bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcohol Use Among Mental Health Professionals in China: A Nationwide Cross-sectional Survey
Authors: Tao Rui , Jiang Feng , Min Kaiyuan , Liu Tingfang , Liu Yuanli , Xia Lei , Wang Juan , Liu Huanzhong , Tang Yi-lang
Published: June 2020

Aim

To survey the use of alcohol, and its correlates by mental health professions in China, a nation where there is rapid increase in alcohol consumption and problems.

Methods

As a part of a large-scale, nation-wide online survey of healthcare professionals, we collected demographic variables and other health-related variables anonymously. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to collect data on alcohol use.

Results

13,980 mental health professionals completed the survey (4382 doctors, 9339 nurses and 259 clinical psychologists), representing 64% of the total targeted. Respondents were predominantly female (75.1%). Alcohol consumption was reported by 41.8% of participants (by 53.9% of doctors, 36.2% of nurses and 40.5% of clinical psychologists). Based on the cut-off scores of the AUDIT-C (≥3 for women and ≥4 for men), 7.5% were classified as probable alcohol misusers in the past year, and the rates were 10.2% in doctors, 6.3% in nurses and 5.8% in clinical psychologists. Multiple logistic regression showed that male sex (OR = 3.772; CI = 3.206–4.439), being a doctor (OR = 1.259; CI = 1.052–1.506), being divorced or widowed (OR = 1.979; CI = 1.467–2.666), having an associate degree or less (OR = 1.809; CI = 1.040–3.147), working in Northeast China (OR = 1.538; CI = 1.281–1.848) and the habit of smoking (OR = 3.345; CI = 2.280–3.967) were significantly associated with alcohol misuse.

Conclusions

Alcohol use and misuse were relatively common among mental health professionals in China, and male sex, being a doctor, with lower education, working in Northeast China and cigarette smoking were significant associations. Awareness and interventions are recommended to promote healthier use of alcohol in this professional group, especially among risk subgroups.
Has agricultural intensification impacted maize root traits and rhizosphere interactions related to organic N acquisition?
Authors: Schmidt Jennifer E , Poret-Peterson Amisha , Lowry Carolyn J , Gaudin Amélie C M
Published: June 2020

Plant–microbe interactions in the rhizosphere influence rates of organic matter mineralization and nutrient cycling that are critical to sustainable agricultural productivity. Agricultural intensification, particularly the introduction of synthetic fertilizer in the USA, altered the abundance and dominant forms of nitrogen (N), a critical plant nutrient, potentially imposing selection pressure on plant traits and plant–microbe interactions regulating N cycling and acquisition. We hypothesized that maize adaptation to synthetic N fertilization altered root functional traits and rhizosphere microbial nutrient cycling, reducing maize ability to acquire N from organic sources. Six maize genotypes released pre-fertilizer (1936, 1939, 1942) or post-fertilizer (1984, 1994, 2015) were grown in rhizoboxes containing patches of 15N-labelled clover/vetch residue. Multivariate approaches did not identify architectural traits that strongly and consistently predicted rhizosphere processes, though metrics of root morphological plasticity were linked to carbon- and N-cycling enzyme activities. Root traits, potential activities of extracellular enzymes (BG, LAP, NAG, urease), abundances of N-cycling genes (amoA, narG, nirK, nirS, nosZ) and uptake of organic N did not differ between eras of release despite substantial variation among genotypes and replicates. Thus, agricultural intensification does not appear to have impaired N cycling and acquisition from organic sources by modern maize and its rhizobiome. Improved mechanistic understanding of rhizosphere processes and their response to selective pressures will contribute greatly to rhizosphere engineering for sustainable agriculture.
Polyandry and paternity affect disease resistance in eusocial wasps
Authors: Saga Tatsuya , Okuno Masaki , Loope Kevin J , Tsuchida Koji , Ohbayashi Kako , Shimada Masakazu , Okada Yasukazu
Published: June 2020

Polyandry (multiple mating by females) is a central challenge for understanding the evolution of eusociality. Several hypotheses have been proposed to explain its observed benefits in eusocial Hymenoptera, one of which, the parasite–pathogen hypothesis (PPH), posits that high genotypic variance among workers for disease resistance prevents catastrophic colony collapse. We tested the PPH in the polyandrous wasp Vespula shidai. We infected isolated workers with the entomopathogenic fungus Beauveria bassiana and quantified their survival in the laboratory. Additionally, we conducted a paternity analysis of the workers using nine microsatellite loci to investigate the relationship between survival and the matriline and patriline membership of the workers. As predicted by the PPH, nestmate workers of different patrilines showed differential resistance to B. bassiana. We also demonstrated variation in virulence among strains of B. bassiana. Our results are the first to directly support the PPH in eusocial wasps and suggest that similar evolutionary pressures drove the convergent origin and maintenance of polyandry in ants, bees, and wasps.
Contrasting parental color morphs increase regularity of prey deliveries in an African raptor
Authors: Nebel Carina , Sumasgutner Petra , McPherson Shane C , Tate Gareth J , Amar Arjun
Published: June 2020

