bluuebunny/crossref_metadata_2025 huggingface dataset:
Palliative Caregivers’ Spirituality, Views About Spiritual Care, and Associations With Spiritual Well-Being: A Mixed Methods Study
Authors: O’Callaghan Clare , Seah Davinia , Clayton Josephine M. , Welz Martina , Kissane David , Georgousopoulou Ekavi N. , Michael Natasha
Published: September 2019

Background:

Spiritual care is integral to palliative care. It engenders a sense of purpose, meaning, and connectedness to the sacred or important and may support caregiver well-being.

Aim:

To examine caregivers’ spirituality, religiosity, spiritual well-being, and views on spiritual/religious support.

Design:

A mixed-methods study across 4 Australian sites, recruiting caregivers of patients with a life expectancy of under 12 months. The anonymous semistructured questionnaire used included research team developed and adapted questions examining religion/spirituality’s role and support and views on hospitals supporting spiritual/religious requirements. It additionally included the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12).

Results:

One hundred nine caregivers participated (47.4% responded). Median spiritual well-being was 30.5 on FACIT-Sp-12. Religious affiliation was associated with higher Faith subscores ( P < .001). Spirituality was very important to 24.5%, religiosity to 28.2%, and unimportant to 31.4% and 35.9%, respectively. Caregivers prayed ( P = .005) and meditated ( P = .006) more following patients’ diagnoses, gaining comfort, guidance, and strength. Caregivers whose spiritual/religious needs were met to moderate/full extent by external religious/faith communities (23.8%) reported greater spiritual well-being ( P < .001). Hospitals supported moderate/full caregiver spiritual needs in 19.3%. Pastoral care visits comforted 84.4% of those who received them (n = 32) but elicited discomfort in 15.6%. Caregivers also emphasized the importance of humane staff and organizational tone in supporting spiritual care.

Conclusions:

Hospital-based spiritual care providers should seek to identify those who seek pastoral or religiously orientated care. Genuine hospitality of showing concern for the other ensures the varied yet inevitably humanist requirements of the caregiver community are met.
Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases
Authors: Akgün Kathleen M. , Krishnan Supriya , Feder Shelli L. , Tate Janet , Kutner Jean S. , Crothers Kristina
Published: September 2019

Background:

Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified by statin discontinuation.

Methods:

Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using the Edmonton Symptom Assessment System.

Results:

The mean age of the patients was 73.8 years (standard deviation [SD]: ±11.0) and the mean medication count was 11.6 (SD: ±5.0). We identified 3 dyspnea trajectory groups: none (n = 108), mild (n = 130), and moderate–severe (n = 70). Statins were discontinued in 51.8%, 48.5%, and 42.9% of patients, respectively. In multivariable models adjusting for age, sex, diagnosis, and statin discontinuation, each additional medication was associated with 8% (odds ratio [OR] = 1.08 [1.01-1.14]) and 16% (OR = 1.16 [1.08-1.25]) increased risk for mild and moderate–severe dyspnea, respectively. In stratified models, polypharmacy was associated with dyspnea in the statin continuation group only (mild OR = 1.12 [1.01-1.24], moderate–severe OR = 1.24 [1.11-1.39]) versus statin discontinuation (mild OR = 1.03 [0.95-1.12], and moderate–severe OR = 1.09 [0.98-1.22]).

Conclusion:

Polypharmacy was strongly associated with dyspnea. Prospective interventions to decrease polypharmacy may impact dyspnea symptoms, especially for statins.
A rare case of endophthalmitis after bleb needle revision for glaucoma Xen® gel stent
Authors: Napoli Luca , Riva Ivano , Oddone Francesco , Michelessi Manuele , Quaranta Luciano
Published: September 2019

Purpose:

To describe the first case of endophthalmitis caused by Sphingobacterium spiritivorum, a glucose non-fermenting Gram-negative rod, in a patient previously implanted with a Xen® gel stent.

Case report description:

An 83-year-old patient, affected by open-angle glaucoma and with a previous surgery of combined cataract extraction and Xen gel stent implantation, developed endophthalmitis 1 month after bleb needle revision with 5-fluorouracil injection. At presentation, best corrected visual acuity was hand movement, hypopyon was evident into the anterior chamber and a flat bleb with no sign of leakage was present over the Xen gel implant.

