bluuebunny/crossref_metadata_2025 huggingface dataset:
Oviposition Behavior and Development of Aster Leafhoppers (Hemiptera: Cicadellidae) on Selected Host Plants From the Canadian Prairies
Authors: Romero Berenice , Olivier Chrystel , Wist Tyler , Prager Sean M
Published: September 2020

Some plant pathogens are capable of manipulating their insect vectors and plant hosts in a way that disease transmission is enhanced. Aster leafhopper (Macrosteles quadrilineatus Forbes) (Hemiptera: Cicadellidae) is the main vector of Aster Yellows Phytoplasma (Candidatus Phytoplasma asteris) in the Canadian Prairies, which causes Aster Yellows (AY) disease in over 300 plant species including cereals and oilseeds. However, little is known about the host range of Aster leafhoppers or their host-choice selection behavior in this geographical region. Several crop and noncrop species commonly found in the Canadian Prairies were evaluated as food and reproductive hosts for Aster leafhoppers through no-choice bioassays. To study possible effects of pathogen infection, AY-uninfected and AY-infected insects were used. Cereals and some noncrops like fleabane were suitable reproductive hosts for Aster leafhoppers, with numbers of offspring observed in treatments using both AY-uninfected and AY-infected insects, suggesting an egg-laying preference on these plant species. Development was similar across the different plant species, except for canola and sowthistle, where growth indexes were lower. Sex-ratios of Aster leafhopper adults did not differ among the plant species or with respect to AY infection. Potential fecundity differed across plant species and was affected by the infection status of the insect. These findings have implications for AY epidemiology and suggest that while cereals can be suitable host plants for Aster leafhopper oviposition and development, some noncrop species could act as alternate hosts for leafhoppers that migrate into the Canadian Prairies before emergence of cereal and canola crops.
The Impact of Artificial Sweeteners on Insects
Authors: Lee Shao-Hung , Choe Dong-Hwan , Lee Chow-Yang
Published: September 2020

Artificial sweeteners are sweet-tasting additives found in consumable products as substitutes for naturally occurring sugars. They are derived from plant extracts or manufactured by chemical synthesis. Ingestion of sweeteners by insects can lead to significant physiological effects, such as mortality, decreased fecundity, and behavioral change. Due to their low toxicity toward humans and the issues associated with conventional insecticide usage, artificial sweeteners have recently gained attention for their potential use as biorational insecticides. Here, we review their impact on insects and potential as novel insecticides.
Associations Between Peer Use, Costs and Benefits, Self-Efficacy, and Adolescent E-cigarette Use
Authors: Durkin Kristine , Williford Desireé N , Turiano Nicholas A , Blank Melissa D , Enlow Paul T , Murray Pamela J , Banvard-Fox Christine , Duncan Christina L
Published: September 2020

Objective

Prior research identified peer use as a salient risk factor of adolescent electronic cigarette (e-cigarette) use, but has not expanded on the mechanisms of this association.

Methods

Participants were 562 adolescents recruited from rural and suburban public high schools and an adolescent medicine clinic in the mid-Atlantic United States. Participants completed a packet of questionnaires that assessed demographics, substance use, expectations about the consequences of e-cigarette use, and perceptions of their own self-efficacy to resist using e-cigarettes. We estimated a series of mediation models using the MODEL INDIRECT command in MPLUS statistical software. In all models, significance of indirect effects from peer e-cigarette use to self-reported e-cigarette use were tested via two variables: (a) expected costs, (b) benefits of e-cigarette use, and (c) the perceived self-efficacy of the individual to refrain from e-cigarette use.

Results

Adolescents with more peers using e-cigarettes were more likely to have ever used an e-cigarette and perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 1). Those with more peers using e-cigarettes were more likely to be currently using e-cigarettes themselves because they perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 2).

Conclusion

Peer use, self-efficacy to resist use, and expectations of cost and benefits of e-cigarette use should be considered as possible targets when devising tailored interventions and policies to prevent or reduce negative health consequences of long-term e-cigarette use.
Intrinsic DNA topology as a prioritization metric in genomic fine-mapping studies
Authors: Ainsworth Hannah C , Howard Timothy D , Langefeld Carl D
Published: September 2020

In genomic fine-mapping studies, some approaches leverage annotation data to prioritize likely functional polymorphisms. However, existing annotation resources can present challenges as many lack information for novel variants and/or may be uninformative for non-coding regions. We propose a novel annotation source, sequence-dependent DNA topology, as a prioritization metric for fine-mapping. DNA topology and function are well-intertwined, and as an intrinsic DNA property, it is readily applicable to any genomic region. Here, we constructed and applied Minor Groove Width (MGW) as a prioritization metric. Using an established MGW-prediction method, we generated a MGW census for 199 038 197 SNPs across the human genome. Summarizing a SNP’s change in MGW (ΔMGW) as a Euclidean distance, ΔMGW exhibited a strongly right-skewed distribution, highlighting the infrequency of SNPs that generate dissimilar shape profiles. We hypothesized that phenotypically-associated SNPs can be prioritized by ΔMGW. We tested this hypothesis in 116 regions analyzed by a Massively Parallel Reporter Assay and observed enrichment of large ΔMGW for functional polymorphisms (P = 0.0007). To illustrate application in fine-mapping studies, we applied our MGW-prioritization approach to three non-coding regions associated with systemic lupus erythematosus. Together, this study presents the first usage of sequence-dependent DNA topology as a prioritization metric in genomic association studies.
signatureSearch: environment for gene expression signature searching and functional interpretation
Authors: Duan Yuzhu , Evans Daniel S , Miller Richard A , Schork Nicholas J , Cummings Steven R , Girke Thomas
Published: September 2020

