bluuebunny/crossref_metadata_2025 huggingface dataset:
21. Applications: prisoners’ rights
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. It discusses European Convention law and relates it to domestic law under the HRA. Questions, discussion points, and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter considers the application of Convention rights in the field of prisoners’ rights; the impact of Convention rights on prisoners in the UK is considered. Prisoners remain within the protection of the European Convention on Human Rights, though the application of these rights will take their position into account. Prisoners’ rights include not only rights to the non-arbitrary loss of liberty (Article 5) and rights to fair procedures (Articles 5 and 6), but also not to be disproportionately denied the rights and freedoms in Articles 8–11. Imprisonment deprives individuals of their liberty and, therefore, is a public function for which the state is responsible under the Convention. The controversy over prisoners’ right to vote is discussed in Chapter 25.
26. Anti-terrorism law and human rights
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of la and legal debate. It discusses European Convention law and relates it to domestic law under the HRA. Questions, discussion points, and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter considers the application of human rights in the special circumstances of the threat of terrorism and counter-terrorism measures taken in the UK. It considers the compatibility of the Terrorism Act 2000, and other subsequent measures, with human rights. This includes matters such as the definition of terrorism, police powers under the Act (such as random stop and search), and measures, such as TPIMs, to control terrorist suspects. The impact of these measures on the right to liberty and on private life are important themes. The chapter also considers the effect of such measures on the right to a fair hearing (in Articles 5 and 6). These special powers are often controversial giving rise, as they do, to important tensions between the rule of law and the duty on states to uphold the safety and security of the population.
3. Consent
Authors: Samanta Jo , Samanta Ash
Published: September 2021

This chapter deals with consent as a necessary precondition for medical treatment of competent adults. It provides an overview of the common law basis of the Mental Capacity Act 2005, followed by discussion of issues relating to information disclosure, public policy, and the key case of Montgomery and how this applies to more recent cases. It considers the statutory provisions for adults who lack capacity, exceptions to the requirement to treat patients who lack capacity in their best interests, and consent involving children under the Children Act 1989. Gillick competence, a concept applied to determine whether a child may give consent, is also explained. Relevant case law, including Gillick, which gave rise to the concept, are cited where appropriate.
9. Prevention of Marine Pollution
Authors: Boyle Alan , Redgwell Catherine
Published: September 2021

This chapter focuses on threats of pollution to the health of the marine environment. It focuses in particular on marine pollution. The oceans constitute a large expanse of common space. The oceans have been freely used for maritime commerce, exploitation of living resources, extraction of oil and gas, and as a disposal area for waste products for centuries. The law needs to protect marine ecosystems as much as any others on land. Climate change has now begun to harm marine ecosystems and international law needs to consider this. The chapter aims to demonstrate the extent to which an international legal regime for the control of marine pollution from ships has developed since 1972, and the degree to which it has proved effective. The big question is: how can it be made more effective in the future?
2. Stop and search
Authors: Parmar Alpa
Published: September 2021

This chapter examines the powers of the police to stop and search people in the context of an initial discussion of police culture and discretion in general. The development of greater powers over the last 35 years since the Police and Criminal Evidence Act 1984 (PACE) was introduced is charted. The chapter considers whether stop and search is racially discriminatory; the constraints and controls on the exercise of discretion; and the impact of stop-search powers. It argues that the working assumptions based on ‘suspiciousness’—i.e. hunch, incongruity, and stereotyping on the basis of types of people, previous records, and so forth—still play as important a part in influencing the exercise of discretion as do legal constraints. This is all true even when responding to citizen reports of suspected offences.
12. Victims, the accused and the future of criminal justice
Authors: Welsh Lucy , Skinns Layla , Sanders Andrew
Published: September 2021

This chapter discusses how developments in criminal justice have affected suspects’ rights; different types of victims’ ‘rights’; whether victims have (legally) enforceable rights; and enhancing victims’ rights without eroding defendants’ rights. It concludes with an overview of the impact of neoliberalism, the extent to which the system incorporates the ‘core values’ it ostensibly subscribes to, and how to make criminal justice more freedom-enhancing.
Medical Intelligence Team Lessons Learned: Early Activation and Knowledge Product Development Mitigate COVID-19 Threats
Authors: Migliore Laurie , Hopkins Dawnkimberly , Jumpp Savannah , Brackett Ceferina , Cromheecke Jessica
Published: September 2021

