bluuebunny/crossref_metadata_2025 huggingface dataset:
D
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with D, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Dalteparin, Dexamethasone, Diamorphine (heroin), Diazepam, Diazoxide, Digoxin, Digoxin-specific antibody, Dihydrocodeine, Dobutamine, Domperidone, Dopamine, Dornase alfa (recombinant human DNase), and Doxapram
P
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with P, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Palivizumab, Pamidronate disodium, Pancreatin, Pancuronium, Paracetamol = Acetaminophen (USAN), Parenteral nutrition, Penicillin (Penicillin G; Benzylpenicillin), Pethidine = Meperidine (USAN), Phenobarbital = Phenobarbitone (former BAN), Phenytoin, Phosphate, Piperacillin with tazobactam (piperacillin-tazobactam), Plasma albumin (human albumin solution), Plasma substitutes, Platelets, Pneumococcal vaccines, Polio vaccines, Polystyrene sulfonate resins, Potassium chloride, Praziquantel, Prednisolone, Probiotics, Progesterone, Proguanil (with or without atovaquone), Propofol, Propranolol, Prostaglandins E1 (alprostadil) and E2 (dinoprostone), Pyrazinamide, Pyridoxine (vitamin B6) and pyridoxal phosphate, and Pyrimethamine
Asymmetric spatial distribution of subsolar metallicity stars in the Milky Way nuclear star cluster
Authors: Feldmeier-Krause A , Kerzendorf W , Do T , Nogueras-Lara F , Neumayer N , Walcher C J , Seth A , Schödel R , de Zeeuw P T , Hilker M , Lützgendorf N , Kuntschner H , Kissler-Patig M
Published: March 2020

We present stellar metallicity measurements of more than 600 late-type stars in the central 10 pc of the Galactic Centre. Together with our previously published KMOS data, this data set allows us to investigate, for the first time, spatial variations of the nuclear star cluster’s metallicity distribution. Using the integral-field spectrograph KMOS (VLT), we observed almost half of the area enclosed by the nuclear star cluster’s effective radius. We extract spectra at medium spectral resolution and apply full spectral fitting utilizing the PHOENIX library of synthetic stellar spectra. The stellar metallicities range from [M/H] = −1.25 dex to [M/H] > +0.3 dex, with most of the stars having supersolar metallicity. We are able to measure an anisotropy of the stellar metallicity distribution. In the Galactic north, the portion of subsolar metallicity stars with [M/H] < 0.0 dex is more than twice as high as in the Galactic south. One possible explanation for different fractions of subsolar metallicity stars in different parts of the cluster is a recent merger event. We propose to test this hypothesis with high-resolution spectroscopy and by combining the metallicity information with kinematic data.
A Volume-limited Sample of Cataclysmic Variables from Gaia DR2: Space Density and Population Properties
Authors: Pala A F , Gänsicke B T , Breedt E , Knigge C , Hermes J J , Gentile Fusillo N P , Hollands M A , Naylor T , Pelisoli I , Schreiber M R , Toonen S , Aungwerojwit A , Cukanovaite E , Dennihy E , Manser C J , Pretorius M L , Scaringi S , Toloza O
Published: March 2020

We present the first volume-limited sample of cataclysmic variables (CVs), selected using the accurate parallaxes provided by the second data release (DR2) of the European Space Agency Gaia space mission. The sample is composed of 42 CVs within 150 pc, including two new systems discovered using the Gaia data, and is $(77 \pm 10)$ per cent complete. We use this sample to study the intrinsic properties of the Galactic CV population. In particular, the CV space density we derive, $\rho =(4.8^{+0.6}_{-0.8}) \times 10^{-6}\, \mbox{$\mathrm{pc}^{-3}$}$, is lower than that predicted by most binary population synthesis studies. We also find a low fraction of period bounce CVs, seven per cent, and an average white dwarf mass of $\langle M_\mathrm{WD} \rangle = (0.83 \pm 0.17)\, \mathrm{M}_\odot$. Both findings confirm previous results, ruling out the presence of observational biases affecting these measurements, as has been suggested in the past. The observed fraction of period bounce CVs falls well below theoretical predictions, by at least a factor of five, and remains one of the open problems in the current understanding of CV evolution. Conversely, the average white dwarf mass supports the presence of additional mechanisms of angular momentum loss that have been accounted for in the latest evolutionary models. The fraction of magnetic CVs in the 150 pc sample is remarkably high at 36 per cent. This is in striking contrast with the absence of magnetic white dwarfs in the detached population of CV progenitors, and underlines that the evolution of magnetic systems has to be included in the next generation of population models.
Stellar wind effects on the atmospheres of close-in giants: a possible reduction in escape instead of increased erosion
Authors: Vidotto A A , Cleary A
Published: March 2020