signatureSearch is an R/Bioconductor package that integrates a suite of existing and novel algorithms into an analysis environment for gene expression signature (GES) searching combined with functional enrichment analysis (FEA) and visualization methods to facilitate the interpretation of the search results. In a typical GES search (GESS), a query GES is searched against a database of GESs obtained from large numbers of measurements, such as different genetic backgrounds, disease states and drug perturbations. Database matches sharing correlated signatures with the query indicate related cellular responses frequently governed by connected mechanisms, such as drugs mimicking the expression responses of a disease. To identify which processes are predominantly modulated in the GESS results, we developed specialized FEA methods combined with drug-target network visualization tools. The provided analysis tools are useful for studying the effects of genetic, chemical and environmental perturbations on biological systems, as well as searching single cell GES databases to identify novel network connections or cell types. The signatureSearch software is unique in that it provides access to an integrated environment for GESS/FEA routines that includes several novel search and enrichment methods, efficient data structures, and access to pre-built GES databases, and allowing users to work with custom databases.
Replication protein A: a multifunctional protein with roles in DNA replication, repair and beyond
Authors: Dueva Rositsa , Iliakis George
Published: September 2020

Single-stranded DNA (ssDNA) forms continuously during DNA replication and is an important intermediate during recombination-mediated repair of damaged DNA. Replication protein A (RPA) is the major eukaryotic ssDNA-binding protein. As such, RPA protects the transiently formed ssDNA from nucleolytic degradation and serves as a physical platform for the recruitment of DNA damage response factors. Prominent and well-studied RPA-interacting partners are the tumor suppressor protein p53, the RAD51 recombinase and the ATR-interacting proteins ATRIP and ETAA1. RPA interactions are also documented with the helicases BLM, WRN and SMARCAL1/HARP, as well as the nucleotide excision repair proteins XPA, XPG and XPF–ERCC1. Besides its well-studied roles in DNA replication (restart) and repair, accumulating evidence shows that RPA is engaged in DNA activities in a broader biological context, including nucleosome assembly on nascent chromatin, regulation of gene expression, telomere maintenance and numerous other aspects of nucleic acid metabolism. In addition, novel RPA inhibitors show promising effects in cancer treatment, as single agents or in combination with chemotherapeutics. Since the biochemical properties of RPA and its roles in DNA repair have been extensively reviewed, here we focus on recent discoveries describing several non-canonical functions.
Characteristics of mutational signatures of unknown etiology
Authors: Hu Xiaoju , Xu Zhuxuan , De Subhajyoti
Published: September 2020

Although not all somatic mutations are cancer drivers, their mutational signatures, i.e. the patterns of genomic alterations at a genome-wide scale, provide insights into past exposure to mutagens, DNA damage and repair processes. Computational deconvolution of somatic mutation patterns and expert curation pan-cancer studies have identified a number of mutational signatures associated with point mutations, dinucleotide substitutions, insertions and deletions, and rearrangements, and have established etiologies for a subset of these signatures. However, the mechanisms underlying nearly one-third of all mutational signatures are not yet understood. The signatures with established etiology and those with hitherto unknown origin appear to have some differences in strand bias, GC content and nucleotide context diversity. It is possible that some of the hitherto ‘unknown’ signatures predominantly occur outside gene regions. While nucleotide contexts might be adequate to establish etiologies of some mutational signatures, in other cases additional features, such as broader (epi)genomic contexts, including chromatin, replication timing, processivity and local mutational patterns, may help fully understand the underlying DNA damage and repair processes. Nonetheless, remarkable progress in characterization of mutational signatures has provided fundamental insights into the biology of cancer, informed disease etiology and opened up new opportunities for cancer prevention, risk management, and therapeutic decision making.
Six-membered-ring inorganic materials: definition and prospects
Authors: Liu Gang , Chen Xing-Qiu , Liu Bilu , Ren Wencai , Cheng Hui-Ming
Published: September 2020

