bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal changes in fellow eyes of choroidal neovascularization associated with central serous chorioretinopathy: Optical coherence tomography angiography study
Authors: Sahoo Niroj Kumar , Mandadi Spoorti Krishna Reddy , Singh Sumit Randhir , Sacconi Riccardo , Iovino Claudio , Peiretti Enrico , Querques Giuseppe , Chhablani Jay
Published: August 2020

Purpose:

To report longitudinal changes in fellow eyes of chronic central serous chorioretinopathy (CSCR) associated choroidal neovascularization (CNV) using optical coherence tomography angiography (OCTA) and determine factors affecting neovascular conversion.

Methods:

Medical records of patients with chronic CSCR complicated by CNV and a minimum follow up of 6 months were reviewed. OCT and OCTA features were analyzed at baseline and final follow up. Baseline factors were assessed for predictive value against presence of CNV at follow up and conversion to exudative form.

Results:

Twenty-six subjects (26 CNV and 26 fellow eyes) were included in the study and followed up for a mean period of 26 ± 17 months. Nine eyes had CNV network in fellow eye at baseline, out of which three (33%) had a conversion to exudative CNV. Among the remaining 17 eyes, one eye developed a new network during a period of 44 months. An increase in the size of network was seen from 0.886 ± 0.945 mm2 at baseline to 1.326 ± 1.263 mm2 at follow up. Baseline choroidal thickness at sub-fovea was 345.4 ± 74.9 microns in eyes having network at last visit, compared to 440.1 ± 73.7 microns in eyes having no network.( p < 0.001) None of the baseline variables were found to be significantly associated with conversion to exudative form or presence of CNV on follow up in multivariate analysis.

Conclusion:

A conversion rate to exudative form was seen in 33% of fellow eyes with CNV. Relatively thinner choroid at baseline was associated with exudative conversion during follow up.
Dyslipidemia in HIV-Infected Children and Adolescents on Antiretroviral Therapy Receiving Care at Kilimanjaro Christian Medical Centre in Tanzania: A Cross-Sectional Study
Authors: Irira Michael E , Philemon Rune N , Mmbaga Joshua Y , Komba Venancia , Bartlett John , Kinabo Grace D , Mmbaga Blandina T
Published: August 2020

Background:

Worldwide prevalence of dyslipidemia in HIV-infected children on antiretroviral medications (ARVs) is rising due to extensive use of treatment during their entire lives. Dyslipidemia is the potential side effect of ARVs, especially in individuals taking protease inhibitors. The objective of this study was to determine the prevalence of dyslipidemia in HIV-infected children on ARVs receiving care at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania.

Methods:

This was a cross-sectional hospital-based study conducted from September 2015 to May 2016 at KCMC. HIV-infected children and adolescents less than 17 years on ARVs for more than 6 months were enrolled. Blood samples were taken to determine levels of triglycerides (TGs), total cholesterol, lipoproteins (including low-density lipoprotein (LDL) and high-density lipoprotein (HDL)), CD4+ T cells, and viral load (VL). Anthropometric measurements were used to assess nutritional status. SPSS 20.0 was used for analysis. Logistic regression estimated odds ratio (OR) and 95% confidence interval (CI), and P value <.05 was considered significant. Written consent was obtained from parents/guardians on behalf of their children and assent for older children.

Results:

A total of 260 participants were included in the study; the median age at HIV diagnosis was 3 (interquartile range (IQR) = 1-6) years. The overall prevalence of dyslipidemia was 46.5% with hypercholesterolemia (⩾200 mg/dl) of 11.2%, HDL (<35 mg/dl) of 22.7%, LDL (⩾130 mg/dl) of 7.7%, and hyperglyceridemia (TG ⩾150 mg/dl) of 12.3%. Children aged between 6 and 12 years at HIV diagnosis had 2.7 times higher odds of developing dyslipidemia compared with younger age at diagnosis (OR = 2.7; 95% CI = 1.1-6.6). Patients with advanced (OR = 6.4; 95% CI = 1.5-27.1) or severe (OR = 9.8; 95% CI = 1.2-76.5) HIV-associated immunodeficiency at diagnosis had higher odds of developing dyslipidemia. Protease inhibitor use was associated with higher odds of developing dyslipidemia (OR = 3.1; 95% CI = 1.4-7.1).

Conclusion:

Late diagnosis of HIV at 6 years of age or more, advanced, or severe immunosuppression, and the use of protease inhibitors were independent predictors of dyslipidemia in children on ARVs after 6 months of treatment, and with low HDL levels observed most commonly. Monitoring lipid profiles in children, especially those on protease inhibitors and with advanced/severe immunosuppression at diagnosis, may help in preventing future complications.
Coexisting Coronary and Carotid Artery Disease – Which Technique and in Which Order? Case Report and Review of Literature
Authors: Manthey Sina , Spears Jenna , Goldberg Sheldon
Published: August 2020

Coexisting carotid artery stenosis and coronary artery disease is common and there is currently no consensus in treatment guidelines on the timing, sequence and methods of revascularization. We report a case of a patient with symptomatic triple vessel coronary artery disease as well as asymptomatic severe right internal carotid artery stenosis. Our patient underwent myocardial revascularization first, because she presented with unstable angina and was asymptomatic neurologically. This article summarizes current literature about the approach to carotid and coronary artery revascularization and addresses the decision-making process regarding the timing and sequence of revascularization.
Cost analysis of home telerehabilitation for speech treatment in people with Parkinson’s disease
Authors: Saiyed Masnoon , Hill Anne J , Russell Trevor G , Theodoros Deborah G , Scuffham Paul
Published: August 2020

Introduction

Geographical barriers and impaired physical mobility among people with Parkinson’s disease (PD) hinder their timely access to speech pathology services. We compared the costs of delivering a speech treatment via in-person consultation versus telerehabilitation.

