bluuebunny/crossref_metadata_2025 huggingface dataset:
First Report of Southern Blight of Industrial Hemp Caused by Athelia rolfsii in Louisiana
Authors: Singh Raghuwinder , De Souza Monique , Burks Tim , Price Trey
Published: August 2021

Louisiana growers planted their first industrial hemp (Cannabis sativa L.) crop in 2020. A total of 932 licensed acres were planted, predominantly with CBD cultivars, for hemp fiber, extraction of plant resin, and grain and seed production. Between June and August of 2020, southern blight was reported from all major growing areas including Avoyelles, East Baton Rouge, Lafayette, Lincoln, and Rapides Parishes. Disease incidence and severity varied from 10 to 50% and from 30 to 90%, respectively. Based on morphological characteristics and sequence analysis, the fungus was identified as Athelia rolfsii (anamorph: Sclerotium rolfsii). To our knowledge, this is the first report of southern blight of industrial hemp caused by A. rolfsii in Louisiana.
Building a nursing legacy
Authors: Graber Jennifer , Saylor Jennifer , Jackson Amy , Hayes Evelyn
Published: August 2021

A nurse's legacy can be defined in multiple ways. This article describes a project based on a qualitative research study that focused on legacy building in nursing.
Breaking out of the system and moving to strengths-based care
Authors: MacDonald Barbara J. , Dickinson Jane K.
Published: August 2021

Strengths-based approaches focus on identifying an individual's assets and resources to find solutions that support their health. These principles are already inherent in nursing philosophies and processes. This article presents a call to reshape the current deficit-based, provider-centric model by formalizing inclusion of holistic, strengths-based approaches into nursing care.
Medical Student Experiences With Electronic Health Records Nationally: A Longitudinal Analysis Including School-Level Effects
Authors: Cuddy Monica M. , Foster Lauren M. , Wallach Paul M. , Hammoud Maya M. , Swanson David B.
Published: August 2021

Purpose

Increasingly, medical school graduates have been expected to be competent in the knowledge and skills associated with effective electronic health record (EHR) use. Yet little is known about how student experiences with EHRs have changed over time or how these trends vary by medical school. This study examined shifts in U.S. medical student interactions with EHRs during their clinical education, 2012–2016, and how these interactions varied by clerkship within and across medical schools.

Method

Data came from an online survey about EHR use administered to medical students after completing the Step 2 Clinical Knowledge portion of the United States Medical Licensing Examination. For a sample of 17,202 medical students from 140 U.S.-based Liaison Committee on Medical Education accredited medical school campuses, multilevel modeling techniques were used to estimate overall and school-specific trends in student access to and entry of information into EHRs for 7 core inpatient clerkships.

Results

Results showed upward trajectories in likelihood of student EHR experiences, with smaller increases found for information entry compared with access. These trends varied by inpatient clerkship rotation, with some disciplines exhibiting more rapid increases than others. For both access and information entry, estimated clerkship-specific trajectories differed by medical school in terms of size and direction. For all clerkships, greater school-to-school variation in the likelihood of student entry, compared with student access, remained at the end of the study period.

Conclusions

Increases in medical student interactions with EHRs suggest a growing commitment to educating students on safe and effective EHR use. Nonetheless, at some schools and in some clerkships, students may receive inadequate educational opportunities to practice using EHRs. In turn, medical students may be differentially prepared to effectively engage with EHRs upon entering residency, particularly with the knowledge and skills needed to effectively document and transmit information in EHRs.
Frequency of Social Media and Digital Scholarship Keywords in U.S. Medical Schools’ Promotion and Tenure Guidelines
Authors: Maldonado Graciela , Smart Jonathan , Wiechmann Warren , Kaplan Sherrie H. , Billimek John , Wray Alisa , Toohey Shannon , Boysen-Osborn Megan
Published: August 2021

Purpose

Medical schools must have clear policies and procedures for promotion and tenure (P&T) of faculty. Social media and digital scholarship (SMDS) is an emerging form of scholarship capable of reaching audiences quickly, conveniently, and in a wide variety of formats. It is unclear how frequently SMDS is considered during P&T reviews. The authors sought to determine whether current P&T guidelines at medical schools consider SMDS.

Method

The authors acquired P&T guidelines from any U.S. Liaison Committee on Medical Education–accredited medical school (or their governing university) that were available online between October and December 2020. Using an iterative process, they developed a bank of keywords that were specific to SMDS or that could include SMDS between October and December 2020. The authors searched each school’s guidelines for each keyword and determined whether the word was being used in relation to crediting faculty for SMDS in the context of P&T procedures. The primary outcome measure was the dichotomous presence or absence of SMDS-specific keywords in each school’s P&T guidelines.

Results

The authors acquired P&T guidelines from 145/154 (94%) medical schools. After removing duplicate documents, the authors considered 139 guidelines. The keyword bank included 59 terms, of which 49 were specific to SMDS and 10 were umbrella terms that could be inclusive of SMDS. Of the 139 guidelines, 121 (87%) contained at least 1 SMDS-specific keyword. Schools had a median of 3 SMDS-specific keywords in their P&T guidelines.

