bluuebunny/crossref_metadata_2025 huggingface dataset:
Implicit bias of encoded variables: frameworks for addressing structured bias in EHR–GWAS data
Authors: Dueñas Hillary R , Seah Carina , Johnson Jessica S , Huckins Laura M
Published: August 2020

The ‘discovery’ stage of genome-wide association studies required amassing large, homogeneous cohorts. In order to attain clinically useful insights, we must now consider the presentation of disease within our clinics and, by extension, within our medical records. Large-scale use of electronic health record (EHR) data can help to understand phenotypes in a scalable manner, incorporating lifelong and whole-phenome context.

However, extending analyses to incorporate EHR and biobank-based analyses will require careful consideration of phenotype definition. Judgements and clinical decisions that occur ‘outside’ the system inevitably contain some degree of bias and become encoded in EHR data. Any algorithmic approach to phenotypic characterization that assumes non-biased variables will generate compounded biased conclusions. Here, we discuss and illustrate potential biases inherent within EHR analyses, how these may be compounded across time and suggest frameworks for large-scale phenotypic analysis to minimize and uncover encoded bias.
Benefits to migratory fish populations of entrainment and its potential role in fisheries collapse
Authors: Chambers Mark S
Published: August 2020

According to the entrainment hypothesis, traditional migratory routes develop in fish populations through social interactions. First-time migrants learn migratory routes by following experienced conspecifics and, by repeating the migration, contribute to guiding future cohorts along the same route. The loss of collective memory of migratory routes may be a precursor to fisheries collapse. The survival value of entrainment has not been convincingly demonstrated, and this possibly explains why there has not been greater interest in this putative migratory mechanism. I propose that the relative frequency of demonstrators of alternative contingents provides information to first-time migrants on relative survival rates. Using simulation, I show that a population in which contingent adoption is regulated by entrainment can achieve higher overall survival rates than a comparable population with fixed rates of contingent adoption in the situation where mortality rates differ among contingents. In certain cases, the advantage could be even larger in the presence of fishing mortality. I also compare the responses of the entrainment-based and fixed-rate migration populations in a scenario intended to mimic the cessation of fishing after a period of high fishing mortality, such as might occur after the collapse of a fishery.
Influence of fish backbone model geometrical features on the numerical target strength of swimbladdered fish
Authors: Pérez-Arjona I , Godinho L , Espinosa V
Published: August 2020

The method of fundamental solutions has been applied to evaluate the influence of fish models geometrical features on the target strength (TS) directivity and TS frequency response of swimbladdered fish. Simplified models were considered for two fish species: gilt-head sea bream (Sparus aurata, Linnaeus 1758) and Atlantic salmon (Salmo salar, Linnaeus 1758), and different geometrical details of their morphology were studied, such as backbone presence, and its curvature or the inclusion of vertebrae modulation. Swimbladder shape and tilt, together with the inclusion of backbone (and its realistic curvature) for dorsal measurements were the most important features for proper estimation of mean TS. The estimation of mean TS is considered including the effect of fish tilt, the echosounder frequency, and the fish-to-transducer distance.
Significance of prophylactic urethrectomy at the time of radical cystectomy for bladder cancer
Authors: Hakozaki Kyohei , Kikuchi Eiji , Ogihara Koichiro , Shigeta Keisuke , Abe Takayuki , Miyazaki Yasumasa , Kaneko Gou , Maeda Takahiro , Yoshimine Shunsuke , Kanai Kunimitsu , Ide Hiroki , Shirotake Suguru , Oyama Masafumi , Mizuno Ryuichi , Oya Mototsugu
Published: August 2020

Background

Prophylactic urethrectomy at the time of radical cystectomy is frequently recommended for patients with bladder cancer at a high risk of urethral recurrence without definitive evidence. The present study attempted to clarify the survival benefits of performing prophylactic urethrectomy.

Methods

We identified 214 male patients who were treated by radical cystectomy with an incontinent urinary diversion in our seven institutions between 2004 and 2017. We used propensity score matching and ultimately identified 114 patients, 57 of whom underwent prophylactic urethrectomy (prophylactic urethrectomy group) and 57 who did not (non-prophylactic urethrectomy group).

Results

No significant differences were observed in the 5-year overall survival rate between the prophylactic urethrectomy and non-prophylactic urethrectomy groups in the overall. However, the local recurrence rate was significantly lower in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.015). In the subgroup of 58 patients with multiple tumours and/or concomitant carcinoma in situ at the time of transurethral resection of bladder tumour, the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.021). A multivariate analysis revealed that performing prophylactic urethrectomy was the only independent predictor of the overall survival rate (P = 0.016). In those patients who were treated without neoadjuvant chemotherapy (n = 38), the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.007).

