bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Determinants of Health for People With Serious Mental Illness After Transitioning to the Community
Authors: Kellett Kathy , Ligus Kaleigh , Baker Kristin , Robison Julie
Published: December 2020

Approximately 10 million, or 6 percent, of the U.S. population experience serious mental illness (SMI) (NAMI, 2019). Social determinants of health (SDOH) associated with this population can provide important information for targeted innovations with the potential to reduce disease burden and improve quality of life. Using secondary data from Connecticut’s Money Follows the Person Rebalancing Demonstration, this research compares people age 50+ who transitioned out of an institution onto the Medicaid HCBS Mental Health Waiver (MHW) (n= 271) to those receiving Mental Health services through the Medicaid State Plan (MHSP) (n=278). Analyses examine SDOH in both groups and are organized around five broad domains: Finances; education; social/community context, health/health care, and neighborhood/built environment. MHSP participants were significantly more likely to report not having enough money at the end of the month at 6 (42% vs. 21%), 12 (37% vs. 20%), and 24 (37% vs. 17%) months. Significantly more MHSP than MHW participants did not like where they lived at 6 (12% vs. 1%) and 24 (24% vs. 5%) months. Significantly more MHSP than MHW participants were unhappy with the help they received in the community at 6 (22% vs. 8%), 12 (23% vs. 7%), and 24 (19% vs. 5%) months. Groups did not differ by education, social/community context, health/health care, feelings of safety where they live, or on post-transition hospitalizations, ED use or reinstitutionalization. To improve quality of life in the community, MHSP participants could benefit from greater assistance with finances, housing, and community services.
Rehabilitation Therapy Staffing Composition and Post-Acute Care Quality in Skilled Nursing Facilities
Authors: Wang Xiao (Joyce) , Hefele Jennifer , Driscol Laura , Wang Joyce
Published: December 2020

Rehabilitation therapy staffing is crucial in achieving high quality of post-acute care (PAC) in skilled nursing facilities (SNFs), but few studies have explored therapy staffing composition and how it relates to SNFs’ PAC quality. This study describes SNFs’ therapy staffing composition and its association with facility-level PAC fall rates. Our study was a cross-sectional study using facility-level data (Q3 2017-Q2 2018). Data sources include Nursing Home Compare, Payroll-Based Journal data, Area Health Resource File and LTCFocUS.org. The first independent variable was the share of total therapy staff in the direct care team, a ratio between total therapy staffing hours and total direct care hours (includes nursing).To further understand the composition of therapy staff with different qualifications within the therapy team, two variables were generated: 1) proportion of higher skilled therapy staff (i.e. assistant, therapist) hours of total therapy hours; and 2) assistant to therapist ratio. Multivariate linear regression modeling was used, controlling for other characteristics and state fixed effects. Our results show SNF therapy staffing compositions varied significantly by profit status, chain affiliation, and urban/rural location. Further, SNFs with higher shares of therapy staff and higher skilled staff had significantly lower fall rates. However, SNFs with higher assistant-to-therapist ratios had higher fall rates. Our results demonstrated the value of having a multidisciplinary team with higher skilled staff. The results also supported researchers’ concerns that recent Medicare payment change (i.e. the Patient Driven Payment Model) may negatively impact quality by reinforcing providers’ incentives of reducing rehabilitation staffing and/or using lower-skilled staff.
The Role of Age, Political Affiliation, and Framing in Attitudes Toward Hispanic and Latinx Immigrants
Authors: Yan Mengzhao , Gassoumis Zachary , Wilber Kathleen , Navarro Sheila Salinas
Published: December 2020

The United States is experiencing rapid aging and increasing racial and ethnic diversity. Nevertheless, political rhetoric about immigrants has stoked negative assumptions and beliefs adding to fear and cultural misperceptions. Among those most affected are people of Hispanic/LatinX ethnicity, who comprise approximately 18% of the population. To address negative stereotypes, we sought to test how framing affected attitudes about Hispanic/LatinX immigrants and how people in different generations across the political spectrum respond to framing. As part of the “Latinos and Economic Security (LES),” a national research project funded by the Ford Foundation, we launched the “Well Being 501 Latino Economic Security” survey through the American Life Panel of RAND Corporation in 2018. Before answering the survey questions, participants (n=739) were randomly assigned to three different conditions: a 100-word priming statement focused on Hispanic/LatinX work ethic/religiosity/patriotism (33.29%), a 100-word priming statement focused on justice/equity/fairness (32.75%), and a control group with no priming statement (33.96%). We used multiple linear regression to examine relationships among demographic variables, age, political affiliation, and priming statements and attitudes toward Hispanic/LatinX immigrants. Key findings include: 1) age, political affiliation, education level, race and ethnicity, and gender explained 47.5% of the variance in attitudes; 2) baby boomers and generation X were significantly less tolerant of Hispanic/LatinX; 3) priming statements played a salient mediating role in neutralizing negative attitudes. By employing a developmental perspective, we proposed six recommendations from the aspects of reframing policy narrative and developing educational programs targeted at improving attitudes toward Hispanic/LatinX immigrants.
4:10 Cycles of Very Low Calories Protect Against Tumor Xenografts, but Not Metastases in the Absence of Chemotherapy
Authors: Pomatto Laura Corrales-Diaz , Bosompra Oye , Wong Sarah , Bodogai Monica , Kato Jonathan , Carpenter Melissa , Biragyn Arya , de Cabo Rafael
Published: December 2020

