bluuebunny/crossref_metadata_2025 huggingface dataset:
Young Terrorists or Child Soldiers? ISIS Children, International Law and Victimhood
Authors: Nyamutata Conrad
Published: January 2020

Since the Syrian conflict broke out, a significant number of Western citizens travelled to the warzone to join the Islamic State of Iraq and Syria (ISIS). By common definitions, some of the persons travelled as ‘children’. However, since the defeat of ISIS, Western countries are facing a conundrum on how to treat these young former fighters. The status of these children has been contentious. Among the Western countries, there does not seem to be a clear position or consistent approach on how such children should be treated. It would appear that the approaches towards the dilemma on these young persons have, predominantly, been dictated by the political whims of individual states. Generally, the children have been regarded as young ‘terrorists’ likely to pose danger to Western societies if repatriated back. However, the perceptions and actions towards these minors seem to depart from the normative approaches to children associated with armed conflict. The widely reported case of British teenager Shamima Begum shone the spotlight on the predicaments of children formerly associated with ISIS. This article makes a case for the treatment of ISIS-associated children to be considered as child soldiers. When analysed closely, these children deserve protections accorded to all children recruited for purposes of warfare. Recent case law seems to imply that such protection does not cease even after the age of 18 years. All considered, the denial of repatriation appears inimical to normative standards on children associated with armed conflict. Furthermore, the approaches of some of the Western countries could be vulnerable to criticism for violation of the rule of law. The arbitrary revocation of citizenship and barring of returns appear starkly in conflict with norms of natural justice. With this in mind, this article asserts that a consistent approach would require the Western approaches to treat ISIS-associated children as victims first and accord them protections recognised in international law.
Resistance of Amaranthus Spp. to the Green Peach Aphid (Hemiptera: Aphididae)
Authors: Nampeera Esther L , Blodgett Sue , O’Neal Matthew E , Nonnecke Gail R , Murungi Lucy K , Abukutsa-Onyango Mary O , Wesonga John M
Published: January 2020

The green peach aphid [Myzus persicae (Sulzer)] is an important pest of amaranth grown for leaf consumption (i.e., leafy amaranth) in the tropics. Aphids reduce the amount of fresh leaf yield of amaranth and the value of leafy amaranth as aphid-infested leaves are not marketable. Our objective was to evaluate Amaranthus species selected by a breeding program in East Africa to develop cultivars for leaf consumption with resistance to M. persicae. We focused on antibiosis to determine whether varieties of Amaranthus spp. could be grown without producing an aphid population. Artificial infestations of aphids were placed on multiple selections of three species of Amaranthus: two selections of A. blitum, four selections of A. hybridus and one selection of A. hypochondriacus. Aphid populations were assessed over a 5-wk period. Evaluations of vegetative yield, leaf damage symptoms, and specific leaf area (SLA) were made of the seven selections at the end of this experiment. Aphid populations assessed 49 d after planting differed significantly (P ≤ 0.001) among the amaranth species and within selections of the same species. The selections of A. blitum had the lowest aphid populations, and A. hybridus had the highest populations. Selections of A. hybridus produced the most marketable leaves (i.e., aphid free). The fresh weight of A. blitum were the lowest of the seven selections, whereas A. hybridus had the greatest fresh leaf weight. Implications of these finding for further promotion of amaranth breeding are discussed related to pest management for leaf production.
The Psychological Costs of Citizen Coproduction
Authors: Thomsen Mette Kjærgaard , Baekgaard Martin , Jensen Ulrich Thy
Published: January 2020

Coproduction where citizens collaborate with public employees in producing and delivering public services is often argued to be associated with benefits for either participating citizens, their relatives, friends, or society at large. Less is known about the potential downsides associated with citizen participation in coproduction of public services. We argue that psychological costs, such as experiences of stigma, stress, and loss of autonomy may arise among citizens in response to coproduction initiatives stimulated or directly imposed by public organizations. We test our propositions in two randomized vignette experiments on a representative sample of Danish citizens. First, we manipulate whether citizens are encouraged to coproduce public services yielding private or collective benefits. Second, we induce perceived self-efficacy among a subsample of citizens. We find that citizens are more likely to experience psychological costs when they are encouraged to coproduce public services resulting in private benefits for relatives or friends in contrast to collective benefits for a larger group of people. Furthermore, these psychological costs are felt to a greater extent among citizens with low self-efficacy. Fusing insights from multiple perspectives, our study pushes the theoretical frontiers of coproduction literature by illustrating how complex emotional responses is an overlooked, but integral part of a more comprehensive theory on the manifestations and effects of citizen coproduction.
Pneumonia of unknown aetiology in Wuhan, China: potential for international spread via commercial air travel
Authors: Bogoch Isaac I , Watts Alexander , Thomas-Bachli Andrea , Huber Carmen , Kraemer Moritz U G , Khan Kamran
Published: January 2020

There is currently an outbreak of pneumonia of unknown aetiology in Wuhan, China. Although there are still several unanswered questions about this infection, we evaluate the potential for international dissemination of this disease via commercial air travel should the outbreak continue.
The governance of nuclear power in China
Authors: Andrews-Speed Philip
Published: January 2020

