Level 1B Research Articles

Role of physical therapy in reducing length of stay and occurrence of post intensive care syndrome among COVID 19 patients admitted to the intensive care unit

Post intensive care syndrome (PICS) is a debilitating co‐morbidity associated with prolonged stay in the intensive care unit (ICU). The symptomatology of PICS includes decreased muscle functioning, increased muscle weakness, increased states of delirium, and increased occurrence of ICU‐acquired weakness. Patients hospitalized with COVID‐19 are at high risk for developing PICS due to the debilitating nature of the disease, prolonged periods of inactivity with the use of mechanical ventilation, and muscle weakness after cessation of mechanical ventilation. With the sudden pandemic of COVID‐19, research on the appropriate physical therapy protocols to provide effective care for these patients during their stay in the ICU is limited. The purpose of the study was to determine if early mobilization and rehabilitation in patients with COVID‐19 can reduce PICS and length of hospital stay. Using PUBMed, Google Scholar, and other databases, a systematic review of literature was conducted and ranked using the Oxford Centre of Evidence‐based Medicine. Of the literature reviewed, 73% of the articles were found to have level 2B and 27% were level 1B. Preliminary results revealed that the majority of patients adhering to early intervention and mobilization yielded improvements in the form of decreased length of hospital stay in the ICU and enhanced functional mobility upon discharge. Based on the results, we can surmise that early mobilization administered to mechanically ventilated patients may provide the same benefits to patients with COVID‐19 in the form of decreased length of hospital stay and reduced likelihood of developing PICS.

Analysis of coastal wind speed retrieval from CYGNSS mission using artificial neural network

This paper demonstrates the capability and performance of sea surface wind speed retrieval in coastal regions (within 200 km away from the coastline) using spaceborne Global Navigation Satellite System Reflectometry (GNSS-R) data from NASA's Cyclone GNSS (CYGNSS) mission. The wind speed retrieval is based on the Artificial Neural Network (ANN). A feedforward neural network is trained with the collocated CYGNSS Level 1B (version 2.1) observables and the wind speed from European Centre for Medium-range Weather Forecast Reanalysis 5th Generation (ECMWF ERA5) data in coastal regions. An ANN model with five hidden layers and 200 neurons in each layer has been constructed and applied to the validation set for wind speed retrieval. The proposed ANN model achieves good wind speed retrieval performance in coastal regions with a bias of −0.03 m/s and a RMSE of 1.58 m/s, corresponding to an improvement of 24.4% compared to the CYGNSS Level 2 (version 2.1) wind speed product. The ANN based retrievals are also compared to the ground truth measurements from the National Data Buoy Center (NDBC) buoys, which shows a bias of −0.44 m/s and a RMSE of 1.86 m/s. Moreover, the sensitivities of the wind speed retrieval performance to different input parameters have been analyzed. Among others, the geolocation of the specular point and the swell height can provide significant contribution to the wind speed retrieval, which can provide useful reference for more generic GNSS-R wind speed retrieval algorithms in coastal regions.

Interventions Within the Scope of Occupational Therapy to Improve Activities of Daily Living, Rest, and Sleep in People With Parkinson's Disease: A Systematic Review.

People with Parkinson's disease (PD) commonly experience difficulty in performing activities of daily living (ADLs), which affects their perceived quality of life. To examine the evidence for the effectiveness of interventions within the scope of occupational therapy to improve performance and participation in ADLs, rest, and sleep in adults with PD. Databases searched were MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane Collection. Included articles were published between January 2011 and December 2018. Study Selection and Data Collection: Articles describing Level 1b, 2b, and 3b studies that examined outcomes related to ADLs, rest, and sleep in people with PD were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Forty-five articles (10 Level 1b, 27 Level 2b, and 8 Level 3b) met the inclusion criteria. Strong strength of evidence was found to support inpatient multidisciplinary intensive rehabilitation treatment (MIRT) to improve ADLs, and moderate strength of evidence that MIRT improves sleep performance. Low strength of evidence was present for outpatient occupational therapy to improve ADL and sleep outcomes. Low strength of evidence was found for resistance exercise programs to improve ADLs, but moderate strength of evidence indicates that multimodal exercise programs and targeted exercise programs can improve ADLs. Low to moderate strength of evidence suggested that alternative therapies and cognitive-behavioral therapy have a positive impact on ADLs and sleep. These results can be used to inform evidence-based occupational therapy practice. What This Article Adds: This article provides information for practitioners on the effectiveness of interventions within the scope of occupational therapy practice to improve ADLs and sleep.

