bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethics of HIV and hepatitis B cure research
Authors: Sugarman Jeremy
Published: February 2020

Purpose of review

Achieving a cure for HIV or hepatitis B virus (HBV) is expected to have a range of salutary effects including eliminating the need for continued treatments, minimizing risk to sexual and injecting partners, reducing prevalence, and decreasing stigma. Nevertheless, conducting research to achieve such laudable goals is necessarily associated with a broad set of ethical challenges. This review aims at describing key findings from selected peer-reviewed literature published in the last 2 years (2018–2019) that enhance understanding of some of these issues.

Recent findings

A variety of ethical issues in HIV cure research have been informed by recent conceptual and empirical scholarship. These include: analytical treatment interruptions; attitudes towards participation; responsibilities to nonparticipants; consent and terminology; and selected other issues.

Understanding of the ethical issues in HIV cure research has been enhanced by sustained normative and empirical scholarship with a range of stakeholders. This work has crucial implications for HBV cure research, but there is also a pressing need for directed work on HBV cure research. In both HIV and HBV cure research, such scholarship promises to help ensure that critically important research efforts are ethically sound.
Muscle-strengthening exercise and prevalent hypertension among 1.5 million adults: a little is better than none
Authors: Bennie Jason A. , Lee Duck-chul , Brellenthin Angelique G. , De Cocker Katrien
Published: February 2020

Background:

Clinical evidence suggests that muscle-strengthening exercise (using weight machines/body weight exercises) may be an important antihypertensive lifestyle therapy. However, epidemiological research on the association between muscle-strengthening exercise and hypertension is limited. We conducted the first population-level study describing the associations between muscle-strengthening exercise and prevalent hypertension among a large sample of US adults.

Methods:

In this cross-sectional study, data were pooled from four US health surveillance surveys (2011–2017) (n = 1 539  309, aged ≥18 years). Muscle-strengthening exercise frequency and self-reported clinically diagnosed hypertension (n = 431 313; 28%) were assessed using the same items across each survey. Generalized linear models using Poisson regression with robust error variance were used to calculate the prevalence ratios of hypertension (outcome variable) across muscle-strengthening exercise [exposure variables: 0 (reference); 1 to ≥7 times/week), adjusting for potential cofounders.

Results:

Compared with those doing none, the adjusted prevalence ratios for hypertension were 0.67 (95% CI: 0.66–0.68), 0.67 (95% CI: 0.67–0.68), 0.70 (95% CI: 0.69–0.70), 0.61 (95% CI: 0.60–0.63), 0.62 (95% CI: 0.61–0.64), 0.60 (95% CI: 0.58–0.62) and 0.83 (95% CI: 0.82–0.84) among the groups engaging in muscle-strengthening exercise one, two, three, four, five, six, and at least seven times/week, respectively. Associations remained after stratification for sociodemographic factors (age, sex), lifestyle characteristics (aerobic exercise, BMI, self-rated health, smoking, alcohol) and comorbidities (e.g. arthritis, diabetes, depression).

Conclusion:

Among over 1.5 million adults, compared with those doing none, any weekly frequency in muscle-strengthening exercise was associated with a lower prevalence of hypertension. Longitudinal studies and large-scale muscle-strengthening exercise interventions with population representative samples are needed to confirm these preliminary cross-sectional observations.
Actionable Ventricular Tachycardia During In-Hospital ECG Monitoring and Its Impact on Alarm Fatigue
Authors: Pelter Michele M. , Suba Sukardi , Sandoval Cass , Zègre-Hemsey Jessica K. , Berger Sarah , Larsen Amy , Badilini Fabio , Hu Xiao
Published: February 2020

Background:

Ventricular tachycardia (V-tach) is the most common lethal arrhythmia, yet 90% of alarms are false and contribute to alarm fatigue. We hypothesize that some true V-tach also causes alarm fatigue because current criteria are too sensitive (i.e., ≥6 beats ≥100 beats/min [bpm]).

Purpose:

This study was designed to determine (1) the proportion of clinically actionable true V-tach events; (2) whether true actionable versus nonactionable V-tach differs in terms of heart rate and/or duration (seconds); and (3) if actionable V-tach is associated with adverse outcomes.

Methods:

This was a secondary analysis in 460 intensive care unit (ICU) patients. Electronic health records were examined to determine if a V-tach event was actionable or nonactionable. Actionable V-tach was defined if a clinical action(s) was taken within 15 minutes of its occurrence (i.e., new and/or change of medication, defibrillation, and/or laboratory test). Maximal heart rate and duration for each V-tach event were measured from bedside monitor electrocardiography. Adverse patient outcomes included a code blue event and/or death.

Results:

In 460 ICU patients, 50 (11%) had 151 true V-tach events (range 1–20). Of the 50 patients, 40 (80%) had only nonactionable V-tach (97 events); 3 (6%) had both actionable and nonactionable V-tach (32 events); and 7 patients (14%) had only actionable V-tach (23 events). There were differences in duration comparing actionable versus nonactionable V-tach (mean 56.19 ± 116.87 seconds vs. 4.28 ± 4.09 seconds; P = 0.001) and maximal heart rate (188.81 ± 116.83 bpm vs. 150.79 ± 28.26 bpm; P = 0.001). Of the 50 patients, 3 (6%) had a code blue, 2 died, and all were in the actionable V-tach group.