Conclusions

As the presence and impact of SMDS increase, schools should provide guidance on its role in the P&T process. Faculty should receive clear guidance on how to document quality SMDS for their promotion file.
Adapting the Admissions Interview During COVID-19: A Comparison of In-Person and Video-Based Interview Validity Evidence
Authors: Kulasegaram Kulamakan , Baxan Victorina , Giannone Elicia , Latter David , Hanson Mark D.
Published: August 2021

COVID-19 physical distancing limited many medical schools’ abilities to conduct in-person interviews for the 2020 admissions cycle. The University of Toronto (U of T) Temerty Faculty of Medicine was already in the midst of its interview process, with two-thirds of applicants having completed the in-person modified personal interview (MPI). As the university and surrounding region were shut down, the shift was made in the middle of the application cycle to a semisynchronous video-based MPI interview (vMPI) approach. U of T undertook the development, deployment, and evaluation of the 2 approaches mid-admissions cycle. Existing resources and tools were used to create a tailored interview process with the assistance of applicants. The vMPI was similar in content and process to the MPI: a 4-station interview with each station mapped to attributes relevant to medical school success. Instead of live interviews, applicants recorded 5-minute responses to questions for each station using their own hardware. These responses were later assessed by raters asynchronously. Out of 627 applicants, 232 applicants completed the vMPI. Validity evidence was generated for the vMPI and compared with the MPI on the internal structure, relationship to other variables, and consequential validity, including applicant and interviewer acceptability. Overall, the vMPI demonstrated similar reliability and factor structure to the MPI. As with the MPI, applicant performance was predicted by nonacademic screening tools but not academic measures. Applicants’ acceptance of the vMPI was positive. Most interviewers found the vMPI to be acceptable and reported confidence in their ratings. Continuing physical distancing concerns will require multiple options for admissions committees to select medical students. The vMPI is an example of a customized approach that schools can implement and may have advantages for selection beyond the COVID-19 pandemic. Future evaluation will examine additional validity evidence for the tool.
Single-Site Retrospective Assessment of Surgical Outcomes in Non-Ambulatory Patients with Degenerative Cervical Myelopathy
Authors: Boehm Blake A. , Njoku Innocent , Furey Christopher G.
Published: August 2021

Study Design.

A retrospective study of surgical outcomes in patients with degenerative cervical myelopathy (DCM).

Objective.

To better characterize outcomes following cervical decompression in those with severe, non-ambulatory forms of DCM.

Summary of Background Data.

DCM represents a collection of age-related degenerative processes of the cervical spine that can result in motor, sensory, and autonomic dysfunction, leading to significant reductions in quality of life. Individuals with severe, non-ambulatory forms of DCM are often treated with spinal decompression although the extent of neurological improvement for this patient population is unclear.

Methods.

A retrospective analysis of 48 non-consecutive non-ambulatory patients who underwent cervical decompression surgery between January 2007 and December 2018. Paired t tests and Wilcoxon signed rank tests were used to compare Nurick grade and modified Japanese Orthopedic Association (mJOA) score before and after surgery. Patient demographics, operative details, and postsurgical complications were analyzed using descriptive statistics.

Results.

Patients experienced significant improvements in both Nurick grade and mJOA score following cervical decompression surgery. The mean Nurick grade improved from 4.10 ± 0.31 to 2.21 ± 0.82 (P < 0.001, paired t test; 95% confidence interval [CI] –2.08 to –1.71), while the mean mJOA score improved from 10.58 ± 1.51 to 13.60 ± 1.58 (P < 0.001, paired t test; 95% CI 2.59–3.45). The average follow-up duration was 2.50 ± 1.83 years. Following surgery, 44 of the 48 patients in the study gained the ability to ambulate without the aid of a walking frame or someone else's assistance.

Conclusion.

This study demonstrated that patients with severe forms of DCM experienced significant improvement in neurological function following cervical decompression surgery. These improvements indicate that cervical decompression surgery is effective in this patient population and has the potential to improve neurological status.

Level of Evidence: 3
Does Engaging Patients with Relevant Education About Long-Term Opioid Use Before Spine Surgery Affect Long-term Opioid Use? A Randomized Controlled Trial
Authors: Rhon Daniel I. , Greenlee Tina A. , Gill Norman W. , Carlson Andrew E. , Hart Allison M. , Larsen Trent H. , McLelland Alex , Mayhew Rachel J. , McCafferty Randall R. , Koppenhaver Shane L.
Published: August 2021

Study Design.

Parallel-arm randomized controlled trial.

Objective.

To assess the effectiveness of an enhanced video education session highlighting risks of opioid utilization on longterm opioid utilization after spine surgery.

Summary of Background Data.

Long-term opioid use occurs in more than half of patients undergoing spine surgery and strategies to reduce this use are needed.

Methods.

Patients undergoing spine surgery at Brooke Army Medical Center between July 2015 and February 2017 were recruited at their preoperative appointment, receiving the singlesession interactive video education or control at that same appointment. Opioid utilization was tracked for the full year after surgery from the Pharmacy Data Transaction Service of the Military Health System Data Repository. Self-reported pain also collected weekly for 1 and at 6months.

Results.

A total of 120 participants (40 women, 33.3%) with a mean age of 45.9 ± 10.6 years were randomized 1:1 to the enhanced education and usual care control (60 per group). In the year following surgery the cohort had a mean 5.1 (standard deviation [SD] 5.9) unique prescription fills, mean total days’ supply was 88.3 (SD 134.9), and mean cumulative morphine milligrams equivalents per participant was 4193.0 (SD 12,187.9) within the year after surgery, with no significant differences in any opioid use measures between groups. Twelve individuals in the standard care group and 13 in the enhanced education group were classified with having long-term opioid utilization.