Conclusions

Prophylactic urethrectomy at the time of radical cystectomy may have a survival benefit in patients with multiple tumours and/or concomitant carcinoma in situ, particularly those who do not receive neoadjuvant chemotherapy.
New Mosquitocide Derived From Volcanic Rock
Authors: Deguenon Jean M , Riegel Claudia , Cloherty-Duvernay Erin R , Chen Kaiying , Stewart David A , Wang Bo , Gittins David , Tihomirov Larissa , Apperson Charles S , McCord Marian G , Roe R Michael
Published: August 2020

Malaria, dengue, yellow fever, and the Zika and West Nile Viruses are major vector-borne diseases of humans transmitted by mosquitoes. According to the World Health Organization, over 80% of the world’s population is at risk of contacting these diseases. Insecticides are critical for mosquito control and disease prevention, and insect insecticide resistance is on the increase; new alternatives with potentially different modes of action from current chemistry are needed. During laboratory screening of industrial minerals for insecticide activity against Anopheles gambiae (Giles) (Diptera: Culicidae) we discovered a novel mechanical insecticide derived from volcanic rock (MIVR) with potential use as a residual spray. In modified WHO cone tests, the time to 50% mortality was 5 h under high-humidity conditions. MIVR treated surfaces demonstrated no mosquito repellency. In field studies where the mechanical insecticide was applied to wood using standard spray equipment and then placed under stilt homes in New Orleans, LA, the residual activity was >80% after 9 wk against Aedes aegypti (L.) (Diptera: Culicidae), Aedes albopictus (Skuse) (Diptera: Culicidae) and Culex quinquefasciatus (Say) (Diptera: Culicidae) (with similar efficacy to a positive chemical insecticide control). In scanning electron microcopy studies, the MIVR was transferred as particles mostly to the legs of the mosquito. This wettable powder made from volcanic rock is a mechanical insecticide representing a potential new mode of action different from current chemistry for mosquito control and is in commercial development under the trade name Imergard™WP as an indoor and outdoor residual spray.
Atypical Severe Shock-like Reactions in Adolescents After Trimethoprim-Sulfamethoxazole Therapy
Authors: Rathe Jennifer A , Poole Nicole , Melvin Ann
Published: August 2020

Severe drug hypersensitivity reactions to antibiotics are rare but trimethoprim-sulfamethoxazole (TMP-SMX) is uniquely associated with numerous and varied manifestations including a reaction resembling septic shock, first observed in human immunodeficiency virus (HIV)/AIDS patients. Over the past 25 years about 20 cases have been reported and an association with the virus and related immune system dysregulation was assumed. However, recent reports in adults have recognized similar shock-like reactions in non-HIV infected individuals. Here we review severe TMP-SMX hypersensitivity reactions and within the context of these known reactions, describe three non-HIV infected adolescent patients with shock-like reactions to TMP-SMX observed in one institution over 1.5 years.
Non-invasive imaging reveals convergence in root and stem vulnerability to cavitation across five tree species
Authors: Peters Jennifer M R , Gauthey Alice , Lopez Rosana , Carins-Murphy Madeline R , Brodribb Timothy J , Choat Brendan
Published: August 2020

Root vulnerability to cavitation is challenging to measure and under-represented in current datasets. This gap limits the precision of models used to predict plant responses to drought because roots comprise the critical interface between plant and soil. In this study, we measured vulnerability to drought-induced cavitation in woody roots and stems of five tree species (Acacia aneura, Cedrus deodara, Eucalyptus crebra, Eucalytus saligna, and Quercus palustris) with a wide range of xylem anatomies. X-ray microtomography was used to visualize the accumulation of xylem embolism in stems and roots of intact plants that were naturally dehydrated to varying levels of water stress. Vulnerability to cavitation, defined as the water potential causing a 50% loss of hydraulic function (P50), varied broadly among the species (–4.51 MPa to –11.93 MPa in stems and –3.13 MPa to –9.64 MPa in roots). The P50 of roots and stems was significantly related across species, with species that had more vulnerable stems also having more vulnerable roots. While there was strong convergence in root and stem vulnerability to cavitation, the P50 of roots was significantly higher than the P50 of stems in three species. However, the difference in root and stem vulnerability for these species was small; between 1% and 31% of stem P50. Thus, while some differences existed between organs, roots were not dramatically more vulnerable to embolism than stems, and the differences observed were less than those reported in previous studies. Further study is required to evaluate the vulnerability across root orders and to extend these conclusions to a greater number of species and xylem functional types.
AT 2017gbl: a dust obscured TDE candidate in a luminous infrared galaxy
Authors: Kool E C , Reynolds T M , Mattila S , Kankare E , Pérez-Torres M A , Efstathiou A , Ryder S , Romero-Cañizales C , Lu W , Heikkilä T , Anderson G E , Berton M , Bright J , Cannizzaro G , Eappachen D , Fraser M , Gromadzki M , Jonker P G , Kuncarayakti H , Lundqvist P , Maeda K , McDermid R M , Medling A M , Moran S , Reguitti A , Shahbandeh M , Tsygankov S , U V , Wevers T
Published: August 2020

We present the discovery with Keck of the extremely infrared (IR) luminous transient AT 2017gbl, coincident with the Northern nucleus of the luminous infrared galaxy (LIRG) IRAS 23436+5257. Our extensive multiwavelength follow-up spans ∼900 d, including photometry and spectroscopy in the optical and IR, and (very long baseline interferometry) radio and X-ray observations. Radiative transfer modelling of the host galaxy spectral energy distribution and long-term pre-outburst variability in the mid-IR indicate the presence of a hitherto undetected dust obscured active galactic nucleus (AGN). The optical and near-IR spectra show broad ∼2000 km s−1 hydrogen, He i, and O i emission features that decrease in flux over time. Radio imaging shows a fast evolving compact source of synchrotron emission spatially coincident with AT 2017gbl. We infer a lower limit for the radiated energy of 7.3 × 1050 erg from the IR photometry. An extremely energetic supernova would satisfy this budget, but is ruled out by the radio counterpart evolution. Instead, we propose AT 2017gbl is related to an accretion event by the central supermassive black hole, where the spectral signatures originate in the AGN broad line region and the IR photometry is consistent with re-radiation by polar dust. Given the fast evolution of AT 2017gbl, we deem a tidal disruption event (TDE) of a star a more plausible scenario than a dramatic change in the AGN accretion rate. This makes AT 2017gbl the third TDE candidate to be hosted by a LIRG, in contrast to the so far considered TDE population discovered at optical wavelengths and hosted preferably by post-starburst galaxies.
No redshift evolution of non-repeating fast radio burst rates
Authors: Hashimoto Tetsuya , Goto Tomotsugu , On Alvina Y L , Lu Ting-Yi , Santos Daryl Joe D , Ho Simon C-C , Kim Seong Jin , Wang Ting-Wen , Hsiao Tiger Y-Y
Published: August 2020