Outcome:

Immediate pars plana vitrectomy was performed, with intravitreal antibiotic administration and silicon oil tamponade. S. spiritivorum was isolated from vitreous bacterial culture. According to the antibiogram, patient was treated with topical fortified ceftazidime eyedrops and appropriate systemic antibiotics (intravenous meropenem, 500 mg every 8 h for 7 days, followed by oral cotrimoxazole, 160 + 800 mg, twice a day for 10 days). After 2 weeks of treatment, ocular inflammation was resolved, best corrected visual acuity was 0.1 (Snellen chart) and intraocular pressure was 18 mm Hg without topical hypotensive therapy.

Conclusion:

S. spiritivorum was isolated for the first time as a causative agent of endophthalmitis in humans. Bleb needle revision in patients with Xen gel implant is not free of complications, and an attentive follow-up is required.
Longitudinal assessment of coping and quality of life over 24 months postpartum in mothers living with HIV
Authors: Faria Evelise R , Gonçalves Tonantzin R , Carvalho Fernanda T , Piccinini Cesar A
Published: September 2019

This study investigated the influence of coping strategies on quality of life of mothers living with HIV over 24 months postpartum. Fifty-six Brazilian mothers living with HIV answered quality of life and coping scales at pregnancy, 3rd, 12th, and 24th month postpartum. Mixed model longitudinal regressions were conducted. Quality of life improved in physical, level of independence, and environmental domains over time. While problem-focused coping was positively associated with all changes in quality of life, emotionally focused strategies showed inverse association with physical and environmental quality of life. Health care should help mothers living with HIV to actively cope with HIV together with political and community efforts to address their social vulnerability.
Prevalence and determinants of motor stereotypies in autism spectrum disorder: A systematic review and meta-analysis
Authors: Melo Cláudia , Ruano Luís , Jorge Joana , Pinto Ribeiro Tiago , Oliveira Guiomar , Azevedo Luís , Temudo Teresa
Published: September 2019

Stereotypies are frequently reported in people with autism spectrum disorder (ASD) but remain one of the less explained phenomena. We aimed to describe, through a systematic review and a meta-analysis, the prevalence of motor stereotypies in ASD and study the factors that influence this prevalence. Our literature search included MEDLINE, Scopus, and PsycINFO databases. Quality and risk of bias were assessed. Thirty-seven studies were included and the median prevalence of motor stereotypies in ASD was 51.8%, ranging from 21.9% to 97.5%. The most frequent determinants associated with a higher number of stereotypies in ASD were a younger age, lower intelligence quotient, and a greater severity of ASD. Moreover, gender did not seem to influence the prevalence of stereotypies. Meta-analytic analysis showed that lower IQ and autism diagnosis (independent of IQ) are associated with a higher prevalence of motor stereotypies (odds ratio = 2.5 and 4.7, respectively). Limitations of the reviewed literature include the use of convenience samples, with small sizes and heterogeneous inclusion criteria, and the predominance of high-functioning autism individuals.
Angry, frustrated, and overwhelmed: The emotional experience of consuming news about President Trump
Authors: Wagner María Celeste , Boczkowski Pablo J
Published: September 2019

The emotional experience of consuming news about politics has been traditionally understudied. We aim to contribute to filling this void through a study of the emotional responses related to encountering stories about a high-profile political topic: the first 10 months of the administration of the US President, Donald Trump. To understand this, we draw upon 71 semi-structured interviews conducted in the greater metropolitan areas of Chicago, Miami and Philadelphia between January and October 2017. Our analysis indicates that: talking about political news often was a synonym of talking about President Trump; people expressed a high level of emotionality when recalling these experiences, which were more intense on social media and among those for whom the news felt more personal; feelings of anger or distress were often tied to wanting to increase political engagement; and individuals frequently develop mechanisms to cope with high levels of emotionality.
What is the evidence for the activities of Namaste Care? A rapid assessment review
Authors: Bray Jennifer , Brooker Dawn J , Garabedian Claire
Published: September 2019

Objectives

To assess the quality of research evidence for the different activity components for the psycho-social Namaste Care intervention for care home residents with advanced dementia.

