bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of fatigue on neurorehabilitation
Authors: Welch Killian A. , Kutlubaev Mansur A.
Published: May 2020

Fatigue is common in neurological disease and associated with substantial disability. Aetiology is generally multifactorial, meaning an individualized, patient-specific understanding of relevant contributors is central to effective management. Primary factors may include brain injury, endocrine changes, or inflammation; medications, deconditioning, psychiatric disorders, pain, and unhelpful beliefs about activity are potential secondary factors. Heterogeneity of causation makes a unifying theory of fatigue elusive, but convergent data across neurological conditions suggest dysfunction in the striatal-thalamic-frontal system is important. Computational neuroscience models suggest fatigue could arise from metacognitive recognition of failure of homeostatic process, then perpetuated by fatigue expectation altering neurocomputational processes during preparation and monitoring of effortful activity. Treatment is guided by biopsychosocial formulation, with emphasis on maintaining factors. Exercise has best evidence, ideally delivered through individually tailored exercise programmes. Cognitive behavioural therapy (CBT) can be helpful in more cognitively able patients. Evidence for pharmacological treatments is weak, though amantadine is generally first choice.
Vocational rehabilitation
Authors: Tyerman Andy
Published: May 2020

Work is a fundamental human right and a key element in quality of life, yet only a minority of people with a neurological condition return to, remain in, or attain work. A range of factors are associated with work for people with specific neurological conditions. Vocational rehabilitation (VR) to address key vocational needs are outlined (i.e. vocational assessment, return to work, preparation for alternative work, transition from education to employment, and long-term job retention), illustrated by examples.

Specialist VR programmes typically report positive outcomes. However, there is a need for more controlled studies to evaluate the effectiveness of VR in addition to core neurorehabilitation and the added value of specialist as opposed to generic VR provision.

There is also a pressing need for neurorehabilitation and VR services to prioritize unmet vocational needs, generate practice-based evidence, and provide evidence of cost-effectiveness.
Neuropalliative rehabilitationManaging neurological disability in the context of a deteriorating illness
Authors: Eva Gail , Bayly Jo , Playford E. Diane
Published: May 2020

Although the concepts of ‘rehabilitation’ and ‘palliative care’ may seem paradoxical, the two approaches have a great deal in common. Rehabilitation for people with deteriorating, life-limiting neurological conditions can be organized into four distinct but overlapping categories: preventative, restorative, supportive, and palliative. Patients with neurological conditions can report palliative care needs from diagnosis; neuropalliative rehabilitation needs to be available within the context of whatever services are most appropriate for the patient’s circumstances at the time, requiring excellent coordination of care between neurology, palliative care, and rehabilitation services. Neuropalliative rehabilitation follows the same process that would be used in other conditions, but is underpinned by specific palliative care skills which include the ability to work flexibly with rapidly changing conditions, as well as understanding and being able to manage the tension between the patient’s active engagement in life and acknowledging loss and death.
Music supported therapy in neurorehabilitation
Authors: Altenmüller Eckart , Stewart Lauren
Published: May 2020

Music-induced brain plasticity is a powerful means to improve neurologic function in rehabilitation following brain injury or degenerative disease. In motor dysfunctions following stroke, keyboard playing may improve fine motor functions along with neurophysiological changes in audiomotor networks. Rhythmic cueing has a positive effect in gait disorders, improving stride length, speed, and overall mobility. Melodic intonation therapy can improve recovery from non-fluent aphasia via activation of right-hemispheric networks. Music supported therapy can at least temporarily improve cognition in dementia and may have impact on rehabilitation of disorders of consciousness. Effects of music-induced brain plasticity together with music’s ability to tap into the emotion and reward system in the brain can thus be used to facilitate neurorehabilitation.
Technology to enhance arm and hand function
Authors: Prochazka Arthur
Published: May 2020

About 2% of people have weak or paralysed upper limbs (ULs) due to stroke or spinal cord injury (SCI). Physiotherapy involving exercise can improve motor function in many such cases, but the time and resources required are often unavailable. Adherence to repeated intensive exercise tends to decline, especially after participants leave the clinical environment. There is a need for technology that can restore neuromuscular control and improve motivation by making exercise therapy enjoyable, and that extends the therapy into the home with the use of remote communication (e.g. ‘tele-coaching’). Over the last 20 years many devices have been developed and tested. Neuroprostheses (NPs) that activate UL muscles with functional electrical stimulation (FES) either via surface or implanted electrodes are now commercially available or in clinical trials. The use of robotic devices to enhance exercise therapy has been an active area of research and development. Recent studies indicate that improvements in motor function depend largely on the efforts made by the participant. This chapter reviews conventional exercise therapy, FES, and robotic and passive exercise devices that improve motor function and enhance engagement in UL rehabilitation. It is suggested that important developments in the next few years will include the widespread availability of affordable FES and in-home exercise devices, and the gradual adoption of tele-coaching over the internet.
Anatomy of the eye and the healthy fundus
Authors: Gahir Navjot K. , Shah Mirriam
Published: May 2020

