bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Radiographic Union Score for Hip Is Predictive of Femoral Neck Fracture Complications Within 2 Years
Authors: Bernaus Martí , Slobogean Gerard P. , Bzovsky Sofia , Heels-Ansdell Diane , Zhou Qi , Bhandari Mohit , Swiontkowski Marc , Sprague Sheila ,   on behalf of the FAITH Investigators
Published: December 2019

Objectives:

To determine if the Radiographic Union Score for Hip (RUSH) measured at 3 and 6 months after femoral neck fracture were predictive of reoperation for infection, nonunion, delayed union, avascular necrosis, or implant failure within 24 months of initial surgery.

Design:

Secondary analysis of a randomized controlled trial. Logistic regression was performed to investigate associations between lower RUSH and reoperation. Results were reported as odds ratios (OR), 95% confidence intervals (CIs), and associated P values. All tests were 2 tailed with alpha = 0.05.

Setting:

Eighty-one clinical sites across 8 countries.

Patients/Participants:

Data from 734 of the clinical trial participants with radiographs at 3 and 6 months after fracture fixation were included.

Intervention:

A reviewer blinded to patients' outcomes independently assigned a RUSH at each follow-up time point.

Main Outcome Measures:

Revision surgery rate related to intervention.

Results:

Lower RUSH at 3 and 6 months were associated with increased odds of reoperation within 24 months of fracture fixation. For every 2-point decrease in RUSH at 3 months, there was a 16% increase in the odds of a patient experiencing a re-operation (OR, 1.16; 95% CI, 1.10–1.22; P < 0.0001). A similar association was observed at the 6-month assessment for every 2-point decrease (OR = 1.05; 95% CI, 1.01–1.09; P = 0.005).

Conclusions:

Decreased radiographic healing as early as 3 months post fracture fixation is associated with developing patient important femoral neck fracture reoperations. This relationship may guide early treatment decisions, suggesting that 3- and 6-month RUSH are a useful surrogate measure of reoperations within 24 months of fracture fixation.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
The Transverse Gravitational Deviation Index, a Novel Gravity Line-Related Spinal Parameter, Relates to Balance Control and Health-Related Quality of Life in Adults With Spinal Deformity
Authors: Moke Lieven , Overbergh Thomas , Severijns Pieter , Schelfaut Sebastiaan , Moens Pierre , Van de loock Kristel , Hermans Lore , Molenaers Guy , Jonkers Ilse , Scheys Lennart
Published: December 2019

Study Design.

Prospective cross-sectional case-control study design.

Objective.

This study aims to analyze the relation between balance control as well as health-related quality of life (HRQOL) in patients with adult spinal deformity (ASD), with a novel gravity line (GL)-related 3D spinal alignment parameter, the transverse gravitational deviation index (TGDI), defined to quantify the transverse plane position of any vertebra with respect to the GL.

Summary of Background Data.

Demographic data and balance control have both been identified as important determinants of HRQOL in ASD patients during a preoperative setting. Therefore, a better understanding of the relation between spinal alignment and balance is required.

Methods.

After informed consent, 15 asymptomatic healthy volunteers (mean age 60.1 ± 11.6 years old) and 55 ASD patients (mean age 63.5 ± 10.1 years old) were included. Relation between performance on BESTest as well as core outcome measures index (COMI) with spinopelvic alignment was explored using General Linear Modeling (GLM). A P-value ≤0.05 was considered statistically significant.

Results.

The L3 TGDI was identified to relate to balance control in the total ASD population after correction for confounding demographic factors (P = 0.001; adjusted R
2 = 0.500) and explained 19% of the observed variance in balance performance. In addition, COMI is related to L3 TGDI in a subgroup of ASD patients with combined coronal and sagittal malalignment of L3 (P = 0.027; slope B = 0.047), despite significant influence of age (P = 0.020).

Conclusion.

In ASD patients with a combined coronal and sagittal malalignment of the L3 vertebra, both the level of balance impairment as well as HRQOL are related to the distance component of the L3 TGDI, that is, the offset between the center of the L3 vertebral body and the GL in the transverse plane.

Level of Evidence: 2
Targeted Temperature Management at 33 Versus 36 Degrees: A Retrospective Cohort Study
Authors: Johnson Nicholas J. , Danielson Kyle R. , Counts Catherine R. , Ruark Katelyn , Scruggs Sue , Hough Catherine L. , Maynard Charles , Sayre Michael R. , Carlbom David J.
Published: December 2019

Objectives:

To determine the association between targeted temperature management goal temperature of 33°C versus 36°C and neurologic outcome after out-of-hospital cardiac arrest.

Design:

This was a retrospective, before-and-after, cohort study.

Setting:

Urban, academic, level 1 trauma center from 2010 to 2017.

Patients:

Adults with nontraumatic out-of-hospital cardiac arrest who received targeted temperature management.

Interventions:

Our primary exposure was targeted temperature management goal temperature, which was changed from 33°C to 36°C in April of 2014 at the study hospital. Primary outcome was neurologically intact survival to discharge. Secondary outcomes included hospital mortality and care processes.

