bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations Between Objective Sleep Behaviors and Blood Glucose Variability in Young Children With Type 1 Diabetes
Authors: Monzon Alexandra D , Marker Arwen M , Noser Amy E , Clements Mark A , Patton Susana R
Published: June 2020

Background

Young children with Type 1 diabetes (T1D) are at risk for extreme blood glucose variability, a risk factor for suboptimal glycated hemoglobin A1c (HbA1c) and long-term health complications. We know that a reciprocal relationship exists between sleep and glycemic outcomes in older youth with T1D; however, little research has examined objective sleep in young children (<7 years) with T1D.

Purpose

This study examines bidirectional associations between sleep behaviors and glycemic variability in young children with T1D.

Methods

Thirty-nine young children with T1D (Mage 4.33 ± 1.46 years; MHbA1c 8.10 ± 1.06%) provided accelerometry data to objectively measure sleep onset latency, number of nighttime awakenings, and total sleep time. We also assessed HbA1c, average blood glucose, and glycemic variability (i.e., standard deviation of blood glucose from device downloads). We evaluated bidirectional relationships using multilevel modeling in SAS, with weekday/weekend as a Level 2 moderator.

Results

Children averaged 8.5 ± 1.44 hr of sleep per night, but only 12.8% met current sleep recommendations. Children experienced more nighttime awakenings, higher blood glucose, and more glycemic variability on weekends. Sleep onset latency and nighttime awakenings predicted greater glycemic variability on weekends, and weekend glycemic variability predicted increased nighttime awakenings.

Conclusions

Most young children with T1D did not meet sleep recommendations. Young children experienced more nighttime awakenings, higher blood glucose, and increased glycemic variability on weekends only, when routines may be less predictable. Findings suggest that one way families of young children with T1D may be able to decrease glycemic variability is to keep consistent routines on weekdays and weekends.
Conservative plumage masks extraordinary phylogenetic diversity in the Grallaria rufula (Rufous Antpitta) complex of the humid Andes
Authors: Chesser R Terry , Isler Morton L , Cuervo Andrés M , Cadena C Daniel , Galen Spencer C , Bergner Laura M , Fleischer Robert C , Bravo Gustavo A , Lane Daniel F , Hosner Peter A
Published: June 2020

The Grallaria rufula complex is currently considered to consist of 2 species, G. rufula (Rufous Antpitta) and G. blakei (Chestnut Antpitta). However, it has been suggested that the complex, populations of which occur in humid montane forests from Venezuela to Bolivia, comprises a suite of vocally distinct yet morphologically cryptic species. We sequenced nuclear and mitochondrial DNA for 80 individuals from across the distribution of the complex to determine the extent of genetic variation between and within described taxa. Our results revealed 18 geographically coherent clades separated by substantial genetic divergence: 14 within rufula, 3 within blakei, and 1 corresponding to G. rufocinerea (Bicolored Antpitta), a species with distinctive plumage found to be nested within the complex. Neither G. rufula nor G. blakei as presently defined was monophyletic. Although 6 of the 7 recognized subspecies of G. rufula were monophyletic, several subspecies contained substantial genetic differentiation. Genetic variation was largely partitioned across recognized geographic barriers, especially across deep river valleys in Peru and Colombia. Coalescent modeling identified 17 of the 18 clades as significantly differentiated lineages, whereas analyses of vocalizations delineated 16 biological species within the complex. The G. rufula complex seems unusually diverse even among birds of the humid Andes, a prime location for cryptic speciation; however, the extent to which other dispersal-limited Andean species groups exhibit similar degrees of cryptic differentiation awaits further study.
Irinotecan and vandetanib create synergies for treatment of pancreatic cancer patients with concomitant TP53 and KRAS mutations
Authors: Kaushik Aman Chandra , Wang Yan-Jing , Wang Xiangeng , Wei Dong-Qing
Published: June 2020

Background: The most frequently mutated gene pairs in pancreatic adenocarcinoma (PAAD) are KRAS and TP53, and our goal is to illustrate the multiomics and molecular dynamics landscapes of KRAS/TP53 mutation and also to obtain prospective novel drugs for KRAS- and TP53-mutated PAAD patients. Moreover, we also made an attempt to discover the probable link amid KRAS and TP53 on the basis of the abovementioned multiomics data. Method: We utilized TCGA & Cancer Cell Line Encyclopedia data for the analysis of KRAS/TP53 mutation in a multiomics manner. In addition to that, we performed molecular dynamics analysis of KRAS and TP53 to produce mechanistic descriptions of particular mutations and carcinogenesis. Result: We discover that there is a significant difference in the genomics, transcriptomics, methylomics, and molecular dynamics pattern of KRAS and TP53 mutation from the matching wild type in PAAD, and the prognosis of pancreatic cancer is directly linked with a particular mutation of KRAS and protein stability. Screened drugs are potentially effective in PAAD patients. Conclusions: KRAS and TP53 prognosis of PAAD is directly associated with a specific mutation of KRAS. Irinotecan and vandetanib are prospective drugs for PAAD patients with KRASG12Dmutation and TP53 mutation.
High-dimensional empirical likelihood inference
Authors: Chang Jinyuan , Chen Song Xi , Tang Cheng Yong , Wu Tong Tong
Published: June 2020

