., Skinner, B., Walsgrove, J., Dickson, J., Constantin, K., Karen, M., O'Brien, P., O'Donohoe, L., Payne, H., Sundayi, S., Walker, E., Brooke, J., Cardy, J., Humphreys, S., Kessack, L., Kubitzek, C., Kumar, S., Cotterill, D., Hodzovic, E., Hosdurga, G., Miles, E., Saunders, G., Campbell, M., Chan, P., Jemmett, K., Raj, A., Naik, A., Ramamoorthy, R., Shah, N., Sylvan, A., Blyth, K., Burtenshaw, A., Freeman, D., Johnson, E., Lo, P., Martin, T., Plunkett, E., Wollaston, J., Allison, J., Carroll, C., Craw, N., Craw, S., Pitt-Kerby, T., Rowland-Axe, R., Spurdle, K., McDonald, A., Simon, D., Sinha, V., Banner-Goodspeed, V., Boone, M., Campbell, K., Lu, F., Scannell, J., Sobol, J., Balajonda, N., Clemmons, K., Conde, C., Funk, B., Hopkins, T., Olaleye, O., Omer, O., Pender, M., Porto, A., Waweru, P., Yeh, E., Bodansky, D., Evans, A., Kleopoulos, S., Maril, R., Mathney, E., Sanchez, A., Tinuoye, E., Bateman, B., Eng, K., Jiang, N., Ladha, K., Needleman, J., Chen, L.L., Lane, R., Robinowitz, D., Ghushe, N., Irshad, M., Patel, S., Takemoto, S., Wallace, A., Mazzeffi, M., Rock, P., Wallace, K., Zhu, X., Chua, P., Mattera, M., Sharar, R., Thilen, S., Treggiari, M., Morgan, A., Sofjan, I., Subramaniam, K., Avidan, M., Maybrier, H., Muench, M., and Wildes, T.
Subjects: Male, HSJ UCI, Critical Care and Intensive Care Medicine, law.invention, Perioperative Care/methods, 0302 clinical medicine, Surgical procedures, 030202 anesthesiology, law, Critical care/utilisation, Postoperative care/methods, Postoperative care/statistics and numerical data, Surgical procedures, operative/mortality, statistics and numerical data, Prospective Studies, Postoperative Period, Postoperative care/methods, education.field_of_study, Postoperative care/method, Elective Surgical Procedures/mortality, fluid output, Middle Aged, fluid administration, Intensive care unit, Hospitalization, Length of Stay/statistics & numerical data, operative/mortality, Intensive Care Units/statistics & numerical data, outcome, Female, Elective Surgical Procedure, Human, Adult, medicine.medical_specialty, Logistic Model, Postoperative care/statistics and numerical data, Critical care/utilisation, Population, Intensive Care Unit, Elective Surgical Procedures/statistics & numerical data, Hospitalization/statistics & numerical data, Humans, Logistic Models, Surgical procedures, operative/mortality, Postoperative care, methods, Perioperative Care, NO, 03 medical and health sciences, Anesthesiology, Intensive care, medicine, Elective surgery, Intensive care medicine, education, business.industry, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Clinical trial, Prospective Studie, septic shock, business
Abstract: PURPOSE: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. METHODS: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. RESULTS: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10-5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. CONCLUSIONS: We did not identify any survival benefit from critical care admission following surgery. info:eu-repo/semantics/publishedVersion
Published: 2017

