bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross-Cultural Equivalence of De Jong Gierveld Loneliness Scale Among Older Native and Diasporic Chinese Adults
Authors: Cheung Sie-Long , Hobbelen Hans J S M , van der Schans Cees P , Krijnen Wim P
Published: September 2020

Background and Objectives

Loneliness is prevalent among older adults and known to be detrimental to mental health. The objective of this study was to determine the psychometric properties of the Chinese 6-item De Jong Gierveld Loneliness Scale (DJGLS) in the older native and diasporic Chinese community.

Research Design and Methods

Participants were recruited from a local community in urban Tianjin, China and urban Chinese communities of older adults in the Netherlands. Scale properties, including reliability, were calculated with Cronbach’s alpha and multiple-group confirmatory factor analysis to examine the 2-dimensional structure of the scale and the cross-cultural equivalence between both countries. Item response analysis was employed to plot the relationships between the item response and expected total scale score.

Results

A total of 193 older adults from China and 135 older adults from the Netherlands were included. The Cronbach’s alphas were 0.68 (China) and 0.71 (the Netherlands). The DJGLS’s 2-dimensional structure was validated by the goodness of fit and the factor loadings. Cross-cultural equivalence was demonstrated with the multiple-group confirmatory analysis. In addition, sufficient discriminative power of the individual items was demonstrated by item response analysis in both countries.

Discussion and Implications

This study is the first to provide a detailed item behavior analysis with an item response analysis of the DJGLS. In conclusion, the findings of this study suggest that the DJGLS has an adequate and similar item and scalar equivalence for use in Chinese populations.
Non-Lethal Intoxication by Ingestion of 50 Castor Beans: Serial Measurement of Ricinine in Blood, Plasma and Urine
Authors: Lefever Stefanie , Geerts Inge , Vermeulen Edith , Vermeersch Pieter , De Rydt Frederic , Dobbels Laurens , Gillis Marc , Croes Kathleen
Published: September 2020

A 30-year-old woman presented to the emergency department 2 days after ingestion of 50 castor beans. Her symptoms on admission were vomiting, diarrhea, abdominal cramps, agitation and anxiety. Initial laboratory tests showed a slightly elevated C-reactive protein and mild liver and kidney dysfunction. The patient was transferred to the medium care unit of our hospital where she was observed for possible organ failure. During the next days, the kidney function improved and liver function started to recover. Four days after admission, the patient was transferred to the psychiatric ward. Urine, serum, plasma and whole-blood samples were analyzed for ricinine using a quantitative LC–MS-MS method. Initial values on admission (serum and urine) were very high in comparison with previously reported cases. Based on these values, the patient was monitored closely in the following days. The patient made a full recovery, and during the course of hospitalization, concentrations of ricinine in plasma/serum, blood and urine gradually declined. The presence of ricinine in a patient’s blood or plasma is a proof of castor bean and, hence, ricin exposure. However, based on this case and previously reported cases in literature, we can conclude that no clear correlation can be established between ricinine blood, plasma or urine levels and the severity of the intoxication. Clinicians should be aware of the potential danger of a ricin intoxication, and patients should be monitored closely for several days due to the unpredictable outcome of the intoxication.
Optimal Retirement Policies with Present-Biased Agents
Authors: Yu Pei Cheng
Published: September 2020

This paper incorporates quasi–hyperbolic discounting into a Mirrlees taxation model to study the design of retirement policies for present-biased agents. I show that the government can improve the screening of productivity by exploiting time inconsistency. This is done by providing commitment to sophisticated agents and taking advantage of the incorrect beliefs of naïve agents. This can be achieved even if the degrees of present bias and sophistication are private information. I also demonstrate how the government can implement the optimal mechanism using retirement savings accounts and social security benefits.
Test Case Prioritization—ANT Algorithm With Faults Severity
Authors: Vescan Andreea , Pintea Camelia-M , Pop Petrică C
Published: September 2020

Regression testing is applied whenever a code changes, ensuring that the modifications fixed the fault and no other faults are introduced. Due to a large number of test cases to be run, test case prioritization is one of the strategies that allows to run the test cases with the highest fault rate first. The aim of the paper is to present an optimized test case prioritization method inspired by ant colony optimization, test case prioritization–ANT. The criteria used by the optimization algorithm are the number of faults not covered yet by the selected test cases and the sum of severity of the faults. The cost, i.e. time execution, for test cases is considered in the computation of the pheromone deposited on the graph’s edges. The average percentage of fault detected metric, as best selection criterion, is used to uncover maximum faults with the highest severity, and reducing the regression testing time. Several experiments are considered, detailed and discussed, comparing various algorithm parameter’s alternatives. A benchmark project is also used to validate the proposed approach. The obtained results are encouraging, being a cornerstone for new perspectives to be considered.
Temperature as a constraint on the timing and duration of African elephant foraging trips
Authors: Rozen-Rechels David , Valls-Fox Hugo , Mabika Cheryl Tinashe , Chamaillé-Jammes Simon
Published: September 2020

