bluuebunny/crossref_metadata_2025 huggingface dataset:
Deriving internal crown geometric features of Douglas-fir from airborne laser scanning in a realized-gain trial
Authors: du Toit Francois , Coops Nicholas C , Goodbody Tristan R H , Stoehr Michael , El-Kassaby Yousry A
Published: November 2020

Tree improvement programs are critical to establishing high yield seed sources while maintaining genetic diversity and developing sustainable plantation forests. Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) is commonly used in improvement programs due to its superior strength and stiffness properties. Progeny testing trials in British Columbia (BC), Canada aim to increase stem volume without sacrificing wood quality. As genetically improved stock in BC is entering its fourth generation, wood quality and branch attributes are becoming more important as selection criteria evolve. This study investigates the utility of Airborne Laser Scanning (ALS) to produce metrics that describe branch attributes, and test whether these attributes showed differences in trees of three different genetic gain levels (GL); Wild-Stand (WS), Mid-Gain (MG) and Top-Cross (TC), planted at two different spacings (2.9 m and 4.0 m) in a realized-gain trial. New methods were developed to utilize ALS data to estimate metrics such as branch angle, length and volume using a point clustering approach. The relative impact of GL and spacing on branch attributes were assessed. Spacing was significant for branch angle (2.9 m = 73.53°, 4.0 m = 72.46°), whereas GL (WS = 0.861 m, MG = 0.917 m, TC = 0.948 m) and spacing (2.9 m = 0.884, 4.0 m = 0.942) were significant for length. For all metrics, TC trees at 4.0 m spacing were consistently significantly different whenever GL or the interaction effect was significant. This data provide an insight into how ALS can be used to model branch attributes, whereas the ability to analyse trees by plot, individual tree and individual branch attributes further allows researchers and foresters to maximize the value of ALS data. Findings from this research can be integrated into large-scale programs not just for monitoring trees, but also for identifying new trees that can display attributes associated with larger volumes and increased value.
Importance-aware personalized learning for early risk prediction using static and dynamic health data
Authors: Tan Qingxiong , Ye Mang , Ma Andy Jinhua , Yip Terry Cheuk-Fung , Wong Grace Lai-Hung , Yuen Pong C
Published: November 2020

Objective

Accurate risk prediction is important for evaluating early medical treatment effects and improving health care quality. Existing methods are usually designed for dynamic medical data, which require long-term observations. Meanwhile, important personalized static information is ignored due to the underlying uncertainty and unquantifiable ambiguity. It is urgent to develop an early risk prediction method that can adaptively integrate both static and dynamic health data.

Materials and Methods

Data were from 6367 patients with Peptic Ulcer Bleeding between 2007 and 2016. This article develops a novel End-to-end Importance-Aware Personalized Deep Learning Approach (eiPDLA) to achieve accurate early clinical risk prediction. Specifically, eiPDLA introduces a long short-term memory with temporal attention to learn sequential dependencies from time-stamped records and simultaneously incorporating a residual network with correlation attention to capture their influencing relationship with static medical data. Furthermore, a new multi-residual multi-scale network with the importance-aware mechanism is designed to adaptively fuse the learned multisource features, automatically assigning larger weights to important features while weakening the influence of less important features.

Results

Extensive experimental results on a real-world dataset illustrate that our method significantly outperforms the state-of-the-arts for early risk prediction under various settings (eg, achieving an AUC score of 0.944 at 1 year ahead of risk prediction). Case studies indicate that the achieved prediction results are highly interpretable.

Conclusion

These results reflect the importance of combining static and dynamic health data, mining their influencing relationship, and incorporating the importance-aware mechanism to automatically identify important features. The achieved accurate early risk prediction results save precious time for doctors to timely design effective treatments and improve clinical outcomes.
No Evidence That Salt Water Ingestion Kills Adult Mosquitoes (Diptera: Culicidae)
Authors: Yee Donald A , Dean Catherine , Webb Cameron , Henke Jennifer A , Perezchica-Harvey Gabriela , White Gregory S , Faraji Ary , Macaluso Joshua D , Christofferson Rebecca
Published: November 2020

Various products and insecticides are available that purport to reduce wild populations of adult mosquitoes. Recently, several manufacturers and general public comments on the internet have promoted devices that claim that ingestion of salt will significantly reduce populations of wild mosquitoes to near zero; there are no known scientific efficacy data that support these claims. We tested the survival of nine mosquito species of pest and public health importance across four adult diets: Water Only, Sugar Water Only (8.00%), Salt Water Only (1.03%), and Sugar + Salt Water. Species included the following: Aedes aegypti (L.), Aedes albopictus (Skuse), Aedes dorsalis (Meigen), Aedes notoscriptus (Skuse), Aedes vigilax (Skuse), Anopheles quadrimaculatus (Say), Culex pipiens (L.), Culex quinquefasciatus (Say), and Culex tarsalis (Coquillett). Male and female mosquitoes were placed in cages and allowed to feed on liquid diets under controlled environmental conditions for 1 wk. For seven of the nine species, adult survival was significantly higher in the presence (Sugar Water, Sugar + Salt Water) versus the absence (Water Only, Salt Only) of sugar, with no indication that salt had any effect on survival. Anopheles quadrimaculatus showed intermediate survival in Sugar + Salt to either Sugar Only or no sugar diets, whereas Aedes dorsalis showed low survival in Salt Only versus other diets. Based on our data and coupled with the fact that mosquitoes have physiological and behavioral adaptations that allow them to avoid or process excess salt (as found in blood meals), we conclude that there is no scientific foundation for salt-based control methods of mosquitoes.
Governing Practices and Strategic Narratives for Syrian Refugee Returns
Authors: Şahin Mencütek Zeynep
Published: November 2020