Occupational Therapy Interventions for Instrumental Activities of Daily Living for Adults With Parkinson's Disease: A Systematic Review.

Instrumental activities of daily living (IADLs) are important for independence, safety, and productivity, and people with Parkinson's disease (PD) can experience IADL limitations. Occupational therapy practitioners should address IADLs with their clients with PD. To systematically review the evidence for the effectiveness of occupational therapy interventions to improve or maintain IADL function in adults with PD. MEDLINE, CINAHL, PsycINFO, OTseeker, and Cochrane databases from January 2011 to December 2018. Study Selection and Data Collection: Primary inclusion criteria were peer-reviewed journal articles describing Level 1-3 studies that tested the effect of an intervention within the scope of occupational therapy on an IADL outcome in people with PD. Three reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-two studies met the inclusion criteria and were categorized into four themes on the basis of primary focus or type of intervention: physical activity, specific IADL-focused, cognitive rehabilitation, and individualized occupational therapy interventions. There were 9 Level 1b, 9 Level 2b, and 4 Level 3b studies. Strong strength of evidence was found for the beneficial effect of occupational therapy-related interventions for physical activity levels and handwriting, moderate strength of evidence for IADL participation and medication adherence, and low strength of evidence for cognitive rehabilitation. Occupational therapy interventions can improve health management and maintenance (i.e., physical activity levels, medication management), handwriting, and IADL participation for people with PD. Further research is needed on cognitive rehabilitation. This review is limited by the small number of studies that specifically addressed IADL function in treatment and as an outcome. What This Article Adds: Occupational therapy intervention can be effective in improving or maintaining IADL performance and participation in people with PD. Occupational therapy practitioners can address IADL function through physical activity interventions, interventions targeting handwriting and medication adherence, and individualized occupational therapy interventions.

Correlation of Likert scores III–V with increasingly worse pathology in radical prostatectomy specimens significant only for men aged <60 or PSAD >0.15, with age <60 as good as PSAD <0.15 at discriminating lower risk in Likert III

Objectives: This study aimed to compare Likert scores with radical prostatectomy specimens. Methods: This study examined 443 men with validated pre-biopsy magnetic resonance imaging results and used cross-tabulation and chi-square significance testing with National Comprehensive Cancer Network risk categories. Results: The mean prostate-specific antigen (PSA) was 10, and the mean age was 64 years. Comparing Likert III to Likert V and Likert IV to Likert V, both (each p=0.02) were significantly associated with higher prostate cancer risk groups, but Likert III versus Likert IV was not ( p=0.1). Within the subgroup PSA density (PSAD) <0.15 ( n=140), the correlation of Likert score and final pathological risk group was lost ( p=0.5), but it was not lost within the subgroup PSAD >0.15 ( n=281; p=0.045 III vs. IV only and p=0.055 overall). Within the subgroup age <60 ( n=104), the correlation of Likert score and final pathological risk group was significant ( p=0.006 for III vs. IV and p=0.04 overall), whereas within the subgroup age >60 ( n=339) this significant difference was lost ( p=0.34). Further subgroup analysis within Likert III ( n=86) found that men <60 ( n=22) had neither high-grade (G3 or G4 or G5) nor very high-risk disease. There were only two high-risk cases, both of which were G2T3a (2/22; 10%). In men with Likert III and PSAD <0.15 ( n=31), there were seven high-risk and two very high-risk cases (9/31; 25%). This difference was not significant ( p=0.31) Conclusion: With these two findings, we recommend that men <60 with Likert III can be counselled like men with Likert III and PSAD <0.15, that they are unlikely to have unfavourable or high-risk disease and that they may wish to avoid biopsy or treatment. Level of evidence: Level 1b.

