bluuebunny/crossref_metadata_2025 huggingface dataset:
Feed efficiency and carcass metrics in growing cattle1
Authors: Kelly David N , Murphy Craig , Sleator Roy D , Judge Michelle M , Conroy Stephen B , Berry Donagh P
Published: October 2019

Some definitions of feed efficiency such as residual energy intake (REI) and residual gain (RG) may not truly reflect production efficiency. The energy sinks used in the derivation of the traits include metabolic live-weight; producers finishing cattle for slaughter are, however, paid on the basis of carcass weight, as opposed to live-weight. The objective of the present study was to explore alternative definitions of REI and RG which are more reflective of production efficiency, and quantify their relationship with performance, ultrasound, and carcass traits across multiple breeds and sexes of cattle. Feed intake and live-weight records were available on 5,172 growing animals, 2,187 of which also had information relating to carcass traits; all animals were fed a concentrate-based diet representative of a feedlot diet. Animal linear mixed models were used to estimate (co)variance components. Heritability estimates for all derived REI traits varied from 0.36 (REICWF; REI using carcass weight and carcass fat as energy sinks) to 0.50 (traditional REI derived with the energy sinks of both live-weight and ADG). The heritability for the RG traits varied from 0.24 to 0.34. Phenotypic correlations among all definitions of the REI traits ranged from 0.90 (REI with REICWF) to 0.99 (traditional REI with REI using metabolic preslaughter live-weight and ADG). All were different (P < 0.001) from one suggesting reranking of animals when using different definitions of REI to identify efficient cattle. The derived RG traits were either weakly or not correlated (P > 0.05) with the ultrasound and carcass traits. Genetic correlations between the REI traits with carcass weight, dressing difference (i.e., live-weight immediately preslaughter minus carcass weight) and dressing percentage (i.e., carcass weight divided by live-weight immediately preslaughter) implies that selection on any of the REI traits will increase carcass weight, lower the dressing difference and increase dressing percentage. Selection on REICW (REI using carcass weight as an energy sink), as opposed to traditional REI, should increase the carcass weight 2.2 times slower but reduce the dressing difference 4.3 times faster. While traditionally defined REI is informative from a research perspective, the ability to convert energy into live-weight gain does not necessarily equate to carcass gain, and as such, traits such as REICW and REICWF provide a better description of production efficiency for feedlot cattle.
Gill fouling in the economically important freshwater shrimp Macrobrachium rosenbergii (De Man, 1879) (Caridea: Palaemonidae)
Authors: Wortham Jen L , VanMaurik Lauren
Published: October 2019

The giant freshwater prawn, Macrobrachium rosenbergii (De Man, 1879), lives in freshwater environments of the Indo-West Pacific region and is commonly farmed. Males transition into three male morphotypes that differ in behavior and morphology. Small-clawed males (SM) molt into orange-clawed males (OC) that molt into the harvested and largest blue-clawed males (BC). Grooming behaviors can remove fouling such as sediment particles, bacteria, and other organisms, all of which are commonly found in the natural environment as well as in aquaculture environments. Because individuals of this species groom their bodies frequently, especially the gills, the objective of the study was to observe gills of male morphotypes and females and evaluate their fouling levels and types using light microscopy, bacterial counts, and scanning electron microscopy. The male morphotypes and females are fouled differently, with grooming behaviors being effective in removing sedimentary and bacterial fouling from the gills. Although their relative efficiencies in removing fouling materials from the gills were not statistically significant, OC and BC exhibited contrasting gill fouling patterns with higher bacterial than sedimentary fouling in the former but the opposite in the latter. This difference may be attributed to differential levels of fouling related to variation in behavioral priorities, grooming behaviors, and morphology. Control of bacterial and sedimentary fouling in aquaculture could have large implications on the quality and survival of harvested individuals.
Carbon Dioxide Fumigation to Shorten Cold Disinfestation Treatments for Thaumatotibia leucotreta (Lepidoptera: Tortricidae) in Citrus Fruit
Authors: Grout Tim G , Stoltz Kim C
Published: October 2019

Although elevated levels of carbon dioxide have been used in controlled atmosphere treatments with low oxygen levels for a number of deciduous crops, the use of much higher concentrations of carbon dioxide followed by a short cold treatment for citrus was only suggested as a viable option for disinfestation in 2005. Carbon dioxide alone, for a period of 24 h at concentrations up to 70% in air caused variable levels of mortality of Thaumatotibia leucotreta (Meyrick) larvae in citrus, but never completely controlled this pest. The susceptibility to carbon dioxide appeared to vary more with the batch of T. leucotreta eggs than with different citrus cultivars. By following CO2 fumigation with a short cold treatment, complete control of this pest was achieved and the results with sequential treatments were more consistent. The efficacy of the combined treatment was reduced when it took ≥12 h to move fruit after fumigation into a cold room at 2°C, or if the temperature was not reduced below 12°C within 24 h after fumigation. In these cases, the benefit of the short cold treatment was lost and mortality was similar to CO2 fumigation alone. These results hold promise for the development of a shorter commercial treatment to meet quarantine restrictions against this pest in citrus.
Increased Suitability of Poleward Climate for a Tropical Butterfly (Euripus nyctelius) (Lepidoptera: Nymphalidae) Accompanies its Successful Range Expansion
Authors: Au Tsun Fung , Bonebrake Timothy C
Published: October 2019

