bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of Ethiopian Wheat Germplasm for Resistance to Four Puccinia graminis f. sp. tritici Races Facilitated by Single-Race Nurseries
Authors: Hundie Bekele , Girma Bedada , Tadesse Zerihun , Edae Erena , Olivera Pablo , Abera Endale Hailu , Bulbula Worku Denbel , Abeyo Bekele , Badebo Ayele , Cisar Gordon , Brown-Guedira Gina , Gale Sam , Jin Yue , Rouse Matthew N.
Published: April 2019

In Ethiopia, breeding rust resistant wheat cultivars is a priority for wheat production. A stem rust epidemic during 2013 to 2014 on previously resistant cultivar Digalu highlighted the need to determine the effectiveness of wheat lines to multiple races of Puccinia graminis f. sp. tritici in Ethiopia. During 2014 and 2015, we evaluated a total of 97 bread wheat and 14 durum wheat genotypes against four P. graminis f. sp. tritici races at the seedling stage and in single-race field nurseries. Resistance genes were postulated using molecular marker assays. Bread wheat lines were resistant to race JRCQC, the race most virulent to durum wheat. Lines with stem rust resistance gene Sr24 possessed the most effective resistance to the four races. Only three lines with adult plant resistance possessed resistance effective to the four races comparable with cultivars with Sr24. Although responses of the wheat lines across races were positively correlated, wheat lines were identified that possessed adult plant resistance to race TTKSK but were relatively susceptible to race TKTTF. This study demonstrated the importance of testing wheat lines for response to multiple races of the stem rust pathogen to determine if lines possessed non-race-specific resistance.

[Formula: see text] Copyright © 2019 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Mapping a Resistance Gene to Puccinia graminis f. sp. tritici in the Bread Wheat Cultivar ‘Matlabas’
Authors: Wessels Elsabet , Prins Renée , Boshoff Willem H. P. , Zurn Jason D. , Acevedo Maricelis , Pretorius Zacharias A.
Published: April 2019

Puccinia graminis f. sp. tritici race TTKSF+ was collected from the South African wheat cultivar ‘Matlabas’ in 2010. F2 and F3 populations derived from a Matlabas × Line 37-07 cross segregated for a single resistance gene to race TTKSF that is avirulent to Matlabas. In screening genomic DNA bulks of susceptible or resistant F2 plants with simple sequence repeat (SSR) markers, three chromosome arm 2BS markers and one multilocus marker amplified alleles present only in the resistant bulks and Matlabas. Additional 2B-specific SSR markers, incorporating markers spanning regions containing Sr9h, SrWLR, Sr28, and Sr47, were screened in the parental lines and mapped in the F2 population. Linkage and QTL mapping showed that the gene is located between Xbarc160 in the centromeric region and Xgwm47 on the long arm of chromosome 2B. When 2B-specific SNP markers were mapped, the area of interest was delimited to a 15.3 cM region on chromosome arm 2BL, with XIWA543-HRM and Xgwm47 as flanking loci. Matlabas, Webster, and related Sr9h lines all produced a similar, low infection type to race TTKSF, but were susceptible to race TTKSF+. Phenotypic data and allelic studies suggested that stem rust resistance in Matlabas was derived from an Sr9h source.
Effects of Set-Point Substrate Moisture Control on Oomycete Disease Risk in Containerized Annual Crops Based on the Tomato–Phytophthora capsici Pathosystem
Authors: Del Castillo Múnera Johanna , Belayneh Bruk , Lea-Cox John , Swett Cassandra L.
Published: April 2019

In containerized (potted) annual nursery and greenhouse crops, set point-controlled irrigation allows adaptation to increasing water insecurity by precisely reducing water inputs. A key factor influencing adoption is lack of information on disease risk. To facilitate adaptive water use, effects of set-point substrate moisture (SM) control on disease risk and water savings in containerized annual production were evaluated using the Phytophthora capsici–tomato pathosystem (a model system for water stress predisposition to pathogen infection), comparing outcomes of imposing midrange SM (15% volumetric water content [VWC]) and low-range SM (10% VWC) with well-watered (20% VWC) plants. Reducing soil moisture to 10% VWC differentially reduced stem water potential (P < 0.05) and enhanced rate of wilt progress (P = 0.006) and root rot severity (P = 0.03) in P. capsici inoculated plants compared with noninoculated plants. Furthermore, incidence of fine root infections in inoculated asymptomatic plants was greater under reduced SM (10% VWC) compared with in well-watered plants (P < 0.05). Mild reductions to 15% VWC did not influence plant performance (root and shoot weights and plant height) or pathogen infection in either inoculated or noninoculated plants compared with well-watered plants and reduced water inputs by 17%, indicating potential for reducing water usage without increasing disease risk. Furthermore, P. capsici inoculated plants had lower shoot biomass and greater root infection incidence when 15% VWC was applied to older compared with younger plants; the inverse was true for root rot severity, although root rot development was minor overall (P < 0.05). These results indicate that water use reductions pose disease risks, but there is potential to reduce water use and effectively manage plant pathogens in containerized production. Overall, this study indicates that physiological indices should not be solely relied on to develop water reduction methods.
Racially Ambiguous Babies and Racial Narratives in the United States: A Growing Contradiction for Health Disparities Research
Authors: Hsu Paul , Bryant Mara C. , Hayes-Bautista Teodocia Maria , Partlow Keosha R. , Hayes-Bautista David E.
Published: April 2019

Researchers attempting to identify and track health disparities and inequities generally use five racial or ethnic (R/E) categories—four racial groups (white, black, Asian/Pacific Islander, and American Indian) and one ethnic group (Hispanic)—to analyze and predict variations in health outcomes in the overall U.S. population. These categories are used as if they were permanent, naturally occurring, internally homogeneous, and discrete. However, the United States is becoming increasingly racially ambiguous because of (1) the growth of the Latino population, nearly half of whom do not identify with one of the four racial groups; and (2) the growing population of racially ambiguous babies, whose mothers and fathers are of different R/E groups. In California, an average annual 52.6% of the babies born between 2011 and 2015 were racially ambiguous (i.e., their parents were from different R/E groups or at least one parent was something other than a single race).