In arid and semiarid environments, water is a key resource that is limited in availability. During the dry season, perennial water sources such as water pans often are far apart and shape the daily movement routines of large herbivores. In hot environments, endotherms face a lethal risk of overheating that can be buffered by evaporative cooling. Behavioral adjustments are an alternative way to reduce thermal constraints on the organism. The trade-off between foraging and reaching water pans has been studied widely in arid environments; however, few studies have looked into how ambient temperature shapes individual trips between two visits to water. In this study, we tracked during the dry season the movement of eight GPS-collared African elephants (Loxodonta africana) cows from different herds in Hwange National Park, Zimbabwe. This species, the largest extant terrestrial animal, is particularly sensitive to heat due to its body size and the absence of sweat glands. We show that most foraging trips depart from water at nightfall, lowering the average temperature experienced during walking. This pattern is conserved across isolated elephant populations in African savannas. We also observed that higher temperatures at the beginning of the trip lead to shorter trips. We conclude that elephants adjust the timing of foraging trips to reduce the thermal constraints, arguing that further considerations of the thermal landscape of endotherms are important to understand their ecology.
Primary tracheal schwannoma resected in a Turner syndrome patient: a case report
Authors: Chávez-Fernández D A , Zúñiga-Garza E , López-Saucedo R A
Published: September 2020

We report a case of primary tracheal schwannoma in a 31-year-old woman. She had a previous history of follicular thyroid carcinoma treated surgically and Turner syndrome. In a follow-up computed tomography scan, we found a partially obstructing intraluminal tracheal tumor, which was confirmed by bronchoscopy. The patient was treated by surgical resection and primary tracheal anastomosis. The tumor was 14 mm in diameter, with an intact capsule. Histologic analysis revealed a Schwann cell origin tumor.
International travel during the COVID-19 pandemic: implications and risks associated with ‘travel bubbles’
Authors: Sharun Khan , Tiwari Ruchi , Natesan SenthilKumar , Yatoo Mohd Iqbal , Malik Yashpal Singh , Dhama Kuldeep
Published: September 2020

Air travel is considered as the major route that facilitated the distribution of COVID-19 across international borders. Passengers with asymptomatic and pre-symptomatic SARS-CoV-2 infection can bypass the symptom-based surveillance systems established in the airports. Travel bubbles should be considered as an effective compromise in preventive strategies. Therefore, strict preventive measures have to be implemented at the entry and exit points in addition to the measures taken for preventing on-board transmission SARS-CoV-2.
The sound of silence: Breathing analysis for finding traces of trauma and depression in oral history archives
Authors: Salah Almila Akdag , Salah Albert Ali , Kaya Heysem , Doyran Metehan , Kavcar Evrim
Published: September 2020

Many people experience a traumatic event during their lifetime. In some extraordinary situations, such as natural disasters, war, massacres, terrorism, or mass migration, the traumatic event is shared by a community and the effects go beyond those directly affected. Today, thanks to recorded interviews and testimonials, many archives and collections exist that are open to researchers of trauma studies, holocaust studies, and historians, among others. These archives act as vital testimonials for oral history, politics, and human rights. As such, they are usually either transcribed or meticulously indexed. In this work, we propose to look at the nonverbal signals emitted by victims of various traumatic events when they describe the trauma and we seek to render these for novel representations without taking into account the explicit verbal content. Our preliminary paralinguistic analysis on a manually annotated collection of testimonials from different archives, as well as on a corpus prepared for depression and post-traumatic stress disorder detection indicates a tentative connection between breathing and emotional states of speakers, which opens up new possibilities of exploring oral history archives.
Sub-Chandrasekhar-mass detonations are in tension with the observed t0−MNi56 relation of type Ia supernovae
Authors: Kushnir Doron , Wygoda Nahliel , Sharon Amir
Published: September 2020

Type Ia supernovae (SNe Ia) are likely the thermonuclear explosions of carbon–oxygen (CO) white-dwarf (WD) stars, but their progenitor systems remain elusive. Recent studies have suggested that a propagating detonation within a thin helium shell surrounding a sub-Chandrasekhar mass CO core can subsequently trigger a detonation within the core (the double-detonation model, DDM). The outcome of this explosion is similar to a central ignition of a sub-Chandrasekhar mass CO WD (SCD). While SCD is consistent with some observational properties of SNe Ia, several computational challenges prohibit a robust comparison to the observations. We focus on the observed t0−MNi56 relation, where t0 (the γ-rays’ escape time from the ejecta) is positively correlated with MNi56 (the synthesized 56Ni mass). We apply our recently developed numerical scheme to calculate SCD and show that the calculated t0−MNi56 relation, which does not require radiation transfer calculations, converges to an accuracy of a few per cent. We find a clear tension between our calculations and the observed t0−MNi56 relation. SCD predicts an anticorrelation between t0 and MNi56, with $t_0\approx 30\, \textrm{d}$ for luminous ($M_\text{Ni56}\gtrsim 0.5\, \mathrm{ M}_{\odot }$) SNe Ia, while the observed t0 is in the range of $35\!-\!45\, \textrm{d}$. We show that this tension is larger than the uncertainty of the results, and that it exists in all previous studies of the problem. Our results hint that more complicated models are required, but we argue that DDM is unlikely to resolve the tension with the observations.
A genetic screen for suppressors of hyper-repression of the fission yeast PHO regulon by Pol2 CTD mutation T4A implicates inositol 1-pyrophosphates as agonists of precocious lncRNA transcription termination
Authors: Garg Angad , Shuman Stewart , Schwer Beate
Published: September 2020

