bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of clinical assessment and child mortality: a three-country cross-sectional study
Authors: Perales Nicole A , Wei Dorothy , Khadka Aayush , Leslie Hannah H , Hamadou Saïdou , Yama Gervais Chamberlin , Robyn Paul Jacob , Shapira Gil , Kruk Margaret E , Fink Günther
Published: May 2020

This analysis describes specific gaps in the quality of health care in Central Africa and assesses the association between quality of clinical care and mortality at age 2–59 months. Regionally representative facility and household surveys for the Democratic Republic of the Congo, Cameroon and Central African Republic were collected between 2012 and 2016. These data are novel in linking facilities with households in their catchment area. Compliance with diagnostic and danger sign protocols during sick-child visits was observed by trained assessors. We computed facility- and district-level compliance indicators for patients aged 2–59 months and used multivariate multi-level logistic regression models to estimate the association between clinical assessment quality and mortality at age 2–59 months in the catchment areas of the observed facilities. A total of 13 618 live births were analysed and 1818 sick-child visits were directly observed and used to rate 643 facilities. Eight percent of observed visits complied with 80% of basic diagnostic protocols, and 13% of visits fully adhered to select general danger sign protocols. A 10% greater compliance with diagnostic protocols was associated with a 14.1% (adjusted odds ratio (aOR) 95% CI: 0.025–0.244) reduction in the odds of mortality at age 2–59 months; a 10% greater compliance with select general danger sign protocols was associated with a 15.3% (aOR 95% CI: 0.058–0.237) reduction in the same odds. The results of this article suggest that compliance with recommended clinical protocols remains poor in many settings and improvements in mortality at age 2–59 months could be possible if compliance were improved.
An Evaluation of Baseline Kidney Function in the REPRIEVE Trial of Pitavastatin in Human Immunodeficiency Virus
Authors: Overton Edgar T , Kantor Amy , Fitch Kathleen V , Muntner Paul , Supparatpinyo Khuanchai , Mosepele Mosepele , Mohapi Lerato , Cardoso Sandra Wagner , Patil Sandesh , de Lacerda Marcus V G , McComsey Grace , Aberg Judith A , Douglas Pamela S , Grinspoon Steven K , Ribaudo Heather , Wyatt Christina M
Published: May 2020

Background

Chronic kidney disease is a common comorbid condition among persons living with human immunodeficiency virus (PWH). We characterized baseline kidney function in the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) trial cohort.

Methods

REPRIEVE enrolled PWH with low to moderate cardiovascular risk based on traditional risk factors to evaluate the effect of statin therapy on cardiovascular events. We determined baseline estimated glomerular filtration rate (eGFR) with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease, and Cockcroft-Gault equations, and we evaluated baseline factors associated with eGFR <90 mL/min/1.73 m2 by logistic regression. We performed Bland-Altman plots and scatterplots to assess agreement between equations.

Results

Among 7770 participants enrolled, the median age was 50 years, 31% were female (natal sex), 43% black or African American and 15% Asian, the median body mass index (calculated as calculated as weight in kilograms divided by height in meters squared) was 25.8, and the median CD4 cell count 620/µL. The median CKD-EPI eGFR was 97 mL/min/1.73 m2, and 38% had an eGFR <90 mL/min/1.73 m2. In the adjusted model, factors associated with eGFR <90 mL/min/1.73 m2 included white race, older age, higher body mass index, high-income region of enrollment, hypertension, and tenofovir disoproxil fumarate. The CKD-EPI and Modification of Diet in Renal Disease equations demonstrated strong agreement, particularly at lower eGFR values. Overall, there was 56% concordance between the 3 equations (categories <60, 60 to <90, ≥90 mL/min), improving to 73% after accounting for individual body surface area.

Conclusions

REPRIEVE enrolled a diverse cohort including a substantial number of PWH with reduced kidney function. Factors associated with reduced eGFR included traditional risk factors and tenofovir disoproxil fumarate exposure. Three commonly used equations have only fair agreement, with potential implications for both clinical care and epidemiologic studies.

Clinical Trials Registration

NCT02344290.
Adenovirus Viral Kinetics and Mortality in Ex Vivo T Cell-Depleted Hematopoietic Cell Transplant Recipients With Adenovirus Infection From a Single Center
Authors: Lee Yeon Joo , Fang Jiaqi , Zavras Phaedon D , Prockop Susan E , Boulad Farid , Tamari Roni , Perales Miguel Angel , Papadopoulos Esperanza B , Jakubowski Ann A , Giralt Sergio A , Papanicolaou Genovefa A
Published: May 2020

Background

We report on predictors of adenovirus (ADV) viremia and correlation of ADV viral kinetics with mortality in ex vivo T-cell depleted (TCD) hematopoietic cell transplant (HCT).

