bluuebunny/crossref_metadata_2025 huggingface dataset:
Cause-specific late mortality after allogeneic stem cell transplantation
Authors: Bhatia Smita
Published: December 2019

Conditional on surviving the first 2 to 5 years after allogeneic blood or marrow transplantation (BMT), the 10-year overall survival approaches 80%. Nonetheless, the risk of late mortality remains higher than the age- and sex-matched general population for several years after BMT. The higher mortality rates in transplant recipients translate into shorter projected life expectancies compared with the general population. Risk of relapse-related mortality reaches a plateau within 10 years after BMT. With increasing time from BMT, nonrelapse-related mortality becomes the leading cause of death, and continues to increase with time after BMT. The major causes of nonrelapse mortality include infection (with or without chronic graft-versus-host disease), subsequent neoplasms, and cardiopulmonary compromise. In this review, findings from large cohorts are summarized, identifying opportunities for risk-based anticipatory intervention strategies to reduce mortality.
Pediatric-inspired protocols in adult acute lymphoblastic leukemia: are the results bearing fruit?
Authors: Muffly Lori , Curran Emily
Published: December 2019

Observational findings demonstrating improved survival for younger adults following pediatric, as opposed to adult, acute lymphoblastic leukemia (ALL) regimens have been translated into international, prospective multicenter clinical trials testing the pediatric regimen in young adult ALL. The results of these studies confirm the feasibility of delivering the pediatric regimen in the adult oncology setting and establish the superiority of this approach relative to historical adult cooperative group regimen results. Specific toxicities, including thrombosis, hepatotoxicity, and osteonecrosis, are more prevalent in adults receiving the pediatric regimen relative to young children. Persistent minimal residual disease (MRD) is a strong prognostic indicator in adults receiving the pediatric regimen; sensitive, high-quality MRD evaluation should be performed in all patients receiving these therapies. Incorporation of targeted agents, particularly in the frontline and MRD+ setting, will usher in the next era of the pediatric regimen in adult ALL.
Mechanisms of and approaches to overcoming resistance to immunotherapy
Authors: Schultz Liora , Gardner Rebecca
Published: December 2019

Immunotherapies have been successfully developed for the treatment of B-cell acute lymphoblastic leukemia (B-ALL) with FDA approval of blinatumomab, inotuzumab, and tisagenlecleucel for relapsed or refractory patients. These agents target either CD19 or CD22, which are both expressed on the surface of the leukemic blasts in the majority of patients. The use of these agents has greatly transformed the landscape of available treatment, and it has provided curative therapy in some patients. As the field has matured, we are learning that for most patients, the currently available immunotherapies are not curative. Leukemic resistance to both CD19 and CD22 pressure has been described and is a major component of developed resistance to these therapies. Patients with B-ALL have developed CD19- or CD22-negative B-ALL, and in more rare cases, they have undergone lineage switch to acute myeloid leukemia. Current efforts are focusing on overcoming antigen escape, either by forced antigen expression or by dual-targeting therapies. A functional immune system is also required for maximal benefit of immunotherapy, particularly with chimeric antigen receptor (CAR) T-cell therapies. Data are now being produced that may allow for the prospective identification of patients whose immune deficits may be identified up front and predict failure. Preclinical work is focusing on additional engineering of CAR T cells to overcome these inherent immune deficits. Last, with improved knowledge of which patients are likely to benefit from immunotherapy as definitive treatment, those patients who are predicted to develop resistance may be prospectively recommended to undergo a consolidative hematopoietic cell transplant to lessen the recurrence risk.
Novel agents and immune invasion in Hodgkin lymphoma
Authors: Merryman Reid W. , LaCasce Ann
Published: December 2019

The approval of brentuximab vedotin (BV) and the PD-1 inhibitors nivolumab and pembrolizumab has dramatically improved outcomes for patients with relapsed or refractory (R/R) classic Hodgkin lymphoma (HL). With the goal of increasing long-term disease control rates and decreasing late toxicities, these agents are currently being tested in earlier phases of treatment in combination with chemotherapy agents. In the R/R setting, our expanding understanding of HL’s various mechanisms of immune evasion and treatment resistance has spurred a growing number of rationally designed combination trials. Beyond BV and PD-1 blockade, other novel therapies have demonstrated encouraging preliminary results, including targeted agents, like the CD25 antibody-drug conjugate ADCT-301, and cellular therapies, including CD30 chimeric antigen receptor T cells and Epstein-Barr virus (EBV)-directed cytotoxic T cells. These trials, coupled with the rapid development of prognostic and predictive biomarkers, should drive additional breakthroughs that promise safer and more effective therapies for patients with HL in the future.
Cure at what (systemic) financial cost? Integrating novel therapies into first-line Hodgkin lymphoma treatment
Authors: Huntington Scott F.
Published: December 2019

Classic Hodgkin lymphoma (cHL) stands out as success story in the field of medical oncology, with multiagent chemotherapy with or without radiation leading to durable remission for most patients. Large-scale clinical trials during the past 40 years have sought to minimize toxicities while maintaining strong efficacy, including efforts to reduce the size of radiation fields, minimize alkylator chemotherapy, reduce the number of chemotherapy cycles, and omit radiation in select populations. The last decade has also ushered in novel therapies, including brentuximab vedotin (BV), that have improved clinical outcomes for patients with cHL resistant to standard cytotoxic therapies. More recently, a large randomized trial compared BV plus chemotherapy with chemotherapy alone for first-line treatment of advanced stage cHL. With ∼24 months of available follow-up, the BV containing regimen was found to be associated with a reduction in the risk of progression, death, or incomplete response to first-line treatment (modified progression-free survival). Whether this early signal of improved efficacy is worth the additional acute toxicities and added drug-related expenses associated with incorporating BV into first-line treatment remains controversial. This chapter provides historical background; reviews the cost-effectiveness of available cHL therapies; and summarizes potential ways to balance innovation, affordability, and patient access to novel therapeutics.
Iron overload in transfusion-dependent patients
Authors: Coates Thomas D.
Published: December 2019

