Monkeypox in Patient Immunized with ACAM2000 Smallpox Vaccine During 2022 Outbreak.

We report a case of monkeypox in the United States in a patient who had been vaccinated with ACAM2000 smallpox vaccine 8 years earlier. Despite his vaccination status, he still contracted disease. He showed prodromal symptoms preceding development of painless penile lesions that later coalesced.

Translating Clinical Questions by Physicians Into Searchable Queries: Analytical Survey Study.

BACKGROUND: Staying up to date and answering clinical questions with current best evidence from health research is challenging. Evidence-based clinical texts, databases, and tools can help, but clinicians first need to translate their clinical questions into searchable queries. MacPLUS FS (McMaster Premium LiteratUre Service Federated Search) is an online search engine that allows clinicians to explore multiple resources simultaneously and retrieves one single output that includes the following: (1) evidence from summaries (eg, UpToDate and DynaMed), (2) preappraised research (eg, EvidenceAlerts), and (3) non-preappraised research (eg, PubMed), with and without validated bibliographic search filters. MacPLUS FS can also be used as a laboratory to explore clinical questions and evidence retrieval. OBJECTIVE: Our primary objective was to examine how clinicians formulate their queries on a federated search engine, according to the population, intervention, comparison, and outcome (PICO) framework. Our secondary objective was to assess which resources were accessed by clinicians to answer their questions. METHODS: We performed an analytical survey among 908 clinicians who used MacPLUS FS in the context of a randomized controlled trial on search retrieval. Recording account log-ins and usage, we extracted all 1085 queries performed during a 6-month period and classified each search term according to the PICO framework. We further categorized queries into background (eg, "What is porphyria?") and foreground questions (eg, "Does treatment A work better than B?"). We then analyzed the type of resources that clinicians accessed. RESULTS: There were 695 structured queries, after exclusion of meaningless queries and iterations of similar searches. We classified 56.5% (393/695) of these queries as background questions and 43.5% (302/695) as foreground questions, the majority of which were related to questions about therapy (213/695, 30.6%), followed by diagnosis (48/695, 6.9%), etiology (24/695, 3.5%), and prognosis (17/695, 2.5%). This distribution did not significantly differ between postgraduate residents and medical faculty physicians (P=.51). Queries included a median of 3 search terms (IQR 2-4), most often related to the population and intervention or test, rarely related to the outcome, and never related to the comparator. About half of the resources accessed (314/610, 51.5%) were summaries, 24.4% (149/610) were preappraised research, and 24.1% were (147/610) non-preappraised research. CONCLUSIONS: Our results, from a large sample of real-life queries, could guide the development of educational interventions to improve clinicians' retrieval skills, as well as inform the design of more useful evidence-based resources for clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov NCT02038439; https://www.clinicaltrials.gov/ct2/show/NCT02038439.

Context-aware grading of quality evidences for evidence-based decision-making.

Processing huge repository of medical literature for extracting relevant and high-quality evidences demands efficient evidence support methods. We aim at developing methods to automate the process of finding quality evidences from a plethora of literature documents and grade them according to the context (local condition). We propose a two-level methodology for quality recognition and grading of evidences. First, quality is recognized using quality recognition model; second, context-aware grading of evidences is accomplished. Using 10-fold cross-validation, the proposed quality recognition model achieved an accuracy of 92.14 percent and improved the baseline system accuracy by about 24 percent. The proposed context-aware grading method graded 808 out of 1354 test evidences as highly beneficial for treatment purpose. This infers that around 60 percent evidences shall be given more importance as compared to the other 40 percent evidences. The inclusion of context in recommendation of evidence makes the process of evidence-based decision-making "situation-aware."

Diffusion of Proteins across Silica Colloidal Crystals.

