bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Magnetic Resonance Imaging Diffusion Restriction of the Optic Disc Head a New Marker for Idiopathic Intracranial Hypertension?
Authors: Nagarajan Elanagan , Digala Lakshmi P. , Sivaraman Manjamalai , Bollu Pradeep C.
Published: December 2019

Background Idiopathic intracranial hypertension (IIH) is a headache syndrome due to raised intracranial pressure of unknown etiology. Before making the diagnosis of IIH, secondary causes of raised intracranial pressure must be ruled out. The radiological features associated with this condition have variable sensitivity and specificity. In this case series, we aim to describe a potential new radiological marker of IIH, that is, diffusion restriction, in the optic disc head and propose that this can be a specific finding in the appropriate clinical picture.

Importance IIH causes vision loss and disabling daily headaches. The diagnosis of this condition is based on history and physical examination findings. Magnetic resonance imaging (MRI) is used to exclude other causes, but specific radiological markers for the diagnosis of IIH are lacking.

Observations Five patients presented with the main complaint of headache, which was associated with blurry vision. All of our patients had a formal neuro-ophthalmological evaluation that confirmed the presence of optic disc edema in both eyes. They also underwent an MRI of the brain that showed diffusion restriction in the optic nerve head in either eye or both eyes. Patients underwent lumbar puncture in the lateral decubitus position, which revealed cerebrospinal fluid opening pressures > 25 cm H2O. They all responded well to standard treatments, with the resolution of symptoms in their follow-up appointments.

Conclusion and Relevance The MRI diffusion restriction in the optic nerve head may be a reliable noninvasive marker for the diagnosis of IIH in the appropriate clinical picture.
Stochastic many-body perturbation theory for electron correlation energies
Authors: Li Zhendong
Published: December 2019

Treating electron correlation more accurately and efficiently is at the heart of the development of electronic structure methods. In the present work, we explore the use of stochastic approaches to evaluate high-order electron correlation energies, whose conventional computational scaling is unpleasantly steep, being O(Nn+3) with respect to the system size N and the perturbation order n for the Møller-Plesset (MP) series. To this end, starting from Goldstone’s time-dependent formulation of ab initio many-body perturbation theory (MBPT), we present a reformulation of MBPT, which naturally leads to a Monte Carlo scheme with O(nN2 + n2N + f(n)) scaling at each step, where f(n) is a function of n depending on the specific numerical scheme. Proof-of-concept calculations demonstrate that the proposed quantum Monte Carlo algorithm successfully extends the previous Monte Carlo approaches for MP2 and MP3 to higher orders by overcoming the factorial scaling problem. For the first time, Goldstone’s time-dependent formulation is made useful numerically for electron correlation energies, not only being purely as a theoretical tool.
Packing fraction related distortion of Mn6C octahedra and its effect on the first order magnetic transition in Mn based antiperovskites
Authors: Mungale Aishwarya , Priolkar K. R.
Published: December 2019

In this paper, we attempt to understand the cause of magnetostructural transformation in Mn-based antiperovskites by calculating extended x-ray absorption fine structure at the K edges of constituent metal atoms in three antiperovskite compounds, Mn3GaC, Mn3SnC, and Mn3InC. These three compounds have very different magnetic ground states despite the similar cubic structure. Our calculations show that the distortions of Mn6C octahedra, which are responsible for the first-order magnetic transition to the antiferromagnetic state, depend on the packing fraction of the lattice.
Laser-induced dynamics of molecules with strong nuclear quadrupole coupling
Authors: Yachmenev Andrey , Thesing Linda V. , Küpper Jochen
Published: December 2019

We present a general variational approach for computing the laser-induced rovibrational dynamics of molecules, taking into account the hyperfine effects of the nuclear quadrupole coupling. The method combines the general variational approach TROVE (Theoretical Ro-Vibrational Energies), which provides accurate rovibrational hyperfine energies and wavefunctions for arbitrary molecules, with the variational method RichMol, designed for generalized simulations of the rovibrational dynamics in the presence of external electric fields. We investigate the effect of the nuclear quadrupole coupling on the short-pulse laser alignment of a prototypical molecule CFClBrI, which contains nuclei with large quadrupole constants. The influence of the nuclear quadrupole interactions on the postpulse molecular dynamics is negligible at early times, for the first several revivals; however, at longer time scales, the effect is entirely detrimental and strongly depends on the laser intensity. This effect can be explained by dephasing in the laser-excited rotational wavepacket due to irregular spacings between the hyperfine-split nuclear spin states across different rotational hyperfine bands.
Flow-induced shift of the Donnan equilibrium for ultra-sensitive mass transport measurement through a single nanochannel
Authors: Gravelle Simon , Ybert Christophe
Published: December 2019

Despite mass flow being arguably the most elementary transport associated with nanofluidics, its measurement still constitutes a significant bottleneck for the development of this promising field. Here, we investigate how a liquid flow perturbs the ubiquitous enrichment—or depletion—of a solute inside a single nanochannel. Using fluorescence correlation spectroscopy to access the local solute concentration, we demonstrate that the initial enrichment—the so-called Donnan equilibrium—is depleted under flow, thus revealing the underlying mass transport. Combining theoretical and numerical calculations beyond the classical 1D treatment of nanochannels, we rationalize quantitatively our observations and demonstrate unprecedented flow rate sensitivity. Because the present mass transport investigations are based on generic effects, we believe that they can develop into a versatile approach for nanofluidics.
Sampling general distributions with quasi-regular grids: Application to the vibrational spectra calculations
Authors: Flynn Shane W. , Mandelshtam Vladimir A.
Published: December 2019

