bluuebunny/crossref_metadata_2025 huggingface dataset:
An expanded landscape of human long noncoding RNA
Authors: Jiang Shuai , Cheng Si-Jin , Ren Li-Chen , Wang Qian , Kang Yu-Jian , Ding Yang , Hou Mei , Yang Xiao-Xu , Lin Yuan , Liang Nan , Gao Ge
Published: July 2019

Long noncoding RNAs (lncRNAs) are emerging as key regulators of multiple essential biological processes involved in physiology and pathology. By analyzing the largest compendium of 14,166 samples from normal and tumor tissues, we significantly expand the landscape of human long noncoding RNA with a high-quality atlas: RefLnc (Reference catalog of LncRNA). Powered by comprehensive annotation across multiple sources, RefLnc helps to pinpoint 275 novel intergenic lncRNAs correlated with sex, age or race as well as 369 novel ones associated with patient survival, clinical stage, tumor metastasis or recurrence. Integrated in a user-friendly online portal, the expanded catalog of human lncRNAs provides a valuable resource for investigating lncRNA function in both human biology and cancer development.
Nonparametric expression analysis using inferential replicate counts
Authors: Zhu Anqi , Srivastava Avi , Ibrahim Joseph G , Patro Rob , Love Michael I
Published: July 2019

A primary challenge in the analysis of RNA-seq data is to identify differentially expressed genes or transcripts while controlling for technical biases. Ideally, a statistical testing procedure should incorporate the inherent uncertainty of the abundance estimates arising from the quantification step. Most popular methods for RNA-seq differential expression analysis fit a parametric model to the counts for each gene or transcript, and a subset of methods can incorporate uncertainty. Previous work has shown that nonparametric models for RNA-seq differential expression may have better control of the false discovery rate, and adapt well to new data types without requiring reformulation of a parametric model. Existing nonparametric models do not take into account inferential uncertainty, leading to an inflated false discovery rate, in particular at the transcript level. We propose a nonparametric model for differential expression analysis using inferential replicate counts, extending the existing SAMseq method to account for inferential uncertainty. We compare our method, Swish, with popular differential expression analysis methods. Swish has improved control of the false discovery rate, in particular for transcripts with high inferential uncertainty. We apply Swish to a single-cell RNA-seq dataset, assessing differential expression between sub-populations of cells, and compare its performance to the Wilcoxon test.
Evaluating the pathways linking complementary feeding practices to obesity in early life
Authors: Thompson Amanda L
Published: July 2019

The complementary feeding period, when solids and liquids other than breast milk and formula are added to the infant diet, is an important development window shaping infant growth and weight gain, metabolic development, and lifelong eating practices. Yet, relatively little is known about how the timing and types of foods offered to infants at this stage may shape their growth and subsequent risk of developing obesity. This narrative review describes the existing literature on complementary feeding practices, discusses potential biological and behavioral pathways linking complementary feeding practices to the development of obesity, and offers potential avenues for intervention. While further research is needed to more fully understand optimal complementary feeding practices, existing evidence supports the importance of healthful early feeding practices in the physiological and behavioral regulation of growth and metabolism and the need for early intervention to prevent the development of obesity.
Ventricular Catheter Tract Hemorrhage as a Risk Factor for Ventriculostomy-Related Infection
Authors: Kim Julie , Lee James , Feng Rui , Chartrain Alexander , Sobotka Stanislaw , Griffiths Stephen , Weiss Nirit , Dangayach Neha , Bederson Joshua , Mayer Stephan A , Gordon Errol
Published: July 2019

BACKGROUND

Ventriculostomy-related infection (VRI) is a feared complication of external ventricular drain (EVD) placement. Although many contributing factors to VRI have been examined, little is known whether there is an association between ventriculostomy-related catheter tract hemorrhage (VCTH) and VRI.

OBJECTIVE

To evaluate risk factors for VRI and assess possible correlations with VCTH.

METHODS

We performed a retrospective analysis of patients with EVD placement in a neurocritical care unit between 2011 and 2015. VRI was defined as clinical signs of infection with a positive cerebrospinal fluid gram stain and isolation of cerebrospinal fluid culture. VCTH was diagnosed by computed tomography immediately after EVD insertion.

RESULTS

A total of 247 patients with EVD were identified during the 5-yr study period. An association between VCTH and gram-negative VRI was identified (P = .02). Ten percent (25 of 247 patients) developed a VRI, and 7% (18 of 247 patients) had a VCTH. Of the 25 patients with VRI, 20% (n = 5) had a VCTH, compared to 6% (n = 13) of 222 patients who had an EVD placed but did not develop VRI. There were no significant differences in demographic and clinical factors except for multiple EVD insertions (P < .00001), EVD duration (P < .001), and hospital length of stay (P < .001).

