bluuebunny/crossref_metadata_2025 huggingface dataset:
ResCap: plant resistance gene prediction and probe generation pipeline for resistance gene sequence capture
Authors: Kushwaha Sandeep K , Åhman Inger , Bengtsson Therése
Published: November 2021

The discovery of novel resistance genes (R-genes) is an important component in disease resistance breeding. Nevertheless, R-gene identification from wild species and close relatives of plants is not only a difficult but also a cumbersome process. In this study, ResCap, a support vector machine-based high-throughput R-gene prediction and probe generation pipeline has been developed to generate probes from genomic datasets. ResCap contains two integral modules. The first module identifies the R-genes and R-gene like sequences under four categories containing different domains such as TIR-NBS-LRR (TNL), CC-NBS-LRR (CNL), Receptor-like kinase (RLK) and Receptor-like proteins (RLPs). The second module generates probes from extracted nucleotide sequences of resistance genes to conduct sequence capture (SeqCap) experiments. For the validation of ResCap pipeline, ResCap generated probes were synthesized and a sequence capture experiment was performed to capture expressed resistance genes among six spring barley genotypes. The developed ResCap pipeline in combination with the performed sequence capture experiment has shown to increase precision of R-gene identification while simultaneously allowing rapid gene validation including non-sequenced plants.

Availability and implementation

The ResCap pipeline is available at http://rescap.ltj.slu.se/ResCap/

Contact

sandeep.kushwaha@slu.se or sandeep@niab.org.in

Supplementary information

Supplementary materials are available at Bioinformatics Advances online.
Critical care management of the patient with pulmonary hypertension
Authors: Barnett Christopher F , O’Brien Connor , De Marco Teresa
Published: November 2021

Pulmonary hypertension (PH) is a common diagnosis in patients admitted to the cardiac intensive care unit with a wide range of underlying causes. A detailed evaluation to identify all factors contributing to the elevated pulmonary artery pressure and provide an assessment of right ventricular haemodynamics and function is needed to guide treatment and identify patients at highest risk for poor outcomes. While in many patients management of underlying and triggering medical problems with careful monitoring is appropriate, a subset of patients may benefit from specialized treatments targeting the pulmonary circulation and support of the right ventricle. In such cases, collaboration with or transfer to a centre with special expertise in the management of PH may be warranted.
The Nature and Context of Rules and the Identification of Customary International Law
Authors: Johnston Katie A
Published: November 2021

The International Court of Justice (ICJ) regularly invokes a two-element test for the identification of customary international law: state practice accompanied by opinio juris. Yet the Court’s application of this test has appeared inconsistent. In some cases, an absence of evidence of opinio juris leads to a finding that an alleged rule of customary international law does not exist; yet in other cases, there is no clear evidence of opinio juris on the part of states participating in the practice, but the Court nevertheless concludes that the alleged customary rule exists. In other cases, the Court concludes that a customary rule exists apparently based on evidence of opinio juris alone. This article argues that these judgments do not undermine the ICJ’s claim to be applying a two-element analysis but reveal something fundamental about how customary international law is identified – namely, that how the existence of state practice and opinio juris is evaluated may vary depending on the nature of the customary rule under investigation (for example, whether it is a permissive or prohibitive rule) and the context of underlying international law rules in which that alleged new customary international law rule is located.
The Power of Knowledge: How Think Tanks Impact US Foreign Policy
Authors: Zaytsev Dmitry G , Kuskova Valentina V , Kononova Alexandra
Published: November 2021

Studies on foreign policy consider government as the key actor in policy formulation and implementation. Research, apparently, has devoted far less attention to impact of knowledge brokers, such as think tanks, on policy-making. How and why do think tanks influence US foreign policy? An analysis of five think tanks that differ in terms of their proximity to elites, origin, and ideology reveals two types of nonstate actors’ impact on foreign policy. Think tanks either advocate for own alternative policy proposals, solutions, and actions (“alternatives’ facilitators”), or clarify, justify, and legitimize those of the governments (“policy legitimizers”). These two roles dictate special mechanisms and think tank impact directions. In the first type, think tanks are less oriented toward mass media, but more oriented toward coalitions with nonstate actors and influence the opinions of elites. The second type is the opposite: higher orientation toward mass media and more pronounced connections with elites, and influence on the public. Different origins and strategy of think tanks may be the reasons for some observed differences.
Glue Genes Are Subjected to Diverse Selective Forces during Drosophila Development
Authors: Borne Flora , Kulathinal Rob J , Courtier-Orgogozo Virginie
Published: November 2021