Methods

T cell-depleted HCT recipients from January 1, 2012 through September 30, 2018 were prospectively monitored for ADV in the plasma through Day (D) +100 posttransplant or for 16 weeks after the onset of ADV viremia. Adenovirus viremia was defined as ≥2 consecutive viral loads (VLs) ≥1000 copies/mL through D +100. Time-averaged area under the curve (AAUC) or peak ADV VL through 16 weeks after onset of ADV viremia were explored as predictors of mortality in Cox models.

Results

Of 586 patients (adult 81.7%), 51 (8.7%) developed ADV viremia by D +100. Age <18 years, recipient cytomegalovirus seropositivity, absolute lymphocyte count <300 cells/µL at D +30, and acute graft-versus-host disease were predictors of ADV viremia in multivariate models. Fifteen (29%) patients with ADV viremia died by D +180; 8 of 15 (53%) died from ADV. Peak ADV VL (hazard ratio [HR], 2.25; 95% confidence interval [CI], 1.52–3.33) and increasing AAUC (HR, 2.95; 95% CI, 1.83–4.75) correlated with mortality at D +180.

Conclusions

In TCD HCT, peak ADV VL and ADV AAUC correlated with mortality at D +180. Our data support the potential utility of ADV viral kinetics as endpoints in clinical trials of ADV therapies.
Recent progress in synchrotron radiation 3D–4D nano-imaging based on X-ray full-field microscopy
Authors: Takeuchi Akihisa , Suzuki Yoshio
Published: May 2020

The advent of high-flux, high-brilliance synchrotron radiation (SR) has prompted the development of high-resolution X-ray imaging techniques such as full-field microscopy, holography, coherent diffraction imaging and ptychography. These techniques have strong potential to establish non-destructive three- and four-dimensional nano-imaging when combined with computed tomography (CT), called nano-tomography (nano-CT). X-ray nano-CTs based on full-field microscopy are now routinely available and widely used. Here we discuss the current status and some applications of nano-CT using a Fresnel zone plate as an objective. Optical properties of full-field microscopy, such as spatial resolution and off-axis aberration, which determine the effective field of view, are also discussed, especially in relation to 3D tomographic imaging.
The Unfinished Business of Respect for Autonomy: Persons, Relationships, and Nonhuman Animals
Authors: Walker Rebecca L
Published: May 2020

This essay explores three issues in respect for autonomy that pose unfinished business for the concept. By this, I mean that the dialogue over them is ongoing and essentially unresolved. These are: (1) whether we ought to respect persons or their autonomous choices; (2) the role of relational autonomy; and (3) whether nonhuman animals can be autonomous. In attending to this particular set of unfinished business, I highlight some critical moral work left aside by the concept of respect for autonomy as understood in Beauchamp and Childress’ Principles of Biomedical Ethics. Specifically, while significant pragmatic traction is gained by the authors’ focus on autonomous choice, carving such a focus out from the broader questions of moral respect and the autonomy of the person leaves aside a number of questions that we might have thought a view about respect for autonomy in biomedicine ought to answer. These include: How should physicians respond when autonomous patients make decisions that appear nonautonomous? What is the impact of the view that autonomy is “relational” for cross-cultural differences in how autonomy is respected? If chimpanzees (and by extension young children) can be autonomous, what does that mean for how they should be treated?
The Psychodynamic Aspects of Migration
Authors: Rothe Eugenio M. , Pumariega Andres J.
Published: May 2020

The chapter on the psychodynamic aspects of migration explains the parallels between the process of migration and of life and human development, which can be understood as a series of attachments and separations that can lead to personal growth but involve mourning for what is lost and forming new attachments. It explains the concept of culture shock and the process of transformation of the identity of the immigrant, the dynamics involved in acquiring a new language, and the psychodynamic challenges of starting a life in the new host country. It explains the psychological defenses that the immigrant may put in place to deal with the massive losses of migration and adapt to the new country, such as the loss of past human connections and material possessions, as well as the loss of a familiar climate and geography. It discusses the family dynamics of leaving children behind in the care of relatives and later reunifications with the immigrant parents in the new host country. The chapter offers treatment recommendations to deal with these issues. The chapter is also illustrated with case studies.
Refugees and Special Populations
Authors: Rothe Eugenio M. , Pumariega Andres J.
Published: May 2020

The chapter on refugees and special populations defines what constitutes a refugee and describes the demographics and sociopolitical causes of the refugee problem worldwide. It describes the different types of circumstances that produce forced migrations and the sociocultural and psychodynamic phases of the refugee experience, beginning with the departure from the country of origin and ending in the arrival and adaptation into the host country. It discusses the plight of unaccompanied child and adolescent refugees and the case of child soldiers. It describes the epidemiological findings among the different refugee populations worldwide and the controversies that exist in various countries in validating and granting a person refugee status, as well as the controversies of understanding the refugee experiences from a pathological–traumatic perspective in contrast with a resiliency perspective. It describes the mental health assessment and screening of refugees, access to care, treatment interventions, the treatment process, the existing evidence-based treatments and preventive interventions, as well as implications for policy, practice, and research. It also illustrates the controversies with a clinical case.
Culture, Identity, and Mental Health
Authors: Rothe Eugenio M. , Pumariega Andres J.
Published: May 2020