Design

Namaste Care is a multi-component intervention delivered on a daily basis to people living with advanced dementia or people at end of life with dementia. A significant part of its operationalisation within care homes is the delivery of a number of activities delivered by trained in-house Namaste Care workers to a group of residents with similar high dependency needs. The Namaste Care workers focus on touch, music, nature, sensory experience, aromas and interactions with objects delivered in a way to enhance feelings of enjoyment and wellbeing. This review evaluated the evidence for using these activities with people living with advanced dementia. A systematic search of peer-reviewed research articles was conducted between November 2016 and September 2018 using search terms of activities used in Namaste Care. The quality of each accepted article was rated using the Rapid Evidence Assessment scale.

Results

The initial literature search returned 1341 results: 127 articles including 42 reviews were included. The majority of activity interventions yielded between 10 and 20 peer-reviewed papers. The use of smells and aromas, interacting with animals and dolls, the use of various forms of music (e.g. background music, singing, personalised music), nature, lighting, various forms of touch/massage and sensory interventions (including Snoezelen) all appear to have proven efficacy with people living with advanced dementia.

Conclusions

There is generally a limited number of research papers and reviews in this area, but overall there is a good evidence base for including these activities within Namaste Care for people living with advanced dementia.
Education and cosmopolitanism: Liberating our non-cosmopolitan minds through mindfulness
Authors: Ergas Oren
Published: September 2019

This paper locates the main challenge for education in cosmopolitanism within the nature of education when interpreted as a “mind-making process.” Based on this interpretation, education is currently a process that shapes non-cosmopolitan minds, for the practices generally associated with it habituate the human mind to see “reality” through contingent social narratives. The aspiration of education in cosmopolitanism to cultivate “a sense of feeling at home and caring for the world,” requires practices that also liberate the mind from the contingencies of the social narratives into which it happens to be born. For such purpose, education requires an ethical meta-narrative, which applies to all human beings and appeals to a mutual human language. Following calls for embracing a pluralistic epistemology in policy making, this paper proposes the interdisciplinary field of contemplative studies that focuses on the understanding of the embodied mind, as a point of origin for considering education as such and education in cosmopolitanism in particular. Mindfulness is then interpreted as one possible practical pedagogy based on which we can practice detachment from the contingency of social narratives by cultivating grounded-ness in the non-contingency of pre-conceptual embodied first-person experience.
The Relationship Between Temperament Traits and Post-Traumatic Stress Disorder Symptoms and Its Moderators: Meta-Analysis and Meta-Regression
Authors: Cyniak-Cieciura Maria , Zawadzki Bogdan
Published: September 2019

Posttraumatic stress disorder (PTSD) is a chronic and disabling reaction to extreme stress. Because of the strong consequences of long-lasting PTSD symptoms, the research of risk and protective factors is needed. Presented meta-analysis aimed to verify temperament traits according to the Regulative Theory of Temperament as risk/protective factors of PTSD symptoms development. The studies for this meta-analysis were found in four main databases of scientific journals and due to contact with first authors, the unpublished data was accessed as well. The inclusion criteria allowed studies with traumatized adult populations and operationalization of the temperament according to the Regulative Theory of Temperament. Finally, data were included from 19 studies (5971 people: 3443 men and 2528 females, in the age of 13-85) with prospective, longitudinal and cross-sectional study designs, carried out among people exposed to combat trauma, occupational trauma (policemen and fire-fighters), disasters (flood, fire and mining catastrophes), motor vehicle accidents and chronic illnesses. The results show significant moderate and weak relations of all temperament traits to PTSD symptoms regardless of people’s gender, type of study, type of trauma, DSM version and temperament measure as well as the time elapsed after the trauma. Among different moderators, a previously unrecognized effect of gender was revealed as it explained a significant amount of variance in the case of emotional reactivity, endurance, and perseveration - the relationship was significantly stronger among men than women. Methodological conclusions for further research on personality and trauma are drawn.
Blending Video-Reflexive Ethnography With Solution-Focused Approach: A Strengths-Based Approach to Practice Improvement in Health Care
Authors: Mesman J. , Walsh K. , Kinsman L. , Ford K. , Bywaters D.
Published: September 2019