40. Physician variation in opioid prescribing: the importance of sex and gender

Author: Parya Borhani, Anamika Mishra, Paula A. Rochon, and Jennifer Akerman
Subjects: Male, medicine.medical_specialty, business.industry, Health Policy, Ethnic group, Identity (social science), Social constructionism, Affect (psychology), Drug Prescriptions, United States, Analgesics, Opioid, Race (biology), Action plan, Physicians, Health care, Medicine, Humans, Female, Practice Patterns, Physicians', business, Psychiatry, Health policy
Abstract: Concern about the link between opioid prescribing and preventable adverse drug events has led to a series of initiatives to reduce opioid use, with opioids identified as one of three high-priority drug classes targeted to reduce patient harms in the United States (US)’s National Action Plan for Adverse Drug Event Prevention .1 Variation in opioid prescribing practices by physicians has been observed, yet the reasons why these differences exist remain largely unknown. A better understanding of these differences may help to improve prescribing practice for opioids. Sex and gender considerations in opioid prescribing practices have not been well studied and may help address this important knowledge gap. There is some evidence to suggest that sex and gender of physicians can affect prescribing practices for older adults.2 Patient gender has also been related to the experience of health conditions, health-seeking behaviours and medication use.3–5 Sex (biologic), a term describing the physical characteristics and biological attributes of males, females and intersex individuals, influences biological manifestations of medical conditions and responses to drug therapy.5 In contrast, gender (sociocultural) refers to the socially constructed norms, behaviours and roles associated with being a man, woman or gender diverse person.6 While these concepts are related, they are often incorrectly interchanged. Considering sex and gender, and how they intersect with key identity factors such as age, culture, race and ethnicity, is an analytical approach7 that can be applied to systematically explore the influence of sex and gender on prescribing practices, revealing potentially important differences or trends that would otherwise remain obscured. Such an approach provides the opportunity to inform prescribing practices in general, and pain management strategies in particular. This will allow healthcare provision to be tailored to the unique needs of women, men and gender diverse people, including those in …
Published: 2021

41. Bowel, Urinary, and Sexual Function in Patients with Low to Intermediate Risk Prostate Cancer on Active Surveillance and Primary Focal Cryotherapy

Author: Sommer Jessica, Katz Aaron, Akerman Meredith, and Mendelson Jordan
Subjects: Cultural Studies, medicine.medical_specialty, business.industry, medicine.medical_treatment, Urinary system, Urology, Cryotherapy, medicine.disease, Education, Prostate cancer, medicine, In patient, Sexual function, business, Intermediate risk
Abstract: Both active surveillance (AS) and primary focal cryotherapy (PFC) are considered suitable approaches for men with low to intermediate risk prostate cancer (PCa). We aim to identify any differences in bowel, urinary, and sexual function that may exist between patients on AS and those who have undergone PFC.
Published: 2021

42. miR‐133a Replacement Attenuates Thoracic Aortic Aneurysm in Mice

Author: Jessica Riopedre-Maqueira, Joyce E Oh, Adam W Akerman, Amari DeVaughn, Jessica K Harrison, Charles M Raybuck, Jaleel M Townsend, Elizabeth N Collins, John S. Ikonomidis, Jeffrey A. Jones, Lauren B Collins, Andrew R Peterson, Rebecca L Vanbuskirk, and Ailet Reyes
Subjects: Genetic Vectors, miR‐133a, thoracic aortic aneurysm, Aorta, Thoracic, Vascular Remodeling, complex mixtures, Thoracic aortic aneurysm, fibroblast, Extracellular matrix, Calcium Chloride, Cell Movement, In vivo, parasitic diseases, microRNA, Cell Adhesion, medicine, Animals, Fibroblast, Furin, Cells, Cultured, Original Research, Gene knockdown, Cardiovascular Surgery, Aortic Aneurysm, Thoracic, biology, business.industry, Lentivirus, Genetic Therapy, Fibroblasts, medicine.disease, Aneurysm, myofibroblast, digestive system diseases, Mice, Inbred C57BL, Disease Models, Animal, MicroRNAs, Phenotype, medicine.anatomical_structure, Cancer research, biology.protein, Cardiology and Cardiovascular Medicine, business, Myofibroblast, Basic Science Research, Dilatation, Pathologic
Abstract: Background Thoracic aortic aneurysms (TAAs) occur because of abnormal remodeling of aortic extracellular matrix and are accompanied by the emergence of proteolytically active myofibroblasts. The microRNA miR‐133a regulates cellular phenotypes and is reduced in clinical TAA specimens. This study tested the hypothesis that miR‐133a modulates aortic fibroblast phenotype, and overexpression by lentivirus attenuates the development of TAA in a murine model. Methods and Results TAA was induced in mice. Copy number of miR‐133a was reduced in TAA tissue and linear regression analysis confirmed an inverse correlation between aortic diameter and miR‐133a. Analyses of phenotypic markers revealed an mRNA expression profile consistent with myofibroblasts in TAA tissue. Fibroblasts were isolated from the thoracic aortae of mice with/without TAA. When compared with controls, miR‐133a was reduced, migration was increased, adhesion was reduced, and the ability to contract a collagen disk was increased. Overexpression/knockdown of miR‐133a controlled these phenotypes. After TAA induction in mice, a single tail‐vein injection of either miR‐133a overexpression or scrambled sequence (control) lentivirus was performed. Overexpression of miR‐133a attenuated TAA development. The pro‐protein convertase furin was confirmed to be a target of miR‐133a by luciferase reporter assay. Furin was elevated in this murine model of TAA and repressed by miR‐133a replacement in vivo resulting in reduced proteolytic activation. Conclusions miR‐133a regulates aortic fibroblast phenotype and over‐expression prevented the development of TAA in a murine model. These findings suggest that stable alterations in aortic fibroblasts are associated with development of TAA and regulation by miR‐133a may lead to a novel therapeutic strategy.
Published: 2021

