6-month Period Research Articles

Study protocol: Optimising patient positioning for the planning of accelerated partial breast radiotherapy for the integrated magnetic resonance linear accelerator: OPRAH MRL

BackgroundAccelerated partial breast irradiation (APBI) is an accepted treatment option for early breast cancer. Treatment delivered on the Magnetic Resonance integrated Linear Accelerator (MRL) provides the added assurance of improved soft tissue visibility, important in the delivery of APBI. This technique can be delivered in both the supine and prone positions, however current literature suggests that prone treatment on the MRL is infeasible due to physical limitations with bore size. This study aims to investigate the feasibility of positioning patients on a custom designed prone breast board compared with supine positioning on a personalised vacuum bag. Geometric distortion, the relative position of Organs at Risk (OAR) to the tumour bed and breathing motion (intrafraction motion) will be compared between the supine and prone positions. The study will also investigate the positional impact on dosimetry, patient experience, and position preference.MethodsUp to 30 patients will be recruited over a 12-month period for participation in this Human Research Ethics Committee approved exploratory cohort study. Patients will be scanned on the magnetic resonance imaging (MRI) Simulator in both the supine and prone positions as per current standard of care for APBI simulation. Supine and prone positioning comparisons will all be assessed on de-identified MRI image pairs, acquired using appropriate software. Patient experience will be explored through completion of a short, anonymous electronic survey. Descriptive statistics will be used for reporting of results with categorical, parametric/non-parametric tests applied (data format dependent). Survey results will be interpreted by comparison of percentage frequencies across the Likert scales. Thematic content analysis will be used to interpret qualitative data from the open-ended survey questions.DiscussionThe results of this study will be used to assess the feasibility of treating patients with APBI in the prone position on a custom designed board on the MRL. It may also be used to assist with identification of patients who would benefit from this position over supine without the need to perform both scans. Patient experience and technical considerations will be utilised to develop a tool to assist in this process.Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN1262400067583. Registered 28th of May 2024. https://www.anzctr.org.au/ACTRN12624000679583.aspx

Diagnostic application of the ColonFlag AI tool in combination with faecal immunochemical test in patients on an urgent lower gastrointestinal cancer pathway

ObjectiveColorectal cancer (CRC) is the fourth most common cancer in the UK. Patients with symptoms suggestive of CRC should be referred for urgent investigation. However, gastrointestinal symptoms are often non-specific...

Real world analysis of treatment change and response in adults with attention-deficit/hyperactivity disorder (ADHD) alone and with concomitant psychiatric comorbidities: results from an electronic health record database study is the United States

BackgroundThe objectives of this study were to examine the association of psychiatric comorbidities and patient characteristics with treatment change and response as well as to assess the association between treatment change and healthcare resource utilization (HCRU) among adult patients with attention-deficit/hyperactivity disorder (ADHD) and psychiatric comorbidities.MethodsDe-identified electronic health records from the NeuroBlu Database (2002–2021) were used to select patients ≥ 18 years with ADHD who were prescribed ADHD-specific medication. The index date was set as the first prescription of ADHD medication. The outcomes were treatment change (discontinuation, switch, add-on, or drop) and HCRU (inpatient, outpatient, composite) within 12 months of follow-up. Cox proportional-hazard model was used to assess the association between clinical and demographic patient characteristics and treatment change, while generalized linear model with negative binomial distribution and log link function was used to assess the association between key risk factors linked to treatment change and HCRU rates.ResultsA total of 3,387 patients with ADHD were included (ADHD only: 1,261; ADHD + major depressive disorder (MDD): 755; ADHD + anxiety disorder: 467; ADHD + mood disorder: 164). Nearly half (44.8%) of the study cohort experienced a treatment change within the 12-month follow-up period. Treatment switch and add-on were more common in patients with ADHD and comorbid MDD and anxiety disorder (switch: 18.9%; add-on: 20.5%) compared to other cohorts (range for switch: 8.5–13.6%; range for add-on: 8.9–12.1%) Survival analysis demonstrated that the probability of treatment change within 12 months from treatment initiation in the study cohort was estimated to be 42.4%. Outpatient visit rates statistically significantly increased from baseline (mean [SD] 1.03 [1.84] visits/month) to 3 months post-index (mean [SD] 1.62 [1.91] visits/month; p < 0.001), followed by a gradual decline up to 12 months post-index. Being prescribed both a stimulant and a non-stimulant at index date was statistically significantly associated with increased risk of treatment change (adjusted hazard ratio: 1.64; 95% CI: 1.13, 2.38; p = 0.01).ConclusionsThis real-world study found that treatment change was common among patients with ADHD and psychiatric comorbidities. These findings support the need for future studies to examine the unmet medical and treatment needs of this complex patient population.

