bluuebunny/crossref_metadata_2025 huggingface dataset:
Sea-Blue Histiocytosis of Bone Marrow in a Patient with t(8;22) Acute Myeloid Leukemia
Authors: Imataki Osamu , Uemura Makiko
Published: July 2020

An 80-year-old Japanese male was treated with chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, and prednisolone, for non-Hodgkin lymphoma. Nine months after the chemotherapy, he was diagnosed with acute myeloid leukemia (AML) (M4) with translocation 8p11 and 22q13. The patient bone marrow indicated a remarkable degree of sea-blue histiocytosis. His disease was aggressive, and he died of the disease. Sea-blue histiocytes are macrophages harboring blue vacuoles and granular deposition, which results from the phagocytosis of dead cells and the subsequent deposition of phospholipids. AML with the t(8; 22) (p11; q13) translocation is a rare subtype of AML, which is a rare translocation with a prevalence of less than 1.0% among all AML cases. The oncogenesis of t(8; 22) (p11; q13) is caused by the fusion protein monocytic leukemia zinc finger protein (MOZ) and transcription factor p300. MOZ can be fused to various translocation targets including CBT, TIF2, and p300, corresponding to t(8; 16), inv(8), and t(8; 22), respectively. This subgroup of AML reveals the hallmarks of the disease, including monocytic arrest and erythro/hemophagocytosis by blasts. A substantial proportion of the AML M4/M5 subtype harboring MOZ as an aberrant fusion gene represents erythrophagocytosis. Although rare, t(8; 22) is very specific to the AML M4/M5 subtype and seems to represent sea-blue histiocytosis as one of the characteristic features of monocytic AML with macrophage activation. Thus, sea-blue histiocytes are considered to be one of hallmarks in monocytic AML with MOZ translocation.
Home Range Size and Seasonal Variation in Habitat Use of Aye-Ayes (Daubentonia madagascariensis) in Torotorofotsy, Madagascar
Authors: Sefczek Timothy M. , Hagenson Ryan A. , Randimbiharinirina Doménico Roger , Rakotondrazandry Jeannin Nicolas , Louis Edward E.
Published: July 2020

Madagascar’s dramatic climatic fluctuations mean most lemurs adjust behaviors seasonally as resource availability fluctuates. Many lemurs will adopt one of two strategies, a resource maximizer or an area minimizer, when adjusting to seasonal shifts in resource availability. However, it is unknown if and how aye-aye (Daubentonia madagascariensis) ranging behavior is influenced by seasonality. We explored whether habitat use changed seasonally. We followed two aye-ayes, an adult male and an adult female, in the undisturbed forest of Torotorofotsy, Madagascar, from April 2012 to December 2017. We used instantaneous focal-animal sampling to collect behavioral data every 5 min and GPS locations every 20 min. We used the minimum convex polygon (MCP) to determine overall home range, and the Brownian bridge movement model (BBMM) to estimate overall and seasonal home range of the female aye-aye from November 2014 to October 2017. We used Wilcoxon signed-rank tests to determine whether there were significant differences in home range sizes between seasons across years and to examine whether there were seasonal differences in height of invertebrate foraging, generalized linear models to assess seasonal differences in travel rates and nesting locations, and χ2 tests to determine whether there were differences in forest strata use when foraging on invertebrates. The male’s MCP home range was 2,586 ha, and the female’s MCP home range was 765 ha. The seasonal BBMM for the female varied between 443.6 and 1,010.0 ha, though infant rearing appears to have influenced these values. There were no significant differences in seasonal home range, travel rates, nesting locations, or height of invertebrate feeding. However, canopy level invertebrate foraging occurred more often than understory or ground levels. It appears aye-ayes in this undisturbed forest were not influenced by seasonal shifts and had larger home ranges than any previously reported. These findings may indicate that aye-ayes in an undisturbed forest are resource maximizers, closely linked to invertebrate assemblages.
СЕСТРИНСЬКА СПРАВА ЯК ОБ’ЄКТ СОЦІОЛОГІЧНОГО АНАЛІЗУ
Authors: Furso N.
Published: July 2020

Сформульовано і обґрунтовано основні тематичні напрямки соціологічних досліджень, спрямованих на вдосконалення та гуманізацію сестринської справи. Визначено місце і статус середнього медичного персоналу в сучасній структурі суспільства, і на цій основі обґрунтовано роль середнього медичного персоналу в досягненні позитивних результатів соціальної політики. На основі великого архівного матеріалу проведено аналіз історичного досвіду сестринської справи в країні, визначено особливості його розвитку. Виявлено основні етапи та особливості сучасного розвитку сестринської справи.
РЕАНІМАЦІЙНІ ЗАХОДИ: МЕТОДИКА ТА НЕОБХІДНІСТЬ ПРОВЕДЕННЯ
Authors: Titorchuk V. S.
Published: July 2020

Ця стаття включає інформацію про відновлення прохідності дихальних шляхів, підтримку дихання і кровообігу без використання спеціальної техніки в позалікарняних умовах до прибуття спеціалізованої бригади реаніматологів.
ОСОБЛИВОСТІ ПСИХОЕМОЦІЙНИХ І КОГНІТИВНИХ ПОРУШЕНЬ У ХВОРИХ НА ЦУКРОВИЙ ДІАБЕТ 2 ТИПУ В ПОЄДНАННІ З ДІАБЕТИЧНОЮ СТОПОЮ
Authors: Rak S. O.
Published: July 2020

