bluuebunny/crossref_metadata_2025 huggingface dataset:
In vivo assessment of the toxicity of electronic cigarettes to zebrafish (Danio rerio) embryos, following gestational exposure, in terms of mortality, developmental toxicity, and hair cell damage: Toxicity of E-cigs to zebrafish embryos
Authors: Chang YS , Park SM , Rah YC , Han EJ , Koun SI , Chang J , Choi J
Published: August 2020

With the ban of conventional cigarettes from public spaces, electronic cigarette (E-cig) liquids have emerged as a nicotine replacement treatment for smoking cessation. However, consumers possess little knowledge of the ingredients and health effects of E-cig liquids following exposure. This study evaluated hair cell damage and developmental toxicities following gestational exposure to E-cig liquids. Zebrafish embryos were exposed to E-cig liquids at different concentrations (0.1%, 0.2%, and 0.4%). Embryonic developmental toxicity and hair cell damage was evaluated at 6 and 7 d, respectively, after fertilization. The average number of hair cells in the anterior lateral line (ALL) and posterior lateral line (PLL) following E-cig exposure was compared to that of the control. Morphological abnormalities and heart rate were evaluated. E-cig liquids significantly damaged the hair cells in the ALL, compared to the control (control; 52.85 ± 5.29 cells, 0.1% E-cig; 49.43 ± 7.70 cells, 0.2% E-cig; 40.68 ± 12.00 cells, 0.4% E-cig; 32.14 ± 20.75%; n = 29–40; p < 0.01). At high concentrations, E-cig liquids significantly damaged the hair cells in the PLL (control; 36.88 ± 5.43 cells, 0.1% E-cig; 33.06 ± 5.21 cells, 0.2% E-cig; 30.95 ± 8.03 cells, 0.4% E-cig; 23.72 ± 15.53%, n = 29–40; p < 0.01). No morphological abnormalities in body shape, somites, notochord, tail, and pectoral fin were observed; however, abnormalities were observed in the dorsal fin and heart rate at high concentrations. Thus, gestational exposure to E-cigs significantly damaged hair cells in a concentration-dependent manner and induced developmental toxicities to the dorsal fin and heart rate at high concentrations.
Challenges posed by the EU minimum wage initiative to the ETUC and European trade union cooperation
Authors: Lovén Seldén Kristina
Published: August 2020

This article addresses recent developments in the debate on a European minimum wage and tries to shed light on the Swedish standpoint, which from a European perspective might be difficult to comprehend. The article argues that even though the ETUC secretariat has tried to find a balance among the member organisations regarding the EU initiative on a fair minimum wage, it is far from enough from a Swedish and Nordic perspective. Issues such as how to approach collective bargaining, how to think about minimum wages and the role of the government in industrial relations cause problems when unions that operate in relatively diverse institutional contexts try to cooperate. It is therefore likely that the EU minimum wage will continue to be at the core of European trade union discussions in the coming years. At the same time, institutional differences between countries are not the only factors determining union cooperation in Europe. Contextual factors also matter.
VA Care Coordination Program Increased Primary Care Visits and Improved Transitional Care for Veterans Post Non-VA Hospital Discharge
Authors: Ayele Roman A. , Liu Wenhui , Rohs Carly , McCreight Marina , Mayberry Ashlea , Sjoberg Heidi , Kelley Lynette , Glasgow Russell E. , Rabin Borsika A. , Battaglia Catherine
Published: August 2020

Veterans are increasingly eligible for non-VA care through the Veteran Health Administration (VA) Maintaining Internal Systems and Strengthening Integrated Outside Networks Act while maintaining care in the VA. Continuity of care is challenging when delivered across multiple systems resulting in avoidable complications. The Community Hospital Transitions Program (CHTP) intervention was developed to address challenges veterans face post non-VA hospitalization. Propensity score–matched analysis was used to compare outcomes between 334 intervention and matched control patients who were discharged from non-VA hospitals. Veterans in CHTP were more likely than matched controls to receive a follow-up appointment within 14 days (mean: 0.43 vs 0.34, P < .05) and 30 days (mean: 0.62 vs 0.50, P < .05). There were no significant differences in 30-day readmissions or 30-day emergency department visits. CHTP veterans received timely follow-up care post discharge in VA facilities. Providing quality care to dual-use veterans is dependent on coordinated transitional care.
Exploring Readiness for Teleprecepting in Psychiatric Mental Health Nurse Practitioner Training
Authors: Johnson Deborah S. , Ling Amanda , Melino Katerina
Published: August 2020

OBJECTIVE:

Telehealth offers a solution to many challenges in health care, including the shortage of psychiatric providers. Recently the need to limit patient and provider exposure to coronavirus disease 2019 (COVID-19) has escalated implementation of telehealth across the globe. As telehealth utilization expands, its role in nursing education and training requires systematic evaluation. Since publication of the National Organization of Nurse Practitioner Faculty white paper supporting telehealth in health care delivery and nurse practitioner education, several studies have demonstrated successful didactic instruction and training in telehealth. However, a recent literature review found no studies evaluating the use of telehealth technology as a means of precepting in clinical training.