The atmospheres of highly irradiated exoplanets are observed to undergo hydrodynamic escape. However, due to strong pressures, stellar winds can confine planetary atmospheres, reducing their escape. Here, we investigate under which conditions atmospheric escape of close-in giants could be confined by the large pressure of their host star’s winds. For that, we simulate escape in planets at a range of orbital distances ([0.04, 0.14] au), planetary gravities ([36, 87 per cent] of Jupiter’s gravity), and ages ([1, 6.9] Gyr). For each of these simulations, we calculate the ram pressure of these escaping atmospheres and compare them to the expected stellar wind external pressure to determine whether a given atmosphere is confined or not. We show that although younger close-in giants should experience higher levels of atmospheric escape, due to higher stellar irradiation, stellar winds are also stronger at young ages, potentially reducing escape of young exoplanets. Regardless of the age, we also find that there is always a region in our parameter space where atmospheric escape is confined, preferably occurring at higher planetary gravities and orbital distances. We investigate confinement of some known exoplanets and find that the atmosphere of several of them, including π Men c, should be confined by the winds of their host stars, thus potentially preventing escape in highly irradiated planets. Thus, the lack of hydrogen escape recently reported for π Men c could be caused by the stellar wind.
The intracluster light as a tracer of the total matter density distribution: a view from simulations
Authors: Alonso Asensio Isaac , Dalla Vecchia Claudio , Bahé Yannick M , Barnes David J , Kay Scott T
Published: March 2020

By using deep observations of clusters of galaxies, it has been recently found that the projected stellar mass density closely follows the projected total (dark and baryonic) mass density within the innermost ∼140 kpc. In this work, we aim to test these observations using the Cluster-EAGLE simulations, comparing the projected densities inferred directly from the simulations. We compare the iso-density contours using the procedure of Montes & Trujillo, and find that the shape of the stellar mass distribution follows that of the total matter even more closely than observed, although their radial profiles differ substantially. The ratio between stellar and total matter density profiles in circular apertures shows a slope close to −1, with a small dependence on the cluster’s total mass. We propose an indirect method to calculate the halo mass and mass density profile from the radial profile of the intracluster stellar mass density.
Atypical work, worker voice and supervisor responses
Authors: Sluiter Roderick , Manevska Katerina , Akkerman Agnes
Published: March 2020

We study atypical workers’ experiences with voice of in the Netherlands. We take a relational approach to worker voice and hypothesize that atypical workers are particularly vulnerable to refrain from voice and to experience suppression. We test our hypotheses using unique data on workers’ actual experiences with voicing discontent and supervisors’ responses (N = 4708; collected in 2017 and 2018). We find that temporary and freelance work, job insecurity, replaceability and precarious values are barriers to worker voice. Job insecurity and precarious values are associated with less support and more suppression from supervisors. These insights offer a valuable contribution to scholarly and public debates on atypical work by demonstrating how it not only affects workers’ job security, income stability and entitlements but also reduces workers’ ability to speak up and solve problems at work.
Detecting sleep using heart rate and motion data from multisensor consumer-grade wearables, relative to wrist actigraphy and polysomnography
Authors: Roberts Daniel M , Schade Margeaux M , Mathew Gina M , Gartenberg Daniel , Buxton Orfeu M
Published: March 2020

Study Objectives

Multisensor wearable consumer devices allowing the collection of multiple data sources, such as heart rate and motion, for the evaluation of sleep in the home environment, are increasingly ubiquitous. However, the validity of such devices for sleep assessment has not been directly compared to alternatives such as wrist actigraphy or polysomnography (PSG).

Methods

Eight participants each completed four nights in a sleep laboratory, equipped with PSG and several wearable devices. Registered polysomnographic technologist-scored PSG served as ground truth for sleep–wake state. Wearable devices providing sleep–wake classification data were compared to PSG at both an epoch-by-epoch and night level. Data from multisensor wearables (Apple Watch and Oura Ring) were compared to data available from electrocardiography and a triaxial wrist actigraph to evaluate the quality and utility of heart rate and motion data. Machine learning methods were used to train and test sleep–wake classifiers, using data from consumer wearables. The quality of classifications derived from devices was compared.

Results

For epoch-by-epoch sleep–wake performance, research devices ranged in d′ between 1.771 and 1.874, with sensitivity between 0.912 and 0.982, and specificity between 0.366 and 0.647. Data from multisensor wearables were strongly correlated at an epoch-by-epoch level with reference data sources. Classifiers developed from the multisensor wearable data ranged in d′ between 1.827 and 2.347, with sensitivity between 0.883 and 0.977, and specificity between 0.407 and 0.821.

Conclusions

Data from multisensor consumer wearables are strongly correlated with reference devices at the epoch level and can be used to develop epoch-by-epoch models of sleep–wake rivaling existing research devices.
Molecular docking analyses of CYP450 monooxygenases of Tribolium castaneum (Herbst) reveal synergism of quercetin with paraoxon and tetraethyl pyrophosphate: in vivo and in silico studies
Authors: Ghaffar Ammarah , Sehgal Sheikh Arslan , Fatima Rida , Batool Roya , Aimen Ume , Awan Sliha , Batool Sajida , Ahmad Faheem , Nurulain Syed M
Published: March 2020

Pest management in stored grain industry is a global issue due to the development of insecticide resistance in stored grain insect pests. Excessive use of insecticides at higher doses poses a serious threat of food contamination and residual toxicity for grain consumers. Since the development of new pesticide incurs heavy costs, identifying an effective synergist can provide a ready and economical tool for controlling resistant pest populations. Therefore, the synergistic property of quercetin with paraoxon and tetraethyl pyrophosphate has been evaluated against the larvae and adults of Tribolium castaneum (Herbst). Comparative molecular docking analyses were carried out to further identify the possible mechanism of synergism. It was observed that quercetin has no insecticidal when applied at the rate of 1.5 and 3.0 mg/g; however, a considerable synergism was observed when applied in combination with paraoxon. The comparative molecular docking analyses of CYP450 monooxygenase (CYP15A1, CYP6BR1, CYP6BK2, CYP6BK3) family were performed with quercetin, paraoxon and tetraethyl pyrophosphate which revealed considerable molecular interactions, predicting the inhibition of CYP450 isoenzyme by all three ligands. The study concludes that quercetin may be an effective synergist for organophosphate pesticides depending upon the dose and type of the compound. In addition, in silico analyses of the structurally diversified organophosphates can effectively differentiate the organophosphates which are synergistic with quercetin.
Reducing Waste and Increasing Sustainability in Health Care Settings
Authors: Kleber Julie , Cohen Bevin
Published: March 2020