Fast radio bursts (FRBs) are millisecond transients of unknown origin(s) occurring at cosmological distances. Here we, for the first time, show time-integrated-luminosity functions and volumetric occurrence rates of non-repeating and repeating FRBs against redshift. The time-integrated-luminosity functions of non-repeating FRBs do not show any significant redshift evolution. The volumetric occurrence rates are almost constant during the past ∼10 Gyr. The nearly-constant rate is consistent with a flat trend of cosmic stellar-mass density traced by old stellar populations. Our findings indicate that the occurrence rate of non-repeating FRBs follows the stellar-mass evolution of long-living objects with ∼Gyr time-scales, favouring e.g. white dwarfs, neutron stars, and black holes, as likely progenitors of non-repeating FRBs. In contrast, the occurrence rates of repeating FRBs may increase towards higher redshifts in a similar way to the cosmic star formation rate density or black hole accretion rate density if the slope of their luminosity function does not evolve with redshift. Short-living objects with ≲Myr time-scales associated with young stellar populations (or their remnants, e.g. supernova remnants, young pulsars, and magnetars) or active galactic nuclei might be favoured as progenitor candidates of repeating FRBs.
Authentication, characterization and contamination detection of cell lines, xenografts and organoids by barcode deep NGS sequencing
Authors: Chen Xiaobo , Qian Wubin , Song Zhenzhen , Li Qi-Xiang , Guo Sheng
Published: August 2020

Misidentification and contamination of biobank samples (e.g. cell lines) have plagued biomedical research. Short tandem repeat (STR) and single-nucleotide polymorphism assays are widely used to authenticate biosamples and detect contamination, but with insufficient sensitivity at 5–10% and 3–5%, respectively. Here, we describe a deep NGS-based method with significantly higher sensitivity (≤1%). It can be used to authenticate human and mouse cell lines, xenografts and organoids. It can also reliably identify and quantify contamination of human cell line samples, contaminated with only small amount of other cell samples; detect and quantify species-specific components in human–mouse mixed samples (e.g. xenografts) with 0.1% sensitivity; detect mycoplasma contamination; and infer population structure and gender of human samples. By adopting DNA barcoding technology, we are able to profile 100–200 samples in a single run at per-sample cost comparable to conventional STR assays, providing a truly high-throughput and low-cost assay for building and maintaining high-quality biobanks.
Urinary Tract Infections Caused by Fluconazole-Resistant Trichosporon japonicum in 2 Kidney Transplant Patients and Analysis of Their Homology
Authors: Li Tingting , Huang Ying , Chen Xianguo , Wang Zhongxin , Xu Yuanhong
Published: August 2020

Trichosporon spp. are emerging opportunistic agents that cause systemic diseases and life-threatening disseminated disease in immunocompromised hosts. Trichosporon japonicum is a highly rare cause of invasive trichosporonosis. In this study, we describe 2 cases of urinary tract infection caused by Trichosporon japonicum in kidney transplant patients. Culturing of urine samples yielded bluish-green colonies of T. japonicum on Candida chromogenic fungal medium. The isolates were identified as T. japonicum by matrix-assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI TOF-MS; Autof MS 1000). The identification of T. japonicum was further confirmed by 18S rRNA gene sequencing. In vitro drug susceptibility testing showed that the 2 strains of T. japonicum were resistant to 5-flucytosine, fluconazole, and caspofungin, with dose-dependent sensitivity to itraconazole and voriconazole but sensitivity to amphotericin B. The homology of the 2 T. japonicum strains, as determined by cluster analysis and principal component analysis of MALDI-TOF MS, was ~85%, suggesting a common nosocomial origin. The first 2 case reports of fluconazole-resistant T. japonicum urinary infection in kidney transplant recipients are presented.
Intrathecal Morphine in Postoperative Analgesia for Colorectal Cancer Surgery: A Retrospective Study
Authors: Young Jamie , Macpherson Alistair , Thakerar Arti , Alexander Marliese
Published: August 2020

Background

Colorectal cancer surgery is commonly performed with adequate analgesia essential for patient recovery. This study assessed the effectiveness of intrathecal morphine and patient-controlled analgesia (ITM + PCA) vs patient-controlled analgesia alone (PCA) for postoperative pain management in colorectal cancer surgery.

Methods

This retrospective study extracted and analyzed data covering a 4-year period (2014–2018) from a clinical database with 24- and 48-hour postsurgery follow-up. Primary outcomes included pain scores, median opioid consumption (oral morphine equivalence dose), sedation, nausea and vomiting, and length of admission. Outcomes were analyzed for ITM + PCA vs PCA alone, overall and stratified by laparotomy or laparoscopy procedures.