Methods

We used data from a non-inferiority randomised controlled trial delivering the Lee Silverman Voice Treatment (LSVT LOUD®), where patients with dysarthria associated with PD were assigned to either the urban in-person group ( N = 16) or the urban online group ( N = 15), supplemented with a non-randomised group (regional online; N = 21). We compared costs over a one-month treatment period from a health-system perspective and a patient perspective.

Results

The mean treatment costs of both urban online ($1076) and regional ($1206) treatments tended to be slightly higher than urban in-person ($1020) from a health-system perspective. From a patient perspective, the mean treatment cost was $831 in the urban in-person group, $247 in the urban online group and $200 in the regional group.

Discussion

LSVT LOUD® may be delivered via telerehabilitation at a slightly higher cost than in-person delivery from a health-system perspective, but it is cost saving from a patient perspective. Telerehabilitation is an economically beneficial alternative for the delivery of the LSVT LOUD® programme in PD patients with speech disorders.
Skeletal muscle expression of adipose-specific phospholipase in peripheral artery disease
Authors: Parmer Caitlin , De Sousa-Coelho Ana Luisa , Cheng Henry S , Daher Grace , Burkart Alison , Dreyfuss Jonathan M , Pan Hui , Prenner Joshua C , Keilson Jessica M , Pande Reena , Henkin Stanislav , Feinberg Mark W , Patti Mary Elizabeth , Creager Mark A
Published: August 2020

Flow-limiting atherosclerotic lesions of arteries supplying the limbs are a cause of symptoms in patients with peripheral artery disease (PAD). Musculoskeletal metabolic factors also contribute to the pathophysiology of claudication, which is manifest as leg discomfort that impairs walking capacity. Accordingly, we conducted a case–control study to determine whether skeletal muscle metabolic gene expression is altered in PAD. Calf skeletal muscle gene expression of patients with PAD and healthy subjects was analyzed using microarrays. The top-ranking gene differentially expressed between PAD and controls (FDR < 0.001) was PLA2G16, which encodes adipose-specific phospholipase A2 (AdPLA) and is implicated in the maintenance of insulin sensitivity and regulation of lipid metabolism. Differential expression was confirmed by qRT-PCR; PLA2G16 was downregulated by 68% in patients with PAD ( p < 0.001). Expression of Pla2g16 was then measured in control (db/+) and diabetic (db/db) mice that underwent unilateral femoral artery ligation. There was significantly reduced expression of Pla2g16 in the ischemic leg of both control and diabetic mice (by 51%), with significantly greater magnitude of reduction in the diabetic mice (by 79%). We conclude that AdPLA is downregulated in humans with PAD and in mice with hindlimb ischemia. Reduced AdPLA may contribute to impaired walking capacity in patients with PAD via its effects on skeletal muscle metabolism. Further studies are needed to fully characterize the role of AdPLA in PAD and to investigate its potential as a therapeutic target for alleviating symptoms of claudication.
Diminished citizenship in the era of mass incarceration
Authors: Sered Susan Starr
Published: August 2020

This paper lays out a model of diminished citizenship as a tool for understanding the experiences of the large population of people who, at least in part by virtue of their relations with criminal justice apparatuses, do not benefit from the full complement of responsibilities and rights associated with citizenship in a modern democracy. The frame of diminished citizenship places mass incarceration within a larger historical and social context, moving ideas about “criminals” away from the individual focus of mainstream criminology and providing a useful framework for considering how a variety of marginalized groups navigate the American landscape. At the same time, the frame of mass incarceration offers insights into a crucial mechanism for constructing, diminishing and enforcing citizenship in the United States. Our argument draws on our decade-long ethnographic research with a cohort of women who had been released from prison in Massachusetts in 2007–2008.
The imperative and promise of neo-abolitionism in social work
Authors: Gregory Joshua R
Published: August 2020

Neo-abolitionism, the social movement to abolish whiteness, contends that whiteness—not white people—possesses no humane or redeemable quality, in and of itself, but functions solely as the keystone of racialization and systemic racial oppression. Neo-abolitionism has not garnered legitimacy or secured broad commitment from any profession or discipline in the United States. This is unsurprising given the existential anathema, to a society founded upon white supremacy, of such a direct ideological affront and material challenge to the reigning social and institutional order. Practically speaking, though, neo-abolitionism has failed to translate theoretical philosophy to a viable sociopolitical agenda comprised of actionable routes toward social change that might subvert the hegemony of whiteness and erode the social construction of race. As whiteness increasingly inflicts harm and sows division in the contemporary historical moment, social work faces the imperative to seriously consider the merits of neo-abolitionism.