У статті наведено результати аналізу психоемоційних та когнітивних порушень у хворих на цукровий діабет 2 типу, ускладнений діабетичною стопою. Автори відзначають прямо пропорційну залежність між клінічною формою діабетичної стопи та ступенем вираження когнітивних порушень.
Biomarkers in Advanced Heart Failure
Authors: Loungani Rahul S. , Mentz Robert J. , Agarwal Richa , DeVore Adam D. , Patel Chetan B. , Rogers Joseph G. , Russell Stuart D. , Felker G. Michael
Published: July 2020

Biomarkers have a well-defined role in the diagnosis and management of chronic heart failure, but their role in patients with left ventricular assist devices and cardiac transplant is uncertain. In this review, we summarize the available literature in this patient population, with a focus on clinical application. Some ubiquitous biomarkers, for example, natriuretic peptides and cardiac troponin, may assist in the diagnosis of left ventricular assist device complications and transplant rejection. Novel biomarkers focused on specific pathological processes, such as left ventricular assist device thrombosis and profiling of leukocyte activation, continue to be developed and show promise in altering the management of the advanced heart failure patient. Few biomarkers at this time have been assessed with sufficient scrutiny to warrant broad, universal application, but encouraging limited data and large potential for impact should prompt ongoing investigation.
Short Physical Performance Battery and Incident Cardiovascular Events Among Older Women
Authors: Bellettiere John , Lamonte Michael J. , Unkart Jonathan , Liles Sandy , Laddu‐Patel Deepika , Manson JoAnn E. , Banack Hailey , Seguin‐Fowler Rebecca , Chavez Paul , Tinker Lesley F. , Wallace Robert B. , LaCroix Andrea Z.
Published: July 2020

Background

The Short Physical Performance Battery (SPPB) is an inexpensive, reliable, and easy‐to‐implement measure of lower‐extremity physical function. Strong evidence links SPPB scores with all‐cause mortality, but little is known about its relationship with incident cardiovascular disease (CVD).

Methods and Results

Women (n=5043, mean age=79±7) with no history of myocardial infarction or stroke completed 3 timed assessments—standing balance, strength (5 chair stands), and usual gait speed (4 m walk)—yielding an SPPB score from 0 (worst) to 12 (best). Women were followed for CVD events (myocardial infarction, stroke, or CVD death) up to 6 years. Hazard ratios were estimated for women with
Very Low
(0–3),
Low
(4–6),
Moderate
(7–9), and
High
(10–12) SPPB scores using Cox proportional hazard models adjusted for demographic, behavioral, and health‐related variables including objective measurements of physical activity, blood pressure, lipids, and glucose levels. Restricted cubic splines tested linearity of associations. With 361 CVD cases, crude incidence rates/1000 person‐years were 41.0, 24.3, 16.1, and 8.6 for
Very Low
,
Low
,
Moderate,
and
High
SPPB categories, respectively. Corresponding fully adjusted hazard ratios (95% CIs) were 2.28 (1.50–3.48), 1.70 (1.23–2.36) 1.49 (1.12–1.98), and 1.00 (referent);
P
‐trend <0.001. The dose‐response relationship was linear (linear
P
<0.001; nonlinear
P
>0.38).

Conclusions

Results suggest SPPB may provide a measure of cardiovascular health in older adults beyond that captured by traditional risk factors. Because of its high test‐retest reliability and low administrative burden, the SPPB should be a routine part of office‐based CVD risk assessment.
Neural Correlates of Phonetic Adaptation as Induced by Lexical and Audiovisual Context
Authors: Ullas Shruti , Hausfeld Lars , Cutler Anne , Eisner Frank , Formisano Elia
Published: July 2020

When speech perception is difficult, one way listeners adjust is by reconfiguring phoneme category boundaries, drawing on contextual information. Both lexical knowledge and lipreading cues are used in this way, but it remains unknown whether these two differing forms of perceptual learning are similar at a neural level. This study compared phoneme boundary adjustments driven by lexical or audiovisual cues, using ultra-high-field 7-T fMRI. During imaging, participants heard exposure stimuli and test stimuli. Exposure stimuli for lexical retuning were audio recordings of words, and those for audiovisual recalibration were audio–video recordings of lip movements during utterances of pseudowords. Test stimuli were ambiguous phonetic strings presented without context, and listeners reported what phoneme they heard. Reports reflected phoneme biases in preceding exposure blocks (e.g., more reported /p/ after /p/-biased exposure). Analysis of corresponding brain responses indicated that both forms of cue use were associated with a network of activity across the temporal cortex, plus parietal, insula, and motor areas. Audiovisual recalibration also elicited significant occipital cortex activity despite the lack of visual stimuli. Activity levels in several ROIs also covaried with strength of audiovisual recalibration, with greater activity accompanying larger recalibration shifts. Similar activation patterns appeared for lexical retuning, but here, no significant ROIs were identified. Audiovisual and lexical forms of perceptual learning thus induce largely similar brain response patterns. However, audiovisual recalibration involves additional visual cortex contributions, suggesting that previously acquired visual information (on lip movements) is retrieved and deployed to disambiguate auditory perception.
Micranthes petiolaris variety shealyi: A New Variety of Micranthes (Section Stellares, Saxifragaceae) from South Carolina