China has the third largest fleet of nuclear power plants in the world, totalling more than 45 GWe at the end of 2019. With the current high rate of growth, its capacity will soon overtake that of France. The country’s nuclear power industry has suffered no serious accidents to date. Nevertheless, the poor safety record of some other heavy industries in China, combined with the rapid growth of civil nuclear power capacity, has raised concerns over the industry’s ability to prevent a serious accident. The organization, development and governance of China’s nuclear power industry reflects the high strategic importance that the government has placed on the industry over several decades. At the same time, it has taken steps to address domestic and international concerns over its ability to effectively govern nuclear safety and security. The country has become party to most major treaties and conventions relating to nuclear matters and has frequent interaction with the International Atomic Energy Agency. Despite many significant steps taken by the government, a number of questions remain concerning: the capacity and independence of the National Nuclear Safety Administration; the relatively incoherent nature of the body of laws, regulations and rules that govern nuclear safety and security; the absence of a clear legal basis for managing civil nuclear liability, especially in the context of an accident with transboundary consequences; and the quality of public participation, especially in the case of planned nuclear power plants.
The NICE Guideline On Medicinal Cannabis: Keeping Pandora’s Box Shut Tight?
Authors: Case Paula
Published: January 2020

November 2018 saw the prescription of unlicensed medicinal cannabis products being legalised in the UK, accompanied by loud media fanfare. One year on, it seems that access to medicinal cannabis in this country continues to be extremely rare, raising questions about what might be stopping doctors from making use of the legal space to prescribe. This commentary explores some of these questions, outlining the theoretical space for legal prescribing and examining whether the recently announced National Institute for Health and Care Excellence guideline does anything to ease the deadlock.
Lyman continuum escape fraction in Ly α emitters at z ≃ 3.1
Authors: Bian Fuyan , Fan Xiaohui
Published: January 2020

We measure the Lyman continuum (LyC) escape fraction in 54 faint Lyman-alpha emitters (LAEs) at $z$ ≃ 3.1 in the GOODS-South field. With the average magnitude of R = 26.7 AB (MUV = −18.8 and L ≃ 0.1L*), these galaxies represent a population of compact young dwarf galaxies. Their properties are likely to resemble those in the galaxies responsible for reionizing the Universe at $z$ > 6. We do not detect LyC emission in any individual LAEs in the deep HST F336W images, which covers the rest-frame 820 Å. We do not detect the LyC emission of these LAEs in the stacked F336W images either. The 3σ upper limit of LyC escape fractions is $f_{\rm esc}\lt 14\!-\!32{{\ \rm per\ cent}}$. However, the high Ly α rest-frame equivalent width (EW), low stellar mass, and UV luminosity of these LAEs suggest that they should have $f_{\rm esc}\gt 50{{\ \rm per\ cent}}$. The low LyC escape fraction from this work and other stacking analyses suggests that the LyC-leaking galaxies with $f_{\rm esc}\gt 50{{\ \rm per\ cent}}$ at $z$ = 2–3 do not follow the relation between fesc and UV luminosity and Ly α EW derived from typical galaxies at similar redshifts. Therefore, the UV luminosity and Ly α EW are not the best indicators for the LyC escape fraction.
Genetic Basis of De Novo Appearance of Carotenoid Ornamentation in Bare Parts of Canaries
Authors: Gazda Małgorzata Anna , Toomey Matthew B , Araújo Pedro M , Lopes Ricardo J , Afonso Sandra , Myers Connie A , Serres Kyla , Kiser Philip D , Hill Geoffrey E , Corbo Joseph C , Carneiro Miguel
Published: January 2020

Unlike wild and domestic canaries (Serinus canaria), or any of the three dozen species of finches in genus Serinus, the domestic urucum breed of canaries exhibits bright red bills and legs. This novel trait offers a unique opportunity to understand the mechanisms of bare-part coloration in birds. To identify the mutation producing the colorful phenotype, we resequenced the genome of urucum canaries and performed a range of analyses to search for genotype-to-phenotype associations across the genome. We identified a nonsynonymous mutation in the gene BCO2 (beta-carotene oxygenase 2, also known as BCDO2), an enzyme involved in the cleavage and breakdown of full-length carotenoids into short apocarotenoids. Protein structural models and in vitro functional assays indicate that the urucum mutation abrogates the carotenoid-cleavage activity of BCO2. Consistent with the predicted loss of carotenoid-cleavage activity, urucum canaries tended to have increased levels of full-length carotenoid pigments in bill tissue and reduced levels of carotenoid-cleavage products (apocarotenoids) in retinal tissue compared with other breeds of canaries. We hypothesize that carotenoid-based bare-part coloration might be readily gained, modified, or lost through simple switches in the enzymatic activity or regulation of BCO2 and this gene may be an important mediator in the evolution of bare-part coloration among bird species.
Gender issues from the perspective of health-care professionals in Neuro-oncology: an EANO and EORTC Brain Tumor Group survey
Authors: Le Rhun Emilie , Weller Michael , Niclou Simone P , Short Susan , Piil Karin , Boele Florien , Rudà Roberta , Theodorou Marilena , Brandsma Dieta , van den Bent Martin , Dirven Linda
Published: January 2020

Background

Women represent an increasing proportion of the overall workforce in medicine but are underrepresented in leadership roles.

Methods

To explore gender inequalities and challenges in career opportunities, a web-based survey was conducted among the membership of the European Association of Neuro-Oncology and the Brain Tumor Group of the European Organisation for Research and Treatment of Cancer.