Distribution shifts are a common response in butterflies to a warming climate. Hong Kong has documented records of several new butterfly species in recent decades, comprising a high proportion of tropical species, some of which have successfully established. In this study, we examined possible drivers for the establishment of Euripus nyctelius Doubleday (Lepidoptera: Nymphalidae) by studying its thermal physiology and modeling current climate and future distributions projected by species distribution modeling (SDM). We found that E. nyctelius adults have a significantly higher critical thermal minimum than its local temperate relative, Hestina assimilis Linnaeus (Lepidoptera: Nymphalidae), suggesting a possible physiological constraint that may have been lifted with recent warming. SDMs provide further evidence that a shifting climate envelope may have improved the climate suitability for E. nyctelius in Hong Kong and South China—however, we cannot rule out the role of other drivers potentially influencing or driving range expansion, habitat change in particular. Conclusive attribution of warming-driven impacts for most tropical species is difficult or not possible due to a lack of historical or long-term data. Tropical insects will require a significant advancement in efforts to monitor species and populations across countries if we are to conclusively document climate-driven shifts in species distributions and manage the consequences of such species redistribution. Nevertheless, the warming climate and subsequent increased climatic suitability for tropical species in poleward areas, as shown here, is likely to result in future species redistribution events in subtropical and temperate ecosystems.
NSD3S stabilizes MYC through hindering its interaction with FBXW7
Authors: Gonzalez-Pecchi Valentina , Kwan Albert K , Doyle Sean , Ivanov Andrey A , Du Yuhong , Fu Haian
Published: October 2019

The MYC transcription factor plays a key role in cell growth control. Enhanced MYC protein stability has been found to promote tumorigenesis. Thus, understanding how MYC stability is controlled may have significant implications for revealing MYC-driven growth regulatory mechanisms in physiological and pathological processes. Our previous work identified the histone lysine methyltransferase nuclear receptor binding SET domain protein 3 (NSD3) as a MYC modulator. NSD3S, a noncatalytic isoform of NSD3 with oncogenic activity, appears to bind, stabilize, and activate the transcriptional activity of MYC. However, the mechanism by which NSD3S stabilizes MYC remains to be elucidated. To uncover the nature of the interaction and the underlying mechanism of MYC regulation by NSD3S, we characterized the binding interface between both proteins by narrowing the interface to a 15-amino acid region in NSD3S that is partially required for MYC regulation. Mechanistically, NSD3S binds to MYC and reduces the association of F-box and WD repeat domain containing 7 (FBXW7) with MYC, which results in suppression of FBXW7-mediated proteasomal degradation of MYC and an increase in MYC protein half-life. These results support a critical role for NSD3S in the regulation of MYC function and provide a novel mechanism for NSD3S oncogenic function through inhibition of FBXW7-mediated degradation of MYC.
Treating or Killing? The Divergent Moral Implications of Cardiac Device Deactivation
Authors: Pilkington Bryan C
Published: October 2019

In this article, I argue that there is a moral difference between deactivating an implantable cardioverter defibrillator (ICD) and turning off a cardiac pacemaker (CP). It is, at least in most cases, morally permissible to deactivate an ICD. It is not, at least in most cases, morally permissible to turn off a pacemaker in a fully or significantly pacemaker-dependent patient. After describing the relevant medical technologies—pacemakers and ICDs—I continue with contrasting perspectives on the issue of deactivation from practitioners involved with these devices: physicians, nurses, and allied professionals. Next, I offer a few possible analyses of the situation, relying on recent work in medical ethics. Considerations of intention, responsibility, and replacement support my distinguishing between ICDs and CPs. I conclude by recommending a change in policy of one of the leading cardiac societies.
Topical Review: A Biopsychosocial Framework for Pediatric Narcolepsy and Idiopathic Hypersomnia
Authors: Graef Danielle M , Byars Kelly C , Simakajornboon Narong , Dye Thomas J
Published: October 2019

Objective

Provide an overview of current research findings in pediatric central disorders of hypersomnolence (CDH) and propose a biopsychosocial model for clinical management, with a focus on interdisciplinary care and future directions for research and clinical practice.

Methods

Literature review drawing from pediatric and adult narcolepsy, as well as pediatric sleep and chronic pain research to develop an integrative biopsychosocial model for pediatric CDH.