How do host states attempt to speed up returns of refugees before peacebuilding and the lack of official arrangements with the home state? Building on the conceptual framework, which coalesces governing practices, strategic narratives, and issue linkages, the article explains the early stages of policy formulation and discourses on refugee returns. Empirically, it draws from Turkey’s return initiatives targeting Syrians since 2016. It argues that the Turkish government seeks to advance in (1) practices promoting self-organized voluntary returns of a small number of refugees and (2) the preparation of ground for mass repatriation and resettlement back to Northern Syria. The strategic return narrative has 2-fold target audiences and aims. While keeping the domestic constituency stands as the main motivation by conveying the message of ‘Syrians are returning’, legitimizing unilateral cross-border interventions targets the international audience. The article contributes to the lack of research on the governance of refugee returns by examining the host states’ strategic narrating in relation to the domestic and geopolitical interests.
Direct transarterial embolization via the deep circumflex iliac artery for a type II endoleak using a novel Onyx™ mixture
Authors: Ghaly Paul , Schlaphoff Glen , Iliopoulos Jim , Ahmad Mehtab
Published: November 2020

Internal iliac artery aneurysms (IIAA) can be associated with abdominal aortic aneurysms. We describe a technique of successful transarterial embolization using a mixture of Onyx™ formulations in a 72-year-old with previous open and endovascular aneurysm repairs of his abdominal aorta and a residual large left IIAA causing a Type II endoleak. We demonstrate that utilization of the deep circumflex iliac artery is a safe and viable alternate route to treating IIAA when direct access is not achievable.
In vitro mutagenicity of selected environmental carcinogens and their metabolites in MutaMouse FE1 lung epithelial cells
Authors: Hölzl-Armstrong Lisa , Nævisdal Andrea , Cox Julie A , Long Alexandra S , Chepelev Nikolai L , Phillips David H , White Paul A , Arlt Volker M
Published: November 2020

Chemicals in commerce or under development must be assessed for genotoxicity; assessment is generally conducted using validated assays (e.g. Tk mouse lymphoma assay) as part of a regulatory process. Currently, the MutaMouse FE1 cell mutagenicity assay is undergoing validation for eventual use as a standard in vitro mammalian mutagenicity assay. FE1 cells have been shown to be metabolically competent with respect to some cytochrome P450 (CYP) isozymes; for instance, they can convert the human carcinogen benzo[a]pyrene into its proximate mutagenic metabolite. However, some contradictory results have been noted for other genotoxic carcinogens that require two-step metabolic activation (e.g. 2-acetylaminofluorene and 2-amino-3-methylimidazo[4,5-f]quinoxaline). Here, we examined three known or suspected human carcinogens, namely acrylamide, 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) and 4-aminobiphenyl (4-ABP), together with their proximate metabolites (i.e. glycidamide, N-OH-PhIP and N-OH-4-ABP), to aid in the validation of the FE1 cell mutagenicity assay. Assessments of the parent compounds were conducted both in the presence and absence of an exogenous metabolic activation mixture S9; assessments of the metabolites were in the absence of S9. The most potent compound was N-OH-PhIP -S9, which elicited a mutant frequency (MF) level 5.3-fold over background at 5 µM. There was a 4.3-fold increase for PhIP +S9 at 5 µM, a 1.7-fold increase for glycidamide −S9 at 3.5 mM and a 1.5-fold increase for acrylamide +S9 at 4 mM. Acrylamide −S9 elicited a marginal 1.4-fold MF increase at 8 mM. Treatment with PhIP −S9, 4-ABP ±S9 and N-OH-4-ABP −S9 failed to elicit significant increases in lacZ MF with any of the treatment conditions tested. Gene expression of key CYP isozymes was quantified by RT-qPCR. Cyp1a1, 1a2 and 1b1 are required to metabolise PhIP and 4-ABP. Results showed that treatment with both compounds induced expression of Cyp1a1 and Cyp1b1 but not Cyp1a2. Cyp2e1, which catalyses the bioactivation of acrylamide to glycidamide, was not induced after acrylamide treatment. Overall, our results confirm that the FE1 cell mutagenicity assay has the potential for use alongside other, more traditional in vitro mutagenicity assays.
Cognitive complaints in brain tumor patients and their relatives’ perspectives
Authors: Gosselt Isabel K , Scheepers Vera P M , Spreij Lauriane A , Visser-Meily Johanna M A , Nijboer Tanja C W
Published: November 2020

Background

Cognitive deficits have been frequently assessed in brain tumor patients. However, self-reported cognitive complaints have received little attention so far. Cognitive complaints are important as they often interfere with participation in society. In this study, cognitive complaints were systematically assessed in brain tumor patients. As patients’ experiences and relatives’ estimations may vary, the level of agreement was investigated.