Since the 1960s, plastic has been used in the production of medical equipment and products that improve patient comfort, safety, and treatment. Yet an unwelcome challenge has emerged in the years since: how to safely dispose of this material without negatively affecting human health and the environment. Working with medical devices and supplies that are constructed using plastics, nurses are at the forefront of this issue and must identify solutions, collaborate with other health care workers, and lead efforts to establish more sustainable options. This series is in collaboration with the Alliance of Nurses for Healthy Environments (https://envirn.org).
Improving Preoperative Cardiac Risk Prediction
Authors: Rosenberg Karen
Published: March 2020

According to this study:

Preoperative N-terminal pro-B-type natriuretic peptide levels are predictive of major cardiovascular events and death after noncardiac surgery and can be used to improve preoperative cardiac risk stratification.
Pharmacological Options for Treating Delirium in Critically Ill Adults
Authors: Weeks Susan Mace
Published: March 2020

Editor's note: The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see https://nursing.cochrane.org.
‘Kindly Women and Practically Trained Subordinates’
Authors: Brown Theresa
Published: March 2020

How nursing's past holds back our present.
Neurally Adjusted Ventilatory Assist versus Pressure Support Ventilation in Difficult Weaning
Authors: Liu Ling , Xu Xiaoting , Sun Qin , Yu Yue , Xia Feiping , Xie Jianfeng , Yang Yi , Heunks Leo , Qiu Haibo
Published: March 2020

Background

Difficult weaning frequently develops in ventilated patients and is associated with poor outcome. In neurally adjusted ventilatory assist, the ventilator is controlled by diaphragm electrical activity, which has been shown to improve patient–ventilator interaction. The objective of this study was to compare neurally adjusted ventilatory assist and pressure support ventilation in patients difficult to wean from mechanical ventilation.

Methods

In this nonblinded randomized clinical trial, difficult-to-wean patients (n = 99) were randomly assigned to neurally adjusted ventilatory assist or pressure support ventilation mode. The primary outcome was the duration of weaning. Secondary outcomes included the proportion of successful weaning, patient–ventilator asynchrony, ventilator-free days, and mortality. Weaning duration was calculated as 28 days for patients under mechanical ventilation at day 28 or deceased before day 28 without successful weaning.

Results

Weaning duration in all patients was statistically significant shorter in the neurally adjusted ventilatory assist group (n = 47) compared with the pressure support ventilation group (n = 52; 3.0 [1.2 to 8.0] days vs. 7.4 [2.0 to 28.0], mean difference: −5.5 [95% CI, −9.2 to −1.4], P = 0.039). Post hoc sensitivity analysis also showed that the neurally adjusted ventilatory assist group had shorter weaning duration (hazard ratio, 0.58; 95% CI, 0.34 to 0.98). The proportion of patients with successful weaning from invasive mechanical ventilation was higher in neurally adjusted ventilatory assist (33 of 47 patients, 70%) compared with pressure support ventilation (25 of 52 patients, 48%; respiratory rate for neurally adjusted ventilatory assist: 1.46 [95% CI, 1.04 to 2.05], P = 0.026). The number of ventilator-free days at days 14 and 28 was statistically significantly higher in neurally adjusted ventilatory assist compared with pressure support ventilation. Neurally adjusted ventilatory assist improved patient ventilator interaction. Mortality and length of stay in the intensive care unit and in the hospital were similar among groups.

Conclusions

In patients difficult to wean, neurally adjusted ventilatory assist decreased the duration of weaning and increased ventilator-free days.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Neonatal hip ultrasound: tangent to lateral roof angle correlates better with stability than alpha angle according to Graf or percentage femoral head coverage
Authors: Wilkinson A. Graham , Wilkinson Sally , Elton Robert A. , Davis Joanna
Published: March 2020