Before the advent of effective iron chelation, death from iron-induced cardiomyopathy occurred in the second decade in patients with transfusion-dependent chronic anemias. The advances in our understanding of iron metabolism; the ability to monitor iron loading in the liver, heart, pancreas and pituitary; and the availability of several effective iron chelators have dramatically improved survival and reduced morbidity from transfusion-related iron overload. Nevertheless, significantly increased survival brings about new complications such as malignant transformation resulting from prolonged exposure to iron, which need to be considered when developing long-term therapeutic strategies. This review discusses the current biology of iron homeostasis and its close relation to marrow activity in patients with transfusion-dependent anemias, and how biology informs clinical approach to treatment.
Sickle cell disease: a comprehensive program of care from birth
Authors: de Montalembert Mariane , Tshilolo Léon , Allali Slimane
Published: December 2019

As more children are appropriately being diagnosed, the burden of sickle cell disease is increasing greatly in Africa and in high-resource countries such as the United States and Europe. Early management is mandatory, but newborn screening is not implemented everywhere. Point-of-care testing devices are increasingly being used in low-resource countries, showing good sensitivity and specificity. Because the diagnosis is often traumatic for the families, the announcement should be made by an experienced person. The development of care networks is urgently required to facilitate daily life by defining the respective functions of nearby and highly specialized health care professionals, who should work in close collaboration. Comprehensive programs targeting the prevention of pneumococcal infections, malaria in infested zones, and stroke may substantially improve patient care. Hydroxyurea is increasingly being used, but whether it should be systematically prescribed in all children is debated, and its access is still limited in many African countries. Yearly checkups should be organized early in life in order to screen and then treat any organ impairment. Enhancing parents’ and patients’ knowledge and skills is mandatory.
Optimal disease management and health monitoring in adults with sickle cell disease
Authors: Howard Jo , Thein Swee Lay
Published: December 2019

In countries with access to organized health care, survival of children with sickle cell disease (SCD) has greatly improved, resulting in a growing population of adults with SCD. Transition from pediatric to adult care presents many challenges for the patient, who now faces the reality of emerging complications in many organs that are cumulative, adding to other age-related nonsickle conditions that interact and add to the disease morbidity. We recommend regular comprehensive annual assessments, monitoring for early signs of organ damage and joint clinics with relevant specialists, if applicable. While maintaining a low threshold for intervention with disease-modifying therapies, we should always keep in mind that there is no single complication that is pathognomonic of SCD, and nonsickle comorbidities should always be excluded and treated if present. We need to reevaluate our approach to managing adults with SCD by putting a greater emphasis on multidisciplinary care while proactively considering curative options (hematopoietic stem cell transplant and gene therapy) and experimental pharmacological agents for adults with SCD of all ages before complications render the patients ineligible for these treatments.
MRD evaluation of AML in clinical practice: are we there yet?
Authors: Freeman Sylvie D. , Hourigan Christopher S.
Published: December 2019

MRD technologies increase our ability to measure response in acute myeloid leukemia (AML) beyond the limitations of morphology. When applied in clinical trials, molecular and immunophenotypic MRD assays have improved prognostic precision, providing a strong rationale for their use to guide treatment, as well as to measure its effectiveness. Initiatives such as those from the European Leukemia Network now provide a collaborative knowledge-based framework for selection and implementation of MRD assays most appropriate for defined genetic subgroups. For patients with mutated-NPM1 AML, quantitative polymerase chain reaction (qPCR) monitoring of mutated-NPM1 transcripts postinduction and sequentially after treatment has emerged as a highly sensitive and specific tool to predict relapse and potential benefit from allogeneic transplant. Flow cytometric MRD after induction is prognostic across genetic risk groups and can identify those patients in the wild-type NPM1 intermediate AML subgroup with a very high risk for relapse. In parallel with these data, advances in genetic profiling have extended understanding of the etiology and the complex dynamic clonal nature of AML, as well as created the opportunity for MRD monitoring using next-generation sequencing (NGS). NGS AML MRD detection can stratify outcomes and has potential utility in the peri-allogeneic transplant setting. However, there remain challenges inherent in the NGS approach of multiplex quantification of mutations to track AML MRD. Although further development of this methodology, together with orthogonal testing, will clarify its relevance for routine clinical use, particularly for patients lacking a qPCR genetic target, established validated MRD assays can already provide information to direct clinical practice.
New advances in the diagnosis of von Willebrand disease
Authors: Sharma Ruchika , Haberichter Sandra L.
Published: December 2019

von Willebrand disease (VWD) is the most common autosomal inherited bleeding disorder, with an estimated prevalence of 1 in 1000 individuals. VWD is classified into quantitative and qualitative forms. Diagnosis of VWD is complex and requires (1) a personal history of bleeding symptoms, (2) family history of bleeding or VWD, and (3) confirmatory laboratory testing. There are certain bleeding assessment tools to objectively measure bleeding symptoms in patients that have been shown to correlate with the diagnosis as well as the severity of VWD. Laboratory diagnosis requires at least initially a measurement of von Willebrand factor (VWF) antigen levels, VWF platelet binding activity (VWF:RCo, VWF:GPIbM, and VWF:GPIbR), and factor VIII (FVIII) activity. Additional testing to confirm the specific subtype may include VWF collagen binding activity, low-dose ristocetin VWF-platelet binding, FVIII-VWF binding, VWF multimer analysis, and VWF propeptide antigen. Recent advances have been made regarding some of these assays. Molecular testing in VWD is not found to be useful in “low VWF” or most type 1 VWD cases but may be informative in patients with severe type 1 VWD, type 1C VWD, type 2 VWD, or type 3 VWD for accurate diagnosis, genetic counseling, and appropriate treatment. The diagnostic algorithm for VWD is complex, but advances continue to be made in improving VWF functional assays and diagnostic pathways.
Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management
Authors: Leebeek F. W. G. , Muslem R.
Published: December 2019