Authors: CUSHMAN LAARY J. , RICHARDS VINCENT P. , MCMILLAN PATRICK D.
Published: July 2020

A new variety of Micranthes is described from a low-elevation granite outcrop in Pickens County, South Carolina. It is similar to high elevation Micranthes petiolaris populations in leaf morphology and chloroplast DNA (cpDNA) sequences, but differs in its annual habit, floral morphology, phenology, and ecology. The variety is known only from the type locality, with most clusters of individuals occurring along the forested boundary of an open granite outcrop, associated with Juniperus virginiana L., and growing upon moist to saturated moss mats and/or shallow soils. A discussion comparing the proposed taxon with M. petiolaris is provided, with notes about the distribution, habitat, and taxonomy of the variety.
Optimization of Sample Preparation Using Glass Slides for Spectral Pathology
Authors: Dowling Lewis M. , Roach Paul , Rutter Abigail V. , Yousef Ibraheem , Pillai Srinivas , Latham Deborah , van Pittius Daniel G. , Sulé-Suso Josep
Published: July 2020

The clinical translation of Fourier transform infrared (FT-IR) microspectroscopy in pathology will require bringing this technique as close as possible to standard practice in pathology departments. An important step is sample preparation for both FT-IR microspectroscopy and pathology. This should entail minimal disruption of standard clinical practice while achieving good quality FT-IR spectral data. In fact, the recently described possibility of obtaining FT-IR spectra of cells placed on glass substrates brings FT-IR microspectroscopy closer to a clinical application. We have now furthered this work in order to identify two different types of lung cancer cells placed on glass coverslips. Two types of sample preparation which are widely used in pathology, cytospin and smear, have been used. Samples were fixed with either methanol, used in pathology, or formalin (4% paraformaldehyde) used widely in spectroscopy. Fixation with methanol (alcohol-based fixative) removed lipids from cells causing a decrease in intensity of the peaks at 2850 cm−1 and 2920 cm−1. Nevertheless, we show for the first time that using either type of sample preparation and fixation on thin glass coverslips allowed to differentiate between two different types of lung cancer cells using either the lipid region or the fingerprint region ranging from 1800 cm−1 to 1350 cm−1. We believe that formalin-fixed cytospin samples would be preferred to study cells on thin coverslips using FT-IR microspectroscopy. This work presents a clear indication for future advances in clinical assessment of samples within pathology units to gain a deeper understanding of cells/tissues under investigation.
Comparing Two Treatments in Two Period Repeated Measurement Design
Authors: Sinha Abhik , Bandyopadhyay Uttam , Bhattacharya Rahul
Published: July 2020

This work deals with nonparametric test procedures for comparing effects of two treatments in two period parallel group design, where each subject receives the same treatment over the two periods. The procedures are based on consistent estimators of relative treatment effects in each period and that of covariate adjusted effects with responses in period 1 as covariates. Related asymptotic results are obtained followed by necessary simulation studies to evaluate the performance of the tests.

AMS 2010 subject classifications: 62G10 62J15
‘To Tell China’s Story Well’: China’s International Messaging during the COVID-19 Pandemic
Authors: Jacob Jabin T.
Published: July 2020

The COVID-19 pandemic has dented China’s image as an efficient party-state, given how an effort to cover up the outbreak and the resulting delays in reporting led to the virus spreading beyond its origins in Wuhan in Hubei province to the rest of the country as well as rapidly across the world. This article examines China’s massive external propaganda effort launched as part of the effort to repair the damage to its global image and interests. It notes how China has not let the situation stop it from pursuing its traditional foreign policy and security interests, including, of competition with the USA. The article also argues that it is the ruling Communist Party of China’s concerns about its legitimacy at home that have determined the nature and scale of Chinese responses to the pandemic outside its borders.
Patterns of Expenditure in Healthcare for Elderly in Shanghai
Authors: Bifan Zhu , Fen Li , Linan Wang , Changying Wang , Chunlin Jin
Published: July 2020

This study aims to summarise the characteristics of elderly care system and analyse expenditures of healthcare for the elderly in Shanghai. The authors use medical records of 2015 and health account results of 2014 based on System of Health Accounts 2011 to describe the pattern of care expenditures for elderly. Individuals aged 60 years and above account for 19.5 per cent of Shanghai’s population but utilise 52.2 per cent of all outpatient visits and 45.3 per cent of all hospitalisations. Almost two-thirds of their medical expenditures occur in hospitals and 16 per cent in community health centres, corresponding to the status of resource allocation. The out-of-pocket payment ratio of the elderly is lower than that of the younger adults, which is attributable to the preferential reimbursement polices set by the insurance schemes. The leading causes of expenditures are cardiovascular disease, neoplasms and respiratory diseases. Care for the elderly costs more, and the elderly use more services than other age groups. The article recommends the monitoring of irrational utilisation of services, strengthening of primary level care and integration of services across different facilities to streamline care for elderly in Shanghai.
Enhancing Teaching Quality in Higher Education: A Case Study of a Regional University in China
Authors: Lai Manhong
Published: July 2020