The human eye is an intricate and widely used major sense organ of the body, and has been commonly likened to a camera. Broadly it can be divided into two main segments—the anterior segment and the posterior segment. Understanding the basic anatomy of the human eye is a requirement for all health-care providers, but sound knowledge is of paramount importance to those involved in eye screening. This chapter describes and includes pictorial emphasis of the anatomy of the eye, and more specifically, the human retina and its structure and function. The detail provided here is limited, but relevant to those involved in eye screening. A more in-depth and comprehensive discussion of the anatomy of the eye is beyond the scope of this book and, therefore, further reading is recommended.
Advanced diabetic eye disease
Authors: Whitehouse Karen
Published: May 2020

Advanced diabetic eye disease can remain asymptomatic for a long time, due to the slow progression of proliferative retinopathy and the fact that the macula may not be affected. This chapter examines the progression of proliferative disease and its’ natural history if left untreated. Diabetic retinopathy screening is an important factor in intervention and treatment. The grading criteria for advanced disease (R3) as defined by the NHS Diabetic Eye screening Programme (NHSDESP) is discussed, as well as the management of the patient and subsequent treatment regimen.
The screening episode: visual acuity, mydriasis, and digital photography
Authors: Roy David K. , Amrelia Prashant
Published: May 2020

Early eye screening detection and treatment is fundamental in managing significant complications of chronic disease, both for improving diabetic retinopathy (DR) clinical outcomes and improving the economic burdens. Early detection and subsequent treatment can substantially reduce the risk of blindness from DR. This chapter will review the screening episode, measuring visual acuity, drop instillation, contraindications, and correct camera operation. It will review problems associated with incorrect camera operation and the NHS Diabetic Eye Screening Programme (NHSDESP) standards of acceptable image quality. This will guide the screener in obtaining clear, well-centred, gradable digital images of the retina in diabetic patients with vision better than no perception of light in both eyes, as well as providing a greater understanding of issues associated with screening.
How to grade
Authors: Whitehouse Karen
Published: May 2020

This chapter will provide guidance on best practice. A good grader should have the ability to work autonomously and have keen attention to detail; the grading environment should be quiet with appropriate lighting, and grading undertaken on high quality computer equipment and screens. All graders will adopt their own methodology for grading and use a step-by-step method, which may also use image manipulation. For accuracy and consistency, graders should adhere to minimum standards and numbers of grades as required by the NHS diabetic eye screening programme (NHSDESP). In the UK, graders should be adequately trained and participate in monthly test and training sets.
Programme administration and fail-safe
Authors: Smith Rebecca
Published: May 2020

Effective administration and fail-safe is essential to any screening programme. It helps ensure that the programme functions successfully to a high quality, but most importantly, it helps identify the patient cohort and ensure patient safety at all points in the pathway. A clear structure needs to be in place identifying roles and responsibilities, with procedures, policies, and regular audits in place. The programme needs the capacity to produce performance reports on an ad hoc basis to show how it is performing and to improve its service for its patients. Screening programmes in different countries will adapt their protocols and administration according to their primary- and health-care delivery model and provision. This chapter sets out that used in the UK model, which has the national health service provision with free health care at its core.
Models of screening and information technology
Authors: Mills Andrew
Published: May 2020

A co-ordinated screening service needs centralized storage, and a server computer to receive data from and send data to users. From the user’s point of use, one local computer is needed to collect information or display patient data from the centralized store. All connections must be secure and meet current local data protection laws. The model of screening determines how best to transfer patient data between server and end-users, and may require a mixed approach to offer the greatest flexibility and reach for screening. There is no doubt that the screening service would continue to evolve with advances in information technology and connectivity.
Training and accreditation for retinal screening and grading
Authors: Whitehouse Karen
Published: May 2020

In all national screening programmes, staff training to confirm competency and accreditation to practice in their profession is required for patient safety. This chapter sets out an example of how the UK diabetic eye programme has evolved in this respect. The current National Vocational Qualifications (NVQ) level 3: Health screener: diabetic eye screening for personnel undertaking screening and grading, will be explained. In some programmes, slit lamp examination is now provided by graders, as well as ophthalmologists and optometrists. The current requirement is detailed. In addition, all grading staff should also participate in test and training of retinal image sets in order to confirm accuracy of grading. At least 10 test sets should be undertaken per annum.
Medical management of diabetic retinopathy
Authors: Dodson Paul M.
Published: May 2020

Medical management is focused on the proven benefit of tight glucose and blood pressure (BP) control. Standard management includes multiple cardiovascular risk factor management with angiotensin receptor blockade, statin, and fibrate treatment. Targets to achieve include HbA1c <7% (53 mmol/mol), BP <140/80, and serum cholesterol <4 mmol/L. A number of large recent trials have specifically demonstrated the beneficial effects on diabetic retinopathy (DR) of angiotensin receptor blockade (the DIRECT study) and fenofibrate (the fenofibrate intervention and event lowering in diabetes [FIELD] and action to control cardiovascular risk in diabetes [ACCORD] eye studies).
Introduction
Authors: Childress James F.
Published: May 2020