Leadership during the emergence of the novel coronavirus pandemic is complex and involves coordinated efforts between multiple levels of leadership from the medical, installation, local, state, and federal levels. Medical intelligence is critical to successful pandemic threat mitigation. We describe one of the first coronavirus (Coronavirus Disease-2019 (COVID-19)) impacted Department of Defense Medical Treatment Facility’s strategic activation of a COVID-19 Medical Intelligence Team (MIT), the products developed, and lessons learned during the pandemic onset. The MIT bridged COVID-19 knowledge and policy gaps by developing and delivering daily intelligence briefings on four domains: epidemiology and infectious disease, healthcare capabilities and infrastructure, policy and regulations, and diagnostics and therapeutic interventions. Twenty-three products were developed and delivered to aid in leadership decision-making and local policy development in the absence of higher-level policy and guidance. Employing MITs in future pandemic response strategy may more effectively mitigate pandemic threats and improve force health protection.
DIANA-miTED: a microRNA tissue expression database
Authors: Kavakiotis Ioannis , Alexiou Athanasios , Tastsoglou Spyros , Vlachos Ioannis S , Hatzigeorgiou Artemis G
Published: September 2021

microRNAs (miRNAs) are short (∼23nt) single-stranded non-coding RNAs that act as potent post-transcriptional gene expression regulators. Information about miRNA expression and distribution across cell types and tissues is crucial to the understanding of their function and for their translational use as biomarkers or therapeutic targets. DIANA-miTED is the most comprehensive and systematic collection of miRNA expression values derived from the analysis of 15 183 raw human small RNA-Seq (sRNA-Seq) datasets from the Sequence Read Archive (SRA) and The Cancer Genome Atlas (TCGA). Metadata quality maximizes the utility of expression atlases, therefore we manually curated SRA and TCGA-derived information to deliver a comprehensive and standardized set, incorporating in total 199 tissues, 82 anatomical sublocations, 267 cell lines and 261 diseases. miTED offers rich instant visualizations of the expression and sample distributions of requested data across variables, as well as study-wide diagrams and graphs enabling efficient content exploration. Queries also generate links towards state-of-the-art miRNA functional resources, deeming miTED an ideal starting point for expression retrieval, exploration, comparison, and downstream analysis, without requiring bioinformatics support or expertise. DIANA-miTED is freely available at http://www.microrna.gr/mited.
Bypass of complex co-directional replication-transcription collisions by replisome skipping
Authors: Brüning Jan-Gert , Marians Kenneth J
Published: September 2021

Collisions between the replisome and RNA polymerases [RNAP(s)] are the main obstacle to DNA replication. These collisions can occur either head-on or co-directionally with respect to the direction of translocation of both complexes. Whereas head-on collisions require additional factors to be resolved, co-directional collisions are thought to be overcome by the replisome itself using the mRNA transcript as a primer. We show that mRNA takeover is utilized primarily after collisions with single RNAP complexes with short transcripts. Bypass of more complex transcription complexes requires the synthesis of a new primer downstream of the RNAP for the replisome to resume leading-strand synthesis. In both cases, bypass proceeds with displacement of the RNAP. Rep, Mfd, UvrD and RNase H can process the RNAP block and facilitate replisome bypass by promoting the formation of continuous leading strands. Bypass of co-directional RNAP(s) and/or R-loops is determined largely by the length of the obstacle that the replisome needs to traverse: R-loops are about equally as potent obstacles as RNAP arrays if they occupy the same length of the DNA template.
Verticillium dahliaeeffector VDAL protects MYB6 from degradation by interacting with PUB25 and PUB26 E3 ligases to enhance Verticillium wilt resistance
Authors: Ma Aifang , Zhang Dingpeng , Wang Guangxing , Wang Kai , Li Zhen , Gao Yuanhui , Li Hengchang , Bian Chao , Cheng Jinkui , Han Yinan , Yang Shuhua , Gong Zhizhong , Qi Junsheng
Published: September 2021

Verticillium wilt is a severe plant disease that causes massive losses in multiple crops. Increasing the plant resistance to Verticillium wilt is a critical challenge worldwide. Here, we report that the hemibiotrophic Verticillium dahliae-secreted Asp f2-like protein VDAL causes leaf wilting when applied to cotton leaves in vitro but enhances the resistance to V. dahliae when overexpressed in Arabidopsis or cotton without affecting the plant growth and development. VDAL protein interacts with Arabidopsis E3 ligases plant U-box 25 (PUB25) and PUB26 and is ubiquitinated by PUBs in vitro. However, VDAL is not degraded by PUB25 or PUB26 in planta. Besides, the pub25 pub26 double mutant shows higher resistance to V. dahliae than the wild-type. PUBs interact with the transcription factor MYB6 in a yeast two-hybrid screen. MYB6 promotes plant resistance to Verticillium wilt while PUBs ubiquitinate MYB6 and mediate its degradation. VDAL competes with MYB6 for binding to PUBs, and the role of VDAL in increasing Verticillium wilt resistance depends on MYB6. Taken together, these results suggest that plants evolute a strategy to utilize the invaded effector protein VDAL to resist the V. dahliae infection without causing a hypersensitive response (HR); alternatively, hemibiotrophic pathogens may use some effectors to keep plant cells alive during its infection in order to take nutrients from host cells. This study provides the molecular mechanism for plants increasing disease resistance when overexpressing some effector proteins without inducing HR, and may promote searching for more genes from pathogenic fungi or bacteria to engineer plant disease resistance.
The Vot-ER Healthy Democracy Campaign: A National Medical Student Competition to Increase Voting Access
Authors: Ruxin Talia R. , Ha Yoonhee P. , Grade Madeline M. , Brown Rory , Lawrence Carlton , Martin Alister F.
Published: September 2021

Problem

Voting affords citizens a direct say in the leaders and policies that affect their health. However, less than 20% of eligible U.S. citizens have been offered the chance to register to vote at a government-funded agency like a hospital or clinic that provides Medicaid or Medicare services. Medical students are well positioned to increase voting access due to their interactions with multiple actors in health care settings, including patients, visitors, colleagues, and others.