METHODS:

This small-scale qualitative study investigates the readiness of one behavioral health clinic to provide teleprecepting to psychiatric mental health nurse practitioner students. Two preceptors and one student were interviewed using a peer-reviewed semistructured interview guide using video chat. Responses were reviewed, coded, and categorized into themes.

RESULTS:

Thematic analysis of the interviews revealed three categories for consideration in establishing teleprecepting. Clinical factors, logistics, and comparison with traditional precepting are discussed. Interviewees viewed teleprecepting as a viable method of increasing access to clinical training.

CONCLUSIONS:

This project supports teleprecepting as a feasible strategy for improving access to clinical training and as a technological resource that merits systematic evaluation. Practice guidelines are needed for teleprecepting of advanced practice registered nurse students, and both preceptors and students may benefit from training to support best practices prior to implementation.
Counter/Infections: Dis/abling Spaces and Cultures
Authors: Schillmeier Michael
Published: August 2020

With COVID-19 we experience the dramatic effects of a cosmopolitical event by which a non-human actor politicizes, i.e. unbuttons the normalcy of the ‘cosmos’ of shared lived spaces, what we take for granted as and what we expect from a globalized life-world. The dynamics of infection unfold an existential learning situation not only of how we live and how we wish to live, but also how we may compose modes of counterinfections to become better ‘equipped’ to keep living well with others. Thinking with Hannah Arendt, Georg Simmel, Georges Canguilhem, Alfred North Whitehead and others, the first part of the paper unfolds a conceptual framework for inquiries into the social complexity of lived embodied spaces and cultures. The idea of counter/infection alludes to the central mode of the social that can be understood as a process of creating and transforming the differences of value relations that may allow or endanger, enable or disable, enrich or limit embodied interaction. With this in mind, the second part of the paper reflects on how issues of dis/abling experiences as they have been portrayed in Space and Culture can be rethought and re-presented as social processes of dis/abling counter/infections.
‘Not All of Us Can Be Nurses’: Proposing and Resisting Entrepreneurship Education in Rural Lesotho
Authors: Dungey Claire , Ansell Nicola
Published: August 2020

Education in Lesotho, as in much of the world, has historically held out the promise of a ‘better future’. Success in school and the achievement of academic credentials were expected to lead to a secure future in the formal economy. With increasing school enrolment and growing youth unemployment, such futures are now illusory for most youth. In 2009, Lesotho introduced a radical new curriculum that aims to instil in young people skills and attitudes for entrepreneurship, enabling them to build their own futures in an increasingly uncertain world. Based on 9-months’ ethnographic fieldwork in two primary schools and their surrounding rural communities, we trace how the new curriculum is being delivered in schools and how it is intervening in children’s aspirations. Despite lessons intended to prepare them for livelihoods in the informal economy, young Basotho prize the security of a salaried job as a nurse, teacher, police officer, or soldier. We frame this contradiction in relation to concepts of doxic and habituated aspirations, concluding that due to the way schools deliver entrepreneurship education it both fails to displace long-standing doxic aspirations to professional careers, and fails to engage with young people’s habituated expectations of rural livelihoods.
Co-constructing the assessment criteria for EFL writing by instructors and students: A participative approach to constructively aligning the CEFR, curricula, teaching and learning
Authors: Zhao Huahui , Zhao Beibei
Published: August 2020

The current assessment in language classrooms prevailingly utilizes the criteria provided by instructors, regarding learners as passive recipients of assessment. The current study drew upon sustainable assessment and the community of practice to highlight the importance of involving learners in co-constructing the assessment criteria and argued that using the criteria provided by instructors could lead to discrepancy between assessment, teaching, and learning. It adopted a participatory approach and investigated how to involve learners in co-constructing the assessment criteria with instructors in tertiary English writing instruction in China, based on the European Language Profile (ELP), an evolved version of the Common European Framework of Reference for Languages (CEFR). Two writing instructors and 146 tertiary students played different, yet interactive roles in adapting the assessment criteria in the local context. Instructors drafted the criteria in line with curricula, teaching, learning and learners. Learners utilized the draft criteria in a training session and suggested possible modifications to the criteria in a survey. Suggestions were used to revise the descriptors alongside teachers’ reflections via reflective logs. A follow-up survey explored students’ perceptions of the feasibility and usefulness of the modified descriptors to investigate the effectiveness of co-constructing the assessment criteria for learning and reveal further improvement if necessary. Vigilant decision-making processes were thickly described regarding how assessment descriptors were selected, arranged, and modified to constructively align them with curricula, teaching, and learning. Statistical and thematic analyses were conducted to examine the accessibility, feasibility, and usefulness of the assessment descriptors prior to and after the modifications. Results substantiated the effectiveness and thus the importance of co-constructing assessment criteria for enhancing the quality of assessment criteria and developing learners’ cognitive and metacognitive knowledge of writing and assessment. Implications for language tutors regarding co-constructing assessment criteria in local contexts were deliberated on at the end of the article.
Applying for ST3 Urology: An overview
Authors: Morton Simon , O’ Riordan Anna , Thorpe Andrew
Published: August 2020

Level of evidence: not applicable for this review article.
Registered nurses’ experiences with master’s degree competence in the specialist health service: A qualitative descriptive study
Authors: Kjellaas Siri , Fredheim Gunilla , Moen Øyfrid Larsen
Published: August 2020