The introduction characterizes “doing public bioethics” as analyzing and assessing actual and proposed public policies regarding biomedicine, healthcare, and public health. It may include attention to public discourse and public culture, and to professional discourse and practice, as ways to influence public policy or as an end in and of itself. “Public bioethics” also refers to commissions, councils, task forces, and the like, that are governmentally established, sponsored, or funded for the purpose of deliberating collectively about bioethical issues, again with a primary goal of recommending public policies. In addition to examining different types of public bioethics bodies, the introduction provides an overview of the volume and its chapters along with an indication of their context and origins, including the author’s experiences on public bioethics bodies.
Paternalism in Healthcare and Health Policy
Authors: Childress James F.
Published: May 2020

This chapter provides conceptual clarity about paternalism along with a framework for ethically assessing paternalistic actions in both clinical practice and health policy. Not only does paternalism remain common and formidable in both contexts but also it has gained new momentum over the last two decades, for instance, as “neopaternalists” have offered arguments for governmental policies that, at a minimum, seek to protect or benefit individuals through shaping or steering their choices without actually limiting or coercing those choices. This chapter examines the nature of paternalism, particularly by probing its moral foundations and limits and drawing several distinctions that bear on its justification (weak and strong, pure and mixed, hard and soft). It also considers circumstances in which different types of paternalistic interventions may be justified, and, finally, assesses the “new paternalism,” based on behavioral economics and psychology, that now figures in many proposals for health-related public policies.
Narratives versus Norms
Authors: Childress James F.
Published: May 2020

This chapter argues that, properly understood, both narratives, which include cases, and norms, which include principles and rules, are essential and indispensable in ethics—the difficult questions concern their relations. It attends first to the controversy about cases and case judgments in relation to principles, showing that the debate is largely misplaced. Then, using the well-known case of Donald/Dax Cowart, who attempted to refuse treatments necessary to save his life following severe burns, this chapter stresses the role of narratives in interpreting the requirements of the principle of respect for persons and their autonomous choices. Finally, it examines the value of and tensions between personal and communal narratives as reflected in appeals to personal experience and appeals to principles and rules embedded in societal narratives, particularly in shaping public policy.
Religion, Bioethics, and Public Policy
Authors: Childress James F.
Published: May 2020

This chapter starts by analyzing and evaluating two stories about the role of religion in the origin and development of bioethics and about the secularization of bioethics. Both stories employ different conceptions of religion, and neglect the range and diversity of bioethics in the United States. Both stories, inaccurate and inadequate in different ways, claim that religion has only a limited place in contemporary bioethics in part as a result of allegedly excessive attention to public bioethics and to principles-based reasoning in that context. The chapter then critically examines a prominent and sometimes illuminating but ultimately flawed sociological interpretation of the secularization of public bioethics. Much of the controversy featured in this chapter hinges on claims about whether the prominent role of principles-based reasoning in bioethics, especially in public bioethics, has contributed to and/or reflected a process of secularization.
Radial migration and vertical action in N-body simulations
Authors: Mikkola Daniel , McMillan Paul J , Hobbs David
Published: May 2020

We study the radial migration of stars as a function of orbital action as well as the structural properties of a large suite of N-body simulations of isolated disc galaxies. Our goal is to establish a relationship between the radial migration efficiency of stars and their vertical action. We aim to describe how that relationship depends on the relative gravitational dominance between the disc and the dark matter halo. By changing the mass ratio of our disc and dark matter halo, we find a relationship between disc dominance, number, and strength of spiral arms, and the ensuing radial migration as a function of the vertical action. We conclude that the importance of migration at large vertical action depends on the strength of the spiral arms and therefore the dominance of the disc. Populations with more radial action undergo less radial migration, independently of disc dominance. Our results are important for the future of analytical modelling of radial migration in galaxies and further the understanding of radial migration that is a key component of the restructuring of galaxies, including the Milky Way.
Gravitational waves from Population III binary black holes formed by dynamical capture
Authors: Liu Boyuan , Bromm Volker
Published: May 2020

We use cosmological hydrodynamic simulations to study the gravitational wave (GW) signals from high-redshift binary black holes (BBHs) formed by dynamical capture (ex situ formation channel). We in particular focus on black holes (BHs) originating from the first generation of massive, metal-poor, so-called Population III (Pop III) stars. An alternative (in situ) formation pathway arises in Pop III binary stars whose GWligi signature has been intensively studied. In our optimistic model, we predict a local GW event rate density for ex situ BBHs (formed at z > 4) of ∼0.04 yr−1 Gpc−3. This is comparable to or even higher than the conservative predictions of the rate density for in situ BBHs ∼0.01–0.1 yr−1 Gpc−3, indicating that the ex situ formation channel may be as important as the in situ one for producing GW events. We also evaluate the detectability of our simulated GW events for selected planned GW instruments, such as the Einstein Telescope (ET). For instance, we find the all-sky detection rate with signal-to-noise ratios above 10 to be ${\lesssim} 100\, \rm {yr^{-1}}$ for the xylophone configuration of ET. However, our results are highly sensitive to the subgrid models for BBH identification and evolution, such that the GW event efficiency (rate) is reduced by a factor of 4 (20) in the pessimistic case. The ex situ channel of Pop III BBHs deserves further investigation with better modelling of the environments around Pop III-seeded BHs.
Stochastic ion and electron heating on drift instabilities at the bow shock
Authors: Stasiewicz Krzysztof
Published: May 2020

