bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantification of Viable Cells of Pseudomonas syringae pv. tomato in Tomato Seed Using Propidium Monoazide and a Real-Time PCR Assay
Authors: Chai A-li , Ben Hai-yan , Guo Wei-tao , Shi Yan-xia , Xie Xue-wen , Li Lei , Li Bao-ju
Published: February 2020

Pseudomonas syringae pv. tomato is a seedborne pathogen that causes bacterial speck disease in tomato. P. syringae pv. tomato is typically detected in tomato seed using quantitative real-time PCR (qPCR) but the inability of qPCR to distinguish between viable and nonviable cells might lead to an overestimation of viable P. syringae pv. tomato cells. In the present study, a strategy involving a propidium monoazide (PMA) pretreatment followed by a qPCR (PMA-qPCR) assay was developed for quantifying viable P. syringae pv. tomato cells in contaminated tomato seed. PMA could selectively bind to the chromosomal DNA of dead bacterial cells and, therefore, block DNA amplification of qPCR. The primer pair Pst3F/Pst3R was designed based on gene hrpZ to specifically amplify and quantify P. syringae pv. tomato by qPCR. The PMA pretreatment protocol was optimized for selectively detecting viable P. syringae pv. tomato cells, and the optimal PMA concentration and light exposure time were 10 μmol liter−1 and 10 min, respectively. In the sensitivity test, the detection limit of PMA-qPCR for detecting viable cells in bacterial suspension and artificially contaminated tomato seed was 102 CFU ml−1 and 11.86 CFU g−1, respectively. For naturally contaminated tomato seed, viable P. syringae pv. tomato cells were quantified in 6 of the 19 samples, with infestation levels of approximately 102 to 104 CFU g−1. The results indicated that the PMA-qPCR assay is a suitable tool for quantifying viable P. syringae pv. tomato cells in tomato seed, which could be useful for avoiding the potential risks of primary inoculum sources from contaminated seed.
The Elements of a Nursing Malpractice Case, Part 4: Harm
Authors: Brous Edie
Published: February 2020

Harm must be proven to collect damages.
The Professional Behaviors New Nurses Need: Findings From a National Survey of Hospital Nurse Leaders
Authors: Sortedahl Charlotte , Ellefson Shanna , Fotsch Danielle , Daley Katie
Published: February 2020

AIM

The purpose of this study was to survey hospital nurse leaders throughout the United States to determine which professional behaviors they believe are essential for nursing students to learn in the classroom.

BACKGROUND

This study was part of a multiphase study. The survey was revised from a previous survey administered to nurse leaders in the Midwest.

METHOD

Participants were surveyed using 46 items in the categories of Change, Communication, Conflict, Leadership, and Self-Awareness.

RESULTS

The highest ranked category was Communication, followed by Self-Awareness, Change, Leadership, and Conflict. The highest rated items in each category were communication with patients, accept constructive criticism, manage change, prioritization, and conflict resolution techniques.

CONCLUSION

Nurse educators and leaders can use the findings to continue to refine nursing education.
Menstrual Bleeding and Spotting With the Levonorgestrel Intrauterine System (52 mg) During the First-Year Post-Insertion: A Systematic Review and Meta-analysis
Authors: Maldonado Lauren Y. , Sergison Jill E. , Gao Xiaoming , Hubacher David
Published: February 2020

(Abstracted from Am J Obstet Gynecol 2019. doi:10.1016/j.ajog.2019.09.044)

Many users of the levonorgestrel intrauterine system (LNG-IUS) have medically benign changes in their menstrual pattern. Prescribing information for the most commonly used LNG-IUS devices report an overall decrease in bleeding and spotting days over time.
Oral Antihypertensive Regimens (Nifedipine Retard, Labetalol, and Methyldopa) for Management of Severe Hypertension in Pregnancy: An Open-Label, Randomized Controlled Trial
Authors: Easterling Thomas , Mundle Shuchita , Bracken Hillary , Parvekar Seema , Mool Sulabha , Magee Laura A. , von Dadelszen Peter , Shochet Tara , Winikoff Beverly
Published: February 2020

(Abstracted from Lancet 2019;394:1011–1121)

Hypertension complicates 1 in 10 pregnancies and has been associated with a number of maternal, fetal, and neonatal adverse events. In cases of severe hypertension (defined by a systolic blood pressure [BP] ≥ 160 mm Hg or diastolic BP ≥ 110 mg), urgent antihypertensive treatment is warranted.
Ursodeoxycholic Acid Versus Placebo in Women With Intrahepatic Cholestasis of Pregnancy (PITCHES): A Randomized Controlled Trial
Authors: Chappell Lucy C. , Bell Jennifer L. , Smith Anne , Linsell Louise , Juszczak Edmund , Dixon Peter H. , Chambers Jenny , Hunter Rachael , Dorling Jon , Williamson Catherine , Thornton Jim G.
Published: February 2020

(Abstracted from Lancet 2019;394:849–860)

Intrahepatic cholestasis of pregnancy (ICP) is a common liver disorder associated with preterm birth, stillbirth, meconium-stained amniotic fluid, and admission to the neonatal unit. Ursodeoxycholic acid (UDA) is widely recommended for the treatment of ICP, but adequate evidence to support this treatment is lacking.
Incidence of Maternal Sepsis and Sepsis-Related Maternal Deaths in the United States
Authors: Hensley Matthew K. , Bauer Melissa E. , Admon Lindsay K. , Prescott Hallie C.
Published: February 2020