The application of master’s degree competence in nursing practice has been a hot topic of debate in various forums in recent years. International findings suggest that nurses with master’s degrees can make a positive contribution to the quality of services and patient safety, and an association has been suggested between higher education in nursing and a reduced mortality rate in hospitals. Therefore, this study aimed to investigate registered nurses’ (RNs’) experiences with how a master’s level education affected their work in the specialist health service. An inductive qualitative study design was used. Data were collected through focus group interviews with 18 participants in five groups and analysed using content analysis. This study is reported in accordance with COREQ. The results showed an ‘expectation gap’ between the RNs with master’s degrees and their managers. Our findings also reflected the RNs’ ambivalent experiences of being both a threat and a resource. The application of the competence describes the desire to utilise and recognise the master’s qualification. Furthermore, expectations for the future in the specialist health service were focussed on more evidence-based practice. The results of this study highlight that enhanced competence is a priority area aimed at meeting current and future needs for evidence-based practice and effective services. Clinical master’s degrees place emphasis on both the RNs’ clinical skills and their ability to obtain and apply new knowledge.
Insights Provided by Depression Screening Regarding Pain, Anxiety, and Substance use in a Veteran Population
Authors: Stevens Elizabeth R. , Mazumdar Medha , Caniglia Ellen C. , Khan Maria R. , Young Kailyn E. , Edelman E. Jennifer , Gordon Adam J. , Fiellin David A. , Maisto Stephen A. , Chichetto Natalie E. , Crystal Stephan , Gaither Julie R. , Justice Amy C. , Braithwaite R. Scott
Published: August 2020

Objective:

We sought to quantify the extent to which a depression screening instrument commonly used in primary care settings provides additional information regarding pain interference symptoms, anxiety, and substance use.

Methods:

Veterans Aging Cohort Study (VACS) data collected from 2003 through 2015 was used to calculate odds ratios (OR) for associations between positive depression screening result cutoffs and clustering conditions. We assessed the test performance characteristics (likelihood ratio value, positive predictive value, and the percentage of individuals correctly classified) of a positive Patient Health Questionnaire (PHQ-9 & PHQ-2) depression screen for the identification of pain interference symptoms, anxiety, and substance use.

Results:

A total 7731 participants were included in the analyses. The median age was 50 years. The PHQ-9 threshold of ≥20 was strongly associated with pain interference symptoms (OR 21.6, 95% CI 17.5-26.7) and anxiety (OR 72.1, 95% CI 52.8-99.0) and yielded likelihood ratio values of 7.5 for pain interference symptoms and 21.8 for anxiety and positive predictive values (PPV) of 84% and 95%, respectively. A PHQ-9 score of ≥10 still showed significant associations with pain interference symptoms (OR 6.1, 95% CI 5.4-6.9) and symptoms of anxiety (OR 11.3, 95% CI 9.7-13.1) and yet yielded lower likelihood ratio values (4.36 & 8.24, respectively). The PHQ-9 was less strongly associated with various forms of substance use.

Conclusion:

Depression screening provides substantial additional information regarding the likelihood of pain interference symptoms and anxiety and should trigger diagnostic assessments for these other conditions.
Mainstream Flavor: Ethnic Cuisine and Assimilation in the United States
Authors: Boch Anna , Jiménez Tomás , Roesler Katharina
Published: August 2020

Assimilation theories posit that cultural change is part and parcel of the assimilation process. That change can register in the symbols and practices that individuals invoke as part of an ethnic experience. But cultural change also includes the degree to which the mainstream takes up those symbols and practices as part of its composite culture. We develop a way to examine whether cuisine, an important component of ethnic culture, is part of the mainstream’s composite culture and the contextual factors associated with the presence of ethnic cuisine in the composite culture. We begin with a comparison of 761,444 reviews of Mexican, Italian, Chinese, and American restaurants across the United States from Yelp!, an online customer review platform. We find that reviews of Mexican restaurants mention ethnicity and authenticity much more than reviews of Italian and American restaurants, but less than reviews of Chinese restaurants, suggesting intermediate mainstreaming of Mexican cuisine. We then examine Mexican restaurant reviews in the 82 largest U.S. core-based statistical areas (CBSAs) to uncover the contextual factors associated with Mexican cuisine’s local mainstream presence. We find that Mexican food is less defined in ethnic terms in CBSAs with larger and more culturally distinct Mexican populations and at less-expensive restaurants. We argue that regional versions of the composite culture change as ethnic groups come to define a region demographically and culturally.
Hereditary α tryptasemia is a valid genetic biomarker for severe mediator-related symptoms in mastocytosis
Authors: Greiner Georg , Sprinzl Bettina , Górska Aleksandra , Ratzinger Franz , Gurbisz Michael , Witzeneder Nadine , Schmetterer Klaus G. , Gisslinger Bettina , Uyanik Goekhan , Hadzijusufovic Emir , Esterbauer Harald , Gleixner Karoline V. , Krauth Maria T. , Pfeilstöcker Michael , Keil Felix , Gisslinger Heinz , Nedoszytko Boguslaw , Niedoszytko Marek , Sperr Wolfgang R. , Valent Peter , Hoermann Gregor
Published: August 2020