Cancer is a leading cause of mortality, with its incidence only expected to rise with an increasingly aging population. Dietary interventions, primarily caloric restriction (CR), lower cellular energy metabolism and have long been utilized to slow the aging process and protect against age-related diseases, including cancer. However, due to the stringency of CR, dietary alternatives that offer the same beneficial outcomes in cancer prevention and longevity have become increasingly attractive. Periodic cycles (4 days twice a month) of low caloric intake followed by a standard ad libitum (AL) diet was previously shown to promote health-span in mice and humans and protect against primary tumorigenesis and enhanced the effects of chemotherapy. The aim of our study was to compare the tumorigenic potential of 4T1 cells, a murine model of stage IV breast cancer, in young and aged female BALB/c mice fed either periodic cycles of low caloric diets versus chronic 20% CR. Compared to AL controls, we found a significant delay in primary tumor growth in mice regardless of diet composition by the 4:10 cycles of very low caloric intake. However, unlike in CR, CR-alternative diets were not protective against lung metastases in the absence of chemotherapy. Our study sheds light into the underlying differences of calorie-based interventions in the absence of chemotherapy.
A Metabolic Stress Response
Authors: Leiser Scott , Choi Christopher , Bhat Ajay , Evans Charles
Published: December 2020

An organism’s ability to respond to stress is crucial for long-term survival. These stress responses are coordinated by distinct but overlapping pathways, many of which have been found to also regulate longevity in multiple organisms across species. Despite extensive effort, our understanding of these pathways and how they affect aging remains incomplete and thus is a key area of study in Geroscience. Our previous work identified flavin-containing monooxygenase-2 (fmo-2) as a key longevity-promoting gene downstream of at least three longevity promoting pathways, including the hypoxic response, the pentose phosphate pathway, and the dietary restriction pathway. Based on the commonalities of these pathways, we hypothesized that fmo-2, a classically annotated xenobiotic enzyme, might play a key endogenous role in responding to metabolic stress. Our resulting data, using metabolic profiling and further epistatic analysis, both support this hypothesis and link fmo-2’s mechanism to modifications to one-carbon metabolism (OCM), a key intermediate pathway between the nucleotide metabolism, methylation, and transsulfuration pathways. Using mathematical modeling and a novel metabolomics approach, we were able to further identify the likely mechanism of fmo-2-mediated metabolic effects, and connect them to both OCM and downstream components. We propose a model whereby nematode fmo-2 represents a class of enzymes that are able to modify large aspects of metabolism, similar to how transcription factors modify gene expression, and that fmo-2 is a key member of a conserved metabolic stress response.
Discussions Between People With Dementia and Care Partners About End-of-Life Care Planning
Authors: Shepherd-Banigan Megan , Ford Cassie , Belanger Emmanuelle , Van Houtven Courtney
Published: December 2020

Advanced care planning (ACP) leads to better end-of-life (EoL) care. Yet, some care-partners are unaware of the person with dementia’s (PwD) preferences. Care-partners play an important role in urging PwD to consider their EoL care wishes early in their disease course and to document those wishes. However, it is unknown whether discussions between care-partners and PwD are associated with documenting EoL care plans. We apply generalized linear models to baseline data from the CARE-IDEAS study which includes a sample of patients who received an amyloid PET scan and their care-partners (n=1,672). We examine the association between PwD report of having discussed EoL care with their care-partner and PwD report of having documented their plans through an advanced directive, a living will, or designating a health care proxy. PwD who reported speaking with their care-partners about EoL care were 10% (marginal probability (MP) 0.10; 95% CI: 0.8, 0.13) more likely to have documented their EoL care wishes. Furthermore, if PwD and care-partners agreed that they had discussed EoL care, PwD were 7% (MP 0.7; 95% CI 0.04, 0.10) more likely to report that they documented their EoL care plans. The positive association between communicating with care-partners about EoL care and having formal EoL care plans suggests that the ACP process could be a systematic approach to increase the care-partner’s knowledge of PwD EoL wishes. These results also suggest that increasing involvement of care partners in ACP may encourage patients to document their wishes at end of life.
Predictors of Effort-Reward Imbalance Among Employees Providing Three Types of Long-Term Care Services in Japan
Authors: Honda Ayumi , Fauth Elizabeth , Liu Yin , Honda Sumihisa
Published: December 2020

Increasingly, employees are leaving their jobs as long-term care workers in Japan. The purpose of this study was to identify predictive factors of effort-reward imbalance (ERI) among employees in long-term care, to better understand factors associated with excessive effort and reduced reward. This cross-sectional study included 944 participants providing three types of long-term care: home-based (n=201), community-based (n=128), and institutional (n=615). Multiple logistic regression analysis was used to identify factors associated with self-reported ERI, where higher ERI scores indicated greater work-related efforts and lower rewards. Key independent variables included type of occupation, employment status, position, daily working hours, job satisfaction, and annual income. Our results showed that low job satisfaction was the sole common factor associated with ERI in employees across all three types of long-term care. Other predictive factors for ERI differed by type of long-term care services. Working longer hours predicted ERI in community-based and institutional care employees, but not home-based care employees. For institutional care employees, being a care manager, holding a position of department head, having family-related stress were risk factors for ERI, suggesting that in this setting, the rewards of higher income and more prestige in leadership positions are offset by greater work-related demands. In conclusion, factors associated with ERI were both common and distinct among employees providing different types of long-term care services. Adjusting work demands and working hours, and identifying unique contributors to ERI within specific long-term care settings may help with job retention in these occupations.
Health Behaviors and eHealth Literacy Among Older Adults, HINTS 2019
Authors: Sanchez Ruth , Kay Hannah , Srikanth Pooja , Sandow Lyndsey , Zhang Michelle
Published: December 2020