Chronic heart failure (HF) is a growing health problem, and it is associated with high morbidity and mortality. Left ventricular assist devices (LVADs) are nowadays an important treatment option for patients with end-stage HF not only as a bridging tool to heart transplantation but also, as a permanent therapy for end-stage HF (destination therapy). The use of LVAD is associated with a high risk for bleeding complications and thromboembolic events, including pump thrombosis and ischemic stroke. Bleeding is the most frequent complication, occurring in 30% to 60% of patients, both early and late after LVAD implantation. Although the design of LVADs has improved over time, bleeding complications are still the most common complication and occur very frequently. The introduction of an LVAD results in an altered hemostatic balance as a consequence of blood-pump interactions, changes in hemodynamics, acquired coagulation abnormalities, and the strict need for long-term anticoagulant treatment with oral anticoagulants and antiplatelet therapy. LVAD patients may experience an acquired coagulopathy, including platelet dysfunction and impaired von Willebrand factor activity, resulting in acquired von Willebrand syndrome. In this educational manuscript, the epidemiology, etiology, and pathophysiology of bleeding in patients with LVAD will be discussed. Because hematologist are frequently consulted in cases of bleeding problems in these individuals in a critical care setting, the observed type of bleeding complications and management strategies to treat bleeding are also reviewed.
What we have learned about direct oral anticoagulant reversal
Authors: Siegal Deborah M.
Published: December 2019

Bleeding is the main complication of oral anticoagulant (OAC) therapy, with major bleeds occurring in about 2% to 4% of OAC-treated patients per year. Although direct oral anticoagulants (DOACs) reduce the risk of major, fatal, and intracranial hemorrhage, major DOAC-related bleeding is associated with substantial morbidity and mortality, with case-fatality rates of 8% to 15% reported. Specific reversal agents for dabigatran (idarucizumab) and factor Xa inhibitors (andexanet) correct laboratory indices of anticoagulant effect. Clinical studies suggest that the majority of patients receiving these agents for DOAC-associated major bleeds experience clinical hemostasis. However, uncertainty remains regarding the incremental benefit of these agents and prothrombin complex concentrates over supportive measures alone, based on cohort studies that lacked control groups. Similar methodologic limitations preclude firm conclusions regarding the harms associated with use of these agents. Importantly, patients with DOAC-related major bleeding have substantial short-term risks of thrombosis and mortality, emphasizing the need for individualized patient assessment and protocolized bleed management strategies that include assessment of candidacy for safe resumption of OACs. With expanding indications and increasing prevalence of DOAC-eligible patients, bleeding complications and their management represent an ever-greater major health problem.
Microbiota modification in hematology: still at the bench or ready for the bedside?
Authors: Severyn Christopher J. , Brewster Ryan , Andermann Tessa M.
Published: December 2019

Growing evidence suggests that human microbiota likely influence diverse processes including hematopoiesis, chemotherapy metabolism, and efficacy, as well as overall survival in patients with hematologic malignancies and other cancers. Both host genetic susceptibility and host-microbiota interactions may impact cancer risk and response to treatment; however, microbiota have the potential to be uniquely modifiable and accessible targets for treatment. Here, we focus on strategies to modify microbiota composition and function in patients with cancer. First, we evaluate the use of fecal microbiota transplant to restore microbial equilibrium following perturbation by antibiotics and chemotherapy, and as a treatment of complications of hematopoietic stem cell transplantation (HSCT), such as graft-versus-host disease and colonization with multidrug-resistant organisms. We then address the potential use of both probiotics and dietary prebiotic compounds in targeted modulation of the microbiota intended to improve outcomes in hematologic diseases. With each type of therapy, we highlight the role that abnormal, or dysbiotic, microbiota play in disease, treatment efficacy, and toxicity and evaluate their potential promise as emerging strategies for microbiota manipulation in patients with hematologic malignancies and in those undergoing HSCT.
From Budd-Chiari syndrome to acquired von Willebrand syndrome: thrombosis and bleeding complications in the myeloproliferative neoplasms
Authors: Stein Brady L. , Martin Karlyn
Published: December 2019

Thrombotic and hemorrhagic complications are prevalent in patients with essential thrombocythemia, polycythemia vera, and myelofibrosis. Given the impact on morbidity and mortality, reducing the risk of thrombosis and/or hemorrhage is a major therapeutic goal. Historically, patients have been risk stratified on the basis of traditional factors, such as advanced age and thrombosis history. However, multiple factors contribute to the thrombotic tendency, including gender, mutational profile, inflammatory stress, and abnormal cell adhesion. Management includes cardiovascular risk reduction and use of antiplatelet therapy, depending on myeloproliferative neoplasm subtype and mutational status. Anticoagulation is a mainstay of therapy for those with venous thrombosis, but practice patterns remain heterogeneous. Cytoreduction is indicated for higher-risk patients, but efficacy may depend on the involved vascular bed. Management of special situations, such as unusual site thrombosis, bleeding, the perioperative period, and pregnancy, are especially challenging. In this article, risk factors and treatment strategies for myeloproliferative neoplasm thrombosis and bleeding, including special situations, are reviewed. Insights gained from recent studies may lead to the development of a more precise risk classification and tailored therapy.
Common variable immune deficiency: case studies
Authors: Cunningham-Rundles Charlotte
Published: December 2019