Measurements and Main Results:

Of 782 out-of-hospital cardiac arrest patients transported to the study hospital, 453 (58%) received targeted temperature management. Of these, 258 (57%) were treated during the 33°C period (targeted temperature management 33°C) and 195 (43%) were treated during the 36°C period (targeted temperature management 36°C). Patients treated during targeted temperature management 33°C were older (57 vs 52 yr; p < 0.05) and had more arrests of cardiac etiology (45% vs 35%; p < 0.05), but otherwise had similar baseline characteristics, including initial cardiac rhythm. A total of 40% of patients treated during targeted temperature management 33°C survived with favorable neurologic outcome, compared with 30% in the targeted temperature management 36°C group (p < 0.05). After adjustment for demographic and cardiac arrest characteristics, targeted temperature management 33°C was associated with increased odds of neurologically intact survival to discharge (odds ratio, 1.79; 95% CI, 1.09–2.94). Targeted temperature management 33°C was not associated with significantly improved hospital mortality. Targeted temperature management was implemented faster (1.9 vs 3.5 hr from 911 call; p < 0.001) and more frequently in the emergency department during the targeted temperature management 33°C period (87% vs 55%; p < 0.001).

Conclusions:

Comatose, adult out-of-hospital cardiac arrest patients treated during the targeted temperature management 33°C period had higher odds of neurologically intact survival to hospital discharge compared with those treated during the targeted temperature management 36°C period. There was no significant difference in hospital mortality.
A Faith-Based Intervention to Improve Hypertension Management Among African Americans
Authors: Harvin Lori A. , Winter Dorothea M. , Hoover Evelyn L. , Lewis Lisa M.
Published: December 2019

High mortality rates continue among African Americans related to complications of uncontrolled hypertension. The purpose of this study was to determine if a faith-based self-management education program would improve self-care activities related to the management of hypertension among African American adults. Ten African American adults who reported a diagnosis of hypertension for 6 months or longer completed an 8-week education program focused on strategies for hypertension management. The education program was enhanced with the utilization of spiritual components of prayer, Scripture reading, and journaling.
When Partners Turn Violent
Authors: McCarthy Jessica , Stagg Denise
Published: December 2019

Intimate partner violence (IPV) occurs across all cultures, ethnicities, socioeconomic classes, and educational backgrounds. Nurses should be aware of IPV and causative factors that include personal attributes, stressors, and community issues. The Intimate Partner Exposome conceptual model is used to identify exogenous and endogenous IPV risk factors. In addition, distinctive environmental factors can increase risk for IPV. The purpose of this article is to increase recognition of causative factors and presenting signs to enhance the nurse's ability to identify and assist IPV victims.
Living with Crohn's
Authors: Jefferson Khará
Published: December 2019

The lifelong, chronic nature of Crohn's disease produces incessant stress that affects individuals physically, emotionally, and socially. Coping with the symptoms and treatment is improved when persons engage their faith and spiritual resources. Clear understanding of the physical and emotional aspects of Crohn's can support a person's ability to manage the disease. Knowledge of emerging treatments also provides nurses with hopeful input to share with their patients.
Reliability of Periocular Anthropometry: A Comparison of Direct, 2-Dimensional, and 3-Dimensional Techniques
Authors: Guo Yongwei , Hou Xiaoyi , Rokohl Alexander C. , Jia Renbing , Heindl Ludwig M.
Published: December 2019

BACKGROUND

Three-dimensional (3D) imaging has become increasingly popular in aesthetic surgery. However, few studies have emphasized its application in the periocular region.

OBJECTIVE

To provide evidence supporting the reliability of generalizing periocular measurements obtained using caliper-derived direct anthropometry and 2-dimensional (2D) photogrammetry to 3D stereophotogrammetry.

MATERIALS AND METHODS

Periocular surfaces were captured using a stereophotogrammetry system for 46 normal Caucasian individuals. Twenty-two periocular variables were directly, 2-dimensionally, and 3-dimensionally measured. Reliability of these measurements was evaluated and compared with each other.

RESULTS

The results revealed that, for direct (intra-rater reliability only), 2D, and 3D anthropometry, overall intra-rater and inter-rater intraclass correlation coefficient estimates were 0.88, 0.99 and 0.97, and 0.98 and 0.92, respectively; mean absolute differences were 0.84 mm, 0.26 and 0.36 units, and 0.35 and 0.67 units, respectively; technical error of measurement (TEM) estimates were 0.85 mm, 0.25 and 0.36 units, and 0.32 and 0.65 units, respectively; relative error measurement estimates were 6.46%, 1.69% and 2.74%, and 1.67% and 5.11%, respectively; and relative TEM estimates were 6.25%, 1.62% and 2.78%, and 2.12% and 5.12%, respectively.

CONCLUSION

Stereophotogrammetry and the authors' landmark location protocol yield very good reliability for a series of 2D and 3D measurements.
Therapeutic Drug Monitoring-Guided Crushed Sofosbuvir-Velpatasvir Treatment: A Case Study
Authors: Lalanne Sébastien , Jézéquel Caroline , Tron Camille , Verdier Marie-Clémence , Mercerolle Marion , Pronier Charlotte , Guyader Dominique , Lemaitre Florian
Published: December 2019

