bluuebunny/crossref_metadata_2025 huggingface dataset:
Disease- and Treatment-related Complications in Older Patients With Inflammatory Bowel Diseases: Comparison of Adult-onset vs Elderly-onset Disease
Authors: Rozich Jacob J , Luo Jiyu , Dulai Parambir S , Collins Angelina E , Pham Lysianne , Boland Brigid S , Sandborn William J , Singh Siddharth
Published: December 2020

Background

The incidence and prevalence of inflammatory bowel diseases (IBD) in older adults are rising. There is a limited comparative assessment of risk of disease- and treatment-related complications in older patients (older than 60 years) with adult-onset (age at disease onset, 18–59 years; AO-IBD) vs elderly-onset IBD (age at disease onset, older than 60 years; EO-IBD). We compared clinical outcomes in older patients with IBD with AO-IBD vs EO-IBD.

Methods

We conducted a retrospective cohort study comparing risk of disease-related complications (IBD-related surgery, hospitalization, treatment escalation, clinical flare, or disease complication) and treatment-related complications (serious infection, malignancy, or death) in older patients with AO-IBD vs EO-IBD through Cox proportional hazard analysis, adjusting for age at cohort entry, disease phenotype, disease duration, prior surgery and/or hospitalization, medication use, disease activity at cohort entry, and comorbidities.

Results

We included 356 older patients with IBD (AO-IBD, 191 patients, 67 ± 5 y at cohort entry; EO-IBD, 165 patients, 72 ± 8 y at cohort entry). No significant differences were observed in the risk of disease-related complications in older patients with prevalent vs incident IBD (adjusted hazard ratio [aHR], 0.85; 95% CI, 0.58–1.25), although risk of IBD-related surgery was lower in older patients with prevalent IBD (aHR, 0.47; 95% CI, 0.25–0.89). Older patients with prevalent IBD were significantly less likely to experience treatment-related complications (aHR, 0.58; 95% CI, 0.39–0.87).

Conclusion

Patients with AO-IBD have lower risk of treatment-related complications as they age compared with patients with EO-IBD, without a significant difference in risk of disease-related complications.
“We Can Do This”: Merkel, Migration and the Fantasy of Control
Authors: Zehfuss Maja
Published: December 2020

At the height of the so-called 2015 refugee crisis, Angela Merkel, Chancellor of the Federal Republic of Germany, is thought to have opened the country's borders to a million refugees. She was celebrated as an international leader and the refugees’ savior, while the country was seen as having a welcome culture. Retrospectively, however, her refugee policy is construed as a mistake. Both interpretations agree that Merkel opened the border. Deploying a detailed reading of events, this article asks what political imaginary is invoked through this representation and what its consequences are. It draws out how paying attention to temporality reveals the racialization involved in producing the problem. First, the article sets out the centrality of Merkel and the border opening to accounts of the events, drawing out the temporality of events and its implications. Second, it asks what it means to say that the border was opened, complicating this representation. Finally, it shows how the focus on the border opening invoked a political imaginary marked by a fantasy of control that obscures its own exclusions. Recognizing bordering as about control over the temporality of community alerts us to how the impossible desire to control the future racializes those seeking refuge.
Spanning Thousands of Miles and Years: Political Nostalgia and China's Revival of the Silk Road
Authors: Benabdallah Lina
Published: December 2020

The study of international relations (IR) has paid increasing attention over the last decade or so to the politics of memory, trauma, shame, but to a less extent to the political instrumentalization of positive experiences of the past. Indeed, IR theory rarely engaged the concept of nostalgia and its place within foreign policy making despite its potential for providing a powerful theoretical lens to explain hegemonic power dynamics. Sitting at the intersection of time and space, of time and affect, and of past and present, political nostalgia enables state leaders to move back and forth in time bringing back the past not for the past's sake but for the promise of a prosperous future. This article examines Chinese government's nostalgic borrowings from the Ancient Silk Road in order to associate Xi Jinping's new grand strategy, the New Silk Road to notions of inclusivity and prosperity. Reviving stories about fifteenth-century Chinese admiral Zheng He and reconstructing the history of his maritime navigations through stories and images of camel caravans crossing sand dunes are illustrations of political nostalgia.
Angling for Influence: Institutional Proliferation in Development Banking
Authors: Pratt Tyler
Published: December 2020

Why do states build new international organizations (IOs) in issue areas where many institutions already exist? Prevailing theories of institutional creation emphasize their ability to resolve market failures, but adding new IOs can increase uncertainty and rule inconsistency. I argue that institutional proliferation occurs when existing IOs fail to adapt to shifts in state power. Member states expect decision-making rules to reflect their underlying power; when it does not, they demand greater influence in the organization. Subsequent bargaining over the redistribution of IO influence often fails due to credibility and information problems. As a result, under-represented states construct new organizations that provide them with greater institutional control. To test this argument, I examine the proliferation of multilateral development banks since 1944. I leverage a novel identification strategy rooted in the allocation of World Bank votes at Bretton Woods to show that the probability of institutional proliferation is higher when power is misaligned in existing institutions. My results suggest that conflict over shifts in global power contribute to the fragmentation of global governance.
Prevalence of Field-Collected House Flies and Stable Flies With Bacteria Displaying Cefotaxime and Multidrug Resistance
Authors: Pileggi Matthew T , Chase John R , Shu Runhang , Teng Lin , Jeong Kwangcheol C , Kaufman Phillip E , Wong Adam C N
Published: December 2020