(Abstracted from JAMA 2019;322(9):890–892)

Limited data exist on the incidence of maternal sepsis and sepsis-related mortality in the US population-based estimates have had a limited focus on specific populations or have not followed patients longitudinally. In this research letter, the authors assess the nationwide incidence and outcomes of maternal sepsis and sepsis-related mortality overall, during, and after delivery hospitalization.
A Primer on the Military Health System’s Approach to Medical Research and Development
Authors: Rasmussen Todd E. , Kellermann Arthur L. , Rauch Terry M.
Published: February 2020

The Military Health System (MHS) has a medical research program aimed at a wide range of health-, disease-, and injury-related topic areas that works with civilian academic institutions and the biomedical industry to accomplish its goals. There are many opportunities for civilian academic institutions and the biomedical industry to engage with this program, but its unique features are important to understand to optimize the chances for successful partnerships. Unlike the National Institutes of Health, which uses an “investigator-initiated” approach, the Department of Defense (DoD) aligns its funding with specific needs, also referred to as requirements; thus, DoD research is often described as “requirements-driven” research. At the highest level, requirements are aligned with the National Security Strategy and National Defense Strategy, though requirements documents list specific areas in medicine with unmet needs. Military labs and the Uniformed Services University of the Health Sciences, which can also receive DoD appropriations to conduct medical research, serve as hubs that interface with civilian academic institutions and the biomedical industry and organize and track the overall progress of DoD investments. As a mechanism to propel findings from “bench to bedside,” the military budgets funds for the various phases of research and development for a given topic area. Research programs are most effective when they are integrated into the MHS learning health system, which allows MHS clinical communities to inform and track research investments and evaluate the utility of research products in real clinical practice settings. This Perspective provides introductory information and a basic framework for those interested in performing DoD-funded medical research or collaborating with researchers in military labs. It is hoped that as academic institutions and the biomedical industry look to increase efficiency in medical research, they will find ways to engage with DoD research opportunities and consider elements of the military’s approach useful.
Using a Logic Model to Design and Evaluate a Quality Improvement Leadership Course
Authors: Rajashekara Shruthi , Naik Aanand D. , Campbell Claire M. , Gregory Megan E. , Rosen Tracey , Engebretson Autumn , Godwin Kyler M.
Published: February 2020

Strong leadership is an essential factor in the success of quality improvement (QI) initiatives that generate and sustain improvements in patient outcomes. Notably, there is a rising need for frontline clinicians, who are often charged with leading QI efforts, to receive training in blended QI and leadership methods and skills. The Leading Healthcare Improvement (LHI) course is a longitudinal leadership course embedded within the Department of Veterans Affairs Quality Scholars (VAQS) program, a multisite interprofessional QI fellowship program. The LHI course was developed to provide frontline clinicians who are emerging QI leaders with the skills to lead and advance improvement efforts at their institutions. It consists of eight 60-minute online sessions and was implemented and delivered to a cohort of interprofessional fellows at 9 sites during the 2017–2018 academic year.

This article describes the use of a logic model as a framework to guide the planning, implementation, and evaluation of the LHI course. The authors developed 5 logic model components: inputs, activities, outputs, short-term outcomes, and long-term outcomes. They defined the short-term outcomes using feedback from fellows and an evaluation of the fellows’ abstract submissions to the VAQS Summer Institute. Submissions were reviewed to identify how fellows applied the LHI course concepts to QI projects at their respective sites. The authors also collected preliminary impact data from fellows to determine long-term outcomes.

Finally, they used the logic model to inform changes to the LHI course based on the evaluation data they collected and developed plans to measure the impact of the course on learners, patients, and the health care system. The authors conclude with lessons learned to guide others who are implementing similar QI efforts.
Gendered Expectations: Strategies for Navigating Structural Challenges in Support of Transgender and Nonbinary Trainees in Academic Medicine
Authors: Cook Tiffany E. , Dimant Oscar E. , Novick Rebecca , Adegbola Adetoro , Blackstock Uché , Drake Carolyn B. , Patenaude Mason E. , Ravenell Joseph E. , Radix Asa , Greene Richard E.
Published: February 2020

Members of the lesbian, gay, bisexual, transgender, and queer community experience marginalization, bias, and discrimination, including in the world of academic medicine. People who are transgender and nonbinary (TGNB) experience further marginalization compared with individuals who are lesbian, gay, bisexual, and queer. According to a recent survey, more than half of medical students who are TGNB chose not to disclose their gender identities during training due to fears of discrimination, feeling a lack of support, and concerns about future career options. Academic medicine has historically pathologized TGNB individuals, perpetuating discrimination structurally and reinforcing discriminatory behaviors of peers and faculty. In this Perspective, the authors provide a comprehensive overview of the challenges that administrators and educators face in creating a learning environment that is inclusive of TGNB trainees. They outline opportunities for change and provide strategies to address administrative and educational challenges, including those related to institutional climate, policies, data collection, physical spaces, health care, curriculum, mentoring, and the evaluation of TGNB trainees. Finally, the authors issue a call to action for medical educators and administrators to create environments in which trainees who are TGNB can fulfill their educational mission: to learn the practice of medicine.
Toward Creating Equity in Awards Received During Medical School: Strategic Changes at One Institution
Authors: Teherani Arianne , Harleman Elizabeth , Hauer Karen E. , Lucey Catherine
Published: February 2020

Membership in the Alpha Omega Alpha Honor Medical Society (AΩA) is a widely recognized achievement valued by residency selection committees and employers. Yet research has shown selection favors students from racial/ethnic groups not underrepresented in medicine (not-UIM). The authors describe efforts to create equity in AΩA selection at the University of California, San Francisco, School of Medicine, through implementation of a holistic selection process, starting with the class of 2017, and present outcomes.

