bluuebunny/crossref_metadata_2025 huggingface dataset:
Extensive reading and class readers: the case for no choice
Authors: Ramonda Kris
Published: February 2020

The benefits of extensive reading (ER) are well known, yet integrating ER into curricula has been problematic. One factor is the adherence to the principle that students should freely choose what to read, which complicates connecting out-of-class reading with in-class content. Class readers, however, can more easily tie in book content with classroom activities, thereby allowing students to discuss their shared knowledge in a way that might foster motivation for reading and add legitimacy to ER as part of the curriculum. To investigate this further, in the current study, 137 undergraduate Japanese students of English were assigned six class readers and then freely chose six more graded readers. Using a mixed methods approach, student perceptions were collected, coded, and analysed. Contrary to expectations, many learners indicated a preference for class readers for numerous reasons. These findings suggest that class readers should not be discounted in ER programs.
Genomic analyses reveal distinct genetic architectures and selective pressures in buffaloes
Authors: Sun Ting , Shen Jiafei , Achilli Alessandro , Chen Ningbo , Chen Qiuming , Dang Ruihua , Zheng Zhuqing , Zhang Hucai , Zhang Xiaoming , Wang Shaoqiang , Zhang Tao , Lu Hongzhao , Ma Yun , Jia Yutang , Capodiferro Marco Rosario , Huang Yongzhen , Lan Xianyong , Chen Hong , Jiang Yu , Lei Chuzhao
Published: February 2020

Background

The domestic buffalo (Bubalus bubalis) is an essential farm animal in tropical and subtropical regions, whose genomic diversity is yet to be fully discovered.

Results

In this study, we describe the demographic events and selective pressures of buffalo by analyzing 121 whole genomes (98 newly reported) from 25 swamp and river buffalo breeds. Both uniparental and biparental markers were investigated to provide the final scenario. The ancestors of swamp and river buffalo diverged ~0.23 million years ago and then experienced independent demographic histories. They were domesticated in different regions, the swamp buffalo at the border between southwest China and southeast Asia, while the river buffalo in south Asia. The domestic stocks migrated to other regions and further differentiated, as testified by (at least) 2 ancestral components identified in each subspecies. Different signals of selective pressures were also detected in these 2 types of buffalo. The swamp buffalo, historically used as a draft animal, shows selection signatures in genes associated with the nervous system, while in river dairy breeds, genes under selection are related to heat stress and immunity.

Conclusions

Our findings substantially expand the catalogue of genetic variants in buffalo and reveal new insights into the evolutionary history and distinct selective pressures in river and swamp buffalo.
Simulation testing a new multi-stage process to measure the effect of increased sampling effort on effective sample size for age and length data
Authors: Thorson James T , Bryan Meaghan D , Hulson Peter-John F , Xu Haikun , Punt André E
Published: February 2020

Ocean management involves monitoring data that are used in biological models, where estimates inform policy choices. However, few science organizations publish results from a recurring, quantitative process to optimize effort spent measuring fish age. We propose that science organizations could predict the likely consequences of changing age-reading effort using four independent and species-specific analyses. Specifically we predict the impact of changing age collections on the variance of expanded age-composition data (“input sample size”, Analysis 1), likely changes in the variance of residuals relative to stock-assessment age-composition estimates (“effective sample size”, Analysis 2), subsequent changes in the variance of stock status estimates (Analysis 3), and likely impacts on management performance (Analysis 4). We propose a bootstrap estimator to conduct Analysis 1 and derive a novel analytic estimator for Analysis 2 when age-composition data are weighted using a Dirichlet-multinomial likelihood. We then provide two simulation studies to evaluate these proposed estimators and show that the bootstrap estimator for Analysis 1 underestimates the likely benefit of increased age reads while the analytic estimator for Analysis 2 is unbiased given a plausible mechanism for model misspecification. We conclude by proposing a formal process to evaluate changes in survey efforts for stock assessment.
Acoustic scattering by a semi-infinite angular sector with impedance boundary conditions, II: the far-field asymptotics
Authors: Lyalinov Mikhail A
Published: February 2020

This work is a natural continuation of our recent study devoted to the scattering of a plane incident wave by a semi-infinite impedance sector. We develop an approach that enables us to compute different components in the far-field asymptotics. The method is based on the Sommerfeld integral representation of the scattered wave field, on the careful study of singularities of the integrand and on the asymptotic evaluation of the integral by means of the saddle point technique. In this way, we describe the waves reflected from the sector, diffracted by its edges or scattered by the vertex as well as the surface waves. Discussion of the far-field in the so-called singular directions (or in the transition zones) is also addressed.
CRISPRpic: fast and precise analysis for CRISPR-induced mutations via

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ounting
Authors: Lee HoJoon , Chang Howard Y , Cho Seung Woo , Ji Hanlee P
Published: February 2020

Analysis of CRISPR-induced mutations at targeted locus can be achieved by polymerase chain reaction amplification followed by parallel massive sequencing. We developed a novel algorithm, named as CRISPRpic, to analyze the sequencing reads for the CRISPR experiments via counting exact-matching and pattern-searching. Compare to the other methods based on sequence alignment, CRISPRpic provides precise mutation calling and ultrafast analysis of the sequencing results. Python script of CRISPRpic is available at https://github.com/compbio/CRISPRpic.
‘Or’ in Paradise Lost: the Poetics of Incertitude Reconsidered
Authors: Leonard John
Published: February 2020

