bluuebunny/crossref_metadata_2025 huggingface dataset:
Barth and Modern Moral Philosophy
Authors: Woodard-Lehman Derek Alan
Published: March 2020

This chapter argues against the familiar consensus that Barth’s relationship to modern moral philosophy is oppositional. It demonstrates that Barth appropriates the central insights of his philosophical predecessors and incorporates them into his ethics, even as he anticipates one of the most fruitful developments in contemporary moral philosophy: Stephen Darwall’s ‘second-personal ethics’. Rather than casting autonomy as sin, he recasts obedience to the Word of God as a form of autonomy. Barth incorporates the rational form of Kantian self-legislation and the social form of Hegelian mutual recognition into his account of subjective reception of revelation. Because Barth does not separate the sovereignty of revelation from the sociality of the church’s interpretation of Scripture and confession of faith, we—Barth’s readers—must not separate his account of hearing the Word of God from his account of hearing the divine command. In fact, we should take his account of the subjective reception of revelation as his most fulsome and winsome account of practical reason.
Barth and Public Life
Authors: Werpehowski William
Published: March 2020

This chapter considers the meaning, spirit, and normative direction of Christian ‘public life’ in the theology and ethics of Karl Barth. Barth viewed the notion of public life quite expansively without losing sight of an area of human existence that one might reasonably call ‘private’. The spirit of Christian public life for him crucially includes both a Christocentric imagination and a secular sensibility. Additionally, it involves the responsive virtues of hope, humility, courage, and merciful solidarity with one’s fellow human creatures. I approach the question of the normative direction or directions basic to Christian public existence by reflecting on Barth’s specific treatment of Jesus Christ’s call to discipleship along with his analysis of ‘the lordless powers’ in his unfinished ethics of reconciliation.
Barth and Judaism
Authors: Rashkover Randi
Published: March 2020

This chapter reflects upon the relationship between Barth’s theology and Jewish thought. Currently we inherit a certain framing of this relationship, generated by a family of Jewish thinkers who placed particular stress on the ‘wholly other’ character of God and God’s revelation as command and love. Yet this Jewish appropriation of Barth has resulted in an unwanted strain of antinomianism and the installation of a ‘gnostic’ sensibility, which insists upon the dramatic separation between God, world, and word. The goal of this chapter is to reorient the encounter between Barth and Jewish theology. To that end, it considers the relation between Barth’s theology and Jewish thought in light of the challenge posed by modern science to religion, and it does so by way of a comparison between Barth’s theology and the work of his teacher at Marburg, the great Jewish philosopher Hermann Cohen.
Barth and Roman Catholic Theology
Authors: Molnar Paul D.
Published: March 2020

Taking Barth’s doctrines of revelation and the Trinity as a starting point, this chapter places Barth’s thought primarily in conversation with Walter Kasper. It considers Kasper’s work as an attempt to integrate insights drawn from Barth and Karl Rahner, while placing their views within the wider context of post-Vatican II Roman Catholic theology, as well as the thinking of Hans Urs von Balthasar. By focusing on the different attitudes of Barth and Kasper to the analogia entis (analogy of being), the chapter proposes that the primary issue related to ecumenical unity that emerges concerns whether, and to what extent, contemporary theologians are willing to allow Jesus Christ himself to stand as the first and the final Word in all theological reflection.
Rights, Religion, and Violence at Mexico’s Borders
Authors: Kovic Christine
Published: March 2020

How do the faithful, poor and non-poor alike, live their everyday faith in the context of poverty, violence, and oppression? How have different sectors of church leadership understood and responded to poverty and violence? How have acts of the faithful pressured members of the church leadership to respond? The chapter explores violence in contemporary Latin America and the Church’s involvement in politics to resist such violence. It focuses on Mexico and its borders, sites that are closely connected to both Central America and the United States because of migrants crossing the region, transnational activism, and political and economic policies of the US and Mexican governments to limit migration. It begins with an overview of the ways that religious actors, especially the Catholic Church, conceptualized political and structural violence in the 1960s and 1970s and supported concrete projects to challenge root causes of poverty. The following section addresses the church’s response to unequal distribution of land and wealth and the violence of civil wars in the region. The subsequent sections address the faith-based work in support of Central American and Mexican refugees and migrants at the US-Mexico border and in Mexico, respectively, beginning in the 1990s. In contrast to the work of earlier decades, individuals, shelters, and organizations support migrant populations in transit with limited support from institutional churches. The chapter concludes with an analysis of the changing forms of violence in Mexico and Central America, as well as the changing response to this violence by religious actors.
Protestant Innovative Evangelizing to Oral Cultures in Guatemala
Authors: McCleary Rachel M.
Published: March 2020

Protestant missions to Guatemala, in varying degrees, incorporated innovative oral, visual, and audio evangelizing strategies in their proselytizing. The traditional mainline Protestant bias favoring the “triumph of literacy” over oral/audible forms of learning sidetracked those missions engaged in vernacular translations of the Bible away from direct evangelization and toward investment of significant financial and human resources into literacy programs. Pentecostals continued to emphasize the oral/aural dynamic of evangelizing, thereby becoming the quickest-growing and largest segment of Protestantism in Guatemala. Consequently, institution-building requisite for investment in traditional forms of human capital (education and health) has not characterized Protestantism in Guatemala. This argument can be extended to other regions of the world—notably the rest of Latin America, Asia, and Africa—laying the foundation for a broader, global understanding of Pentecostalism and low investment in human capital.
Liberation Theology
Authors: Berryman Phillip
Published: March 2020

