bluuebunny/crossref_metadata_2025 huggingface dataset:
The sounds of fighting: contests between violet vinegar crabs, Episesarma versicolor (Tweedie, 1940) (Decapoda: Brachyura: Sesarmidae), are resolved through acoustic communication
Authors: Goh Song Lin Rigel , Vishnu Hari , Ng Ngan Kee
Published: June 2019

Sound plays an important role in animal communication. Sesarmid crabs (family Sesarmidae) are semi-terrestrial crabs found in tropical and temperate regions, and are known to communicate through acoustic signals. The violet vinegar crab Episesarma versicolor (Tweedie, 1940) is a tree-climber known to possess sound-producing structures. The significance of sounds produced by E. versicolor during intraspecific contests, however, remains unknown. We investigated the context in which sound production occurs by staging 27 trials using male crabs. Three main types of acoustic behaviours were documented: rapping, leg stamping, and vibration. With the exception of vibration, these behaviours were also observed in female crabs. The air or the wood substrate was utilised to transmit acoustic signals, with each sound having unique spectral and temporal features serving different purposes. Rapping and leg stamping may be an advertisement of the sender’s resource-holding potential for territorial defence and asserting dominance during fights. Vibration is likely a victory display that discourages the contest loser as well as individuals in the vicinity from engaging the victor in another fight. Episesarma versicolor can therefore produce acoustic signals that may contain information about the sender, minimising costs associated with direct conflicts.
Determination of Eligibility for Influenza Research: A Clinical Informatics Approach
Authors: Silveira Fernanda P , Saul Melissa , Nowalk Mary Patricia , Saul Sean , Sax Theresa M , Eng Heather , Zimmerman Richard K , Balasubramani Goundappa K
Published: June 2019

Background

A clinical informatics algorithm (CIA) was developed to systematically identify potential enrollees for a test-negative, case-control study to determine influenza vaccine effectiveness, to improve enrollment over manual records review. Further testing may enhance the CIA for increased efficiency.

Methods

The CIA generated a daily screening list by querying all medical record databases for patients admitted in the last 3 days, using specified terms and diagnosis codes located in admission notes, emergency department notes, chief complaint upon registration, or presence of a respiratory viral panel charge or laboratory result (RVP). Classification and regression tree analysis (CART) and multivariable logistic regression were used to refine the algorithm.

Results

Using manual records review, 204 patients (<4/day) were approached and 144 were eligible in the 2014–2015 season compared with 3531 (12/day) patients who were approached and 1136 who were eligible in the 2016–2017 season using a CIA. CART analysis identified RVP as the most important indicator from the CIA list for determining eligibility, identifying 65%–69% of the samples and predicting 1587 eligible patients. RVP was confirmed as the most significant predictor in regression analysis, with an odds ratio (OR) of 4.9 (95% confidence interval [CI], 4.0–6.0). Other significant factors were indicators in admission notes (OR, 2.3 [95% CI, 1.9–2.8]) and emergency department notes (OR, 1.8 [95% CI, 1.4–2.3]).

Conclusions

This study supports the benefits of a CIA to facilitate recruitment of eligible participants in clinical research over manual records review. Logistic regression and CART identified potential eligibility screening criteria reductions to improve the CIA’s efficiency.
Imagining Insurance in Japanese High Schools during the Era of Rapid Modernisation: From ‘Distrust’ to the Japanese ‘Spirit’
Authors: WILLIAMSON Piers R , NAGASHIMA Miori
Published: June 2019

Individual private insurance is a risk-management practice that plays an important role in many people’s lives. Despite its prominence in industrialised countries, it remains an understudied area in Japan studies, where most work has focused on social insurance. Using insights from the governmentality literature, and in particular François Ewald’s concept of an ‘insurantial imaginary’, we examine the changing perceptions towards private non-life insurance during Japan’s period of high growth and rapid modernisation (1964–1992). While individual private insurance developed in Western Europe and the US over hundreds of years, it did not take off in Japan until the early postwar era. We argue that, like in Western Europe and the US, individual private insurance in Japan had to overcome normative resistance. The norms in Japan, however, were different. To illustrate this, we look at winning essays from an annual high school writing competition run by the Japanese insurance industry as part of a wide-ranging publicity campaign. We conclude that private insurance in Japan passed through four stages of moral understanding to successfully incorporate existing counter norms centred on ‘sincerity’ and ‘mutual aid’. What was initially viewed with ‘distrust’ ended up as a supposed manifestation of the Japanese ‘spirit’.
3Postcolonial Theory
Authors: Powell Edward
Published: June 2019

This chapter covers selected research in postcolonial theory published in 2018, beginning with books and edited collections before discussing journal special issues. Literary form features in many of these works, particularly as reconsiderations of ‘minor’ genres and their relationship to capitalism. Meanwhile, the place of postcolonial studies itself within capitalism came under new scrutiny, along with that of world literature.
Host Alternative NADH:Ubiquinone Oxidoreductase Serves as a Susceptibility Factor to Promote Pathogenesis of Rhizoctonia solani in Plants
Authors: Kant Ravi , Tyagi Kriti , Ghosh Srayan , Jha Gopaljee
Published: June 2019