CONCLUSION

VCTH is a potentially significant risk factor for VRI. Further analysis will be needed to confirm the strength of this association, and to delineate the possible mechanisms by which tract hemorrhage may serve as a nidus for bacterial penetration into the central nervous system.
Repeat Resection of a Cavernous Malformation of the Optic Nerve/Chiasm via a Frontotemporal Approach: 2-Dimensional Operative Video
Authors: Gozal Yair M , Alzhrani Gmaan , Abou-Al-Shaar Hussam , Couldwell William T
Published: July 2019

Cavernous malformations are benign vascular lesions that can arise throughout the central nervous system. The occurrence of a cavernous malformation within the optic nerve or chiasm, however, is extremely uncommon. The case described in this video involved a 36-yr-old woman who presented 3 mo after undergoing a left frontotemporal craniotomy for resection of an optic nerve cavernous malformation. She had initially presented to an outside hospital with vision loss, and the left optic nerve lesion was identified and resected. Although her vision had reportedly improved slightly postoperatively, she awoke 3 mo later with bilateral subjective blurriness and new visual field deficits. Magnetic resonance imaging revealed enlargement of the left optic apparatus hemorrhagic lesion, corresponding to residual cavernous malformation. Given the recurrence of hemorrhage and the associated visual symptoms, the patient underwent a redo left frontotemporal craniotomy for resection of the optic nerve and chiasmal lesion. Histopathologic evaluation revealed thick-walled vessels with focal intervening glial tissue, an absence of neoplastic cells, and hemorrhage, consistent with a cavernous malformation. The patient tolerated the procedure well. Postoperatively, she experienced immediate amelioration in her visual symptoms. She was discharged home on postoperative day 3, and her bitemporal visual field deficit continued to progressively improve through her last ophthalmologic appointment 14 mo after surgery. Postoperative and subsequent surveillance neuroimaging demonstrated complete resection of the cavernous malformation without evidence of recurrence. This case demonstrates the techniques utilized to ensure complete resection of the malformation in this very eloquent region. The patient provided consent for publication.
First detection of PSR B1259−63/LS 2883 in the millimeter and submillimeter wavelengths with ALMA
Authors: Fujita Yutaka , Kawachi Akiko , Akahori Takuya , Nagai Hiroshi , Yamaguchi Masaki
Published: July 2019

We report Atacama Large Millimeter/submillimeter Array (ALMA) observations of the binary system containing the pulsar PSR B1259−63 orbiting around a Be star LS 2883 after the 2017 periastron passage. We detected radio continuum emission from the binary system in the millimeter/submillimeter wavelengths for the first time. At Band 3 (97 GHz), the flux 84 days after the periastron is almost the same as that 71 days after the periastron. Although the binary system showed intense GeV gamma-ray flares during our observations, the Band 3 flux did not indicate any time correlation with them. The Band 3 fluxes are consistent with an extrapolation of the radio spectrum at lower frequencies. Assuming that it is synchrotron emission, we constrain magnetic fields (≲0.6 G) and the high-energy cutoff of the electrons (γ ≳ 360). The flux at Band 7 (343 GHz) 69 days after the periastron shows a significant excess from the extrapolation of the radio spectrum at lower frequencies. The flux may be associated with the circumstellar disk around the Be star. We also present the results of Australian Telescope Compact Array (ATCA) observations at 94 GHz for the 2014 periastron passage, which show that the radio spectrum was relatively soft when the pulsar passed the disk.
Aberrant MUC1 accumulation in salivary glands of Sjögren’s syndrome patients is reversed by TUDCA in vitro
Authors: Castro Isabel , Albornoz Nicolás , Aguilera Sergio , Barrera María-José , González Sergio , Núñez Matilde , Carvajal Patricia , Jara Daniela , Lagos Carolina , Molina Claudio , Urzúa Ulises , Hermoso Marcela A , González María-Julieta
Published: July 2019

Objectives

Xerostomia in SS patients has been associated with low quality and quantity of salivary mucins, which are fundamental for the hydration and protection of the oral mucosa. The aim of this study was to evaluate if cytokines induce aberrant mucin expression and whether tauroursodeoxycholic acid (TUDCA) is able to counteract such an anomaly.

Methods

Labial salivary glands from 16 SS patients and 15 control subjects, as well as 3D acini or human submandibular gland cells stimulated with TNF-α or IFN-γ and co-incubated with TUDCA, were analysed. mRNA and protein levels of Mucin 1 (MUC1) and MUC7 were determined by RT-qPCR and western blot, respectively. Co-immunoprecipitation and immunofluorescence assays for mucins and GRP78 [an endoplasmic reticulum (ER)-resident protein] were also performed. mRNA levels of RelA/p65 (nuclear factor-κB subunit), TNF-α, IL-1β, IL-6, SEL1L and EDEM1 were determined by RT-qPCR, and RelA/p65 localization was evaluated by immunofluorescence.

Results

MUC1 is overexpressed and accumulated in the ER of labial salivary gland from SS patients, while MUC7 accumulates throughout the cytoplasm of acinar cells; however, MUC1, but not MUC7, co-precipitated with GRP78. TUDCA diminished the overexpression and aberrant accumulation of MUC1 induced by TNF-α and IFN-γ, as well as the nuclear translocation of RelA/p65, together with the expression of inflammatory and ER stress markers in 3D acini.