Informed by the definition ofholistic review, medical school leaders applied strategic changes grounded in evidence on inclusion, mitigating bias, and increasing opportunity throughout the AΩA selection process. These addressed increasing selection committee diversity, revising selection criteria and training committee members to review applications using a new instrument, broadening student eligibility and inviting applications, reviewing blinded applications, and making final selection decisions based on review and discussion of a rank-ordered list of students that equally weighted academic achievement and professional contributions.

The authors compared AΩA eligibility and selection outcomes for 3 classes (2014–2016) during clerkship metric–driven selection, which prioritized academic achievement, and 3 classes (2017–2019) during holistic selection. During clerkship metric–driven selection, not-UIM students were 4 times more likely than UIM students to be eligible for AΩA (P= .001) and 3 times more likely to be selected (P= .001). During holistic selection, not-UIM students were 2 times more likely than UIM students to be eligible for AΩA (P= .001); not-UIM and UIM students were similarly likely to be selected (odds ratio = .7,P= .12)

This new holistic selection process created equity in representation of UIM students among students selected for AΩA. Centered on equity pedagogy, which advocates dismantling structures that create inequity, this holistic selection process has implications for creating equity in awards selection during medical education.
Quality of Life in Youth With Chronic Pain
Authors: Lee Soeun , McMurtry C. Meghan , Summers Caroline , Edwards Kim , Elik Nezihe , Lumley Margaret N.
Published: February 2020

Objectives:

Pediatric chronic pain has often been examined from a risk perspective, and relatively less is known about the individual and family-level resilience factors that help youth with chronic pain maintain their quality of life (QOL). This cross-sectional study: (1) examined the relations among purported youth and parent resilience (youth pain acceptance and pain self-efficacy, parent psychological flexibility) and risk (youth pain intensity and parent protectiveness) factors with youth QOL, and (2) tested exploratory statistical mechanisms that may explain relations between parent and youth variables.

Methods:

Participants included 122 youth (10 to 17 y; M=14.26, SD=2.19) seen in an interdisciplinary pediatric chronic pain program and a parent. Youth completed measures of their average pain, QOL, pain acceptance, and pain self-efficacy. Parents completed measures of their pain-related psychological flexibility and behavioral responses to pain (ie, protectiveness, distraction, monitoring, minimizing).

Results:

Youth pain acceptance, pain self-efficacy, and parent psychological flexibility were highly positively correlated with each other, and with overall youth QOL. Evidence for a buffering effect of pain acceptance and pain self-efficacy on the association between pain intensity and QOL was not found. Protectiveness was found to be a significant mediator of the relation between parental psychological flexibility and youth QOL.

Discussion:

The results are discussed in the context of the resilience-risk framework and current understandings of the role of parental factors for pediatric chronic pain.
Effect of Extended Prophylactic Antibiotic Duration in the Treatment of Open Fracture Wounds Differs by Level of Contamination
Authors: Stennett Christina A. , O'Hara Nathan N. , Sprague Sheila , Petrisor Brad , Jeray Kyle J. , Leekha Surbhi , Yimgang Doris P. , Joshi Manjari , O'Toole Robert V. , Bhandari Mohit , Slobogean Gerard P. ,   the FLOW Investigators
Published: February 2020

Objective:

To determine the association between prophylactic antibiotic duration after the definitive wound closure of an open fracture and deep surgical site infection (SSI).

Design:

Retrospective cohort study.

Setting:

41 clinical sites in the United States, Canada, Australia, Norway, and India.

Participants:

Patients (N = 2400) with open fractures of the extremities who participated in the Fluid Lavage of Open Wounds (FLOW) trial.

Intervention:

Extended antibiotic prophylaxis, defined as more than 72 hours of continuous antibiotic use after definitive wound closure.

Main Outcome Measurement:

Deep SSI diagnosed within 1 year of enrollment.

Results:

Forty-two percent of participants received extended antibiotic prophylaxis. Deep SSI prevalence was 5%, 8%, and 23% for wounds with mild, moderate, and severe contamination, respectively. In open fractures with mild contamination, extended antibiotic use showed a trend toward increased odds [adjusted odds ratio (aOR) = 1.39; 95% confidence interval (CI), 0.92–2.11] of deep SSI compared with shorter use. No association was found among patients with moderate contamination (aOR = 1.09; 95% CI, 0.53–2.27). By contrast, extended antibiotic prophylaxis was strongly protective (aOR = 0.20; 95% CI, 0.07–0.60) against deep SSI in patients with severe contamination. Propensity score sensitivity analysis results were consistent with these findings.