Comparison of combination therapy with tamsulosin and dutasteride or finasteride in patients with benign prostatic hyperplasia: a randomized clinical trial

BackgroundBased on our observations at the largest outpatient urology clinic in Iran, patients for whom finasteride is prescribed as a secondary drug to tamsulosin tend to experience earlier and more severe sexual side effects without any difference in the amelioration of symptoms. This study aimed to compare the time lag, efficacy, and side effects of combination therapy with varying doses of dutasteride or finasteride added to tamsulosin for benign prostatic hyperplasia (BPH) treatment.MethodsIn this study 165 were randomized into 5 groups (each N = 33); receiving tamsulosin 0.4mg plus either of A: finasteride 3mg, B: placebo, C: dutasteride 0.25mg, D: finasteride 5mg or E: dutasteride 0.5mg. During the 6-month period of the study, International Prostate Symptom Score (IPSS), post-void residual urine (PVR), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate specific antigen (PSA) and maximum urinary flow rate (Qmax) were evaluated at baseline and at the 1st, 3rd and 6th month. The differences between each time point and baseline were then compared between groups.ResultsAt 3-month follow-up, group E exhibited a higher decrease in PSA but a greater increase in Qmax compared to group A (p = 0.047 and 0.006, respectively). Group C showed higher Qmax increase compared to group A at 3 and 6 months (p = 0.003 and 0.014) and concurrently a more pronounced PV decrease at 1 and 3 months (p = 0.047 and 0.003, respectively). Group D had a significantly more decrease in their IIEF-5 compared to group A at one-month visit (p = 0.006).ConclusionsIn summary, at the sixth-month follow-up, dutasteride demonstrated superiority over finasteride solely in enhancing Qmax. Therefore, dutasteride may be marginally more beneficial as a secondary component of combination therapy in BPH.Trial registration IRCT, IRCT20120516009772N2. Registered 18 January 2021 Retrospectively registered, https://irct.behdasht.gov.ir/search/result?query=IRCT20120516009772N2.

Study on the role of iron chelators in the management of iron overload among transfusion-dependent thalassemia (TDT) pediatric patients

This study aims to investigate the efficacy and safety of Deferasirox, an oral iron chelator, in reducing iron burden in pediatric patients with transfusion-dependent beta-thalassemia. Thalassemia syndromes, particularly beta-thalassemia, are inherited hemoglobin disorders requiring regular blood transfusions, leading to iron overload and subsequent complications. Effective management of iron overload is crucial to prevent morbidity and mortality. It was a descriptive observational study on Children between the ages of 2 years and 12 years who present with transfusion-dependent thalassemia and areon blood transfusion and develop iron overload, which is evaluated by serum ferritin levels of more than 2000mcg/l are administered iron chelator Deferasirox (14 mg/kg/d)and patients are evaluated for myocardial, hepatic, pancreatic iron burden and conditions of iron toxicity with the help of Cardiac MRI T2, LIC (Liver Iron Concentration), MRI T2 Pancreas, LVEF (Left Ventricular Ejection Fraction). A total of 22 patients enrolled in the study; significant reductions were observed in mean serum ferritin levels (2,388 mcg/dl to 2,054 mcg/dl, p=0.0009), transferrin saturation (70.45% to 64.32%, p=0.00005), and serum transaminases (44.55 U/L to 40.27 U/L, p=0.003) at 6 months. Cardiac MRI T2* increased from 19.55 ms to 22.95 ms (p=0.045) at the end of 6 months and at the end of 12 months from 19.55 to 28.23 (p=0.0016), and LIC reduced from 20.73 mg Fe/g dw to 11.59 mg Fe/g dw (p=0.00005). Pancreatic T2 improved from 15.96 ms to 20.23 ms at 12 months (p=0.007). A transient increase in serum creatinine was observed at 6 months from 0.64+/-0.14 mg/dL to 0.7+/-0.13mg/dL(p=0.009), which returned to normal at the end of 12 months to 0.63 mg/dL, no additional therapy-related adverse events were reported. Deferasirox has demonstrated significant efficacy in reducing iron overload in pediatric patients with transfusion-dependent beta thalassemia over a 12-month period. The substantial improvements in serum ferritin, cardiac MRI T2*, LIC, transferrin saturation, and pancreatic T2, coupled with its excellent safety profile, support the use of DFX as a cornerstone in the management of iron overload in this vulnerable population.