Conclusion

Chronic inflammation alters the secretory process of MUC1, inducing ER stress and affecting the quality of saliva in SS patients. TUDCA showed anti-inflammatory properties decreasing aberrant MUC1 accumulation. Further studies are necessary to evaluate the potential therapeutic effect of TUDCA in restoring glandular homeostasis in SS patients.
Analysis of primitive genetic interactions for the design of a genetic signal differentiator
Authors: Halter Wolfgang , Murray Richard M , Allgöwer Frank
Published: July 2019

We study the dynamic and static input–output behavior of several primitive genetic interactions and their effect on the performance of a genetic signal differentiator. In a simplified design, several requirements for the linearity and time-scales of processes like transcription, translation and competitive promoter binding were introduced. By experimentally probing simple genetic constructs in a cell-free experimental environment and fitting semi-mechanistic models to these data, we show that some of these requirements can be verified, while others are only met with reservations in certain operational regimes. Analyzing the linearized model of the resulting genetic network, we conclude that it approximates a differentiator with relative degree one. Taking also the discovered nonlinearities into account and using a describing function approach, we further determine the particular frequency and amplitude ranges where the genetic differentiator can be expected to behave as such.
Low-income workers’ perceptions of wages, food acquisition, and well-being
Authors: Beck Lindsay , Quinn Emilee L , Hill Heather D , Wolf Jessica , Buszkiewicz James , Otten Jennifer J
Published: July 2019

Although studies have demonstrated an association between increased economic resources and improvements in food security and health, there is a paucity of qualitative research regarding the relationships between household resources, food security, and health. Policy changes related to increasing low wages are potential opportunities to understand changes to material resources. The aims of this analysis were to describe how low-wage workers perceive household resources in relation to food acquisition and to explore how workers in low-wage jobs connect food and diet to perceptions of health and well-being. We analyzed 190 transcripts from 55 workers in low-wage jobs who were living in households with children who were part of the Seattle Minimum Wage Study (up to three in-depth qualitative interviews and one phone survey per participant, conducted between 2015 and 2017). We coded and analyzed interviews using Campbell’s food acquisition framework and best practices for qualitative research. Participants relied on a combination of wages, government assistance, and private assistance from community or family resources to maintain an adequate food supply. Strategies tended to focus more on maintaining food quality than food quantity. Restricted resources also limited food-related leisure activities, which many participants considered important to quality of life. Although many low-wage workers would like to use additional income to purchase higher quality foods or increase food-related leisure activities, they often perceive trade-offs that limit income-based adjustments to food-spending patterns. Future studies should be specifically designed to examine food choices in response to changes in income.
Financial and Clinical Impact of Transfer Patients at Major Teaching Hospitals
Authors: Baker Matthew C. , Koopman Christopher J. , Landman James H. , Alsdurf Charles R. , Gundling Richard L. , Haberman Merle , Horvath Keith A. , Orlowski Janis M.
Published: July 2019

Purpose

The authors examined the “hub-and-spoke” health care system in the United States for patients transferred from one hospital (“spoke”) to a major teaching hospital (“hub”) and assessed the financial and clinical impact of this system on major teaching hospitals.

Method

The authors surveyed Council of Teaching Hospitals and Health Systems members to collect detailed financial and clinical data from fiscal year 2015 for transfer cases and nontransfer cases (cases directly admitted to the teaching hospital). Data included computed margins (the difference between revenue received and direct and indirect facility costs as estimated by the hospitals) as well as case severity, average length of stay (ALOS), time of admission, surgical or medical status, and other situational variables for All Patient Refined Diagnosis Related Groups (APR-DRGs). The authors used an ordinary least-squares regression model with fixed effects to analyze the data.

Results

Twenty-six hospitals provided data. The average difference between transfer and nontransfer cases was a 2.18 day longer ALOS and a $1,716 lower computed margin, for a case in the same APR-DRG and hospital (P < .001 for both outcomes). Transfer cases had a 19% higher case severity of illness rating and were disproportionately represented among complex APR-DRGs. Transfer patients were 14% more likely to be Medicaid beneficiaries.

Conclusions

Compared with nontransfer cases, transfer cases at major teaching hospitals were more complex and resulted in greater resource utilization, affecting the financial margins on which teaching hospitals rely to support their multipart mission.
The Empirical Challenge of 21st-Century Medical Education
Authors: Wartman Steven A.
Published: July 2019

Medical education is at a crossroads. Facing challenges wrought by science and technology as well as societal change, the curriculum is increasingly out of synch with new needs in teaching content and medical practice. The path to significant curricular reform is difficult because of a variety of factors, including deeply entrenched values, the natural resistance to change, and the accreditation process. Indeed, even the very definition of what it means to be a professional is changing with profound implications for the future role of the physician and the sacrosanct doctor–patient relationship.

In this Invited Commentary, the author enumerates challenges facing medical education in the current era. To address these challenges, the author recommends specific curricular emphases for 21st-century medical education: knowledge capture and curation, collaboration with and management of artificial intelligence applications, a deep understanding of probabilistic reasoning, and the cultivation of empathy and compassion in accordance with ethical standards. Given these needs, it is imperative that schools act today to undertake significant curricular reform and, in so doing, strive to make the hard changes necessary to produce optimal practitioners in a rapidly transforming 21st century. The author provides first steps an institution can take to begin to address these challenges.
Invoking the Medical Humanities to Develop a #MedicineWeCanTrust
Authors: Bleakley Alan
Published: July 2019

