bluuebunny/crossref_metadata_2025 huggingface dataset:
Big Questions in Ecology and Evolution
Authors: Sherratt Thomas N. , Wilkinson David M.
Published: November 2020

Why do we age? Why cooperate? Why do so many species engage in sex? Why do the tropics have so many species? When did humans start to affect world climate? This book provides an introduction to a range of fundamental questions that have taxed evolutionary biologists and ecologists for decades. Some of the phenomena discussed are, on first reflection, simply puzzling to understand from an evolutionary perspective, whilst others have direct implications for the future of the planet. All of the questions posed have at least a partial solution, all have seen exciting breakthroughs in recent years, yet many of the explanations continue to be hotly debated. Big Questions in Ecology and Evolution is a curiosity-driven book, written in an accessible way so as to appeal to a broad audience. It is very deliberately not a formal text book, but something designed to transmit the excitement and breadth of the field by discussing a number of major questions in ecology and evolution and how they have been answered. This is a book aimed at informing and inspiring anybody with an interest in ecology and evolution. It reveals to the reader the immense scope of the field, its fundamental importance, and the exciting breakthroughs that have been made in recent years.
Presenting Science
Authors: Issever Cigdem , Peach Ken
Published: November 2020

Giving a talk' is one of the most important ways in which we communicate our research. The 'talk' covers everything from a ten-minute briefing on progress to a handful of colleagues, to a keynote address to a major international conference with more than a thousand delegates. Whatever the occasion, the aim is the same - to get the message across clearly and effectively. At the same time, presentational skills are becoming more important in all walks of life - and presenting science has particular issues. Our aim is to equip the reader with the basic skills needed to make a good presentation, and our approach is pragmatic, not dogmatic. We emphasise four points: - The goal is to communicate the science to the audience. - The speaker is responsible for everything that appears, and does not appear, on each slide. - The structure and appearance of the presentation are part of the communication process. - There is no standard way of doing things. Giving a good talk on science is a skill that can be learnt like any other: in this book we take the reader through the process of presenting science to a wide variety of audiences.
Best of Five MCQs for MRCPsych Paper 1
Authors: Palaniyappan Lena , Krishnadas Rajeev
Published: November 2020

Following hot on the heels of the launch of the new syllabus and new MRCPsych exam in Spring 2008 by the Royal College of Psychiatrists, this book contains 450 multiple choice questions to help psychiatry trainees to prepare for paper 1 of the exam. Supporting these MCQs are detailed explanatory answers and revision notes, referenced to the key textbooks used by trainees. The book's content is closely matched to the MRCPsych syllabus and includes practice papers for true exam preparation.
Best of Five MCQs for MRCPsych Paper 3
Authors: Palaniyappan Lena , Krishnadas Rajeev
Published: November 2020

Following the recent changes to the syllabus and MRCPsych exam by the Royal College of Psychiatrists, this book contains 450 multiple choice questions to help psychiatry trainees to prepare for Paper 3 of the exam. Supporting these MCQs are detailed explanatory answers and revision notes, referenced to the key textbooks used by trainees. The book's content is closely matched to the MRCPsych syllabus and includes practice papers for true exam preparation.
Principles of oral health promotion
Authors: Daly Blánaid , Batchelor Paul , Treasure Elizabeth , Watt Richard
Published: November 2020

Dental diseases affect a large number of people, cause much discomfort and pain, and are costly to treat. Their impact is therefore considerable, to both the individual and wider society (see Chapters 3 and 21 for a more detailed overview of oral health impacts). A particular concern is the pervasive nature of oral health inequalities with the burden of oral diseases now increasingly experienced amongst less educated and socially excluded groups in society. The causes of dental diseases are well known and effective preventive measures have been identified. However, treatment services still dominate oral health systems around the world. There is growing recognition within the dental profession that treatment services will never successfully treat away the causes of dental diseases (Blinkhorn 1998). In the Lancet , one of the top medical journals, an editorial on oral health highlighted the need to reorient dental services towards prevention (Lancet 2009). What type of preventive approach should be adopted to promote oral health and reduce inequalities? It is essential that preventive interventions address the underlying determinants of oral disease and inequalities to achieve sustainable improvements in population oral health. Effectiveness reviews of clinical preventive measures and health education programmes have highlighted that these approaches do not reduce oral health inequalities and only achieve short-term positive outcomes. A radically different preventive approach is therefore needed. If treatment services and traditional clinical preventive approaches are not capable of dealing effectively with dental diseases, then other options need to be considered. In recent decades, the health promotion movement has arisen, partly in response to the recognized limitations of treatment services to improve the health of the public. With escalating costs and wider acceptance that doctors and dentists are not able to cure most chronic conditions, increasing interest has focused on alternative means of dealing with health problems. The origins of health promotion date back to the work of public health pioneers in the 19th century. At that time, rapid industrialization led to the creation of poor and overcrowded working and living conditions for the majority of the working classes in the large industrial towns and cities of Europe and North America.
Revision Notes for the Respiratory Medicine Specialty Certificate Examination
Authors: Patterson Coleman , Coleman Meg
Published: November 2020