Mastocytosis is a hematopoietic neoplasm characterized by expansion of KIT D816V-mutated clonal mast cells in various organs and severe or even life-threatening anaphylactic reactions. Recently, hereditary α-tryptasemia (HαT) has been described as a common genetic trait with increased copy numbers of the α-tryptase encoding gene, TPSAB1, and associated with an increased basal serum tryptase level and a risk of mast cell activation. The purpose of our study was to elucidate the clinical relevance of HαT in patients with mastocytosis. TPSAB1 germline copy number variants were assessed by digital polymerase chain reaction in 180 mastocytosis patients, 180 sex-matched control subjects, 720 patients with other myeloid neoplasms, and 61 additional mastocytosis patients of an independent validation cohort. α-Tryptase encoding TPSAB1 copy number gains, compatible with HαT, were identified in 17.2% of mastocytosis patients and 4.4% of the control population (P < .001). Patients with HαT exhibited higher tryptase levels than patients without HαT (median tryptase in HαT+ cases: 49.6 ng/mL vs HαT− cases: 34.5 ng/mL, P = .004) independent of the mast cell burden. Hymenoptera venom hypersensitivity reactions and severe cardiovascular mediator-related symptoms/anaphylaxis were by far more frequently observed in mastocytosis patients with HαT than in those without HαT. Results were confirmed in an independent validation cohort. The high prevalence of HαT in mastocytosis hints at a potential pathogenic role of germline α-tryptase encoding TPSAB1 copy number gains in disease evolution. Together, our data suggest that HαT is a novel emerging robust biomarker in mastocytosis that is useful for determining the individual patient´s risk of developing severe anaphylaxis.
Prospective long-term follow-up after first-line subcutaneous cladribine in hairy cell leukemia: a SAKK trial
Authors: Benz Rudolf , Arn Kornelius , Andres Martin , Pabst Thomas , Baumann Michael , Novak Urban , Hitz Felicitas , Hess Urs , Zenhaeusern Reinhard , Chalandon Yves , Mey Ulrich , Blum Sabine , Rauch Daniel , O'Meara Stern Alix , Cantoni Nathan , Bargetzi Mario , Bianchi-Papina Elena , Rossi Davide , Passweg Jakob , Lohri Andreas , Berardi Simona , Li Qiyu , Feller Anita , Stussi Georg
Published: August 2020

Hairy cell leukemia (HCL) remains an incurable disease. However, first-line treatment with either intravenous or subcutaneous cladribine generally leads to long-lasting remissions. Although there are excellent long-term data for intravenous application, similar data regarding subcutaneous administration are lacking. We therefore analyzed the long-term outcome of 3 prospective multicenter clinical trials on subcutaneous cladribine performed by the Swiss Group for Clinical Cancer Research (SAKK), which recruited 221 patients with classical HCL between 1993 and 2005. Median overall survival from start of treatment was not reached. Pretreatment anemia, higher Eastern Cooperative Oncology Group score, and higher age were associated with poorer overall survival in multivariable analysis, whereas early progression at 24 and 36 months had no significant impact on overall survival. Second-line treatment was necessary in 53 (23.7%) patients after a median of 5 (range, 0.2-20.4) years, and first retreatment was mainly monotherapy with cladribine (66%) or rituximab (15.1%) or a combination of these drugs (15.1%). A total of 44 (19.9%) patients developed second primary malignancies with a median time to occurrence of 5.7 (range, 0.01-17.5) years. Second primary malignancies were the main cause for death (14; 27.5%). Compared with a matched normal Swiss population, the incidence of second primary malignancies was not increased. However, survival of patients with HCL was slightly inferior by comparison (P = .036). In conclusion, the outcome of HCL patients treated with subcutaneous cladribine is excellent, and in most patients, 1 cycle of subcutaneous cladribine is sufficient for long-term disease control.
UV protection for young athletes: using participatory program planning to develop a sports schools program
Authors: Stölzel Friederike , Wolff Michaela , Fieber Vera , Glausch Melanie , Wachs Claudia , Breitbart Eckhard , Bornhäuser Martin , Seidel Nadja
Published: August 2020

Background

The incidence of melanoma increased rapidly throughout the last decades, with overexposure to ultraviolet (UV) radiation being an established risk factor. Due to their intensive sun exposure, many student athletes (SAs) have an increased risk for skin cancer. The Clever in Sun and Shade Program (CSSP) aims at enforcing positive attitudes toward UV protection (UVP) and at supporting sports schools in establishing UVP strategies.

Methods

CSSP was developed in 2019 using participatory program planning (PPP) as well as following WHO recommendations for UVP at schools. After drafting first material, within a PPP groups were conducted at a partner school (convenience sample 1) with students (n = 20), teachers (n = 5), school administration (n = 2), and coaches (n = 5). Materials were then adapted. Program acceptance and feasibility were tested at two further schools (convenience sample 2) with PPP groups of students (n = 95) and school administration (n = 2). Content analyses and descriptive statistics were conducted.