In the 1960s, young Latin American theologians proposed that the circumstances of their continent—overwhelmingly poor and Catholic—raised questions that required their own theology. These questions arose from a pastoral context, but had political implications. They have pursued these questions through different contexts, especially the military dictatorships and the conflicts in Central America. In the 1980s, dozens of theologians worked together to develop major themes in theology (God, Christ, church) from a liberation standpoint. In the changed context of the twenty-first century, some theologians have continued their work, and have been pleased with the direction of the papacy under Pope Francis.
Prophetic Martyrdom in Modern Latin America
Authors: Brett Edward T.
Published: March 2020

Following the Second Vatican Council (1962–1965), over a thousand priests and religious sisters and brothers were exiled, imprisoned, tortured, or murdered in Latin America by authoritarian governments. A much larger number of lay Church workers were also incarcerated, brutalized, or killed. Most suffered or died because, following the ideals of Vatican II and the Second Latin American Bishops Conference at Medellín, Colombia (1968), they committed themselves to the amelioration of the marginalized in their countries, even though they were fully aware that to do so placed their lives in great peril. This chapter treats a select number—mostly priests and nuns—who were killed because of their prophetic devotion to the poor. It is limited to the nations of Mexico, Brazil, Chile, Argentina, and Central America. It also touches on the bitter divisions that resulted in the Church as a consequence of this new religious activism. Finally, it demonstrates why the deaths of so many religious-based social justice activists forced the institutional Catholic Church to reexamine its outdated criteria for martyrdom.
Conversion Processes and Social Networks in Latin America
Authors: Gooren Henri
Published: March 2020

Different varieties of Pentecostalism are successful in Latin America, where Chile, Brazil, and the Central American countries are now 20 to 30 percent Protestant. This chapter analyzes conversion processes and social networks in Latin America by comparing the two extremes of Pentecostal growth. Paraguay is arguably the least Pentecostalized country in the region, whereas Chile is one of the most Pentecostal. Based on recent ethnographic fieldwork research in Asunción and Santiago de Chile, the chapter first reviews the literature on Pentecostal growth in Latin America and establishes the main growth periods of Pentecostalism in both countries, identifying some of the most successful churches. Next, it analyzes the role of conversion in these churches by drawing on the conversion career approach, using quotes from life history interviews. Individual, contextual, and institutional factors (like doctrine, ritual, organization, and evangelization methods) are explored, as well as the role of the new converts’ social networks. The conclusion offers a new theoretical framework for analyzing the role of social networks in Pentecostal conversion for the Chile and Paraguay cases and for Latin America in general.
Christianity and Ecology in Latin America
Authors: Lorentzen Lois Ann
Published: March 2020

This chapter explores Christianity and ecology in Latin America by charting the religious beliefs and practices of the Roman Catholic Church and liberation theologians, ecofeminist movements, and Protestant faith traditions (emphasizing evangelical and Pentecostal Protestantism). In each case, religious symbols, theologies, rituals, and movements are analyzed as they relate to the nonhuman world. The chapter begins with initial contact between Roman Catholicism and indigenous religions and the consequences for the environment. The ecotheology emerging from liberation theology is explored as well as Pope Francis’s encyclical Laudato Si (Praise be to you): On Care for our Common Home. Environmental movements and activism rooted in both Catholic and Protestant beliefs are also explored.
A New Pentecost
Authors: Rivera-Pagán Luis N.
Published: March 2020

This chapter deals with a classic anthropological study in Latin American religious history: the conversion, in the middle of the twentieth century, of a Puerto Rican sugarcane worker to Pentecostalism. The author expands that study to analyze the geometrical expansion of Pentecostal and charismatic Christianity in Latin America. It discusses issues like glossolalia, divine healing, charismatic worship, missionary expansion of the Pentecostal churches, and the consequences for a meaningful but scarcely studied cultural transformation of Latin America. Pentecostalism, in its diverse manifestations, is now a meaningful religious, social, and political movement in several nations of the Latin American continent, as the election of Jair Messias Bolsonaro to Brazil’s presidency has dramatically demonstrated.
Morphological and Pathogenic Characterization of Sclerotium rolfsii, the Causal Agent of Southern Blight Disease on Common Bean in Uganda
Authors: Paparu Pamela , Acur Amos , Kato Fred , Acam Catherine , Nakibuule Justine , Nkuboye Allan , Musoke Stephen , Mukankusi Clare
Published: March 2020

Over the last 5 years, Southern blight caused by Sclerotium rolfsii Sacc. has superseded root rots caused by pathogens such as Fusarium and Pythium spp. as a major constraint of common bean (Phaseolus vulgaris L.) production in Uganda. Although S. rolfsii is prevalent in all bean-growing regions of Uganda, there is a lack of information about its diversity and pathogenicity to guide the development of effective management strategies. In total, 348 S. rolfsii isolates were obtained from bean fields in seven agroecological zones of Uganda, with the following objectives: to characterize their morphology, based on mycelial growth rate, mycelium texture, and number of sclerotia; and to determine the pathogenicity of 75 selected isolates on five common bean varieties in artificially inoculated soils in a screenhouse. We found that mycelial growth rate and the number of sclerotia produced on artificial media varied among agroecological zones but not within a zone. The five bean varieties tested were found to be susceptible to S. rolfsii, including varieties MLB49-89A and RWR719 that are resistant to Fusarium and Pythium root rots, respectively. Preemergence damping-off ranged between 0 and 100%, and disease severity index ranged between 4.4 and 100%. The widespread and high levels of S. rolfsii virulence on varieties of common bean indicate that management intervention is urgently required to help reduce losses incurred by Ugandan smallholder farmers.