Results

In total, 283 patients were included: ITM + PCA (163) and PCA alone (120). Median opioid consumption in the first 24 hours for ITM + PCA vs PCA alone was lower for laparotomy (–32.7 mg, P<0.001) and laparoscopy (–14.3 mg, P<0.001). Median pain score (worst pain) within the first 24 hours for ITM + PCA vs PCA alone was similar for laparotomy (P>0.05) and lower for laparoscopy (–1 unit, P=0.031). Sedation occurred less frequently for ITM + PCA vs PCA at 24 hours (3.5% vs 11.4%, P=0.031), with nonsignificant reduction at 48 hours (4.8% vs 18.8%, P=0.090) for laparotomy, but with no difference for laparoscopy (P>0.05). Incidence of nausea and vomiting and length of admission were similar for ITM + PCA vs PCA alone for laparotomy or laparoscopy (P>0.05).

Conclusion

This retrospective study demonstrated that ITM + PCA can achieve similar analgesic effects after laparotomy and laparoscopy colorectal cancer surgery compared with PCA alone while resulting in a reduction of oral opioid consumption and lower incidence of sedation.
Undermining Governors: Argentina’s Double-Punishment Federal Spending Strategy
Authors: Fenwick Tracy Beck , González Lucas
Published: August 2020

Throughout Latin American federations, programmatic welfare spending is increasingly nationally oriented and bureaucratically delivered. By explaining the logic and the effects of combining two types of federal spending, discretionary and non-discretionary, this article uncovers an additional driver that contributes to understanding policymaking and its implementation not only in Argentina, but potentially in other robust federal systems such as Brazil, Canada, and the United States. Using original data on federal infrastructure and programmatic social welfare spending for the twenty-four provinces of Argentina between 2003 and 2015, we provide empirical evidence that both forms of spending penalize opposition districts and more populated urban provinces (regardless of partisan affinity), and thus undercut the ability of key governors to become future presidential challengers. This research suggests that presidents of territorially diverse federations with strong governors can utilize the dual-punishment spending strategy to alter the balance of power, reinforcing the dominance of the center.
Medical breakthroughs: chance and opportunity
Authors: Hughes J M B
Published: August 2020

Medical advances of great importance in improving diagnosis, treatment or prevention of disease are often called ‘breakthroughs’. The processes by which breakthroughs are achieved are multiple, but may include necessity (a problem which must be solved), opportunity (the time must be right), chance (the unexpected), curiosity (a desire to understand mechanisms) and ingenuity (ability to find a solution). Discovery can be the start of a chain reaction, so that the breakthrough at the end of the chain becomes “inevitable”. Two examples are given in which these attributes played a part (i) the development of a vaccine against the poliomyelitis virus and (ii) the harnessing of penicillin as a therapeutic agent to treat serious bacterial infections.
Collagen scaffolds functionalized with triple-helical peptides support 3D HUVEC culture
Authors: Malcor Jean-Daniel , Hunter Emma J , Davidenko Natalia , Bax Daniel V , Cameron Ruth , Best Serena , Sinha Sanjay , Farndale Richard W
Published: August 2020

Porous biomaterials which provide a structural and biological support for cells have immense potential in tissue engineering and cell-based therapies for tissue repair. Collagen biomaterials that can host endothelial cells represent promising tools for the vascularization of engineered tissues. Three-dimensional collagen scaffolds possessing controlled architecture and mechanical stiffness are obtained through freeze–drying of collagen suspensions, followed by chemical cross-linking which maintains their stability. However, cross-linking scaffolds renders their biological activity suboptimal for many cell types, including human umbilical vein endothelial cells (HUVECs), by inhibiting cell–collagen interactions. Here, we have improved crucial HUVEC interactions with such cross-linked collagen biomaterials by covalently coupling combinations of triple-helical peptides (THPs). These are ligands for collagen-binding cell-surface receptors (integrins or discoidin domain receptors) or secreted proteins (SPARC and von Willebrand factor). THPs enhanced HUVEC adhesion, spreading and proliferation on 2D collagen films. THPs grafted to 3D-cross-linked collagen scaffolds promoted cell survival over seven days. This study demonstrates that THP-functionalized collagen scaffolds are promising candidates for hosting endothelial cells with potential for the production of vascularized engineered tissues in regenerative medicine applications.
Expression of mitochondrial TSPO and FAM173B is associated with inflammation and symptoms in patients with painful knee osteoarthritis
Authors: Palada Vinko , Siddiqah Ahmed Aisha , Hugo Anders , Radojčić Maja R , Svensson Camilla I , Kosek Eva
Published: August 2020

Objectives

To characterize the expression profiles of two nuclear-encoded mitochondrial genes previously associated with chronic pain, the translocator protein (TSPO) and family with sequence similarity 173B (FAM173B), in different knee compartments from patients with painful knee OA. Also, to examine their association with the joint expression of inflammatory cytokines/chemokines and clinical symptoms.

Methods

The study was performed on 40 knee OA patients and 19 postmortem (PM) controls from which we collected the knee tissues: articular cartilage (AC), synovial membrane (SM) and subchondral bone (SB). Quantitative real-time polymerase chain reaction was used to determine the relative mRNA levels of TSPO, FAM173B, and inflammatory mediators IL6, IL8, IL10, IL12, MCP1, CCL11 and CCL17. OA patients rated their pain intensity (visual analogue scale), severity of knee-related outcomes (KOOS) and pain sensitivity assessed by pressure algometry.

