bluuebunny/crossref_metadata_2025 huggingface dataset:
Review on Computerized Prediction of Nutrients in Thermally Processed Canned Food
Authors: Hayakawa Kan-Ichi
Published: February 2020

Basic principles are briefly discussed for mathematical evaluation of nutrient concentration in thermally processed food. This evaluation is based on the use of equations for predicting the temperature of food subjected to a thermal process and for evaluating the rates of thermal degradation of a nutrient at different temperatures. Several computer programs were prepared by various researchers to minimize manual calculations required for estimating nutrient retention in thermally processed food. The computational characteristics of these programs are critically examined.
Cost Effectiveness and Automation
Authors: Aulik David J
Published: February 2020

The factors of (1) increasing volume of analyses required for research, quality assurance, and product development, (2) higher labor costs, and (3) improving technologies in automated analytical equipment have prompted operators of food analysis laboratories to consider automation as the possible panacea by which their laboratories can become optimally cost effective. This paper addresses the caveats associated with automation. These considerations should be included in the list of criteria used in decision-making to evaluate the best means by which a food analysis laboratory may be kept cost efficient.
Isolation of Chlorophenoxy Herbicides on Columns of Glass Beads
Authors: Osadchuk Mike , Salahub Edward , Robinson Pat
Published: February 2020

A method for the analysis of chlorophenoxy herbicide residues has been developed based on the observed adsorptive affinity of chlorophenoxy acids for glass surfaces. Extracted residues of 2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) herbicides are adsorbed onto a column of fine mesh glass beads, and subsequently esterified with diazomethane for gas-liquid chromatographic quantitation, using an electron capture detector. Prior to injection, the esterified sample is cleaned up by passing through a Florisil column. The method is sensitive to about 0.05 ppm 2,4-D and 0.01 ppm 2,4,5-T. Recoveries averaged from 81 to 101%, depending on the level added and the substrate.
Differentiation of Rennet from Other Milk-Clotting Enzymes by Polyacrylamide Gel Electrophoresis
Authors: Prager Manfred J
Published: February 2020

Polyacrylamide gel electrophoresis was used to differentiate animal rennet and other milk-clotting enzymes. After electrophoresis, the separated components were visualized by staining with aniline blue-black. Two prominent proteins were found in calf and bovine rennet, while only 1 major protein was observed in pepsin and enzymes of microbial origin. These patterns provided a basis for distinguishing animal rennet and the other enzymes as well as a means of identifying each type of enzyme by the characteristic pattern shown.
Determination of Lime in Magnesite by Atomic Absorption, X-Ray Fluorescence, and Gravimetric Analyses
Authors: Prager Manfred J , Graves Donald
Published: February 2020

Methods were developed for determining lime in magnesite by atomic absorption (AAS) and x-ray fluorescence (XRF) spectroscopy. The procedures were evaluated by using reference materials and commercial samples that had been analyzed gravimetrically. For AAS, samples are dissolved in HCl and the absorption is measured at 422.7 nm in a nitrous oxideacetylene flame. XRF determinations are made by using fused disks and a standard addition method. The intensity of the CaKα line corrected for background is measured. Regression analysis of the data shows that both instrumental methods are acceptable substitutes for the gravimetric procedure. Analysis of reference materials indicates that the methods are accurate. The AAS procedure is the simplest and fastest of the 3 methods.
Rapid Determination of Alkaline Phosphatase Reactivation
Authors: Kleyn Dick H , Ho Chia-Lu
Published: February 2020

A study was conducted to determine the feasibility of using the qualitative screening method specifying phenolphthalein monophosphate for differentiating reactivated and residual alkaline phosphatase activity. The relative increase in activity of the enzyme in the presence of MgCl2 serves to distinguish reactivated and residual alkaline phosphatase activity. Ten samples each of pasteurized (172°F for 24 sec), sterilized (about 300°F for a minimum of 2 sec) half-and-half and heavy cream were analyzed. Most samples yielded negative results initially but demonstrated activity after incubation 1 hr at 34°C. The average values, in terms of + marks, for the half-and-half and heavy cream in samples without MgCl2 were <1 and 2.4, respectively ; for samples treated with MgCl2, the values were 2.18 and 4.6, respectively, indicating reactivated phosphatase activity. In samples containing various levels of raw milk, the activity observed in the diluted, Mg2+-containing samples was less than in the undiluted samples containing no Mg, indicating residual phosphatase activity.
Synchronous primary lung and breast carcinoma removed via a single incision
Authors: Mohamed Saifullah , Jawad Faisal , Darr Adnan , Christensen Thomas Decker , Steyn Richard
Published: February 2020

We describe a case of a middle-aged female who was diagnosed with synchronous primary lung and breast cancer following a bout of recurrent chest infections. Subsequent Multi Disciplinary Team (MDT) discussion proposed that in light of the patients’ multiple comorbidities, both lesions should be resected simultaneously under one general anaesthetic. The patient underwent an initial left mastectomy and axillary node clearance. Through the same incision, a left anterolateral thoracotomy was created to complete a left lower lobectomy. Post-operatively she made an uncomplicated recovery and was discharged 7 days after the procedure. Despite undergoing a longer and more complex procedure, her length of stay was in keeping with the average length of stay for a patient undergoing a thoracotomy and lobectomy [1].