Disassortative mating in color-polymorphic raptors is a proposed mechanism for the maintenance of color polymorphism in populations. Selection for such a mating system may occur if there are fitness advantages of mating with a contrasting morph. In the black sparrowhawk (Accipiter melanoleucus), mixed-morph pairs may have a selective advantage because they produce offspring that have higher survival rates. Two hypotheses, which may explain the mechanism, are the “avoidance-image” and “complementarity” hypotheses. The first suggests that, within a predator’s territory, prey develop a search image for the more commonly encountered parental morph, for example, the male morph during incubation and brooding. Females of a contrasting morph to their partner would then have higher capture rates once they commence hunting in the later nestling phase. Thus, the “avoidance-image” hypothesis predicts higher provisioning rates for mixed-morph pairs. Alternatively, the “complementarity” hypothesis posits that different color morphs exploit different environmental conditions, allowing mixed-morph pairs to hunt under a wider range of conditions and predicts that food is delivered more consistently. We test these hypotheses using nest cameras to record prey delivery rates during the late nestling phase when both parents are hunting. We found support for the “complementarity” hypothesis, with mixed-morph pairs delivering food more consistently but not at a higher rate. This higher consistency in prey deliveries may explain the improved survival of the offspring of mixed-morph pairs and could, therefore, play a role in maintaining the stability of color polymorphism in this system.
An effect size statistical framework for investigating sexual dimorphism in non-avian dinosaurs and other extinct taxa
Authors: Saitta Evan T , Stockdale Maximilian T , Longrich Nicholas R , Bonhomme Vincent , Benton Michael J , Cuthill Innes C , Makovicky Peter J
Published: June 2020

Despite reports of sexual dimorphism in extinct taxa, such claims in non-avian dinosaurs have been rare over the last decade and have often been criticized. Since dimorphism is widespread in sexually reproducing organisms today, under-reporting in the literature might suggest either methodological shortcomings or that this diverse group exhibited highly unusual reproductive biology. Univariate significance testing, especially for bimodality, is ineffective and prone to false negatives. Species recognition and mutual sexual selection hypotheses, therefore, may not be required to explain supposed absence of sexual dimorphism across the grade (a type II error). Instead, multiple lines of evidence support sexual selection and variation of structures consistent with secondary sexual characteristics, strongly suggesting sexual dimorphism in non-avian dinosaurs. We propose a framework for studying sexual dimorphism in fossils, focusing on likely secondary sexual traits and testing against all alternate hypotheses for variation in them using multiple lines of evidence. We use effect size statistics appropriate for low sample sizes, rather than significance testing, to analyse potential divergence of growth curves in traits and constrain estimates for dimorphism magnitude. In many cases, estimates of sexual variation can be reasonably accurate, and further developments in methods to improve sex assignments and account for intrasexual variation (e.g. mixture modelling) will improve accuracy. It is better to compare estimates for the magnitude of and support for dimorphism between datasets than to dichotomously reject or fail to reject monomorphism in a single species, enabling the study of sexual selection across phylogenies and time. We defend our approach with simulated and empirical data, including dinosaur data, showing that even simple approaches can yield fairly accurate estimates of sexual variation in many cases, allowing for comparison of species with high and low support for sexual variation.
Towards a new understanding of the division of labour in heterantherous flowers: the case ofPterolepis glomerata(Melastomataceae)
Authors: Telles Francismeire Jane , Klunk Cristian Luan , Maia Fabiano Rodrigo da , de Brito Vinícius Lourenço Garcia , Varassin Isabela Galarda
Published: June 2020

Pollen-flowers with heteromorphic stamens have been shown to promote an intrafloral division of labour as a solution to fitness costs arising from pollen consumption by bees, known as the pollen dilemma. Usually, the division is based on morphological differences in anther and pollen traits that correlate with stamen function: pollinating anthers are larger and contain more and higher-quality pollen grains than feeding anthers. Here, we present a new strategy based on a high investment in reward production and thus attraction, in the heterantherous Pterolepis glomerata, to overcome short flower longevity and maintain reproductive success. In P. glomerata small feeding anthers not only produced more pollen grains and more grains with cytoplasmic content, but also released more pollen than pollinating anthers after a single visit. This pattern was consistent until the end of floral anthesis, showing the existence of pollen-dosing mechanisms. Bees equally visited flowers with yellow feeding anthers and pollinating anthers with yellow connective appendages, indicating a visual similarity, as predicted by bee vision modelling. Our results demonstrate that the division of labour might have different outcomes. Instead of the classical expectation of more investment in reproductive pollen in pollinating stamens, P. glomerata invested more in attraction and reward in feeding stamens.
Identification and Validation of a Novel Clinical Signature to Predict the Prognosis in Confirmed Coronavirus Disease 2019 Patients
Authors: Wu Shangrong , Du Zhiguo , Shen Sanying , Zhang Bo , Yang Hong , Li Xia , Cui Wei , Cheng Fangxiong , Huang Jin
Published: June 2020

Background

Our aim in this study was to identify a prognostic biomarker to predict the disease prognosis and reduce the mortality rate of coronavirus disease 2019 (COVID-19), which has caused a worldwide pandemic.

Methods

COVID-19 patients were randomly divided into training and test groups. Univariate and multivariate Cox regression analyses were performed to identify the disease prognosis signature, which was selected to establish a risk model in the training group. The disease prognosis signature of COVID-19 was validated in the test group.