Results

A total of 228 colleagues responded to the survey: 129 women (median age 45 years; range, 25-66 years) and 99 men (median age 48 years; range, 24-81 years); 153 participants (67%) were married and 157 participants (69%) had at least 1 child. Women less often declared being married (60% vs 77%, P = .007) or having a child (63% vs 77%, P = .024). Men more frequently had a full-time position (88% vs 75%, P = .036). Women and men both perceived an underrepresentation of women in leadership positions. Half of participants agreed that the most important challenges for women are leading a team and obtaining a faculty position. Fewer women than men would accept such a position (42% vs 56%). The main reasons were limited time for career and an inappropriate work and life balance. Women specifically cited negative discrimination, limited opportunities, and lack of self-confidence. Discrimination of women at work was perceived by 64% of women vs 47% of men (P = .003).

Conclusion

Women are perceived as experiencing more difficulties in acquiring a leadership position. Personal preferences may account for an underrepresentation of women in leadership positions, but perceived gender inequalities extend beyond disparities of access to leadership.
The Role of A Priori–Identified Addiction and Smoking Gene Sets in Smoking Behaviors
Authors: Evans Luke M , Johnson Emma C , Melroy-Greif Whitney E , Hewitt John K , Hoeffer Charles A , Keller Matthew C , Saba Laura M , Stitzel Jerry A , Ehringer Marissa A
Published: January 2020

Introduction

Smoking is a leading cause of death, and genetic variation contributes to smoking behaviors. Identifying genes and sets of genes that contribute to risk for addiction is necessary to prioritize targets for functional characterization and for personalized medicine.

Methods

We performed a gene set–based association and heritable enrichment study of two addiction-related gene sets, those on the Smokescreen Genotyping Array and the nicotinic acetylcholine receptors, using the largest available GWAS summary statistics. We assessed smoking initiation, cigarettes per day, smoking cessation, and age of smoking initiation.

Results

Individual genes within each gene set were significantly associated with smoking behaviors. Both sets of genes were significantly associated with cigarettes per day, smoking initiation, and smoking cessation. Age of initiation was only associated with the Smokescreen gene set. Although both sets of genes were enriched for trait heritability, each accounts for only a small proportion of the single nucleotide polymorphism-based heritability (2%–12%).

Conclusions

These two gene sets are associated with smoking behaviors, but collectively account for a limited amount of the genetic and phenotypic variation of these complex traits, consistent with high polygenicity.

Implications

We evaluated evidence for the association and heritable contribution of expert-curated and bioinformatically identified sets of genes related to smoking. Although they impact smoking behaviors, these specifically targeted genes do not account for much of the heritability in smoking and will be of limited use for predictive purposes. Advanced genome-wide approaches and integration of other ‘omics data will be needed to fully account for the genetic variation in smoking phenotypes.
Antiplatelet and Anticoagulant Risk for Select Spine Interventions: A Retrospective Cohort
Authors: Ehsanian Reza , Rosati Renee M , Kennedy David J , Schneider Byron J
Published: January 2020

Objectives

To identify significant bleeding complications following spinal interventions in patients taking medications with antiplatelet or anticoagulation effect.

Design

Retrospective chart review of a 12-month period.

Setting

Outpatient academic medical practice.

Interventions

Injections during outpatient interventional spine clinical encounters, including 14 cervical transforaminal epidural steroid injections, 26 cervical medial branch blocks, seven cervical radiofrequency neurotomies, three cervical facet joint injections, 88 lumbar transforaminal epidural steroid injections, 66 lumbosacral medial branch blocks, 18 lumbosacral radiofrequency neurotomies, 13 lumbar facet joint injections, one caudal epidural steroid injection, 11 sacral transforaminal epidural steroid injections, and 32 sacroiliac joint injections.

Main Outcome Measure

Epidural hematoma or other serious bleeding.

Results

In this cohort of 275 consecutive encounters with available records in which patients underwent a spinal injection while continuing medications with antiplatelet or anticoagulant effect, zero of the 275 clinical encounters (0%, 95% confidence interval = 0–1.4%) resulted in epidural hematoma or other serious bleeding. For antiplatelet medication, nonsteroidal anti-inflammatory drugs were continued in 102 procedures, aspirin in 142, clopidogrel in 21, and meloxicam and/or Celebrex in 81; for anticoagulation medication, warfarin was continued in four procedures, apixaban in six, dabigatran in one, and fondaparinux in two. Of note, one patient suffered a deep vein thrombosis, which was identified at two-week follow-up despite continuing aspirin therapy.

Conclusions

This cohort adds to the growing evidence that the risk of serious bleeding complications from select spine interventions while continuing medications with antiplatelet or anticoagulant effect appears low.
Balance and Gait After First Minor Ischemic Stroke in People 70 Years of Age or Younger: A Prospective Observational Cohort Study
Authors: Hamre Charlotta , Fure Brynjar , Helbostad Jorunn L , Wyller Torgeir B , Ihle-Hansen Hege , Vlachos Georgios , Ursin Marie , Tangen Gro Gujord
Published: January 2020

Background

Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients <70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group.

Objective

The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients ≤70 years with minor ischemic stroke (National Institutes of Health Stroke Scale score ≤3). This study also explored factors predicting impaired balance after 12 months.

Design

This study was designed as an explorative longitudinal cohort study.