Effects of Melatonin on Sleep Quality and Patient-Reported Outcomes After Arthroscopic Rotator Cuff Surgery: A Prospective Randomized Controlled Trial.

Sleep disturbance is a significant symptom associated with both rotator cuff tears and arthroscopic rotator cuff repair. Melatonin has been shown to be safe and effective in managing multiple sleep disorders, including secondary sleep disorders, with relatively minor adverse effects and lack of addictive potential. To investigate the effects of oral melatonin on postoperative sleep quality after arthroscopic rotator cuff repair. Randomized controlled trial; Level of evidence, 1. This was a prospective randomized clinical trial evaluating patients undergoing arthroscopic rotator cuff repair. Exclusion criteria included history of alcohol abuse, current antidepressant or sedative use, revision rotator cuff repair, severe glenohumeral arthritis, and concurrent adhesive capsulitis. Patients were randomly assigned in a 1:1 ratio to 1 of 2 groups: 5-mg dose of melatonin 1 hour before bedtime or standard sleep hygiene (≥6 hours per night, avoiding caffeine and naps in the evening). Patients in the melatonin group took their assigned melatonin dose for 6 weeks beginning the day of surgery. Patient-reported outcome assessments, including the Pittsburgh Sleep Quality Index (PSQI), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the Single Assessment Numeric Evaluation (SANE), and pain medication charts were collected preoperatively as well as at 2 weeks, 6 weeks, 3 months, 4 months, and 6 months postoperatively. Numeric variables were analyzed using paired and unpaired t tests, with significance set at P < .05. Eighty patients were included for final analysis (40 in the control group, 40 in the melatonin group). Patient characteristics such as age, sex, race, body mass index, and laterality did not differ significantly (P≥ .05). Preoperative ASES, SANE, and PSQI scores did not differ between groups (P≥ .055). PSQI scores were significantly lower (better quality sleep) in the melatonin group at the 6-week postoperative period (P = .036). There was a positive correlation between how patients rated the intensity of their pain and the PSQI at the 6-week postoperative period (0.566). The PSQI question regarding sleep quality was found to be significantly lower in the melatonin group at the 3-month, 4-month, and 6-month postoperative periods (P = .015, P = .041, and P≤ .05, respectively). SANE scores were significantly lower in the melatonin group (P = .011) at 6 weeks and then higher in the melatonin group (P = .017) at 6 months. ASES scores were significantly higher in the melatonin group at 4 and 6 months (P = .022 and P = .020, respectively). Lastly, patients who were randomized into the melatonin group were found to use significantly less narcotic medication at the 4-month postoperative period (P = .046). Melatonin use after arthroscopic rotator cuff repair led to improved sleep quality (PSQI) in the early postoperative period as well as improved functional outcomes (ASES and SANE scores) and decreased narcotic use in the later postoperative period. Patients with significant sleep disturbances associated with rotator cuff repairs may benefit from the use of melatonin. NCT04278677 (ClinicalTrials.gov identifier).

Medication management and electrocardiogram screening in children with attention deficit hyperactivity disorder.