Conclusion.

The video education session did not influence opioid use after spine surgery compared to the usual care control. There was no significant difference in individuals classified as long-term opioid users after surgery based on the intervention group. Prior opioid use was a strong predictor of future opioid use in this cohort. Strategies to improve education engagement, understanding, and decision- making continue to be of high importance for mitigating risk of long-term opioid use after spine surgery.

Level of Evidence: 1
Bronchoalveolar Lavage Gram Stains for Early Bacterial Identification in Pneumonia: Should They Stay or Should They Go?
Authors: Klimko Claire V. , Sanders James M. , Monogue Marguerite L. , Tilahun Belen A. , Arasaratnam Reuben J. , Reisch Joan S. , Johns Meagan L.
Published: August 2021

OBJECTIVES:

The primary endpoint was to determine the sensitivity and specificity of the bronchoalveolar lavage Gram stain in predicting culture results. Secondary endpoints included determining the proportion of Gram stains from bronchoalveolar lavages that accurately identify culture isolates and the duration of antibiotic treatment before bronchoalveolar lavage collection.

DESIGN:

Retrospective, observational study.

SETTING:

Four ICUs at a single academic medical center.

SUBJECTS:

Patients at least 18 years old admitted to an ICU with a diagnosis of pneumonia, collection of a bronchoalveolar lavage sample, and receipt of antibiotics.

MEASUREMENTS AND MAIN RESULTS:

Two-hundred five isolates were included. Gram stains for Gram-positive and Gram-negative isolates showed high specificity, 97.3% and 100%, respectively, but lower sensitivity at 61.9% and 54.2%, respectively. The positive predictive value and negative predictive value were 77.2% and 95.7% for Gram-positive isolates and 100% and 84.4% for Gram-negative isolates, respectively. Gram stains correctly identified isolates on the bronchoalveolar lavage culture in 61.9% of Gram-positive organisms and in 54.2% of Gram-negative organisms.

CONCLUSIONS:

Gram stains accurately identified causative organisms in a limited number of patients making the utility of the Gram stain an uncertain modality for predicting causative respiratory pathogens from bronchoalveolar lavage samples.
Older Adults' Perception on and Use of Patient Portals
Authors: Son Hyojin , Nahm Eun-Shim , Zhu Shijun , Galik Elizabeth , Van de Castle Barbara , Seidl Kristin L. , Russomanno Vince
Published: August 2021

Older adults can benefit from using patient portals. Little is known whether perception of and use of patient portals differ among older adults in diverse healthcare contexts. This study analyzed the difference in perceived usability, self-efficacy, and use of patient portals between older adults recruited from a healthcare system (n = 174) and older adults recruited from nationwide communities (n = 126). A secondary data analysis was conducted using the data sets of two independent studies. A series of linear and ordinal logistic regression analyses were performed. The healthcare system sample had more health issues, higher levels of perceived usability and self-efficacy, and frequent use of patient portals compared with the community sample. This study indicates that efforts to improve usability of patient portals and self-efficacy are essential for all older adult users. The association between perceived usability and patient portal use was stronger in the community sample than in the healthcare system sample, suggesting that approaches to support older adults' efficient use of patient portals should be tailored to their health status and care needs. Future studies may include inpatient and outpatient portals and investigate the impact on health outcomes of older adults across care settings.
Medical malpractice in stress urinary incontinence management: A 30-year legal database review
Authors: Lynch Niccola B. , Xu Linhan , Ambinder David , Malik Rena D.
Published: August 2021

Background:

The purpose of this study is to investigate the most common reasons for and judicial outcomes of malpractice claims related to stress urinary incontinence (SUI) management.

Materials and methods:

Using the Westlaw database, a search was performed using the terms “medical malpractice” or “negligence” in combination with “stress incontinence” or “stress urinary incontinence” between January 1, 1990 and January 1, 2020. Extracted information included trial date, demographic information, defendant profession, procedure performed, procedure complications, alleged malpractice, trial outcome, and monetary award. Data were analyzed using descriptive statistics.

Results:

The Westlaw search yielded 79 case results. Of the cases, 70.4% (n = 38/54) had a defense verdict, 22.2% (n = 12/54) had a plaintiff verdict, and 7.4% (n = 4/54) were settled. The most commonly implicated procedure was mid-urethral sling (63.2%, n = 36/57). Among the plaintiffs, 48.4% (n = 61/126) claimed negligence in preoperative care, 33.3% (n = 42/126) claimed negligence in surgical performance, and 18.3% (n = 23/126) claimed negligence in postoperative care. Lack of informed consent was the most common complaint related to negligence in preoperative care (42.6%, n = 26/61). The average indemnity payment was $1,253,644 for preoperative care negligence, $1,254,491 for surgical performance negligence, and $2,239,198 for postoperative care negligence. Of the defendants, 63.4% (n = 52) were gynecologists and 36.6% (n = 30) were urologists.