Approach

Vot-ER, a nonpartisan, nonprofit organization that aims to promote civic engagement in health care settings, launched the inaugural Healthy Democracy Campaign from July 20 to October 9, 2020. As part of this national, gamification-based competition, medical student captains were recruited to lead teams of health care trainees and professionals that helped eligible adults start the voter registration and/or mail-in ballot request process before the November 2020 elections. Post competition, medical student captains were surveyed about their motivations for participating and skills and knowledge gained.

Outcomes

In total, 128 medical student captains at 80 medical schools in 31 states and the District of Columbia formed teams that helped 15,692 adults start the voter registration and/or mail-in ballot request process. Eighty-two (64.1%) captains responded to the post competition survey, representing 56 (70.0%) of the participating schools. The top-ranked motivation for participating in the campaign was the desire to address social and racial inequities (37, 45.1%). Respondents reported gaining skills and knowledge in several aspects of civic engagement, including community organizing (67, 81.7%) and voting rights (63, 76.8%). The majority of respondents planned to incorporate voter registration into their future practice (76, 92.7%).

Next Steps

Future Healthy Democracy Campaigns will aim to continue closing the voting access gap and promote the long-term inclusion of hands-on civic engagement in medical education and practice.
Novel, Low-Cost Intervention to Promote Women’s Advancement in Global Health Research
Authors: Walsh Kathleen F. , Fahme Sasha , Reif Lindsey K. , Mathad Jyoti , Konopasek Lyuba , Downs Jennifer A.
Published: September 2021

Problem

Women comprise 7 out of every 10 health care workers globally yet are significantly underrepresented in leadership positions. The COVID-19 pandemic has exacerbated underlying gender disparities, placing additional burdens on many female global health professionals.

Approach

The authors describe the development of a novel, low-cost pilot program—the Female Global Scholars Program (Weill Cornell Medicine)—established in April 2018 to promote the advancement of female global health research professionals and prepare them for leadership positions in this field. Using a logic model, the program was informed by discussion with peers at scientific symposia, qualitative research examining the barriers women experience in global health, discussions with experts in the fields of global health and medical education, and a literature review of other initiatives focused on fostering female advancement. The program provides opportunities to learn leadership skills and peer mentoring to female junior investigators in global health research over the course of 2 years through attendance of a symposium and skill-building workshop, skill-building webinars, and the building of a peer mentor group.

Outcomes

The inaugural cohort of the Female Global Scholars Program (April 2018–March 2020) included 10 female global health researchers from 6 countries (Haiti, India, Kenya, Tanzania, Uganda, and the United States) across 3 continents. By the end of year 1, 6 participants received academic promotions. Additionally, the inaugural 10 scholars collectively presented at 11 international conferences and submitted 22 abstracts and 19 manuscripts.

Next Steps

The authors hope to provide additional support and guidance to scholars as they become leaders of their own versions of this program at their home sites and plan to expand the faculty group to further lessen the time burden, while enabling the program to provide additional research mentorship to scholars.
Integrating genetic and social factors to understand health disparities in lupus
Authors: Ramos Paula S.
Published: September 2021

Purpose of review

Both social and genetic factors are associated with health outcomes in systemic lupus erythematosus (SLE), thus playing a role in its health disparities. Despite the growing list of social and genetic factors associated with SLE outcomes, studies integrating sociocultural and individual determinants of health to understand health disparities in SLE are lacking. We review the contributions of different social and genetic factors to the disparities in SLE, and propose a socioecological model to integrate and examine the complex interactions between individual and social factors in SLE outcomes.

Recent findings

Multiple studies collecting comprehensive social data and biospecimens from diverse populations are underway, which will contribute to the elucidation of the interplay and underlying mechanisms by which positive and negative social determinants of health influence epigenomic variation, and how the resulting biological changes may contribute to the lupus health disparities.

There is growing awareness of the need to integrate genomic and health disparities research to understand how social exposures affect disease outcomes. Understanding the contributions of these factors to the SLE health disparity will inform the development of interventions to eliminate risk exposures and close the health disparity gap.
Nitinol Compression Screws in Foot and Ankle Surgery
Authors: Ellington John K. , Lewis John S. , Barcel David A. , Vier David D. , Kaiser Phil
Published: September 2021

Fracture fixation and joint arthrodesis are among the most common procedures in foot and ankle surgery. Successful outcomes rely on union between bony interfaces. With a thin and relatively delicate soft tissue envelope, the foot and ankle require implants and techniques that generate compression to achieve bony union while respecting local soft tissue anatomy. Recently, orthopedic implants comprised of nitinol metal have been demonstrated to have a unique advantage in achieving compression through the alloy’s unique inherent properties of shape memory and super elasticity. Nitinol implants offer the surgeon a tool to apply dynamic compression in fracture fixation and joint arthrodesis that adapts and persists after the patient leaves the operating room. Here we discuss the indications and use of a novel nitinol screw in foot and ankle surgery.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Evaluating Characteristics Associated with Success with Tube Weaning After Intensive Multidisciplinary Intervention
Authors: Sharp William G. , Volkert Valerie M. , Raol Nikhila
Published: September 2021

Objective:

Evidence suggests intensive multidisciplinary intervention holds benefit for children with feeding tube dependence complicated by comorbid medical, behavioral, and/or developmental conditions; however, much remains unknown regarding factors affecting a patient achieving full oral feeding after intervention.