Molecular evolutionary studies usually focus on genes with clear roles in adult fitness or on developmental genes expressed at multiple time points during the life of the organism. Here, we examine the evolutionary dynamics of Drosophila glue genes, a set of eight genes tasked with a singular primary function during a specific developmental stage: the production of glue that allows animal pupa to attach to a substrate for several days during metamorphosis. Using phenotypic assays and available data from transcriptomics, PacBio genomes, and sequence variation from global populations, we explore the selective forces acting on glue genes within the cosmopolitan Drosophila melanogaster species and its five closely related species, D. simulans, D. sechellia, D. mauritiana, D. yakuba, and D. teissieri. We observe a three-fold difference in glue adhesion between the least and the most adhesive D. melanogaster strain, indicating a strong genetic component to phenotypic variation. These eight glue genes are among the most highly expressed genes in salivary glands yet they display no notable codon bias. New copies of Sgs3 and Sgs7 are found in D. yakuba and D. teissieri with the Sgs3 coding sequence evolving rapidly after duplication in the D. yakuba branch. Multiple sites along the various glue genes appear to be constrained. Our population genetics analysis in D. melanogaster suggests signals of local adaptive evolution for Sgs3, Sgs5, and Sgs5bis and traces of selective sweeps for Sgs1, Sgs3, Sgs7, and Sgs8. Our work shows that stage-specific genes can be subjected to various dynamic evolutionary forces.
What does an explanted PASCAL device look like?
Authors: Van Hemelrijck Mathias , Sromicki Juri , Schmiady Martin O , Mestres Carlos-A
Published: November 2021

We report the case of a 78-year-old female patient who had a PASCAL device implanted for severe degenerative mitral regurgitation. Intraprocedural echocardiography revealed persistent severe mitral regurgitation due to device dislocation. Implanting another device was not possible. After 8 days, the device was explanted, and the valve was replaced with a biological prosthesis. The PASCAL device and resected mitral valve leaflets were sent for histopathological workup.
Everyday Cruelties: Political Economies of Migration and Indifference
Authors: Bashovski Marta
Published: November 2021

This article examines how attitudes and structures of indifference to oppression and global inequality—practices of cruelty—are cultivated at both macro (institutional) and micro (everyday life) levels. First, following (Inayatullah and Blaney 2010a, 2010b), I suggest that a core premise of classical political economy—the split between self and other—is depoliticized and rationalized by contemporary discourses of international political economy. This depoliticization is a condition of possibility for attitudes of indifference. Consequently, understanding attitudes and structures of indifference requires re-politicizing political economy as a cultural encounter structured through gendered and racialized hierarchies. Second, I argue that indifference to cruelty is cultivated through recourse to ethical rather than political imperatives, which foreground ethical action in ways that continue to depoliticize the cruelties of global inequality. Two sites animate this project and foreground a form of banal cruelty justified through the cultivation of political indifference: at the microlevel, a dystopian short story that takes an ethicized indifference as the basis for accounting for racialized and gendered labor migration (George Saunders’ “The Semplica Girl Diaries”), and, at the macro-level, Canada's Temporary Foreign Worker programs, which produce depoliticized justifications for systemic racialized exploitation. I argue that this ethicization of political relationships is a way of precluding engagement with the colonial politics of indifference and the everyday cruelties of political economy through which inequalities and exploitations are produced and reproduced.
Assessment of Two Novel Host-Derived Beauveria bassiana (Hypocreales: Cordycipitaceae) Isolates Against the Citrus Pest, Diaphorina citri (Hemiptera: Liviidae)
Authors: Cisneros Jonathan , Wendel Justin , Jaronski Stefan , Vitek Christopher , Ciomperlik Matthew , Flores Daniel
Published: November 2021

The Asian citrus psyllid (ACP), Diaphorina citri Kuwayama (Hemiptera: Liviidae), vectors ‘Candidatus Liberibacter spp.’, the causative agent of Citrus Greening Disease (CGD) or Huanglongbing (HLB). Managing populations of psyllids in the Lower Rio Grande Valley (LRGV), TX, United States is imperative given a continuous increase in HLB-positive trees. A component of integrated pest management (IPM) program is the use of strains of entomopathogenic fungi for the biological control of D. citri. In an attempt to find endemic strains of entomopathogenic fungi that grow favorably under LRGV environmental conditions and naturally infect D. citri, psyllids were collected from local residential areas, surface sterilized, and plated on a semi-selective agar medium. Collection of over 9,300 samples from 278 sites throughout the LRGV led to the positive identification of two Beauveria bassiana (Balsamo-Crivellii) Vuillemin (Hypocreales: Cordycipitaceae) isolates, ACP18001 and ACP18002. Chi-square analysis of primary and secondary acquisition bioassays revealed that both field isolated strains outperformed Cordyceps (Isaria) fumosorosea (Wize) (Hypocreales: Cordycipitaceae) Apopka97 under both primary (direct spray) and secondary acquisition (adult exposure to sprayed foliage) bioassays with ACP18002 marginally outperforming ACP18001 under secondary acquisition. Slopes of the dose response regression lines for the three fungi were not significantly different. In addition, the thermal profiles for vegetative growth of each isolate indicated that the field isolates grew at higher rates than the standard at higher temperatures. The new isolates may prove to be good candidates for the management of D. citri populations in the LRGV.
Jónsson-style canonicity in distributive modal µ-calculus
Authors: Zhao Zhiguang
Published: November 2021

In the present paper, we obtain a Jónsson-style canonicity proof for the Sahlqvist fragment of distributive modal $\mu $-calculus in clopen semantics, alternative to the canonicity-via-correspondence argument in Conradie and Craig (2017, Journal of Logic and Computation, 27, 705–748), generalizing the results in Bezhanishvili and Hodkinson (2012, Theoretical Computer Science, 424, 1–19). The key ingredient of this proof is a characterization result about $\sigma $-contracting maps.
Taking back control? Rule by law(s) and the executive in the post-Brexit world
Authors: Barnard Catherine
Published: November 2021