In this study, the authors report the case of a patient diagnosed with hepatitis C virus who was treated with sofosbuvir–velpatasvir (400/100 mg). As the patient was unable to swallow whole tablets, therapeutic drug monitoring was performed to evaluate the effect of crushing sofosbuvir–velpatasvir tablets on drug absorption and global exposure.
Identification of cardiac organ damage in arterial hypertension: insights by echocardiography for a comprehensive assessment
Authors: Cameli Matteo , Lembo Maria , Sciaccaluga Carlotta , Bandera Francesco , Ciccone Marco M. , D’Andrea Antonello , D’Ascenzi Flavio , Esposito Roberta , Evola Vincenzo , Liga Riccardo , Mandoli Giulia E. , Palmiero Pasquale , Santoro Ciro , Scicchitano Pietro , Sorrentino Regina , Zito Annapaola , Pedrinelli Roberto , Mondillo Sergio , Mattioli Anna V. , Galderisi Maurizio
Published: December 2019

Arterial hypertension, a widespread disease, whose prevalence increases with age, represents a major risk factor for cardiovascular events, causing damage in several organs, including the heart. In this context, echocardiography has a clear and pivotal role, being able to assess cardiac morphology and detect haemodynamic changes induced by this disease. 2018 European Society of Cardiology/European Society of Hypertension guidelines on AH identified main echo parameters such as left ventricular mass, relative wall thickness and left atrial volume, for detecting cardiac organ damage. The present review highlights the advantage of additional echocardiographic parameters such as diastolic measurement and both thoracic and abdominal aortic dimensions. An overlook on aortic valve should also be suggested to detect aortic regurgitation and stenosis, both frequent complications in hypertensive patients. In this kind of comprehensive assessment, the combination of standard and advanced echocardiography (speckle tracking echocardiography and, with a lesser extent, three-dimensional echocardiography) could be considered to improve the diagnostic accuracy, stratify prognosis and address management in arterial hypertension.
The Microbiome of the Nasolacrimal System and Its Role in Nasolacrimal Duct Obstruction
Authors: Curragh David Stephen , Bassiouni Ahmed , Macias-Valle Luis , Vreugde Sarah , Wormald Peter-John , Selva Dinesh , Psaltis Alkis James
Published: December 2019

The authors have demonstrated a decreased relative abundance of Corynebacterium at the middle meatus of patients with ipsilateral nasolacrimal duct obstruction (NLDO), compared with controls, and that the lacrimal sac microbiome is similar to the sinonasal microbiome. An altered microbial state may, therefore, be associated with NLDO, either as a consequence or a risk factor, and merits future research.

Purpose:

Acquired nasolacrimal duct obstruction (NLDO) is a common problem leading to epiphora, the pathophysiology of which remains unclear. Culture-based studies have found Staphylococcal species to be the most prevalent organisms, reported in 47% to 73% of patients with NLDO. Recently, culture-independent molecular methods of have allowed more comprehensive detailing of local microbiota. This study aims to evaluate the sinonasal and lacrimal microbiome of patients undergoing dacryocystorhinostomy for NLDO using 16S-amplicon sequencing.

Methods:

Guarded intraoperative swabs were taken from the middle meatus (MM), inferior meatus, and the opened lacrimal sac of 14 NLDO patients undergoing dacryocystorhinostomy and from the inferior meatus and MM on the contralateral unaffected side. MM swabs from 12 control patients were compared with NLDO patients.

Results:

Comparing microbiota at lacrimal sac to MM and inferior meatus sites reveals that the lacrimal sac microbiome is dominated by Staphylococci (36.3%) and Corynebacterium (35.8%). No significant genus differential abundance between the 3 sites, and between the ipsilateral and contralateral sinonasal swabs, and no convincing evidence of reduced alpha diversity in all comparisons. There was a statistically significant lower relative abundance of Corynebacterium (37.6% vs. 65.1%; p = 0.035) in the MM of NLDO patients compared with controls.

Conclusions:

The lacrimal sac microbiome in acquired NLDO is similar to the sinonasal microbiome. The relative abundance of Corynebacterium was reduced compared with controls. These findings suggest that an altered sinonasal microbiome may be associated with NLDO, either as a consequence or a risk factor, and merits future research.
Epibulbar Osseous Choristoma: A Rare Find in the Superior Conjunctival Tarsal Plate of the Upper Eyelid
Authors: Chan Sarah , Stewart Christopher M.
Published: December 2019

A 37-year-old male was found to have a firm yellowy-white palpable mass embedded within the conjunctival surface of the tarsal plate of the left upper eyelid. This was asymptomatic and noted on a routine examination for contralateral epiphora. An excisional biopsy was performed and a “rock-like nodule” was removed with histopathology confirming the presence of mature bone. While the literature describes these lesions located in other aspects of the orbit, this is the first described case of an epibulbar osseous choristoma located in the tarsal plate of the upper eyelid.
CircularRNA as novel biomarkers in liver diseases
Authors: Chien Yueh , Tsai Ping-Hsing , Lai Ying-Hsiu , Lu Kai-Hsi , Liu Chao-Yu , Lin Heng-Fu , Huang Chi-Shuan , Wu Wai-Wah , Wang Chien-Ying
Published: December 2019