Conclusions:

Negligent preoperative care, with a particular emphasis on failure to obtain informed consent, and negligent surgical performance are the leading causes of malpractice claims during SUI management. Mid-urethral sling was the most commonly litigated procedure. This study highlights key factors to consider in minimizing malpractice risk during SUI management.
Neighborhood Walkability and Mortality in a Prospective Cohort of Women
Authors: India-Aldana Sandra , Rundle Andrew G. , Zeleniuch-Jacquotte Anne , Quinn James W. , Kim Byoungjun , Afanasyeva Yelena , Clendenen Tess V. , Koenig Karen L. , Liu Mengling , Neckerman Kathryn M. , Thorpe Lorna E. , Chen Yu
Published: August 2021

Background:

There is a paucity of prospective cohort studies evaluating neighborhood walkability in relation to the risk of death.

Methods:

We geocoded baseline residential addresses of 13,832 women in the New York University Women’s Health Study (NYUWHS) and estimated the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) for each participant circa 1990. The participants were recruited from 1985 to 1991 in New York City and followed for an average of 27 years. We conducted survival analyses using Cox proportional hazards models to assess the association between neighborhood walkability and risk of death from any cause, obesity-related diseases, cardiometabolic diseases, and obesity-related cancers.

Results:

Residing in a neighborhood with a higher neighborhood walkability score was associated with a lower mortality rate. Comparing women in the top versus the lowest walkability tertile, the hazards ratios (and 95% CIs) were 0.96 (0.93, 0.99) for all-cause, 0.91 (0.86, 0.97) for obesity-related disease, and 0.72 (0.62, 0.85) for obesity-related cancer mortality, respectively, adjusting for potential confounders at both the individual and neighborhood level. We found no association between neighborhood walkability and risk of death from cardiometabolic diseases. Results were similar in analyses censoring participants who moved during follow-up, using multiple imputation for missing covariates, and using propensity scores matching women with high and low neighborhood walkability on potential confounders. Exploratory analyses indicate that outdoor walking and average BMI mediated the association between neighborhood walkability and mortality.

Conclusion:

Our findings are consistent with a protective role of neighborhood walkability in obesity-related mortality in women, particularly obesity-related cancer mortality.
Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia
Authors: Al Qurashi Abdullah A. , Shah Mardan Qutaiba N.M. , Mortada Hatan , Maddawi Hadeel , Hakami Alqassem Y. , Mrad Mohamed Amir
Published: August 2021

Background:

Graduates of medical school must choose a specific specialty as a life-long practice from a large pool of medical specialties. This decision stands out as one of the most memorable and critical in their lifetimes. To reach such a decision with satisfaction, medical school graduates consider a variety of factors. This is the first study to explore the influential factors on pursuing plastic surgery as a career in Saudi Arabia.

Methods:

This is a cross-sectional, unicentral study based on an electronic questionnaire that has been constructed with an assistance of field experts to ensure a sufficient coverage of the influential factors. Only those with an established interest in plastic surgery were included. Institutional review board approval was obtained for this study.

Results:

Of the 695 questionnaires fully completed by third-year medical students up to intern doctors, only 32 (4.6%) expressed an interest in the pursuit of plastic surgery as a future career, with a female predominance of 62.5% (N = 20). The factors that influenced their decision of specialty choice were the geographic advantage (81.3%), predominance of nonurgent cases (71.9%), the reward associated with immediate outcome (71.9%), and prior significant events (71.9%).

Conclusions:

Certain factors, as explored by this study, strongly influence the choice of plastic surgery as a future specialty, among Saudi medical graduates. Cultivating more knowledge about plastic surgery as a specialty may help consider scientific research as an impactful factor in the future for further development in the field.
Neurologically asymptomatic patients frequently present cerebral injuries during malignant hypertension: a MRI study
Authors: Boulestreau Romain , Lucas Ludovic , Cremer Antoine , Debeugny Stéphane , Rubin Sébastien , Gaudissard Julie , Doublet Julien , Sibon Igor , Gosse Philippe
Published: August 2021

Background:

Acute and diffuse microvascular damage characterizes malignant hypertension (MHT), the deadliest form of hypertension (HTN). Although its ophthalmological, renal and cardiological repercussions are well known, brain involvement is considered rare with few descriptions, although it is one of the main causes of death. We hypothesized that brain MRI abnormalities are common in MHT, even in patients without objective neurological signs.

Method:

We analyzed retrospectively the brain MRI of patients admitted for acute MHT between 2008 and 2018 in Bordeaux University Hospital, regardless of their neurological status. A trained operator analyzed every brain MRI, looking for posterior reversible encephalopathy syndrome (PRES), ischemic stroke, intracerebral hematoma (ICH) and microangiopathy markers. We included 58 patients without neurological signs, 66% were men, and mean age was 45.6 ± 11.3 years.

Results:

Brain MRI were normal in 26% of patients but we found at least one acute abnormality on brain MRI in 29% and an Small Vessel Disease score (SVD score) of two or higher in 52%. In patients with neurological signs, these findings were 9, 53 and 70%, respectively. A PRES was found in 16% of asymptomatic patients and 31% had an ischemic stroke and/or a cerebral hematoma.

Conclusion:

PRES, recent hematoma, ischemic stroke and severe cerebral microangiopathy are common findings in MHT patients without neurological signs on admission. The impact of these findings on patient management, and their cerebrovascular and cognitive prognostic value, should be established. Brain MRI might need to become systematic in patients suffering from MHT episodes.
Negative Corneal Fluorescein Staining as an Exceptionally Early Sign of Acanthamoeba Keratitis: A Case Report
Authors: Korkmaz Ilayda , Barut Selver Ozlem , Simsek Cem , Palamar Melis
Published: August 2021

Objectives:

To report the negative fluorescein staining as an early sign of Acanthamoeba keratitis (AK).