Fission yeast phosphate homeostasis genes are repressed in phosphate-rich medium by transcription of upstream lncRNAs that interferes with activation of the flanking mRNA promoters. lncRNA control of PHO gene expression is influenced by the Thr4 phospho-site in the RNA polymerase II CTD and the 3′ processing/termination factors CPF and Rhn1, mutations of which result in hyper-repression of the PHO regulon. Here, we performed a forward genetic screen for mutations that de-repress Pho1 acid phosphatase expression in CTD-T4A cells. Sequencing of 18 independent STF (Suppressor of Threonine Four) isolates revealed, in every case, a mutation in the C-terminal pyrophosphatase domain of Asp1, a bifunctional inositol pyrophosphate (IPP) kinase/pyrophosphatase that interconverts 5-IP7 and 1,5-IP8. Focused characterization of two STF strains identified 51 coding genes coordinately upregulated vis-à-vis the parental T4A strain, including all three PHO regulon genes (pho1, pho84, tgp1). Whereas these STF alleles—asp1-386(Stop) and asp1-493(Stop)—were lethal in a wild-type CTD background, they were viable in combination with mutations in CPF and Rhn1, in which context Pho1 was also de-repressed. Our findings implicate Asp1 pyrophosphatase in constraining 1,5-IP8 or 1-IP7 synthesis by Asp1 kinase, without which 1-IPPs can accumulate to toxic levels that elicit precocious termination by CPF/Rhn1.
Congregations Serving Homeless Populations: Examining Predictive Factors and Policy Implications
Authors: Fisher Catherine C , Ortiz Larry , Alemi Qais , Malika Nipher M
Published: September 2020

In this study, authors analyzed data from the 2012 National Congregations Study (NCS) to explore what factors are predictive of a congregation’s engagement in programs serving people experiencing homelessness. Using a cross-sectional sample of 1,328 congregations derived from the third wave of the NCS, authors applied multivariate logistic regression to identify congregational characteristics associated with programming for homeless adults. Approximately one-fourth of all congregations in our sample reported some type of homeless programming. The authors’ final model indicates that 10 variables predict greater likelihood of congregations having programs serving the homeless, which include factors such as larger annual spending and lower percentage low-income congregants; recent formation of a nonprofit entity; collaboration with another organization; certain religious traditions; and the presence of other sponsored programs such as (a) services targeting a specific gender, (b) services helping sexual assault and domestic violence victims, and (c) services for older adults. Given the ongoing U.S. homelessness crisis, this study may help housing authorities and local continuums of care identify congregations for potential partnership to help achieve the Housing First policy priorities and meet specific homeless subpopulation needs.
Effects of Violence on Trauma among Immigrant Women from Central America
Authors: Vila Arlette , Pomeroy Elizabeth C
Published: September 2020

The purpose of the study was to explore the effects of violence on trauma among forced-immigrant women from the northern triangle of Central America (NTCA) resulting from direct and indirect violence in their country of origin and during the migratory journey through Mexico. In trauma theory the concept of compounding stressors is an important framework for understanding aspects of human development, especially among low-socioeconomic-status and oppressed populations. Authors hypothesized that violence would have an impact on trauma and conducted interviews with 108 women ages 18 to 65 from the NTCA who traveled by land across Mexico before entering the United States. A survey instrument captured demographic information and types of violence experienced in the home country and during the migratory journey. A standardized screening tool was used to measure trauma symptoms. A hierarchical regression model for trauma was entered in the following order: (a) demographics and (b) violence. Violence was found to be a significant predictor for trauma. Findings suggest that having experienced violence in the country of origin and through the migratory journey had a powerful role in predicting trauma symptoms among immigrant women from the NTCA.
A Rapid and Sensitive Reverse Transcription–Loop-Mediated Isothermal Amplification (RT-LAMP) Assay for the Detection of Indian Citrus Ringspot Virus
Authors: Kokane Amol D. , Kokane Sunil B. , Warghane Ashish J. , Gubyad Mrugendra G. , Sharma Ashwani Kumar , Reddy M. Krishna , Ghosh Dilip Kumar
Published: September 2020

Indian citrus ringspot virus (ICRSV) is a devastating pathogen that has a particularly deleterious effect on the ‘Kinnow mandarin’, a commercial citrus crop cultivated in the northwest of India. ICRSV belongs to the Mandarivirus genus within the family of Alphaflexiviridae and has a positive sense single-stranded RNA (ssRNA) genome consisting of six open reading frames (ORFs). Severe cases of ICRSV result in a significant reduction in both the yield and quality of crops. Consequently, there is an urgent need to develop methods to detect ICRSV in an accurate and timely manner. Current methods involve a two-step reverse transcription polymerase chain reaction (RT-PCR) that is time consuming. Here, we describe a novel, one-step reverse transcription loop-mediated isothermal amplification (RT-LAMP) method for the sensitive and rapid detection of ICRSV. To standardize the RT-LAMP assay, four different primers were designed and tested to target the coat protein gene of ICRSV. Amplification results were visualized by a color change after addition of SYBR Green I. The standardized RT-LAMP assay was highly specific and successfully detected all 35 ICRSV isolates tested from the Punjab and Haryana states of India. Furthermore, there was no cross-reaction with 17 isolates of five other citrus pathogens that are common in India. The ICRSV RT-LAMP assay developed in the present study is a simple, rapid, sensitive, specific technique. Moreover, the assay consists of only a single step and is more cost effective than existing methods. This is the first application of RT-LAMP for the detection of ICRSV. Our RT-LAMP assay is a powerful tool for the detection of ICRSV and will be particularly useful for large-scale indexing of field samples in diagnostic laboratories, in nurseries, and for quarantine applications.
Plate osteosynthesis of midshaft clavicle fractures in adolescent contact sports athletes - adolescent clavicle fracture
Authors: Kamaci Saygin , Bess Laura , Glogovac Georgina , Colosimo Angelo J.
Published: September 2020