We describe the social-legal construction of hard-edged, binary racial categories in the United States from 1790 to the present (and the subsequent racial structuring of U.S. society along those categories). Researchers should shift the conceptualization of race from that of an innate, individual trait to that of a narrative, and should consider the impact that racial narratives can have on the life courses of individuals categorized as nonwhite. In light of the increasing racial ambiguity in the United States, the Latino fuzzy-edged, multivalent racial narrative that embraces racial mixing may be one alternative to the United States’ hard-edged, binary one.
America’s Best Medical Schools: A Renewed Critique of the U.S. News & World Report Rankings
Authors: McGaghie William C.
Published: April 2019

This Invited Commentary amplifies the continuing critique of the U.S. News & World Report rankings of U.S. medical schools and academic medical centers. The article begins with a critical quote about the medical school rankings published in this journal nearly 20 years ago and points out that little has changed in nearly two decades. The author then reports how the flawed rankings are performed and why U.S. medical school rankings are taken seriously, addresses the varied missions of U.S. medical schools, describes what really matters for success in medical school and professional life, sets a path forward to improve methods of medical school evaluation, and speaks to the irony of dismissing the rankings while still using them for marketing and fund-raising. The article concludes with a critical argument about the U.S. News & World Report rankings not only of medical schools but also of schools across the learned professions.
How Medical Error Shapes Physicians’ Perceptions of Learning: An Exploratory Study
Authors: Shepherd Lisa , LaDonna Kori A. , Cristancho Sayra M. , Chahine Saad
Published: April 2019

Purpose

Error is inevitable in medicine, given its inherent uncertainty and complexity. Errors can teach powerful lessons; however, because of physicians’ self-imposed silence and the intricacies of responsibility and blame, learning from medical error has been underexplored. The purpose of this study was to understand how physicians perceived learning from medical errors by exploring the tension between responsibility and blame and factors that affected physicians’ learning.

Method

Nineteen physicians participated in semistructured interviews, conducted in 2016–2017 at Western University in Canada, that probed their experiences in learning from medical errors. Data collection and analysis were conducted iteratively, with themes identified through constant comparative analysis.

Results

Participants felt personal responsibility and blame for their errors. Residency produced particularly salient memories of errors. Participants identified interconnecting cultural factors (normalizing error, peer support and mentorship, formal rounds) and individual factors (emotional response, confidence and experience), which either helped or hindered their perceived learning.

Conclusions

Learning from medical error requires navigation through blame and responsibility. The keen responsibility felt by physicians must be acknowledged when enacting a system-based approach to medical error. Adopting a learning culture perspective suggests opportunities to enable and disable features of the learning environment to optimize learning from error as residents learn to become the most responsible physician for all outcomes. A better understanding of the factors that shape learning from error can help make the transition from error to learning more explicit, thereby increasing the opportunity to learn and teach from errors that permeate the practice of medicine.
The Long-term Reoperation Rate Following Surgery for Lumbar Herniated Intervertebral Disc Disease
Authors: Kim Chi Heon , Chung Chun Kee , Choi Yunhee , Kim Min-Jung , Yim Dahae , Yang Seung Heon , Lee Chang Hyun , Jung Jong-Myung , Hwang Sung Hwan , Kim Dong Hwan , Yoon Joon Ho , Park Sung Bae
Published: April 2019

Study Design.

A retrospective cohort study of a nationwide sample database.

Objective.

The objective of the present study was to compare the long-term incidence of reoperation for lumbar herniated intervertebral disc disease (HIVD) after major surgical techniques (open discectomy, OD; laminectomy; percutaneous endoscopic lumbar discectomy, PELD; fusion).

Summary of Background Data.

HIVD is a major spinal affliction; if the disease is intractable, surgery is recommended. Considering both the aging of patients and the chronicity of lumbar degenerative disease, the effect of surgical treatment for the lumbar spine should be durable for as long as possible.

Methods.

The National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Republic of Korea was utilized to establish a cohort of adult patients (N = 1856) who underwent first surgery for lumbar HIVD during 2005 to 2007. Patients were followed for 8 to 10 years. Considering death before reoperation as a competing event, reoperation hazards were compared among surgical techniques using the Fine and Gray regression model after adjustment for age, gender, Charlson comorbidity score, osteoporosis, diabetes, the severity of disability, insurance type, and hospital type.

Results.

The overall cumulative incidences of reoperation were 4% at 1 year, 6% at 2 years, 8% at 3 years, 11% at 5 years, and 16% at 10 years. The cumulative incidences of reoperation were 16%, 14%, 16%, and 10% after OD, laminectomy, PELD, and fusion, respectively, at 10 years postoperation, with no difference among the surgical techniques. However, the distribution of reoperation types was significantly different according to the first surgical technique (P < 0.01). OD was selected as the reoperation surgical technique in 80% of patients after OD and in 81% of patients after PELD.