The newly introduced Specialty Certificate Examinations are a compulsory component of assessment for all UK medical trainees and represent the final examination barrier before getting the certificate of completion of training. This book provides a unique exam-specific revision guide for the Respiratory specialty certificate exam. Comprising of best of five test multiple choice questions and revision notes to facilitate targeted study, Revision Notes for the Respiratory Medicine Specialty Certificate Examination is the only book you need to prepare for this important examination. Questions are based around clinical scenarios and supplemented with images of radiological investigations such as x-rays, and lung function tests. Each question is structured as in the exam itself. The second half of the book comprises of a series of tutorials covering key areas and difficult concepts assessed in the examination including respiratory infection, respiratory malignancy, industrial lung disease, sleep disorders, standard respiratory tests and medical statistics. The combined approach allows trainees to become acquainted with the "best of five" format and facilitate recognition of areas of weakness and targeted study.
Measuring, Assessing and Recording: Pulse, Body Temperature, Respirations and Oxygen Saturation
Authors: Deamer Paula , Attoe Tina
Published: November 2020

As part of the measuring physical observations simulated examination, students will be asked to measure, assess and record pulse, body temperature, respirations and oxygen saturation. This assessment is becoming more common in all universities as it has been identified as a mandatory simulated assessment within the NMC Essential Skills Clusters (NMC 2007). Although this chapter will focus upon each observation in turn, it is imperative that when undertaking physical observations the findings are not assessed in isolation. Like a jigsaw, each result, alongside the patient’s appearance, pallor, demeanour and responsiveness, link together to form an overall picture of the patient’s condition. The skill of undertaking these observations may sometimes be reviewed as being routine, but the skill has important clinical significance. Students have to demonstrate their underpinning knowledge and to make sense of the relevance of the observations—this can be complex and challenging. Some student nurses will have previous experience, prior to commencing their nurse education training, of taking patients’ physical observations, but the ability to demonstrate an understanding of the underpinning knowledge differentiates between the role of a health care support worker and a student nurse. Revision of key material will enable the student to understand, undertake and assess the relevance of measuring pulse, body temperature, respirations and oxygen saturation. The importance of the professional nurse’s ability to accurately assess, record and evaluate pulse rate, body temperature, respirations and oxygen saturation cannot be underestimated. Concern has been raised that NHS staff are failing to recognize patient deterioration in a timely manner. In a study by the National Patient Safety Agency (NPSA 2007) factors for this lack of recognition included failure to take physical observations, not acknowledging the significance of the observations and finally not reporting on issues that were of concern, or acting upon these findings. Guidelines on recognizing and managing patient deterioration have been issued by NICE (2007) alongside competencies for recognition and management of a deteriorating patient, which all staff working in acute settings should achieve (DOH 2009). Throughout these the importance of assessing, recording, evaluating and appropriately reacting to the results of physical observations cannot be denied.
Basic Life Support (BLS)
Authors: Cree Clare
Published: November 2020

This chapter will focus on preparing you to undertake an OSCE in the skill of basic life support (BLS), in a cardiac arrest situation, following the Resuscitation Council (UK) Guidelines (2010). Basic life support guidance is aimed especially at adults who in their professions have a duty to respond to a cardiac arrest. Basic life support refers to maintaining the airway, breathing and circulation without the use of any equipment, other than protective devices (Resuscitation Council (UK) 2010). A number of studies (Ahmet and Sarac 2009; Berdowski et al. 2009; Oermann et al. 2011) recognize that effective implementation of guidance is likely to be enhanced by comprehensive and timely education. Soar et al. (2010) suggest that survival from cardiac arrest is dependent on a number of factors—particularly that respondents are well equipped and practiced in the skill and that quality educational packages are readily available to those responders. This chapter will endeavour to provide you with the relevant information to revise the components required to complete an OSCE in the skill. Emphasis is placed on the importance of providing effective, good quality chest compressions whilst minimizing any pauses and so maximizing blood flow and oxygenation. Note: The first aspect of the BLS skill you will be expected to carry out during your OSCE is a full risk assessment of the situation including safety and infection control issues. A respondent to any medical emergency should not put themselves or those around them at any risk. If this is impossible, however, measures should be taken to minimize that risk whilst ensuring no further harm comes to the casualty. In your OSCE, you will be expected to review the surrounding area for hazards, e.g. deep water, electricity, oncoming vehicles, fire and smoke, falling debris, biological threats, etc., to ensure your own and the patient’s safety. Note: This will depend on the way in which your OSCE station has been set up and if there are no threats to yourself or the patient you will need to verbalize to the examiner that you have checked the surrounding area and that it is safe for you to continue.
Understanding Cancer
Authors: Hughes Cathy
Published: November 2020