43. A new index for obstetrics safety and quality of care: integrating cesarean delivery rates with maternal and neonatal outcomes

Author: Anthony M. Vintzileos, Sangeeta Ramani, Cande V. Ananth, Tara A. Halpern, and Meredith Akerman
Subjects: medicine.medical_specialty, Quality management, business.industry, Obstetrics, Cesarean Section, Medical record, Infant, Newborn, Obstetrics and Gynecology, Logistic regression, Quality Improvement, Confidence interval, Hospitals, Patient safety, Cross-Sectional Studies, Quartile, Obstetrics and gynaecology, Pregnancy, medicine, Humans, Female, Metric (unit), business, reproductive and urinary physiology
Abstract: Background Cesarean delivery rates have been used as obstetrical quality indicators. However, these approaches do not consider the accompanying maternal and neonatal morbidities. A challenge in the field of obstetrics has been to establish a valid outcomes quality measure that encompasses preexisting high-risk maternal factors and associated maternal and neonatal morbidities and is universally acceptable to all stakeholders, including patients, healthcare providers, payers, and governmental agencies. Objective This study aimed to (1) establish a new single metric for obstetrical quality improvement among nulliparous patients with term singleton vertex-presenting fetus, integrating cesarean delivery rates adjusted for preexisting high-risk maternal factors with associated maternal and neonatal morbidities, and (2) determine whether obstetrician quality ranking by this new metric is different compared with the rating based on individual crude and/or risk-adjusted cesarean delivery rates. The single metric has been termed obstetrical safety and quality index. Study Design This was a cross-sectional study of all nulliparous patients with term singleton vertex-presenting fetuses delivered by 12 randomly chosen obstetricians in a single institution. A review of all records was performed, including a review of maternal high-risk factors and maternal and neonatal outcomes. Maternal and neonatal medical records were reviewed to determine crude and adjusted cesarean delivery rates by obstetricians and quantify maternal and neonatal complications. We estimated the obstetrician-specific crude cesarean delivery rates and rates adjusted for obstetrician-specific maternal and neonatal complications from logistic regression models. From this model, we derived the obstetrical safety and quality index for each obstetrician. The final ranking based on the obstetrical safety and quality index was compared with the initial ranking by crude cesarean delivery rates. Maternal and neonatal morbidities were analyzed as ≥1 and ≥2 maternal and/or neonatal complications. Results These 12 obstetricians delivered a total of 535 women; thus, 1070 (535 maternal and 535 neonatal) medical records were reviewed to determine crude and adjusted cesarean delivery rates by obstetricians and quantify maternal and neonatal complications. The ranking of crude cesarean delivery rates was not correlated (rho=0.05; 95% confidence interval, −0.54 to 0.60) to the final ranking based on the obstetrical safety and quality index. Of note, 8 of 12 obstetricians shifted their rank quartiles after adjustments for high-risk maternal conditions and maternal and neonatal outcomes. There was a strong correlation between the ranking based on ≥1 maternal and/or neonatal complication and ranking based on ≥2 maternal and/or neonatal complications (rho=0.63; 95% confidence interval, 0.08–0.88). Conclusion Ranking based on crude cesarean delivery rates varied significantly after considering high-risk maternal conditions and associated maternal and neonatal outcomes. Therefore, the obstetrical safety and quality index, a single metric, was developed to identify ways to improve clinician practice standards within an institution. Use of this novel quality measure may help to change initiatives geared toward patient safety, balancing cesarean delivery rates with optimal maternal and neonatal outcomes. This metric could be used to compare obstetrical quality not only among individual obstetricians but also among hospitals that practice obstetrics.
Published: 2021