Methods:

This retrospective review involved consecutive patients (birth to age 21 years) admitted to an intensive multidisciplinary intervention program over a 5-year period (June 2014–2019) for feeding tube dependence and food refusal. This study compared the clinical presentation and treatment outcomes for patients who successfully transitioned to full oral feeding versus patients experiencing a partial wean at the last follow-up.

Results:

Eighty-one patients completed intervention and provided outcome data (46 male patients and 35 female patients; age range 10–230 mo). Fifty-eight patients (72%) weaned from tube feeding at the last follow-up; 23 patients (28%) experienced a partial wean. The full wean group experienced greater progress by discharge (e.g., oral intake and goals achieved) and participated in longer follow-up compared with the partial wean group. Clinical characteristics associated with lack of full wean included a history of congenital heart disease requiring surgery and a history of developmental disabilities.

Conclusion:

Improving response to intensive multidisciplinary intervention likely necessitates the development of treatment adjuncts for patients whose medical and/or developmental conditions complicate wean from tube feeding, tailoring treatment for at-risk populations. Future iterations of this model of care should also adjust the quantity and/or quality of follow-up support for patients who discharge from intervention below certain clinical benchmarks.
Healthcare provider knowledge, attitudes, and preferences in management of genitourinary syndrome of menopause in the Mid-South
Authors: Morris Joshua , Clark Cassidy , Reed Laura , Pace Diane , Cao Xueyuan , Khanna Pallavi
Published: September 2021

Objective:

This study explored the clinical management practices of healthcare providers who treat menopausal women in an urban Mid-South area. The study specifically examined their knowledge of prescribing and counseling related to the care of women who present with complaints or clinical findings of genitourinary syndrome of menopause.

Methods:

An electronic questionnaire was distributed to healthcare providers involved in the care of women undergoing menopausal transition spanning a variety of medical specialties. The questionnaire was distributed to academic program directors, coordinators, and ListServ administrators to forward to targeted respondents. Items included demographic questions, clinical knowledge, management practices, and preferences. Statistical analysis for associations between demographics was performed using Chi-squared tests and between age groups with Kruskal Wallis tests.

Results:

The final sample contained 106 healthcare providers. Respondents were demographically diverse and encompassed multiple levels of professional training including Attendings, Trainees (Residents and Fellows), as well as Advanced Practice Registered Nurses. Significant differences were noted in many areas examined in our questionnaire, comprising knowledge, management, counseling, and prescribing practices surrounding the treatment of genitourinary syndrome of menopause when accounting for training level, specialty, and years in practice. Among all respondents, 10.4% reported rarely or never discussing menopausal symptoms with their patients. Most respondents (76.4%) stated they had prescribed topical therapies for genitourinary syndrome of menopause, with over 90% of practitioners prescribing lubricants/moisturizers and estradiol cream; however, only 55% reported being familiar with the US Food and Drug Administration's boxed warning on low-dose vaginal estrogen. Nearly half of the respondents (49%) reported being uncomfortable counseling about the boxed warning on low-dose vaginal estrogen.

Conclusion:

This study identifies gaps in Mid-South healthcare providers’ awareness of the boxed warning on low-dose vaginal estrogen as well as their comfort level in providing counseling regarding the risks, benefits, and alternatives to vaginal estrogen. Integrated practice between physicians and Advanced Practice Registered Nurses can lead to a significant benefit to patients experiencing menopause as shared experience and knowledge are shared between each group. Our survey does reveal gaps in knowledge and practice for optimal outcomes for patients experiencing genitourinary syndrome of menopause. These results will be useful in providing continuing education to providers and more effective communication, evaluation, and treatment to patients.
Prevalence and risk factors for menopausal symptoms in middle-aged Chinese women: a community-based cross-sectional study
Authors: Wang Xueyin , Wang Linhong , Di Jiangli , Zhang Xiaosong , Zhao Gengli
Published: September 2021

Objectives:

To examine the prevalence and risk factors of menopausal symptoms in middle-aged Chinese women.