The aim of this study was to determine the relationship of tangent to the lateral roof angle (TLRA), Graf’s alpha angle and percentage femoral head cover (PHC) and to observed stability, and to establish intraobserver and interobserver errors for measurement of alpha angle and TLRA. In total, 2235 babies referred to the hip review clinic over a period of 8  years. Intraobserver and interobserver errors were calculated from readings of 383 hip images by an experienced paediatric radiologist and a trainee. Taking TLRA <70° as abnormal resulted in sensitivity for unstable right hips of 88% compared with 77% for alpha angle <60° (P  =  0.002) and 81% for PHC <60% (P  =  0.028) and specificity of TLRA 89%, alpha angle 90% (P  =  0.07) and PHC 83% (P  <  0.001). Corresponding figures for left hips are sensitivity of TLRA 99%, alpha angle 91% (P  <  0.001) and PHC 96% (P  =  0.013), and specificity TLRA 86%, alpha angle 83% (P  =  0.001) and PHC 67% (P  <  0.001). Mean intraobserver errors for alpha angle were 1.85° and 1.81° for consultant and trainee compared to 2.54 and 2.55 for TLRA. Mean interobserver errors were 2.22 for alpha angle and 3.42 for TLRA. TLRA, a new parameter, correlated better with observed stability with significant improvement in sensitivity in both hips and specificity in left hips compared with Graf’s alpha angle, and significantly improved sensitivity and specificity in both hips compared with percentage femoral head cover.
Arthroscopic-assisted Retrograde Drilling for the Treatment of Osteochondral Lesions of the Femoral Head: Surgical Technique and Outcome of a Case Series
Authors: Slullitel Pablo A. , Nally Francisco J. , Garcia-Mansilla Agustin M. , Zanotti Gerardo , Piccaluga Francisco , Buttaro Martín A. , Comba Fernando
Published: March 2020

When femoral head chondropaties are located medially or parafoveal, they pose a challenge to arthroscopically reach the affected area through commonly used portals. Though surgical hip dislocation remains as the gold standard for treatment of such lesions, many patients reject surgery for its potential complications and postoperative demanding rehabilitation protocol. We aimed to describe the surgical technique for microfracturing osteochondral lesions of the femoral head with a 3.2-mm drill in an arthroscopically assisted manner and to describe the outcome of this procedure. We describe 9 transtrochanteric drillings throughout an otherwise uneventful arthroscopic treatment of femoroacetabular impingement pathology. All of them had a parafoveal osteochondral lesion unapproachable with curved awls through routinely used portals. After debriding the cartilage flap with a chondrotome, the surgical technique consisted of a minimally invasive 3.2-mm drilling through the femoral lateral cortex fluoroscopically guided. Mean follow-up was 55.8 months (range, 43 to 113 mo). Outcome was evaluated with the modified Harris Hip Score (mHHS) and healing was assessed through magnetic resonance imaging findings. Overall, all patients showed better results when comparing preoperative and postoperative mHHS (43.8 vs. 79.5; P=0.0008). No complications were reported due to the surgical technique. Complete healing of the osteochondral lesion was confirmed in 7 of 9 cases, and partially in one. One patient with Tönnis 2 preoperative changes required conversion to total hip arthroplasty at 80-month follow-up. Retrograde drilling was a valid option for treating small-sized medially located osteochondral lesions of the femoral head which are difficult to treat through standard arthroscopic portals.
Subtherapeutic Linezolid Concentration in a Patient With Bullous Pemphigoid Complicated by Methicillin-Resistant Staphylococcus aureus Infection: A Case Study
Authors: Chen Congqin , Zhang Min , Chen Hong , Fang Jie
Published: March 2020

We presented a case of subtherapeutic linezolid concentration in a patient with bullous pemphigoid characterized by large area skin anabrosis complicated by methicillin-resistant Staphylococcus aureus infections.
Knowledge and attitudes associated with menopause among women aged 45 to 60 years: a pilot study among rural and urban women in Bangladesh
Authors: Harun Md. Golam Dostogir , Salema Umme , Chowdhury Aluddin , Haque Md. Imdadul , Kafi Mohammad Abdullah Heel , Shahajahan Md. , Sharmin Sabrina
Published: March 2020

Objective:

To assess knowledge and attitudes associated with the menopause transition among women in Bangladesh.

Methods:

A cross-sectional survey was conducted among women (age range 45-60 y), 160 participants were selected from both urban and rural settings using a systematic sampling procedure. We used face-to-face interview techniques employing a semistructured questionnaire. Bivariate and multivariate regression analyses were done to assess the associated factors.

Results:

Around one-fourth (23%) of the participants did not have a basic understanding about symptoms of menopause. Knowledge about menopause increased proportionately with higher education levels (primary education, risk ratio [RR] = 3.91, 95% confidence interval [CI] = 0.66-22.92; secondary education, RR = 6.10, 95% CI = 1.26-29.41; higher education, RR = 6.74, 95% CI = 1.33-34) and was more common among urban than rural women (P = 0.001). In addition, women who were service holders had greater knowledge about menopause compared with women who worked in the home (RR = 8.67, 95% CI = 1.94-38.58). Most of the women (96%) suffered from different kinds of depression during the menopause transition. Key barriers to gaining knowledge about menopause included access to information (63%), social stigma (57%), and shame (52%).

Conclusions:

Menopause is a neglected issue in Bangladesh. Accurate and appropriate information regarding premenopause and menopause can help women cope with this life transition. Social and familial support may also play a role in minimizing isolation and depression. Public health messaging to increase awareness and knowledge about menopause should be undertaken to overcome the stigma and shame associated with menopause in Bangladesh.

Video Summary:
http://links.lww.com/MENO/A556.
Linguistic translation and validation of the Menopause-specific Quality of Life (MENQOL) questionnaire in Greek menopausal women
Authors: Papadima Evgenia-Ioanna , Boutsiadis Anastasios , Soldatou Alexandra , Ivanidou Sofia , Vassilakou Tonia , Michala Lina
Published: March 2020

Objective:

The objective of this study was to translate the Menopause-specific Quality of Life (MENQOL) questionnaire in Greek and validate it for usage in the Greek population both in written and electronic form.