Results

Youth with CDH are vulnerable to impairments in academics, emotional, and behavioral functioning, activity engagement and quality of life (QOL). There is a complex interrelationship between neurobiological features of disease, treatment-related factors, and psychological, sleep-related, and contextual factors across development. Research is limited largely to adults and pediatric narcolepsy type 1 and the mechanisms and evolution of morbidity remain poorly understood.

Conclusions

In addition to first-line treatment (pharmacotherapy), routine screening of bio-behavioral and psychosocial functioning and QOL is needed to identify risk for compromised functioning warranting adjunctive interventions with behavioral health specialists.
An Investment in the Future: Institutional Aspects of Credential Recognition of Refugees in Germany
Authors: Jacobsen Jannes
Published: October 2019

Adding to the rich literature on the economic integration of refugees, this article extends the scope towards the role of institutions by focusing on the transfer of human capital by means of credential recognition. The 2012 Federal Act of Recognition in Germany is a new institution that provides the possibility to study the transfer of human capital in depth. I argue that analysing the decision for recognition of credentials is an important aspect of economic integration because it mirrors an investment in future labour-market access. I hypothesize that institutions, such as integration and language classes and the refugee status by admission, are key for explaining who tries to obtain official recognition for their credentials. In order to test my hypothesis, I employ panel data from the IAB-BAMF-SOEP Survey of Refugees in Germany. Results show that both a secure residence title and participation in language/integration classes lead to a higher likelihood of applying for the recognition of degrees.
Spinal extradural arachnoid cyst in a child—a case report
Authors: Oyemolade Toyin A , Adeolu Augustine A , Idowu Olusola K
Published: October 2019

Extradural spinal arachnoid cysts are rare lesions. They frequently communicate with the subarachnoid space through a defect in the dura. Symptoms result from compression of the spinal cord or nerve roots. The treatment of choice is complete surgical excision. We report the case of a 12-year-old girl with extradural spinal arachnoid cyst who had complete surgical excision with good outcome.
Inguinal hernia with complete urinary bladder herniation: a case report and review of the literature
Authors: Papatheofani Vasiliki , Beaumont Katharina , Nuessler Natascha C
Published: October 2019

Although inguinal hernias are common, inguinal herniation of the urinary bladder wall is rare. Moreover, the complete migration of the urinary bladder into the scrotum is considered less frequent. The majority of patients with bladder hernias are asymptomatic and diagnosis is made intraoperatively; however, difficulties in urination may lead to the correct diagnosis. We report about a case of a large right-sided scrotal hernia with complete bladder herniation presenting without urological symptoms.
A Review of Conceptual Approaches and Empirical Evidence on Probability and Nonprobability Sample Survey Research
Authors: Cornesse Carina , Blom Annelies G , Dutwin David , Krosnick Jon A , De Leeuw Edith D , Legleye Stéphane , Pasek Josh , Pennay Darren , Phillips Benjamin , Sakshaug Joseph W , Struminskaya Bella , Wenz Alexander
Published: October 2019

There is an ongoing debate in the survey research literature about whether and when probability and nonprobability sample surveys produce accurate estimates of a larger population. Statistical theory provides a justification for confidence in probability sampling as a function of the survey design, whereas inferences based on nonprobability sampling are entirely dependent on models for validity. This article reviews the current debate about probability and nonprobability sample surveys. We describe the conditions under which nonprobability sample surveys may provide accurate results in theory and discuss empirical evidence on which types of samples produce the highest accuracy in practice. From these theoretical and empirical considerations, we derive best-practice recommendations and outline paths for future research.
Optical continuum photometric reverberation mapping of the Seyfert-1 galaxy Mrk509
Authors: Nuñez F Pozo , Gianniotis N , Blex J , Lisow T , Chini R , Polsterer K L , Pott J-U , Esser J , Pietrzyński G
Published: October 2019

We present the results of a two year optical continuum photometric reverberation mapping campaign carried out on the nucleus of the Seyfert-1 galaxy Mrk509. Specially designed narrow-band filters were used in order to mitigate the line and pseudo-continuum contamination of the signal from the broad line region, while allowing for high-accuracy flux-calibration over a large field of view. We obtained light curves with a sub-day time sampling and typical flux uncertainties of 1%. The high photometric precision allowed us to measure inter-band continuum time delays of up to ∼2 days across the optical range. The time delays are consistent with the relation τ∝λ4/3 predicted for an optically thick and geometrically thin accretion disk model. The size of the disk is, however, a factor of 1.8 larger than predictions based on the standard thin-disk theory. We argue that, for the particular case of Mrk509, a larger black hole mass due to the unknown geometry scaling factor can reconcile the difference between the observations and theory.
Time-restricted feeding for the prevention of cardiometabolic diseases in high-stress occupations: a mechanistic review
Authors: Waldman Hunter S , Renteria Liliana I , McAllister Matthew J
Published: October 2019