The six-membered ring (SMR) is a common structure unit for numerous material systems. These materials include, but are not limited to, the typical two-dimensional materials such as graphene, h-BN, and transition metal dichalcogenides, as well as three-dimensional materials such as beryllium, magnesium, MgB2 and Bi2Se3. Although many of these materials have already become ‘stars’ in materials science and condensed-matter physics, little attention has been paid to the roles of the SMR unit across a wide range of compositions and structures. In this article, we systematically analyze these materials with respect to their very basic SMR structural unit, which has been found to play a deterministic role in the occurrence of many intriguing properties and phenomena, such as Dirac electronic and phononic spectra, superconductivity and topology. As a result, we have defined this group of materials as SMR inorganic materials, opening up a new perspective on materials research and development. With their unique properties, SMR materials deserve wide attention and in-depth investigation from materials design, new physical discoveries to target-wizard applications. It is expected that SMR materials will find niche applications in next-generation information technology, renewable energy, space, etc.
Discrimination, Sexual Orientation Discrimination, and Severity of Tobacco Use Disorder in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III
Authors: Kcomt Luisa , Evans-Polce Rebecca J , Engstrom Curtiss W , West Brady T , McCabe Sean Esteban
Published: September 2020

Introduction

Tobacco use is more prevalent among sexual minority populations relative to heterosexual populations. Discrimination is a known risk factor for tobacco use. However, the relationship between exposure to different forms of discrimination, such as racial or ethnic discrimination and sexual orientation discrimination, and tobacco use disorder (TUD) severity has not been examined.

Aims and Methods

Using data from the 2012–2013 National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36 309 US adults), we conducted multivariable logistic regression analyses to examine the associations among racial or ethnic discrimination, sexual orientation discrimination, and TUD severity for lesbian or gay-, bisexual-, and heterosexual-identified adults. Consistent with the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), past-year moderate-to-severe TUD was defined as the presence of ≥4 DSM-5 TUD symptoms.

Results

Higher levels of lifetime racial or ethnic discrimination were associated with significantly greater odds of past-year moderate-to-severe TUD among sexual minorities (adjusted odds ratio [AOR] = 1.03, 95% confidence interval [CI] = 1.01–1.05) and heterosexuals (AOR = 1.04, 95% CI = 1.03–1.05). Stressful life events, mood disorder, and anxiety disorder had significant associations with moderate-to-severe TUD among sexual minorities (AOR range: 1.86–5.22, p < .005) and heterosexuals (AOR range: 1.71–3.53, p < .005). Among sexual minorities, higher levels of racial or ethnic and/or sexual orientation discrimination were associated with greater odds of any TUD (AOR = 1.02, 95% CI = 1.01–1.03).

Conclusions

Sexual minorities and heterosexuals who experience higher levels of racial or ethnic discrimination are at heightened risk of having moderate-to-severe TUD. Exposure to higher levels of discrimination also increases the risk of having any TUD among sexual minority adults. Health providers and tobacco cessation professionals should be cognizant of the minority stressors experienced by their clients and their potential impact on TUD severity.

Implications

This study is the first to show how experiences of racial or ethnic and sexual orientation discrimination are associated with DSM-5 TUD severity among sexual minority and heterosexual populations. Individuals exposed to multiple minority stressors may have increased vulnerability for developing TUD and related adverse health consequences. Our study underscores the importance of considering racial or ethnic discrimination and the multiple minority statuses that individuals may hold. Eliminating all forms of discrimination and developing interventions that are sensitive to the role that discrimination plays in TUD severity may attenuate the tobacco use disparities between sexual minority and heterosexual adults.
Calculation of a key function in the asymptotic description of moving contact lines
Authors: Scott Julian F
Published: September 2020

An important element of the asymptotic description of flows having a moving liquid/gas interface which intersects a solid boundary is a function denoted $Q_i \left( \alpha \right)$ by Hocking and Rivers (The spreading of a drop by capillary action, J. Fluid Mech. 121 (1982) 425–442), where $0 < \alpha < \pi$ is the contact angle of the interface with the wall. $Q_i \left( \alpha \right)$ arises from matching of the inner and intermediate asymptotic regions introduced by those authors and is required in applications of the asymptotic theory. This article describes a new numerical method for the calculation of $Q_i \left( \alpha \right)$, which, because it explicitly allows for the logarithmic singularity in the kernel of the governing integral equation and uses quadratic interpolation of the non-singular factor in the integrand, is more accurate than that employed by Hocking and Rivers. Nonetheless, our results show good agreement with theirs, with, however, noticeable departures near $\alpha = \pi $. We also discuss the limiting cases $\alpha \to 0$ and $\alpha \to \pi $. The leading-order terms of $Q_i \left( \alpha \right)$ in both limits are in accord with the analysis of Hocking (A moving fluid interface. Part 2. The removal of the force singularity by a slip flow, J. Fluid Mech. 79 (1977) 209–229). The next-order terms are also considered. Hocking did not go beyond leading order for $\alpha \to 0$, and we believe his results for the next order as $\alpha \to \pi $ to be incorrect. Numerically, we find that the next-order terms are $O\left( {\alpha ^2} \right)$ for $\alpha \to 0$ and $O\left( 1 \right)$ as $\alpha \to \pi $. The latter result agrees with Hocking, but the value of the $O\left( 1 \right)$ constant does not. It is hoped that giving details of the numerical method and more precise information, both numerical and in terms of its limiting behaviour, concerning $Q_i \left( \alpha \right)$ will help those wanting to use the asymptotic theory of contact-line dynamics in future theoretical and numerical work.
Back to Basics: Basic Research Spillovers, Innovation Policy, and Growth
Authors: Akcigit Ufuk , Hanley Douglas , Serrano-Velarde Nicolas
Published: September 2020