High-dimensional statistical inference with general estimating equations is challenging and remains little explored. We study two problems in the area: confidence set estimation for multiple components of the model parameters, and model specifications tests. First, we propose to construct a new set of estimating equations such that the impact from estimating the high-dimensional nuisance parameters becomes asymptotically negligible. The new construction enables us to estimate a valid confidence region by empirical likelihood ratio. Second, we propose a test statistic as the maximum of the marginal empirical likelihood ratios to quantify data evidence against the model specification. Our theory establishes the validity of the proposed empirical likelihood approaches, accommodating over-identification and exponentially growing data dimensionality. Numerical studies demonstrate promising performance and potential practical benefits of the new methods.
Oncogenic mechanisms in renal insufficiency
Authors: Volovat Simona Ruxandra , Volovat Constantin , Miron Ingrith , Kanbay Mehmet , Goldsmith David , Lungulescu Cristian , Badarau Silvia Corina , Covic Adrian
Published: June 2020

The prevalence of both cancer and end-stage renal disease is increasing. In addition, medical advances have meant increased survival rates for both diseases. Many chemotherapeutics are renally excreted, and conversely, renal insufficiency promotes a pro-neoplastic state, including genitourinary and other cancers. Dialysis prolongs life while increasing cancer risk. Proposed oncogenic mechanisms include immune dysfunction, chronic inflammation, changes in gut microbiota and stimulation of the renin–angiotensin system. This review summarizes current concepts in the relationship between cancer and renal insufficiency.
Will the COVID-19 epidemic reshape cardiology?
Authors: Alkhouli Mohamad , Coylewright Megan , Holmes David R
Published: June 2020

The emergence of the COVID-19 epidemic posed unprecedented challenges to the cardiology community. In this perspective, we review the major changes associated with the COVID-19 crisis on major domains of cardiology.
Non-trophic Functional Ecology of Vertebrate Teeth: A Review
Authors: Gorman Courtney E , Hulsey C Darrin
Published: June 2020

Synopsis

Teeth are critical to the functional ecology of vertebrate trophic abilities, but are also used for a diversity of other non-trophic tasks. Teeth can play a substantial role in how animals move, manipulate their environment, positively interact with conspecifics, antagonistically interact with other organisms, and sense the environment. We review these non-trophic functions in an attempt to place the utility of human and all other vertebrate dentitions in a more diverse framework that emphasizes an expanded view of the functional importance and ecological diversity of teeth. In light of the extensive understanding of the developmental genetics, trophic functions, and evolutionary history of teeth, comparative studies of vertebrate dentitions will continue to provide unique insights into multi-functionality, many-to-one mapping, and the evolution of novel abilities.
Post-processing of the planewave approximation of Schrödinger equations. Part I: linear operators
Authors: Cancès Eric , Dusson Geneviève , Maday Yvon , Stamm Benjamin , Vohralík Martin
Published: June 2020

In this article we prove a priori error estimates for the perturbation-based post-processing of the plane-wave approximation of Schrödinger equations introduced and tested numerically in previous works (Cancès, Dusson, Maday, Stamm and Vohralík, (2014), A perturbation-method-based a posteriori estimator for the planewave discretization of nonlinear Schrödinger equations. C. R. Math., 352, 941--946; Cancès, Dusson, Maday, Stamm and Vohralík, (2016), A perturbation-method-based postprocessing for the planewave discretization of Kohn–Sham models. J. Comput. Phys., 307, 446--459.) We consider here a Schrödinger operator ${{\mathscr{H}} \,}= -\frac{1}{2}\varDelta +{\mathscr{V}}$ on $L^2(\varOmega )$, where $\varOmega $ is a cubic box with periodic boundary conditions and where ${\mathscr{V}}$ is a multiplicative operator by a regular-enough function ${\mathscr{V}}$. The quantities of interest are, on the one hand, the ground-state energy defined as the sum of the lowest $N$ eigenvalues of ${{\mathscr{H}} \,}$, and, on the other hand, the ground-state density matrix that is the spectral projector on the vector space spanned by the associated eigenvectors. Such a problem is central in first-principle molecular simulation, since it corresponds to the so-called linear subproblem in Kohn–Sham density functional theory. Interpreting the exact eigenpairs of ${{\mathscr{H}} \,}$ as perturbations of the numerical eigenpairs obtained by a variational approximation in a plane-wave (i.e., Fourier) basis we compute first-order corrections for the eigenfunctions, which are turned into corrections on the ground-state density matrix. This allows us to increase the accuracy by a factor proportional to the inverse of the kinetic energy cutoff ${E_{\textrm{c}}}^{-1}$ of both the ground-state energy and the ground-state density matrix in Hilbert–Schmidt norm at a low computational extra cost. Indeed, the computation of the corrections only requires the computation of the residual of the solution in a larger plane-wave basis and two fast Fourier transforms per eigenvalue.
Large-scale assessment of antimicrobial resistance marker databases for genetic phenotype prediction: a systematic review
Authors: Mahfouz Norhan , Ferreira Inês , Beisken Stephan , von Haeseler Arndt , Posch Andreas E
Published: June 2020

Background

Antimicrobial resistance (AMR) is a rising health threat with 10 million annual casualties estimated by 2050. Appropriate treatment of infectious diseases with the right antibiotics reduces the spread of antibiotic resistance. Today, clinical practice relies on molecular and PCR techniques for pathogen identification and culture-based antibiotic susceptibility testing (AST). Recently, WGS has started to transform clinical microbiology, enabling prediction of resistance phenotypes from genotypes and allowing for more informed treatment decisions. WGS-based AST (WGS-AST) depends on the detection of AMR markers in sequenced isolates and therefore requires AMR reference databases. The completeness and quality of these databases are material to increase WGS-AST performance.