The aim of this chapter is provide an overview of cancer, a biologically similar, but diverse, group of diseases. Understanding the disease process will help the practising nurse to plan nursing care and to seek appropriate specialist advice. Cancer can affect almost any part of the body and has significance for different age groups and within different cultures, so the effect on the individual, the prognosis, and the treatment will significantly differ depending upon cancer site and treatment setting. This chapter will outline symptoms in relation to the site of the body affected to illustrate the effect of cancer on an individual, and consideration will also be given to the wider impact of the disease. This chapter is underpinned by the principles of evidence-based patient-centred care and will focus on the concepts associated with promoting lifestyles that reduce the risk of developing cancer, screening to identify those at risk, detection of early disease, and the care and management of the individual with and beyond cancer. Cancer refers to a condition in which there is abnormal growth of cells. The characteristics of cancer cells are that they divide uncontrollably, do not require stimulation for growth as do normal cells, and are not restrained by the presence of neighbouring cells. Because cancer is concerned with a failure in the growth control mechanism of the cell at a gene or DNA level and because there are potentially as many different types of cancer as there are types of body cell, no two cancers are exactly alike (Cancer Research UK, 2009). The site at which a cancer first develops (primary cancer), such as lung or breast, is often used broadly to describe it; however, cancer is generally defined by the origin of the type of cell that has become cancerous. The most frequent sites and types of cancer are as follows….● Carcinomas—arise in epithelial cells in the skin, gastrointestinal tract, and other internal organs, and make up about 85% of all cancers (Cancer Research UK, 2010a) ● Haematological (blood and lymphatic system) cancers—arise from blood or bone marrow cells; include leukaemia, lymphoma, and myeloma, and make up about 7% of all cancers, but leukaemia is the commonest cancer in children (Cancer Research UK, 2010b)…
Understanding Coronary
Heart Disease
Authors: Pottle Alison
Published: November 2020

The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with coronary heart disease (CHD) in an evidence-based and person-centred way. The chapter will provide a comprehensive overview of the causes, risk factors, and impact of CHD. In guiding you through patient assessment, the differences between acute coronary syndromes (ACS) and angina are established before exploring best practice to deliver care, as well as to prevent or to minimize further ill-health. Nursing assessments and priorities are highlighted throughout, and the nursing management of the symptoms and common health problems associated with coronary heart disease can be found in Chapters 15, 22, 24, and 25, respectively. CHD is defined as the failure of the coronary arteries to deliver adequate oxygen for myocardial work. It is almost always caused by atherosclerosis—a gradual build-up of fatty plaques within the artery wall that reduces blood flow. This failure to meet metabolic demands results in a range of clinical conditions sharing common pathological process (Baxendale, 1992), including ACS and angina. Chest pain is the symptom that informs clinical decision-making. It is classified based on history-taking and investigations such as the electrocardiogram (ECG). Angina was first described by Heberden in 1772 as a ‘painful and disagreeable sensation in the breast, which seems as if it would take their life away if it were to increase or continue.’ (cited by Fox et al., 2006). Stable angina is described as a clinical syndrome that is characterized by discomfort in the chest, jaw, shoulder, back, and arms, typically elicited by exertional emotional stress and relieved by rest or nitroglycerine (Fox et al., 2006). ACS is an umbrella term for several clinical presentations, including unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). The European Society of Cardiology defines ACS as ‘. . . a life threatening manifestation of atherosclerosis . . . caused by a ruptured atherosclerotic plaque . . . causing sudden complete or critical reduction in blood flow’ (Bassand et al., 2007).
Wind Power in Germany
Authors: Valentine Scott
Published: November 2020

In the previous chapter, the malleability of Danish energy policy was highlighted as a key factor behind the successful diffusion of wind power in Denmark. This chapter examines wind power diffusion in Germany, and in the process highlights a different, though equally successful policy ideology. Compared to policy of its Nordic neighbor, wind power development policy in Germany has been far more structured and invariable. In fact, the success of Germany’s wind power development strategy often serves as an exemplar for proponents of consistent feed-in tariff regimes, which is considered by some to be the most effective strategy for driving wind power development. As this chapter will demonstrate, fostering wind power development in Germany is, like in other nations, a complex challenge involving dynamic interactions between government and nongovernment actors. As German wind power capacity expanded, there has been social dissent and utility opposition. Nevertheless, the German government has remained committed to aggressive wind power diffusion policies and has responded to emergent challenges in a remarkably unified manner wherein state, regional, and local government actors have formed integrated problem-solving networks. This chapter also highlights the seamless web of nation-specific STEP factors influencing wind power development that is apparent in Germany. As one pair of researchers observed, wind power development in Germany has been marked by “close interplay between the actors within the political system, technical and economic development, as well as social factors.” As has been the case in most industrialized nations, forces in support of wind power development began to amass during the two energy crises of the 1970s. As the government began to evaluate its alternative energy technology options, nuclear power and wind power emerged as the two most viable utility-scale options. In the 1970s, nuclear power in Germany enjoyed a modicum of developmental success. The nation’s first commercial nuclear power plant commenced operation in 1969. By 2010, nuclear power contributed approximately 22% to Germany’s electricity supply. However, nuclear power development has been contentious. Although there has been industrial support, there has also been strident public opposition, especially since Chernobyl.
Resorption of immune deposits in membranous lupus nephritis following rituximabvsconventional immunosuppressive treatment
Authors: Zickert Agneta , Lannfelt Klas , Schmidt Mende Jan , Sundelin Birgitta , Gunnarsson Iva
Published: November 2020

Objectives

Studies on repeat renal biopsies in membranous LN (MLN) are limited, and evaluation of treatment response is mainly based on proteinuria. EM of renal biopsies from rituximab (RTX)-treated MLN patients has revealed resorption of sub-epithelial ICs. Whether resorption phenomena are useful for treatment evaluation, or differs between treatment regimens is not known. We studied EM findings and clinical treatment response in MLN patients after RTX vs conventional immunosuppressive treatment.