We studied the diffusion of three model proteins, lysozyme (Lz), bovine hemoglobin (BHb), and bovine serum albumin (BSA), normal to the (111) plane of sintered silica colloidal crystals with three different pore "radii" (7.5, 19, and 27 nm). We demonstrated that these colloidal crystals exhibit size selectivity when the nanopores are sufficiently small (7.5 and 19 nm). Because these nanopores are still larger than the diffusing proteins, the observed size selectivity can be attributed to the tortuosity of the colloidal nanopores. Larger (27 nm) nanopores led to higher transport rates but at the cost of selectivity. In addition to the size selectivity, we also demonstrated that 19 nm nanopores possess shape selectivity for the proteins of comparable molecular weights. We showed that the high temperature sintering required for the preparation of sintered colloidal crystals reduces the extent of interactions between the proteins and the nanopore surface, which appear to play a minor role in the diffusion, and that transport selectivity is decided solely by protein size and shape. Taken together, our observations suggest that sintered silica colloidal crystals constitute promising nanoporous membranes for protein separations, with easily controllable pore size, size and shape selectivity, and minimal surface fouling.

Improving medication adherence in patients with cardiovascular disease: a systematic review.

OBJECTIVE: To evaluate and compare the effect of interventions for improving adherence to medications for atherosclerotic cardiovascular disease (ASCVD) secondary prevention. METHODS: We extracted eligible trials from a 2014 Cochrane systematic review on adherence for any condition. We updated the search from CENTRAL, Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts and trial registers through November 2016. Study reports needed to be from a randomised controlled trial, incorporate participants identified as having ASCVD and interventions aimed at improving adherence to medicines for secondary prevention of ASCVD and measure both adherence and a clinical outcome. Two reviewers independently determined the eligibility of studies, extracted data and conducted a narrative synthesis. RESULTS: We identified 17 trials (n=17 448 participants). Most trials had high risk of bias in at least one domain. The intervention group adherence rates ranged from 44%to99% and the comparator group adherence rates ranged from 13% to 96%. Three distinct interventions reported improvements in both adherence and clinical outcomes: short message service (65% vs 13% of participants with high adherence in the intervention vs control group), a fixed-dose combination pill (86% vs 65% adherence, risk ratio of being adherent, 1.33; 95% CI 1.26 to 1.41) and a community health worker-based intervention (97% in the intervention group compared with 92% in the control group; OR=2.62, 95% CI 1.32 to 5.19). CONCLUSIONS: We identified three interventions that demonstrated improvements in adherence and clinical outcomes. Ongoing, longer-term trials will help determine whether short-term changes in adherence can be maintained and lead to differences in clinical events.

Evaluation of chlorine dioxide as a supplementary pretreatment reagent for lignocellulosic biomass.

Chlorine dioxide (ClO2) is a bleaching reagent used in paper industry. Two different types of pretreatment methods were investigated incorporating ClO2 as a secondary reagent: (a) alkaline followed by ClO2 treatment; (b) dilute-sulfuric acid followed ClO2 treatment. In these methods, ClO2 treatment has shown little effect on delignification. Scheme-a has shown a significant improvement in enzymatic digestibility of glucan far above that treated by ammonia alone. On the contrary, dilute-acid followed by ClO2 treatment has shown negative effect on the enzymatic hydrolysis. The main factors affecting the enzymatic hydrolysis are the changes of the chemical structure of lignin and its distribution on the biomass surface. ClO2 treatment significantly increases the carboxylic acid content and reduces phenolic groups of lignin, affecting hydrophobicity of lignin and the H-bond induced association between the enzyme and lignin. This collectively led to reduction of unproductive binding of enzyme with lignin, consequently increasing the digestibility.

Defining the publication source of high-quality evidence in urology: an analysis of EvidenceUpdates.