Methods

We present a systematic evaluation of the performance of publicly available AMR marker databases for resistance prediction on clinical isolates. We used the public databases CARD and ResFinder with a final dataset of 2587 isolates across five clinically relevant pathogens from PATRIC and NDARO, public repositories of antibiotic-resistant bacterial isolates.

Results

CARD and ResFinder WGS-AST performance had an overall balanced accuracy of 0.52 (±0.12) and 0.66 (±0.18), respectively. Major error rates were higher in CARD (42.68%) than ResFinder (25.06%). However, CARD showed almost no very major errors (1.17%) compared with ResFinder (4.42%).

Conclusions

We show that AMR databases need further expansion, improved marker annotations per antibiotic rather than per antibiotic class and validated multivariate marker panels to achieve clinical utility, e.g. in order to meet performance requirements such as provided by the FDA for clinical microbiology diagnostic testing.
Extensions of paraconsistent weak Kleene logic
Authors: Paoli Francesco , Pra Baldi Michele
Published: June 2020

Paraconsistent weak Kleene ($\textrm{PWK}$) logic is the $3$-valued logic based on the weak Kleene matrices and with two designated values. In this paper, we investigate the poset of prevarieties of generalized involutive bisemilattices, focussing in particular on the order ideal generated by Α$\textrm{lg} (\textrm{PWK})$. Applying to this poset a general result by Alexej Pynko, we prove that, exactly like Priest’s logic of paradox, $\textrm{PWK}$ has only one proper nontrivial extension apart from classical logic: $\textrm{PWK}_{\textrm{E}}\textrm{,}$ PWK logic plus explosion. This $6$-valued logic, unlike $\textrm{PWK} $, fails to be paraconsistent. We describe its consequence relation via a variable inclusion criterion and identify its Suszko-reduced models.
Japanese structure survey of radiation oncology in 2013
Authors: Numasaki Hodaka , Teshima Teruki , Okuda Yasuo , Ogawa Kazuhiko ,   Japanese Society for Radiation Oncology Database Committee
Published: June 2020

This paper describes the ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution to identify and overcome any existing limitations. From December 2014 to July 2017, the Japanese Society for Radiation Oncology conducted a questionnaire based on the Japanese national structure survey of radiation oncology in 2013. Data were analyzed based on institutional stratification by the annual number of new patients treated with radiotherapy per institution. The estimated annual numbers of new and total (new plus repeat) patients treated with radiation were 216 000 and 257 000, respectively. Additionally, the estimated cancer incidence was 862 452 cases with ~25.0% of all newly diagnosed patients being treated with radiation. The types and numbers of treatment devices actually used included linear accelerator (LINAC; n = 880), Gamma Knife (n = 45), 60Co remote afterloading system (RALS; n = 23) and 192Ir RALS (n = 128). The LINAC system used dual-energy functions in 675 units, 3D conformal radiotherapy functions in 785 and intensity-modulated radiotherapy (IMRT) functions in 494. There were 831 Japan Radiological Society/Japanese Society for Radiation Oncology-certified radiation oncologists, 1130.6 full-time equivalent (FTE) radiation oncologists, 2214.6 FTE radiotherapy technologists, 196.6 FTE medical physicists, 183.8 FTE radiotherapy quality managers and 856.7 FTE nurses. The frequency of IMRT use significantly increased during this time. In conclusion, the Japanese structure of radiation oncology has clearly improved in terms of equipment and utility although there was a shortage of personnel in 2013.
Genetic evidence illuminates the origin and global spread of the slug Deroceras invadens
Authors: Hutchinson John M C , Schlitt Bettina , Kořínková Tereza , Reise Heike , Barker Gary M
Published: June 2020

The terrestrial slug Deroceras invadens has spread across much of the world over the last century. What is there to learn about its origin, colonizations and diversity by comparing barcoding sequences of the mitochondrial gene COI (cytochrome c oxidase subunit I)? Samples from 317 localities covering most of the species’ range yielded 87 haplotypes. Higher diversity, the predominance of private haplotypes and geographic structuring all indicate a native range centred on southern Italy, including eastern Sicily. In contrast, central Italy is dominated by one haplotype, although accompanied by both close and more distant relatives; the lack of geographic structuring suggests recent expansion from a restricted distribution within that region. Beyond the Alps, two haplotypes predominate, accompanied by very similar variants; such star-shaped genealogies characterize recent population growth. Also, some rarer haplotypes have been independently introduced. Generally, haplotypes are well mixed here, often co-occurring at a locality. In North America and Australasia, some frequent haplotypes were likely directly introduced from Italy, because they were not found elsewhere in Europe. The rarity or absence in these continents of one or other of the two dominant European haplotypes suggests that import inspections have restricted repeated introductions. A skyline plot detects the recent demographic expansion but also indicates an earlier population decline in the native area. This may explain why the one-dimensional summary statistics FS and R2 did not signal population growth. A review of 41 other studies that used DNA to analyse invasions of terrestrial molluscs documents considerable diversity in methodology. Studies using genetic data to date recent invasions probably should adjust standard substitution rates upwards.
“Zooming in” on Glioblastoma: Understanding Tumor Heterogeneity and its Clinical Implications in the Era of Single-Cell Ribonucleic Acid Sequencing
Authors: Khalafallah Adham M , Huq Sakibul , Jimenez Adrian E , Serra Riccardo , Bettegowda Chetan , Mukherjee Debraj
Published: June 2020

