bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of individualized lifetime benefit from cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation in apparently healthy people
Authors: Jaspers Nicole E M , Blaha Michael J , Matsushita Kunihiro , van der Schouw Yvonne T , Wareham Nicholas J , Khaw Kay-Tee , Geisel Marie H , Lehmann Nils , Erbel Raimund , Jöckel Karl-Heinz , van der Graaf Yolanda , Verschuren W M Monique , Boer Jolanda M A , Nambi Vijay , Visseren Frank L J , Dorresteijn Jannick A N
Published: April 2019

Aims

The benefit an individual can expect from preventive therapy varies based on risk-factor burden, competing risks, and treatment duration. We developed and validated the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model for the estimation of individual-level 10 years and lifetime treatment-effects of cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation in apparently healthy people.

Methods and results

Model development was conducted in the Multi-Ethnic Study of Atherosclerosis (n = 6715) using clinical predictors. The model consists of two complementary Fine and Gray competing-risk adjusted left-truncated subdistribution hazard functions: one for hard cardiovascular disease (CVD)-events, and one for non-CVD mortality. Therapy-effects were estimated by combining the functions with hazard ratios from preventive therapy trials. External validation was performed in the Atherosclerosis Risk in Communities (n = 9250), Heinz Nixdorf Recall (n = 4177), and the European Prospective Investigation into Cancer and Nutrition-Netherlands (n = 25 833), and Norfolk (n = 23 548) studies. Calibration of the LIFE-CVD model was good and c-statistics were 0.67–0.76. The output enables the comparison of short-term vs. long-term therapy-benefit. In two people aged 45 and 70 with otherwise identical risk-factors, the older patient has a greater 10-year absolute risk reduction (11.3% vs. 1.0%) but a smaller gain in life-years free of CVD (3.4 vs. 4.5 years) from the same therapy. The model was developed into an interactive online calculator available via www.U-Prevent.com.

Conclusion

The model can accurately estimate individual-level prognosis and treatment-effects in terms of improved 10-year risk, lifetime risk, and life-expectancy free of CVD. The model is easily accessible and can be used to facilitate personalized-medicine and doctor–patient communication.
RNA interference in the oleaginous yeast Rhodosporidium toruloides
Authors: Liu Xiangjian , Zhang Yue , Liu Hongdi , Jiao Xiang , Zhang Qi , Zhang Sufang , Zhao Zongbao Kent
Published: April 2019

The red yeast Rhodosporidium toruloides is an excellent microbial host for production of carotenoids, neutral lipids and valuable enzymes. In recent years, genetic tools for gene expression and gene disruption have been developed for this red yeast. However, methods remain limited in terms of fine-tuning gene expression. In this study, we first demonstrated successful implementation of RNA interference (RNAi) in R. toruloides NP11, which was applied to down-regulate the expression of autophagy related gene 8 (ATG8), and fatty acid synthase genes (FAS1 and FAS2), respectively. Compared with the control strain, RNAi-engineered strains showed a silencing efficiency ranging from 11% to 92%. The RNAi approach described here ensures selective inhibition of the target gene expression, and should expand our capacity in the genetic manipulation of R. toruloides for both fundamental research and advanced cell factory development.
Risk of Infection and Types of Infection Among Elderly Patients With Inflammatory Bowel Disease: A Retrospective Database Analysis
Authors: Khan Nabeel , Vallarino Carlos , Lissoos Trevor , Darr Umar , Luo Michelle
Published: April 2019

Background

Inflammatory bowel disease (IBD) treatment in the elderly is challenging in part because of increased risk of infections. The aim of our study was to determine the absolute and relative risk of infections among the elderly IBD patient population and to identify factors affecting the risk of infections in the overall IBD patient population.

Methods

A retrospective study of patients with IBD initiating corticosteroids, immunomodulators (IM), or biologic therapy (January 2010–December 2014) was conducted using the Truven Market Scan database. IM and biologic exposure were assessed in a time-dependent manner. ICD-9 codes identified infection during follow-up. A Cox proportional hazards model was fitted to gauge the association between age, other covariates, and infection risk.

Results

We identified 63,759 patients with IBD. We found 2664 infections (incidence rate [IR] = 16.95/100 person-years) among 8788 elderly patients with IBD and 10,515 (IR = 10.49/100 person-years) among the nonelderly group. Pneumonia (39.8%), sepsis (13.2%), and candidiasis (12.9%) were the most common infections in the elderly. Factors associated with a higher risk of infection included being elderly (HR: 1.27, P < 0.0001), anti-TNF therapy (HR: 1.64, P < 0.0001), IM therapy (HR: 1.32, P < 0.0001), and polypharmacy (HR: 1.32, P < 0.0001).

Conclusions

Advanced age, anti-TNF (biologic) therapy, and IM therapy were associated with an increased risk of infection. Pneumonia was the most common infection among the elderly IBD population. Physicians should be mindful of these risks when prescribing medications for elderly patients with IBD, and ensure their patients are adequately vaccinated.
Pilot feasibility trial of the MyPEEPS mobile app to reduce sexual risk among young men in 4 cities
Authors: Ignacio Matt , Garofalo Robert , Pearson Cynthia , Kuhns Lisa M , Bruce Josh , Scott Batey D , Radix Asa , Belkind Uri , Hidalgo Marco A , Hirshfield Sabina , Schnall Rebecca
Published: April 2019

Objectives

Our study team adapted the MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) curriculum, an evidence-based human immunodeficiency virus (HIV) prevention intervention, from a face-to-face, group-based intervention to an individual-level mobile responsive web-based intervention to improve HIV risk behaviors in very young men, aged 13–18 years.