Common variable immune deficiency (CVID) is one of the most common congenital immune defects encountered in clinical practice. The condition occurs equally in males and females, and most commonly in the 20- to 40-year-old age group. The diagnosis is made by documenting reduced serum concentrations of immunoglobulin G (IgG), IgA, and usually IgM, together with loss of protective antibodies. The genetics of this syndrome are complex and are still being unraveled, but the hallmarks for most patients, as with other immune defects, include acute and chronic infections of the sinopulmonary tract. However, other noninfectious autoimmune or inflammatory conditions may also occur in CVID, and indeed these may be the first and only sign that a significant immune defect is present. These manifestations include episodes of immune thrombocytopenia, autoimmune hemolytic anemia, or neutropenia, in addition to splenomegaly, generalized or worrisome lymphadenopathy, and malignancy, especially lymphoma. These issues commonly bring the patient to the attention of hematologists for both evaluation and treatment. This article discusses 3 cases in which patients with CVID had some of these presenting issues and what hematology input was required.
Rocuronium-induced anaphylaxis: a case report
Authors: Takahashi Kanako , Tanaka Satoru , Watanabe Masanori , Yamakage Michiaki
Published: December 2019

Background

Neuromuscular blocking agents are frequently a cause of anaphylaxis that occurs in the perioperative period, and a skin prick test is an examination for definite diagnosis.

Case presentation

We report our experience of a patient with rocuronium-induced anaphylaxis who was scheduled to undergo open-heart surgery. After induction of anesthesia, anaphylaxis was suspected because the patient’s blood pressure decreased, airway pressure increased, and skin flushing and edema were observed on her neck and arms. With rapid treatment, good progress was seen without complications. About 5 weeks later, skin prick tests were performed for rocuronium and vecuronium. She was positive for rocuronium and negative for vecuronium. Seven weeks after anaphylaxis, vecuronium was used for the surgery and she had no symptoms that indicated anaphylaxis. The operation was completed uneventfully.

Conclusion

We experienced a case of anaphylaxis caused by rocuronium. After a definite diagnosis had been made by a skin prick test, safe anesthesia management was possible using vecuronium during the reoperation.
Modified percutaneous radiologic gastrostomy technique without endoscopic or nasogastric access
Authors: Tabashy Reda , Darwish Amira , Ibrahim Ashraf , Gad El-Mola Mohamed
Published: December 2019

Background

The aim of this study is to evaluate the efficacy and safety of a modified percutaneous radiologic gastrostomy (MPRG) technique under ultrasound and fluoroscopic guidance without endoscopic or nasogastric access.

Results

The study included 24 patients: 10 males and 14 females whose ages ranged from 44 to 80 years old. Ten patients had esophageal cancer and 14 patients had neck cancer. Technical success was achieved in 23 out of the 25 procedures (92%). Two procedures failed (8%) and were converted to the conventional technique by using the nasogastric tube. No major complications were reported. Minor complications were observed in 5 patients (20%): intraperitoneal air and contrast leakage in 4 patients and focal mucosal dissection by the contrast in 1 patient.

Conclusion

The MPRG has high technical success rate, is safe with no major complications, and is most feasible when endoscopic or nasogastric access cannot be performed.
Public Preferences for New Information on Opioids
Authors: Testa Paul F. , Moffitt Susan L. , Schenk Marie
Published: December 2019

Context: Educating the public through information campaigns is a commonly used policy approach to public health problems. Yet, experimental methods that assess the impact of information campaigns may misestimate their effects by failing to account for respondents' willingness to receive new information.

Methods: This article uses a doubly randomized survey experiment conducted on a nationally representative sample, where some subjects are randomly assigned to an informational treatment about opioids while other subjects are given the choice of whether to receive treatment or not, to examine how public willingness to seek new information shapes the way they update their preferences about policies related to the opioid epidemic.

Findings: Among those likely to receive information, treatment has a large positive effect on increasing support for policies that address the opioid epidemic by about one half of a standard deviation. Among those who would avoid this information, preferences appear to be unmoved by treatment. These effects would be missed by standard experimental designs.

Conclusion: While redressing information asymmetries is only one part of a public health strategy for addressing the opioid epidemic, our findings highlight the importance of access to and receptiveness toward new information.
Tramadol Does Not Improve Performance or Impair Motor Function in Trained Cyclists
Authors: BEJDER JACOB , BREENFELDT ANDERSEN ANDREAS , BONNE THOMAS CHRISTIAN , PIIL JACOB FEDER , HAGEN LINN CAMILLA HAUAN , DEHNES YVETTE , EIBYE KASPER HVID , NYBO LARS , NORDSBORG NIKOLAI BAASTRUP
Published: December 2019

Purpose

To investigate the hypothesis that a therapeutic oral dose of Tramadol improves cycling time trial performance and compromises motor-cognitive performance in highly trained cyclists.