Methods

Twenty-four patients with MLN and renal biopsies performed before and after treatment were included in this retrospective observational study. Laboratory data were collected at both biopsy occasions. Seven patients had received RTX and 17 had received conventional treatment (CYC, MMF or AZA). Electron micrographs of renal tissue were scored using an arbitrary scale (0–3) for the level of sub-epithelial ICs, resorption of ICs and podocyte fusion.

Results

Sub-epithelial ICs decreased after treatment, however not significantly and with no difference between treatments. The resorption phenomena increased after RTX (P = 0.028), but not after conventional therapy (P = 0.29). Six out of seven (86%) RTX-treated patients had increased resorption vs 7/17 (41%) after conventional therapies (P = 0.047). Clinical responders had more pronounced resorption of ICs vs non-responders (P = 0.022).

Conclusions

We report increased resorption of ICs in repeat renal biopsies in MLN, especially after RTX treatment. Increased resorption phenomena were associated with clinical response, suggesting that EM findings may be useful for treatment evaluation in MLN. Although of limited size, the study indicates that RTX is effective both clinically and at a tissue level.
Ultrasonographic Halo Score in giant cell arteritis: association with intimal hyperplasia and ischaemic sight loss
Authors: van der Geest Kornelis S. M. , Wolfe Konrad , Borg Frances , Sebastian Alwin , Kayani Abdul , Tomelleri Alessandro , Gondo Prisca , Schmidt Wolfgang A. , Luqmani Raashid , Dasgupta Bhaskar
Published: November 2020

Objectives

We investigated the relationship between the ultrasonographic Halo Score and temporal artery biopsy (TAB) findings in GCA.

Methods

This is a prospective study including 90 patients suspected of having GCA. Ultrasonography of temporal/axillary arteries and a TAB were obtained in all patients at baseline. An experienced pathologist evaluated whether TAB findings were consistent with GCA, and whether transmural inflammation, giant cells and intimal hyperplasia were present. Ultrasonographic Halo Scores were determined. Receiver operating characteristic analysis was performed.

Results

Twenty-seven patients had a positive TAB, while 32 patients with a negative TAB received a clinical diagnosis of GCA after 6 months of follow-up. Patients with a positive TAB showed higher Halo Scores than patients with a negative TAB. The presence of intimal hyperplasia in the biopsy, rather than the presence of transmural inflammation or giant cells, was associated with elevated Halo Scores in patients with GCA. The Halo Score discriminated well between TAB-positive patients with and without intimal hyperplasia, as indicated by an area under the curve of 0.82 in the receiver operating characteristic analysis. Patients with a positive TAB and intimal hyperplasia more frequently presented with ocular ischaemia (40%) than the other patients with GCA (13–14%).

Conclusion

The ultrasonographic Halo Score may help to identify a subset of GCA patients with intimal hyperplasia, a TAB feature associated with ischaemic sight loss.
Feasibility of using a peer coach to deliver a behavioral intervention for promoting postpartum weight loss in Black and Latina mothers
Authors: Herring Sharon J , Bersani Veronica M , Santoro Christine , McNeil Saleemah J , Kilby Linda M , Bailer Brooke
Published: November 2020

Peer coaching may provide a culturally relevant and potentially scalable approach for delivering postpartum obesity treatment. We aimed to evaluate the feasibility of peer coaching to promote postpartum weight loss among ethnic minority women with obesity. This pilot study was a prospective, parallel-arm, randomized controlled trial. Twenty-two obese, Black or Latina mothers ≤6 months postpartum were recruited from the Philadelphia Special Supplemental Nutrition Education Program for Women, Infants and Children (WIC) and randomly assigned to either: (a) a peer-led weight loss intervention (n = 11) or (b) usual WIC care (n = 11). The intervention provided skills training and problem solving via six calls and two in-person visits with a Black mother trained in behavioral weight control strategies. Text messaging and Facebook served as platforms for self-monitoring, additional content, and interpersonal support. Both arms completed baseline and 14 week follow-up assessments. All participants were retained in the trial. Intervention engagement was high; the majority (55%) responded to at least 50% of the self-monitoring text prompts, and an average of 3.4 peer calls and 1.7 visits were completed. Mean weight loss among intervention participants was −1.4 ± 4.2 kg compared to a mean weight gain of 3.5 ± 6.0 kg in usual WIC care. Most intervention participants strongly agreed that the skills they learned were extremely useful (90%) and that the coach calls were extremely helpful for weight control (80%). Results suggest the feasibility of incorporating peer coaching into a postpartum weight loss intervention for ethnic minority women with obesity. Future research should examine the sustained impact in a larger trial.
An ABA–flavonoid relationship contributes to the differences in drought resistance between different sea buckthorn subspecies
Authors: Gao Guori , Lv Zhongrui , Zhang Guoyun , Li Jiayi , Zhang Jianguo , He Caiyun
Published: November 2020