The analysis of the wave content inside a perpendicular bow shock indicates that heating of ions is related to the lower hybrid drift (LHD) instability, and heating of electrons is related to the electron cyclotron drift (ECD) instability. Both processes represent stochastic acceleration caused by the electric field gradients on the electron gyroradius scales, produced by the two instabilities. Stochastic heating is a single-particle mechanism where large gradients break adiabatic invariants and expose particles to direct acceleration by the direct current and wave fields. The acceleration is controlled by function $\chi = m_iq_i^{-1} B^{-2}$div(E), which represents a general diagnostic tool for processes of energy transfer between electromagnetic fields and particles, and the measure of the local charge non-neutrality. The identification was made with multipoint measurements obtained from the Magnetospheric Multiscale spacecraft. The source for the LHD instability is the diamagnetic drift of ions, and for the ECD instability the source is ExB drift of electrons. The conclusions are supported by laboratory diagnostics of the ECD instability in Hall ion thrusters.
Mapping domains of ARS2 critical for its RNA decay capacity
Authors: Melko Mireille , Winczura Kinga , Rouvière Jérôme Olivier , Oborská-Oplová Michaela , Andersen Pia K , Heick Jensen Torben
Published: May 2020

ARS2 is a conserved protein centrally involved in both nuclear RNA productive and destructive processes. To map features of ARS2 promoting RNA decay, we utilized two different RNA reporters, one of which depends on direct ARS2 tethering for its degradation. In both cases, ARS2 triggers a degradation phenotype aided by its interaction with the poly(A) tail exosome targeting (PAXT) connection. Interestingly, C-terminal amino acids of ARS2, responsible for binding the RNA 5′cap binding complex (CBC), become dispensable when ARS2 is directly tethered to the reporter RNA. In contrast, the Zinc-finger (ZnF) domain of ARS2 is essential for the decay of both reporters and consistently co-immunoprecipitation analyses reveal a necessity of this domain for the interaction of ARS2 with the PAXT-associated RNA helicase MTR4. Taken together, our results map the domains of ARS2 underlying two essential properties of the protein: its RNP targeting ability and its capacity to recruit the RNA decay machinery.
Beta class amino methyltransferases from bacteria to humans: evolution and structural consequences
Authors: Woodcock Clayton B , Horton John R , Zhang Xing , Blumenthal Robert M , Cheng Xiaodong
Published: May 2020

S-adenosyl-l-methionine dependent methyltransferases catalyze methyl transfers onto a wide variety of target molecules, including DNA and RNA. We discuss a family of methyltransferases, those that act on the amino groups of adenine or cytosine in DNA, have conserved motifs in a particular order in their amino acid sequence, and are referred to as class beta MTases. Members of this class include M.EcoGII and M.EcoP15I from Escherichia coli, Caulobacter crescentus cell cycle–regulated DNA methyltransferase (CcrM), the MTA1-MTA9 complex from the ciliate Oxytricha, and the mammalian MettL3-MettL14 complex. These methyltransferases all generate N6-methyladenine in DNA, with some members having activity on single-stranded DNA as well as RNA. The beta class of methyltransferases has a unique multimeric feature, forming either homo- or hetero-dimers, allowing the enzyme to use division of labor between two subunits in terms of substrate recognition and methylation. We suggest that M.EcoGII may represent an ancestral form of these enzymes, as its activity is independent of the nucleic acid type (RNA or DNA), its strandedness (single or double), and its sequence (aside from the target adenine).
Metabolic cofactors NADH and FAD act as non-canonical initiating substrates for a primase and affect replication primer processing in vitro
Authors: Julius Christina , Salgado Paula S , Yuzenkova Yulia
Published: May 2020

To initiate replication on a double-stranded DNA de novo, all organisms require primase, an RNA polymerase making short RNA primers which are then extended by DNA polymerases. Here, we show that primase can use metabolic cofactors as initiating substrates, instead of its canonical substrate ATP. DnaG primase of Escherichia coli initiates synthesis of RNA with NADH (the reduced form of nicotinamide adenine dinucleotide) and FAD (flavin adenine dinucleotide) in vitro. These cofactors consist of an ADP core covalently bound to extra moieties. The ADP component of these metabolites base-pairs with the DNA template and provides a 3′-OH group for RNA extension. The additional cofactors moieties apparently contact the ‘basic ridge’ domain of DnaG, but not the DNA template base at the –1 position. ppGpp, the starvation response regulator, strongly inhibits the initiation with cofactors, hypothetically due to competition for overlapping binding sites. Efficient RNA primer processing is a prerequisite for Okazaki fragments maturation, and we find that the efficiency of primer processing by DNA polymerase I in vitro is specifically affected by the cofactors on its 5′-end. Together these results indicate that utilization of cofactors as substrates by primase may influence regulation of replication initiation and Okazaki fragments processing.
The LACE+ Index as a Predictor of 90-Day Supratentorial Tumor Surgery Outcomes
Authors: Winter Eric , Haldar Debanjan , Glauser Gregory , Caplan Ian F , Shultz Kaitlyn , McClintock Scott D , Chen Han-Chiao Isaac , Yoon Jang W , Malhotra Neil R
Published: May 2020

BACKGROUND

The LACE+ (Length of stay, Acuity of admission, Charlson Comorbidity Index [CCI] score, and Emergency department [ED] visits in the past 6 mo) index risk-prediction tool has never been successfully tested in a neurosurgery population.