Conclusions:

In our sample, <1% experienced a code blue following true V-tach. Heart rate and duration for actionable V-tach were much faster and longer than that for nonactionable V-tach. Current default settings typically used for electrocardiographic monitoring (i.e., ≥6 beats ≥100 bpm) appear to be too conservative and can lead to crisis/red level nuisance alarms that contribute to alarm fatigue. A prospective study designed to test whether adjusting default settings to these higher levels is safe for patients is needed.
Regional homogeneity and functional connectivity in resting-state brain activity in tinnitus patients
Authors: Yang Haidi , Lin Haiyan , Lin Xiaofeng , Zhang Xueyuan , Xiong Hao , Zheng Yiqing
Published: February 2020

Objective:

Subjective tinnitus is characterized by the perception of sound in the absence of any external auditory stimuli. This perceived sound may be related to altered intrinsic neural activity generated along the central auditory pathway. This retrospective study was designed to investigate regional homogeneity and functional connectivity in the resting-state brain activity of patients with tinnitus.

Methods:

We recruited tinnitus patients with normal hearing or mild hearing loss (
n
= 17) and age-matched healthy controls (
n
= 20), and examined regional homogeneity and functional connectivity in resting-state brain activity using resting-state functional magnetic resonance imaging data. The present study protocol was approved by the Institutional Review Board on Experimental Ethics at Sun Yat-sen University, China (approval No. SYSEC-KY-KS-2019-083).

Results:

Compared with normal controls, patients with tinnitus had significantly decreased regional homogeneity in the anterior lobe of the cerebellum and increased homogeneity in the inferior frontal gyrus (
P
< 0.05 corrected at a cluster-level). In addition, tinnitus patients showed enhanced functional connectivity between the inferior frontal gyrus and the ventral striatum and midbrain, as well as increased connectivity between the cerebellum and ventromedial prefrontal cortex (
P
< 0.05 corrected at a cluster-level). We also found decreased connectivity between the cerebellum and the anterior insula compared with controls (
P
< 0.05 corrected at a cluster-level).

Conclusion:

Abnormal connectivity in non-auditory brain structures, particularly those related to emotion processing, may be associated with tinnitus persistence.
Predictors of mortality, limb loss, and discharge disposition at admission among patients with necrotizing skin and soft tissue infections
Authors: Horn Dara L. , Shen Jolie , Roberts Emma , Wang Theresa N. , Li Kevin S. , O'Keefe Grant E. , Cuschieri Joseph , Bulger Eileen M. , Robinson Bryce R.H.
Published: February 2020

BACKGROUND

Necrotizing soft tissue infections (NSTI) represent a heterogeneous group of rapidly progressive skin and soft tissue infections associated with significant morbidity and mortality. Efforts to identify factors associated with death have produced mixed results, and little or no data is available for other adverse outcomes. We sought to determine whether admission variables were associated with mortality, limb loss, and discharge disposition in patients with NSTI.

METHODS

We analyzed prospectively collected data of adult patients with surgically confirmed NSTI from an NSTI registry maintained at a quaternary referral center. Factors independently associated with mortality, amputation, and skilled nursing facility discharge were identified using logistic regression.

RESULTS

Between 2015 and 2018, 446 patients were identified. The median age was 55 years (interquartile range, 43–62). The majority of patients were male (65%), white (77%), and transferred from another facility (90%). The perineum was most commonly involved (37%), followed by the lower extremity (34%). The median number of operative debridements was 3 (interquartile range, 2–4). Overall mortality was 15%, and 21% of extremity NSTI patients required amputation. Age greater than 60 years; creatinine greater than 2 mg/dL; white blood cell count greater than 30 x 10^3 /μl, platelets less than 150 × 103/μL, and clostridial involvement were independently associated with greater odds of death; perineal involvement was associated with lower odds of death. Age greater than 60 years; sex, male; nonwhite race; diabetes; chronic wound as etiology; leg involvement; transfer status; and sodium, less than 130 mEq/L were independently associated with amputation. Age greater than 60 years; sex, female; nonwhite race; perineal involvement; and amputation were associated with skilled care facility discharge.

CONCLUSION

Necrotizing soft tissue infections are a heterogeneous group of infections involving significantly different patient populations with different outcomes; efforts to differentiate and predict adverse outcomes in NSTI should include laboratory data, comorbidities, infection site, and/or etiology to improve predictions and better account for this heterogeneity.