Surgical treatment of mid-shaft clavicle fractures via anatomical plates in adult athletes is documented to be safe and effective. Functional and cosmetic outcomes in adolescent contact sports athletes have not been well documented. Adolescent athletes (age 11–19) surgically treated for mid-shaft clavicle fractures between 1 May 2011 and 30 October 2017 were included in this study. Twenty-one adolescent athletes with a mean follow-up of 44 months were reviewed. Retrospective chart reviews were performed. Functional and cosmetic outcomes, return to sports time/rate were analyzed using Nottingham Clavicle Scores and a ‘Custom Questionnaire’. Return of function and healing, evidenced on radiographs, was achieved in all 21 patients. All patients returned back to competitive sports. The mean time to return back to training was 45.9 ± 16 (24–76) days. Sixteen (76.1%) of the patients reported Nottingham Clavicle Scores with a mean score of 91.7 (85–98). In the Custom Questionnaire, 16 patients who participated in the phone interview were satisfied with the cosmetic outcomes. The most common complaint was implant prominence and irritation in 6 (40%) patients, subsequently requiring implant removal in 3 (18.8%). Surgical fixation of mid-shaft clavicle fractures can lead to excellent union and cosmetic outcomes and a rapid return to sports in adolescent contact sport athletes. However, one should consider the outcomes of implant-related complaints and the possibility of implant removal surgery in the future.
Dimeglio’s derotation of calcaneo pedal block and Pirani’s talar head reduction: a quantitative matching
Authors: Agarwal Anil , Rastogi Prateek
Published: September 2020

We aimed to determine the quantitative value of derotation of calcaneo pedal block (DCPB) of Dimeglio system equivalent to talar head reduction of Pirani system. We also compared the ankle dorsiflexion obtained post tenotomy for different measures of DCPB. The study involved 53 idiopathic clubfoot children (86 feet) treated with Ponseti technique. Percutaneous Achilles tenotomy to correct ankle equinus was performed when forefoot adduction, heel varus were corrected and ankle dorsiflexion was <10°. Pirani’s coverage of lateral head of talus was taken as a determinant of adequate DCPB and to perform tenotomy. Mean patient age at enrollment was 60.9 ± 71.1 days. The median pre and posttreatment Dimeglio scores were 13 (range 4–20) and 0 (range 0–3), respectively. DCPB at the time of talar head reduction was 53.8 ± 9.8°. In 85% feet, talar head reduction was obtained by DCPB 60° and all were reduced by 70°. The average ankle dorsiflexion improved significantly with DCPB ≥ 50°. The measure at which DCPB matched with talar head reduction of Pirani system was variable (40–70°). In all feet, talar head was reduced by 70° DCPB. Post tenotomy, ankle dorsiflexion was better with DCPB ≥ 50°.
A Comparison of Casting Versus Splinting for Nonoperative Treatment of Pediatric Phalangeal Neck Fractures
Authors: Liao Janice C.Y. , Huan Sarah K.W. , Tan Ruth E.S. , Lim Jin Xi , Chong Alphonsus K.S. , Das De Soumen
Published: September 2020

Background:

Phalangeal neck fractures account for 13% of pediatric finger fractures. Al Qattan type I (undisplaced) fractures are treated nonoperatively. There is increasing evidence that Type 2 (displaced) fractures achieve remarkable fracture remodeling with nonoperative treatment and patients frequently make a full functional recovery. The options available for nonoperative management of these fractures are either a plaster cast or a removable splint. We hypothesized that there would be no significant difference in radiologic outcome in pediatric phalangeal neck fractures (Types I and II) treated with splint or cast immobilization.

Methods:

This is a retrospective study of patients aged 18 and below with phalangeal neck fractures treated nonoperatively from 2008 to 2017. Radiographs were compared at <1 week and >3 weeks after injury. Translation and angulation in coronal and sagittal planes were measured and compared using Student t tests. Baseline variables were compared using χ2 or Fisher exact tests.

Results:

There were 47 patients with phalangeal neck fractures treated nonoperatively during the study period. There were 9 type I and 38 type II fractures. The mean age was 10 years with 40 males and 7 females. Fractures occurred in 33 dominant and 14 nondominant hands and involved 29 proximal and 18 middle phalanges. Nineteen children were treated in casts and 28 with removable splints. The mean duration of follow-up was similar between the 2 groups. The most affected phalanx was the proximal phalanx of the small finger and the most common fracture pattern was type IIA. There was no significant difference in clinical and radiologic outcomes between children who were treated in casts and those treated in removable splints.