Enhancing university teaching has become a focus of higher education reform policies on the Chinese mainland. Facilitating teacher collaboration within teacher communities is perceived to be an effective way of enhancing teaching quality. Using qualitative methods, we conducted in-depth interviews at a sample university (H) which is a regional university operated and financially supported by the regional government. Twenty academics in four separate departments (Management, Information Technology, Education, and Physics) were interviewed. First, we found that University H had arranged joint enterprises, that a standardized repertoire was used, and that detailed controls were exercised over teaching performance. Second, we also found that the rationale of patriarchal governance was hindering the development of a community of practice. Third, young teachers were employing a strategy of passive resistance to the arranged collaboration.
Trust in Autonomous Cars: Exploring the Role of Shared Moral Values, Reasoning, and Emotion in Safety-Critical Decisions
Authors: Yokoi Ryosuke , Nakayachi Kazuya
Published: July 2020

Objective

Autonomous cars (ACs) controlled by artificial intelligence are expected to play a significant role in transportation in the near future. This study investigated determinants of trust in ACs.

Background

Trust in ACs influences different variables, including the intention to adopt AC technology. Several studies on risk perception have verified that shared value determines trust in risk managers. Previous research has confirmed the effect of value similarity on trust in artificial intelligence. We focused on moral beliefs, specifically utilitarianism (belief in promoting a greater good) and deontology (belief in condemning deliberate harm), and tested the effects of shared moral beliefs on trust in ACs.

Method

We conducted three experiments ( N = 128, 71, and 196, for each), adopting a thought experiment similar to the well-known trolley problem. We manipulated shared moral beliefs (shared vs. unshared) and driver (AC vs. human), providing participants with different moral dilemma scenarios. Trust in ACs was measured through a questionnaire.

Results

The results of Experiment 1 showed that shared utilitarian belief strongly influenced trust in ACs. In Experiment 2 and Experiment 3, however, we did not find statistical evidence that shared deontological belief had an effect on trust in ACs.

Conclusion

The results of the three experiments suggest that the effect of shared moral beliefs on trust varies depending on the values that ACs share with humans.

Application

To promote AC implementation, policymakers and developers need to understand which values are shared between ACs and humans to enhance trust in ACs.
The impact of COVID-19 pandemic on international students in Canada
Authors: Firang David
Published: July 2020

The rate at which the coronavirus (aka COVID-19) pandemic is exterminating thousands of people and leaving millions sick has pushed the International Federation of Social Workers to call on scholars to examine the impact of the pandemic on vulnerable populations. One of the most vulnerable population groups ignored by social work research on COVID-19 is international students. Drawing on media sources, academic literature, and the author’s interactions with international students, this essay argues that international students are more vulnerable during this pandemic. The essay contributes to our holistic understanding of how social work can mitigate the impact of the pandemic in general.
Interventions to Reduce Aerosolized Microbes in Dental Practice: A Systematic Review with Network Meta-analysis of Randomized Controlled Trials
Authors: Koletsi D. , Belibasakis G.N. , Eliades T.
Published: July 2020

The aim of this systematic review and network meta-analysis was to identify and rank the effectiveness of different interventions used in dental practice to reduce microbial load in aerosolized compounds. Seven electronic databases were searched to April 6, 2020, for randomized controlled trials (RCTs) or nonrandomized prospective studies in the field. Study selection, data extraction, and risk-of-bias assessment were performed for all included studies, while the outcome of interest pertained to differences in bacterial load quantification through the use of different interventions prior to aerosol-generating procedures in dental practices. Random effects frequentist network meta-analysis was performed, with mean difference (MD) and 95% CI as the effect measure. Confidence in the documented evidence was assessed through the newly fueled CINeMA framework (Confidence in Network Meta-analysis) based on the GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation). Twenty-nine clinical trials were deemed eligible, 21 RCTs and 8 nonrandomized studies, while 11 RCTs contributed to the network meta-analysis, comprising 10 competing interventions. Tempered chlorhexidine (CHX) 0.2% as compared with nonactive control mouth rinse, prior to routine ultrasonic scaling, was most effective toward reduced postprocedural bacterial load with an MD of −0.92 (95% CI, −1.54 to −0.29) in log10 bacterial CFUs (colony-forming units). For CHX 0.2%, an MD of −0.74 (95% CI, −1.07 to −0.40) was observed as compared with control. Tempered CHX 0.2% presented the highest probabilities of being ranked the most effective treatment (31.2%). Level of confidence varied from very low to moderate across all formulated comparisons. These findings summarize the current state of research evidence in the field of aerosolized bacteria in dentistry. Instigated by the era of SARS-CoV-2 pandemic, the stipulation of a broader evaluation of the aerosolized microbes, including viruses, potentially coupled with disinfectant-based prevention schemes should be prioritized.
COVID-19’s Fierce Subversion of Our Supposed Separateness: Cultivating Life With and For All Others
Authors: Adams Will W.
Published: July 2020

The COVID-19 pandemic is not only a biological crisis but a psychological, sociocultural, economic, and spiritual one. Our most grave threat is not the coronavirus itself, but what we do in response. The understandable fear generated by the real dangers of this plague could reinforce a foundational confusion that recurrently brings suffering to us and all our relations: Namely, the dissociative fantasy that I am merely a separate, skin-bounded, autonomous, sovereign self. Fear and greed tend to follow this from this mistakenly contracted identity. Alternately, in fierce ways we would have never wished for, today’s circumstances may be fostering a transformation of consciousness and culture. COVID-19 could subvert our supposedly separate self-sense, world-view, and way of being with others; disclose the “interrelated structure of reality” (as Dr. King put it); highlight the ethical implications that inherently come with it; and summon forth our loving, compassionate responsibility. Working with theoretical ideas and peoples’ actual lived experience, the present article offers suggestions for collaboration—with and for all others—in this precarious time. Insights from humanistic, existential, phenomenological, and transpersonal psychology are set into dialogue with recent examples from daily life.
Walking spaces: Changing pedestrian practices in Britain since c. 1850
Authors: Pooley Colin
Published: July 2020