Methods

Brain tumor outpatients (n = 47) and relatives (n = 42) completed the inventory Cognitive Complaints—Participation, assessing cognitive complaints across 10 daily life activities and cognitive domains (total, memory, executive, attention). Cognitive complaints scores were compared between patients with different clinical characteristics (tumor type, number of treatments, the absence/presence of epilepsy). Complaints difference scores in patient-relative pairs were calculated to explore the level of agreement using intraclass correlations (ICC). Furthermore, we explored whether the level of agreement was related to (1) the magnitude of cognitive complaints in patient-relative pairs and (2) patients’ cognitive functioning (assessed with the Montreal Cognitive Assessment).

Results

Patients and relatives reported most cognitive complaints during work/education (100%) and social contacts (88.1%). Patients with different clinical characteristics reported comparable cognitive complaints scores. Overall, the level of agreement in patient-relative pairs was moderate-good (ICC 0.73-0.86). Although in 24% of the pairs, there was a substantial disagreement. The level of agreement was not related to the magnitude of complaints in patient-relative pairs or patients’ cognitive functioning.

Conclusion

Both the perspectives of brain tumor patients and their relatives’ on cognitive complaints are important. Clinicians could encourage communication to reach mutual understanding.
A Low Level of Darunavir Resistance–Associated Mutation Emergence in Patients With Virological Failure During Long-term Use of Darunavir in People With HIV. The ANRS CO3 Aquitaine Cohort
Authors: Chaussade Hélène , Tumiotto Camille , Le Marec Fabien , Leleux Olivier , Lefèvre Lucile , Lazaro Estibaliz , Lafon Marie-Edith , Nyamankolly Elsa , Duffau Pierre , Neau Didier , Bellecave Pantxika , Bonnet Fabrice
Published: November 2020

Background

Ritonavir-boosted darunavir (DRV/r) is a protease inhibitor (PI) indicated for the treatment of naïve and pretreated HIV-infected patients since 2007. Our study aims to describe DRV/r-treated patients experiencing virological failure (VF) documented with HIV resistance testing.

Methods

Data from patients belonging to the ANRS CO3 Aquitaine Cohort treated with a regimen including DRV/r between February 2007 and December 2015 were analyzed. Baseline characteristics of patients experiencing VF (defined by 2 consecutive plasma viral loads >50 copies/mL) were compared with those without VF. We then described factors associated with VF as emergence of IAS DRV resistance–associated mutations (RAMs).

Results

Among the 1458 patients treated at least once with a DRV/r-based regimen, 270 (18.5%) patients experienced VF during follow-up, including 240 with at least 1 genotype resistance test (GRT). DRV RAMs were detected in 29 patients (12%). Among them, 25/29 patients had ≥2 DRV RAMs before DRV/r initiation, all of whom had experienced VF during previous PI treatments. For 18/29, DRV/r was maintained after VF, and controlled viremia was restored after modification of DRV-associated antiretroviral molecules or increased DRV dose. Finally, only 6/29 patients selected new DRV RAMs after DRV/r initiation. All of these experienced previous VFs while on other PIs.

Conclusions

These results highlight the efficacy and robustness of DRV/r, as the emergence of DRV RAMs appeared in <0.4% of patients receiving a DRV/r-based regimen in our large cohort.
A longitudinal analysis of fast-food exposure on child weight outcomes: Identifying causality through school transitions
Authors: Dunn Richard A , Nayga Rodolfo M , Thomsen Michael R , Rouse Heather L
Published: November 2020

This article investigates the effect of fast-food availability on childhood weight outcomes by gender, race, and location. We use a novel identification strategy based on changes in fast-food exposure along the route between the home and school that occur as students progress through the public school system and transition to different types of schools, e.g. from elementary school to intermediate school or from intermediate school to high school. Using a longitudinal census of height and weight for public school students in Arkansas, we find no evidence that changes in fast-food exposure are associated with changes in body mass index z-score for any student subpopulation.
FLUOROSCOPY-GUIDED BILIARY PROCEDURES IN A PREGNANT, LIVER TRANSPLANT PATIENT: FETUS RADIATION PROTECTION
Authors: Gerasia R , Cannataci C , Gallo G S , Tafaro C , Caruso C , Maruzzelli L , Miraglia R
Published: November 2020

We report three cases of clinically necessary, fluoroscopy-guided, percutaneous biliary procedures performed safely in a pregnant, liver transplant recipient using three different angiography suites. The uterine cumulative equivalent dose was 0.25 mSv, a value obtained by adding the doses of the three procedures described above, and which is relatively low when compared with the naturally occurring background radiation exposure for a 9-month pregnancy (~0.5–1 mSv). Our experience shows that staff knowledge, awareness and liaison promote the application of all dose reduction strategies possible while still achieving the clinical aim despite using different angiographic equipment.
Riding the Tiger: Managing Risk in U.S. Housing Finance and Health Insurance Welfare Markets
Authors: Morgan Kimberly J , Reisenbichler Alexander
Published: November 2020