Methods:

Case report and brief review of related literature.

Report of Case:

A 30-year-old, contact lens wearer, woman presented with mild irritation and pain in the right eye. The best-corrected visual acuity (BCVA) was 20/20 in both eyes. Slit-lamp examination revealed a peripheral corneal infiltration. Empirical antimicrobial therapy was initiated. Within the third day, peripheral corneal opacity regressed but a Y-shaped linear epitheliopathy with a negative fluorescein staining, because of a ridge-like epithelial irregularity, was observed in the central cornea. Clinical findings progressed rapidly. Confocal microscopy revealed hyper-reflective cysts with the typical double-ring sign consistent with AK. Therefore, topical chlorhexidine and propamidine were initiated. Clinical findings regressed subsequently. The final BCVA was 20/20 in both eyes.

Conclusion:

Acanthamoeba keratitis usually manifest as superficial epitheliopathy and progresses to the stroma. Findings may be obscure or atypical; comprehensive and careful examination may reveal mild findings in the early stages.
The Significance of Depression for Short-term Readmission and Mortality After a Pneumonia Admission
Authors: Graversen Susanne B. , Pedersen Henrik S. , Ribe Anette R. , Foss Catherine H. , Sandbaek Annelli
Published: August 2021

Background:

Depression is highly prevalent among hospitalized patients with pneumonia. At discharge, these patients transfer to a less care-intensive home-based setting. Nevertheless, little is known on the prognosis in the postdischarge period.

Objective:

The objective of this study was to investigate the influence of depression on 30-day mortality and readmission in persons discharged after a pneumonia admission.

Design:

This was a population-based cohort study using the Danish registries.

Subjects:

All persons aged 50+ years with a pneumonia admission in 2000–2016 in Denmark.

Measures:

Mortality rate ratios for 30-day mortality and incidence rate ratios for 30-day readmission in pneumonia patients with versus without depression.

Results:

We identified 379,265 pneumonia admissions, hereof 83,257 (22.0%) with depression. The overall adjusted mortality rate ratio was 1.29 (95% confidence interval: 1.25–1.33), and the overall adjusted incidence rate ratio was 1.07 (95% confidence interval: 1.05–1.08). The mortality risk was higher for all ages and throughout the 30-day period in persons with versus without depression. This risk was modified by sociodemographic and socioeconomic characteristics (excluding sex and education), admission-related factors, comorbidities, and use of benzodiazepines, opioids, or antipsychotics. The readmission risk was higher until age 90 and tended to be higher throughout the 30-day period. This risk was modified by age, cohabitation, residency, admission-related factors, comorbidities, and use of opioids or antipsychotics. For both outcomes, the relative effect of depression was highest among the youngest, among those with a short hospital stay and among those with few comorbidities.

Conclusion:

Depression is an independent risk factor for 30-day mortality and readmission in persons who transfer from hospital care to home-based care.
Incidence and relevance of clinically indeterminate nonregional lymph nodes in the treatment of oesophageal cancer
Authors: Pucher Philip H. , White Annabelle , Padfield Olivia , Davies Andrew R. , Maisey Nick , Qureshi Asad , Subesinghe Manil , Baker Cara , Gossage James A.
Published: August 2021

Objectives

Metastatic involvement of nonregional supraclavicular or superior mediastinal lymph nodes in distal oesophageal cancer is rare but has important implications for prognosis and management. The management of nonregional lymph nodes which appear indeterminate on CT and FDG PET-CT (subcentimeter nodes or those with preserved normal morphology, but increased FDG avidity) can present a diagnostic dilemma. This study investigates the incidence, work-up and clinical significance of nonregional clinically indeterminate FDG avid lymph nodes.

Methods

A single-centre retrospective review of all FDG PET-CT scans conducted over 5 years was conducted. Patients with mid- or distal oesophageal cancer with nonregional FDG avid nodes were identified. Subsequent work-up, management and outcomes were retrieved from electronic health records.

Results

Reports for 1189 PET-CT scans were reviewed. A total of 79 patients met the inclusion criteria. Of these, 18 (23%) were deemed to have disease and performance status potentially amenable to radical surgery and underwent further assessment. The indeterminate lymph nodes were successfully sampled via endobronchial ultrasound (EBUS) or ultrasound-guided fine-needle aspiration (US-FNA) in 100% of cases. 15/18 (83.3%) of samples were benign and proceeded to surgery. Outcomes for patients who proceeded to surgery were similar to other cohorts. None had pathology suggesting false-negative lymph node sampling.

Conclusions

EBUS and US-FNA are effective means of sampling clinically indeterminate nonregional lymph nodes, and can significantly impact prognosis, and management. Further investigations in this context are of value in this cohort and should be pursued. Nonregional clinically indeterminate lymph nodes represent a diagnostic dilemma in oesophageal cancer staging. Additional investigations in the form of endobronchial ultrasound are effective at providing additional staging information, and can substantially influence patient care.
Clonal hematopoiesis and myeloid malignancies: clonal dynamics and clinical implications
Authors: Elena Chiara , Gallì Anna , Bono Elisa , Todisco Gabriele , Malcovati Luca
Published: August 2021

Purpose of review

Clinical and experimental studies have uncovered relevant clinical implications of clonal hematopoiesis. However, the true magnitude of this process, clonal dynamics over time and mechanisms of progression into overt malignancy remain to be largely elucidated. In this article, the consequences of clonal hematopoiesis, its significance in the context of cytopenia, and its implications in the clinical management of patients with myeloid malignancies are reviewed and discussed.