Drought is the most severe abiotic stress and hinders the normal growth and development of plants. Sea buckthorn (Hippophae rhamnoides Linn.) is a typical drought-resistant tree species. In this study, the leaves of the H. rhamnoides ssp. sinensis (‘FN’) and H. rhamnoides ssp. mongolica (‘XY’) were selected during drought-recovery cycles for RNA sequencing, and physiological and biochemical analyses. The results revealed that drought stress significantly decreased leaf water potential, net photosynthetic rate and stomatal conductance in both sea buckthorn subspecies. Similarly, the contents of flavone, flavonol, isoflavone and flavanone significantly decreased under drought stress in ‘XY’. Conversely, in ‘FN’, the flavone and abscisic acid (ABA) contents were significantly higher under drought stress and recovered after rehydration. Meanwhile, 4618 and 6100 differentially expressed genes (DEGs) were identified under drought stress in ‘FN’ and ‘XY’, respectively. In total, 5164 DEGs were observed in the comparison between ‘FN’ and ‘XY’ under drought stress. This was more than the 3821 and 3387 DEGs found when comparing the subspecies under control and rehydration conditions, respectively. These DEGs were mainly associated with carotenoid biosynthesis, flavonoid biosynthesis, photosynthesis and plant hormone signal transduction. Six hub DEGs (ABCG5, ABCG22, ABCG32, ABCG36, ABF2 and PYL4) were identified to respond to drought stress based on weighted gene co-expression network analysis and Basic Local Alignment Search Tool (BLAST) analysis using DroughtDB. These six DEGs were annotated to play roles in the ABA-dependent signaling pathway. Sixteen RNA sequencing results involving eight genes and similar expression patterns (12/16) were validated using quantitative real-time Polymerase Chain Reaction (PCR). The biochemical and molecular mechanisms underlying the regulation of drought responses by ABA and flavonoids in sea buckthorn were clarified. In this study, gene co-expression networks were constructed, and the results suggested that the mutual regulation of ABA and flavonoid signaling contributed to the difference in drought resistance between the different sea buckthorn subspecies.
Overlooked cryptic diversity inMuschampia(Lepidoptera: Hesperiidae) adds two species to the European butterfly fauna
Authors: Hinojosa Joan C , Dapporto Leonardo , Brockmann Ernst , Dincă Vlad , Tikhonov Valentin , Grishin Nick , Lukhtanov Vladimir A , Vila Roger
Published: November 2020

Cryptic species represent a challenge for documenting global biodiversity. Even in well-studied groups, such as European butterflies, the application of integrative approaches has allowed the recognition of an unexpected number of cryptic taxa. Here, we combine the analysis of mitochondrial (cytochrome c oxidase I, COI) and nuclear (internal transcribed spacer 2, ITS2) markers with geometric morphometrics of the male genitalia to study diversity within the butterfly Muschampia proto. The nuclear marker reveals three well-supported and deeply diverged lineages, which are also detected based on mitochondrial DNA, although the latter recovers one of them as paraphyletic with poor support. These lineages also present distinct male genital characters, which allow blind assignment of > 97% of specimens when applying a jackknife procedure. We conclude that M. proto comprises three cryptic species that started to differentiate ~2 Mya: M. proto, distributed in northern Africa, the Iberian Peninsula and southern France; Muschampia alta comb. & stat. nov., occurring in southern Italy and the Balkan Peninsula; and Muschampia proteides, present in the easternmost part of Europe, the Near East and Iran. This discovery adds two new species to the European butterfly fauna and highlights the necessity to continue investigating potential cryptic diversity.
Risk Factors for Invasive Pulmonary Aspergillosis in Critically Ill Patients With Coronavirus Disease 2019-Induced Acute Respiratory Distress Syndrome
Authors: Chauvet Paul , Mallat Jihad , Arumadura Clothilde , Vangrunderbeek Nicolas , Dupre Céline , Pauquet Philippe , Orfi Annis , Granier Maxime , Lemyze Malcolm
Published: November 2020

Severe coronavirus disease 2019 pneumonia can lead to acute respiratory distress syndrome. Recently, several publications reported on coronavirus disease 2019-associated pulmonary aspergillosis. However, risk factors remain unclear. We retrospectively collected all the cases of coronavirus disease 2019 acute respiratory distress syndrome patients (n = 46) admitted to our 34-bed ICU between March 24, 2020, and May 25, 2020, and identified six patients that met the diagnosis of invasive pulmonary aspergillosis according to previously established definitions. This population exhibited higher severity scores at admission and less hospital discharge compared with noninvasive pulmonary aspergillosis patients. Chronic obstructive pulmonary disease, malnutrition, and systemic corticosteroid use were identified as risk factors for invasive pulmonary aspergillosis in coronavirus disease 2019-induced acute respiratory distress syndrome patients. Coronavirus disease 2019-associated pulmonary aspergillosis may be a serious concern regarding corticosteroids use to control the inflammatory response of coronavirus disease 2019-induced acute respiratory distress syndrome.
Creating Solutions to the Common Problems in Health Professional Workforce Learning Through Human-Centered Design
Authors: Leo Joan , Clark Robyn
Published: November 2020