Conclusion.

The probability of reoperation did not differ among OD, laminectomy, PELD, and fusion during the 10-year follow-up period. However, OD was the most commonly used technique in reoperation.

Level of Evidence: 4
TAMOXIFEN-INDUCED CHORIORETINAL CHANGES
Authors: Crisóstomo Sara , Vieira Luísa , Cardigos Joana , Fernandes Diogo H. , Luís Maria E. , Nunes Susana , Morujão Inês , Anjos Rita , Flores Rita
Published: April 2019

Purpose:

To study structural chorioretinal changes in tamoxifen-treated patients.

Methods:

Cross-sectional case–control study comparing structural chorioretinal aspects in tamoxifen-treated patients and healthy controls. Enhanced depth spectral domain optic coherence tomography with choroidal binarization and optic coherence tomography angiography were performed. Individual retinal layer thickness and chorioretinal vascular components were compared. Subgroup analysis regarding history of chemotherapy was performed.

Results:

Two hundred eyes of 100 TAM-treated patients (Group 1) and 80 eyes of 40 healthy controls (Group 2) were included. Of the 200 spectral domain optic coherence tomography scans from patients, 2 showed structural changes attributable to tamoxifen. Group 1 showed significantly lower values in choroidal parameters and in total retinal, ganglion cell layer, inner plexiform layer, outer nuclear layer, and retinal pigment epithelial thicknesses as well as an increased thickness in the outer plexiform layer. The subgroup not submitted to chemotherapy maintained significant reductions in total retinal thickness, ganglion cell layer, retinal pigment epithelium, outer nuclear layer, outer retinal layer, choroidal parameters, as well as an increased thickness in the outer plexiform layer, in comparison with Group 2.

Conclusion:

Subclinical structural retinal changes could indicate early retinal pigment epithelial and photoreceptor damage. The new finding of choroidal thinning could point toward another important pathophysiologic process in tamoxifen-induced toxicity.
Kahook Dual Blade Excisional Goniotomy and Goniosynechialysis Combined With Phacoemulsification for Angle-closure Glaucoma: 6-Month Results
Authors: Dorairaj Syril , Tam Mai Dang
Published: April 2019

Purpose:

The purpose of this study was to characterize reductions in intraocular pressure (IOP) and the need for IOP-lowering medications following phacoemulsification combined with Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy in eyes with angle-closure glaucoma and cataract.

Methods:

In this retrospective, interventional case series, preoperative, operative, and postoperative data were collected through 6 months of follow-up from 42 eyes of 24 subjects. Outcomes included mean IOP reduction, reduction in IOP-lowering medications, and the proportion of patients achieving IOP reduction ≥20%, IOP≤18 mm Hg, and reduction of ≥1 medication.

Results:

Preoperatively, mean (SE) IOP was 25.5 (0.7) mm Hg and the mean number of IOP-lowering medications used was 2.3 (0.1) per eye. Through 6 months of follow-up, mean IOP reductions of 10.1 to 12.8 mm Hg (38.4% to 49.5%; P<0.0001) and mean IOP medication reductions of −2.2 to −2.3 (91.7% to 98.4%; P<0.0001) were seen. At month 6, 92.9% of eyes (39/42) achieved IOP≤18 mm Hg, 100% (42/42) achieved IOP reduction of ≥20%, 100% (42/42) required ≥1 fewer medications for IOP control, and 85.7% (36/42) were medication free.

Conclusions:

Phacoemulsification combined with Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy safely provides statistically and clinically meaningful reductions in both IOP and the need for IOP-lowering medications in eyes with angle-closure glaucoma.
Differences in Optic Nerve Head Blood Flow Regulation in Normal Tension Glaucoma Patients and Healthy Controls as Assessed With Laser Speckle Flowgraphy During the Water Drinking Test
Authors: Mursch-Edlmayr Anna S. , Luft Nikolaus , Podkowinski Dominika , Ring Michael , Schmetterer Leopold , Bolz Matthias
Published: April 2019

Précis:

Optic nerve head (ONH) perfusion was not significantly altered in subjects with normal tension glaucoma (NTG) nor in healthy individuals after performing the water drinking test (WDT), because of its limited effect on ocular perfusion pressure (OPP).

Purpose:

ONH blood flow can be maintained stable in healthy individuals because of a physiological phenomenon called autoregulation. Impairment of autoregulation has been shown especially under condition of NTG. The purpose of this study was to investigate the ONH blood flow autoregulation in patients with NTG by influencing the OPP with the WDT.

Methods:

The study included 9 eyes from 9 white patients with a diagnosis of NTG and 9 eyes from age-matched and sex-matched healthy individuals. In the glaucoma group, the antiglaucomatous therapy was paused 3 weeks before the investigations. Measurements of ONH blood flow were performed with laser speckle flowgraphy. After baseline measurements, individuals ingested 800 mL of water in <5 minutes. Measurements were repeated after 15, 30, and 45 minutes.

Results:

The water ingestion led to a significant rise in intraocular pressure (P<0.001) but also mean arterial pressure (P<0.001) in both groups. This resulted in stable OPP (P=0.051) with no significant difference between the groups (P=0.43). ONH blood flow remained stable over time in both groups (P=0.719). No significant interaction of time and group was shown for all parameters.