Materials and methods

In adapting the MyPEEPS intervention to mobile app, we used a series of methodologies, including expert panel reviews, weekly team meetings with the software development company, and conducted in-depth interviews with very young men. Following the iterative process, we conducted a 6-week pre–post feasibility pilot trial with 40 young men in Birmingham, AL; Chicago, IL; New York City, NY; and Seattle, WA. Primary outcomes of interest were uptake of the app, accessibility and satisfaction.

Results

Across all 4 sites, 62.5% (25/40) of participants completed all modules in the app in an average of 28.85 (SD 21.69) days. Participants who did not attend to the follow-up visit did not complete any of the app modules. Overall participants reported that the app was easy to use, useful and has the potential to improve their sexual health knowledge and behavior and awareness in risky contexts. Participants also highly rated the app, information and interface quality of the app.

Discussion

Lessons learned from the pilot included the need for reminder systems and providing anticipatory guidance about Internet connectivity when using the app. These changes will be incorporated into study procedures for our multisite trial.

Conclusion

Overall, participants found the app to be highly usable and have the potential to positively improve their sexual risk behavior.
Mycoplasma hyopneumoniae–Lawsonia intracellularis dual challenge modulates intestinal integrity and function1
Authors: Helm Emma T , Curry Shelby M , Schwartz Kent J , Lonergan Steven M , Gabler Nicholas K
Published: April 2019

Lawsonia intracellularis (LI) and Mycoplasma hyopneumoniae (Mh) are 2 globally distributed pathogens that cause significant morbidity and mortality in grow-finish pigs. However, mechanisms that reduce growth and feed efficiency during LI and Mh infection are poorly defined. We hypothesized that reductions in performance are partially due to declines in intestinal function and integrity; thus, this study aimed to evaluate intestinal function and integrity of pigs during a 21-d Mh and LI dual challenge (MhLI). Littermate pairs of barrows (48.1 ± 6.7 kg BW) were selected; 1 pig from each pair was assigned to either MhLI challenge or nonchallenge treatments (n = 12). Pigs were individually housed, fed a corn-soybean diet, and allowed to acclimate for 21 d prior to inoculation. On days postinoculation (dpi) 0, MhLI pigs were dual inoculated with LI and Mh. On dpi 21, all pigs were euthanized for ileal and colon tissue collection. Formalin-fixed tissues were clinically scored and morphology analyzed, frozen tissues assayed for digestive enzyme activities, and fresh tissues mounted into modified Ussing Chambers to assess active nutrient transport, barrier integrity, and bacterial translocation. Data were analyzed using the Mixed Procedure of SAS with treatment as a fixed effect, age and start BW as covariates, and litter as a random effect. Compared with controls, MhLI pigs had decreased ADG (38%, P < 0.001), ADFI (25%, P < 0.001), and G:F (19%, P = 0.012). The MhLI dual challenge did not alter ileum morphology or transepithelial resistance (P > 0.10); however, ex vivo mucosal to serosal translocation of S. Typhimurium in the colon was increased (60%, P = 0.003) in MhLI pigs compared with controls. Additionally, MhLI pigs had increased ileal glucose transport (30%, P = 0.05) and decreased sucrase activity (30%, P = 0.049) compared with controls. This MhLI challenge antagonized intestinal function and integrity, and this may be a contributing factor to reduced pig performance.
Breast Cancer Screening in High-Risk Patients during Pregnancy and Breastfeeding: A Systematic Review of the Literature
Authors: Zha Nanxi , Alabousi Mostafa , Abdullah Peri , Freitas Vivianne , Linthorst Rhys , Muhn Narry , Alabousi Abdullah
Published: April 2019

There are currently no clear guidelines for high-risk breast cancer screening during the pregnancy and breastfeeding periods. The objective of this systematic review (SR) was to assess the available evidence pertaining to breast cancer screening recommendations in this population with the aim of supporting future guidelines. We performed a SR of the literature using the electronic databases MEDLINE and Embase. Predetermined inclusion and exclusion criteria were used during the abstract screening and full-text data extraction phases. We retrieved 2,274 abstracts after removal of duplicates, from which 16 studies were included based on predetermined eligibility criteria. Most of the studies found were narrative reviews and expert opinions. Clinical breast exam (CBE) was recommended by 12 studies during pregnancy and by 6 studies in the breastfeeding period. Mammography was recommended in the breastfeeding period by 2 studies. Magnetic resonance imaging was recommended in the breastfeeding period by 2 studies. Ultrasound was considered not appropriate for screening in this population. The information extracted from this SR is based primarily on expert opinion and anecdotal evidence, which explains the lack of standardized guidelines for high-risk breast cancer screening in this population. However, expert opinion may be a surrogate outcome for high-risk breast cancer screening recommendations in this subset of patients, and as such, may justify the clinical management to be tailored accordingly. This SR summarizes the evidence pertaining to high-risk breast cancer screening during pregnancy and breastfeeding, which could serve as a catalyst for future research on the topic.
Evaluation of Leaf Consumption and Determination of Economic Injury Level Caused by Plutella xylostella (L.) (Lepidoptera: Plutellidae) in Brassica oleracea var. acephala (Brassicales: Brassicaceae)
Authors: Massarolli Angélica , Bersani Bruna Camila Gualda , Roza Fernando Henrique Dalla , Butnariu Alessandra Regina , Pereira Mônica Josene Barbosa , Foerster Luís Amilton
Published: April 2019