Results

The gene expression of TSPO in SM was elevated in OA patients compared with control subjects while there were no group differences in AC and SB. Expression of FAM173B was reduced in SM but elevated in SB in OA patients compared with controls. The expression of TSPO and FAM173B in SM and SB was associated with the expression of inflammatory substances, but not in AC. Synovial expression of TSPO correlated with lower pain intensity and FAM173B with increased pressure pain sensitivity in OA.

Conclusion

Our results suggest that altered expression of TSPO and FAM173B is associated with joint expression of inflammatory mediators and with clinical symptoms indicating the relevance for the pathophysiology of knee OA.
The Latent Structure of Negative Symptoms in Individuals With Attenuated Psychosis Syndrome and Early Psychosis: Support for the 5 Consensus Domains
Authors: Chang Wing Chung , Strauss Gregory P , Ahmed Anthony O , Wong Sandra C Y , Chan Joe K N , Lee Edwin H M , Chan Sherry K W , Hui Christy L M , James Sydney H , Chapman Hannah C , Chen Eric Y H
Published: August 2020

Negative symptoms are prevalent in the prodromal and first-episode phases of psychosis and highly predictive of poor clinical outcomes (eg, liability for conversion and functioning). However, the latent structure of negative symptoms is unclear in the early phases of illness. Determining the latent structure of negative symptoms in early psychosis (EP) is of critical importance for early identification, prevention, and treatment efforts. In the current study, confirmatory factor analysis was used to evaluate latent structure in relation to 4 theoretically derived models: 1. a 1-factor model, 2. a 2-factor model with expression (EXP) and motivation and pleasure (MAP) factors, 3. a 5-factor model with separate factors for the 5 National Institute of Mental Health (NIMH) consensus development conference domains (blunted affect, alogia, anhedonia, avolition, and asociality), and 4. a hierarchical model with 2 second-order factors reflecting EXP and MAP, as well as 5 first-order factors reflecting the 5 consensus domains. Participants included 164 individuals at clinical high risk (CHR) who met the criteria for a prodromal syndrome and 377 EP patients who were rated on the Brief Negative Symptom Scale. Results indicated that the 1- and 2-factor models provided poor fit for the data. The 5-factor and hierarchical models provided excellent fit, with the 5-factor model outperforming the hierarchical model. These findings suggest that similar to the chronic phase of schizophrenia, the latent structure of negative symptom is best conceptualized in relation to the 5 consensus domains in the CHR and EP populations. Implications for early identification, prevention, and treatment are discussed.
Green synthesis of silver nanoparticles using Indian male fern (Dryopteris Cochleata), operational parameters, characterization and bioactivity on Naja naja venom neutralization
Authors: Singh Pushpendra , Yasir Mohammad , Khare Ruchi , Shrivastava Rahul
Published: August 2020

Snakebite is considered as one of the acute severe medical problems across the world. Snake venoms composed of various group of toxins, enzymes and non-toxic enzymes. Phospholipases A2 present in Naja naja snake venom plays a significant role in lipid signalling and contributes to different inflammation in the human body. Dryopteris cochleata rhizomes have antioxidant, antimicrobial property and used to treat lesions, gonorrhoea, sores, muscular pain, rheumatic and also useful in dog and snake bites. In this study, Indian male fern D. cochleata rhizomes have been used for green synthesis of silver nanoparticles with the aim to increase the bioactivity of plant extract and to evaluate N. naja snake venom inhibition activity of prepared nanoparticles. Green synthesized nanoparticles were characterized with the help of ultraviolet–visible spectroscopy, Fourier-transform infrared spectroscopy, X-ray powder diffraction and atomic force microscopy. Naja naja venom inhibition activity of nanoparticles was performed using in vitro phospholipases A2 assay and tissue damage activity. The results showed that surface plasmon resonance maxima peaks of nanoparticles were observed at 424 nm. Average particle size was around 35 nm, with a spherical shape. Neutralization results exhibited that synthesized silver nanoparticles from D. cochleata decreased percentage of tissue damage, resulting in significant inhibition of phospholipase A2 and N. naja snake venom. Results concluded that green synthesized silver nanoparticles from D. cochleata rhizome neutralize N. naja snake venom activity.
Reducing Barriers for RN-BSN Education: The Assessment Competency Evaluation
Authors: Goliat Laura , Gravens Kathleen A. , Bonnett Pamela L. , Schrull Patricia L. , Bowler Connie , Prosser Regina , Vitantonio Deborah A. , Batch-Wilson Wendy , Szweda Christine , Kavanagh Joan M. , Mau Kathleen A. , Sharpnack Patricia A. , Dillon-Bleich Kimberly , Drennen Carol
Published: August 2020

The Northeast Team of the Ohio Action Coalition, composed of regional clinical and academic educators, identified a potential barrier for nurses pursuing a baccalaureate degree. Duplication of health assessment content was identified for some associate degree graduates enrolled in RN-BSN programs, thereby adding extra time and cost for attaining the baccalaureate degree. In response, the Northeast Team of the Ohio Action Coalition developed an assessment competency evaluation that, if successfully passed, would grant credit for the health assessment course. The assessment competency evaluation provided the opportunity for students to demonstrate competency in both health assessment and clinical judgment skills.
Immune-related adverse events in a patient with eosinophilic enteritis treated with immune checkpoint inhibitors (anti-PD-1)
Authors: Cybulska-Stopa Bożena , Kamińska-Winciorek Grażyna , Dyduch Grzegorz
Published: August 2020