The liver is an essential organ that is primarily responsible for digestion and eliminating toxic substances from the body. After the industrial revolution, Western diet and lifestyle changes have increased the incidence of several liver diseases, including non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), liver cirrhosis, and hepatocellular carcinoma (HCC). NAFLD and NASH are mostly asymptomatic at early stages, and the disease progression from NAFLD to life-threatening HCC remains not fully understood. Circular RNA (circRNA) is consist of a circular structure, and the circRNA-microRNA(miRNA)-mRNA axes have been shown to be involved in several cellular events, including apoptosis, vascularization, metastasis, etc. The highly stable structure of circRNAs has enabled themselves to be used as putative biomarkers of several diseases. Here, we conducted a literature review and discussed the identified roles of circRNAs in NAFLD, NASH, liver cirrhosis, and HCC. For example, deficiency of circRNA_0046366 and circRNA_0046367 has been shown as the characteristics of NAFLD, and restoration of these circRNAs ameliorates the oxidative stress, lipotoxicity, and disease severity in NAFLD. Silencing of circ_0071410 was shown to alleviate hepatic stellate activation, the key step of liver cirrhosis. CDR1 and circ_0067934 can facilitate the invasion and metastasis of HCC, while circMTO1 negatively regulates the progression of HCC. Although several research works have been conducted, the whole picture of circRNA-related underlying mechanisms is unclear. Future works using high-throughput bioinformatic approaches will be needed to delineate the role of circRNAs in liver diseases and to further develop novel diagnostics and therapeutics.
Standardizing Multidisciplinary Rounds
Authors: Brown Lauren , Saini Virender , Carter Chris
Published: December 2019

OBJECTIVE

To describe the impact of a standardized rounding process on rounding time and multidisciplinary member attendance.

BACKGROUND

Rounding efficiency and effectiveness are often compromised by lack of standardization of important elements including start time and location, the attendance of multidisciplinary representatives, patient presentation highlights, and physician workflow. In 2017, the study authors noted inefficiencies and process failures in multidisciplinary rounds within our ICU.

METHODS

We conducted a retrospective review of rounding data before and after the implementation of a simplified and streamlined rounding template for ICU nurses and measures to standardize rounding processes and attendance.

RESULTS

Rounding time was decreased by 25% in postimplementation phase. Additionally, attendance of respiratory therapists, clinical dietitians, and case managers improved.

CONCLUSIONS

We suggest the piloting of these strategies in other ICUs that experience similar inefficiencies and process failures during multidisciplinary rounds.
Exploring the Relationship Between Patient Falls and Levels of Nursing Education and Certification
Authors: Coto Jeffrey A. , Wilder Coleen R. , Wynn Leanna , Ballard Maria C. , Webel Daniel , Petkunas Heather
Published: December 2019

OBJECTIVE

To examine if increasing the percentage of nurses with bachelor degrees (BSNs) and/or certified nurses leads to improved patient outcomes, specifically the number of reported falls.

BACKGROUND

Research suggests a link between higher levels of education and expertise and positive patient outcomes, including falls. The Institute of Medicine recommends an increase in BSN nurses.

METHODS

This was a retrospective cross-sectional cohort analysis using data from the National Database of Nursing Quality Indicators from 2010 to 2016 from multiple medical centers in Central and Southern Illinois.

RESULTS

With every 1-unit increase in the percentage of BSN nurses or certified nurses, a reduction in total patient falls per 1000 patient-days can be expected in the amount of 0.02 to 0.04 and 0.01 to 0.03, respectively, all else held constant.

CONCLUSIONS

Improvements to patient outcomes may be optimized with increased percentages of nurses with bachelor degrees and/or certifications.
Effectiveness of Elastic Taping in Patients With Knee Osteoarthritis
Authors: Ye Wenwen , Jia Chengsen , Jiang Junliang , Liang Qiu , He Chengqi
Published: December 2019

Objective

The aim of the study was to assess the effects of elastic taping on pain, physical function, range of motion, and muscle strength in patients with knee osteoarthritis.

Design

We searched the PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Physiotherapy Evidence Database, Scopus, EMBASE, OVID, CNKI, and WANFANG to identify relevant randomized controlled trials. The primary outcome measures were pain and physical function. The secondary outcome measures were range of motion and muscle strength.

Results

Eleven randomized controlled trials involving 490 patients with knee osteoarthritis were included. A statistically significant difference was detected in pain (standardized mean difference = −0.78, 95% confidence interval = 1.07 to −0.50, P < 0.00001), physical function (standardized mean difference = 0.73, 95% confidence interval = −1.03 to −0.43, P < 0.00001), range of motion (mean difference = 2.04, 95% confidence interval = 0.14 to 3.94, P = 0.04), and quadriceps muscle strength (mean difference = 2.42, 95% confidence interval = 1.09 to 3.74, P = 0.0004). No significant differences were found for the hamstring muscle strength.

Conclusions

Elastic taping has significant effects on pain, physical function, range of motion, and quadriceps muscle strength in patients with knee osteoarthritis. The current evidence is insufficient to draw conclusions on the effects of elastic taping combined with other physiotherapy for knee osteoarthritis. Further studies are needed to investigate the long-term effects of elastic taping combined with other physiotherapy compared with elastic taping alone for knee osteoarthritis.
Effects of Home Exercises on Shoulder Pain and Pathology in Chronic Spinal Cord Injury
Authors: Cardenas Diana D. , Felix Elizabeth R. , Cowan Rachel , Orell Melanie F. , Irwin Robert
Published: December 2019

Objective

The aims of this study were to replicate findings that a home exercise program intervention improved shoulder pain and function and to assess changes in supraspinatus tendon pathology associated with the home exercise program in persons with chronic spinal cord injury.