Conclusions:

Our findings show that the WDT does not significantly influence the OPP and therefore has to be considered inferior to other methods used to assess blood flow autoregulation.
Prevalence and Clinical Characteristics of Childhood Glaucoma at a Tertiary Care Children’s Hospital
Authors: Bouhenni Rachida A. , Ricker Isabel , Hertle Richard W.
Published: April 2019

Precis:

Glaucoma suspect was the most prevalent category in this study followed by glaucoma associated with acquired ocular anomaly and juvenile open-angle glaucoma. Primary congenital glaucoma was diagnosed in only 3% of the population studied.

Purpose:

To describe the prevalence and clinical characteristics of childhood glaucoma diagnosed over a 10-year period among patients aged 18 years or below who were seen at a tertiary care children’s hospital using the new Childhood Glaucoma Research Network classification system.

Methods:

Medical records of all patients aged 18 years or below (n=108) who were diagnosed with glaucoma between January 1, 2008 through September 30, 2018 were reviewed. Data collected included demographics (age at diagnosis, sex, and family history of glaucoma), intraocular pressure, disc-to-cup ratio, retinal nerve fiber layer thickness, and refractive errors. Clinical characteristics of each patient were evaluated according to the criteria established by Childhood Glaucoma Research Network. Categorical distributional equivalence comparisons were performed using the Pearson χ2 test. A P-value <0.05 was defined as statistically significant.

Results:

A total of 108 patients with a diagnosis of childhood glaucoma or glaucoma suspect were included in this study. Sixty-four percent of these patients were males (P<0.0001). The mean age at the time of diagnosis was 7.07±5.4 years. “Glaucoma suspect” was the most prevalent category (46%, P=0.0002), followed by glaucoma associated with the acquired ocular anomaly (20%) and juvenile open-angle glaucoma (16%). Primary congenital glaucoma represented 3% and all these patients were males. Sixty-nine percent of the patients had bilateral involvement (P=0.0073). The highest intraocular pressure recorded in the study was 57 mm Hg, the largest cup-to-disc ratio was 0.96, and the lowest retinal nerve fiber layer measurement was 39 μm. Ninety-two percent of the patients had refractive errors and 85% of them had astigmatism.

Conclusions:

Establishing a pattern and the associated clinical characteristics of childhood glaucoma at tertiary care children’s hospitals will help in developing collaborative research efforts and effective treatment/management strategies for children with these rare groups of disorders.
Incidence of Bleeding Complications With Flexible Bronchoscopy in Cancer Patients With Thrombocytopenia
Authors: Faiz Saadia A. , Jimenez Carlos A. , Fellman Bryan M. , Huk Tauqir , Jazbeh Sammer , Haque Sajid A. , Morice Rodolfo C. , Grosu Horiana B. , Balachandran Diwakar D. , Shannon Vickie R. , Eapen Georgie A. , Bashoura Lara
Published: April 2019

Background:

Bronchoscopy is a safe procedure, but current guidelines recommend transfusion for platelets <20 K/μL. Studies of bronchoscopy in thrombocytopenia are limited.

Objectives:

Our objective was to evaluate the incidence of bleeding with flexible bronchoscopy in those with thrombocytopenia especially those <20 K/μL.

Method:

We performed a retrospective review of all flexible bronchoscopies between June 1, 2008 and December 31, 2010. Biopsies and therapeutic procedures were excluded. The χ2, Fisher exact, and Rank-sum test were conducted to evaluate associations of clinically significant bleeding.

Results:

There were 1711 patients who underwent 2053 flexible bronchoscopies. Cancer diagnosis included hematologic (61.3%) and solid organ malignancy (34.9%). Half of the bronchoscopies had moderate to severe thrombocytopenia (<100 K/μL) with the following ranges: 14.7% with 50 to <100 K/μL, 20.6% with 20 to <50 K/μL, 10.6% with 10 to <20 K/μL, 4.1% with <10 K/μL. Platelet transfusion was given in 90.6% of those with platelets <10 K/μL and 55.5% of those with platelets 10 to <20 K/μL. The nasal route for bronchoscopy was used in 92.4%. Bleeding complication rate however was 1.1% (0.2% major) and not affected by platelets.

Conclusion:

Bronchoscopy with lavage can be safely performed without platelet transfusion in those with platelets of ≥10 K/μL. In the absence of nasal bleeding, trauma, or deformity, the nasal route can be used for bronchoscopy.
Tablet-Based Patient Education Regarding Human Papillomavirus Vaccination in Colposcopy Clinic
Authors: Gockley Allison A. , Pena Nancy , Vitonis Allison , Welch Kelly , Duffey-Lind Eileen C. , Feldman Sarah
Published: April 2019

Objective

The aim of this study was to use an electronic tablet–based education module to increase patient knowledge about human papillomavirus (HPV).

Methods

Patients presenting to an academic colposcopy clinic were first queried as to whether they had been infected with HPV. A quality improvement project was then conducted using a 4-question pretest assessing baseline knowledge about HPV and cancer, followed by a tablet-based education module and a 5-question posttest.

Results

Between June 2017 and January 2018, 119 patients participated in the tablet education. At their initial visit, only 50 (42.0%) of patients were aware that they had an HPV infection; however, medical records revealed that 74 women (62.2%) were presenting with a documented HPV infection. After the tablet education, 95% of women identified cervical cancer as a problem that can be caused by HPV, as compared with 88.2% in the pretest (p = .046). Knowledge of head and neck cancer as a disease that can be caused by HPV increased from 10.9% to 80.7% (p < .001). More patients answered that they “definitely” or “probably” would consider the vaccine for a child in their family: 108 (95.6%) pretest vs. 112 (99.1%) posttest (p = .046). The activities were ranked as “extremely” or “very” helpful by 93.3% of patients.