LEVEL OF EVIDENCE

Prognostic, Level III.
Palm fruit colours are linked to the broad-scale distribution and diversification of primate colour vision systems
Authors: Onstein Renske E. , Vink Daphne N. , Veen Jorin , Barratt Christopher D. , Flantua Suzette G. A. , Wich Serge A. , Kissling W. Daniel
Published: February 2020

A long-standing hypothesis in ecology and evolution is that trichromatic colour vision (the ability to distinguish red from green) in frugivorous primates has evolved as an adaptation to detect conspicuous (reddish) fruits. This could provide a competitive advantage over dichromatic frugivores which cannot distinguish reddish colours from a background of green foliage. Here, we test whether the origin, distribution and diversity of trichromatic primates is positively associated with the availability of conspicuous palm fruits, i.e. keystone fruit resources for tropical frugivores. We combine global data of colour vision, distribution and phylogenetic data for more than 400 primate species with fruit colour data for more than 1700 palm species, and reveal that species richness of trichromatic primates increases with the proportion of palm species that have conspicuous fruits, especially in subtropical African forests. By contrast, species richness of trichromats in Asia and the Americas is not positively associated with conspicuous palm fruit colours. Macroevolutionary analyses further indicate rapid and synchronous radiations of trichromats and conspicuous palms on the African mainland starting 10 Ma. These results suggest that the distribution and diversification of African trichromatic primates is strongly linked to the relative availability of conspicuous (versus non-conspicuous) palm fruits, and that interactions between primates and palms are related to the coevolutionary dynamics of primate colour vision systems and palm fruit colours.
Argonaute Binding within 3’-Untranslated Regions Does Not Predict Gene Repression
Authors: Chu Yongjun , Kilikevicius Audrius , Liu Jing , Johnson Krystal C. , Yakota Shinnichi , Corey David R.
Published: February 2020

Despite two decades of study, the full scope of RNAi in mammalian cells has remained obscure. Here we combine: 1) Knockout of argonaute (AGO) variants; 2) RNA sequencing analysis of gene expression changes; and 3) Crosslinking Immunoprecipitation Sequencing (CLIP-seq) using anti-AGO2 antibody to identify potential microRNA (miRNA) binding sites. We find that knocking out AGO1, AGO2, and AGO3 are necessary to achieve full impact on gene expression. CLIP-seq reveals several hundred significant AGO2 associations within the 3’-untranslated regions of cytoplasmic transcripts. The standard mechanism of miRNA action would suggest that these associations repress gene expression. Contrary to this expectation, clusters are poorly correlated with gene repression in wild-type versus knockout cells. Many clusters are associated with increased gene expression in wild-type versus knock out cells, including the strongest cluster within theMYC3’-UTR. Our results suggest that assumptions about miRNA action should be re-examined.
Diet Post-translationally Modifies The Gut Microbial Proteome To Modulate Renal Function
Authors: Lobel Lior , Cao Y. Grace , Glickman Jonathan N. , Garrett Wendy S.
Published: February 2020

We identify a novel mechanism linking diet, gut microbial metabolism, and renal function. We found that a sulfur amino acid-based dietary intervention post-translationally modifies a microbial enzyme, blunting its uremic toxin-producing activity and alleviating chronic kidney disease (CKD) in a preclinical model. We also define a heretofore unknown role for the post-translational modification S-sulfhydration within the gut microbiome. This study provides a framework for understanding how diet can tune microbiota function via protein post-translational modification without altering microbial community composition to support healthy host physiology beyond the gut and specifically how a dietary modification can inhibit tryptophanase activity to ameliorate CKD progression.

One Sentence Summary

We found that diet post-translationally modifies the gut microbiota proteome to modulate kidney function.
Caregivers’ perspectives on health-care transition in autism
Authors: Schwartz Jaclyn K. , Agrawal Mavara , Treminio Ingris , Espinosa Sofia , Rodriguez Melissa , Richard Lynne
Published: February 2020

Purpose

Adults with autism spectrum disorder (ASD) experience significant health-care disparities across physical and mental health domains resulting in poorer health and quality of life. Poor transitions to adult care negatively impact the health of adults with ASD. Current research focuses on personal factors in research samples that lack diversity. The purpose of this study is to examine the lived health-care experiences of geographically and ethnically diverse young adults with ASD in adult care settings in the USA to understand provider and system-level factors affecting their health.

Design/methodology/approach

Nine caregivers of young adults with ASD participated in key informant interviews describing their experiences in navigating the health-care system. Data were analyzed using a grounded theory approach.

Findings

The data indicated that limited quantity of services, poor quality of services, and high cost of services had a negative effect on the health of adults with ASD. Issues cascaded to become more complex.

Practical implications

Practical implications for payors, providers, persons with ASD and their families are discussed in this paper.

Originality/value

To the best of the authors’ knowledge, this study answers the call to better understand system-level factors affecting the health of geographically and ethnically diverse people with ASD.
Traditional cyberloafing, mobile cyberloafing and personal mobile-internet loafing in business organizations
Authors: Batabyal Sauvik Kumar , Bhal Kanika Tandon
Published: February 2020

Purpose

Possession and usage of data-enabled smartphones have added further complexity to the issue of cyberloafing behavior and it certainly evokes newer ethical concerns. This study aims to explore how working individuals perceive the ethicality of their cyberloafing behaviors at the workplace and the cognitive logics they apply to justify their cyberloafing behavior.

Design/methodology/approach

Incorporating constructivist grounded theory methodology, 19 working managers from various organizations were interviewed face-to-face and responses were audio-recorded with prior consent. The recordings were transcribed verbatim, simultaneously analyzed and coded to let the themes emerge out of the data.