Several Miltonists, beginning with Virginia Mollenkott in 1974, have identified ‘or’ as a key word in Paradise Lost because it is the word most associated with choice. In recent years, Peter C. Herman has made the bolder claim that ‘or’ is the poem’s key word because it refuses to choose. Herman argues that Paradise Lost is characterized by a ‘poetics of incertitude’ calculated to frustrate the reader. Whilst agreeing with earlier critics that ‘or’ is a key word in the poem, this essay challenges the claim that it always refuses (or even consistently offers) choices. A series of close readings demonstrates that Milton frequently uses ‘or’ to affirm, not waver. In ‘cletic’ (summoning) hymns, epic catalogues, and oratorical speeches, ‘or’ most often signals certainty, not incertitude. In the debate in Hell, every orator uses ‘or’ to pressure his audience to assent, not vacillate. The present essay is not, however, an attempt to replace Herman’s ‘poetics of incertitude’ with a rival ‘poetics of certainty’. The emphasis is on the diversity of ‘or’ in Paradise Lost. ‘Or’ sometimes signals uncertainty, but Milton never values incertitude for its own sake. The essay concludes by examining the poem’s cautious ventures into theology and astronomy, where Milton does keep his options open with ‘or’, but even in these cases he sometimes hints at a preference between the choices he declines to make.
Work-Hour Trajectories and Associated Socioeconomic Characteristics among Single-Mother Families
Authors: Wu Chi-Fang , Chang Yu-Ling , Rhodes Emily , Musaad Salma , Jung Woojin
Published: February 2020

Although social work research has paid substantial attention to employment patterns among low-income single mothers after welfare reform, little is known about their work-hour trajectories over time. This study uses group-based trajectory modeling to analyze the work-hour trajectories among low-income single mothers in the United States (N = 870). Only approximately two-fifths (41.9 percent) of participants in the sample had stable employment. About 18 percent did not work throughout the study period. Yet several groups experienced changes in working patterns over time: increasing hours (20.7 percent), decreasing then increasing hours (11.3 percent), and decreasing hours (8.4 percent). This study uses a generalized linear mixed model to determine the factors associated with change in work hours over time. Significant factors include marital status, high school completion, race, citizenship, homeownership, child care arrangement, income support program participation, work disability, age of youngest child, age of the mother, state unemployment rate, and state minimum wage. These findings have important policy implications for targeting supports to diverse needs of low-income single-mother families to promote employment stability and economic improvement.
A qualitative study of patient preferences for prompts and reminders for a direct-mail fecal testing program
Authors: Davis Melinda M , Schneider Jennifer L , Gunn Rose , Rivelli Jennifer S , Vaughn Katherine A , Coronado Gloria D
Published: February 2020

Programs that directly mail fecal immunochemical tests (FIT) to patients can increase colorectal cancer (CRC) screening, especially in low-income and Latino populations. Few studies have explored patient reactions to prompts or reminders that accompany such programs. As part of the Participatory Research to Advance Colon Cancer Prevention pilot study, which tested prompts and reminders to a direct-mail FIT program in a large, urban health center, we conducted telephone interviews among English- and Spanish-speaking participants who were assigned to receive a series of text message prompts, automated phone call reminders, and/or live phone call reminders. We analyzed interviews using a qualitative content analysis approach. We interviewed 41 participants, including 25 responders (61%) and 16 nonresponders (39%) to the direct-mail program. Participants appreciated program ease and convenience. Few participants recalled receiving prompts or automated/live reminders; nevertheless, the vast majority (95%, n = 39) thought reminders were acceptable and helpful and suggested that 2–3 reminders delivered starting 1 week after the mailed FIT would optimally encourage completion. Prompts and reminders used with mailed-FIT programs are accepted by patients, and my help boost response rates.
Genetically Distinct Acidovorax citrulli Strains Display Cucurbit Fruit Preference Under Field Conditions
Authors: Zhao Mei , Dutta Bhabesh , Luo Xuelin , Burdman Saul , Walcott Ron
Published: February 2020

Strains of Acidovorax citrulli, the causal agent of bacterial fruit blotch (BFB) of cucurbits, can be assigned to two groups, I and II. The natural association of group I and II strains with different cucurbit species suggests host preference; however, there are no direct data to support this hypothesis under field conditions. Hence, the objective of this study was to assess differences in the prevalence of group I and II A. citrulli strains on cucurbit species in the field. From 2017 to 2019, we used group I and II strains to initiate BFB outbreaks in field plots planted with four cucurbit species. At different times, we collected symptomatic tissues and assayed them for group I and II strains using a group-specific PCR assay. Binary distribution data analysis revealed that the odds of melon, pumpkin, and squash foliage infection by group I strains were 21.7, 11.5, and 22.1 times greater, respectively, than the odds of watermelon foliage infection by the group I strain (P < 0.0001). More strikingly, the odds of melon fruit infection by the group I strain were 97.5 times greater than watermelon fruit infection by the same strain (P < 0.0001). Unexpectedly, some of the group II isolates recovered from the 2017 and 2019 studies were different from the group II strains used as inocula. Overall, data from these experiments confirm that A. citrulli strains exhibit a preference for watermelon and melon, which is more pronounced in fruit tissues.
Nursing Innovation
Authors: Nelson Roxanne
Published: February 2020