This article argues that the current reassertion of parliamentary sovereignty is, in fact, the reassertion of the control of the executive (Whitehall), to the detriment of genuine control by parliament (Westminster). Parliament is being used to pass Acts of Parliament to take back control from the EU, but with remarkably little scrutiny. And, in that process, those Acts are being used to authorize the delegation of significant powers to the executive, largely through ‘Henry VIII’ powers. These powers enable ministers, by secondary legislation, to amend or repeal both primary and secondary legislation. Law is being used to take back control. However, the genuine democratic checks on that law are few. The result may be that taking back control from Brussels results in decisions being made by Whitehall, decisions disconnected from, in particular, the sentiments of the devolved administrations and the still large number of people who have never accepted Brexit.
Determinants of the decision to be vaccinated against COVID-19 as exemplified by employees of a long-term health care centre
Authors: Tylec Aneta , Janiszewska Mariola , Siejko Krzysztof , Kucharska Katarzyna
Published: November 2021

Introduction

Health care professionals cover the front line in the battle against infectious diseases. Vaccination of healthcare workers represents a vital element of the strategy for enhancing epidemic safety and improving the quality of health care, inter alia, by limiting microorganism transmission, and reducing patient morbidity and mortality.

Method

The study group consisted of all employees of the long-term health care centre in Lublin, Poland. Participants were requested to complete a questionnaire prepared for the purpose of the study, along with a mandatory COVID-19 vaccination interview questionnaire.

Results

The vaccination coverage rate for the group of medical workers was 77.3% and of non-medical 86%. The most frequently indicated sources of information on vaccination were the mass media. Males more often than females used the press as a source of information on vaccination. Scientific articles were the most common source of information for both people with higher education and medical professionals. The most common motive for vaccination for females is concern for the health of one's family, and for HCWs and people with at least secondary education-concern for the health of patients.

Conclusion

At least one assessed factor influences the decision to be vaccinated. The mass media are of the greatest importance in obtaining information about vaccination.
Longitudinal Follow-up of Preterm Breastfeeding to 12 Weeks Corrected Gestational Age
Authors: Perrella Sharon L. , Nancarrow Kathryn , Rea Alethea , Murray Kevin , Simmer Karen N. , Geddes Donna T.
Published: November 2021

Background:

Preterm infants have shorter breastfeeding duration than that of term infants. Details of postdischarge feeding methods and difficulties are needed to inform the care of preterm breastfeeding dyads.

Purpose:

To describe postdischarge breastfeeding characteristics of mother–preterm infant dyads up to 12 weeks corrected gestational age (CGA).

Methods:

A prospective observational study of preterm dyads (birth 24-33 weeks' gestation) that fed their mother's own milk (MOM) at discharge from a neonatal unit in Perth, Western Australia. Feeding method and frequency, breastfeeding duration, difficulties, and nipple shield use were recorded at 2, 6, and 12 weeks CGA.

Results:

Data were obtained for 49 mothers (singleton infant n = 39, twins n = 10). At 12 weeks CGA, 59% fed any MOM with 47% exclusively fed MOM and 31% fully breastfed. Nipple shield use reduced from 42% at 2 weeks CGA to 11% at 12 weeks CGA. Compared with mothers who exclusively fed MOM at discharge (n = 41) those who fed both MOM and infant formula (n = 8) were more likely to wean before 12 weeks CGA (P < .001). Weaning occurred before 2 weeks CGA in 12/19 (63%), with low milk supply the most frequently cited reason.

Implications for Practice:

Most mothers with a full milk supply at discharge successfully transition to predominant breastfeeding. Frequent milk removal needs to be prioritized throughout the preterm infant's hospital stay.

Implications for Research:

Examination of facilitators and barriers to early and continued frequent milk removal across the postpartum period is required to identify strategies to optimize lactation after preterm birth.
Fewer Patients per Nurse Does Not Offset Increased Nurse Stress Related to Treatment Uncertainty and Mortality in the Neonatal Intensive Care Unit
Authors: Hagan Joseph , Walden Marlene , Brand Melinda Colleen
Published: November 2021

Background:

Many inpatient healthcare institutions' nurse staffing plans systematically assign fewer patients to nurses when patient acuity is high, but the impact of this strategy on components of nurse stress has not been thoroughly investigated.

Purpose:

To examine the relationship between nurse-to-patient ratio assigned based on NICU patient acuity with the Nurse Stress Scale (NSS) subscales Death and Dying, Conflict with Physicians, Inadequate Preparation, Lack of Support, Conflict with Other Nurses, Work Load, and Uncertainty Concerning Treatment.

Methods:

A survey including the NSS tool items, demographic questions, and a question about nurse-to-patient ratio during the shift was administered. Cronbach's α, linear regression, and Spearman's correlation were used for data analysis.