A Review of UK-based National and International Scientific Meeting Published Abstracts in Response to the Draft NICE Aortic Aneurysm Guidelines

UK National Institute for Health and Care Excellence (NICE) draft clinical guidelines (CG) (2018) regarding aortic aneurysm repair were disputed internationally. We aim to appraise the academic response to the draft CG in terms of quantity and scientific quality by reviewing published conference abstracts from three major national and international, UK meetings. Abstracts related to aortic practice from The Vascular Societies Annual Scientific Meeting, British Society for Endovascular Therapy (BSET) & Charing Cross (CX) meetings from 2019 were reviewed for methodology, sample size, data collection period, scientific quality and conclusions that supported or conflicted the draft guideline. A total of 549 abstracts were identified from VSGBI, BSET and CX abstract books of which, 226 (41.2%) were related to aortic practices. Of these, 115 (50.9%) were related to EVAR. Twenty-two of these abstracts (19.1%) were identified as having findings relevant to the draft guidelines. Eighteen (15.7%) were identified as findings that potentially conflict the draft CG and 4 (3.5%) that could support the initial recommendations. Six abstracts (5.2%) made direct reference to or challenged the draft CG. The median data collection period was 4 years. The median sample size was 102 patients. In general, scientific quality was poor, with 82% of selected abstracts were graded at level 2b. We have demonstrated a concerted response to the draft NICE clinical guidelines relating to the treatment of abdominal aortic aneurysms at three large scientific meetings. As a result of which and other factors, significant changes were made to the finalized NG156. There is still paucity in evidence regarding the long-term safety and cost-effectiveness of EVAR.

Comparison of topical honey and povidone iodine-based dressings for wound healing: a systematic review and meta-analysis.

In this review and meta-analysis, we analyse the evidence to compare the efficacy of honey and povidone iodine-based dressings on the outcome of wound healing. A systematic literature search was performed using PRISMA guidelines in academic databases including MEDLINE, Scopus, Embase and CENTRAL. A meta-analysis was carried out to assess the effect of honey and povidone iodine-based dressings on mean healing duration, mean hospital stay duration and visual analogue scale (VAS) score of pain. From the search, 12 manuscripts with a total of 1236 participants (mean age: 40.7±11.7 years) were included. The honey-based dressings demonstrated a medium-to-large effect in reduction of mean healing duration (Hedge's g: -0.81), length of hospital stay (-3.1) and VAS score (-1.2) as compared with the povidone iodine-based dressings. We present evidence (level 1b) in favour of using honey for improvement of wound recovery as compared with povidone iodine. This review and meta-analysis demonstrate beneficial effects of honey-based dressings over povidone iodine-based dressings for wound recovery.

Acute Effects of Dry Needling on Myofascial Trigger Points in the Triceps Surae of Ballet Dancers: A Pilot Randomized Controlled Trial.

BackgroundThere is convincing evidence that dancers suffer injuries to the triceps surae musculature. Research on the immediate effects of dry needling (DN) is limited, and it is important to understand the acute effects of this treatment prior to performance.PurposeThe purpose of this pilot study was to assess the immediate effects of DN on myofascial trigger points in terms of skin surface temperature, pain, active and passive range of motion, and torque production in the triceps surae of ballet dancers.Study DesignRandomized, double-blinded pilot studyMethodsProfessional ballet dancers that fit inclusion and exclusion criteria (n=11) were randomly assigned to an experimental or control group. The dancers had three pre-determined standard point (SP) measurement spots that were used as a baseline for surface temperature comparisons. The dancers were also palpated for trigger point (TP) spots. Both SP and TP spots were marked for future measurements. The experimental group received DN, while the control group received sham DN (SHAM) to their bilateral calves at the TP spots. Immediately prior to and following treatment, both DN and SHAM groups were tested for skin surface temperature, pain, range of motion, and plantar flexion torque by blinded assessors. Paired t-tests and independent t-tests were performed to examine for differences between groups.ResultsThe surface temperature for the TP was higher than the SP measurements prior to intervention (Right calf p= .014; Left calf p= .031). There were no significant changes in VAS scale reported pain and ROM. The plantar flexion torque measurements showed an increase in the DN group of the left calf at the angular velocity of 60 degrees/sec.ConclusionThis was a unique pilot study examining the acute effects of DN on professional ballet dancers. The results were limited due to low sample size. However, the methodology for this study and surface temperature results invites future research.Level of evidenceLevel 1b

Quality-of-Life Discrepancies Among Autistic Adolescents and Adults: A Rapid Review.