This chapter presents conclusions and future directions on culture, identity, and mental health, including the importance of identity and culture, separations and mourning as an important part of the immigrant experience, immigration-related separations, understanding acculturation, transnational identities, pilgrimages, and return migrations, understanding and treating refugees and special populations, criminality among immigrants to the United States, immigration and race, American narratives and immigrant narratives, treatment of immigrants and the children of immigrants, alternative futures for cultural identity – intercultural future and tribalistic future.
The Physician in Practice
Authors: Wijdicks Eelco F.M.
Published: May 2020

Celluloid physicians emerged early in cinema. When medicine changed and became more sophisticated, cinema took notice and changed in parallel. The family physician became a hospital specialist, primarily saving lives, but then physicians’ vulnerability (and misjudgments) entered screenplays. The cinematic history of general practitioners shows film doctors doing very little actual doctoring. Many specialties are absent in film because they are less understood or provide no inspiration for a plot line. The psychiatrist, gynecologist, and surgeon have common appearances due to the preferred topic matter. This chapter discusses the portrayal of physicians by actors and how this could affect the audience’s perception of the profession. This chapter reviews the authenticity of the doctor. What does cinema think we are?
Transplantation
Authors: Wijdicks Eelco F.M.
Published: May 2020

For many of us the heart is still symbolic of the soul. Therefore, the advent of heart transplantation opened up new avenues for movie plots. The experience of the transplant recipient has captured screenwriters’ attention. Screenwriters are intrigued by the complexity of heart transplantation and, with it, themes based on the centrality of the heart in emotions, the possibility of a donor’s personality traits being transmitted to the recipient, quests to find the donor’s family and cloning organ donors to treat complex disease. Transplant tourism and trafficking are other commonly covered topics. This chapter reviews the history of transplantation and connects it with its cinematic representations– from horrific to compassionate.
Medical Violations
Authors: Wijdicks Eelco F.M.
Published: May 2020

Medical research often involves experiments, and these may include psychological experiments into human behavior, which have attracted filmmakers. A number of atrocities have been depicted in films, and they importantly record horrific episodes in the history of medicine. Filmmakers have been drawn toward medicine’s failures and foibles including chilling “extreme measures” in the medical tradition and even modern medicine. The medical discoveries and stories of overcoming disease seem to be less interesting to filmmakers; narratives of sham “treatment,” professional abuse of power, and wickedness work better.
Activism and Medicine
Authors: Wijdicks Eelco F.M.
Published: May 2020

Filmmakers are interested in dramas in which medicine and politics meet. This chapter discusses documentaries on health care in the United States contrasted with that in the United Kingdom, AIDS activism, the pharmaceutical industry, the women’s reproductive rights debate, and the vaccine-and-autism debate. Films by medical activists are often skewed in their presentation and usually attract only a like-minded audience and end up “preaching to the choir.” However, as questions of health care, abortion, vaccination, and drug availability and safety continue to create political debate, these films invite the medical establishment to respond (and sometimes, reluctantly, they must do so).
Adolescent and Young Adult Medicine
Authors: Hwang Loris Y. , Perry Martha F. , Tanaka Diane , Inwards-Brelan David J. , Voss Raina
Published: May 2020

This chapter on adolescent and young adult medicine reviews the topics found on the content outline for the General Pediatrics board exam. These overarching main topics include pubertal, cognitive, and emotional growth and development; sexual behavior and orientation; gender identity; gynecology; and mental and behavioral health issues. The teaching points are highlighted by taking a case-based approach. The patient vignettes include issues in menstrual disorders; sexually transmitted infections; pelvic inflammatory disease; contraception; care for lesbian, gay, bisexual, and transgender (LGBT) youth; eating disorders; substance use; school challenges; violence; and assault. Also reviewed are the adolescent development of self-identity, guidelines in preventive care, patient adherence to complex treatment regimens for chronic illness, and transitions to adult healthcare.
Genetics
Authors: Woods Jeremy D. , Dipple Katrina M. , Wong Derek A.
Published: May 2020

Recognition and comanagement of genetic disorders is an increasingly important aspect of general pediatric care. Timely diagnosis and proper management of treatable genetic disorders often have profound implications for the survival and development of the affected individuals. This chapter provides general pediatricians with the knowledge base necessary to understand modern genetic testing, recognize the presentation of the more commonly encountered genetic diseases, and provide ability to coordinate and manage these children’s complex medical issues. The question-and-answer format provides active learning in a wide array of subjects, including the application of testing modalities (e.g., karyotyping, chromosomal microarray, and DNA sequencing), as well as inborn errors of metabolism, disorders of sex development, and more common mutations and deletions.
Oncology
Authors: Kao Roy L. , Ruiz Maritza E. , Gotesman Moran , Ch’ng James H.
Published: May 2020