Results

The signature of COVID-19 was combined with the following 5 indicators: neutrophil count, lymphocyte count, procalcitonin, age, and C-reactive protein. The signature stratified patients into high- and low-risk groups with significantly relevant disease prognosis (log-rank test, P < .001) in the training group. The survival analysis indicated that the high-risk group displayed substantially lower survival probability than the low-risk group (log-rank test, P < .001). The area under the receiver operating characteristic (ROC) curve showed that the signature of COVID-19 displayed the highest predictive accuracy regarding disease prognosis, which was 0.955 in the training group and 0.945 in the test group. The ROC analysis of both groups demonstrated that the predictive ability of the signature surpassed the use of each of the 5 indicators alone.

Conclusions

The signature of COVID-19 presents a novel predictor and prognostic biomarker for closely monitoring patients and providing timely treatment for those who are severely or critically ill.
Climate change, the politics of anticipation and future riskscapes in Africa
Authors: Müller-Mahn Detlef , Moure Mar , Gebreyes Million
Published: June 2020

The authors review two conceptual frameworks of risk management and apply them to the context of climate change in Africa, based on case studies in Côte d′Ivoire and Ethiopia. Politics of anticipation refers to a type of policy-making that uses scientific forecasts to manage future risks. Riskscapes, by contrast, are temporalspatial phenomena, which highlight perception, discourse and practice in relation to multiple risks and uncertainties. In view of the heterogeneity of the African continent, the article cautions against an uncritical use of anticipatory politics and argues for expanding the understanding of complex riskscapes in relation to the future.
Neutrophilic HGF-MET Signalling Exacerbates Intestinal Inflammation
Authors: Stakenborg Michelle , Verstockt Bram , Meroni Elisa , Goverse Gera , De Simone Veronica , Verstockt Sare , Di Matteo Mario , Czarnewski Paulo , Villablanca Eduardo J , Ferrante Marc , Boeckxstaens Guy E , Mazzone Massimiliano , Vermeire Séverine , Matteoli Gianluca
Published: June 2020

Background and Aims

Ulcerative colitis [UC] is associated with excessive neutrophil infiltration and collateral tissue damage, but the link is not yet completely understood. Since c-MET receptor tyrosine kinase [MET] is required for neutrophil chemoattraction and cytotoxicity in response to its ligand hepatocyte growth factor [HGF], we aimed to identify the function of HGF-MET signalling in neutrophils in UC patients and in mice during intestinal inflammation.

Methods

Serum and colonic biopsies from healthy controls and UC patients with active [Mayo endoscopic subscore 2–3] and inactive [Mayo endoscopic subscore 0–1] disease were collected to assess the level of serum and colonic HGF. Disease progression and immune cell infiltration were assessed during dextran sodium sulphate [DSS] colitis in wild-type and MRP8-Cre MET-LoxP mice.

Results

Increased mucosal HGF expression was detected in patients with active UC, and in mice during the inflammatory phase of DSS colitis. Similarly, serum HGF was significantly increased in active UC patients and positively correlated with C-reactive protein and blood neutrophil counts. Flow cytometric analysis also demonstrated an upregulation of colonic MET+ neutrophils during DSS colitis. Genetic ablation of MET in neutrophils reduced the severity of DSS-induced colitis. Concomitantly, there was a decreased number of TH17 cells, which could be due to a decreased production of IL-1β by MET-deficient neutrophils.

Conclusions

These data highlight the central role of neutrophilic HGF-MET signalling in exacerbating damage during intestinal inflammation. Hence, selective blockade of this pathway in neutrophils could be considered as a novel therapeutic approach in UC.
Stopping Clinical Trials in Inflammatory Bowel Disease During the COVID-19 Pandemic Is Not a Responsible Act
Authors: Schreiber Stefan , Dignass Axel , Rogge Annette , Rubin David T
Published: June 2020

The intense competition for resources to combat COVID-19 has greatly reduced access to health care for patients with other diseases. After the disastrous overrun of hospitals through COVID-19 patients in some jurisdictions, availability of resources for ‘elective’ medical procedures, including care for the chronically ill, has been greatly reduced in many places as a pre-emptive measure before or during the blooming of infection clusters. Pharmaceutical companies have either stopped recruitment or even cancelled ongoing clinical trials in chronic diseases. Pre-emptive triage and its impact on medical ethics is discussed in the framework of care for inflammatory bowel disease.
The scars of religious war in histories of French cities (1600–1750)
Authors: Diefendorf Barbara B
Published: June 2020

This article explores the memory of France’s Wars of Religion in urban histories published during the century and a half that followed the restoration of peace with the Edict of Nantes in 1598. It asks why, despite explicit prohibitions against reviving memories of injuries suffered during the wars, local historians persisted in demonizing former opponents in histories that remained overtly confessional in their representation of the troubles. The article focuses on Catholic authors, who wrote fifty-six of the fifty-eight works examined. Protestants had little incentive to memorialize the towns in which they had a limited and declining position. Catholics, by contrast, mobilized memory to reaffirm a local identity rooted in Catholic practice and belief. Retelling the suffering local populations endured and recounting the city’s ritual responses to the religious schism, they pushed Protestants to the margins of a civic culture represented as inherently Catholic even in a bi-confessional state.
Cognitive Functions Predict Trajectories of Sleepiness Over 10 Years: A Population-Based Study
Authors: Cohen Ann D , Jia Yichen , Smagula Stephen , Chang Chung-Chou H , Snitz Beth , Berman Sarah B , Jacobsen Erin , Ganguli Mary
Published: June 2020

Background

Excessive daytime sleepiness is associated with chronic disorders of aging and mortality. Because longitudinal data are limited on the development of sleep disturbances and cognitive changes in older adults, we investigated the demographic, clinical, and cognitive predictors of self-reported daytime sleepiness over a period of 10 years.