Plutella xylostella (L.) is a microlepidopteran found in all brassica-producing regions of the world. However, no economic injury level (EIL) has been established for this pest in collard greens. Therefore, studies evaluating the EIL of P. xylostella in this crop based on the number of caterpillars per plant can assist pest monitoring and the most effective time for pest control, ensuring profits and the use of pesticides only when required. The present study assessed leaf consumption of caterpillars at different levels of infestation and determinined the EIL for P. xylostella in collard greens. Based on the yield reduction index of collard greens for P. xylostella, EIL was estimated for different scenarios of pest control costs, setting the market value of the bunch of collard greens, and, alternatively, with prices varying and the control cost fixed. In simulated scenarios for 7 d after infestation, the number of caterpillars per plant was always below 1.38, whereas for 10 d, the maximum number was 1.25 caterpillars per plant. When simulating scenarios with different market values for the bunch of collard greens the lower the price of the collard greens bunch, the higher the mean number of caterpillars per plant to compensate the application cost. The mean number of caterpillars per plant ranged from 4.59 to 0.38 in the evaluation for 7 d, and from 4.17 to 0.35 caterpillars per plant for 10 d according to the price of the bunch of collard greens.
Political Contributions and Public Procurement: Evidence from Lithuania
Authors: Baltrunaite Audinga
Published: April 2019

This paper studies whether firms trade political contributions for public procurement contracts. Combining data on Lithuanian government tenders, corporate donors, and firm characteristics, I examine how a ban on corporate contributions affects the awarding of procurement contracts to companies that donated in the past. Consistent with political favoritism, donors’ probability of winning falls by five percentage points as compared to that of nondonor firms after the ban. Evidence on bidding and victory margins suggests that corporate donors may receive auction-relevant information affecting procurement outcomes in their favor.
Postoperative adjuvant chemotherapy combined with intracavitary brachytherapy achieved the equivalent survival compared with concurrent chemoradiotherapy in cervical cancer patients with intermediate-risk
Authors: Yu Hao , Zhang Linlin , Li Dapeng , Liu Naifu , Yin Yueju , Zhang Lu , Yuan Lingqin , Liu Ming , Sheng Xiugui
Published: April 2019

Objectives

The current study was aimed to evaluate the efficacy and toxicity of postoperative adjuvant chemotherapy (CT) combined with intracavitary brachytherapy (ICRT) in cervical cancer patients with intermediate-risk.

Methods

We analyzed the medical records of 558 patients who were submitted to radical surgery for Stage IB-IIA cervical cancer. A total of 172 of those 558 patients were considered intermediate-risk according to the GOG criteria. Among those 172 patients, 102 were subjected to CT combined with ICRT (CT+ICRT) and the remaining 70 patients were treated with concurrent chemoradiation (CCRT). The 3-year disease free survival (DFS), overall survival (OS), and complications of each group were evaluated and analyzed.

Results

No significant difference was observed in 3-year DFS or OS of the patients submitted to CT+ICRT and CCRT. Importantly, the frequencies of grade III to IV acute complications were significantly higher in patients submitted to CCRT than in those treated with CT+ICRT (Hematologic, P = 0.016; Gastrointestinal, P = 0.041; Genitourinary, P = 0.019). Moreover, the frequencies of grade III–IV late complications in patients treated with CCRT were significantly higher compared with CT+ICRT-treated patients (Gastrointestinal, P = 0.026; Genitourinary, P = 0.026; Lower extremity edema, P = 0.008).

Conclusions

Postoperative adjuvant CT+ICRT treatment achieved equivalent 3-year DFS and OS but low complication rate compared to CCRT treatment in early stage cervical cancer patients with intermediate-risk.
Phase II trial of S-1 plus cisplatin combined with bevacizumab for advanced non-squamous non-small cell lung cancer (TCOG LC-1202)
Authors: Miyanaga Akihiko , Kubota Kaoru , Hosomi Yukio , Okuma Yusuke , Minato Koichi , Fujimoto Sakae , Okamoto Hiroaki , Satouchi Miyako , Isobe Hiroshi , Aono Hiromi , Takiguchi Yuichi , Gemma Akihiko ,   for The Tokyo Cooperative Oncology Group
Published: April 2019

Background

S-1 plus cisplatin is a standard chemotherapy regimen for advanced non-small cell lung cancer (NSCLC). The addition of bevacizumab has been shown to significantly improve overall survival (OS) in patients with advanced non-squamous (NSq) NSCLC who received carboplatin plus paclitaxel, however, failed to show an OS advantage in patients who received cisplatin plus gemcitabine.

Methods

Chemotherapy-naive patients with Stage IIIB, IV or recurrent non-SQ NSCLC were treated with a 3-week cycle of S-1 80 mg/m2 on days 1–14, cisplatin 60 mg/m2 on day 8 and bevacizumab 15 mg/kg on day 8 for 4–6 cycles. Patients without progressive disease (PD) received maintenance bevacizumab 15 mg/kg on day 1 with a 3-week cycle and S-1 80 mg/m2 every other day. The primary endpoint was progression-free survival (PFS). Secondary endpoints were objective response rate (ORR), OS, toxicity profile and Quality of life (QOL).