Results

Less than 50% of SAs and coaches of sample 1 expressed positive attitudes toward UVP, less than 10% reported appropriate UVP behavior. By using PPP, program material was adapted to the target groups’ needs, i.e., by including specific barriers and solutions. Only the most accepted video drafts were produced. The majority of SAs of sample 2 (80-86%) used predominantly positive adjectives such as “important” and “positive” to describe the completed videos and the behavior self-check poster.

Conclusions

PPP process has greatly influenced concept and materials of CSSP for sports schools. Integration of future program participants has proven to be an important component in creating a fitting and feasible program. CSSP for sports schools is a program free of charge that enables sports schools to integrate UVP into their daily routine. It will be disseminated in cooperation with German Olympic Sports Confederation and German Cancer Aid in 2021.
ImmunoGlobe: enabling systems immunology with a manually curated intercellular immune interaction network
Authors: Atallah Michelle B. , Tandon Varun , Hiam Kamir J. , Boyce Hunter , Hori Michelle , Atallah Waleed , Spitzer Matthew H. , Engleman Edgar , Mallick Parag
Published: August 2020

Background

While technological advances have made it possible to profile the immune system at high resolution, translating high-throughput data into knowledge of immune mechanisms has been challenged by the complexity of the interactions underlying immune processes. Tools to explore the immune network are critical for better understanding the multi-layered processes that underlie immune function and dysfunction, but require a standardized network map of immune interactions. To facilitate this we have developed ImmunoGlobe, a manually curated intercellular immune interaction network extracted from Janeway’s Immunobiology textbook.

Results

ImmunoGlobe is the first graphical representation of the immune interactome, and is comprised of 253 immune system components and 1112 unique immune interactions with detailed functional and characteristic annotations. Analysis of this network shows that it recapitulates known features of the human immune system and can be used uncover novel multi-step immune pathways, examine species-specific differences in immune processes, and predict the response of immune cells to stimuli. ImmunoGlobe is publicly available through a user-friendly interface atwww.immunoglobe.organd can be downloaded as a computable graph and network table.

Conclusion

While the fields of proteomics and genomics have long benefited from network analysis tools, no such tool yet exists for immunology. ImmunoGlobe provides a ground truth immune interaction network upon which such tools can be built. These tools will allow us to predict the outcome of complex immune interactions, providing mechanistic insight that allows us to precisely modulate immune responses in health and disease.
Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study
Authors: Lorenzen Ulf , Pohlmann Markus , Hansen Jonathan , Klose Phil , Gruenewald Matthias , Renner Jochen , Elke Gunnar
Published: August 2020

Background

In morbidly obese patients undergoing laparoscopic bariatric surgery, the combination of obesity-related comorbidities, pneumoperitoneum and extreme posture changes constitutes a high risk of perioperative hemodynamic complications. Thus, an advanced hemodynamic monitoring including continuous cardiac index (CI) assessment is desirable. While invasive catheterization may bear technical difficulties, transesophageal echocardiography is contraindicated due to the surgical procedure. Evidence on the clinical reliability of alternative semi- or non-invasive cardiac monitoring devices is limited. The aim was to compare the non-invasive vascular unloading to a semi-invasive pulse contour analysis reference technique for continuous CI measurements in bariatric surgical patients.

Methods

This prospective observational study included adult patients scheduled for elective, laparoscopic bariatric surgery after obtained institutional ethics approval and written informed consent. CI measurements were performed using the vascular unloading technique (Nexfin®) and semi-invasive reference method (FloTrac™). At 10 defined measurement time points, the influence of clinically indicated body posture changes, passive leg raising, fluid bolus administration and pneumoperitoneum was evaluated pre- and intraoperatively. Correlation, Bland-Altman and concordance analyses were performed.

Results

Sixty patients (mean BMI 49.2 kg/m2) were enrolled into the study and data from 54 patients could be entered in the final analysis. Baseline CI was 3.2 ± 0.9 and 3.3 ± 0.8 l/min/m2, respectively. Pooled absolute CI values showed a positive correlation (rs = 0.76,P < 0.001) and mean bias of of − 0.16 l/min/m2(limits of agreement: − 1.48 to 1.15 l/min/m2) between the two methods. Pooled percentage error was 56.51%, missing the criteria of interchangeability (< 30%). Preoperatively, bias ranged from − 0.33 to 0.08 l/min/m2with wide limits of agreement. Correlation of CI was best (rs = 0.82,P < 0.001) and percentage error lowest (46.34%) during anesthesia and after fluid bolus administration. Intraoperatively, bias ranged from − 0.34 to − 0.03 l/min/m2with wide limits of agreement. CI measurements correlated best during pneumoperitoneum and after fluid bolus administration (rs = 0.77,P < 0.001; percentage error 35.95%). Trending ability for all 10 measurement points showed a concordance rate of 85.12%, not reaching the predefined Critchley criterion (> 92%).

Conclusion

Non-invasive as compared to semi-invasive CI measurements did not reach criteria of interchangeability for monitoring absolute and trending values of CI in morbidly obese patients undergoing bariatric surgery.