Walking is one of the most sustainable and healthy forms of everyday travel over short distances, but pedestrianism has declined substantially in almost all countries over the past century. This paper uses a combination of personal testimonies and government reports to examine how the spaces through which people travel have changed over time, to chart the impacts that such changes have had on pedestrian mobility and to consider the shifts that are necessary to revitalise walking as a common form of everyday travel. In the nineteenth century, most urban spaces were not especially conducive to walking, but many people did walk as they had little alternative and the sheer number of pedestrians meant that they could dominate urban space. In the twentieth century, successive planning decisions have reshaped cities making walking appear both harder and riskier. Motorised transport has been normalised and pedestrianism marginalised. Only radical change will reverse this.
Traumatic inguinal hernia: An uncommonly reported entity
Authors: Jadav Devendra , Gorchiya Asharam , Shekhawat Raghvendra Singh , Kanchan Tanuj
Published: July 2020

Traumatic abdominal wall herniation, especially of the groin region, is a rare condition and typically results from a high-energy trauma to the abdominal wall. We report a fatal case of a road-traffic collision involving a young male motorcyclist who collided with a speeding lorry. The victim sustained multiple injuries over the chest and abdomen, with traumatic inguinal herniation causing gross distension of the scrotum. At autopsy, multiple lacerations of thoracic and abdominal organs were seen, along with traumatic disruption of the right inguinal canal. The contused terminal ileum was present in the scrotal sac. A literature search has revealed a limited number of reported cases of gross inguinal herniation following thoracoabdominal trauma. In cases of high-energy trauma to the thoraco-abdominal region with unilateral or bilateral distension of the scrotum, the possibility of herniation of the abdominal contents into the scrotal sac should be considered by the forensic pathologist.
A missed case of lurasidone induced laryngospasm: A case study and overview of extrapyramidal symptom identification and treatment
Authors: Caffrey Deirdre , Sowden Gillian L
Published: July 2020

Objective

Many patients with bipolar disorder are treated exclusively in primary care settings, and the use of atypical antipsychotics as primary treatment for bipolar depression is increasing. Extrapyramidal symptoms (EPS) are common side effects of antipsychotic medications, and clinicians should actively monitor for these symptoms when prescribing antipsychotic medications. Accurate diagnosis of EPS is especially important as the symptoms can be highly distressing, and in some cases, life threatening. Our aim is to familiarize primary care providers and other clinicians prescribing antipsychotic medications with EPS and to aid in its rapid diagnosis and treatment.

Method

We describe a case of lurasidone induced dystonia with prominent laryngospasm and oculogyric crisis which was missed for many years in the primary care setting, largely due to misdiagnosis of symptoms as being related to anxiety and panic attacks.

Results

In addition to summarizing this illustrative case, we present the most common forms of EPS and summarize the primary therapies for each type of EPS.

Conclusions

With increased management of bipolar disorder in the primary care setting and increased use of atypical antipsychotics as the primary therapy for bipolar disorder, it is essential that all practitioners are prepared to actively monitor for EPS, followed by its rapid diagnosis and treatment.
Governing Parental Drug Use in the UK: What’s Hidden in “Hidden Harm?”
Authors: Whittaker Anne , Martin Fiona , Olsen Anna , Wincup Emma
Published: July 2020

In 2003, the UK Advisory Council on the Misuse of Drugs published Hidden Harm, the product of an inquiry that exposed the “problems” of parental drug use and its neglect by professionals. It outlined an extensive program of reforms designed to protect children from harm. Despite its far-reaching influence, it has rarely been subject to scrutiny, with analyses focusing on its impact instead. Drawing on Bacchi’s post-structuralist “What’s the Problem Represented to be” approach, we examine problematizations within Hidden Harm and their implications for the governance of family life. We illustrate how Hidden Harm produced a simplified version of parenting and child welfare within the context of drug use by largely equating drug use with “bad” parenting and child maltreatment and by ignoring the social determinants of health and the wider social ecology of family life. Using a tried-and-tested driver of policy change, Hidden Harm created a “scandal” about the lack of intervention by professionals that was used to justify and legitimize increased state intervention into the lives of parents who use drugs. Hidden Harm proposed simplistic “solutions” that centered on drug treatment, child protection and the responsibilization of professionals to govern “risky” parents. We argue these rationalities, subjectivities and strategies serve to marginalize and stigmatize families further and hide alternative approaches to understanding, representing and responding to the complex needs of children and families who are disproportionately affected by health and social inequalities. By uncovering what is hidden in Hidden Harm, we aim to stimulate further research and theoretically informed debate about policy and practice related to child welfare, parenting and family life within the context of drug use. We conclude with some ideas about how to reframe public discourse on parents who use drugs and their children, in tandem with collaborative responses to alleviate child poverty and inequalities.
“Whatever It Takes”: Danger, Necessity, and Realism in American Public Policy
Authors: Roberts Alasdair
Published: July 2020