Health professionals operate within time and resource constrained environments, which can create barriers to engage in learning. There is increasing recognition that a large proportion of learning in the workplace is informal, unstructured, and occurring in the absence of an educator. The experiential nature of workplace learning, environmental constraints, and part-time health workforces require that learning be accessible, flexible, and engaging.
Postapproval trials versus patient registries: comparability of advanced melanoma patients with brain metastases
Authors: Ismail Rawa K. , Sikkes Nienke O. , Wouters Michel W.J.M. , Hilarius Doranne L. , Pasmooij Anna M.G. , van den Eertwegh Alfonsus J.M. , Aarts Maureen J.B. , van den Berkmortel Franchette W.P.J. , Boers-Sonderen Marye J. , de Groot Jan Willem B. , Haanen John B.A.G. , Hospers Geke A.P. , Kapiteijn Ellen , Piersma Djura , van Rijn Roos S. , Suijkerbuijk Karijn P.M. , ten Tije Bert-Jan , van der Veldt Astrid A.M. , Vreugdenhil Art , van Dartel Maaike , de Boer Anthonius
Published: November 2020

Postapproval trials and patient registries have their pros and cons in the generation of postapproval data. No direct comparison between clinical outcomes of these data sources currently exists for advanced melanoma patients. We aimed to investigate whether a patient registry can complement or even replace postapproval trials. Postapproval single-arm clinical trial data from the Medicines Evaluation Board and real-world data from the Dutch Melanoma Treatment Registry were used. The study population consisted of advanced melanoma patients with brain metastases treated with targeted therapies (BRAF- or BRAF-MEK inhibitors) in the first line. A Cox hazard regression model and a propensity score matching (PSM) model were used to compare the two patient populations. Compared to patients treated in postapproval trials (n = 467), real-world patients (n = 602) had significantly higher age, higher ECOG performance status, more often ≥3 organ involvement and more symptomatic brain metastases. Lactate dehydrogenase levels were similar between both groups. The unadjusted median overall survival (mOS) in postapproval clinical trial patients was 8.7 (95% CI, 8.1–10.4) months compared to 7.2 (95% CI, 6.5–7.7) months (P < 0.01) in real-world patients. With the Cox hazard regression model, survival was adjusted for prognostic factors, which led to a statistically insignificant difference in mOS for trial and real-world patients of 8.7 (95% CI, 7.9–10.4) months compared to 7.3 (95% CI, 6.3–7.9) months, respectively. The PSM model resulted in 310 matched patients with similar survival (P = 0.9). Clinical outcomes of both data sources were similar. Registries could be a complementary data source to postapproval clinical trials to establish information on clinical outcomes in specific subpopulations.
The interplay between HIV and COVID-19: summary of the data and responses to date
Authors: Brown Lillian B. , Spinelli Matthew A. , Gandhi Monica
Published: November 2020

Purpose of review

We examine the interplay between the HIV and COVID-19 epidemics, including the impact of HIV on COVID-19 susceptibility and severe disease, the effect of the COVID-19 epidemic on HIV prevention and treatment, and the influence of the HIV epidemic on responses to COVID-19.

Recent findings

Evidence to date does not suggest that people living with HIV (PLWH) have a markedly higher susceptibility to SARS-CoV-2 infection, with disparities in the social determinants of health and comorbidities likely having a greater influence. The majority of literature has not supported a higher risk for severe disease among PLWH in Europe and the United States, although a large, population-based study in South Africa reported a higher rate of death due to COVID-19. Higher rates of comorbidities associated with COVID-19 disease severity among PLWH is an urgent concern. COVID-19 is leading to decreased access to HIV prevention services and HIV testing, and worsening HIV treatment access and virologic suppression, which could lead to worsening HIV epidemic control.

Conclusion

COVID-19 is threatening gains against the HIV epidemic, including the U.S. Ending the HIV Epidemic goals. The ongoing collision of these two global pandemics will continue to need both study and interventions to mitigate the effects of COVID-19 on HIV efforts worldwide.
The Effect of Aromatherapy on Elderly Persons With Dry Skin
Authors: Karadağ Songül , Akça Nazan Kılıç , Çürük Gülsüm Nihal , Kaplan Ali
Published: November 2020

Dry skin, which is one of the most frequent dermatological problems seen in the elderly population, is an important problem that increases with aging. This study was conducted as a randomized controlled experimental trial to determine the effect of aromatherapy, applied to elderly persons residing in a nursing home in a city center, on dry skin. Elderly persons were grouped into a control group (20 elderly persons), an olive oil group (20 elderly persons), and an aromatherapy group (20 elderly persons). When examining between-measurements differences of the groups in the study, skin moisture levels of the elderly individuals in the aromatherapy group increased in all zones, arm, leg, back, and chest, at measurements of the second and fourth weeks compared with the first measurements. This improvement was determined to be higher after the second week. Skin moisture levels of elderly persons in the olive oil group were determined to significantly increase at the arm zone in the fourth week and at the back zone in the second and fourth weeks compared with the first measurements. Skin moisture levels of elderly persons in the control group, on the contrary, did not change in the second and fourth weeks compared with the first measurements and their dry skin continued at the same level. The intervention performed in this manner in the present study can be used in the clinical practice as an effective nursing intervention to reducing dry skin among elderly persons.
Dose Assessment Following a 238Pu-contaminated Wound Case with Chelation and Excision
Authors: Poudel Deepesh , Klumpp John A. , Bertelli Luiz , Dumit Sara , Waters Tom L.
Published: November 2020

