bluuebunny/crossref_metadata_2025 huggingface dataset:
Political Consequences of Economic Hardship: State Economic Activity and Polarization in American Legislatures
Authors: Garro Haritz
Published: September 2020

Previous literature has explored the effects of economic conditions on voting behavior. In this article, I analyze how the economy affects legislative polarization. Using recently available state legislator ideal point estimates, I find a strong negative relationship between state economic activity and political polarization. States that fared worse economically have experienced greater increases in legislative polarization. I show this relationship is causal by employing an instrumental variables strategy. The instrument isolates exogenous variation in state economic activity by exploiting time-series variation in oil prices, which differentially affects individual states according to their economic dependence on oil production. The estimated polarization effects are stronger for Republicans. The findings have implications for understanding the interaction between the economy and political outcomes. (JEL H7, H83).
E-Discovery in Investment Treaty Arbitration: Practice, Procedures, Challenges and Opportunities
Authors: Shirlow Esmé
Published: September 2020

Document production, and with it e-discovery, presents unique opportunities but also challenges for parties and tribunals seeking fair, efficient and effective investor-state arbitration proceedings. Despite the prevalence of electronically stored information and the potential utility of technology-assisted review techniques, e-discovery procedures in investor-state arbitration are relatively underdeveloped. Applicable procedural rules and guidelines are largely silent as to the mechanics of e-discovery. Analysis of investor-state arbitration decisions indicates a further reticence on the part of parties and investor-state tribunals to squarely address issues of e-discovery proactively. This means that the use, selection and scope of e-discovery are left almost entirely to parties and tribunals to navigate on a case-by-case and largely ad hoc basis. Given the likely increasing relevance of e-discovery in international investor-state arbitration, this article considers how parties and tribunals might be supported to become better equipped to accommodate e-discovery appropriately in investor-state arbitration.
Digital cultural colonialism: measuring bias in aggregated digitized content held in Google Arts and Culture
Authors: Kizhner Inna , Terras Melissa , Rumyantsev Maxim , Khokhlova Valentina , Demeshkova Elisaveta , Rudov Ivan , Afanasieva Julia
Published: September 2020

In February 2011, Google launched its Google Art Project, now known as Google Arts and Culture (GA&C), that currently hosts approximately six million high-resolution images of artworks from around the world, with an objective to make culture more accessible. We demonstrate that GA&C has experienced dramatic growth in recent years and includes artworks for almost every country from the UN member list. However, we document a noticeable lack of balance in the aggregator, with some countries and institutions being prioritized, and a major proportion of the holdings featuring content that resides in the USA. Moreover, after examining Russian and French collections, we see the dominance of artworks from their capital cities in GA&C, while art from provinces is clearly underrepresented. Finally, we find a dominance of art from the 20th century with some emphasis on artworks demonstrating a break in canon or ‘otherness’ of non-Western countries. The discrepancies that we observe give evidence to support previously posited ideas of digital cultural colonialism. This may be due to a lack of data transparency or availability of previously digitized content in the countries with a lower representation in the portal, or an unintentional digital amplification of conventional traditions of art collection and interpretation that dominate museum displays in larger Western cities. We call for explicit statement by platforms on their collection and selection criteria and the need for researchers to understand the biases emerging from aggregated digitized content.
Aneurysmal Subarachnoid Hemorrhage: Trends, Outcomes, and Predictions From a 15-Year Perspective of a Single Neurocritical Care Unit
Authors: Samuels Owen B , Sadan Ofer , Feng Chen , Martin Kathleen , Medani Khalid , Mei Yajun , Barrow Daniel L
Published: September 2020

BACKGROUND

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with disproportionally high mortality and long-term neurological sequelae. Management of patients with aSAH has changed markedly over the years, leading to improvements in outcome.

OBJECTIVE

To describe trends in aSAH care and outcome in a high-volume single center 15-yr cohort.

METHODS

All new admissions diagnosed with subarachnoid hemorrhage (SAH) to our tertiary neuro-intensive care unit between 2002 and 2016 were reviewed. Trend analysis was performed to assess temporal changes and a step-wise regression analysis was done to identify factors associated with outcomes.

RESULTS

Out of 3970 admissions of patients with SAH, 2475 patients proved to have a ruptured intracranial aneurysm. Over the years of the study, patient acuity increased by Hunt & Hess (H&H) grade and related complications. Endovascular therapies became more prevalent over the years, and were correlated with better outcome. Functional outcome overall improved, yet the main effect was noted in the low- and intermediate-grade patients. Several parameters were associated with poor functional outcome, including long-term mechanical ventilation (odds ratio 11.99, CI 95% [7.15-20.63]), acute kidney injury (3.55 [1.64-8.24]), pneumonia (2.89 [1.89-4.42]), hydrocephalus (1.80 [1.24-2.63]) diabetes mellitus (1.71 [1.04-2.84]), seizures (1.69 [1.07-2.70], H&H (1.67 [1.45-1.94]), and age (1.06 [1.05-1.07]), while endovascular approach to treat the aneurysm, compared with clip-ligation, had a positive effect (0.35 [0.25-0.48]).