To quantify the proportion of referrals sent to Crumlin Cardiology Department for cardiac screening prior to commencement or modifying attention deficit hyperactivity disorder medication and assess the number detected with a clinically significant abnormality. A prospective audit was performed over a 6-month period, from November 2021 to April 2022 inclusive. Referrals sent via outpatient department triage letters, electrocardiogram dept. email, and walk-in electrocardiogram service were screened for those pertaining to commencing or modifying medication for children with attention deficit hyperactivity disorder. Each referral was coded against National Institute for Health and Care Excellence guidelines to determine the degree of clinical details given. Reported abnormalities, recommended management, and correspondence were recorded. Ninety-one referrals were received during the 6-month audit period. More than half lacked a clinical indication for referral (53/91, 58.2%), with fewer than one third (26/91, 28.5%) meeting National Institute for Health and Care Excellence criteria for referral for cardiology. Eighty (80/91) referrals had clinical outcomes available for review (missing outpatient department information and age outside of service range accounted for eleven referrals with unavailable clinical outcomes). Of the eighty clinically reviewed referrals, seventy-two (72/80, 90%) were reported as normal with no cardiology follow up required. Eight referrals (8/80, 10%) were reviewed in the Cardiology Outpatient Department prior to commencement or modifying attention deficit hyperactivity disorder medication. Of these, only one (1/80 1%) had a clinically significant abnormality which was a potential contraindication to attention deficit hyperactivity disorder medication use, and this referral was appropriate as per National Institute for Health and Care Excellence guidelines. Routine screening prior to attention deficit hyperactivity disorder medication prescription in the absence of clinical indications (as per National Institute for Health and Care Excellence) contributed to delays in medication initiation among young people with attention deficit hyperactivity disorder. Unnecessary referrals have resource implications for cardiology clinical team. Improved adherence to National Institute for Health and Care Excellence guidelines would provide benefits for patients and clinicians.

Scottish Crofting and an Alternative to Capitalism

ABSTRACT Small-scale farming communities in Scotland engaged in a combination of food sovereignty, agroecology, or land sovereignty are, to some extent, offering an alternative to capitalism. These strategies have not only made them more resilient to the recent crises of capitalism but have done so by reducing their dependency upon it. During these crises, such as the COVID-19 pandemic, they were not only more able to sustain themselves when long food supply chains collapsed but they also increased their autonomy and sustainability through an increased demand for local food networks. What is more, in certain areas, these strategies have transformed social relations and, at times, revealed unalienated practices such as gift economies. This research was conducted over a 15-month period and primarily consisted of seasonal interviews with 14 small-scale food producers in Scotland. This paper will examine the manner in which the agricultural practices of these communities offer a glimpse of what an alternative to capitalism might look like through an analysis that draws on the work of James C. Scott, Marcell Mauss and John Holloway.

Safety, Tolerability, and Short-Term Efficacy of Low-Level Light Therapy for Dry Age-Related Macular Degeneration.

Photobiomodulation (PBM) has become a promising approach for slowing the progression of early and intermediate dry age-related macular degeneration (dAMD) to advanced AMD. This technique uses light to penetrate tissues and activate molecules that influence biochemical reactions and cellular metabolism. This preliminary analysis is aimed at assessing the safety, tolerability, and short-term effectiveness of the EYE-LIGHT®PBM treatment device in patients with dAMD. The EYE-LIGHT® device employs two wavelengths, 590nm (yellow) and 630nm (red), in both continuous and pulsed modes. Patients over 50years of age with a diagnosis of dAMD in any AREDS (Age-Related Eye Disease Study) category were randomly assigned to either the treatment group or the sham group. The treatment plan consisted of an initial cycle of two sessions per week for 4weeks. Safety, tolerability, and compliance outcomes, along with functional and anatomical outcomes, were assessed at the end of the fourth month. This preliminary analysis included data from 76 patients (152 eyes). All patients were fully compliant with treatment sessions, and only one fifth of patients treated with PBM reported mild ocular adverse events, highlighting exceptional results in terms of tolerability and adherence. Changes in best-corrected visual acuity (BCVA) from baseline to month 4 differed significantly between the sham and PBM-treated groups, favoring the latter, with a higher proportion achieving a gain of five or more letters post-treatment (8.9% vs. 20.3%, respectively; p = 0.043). No significant differences in central subfield thickness (CST) were observed between the two groups over the 4-month period. The study also found a statistically significant disparity in mean drusen volume changes from baseline to month 4 between the groups in favor of patients treated with PBM (p = 0.013). These preliminary results indicate that PBM treatment using the EYE-LIGHT® system is safe and well tolerated among patients with dAMD. Furthermore, both functional and anatomical data support the treatment's short-term efficacy. ClinicalTrials.gov identifier NCT06046118.