Results:

Analysis of the 72 participating NICU nurses' survey responses showed fewer patients per nurse during the shift was negatively correlated with stress related to Death and Dying (P < .001) and Uncertainty Concerning Treatment (P = .002) subscale scores. This inverse relationship remained significant after controlling for education and years of experience.

Implications for Practice:

The observed higher stress can be inferred to be due to high patient acuity since fewer patients are assigned to nurses caring for high-acuity patients. Improvements in communication to nurses about patients' medical condition, treatment rationale, and information that should be conveyed to the family could reduce nurse stress from treatment uncertainty. Targeted education and counseling could help nurses cope with stress due to patient deaths.

Implications for Research:

Interventions to reduce stress related to treatment uncertainty and death of patients among NICU nurses caring for high-acuity infants should be developed and evaluated.
High-Frequency, Low-Dose Education to Improve Neonatal Outcomes in Low-Resource Settings
Authors: Spies Lori A. , Riley Cheryl , Nair Rakhi , Hussain Naveed , Reddy M. Padmanabh
Published: November 2021

Background:

Annually 2.5 million infants die in the first 28 days of life, with a significant regional distribution disparity. An estimated 80% of those could be saved if neonatal resuscitation were correctly and promptly initiated. A barrier to achieving the target is the knowledge and skills of healthcare workers.

Purpose:

The objective of this cluster randomized trial was to assess the improvement and retention of resuscitation skills of nurses, midwives, and birth attendants in 2 birth centers serving 60 villages in rural India using high-frequency, low-dose training.

Results:

There was a significant difference (P < .05) between the groups in the rate of resuscitation, with 18% needing resuscitation in the control group and 6% in the intervention group. The posttest scores for knowledge retention at the final 8-month evaluation were significantly better in the intervention group than in the control group (intervention group mean rank 19.4 vs control group mean rank 10.3; P < .05). The success rate of resuscitation was not significantly different among the groups.

Implications for Practice:

Improved knowledge retention at 8 months and the lower need for resuscitation in the intervention group support the efficacy of the high-frequency, low-dose education model of teaching in this setting.

Implications for Research:

Replication of these findings in other settings with a larger population cohort is needed to study the impact of such intervention on birth outcomes in low-resource settings.
NICU Staff's Perceptions and Attitudes Toward the Family Integrated Care (FICare) Model
Authors: Tang Xiaoli , Sha Sha , Jin Qian , Lu Hong
Published: November 2021

Background:

Family Integrated Care (FICare) is an innovative model that encourages parents to assume the role of primary caregivers during the neonatal period.

Purpose:

To conduct a survey of neonatal intensive care unit (NICU) nurses and physicians on a national scale to determine their perceptions and attitudes toward FICare.

Methods:

Data on 3 domains were collected: demographic characteristics, FICare perceptions, and attitudes. The survey included 299 NICU nurses and physicians from 31 tertiary-level NICUs across China (response rate = 96.5%).

Results:

The respondents showed a positive attitude toward implementing FICare and recognized its positive impact on infants. However, some respondents raised concerns regarding its feasibility and limitations of the NICU setting. The respondents' perceptions and attitudes of FICare varied based on their personal characteristics, such as marital status and day/night work shifts.

Implications for Practice and Research:

Most NICU nurses and physicians reported that FICare can benefit infants. Despite some constraints related to the NICU environmental conditions, most NICU leaders felt positive about implementing FICare in China. Therefore, establishing key strategies for performing FICare, selecting appropriate personnel, and educating the staff regarding FICare are useful approaches to promote FICare implementation. FICare requires the team's collaborative effort with the support of NICU leaders to overcome system and setting barriers. Nurses should serve as navigators to guide its implementation. More studies on healthcare setting policies, parents' perceptions, and approaches for healthcare professionals to perform FICare in China are required.
Standardized nCPAP Care Bundle to Decrease Days to Wean Off nCPAP
Authors: Kim-Yang Lynne , Huffman Penni
Published: November 2021

Background:

Effective bubble nasal continuous positive airway pressure (bnCPAP) implementation is a means to maintain functional residual capacity (FRC) and avoid pulmonary morbidities in neonates.

Purpose:

A quality improvement project was introduced to establish a standardized bnCPAP care bundle.

Methods:

A bnCPAP care bundle focusing on shoulder roll use, bnCPAP positioning, assessment for suctioning need, and nasopharynx suctioning was created. The outcome measures collected were percentage of time the infant's pulse saturation was less than 86%, corrected gestational age (CGA) when off bnCPAP, length of time a neonate is on bnCPAP, Downes' score, and compliance to bnCPAP care bundle.

Results:

An independent-samples t test found a statistically significant higher mean prior to the initiative in the percentage of time the oxygen saturation was less than 86%, Downes' score, length of time, and CGA to wean off bnCPAP (M = 11.7% ± 10.1%, M = 1.6 ± 1.1, M = 27.7 days ± 29.0 days, and M = 35.0 weeks ± 3.38 weeks, respectively) than after the initiative (M = 4.0% ± 4.8%, M = 1.1 ± 0.8, M = 11.2 days ± 10.2 days, and M = 32.8 weeks ± 1.00 weeks, respectively).