CONCLUSION

This large, single referral center, retrospective analysis reveals important trends in the treatment of aSAH. It also demonstrates that despite improvement in functional outcome over the years, systemic complications remain a significant risk factor for poor prognosis. The historic H&H determination of outcome is less valid with today's improved care.
Investigation of the Genetic Diversity of a Rice Core Collection of Japanese Landraces using Whole-Genome Sequencing
Authors: Tanaka Nobuhiro , Shenton Matthew , Kawahara Yoshihiro , Kumagai Masahiko , Sakai Hiroaki , Kanamori Hiroyuki , Yonemaru Jun-ichi , Fukuoka Shinichi , Sugimoto Kazuhiko , Ishimoto Masao , Wu Jianzhong , Ebana Kaworu
Published: September 2020

The Rice Core Collection of Japanese Landraces (JRC) consisting of 50 accessions was developed by the genebank at the National Agriculture and Food Research Organization (NARO) in 2008. As a Japanese landrace core collection, the JRC has been used for many research projects, including screening for different phenotypes and allele mining for target genes. To understand the genetic diversity of Japanese Landraces, we performed whole-genome resequencing of these 50 accessions and obtained a total of 2,145,095 single nucleotide polymorphism (SNPs) and 317,832 insertion–deletions (indels) by mapping against the Oryza sativa ssp. japonica Nipponbare genome. A JRC phylogenetic tree based on 1,394 representative SNPs showed that JRC accessions were divided into two major groups and one small group. We used the multiple genome browser, TASUKE+, to examine the haplotypes of flowering genes and detected new mutations in these genes. Finally, we performed genome-wide association studies (GWAS) for agronomical traits using the JRC and another core collection, the World Rice Core Collection (WRC), comprising 69 accessions also provided by the NARO genebank. In leaf blade width, a strong peak close to NAL1, a key gene for the regulation of leaf width, and, in heading date, a peak near HESO1 involved in flowering regulation were observed in GWAS using the JRC. They were also detected in GWAS using the combined JRC + WRC. Thus, JRC and JRC + WRC are suitable populations for GWAS of particular traits.
Comorbid Major Depressive Disorder in Schizophrenia: A Systematic Review and Meta-Analysis
Authors: Etchecopar-Etchart Damien , Korchia Theo , Loundou Anderson , Llorca Pierre-Michel , Auquier Pascal , Lançon Christophe , Boyer Laurent , Fond Guillaume
Published: September 2020

Comorbid major depressive disorder (MDD) in schizophrenia (SZ; SZ-MDD) has been identified as a major prognostic factor. However, the prevalence and associated factors of SZ-MDD have never been explored in a meta-analysis. All studies assessing the prevalence of SZ-MDD in stabilized outpatients with a standardized scale or with structured interviews were included. The Medline, Web of Science, PsycINFO, and Google Scholar databases were searched. Using random effects models, we calculated the pooled estimate of the prevalence of SZ-MDD. We used meta-regression and subgroup analyses to evaluate the potential moderators of the prevalence estimates, and we used the leave-one-out method for sensitivity analyses. Of the 5633 potentially eligible studies identified, 18 studies (n = 6140 SZ stabilized outpatients) were retrieved in the systematic review and included in the meta-analysis. The pooled estimate of the prevalence of SZ-MDD was 32.6% (95% CI: 27.9–37.6); there was high heterogeneity (I2 = 92.6%), and Egger’s test did not reveal publication bias (P = .122). The following factors were found to be sources of heterogeneity: publication in or after 2015, the inclusion of patients from larger studies, the assessment tools, the inclusion of patients with substance use disorder or somatic chronic diseases, age, education level, the lifetime number of hospitalizations, and antidepressant use. Two-thirds of the extracted variables could not be explored due to an insufficient amount of published data. The prevalence of MDD is high among SZ individuals. Healthcare providers and public health officials should have an increased awareness of the burden of SZ-MDD.
Spatiotemporal trends of cutaneous leishmaniasis in Costa Rica
Authors: Bayles Brett R , Rusk Andria E , Pineda Maria Alvarez , Chen Bobin , Dagy Keira , Hummel Tyler , Kuwada Kira , Martin Serena , Guzmán Carlos Faerron
Published: September 2020

Background

Cutaneous leishmaniasis (CL) remains an important neglected tropical disease in Costa Rica, which has one of the largest burdens of this disease in Latin America.

Methods

We identified district-level hotspots of CL from 2006 to 2017 and conducted temporal analysis to identify where hotspots were increasing across the country.

Results

Clear patterns of CL risk were detected, with persistent hotspots located in the Caribbean region, where risk was also found to be increasing over time in some areas.

Conclusions

We identify spatiotemporal hotspots, which may be used in support of the leishmaniasis plan of action for the Americas.
Case of Generalized Tumor-Type Rosai–Dorfman Disease With Sarcoidosis-Like Histological Features and IgG4-Positive Plasma Cells
Authors: Tan Yixin , Zhou Ying , Zhan Yi , Luo Shuaihantian , Liu Yu , Zhang Guiying
Published: September 2020