With rapid shifts in how health information is reported and consumed, providers and patients must consider their electronic or “eHealth” literacy. The purpose of this study was to analyze how older adults (age 60+) seek health information in the context of online and offline resources and how eHealth literacy correlates with health behaviors. We performed a cross-sectional analysis of a nationally representative sample of 2,587 U.S. older adults drawn from the Health Information National Trends Survey (HINTS) Iteration 5 Cycle 3. Weighted descriptive analyses were conducted to examine the association between CDC-recommended health behavior guidelines on produce consumption and exercise, eHealth literacy, and sociodemographics. Weighted logistic regression analyses were conducted with STATA 16.0 to assess the relationship between healthy behaviors and eHealth literacy controlling for sociodemographics. The weighted sample reported the following demographic characteristics: average age 71 years (range 60-98), 53.6% female, 73.8% White, 9.7% Black and 8.6% Hispanic. Of older adults, 26.7% performed 2 or more health behaviors regularly. Among older adults, those who have looked up medical information using electronics are 1.79 (95% confidence interval: 1.24, 2.58) times more likely to meet 2 or more CDC-recommended health behavior guidelines as compared to those that have not, after controlling for survey group, education, race/ethnicity and gender. Access and utilization of online resources among older adults may influence their health behaviors and health outcomes. Providers should consider the eHealth literacy of their older adult patients and direct them to appropriate and reliable online resources.
Stressful Life Events and Inflammation in Midlife: Comparing Associations With suPAR, CRP, and IL-6
Authors: Bourassa Kyle , Rasmussen Line , Moffitt Terrie , Caspi Avshalom
Published: December 2020

Stressful life events are associated with poorer health, but the physiological mechanisms of this association are unclear. One mechanism that might play a role in this association is systemic inflammation. Using participants (n=828) from the Dunedin Longitudinal Study, we studied the association of stressful life events and inflammation from age 32 to 45. Inflammation was assessed using C-reactive protein (CRP), interleukin-6 (IL-6), and suPAR. We examined associations between stressful life events and systemic inflammation, as well as whether adverse childhood experiences (ACEs) moderated these associations. More adult stressful life events were associated with greater suPAR at age 38 (r = 0.12, p < .001) and age 45 (r = 0.19, p < .001). CRP and IL-6 did not evidence consistent associations at age 38 and 45. An increase in suPAR from age 38 to 45 was associated with more stressful life events in the interim, β = 0.10, p = .001. SuPAR at age 45 was independently associated with both childhood ACEs, β = 0.20, p < .001, and adult stressful life events, β = 0.18, p < .001. ACEs significantly moderated the association of stressful life events and suPAR at age 45, β = 0.12, p = .001, such that people with more childhood ACEs evidenced a stronger association between stressful life events and inflammation in midlife. These results were robust to controlling for clinical (sex, body mass, smoking) and childhood covariates (childhood IQ, SES, self-control). Systemic inflammation is one mechanism through which stressful life events could impact health.
Lifestyle Adjustment and Mobility-Related Goal Setting After Driving Cessation With People Living With Dementia
Authors: Scott Theresa , Liddle Jacki , Beattie Elizabeth , Gustafsson Louise , Mitchell Geoffrey , Rooney Donna , Pachana Nancy
Published: December 2020

Community mobility is an important social determinant of health. For people living with dementia, the forfeiture of a driving licence can signal a loss of independence, limiting access to activities outside of the home. Loss of community connectivity and social participation has a substantial impact on quality of life and may lead to depression and more rapid cognitive decline. This study is focused on a driving cessation intervention that helps people with dementia identify personal goals that are framed around community mobility and adjusting to life without driving. Health professionals work with participants to translate these into specific, practical and achievable outcomes by program end. Participants may nominate more than one goal. This study reports on goal setting and achievement. Using a modified version of the Canadian Occupational Performance Measure it examines pre- to post-intervention achievement of, and satisfaction with, identified goals for 17 participants living with dementia aged 63-93 (M=75.24, 76% male) from regional and metropolitan Australia. Thematic analysis of clinical interviews and field notes highlighted the range of desired goals, and the challenges posed and problem-solving strategies used in setting realistic, non-driving goals. Significant positive improvements were found across a total of 29 goals for (i) performance t(28) = -10.01, p < .000, and (ii) satisfaction, t(28) = -10.32, p < .000. The implications for practice are that supportive goal-setting of personally relevant objectives and valued activities following driving cessation may be effective in lessening some of the negative effects of giving up driving for people with dementia.
Frailty and Risk of Serious Infections in Biologic-treated Patients With Inflammatory Bowel Diseases
Authors: Singh Siddharth , Heien Herbert C , Sangaralingham Lindsey , Shah Nilay D , Lai Jennifer C , Sandborn William J , Moore Alison A
Published: December 2020

Background

Identifying biologic-treated patients with inflammatory bowel diseases (IBDs) at higher risk of serious infections is a priority. We conducted a retrospective cohort study evaluating frailty and risk of serious infections in biologic-treated patients with IBD.

