bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization and Comparison of Primary Care Appointment Utilization Patterns Among Military Health System Beneficiaries
Authors: Self Amanda , Khan Munziba , Banaag Amanda , Koehlmoos Tracey
Published: August 2020

Introduction

The role of primary care in the United States is vitally important to improving health outcomes, minimizing waste, and controlling cost. The Military Health System is tasked with both caring for its beneficiaries and ensuring the medical readiness of active duty service members, who often have needs unique to those in the civilian population. Balancing the number of individuals assigned to a primary care clinician with the clinician’s capacity to meet their medical needs and anticipated appointment demand is a fundamental cornerstone of effective primary care clinic management in any setting.

Materials and methods

Using the Military Health System Data Repository, this cross-sectional study utilized descriptive statistics and Poisson regression to describe crude and adjusted primary care appointment utilization trends among Military Health System beneficiaries during fiscal year 2016.

Results

The primary care appointment utilization rate of the study population was 3.3 visits per person-year. The youngest and oldest age groups, women, active duty, and those enrolled to Army clinics had the highest utilization rates within each of the respective covariates. Active duty women had the highest utilization of any group in the data set, with a crude rate of 4.7 visits per person-year.

Conclusions

Primary care utilization trends are different among different demographic subgroups within the Military Health System (MHS). Unmet demand, patient acuity, clinician continuity, robustness of team support, and other important factors that influence appointment utilization were not incorporated in this study. Superficially, these data suggest that the MHS enrollment target of 1,100–1,300 patients per full-time primary care clinician is roughly appropriate, though this should be interpreted with caution given the limitations.
ACK1–AR and AR–HOXB13 signaling axes: epigenetic regulation of lethal prostate cancers
Authors: Kim Eric H , Cao Dengfeng , Mahajan Nupam P , Andriole Gerald L , Mahajan Kiran
Published: August 2020

The androgen receptor (AR) is a critical transcription factor in prostate cancer (PC) pathogenesis. Its activity in malignant cells is dependent on interactions with a diverse set of co-regulators. These interactions fluctuate depending on androgen availability. For example, the androgen depletion increases the dependence of castration-resistant PCs (CRPCs) on the ACK1 and HOXB13 cell survival pathways. Activated ACK1, an oncogenic tyrosine kinase, phosphorylates cytosolic and nuclear proteins, thereby avoiding the inhibitory growth consequences of androgen depletion. Notably, ACK1-mediated phosphorylation of histone H4, which leads to epigenetic upregulation of AR expression, has emerged as a critical mechanism of CRPC resistance to anti-androgens. This resistance can be targeted using the ACK1-selective small-molecule kinase inhibitor (R)-9b. CRPCs also deploy the bromodomain and extra-terminal domain protein BRD4 to epigenetically increase HOXB13 gene expression, which in turn activates the MYC target genes AURKA/AURKB. HOXB13 also facilitates ligand-independent recruitment of the AR splice variant AR-V7 to chromatin, compensating for the loss of the chromatin remodeling protein, CHD1, and restricting expression of the mitosis control gene HSPB8. These studies highlight the crosstalk between AR–ACK1 and AR–HOXB13 pathways as key mediators of CRPC recurrence.
Frequency of false-positive FISH 1p/19q codeletion in adult diffuse astrocytic gliomas
Authors: Ball Matthew K , Kollmeyer Thomas M , Praska Corinne E , McKenna Michelle L , Giannini Caterina , Raghunathan Aditya , Jentoft Mark E , Lachance Daniel H , Kipp Benjamin R , Jenkins Robert B , Ida Cristiane M
Published: August 2020

Background

Oligodendroglioma is genetically defined by concomitant IDH (IDH1/IDH2) mutation and whole-arm 1p/19q codeletion. Codeletion of 1p/19q traditionally evaluated by fluorescence in situ hybridization (FISH) cannot distinguish partial from whole-arm 1p/19q codeletion. Partial 1p/19q codeletion called positive by FISH is diagnostically a “false-positive” result. Chromosomal microarray (CMA) discriminates partial from whole-arm 1p/19q codeletion. Herein, we aimed to estimate the frequency of partial 1p/19q codeletion that would lead to a false-positive FISH result.

Methods

FISH 1p/19q codeletion test probe coordinates were mapped onto Oncoscan CMA data to determine the rate of partial 1p/19q codeletion predicted to be positive by FISH. Diffuse astrocytic gliomas with available CMA data (2015–2018) were evaluated and classified based on IDH1-R132H/ATRX/p53 immunohistochemistry, IDH/TERT promoter targeted sequencing, and/or CMA according to classification updates. Predicted false-positive cases were verified by FISH whenever possible.

Results

The overall estimated false-positive FISH 1p/19q codeletion rate was 3.6% (8/223). Predicted false positives were verified by FISH in 6 (of 8) cases. False-positive rates did not differ significantly (P = .49) between IDH-mutant (4.6%; 4/86) and IDH-wildtype (2.9%; 4/137) tumors. IDH-wildtype false positives were all WHO grade IV, whereas IDH-mutant false positives spanned WHO grades II-IV. Testing for 1p/19q codeletion would not have been indicated for most false positives based on current classification recommendations.