Community-based dementia risk management and prevention program for Aboriginal Australians (DAMPAA): a randomised controlled trial study protocol

IntroductionAboriginal and Torres Strait Islander peoples are the First Peoples of Australia. Up to 45% of dementia in these populations is due to potentially modifiable risk factors. The Dementia Prevention...

A revisit of knowledge, attitude and practice of emergency contraception in Hong Kong

ObjectivesTo revisit women’s knowledge, attitudes and practices (KAP) regarding emergency contraception (EC) in Hong Kong. The research sought to provide insights for improving the accessibility and quality of EC services.Study...

Model based fitting of pattern reversal visually evoked potentials provides a reliable characterization of waveform components

ObjectiveTo introduce a novel approach to analyzing pattern reversal visual evoked potentials (prVEPs) using a difference-of-gammas model-based fitting method. MethodsprVEP was recorded from uninjured youth ages 11–19 years during pre- or post-season sports evaluation. A difference-of-gammas model fit was used to extract the amplitude, peak time, and peak width of each of four gamma components. The within session reliability and stability of fits across a 6-month period were determined. To demonstrate an application of this analysis, changes in parameters across age were determined. ResultsA difference-of-gammas model consisting of four gamma functions was fit to the prVEP of 151 youth. Peak times and amplitudes of functions corresponded to standard measures of the N75, P100, and N135 components respectively, and a late gamma peak (mean peak time 219 ms). We extracted the peak width, which increased with each subsequent temporal peak. Parameter fits were reliable within sessions (correlation coefficient > 0.92 for all measured parameters; good agreement on Bland-Altman calculation) and were stable between sessions separated by less than 6 months (correlation coefficient > 0.90). Standard peak analysis metrics extracted from the difference-of-gamma model fits were largely consistent with gold-standard peak analysis measurements. ConclusionsThe difference-of-gammas model provides a stable and reliable within-participant representation of the global temporal variability of prVEP waveforms across a large sample of youth. SignificanceUsing difference-of-gammas model to characterize the global temporal variability of the prVEP waveform offers a promising direction to enhance analysis for identifying and following subtle changes in neurologic conditions.

The Anatomic Pathology Hospitalist Model.

Challenges to staffing a high-quality frozen section service include consolidation of health systems and pathology practices, off-campus relocation of some pathology offices, growing numbers of stand-alone surgery centers, and subspecialization among pathologists and surgeons. To address these challenges, we developed a novel anatomic pathology hospitalist model with explicit emphasis in frozen section. To evaluate our anatomic pathology hospitalist program's impact on (1) frozen section staffing, (2) frozen-permanent diagnostic concordance, and (3) turnaround time. Frozen section staffing and performance data were collected for the 28-month period spanning July 1, 2021, to October 31, 2023. Outcomes were compared between hospitalists, nonhospitalists, and fellows. Hospitalists performed more frozen sections per month than nonhospitalists (median, 87 versus 17, respectively; P = .002). After implementation, nonhospitalists' average frozen section staffing obligation fell from 3.7 (30%) of 12.3 total service days per month to 2.8 (22%) of 12.6 total service days per month (P = .005), compared with hospitalists' average of 9.5 frozen section days (69%) of 13.7 total service days per month. Frozen-permanent concordance was marginally but significantly higher for hospitalists (4701 of 4744 blocks, 99.1%) than nonhospitalists (7259 of 7362 blocks, 98.6%; P = .02). Concordance did not correlate with pathologists' academic rank or subspecialization. Turnaround times were comparable for hospitalists, nonhospitalists, and fellows across multiple metrics. Our anatomic pathology hospitalists significantly reduced the frozen section obligations of nonhospitalist faculty, with a small but significant increase in frozen-permanent concordance and no substantial change in turnaround time.