We introduce a new method for sampling a general multidimensional distribution function Px using a quasiregular grid (QRG) of points xi (i = 1, …, N). This grid is constructed by minimizing a pairwise functional, ∑u(xi, xj) → min, with the short-range pair pseudopotential u(xi, xj), defined locally according to the underlying distribution P(x). While QRGs can be useful in many diverse areas of science, in this paper, we apply them to construct Gaussian basis sets in the context of solving the vibrational Schrödinger equation. Using some 2D and 3D model systems, we demonstrate that the resulting optimized Gaussian basis sets have properties superior to other choices explored previously in the literature.
Clinical performance of artery stents is improved with grafting technique
Authors: Mandel Savannah
Published: December 2019

By developing a new way to directly graft peptides to stents, scientists aim to improve treatment for narrowed arteries in the heart, vessels and brain.
Updated method considers system’s structure when calculating entropy
Authors: Bandari Anashe
Published: December 2019

Calculations of configurational entropy traditionally do not take the symmetries of a system into account, which can have nonnegligible effects on other parameters.
Predicting the formation of ice on aircraft
Authors: Mandel Savannah
Published: December 2019

A 3D model based on unstructured mesh can predict ice formation on complex shaped aircraft.
Dual luminescent organic LEDs with tunable emission characteristics
Authors: Mandel Savannah
Published: December 2019

Using a single active organic component, zinc-phthalocyanine, scientists demonstrate tuning of a dual luminescent thin film and organic light-emitting diode.
Cystic fibrosis carriers are at increased risk for a wide range of cystic fibrosis-related conditions
Authors: Miller Aaron C. , Comellas Alejandro P. , Hornick Douglas B. , Stoltz David A. , Cavanaugh Joseph E. , Gerke Alicia K. , Welsh Michael J. , Zabner Joseph , Polgreen Philip M.
Published: December 2019

Autosomal recessive diseases, such as cystic fibrosis (CF), require inheritance of 2 mutated genes. However, some studies indicate that CF carriers are at increased risk for some conditions associated with CF. These investigations focused on single conditions and included small numbers of subjects. Our goal was to determine whether CF carriers are at increased risk for a range of CF-related conditions. Using the Truven Health MarketScan Commercial Claims database (2001–2017), we performed a population-based retrospective matched-cohort study. We identified 19,802 CF carriers and matched each carrier with 5 controls. The prevalence of 59 CF-related diagnostic conditions was evaluated in each cohort. Odds ratios for each condition were computed for CF carriers relative to controls. All 59 CF-related conditions were more prevalent among carriers compared with controls, with significantly increased risk (
P
< 0.05) for 57 conditions. Risk was increased for some conditions previously linked to CF carriers (e.g., pancreatitis, male infertility, bronchiectasis), as well as some conditions not previously reported (e.g., diabetes, constipation, cholelithiasis, short stature, failure to thrive). We compared our results with 23,557 subjects with CF, who were also matched with controls; as the relative odds of a given condition increased among subjects with CF, so did the corresponding relative odds for carriers (
P
< 0.001). Although individual-level risk remained low for most conditions, because there are more than 10 million carriers in the US, population-level morbidity attributable to the CF carrier state is likely substantial. Genetic testing may inform prevention, diagnosis, and treatment for a broad range of CF carrier-related conditions.
Single-electron current gain in a quantum dot with three leads
Authors: Welker Armin C , Weis Jürgen
Published: December 2019

The conductance through a quantum dot (QD) between a source and a drain electrode is usually controlled electrostatically by a nearby gate electrode. A periodic modulation of the conductance versus gate voltage is observed, swapping between Coulomb blockade and single-electron tunneling. By controlling the Fermi level of a third (‘base’) lead attached to the QD, we were able to switch a single-electron current from source to drain, exceeding the single-electron current to or from the base lead. A simple model is presented revealing the role of ground- and excited states within the QD for this dynamic operation of a single-electron transistor.
Memristor-based vector neural network architecture*
Authors: Liu Hai-Jun , Chen Chang-Lin , Zhu Xi , Sun Sheng-Yang , Li Qing-Jiang , Li Zhi-Wei
Published: December 2019

Vector neural network (VNN) is one of the most important methods to process interval data. However, the VNN, which contains a great number of multiply-accumulate (MAC) operations, often adopts pure numerical calculation method, and thus is difficult to be miniaturized for the embedded applications. In this paper, we propose a memristor based vector-type backpropagation (MVTBP) architecture which utilizes memristive arrays to accelerate the MAC operations of interval data. Owing to the unique brain-like synaptic characteristics of memristive devices, e.g., small size, low power consumption, and high integration density, the proposed architecture can be implemented with low area and power consumption cost and easily applied to embedded systems. The simulation results indicate that the proposed architecture has better identification performance and noise tolerance. When the device precision is 6 bits and the error deviation level (EDL) is 20%, the proposed architecture can achieve an identification rate, which is about 92% higher than that for interval-value testing sample and 81% higher than that for scalar-value testing sample.
Growth and doping of bulk GaN by hydride vapor phase epitaxy*
Authors: Zhang Yu-Min , Wang Jian-Feng , Cai De-Min , Ren Guo-Qiang , Xu Yu , Wang Ming-Yue , Hu Xiao-Jian , Xu Ke
Published: December 2019