[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Adding Epidemiologically Important Meteorological Data to Peanut Rx, the Risk Assessment Framework for Spotted Wilt of Peanut
Authors: Chappell Thomas M. , Codod Clarence B. , Williams Blake W. , Kemerait Robert C. , Culbreath Albert K. , Kennedy George G.
Published: March 2020

Management of disease affecting peanut in the southeastern United States has benefited from extensive field research identifying disease-associated risk factors since the 1990s. An assessment of risk factors associated with tomato spotted wilt (TSW), caused by tomato spotted wilt virus and spread exclusively by thrips, is available to growers through Peanut Rx, a tool developed to inform peanut management decisions. Peanut Rx provides an assessment of relative TSW risk as an index. The assessment provides information about the relative degree to which a field characterized by a specified suite of practices is at risk of crop loss caused by TSW. Loss results when infection occurs, and infection rates are determined, in part, by factors outside a grower’s control, primarily the abundance of dispersing, viruliferous thrips. In this study, we incorporated meteorological variables useful for predicting thrips dispersal, increasing the robustness of the Peanut Rx framework in relation to variation in the weather. We used data from field experiments and a large grower survey to estimate the relationships between weather and TSW risk mediated by thrips vectors, and developed an addition to Peanut Rx that proved informative and easy to implement. The expected temporal occurrence of major thrips flights, as a function of heat and precipitation, was translated into the existing risk-point system of Peanut Rx. Results from the grower survey further demonstrated the validity of Peanut Rx for guiding growers’ decisions to minimize risk of TSW.
Identifying and Supporting Students to Prevent USMLE Step 1 Failures When Testing Follows Clerkships: Insights From 9 Schools
Authors: Swan Sein Aubrie , Daniel Michelle , Fleming Amy , Morrison Gail , Christner Jennifer G. , Esposito Karin , Pock Arnyce R. , Grochowski Colleen O. , Dalrymple John L. , Santen Sally A.
Published: March 2020

Several schools have moved the United States Medical Licensing Examination Step 1 exam after core clerkships, and others are considering this change. Delaying Step 1 may improve Step 1 performance and lower Step 1 failure rates. Schools considering moving Step 1 are particularly concerned about late identification of struggling students and late Step failures, which can be particularly problematic due to reduced time to remediate and accumulated debt if remediation is ultimately unsuccessful. In the literature published to date, little attention has been given to these students. In this article, authors from 9 medical schools with a postclerkship Step 1 exam share their experiences. The authors describe curricular policies, early warning and identification strategies, and interventions to enhance success for all students and struggling students in particular. Such learners can be identified by understanding challenges that place them “at risk” and by tracking performance outcomes, particularly on other standardized assessments. All learners can benefit from early coaching and advising, mechanisms to ensure early feedback on performance, commercial study tools, learning specialists or resources to enhance learning skills, and wellness programs. Some students may need intensive tutoring, neuropsychological testing and exam accommodations, board preparation courses, deceleration pathways, and options to postpone Step 1. In rare instances, a student may need a compassionate off-ramp from medical school. With the National Board of Medical Examiner’s announcement that Step 1 scoring will change to pass/fail as early as January 2022, residency program directors might use failing Step 1 scores to screen out candidates. Institutions altering the timing of Step 1 can benefit from practical guidance by those who have made the change, to both prevent Step 1 failures and minimize adverse effects on those who fail.
The Impact of Paid Maternity Leave on the Mental and Physical Health of Mothers and Children: A Review of the Literature and Policy Implications
Authors: Van Niel Maureen Sayres , Bhatia Richa , Riano Nicholas S. , de Faria Ludmila , Catapano-Friedman Lisa , Ravven Simha , Weissman Barbara , Nzodom Carine , Alexander Amy , Budde Kristin , Mangurian Christina
Published: March 2020

For decades, national paid maternity leave policies of 12 weeks or more have been established in every industrialized country except the United States. Despite women representing 47% of the current U.S. labor force, only 16% of all employed American workers have access to paid parental leave through their workplace. As many as 23% of employed mothers return to work within ten days of giving birth, because of their inability to pay living expenses without income. We reviewed recent studies on the possible effects of paid maternity leave on the mental and physical health of mothers and children. We found that paid maternity leave is associated with beneficial effects on (1) the mental health of mothers and children, including a decrease in postpartum maternal depression and intimate partner violence, and improved infant attachment and child development, (2) the physical health of mothers and children, including a decrease in infant mortality and in mother and infant rehospitalizations, and an increase in pediatric visit attendance and timely administration of infant immunizations, and (3) breastfeeding, with an increase in its initiation and duration. Given the substantial mental and physical health benefits associated with paid leave, as well as favorable results from studies on its economic impact, the United States is facing a clear, evidence-based mandate to create a national paid maternity leave policy. We recommend a national paid maternity leave policy of at least 12 weeks.
Intrascleral sewing-machine technique: A Grooveless/flapless cyclopexy technique for large traumatic Cyclodialysis cleft repairs in pars plana vitrectomy
Authors: Huang Liuhui , Zhang Qi , Jin Haiying
Published: March 2020

Purpose:

To describe a minimally invasive technique for the repair of large traumatic cyclodialysis clefts using intrascleral sewing machine suture and overhand friction knot techniques in pars plana vitrectomy.