Conclusions:

The evidence suggests differential effects of extended postclosure antibiotic duration on SSI odds contingent on the degree of contamination in open fracture wounds. Although extended antibiotic duration resulted in lower odds of SSI among patients with severely contaminated wounds, we observed a trend toward higher odds of SSI in mildly contaminated wounds.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Making the Most of Systematic Reviews and Meta-analyses in Spine Surgery
Authors: Lu Victor M. , Graffeo Christopher S. , Mikula Anthony L. , Perry Avital , Carlstrom Lucas P. , Elder Benjamin D. , Freedman Brett A. , Krauss William E.
Published: February 2020

Study Design.

Review.

Objective.

To provide practicing spine surgeons a primer with key insights for reading, interpreting, and clinically integrating systematic reviews and meta-analyses.

Summary of Background Data.

Evidence-based medicine (EBM) refers to a family of standardized techniques for critical appraisal of clinical research. Within the contemporary spine literature, EBM is most commonly encountered in the form of systematic reviews and meta-analyses. Although these analytic techniques are potentially useful when appropriately applied to well-formulated questions with adequate primary data in the literature, the rapid and somewhat indiscriminate increase in volume of systematic reviews and meta-analyses published may be associated with an overall dilution in their quality, as well as misperceptions regarding the applicability of particular EBM studies to spine surgery in general.

Methods.

The collective experience of spine specialists with vested interests in advancing EBM and its utility was summarized into a primer.

Results.

We emphasize components that are pertinent methodologically (search strategy, study number, meta-analysis, bias, and certainty), and pertinent clinically (outcomes) to interpreting, and clinically integrating systematic reviews and meta-analyses into spine surgery practice.

Conclusions.

Armed with these insights into these five perspectives, we anticipate that practicing spine surgeons will be better equipped to interpret systematic reviews and meta-analyses in a fashion that will meaningfully impact their patient care.

Level of Evidence: 2
The Effect of Surgical Decompression and Fusion on Functional Balance in Patients With Degenerative Lumbar Spondylolisthesis
Authors: Haddas Ram , Lieberman Isador , Block Andrew , Derman Peter
Published: February 2020

Study Design.

Prospective cohort study.

Objective.

To quantify the effect of lumbar decompression and fusion surgery on balance and stability in patients with degenerative lumbar spondylolisthesis (DLS) and compare them to controls.

Summary of Background Data.

DLS is a condition in which one vertebra subluxates relative to an adjacent vertebra in the absence of a disruption in the neural arch. While the existing literature demonstrates that decompression and fusion can successfully alleviate pain and reduce disability in patients with DLS, no studies to date have used quantitative dynamic testing to determine the effect of surgery on cone of economy (CoE) measures in this patient population.

Methods.

Forty-five DLS patients performed a series of functional balance tests a week before and 3 months after surgery and were compared to 28 controls. The outcome measures included range of sway (RoS) and total sway for the center of mass (CoM) and head in the sagittal, coronal, and axial planes, along with leg and back Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Fear/Avoidance Behavior Questionnaire (FABQ), Tampa Scale of Kinesophobia (TSK), and Demoralization scale.

Results.

RoS for the CoM (P < 0.005) and head (P < 0.017) decreased in all planes postoperatively. Reductions in CoM (P = 0.001) and head total sway (P = 0.001) were also observed after surgery. Furthermore, patients with DLS reported strong improvements in VAS low back (P = 0.001), VAS leg (P = 0.001), ODI (P = 0.001), FABQ Physical (P = 0.003), TSK (P = 0.001), and demoralization (P = 0.044) with surgical intervention. Although total sway was reduced after surgery, it did not return to the level of normal controls as demonstrated with more total sway of their CoM (P = 0.002) and head (P = 0.001) as well as more sagittal head RoS (P = 0.048).

Conclusion.

This study confirms that surgical intervention for degenerative spondylolisthesis is effective at reducing disability, back and leg pain, demoralization, kinesiophobia, and fear-avoidance beliefs related to physical activity in patients with DLS. Furthermore, such patients exhibit a significantly more stable stance after surgery. However, balance parameters did not completely normalize by 3 months postoperatively.

Level of Evidence: 3
Preoperative Risk Stratification
Authors: Casper David S. , Rihn Jeffrey A.
Published: February 2020

Study Design.

Spine update.

Objective.

The purpose of this study is to provide a review of preoperative clearance and optimization, before elective spine surgery.

Summary of Background Data.

Patient optimization preceding elective surgery is critical to ensure the best possible outcome.

Methods.

Historical and current literature pertaining to patient clearance and optimization, before elective surgery, was reviewed. These data were then synthesized and assessed to provide a balanced view on current trends in regards to preoperative management and optimization.

Results.

The American Academy of Cardiology defines spine surgery as “intermediate” risk, and thus patients are permitted to forgo formal cardiac evaluation if they have no active cardiac condition and demonstrate adequate functional capacity; however, those with active or chronic medical conditions require further investigation before elective operations.

Conclusion.

Overall, preoperative screening and optimization of comorbidities are vital to ensure positive outcomes in elective spine surgery, and the aforementioned criteria must be considered on an individual basis. Further research into specific preoperative optimization guidelines would help to ensure successful outcomes for those undergoing spine surgery.