This article examines the political and economic dynamics of welfare markets in the USA. These marketplaces differ from other public–private welfare arrangements in that the state crafts and sustains these markets with the aim of using competition to promote cost-effective welfare provision. However, welfare markets face fundamental tensions between competition and stability that we trace to the allocation of risk between the state and private providers. Faced with the prospect of bearing potential losses, private firms often deploy instruments to reduce risk, lobby for risk protections from policymakers, or threaten to exit the market. The result is markets that are either non-competitive but stable, or competitive but unstable. In short, when policymakers create welfare markets they are riding a tiger, making themselves vulnerable to the functioning of markets over which they have imperfect control. We theorize and illustrate these dynamics through analyses of mortgage securitization, Medicare Advantage markets and the Obamacare health exchanges. This article contributes to the study of the US welfare state, speaks to the perils of marketized welfare in rich democracies and shows how market reforms can lead to unexpected state expansion.
Seasonal variation in sleep homeostasis in migratory geese: a rebound of NREM sleep following sleep deprivation in summer but not in winter
Authors: van Hasselt Sjoerd J , Mekenkamp Gert-Jan , Komdeur Jan , Allocca Giancarlo , Vyssotski Alexei L , Piersma Theunis , Rattenborg Niels C , Meerlo Peter
Published: November 2020

Sleep is a behavioral and physiological state that is thought to serve important functions. Many animals go through phases in the annual cycle where sleep time might be limited, for example, during the migration and breeding phases. This leads to the question whether there are seasonal changes in sleep homeostasis. Using electroencephalogram (EEG) data loggers, we measured sleep in summer and winter in 13 barnacle geese (Branta leucopsis) under semi-natural conditions. During both seasons, we examined the homeostatic regulation of sleep by depriving the birds of sleep for 4 and 8 h after sunset. In winter, barnacle geese showed a clear diurnal rhythm in sleep and wakefulness. In summer, this rhythm was less pronounced, with sleep being spread out over the 24-h cycle. On average, the geese slept 1.5 h less per day in summer compared with winter. In both seasons, the amount of NREM sleep was additionally affected by the lunar cycle, with 2 h NREM sleep less during full moon compared to new moon. During summer, the geese responded to 4 and 8 h of sleep deprivation with a compensatory increase in NREM sleep time. In winter, this homeostatic response was absent. Overall, sleep deprivation only resulted in minor changes in the spectral composition of the sleep EEG. In conclusion, barnacle geese display season-dependent homeostatic regulation of sleep. These results demonstrate that sleep homeostasis is not a rigid phenomenon and suggest that some species may tolerate sleep loss under certain conditions or during certain periods of the year.
Insomnia in the context of short sleep increases suicide risk
Authors: Anna Karin Hedström , Hössjer Ola , Bellocco Rino , Ye Weimin , Trolle Lagerros Ylva , Åkerstedt Torbjörn
Published: November 2020

Study Objectives

The relationship between insomnia and suicide risk is not completely understood. We aimed to investigate the influence of insomnia on suicide risk, taking both sleep duration and depression into consideration.

Methods

The present study is based on a Swedish prospective cohort study of 38,786 participants with a mean follow-up time of 19.2 years. Cox proportional hazards models with attained age as time-scale were used to estimate hazard ratios (HRs) of death by suicide with 95% confidence intervals (CI) for participants categorized by frequency of insomnia symptoms. Causal mediation analysis was performed to assess to what extent the relationship between insomnia and suicide risk is mediated by depression.

Results

Insomnia was only associated with suicide risk among short sleepers, whereas no significant association was observed among those who slept 7 h/night or more. The total effect of insomnia in the context of short sleep on suicide risk, expressed on the HR scale, was 2.85 (95% CI 1.42–5.74). The direct effect was 2.25 (95% CI 1.12–4.54) and the indirect effect, mediated by depression, was 1.27 (95% CI 1.05–1.53). Of the total effect, 32% was mediated by depression. The association between insomnia and suicide risk became more pronounced with decreasing depressive symptoms (p value for trend <0.05).

Conclusions

Insomnia in the context of short sleep increases suicide risk, both directly and indirectly by affecting the risk of depression. Abnormalities of sleep duration and insomnia symptoms should be evaluated when assessing suicide risk.
Determinants of postpartum sleep duration and sleep efficiency in minority women
Authors: Spaeth Andrea M , Khetarpal Risha , Yu Daohai , Pien Grace W , Herring Sharon J
Published: November 2020

Study Objectives

To examine demographic, psychosocial, and behavioral determinants of postpartum sleep duration and sleep efficiency among a cohort of black and Latina women.

Methods

Data were from 148 women (67% black, 32% Latina) at 5 months postpartum, recruited from an academic medical center in Philadelphia. Relevant demographic, psychosocial and behavioral predictors were assessed via questionnaire. Nocturnal sleep was objectively measured for 1 week using wrist actigraphy. Sleep duration was examined as a continuous variable and in categories (<7 versus ≥7 h per night); sleep efficiency was examined as a continuous variable. Independent multiple linear regression models were built to evaluate significant determinants of sleep.

Results

Adjusted models revealed that breastfeeding, having a bedtime after midnight, and being employed were associated with shorter sleep duration (–25–33 min, all p < 0.05). Multiparity, being unmarried, being employed, breastfeeding, having a bedtime after midnight, bedsharing, and responding to infant awakenings by getting up immediately rather than waiting a few minutes to see if the infant fell back asleep, were all significant determinants of sleeping <7 h per night (OR varying: 2.29–4.59, all p < 0.05). Bedsharing was the only variable identified from the multiple regression model that associated with poorer sleep efficiency (–3.8%, p < 0.05).