Empowering nurses to solve workplace challenges using design thinking.
Reproduction, DNA Methylation, and Biological Age
Authors: Kresovich Jacob K. , Harmon Quaker E. , Xu Zongli , Nichols Hazel B. , Sandler Dale P. , Taylor Jack A.
Published: February 2020

(Abstracted from Hum Reprod 2019;34:1965–1973)

Metabolic demands of pregnancy result in physiological systematic changes and increases in oxidative stress to the mother that may accelerate senescence and biological aging. Epigenetic clocks are a new tool designed to estimate biological age beyond measurement of telomeres alone and may provide more robust estimates for the impact of pregnancy on biological age.
Contribution of COMT and BDNF Genotype and Expression to the Risk of Transition From Acute to Chronic Low Back Pain
Authors: Baumbauer Kyle M. , Ramesh Divya , Perry Mallory , Carney Katherine B. , Julian Thomas , Glidden Nicole , Dorsey Susan G. , Starkweather Angela R. , Young Erin E.
Published: February 2020

Objectives:

A number of factors, including heritability and the environment, contribute to risk of transition from acute low back pain to chronic low back pain (CLBP). The aim of this study was to (1) compare somatosensory function and pain ratings at low back pain (LBP) onset between the acute low back pain and CLBP conditions and (2) evaluate associations between BDNF and COMT polymorphisms and expression levels at LBP onset to acute and chronic pain burden and risk for transition to the chronic pain state.

Methods:

In this longitudinal study, 220 participants were enrolled following recent onset of LBP and data were collected until the LBP resolved or until the end of the study at 6 months. Forty-two participants’ pain resolved before 6 weeks from onset and 42 participants continued to have pain at 6 months. Patient-reported pain burden, somatosensory function (quantitative sensory testing), and blood samples were collected at each study visit.

Results:

CLBP is associated with greater pain burden and somatosensory hypersensitivity at the time of LBP onset. COMT rs4680 genotype (GG) was associated with acute cold pain sensitivity and with the risk for transition to CLBP while COMT expression was independently associated with risk for transition.

Discussion:

CLBP was characterized by higher reported pain burden and augmented hypersensitivity at LBP onset. COMT expression and genotype were associated with acute pain burden and likelihood of transition to CLBP.
Hypervigilance for Bodily Sensations in the Back During a Movement Task in People With Chronic and Recurrent Low Back Pain
Authors: Clauwaert Amanda , Schouppe Stijn , Van Oosterwijck Jessica , Danneels Lieven , Van Damme Stefaan
Published: February 2020

Objectives:

The current study assessed the role of hypervigilance for bodily sensations in the back in long-term low back pain problems.

Methods:

People with chronic low back pain, recurrent low back pain, and no low back pain were compared on the extent to which they attended to somatosensory stimuli on the back during a movement task. To measure hypervigilance, somatosensory event-related potentials (SEPs) to task-irrelevant tactile stimuli on the back were measured when preparing movements in either a threatening or a neutral condition, indicated by a cue signaling possible pain on the back during movement or not.

Results:

Results showed stronger attending to stimuli on the back in the threat condition than in the neutral condition, as reflected by increased amplitude of the N96 SEP. However, this effect did not differ between groups. Similarly, for all 3 groups the amplitude of the P172 was larger for the threatening condition, suggesting a more general state of arousal resulting in increased somatosensory responsiveness. No significant associations were found between somatosensory attending to the back and theorized antecedents such as pain catastrophizing, pain-related fear, and pain vigilance.

Discussion:

The current study confirmed that individuals preparing a movement attended more toward somatosensory stimuli at the lower back when anticipating back pain during the movement, as measured by the N96 SEP. However, no differences were found between participants with chronic low back pain or recurrent low back pain, or the pain-free controls.
Multiple Sclerosis
Authors: Fang Xiang , Patel Chilvana , Gudesblatt Mark
Published: February 2020

Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of the central nervous system. The disease affects more women than men and often is diagnosed during a woman’s childbearing years. Typical clinical presentations of the disease are extensive and variable, with symptoms that include dysregulated mood, fatigue, vision problems, weakness, tremor, imbalance, abnormal sensations, bladder dysfunction, and heat sensitivity. If a woman aged 15–50 years experiences these neurologic symptoms in isolation or combination, and the symptoms are not explained by other underlying medical conditions, MS should be suspected. Multiple sclerosis can be divided into four clinical subtypes: 1) relapsing-remitting MS, 2) secondary progressive MS, 3) primary progressive MS, and 4) clinically isolated syndrome. Relapsing-remitting MS at the time of onset is the most common form and accounts for approximately 80% of all cases of MS. Relapsing-remitting MS does not affect life expectancy. However, because of the neurodegenerative and progressive course of the disease, patients accumulate physical and cognitive disabilities over time that result in impaired ability to work, increased financial burden, and slightly increased mortality. A variety of possible risk and prognostic indicators have been identified that may predict the course of disease, particularly the extent of relapses and disability. Multiple sclerosis currently is incurable, but many disease-modifying therapies are available that can reduce the frequency of clinically evident exacerbations and accumulation of disease burden as defined by the number of lesions identified on magnetic resonance imaging. The choice of disease-modifying therapies, contraception use, and treatment of symptoms should be individualized based on age at onset and disease activity and, during pregnancy, the gestational age. Proactive management of MS across the woman’s life cycle reduces morbidity, improves maternal and fetal health during pregnancy and the postpartum period, and increases quality-of life-measures for patients and their families.
Management of Neglected Traumatic Hip Dislocation in Children
Authors: Gardner Richard O.E. , Worku Nardos , Nunn Timothy R. , Zerfu Tewodros T. , Kassahun Mesfin E.
Published: February 2020

Background:

Neglected traumatic hip dislocation in children is uncommon and there is no consensus on appropriate management. Previous studies report varied operative management with high rates of avascular necrosis and postoperative subluxation/dislocation. We report a series of 7 consecutive cases who underwent operative reduction after neglected hip dislocation and describe our technique for treatment.