This article introduces a general equilibrium model of endogenous technical change through basic and applied research. Basic research differs from applied research in the nature and the magnitude of the generated spillovers. We propose a novel way of empirically identifying these spillovers and embed them in a framework with private firms and a public research sector. After characterizing the equilibrium, we estimate our model using micro-level data on research expenditures by French firms. Our key finding is that uniform research subsidies can accentuate the dynamic misallocation in the economy by oversubsidizing applied research. Policies geared towards public basic research and its interaction with the private sector are significantly welfare-improving.
Effects of Inoculum Density and Cultivar Susceptibility on Rhizoctonia Damping-Off and Crown and Root Rot in Sugar Beet
Authors: Brantner Jason R. , Chanda Ashok K.
Published: September 2020

Damping-off and crown and root rot of sugar beet caused by Rhizoctonia solani anastomosis group 2-2 (AG 2-2) are important soilborne diseases in Minnesota and North Dakota. Management involves an integrated approach, including crop rotation, use of resistant cultivars, and timely fungicide application. Our objectives were to evaluate the role of inoculum density and cultivar susceptibility on the onset and development of Rhizoctonia diseases and on yield and quality in sugar beet. Three cultivars varying in susceptibility were sown in field plots inoculated with 0, 20, 40, or 60 kg/ha of R. solani AG 2-2 IIIB infested barley during 2013 and 2015. In both years, there was a significant linear effect of inoculum density with decreasing area under the stand establishment curve (AUSEC), root yield, and sucrose quality as inoculum density increased. Cultivar susceptibility significantly affected AUSEC as well as sucrose quality in both years and root yield in 2013. In both years, there was an inoculum density by cultivar interaction on disease ratings, with the partially resistant cultivar resulting in lower ratings than the moderate and susceptible cultivars, especially as inoculum density increased. These results have implications for cultivar selection and for use and timing of postemergence fungicide application based on field history of inoculum pressure.
Diversity and Virulence ofStreptomycesspp. Causing Potato Common Scab in Prince Edward Island, Canada
Authors: Hudec Cindy , Novinscak Amy , Filion Martin
Published: September 2020

Common scab (CS) is a potato disease that significantly decreases the market value of potato tubers after the development of necrotic lesions on their surface. Streptomyces scabiei is the main causal agent of CS; however, other closely related species, including S. acidiscabies and S. turgidiscabies, have also been shown to cause the disease. In this study, we characterized the genetic and phenotypic diversity of Streptomyces spp. causing CS in Prince Edward Island, the main potato-producing province in Canada. Two hundred and ninety-six pathogenic Streptomyces spp. isolates were retrieved from diseased tubers harvested from six fields located across a longitudinal geographical gradient. Genome fingerprinting analyses using repetitive elements PCR (ERIC- and BOX-PCR) revealed 14 distinct genetic groups. Thirteen groups were taxonomically affiliated with S. scabiei, whereas the fourteenth group was affiliated with S. acidiscabies. Their geographical distribution was characterized and revealed that on average between six and eight different genetic groups were detected per field, with variable abundance. Virulence assays showed strong differences in virulence between the genetic groups, ranging from low to highly virulent. Interestingly, pathogenic Streptomyces spp. populations in each field seem to be dominated by the most virulent genetic groups. The results obtained will contribute to better understanding of the population dynamic of pathogenic Streptomyces spp. causing CS of potato and promoting the development of more efficient detection and intervention tools to manage this important potato disease.
The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria
Authors: Gadrey Shrirang M. , Clay Russ , Zimmet Alex N. , Lawson Alexander S. , Oliver Samuel F. , Richardson Emily D. , Forrester Vernon J. , Andris Robert T. , Rhodes Garret T. , Voss John D. , Moore Christopher C. , Moorman J. Randall
Published: September 2020

Objectives:

The Sepsis-3 taskforce defined sepsis as suspicion of infection and an acute rise in the Sequential Organ Failure Assessment score by 2 points over the preinfection baseline. Sepsis-3 studies, though, have not distinguished between acute and chronic organ failure, and may not accurately reflect the epidemiology, natural history, or impact of sepsis. Our objective was to determine the extent to which the predictive validity of Sepsis-3 is attributable to chronic rather than acute organ failure.

Design:

Retrospective cohort study.

Setting:

General medicine inpatient service at a tertiary teaching hospital.

Patients:

A total of 3,755 adult medical acute-care encounters (1,864 confirmed acute infections) over 1 year.

Interventions:

None.