This case highlights the importance of a pre-planned multidisciplinary approach to deal with synchronous pathology in an efficiently synchronous manner to improve patient outcomes.
Photons to food: genetic improvement of cereal crop photosynthesis
Authors: Furbank Robert T , Sharwood Robert , Estavillo Gonzalo M , Silva-Perez Viridiana , Condon Anthony G
Published: February 2020

Photosynthesis has become a major trait of interest for cereal yield improvement as breeders appear to have reached the theoretical genetic limit for harvest index, the mass of grain as a proportion of crop biomass. Yield improvements afforded by the adoption of green revolution dwarfing genes to wheat and rice are becoming exhausted, and improvements in biomass and radiation use efficiency are now sought in these crops. Exploring genetic diversity in photosynthesis is now possible using high-throughput techniques, and low-cost genotyping facilitates discovery of the genetic architecture underlying this variation. Photosynthetic traits have been shown to be highly heritable, and significant variation is present for these traits in available germplasm. This offers hope that breeding for improved photosynthesis and radiation use efficiency in cereal crops is tractable and a useful shorter term adjunct to genetic and genome engineering to boost yield potential.
Staff attitudes to completely smoke-free policies and smoking cessation practices in a mental health setting
Authors: Ratier-Cruz A , Smith J G , Firn M , Rinaldi M
Published: February 2020

Background

Mental health trusts in England were expected to become completely smoke-free and embed smoking cessation practices by 2018. Such policies are fraught with concerns and have received mixed support from mental health staff. Understanding staff attitudes to these practices prior to enforcement of the policy could help design an effective implementation strategy.

Methods

A cross-sectional survey was conducted with clinical and non-clinical staff in a Mental Health Trust to understand smoking cessation practices and attitudes to the implementation of a completely smoke-free policy.

Results

There were 631 responses. Most participants disagreed with the policy on wards (59.6%) and throughout all mental health settings (57.4%). Clinicians expressed significantly lower organizational policy support (P = 0.001) than non-clinicians (P = 0.001). Psychiatrists were more supportive of the organizational items than nurses and allied health professionals. Clinicians’ attitudes towards smoking cessation practices were less positive for those who were current smokers (P < 0.001), but more positive for clinicians who had received or were interested in attending smoking cessation training (P < 0.001).

Conclusions

Partial and completely smoke-free policies remain unsupported by staff in mental health settings. Smoking cessation training appears to reinforce rather than alter attitudes towards smoking cessation.
Transdisciplinary Research in Energetics and Cancer early career investigator training program: first year results
Authors: Irwin Melinda L , Lowry Diana , Neuhouser Marian L , Ligibel Jennifer , Schmitz Kathryn , Patterson Ruth E , Colditz Graham , Li Fangyong , Nebeling Linda
Published: February 2020

Energy imbalance increases cancer burden by increasing cancer risk and mortality. Training early career investigators on conducting impactful energy balance and cancer research is needed. We developed a Transdisciplinary Research in Energetics and Cancer (TREC) Training Program for early career investigators. This analysis examined program satisfaction, knowledge gained, publications, and awards among Year 1 participants (i.e., fellows). The program consists of an in-person course, followed by 1 year of mentorship. Faculty and fellows completed precourse and postcourse surveys. Following the mentorship period, we surveyed fellows for TREC-related research productivity, including publications and grant funding attributed to the program. Twenty fellows were accepted into the program: 3 basic, 7 clinical, and 10 population scientists. Sixteen fellows were junior faculty and four were postdoctoral fellows. The course included ~50 lectures, small group sessions, and faculty–fellow sessions. 96.7% of attendees rated the course in the highest categories of “good/very good.” Knowledge significantly improved in 37 of 39 research competencies (94.8%). In the 18 months following the course, fellows published 25 manuscripts, with 3 published in journals with impact factor ≥10. Nineteen grants were funded to TREC fellows (i.e., 7 National Institutes of Health awards, 2 American Cancer Society [ACS] awards, and 10 foundation/pilot awards), and 7 fellows received career promotions. The program’s impact will be defined by the degree to which TREC fellows produce discoveries that could improve the health of populations at risk for and/or surviving cancer. Upon the conclusion of our fifth year in 2021, we will publicly disseminate the program material.
Characterization of Leaf Spot Pathogens from Several Spinach Production Areas in the United States
Authors: Liu Bo , Stein Larry , Cochran Kimberly , du Toit Lindsey J. , Feng Chunda , Dhillon Braham , Correll James C.
Published: February 2020

Leaf spot diseases have become a major concern in spinach production in the United States. Determining the causal agents of leaf spots on spinach, their prevalence and pathogenicity, and fungicide efficacy against these pathogens is vital for effective disease management. Spinach leaves with leaf spots were collected from Texas, California, Arizona, and South Carolina from 2016 to 2018, incubated in a moist chamber, and plated on potato dextrose and tryptic soy agar media. Fungal and bacterial colonies recovered were identified based on morphology and sequence analysis of the internal transcribed spacer rDNA and 16S rRNA, respectively. Two predominant genera were isolated: (i) Colletotrichum spp., which were identified to species based on sequences of both introns of the glutamate synthetase (GS-I) and glyceraldehyde-3-phosphate dehydrogenase (gapdh-I) genes; and (ii) Stemphylium spp., identified to species based on sequences of the gapdh and calmodulin (cmdA) genes. Anthracnose (Colletotrichum spinaciae) and Stemphylium leaf spot (Stemphylium vesicarium and S. beticola) were the predominant diseases. Additional fungi recovered at very limited frequencies that were also pathogenic to spinach included Colletotrichum coccodes, C. truncatum, Cercospora beticola, and Myrothecium verrucaria. All of the bacterial isolates were not pathogenic on spinach. Pathogenicity tests showed that C. spinaciae, S. vesicarium, and S. beticola caused significant leaf damage. The fungicides Bravo WeatherStik (chlorothalonil), Dithane F-45 (mancozeb), Cabrio (pyraclostrobin), and Merivon (fluxapyroxad and pyraclostrobin) were highly effective at reducing leaf spot severity caused by an isolate of each of C. spinaciae and S. vesicarium, when inoculated individually and in combination.
Bisphosphonate drug holidays
Authors: DiGiulio Mary , Loveless Thomas , Heider Gerti , Fagan Kathleen , Porsche Barbara
Published: February 2020