Methods:

All 7 children sustained posterior dislocations and had no treatment before presentation at our institution. An associated marginal acetabular fracture was present in 2 cases. One additional patient was excluded from the study due to complete loss of articular cartilage that precluded open reduction. The mean time before surgical intervention was 13.1 months (4 to 36 mo) with a mean age of 7 years (5.3 to 10.8 y). All children underwent preoperative skeletal traction for 10 to 14 days. A postero-lateral approach was used in all cases. The acetabulum was cleared of scar tissue and a femoral shortening performed as required (5 cases). Minor erosion of the articular cartilage of the posterior aspect of the femoral head was noted in 3/6 cases. After reduction, a posterior capsulorrhaphy was performed and the patient immobilized in a hip spica for 6 to 12 weeks.

Results:

The mean follow-up was 44 months (33 to 56 mo). The majority of children (86%) could walk and run without a limp, could squat, and had no pain. One child had mild pain and a limp. Mean Harris Hip Score was 98.9. No hip subluxed or dislocated postoperatively. The radiographs at latest follow-up showed no evidence of growth disturbance in 29% of cases, coxa magna in 57%, and partial femoral head collapse in 1 case (14%). Of note, those patients managed within 8 months of injury had none or minimal evidence of growth disturbance.

Conclusions:

At medium-term follow-up, open reduction with a postero-lateral approach, posterior capsulorrhaphy, and femoral shortening (as required) produces a satisfactory outcome with a stable, congruent reduction. Good clinical function can be expected with a low incidence of avascular necrosis.

Level of Evidence:

Level IV.
Potential Selection Bias in Observational Studies Comparing Cervical Disc Arthroplasty to Anterior Cervical Discectomy and Fusion
Authors: Goz Vadim , Martin Brook I. , Donnally Chester J. , Brodke Darrel , Spina Nicholas , Lawrence Brandon , Spiker William Ryan
Published: February 2020

Study Design.

Retrospective study using a national administrative database.

Objective.

To define the cohort differences in patient characteristics between patients undergoing cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) in a large national sample, and to describe the impact of those baseline patient characteristics on analyses of costs and complications.

Summary of Background Data.

CDA was initially studied in high quality, randomized trials with strict inclusion criteria. Recently a number of non-randomized, observational studies have been published an attempt to expand CDA indications. These trials are predisposed to falsely attributing differences in outcomes to an intervention due to selection bias.

Methods.

Adults undergoing ACDF or CDA between 2004 and 2014 were identified using International Classification of Diseases, 9th, Clinical Modification (ICD-9-CM) diagnosis and procedure codes. Perioperative demographics, comorbidities, complications, and costs were queried. Patient characteristics were compared via chi-square and t tests. Cost, mortality, and complications were compared between ACDF and CDA cohorts using models that adjusted for demographics and comorbidities, as well as “naïve” models that did not.

Results.

A total of 290,419 procedures, 98.2% ACDF and 1.8% CDA, were included in the sample. Compared with ACDF patients, CDA patients were younger, healthier as evidenced by number of comorbidities, and had an improved socioeconomic status as measured by income and insurance. The naïve logistic regression model showed that hospital costs for CDA were $549 lower than ACDF. In the fully specified model, CDA was $574 more expensive. The naïve model for medical complications suggests a protective advantage for CDA over ACDF, odds ratio of 0.627, P < 0.01. No statistically significant difference was found in the fully specified model in terms of complications.

Conclusion.

Patients undergoing CDA were younger and healthier with higher socioeconomic statuses compared with ACDF patients. Accounting for these baseline differences significantly attenuated the apparent benefit for CDR on costs and medical complications.

Level of Evidence: 3
Neuroanesthesia Guidelines for Optimizing Transcranial Motor Evoked Potential Neuromonitoring During Deformity and Complex Spinal Surgery
Authors: Walker Corey T. , Kim Han Jo , Park Paul , Lenke Lawrence G. , Weller Mark A. , Smith Justin S. , Nemergut Edward C. , Sciubba Daniel M. , Wang Michael Y. , Shaffrey Christopher , Deviren Vedat , Mummaneni Praveen V. , Chang Joyce M. , Mummaneni Valli P. , Than Khoi D. , Berjano Pedro , Eastlack Robert K. , Mundis Gregory M. , Kanter Adam S. , Okonkwo David O. , Shin John H. , Lewis Jason M. , Koski Tyler , Hoh Daniel J. , Glassman Steven D. , Vinci Susan B. , Daniels Alan H. , Clavijo Claudia F. , Turner Jay D. , McLawhorn Marc , Uribe Juan S.
Published: February 2020

Study Design.