Methods

Using an administrative claims database, we identified biologic-treated patients with IBD between 2014 and 2018 with follow-up 1 year before and after treatment initiation. Using a validated claims-based hospital frailty risk scoring system, patients were classified as frail and nonfrail. We compared the risk of serious infections (infections requiring hospitalization) between frail and nonfrail patients using Cox proportional hazard analysis adjusting for age, comorbidities, disease characteristics, health care utilization, use of corticosteroids, immunomodulators, and opiates.

Results

We included 5987 biologic-treated patients with IBD (4881 on TNFα antagonists, 1106 on vedolizumab), of whom 2350 (39.3%) were classified as frail; over 7115 person-years of follow-up was included, and 520 patients developed serious infection. Frailty was not associated with increased risk of serious infection (adjusted hazard ratio [aHR], 1.12; 95% CI, 0.93–1.36), whereas advanced age (older than 60 years), high comorbidity burden, corticosteroid use, opiate use, and prior serious infection were associated with increased risk of serious infection. On stratified analysis, frailty was associated with increased risk of serious infections in vedolizumab-treated patients (aHR, 1.69; 95% CI, 1.03–2.79) but not in TNFα antagonist-treated patients (aHR, 1.03; 95% CI, 0.83–1.27).

Conclusions

In biologic-treated patients with IBD, frailty assessed using a claims-based frailty index was not independently associated with increased risk of serious infections. Future studies evaluating objective and biological measures of frailty are warranted to risk-stratify older patients with IBD.
Variational convergence of discrete elasticae
Authors: Scholtes Sebastian , Schumacher Henrik , Wardetzky Max
Published: December 2020

We discuss a discretization of the Euler–Bernoulli bending energy and of Euler elasticae under clamped boundary conditions by polygonal lines. We show Hausdorff convergence of the set of almost minimizers of the discrete bending energy to the set of smooth Euler elasticae under mesh refinement in (i) the $W^{1,\infty }$-topology for piecewise-linear interpolation; and in (ii) the $W^{2,p}$-topology, $p \in [2,\infty [$, using a suitable smoothing operator to create $W^{2,p}$-curves from polygons.
Some Remarks on Fano Three-Folds of Index Two and Stability Conditions
Authors: Pertusi Laura , Yang Song
Published: December 2020

We prove that ideal sheaves of lines in a Fano three-fold $X$ of Picard rank one and index two are stable objects in the Kuznetsov component ${\operatorname{\mathsf{Ku}}}(X)$, with respect to the stability conditions constructed by Bayer, Lahoz, Macrì, and Stellari, giving a modular description to the Hilbert scheme of lines in $X$. When $X$ is a cubic three-fold, we show that the Serre functor of ${\operatorname{\mathsf{Ku}}}(X)$ preserves these stability conditions. As an application, we obtain the smoothness of nonempty moduli spaces of stable objects in ${\operatorname{\mathsf{Ku}}}(X)$. When $X$ is a quartic double solid, we describe a connected component of the stability manifold parametrizing stability conditions on ${\operatorname{\mathsf{Ku}}}(X)$.
Pedrowygomyia (Diptera: Simuliidae): Discovery of a New Species After 30 yr
Authors: Nascimento Jeane Marcelle Cavalcante do , Hamada Neusa , Huamantinco-Araujo Ana A
Published: December 2020

Pedrowygomyia is a Neotropical genus of Simuliidae composed of four species; all were described in 1989 from high-elevation (above 3,000 m) areas in the Andean region. In this article, a new species for this genus, Pedrowygomyia hanaq n. sp., is described based on all stages of development. The new species was collected in the south-central Andes of Peru at an altitude above 4,000 m, and its known distribution is currently restricted to the type-locality. Based on the pupal stage, the new species appears to be more closely related to Pedrowygomyia punapi (Wygodzinsky & Coscarón) (Diptera: Simuliidae), a species known from Argentina, Bolivia, and Chile.
Real-World Effectiveness of Human Papillomavirus Vaccination Against Vulvovaginal High-Grade Precancerous Lesions and Cancers
Authors: Dehlendorff Christian , Baandrup Louise , Kjaer Susanne K
Published: December 2020

Background

Vaccination against human papillomavirus (HPV) has proven to be effective against severe cervical lesions and genital warts, whereas no previous study has provided real-world data on the HPV vaccine effectiveness against high-grade vulvovaginal lesions.

Methods

A cohort of all women age 17-26 years living in Denmark during 2006-2019 was followed in nationwide registers for individual-level information about HPV vaccination and first diagnoses of vulvar and vaginal high-grade squamous intraepithelial lesions (HSIL+) or worse. The cumulative incidence of vulvar and vaginal HSIL+, respectively, was estimated with the Aalen-Johansen estimator, and Cox proportional hazards regression was used to estimate hazard ratios (HRs) for vulvar and vaginal lesions separately, comparing women vaccinated at age 16 years or younger and at age 17-26 years with unvaccinated women.

Results

The cohort consisted of 514 537 women, of which 50.6% were vaccinated at baseline (<16 years), 31.8% were vaccinated during follow-up (17-26 years), and 17.6% remained unvaccinated. The cumulative incidence was less than 0.6‰ for vulvar HSIL+ and less than 0.2‰ for vaginal HSIL+. Adjusted analyses showed reduced HRs for both vulvar (HR = 0.22, 95% confidence interval = 0.13 to 0.38) and vaginal HSIL+ (HR = 0.16, 95% confidence interval = 0.04 to 0.55) for women vaccinated at age 16 years or younger compared with unvaccinated women. For women vaccinated at 17-26 years of age, the reductions in HRs were smaller for vaginal HSIL+ and close to 0 for vulvar HSIL+.