Bisphosphonates have been safely used to treat osteoporosis, effectively reducing fracture risk after 3 to 5 years of treatment. Recent concerns about long-term safety coupled with posttreatment fracture risk reduction have increased support for drug holidays. The decision to start low-risk patients on drug holidays must be based on current fracture risk assessment.
Integrating the 2019 AGS Beers Criteria into NP practice
Authors: Diggins Kristene
Published: February 2020

The American Geriatrics Society Beers Criteria, designed to prevent the prescription of potentially inappropriate medications to older adult patients, were updated in 2019. This article provides a stepwise protocol on how to incorporate the Beers Criteria guidelines into NP practice using a case study model.
Adding telehealth simulation into NP programs
Authors: Robinson-Reilly Melissa , Irwin Pauletta , Coutts Rosanne , Slattery Nicola
Published: February 2020

NP educators are challenged to ensure their students have opportunities to learn how to apply skills within a telehealth context. This article presents an integration of telehealth into clinical learning, depicting the connectedness possible when a healthcare professional and patient are challenged by geographic distance.
Caring for patients who are homeless
Authors: Mcenroe-Petitte Denise M.
Published: February 2020

Nurses interact with patients across many settings. This article discusses concerns for patients considered homeless and the role of nurses in addressing their healthcare needs.
Neurological Complication Rates of Epidural Injections and Selective Nerve Blocks
Authors: Hwang Byungkwan , Lee Joongyeb , Park Byung-Joo
Published: February 2020

Objectives:

Epidural injections and selective nerve blocks are widely used for pain relief, but steroid usage is controversial due to safety concerns. We carried out this retrospective cohort study to estimate the incidence rates of neurological complications associated with epidural and selective nerve blocks, in relation to steroid use patterns.

Materials and Methods:

Using a national insurance claims database, we identified patients who received at least one epidural injection or nerve block from 2009 to 2013. We estimated incidence rates and hazard ratios in propensity score-matched cohorts stratified by steroids, using the Charlson comorbidity index, age, sex, anesthetics, and antithrombotics as variables. We included cases attending hospital within 24 hours after injection and treated for neurological complications.

Results:

Incidence rates of neurological complications per 100,000 person-days for injections with and without steroids were 1.48 (95% confidence interval [CI]: 1.25-1.65) and 0.86 (95% CI: 0.66-1.30), respectively; rates for particulate steroid injections and nonparticulate steroid injections were 1.73 (95% CI: 1.41-1.95) and 0.90 (95% CI: 0.43-1.47), respectively. The adjusted hazard ratio (aHR) of neurological complications for injections with versus without steroids was 1.71 (95% CI: 0.96-2.49). The aHR of particulate versus nonparticulate steroid injections was 4.98 (95% CI: 1.01-262.35), at the cervicothoracic level. The aHR of neurological complications for nonparticulate steroids compared with nonsteroidal injections was 0.97 (95% CI: 0.46-3.01).

Discussion:

At the cervicothoracic level, the incidence rate of neurological complications with particulate steroid injections was higher than that with nonparticulate steroid injections. Injections with nonparticulate steroids and without steroids were equally safe.
Activity of fibroblast-like synoviocytes in rheumatoid arthritis was impaired by dickkopf-1 targeting siRNA
Authors: Liu Yan-Ying , Wang Shi-Yao , Li Ying-Ni , Bian Wen-Jie , Zhang Lin-Qi , Li Yu-Hui , Long Li , Liu Xia , Zhang Xue-Wu , Li Zhan-Guo
Published: February 2020

Background

Fibroblast-like synoviocytes (FLSs), resident mesenchymal cells of synovial joints, play an important role in the pathogenesis of rheumatoid arthritis (RA). Dickkopf-1 (DKK-1) has been proposed to be a master regulator of bone remodeling in inflammatory arthritis. Here, potential impairation on the activity of FLSs derived from RA to small interfering RNAs (siRNAs) targeting DKK-1 was investigated.

Methods

siRNAs targeting DKK-1 were transfected into FLSs of patients with RA. Interleukin (IL)-1β, IL-6, IL-8, matrix metalloproteinase (MMP) 2, MMP3, MMP9, transforming growth factor (TGF)-β1, TGF-β2 and monocyte chemoattractant protein (MCP)-1 levels in the cell culture supernatant were detected by enzyme-linked immunosorbent assay (ELISA). Invasion assay and 3H incorporation assay were utilized to investigate the effects of siRNAs targeting DKK-1 on FLSs invasion and cell proliferation, respectively. Western blotting was performed to analyze the expression of nuclear factor (NF)-κB, interleukin-1 receptor-associated kinase (IRAK)1, extracellular regulated protein kinases (ERK)1, Jun N-terminal kinase (JNK) and β-catenin in FLSs.