Methods:

This prospective, noncomparative, interventional case series included seven eyes of seven patients with a large traumatic cyclodialysis cleft. The sewing machine technique was modified by an intrascleral approach. The procedure was transconjunctival or subconjunctival performed without scleral flaps/grooves. An overhand friction knot was used to lead the cutting ends of the suture buried in the scleral tunnel.

Results:

The closure of the cyclodialysis cleft was achieved in seven eyes. The mean follow-up duration was 49.1 ± 15.6 weeks (range, 30–70 weeks). The intraocular pressure increased from 7.3 ± 2.1 mm Hg (range, 5–11 mmHg) preoperatively to 13.6 ± 2.4 mm Hg (range, 10–17 mmHg) postoperatively (P < 0.01). The best-corrected visual acuity improved from a mean of 2.76 ± 2.77 logarithm of the minimum angle of resolution preoperatively to 0.63 ± 0.82 logarithm of the minimum angle of resolution at the final follow-up (P < 0.01).

Conclusion:

In conclusion, the present technique is safe and effective in the treatment of large traumatic cyclodialysis clefts with minimal surgical trauma and a decreased surgical duration.
Rabbit Fungal Keratitis Model of Fusarium solani Tested Against Three Commercially Available Antifungal Drugs
Authors: Aung Thet Tun , Chor Wei Hong Jeff , Lynn Myoe Naing , Chan Anita Sook Yee , Tan Donald T.H. , Beuerman Roger W.
Published: March 2020

Objectives:

The purpose of this study was to develop a reproducible preclinical Fusarium solani keratitis model, which would allow comparative testing of currently available antifungals (NATACYN [Alcon, Fort Worth, TX], voriconazole 1%, and amphotericin B 0.1%) as well as efficacy testing of new antifungals for translation into clinical practice in the future.

Methods:

The rabbit F. solani keratitis model was developed in New Zealand white rabbits using local and systemic immunosuppression. Infection was introduced by intrastromal injection of F. solani spores into one of the immunosuppressed rabbit eyes while the contralateral eye was a control. Progress of the infection was assessed by the clinical features, histopathology, and viable fungal counts. In this study, the efficacy of currently available antifungals (NATACYN [Alcon], voriconazole 1%, and amphotericin B 0.1%) was compared. Rabbits were randomly divided (n=4 in each group), and the respective antifungal was instilled topically 5 times/day for 7 days. Treatment effects were analyzed by evaluating the anterior segment with the help of slit-lamp, histopathological findings and viable fungal culture at the end of the experiment.

Results:

We report the development of a reproducible and progressive rabbit F. solani keratitis model as shown by the substantial viable fungal counts (3 log CFU), the presence of large patchy lesions and substantial hypopyon in the 12-day model correlated with specific histopathological analysis for fungus (extended F. solani hyphae from midcorneal stroma into the anterior chamber and traverse Descemet membrane with anterior chamber suppurative plaque). Voriconazole 1% and NATACYN revealed significant reduction of the fungal wound area (P=0.02 and 0.021), respectively, while amphotericin B 0.1% exhibited P value of 0.083 compared with their infected nontreated controls. Voriconazole 1% and amphotericin B 0.1% showed significant viable fungal count differences (P=0.004 and 0.01), respectively, whereas P value of NATACYN was 0.337 compared with control infected corneas.

Conclusion:

The reported rabbit fungal keratitis model can be used for screening new antifungals and evaluating currently available antifungals to facilitate better clinical outcomes. Voriconazole 1% showed the best efficacy among the three tested currently available antifungals by showing the significant differences in both wound size and viable fungal count comparisons in our F. solani rabbit keratitis model.
Reoperations for Complications Within 90 Days After Glaucoma Surgery
Authors: Chu Chia-Kai , Liebmann Jeffrey M. , Cioffi George A. , Blumberg Dana M. , Al-Aswad Lama A.
Published: March 2020

Objective:

To describe reoperations in the operating room for complications encountered within 90 days after glaucoma surgery at a single institution over a 2-year period.

Design:

Retrospective case series.

Subjects:

Adult patients who have undergone glaucoma surgery including a tube shunt, trabeculectomy with mitomycin C, trabectome, or transcleral cyclophotocoagulation from June 1, 2015 to August 30, 2017 at a single institution.

Methods:

These patients were then examined for postoperative complications that required reoperations within the first 90 days including revision of the tube shunt, revision of the trabeculectomy, drainage of the choroidal, or placement of a tube shunt.

Main Outcome Measures:

Percentage of reoperations for complications within the first 90 days after glaucoma surgery and surgical indications for these reoperations.