OBJECTIVES: To determine the publication sources of urology articles within EvidenceUpdates, a second-order peer review system of the medical literature designed to identify high-quality articles to support up-to-date and evidence-based clinical decisions. MATERIALS AND METHODS: Using administrator-level access, all EvidenceUpdates citations from 2005 to 2014 were downloaded from the topics 'Surgery-Urology' and 'Oncology-Genitourinary'. Data fields accessed included PubMed unique reference identifier, study title, abstract, journal and date of publication, as well as clinical relevance and newsworthiness ratings as determined by discipline-specific physician raters. The citations were then coded by clinical topic (oncology, voiding dysfunction, erectile dysfunction/infertility, infection/inflammation, stones/endourology/laparoscopy, trauma/reconstruction, transplant, or other), journal category (general medical journal, oncology journal, urology journal, non-urology specialty journal, Cochrane review, or other), and study design (randomised controlled trial [RCT], systematic review, observational study, or other). Articles that were perceived to be misclassified and/or of no direct interest to urologists were excluded. Descriptive statistics using proportions and 95% confidence intervals, as well as means and standard deviations (SDs) were used to characterise the overall data cohort and to analyse trends over time. RESULTS: We identified 731 unique citations classified under either 'Surgery-Urology' or 'Oncology-Genitourinary' for analysis after exclusions. Between 2005 and 2014, the most common topics were oncology (48.6%, 355 articles) and voiding dysfunction (21.8%, 159). Within the topic of oncology, prostate cancer contributed over half the studies (54.6%, n = 194). The most common study types were RCTs (42.3%, 309 articles) and systematic reviews (39.6%, 290). Systematic reviews had a nearly fourfold relative increase within less than a decade. The largest proportion of studies relevant to urology were published in general oncology journals (20.0%, n = 146), followed by the Cochrane Library (19.3%, n = 141) and general medical journals (17.2%, n = 126). Urology-specific journals contributed to only approximately one-tenth of EvidenceUpdates alerts (9.4%, n = 69), with the highest contribution occurring during the 2013/2014 period. For clinical relevance and newsworthiness scores (each graded on scales of 1-7), urology journals scored the highest in clinical relevance with a mean (SD) of 5.9 (0.75) and general medical journals scored highest for newsworthiness at 5.3 (0.94). On average, RCTs scored highest both for clinical relevance and newsworthiness with mean (SD) scores of 5.71 (0.81) and 5.22 (0.91), respectively. CONCLUSION: A large number of high-quality, clinically relevant, and newsworthy peer-reviewed urology publications are published outside of traditional urology journals. This requires urologists to implement well-defined strategies to stay abreast of current best evidence.

Relationship Between Body Mass Index and Workers' Compensation Claims and Costs: Results From the North Carolina League of Municipalities Database.

OBJECTIVE: To determine whether a relationship exists between elevated levels of body mass index (BMI) and workers' compensation measures. METHODS: This was a retrospective analysis of 3951 workers' compensation claimants between 1981 and 2009 representing municipal workplaces. A BMI scale composed of seven levels, including two overweight tiers, was used. RESULTS: Higher BMI levels were related to more lost workdays, indemnity costs, and total costs. Medical care costs were virtually the same in overweight and obese claimants and moderately higher than claimants with recommended BMIs. Males were more likely to incur workers' compensation claims than females across all BMI tiers; yet, obese females incurred twice as many lost workdays and indemnity costs, and nearly 50% higher medical costs and total costs than obese men. CONCLUSIONS: Elevated levels of BMI negatively influence several workers' compensation outcome measures.

WhatisKT wiki: a case study of a platform for knowledge translation terms and definitions--descriptive analysis.