Rosai–Dorfman disease (RDD, also known as sinus histiocytosis with massive lymphadenopathy) is a rare and benign non–Langerhans cell histiocytosis. Skin biopsy usually shows nodular or diffuse dermatitis. Rosai–Dorfman cells (RDD cells) and emperipolesis are the key to diagnosis. RDD cells express S-100 antigen, CD68, CD163, α1-antitrypsin, α1-antichymotrypsin, and ham-56, whereas Langerhans cell markers such as CD1a and langerin are negative. We presented a case of a 55-year-old man with varying sizes of many dark red nodules and lumps over the face, trunk, and limbs for approximately 1 year but without systemic involvement. The results of the laboratory evaluations were notable for an increased level of serum IL-6 and serum IgG4. Histopathological examination showed a diffused dense nodular infiltration of “nude” epithelioid histiocytes with infiltration of minimal lymphocytes and plasm cells around the epithelioid nodules. Immunohistochemistry identified nodular histiocytes being stained strongly positive for S-100 and CD68 but negative for CD1a. Plasma cells showed focally positive for IgG, IgG4, and CD38 and with a ratio of IgG4/IgG >40%. Considering these findings, we believe that our case meets the diagnostic description of “cutaneous Rosai–Dorfman disease” and is, therefore, a rare case with clinical features of multiple tumor-like nodules, sarcoidosis-like histological features, and immunohistochemistry of IgG4-positive plasma cells.
Effect of two different pre-operative exercise training regimens before colorectal surgery on functional capacity
Authors: Minnella Enrico M. , Ferreira Vanessa , Awasthi Rashami , Charlebois Patrick , Stein Barry , Liberman Alexander S. , Scheede-Bergdahl Celena , Morais José A. , Carli Francesco
Published: September 2020

BACKGROUND

Multimodal prehabilitation, including exercise training, nutritional therapy and anxiety reduction, has been shown to attenuate functional decline associated with surgery. Due to the growing interest in functional status as a targeted surgical outcome, a better understanding of the optimal prescription of exercise is critical.

OBJECTIVE

The objective is to compare peri-operative functional trajectory in response to two different exercise training protocols within a 4-week, supervised, multimodal prehabilitation programme.

DESIGN

This was a single blinded, single centre, randomised controlled study. Participants performed four assessments: at baseline, after prehabilitation (just before surgery), and at 1 and 2 months after surgery.

PATIENTS

Adult patients scheduled for elective resection of nonmetastatic colorectal cancer were included provided there were no absolute contraindications to exercise nor poor language comprehension.

INTERVENTION

Patients followed either high-intensity interval training (HIIT), or moderate intensity continuous training (MICT), as part of a 4-week multimodal prehabilitation programme. Both groups followed the same supervised resistance training, nutritional therapy and anxiety reduction interventions. All patients followed standardised peri-operative management.

MAIN OUTCOME MEASURE

Changes in oxygen consumption at anaerobic threshold, measured with sequential cardio-pulmonary exercise testing, were assessed and compared between groups.

RESULTS

Forty two patients were included in the primary analysis (HIIT n = 21 vs. MICT n = 21), with mean ± SD age 64.5 ± 11.2 years and 62% were men. At 2 months after surgery, 13/21 (62%) in HIIT and 11/21 (52%) in MICT attended the study visits. Both protocols significantly enhanced pre-operative functional capacity, with no difference between groups: mean (95% confidence interval) oxygen consumption at anaerobic threshold 1.97 (0.75 to 3.19) ml kg−1 min−1 in HIIT vs. 1.71 (0.56 to 2.85) in MICT, P = 0.753. At 2 months after surgery, the HIIT group showed a higher improvement in physical fitness: 2.36 (0.378 to 4.34) ml kg−1 min−1, P = 0.021. No adverse events occurred during the intervention.

CONCLUSION

Both MICT and HIIT enhanced pre-operative functional capacity.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03361150.
Intralesional Bleomycin for Orbital Lymphatic Malformations: Comparison of Clinical Versus Radiologic Regression by Volumetric Analysis
Authors: Dave Tarjani Vivek , Madhuri Bejjanki Kavya , Kaliki Swathi
Published: September 2020

Purpose:

The aim of the study was to investigate the clinical resolution versus radiologic regression of orbital lymphatic malformations (LMs) following treatment with intralesional bleomycin sulfate sclerotherapy.

Methods:

A retrospective interventional study of 24 eyes with orbital LMs treated with nonimage-guided bleomycin sclerotherapy. The clinical and radiologic outcomes were classified as excellent, good, fair, and poor. Regression was assessed clinically and by radiologic volumetrics.

Results:

Mean age at presentation was 17 ± 18 years (median 11, range 5 months to 70 years). Lesion morphology was microcystic in 11 (46%), macrocystic in 8 (34%), and mixed in 5 (21%) eyes. Mean units of bleomycin injected per session were 4 ± 2 IU (median 5 IU, range 1–6 IU). Mean number of treatment sessions required was 2 ± 1 (median 2, range 1–6). Cumulative units of bleomycin injected were 11 ± 9 (median 9, range 1–38 IU). The clinical response was excellent in 19 (79%), good in 4 (17%), and fair in 1 (4%). The mean preoperative and postoperative lesion volumes were 7 ± 4 cm3 and 0.8 ± 1.2 cm3, respectively (p < 0.0001, 95% CI, −7.89 to −4.51). Radiologic resolution of LM was excellent in 6 (25%), good in 8 (33%), fair in 7 (29%), and poor in 3 (13%) eyes. Spearman’s rank correlation coefficient for correlation between clinical and radiologic grading was 0.51 (p = 0.01, 95% CI, 0.13–0.75%). There was a sustained tumor resolution without recurrence over a mean follow-up duration was 2 years (median 18 months; range 12–60 months).