Measurements and Main Results:

We measured the total Sequential Organ Failure Assessment score at the onset of infection and separated its components (baseline and acute rise) using case-by-case chart reviews. We compared the predictive validities of acuity-focused (acute rise in Sequential Organ Failure Assessment ≥ 2) and conventional (total Sequential Organ Failure Assessment ≥ 2) implementations of Sepsis-3 criteria. Measures of predictive validity were change in the rate of outcomes and change in the area under receiver operating characteristic curves after adding sepsis criteria to multivariate logistic regression models of baseline risk (age, sex, race, and Charlson comorbidity index). Outcomes were inhospital mortality (primary) and ICU transfer or inhospital mortality (secondary). Acuity-focused implementations of Sepsis-3 were associated with neither a change in mortality (2.2% vs 1.2%; p = 0.18) nor a rise in area under receiver operating characteristic curves compared with baseline models (0.67 vs 0.66; p = 0.75). In contrast, conventional implementations were associated with a six-fold change in mortality (2.4% vs 0.4%; p = 0.01) and a rise in area under receiver operating characteristic curves compared with baseline models (0.70 vs 0.66; p = 0.04). Results were similar for the secondary outcome.

Conclusions:

The evaluation of the validity of organ dysfunction-based clinical sepsis criteria is prone to bias, because acute organ dysfunction consequent to infection is difficult to separate from preexisting organ failure in large retrospective cohorts.
Electronic cigarettes, vaping-related lung injury and lung cancer: where do we stand?
Authors: Petrella Francesco
Published: September 2020

Electronic cigarettes have been considered a promising alternative to nicotine replacement products to help heavy tobacco smokers quit smoking. They work thanks to a heating coil causing evaporation of the liquid rapidly followed by cooling, thus creating an aerosol, a completely different mechanism from the combustion of tobacco in traditional cigarettes. The term ‘vaping’ indicates the use of electronic cigarettes or other devices to inhale heated, aerosolized nicotine, or other substances like cannabidiol, tetrahydrocannabinol, or butane hash oils together with solvents, mainly propylene glycol and vegetable glycerine or their combination. A very fast increase of vaping among adolescents has been observed since electronic cigarettes and other vaping devices first appeared. Although electronic cigarettes have been advocated as a short-term cessation aid for tobacco smokers or as a long-term alternative, there is the concrete risk that they can be perceived by young nonsmokers as a less dangerous alternative to tobacco smoking, thus stimulating nonsmokers to start smoking rather than helping heavy tobacco smokers to quit smoking. Moreover, several cases of exogenous lipoid pneumonia and diffuse alveolar hemorrhage with proven alveolar injury, as well as vaping-associated bronchiolitis obliterans, have been recently reported among electronic cigarette smokers, with severe clinical impact, thus posing the risk of the life-threatening toxic potential of vaping. At the moment, no definitive assessment can be made about the efficacy of electronic cigarettes as a smoking cessation aid, and further studies are required about vaping-related life-threatening acute lung injury.
Factors Affecting the Efficacy of Suction Curettage Using an Arthroscopic Shaver for Bromhidrosis
Authors: Fang Chien-Liang , Tsai Chong-Bin , Chen Ming-Shan , Yang Hsin-Yi , Fang Kai-Jan
Published: September 2020

BACKGROUND

Suction-curettage using an arthroscopic shaver is the most effective surgical treatment for bromhidrosis; however, information regarding the procedure is limited. This study investigated the factors that affect the efficacy of suction-curettage.

PATIENTS AND METHODS

We retrospectively evaluated data for 215 patients (430 axillae) with bromhidrosis treated with suction-curettage using an arthroscopic shaver between 2011 and 2019.

RESULTS

Excellent or good efficacy with improved malodor was achieved in 418 axillae (97.21%). Secondary suction-curettage was performed for 11 (2.56%), with excellent results. Efficacy and need for secondary suction-curettage were not associated with age, sex, shaving time, and tumescent infiltration use. Complications were observed in 52 (12.09%) axillae, including hematoma or seroma, epidermis decortication, skin necrosis, and infections; 10 (2.33%) required local debridement for wounds. Complications showed a significant difference with respect to age (p < .001). Pain scores on postoperative Day 2 were significantly lower for patients treated using tumescent infiltration than those for the others (1.65 ± 0.84 vs 4.57 ± 1.16; p < .001).

CONCLUSION

The results suggest that 7 to 15 minutes of suction curettage using an arthroscopic shaver is sufficient to achieve good efficacy for bromhidrosis with few complications. Older age was a risk factor for complications, and tumescent infiltration use achieved good postoperative pain control.

Levels of Evidence

II.
The Vascular Component of Melasma: A Systematic Review of Laboratory, Diagnostic, and Therapeutic Evidence
Authors: Masub Natasha , Nguyen Julie K. , Austin Evan , Jagdeo Jared
Published: September 2020

BACKGROUND

Melasma is a common acquired disorder of hyperpigmentation, classically manifesting as symmetric brown patches on the face. Although the exact pathogenesis is not fully understood, vascular abnormalities have been implicated in melasma.

OBJECTIVE

To evaluate the laboratory and clinical evidence regarding the safety and efficacy of antivascular agents for the treatment of melasma.