Conclusion

Selective 1p/19q codeletion testing and cautious interpretation for conflicting FISH and histopathological findings are recommended to avoid potential misdiagnosis.
Environmental Peacebuilding
Authors: Ide Tobias
Published: August 2020

Interest in the environmental dimensions of peacebuilding has emerged from the early 2000s onward due to two developments. First, with an increasing number of peacebuilding interventions by the international community and nongovernmental organizations (NGOs), addressing environmental issues in post-conflict contexts has become a major concern. This is especially so as water and land are crucial for (re-)building livelihoods while modern wars produce considerable environmental damage. Second, an increasing number of scholars and policymakers are expressing concerns about the security implications of global environmental change, with the impact of climate change on violent conflict being a particularly salient topic. A focus on environmental cooperation and its potential peace-enhancing effects provides a complementary analytical perspective that can counter determinist and securitizing environmental conflict narratives. Environmental peacebuilding can be broadly defined as efforts to build more peaceful relations through conflict prevention, resolution, and recovery processes that integrate the management of environmental issues. In this context, peace refers to negative peace (the absence of physical violence) as well as positive peace (the absence of structural violence and the inconceivability of physical violence). Environmental peacebuilding can take place at the macro level (e.g., between states) as well as on the meso level and the micro level (e.g., between or within local communities). Environmental peacebuilding includes four sets of practices (which are not mutually exclusive): First, with resources like water or land becoming increasingly scarce in some regions and oil or mining projects often being heavily contested, preventing conflicts over natural resources is increasingly important. Second, in post-conflict contexts, natural resources must be managed well, for instance to reduce land-related grievances or prevent conflict financing through resource revenues. Third, climate change mitigation, adaptation to environmental change, and disaster risk reduction (DRR) can reduce grievances and promote community coherence. Finally, joint and severe environmental problems can act as entry points for cooperation across political divides, hence supporting processes of trust building and deepening interdependence (the respective set of practices is often termed environmental peacemaking). These practices can also fail, however, implying that they have no impact on environmental problems or peace processes. In the worst case, environmental peacebuilding practices can even facilitate new forms of exclusion, conflict, and environmental degradation. Over the past two decades, interest in environmental peacebuilding has grown remarkably, not at least due to the intensification of environmental problems and recent trends toward a less peaceful world. As a result of these developments, the literature on environmental peacebuilding has grown dramatically.
Archaeology and Political Evolution
Authors: Feinman Gary M.
Published: August 2020

Humans are able to aggregate and cooperate at scales larger than almost all other animals. In contrast, however, to species such as social insects, whose communities are composed of close biological relations, humans form large groupings with individuals who are not necessarily close kin. Although from a global, long-term perspective, the size and density of human social groupings reveal a basic trend toward larger political affiliations and concentrations of people, the specific historical pathways from place to place and region to region have been neither uniform nor unilinear. Human social networks and cooperative arrangements are generally fragile, so that the course of political history is littered with failed states and institutional collapses, as well as eras of rapid growth, imperial expansions, and the foundation of dense urban centers. The temporal record of human political formations, changes in them, and ultimate breakdowns and dissolutions in cooperative arrangements occurred before the advent of written records. These include key shifts that occurred in many global regions where mobile foraging populations settled down in more-sedentary communities, a shift that frequently provoked new behaviors, challenges, and institutions. Likewise, the establishment of the earliest cities and their associated means of governance often preceded the presence of documentary accounts of how such processes occurred. For these reasons, archaeological fieldwork and interpretation now is recognized as a vital empirical basis to document, study, and compare human political evolution over time. As recently as the mid-20th century, a much-narrower vision for archaeology that scripted little potential for the study of prehistoric sociopolitical organization was followed. Sociopolitical organization was seen as nearly impossible to investigate. To study ancient social organization, archaeologists had to frame the right questions and then devise the investigatory means to address them. The current examination of preindustrial human political evolution and change reflects more than a century of iterative interplay and debate involving models of political behavior derived from history and social sciences and the collection and processing of multiscalar, global suites of evidence from archaeological research. As the empirical foundation of human political history is strengthened, and long-held unilinear models and dichotomous frames that artificially divide the West from the rest and the past from the present are transcended, we enter an exciting era in which the diverse forms and temporal pathways through which human cooperative institutions evolved must be acknowledged and used to help guide better futures.
Yiddish Linguistics
Authors: Bleaman Isaac L.
Published: August 2020