44. Targeting reactive nitroxidative species in preclinical models of migraine

Author: Simon Akerman, Daniela Salvemini, and Marcela Romero-Reyes
Subjects: 0301 basic medicine, Neurons, business.industry, Calcitonin Gene-Related Peptide, Migraine Disorders, Headache, General Medicine, Pharmacology, Calcitonin gene-related peptide, medicine.disease, Nitric Oxide, Nitric oxide, Rats, 03 medical and health sciences, chemistry.chemical_compound, 030104 developmental biology, 0302 clinical medicine, chemistry, Migraine, Medicine, Animals, Neurology (clinical), business, 030217 neurology & neurosurgery, Peroxynitrite
Abstract: Background Reactive nitroxidative species, such as nitric oxide but particularly peroxynitrite, have been strongly implicated in pain mechanisms. Targeting peroxynitrite is anti-nociceptive in pain models, but little is known about its role in migraine mechanisms. Given the need to validate novel targets for migraine headache, our objective was to study the potential of reactive nitroxidative species, particularly peroxynitrite, as novel targets for drug discovery and their role in migraine mechanisms. Methods We recorded neuronal activity in rats with extracellular electrodes and examined the effects of targeting nitric oxide or peroxynitrite on ongoing and cranial-evoked firing rates of central trigeminocervical neurons. We injected calcitonin gene-related peptide (which produces migraine-like headache in migraineurs) and characterized neuronal responses to cranial stimulation and on behavioral responses to nociceptive periorbital stimulation and determined the effects of targeting reactive nitroxidative species on the mediated changes. Results L-NAME (nitric oxide synthase inhibitor) and Fe(III)5,10,15,20-tetrakis(4-sulfonatophenyl)porphyrinato chloride (FeTPPS; peroxynitrite decomposition catalyst) inhibited ongoing and dural-evoked responses of trigeminocervical neurons, without affecting normal facial-cutaneous responses. Calcitonin gene-related peptide caused activation and sensitization of dural-responsive trigeminovascular neurons with hypersensitivity to intracranial and extracranial stimulation, and reduction of periorbital withdrawal thresholds. Only the peroxynitrite decomposition catalyst prevented these neuronal and behavioral nociceptive responses. Discussion The data support that calcitonin gene-related peptide mediates the underlying neurobiological mechanisms related to the development of migraine-like headache. They also confirm the role of nitric oxide and implicate peroxynitrite production along the trigeminovascular migraine pathway in these mechanisms. The data also support peroxynitrite as a novel and potentially effective target for migraine treatment. The current drug development focus on peroxynitrite decomposition catalysts for chronic pain disorders should therefore extend to migraine.
Published: 2021

45. Liposomal Bupivacaine to Treat Postoperative Pain: Comment

Author: Tiffany Tedore, Michael Akerman, Ryan Lippell, Roniel Weinberg, and Ashley V Wells
Subjects: Pain, Postoperative, Anesthesiology and Pain Medicine, Text mining, business.industry, Anesthesia, Postoperative pain, MEDLINE, Medicine, Humans, business, Liposomal Bupivacaine, Bupivacaine
Published: 2021

46. The Use of High-Flow Nasal Cannula and the Timing of Safe Feeding in Children with Bronchiolitis

Author: Meredith Akerman, Arsenia Asuncion, Thomas P. Conway, and Claudia Halaby
Subjects: Pediatric intensive care unit, Pulmonology, business.industry, General Engineering, Retrospective cohort study, Guideline, high flow, medicine.disease, medicine.disease_cause, Pediatrics, infant, Enteral administration, Bronchiolitis, Anesthesia, medicine, bronchiolitis, business, High flow, oxygen, Nasal cannula, feeding, Oral feeding
Abstract: Objective The use of high-flow nasal cannula (HFNC) as non-invasive respiratory support in children with bronchiolitis has increased over the last several years. Several studies have investigated enteral feeding safety while on HFNC. This study compares the safety of oral feeding prior to and following implementation of an HFNC feeding guideline. Patients and methods A retrospective study was designed, in children ≤2 years of age with bronchiolitis, requiring HFNC, from 2017 to 2019. We defined feeding complications on HFNC and defined safety as the absence of such complications. We gathered the following data: oral feeding timing from the HFNC initiation, duration of enteral feeding on HFNC, and HFNC flow rate at which the feeding was initiated. We compare the data prior to and post-implementation of an HFNC feeding guideline. Results Descriptive statistics were calculated separately by pre and post guideline implementation. Patients in both pre and post guideline implementation groups had no feeding complications on HFNC. Subjects in the post (n=50) vs. pre-guideline implementation (n=36) had a higher median amount of liters flow when initiating enteral feeding (8.0 vs. 6.0 respectively, p
Published: 2021