METHODS

A systematic review of PubMed, EMBASE, and Cochrane was conducted on May 13, 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Original research articles investigating the role of vascularity and/or evaluating the use of antivascular therapeutics in melasma were included. Clinical recommendations were based on the American College of Physicians guidelines.

RESULTS

A total of 34 original research articles as follows were identified: 4 laboratory studies, 15 diagnostic studies, and 15 therapeutic studies.

CONCLUSION

There is promising evidence supporting the use of tranexamic acid and laser/light therapies to treat the vascular component of melasma, and more rigorous clinical trials are needed to validate their efficacy. Clinicians may consider treatment with one or more antivascular therapeutics in patients with melasma. Further research is warranted to characterize the role of cutaneous vascularization in melasma and may provide insights for novel therapies.
Perceptions of disaster management knowledge and skills among advanced practice registered nurses
Authors: Fil Samantha L. , Champion Jane Dimmitt , Christiansen Brittany
Published: September 2020

Background and purpose:

Disaster management experts around the world agree that nurses play a vital role in disaster preparation, response, and recovery. The Joint Commission on Accreditation of Health care Organizations requires biannual disaster drills for accredited facilities, and there are numerous training resources and educational materials on disaster management topics. Multiple federal and state laws govern health care provider activities during a disaster. However, there is a lack of guidance and evidence surrounding the specific roles and responsibilities of advanced practice registered nurses (APRNs) in a disaster setting. This project assesses APRNs knowledge of disaster management roles and responsibilities and the training for these roles.

Methods:

Using a cross-sectional survey research design, a 68-item survey was distributed via e-mail and social media to members of Texas APRN professional organizations. A convenience sample of those responding and meeting inclusion criteria (Texas-licensed APRN) was analyzed using SPSS to perform descriptive and nonparametric statistics.

Results:

Thirty-one percent of responding APRNs considered themselves prepared for the management of disasters. A majority of statements (29/47, 61.7%) evaluating APRN knowledge and skills were significantly different (p < .05) across three training and experience categories: post-APRN program education, workplace/community drills or exercises, and planning or disaster response.

Implications for practice:

More clearly defined roles and readily available training and resources will improve APRNs preparation for disaster situations. Recurrent training and professional experience increase knowledge and confidence related to advanced practice disaster management competencies.
The growing need to provide training in clinical procedures in family nurse practitioner educational programs
Authors: Woroch Ruth A. , Bockwoldt Denise
Published: September 2020

Family nurse practitioners (FNPs) have a plethora of employment options upon graduation. Besides primary care, many are working in nontraditional settings such as urgent care, emergency departments, retail health, and specialty practices. In many of these settings, practitioners are required to perform procedures. However, more information is needed on the type of settings in which recent FNP graduates are working, the procedures being performed in these settings, and the perceptions of graduates of how prepared they felt to perform these procedures. Family nurse practitioners who completed an FNP program within the previous five years and who attended the 2019 AANP National Conference were invited to participate in a survey to assess their preparation in clinical procedures. Results revealed that more than half of the 198 respondents reported doing incision and drainage of abscesses and laceration repair. Respondents were divided on how they first learned to perform the procedures, with 47% stating that a preceptor demonstrated procedures to them during a clinical practicum experience, 42% stating that they learned on the job after graduation, and 43% reported that their FNP program provided training or simulation activities related to procedures. More than a quarter of respondents reported that they took a class on procedures. In all, 61% reported that they did not feel adequately prepared to perform procedures on graduation. Results indicated that colleges of nursing should ensure that FNP students have opportunities to master the procedures that are frequently performed by FNPs.
Screening for chronic kidney disease in a hypertensive primary care cohort
Authors: Llewellyn Sarah
Published: September 2020

Background:

Screening rates for chronic kidney disease (CKD) in primary care settings remain low. Although primary care providers are well positioned to offer this testing, there are many barriers that contribute to low screening rates.

Purpose:

The purpose of this study was to examine both practice and contextual factors that relate to screening for CKD in a cohort of primary care patients with hypertension.

Methods:

A mixed-methods, single-embedded, convergent parallel design was used for this organizational case study. The Chronic Care Model served as the framework. Electronic medical record data, resource walk-through, and provider surveys were collected from selected primary care clinics within one large academic medical center in the Pacific Northwest. Analyses included regression models, descriptive statistics, narrative content analysis, and pattern matching for organizational case creation.

Results:

Screening rates were low in the cohort, but patients with more risk factors for CKD were more likely to receive orders for screening. Organizational and community support was deemed necessary for primary care providers to effectively translate guidelines into practice.

Implications for practice:

The results of this study offer support for a wholistic approach to guideline translation into practice. Participants in the study were open to increased screening for CKD but needed support in multiple ways from the organization. Guidelines alone were not deemed the ideal vehicles for translation of research into practice.
Improving timely sepsis care using the surviving sepsis campaign one-hour bundle in a rural emergency department
Authors: Bray Carla , Kennedy Christopher
Published: September 2020

Background:

Sepsis is deadly when not recognized and treated in a timely manner and leads to 270,000 deaths each year in America. Mortality increases eight percent for each hour treatment is delayed. Sepsis-related admission is the most expensive condition in the United States with a median cost per patient of $32,421.