Trust is a complex phenomenon that resists easy definition, but it is easily recognizable, or rather its absence is impossible to miss. The author draws inspiration from the #MedsWeCanTrust movement to advocate for #MedicineWeCanTrust. Trust can be seen as a “soft,” “tender-minded,” optimistic condition fighting for survival in a “hard,” “tough-minded,” or jaundiced medicine. Modern medicine is traditionally patriarchal, individualistic, and resistant to encouraging democratic, collaborative habits as it socializes its young into hierarchical structures or eats them whole. Yet trust is a health intervention and essential for the innovative expansion of medical culture as it encourages authentic democracy, interprofessional clinical teamwork, and patient-centeredness. Increases in trust lead to greater tolerance of uncertainty, one of the primary goals of medical education. Recent curriculum development work has shown that the medical humanities offer a superb delivery mechanism for ensuring democratic habits in medicine that align with social justice agendas, key to addressing links between social inequalities and compromised physical and mental health. Where lack of trust is associated with cynicism in doctors, increasing trust loosens dependence upon suffocating control mechanisms. This allows medicine to take on the moral concerns and uncertainties of an adulthood that also promises emotional warmth, guidance, support, and improved communication between colleagues and with patients. Medicine must embrace trust as the matrix of health care, and the medical humanities can educate for values such as tolerance of uncertainty and ambiguity as a basis for engendering trust.
Brief Cognitive Behavioral Therapy For Chronic Pain
Authors: Beehler Gregory P. , Murphy Jennifer L. , King Paul R. , Dollar Katherine M. , Kearney Lisa K. , Haslam Aaron , Wade Michael , Goldstein Wade R.
Published: July 2019

Objectives:

Although cognitive behavioral therapy is an effective intervention for chronic pain, it is a lengthy treatment typically applied only in specialty care settings. The aim of this project was to collect preliminary effectiveness data for Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP), an abbreviated, modular form of treatment designed for use in primary care.

Methods:

A clinical demonstration project was conducted in which Brief CBT-CP was delivered to primary care patients by 22 integrated care providers practicing in the Primary Care Behavioral Health model of Veterans Health Administration primary care clinics. Brief measures were used at each appointment to collect patient-reported clinical outcomes.

Results:

One hundred eighteen patients provided sufficient data for analysis (male, 75%; mean age, 51.4 y). Multilevel modeling suggested that a composite measure of pain intensity and functional limitations showed statistically significant improvements by the third appointment (Cohen’s d=0.65). Pain-related self-efficacy outcomes showed a similar pattern of results but of smaller effect size (Cohen’s d=0.22). The exploratory analysis identified that Brief CBT-CP modules addressing psychoeducation and goal setting, pacing, and relaxation training were associated with the most significant gains in treatment outcomes.

Discussion:

These findings provide early support for the effectiveness of Brief CBT-CP when delivered by providers in every day Primary Care Behavioral Health settings. Results are discussed in relation to the need for additional research regarding the potential value of employing safe, population-based, nonpharmacological approaches to pain management in primary care.
Reducing 30-Day Readmissions Through Nursing Science
Authors: Stixrood Bridget
Published: July 2019

The Transition Management Model was developed by and for nurse care coordinators at an Independent Health Network to reduce Medicare and Medicaid 30-day readmission rates. Preimplementation assessment revealed the need for a nursing science framework to effectively reduce 30-day readmissions. The model was developed through thoughtful integration of transitions theory with best practice guidelines set forth by Project BOOST. Initial results of the Transition Management Model produced a decline in readmission rates by 11%. The Transition Management Model initiative can serve as an exemplar for the integration of transitions theory to best practice guidelines to effectively reduce 30-day readmissions.
Reconceptualizing the Electronic Health Record for a New Decade
Authors: Robichaux Catherine , Tietze Mari , Stokes Felicia , McBride Susan
Published: July 2019

Since the 2009 publication by Petrovskaya et al on, “Dilemmas, Tetralemmas, Reimagining the Electronic Health Record,” and passage of the Health Information Technology for Economic Clinical Health (HITECH) Act, 96% of hospitals and 78% of providers have implemented the electronic health record. While many positive outcomes such as guidelines-based clinical decision support and patient portals have been realized, we explore recent issues in addition to those continuing problems identified by Petrovskaya et al that threaten patient safety and integrity of the profession. To address these challenges, we integrate polarity thinking with the tetralemma model discussed by Petrovskaya et al and propose application of a virtue ethics framework focused on cultivation of technomoral wisdom.
Fractal Deposits of a Hemostatic Hydrophilic Polymer in Mohs Micrographic Surgery Frozen Sections: A Histologic Analysis and Comparison With Sodium Polystyrene Sulfonate (Kayexalate)
Authors: Urman Danielle , Ledon Jennifer , Kolker Steven , Bennett Richard G.
Published: July 2019

Hydrophilic polymer with potassium ferrate (HPPF) powder is available as an over-the-counter hemostatic agent used by patients to stop superficial bleeding. In dermatology, it is applied to stop bleeding after superficial shave or punch biopsies or in open wounds after Mohs micrographic surgery. Despite its widespread availability, however, HPPF in histopathologic skin sections is highly unusual. We noted HPPF in skin closely resembles sodium polystyrene sulfonate (SPS) seen in colonic necrosis; SPS is a potassium binder given orally or rectally in hyperkalemic patients with end-stage renal disease. We describe the in vivo and in vitro histologic appearance of HPPF, compare HPPF with SPS, and discuss its potential migration into blood or lymph vessels.
Cadaveric Skin Grafts May Greatly Increase the Healing Rate of Recalcitrant Ulcers When Used Both Alone and in Combination With Split-Thickness Skin Grafts
Authors: Mosti Giovanni , Mattaliano Vincenzo , Magliaro Antonio , Picerni Pietro , Bastiani Luca
Published: July 2019

BACKGROUND

Leg ulcers that do not heal despite appropriate treatment are defined as recalcitrant ulcers. Large surface area, depth, and long duration represent some of most important factors impeding ulcer healing. After sharp debridement, dermal substitutes including skin from cadaver donors may increase the healing rate of recalcitrant ulcers reducing the risk of scar formation and recurrence.