Methods

Patients were recruited consecutively from 2 stroke units. Balance and gait were assessed with the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, and preferred gait speed. Predictors for impaired balance were explored using logistic regression.

Results

This study included 101 patients. Mean (SD) age was 55.5 (11.4) years, 20% were female, and mean (SD) National Institutes of Health Stroke Scale score was 0.6 (0.9) points. The Mini-BESTest, gait speed, and Timed Up and Go improved significantly from the acute phase to 3 months, and gait speed also improved from 3 to 12 months. At 12 months, 26% had balance impairments and 33% walked slower than 1.0 m/s. Poor balance in the acute phase (odds ratio = 0.92, 95% confidence interval = 0.85–0.95) was the only predictor of balance impairments (Mini-BESTest score ≤22) at 12 months poststroke.

Limitations

Limitations include lack of information about pre-stroke balance and gait impairment and poststroke exercise. Few women limited the generalizability.

Conclusion

This study observed improvements in both balance and gait during the follow-up; still, about one-third had balance or gait impairments at 12 months poststroke. Balance in the acute phase predicted impaired balance at 12 months.
Amino Acid Polymorphism in Succinate Dehydrogenase Subunit C Involved in Biological Fitness of Botrytis cinerea
Authors: Shao Wenyong , Sun Jingtao , Zhang Xiaoke , Chen Changjun
Published: January 2020

Succinate dehydrogenase (SDH) is an important respiratory enzyme which participates in the tricarboxylic acid cycle and oxidative phosphorylation. A previous study of the baseline sensitivity of Botrytis cinerea against SDH inhibitors (SDHIs) showed that intrinsic sensitivity of the small population against the SDHIs exhibited significant differences. In the sequencing assay, we found five kinds of amino acid polymorphism in SDH subunit C (SdhC) of B. cinerea isolates which were never exposed to the SDHIs. To validate that amino acid polymorphism in the SdhC of B. cinerea confers intrinsic sensitivity against the SDHIs, the replacement mutants containing each kind of amino acid polymorphism of SdhC exhibited phenotype differences in intrinsic sensitivity to SDHIs, mycelial growth, sporulation, virulence, oxidative stress response, and carbon source utilization. These results indicated that SdhC of B. cinerea experienced positive selection during evolution and resulted in amino acid polymorphism which is involved in intrinsic sensitivity to SDHIs and biological fitness.
Family Caregiver-Receiver Mutuality
Authors: Streck Brennan P. , Wardell Diane Wind , Wood Geri LoBiondo
Published: January 2020

There are more than 43 million family caregivers in the United States. In studies of family caregivers and receivers, evidence suggests that family caregiver-receiver mutuality is linked to health. Lack of a clear definition of family caregiver-receiver mutuality is an obstacle that prevents scientific progress and effective operationalization of the concept. To address this issue, the authors applied Walker and Avant's method for concept analysis and clarified the concept of family caregiver-receiver mutuality. A standardized definition of caregiver-receiver mutuality is presented along with antecedents, consequences, defining attributes, empirical referents, and case illustrations.
A Meta-analysis Assessing the Association Between COL11A1 and GDF5 Genetic Variants and Intervertebral Disc Degeneration Susceptibility
Authors: Wu Fashuai , Huang Xin , Zhang Zhicai , Shao Zengwu
Published: January 2020

Study Design.

Meta-analysis to collect relevant studies to assess the association between COL11A1 and GDF5 genetic variants and susceptibility to IDD.

Objective.

The aim of this study was to assess whether or not COL11A1 and GDF5 genetic variants were associated with susceptibility to IDD.

Summary of Background Data.

IDD or LDH is a major public health problem. There have been several studies evaluating the relationship between COL11A1 and GDF5 genetic variants with risk of intervertebral disc degeneration (IDD). However, the studies were limited in discrete outcome and sample size, and some of the results were contradictory.

Methods.

We systematically searched the relevant publications in electronic databases. Eligible studies were included based on the defined criteria. The pooled odds ratios (ORs) with its 95% confidence intervals (CIs) were received using STATA 15. Subgroup analysis, sensitivity analysis, publication bias, and the “Trim and fill” method were performed in the meta-analysis.

Results.

A total of 3287 IDD cases and 5115 controls were incorporated into the meta-analysis. Our results demonstrated that COL11A1 rs1676486 was significantly associated with increased IDD susceptibility under all genetic models (allele model T vs. C: OR = 1.40, 95% CI 1.23–1.59, P = 0.000; homozygote model TT vs. CC: OR = 1.89, 95%CI 1.40–2.56, P = 0.000; dominant model TT+TC vs. CC: OR = 1.52, 95% CI 1.29–1.80, P = 0.000; recessive model TT vs. TC + CC: OR = 1.58, 95% CI 1.18–2.12, P = 0.002). However, GDF5 rs143383 was not (allele model T vs. C: OR = 1.15, 95% CI 0.91–1.44, P = 0.244; homozygote model TT vs. CC: OR = 1.22, 95% CI 0.75–2.00, P = 0.429; dominant model TT vs. CC+CT: OR = 1.22, 95% CI 0.95–1.57, P = 0.112; recessive model TC + TT vs. CC: OR = 1.12, 95% CI 0.73–1.73, P = 0.594). Subgroup analysis indicated ethnicity was not the source of heterogeneity. Sensitivity analysis, publication bias, and the “Trim and fill” method demonstrated the meta-analysis was of reliability.