Conclusions

Patients presenting to colposcopy clinic are not well educated regarding the connection between an abnormal Pap test, HPV infection, and certain cancers. Tablet-based education improves patient knowledge of HPV-associated cancers in an outpatient clinic setting.
Clinical features and outcomes of revascularization in very old patients with left main coronary artery disease
Authors: Sliman Hussein , Jaffe Ronen , Rubinshtein Ronen , Karkabi Basheer , Zissman Keren , Flugelman Moshe Y. , Zafrir Barak
Published: April 2019

Background

Coronary artery disease (CAD) is often more extensive in older adults and may involve multivessel and left main coronary artery (LMCA) disease. Elderly patients are commonly excluded from clinical trials, and limited real-world data exist on the management of LMCA disease in the very old. We aimed to investigate clinical features and outcomes of very old patients undergoing revascularization due to LMCA disease.

Patients and methods

A retrospective single-center analysis of patients at least 80 years (n = 139) who underwent revascularization owing to CAD involving unprotected LMCA stenosis more than 50% was conducted. Subsequent major adverse cardiovascular events (MACE: myocardial infarction, stroke, and all-cause death) and repeat revascularizations were recorded, and their relation to revascularization procedure was studied.

Results

Percutaneous coronary intervention (PCI) was performed in 74 patients and coronary artery bypass surgery (CABG) in 65. Most patients (80%) had multivessel disease involving at least 2 additional coronary arteries. PCI was associated with older age, higher rates of baseline disability, previous revascularization, reduced ventricular function, significant aortic stenosis, and presentation with acute coronary syndrome, compared with CABG. Cumulative 3-year MACE rates were higher in patients undergoing PCI versus CABG (P = 0.009). After multivariable adjustment, predictors of MACE included presentation with ST-segment elevation myocardial infarction (STEMI) [hazard ratio (HR) = 2.39; 95% confidence interval: 1.24–4.63; P = 0.010], revascularization by PCI compared with CABG [HR = 2.21 (1.18–4.15); P = 0.013], baseline disability [HR = 2.17 (1.20–3.91); P = 0.010], and distal LMCA disease [HR = 1.87 (1.04–3.38); P = 0.038]. The difference in 3-year MACE between PCI and CABG was not observed in a propensity-score analysis of 90 patients matched 1: 1 for baseline disability, STEMI, and aortic stenosis (P = 0.797).

Conclusion

In very old patients undergoing coronary revascularization owing to LMCA disease, PCI was associated with worse cardiovascular outcomes compared with CABG, influenced by a more severe and comorbid population selected for PCI. Baseline disability, presentation with STEMI, and distal LMCA bifurcation disease were additional independent outcome predictors.
Incivility and Clinical Performance, Teamwork, and Emotions
Authors: Johnson Susan L. , Haerling Katie A. , Yuwen Weichao , Huynh Van , Le Chi
Published: April 2019

Background:

Incivility has been identified as a common occurrence in health care settings. While anecdotal evidence exists that these behaviors negatively impact patient care, more robust evidence is lacking.

Purpose:

This randomized controlled trial investigated the effects of exposure to incivility on clinical performance, teamwork, and emotions.

Methods:

Teams of nurses were randomly assigned to a control or experimental group. The experimental group was exposed to incivility. Both groups were then prompted to perform basic life support on a high-fidelity manikin. Teams were scored on cardiopulmonary resuscitation (CPR) performance and teamwork. Individuals completed measures of affect and a cognitive test.

Results:

There were no differences in CPR, cognitive or teamwork scores, or emotional state. However, 66% of the experimental group had a major error in their CPR performance. None of the control groups made the same error.

Conclusions:

These findings support anecdotal evidence that exposure to incivility may contribute to errors in clinical performance.
Quality of Sleep in a Pediatric Hospital
Authors: Crawford Sara , Utt Aaron , Beebe Caylin , Armbruster Renee , Fisher Amanda , Olney Adrienne , Sherman Ashley K. , Roberts Cristine
Published: April 2019

OBJECTIVE

To investigate the amount and type of hospitalized children's nighttime sleep interruptions, perceptions, and efficiency.

BACKGROUND

Sleep in hospitals is notoriously poor and impedes healing. Pediatric studies have been limited including breadth of diagnoses, age, or measures.

METHODS

Actigraphy, sleep surveys, and nursing diaries were used to describe sleep on 2 nursing units along with environmental assessments.

RESULTS

Ninety-five children from 1 month to 17 years with multiple diagnoses participated. The median number of awakenings was 2.7 per night. The median for the longest uninterrupted episode of sleep was 5.5 hours. Children need 8 to 17 hours of daily sleep, while this sample had a median of 7.5 hours of night sleep. Sensors showed talk as the predominant noise, whereas surveys showed alarms and vital signs awakened patients.

CONCLUSIONS

Children are not getting essential, minimally interrupted sleep in hospitals. Disseminating results will increase awareness and accelerate environmental changes.
Pharmaceutical consultations in oncology: French Society for Oncology Pharmacy (Société Francaise de Pharmacie Oncologique – SFPO) guidelines
Authors: Petit-Jean Emilie , Correard Florian , Maillan Gaelle , de Crozals Françoise , Bertrand Benjamin , Regnier Véronique , Chevrier Régine , Streicher Caroline , Madelaine Isabelle , Pourroy Bertrand
Published: April 2019

Introduction:

Pharmaceutical consultations is a key point for oral therapy-treated cancer patients’ management.