OBJECTIVE

Assessing if, after sharp debridement, dermal substitutes including skin from cadaver donors may increase the healing rate of recalcitrant ulcers reducing the risk of scar formation and recurrence.

PATIENTS AND METHODS

Among patients admitted to our hospital for all types of chronic leg ulcers, we retrospectively reviewed the records of patients affected by recalcitrant ulcers (surface greater than 100 cm2, tissue loss involving epidermis, dermis, and subcutaneous tissue, duration longer than 1 year, and showing no healing tendency). After sharp debridement, the ulcers were covered by allografts with strict follow-up after discharge. Multiple allografts were performed when necessary, and a final autograft was applied in case of incomplete healing.

RESULTS

The records of 414 patients were analyzed. Forty-three patients were lost at follow-up, and the remaining 371 healed after 765 grafting procedures. In 163 patients, the ulcers healed by means of a final autograft. In all the remaining cases, allograft led to ulcer healing.

CONCLUSION

Allografts represent an effective treatment option in case of recalcitrant, large, deep and long-lasting leg ulcers.
Validated Assessment Scales for the Female Asian Calf
Authors: Seo Kyle , Geister Thorin L. , Yu Chao Yates Yen , Chhabra Chiranjiv , Corduff Niamh , Fabi Sabrina G. , Hornfeldt Carl S. , Kerscher Martina , Lam Stephanie , Pavicic Tatjana , Peng Peter H.L. , Rzany Berthold , Suwanchinda Atchima , Tseng Fang-Wen , Pooth Rainer
Published: July 2019

BACKGROUND

Clinical photonumeric scales have been developed and validated to objectively measure the effectiveness of aesthetic treatments in specific anatomical areas; however, these are based on the typical features of Caucasian patients. No clinical scale for Asian calf appearance currently exists.

OBJECTIVE

To develop and validate a calf assessment scale for use in the female Asian patient population.

METHODS AND MATERIALS

During 2 validation sessions, 13 raters assessed calf images of female Asian subjects (N = 35) viewed from behind with feet flat on the floor (at rest) and on tiptoes (dynamic). Images were rated from 0 (very slim, linear profile) to 4 (very severe convex profile).

RESULTS

Inter-rater and intra-rater reliability were “substantial” (≥0.6, intraclass correlation coefficient [ICC] and weighted kappa) for the calf—at rest, calf—dynamic, and calf summary score. Reliability was “substantial” for calf—at rest and calf–dynamic (≥0.6, ICC and weighted kappa) and “almost perfect” (0.85) for the calf summary score. BMI and calf circumference were highly correlated with scale ratings, and calf circumference was a significant predictor.

CONCLUSION

This new photonumeric assessment scale has value for assessing the female Asian calf, providing a standardized measure of calf appearance in clinical practice and clinical research settings.
Mohs Micrographic Surgery at the Skin and Cancer Foundation Australia, 20 Years Later (1997–2017)
Authors: Stewart Thomas J. , Moreno Bonilla Gilberto , Venning Victoria L. , Lee Simon , Fernandez-Peñas Pablo
Published: July 2019

BACKGROUND

The availability of Mohs micrographic surgery (MMS) in Australia has increased dramatically since its inception in the 1980s.

OBJECTIVE

This study aimed to describe the evolution of MMS practices at the Skin and Cancer Foundation Australia (SCFA) over the past 20 years (1997–2017).

METHODS

Retrospective analysis of Mohs surgery cases at SCFA in 2017, 2007, and 1997, comparing data on sex, age, tumor type and site, initial tumor and final defect size, number of surgical stages and sections, and closure management. The present study is limited by being a retrospective analysis from a single institution.

RESULTS

There was a 415% increase in the number of Mohs surgery cases from 1997 to 2017, and a significant increase in Mohs surgery-treated squamous cell carcinoma. The preoperative tumor and final defect size have decreased. More side-to-side closures and fewer grafts are being performed over time.

LIMITATIONS

Retrospective analysis from a single institution.

CONCLUSION

Over the last 20 years, MMS has remained appropriate in its application and is being increasingly used for treatment of squamous cell carcinoma suggesting improved access.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN TWO CASES OF SOLAR RETINOPATHY
Authors: Padidam Sneha , Burke Marie T. , Apple Daniel B. , Suchomel John R. , Lin Xihui
Published: July 2019

Purpose:

To report optical coherence tomography angiography findings obtained in two patients with solar retinopathy.

Methods:

Two case reports.

Results:

Two patients presented with blurry vision after sun gazing during the recent solar eclipse and were found to have characteristic foveal lesions on examination and optical coherence tomography consistent with solar retinopathy. Optical coherence tomography angiography showed a focal area of nonperfusion of the choriocapillaris in the affected eyes.