Conclusion.

Our results suggested that COL11A1 rs1676486 was significantly associated with IDD and the T allele was a risky factor. However, GDF5 rs143383 was not.

Level of Evidence: 1
Preoperative Predictors of Better Long-term Functional Ability and Decreased Pain Following LSS Surgery
Authors: Tuomainen Iina , Pesonen Janne , Rade Marinko , Pakarinen Maarit , Leinonen Ville , Kröger Heikki , Airaksinen Olavi , Aalto Timo
Published: January 2020

Study Design.

A prospective observational 10-year follow-up study.

Objective.

This study aimed to examine preoperative predictors for better surgical outcomes in patients with lumbar spinal stenosis (LSS) 10 years after surgery.

Summary of Background Data.

LSS is a leading cause of low back surgery in patients older than 65 years. Limited data are available for predictors of long-term surgical outcomes in patients with LSS.

Methods.

At the baseline, 102 patients with LSS underwent decompressive surgery, and 72 of the original study sample participated in a 10-year follow-up study. Study patients filled out a questionnaire preoperatively, and follow-up data were collected at 3 months, 6 months, 1 year, 2 years, 5 years, and 10 years postoperatively. Surgical outcomes were evaluated in terms of disability with the Oswestry Disability Index (ODI) and pain with the visual analog scale (VAS). Predictors in the models were nonsmoking status, absence of previous lumbar surgery, self-rated health, regular use of painkillers for symptom alleviation, and BMI. Statistical analyses included longitudinal associations, subgroup analyses, and cross-sectional analyses.

Results.

Using multivariate analysis, statistically significant predictors for lower ODI and VAS scores at 10 years were nonsmoking status, absence of previous lumbar surgery, better self-rated health, and regular use of painkillers for <12 months. Patients who smoked preoperatively or had previous lumbar surgery experienced more pain and disability at the 10-year follow-up.

Conclusion.

These study results can enhance informed decision-making processes for patients considering surgical treatment for LSS by showing preoperative predictors for surgical outcomes up to 10 years after surgery. Smokers and patients with previous lumbar surgery showed a decline in surgical benefits after 5 years.

Level of Evidence: 3
Demographic Shifts, Case Mix, Activity, and Outcome for Elderly Patients Admitted to Adult General ICUs in England, Wales, and Northern Ireland
Authors: Jones Andrew , Toft-Petersen Anne P. , Shankar-Hari Manu , Harrison David A. , Rowan Kathryn M.
Published: January 2020

Objectives:

Major increases in the proportion of elderly people in the population are predicted worldwide. These population increases, along with improving therapeutic options and more aggressive treatment of elderly patients, will have major impact on the future need for healthcare resources, including critical care. Our objectives were to explore the trends in admissions, resource use, and risk-adjusted hospital mortality for older patients, admitted over a 20-year period between 1997 and 2016 to adult general ICUs in England, Wales, and Northern Ireland.

Design: Retrospective analysis of national clinical audit database.Setting:

The Intensive Care National Audit & Research Centre Case Mix Programme Database, the national clinical audit for adult general ICUs in England, Wales, and Northern Ireland.

Patients:

All adult patients 16 years old or older admitted to adult general ICUs contributing data to the Case Mix Programme Database between January 1, 1997, and December 31, 2016.

Measurements and Main Results:

The annual number, trends, and outcomes for patients across four age bands (16–64, 65–74, 75–84, and 85+ yr) admitted to ICUs contributing to the Case Mix Programme Database from 1997 to 2016 were examined. Case mix, activity, and outcome were described in detail for the most recent cohort of patients admitted in 2015–2016. Between 1997 to 2016, the annual number of admissions to ICU of patients in the older age bands increased disproportionately, with increases that could not be explained solely by general U.K. demographic shifts. The risk-adjusted acute hospital mortality decreased significantly within each age band over the 20-year period of the study. Although acute severity at ICU admission was comparable with that of the younger age group, apart from cardiovascular and renal dysfunction, older patients received less organ support. Older patients stayed longer in hospital post-ICU discharge, and hospital mortality increased with age, but the majority of patients surviving to hospital discharge returned home.

Conclusions:

Over the past two decades, elderly patients have been more commonly admitted to ICU than can be explained solely by the demographic shift. Importantly, as with the wider population, outcomes in elderly patients admitted to ICU are improving over time, with most patients returning home.
Reversibility of Acute Kidney Injury in Medical ICU Patients: Predictability Performance of Urinary Tissue Inhibitor of Metalloproteinase-2 x Insulin-Like Growth Factor-Binding Protein 7 and Renal Resistive Index
Authors: Garnier Fanny , Daubin Delphine , Larcher Romaric , Bargnoux Anne-Sophie , Platon Laura , Brunot Vincent , Aarab Yassir , Besnard Noémie , Dupuy Anne-Marie , Jung Boris , Cristol Jean-Paul , Klouche Kada
Published: January 2020

Objectives:

Urinary biomarkers and renal Doppler sonography remain considered as promising tools to distinguish transient from persistent acute kidney injury. The performance of the urinary biomarker, tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 and of renal resistive index to predict persistent acute kidney injury showed contradictory results. Our aim was to evaluate the performance of tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 and renal resistive index in predicting reversibility of acute kidney injury in critically ill patients.