Trial registration

The study was registered retrospectively on June 12, 2017 with the registration numberNCT03184272.
Early drop in systolic blood pressure, heart rate at admission, and their effects on worsening renal function in elderly patients with acute heart failure
Authors: Takeuchi Makoto , Nagai Michiaki , Dote Keigo , Kato Masaya , Oda Noboru , Kunita Eiji , Kagawa Eisuke , Yamane Aya , Kobayashi Yusuke , Shiota Haruko , Osawa Ayano , Kobatake Hiroshi
Published: August 2020

Background

Regardless of patients’ baseline renal function, worsening renal function (WRF) during hospitalization is associated with poor outcomes. In individuals with acute heart failure (AHF), one predictor of WRF is an early drop in systolic blood pressure (SBP). Few studies have investigated WRF in elderly AHF patients or the influence of these patients’ heart rate (HR) at admission on the relationship between an early SBP drop SBP and the AHF.

Methods

We measured the SBP and HR of 245 elderly AHF inpatients (83 ± 6.0 years old, females 51%) at admission and another six times over the next 48 h. We defined ‘WRF’ as a serum creatinine increase ≥0.3 mg/dL by Day 5 post-admission. We calculated the ‘early SBP drop’ as the difference between the admission SBP value and the lowest value during the first 48 h of hospitalization.

Results

There were significant differences between the 36 patients with WRF and the 209 patients without WRF: early SBP drop (51 vs. 33 mmHg, p < 0.01) and HR at admission (79 vs. 90 bpm, p < 0.05), respectively. In the multiple logistic regression analysis adjusted for the confounders, higher early SBP drop (p < 0.04) and lower HR at admission (p < 0.01) were significantly associated with WRF. No significant association was shown for the interaction term of early SBP drop × HR at admission with WRF.

Conclusions

In these elderly AHF patients, exaggerated early SBP drop and lower HR at admission were significant independent predictors of WRF, and these factors were additively associated with WRF.
Study protocol: pragmatic randomized control trial of my tools 4 care- in care (MT4C-in care) a web-based tool for family Carers of persons with dementia residing in long term care
Authors: Duggleby Wendy , O’Rourke Hannah , Swindle Jennifer , Peacock Shelley , McAiney Carrie , Baxter Pamela , Thompson Genevieve , Dubé Véronique , Nekolaichuk Cheryl , Ghosh Sunita , Holroyd-Leduc Jayna
Published: August 2020

Background

When a family member resides in long term care facility (LTC), family carers continue caregiving and have been found to have decreases in mental health. The aim of My Tools 4 Care – In Care (an online intervention) is to support carers of persons living with dementia residing in LTC through transitions and increase their self-efficacy, hope, social support and mental health. This article comprises the protocol for a study to evaluate My Tools 4 Care-In Care (MT4C-In Care) by asking the following research questions:

Is there a 2 month (immediately post-intervention) and 4 month (2 months post-intervention) increase in mental health, general self-efficacy, social support and hope, and decrease in grief and loneliness, in carers of a person living with dementia residing in LTC using MT4C-In CARE compared to an educational control group?

Do carers of persons living with dementia residing in LTC perceive My Tools 4 Care- In Care helps them with the transitions they experience?

Methods

This study is a single blinded pragmatic mixed methods randomized controlled trial. Approximately 280 family carers of older persons (65 years of age and older) with dementia residing in LTC will be recruited for this study. Data will be collected at three time points: baseline, 2 month, and 4 months. Based on the feasibility study, we hypothesize that participants using MT4C-In Care will report significant increases in hope, general self-efficacy, social support and mental health quality of life, and significant decreases in grief and loneliness from baseline, as compared to an educational control group. To determine differences between groups and over time, generalized estimating equations analysis will be used. Qualitative descriptive analysis will be used to further evaluate MT4C-In Care and if it supports carers through transitions.

Discussion

Data collection will begin in four Canadian provinces (Alberta, Manitoba, Ontario and Saskatchewan) in February 2020 and is expected to be completed in June 2021. The results will inform policy and practice as MT4C-In Care can be revised for local contexts and posted on websites such as those hosted by the Alzheimer Society of Canada.

Trial registration

NCT04226872 ClinicalTrials.gov Registered 09 January 2020

Protocol Version #2 Feb 19, 2020.
Late-life falling and depressive symptoms associated with the risk of Parkinson’s disease: a nationwide cohort data analysis
Authors: Jung Yu Jin , Kim Ryul , Yoo Dallah , Han Kyungdo , Lee Jee-Young
Published: August 2020

Background

This study aimed to evaluate the relationship between the history of late-life falling and the development of Parkinson’s disease (PD) and investigate whether depressive symptoms interact with falling to increase PD risk.

Methods

We identified 1,223,726 subjects without PD who underwent the National Screening Program for Transitional Age at 66 years between 2009 and 2013 using the National Health Cohort database. In this program, every participant was assessed whether they experienced falling for the past six months. Depressive symptoms were evaluated with a three-item questionnaire extracted from the Geriatric Depression Scale. Incident PD was traced for a mean 4.23 ± 1.50 years. Cox proportional hazard regression models were used to assess the risk of PD by falling history with and without depressive symptoms after adjusting for other confounding variables.