Conclusion:

Changes to the choriocapillaris layer on optical coherence tomography angiography in two patients with solar retinopathy suggest that damage is not limited to the retina.
Donor Diabetes Mellitus Severity and Corneal Transplant Suitability in a US Eye Bank Donor Population
Authors: Rand Gabriel M. , Polla Daniel J. , Patel Sejal H. , Gore Patrick K. , Forest-Smith Lynn , Livesay Tina M. , Chuck Roy S.
Published: July 2019

Purpose:

To determine whether donor diabetes mellitus (DM) severity is associated with differences in endothelial cell density (ECD) and surgically unsuitable tissue.

Methods:

Raw data were obtained from Saving Sight Eye Bank (Kansas City, MO) including 10,454 donated eyes from 5346 eligible donors from July 2014 through May 2017. Donors were grouped into 5 categories by their insulin use and the presence of microvascular end-organ complications. The categories were non-DM (NDM), noninsulin-dependent DM without complications (NIDDMnc), noninsulin-dependent DM with complication (NIDDMc), insulin-dependent DM without complications, and insulin-dependent DM with complication. Outcome variables included ECD and tissue transplant suitability. Mixed effects models were used to adjust for the random effect of repeated measures and fixed effects of donor age, race, lens status, and death to refrigeration and death to preservation times. Interaction effects of DM severity group and donor age and DM severity group and lens status were included in the models.

Results:

One thousand six hundred eighty-four (32.1%) donors had a diagnosis of DM. Six hundred fifty-eight donors were in the NIDDMnc group, 225 in the NIDDMc group, 404 in the insulin-dependent DM without complication group, and 397 in the insulin-dependent DM with complication group. Compared with non-DM, donors with DM were older (P < 0.001) and more likely to be pseudophakic (P < 0.001). DM severity groups did not affect adjusted ECD at mean donor age. There was no statistically significant ECD interaction between DM severity group and lens status. There was a statistically significant ECD crossover interaction with NIDDMnc and donor age (P < 0.001). In phakic eyes, NIDDMc was associated with a statistically significantly lower odds of transplant suitability (odds ratio 0.62, P = 0.006).

Conclusions:

DM severity does not affect lowering adjusted ECD at mean donor age. DM severity and pseudophakia were not associated with lower adjusted ECD. NIDDMnc was associated with an attenuation of the age-dependent decrease in ECD. NIDDMc was associated with decreased transplant suitability in phakic eyes. Future studies should include age, lens status, and interaction effects in their models of ECD and transplant suitability.
Technique for Ensuring Type I Bubble Formation for Pre-Descemet Endothelial Keratoplasty Preparation
Authors: Saint-Jean Alejandro , Soper Mark , Den Beste Kyle , Iverson Shawn , Price Marianne O. , Price Francis W.
Published: July 2019

Purpose:

To describe a technique that ensures the production of a type 1 bubble when preparing pre-Descemet endothelial keratoplasty (PDEK) grafts with a high rate of predictability.

Methods:

Donor corneas were placed on a support disc, and a blunt instrument was used to score 360 degrees of the peripheral Descemet membrane and endothelium just inside the trabecular meshwork. Air was injected in several short bursts and several stages with a 30-gauge needle on a 3-mL syringe 2.0 mm away from the limbus to create a type 1 big bubble. The technique was tested by 2 operators (M.S. and A.S.-J.) in 26 human donor corneas, including 12 for possible transplantation, over a 9-month period. Anterior segment optical coherence tomograph (AS-OCT) was performed in 1 case proving a type 1 bubble.

Results:

A type 1 big bubble was successfully created in 24 of 26 attempted cases (92.3%). The technique was used successfully to obtain PDEK tissue for transplant in 9 eyes. One case was not technically acceptable because of diffuse cell loss (>10%); however, the bubble preparation itself was successful. One case had a mixed bubble because of incomplete scoring, resulting in a Descemet membrane endothelial keratoplasty graft used for transplant. One case failed to form any bubble likely because the scoring was too central. Of a total of 26 cases, 14 cases were for practice.

Conclusions:

The Soper technique significantly improved the success rate of creating a type 1 bubble for PDEK preparation.
Influenza in Children With Special Risk Medical Conditions
Authors: Tuckerman Jane , Misan Siobhan , Crawford Nigel W. , Marshall Helen S.
Published: July 2019

Background:

Children with special risk medical conditions (SRMC) are over-represented in influenza hospitalizations. A systematic review was undertaken to determine whether children with SRMCs experience greater complications or severity following influenza infection.

Methods:

Bibliographies of pertinent articles were searched in MEDLINE and EMBASE (1990 to March 2018) and contact made with the investigators of unpublished studies containing relevant data. Studies of children (aged ≤18 years) with a SRMC hospitalized with influenza were included. Outcomes were pneumonia, intensive care unit (ICU) admission, mechanical ventilation, neurologic outcomes (seizures, encephalopathy), death and length of stay in hospital or ICU.

Results:

Twenty-two studies met inclusion criteria. Compared with healthy peers, children with SRMC had higher odds of ICU admission [pooled odds ratio (OR) 1.66 (95% confidence interval (CI): 1.25–2.21)], for mechanical ventilation [pooled OR 1.53 (95% CI: 0.93–2.52)] and death [pooled OR 1.34 (95% CI: 0.74–2.41)]. Additionally, children with SRMC were more likely to develop bacterial pneumonia (crude OR 1.7; 95% CI: 1.1–2.6) or experience prolonged hospital length of stay [adjusted rate ratio 1.75 (95% CI: 1.44–2.11)]. The level of GRADE evidence was low for all outcomes considered in this review.