Factors such as shift work, poor diet, lack of physical activity, and irregular sleep patterns put men and women employed in high-stress occupations (e.g., firefighters, police officers) at risk for cardiometabolic diseases. Time-restricted feeding (TRF) is a new approach to combatting many of these diseases; it places an emphasis on when meals are consumed, rather than calorie content. By only manipulating the eating “window,” and without changing the food composition of the diet, research in rodent models has shown promising results that have health implications in people, such as obesity prevention, improved insulin sensitivity, and decreased oxidative stress, inflammation, and cholesterol synthesis. Human trials remain limited and the current data are mixed with regard to TRF and improving health. Present findings suggest the timing of the feeding-fasting window, with feeding taking place in the waking hours and fasting in the evening hours, might offer the greatest benefit for improving cardiometabolic markers. Although additional human trials are needed, TRF might reset and synchronize metabolic “clocks” found throughout the body that are disturbed with obesity, shift work, and frequent eating. Therefore, TRF might offer an effective feeding-fasting paradigm with significant clinical implications for the management and treatment of cardiometabolic diseases observed in individuals in high-stress occupations in the United States and in the US population in general. This review outlines the current rodent and human evidence in these areas and the efficacy of TRF for improving human health.
Helicopter money: survey evidence on expectation formation and consumption behaviour
Authors: Djuric Uros , Neugart Michael
Published: October 2019

The effects of helicopter money on expectations and economic outcomes are empirically largely unexplored. We fielded a representative survey among the German population, randomly assigning respondents to various unconventional monetary policy scenarios that raise household income. We find that in all policy treatments people spend almost 40% of the transfer, which is a non-trivial share that could increase aggregate demand. Policies do not raise inflation expectations. Differences in how transfers are implemented appear to be mostly irrelevant because of idiosyncratic behaviour by households that largely does not take into account general equilibrium effects and governments’ future policies.
The nth-order moment of the nuclear charge density and contribution from the neutrons
Authors: Kurasawa Haruki , Suzuki Toshio
Published: October 2019

The relativistic expression for the $n$th-order moment of the nuclear charge density is presented. For the mean square radius (msr) of the nuclear charge density, the non-relativistic expression, which is equivalent to the relativistic one, is also derived consistently up to $1/M^2$ with use of the Foldy–Wouthuysen transformation. The difference between the relativistic and non-relativistic expressions for the msr of the point proton density is also discussed. The $n(\ge 4)$th-order moment of the nuclear charge density depends on the point neutron density. The fourth-order moment yields useful information on the msr of the point neutron density, and is expected to play an important role in electron scattering off neutron-rich nuclei.
Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update
Authors: MacKay-Lyons Marilyn , Billinger Sandra A , Eng Janice J , Dromerick Alex , Giacomantonio Nicholas , Hafer-Macko Charlene , Macko Richard , Nguyen Emily , Prior Peter , Suskin Neville , Tang Ada , Thornton Marianne , Unsworth Karen
Published: October 2019

Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription—the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012 to 2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. The AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke.
The politics of exclusion: fighting for patients with Kidney failure in Yemen’s War
Authors: Heller Pérache André , Leeuwen Crystal van , Fall Chiara
Published: October 2019

Background

To contribute toward the dialogue on addressing non-communicable and chronic disease in humanitarian emergencies, this article will explore the experiences of Médecins Sans Frontières in attempting to find support for the haemodialysis network in Yemen. With the changing profile of the global disease burden and a broadening concept of emergency health needs to include chronic illness and disability, the aid sector has committed through the World Humanitarian Summit and the Sustainable Development Goals to leave no one behind and thus to meet the health needs of these previously excluded and highly vulnerable people. The civil war in Yemen compromised the medical supply chain supporting the health facilities providing dialysis for patients with end-stage renal disease. The article will critique the aid sector’s slow response to this issue and expose the gap between principles, commitments, and practice related to noncommunicable disease in emergencies.

Method

Following direct experiences from the authors as leaders in the aid response in Yemen, reviews of grey literature from aid and health actors in Yemen were conducted along with a review of literature and policy documents related to noncommunicable disease in emergency. Key informant interviews and press statements supported analysis and events that took place in the time span of roughly 4 years that frames this period of analysis.

Results

Examination of the impacted patient population, interviews, literature and documented events indicates that there is discord between policy, commitments stated by aid donors and practice.