The urinary excretion and wound retention data collected after a 238Pu-contaminated wound were analyzed using Markov Chain Monte Carlo (MCMC) to obtain the posterior distribution of the intakes and doses. An empirical approach was used to model the effects of medical treatments (chelation and excision) on the reduction of doses. It was calculated that DTPA enhanced the urinary excretion, on average, by a factor of 17. The empirical analysis also allowed calculation of the efficacies of the medical treatments—excision and chelation averted approximately 76% and 5.5%, respectively, of the doses that would have been if there were no medical treatment. All bioassay data are provided in the appendix for independent analysis and to facilitate the compartmental modeling approaches being developed by the health physics community.
Morphine produces better thermal analgesia in young Huntington mice and are associated with less neuroinflammation in spinal cord
Authors: Liu Yuan-Yuarn , Lin Ya-Chi , Hsiao Hung-Tsung , Wang Jeffery Chi-Fei , Liu Yen-Chin
Published: November 2020

Background:

Huntington’s disease (HD) is an inherited disease characterized by both mental and motor dysfunctions. Our previous studies showed that HD mice demonstrate a diminished pain response. However, few studies have focused on the relationship between HD and morphine analgesia. The purpose of this study is to investigate and compare the analgesic effects of morphine in HD and wild-type (WT) mice.

Methods:

We used clinically similar transgenic HD mice (7-10 weeks of age with motor dysfunction at 8-9 mo of age) carrying a mutant Huntington CAG trinucleotide repeats to evaluate morphine analgesia. The morphine (10 mg/kg subcutaneously) analgesia was evaluated with a tail-flick in hot water (52°C). Mice spinal cords were harvested at the end of the analgesia studies. An immunofluorescence assay and western blotting were used to identify changes in the cells and cytokines.

Results:

Our data demonstrate that preonset young HD mice exhibited a better analgesic response to morphine than the WT mice. Western blotting and an immunohistological examination of the lumbar spinal cord tissue indicated less activation of glial cells and astrocytes in the HD mice compared with the WT mice. The production levels of tumor necrosis factor α and interleukine-1β were also lower in the young HD mice.

Conclusion:

Our data demonstrate better morphine analgesic and less pain-related cytokine responses at the spinal cord level for HD mice. Further studies are needed to determine the morphine analgesia mechanism in HD.
Physician decision support system for idiopathic sudden sensorineural hearing loss patients
Authors: Liao Wen-Huei , Cheng Yen-Fu , Chen Yen-Chi , Lai Ying-Hui , Lai Feipei , Chu Yuan-Chia
Published: November 2020

Background:

Idiopathic sudden sensorineural hearing loss (ISSNHL) is an emergency disease, and its pathogenesis is still largely unknown, making it difficult to diagnose and develop a therapeutic strategy. To predict the treatment outcomes and further customize the treatment strategy, we used a physician decision support system that incorporates complex information from electronic health records. We first developed the infrastructure of the physician decision support system, including an integrated data warehouse and an automatic data de-identification workflow.

Methods:

We next conducted a cohort study to evaluate the treatment outcomes of 757 ISSNHL patients using the modified Siegel’s criteria. The complete recovery (<25 dB) as a hearing outcome for ISSNHL patients was compared based on pretreatment hearing grades and disease onset with adjusted for age and sex after treatment initiation.

Results:

The results showed that a complete recovery hearing outcome based on pretreatment hearing grades and disease onset in consideration of age and sex was associated with a low risk of pretreatment hearing Grade 2 (26-45 dB) (adjusted odds ratio 12.3, 95% confidence interval [CI]: 4.8-31.3) and disease onset ≤7 days (adjusted odds ratio 13.9, 95% CI: 4.2-45.8), respectively. Hearing recovery outcomes among complete recovery and noncomplete recovery (>25 dB) subjects according to pretreatment hearing grades were 32.9% (Grade 2 or 26-45 dB HL), 25.4% (Grade 3 or 46-75 dB HL), 31.1% (Grade 4 or 76-90 dB), and 4.5% (Grade 5, or >90 dB HL) (p < 0.0001). Patients with pretreatment hearing Grade 2 who received treatment within ≤7 days of disease onset had the highest rate of complete recovery (32.9%, 23/70).

Conclusion:

In summary, using the physician decision support system, we successfully identified two predictors, the pretreatment hearing Grade 2 (26-45 dB) and treatment within ≤7 days of disease onset, associated with the highest odds of achieving complete recovery (<25 dB) of hearing in patients with ISSNHL.
Impact of the COVID-19 pandemic on the use of advance care planning services within the veterans administration system in Taiwan
Authors: Lin Ming-Hwai , Hsu Jo-Lan , Chen Tzeng-Ji , Hwang Shinn-Jang
Published: November 2020

Background:

The aim of this study is to investigate the effect of COVID-19 on the outpatient advance care planning (ACP) services provided by veterans hospitals in Taiwan.

Methods:

This study adopted a retrospective data analysis. We investigated ACP services provided by 15 veterans hospitals in Taiwan from 2019 to June 2020. We also conducted a statistical analysis on the ACP services provided by the Taipei Veterans General Hospital.