Quality of life (QoL) is a core outcome of occupational therapy, but it is decreased among autistic adolescents and adults. This is the first review of QoL from an occupational therapy standpoint. To identify self-reported QoL differences between autistic and nonautistic samples; investigate sex differences in QoL among autistic people; examine consistency in QoL among autistic people across age, intellectual disability (ID), and self- versus proxy-report method; and appraise occupational therapy-related interventions addressing QoL among autistic people. Articles published in peer-reviewed journals between 2010 and 2020, located through Academic Search Ultimate, PubMed, and OTseeker, along with the American Journal of Occupational Therapy, British Journal of Occupational Therapy, Canadian Journal of Occupational Therapy, and Australian Occupational Therapy Journal. Study Selection and Data Collection: Article samples consisted of at least 20% autistic females and used self-reported QoL measures. Qualitative research was excluded, as well as studies with participants younger than age 13 yr. Twenty-seven articles qualified (3 Level 1B, 13 Level 3B, and 11 Level 4). Autistic adolescents and adults demonstrated decreased self-reported QoL compared with nonautistic peers across age and ID presence. One article compared sex differences in QoL among autistic people. Interventions improved QoL among autistic people. Autistic adolescents and adults demonstrate decreased QoL in comparison with nonautistic peers. Questions remain related to sex differences in QoL among autistic people, an area for future research. Multiple evidence-based approaches to improve QoL in the autistic population are relevant to occupational therapy practice. What This Article Adds: Self-reported QoL among autistic adolescents and adults is clearly lower than among their nonautistic counterparts. This article provides information on multiple interventions related to occupational therapy to improve QoL among autistic people.

Informed consent: What risks are material to patients consenting for urological procedures?

Objective: This study aimed to assess patient recall of the consent discussion for urological procedures and to identify which risks were material to urology patients. Methods: A total of 102 patients undergoing urological procedures were interviewed in the 24-hour period surrounding the procedure. A self-designed, piloted questionnaire recorded information from the patient’s signed consent form and patient-reported data of the consent discussion. Results: The mean patient recall was 2.06 risks, whereas the average number of risks listed by the operating surgeon on the consent form was 5.69 risks. The most frequently recalled risk was impotence (91%), followed by urinary incontinence (63%) and haematuria (61%). The risks associated with poorest patient recall were stent symptoms (0%), urethral catheter insertion (5%) and recurrence (8%). Conclusions: Poor patient recall of the consent discussion has again been demonstrated in this study. However, certain urological procedure risks are better recalled by patients, with impotence, urinary incontinence and haematuria being most frequently recalled. Medical terminology such as stent or catheter may be poorly recalled due to a disparity in understanding between patient and clinician. Clinicians should be aware of poor patient recall when consenting for urology procedures and should ensure precise documentation. Level of evidence: Level 2b.

Accentuated Eccentric Loading is Superior to Traditional Loading for Improving Acute Countermovement Jump Performance in Adult, Resistance-Trained Males.

Clinical Scenario: Traditional loading (TL) is a common technique to employ when engaging in countermovement jumps (CMJ). Accentuated eccentric loading (AEL) is a newer modality that is being explored for acute CMJ performance. Focused Clinical Question: In adult, resistance-trained males, will AEL have a superior impact on acute CMJ performance compared to TL? Summary of Key Findings: The literature was searched for studies that examined the influence of AEL on acute CMJ performance compared to a TL protocol. TL was defined as any loading condition that utilized an equivalent resistance during both the eccentric and concentric contractions. Three studies met the inclusion and exclusion criteria, and were identified and included in the critically appraised topic. Each of the 3 studies found that various AEL conditions were either equal to or better than TL when examining subsequent CMJ performance. In no specific CMJ outcome measure was TL deemed to have a greater impact than AEL. Clinical Bottom Line: AEL provides more favorable acute CMJ performance than TL in adult, resistance-trained males. Strength of Recommendation: Consistent findings from 2 randomized crossover studies and one repeated-measured design investigation suggest level 2b evidence to support AEL as an ideal protocol for acute CMJ performance.