Methods

We jointly modeled latent trajectories over time of sleepiness, cognitive domains, and informative attrition and then fit models to identify cognitive trajectories and baseline characteristics that predicted the trajectories of sleepiness.

Results

Three latent trajectory groups were identified: emerging sleepiness, persistent sleepiness, and consistently low daytime sleepiness accounting for attrition in all groups. Compared with low sleepiness, emerging sleepiness was significantly associated with declining attention and subjective memory complaints; persistent sleepiness was associated with lower baseline scores in all cognitive domains, declining language trajectory, and more subjective memory complaints.

Conclusions

These findings suggest that persistent sleepiness and emerging daytime sleepiness are associated with cognitive decline and multiple morbidities, albeit more subtly in emerging daytime sleepiness. Furthermore, these data suggest that change in the cognitive domain of attention and subjective memory complaints may be early indicators of future sleep disturbance.
Impact of Reactogenicity After Two Doses of Recombinant Zoster Vaccine Upon Physical Functioning and Quality of Life: An Open Phase III Trial in Older Adults
Authors: Schmader Kenneth E , Levin Myron J , Chen Michael , Matthews Sean , Riley Megan E , Woo Wayne , Hervé Caroline , Grupping Katrijn , Schuind Anne E , Oostvogels Lidia , Curran Desmond
Published: June 2020

Background

Herpes zoster may significantly impact quality of life (QoL) in older adults. The recombinant zoster vaccine (RZV) is efficacious in adults aged ≥50 and older and is associated with increased reactogenicity compared to placebo. We report here on the impact of reactogenicity of the second RZV dose on the QoL and physical functioning (PF) of vaccine recipients, and summarize findings following both doses.

Method

In this single-arm study, 401 adults aged ≥50 and older were enrolled to receive two RZV doses 2 months apart. Change in mean Short Form Survey-36 (SF-36) PF and EuroQol-5 Dimension (EQ-5D) scores, reactogenicity, safety, productivity loss, and healthcare resource utilization were evaluated.

Results

In total, 391 (97.5%) participants received dose 2. Post-dose 2, the most common solicited local symptoms were injection site pain (75.1%), erythema (22.4%), and swelling (13.9%), and the most common systemic symptoms were fatigue (46.3%), headache (37.5%), and myalgia (32.9%). Grade 3 solicited (local and systemic) adverse events were reported by 61 (15.6%) participants and were associated with a transient clinically significant decrease in SF-36 PF score on Days 1–2 post-dose 2 that recovered by Day 3. Overall, no clinically important reduction in mean SF-36 PF scores was observed from baseline to post-dose 2 (mean change −0.4), and no quality-adjusted-life-year loss was recorded.

Conclusions

Overall, QoL and PF of RZV vaccinees were not affected by vaccine-related reactogenicity. A transient reduction was observed in the first 2 days after RZV vaccination in individuals with Grade 3 adverse events. No safety concerns were identified.
A Core Outcome Set for Nonpharmacological Community-Based Interventions for People Living With Dementia at Home: A Systematic Review of Outcome Measurement Instruments
Authors: Harding Andrew J E , Morbey Hazel , Ahmed Faraz , Opdebeeck Carol , Elvish Ruth , Leroi Iracema , Williamson Paula R , Keady John , Reilly Siobhan T
Published: June 2020

Background and Objectives

It is questionable whether existing outcome measurement instruments (OMIs) in dementia research reflect what key stakeholders’ value. We attained consensus from more than 300 key stakeholders, including people living with dementia, and identified 13 core outcome items for use in nonpharmacological and community-based interventions for people with dementia living at home. In this systematic review, we review OMIs that have previously been used in dementia care research to determine how, or even if, the 13 core outcome items can be measured.

Research Design and Methods

We extracted self-reported OMIs from trials, reviews, and reports of instrument development. Searches were undertaken in the ALOIS database, MEDLINE, PsycINFO, CINAHL, SocINDEX, and COSMIN databases. We aimed to assess the psychometric properties of OMI items for face validity with the core outcome items, content validity, internal consistency, and responsiveness. We held a coresearch workshop involving people living with dementia and care partners in order to ratify the findings.

Results

In total 347 OMIs were located from 354 sources. Of these, 76 OMIs met the inclusion criteria. No OMIs were deemed to have sufficient face validity for the core outcome set (COS) items, and no OMIs proceeded to further assessment. The “best” available OMI is the Engagement and Independence in Dementia Questionnaire.