OBJECTIVE

To assess the ability of LACE+ to predict adverse outcomes after supratentorial brain tumor surgery.

METHODS

LACE+ scores were retrospectively calculated for all patients (n = 624) who underwent surgery for supratentorial tumors at the University of Pennsylvania Health System (2017-2019). Confounding variables were controlled with coarsened exact matching. The frequency of unplanned hospital readmission, ED visits, and death was compared for patients with different LACE+ score quartiles (Q1, Q2, Q3, and Q4).

RESULTS

A total of 134 patients were matched between Q1 and Q4; 152 patients were matched between Q2 and Q4; and 192 patients were matched between Q3 and Q4. Patients with higher LACE+ scores were significantly more likely to be readmitted within 90 d (90D) of discharge for Q1 vs Q4 (21.88% vs 46.88%, P = .005) and Q2 vs Q4 (27.03% vs 55.41%, P = .001). Patients with larger LACE+ scores also had significantly increased risk of 90D ED visits for Q1 vs Q4 (13.33% vs 30.00%, P = .027) and Q2 vs Q4 (22.54% vs 39.44%, P = .039). LACE+ score also correlated with death within 90D of surgery for Q2 vs Q4 (2.63% vs 15.79%, P = .003) and with death at any point after surgery/during follow-up for Q1 vs Q4 (7.46% vs 28.36%, P = .002), Q2 vs Q4 (15.79% vs 31.58%, P = .011), and Q3 vs Q4 (18.75% vs 31.25%, P = .047).

CONCLUSION

LACE+ may be suitable for characterizing risk of certain perioperative events in a patient population undergoing supratentorial brain tumor resection.
Digital technologies as a means of accessing powerful mathematical ideas. A study of adults with low schooling in Mexico
Authors: Palmas Santiago , Rojano Teresa , Sutherland Rosamund
Published: May 2020

This paper derives from a study which main purpose was to investigate how a group of adults with low schooling can have access to powerful mathematical ideas when working with activities that involve the use of technology resources and that take into account the adults’ previous experience with mathematics. Specifically, adults’ previous experience with area calculation was considered. Principles of the Theory of Didactical Situations (TDS) formulated by Brousseau guided the study design, and Pick’s theorem was recreated in a dynamic digital setting, with which it is possible to calculate the area of regular and irregular polygons. In this approach, intuitive notions of area and perimeter are resorted to, seeking to promote the experience with powerful ideas such as ‘the generality of a method’, ‘realizing the existence of different methods used for one and the same end’ and ‘realizing that each method possesses advantages and limitations’. Analysis of interview protocols from three noteworthy cases (which include both adults’ work in the digital setting and their discussions with the researcher) suggests the presence of powerful underlying mathematical ideas, such as the idea of generality and the power of a method and the features of the constituent elements of a geometric figure that are involved in calculating its attributes, attributes such as area.
Dual Role of Auxin in Regulating Plant Defense and Bacterial Virulence Gene Expression During Pseudomonas syringae PtoDC3000 Pathogenesis
Authors: Djami-Tchatchou Arnaud T. , Harrison Gregory A. , Harper Chris P. , Wang Renhou , Prigge Michael J. , Estelle Mark , Kunkel Barbara N.
Published: May 2020

Modification of host hormone biology is a common strategy used by plant pathogens to promote disease. For example, the bacterial pathogen strain Pseudomonas syringae DC3000 (PtoDC3000) produces the plant hormone auxin (indole-3-acetic acid [IAA]) to promote PtoDC3000 growth in plant tissue. Previous studies suggest that auxin may promote PtoDC3000 pathogenesis through multiple mechanisms, including both suppression of salicylic acid (SA)-mediated host defenses and via an unknown mechanism that appears to be independent of SA. To test if host auxin signaling is important during pathogenesis, we took advantage of Arabidopsis thaliana lines impaired in either auxin signaling or perception. We found that disruption of auxin signaling in plants expressing an inducible dominant axr2-1 mutation resulted in decreased bacterial growth and that this phenotype was suppressed by introducing the sid2-2 mutation, which impairs SA synthesis. Thus, host auxin signaling is required for normal susceptibility to PtoDC3000 and is involved in suppressing SA-mediated defenses. Unexpectedly, tir1 afb1 afb4 afb5 quadruple-mutant plants lacking four of the six known auxin coreceptors that exhibit decreased auxin perception, supported increased levels of bacterial growth. This mutant exhibited elevated IAA levels and reduced SA-mediated defenses, providing additional evidence that auxin promotes disease by suppressing host defense. We also investigated the hypothesis that IAA promotes PtoDC3000 virulence through a direct effect on the pathogen and found that IAA modulates expression of virulence genes, both in culture and in planta. Thus, in addition to suppressing host defenses, IAA acts as a microbial signaling molecule that regulates bacterial virulence gene expression.
Refining the Life Cycle ofPlasmodiophora brassicae
Authors: Liu Lijiang , Qin Li , Zhou Zhuqing , Hendriks Wilhelmina G. H. M. , Liu Shengyi , Wei Yangdou
Published: May 2020