Professionals seldom discuss those things that go well-rather the focus is often on problems, poor outcomes, and what does not go well. Exnovation is about illuminating the invisible or hidden strengths of existing practices in order to improve practice and is central to the contemporary, qualitative elicitation method: video-reflexive ethnography (VRE). VRE is a method to explore and articulate the taken for granted by means of short video clips of one’s own work practice that provides a basis for sharing experiences, assumptions, questions, and concerns about the way things are done in order to effect practice improvement. Reflexivity is key to the method. The creation of a safe space for this shared reflexivity is essential. Improvement activities frequently draw upon problem-focused approaches that imply blame and fault. Such approaches can serve to close down discussion, give rise to anxiety, and inhibit the very improvements sought. In contrast, a strengths-based, solution-focused approach serves to create the safe place where shared practices, rather than individuals, are the center of attention. By focusing on what works well practitioners are encouraged to identify and build on existing strengths. A solution-focused approach used alongside VRE provides a scaffold for building improvement that is relevant to context. In this article, we discuss exnovation, the elicitation method of video-reflexivity, and the incorporation of a strengths-based solution-focused approach with VRE. We highlight the transformative and complementary qualities of these methods and draw upon practical examples from health care to demonstrate how they serve to strengthen and enhance each other.
Conducting the Pilot Study: A Neglected Part of the Research Process? Methodological Findings Supporting the Importance of Piloting in Qualitative Research Studies
Authors: Malmqvist Johan , Hellberg Kristina , Möllås Gunvie , Rose Richard , Shevlin Michael
Published: September 2019

During the development of research to compare the processes and impact of inclusive education in Sweden with results obtained from a study undertaken in Ireland, a pilot study was conducted and documented. The pilot study had three aims: (1) to gather data to provide guidance for a substantive study adapted to Swedish conditions through modification of Irish research procedures and instruments, (2) to critically interrogate how we as researchers could most effectively conduct a pilot study utilizing observational and video-recorded data, and (3) to use the Irish theoretical model as a tool of analysis for studying inclusion in two Swedish schools. Although pilot studies are frequently conducted to assess the efficacy of research instruments for use in qualitative research projects, few publications have drawn upon empirical findings related to such studies. Additionally, while methodological texts recommend the use of pilot studies in qualitative research, there is a lack of reported research focusing on how to conduct such pilot studies. We argue that our methodological findings may contribute to greater awareness of the important role that a pilot study may have for full-scale qualitative research projects, for example, in case study research where semi-structured qualitative interviews are used. This argument is based on the assumption that researchers, and especially novice researchers, having conducted a pilot study will be better informed and prepared to face the challenges that are likely to arise in the substantive study and more confident in the instruments to be used for data collection. A proper analysis of the procedures and results from the pilot study facilitates the identification of weaknesses that may be addressed. A carefully organized and managed pilot study has the potential to increase the quality of the research as results from such studies can inform subsequent parts of the research process.
Professional perceptions of the care-crime connection: Risk, marketisation and a failing system
Authors: Shaw Julie , Greenhow Sarah
Published: September 2019

Reporting the findings from an English study of practitioners working within multi-agency settings, this article will explore their perceptions of the factors that contribute to the criminalisation of children in care. The findings support the contention that children get into trouble as a consequence of a number of system level deficiencies, along with a defensive, risk averse approach to practice which permeates throughout children’s social care and criminal justice agencies. The impact of an under-confident and transient residential care workforce is discussed, along with the privatisation of children’s home provision. Yet while residential care was confirmed as being the more problematic environment, children in foster care were not immune to unnecessary criminalisation. Unchanged, this will continue to produce negative outcomes in terms of criminalisation, the longer term effects of which will impact the life-chances of young people for years to come.
Emotional instability and expressive suppression are related to paranoia in daily life: An electronic mobile assessment study in nonclinical individuals
Authors: Nittel Clara Marie , Lamster Fabian , Rief Winfried , Kircher Tilo , Soll Daniel , Mehl Stephanie
Published: September 2019

Although instable negative emotions and problems in emotion regulation (ER) are common in patients with psychosis and are discussed as potential factors involved in the formation and maintenance of paranoia, it is unclear whether they increase the risk of developing paranoia in nonclinical controls. The present study aims to investigate whether the instability of negative emotions leads to paranoia in healthy participants. It should be further analyzed if the application of maladaptive ER strategies enhances subclinical paranoid ideation and if the use of adaptive ER strategies reduces subclinical paranoid ideation.