Antibiotic use in livestock accounts for 80% of total antibiotic use in the United States and has been described as the driver for resistance evolution and spread. As clinical infections with multidrug-resistant pathogens are rapidly rising, there remains a missing link between agricultural antibiotic use and its impact on human health. In this study, two species of filth flies from a livestock operation were collected over the course of 11 mo: house flies Musca domestica (L.) (Diptera: Muscidae), representing a generalist feeder, and stable flies Stomoxys calcitrans (L.) (Diptera: Muscidae), representing a specialist (blood) feeder. The prevalence of flies carrying cefotaxime-resistant (CTX-R) bacteria in whole bodies and dissected guts were assayed by culturing on antibiotic-selective media, with distinct colonies identified by Sanger sequencing. Of the 149 flies processed, including 81 house flies and 68 stable flies, 18 isolates of 12 unique bacterial species resistant to high-level cefotaxime were recovered. These isolates also showed resistance to multiple classes of antibiotics. The CTX-R isolates were predominantly recovered from female flies, which bore at least two resistant bacterial species. The majority of resistant bacteria were isolated from the guts encompassing both enteric pathogens and commensals, sharing no overlap between the two fly species. Together, we conclude that house flies and stable flies in the field could harbor multidrug-resistant bacteria. The fly gut may serve as a reservoir for the acquisition and dissemination of resistance genes.
A Checklist of Macronyssid Species (Mesostigmata: Macronyssidae) From Brazil
Authors: Bassini-Silva Ricardo , Jacinavicius Fernando de Castro , Huang-Bastos Matheus , Dowling Ashley P G , Barros-Battesti Darci Moraes
Published: December 2020

Macronyssid mites are parasites of reptiles, birds, and mammals. A checklist of macronyssid species of Brazil is provided, containing 13 genera and 26 species collected from 99 host species.
Plastic Surgery at War: A Scoping Review of Current Conflicts
Authors: Fox Justin P , Markov Nickolay P , Markov Alexandra M , O’Reilly Eamon , Latham Kerry P
Published: December 2020

Introduction

The scope of military plastic surgery and location where care is provided has evolved with each major conflict. To help inform plastic surgeon utilization in future conflicts, we conducted a review of military plastic surgery-related studies to characterize plastic surgeon contributions during recent military operations.

Materials and Methods

Using a scoping review design, we searched electronic databases to identify articles published since September 1, 2001 related to military plastic surgery according to a defined search criterion. Next, we screened all abstracts for appropriateness based on pre-established inclusion/exclusion criteria. Finally, we reviewed the remaining full-text articles to describe the nature of care provided and the operational level at which care was delivered.

Results

The final sample included 55 studies with most originating in the United States (54.5%) between 2005 and 2019 and were either retrospective cohort studies (81.8%) or case series (10.9%). The breadth of care included management of significant upper/lower extremity injuries (40%), general reconstructive and wound care (36.4%), and craniofacial surgery (16.4%). Microsurgical reconstruction was a primary focus in 40.0% of published articles. When specified, most care was described at Role 3 (25.5%) or Roles 4/5 facilities (62.8%) with temporizing measures more common at Role 3 and definite reconstruction at Roles 4/5. Several lessons learned were identified that held commonality across plastic surgery domain.

Conclusions

Plastic surgeons continue to play a critical role in the management of wounded service members, particularly for complex extremity reconstruction, craniofacial trauma, and general expertise on wound management. Future efforts should evaluate mechanisms to maintain these skill sets among military plastic surgeons.
Evaluating Perioperative Glycemic Control of Non-cardiac Surgical Patients with Diabetes
Authors: Todd L Alan , Vigersky Robert A
Published: December 2020

Introduction

Hyperglycemia during the perioperative period has generally been accepted as a contributor of poor outcomes in patients with diabetes mellitus undergoing surgery. Although an optimal glycemic range has not been clearly established in the literature, a consensus among national medical organizations generally recommends serum glucose levels to be maintained less than 180 mg/dL during the perioperative period.

Materials and Methods

The primary purpose of this evidence-based project was to identify the range of blood glucose values obtained from adult patients with diabetes mellitus undergoing non-cardiac surgery at a large military medical facility. The secondary purpose of this project was to assess the need for change in future practice. A retrospective review of the electronic medical record was conducted to identify adult surgical patients with diabetes scheduled for non-cardiac surgery. Preoperative and postoperative blood glucose values were obtained from the electronic medical record. The frequency of blood glucose values maintained within the recommended range of 140-180 mg/dL was recorded. Additional demographic data were collected to include age, height, weight, body mass index, length of surgery, and insulin/oral glycemic medications.

Results

Of the 9,449 surgeries performed between January 1, 2013, and December 31, 2013, there were 762 (8%) adult non-cardiac surgical patients identified with either a diagnosis of diabetes or a blood glucose value reported during the perioperative period. The recommended blood glucose range of 140-180 mg/dL was achieved in 31.3% (179 of 572) of patients before surgery and 28.6% (71 of 248) after surgery. A blood glucose value was not recorded before or after surgery in 24.9% (190 of 762) of patients identified as having pre-diabetes or diabetes.