Implications for Practice and Research:

Implementing a standardized bnCPAP care bundle showed improvement in oxygen saturation and increased success of weaning off bnCPAP. Future studies to increase the collected data are needed to compare the outcomes on infants born at each gestational age.
Cyanoacrylate Securement in Neonatal PICC Use
Authors: van Rens Matheus , Nimeri Abdelghafar M. A. , Spencer Timothy R. , Hugill Kevin , Francia Airene L. V. , Olukade Tawa Olayemi , Mahmah Mohamad Adnan
Published: November 2021

Background:

Within every neonatal clinical setting, vascular access devices are considered essential for administration of fluids, nutrition, and medications. However, use of vascular access devices is not without danger of failure. Catheter securement adhesives are being evaluated among adult populations, but to date, studies in neonatal settings are scant.

Purpose:

This research describes the prevalence of peripherally inserted central catheter failure related to catheter securement before and after the introduction of tissue adhesive for catheter securement. The identified modifiable risks might be used to evaluate efficacy, to innovate neonatal practice and support future policy developments.

Method and Setting:

This was a retrospective observational analysis of routinely collected anonymized intravenous therapy-related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar.

Results:

The results showed that the use of an approved medical grade adhesive for catheter securement resulted in significantly less therapy failures, compared with the control group. This remains significant after adjusting for day of insertion, gestational age, birth weight, and catheter type.

Implications for Practice and Research:

In parallel with currently published international literature, this study's findings support catheter securement with an octyl-based tissue adhesive in use with central venous catheters. When device stabilization is most pertinent, securement with tissue adhesive is a safe and effective method for long-term vascular access among the neonatal population.
Percutaneous Treatment With Bridge Plate and Extra-articular Screws in Low-Energy and High-Energy Lisfranc Injuries
Authors: Randolino Juan P. , López Valeria
Published: November 2021

Although there is no consensus regarding surgical treatment of unstable sprains and fractures dislocations of the Lisfranc complex, both anatomic reduction, proper alignment and adequate stabilization of the tarsometatarsal columns are essential when looking for good results. With the advent of minimally invasive surgery, and bearing in mind that the percentages of complications and sequelae despite the good results in reduction quality are still important, we aim to show the clinical and radiographic results over 1-year follow-up obtained by indirect reduction and percutaneous fixation with bridge plate and extra-articular screws in a series of patients with low-energy and high-energy Lisfranc lesions. Eleven patients were operated upon diagnosed with acute tarsometatarsal joint injuries, which showed unstable sprains and/or fracture dislocation with partial articular fracture and a minimum of 1-year follow up. The average age was 30.7 years. The results of the postoperative tomographic controls were as follows: residual joint step average of 0.2 mm, 0.45, and 0 mm in first cuneiform-base of first metatarsal, second cuneiform-base of second metatarsal and third cuneiform-base of third metatarsal, respectively. Anatomical reduction was obtained in the majority of our patients with very good functional results in the evaluated period. Although this is an ongoing investigation, we believe that this method could be taken into account in properly selected patients, even in high-energy injuries.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Nottingham Palmar Plate Arthroplasty for Metacarpophalangeal Joint Noninflammatory Arthritis
Authors: Trickett Ryan W. , Oni John A.
Published: November 2021

Palmar (volar) plate interposition arthroplasty for osteoarthritis (OA) of the metacarpophalangeal (MCP) joints of the fingers is a well-established technique. Its use has diminished since its initial description and introduction because of poor results in patients with inflammatory arthropathy and a difficult surgical technique. We report the surgical technique and mid-term results of the novel Nottingham interposition arthroplasty for noninflammatory MCP joint OA. A dual dorsal and palmar incision is utilized to maximize the harvest of interposition substance. The surgical technique is described and illustrated in full. Prospective data concerning pain, range of movement and function are reported. The results of 12 arthroplasties in 9 patients are reported. At a median follow-up of 76.1 months the median arc of movement was 44 degrees, favoring an improvement in flexion. The median visual analog score for pain was 0, with all but 1 patient reporting no pain at all. Range of movement has been further improved with a progressively less restrictive rehabilitation regimen giving a median arc of 70 degrees in the more recent patients. Compared with modern implant arthroplasty techniques, the Nottingham Palmar Plate Arthroplasty has demonstrated favorable results in terms of range of movement and most importantly resolution of pain. We consider it to be a viable option in the first line management of MCP joint OA.
The Gigli Saw Osteotomy: A One-Man or Two-Man Technique?
Authors: Bor Noam , Dujovny Eytan , Rozen Nimrod , Rubin Guy
Published: November 2021

A method to enhance the use of the Gigli saw by two surgeons instead of one is presented. The completion of the osteotomy is easier, more efficient and safer for the patient.
Phase II Study of the Modified Weekly Nab-paclitaxel Regimen in Previously Treated Patients With Advanced Non–Small Cell Lung Cancer
Authors: Yoshimura Naruo , Sawa Kenji , Nakai Toshiyuki , Matsumoto Yoshiya , Mitsuoka Shigeki , Kimura Tatsuo , Asai Kazuhisa , Yana Takashi , Kawaguchi Tomoya , Hirata Kazuto
Published: November 2021

Objectives:

We conducted a clinical phase II study to evaluate the modified weekly nanoparticle albumin-bound paclitaxel (nab-paclitaxel) regimen in pretreated patients with advanced non–small cell lung cancer (NSCLC).