Linguistic studies of Yiddish span several centuries and incorporate a wide range of research questions and methodologies, from philological analyses of Old Yiddish texts to generative approaches to particular grammatical constructions. The historical development of the language has undoubtedly been, and continues to be, the most hotly debated research topic in Yiddish linguistics. However, other productive areas of inquiry have included structural analysis (e.g., syntax, semantics, and phonology), dialectology and other fields of sociolinguistics (e.g., language contact and interspeaker variation), and, increasingly, computational approaches (e.g., the construction and use of linguistic corpora). Historically, Yiddish linguists have often played a major role in language planning efforts, including the production of style manuals, dictionaries, and textbooks—so much so that “Yiddish linguist” has often been understood as synonymous with “Yiddish standardizer.” However, the primary focus of this bibliography is descriptive linguistic research. (Information on standard Yiddish reference works, which can be unparalleled sources of linguistic data and a useful starting point for new research projects, can be found in the more general Oxford Bibliographies article “Yiddish.”) The works included here represent a curated sample, rather than an exhaustive list, of publications and research tools in the various subfields of Yiddish linguistics. (See Bibliographies for more comprehensive references.) Due to the centrality of language in research on the history, literature, and folk culture of Ashkenazic Jews, this bibliography is likely to be useful not only to linguists, but also to researchers in related disciplines within Yiddish and Jewish studies.
Utility of Repeat Nasopharyngeal SARS-CoV-2 RT-PCR Testing and Refinement of Diagnostic Stewardship Strategies at a Tertiary Care Academic Center in a Low-Prevalence Area of the United States
Authors: Lepak Alexander J , Chen Derrick J , Buys Ashley , Stevens Linda , Safdar Nasia
Published: August 2020

Background

Multiple factors have led to an extremely high volume of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) testing. Concerns exist about sensitivity and false-negative SARS-CoV-2 RT-PCR testing results. We describe a retrospective observational study examining the utility of repeat nasopharyngeal (NP) SARS-CoV-2 RT-PCR testing at an academic center in a low-prevalence setting.

Methods

All patients within our health system with >1 NP SARS-CoV-2 RT-PCR test result were included. SARS-CoV-2 RT-PCR testing was performed according to 1 of 4 validated assays. Key clinical and demographic data were collected, including whether the patient was inpatient or outpatient at time of the test and whether the test was performed as part of a person under investigation (PUI) for possible coronavirus disease 2019 or for asymptomatic screening.

Results

A total of 660 patients had >1 NP SARS-CoV-2 PCR test performed. The initial test was negative in 638. There were only 6 negative-to-positive conversions (0.9%). All 6 were outpatients undergoing a PUI workup 5–17 days after an initial negative result. In >260 inpatients with repeat testing, we found no instances of negative-to-positive conversion including those undergoing PUI or asymptomatic evaluation.

Conclusions

In a low-prevalence area, repeat inpatient testing after an initial negative result, using a highly analytically sensitive SARS-CoV-2 RT-PCR, failed to demonstrate negative-to-positive conversion. The clinical sensitivity of NP RT-PCR testing may be higher than previously believed. These results have helped shape diagnostic stewardship guidelines, in particular guidance to decrease repeated testing in the inpatient setting to optimize test utilization and preserve resources.
Lessons Learned From the First 10 Consecutive Cases of Intravenous Bacteriophage Therapy to Treat Multidrug-Resistant Bacterial Infections at a Single Center in the United States
Authors: Aslam Saima , Lampley Elizabeth , Wooten Darcy , Karris Maile , Benson Constance , Strathdee Steffanie , Schooley Robert T
Published: August 2020

Background

Due to increasing multidrug-resistant (MDR) infections, there is an interest in assessing the use of bacteriophage therapy (BT) as an antibiotic alternative. After the first successful case of intravenous BT to treat a systemic MDR infection at our institution in 2017, the Center for Innovative Phage Applications and Therapeutics (IPATH) was created at the University of California, San Diego, in June 2018.

Methods

We reviewed IPATH consult requests from June 1, 2018, to April 30, 2020, and reviewed the regulatory process of initiating BT on a compassionate basis in the United States. We also reviewed outcomes of the first 10 cases at our center treated with intravenous BT (from April 1, 2017, onwards).

Results

Among 785 BT requests to IPATH, BT was administered to 17 of 119 patients in whom it was recommended. One-third of requests were for Pseudomonas aeruginosa, Staphylococcus aureus, and Mycobacterium abscessus. Intravenous BT was safe with a successful outcome in 7/10 antibiotic-recalcitrant infections at our center (6 were before IPATH). BT may be safely self-administered by outpatients, used for infection suppression/prophylaxis, and combined successfully with antibiotics despite antibiotic resistance, and phage resistance may be overcome with new phage(s). Failure occurred in 2 cases despite in vitro phage susceptibility.

Conclusions

We demonstrate the safety and feasibility of intravenous BT for a variety of infections and discuss practical considerations that will be critical for informing future clinical trials.
Upper Extremity Muscle Strength in Children With Unilateral Spastic Cerebral Palsy: A Bilateral Problem?
Authors: Dekkers Koen J F M , Rameckers Eugene A A , Smeets Rob J E M , Gordon Andrew M , Speth Lucianne A W M , Ferre Claudio L , Janssen-Potten Yvonne J M
Published: August 2020

Objective

The objective was to investigate whether muscle strength in the nonaffected and affected upper extremities (UEs) in children (7–12 years) with unilateral spastic cerebral palsy (USCP) differs from that in children with typical development (TD).