Conclusion

Diabetes is a frequent finding in surgical patients. Monitoring blood glucose values during the perioperative period may allow for early treatment and prevent complications related to poor glycemic control. The results of this project revealed 2 potential areas of improvement in the care of non-cardiac surgical patients with diabetes: (1) improving compliance with obtaining blood glucose values before and after surgery and (2) reducing the incidence of postoperative hyperglycemia (>180 mg/dL) which potentially could prevent avoidable complications related to poor glycemic control.
Inclusion of a Military-specific, Virtual Reality–based Rehabilitation Intervention Improved Measured Function, but Not Perceived Function, in Individuals with Lower Limb Trauma
Authors: Sheehan Riley C , Fain AuraLea C , Wilson Jonathan B , Wilken Jason M , Rábago Christopher A
Published: December 2020

Introduction

Lower extremity injury is common in the military and can lead to instability, pain, and decreased function. Military service also places high physical demands on service members (SMs). Standard treatment interventions often fail to align with these unique demands. Thus, the goal of the study was to evaluate the effectiveness of a military-specific virtual reality–based rehabilitation (VR) intervention supplemental to standard care (SC) in improving military performance in SMs with lower extremity injuries.

Materials and Methods

As part of an institutional review board–approved randomized control trial, SMs receiving care at an advanced rehabilitation center were randomized to receive either SC or VR in addition to SC (VR+SC). Participants were evaluated before treatment and ∼3 weeks later using a previously developed and validated military-specific assessment. Perceived improvement in physical function was measured using a Global Rating of Change (GROC) questionnaire. A repeated measures ANOVA was used to evaluate the effects of adding VR on the military-specific assessment measures. Linear regression was used to determine the relationship between perceived improvement, measured improvement, and VR volume.

Results

The VR+SC group was able to traverse a greater distance in the assessment following the VR intervention. There was no significant difference in GROC between groups. For the VR+SC group, change in distance completed was not correlated with GROC, but GROC was correlated with VR volume.

Conclusion

VR improved the distance that participants were able to traverse in the assessment. However, the VR+SC group demonstrated a disconnect between their perceived functional improvement as measured by the GROC and functional improvement as measured by the change in the distance completed. Rather, the perceived improvement appears to be more correlated with the volume of VR received. The way in which the treatment progression is structured and communicated may influence how patients perceive their change in physical function.
Mild Traumatic Brain Injury and Postconcussive Symptom Endorsement: A Parallel Comparison Between Two Nonclinical Cohorts
Authors: Cornwell R Elisabeth , Arango Jorge I , Eagye C B , Hill-Pearson Candace , Schwab Karen , Souvignier Alicia R , Pazdan Renee M
Published: December 2020

Introduction

The prevalence of mild traumatic brain injury (mTBI) is commonly estimated based on indirect metrics such as emergency department visits and self-reporting tools. The study of postconcussive symptoms faces similar challenges because of their unspecific character and indistinct causality. In this article, we compare two nonclinical, epidemiological studies that addressed these two elements and were performed within a relatively narrow period in the state of Colorado.

Materials and Methods

De-identified datasets were obtained from a random digit-dialed survey study conducted by the Craig Hospital and a study surveying soldiers returning from deployment by Defense and Veteran Traumatic Brain Injury Center. Information pertinent to participants’ demographics, a history of mTBI, and symptom endorsement was extracted and homogenized in order to establish a parallel comparison between the populations of the two studies.

Results

From the 1,558 (Warrior Strong, 679; Craig Hospital, 879) records selected for analysis, 43% reported a history of at least one mTBI. The prevalence was significantly higher among individuals from the Defense and Veteran Traumatic Brain Injury Center study independent of gender or race. Repetitive injuries were reported by 15% of the total combined cohort and were more prevalent among males. Symptom endorsement was significantly higher in individuals with a positive history of mTBI, but over 80% of those with a negative history of mTBI endorsed at least one of the symptoms interrogated. Significant differences were observed between the military and the civilian populations in terms of the types and frequencies of the symptoms endorsed.

Conclusions

The prevalence of mTBI and associated symptoms identified in the two study populations is higher than that of previously reported. This suggests that not all individuals sustaining concussion seek medical care and highlights the limitations of using clinical reports to assess such estimates. The lack of appropriate mechanisms to determine symptom presence and causality remains a challenge. However, the differences observed in symptom reporting between cohorts raise questions about the nature of the symptoms, the impact on the quality of life for different individuals, and the effects on military health and force readiness.
Oxygen Management During Collective Aeromedical Evacuation of 36 COVID-19 Patients With ARDS
Authors: Beaussac Madeleine , Boutonnet Mathieu , Koch Lionel , Paris Raphael , Di Filippo Julia , Distinguin Berangère , Murris Sophie , Dupre Henri-Louis , Muller Violaine , Turc Jean
Published: December 2020

Objective

The ongoing coronavirus disease-2019 pandemic leads to the saturation of critical care facilities worldwide. Collective aeromedical evacuations (MEDEVACS) might help rebalance the demand and supply of health care. If interhospital transport of patients suffering from ARDS is relatively common, little is known about the specific challenges of collective medevac. Oxygen management in such context is crucial. We describe our experience with a focus on this resource.