Methods:

The original English questionnaire MENQOL with 1-month recall period was translated by our team. According to instructions by Mapi Research Trust, the questionnaire was forward and back-translated, followed by patient testing and proofreading. Then it was transcripted electronically. Validation was performed with the following tests: internal consistency (reliability), stability (test-retest reliability) with Cronbach's alpha correlations, independent and paired t tests, and Pearson's correlation coefficients.

Results:

A total of 105 women, the majority recently menopausal, participated in the study. Internal consistency using the Cronbach's alpha showed high reliability ranging between 0.833 (physical domain) and 0.896 (vasomotor domain) for the written, and 0.720 (physical domain) and 0.868 (vasomotor domain) for the online form. Test-retest reliability was also high for both forms. The sexual domain of MENQOL had the higher mean, indicating the highest impact on quality of life (3.80 ± 2.35).

Conclusions:

The Greek version of MENQOL is a reliable instrument for evaluating menopausal women. Availability of an online form will allow wider dissemination of the questionnaire. Further use of the questionnaire in Greece may lead to better understanding of the bothersome symptoms of menopause; a prerequisite to develop intervention studies for amelioration of quality of life.
Relationship between age at menarche and risk of glucose metabolism disorder: a systematic review and dose-response meta-analysis
Authors: Ren Yongcheng , Zou Haiyin , Zhang Dongdong , Han Chengyi , Hu Dongsheng
Published: March 2020

Objective:

Studies investigating the impact of age at menarche on glucose metabolism disorder have reached inconsistent conclusions, and a quantitative comprehensive assessment of the dose-response association between age at menarche and glucose metabolism disorder has not been reported. We performed a systematic review and meta-analysis of studies assessing the risk of glucose metabolism disorder by age at menarche.

Methods:

MEDLINE via PubMed and EMBASE databases were searched up to March 13, 2019. Restricted cubic splines were used to model the dose-response association.

Results:

Twenty-five publications (including 34 studies) were included in the meta-analysis. The summary risk ratios (RRs) and 95% confidence limit (CL) per 1-year increase in age at menarche were 0.98 (95% CL 0.98, 0.99) for type 2 diabetes mellitus (T2DM), 0.97 (95% CL 0.96, 0.99) for impaired fasting glucose (IFG), and 0.98 (95% CL 0.97, 0.99) for gestational diabetes mellitus (GDM). We identified linear negative correlations between age at menarche and T2DM (P
nonlinearity = 0.052) and IFG (P
nonlinearity = 0.145), a nonlinear dose-response between age at menarche and GDM (P
nonlinearity = 0.038).

Conclusions:

Older age at menarche (range 8-18 years old) is associated with reduced risk of glucose metabolism disorder. The strongest reduction in risk of GDM is observed at menarche age of 14.5 years.
Perioperative Fluid Resuscitation in Free Flap Breast Reconstruction: When Is Enough Enough?
Authors: Karamanos Efstathios , Walker Rachael , Wang Howard T. , Shah Amita R.
Published: March 2020

Background:

Perioperative liberal fluid resuscitation (LFR) can result in interstitial edema and venous congestion and may be associated with compromised perfusion of free flaps and higher incidence of wound complications. We hypothesized that restrictive intraoperative fluid resuscitation improves flap perfusion and lowers the wound complication rate in free flap breast reconstruction.

Methods:

Patients undergoing free flap reconstruction of the breast from 2010 to 2018 were retrospectively reviewed. The study population was divided into 2 groups, LFR (≥7 ml/kg/h) and restrictive fluid resuscitation (RFR) (<7 ml/kg/h). Mean percutaneous oximetry readings of the flap over the first 24 hours were recorded. Primary outcome was development of any wound complication. Secondary outcomes were mean percutaneous oximetry readings within the first 24 hours, length of stay, and development of acute kidney injury.

Results:

One hundred twenty-six patients were identified, with 41 patients undergoing LFR. The mean fluid received for the RFR group was 5.5 versus 10.2 ml/kg/h for the LFR group (P < 0.001). LFR resulted in a significantly higher incidence of wound complications (76% versus 15%, P < 0.001). The mean oximetry readings within 24 hours were significantly lower for the LFR group (41% versus 56%, P < 0.001). Urine output intraoperatively and within the first 24 hours was similar between the 2 groups. No patients developed acute kidney injury.

Conclusion:

RFR in free flap breast reconstruction is associated with increased flap perfusion and lower incidence of wound-related complications and should be considered whenever possible.
Treatment of Upper Extremity Lymphedema following Chemotherapy and Radiation for Head and Neck Cancer
Authors: Szpalski Caroline , Hanasono Matthew M. , Chang Edward I.
Published: March 2020

In the industrialized world, the most common cause of secondary lymphedema is iatrogenic. The inciting event is generally a combination of lymph node resection, chemotherapy, and radiation therapy. Although a regional nodal dissection is often the primary risk factor, lymphedema can also result from sentinel node dissections, or as in the case presented without any surgical resection. Here, we present a unique case of upper extremity lymphedema resulting from definitive chemoradiation for squamous cell carcinoma of the head and neck. The patient was treated using a combined approach with a lymphaticovenular anastomosis and a free vascularized inguinal lymph node transfer.
Regulatory T cells counteract neuropathic pain through inhibition of the Th1 response at the site of peripheral nerve injury
Authors: Davoli-Ferreira Marcela , de Lima Kalil A. , Fonseca Miriam M. , Guimarães Rafaela M. , Gomes Francisco I. , Cavallini Maria C. , Quadros Andreza U. , Kusuda Ricardo , Cunha Fernando Q. , Alves-Filho Jose C. , Cunha Thiago M.
Published: March 2020