Conclusions

Findings may inform interventions for improving postpartum sleep in socioeconomically disadvantaged, racial/ethnic minority postpartum women.
Cross-participant prediction of vigilance stages through the combined use of wPLI and wSMI EEG functional connectivity metrics
Authors: Imperatori Laura Sophie , Cataldi Jacinthe , Betta Monica , Ricciardi Emiliano , Ince Robin A A , Siclari Francesca , Bernardi Giulio
Published: November 2020

Functional connectivity (FC) metrics describe brain inter-regional interactions and may complement information provided by common power-based analyses. Here, we investigated whether the FC-metrics weighted Phase Lag Index (wPLI) and weighted Symbolic Mutual Information (wSMI) may unveil functional differences across four stages of vigilance—wakefulness (W), NREM-N2, NREM-N3, and REM sleep—with respect to each other and to power-based features. Moreover, we explored their possible contribution in identifying differences between stages characterized by distinct levels of consciousness (REM+W vs. N2+N3) or sensory disconnection (REM vs. W). Overnight sleep and resting-state wakefulness recordings from 24 healthy participants (27 ± 6 years, 13F) were analyzed to extract power and FC-based features in six classical frequency bands. Cross-validated linear discriminant analyses (LDA) were applied to investigate the ability of extracted features to discriminate (1) the four vigilance stages, (2) W+REM vs. N2+N3, and (3) W vs. REM. For the four-way vigilance stages classification, combining features based on power and both connectivity metrics significantly increased accuracy relative to considering only power, wPLI, or wSMI features. Delta-power and connectivity (0.5–4 Hz) represented the most relevant features for all the tested classifications, in line with a possible involvement of slow waves in consciousness and sensory disconnection. Sigma-FC, but not sigma-power (12–16 Hz), was found to strongly contribute to the differentiation between states characterized by higher (W+REM) and lower (N2+N3) probabilities of conscious experiences. Finally, alpha-FC resulted as the most relevant FC-feature for distinguishing among wakefulness and REM sleep and may thus reflect the level of disconnection from the external environment.
Mapping Africa’s Biodiversity: More of the Same Is Just Not Good Enough
Authors: Farooq Harith , Azevedo Josué A R , Soares Amadeu , Antonelli Alexandre , Faurby Søren
Published: November 2020

Species distribution data are fundamental to the understanding of biodiversity patterns and processes. Yet, such data are strongly affected by sampling biases, mostly related to site accessibility. The understanding of these biases is therefore crucial in systematics, biogeography, and conservation. Here we present a novel approach for quantifying sampling effort and its impact on biodiversity knowledge, focusing on Africa. In contrast to previous studies assessing sampling completeness (percentage of species recorded in relation to predicted), we investigate whether the lack of knowledge of a site attracts scientists to visit these areas and collect samples of species. We then estimate the time required to sample 90% of the continent under a Weibull distributed biodiversity sampling rate and the number of sampling events required to record $ \ge $50% of the species. Using linear and spatial regression models, we show that previous sampling has been strongly influencing the resampling of areas, attracting repeated visits. This bias has existed for over two centuries, has increased in recent decades, and is most pronounced among mammals. It may take between 172 and 274 years, depending on the group, to achieve at least one sampling event per grid cell in the entire continent. Just one visit will, however, not be enough: in order to record $ \ge $50% of the current diversity, it will require at least 12 sampling events for amphibians, 13 for mammals, and 27 for birds. Our results demonstrate the importance of sampling areas that lack primary biodiversity data and the urgency with which this needs to be done. Current practice is insufficient to adequately classify and map African biodiversity; it can lead to incorrect conclusions being drawn from biogeographic analyses and can result in misleading and self-reinforcing conservation priorities. [Amphibians; birds; mammals; sampling bias; sampling gaps; Wallacean shortfall.]
Evaluation of Longitudinal and Tubular Compression Treatment for Lower Limb Edema
Authors: Sibbald R. Gary , Elliott James A. , Coutts Patricia , Persaud-Jaimangal Reneeka
Published: November 2020

BACKGROUND

Many patients with lower limb edema do not tolerate traditional higher-pressure compression devices and require alternative devices for edema control.

METHODS

Two systems were evaluated for control of bilateral or unilateral lower limb edema: an elasticized longitudinal stockinette (ELS; EdemaWear; Compression Dynamics, Omaha, Nebraska) and an elasticized tubular bandage (ETB; Tubigrip; Mölnlycke Health Care, Norcross, Georgia). Twenty-five patients were recruited; patients with bilateral edema (n = 12) wore the ELS on one limb, and the ETB on the other. Patients with unilateral edema (n = 13) were randomized to wear either the ELS or ETB. Edema measurements, leg pain, and patient preference were recorded.