Conclusion:

There was no difference in the clinical and radiologic outcomes in pediatric phalangeal neck fractures treated with cast or splint immobilization. Splinting has the added benefits of increased comfort and hygiene and we routinely offer splinting as a viable alternative in the nonoperative treatment of Al Qattan type I and type II phalangeal fractures.

Type of Study/Level of Evidence:

Level III—therapeutic studies.
Intraoperative Neuromonitoring Use Patterns in Degenerative, Nondeformity Cervical Spine Surgery
Authors: Konopka Jeffrey A. , Grabel Zachary J. , Segal Dale N. , Rhee John M.
Published: September 2020

Study Design:

A cross-sectional survey study.

Objective:

To determine the neuromonitoring (NM) usage patterns among cervical spine surgeons when performing degenerative, nondeformity cervical spine surgery.

Summary of Background Data:

Intraoperative NM is frequently used in spine surgery. Although there is literature to support the use of NM in deformity surgery, its utility in degenerative cervical spine surgery remains unclear.

Materials and Methods:

A survey was distributed to members of the Cervical Spine Research Society to assess practice patterns of NM use during degenerative cervical spine surgery. The survey consisted of 17 multiple choice questions. The first 3 questions focus on practice experience. The remaining 14 questions pertain to NM practice patterns in the setting of radiculopathy and myelopathy.

Results:

Significantly more surgeons routinely (>75% of the time) used NM for myelopathy versus radiculopathy (64% vs. 38%, P<0.001). Private practitioners were overall more likely to use NM than academicians (55% vs. 28%, P=0.007 for radiculopathy; 75% vs. 57%, P=0.09 for myelopathy). No significant difference in NM usage was found comparing neurosurgeons and orthopedic spine surgeons. The most commonly cited primary reasons for NM usage were prevention of positioning/hypotension-related neurological complications, and medicolegal protection.

Conclusions:

Routine NM use during degenerative cervical surgery is significantly more common in myelopathy and is thought to be of more value than in radiculopathy. However, the most common reasons for usage were to provide medicolegal cover and to mitigate neurological complications related to positioning/hypotension, rather than to protect against direct surgical events. These findings contrast the prevailing notion that NM is beneficial in reducing complications related to events occurring in the surgical site when performing spinal deformity correction. We believe that these data provide an important baseline for informing best practice guidelines and further study regarding appropriate NM use for degenerative, nondeformity, cervical spine surgery.
Physiologic Response to Angiotensin II Treatment for Coronavirus Disease 2019–Induced Vasodilatory Shock: A Retrospective Matched Cohort Study
Authors: Leisman Daniel E. , Mastroianni Fiore , Fisler Grace , Shah Sareen , Hasan Zubair , Narasimhan Mangala , Taylor Matthew D. , Deutschman Clifford S.
Published: September 2020

Objectives:

To assess the early physiologic response to angiotensin-II treatment in patients with coronavirus disease 2019–induced respiratory failure and distributive shock.

Design:

Retrospective consecutive-sample cohort study.

Setting:

Three medical ICUs in New York during the coronavirus disease 2019 outbreak.

Patients:

All patients were admitted to the ICU with respiratory failure and were receiving norepinephrine for distributive shock.

Interventions:

The treatment groups were patients who received greater than or equal to 1 hour of angiotensin-II treatment. Time-zero was the time of angiotensin-II initiation. Controls were identified using a 2:1 hierarchical process that matched for 1) date and unit of admission; 2) specific organ support modalities; 3) age; 4) chronic lung, cardiovascular, and kidney disease; and 5) sex. Time-zero in the control group was 21 hours post vasopressor initiation, the mean duration of vasopressor therapy prior to angiotensin-II initiation in the treated group.

Measurements and Main Results:

Main outcomes were trajectories of vasopressor requirements (in norepinephrine-equivalent dose) and mean arterial pressure. Additionally assessed trajectories were respiratory (Pao
2/Fio
2, Paco
2), metabolic (pH, creatinine), and coagulation (d-dimer) dysfunction indices after time-zero. We also recorded adverse events and clinical outcomes. Trajectories were analyzed using mixed-effects models for immediate (first 6 hr), early (48 hr), and sustained (7 d) responses. Twenty-nine patients (n = 10 treated, n = 19 control) were identified. Despite matching, angiotensin-II–treated patients had markedly greater vasopressor requirements (mean: 0.489 vs 0.097 µg/kg/min), oxygenation impairment, and acidosis at time-zero. Nonetheless, angiotensin-II treatment was associated with an immediate and sustained reduction in norepinephrine-equivalent dose (6 hr model: β = –0.036 µg/kg/min/hr; 95% CI: –0.054 to –0.018 µg/kg/min/hr, p
interaction=0.0002) (7 d model: β = –0.04 µg/kg/min/d, 95% CI: –0.05 to –0.03 µg/kg/min/d; p
interaction = 0.0002). Compared with controls, angiotensin-II–treated patients had significantly faster improvement in mean arterial pressure, hypercapnia, acidosis, baseline-corrected creatinine, and d-dimer. Three thrombotic events occurred, all in control patients.