Method:

Nonclinical controls ( n = 83) repeatedly reported the presence and instability of negative emotions, paranoia, and the use of maladaptive (expressive suppression, rumination) and adaptive (reappraisal, acceptance) ER strategies in their daily life on six consecutive days using electronic mobile assessment.

Results:

Hierarchical linear regression analysis revealed that nonclinical controls reporting a pronounced instability of negative emotions showed more pronounced paranoia at a subsequent time point. Moreover, participants who used expressive suppression at a certain time experienced more severe paranoia at the subsequent time point.

Conclusion:

If these findings are confirmed in high-risk samples, ER processes could be considered as an additional factor in theoretical models of paranoia formation.
Clinician Satisfaction and Self-Efficacy With CenteringParenting Group Well-Child Care Model: A Pilot Study
Authors: Desai Shyam , Chen Futu , Boynton-Jarrett Renée
Published: September 2019

Introduction: Group-based models for well-child care have been shown to positively affect patient experience. One promising group well-child care model is CenteringParenting. However, clinician self-efficacy with delivery of the model is unknown and clinician satisfaction with the model has been understudied. Objectives: To investigate sense of self-efficacy, degree of satisfaction, and comfort with trauma-informed care (TIC) among diverse clinical providers implementing the CenteringParenting curriculum. We also examined the relationship between self-efficacy, satisfaction, and comfort with TIC, and delivery of the model. Methods: Electronic surveys were sent to CenteringParenting providers (N = 98) from 49 clinics. Providers (N = 41) from 24 clinical sites completed the survey, corresponding to a 42% individual and 49% site response rate. Surveys explored provider: satisfaction with the curriculum, perceived self-efficacy, and perspective on competency with TIC. Results: Providers indicated that the CenteringParenting model achieves each of its four objectives (means ranged from 4.10 to 4.52 for each objective, with 5 being the highest possible response). Providers rated their level of satisfaction (scale of 1 [unsatisfied] to 5 [very satisfied]) with their ability to address patient concerns higher with CenteringParenting in the group care setting (mean = 4.10) than in the individual care setting (mean = 3.55). Respondents demonstrated a high mean average Self-Efficacy in Group Care score of 93.63 (out of 110). Unadjusted logistical regression analyses demonstrated that higher provider Self-Efficacy in Group Care score (odds ratio [OR] = 1.08) and higher comfort with TIC (OR = 22.16) is associated with curriculum content being discussed with a facilitative approach. Conclusions: Providers from diverse clinical sites report high satisfaction with and self-efficacy in implementing the CenteringParenting model.
The Varied College Pathways of Latino Young Adults: A Narrative Study of Empowerment Theory
Authors: Arámbula Turner Tracy
Published: September 2019

School counselors are uniquely positioned to promote college going and improve lagging postsecondary matriculation for Latino men. Hipolito-Delgado and Lee’s empowerment framework guided this narrative inquiry to consider how school counselors (dis)empower Latinos via (in)access to college-going information. Findings revealed that participants experienced clear pathways or prohibitive roadblocks through the actions of school counselors as gatekeepers. Implications for school counseling practice and future research are situated within recommendations for creating more equitable college pathways.
School Counselors’ Experiences and Responses During the South Carolina “1,000-Year Flood”
Authors: Limberg Dodie , Ohrt Jonathan H. , Carlson Ryan G. , Bordonada Tiffany M. , Bates Douglas , Wymer Brooke C. , Guest Jessie D.
Published: September 2019

The purpose of our study was to explore the experiences of school counselors during the 2015 South Carolina “1,000-year flood.” We used consensual qualitative research methodology and identified seven domains that described the participants’ personal and professional experiences during and after the flood. We also identified the actions they took within their school system to respond to the aftermath of the flood. We discuss findings and implications for school counselors and school counselor educators.
Occipitocervical Fixation: General Considerations and Surgical Technique
Authors: Joaquim Andrei Fernandes , Osorio Joseph A. , Riew K. Daniel
Published: September 2019

Study Design:

Narrative literature review.