Results

DKK-1 targeting siRNAs inhibited the expression of DKK-1 in FLSs (P < 0.01). siRNAs induced a significant reduction of the levels of IL-6, IL-8, MMP2, MMP3 and MMP9 in FLSs compared to the control group (P < 0.05). DKK-1 targeting siRNAs inhibited the proliferation and invasion of FLSs (P < 0.05). Important molecules of pro-inflammatory signaling in FLSs, including IRAK1 and ERK1, were decreased by the inhibition of DKK-1 in FLSs. In contrast, β-catenin, a pivotal downstream molecule of the Wnt signaling pathway was increased.

Conclusions

By inhibiting DKK-1, we were able to inhibit the proliferation, invasion and pro-inflammatory cytokine secretion of FLSs derived from RA, which was mediated by the ERK or the IRAK-1 signaling pathway. These data indicate the application of DKK-1 silencing could be a potential therapeutic approach to RA.
Higher intakes of fruits and vegetables are related to fewer menopausal symptoms: a cross-sectional study
Authors: Safabakhsh Maryam , Siassi Fereydoun , Koohdani Fariba , Qorbani Mostafa , Khosravi Shahla , Abshirini Maryam , Aslani Zahra , Khajehnasiri Farahnaz , Sotoudeh Gity
Published: February 2020

Objectives:

The aim of this study was to explore the associations between fruit and vegetable (FV) intake, and its subgroups and menopausal symptoms along with its subtypes in postmenopausal women.

Methods:

This cross-sectional study included 393 postmenopausal women in municipality health centers in the south of Tehran, Iran. Sociodemographic data, dietary intakes, and anthropometric measures were obtained from individuals. Menopause rating scale (MRS) questionnaire was employed to measure menopausal symptoms. The total MRS score (TMRSS) was the sum of the somatic score (SS), psychological score (PS), and urogenital score (US). Participants were divided into low and high total MRS and its domain scores.

Results:

After adjustment for confounding variables, an inverse relationship was found between total FV with TMRSS (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.06-0.81) and SS (OR 0.30, 95% CI 0.11-0.82). In addition, the consumption of total fruits was significantly related to lower SS (OR 0.27, 95% CI 0.10-0.71). Only intake of citrus fruits was inversely associated with TMRSS (OR 0.23, 95% CI 0.07-0.71) and SS (OR 0.28, 95% CI 0.11-0.70). Likewise, intakes of total FV (OR 2.46, 95% CI 1.37-4.41), total vegetables (OR 2.54, 95% CI 1.10-5.88), green leafy vegetables (OR 3.59, 95% CI 1.47-8.75), dark yellow vegetables (OR 2.28, 95% CI 1.00-5.18), other vegetables (OR 5.23, 95% CI 1.17-15.39), and citrus fruits were linked to higher US (OR 4.35, 95% CI 1.77-10.71).

Conclusion:

The results of the present study showed that some FV subgroups had inverse associations with climacteric symptoms, whereas higher intake of some subgroups of FV appeared to be associated with more urogenital symptoms in postmenopausal women.
Aortic remodeling is modest and sex-independent in mice when hypertension is superimposed on aging
Authors: Spronck Bart , Ferruzzi Jacopo , Bellini Chiara , Caulk Alexander W. , Murtada Sae-Il , Humphrey Jay D.
Published: February 2020

Objectives:

Increased central artery stiffness associates with cardiovascular disease. Among other factors, hypertension and aging are strong contributors to central artery stiffening, yet it has been difficult to separate their effects. Herein, we study isolated and combined effects of hypertension and aging on central artery remodeling in multiple mouse models as a function of sex.

Methods:

We biomechanically phenotyped the aorta as a function of two different methods of inducing hypertension [infusion of angiotensin II (AngII) or combining a high salt diet with inhibition of endothelial-derived nitric oxide synthase using l-NAME] in male and female wild-type and fibulin-5 null mice, the latter of which models aspects of aortic aging.

Results:

Despite increasing blood pressure similarly, salt + l-NAME led to adaptive and maladaptive remodeling in the abdominal and thoracic aorta, respectively, whereas AngII caused luminal dilatation but little remodeling of the wall. Importantly, effects of aging were more dramatic than those resulting from induced hypertension and, consequently, superimposing hypertension on aging led to modest additional changes in luminal radius and wall thickness, though wall stress and stiffness increased mainly because of the elevated pressure.

Conclusion:

Our results suggest that effects of hypertension on aortic remodeling are modest when superimposed on aging in mice, largely independent of sex. These findings are consistent with general observations in humans and in spontaneously hypertensive rats, though separated here for the first time in a rodent model characterized by a severe loss of elastic fiber integrity similar to that found in the aged human aorta.
Qualitative and Quantitative Analysis of the Corneal Endothelium With Smartphone Specular Microscopy
Authors: Fliotsos Michael J. , Deljookorani Shiva , Dzhaber Daliya , Chandan Subhangi , Ighani Mehrnaz , Eghrari Allen O.
Published: February 2020

Purpose:

We sought to demonstrate the feasibility of a lower-cost, portable method for qualitative and quantitative analysis of the corneal endothelium using a smartphone and slit-lamp biomicroscope.