Doping is essential in the growth of bulk GaN substrates, which could help control the electrical properties to meet the requirements of various types of GaN-based devices. The progresses in the growth of undoped, Si-doped, Ge-doped, Fe-doped, and highly pure GaN by hydride vapor phase epitaxy (HVPE) are reviewed in this article. The growth technology and precursors of each type of doping are introduced. Besides, the influence of doping on the optical and electrical properties of GaN are presented in detail. Furthermore, the problems caused by doping, as well as the methods to solve them are also discussed. At last, highly pure GaN is briefly introduced, which points out a new way to realize high-purity semi-insulating (HPSI) GaN.
Noise-induced resistive switching in a memristor based on ZrO2(Y)/Ta2O5 stack
Authors: Filatov D O , Vrzheshch D V , Tabakov O V , Novikov A S , Belov A I , Antonov I N , Sharkov V V , Koryazhkina M N , Mikhaylov A N , Gorshkov O N , Dubkov A A , Carollo A , Spagnolo B
Published: December 2019

Resistive switching (RS) is studied in a memristor based on a ZrO2(Y)/Ta2O5 stack under a white Gaussian noise voltage signal. We have found that the memristor switches between the low resistance state and the high resistance state in a random telegraphic signal (RTS) mode. The effective potential profile of the memristor shows from two to three local minima and depends on the input noise parameters and the memristor operation. These observations indicate the multiplicative character of the noise on the dynamical behavior of the memristor, that is the noise perceived by the memristor depends on the state of the system and its electrical properties are influenced by the noise signal. The detected effects manifest the fundamental intrinsic properties of the memristor as a multistable nonlinear system.
The role of Egyptian State Awards in changing researchers’ performance in the science and technology sector
Authors: Ibrahim Bahaa
Published: December 2019

Egyptians generally pay attention to the State Awards as the most prestigious awards that Egyptian researchers can receive, including the Nile Award, the State Appreciation Award, the State Award of Excellence, and the State Encouragement Award. The current study is an attempt to investigate the role of national awards in the scientific research system, in order to identify the characteristics of Egyptian State Award laureates in science and technology during 2012–5, to determine their international literature, and to explore the implications of receiving a national award using bibliometric indicators. Scopus database was used to extract data, and the statistical software package SPSS was used to analyze. The study sample was 212 laureates, in addition to the control group of 184 researchers who closely matches the academic profiles of the laureates. The performance of the laureates and the control group was compared before and after the award by using four bibliometric indicators and the Wilcoxon matched-pairs signed-ranks test. The laureates produced 13,598 publications from 1958 to 2018. Most of the laureates’ literature (94.35%) were published with coauthors. The Egyptian State Award laureates often collaborate with their Saudi Arabian and American colleagues, more than others. The average values of publications, citations, and citations per publication have increased after receipt of the award, unlike the h-index. Results indicated that receiving the State Award has a negative impact on the laureates’ performance.
Bariatric surgery and type 2 diabetes
Authors: Stewart Jennifer , Allen Sarah , Weidman-Evans Emily
Published: December 2019

Type 2 diabetes is primarily managed with lifestyle modifications, self-monitoring of blood glucose, and medication. The goal is to maintain A1C less than 7% in most patients and prevent damage to other organs such as the kidneys and heart. Patients who are obese and cannot achieve normal blood glucose levels despite diet, exercise, and multiple medications may be considered for bariatric surgery. The Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy have been shown to improve A1C, reduce weight, and reduce the number of medications patients need for diabetes management. Comorbidities such as hyperlipidemia and hypertension also may improve. This article describes types of bariatric surgery, proper selection of surgical candidates, patient education, and the postoperative patient management necessary for long-term success in improving blood glucose control.
Helping survivors of sexual assault
Authors: Thompson Katherine M.
Published: December 2019

Sexual assault is a widespread problem in US communities, affecting about one in every three women and one in every eight men. These assaults reverberate through the lives of survivors and their loved ones, often for decades or even a lifetime. Healthcare providers must be empowered and equipped to contribute to the medical and mental health of survivors. This article provides a framework for that knowledge and empowerment.
What We Have to Lose: Prevention vs. Intervention in Obstetric Care
Authors: Carraher Jennifer
Published: December 2019

Concerns about medicalization can have unintended consequences for those most at risk.
The Top Health Care Stories of 2019: A Sense of Urgency Heading into an Election Year
Authors: Molyneux Jacob
Published: December 2019

Negative trends intensify for key measures of population health and access to care.
Using Aquablation to Treat Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia
Authors: Kennedy Catriona , Paterson Catherine
Published: December 2019

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library. For more information, see https://nursing.cochrane.org.
A Patient's Final Freedom
Authors: Istanboulian Laura
Published: December 2019

Despite end-stage COPD, she is able to make a graceful final exit on her own terms.
2019 Visionary Leader Iesha Bethley
Authors: Kelly Leisa , Solomon Sophia
Published: December 2019