Conclusions

HPV vaccination before 17 years of age reduces the risk of vulvar and vaginal HSIL+ based on real-world data.
Melatonin reduces radiation damage in inner ear
Authors: Chen Ting , Luo Yuling , Li Qi , Yang Chen , Yuan Yixin , Peng Jinhao , Ban Molu , Liang Yong , Zhang Wei
Published: December 2020

The purpose of this study was to use a murine model to determine if melatonin can protect the inner ear from radiation-induced damage. A total of 81 4-week-old Balb/c mice were randomly divided into five groups: control group; 50 mg/kg melatonin group; 5 mg/kg melatonin+radiotherapy group; 50 mg/kg melatonin+radiotherapy group; radiotherapy group. The radiotherapy groups received 16 Gy irradiation and melatonin was administered by intraperitoneal injection 30 min before radiotherapy. On days 3 and 7 after irradiation the function of outer hair cells was determined by auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAEs) testing, pathological changes of inner ear cells were observed by light microscopy, and the expression of prestin mRNA was determined. ABR thresholds were increased and wave I latencies were extended after radiotherapy; however, the increases were lower in the groups that received melatonin (P < 0.05). DPOAEs showed radiotherapy-induced hearing loss at 8–12 kHz, and hearing loss was greater on day 7 than day 3. However, hearing loss was less in the melatonin groups (P < 0.05). Histopathological examination showed irradiation resulted in breaks and distortion of the cochlear basement membrane, disruption of the stria vascularis, and swelling of outer hair cells. Melatonin reduced these changes. Radiotherapy upregulated prestin mRNA expression. Radiotherapy-induced upregulation of prestin was decreased in the melatonin groups (P < 0.05), and the decrease was greater in the 50 mg/kg melatonin group (P < 0.05). Melatonin protects against radiation-induced cochlear damage by reducing damage to outer hair cells.
Breast lipofilling as a treatment for breast hypoplasia in Becker naevus syndrome: a case report
Authors: Christodoulides Natasha , Kelly Gerard A , O’Sullivan Sean T
Published: December 2020

A Becker’s naevus is a rare, pigmented, cutaneous hamartoma, which when associated with other cutaneous or musculoskeletal anomalies is termed Becker naevus syndrome. Female patients commonly seek medical attention for breast hypoplasia. Here, we describe our experience in the surgical management of unilateral breast hypoplasia in a patient with Becker naevus syndrome, using high-volume autologous fat grafting. This is, to our knowledge, the second report in the literature describing the aforementioned management technique in this patient cohort.
Nestled in the city heat: urban nesting behavior enhances embryo development of an invasive lizard
Authors: Tiatragul Sarin , Hall Joshua M , Warner Daniel A
Published: December 2020

Urbanization transforms many aspects of natural landscapes and poses many new challenges for individual survival and population persistence. Thus, urbanization provides an opportunity to examine how organisms deal with novel environmental change. Many studies provide evidence of phenotypic adaptation to urban environments, but few focus on responses during early life stages. Filling this information gap is important, because early life stages are particularly sensitive to abiotic factors, and no population is sustainable without successful embryo development. We tested the hypotheses that (i) embryos tolerate warmer temperature conditions of urbanized areas and (ii) maternal nesting behavior protects embryos from potentially lethal thermal conditions in urbanized habitats. We studied introduced populations of a subtropical lizard, Anolis cristatellus, in suburban and forested areas in Miami, Florida. In each habitat, we measured microenvironment variables for locations that females used for nesting vs. locations they did not use. We then incubated eggs from both populations under thermal conditions that mimicked used and unused sites. Nests in the suburban site were warmer than in the forest; however, in the suburban site, locations that females used were relatively cool compared with locations that were not used. We found no evidence that embryos are adapted to their respective suburban or forested thermal environments, but rather maternal nest-site choice enhanced embryo development in the suburban habitat. Maternal nesting behavior is likely an important factor for population persistence under major environmental changes, and a key contributor to the establishment and spread of invasive organisms across urbanized landscapes.
HCT/HESP study of two carbon stars from the LAMOST survey
Authors: Shejeelammal J , Goswami Aruna , Shi Jianrong
Published: December 2020