Results

From June 2013 to January 2015, 39 eligible patients were enrolled from eight institutions. Thirty-one patients (79%) completed four cycles of induction chemotherapy, and maintenance chemotherapy was initiated in 23 patients (59%). Median PFS, OS and ORR were 7.3 months (95% CI: 5.9–8.7), 21.4 months (95% CI: 14.7—not reached) and 64%, respectively. The most common grade 3/4 toxicities were leukopenia (12.8%), neutropenia (23.0%) and hypertension (28.2%). QOL analyses showed detrimental effects after initiation of the regimen.

Conclusions

S-1 plus cisplatin in combination with bevacizumab met the primary endpoint in patients with advanced NSq-NSCLC. RR was anticipated to be high with acceptable toxicities.
A New Perspective on the Syriac Hwayt Qāṭēl in a Non-Past Context
Authors: Napiórkowska Lidia
Published: April 2019

This article presents a new perspective on the meaning and function of the Syriac construction hwayt qāṭēl used with a non-past reference. Beginning with the traditional method of cross-linguistic comparison, the author contextualizes the construction in question within a pragmatic- cognitive framework of general linguistics, an approach that has so far been largely overlooked in Syriac studies. The language used here for comparison is the literary Christian of Urmi, a modern dialect of Aramaic, whose verbal system presents itself as a valid typological parallel for Syriac. Thus, through analysing the renditions of hwayt qāṭēl in Christian Urmi Neo-Aramaic within the corpus of the New Testament, the semantics and function of the Syriac hwayt qāṭēl receive precise characteristics, followed by an attempt to explain the use of the past tense form hwayt (perfect) for the present-future reference. An additional brief treatment of other command-related forms in Syriac, such as the imperative and imperative-derived constructions, contributes further, more detailed observations on the Syriac verbal system.
Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012–2017)
Authors: Al-Obaidi Mohanad , Hasbun Rodrigo , Vigil Karen J , Edwards Angelina R , Chavez Violeta , Hall David R , Dar Wasim A , De Golovine Aleksandra , Ostrosky-Zeichner Luis , Bynon John S , Nigo Masayuki
Published: April 2019

Background

Disseminated strongyloidiasis in solid organ transplant recipients is a rare but devastating infection. In our center, we implemented a universal screening of all candidates for kidney transplantation. We assessed the seroprevalence and utility of universal screening for strongyloidiasis in our center.

Methods

Patients were identified from our transplant referral list (from July 2012 to June 2017). Demographics, pretransplant laboratory, and serological screenings were retrospectively collected. For Strongyloides-seropositive (SSp) patients, data on travel history, symptoms, treatment, and stool ova and parasite examinations were extracted. Logistic regression and multiple imputation for missing data were performed.

Results

A total of 1689 patients underwent serological screening, of whom 168 (9.9%) were SSp. Univariate analysis revealed that SSp patients had higher rates of eosinophilia, diabetes mellitus, latent tuberculosis and were likely to be either Hispanic or Asian (P < .05). In multivariate analysis, eosinophilia (P = .01), diabetes mellitus (P = .02), and Asian race (P = .03) were associated with being SSp, but 45 (27%) of the SSp patients did not have any of these 3 factors, and 18 SSp patients (11%) had no epidemiological risk factors. All patients received ivermectin, and none developed disseminated strongyloidiasis. Of patients who underwent serological screening on multiple occasions, 6.8% seroconverted while waiting for kidney transplantation.

Conclusions

We found a high rate of Strongyloides seropositivity among our kidney transplantation candidates. No epidemiological risk factors effectively predicted SSp status in our population, and universal screening identified a large number of patients without such factors. Serial screening should be considered when a long wait time is expected before transplantation.
Probing the Molecular Structure and Orientation of the Leaf Surface of Brassica oleracea L. by Polarization Modulation-Infrared Reflection-Absorption Spectroscopy
Authors: Hama Tetsuya , Seki Kousuke , Ishibashi Atsuki , Miyazaki Ayane , Kouchi Akira , Watanabe Naoki , Shimoaka Takafumi , Hasegawa Takeshi
Published: April 2019

The surface of most aerial plant organs is covered with the cuticle, a membrane consisting of a variety of organic compounds, including waxes, cutin (a polyester) and polysaccharides. The cuticle serves as the multifunctional interface between the plant and the environment, and plays a major role in protecting plants against various environmental stress factors. Characterization of the molecular arrangements in the intact cuticle is critical for the fundamental understanding of its physicochemical properties; however, this analysis remains technically challenging. Here, we describe the nondestructive characterization of the intact cuticle of Brassica oleracea L. leaves using polarization modulation-infrared (IR) reflection-absorption spectroscopy (PM-IRRAS). PM-IRRAS has a probing depth of less than several hundreds of nanometers, and reveals the crystalline structure of the wax covering the cuticle surface (epicuticular wax) and the nonhydrogen-bonding character of cutin. Combined analysis using attenuated total reflection-IR spectra suggested that hemicelluloses xylan and xyloglucan are present in the outer cuticle region close to the epicuticular wax, whereas pectins are dominant in the inner cuticle region (depth of ≤2 μm). PM-IRRAS can also determine the average orientation of the cuticular molecules, as indicated by the positive and negative spectral peaks. This unique advantage reveals the orientational order in the intact cuticle; the hydrocarbon chains of the epicuticular wax and cutin and the backbones of hemicelluloses are oriented perpendicular to the leaf surface. PM-IRRAS is a versatile, informative and easy-to-use technique for studying plant cuticles because it is nondestructive and does not require sample pretreatment and background measurements.
Recommendations for acquisition and interpretation of MRI of the spine and sacroiliac joints in the diagnosis of axial spondyloarthritis in the UK
Authors: Bray Timothy J P , Jones Alexis , Bennett Alexander N , Conaghan Philip G , Grainger Andrew , Hodgson Richard , Hutchinson Charles , Leandro Maria , Mandl Peter , McGonagle Denis , O’Connor Phill , Sengupta Raj , Thomas Marianna , Toms Andoni , Winn Naomi , Hall-Craggs Margaret A , Marzo-Ortega Helena , Machado Pedro M ,   British Society of Spondyloarthritis (BRITSpA)
Published: April 2019