Discussion and Implications

This study provides a practical resource for those designing dementia research trials. Being able to measure the COS items would herald a paradigm shift for dementia research, be responsive to what key stakeholders value and enhance the ability to make comparisons.
Can Morphology Predict the Conservation Status of Iguanian Lizards?
Authors: Miles Donald B
Published: June 2020

Synopsis

The integrity of regional and local biological diversity is under siege as a result of multiple anthropogenic threats. The conversion of habitats, such as rain forests, into agricultural ecosystems, reduces the area available to support species populations. Rising temperatures and altered rainfall patterns lead to additional challenges for species. The ability of conservation biologists to ascertain the threats to a species requires data on changes in distribution, abundance, life history, and ecology. The International Union for the Conservation of Nature (IUCN) uses these data to appraise the extinction risk for a species. However, many species remain data deficient (DD) or unassessed. Here, I use 14 morphological traits related to locomotor function, habitat, and feeding to predict the threat status of over 400 species of lizards in the infraorder Iguania. Morphological traits are an ideal proxy for making inferences about a species’ risk of extinction. Patterns of morphological covariation have a known association with habitat use, foraging behavior, and physiological performance across multiple taxa. Results from phylogenetic general linear models revealed that limb lengths as well as head characters predicted extinction risk. In addition, I used an artificial neural network (ANN) technique to generate a classification function based on the morphological traits of species with an assigned IUCN threat status. The network approach identified eight morphological traits as predictors of extinction risk, which included head and limb characters. The best supported model had a classification accuracy of 87.4%. Moreover, the ANN model predicted >18% of DD/not assessed species were at risk of extinction. The predicted assessments were supported by other sources of threat status, for example, Convention on International Trade in Endangered Species appendices. Because of the functional link between morphology, performance, and ecology, an ecomorphological approach may be a useful tool for rapid assessment of DD or poorly known species.
Emotional Labor and the Power of International Bureaucrats
Authors: Nair Deepak
Published: June 2020

This article advances a theory on the power of international bureaucrats and bureaucracies in world politics. It argues that bureaucrats become powerful when they stage emotionally calibrated performances as “servants” before state principals and carve out space for action through “whispering,” “propagating,” cultivating patrons, and building coalitions in the backstage of official interaction. These “servant” performances involve what sociologist Arlie Hochschild calls “emotional labor”—the management of feelings in work performances. I develop a theory of emotional labor that suggests why international bureaucrats manage emotions as they perform as servants and why some bureaucrats with prized sociological profiles are empowered on the back of “confident” servant performances. In contrast to principal–agent, constructivist, and psychological accounts, this is a micro-sociological explanation for bureaucratic power. I evaluate this theory with an ethnography of the Secretariat of the Association of Southeast Asian Nations (ASEAN)—a “least likely” case for bureaucratic power under prevailing theorizations. I also demonstrate how the ASEAN case is a sharper instance of a more general phenomenon. This article advances the study of emotions and emotional labor, the role of social class in shaping competent practice, and the debate on the power of bureaucrats and international organizations in international relations.
Universal Screening of Gastrointestinal Malignancies for Mismatch Repair Deficiency at Stanford
Authors: Abrha Aser , Shukla Navika D , Hodan Rachel , Longacre Teri , Raghavan Shyam , Pritchard Colin C , Fisher George , Ford James , Haraldsdottir Sigurdis
Published: June 2020

Background

In light of recent Food and Drug Administration (FDA) approval of immune checkpoint inhibitors for mismatch repair deficient (dMMR) malignancies, identifying patients with dMMR malignancies has become increasingly important. Although screening for dMMR in colorectal cancer (CRC) is recommended, it is less common for extracolonic gastrointestinal (GI) malignancies. At Stanford Comprehensive Cancer Institute (SCCI), all GI malignancies have been screened for dMMR via immunohistochemistry since January 2016.

Methods

In this study, we conducted a retrospective review of all patients with GI malignancies screened for dMMR between January 2016 and December 2017. Tumor sequencing was performed on cases negative for germline pathogenic variants where tumor material was available.

Results

A total of 1425 consecutive GI malignancies were screened for dMMR at SCCI during the study period, and 1374 were included for analysis. dMMR was detected in 7.2% of all GI malignancies. We detected the highest prevalence of dMMR in gastric (15 of 150, 10.0%) followed by colorectal (63 of 694, 9.1%), pancreatic (13 of 244, 5.3%), and gastroesophageal malignancy (6 of 132, 4.5%) patients. Lynch syndrome was the most common etiology for dMMR in colorectal cancer (41.5%), double somatic (confirmed or possible) pathogenic variants the most common etiology in pancreatic cancer (44.4%), and somatic MLH1 hypermethylation the most common etiology in gastric (73.3%) and gastroesophageal cancer (83.3%).

Conclusions

Given the relatively high incidence of dMMR in GI malignancies, we recommend screening all GI malignancies. Our results suggest that although a rare occurrence, double somatic pathogenic variants may be a biologically significant pathway causing dMMR in pancreatic cancer.
An Early Test-and-Treat Strategy for Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Schiffer Joshua T , Johnston Christine , Wald Anna , Corey Lawrence
Published: June 2020

As coronavirus disease 2019 cases and deaths continue to expand globally, there is an urgent need to develop, test, and approve effective antiviral therapies. Currently, a majority of clinical trials are evaluating therapies in patients who are already hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection. Given that the median time between development of symptoms and need for hospitalization is 1 week, a golden opportunity to intervene early is being missed. Indeed, for many other viral infections, early treatment soon after development of symptoms is associated with decreased mortality, lower hospitalization rates, and lower likelihood of transmission to others. In this study, we advocate for randomized, double-blind, placebo controlled, clinical trials to evaluate promising agents early during SARS CoV-2 infection.
Education Policy Trump Style: The Administrative Presidency and Deference to States in ESSA Implementation
Authors: Wong Kenneth K
Published: June 2020