Level of Evidence: N/A
Mean Airway Pressure As a Predictor of 90-Day Mortality in Mechanically Ventilated Patients*
Authors: Sahetya Sarina K. , Wu T. David , Morgan Brooks , Herrera Phabiola , Roldan Rollin , Paz Enrique , Jaymez Amador A. , Chirinos Eduardo , Portugal Jose , Quispe Rocio , Brower Roy G. , Checkley William ,   INTENSIVOS Cohort Study
Published: February 2020

Objectives:

To determine the association between mean airway pressure and 90-day mortality in patients with acute respiratory failure requiring mechanical ventilation and to compare the predictive ability of mean airway pressure compared with inspiratory plateau pressure and driving pressure.

Design:

Prospective observational cohort.

Setting:

Five ICUs in Lima, Peru.

Subjects:

Adults requiring invasive mechanical ventilation via endotracheal tube for acute respiratory failure.

Interventions:

None.

Measurements and Main Results:

Of potentially eligible participants (n = 1,500), 65 (4%) were missing baseline mean airway pressure, while 352 (23.5%) were missing baseline plateau pressure and driving pressure. Ultimately, 1,429 participants were included in the analysis with an average age of 59 ± 19 years, 45% female, and a mean Pao
2/Fio
2 ratio of 248 ± 147 mm Hg at baseline. Overall, 90-day mortality was 50.4%. Median baseline mean airway pressure was 13 cm H2O (interquartile range, 10–16 cm H2O) in participants who died compared to a median mean airway pressure of 12 cm H2O (interquartile range, 10–14 cm H2O) in participants who survived greater than 90 days (p < 0.001). Mean airway pressure was independently associated with 90-day mortality (odds ratio, 1.38 for difference comparing the 75th to the 25th percentile for mean airway pressure; 95% CI, 1.10–1.74) after adjusting for age, sex, baseline Acute Physiology and Chronic Health Evaluation III, baseline Pao
2/Fio
2 (modeled with restricted cubic spline), baseline positive end-expiratory pressure, baseline tidal volume, and hospital site. In predicting 90-day mortality, baseline mean airway pressure demonstrated similar discriminative ability (adjusted area under the curve = 0.69) and calibration characteristics as baseline plateau pressure and driving pressure.

Conclusions:

In a multicenter prospective cohort, baseline mean airway pressure was independently associated with 90-day mortality in mechanically ventilated participants and predicts mortality similarly to plateau pressure and driving pressure. Because mean airway pressure is readily available on all mechanically ventilated patients and all ventilator modes, it is a potentially more useful predictor of mortality in acute respiratory failure.
YEARS Algorithm Versus Wells’ Score: Predictive Accuracies in Pulmonary Embolism Based on the Gold Standard CT Pulmonary Angiography*
Authors: Abdelaal Ahmed Mahmoud M. Alkhatip Ahmed , Donnelly Maria , Snyman Lindi , Conroy Patrick , Hamza Mohamed Khaled , Murphy Ian , Purcell Andrew , McGuire David
Published: February 2020

Objectives:

This study retrospectively applied Wells’ score and YEARS algorithm to the same sample of patients to evaluate the predictive performance of each when compared with the gold standard CT pulmonary angiography.

Design:

Retrospective analytical study.

Setting:

A tertiary University Hospital in Ireland.

Patients:

Data from 794 patients who underwent CT pulmonary angiography to rule out pulmonary embolism.

Interventions:

Patients were analyzed using retrospective application of both Wells’ score and YEARS algorithm. Sensitivity, specificity, and diagnostic odds ratio were calculated and compared.

Measurements and Main Results:

Of 794 scans, 78 (9.8%) were positive for pulmonary embolism. The YEARS algorithm was more sensitive than the Wells’ score (97.44% vs 74.36%) but was less specific (13.97% vs 33.94%). Furthermore, the diagnostic odds ratio of YEARS was higher than Wells’ score (6.27 vs 1.48). YEARS provides better negative predictive value (98% vs 92.4%), and both scores have poor positive predictive value (10.9%).

Conclusions:

Both scores successfully exclude pulmonary embolism, although YEARS has a better negative predictive value. Both exhibit poor positive predictive value.
The Ethics of Compulsory Treatment of Addictions Under Canadian Legislation: Restricting Freedom to Promote Long-Term Autonomy?
Authors: Chase Jocelyn
Published: February 2020

The opioid epidemic has brought a growing focus on the treatment of addictions. Some have proposed that patients with severe addiction be subject to mandated compulsory treatment under Canadian Mental Health Legislation, paralleling the growing use of civil commitment for addiction treatment in the United States. This article presents a bioethical analysis of the legal, medical, and societal implications of compulsory treatment for addiction under civil commitment. Concerns around patient autonomy, harm, efficacy, and social justice make compulsory treatment of addiction an inadequate routine option for a complex biopsychosocial illness. Instead, continued efforts to foster voluntary, evidence based and socially compassionate care for Canadians with addictions must be emphasized through policy and research.