There are two mentalities of rule, idealism and realism, which differ in their assumptions about how far government policy can be guided by principles alone. The late 1990s were a highpoint for idealism, but the 21st century has proved to be an age of realism. During recurrent crises, American leaders have bent principles and pledged instead to “do whatever it takes” to protect vital interests. The conditions that encourage the realist mentality—turbulence, uncertainty, and danger—will persist in coming decades. We should learn more about how realist statecraft works in democratic states.
5 Years of Diode Laser “Π” Technique for Bilateral Vocal Fold Immobility: A Technique That Improves Airway and Is Friendly to the Voice
Authors: Karkos Petros D. , Stavrakas Marios , Koskinas Ioannis , Markou Konstantinos , Triaridis Stefanos , Constantinidis Jannis
Published: July 2020

Background:

To demonstrate the efficacy of a new laser surgical technique for bilateral vocal fold immobility (BVFI) on postoperative quality of voice and swallowing.

Methods:

Prospective study in a tertiary university hospital and a private hospital. Patients with iatrogenic BVFI were included. Outcome measures were Voice Handicap Index 10, 10-item Eating Assessment Tool, flexible laryngoscopy, and success of decannulation.

Results:

Forty patients with post thyroidectomy BVFI were initially enrolled in our study; only 12 patients returned questionnaires and kept their follow-ups and were included in the study. All patients were successfully decannulated and remain decannulated up to 24-month follow-up. There was a statistically significant improvement in quality of swallowing and no significant deterioration in quality of voice. There was no need for revision up to 24-month follow up.

Conclusions:

The “Π” technique using diode laser technology is a new and safe technique for BVFI with excellent long-term decannulation rates and improvement in quality of life and swallowing without significant changes in voice quality.
Pain and Opioid Analgesic Use After Otorhinolaryngologic Surgery
Authors: Kim Matthew , Kacker Ashutosh , Kutler David I. , Tabaee Abtin , Stewart Michael G. , Kjaer Klaus , Sclafani Anthony P.
Published: July 2020

Objective

To quantify pain and opioid use after otorhinolaryngologic surgery. To determine the effect of patient and surgical factors on primary outcomes.

Study Design

Prospective cohort.

Setting

Tertiary academic hospital.

Subjects and Methods

Patients undergoing elective otorhinolaryngologic surgery were prospectively enrolled. Patients completed demographic surveys and psychometric questionnaires assessing attitudes toward pain and baseline anxiety and depression before surgery. After surgery, patients documented peak pain levels (0‐100 mm, visual analog scale) and daily prescription and nonprescription analgesic requirements over a 2‐week period. Average daily and cumulative pain and opioid use were calculated and compared among patient cohorts stratified by procedure and preoperative factors.

Results

A total of 134 patients were enrolled. Total tonsillectomy was associated with significantly higher pain scores and opioid consumption, as compared to all other procedures. There was moderate correlation between average cumulative pain and opioid use. Older patients required significantly fewer doses of opioids. There was no effect of sex, marital status, or education level on postoperative pain or opioid use. Psychometric instrument scores and chronic pain or analgesic use were not associated with significant differences in pain or opioid requirements. Most patients were prescribed substantially more opioids than they actually required.

Conclusion

Postoperative pain following elective otorhinolaryngologic surgery decreases dramatically within the first week and requires only few days of opioid analgesia, with the exception of tonsillectomy. Almost all patients required fewer than 15 doses of opioids.
Factors Influencing the Development of Pneumonia in Patients With Head and Neck Cancer: A Meta‐analysis
Authors: Reddy Priyanka D. , Yan Flora , Nguyen Shaun A. , Nathan Cherie‐Ann O.
Published: July 2020

Objective

The aim of this study was to identify factors that are associated with the occurrence of pneumonia in patients with head and neck cancer (HNC) after treatment.

Data Sources

PubMed, Scopus, OVID, and Cochrane Library from inception to November 26, 2019.

Review Methods

A systematic review in accordance with the PRISMA guidelines and an assessment of bias were performed. Included studies reported on the risk factors of pneumonia development after HNC treatment via odds ratios and subdistribution hazard ratios from regression analysis.

Results

Fifteen studies were included, comprising 30,962 patients with a mean age of 70 years (range, 19‐95 years). Of these, 71.6% are male. The results of our study indicate that the following were independent risk factors contributing to the development of pneumonia: male sex, habitual alcohol consumption, poor oral hygiene before treatment, pretreatment dysphagia, hypopharynx and nasopharynx tumor sites, use of radiotherapy with or without chemotherapy versus surgery alone, addition of chemotherapy to radiotherapy, reirradiation, neck dissection, increased duration of tracheotomy, and use of sedatives for sleeping.

Conclusion

Multiple patient‐, tumor‐, and treatment‐specific risk factors were identified in predicting pneumonia. Recognition of these risk factors early on may help prevent or at least detect pneumonia in this vulnerable group of patients.
MicroRNA Profiling as a Methodology to Diagnose Ménière’s Disease: Potential Application of Machine Learning
Authors: Shew Matthew , Wichova Helena , Bur Andres , Koestler Devin C. , St Peter Madeleine , Warnecke Athanasia , Staecker Hinrich
Published: July 2020

Objective

Diagnosis and treatment of Ménière’s disease remains a significant challenge because of our inability to understand what is occurring on a molecular level. MicroRNA (miRNA) perilymph profiling is a safe methodology and may serve as a “liquid biopsy” equivalent. We used machine learning (ML) to evaluate miRNA expression profiles of various inner ear pathologies to predict diagnosis of Ménière’s disease.