Phytopathogens have evolved mechanisms to utilize host genes (commonly known as susceptibility factors) to promote their pathogenesis. Rhizoctonia solani is a highly destructive fungal pathogen of various plants, including rice. We previously reported rice genes that were differentially regulated during R. solani pathogenesis. In this study, we analyzed the role of tomato homologs of two rice genes, isoflavone reductase (IFR) and alternative NADH:ubiquinone oxidoreductase (NUOR), as potential susceptibility factors for R. solani. Virus-induced gene silencing of NUOR in tomato resulted in compromised susceptibility against R. solani, whereas IFR-silenced plants demonstrated susceptibility similar to that of control plants. NUOR silencing in tomato led to homogenous accumulation of reactive oxygen species (optimum range) upon R. solani infection. In addition, the expression and enzyme activity of some host defense and antioxidant genes was enhanced, whereas H2O2 content, lipid peroxidation, and electrolyte leakage were reduced in NUOR-silenced plants. Similarly, transient silencing of OsNUOR provided tolerance against R. solani infection in rice. Overall, the data presented in this study suggest that NUOR serves as a host susceptibility factor to promote R. solani pathogenesis.
CE: Addressing Implicit Bias in Nursing: A Review
Authors: Narayan Mary Curry
Published: June 2019

This article examines the nature of implicit, or unconscious, bias and how such bias develops. It describes the ways that implicit bias among health care providers can contribute to health care disparities and discusses strategies nurses can use to recognize and mitigate any biases they may have so that all patients receive respectful and equitable care—regardless of their race, ethnicity, religion, sexual orientation, gender identification, socioeconomic status, disabilities, stigmatized diagnoses, or any characteristic that distinguishes them from societal norms.
Surgical Management of Fibroadipose Vascular Anomaly of the Lower Extremities
Authors: Wang Kemble K. , Glenn Rachel L. , Adams Denise M. , Alomari Ahmad I. , Al-Ibraheemi Alyaa , Anderson Megan E. , Chaudry Gulraiz , Fishman Steven J. , Greene Arin K. , Shaikh Raja , Trenor Cameron C. , Kozakewich Harry P. , Spencer Samantha A.
Published: June 2019

Background:

Fibroadipose vascular anomaly (FAVA) is a recently-defined vascular malformation often involving the extremities and presenting in childhood. Patients may present to orthopaedic surgeons with pain, swelling, joint contractures, and leg length discrepancy. There is no established therapy or treatment paradigm. We report on outcomes following surgical excision for patients with this condition.

Methods:

Between 2007 and 2016, all 35 patients that underwent excision of lower-extremity FAVA were retrospectively reviewed using a combination of medical records, radiologic findings, and telemedicine reviews.

Results:

Mean age at initial presentation was 12.3±6.8 years. Mean follow-up from time of definitive diagnosis at our institution was 66 months (range: 12 to 161 mo). Mean follow-up after surgery was 35 months (range: 6 to 138 mo). Females were affected more than males (71% vs. 29%). The most common location of FAVA was in the calf (49%), followed by the thigh (40%). The most commonly involved muscle was gastrocnemius (29%), followed by the quadriceps (26%). At latest follow-up after surgery, there was an improvement in the proportion of patients with pain at rest (63% vs. 29%), pain with activity (100% vs. 60%), as well as analgesia use (94% vs. 37%). Fourteen patients (40%) had symptomatic residual disease or recurrence of FAVA requiring further treatment. Six patients (17%) required further surgery and 6 (17%) required further interventional radiologic procedures. Three patients (9%) required eventual amputation for intractable pain and loss of function. Lesions with direct nerve involvement were associated with persistent neuropathic symptoms at latest follow-up (P=0.002) as well as symptomatic residual disease and/or recurrence requiring further treatment (P=0.01). Seventeen patients (49%) had 19 preoperative joint contractures. Eighteen of the 19 contractures (95%) had sustained improvement at latest follow-up.

Conclusions:

In carefully selected patients, surgical excision of FAVA results in improvement of symptoms. However, symptomatic residual disease and/or recurrence are not uncommon. Direct nerve involvement is associated with a worse outcome.

Level of Evidence:

Level IV—case series.
Life, God, and Help
Authors: Lucas Denise , Bischof Janet , Resick Lenore
Published: June 2019

Women who work, yet remain poor and uninsured, struggle to live with limited resources. This phenomenological study interviewed 57 such women, hearing how they turned to God or other help to accomplish the major theme of life, with additional themes of God and help. Findings can guide nurses caring for these women to validate the importance of nonmonetary resources and assist in obtaining essential community resources to meet their needs.
Evangelism in Patient Care
Authors: Fowler Marsha D.
Published: June 2019

Evangelism has been present in modern nursing care from the days of Nightingale in the Crimea. Even so, there is little in the way of ethical analysis and guidance regarding evangelism in healthcare. This article examines Nightingale's concern about evangelism in nursing care; discusses the boundaries established by the 2015 American Nurses Association Code of Ethics for Nurses with Interpretive Statements; and analyzes ethical issues including vocation, power, vulnerability and voluntariness, religious diversity, spiritual care, harm, and the Great Commission. Within the context of ethical analysis, broad guidelines are provided for nurses in clinical practice.
Predictors of Adverse Outcomes in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Bazoukis George , Letsas Konstantinos P. , Thomopoulos Costas , Tse Gary , Korantzopoulos Panagiotis , Naka Katerina K. , Kalfakakou Vassiliki , Vlachos Konstantinos , Bazoukis Xenophon , Papadatos Stamatis S. , Michelongona Paschalia , Saplaouras Athanasios , Georgopoulos Stamatis , Karamichalakis Nikolaos , Asvestas Dimitris , Liu Tong , Efremidis Michael , Sideris Antonios , Tsioufis Costas , Baranchuk Adrian , Stavrakis Stavros
Published: June 2019