Recent findings

Clonal hematopoiesis has been associated with higher risk of hematologic cancers, as well as of death from cardiovascular causes. Clonal hematopoiesis has been proven clinically relevant in the context of disorders characterized by peripheral blood cytopenia, including aplastic anemia, cytopenia of undetermined significance, as well as unexplained anemia of the elderly.

The available evidence has been proving the utility of somatic mutational analysis in patients with unexplained cytopenia, as well as in those receiving a diagnosis of myeloid neoplasm, enabling more accurate diagnosis, risk assessment, effective therapeutic strategies and residual disease monitoring. The access to a minimally invasive assessment is paving the way for screening programs of clonal hematopoiesis in individuals with absent or mild hematologic phenotype, as well as for therapeutic targeting of preleukemia cells.
Comparative Effectiveness of Intravenous Azithromycin Versus Erythromycin Stimulating Antroduodenal Motility in Children
Authors: Mougey Edward B. , Saunders Madison , Franciosi James P. , Gomez‐Suarez Roberto A.
Published: August 2021

Background:

Azithromycin has been shown to improve gastrointestinal motility in adults and may have fewer drug interactions and reduced arrhythmogenic effects than erythromycin. We hypothesized that azithromycin is comparable to erythromycin in eliciting pharmacodynamic outcomes for antral and small bowel motility.

Objective:

To compare the pharmacodynamic effectiveness of azithromycin and erythromycin for eliciting antral and duodenal motility in pediatric patients who underwent antroduodenal manometry for different indications.

Methods:

We conducted a retrospective comparison of clinic data and manometric pharmacodynamics outcomes in patients who underwent antroduodenal manometry between 2013 and 2017.

Results:

Fifty‐one patients mean age (± standard deviation) 9.7 (5.4) years, received either azithromycin 3 mg/kg (n = 20) or erythromycin 2 mg/kg (n = 31) during antroduodenal manometry. For patients receiving erythromycin, mean area under the curve (AUC) across all eight pressure ports increased from median [95% confidence interval] 2256 [1585, 2602] to 8742 [5876, 11761] mmHg × s (P < 0.001) and mean motility index increased from 8.63 [7.87, 9.42] to 11.98 [11.20, 12.21] (P < 0.001). For patients receiving azithromycin, mean AUC increased from 2255 [1585, 2602] to 8254 [5649, 10470] mmHg × s (P < 0.001) and motility index increased from 8.63 [7.87,9.42] to 11.79 [11.03, 12.21] (P < 0.001). Neither mean stimulated AUC nor mean motility index was significantly different between azithromycin and erythromycin treatments. There was no significant difference in side effects between groups.

Conclusions:

Azithromycin and erythromycin have similar pharmacodynamic effects on antral and small bowel contractility in children. Azithromycin should be considered an acceptable alternative to erythromycin as an upper gastrointestinal tract prokinetic for children and has historically had fewer side effects than erythromycin.
Going Up!
Authors: Brandford Arica , Brandford-Stevenson Angela
Published: August 2021

The “glass escalator” refers to the structural advantage that males possess in female-dominated occupations that tend to enhance their careers. Males are less likely to enter female-dominated occupations, but when they do, they tend to rise faster and quicker to upper levels of leadership. There is limited research on the glass escalator and its effect on nursing. However, the concept has far-reaching effects for both nurse leaders and the nursing profession. Thus, a critical examination of this phenomenon is crucial. Although males represent 10% of the nursing workforce, they hold close to half of top leadership positions in nursing. While the impact of the glass escalator is clear for White males, it does not appear to apply to minority males or persons of color equally or equitably. In light of each of these factors, it is crucial that nurse leaders understand the glass escalator phenomenon, prior and current research, its implications, and have clear suggestions for addressing it in the workplace moving forward.
Comprehensive Clinicopathologic Analysis for Mismatch Repair Protein Expression in Unselected Endometrial Carcinoma Patients With an Emphasis on the Role of MLH1 Deficiency
Authors: Huang Szu-Wei , Lin Hao , Huang Chao-Cheng , Ou Yu-Che , Fu Hung-Chun , Tsai Ching-Chou , Changchien Chan-Chao , Wu Chen-Hsuan
Published: August 2021