Design

The study is a single-blind randomized controlled trial. Individuals with spinal cord injury of at least 1 yr and chronic shoulder pain of moderate or greater average intensity were enrolled. Participants were randomized to a 12-wk home exercise program consisting of strengthening and stretching exercises or to an education-only control group, with immediate postintervention and 4-wk postintervention (16 wks) follow-ups. The main outcome measures were self-report measures of shoulder pain and impairment, the Physical Examination of the Shoulder Scale, quantitative ultrasound metrics of the supraspinatus tendon, and the Ultrasound Shoulder Pathology Rating Scale.

Results

Thirty-two participants were randomized to home exercise program or education-only control condition. The mean ± SD age was 44.8 ± 12.5; 81.3% were male; 65.6% had motor complete paraplegia. Using a per-protocol, within-group analysis method, significant differences were observed between baseline and postintervention for the home exercise program group for the least pain intensity (P = 0.02), number of days with shoulder pain (P = 0.042), Physical Examination of the Shoulder Scale scores (dominant side, P = 0.036; nondominant side, P = 0.008), the Disabilities of the Arm, Shoulder, and Hand (P = 0.028), and the Patient Global Impression of Change (P = 0.015). The education-only control condition group demonstrated significant changes in average unpleasantness of shoulder pain after the intervention period (P = 0.049). Comparisons in changes from baseline between groups showed that the home exercise program group had greater improvements in nondominant-side Physical Examination of the Shoulder Scale scores and global impression of change, whereas the education-only control condition group had greater improvements in depressive symptoms.

For quantitative ultrasound measures, no significant changes were found with within-group analyses for the home exercise program group, although the education-only control condition group demonstrated a decrease in tendon width in the nondominant-side supraspinatus tendon (P = 0.036). Comparison of changes between groups suggests that the education-only control condition group had a greater increase in dominant shoulder supraspinatus tendon ultrasound contrast at the end of the study.

Conclusions

Changes in several measures of shoulder pain and function occurred after the home exercise program intervention, although the magnitude of changes was only significantly greater than those of the education-only control condition group for two measures. Significant changes in supraspinatus pathology were not detected with quantitative ultrasound metrics.
The Impact of Concurrent Antiretroviral Therapy and MDR-TB Treatment on Adverse Events
Authors: Smith Jonathan P. , Gandhi Neel R. , Shah N. Sarita , Mlisana Koleka , Moodley Pravi , Johnson Brent A. , Allana Salim , Campbell Angela , Nelson Kristin N. , Master Iqbal , Brust James C.M.
Published: December 2019

Background:

South Africa has among the highest incidence of multidrug-resistant tuberculosis (MDR-TB) and more than 70% of patients are HIV co-infected. MDR-TB treatment is associated with frequent adverse events (AEs). Although guidelines recommend concurrent treatment of MDR-TB and HIV, safety data on concurrent therapy are limited.

Methods:

We conducted a prospective observational study of MDR-TB patients with and without HIV-coinfection in South Africa between 2011 and 2015. Participants received standardized MDR-TB and HIV regimens. Participants were followed monthly for the duration of MDR-TB therapy and screened for clinical and laboratory AEs. Audiometry was performed monthly during the intensive phase; color discrimination testing was performed every 2 months.

Results:

We enrolled 150 HIV-infected and 56 HIV-uninfected participants. Nearly all experienced at least one clinical (93%) or laboratory (96%) AE. The most common clinical AEs were peripheral neuropathy (50%) and difficulty sleeping (48%); the most common laboratory AEs were hypokalemia (47%) and decreased creatinine clearance (46%). Among 19 clinical and lab AEs examined, there were no differences by HIV status, except for diarrhea (27% HIV-infected vs. 13% HIV-uninfected, P = 0.03). Hearing loss was experienced by 72% of participants (8% severe loss). Fourteen percent experienced color discrimination loss (4% severe loss). There were no differences in frequency or severity of hearing or vision loss by HIV status.

Conclusions:

AEs were common, but not more frequent or severe among MDR-TB/HIV co-infected participants receiving concurrent antiretroviral therapy. Given the favorable treatment outcomes associated with concurrent treatment, antiretroviral therapy initiation should not be delayed in MDR-TB patients with HIV-coinfection.
High-Fidelity Patient Simulation Increases Saudi Dietetics Students' Self-efficacy in Applying the Nutrition Care Process
Authors: Alkhaldy Areej A. , Mosli Rana H.
Published: December 2019

In this repeated-measures pre/postintervention study, we evaluated the effect of high-fidelity patient simulation-based learning (HPSL) on dietetics students' self-efficacy in applying the nutrition care process. Furthermore, we assessed their perceptions, attitudes, satisfaction, and self-confidence toward HPSL. Forty-one Saudi dietetics undergraduates participated in an HPSL exercise involving a newly diagnosed diabetic ketoacidosis case. We found that the students' self-efficacy score in applying the nutrition care process significantly increased (P = .01) following the intervention, from 3.0 (interquartile range [IQR] = 2.4-3.2) to 3.2 (IQR = 2.8-3.5), and participants reported overall positive attitudes toward HPSL, including enhanced perceived benefits to communication skills.
Atrial fibrillation and stroke: how much atrial fibrillation is enough to cause a stroke?
Authors: Healey Jeff S. , Amit Guy , Field Thalia S.
Published: December 2019

Purpose of review

The association between atrial fibrillation and stroke is firmly established, and anticoagulation reduces stroke risk in patients with atrial fibrillation. However, the role of anticoagulation in very brief durations of atrial fibrillation (subclinical atrial fibrillation) is an area of controversy.