Methods

We retrospectively analyzed the first six collective medevac performed during the coronavirus disease-2019 pandemic by the French Military Health Service from March 17 to April 3, 2020. Oxygen management was compliant with international guidelines as well as aeronautical constraints and monitored throughout the flights. Presumed high O2 consumers were scheduled to board the last and disembark the first.

Results

Thirty-six mechanically ventilated patients were successfully transported within Europe. The duration of onboard ventilation was 185 minutes (145-198.5 minutes), including the flight, the boarding and disembarking periods. Oxygen intake was 1,650 L per patient per flight (1,350-1,950 L patient per flight) and 564 L per patient per hour (482-675 L per patient−1 per hour) and surpassed our anticipation. As anticipated, presumed high O2 consumers had a reduced ventilation duration onboard. The estimations of oxygen consumptions were frequently overshot, and only two hypoxemia episodes occurred.

Conclusion

Oxygen consumption was higher than expected, despite anticipation and predefined oxygen management measures, and encourages to a great caution in the processing of such collective medevac missions.
Battlefield Vital Sign Monitoring in Role 1 Military Treatment Facilities: A Thematic Analysis of After-Action Reviews from the Prehospital Trauma Registry
Authors: Carius Brandon M , Naylor Jason F , April Michael D , Fisher Andrew D , Hudson Ian L , Stednick Peter J , Maddry Joseph K , Weitzel Erik K , Convertino Victor A , Schauer Steve G
Published: December 2020

Introduction

The Prehospital Trauma Registry (PHTR) captures after-action reviews (AARs) as part of a continuous performance improvement cycle and to provide commanders real-time feedback of Role 1 care. We have previously described overall challenges noted within the AARs. We now performed a focused assessment of challenges with regard to hemodynamic monitoring to improve casualty monitoring systems.

Materials and Methods

We performed a review of AARs within the PHTR in Afghanistan from January 2013 to September 2014 as previously described. In this analysis, we focus on AARs specific to challenges with hemodynamic monitoring of combat casualties.

Results

Of the 705 PHTR casualties, 592 had available AAR data; 86 of those described challenges with hemodynamic monitoring. Most were identified as male (97%) and having sustained battle injuries (93%), typically from an explosion (48%). Most were urgent evacuation status (85%) and had a medical officer in their chain of care (65%). The most common vital sign mentioned in AAR comments was blood pressure (62%), and nearly one-quarter of comments stated that arterial palpation was used in place of blood pressure cuff measurements.

Conclusions

Our qualitative methods study highlights the challenges with obtaining vital signs—both training and equipment. We also highlight the challenges regarding ongoing monitoring to prevent hemodynamic collapse in severely injured casualties. The U.S. military needs to develop better methods for casualty monitoring for the subset of casualties that are critically injured.
Antifungal efficacy of isavuconazole and liposomal amphotericin B in a rabbit model of Exserohilum rostratum meningoencephalitis: A preclinical paradigm for management of CNS phaeohyphomycosis
Authors: Petraitis Vidmantas , Petraitiene Ruta , Katragkou Aspasia , Maung Bo Bo Win , Moradi Patriss W , Sussman-Straus Gittel E , Naing Ethan , Kovanda Laura L , Finkelman Malcolm A , Walsh Thomas J
Published: December 2020

Treatment options for Exserohilum rostratum meningoencephalitis and other causes of phaeohyphomycosis of the central nervous system (CNS) are limited, while mortality and morbidity remain high. We therefore evaluated isavuconazole, a new antifungal triazole in comparison to liposomal amphotericin B (LAMB), in vitro and in the rabbit model of Exserohilum rostratum meningoencephalitis. We hypothesized that isavuconazole alone or in combination with LAMB or micafungin may be alternative options for treatment of CNS phaeohyphomycosis. We therefore investigated the in vitro antifungal activity of isavuconazole alone or in combination with amphotericin B deoxycholate (DAMB) or micafungin and efficacy of treatment with isavuconazole and LAMB in a rabbit model of experimental E. rostratum meningoencephalitis. Combination checkerboard plates were used to determine the minimum inhibitory concentrations, minimal lethal concentrations, fractional inhibitory concentration indices, and Bliss surface analysis of isavuconazole and amphotericin B deoxycholate (DAMB), either alone or in combination. As there were no in vitro synergistic or antagonistic interactions for either combination of antifungal agents against the E. rostratum isolates, in vivo studies were conducted with isavuconazole and LAMB as monotherapies. Rabbits were divided in following groups: treated with isavuconazole at 60 mg/kg/d (ISAV60), LAMB at 5.0 (LAMB5), 7.5 (LAMB7.5), and 10 mg/kg/d (LAMB10), and untreated controls (UC). In ISAV60-, LAMB5-, LAMB7.5-, and LAMB10-treated rabbits, significant reductions of fungal burden of E. rostratum in cerebral, cerebellar, and spinal cord tissues (P < 0.01) were demonstrated in comparison to those of UC. These antifungal effects correlated with significant reduction of CSF (1→3)-β-D-glucan levels vs UC (P < 0.05). These data establish new translational insights into treatment of CNS phaeohyphomycosis.
Improvement in Quality of Life Following Surgical Resection of Benign Intradural Extramedullary Tumors: A Prospective Evaluation of Patient-Reported Outcomes
Authors: Newman William C , Berry-Candelario John , Villavieja Jemma , Reiner Anne S , Bilsky Mark H , Laufer Ilya , Barzilai Ori
Published: December 2020

BACKGROUND

Historically, symptomatic, benign intradural extramedullary (IDEM) spine tumors have been managed with surgical resection. However, minimal robust data regarding patient-reported outcomes (PROs) following treatment of symptomatic lesions exists. Moreover, there are increasing reports of radiosurgical management of these lesions without robust health-related quality of life data.