Do Perioperative Systemic Corticosteroids Improve Cochlear Implant Hearing Preservation Outcomes?

Do Perioperative Systemic Corticosteroids Improve Cochlear Implant Hearing Preservation Outcomes?

Adiposity as a Risk Factor for Sport Injury in Youth: A Systematic Review.

To determine whether high or low adiposity is associated with youth sport-related injury. Ten electronic databases were searched to identify prospective studies examining the association between adiposity [body mass index (BMI) or body fat] and a future time-loss or medical attention sport-related musculoskeletal injury or concussion in youth aged 20 years and younger. Two independent raters assessed the quality (Downs and Black criteria) and risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Random-effects meta-analyses were used to calculate pooled odds ratio [95% confidence interval (CI)] of injury. Of 11 424 potentially relevant records, 38 articles were included with 17 eligible for meta-analyses. In qualitative synthesis, no clear association was identified between adiposity and any sport injury; however, 16/22 studies identified high adiposity as a significant risk factor for lower-extremity injury. Meta-analyses revealed higher BMI in youth with any sport-related injury and lower BMI in youth who developed a bone stress injury (BSI) compared with noninjured controls. The pooled OR (95% CI) examining the association of BMI and injury risk (excluding bone injury) was 1.18 (95% CI: 1.03-1.34). A major source of bias in included articles was inconsistent adjustment for age, sex, and physical activity participation. Level 2b evidence suggests that high BMI is associated with greater risk of youth sport injury, particularly lower-extremity injury and excluding BSI or fracture. Although pooled mean differences were low, anthropometric risk of injury seems to be dependent on type and site of injury in youth sport.

Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience

Objectives: This study aimed to describe a UK institution’s experience with local anaesthetic (LA) transperineal (TP) prostate biopsies (PB), and to report 30-day complications following LATPPB, including a large cohort that did not receive antibiotic prophylaxis. Patients and methods: A prospective database of 313 consecutive patients undergoing LATPPB was maintained, describing patient and disease characteristics, and complications. From September 2019 to January 2020, antibiotic prophylaxis was given before LATPPB ( n=149). Following a change to routine care, from January 2020 to July 2020, prophylactic antibiotics were not given before LATPPB ( n=164). A comparative analysis was performed to determine complication rates following antibiotic prophylaxis discontinuation using electronic hospital and primary care records. Results: Patient and disease characteristics were comparable in antibiotic and non-antibiotic cohorts, and representative of PB and prostate cancer cohorts described in the urological literature. The infection-related complication rate was 0.32% across all patients, and 0% for those not receiving antibiotic prophylaxis. The overall complication rate was 0.64%, and 0.61% for those not receiving antibiotic prophylaxis. There were no severe (Clavien–Dindo 3–5) complications. The unplanned hospital admission rate was 0.64%. Conclusion: The complication rate after LATPPB was low, with no infection-related complications in patients who did not receive antibiotic prophylaxis. This provides further evidence supporting the discontinuation of routine prophylactic antibiotics before TPPB. Level of evidence: Level 2b.

Sensor calibration impacts on dust detection based on MODIS and VIIRS thermal emissive bands