Conclusions:

Angiotensin-II treatment for coronavirus disease 2019–induced distributive shock was associated with rapid improvement in multiple physiologic indices. Angiotensin-II in coronavirus disease 2019–induced shock warrants further study.
Complications of Monochorionic Diamniotic Twins: Stepwise Approach for Early Identification, Differential Diagnosis, and Clinical Management
Authors: Micheletti Talita , Eixarch Elisenda , Bennasar Mar , Martinez Josep María , Gratacos Eduard
Published: September 2020

One in three monochorionic twins may develop complications during pregnancy. Monochorionic twins, especially monochorionic diamniotic (MCDA), present specific problems caused by the presence of interfetal placental anastomoses. The first critical step in the management of MCDA twins is identification in the first trimester. Secondly, close follow-up every 2 weeks is mandatory to allow early diagnosis and timely treatment of twin-twin transfusion syndrome. Other potentially severe complications include selective fetal growth restriction, twin anemia polycythemia syndrome or single fetal death. Thirdly, a correct differential diagnosis is critical to establish the best therapy. This may represent a clinical challenge since MCDA twin complications often overlap. A simple diagnostic algorithm may be of great help to establish the right diagnosis and management option. In this review we summarize the main steps for the clinical follow-up, differential diagnosis, and targeted management of MCDA twins complications.
Paraneoplastic Conjunctival Acanthosis Nigricans: A Case Report
Authors: Huang Natalie , Yin Han Y. , Swan Robert
Published: September 2020

Purpose:

To report a patient who presented with red eye and diffuse palpebral conjunctival thickening and papillary growth bilaterally.

Methods:

A 63-year-old woman with a medical history of stage IV adenocarcinoma of the lung with metastasis to the bone, the lung, and the lymph nodes presented with redness and irritation of both eyes for 3 months. The patient has been treated with topical corticosteroids for 3 weeks with no relief of symptoms.

Results:

Clinical examination and pathology report of conjunctival biopsy confirmed the diagnosis of conjunctival acanthosis nigricans.

Conclusions:

Conjunctival acanthosis nigricans is a rare paraneoplastic condition that resembles papilloma and can present a challenge in diagnosis. When acanthosis nigricans occurs after the diagnosis of malignancy, it can be an indicator of progression of the underlying condition. The diagnosis of conjunctival acanthosis nigricans in a patient with no history of cancer should prompt clinicians for further malignancy workup.
Effects of a Workplace Violence Intervention on Hospital Employee Perceptions of Organizational Safety
Authors: Marquez Sergio M. , Chang Chu-Hsiang , Arnetz Judith
Published: September 2020

Objective:

To examine hospital employee perceptions of organizational safety one-year following a workplace violence intervention and to evaluate perceptions based on violence exposure status.

Methods:

In 2014, 343 employees across 41 hospital units (N = 21 control units, N = 20 intervention units) completed a questionnaire capturing organizational safety perceptions and violence exposure.

Results:

Intervention unit employees reported more positive perceptions of organizational safety compared to control unit employees. However, intervention group employees who experienced patient-to-worker violence (Type II) had significantly more positive perceptions than those who experienced worker-to-worker violence (Type III).

Conclusions:

Organizational safety perceptions improved following a violence-prevention intervention, especially among employees who reported Type II violence. Certain employees report worsened safety perceptions. Hospitals and units that implement violence prevention interventions should strive to address all types of violent behavior.
Current and novel imaging techniques to evaluate myocardial dysfunction during hemodialysis
Authors: Hur Lisa , McIntyre Christopher W.
Published: September 2020

Purpose of review

Patients on hemodialysis have significantly higher rates of cardiovascular mortality resulting from a multitude of myocardial dysfunctions. Current imaging modalities allow independent assessment of cardiac morphology, contractile function, coronary arteries and cardiac perfusion. Techniques such as cardiac computed tomography (CT) imaging have been available for some time, but have not yet had widespread adoption because of technical limitations related to cardiac motion, radiation exposure and safety of contrast agents in kidney disease.

Recent findings

Novel dynamic contrast-enhanced (DCE) CT imaging can be used to acquire high-resolution cardiac images, which simultaneously allow the assessment of coronary arteries and the quantitative measurement of myocardial perfusion. The advancement of recent CT scanners and cardiac protocols have allowed noninvasive imaging of the whole heart in a single imaging session with minimal cardiac motion artefact and exposure to radiation.

DCE-CT imaging in clinical practice would allow comprehensive evaluation of the structure, function, and hemodynamics of the heart in a short, well tolerated scanning session. It is an imaging tool enabling the study of myocardial dysfunction in dialysis patients, who have greater cardiovascular risk than nonrenal cardiovascular disease populations, both at rest and under cardiac stress associated with hemodialysis itself.
Nutritional status assessment: a neglected biomarker in persons with end-stage kidney disease
Authors: Viramontes-Hörner Daniela , Taal Maarten W.
Published: September 2020

Purpose of review

Malnutrition is a frequent complication and risk factor for adverse outcomes in the dialysis population that is often underrecognized and neglected. This article reviews published literature on the associations between malnutrition, mortality, quality of life and hospitalizations in persons on dialysis in order to raise awareness of the importance of preventing and treating it.