Conclusion

The aid sector must use a more contextualised approach when designing programmes to manage the burden of non-communicable diseases in health contexts where crises occur, particularly for lifesaving forms of therapy. Aid agencies and the global health community must increase pressure on donors and implementing agencies to live up to their commitments to include these patient populations.
Transdiagnostic Dysfunctions in Brain Modules Across Patients with Schizophrenia, Bipolar Disorder, and Major Depressive Disorder: A Connectome-Based Study
Authors: Ma Qing , Tang Yanqing , Wang Fei , Liao Xuhong , Jiang Xiaowei , Wei Shengnan , Mechelli Andrea , He Yong , Xia Mingrui
Published: October 2019

Psychiatric disorders, including schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD), share clinical and neurobiological features. Because previous investigations of functional dysconnectivity have mainly focused on single disorders, the transdiagnostic alterations in the functional connectome architecture of the brain remain poorly understood. We collected resting-state functional magnetic resonance imaging data from 512 participants, including 121 with SCZ, 100 with BD, 108 with MDD, and 183 healthy controls. Individual functional brain connectomes were constructed in a voxelwise manner, and the modular architectures were examined at different scales, including (1) global modularity, (2) module-specific segregation and intra- and intermodular connections, and (3) nodal participation coefficients. The correlation of these modular measures with clinical scores was also examined. We reliably identify common alterations in modular organization in patients compared to controls, including (1) lower global modularity; (2) lower modular segregation in the frontoparietal, subcortical, visual, and sensorimotor modules driven by more intermodular connections; and (3) higher participation coefficients in several network connectors (the dorsolateral prefrontal cortex and angular gyrus) and the thalamus. Furthermore, the alterations in the SCZ group are more widespread than those of the BD and MDD groups and involve more intermodular connections, lower modular segregation and higher connector integrity. These alterations in modular organization significantly correlate with clinical scores in patients. This study demonstrates common hyper-integrated modular architectures of functional brain networks among patients with SCZ, BD, and MDD. These findings reveal a transdiagnostic mechanism of network dysfunction across psychiatric disorders from a connectomic perspective.
Morphological Profiling of Schizophrenia: Cluster Analysis of MRI-Based Cortical Thickness Data
Authors: Pan Yunzhi , Pu Weidan , Chen Xudong , Huang Xiaojun , Cai Yan , Tao Haojuan , Xue Zhiming , Mackinley Michael , Limongi Roberto , Liu Zhening , Palaniyappan Lena
Published: October 2019

The diagnosis of schizophrenia is thought to embrace several distinct subgroups. The manifold entities in a single clinical patient group increase the variance of biological measures, deflate the group-level estimates of causal factors, and mask the presence of treatment effects. However, reliable neurobiological boundaries to differentiate these subgroups remain elusive. Since cortical thinning is a well-established feature in schizophrenia, we investigated if individuals (patients and healthy controls) with similar patterns of regional cortical thickness form naturally occurring morphological subtypes. K-means algorithm clustering was applied to regional cortical thickness values obtained from 256 structural MRI scans (179 patients with schizophrenia and 77 healthy controls [HCs]). GAP statistics revealed three clusters with distinct regional thickness patterns. The specific patterns of cortical thinning, clinical characteristics, and cognitive function of each clustered subgroup were assessed. The three clusters based on thickness patterns comprised of a morphologically impoverished subgroup (25% patients, 1% HCs), an intermediate subgroup (47% patients, 46% HCs), and an intact subgroup (28% patients, 53% HCs). The differences of clinical features among three clusters pertained to age-of-onset, N-back performance, duration exposure to treatment, total burden of positive symptoms, and severity of delusions. Particularly, the morphologically impoverished group had deficits in N-back performance and less severe positive symptom burden. The data-driven neuroimaging approach illustrates the occurrence of morphologically separable subgroups in schizophrenia, with distinct clinical characteristics. We infer that the anatomical heterogeneity of schizophrenia arises from both pathological deviance and physiological variance. We advocate using MRI-guided stratification for clinical trials as well as case–control investigations in schizophrenia.
PROS: The Programme for the Reform of the Law on Soliciting, 1976–1982
Authors: Connell Kieran
Published: October 2019

In the late 1970s, a campaign was mounted to reform the legal landscape faced by sex workers, which had remained unaltered since a series of recommendations made in the Wolfenden Report were implemented by the government two decades earlier. While Wolfenden is commonly associated with the arrival of Britain’s ‘permissive’ 1960s, when it came to the issue of prostitution, it helped usher in even more restrictive conditions for sex workers. This article looks at attempts to challenge this status quo by focusing on the Programme for the Reform of the Law on Soliciting (PROS), which was founded in Birmingham in 1976 and became one of the most visible groups advocating for a change in the law. Its activities culminated with the 1982 Criminal Justice Act, which ostensibly abandoned the policy of imprisoning prostitutes on soliciting offences. The case of PROS, I argue, offers a further reminder of the afterlife of the liberalizing ethos associated with the 1960s. Moreover, it provides a different way of engaging with a historical conjuncture more commonly associated with themes such as rising individualism, the fragmentation of left-wing activism, and the arrival of Thatcherism.
No longer failing to treat heart failure
Authors: Parch Jonathan , Powell Chloe
Published: October 2019