Results

In this cohort, the PD incidence rate was 1.30 and 1.03 cases per 1000 person-years in groups with and without falling and 1.34 and 1.00 cases per 1000 person-years in groups with and without depressive symptoms. The predictive risk of PD was increased by either a history of falling (HR = 1.24; 95% CI 1.11–1.40) or the presence of depressive symptoms (HR = 1.31; 95% CI 1.21–1.42) after adjusting for possible confounding variables. For individuals with both falling and depressive symptoms, PD risk increased further (HR = 1.66; 95% CI 1.40–1.97), but with sex-differences. The two factors increased PD risk in a sub-additive manner in men, whereas synergistically in women.

Conclusions

This national cohort database shows that late-life depressive symptoms accompanied by a falling event pose an increase in the risk of PD in older adults.
A structural equation model of factors associated with HIV risk behaviors and mental health among men who have sex with men in Malawi
Authors: Zhao Yuan , Rao Amrita , Wirtz Andrea L. , Umar Eric , Trapence Gift , Jumbe Vincent , Ketende Sosthenes , Kamba Dunker , Beyrer Chris , Baral Stefan
Published: August 2020

Background

Men who have sex with men (MSM) bear a disproportionate burden of HIV in Malawi. Early prevention efforts in Malawi have been largely focused on preventing heterosexual and vertical transmission of HIV, and MSM have rarely been the specific benefactors of these efforts, despite facing both higher prevalence of HIV coupled with multiple barriers to prevention and care. To better facilitate the design of culturally relevant HIV prevention programs and prioritize resources among MSM in resource limited settings, the objective of this analysis was to estimate the relationship between social factors and HIV related risk behaviors and mental health.

Methods

338 MSM were recruited using respondent-driven sampling in Blantyre, Malawi from April 2011 to March 2012. Structural equation models were built to test the association between six latent factors: participation in social activities, social support, stigma and human rights violations, depression symptomatology, condom use, and sexual risk behaviors, including concurrent sexual partnerships and total number of partners.

Results

The mean age of participants was 25 years old. Almost 50% (158/338) of the participants were unemployed and 11% (37/338) were married or cohabiting with women. More than 30% (120/338) of the participants reported sexual behavior stigma and 30% (102/338) reported depression symptomatology. Almost 50% (153/338) of the participants reported any kind of HIV-related risk behaviors and 30% (110/338) participated in one of the recorded social activities. Significant associations were identified between stigma and risk behaviors (β = 0.14, p = 0.03); stigma and depression symptomatology (β = 0.62, p = 0.01); participation in social activities and depression symptomatology (β = 0.17, p = 0.01).

Conclusion

Results suggest MSM reporting stigma are more likely to report sexual risk practices associated with HIV/STI transmission and depressive symptoms, while those reporting participation in social activities related to HIV education are less likely to be depressed. Furthermore, interventions at the community level to support group empowerment and engagement may further reduce risks of HIV transmission and improve mental health outcomes. Taken together, these results suggest the potential additive benefits of mental health services integrated within comprehensive HIV prevention packages to optimize both HIV-related outcomes and general quality of life among MSM in Malawi.
Diagnostic accuracy of contrast-enhanced diffusion-weighted MRI for liver metastases of pancreatic cancer: towards adequate staging and follow-up of pancreatic cancer – DIA-PANC study: study protocol for an international, multicenter, diagnostic trial
Authors: Litjens G. , Rivière D. M. , van Geenen E. J. M. , Radema S. A. , Brosens L. A. A. , Prokop M. , van Laarhoven C. J. H. M. , Hermans J. J.
Published: August 2020

Background

At the time of surgery, approximately 10–20% of the patients with pancreatic cancer are considered unresectable because of unexpected liver metastasis, peritoneal carcinomatosis or locally advanced disease. This leads to futile surgical treatment with all the associated morbidity, mortality and costs. More than 50% of all liver metastases develop in the first six months postoperatively. These (subcentimeter) liver metastases are most likely already present at the time of diagnosis and have not been identified pre-operatively, due to the poor sensitivity of routine preoperative contrast-enhanced CT (CECT).

Methods

The DIA-PANC study is a prospective, international, multicenter, diagnostic cohort study investigating diffusion-weighted, contrast-enhanced MRI for the detection of liver metastases in patients with all stages of pancreatic cancer. Indeterminate or malignant liver lesions on MRI will be further investigated histopathologically. For patients with suspected liver lesions without histopathological proof, follow up imaging with paired CT and MRI at 3-, 6- and 12-months will serve as an alternative reference standard.

Discussion

The DIA-PANC trial is expected to report high-level evidence of the diagnostic accuracy of MRI for the detection of liver metastases, resulting in significant value for clinical decision making, guideline development and improved stratification for treatment strategies and future trials. Furthermore, DIA-PANC will contribute to our knowledge of liver metastases regarding incidence, imaging characteristics, their number and extent, and their change in time with or without treatment. It will enhance the worldwide implementation of MRI and consequently improve personalized treatment of patients with suspected pancreatic ductal adenocarcinoma.