Findings

Where neo-abolitionism has stalled in attempts to move beyond theorization and academic debate in disciplines such as history and sociology, the organizing capacity, praxis techniques, and advocacy expertise of social work—as much a profession as a discipline—offer means of real progress toward abolishing the ideological and material supports of the social construction of whiteness at large, which proliferates racial injustice and undergirds myriad inequities beyond race.

Applications

Neo-abolitionism addresses the imperative faced by social work, in research, practice, and pedagogy, to move beyond mediation and toward elimination of the structural injustices and manifest inhumanities in lived experience propagated by white hegemony.
Same, same but different: A comparative study of the Swedish and German support systems for young victims of crime
Authors: Thunberg Sara , Willems Diana , Schmoll Annemarie , Yngborn Annalena
Published: August 2020

Sweden and Germany are often compared, which suggests that much can be learned from each country. One aspect that needs further investigation concerns support for young victims of crime. The study therefore compares the Swedish and German welfare systems’ handling of young victims who need support after victimization, to see what can be learned from each respective country. The comparisons make it clear that both countries’ support systems developed out of similar social movements in the 1970s. However, there are differences between the two welfare states’ approaches to supporting young people. The reasons for the similarities and differences are discussed, along with practical implications for social policy.
The Ethical Algorithm: Journalist/Whistleblower Relationships Explored Through the Lens of Social Exchange
Authors: Waters Stephenson
Published: August 2020

This study examined the ethical and professional judgments journalists consider when deciding to trust a whistleblower and determined how whistleblowers influence ethical and newsgathering processes. With a qualitative study, this research uncovered common ethical and procedural considerations journalists, who are influenced by gatekeeping forces, make when presented with information from a whistleblower, with the goal to create a conceptual model—an “ethical algorithm”—that journalists employ when deciding to publish whistleblower disclosures. In addition, the decision to build a trust relationship with a whistleblower is examined from the frameworks of ethical considerations, professional standards, and ethics codes. Finally, the journalist–whistleblower relationship is considered as a form of social exchange, a negotiated relationship in which parties determine trust as a result of an exchange of mutually beneficial acts.
A 12-Week Multi-Modal Exercise Program: Feasibility of Combined Exercise and Simplified 8-Style Tai Chi Following Lung Cancer Surgery
Authors: Lu Ting , Denehy Linda , Cao Yuejiao , Cong Qirui , Wu En , Granger Catherine L. , Ni Jun , Edbrooke Lara
Published: August 2020

Objective:

To assess the feasibility, safety, and preliminary effect of a 12-week multi-modal rehabilitation program targeted at improving health-related quality of life and physical activity levels of patients with lung cancer following treatment.

Methods:

Patients with stage I to IIIA non-small cell lung cancer were included 6 to 12 weeks following completion of treatment. The intervention comprised of aerobic exercise (brisk walking), resistance training and 8-style Tai Chi. The 12-week program included 2 supervised center-based sessions per week of 90 minutes duration and home-based exercise. The primary outcomes were the feasibility and safety of the intervention. Secondary outcomes (assessed pre and post program) were physical and patient-reported outcomes.

Results:

Seventy-eight patients were approached during the 6-month recruitment period and 17 (22%) consented to the study. Eight participants (47%) met the definition of adherence to the program (attending at least 70% of supervised sessions). No serious adverse events occurred. A significant reduction in anxiety and depression was observed post-program. In addition, improvements in respiratory function, sleep quality, and some health-related quality of life domains were observed post-program. There were no significant differences in functional capacity or physical activity levels.

Conclusion:

This multi-modal exercise training program was safe, although the feasibility of the program in its current state is not supported given the low consent rate and low adherence to the intervention.
Linking Supervisor and Subordinate’s Negative Work–Family Experience: The Role of Family Supportive Supervisor Behavior
Authors: Pan Su-Ying , Chuang Aichia , Yeh Ying-Jung
Published: August 2020

In the past decade, family supportive supervisor behavior (FSSB) has emerged as an important factor that can help employees manage work–family needs. Although the existing literature has documented the benefits of FSSB, we know little about the emerging process of FSSB. Drawing on the conservation of resources theory, we propose that supervisor engagement in FSSB is influenced by the extent to which the supervisor has sufficient resources for work. This study uses the joint effect of supervisors’ family–work conflict (FWC) and organizational work–family culture to predict the time supervisors spend on core tasks, FSSB, and subordinates’ work–family conflict (WFC), in sequence. Data were collected from paired supervisor–subordinate dyads among 83 supervisors and 276 subordinates. The results indicate that supervisors with high FWC spend more time on core tasks and display less FSSB, which ultimately result in higher subordinates’ WFC, especially in organizations with a lower level of organizational work–family culture. In contrast, supervisors’ FWC does not result in any negative influences on the supervisors themselves or their subordinates at work in organizations with a higher level of organizational work–family culture. Therefore, the theoretical model provides evidence that supervisors’ negative work–family experience cascades down to their subordinates.
Helicopter Pilots’ Tasks, Subjective Workload, and the Role of External Visual Cues During Shipboard Landing
Authors: Tušl Martin , Rainieri Giuseppe , Fraboni Federico , De Angelis Marco , Depolo Marco , Pietrantoni Luca , Pingitore Andrea
Published: August 2020