Objectives

To develop evidence-based recommendations on the use of MRI in the diagnosis of axial SpA (axSpA).

Methods

A working group comprising nine rheumatologists and nine musculoskeletal radiologists with an interest in axSpA was established, with support from the British Society of Spondyloarthritis (BRITSpA). Two meetings were held. In the first meeting, research questions were formulated. In the second meeting, the results of a systematic literature review designed to inform the recommendations were reviewed. An anonymized Delphi process was used to formulate the final set of recommendations. For each recommendation, the level of evidence and strength of recommendation was determined. The level of agreement was assessed using a 0–10 numerical rating scale.

Results

Two overarching principles were formulated, as follows: The diagnosis of axSpA is based on clinical, laboratory and imaging features (overarching principle 1), and patients with axSpA can have isolated inflammation of either the sacroiliac joints or the spine (overarching principle 2). Seven recommendations addressing the use of MRI in the assessment of patients with suspected axSpA were formulated, covering topics including recommended sequences, anatomical coverage, acquisition parameters and interpretation of active and structural MRI lesions. The level of agreement for each recommendation was very high (range 8.8–9.8).

Conclusion

A joint rheumatology and radiology consensus on the acquisition and interpretation of MRI in axSpA diagnosis was achieved, and a research agenda formulated. This consensus should help standardize practice around MRI and ensure a more informed, consistent approach to the diagnosis of axSpA.
0632 Time of Day and Time on Task Effects on Working Memory and Sleepiness of Bus Drivers
Authors: Maghsoudipour Maryam , Moradi Ramin , Pouyakian Mostafa , Yaseri Mehdi , Moghimi Sara
Published: April 2019

Introduction

Fatigue and sleepiness have direct effects on vigilance, and cognitive functions of drivers. The objective of this study was to analyze individual bus drivers' characteristics and work shift parameters and relation to the working memory performance and sleepiness.

Methods

This prospective study was conducted on 35 inter-city bus drivers by convenience sampling. We collected data during the time span of a 24-hour round trip by using the demographic questionnaire, Epworth Sleepiness Scale (ESS), Karolinska Sleepiness Scale (KSS), and reversed digit span memory test (part of the Wechsler-Adult Intelligence Test). A linear mixed model was used for statistic analysis.

Results

The mean (± SD) of Epworth Sleepiness Scale score was 6.4 (±2.7). 12.5% of drivers had excessive daytime sleepiness according to ESS results. The circadian effect of time of day on the drivers' working memories was statistically significant (P=0.001), and the working memory was minimum at 04:00 am (± 1). Additionally, the differences in sleepiness at different times of day were statistically significant (P=0.001); with the highest score at 04:00 am (± 1). Time on task and time of sleep parameters did not show a significant effect on working memory (p> 0.05). Time on task parameter affected sleepiness significantly (p=0.024).

Conclusion

The circadian factor was the most important predictor of cognitive performance compared to time on task (fatigue) and time of sleep. Although, time on task had a significant effect on sleepiness and sleepiness significantly decreased working memory. We conclude that optimizing the drivers' schedule is the most important intervention to optimize drivers' performance and increase road safety.

Support (If Any)

Not
0944 A Comparison Of Medical-grade Actigraphy Devices With Polysomnography During Inpatient Rehabilitation For Traumatic Brain Injury (TBI)
Authors: Guerrero Giselle Y , Schwartz Daniel , Silva Marc A , Zeitzer Jamie Marc , Monden Kimberley , Wittine Lara , Bogner Jennifer , Reljic Tea , Nakase-Richardson Risa
Published: April 2019

Introduction

Sleep disturbances in TBI population can have negative consequences on physical, psychological and cognitive recovery. While polysomnography (PSG) is the gold standard for evaluating sleep disorders, actigraphy has been widely used to screen for sleep-wake disorders, especially ones that change longitudinally. In a small sample of TBI patients (n=50, single center sample of convenience) during inpatient rehabilitation, we have previously found two models (Philips Actiwatch2/Actiwatch Spectrum) to be feasible and valid for collecting sleep data. Herein, we extend this validation to a prospective study of more than 200 TBI patients and include both the Actigraph Core wGT3X-BT (ACT-Core) and Philips Actiwatch Spectrum Plus (PASP).