Arrhythmogenic cardiomyopathy (AC) is a hereditary disorder characterized by degeneration of cardiac myocytes and their subsequent replacement by fat and fibrous tissue primarily in the right ventricle. Our study aimed to systematically evaluate the impact of significant demographic, clinical, electrocardiographic, and echocardiographic factors in arrhythmic events in AC patients. MEDLINE and Cochrane library databases were manually searched without year or language restriction or any other limits until July 31, 2017. A pooled odds ratio with 95% confidence intervals was calculated for each of the risk factors. Our search retrieved 26 studies (n = 2680 patients, mean age: 37.9 years old, males: 51.9%) which were included in the quantitative synthesis. The most reliable predicting factors/parameters are the following: (1) male gender, (2) presyncope, (3) left ventricular dysfunction, (4) T-wave inversions in inferior leads, (5) proband status, (6) late potentials, (7) syncope, (8) inducibility at electrophysiological study, (9) right ventricular dysfunction, (10) epsilon waves, and (11) premature ventricular contractions greater than 1000/24 h. On the contrary, family history of sudden cardiac death, palpitations, premature ventricular contractions greater than 500/24 h, and T-wave inversions in right precordial leads fail to determine the outcome in this meta-analysis. In conclusion, multiple risk factors have been associated with arrhythmic events in AC patients. However, larger studies are needed to discriminate those patients who will benefit from implantable cardioverter defibrillators.
Long-term Effects of Cumulative Average PM2.5 Exposure on the Risk of Hemorrhagic Stroke
Authors: Noh Juhwan , Sohn Jungwoo , Han Minkyung , Kang Dae Ryong , Choi Yoon Jung , Kim Hyeon Chang , Suh Il , Kim Changsoo , Shin Dong Chun
Published: June 2019

Background:

Epidemiological studies have revealed associations between the fine particle (PM2.5; aerodynamic diameter <2.5 μm) exposure and cardiovascular disease. Researchers have also recently begun investigating the association between PM2.5 exposure and hemorrhagic stroke (HS) and identifying subpopulations vulnerable to PM2.5 exposure. Long-term cumulative average PM2.5 exposure may affect the risk of HS, and these effects may be modified by risk factors.

Methods:

This retrospective study evaluated the effects of PM2.5 on the time-to-first-diagnosis of HS among 62,676 Seoul metropolitan city residents with 670,431 total person-years of follow-up; this cohort is a subset from a nationally representative cohort of 1,025,340 individuals from the Korean National Health Insurance Service database (2002–2013). A time-dependent Cox proportional hazards model was used to adjust for age, sex, household income, insurance type, body mass index, smoking status, medical history, and family history. The annual mean PM2.5 concentrations for 25 districts were used as the time-dependent variable. Subgroup analyses of the traditional risk factors of HS were performed to evaluate potential effect modifications.

Results:

Each 10-μg/m3 increment in cumulative average PM2.5 exposure was noticeably associated with HS (hazard ratio [HR] = 1.43; 95% confidence interval [CI]: 1.09–1.88). The adverse effects of PM2.5 exposure were modified by ≥65 years of age (HR = 2.00; 95% CI = 1.32, 3.02) and obesity (body mass index ≥25 kg/m2; HR = 1.91; 95% CI = 1.28, 2.84).

Conclusions:

Cumulative average PM2.5 exposure might increase the risk of HS. Elderly (≥65 years) and obese individuals may be more vulnerable to the effects of PM2.5 exposure.
The Relationship Between Occupational Exposure to Low-dose Ionizing Radiation and Changes in Thyroid Hormones in Hospital Workers
Authors: Wong Yi-Sin , Cheng Ya-Yun , Cheng Tain-Junn , Huang Chien-Cheng , Yeh Jun-Jun , Guo How-Ran
Published: June 2019

Background:

The effects of ionized radiation on the thyroid have been extensively studied. However, most studies have focused on high-dose radiation received accidentally or through therapy, and few were on low-dose occupational exposure.

Methods:

Using a retrospective cohort study design, we collected health examination reports from employees who worked on jobs with occupational exposure to radiation at a hospital to evaluate possible changes in the serum thyroid hormones and determine whether there is a dose-response effect. After excluding those with diseases that may affect thyroid function and who were pregnant at any given examination during the study periods we followed the remaining 326 workers for 12 years and evaluated the associations between radiation exposure and changes in serum thyroid hormones using the generalized estimating equation for repeated measures. Data from an external comparison cohort were used to adjust for changes over time.

Results:

We observed declines in triiodothyronine (T3) and thyroxine (T4) over the study period, but not in thyroid-stimulating hormone (TSH). In addition, we found negative dose-response relationships between exposure duration and declines in the serum levels of T3 (a change of −0.037 ng/ml/year after adjusting for sex and age at the beginning of follow-up; 95% confidence interval [CI] = −0.042, −0.032 ng/ml/year) and T4 (−0.115 µg/dl/year; 95% CI = −0.140, −0.091 µg/dl/year). We also observed an increase in the TSH level (0.683 µIU/ml/year; 95% CI = 0.151, 1.214 µIU/ml/year) after the ninth year of follow-up.