Methods

A cross-sectional study design was used. Isometric arm strength (wrist flexion, wrist extension with flexed and extended fingers, elbow flexion/extension) was assessed in 72 children (mean age = 9.3 [SD = 1.9] years) with USCP, and isometric grip/pinch strength was assessed in 86 children (mean age = 9.3 [SD = 1.8] years) with USCP. Arm/grip/pinch strength was assessed in 120 children (mean age = 9.5 [SD = 1.7] years) with TD. Arm strength was measured with a hand-held dynamometer, and grip/pinch strength was measured with a calibrated, modified (digitized) grip dynamometer and a pinch meter. The nonaffected UE of children with USCP was compared with the preferred UE of children with TD because both sides represent the preferred UE. The affected UE was compared with the nonpreferred UE of children with TD, as both sides represent the nonpreferred UE.

Results

In all measurements except for grip strength of the preferred UE, children with USCP were weaker than children with TD.

Conclusions

In children with USCP, muscle strength weakness exists in both UEs.

Impact

When unimanual or bimanual ability limitations are present in children with unilateral cerebral palsy, investigation of the muscle strength of the nonaffected UE should be part of the assessment.
Can Personal Parties Facilitate Women’s Political Seniority? A Study of Internal Rules of Conduct
Authors: Smrek Michal
Published: August 2020

Leader-driven personal parties often campaign on a ticket promising elite renewal and novel ways of doing politics. One way of looking apart from the sitting political establishment is to recruit women into visible party positions. This study examines whether personal parties can improve women’s access to reelection by institutionalizing performance-based rules of internal promotion, which are necessitated by the lack of organic party cohesion. A site-intensive study of the Slovak Freedom and Solidarity party identifies a number of gendered structural constraints that impede the party’s female incumbents from excelling in those tasks that are deemed important by the party.
Cellular and molecular mechanisms of xenobiotics-induced premature senescence
Authors: Liang Yuehui , Liang Ningjuan , Yin Lirong , Xiao Fang
Published: August 2020

Premature senescence, which share common features with replicative senescence such as morphology, senescence-associated galactosidase (SA-β-gal) activity, cell cycle regulation, and gene expression, can be triggered by the exposure of various xenobiotics including environmental pollutant, peroxides, and anticancer drugs. The exact mechanisms underlying the senescence onset and stabilization are still obscure. In this review, we summarized the possible cellular and molecular mechanisms of xenobiotics-induced premature senescence, including induction of reactive oxygen species (ROS), tumor suppressors, and DNA damage; disequilibrium of calcium homeostasis; activation of transforming growth factor-β (TGF-β); and blockage of aryl hydrocarbon receptor (AHR) pathway. The deeper understanding of the molecular mechanisms underlying xenobiotics-induced senescence may shed light on new therapeutic strategies for age-related pathologies and extend healthy lifespan.
Limited vertical CO2 transport in stems of mature boreal Pinus sylvestris trees
Authors: Tarvainen Lasse , Wallin Göran , Linder Sune , Näsholm Torgny , Oren Ram , Ottosson Löfvenius Mikaell , Räntfors Mats , Tor-Ngern Pantana , Marshall John D
Published: August 2020

Several studies have suggested that CO2 transport in the transpiration stream can considerably bias estimates of root and stem respiration in ring-porous and diffuse-porous tree species. Whether this also happens in species with tracheid xylem anatomy and lower sap flow rates, such as conifers, is currently unclear. We infused 13C-labelled solution into the xylem near the base of two 90-year-old Pinus sylvestris L. trees. A custom-built gas exchange system and an online isotopic analyser were used to sample the CO2 efflux and its isotopic composition continuously from four positions along the bole and one upper canopy shoot in each tree. Phloem and needle tissue 13C enrichment was also evaluated at these positions. Most of the 13C label was lost by diffusion within a few metres of the infusion point indicating rapid CO2 loss during vertical xylem transport. No 13C enrichment was detected in the upper bole needle tissues. Furthermore, mass balance calculations showed that c. 97% of the locally respired CO2 diffused radially to the atmosphere. Our results support the notion that xylem CO2 transport is of limited magnitude in conifers. This implies that the concerns that stem transport of CO2 derived from root respiration biases chamber-based estimates of forest carbon cycling may be unwarranted for mature conifer stands.
A cross-sectional survey to assess the risk factors associated with stigmatizing attitudes towards patients with podoconiosis among rural youth in southern Ethiopia
Authors: Engdawork Kibur , Davey Gail , Ayode Desta , McBride Colleen M , Tadele Getnet
Published: August 2020

Background

Many health conditions are associated with stigma due to beliefs about their causes and the physical changes experienced by patients. Among such conditions are several neglected tropical diseases (NTDs). Podoconiosis, classified as an NTD, is a form of lymphoedema caused by the co-influence of genetic and environmental factors. It is a major public health problem in Ethiopia and is associated with intense stigma. Despite this, little is known about the factors contributing to stigmatizing attitudes against patients with the disease.

Methods

A cross-sectional survey was conducted in southern Ethiopia to analyse the attitudes of rural youth and associated risk factors for stigmatizing attitudes towards patients with podoconiosis, with the aim of informing stigma reduction strategies.