Methods

This is a secondary analysis from a six-center, prospective, observational cohort study from the TBI Model System Lifetimes Study where overnight, fully attended polysomnography with concomitant actigraphy were conducted on moderate to severe TBI subjects during acute inpatient rehabilitation as part of an ongoing PCORI-funded clinical trial. Actigraphy variables of total sleep time (TST), sleep efficiency (SE), sleep latency (SL), wake after sleep onset (WASO) were compared between actigraphy devices and with Level 1, fully attended PSG (Phillips Sleepware-G3) to evaluate their concordance (Pearson). PASP-derived sleep was determined with Actiware (sensitivity=Automatic), while ACT-Core-derived sleep was determined with ActiLife (Cole-Kripke algorithm).

Results

Simultaneous collection of PSG and PASP (n=230) and ACT-Core (n=179) were examined. Correlations (p>.01) with PSG were found for both PASP and ACT-Core for TST (r=.70, .69), SE (r=.33, .31), and WASO (r=-.19, -.24) respectively. Comparison of actigraphy devices to one another revealed correlations (p>.01) for TST (r=.80), SE (r=.58), WASO (r=.68), and SL (r=.23).

Conclusion

This larger, prospective study across six-centers supports the use of actigraphy as a proxy measure of sleep quantity (TST, SE) in acute neurorehabilitation admissions with moderate to severe TBI. No relationship was found for SL with mixed findings for WASO. Sensitivity analyses with subsets of TBI survivors with comorbidities (sleep apnea, spasticity, muscle strength) may affect agreement and warrant further study.

Support (If Any)

PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015) for DVBIC, NIDILRR.
Dense Geographic and Genomic Sampling Reveals Paraphyly and a Cryptic Lineage in a Classic Sibling Species Complex
Authors: Linck Ethan , Epperly Kevin , Van Els Paul , Spellman Garth M , Bryson Robert W , McCormack John E , Canales-Del-Castillo Ricardo , Klicka John
Published: April 2019

Incomplete or geographically biased sampling poses significant problems for research in phylogeography, population genetics, phylogenetics, and species delimitation. Despite the power of using genome-wide genetic markers in systematics and related fields, approaches such as the multispecies coalescent remain unable to easily account for unsampled lineages. The Empidonax difficilis/Empidonax occidentalis complex of small tyrannid flycatchers (Aves: Tyrannidae) is a classic example of widely distributed species with limited phenotypic geographic variation that was broken into two largely cryptic (or “sibling”) lineages following extensive study. Though the group is well-characterized north of the US Mexico border, the evolutionary distinctiveness and phylogenetic relationships of southern populations remain obscure. In this article, we use dense genomic and geographic sampling across the majority of the range of the E. difficilis/E. occidentalis complex to assess whether current taxonomy and species limits reflect underlying evolutionary patterns, or whether they are an artifact of historically biased or incomplete sampling. We find that additional samples from Mexico render the widely recognized species-level lineage E. occidentalis paraphyletic, though it retains support in the best-fit species delimitation model from clustering analyses. We further identify a highly divergent unrecognized lineage in a previously unsampled portion of the group’s range, which a cline analysis suggests is more reproductively isolated than the currently recognized species E.difficilis and E. occidentalis. Our phylogeny supports a southern origin of these taxa. Our results highlight the pervasive impacts of biased geographic sampling, even in well-studied vertebrate groups like birds, and illustrate what is a common problem when attempting to define species in the face of recent divergence and reticulate evolution.
VI The Sixteenth Century: Excluding Drama after 1550
Authors: Archer Harriet , Wood Richard
Published: April 2019

This chapter has three sections: 1. General; 2. Sidney; 3. Spenser. Section 1 is by Harriet Archer; sections 2 and 3 are by Richard Wood.
CE: Original Research: Work-Related Stress and Positive Thinking Among Acute Care Nurses: A Cross-Sectional Survey
Authors: Tully Salena , Tao Hong
Published: April 2019

Background: Acute care nurses work in highly taxing environments, and as such are vulnerable to work-related stress, burnout, and attrition. Yet some nurses appear to flourish even in the presence of such stress, perhaps because of differences in their cognitive processes. Positive thinking, a set of skills that can be learned, has been linked to increased well-being, physical health, and longevity. But at this writing, there has been scant research investigating the use of positive thinking among nurses.

Purpose: To assess the relationship between perceptions of work-related stress and the use of positive thinking among acute care nurses.

Methods: A cross-sectional survey consisting of the Expanded Nursing Stress Scale, the Positive Thinking Skills Scale (PTSS), and a demographic questionnaire was administered to a convenience sample of 298 RNs, which included nurses already working for an eight-campus health care system and newly hired nurses during orientation.

Results: Compared to the established group, the incoming RNs were generally younger, had less education, and reported higher levels of both work-related stress and positive thinking. Linear regression analysis revealed that an increase in perceived stress was predictive of an increase in positive thinking. The PTSS, which had not been previously tested among nurses, was found to be reliable and valid.