Materials and Methods:

This multicenter single-arm phase II study enrolled patients with advanced NSCLC who had previously received >1 chemotherapy regimen. Patients received nab-paclitaxel at 80 mg/m2 on days 1, 8, and 15 (21-d cycle). The primary endpoint was the investigator-assessed overall response rate (ORR). Secondary endpoints included overall survival, progression-free survival (PFS), disease control rate, and safety. The planned enrollment was 30 patients according to a Simon 2-stage minimax design.

Results:

Thirty patients were enrolled between November 2015 and August 2017. Seventeen patients (56.7%) had received >2 regimens. The ORR was 23.3% (95% confidence interval [CI], 8.2%-38.4%), meeting the primary objective of the study. Median PFS was 5.7 months (95% CI, 3.4-9.0 mo), and median overall survival was 12.6 months (95% CI, 8.7-20.8 mo). The median number of treatment cycles was 4 (range, 1 to 20) over the entire study period, and median dose intensity was 63.6 mg/m2/wk (range, 45.7 to 100.0 mg/m2/wk). No new safety signals were reported; the most common grade ≥3 adverse events were neutropenia (56.7%), leukopenia (23.3%), and infection (10.0%). No cases of febrile neutropenia were observed.

Conclusions:

Nab-paclitaxel monotherapy with a dose and schedule suitable for outpatients showed high ORR, long median PFS, and acceptable toxicity for patients with previously treated NSCLC. This dosage method may be useful for selected patients.
Techniques to Relieve Pain Associated With Botulinum Injections for Palmar and Plantar Hyperhidrosis
Authors: Nasser Sarah , Farshchian Mehdi , Kimyai‐Asadi Arash , Potts Geoffrey A.
Published: November 2021

BACKGROUND

Palmar and plantar hyperhidrosis (HH) is a common condition characterized by excessive sweating of the palms and soles. Botulinum neurotoxin (BTX) is a very effective and safe treatment. However, the associated intense injection pain is a major limiting factor deterring patients from selecting this treatment.

OBJECTIVE

The aim of this study was to review the numerous techniques used to minimize pain accompanying injections for palmoplantar HH. Additionally, the advantages and limitations of each modality will be discussed.

MATERIALS AND METHODS

The authors performed a comprehensive literature search in PubMed/MEDLINE, Embase, Cochrane Central, and Google Scholar on randomized controlled trials, cohort studies, and case series on techniques to relieve pain of BTX injections for treatment of palmar and plantar HH.

RESULTS

Current available techniques in reducing botulinum injection with merits and drawbacks are nerve blocks, Bier blocks, cryoanalgesia, needle-free anesthesia, topical anesthetics, and vibration anesthesia.

CONCLUSION

Topical anesthesia, ice, and vibration are the safest and most convenient noninvasive available methods to relieve pain associated with botulinum injection. Nerve blocks, Bier block, and needle-free anesthesia provide better anesthesia but are limited by the need for training and equipment.
Determination of Margins for Tumor Clearance in Dermatofibrosarcoma Protuberans: A Single-Center Study of 222 Cases Treated With Modified Mohs Surgery
Authors: Serra-Guillén Carlos , Llombart Beatriz , Nagore Eduardo , Guillén Carlos , Sanmartín Onofre
Published: November 2021

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is an invasive skin tumor traditionally associated with very high recurrence rates when treated with conventional surgery (CS).

OBJECTIVE

To calculate the minimum margin that would have been required to achieve complete tumor clearance with hypothetical CS. To analyze DFSP characteristics and Mohs micrographic surgery (MMS) effectiveness in treatment of this tumor.

MATERIALS AND METHODS

Minimum margin was calculated by measuring the largest distance from the visible edge of the tumor to the edge of the surgical defect. Tumor variables (age, sex, size, time since onset, and location) were correlated with surgical variables (number of stages and minimum margin).

RESULTS

We studied 222 cases of DFSP treated with MMS. A mean of 1.47 MMS stages and a mean minimum margin of 1.23 cm were required to achieve tumor clearance. Tumors on the head and neck required significantly more stages and a significantly wider margin. Tumor size was positively correlated with time to diagnosis, age, and number of MMS stages.

CONCLUSION

Tumors located on the head and neck have greater subclinical extension. Tumor size was also a predictor of surgical difficulty, but time to diagnosis was not.
Management of Transected Invasive Melanoma: A Single Institution Retrospective Review
Authors: Duncan James Robert , Beal Lauren L. , Daugherty Andrew , Elston Carly , Contreras Carlo , Phillips Carlton Blake , Huang Conway
Published: November 2021

BACKGROUND

Deep transection of invasive melanoma precludes accurate measurement of Breslow depth, which may affect tumor staging.

OBJECTIVE

To determine the frequency of upstaging of transected invasive melanomas after excision, characterize the impact on National Comprehensive Cancer Network (NCNN)-recommended treatment, and determine predictors of subsequent upstaging.