Conclusions:

Bleomycin sclerotherapy for orbital LMs gives an excellent to good clinical response in 93%. However, a parallel radiologic regression is seen only in 58%. The endpoint to assess response should be clinical. Treatment till complete radiologic resolution may not be necessary.
Are Medicare wellness visits improving outcomes?
Authors: Watkins Susan , Astroth Kim Schafer , Kim MyoungJin , Dyck Mary J.
Published: September 2020

Background:

As the largest and unhealthiest population in American history enrolls as Medicare beneficiaries, it is vital for primary care providers to understand how to maximize Medicare wellness provisions. The Baby Boomer population has been documented to have the highest chronic disease prevalence related to preventable lifestyle behaviors. Perpetual unhealthy lifestyle behaviors associated with chronic disease prevalence are detrimental to life quality and the American Medicare resource structure. Since 2011, the Affordable Care Act provisions have included free wellness visits designed to prevent disease for Medicare beneficiaries, who continue to grossly underuse these services.

Objectives:

This systematic review was conducted to evaluate the quality, level, and strength of evidence regarding Medicare wellness service efficacy on related health outcomes.

Data sources:

The methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for selection of 21 research-based articles included in the analysis. Results from the 21 eligible studies revealed low research quality and vigor; therefore, lacking causality and generalizability of medicare wellness visit (MWV) efficacy on health promotion outcomes.

Conclusions:

The evidence is focused on how MWVs are affecting preventive care utilization instead of patient health outcomes. In the interest of reducing chronic disease prevalence and the economic burden on our health care system, it is important to understand how these services affect health promotion outcomes.

Implications for practice:

The results of this systematic literature review substantiate the need for primary care providers to study MWV efficacy on health promotion outcomes for the Medicare population.
Integration of primary care into the substance use disorder outpatient treatment setting
Authors: Wasserman Rachel , Terrien Jill
Published: September 2020

Background:

Americans experiencing substance use disorder (SUD) carry a significant chronic disease burden, yet only half use primary care. Patients in treatment for SUD who are connected with primary care typically have better overall health outcomes.

Local problem:

The identified intensive outpatient program (IOP) had no protocol in place to engage patients with primary care.

Methods:

This project piloted the development and implementation of an original, evidence-based primary care integration program. It consisted of a psychoeducation group, a referral by case management, and establishment of an internal referral process to affiliated primary care providers (PCPs).

Interventions:

Following the psychoeducation group, pre and posttests of patient-reported knowledge and attitudes regarding primary care were compared. Participants were contacted to collect further data after IOP discharge. An education and feedback session was held with affiliated PCPs, and an internal referral process was devised by leadership.

Results:

Mean scores measuring patient knowledge and attitudes regarding primary care increased after participation in the structured psychoeducation group. By time of IOP discharge, 100% (n = 12) of participants had either a referral or scheduled appointment with a PCP in place. At time of follow-up, 90% (n = 9) reported that they had attended or planned to attend their scheduled PCP appointment.

Conclusions:

A comprehensive integration program in the IOP setting can improve patient engagement with primary care. Quality improvement implementation will require consideration of challenges faced during the pilot involving scheduling, staff buy-in, changes in patient acuity, the electronic medical record, and insurance.
Connecting veterans with smoking cessation services in less than 3 minutes
Authors: Boe Rony , Ridner Stanley Lee
Published: September 2020

Veterans smoke disproportionately higher (nearly 1.3 times greater) than the general population and puts them at greater risk for tobacco-related illnesses. Annual screenings by the primary care providers are conducted at Veterans Health Administration (VHA) primary care clinics, but this practice may be inadequate to overcome the chronicity of smoking. The Ask, Advise, Refer strategy for smoking cessation was integrated in the workflow and implemented by the nursing staff at a VHA outpatient surgery clinic. Nurses established smoking status, advised smokers to quit, and for those interested, provided the smoker a list of resources Department of Veterans Affairs' approved smoking cessation options (telephone, text, and web-based interventions). All the smokers took a referral card containing a list of resources to help them quit smoking. During the follow-up phone calls after the clinic visit, 19% of patients reported using at least one of the resources listed on the card. Each clinical encounter should be viewed by health care providers as a window of opportunity to promote smoking cessation. The simplicity of the AAR strategy is effective in promoting smoking cessation especially in busy outpatient settings.
Measurement of nonbillable service value activities by nurse practitioners, physician assistants, and clinical nurse specialists in ambulatory specialty care
Authors: Winter Shira , Chan Garrett K. , Kuriakose Clair , Duderstadt Karen , Spetz Joanne , Hsieh Debbie , Platon Charlene , Chapman Susan A.
Published: September 2020

Background:

Revenue-generating health care activities, generally accepted as a measure of productivity, do not account for the full range of health care activities that enhance patient care.

Purpose:

We analyzed the quantity, duration, and type of “service value activities” performed by nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs), which are nonbillable service activities that contribute to billable service provision, quality of care, and value of care.

Methods:

Data were obtained from ambulatory specialties at one health care institution over a 13-month period. First, descriptive statistics were calculated by time-based code for each category of provider (medical, surgical, transplant, hematology/oncology, and anesthesia). Then qualitative comments were analyzed for frequency of key words.

Results:

Each provider spent an estimated average of between 3.7 and 36.5 hours per month on service value activities, with the greatest number of these activities related to orders, chart review, and documentation.