The following manuscript is the winning 2019 Richard Hader Visionary Leader Award entry submitted to Nursing Management in recognition of Iesha Bethley, MSN, RN, CMSRN, neurology unit nurse manager at Our Lady of the Lake Regional Medical Center in Baton Rouge, La. Iesha was formally recognized for her achievements before the Keynote Address on October 17 at Congress2019 in New Orleans, La., where she received the award, sponsored by Hackensack Meridian Health.
Supplemental screening in the dense breast: does molecular breast imaging have a role?
Authors: Rhodes Deborah J.
Published: December 2019

With the passage of a 2019 US federal law directing FDA to ensure that mammography facilities provide a summary to patients categorizing their breast density and explaining how it can influence mammography accuracy, providers will increasingly be called on to discuss the options for supplemental screening. Numerous studies have elucidated the extent of masking that occurs with mammography screening in dense breasts when mammography is compared with other supplemental screening modalities. Despite this evidence, there is currently no consensus among experts or imaging societies as to whether or with what supplemental screening should be performed, leaving providers to counsel patients regarding the balance of benefits and harms.
The Impact of Device Innovation on Clinical Outcomes in Expander-based Breast Reconstruction
Authors: Momeni Arash , Li Alexander Y. , Tsai Jacqueline , Wan Derrick , Karin Mardi R. , Wapnir Irene L.
Published: December 2019

Background:

Staged expander-based breast reconstruction represents the most common reconstructive modality in the United States. The introduction of a novel tissue expander with an integrated drain (Sientra AlloX2) holds promise to further improve clinical outcomes.

Methods:

Patients who underwent immediate expander-based pre-pectoral breast reconstruction were identified. Two cohorts were created, that is, patients who underwent placement of a conventional tissue expander [133MX (Allergan)] (Group 1) versus AlloX2 (Sientra) (Group 2). The study endpoint was successful completion of expansion with the objective being to investigate differences in outcome following expander placement.

Results:

Fifty-eight patients underwent 99 breast reconstructions [Group 1: N = 24 (40 breasts) versus Group 2: N = 34 (59 breast)]. No differences were noted for age (P = 0.586), BMI (P = 0.109), history of radiation (P = 0.377), adjuvant radiotherapy (P = 1.00), and overall complication rate (P = 0.141). A significantly longer time to drain removal was noted in Group 1 (P < 0.001). All patients with postoperative infection in Group 1 required surgical treatment versus successful washout of the peri-prosthetic space via the AlloX2 drain port in 3 of 5 patients in Group 2 (P = 0.196). Furthermore, both cases of seroma in Group 1 required image-guided drainage versus in-office drainage via the AlloX2 drain port in 1 patient in Group 2 (P =0.333).

Conclusion:

The unique feature of the AlloX2 provides surgeons easy access to the peri-prosthetic space without altering any of the other characteristics of a tissue expander. This resulted in a reduced time to drain removal and facilitated management of postoperative seroma and infection.
A Comprehensive Review of Medicinal Leeches in Plastic and Reconstructive Surgery
Authors: Hackenberger Paige N. , Janis Jeffrey E.
Published: December 2019

Medicinal leeches are a US Food and Drug Administration-approved treatment for venous congestion in graft tissue to promote healing and can serve as a nonsurgical option for plastic surgery patients with concern for tissue compromise. Although there is a wealth of documentation on medicinal leech therapy, the surgical space currently lacks an updated summary of proper indications, use, and risks as they pertain to plastic surgical patients. The purpose of this article is to provide a platform for understanding the recent literature as it relates to reconstruction to improve understanding of indications and necessary considerations in using hirudotherapy. Topics examined include basics of hirudotherapy, indications in plastic surgery, implementation (leech application, number and duration of therapy, and removal), risks (infection and bleeding), and alternative treatments. The evidence provided will aid in physician understanding and implementation, patient counseling, and the informed consent process.
Rehab MATRIX: Content Validity of a Nursing-Led Patient Assignment Algorithm
Authors: Ifejika Nneka L. , Okpala Munachi N. , Moser Hope A. , Watkins Jeffrey N. , Noser Elizabeth A.
Published: December 2019

Purpose: The provision of conscientious nursing care is at the forefront of health quality. Unfortunately, a lack of standardization in the assignment of patients to nurses can lead to care inequities. Rehab MATRIX is a nursing-led tool that equitably assigns patients using select acuity variables. Design and Methods: In this initial study, we asked focus groups of 19 registered nurses and 8 patient care assistants to identify medical interventions that increase the effort of nursing care at a 24-bed inpatient rehabilitation facility (IRF). This IRF is affiliated with a comprehensive heart and vascular institute, a level I trauma center, and a The Joint Commission (TJC) Comprehensive Stroke Center. Findings: Thirteen acuity variables were included in the Rehab MATRIX patient assignment grid. High-acuity patients with greater than 6 variables were color-coded “red,” medium-acuity patients with 3 to 5 variables were color-coded “yellow,” and low-acuity patients with less than 3 variables were color-coded “green.” Each registered nurse and patient care assistant were assigned an equitable number of red-, yellow-, and green-coded patients per shift. New admissions were Rehab MATRIX color-coded during nursing report and assigned objectively. Conclusions: Nursing staff at a wide-ranging IRF created Rehab MATRIX, an equitable patient assignment tool, representative of nursing effort needed to provide quality care. Clinical Relevance: Nursing-led patient assignment tools increase autonomy and provide the opportunity for all nursing staff to influence healthcare practice. These factors may lead to increased nursing satisfaction and decreased burnout.
The Cue-Response Theory and Nursing Care of the Patient With Acquired Brain Injury
Authors: Olson DaiWai M. , Ortega-Pérez Stefany
Published: December 2019