Recent findings

Stroke risk increases alongside burden of atrial fibrillation. Ongoing trials will clarify if 24 h or less of atrial fibrillation on extended monitoring necessitates lifelong anticoagulation. Trials examining empiric anticoagulation for individuals with ESUS did not demonstrate benefit over antiplatelet agents. However, hypothesis-generating sub-analyses suggest that certain at-risk groups may benefit. Atrial cardiopathy is associated with subclinical atrial fibrillation and research examining anticoagulation after ESUS in this population is underway.

Stroke risk increases alongside burden of ectopic atrial activity. However, this risk may in part be because of prothrombotic dysfunction associated with atrial cardiopathy in addition to the arrhythmia itself. The minimal amount of subclinical atrial fibrillation to warrant anticoagulation for stroke prevention, and how this may be modified by the total duration of monitoring, will be clarified by the results of ongoing clinical trials. Currently research will also help identify whether a select group of ESUS patients who have structural and electrophysiological markers of atrial cardiopathy warrant anticoagulation for secondary prevention.
Current opinion neurology: visual pathway biomarkers in Alzheimer's disease
Authors: Van Stavern Gregory P.
Published: December 2019

Purpose of review

The incidence of Alzheimer's disease is increasing. Premortem diagnosis of Alzheimer's disease is now possible but require invasive and expensive testing such as PET amyloid beta binding and/or spinal fluid amyloid beta levels. There is a great need for minimally invasive and inexpensive biomarkers to allow for early diagnosis and intervention.

Recent findings

There has been a large volume of literature assessing ocular biomarkers for Alzheimer's disease. Much of the research to date has significant limitations, including sample size, variable diagnostic criteria for Alzheimer's disease, lack of biomarker assessment, and focus on patients with well established dementia. Work that is more recent has included individuals with early and preclinical Alzheimer's disease with biomarkers included in the design. These studies have shown consistent features of visual pathway involvement in Alzheimer's disease, even in the earliest and preclinical stages.

It is possible that in the future, ocular biomarkers (particularly retinal imaging techniques) may be part of a multimodality alogorithm screening for preclinical Alzheimer's disease, perhaps combined with other methods, such as blood-based biomarkers.
Glycomyces buryatensis sp. nov., an actinobacterium isolated from steppe soil
Authors: Nikitina Elena , Liu Shao-Wei , Li Fei-Na , Buyantueva Lyubov , Abidueva Elena , Sun Cheng-Hang
Published: December 2019

A novel actinobacterial strain, designated 18T, was isolated from a steppe soil sample collected in Buryatia, Russia and subjected to polyphasic taxonomic characterization. The strain was aerobic and Gram-stain-positive. The 16S rRNA gene sequence of strain 18T exhibited highest similarity to

Glycomyces paridis

CPCC 204357T (97.2 %). Results of phylogenetic analysis showed that strain 18T formed a distinct branch clearly affiliated to the genus

Glycomyces

. Whole-cell hydrolysates of the isolate contained meso-diaminopimelic acid as the cell-wall diamino acid. The whole-cell sugar profile was found to contain galactose, glucose, ribose and xylose. MK-10(H4) and MK-11(H4) were the predominant menaquinones. The polar lipid profile consisted of diphosphatidylglycerol, phosphatidylglycerol, five unidentified phospholipids and four unidentified polar lipids. The major fatty acids identified were anteiso-C15 : 0 and iso-C15 : 0. The G+C content of the genomic DNA of strain 18T was 68.0 mol% (draft genome sequence). Based on its phylogenetic, phenotypic and chemotaxonomic features, strain 18T was considered to represent a novel species of the genus

Glycomyces

, for which the name Glycomyces buryatensis sp. nov. is proposed. The type strain of Glycomyces buryatensis is 18T (=JCM 33362T=CGMCC 4.7610T).
Utilization of Family Planning and Associated Factors among Reproductive Age Women with Disability in Arba Minch Town, Southern Ethiopia
Authors: Yesgat Yibeltal Mesfin , G/Meskel Feleke , Estifanous Wubshet , Gizachew Yordanos , Jemal Seid , Atnafu Natneal , Nuriye Keyirden
Published: December 2019

Introduction

globally, one type of contraceptive was used by around 63 percent of women. Women with disabilities account for 10 percent of all women and make up three-quarters of the disabled people in low and middle-income countries.

Objective

to assess utilization of family planning and associated factors among reproductive-age women with disability group in Arba Minch town, southern Ethiopia from 1st March to April 15, 2019.

Methods

community-based cross-sectional study with simple random sampling was used to select 4l8 reproductive age women with disabilities. Data were collected using a structured questionnaire and interview by eight trained females who completed grade twelve two of which communicate by speaking and sign language. Data were entered using Epi info 7 and exported to SPSS version 20 for analysis. A statically significant variable in the final model was declared by AOR, 95%CI and p-value <0.05.

Result

in the current study family planning utilization among all reproductive-age women with disabilities was 33.7%. Family planning utilization was 2.2 times higher among those who have employed compared with those with not employed (AOR2.2 95% CI, 1.77-4.15). Women who had a positive attitude were 2.3 times more likely to use family planning than negative attitudes (AOR 2.3:95% CI, 1.21- 3.87). Besides these women who got married were almost four times more likely to use family planning methods than unmarried (AOR 3.9:95% CI, 2.31-6.63).