Conclusion: This is the first U.S. study to evaluate the use of positive thinking in managing work-related stress among acute care nurses. The data suggest that positive thinking skills are being used to cope with such stress. But the mean PTSS scores for both groups were only slightly above midline, suggesting that nurses’ use of positive thinking as a coping skill can be improved through formal training and education.
The “silent” pain of endometriosis
Authors: Perkins Amanda
Published: April 2019

Compassionate care can change the lives of women with this condition.
Caring for adolescents experiencing cyberbullying
Authors: Florang Jesse Edward
Published: April 2019

Help young patients maintain mental and overall health by using Orem's self-care deficit theory to guide interventions.
Nurses as advocates
Authors: Watson Jeffery
Published: April 2019

How will you be a part of harnessing the collective wisdom and strength of the nursing profession?
Quality improvement tools for nursing practice
Authors: Harkness Turna L. , Pullen Richard L.
Published: April 2019

Do you want increased patient safety and better clinical outcomes without breaking the bank? Get involved with the QI process.
Incidence of graft failure with Achilles tendon allograft combined with RetroScrewTM tibial fixation in primary anterior cruciate ligament reconstruction
Authors: Mantell Matthew , Fox Brad , Baker Matthew , Kappa Jason , Ho Anthony , Pandarinath Rajeev
Published: April 2019

Background:

The purpose of this study was to determine the failure rate of primary anterior cruciate ligament (ACL) reconstruction with low-dose irradiated Achilles tendon allograft by a single surgeon using RetroscrewTM (Arthrex, Naples, FL) tibial fixation. The same surgical technique, source for the allograft tissue, and postoperative rehabilitation were used.

Methods:

Fifty patients undergoing primary ACL reconstruction with Achilles tendon allograft from 2010-2012 were available with a minimum of 2-years of follow-up. Patients were excluded if they had undergone previous ipsilateral knee surgery. The mean age was 31.3 yr old at the time of surgery. Patients were evaluated with International Knee Documentation Committee (IKDC) scores, subjective instability, and return to sports at latest follow-up. Failure was defined as need for revision ACL reconstruction based on subjective symptoms, objective physical findings of laxity on Lachman examination, and evidence of re-tear on MRI.

Results:

Twelve of the 51 operative knees had reruptures with continued instability (23.5%). There was no significant difference between the age of patients with intact (31) and patients with re-rupture (32.1; P=0.317). Patients presented with graft failure at an average of 1.65 yr postoperatively.

Conclusions:

The results of our study showed an unacceptably high rate of failure of irradiated fresh frozen Achilles allograft for primary ACL reconstruction using tibial Retroscrew fixation.
Seasonal changes in body composition in collegiate baseball players
Authors: Frantz Travis L. , Van Matre Brandon T. , Palmer Tyler S. , Ruiz Matthew D.
Published: April 2019

Background:

Body composition is a growing concern in all sports, including baseball. This study was conducted to measure changes in body composition from the beginning of the season to the end and to determine if different changes occurred in position players compared to pitchers.

Methods:

Participants’ (n=29; age 19.90±1.14) body mass, body mass index (BMI), and percent body fat as estimated by skinfold calipers were recorded immediately before and after the baseball season.

Results:

There was a significant decrease in weight of nearly 1 kg (P=0.02) with a corresponding decrease in BMI (P=0.02) without a change in percent body fat (P=0.31). When examined by position, significant change in percent body fat did occur between position players (−0.9%) and pitchers (+0.2%). Specifically, pitchers had increased body fat in the triceps (P=0.04), subscapular (P=0.03), and suprailiac (P=0.04) regions when compared to position players.

Conclusions:

Body composition does change during the course of a baseball season, and these changes have the potential to impact performance and outcome measures as it relates to baseball. Principles of kinesiology suggest that it could significantly influence power, speed, agility, and quickness, but further study is needed to determine the practical on-field implications of the seasonal changes in body composition observed in baseball players.
Effect of chronic narcotic use on episode-of-care outcomes following primary anatomic total shoulder arthroplasty
Authors: Mayer Megan N. , Mulligan Ryan P. , Villarreal Arturo D. , Lonergan Timothy M. , Brolin Tyler J. , Azar Frederick M. , Throckmorton Thomas W.
Published: April 2019

Background:

Bundled-care payments for total shoulder arthroplasty (TSA) make early outcomes relevant because they typically are tied to a 90-day episode-of-care. The purpose of this study was to determine the effect of chronic preoperative narcotic use on early postoperative pain relief, narcotic use, length of hospital stay, readmissions, and complications in patients with primary TSA.

Methods:

Chronic narcotic use was defined as use of narcotic pain medication for at least 3 mo before surgery. Narcotic use was converted to oral morphine equivalents (OME) for in-hospital use, discharge medications, and prescriptions at 2-, 6-, and 12-week visits. Statistical analyses used Fisher’s exact test for dichotomous variables and Student’s t-test for continuous variables. Differences with P<0.05 were considered statistically significant.

Results:

Of 152 patients with primary TSA, 27 were chronic preoperative narcotic users and 125 were not. There were no statistically significant differences between groups with regard to age, gender, laterality, or body mass index. At 2 wk postoperatively, there was no significant difference in visual analog scores VAS; however, at 6 and 12 wk, chronic narcotic users had significantly higher VAS and a significantly higher cumulative narcotic requirement. There were no significant differences in length of hospital stay, complications, or readmission rates.

Conclusions:

Chronic preoperative narcotic use is a risk factor for a more difficult postoperative course after TSA compared to that in narcotic-naïve patients. Chronic opioid users, however, do not necessarily require additional perioperative resources, which is relevant to risk stratification in the emergence of bundled payment programs for TSA.