Conclusions:

While there was evidence that ICU management and bacterial pneumonia increases in children with SRMC, evidence showing an increase in the probability of death or need for mechanical ventilation was inconsistent. Further research using large datasets should evaluate the impact of complications and associated morbidity from influenza in SRMC children.
Gram-negative Late-onset Sepsis in Extremely Low Birth Weight Infants Is Emerging in The Netherlands Despite Quality Improvement Programs and Antibiotic Stewardship!
Authors: Ran Nicolien C. , van den Hoogen Agnes , Hemels Marieke A. C.
Published: July 2019

Background:

Late-onset sepsis (LOS) is still an important cause of morbidity and mortality in premature infants. Indwelling devices and lower birth weight (BW) are the most important risk factors. Quality improvement programmes are implemented to reduce incidence of LOS. An increasing number of extremely low BW infants (ELBWs) (≤1000 g) are treated in the Netherlands, including infants with gestational age (GA) 24 weeks since Dutch law changed in 2010. We evaluated the incidence and causative microorganisms of LOS in ELBWs over an 8-year period in 2 Dutch neonatal intensive care units (NICUs).

Methods:

The first LOS episodes of all ELBWs admitted to the NICU of the Wilhelmina Children’s Hospital Utrecht and the Isala Hospital Zwolle were included retrospectively from January 2008 to December 2015. LOS was defined as clinical signs of sepsis >72 hours postpartum, combined with a positive blood culture and C-reactive protein of ≥10 mg/L.

Results:

Two hundred fifty-five out of 923 ELBWs (27.6%) had an episode of LOS, and no decrease in incidence was seen over the years. ELBWs with LOS had lower GA and BW. The percentage of Gram-negative organisms increased from 0% in 2008 to 27% in 2015, mainly in infants with GA <26 weeks. The number of invasive fungal infections decreased to zero.

Conclusions:

No significant decrease in incidence of LOS in ELBWs was seen, despite the introduction of quality improvement programmes and attention to antibiotic stewardship. Furthermore, an increase in Gram-negative LOS was observed, with an overrepresentation among the growing proportion of the NICU population at the lowest GA and weight. Prevention, including high compliance to hand hygiene policies, may be an impactful intervention.
Revisiting Bacterial Interference in the Age of Methicillin-resistant Staphylococcus aureus
Authors: Planet Paul J. , Parker Dane , Ruff Naomi L. , Shinefield Henry R.
Published: July 2019

Bacteria compete with each other for local supremacy in biologic and environmental niches. In humans, who host an array of commensal bacteria, the presence of one species or strain can sometimes prevent colonization by another, a phenomenon known as “bacterial interference.” We describe how, in the 1960s, infants (and later adults) were actively inoculated with a relatively benign strain of Staphylococcus aureus, 502A, to prevent colonization with an epidemic S. aureus strain, 80/81. This introduced bacterial interference as a clinical approach to disease prevention, but little was known about the mechanisms of interference at that time. Since then, much has been learned about how bacteria interact with each other and the host to establish carriage, compete for niches and shift from harmless commensal to invasive pathogen. We provide an overview of these findings and summarize recent studies in which the genome and function of 502A were compared with those of the current epidemic strain, USA300, providing insight into differences in their invasiveness and immunogenicity. Although staphylococcal vaccines have been developed, none has yet been approved for clinical use. Further studies of staphylococcal strains and the molecular characteristics that lead to exclusion of specific bacteria from some niches may provide an alternative path to disease prevention.
Borderline-Positive Quantiferon in Children
Authors: Nygaard Ulrikka , Poulsen Anja , Yde Nielsen Alex , Ravn Pernille , Hawwa Vissing Nadja
Published: July 2019

We systematically retested children with borderline-positive quantiferon (0.35–0.99 IU/mL) during the period 2015–2019. Among 647 tests, 27 (4%) were positive (>0.35 IU/mL). Borderline-positive quantiferon accounted for 10 of 27 (37%) positive tests. When retested, 9 of 10 (90%) were negative. Children younger than 5 years had negative tuberculin skin tests. Thus, we found high test variability in the borderline range and, in some children, high suspicion of false positive tests.
Oxycodone, fentanyl, and morphine amplify established neuropathic pain in male rats
Authors: Green-Fulgham Suzanne M. , Ball Jayson B. , Kwilasz Andrew J. , Fabisiak Timothy , Maier Steven F. , Watkins Linda R. , Grace Peter M.
Published: July 2019