Pediatric oncology focuses on the diagnosis and management of cancer in infants, children, and adolescents. Leukemias, lymphomas, and other hematological malignancies are the most common group of pediatric cancers, followed by brain tumors. Other important pediatric cancers include Wilms tumor, neuroblastoma, sarcomas, histiocytosis, and germ cell tumors. Certain cancers can present with oncologic emergencies, such as tumor lysis syndrome or spinal cord compression, or as part of a cancer predisposition syndrome. With increased survival rates, short- and long-term complications of chemotherapy, radiation, surgery, and hematopoietic cell transplantation are also prevalent and important to recognize. This chapter reviews these key concepts in pediatric oncology using board review–style questions and answers.
Hematology
Authors: Kao Roy L. , Ch’ng James H. , Gotesman Moran , Ruiz Maritza E.
Published: May 2020

Pediatric hematology focuses on the diagnosis and management of disorders of the blood and blood-forming organs in infants, children, and adolescents. These include disorders in the number or function of platelets, erythrocytes (red blood cells), leukocytes (white blood cells), and coagulation factors, among others, that lead to abnormal bleeding, clotting, oxygen delivery, infectious predisposition, and other complications. Using pediatric board review questions and answers, this chapter reviews key concepts in nonmalignant hematology of interest to both general pediatricians and pediatric specialists. Specific topics include the evaluation and management of iron and other nutritional deficiency anemias, hemolytic anemias, hemoglobinopathies, bleeding disorders, immune-mediated cytopenias, bone marrow failure syndromes, platelet disorders, neutropenia and other leukocyte disorders, and transfusion reactions, among others.
Rheumatologic Disorders
Authors: Yong Terwa , Hoftman Alice
Published: May 2020

This chapter reviews the pediatric rheumatologic disorders that present to the general practitioner in settings involving regular or urgent care. The clinical scenarios presented, which are followed by a question-and-answer format review, encompass common and rare rheumatologic conditions. The conditions reviewed include such topics as Henoch-Schönlein purpura, Kawasaki disease, acute rheumatic fever, juvenile idiopathic arthritis, ankylosing spondylitis, postinfectious arthritis, various causes of autoimmune and nonautoimmune musculoskeletal joint pain (including some genetic connective tissue disorders and lupus). Furthermore, some of the salient laboratory testing specific to rheumatologic illnesses is covered in relation to these conditions.
Cardiology
Authors: Reardon Leigh C. , Wong Vanessa L. , Gallotti Roberto G. , Moore Jeremy P.
Published: May 2020

This chapter reviews important concepts in pediatric cardiology through board-relevant questions. Emphasis is placed on the diagnosis of common cardiac conditions, evaluation of murmurs, understanding electrocardiograms, appropriate ordering and use of diagnostic tests, appropriate emergency management of common cardiac conditions, and the recognition of important genetic cardiac conditions. The chapter provides answers to each question with explanations of the correct and incorrect answers.
Pulmonology
Authors: Bansal Manvi , Perez Iris A. , Keens Thomas G.
Published: May 2020

This chapter presents vignettes on commonly encountered pulmonary issues in a general pediatric practice. It details the clinical presentation, evaluation, and management of upper and lower airway disorders, parenchymal lung diseases, respiratory control disorders, and ventilatory muscle disorders. Clinical pearls in the recognition of rare pulmonary diseases are discussed. Illustrative cases highlight the appropriate use of procedures and laboratory and radiographic tests such as chest radiographs, computerized tomography scans, pulmonary function tests, blood gases, polysomnography, and bronchoscopy to aid diagnosis. Also reviewed are clinical guidelines and current data that impact the management approach.
Ophthalmology
Authors: Hemmati Houman David
Published: May 2020

This chapter examines ophthalmic disorders that are commonly encountered in a general pediatrics practice as well as rare but important ophthalmic disorders whose prompt and accurate diagnosis and treatment are critical to ensure preservation of vision and, in some cases, preservation of life. It examines neonatal diseases such as ophthalmia neonatorum, retinopathy of prematurity, and nasolacrimal duct obstruction, providing a review of key diseases in the differential diagnoses and offering guidance on proper management. It discusses diagnostic measures for potentially life-threatening diseases like orbital cellulitis and offers a discussion on the management of common pediatric ophthalmology conditions that typically concern parents, including hordeolum (or stye), strabismus, corneal abrasion, and eyelid capillary hemangioma.
Psychosocial Issues
Authors: Mogil Catherine , Bemis Heather , Lee Jena , Bursch Brenda
Published: May 2020