Local problem:

Baseline data for patients with sepsis revealed that only 30% were recognized in triage, only 20% received correct amounts of fluids, and only 45% received antibiotics within one hour. The aim of this project was to improve timely sepsis care to 75% for patients in a rural emergency department within 90 days.

Methods:

A rapid cycle quality improvement project was completed, consisting of four plan-do-study-act cycles over 90 days. Each cycle included tests of change related to team and patient engagement, screening, and the use of timely sepsis orders. Data were collected three times weekly and analyzed using run charts.

Interventions:

Interventions included screening in triage with positively screened patients receiving participatory education, team handoff communication, a sepsis checklist for nurse-driven orders, and Power Hour for timely care.

Results:

Team communication improved to 83%. Patient education exceeded goal, with 100% of patients taking an active role in care. Sepsis screening improved to 100%. The recommended One-Hour Bundle for timely sepsis treatment improved to 83%.

Conclusion:

The project was successful in improving patient and team engagement, screening, and sepsis care within 1 hour for emergency department patients.
U.S. nurse practitioners' HIV screening behaviors and health center characteristics
Authors: Sutherland Jodi L. , Fantasia Heidi Collins , Jiang Lan , Si Bing
Published: September 2020

One of the most effective strategies to end the human immunodeficiency virus (HIV) epidemic is HIV screening technologies. Routine HIV screening reaches the first-time tester, people with undiagnosed HIV, and those persons who are in need of frequent retesting due to their ongoing risk. This secondary analysis examined nurse practitioners' (NPs) rates of offering routine HIV screening and health center HIV screening characteristics. A convenience sample of NPs completed either a paper and pencil or an online survey in February 2016. Nurse practitioners responded to several questions about their behaviors and the health center characteristics where they work related to HIV screening. Many NPs (31%) never offer routine HIV screening to patients. Efforts are needed to implement structural changes to increase HIV screening rates among NPs and the health centers where they work. Nurse practitioners, health centers, and the health center policies must align to address the HIV epidemic and implement national HIV screening recommendations.
Providing effective inpatient care for cirrhosis by improving utilization of national guidelines
Authors: Smith Tracy Ellen , Jefferson Khara'
Published: September 2020

Background:

Over the past 10 years, cirrhosis incidence has increased dramatically, with a 59% increase in the need for treatment of disease complications. Cirrhosis treatment complexity and cost have increased substantially, and cirrhosis deaths are increasing by 10.5% yearly.

Local problem:

A review of 29 cirrhosis admissions revealed that guideline criteria were only addressed 66% of the time on 10 key cirrhosis issues. After identifying gaps in care, the project aimed to improve right care for cirrhosis by 20% within 90 days by using a guideline-based checklist and chart audit process.

Methods:

The quality improvement (QI) initiative used four Plan-Do-Study-Act cycles. Cycles included tests of change for the checklist, patient engagement, chart audit, and team participation.

Interventions:

A guideline-based cirrhosis checklist focused on providing right care for cirrhosis patient admissions. Patient engagement was addressed with a shared decision-making tool. To monitor data, a chart audit was created. Team engagement included biweekly QI meetings with an agenda and a postmeeting survey.

Results:

The project aim was achieved, improving cirrhosis guideline-based care by 22%, while utilization of the guideline-based checklist rose to 100%. Moreover, 96% of patients approached for shared decision making agreed to participate, and the chart audit was completed on all patients. Team engagement and satisfaction remained high throughout the cycles.

Conclusions:

The project team used an evidence-based approach to effectively improve inpatient care for cirrhosis. Engaging providers and patients with this approach led to high patient and team participation and improved project outcomes.
Evaluating interventions to delay the progression of prediabetes to type-2 diabetes mellitus in an uninsured Hispanic population
Authors: Botah-Oduro Ophelia , Talley Michele H.
Published: September 2020

Background:

Diabetes is a chronic progressive disease affecting 34 million Americans. The Centers for Disease Control and Prevention estimates that 12.5% of people aged 20 years or older diagnosed with diabetes are Hispanic. The American Diabetes Association further estimates that 84.1 million Americans aged 20 years and older have prediabetes based on fasting blood sugar and hemoglobin A1c (HbA1c) levels alone.

Local problem:

In Georgia, the overall rate of diagnosed diabetes is 9.7%, undiagnosed is 6.5%, and prediabetes is 1.1%. The prevalence of diabetes for the Hispanic population in Georgia is 9% and is 10% among Clayton County residents. The purpose of this quality improvement project (QIP) was to evaluate interventions implemented to delay the progressions of prediabetes to type-2 diabetes in an uninsured Hispanic population.

Methods:

Retrospective chart review was conducted comparing pre- and postmeasurements for HbA1c and body mass index (BMI) in Hispanic patients identified as having prediabetes.