BACKGROUND: More than a hundred terms, often with unclear definitions and varying emphases, are used by health research and practice communities across the world who are interested in getting the best possible evidence applied (e.g., knowledge translation, implementation science, diffusion of innovations, and technology transfer). This makes finding published evidence difficult and can result in reduced, misinterpreted, or challenging interactions among professionals. Open dialogue and interaction among various professionals is needed to achieve consolidation of vocabulary. We use case report methods to describe how we sought to build an online tool to present the range of terms and facilitate the dialogue process across groups and disciplines interested in harnessing research evidence for healthcare. METHODS: We used a wiki platform from Wikispaces to present the problem of terminology and make a case and opportunity for collaboration on usage. Wikis are web sites where communities of users can collaborate online to build content and discuss progress. We gathered terms related to getting research into practice, sought published definitions, and posted these on the wiki (WhatisKT http://whatiskt.wikispaces.com/). We built the wiki in mid-2008 and promoted it through various groups and publications. This report describes the content of the site, our promotion efforts, use of the site, and how the site was used for collaboration up to the end of 2011. RESULTS: The WhatisKT wiki site now includes more than 120 pages. Traffic to the site has increased substantially from an average of 200 monthly visits in 2008 to 1700 in 2011. Visitors from 143 countries viewed the wiki in 2011, compared with 12 countries in 2008. However, most use has been limited to short term accesses of about 40 seconds per visit, and discussion of consolidation and solidifying terminology is conspicuously absent. CONCLUSIONS: Although considerable interest exists in the terms and definitions related to getting research into practice based on increasing numbers of accesses, use of the WhatisKT wiki site for anything beyond quick lookups was minimal. Additional efforts must be directed towards increasing the level of interaction among the members of the site to encourage collaboration on term use.

"Push" versus "Pull" for mobilizing pain evidence into practice across different health professions: a protocol for a randomized trial.

BACKGROUND: Optimizing pain care requires ready access and use of best evidence within and across different disciplines and settings. The purpose of this randomized trial is to determine whether a technology-based "push" of new, high-quality pain research to physicians, nurses, and rehabilitation and psychology professionals results in better knowledge and clinical decision making around pain, when offered in addition to traditional "pull" evidence technology. A secondary objective is to identify disciplinary variations in response to evidence and differences in the patterns of accessing research evidence. METHODS: Physicians, nurses, occupational/physical therapists, and psychologists (n = 670) will be randomly allocated in a crossover design to receive a pain evidence resource in one of two different ways. Evidence is extracted from medical, nursing, psychology, and rehabilitation journals; appraised for quality/relevance; and sent out (PUSHed) to clinicians by email alerts or available for searches of the accumulated database (PULL). Participants are allocated to either PULL or PUSH + PULL in a randomized crossover design. The PULL intervention has a similar interface but does not send alerts; clinicians can only go to the site and enter search terms to retrieve evidence from the cumulative and continuously updated online database. Upon entry to the trial, there is three months of access to PULL, then random allocation. After six months, crossover takes place. The study ends with a final three months of access to PUSH + PULL. The primary outcomes are uptake and application of evidence. Uptake will be determined by embedded tracking of what research is accessed during use of the intervention. A random subset of 30 participants/ discipline will undergo chart-stimulated recall to assess the nature and depth of evidence utilization in actual case management at baseline and 9 months. A different random subset of 30 participants/ discipline will be tested for their skills in accessing evidence using a standardized simulation test (final 3 months). Secondary outcomes include usage and self-reported evidence-based practice attitudes and behaviors measured at baseline, 3, 9, 15 and 18 months. DISCUSSION: The trial will inform our understanding of information preferences and behaviors across disciplines/practice settings. If this intervention is effective, sustained support will be sought from professional/health system initiatives with an interest in optimizing pain management. TRIAL REGISTRATION: Registered as NCT01348802 on clinicaltrials.gov.

The quality, breadth, and timeliness of content updating vary substantially for 10 online medical texts: an analytic survey.