The cue-response theory is herewith proposed to replace the coma cue-response conceptual framework as a nursing theory for care of patients with acquired brain injury (ABI). After ABI, nurses assess patients and develop an understanding of their condition by interpreting meaning from physiologic and observational or behavioral cues. These interpretations form the basis for optimizing the timing of discrete nursing interventions; the outcome of which influences the trajectory toward recovery or toward secondary brain injury. The cue-response theory applies specifically for nurses’ use to determine which interventions should be used and when those interventions should be carried out. The theory recognizes the knowledge potential and knowledge produced in the context of nursing care of all patients with ABI, not just those with coma, and broadens our understanding of how the timing of nursing interventions directly impacts secondary brain injury and the brain entropy state.
Work Environment and Worksite Health Promotion in Nine European Countries
Authors: van der Put Anne C. , van der Lippe Tanja
Published: December 2019

Objective:

To study to what extent the work environment influences the use of worksite health promotion (WHP).

Methods:

Data came from the European Sustainable Workforce survey, with data from employees and managers in 259 organizations. We analyze use of three types of WHP (healthy menus, sports facilities, and health checks) using multilevel logistic models.

Results:

Employees are more likely to use each type of WHP when a larger share of their direct colleagues do so. Use of healthy menus is more likely among employees who work more hours, have more autonomy, and work in organizations with less work-oriented culture. Autonomy is also associated with more use of sports facilities, while work-oriented culture is negatively related to use of health checks.

Conclusions:

Our results suggest the work environment should be included when studying WHP use.
Early Exchange Transfusion to Treat Neonates With Gestational Alloimmune Liver Disease
Authors: Fischer Hendrik S. , Staufner Christian , Sallmon Hannes , Henning Stephan , Bührer Christoph
Published: December 2019

Objectives:

Exchange transfusion (ET) and intravenous immunoglobulin are potentially life‐saving treatment options in newborns with gestational alloimmune liver disease (GALD). Since 2008, early ET has been the standard of care for symptomatic neonates with suspected GALD in our unit. The present study's aim was to investigate the outcomes of this approach.

Methods:

From 2008 to 2018, all neonates who received ET for suspected GALD were identified, and their clinical course and outcomes were analyzed in a descriptive cohort study. In survivors, liver function parameters before ET and maximum values after ET and at discharge were compared.

Results:

During the 11‐year period, 12 infants received ET for suspected GALD at a median (range) chronological age of 11 (1–23) days and gestational age of 38 (32–40) weeks. Signs of impaired liver function, most frequently postnatal hypoglycemia, hyperferritinemia, direct hyperbilirubinemia, and coagulopathy, were present in all infants. Survival without a liver transplant in the overall cohort was 10 of 12 (83.3%) and 7 of 9 (78%) in those fulfilling the criteria of acute liver failure. Two patients died, one of them after liver transplantation. Direct bilirubin typically increased after ET, even in survivors. All survivors recovered and were discharged from the pediatric hepatology outpatient clinic after 8 (3–11) months of follow‐up.

Conclusions:

In newborns with suspected GALD, a limited diagnostic work‐up followed by early ET may lead to favorable outcomes. More data are required to develop an evidence‐based clinical approach to GALD.
Characterization of Upper Gastrointestinal Motility in Infants With Persistent Distress and Non‐IgE‐mediated Cow's Milk Protein Allergy
Authors: Omari Taher , Tobin Jacinta M. , McCall Lisa , Savage Karina , Ferris Lara , Hammond Paul , Kritas Stamatiki , Quinn Patrick , Abu‐Assi Rammy , Moore David , Davidson Geoffrey , Gold Michael , Heine Ralf G.
Published: December 2019

Background:

Persistent crying in infancy is common and may be associated with gastroesophageal reflux disease (GERD) and/or non‐IgE‐mediated cow's milk protein allergy (CMPA). We aimed to document upper gastrointestinal motility events in infants with CMPA and compare these to findings in infants with functional GERD.

Methods:

Infants aged 2 to 26 weeks with persistent crying, GERD symptoms and possible CMPA were included. Symptoms were recorded by 48‐hour cry‐fuss chart and validated reflux questionnaire (infant GERD questionnaire [IGERDQ]). Infants underwent a blinded milk elimination‐challenge sequence to diagnose CMPA. GERD parameters and mucosal integrity were assessed by 24‐hour pH‐impedance monitoring before and after cow's milk protein (CMP) elimination. 13C‐octanoate breath testing for gastric emptying dynamics, dual‐sugar intestinal permeability, fecal calprotectin, and serum vitamin D were also measured.