Design:

Prospective observational study.

Setting:

Twenty-bed medical ICU in an university hospital.

Patients:

Consecutive patients with acute kidney injury.

Intervention:

None.

Measurements and Main Results:

Renal resistive index was measured within 12 hours after admission, and urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 was measured at H0, H6, H12, and H24. Renal dysfunction reversibility was evaluated at day 3. Receiver operating characteristic curves were plotted to evaluate diagnostic performance of renal resistive index and tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 to predict a persistent acute kidney injury. Overall, 100 patients were included in whom 50 with persistent acute kidney injury. Renal resistive index was higher in persistent acute kidney injury group. Urinary tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 was not significantly different at each time between both groups. The performance of tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 was poor with respectively an area under the receiver operating characteristic curves of 0.57 (95% CI, 0.45–0.68), 0.58 (95% CI, 0.47–0.69), 0.61 (95% CI, 0.50–0.72), and 0.57 (95% CI, 0.46–0.68) at H0, H6, H12, and H24. The area under the receiver operating characteristic curve for renal resistive index was 0.93 (95% CI, 0.89–0.98). A renal resistive index greater than or equal to 0.685 predicting persistent acute kidney injury with 78% (95% CI, 64–88%) sensitivity and 90% (95% CI, 78–97%) specificity.

Conclusions:

Renal resistive index had a good performance for predicting the reversibility of acute kidney injury in critically ill patients. Urinary tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 was unable to differentiate transient from persistent acute kidney injury.
Mesenchymal Stromal Cells Protect the Blood-Brain Barrier, Reduce Astrogliosis, and Prevent Cognitive and Behavioral Alterations in Surviving Septic Mice
Authors: Silva Adriano Y. O. , Amorim Érica A. , Barbosa-Silva Maria C. , Lima Maiara N. , Oliveira Helena A. , Granja Marcelo G. , Oliveira Karina S. , Fagundes Paula M. , Neris Rômulo L. S. , Campos Raquel M. P. , Moraes Carolina A. , Vallochi Adriana L. , Rocco Patricia R. M. , Bozza Fernando A. , Castro-Faria-Neto Hugo C. , Maron-Gutierrez Tatiana
Published: January 2020

Objectives:

Survivors of sepsis are frequently left with significant cognitive and behavioral impairments. These complications derive from nonresolving inflammation that persists following hospital discharge. To date, no study has investigated the effects of mesenchymal stromal cell therapy on the blood-brain barrier, astrocyte activation, neuroinflammation, and cognitive and behavioral alterations in experimental sepsis.

Design:

Prospective, randomized, controlled experimental study.

Setting:

Government-affiliated research laboratory.

Subjects:

Male Swiss Webster mice (n = 309).

Interventions:

Sepsis was induced by cecal ligation and puncture; sham-operated animals were used as control. All animals received volume resuscitation (1 mL saline/mouse subcutaneously) and antibiotics (meropenem 10 mg/kg intraperitoneally at 6, 24, and 48 hours). Six hours after surgery, mice were treated with mesenchymal stromal cells IV (1 × 105 cells in 0.05 mL of saline/mouse) or saline (0.05 mL IV).

Measurements and Main Results:

At day 1, clinical score and plasma levels of inflammatory mediators were increased in cecal ligation and puncture mice. Mesenchymal stromal cells did not alter clinical score or survival rate, but reduced levels of systemic interleukin-1β, interleukin-6, and monocyte chemoattractant protein-1. At day 15, survivor mice completed a battery of cognitive and behavioral tasks. Cecal ligation and puncture mice exhibited spatial and aversive memory deficits and anxiety-like behavior. These effects may be related to increased blood-brain barrier permeability, with altered tight-junction messenger RNA expression, increased brain levels of inflammatory mediators, and astrogliosis (induced at day 3). Mesenchymal stromal cells mitigated these cognitive and behavioral alterations, as well as reduced blood-brain barrier dysfunction, astrocyte activation, and interleukin-1β, interleukin-6, tumor necrosis factor-α, and interleukin-10 levels in vivo. In cultured primary astrocytes stimulated with lipopolysaccharide, conditioned media from mesenchymal stromal cells reduced astrogliosis, interleukin-1β, and monocyte chemoattractant protein-1, suggesting a paracrine mechanism of action.

Conclusions:

In mice who survived experimental sepsis, mesenchymal stromal cell therapy protected blood-brain barrier integrity, reduced astrogliosis and neuroinflammation, as well as improved cognition and behavior.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH RETINITIS PIGMENTOSA–ASSOCIATED CYSTOID MACULAR EDEMA
Authors: Yeo Joon Hyung , Kim Yoon Jeon , Yoon Young Hee
Published: January 2020

Purpose:

To investigate the microstructure of cystoid macular edema (CME) in retinitis pigmentosa (RP) and the associated vascular changes using optical coherence tomography (OCT) angiography.

Methods:

In this retrospective study, we included 42 eyes of 21 patients with RP and age-similar normally sighted controls who underwent both OCT and optical coherence tomography angiography. Using OCT, spatial distribution of CME and the retinal layer, which CME located, was examined. Optical coherence tomography angiography images of the superficial capillary plexus and deep capillary plexus were obtained. Foveal and parafoveal flow densities in each layer and foveal avascular zone area were measured.