The chapter on psychosocial issues reviews the impact of the family environment, medical illness, and societal stressors on child well-being. The chapter incorporates clinical scenarios in vignettes that are followed by a question-and-answer format to support clinical application of the material. The psychosocial issues that are presented include different family presentations (e.g., divorce, death of a loved one, adoption, foster care); educational issues (e.g., giftedness); and societal factors (e.g., socioeconomic status, community violence, impact of media). In addition, attention is paid to how these factors have an impact on medical conditions, chronic illness, and other childhood psychological/behavioral challenges (e.g., enuresis, vulnerable child syndrome, pain).
Herbal Medicine and Nutritional Supplements for Gut Health
Authors: Fitzgerald Kara , Contractor Nikky
Published: May 2020

Gastrointestinal complaints are among the most common health considerations. Current therapies such as acid blockers, non-steroidal anti-inflammatory drugs (NSAIDS) and antibiotics are not without their challenges and adverse effects. Herbal medicine provides an array of anti-inflammatory, antimicrobial, antiemetic, and carminative plants that provide additional tools to the health care professional. Quality dietary and nutritional supplements containing extracts of herbs, prebiotics, or probiotics offer a standardized delivery system for these ingredients. Herbal medicine and dietary supplements have been demonstrated to be effective in various gastrointestinal conditions. This chapter will highlight the nutraceutical products that have been proven in clinical trials to treat and mitigate digestive health ailments.
Mind–Body Interventions in the Care of Functional Gastrointestinal Disorders
Authors: Snider Adam , Naim Omid
Published: May 2020

This chapter reviews the clinical utility of various mind–body interventions (MBIs) in the treatment of functional gastrointestinal disorders (FGID), including cognitive behavioral therapy, mindfulness, yoga, hypnosis, and biofeedback. Chronic or traumatic stress may dysregulate functions of the autonomic nervous system and lead to maladaptive changes in the brain–gut axis. Optimized regulation of the autonomic nervous system improves gastrointestinal function and may be a common factor in various MBIs used to treat stress-related FGID. In recent years, an expansion of randomized controlled trials and meta-analyses has provided additional evidence supporting the use of MBIs in treatment of FGID symptoms and related quality of life. This chapter includes a theoretical discussion of the stress response, the relaxation response, and the role of the mind as a regulatory process. The chapter also addresses practical issues relevant to incorporating MBIs into the treatment of FGID, including the doctor–patient relationship and successful referral to an MBI practice or provider.
Weight Disorders
Authors: Matarese Laura E. , Harvin Glenn , Ali Eslam
Published: May 2020

Obesity and its associated comorbidities remain a significant global health issue. Despite the well-known consequences and related comorbidities associated with being overweight and obese, the prevalence remains alarmingly high and is increasing. In 2011–2014, the prevalence of obesity was 36.5% in adults and 17% in youth. The exact reasons for the prevalence and increase are multifactorial but reflect the overall lack of success of standard treatments. It is therefore not surprising that individuals often seek alternative therapies, including a variety of fibers, minerals, teas, and herbal supplements. Aside from the financial implications, many of these products have very little supporting evidence; some are unsafe. This chapter will review some of these alternative therapies with emphasis on the scientific evidence that supports or refutes their use.
Functional Medicine
Authors: Sheeler Robert D.
Published: May 2020

Functional medicine is an emergent field that combines traditional Western medicine, systems biology, and a deep understanding of biochemistry with a personalized precision approach to the individual in their sociocultural context. It believes that modifying upstream pathways and searching for root causes give better outcomes than care based on suppressing signs and symptoms of end-stage disease. Functional medicine practice uses specific tools and heuristics such as the Functional Medicine Matrix and Timeline to uncover relationships of presenting complaints to the underlying cellular level pathophysiology. The systems biology approach cuts across organ systems to find unifying biochemical and physiological imbalances that, when successfully treated, can prevent, arrest, and even ameliorate disease.
Lifestyle Medicine
Authors: Singh Marvin M.
Published: May 2020

The digestive tract, which houses the more than 100 trillion microorganisms known as the gut microbiome, plays a central role in achieving and maintaining optimal health and wellness. Furthermore, modulation of the gut microbiome via particular lifestyle interventions may help in the management and prevention of chronic diseases. Toxin avoidance, appropriate dietary choices, adequate exercise, appropriate sleep quality and quantity, mitigation of stress, and social interconnectedness are central concepts to the development of any lifestyle program. Utilizing a personalized approach can help patients optimize their health according to their genes, gut microbiome composition, metabolomics, and environmental factors. While this is an emerging field of medicine, there is substantial evidence to date that supports the key role that these elements play in health, well-being, and longevity.
The Potential and Impacts of Practical Application of Beauchamp and DeGrazia’s Six Principles
Authors: Carbone Larry
Published: May 2020

This commentary focuses on the potential and impacts of practically engaging Beauchamp and DeGrazia’s six principles of animal research ethics in industry, government, and academic laboratories. Specifically addressed is how veterinarians can and should work closely with Institutional Animal Care and Use Committees (IACUCs) in employing the principles to assess ways of improving our understanding of animals’ health, welfare, and desires. By contrast to the Russell and Burch Three-Rs model, Beauchamp and DeGrazia’s principles would substantially change how human benefits are balanced against animal harms and how pain medications are intentionally withheld from animals. Following these principles would also improve harm–benefit evaluations, requiring a stronger assessment of social benefit.
Commentary on the Beauchamp-DeGrazia Framework of Principles
Authors: Landi Margaret S.
Published: May 2020