Findings

The research showed that working managers use varied combinations of office computers, personal laptops, smartphones, wireless internet provided at the office and personal mobile-internet to loaf around at workplaces. Moreover, it unearthed that employees use nine different neutralization techniques and six different ethical logics (with normative undertones) in a network fashion while considering the ethicality of cyberloafing behavior.

Practical implications

Recognizing the complexities is imperative to moderate any deviant behavior in an organization. The layers of ethicality and neutralization tactics will equip the working managers and companies to place the required internet and smartphone usage policies in the future.

Originality/value

This research has taken into account all forms of cyberloafing behaviors. The perceived ethicality of cyberloafing behavior at the workplace was not fully explored in a holistic manner before, specifically in the Indian context.
Evidence and indications for systemic treatment in diabetic retinopathy: a systematic review
Authors: Elkjaer Anna Sofie , Lynge Sidsel Kirstine , Grauslund Jakob
Published: February 2020

Eye screening is mandatory in diabetes, but treatment is only indicated at the sight‐threatening stages of diabetic retinopathy (DR). Treatments include intravitreal injections, laser photocoagulation and vitrectomy, which are all invasive options. In order to prevent or delay DR, it is important to investigate earlier, non‐invasive managements prior to sight‐threatening DR. The aim of this study is to evaluate the effect of systemic treatment on incident and progressive DR. The search in this systematic review was performed in PubMed and Embase using the keywords ‘diabetic retinopathy’ AND ‘systemic therapy’. Two independent researchers identified 619 studies; 26 duplicates were removed, 579 articles were excluded based on title and abstract, and six were removed after full‐text assessment. Five articles were added from reference screening, resolving in a total of 13 eligible articles. These were quality‐assessed using the Cochrane Risk of Bias tool. Twelve randomized control trials and one follow‐up study were included. Intensive glycaemic control (IGC), antihypertensive and lipid‐lowering treatments were some of the main interventions tested in the studies. Three studies found statistically significant reduction of progression of DR by IGC, three by antihypertensive, and two by the lipid‐lowering drug fenofibrate. Systemic intervention appears important in different stages of DR. While IGC seems effective in relation to incident and progressive DR, antihypertensive treatments may be valuable in the early stages of DR, as opposed to fenofibrate, which could benefit at a later stage.
Evaluating glucose‐lowering treatment in older people with diabetes: Lessons from the IMPERIUM trial
Authors: Sinclair Alan J. , Heller Simon R. , Pratley Richard E. , Duan Ran , Heine Robert J. , Festa Andreas , Kiljański Jacek
Published: February 2020

Understanding the benefits and risks of treatments to be used by older individuals (≥65 years old) is critical for informed therapeutic decisions. Glucose‐lowering therapy for older patients with diabetes should be tailored to suit their clinical condition, comorbidities and impaired functional status, including varying degrees of frailty. However, despite the rapidly growing population of older adults with diabetes, there are few dedicated clinical trials evaluating glucose‐lowering treatment in older people. Conducting clinical trials in the older population poses multiple significant challenges. Despite the general agreement that individualizing treatment goals and avoiding hypoglycaemia is paramount for the therapy of older people with diabetes, there are conflicting perspectives on specific glycaemic targets that should be adopted and on use of specific drugs and treatment strategies. Assessment of functional status, frailty and comorbidities is not routinely performed in diabetes trials, contributing to insufficient characterization of older study participants. Moreover, significant operational barriers and problems make successful enrolment and completion of such studies difficult. In this review paper, we summarize the current guidelines and literature on conducting such trials, as well as the learnings from our own clinical trial (IMPERIUM) that assessed different glucose‐lowering strategies in older people with type 2 diabetes. We discuss the importance of strategies to improve study design, enrolment and attrition. Apart from summarizing some practical advice to facilitate the successful conduct of studies, we highlight key gaps and needs that warrant further research.
Defining and identifying predictors of rapid response to pediatric obesity treatment
Authors: Eichen Dawn M. , Mestre Zoe L. , Strong David R. , Rhee Kyung E. , Boutelle Kerri N.
Published: February 2020

Early weight loss (rapid response [RR]) is associated with better outcomes in adults. Less is known about RR in children enrolled in weight‐loss treatment. The aim of the current study was to establish an RR weight‐loss threshold following 4 weeks of pediatric obesity treatment and identify characteristics associated with achieving RR. One hundred thirty‐seven children aged 8 to 12 with overweight/obesity and parents participated in 6 months of family‐based or parent‐based treatment. Receiver operating characteristic curves evaluated how weight loss at week 4 related to decreases of 5% at posttreatment and 10% at 6‐ and 18‐month follow‐ups of standardized body mass index (BMIz), percentage distance of a child's BMI from the median BMI for sex and age, and percentage above the 95th percentile. Weight loss of 2.4% to 3.4% at week 4 predicted 5% change at posttreatment (AUC's = .68‐.75; P's ≤ .002) and 10% change at 6‐month follow‐up (AUC's = .63‐.70; P's ≤ .02). No model was significant at 18‐month follow‐up. Amount of parent weight (lbs) change at week 4 was associated with child achieving RR. Males and Non‐Hispanic Whites were more likely to achieve RR. This threshold could be used to mark early significant progress and guide clinical evaluations of treatment response to paediatric obesity treatment.
Sleep and resting‐state functional magnetic resonance imaging connectivity in middle‐aged adults and the elderly: A population‐based study
Authors: Lysen Thom S. , Zonneveld Hazel I. , Muetzel Ryan L. , Ikram M. Arfan , Luik Annemarie I. , Vernooij Meike W. , Tiemeier Henning
Published: February 2020