The use of immune checkpoint inhibitors (ICIs) in melanoma patients has significantly improved treatment outcomes. Unfortunately, ICI therapy is associated with specific immune-related adverse events (irAEs). There is limited data on the use of ICIs in patients with autoimmune or allergic diseases, because these patients have typically been excluded from clinical trials. Eosinophilic inflammatory bowel disease (primary eosinophilic gastrointestinal disorders) is a rare condition defined as eosinophilic infiltration in the wall of the gastrointestinal tract in the absence of other known causes of tissue eosinophilia. We present a case of a 51-year-old woman with eosinophilic enteritis who was treated with anti-PD-1 because of metastatic melanoma. The use of anti-PD-1 therapy in a metastatic melanoma patient with a positive history of eosinophilic enteritis resulted in the appearance of many immune-related complications (hypothyroidism, hepatitis, skin lesions, colitis). The patient discontinued anti-PD-1 treatment and glucocorticoid therapy was started. All AEs have resolved without any sequelae, and there are no symptoms of eosinophilic enteritis. Currently, the patient has no complaints, and has no clinical features of recurrence or dissemination of melanoma (April 2020); she remains under constant oncological supervision. The use of anti-PD-1 therapy in a patient with metastatic melanoma and a positive history of eosinophilic enteritis resulted in almost complete remission of melanoma but also the appearance of many immune-related complications, none of which were life-threatening. Patients with eosinophilic enteritis may be eligible for anti-PD-1 therapy; however, they should be closely monitored for the appearance of various irAEs when receiving this therapy.
Blood pressure and cardiovascular risk factors in women treated for climacteric symptoms with acupuncture, phytoestrogens, or hormones
Authors: Palma Federica , Fontanesi Francesca , Neri Isabella , Xholli Anjeza , Facchinetti Fabio , Cagnacci Angelo
Published: August 2020

Objective:

To evaluate the response of cardiovascular risk factors to the treatment of climacteric symptoms.

Methods:

In this prospective study, women reporting climacteric symptoms were randomized to 3 months of treatment with either acupuncture (n = 19), phytoestrogens (75 mg soy isoflavones, BID; n = 22), or low-dose hormone therapy (HT; 0.3 mg conjugated equine oestrogens plus 1.5 mg medroxyprogesterone acetate; n = 20). Greene's climacteric scale, blood pressure (BP), lipids, glucose, insulin, and homeostatic model assessment of insulin resistance were assessed before and after treatment. Observed changes were compared by analysis of variance.

Results:

HT and acupuncture reduced Greene climacteric score to a similar extent, but the effect of phytoestrogens was significantly lower (P < 0.05). With acupuncture, systolic (−7.4 ± 15.3 mm Hg; P < 0.05) and diastolic BP (−8.3 ± 7.7mm Hg; P < 0.01) decreased, and the same occurred with phytoestrogens (−8.4 ± 9.0 mm Hg [P < 0.01] and −6.6 ± 7.9 mm Hg [P < 0.01]). Neither BP systolic (1.9 ± 17.5 mm Hg) nor BP diastolic (−1.4 ± 9.6 mm Hg) changed during HT. Low-density lipoprotein cholesterol decreased with phytoestrogens (−9.9 ± 19.6 mg/dL; P < 0.05), and triglycerides increased with both HT (34.5 ± 12.2 mg/dL; P < 0.01) and phytoestrogens (17.41 ± 24.4 mg/dL; P < 0.01). A slight but significant increase in homeostatic model assessment of insulin resistance (0.14 ± 0.5; P < 0.05) was observed after HT.

Conclusions:

Treatment of climacteric symptoms with acupuncture and phytoestrogens, but not HT, is associated with a clear BP reduction, and phytoestrogens with potentially positive alterations in low-density lipoprotein cholesterol level.

Trial Registration:

EudractCT Number 2008-006053-41.

Video Summary:
http://links.lww.com/MENO/A637.
Assessment of menopausal symptoms and quality of life in women with premature ovarian failure after hematopoietic stem-cell transplantation for hematologic diseases
Authors: Su Huina , Li Huiling , Yang Xin , Wang Chaohua , Zhao Yang
Published: August 2020

Objective:

This study aimed to evaluate and compare menopausal symptoms and quality of life between women with premature ovarian failure who underwent hematopoietic stem-cell transplantation (HSCT) for hematologic diseases and naturally menopausal women.

Methods:

This observational study enrolled 415 women (215 HSCT women and 200 naturally menopausal women as control group) from June 2017 to November 2019 in the menopause clinic of Peking University People's Hospital. Menopausal symptoms and quality of life were evaluated using the modified Kupperman index (KI), menopause rating scale (MRS), and menopause quality of life questionnaire.

Results:

The total KI and MRS scores were 12.53 ± 8.27 and 7.69 ± 6.50 in the HSCT group and 21.57 ± 9.23 and 12.05 ± 6.70 in the control group, respectively (P < 0.05). The scores related to sexual problems and vaginal dryness were 1.20 ± 1.24 and 1.07 ± 1.24 in the HSCT group and 1.15 ± 1.01 and 1.01 ± 1.01 in the control group, respectively (P > 0.05). Age was a risk factor for menopausal symptoms (odds ratio 1.70, 95% confidence interval 1.01-1.12). The main reasons for consultations in the HSCT group were amenorrhea and infertility (76.74%).