OBJECTIVE

To prospectively analyze PROs among patients with benign IDEM spine tumors undergoing surgical resection to define the symptomatic efficacy of surgery.

METHODS

Prospective, single-center observational cohort study of patients with benign IDEM spine tumors undergoing open surgical resection. Pre- and postoperative Brief Pain Index (BPI) and MD Anderson Symptom Inventory (MDASI) questionnaires were used to quantitatively assess their symptom control after surgical intervention. Matched pairs were analyzed with the Wilcoxon signed-rank test.

RESULTS

A total of 57 patients met inclusion criteria with both pre- and postoperative PROs. There were 35 schwannomas, 18 meningiomas, 2 neurofibromas, 1 paraganglioma, and 1 mixed schwannoma/neurofibroma. Most patients were American Spinal Injury Association Impairment (ASIA) E (93%) with high-grade spinal cord compression (77%), and underwent either a 2 or 3 level laminectomy (84%). Surgical resection resulted in statistically significant improvement in all 3 composite BPI constructs of pain-severity, pain-interference, and overall patient pain experience (P < .0001). Surgical resection resulted in statistically significant improvements in all composite scores for the MDASI core symptom severity, spine tumor, and disease interference constructs (P < .01). Three patients (5%) had postoperative complications requiring surgical interventions (2 wound revisions and 1 ventriculo-peritoneal shunt).

CONCLUSION

Surgical resection of IDEM spine tumors provides rapid, significant, and durable improvement in PROs.
Risk Reduction and Redemption: An Interpretive Account of the Right to Rehabilitation in the Jurisprudence of the European Court of Human Rights
Authors: O’Loughlin Ailbhe
Published: December 2020

This article exposes the disjunction between the progressive rhetoric of the European Court of Human Rights (ECtHR) on rehabilitation and the reality for life-sentenced prisoners. It illuminates the tensions between the Court’s jurisprudence on the prisoner’s right to rehabilitation and a nebulous ‘right to security’ of the public that threatens to undermine prisoners’ rights. It is argued that two distinct conceptual frameworks for understanding rehabilitation for life-sentenced prisoners underpin the ECtHR’s jurisprudence: rehabilitation as risk reduction and rehabilitation as redemption. The first is shaped by a preoccupation with identifying and reducing risk factors for offending. The second reflects the idea that offending indicates bad character but that people can atone for their crimes by working hard to change themselves. The article concludes that the ECtHR, by placing the onus on life-sentenced prisoners to demonstrate they have achieved rehabilitation, risks entrenching the trends of popular punitiveness and precautionary penal warehousing that it has sought to oppose.
Risk and resilience of well-being in caregivers of young children in response to the COVID-19 pandemic
Authors: Davidson Bridget , Schmidt Ellyn , Mallar Carolina , Mahmoud Farah , Rothenberg William , Hernandez Julieta , Berkovits Michelle , Jent Jason , Delamater Alan , Natale Ruby
Published: December 2020

The COVID-19 pandemic is impacting communities worldwide, with direct effects of illness and mortality, and indirect effects on economies, workplaces, schools/daycares, and social life. However, we understand very little about the effects of this pandemic on families of young children. We used a risk and resilience model to evaluate the effects of the pandemic on mental health in diverse caregivers (N = 286) with children ages birth to 5. We evaluated the hypotheses that (a) pandemic stress and caregiver-reported child psychosocial concerns correlate with caregivers’ mental health symptoms and (b) caregivers’ pandemic-related self-efficacy and coping mediate these relationships. Caregivers completed surveys in April–May 2020 assessing pandemic stress (e.g., health, finances, and housing), child psychosocial problems, coping strategies, and self-efficacy to manage family needs. Our primary outcome was caregivers’ self-reported changes in mental health symptoms since the outbreak. Path analysis revealed that higher pandemic stress was associated with caregivers’ reduced confidence in meeting their family’s needs related to COVID-19, which correlated with worse caregiver mental health symptoms. Greater child psychosocial problems also predicted worse caregiver mental health symptoms. Findings suggest that pandemic stress, child psychosocial problems, and caregiver self-efficacy are interrelated in their influence on caregivers’ mental health. While further research is needed to examine strategies to foster resilience and buffer the pandemic’s effects on caregiver mental health, this is a first step in evaluating the psychosocial effects of this pandemic in families of young children. Clinical implications are discussed for a tiered response to mitigate the pandemic’s impacts on family functioning.
Roles and Responsibilities of Nurses in Advance Care Planning in Palliative Care in the Acute Care Setting
Authors: Fliedner Monica , Halfens Ruud J. G. , King Cynthia R. , Eychmueller Steffen , Lohrmann Christa , Schols Jos M. G. A.
Published: December 2020