Implications for practice:

More thorough exploration of the quantity and type of service value activities performed may lead to a better understanding of the role and contribution of NPs, PAs, CNSs, and other health care professionals to patient care.
Integrating strategies for improving diagnostic reasoning and error reduction
Authors: Nordick Christina L.
Published: September 2020

Errors of diagnostic reasoning contribute significantly to patient harm. Students, novice diagnosticians, and even experienced clinicians often have difficulty understanding or describing the processes of diagnostic reasoning. Inappropriate use of cognitive heuristics and poor logical reasoning by novice or experienced diagnosticians may result in missed or delayed diagnoses. Reduction of diagnostic errors through knowledge acquisition, self-reflection, and check lists has individually demonstrated some improvements in diagnostic reasoning. Implementing the diagnostic and reasoning tool (DaRT), a method of reasoning which integrates the evidence-based strategies of knowledge acquisition, metacognition, and logical reasoning skills throughout the patient encounter, results in improvement in diagnostic reasoning in advanced practice nurses. Use of the DaRT in one university setting resulted in significant improvement in advanced health assessment skills and diagnostic reasoning abilities as demonstrated by improvements of 28–55% end-of-program Health Education Systems Incorporated scores. Translation into practice settings may further support the use of this multiple-modality tool.
Implementation and evaluation of a self-care toolkit for caregivers of families with dementia
Authors: Smith Carolyn Wordly , Graves Barbara Ann
Published: September 2020

Background:

Family caregivers who care for individuals with dementia are more likely to develop chronic stress, major depression, anxiety, and physical health disorders and they have a higher mortality rate compared with the general population.

Local problem:

Caregivers are at an increased risk of physical and mental disorders. Many report that they are fatigued and need more forms of support.

Methods:

This project involved a convenience sample of 35 family caregivers who cared for family with dementia. Prequestionnaires and postquestionnaires were used to determine improvements in caregiver health and well-being and caregiver resources for supportive services as well as reduction in caregiver stress.

Interventions:

An evidence-based educational class was developed and implemented based on the Family Care Alliance (FCA): Taking Care of YOU: Self-Care for Family Caregivers Toolkit. The project aimed to (1) assess two FCA recommended domains: caregiver health and well-being and caregiver resources for supportive services and (2) reduce caregiver stress.

Results:

Stress Inventory results showed notable change in high risk/low risk categorization from pretest to posttest. At pretest, 31 caregivers were categorized as at high risk for unhealthy levels of stress, but posttest showed only 9 caregivers were so categorized. Approximately, 70% of those at high risk at pretest were categorized as low risk at posttest.

Conclusions:

This project validated that evidence-based educational interventions can improve caregiver knowledge and self-care. Continued support may be promoted by incorporating education and offering resource brochures to caregivers during primary care visits.
A nurse practitioner–led effort to reduce 30-day heart failure readmissions
Authors: Charteris Elaine J. , Pounds Bunny
Published: September 2020

Background:

Heart failure (HF) affects over 6.5 million Americans and is the leading reason for hospital admissions in patients over the age of 65. Readmission rates within 30 days are 21.4% nationally, and 12% of those are likely preventable. Veterans are especially vulnerable to developing cardiac diseases requiring hospitalization and subsequent readmission.

Local problem:

The Southern Arizona Veterans Administration Health Care System has over 5,600 patients diagnosed with HF and a 30-day readmission rate of 21.65%. The aim of this quality improvement project was to reduce 30-day all-cause readmissions by 1% over 8 weeks.

Methods:

To reduce HF readmissions, the plan-do-study-act rapid-cycle method of quality improvement was used.

Interventions:

A dedicated multidisciplinary HF clinic was formed with a cardiology nurse practitioner, clinical pharmacists, and a dietician. A veteran-centered shared decision-making tool for setting self-care goals was implemented.

Results:

The readmission rate of patients seen in the multidisciplinary clinic (n = 33) was reduced by 0.2%. The percentage of veterans seen within 14 days increased from 30% to 54.5%. The average number of days between discharge and cardiology follow-up improved from 45 to 19 days. Veterans were able to set at least one self-care goal 87% of the time. Patient satisfaction with the multidisciplinary clinic was high at 93%.

Conclusions:

Implementing a dedicated, multidisciplinary HF clinic reduced readmissions, improved timeliness of visits, and was well received. Use of a veteran-centered patient engagement tool resulted in more veterans setting self-care goals.
Neonatal Eating Assessment Tool—Mixed Breastfeeding and Bottle-feeding: Reference values and factors associated with problematic feeding symptoms in healthy, full-term infants
Authors: Pados Britt Frisk , Johnson Jamarii , Nelson Madeline
Published: September 2020

Background:

The Neonatal Eating Assessment Tool—Mixed Breastfeeding and Bottle-feeding (NeoEAT—Mixed Feeding) is a parent-report assessment of symptoms of problematic feeding in infants who are feeding by both breast and bottle.

Purpose:

To establish reference values for the NeoEAT—Mixed Feeding and evaluate factors that contribute to symptoms of problematic feeding in healthy, full-term infants.

Methods:

Parents of 409 infants less than 7 months old completed an online survey. Median and percentile scores are presented for infants aged 0–2, 2–4, 4–6, and 6–7 months old.

Results:

Neonatal Eating Assessment Tool—Mixed Feeding total score and scores for the Gastrointestinal Tract Function and Energy & Physiologic Stability subscales decreased with increasing infant age. Infant Regulation and Feeding Flexibility subscale scores remained stable over time, whereas Sensory Responsiveness subscale scores increased with increasing infant age. Infants with more gastrointestinal symptoms had higher NeoEAT—Mixed Feeding total scores.