Many of us in the animal research community regularly face an internal conflict. We witness developments of new treatments while recognizing that animals experience study-based harms despite our systems of care. Beauchamp and DeGrazia identify significant gaps left by reigning models of harm–benefit principles and the Three Rs. Their six principles must be seriously considered in debates about the conditions of morally justified animal research because they provoke bioethical questions neglected by harm–benefit analyses (HBA) and the Three Rs. However, some problems need more discussion than can be found in Beauchamp and DeGrazia’s framework. For example, more material on basic research and its justification would be helpful, as would analysis of how improvements in study design are paramount for increasing the benefit of HBA.
Definitions, Classification, and Epidemiology of Intellectual Disability
Authors: Cooper Sally-Ann
Published: May 2020

Intellectual disability is a social construct rather than a purely statistical construct, with the core features being (i) impaired intelligence more than two standard deviations from the population mean, (ii) impaired adaptive functioning, along with (iii) onset during childhood/youth. The majority of people with intellectual impairments have mild intellectual impairments (6 mild:1 moderate-profound impairments), and the majority with intellectual impairments in whom this is disabling have mild rather than severe intellectual disability (ID). There is considerable complexity in interpreting findings from studies and meta-analysis on prevalence of ID, but it appears that in high-income countries, about 5/1,000 adults have ID, falling to about 2/1,000 over the age of 65 years. Prevalence is higher in children and young people, boys/men (about 58%), and in low-income countries (though it may be less disabling in less technology-driven communities). For complex reasons, prevalence varies with geography, and over time.
Schizophrenia and Related Psychoses in People with Intellectual Disability
Authors: Humphries Laura , Michael Dasari , Hassiotis Angela
Published: May 2020

Individuals with an Intellectual Disability (ID) have an increased prevalence of Schizophrenia Spectrum Disorders (SSDs). The complex interplay between the symptoms of SSD and the individual’s level of development often give rise to atypical presentations. This is more so in individuals with a significant ID. Current classification systems may not adequately cover all the conditions experienced by individuals and may not be entirely captured under SSDs. It is important that the clinician gathers appropriate information from all relevant sources, including family, carers, educational establishments, and day care providers. Evidence for interventions in ID is sparse and treatment guidelines are based on evidence from the general population, which need to be extrapolated with caution, bearing in mind individual characteristics. The management of SSDs in ID requires a holistic approach, which takes into account their level of ID, sensitivity to medication, side effects and drug interactions and consideration towards other therapeutic modalities such as individual supports or CBT. The social aspects of management play a vital part in the treatment programme and the involvement of family and carers is crucial.
The Assessment and Treatment of Personality Disorders in People with Intellectual and Developmental Disabilities
Authors: Lindsay William R. , Chester Verity , Alexander Regi
Published: May 2020

Knowledge about the assessment of personality disorder (PD) in people with intellectual and developmental disabilities (IDD) has improved significantly in the last 15 years. Guidelines have been developed starting with recommendations by Alexander and Cooray (2003) that informant information, observation, and interview should be employed in a convergent assessment. Specific considerations should be given to the features of IDD itself such as delay in perspective taking abilities. While initial research found widely differing prevalence of PD in people with IDD, more recent research following guidelines, has been more consistent. It has also been demonstrated that PD has an orderly relationship with the assessment of general personality and with emotional problems. Recent alterations in the assessment of PD in the general population have been found suitable for people with IDD and it has also been found that generic services for this population are suitable for those with IDD and PD.
Cell Therapies for Spinal Cord Injury: Trends and Challenges of Current Clinical Trials
Authors: Bartlett Richard D , Burley Sarah , Ip Mina , Phillips James B , Choi David
Published: May 2020

Cell therapies have the potential to revolutionize the treatment of spinal cord injury. Basic research has progressed significantly in recent years, with a plethora of cell types now reaching early-phase human clinical trials, offering new strategies to repair the spinal cord. However, despite initial enthusiasm for preclinical and early-phase clinical trials, there has been a notable hiatus in the translation of cell therapies to routine clinical practice. Here, we review cell therapies that have reached clinical trials for spinal cord injury, providing a snapshot of all registered human trials and a summary of all published studies. Of registered trials, the majority have used autologous cells and approximately a third have been government funded, a third industry sponsored, and a third funded by university or healthcare systems. A total of 37 cell therapy trials have been published, primarily using stem cells, although a smaller number have used Schwann cells or olfactory ensheathing cells. Significant challenges remain for cell therapy trials in this area, including achieving stringent regulatory standards, ensuring appropriately powered efficacy trials, and establishing sustainable long-term funding. However, cell therapies hold great promise for human spinal cord repair and future trials must continue to capitalize on the exciting developments emerging from preclinical studies.
USING DICENTRIC DOSE ESTIMATES AND EARLY RADIATION-INDUCED BLOOD CELL COUNT CHANGES OF REAL CASE HISTORIES FOR VALIDATION OF THE HEMODOSE BIODOSIMETRY TOOL
Authors: Haupt Julian , Ostheim Patrick , Port Matthias , Abend Michael
Published: May 2020