Sleep problems increase with ageing. Increasing evidence suggests that sleep problems are not only a consequence of age‐related processes, but may independently contribute to developing vascular or neurodegenerative brain disease. Yet, it remains unclear what mechanisms underlie the impact sleep problems may have on brain health in the general middle‐aged and elderly population. Here, we studied sleep's relation to brain functioning in 621 participants (median age 62 years, 55% women) from the population‐based Rotterdam Study. We investigated cross‐sectional associations of polysomnographic and subjectively measured aspects of sleep with intrinsic neural activity measured with resting‐state functional magnetic resonance imaging on a different day. We investigated both functional connectivity between regions and brain activity (blood‐oxygen‐level‐dependent signal amplitude) within regions, hierarchically towards smaller topographical levels. We found that longer polysomnographic total sleep time is associated with lower blood‐oxygen‐level‐dependent signal amplitude in (pre)frontal regions. No objective or subjective sleep parameters were associated with functional connectivity between or within resting‐state networks. The findings may indicate a pathway through which sleep, in a ‘real‐life’ population setting, impacts brain activity or regional brain activity determines total sleep time.
Online implementation of an event history calendar with formr: A tutorial
Authors: Wieczorek Larissa L. , Tata Cyril S. , Penke Lars , Gerlach Tanja M.
Published: February 2020

Event history calendars (EHCs) are popular tools for retrospective data collection. Originally conceptualized as face‐to‐face interviews, EHCs contain various questions about the respondents' autobiography in order to use their experiences as cues to facilitate remembering. For relationship researchers, EHCs are particularly valuable when trying to reconstruct the relational past of individuals. However, although many studies are conducted online nowadays, no freely available online adaptation of the EHC is available yet. In this tutorial, detailed instructions are provided on how to implement an online EHC for the reconstruction of romantic relationship histories within the open‐source frameworkformr. Ways to customize the online EHC and provide a template for researchers to adapt the tool for their own purposes are showcased.
Microaggression: Conceptual and scientific issues
Authors: McClure Emma , Rini Regina
Published: February 2020

Scientists, philosophers, and policymakers disagree about how to define microaggression. Here, we offer a taxonomy of existing definitions, clustering around (a) the psychological motives of perpetrators, (b) the experience of victims, and (c) the functional role of microaggression in oppressive social structures. We consider conceptual and epistemic challenges to each and suggest that progress may come from developing novel hybrid accounts of microaggression, combining empirically tractable features with sensitivity to the testimony of victims.
Endurance exercise training volume is not associated with progression of coronary artery calcification
Authors: Kleiven Øyunn , Bjørkavoll‐Bergseth Magnus F. , Omland Torbjørn , Aakre Kristin M. , Frøysa Vidar , Erevik Christine B. , Greve Ole J. , Melberg Tor H. , Auestad Bjørn , Skadberg Øyvind , Edvardsen Thor , Ørn Stein
Published: February 2020

Background

Recent cross‐sectional studies have suggested a dose‐dependent relationship between lifelong exposure to physical activity and the burden of calcified coronary artery disease (CAD). No longitudinal studies have addressed this concern.

Hypothesis

Exercise volume is associated with progression of coronary artery calcium (CAC), defined as ≥10 units increase in CAC score.

Methods

Sixty‐one recreational athletes who were assessed by coronary computed tomography angiography (CCTA) as part of the NEEDED 2013/14 study were re‐assessed 4‐5 years later, in 2018.

Results

Subjects were 45.9 ± 9.6 years old at inclusion, and 46 (74%) were male. Between 2013 and 2018, the participants reported median 5 (range: 0‐20, 25th‐75th percentile: 4‐6) hours of high‐intensity exercise per week. None of the included subjects smoked during follow‐up. At inclusion, 21 (33%) participants had coronary artery calcifications. On follow‐up CCTA in 2018, 15 (25%) subjects had progressive coronary calcification (≥10 Agatston units increase in CAC). These subjects were older (53 ± 9 vs 44 ± 9 years old, P = .002) and had higher levels of low‐density lipoprotein at baseline (3.5 (2.9‐4.3) vs 2.9 (2.3‐3.5) mmol/L, P = .031) as compared to subjects with stable condition. No relationship was found between hours of endurance training per week and progression of coronary artery calcification. In multiple regression analysis, age and baseline CAC were the only significant predictors of progressive CAC.