The inflammatory/immune response at the site of peripheral nerve injury participates in the pathophysiology of neuropathic pain. Nevertheless, little is known about the local regulatory mechanisms underlying peripheral nerve injury that counteracts the development of pain. Here, we investigated the contribution of regulatory T (Treg) cells to the development of neuropathic pain by using a partial sciatic nerve ligation model in mice. We showed that Treg cells infiltrate and proliferate in the site of peripheral nerve injury. Local Treg cells suppressed the development of neuropathic pain mainly through the inhibition of the CD4+ Th1 response. Treg cells also indirectly reduced neuronal damage and neuroinflammation at the level of the sensory ganglia. Finally, we identified IL-10 signaling as an intrinsic mechanism by which Treg cells counteract neuropathic pain development. These results revealed Treg cells as important inhibitory modulators of the immune response at the site of peripheral nerve injury that restrains the development of neuropathic pain. In conclusion, the boosting of Treg cell function/activity might be explored as a possible interventional approach to reduce neuropathic pain development after peripheral nerve damage.
The study of multiple diagnosis models of human prostate cancer based on Taylor database by artificial neural networks
Authors: Jiang Fu-Neng , Dai Li-Jun , Wu Yong-Ding , Yang Sheng-Bang , Liang Yu-Xiang , Zhang Xin , Zou Cui-Yun , He Ren-Qiang , Xu Xiao-Ming , Zhong Wei-De
Published: March 2020

Background:

Prostate cancer (PCa) is the most common malignancy seen in men and the second leading cause of cancer-related death in males. The incidence and mortality associated with PCa has been rapidly increasing in China recently.

Methods:

Multiple diagnostic models of human PCa were developed based on Taylor database by combining the artificial neural networks (ANNs) to enhance the ability of PCa diagnosis. Genetic algorithm (GA) is used to select feature genes as numerical encoded parameters that reflect cancer, metastatic, or normal samples. Back propagation (BP) neural network and learning vector quantization (LVQ) neural network were used to build different Cancer/Normal, Primary/Metastatic, and Gleason Grade diagnostic models.

Results:

The performance of these modeling approaches was evaluated by predictive accuracy (ACC) and area under the receiver operating characteristic curve (AUC). By observing the statistically significant parameters of the three training sets, our Cancer/Normal, Primary/Metastatic, and Gleason Grade models’ with ACC and AUC can be drawn (97.33%, 0.9832), (99.17%, 0.9952), and (90.48%, 0.8742), respectively.

Conclusion:

These results indicated that our diagnostic models of human PCa based on Taylor database combining the feature gene expression profiling data and artificial intelligence algorithms might act as a powerful tool for diagnosing PCa. Gleason Grade diagnostic models were used as novel prognostic diagnosis models for biochemical recurrence–free survival and overall survival, which might be helpful in the prognostic diagnosis of PCa in patients.
Non–small cell lung cancer in the very young: Higher EGFR/ALK mutation proportion than the elder
Authors: He Chien-Hui , Shih Jen-Fu , Lai Shinn-Liang , Chen Yuh-Min
Published: March 2020

Background:

This study aimed to analyze pathologic characteristics, treatment, prognosis, and tumor epidermal growth factor receptor/anaplastic large-cell lymphoma kinase (EGFR/ALK) mutation proportion of non–small cell lung cancer (NSCLC) patients aged <40 years at diagnosis.

Methods:

We retrospectively reviewed data of NSCLC patients diagnosed at Taipei Veterans General Hospital between June 2007 and December 2014, aged <90 years at the time of the diagnosis.

Results:

We found 5051 cases of NSCLC, including 168 patients who were <40 years (younger group) and 4883 patients aged 40 to 89 years (older group). We found that the younger group had a significantly higher proportion of the EGFR mutation (22.6% vs 16.2%, p = 0.026) and the ALK mutation (4.2% vs 0.5%, p < 0.001) than the older group. Although the younger group included more stage IV patients (60.1% vs 49.6%, p = 0.002), it had a better overall survival (OS) rate (1 year: 73.7% vs 66.2%, p = 0.043; 5 years: 44.4% vs 33.7%, p = 0.004) (median survival time: 55 vs 26 months, p = 0.002). About the histologic subtype of NSCLC, the younger group presented less frequent cases of squamous cell carcinoma (4.2% vs 16.1%, p < 0.001), whereas the adenocarcinoma subtype was similarly frequent in the two groups (76.8% vs 76.5%, p = 0.924).

Conclusion:

The OS rate in younger NSCLC patients was higher than that in the older NSCLC patients, despite the higher rate of stage IV NSCLC patients in the younger group. This survival benefit is most likely due to the higher proportion of the EGFR and ALK mutations and the corresponding tyrosine kinase inhibitor treatment.
Utility and Safety of Airway Stenting in Distal Airways Stenosis After Lung Transplant
Authors: DiBardino David M. , Andronov Michelle , Haas Andrew R. , Lanfranco Anthony R. , Ma Kevin C.
Published: March 2020

Background:

Airway complications after lung transplantation are a difficult to treat clinical entity. A subset of these patients develop progressive distal airway stenosis (DAS) and a total loss of lobar airways. Stents may be placed to prevent continued obstruction. However, there is little data to suggest stent placement provides durable airway patency or a reduction in the need for further interventions.