Since the 1960s, U.S. presidents have used their executive, administrative, and political power to pursue policy goals in elementary and secondary education. This article analyzes the K-12 education policy strategies pursued during the first three years of the Donald Trump presidency, focusing on two main aspects of Trump’s approach to education policy. First, I analyze Trump’s heavy reliance on executive and administrative tools and his use of these tools to promote state flexibility, diminish federal direction on civil rights issues, and expand private and public school choice. Second, I examine the Trump administration’s approach to implementing the Every Student Succeeds Act of 2015 (ESSA), especially in reviewing state plans pursuant to the ESSA. The administration took a highly deferential approach as states sought approval for their ESSA plans and in a way that suggests the Trump presidency is shifting federal involvement in K-12 education policy away from prioritizing equity and oversight.
Outcomes in patients with severe COVID-19 disease treated with tocilizumab: a case–controlled study
Authors: Rojas-Marte G , Khalid M , Mukhtar O , Hashmi A T , Waheed M A , Ehrlich S , Aslam A , Siddiqui S , Agarwal C , Malyshev Y , Henriquez-Felipe C , Sharma D , Sharma S , Chukwuka N , Rodriguez D C , Alliu S , Le J , Shani J
Published: June 2020

Background

COVID-19 is an ongoing threat to society. Patients who develop the most severe forms of the disease have high mortality. The interleukin-6 inhibitor tocilizumab has the potential to improve outcomes in these patients by preventing the development of cytokine release storm.

Aims

To evaluate the outcomes of patients with severe COVID-19 disease treated with the interleukin-6 inhibitor tocilizumab.

Methods

We conducted a retrospective, case–control, single-center study in patients with severe to critical COVID-19 disease treated with tocilizumab. Disease severity was defined based on the amount of oxygen supplementation required. The primary endpoint was the overall mortality. Secondary endpoints were mortality in non-intubated patients and mortality in intubated patients.

Results

A total of 193 patients were included in the study. Ninety-six patients received tocilizumab, while 97 served as the control group. The mean age was 60 years. Patients over 65 years represented 43% of the population. More patients in the tocilizumab group reported fever, cough and shortness of breath (83%, 80% and 96% vs. 73%, 69% and 71%, respectively). There was a non-statistically significant lower mortality in the treatment group (52% vs. 62.1%, P = 0.09). When excluding intubated patients, there was statistically significant lower mortality in patients treated with tocilizumab (6% vs. 27%, P = 0.024). Bacteremia was more common in the control group (24% vs. 13%, P = 0.43), while fungemia was similar for both (3% vs. 4%, P = 0.72).

Conclusion

Our study showed a non-statistically significant lower mortality in patients with severe to critical COVID-19 disease who received tocilizumab. When intubated patients were excluded, the use of tocilizumab was associated with lower mortality.
High proton pump inhibitor exposure increases risk of calcinosis in systemic sclerosis
Authors: Host Lauren V , Campochiaro Corrado , Afonso Ana , Nihtyanova Svetlana I , Denton Christopher P , Ong Voon H
Published: June 2020

Objective

To investigate the association between proton pump inhibitor (PPI) use and the presence and severity of calcinosis in SSc.

Methods

We analysed data from two SSc cohorts from a single centre. Cohort 1 included 199 patients reviewed over 10 years, for whom retrospective data on PPI use and calcinosis were available. Cohort 2 was recruited prospectively and included 215 consecutive patients, who underwent clinical assessment. Outcomes of interest were presence of current calcinosis (CC) or calcinosis at any time (CAT).

Results

The cohort 1 data analysis showed that among patients on standard dose PPI 20% had calcinosis, while in those on high doses of PPI calcinosis was present in 39% (P = 0.003). Analysis of the data from cohort 2 confirmed these findings, demonstrating that the odds of CAT increased significantly with longer PPI exposure [odds ratio (OR) 1.04, 95% CI: 1.02, 1.06; P < 0.001], longer disease duration (OR 1.08, 95% CI: 1.05, 1.12; P < 0.001) and greater age (OR 1.03, CI: 1.01, 1.05; P = 0.010). Multivariable logistic regression showed that higher exposure to PPI remained a significant predictor of calcinosis, with PPI exposure >10 years increasing the risk of CAT >6-fold, compared with no PPI (OR 6.37, 95% CI: 1.92, 21.17; P = 0.003) after adjusting for disease duration and antibodies.

Conclusion

We confirm a significant association between high PPI exposure with severity of calcinosis in SSc. Given the clinical impact of calcinosis and reflux in SSc, PPI exposure as a potentially modifiable risk factor for calcinosis requires further evaluation.
Time to remission in swollen joints is far faster than patient reported outcomes in rheumatoid arthritis: results from the Ontario Best Practices Research Initiative (OBRI)
Authors: Pope Janet E , Rampakakis Emmanouil , Movahedi Mohammad , Cesta Angela , Sampalis John S , Bombardier Claire ,   for OBRI investigators
Published: June 2020

Objectives

RA patients are often not in remission due to patient global assessment of disease activity (PtGA) included in disease activity indices. The aim was to assess the lag of patient-reported outcomes (PROs) after remission measured by clinical disease activity index (CDAI) or swollen joint count (SJC28).