Expert opinion—modified Delphi study.

Objective.

We used a modified Delphi approach to obtain consensus among leading spinal deformity surgeons and their neuroanesthesiology teams regarding optimal practices for obtaining reliable motor evoked potential (MEP) signals.

Summary of Background Data.

Intraoperative neurophysiological monitoring of transcranial MEPs provides the best method for assessing spinal cord integrity during complex spinal surgeries. MEPs are affected by pharmacological and physiological parameters. It is the responsibility of the spine surgeon and neuroanesthesia team to understand how they can best maintain high-quality MEP signals throughout surgery. Nevertheless, varying approaches to neuroanesthesia are seen in clinical practice.

Methods.

We identified 19 international expert spinal deformity treatment teams. A modified Delphi process with two rounds of surveying was performed. Greater than 50% agreement on the final statements was considered “agreement”; >75% agreement was considered “consensus.”

Results.

Anesthesia regimens and protocols were obtained from the expert centers. There was a large amount of variability among centers. Two rounds of consensus surveying were performed, and all centers participated in both rounds of surveying. Consensus was obtained for 12 of 15 statements, and majority agreement was obtained for two of the remaining statements. Total intravenous anesthesia was identified as the preferred method of maintenance, with few centers allowing for low mean alveolar concentration of inhaled anesthetic. Most centers advocated for <150 μg/kg/min of propofol with titration to the lowest dose that maintains appropriate anesthesia depth based on awareness monitoring. Use of adjuvant intravenous anesthetics, including ketamine, low-dose dexmedetomidine, and lidocaine, may help to reduce propofol requirements without negatively effecting MEP signals.

Conclusion.

Spine surgeons and neuroanesthesia teams should be familiar with methods for optimizing MEPs during deformity and complex spinal cases. Although variability in practices exists, there is consensus among international spinal deformity treatment centers regarding best practices.

Level of Evidence: 5
Reporting of Outcomes and Outcome Measures in Studies of Interventions to Prevent and/or Treat Delirium in the Critically Ill: A Systematic Review
Authors: Rose Louise , Agar Meera , Burry Lisa , Campbell Noll , Clarke Mike , Lee Jacques , Marshall John , Siddiqi Najma , Page Valerie ,   for the Development of Core Outcome Sets for Effectiveness Trials of Interventions to Prevent and/or Treat Delirium (Del-COrS) Group
Published: February 2020

Objectives:

To inform development of a core outcome set, we evaluated the scope and variability of outcomes, definitions, measures, and measurement time-points in published clinical trials of pharmacologic or nonpharmacologic interventions, including quality improvement projects, to prevent and/or treat delirium in the critically ill.

Data Sources:

We searched electronic databases, systematic review repositories, and trial registries (1980 to March 2019).

Study Selection and Data Extraction:

We included randomized, quasi-randomized, and nonrandomized intervention studies of pharmacologic and nonpharmacologic interventions. We extracted data on study characteristics, verbatim descriptions of study outcomes, and measurement characteristics. We assessed quality of outcome reporting using the Management of Otitis Media with Effusion in Children with Cleft Palate study scoring system; risk of bias and study quality using the Cochrane tool and Scottish Intercollegiate Guidelines Network checklists. We categorized reported outcomes using Core Outcome Measures in Effectiveness Trials taxonomy.

Data Synthesis:

From 195 studies (1/195 pediatric) recruiting 74,632 participants and reporting a mean (sd) of 10 (6.2) outcome domains, we identified 12 delirium-specific outcome domains. Delirium incidence (147, 75% of studies), duration (67, 34%), and antipsychotic use (42, 22%) were most commonly reported. We identified a further 94 non–delirium-specific outcome domains within 19 Core Outcome Measures in Effectiveness Trials taxonomy categories. For both delirium-specific and nonspecific outcome domains, we found multiple outcomes in domains due to differing descriptions and time-points. The Confusion Assessment Method-ICU with Richmond Agitation-Sedation Scale to assess sedation was the most common measure used to ascertain delirium (51, 35%). Measurement generally began at randomization or ICU admission, and lasted from 1 to 30 days, ICU/hospital discharge. Frequency of measurement was highly variable with daily measurement and greater than daily measurement reported for 36% and 37% of studies, respectively.

Conclusions:

We identified substantial heterogeneity and multiplicity of outcome selection and measurement in published studies. These data will inform the consensus building stage of a core outcome set to inform delirium research in the critically ill.
Epigenetics of Sepsis
Authors: Binnie Alexandra , Tsang Jennifer L. Y. , Hu Pingzhao , Carrasqueiro Gabriela , Castelo-Branco Pedro , dos Santos Claudia C.
Published: February 2020

Objectives:

Recent evidence from the fields of microbiology and immunology, as well as a small number of human sepsis studies, suggest that epigenetic regulation may play a central role in the pathogenesis of sepsis. The term “epigenetics” refers to regulatory mechanisms that control gene expression but are not related to changes in DNA sequence. These include DNA methylation, histone modifications, and regulation of transcription via non-coding RNAs. Epigenetic modifications, occurring in response to external stressors, lead to changes in gene expression, and thus lie at the intersection between genetics and the environment. In this review, we examine data from in vitro studies, animal studies, and the existing human sepsis studies in epigenetics to demonstrate that epigenetic mechanisms are likely central to the pathogenesis of sepsis and that epigenetic therapies may have potential in the treatment of sepsis and its associated organ failures.