Conclusions:

Compared with naturally menopausal women with the same number of years since menopause, the MRS and KI scores of women with premature ovarian failure who underwent HSCT showed milder symptoms. The MRS may be a better alternative to reflect the severity of menopausal symptoms. Age was a risk factor for menopausal symptoms. Oncofertility counseling should be initiated as early as possible before the start of treatment.
Transgender adults, gender-affirming hormone therapy and blood pressure: a systematic review
Authors: Connelly Paul J. , Clark Anna , Touyz Rhian M. , Delles Christian
Published: August 2020

Objectives:

Gender-affirming hormone therapy (GHT) is utilized by people who are transgender to align their secondary sex characteristics with their gender identity. Data relating to cardiovascular outcomes in this population are limited. We aimed to review the impact of GHT on the blood pressure (BP) of transgender individuals.

Methods:

We searched PubMed/MEDLINE, SCOPUS and Cochrane Library databases for articles published relating to the BP of transgender adults commencing GHT. Methodological quality was assessed via the ‘Quality Assessment Tool for Before–After (Pre–Post) Studies with No Control Group’.

Results:

Six hundred articles were screened, of which 14 studies were included in this systematic review encompassing 1309 individuals (∼50% transgender men and women) treated with GHT between 1989 and 2019. These articles were all pre–post observational studies without control groups. Mean ages ranged between 23.0–36.7 years (transgender men) and 25.2–34.8 years (transgender women). Interventions were diverse and included oral, transdermal and injectable hormonal preparations with 4 months to 5 years follow-up. Most studies in transgender men did not demonstrate a change in BP, whereas transgender women on GHT demonstrated both increases and decreases in SBP. These studies were heterogenous with significant methodological limitations and only two were determined to have a good quality rating.

Conclusion:

There is currently insufficient data to advise the impact of GHT on BP in transgender individuals. Better quality research is essential to elucidate whether exogenous sex hormones modulate BP in transgender people and whether this putative alteration infers poorer cardiovascular outcomes.
Effects of Teaching Evidence-Based Medicine on Physician Assistant Students′ Critical Appraisal, Self-Efficacy, and Clinical Application: A Randomized Controlled Trial
Authors: Stack Matthew A. , DeLellis Nailya O. , Boeve Wallace , Satonik Robert C.
Published: August 2020

Purpose

To use a randomized controlled design to explore the effects of evidence-based medicine (EBM) education on physician assistant (PA) students' EBM knowledge, self-efficacy, and evidence-seeking behavior in a simulated clinical situation and to present a model of EBM competence.

Methods

Sixty-one didactic-year PA students from one Midwestern University (2 sequential cohorts) were randomized to receive the standard PA curriculum plus EBM training (intervention) or the standard PA curriculum only (control). Evidence-based medicine knowledge was measured with a validated Fresno test. Self-efficacy was measured with a validated Likert scale. Clinical application of EBM skills was measured with an objective structured clinical examination (OSCE).

Results

Evidence-based medicine education led to significant improvements on the Fresno and self-efficacy tests, both within and between groups. On the OSCE, the intervention group performed no better than the control group. Higher Fresno pretest scores were significantly related to decreasing improvements in the posttest scores: R = −0.634.

Conclusion

Teaching EBM to PA students improved their EBM knowledge and self-efficacy but not their clinical application. Future research should focus on enhancing EBM evaluation and application in the clinical setting.
Reduced Gritty Perseverance Partially Explains the Relationship Between Overinvolved Parenting and Stress in Physician Assistant Graduate Students
Authors: Francis Andrea P. , Drake Nicole , Chen Matthew , Young Lauren
Published: August 2020

Purpose

The purpose of this research was to assess the role of noncognitive factors (socioeconomic status [SES], overinvolved parenting, and grit) in predicting perceived stress and grade point average (GPA) among graduate students enrolled in a physician assistant (PA) program.

Methods

In this cross-sectional survey study, 98 PA students completed surveys measuring SES, overinvolved parenting, grit (passion), grit (perseverance), self-reported GPA, and perceived stress.

Results

More overinvolved parenting was reported by PA students under the age of 25 years compared to those over the age of 25. Lower SES predicted higher perceived stress. After controlling for SES, grit (perseverance) partially mediated the relationship between overinvolved parenting and perceived stress. Neither parenting style nor grit was associated with GPA.

Conclusions

Younger PA students reported higher levels of overinvolved parenting. The relationship between experiences with overinvolved parenting and current levels of stress in PA school is partially explained by reduced gritty resilience.
Reimagining Physician Assistant Education
Authors: Hills Karen , VanderMeulen Stephane , Snyder Jennifer A. , Kohlhepp William , Alexander Lisa Mustone , Lane Steven
Published: August 2020

The physician assistant (PA) profession has successfully flourished for over 50 years, demand for graduates remains strong, and there is a wealth of research on the quality of care that PA graduates provide. Nevertheless, health care and education are constantly changing, and we must change with them. We must continually scan the horizon and consider how best to adapt to current issues like the clinical sites crisis, as well as evolutions in technology, pedagogy, and in our students themselves. The Physician Assistant Education Association Presidents Commission, a group of past presidents, sought to stimulate a conversation on “reimagining PA education” through the lens of advances in our knowledge of the neuroscience of learning and changes in technology, including simulation, and a broader focus on innovation and “thinking outside the box.” Through interviews with PA faculty and leaders, we provide some examples of areas of innovation in education, especially on the possibilities presented by a more flexible approach to innovation from the accreditation body than many PA faculty might perceive. One initial conclusion is that PA educators should focus more on helping students to “think like clinicians” from the start of their education. This paper is primarily intended to stimulate dialog, and we encourage all PA educators to form—and more importantly, share—their own thoughts and questions, through the PAEA professional learning communities and Digital Learning Hub (PAEAlearning.org/learn/digital-learning-hub/).
Intraoperative Electrocochleography of Posterior Fossa Tumors Producing Menière's Syndrome
Authors: Varadarajan Varun V. , Riggs Willian J. , Hiss Meghan M. , Moberly Aaron C. , Dodson Edward E. , Adunka Oliver F. , Mattingly Jameson K.
Published: August 2020

Objectives:

Intraoperative electrocochleography (ECochG) has provided insight regarding inner ear pathophysiology during neurotologic procedures. In this study, intraoperative ECochG findings are reported in patients who presented with episodic aural and vestibular symptoms during resection of posterior fossa neoplasms.