Results:

Fifty infants (mean age 13 ± 7 weeks; 27 boys) were enrolled. On the basis of CMP elimination‐challenge outcomes, 14 (28%) were categorized as non‐IgE‐mediated CMPA, and 17 (34%) were not allergic to milk; 12 infants with equivocal findings, and 7 with incomplete data were excluded. There were no baseline differences in GERD parameters between infants with and without CMPA. In the CMPA group, CMP elimination resulted in a significant reduction in reflux symptoms, esophageal acid exposure (reflux index), acid clearance time, and an increase in esophageal mucosal impedance.

Conclusions:

In infants with persistent crying, upper gastrointestinal motility parameters did not reliably differentiate between non‐IgE‐mediated CMPA and functional GERD. In the group with non‐IgE‐mediated CMPA, elimination of CMP significantly improved GERD symptoms, esophageal peristaltic function, and mucosal integrity.
Mental Health Disorders and Psychosocial Distress in Pediatric Celiac Disease
Authors: Coburn Shayna , Rose Meredith , Sady Maegan , Parker Margaret , Suslovic William , Weisbrod Vanessa , Kerzner Benny , Streisand Randi , Kahn Ilana
Published: December 2019

Objectives:

Celiac disease (CeD) has been associated with increased mental health disorders (MHD) and psychosocial distress in children, which may complicate treatment with the gluten‐free diet (GFD). This single‐center cross‐sectional study examined psychological comorbidities in children with CeD to assess psychological needs in CeD care.

Methods:

Participants were 73 parents (95% mothers) of children (ages 3–18) attending a multidisciplinary celiac disease clinic. Parents completed electronic surveys about their child's MHD history, psychological symptoms, and GFD experiences. Rates of MHD were calculated and compared with National Institute of Mental Health population‐level data. Differences in psychosocial symptoms and GFD experiences were examined based on child age, time since CeD diagnosis, and MHD.

Results:

Thirty‐four percentage of children had at least 1 MHD; anxiety disorders (16%, P < 0.001) and attention‐deficit/hyperactivity disorder (ADHD; 16%, P = 0.01) were more common than general population rates. More than 1 quarter of parents reported current child psychosocial distress (28%–39%), and approximately half reported parent stress (51%) and financial burden (46%) associated with the GFD. Parents of children with new CeD diagnoses reported lower confidence in the GFD (P < 0.01) but MHD, stress, and financial burden did not differ by time since CeD diagnosis. Children with MHD had more anxiety, anger, overall distress, and parent distress than those without MHD (Ps < .05).

Conclusions:

Comorbid CeD and MHD was common and was associated with increased child and parent psychosocial distress. Our findings emphasize the importance of psychological screening and services to assess for and treat comorbid MHD and to mitigate psychosocial distress associated with the GFD.
Forced Enlightenment
Authors: Carney Katherine Bernier , Guite Jessica W. , Young Erin E. , Starkweather Angela R.
Published: December 2019

Background

Childhood cancer survivorship can be described as a lifelong experience that requires vigilant follow-up care and continual support. Although there is growing qualitative and quantitative literature on this experience, articles focusing on qualitative synthesis are lacking. Qualitative metasynthesis can further facilitate the knowledge of survivorship experiences to inform care.

Objective

The aim of this qualitative metasynthesis was to investigate the experiences of childhood cancer survivors and develop an integrated understanding of the survivorship experience.

Methods

The method of qualitative meta-ethnography guided this research. Data extracted from the studies were directly compared through reciprocal translation.

Results

A total of 18 qualitative articles met the inclusion criteria. The authors identified 4 key metaphors, including Transcendence, Lingering Shadows, Fortifying Bonds, and Ongoing Acclimation. The metaphors are brought together by 3 essential concepts that drive the survivorship experience: (1) recognition of wisdom gained, (2) acknowledgment of vulnerabilities, and (3) actions taken to manage present and future. Together, these metaphors and essential concepts make up the global theme “Forced Enlightenment.”

Conclusion

This metasynthesis illuminates the complex nature of the childhood cancer survivorship experience, in which survivors work to grow beyond their treatment experience while inevitably being tied to it. Next steps should include further exploration of individual metaphors and validation of forced enlightenment as an experience.

Implications for Practice

Each of the metaphors may be used to guide the development of nursing interventions. Translation to clinical practice should focus on prioritizing coping and adaptation skills during cancer treatment, which can be carried through survivorship.
Association Between Technology Use and Social Integration Among Veterans With Disabilities
Authors: Stacy Meaghan , Lindsey Hayley , Tsai Jack
Published: December 2019

Social connectedness has positive effects on physical and mental health. Many aspects of life, including social networks, are increasingly technology-based, influenced by access to computers. Individuals with psychiatric disabilities may experience unique barriers to computer use. The current study evaluated computer use among 199 veterans in Connecticut and Houston, Texas, with psychiatric and/or physical disabilities, and its association with social integration. Two-thirds had used a computer within the past month, most commonly for information seeking, but also for social interaction. However, computer use and social integration were not significantly associated. The study suggests a greater rate of computer use than anticipated, encouraging given society's increasing reliance on technology. Future research into experience with other modalities is needed, as is research into veterans' willingness and desire to use technology for various purposes.
Commentary on “Synchrony Between Bipolar Mood Cycles and Lunar Tidal Cycles Ended After Initiation of Light Treatment and Treatment of Hypothyroidism”
Authors: KAHN DAVID A.
Published: December 2019