RESULTS

There were 14 females (56%) and 11 males (44%); mean age was 66 years (range, 32-88 years); and mean body mass index was 40.4 kg/m2 (range, 26.1–66.9 kg/m2). Patients with bilateral edema wearing ELS had a foot-to-leg circumference between 25.5 and 42.9 cm pre-ELS that remained essentially unchanged at 2 weeks. The five patients with unilateral edema using ELS had a 24.3– to 43.7-cm circumference pre-ELS and 24.2- to 42.6-cm range at 2 weeks. The patients with bilateral edema using ETBs had a foot-to-leg circumference of 25.5 to 43.7 cm before treatment, unchanged 2 weeks later. The eight patients with unilateral edema using ETB had a 25.4- to 45.3-cm circumference pre-ETB and 24.8– to 42.0-cm range post-ETB. Mean pain levels decreased from 1.0 at week 0 to 0.5 at week 2. More patients preferred ELS (17/23, 78.3%) over ETB (5/23, 21.7%).

CONCLUSIONS

Both systems were easy to apply and provided low compression without increased pain. The ELS was preferred by more patients (78.3%) than ETB (21.7%).
Conservative Management of Catastrophic Antiphospholipid Syndrome-Related Skin Necrosis: A Case Report
Authors: Niu Niu , Jiang Qixia , Cheng Dongrui , Wang Zhongling
Published: November 2020

Catastrophic antiphospholipid syndrome is an extremely rare autoimmune disease with complex and diverse clinical manifestations. Cutaneous necrosis is one of its rare clinical features. However, interventions for this manifestation are not standardized and lack evidence, which increases treatment difficulty. Here, study authors report the successful care and follow-up of a 46-year-old female patient with nephrotic syndrome and catastrophic antiphospholipid syndrome complicated by full-thickness cutaneous necrosis of the dorsum of the right hand that lasted more than 4 months and 1 month prior to wound treatment, respectively. Study authors set up an interprofessional team, including a nephrologist, a vascular surgeon, and two specialist wound care nurses to provide holistic wound care and treat her complex systemic conditions. After 84 days of treatment, which involved removing necrotic tissue with autolytic wound debridement, reducing inflammation with hydrofiber dressings containing silver, and promoting re-epithelialization with hydrocolloid paste and systemic medications, the wound healed successfully. Authors followed up with the patient at 1, 4, 6, 11, and 19 months after healing. The quality of scar was monitored, and the function of her right hand recovered normally.
Multimodality Imaging of Common Breast Cancers
Authors: Martin Jessica F. , Lee Su-Ju , Mahoney Mary C.
Published: November 2020

The most common types of primary breast malignancies (invasive ductal carcinoma, invasive lobular carcinoma, and ductal carcinoma in situ) each typically demonstrate unique imaging features. Given the increasing importance of diagnosing breast cancers as early as possible to ensure prompt treatment and improved patient outcomes, it is critical for radiologists to readily recognize these characteristics on multimodality imaging.
COVID-19
Authors: Rogge Mary Madeline , Gautam Bibha
Published: November 2020

In 2019, a novel coronavirus infection was detected in humans. As coronavirus disease 2019 (COVID-19) spread around the world, often confusing and contradictory information about the disease proliferated rapidly. This article reviews what is currently known about COVID-19, including transmission, epidemiology, immunologic responses, clinical manifestations, and disease management.
What did you say? A review of the management of sudden sensorineural hearing loss
Authors: Tiefel Nicole L.
Published: November 2020

Ambulatory care providers are likely to encounter patients who complain of sudden hearing loss and may be challenged to provide the most appropriate treatments. Using a vignette, this article provides an overview of recently updated guidelines that can help with rapid identification and management, to increase the likelihood of hearing improvement.
Ethical tipping point
Authors: Steers Mai-Ly N. , Gallups Sarah F.
Published: November 2020

This article discusses ethical concerns surrounding social media content posted by nurses; specifically, how these posts may violate public trust. It also summarizes considerations for nurses to contemplate before posting to social media and provides examples of positive uses of social media.
Characteristics of Women of Reproductive Age With Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status—United States, January 22–June 7, 2020
Authors: Ellington Sascha , Strid Penelope , Tong Van T. , Woodworth Kate , Galang Romeo R. , Zambrano Laura D. , Nahabedian John , Anderson Kayla , Gilboa Suzanne M.
Published: November 2020

(Abstracted from MMWR Morb Mortal Wkly Rep 2020;69:769–775)

Pregnant women are at greater risk of severe respiratory infection due to immunologic and physiologic changes in the setting of several viral infections such as influenza. However, there are limited data among this population to date that determine the prevalence and severity of COVD-19 and whether its signs and symptoms differ between pregnant and nonpregnant women.
Medical Students’ Reflections on the Recent Changes to the USMLE Step Exams
Authors: Cangialosi Peter T. , Chung Brian C. , Thielhelm Torin P. , Camarda Nicholas D. , Eiger Dylan S.
Published: November 2020

The United States Medical Licensing Examination (USMLE) consists of Step 1, Step 2 Clinical Knowledge, Step 2 Clinical Skills, and Step 3. To be licensed to practice medicine in the United States, medical students must pass all parts of the USMLE. However, in addition to that pass/fail grade, students are currently given a numerical score for Step 1, Step 2 Clinical Knowledge, and Step 3. Residency program directors have come to use the Step 1 score to efficiently screen a growing number of residency applicants. As a result, a deleterious environment in undergraduate medical education has been created, given the importance of Step 1 to medical students matching to their preferred residency program. It was announced in February 2020 that the score-reporting protocol for Step 1 would be changed from a 3-digit numerical score to pass/fail only, beginning no earlier than January 1, 2022. This decision will undoubtedly impact medical students, medical schools, and residency program directors.