Methods

Following two familiarization trials, 16 highly trained cyclists completed a preloaded time trial (1 h at 60% of peak power followed by a 15-km time trial) after ingestion of 100 mg Tramadol or placebo in a double-blind placebo-controlled counterbalanced crossover design separated by at least 4 d washout. Visuomotor tracking and math tasks were completed during the preload (n = 10) to evaluate effects on cognition and fine motor performance.

Results

Time trial mean power output (298 ± 42 W vs 294 ± 44 W) and performance (1474 ± 77 s vs 1483 ± 85 s) were similar with Tramadol and placebo treatment, respectively. In addition, there were no differences in perceived exertion, reported pain, blood pH, lactate, or bicarbonate concentrations across trials. Heart rate was higher (P < 0.001) during the Tramadol time trial (171 ± 8 bpm) compared with placebo (167 ± 9 bpm). None of the combined motor-cognitive tasks were impaired by Tramadol ingestion, in fact fine motor performance was slightly improved (P < 0.05) in the Tramadol trial compared with placebo.

Conclusions

In highly trained cyclists, ingestion of 100 mg Tramadol does not improve performance in a 15-km cycling time trial that was completed after a 1-h preload at 60% peak power. Additionally, a therapeutic dose of Tramadol does not compromise complex motor-cognitive or simple fine motor performances.
Effect of Hyperoxia on Critical Power and V˙O2 Kinetics during Upright Cycling
Authors: GOULDING RICHIE P. , ROCHE DENISE M. , MARWOOD SIMON
Published: December 2019

Introduction/Purpose

Critical power (CP) is a fundamental parameter defining high-intensity exercise tolerance; however, its physiological determinants are incompletely understood. The present study determined the impact of hyperoxia on CP, the time constant of phase II pulmonary oxygen uptake kinetics (τ
V˙O2), and muscle oxygenation (assessed by near-infrared spectroscopy) in nine healthy men performing upright cycle ergometry.

Methods

Critical power was determined in normoxia and hyperoxia (fraction of inspired O2 = 0.5) via four severe-intensity constant load exercise tests to exhaustion on a cycle ergometer, repeated once in each condition. During each test, τ
V˙O2 and the time constant of muscle deoxyhemoglobin kinetics (τ[HHb]), alongside absolute concentrations of muscle oxyhemoglobin ([HbO2]), were determined.

Results

Critical power was greater (hyperoxia, 216 ± 30 W vs normoxia, 197 ± 29 W; P < 0.001), whereas W′ was reduced (hyperoxia, 15.4 ± 5.2 kJ; normoxia, 17.5 ± 4.3 W; P = 0.037) in hyperoxia compared with normoxia. τ
V˙O2 (hyperoxia, 35 ± 12 s vs normoxia, 33 ± 10 s; P = 0.33) and τ[HHb] (hyperoxia, 11 ± 5 s vs normoxia, 14 ± 5 s; P = 0.65) were unchanged between conditions, whereas [HbO2] during exercise was greater in hyperoxia compared with normoxia (hyperoxia, 73 ± 20 vs normoxia, 66 ± 15 μM; P < 0.001).

Conclusions

This study provides novel insights into the physiological determinants of CP and by extension, exercise tolerance. Microvascular oxygenation and CP were improved during exercise in hyperoxia compared with normoxia. Importantly, the improved microvascular oxygenation afforded by hyperoxia did not alter τ
V˙O2, suggesting that microvascular O2 availability is an independent determinant of the upper limit for steady-state exercise, that is, CP.
Trail Runners Cannot Reach V˙O2max during a Maximal Incremental Downhill Test
Authors: LEMIRE MARCEL , HUREAU THOMAS J. , REMETTER ROMAIN , GENY BERNARD , KOUASSI BLAH Y. L. , LONSDORFER EVELYNE , ISNER-HOROBETI MARIE-EVE , FAVRET FABRICE , DUFOUR STÉPHANE P.
Published: December 2019

Purpose

The purpose of this study was twofold: (i) determine if well-trained athletes can achieve similar peak oxygen uptake (V˙O2peak) in downhill running (DR) versus level running (LR) or uphill running (UR) and (ii) investigate if lower limb extensor muscle strength is related to the velocity at V˙O2peak (vV˙O2peak) in DR, LR, and UR.

Methods

Eight athletes (V˙O2max = 68 ± 2 mL·min−1·kg−1) completed maximal incremental tests in LR, DR (−15% slope), and UR (+15% slope) on a treadmill (+1, +1.5, and +0.5 km·h−1 every 2 min, respectively) while cardiorespiratory responses and spatiotemporal running parameters were continuously measured. They were also tested for maximal voluntary isometric strength of hip and knee extensors and plantar flexors.

Results

Oxygen uptake at maximal effort was approximately 16% to 18% lower in DR versus LR and UR (~57 ± 2 mL·min−1·kg−1, 68 ± 2 mL·min−1·kg−1, and 70 ± 3 mL·min−1·kg−1, respectively) despite much greater vV˙O2peak (22.7 ± 0.6 km·h−1 vs 18.7 ± 0.5 km·h−1 and 9.3 ± 0.3 km·h−1, respectively). At vV˙O2peak, longer stride length and shorter contact time occurred in DR versus LR and UR (+12%, +119%, −38%, and −61%, respectively). Contrary to knee extensor and plantar flexor, hip extensor isometric strength correlated to vV˙O2peak in DR, LR, and UR (r = −0.86 to −0.96, P < 0.05). At similar V˙O2, higher heart rate and ventilation emerged in DR versus LR and UR, associated with a more superficial ventilation pattern.