According to a recent report, mood cycles in a group of patients with rapid cycling bipolar disorder oscillated in synchrony with lunar gravimetric tides. Mood switches in a 67-year-old woman with rapid cycling bipolar II disorder on lithium maintenance treatment were assessed with a χ2 periodogram and a χ2 analysis of the mood switches in relation to the lunar tidal cycle. During a period when she was treated with nortriptyline and her thyroid-stimulating hormone levels were elevated, her mood switches had a significant (P<0.05) 29- to 30-day periodicity, and the χ2 analysis showed that the switches were distributed nonrandomly in relation to the spring-neap lunar tidal cycle (P<0.0001); 14 of 15 switches occurred within 2 days of the spring tides. After nortriptyline was discontinued, thyroid-stimulating hormone levels were normalized with treatment with levothyroxine, and consistent bright light treatment was started, the synchrony between mood cycles and lunar cycles disappeared, and rapid cycling eventually stopped. The possibility that lunar mood cycling is sometimes contingent on antidepressant treatment, decreased thyroid function, and certain types of light-dark cycles needs to be considered in future research on lunar tidal influences on the course of bipolar illness.
Motives for Illicit Drug Use Among Individuals With Body Dysmorphic Disorder
Authors: HOUCHINS JOSEPH R. , KELLY MEGAN M. , PHILLIPS KATHARINE A.
Published: December 2019

Drug use disorders (DUDs) are highly prevalent in body dysmorphic disorder (BDD), but motives for illicit drug use in BDD have not yet been explored. This study examined motives for drug use and clinical correlates of drug use motives in a sample of individuals with BDD and lifetime drug use, using the Drug Use Motives Questionnaire and 3 additional body image–specific drug use motives. As predicted, the Drug Use Motives Questionnaire coping motive was positively associated with attempted suicide and a lifetime DUD. All 3 body image–specific motives for drug use were also significantly associated with a lifetime DUD. In addition, they were the only variables that were significantly associated with greater severity of BDD. These results build on previous evidence suggesting that coping motives are related to problematic substance use and suicide attempts in BDD.
Categorizing Cannabis and Alcohol Use Patterns of Emerging Adults in Psychiatric Partial Hospitalization Treatment
Authors: BLEVINS CLAIRE E. , GRIMONE KRISTIN R. , CAVINESS CELESTE M. , STEIN MICHAEL D. , ABRANTES ANA M.
Published: December 2019

Background:

Emerging adulthood is a common and problematic time for alcohol and cannabis use. Emerging adulthood also represents a vulnerable time period for anxiety and depression. Substance use and mental health issues are highly comorbid, yet substance use is commonly neglected in psychiatric care.

Objective:

The goal of this study was to categorize the cannabis and alcohol use patterns of emerging adults in psychiatric care and to evaluate relationships with use-related problems, psychiatric symptomatology, and motives for use.

Methods:

Participants were emerging adults who were consecutive admissions to a young adult psychiatric partial hospital program from 2017 to 2018. Of 318 participants who completed questionnaires, 244 (76.7%) reported cannabis and/or alcohol use in the previous month. Cluster analyses and analysis of variance tests were conducted to categorize and differentiate between participants who reported use.

Results:

Results from cluster analyses identified 4 categories of use: low cannabis/high alcohol (35.7%), low cannabis/low alcohol (17.6%), high cannabis/low alcohol (29.1%), and high cannabis/high alcohol (17.6%). Individuals in categories with the highest rates of use and co-use reported more alcohol problems (F=24.31, P<0.001), cannabis problems (F=36.75, P<0.001), depression (F=3.60, P=0.01), and motives: social (F=6.12, P<0.001), coping with anxiety (F=20.43, P<0.001), coping with depression (F=17.80, P<0.001), enhancement (F=7.85, P<0.001), and conformity (F=4.92, P<0.01).

Conclusions/Importance:

Clear categories of substance use emerged. Participants who were heavier users were more likely to use to alleviate psychiatric symptomatology, yet they also reported greater psychiatric symptomatology and use-related problems. Among a psychiatric sample of emerging adults, cannabis and alcohol use was common and problematic. Thus, substance use should be evaluated for and, if present, targeted with interventions during psychiatric care.
Psychological Function, Iyengar Yoga, and Coherent Breathing: A Randomized Controlled Dosing Study
Authors: SCOTT TAMMY M. , GERBARG PATRICIA L. , SILVERI MARISA M. , NIELSEN GREYLIN H. , OWEN LIZ , NYER MAREN , BROWN RICHARD P. , STREETER CHRIS C.
Published: December 2019

Background:

Evidence suggests that yoga may be an effective treatment for major depressive disorder (MDD). Studies evaluating the “dosing” of yoga treatment and efficacy for MDD are needed. The goal of this study was to assess the effects of an intervention combining Iyengar yoga and coherent breathing in participants with MDD and determine the optimal intervention dose.

Methods:

Thirty-two participants (18 to 65 y of age) diagnosed with MDD were randomized to a high-dose group (HDG) or a low-dose group (LDG) of yoga and coherent breathing for 12 weeks. The HDG (n=15) involved three 90-minute yoga classes and four 30-minute homework sessions per week. The LDG (n=15) involved two 90-minute yoga classes and three 30-minute homework sessions per week. Participants were evaluated at baseline, week 4, week 8, and week 12 with the following instruments: Positivity Self-Test, Spielberger State Anxiety Inventory, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index, and Exercise-induced Feeling Inventory. Data were analyzed using intent-to-treat methods.