Methods:

A cross-sectional, community-based study recruited 6,745 women aged 40 to 55 years in the eastern, central, and western regions of China during 2018. Menopausal status was categorized into reproductive stage (defined as regular menstruation or subtle changes in menstrual cycle characteristics), menopausal transition (the beginning of a persistent difference of 7 d in the length of consecutive cycles, or the last menstruation having occurred no more than 12 mo), or postmenpause (the end of the 12 mo period of amenorrhea) according to the Stages of Reproductive Aging Workshop classification. Menopausal symptoms were determined by the modified Kupperman Menopausal Index (KMI) questionnaire and considered nonmenopausal symptoms (total KMI score<15) and menopausal symptoms (total KMI score≥15). Demographic, lifestyle, physical, and menopausal characteristics were collected by face-to-face interviews. Logistic regression models were used to identify factors associated with the risk of menopausal symptoms.

Results:

Among all participants, the mean age was 46.9 years, and 15.7% (1,001/6,364) of participants reported experiencing menopausal symptoms. The prevalence of menopausal symptoms was 9.3% (303/3,256), 23.9% (293/1,227), and 21.5% (405/1,881) in the reproductive stage, menopausal transition, and postmenopausal stage, respectively. Overall, the three most prevalent menopausal symptoms were insomnia (44.7%), fatigue (40.4%), and mood swings (37.2%). The multivariable logistic regression model showed that menopausal status, residence, nulliparity, and chronic diseases were associated with the risk of menopausal symptoms (all P < 0.05). Women during menopausal transition (OR = 2.66, 95% CI: 2.21-3.20) or postmenopause (OR = 2.26, 95% CI: 1.82-2.80) had significantly increased risk of menopausal symptoms compared with those in the reproductive stage.

Conclusions:

Menopausal status, residence, nulliparity, and chronic diseases were associated with menopausal symptoms in middle-aged Chinese women.
Mind the gap: primary care physicians and gynecologists’ knowledge about menopause and their attitudes to hormone therapy use in Jamaica
Authors: Harrison Giselle M. , Medley Natalie N. , Carroll Kamali N. , Simms-Stewart Donnette A. , Wynter Shaun H. , Fletcher Horace M. , Rattray Carole A.
Published: September 2021

Objectives:

The study objective was to evaluate physicians’ knowledge, attitude, and practices toward menopause and hormone therapy.

Methods:

This study was a cross-sectional study using a stratified sample of physicians across the four health regions in Jamaica, between September and October 2017. A total of 145 physicians (75% response rate) completed a questionnaire to assess knowledge and attitudes toward menopause and prescribing hormonal therapy. Univariate and bivariate analyses were used to describe and compare the knowledge, attitudes, and practices in participants.

Results:

The majority of physicians (66%) self-reported a moderate level of knowledge of menopausal treatment options. Self-reported knowledge was associated with years in practice (P < 0.0001) and level of experience (P < 0.0001). Those who identified as having good and moderate knowledge were likely to discuss treatment options with patients (P < 0.005), while physicians with good knowledge were more likely to prescribe hormone therapy (P < 0.05). Correct responses regarding common menopause symptoms were noted in >60% physicians; however, there was a precipitous fall in correct responses regarding findings related to the Women's Health Initiative (<45%). More consultant grade physicians were confident and less confused about prescribing hormone therapy (P < 0.05) compared to junior grade physicians. When stratified by level of experience, knowledge level was the factor that discouraged physicians from seeing symptomatic menopausal patients (P < 0.05).

Conclusions:

This study highlights the gaps in knowledge and practices and a need for carefully designed curricula to provide individualized, risk-mitigated training in menopause healthcare.

Video Summary:

http://links.lww.com/MENO/A814.
Conjunctival Autofluorescence and Cytological Changes in Pterygium
Authors: S Pai Sangeetha Vijayam , Kishore Alisha , Sen Seema , Sharma Namrata , Tandon Radhika
Published: September 2021

Purpose:

The purpose of this study was to evaluate the presence and pattern of autofluorescence and its related cytological changes in pterygium.

Methods:

Eighty-six patients with unilateral pterygium and 76 controls were recruited. We graded pterygium, looked for autofluorescence, performed cytology of the nasal conjunctiva, repeated evaluation after 6 months, compared findings with controls, and assessed the progression of pterygium from photographs with the help of ImageJ software.

Results:

Autofluorescence was present in 51% of cases with pterygium. Autofluorescence at the leading edge (65.9%) was the predominant pattern seen. In total, 83.3% of grade 3 pterygia, 64.7% of grade 2 pterygia, and 28.9% of grade 1 pterygia (P value <0.0005) had autofluorescence. Impression cytology showed conjunctival epithelial cells in 60% of cases, significant squamous metaplasia in grade 3 pterygia (45%) compared with grade 2 pterygia (11.8%), and normal conjunctival epithelial cells in grade 1 pterygia (P value < 0.0005).