Methods:

A retrospective cohort study was conducted using patients with DAS who underwent a variety of interventions. Demographic information and complications were described using nonparametric methods. Lung function at 1 year and bronchoscopies per month were compared between stented and nonstented patients using a Mann-Whitney test. For patients treated with stenting, bronchoscopies per month were compared before and after stenting using a Wilcoxon signed-rank test. Airway patency was compared between stented and nonstented patients using the Fischer exact test.

Results:

Eleven airways were identified as DAS phenotype, 5 of which were treated with stents. Within the stented airways, a trend toward an increase in bronchoscopies per month was seen after stent placement. Comparing the stented versus nonstented patients, there was no improvement in lung function, no reduction in bronchoscopies per month, and no difference in airway patency for stented patients.

Conclusion:

Patients with DAS phenotypes that were treated with endobronchial stenting did not require less airway intervention or have greater final airway patency compared with the nonstented airways. Among the stented patients, the need for airway manipulation did not decrease after stent placement.
High-mobility Group Box 1 Protein in Pediatric Trauma Patients With Acute Traumatic Coagulopathy or Disseminated Intravascular Coagulation
Authors: Ulusoy Emel , Duman Murat , Çağlar Aykut , Küme Tuncay , Er Anil , Akgül Fatma , Çitlenbik Hale , Yilmaz Durgül , Ören Hale
Published: March 2020

Objectives:

Trauma can induce the release of high-mobility group box 1 (HMGB1), which plays an important role in the activation of coagulation. In this study, we aimed to evaluate the role of HMGB1 in the early diagnosis of acute traumatic coagulopathy (ATC), disseminated intravascular coagulation, and clinical course.

Materials and Methods:

One hundred pediatric trauma patients and 50 healthy controls were enrolled. Demographic data, physical examination results, trauma scores, International Society on Thrombosis and Hemostasis score, laboratory values, transfusion requirements, and needs for mechanical ventilation were recorded. Blood samples for HMGB1 were assessed by an enzyme-linked immunosorbent assay.

Results:

Thirty-five patients had ATC and 3 patients had overt disseminated intravascular coagulation. In trauma patients, HMGB1 levels were statistically higher than those in the control group (P<0.001). There was a positive correlation between HMGB1 levels and D-dimer levels (r=0.589, P<0.001). ATC patients had higher plasma HMGB1 levels than those without ATC (P=0.008). High HMGB1 levels were associated with the duration of mechanical ventilation, need for intensive care unit observation, length of hospital stay, and mortality.

Conclusion:

This study showed the early increase of HMGB1 in pediatric trauma cases and demonstrated the significant association of high HMGB1 levels with the development of ATC, disseminated intravascular coagulation, trauma severity, clinical outcome, and mortality.
Nurses' Experiences When Introducing Patient-Reported Outcome Measures in an Outpatient Clinic
Authors: Thestrup Hansen Stine , Kjerholt Mette , Friis Christensen Sarah , Brodersen John , Hølge-Hazelton Bibi
Published: March 2020

Background

Application of patient-reported outcome measures (PROM) seems to be a step toward person-centered care and identifying patients’ unmet needs.

Objective

To investigate the experiences of nurses when PROMs were introduced in a hematological clinical practice as part of a multimethod intervention study.

Methods

The qualitative framework was guided by the interpretive description (ID) methodology, including a focused ethnographic approach with participant observations and interviews. The instruments introduced were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Outcomes and Experiences Questionnaire. Analysis was inspired by Habermas’ critical theory.

Results

The analysis revealed 2 predominant themes of nurses’ experiences: “PROMs are only used when there is time—which there rarely is” and “PROMs cannot be used without a strategy, just because they are present.”

Conclusions

Nurses’ experiences with PROMs depended on the systems’ rationale, resulting in limited capacity to use and explore PROMs. Nurses believed that PROMs might have the potential to support clinical practice, as PROMs added new information about patients’ conditions but also identified needs within supportive care, leaving the potential of PROMs uncertain. Simply introducing PROMs to practice does not necessarily actuate their potential because use of PROMs is dependent on institutional conditions and mandatory tasks are prioritized.

Implications for Practice

This study contributes knowledge of nurses’ experiences when introducing PROMs in a hematological outpatient clinical practice. Findings can guide future PROMs research within the field of nursing.
Inpatient Step Counts, Symptom Severity, and Perceived Health Status After Lung Resection Surgery
Authors: Rodríguez-Torres Janet , López-López Laura , Cabrera-Martos Irene , Quero-Valenzuela Florencio , Cahalin Lawrence P. , Cebrià-i-Iranzo Maria dels Àngels , Valenza Marie Carmen
Published: March 2020

Background

The clinical relevance of inpatient step counts after lung surgery remains unknown.

Objective

The aim of this study was to identify those factors related to physical activity measured by step count, during the inpatient stay, and its relationship with symptom severity and perceived health status at hospital admission, discharge, and 1 month after discharge.

Methods

We studied the inpatient step count of 73 participants who underwent lung resection surgery. The number of steps was measured using a triaxial accelerometer. The health status and the severity of symptoms were examined at hospital admission, discharge, and 1 month after discharge.