Glioblastoma (GBM) is the most common primary brain malignancy in adults and one of the most aggressive of all human cancers. It is highly recurrent and treatment-resistant, in large part due to its infiltrative nature and inter- and intratumoral heterogeneity. This heterogeneity entails varying genomic landscapes and cell types within and between tumors and the tumor microenvironment (TME). In GBM, heterogeneity is a driver of treatment resistance, recurrence, and poor prognosis, representing a substantial impediment to personalized medicine. Over the last decade, sequencing technologies have facilitated deeper understanding of GBM heterogeneity by “zooming in” progressively further on tumor genomics and transcriptomics. Initial efforts employed bulk ribonucleic acid (RNA) sequencing, which examines composite gene expression of whole tumor specimens. While groundbreaking at the time, this bulk RNAseq masks the crucial contributions of distinct tumor subpopulations to overall gene expression. This work progressed to the use of bulk RNA sequencing in anatomically and spatially distinct tumor subsections, which demonstrated previously underappreciated genomic complexity of GBM. A revolutionary next step forward has been the advent of single-cell RNA sequencing (scRNAseq), which examines gene expression at the single-cell level. scRNAseq has enabled us to understand GBM heterogeneity in unprecedented detail. We review seminal studies in our progression of understanding GBM heterogeneity, with a focus on scRNAseq and the insights that it has provided into understanding the GBM tumor mass, peritumoral space, and TME. We highlight preclinical and clinical implications of this work and consider its potential to impact neuro-oncology and to improve patient outcomes via personalized medicine.
Telemedicine in Neurosurgery: Lessons Learned from a Systematic Review of the Literature for the COVID-19 Era and Beyond
Authors: Eichberg Daniel G , Basil Gregory W , Di Long , Shah Ashish H , Luther Evan M , Lu Victor M , Perez-Dickens Maggy , Komotar Ricardo J , Levi Allan D , Ivan Michael E
Published: June 2020

BACKGROUND

Evolving requirements for patient and physician safety and rapid regulatory changes have stimulated interest in neurosurgical telemedicine in the COVID-19 era.

OBJECTIVE

To conduct a systematic literature review investigating treatment of neurosurgical patients via telemedicine, and to evaluate barriers and challenges. Additionally, we review recent regulatory changes that affect telemedicine in neurosurgery, and our institution's initial experience.

METHODS

A systematic review was performed including all studies investigating success regarding treatment of neurosurgical patients via telemedicine. We reviewed our department's outpatient clinic billing records after telemedicine was implemented from 3/23/2020 to 4/6/2020 and reviewed modifier 95 inclusion to determine the number of face-to-face and telemedicine visits, as well as breakdown of weekly telemedicine clinic visits by subspecialty.

RESULTS

A total of 52 studies (25 prospective and 27 retrospective) with 45 801 patients were analyzed. A total of 13 studies were conducted in the United States and 39 in foreign countries. Patient management was successful via telemedicine in 99.6% of cases. Telemedicine visits failed in 162 cases, 81.5% of which were due to technology failure, and 18.5% of which were due to patients requiring further face-to-face evaluation or treatment. A total of 16 studies compared telemedicine encounters to alternative patient encounter mediums; telemedicine was equivalent or superior in 15 studies. From 3/23/2020 to 4/6/2020, our department had 122 telemedicine visits (65.9%) and 63 face-to-face visits (34.1%). About 94.3% of telemedicine visits were billed using face-to-face procedural codes.

CONCLUSION

Neurosurgical telemedicine encounters appear promising in resource-scarce times, such as during global pandemics.
Solid-state intramolecular motions in continuous fibers driven by ambient humidity for fluorescent sensors
Authors: Jiang Yunmeng , Cheng Yanhua , Liu Shunjie , Zhang Haoke , Zheng Xiaoyan , Chen Ming , Khorloo Michidmaa , Xiang Hengxue , Tang Ben Zhong , Zhu Meifang
Published: June 2020

One striking feature of molecular rotors is their ability to change conformation with detectable optical signals through molecular motion when stimulated. However, due to the strong intermolecular interactions, synthetic molecular rotors have often relied on fluid environments. Here, we take advantage of the solid-state intramolecular motion of aggregation-induced emission (AIE) molecular rotors and one-dimensional fibers, developing highly sensitive optical fiber sensors that respond to ambient humidity rapidly and reversibly with observable chromatic fluorescence change. Moisture environments induce the swelling of the polymer fibers, activating intramolecular motions of AIE molecules to result in red-shifted fluorescence and linear response to ambient humidity. In this case, polymer fiber provides a process-friendly architecture and a physically tunable medium for the embedded AIE molecules to manipulate their fluorescence response characteristics. Assembly of sensor fibers could be built into hierarchical structures, which are adaptive to diverse-configuration for spatial-temporal humidity mapping, and suitable for device integration to build light-emitting sensors as well as touchless positioning interfaces for intelligence systems.
Cannabis vaping: Understanding the health risks of a rapidly emerging trend
Authors: Chadi Nicholas , Minato Claudia , Stanwick Richard
Published: June 2020