Methods

RA patients enrolled in the Ontario Best Practices Research Initiative registry not in low disease state at baseline with at ≥6 months of follow-up, were included. Low disease state was defined as CDAI ≤ 10, SJC28 ≤ 2, PtGA ≤ 2cm, pain score ≤ 2cm, or fatigue ≤ 2cm. Remission included CDAI ≤ 2.8, SJC28 ≤ 1, PtGA ≤ 1cm, pain score ≤ 1cm, or fatigue ≤ 1cm. Time to first low disease state/remission based on each definition was calculated overall and stratified by early vs established RA.

Results

A total of 986 patients were included (age 57.4 (12.9), disease duration 8.3 (9.9) years, 80% women). The median (95% CI) time in months to CDAI ≤ 10 was 12.4 (11.4, 13.6), SJC28 ≤ 2 was 9 (8.2, 10), PtGA ≤ 2cm was 18.9 (16.1, 22), pain ≤ 2cm was 24.5 (19.4, 30.5), and fatigue ≤ 2cm was 30.4 (24.8, 31.7). For remission, the median (95% CI) time in months to CDAI ≤ 2.8 was 46.5 (42, 54.1), SJC28 ≤ 1 was 12.5 (11.4, 13.4), PtGA ≤ 1cm was 39.6 (34.6, 44.8), pain ≤ 1cm was 54.7 (43.6, 57.5) and fatigue ≤ 1cm was 42.6 (36.8, 48). Time to achieving low disease state and remission was generally significantly shorter in early RA compared with established RA with the exception of fatigue.

Conclusion

Time to achieving low disease state or remission based on PROs was considerably longer compared with swollen joint count. Treating to a composite target in RA could lead to inappropriate changes in DMARDs.
Varieties of Gender Regimes
Authors: Walby Sylvia
Published: June 2020

What are the varieties of gender regimes? The focus is the theory of varieties of gender regimes—domestic and public regimes; and, within the public, both neoliberal and social democratic varieties—and pathways to alternative forms. Is this model sufficient to encompass the turn to less progressive forms and multiple global regions or are further varieties needed? At stake here is the distinction between modern and premodern, public and domestic, the meaning of conservative, the concept of the family, and the theorization of violence. The article offers engagement with critics and further development of the theory.
Induction of Oxidative DNA Damage and Epithelial Mesenchymal Transitions in Small Airway Epithelial Cells Exposed to Cosmetic Aerosols
Authors: Pearce Kaitlin M , Okon Imoh , Watson-Wright Christa
Published: June 2020

Engineered metal nanoparticles (ENPs) are frequently incorporated into aerosolized consumer products, known as nano-enabled products (NEPs). Concern for consumer pulmonary exposures grows as NEPs produce high concentrations of chemically modified ENPs. A significant knowledge gap still exists surrounding NEP aerosol respiratory effects as previous research focuses on pristine/unmodified ENPs. Our research evaluated metal-containing aerosols emitted from nano-enabled cosmetics and their induction of oxidative stress and DNA damage, which may contribute to epithelial mesenchymal transitions (EMT) within primary human small airway epithelial cells. We utilized an automated NEP generation system to monitor and gravimetrically collect aerosols from two aerosolized cosmetic lines. Aerosol monitoring data were inputted into modeling software to determine potential inhaled dose and in vitro concentrations. Toxicological profiles of aerosols and comparable pristine ENPs (TiO2 and Fe2O3) were used to assess reactive oxygen species and oxidative stress by fluorescent-based assays. Single-stranded DNA (ssDNA) damage and 8-oxoguanine were detected using the CometChip assay after 24-h exposure. Western blots were conducted after 21-day exposure to evaluate modulation of EMT markers. Results indicated aerosols possessed primarily ultrafine particles largely depositing in tracheobronchial lung regions. Significant increases in oxidative stress, ssDNA damage, and 8-oxoguanine were detected post-exposure to aerosols versus pristine ENPs. Western blots revealed statistically significant decreases in E-cadherin and increases in vimentin, fascin, and CD44 for two aerosols, indicating EMT. This work suggests certain prolonged NEP inhalation exposures cause oxidative DNA damage, which may play a role in cellular changes associated with reduced respiratory function and should be of concern.
Adjuvant chemotherapy in colon cancer: state of the art and future perspectives
Authors: Iveson Tim
Published: June 2020

Purpose of review

This article will review the results of recent studies, which have investigated the duration of adjuvant chemotherapy and also suggest, which aspects of adjuvant treatment need investigation in future studies.

Recent findings

The IDEA collaboration investigated whether the duration of adjuvant chemotherapy with an oxaliplatin doublet could be reduced from 6 to 3 months. Although this study did not demonstrate noninferiority for 3 months treatment, it did show noninferiority for patients receiving 3 months CAPOX chemotherapy and for those patients with low-risk stage III disease receiving 3 months’ treatment. There was also significantly less toxicity seen with 3 months’ treatment. Recent studies have shown that detectable ctDNA postoperatively can predict those patients most likely to relapse and so benefit from adjuvant treatment.