Methods:

In this study, at a single academic center, we recruited healthy participants to undergo imaging of the corneal endothelium using both a smartphone-based method and a specular microscope. Participants first had their eyes imaged with a CellChek NSP-9900 Specular Microscope (Konan Medical, Inc, Irvine, CA). For image capture on the smartphone, a beam of light approximately 0.2 mm in diameter was directed to the center of the cornea with a slit-lamp biomicroscope to achieve specular reflection. With 40× zoom on the slit-lamp and 4K video mode set on an iPhone 7 Plus held to an ocular, the corneal endothelium was recorded until the hexagonal pattern of cells was identified and the sharpest frame from the video was selected.

Results:

The videos were analyzed from 14 sets of eyes (average length 2 minutes 40 seconds). The average intraclass correlation coefficient was 0.67 (95% confidence interval, 0.43–0.82). The mean difference between smartphone endothelial cell count and specular endothelial cell count was −209 cells/mm2 (SD = 483 cells/mm2), which did not achieve significance (P = 0.14). A Bland–Altman analysis with simple linear regression showed no proportional bias when comparing the 2 modalities (coefficient = −0.20; t-value = −0.42; P = 0.68).

Conclusions:

Smartphone specular microscopy is capable of qualitative and quantitative analysis of the corneal endothelium. Further refinement to standardize the light source and automate analysis will increase feasibility.
Differential modulation of excitatory and inhibitory populations of superficial dorsal horn neurons in lumbar spinal cord by Aβ-fiber electrical stimulation
Authors: Fan Wei , Sdrulla Andrei D.
Published: February 2020

Activation of Aβ-fibers is fundamental to numerous analgesic therapies, yet its effects on dorsal horn neuronal activity remain unclear. We used multiphoton microscopy of the genetically encoded calcium indicator GCaMP6s to characterize the effects of Aβ-fiber electrical stimulation (Aβ-ES) on neural activity. Specifically, we quantified somatic responses evoked by C-fiber intensity stimulation before and after a 10-minute train of dorsal root Aβ-ES in superficial dorsal horn (SDH) neurons, in mouse lumbar spinal cord. Aβ-ES did not alter C-fiber-evoked activity when GCaMP6s was virally expressed in all neurons, in an intact lumbar spinal cord preparation. However, when we restricted the expression of GCaMP6s to excitatory or inhibitory populations, we observed that Aβ-ES modestly potentiated evoked activity of excitatory neurons and depressed that of inhibitory neurons. Aβ-ES had no significant effects in a slice preparation in either SDH population. A larger proportion of SDH neurons was activated by Aβ-ES when delivered at a root rostral or caudal to the segment where the imaging and C-fiber intensity stimulation occurred. Aβ-ES effects on excitatory and inhibitory populations depended on the root used. Our findings suggest that Aβ-ES differentially modulates lumbar spinal cord SDH populations in a cell type– and input-specific manner. Furthermore, they underscore the importance of the Aβ-ES delivery site, suggesting that Aβ stimulation at a segment adjacent to where the pain is may improve analgesic efficacy.
Health Literacy, Drug Knowledge, and Drug Misuse Behaviors Among North Korean Refugees
Authors: Jeon Jeong Hee , Lee In Sook
Published: February 2020

Purpose

This study measured levels of health literacy, drug knowledge, and drug misuse behavior and analyzed the relationship among major variables related to 137 North Korean refugees who could only receive limited medical benefits owing to cultural and linguistic barriers.

Method

The data were analyzed using descriptive statistics, t test, and the Pearson correlation coefficient using SPSS.

Results

The subjects' health literacy and drug knowledge levels were low; however, drug misuse behavior was not high. The drug dosage was significant considering the health literacy of the subjects; notably, the functional health literacy of women was high. However, many drug misuse cases were identified among women in their 40s. Health literacy and drug knowledge levels showed a significant relationship.

Conclusion

It is necessary to provide community-based information to vulnerable groups to ensure safe use of medications and to develop a level-based and tailored educational program considering North Korean refugees' literacy levels and cultural characteristics.
On-Demand and Low Dose Intratympanic Gentamicin for Meniere's Disease: A Customized Approach
Authors: Celis-Aguilar Erika , Castro-Bórquez Karla Mariana , Obeso-Pereda Alejandra , Escobar-Aispuro Lucero , Burgos-Paez Alan , Alarid-Coronel José M. , Verdiales-Lugo Sergio , León-Leyva Ivonne Carolina , Trejo-González Cosme Francisco , López-Favela Lilia Miriam , Martínez-Román Leticia
Published: February 2020

Objective:

To evaluate the efficacy of on demand and low dose intratympanic gentamicin (ITG) in patients with intractable Meniere's disease (MD).

Study Design:

Clinical chart review.

Setting:

Secondary care center.

Patients:

Subjects with MD who failed conventional treatment and underwent on demand ITG infiltration from June 2013 to December 2018.

Intervention:

0.4 to 0.5 ml of buffered gentamicin were administered through an intratympanic route. A total of 5 mg in case of low dose and 20 mg as a standard dose.

Main Outcome Measures:

Vertigo control, Meniere's Disease Functional Level Scale (MDFLS), Dizziness Handicap Inventory (DHI), and pure tone audiometry pre and posttreatment.