As a soilborne protist pathogen, Plasmodiophora brassicae causes the devastating clubroot disease on Brassicaceae crops worldwide. Due to its intracellular obligate biotrophic nature, the life cycle of P. brassicae is still not fully understood. Here, we used fluorescent probe-based confocal microscopy and transmission electron microscopy (TEM) to investigate the infection process of P. brassicae on the susceptible host Arabidopsis under controlled conditions. We found that P. brassicae can initiate the primary infection in both root hairs and epidermal cells, producing the uninucleate primary plasmodium at 1 day postinoculation (dpi). After that, the developed multinucleate primary plasmodium underwent condensing and cytoplasm cleavage into uninucleate zoosporangia from 1 to 4 dpi. This was subsequently followed by the formation of multinucleate zoosporangia and the production of secondary zoospores within zoosporangium. Importantly, the secondary zoospores performed a conjugation in the root epidermal cells after their release. TEM revealed extensive uninucleate secondary plasmodium in cortical cells at 8 dpi, indicating the establishment of the secondary infection. The P. brassicae subsequently developed into binucleate, quadrinucleate, and multinucleate secondary plasmodia from 10 to 15 dpi, during which the clubroot symptoms appeared. The uninucleate resting spores were first observed in the cortical cells at 24 dpi, marking the completion of a life cycle. We also provided evidence that the secondary infection of P. brassicae may represent the diploid sexual life stage. From these findings, we propose a refined life cycle of P. brassicae which will contribute to understanding of the complicated infection biology of P. brassicae.
Incidence and Classification of Nonroutine Events during Anesthesia Care
Authors: Liberman Justin S. , Slagle Jason M. , Whitney Gina , Shotwell Matthew S. , Lorinc Amanda , Porterfield Eric , Weinger Matthew B.
Published: May 2020

Background

A nonroutine event is any aspect of clinical care perceived by clinicians or trained observers as a deviation from optimal care based on the context of the clinical situation. The authors sought to delineate the incidence and nature of intraoperative nonroutine events during anesthesia care.

Methods

The authors prospectively collected audio, video, and relevant clinical information on 556 cases at three academic hospitals from 1998 to 2004. In addition to direct observation, anesthesia providers were surveyed for nonroutine event occurrence and details at the end of each study case. For the 511 cases with reviewable video, 400 cases had no reported nonroutine events and 111 cases had at least one nonroutine event reported. Each nonroutine event was analyzed by trained anesthesiologists. Rater reliability assessment, comparisons (nonroutine event vs. no event) of patient and case variables were performed.

Results

Of 511 cases, 111 (21.7%) contained 173 nonroutine events; 35.1% of event-containing cases had more than one nonroutine event. Of the 173 events, 69.4% were rated as having patient impact and 12.7% involved patient injury. Longer case duration (25th vs. 75th percentile; odds ratio, 1.83; 95% CI, 1.15 to 2.93; P = 0.032) and presence of a comorbid diagnosis (odds ratio, 2.14; 95% CI, 1.35 to 3.40; P = 0.001) were associated with nonroutine events. Common contributory factors were related to the patient (63.6% [110 of 173]) and anesthesia provider (59.0% [102 of 173]) categories. The most common patient impact events involved the cardiovascular system (37.4% [64 of 171]), airway (33.3% [57 of 171]), and human factors, drugs, or equipment (31.0% [53 of 171]).

Conclusions

This study describes characteristics of intraoperative nonroutine events in a cohort of cases at three academic hospitals. Nonroutine event–containing cases were commonly associated with patient impact and injury. Thus, nonroutine event monitoring in conjunction with traditional error reporting may enhance our understanding of potential intraoperative failure modes to guide prospective safety interventions.

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What We Already Know about This Topic

What This Article Tells Us That Is New
Harm of IV High-Dose Vitamin C Therapy in Adult Patients: A Scoping Review
Authors: Yanase Fumitaka , Fujii Tomoko , Naorungroj Thummaporn , Belletti Alessandro , Luethi Nora , Carr Anitra C. , Young Paul J. , Bellomo Rinaldo
Published: May 2020

Objectives:

The potential harm associated with the use of IV vitamin C has not been systematically assessed. We aimed to review the available evidence on harm related to such treatment.

Data Sources:

We searched MEDLINE, EMBASE, Cochrane Library, National Institute of Health Clinical Trials Register, and World Health Organization International Clinical Trials Registry Platform.

Study Selection:

We included studies in adult population that reported harm related to IV high-dose vitamin C which we defined as greater than or equal to 6 g/d, greater than or equal to 75 mg/kg/d, or greater than or equal to 3 g/m2/d.

Data Extraction:

Two independent investigators screened records and extracted data.

Data Synthesis:

We identified 8,149 reports, of which 650 full text were assessed for eligibility, leaving 74 eligible studies. In these studies, 2,801 participants received high-dose vitamin C at a median (interquartile range) dose of 22.5 g/d (8.25–63.75 g/d), 455 mg/kg/d (260–925 mg/kg/d), or 70 g/m2/d (50–90 g/m2/d); and 932 or more adverse events were reported. Among nine double-blind randomized controlled trials (2,310 patients), adverse events were reported in three studies with an event rate per patient for high-dose vitamin C identical to placebo group in one study (0.1 [1/10] vs 0.1 [1/10]), numerically lower in one study (0.80 [672/839] vs 0.82 [709/869]), and numerically higher in one study (0.33 [24/73] vs 0.23 [17/74]). Six double-blind randomized controlled trials reported no adverse event in either group. Five cases of oxalate nephropathy, five cases of hypernatremia, three cases of hemolysis in glucose-6-phosphate dehydrogenase deficiency patients, two cases of glucometer error, and one case of kidney stones were also reported overall.