Carbon stars, enhanced in carbon and neutron-capture elements, provide a wealth of information about the nucleosynthesis history of the Galaxy. In this work, we present the first ever detailed abundance analysis of the carbon star LAMOSTJ091608.81+230734.6 and a detailed abundance analysis of neutron-capture elements for the object LAMOSTJ151003.74+305407.3. Updates on the abundances of elements C, O, Mg, Ca, Cr, Mn and Ni for LAMOSTJ151003.74+305407.3 are also presented. Our analysis is based on high-resolution spectra obtained using the Hanle Echelle Spectrograph (HESP) attached to the Himalayan Chandra Telescope (HCT) at the Indian Astronomical Observatory, Hanle. The stellar atmospheric parameters (Teff, log g, microturbulance ζ, metallicity [Fe/H]) are found to be (4820, 1.43, 1.62, −0.89) and (4500, 1.55, 1.24, −1.57) for these two objects, respectively. The abundance estimates of several elements, namely C, N, O, Na, α-elements, Fe-peak elements and neutron-capture elements Rb, Sr, Y, Zr, Ba, La, Ce, Pr, Nd, Sm and Eu, are presented. Our analysis shows the star LAMOSTJ151003.74+305407.3 to be a CEMP-r/s star, and LAMOSTJ091608.81+230734.6 to be a CH giant. We have examined if the i-process model yields ([X/Fe]) of heavy elements could explain the observed abundances of the CEMP-r/s star based on a parametric model-based analysis. The negative values obtained for the neutron-density-dependent [Rb/Zr] ratio confirm former low-mass asymptotic giant branch companions for both stars. Kinematic analysis shows that LAMOSTJ151003.74+305407.3 belongs to the Galactic halo population while LAMOSTJ091608.81+230734.6 belongs to the disc population.
Disease course of neurofibromatosis type 2: a 30-year follow-up study of 353 patients seen at a single institution
Authors: Forde Claire , King Andrew T , Rutherford Scott A , Hammerbeck-Ward Charlotte , Lloyd Simon K , Freeman Simon R , Pathmanaban Omar N , Stapleton Emma , Thomas Owen M , Laitt Roger D , Stivaros Stavros , Kilday John-Paul , Vassallo Grace , McBain Catherine , Kerrigan Simon , Smith Miriam J , McCabe Martin G , Harkness Elaine F , Evans D Gareth
Published: December 2020

Background

Limited data exist on the disease course of neurofibromatosis type 2 (NF2) to guide clinical trial design.

Methods

A prospective database of patients meeting NF2 diagnostic criteria, reviewed between 1990 and 2020, was evaluated. Follow-up to first vestibular schwannoma (VS) intervention and death was assessed by univariate analysis and stratified by age at onset, era referred, and inheritance type. Interventions for NF2-related tumors were assessed. Cox regression was performed to determine the relationship between individual factors from time of diagnosis to NF2-related death.

Results

Three hundred and fifty-three patients were evaluated. During 4643.1 follow-up years from diagnosis to censoring, 60 patients (17.0%) died. The annual mean number of patients undergoing VS surgery or radiotherapy declined, from 4.66 and 1.65, respectively, per 100 NF2 patients in 1990-1999 to 2.11 and 1.01 in 2010-2020, as the number receiving bevacizumab increased (2.51 per 100 NF2 patients in 2010-2020). Five patients stopped bevacizumab to remove growing meningioma or spinal schwannoma. 153/353 (43.3%) had at least one neurosurgical intervention/radiation treatment within 5 years of diagnosis. Patients asymptomatic at diagnosis had longer time to intervention and better survival compared to those presenting with symptoms. Those symptomatically presenting <16 and >40 years had poorer overall survival than those presenting at 26-39 years (P = .03 and P = .02, respectively) but those presenting between 16 and 39 had shorter time to VS intervention. Individuals with de novo constitutional variants had worse survival than those with de novo mosaic or inherited disease (P = .004).

Conclusion

Understanding disease course improves prognostication, allowing for better-informed decisions about care.
High frequency of disease progression in pediatric spinal cord low-grade glioma (LGG): management strategies and results from the German LGG study group
Authors: Perwein Thomas , Benesch Martin , Kandels Daniela , Pietsch Torsten , Schmidt René , Quehenberger Franz , Bison Brigitte , Warmuth-Metz Monika , Timmermann Beate , Krauss Jürgen , Thomale Ulrich-Wilhelm , Kortmann Rolf-Dieter , Driever Pablo Hernáiz , Gnekow Astrid Katharina
Published: December 2020

Background

Knowledge on management of pediatric spinal cord low-grade glioma (LGG) is scarce.

Methods

We analyzed clinical datasets of 128 pediatric patients with spinal LGG followed within the prospective multicenter trials HIT-LGG 1996 (n = 36), SIOP-LGG 2004 (n = 56), and the subsequent LGG-Interim registry (n = 36).

Results

Spinal LGG, predominantly pilocytic astrocytomas (76%), harbored KIAA1549-BRAF fusion in 14/35 patients (40%) and FGFR1-TACC1 fusion in 3/26 patients (12%), as well as BRAFV600E mutation in 2/66 patients (3%). 10-year overall survival (OS) and event-free survival (EFS) was 93% ± 2% and 38% ± 5%, respectively. Disseminated disease (n = 16) was associated with inferior OS and EFS, while age ≥11 years and total resection were favorable factors for EFS. We observed 117 patients following total (n = 24) or subtotal/partial resection (n = 74), biopsy (n = 16), or radiologic diagnosis only (n = 3). Eleven patients were treated first with chemotherapy (n = 9) or irradiation (n = 2). Up to 20.8 years after diagnosis/initial intervention, 73/128 patients experienced one (n = 43) or up to six (n = 30) radiological/clinical disease progressions. Tumor resections were repeated in 36 patients (range, 2-6) and 47 patients required nonsurgical treatment (chemotherapy, n = 20; radiotherapy, n = 10; multiple treatment lines, n = 17). Long-term disease control for a median of 6.5 (range, 0.02-20) years was achieved in 73/77 patients following one (n = 57) or repeated (n = 16) resections, and in 35/47 patients after nonsurgical treatment.