Screening for mismatch repair (MMR) deficiency in unselected patients with endometrial carcinoma (EC) and the clinicopathologic descriptions of ECs with MMR deficiency have been well demonstrated in Western populations, but studies on Asian populations are relatively scarce. In this study, we described the clinicopathologic features of ECs according to MMR status in unselected Taiwanese patients. We also conducted subgroup analysis of MMR-deficient (dMMR) cases according to the presence or absence of MLH1. Patients diagnosed with ECs between January 2017 and February 2020 at our institution were included. Immunohistochemistry analysis of MLH1, PMS2, MSH2, and MSH6 proteins on endometrial primary tumors and clinicopathologic variables were assessed retrospectively. A total of 231 EC patients were enrolled, of whom 50 (21.6%) had dMMR tumors. Of these 50 cases, 39 had tumors that lacked MLH1 expression and 11 were positive for MLH1. The overall dMMR group was significantly related to older age, parity, and high histologic grade compared with the MMR-proficient (pMMR) group. ECs with MLH1 deficiency were obviously associated with several poor pathologic features, including high histologic grade, lymph node metastasis, and lymphovascular space invasion. Moreover, we first reported that parity and the late age at menopause are strongly correlated with MLH1-related dMMR EC group compared with pMMR group. In conclusion, triaging EC patients into pMMR, MLH1-related dMMR and non–MLH1-related dMMR groups by immunohistochemistry analysis may help clinicians to predict disease behavior and guide further management. The strong association between parity and MLH1-related dMMR ECs warrants further investigation on the underlying mechanism.
Electromyographic Analysis of a Selective Exercise for the Serratus Anterior Muscle Among Patients With Frozen Shoulder and Subacromial Impingement Syndrome
Authors: Miyasaka Junsuke , Arai Ryuzo , Yoshioka Yuji , Matsumura Aoi , Hasegawa Satoshi , Kuriyama Shinichi , Nakamura Shinichiro , Ichihashi Noriaki , Matsuda Shuichi
Published: August 2021

Objective

Patients with shoulder disorders show altered periscapular muscle activity (e.g., decreased serratus anterior and increased upper trapezius activities). We herein devised a novel method for strengthening serratus anterior without excessive upper trapezius activation, named squeezing ball exercise in which patients squeezed a ball between both elbows with maximum voluntary isometric contraction in the horizontal adduction direction with the arms elevated at a 45-degree angle. The present study aimed to investigate whether the squeezing ball exercise could produce high muscle activity in the serratus anterior in patients with frozen shoulder and subacromial impingement syndrome before the rehabilitation intervention.

Design

This is a proof-of-concept study. Serratus anterior and upper trapezius activities during squeezing ball exercise were evaluated using electromyography in 16 patients with frozen shoulders and subacromial impingement syndrome. Electromyography signals were normalized using maximal voluntary isometric contraction, and the muscle balance ratios (upper trapezius/serratus anterior) were calculated.

Results

The average serratus anterior and upper trapezius activity was 69.9% ± 30.8% and 10.2% ± 6.3% maximal voluntary isometric contraction during the squeezing ball exercise, respectively, whereas the upper trapezius–serratus anterior ratio of the affected side was 0.15 ± 0.07.

Conclusions

The high serratus anterior activation and low upper trapezius–serratus anterior ratio during squeezing ball exercise could be attributed to the limb position where shortened serratus anterior exerts itself without painful subacromial impingement. Squeezing ball exercise could be a novel rehabilitation tool for patients with frozen shoulders and subacromial impingement syndrome.
Moderators of Improvements in Fatigue Impact After a Self-management Intervention in Multiple Sclerosis
Authors: Knowles Lindsey M. , Hugos Cinda L. , Cameron Michelle H. , Haselkorn Jodie K. , Bourdette Dennis N. , Turner Aaron P.
Published: August 2021

Fatigue is one of the most common and disabling symptoms of multiple sclerosis. A recent randomized controlled trial comparing a fatigue self-management program and a general multiple sclerosis education program found that both programs improved fatigue in participants with multiple sclerosis. Participants were randomized to a self-management program (fatigue: take control, n = 109) or a multiple sclerosis education program (multiple sclerosis: take control, n = 109). This secondary analysis of that trial used multilevel moderation analysis to examine moderators of treatment-related effects on fatigue (Modified Fatigue Impact Scale) from baseline through the 6-mo follow-up. The following potential treatment moderators were examined: age, sex, cohabitation/marital status, and baseline levels of self-efficacy, depression symptoms, and sleep quality. Cohabitation status (living with or without a spouse/partner) interacted with intervention group and time to predict fatigue impact (P = 0.04). Fatigue: take control participants who lived with a spouse/partner showed a marginal effect in greater rate of improvement in fatigue compared with those who lived alone (P = 0.08). However, rates of improvement in fatigue in multiple sclerosis: take control participants were similar in those living with or without a spouse/partner. These findings suggest that living with a spouse or partner may facilitate benefit from self-management interventions for multiple sclerosis–related fatigue. Future research should investigate the contribution of supportive others in self-management of fatigue in multiple sclerosis.
Predictors of secondary HIV transmission risk in a cohort of adolescents living with HIV in South Africa
Authors: Toska Elona , Zhou Siyanai , Laurenzi Christina A. , Haghighat Roxanna , Saal Wylene , Gulaid Laurie , Cluver Lucie
Published: August 2021

Objective:

Preventing secondary HIV transmission from adolescents and young people living with HIV (AYPLHIV) to their partners and children is critical to interrupting the HIV infection cycle in sub-Saharan Africa. We investigated predictors of secondary HIV transmission risk (past-year sexual risk combined with past-year viremia) among AYPLHIV in South Africa.

Design:

A prospective cohort of AYLPHIV in South Africa recruited n = 1046 participants in 2014–2015, 93.6% of whom were followed up in 2016–2017 (1.5% mortality). Questionnaires used validated scales where available and biomarkers were extracted from n = 67 health facilities.

Methods:

Multivariate logistic regressions tested baseline factors associated with secondary HIV transmission risk, controlling for covariates, with marginal effect modelling combinations.