Conclusion

The level of family planning utilization was low among reproductive women with disabilities and factors associated were attitude, marital status, & employed status, therefore governmental and non-governmental organization should promote for women with disabilities to change the attitude and creating job opportunities.
DrivAER: Identification of driving transcriptional programs in single-cell RNA sequencing data
Authors: Simon Lukas M. , Yan Fangfang , Zhao Zhongming
Published: December 2019

Single cell RNA sequencing (scRNA-seq) unfolds complex transcriptomic data sets into detailed cellular maps. Despite recent success, there is a pressing need for specialized methods tailored towards the functional interpretation of these cellular maps. Here, we present DrivAER, a machine learning approach that scores annotated gene sets based on their relevance to user-specified outcomes such as pseudotemporal ordering or disease status. We demonstrate that DrivAER extracts the key driving pathways and transcription factors that regulate complex biological processes from scRNA-seq data.
Mitral valve leaflet response to ischemic mitral regurgitation: From gene expression to tissue remodeling
Authors: Howsmon Daniel P. , Rego Bruno V. , Castillero Estibaliz , Ayoub Salma , Khalighi Amir H. , Gorman Robert C. , Gorman Joseph H. , Ferrari Giovanni , Sacks Michael S.
Published: December 2019

Aims

Ischemic mitral regurgitation is frequently observed following myocardial infarction and is associated with higher mortality and poor clinical prognosis if left untreated. Accumulating evidence suggests that mitral valve leaflets actively remodel post–myocardial infarction, yet the cellular mechanisms underlying these responses and how this affects tissue function remain largely unknown. We sought to elucidate mitral valve remodeling post myocardial infarction at the tissue, cellular, and transcriptomic levels.

Methods and Results

The mechanical behavior of ovine mitral valve leaflets pre– and 8 weeks post– myocardial infarction reveal a significant decrease in radial direction extensibility, which essentially eliminated the mechanical anisotropy typically observed in healthy mitral valves. Quantitative histology and ultrastructural assessment by transmission electron microscopy revealed altered leaflet composition and architecture at 8 weeks post–myocardial infarction. Assessment of the mitral valve interstitial cell nuclear aspect ratio, a metric of cellular deformation, revealed that they were on average rounder following myocardial infarction. RNA sequencing indicated that YAP-induced genes were elevated at 4 weeks post–myocardial infarction and genes related to extracellular matrix organization were some of the most downregulated in sheep with IMR compared to sheep without ischemic mitral regurgitation at 4 weeks post–myocardial infarction. Additionally, RNA sequencing revealed the possible recruitment of immune cells in this remodeling process due to the drastic elevation of CXCL9 and CLEC10A.

Conclusions

Our multiscale assessment revealed significant mechanical and microstructural changes due to myocardial infarction. RNA sequencing provided a baseline for global gene expression changes in response to myocardial infarction with and without ischemic mitral regurgitation and suggests YAP-induced mechanotransduction, altered expression of extracellular matrix–related genes, and recruitment of immune cells as mechanisms contributing to altered mitral valve biomechanics post–myocardial infarction.
Changes in subjective preference do not require dopamine signaling or the orbital frontal cortex
Authors: Lefner Merridee J. , Magnon Alexa P. , Gutierrez James M. , Lopez Matthew R. , Wanat Matthew J.
Published: December 2019

‘Sunk’ or unrecoverable costs impact proximal reward-based decisions across species. However, it is not known if these incurred costs elicit a long-lasting change in reward value. To address this, we identified the relative preference between different flavored food pellets in rats. Animals were then trained to experience the initially preferred reward after short delays and the initially less preferred reward after long delays. This training regimen enhanced the preference for the initially less desirable food reward. We probed whether this change in subjective preference involved dopamine signaling or the orbital frontal cortex (OFC) given that these neural systems contribute to reward valuation. Systemic dopamine receptor antagonism attenuated anticipatory responding during training sessions but did not prevent the change in reward preference elicited by incurred temporal costs. OFC lesions had no effect on anticipatory responding during training or on the change in reward preference. These findings collectively illustrate that the neural systems involved with economic assessments of reward value are not contributing to changes in subjective preference.
Enhanced post-traumatic headache-like behaviors and diminished contribution of peripheral CGRP in female rats following a mild closed head injury
Authors: Bree Dara , Mackenzie Kimberly , Stratton Jennifer , Levy Dan
Published: December 2019

Introduction

Females are thought to have increased risk of developing posttraumatic headache (PTH) following a traumatic head injury, or concussion. However, the processes underlying this susceptibility remain unclear. We previously explored the development of PTH-like pain behaviors in a novel rat model of mild closed head injury, along with the ability of sumatriptan and an anti-calcitonin-gene-related peptide monoclonal antibody to ameliorate these behaviors. Here, we explored the development of PTH-like behaviors and the effectiveness of these headache therapies in females subjected to the same head trauma protocol.

Methods

Adult female Sprague Dawley rats were subjected to a mild closed head injury using a weight-drop device. Characterization of headache and pain related behaviors included assessment of changes in cutaneous cephalic and extracephalic tactile pain sensitivity, using von Frey monofilaments. Sensitivity to headache/migraine triggers was tested by examining the effect of systemic administration of a low-dose of glyceryl trinitrate (GTN). Treatments included acute systemic administration of sumatriptan and repeated systemic administration of a mouse anti-calcitonin-gene-related peptide monoclonal antibody. Serum levels of calcitonin-gene-related peptide were measured at various time points in females and males after the head injury.