Conclusions:

We concluded that despite low exposure doses, occupational exposure to ionizing radiation in healthcare workers still may be associated with the declines in the serum levels of T3 and T4.
Closure of Intractable Enterocutaneous Fistula with a Rectus Abdominis Musculocutaneous Flap
Authors: Hashiguchi Shin-ichiro , Rikimaru Hideaki , Rikimaru-Nishi Yukiko , Ohmaru Youkou , Migita Hisashi , Morihisa Youichiro , Morinaga Keigo , Kiyokawa Kensuke
Published: June 2019

Large enterocutaneous fistulas of the small intestine are rare and difficult to close, particularly if the fistula is associated with massive leakage of digestive juice and the residual intestinal tract is too short for anastomosis. We present a patient who underwent small bowel resection and secondary anastomosis following massive necrosis of the small intestine due to superior mesenteric artery thrombosis. After resection of an enterocutaneous fistula and reanastomosis, the residual small bowel was only 70 cm long with a persistent fistula. We successfully closed the fistula by employing a hinged rectus abdominis musculocutaneous flap. Here, we report our procedure for treating a large enterocutaneous fistula without performing laparotomy and bowel resection.
DIFFERENCE BETWEEN PACHYCHOROID AND NONPACHYCHOROID POLYPOIDAL CHOROIDAL VASCULOPATHY AND THEIR RESPONSE TO ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY
Authors: Chang Yun-Chia , Cheng Cheng-Kuo
Published: June 2019

Purpose:

Recent investigations have found a biphasic pattern of choroidal thickness within polypoidal choroidal vasculopathy (PCV) patients. This study aims to investigate the relationship between choroidal thickness and the clinical features of PCV eyes.

Method:

We investigated the correlation between various clinical features including subfoveal choroidal thickness (SFCT) and the response to 3-monthly anti–vascular endothelial growth factor (VEGF) treatments in 62 consecutive, treatment-naive PCV patients (66 eyes). After finding out SFCT as the only factor that was correlated with anti-VEGF treatment, we then set up to determine a best cutoff line for SFCT that could be used as a parameter to differentiate PCV patients into pachychoroid and nonpachychoroid groups using the Youden index for best combined specificity and sensitivity. We then compared the demographic features, clinical characteristics, and the response to anti-VEGF between both groups, to determine whether there is a difference between these two groups.

Results:

Subfoveal choroidal thickness was the only significant factor for the treatment effect. The SFCT of 267.5 µm is the best cutoff line. The pachychoroid group showed significant younger ages (64.1 ± 9.6 vs. 72.0 ± 8.2, P = 0.004), fewer age-related macular degeneration–like features (50.0 vs. 81.3%, P = 0.027), more central serous chorioretinopathy–like features (typical retinal pigment epithelial mottling [61.1 vs. 16.7%, P = 0.0014] and choroidal vascular hyperpermeability [88.9 vs. 37.5%, P = 0.0002]), and less response to 3-monthly anti-VEGF treatments (27.8 vs. 83.3%, P < 0.0001) as compared to the nonpachychoroid group.

Conclusion:

Polypoidal choroidal vasculopathy patients could be subclassified into pachychoroid and nonpachychoroid groups. The pachychoroid subtype of PCV has significantly younger ages, fewer age-related macular degeneration–like features, more central serous chorioretinopathy–like features, and less response to anti-VEGF treatment.
NONCONFOCAL ULTRA-WIDEFIELD SCANNING LASER OPHTHALMOSCOPY
Authors: Ajlan Radwan S. , Barnard Luke R. , Mainster Martin A.
Published: June 2019

Purpose:

Bowtie-shaped polarization artifacts are often present in nonconfocal ultra-widefield scanning laser ophthalmoscope (SLO) images. We studied these artifacts and evaluated their potential value as clinical biomarkers in screening for center-involving diabetic macular edema (DME).

Methods:

We performed a retrospective, observational, cohort study on 78 diabetic adult patients (143 eyes) who had spectral domain optical coherence tomography and nonmydriatic nonconfocal ultra-widefield SLO testing on the same day. Scanning laser ophthalmoscope green-only (532 nm), red-only (635 nm), and composite pseudocolor (532 plus 635 nm) images were examined for the presence of a foveal bowtie polarization artifact.

Results:

Polarization artifacts were absent in all but one eye with center-involving DME (32 of 33 eyes). Polarization artifacts were also absent in many eyes without center-involving DME (49 of 110 eyes in pseudocolor images). As clinical biomarkers of center-involving DME, artifact absence has high specificity (99, 100, and 98% for green, red, and pseudocolor images, respectively) but poor sensitivity (49, 31, and 40% for green, red, and pseudocolor images, respectively).