Results:

A total of 622 glaucoma procedures were performed on 600 eyes in 525 patients over a 2-year period from June 1, 2015 to June 30, 2017 by 4 glaucoma surgeons at a single institution. Of these, 275 (44%) were trabeculectomy with mitomycin C, 253 (41%) were the placement of a tube shunt, 33 (5%) were cyclophotocoagulation, and 61 (10%) were trabectome procedures. Postoperative complications requiring reoperations within 90 days developed in 15 patients (2.4%) overall including 7 patients (2.5%) in the trabeculectomy with mitomycin C group and 8 patients (3.1%) in the tube shunt group. Five patients developed bleb leaks, 3 patients developed serous choroidal effusions, 3 patients had tube exposure, 1 patient had tube retraction, 1 patient had persistent iritis from iris touching the tube, and 1 had encapsulation around the tube. The rate of reoperation for complications was similar between the tube group and the trabeculectomy group (P=0.67, χ
2 test). There were no complications requiring reoperations in 90 days for transcleral cyclophotocoagulation or trabectome.

Conclusions:

Early postoperative complications requiring reoperations within the first 90 days after glaucoma surgery were low and comparable with previous studies. Common indications for reoperation within 90 days include wound leak and tube shunt-related issues.
The Relationship Between Corvis ST Tonometry Parameters and Ocular Response Analyzer Corneal Hysteresis
Authors: Fujishiro Takashi , Matsuura Masato , Fujino Yuri , Murata Hiroshi , Tokumo Kana , Nakakura Shunsuke , Kiuchi Yoshiaki , Asaoka Ryo
Published: March 2020

Precis:

Corvis ST Tonometry and Ocular Response Analyzer (ORA) measurements were conducted in primary open-angle glaucoma and normative subjects. Many parameters were significantly correlated, however, the strengths were weak to moderate.

Purpose:

Reichert ORA parameters are derived from pressure information following the application of air-jet, whereas detailed structural observation can be made using the Corneal Visualization Scheimpflug Technology instrument (CST). The purpose of the study was to investigate the association between CST measurements and ORA measured corneal hysteresis (CH).

Methods:

Measurements of CST, ORA, axial length, average corneal curvature, central corneal thickness (CCT) and intraocular pressure with Goldmann applanation tonometry were carried out in 104 eyes of 104 patients with primary open-angle glaucoma and 35 eyes from normative subjects. The association between CST and ORA parameters was assessed using linear regression analysis, with model selection based on the second order bias corrected Akaike Information Criterion index.

Results:

Deformation amplitude ratio (corneal softness, R=−0.51), SP A1 (corneal stiffness, R=0.41), and Inverse Radius (integrated area under the curve of the inverse concave radius, R=−0.44) were significantly correlated with CH (P <0.05). The optimal model to explain CH using CST measurements was given by: CH=−76.3+4.6×A1 time (applanation time in the corneal inward movement)+1.9×A2 time (second applanation time in the corneal outward movement) + 3.1 × highest concavity deformation amplitude (magnitude of movement of the corneal apex from before deformation to its highest concavity) + 0.016×CCT (R
2=0.67; P<0.001).

Conclusions:

CST parameters are significant, but weakly or moderately, related to ORA measured CH.
The Influence of Combined CYP2D6 and CYP2C19 Genotypes on Venlafaxine and O-Desmethylvenlafaxine Concentrations in a Large Patient Cohort
Authors: Kringen Marianne K. , Bråten Line S. , Haslemo Tore , Molden Espen
Published: March 2020

Purpose

The antidepressant venlafaxine is largely O-desmethylated by CYP2D6, whereas CYP2C19 mediates an alternative metabolic route of venlafaxine through N-desmethylation. The aim of this study was to investigate the combined effect of genotype-predicted CYP2D6 and CYP2C19 phenotypes on serum concentrations of venlafaxine and metabolites in a large patient population.

Methods

Patients were retrospectively included from a therapeutic drug monitoring service at Diakonhjemmet Hospital in Oslo (Norway) between January 01, 2007, and December 31, 2017. The study population was divided into different phenotype subgroups according to the combinations of CYP2D6/CYP2C19 phenotypes; intermediate metabolizers (IMs), poor metabolizers (PMs) and ultrarapid metabolizers, and compared using combined normal metabolizers (NMs) as reference.

Findings

The dose-adjusted serum concentration of venlafaxine was 4- and 13-fold increased in combined CYP2D6 IM/CYP2C19 PMs and combined PMs, respectively, compared with combined NMs (P < 0.001). The sum concentration of venlafaxine + ODV (pharmacological active moiety) was increased 1.9 and 3.6-fold, respectively, in the same phenotype groups. Furthermore, the dose-adjusted active moiety exposure was similar in combined IMs as combined CYP2D6 PM/CYP2C19 NMs. CYP2D6 and CYP2C19 phenotypes explained 46% of the interindividual variability in dose-adjusted venlafaxine serum concentrations, whereas CYP2D6 alone explained 24%.