Helicopter shipboard landing is a cognitively complex task that is challenging both for pilots and their crew. Effective communication, accurate reading of the flight instruments, as well as monitoring of the external environment are crucial for a successful landing. In particular, the final phases of landing are critical as they imply high workload situations in an unstable environment with restricted space. In the present qualitative study, we interviewed ten helicopter pilots from the Italian Navy using an applied cognitive task analysis approach. We aimed to obtain a detailed description of the landing procedure, and to identify relevant factors that affect pilots’ workload, performance, and safety. Based on the content analysis of the interviews, we have identified six distinct phases of approaching and landing on a ship deck and four categories of factors that may significantly affect pilots’ performance and safety of the landing procedure. Consistent with previous studies, our findings suggest that external visual cueing is vital for a successful landing, in particular during the last phases of landing. Therefore, based on the pilots’ statements, we provide suggestions for possible improvements of external visual cues that have the potential to reduce pilots’ workload and improve the overall safety of landing operations.
Care of Children With Disabilities in Rural Areas: Meanings and Impact on Everyday life and Health. Study Protocol
Authors: Cantero-Garlito Pablo A. , Flores-Martos Juan Antonio , Moruno-Miralles Pedro
Published: August 2020

The general objective of this study is to describe and analyze the meanings that participants gave to the experience related to maternal caregiving activities of children with disabilities in the rural context and their impact on daily life and health. In order to achieve this general objective, the following specific objectives were established: (1) To describe the meanings given to experiences related to caregiving activities of children with disabilities; (2) To analyze the impact on daily life and health that these mothers attribute to those activities; (3) To describe how they experience the support provided by the social and healthcare system in rural areas. An interpretative paradigm was selected, using a qualitative approach and a phenomenological design. Twelve mothers were included. Data were collected through semi-structured interviews. A discourse analysis of the narrative information was performed using open, axial, and selective coding processes and the constant comparative method.
Medication management surrounding transitions of care: A qualitative assessment of community pharmacists’ preferences (MEMO TOC)
Authors: Hambrook Miranda , Peterson Shaylee , Gorman Sean , Becotte Greg , Burrows Andrea
Published: August 2020

Background:

Multiple medication changes during hospitalization increase the risk of errors upon discharge. Community pharmacists may face barriers to providing pharmaceutical care because of the lack of clinical information and communication from hospitals. Studies implementing handover to community pharmacists upon hospital discharge reported improved patient outcomes, but interventions were time-consuming.

Methods:

One-on-one interviews and a focus group were conducted to identify community pharmacists’ barriers to providing care to patients recently discharged from hospital and to determine their preferences for hospital discharge prescriptions. Transcripts were qualitatively analyzed using an inductive semantic approach.

Results:

Four one-on-one interviews and an 8-participant focus group were conducted. Participants described barriers to providing care to discharged patients, including lack of communication, incomplete prescriptions, and limited clinical information. Participants identified that the most valuable information to include comprised laboratory values, hospital contact information and annotation of medication changes. These items would improve their abilities to provide timely and high-quality pharmaceutical care.

Interpretation:

Our results were similar to prior literature identifying a lack of communication and clinical information as barriers to providing care to recently discharged patients. Unexpectedly, study participants did not rate medication indication as a strongly preferred information item.

Conclusions:

Hospital discharge prescriptions lack information, which makes it challenging for community pharmacists to provide pharmaceutical care. Discharge prescriptions should include additional clinical information. Can Pharm J (Ott) 2020;153:xx-xx.
Spanning leader–subordinate relationships through negative interactions: An examination of leader–member exchange breaches
Authors: Kangas Hilpi
Published: August 2020

The study aims to discover the dynamic and processual nature of a supervisory relationship (here a leader–member exchange) through a novel, theoretical concept termed leader–member exchange breach, and by examining the characteristics of negative exchange interactions within the leader–member exchange relationship. The notion of the leader–member exchange breach is empirically defined through data on 336 responses to open-ended questions on negative interactions between leaders and subordinates, analyzed through qualitative analysis methods. The results of the study raise questions about the complexity of leader–member exchange relationships and show that breaches of the leader–member exchange relationship might lead to a reassessment of the dyadic relationship between leaders and their subordinates, spanning or even breaking the exchange relationships. This study extends current knowledge on leader–member exchange relationships by providing a viewpoint on the leader–member exchange breach that helps explain the processual and dynamic nature of those relationships through interpersonal interactions and exchanges.
CRITCON-Pandemic levels: A stepwise ethical approach to clinician responsibility
Authors: Harvey Dan , Gardiner Dale , McGee Andrew , DeBeer Thearina , Shaw David
Published: August 2020

CRITCON-Pandemic levels with an associated operational responsibility matrix were recently published by the Intensive Care Society as a modification to Winter Flu CRITCON levels, to better account for differences between a winter flu surge in critical care activity and the capacity challenges of the COVID-19 pandemic. In this paper, we propose an expansion and explanation of the operational matrix to suggest a stepwise ethical approach to clinician responsibility. We propose and outline the main ethical risks created at each level and discuss how those risks can be mitigated through a balanced application of the predominant ethical principle which in turn provides practical guidance to clinician responsibility. We thus seek to specify the ethical and legal principles that should be used in applying the operational matrix, and what the practical effects could be.
Long non-coding RNA LINC00473 acts as a microRNA-29a-3p sponge to promote hepatocellular carcinoma development by activating Robo1-dependent PI3K/AKT/mTOR signaling pathway
Authors: Song Qiqin , Zhang Hongyue , He Jinan , Kong Hongyan , Tao Ran , Huang Yu , Yu Haijing , Zhang Zhongwei , Huang Zhiyong , Wei Lai , Liu Chenghai , Wang Likui , Ning Qin , Huang Jiaquan
Published: August 2020