It has been shown that for patients receiving adjuvant CAPOX chemotherapy, or those receiving adjuvant chemotherapy for low-risk stage III colon 3 months’ chemotherapy gives similar outcomes to 6 months’ treatment with significantly less toxicity.
PENTOSAN POLYSULFATE SODIUM-INDUCED PIGMENTARY MACULOPATHY WITH NONLEAKING CYSTOID MACULAR EDEMA SUCCESSFULLY TREATED WITH ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY
Authors: De Larochellière Elianne , Bourgault Serge
Published: June 2020

Purpose:

To report a case of nonleaking cystoid macular edema (CME) associated with pentosan polysulfate sodium (PPS)-induced pigmentary maculopathy.

Methods:

Multimodal imaging, including optical coherence tomography, fundus photography, autofluorescence, and fluorescein angiography, was used to substantiate our diagnosis, further characterize the cystoid macular edema showed by our patient and to monitor the response to treatment.

Results:

A 59-year-old woman was referred for decreased visual acuity and bilateral macular edema. She had been treated for interstitial cystitis with PPS for 10 years. Multimodal imaging showed the characteristic features of PPS-induced pigmentary maculopathy. Moreover, fluorescein angiogram showed nonleaking cystoid macular edema in both eyes. She was treated successfully with intravitreal injections of bevacizumab.

Conclusion:

To our knowledge, this report is the first to demonstrate that PPS-associated cystoid macular edema can be nonleaking on fluorescein angiography and responds well to intravitreal anti-vascular endothelial growth factor injections.
Learning in Pediatric Emergency Situations: A Qualitative Study of Residents’ Perspectives*
Authors: Petrescu Matei S. , Stalmeijer Renee E. , Rethans Jan-Joost , Thammasitboon Satid
Published: June 2020

Objectives:

To explore resident learning in the context of emergency situations. The guiding research questions were: How do residents learn in emergency situations? What factors facilitate or hinder their learning?

Design:

A qualitative approach was used in order to understand the different perspectives of participants and explore the context of emergency situations. Aware of the complex sociocultural interactions in emergency situations, we used the methodology of constructivist grounded theory.

Setting:

A medium-sized pediatric academic hospital in San Antonio, TX.

Subjects:

Twenty pediatric residents participated in semi-structured interviews.

Interventions:

None.

Measurements and Main Results:

We used an iterative process of data collection and analysis. The process continued until thematic saturation was reached. The data were coded and analyzed using constant comparison. Codes were clustered into themes informed by the theory of situated learning. Several methods were used to ensure trustworthiness of results. Three main themes were identified. First, resident participation in emergency situations takes different forms. Residents participate mostly in helping roles. Watching is an under-recognized form of participation yet offered unique experiences. Managing roles are rarely afforded to residents. Second, resident participation is informed by the context of the emergency situation. Based on contextual clues (e.g., safety, needs), residents infer potential risks and values from their participation, which guides their participatory role. Residents may shift their form of participation, based on changes in the context. Supervisors play a significant role in guiding resident participation. Third, engagement, a state of cognitive and emotional focus, is critical in learning. The context of the emergency situation plays a role in the level of resident engagement. Supervisors may also foster resident engagement.

Conclusions:

Resident participation in emergency situations is complex and informed by the context. Learning in emergency situations is influenced by residents’ level of mental engagement. Supervisors may positively guide resident participation, foster engagement, and enable them to reach their learning goals in emergency situations.
Sex Differences in the Massively Transfused Trauma Patient
Authors: Taghavi Sharven , Tatum Danielle , Reza Tara , Smith Alison , McGrew Patrick , Harris Charles , Guidry Chrissy , Schroll Rebecca , Duchesne Juan
Published: June 2020

Introduction:

Recent studies have suggested the female hypercoaguable state may have a protective effect in trauma. However, whether this hypercoagulable profile confers a survival benefit in massively transfused trauma patients has yet to be determined. We hypothesized that females would have better outcomes than males after traumatic injury that required massive transfusion protocol (MTP).

Patients and Methods:

All trauma patients who underwent MTP at an urban, level 1, academic trauma center were reviewed from November 2007 to October 2018. Female MTP patients were compared to their male counterparts.

Results:

There were a total of 643 trauma patients undergoing MTP. Of these, 90 (13.8%) were female and 563 (86.2%) were male. Presenting blood pressure, heart rate, shock index, and injury severity score (ISS) were not significantly different. Overall mortality and incidence of venous thromboembolism were similar. Complication profile and hospital stay were similar. On logistic regression, female sex was not associated with survival (HR: 1.04, 95% CI: 0.56–1.92, P = 0.91). Variables associated with mortality included age (HR: 1.02, 95% CI: 1.05–1.09, P = 0.03) and ISS (HR: 1.07, 95% CI: 1.05–1.09, P < 0.001). Increasing Glascow Coma Scale was associated with survival (HR: 0.85, 95% CI: 0.82–0.89, P < 0.001). On subset analysis, premenopausal women (age < 50) did not have a survival advantage in comparison with similar aged males (HR: 0.68, 95% CI: 0.36–1.28, P = 0.24).

Discussion:

Sex differences in coagulation profile do not result in a survival advantage for females when MTP is required.