Interventions:

Patients with HbA1c of 5.7–6.1% were provided with a diabetes tool kit, whereas patients with an HbA1c of 6.2–6.4% were given the diabetes tool kit plus metformin.

Results:

A decrease in mean HbA1c was noted in both groups of patients. However, a paired sample t-test indicated nonsignificant decrease in HbA1c for the diabetes tool kit group (p = .51) but significant decrease for the diabetes tool group kit plus metformin group (p < .01).

Conclusions:

Although this QIP did not reveal statistically significant changes in HbA1c and BMI for both groups, the results were clinically significant among this Hispanic population.
Quality of life among women veterans
Authors: Devine Debbie T. , McMillan Susan C. , Kip Kevin , Powell-Cope Gail
Published: September 2020

Background:

Of 23 million US veterans, 2 million are women. Female veterans often have physical and mental health disorders, but only 6.5% use the Veterans Health Administration (VA) system. Health care for women veterans is challenging in a health care system unfamiliar with this population.

Purpose:

The purpose of this study was to investigate how receipt of treatment by female veterans at a VA women's health specialty clinic affected levels of distress, quality of life (QOL), and depression.

Methods:

A retrospective record review was completed on 51 female veterans between the ages of 40 and 60 years attending a VA clinic. The clinic provides comprehensive women's health services to female veterans. Multiple linear regression models were fit to explore QOL and depression levels with socioeconomic status, parity, years of service, and military sexual trauma (MST).

Results:

Female veterans had significantly lower baseline scores for QOL than did a comparison group. The only significant predictor associated with higher health-related symptom scores at baseline was a history of MST (β = 0.363; t = 2.44; p = .02). Means and standard deviations for total scores were significantly higher than those of the comparison group. Higher symptom scores indicated lower QOL among female veterans.

Implications for practice:

Study findings suggested that timely, comprehensive, gender-specific health care can significantly improve overall QOL and depression levels. Nurse practitioners play a leading role in providing primary care to this population with significant potential to impact QOL, depression levels, and overall health of female veterans.
Implementation of the chronic obstructive pulmonary disease Assessment Test in clinical practice
Authors: Abrams Meghan E.
Published: September 2020

Background:

The chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) is a questionnaire used for COPD symptom assessment that is valid, reliable, and evidence based; yet, few specialty or primary care practices have formally implemented it in practice.

Local problem:

The University of Colorado's pulmonary division has consistently been rated the best in the country by US News and World Reports; however, the dedicated multidisciplinary COPD clinic at the University had yet to formally implement any COPD Assessment tools for COPD symptom management. This quality improvement project focused on the successful implementation of the CAT for management of COPD and whether its use impacts symptom management.

Methods:

Plan-Do-Study-Act cycles were used to implement the CAT questionnaire in the outpatient COPD clinic from April 16 to September 30, 2019. Weekly retrospective chart evaluation was completed to evaluate CAT completion, documentation, and associated medical intervention rates. Weekly patient phone surveys were completed on qualifying COPD patients to garner patient opinion on the utility of the CAT in symptom management.

Interventions:

The CAT was administered to all COPD patients in University of Colorado Hospital's COPD clinic. Cat-themed signs, decorations, and treats were provided to staff on COPD clinic days to increase staff buy-in.

Results:

The CAT was completed on 217 of 245 (89%) patients with COPD. Of patients surveyed, 81% (n = 53) noted that their symptoms were better managed after CAT implementation.

Conclusions:

Implementation and utilization of COPD assessment tools, like the CAT, are practical and sustainable in a specialty practice setting. Moreover, the CAT helps with COPD symptom management.
Exploring family nurse practitioner professional identity formation at rural health care facilities
Authors: Owens Rhoda A.
Published: September 2020

Background:

Nurse practitioners (NPs) are being used to meet the increased demand for rural primary care.

Purpose:

The purpose of this study was to explore the perceptions and experiences of rural NPs while they transitioned from being registered nurses to family NPs (FNPs). In addition, the study examined if and how new FNPs experienced their professional identity formation in their first year of rural primary care practice.

Methodological orientation:

A qualitative phenomonological research design was used.

Sample:

A sample of 12 FNPs who graduated from one of three Midwestern university programs, worked, and provided primary care at a rural health care facility located in one of four full-practice states were used within the study.

Conclusions:

Participants experienced new nurse practitioner professional identity formation beginning in their education programs, which continued throughout their first year of practice. Four themes emerged from the data analysis: learning new knowledge, skills, roles, and responsibilities; interactions with patients, providers, and interprofessional team members; incentive to learn and practice in rural health care; and professional identity formation.

Implications for practice:

The emerging model, The Process of Professional Identity Formation for Rural Family NPs, shows potential for use as a framework to guide rural NP curriculum and professional development programs. Policy makers must also continue the push to increase the number of states allowing NPs full independent practice. These efforts could promote rural NP support, recruitment, and retention that will be key to meeting the primary care needs of rural and vulnerable populations.