Background:

Long non-coding RNAs have suppressive or oncogenic effects in various types of cancers by serving as competing endogenous RNAs for specific microRNAs. In the present study, we aim to delineate the underlying mechanism by which the LINC00473/miR-29a-3p/Robo1 axis affects cell proliferation, migration, invasion, and metastasis in hepatocellular carcinoma (HCC).

Methods:

The level of Robo1 was examined in HCC tissues and cells, along with its regulatory effects on proliferation, migration, and invasion of HCC cells. Afterwards, the possible involvement of the PI3K/AKT/mTOR signaling pathway was determined. Next, miR-29a-3p expression was overexpressed or inhibited to investigate its regulatory role on HCC cell activities. The interaction among miR-29a-3p, Robo1, and LINC00473 was further characterized. Finally, a xenograft tumor in nude mice was conducted to measure tumorigenesis and metastasis in vivo.

Results:

miR-29a-3p was downregulated while Robo1 was upregulated in HCC tissues and cells. miR-29a-3p targeted Robo1 and negatively regulated its expression. In response to miR-29a-3p overexpression, Robo1 silencing or LINC00473 silencing, HCC cell proliferation, migration, invasion, tumor progression, and metastasis were impeded, which was involved with the inactivation of the PI3K/AKT/mTOR signaling pathway. Notably, LINC00473 could competitively bind to miR-29a-3p to upregulate Robo1 expression.

Conclusion:

LINC00473 might be involved in HCC progression by acting as a miR-29a-3p sponge to upregulate the expression of Robo1 that activates the PI3K/AKT/mTOR signaling pathway, which leads to enhanced cell proliferation, migration, invasion, tumor progression, and metastasis in HCC.
Divorce in the Digital Age
Authors: Dunn Tasha R.
Published: August 2020

In this article, I propose and use the method of cyber autoethnography to share my lived experience of divorce in the digital landscape and how I navigate this expansive, amorphous, and increasingly complex terrain. My emphasis on the digital expands the realm of autoethnographic research, which has focused primarily on human experiences in physical places. I focus instead on human experiences, particularly those of divorce, in cyberspaces such as Facebook. My vulnerability stems from the recognition that deeper qualitative understandings are needed to help people better navigate their relational histories and futures online as our lives and thus our relationships become inextricably tethered to digital technology.
Transtubular potassium gradient predicts kidney function impairment after adrenalectomy in primary aldosteronism
Authors: Liao Hung-Wei , Wang Shuo-Meng , Chan Chieh-Kai , Lin Yen-Hung , Lin Po-Chih , Ho Chen-Hsun , Liu Yu-Chun , Chueh Jeff S , Wu Vin-Cent , Lai Tai-Shuan , Yang Shao-Yu , Liu Kao-Lang , Chang Chin-Chen , Lee Bo-Chiag , Huang Kuo-How , Lin Lian-Yu , Liao Shih-Cheng , Yen Ruoh-Fang , Lu Ching-Chu , Er Leay-Kiaw , Hu Ya-Hui , Chang Chia-Hui , Wu Che-Hsiung , Tsai Yao-Chou , Chueh Shih-Chieh Jeff , Huang Wei-Chieh , Chen Ying-Ying , Wu Kwan-Dun
Published: August 2020

Background:

In primary aldosteronism (PA), kidney function impairment could be concealed by relative hyperfiltration and emerge after adrenalectomy. We hypothesized transtubular gradient potassium gradient (TTKG), a kidney aldosterone bioactivity indicator, could correlate to end organ damage and forecast kidney function impairment after adrenalectomy.

Methods:

In the present prospective study, we enrolled lateralized PA patients who underwent adrenalectomy and were followed up 12 months after operation in the Taiwan Primary Aldosteronism Investigation (TAIPAI) registry from 2010 to 2018. The clinical outcome was kidney function impairment, defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 at 12 months after adrenalectomy. End organ damage is determined by microalbuminuria and left ventricular mass.

Results:

In total, 323 patients [mean, 50.8 ± 10.9 years old; female 178 (55.1%)] were enrolled. Comparing pre-operation and post-operation data, systolic blood pressure, serum aldosterone, urinary albumin to creatinine ratio and eGFR decreased. TTKG ⩾ 4.9 correlated with pre-operative urinary albumin to creatinine ratio >50 mg/g [odds ratio (OR) = 2.42; p = 0.034] and left ventricular mass (B = 20.10; p = 0.018). Multivariate logistic regression analysis demonstrated that TTKG ⩾ 4.9 could predict concealed chronic kidney disease (OR = 5.42; p = 0.011) and clinical success (OR = 2.90, p = 0.017) at 12 months after adrenalectomy.