HemoDose is a software tool, which estimates absorbed doses based on blood cell counts (BCC). The aim of our study was to validate HemoDose for early dose estimates. Dose estimates generated by HemoDose were compared with dose estimates stored in SEARCH from radiation victims. Moreover, BCC from unirradiated donors and corresponding HemoDose dose estimates were analysed. We employed linear or logistic regression analysis. There was a significant correlation between calculated doses by HemoDose based on single and multiple lymphocyte counts when omitting lowest and highest dose estimates. Furthermore, there was a significant correlation between calculated doses by HemoDose based on lymphocyte counts and the estimated doses based on DIC. The dose estimates by HemoDose based on lymphocyte counts and DIC showed a comparable correlation with HARS degrees 0 and 4. In conclusion, HemoDose dose estimation based on early lymphocyte counts appears to be a promising biodosimetry tool under certain considerations.
14Popular Culture
Authors: Danesi Marcel
Published: May 2020

This review of three introductory textbooks in the field of popular culture published in 2018 and 2019 focuses on the different perspectives they provide on such culture, as a means for understanding its current state and future evolution. It is divided into six sections: 1. Introduction; 2. Pop Culture, People, and Politics; 3. A Pastiche Approach to Cinema; 4. Pop Culture Theories; 5. Pop Culture and the Internet; 6. Conclusion. Pop culture is changing radically today, breaking away from the historical flow that gained momentum in then 1920s, because its delivery through the Internet may be fragmenting its organic textuality. As a distinct form of culture, pop culture crystallized primarily in the US in the first decades of the twentieth century, arguably as a way for young people to contest and openly violate the restrictive social traditions of colonial America through new music, fashions, and overall lifestyles. It spread rapidly and broadly throughout American cities and other areas of the urbanized world—a diffusion made possible by new technologies, such as radio and cinema. From the outset, trends in pop culture influenced aesthetic tastes, politics, and even major musical and literary movements that were once considered to be part of ‘high culture’, gradually obliterating binary distinctions such as high-versus-low in cultural matters. In a phrase, what started out as a lifestyle reaction against puritanical colonial culture became a major source of new aesthetics (new music, new writing, and so on), remaining so ever since. But pop culture may have run its course with the rise of meme culture on the Internet. The books under review here are thus quite significant, not only because they present complementary views of pop culture to a broad audience, but also because we can draw from them a picture of how pop culture is evolving in the digital age and what this might imply for the future of this century-old cultural experiment.
Inpatient Unit Leaders' Perspectives on Parent Engagement in Neonatal and Pediatric Intensive Care
Authors: Vance Ashlee J. , Docherty Sharron , Brandon Debra H.
Published: May 2020

Background:

Hospital unit leaders help set the unit's priorities and are responsible for guiding the unit mission and philosophy of care; however, the perspective of leaders in facilitating parent engagement within intensive care units is limited.

Purpose:

The purpose of this study was to explore how medical and nursing unit leaders facilitate parent engagement in intensive care settings.

Methods:

Qualitative secondary analysis of 16 semistructured interviews of unit leadership (medical directors and nurse managers). Directed content analysis explored themes within the interviews using systematic strategies to ensure rigor.

Findings:

Unit leadership described 3 main features of care delivery necessary for supporting parent engagement: (1) culture of care, (2) relationships in care, and (3) environment of care. Communication among providers and parents and timing of decision-making were key areas addressed, along with concerns about physical space limiting parent engagement. Unit leaders discussed how the 3 main features (unit culture, relationships, and physical space) of care delivery were interconnected to optimize parent engagement.

Implications for Practice:

Overall, unit leaders recognized the importance of each feature of care delivery in facilitating engagement. Parent engagement is ultimately influenced by the optimization of delivering inclusive care: the physical space, the policies surrounding medical and nursing care, and the overall culture of the unit.

Implications for Research:

Future research needs to explore best practices around relationship building and managing space limitations. Further clarification of the needs and expectations of both parents and providers surrounding parent engagement in intensive care settings is needed.
Can Procalcitonin Improve Antibiotic Stewardship for Late-Onset Sepsis Evaluations in Neonates?
Authors: Gareau-Terrell Jennifer , Branham Steven
Published: May 2020

Background:

Procalcitonin (PCT) use is not widespread in the neonatal population during late-onset sepsis evaluations. Minimal data exist on appropriate PCT cutoff levels to treat with antibiotics for neonatal sepsis. New guidelines were implemented in select central Texas neonatal intensive care units for late-onset sepsis (infants older than 72 hours) with recommended PCT cutoff levels for antibiotic administration.