Dust detection using remotely sensed measurements has been one of the challenging problems encountered by atmospheric scientists. MODerate Resolution Imaging Spectroradiometer (MODIS) on the Terra (T) and Aqua (A) platforms have been a versatile sensor for well over 21 and 18 years respectively, and have been extremely useful in the retrieval of aerosol information over the entire globe. The MODIS radiances from the Level 1B in general are expected to be within 5% accuracy in the reflective wavelengths and within 1% in the thermal emissive wavelengths. In this paper, we evaluate the sensitivity of previously developed dust detection technique based on thermal emissive wavelengths, which correspond to MODIS bands 20, 29, 31, and 32 respectively. The Thermal Emissive Dust Index (TEDI) performed very comparably to the traditional Aerosol Optical Thickness (AOT) retrievals by MODIS reflective channels. Since the MODIS Thermal Emissive Bands (TEB) are well calibrated on-orbit using a BlackBody (BB) source, the calibration of these long wave infrared bands is quite robust. As A-MODIS continues to perform well beyond its designed lifetime of 6 years, the instrument has undergone various levels of degradation during its mission time. As a consequence, it is imperative to check the impacts of calibration on the higher-level retrievals. In this paper, we rigorously analyze the sensitivity of TEDI due to the impact of calibration by the afore-mentioned TEB. The perturbation of the dominant (linear) calibration term demonstrated the following: first, there was a correlation in the sensitivity of the TEDI due to the uncertainty in the linear calibration term. Based on a perturbation in the linear calibration term for all aforementioned bands over a range of ±5% yielded the TEDI sensitivity to vary from approximately −3.2% to about −3.6%. When considering the uncertainty in each individual band significant changes were observed. The least change was observed for the perturbation in the calibration of band 20 with the TEDI sensitivity and the largest sensitivity in TEDI was observed in the perturbation of band 31 calibration. Thus, in the case of TEDI, noticeable sensitivity due to calibration uncertainty was observed in bands 29, 31, and 32, reiterating the importance of the TEB calibration in these bands. Also, the dust detection scheme based on A-MODIS was successfully transferred to the follow-on sensors such as Suomi (SNPP) and NOAA 20 (N20) VIIRS. The results presented in this paper would be extremely helpful in understanding impacts of calibration on the higher-level products for both current and future missions based on the MODIS heritage. Finally, the work also identifies the importance of radiometric fidelity in maintaining the accuracy of the dust detection. Results presented will show drastic improvement of the Saharan dust detection after the reduction of the electronic crosstalk in the 8.5 µm channel of T-MODIS.

Mission-Long Recalibrated Science Quality Suomi NPP VIIRS Radiometric Dataset Using Advanced Algorithms for Time Series Studies

Suomi NPP has been successfully operating since its launch on 28 October 2011. As one of the major payloads, along with microwave and infrared sounders (Advanced Technology Microwave Sounder (ATMS), Cross-track Infrared Sounder (CrIS)), and ozone mapping/profiling (OMPS) instruments, the Visible Infrared Imaging Radiometer Suite (VIIRS) has performed for well beyond its mission design life. Its data have been used for a variety of applications for nearly 30 environmental data products, including global imagery twice daily with 375 and 750 m resolutions, clouds, aerosol, cryosphere, ocean color and sea-surface temperature, a number of land products (vegetation, land-cover, fire and others), and geophysical and social economic studies with nightlights. During the early days of VIIRS operational calibration and data production, there were inconsistencies in both algorithms and calibration inputs, for several reasons. While these inconsistencies have less impact on nowcasting and near real-time applications, they introduce challenges for time series analysis due to calibration artifacts. To address this issue, we developed a comprehensive algorithm, and recalibrated and reprocessed the Suomi NPP VIIRS radiometric data that have been produced since the launch. In the recalibration, we resolved inconsistencies in the processing algorithms, terrain correction, straylight correction, and anomalies in the thermal bands. To improve the stability of the reflective solar bands, we developed a Kalman filtering model to incorporate onboard solar, lunar, desert site, inter-satellite calibration, and a deep convective cloud calibration methodology. We further developed and implemented the Solar Diffuser Surface Roughness Rayleigh Scattering model to account for the sensor responsivity degradation in the near infrared bands. The recalibrated dataset was validated using vicarious sites and alternative methods, and compared with independent processing from other organizations. The recalibrated radiometric dataset (namely, the level 1b or sensor data records) also incorporates a bias correction for the reflective solar bands, which not only addresses known calibration biases, but also allows alternative calibrations to be applied if so desired. The recalibrated data have been proven to be of high quality, with much improved stability (better than 0.3%) and accuracy (by up to 2%). The recalibrated radiance data are now available from 2012 to 2020 for users and will eventually be archived on the NOAA CLASS database.