Methods:

French Society for Oncology Pharmacy built recommendations according to French High Authority of Health regarding the guidelines for Good Practice.

Results:

Fourteen guidelines were issued and tools proposed to hospital pharmacist's community.

Discussion:

These guidelines allow to secure management of cancer patients treated by oral therapies.
Genetic Underpinnings of Renal Cell Carcinoma With Leiomyomatous Stroma
Authors: Parilla Megan , Alikhan Mir , Al-Kawaaz Mustafa , Patil Sushant , Kadri Sabah , Ritterhouse Lauren L. , Segal Jeremy , Fitzpatrick Carrie , Antic Tatjana
Published: April 2019

Renal cell carcinoma (RCC) with leiomyomatous stroma is a provisional category of RCC in the 2016 World Health Organization Classification of Tumors of the Urinary System. Microscopic examination of hematoxylin and eosin–stained sections reveals this entity to be well-circumscribed with tubulopapillary growth of cells with clear cytoplasm in a background of leiomyomatous stroma. Herein we describe the genetic features of 15 University of Chicago Medical Center archived cases with hematoxylin and eosin histology matching the provisional diagnosis. Immunohistochemical (IHC) stains revealed 1/15 of these tumors to be clear cell renal cell carcinoma (ccRCC) and 6/15 to be clear cell papillary renal cell carcinoma (ccpRCC), demonstrating the morphologic overlap with these discrete known entities. Interestingly 3/6 of the ccpRCCs had chromosome 18 gain suggesting there may be novel specific genetic changes in ccpRCC with leiomyomatous stroma. Of the remaining 8 tumors with IHC staining patterns that do not fit either ccRCC or ccpRCC only 3 of these had mutations in the recently described TCEB1 gene with concurrent monosomy of chromosome 8. These 3 cases had a somewhat unique IHC pattern that possibly could separate them from the 5 other non-ccRCC/non-ccpRCC cases. This descriptive study, although small, demonstrates the difficulty in applying the current World Health Organization provisional criteria at a single institution with suggestion of an immunohistochemcial panel that may assist in the diagnosis of TCEB1-mutated RCC with leiomyomatous stroma.
Coarctation of the Aorta in Adolescence
Authors: Asad Imran , Lee Michelle Sin , Banihani Rudaina , Wong Peter D. , Etoom Yousef
Published: April 2019

Although coarctation of the aorta (CoAo) is a congenital anomaly, it can pose a diagnostic challenge in those presenting beyond neonatal period, as some patients can remain asymptomatic until complications of hypertension develop later in life. Careful physical examination can play an important role in timely diagnosis and prevention of complications.

We present 2 cases of adolescents with undiagnosed CoAo who both presented with nonspecific headaches and hypertension. Both were initially misdiagnosed as essential hypertension until careful detailed physical examination later detected weak/absent femoral pulses and discrepancy in upper and lower limb blood pressures. These findings raised the clinical suspicion of CoAo, which was confirmed on further investigations.

Our cases highlight the importance of considering CoAo in the differential diagnosis of hypertension in adolescents. These cases also stress the significance of detailed cardiac examination including 4-limb blood pressure and femoral pulses in a patient presenting to the emergency department with high blood pressure irrespective of the primary complaint.
HIV Pre-exposure Prophylaxis (PrEP) Uptake Among Gay and Bisexual Men in Australia and Factors Associated With the Nonuse of PrEP Among Eligible Men: Results From a Prospective Cohort Study
Authors: Hammoud Mohamed A. , Vaccher Stefanie , Jin Fengyi , Bourne Adam , Maher Lisa , Holt Martin , Bavinton Benjamin R. , Haire Bridget , Degenhardt Louisa , Grulich Andrew , Prestage Garrett P.
Published: April 2019

Background:

HIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention strategy, yet some gay and bisexual men (GBM) who are eligible to access PrEP are not using it. We report the incidence of PrEP uptake, factors predicting its initiation, and identify characteristics associated with nonuptake of PrEP among Australian GBM who meet the eligibility criteria.

Methods:

The Following Lives Undergoing Change (Flux) Study is a national, online, prospective observational study among GBM focusing on licit and illicit drug use. Participants (N = 1257) responded to baseline and 6-monthly follow-up questionnaires. Incidence per 100 person-years and incidence rate ratios of PrEP initiation are presented. Multivariate Poisson regression was used to examine associations with PrEP initiation and logistic regression to examine associations with nonuptake of PrEP among eligible GBM.

Results:

Among GBM who met the eligibility criteria, 69.8% of men did not commence PrEP. Factors independently associated with nonuptake of PrEP were younger age, living in an Australian state without a PrEP trial, lower social engagement with other gay men, less use of illicit party drugs or use of illicit party drugs for sex, and less likely to have engaged in HIV sexual risk behaviors such as group sex or any condomless anal intercourse.