Data Sources:

Online search of published scientific literature via Pubmed using the term “epigenetics” in combination with the terms “sepsis”, “infection”, “bacterial infection”, “viral infection”, “critical illness”, “acute respiratory distress syndrome”, and “acute lung injury”.

Study Selection:

Articles were chosen for inclusion based on their relevance to sepsis, acute inflammation, sepsis-related immune suppression, and sepsis-related organ failure. Reference lists were reviewed to identify additional relevant articles.

Data Extraction:

Relevant data was extracted and synthesized for narrative review.

Data Synthesis:

Epigenetic regulation is a key determinant of gene expression in sepsis. At the onset of infection, host-pathogen interactions often result in epigenetic alterations to host cells that favor pathogen survival. In parallel, the host inflammatory response is characterized by epigenetic modifications in key regulatory genes, including tumor necrosis factor and interleukin-1β. In human sepsis patients, multiple epigenetic modifying enzymes show differential expression in early sepsis, suggesting a role for epigenetics in coordinating the response to infection. In the later stages of sepsis, epigenetic modifications accompany endotoxin tolerance and the immune-suppressed state. In animal models, treatment with epigenetic modifiers can mitigate the effects of sepsis and improve survival as well as reverse sepsis-associated organ injury.

Conclusions:

Epigenetic modifications are associated with key phases of sepsis, from the host-pathogen interaction, to acute inflammation, to immune suppression. Epigenetic markers show promise in the diagnosis and prognosis of sepsis and epigenetic modifying agents show promise as therapeutic tools in animal models of sepsis. Human studies in the area of epigenetics are sorely lacking and should be a priority for sepsis researchers.
Initial Assessment of the Percutaneous Electrical Phrenic Nerve Stimulation System in Patients on Mechanical Ventilation
Authors: O’Rourke James , Soták Michal , Curley Gerard F. , Doolan Aoife , Henlín Tomáš , Mullins Gerard , Tyll Tomáš , Omlie William , Ranieri Marco V.
Published: February 2020

Objectives:

Maintaining diaphragm work using electrical stimulation during mechanical ventilation has been proposed to attenuate ventilator-induced diaphragm dysfunction. This study assessed the safety and feasibility of temporary percutaneous electrical phrenic nerve stimulation on user-specified inspiratory breaths while on mechanical ventilation.

Design:

Two-center, nonblinded, nonrandomized study.

Setting:

Hospital ICU.

Patients:

Twelve patients mechanically ventilated from 48 hours to an expected 7 days.

Interventions:

Leads were inserted to lie close to the phrenic nerve in the neck region using ultrasound guidance. Two initial patients had left-sided placement only with remaining patients undergoing bilateral lead placement. Percutaneous electrical phrenic nerve stimulation was used for six 2-hour sessions at 8-hour intervals over 48 hours.

Measurements and Main Results:

Data collected included lead deployment success, nerve conduction, ventilation variables, work of breathing, electrical stimulation variables, stimulation breath synchrony, and diaphragm thickness measured by ultrasound at baseline, 24, and 48 hours. Primary endpoints included ability to capture the left and/or right phrenic nerves and maintenance of work of breathing within defined limits for 80% of stimulated breaths. Lead insertion was successful in 21 of 22 attempts (95.5%). Analysis of 36,059 stimulated breaths from 10 patients with attempted bilateral lead placement demonstrated a mean inspiratory lag for phrenic nerve stimulation of 23.7 ms (p < 0.001 vs null hypothesis of <88ms). Work of breathing was maintained between 0.2 and 2.0 joules/L 96.8% of the time, exceeding the 80% target. Mean diaphragm thickness increased from baseline by 7.8% at 24 hours (p = 0.022) and 15.0% at 48 hours (p = 0.0001) for patients receiving bilateral stimulation after excluding one patient with pleural effusion. No serious device/procedure-related adverse events were reported.

Conclusions:

The present study demonstrated the ability to safely and successfully place percutaneous electrical phrenic nerve stimulation leads in patients on mechanical ventilation and the feasibility of using this approach to synchronize electrical stimulation with inspiration while maintaining work of breathing within defined limits.
Dietary total antioxidant capacity and colorectal cancer and colorectal adenomatous polyps: a case-control study
Authors: Rafiee Pegah , Jafari Nasab Saeede , Bahrami Alireza , Rezaeimanesh Nasim , Jalali Saba , Hekmatdoost Azita , Sadeghi Amir , Naja Farah , Houshyari Mohammad , Hejazi Ehsan
Published: February 2020