Neuropsychiatric manifestations of hospitalized patients with coronavirus disease 2019 during the second wave in Egypt

BackgroundStudies suggested that COVID-19 virus causes neurological and psychiatric manifestations with different mechanisms. However, prevalence of neurological and psychiatric manifestations among COVID-19 patients varies across studies from 18.1%: 82.3%. The objective of this study was to determine neuropsychiatric manifestations in a sample of Egyptian COVID-19 hospitalized patients during the second wave of the pandemic and to detect factors affecting neurological and psychiatric prevalence. This cross-sectional study was conducted at Ain Shams university isolation hospitals and included 110 hospitalized COVID-19 patients, over a 2-month period from June 2021 to August 2021. Patients underwent a careful history taking, full neurological examination including Mini-Mental State Examination, the Structured Clinical Interview for DSM-IV (SCID I), COVID-19 severity criteria. Any available imaging and laboratory tests were recorded.Results83 (75.5%) patients had neurological manifestations. The most common neurological manifestations were headache (50.9%), hypogeusia (24.5%), hyposmia, paresthesia (23.6% each) and coma (15.5%). After exclusion of 17 patients who could not be examined by Mini-Mental State Examination, psychiatric manifestations were seen in 56 patients (61.5%) out of the remaining 91 patients. The most prevalent psychiatric disorders were delirium (30.8%), depression (19%), and adjustment disorder (17.5%). Moreover, hypertension, COVID-19 severity, place of admission, and high levels of LDH and ALT affected neurological manifestations prevalence.ConclusionsCOVID-19 infection and its immune reaction along with its social and psychological effects have a great impact on mental and physical health. Hence, neuropsychiatric evaluation cannot be ignored in any case with COVID-19 infection.

A - 108 Changes in Memory and Attention Function Post-COVID-19 Infection in Older Adults with MCI

Abstract Objective Persons with mild cognitive impairment (MCI) are more likely to develop dementia due to pre-existing cognitive impairment. COVID-19 is associated with an increased risk of developing dementia one-year post-infection. The purpose of this study is to explore the impact of COVID-19 infection on memory and attention in an amnestic sample. It was hypothesized that older adults with MCI would have significantly worse cognitive function post-COVID-19 infection. Method The current sample was drawn from a larger study of late life brain health. Our sample consisted of 9 older adults (mean age = 77.89 ± 9.89) with MCI. Participants were predominately White (77.78%) and male (100%). Participants completed the Rey Auditory Verbal Learning Test (RAVLT) at baseline (T1) and 6 months (T2). All participants received the COVID-19 vaccine prior to T1 and contracted COVID-19 between T1 and T2. Paired sample t-tests evaluated cognitive change over time. Results Participants experienced non-significant change on the RAVLT Trial 6 (t = 0.00, p = 0.91), RAVLT Delayed Recall (t = 1.00, p = 0.35), RAVLT Sum Trials 1–5 (t = −1.49, p = 0.18), and RAVLT Trial 1 (t = −0.12, p = 0.91). Conclusions In our sample of older adults with MCI, contracting COVID-19 was not associated with significant worsening of learning, memory, or attention over a 6-month period. These findings suggest that the 6–12-month period post-COVID-19 infection may be a critical window for significant worsening of cognitive function. Future research should directly assess cognitive function in older at-risk groups 6–12 months post-COVID-19 infection.

Longitudinal refractive errors over 36 months in Hispanic and Black children.