Conclusion

No relationship between exercise training volume and the progression of coronary artery calcification was found in this longitudinal study of middle‐aged recreational athletes.
Incisional infections associated with ventral midline celiotomy in horses
Authors: Shearer Tara R. , Holcombe Susan J. , Valberg Stephanie J.
Published: February 2020

Objective

To review the veterinary literature regarding healing and complications associated with equine celiotomy including anatomy and physiology, risk factors for incisional infection and hernia, and treatment.

Etiology

Celiotomy is the most common approach to treat horses with surgical colic. Incision through the linea alba provides exposure to most of the abdomen for exploration, exteriorization, and correction of surgical lesions. Incisional apposition relies on suture strength during anesthetic recovery and for the first 30 days postoperatively. Factors associated with the patient, surgical lesion and procedures, anesthesia, and recovery put the horse at risk for surgical site infection. Infection is the most important risk factor for incisional hernia formation.

Diagnosis

A presumptive diagnosis of surgical site infection is made based on the presence of fever and incisional swelling, pain, and discharge. Ultrasonography can be used to identify areas of fluid accumulation prior to the appearance of incisional drainage. Definitive diagnosis is based on positive bacteriologic culture of the incisional discharge. Incisional hernia is diagnosed by palpation of the incision, usually 30–60 days after surgery. Ultrasound of the incision may aide in early diagnosis of incisional hernia if gaps along the incision in the linea alba are apparent.

Therapy

No objective data exist to assess the efficacy of specific therapies for surgical site infections following celiotomy. Principles of treatment include the establishment of drainage, bandaging, antimicrobial therapy based on culture and sensitivity, and extended rest in an attempt to avoid incisional hernia or dehiscence. Treatment for incisional hernia includes prolonged circumferential bandaging, open or minimally invasive hernia repair, or no treatment.

Prognosis

Incisional complications are associated with prolonged convalescence and diminished prognosis for return to athleticism. Limiting risk factors for surgical site infections, prompt treatment, and incisional support may optimize celiotomy healing and timely return to function. Horses compete in many disciplines with incisional hernias.
A prospective randomized, double‐blinded clinical study evaluating the efficacy and safety of bupivacaine versus morphine‐bupivacaine in caudal epidurals in cats with urethral obstruction
Authors: Pratt Chap L. , Balakrishnan Anusha , McGowan Erin , Drobatz Kenneth J. , Reineke Erica L.
Published: February 2020

Objective

To investigate the efficacy and safety of the caudal epidural technique in cats with urethral obstruction (UO).

Design

Prospective, double‐blinded, randomized, sham‐controlled study.

Animals

Eighty‐eight male cats with UO.

Interventions

Thirty cats randomized to bupivacaine epidural (BUP), 28 cats to bupivacaine‐morphine epidural (BUP/MOR), and 30 cats to sham epidural (SHAM).

Measurements and Main Results

Time to perform the epidural and efficacy of the epidural was assessed by evaluation of tail and perineal responses. The amount of propofol for urinary catheterization and time to administration of rescue analgesia (buprenorphine) was recorded. Cats were monitored for epidural complications. The median time to perform the epidural was 2 min (range, 0.2‐13 min and range, 0.5‐13 min), with an epidural success rate of 70%. The median amount of propofol administered for urinary catheterization was significantly less in the BUP (2.1 mg/kg; range, 0‐7.5 mg/kg) and MOR/BUP cats (1.85 mg/kg; range, 0‐8.6 mg/kg) as compared to SHAM cats (4 mg/kg; range, 0‐12.7 mg/kg) (P = 0.006,P = 0.0008, respectively). The median time to administration of rescue analgesia was also significantly longer in the BUP (10 h; range, 2‐32 h) and MOR/BUP cats (10 h; range, 4‐45 h) as compared to SHAM cats (4 h; range, 2‐36 h) (P = 0.0026,P = 0.0004, respectively). There were no recognized complications related to the epidural.

Conclusion

Caudal epidural appears to be safe, may reduce the amount of IV anesthesia needed to facilitate urinary catheterization, and can be used to provide long‐term analgesia in the hospital.
Normative ocular data for juvenile and adult Japanese quail (Coturnix japonica)
Authors: Presby Justine A. , Scott Erin M. , Norman Keri N. , Hoppes Sharman M. , Tizard Ian
Published: February 2020

Objective

To obtain normative ocular data for Japanese quail as they mature from juveniles to adults.

Animals Studied

Twenty‐six captive Japanese quail comprising thirteen males and thirteen females, free of ocular disease, were included in the study.

Procedures

Ophthalmic reference values were measured in both eyes at 1 and 5 months of age. A complete ophthalmic examination was performed, including neuro‐ophthalmic reflexes, slit lamp biomicroscopy, phenol red thread test (PRTT), rebound tonometry, fluorescein staining, horizontal corneal diameter measurement, indirect ophthalmoscopy, and ocular ultrasound biometry. Ultrasound biomicroscopy measurements of axial globe length, lens thickness, vitreal chamber length, and pecten length were recorded. The depth of the anterior chamber was calculated by subtracting the lens thickness and vitreous length from the axial globe length. Measures of association and descriptive statistics were analyzed using STATA‐14 and STATA‐15.