Results

The survey included 336 randomly selected youth. Of the 177 (52.7%) youth who held more stigmatizing attitudes toward patients with podoconiosis, 105 (59.3%) were females and 171 (96.6%) did not have affected friends. Accurate knowledge about gene–environment influences and rejection of infectious causes of podoconiosis were associated with less stigmatizing attitudes.

Conclusions

Improving understanding of the gene–environment interaction and dispelling beliefs about infectious causes may reduce negative attitudes about podoconiosis. Affected youth may play an important role as agents of change to spread non-stigmatizing messages.
An Organizational Socialization Perspective on Young Adults’ Ideas About Retirement: Examining Sources of Retirement Information, Meanings of Retirement, and Source-Meaning Associations
Authors: Gettings Patricia E , Anderson Lindsey B
Published: August 2020

This study drew from literature on organizational socialization, namely an early phase called vocational anticipatory socialization (VAS), to examine the sources of information from which young adults learn about retirement, the meanings they ascribe to retirement, and associations between sources of retirement information and meanings. In study 1, quantitative content analysis was used to code 671 responses from young adults. In study 2, semi-structured interviews with 16 young adults were conducted and abductively analyzed. Results revealed 16 sources of information about retirement with grandparents and parents emerging as primary sources, and 13 meanings of retirement (e.g., freedom from work, financial issues, how time is spent, life phase, physical decline) that can be combined to construct negative or positive framings. In addition, chi-square analyses indicated significant associations between some source-meaning combinations in study 1, whereas study 2 revealed the nature of explicit and implicit advice from family members. Theoretical and practical implications are discussed.
Original Research: Nurses' Knowledge and Comfort with Assessing Inpatients' Firearm Access and Providing Education on Safe Gun Storage
Authors: Sheppard Kimberly Smith , Hall Kathryn , Carney Julia , Griffith Catherine , Rudolph Meaghan , Zelinsky Megan , Gettings Elise
Published: August 2020

Purpose:

This study sought to evaluate nurses' knowledge and comfort with assessing inpatients' access to firearms and providing education on firearm safety and storage. Facilitators and barriers to such assessment, as well as best methods for educating nurses and patients on firearm safety and storage, were also explored.

Methods:

Nurses from a general medical unit and a psychiatric unit at a large urban hospital were invited to complete a 22-question online survey. Descriptive statistics were computed to analyze survey responses for each unit.

Results:

Forty-two nurses—21 from each unit—participated. More than 50% of nurses on each unit were unfamiliar with state law on safe gun storage, and none had prior training in educating others on firearm safety and storage. Compared with nurses on the psychiatric unit, those on the general medical unit were less comfortable asking patients about firearm access and safe gun storage. Several facilitators and barriers to assessment emerged. Facilitators identified by similar numbers of nurses on each unit included receiving relevant education and having educational information available for patients. Nurses on both units also endorsed having a safety protocol and a documentation policy in place. Barriers identified by similar numbers of nurses on each unit included lack of adequate knowledge about firearm safety and lack of patient educational materials. More medical unit than psychiatric unit nurses also named lack of time and not knowing what to do with collected information. More than 80% of nurses on each unit reported that they would feel comfortable providing patients with information on safe firearm storage if it were available; a pamphlet was endorsed most often as the best method. A one-hour class involving the security department and other disciplines was the top endorsed nurse learning strategy.

Conclusions:

Findings from this study highlighted several factors, including nursing specialty, that may influence inpatient assessment of firearm access and safe gun storage. These results can help inform hospital policies and nursing education initiatives aimed at improving safe gun storage practices among patients and the general public.
Stryde Weight-bearing Internal Lengthening Nail
Authors: Robbins Craig , Paley Dror
Published: August 2020

Since May 2018, 106 patients (187 limb segments) have completed internal lengthening with the Stryde implant. Fifty-seven skeletally mature patients (12 female and 45 male) underwent cosmetic stature lengthening of the femur (41), tibia (4), or combined bilateral femur and tibia (12). Forty-nine other patients (ages 9 to 60 y) with a variety of limb length discrepancy etiologies including metabolic, congenital, genetic, and posttraumatic, underwent unilateral lengthening of the femur (37) or tibia (12). All patients undergoing lengthening alone were allowed immediate full weight-bearing as tolerated. Patients with secondary ipsilateral acute deformity corrections had restricted weight-bearing until sufficient healing was present at the metaphyseal site. The mechanical axis deviation following lengthening was not statistically significantly related to limb segment, patient weight, nail diameter, or distraction amount, but tended towards varus in the femurs and valgus in the tibias. Fifty-two stature patients and 43 unilateral patients lengthened to within 10 and 5 mm of their goals, respectively. One tibial nail stopped functioning prematurely and was exchanged to complete the lengthening. Seven patients required secondary unplanned operations. Successful outcomes were achieved in all patients. Strict adherence to careful preoperative planning, and postoperative lengthening protocols including specialized limb lengthening physiotherapy are important to the success. There were no issues related to biological incompatibility of the Biodur 108 alloy stainless steel from which the implant was fabricated.
Quantitative Assessment of Eosinophils in Dermatomyositis Skin Biopsies With Correlation of Eosinophils to Pruritus and Other Clinical Features
Authors: Khanna Urmi , Vaughan Heidi , North Jeffrey , Haemel Anna
Published: August 2020