47. Information, control and health promotion in the Brazilian context of the pandemic

Author: Fátima Madalena de Campos Lico, Rosilda Mendes, Elisabete Agrela de Andrade, Marco Akerman, Maria Cristina Trousdell Franceschini, and Douglas Roque Andrade
Subjects: Health (social science), behavior control, health promotion, media_common.quotation_subject, Population, Vulnerability, Context (language use), information dissemination, coronavirus infection, INFORMAÇÃO EM SAÚDE, Political science, solidarity, Humans, AcademicSubjects/MED00860, education, Pandemics, Sophistication, media_common, education.field_of_study, Government, SARS-CoV-2, business.industry, Public Health, Environmental and Occupational Health, COVID-19, Public relations, Solidarity, Health promotion, Public sphere, business, Brazil, Perspectives
Abstract: Summary This article discusses how preventive and promotional discourses have been incorporated by the Brazilian population in the context of the coronavirus pandemic. It analyzes materials posted on the internet and social after the first case of COVID 19-related death in Brazil that are related health promotion and COVID-19 aimed at orienting society’s response to the pandemic. The analysis considers two key factors: the mismanagement of the pandemic by the Brazilian government and infodemic. There is complex use of scientific information with recommendations that focus on what people should do (intervention) and in transforming individuals’ behaviors, based on an ideal model of healthy behaviors. Narratives aimed to delegate to the population and specific groups the task of taking care of themselves have been reinforced, removing from the State the responsibility to offer conditions for the population to address the situation. There is a sophistication of strategies that blame individual practices, personal organization and that are disconnected from the collective, especially for those who live in situation of extreme vulnerability. Concomitantly, there are also discourses based on notions of solidarity and renewed social connections, which are empowering and consistent with the practice of health promotion as it attributes meanings to the subjects and their ways of life. We conclude that greatest advocacy in the field of health promotion at this moment is political and could be directed toward reaffirming health promotion principles, supporting permanent mobilization against setbacks in the public sphere and defending a new, democratic, inclusive and collective vision of society.
Published: 2021

48. A new prenatal sonographic sign of epidermolysis bullosa

Author: Ori Shen, Yehudit Akerman, Daniela Chen, and Shachar Zuckerman
Subjects: External ears, medicine.medical_specialty, integumentary system, business.industry, Ultrasound, Skin surfaces, Pyloric Atresia, 030204 cardiovascular system & hematology, medicine.disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Viable pregnancy, 0302 clinical medicine, medicine.anatomical_structure, otorhinolaryngologic diseases, medicine, Radiology, Nuclear Medicine and imaging, Radiology, Epidermolysis bullosa, Ultrasonography, business, Nose
Abstract: We report on the prenatal sonographic appearance of epidermolysis bullosa (EB). The third viable pregnancy of a consanguineous couple was found at 23 weeks to have dysplastic external ears and nose. The neonate was born at 33 weeks and was found to have junctional EB with pyloric atresia. On reviewing the 23-week ultrasound images, skin denudation was evident. This is a report of visualization of skin denudation in EB. When EB is suspected prenatally, special attention should be given to the visualization of skin surfaces.
Published: 2020

49. Reply to Kunoe (2020) and Ghosh & Singh (2020) regarding Nunes et al . (2020): Opioid use and dropout from extended‐release naltrexone in a controlled trial: implications for mechanism