Conclusions:

Despite meeting formal eligibility criteria for PrEP, men who were relatively less sexually active or less socially connected were less likely to initiate PrEP. Men who did not initiate PrEP may assess their risk as insufficient relative to others to warrant using PrEP because they engaged in less frequent “risky” behaviors.
HIV Positivity and Referral to Treatment Following Testing of Partners and Children of PLHIV Index Patients in Public Sector Facilities in South Africa
Authors: Joseph Davey Dvora , Wall Kristin M. , Serrao Claire , Prins Marlien , Feinberg Madaline , Mtonjana Ntokozo , Hlophe Khanyo , Zuma Lindiwe , Sejake Senate , Malone Todd
Published: April 2019

Background:

There is an imperative need for innovative interventions to identify people living with HIV and initiate them on antiretroviral therapy. The objective of this study was to determine the feasibility of providing index partner/child testing of people living with HIV.

Methods:

We trained 86 nurses and counsellors in 56 public health facilities in 6 high HIV burden Districts in South Africa 2017 to provide index partner/child testing (tracing and testing of partners/children of people living with HIV). We collected programmatic data including index partner/child HIV positivity by age, gender, and location of testing. In subanalyses, we evaluated factors associated with identifying HIV-positive partners and children in separate models using multivariable logistic regression.

Results:

We tested 16,033 partners and children of index patients between October 2017 and June 2018. Most of those tested were women (61%) and 20–39 years old (39%). Overall, 6.4% were 10–14 years old, 9.5% were 15–19 years, and 8% were ≥50 years. HIV positivity was 38% [95% confidence interval (CI) = 36% to 40%]. In children ages 10–14 years, 13% were HIV-infected (95% CI = 11% to 14%). In subanalyses, HIV positivity in partners was associated with their increased age [adjusted odds ratio (aOR) for increase in 5-year age category = 1.21; 95% CI = 1.04 to 1.42], female gender (aOR = 1.38; 95% CI = 1.04 to 1.82), and index partner bringing the partner in for HIV testing vs. referring the partner through the provider or recommending testing to the partner (aOR = 1.94, 95% CI = 1.43 to 2.63), adjusting for location of testing. Almost all patients diagnosed (97%) were referred to antiretroviral therapy.

Conclusions:

Providing index partner/child testing was feasible and we identified a very high yield when testing partners and children of index patients. Index partner and children testing should be offered to all patients living with HIV to improve case finding.
HIV Disease Severity Is Sensitive to Temporal Changes in Alcohol Use: A National Study of VA Patients With HIV
Authors: Williams Emily C. , McGinnis Kathleen A. , Tate Janet P. , Matson Theresa E. , Rubinsky Anna D. , Bobb Jennifer F. , Lapham Gwen T. , Edelman E. Jennifer , Catz Sheryl L. , Satre Derek D. , Bryant Kendall J. , Marshall Brandon D. L. , Kraemer Kevin L. , Bensley Kara M. , Richards Julie E. , Skanderson Melissa , Justice Amy C. , Fiellin David A. , Bradley Katharine A.
Published: April 2019

Background:

Alcohol use influences HIV disease severity through multiple mechanisms. Whether HIV disease severity is sensitive to changes in alcohol use among people with HIV (PWH) is understudied.

Setting:

National Veterans Health Administration.

Methods:

Pairs of AUDIT-C screens within 9–15 months (February 1, 2008–September 30, 2014) were identified among PWH from the Veterans Aging Cohort Study (VACS). Initial and follow-up VACS Index 2.0 pairs obtained 0–270 days after initial and follow-up AUDIT-Cs, respectively, determined change in VACS Index 2.0, a composite HIV severity measure. Change in VACS Index 2.0 was regressed on AUDIT-C change scores (−12 to +12) adjusted for demographics, initial VACS Index 2.0, and days between VACS Index measures.

Results:

Among 23,297 PWH (76,202 observations), most had no (51%) or low-level (38%) alcohol use initially. Most (54%) had no subsequent change; 21% increased and 24% decreased drinking. Initial VACS Index 2.0 scores ranged from 0 to 134, change scores ranged from −65 to +73, with average improvement of 0.76 points (SD 9.48). AUDIT-C change was associated with VACS Index 2.0 change (P < 0.001). Among those with stable alcohol use (AUDIT-C change ≤ │1│ point), VACS Index 2.0 improvements ranged 0.36–0.60 points. For those with maximum AUDIT-C increase (change from 0 to 12), VACS Index 2.0 worsened 3.74 points (95% CI: −4.71 to −2.78); for those with maximum AUDIT-C decrease (change from 12 to 0), VACS Index 2.0 changed minimally [−0.60 (95% CI: −1.43 to 0.23)].

Conclusions:

In this national sample, improvement in HIV severity was generally greatest among those with stable alcohol use (primarily those with no use).
Mandibular Spatial Reorientation and Morphological Alteration of Crouzon and Apert Syndrome
Authors: Lu Xiaona , Sawh-Martinez Rajendra , Forte Antonio Jorge , Wu Robin , Cabrejo Raysa , Wilson Alexander , Steinbacher Derek M. , Alperovich Michael , Alonso Nivaldo , Persing John A.
Published: April 2019

Background

From infancy to adulthood, the mandible develops increased ramus height, prominence of the chin, and laterally widened gonial angles. In Crouzon and Apert syndromes, both relative retrognathia and prognathic jaws have been reported. Growth is influenced by a variety of factors, including the growth and relative position of the skull base, functional coordination, and the spatial influence of the laryngopharynx. Thus, this study aimed to explore in detail the evolution of the mandible in both syndromes and its relationship with the entire facial structure and skull base.

Methods

One hundred twenty-three preoperative computed tomographic scans (Crouzon, n = 36; Apert, n = 33; control, n = 54) were included and divided into 5 age subgroups. Computed tomographic scans were measured using Materialise software. Cephalometrics relating to the mandible, facial structures, and cranial base were collected. Statistical analyses were performed using t test and statistical power analysis.