Results

Of the 73 participants, 35 were active and 38 were sedentary during the hospitalization. The mean number of steps walked during 3 inpatient days was 6689 ± 3261 and 523 ± 2273 (P < .001) for the active and sedentary groups, respectively. The dyspnea and fatigue scores in the sedentary group across data collection points (hospital admission, discharge, and follow-up) were significantly worse (P < .01). In regard to pain, the sedentary group presented worse results, than the active group, at discharge and follow-up (P < .01). The correlation analysis indicated significant but weak correlations (r < 0.500) between inpatient steps per day and symptom severity at 1-month follow-up (T2) after surgery.

Conclusion

Inpatient step count may be a risk factor for symptom severity and perceived health status during hospitalization and within the first month after lung resection surgery.

Implications for Practice

Nurses should consider recommending physical activity during hospitalization for patients after lung resection.
Too Much Cancer Care?
Authors: Ellen Moriah E. , Perlman Saritte , Shach Ruth
Published: March 2020

Background

“Unnecessary use of health services” refers to care that does not add value for patients and can lead to physical, emotional, and economical harm. High rates of overuse have been reported within oncology, and patients experience its consequences.

Objective

The aim of this study was to explore perceptions and experiences of oncology nurses regarding unnecessary use of oncology services.

Methods

In-depth, semistructured interviews were conducted with a convenience sample of 20 oncology nurses currently practicing in Israel. Interviews were recorded, transcribed, and analyzed thematically.

Results

Themes included perceptions of unnecessary use of health services in cancer (causes and effects of unnecessary use, current and proposed solutions) and negative effects of unnecessary cancer care on patients, families, providers, and the system, including decreased quality of life, increased suffering, and emotional effects on patients and families. Causes were seen on provider, family, and patient levels, such as difficulty for providers to “give up,” lack of registered nurses' authority, and family and patient demands. Multidisciplinary care provision, nurses' role, and the patient-provider relationship were seen as existing facilitators minimizing unnecessary use. Future improvement can be achieved by strengthening relationships, providing support to healthcare providers, and improving communication.

Conclusions

Nurses perceive unnecessary use of health services as a result of multiple, interlinked and complex causes, but few targeted interventions exist. Future research should explore quantifying unnecessary use to determine an accurate representation of the issue.

Implications for Practice

Solutions should include engaging patients and families, involving nurses, and fostering multidisciplinary collaborative teamwork to positively affect care and treatment decision-making processes.
Pediatric Femur Fractures
Authors: Kamienski Mary C.
Published: March 2020

Trauma is the leading cause of death and disability in children. Orthopaedic trauma has led to more than 84,000 hospital admissions annually and costs nearly a billion dollars. Femoral diaphyseal fractures account for nearly 2% of all bony injuries in children and are the most common orthopaedic injury requiring hospitalization. These injuries occur at an annual rate of 19 per 100,000, with an associated cost of millions of dollars. Emergency department (ED) visits for musculoskeletal injuries account for 10%–15% of the 100 million annual visits to U.S. pediatric EDs. Treatment of femur fractures in children vary on the basis of the mechanism of injury, the patient's age, weight, the fracture pattern, family circumstances, and cost. Treatment ranges from noninvasive to invasive and includes traction, casting, internal fixation, and external fixation. Complications can include infection, delayed or malunion, leg length discrepancy, ossification, and refracture. Attention to pain control and anxiety management becomes a major focus for nursing. Pediatric femur fracture can have a devastating impact on the child and the family and requires monitoring for 12–24 months. This injury is significant and can be a life-changing event for the child and the entire family. A case study is used as an example of the extent of the problem with pediatric patients and highlights the long-term effect of this injury.
Obesity Treatment
Authors: Patel Khyati
Published: March 2020

Obesity, a chronic multifactorial disease, has been on the rise in the United States in recent years. It paves a way to other chronic conditions and related morbidity and mortality. The treatment of obesity should have a chronic approach involving lifestyle modifications from the very beginning. Along with reduced calorie diet, increased physical activity, and behavior modifications, various short- and long-term pharmacological agents are available to help with the weight loss. For qualifying patients, selection of an appropriate agent based on its mechanism, efficacy, and safety profile as well as patient preference can provide desired outcomes. This medical weight management should be a multidisciplinary approach involving nurses to provide continuous patient education and motivation.
School-Based Physical Therapy Services: Predicting the Gap Between Ideal and Actual Embedded Services
Authors: Clevenger Valerie D. , Jeffries Lynn M. , Effgen Susan K. , Chen Sixia , Arnold Sandra H.
Published: March 2020

Purpose:

To ascertain the variables predicting the gap between ideal and actual practice in embedding school-based physical therapy services.

Methods:

School-based physical therapists completed an online survey estimating ideal and actual practice of embedding physical therapy services. Predictive modeling was used to determine whether disability, interventions, goals, families, teachers, workload, billing, and/or contracts predicted the gap between estimated ideal and actual practice.

Results:

Data from 410 participants revealed that severity of students' disability, billing, written contracts, and families' preferences predicted the gap between estimated ideal and actual services. Actual practice varied based on region, APTA membership, and Academy of Pediatric Physical Therapy membership.

Conclusions:

Our model predicts the gap between estimates of ideally and actually embedding school-based physical therapy services. While 4 variables predicted the gap, further research is needed to develop a predictive model of actual practice to inform school-based physical therapy practice.