Conclusions:

There is no consistent evidence that IV high-dose vitamin C therapy is more harmful than placebo in double-blind randomized controlled trials. However, reports of oxalate nephropathy, hypernatremia, glucometer error, and hemolysis in glucose-6-phosphate dehydrogenase deficiency patients warrant specific monitoring.
No Apparent Influence of Nonadherence on Tacrolimus Intrapatient Variability in Stable Kidney Transplant Recipients
Authors: Gokoel Sumit R. M. , Zwart Tom C. , Moes Dirk Jan A. R. , van der Boog Paul J. M. , de Fijter Johan W.
Published: May 2020

Background:

High intrapatient variability (IPV) in tacrolimus exposure has been associated with an increased risk of graft rejection and graft loss. It has been suggested that medication nonadherence has high impact on IPV. The objective of this study is to assess the relationship between tacrolimus IPV and medication nonadherence in stable kidney transplant recipients.

Methods:

This study was conducted within the Reducing Renal Function Deterioration trial (Netherlands Trial Register: NTR7256), which included stable kidney transplant recipients. Nonadherence was assessed quantitatively by electronic monitoring (EM) and qualitatively using the composite adherence score (CAS) consisting of patient self-reporting (Immunosuppressant Therapy Adherence Scale), a physician report, and the tacrolimus trough concentrations (C0). IPV in tacrolimus C0 and area under the concentration–time curves (AUCs) was evaluated at 5 and 3 sampling instances, respectively.

Results:

Data of 64 kidney transplant recipients (43 males, 21 females; mean age 53.6 years), mean time post-transplantation 5.4 years, were collected. Mean missed tacrolimus intake was 7% (0.3%–13.4%) based on EM, missing one intake every 2 weeks. Based on the CAS, 68.9% of the patients were categorized as nonadherent. The mean IPV was 17.9% (4.4%–65.3%) and 20.2% (2.5%–51.6%) for tacrolimus C0 and AUCs, respectively. The nonadherence data displayed a nonparametric distribution, with nonadherence scores mostly in the lower ranges. There was no significant difference in the mean IPV between adherent and nonadherent patients. There were no differences in EM, CAS, physician report, or time-in-therapeutic range, but patients with a low AUC IPV showed a slightly higher Immunosuppressant Therapy Adherence Scale score than those with a high AUC IPV (P = 0.035).

Conclusions:

There was no apparent relationship between IPV and nonadherence in this motivated kidney transplant recipient population, with one missed tacrolimus dose every 2 weeks.
Can walking exercise programs improve health for women in menopause transition and postmenopausal? Findings from a scoping review
Authors: Sydora Beate C. , Turner Cailey , Malley Alexandra , Davenport Margie , Yuksel Nese , Shandro Tami , Ross Sue
Published: May 2020

Objective:

Our goal was to explore the range and characteristics of published papers on therapeutic walking programs for menopausal women and to identify program features that resulted in successful outcomes including reduced symptoms and improved long-term wellness.

Methods:

We searched biomedical and exercise-related databases for articles published up to June 1, 2017, using keywords related to menopause and walking. Data were collected into EndNote X8 reference manager to identify and remove duplicates. The final selection included all articles that studied walking as a health intervention for women in menopause transition or postmenopausal.

Results:

A total of 3,244 papers were collected from the six databases. After removing duplicates and applying inclusion and exclusion criteria, 96 articles were charted, including 77 different walking programs. Walking interventions ranged from 4 weeks to 3 years with an average weekly frequency of 3.8 ± 1.8 and were applied to a variety of symptoms and their biological markers and risk factors. Overall, 91% of the programs showed a beneficial outcome in at least one menopause-related medical issue. Information on menopause-specific symptoms, especially vasomotor symptoms and sleep problems, was scarce.

Conclusion:

The scoping review highlights the growing interest in walking programs as therapies for menopause and related symptoms and provides evidence of their possible benefit as a wellness option for women in menopause and beyond. Further research would be recommended to establish the therapeutic value of walking programs for women with specific focus on typical menopause symptoms at different stages of menopause.

Video Summary:http://links.lww.com/MENO/A587.
Dairy intake is not associated with improvements in bone mineral density or risk of fractures across the menopause transition: data from the Study of Women's Health Across the Nation
Authors: Wallace Taylor C. , Jun Shinyoung , Zou Peishan , McCabe George P. , Craig Bruce A. , Cauley Jane A. , Weaver Connie M. , Bailey Regan L.
Published: May 2020

Objective:

Menopause represents a period in which bone deterioration is accelerated; thus, primary prevention strategies to address age-related bone loss are crucial. Dairy products contain more than a dozen essential nutrients, including calcium, phosphorus, vitamin D, and high-quality protein, as well as bioactive compounds that may promote bone mineralization. However, the relationship between dairy consumption and bone health across the menopause transition remains largely unknown. The purpose of this analysis was to estimate the change in lumbar spine and femoral neck bone mineral density and the risk of bone fracture by the frequency of dairy intakes among women across the menopausal transition using the publicly available data from the Study of Women's Health Across the Nation.