Conclusions

The majority of patients experienced disease progression, even after years. Multiple interventions were required for more than a third, yet multimodal treatment enabled long-term disease control. Molecular testing may reveal therapeutic targets.
The persistent presence of Chrysaora fulgida (Scyphozoa; Discomedusae) in the northern Benguela ecosystem is not reflected by constant recruitment
Authors: Skrypzeck Heidi , Gibbons Mark J
Published: December 2020

Unlike the situation in most temperate systems, medusae of Chrysaora (in this case, Chrysaora fulgida) are present year-round off Namibia, in a variety of size classes, implying the year-round release of ephyrae. This hypothesis was investigated by studying temporal changes in ephyrae and other gelatinous zooplankton in Walvis Bay over a 2-year period (January 2012 to December 2013), using biweekly plankton samples. All 12 of the recovered taxa were characteristically neritic and included meroplanktonic Hydrozoa and Scyphozoa as well as cydippid ctenophores and shallow water siphonophores. While ephyrae of C. fulgida were dominant overall and peaked in abundance during mid-spring, they were not present all year round, being replaced (in part) by medusae of Obelia in autumn and by the siphonophore Muggiaea atlantica in mid-summer and mid-winter. The structure of the assemblages was driven primarily by bottom water temperature and day length (explaining 27.2% of the variability in community structure). The recruitment of ephyrae of C. fulgida to the plankton off Walvis Bay is not continuous throughout the year, and this challenges our understanding of the population dynamics of this species in the region.
Citizenship
Authors: Spiro Peter J.
Published: December 2020

Almost everyone has citizenship, and yet it has emerged as one of the most hotly contested issues of contemporary politics. Even as cosmopolitan elites and human rights advocates aspire to some notion of “global citizenship,” populism and nativism have re-ignited the importance of national citizenship. Either way, the meaning of citizenship is changing. Citizenship once represented solidarities among individuals committed to mutual support and sacrifice, but as it is decoupled from national community on the ground, it is becoming more a badge of privilege than a marker of equality. Intense policy disagreement about whether to extend birthright citizenship to the children of unauthorized immigrants opens a window on other citizenship-related developments. At the same time that citizenship is harder to get for some, for others it is literally available for purchase. The exploding incidence of dual citizenship, meanwhile, is moving us away from a world in which states jealously demanded exclusive affiliation, to one in which individuals can construct and maintain formal multinational identities. Citizenship does not mean the same thing to everyone, nor have states approached citizenship policy in lockstep. Rather, global trends point to a new era for citizenship as an institution. In Citizenship: What Everyone Needs to Know®, legal scholar Peter J. Spiro explains citizenship through accessible terms and questions: what citizenship means, how you obtain citizenship (and how you lose it), how it has changed through history, what benefits citizenship gets you, and what obligations it extracts from you--all in comparative perspective. He addresses how citizenship status affects a person's rights and obligations, what it means to be stateless, the refugee crisis, and whether or not countries should terminate the citizenship of terrorists. He also examines alternatives to national citizenship, including sub-national and global citizenship, and the phenomenon of investor citizenship. Spiro concludes by considering whether nationalist and extremist politics will lead to a general retreat from state-based forms of association and the end of citizenship as we know it. Ultimately, Spiro provides historical and critical perspective to a concept that is a part of our everyday discourse, providing a crucial contribution to our understanding of a central organizing principle of the modern world.
Comparative Analysis of Botrytis cinerea in Response to the Microbial Secondary Metabolite Benzothiazole Using iTRAQ-Based Quantitative Proteomics
Authors: Cui Kaidi , He Leiming , Zhao Yunhe , Mu Wei , Lin Jin , Liu Feng
Published: December 2020

Benzothiazole is a microbial volatile compound with strong antifungal activity against the phytopathogenic fungus Botrytis cinerea, but its mode of action against fungi remains largely unknown. Understanding the molecular mechanisms underlying its activity could aid the design and synthesis of similar compounds against pathogenic fungi. Based on the results of morphological and antifungal activity assays, B. cinerea was exposed to 2.5 µl/liter of benzothiazole for 12, 24, and 48 h, and an isobaric tags for relative and absolute quantitation-based quantitative proteomic analysis showed that 378 out of 5,110 identified proteins were differentially expressed proteins (DEPs). The majority of these DEPs were associated with carbohydrate metabolism, oxidation reduction processes, and energy production. Further analysis showed that benzothiazole inhibited mitochondrial membrane organization and decreased the mitochondrial membrane potential of B. cinerea. In addition, the key enzymes of the glyoxylate cycle were downregulated after benzothiazole treatment, and a biochemical analysis indicated that inhibition of the glyoxylate cycle by benzothiazole blocked nutrient availability and interfered with adenosine triphosphate generation. This study provides markers for future research of the molecular responses of B. cinerea to benzothiazole stress.
Emerging practices in onboarding programs for PAs
Authors: Anglin Lorraine , Sanchez Mara , Butterfield Rita , Rana Rachel , Everett Christine M. , Morgan Perri
Published: December 2020

Objective:

This is the final article in a series that examines the role of onboarding programs for new physician assistants (PAs) and NPs. On-the-job learning is highly relevant for this workforce. Here we examine the strategies organizations use to impart information and skills in onboarding programs.

Methods:

In 2018, we interviewed 13 administrators of onboarding programs. Interviews were transcribed and analyzed for themes by a team of researchers, with feedback from interviewees.