Implications for practice:

The reported reference values may be used to identify infants in need of further assessment, referral, and intervention. In healthy, full-term infants with concurrent gastrointestinal symptoms and problematic feeding, interventions targeted at gastrointestinal symptoms may help to improve symptoms of problematic feeding as well.
Development and implementation of a primary care clinic workflow protocol to meet opioid prescribing guidelines
Authors: Weller Lori M.
Published: September 2020

Background:

Nearly 50% of opioid overdose deaths in the United States involve the use of prescription opioids. Primary care providers can help decrease the risk of opioid overdose deaths by adhering to opioid prescribing guidelines for chronic pain management.

Local problem:

Ten Washington State primary care clinics had gaps in guideline adherence and mandated electronic medical record (EMR) documentation for prescribing opioids.

Methods:

A quality improvement project using an educational intervention was implemented.

Interventions:

Primary care providers and support staff (defined as registered nurses and medical assistants) from the 10 primary care clinics viewed the project's instructional YouTube webinar that explained the project's primary care clinic workflow protocol, opioid prescribing best practice guidelines, and the organization's mandated EMR charting for chronic pain management. Preintervention and postintervention measures, which included five different documented patient completion rates of the organization's best practices for opioid prescribing, were used to assess for improvement to guideline adherence. Additionally, participants completed a questionnaire regarding their perceptions of the webinar as an educational tool.

Results:

Postintervention data showed significantly (p ≤ .05) increased completion rates for three of five outcome measures, indicating improvement in guideline adherence. The majority of participants reported that the webinar information would help them better adhere to best practice guidelines.

Conclusions:

A workflow protocol for opioid prescribing taught via a YouTube webinar was an effective method for disseminating and implementing best practices in the primary care setting. Similar workflow protocols, taught via webinar, could be equally beneficial in other primary care clinics.
Cardiovascular disease knowledge, risk factors, and resilience among US veterans with and without post-traumatic stress disorder
Authors: Angosta Alona D. , Reyes Andrew Thomas , Cross Chad , Pollom Trevor , Sood Komal
Published: September 2020

Background:

Cardiovascular disease (CVD) is the leading cause of death in the United States and the leading cause of hospitalization and disability among the US veterans. Information about CVD knowledge and risk factors, and connection between psychological health and CVD among veterans transitioning from the military are limited.

Purpose:

We examined the existing knowledge of CVD and its risk factors among the US veterans with and without post-traumatic stress disorder (PTSD), and the relationship between knowledge, risk factors, resilience, and PTSD.

Methods:

A total of 104 veterans participated in our study by responding to the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Heart Disease Fact Questionnaire (HDFQ) knowledge scale, and Connor-Davidson Resilience Scale 10. Data were extracted from the online Qualtrics survey software into SPSS (v. 25) for analysis.

Results:

Mean age was 52.3 years, mostly males (85.6%), married (72.1%), employed (54.8%), and with college education. Most were in the Navy or Air Force (72.1%) and served in a war (68.0%). Hypertension, high cholesterol, and obesity were the most common CVD risk factors reported. Average CVD knowledge score was 85%. Marines scored higher on resilience than other branches of the military. Seventeen percent reported having PTSD. The Connor-Davidson Resilience Scale 10 was significantly correlated with the HDFQ in the probable PTSD group (r = .589, p = .013).

Implications for practice:

Our study provides information about the knowledge and risk factors of CVD among veterans and insights about interventions needed to improve CV health. Nurse practitioners should assess the CV and psychological health of veterans and screen for PTSD to provide appropriate care and referral.
Neointima characteristics as a prognostic marker for drug-coated balloon angioplasty in patients with in-stent restenosis: an optical coherence tomography study
Authors: Kim Hyung Oh , Jung Hae Won , Lee Jung-Hee , Kim Jung-Sun , Hong Sung-Jin , Ahn Chul-Min , Kim Byeong-Keuk , Kim Weon , Kim Soo-Joong , Kim Woong , Ko Young-Guk , Choi Donghoon , Hong Myeong-Ki , Jang Yangsoo
Published: September 2020

Background

Research has shown that the prognosis of in-stent restenosis (ISR) lesions after drug-coated balloon (DCB) angioplasty can differ in relation to in-stent neointimal characteristics. However, changes in neointima characteristics after DCB have not been studied. This study sought to investigate changes in neointima characteristics after DCB for ISR.

Methods

From the Yonsei Optical Coherence Tomography (OCT) registry, data on DCBs performed in patients with ISR were collected. Neointima characteristics were categorized as homogeneous, heterogeneous, layered neointima, and neoatherosclerosis in each OCT procedure. Homogeneous and layered neointima were classified as a favorable neointima, while heterogeneous neointima and neoatherosclerosis were classified as an unfavorable neointima. The data of 67 ISR patients were analyzed.

Results

The median duration between initial and follow-up OCT was 9.6 months. Patients with homogeneous and layered neointima on the initial OCT before DCB mostly appeared as homogeneous (66.7 and 68.2%, respectively) on the follow-up OCT, whereas most of the patients with heterogeneous neointima on the initial OCT remained unaltered (70%). Patients with unfavorable neointima at either the initial (P = 0.023) or the follow-up OCT (P = 0.037) had a worse major adverse cardiovascular event-free survival than the other patients. Patients who showed unfavorable neointima at both the initial and the follow-up OCT had the worst event-free survival (P = 0.038).