Opioids are widely prescribed for chronic pain, including neuropathic pain, despite growing evidence of long-term harm. Previous preclinical studies have documented exacerbation of nociceptive hypersensitivity, including that induced by peripheral nerve injury, by morphine. The present series of behavioral studies sought to replicate and extend our prior research, which demonstrated a multimonth exacerbation of nociceptive hypersensitivity by a 5-day course of morphine initiated 10 days after nerve injury. The current studies demonstrate that enduring exacerbation of nociceptive hypersensitivity is not restricted to morphine, but rather is also created by the clinically relevant opioids fentanyl and oxycodone when these are likewise administered for 5 days beginning 10 days after nerve injury. Furthermore, enduring exacerbation of nociceptive hypersensitivity is also observed when the same dosing regimen for either morphine, fentanyl, or oxycodone begins 1 month after nerve injury. Finally, a striking result from these studies is that no such exacerbation of nociceptive hypersensitivity occurs when either morphine, fentanyl, or oxycodone dosing begins at the time of nerve injury. These results extend our previous findings that morphine exacerbates nociceptive hypersensitivity to the clinically relevant opioids fentanyl and oxycodone when administered after the development of nociceptive hypersensitivity, while also providing possible clinically relevant insight into when these opioids can be safely administered and not exacerbate neuropathic pain.
Developing Computer-Based Learning on Care of Aged and Dying Incarcerated People
Authors: Kitt-Lewis Erin , Loeb Susan J. , Wion Rachel K. , Myers Valerie H. , Jerrod Tiffany , Strickfaden Sophia
Published: July 2019

Introduction:

Corrections agencies are exploring ways to securely and cost-effectively increase access to high-quality, evidence-based educational programs for personnel. Technology-based instructional tools hold strong potential for continuing education. The Institute for Healthcare Improvement's Framework for Going to Full Scale was employed to guide a systematic approach.

Purpose:

The purpose of this article is to outline and describe the design and development of a media-rich interactive computer-based learning product, Enhancing Care for Aged and Dying in Prison, which addresses geriatric and end-of-life care issues in corrections.

Method:

Through an iterative process, the research team developed the computer-based educational program that included program and module-specific objectives in alignment with goals and priorities of the end users, detailed evidence-based content that was engaging and visually appealing, and assessments aimed at testing the user's knowledge.

Results:

The Enhancing Care for Aged and Dying in Prison contains six modules, created under the careful guidance of the research team and the two advisory boards. Contents, including images and testimonials, were selected purposefully and strategically. Module objectives were developed in alignment with the goals and priorities of each module, and assessments tested user knowledge level pre/post module exposure. Completion of the training product advances the research and development necessary to further the goal of full-scale dissemination of the computer-based education.

Discussion/Conclusions:

The goal of this program is to enhance care and improve quality of life for aged and dying inmates. Evidence-based training products are critical in preparing not only forensic nurses who work in corrections but also the broader group of correctional personnel in how to better meet the care needs of incarcerated persons.
Assessing DPT Students' Self-perceived Readiness to Discuss Sexual Health Before and After Instruction From a Patient-Educator
Authors: Felter Cara E.
Published: July 2019

Introduction.

Physical therapists (PTs) spend considerable time with their patients and may address certain aspects of sexual health; however, professional readiness to discuss sexual health among health care students is generally lacking.

Methods.

All students (n = 60) enrolled in a second-year neuromuscular class in a professional, entry-level, PT education program were invited to participate in this study. The Students' Attitudes Towards Addressing Sexual Health Questionnaire was administered as an electronic survey before and after a classroom training on sexuality and disability led by a patient-educator. Pretraining and posttraining total survey scores were analyzed, as were scores for individual survey items.

Results.

Participants' average total scores increased significantly after training, indicating an increased self-perceived readiness to discuss sexual health. Scores for survey items most closely related to the training also increased.

Discussion and Conclusions.

Classroom-based training with a patient-educator may improve some aspects of student readiness to discuss sexual health; however, other aspects may require maturity, mentorship, and clinical experience. Further investigation is needed to understand students' readiness to discuss sexual health with patients and to refine the PT role regarding sexual health.
Construct Validation of a Printed Bone Substitute in Otologic Education
Authors: Wong Veronica , Unger Bertram , Pisa Justyn , Gousseau Michael , Westerberg Brian , Hochman Jordan B.
Published: July 2019

Patient safety demands enhancements in training. Graduated cadaveric bone exposure is fundamental to otologic training. Printed bone models (PBM) provide a low-cost, anatomically consistent adjunct to cadaveric materials in trainee skill acquisition.

The purpose of this study is to determine if resident training level can be distinguished on the basis of performance employing a printed temporal bone model, graded by a previous validated scale.

Methods:

Nineteen residents (11 male, 8 female) from 9 graduate programs, attending a National Otolaryngology Conference, completed a mastoidectomy with posterior tympanotomy on identic 3D PBMs and a Likert scale (1–7) survey on subjective appreciation of the simulation. Four experts graded participant performance using the previously validated Welling Scale.

Results:

ANOVA revealed significant performance differences between the junior/intermediate and junior/senior PGY cohorts. No difference was observed between intermediate/senior cohorts on the basis of PGY or subjective temporal bone dissection experience. Clustering aspects of the scale with specific focus on thinning tasks found a similar outcome to the composite scale scores.

Subjective experience judged printed bone to be similar to cadaveric in drill–bone interaction. Participants believed the simulation would improve surgical performance, comfort with actual patients, and operative speed.

Conclusion:

Subjectively, printed bone compared favorably to cadaveric.

The simulation demonstrated construct validity but was challenged in differentiating senior from intermediate trainee performance. This may be a function of the PBM inherent character, limitations in grading instrument fidelity or sample size. It is also possible that the dominant period of skill acquisition for mastoidectomy and posterior tympanotomy are primarily acquired during the junior training.