Colorectal cancer (CRC) is the third most common and the third most deadly cancer worldwide. In Iran, CRC is the third and fifth most common cancer in females and males, respectively. Chronic oxidative stress has been implicated in the development of CRC and its precursor, colorectal adenomatous polyps (CAP). While there were a few studies that suggested a favorable role of individuals antioxidants on the CRC risk, the total antioxidant capacity (TAC) of diet has been less investigated. Consequently, the aim of this study is to investigate the association of TAC with the odds of CRC and CAP. This is a case-control study. The participants were 130 cases with incident, histologically confirmed CRC, 134 cases with incident of CAP and 243 hospital-based controls. TAC has been assessed with dietary ferric-reducing antioxidant potential and oxygen radical absorbance capacity method based on collected dietary intake data through a reproducible and valid food frequency questionnaire. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between the TAC and CRC and CAP odds were estimated by multiple logistic regression. After controlling for potential confounders, TAC was significantly associated with CRC and CAP odds. (ORQ3-Q1 for CRC = 0.25, 95% CI: 0.13–0.46, P
trend = 0.001. ORQ3-Q1 for CAP = 0.48, 95% CI: 0.27–0.85, P
trend = 0.01). The findings of this study suggested an inverse association between TAC and CRC and CAP risk.
The Effect of Implementation of a Nursing Information System
Authors: Liao Min-Chi , Chiu Jing-Er , Tsai Ching-Mei
Published: February 2020

The implementation of a nursing information system is a revolutionary change in that with its help nurses can quickly complete various assessments and treatment records and simplify manual work. Consequently, physicians and interdisciplinary teams can query information and deliver the most accurate treatment. Since the implementation of a nursing information system to the case hospital, the recording time difference between new and senior nurses was reduced; for new nurses, the recording time per shift decreased from 66.2 ± 15.0 minutes to 37.16 ± 15.7 minutes, while for senior nurses with more than 10 years of experience, it decreased from 45.4 ± 6.65 minutes to 29.1 ± 4.23 minutes. With the application of the innovation diffusion theory, the Nursing Department achieved cross-team cooperation with the Information Department and successfully developed the nursing information system, which laid a solid foundation for the case hospital to further develop other information systems.
Blood Pressure Management Following Acute Ischemic Stroke
Authors: Tucker Natalie , Stoffel Jaclyn M. , Hayes Lisa , Jones G. Morgan
Published: February 2020

Elevated blood pressure is common in patients with acute ischemic stroke. While this may occur secondary to the body's own response to preserve cerebral blood flow, elevated blood pressure may also increase the risk of hemorrhagic transformation. Current guidelines recommend various blood pressure goals based upon multiple factors, including thresholds specific to certain treatment interventions. Despite these guidelines, there is limited evidence to support specific blood pressure targets, and variability in clinical practice is common. The purpose of this review was to discuss blood pressure management in adult patients with acute ischemic stroke, focusing on appropriate targets in the setting of alteplase administration, mechanical thrombectomy, and hemorrhagic transformation.
The Association Between Perceived Racial Discrimination and Hypertension in a Low-Income, Racially Integrated Urban Community
Authors: Gabriel Angel C. , Bell Caryn N. , Bowie Janice V. , Hines Anika L. , LaVeist Thomas A. , Thorpe Roland J.
Published: February 2020

We examined the association between perceived racial discrimination and hypertension among African Americans and whites who live in a low-income, racially integrated, urban community. Hypertension was defined as having a systolic blood pressure 140 mm Hg or more, a diastolic blood pressure 90 mm Hg or more, or taking antihypertensive medication(s). Perceived racial discrimination was based on self-reported responses of experiencing racial discrimination in various settings. Using modified Poisson multivariable regression models, we found no association between perceived racial discrimination and hypertension (prevalence ratio: 0.96, 95% confidence interval: 0.90-1.04). Findings suggest that social context may play a role in the relationship between perceived racial discrimination and hypertension.
Rural-Urban Differences in Roles and Support for Community Health Workers in the Midwest
Authors: Trout Kate E. , Chaidez Virginia , Palmer-Wackerly Angela L.
Published: February 2020

The Patient Protection and Affordable Care Act supports the integration of community health workers (CHWs) into the health care workforce, but little is known about integration and current roles of CHWs among employers in community settings. This analysis of 97 employers described the roles of CHWs in Nebraska and found significant differences between CHWs practicing in rural and urban areas in organization types employing CHWs, funding sources, and minority populations served. The findings suggest that the utility of CHWs is widely recognized among employers, but deliberate support will be needed to better define the roles of CHWs to meet the needs of the increasingly diverse demographic.
Predictors of Statin Intolerance in Patients With a New Diagnosis of Atherosclerotic Cardiovascular Disease Within a Large Integrated Health Care Institution: The IMPRES Study
Authors: Bair Tami L. , May Heidi T. , Knowlton Kirk U. , Anderson Jeffrey L. , Lappe Donald L. , Muhlestein Joseph B.
Published: February 2020