The objective of this retrospective study was to analyze dermatomyositis skin biopsies for the presence of eosinophils and correlate this finding with other histopathologic and clinical characteristics. Cases of dermatomyositis evaluated in a single dermatologist's adult autoimmunity practice over a 2.5-year period were identified via ICD-10 diagnosis code. Dermatopathology archives were then searched for any corresponding biopsies consistent with dermatomyositis, and those identified were assessed for eosinophils, adnexal involvement, epidermal atrophy, dermal mucin, and basement membrane thickening. Histopathologic findings were correlated with key clinical features, including itch. A total of 39 biopsies from 17 patients were included. Eosinophils were noted in 44% of biopsies (n = 17) from 12 patients. Dermal mucin deposition and adnexal interface dermatitis were noted in 72% (n = 28) and 44% (n = 17) of biopsy specimens, respectively. Of 12 patients with eosinophils present in at least 1 biopsy specimen, 11 (92%) patients had a clinical history of pruritus of their skin lesions (P = 0.052). Limitations of this study include retrospective design and small number of patients.
The Emperor's New Clothes: A Critique of the Current WHO Classification of Malignant Melanoma
Authors: Weyers Wolfgang
Published: August 2020

The World Health Organization’s classification of skin tumors of 2018 presents melanoma as a loose assembly of independent biologic entities, each of which is characterized by a distinctive constellation of clinical, histopathologic, and molecular findings that evolve through different pathways of lesional progression from a benign to an intermediate and, ultimately, malignant tumor. The alleged pathways, however, are based on vague correlations and fail to take into account the common occurrence of lesions that cannot be assigned to either of them. Moreover, there is no such thing as a lesional progression. The evolvement of neoplasms is always a clonal and, therefore, initially focal event. In the majority of melanomas, there is no evidence of a juxtaposition of a benign, intermediate, and malignant portion. Occasionally, a melanoma may develop within the confines of a melanocytic nevus, but a nevus cannot transform into melanoma. The concept of lesional progression merely serves to handle problems of differential diagnosis because it obscures and, in fact, denies the difference between benign and malignant neoplasms. In the current classification of the World Health Organization, every lesion is said to bear some risk of malignant progression, intermediate categories are recognized for all alleged pathways, and no distinction is made between “high-grade dysplasia” and melanoma in situ. Differentiation between benign and malignant neoplasms of melanocytes may be difficult, but the concept of lesional progression does not address those problems; it merely offers evasions under the disguise of diagnoses.
Efficacy and Safety of Pegylated Interferon for the Treatment of Chronic Hepatitis B in Children and Adolescents
Authors: He Yi , Yin Jingyang , Xu Hongmei
Published: August 2020

Background:

Pegylated interferon (PEG-IFN) has recently been approved for the treatment of chronic hepatitis B in children and adolescents. However, the exact efficacy and safety remains to be confirmed.

Objectives:

A systematic review and meta-analysis was performed to assess the efficacy and safety of PEG-IFN for the treatment of chronic hepatitis B in children and adolescents.

Methods:

Databases including MEDLINE/PubMed, Ovid-EMbase, the Cochrane Library and China National Knowledge Internet were searched to collect clinical trials examining the efficacy and safety of PEG-IFN in children and adolescents with confirmed hepatitis B virus infection. Data for treatment response, relapse, treatment discontinuations and adverse events were extracted and summarized.

Results:

A total of 10 clinical trials involving 658 patients were identified. Results indicate that 43% (95% confidence interval [CI]: 25%–61%) of the subjects treated with PEG-IFN achieved HBeAg serologic response, 18% (95% CI: 6%–35%) achieved HBsAg serologic response, 68% (95% CI: 55%–79%) achieved virologic response after the end of treatment and 60% (95% CI: 30%–87%) achieved sustained virologic response.

Conclusion:

Current evidence indicates that PEG-IFN is effective in children and adolescents with hepatitis B virus and that treatment discontinuation due to serious adverse events is infrequent.
Assessment of Employability Skills: A Systematic Review of the Availability and Usage of Professional Behavior Assessment Instruments
Authors: McCallum Christine A. , Murray Leigh , Tilstra Michele , Lairson Alexia
Published: August 2020

Background/Purpose.

Professionalism is highly valued by health care practitioners, resulting in an increased focus by education programs on explicit instruction and development of student professional behaviors (PB), skills and abilities. However, a comprehensive review of valid and reliable PB assessment instruments (PBAIs) for use in educational programs is lacking. The purpose of this systematic review is twofold 1) to identify and evaluate PBAIs available for use within professional physical therapy (PT) programs and 2) to present a PB advising model to guide student development.

Methods.