L’épidémie d’opioïdes met de plus en plus l’accent sur le traitement des dépendances. Certains ont proposé que les patients souffrant de toxicomanie grave soient soumis à un traitement obligatoire en vertu de la législation canadienne sur la santé mentale, parallèlement à l’utilisation croissante de l’engagement civil pour le traitement de la toxicomanie aux États-Unis. Cet article présente une analyse bioéthique des implications juridiques, médicales et sociétales du traitement obligatoire de la dépendance sous l’engagement civil. Les préoccupations concernant l’autonomie, le préjudice, l’efficacité et la justice sociale des patients font du traitement obligatoire de la toxicomanie une option de routine inadéquate pour une maladie biopsychosociale complexe. Au lieu de cela, il faut mettre l’accent sur les politiques et la recherche afin de favoriser les soins volontaires, fondés sur des preuves et socialement compatissants pour les Canadiens souffrant de toxicomanie.
Tracing the Origin of Food-borne Disease Outbreaks
Authors: Jacobs Rianne , Teunis Peter , van de Kassteele Jan
Published: February 2020

Background:

Food-borne disease outbreaks constitute a large health burden on society. One of the challenges when investigating such outbreaks is to trace the origin of the outbreak. In this study, we consider a network model to determine the spatial origin of the contaminated food product that caused the outbreak.

Methods:

The network model we use replaces the classic geographic distance of a network by an effective distance so that two nodes connected by a long-range link may be more strongly connected than their geographic distance would suggest. Furthermore, the effective distance transforms complex spatial patterns into regular topological patterns, creating a means for easier identification of the origin of the spreading phenomenon. Because detailed information on food distribution is generally not available, the model uses the gravity model from economics: the flow of goods from one node to another increases with population size and decreases with the geographical distance between them.

Results:

This effective distance network approach has been shown to perform well in a large Escherichia coli O104:H4 outbreak in Germany in 2011. In this article, we apply the same method to various food-borne disease outbreaks in the Netherlands. We found the effective distance network approach to fail in certain scenarios.

Conclusions:

Great care should be taken as to whether the underlying network model correctly captures the spreading mechanism of the outbreak in terms of spatial scale and single or multiple source outbreak.
Community-wide Mortality Rates in Beijing, China, During the July 2012 Flood Compared with Unexposed Periods
Authors: Yan Meilin , Wilson Ander , Peel Jennifer L. , Magzamen Sheryl , Sun Qinghua , Li Tiantian , Anderson G. Brooke
Published: February 2020

Background:

On 21–22 July 2012, Beijing, China, suffered its heaviest rainfall in 60 years. Two studies have estimated the fatality toll of this disaster using a traditional surveillance approach. However, traditional surveillance can miss disaster-related deaths, including a substantial number of deaths from natural causes triggered by disaster exposure. Here, we investigated community-wide mortality risk during this flood compared with rates in unexposed reference periods.

Methods:

We compared community-wide mortality rates on the peak flood day and the four following days to seasonally matched nonflood days in previous years (2008–2011), controlling for potential confounders, to estimate the relative risks (RRs) of daily mortality among Beijing residents associated with this flood.

Results:

On 21 July 2012, the flood-associated RRs were 1.34 (95% confidence interval = 1.11, 1.61) for all-cause, 1.37 (1.01, 1.85) for circulatory, and 4.40 (2.98, 6.51) for accidental mortality, compared with unexposed periods. We observed no evidence of increased risk of respiratory mortality. For the flood period of 21–22 July 2012, we estimated a total of 79 excess deaths among Beijing residents; by contrast, only 34 deaths were reported among Beijing residents in a study using a traditional surveillance approach.

Conclusions:

To our knowledge, this is the first study analyzing community-wide changes in mortality rates during the 2012 flood in Beijing and one of the first to do so for any major flood worldwide. This study offers critical evidence on flood-related health impacts, as urban flooding is expected to become more frequent and severe in China.
Closing the Breast Cancer Loop: Barriers and Perceptions of Breast Reconstruction among Rural Women
Authors: Mullens Cody L. , Hernandez J. Andres , Conn Mary Ellen , Kennedy-Rea Stephenie , Ueno Cristiane M.
Published: February 2020

Background:

Despite policies such as the Women's Health and Cancer Rights Act (WHCRA) and Breast Cancer Patient Education Act, rates for breast reconstruction vary and are especially low for some subpopulations of patients, especially rural women. In order to better understand patient perceptions, qualitative analysis using focus groups is an underutilized tool for obtaining patient perspectives regarding health-related issues and access to care. Our aim was to better understand patient perceptions using qualitative analysis.

Methods:

Three focus groups were held in rural counties within West Virginia in order to better understand patient perceptions, knowledge, and beliefs regarding breast health, breast cancer, access to breast reconstruction, and how to disseminate and educate this patient population regarding their right to accessing breast reconstruction.

Results:

Major themes analyses revealed perceived barriers to care related to lacking care coordination, lack of insurance coverage and other resources, as well as issues related to transportation. Participants consistently discussed avoiding breast screening care due fear and denial in addition to pain. Few patients were aware of their right to accessing breast reconstruction per the WHCRA, and many were concerned about follow-up burden, complications, and general fear related to breast reconstruction. Themes related to dissemination of information to promote the option of breast reconstruction included social media, patient counseling by their referring physician, and other means of intervention in clinics and other points in the care coordination chain.