OBJECTIVE: To evaluate the quality of evidence reporting, breadth of coverage, and timeliness of content updating of 10 selected online medical texts. STUDY DESIGN AND SETTING: Each text was assessed for quality based on an 11-item scale, which included items related to editorial policy and updating, appraisal, and transparent incorporation of newly published clinical research and evidence-based guidelines. Breadth of coverage was determined by the percentage of 60 randomly selected International Classification of Diseases 10 (ICD-10) codes covered by each of the texts. The same 60 ICD-10 codes were used to obtain a sample of topic chapters for the assessment of timeliness of updates. RESULTS: Quality scores ranged from a high of 9 of 11 points (Clinical Evidence) to a low of 0 of 11 points (PEPID), with a mean score of 6.7. Breadth of coverage ranged from 83% of randomly selected topics covered (UpToDate) to 25% (Clinical Evidence), with 6 of 10 texts covering 60% or more; average coverage across all texts was 57%. Variability was also observed with regard to average time since last content update, ranging from 3.5 (DynaMed) to 29 months (First Consult), with an average time since update of 12.4 months. CONCLUSION: No single resource was ideal and those seeking answers to clinical questions are well-advised not to rely solely on a single point-of-care product.

Retrieving randomized controlled trials from medline: a comparison of 38 published search filters.

BACKGROUND: People search medline for trials of healthcare interventions for clinical decisions, or to produce systematic reviews, practice guidelines, or technology assessments. Finding all relevant randomized controlled trials (RCTs) with little extraneous material is challenging. OBJECTIVE: To provide comparative data on the operating characteristics of search filters designed to retrieve RCTs from medline. METHODS: We identified 38 filters. The testing database comprises handsearching data from 161 clinical journals indexed in medline. Sensitivity, specificity and precision were calculated. RESULTS: The number of terms and operating characteristics varied considerably. Comparing the retrieval against the single term 'randomized controlled trials.pt.' (sensitivity for retrieving RCTs, 93.7%), 24 of 38 filters had statistically higher sensitivity; 6 had a sensitivity of at least 99.0%. Four other filters had specificities (non retrieval of non-RCTs) that were statistically not different or better than the single term (97.6%). Precision was poor: only two filters had precision (proportion of retrieved articles that were RCTs) statistically similar to that of the single term (56.4%)-all others were lower. Filters with more search terms often had lower specificity, especially at high sensitivities. CONCLUSION: Many RCT filters exist (n = 38). These comparative data can direct the choice of an RCT filter.

Cytoplasmic delivery of liposomal contents mediated by an acid-labile cholesterol-vinyl ether-PEG conjugate.

An acid-cleavable PEG lipid, 1'-(4'-cholesteryloxy-3'-butenyl)-omega-methoxy-polyethylene[112] glycolate (CVEP), has been developed that produces stable liposomes when dispersed as a minor component (0.5-5 mol %) in 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE). Cleavage of CVEP at mildly acidic pHs results in dePEGylation of the latently fusogenic DOPE liposomes, thereby triggering the onset of content release. This paper describes the synthesis of CVEP via a six-step sequence starting from the readily available precursors 1,4-butanediol, cholesterol, and mPEG acid. The hydrolysis rates and release kinetics from CVEP/DOPE liposome dispersions as a function of CVEP loading, as well as the cryogenic transmission electron microscopy and pH-dependent monolayer properties of 9:91 CVEP/DOPE mixtures, also are reported. When folate receptor-positive KB cells were exposed to calcein-loaded 5:95 CVEP/DOPE liposomes containing 0.1 mol % folate-modified 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-polyethylene[76] glycolamide (folate-PEG-DSPE), delivery of the calcein cargo to the cytoplasm of the cells was observed as determined by fluorescence microscopy and flow cytometry. Fluorescence resonance energy transfer analysis of lipid mixing in these cells was consistent with membrane-membrane fusion between the liposome and endosomal membranes.

Molecular phylogenetics of an aquatic plant lineage, Potamogetonaceae.