Palliative care focuses on symptom management, discussion of treatment and care decisions, network organization, and support of the family. As part of the advance care planning (ACP) process, staff nurses in the acute care setting are often involved in all of the above areas. It is yet unclear what nurses' roles and responsibilities are and what skills are needed in the ACP process. The themes that staff nurses and advanced practice registered nurses (APRNs) discuss in relationship to ACP are manifold. This scoping review demonstrates that staff nurses' core role is advocating for the wishes and values of patients with any life-limiting disease. Staff nurses also serve as facilitators, educators, and advocates to help start ACP conversations and ease patients' transitions between settings based on well-discussed decisions. To be able to engage in ACP discussions, APRNs must have excellent communication skills. Continuous training to improve these skills is mandatory. In the future, clarifying the contribution of staff nurses and APRNs in the ACP process in relation to other members of the interprofessional team can lay the groundwork for improved interprofessional collaboration.
Malignant Mixed Germ Cell Tumors of the Ovary
Authors: Safdar Nida S. , Stall Jennifer N. , Young Robert H.
Published: December 2020

One hundred malignant mixed germ cell tumors of the ovary that occurred in patients 3 to 55 years (mean: 20 y) of age are described. The clinical presentation was usually that of any highly malignant tumor of the ovary (abdominal pain and distension), but rarely (3 cases) endocrine manifestations were present. The tumors were usually unilateral (96%), ranged from 4 to 38 cm (mean: 16 cm), and were uniformly solid or, more often, solid and cystic; occasionally the typical appearance of dysgerminoma could be appreciated. The most common tumor type was yolk sac tumor (91%), followed by dysgerminoma (61%), immature teratoma (58%), embryonal carcinoma (38%), and choriocarcinoma (11%). A variety of admixtures were encountered; dysgerminoma and yolk sac tumor was the most common combination (25% of the tumors) with the 2 components often being sharply demarcated. Immature teratoma and yolk sac tumor was the next most common pairing (20%) followed by yolk sac tumor and embryonal carcinoma, with or without immature teratoma (16%). Tumors with a choriocarcinoma component had the most varied combinations of tumor types. Embryoid bodies were seen in 21% of the tumors, most often as fragmented forms arranged in a nodular manner with yolk sac tumor and/or embryonal carcinoma; uncommonly they occurred singly or in clusters. Numerous confluent well-formed embryoid bodies (polyembryoma) were prominent in 2 tumors. Three tumors had a focal diffuse embryoma pattern. The specific tumor types showed the known diverse spectrum of microscopic appearances, but the frequent haphazard arrangement of 2 or more subtypes often resulted in complex morphology. Overgrowth of another neoplastic component, most often primitive neuroectodermal tumor, occurred in 10% of the tumors further complicating the histologic picture. This is the largest series of ovarian malignant mixed germ cell tumors reported and details their characteristics including associations of their subtypes and the frequent apparent role of embryoid bodies in giving rise to yolk sac tumor and embryonal carcinoma components.
Immunotherapy in EGFR-Mutant and ALK-Positive Lung Cancer
Authors: Gavralidis Alexander , Gainor Justin F.
Published: December 2020

Non–small cell lung cancer (NSCLC) is a heterogeneous disease, commonly defined by genetic alterations in oncogenic drivers. Targeted therapies have transformed the management of oncogene-driven lung cancers, with targeted agents now approved in the United States for 7 distinct molecular alterations. Nonetheless, acquired resistance remains an ongoing challenge, underscoring the need for alternative therapeutic approaches. Immune checkpoint inhibitors targeting the programmed cell death 1 (PD-1) axis have emerged as important therapies in the management of advanced NSCLC, but the role of these agents in patients with oncogenic driver mutations remains unclear. Here, we focus on epidermal growth factor receptor–mutant and anaplastic lymphoma kinase–rearranged NSCLC as paradigms to explore the role of immune checkpoint inhibitors in oncogene-driven NSCLC. We provide an overview of the clinical data examining programmed death ligand 1 (PD-L1) inhibitor monotherapy, PD-(L)1 inhibitors, and tyrosine kinase inhibitor combinations, as well as combinations of PD-(L)1 inhibitors and chemotherapy.
Randomized Pilot Study of an Advanced Smart-Pill Bottle as an Adherence Intervention in Patients With HIV on Antiretroviral Treatment
Authors: Ellsworth Grant B. , Burke Leah A. , Wells Martin T. , Mishra Satish , Caffrey Matthew , Liddle David , Madhava Malika , O'Neal Curtis , Anderson Peter L. , Bushman Lane , Ellison Lucas , Stein Josh , Gulick Roy M.
Published: December 2020

Background:

Adherence is critical to achieve the benefits of antiretroviral therapy. A smart-pill bottle service that transmits real-time adherence data via cellular networks to a central service and prompts nonadherent patients with phone or text messages may improve adherence.

Methods:

Adults with HIV taking a tenofovir-containing regimen with suboptimal adherence were randomized to adherence counseling ± a smart-pill bottle service for 12 weeks. Tenofovir diphosphate (TFV-DP) levels by dried blood spot, HIV RNA levels, CD4 cell counts, and self-reported adherence were collected.