The rapid emergence of youth vaping has completely changed the landscape of adolescent substance use in Canada and has become a pressing public health issue of our time. While nicotine remains the most common substance encountered in vaping devices, cannabis vaping is now reported by one-third of youth who vape. Though cannabis vaping is thought to generate fewer toxic emissions than cannabis smoking, it has been associated with several cases of acute lung injury and often involves high-potency forms of cannabis, exposing youth to several acute and long-term health risks. The low perceived riskiness of cannabis as a substance and of vaping as a mode of consumption may bring a false sense of security and be particularly appealing for youth who may be looking for a ‘healthier way’ to use substances. While research is still lacking on how best to support youth who may have already initiated cannabis vaping, concerted efforts among paediatric providers, public health experts, schools, communities, and families are urgently needed to limit the spread of cannabis vaping among Canadian youth.
What risk factors for sudden infant death syndrome are preterm and term medically complex infants exposed to at home?
Authors: Mitchell Ian , Wang Daniel Y , Troskie Christine , Loczy Lisa , Li Abby , Paes Bosco , Lanctôt Krista
Published: June 2020

Objectives

Risk factors for sudden infant death syndrome include premature birth, maternal smoking, prone or side sleeping position, sleeping with blankets, sharing a sleeping surface with an adult, and sleeping without an adult in the room. In this study, we compare parents’ responses on sleep patterns in premature and term infants with medical complexity.

Methods

Parents of children enrolled in the Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab were phoned monthly regarding their child’s health status until the end of each respiratory syncytial virus season. Baseline data were obtained on patient demographics, medical history, and neonatal course. Responses on adherence to safe sleep recommendations were recorded as part of the assessment.

Results

A total of 2,526 preterms and 670 term infants with medical complexity were enrolled. Statistically significant differences were found in maternal smoking rates between the two groups: 13.3% (preterm); 9.3% (term) infants (χ 2=8.1, df=1, P=0.004) and with respect to toys in the crib: 12.3% (term) versus 5.8% preterms (χ 2=24.5, df=1, P<0.0005). Preterm infants were also significantly more likely to be placed prone to sleep (8.8%), compared with term infants (3.3%), (χ 2=18.1, df=1, P<0.0005).

Conclusion

All the infants in this study had frequent medical contacts. There is a greater prevalence of some risk factors for sudden infant death syndrome in preterm infants compared to term infants with medical complexity. Specific educational interventions for vulnerable infants may be necessary.
Prevalence of suicidal ideation, plan, attempts and its associated factors in selected rural and urban areas of Puducherry, India
Authors: Singh Aakanksha , Saya Ganesh Kumar , Menon Vikas , Olickal Jeby Jose , Ulaganeethi Revathi , Sunny Roshina , Subramanian Sadhana , Kothari Ashutosh , Chinnakali Palanivel
Published: June 2020

Background

The Union Territory of Puducherry has a high rate of suicide in India. This study aims to find the prevalence of suicidal ideation, plan and suicide attempts and the risk factors of suicidal behaviours.

Methods

This community-based cross-sectional study was conducted among adults aged 18 years and above in rural and urban areas of Puducherry, India. Columbia Suicide Severity Rating Scale questionnaire was used. Prevalence ratio was estimated to assess the factors associated.

Results

The 12-month and lifetime prevalence of suicidal ideation was reported to be 12.5% (95% CI: 10.4–15.0%) and 20% (95% CI: 17.4–22.9%), respectively. About 0.7% (95% CI: 0.3–1.5%) and 2.1% (95% CI: 1.2–3.3%) of the participants had suicide plan in past 12 months and ever in their lifetime, respectively. Around 1% (95% CI: 0.5–2.0%) and 5.7% (95% CI: 4.3–7.6%) of the participants had attempted suicide in past 12 months and ever in their lifetime, respectively. Family issues, physical abuse, unemployment and place of residence were significantly associated with suicidal ideation in multivariable analysis.

Conclusion

Prevalence of suicidal ideation and suicide attempt were very high in the study area. Unemployment, physical abuse and family issues were significantly associated with suicidal behaviour.
Patient-Centered Health Education Intervention to Empower Preventive Diabetic Foot Self-care
Authors: Makiling Meryl , Smart Hiske
Published: June 2020

BACKGROUND

Diabetes impairs the body’s ability to produce or respond to the hormone insulin resulting in abnormal metabolism of carbohydrates and elevated glucose levels in the body. Because of these factors, diabetes can cause several complications that include heart disease, stroke, hypertension, eye complications, kidney disease, skin complications, vascular disease, nerve damage, and foot problems. Diabetes education allows patients to explore effective interventions into living their life with diabetes and incorporate the necessary changes to improve their lifestyle.

OBJECTIVE

To educate patients diagnosed with diabetes or followed up for diabetes management by other departments with regard to their own responsibility in maintaining preventive foot self-care.