Conclusions:

The presence and pattern of conjunctival autofluorescence and cytological changes, especially squamous metaplasia, are linked to the severity or grade of pterygium.
Summary of the 2020 focused updates to U.S. asthma management guidelines: What has changed and what hasn't?
Authors: Mammen Jennifer R. , McGovern Colleen M.
Published: September 2021

Despite the availability of effective medications, the majority of pediatric and adult patients with persistent asthma have uncontrolled symptoms. This has been attributed to patient nonadherence and poor self-management, but clinicians also contribute through inaccurate assessment of asthma and lack of familiarity with best practice guidelines for medication management. Thus, improving patient outcomes will require improving clinical management by health care providers, including utilization of evidence-based practice guidelines. In this report, we briefly summarize key points of the national guidelines for asthma management and delineate important changes enacted by 2020 Expert Panel Report-4 updates. These include revised recommendations on the use of fractional exhaled nitric oxide testing, indoor allergen mitigation, bronchial thermoplasty, adjunctive immunotherapy, and important modifications to medication management that are likely to have widespread impact on prescribing throughout the United States. In particular, for all patients aged five years and older taking stepwise therapy levels 3–4, it is now recommended to use Single Maintenance and Reliever Therapy, whereas the use of intermittent inhaled corticosteroids (ICSs) administered at the same time as short-acting beta agonist is recommended for step 2 to reduce symptom burden, improve control, and minimize total ICS dose.
Leading the Development of a Network-Wide Professional Practice Model
Authors: Mislan Tim , Johnson Kari , Keitel Sheila
Published: September 2021

The health care settings of today are rapidly evolving in form and function, challenging nurse executives to adopt, adapt, and develop new ways to lead and find professional fulfillment in their roles. The organizational design of many health care settings has changed from a functional to a matrix structure to facilitate more effective and efficient operations. While the structures and reporting relationship of contemporary nurse executives may have changed significantly, the primary responsibility of championing the advancement of the profession of nursing remains essential. The mastery of change management methods is critical for the nurse executive to successfully lead in today's dynamic health care settings. A well-developed and actualized nursing professional practice model is a foundational tool for the nurse executive to employ to advance the profession of nursing in any health care setting or structure. This article describes how a nurse executive used change management methods and principles to lead the development of a new network-wide unifying nursing professional practice model in a highly matrixed health care setting.
Associations Between Fatigue, Sleep Disturbance, Physical Activity, and Quality of Life for Children With Cancer
Authors: Wu Wei-Wen , Tang Chia-Chun , Jou Shiann-Tarng , Yu Tsung-Hsien
Published: September 2021

Background

Fatigue, sleep disturbance, and physical inactivity have been increasingly recognized as health issues that negatively affect quality of life (QoL) for children with cancer. Existing studies focus either on children receiving treatment or in survivorship, but not on both populations in a study. This causes difficulty in examining differences of these issues between treatment statuses and identifying associations of these issues with QoL.

Objective

The aims of this study were to examine differences in fatigue, sleep disturbance, physical activity, and QoL between on- and off-treatment children and to identify their associations with QoL.

Methods

The correlational study was conducted with 100 children with cancer 7 to 12 years old. Descriptive, bivariate, and multivariate regression analyses were used.

Results

Participants undergoing treatment had higher degrees of fatigue (P = .002), physical inactivity (P = .004), and QoL distress (P = .001) than those in survivorship. Mean sums (SDs) of sleep disturbance were 47.15 (8.23) and 48.48 (7.13) in the on- and off-treatment groups. Age (P = .000), sex (P = .023), fatigue (P = .000), and sleep disturbance (P = .004) were significantly associated with QoL distress.

Conclusions

This study is unique in that a frame of reference is addressed to gain insight into the distinct developmental issues of school-aged children undergoing cancer treatment and in survivorship. More studies are needed.

Implications for Practice

Interventions to increase QoL should target children who are younger, male, and have higher levels of fatigue and sleep disturbance. Diagnosis and treatment of sleep disturbance should be considered as part of routine activities.
Psychiatry in the Time of COVID: Credibility, Uncertainty, and Self-Reflection
Authors: Adler David A. , Erlich Matthew D. , Goldman Beth , Berlant Jeffrey , Edwards Matthew L. , First Michael B. , Oslin David W. , Siris Samuel G. , Talley Rachel M. , Wagner Elizabeth S. ,   Psychopathology Committee of the Group for Advancement of Psychiatry
Published: September 2021

Public trust in the credibility of medicine and physicians has been severely tested amid the COVID-19 pandemic and growing sociopolitical fissures in the United States. Physicians are being asked to be ambassadors to the public of scientific information. Psychiatrists have an opportunity to help the public understand and accept a “new normal” during a time of such uncertainty. Using a case example, we review the impact of uncertainty and fear on scientific and medical credibility. Although the pandemic provides an opportunity for systemic change, the consequences of any change remain unknown. To help patients navigate the uncertainty, we conclude by offering four guidelines to clinicians: the public has little interest in understanding the scientific method; we need to acknowledge that we do not have all the answers; credibility and trustworthiness are linked to our ability to be trusted, believable messengers; and we can retain scientific credibility while acknowledging uncertainty.
The Significance of Flat/Invisible Dysplasia and Nonconventional Dysplastic Subtypes in Inflammatory Bowel Disease: A Review of Their Morphologic, Clinicopathologic, and Molecular Characteristics
Authors: Choi Won-Tak , Kővári Bence P. , Lauwers Gregory Y.
Published: September 2021