Results:

Thirty-one patients, 16 women and 15 men with a mean age of 52.81 (22–79) years were included. The number of ITG injections ranged from 1 to 7, with a mean of 2.52 applications per patient. Mean interval between doses was 212.15 (21–1442) days. Average follow-up was 24.03 months. An improvement on MDFLS was seen on 77.4% (n = 24) patients. DHI score improved after gentamicin treatment (mean 55.23 versus 24.06,p ≤ 0.001). Thirty patients (96.8%) reached complete or substantial vertigo control. Only one patient did not achieve control. Hearing was preserved in 43.5% (n = 10) of analyzed audiograms, whereas 17.4% (n = 4) developed hearing loss greater than 20 dB, which was not statistically significant (p = 0.099).

Conclusions:

In our study, on demand and low dose ITG was effective for vertigo control in patients with intractable MD. Individualized therapy is recommended in all patients to minimize vestibular and cochlear toxicity.
Speech Perception Gap Is Predictive of an Active Middle Ear Implant Advantage
Authors: Shohet Jack A. , Gende Deanna M. , Bibee Jacqueline , Patzkowski Gina , Tanita Cheryl
Published: February 2020

Objective:

Evaluate whether the difference between word recognition score (WRS) obtained unaided under earphone and with a hearing aid (HA), the speech perception gap (SPgap), is predictive of performance with a totally implantable active middle ear implant (AMEI).

Study Design:

Retrospective review of systematically collected data.

Setting:

Private otologic practice.

Patients:

One hundred thirty six ears (133 patients) with sensorineural hearing loss implanted with an AMEI. Subjects were 73.5% men, with mean age = 61.3 years.

Intervention:

Previous AMEI.

Main Outcome Measures:

WRS with earphone at phonetically balanced maximum (PB-MAX), and with HA and AMEI at 50 dB HL. Differences between earphone, HA and AMEI word recognition, grouped as positive or negative speech perception gap (+SPgap/–SPgap) between two devices.

Results:

A +SPgap (WRS poorer with device than earphone) occurred in 86.0% of patients with HA and 42.3% with the AMEI. Mean SPgap = 24.7% with HA and 3.0% with AMEI (p ≤ 0.001). With a HA +SPgap, AMEI performance was better than HA by an average difference of 23.2% WRS, with AMEI more than HA in 82.9% of subjects. With HA –SPgap, the mean difference was 1.1% correct and AMEI more than HA in 47.4% of subjects (p ≤ 0.001 and p ≤ 0.002, for mean difference and percent of subjects, respectively). The larger the +SPgap (earphone-HA), the greater the advantage of AMEI over HA (r = 0.62, p ≤ 0.001).

Conclusion:

A speech perception gap between earphone PB-MAX and aided word recognition score suggests a patient may have better speech perception with an AMEI than with his/her hearing aid. This information is useful for counseling patients who are not performing well or are unsatisfied with their hearing aid.
Evaluation of Insertion Forces and Cochlea Trauma Following Robotics-Assisted Cochlear Implant Electrode Array Insertion
Authors: Kaufmann Christopher R. , Henslee Allan M. , Claussen Alex , Hansen Marlan R.
Published: February 2020

Hypothesis:

The objective was to evaluate the effect of cochlear implant (CI) insertion technique on electrode insertion forces and intracochlear trauma. We hypothesize that robotics-assisted insertions will reduce insertion forces and intracochlear trauma compared with manual insertions.

Background:

Variability in CI outcomes exists across patients, implant centers, surgeons, and electrode types. While surgical techniques that reduce electrode insertion trauma are well established, insertion trauma remains one contributing factor to variability in CI outcomes. Previous work demonstrates that micromechanically controlled insertion tools reduce both maximum insertion forces and insertion variability compared with manual insertions.

Methods:

CI electrode insertions were performed either by hand (n = 12) or utilizing a robotics-assisted tool (n = 12) in fresh frozen, human cadaveric cochleae using electrodes from four different CI manufacturers. Electrodes array insertion forces were additionally evaluated in benchtop cochlea models. Following cadaveric insertions, samples were imaged via high resolution x-ray microscopy to evaluate electrode position and intracochlear trauma events based on a modified Eshraghi scale.

Results:

Electrode array insertions performed by robotics-assisted system showed significantly lower insertion forces and variability. Manual electrode array insertions had a significantly higher overall trauma score of 3.1 ± 2.0 compared with 0.9 ± 1.0 for robotics-assisted insertions. Robotics-assisted insertions had higher rate of basilar membrane elevations while manual insertions showed higher rates of severe trauma events.

Conclusions:

The robotic-assisted insertion system reduced trauma events associated with CI electrode insertions in cadaveric cochleae compared with manual insertions. Surgical devices which help to precisely and more consistently insert electrodes may improve CI outcomes and hearing preservation.
Influenza management with new therapies
Authors: O'Sullivan Shane , Torres Antoni , Rodriguez Alejandro , Martin-Loeches Ignacio
Published: February 2020

Purpose of review

Influenza represents a significant treatment burden to critical care services. A variety of treatment strategies exist, with more and more therapeutic avenues opening up as research progresses. We examined both pharmacological and supportive treatment strategies currently available to see how they might be applied in an ICU setting.