Study Design

Prospective cohort study.

Setting

Tertiary academic hospital.

Subjects and Methods

Perilymph was collected during labyrinthectomy (Ménière’s disease, n = 5), stapedotomy (otosclerosis, n = 5), and cochlear implantation (sensorineural hearing loss [SNHL], n = 9). miRNA was isolated and analyzed with the Affymetrix miRNA 4.0 array. Various ML classification models were evaluated with an 80/20 train/test split and cross‐validation. Permutation feature importance was performed to understand miRNAs that were critical to the classification models.

Results

In terms of miRNA profiles for conductive hearing loss versus Ménière’s, 4 models were able to differentiate and identify the 2 disease classes with 100% accuracy. The top‐performing models used the same miRNAs in their decision classification model but with different weighted values. All candidate models for SNHL versus Ménière’s performed significantly worse, with the best models achieving 66% accuracy. Ménière’s models showed unique features distinct from SNHL.

Conclusions

We can use ML to build Ménière’s‐specific prediction models using miRNA profile alone. However, ML models were less accurate in predicting SNHL from Ménière’s, likely from overlap of miRNA biomarkers. The power of this technique is that it identifies biomarkers without knowledge of the pathophysiology, potentially leading to identification of novel biomarkers and diagnostic tests.
Human Papillomavirus–Associated Anogenital Pathology in Females With HPV‐Positive Oropharyngeal Squamous Cell Carcinoma
Authors: Larish Alyssa , Yin Linda , Glaser Gretchen , Moore Eric , Bakkum‐Gamez Jamie , Routman David , Ma Daniel , Price Daniel , Janus Jeffrey , Price Katharine , Chintakuntlawar Ashish , Neben‐Wittich Michelle , Foote Robert , Van Abel Kathryn
Published: July 2020

We sought to determine the incidence and location of human papillomavirus (HPV)–associated anogenital disease in women with HPV‐positive oropharyngeal squamous cell carcinoma (OPSCC) via a retrospective cohort study with prospective contact to update history at Mayo Clinic in Rochester, Minnesota. Females undergoing treatment for nonmetastatic HPV‐positive OPSCC from 2011 to 2019 were identified. Clinical history and outcomes were abstracted from medical records. Patients without documented anogenital history were contacted, consented, and administered a survey, and external records were requested and reviewed. Seventeen of 46 patients (37.0%) had a history of anogenital HPV‐associated disease, and 16 of 17 (94.1%) required procedures to diagnose or treat HPV lesions. The cervix was the most common site (16/17, 94.1%). Procedures included colposcopy (n = 6), cervical excision (n = 3), cryotherapy (n = 4), and hysterectomy (n = 3). One case of fatal cervical carcinoma was noted, diagnosed 1 year following OPSCC. Three of 17 (17.6%) had HPV‐related vulvovaginal disease, and 1 of 17 had anal disease. Patients with a history of HPV‐positive OPSCC may be at elevated risk for HPV‐associated anogenital disease.
Building Community Relations and Promoting Cancer Prevention: An Oral Cancer Screening Event
Authors: Straughan Alexander J. , Zapanta Philip E. , Goodman Joseph F.
Published: July 2020

Communities often call upon their university hospitals to help with health screening events. Otolaryngologists can play an important role in prevention and education. We recently evaluated 285 community members at an oral cancer screening event at a community health “expo.” An intake form and oral exam identified 67 with conditions that warranted further evaluation: 16 for dental follow‐up; 25 for further ear, nose, and throat (ENT) evaluation; and 26 for primary care follow‐up. One patient was identified with laryngeal cancer after referral for dysphonia. The event served to increase awareness of oral cancer among high‐risk patients via educational materials and podium presentations. There was a positive effect on our university’s credibility and reputation in the local community. Medical students interested in ENT received valuable supervised hands‐on experience. This screening event identified opportunities for collaboration with local dental societies and primary care physicians for prevention and early detection of oral cancer.
Olfactory Dysfunction in COVID‐19 Patients: Prevalence and Prognosis for Recovering Sense of Smell
Authors: D’Ascanio Luca , Pandolfini Manlio , Cingolani Cristina , Latini Gino , Gradoni Paolo , Capalbo Maria , Frausini Gabriele , Maranzano Massimo , Brenner Michael J. , Di Stadio Arianna
Published: July 2020