Here, the authors discuss the impact that the change to Step 1 scoring will have on these key stakeholder groups, from their perspective as students at MD-granting medical schools in the United States. They also call attention to outstanding issues with the USMLE that must be addressed to improve undergraduate medical education for all stakeholders, and they offer advice for further improvements to the residency application process.
Evaluation of Biomarkers in Critical Care and Perioperative Medicine
Authors: Soussi Sabri , Collins Gary S. , Jüni Peter , Mebazaa Alexandre , Gayat Etienne , Le Manach Yannick
Published: November 2020

Interest in developing and using novel biomarkers in critical care and perioperative medicine is increasing. Biomarkers studies are often presented with flaws in the statistical analysis that preclude them from providing a scientifically valid and clinically relevant message for clinicians. To improve scientific rigor, the proper application and reporting of traditional and emerging statistical methods (e.g., machine learning) of biomarker studies is required. This Readers’ Toolbox article aims to be a starting point to nonexpert readers and investigators to understand traditional and emerging research methods to assess biomarkers in critical care and perioperative medicine.
Accuracy of Posterior Wall Acetabular Fracture Lag Screw Placement: Correlation Between Intraoperative Fluoroscopy and Postoperative Computer Tomography
Authors: Rashidifard Christopher , Boudreau John , Revak Thomas
Published: November 2020

Objective:

Compare intraoperative “on end” fluoroscopy lag screw position to postoperative computer tomography.

Design:

Retrospective review.

Clinical Setting:

Level 1 trauma center.

Patients:

One hundred sixteen patients sustaining operative acetabular fractures with posterior wall components.

Intervention:

Posterior wall lag screws placed using “on end” fluoroscopic imaging.

Main Outcome Measurements:

The primary outcome was determining correlation between lag screw position, in relation to the acetabular articular margin, using intraoperative fluoroscopy and postoperative computer tomography. Analysis was performed based on location around the acetabulum, including posterior (P), superoposterior (SP), and superior (S) regions, and screws 0–5, 5–10, and >10 mm from the joint.

Results:

Two hundred forty-four lag screws were identified as follows: 51.6% in the P group, 25.4% in SP, and 23.0% in the S group with excellent correlation noted in all groups. For screws pooled based on fluoroscopic distance from the joint, 28.3% were 0–5 mm, 52.9% 5.01–10 mm, and 18.4% >10 mm. Correlation coefficients were 0.60 for 0–5 mm and 0.68 for both groups >5 mm. Subdividing screws based on anatomic region and fluoroscopic location found increasing correlation as screws moved further from the joint in the P region. In the SP group, excellent correlation was noted for screws 0–5 mm with decreasing correlation further from the joint. Within the S group, correlation for screws 0–5 mm did not reach significance, but good correlation was noted for screws >5 mm. Overall incidence of intraarticular screws was 1.2%.

Conclusions:

Intraoperative axial fluoroscopy for posterior wall lag screw placement correlates closely with postoperative computer tomography allowing for reliable posterior wall lag screw placement in all regions around the acetabulum. Care should be taken while placing lag screws within 5 mm of the articular surface, particularly within the posterior region.
Pain During Sex Before and After Surgery for Lumbar Disc Herniation
Authors: Holmberg Siril T. , Salvesen Øyvind O. , Vangen-Lønne Vetle , Hara Sozaburo , Fredheim Olav M. , Solberg Tore K. , Jakola Asgeir S. , Solheim Ole , Nygaard Øystein P. , Gulati Sasha
Published: November 2020

Study Design.

Observational multicenter study.

Objective.

The aim of this study was to evaluate changes in pain during sexual activity after surgery for lumbar disc herniation (LDH).

Summary of Background Data.

There are limited data available on sexual function in patients undergoing surgery for LDH.

Methods.

Data were retrieved from the Norwegian Registry for Spine Surgery. The primary outcome was change in pain during sexual activity at one year, assessed by item number eight of the Oswestry disability index (ODI) questionnaire. Secondary outcome measures included ODI, EuroQol-5D (EQ-5D), and numeric rating scale (NRS) scores for back and leg pain.

Results.

Among the 18,529 patients included, 12,103 (64.8%) completed 1-year follow-up. At baseline, 16,729 patients (90.3%) provided information about pain during sexual activity, whereas 11,130 (92.0%) among those with complete follow-up completed this item. Preoperatively 2586 of 16,729 patients (15.5%) reported that pain did not affect sexual activity and at 1 year, 7251 of 11,130 patients (65.1%) reported a normal sex-life without pain. Preoperatively, 2483 (14.8%) patients reported that pain prevented any sex-life, compared to 190 patients (1.7%) at 1 year. At baseline, 14,143 of 16,729 patients (84.5%) reported that sexual activity caused pain, and among these 7232 of 10,509 responders (68.8%) reported an improvement at 1 year. A multivariable regression analysis showed that having a life partner, college education, working until time of surgery, undergoing emergency surgery, and increasing ODI score were predictors of improvement in pain during sexual activity. Increasing age, tobacco smoking, increasing body mass index, comorbidity, back pain >12 months, previous spine surgery, surgery in two or more lumbar levels, and complications occurring within 3 months were negative predictors.