Recent findings

Supportive care in Influenza centres around optimizing respiratory failure, particularly through well established and recognized ventilatory strategies. Noninvasive ventilation and high-flow nasal oxygen may have a limited role in selected patients under carefully monitored circumstances. Drug therapy exerts only a modest clinical effect and has been poorly studied in the critically ill, though there is some evidence to support the use of neuraminidase inhibitors (NAI) – particularly oseltamivir – as early as possible in this cohort. Newer agents have failed to demonstrate superiority over NAIs but may be useful options if the patient fails to respond or should resistant influenza strains emerge. Steroid therapy, in the absence of another indication, must be recommended against given the repeated trend towards increased mortality in this group.

Influenza management is an evolving field of significant interest to any critical care provider. Currently, good respiratory supportive care and early enteral oseltamivir are the best supported treatment strategies. Further study in the intensive care setting will be needed before the use of novel agents can be recommended.
Correlation of PD-L1 expression on tumor cell and tumor infiltrating immune cell with 18F-fluorodeoxyglucose uptake on PET/computed tomography in surgically resected pulmonary adenocarcinoma
Authors: Hu Bingxin , Xiao Jie , Xiu Yan , Fu Zhequan , Shi Hongcheng , Cheng Dengfeng
Published: February 2020

Objective

The uptake of 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) is known to be linked to programmed death ligand 1 (PD-L1) expression on tumor cells (TC). However, the association between PD-L1 expression on immune cells (IC) and 18F-FDG accumulation is still unclear. Here, we conducted a clinicopathological study to investigate the relationship between PD-L1 expression on TC/IC and 18F-FDG uptake in patients with surgically resected pulmonary adenocarcinoma (ADC).

Methods

A total of 450 ADC patients who underwent preoperative 18F-FDG-PET/CT imaging were analyzed retrospectively. Immunohistochemistry analysis was performed for PD-L1 expression on TC and IC in ADC specimens with SP142. PD-L1 expression was performed on whole-tissue sections and given scores (0/1/2/3) according to percent of PD-L1+ cells in TC and IC.

Results

Compared to TC0 and IC0, PD-L1 positive expression was 90.4% (407/450) in ADC specimens. Both PD-L1 expression score on TC and IC were associated with maximum standardized uptake (SUVmax). SUVmax augmented with increasing PD-L1 expression (TC0 and IC0, 4.3 ± 3.4; TC or IC1/2/3, 7.7 ± 5.6; TC or IC2/3, 8.1 ± 5.6; TC or IC3, 8.4 ± 5.4). The best cut-off value of PD-L1 expression, determined by receiver operating characteristic curve, was 5.1 for TC or IC1/2/3 [area under the curve (AUC) = 0.713, sensitivity 62.2%, specificity 72.1%]. Multivariate analysis demonstrated that TC or IC1/2/3 subset was correlated with histological subtype, PD-1 expression on IC and SUVmax.

Conclusion

High SUVmax is associated with PD-L1 expression on TC and IC in surgically resected pulmonary ADC. 18F-FDG-PET/CT imaging can be a potential tool to evaluate PD-L1 expression in pulmonary ADC.
Evaluation of a child with suspected nephrolithiasis
Authors: Reusz George S. , Hosszu Adam , Kis Eva
Published: February 2020

Purpose of review

As the incidence of nephrolithiasis in children doubles every 10 years it is becoming a common disease associated with significant morbidity along with considerable economic burden worldwide. The aim of this review is to summarize current data on the epidemiology and causes of renal stones in children and to provide a frame for the first clinical evaluation of a child with suspected nephrolithiasis.

Recent findings

Dietary and environmental factors are the driving force of changing epidemiology. Diagnosis should be based on medical history, presenting signs, examination, first laboratory and radiological workup. Ultrasound should be the initial diagnostic imaging performed in pediatric patients while low-dose computed tomography is rarely necessary for management. Metabolic factors including hypercalciuria, hypocitraturia, low fluid intake as well as specific genetic diseases should be explored after the resolution of initial signs and symptoms.

Appropriate initial evaluation, imaging technique, identification of risk factors and other abnormalities are essential for early diagnosis and prevention of stone-related morbidity in children with suspected nephrolithiasis.
The Implementation of Nursing Specialties in Spain, 2005–2018
Authors: de Almeida Souza Alina Maria , Cuevas-Budhart Miguel Ángel , Raya Florentino Pérez , González Jurado Máximo A. , Gómez del Pulgar Gª-Madrid Mercedes
Published: February 2020

Nursing specialization is considered a significant professional requirement to meet the challenges and needs of the health systems under evolving epidemiological patterns and scientific, technological, and social advances. In Spain, experiences in the training of specialist nurses have followed the same pattern and have been consolidated through legislation. This study aimed to analyze the implementation of the Spanish Nursing Specialty process according to the Royal Decree 450/2005. It used the documentary and systematic analysis method: a systematic review of official regulation documents published in the State Official Bulletin of Spain, Spanish legislative and historical nursing inventories, and other nursing-specific literature. This study shows an extensive account of nursing specialties' development process through a rather long period in Spain. It evidences the complexity involved to ensure legislative legality. The study also points to the need for homogeneity within the programs across the national territory and legal definition for specialty practice. This study could be an illustration to stimulate other nurse leaders in the world working in regulation and nursing specialty development to empower nurses' development and enhance the nurse specialists' contribution to archive the needs of the health system and healthcare of the population.