Conclusion:

Foveal bowtie-shaped polarization artifacts occur routinely in nonconfocal ultra-widefield SLO images. Their presence indicates preserved foveal Henle fiber layer structure. Contemporary nonconfocal ultra-widefield SLO images lack the sensitivity for their bowtie artifacts to serve as reliable biomarkers in screening for center-involving DME.
Comparison of the Effects of Dovitinib and Bevacizumab on Reducing Neovascularization in an Experimental Rat Corneal Neovascularization Model
Authors: Sahan Berna , Ciftci Ferda , Eyuboglu Signem , Yaba Aylin , Yilmaz Bayram , Yalvac Belkıs Ilgaz
Published: June 2019

Purpose:

To compare the inhibitory effects of dovitinib and bevacizumab for treatment of corneal neovascularization (CNV).

Methods:

Thirty-nine adult female Sprague Dawley rats weighing 180 to 250 g were used. CNV was induced by silver nitrate in the right eye of each rat. After the chemical burn, the animals were randomized into 5 groups. Group 1 did not receive any chemical substance. Group 2 received dimethyl sulfoxide, group 3 received bevacizumab 5 mg/mL, group 4 received dovitinib 5 mg/mL, and group 5 received bevacizumab 5 mg/mL + dovitinib 5 mg/mL topically administered twice daily for 14 days. On the 14th day, slit-lamp examination was performed, and anterior segment photographs were taken. The corneal neovascular area was measured on photographs as the percentage of the cornea's total area using computer imaging analysis. The corneal sections were stained with hematoxylin and eosin for histopathological examination.

Results:

A statistically significant decrease in the percentage of CNV was found in all treatment groups (group 3, group 4, and group 5) compared with the control group (group 1) (P < 0.01). A statistically significant difference in the percentage of CNV was found among group 3, group 4, and group 5 (P = 0.003). The percentage of CNV in group 4 was significantly higher than that in group 3 and group 5 (P
1 = 0.004; P
2 = 0.006). There was no statistically significant difference in the percentage of CNV between group 3 and group 5 (P = 0.228).

Conclusions:

Dovitinib is a newly developed multitargeted tyrosine kinase inhibitor. Topical administration of dovitinib effectively inhibited CNV, but this effect of dovitinib was found less than topical bevacizumab.
Successful Intrathecal Rituximab Administration in Refractory Nonteratoma Anti–N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report
Authors: Casares Maritsa , Skinner Holly J. , Gireesh Elakkat D. , Wombles Christina , Schweitzer Josephine , Gwyn P. Gage , Newton Herbert B. , Makar Sherif M. , Lee Kihyeong , Westerveld Michael
Published: June 2019

N-methyl-D-aspartate receptor (NMDA-R) antibody encephalitis is an immune-mediated disorder characterized by the presence of anti-NMDA antibody in serum and cerebrospinal fluid, with a characteristic combination of psychological and neurological signs and symptoms. The scientific knowledge pertaining to the management of anti–NMDA-R encephalitis is growing. It is important that neuroscience nurses be aware of treatments as well as the newest novel treatment options available. Early aggressive intervention is imperative to recovery. The first line of treatment often includes high-dose steroids, intravenous immunoglobulin, and therapeutic plasma exchange. Second-line therapy for refractory NMDA-R encephalitis includes intravenous rituximab and cyclophosphamide. Even with these treatments, up to 25% of patients may be left with severe deficits or have a fatal outcome.1 It is well known that penetration of monoclonal anti-CD20 antibody therapy (rituximab) into the cerebrospinal fluid is 0.1% of that in the serum.2 Therefore, efficacy of rituximab in the treatment of NMDA encephalitis may be improved by intrathecal administration in selected cases with a poor response to intravenous rituximab. We present a case of anti–NMDA-R encephalitis that was refractory to first- and second-line therapies, who responded to intrathecal rituximab, to highlight a novel treatment that may be able to prevent long-term disability and improve clinical outcomes.
Perinatal Posttraumatic Stress Disorder: A Review of Risk Factors, Diagnosis, and Treatment
Authors: Cirino Nicole H. , Knapp Jacqueline M.
Published: June 2019

Importance

Perinatal posttraumatic stress disorder (P-PTSD) occurs in approximately 3% to 15% of women in the postpartum period. It is often underrecognized, poorly characterized, and undertreated. If untreated, it can lead to maternal and infant morbidity.

Objective

The aim of this review article is to discuss P-PTSD as it relates to the obstetrician gynecologist, focusing specifically on identifying perinatal risk factors, P-PTSD diagnostic tools, and treatment options.

Evidence Acquisition

PubMed, PsycINFO, Cochrane Library, and Scopus were searched on MeSH terms and free text for terms related specifically to P-PTSD. Because of the lack of data on treatment specifically for the perinatal population, a second search for general PTSD treatment guidelines was conducted and incorporated into this review.

Results

Risk factors have been identified in the literature in 4 major categories: obstetric, psychiatric, social, and subjective distress during delivery.

Two diagnostic tests, the general PTSD diagnostic tool, the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the specific diagnostic tool, the Perinatal Post-Traumatic Stress Disorder Questionnaire, can both be helpful for the clinician to diagnose patients who may have P-PTSD.

Individual trauma-focused psychotherapy is first line for treatment of P-PTSD. Immediate debriefing interventions and non–trauma-focused psychotherapy has not been shown to be helpful. If trauma-focused psychotherapy is not available or not preferred, selective serotonin reuptake inhibitors and non–trauma-focused psychotherapy can be used.