Results

Juvenile and adult females were heavier than age‐matched males. Weight, intraocular pressure, horizontal corneal diameter, axial globe length, and lens thickness measurements increased with age. No statistically significant differences were found in the remainder of measurements among individuals in different sex or age‐groups.

Conclusions

This work provides reference values and clinical findings that can be used in future research on quail and ocular disease.
Volumetric mapping of the functional neuroanatomy of the respiratory network in the perfused brainstem preparation of rats
Authors: Dhingra Rishi R. , Dick Thomas E. , Furuya Werner I. , Galán Roberto F. , Dutschmann Mathias
Published: February 2020

Key points

The functional neuroanatomy of the mammalian respiratory network is far from being understood since experimental tools that measure neural activity across this brainstem‐wide circuit are lacking.

Here, we use silicon multi‐electrode arrays to record respiratory local field potentials (rLFPs) from 196–364 electrode sites within 8–10 mm3 of brainstem tissue in single arterially perfused brainstem preparations with respect to the ongoing respiratory motor pattern of inspiration (I), post‐inspiration (PI) and late‐expiration (E2).

rLFPs peaked specifically at the three respiratory phase transitions, E2–I, I–PI and PI–E2.

We show, for the first time, that only the I–PI transition engages a brainstem‐wide network, and that rLFPs during the PI–E2 transition identify a hitherto unknown role for the dorsal respiratory group.

Volumetric mapping of pontomedullary rLFPs in single preparations could become a reliable tool for assessing the functional neuroanatomy of the respiratory network in health and disease.

While it is widely accepted that inspiratory rhythm generation depends on the pre‐Bötzinger complex, the functional neuroanatomy of the neural circuits that generate expiration is debated. We hypothesized that the compartmental organization of the brainstem respiratory network is sufficient to generate macroscopic local field potentials (LFPs), and if so, respiratory (r) LFPs could be used to map the functional neuroanatomy of the respiratory network. We developed an approach using silicon multi‐electrode arrays to record spontaneous LFPs from hundreds of electrode sites in a volume of brainstem tissue while monitoring the respiratory motor pattern on phrenic and vagal nerves in the perfused brainstem preparation. Our results revealed the expression of rLFPs across the pontomedullary brainstem. rLFPs occurred specifically at the three transitions between respiratory phases: (1) from late expiration (E2) to inspiration (I), (2) from I to post‐inspiration (PI), and (3) from PI to E2. Thus, respiratory network activity was maximal at respiratory phase transitions. Spatially, the E2–I, and PI–E2 transitions were anatomically localized to the ventral and dorsal respiratory groups, respectively. In contrast, our data show, for the first time, that the generation of controlled expiration during the post‐inspiratory phase engages a distributed neuronal population within ventral, dorsal and pontine network compartments. A group‐wise independent component analysis demonstrated that all preparations exhibited rLFPs with a similar temporal structure and thus share a similar functional neuroanatomy. Thus, volumetric mapping of rLFPs could allow for the physiological assessment of global respiratory network organization in health and disease.
Leveraging National Laboratory Assets to Address Stability Challenges due to Declining Grid Inertia Using Geographically Distributed Electrical–Thermal Co-Emulation
Authors: Hovsapian R. , Panwar M. , Osorio J. D. , Mohanpurkar M. , Maloney D. J.
Published: February 2020

Due to increased penetration of low-inertia resources into the electric grid, challenges are increasing for maintaining wide-area system stability. Grid stability assessment requires a faithful representation of the multiple-physics interaction at the system level, and timescales of interaction varying in orders of magnitude, from microseconds to seconds to several minutes. Along with the simulation-based techniques, hardware-in-the-loop (HIL), controller HIL, and power HIL techniques have been developed to better understand the emergent behavior of the system with emerging technologies. US National Laboratories have played a vital role in research and development to understand the behavior of individual technologies and devices integrated to the electric grid. Each national laboratory forwards a technological and strategic initiative tied core and enabling capabilities. Due to strategic, efficiency, and economic reasons, not all the labs have assets to conduct research on all technologies concomitantly, so it becomes crucial to integrate the labs across geographies to understand the interplay of different technologies together at the system level. This approach avoids duplication of the assets at different lab facilities and helps understand the integrated system behavior of various technologies representative of actual grid conditions by connecting multiple national labs. This paper talks about techniques of connecting three national laboratories to enable co-emulation of electrical–mechanical–thermal characteristics of devices and systems. Such an approach can be used to understand the dynamic and transient interaction of multi-physics in a system level, at-scale emulation using real-time simulation tools and techniques.
Drivers of healthy eating in a workplace in Nepal: a qualitative study
Authors: Tamrakar Dipesh , Shrestha Archana , Rai Anjana , Karmacharya Biraj Man , Malik Vasanti , Mattei Josiemer , Spiegelman Donna
Published: February 2020

Objective

To explore the perceptions, enablers and barriers to employees’ healthy eating in a hospital site.

Design

A qualitative study including focus group discussion and in-depth interview, data were analysed using thematic analysis method.

Setting

The study was carried out among employees of Dhulikhel Hospital-Kathmandu University Hospital, located about 30 km east of Nepal's capital Kathmandu.