Conclusions

The follow-up OCT neointimal characteristics after DCB for ISR was associated with initial OCT characteristics. Sustained unfavorable neointima in serial OCT imaging may reflect poor prognosis in patients with ISR treated with DCB.
Exploring How Epidemic Context Influences Syphilis Screening Impact: A Mathematical Modeling Study
Authors: Tuite Ashleigh R. , Testa Christian , Rönn Minttu , Bellerose Meghan , Gift Thomas , Fridge Jessica , Molotnikov Lauren , Desmarais Catherine , Berruti Andrés , Menzies Nicolas , Malyuta Yelena , Hsu Katherine , Salomon Joshua A.
Published: September 2020

Background

The current syphilis epidemic in the United States is concentrated in gay, bisexual, and other men who have sex with men (MSM), but substantial heterosexual transmission is reported in some parts of the country. Using the US states of Louisiana and Massachusetts as case studies, we investigated how epidemic context influences the impact of population screening approaches for syphilis control.

Methods

We constructed a compartmental metapopulation model parameterized to describe observed patterns of syphilis transmission. We estimated the impact of different approaches to screening, including perfect adherence to current US screening guidelines in MSM.

Results

In Louisiana, where syphilis cases are more evenly distributed among MSM and heterosexual populations, we projected that screening according to guidelines would contribute to no change or an increase in syphilis burden, compared with burden with current estimated screening coverage. In Massachusetts, which has a more MSM-focused outbreak, we projected that screening according to guidelines would be as or more effective than current screening coverage in most population groups.

Conclusions

Men who have sex with men–focused approaches to screening may be insufficient for control when there is substantial transmission in heterosexual populations. Epidemic characteristics may be useful when identifying at-risk groups for syphilis screening.
Anti-glomerular Basement Membrane Disease: What Have We Learned?
Authors: Akhtar Mohammed , Taha Noheir M. , Asim Muhammad
Published: September 2020

Since the first clinicopathologic description by Ernest Goodpasture of a patient whom he considered to have died of influenza in 1919, substantial progress has been made in our knowledge of anti-glomerular basement membrane disease. This has led to a significant decrease in the morbidity and mortality associated with this disease. In this paper, we aim to review the literature that has enhanced our understanding of classic anti-glomerular basement membrane disease and its clinic-pathologic variants in the key areas of immunopathogenesis and histopathology. We also summarize varied clinical presentations and therapeutic strategies.
High-grade B-Cell Lymphoma With MYC, BCL2, and/or BCL6 Translocations/Rearrangements
Authors: Zhang Jijun , Weng Zeping , Huang Yuhua , Li Min , Wang Fang , Wang Yu , Rao Huilan
Published: September 2020

Double-hit/triple-hit lymphomas (DH/THLs) are high-grade B-cell lymphomas with MYC and BCL2 rearrangements and/or BCL6 rearrangements, which have poor outcomes after standard chemoimmunotherapy. This retrospective study analyzed 51 patients (range, 19 to 82 y) diagnosed from 2016 to 2019 and treated for DH/THL (n=34 MYC/BCL6 DHL, n=14 MYC/BCL2 DHL, n=3 THL) at one institution in South China. Extranodal lesions occurred in 32 patients (62.7%), more frequently in MYC/BCL6 DHL (22/34, 64.7%) than in MYC/BCL2 DHL (7/14, 50%). The most common extranodal sites were the stomach (8/32, 25.0%) and intestine (5/32, 15.6%). Most patients (33/45, 73.3%) presented with Ann Arbor stage III/IV. Interestingly, 14.3% (4/28) of MYC/BCL6 DHL tumors showed diffuse, medium-intensity CD30 expression. Epstein-Barr virus–encoded RNA was positive in 3 cases, all MYC/BCL6 DHL. Among 48 patients (94.1%) with follow-up data, 18 (37.5%) died owing to the disease, and the median survival was 5.5 months. Germinal center B cells were observed more frequently in MYC/BCL2 DHL (14/14, 100.0%) than in MYC/BCL6 DHL (15/34, 44.1%; P<0.001). Bone marrow involvement tended to lower overall survival (OS) (P=0.033). No association was observed between stage, B symptoms, lactate dehydrogenase levels, and central nervous system involvement and OS. A total of 25 patients (25/47, 53.2%) with previous hepatitis B virus (HBV) infections had significantly poorer OS (P=0.014). Chronic HBV infection was positively correlated with MYC/BCL6 DHL (r=0.317, P=0.030). Compared with DH/THL in western countries, the disease in South China has distinct characteristics with a higher prevalence of MYC/BCL6 DHL. We speculate that HBV is important in DH/THL tumorigenesis. These findings might provide clues for novel treatment strategies.
Histopathologic Characterization of Mogamulizumab-associated Rash
Authors: Wang Jennifer Y. , Hirotsu Kelsey E. , Neal Tatiana M. , Raghavan Shyam S. , Kwong Bernice Y. , Khodadoust Michael S. , Brown Ryanne A. , Novoa Roberto A. , Kim Youn H. , Rieger Kerri E.
Published: September 2020