This study brings awareness of racial/ethnic difference of refractive error characteristics in clinics. This study aimed to assess longitudinal change in refractive errors over a 36-month period in Hispanic and Black children. Children (2.4 to 15 years old) were studied. Cycloplegic refraction was measured annually. Spherical equivalent was calculated. Astigmatism was evaluated by magnitude of cylinder and power vector (J0 and J45). Absolute value of interocular spherical equivalent difference was used to calculate anisometropia. Mixed-linear model was used to analyze longitudinal annual change in spherical equivalent, cylinder, J0, and J45 over 36 months. A total of 485 participants (310 Black, 175 Hispanic) met the criteria. At the baseline examination, prevalence of myopia, emmetropia, and hyperopia was 39% (n = 187), 31% (n = 150), and 30% (n = 148), respectively. Spherical equivalent of Black children was not significantly different from that in Hispanic children (0.10 ± 2.92 vs. -0.37 ± 2.05 D, p=0.06); however, the Hispanic children had a significantly higher cylinder compared with Black children (Hispanic: 1.46 ± 1.57 D vs. Black: 0.92 ± 1.07 D; p<0.001). Both J0 (p<0.001) and J45 (p=0.01) were significantly different between two groups; the Hispanic children had more with-the-rule astigmatism and oblique astigmatism than the Black children. Prevalence of anisometropia (≥1 D) was higher in Black children (14%) compared with Hispanic children (5%, p=0.006). Over 36 months, spherical equivalent significantly decreased an average of 0.69 D (0.23 D/y, p<0.001) for both groups; neither astigmatism nor anisometropia changed significantly (p>0.05). Astigmatism in the Hispanic children was significantly higher than in Black children. However, the Black children had a higher prevalence and degree of anisometropia than the Hispanic children.

Report of a new species of sand fly, Phlebotomus (Anaphlebotomus) ajithii n. sp. (Diptera: Psychodidae), from Western Ghats, India

BackgroundWestern Ghats is a biodiversity treasure trove with reports of indigenous leishmaniasis cases. Hence, systematic sand fly surveillance was carried out among the tribal population. The present study reports a novel sand fly species, Phlebotomus (Anaphlebotomus) ajithii n. sp. (Diptera: Psychodidae), discovered in the Western Ghats of India.MethodsA comprehensive sand fly survey was conducted across the Kollam, Thrissur, Idukki, Kasaragod and Malappuram districts of Kerala, India. The survey spanned both indoor and outdoor habitats using standard collection methods over a 3-year, 3-month period. DNA barcoding of samples was performed targeting mitochondrial cytochrome c oxidase subunit I (COI) gene, and the sequence generated was subjected to phylogenetic analysis.ResultsPhlebotomus (Anaphlebotomus) ajithii, a new sand fly species, is recorded and described in this communication. The morphological relationship of the new species to other members of the subgenus Anaphlebotomus is discussed. Mitochondrial COI barcode followed by phylogenetic analysis confirmed that specimens of Ph. ajithii belong to the same taxonomic group, while a genetic distance of 11.7% from congeners established it as a distinct species.ConclusionsThe Western Ghats, known for its rich biodiversity, has lacked systematic entomological surveys focusing on sand flies. This study aims to fill this gap and reports and describes a new species of sand fly.Graphical abstract

Tonotopic and Default Frequency Fitting for Music Perception in Cochlear Implant Recipients

Cochlear implants are an effective technique for enhancing speech perception abilities in quiet environments for people with severe to profound deafness. Nevertheless, complex sound signals perception, such as music perception, remains challenging for cochlear implant users. To assess the benefit of a tonotopic map on music perception in new cochlear implant users. A prospective, randomized, double-blind, 2-period crossover study including 26 new cochlear implant users was performed over a 6-month period (June 2021 to November 2021). An anatomical tonotopic map was created using postoperative flat-panel computed tomography and a reconstruction software based on Greenwood function. New cochlear implant users older than 18 years with bilateral severe to profound sensorineural hearing loss or complete hearing loss for less than 5 years were selected in the University Hospital Centre of Rennes in France. The trial was conducted from June to November 2021 (inclusion) and to February 2022 (end of the assessment procedure at 12 weeks postactivation), and the analysis itself was completed in December 2022. Each participant was randomized to receive a conventional map followed by a tonotopic map or vice versa. Participants performed pitch-scaling tasks (multidimensional qualitative assessment, melodic contour identification, melodic recognition test) after 6 weeks of each setting. Thirteen participants were randomized to each sequence. Two of the 26 participants recruited (1 in each sequence) had to be excluded due to the COVID-19 pandemic. The multidimensional qualitative assessment (Gabrielsson test), melodic contour identification, and melodic recognition scores were significantly higher with the tonotopic setting than the conventional one (mean effect [ME], 7.8; 95% CI, 5.0-10.5; ME, 12.1%; 95% CI, 5.7%-18.4%; ME, 14.4%, 95% CI, 8.5%-20.2%; and ME, 2.1, 95% CI, 1.7-2.5, respectively). Among the different dimensions evaluated by the Gabrielsson test, the mean scores for clarity, spaciousness, fullness, nearness, and total impression were significantly higher with tonotopic fitting. Ninety-two percent of the participants kept the tonotopy-based map after the study period. In this randomized clinical trial of patients with new cochlear implants, a tonotopic-based fitting was associated with better results in perception of complex sound signals such as music listening experience. ClinicalTrials.gov Identifier: NCT04922619.