Patients:

Three patients with episodic vertigo who underwent resection of posterior fossa tumors.

Intervention:

Intraoperative ECochG was performed before and after tumor resection with the active electrode at the round window. Acoustic stimuli consisted of click and tone bursts presented in alternating polarity.

Main Outcome Measure:

ECochG responses including summation potential (SP), action potential (AP), and SP:AP ratio values to evaluate for endolymphatic hydrops.

Results:

All subjects presented with asymmetric sensorineural hearing loss (SNHL), episodic vertigo, and tinnitus. Subject 1 was a 63-year-old woman who underwent left translabyrinthine excision of an endolymphatic sac (ELS) tumor and demonstrated no measurable responses until fenestration of the lateral semicircular canal, suggesting severe hydrops relieved by labyrinthotomy. Subject 2 was a 44-year-old woman who underwent right ELS tumor resection and exhibited an elevated SP:AP ratio. Subject 3 was a 55-year-old woman who underwent right retrolabyrinthine resection of a meningioma and exhibited robust responses without hydrops.

Conclusions:

Endolymphatic hydrops secondary to mechanical obstruction by a posterior fossa neoplasm may be demonstrated using intraoperative ECochG. Immediate improvement of hydrops may not be demonstrated after tumor resection.
Noise Damage Accelerates Auditory Aging and Tinnitus: A Canadian Population-Based Study
Authors: Jafari Zahra , Copps Thomas , Hole Glenn , Kolb Bryan E. , Mohajerani Majid H.
Published: August 2020

Objective:

Age-related hearing loss (ARHL) is the third most challenging disability in older adults. Noise is a known modifiable risk factor of ARHL, which can drive adverse health effects. Few large-scale studies, however, have shown how chronic noise exposure (CNE) impacts the progression of ARHL and tinnitus.

Study Design:

Retrospective large-scale study.

Setting:

Audiology clinical practice.

Patients:

In this study, 928 individuals aged 30-100 years without (n=497) or with the experience of CNE (n=431) were compared in their hearing assessments and tinnitus. In order to only investigate the impact of CNE on ARHL and tinnitus, people with other risk factors of hearing loss were excluded from the study.

Intervention:

Diagnostic.

Main Outcome Measures:

Noise damage was associated with a greater ARHL per age decades (pure-tone average(PTA)0.5-4kHz alterations 19.6-70.8 dB vs. 8.0-63.2 dB, ≤0.001), an acceleration of developing a significant ARHL at least by two decades (PTA0.5-4kHz 33.4 dB at 50-59yr vs. 28.2 dB at 30-39yr, ≤0.001), and an increased loss of word recognition scores (total average 84.7% vs. 80.0%, ≤0.001). Significant noise-associated growth in the prevalence of tinnitus also was shown, including more than a triple prevalence for constant tinnitus (28.10% vs. 8.85%, ≤0.001) and near to a double prevalence for intermittent tinnitus (19.10% vs. 11.10%, ≤0.001). Noise also resulted in the elevation of the static compliance of the tympanic membrane throughout age (total average 0.61 vs. 0.85 mmho, ≤0.001).

Conclusions:

Our findings emphasize the significant contribution of CNE in auditory aging and the precipitation of both ARHL and tinnitus.
Clinical Nurse Specialists' Perceptions of Transitioning Into a Rural Community-Based Transitional Care Role
Authors: Cross Kristi L. , Johnson Paula , Allard Billie Lynn , Shuman Clayton J.
Published: August 2020

OBJECTIVE

The aim of this study was to understand the experiences of nurses making the role transition from clinical nurse specialists (CNSs) (hospital based) into transitional care nurse (TCN) roles (community based).

BACKGROUND

The shift from fee-for-service to value-based care has led to the development of transitional care programs. However, little is known about the perceptions of nurses transitioning from a hospital- to a community-based position. Their perceptions can inform training and future recommendations for the TCN role.

METHODS

Five of 6 eligible TCNs from a community rural hospital in Vermont who transitioned from a CNS role to a TCN role participated in individual, face-to-face interviews using a semistructured interview guide. Data were audio recorded, transcribed verbatim, and analyzed using the constant comparative method.

RESULTS

Seven major themes were identified: enhanced patient-centered care, collaboration among the other TCNs, transitioning from expert to novice, recommendations for navigating and negotiating systems, discomfort with the role transition, a level of altruism and autonomy, and recommendations for improving the TCN role. Minor themes supported the major themes.

CONCLUSIONS

Our findings provide implications to improve the transitions of CNSs into a TCN role. Transitional care nurse programs are essential in transitioning individuals from hospital to home. To achieve maximum benefit from TCN programs and ensure their sustainability, nursing leaders must address gaps in both community resources and TCN training.