Objective:

To review and present details on the occipitocervical fixation (OCF) technique as well as considerations for planning the procedure.

Methods:

We present the surgical technique of OCF in a step-by-step didactic and practical manner with surgical tips and tricks, including C1 and C2 screw fixation techniques. Additionally, we discuss complications, the extension of fusion, types of OCF, and how to avoid common side effects associated with OCF.

Results:

The complex and mobile anatomy of the craniocervical junction, when requiring fixation and fusion, warrants rigid instrumentation that can be achieve using a modern screw-plate-rod construct. Indications for OCF are craniocervical instability, and atlantoaxial instability when selective atlantoaxial fusion is not feasible. OCF generally involves occiput-C2 fusion. C1 fixation is generally unnecessary, since it increases the surgical time and is associated with the risk of vascular complications. Selective occiput-C2 fusion is recommended when there is no need for including the cervical subaxial region (eg, when stenosis or fractures coexist in the subaxial spine), and good fixation is achieved at C2. Most instrumentation systems now have occipital plates that are not pre-integrated to rods, making fixation much simpler. Surgical steps, from position to wound closure, are presented in detail, with pearls for practice and discussion of cervical alignment.

Conclusions:

OCF is a challenging procedure, with potential risk of severe adverse effects. Understanding the surgical indications, as well as the nuances of the surgical technique, is required to improve patient outcomes and avoid complications.
Assessment of Surgical Procedural Time, Pedicle Screw Accuracy, and Clinician Radiation Exposure of a Novel Robotic Navigation System Compared With Conventional Open and Percutaneous Freehand Techniques: A Cadaveric Investigation
Authors: Vaccaro Alexander R. , Harris Jonathan A. , Hussain Mir M. , Wadhwa Rishi , Chang Victor W. , Schroerlucke Samuel R. , Samora Walter P. , Passias Peter G. , Patel Rakesh D. , Panchal Ripul R. , D’Agostino Sabino , Whitney Nathaniel L. , Crawford Neil R. , Bucklen Brandon S.
Published: September 2019

Study Design:

Cadaveric study.

Objective:

To evaluate accuracy, radiation exposure, and surgical time of a new robotic-assisted navigation (RAN) platform compared with freehand techniques in conventional open and percutaneous procedures.

Methods:

Ten board-certified surgeons inserted 16 pedicle screws at T10–L5 (n = 40 per technique) in 10 human cadaveric torsos. Pedicle screws were inserted with (1) conventional MIS technique (L2–L5, patient left pedicles), (2) MIS RAN (L2–L5, patient right pedicles), (3) conventional open technique (T10–L1, patient left pedicles), and (4) open RAN (T10–L1, patient right pedicles). Output included (1) operative time, (2) number of fluoroscopic images, and (3) screw accuracy.

Results:

In the MIS group, compared with the freehand technique, RAN allowed for use of larger screws (diameter: 6.6 ± 0.6 mm vs 6.3 ± 0.5 mm; length: 50.3 ± 4.1 mm vs 46.9 ± 3.5 mm), decreased the number of breaches >2 mm (0 vs 7), fewer fluoroscopic images (0 ± 0 vs 108.3 ± 30.9), and surgical procedure time per screw (3.6 ± 0.4 minutes vs 7.6 ± 2.0 minutes) (all P < .05). Similarly, in the open group, RAN allowed for use of longer screws (46.1 ± 4.1 mm vs 44.0 ± 3.8 mm), decreased the number of breaches >2 mm (0 vs 13), fewer fluoroscopic images (0 ± 0 vs 24.1 ± 25.8) (all P < .05), but increased total surgical procedure time (41.4 ± 8.8 minutes vs 24.7 ± 7.0 minutes, P = .000) while maintaining screw insertion time (3.31.4 minutes vs 3.1 ± 1.0 minutes, P = .650).