Author: Narinder Nangia, Bernard L. Silverman, Sarah C. Akerman, Maria A. Sullivan, Adam Bisaga, Edward V. Nunes, and Evgeny Krupitsky
Subjects: Adult, Male, medicine.medical_specialty, Patient Dropouts, Narcotic Antagonists, Medicine (miscellaneous), Article, Russia, law.invention, Double-Blind Method, Randomized controlled trial, law, Ambulatory Care, medicine, Humans, Psychiatry, Dropout (neural networks), Duration of Therapy, Mechanism (biology), business.industry, Opioid use, Opioid use disorder, Opioid-Related Disorders, medicine.disease, Survival Analysis, Naltrexone, Psychiatry and Mental health, Treatment Outcome, Extended release naltrexone, Delayed-Action Preparations, Female, business
Abstract: Extended-release formulations of naltrexone have emerged as effective treatment options for opioid use disorder. This post-hoc analysis examined the temporal relationship between episodes of opioid use and subsequent dropout in a placebo-controlled trial of extended-release injection naltrexone (XR-NTX) to draw inferences about the mechanism by which extended blockade of opioid receptors translates into clinical effectiveness.This was a 24-week multiple-site, double-blind, randomized trial of monthly XR-NTX versus placebo injections. We analyzed time to dropout from treatment using survival analysis with an extended Cox model as a function of treatment (XR-NTX versus placebo) and with weekly urine drug test (UDT) results for opioids at each week as a time-dependent covariate.Thirteen addiction treatment programs in Russia, 2008-09.A total of 250 adults with opioid use disorder who had completed in-patient detoxification.XR-NTX injection or placebo injection every 4 weeks with weekly clinic visits and biweekly counseling.Urine toxicology for opioids measured weekly and week of dropout from treatment.The Cox model yielded a significant interaction of time-dependent urine toxicology by treatment (P = 0.024). Among patients receiving placebo, a positive UDT in a given week increased the risk for dropout from treatment in the subsequent week [hazard ratio (HR) = 6.25; 95% confidence interval (CI) = 3.6-10.0], whereas among patients receiving XR-NTX, a positive UDT result showed no significant effect on risk for dropout (HR = 1.67; 95% CI = 0.6-4.5). The proportion of patients who completed all 24 weeks without any positive UDT result was 31% on XR-NTX compared with 20% on placebo (P = 0.051).Extended-release injection naltrexone was effective at reducing the risk of dropout from opioid use disorder treatment after an episode of opioid use. Just under a third of patients (31%) on XR-NTX had no opioid-positive urine tests across the trial, but the hypothesis that this would differ from placebo (20%) was not confirmed.
Published: 2020

50. A Randomized Controlled Trial Comparing Telehealth Self-Management to Standard Outpatient Management in Underserved Black and Hispanic Patients Living with Heart Failure

Author: Renee Pekmezaris, Lawrence Murray, Meng Zhang, Martin Lesser, Rebecca M. Schwartz, Lorinda Bauer, Paola DiMarzio, Meredith Akerman, Stacy Castillo, Christian Nouryan, Deborah Ahern, Roman Zeltser, Amgad N. Makaryus, and Kathleen Pecinka
Subjects: Adult, Male, Telemedicine, medicine.medical_specialty, 020205 medical informatics, telehealth, education, Medically Underserved Area, Health Informatics, 02 engineering and technology, Telehealth, law.invention, Underserved Population, Young Adult, Health Information Management, Randomized controlled trial, law, 0202 electrical engineering, electronic engineering, information engineering, medicine, Ambulatory Care, Humans, health care economics and organizations, cardiology/cardiovascular disease, Original Research, Aged, Aged, 80 and over, Heart Failure, Self-management, business.industry, Self-Management, General Medicine, Hispanic or Latino, Middle Aged, medicine.disease, Black or African American, Heart failure, Family medicine, home health monitoring, Female, Outpatient management, business
Abstract: Background: Although the American Heart Association promotes telehealth models to improve care access, there is limited literature on its use in underserved populations. This study is the first to compare utilization and quality of life (QoL) for underserved black and Hispanic heart failure (HF) patients assigned to telehealth self-monitoring (TSM) or comprehensive outpatient management (COM) over 90 days. Methods: This randomized controlled trial enrolled 104 patients. Outcomes included emergency department (ED) visits, hospitalizations, QoL, depression, and anxiety. Binary outcomes for utilization were analyzed using chi-square or Fisher's exact test. Poisson or negative binomial regression, repeated-measures analysis of variance, or generalized estimating equations were also used as appropriate. Results: Of 104 patients, 31% were Hispanic, 69% black, 41% women, and 72% reported incomes of
Published: 2019

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