Conclusions

The combined CYP2D6/CYP2C19 phenotype has a significant impact on serum concentrations of venlafaxine and also on the active moiety of venlafaxine + ODV, than CYP2D6 alone. In clinical practice, it is therefore important to take into account phenotype variabilities of both enzymes when assessing the risk of dose-dependent adverse effects during venlafaxine treatment.
Antidepressant-Associated Mania in Bipolar Disorder: A Review and Meta-analysis of Potential Clinical and Genetic Risk Factors
Authors: Melhuish Beaupre Lindsay M. , Tiwari Arun K. , Gonçalves Vanessa F. , Lisoway Amanda J. , Harripaul Ricardo S. , Müller Daniel J. , Zai Clement C. , Kennedy James L.
Published: March 2020

Purposes/Background

Antidepressants (ADs) play a valuable role in treating the depressive episodes of bipolar disorder. However, 14% of these individuals taking ADs experience AD-associated mania (AAM) within a few weeks of starting treatment. Numerous studies have suggested potential clinical and genetic risk factors. We aimed to conduct a comprehensive systematic review and meta-analysis that integrates the past literature with the recent studies and identifies important predictors for AAM.

Methods/Procedures

The review was limited to experimentally designed studies that contain the relevant search terms in PubMed and PsychInfo. After removing studies that were in discordance with our criteria, the review included 24 reports examining clinical risk factors and 10 investigating genetic risk factors. Our meta-analysis was conducted on 5 clinical risk factors, each of which had at least 4 articles with extractable data.

Findings/Results

The only clinical factors in the literature that have been shown to be more indicative of AAM risk are AD monotherapy and tricyclic ADs. Among genetic factors, the serotonin transporter gene polymorphism may play a minor role in AAM. Our meta-analysis provided support for the number of prior depressive episodes.

Implications/Conclusion

Prevention of AAM may be served by early detection of recurrent depression episodes. Further large-scale longitudinal studies are required to determine the underpinnings of AAM.
Antidepressants and the Risk of Cardiovascular Events in Elderly Affected by Cardiovascular Disease
Authors: Biffi Annalisa , Rea Federico , Scotti Lorenza , Lucenteforte Ersilia , Vannacci Alfredo , Lombardi Niccolò , Chinellato Alessandro , Onder Graziano , Vitale Cristiana , Cascini Silvia , Ingrasciotta Ylenia , Roberto Giuseppe , Mugelli Alessandro , Corrao Giovanni
Published: March 2020

Purpose

The purpose of this study was to assess the possible relation between use of antidepressant (AD) drugs, that is, tricyclic ADs, selective serotonin reuptake inhibitors (SSRIs), and atypical ADs (AAs), and the risk of hospitalization for cardiovascular (CV) events among older patients with previous CV diseases.

Methods

A nested case-control study was carried out among patients aged 65 years and older from 5 Italian health care territorial units who were discharged for CV disease during 2008 to 2010. The cohort was composed by 344,747 individuals, and of these, 97,739 (28%) experienced hospital admission for CV events (myocardial infarction, arrhythmia, stroke, heart failure) during follow-up (until 2014) and were included as cases. Up to 5 controls were randomly selected and matched to each. A conditional logistic regression was fitted to estimate the risk of CV events associated with ADs past or current use. A within-patient comparison was performed by the case-crossover design to account the effect of depression.

Findings

Current users of SSRIs and AAs were at increased risk of CV events with odds ratios of 1.25 (95% confidence interval, 1.21–1.29) and 1.31 (1.25–1.37), respectively. An increased risk of arrhythmia and stroke was associated with current use of SSRIs and AAs, whereas an increased risk of heart failure was detected with current use of any ADs. The results were confirmed by the case-crossover approach.

Implications

Evidence that AD use is associated with an increased risk of CV events in accordance with specific mechanisms of action among older people with CV disease was added by this study.
Lean in Healthcare: Time for Evolution or Revolution?
Authors: Wackerbarth Sarah B. , Bishop Susan S. , Aroh Adaeze C.
Published: March 2020

Lean has gained recognition in healthcare as a quality improvement tool. The purpose of this research was to examine the extent to which quality improvement projects in healthcare adhered to Lean's eight-step process. We analyzed 605 publications identified through a systematic literature review following PRISMA guidelines. Each publication was coded using a structured coding sheet. The most frequent type of publication reported empirical research (48.6%) and most of these (80.3%) shared the results of the Lean projects. Of the 237 publications reporting Lean projects, more than half (71.3%) used an experimental, one-site, pre/postdesign. The impact of the project was most often measured using a single metric (59.1%) that was operational (e.g., waiting time). Although most Lean project publications reported the use of tools to “break down the problem” (84.4%, Step 2) and “see countermeasures through” (70.0%, Step 6), fewer than half described using tools associated with each of the other steps. Projects completed an average of 2.77 steps and none of the projects completed all steps. Although some may perceive low adherence to the tenets of Lean as a deficiency, it may be that Lean approaches are evolving to better meet the needs of healthcare.
Using GoFundMe to Obtain Medical Care
Authors: Bayless Katy R.
Published: March 2020

Advancements in surgical interventions, specifically the newer biventricular valve replacement, for babies born with hypoplastic left heart syndrome have increased the survival rate of this otherwise fatal congenital deformity. For those interested in surgical intervention, patients are lucky to have this option, although not all babies are candidates for this surgery. Survival rates must remain only a part of the conversation, as there are significant lifelong medical needs/risks for these babies, including neurologic and developmental disabilities. Medical factors are only part of the story. The out-of-pocket costs for this new procedure are very very high and can financially devastate families, who are frequently turning to crowdsourcing to cover their medical bills. Crowdsourcing to purchase medical procedures invites a host of ethical concerns to be discussed here. Finally, the inclusion of a pediatric palliative care team during these discussions will help parents and providers navigate these difficult and complicated conversations and decisions.
Disruption of Circadian Rhythms and Gut Motility
Authors: Duboc Henri , Coffin Benoit , Siproudhis Laurent
Published: March 2020