CINHAL, PubMed, ERIC, and ProQuest were searched from 1999 to present using key words, along with hand and grey literature searches for studies that assessed PB in PT, occupational therapy (OT), and/or speech language pathology students. Extracted data included study type, design, purpose, study characteristics and PBAI components, including descriptions of processes followed implementing the tool. The McMaster Critical Appraisal tool was used to evaluate methodological quality of studies.

Results.

Fourteen different PBAIs were identified for PB assessment. Five PBAIs were student self-assessment tools, 7 for use by academic or clinical faculty and 2 were both self and faculty assessment tools. Ten parameters for PB advising plans were extracted after synthesizing recommendations for use of each instrument.

Discussion and Conclusion.

Professional behavior assessment instruments are available for use in PT and OT disciplines. A new conceptual PB advising framework is offered. The identified PBAIs can be utilized to assess student performance and should be integrated into student advising process. Future research should focus on further validation of the PBAIs.
A rare heterozygous variant in FGB (Fibrinogen Merivale) causing hypofibrinogenemia in a Swedish family
Authors: Fager Ferrari Marcus , Leinoe Eva , Rossing Maria , Norström Eva , Zetterberg Eva
Published: August 2020

Fibrinogen is essential for normal hemostasis. Congenital fibrinogen disorders (afibrinogenemia, hypofibrinogenemia, dysfibrinogenemia and hypodysfibrinogenemia), caused by pathogenic variants in the genes FGA, FGB and FGG, have the potential of causing bleeding diathesis and/or thrombotic events of variable severity. We describe a case of familial hypofibrinogenemia in a Swedish family. The proband is a 27-year-old woman, with a history of significant bleeding diathesis. She was diagnosed with moderate hypofibrinogenemia (0.8 g/l), and genetic screening identified a rare heterozygous missense variant in FGB (c.854G>A, p.Arg285His) (Fibrinogen Merivale) previously described in a New Zealand European family with symptomatic hypofibrinogenemia. The father, sister and brother of the proband also harbored the FGB variant, segregating with hypofibrinogenemia (0.9–1.2 g/l). The proband showed a more severe bleeding phenotype compared with her other hypofibrinogenemic family members; this was attributed to a concomitant platelet dysfunction, also present in her normofibrinogenemic mother.
Partial Response to Sorafenib in a Child With a Myeloid/Lymphoid Neoplasm, Eosinophilia, and a ZMYM2-FLT3 Fusion
Authors: Munthe-Kaas Monica C. , Forthun Rakel B. , Brendehaug Atle , Eek Anette K. , Høysæter Trude , Osnes Liv T.N. , Prescott Trine , Spetalen Signe , Hovland Randi
Published: August 2020

Dysregulated tyrosine kinases in myeloid/lymphoid neoplasms with eosinophilia are rare, but do occur in children. To increase awareness of this diagnosis, we present a child who was diagnosed after a 3-year disease history. The patient was initially treated according to a T-cell lymphoblastic lymphoma protocol, but genetic analyses at recurrence revealed microdeletions resulting in an in-frame fusion of ZMYM2 and FLT3. Treatment with sorafenib, an FLT3 tyrosine kinase inhibitor, rapidly resulted in significant reduction of lymphadenopathy and normalization of white blood cell and eosinophil counts. At 17 months of treatment, he remains in complete hematologic, but not molecular remission.
Brief Report: Increased Cotinine Concentrations are Associated With Reduced Expression of Cathelicidin (LL-37) and NOD-2 in Alveolar Macrophages of PLWH Who Smoke
Authors: Diaz Philip T. , Ferketich Amy , Wewers Mary E. , Browning Kristine , Gavrilin Mikhail A. , Sarkar Anasuya , Hollyfield Jennifer , Trinka Teresa , Wewers Mark
Published: August 2020

There is a strong link between cigarette smoking and pulmonary complications among people living with HIV. However, the effects of smoking on the local lung immune environment in this population remain unclear. Bronchoalveolar lavage and saliva were collected from HIV-infected smokers involved in a prospective study investigating alveolar macrophage expression of host defense molecules. Salivary cotinine concentrations were inversely related to expression of the immune cell receptor nucleotide-binding oligomerization domain-2 and the cathelicidin antimicrobial peptide LL-37. The negative correlation between salivary cotinine and LL-37 was particularly strong. Our study provides insight into how nicotine may adversely affect lung innate immunity in HIV.
Where are we moving in the classification of idiopathic inflammatory myopathies?
Authors: Tanboon Jantima , Uruha Akinori , Stenzel Werner , Nishino Ichizo
Published: August 2020

Purpose of review

Discoveries of myositis-specific antibodies, transcriptomic signatures, and clinicoseropathological correlation support classification of idiopathic inflammatory myopathies (IIM) into four major subgroups: dermatomyositis, immune-mediated necrotizing myopathy (IMNM), antisynthetase syndrome (ASS), and inclusion body myositis (IBM) whereas leaving polymyositis as a historical nonspecific diagnosis of exclusion. This review summarizes and comments on recent knowledge regarding the major subgroup of IIM.