METHODS

Ten patients completed a validated educational foot care knowledge assessment pretest to determine their existing knowledge about their own foot care after a thorough foot assessment. Preventive diabetic foot self-care education was conducted through a lecture, visual aids, and a return demonstration. Patients then took a posttest questionnaire with the same content as the pretest to determine their uptake of the educational content.

RESULTS

Correct toenail cutting was the most identified educational need. It was a limitation in the pretest (30%), and it remained the lowest-scoring item on the posttest (70%). Walking barefoot was thought to be safe by 60% of participants pretest, but with remedial education, all participants identified this as a dangerous activity posttest. Participants also understood the high importance of having corns and calluses looked after by a health professional.

CONCLUSIONS

Effective communication with patients by healthcare providers who can mold educational content to identified patient needs by teaching much needed skills is a key driver in rendering safe, quality healthcare education interventions.
Efficacy of a Natural Topical Skin Ointment for Managing Split-Thickness Skin Graft Donor Sites: A Pilot Double-blind Randomized Controlled Trial
Authors: Abbasi Mohammad Saeed , Rahmati Javad , Ehsani Amir Houshang , Takzare Alireza , Partoazar Alireza , Takzaree Nasrin
Published: June 2020

OBJECTIVE

To evaluate the safety and efficacy of a new topical skin ointment with natural ingredients (aloe vera, honey, and peppermint) for dressing skin graft donor sites.

DESIGN

A double-blind, placebo-controlled, randomized clinical trial.

PATIENTS AND INTERVENTION

Researchers enrolled patients who were referred for split-thickness skin graft after burns or surgical wounds on the scalp or face area. For each patient, a thin layer of skin (depth, 0.04 mm; approximate size, less than 15 × 7 cm) was harvested from the thigh by a plastic surgeon with an electric or manual dermatome. The donor sites were divided and randomized to receive either natural ointment or petroleum jelly as a topical agent to dressing. Topical agents were applied on donor site wounds on days 0, 4, 7, and 14.

MAIN OUTCOME MEASURES

Wound size, pain, erythema, pruritus, patient discomfort, complications, and physician satisfaction were evaluated at each visit.

MAIN RESULTS

Among 28 patients, there was no significant difference between the two treatment agents regarding the rate of wound healing (P = .415), pain (P = .081), pruritus (P = .527), and patient discomfort (P = .616). The ointment was superior to petroleum jelly in reducing wound erythema (P = .001) and was associated with significantly better treatment satisfaction (P < .001).

CONCLUSIONS

The natural topical ointment investigated in this study may be an acceptable alternative to petroleum jelly in caring for split-thickness donor skin graft donor site wounds to effectively promote wound healing, prevent infection and scarring, reduce pain, and comfort the patient.
A Systems Theoretic Process Analysis of the Medication Use Process in the Operating Room
Authors: Samost-Williams Aubrey , Nanji Karen C.
Published: June 2020

Background

While 4 to 10% of medications administered in the operating room may involve an error, few investigations have prospectively modeled how these errors might occur. Systems theoretic process analysis is a prospective risk analysis technique that uses systems theory to identify hazards. The purpose of this study was to demonstrate the use of systems theoretic process analysis in a healthcare organization to prospectively identify causal factors for medication errors in the operating room.

Methods

The authors completed a systems theoretic process analysis for the medication use process in the operating room at their institution. First, the authors defined medication-related accidents (adverse medication events) and hazards and created a hierarchical control structure (a schematic representation of the operating room medication use system). Then the authors analyzed this structure for unsafe control actions and causal scenarios that could lead to medication errors, incorporating input from surgeons, anesthesiologists, and pharmacists. The authors studied the entire medication use process, including requesting medications, dispensing, preparing, administering, documenting, and monitoring patients for the effects. Results were reported using descriptive statistics.

Results

The hierarchical control structure involved three tiers of controllers: perioperative leadership; management of patient care by the attending anesthesiologist, surgeon, and pharmacist; and execution of patient care by the anesthesia clinician in the operating room. The authors identified 66 unsafe control actions linked to 342 causal scenarios that could lead to medication errors. Eighty-two (24.0%) scenarios came from perioperative leadership, 103 (30.1%) from management of patient care, and 157 (45.9%) from execution of patient care.

Conclusions

In this study, the authors demonstrated the use of systems theoretic process analysis to describe potential causes of errors in the medication use process in the operating room. Causal scenarios were linked to controllers ranging from the frontline providers up to the highest levels of perioperative management. Systems theoretic process analysis is uniquely able to analyze management and leadership impacts on the system, making it useful for guiding quality improvement initiatives.

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Competitive Antagonism of Etomidate Action by Diazepam
Authors: McGrath Megan , Hoyt Helen , Pence Andrea , Jayakar Selwyn S. , Zhou Xiaojuan , Forman Stuart A. , Cohen Jonathan B. , Miller Keith W. , Raines Douglas E.
Published: June 2020

Background

Recent cryo-electron microscopic imaging studies have shown that in addition to binding to the classical extracellular benzodiazepine binding site of the α1β3γ2L γ-aminobutyric acid type A (GABAA) receptor, diazepam also binds to etomidate binding sites located in the transmembrane receptor domain. Because such binding is characterized by low modulatory efficacy, the authors hypothesized that diazepam would act in vitro and in vivo as a competitive etomidate antagonist.