Conclusions:

Rural women have important, unique viewpoints regarding access to and perceived barriers from obtaining breast reconstruction. Plastic surgeons must work diligently to educate, disseminate, and improve care coordination among this population in order to improve access to breast reconstruction among rural breast cancer patients.
Clinical Description and Outcomes of Australian Children With Invasive Group A Streptococcal Disease
Authors: Thielemans Elise , Oliver Jane , McMinn Alissa , Baker Ciara , Britton Philip N. , Clark Julia , Marshall Helen , Blyth Christopher C. , Francis Joshua , Buttery Jim , Smeesters Pierre R. , Crawford Nigel , Steer Andrew C.
Published: February 2020

Background:

Invasive group A streptococcal disease is a severe infection with a high case fatality rate, estimated to cause more than 150,000 deaths per year worldwide. The clinical presentation of this infection is variable, and early diagnosis can be challenging. There are few data on its short- and longer-term outcomes, especially in children. The aim of this study was to assess the clinical presentation, management and short- and longer-term outcomes of invasive group A streptococcal disease in children in Australia.

Methods:

We undertook a prospective surveillance study of children with laboratory-confirmed invasive group A streptococcus disease admitted to 7 sentinel tertiary and quaternary pediatric hospitals in Australia between July 2016 and June 2018. We collected demographic and clinical data and contacted patients 6 months after discharge to assess longer-term outcomes.

Results:

We enrolled 181 children, 7 days to 16 years of age. The principal site of invasive infection was blood (126 children, 69.6%), and the most frequent clinical presentation was pneumonia in 46 children (25.4%). Twenty-six children developed streptococcal toxic shock syndrome (14.4%), and 74 had severe disease (40.9%), including 71 admitted to the intensive care unit. Five children died (2.8%). At discharge and 6 months, 29.3% and 15.2% of the children had persisting health problems, respectively.

Conclusions:

Invasive group A streptococcal infection in Australian children is frequently severe and has a high long-term morbidity burden, highlighting the need for strengthened clinical care pathways, epidemiologic surveillance and prevention strategies.
Phase 2 Study of the Safety, Pharmacokinetics and Efficacy of Ceftaroline Fosamil in Neonates and Very Young Infants With Late-onset Sepsis
Authors: Bradley John S. , Stone Gregory G. , Chan Phylinda L. S. , Raber Susan R. , Riccobene Todd , Mas Casullo Veronica , Yan Jean Li , Hendrick Victoria M. , Hammond Jennifer , Leister-Tebbe Heidi K.
Published: February 2020

Background:

With increasing antimicrobial resistance, antibiotic treatment options for neonatal late-onset sepsis (LOS) are becoming limited. Primary objective of this study was assessment of the safety of ceftaroline fosamil in LOS.

Methods:

Eligible neonates and very young infants 7 to <60 days of age with LOS were enrolled in this phase 2, open-label, multicenter study (NCT02424734) and received ceftaroline fosamil 4 or 6 mg/kg every 8 hours by 1-hour intravenous infusion plus intravenous ampicillin and optional aminoglycoside for 48 hours−14 days. Safety was assessed through the final study visit (21–35 days after the last study therapy dose). Efficacy, assessed as clinical and microbiologic response, was evaluated at end-of-treatment and test-of-cure. Pharmacokinetic samples were collected via sparse-sampling protocol.

Results:

Eleven patients [54.5% male, median (range) age 24 (12–53) days] were enrolled and received ceftaroline fosamil for a median (range) duration of 8 (3–15) days. Ten adverse events (AEs) occurred in 5 (45.5%) patients (safety population); most frequent AE was diarrhea (n = 2). All except 1 AE (diarrhea) were nontreatment-related. Predominant baseline pathogen was Escherichia coli. No patients were clinical failures at end-of-treatment/test-of-cure. Observed sparse steady-state pharmacokinetics data (19 samples) were comparable to previous pediatric data and generally within 90% model prediction intervals; neonatal probability of target attainment was >95% based on established pharmacokinetic/pharmacodynamic targets.

Conclusions:

Safety in neonates and very young infants was consistent with the known ceftaroline fosamil safety profile. These results support the use of ceftaroline fosamil (6 mg/kg every 8 hours) as a potential treatment option for LOS.
Associations Between Influencing Factors, Perceived Symptom Burden, and Perceived Overall Function Among Adults Living With HIV
Authors: Chukwurah Joan N. , Voss Joachim , Mazanec Susan R. , Avery Ann , Webel Allison
Published: February 2020

With adherence to combination antiretroviral therapy, HIV infection is now a chronic, but manageable, disease with associated symptoms and complications. However, there is limited evidence on how symptom burden affects perceived overall function among people living with HIV (PLWH). Furthermore, there is no consensus on the factors that affect symptom burden in PLWH. We examined relationships between factors that may influence symptom burden and perceived overall function, and the association between symptom burden and overall function in 179 adult PLWH. This study was a cross-sectional, secondary analysis using the Theory of Unpleasant Symptoms (Lenz, Pugh, Milligan, Gift, & Suppe, 1997). We found strong evidence that symptoms, especially pain, tiredness, and depression, are prevalent in PLWH, and that symptoms were predicted by perceived social support and the number of comorbidities. Increased symptom burden predicts reduced overall function. Interventions are needed to reduce symptoms and strengthen social support in PLWH. Initiating symptom assessment and management strategies early is paramount.
Family Management Style Improves Family Quality of Life in Children With Epilepsy: A Randomized Controlled Trial
Authors: Liu Huayan , Song Qingqing , Zhu Lihui , Chen Dan , Xie Jianhui , Hu Shengnan , Zeng Shan , Tan Lingfang
Published: February 2020