Heart failure is a leading cause of hospital admissions and death in the United States and worldwide. In 2016, the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America released a joint focused guideline update for the management of patients with Stage C heart failure with reduced ejection fraction. An additional update released in 2017 reinforces the 2016 update's strong recommendation for substituting angiotensin-converting enzyme inhibitors or angiotensin receptor blockers with an angiotensin receptor-neprilysin inhibitor to reduce morbidity and mortality in selected patients. The 2017 and 2016 updates also support adding a sinoatrial node modulator to further reduce heart rates in patients already maximized on beta-blocker therapy. These innovative therapies can significantly improve patients' quality of life and reduce the healthcare costs associated with managing heart failure.
Mental health first aid training
Authors: Kolmetz Melodie J.
Published: October 2019

The Mental Health First Aid course, from the National Council for Behavioral Health in partnership with the Missouri Department of Mental Health, is an 8-hour course that teaches participants how to identify, understand, and respond to signs of mental illnesses and substance use disorders. Sixteen PAs took the course and hope to build a PA network of MHFA trainers.
Atrial tumor thrombus
Authors: Leong Kevin , Kuppasani Kishore , Pyrsopoulos Nikoloas
Published: October 2019

Hepatocellular carcinoma is the fifth most common cancer worldwide. Advanced hepatocellular carcinoma with tumor thrombus metastasis to the right atrium is rare, generally considered inoperable, and has a poor prognosis. This article describes the management of two patients with hepatocellular carcinoma and incidental findings of tumor thrombus invasion into the right atrium.
Associations between professional development benefits and PA career satisfaction
Authors: Wilson Adam B. , Furman Janet , Orozco Jennifer M.
Published: October 2019

Objective:

This study investigated how professional development benefits offered by employers directly correlate to self-perceptions of leadership potential, committee involvement, and career satisfaction among physician assistants (PAs).

Methods:

A retrospective analysis of the 2015 AAPA National Survey and 2016 AAPA Salary Survey explored the associations between the aforementioned variables. Bivariate correlations were used to evaluate the associations between variables.

Results:

Self-perceived leadership attributes were found to be mildly and positively correlated with the number of committees a PA was involved in (P < .001; correlation coefficient (CC) = 0.245). Of the investigated factors, only leadership potential was significantly correlated with career satisfaction (P ≤ .001; CC = 0.059). The proportion of professional development fees, memberships, and expenses covered by employers had no bearing on career satisfaction (P = .438).

Conclusions:

Irrespective of the benefits received, PAs were satisfied with their careers. Intrinsic rewards may have a greater positive association with career satisfaction than extrinsic benefits alone.
Killer amoebas
Authors: Cooper Amanda Marie , Aouthmany Shaza , Shah Kruti , Rega Paul P.
Published: October 2019

Primary amoebic meningoencephalitis (PAM) caused by Naegleria fowleri is a rare and deadly disease that requires prompt treatment with multiple therapies. Although N. fowleri previously was only found in warmer areas, climate change appears to be contributing to its geographic spread. Clinicians should consider PAM when faced with a patient with meningitis, especially if the patient participates in outdoor water activities or practices nasal rinsing.
ECMO as a rescue therapy for cardiogenic shock and a bridge to LVAD
Authors: Freeman Michelle , Lee Marshall
Published: October 2019

This article describes a patient who presented with an ST-segment elevation myocardial infarction that quickly developed into acute cardiogenic shock refractory to conventional medical therapy. Extracorporeal membrane oxygenation was used to manage the patient's heart failure and bridge to a long-term left ventricular assist device.
Leber congenital amaurosis in a young female
Authors: Connelly Abigail M. , Grosel John M.
Published: October 2019

Leber congenital amaurosis is a rare congenital disorder caused by a mutation in any of several different genes that causes rod-cone dystrophy and may eventually lead to blindness. Characteristic findings on fundoscopic examination include retinal pigment migration and macular atrophy. Confirmation can be obtained using electroretinograms and the specific gene can be identified with genetic testing. No treatment is available, but multiple clinical trials are underway.
The Apolipoprotein Allele and Sensorineural Hearing Loss in Older Community-Dwelling Adults in Australia
Authors: Sarant Julia Z. , Bowe Steven J. , McEvoy Mark , Attia John
Published: October 2019

Objectives:

Previous research has investigated whether the apolipoprotein E (APOE) ϵ4 allele, which is associated with an increased risk of cognitive decline, is also associated with hearing loss in older people. Results of the very limited research to date are conflicting, and sample sizes for all but one study were small. The present study aimed to investigate whether there is an association between the APOE ϵ4 allele and hearing loss in a large, population-based sample of community-dwelling older adults.

Design:

Cross-sectional audiometric data on hearing levels and APOE genotypes for 2006 participants (aged 55 to 85 years) of the Hunter Community Study were analyzed using multiple linear regression to examine the association between APOE ϵ4 carrier status and the 4-frequency pure-tone average (0.5 to 4 kHz) in the better hearing ear, and also across individual frequencies in the better ear.