Results:

Sixty-three participants (22% women; 48% black, 25% Latino) were randomized: 30 to the smart-pill bottle (2 of whom were lost to follow-up before the baseline visit), and 33 to control arms. At baseline, 49% of participants had HIV RNA ≤20 copies/mL and 61% reported 100% adherence with ART over 4 days. From baseline to week 12, median TFV-DP levels were +252 and −41 fmol/punch in the bottle and control arms, respectively (P = 0.10). Exploratory exclusion of 3 participants with known or suspected drug–drug interactions found median TFV-DP levels of +278 and −38 fmol/punch, respectively (P = 0.04). There were no differences in study discontinuations, HIV RNA suppression, CD4 cell counts, or self-reported adherence at week 12.

Conclusions:

In a diverse group of participants with suboptimal adherence to ART, the smart-pill bottle service was associated with higher TFV-DP levels.
Pitfalls in Renal Ultrasound
Authors: David Neena , Horrow Mindy M.
Published: December 2020

Ultrasound (US) is replete with pitfalls in technique and interpretation, and renal imaging is no exception. Because US of the kidneys is a very common initial and follow-up imaging examination, it is important to be aware of both common and unusual sources of potential error. This essay will review optimal technique and discuss common overcalls, under calls, and misinterpretations with respect to renal size, hydronephrosis, calculi, cysts, masses, and collections.
Dermatology Ultrasound. Imaging Technique, Tips and Tricks, High-Resolution Anatomy
Authors: Catalano Orlando , Wortsman Ximena
Published: December 2020

This article reviews the ultrasound (US) scanner setting, the examination methodology, and the anatomy of the skin. Dermatologic US requires frequencies of 15 MHz or greater and appropriate probe handling. The use of color Doppler imaging is mandatory, proven that it is set to detect slow flows. Trapezoid field of view, extended field of view, 3-dimensional reconstruction, elastography, and new microvasculature imaging facilities can help, if available. Operators must be aware of the adjustments and tricks useful to improve the image quality. High-resolution US allows detailed assessment of epidermis, dermis, subcutaneous tissue, and skin appendages. Differences exist according to patient age, sex, and body area. Appropriate knowledge of the anatomy is mandatory to image skin abnormalities.
Quantification of Hepatic and Splenic Stiffness After Fontan Procedure in Children and Clinical Implications
Authors: Aliyev Bahruz , Bayramoglu Zuhal , Nişli Kemal , Omeroğlu Rukiye Eker , Dindar Aygün
Published: December 2020

We aimed to investigate Fontan associated liver disease in children by shear wave elastography (SWE). This is a single-center, prospective case-control study included 41 patients with Fontan physiology and 30 healthy controls. Hepatic and splenic shear wave elasticity values were exhibited both as kPa and m/s. The mean hepatic SWE values of Fontan patients (n = 41; 15.8 ± 3.2 kPa or 2.5 ± 1.8 m/s) were significantly higher than the control group (n = 30; 5.59 ± 0.6 kPa or 1.37 ± 0.07 m/s) (P < 0.001). The mean splenic SWE values of Fontan patients were (25.6 ± 4.61 kPa or 2.85 ± 0.22 m/s) significantly higher than the control group (15.9 ± 1.44 kPa or 2.29 ± 0.1 m/s) (P < 0.001). There were statistically significant positive correlations among the follow-up duration after the Fontan procedure with NT-proBNP (P = 0.008, r = 1) and prothrombin time (P = 0.009, r = 0.4) as well as the hepatic SWE values with alanine aminotransferase (P = 0.039, r = 0.32), gamma-glutamyl transferase (P = 0.045, r = 0.31), and PT (P = 0.011, r = 0.39). There has been statistically significant moderate positive correlations of splenic stiffness values with PT (P = 0.047, r = 0.34), and INR (P = 0.038, r = 0.35). The sensitivity and specificity of liver stiffness cutoff value as 11.1 kPa for detection of Fontan associated liver disease were 95% and 100%, respectively. The hepatic and splenic stiffness increase independently in Fontan patients due to parenchymal disease. Hepatic SWE is a reliable and noninvasive predictor of early hepatic alterations that could not be detected only by biochemical results or routine ultrasound examinations.
Willingness to seek laboratory testing for SARS-CoV-2 with home, drive-through, and clinic-based specimen collection locations
Authors: Siegler Aaron J. , Hall Eric , Luisi Nicole , Zlotorzynska Maria , Wilde Gretchen , Sanchez Travis , Bradley Heather , Sullivan Patrick S.
Published: December 2020

Background

SARS-CoV-2 virus testing for persons with COVID-19 symptoms, and contact tracing for those testing positive, will be critical to successful epidemic control. Willingness of persons experiencing symptoms to seek testing may determine the success of this strategy.

Methods

A cross-sectional, online survey in the United States measured willingness to seek testing if feeling ill under different specimen collection scenarios: home-based saliva, home-based swab, drive-through facility swab, and clinic-based swab. Instructions clarified that home-collected specimens would be mailed to a laboratory for testing. We presented similar willingness questions regarding testing during follow-up care.