Level of Evidence:

Level III, prognostic case-control study.
Shoulder replacement surgery: computer-assisted preoperative planning and navigation
Authors: Rodríguez José A. , Entezari Vahid , Iannotti Joseph P. , Ricchetti Eric T.
Published: April 2019

With the increasing use of shoulder arthroplasty, surgeons encounter a greater number of primary and revision cases with glenoid deformity, presenting the challenge of avoiding glenoid component malpositioning that can impact patient function and implant longevity. Surgeons can now use preoperative three-dimensional imaging and templating to better understand each patient’s pathology and arrive at the operating room with a clear surgical strategy for implant type, size, and position. With the advent of intraoperative patient-specific instrumentation and navigation, the surgeon also has the means to translate the preoperative plan in the operating room with increased accuracy, thus, decreasing the likelihood of component malposition and its associated complications.
Tendon transfers for rotator cuff pathologies
Authors: Wagner Eric R. , Elhassan Bassem T.
Published: April 2019

Irreparable rotator cuff tears remain one of the most challenging pathologies faced by shoulder surgeons. In both irreparable anterior (subscapularis) and posterosuperior (supraspinatus and infraspinatus) tears, patients experience marked shoulder dysfunction and pain. In this article, we review the surgical considerations for treating patients with these tears, as well as the tendon transfer options. Irreparable rotator cuff tears are associated with advanced fatty infiltration, tendon retraction, and loss of tendon length. Although there are multiple reconstructive options, most are limited to small series with short-term follow-up. Tendon transfers have emerged as very promising reconstructive options for these patients. When considering the ideal tendon transfer, it is critical to consider the four-tendon transfer principles, as well as the ability of patients to retrain the new transfer to perform a different function. The historical option for posterosuperior tears involved a latissimus dorsi transfer, while the lower trapezius transfer emerged in recent years. The historical transfer for irreparable subscapularis tears was the pectoralis major transfer, while the latissimus dorsi emerged in recent years. Further comparative trials with large patient numbers and longer follow-up are needed to better understand the indications for each of these transfers to treat these difficult pathologies.
Top classic articles to read for elbow training
Authors: Savage-Elliott Ian , O’Brien Michael J.
Published: April 2019

Articles written during the development of a particular field lay the foundation for that field’s incremental advancement. Some are more cited than others; however, each contains formative principles that drive the field forward and change modern day practices. This article reviews a number of these articles that the author believes are important in the education of residents on an upper extremity rotation.
AAFD: Conventional Radiographs are not Enough! I Need the Third Dimension
Authors: Bernasconi Alessio , de Cesar Netto Cesar , Barg Alexej , Burssens Arne , Richter Martinus , Lintz François
Published: April 2019

There is an increasing amount of literature suggesting that 3-dimensional (3D) weight-bearing computed tomography (WBCT) imaging overcomes the inherent limits of traditional bidimensional imaging in foot and ankle surgery. This seems to have a significant impact on the study and on the clinical management of adult acquired flatfooot deformity (AAFD) that by definition is a 3D complex deformity. In this study, we reviewed the recent literature about the use of WBCT in AAFD, starting from a critical analysis about the biases related to conventional radiography and to non-standing CT. Then, we focused on the effects of load on the 3D architecture of the foot and ankle in AAFD. Finally, we discussed the benefits and future perspectives for the use of WBCT in the management of this condition and as a surgical planning tool as well.

Level of Evidence: Diagnostic Level V, expert opinion. See Instructions for Authors for a complete description of levels of evidence.
Quality of Life and 1-Year Survival in Patients With Early Septic Shock: Long-Term Follow-Up of the Australasian Resuscitation in Sepsis Evaluation Trial
Authors: Higgins Alisa M. , Peake Sandra L. , Bellomo Rinaldo , Cooper D. Jamie , Delaney Anthony , Harris Anthony H. , Howe Belinda D. , Nichol Alistair D. , Webb Steve A. , Williams Patricia J.
Published: April 2019

Objectives:

To examine long-term survival and quality of life of patients with early septic shock.

Design:

Prospective, randomized, parallel-group trial.

Setting:

Fifty-one hospitals in Australia, New Zealand, Finland, Hong Kong, and the Republic of Ireland.

Patients:

One-thousand five-hundred ninety-one patients who presented to the emergency department with early septic shock between October 2008 and April 2014, and were enrolled in the Australasian Resuscitation in Sepsis Evaluation trial.

Interventions:

Early goal-directed therapy versus usual care.

Measurements and Main Results:

Long-term survival was measured up to 12 months postrandomization. Health-related quality of life was measured using the EuroQoL-5D-3L, Short Form 36 and Assessment of Quality of Life 4D at baseline, and at 6 and 12 months following randomization. Mortality data were available for 1,548 patients (97.3%) and 1,515 patients (95.2%) at 6 and 12 months, respectively. Health-related quality of life data were available for 85.1% of survivors at 12 months. There were no significant differences in mortality between groups at either 6 months (early goal-directed therapy 21.8% vs usual care 22.6%; p = 0.70) or 12 months (early goal-directed therapy 26.4% vs usual care 27.9%; p = 0.50). There were no group differences in health-related quality of life at either 6 or 12 months (EuroQoL-5D-3L utility scores at 12 mo early goal-directed therapy 0.65 ± 0.33 vs usual care 0.64 ± 0.34; p = 0.50), with the health-related quality of life of both groups being significantly lower than population norms.

Conclusions:

In patients presenting to the emergency department with early septic shock, early goal-directed therapy compared with usual care did not reduce mortality nor improve health-related quality of life at either 6 or 12 months.