Conclusions:

TTKG could predict concealed kidney function impairment and cure of hypertension in PA patients after adrenalectomy. TTKG more than 4.9 as an adverse surrogate of aldosterone and hypokalaemia correlated with pre-operative end organ damage in terms of high proteinuria and cardiac hypertrophy.
Do Glasses Modulate Age Perception?
Authors: Brunet Nicolas M. , Sharp Jonathan
Published: August 2020

No formal studies have reported how glasses influence age perception, except for a London Vision Clinic survey that found that people over 45 look 5 or more years older when wearing eyeglasses. To investigate the effect of eyeglasses and sunglasses on age perception while controlling for age and interpersonal differences, we digitally manipulated the photographs of faces of 50 young adults, to create two age conditions (young and old) and three eyewear conditions (no glasses, eyeglasses, and sunglasses). Participants then estimated the age of the faces, displayed in random order. Contrary to the generally accepted beliefs that wearing eyeglasses makes you look older and wearing sunglasses make you look younger, our results suggest that the effect of glasses on age perception is rather small.
Can parapelvic cysts lead to a non-functioning kidney?
Authors: El-Taji Omar , Alattas Sharifah , Ariyanayagam Ranjan , Warwicker Paul , Chang Sebastian , Goodwin Tanya , Adshead Jim
Published: August 2020

We present a case of non-functioning kidney secondary to a parapelvic cyst in a 45-year-old male who was investigated for a single episode of self-limiting left-sided flank pain. Initial contrast-enhanced computerized tomography (CT) with delayed phases showed a 4 cm left parapelvic cyst and mild renal pelvis dilatation with no other features of obstruction. A Mercaptoacetyltriglycine (MAG3) functional scan showed 52% split function in the affected kidney and prompt drainage with no evidence of obstruction. Although completely asymptomatic after the initial episode we opted to follow him up. Eighteen months on we discovered an atrophic kidney on repeat imaging with a split function of 9% with no change in parapelvic cyst size. We propose that an intermittent silent obstruction, caused by infundibular compression deep inside the kidney, may have caused calyceal dilatation and eventual loss of function in this case. We discuss this rare presentation, review the literature and propose a follow up plan.

Level of evidence: Level 5
Reversing Inoperability in Eisenmenger Syndrome: The “Drug-and-Banding” Approach
Authors: Pradegan Nicola , Pesce Rita , Castaldi Biagio , Zanotto Lorenza , Stellin Giovanni , Vida Vladimiro L.
Published: August 2020

Eisenmenger syndrome (ES) has been considered a cause of inoperability in patients with congenital heart disease (CHD). Even if long-standing vasodilators are efficient to reduce pulmonary vascular resistance (PVR), the best approach to grant stable repair of these patients is still unknown. We describe the case of a 28-year-old man with a diagnosis of untreated large ventricular septal defect and established ES. After few years of vasodilator therapy, the patient underwent pulmonary banding with significant reduction of his PVR. His CHD was then repaired, with clinical and functional improvement at 2-year follow-up.
Right Anterior Mini-Thoracotomy for Discrete Fibromembranous Subaortic Stenosis
Authors: Karangelis Dimos , Loggos Spiros , Mitropoulos Fotios A.
Published: August 2020

Discrete fibromembranous subaortic stenosis is a common type of subaortic stenosis causing clinically significant left ventricular outflow obstruction. Surgery for discrete subaortic stenosis is most often performed through a typical midline sternotomy. Herein, we present our experience with an adult patient who underwent a right mini-thoracotomy for subaortic membrane resection with central cannulation under direct operative vision.
Noninvasive Assessment of Liver Stiffness in Patients Undergoing the Fontan Procedure
Authors: Talwar Sachin , Gudala Vasubabu , Joshi Raja , Shalimar DM , Madhusudhan Kumble Seetharama , Kalaivani Mani , Choudhary Shiv Kumar
Published: August 2020

Background:

Hepatic derangements and liver injury following the Fontan operation (FO) may progress in some cases to hepatic fibrosis (HF) and cirrhosis. The respective roles of transient elastography (TE) or FibroScan, shear wave elastography (SWE), and aspartate transaminase to platelet ratio index (APRI) in assessing liver stiffness (LS) and possible liver injury in these patients are unclear.

Methods:

Thirty-nine patients (31 males), mean age 11.8 ± 5.7 years, median 11 years (interquartile range: 7-14.7 years), undergoing the FO between November 2017 and December 2018 were included. Liver stiffness and HF assessment was done with TE, SWE, and APRI in the preoperative period and postoperatively at 3-, 6-, and 12-month interval.

Results:

The LS values increased over time (postoperative values at 3, 6, and 12 months) as compared to preoperative values by both FibroScan and SWE. The change in liver stiffness measurement (LSM) was statistically significant: LSM0 to LSM3 ( P ≤ .0001), LSM0 to LSM6 ( P ≤ .0001), and LSM0 to LSM12 ( P = .001). Similarly, significant changes were observed on SWE: SWE0 to SWE3 ( P ≤ .0001), SWE0 to SWE6 ( P ≤ .0001), and SWE0 to SWE12 ( P = .001). There was no significant change in the APRI values over time.