Results:

Observed and expected APOE allele frequency distributions did not differ significantly overall from established general population allele frequency distributions. Unadjusted modeling using better ear pure-tone average showed a statistically significant association between APOE ϵ4 allele status (0, 1, 2 copies) and reduced hearing loss, but when the model was adjusted for age, this was no longer statistically significant. Across individual hearing frequencies, unadjusted regression modeling showed APOE ϵ4 status was significantly associated with a reduction in mean hearing thresholds at 1 and 2 kHz, but again this effect was no longer statistically significant after adjusting for age.

Conclusions:

The results of this study did not provide any evidence of a statistically significant association between APOE ϵ4 allele status and hearing loss for older adults. Further investigation of the effect of homozygous carrier status on hearing thresholds is required.
Prevalence and Clinical Significance of Incidental Vertebral Marrow Signal Abnormality in Thoracolumbar Spine MRI
Authors: Carlson Hans L. , Thompson Austin R. , Pettersson David R. , Goodwin Brady , Deloughery Thomas G. , Carlson Nels L. , Marshall Lynn M.
Published: October 2019

Study Design.

A cross-sectional study.

Objective.

This study investigates the prevalence of incidental vertebral marrow signal abnormality (VMSA) in thoracolumbar spine magnetic resonance imaging (MRI) ordered for the evaluation of back and/or leg pain and assess the clinical work-up for VMSAs.

Summary of Background Data.

Patients presenting with back pain are often referred for spine MRI for diagnostic evaluation. VMSA is most frequently found in the lumbar spine and is of clinical concern because it can represent malignancy. Standardized procedures for reporting and managing VMSAs do not exist.

Methods.

The radiology database at the Oregon Health & Science University health system was queried to identify patients with thoracolumbar spine MRI scans performed between January 2014 and June 2016. Patients 16 years or older with MRIs ordered by providers at a multidisciplinary spine specialty clinic for the diagnostic evaluation of back and/or leg pain were included. Radiology reports were searched for keywords pertaining to VMSAs, such as “malignancy.” Medical records of these patients were further reviewed for the clinical work-up and final diagnoses pertaining to the VMSA.

Results.

The study sample included 1503 individual patients, of whom 65 (4%) had MRI radiology reports that described a VMSA. Thirty-one (48%) of the 65 patients with VMSAs had further evaluation recommended by radiology. Ten (32%) of these 31 patients were followed clinically without further diagnostic testing for the VMSA. Of the 65 patients with VMSAs, only one was diagnosed with malignancy (multiple myeloma).

Conclusion.

While VMSAs are not frequently found on thoracolumbar MRIs ordered to evaluate back and/or leg pain, there is a large amount of heterogeneity in how these abnormalities are documented and managed. This may indicate the need for clinical guidelines for the reporting and management of VMSAs detected on spine MRI and for improvement in communication between radiologists and ordering providers.

Level of Evidence: 3
Is There Equivalence Between the Electronic and Paper Version of the Questionnaires for Assessment of Patients With Chronic Low Back Pain?
Authors: Azevedo Bruna Rabelo , Oliveira Crystian B. , Araujo Giulia Marcondes D. , Silva Fernanda G. , Damato Tatiana M. , Pinto Rafael Z. , Christofaro Diego G.D.
Published: October 2019

Study Design.

Cross-sectional study.

Objective.

To investigate the equivalence of electronic and paper version of self-report questionnaires for the assessment of disability, pain, fear of movement, depression, and physical activity of patients with chronic low back pain (LBP).

Summary of Background Data.

Paper and electronic versions of self-report questionnaires are commonly used for assessment of patients with LBP. However, the equivalence of self-report questionnaires commonly used for assessment of patients with chronic LBP remains unclear.

Methods.

Seventy-nine individuals with chronic LBP seeking physiotherapy care were recruited. Participants attended the clinic twice with an interval of 1 week and completed the self-reported questionnaires in a random order. The following questionnaires were administered: Roland Morris Disability Questionnaire (RMDQ); 11-point numerical rating scale (NRS); Tampa Scale for Kinesiophobia (TSK); Center for Epidemiological Studies-Depression (CES-D), and Baecke Habitual Physical Activity Questionnaire (BPAQ). To investigate the equivalence between the two questionnaire versions, intraclass correlation coefficient with 95% confidence interval and Bland-Altman plotting was used.

Results.

The paper and electronic versions of the RMDQ, TSK, and CES-D showed good reliability and the showed moderate reliability. In contrast, the NRS showed poor reliability between the electronic and paper versions.

Conclusion.

Our findings support that the electronic version of the RMDQ, TSK, CES-D, and BPAQ can be administered in clinical and research settings for assessment of patients with chronic LBP. Nevertheless, electronic version of the NRS for assessment of pain intensity should not be used interchangeably in clinical practice in patients with chronic LBP.