Like most aquatic plants, the pondweeds (Potamogetonaceae) are among the most phenotypically reduced and plastic of all angiosperms. As such, hypotheses of structural homology present difficulties for morphological phylogenetic reconstruction. We used non-coding nuclear and plastid DNA data to address Potamogetonaceae relationships and accompanying issues in character evolution and biogeography. Genera currently assigned to Potamogetonaceae, plus Zannichellia, formed a strongly supported monophyletic group. Potamogeton and Stuckenia (Potamogeton subg. Coleogeton) were both resolved as monophyletic. Within Potamogeton proper, two major clades followed the traditional split between broad- and narrow-leaved species, with the latter condition optimized as basal. Heterophylly (submerged plus floating leaves) has evolved several times, and the ancestral distribution for Potamogeton appears to be Northern Hemispheric. Our phylogenetic results have provided a useful genetic framework from which to interpret morphological, cytological and biogeographical evolution.

What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals?

BACKGROUND: We conducted this analysis to determine i) which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii) the proportion of clinically relevant articles in each journal. METHODS: We performed an analytic survey of a hand search of 170 general medicine, general healthcare, and specialty journals for 2000. Research staff assessed individual articles by using explicit criteria for scientific merit for healthcare application. Practitioners assessed the clinical importance of these articles. Outcome measures were the number of high-quality, clinically relevant studies published in the 170 journal titles and how many of these were published in each of four discipline-specific, secondary "evidence-based" journals (ACP Journal Club for internal medicine and its subspecialties; Evidence-Based Medicine for general/family practice; Evidence-Based Nursing for general practice nursing; and Evidence-Based Mental Health for all aspects of mental health). Original studies and review articles were classified for purpose: therapy and prevention, screening and diagnosis, prognosis, etiology and harm, economics and cost, clinical prediction guides, and qualitative studies. RESULTS: We evaluated 60,352 articles from 170 journal titles. The pass criteria of high-quality methods and clinically relevant material were met by 3059 original articles and 1073 review articles. For ACP Journal Club (internal medicine), four titles supplied 56.5% of the articles and 27 titles supplied the other 43.5%. For Evidence-Based Medicine (general/family practice), five titles supplied 50.7% of the articles and 40 titles supplied the remaining 49.3%. For Evidence-Based Nursing (general practice nursing), seven titles supplied 51.0% of the articles and 34 additional titles supplied 49.0%. For Evidence-Based Mental Health (mental health), nine titles supplied 53.2% of the articles and 34 additional titles supplied 46.8%. For the disciplines of internal medicine, general/family practice, and mental health (but not general practice nursing), the number of clinically important articles was correlated withScience Citation Index (SCI) Impact Factors. CONCLUSIONS: Although many clinical journals publish high-quality, clinically relevant and important original studies and systematic reviews, the articles for each discipline studied were concentrated in a small subset of journals. This subset varied according to healthcare discipline; however, many of the important articles for all disciplines in this study were published in broad-based healthcare journals rather than subspecialty or discipline-specific journals.

A generic treatment of Alismatidae in the Neotropics with special reference to Brazil

A Subclasse Alismatidae nos neotrópicos é composta de nove famílias com 11 gêneros das quais, nove ocorrem na bacia amazônica e cinco no Brasil extra-amazônico. Apenas duas famílias não estão presentes no Brasil e mais duas ausentes da Amazônia brasileira. Este trabalho apresenta descrições detalhadas das famílias e gêneros, além de comentários sobre distribuição geográfica dos gêneros. As famílias estão organizadas na sequência sistemática que nós aceitamos. Os gêneros de cada família estão organizados em ordem alfabética i=sem significado sistemático. Fornecemos desenhos de pelo menos um gênero para cada família. Referências importantes -- tais como revisões genéricas, levantamentos da literatura, ou monografias de áreas neotropicais estão relacionadas no início de cada tratamento a nível de família. As excelentes coleções do Projeto Flora Amazônica foram de importância decisiva para nosso trabalho-, sem elas não poderiamoi fazer um tratamento genérico completo para toda a região neotrópica.