Results:

Of the 42 eyes with RP, 32 had CME. All CMEs were located in the inner nuclear layer and limited to the parafovea. The outer nuclear layer/ganglion cell layer was involved in 12 eyes (37.5%). Compared with RP without CME, RP with CME (RP-CME) did not show significant differences in flow density or extent of vascular disruption within the superficial capillary plexus, deep capillary plexus, or foveal avascular zone areas.

Conclusion:

RP-CME was mostly located in the inner nuclear layer of the parafoveal macula, without vascular disruption in optical coherence tomography angiography. Our findings may support the hypothesis that the pathogenesis of RP with CME differs from retinal vascular CME triggered by compromised deep capillary plexus.
OPACIFICATION OF A SCLERAL-SUTURED AKREOS AO60 INTRAOCULAR LENS: SURGICAL TECHNIQUE FOR REMOVAL
Authors: Lavine Jeremy A. , Sharma Sumit
Published: January 2020

Purpose:

To report a case of an opacified scleral-sutured Akreos intraocular lens (IOL) and discuss the technique for surgical removal.

Methods:

A 27-year-old man presented with blurry vision in the right eye 1 year after trauma, pars plana vitrectomy, glaucoma tube shunt surgery, and a scleral-sutured Akreos AO60 IOL. Examination demonstrated a visual acuity of 20/300, a persistently dilated pupil, 360° of peripheral anterior synechiae, and an opacified IOL. The patient underwent IOL explantation.

Results:

Owing to the expected granulation of the Gore-Tex suture, an external approach for suture ligation was not attempted. The suture was identified and ligated nasally with forceps and IOL cutting scissors. The Gore-Tex suture was granulated into the ciliary body temporally and was unable to be identified. The eyelets of the Akreos IOL were ligated to remove the IOL.

Conclusion:

Granulation of the Gore-Tex suture into the ciliary body and sclera requires an internal approach for ligation of the suture or eyelets to remove an opacified scleral-sutured Akreos IOL.
Reducing Diabetic Ketoacidosis Intensive Care Unit Admissions Through an Electronic Health Record-Driven, Standardized Care Pathway
Authors: Edholm Karli , Lappé Katie , Kukhareva Polina , Hopkins Christy , Hatton Nathan D. , Gebhart Benjamin , Nyman Heather , Signor Emily , Davis Mikyla , Kawamoto Kensaku , Johnson Stacy A.
Published: January 2020

Diabetic ketoacidosis (DKA) is a common condition, with wide variation in admission location and clinical practice. We aimed to decrease intensive care unit (ICU) admission for DKA by implementing a standardized, electronic health record-driven clinical care pathway that used subcutaneous insulin, rather than a continuous insulin infusion, for patients with nonsevere DKA. This is a retrospective, observational preintervention to postintervention study of 214 hospital admissions for DKA that evaluated the effect of our intervention on clinical, safety, and cost outcomes. The primary outcome was ICU admission, which decreased from 67.0% to 41.7% (p < .001). Diabetes nurse educator consultation increased from 45.3% to 63.9% (p = .006), and 30-day Emergency Department (ED) return visit decreased from 12.3% to 2.8% (p = .008). Time to initiation of basal insulin increased from 18.19 ± 1.25 hours to 22.47 ± 1.76 hours (p = .05) and reopening of the anion gap increased from 4.7% to 13.9% (p = .02). No changes in ED length of stay (LOS), hospital LOS, hypoglycemia, treatment-induced hypokalemia, 30-day hospital readmission, or inpatient mortality were observed. The implementation of a standardized DKA care pathway using subcutaneous insulin for nonsevere DKA resulted in decreased ICU use and increased diabetes education, without affecting patient safety.
The role of coexisting cardiovascular disease on disease severity in patients with inflammatory bowel disease
Authors: Mantaka Aikaterini , Tsoukali Emmanouela , Fragkaki Maria , Karmiris Konstantinos , Viazis Nikos , Mantzaris Gerassimos J. , Koutroubakis Ioannis E.
Published: January 2020

Objectives:

Chronic inflammation has been implicated in the pathogenesis of atherosclerosis and cardiovascular disease. Data linking the severity of inflammatory bowel disease to coexisting cardiovascular disease are scarce. The aim of the present study was to investigate whether inflammatory bowel disease patients with coexistent cardiovascular disease have more severe disease.

Methods:

We included 103 inflammatory bowel disease patients with coexisting cardiovascular disease compared to 206 age- and sex-matched inflammatory bowel disease patients without cardiovascular disease derived from three referral inflammatory bowel disease Centers. Traditional cardiovascular disease factors and parameters of inflammatory bowel disease severity were compared between the two groups.

Results:

Cardiovascular disease was diagnosed after the inflammatory bowel disease diagnosis in 56.6% of cases. No significant difference was found in the prevalence of surrogate markers of severity (inflammatory bowel disease-related surgeries, hospitalizations, biologics or immunosuppressants’ use, and persistent CRP elevation) between inflammatory bowel disease patients with and without cardiovascular disease. There was no difference between cardiovascular disease patients diagnosed before and after inflammatory bowel disease onset. All traditional risk factors (hypertension, dyslipidemia, smoking, obesity, diabetes mellitus) were significantly more common in cardiovascular disease patients. Cardiovascular disease patients had a trend for lower rates of multiple hospitalizations (16.5% vs. 24.3%, P = 0.05) and inflammatory bowel disease-related surgeries (P = 0.09).