Participants

Focus group discussions were conducted among the 33 participants, who were divided into four groups: (a) support staff (drivers, cook, laundry, gardeners and ward boys), (b) hospital administrators and managers, (c) health personnel (doctors, nurses and assistants) who work 8–12 hours shifts and (d) health personnel who work during office hours. Nine in-depth interviews were conducted among six canteen operators and three managers.

Results

The major factors for promoting healthy eating were identified as the availability of affordable healthy food options in the cafeterias, a commitment to such promotion by the cafeteria manager, operators, staff and hospital administration and the level of education of the employees. The most commonly reported barriers for healthy eating were the unavailability of healthy options, including the lack of food supply from local market, the higher cost of healthy foods, individual food preferences and limited human resources in the cafeteria.

Conclusion

The availability of affordable healthy foods, supply of healthy foods from the market, commitment from cafeteria managers, hospital administrators and health awareness among cafeteria operators may promote healthy eating among employees in a Nepali hospital setting.
Experiences of health after dietary changes in endometriosis: a qualitative interview study
Authors: Vennberg Karlsson Jenny , Patel Harshida , Premberg Asa
Published: February 2020

Objectives

Endometriosis is a chronic disease with no known cure. Persons affected by this disease often use complementary therapies such as dietary changes to reduce their symptoms, and so it is important to investigate whether and how these therapies affect endometriosis symptoms. The aim of this study was to explore how persons with endometriosis experienced their health after dietary changes.

Design

Semi-structured qualitative interviews were conducted with 12 persons with endometriosis who had made individual dietary changes aimed at decreasing their endometriosis symptoms. The interviews were recorded and transcribed verbatim, and analysed using thematic analysis.

Setting

Region Västra Götaland and the estern part of Central Sweden, Sweden.

Participants

Twelve persons with endometriosis aged 28 to 44 were recruited from two Swedish endometriosis support forums on the Internet.

Results

Participants experienced an increase in well-being and a decrease in symptoms following their dietary and lifestyle changes. They also felt that the dietary changes led to increased energy levels and a deeper understanding of how they could affect their health by listening to their body’s reactions. The participants understood that they could influence their symptoms through lifestyle changes. Support from family and friends was important in implementing and sustaining the dietary changes. However, the participants stressed the lack of support from healthcare professionals.

Conclusions

This study contributes to filling the knowledge gap about dietary strategies in endometriosis and lifestyle change as a method of alleviating suffering and increasing well-being. An important finding is that the participants experienced decreased symptoms and increased well-being after adopting an individually-adapted diet. Healthcare professionals should take their patients’ knowledge and experience into consideration, and allow patients to participate in their own care. Further research is necessary to give evidenced-based dietary advices in endometriosis.
Enhancing primary care services for diverse sexual and gender minority populations: a developmental study protocol
Authors: Willging Cathleen , Kano Miria , Green Amy Elizabeth , Sturm Robert , Sklar Marisa , Davies Sonnie , Eckstrand Kristen
Published: February 2020

Introduction

Compared with heterosexual, cisgender populations, sexual and gender minority (SGM) people are more likely to suffer from serious health conditions and insufficient access to health services. Primary care is at the frontlines of healthcare delivery; yet, few clinics have resources or mechanisms in place to meet SGM patient needs. This developmental study protocol focuses on reducing health disparities among SGM patients by identifying, adapting and developing SGM practice guidelines/recommendations and implementation strategies for primary care clinics in urban and rural New Mexico. Using input from patients, healthcare advocates and providers, and researchers, the study will pilot a practice parameter and implementation toolkit to promote SGM-specific cultural competence at multiple service delivery levels.

Methods and analysis

We will recruit providers/staff from four Federally Qualified Health Centers (FQHCs) serving ethnically and geographically diverse communities. Incorporating the Implementation of Change Model and an intersectionality perspective, data collection includes a systematic review of SGM-specific practice guidelines/recommendations, focus groups and semistructured interviews, quantitative surveys and the Nominal Group Technique (NGT) with providers/staff. We will categorise guidelines/recommendations identified through the review by shared elements, use iterative processes of open and focused coding to analyse qualitative data from focus groups, interviews and the NGT, and apply descriptive statistics to assess survey data. Findings will provide the foundation for the toolkit. Focus groups with SGM patients will yield supplemental information for toolkit refinement. To investigate changes in primary care contexts following the toolkit’s pilot, we will undertake systematic walkthroughs and document review at the FQHCs, analysing these data qualitatively to examine SGM inclusiveness. The structured data-informed Plan-Do-Study-Act method will enable further revision of the toolkit. Finally, focus groups, interviews and quantitative surveys with providers/staff will highlight changes made in the FQHCs to address SGM patient needs, barriers to sustainment of changes, satisfaction, acceptability, usability and feasibility of the toolkit.

Ethics and dissemination

The study has been reviewed and approved by the Pacific Institute for Research and Evaluation Institutional Review Board. Informed consent will be obtained from all participants before their involvement in research activities begins. Study results will be actively disseminated through peer-reviewed journals, conference presentations, social media and the internet, and community/stakeholder engagement activities.