Conclusion.

This study clearly demonstrates that a large proportion of patients undergoing surgery for LDH experienced an improvement in pain during sexual activity at 1 year.

Level of Evidence: 2
Use of Inhaled Volatile Anesthetics for Longer Term Critical Care Sedation: A Pilot Randomized Controlled Trial
Authors: Jerath Angela , Wong Kelvin , Wasowicz Marcin , Fowler Tara , Steel Andrew , Grewal Deep , Huszti Ella , Parotto Matteo , Zhang Haibo , Wilcox M. Elizabeth , McDonald Bernard , Overgaard Christopher , Rao Vivek , Ferguson Niall D.
Published: November 2020

Objectives:

Assess feasibility, barriers to recruitment, and safety of volatile-based sedation in longer term sedation patients in North American ICUs with limited or no experience with volatile sedation.

Design:

Open-label, pilot randomized clinical trial performed between October 2013 and September 2018.

Setting:

Four Canadian ICUs across two academic tertiary and quaternary hospitals.

Patients:

Sixty adults anticipated needing sedation and invasive ventilation beyond 48 hours with tidal volumes greater than 350 mL, expected 6-month mortality risk less than 50%, no evidence of high intracranial pressure, or drug contraindications (malignant hyperthermia, allergy).

Interventions:

2:1 randomization to inhaled volatile sedation using isoflurane or standard midazolam and/or propofol IV sedation.

Measurement and Main Results:

Primary outcome of safety and feasibility was assessed by staff satisfaction scores using a five-point Likert scale and serum fluoride measurements. Secondary clinical outcomes included time to extubation, quality of sedation, opioid use, cardiorespiratory parameters, vasopressor and antipsychotic drug use, and 3-month cognitive outcome measured using telephone interview for cognitive status. From 2,210 screened patients, 308 met eligibility criteria secondary to many not requiring sedation, extubation planned within 48 hours, high risk of death, or low tidal ventilation. Of 308 patients, 60 were randomized to isoflurane (n = 41) or IV (n = 19) sedation secondary to lack of substitute decision-maker or physician consent. Duration of inhaled isoflurane and IV sedation were median of 114 and 88 hours, respectively. Nine isoflurane patients crossed into the IV arm secondary to mainly hypercarbia from low tidal ventilation. Nursing and respiratory therapy staff satisfaction scores were quantitatively similar between both sedation approaches. Serum fluoride levels rose with duration of isoflurane sedation but were not associated with altered kidney function. There were no significant differences in secondary clinical outcomes.

Conclusions:

We showed adequate preliminary safety and acceptability of inhaled volatile anesthetics for long-term sedation.
The Self-management Smartphone Application for Cancer Survivors, ReLive
Authors: Song Chi Eun , An Minjeong
Published: November 2020

ReLive is a nursing theory–driven and evidence-based smartphone application that aims to promote self-management among cancer survivors. It has been designed to display symptom measurement results in different traffic light colors, depending on the severity of a user's symptoms (eg, severe symptoms are presented in red). Therefore, it is easy for users to draw inferences about changes in their symptoms. Further, users can simultaneously set several physical activity goals and monitor their performance. Social support, self-efficacy, and quality of life of a user can also be monitored regularly. This study investigated the usability of this application. An iterative formative test, including a cognitive walkthrough and face-to-face interviews, was conducted. Participants were seven individuals with a diagnosis of chronic myeloid leukemia. The ease of use and understanding, acceptability, and usefulness of the application were evaluated. The results revealed that the participants had evaluated ReLive positively. This program could be used as an intervention to deliver health information and manage their performance. Further research is needed to assess the application's effects on self-management among survivors of various types of cancers.
Intensive Care Unit Nurse: Could We Call a Palliative Care Consult? Intensive Care Unit Provider: It's Too Early. Palliative Care Integration in the Intensive Care Unit: The Struggle to Translate Evidence Into Practice
Authors: McAndrew Natalie S. , Guttormson Jill , Marks Sean , Rhodes Mary , Patel Jayshil , McCracken Colleen
Published: November 2020

Despite evidence regarding the value of palliative care, there remains a translation-to-practice gap in the intensive care setting. The purpose of this article is to describe challenges and propose solutions to palliative care integration through the presentation and discussion of a critical care patient scenario. We also present recommendations for a collaborative palliative care practice framework that holds the potential to improve quality of life for patients and families. Collaborative palliative care is characterized by close working relationships with families, interprofessional intensive care unit healthcare teams, and palliative care specialists. The shortage of palliative care specialists has become a pressing policy and practice issue and highlights the importance of increasing primary palliative care delivery by the intensive care team. Underexplored aspects of collaborative palliative care delivery include the interprofessional communication required, identification of key skills, and expected outcomes. Increased recognition of intensive care unit palliative care as a process of engagement among nurses, providers, patients, and their family members heralds a vital culture shift toward collaborative palliative care. The interprofessional palliative specialist team has the expertise to support intensive care teams in developing their primary palliative skills and recognizing when specialist palliative care support is required. Promotion of strategic palliative care delivery through this collaborative framework has the potential to decrease suffering among patients and families and reduce moral distress among healthcare professionals.