Patients with inflammatory bowel disease are at significantly increased risk of dysplasia and colorectal cancer (CRC). The early detection, histologic grading, and removal of dysplasia plays a critical role in preventing the development of CRC. With advances in endoscopic visualization and resection techniques, colectomy is no longer recommended to manage dysplasia, unless surveillance colonoscopy detects flat/invisible dysplasia (either high-grade dysplasia or multifocal low-grade dysplasia) or an endoscopically unresectable lesion. Although there are numerous review articles and book chapters on the morphologic criteria of conventional (intestinal type) dysplasia, the most well-recognized form of dysplasia, at least 7 distinct nonconventional morphologic patterns of epithelial dysplasia have been recently described in inflammatory bowel disease. Most practicing pathologists are not familiar with these nonconventional subtypes and thus, may even overlook some of these dysplastic lesions as benign or reactive. However, the recognition of these subtypes is important, as some of them appear to have a high risk of developing advanced neoplasia (high-grade dysplasia or CRC) and often show molecular alterations characteristic of advanced neoplasia. This review briefly describes the morphologic criteria of conventional dysplasia but predominantly focuses on all 7 nonconventional subtypes as well as our understanding of their clinicopathologic and molecular features that can assist in their risk stratification.
Predicting Alcohol Use From Genome-Wide Polygenic Scores, Environmental Factors, and Their Interactions in Young Adulthood
Authors: Kandaswamy Radhika , Allegrini Andrea , Nancarrow Alexandra F. , Cave Sophie Nicole , Plomin Robert , von Stumm Sophie
Published: September 2021

Objective

Alcohol use during emerging adulthood is associated with adverse life outcomes, but its risk factors are not well known. Here, we predicted alcohol use in 3153 young adults aged 22 years from a) genome-wide polygenic scores (GPS) based on genome-wide association studies for the target phenotypes number of drinks per week and Alcohol Use Disorders Identification Test scores, b) 30 environmental factors, and c) their interactions (i.e., G × E effects).

Methods

Data were collected from 1994 to 2018 as a part of the UK Twins Early Development Study.

Results

GPS accounted for up to 1.9% of the variance in alcohol use (i.e., Alcohol Use Disorders Identification Test score), whereas the 30 measures of environmental factors together accounted for 21.1%. The 30 GPS by environment interactions did not explain any additional variance, and none of the interaction terms exceeded the significance threshold after correcting for multiple testing.

Conclusions

GPS and some environmental factors significantly predicted alcohol use in young adulthood, but we observed no GPS by environment interactions in our study.
Validity of measures for life space mobility and physical activity in older adults with lower-limb amputation
Authors: Esfandiari Elham , Miller William C , Tao Gordon , Imam Bita , Misaghi Ehsan , Lindstrom Heather , Payne Michael W.C.
Published: September 2021

Background:

Older adults with lower-limb amputations (LLAs) often experience lack of confidence and poor balance, which limits their mobility. There are few validated measures for assessing these outcomes in the LLA population.

Objectives:

To assess the validity of the Life Space Assessment (LSA) and the Physical Activity Scale for the Elderly (PASE) for older adults with LLA.

Study design:

Secondary analyses of cross-sectional data.

Methods:

Sixty-eight older adults with LLA across Canada were recruited to complete the LSA and the PASE. Validity was assessed via correlations with the Activities-specific Balance Confidence (ABC), Four-Square Step Test (FSST), and Two-Minute Walk Test (2-MWT).

Results:

As hypothesized, the LSA was positively correlated with the ABC (ρ= 0.36, 95% confidence interval [CI] [0.17, 0.62]) and 2-MWT (r = 0.49, 95% CI [0.27, 0.70]) and negatively correlated with FSST (ρ= −0.39, 95% CI [−0.56, −0.10]). The PASE was positively correlated with the ABC (ρ= 0.34, 95% CI [0.10, 0.56]) and 2-MWT (ρ= 0.32, 95% CI [0.05, 0.52]), and negatively correlated with FSST (ρ= −0.36, 95% CI [−0.53, −0.07]).

Conclusions:

The LSA has validity in measuring life space mobility. The PASE captures the physical activity with weaker support of validity in older adults with LLA.

Clinical relevance:

The LSA and PASE are quick low-cost tools for clinicians to assess mobility-related functional health and physical activity, respectively, in older adults with LLA. However, the PASE may contain activities that are not common among older adults with LLA.
Upper limb prosthesis users: A longitudinal cohort study
Authors: Resnik Linda , Borgia Matthew , Cancio Jill , Heckman Jeffrey , Highsmith Jason , Levy Charles , Webster Joseph
Published: September 2021

Background:

No previous studies have followed prosthesis users with upper limb loss or limb deficiency using their own prostheses to assess change over time.

Objectives:

(1) To describe prostheses and terminal device types used at baseline and 1-year follow-up; (2) to examine changes in functional outcomes and device satisfaction over time; and (3) to examine whether changes in outcomes varied across level of amputation and type of prosthesis used.

Study Design:

Multisite, observational time series design with in-person functional performance and self-report data collected at baseline and 1-year follow-up.