Recent findings

Type 1 interferon (IFN1) pathway activation is the most prominent in dermatomyositis whereas type 2 interferon (IFN2) pathway activation is high in IBM and ASS; neither pathway is distinct in IMNM. Myxovirus-resistant protein A, IFN1 surrogate marker, is now one of definite dermatomyositis muscle biopsy criteria in the new 2018 European Neuromuscular Centre classification of dermatomyositis; the classification emphasizes on different categorization with and without dermatomyositis-specific antibody result. Novel HLA loci associated with anti-TIF1-γ, anti-Mi-2, and anti-Jo-1 antibodies in Caucasian population are identified. Associations of chaperon-assisted selective autophagy (CASA) and complement-mediated autoimmunity in IMNM as well as highly differentiated T cells in IBM are discovered.

Current IIM classification requires integrated clinicoseropathological approaches. Additional information, such as transcriptomics, HLA haplotyping, and potential biomarkers help tailoring categorization that may have future diagnostic and therapeutic implications.
On the joint effect of endogenous spatial attention and defocus blur on acuity: attentional limit to the resolving power of the eye
Authors: De Lestrange-Anginieur E , Leung TW , Kee CS
Published: August 2020

Defocus blur and spatial attention both act on our ability to see clearly over time. However, it is currently unknown how these two factors interact because studies on acuity resolution only focused on the separate effects of attention and defocus blurs. In this study, resolution acuity was measured along the diagonal 135°/315° with horizontal, at 8° eccentricity for clear and blur Landolt C images under various manipulations of covert endogenous attention. We observe that attention not just improves the resolution of clear stimuli, but also modulates the resolution of defocused stimuli for compensating the loss of resolution caused by retinal blur. Our results show, however, that as the degree of attention decreases, the differences between clear and blurred images largely diminish, thus limiting the benefit of an image quality enhancement. It also appeared that attention tends to enhance the resolution of clear images more than blurred targets, suggesting potential variations in the gain of vision correction with the level of attention. This demonstrates that the interaction between spatial attention and focus plays a role in the way we see things. In view of these findings, the development of adaptive (neuro-optical) interventions, which adjust the eye’s focus to attention, may hold promise.

Significance statement

Visual technologies are now attaining a degree of extreme sophistication and diversity, which allows more comprehensive, but often complex manipulations of the optical image formed onto the back of the eye. It is therefore an enigma how those fine and immersive manipulations of the sensory environment are integrated in the brain. In this study, we show that the resolving power of the eye can depend complexly on the interaction between spatial attention and focus. This discovery suggests that perception might be advantageously guided by technologies tailoring optical focus to individual attentional patterns.

Graphical abstract

Proposed neuro-optical mechanism of transformation of stimulus by spatial attention and blur.
The impact of innate accruals quality on the future market value moderated by dividend policy
Authors: Siladjaja Muljanto , Anwar Yuli
Published: August 2020

Purpose

The purpose of this study is to test and prove how the quality of innate accruals can make a significant contribution to the prospect of future market value for manufacturing industries.

Design/methodology/approach

This research used multiple regression method by gathering all observation data on a go public company in the industrial manufacturing sector.

Findings

The results of this test can show that the dividend policy helps reduce the use of accruals to increase investor perceptions about the prospects of the company's future period, especially the value of earnings informativeness, including valid information about the actual fundamental conditions. These results reflect high innate accruals quality, so the use of low accruals, especially in reporting earnings.

Research limitations/implications

This test uses a measurement of a constant growth rate with the calculation of the indicator g in the next five-year period, and the proof has secondary data abnormalities reflecting a very high level of variation in the use of accruals. As an implication of the data that is not normal, it causes a large amount of data pruning through outlier tests. Samples that qualify for processing are 180 from 384 data.

Originality/value

By calculating the value of the dividend payout with the growth rate, the estimated future market price can be done with reasonable accuracy.
Aligning operational practices to competitive strategies to enhance the performance of Indian manufacturing firms
Authors: Sahoo Saumyaranjan
Published: August 2020

Purpose

The main purpose of this study is to understand how collective operational practices are adapted or stimulated by a firm's competitive strategy.

Design/methodology/approach

This study employed a data set drawn from 124 plant managers and directors of Indian manufacturing firms. Multiple regression was used to examine the impact of operational practices of lean, total quality management (TQM) and supply chain management (SCM) within competitive clusters of cost leadership, differentiation and focus strategy.

Findings

Results of the study show that the pattern of impact of operational practices on firm's performance varies according to type of the competitive strategy employed. All the three competitive strategy clusters have reported that TQM is the most important trigger for Indian manufacturing firms with relative effect of TQM practices on firm's performance being higher than that of lean and SCM practices.

Research limitations/implications

Cross-sectional data from Indian manufacturing firms were used, and it would be interesting to test the analytical framework of the study for more sectors and countries. Future studies can take a longitudinal research approach to strengthen the findings of the study.

Practical implications

The findings explain how operational practices are aligned with competitive strategies for practitioners so that they can assign limited resources to build diverse operational capabilities based on their strategic choices.

Originality/value

Although very few classical studies are reported in various contexts involving competitive strategy, operational practices and firm's performance, no existing study focuses on how these three domains are linked together in the context of Indian manufacturing sector.