Level of Evidence: 3
Papillary Hemangioma: An Under-Recognized Entity Not to Be Confused With Glomeruloid Hemangioma
Authors: Maloney Nolan , Miller Patricia , Linos Konstantinos
Published: October 2019

Papillary hemangioma is a recently described benign hemangioma that typically presents on the head and neck of otherwise healthy individuals. It comprises branching papillary structures that protrude into the lumen of ectatic thin-walled vessels. Glomeruloid hemangioma (GH) is a similar, but unique, entity that occurs in patients with POEMS syndrome. The additional clinical implications of GH make distinction from papillary hemangioma critical. An additional case is herein presented and the literature on the subject reviewed. Potential differential diagnoses are discussed, with particular emphasis on the distinction from GH.
Should Margin Status of Biopsies Be Included in Dermatopathology Reports? Clinician Preferences and the Importance of Unambiguous Language
Authors: Jacobsen Emilie , Hippe Daniel S. , Lachance Kristina , Perrone Marie E. , Chang Oliver H. , Shinohara Michi M.
Published: October 2019

Significant communication occurs between pathologists and clinicians through the dermatopathology report. Our objective was to describe clinician preference about reporting of the margin status of skin biopsies of nonmelanoma skin cancers. An anonymous survey was sent to 243 medical providers who submitted specimens to a single institution university medical center; 50 complete responses from attending-level providers and advance practice providers were received. The majority (96%) of those surveyed indicated margins should be reported on skin biopsies of neoplasms, particularly nonmelanoma skin cancers (basal cell carcinoma 96% and squamous cell carcinoma 92%) and atypical nevi (96%). When asked about particular language used to describe the margin status, some phrasing led to more variance in respondents' clinical management decisions, with 96%–98% of respondents making the same decision when presented with “unambiguous” terms and 58%–84% of respondents making the same decision when presented with “ambiguous” language (P < 0.001). Respondents generally preferred “unambiguous” margin descriptions when shown an involved margin (70% vs. 30%, P < 0.001) but accepted “ambiguous” language when the margin was clearly uninvolved (68% vs. 32%, P = 0.015). Most respondents (88%) desire inclusion of treatment recommendations in dermatopathology reports. Microscopic descriptions were highly utilized, particularly by nondermatology trained clinicians (97% vs. 80%, P = 0.09). Clinicians desire inclusion of margins for skin biopsies in dermatopathology reports, at least in some circumstances. The choice of language used to describe the margin status in dermatopathology reports has important implications for patient care. Margin descriptors that are unclear or ambiguous may lead to more variance in clinical management.
Sarcoid Orbital Myopathy: Clinical Presentation and Outcomes
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: October 2019

Sarcoid orbital myopathy is rare and mainly affects the superior rectus/levator complex and lateral rectus, possibly due to neighboring dacryoadenitis. Most settle with systemic corticosteroids, a quarter need second-line immunosuppressants, and one-third will have relapse.

Purpose:

To describe the clinical manifestations, systemic associations, radiological features, and treatment outcome for patients presenting with sarcoid-like granulomatous disease involving the extraocular muscles.

Study design:

Retrospective noncomparative case series and literature review.

Methods:

Patients presenting with presumed sarcoid orbital myopathy between 1990 and 2016 were classified either as having known systemic sarcoidosis at time of orbital presentation (Group I) or as having newly diagnosed sarcoidosis (Group II).

Results:

Twenty patients (15 females; 75%) were identified, 8 having a known systemic sarcoidosis and 12 with a new diagnosis. The average age at presentation was 53.7 years (median 54.5; range 31–78), with the commonest symptoms being swelling, pain, and diplopia. The superior rectus/levator complex was most commonly affected (50%), followed by lateral rectus (40%) and the superior oblique only rarely (2 in Group II), but with no evident bias between the groups. Most patients had additional involvement of lacrimal gland (70%) and orbital fat (95%), and systemic disease was present in 18 of 20 patients. Four patients were on oral corticosteroids prior to orbital presentation (2 in each group) and 16 received oral prednisolone after orbital diagnosis—14 commencing steroids and 2 continued previous steroids. Clinical improvement was noted in 13 of 20 (65%) patients, the results being similar in the 2 groups (p = 1.0). The average follow up was 56 months (median 41; range 1–315), and disease recurrence occurred in 6 patients (30%) at an average interval of 12.5 months after diagnosis.

Conclusions:

This study presents the long-term results of patients with sarcoid-related orbital myopathy and systemic disease may be found in over 80% of newly diagnosed cases. The superior rectus/levator complex and lateral rectus are most commonly involved—possibly due to spill-over inflammation from granulomatous dacryoadenitis. Approximately two-thirds of cases respond well to systemic corticosteroids, while one-third develop recurrent disease.