Methods

The concentration-dependent actions of diazepam on 20 µM etomidate-activated and 6 µM GABA-activated currents were defined (in the absence and presence of flumazenil) in oocyte-expressed α1β3γ2L GABAA receptors using voltage clamp electrophysiology. The ability of diazepam to inhibit receptor labeling of purified α1β3γ2L GABAA receptors by 3[H]azietomidate was assessed in photoaffinity labeling protection studies. The impact of diazepam (in the absence and presence of flumazenil) on the anesthetic potencies of etomidate and ketamine was compared in a zebrafish model.

Results

At nanomolar concentrations, diazepam comparably potentiated etomidate-activated and GABA-activated GABAA receptor peak current amplitudes in a flumazenil-reversible manner. The half-maximal potentiating concentrations were 39 nM (95% CI, 27 to 55 nM) and 26 nM (95% CI, 16 to 41 nM), respectively. However, at micromolar concentrations, diazepam reduced etomidate-activated, but not GABA-activated, GABAA receptor peak current amplitudes in a concentration-dependent manner with a half-maximal inhibitory concentration of 9.6 µM (95% CI, 7.6 to 12 µM). Diazepam (12.5 to 50 µM) also right-shifted the etomidate-concentration response curve for direct activation without reducing the maximal response and inhibited receptor photoaffinity labeling by 3[H]azietomidate. When administered with flumazenil, 50 µM diazepam shifted the etomidate (but not the ketamine) concentration–response curve for anesthesia rightward, increasing the etomidate EC50 by 18-fold.

Conclusions

At micromolar concentrations and in the presence of flumazenil to inhibit allosteric modulation via the classical benzodiazepine binding site of the GABAA receptor, diazepam acts as an in vitro and in vivo competitive etomidate antagonist.

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The 5-Year Incidence of Mental Disorders in a Population-Based ICU Survivor Cohort
Authors: Sareen Jitender , Olafson Kendiss , Kredentser Maia S. , Bienvenu O. Joseph , Blouw Marcus , Bolton James M. , Logsetty Sarvesh , Chateau Dan , Nie Yao , Bernstein Charles N. , Afifi Tracie O. , Stein Murray B. , Leslie William D. , Katz Laurence Y. , Mota Natalie , El-Gabalawy Renée , Sweatman Sophia , Marrie Ruth Ann
Published: June 2020

Objective:

To estimate incidence of newly diagnosed mental disorders among ICU patients.

Design:

Retrospective-matched cohort study using a population-based administrative database.

Setting:

Manitoba, Canada.

Participants:

A total of 49,439 ICU patients admitted between 2000 and 2012 were compared with two control groups (hospitalized: n = 146,968 and general population: n = 141,937), matched on age (± 2 yr), sex, region of residence, and hospitalization year.

Intervention:

None.

Measurements and Main Results:

Incident mental disorders (mood, anxiety, substance use, personality, posttraumatic stress disorder, schizophrenia, and psychotic disorders) not diagnosed during the 5-year period before the index ICU or hospital admission date (including matched general population group), but diagnosed during the subsequent 5-year period. Multivariable survival models adjusted for sociodemographic variables, Charlson comorbidity index, admission diagnostic category, and number of ICU and non-ICU exposures. ICU cohort had a 14.5% (95% CI, 14.0–15.0) and 42.7% (95% CI, 42.0–43.5) age- and sex-standardized incidence of any diagnosed mental disorder at 1 and 5 years post-ICU exposure, respectively. In multivariable analysis, ICU cohort had increased risk of any diagnosed mental disorder at all time points versus the hospitalized cohort (year 5: adjusted hazard ratio, 2.00; 95% CI, 1.80–2.23) and the general population cohort (year 5: adjusted hazard ratio, 3.52; 95% CI, 3.23–3.83). A newly diagnosed mental disorder was associated with younger age, female sex, more recent admitting years, presence of preexisting comorbidities, and repeat ICU admission.

Conclusions:

ICU admission is associated with an increased incidence of mood, anxiety, substance use, and personality disorders over a 5-year period.
Indications and Outcomes of Mohs Micrographic Surgery Using a Multidisciplinary Approach: A Decade of Experience
Authors: Wang Weitao , Lee Joseph , Qin Shuyang , Brown Marc D. , Doerr Timothy
Published: June 2020

BACKGROUND

Traditional approaches of staged outpatient Mohs Micrographic Surgery (MMS) in nonmelanoma skin cancer (NMSC) followed by reconstruction is not possible in a subset of patients.

OBJECTIVE

Assess the indications and outcomes of a multidisciplinary approach MMS.

METHODS AND MATERIALS

Retrospective, single-surgeon, single Mohs specialist, university-based tertiary care referral practice, including all MMS performed in the operating room setting with concurrent reconstruction in patients from 2008 to 2018 with minimum follow-up of 6 months. Patients with NMSCs who completed multidisciplinary MMS approach were included. Number of Mohs stages, duration of procedure, reconstruction techniques, and complications including flap loss, bleeding, hematoma, wound infections, dehiscence, and local recurrence rates were reviewed.