Rash is one of the most common adverse events observed with mogamulizumab, an anti-C-C chemokine receptor 4 monoclonal antibody approved for previously treated mycosis fungoides (MF) and Sezary syndrome (SS). Given the nonspecific clinical presentations of this rash, histopathologic distinction from MF/SS is critical for informing clinical management. We performed a comprehensive characterization of the histopathologic findings in mogamulizumab-associated rash (MAR) with the integration of high-throughput sequencing of T-cell receptor (TCR) genes. Fifty-two biopsy specimens from 19 patients were evaluated retrospectively. Three major histologic reaction patterns were identified: spongiotic/psoriasiform dermatitis (33/52), interface dermatitis (11/52), and granulomatous dermatitis (8/52). Almost half of the specimens (21/52) showed at least 2 of these reaction patterns concurrently. Dermal eosinophils were not a consistent feature, being present in only half (27/52) of specimens and prominent in only 3. Features mimicking MF/SS, including lymphocyte exocytosis, lamellar fibroplasia, and adnexal involvement, were commonly seen but tended to be focal and mild. In 38/43 specimens with available immunohistochemistry, intraepidermal lymphocytes demonstrated a CD4:CD8 ratio ≤1 : 1. Low background levels of the patient’s previously identified MF/SS-associated TCR sequence(s) were demonstrated in 20/46 specimens analyzed by high-throughput sequencing of TCR. We conclude that MAR may demonstrate diverse histologic features. Findings that may distinguish MAR from MF/SS include the inverted or normalized CD4:CD8 ratio within intraepidermal lymphocytes and demonstration of absent or nondominant levels of disease-associated TCR sequences. Correlation with the clinical findings and immunohistochemical and molecular characterization of the patient’s MF/SS before mogamulizumab, when possible, may facilitate recognition of MAR.
Real-Time Effort Driven Ventilator Management: A Pilot Study*
Authors: Hotz Justin C. , Bornstein Dinnel , Kohler Kristen , Smith Erin , Suresh Anil , Klein Margaret , Bhalla Anoopindar , Newth Christopher J. , Khemani Robinder G.
Published: September 2020

Objectives:

Mechanical ventilation of patients with acute respiratory distress syndrome should balance lung and diaphragm protective principles, which may be difficult to achieve in routine clinical practice. Through a Phase I clinical trial, we sought to determine whether a computerized decision support–based protocol (real-time effort–driven ventilator management) is feasible to implement, results in improved acceptance for lung and diaphragm protective ventilation, and improves clinical outcomes over historical controls.

Design:

Interventional nonblinded pilot study.

Setting:

PICU.

Patients:

Mechanically ventilated children with acute respiratory distress syndrome.

Interventions:

A computerized decision support tool was tested which prioritized lung-protective management of peak inspiratory pressure–positive end-expiratory pressure, positive end-expiratory pressure/Fio
2, and ventilatory rate. Esophageal manometry was used to maintain patient effort in a physiologic range. Protocol acceptance was reported, and enrolled patients were matched 4:1 with respect to age, initial oxygenation index, and percentage of immune compromise to historical control patients for outcome analysis.

Measurements and Main Results:

Thirty-two patients were included. Acceptance of protocol recommendations was over 75%. One-hundred twenty-eight matched historical controls were used for analysis. Compared with historical controls, patients treated with real-time effort–driven ventilator management received lower peak inspiratory pressure–positive end-expiratory pressure and tidal volume, and higher positive end-expiratory pressure when Fio
2 was greater than 0.60. Real-time effort–driven ventilator management was associated with 6 more ventilator-free days, shorter duration until the first spontaneous breathing trial and 3 fewer days on mechanical ventilation among survivors (all p ≤ 0.05) in comparison with historical controls, while maintaining no difference in the rate of reintubation.

Conclusions:

A computerized decision support–based protocol prioritizing lung-protective ventilation balanced with reduction of controlled ventilation to maintain physiologic levels of patient effort can be implemented and may be associated with shorter duration of ventilation.
Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials
Authors: Coronado Rogelio A. , Brintz Carrie E. , McKernan Lindsey C. , Master Hiral , Motzny Nicole , Silva Flavio M. , Goyal Parul M. , Wegener Stephen T. , Archer Kristin R.
Published: September 2020

Psychologically informed physical therapy (PIPT) blends psychological strategies within a physical therapist's treatment approach for the prevention and management of chronic musculoskeletal pain. Several randomized trials have been conducted examining the efficacy of PIPT compared to standard physical therapy on important patient-reported outcomes of disability, physical function, and pain. In this review, we examine recent trials published since 2012 to describe current PIPT methods, discuss implications from findings, and offer future directions. Twenty-two studies, representing 18 trials, were identified. The studied PIPT interventions included (1) graded activity or graded exposure (n = 6), (2) cognitive-behavioral-based physical therapy (n = 9), (3) acceptance and commitment-based physical therapy (n = 1), and (4) internet-based psychological programs with physical therapy (n = 2). Consistent with prior reviews, graded activity is not superior to other forms of physical activity or exercise. In a few recent studies, cognitive-behavioral-based physical therapy had short-term efficacy when compared to a program of standardized exercise. There is a need to further examine approaches integrating alternative strategies including acceptance-based therapies (ie, acceptance and commitment therapy or mindfulness) or internet-based cognitive-behavioral programs within physical therapy. Although PIPT remains a promising care model, more convincing evidence is needed to support widespread adoption, especially in light of training demands and implementation challenges.