Water vapor retrieval from MERSI NIR channels of Fengyun-3B satellite using ground-based GPS data

An ensemble-based empirical regression algorithm is for the first time developed to retrieve total column water vapor from the Medium Resolution Spectral Imager (MERSI) near-infrared (NIR) channels onboard the Fengyun-3B (FY-3B) satellite. This retrieval method uses precipitable water vapor (PWV) data estimated from ground-based Global Positioning System (GPS) data to build a regression model in which the reflectance ratio observed from MERSI NIR absorption channels and the corresponding GPS PWV data are the parameters. The MERSI Level 1b data, specifically the three water vapor absorption channels centered at 905 nm, 940 nm, and 980 nm are used to retrieve water vapor. PWV data observed from 256 ground-based GPS stations located in the western North America in 2016 are used as reference data for model development. Then, validation is performed with data obtained during 2017–2019 from both the western North America and Australia to assess the performance of the proposed algorithm. The results indicate that the new PWV results agree very well with ground-based PWV reference data. The mean absolute percentage error (MAPE) for ensemble median PWV is 16.72% ~ 36.74% in western North America and is 15.47% ~ 32.31% in Australia. The RMSE is 4.635 mm ~ 8.156 mm in western North America and is 5.383 mm ~ 8.900 mm in Australia. The weighted mean value using three-channel ratio transmittance has the best retrieval accuracy, with RMSE of 4.635 mm in western North America and 5.383 mm in Australia. This new PWV algorithm can retrieve PWV from FY-3B data with a higher accuracy for different regions. Different from conventional algorithms, no pre-observed information of atmospheric parameters is required in this model.

A Randomised Controlled Trial to Assess the Benefit of Posterior Rhabdosphincter Reconstruction in Early Urinary Continence Recovery after Robot-assisted Radical Prostatectomy

Posterior rhabdosphincter reconstruction (PRR) has been proposed to improve early urinary continence (UC) recovery after radical prostatectomy (RP). In order to generate level 1b evidence, we designed a double-blind randomised controlled trial powered to detect a 20% increase in early UC recovery after robot-assisted RP (RARP). A group of 153 patients with cT1c–3a N0M0 prostate cancer were randomised (73 to control arm and 80 to PRR arm) and 152 completed 12-mo follow-up. For UC defined as no pad use, the recovery hazard ratio at 1-mo follow-up was 2.312 (95% confidence interval [CI] 1.081–4.937; p = 0.030). UC recovery was observed in 33.8% of patients in the PRR arm and 18.1% of patients in the control arm (p = 0.022). At 3-mo follow-up the corresponding rates were 58.8% and 43.1% (p = 0.038). The median time to UC recovery was 106 d (95% CI 73–139) in the control arm and 64 d (95% CI 39–89) in PRR arm (p = 0.897). No differences in pathological outcomes or early and late surgical complications were observed between the arms. We conclude that PRR is safe and increases early UC recovery after RARP. Patient summaryWe investigated reconstruction of a muscular ring that controls the flow of urine, called the rhabdosphincter, after removal of the prostate in robot-assisted surgery. The procedure is safe and increases early recovery of urinary continence.This trial is registered at ClinicalTrials.gov as NCT03302169.

Humanitarian Surgical Missions in Times of COVID-19: Recommendations to Safely Return to a Sub-Saharan Africa Low-Resource Setting.

BackgroundSince the declaration of the pandemic, humanitarian medicine has been discontinued. Until now, there have been no general recommendations on how humanitarian surgical missions should be organized.MethodsBased on our experience in the field of humanitarian surgical missions to Sub-Saharan Africa, a panel of recommendations in times of COVID-19 was developed. The fields under study were as follows: (1) Planning of a multidisciplinary project; (2) Organization of the infrastructure; (3) Screening, management and treatment of SARS-COV-2; (4) Diagnostic tests for SARS-COV-2; (5) Surgical priorization and (6) Context of patients during health-care assistance. We applied a risk bias measurement to obtain a consensus among humanitarian health-care providers with experience in this field.ResultsA total of 94.36% of agreement were reached for the approval of the recommendations. Emergency surgery must be a priority, and elective surgery adapted. For emergency surgery, we established a priority level 1a (< 24 h) and 1b (< 72 h). For an elective procedure, according our American College of Surgeon adaptation score, process with more than 60 points should be reconsidered. Due to the low life expectancy in many African countries, we consider 45–50 years as age of risk. In case of SARS-COV-2 active infection or high clinical suspicion, the screening, management and treatment should be following the international guidelines adapted to duration of the stay, available infrastructure, size of the cooperation team and medical resources.ConclusionsHumanitarian surgical mission in times of COVID-19 is a challenge that must extrapolate the established recommendations to the local cooperation environment.Supplementary InformationThe online version contains supplementary material available at (10.1007/s00268-021-06001-x).