Results:

About 14.2% of AYPLHIV reported high secondary HIV transmission risk. High-risk AYPLHIV were more likely to be sexually infected [adjusted odds ratio (aOR) 2.79, 95% confidence interval (95% CI) 1.66–4.68, P < 0.001], and report hunger (aOR 1.93, 95% CI 1.18–3.14, P = 0.008) and substance use (aOR 2.19, 95% CI 1.19–4.02, P = 0.012). They were more likely to be in power-inequitable relationships (aOR 1.77, 95% CI 1.08–2.92, P = 0.025) and be parents (aOR 4.30, 95% CI 2.16–8.57, P < 0.001). Adolescents reporting none of these factors had a 4% probability of secondary transmission risk, rising to 89% probability with all five identified factors. Older age and early sexual debut were also strongly associated with a higher risk of secondary HIV transmission.

Conclusion:

It is essential to identify and support AYPLHIV at a high risk of secondary transmission. Screening for factors such as mode of infection and parenthood during routine healthcare visits could help identify and provide resources to the most at-risk adolescents.
The Association Between Social and Spatial Closeness With PrEP Conversations Among Latino Men Who Have Sex With Men
Authors: Shrader Cho-Hee , Arroyo-Flores Juan , Stoler Justin , Skvoretz John , Carrico Adam , Doblecki-Lewis Susanne , Kanamori Mariano
Published: August 2021

Background:

US Latino men who have sex with men (LMSM) are a group at highest risk for HIV. One driver of HIV among LMSM is inadequate access to pre-exposure prophylaxis (PrEP) information. The social network theory of homophily suggests that sharing similar sociodemographic factors could influence PrEP conversations within networks. This study aimed to determine how the effects of homophily across sociodemographic, immigration, cultural, and PrEP-related factors are associated with PrEP-related communication.

Setting:

This study was conducted in Miami-Dade County, FL.

Methods:

Data collected between August 2018 and October 2019 included 10 sociocentric friendship groups of 13 LMSM (N = 130). Participants were recruited using respondent-driven sampling by a community-based organization in Miami. We used the multiple regression quadratic assignment procedure to identify the effects of homophily and relationship characteristics on PrEP-related conversations using R software.

Results:

More frequent PrEP-related conversations were associated with dyadic friendships characterized by homophily on knowledge of PrEP effectiveness, heterophily on depressive symptom severity, home addresses proximity, friend closeness, and interaction frequency. Past PrEP-related conversation frequency also increased based on heterophily on the Latino cultural value of familism (ie, emotional support to family). Racial homophily, heterophily on severity of depressive symptoms, home addresses proximity, friendship closeness, and frequency of interactions increased likelihood to encourage a friend to use PrEP.

Discussion:

Social and spatial closeness and homophily play a role in PrEP-related conversations. Information from social networks contextualized in geographic settings can be elucidated to contribute toward the design of novel opportunities to end HIV.
Schizophreniform presentation and abrupt neurologic decline in a patient with late-onset mucopolysaccharidosis type IIIB
Authors: Montenegro Yorran Hardman Araújo , Baldo Guilherme , Giugliani Roberto , Poswar Fabiano de Oliveira , Sobrinho Ruy Pires de Oliveira , Steiner Carlos Eduardo
Published: August 2021

Due to their low frequency and some atypical presentations, inborn errors of metabolism are frequently misdiagnosed or underdiagnosed, which hinders the correct management of these patients. To illustrate that, here we present a patient that, at early school age, had learning disabilities compared to her classmates, especially for writing. She completed basic education in a regular school and was transferred to a secondary school for students with special needs. At 18 years of age, she presented a first psychiatric abrupt outbreak: she spent a month screaming and without sleeping. Behavioral problems then became apparent, especially hyperactivity, destructive and chaotic behavior, anxiety, and auto-aggressivity and hetero-aggressivity. A diagnosis of schizophreniform disorder was established. Clinical genetic evaluation revealed coarse face, macroglossia, coarse thick hair, and mild hepatomegaly, and the hypothesis of mucopolysaccharidosis-III was raised. Laboratory tests indicated high levels of urinary glycosaminoglycans and almost undetectable NAGLU activity, confirming the diagnosis. Sequencing of the NAGLU gene revealed the c.1318G>C (p.Gly440Arg) and c.1834A>G (p.Ser612Gly) mutations.
The influence of electrode spacing on the performance of bioretention cell coupled with MFC
Authors: Ya-Jun Wang , Tian-Jing Chen , Jin-Shou Li , Yun-Mei Si , Wang ZhaoYang
Published: August 2021

In order to explore the influence of electrode spacing on the performance of the enhanced bioretention system, four bioretention cells with microbial fuel cell (BRC–MFC) systems with different electrode spacing were designed, and the effect of electrode spacing on system performance was revealed by analysing its water treatment capacity and electricity production efficiency. The results showed that BRC–MFC had good water treatment capacity and could produce electricity simultaneously. Compared with other BRC–MFC systems with spacing, the BRC3 system (with an electrode spacing of 30 cm) had significant water treatment capacity under different organic loads, especially under high organic load (C/N = 10) operation, COD removal rate was as high as 98.49%,

NH

4

+

−

N

removal rate was as high as 97%, and it had a higher output voltage of 170.46 ± 6.17 mV. It could be seen that proper electrode spacing can effectively improve the water treatment capacity of the BRC–MFC system. This study provided a feasible method for improving the performance of the BRC–MFC system, and revealed the relevant mechanism. A proper electrode spacing with sufficient carbon sources could effectively improve the water treatment capacity of the BRC–MFC system.