Results

In Crouzon syndrome, the angle between the cranial base and gnathion was increased prior to 6 months of age by 10.29 degrees (P < 0.001) and by adulthood to 11.95 degrees (P = 0.003) compared with normal. After 6 months of age, the distance between bilateral mandibular condylions (COR-COL) was narrower by 15% (P < 0.001) in Crouzon syndrome compared with control subjects. Before 6 months of age, Apert COR-COL decreased 16% (P < 0.001) compared with control subjects and 13% (P = 0.006) narrower than Crouzon. During 2 to 6 years of age, Apert mandibular ramus height caught up to, and became longer than, Crouzon by 12% (P = 0.011). The nasion-sella-articulare angle of the Apert skull was 5.04 degrees (P < 0.001) less than Crouzon overall.

Conclusions

In Crouzon syndrome, the changes of the spatial relationship of the mandible to the cranial base develop earlier than the mandibular shape deformity, whereas in Apert syndrome, the spatial and morphological changes are synchronous. The morphological changes of the mandible are disproportional in 3 directions, initially significant shortening of the mandibular width and length, and, subsequently, reduced height. Crouzon has more shortening in mandibular height compared with Apert, reflecting the more shortened posterior cranial base length. The narrowed angle between the mandible and the posterior cranial base in Apert skulls is consistent with the more limited nasopharyngeal and oropharyngeal airway space.
A Design for the Dual Skin Paddle Circumflex Scapular Artery Perforator Flap for the Reconstruction of Complex Soft-Tissue Defects in Children
Authors: Qing Liming , Wu Panfeng , Zhou Zhengbing , Yu Fang , Tang Maolin , Tang Juyu
Published: April 2019

Background

The main drawbacks of the use of the circumflex scapular artery perforator (CSAP) flap for complex soft-tissue defect repair are the limitation of skin paddle size, which can be harvested to allow precise wound coverage and primary closure of the donor site. We developed a variant of the dual skin paddle CSAP flap to extend its applications and minimize donor-site morbidity when reconstructing complex soft-tissue defects in children.

Methods

A detailed anatomical investigation of circumflex scapular artery (CSA) branches was conducted using a standardized injection of lead oxide in 25 fresh cadavers. Dual skin paddle CSAP flaps were harvested for the reconstruction of complex defects in the extremities in 16 children. Three types of dual skin paddle CSAP flap were used in this study: transverse chain-shaped, oblique chain-shaped, and trefoil-shaped flaps.

Results

Three CSA branching patterns with superior branch diameters were observed: 34% of CSAs were of the transverse branch dominant type, 54% were of the descending branch dominant type, and 12% were of the codominant type. Sixteen dual skin paddle CSAP flaps were elevated successfully; they were of the transverse chain-shaped type in 2 cases, the oblique chain-shaped type in 9 cases, and the trefoil-shaped type in 5 cases. All flaps survived postoperatively. Primary closure of the donor site was achieved in all cases.

Conclusions

The CSA system is an appropriate source for harvesting dual skin paddle CASP flap. Use of this flap for the reconstruction of complex soft-tissue defects in the extremities in children is an alternative approach that reduces morbidity and improves the cosmetic outcome at the donor site.
Definition of the Rectum
Authors: D'Souza Nigel , de Neree tot Babberich Michael P. M. , d’Hoore Andre , Tiret Emmanuel , Xynos Evaghelos , Beets-Tan Regina G. H. , Nagtegaal Iris D. , Blomqvist Lennart , Holm Torbjorn , Glimelius Bengt , Lacy Antonio , Cervantes Andres , Glynne-Jones Robert , West Nicholas P. , Perez Rodrigo O. , Quadros Claudio , Lee Kil Yeon , Madiba Thandinkosi E. , Wexner Steven D. , Garcia-Aguilar Julio , Sahani Dushyant , Moran Brendan , Tekkis Paris , Rutten Harm J. , Tanis Pieter J. , Wiggers Theo , Brown Gina
Published: April 2019

Background:

The wide global variation in the definition of the rectum has led to significant inconsistencies in trial recruitment, clinical management, and outcomes. Surgical technique and use of preoperative treatment for a cancer of the rectum and sigmoid colon are radically different and dependent on the local definitions employed by the clinical team. A consensus definition of the rectum is needed to standardise treatment.

Methods:

The consensus was conducted using the Delphi technique with multidisciplinary colorectal experts from October, 2017 to April, 2018.

Results:

Eleven different definitions for the rectum were used by participants in the consensus. Magnetic resonance imaging (MRI) was the most frequent modality used to define the rectum (67%), and the preferred modality for 72% of participants. The most agreed consensus landmark (56%) was “the sigmoid take-off,” an anatomic, image-based definition of the junction of the mesorectum and mesocolon. In the second round, 81% of participants agreed that the sigmoid take-off as seen on computed tomography or MRI achieved consensus, and that it could be implemented in their institution. Also, 87% were satisfied with the sigmoid take-off as the consensus landmark.

Conclusion:

An international consensus definition for the rectum is the point of the sigmoid take-off as visualized on imaging. The sigmoid take-off can be identified as the mesocolon elongates as the ventral and horizontal course of the sigmoid on axial and sagittal views respectively on cross-sectional imaging. Routine application of this landmark during multidisciplinary team discussion for all patients will enable greater consistency in tumour localisation.