Methods:

We analyzed total dairy foods in four categories of <0.5, 0.5 to <1.5, 1.5 to <2.5, and ≥2.5 servings/d or <1.5 and ≥1.5 servings/d. A general linear model was used to estimate the association of dairy intake with the 10-year bone mineral density loss rate and a linear mixed model was used to estimate the annualized bone mineral density loss rate of the femoral neck and lumbar spine. A Cox proportional hazard model was applied to calculate hazard ratios and 95% confidence intervals of the nontraumatic fractures. Poisson regression was used to determine the relative risks and 95% confidence intervals of the nontraumatic fractures. The models were controlled for race/ethnicity, age, height, weight, smoking status, physical activity, alcohol consumption, calcium use, menopausal status, and total caloric intake.

Results:

No significant differences in bone mineral density change were observed, regardless of baseline menopausal status. No significant differences in the risk of nontraumatic fracture were observed.

Conclusions:

In this group of US women undergoing the menopausal transition, dairy food intake was neither associated with femoral and spine bone mineral density loss nor the risk of fractures.
Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension
Authors: Lenders Jacques W.M. , Kerstens Michiel N. , Amar Laurence , Prejbisz Aleksander , Robledo Mercedes , Taieb David , Pacak Karel , Crona Joakim , Zelinka Tomáš , Mannelli Massimo , Deutschbein Timo , Timmers Henri J.L.M. , Castinetti Frederic , Dralle Henning , Widimský Jřri , Gimenez-Roqueplo Anne-Paule , Eisenhofer Graeme
Published: May 2020

Phaeochromocytoma and paraganglioma (PPGL) are chromaffin cell tumours that require timely diagnosis because of their potentially serious cardiovascular and sometimes life- threatening sequelae. Tremendous progress in biochemical testing, imaging, genetics and pathophysiological understanding of the tumours has far-reaching implications for physicians dealing with hypertension and more importantly affected patients. Because hypertension is a classical clinical clue for PPGL, physicians involved in hypertension care are those who are often the first to consider this diagnosis. However, there have been profound changes in how PPGLs are discovered; this is often now based on incidental findings of adrenal or other masses during imaging and increasingly during surveillance based on rapidly emerging new hereditary causes of PPGL. We therefore address the relevant genetic causes of PPGLs and outline how genetic testing can be incorporated within clinical care. In addition to conventional imaging (computed tomography, MRI), new functional imaging approaches are evaluated. The novel knowledge of genotype-phenotype relationships, linking distinct genetic causes of disease to clinical behaviour and biochemical phenotype, provides the rationale for patient-tailored strategies for diagnosis, follow-up and surveillance. Most appropriate preoperative evaluation and preparation of patients are reviewed, as is minimally invasive surgery. Finally, we discuss risk factors for developing metastatic disease and how they may facilitate personalised follow-up. Experts from the European Society of Hypertension have prepared this position document that summarizes the current knowledge in epidemiology, genetics, diagnosis, treatment and surveillance of PPGL.
The Effect of Self-Care Program Based on Modeling and Role Modeling Theory on Body Image Nurturance in Patients With Colorectal Cancer
Authors: Pakzad Khalilabad Roya , Aghebati Nahid , Behnam Vashani Hamid Reza
Published: May 2020

One of the most critical disorders among patients with colorectal cancer is a change in their body image. This study aimed to examine the effect of a self-care program based on the modeling and role-modeling theory on nurturing body image of patients with colorectal cancer. In 2018, a 2-group randomized clinical trial was conducted in Mashhad, Iran. According to the modeling and role-modeling theory, 27 patients allocated in the experimental group received five 30- to 45-minute sessions at the hospital and 4 sessions of phone counseling within 2 weeks. Twenty-seven patients randomly allocated in the control group received the routine care. Data were collected by demographic and body image scales 3 times with the patients. The mean age of the patients in experimental and control groups was not significantly different (P = .46). The mean scores of the body image at the admission time were 26.8 ± 2.6 in the experimental and 27.9 ± 3.1 in control groups (P = .12). However, the mean scores of body image of the experimental group were 24.3 ± 4.6 at the discharge time and 28.1 ± 2.1 during the follow-up phase. In the control group, the body image scores were 21.0 ± 5.6 at discharge time and 22.9 ± 6.1 during the follow-up phase. Repeated-measures analysis of variance revealed significant differences between the 2 groups (P ≤ .001). Application of the self-care program based on the modeling and role-modeling theory can play a critical role in nurturing the body image of patients with colorectal cancer.
Nightingale's Legacy
Authors: Karoliussen Mette Haslund , Hov Reidun
Published: May 2020

Nursing today could benefit from building on Florence Nightingale's legacy. The aim of this article is to describe and discuss how her holistic approach to nursing is supported by scientific discoveries within human ecology, psychoneuroimmunology, and communicology. This combination may bridge the gap between current nursing practices and Nightingale's ethos.