Conclusion:

The inflammatory burden possibly plays a less important role in the development of cardiovascular disease in inflammatory bowel disease patients but future larger prospective studies are needed.
Noninvasive assessment of liver fibrosis in a real-world cohort of patients with known or suspected chronic liver disease using 2D-shear wave elastography
Authors: Petzold Golo , Bremer Sebastian C.B. , Knoop Richard F. , Amanzada Ahmad , Raddatz Dirk , Ellenrieder Volker , Ströbel Philipp , Kunsch Steffen , Neesse Albrecht
Published: January 2020

Objectives

We aimed to investigate the diagnostic accuracy of liver stiffness measurement (LSM) by 2D-shear wave elastography (2D-SWE, GE, Logiq E9) in patients with known or suspected chronic liver disease and to define cutoff values for the different stages of fibrosis.

Methods

First, we retrospectively enrolled 21 patients in a pilot study and validated the results in a prospective cohort of 70 patients between May 2017 and February 2019. In all patients, LSM and liver biopsy were performed. We analyzed the diagnostic accuracy of LSM for the different fibrosis stages and examined the impact of additional clinical parameters on LSM.

Results

The success rate of LSM was 88.6%. In the prospective cohort, optimal cutoff values for F ≥ 1, F ≥ 2, F ≥ 3 and F = 4 were 6.24, 7.86, 8.05 and 10.74 kPa [area under the receiver operating characteristic curve (AUROC) 0.831, 0.913, 0.996 and 0.954]. In both cohorts and in the subgroup of patients with nonalcoholic fatty liver disease (NAFLD) (n = 35), a cutoff value of 8.05 kPa differentiates patients with advanced fibrosis (F ≥ 3) and patients with no or mild fibrosis (F0–F2) with high diagnostic accuracy (AUROC 0.995–1.000). Parameters such as age, sex, BMI, bilirubin- and alanine aminotransferase-level had no significant impact on LSM.

Conclusion

LSM by 2D-SWE is an excellent method to differentiate between patients with advanced fibrosis (F ≥ 3) and patients with no or mild fibrosis (F ≤ 2). We were able to show this also in a subgroup of patients with NAFLD.
A Stronger Patient Voice Improves Transparency and Care
Authors: Wadsworth Barbara , Harmer Catherine A.
Published: January 2020

In the 2nd of a 3-part series on the value of patient and family advisory councils, an early adopter at a large, Magnet®-recognized healthcare system reveals ways in which an environment focused on strong partnerships, a culture of safety, and a commitment to transparency led to the creation of successful councils at multiple hospitals. The authors discuss nursing’s integral role in championing and leading the councils, as well as the benefits of a strong patient-family voice in hospital operations and care processes.
Leading Organizational Cultural Competency
Authors: Ogbolu Yolanda , Scrandis Debra A. , Fitzpatrick Grace , Newhouse Robin
Published: January 2020

Chief nurse executives (CNEs) face challenges in providing high-quality, patient-centered care for diverse populations. Although the implementation of culturally and linguistically appropriate services (CLAS) may improve patient satisfaction, the cost of initiatives and education coupled with shortened episodes of care pose obstacles. The article describes themes from a qualitative study with CNEs, describes resources and best practices, and highlights nurse leader rounds as a vehicle for implementing CLAS.
A Nurse Transitional Home Visit Following Pediatric Hospitalizations
Authors: Pickler Rita , Wade-Murphy Susan , Gold Jennifer , Tubbs-Cooley Heather , White Christine M. , Statile Angela , Hoying Cheryl , Sauers-Ford Hadley , Shah Samir S. , Simmons Jeffery
Published: January 2020

By incorporating focused feedback from families and other stakeholders a multidisciplinary team redesigned a single nurse home visit to improve transitions to home for pediatric patients following short-stay, acute care hospitalizations. Refinements to the nurse-led transitional home visit included standardization of teaching focused on condition- and medication-specific concerns, the use of red flags or warning signs to prompt caregiver action, and the provision of reassurance.
Promoting Bedside Nurse-Led Research Through a Dedicated Neuroscience Nursing Research Fellowship
Authors: Stutzman Sonja , Olson DaiWai , Supnet Charlene , Harper Caryn , Brown-Cleere Shelley , McCulley Becky , Goldberg Mark
Published: January 2020

OBJECTIVE:

We hypothesized that nurses would benefit from the fellowship model traditionally used to engage physicians in clinical research. The Neuroscience Nursing Research Center (NNRC) fellowship program was created as a model for engaging nurses at all levels of clinical practice to become active in clinical research.

BACKGROUND:

The NNRC was established in 2013 as a novel approach to promote bedside nurses as primary investigators in clinical research.

METHODS:

The NNRC developed 4 pathways to nursing research success: research fellowship, student-nurse internship, didactic training, and research consultation.

RESULTS:

Fellows have enrolled more than 900 participants in 14 studies. Nurses have presented more than 20 abstracts at 12 conferences and submitted 11 manuscripts for publication. The NNRC has provided research training to more than 150 nurses.

CONCLUSIONS:

The NNRC program is successful in engaging nurses in research. It shows promise to continue to develop nursing research that is applicable to clinicians and thus improve patient care.