INTRODUCTION: Epilepsy is a common chronic disease with transient brain dysfunction and critically influences the quality of patients' family life. The aim of this study was to analyze the effectiveness of family management style on family quality of life in children. METHODS: We randomized 130 children to either the intervention group (n = 65) or the control group (n = 65). Family management style combined with routine care was applied in the intervention group within the first 24 hours after admission, whereas only routine care was applied in the control group. Family management style contains 3 steps: involve families into the intervention group and determine treatment plan, educate parents on how to manage their family, and monitor quality of home management. Scores on the Beach Center Family Quality of Life Scale (FQOL) of 2 groups were collected at 3 time points: within the first 24 hours after admission (T1), 6 months after discharge (T2), and 12 months after discharge (T3). Repeated-measures analysis of variance of FQOL scores was used to evaluate difference. RESULTS: Full scores and each subscale's scores on FQOL in the control group and the intervention group at T1 had no statistical significance (P > .05). Scores on FQOL at T2 and T3 increased in the intervention group, but there was almost no change in the control group, with statistical significance between the intervention group and the control group (P < .05). Scores on FQOL at T1, T2, and T3 showed that score of subscale except parenting FQOL improved in the intervention group (P < .05), but no difference was shown in the control group (P > .05). There was no difference shown among the control group and the intervention group that interacted with time (P > .05). CONCLUSION: The family management style can effectively improve the family quality of life in children with epilepsy, especially at the satisfaction level of family emotional well-being and disability-related support.
Loading Applied on Osseointegrated Implant by Transtibial Bone-Anchored Prostheses During Daily Activities: Preliminary Characterization of Prosthetic Feet
Authors: Frossard Laurent , Leech Barry , Pitkin Mark
Published: February 2020

Introduction

This case series study laid out principles for characterization of loading profile applied on osseointegrated implant by transtibial bone-anchored prostheses fitted with various feet while presenting benchmark loading data.

Materials and Methods

Three individuals walked and ascended and descended stairs and ramps with instrumented prostheses fitted with a load cell as well as usual and anthropomorphic feet successively. The characterization of the loading profile involved the comparison of 100 variables including spatiotemporal characteristics, loading boundaries, local extremum, and impulse.

Results

The absolute maximum load extracted from 319 gait cycles (GCs) with both prostheses across all activities was 48 %BW, 17 %BW, and 112 %BW for the forces as well as 2 %BWm, 13 %BWm, and 1 %BWm for the moments on and around the anteroposterior, mediolateral, and long axes of the implant, respectively.

Discussion

New evidence presented here indicated that a specific and comprehensive loading characterization capable of differentiating transtibial bone-anchored prostheses was achievable when relying on triaxial direct measurements, recording a range of daily activities in addition to walking, and considering at least nine loading extremum.

Conclusions

Prosthetic care providers could use this characterization for evidence-based fitting of components to the growing population of individuals with transtibial amputation fitted with osseointegrated implants worldwide.
Nerve Integrity Monitor Responses to Direct Facial Nerve Stimulation During Facial Nerve Decompression Surgery Can Predict Postoperative Outcomes
Authors: Yamagishi Tatsuya , Ohshima Shinsuke , Yagi Chihiro , Kitazawa Meiko , Nonomura Yoriko , Izumi Shuji , Morita Yuka , Takahashi Kuniyuki , Horii Arata
Published: February 2020

Objective:

To test whether the threshold of nerve integrity monitor (NIM) responses during facial nerve decompression surgery can predict the postoperative outcome.

Study Design:

Retrospective study.

Setting:

University hospital.

Patients:

Twenty peripheral facial palsy patients who underwent transmastoid decompression surgery.

Intervention:

During decompression surgery, thresholds of NIM responses were measured via direct facial nerve stimulation at three sites: the geniculate ganglion (GG), the second genu (2nd G), and the stylomastoid foramen.

Main Outcome Measures:

Facial nerve function was evaluated before and 6 months after surgery using the Yanagihara grading score (maximum score = 40 points). Complete recovery was defined as an improvement of the grading score to ≥ 36 points without synkinesis. Variables including age, sex, disease (Bell's palsy or Ramsay Hunt syndrome), time after onset, Yanagihara grading score, and electroneurography before surgery, and the thresholds of NIM responses during surgery were compared in the complete and incomplete recovery groups. NIM responders were defined as those exhibiting a NIM response of < 1.5 mA at any site. Postoperative Yanagihara grading scores in NIM responders and NIM nonresponders were compared.

Results:

No variables differed significantly in the complete and incomplete recovery groups before surgery. NIM response thresholds in the complete recovery group at the GG and the 2nd G were significantly lower than the corresponding thresholds in the incomplete recovery group. The postoperative Yanagihara grading scores of NIM responders were significantly better than those of NIM nonresponders.

Conclusion:

NIM responses to intraoperative direct facial nerve stimulation were useful for predicting outcomes after decompression surgery.