Conclusions

This study demonstrates that well-trained endurance athletes, accustomed to DR, achieved lower V˙O2peak despite higher vV˙O2peak during DR versus LR or UR maximal incremental tests. The specific heart rate and ventilation responses in DR might originate from altered running gait and increased lower-limb musculotendinous mechanical loading, furthering our understanding of the particular physiology of DR, ultimately contributing to optimize trail race running performance.
Exercise Intensity and Recovery on Circulating Brain-derived Neurotrophic Factor
Authors: REYCRAFT JOSHUA T. , ISLAM HASHIM , TOWNSEND LOGAN K. , HAYWARD GRANT C. , HAZELL TOM J. , MACPHERSON REBECCA E. K.
Published: December 2019

Introduction

Brain-derived neurotrophic factor (BDNF) is an exercise-induced neurotropin mediating neuroprotection and synaptic plasticity. Although exercise intensity is implicated as a potentially important mediator of BNDF release after exercise, the optimal exercise stimulus (interval vs continuous) and intensity (submaximal vs supramaximal) for augmenting circulating BDNF levels remains unknown. Irisin, an exercise-driven myokine, may also contribute to neuroprotection by upregulating BDNF.

Purpose

To examine the response and recovery of plasma BDNF and irisin after acute exercise of differing intensities.

Methods

Eight males (23.1 ± 3.0 yr of age; V˙O2max 51.2 ± 4.4 mL·kg−1·min−1) completed four acute exercise sessions: 1) moderate-intensity continuous training (MICT, 65% V˙O2max); 2) vigorous-intensity continuous training (VICT, 85% V˙O2max); 3) sprint interval training (SIT, “all out”); and 4) no exercise (CTRL). Blood was collected preexercise as well as immediately, 30 min, and 90 min postexercise. Plasma BDNF and irisin were assessed with commercially available enzyme-linked immunosorbent assay kits.

Results

Plasma BDNF levels increased immediately after exercise in the SIT group (P < 0.0001) with plasma concentrations recovering 30 and 90 min postexercise. The BDNF levels after MICT were reduced 30 min postexercise compared with immediately postexercise (P = 0.0189), with no other changes across time points in MICT and VICT groups. Plasma BDNF area under the curve in SIT was significantly higher compared with CTRL, MICT, and VICT (P = 0.0020). No changes in plasma irisin across exercise groups and time points were found (P > 0.9999).

Conclusions

Plasma BDNF levels increased in an intensity-dependent manner with SIT eliciting the highest BDNF concentration immediately postexercise. These results identify SIT as a time-efficient exercise modality to promote brain health through BDNF release.
“But you have to start somewhere….”: Nurses’ perceptions of what is required to provide quality neonatal care in selected hospitals, Kenya
Authors: Nyikuri Mary , Kumar Pratap , Jones Caroline , English Michael
Published: December 2019

Background:Kenya has one of the highest rates of neonatal mortality in the world at 22/1,000 live births. Improving the quality of newborn care would greatly improve survival rates. There is an increasing consensus that strong health systems are key to achieving improved health outcomes. However, there is significantly less agreement on what to strengthen in low and middle-income countries such as Kenya. As nurses are the main caregivers in many inpatient settings, efforts aimed at improving the quality of facility care for sick newborn babies need to take into account nurses views and opinions. Our intent in this paper is to describe the current state of the nursing environment and what would be required to improve the quality of those environs from nurses’ perspectives.

Methods: Between January 2017 and March 2018, we collected data through non-participant observations, unsolicited conversations and review of admission registers. We also conducted 29 individual in-depth interviews with nurses working in the newborn units (NBU) of a public sector hospital (n=10), a private sector hospital (n=11) and a faith-based hospital (n=8).  The interviews were digitally audio recorded, transcribed verbatim and, together with observation notes, analysed using thematic content analysis.

Results:Nurses as frontline care givers and intervention intermediaries, irrespective of their work contexts, have similar aspirations, needs and expectations from the health systems of how they should be supported to provide quality inpatient care for newborns. These are about the structure of the work environment, especially human resources for health, and the consequences of inadequate structure. They are also about how care is organised and systems that respond to emergencies.

Conclusion:Interventions and investments to improve quality need to be directed towards experienced based co-design where we listen to the problems that nurses experience.
Impact of Live Chat on Purchase in Electronic Markets: The Moderating Role of Information Cues
Authors: Tan Xue (Jane) , Wang Youwei , Tan Yong
Published: December 2019

Live chat tools have emerged as a channel for fostering synchronous communication between sellers and buyers. However, a positive link between live chat and conversion does not suggest causation because customers with high purchase intention are more likely to initiate live chat in the first place. Our research accounts for such selection and studies the impact of live chat with the presence of information cues: product sales volumes and seller feedback scores. Using granular data from Alibaba, we find that live chat can increase purchase probability of tablets by 15.99%. Further, the substitutional or complementary patterns between live chat and the information cues allow us to understand how live chat tools change the ways consumers evaluate product quality and seller credibility. We observe a substitutional effect of live chat on seller feedback score such that sellers with low feedback scores benefit more from live chat conversations than sellers with high scores. On the contrary, products with a high past sales volume sell better after live chat, indicating a reinforcement effect. Such findings deepen our understanding of the difference between various information cues in electronic markets and delineate the specific type of benefit live chat brings if put into best use by sellers and online marketplace designers.
Virginia Gordon as Servant Leader
Authors: Higgins Elizabeth M. , Campbell Susan M.
Published: December 2019