Conclusions and Relevance

Identifying and treating P-PTSD have important implications for maternal and neonatal health. Few treatment studies exist for P-PTSD specifically, so combining P-PTSD research with current guidelines for PTSD is necessary to inform clinical practice.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After participating in this CME activity, the participant should be better able to identify several risk factors for the development of PTSD in the perinatal period; describe 2 diagnostic tools to help diagnose and monitor P-PTSD; and compare effective and ineffective treatment options for perinatal PTSD, recognizing the importance of timing of interventions.
An Observational Study of Deep Learning and Automated Evaluation of Cervical Images for Cancer Screening
Authors: Hu Liming , Bell David , Antani Sameer , Xue Zhiyun , Yu Kai , Horning Matthew P. , Gachuhi Noni , Wilson Benjamin , Jaiswal Mayoore S. , Befano Brian , Long L. Rodney , Herrero Rolando , Einstein Mark H. , Burk Robert D. , Demarco Maria , Gage Julia C. , Rodriguez Ana Cecilia , Wentzensen Nicolas , Schiffman Mark
Published: June 2019

(Abstracted from J Natl Cancer Inst 2019; doi: 10.1093/jnci/djy225)

Ninety-nine percent of cervical cancers cases are caused by infections with a human papillomavirus (HPV). This cancer can be prevented in most women by cervical cancer screening and HPV vaccination.
Effect of Expiratory Muscle Strength Training on Swallowing and Cough Functions in Patients With Neurological Diseases
Authors: Wang Zhuo , Wang Zhi , Fang Qi , Li Huiling , Zhang Lulu , Liu Xueyun
Published: June 2019

Objective

The aim of this review was to evaluate and summarize the results of published studies exploring the effects of expiratory muscle strength training on swallowing and cough functions in patients with neurological diseases.

Data Sources

The study used Embase, PubMed, and the Cochrane Library as data sources.

Review Methods

Randomized controlled trials or pretest/posttest studies of adults with neurological diseases were included. The data included basic population characteristics, penetration-aspiration scores, peak expiratory flow rate, cough volume acceleration, and maximum expiratory pressure.

Results

Ten studies were included in this meta-analysis. Compared with the control groups, expiratory muscle strength training in patients with neurological diseases significantly reduced the penetration-aspiration scores (risk ratio = −0.94, 95% confidence interval = 1.27 to −0.61, P < 0.01) but did not increase the voluntary cough peak expiratory flow rate (risk ratio = 0.57, 95% confidence interval = 0.62 to 1.77, P = 0.35), cough volume acceleration (risk ratio = 33.87, 95% confidence interval = 57.11 to 124.85, P = 0.47), or maximum expiratory pressure (risk ratio = 14.78, 95% confidence interval = 16.98 to 46.54, P = 0.36).

Conclusions

Expiratory muscle strength training might improve swallowing function in patients with neurological diseases. However, conclusive evidence supporting the use of this approach in isolation for improving cough function is unavailable. Additional multicenter, randomized clinical trials performed using reliable and valid cough function outcome measures are required to explore the effects of expiratory muscle strength training on cough function.
The Probable Reasons for Dorsal Hump Problems following Let-Down/Push-Down Rhinoplasty and Solution Proposals
Authors: Tuncel Umut , Aydogdu Oguzhan
Published: June 2019

Background:

Nasal hump relapse and its probable reasons or mechanisms have been less discussed after dorsal preservation rhinoplasty. In this article, the authors would like to share their experiences and offer solutions regarding this subject.

Methods:

Five hundred twenty patients who underwent primary rhinoplasty between the years 2015 and 2017 were included in the study. The push-down method was used for noses with a hump less than 4 mm and the let-down procedure was performed for others. Hump height was measured from profile photographs. The cases were evaluated in terms of nasal dorsal problems and their probable mechanisms.

Results:

Five hundred twenty patients, 448 with a straight nose and 72 with a deviated nose, were enrolled in this study. Mean follow-up was 13 months (range, 9 to 16 months). Visible dorsal hump recurrence was observed in 63 patients, and they appeared at 1 to 4 months postoperatively. Forty-one of these had a dorsal hump more than 4 mm preoperatively. Hump recurrence was not more than 2 mm in 34 patients, and they did not wish to have any revision intervention because of cosmetic satisfaction. In 11 cases, the height of the hump recurrence was 2 to 3 mm. These patients were treated with only minimal rasping. The remaining 18 patients had a hump recurrence with a height of 3 to 4 mm. They underwent secondary surgery using let-down rhinoplasty.

Conclusion:

The authors recommend subperichondrial/subperiosteal dissection, subdorsal excision of cartilaginous and bony septum, scoring the resting upper part of the septum just below the keystone area, and performing lateral keystone dissection and preferring let-down procedure for kyphotic noses to prevent hump relapse after dorsal preservation rhinoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Bioinspired self-healing, superliquiphobic and self-cleaning hydrogel-coated surfaces with high durability
Authors: Multanen Victor , Bhushan Bharat
Published: June 2019

Bioinspired self-healing materials are being developed with intrinsic or extrinsic mechanisms. Some materials heal by an external stimulus, such as heat, UV light, pH, electric field and humidity. Hydrogels are among the commonly used materials, which can self-heal by application of an external stimulus. In this study, a self-healing polyacrylamide hydrogel was selected which is known to swell when exposed to water and heal. Silica nanoparticles were added to the hydrogel and a fluorosilane overcoat was used to produce a superliquiphobic surface with a low tilt angle and self-cleaning properties. A fused titania coating on the glass substrate was used to promote adhesion to hydrogel coatings. Hydrogel-based coatings exhibited the ability to repel water and oil, anti-icing properties down to −60°C, self-cleaning, the ability to maintain superliquiphobicity in hot environments up to about 95°C and high wear resistance. The hydrogel-based coating also demonstrated self-healing capability after hydration of a scratched surface.