Results:

From 2019 to June 2020, 15 veterans hospitals in Taiwan provided ACP services to 2493 individuals. The outpatient ACP services declined significantly after January 2020, decreasing from a national average of 206.2 ± 29.2 declarants per month to 106.2 ± 30.8 declarants per month in the 6 months immediately following the COVID-19 pandemic outbreak (p < 0.001). From the official implementation of the ACP in January 2019 to the end of June 2020, a total of 1126 declarants accepted ACP services at the Taipei Veterans General Hospital. When the COVID-19 pandemic was prevalent, the declarants who received ACP services were younger (i.e., 60.1 ± 15.2 vs 65.5 ± 16.3 years; p < 0.001). After the variables had been adjusted, the changes in the characteristics of the declarants receiving ACP services when the COVID-19 pandemic was prevalent were as follows: a significant increase in the percentage of hospital staff receiving ACP services (odds ratio [OR]: 5.460, 95% confidence interval [CI]: 2.378–12.536); An increase in the percentage of declarants who paid for the ACP services received at their own expense (OR: 3.417, 95% CI: 1.591–7.339); and an increase in the percentage of declarants who received the consultations with three or more people (OR: 2.017, 95% CI: 1.278–3.182).

Conclusion:

COVID-19 severely changed outpatient ACP services provided by hospitals. The results obtained by this study offer valuable insight regarding the provision of outpatient ACP services.
Prospective Study of Disease-Specific Quality-of-Life in Sporadic Vestibular Schwannoma Comparing Observation, Radiosurgery, and Microsurgery
Authors: Carlson Matthew L. , Barnes Jason H. , Nassiri Ashley , Patel Neil S. , Tombers Nicole M. , Lohse Christine M. , Van Gompel Jamie J. , Neff Brian A. , Driscoll Colin L. W. , Link Michael J.
Published: November 2020

Background:

Previous cross-sectional studies analyzing quality of life (QOL) outcomes in patients with sporadic vestibular schwannoma (VS) have shown surprisingly little difference among treatment modalities. To date, there is limited prospective QOL outcome data available comparing baseline to posttreatment scores.

Study Design:

Prospective longitudinal study using the disease-specific Penn Acoustic Neuroma Quality of Life (PANQOL) scale.

Setting:

Large academic skull base center.

Patients:

Patients diagnosed with unilateral VS who completed a baseline survey before treatment and at least one posttreatment survey.

Main Outcome Measures:

Change in PANQOL scores from baseline to most recent survey.

Results:

A total of 244 patients were studied, including 78 (32%) who elected observation, 118 (48%) microsurgery, and 48 (20%) stereotactic radiosurgery. Patients who underwent microsurgery were younger (p < 0.001) and had larger tumors (p < 0.001) than those who underwent observation or radiosurgery; there was no significant difference in duration of follow-up among management groups (mean 2.1 yrs; p = 0.28). When comparing the total PANQOL score at baseline to the most recent survey, the net change was only –1.1, –0.1, and 0.3 points on a 100-point scale for observation, microsurgery, and radiosurgery, respectively (p = 0.89). After multivariable adjustment for baseline features, there were no statistically significant changes when comparing baseline to most recent scores within each management group for facial function, general health, balance, hearing loss, energy, and pain domains or total score. However, the microsurgical group experienced a 10.8-point improvement (p = 0.002) in anxiety following treatment, compared with 1.5 (p = 0.73) and 5.3 (p = 0.31) for observation and radiosurgery, respectively.

Conclusions:

In this prospective longitudinal study investigating differences in QOL outcomes among VS treatment groups using the disease-specific PANQOL instrument, treatment did not modify QOL in most domains. Microsurgery may confer an advantage with regard to patient anxiety, presumably relating to the psychological benefit of “cure” from having the tumor removed.
Nomogram for predicting the risk of gastroesophageal varices after primary endoscopic prophylaxis for variceal hemorrhage in patients with cirrhosis
Authors: Zhang Shuo , Song Weiping , Chang Yizhong , Wang Shenglan , Yang Li , Yang Changqing
Published: November 2020

Background and aims

The aim of this study was to identify predictors of non-high-risk gastroesophageal varices and evaluate the probability of the residual high-risk varices in cirrhosis patients after the primary endoscopic treatment.

Patients and methods

Medical records of the patients with cirrhosis admitted for primary endoscopic prophylaxis gastroesophageal varices hemorrhage were retrospectively analyzed. The patients were divided into high-risk varices and non-high-risk varices groups according to the endoscopy. A nomogram was developed based on the results of multivariate Cox analyses. Accuracy of this model was validated by the concordance index (Harrell’s c-index) and calibration curve.

Results

Altogether 117 patients were enrolled between March 2014 and April 2018. The multivariate Cox analyses identified spleen length <140 mm [odds ratio (OR) = 2.715; P = 0.037), small or medium size of esophageal varices (OR = 4.412; P = 0.017), unaccompanied with gastric varices (OR = 7.025; P = 0.003) and frequency of endoscopic variceal ligation ≥one time per 4 months (OR = 3.834; P = 0.034) as independent factors of non-high-risk varices. All significant predictors were incorporated into a nomogram to predict the residual high-risk varices, which showed a notable accuracy with the concordance index (0.833).

Conclusion

The nomogram-based prediction of residual high-risk varices can be used for risk stratification in cirrhosis patients with gastroesophageal varices.