Highlights:
Pink Prescribing
Authors: O'Malley Patricia Anne
Published: February 2020

Recently, there seems to be more creative advertising regarding bismuth subsalicylate (BSS) for lots of gastrointestinal issues. I have found during medication reconciliation that some patients overuse and believe use of BSS products is without risks. From an advertising perspective, there seem to be many happy persons consuming BSS with no mention of restrictions or safety recommendations. What are the risks associated with its use? How effective is BSS? What about drug interactions?
The interplay between acute bacterial skin and skin structure infections and depression: a vicious circle of major clinical importance
Authors: Bassetti Matteo , Almirante Benito , Giamarellos-Bourboulis Evangelos J. , Gournellis Rossetos , Grande Iria , Marini Maria Giulia , Balestrieri Matteo
Published: February 2020

Purpose of review

Previous studies suggest an association between depression and increased risk of various type of infections, including acute bacterial skin and skin structure infections (ABSSSI). Here, we review the latest advancement in our understanding of immunity in patients with depression and its relevance to disease management and diagnosis, with a special focus on patients suffering from ABSSSI.

Recent findings

Recent studies have highlighted the role of hypothalamic–pituitary–adrenal axis, neuro-endocrine stress signaling pathways and behavioral attitudes (substance abuse and homelessness) in the pathogenesis of infections in depressed patients. Furthermore, acute bacterial infections, in turn, have emerged as a possible risk for depression development because of different mechanisms including antibiotic-driven changes in the microbiota.

Recent evidences have emphasized the threat that comanagement of depression and infection pose to infectious disease physician and psychiatrist. Depressed patients with ABSSSI must be closely monitored for drug side-effects, drug–drug interactions, toxicity, and adequate compliance. New management strategies including new long-acting antibiotics (e.g., dalbavancin) are welcome.
Outcomes following penetrating neck injury during the Iraq and Afghanistan conflicts: A comparison of treatment at US and United Kingdom medical treatment facilities
Authors: Breeze John , Bowley Douglas M. , Combes James G. , Baden James , Orr Linda , Beggs Andrew , DuBose Joseph , Powers David B.
Published: February 2020

INTRODUCTION

The United States and United Kingdom (UK) had differing approaches to the surgical skill mix within deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan.

METHODS

The US and UK combat trauma registries were scrutinized for patients with penetrating neck injury (PNI) at deployed coalition MTF between March 2003 and October 2011. A multivariate mixed effects logistic regression model (threshold, p < 0.05) was used stratified by MTF location and year of injury. The dependent variable was fatality on leaving Role 3, and the independent variables were ISS on arrival, nationality, MTF nationality, and presence of head and neck surgeon.

RESULTS

A total of 3,357 (4.9%) of 67,586 patients who arrived alive at deployed military MTF were recorded to have sustained neck injuries; of which 2,186 (83%) were PNIs and the remainder were blunt injuries. When service members killed in action were included, the incidence of neck injury rose from 4.9% to 10%. Seven hundred nine (32%) of 2,186 patients with PNI underwent neck exploration; 555 patients were recorded to have sustained cervical vascular injury, 230 (41%) of 555 underwent vascular ligation or repair. Where it was recorded, PNI directly contributed to death in 64 (28%) of 228 of patients. Fatality status was positively associated with ISS on arrival (odds ratio, 1.05; 95% confidence interval, 1.04–1.06; p < 0.001) and the casualty being a local national (odds ratio, 1.74; 95% confidence interval, 1.28–2.38; p < 0.001).

CONCLUSION

Significant differences in the treatment and survival of casualties with PNI were identified between nations in this study; this may reflect differing cervical protection, management protocols, and surgical capability and is worthy of further study. In an era of increasing specialization within surgery, neck exploration remains a skill that must be retained by military surgeons deploying to Role 2 and Role 3 MTF.

LEVEL OF EVIDENCE

Retrospective cohort study, level III.
A spatial framework to explore needs and opportunities for interoperable urban flood management
Authors: Dawson David A. , Vercruysse Kim , Wright Nigel
Published: February 2020

Managing current and future urban flood risks must consider the connection (i.e. interoperability) between existing (and new) infrastructure systems to manage stormwater (pluvial flooding). Yet, due to a lack of systematic approaches to identify interoperable flood management interventions, opportunities are missed to combine investments of existing infrastructure (e.g. drainage, roads, land use and buildings) with blue-green infrastructure (e.g. sustainable urban drainage systems, green roofs, green spaces). In this study, a spatial analysis framework is presented combining hydrodynamic modelling with spatial information on infrastructure systems to provide strategic direction for systems-level urban flood management (UFM). The framework is built upon three categories of data: (i) flood hazard areas (i.e. characterize the spatial flood problem); (ii) flood source areas (i.e. areas contributing the most to surface flooding); (iii) the interoperable potential of different systems (i.e. which infrastructure systems can contribute to water management functions). Applied to the urban catchment of Newcastle-Upon-Tyne (UK), the study illustrates the novelty of combining spatial data sources in a systematic way, and highlights the spatial (dis)connectivity in terms of flood source areas (where most of the flood management intervention is required) and the benefit areas (where most of the reduction in flooding occurs). The framework provides a strategic tool for managing stormwater pathways from an interoperable perspective that can help city-scale infrastructure development that considers UFM across multiple systems.

This article is part of the theme issue ‘Urban flood resilience’.