Methods:

Baseline and follow-up outcome scores were compared using Wilcoxon signed-rank tests. Analyses were stratified by amputation level, time since amputation, prosthesis type, and change in device type. Published minimal detectable change (MDC) values were used to determine whether detectable change in outcome measures occurred.

Results:

The longitudinal cohort consisted of 64 participants (mean age 64 years, 56% body-powered users). The only significant differences in outcome measures between baseline and follow-up (after adjustment for false discovery) were hours/day of prosthesis use, which increased from 6.0 (4.4) to 7.3 (5.3) hours (P = 0.0022). Differences in prosthesis use intensity remained significant in analyses stratified by amputation level, time since amputation, prosthesis type, and change in device type. Between 14 and 20% of the sample had change in one or more outcome measures that was greater than the known MDC.

Conclusions:

Most participants had stable outcomes over a year's time, whereas 14–20% experienced either improvement or decline in one or more tests indicating the importance of annual follow-up visits.
A Scoping Literature Review of Simulation Training Program Curriculum Standards
Authors: O'Rourke Jenny , Brown Michelle , Elias Mary Ellen , Podolej Gregory S. , Cardell Annemarie , Golden Antoinette , Gurevich-Gal Raya , Roszczynialski Kelly N. , Tayeb Baraa , Wong Nelson
Published: September 2021

Summary Statement

Simulation educator training is well supported in the literature and endorsed by the Society of Simulation in Healthcare as well as the International Nursing Association for Clinical Simulation and Learning. Despite growth of domestic and international training programs, there is a lack of consensus regarding curriculum standards. Our aim was to identify core curricular components of comprehensive simulation training programs. A scoping literature review of all relevant publications from 2000 to 2020 was conducted using a 6-step design. A team of 10 multidisciplinary, international simulation educators independently reviewed all citations with discrepancies resolved by third-person review. Of the initial 320 identified unique publications, a total of 15 articles were included, all published within the last 6 years. Four themes were identified: domains (n = 6), competencies (n = 3), objectives (n = 8), and other characteristics (n = 3). The findings support a greater understanding of the core curricular content across simulation training programs to support standardization.
Unravelling the mystery of female meiotic drive: where we are
Authors: Clark Frances E. , Akera Takashi
Published: September 2021

Female meiotic drive is the phenomenon where a selfish genetic element alters chromosome segregation during female meiosis to segregate to the egg and transmit to the next generation more frequently than Mendelian expectation. While several examples of female meiotic drive have been known for many decades, a molecular understanding of the underlying mechanisms has been elusive. Recent advances in this area in several model species prompts a comparative re-examination of these drive systems. In this review, we compare female meiotic drive of several animal and plant species, highlighting pertinent similarities.
Why cannot long-term cascade be predicted? Exploring temporal dynamics in information diffusion processes
Authors: Cao Ren-Meng , Liu Xiao Fan , Xu Xiao-Ke
Published: September 2021

Predicting information cascade plays a crucial role in various applications such as advertising campaigns, emergency management and infodemic controlling. However, predicting the scale of an information cascade in the long-term could be difficult. In this study, we take Weibo, a Twitter-like online social platform, as an example, exhaustively extract predictive features from the data, and use a conventional machine learning algorithm to predict the information cascade scales. Specifically, we compare the predictive power (and the loss of it) of different categories of features in short-term and long-term prediction tasks. Among the features that describe the user following network, retweeting network, tweet content and early diffusion dynamics, we find that early diffusion dynamics are the most predictive ones in short-term prediction tasks but lose most of their predictive power in long-term tasks. In-depth analyses reveal two possible causes of such failure: the bursty nature of information diffusion and feature temporal drift over time. Our findings further enhance the comprehension of the information diffusion process and may assist in the control of such a process.
Assessing urinary odours across the oestrous cycle in a mouse model using portable and benchtop gas chromatography-mass spectrometry
Authors: Tang Jia , Poirier Alice C. , Duytschaever Gwen , Moreira Laís A. A. , Nevo Omer , Melin Amanda D.
Published: September 2021

For female mammals, communicating the timing of ovulation is essential for reproduction. Olfactory communication via volatile organic compounds (VOCs) can play a key role. We investigated urinary VOCs across the oestrous cycle using laboratory mice. We assessed the oestrous stage through daily vaginal cytology and analysed urinary VOCs using headspace gas chromatography-mass spectrometry (GC-MS), testing a portable GC-MS against a benchtop system. We detected 65 VOCs from 40 samples stored in VOC traps and analysed on a benchtop GC-MS, and 15 VOCs from 90 samples extracted by solid-phase microextraction (SPME) and analysed on a portable GC-MS. Only three compounds were found in common between the two techniques. Urine collected from the fertile stages of the oestrous cycle had increased quantities of a few notable VOCs compared with urine from non-fertile stages. These VOCs may be indicators of fertility. However, we did not find significant differences in chemical composition among oestrous stages. It is possible that changes in VOC abundance were too small to be detected by our analytical methods. Overall, the use of VOC traps combined with benchtop GC-MS was the more successful of the two methods, yet portable GC-MS systems may still have utility for some
in situ
applications.