Purpose:

To evaluate antibiotic usage in a local neonatal population following late-onset sepsis workups pre-/postimplementation of a PCT guideline.

Methods:

A retrospective pre–/post–quality improvement project using chart review data was performed over 11 months in 2018. Inclusion criteria were infants older than 72 hours of life having a late-onset sepsis workup. The outcome measure is appropriate antibiotic administration, based on laboratory test results or cultures, for infants pre-/post-PCT guidelines.

Results:

The χ2 test indicated that the proportion of infants receiving appropriate antibiotics pre-/postinitiation of PCT guidelines did not significantly differ. There is, however, clinical significance with an improvement in the proportion of appropriate antibiotic administration and a decrease in variability.

Implications for Practice:

Using PCT may help the practitioner identify sepsis earlier and more effectively, thereby reducing morbidity and mortality among neonates while improving antibiotic stewardship.

Implications for Research:

The small sample size in this study and the limited number of neonatal intensive care units limit any inferences. Future research should evaluate the use of PCT in a larger sample across multiple settings.
Analyzing the Time From Discovery to Definitive Surgical Therapy for Lung Cancer Based on Referral Patterns
Authors: Napolitano Michael A. , Skancke Matthew D. , Mortman Keith D.
Published: May 2020

Objective:

Surgery for early stage non–small cell lung cancer can be curative. A delay from diagnosis to surgery can lead to increased mortality. Our objective was to determine if referring patients to specialists before a thoracic surgeon caused a delay in definitive treatment.

Materials and Methods:

A retrospective review was conducted of patients who had surgery for non–small cell lung cancer by a single surgeon at our institution from 2013 to 2016. Patients were divided into 2 groups: those who saw a specialist before a thoracic surgeon and patients who were referred directly to a surgeon once the pulmonary nodule was identified on computed tomography (CT). The time from initial CT to resection was compared. Secondary analysis compared private insurance versus Medicare/Medicaid. Percentage of patients upstaged was compared.

Results:

There was no significant difference between groups when comparing time from CT to surgery (79.88 vs. 79.90 d; P=0.58). There was a significant decrease in time from CT to surgery for patients with private insurance compared with Medicare/Medicaid patients (66.05 vs. 86.99 d; P=0.03) and fewer private insurance patients were upstaged (22.9% vs. 31.8%; P=0.32). More patients who saw a different specialist first were upstaged compared with patients sent directly to thoracic surgery (32.6% vs. 22.2%; P=0.22).

Conclusions:

When comparing time from CT detection of a lung nodule to surgery, no significant difference was found between patients sent to nonthoracic specialists first and those referred directly to a thoracic surgeon. There was a significant decrease in time from CT to surgery for patients with private insurance compared with Medicare/Medicaid.
Management of Ocular Hypotony After Tube Surgery Using Bent Intraluminal Stents
Authors: Song Mi Yeon , Hwang Young Hoon
Published: May 2020

Purpose:

We aimed to report a surgical technique for the management of ocular hypotony after tube surgery.

Methods:

We occluded the tube with ab interno insertion of 2 bent 5-0 polypropylene threads into the tube lumen. Bent stents were used to prevent stent displacement.

Results:

Our case series revealed that this procedure effectively resolved hypotony. Among the 3 cases, the stents were removed in 1 case and left in place in 2 cases. In all cases, the stent location remained stable without displacement.

Conclusion:

The insertion of bent intraluminal stents into the tube may be a useful method for the management of ocular hypotony after tube surgery.
Local and whole-network topologies reveal that pulvinar and semantic hub interactions correlate with picture vocabulary
Authors: Liu Jie , Cui Zhijun , Li Leinian
Published: May 2020

Evidence from cognitive neuroscience indicates that subcortical regions, especially the pulvinar region of the thalamus, are involved in semantic processing. In the current study, graph-based methods were used to investigate whether a cortical–subcortical network is involved in vocabulary processing. In addition to traditional resting-state functional connectivity (rsFC) analysis between local brain areas, we applied a novel method to validate the interaction between semantic network hubs and the pulvinar. Unlike the traditional rsFC, the new metrics assessed rsFC pattern similarity (rsFCS), which was calculated with a cosine similarity algorithm based on whole-network topological information. We also applied a support vector regression program based on left pulvinar connectivity patterns. A brain–behavior analysis was conducted based on 100 randomly selected unrelated participants from the Human Connectome Project S1200 database. After controlling for the visuospatial and attention test scores, the rsFC between the left middle temporal gyrus, left inferior parietal lobule, and left pulvinar was significantly positively correlated with age-adjusted picture vocabulary scores. Similar results were confirmed based on the new rsFCS analysis. The support vector regression procedures also showed a clearly relationship between picture vocabulary scores and left pulvinar-related rsFCs. Our study verified a role for a subcortical–cortical network in vocabulary processing that is based on local and whole-network topologies.