Results

Of 1435 participants, comprising a broad range of sociodemographic groups, 92% were willing to test with a home saliva specimen, 88% with home swab, 71% with drive-through swab, and 60% with clinic collected swab. Moreover, 68% indicated they would be more likely to get tested if there was a home testing option. There were no significant differences in willingness items across sociodemographic variables or for those currently experiencing COVID-19 symptoms. Results were nearly identical for willingness to receive testing for follow-up COVID-19 care.

Conclusions

We observed a hierarchy of willingness to test for SARS-CoV-2, ordered by the degree of contact required. Home specimen collection options could result in up to one-third more symptomatic persons seeking testing, facilitating contact tracing and optimal clinical care. Remote specimen collection options may ease supply chain challenges and decrease the likelihood of nosocomial transmission. As home specimen collection options receive regulatory approval, they should be scaled rapidly by health systems.
Informative Neural Codes to Separate Object Categories
Authors: Shahmohammadi Mozhgan , Vahab Ehsan , Karimi-Rouzbahani Hamid
Published: December 2020

In order to develop object recognition algorithms, which can approach human-level recognition performance, researchers have been studying how the human brain performs recognition in the past five decades. This has already in-spired AI-based object recognition algorithms, such as convolutional neural networks, which are among the most successful object recognition platforms today and can approach human performance in specific tasks. However, it is not yet clearly known how recorded brain activations convey information about object category processing. One main obstacle has been the lack of large feature sets, to evaluate the information contents of multiple aspects of neural activations. Here, we compared the information contents of a large set of 25 features, extracted from time series of electroencephalography (EEG) recorded from human participants doing an object recognition task. We could characterize the most informative aspects of brain activations about object categories. Among the evaluated features, event-related potential (ERP) components of N1 and P2a were among the most informative features with the highest information in the Theta frequency bands. Upon limiting the analysis time window, we observed more information for features detecting temporally informative patterns in the signals. The results of this study can constrain previous theories about how the brain codes object category information.
Whole genome sequencing of nearly isogeneic WMI and WLI inbred rats identifies genes potentially involved in depression
Authors: de Jong Tristan , Kim Panjun , Guryev Victor , Mulligan Megan , Williams Robert W , Redei Eva E , Chen Hao
Published: December 2020

Background

The WMI and WLI inbred rat substrains were generated from the stress-prone, and not yet fully inbred, Wistar Kyoto (WKY) strain using bi-directional selection for immobility in the forced swim test followed by over 38 generations of inbreeding. Despite the low level of genetic diversity among WKY progenitors, the WMI substrain is more vulnerable to stress relative to its WLI control substrain. Here we quantify numbers and classes of sequence variants distinguishing these substrains and test the hypothesis that they are nearly isogenic.

Results

The WLI and WMI genomic DNA were sequenced using Illumina xTen, IonTorrent and 10X Chromium technologies to obtain a combined coverage of over 100X. We identified 4,296 high quality homozygous SNPs and indels that differ between the WMI and WLI substrains. Gene ontology analysis of these variants showed an enrichment for neurogenesis related pathways. In addition, high impact variations were detected in genes previously implicated in depression (e.g.Gnat2), depression-like behavior (e.g.Prlr, Nlrp1a), other psychiatric disease (e.g.Pou6f2, Kdm5a, Reep3, Wdfy3) or stress response (e.g.Pigr).

Conclusions

The high coverage sequencing data confirms the near isogenic nature of the two substrains, which combined with the variants detected can lead to the identification of genetic factors underlying greater susceptibility for depression, stress reactivity, and addiction.
Unusual evolution of tree frog populations in the Chernobyl exclusion zone
Authors: Car Clément , Gilles André , Armant Olivier , Burraco Pablo , Beaugelin-Seiller Karine , Gashchak Sergey , Camilleri Virginie , Cavalie Isabelle , Laloi Patrick , Adam-Guillermin Christelle , Orizaola Germán , Bonzom Jean-Marc
Published: December 2020

Despite the ubiquity of pollutants in the environment, their long-term ecological consequences are not always clear and still poorly studied. This is the case concerning the radioactive contamination of the environment following the major nuclear accident at the Chernobyl nuclear power plant. Notwithstanding the implications of evolutionary processes on the population status, few studies concern the evolution of organisms chronically exposed to ionizing radiation in the Chernobyl exclusion zone. Here, we examined genetic markers for 19 populations of Eastern tree frog (Hyla orientalis) sampled in the Chernobyl region about thirty years after the nuclear power plant accident to investigate microevolutionary processes ongoing in local populations. Genetic diversity estimated from nuclear and mitochondrial markers showed an absence of genetic erosion and higher mitochondrial diversity in tree frogs from the Chernobyl exclusion zone compared to other European populations. Moreover, the study of haplotype network permitted us to decipher the presence of an independent recent evolutionary history of Chernobyl exclusion zone’s Eastern tree frogs caused by an elevated mutation rate compared to other European populations. By fitting to our data a model of haplotype network evolution, we suspected that Eastern tree frog populations in the Chernobyl exclusion zone have a high mitochondrial mutation rate and small effective population sizes. These data suggest that Eastern tree frogs populations might offset the impact of deleterious mutations because of their large clutch size, but also question the long term impact of ionizing radiation on the status of other species living in the Chernobyl exclusion zone.