Statins are among the most prescribed medications because of the well-documented benefits of safely lowering low-density lipoprotein cholesterol. However, many patients are unable or unwilling to continue statin therapy because of real or perceived adverse effects. This study sought to increase understanding about which patients are unlikely to tolerate statin therapy. The Intermountain Healthcare's electronic data repository was queried from January 1, 1999, to December 31, 2013, to identify all adults who survived their first encounter of coronary artery disease (CAD), cerebral vascular disease, or peripheral artery disease and received statin therapy during follow-up. Statin intolerance (SI) was identified by the documentation of clinician-noted intolerance or allergy or by the use of pitavastatin. Patients were followed up for ≥3 years or until death. Of the 48,997 patients evaluated, 3049 (6.2%) were documented with SI. Of those with SI, 9.8% were prescribed a low-intensity, 73.4% a moderate-intensity, and 16.8% a high-intensity statin dose. After adjustment for covariables, significant predictors of SI were female sex [odds ratio (OR) = 1.47, P < 0.0001], age (65–74 vs. <65: OR = 1.15, P = 0.002; ≥75 vs. <65: OR = 0.90, P = 0.03), hypertension (OR = 1.11, P = 0.01), hyperlipidemia (OR = 1.31, P < 0.0001), smoking (OR = 0.88, P = 0.001), renal failure (OR = 1.20, P = 0.009), heart failure (OR = 1.26, P < 0.0001), sleep apnea (OR = 1.22, P < 0.0001), prior malignancy (OR = 1.18, P = 0.007), depression (OR = 1.13, P = 0.04), and index atherosclerotic cardiovascular disease diagnosis (CAD vs. cerebral vascular disease: OR = 1.71, P < 0.0001; CAD vs. peripheral artery disease: OR = 1.23, P = 0.02). In this study, the strongest identified clinical predictor of future SI was female sex. Many standard cardiovascular risk factors were also associated with SI, suggesting that patients with multiple comorbidities are more likely to be vulnerable.
Low-Intensity Ultrasound Modulation May Prevent Myocardial Infarction-induced Sympathetic Neural Activation and Ventricular Arrhythmia
Authors: Wang Songyun , Li Binxun , Li Xuemeng , Wu Lin , Zhu Tongjian , Zhao Dongdong , Jiang Hong
Published: February 2020

Background:

Low-intensity focused ultrasound (LIFU) has been shown to be a beneficial tool for autonomic nervous system modulation, but its effect on the left stellate ganglion (LSG) remains unknown.

Objective:

To seek the effect of LIFU on myocardial infarction (MI)-induced LSG activation and ventricular arrhythmias (VAs).

Methods:

In this study, 20 dogs were included and randomly divided into the LIFU (LIFU & MI, n = 8), Sham (sham LIFU & MI, n = 8), and Control group (sham LIFU & sham MI, n = 4). For each LIFU intervention (1.0–2.0 W, 10 minutes) of the LSG, the LSG function, ventricular effective refractory period (ERP), and temperature were tested pre-intervention and postintervention. Thereafter, MI was induced by left anterior artery ligation and VAs were recorded for 1 hour. At the end, both the LSG and the heart were extracted for biomedical and histological analysis.

Results:

In the Sham group, no significant change was shown in ventricular ERP or LSG function for any intensity settings of sham LIFU intervention when compared with the group baseline. In the LIFU group, however, both 1.5 and 2.0 W LIFU modulation of LSG resulted in significant prolongation of ERP and attenuation of LSG function. Furthermore, the incidence of VAs was significantly attenuated in the LIFU group compared with the Sham group. Moreover, histological analysis showed that no damage or apoptosis was observed in LSG although a statistically significant increase was shown in temperature (maximal increase <1°C) with 1.5 and 2.0 W LIFU intervention.

Conclusion:

LIFU stimulation may be a safe and beneficial tool for LSG attenuation and VA prevention in the MI canine model.
Leadership in Disruptive Times: The Key to Changing Healthcare
Authors: Agee Nancy Howell
Published: February 2020

Quality and safety are the top priorities of every hospital and health system. Patients put their trust in us as healthcare leaders, often in the most vulnerable moments of their lives, and we must respond with high-quality, highly reliable, and compassionate care.

Patients have the right to expect the best return for their healthcare dollars. Recognizing that expectation, progressive hospitals and health systems are embracing the move to value-based care and are enhancing affordability. The goal is to provide greater value to patients by improving quality, lowering costs, and enhancing the patient experience.

Ever-changing market forces affect how hospitals and health systems deliver care and may also affect how much they are reimbursed for services. We must stretch to transform, improve, and even redefine care delivery for all of our patients as well as our teams of caregivers and staff.

Carilion Clinic demonstrates this commitment in our continuing evolution as an integrated delivery system, along with our participation in new national collaborations to improve affordability and advance innovation. We are catalysts for change in a sector that is ripe for it.
Patient Perspectives on Declining to Participate in Home-Based Cardiac Rehabilitation
Authors: Schopfer David W. , Nicosia Francesca M. , Ottoboni Linda , Whooley Mary A.
Published: February 2020

Purpose:

A minority of eligible patients participate in cardiac rehabilitation (CR) programs. Availability of home-based CR programs improves participation in CR, yet many continue to decline to enroll. We sought to explore among patients the rationale for declining to participate in CR even when a home-based CR program is available.

Methods:

We conducted a mixed-methods evaluation of reasons for declining to participate in CR. Between August 2015 and August 2017, a total of 630 patients were referred for CR evaluation during index hospitalization (San Francisco VA Medical Center). Three hundred three patients (48%) declined to participate in CR. Of these, 171 completed a 14-item survey and 10 patients also provided qualitative data through semistructured phone interviews.

Results:

The most common reason, identified by 61% of patients on the survey, was “I already know what to do for my heart.” Interviews helped clarify reasons for nonparticipation and identified system barriers and personal barriers. These interviews further highlighted that declining to participate in CR was often due to competing life priorities, no memory of the initial CR consultation, and inadequate understanding of CR despite referral.

Conclusion:

We identified that most patients declining to participate in a home-based CR program did not understand the benefits and rationale for CR. This could be related to the timing of the consultation or presentation method. Many patients also indicated that competing life priorities prevented their participation. Modifications in the consultation process and efforts to accommodate personal barriers may improve participation.