While olfactory dysfunction associated with coronavirus disease 2019 (COVID‐19) has attracted considerable interest, few studies have tracked outcomes at serial time points or beyond 2 weeks. Furthermore, data are conflicting regarding whether COVID‐19 severity correlates with degree of olfactory dysfunction. This prospective case‐control study analyzed prevalence and severity of subjective loss of smell in outpatients (n = 23) and inpatients (n = 20) with confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection vs healthy controls (n = 25). Olfactory dysfunction was reported more commonly in COVID‐19 patients than in healthy controls (P <. 001), and outpatients paradoxically reported loss of smell more commonly than inpatients (P =. 02). Headaches were present in 52% of patients with olfactory dysfunction. Anosmia or hyposmia persisted beyond 5 days but most of the patients recovered by 30 days, suggesting favorable prognosis for olfaction. Differences between inpatients and outpatients are potentially reflective of timeline of olfactory symptoms and contextual factors, underscoring the importance of corroborative objective testing, coupled with careful tracking of temporal relationships.
Matching the Symptom Profile of Adolescent Disaster Survivors with Changing Diagnostic Criteria of Posttraumatic Stress Disorder: Focus on ICD-11
Authors: Kar Nilamadhab , Sharma Asmita
Published: July 2020

Background:

Considering recent changes in the diagnostic guidelines for posttraumatic stress disorder (PTSD), it has become imperative to review their influence, especially on the symptoms related to children and adolescent victims of disasters. We intended to assess the profile of posttraumatic stress symptoms (PTSS) of adolescents following an earthquake, especially the gender differences, in relation to the changing diagnostic guidelines, particularly ICD-11.

Methods:

In a cross-sectional study, PTSS and functional impairments were evaluated in school-going adolescents in Nepal, one year after the 2015 earthquake, using the Child Posttraumatic Stress Scale (CPSS).

Results:

A considerable proportion of adolescent survivors of the earthquake had PTSS. Most common ones were intrusive thoughts (46.7%), avoiding thoughts, conversations and feelings about the disaster (44.2%), decreased interest in activities (40.0%), distress with reminders (35.6%), and concentration problems (35.6%). Females had a higher prevalence for all the PTSS compared with males, except for avoiding thought, conversations, feelings, and being overly careful/vigilant. Proportion of adolescents who met symptomatic criteria for PTSD diagnosis in different systems ranged from 14.7% in DSM-5 to 15.6% in ICD-11 three-factor model, and 22.2% in DSM-IV and 31.7% in ICD-10. Inclusion of the criterion of significant functional impairment changed the proportions to 10.0%, 10.3%, 12.8%, and 16.4%, respectively. In all of the diagnostic systems, higher proportions of females had possible PTSD.

Conclusion:

Adolescent females had a higher prevalence for most of the PTSS and at the diagnostic level. It appears that for adolescents, diagnosis of PTSD in ICD-11 has become more robust with a focus on core symptoms and having a functional impairment criterion.
Psychological Health Among Armed Forces Doctors During COVID-19 Pandemic in India
Authors: Gupta Simmi , Kohli Kinshuk , Padmakumari P , Dixit Prashant Kumar , Prasad Ajay Shankar , Chakravarthy Bharath Seshadri , Shukla Rajat , Ghana Parthasarathi , Mahapatra Debasish , Varadaraj G
Published: July 2020

Background:

A pandemic poses a significant challenge to the healthcare staff and infrastructure. We studied the prevalence of anxiety and depressive symptoms among armed forces doctors in India during the COVID-19 pandemic and the factors that contribute to these symptoms.

Methods:

The study was conducted from March 30, 2020, to April 2, 2020, using a self-administered questionnaire questionnaire using the hospital anxiety and depression scale (HADS), which was sent through Google Forms. Responses were received from 769 respondents. Data were analyzed for demographic details and HADS scores using the chi-square test and backward logistic regression.

Results:

Anxiety and depressive symptoms were seen in 35.2% and 28.2% of the doctors, respectively. In doctors with anxiety symptoms, significant associations were observed with age (20–35 years, 39.4%, P = 0.01), gender (females, 44.6%, P < 0.001), duration of service (0–10 years, 38%, P = 0.03), and clinical versus non-clinical specialties (non-clinical, 41.3%, P < 0.001) as opposed to marital status, education level, and current department of work. In doctors with depressive symptoms, significant associations were observed with age (P = 0.04), clinical versus non-clinical specialties (P < 0.001), duration of service (0–10 years, 30.1%, P = 0.03), and doctoral degree (P = 0.04) as opposed to gender, marital status, education level, and current working department.

Conclusion:

The study revealed a high prevalence of anxiety and depressive symptoms among armed forces doctors. The main contributing factors are female gender, young age group, non-clinical specialties, and having a doctoral degree.
Bi-directional communication journals as a method of caregiver support during speech and language intervention: A pilot study
Authors: Pelatti Christina Yeager , Martino Alison , Wilson Kaitlyn P.
Published: July 2020

The purpose of this study was to determine whether the inclusion of a bi-directional communication journal between caregivers and student clinicians during a five-week summer preschool programme impacted caregivers’ perceptions and had a positive impact on their children’s language development. This study included a mixed methods design. Child participants (mean age = 4 years, 4 months) were assigned to one of four classrooms; two classrooms served as control classrooms ( n = 12 children), and two participated in the journal intervention ( n = 15 children). Quantitative and qualitative data were collected through questionnaires reflecting caregivers’ perceptions of the speech and language environment and their children’s language development at the start and end of the programme. Quantitative results revealed a significant main effect of time regarding caregivers’ perceptions of their child’s language development. Thematic analysis of narrative questionnaire responses revealed three core themes including: improved communication between caregivers and student clinicians, insight about child’s routines, and application in the home environment. Overall, the results of this pilot study offer preliminary support for the use of bi-directional communication journals as a method of supporting preschoolers’ growth in speech and language skills through caregiver involvement.