RESULTS

Three hundred twenty patients were included, 160 male and 160 female with mean ages of 71.6 and 72.1 years, respectively. Indications for a multidisciplinary approach MMS were as follows: neuro/psych 22.5%, extensive anticipated defect size 55%, patient request/convenience 4.4%, medical intolerance 5%, multiple reasons 8.1%, and unknown in 5%. Average stage required to clear margins was 1.57 ± 0.64. Mean operative times by increasing Mohs stages up to 3 including reconstruction were 125.1, 159.3, and 195.5 minutes, respectively (p < .00001).

CONCLUSION

Indications for a multidisciplinary approach MMS were extensive defects and neuro/psych issues. Advantages include patient tolerance and single-stage procedure.
Estimating a Set of Mortality Risk Functions with Multiple Contributing Causes of Death
Authors: Breger Tiffany L. , Edwards Jessie K. , Cole Stephen R. , Saag Michael , Rebeiro Peter F. , Moore Richard D. , Eron Joseph J.
Published: June 2020

Background:

There are few methodologic examples of how multiple causes of death may be summarized in cause-specific mortality analyses to address limitations of attributing death to a single underlying cause. We propose a cause-of-death weighting approach to estimate the set of risk functions of specific causes of mortality using both underlying and contributing cause-of-death information.

Methods:

We constructed weights according to a user-specified function. Using data from four southern US human immunodeficiency virus (HIV) clinics, we constructed a cause of death-weighted Aalen–Johansen estimator of the cumulative incidence function to estimate risks of five specific causes of mortality in the full sample and by injection drug use history.

Results:

Among 7740 HIV-positive patients initiating antiretroviral therapy between 1999 and 2014, the 8-year risk of all-cause mortality was 17.5% [95% confidence interval (CI) = 16.5, 18.4]. The cause of death-weighted risk of HIV-related mortality was 6.7% (95% CI = 6.0, 7.3) and accounted for 39% (95% CI = 35, 42) of total mortality risk. This compared with 10.2% (95% CI = 9.2, 11.2) using only the underlying cause, in which case HIV-related deaths accounted for nearly 60% of total mortality risk. The proportion attributable to cardiovascular disease among those whose HIV risk factor was injection drug use was twice as high using cause-of-death weights compared with only the underlying cause (8%; 95% CI = 5, 11 vs 4%; 95% CI = 1, 6).

Conclusion:

Using cause of death-weighted estimators to incorporate multiple causes of death may yield different conclusions regarding the importance of certain causes of mortality. See video abstract: http://links.lww.com/EDE/B706.
Glycerin-Assisted Vitreoretinal Surgery in Edematous Cornea
Authors: Kumar Vinod , Surve Abhidnya , Kumar Suneel , Azad Shorya , Sharma Namrata
Published: June 2020

Purpose:

To describe the use of glycerin in improving media clarity in cases with edematous cornea.

Methods:

Retrospective case series including patients with posterior segment pathologies needing surgical invention and having corneal edema. Each case was studied for the role of topical application of glycerin instead of viscoelastic agents and the course of surgery. The cases were followed up for minimum 3 months duration.

Results:

Six cases with corneal edema having posterior segment pathology underwent surgery with intraoperative topical application of glycerin. The corneal edema was seen to clear with progression of surgery and was maintained until the end of surgery. Procedures such as vitreoretinal surgery, identification of break, internal limiting membrane peeling, intraocular lens explantation, scleral indentation, Descemet stripping endothelial keratoplasty graft removal, and subretinal band removal could be performed in these cases.

Conclusion:

Intraoperative glycerin use during vitreoretinal surgeries is helpful in improving the corneal clarity and maintaining it till the end of surgery.
Baseline Findings in the Retrospective Digital Computer Analysis of Keratoconus Evolution (REDCAKE) Project
Authors: Jiménez-García Marta , Ní Dhubhghaill Sorcha , Koppen Carina , Varssano David , Rozema Jos J. ,   and The REDCAKE Study Group
Published: June 2020

Purpose:

To present the baseline data for a large cohort of patients with keratoconus enrolled in the Retrospective Digital Computer Analysis of Keratoconus Evolution (REDCAKE) study.

Methods:

Eight centers contributed the Scheimpflug tomographical data for 906 patients with keratoconus, 743 measured with a Pentacam and 163 with a Galilei. The stage of keratoconus at baseline, the location of the reference points, minimum pachymetry (Pmin), and maximum keratometry (Kmax) were analyzed. The intereye asymmetry was evaluated for Kmax (anterior and posterior), Pmin, and keratoconus stage. Average maps and elevation profiles were calculated for each degree of keratoconus.

Results:

Keratoconus was more frequently diagnosed in men (73%) than in women (27%). At baseline, 500/1155 eyes (43%) presented with moderate to severe changes in the posterior surface, whereas moderate/severe changes were only found in 252 and 63 eyes when evaluating anterior surface and pachymetry, respectively. The location of Pmin was usually inferotemporal (94% OD and 94% OS), while the location of Kmax showed more variability and significantly higher distance from apex (P < 0.05). The keratoconus presentation was chiefly asymmetric for all the parameters studied. Clear differences between stages could be identified in the maps and elevation profiles.

Conclusions:

The staging map set presented can be used as a graphical guidance to classify keratoconus stage. Keratoconus presented asymmetrically, and generally the posterior surface was more affected than the anterior surface or the thickness. Asymmetry is playing a role in KC detection. Although Pmin was almost invariably located inferotemporally, Kmax location showed higher variability and distance from the apex.