Circadian rhythms ensure that physiological processes occur at the most biologically meaningful time. The circadian timing in the gastrointestinal tract involves interlocking transcriptional and translational feedback loops that culminate in the rhythmic expression and activity of a set of clock genes and related hormones. The suprachiasmatic nucleus and peripheral core molecular clocks oscillate every 24 hours and are responsible for the periodic activity of various segments and transit along the gastrointestinal tract. Environmental cues may alter or reset these rhythms to align them with new circumstances. Colonic motility also follows a circadian rhythm with reduced nocturnal activity. Healthy humans have normal bowel motility during the day, frequently following awakening or following a meal, with minimal activity during the night. Maladjusted circadian rhythms in the bowel have been linked to digestive pathologies, including constipation and irritable bowel syndrome. Our advanced knowledge of the link between the circadian clock and gastrointestinal physiology provides potential therapeutic approaches for the treatment of gastrointestinal diseases. This review seeks to establish evidence for the correlation between circadian rhythm, bowel movements and digestive health, and examine the implications of disrupted circadian rhythms on gut physiology.
Autologous Stem Cell Transplantation for Children With Renal Tumors, and Adults With Wilms Tumor: Retrospective Analysis of the Japanese Transplant Registry Unified Management Program
Authors: Kobayashi Ryoji , Inoue Masami , Takahashi Yoshiyuki , Kikuta Atsushi , Ogawa Atsushi , Koga Yuhki , Koh Katsuyoshi , Hashii Yoshiko , Hara Junichi , Kato Koji , Tabuchi Ken , Matsumoto Kimikazu
Published: March 2020

Background:

Almost all pediatric patients with renal tumors are diagnosed with nephroblastoma (Wilms tumor), clear cell sarcoma, or malignant rhabdoid tumor. The choice of treatment is important for relapsed and refractory patients with nephroblastoma. Furthermore, clear cell sarcoma of the kidney (CCSK) and malignant rhabdoid tumor of the kidney (MRTK) have a poor prognosis compared with nephroblastoma. Thus, stem cell transplantation (SCT) is sometimes selected to treat these tumors.

Patients and Methods:

The authors targeted a total of 84 patients with nephroblastoma, CCSK, and MRTK who underwent a first autologous SCT between 1992 and 2014, and were registered in the Japanese Transplant Registry Unified Management Program system. The authors retrospectively analyzed the SCT data for survival rate.

Results:

Five-year overall survival rates for nephroblastoma, CCSK, and MRTK were 72.4%±6.3%, 46.8%±13.8%, and 36.4%±14.5%, respectively. The event-free survival rates at 5 years were 64.9%±6.7%, 35.7%±12.8%, and 27.3%±13.4%, respectively. The relapse rates at 5 years were 25.3%±11.4%, 46.2%±28.4%, and 60.0%±43.1%, respectively.

Conclusion:

Although the survival rate for nephroblastoma was relatively high, those of CCSK and MRTK were poor.
Complexity Leadership in the Nursing Context
Authors: Uhl-Bien Mary , Meyer Danika , Smith Justin
Published: March 2020

Consolidation through mergers and acquisitions is occurring across health care as a strategic move to address the disruptive forces of complexity. While consolidation is improving the overall fitness and viability of health care organizations, it is having the opposite effect on the professionals working within them who are reporting increasing rates of burnout from ongoing complexity in the health care environment. This happens in all organizations that try to respond to complexity with traditional bureaucratic leadership approaches. What is needed is to replace bureaucratic leadership with the networked approach of complexity leadership. The idea is not to “do more with less” but to “do things better.” In this article, we show how to do this by applying complexity leadership to the nursing context. Complexity leadership is a framework for enabling people and organizations for adaptability. It views leaders not as managerial implementers of top-down directives but as collaborators who work together to enhance the overall adaptability and fitness of the system. From a complexity leadership perspective, the role of nurse leaders should be not only to help the system run but also to help it run better by increasing organizational adaptability.
The SHAPE Framework
Authors: Dean Martin Amanda
Published: March 2020

Members of Generation Y (or Millennials) now make up more than 50% of those in the workplace. They are expected to comprise greater than 75% by 2025. The Millennial generation has brought new idiosyncrasies to the workplace, and most literature has focused on ways to manage these differences. The Baby Boom generation is retiring at an increasing pace, leaving ongoing leadership needs in the care of Millennials. Conversations must now shift from how to lead the Millennials to preparing them to lead others. The SHAPE framework highlights some of the idiosyncrasies of this generation and ways they can be leveraged when approaching the challenges of health care today.
Complexity Science Fosters Professional Advanced Nurse Practitioner Role Emergence
Authors: Shelby Melissa , Wermers Rita
Published: March 2020