Conclusion:

Noninvasive methods such as FibroScan and SWE may be of use to assess LS in follow-up of patients undergoing the FO for early recognition of hepatic changes.
Transcultural reliability and validity of an Italian language version of the Constant–Murley Score
Authors: Carosi Matteo , Galeoto Giovanni , Gennaro Stefano Di , Berardi Anna , Valente Donatella , Servadio Annamaria
Published: August 2020

Purpose:

The present study was designed to carry out an Italian translation of the Constant–Murley Score (CMS-IT) and, subsequently, evaluate its reliability and validity.

Methods:

This study included adults diagnosed with any type of clinical shoulder dysfunction who could read and respond to the questionnaires. Those individuals who underwent surgeries of any kind on the affected shoulder during the previous 12 months and individuals with shoulder instabilities were excluded. All of the participants were evaluated by two operators, and the CMS-IT, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and visual analog scale (VAS) were administered. The internal consistency was evaluated using Cronbach’s α, whereas the intra-rater and inter-rater reliabilities were evaluated using the intraclass correlation coefficient (ICC). The validity of the construction was evaluated using Pearson’s correlation coefficient between the scores of the administered scales.

Results:

A population of 72 individuals participated in this study. The internal consistency of the CMS-IT showed a value of 0.81. The ICC values showed that inter- and intra-rater reliability were 0.994 and 0.963, respectively. CMS-IT is inversely correlated with the VAS (−0.55) and DASH (−0.47) scales.

Conclusions:

This study revealed that the CMS-IT contained good internal consistency and good reliability. The results suggested that the CMS-IT questionnaire is a reliable and valid tool for assessing the shoulder dysfunctions of the Italian population, and it deserves broad applications in both clinical practice and research contexts. The scale can also be used as an alternative to the current “gold standard” VAS and DASH.
Helpfulness of Clinical Visit Summary Content From Multi-Specialty Care: A Mixed-Methods Assessment
Authors: Ramar Priya , Roellinger Daniel L. , Merrick Roma F. , Ebbert Jon O. , Philpot Lindsey M.
Published: August 2020

Objective:

We surveyed patients who visited multiple outpatient specialty practices to understand what summary content was most helpful with the goal of optimizing meaningful outpatient clinical visit summary content.

Materials and Methods:

We constructed a survey instrument to measure delivery, use, and contents of clinical visit summaries. We surveyed patients who visited with at least 2 different outpatient medical specialties to understand preferences.

Results:

Most patients in our sample valued the summary information they received, and retained it as healthcare documentation (84%) and/or quick reference in supporting self-care (70%). Patients most commonly reported that information on results of completed tests (91%) and treatment plan instructions (89%) were very helpful. Additionally, patients expressed the importance of online access to clinical visit summary information.

Discussion:

Most patients used the clinical visit summary as healthcare documentation, and valued online availability of their summary information. Patients most often reported that information on results of recently completed tests and specific instructions on treatment plan were very helpful. Patients who sought further information after their visit most often looked to a provider and/or online.

Conclusions:

Patients valued clinical visit summary accessibility and as a reference tool to summarize care and provide next steps. Optimal clinical visit summaries might collate and integrate assessments and recommendations from multiple specialties into coherent care plans for patients.
“A Crazy Roller Coaster at the End”: A Qualitative Study of Death Preparedness With Caregivers of Persons With Dementia
Authors: Durepos Pamela , Ploeg Jenny , Sussman Tamara , Akhtar-Danesh Noori , Kaasalainen Sharon
Published: August 2020

Introduction

Caregivers of persons with dementia experience challenges that can make preparing for end-of-life particularly difficult. Feeling prepared for death is associated with caregiver well-being in bereavement and is promoted by strategies supporting a palliative approach. Further conceptualization of caregiver preparedness for death of persons with dementia is needed to guide the practice of healthcare providers and to inform development of a preparedness questionnaire.

Objectives

We aimed to: 1) explore the end-of-life experiences of caregivers of persons with dementia to understand factors perceived as influencing preparedness; and 2) identify the core concepts (i.e., components), barriers and facilitators of preparedness for death.

Methods

This study used an interpretive descriptive design. Semi-structured interviews were conducted with sixteen bereaved caregivers of persons with dementia, recruited from long-term care homes in Ontario. Data was analyzed through reflexive thematic analysis.

Findings

Four themes were interpreted including: ‘A crazy rollercoaster at the end’ which described the journey of caregivers at end-of-life. The journey provided context for the development of core concepts (i.e., components) of preparedness represented by three themes: ‘A sense of control, ‘Doing right’ and ‘Coming to terms’.

Conclusion

The study findings serve to expand the conceptualization of preparedness and can guide improvements to practice in long-term care. Core concepts, facilitators and influential factors of preparedness will provide the conceptual basis and content to develop the Caring Ahead: Preparing for End-of-Life with Dementia questionnaire.
When plans are used to no effect: Considering implementation performance of greater Brisbane’s compact activity centre policies
Authors: Limb Mark , Grodach Carl , Donehue Paul , Mayere Severine
Published: August 2020