Recent findings

All methods of nutritional assessment namely serum biochemistry, body composition, dietary intake, handgrip strength and nutritional scoring tools are independently associated with increased mortality in dialysis populations. Malnutrition severely affects physical and mental measures of quality of life and increases the number and length of hospitalizations in persons receiving dialysis, resulting in increased healthcare costs. Worsening of nutritional status is also associated with poor survival and higher rates of hospitalizations in this patient population.

Malnutrition is an unacceptably common complication in dialysis patients that is substantially associated with adverse outcomes and higher hospital costs. Further interventional studies assessing the impact of preventing and treating malnutrition on clinical outcomes are warranted and should be considered a priority.
Update in clinical and mouse microbiota research in allogeneic haematopoietic cell transplantation
Authors: Lindner Sarah , Peled Jonathan U.
Published: September 2020

Purpose of review

The intestinal microbiota plays a critical role in intestinal homeostasis and immune regulation and has been recognized as a predictor of clinical outcome in patients undergoing allogeneic haematopoietic cell transplantation (allo-HCT) and specifically a determinant of the severity of graft-versus-host disease (GVHD) in mouse models. As GVHD is the most important cause of nonrelapse mortality (NRM) after allo-HCT, understanding the mechanisms by which modifying the microbiota may prevent or decrease the severity of GVHD would represent an important advance.

Recent findings

Microbiota injury was observed globally and higher diversity at peri-engraftment was associated with lower mortality. Lactose is a dietary factor that promotes post-allo-HCT Enterococcus expansion, which is itself associated with mortality from GVHD in patients and exacerbates GVHD in mice. Bacterial and fungal bloodstream infections are preceded by intestinal colonization with a corresponding organism, supporting the gut as a source for many bloodstream infections. Metabolomic profiling studies showed that GVHD is associated with changes in faecal and plasma microbiota-derived molecules.

In this review, we highlight some of the most recent and important findings in clinical and mouse microbiota research, as it relates to allo-HCT. Many of these are already being translated into clinical trials that have the potential to change future practice in the care of patients.
Neglect syndrome in post-stroke conditions: assessment and treatment (scoping review)
Authors: Tavaszi Ibolya , Nagy Alexandra Szilvia , Szabo Gabor , Fazekas Gabor
Published: September 2020

There is no consensus about the definition or most effective treatment for neglect syndrome. The aim of this review was therefore to evaluate the results of trials that investigated different treatment methods for neglect syndrome. A systematic literature search in PubMed and Web of Science databases was performed to identify studies that investigated the effects of neglect therapies. Authors followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies were selected by two assayers, and disagreement was resolved by a third reviewer. The literature search identified 202 articles: 19 met the inclusion criteria and were included for data extraction. Thirty-five different kinds of assessments were used in these studies, and 17 treatment methods were applied. Successful treatments were reported at least in some parts of the assessments in 12 studies: mirror therapy (in two trials), transcranial magnetic stimulation, street crossing test in virtual reality, smooth pursuit eye movement training, saccadic eye movement therapy, direct current stimulation, eye patching therapy, prism adaptation treatment, socially assistive pet-type therapeutic robot (PARO), Kinesiological Instrument for Normal and Altered Reaching Movement robotic device therapy, transcutaneous electrical nerve stimulation, and optokinetic stimulation (the last two methods in the same trial). No success was shown in seven trials, which contained not only single treatments but combined ones also. Authors concluded that there are no convincing results for or against any of the different therapies used for neglect syndrome. The quality of the trials is questionable, and the numbers of included patients are small in the trials.
Cost and cost-effectiveness of early inpatient rehabilitation after stroke varies with initial disability: the Czech Republic perspective
Authors: Angerova Yvona , Marsalek Pavel , Chmelova Irina , Gueye Tereza , Uherek Stepan , Briza Jan , Bartak Miroslav , Rogalewicz Vladimir
Published: September 2020

The purpose of this prospective study was to determine whether the cost and cost-effectiveness of early rehabilitation after stroke are associated with the degree of initial disability. The data for cost calculations were collected by the bottom-up (micro-costing) method alongside the standard inpatient care. The total sample included 87 patients who were transferred from acute care to early rehabilitation unit of three participating stroke centers at the median time poststroke of 11 days (range 4–69 days). The study was pragmatic so that all hospitals followed their standard therapeutic procedures. For each patient, the staff recorded each procedure and the associated time over the hospital stay. The cost and cost-effectiveness were compared between four disability categories. The average cost of the entire hospitalization was CZK 114 489 (EUR 4348) with the daily average of CZK 5103 (EUR 194). The cost was 2.4 times higher for the immobile category (CZK/EU: 167 530/6363) than the self-sufficient category (CZK/EUR: 68 825/2614), and the main driver of the increase was the cost of nursing. The motor status had a much greater influence than cognitive status. We conclude that the cost and cost-effectiveness of early rehabilitation after stroke are positively associated with the degree of the motor but not cognitive disability. To justify the cost of rehabilitation and monitor its effectiveness, it is recommended to systematically record the elements of care provided and perform functional assessments on admission and discharge.
Randomized Clinical Trial of 20% Mannitol Versus 3% Hypertonic Saline in Children With Raised Intracranial Pressure Due to Acute CNS Infections*
Authors: Rameshkumar Ramachandran , Bansal Arun , Singhi Sunit , Singhi Pratibha , Jayashree Muralidharan
Published: September 2020

Objectives:

Mannitol is a commonly used osmotherapy agent in raised intracranial pressure. However, the side effects of mannitol are significant. In traumatic brain injury (adult and pediatric), hypertonic saline (3%) shows varied results in comparison with 20% mannitol. We compared the effect of 3% hypertonic saline versus 20% mannitol (using common dosing strategies) on raised intracranial pressure in pediatric acute CNS infections.