Trial registration

ClinicalTrials.gov Identifier: NCT03469726. Registered on March 19th 2018 - Retrospectively registered.
Prognosis of pregnancy-associated breast cancer: a meta-analysis
Authors: Shao Chunchun , Yu Zhigang , Xiao Juan , Liu Liyuan , Hong Fanzhen , Zhang Yuan , Jia Hongying
Published: August 2020

Background

Pregnancy-associated breast cancer (PABC) is defined as breast cancer that is diagnosed during pregnancy and/or the postpartum period. Definitions of the duration of the postpartum period have been controversial, and this variability may lead to diverse results regarding prognosis. Moreover, evidence on the dose-response association between the time from the last pregnancy to breast cancer diagnosis and overall mortality has not been synthesized.

Methods

We systematically searched PubMed, Embase, and the Cochrane Library for observational studies on the prognosis of PABC published up to June 1, 2019. We estimated summary-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs). Subgroup analyses based on diagnosis time, PABC definition, geographic region, year of publication and estimation procedure for HR were performed. Additionally, dose-response analysis was conducted by using the variance weighted least-squares regression (VWLS) trend estimation.

Results

A total of 54 articles (76 studies) were included in our study. PABC was associated with poor prognosis for overall survival (OS), disease-free survival (DFS) and cause-specific survival (CSS), and the pooled HRs with 95% CIs were 1.45 (1.30–1.63), 1.39 (1.25–1.54) and 1.40 (1.17–1.68), respectively. The corresponding reference category was non-PABC patients. According to subgroup analyses, the varied definition of PABC led to diverse results. The dose-response analysis indicated a nonlinear association between the time from the last delivery to breast cancer diagnosis and the HR of overall mortality (P < 0.001). Compared to nulliparous women, the mortality was almost 60% higher in women with PABC diagnosed at 12 months after the last delivery (HR = 1.59, 95% CI 1.30–1.82), and the mortality was not significantly different at 70 months after the last delivery (HR = 1.14, 95% CI 0.99–1.25). This finding suggests that the definition of PABC should be extended to include patients diagnosed up to approximately 6 years postpartum (70 months after the last delivery) to capture the increased risk.

Conclusion

This meta-analysis suggests that PABC is associated with poor prognosis, and the definition of PABC should be extended to include patients diagnosed up to approximately 6 years postpartum.
A case report of appendix mucinous adenocarcinoma that recurred after additional surgery and a brief literature review
Authors: Chen Wei , Ye Jun-Wen , Tan Xiao-ping , Peng Xiang , Zhang Yan , Liang Jing-Lin , Huang Mei-Jin
Published: August 2020

Background

The clinical incidence of appendiceal mucinous adenocarcinoma is low. Moreover, the case reports of postoperative relapse after surgery are rarely based on literature search results. Here, we report such a case spanning nearly 7 years and and review the relevant literature.

Case presentation

A 50-year-old female underwent additional surgery after appendectomy, and pathological examination confirmed mucinous adenocarcinoma. The patients underwent HIPEC (hyperthermic intraoperative chemotherapy) and adjuvant chemotherapy. Twenty-six months after the previous surgeries, another surgery, HIPEC, and adjuvant chemotherapy were performed again due to tumour recurrence. To date, the follow-up time is 43 months, and no recurrence or metastasis has been found.

Conclusions

Appendix mucinous adenocarcinoma has a poor prognosis and the diagnosis depends on pathological and immunohistochemical examinations. Its clinical manifestations are non-specific, and CRS + HIPEC should be used for treatment, which is safe and effective.
Understanding individual, family and community perspectives on delaying early birth among adolescent girls: findings from a formative evaluation in rural Bangladesh
Authors: Samandari Ghazaleh , Sarker Bidhan Krishna , Grant Carolyn , Huq Nafisa Lira , Talukder Aloka , Mahfuz Sadia Nishat , Brent Lily , Nitu Syeda Nabin Ara , Aziz Humaira , Gullo Sara
Published: August 2020

Background

Pregnancy among adolescent girls in Bangladesh is high, with 66% of women under the age of 18 reporting a first birth; this issue is particularly acute in the northern region of Bangladesh, an area that is especially impoverished and where girls are at heightened risk. Using formative research, CARE USA examined the underlying social, individual and structural factors influencing married girls’ early first birth and participation in alternative opportunities (such as education or economic pursuits) in Bangladesh.

Methods

In July of 2017, researchers conducted in-depth interviews of community members in two sub-districts of northern Bangladesh (Kurigram Sadar and Rajarhat). Participants (n = 127) included adolescent girls (both married and unmarredi), husbands of adolescent girls, influential adults in the girls’ lives, community leaders, and health providers. All interviews were transcribed, coded and organized using Dedoose software.

Results

Participants recognize the health benefits of delaying first birth, but stigma around infertility and contraceptive use, pressure from mothers-in-law and health provider bias interfere with a girl’s ability to delay childbearing. Girls’ social isolation, lack of mobility or autonomy, and inability to envision alternatives to early motherhood compound the issue; provider bias may also prevent access to methods. While participants agree that pursuit of education and economic opportunities are important, better futures for girls do not necessarily supersede their marital obligations of childrearing and domestic chores.

Conclusions

Findings indicate the need for a multi-level approach to delaying early birth and stimulating girls’ participation in economic and educational pursuits. Interventions must mitigate barriers to reproductive health care; train adolescent girls on viable economic activities; and provide educational opportunities for girls. Effective programs should also address contextual issues by including immediate members of the girls’ families, particularly the husband and mother-in-law.