MATERIALS AND METHODS

A retrospective review of invasive melanomas between January 2017 and December 2019 at a single institution. Deeply transected biopsy reports were compared with subsequent excisions to calculate the frequency of upstaging.

RESULTS

Three hundred sixty (49.6%) of 726 invasive melanomas identified were transected. Forty-nine (13.6%) transected tumors had upstaging that would have altered NCCN-recommended management. “Broadly” transected tumors had upstaging that would have resulted in a change in the management in 5/23 cases (21.7%) versus 2/41 cases (4.9%) for “focally” transected tumors (p = .038). Breslow depth increased by 0.59 mm on average for “broad” transection versus 0.06 mm for “focal” transection (p =< .01). Of the 89 transected pT1a melanomas, specimens with gross residual tumor or pigment after biopsy were upstaged in 8/17 (47.1%) of cases versus 5/72 (6.9%) of specimens without (p =< .01).

CONCLUSION

Upstaging of deeply transected invasive melanomas that would alter NCCN-recommended management occurred in 13.6% of cases. Broad transection and gross residual tumor or pigment after biopsy predicted higher likelihood of upstaging.
CORRELATION OF PHOTORECEPTOR INTEGRITY WITH RETINAL VESSEL DENSITY AND CHORIOCAPILLARIS IN EYES WITH DIABETIC RETINOPATHY
Authors: Kim Jee Taek , Park Eun Jung
Published: November 2021

Purpose:

To investigate the correlation of foveal photoreceptor integrity with the vessel density (VD) of the retina and choriocapillaris using swept source optical coherence tomography angiography in eyes with diabetic retinopathy.

Methods:

We retrospectively reviewed subjects having eyes with diabetic retinopathy, who underwent optical coherence tomography angiography using swept source optical coherence tomography (DRI OCT Triton; Topcon). We analyzed the area of the foveal avascular zone and VDs of the superficial capillary plexus, deep capillary plexus, and choriocapillaris. The length of the lateral extent of ellipsoid zone disruption, central subfield thickness, and subfoveal choroidal thickness were measured. Furthermore, we analyzed factors that were closely associated with the length of ellipsoid zone disruption.

Results:

A total of 159 eyes with diabetic retinopathy and 30 healthy control eyes were included in this study. In all eyes, the lengths of ellipsoid zone disruption were positively correlated with the foveal avascular zone area (P = 0.009). However, they were negatively correlated with the parafoveal VD of the superficial capillary plexus (P = 0.049), the foveal VD of deep capillary plexus (P = 0.003), and that of the choriocapillaris (P = 0.036).

Conclusion:

The size of the foveal avascular zone and ischemia at the deep capillary plexus may play an important role in maintaining foveal photoreceptor integrity in eyes with diabetic retinopathy. Considering optical coherence tomography angiography artifacts, such as projection and shadowing, future studies are required to reveal the correlation between ellipsoid zone disruption and the VD of the choriocapillaris.
Cataract surgery and intraocular lens placement in patients with Fuchs corneal dystrophy: a review of the current literature
Authors: Moshirfar Majid , Huynh Rachel , Ellis James H.
Published: November 2021

Purpose of review

Late-onset Fuchs endothelial corneal dystrophy (FECD) is seen in approximately 4% of individuals over the age of 40. With the growing population of adults over the age of 65, ophthalmologists need to be aware of the preoperative, perioperative, and postoperative considerations involved in cataract surgery in Fuchs patients.

Recent findings

Management of cataract patients with FECD requires preoperative assessment of endothelial cell size, density, and morphology. Considerations for perioperative endothelial cell loss include patients with hyperopia and shallow anterior chambers, phacoemulsification technique, transfer of ultrasonic energy to the cornea, corneal-protective perioperative agents, as well as thermal and mechanical damage.

Ophthalmologists performing cataract surgery on patients with FECD must carefully consider the risks of endothelial cell loss during surgery and minimize the risk of corneal decompensation after surgery. Preoperative management should evaluate the severity of the FECD as well as individual factors such as cataract density, the health and thickness of the cornea, and the anterior chamber depth. Perioperative techniques, adjustments to biometry calculations, and intraocular lens (IOL) selection may help optimize visual outcomes and recovery time.
Veterans Health Administration Scheduling System: The Path to High Reliability Realization
Authors: Ford Jennifer , MacTaggart Patricia , Gunnar William
Published: November 2021

EXECUTIVE SUMMARY

Timely access to services is the gateway to patient safety and quality, and scheduling is foundational to providing access to highly reliable care. An effective and efficient scheduling strategy is dependent on an evidence-based approach that focuses on critical drivers of the scheduling system related to patient safety and quality as well as access. As part of a continuing effort to improve access, the Veterans Health Administration (VHA) completed a direct causation analysis (2015–2020) using an evidence-based framework and comprehensive measurement plan. The analysis, described here, validates access benefits realized specialty by specialty and facility by facility, identifies opportunities for improvement, and acknowledges limitations of the change from the Veterans Information Systems and Technology Architecture scheduling system to the Medical Appointment Scheduling System.