Abstract OT-24-01: Phase I study combining ipatasertib with chemotherapy and atezolizumab in patients with metastatic triple negative breast cancer

Abstract Background: The PI3K-ATK pathway is one of the most common cancer drivers in breast cancer, and the AKT inhibitor ipatasertib (ipat) has shown great efficacy in patients (pts) with metastatic triple negative breast cancer (mTNBC). The current phase I trial is designed to test the safety and efficacy of the following ipat combinations: ipat + carboplatin (C) + paclitaxel (T); ipat + C; ipat + capecitabine (cape) + atezolizumab (atezo). Trial Design: This is a Phase I open-label study for pts with mTNBC. Eligible pts receive one of three regimens: A) weekly carbo AUC 2 plus taxol 80 mg/m2 days 1, 8, 15 and daily ipat 300 mg every 28 days; B) weekly carbo AUC 2, days 1, 8, 15 and daily ipat 400 mg every 28 days; C) cape 750 mg bid 1 week on 1 week off, ipat 300 mg daily and atezo 840 mg iv days 1, 15 every 28 days. Eligibility Criteria: Eligible patients must have histologically confirmed mTNBC (ER/PR ≤ 10%, HER2- per ASCO/CAP); RECIST 1.1 measurable disease; 0-2 lines of chemotherapy prior for mTNBC; AEs recovered to ≤ Gr 2 per CTCAE 5.0; adequate bone marrow, hepatic and renal function. Prior exposure to AKT targeted therapy is excluded.Specific Aims: Primary objectives are to evaluate the safety and tolerability of the combinations and determine the recommended Phase II dose (RP2D) of the combinations. Secondary objectives are to evaluate response rate, clinical benefit rate, progression free survival, and overall survival. Statistical Design: For the safety-lead in, a “3 at risk design” will be utilized to assess toxicity for the combination therapy. The DLT period is 1-cycle (28 days). Each participant will remain on the dosing level according to the escalation dose level they were enrolled in, and intra-dose level escalations will not be allowed, even if the MTD is defined at a higher dose level. Rules for escalation are as follows: if escalating from Level 1, two dose levels will be open, Level 2A, and Level 2B. Only if both 2A and 2B result in a decision to escalate will dose level 3 for this triplet be open. When both 2A and 2B are both open, slots will be given to the arm with the most open slots (starting with 2A if there are ties). When a maximum tolerable dose level has been defined by the dose escalation portion of the study, and the recommended phase 2 dose (RP2D not to exceed the MTD) has been selected, additional patients will be accrued to confirm the tolerability of the regimen. For Arm C, at least 12 patients will be treated at the RP2D to confirm tolerability. Additional patients can be accrued if the total number of patients accrued does not exceed 21 patients (e.g. if the RP2D is dose level 1, with 2A and 2B not well-tolerated based on 3 patients on each 2A and 2B, the total at RP2D could be 15). If one agent is discontinued due to toxicity, then the participant may continue to receive the remaining single agent or doublet agent therapy on protocol. With 12 patients, any specific severe toxicity with 20% incidence will be observed with 93% probability. Citation Format: Yuan Yuan, Susan E. Yost, Jin Sun Lee, Paul H. Frankel, Christopher Ruel, Mireya Murga, Aileen Tang, Norma Martinez, James Waisman, Niki Patel, Mina Sedrak, Daphne Stewart, Sayeh Lavasani, Joanne Mortimer. Phase I study combining ipatasertib with chemotherapy and atezolizumab in patients with metastatic triple negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-24-01.