This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology (part 2)’.
Water droplet dynamics on bioinspired conical surfaces
Authors: Schriner Charles T. , Bhushan Bharat
Published: June 2019

Cacti use the Laplace pressure gradient due to conical geometry as a mechanism for collecting water from fog. Bioinspired surfaces using conical geometry can be developed for water collection from fog for human consumption. A systematic study is presented which investigates the dynamics of water droplets on a bioinspired conical surface. A series of experiments was conducted where a known volume of droplets was deposited on the cone. This was followed by an investigation into droplet dynamics where the droplets are deposited from fog and the volume is unknown. This includes a study on the macroscopic level as well as the microscopic level. The main parameters that were varied for these tests were the tip angle and the cone orientation. The droplet movement observed was compared relatively. Based on captured videos of droplet movement, distance travelled and velocities were measured. The Laplace pressure gradient, gravity and droplet coalescence were found to be the mechanisms of droplet movement on a conical surface. The findings of this study should be of interest in designing bioinspired surfaces with high water collection.

This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology (part 2)’.
A versatile microfluidic device for highly inclined thin illumination microscopy in the mossPhyscomitrella patens
Authors: Elena Kozgunova , Goshima Gohta
Published: June 2019

High-resolution microscopy is a valuable tool to study cellular processes, such as signalling, membrane trafficking, or cytoskeleton remodelling. Several techniques of inclined illumination microscopy allow imaging at near single molecular level; however, the application of these methods to plant cells is limited, due to thick cell walls and necessity to excise a part of the tissue for sample preparation. In this study, we developed simple, easy-to-use microfluidic device for highly inclined and laminated optical sheet (HILO) microscopy using a model plantPhyscomitrella patens. We demonstrated that microfluidic device can be used to culture living cells and enables high-resolution HILO imaging of microtubules without perturbing their dynamics. In addition, our microdevice enables the supply and robust washout of compounds during HILO microscopy imaging, for example to perform microtubule regrowth assay. Furthermore, we tested long-term (48 h) HILO imaging using a microdevice and visualised the developmental changes in the microtubule dynamics during tissue regeneration. The microfluidic device designed in this study provides a novel tool to conduct long-term HILO microscopy and washout assays using plant cells.
Morphology does not covary with predicted behavioural correlations of the domestication syndrome in dogs
Authors: Wheat Christina Hansen , van der Bijl Wouter , Wheat Christopher West
Published: June 2019

Domesticated animals display suites of altered morphological, behavioural and physiological traits compared to their wild ancestors, a phenomenon known as the domestication syndrome (DS). Because these alterations are observed to co-occur across a wide range of present day domesticates, the traits within the DS are assumed to covary within species and a single developmental mechanism has been hypothesized to cause the observed co-occurrence. However, due to the lack of formal testing it is currently not well-resolved if the traits within DS actually covary. Here we test the hypothesis that the presence of the classic morphological domestication traits white pigmentation, floppy ears and curly tails predict the strength of behavioural correlations in support of the DS in 78 dog breeds. Contrary to the expectations of covariation among DS traits, we found that morphological traits did not covary among themselves, nor did they predict the strength of behavioural correlations among dog breeds. Further, the number of morphological traits in a breed did not predict the strength of behavioural correlations. Our results thus contrast with the hypothesis that the DS arises due to a shared underlying mechanism, but more importantly, questions if the morphological traits embedded in the DS are actual domestication traits or post-domestication improvement traits. For dogs, it seems highly likely that strong selection for breed specific morphological traits only happened recently in relation to breed formation. Present day dogs therefore have limited bearing of the initial selection pressures applied during domestication and we should reevaluate our expectations of the DS accordingly.
Largely distinct networks mediate perceptually-relevant auditory and visual speech representations
Authors: Keitel Anne , Gross Joachim , Kayser Christoph
Published: June 2019

Visual speech is an integral part of communication, but it remains unclear whether information carried by lip movements is represented in the same brain regions that mediate acoustic speech comprehension. Our ability to understand acoustic speech seems independent from that to understand visual speech, yet neuroimaging studies suggest that the neural representations largely overlap. Addressing this discrepancy, we tested where the brain represents acoustically and visually conveyed word identities in a full-brain MEG study. Our analyses dissociate cerebral representations that merely reflect the physical stimulus from those that also predict comprehension, and suggest that these overlap only in specific temporal and frontal regions. Moreover, representations predictive of auditory and visual comprehension converge only in angular and inferior frontal regions. These results provide a neural explanation for the behavioural dissociation of acoustic and visual speech comprehension and suggest that cerebral representations encoding word identities may be more modality-specific than often upheld.
MetaPhat: Detecting and decomposing multivariate associations from univariate genome-wide association statistics
Authors: Lin Jake , Tabassum Rubina , Ripatti Samuli , Pirinen Matti
Published: June 2019

Background

Multivariate testing tools that integrate multiple genome-wide association studies (GWAS) have become important as the number of phenotypes gathered from study cohorts and biobanks has increased. While these tools have been shown to boost statistical power considerably over univariate tests, an important remaining challenge is to interpret which traits are driving the multivariate association and which traits are just passengers with minor contributions to the genotype-phenotypes association statistic.