Design:

Open-label randomized controlled trial.

Setting:

PICU of a quaternary care academic institute.

Patients:

Children 1–12 years old, with raised intracranial pressure and modified-Glasgow Coma Scale scores less than or equal to 8, were enrolled.

Interventions:

Patients were randomly assigned to 20%-mannitol (n = 28), 0.5 gram/kg/dose versus 3%-hypertonic saline (n = 29), 10 mL/kg loading followed by 0.5–1 mL/kg/hr infusion. An intraparenchymal catheter was used to monitor the intracranial pressure. The primary outcome was the proportion of patients achieved target average intracranial pressure less than 20 mm Hg during 72 hours. Secondary outcomes were interventions, morbidity, and mortality.

Measurements and Main Results:

The proportion of patients with target average intracranial pressure (< 20 mm Hg) was higher in hypertonic saline-group as compared to mannitol-group (79.3% vs 53.6%; adjusted hazard ratio 2.63; 95% CI: 1.23–5.61). Mean (± se) reduction of intracranial pressure (–14.3 ± 1.7 vs –5.4 ± 1.7 mm Hg; p ≤ 0.001) and elevation of cerebral perfusion pressure (15.4 ± 2.4 vs 6 ± 2.4 mm Hg; p = 0.007) from baseline were significant in hypertonic saline-group. Mean (± se) intracranial pressure over 72 hours was lower (14 ± 2 vs 22 ± 2 mm Hg; p = 0.009), and cerebral perfusion pressure was higher (65 ± 2.2 vs 58 ± 2.2; p = 0.032) in hypertonic saline-group. Hypertonic saline-group had higher modified-Glasgow Coma Scale score at 72 hours (median, interquartile range 10; 7–11 vs 7; 3–9; p = 0.003), lower mortality (20.7% vs 35.7%; p = 0.21), shorter duration of mechanical ventilation (5 vs 15 d; p = 0.002), and PICU stay (11 vs 19 d; p = 0.016) and less severe neurodisability at discharge (31% vs 61%; p = 0.049).

Conclusions:

In pediatric acute CNS infections, 3%-hypertonic saline was associated with a greater reduction of intracranial pressure as compared to 20% mannitol.
A Case of Nonalcoholic Steatohepatitis in Central Precocious Puberty Aggravated by Gonadotropin-releasing Hormone Analog
Authors: Sasaki Yoshiaki , Kajino Hiroki , Gotoda Hiroko
Published: September 2020

We report the case of a girl with central precocious puberty (CPP) and nonalcoholic steatohepatitis (NASH) aggravated by gonadotropin-releasing hormone analog (GnRHa). She was diagnosed with CCP and began treatment with GnRHa at the age of 8 years and 9 months. She already had mild liver dysfunction and was obese at that time; however, liver dysfunction was aggravated during GnRHa initiation. Her liver dysfunction improved after the discontinuation of GnRHa. Liver biopsy was performed twice during GnRHa initiation and findings suggested NASH. In this case, NASH may have been aggravated by the mechanism of estrogen suppression by GnRHa besides obesity. In conclusion, NASH should be ruled out in obese CPP patients with abnormal liver function before starting GnRHa therapy. CPP patients treated with GnRHa require close examination for the early diagnosis of NASH or its progression.
Transitions to Postsecondary Education in Young Adults with Hemoglobinopathies: Perceptions of Patients and Staff
Authors: Allemang Brooke A. , Bradley James , Leone Rosemary , Henze Megan
Published: September 2020

Introduction:

The transition from high school to postsecondary education can be challenging for adolescents and young adults (AYAs) with chronic health conditions. AYAs with hemoglobinopathies, including sickle cell disease, are a particularly vulnerable group whose academic performance is impacted by unpredictable disease symptoms. AYA with hemoglobinopathies may require academic accommodations to promote postsecondary success; however, accessing appropriate supports can be complicated.

Methods:

Given these complexities, a multidisciplinary team in a pediatric outpatient clinic designed and implemented a standardized intervention to support AYA with hemoglobinopathies in navigating the transition to postsecondary education. A quality improvement (QI) project was initiated to support the referral of all eligible patients with hemoglobinopathies to postsecondary accessibility offices. This article will describe the development of the intervention and present key findings from qualitative interviews with patients (ages 18−19) and postsecondary accessibility office staff about the implemented resources as an initial step of an ongoing QI project. We used thematic analysis to identify themes across interviews with both groups of stakeholders.

Results:

Key themes across both groups of interviews highlighted the benefits of the intervention, including (1) knowledge of available services, (2) registering early with appropriate documentation, and (3) self-advocacy.

Conclusions:

The preliminary qualitative findings validate the importance of embedding discussions about the transition to postsecondary education into routine clinic appointments for AYA with chronic health conditions. Clinical implications of this ongoing QI project for health care providers working with AYA with chronic health conditions will be shared.