Fixation of Superolateral Platysma Flap to the Mastoid Fascia: A Novel Isolated Neck Lift Technique.

This study aimed to evaluate the utility of a novel neck lift technique based on fixation of superolateral platysma flap to the mastoid fascia in terms of postoperative aesthetic outcome and patient satisfaction within an 18-month follow-up period. A total of 145 female patients who underwent isolated neck lift operation with the superolateral platysma flap technique were included. Global Aesthetic Improvement Scale (GAIS) scores (by the investigator) and the patient reported outcomes were recorded in terms of improvement in the cervicofacial angle, jowls, platysmal bands and malpositioned cervical fats, at 6 and 18 months, postoperatively. The complications were recorded at early postoperative period and at 1, 6 and 18 months, postoperatively. The median duration of follow-up was 18 months (range, 6-48months). GAIS scores at 18th months, revealed exceptional improvement in the cervicofacial angle (82.8%), the jowls (93.1%), platysmal bands (93.1%) and malpositioned cervical fat (97.2%). Majority of patients were very satisfied with the treatment in terms of the aesthetic improvement. Complications involved the minor ecchymosis (17.2%) and minor skin circulatory problem (11.7%) in the early postoperative period, suture exposure (12.4%) in the postoperative 1st month, and cervical band reformation in the 6th (0.7%) and 18th (1.4%) months. In conclusion, lateral displacement and fixation of superolateral platysma flap to the mastoid fascia seems to be a useful neck lift technique for correction of platysma- and skin-derived aging sings with minor and manageable complications, immediate return to everyday activities and a high patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Impact of continuous glucose monitoring on hospitalizations and glucose control in people with type 2 diabetes: real-world analysis.

The real-world benefits of continuous glucose monitoring (CGM) in the broad type 2 diabetes (T2D) population are not well studied. Our study evaluated the impact of CGM use on health care resource utilization over 12 months in adults with T2D. This retrospective cohort analysis used Optum's de-identified Market Clarity data of >79 million people to evaluate CGM use in people with T2D who were treated with non-insulin (NIT), basal insulin (BIT) and prandial insulin therapy (PIT). The primary outcomes were changes in all-cause hospitalizations, acute diabetes-related hospitalizations and acute diabetes-related emergency room visits during the 6- and 12-month post-index period following transition from blood glucose monitoring to CGM. A pre-specified subgroup analysis assessed glucose control and medication changes among people with T2D over 1 year. The analysis included 74 679 adults with T2D (NIT; n = 25 269), (BIT; n = 16 264) and (PIT; n = 33 146). Significant reductions in all-cause hospitalizations, acute diabetes-related hospitalizations and acute diabetes-related emergency room visits were observed in the 6-month post-index period that were sustained during the 6-12 month post-index period (NIT, -10.1%, -31.0%, -30.7%; BIT, -13.9%, -47.6%, -28.2%; and PIT, -22.6%, -52.7%, -36.6%, respectively). A subgroup analysis of 6030 people showed mean glycated haemoglobin reductions at approximately 3 months, which were also sustained throughout the post-index period: NIT, -1.1 (0.05)%; BIT, -1.1 (0.06)%; and PIT, -0.9 (0.04)%, p < 0.0001. CGM use in real-life across different therapeutic regimens in adults with T2D was associated with reductions in health care resource utilization with improved glucose control over 1 year.