Virginia Gordon was a teacher, scholar, practitioner, and leader who also served as a role model and mentor to others. Her insight and research informed the many innovative initiatives she pursued on behalf of the student advising experience. Gordon's scholarly and evidence-based approach set the stage for academic advising as a field of scholarly inquiry and helped shape the growth and direction of the profession. Virginia Gordon's work was other-directed. Her goal was always to support the growth and development of others. This qualitative study tried to capture Gordon as understood by the higher education professionals who knew her, worked with her, and/or studied with her. That she was other-directed supports our view regarding Virginia Gordon as a servant leader.
BANCOS COMUNITÁRIOS DE DESENVOLVIMENTO: uma análise bibliomética.
Authors: Menezes Daniel Teixeira de , Santos Rafael Carvalho dos , Mariano Sandra Regina Holanda
Published: December 2019

Os Bancos Comunitários de Desenvolvimento (BCDs) vêm se destacando dentro do campo das finanças solidárias, por garantir a democratização do acesso ao crédito e estimular o desenvolvimento de comunidades empobrecidas na tentativa de mudar a realidade socioeconômica dos locais onde estão inseridos. O sucesso apresentado nas experiências de diversos BCDs no país vem conquistando a atenção da academia. Este artigo apresenta uma visão acerca das pesquisas voltadas ao estudo dos BCDs. Realizou-se uma análise bibliométrica a partir do banco de teses e dissertações da CAPES bem como dos artigos disponibilizados nas bases: SPELL, SCIELO, PERIÓDICOS CAPES e ANPAD. Observou-se que o aumento no número de publicações sobre os BCDs coincide com a criação da RBBC e da SENAES. Notou-se ainda, que o tema vem sendo abordado por diferentes áreas de conhecimento, sendo os autores vinculados aos programas de pós-graduação da área de Administração os que mais produziram sobre a temática.
ASSISTÊNCIA DE ENFERMAGEM NA MANUTENÇÃO DO ALEITAMENTO MATERNO: UMA REVISÃO SISTEMÁTICA DE LITERATURA
Authors: BELEMER LETICIA CRISTINA COSTA , FERREIRA WELLINGTON FERNANDO DA SILVA , OLIVEIRA EDINA CORREIA DE
Published: December 2019

Introdução: Amamentar demonstra-se ser próprio no processo biológico, tarefa fácil e um instinto natural, porém, para sua realização corretamente é necessário ensinamentos e um conjunto de condições interativa no contexto social da mãe e filho. Objetivo: Compreender as dimensões da enfermagem na manutenção do aleitamento materno para evitar o desmame precoce. Metodologia: Trata-se de uma revisão sistemática de literatura de caráter explora­tório, com abordagem qualitativa, realizou-se a busca de estudos em periódicos na­cionais em base de dados: SCIELO, LILACS, BIREME, publicados entre os anos de 2012 ao primeiro semestre de 2017, com amostra final constituída por 24 artigos científicos comple­tos. Resultados: Os achados apontam, trabalhos científicos voltados a eixos fundamentais, demonstram intercessão entre aspectos do processo do aleitamento materno, causas e consequências dos fatores relacionados à assistência da enfermagem diante das estratégias do desmame precoce. Conclusão: A reflexão e compreensão dos aspectos de interfaces sobre assistência de enfermagem na manutenção do aleitamento materno, estimulando e evidenciando a importância do profissional enfermeiro e estratégias, propostos e arquitetados como objetivos foram alcançados, e seus resultados, através desta investigação apresentam relevância social, profissional e acadêmica.Palavras-chave: Aleitamento materno; Saúde materno infantil; Desmame precoce; Enfermagem.
CONHECIMENTO DOS PROFISSIONAIS DE ENFERMAGEM NO MANEJO DA DOR DE PACIENTES ONCOLÓGICOS
Authors: Lara Hellen Cristina Almeida Abreu de , Rubira Elizete Aparecida , Marcon Samira Reschetti , Oliveira José Roberto Temponi de , Britto Alyne Silva , Alexandre Roselma Marcele da Silva
Published: December 2019

Introdução: O controle da dor é um dos desafios para o câncer, dentre os profissionais envolvidos nesse manuseio é a equipe de enfermagem. Dessa forma, nota-se a necessidade de avaliações do conhecimento de enfermagem em relação à dor dos pacientes em tratamento oncológico. Objetivo: identificar o conhecimento dos profissionais de enfermagem no manejo da dor de pacientes portadores de neoplasias malignas em tratamento clínico e cirúrgico. Método: Estudo transversal, realizado com os profissionais de enfermagem das clínicas médico e cirúrgica. Foram utilizados 2 questionários: 1º composto por questões abertas e subjetivas, e o 2º questões fechadas e objetivas. Resultados: Entre os profissionais, 60 % conheciam os tipos de dor. Quanto ao conhecimento sobre as escalas existentes, no questionário 1, relataram que conhece as escalas de dor existentes, e 63,6% disseram que não conhecem. No entanto, no questionário 2 36,1% relataram que não conhecem. O grau de concordância entre os questionários, tornou claro a falta de conhecimento no manejo da dor em ambos questionários, pois tanto as respostas subjetivas como as objetivas mostraram baixo conhecimento no manejo e tratamento da dor. Conclusão: Evidenciou que a equipe de enfermagem deve ser treinada no que se refere ao manejo da dor, para que seja possível atrelar conhecimento e ação.
AVALIAÇÃO DA SOBRECARGA DOS CUIDADORES INFORMAIS ATRAVÉS DA ESCALA BURDEN INTERVIEW ATENDIDOS DURANTE O ESTÁGIO DE FISIOTERAPIA EM SAÚDE COLETIVA
Authors: Oliveira Adriano Rodrigues , Gongalvez Giuliano Roberto , Loffredo Maria de Castro Monteiro , Grecco Leandro Henrique
Published: December 2019