Results

We introduce MetaPhat, a novel bioinformatics tool to conduct GWAS of multivariate and correlated traits using univariate summary results and to decompose multivariate associations into sets of central traits based on intuitive trace plots that visualize Bayesian Information Criterion (BIC) and P-value statistics of multivariate association models. We validate MetaPhat with Global Lipids Genetics Consortium GWAS results, and we apply MetaPhat to univariate GWAS results for 21 heritable and correlated polyunsaturated lipid species from 2,045 Finnish samples, detecting 7 independent loci associated with a cluster of lipid species. In most cases, we are able to decompose these multivariate associations to only 3-5 central traits out of all 21 traits included in the analyses. We release MetaPhat as an open source tool written in Python with built-in support for multi-processing, quality control, clumping and intuitive visualizations using the R software.

Conclusions

MetaPhat efficiently decomposes associations between multivariate phenotypes and genetic variants into smaller sets of central traits and improves the interpretation and specificity of genome-phenome associations.

MetaPhat is available under the MIT license at: https://sourceforge.net/projects/meta-pheno-association-tracer
Untapped microbial composition along a horizontal oxygen gradient in a Costa Rican volcanic influenced acid rock drainage system
Authors: Arce-Rodríguez Alejandro , Puente-Sánchez Fernando , Avendaño Roberto , Libby Eduardo , Mora-Amador Raúl , Rojas-Jimenez Keilor , Pieper Dietmar H. , Chavarría Max
Published: June 2019

Based on the analysis of 16S rRNA gene metabarcoding, here we report the shift in the microbial community structure along a horizontal oxygen gradient (0.40-6.06 mg L−1) in a volcanic influenced acid rock drainage (VARD) environment, known as San Cayetano (Cartago, Costa Rica; pH =2.94-3.06, sulfate ~0.87-1.19 g L−1, iron ~35-61 mg L−1). This VARD is dominated by microorganisms involved in the geochemical cycling of iron, sulfur and nitrogen; however, the identity of the species changes with the oxygen gradient along the river course. The anoxic spring of San Cayetano is dominated by a putative anaerobic sulfate-reducing Deltaproteobacterium as well as sulfur-oxidizing bacteria (such asAcidithiobacillusorSulfobacillus), which favor the process of dissolution of sulfide minerals and oxidation of H2S. In oxic conditions, aerobic iron-oxidizers (Leptospirillum, Acidithrix, Ferritrophicum, Ferrovum) and heterotrophic bacteria (Burkholderiaceae Betaproteobacterium,Trichococcus, Acidocella) were identified among others. Thermoplasmatales archaea closely related to environmental phylotypes found in other ARD/AMD niches were also found throughout the entire ecosystem. This work describes the changes in bacterial diversity, and possible metabolic activities occurring along a horizontal oxygen gradient in a volcanic influenced acid rock drainage system.
Neurally-constrained modeling of human gaze strategies in a change blindness task
Authors: Jagatap Akshay , Jain Hritik , Purokayastha Simran , Sridharan Devarajan
Published: June 2019

Visual attention enables us to engage selectively with the most important events in the world around us. Yet, sometimes, we fail to notice salient events. “Change blindness” – the surprising inability to detect and identify salient changes that occur in flashing visual images – enables measuring such failures in a laboratory setting. We discovered that human participants (n=39) varied widely (by two-fold) in their ability to detect changes when tested on a laboratory change blindness task. To understand the reasons for these differences in change detection abilities, we characterized eye-movement patterns and gaze strategies as participants scanned these images. Surprisingly, we found no systematic differences between scan paths, fixation maps or saccade patterns between participants who were successful at detecting changes, versus those who were not. Yet, two low-level gaze metrics – the mean fixation duration and the variance of saccade amplitudes – systematically predicted change detection success. To explain the mechanism by which these gaze metrics could influence performance, we developed a neurally constrained model, based on the Bayesian framework of sequential probability ratio testing (SPRT), which simulated gaze strategies of successful and unsuccessful observers. The model’s ability to detect changes varied systematically with mean fixation duration and saccade amplitude variance, closely mimicking observations in the human data. Moreover, the model’s success rates correlated robustly with human observers’ success rates, across images. Our model explains putative human attention mechanisms during change blindness tasks and provides key insights into effective strategies for shifting gaze and attention for artificial agents navigating dynamic, crowded environments.

Author Summary

Our brain has the remarkable capacity to pay attention, selectively, to the most important events in the world around us. Yet, sometimes, we fail spectacularly to notice even the most salient events. We tested this phenomenon in the laboratory with a change-blindness experiment, by having participants freely scan and detect changes across discontinuous image pairs. Participants varied widely in their ability to detect these changes. Surprisingly, their success correlated with differences in low-level gaze metrics. A Bayesian model of eye movements, which incorporated neural constraints on stimulus encoding, could explain the reason for these differences, and closely mimicked human performance in this change blindness task. The model’s gaze strategies provide relevant insights for artificial, neuromorphic agents navigating dynamic, crowded environments.