This article discusses role emergence from master's-prepared nurse practitioners to Doctor of Nursing Practice (DNP) innovative leaders who utilize Complexity science to impact health care organizations. DNP leaders are in position to disrupt linear traditional leadership and embark on new ideas for improvements in care delivery, organizational system processes, and policies within health care. Complexity science provides the necessary theoretical framework for nurse executives and stakeholders to interact with DNP leaders by engaging in collaborative efforts, cultivating communication from point of service providers to administrators, and coordinating interdisciplinary teams to approach gaps in practice, clinical issues, health care policy, and organizational sustainability. The DNP leader is aware that health care organizations are complex adaptive systems, continuously changing. These require skilled and knowledgeable leaders to support growth within an uncertain environment, and bring evidence to practice while promoting organizational wellness.
Reducing COPD Rehospitalizations
Authors: McGill Carmen
Published: March 2020

Patients with chronic obstructive pulmonary disease (COPD) who are rehospitalized following hospitalization for an exacerbation of COPD are at higher risk of mortality and poor health outcomes. Approximately 20% of patients who are discharged from the hospital following an exacerbation of COPD are readmitted within 30 days. At a home healthcare agency in southeastern United States, 36.4% of patients admitted to the agency with a primary or secondary diagnosis of COPD between August 2018 and January 2019 were rehospitalized within 30 days of admission. A quality improvement project was conducted between January 2019 and July 2019. This project involved implementation of a COPD self-management care plan packet provided by home healthcare nurses to patients with a primary or secondary diagnosis of COPD. The 30-day rehospitalizations for patients with COPD decreased from 36.4% preintervention to 15.4% postintervention. The number of patients receiving timely follow-up with their provider increased from 79% preintervention to 88% postintervention, and COPD medication reconciliation at admission improved from 79% preintervention to 84% postintervention. The generalizability of these results is limited due to a small sample size and inconsistencies in intervention implementation.
Home Health Agency Factors Associated With Acute Care Hospitalization and Emergency Department Use
Authors: Osakwe Zainab Toteh , Sosina Olukayode Ayodeji , Agu Ngozichukwuka , Fleur-Calixte Rose Saint
Published: March 2020

We linked the Medicare Provider Utilization and Payment Data for Home Health and the Home Health Compare data for the year 2016 to identify home healthcare agency (HHA) characteristics associated with acute care hospitalization (ACH) or emergency department (ED) use. The study cohort consisted of 9,800 HHAs. Beta regression was used to examine the association between average age, race/ethnic composition, number of skilled nursing visits, number of therapy visits, percentage of dual eligible patients, HHA ownership, HHA location, Medicare tenure, proportion of patients with a diagnosis of schizophrenia, stroke, diabetes, depression, chronic obstructive pulmonary disease (COPD), heart failure, cancer and Alzheimer disease, and ACH or ED use. After controlling for HHA-level characteristics, variations in HHAs' ACH and unplanned ED visits were found. For-profit HHAs were significantly less likely to have patients with ACH. (Odds ratio = -0.05, p = 0.020), HHAs in the Midwest, South, and West had lower odds of ACH. HHAs that serve more than 50% Black patients had significantly decreased odds (β = -0.16, p < 0.001) of ACH. A 1-unit increase in the proportion of patients with a diagnosis of schizophrenia, COPD, stroke, heart failure, and Alzheimer disease was associated with increased odds of hospitalization. For each unit increase in the number of skilled nursing visits, the odds of ACH increased by 0.02 (p = 0.001). For-profit and nonprofit HHAs had a significant decrease in the odds of unplanned ED visits (p < 0.05). An increase in the proportion of patients with COPD was associated with increased odds of unplanned ED visits (p < 0.001). HHA characteristics are associated with hospitalization and ED use without hospitalization. These characteristics point to variation in quality of care measured by ACH and ED use.
PTEN Loss and Cyclin A2 Upregulation Define a PI3K/AKT Pathway Activation in Helicobacter pylori–induced MALT and DLBCL Gastric Lymphoma With Features of MALT
Authors: Ben Younes Khaoula , Doghri Raoudha , Mrad Karima , Bedhiafi Walid , Benammar-Elgaaied Amel , Sola Brigitte , Ben Aissa-Fennira Fatma
Published: March 2020

Helicobacter pylori infection is strongly associated with primary gastric diseases, such as extranodal mucosa-associated lymphoid tissue (MALT) lymphoma, diffuse large B-cell lymphoma (DLBCL) with histologic evidence of MALT origin, and gastric carcinoma. The cytotoxin-associated gene A (CagA) protein behaves as a bacterial oncoprotein, promoting tumorigenesis via dysregulation of the phosphatidylinositol 3-kinase/AKT pathway (PI3K/AKT). We investigated the molecular mechanisms of PI3K/AKT pathway dysregulation in H. pylori-induced MALT and DLBCL gastric lymphoma. Immunohistochemical assays for CagA, phospho(p)-S473-AKT, PTEN, SHIP, and cyclin A2 proteins were performed on samples from 23 patients with H. pylori-positive MALT lymphoma and 16 patients with H. pylori-positive gastric DLBCL. We showed that CagA localization is correlated with the activation of the AKT pathway in both MALT and DLBCL lymphoma cells. Interestingly, we found a close association between the loss of PTEN, the overexpression of cyclin A2, and the phosphorylation of AKT in gastric MALT and DLBCL tumor cells.