Evaluations of plan implementation are typically conceived in terms of plan conformance (the degree to which outcomes align with planning intent) or plan performance (the degree to which decision makers apply the plan). In this research, we consider the relationship between performance–conformance by evaluating the implementation of compact activity centre policy in greater Brisbane. We examine two decades of changes to local land use planning regulations using content analysis, quantifications of permitted development intensity, and comparisons of actual land use changes with planned intent, to identify evidence of the use of metropolitan scale activity centre policy. We find that the activity centre policy performed well and was used as intended across the metropolitan area. However, despite strong performance, the policy conformed poorly in terms of achieving the expected outcomes. These findings highlight the importance of understanding plan implementation from both performance and conformance perspectives. While conformance evaluations are essential to connect planning intent to physical outcomes, understanding plan performance is also necessary to explain the results of conformance evaluations and whether conformance successes or failures were due to deficiencies with the plan itself or how the plan was used by key actors charged with its implementation.
Electricity capital and accumulation strategies in the U.S. electricity system
Authors: Harrison Conor
Published: August 2020

The U.S. electricity sector has undergone a series of technological and political economic transformations between 1995 and 2020. Some, but not all, states have moved toward the provision of electricity through wholesale electricity markets, while others have remained traditionally regulated. In addition, electricity is increasingly generated from natural gas and renewable energy, and while total electricity consumption is stagnant in the United States, electric utility revenues have continued to grow. In combination with a growing emphasis on increasing shareholder value, the result of these changes has been the entry of a range of new electricity industry, finance, and regulatory actors, as well as a shift in the ways in which existing actors are seeking to realize surplus value. In light of these changes, in this paper, I outline the contemporary contours and contradictions of the U.S. electricity industry and detail five accumulation strategies being used in the industry. Building on scholarship in energy geography and geographies of finance, and based on the analysis of industry documents and financial analyst reports, I detail how the U.S. electricity has been reshaped by the introduction of new types of technologies, financial risk and investment opportunities, and changing modes of regulation. The resulting accumulation strategies are contested, partial, and incomplete, and are therefore a messy set of overlapping and at times contradictory strategies being deployed in an industry in flux.
Densitometric analysis of cornea in patients with neovascular age-related macular degeneration after intravitreal aflibercept loading dose
Authors: Ucgul Atilgan Cemile , Kosekahya Pinar , Ozkoyuncu Kocabas Dilara , Koc Mustafa , Sakir Goker Yasin
Published: August 2020

Purpose:

To evaluate the anatomic changes in the cornea and anterior segment following intravitreal aflibercept loading dose for neovascular age-related macular degeneration.

Methods:

The study included 40 eyes of 40 patients with neovascular age-related macular degeneration. Each patient underwent a loading dose of one injection per month for three consecutive doses of aflibercept (0.05 ml/2 mg). Before and after the loading dose, a record was made for each patient of corneal topography, anterior segment, corneal densitometry, and lens densitometry parameters with the Pentacam HR and specular microscopy parameters with a non-contact specular microscope. The data before and after the aflibercept loading dose were compared.

Results:

Corneal densitometry parameters in the 0- to 2-mm and 2- to 6-mm concentric zones of the posterior layer were significantly higher after the loading dose compared with baseline ( p = 0.03, p = 0.04, respectively). Corneal densitometry parameters of the anterior, central, and total corneal layer in the 10- to 12-mm concentric zone were also significantly higher after the loading dose compared with baseline ( p = 0.009, p = 0.02, and p = 0.007, respectively). No significant changes were determined in respect of corneal topography, anterior segment, lens densitometry, and specular microscopy parameters ( p > 0.05 for all).

Conclusion:

The aflibercept loading dose caused slightly increased densitometric values in some corneal regions while it did not affect the corneal topography, anterior segment, lens densitometry, and specular microscopy parameters.
Upfront triple combination therapy in severe paediatric pulmonary arterial hypertension
Authors: Haarman Meindina G. , Lévy Marilyne , Roofthooft Marcus T.R. , Douwes Johannes M. , Vissia-Kazemier Theresia R. , Szezepanski Isabelle , Berger Rolf M.F. , Bonnet Damien
Published: August 2020

Treatment strategies in paediatric pulmonary arterial hypertension (PAH) have evolved over the last years, but survival is still poor. Recently, in adults with severe PAH, upfront triple combination therapy (uTCT) from diagnosis has been reported to show significant clinical improvement and excellent long-term outcome. This retrospective, observational study aimed to assess the efficacy of uTCT in paediatric PAH.

Children diagnosed with PAH between 2010 and 2019 and started with uTCT were included. World Health Organization Functional Class (WHO-FC), haemodynamics, echocardiography, 6-min walking distance and serum level ofN-terminal pro-brain-natriuretic-peptide were assessed at baseline, after 3 and 6 months and at last available follow-up. Events were defined as death, lung transplantation or Potts shunt.

21 children (median age 4.8 years (2.5–12.8), 57% females) were included. All children except one were in WHO-FC III or IV (28% and 67%, respectively). After 3 months, one child had died and one child had received a Potts shunt. The remaining 19 children showed clinical and echocardiographic improvement, which persisted at 6 months. Children with idiopathic and heritable PAH showed one-, two- and three-year transplant-free survival estimates of 100%, 94% and 87%, albeit 47% of them receiving a Potts shunt during follow-up.

Children with severe PAH, but not pulmonary veno-occlusive disease, improved significantly with uTCT and showed beneficial up to 3-year survival rates, albeit 47% of them receiving a Potts shunt during follow-up. The role of a Potts shunt in conjunction to uTCT in paediatric PAH needs to be further established.