O objetivo do estudo foi identificar a sobrecarga imposta ao cuidador informal através da escala de Burden Interview, de pacientes atendidos durante o estágio de fisioterapia em saúde coletiva. Foram selecionados 15 cuidadores de pacientes com dependência total ou dependência modificada, de acordo com a escala de MIF, os quais responderam ao questionário Burden Interview. Analisando os resultados, observa-se uma sobrecarga imposta a esses cuidadores em todos os domínios da escala (tensão geral, isolamento, decepção, envolvimento emocional e ambiente), bem como no score total 47,27 (±14,94). Desta forma, concluímos que o cuidador sofre uma sobrecarga física e emocional, apontando que apesar de contribuirmos para uma melhor qualidade de vida do internado, pode-se criar uma situação desfavorável ao cuidador. Por esse motivo, acreditamos que nosso estudo pode ser uma ferramenta válida para corroborar com a importância do atendimento multidisciplinar e programas de saúde específicos ao cuidador informal e não apenas ao ser cuidado.
PREVALÊNCIA DE OBESIDADE E HIPERTENSÃO ARTERIAL EM UMA COMUNIDADE URBANA DO DISTRITO FEDERAL, BRASIL
Authors: Dutra Maurílio Tiradentes , Martins Karla Gonçalves , Reis Diego Batista , Santos Débora Kerolayne , Faria Edi Xavier , Araújo Paulo César Ramos
Published: December 2019

Introdução: A hipertensão arterial e a obesidade configuram graves e cada vez mais emergentes desfechos em saúde pública. Objetivo: o propósito deste estudo foi avaliar a prevalência de sobrepeso, obesidade e hipertensão na comunidade urbana de Planaltina, DF, Brasil. Materiais e Métodos: Participaram do estudo 629 voluntários de 20 a 90 anos de idade que responderam a um questionário de saúde e foram submetidos aos seguintes procedimentos: medida da pressão arterial e avaliação antropométrica. Resultados: A prevalência de hipertensão foi de 31,3%, sendo ligeiramente maior no sexo feminino (33,0 vs 28,1%) e crescente com o aumento da faixa etária. A prevalência de obesidade foi de 26,6%, sendo similar entre os sexos (26,7% no masculino e 26,5% no feminino). Excesso de peso (sobrepeso somado à obesidade) foi observado em mais de 50% da amostra em todas as faixas etárias. Conclusões: As prevalências de sobrepeso, obesidade, excesso de peso e hipertensão foram maiores do que as relatadas pelo inquérito telefônico mais recente do Ministério da Saúde. Esses achados são preocupantes e apontam para a premência de ações do poder público que interfiram positivamente na saúde da população estudada.
CONSUMO DE ALCOOL ENTRE UNIVERSITÁRIOS DO INTERIOR DO NORDESTE BRASILEIRO
Authors: Costa Sheila Maria da Conceição , Monteiro Priscila Mikaelly Fernandes , Araújo Janieiry Lima de , Rego Ana Raquel de Figueiredo , NASCIMENTO ELLANY GURGEL COSME DO
Published: December 2019

Objetivo: Descrever e analisar o consumo de álcool entre universitários. Método: Estudo descritivo e quantitativo. A coleta feita por aplicação de questionário com 369 estudantes da Universidade do Estado do Rio Grande do Norte. Os dados foram tabulados e analisados com auxílio do Statistical Package for Social Sciences. Resultados: Os participantes apresentam idade média de 22,11 anos, predominância do sexo feminino (63,68%), estado civil solteiro (84,82%), renda familiar de 1 a 3 salários mínimos (70,46%). No padrão de consumo de álcool observou-se que 70,18% ingeriram bebida alcoólica, o principal motivo foi por pura diversão (32,04%), a média de início foi aos 16 anos. 40,1% afirmaram terem ficado de ‘porre’. A interferência na saúde mais citada foi de problemas para alimentar-se (34,74%). Dos que ingeriram álcool, 2,7% sofreram acidentes sobre efeito do álcool e 1,54% referiram a ocorrência de situações de violência. Observou-se que houve uma redução de consumo no último ano (52,3%) e na última semana (23,3%). Conclusão: A problemática do consumo de álcool está presente desde antes da entrada na universidade e continua, posteriormente, tornando os universitários vulneráveis a esse agravo. Há, portanto, necessidade de intervenções de promoção a saúde sobre o uso de álcool e suas consequências.
DEPRESSÃO E CONSUMO DE ÁLCOOL EM ADOLESCENTES: ANÁLISE DA PRODUÇÃO NO PERÍODO DE OUTUBRO DE 2008 A MARÇO DE 2017
Authors: Martins Raul Aragão , Ribeiro Camila Fernandes , Cruz Luciana Aparecida Nogueira
Published: December 2019

Introdução: As taxas de depressão e o consumo de álcool entre jovens vêm aumentado significativamente ao longo dos anos. Objetivo: O presente estudo objetivou identificar a visibilidade deste tema, considerando a produção científica dos últimos 10 anos. Materiais e Método: Trata-se de um estudo de caráter quantitativo que analisou o número de artigos publicados por ano, por revista e de artigos por primeiro autor e coautor em dois ou mais trabalhos. Resultados e Conclusões: Foi observado a escassez de pesquisas que busquem compreender a relação entre o aumento do consumo de álcool e a depressão entre jovens. Desse modo, muito ainda deve ser feito para que seja possível a orientação e melhoria na qualidade de vida dos adolescentes.