Results:

Significant improvements in all outcome measures were found for both groups, with acute and cumulative benefits. Although the HDG showed greater improvements on all scales, between-group differences did not reach significance, possibly due to lack of power because of the small sample size. Cumulative yoga minutes were correlated with improvement in outcome measures.

Limitation:

This dosing study did not include a non-yoga control.

Conclusions:

Improvement in psychological symptoms correlated with cumulative yoga practice. Both interventions reduced symptoms of depression and anxiety and increased feelings of positivity. The time commitment for yoga practice needs to be weighed against benefits when designing yoga interventions.
Prognostic Value of Generalized Polyspike Trains and Prolonged Epileptiform EEG Runs
Authors: Jensen Camilla Dyremose , Gesche Joanna , Krøigård Thomas , Beier Christoph P.
Published: December 2019

Introduction:

A considerable proportion of patients with genetic/idiopathic generalized epilepsy (IGE) suffer from persistent seizures. In this study, it was questioned if generalized polyspike trains (GPT) or prolonged epileptiform EEG runs allow identification of difficult-to-treat patients in a first seizure clinic setting or after recurrent seizures.

Methods:

The first routine outpatient EEGs from untreated patients (later diagnosed with IGE) and routine EEGs from IGE patients with persistent seizures despite medical treatment were analyzed. Seizure outcome and clinical characteristics were retrospectively assessed based on the patients' records.

Results:

In routine EEGs recorded after first seizure in untreated patients (n = 79), the prevalence of GPT (n = 1; 1.3%) and prolonged epileptiform EEG runs (n = 13; 16.5%) was low. At follow-up, 24 patients (30.4%) were not seizure free, and 3 (3.8%) of them developed drug-resistant IGE. None of the interictal discharges studied was associated with long-term seizure outcome. Treated IGE patients with recurrent seizures (n = 69) had a similar prevalence of GPT (n = 3; 4.3%) and prolonged epileptiform EEG runs (n = 7; 10.1%). At follow-up, 42 patients (60.8%) suffered persistent seizures, and 18 (26%) were drug resistant. Generalized polyspike train and prolonged epileptiform EEG runs had a higher prevalence in patients with drug-resistant epilepsy (GPT: 11.1% vs. 2%; P = 0.1; prolonged epileptiform EEG runs: 27.8% vs. 3.9%; P = 0.004) and persistent seizures (GPT: 7.1% vs. 0%; P = 0.16; prolonged epileptiform EEG runs: 16.7% vs. 0%; P = 0.03) as compared with nonresistant patients.

Conclusions:

Generalized polyspike train and prolonged epileptiform EEG runs were associated with persistent seizures and drug-resistant IGE, but the overall prevalence was low. In a first seizure clinic setting, the diagnostic value of these biomarkers was limited.
Pilot assessment of low NK cell-mediated ADCC andFCGR3Agenetics in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Based on inclusion of family members without ME/CFS as controls, low ADCC is unsuitable as a diagnostic biomarker
Authors: Sung Alexander P. , Tang Jennifer J-J , Guglielmo Michael J. , Smith-Gagen Julie , Bateman Lucinda , Redelman Doug D. , Hudig Dorothy
Published: December 2019

ADCC (antibody-dependent cell-mediated cytotoxicity) is dependent on the varying capacity of NK cells to kill, the affinities ofFCGR3A-encoded CD16A receptors for antibody, and the presence of antigen-specific antibodies.In vivoADCC depends on the number of CD16A receptor-positive NK cells in blood. We hypothesized that low ADCC cell function or low effector cell numbers could be biomarkers or risk factors for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We measured NK cell ADCC lytic capacity and antibody recognition, CD16Apositive NK cells/µl blood, andFCGR3Ahomozygosity for the F allele that encodes low affinity CD16A antibody receptors. ME/CFS patients met the Fukuda 1994 diagnostic criteria. In this pilot report, we examined 5 families, each with 2 to 5 ME/CFS patients, and compared 11 patients, 22 family members without ME/CFS, and 16 unrelated healthy controls. ADCC was measured as CX1:1 cytotoxic capacity (the percentage of51Cr-Daudi tumors with obinutuzumab anti-CD20 antibody that were killed at a 1:1 ratio of CD16Apos NKs to Daudis) and CX-slope. Individual CX1:1 capacities varied from 16.2% to 81.8% and were comparable between patients and unaffected family members, while the ADCC of both family groups was lower than the unrelated healthy controls. The lack of difference between patients and their unaffected family members indicates that low ADCC is unsuitable as a diagnostic biomarker for ME/CFS. Familial CD16Apos NK blood cell counts were lower than unrelated healthy controls. The potential for synergistic effects of combined low CX1:1 and low effector cell counts occurring in the same individual was 24-fold greater for CFS family members than for unrelated controls.FCGR3Aof the families was predominantly F/F homozygous, correlating with the observed low EC50 for NK recognition of target cell-bound antibody. In summary, low ADCC is unsuitable as a biomarker, but could be a familial risk factor, for ME/CFS.