This analysis of the assessments illustrates business validation structures, drivers, processes, and outcomes that can support leadership decision-making related to access. We drew our assessments of people, processes, policies, and technology from on-site interviews, over-the-shoulder observations, large-group discussions, and data from the VHA Support Service Center and facility data systems; we also mapped process steps, keystrokes, and workflow. Our assessments provided support for the VHA’s decision to implement the stand-alone Cerner scheduling system at one site while continuing to implement the Cerner Millennium electronic health record platform that includes the Cerner scheduling system at other VHA sites. The VHA experience provides lessons learned for healthcare leaders who seek highly reliable efforts to improve access to care.
A Computational Hemodynamics Approach to Left Ventricular Assist Device (LVAD) Optimization Validated in a Large Patient Cohort
Authors: Chivukula Venkat Keshav , Loera Gavin , Dragoljic Dina , Martinez Jasmine , Beckman Jennifer A. , Li Song , Mahr Claudius , Aliseda Alberto
Published: November 2021

With increasing use of left ventricular assist devices (LVAD) it is critical to devise strategies to optimize LVAD speed while controlling mean arterial pressure (MAP) and flow according to patient physiology. The complex interdependency between LVAD speed, MAP, and flow frequently makes optimization difficult under clinical conditions. We propose a method to guide this procedure in silico, narrowing the conditions to test clinically. A computational model of the circulatory network that simulates HF and LVAD support, incorporating LVAD pressure–flow curves was applied retrospectively to anonymized patient hemodynamics data from the University of Washington Medical Center. MAP management on 61 patient-specific computational models with a target of 70 mm Hg, resulting flow for a given LVAD speed was analyzed, and compared to a target output of 5 L/min. Before performing virtual MAP management, 51% had a MAP>70 mm Hg and CO>5 L/min, and 33% had a MAP>70 mm Hg and CO<5 L/min. After changing systemic resistance to meet the MAP target (without adjusting LVAD speed), 84% of cases resulted in CO higher than 5 L/min, with a median CO of 6.79 L/min, using the computational predictive model. Blood pressure management alone is insufficient in meeting both MAP and CO targets, due to the risk of hypervolemia, and requires appropriate LVAD speed optimization to achieve both targets, while preserving right heart health. Such computational tools can narrow down conditions to be tested for each patient, providing significant insight into the pump-patient interplay. LVAD hemodynamic optimization has the potential to reduce complications and improve outcomes.
Posttransplant Long-Term Outcomes for Patients with Ventricular Assist Devices on the Heart Transplant Waitlist
Authors: Whitbread James J. , Etchill Eric W. , Giuliano Katherine A. , Suarez-Pierre Alejandro , Lawton Jennifer S. , Hsu Steven , Sharma Kavita , Choi Chun W. , Higgins Robert S. D. , Kilic Ahmet
Published: November 2021

Ventricular assist devices (LVADs) are commonly used in end-stage heart failure for mechanical circulatory support as a bridge to heart transplantation. However, LVADs’ long-term effects on posttransplant survival are unknown. We sought to compare long-term mortality after transplantation for patients with and without LVADs. Using the Organ Procurement and Transplantation Network database, we investigated LVADs’ impact on long-term (3 month, 1 year, 2 years, 5 years, and 8 years) posttransplant mortality risk for all heart transplant recipients between 2010 and 2019. Time-to-event regression analysis quantified mortality risk by LVAD status in both unconditional and conditional survival analyses. Of 20,113 transplant recipients, 8,999 (45%) had a LVAD while on the waitlist. Among those who died after transplantation, patients with LVADs on average died sooner (1.8 years) than patients without LVADs (3.0 years; p < 0.01). On multivariable analysis, patients with LVADs had a 44% higher mortality risk within the first 3 months posttransplant (HR = 1.44, p = 0.03). There was no significant difference in mortality risk between patients who did and did not have pretransplant LVADs after 1, 2, and 5 years of posttransplant conditional survival. While LVAD patients have a survival disadvantage in the first year posttransplant, conditional survival analysis demonstrated no difference in mortality risk between patients with and without LVADs beyond 1 year of follow up. Of the patients who died posttransplant, patients with LVADs on average died sooner than patients without LVADs.
Comparing the Effects of Traditional Education and Root-Cause Analysis on Nursing Students' Attitudes About Safety Culture and Knowledge of Safe Medication Administration Practices
Authors: Miller Kristi Sanborn
Published: November 2021

Background:

Root-cause analysis (RCA) has been used for decades to support a culture of safety in health care institutions. Although RCA has been recommended for inclusion in a nursing curriculum, little research has been conducted on educational strategies or outcomes.

Purpose:

The study aims were to compare differences in attitudes about safety culture and knowledge of safe medication administration after education about RCA (intervention) versus traditional safe medication administration education (control) and to provide psychometric data for the Safety Attitudes Questionnaire (SAQ) with nursing students.

Methods:

An experimental pretesfy/posttest study was conducted in 3 schools of nursing (N = 117).

Results:

Although there was no significant difference in outcomes between the control and intervention groups, increases in SAQ scores were observed for the intervention group. The Cronbach's α for the SAQ was .93.

Conclusions:

The SAQ is a reliable instrument for measuring safety culture in schools of nursing.