Results

Female rats subjected to a mild closed head injury developed cutaneous mechanical hyperalgesia, that was limited to the cephalic region, and was resolved 4 weeks later. Cephalic pain hypersensitivity was ameliorated by treatment with sumatriptan, but was resistant to an early and prolonged treatment with the anti-CGRP monoclonal antibody. Following the resolution of the head injury-evoked cephalic hypersensitivity, administration of GTN produced a renewed and pronounced cephalic and extracephalic pain hypersensitivity that was inhibited by sumatriptan, but only partially by the anti-CGRP treatment. CGRP serum levels were elevated in females but not in males at 7 days post head injury.

Conclusions

Development of PTH-like pain behaviors following a mild closed head injury, and responsiveness to treatment in rats is sexually dimorphic. When compared to males, female rats display a prolonged state of cephalic hyperalgesia, increased responsiveness to a headache trigger, and a poorer effectiveness of an early and prolonged anti-CGRP treatment. The increased risk of females to develop PTH may be linked to enhanced responsiveness of peripheral and/or central pain pathways and a mechanism independent of peripheral CGRP signaling.
Phylogeographic evidence that the distribution of cryptic euryhaline species in theGambusia punctataspecies group in Cuba was shaped by the archipelago geological history
Authors: García-Machado Erik , de Léon José L. Ponce , Gutiérrez-Costa María A. , Michel-Salzat Alice , Germon Isabelle , Casane Didier
Published: December 2019

The main drivers of diversification of freshwater fishes in Cuba are not yet well understood. For example, salt tolerance was thought as the main factor involved in the diversification ofGambusia punctataspecies group in this archipelago. However, evidence from a recent DNA barcoding survey suggested the presence of cryptic species and no correlation between species delimitation and level of salinity. In this study, we analyzed the cryptic diversification ofG. punctataspecies group in Cuba, based on a comprehensive sampling of its distribution and including habitats with different salinity levels. We evaluated the patterns of molecular divergence of the samples by sequencing a set of mitochondrial DNA (mtDNA) regions and genotyping nine nuclear microsatellite loci. We also used cytochrome b gene (cytb) partial sequences and these microsatellite loci to analyze population structure inside putative species. Five mtDNA well-differentiated haplogroups were found, four of them also identified by the analysis of the microsatellite polymorphism which corresponds to two already recognized species,G. punctata, andG. rhizophorae, and three putative new species. The extent of hybrid zones between these groups is also described. In each group, populations inhabiting environments with contrasting salinity levels were identified, indicating a generalized trait not specific toG. rhizophorae. The geographic distribution of the groups suggested a strong association with major relict territories of the Cuban Archipelago that was periodically joined or split-up by changes in seawater levels and land uplifts. Salinity tolerance might have facilitated sporadic and long-distance oversea dispersal but did not prevent speciation in the Cuban archipelago.
Confluence of timing and reward biases in perceptual decision-making dynamics
Authors: Shinn Maxwell , Ehrlich Daniel , Lee Daeyeol , Murray John D. , Seo Hyojung
Published: December 2019

Although the decisions of our daily lives often occur in the context of temporal and reward structures, the impact of such regularities on decision-making strategy is poorly understood. Here, to explore how temporal and reward context modulate strategy, we trained rhesus monkeys to perform a novel perceptual decision-making task with asymmetric rewards and time-varying evidence reliability. To model the choice and response time patterns, we developed a computational framework for fitting generalized drift-diffusion models (GDDMs) which flexibly accommodates diverse evidence accumulation strategies. We found that a dynamic urgency signal and leaky integration, in combination with two independent forms of reward biases, best capture behavior. We also tested how temporal structure influences urgency by systematically manipulating the temporal structure of sensory evidence, and found that the time course of urgency was affected by temporal context. Overall, our approach identified key components of cognitive mechanisms for incorporating temporal and reward structure into decisions.
Acute lymph node slices are a functional model system to study immunity ex vivo
Authors: Belanger Maura C. , Ball Alexander G. , Catterton Megan A. , Kinman Andrew W.L. , Anbaei Parastoo , Groff Benjamin D. , Melchor Stephanie J. , Lukens John R. , Ross Ashley E. , Pompano Rebecca R.
Published: December 2019

The lymph node is a highly organized and dynamic structure that is critical for facilitating the intercellular interactions that constitute adaptive immunity. Most ex vivo studies of the lymph node begin by reducing it to a cell suspension, thus losing the spatial organization, or fixing it, thus losing the ability to make repeated measurements. Live murine lymph node tissue slices offer the potential to retain spatial complexity and dynamic accessibility, but their viability, level of immune activation, and retention of antigen-specific functions have not been validated. Here we systematically characterized live murine lymph node slices as a platform to study immunity. Live lymph node slices maintained the expected spatial organization and cell populations while reflecting the 3D spatial complexity of the organ. Slices collected under optimized conditions were comparable to cell suspensions in terms of both 24-hr viability and inflammation. Slices responded to T cell receptor cross-linking with increased surface marker expression and cytokine secretion, in some cases more strongly than matched lymphocyte cultures. Furthermore, slices processed protein antigens, and slices from vaccinated animals responded to ex vivo challenge with antigen-specific cytokine secretion. In summary, lymph node slices provide a versatile platform to investigate immune functions in spatially organized tissue, enabling well-defined stimulation, time-course analysis, and parallel read-outs.