Results:

Seven strategies were identified and are described in this article: Clinical mentoring, personal and professional mentoring, meeting with/shadowing other professionals, checking in by administrators, delivering didactic content, tailoring content or ramp-up, and assessing/ensuring competency.

Conclusions:

This article describes commonly used strategies in onboarding programs for PAs and NPs and can provide guidance to those designing their own onboarding programs. The programs we examined relied heavily on mentoring and other strategies appropriate for adult learners. Future work should evaluate the effectiveness of onboarding programs.
Are the new PA students helpful to emergency medicine physicians in Israel?
Authors: Berkowitz Oren , Maoz-Breuer Rina , Tal-Or Eran , Nissanholtz-Gannot Rachel
Published: December 2020

Objective:

Physician assistants (PA) began training in Israeli EDs in 2016. Physician perspectives were measured to evaluate the clinical contributions of PA students.

Methods:

Investigators surveyed members of the Israeli Association of Emergency Medicine Physicians in 2017 to rate whether PA students were helpful in patient care and to explore perceptions about PA students.

Results:

Those working with a PA student felt they were helpful to very helpful in all of the clinical tasks measured. The majority (85%) of other physicians wanted to work with a PA student in the future. Ordering medications, administering IV fluid therapy, and suturing accounted for 60% of the tasks that physicians wanted to add to PA scope of practice.

Conclusions:

PA students were helpful in the ED and were meeting expectations for clinical contributions. Most physicians would like to work with PAs and they would like to see PAs increase their scope of practice.
Beyond roofies
Authors: Thompson Katherine M.
Published: December 2020

Substance use in victims of sexual assault, whether voluntary or involuntary, changes the aftermath and recovery process significantly, affecting the way memories are processed and recalled, the chances of developing significant mental health complications, and the disclosure reactions that the survivor receives. Clinicians must understand these differences in order to provide the best possible care to survivors. This article provides an overview of these topics, detailing some of the nuances of interviewing, testing, and the physiology of memory formation and how that affects the outcomes of prosecution in these crimes.
The changing landscape of PAs and NPs in nephrology
Authors: Davis Jane , Zuber Kim
Published: December 2020

Background:

Physician assistants (PAs) and NPs have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased.

Purpose:

To evaluate the workforce patterns of PAs and NPs working in nephrology over the past decade.

Methods:

Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade.

Results:

Surveys of nephrology practitioners show the evolution of the dialysis-focused practitioner to one encompassing all aspects of nephrology: hospital, ICU, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities.

Conclusions:

PAs and NPs in nephrology have the opportunity to use their skills and training in caring for this high-risk population.
Elevated liver function tests in COVID-19
Authors: Clark Ricketta , Waters Bradford , Stanfill Ansley Grimes
Published: December 2020

COVID-19 causes severe respiratory and multiorgan failure, including liver damage and elevated transaminase levels. This article addresses the potential causes of liver function abnormalities in patients diagnosed with COVID-19 and management approaches for NPs focusing on preventing and alleviating liver injury.
33rd Annual APRN Legislative Update
Authors: Phillips Susanne J.
Published: December 2020

In a year unlike any other in recent history, healthcare workers, including advanced practice registered nurses (APRNs), faced challenges and triumphs as the frontline in the battle against COVID-19. This 33rd Annual Legislative Update covers the scope of practice changes and legislative decisions that most impacted APRNs across the US in 2020.
High blood pressure induced by vitamin D deficiency is associated with renal overexpression and hyperphosphorylation of Na+-K+-2Cl- cotransporter type 2
Authors: Luchi Weverton M. , Crajoinas Renato O. , Martins Flavia L. , Castro Paulo de C. , Venturini Gabriela , Seguro Antonio C. , Girardi Adriana C.C.
Published: December 2020

Objectives:

Clinical and epidemiological studies have suggested a correlation between vitamin D deficiency (VDD) and high blood pressure (BP). This study aimed to test the hypothesis that high BP induced by VDD is associated with altered expression and covalent modification of apical sodium transporters along the nephron. The contributions of the intrarenal renin–angiotensin system (RAS) and oxidative stress were also investigated.

Methods:

Male Wistar rats were fed a vitamin D-free (n = 26) or standard diet (n = 25) for 30 days. BP was recorded using noninvasive and invasive procedures. The expression levels of total and phosphorylated apical sodium transporters in rat renal cortex and medulla were evaluated by immunoblotting. Intrarenal RAS components were assessed by immunoblotting and ELISA. Renal oxidative stress was analyzed by measuring the concentrations of thiobarbituric acid reactive substances and reduced glutathione.

Results:

Higher BP levels in VDD rats than controls were accompanied by overexpression and hyperphosphorylation of renal cortical and medullary Na+-K+-2Cl- cotransporter type 2, enhanced levels of phosphorylated Na+/H+ exchanger type 3, and reduced expression levels of total and phosphorylated Na+/Cl- cotransporter. Changes in intrarenal RAS induced by VDD vs. controls included the marked elevation of medullary renin expression, higher expression of cortical angiotensinogen, higher urinary angiotensinogen excretion, and higher cortical and medullary angiotensin II content. VDD rats displayed higher thiobarbituric acid reactive substances/glutathione ratios in the renal cortex and medulla than controls.

Conclusion:

These results suggest that the molecular mechanisms underlying the effects of VDD on BP may include the upregulation of Na+-K+-2Cl- cotransporter type 2 and activation of intrarenal RAS and oxidative stress.