Conclusion:

RAN significantly improved accuracy and decreased radiation exposure in comparison to freehand techniques in both conventional open and percutaneous surgical procedures in cadavers. RAN significantly increased setup time compared with both conventional procedures.
Father communication coaching for children with autism spectrum disorder: A single-subject study
Authors: Flippin Michelle
Published: September 2019

Background and aims

Parent-mediated interventions have been shown to be effective for improving communication skills for children with autism spectrum disorder when implemented by mothers. Little is known about the efficacy of autism spectrum disorder communication interventions implemented by fathers. This study investigated the effects of a 12-week coaching program on a father’s use of responsive strategies. Targeted responsive strategies included follow-in comments, follow-in directives, responsive physical play, and responsive object play. Collateral measures of changes to child communication skills and parental stress levels were also investigated.

Methods

A single subject, multiple baselines across behaviors experiment was conducted with one dyad (i.e. father and child with autism spectrum disorder).

Results

Results showed that the participating father was able to quickly learn to use three of the four targeted responsive strategies (i.e. follow-in comments, follow-in directives, responsive physical play). Child’s use of single words increased over baseline level and beginning use of multi-word utterances was documented. Pre–post intervention changes in ratings of stress for the participating father and mother were noted across child and parent domains.

Conclusions and implications

Findings of this pilot study may have important implications for developing much-needed parent coaching programs to enhance fathers’ use of responsive strategies and increase social communication skills for children with autism spectrum disorder.
Measurable residual disease monitoring in acute myeloid leukemia with t(8;21)(q22;q22.1): results from the AML Study Group
Authors: Rücker Frank G. , Agrawal Mridul , Corbacioglu Andrea , Weber Daniela , Kapp-Schwoerer Silke , Gaidzik Verena I. , Jahn Nikolaus , Schroeder Thomas , Wattad Mohammed , Lübbert Michael , Koller Elisabeth , Kindler Thomas , Götze Katharina , Ringhoffer Mark , Westermann Jörg , Fiedler Walter , Horst Heinz A. , Greil Richard , Schroers Roland , Mayer Karin , Heinicke Thomas , Krauter Jürgen , Schlenk Richard F. , Thol Felicitas , Heuser Michael , Ganser Arnold , Bullinger Lars , Paschka Peter , Döhner Hartmut , Döhner Konstanze
Published: September 2019

Key Points

MRD assessment in t(8;21) AML allows identification of patients at high relapse risk at defined time points during treatment and follow-up. MRD− after treatment is the most favorable factor for relapse risk and survival, and serial MRD analyses define cutoffs predicting relapse.
Are river protected areas sufficient for fish conservation? Implications from large-scale hydroacoustic surveys in the middle reach of the Yangtze River
Authors: Xie Xiao , Zhang Hui , Wang Chengyou , Wu Jinming , Wei Qiwei , Du Hao , Li Junyi , Ye Huan
Published: September 2019

Background

The Yangtze River is the third largest river in the world and suffers from extensive anthropogenic impacts. The fishes in the Yangtze River are essential for the sustainable development of freshwater fisheries and the conservation of aquatic biodiversity in China. However, the fishery resources in the Yangtze River Basin have shown rapid decline due to various human activities. In recent years, nature reserves and germplasm resource reserves have become important means to protect fishes in the Yangtze River. However, nature reserves and germplasm resource reserves that regard freshwater fishes as the main object of protection are not common and have been rarely studied in China. In this paper, a hydroacoustic method and systematic conservation planning tool (Marxan) were combined to evaluate the effectiveness of reserves based on the spatial and temporal patterns of mature fishes in the middle reach of the Yangtze River (MRYR) from 2010 to 2017.

Results

The hydroacoustic survey results indicated that in the longitudinal direction, low densities of mature fish species were observed in the Jingzhou (S2) and Jianli (S4, S5, S6) sections, whereas high densities of fish were observed in other sections, such as the Yichang (S1), Chenglingji to Huangsangkou (S7–S12), and Hukou (S15) sections. Among the regions preferred by fish, S7, S10 and S12 were non-reserves. No significant difference in mature fish density was observed between the non-reserves and nature reserves, and a similar result was obtained between the non-reserves and germplasm resource reserves. In Marxan, the optimal conservation sites selected for habitat restoration, such as the Chenglingji, Dengjiakou, Zhuankou, Hankou, Yangluo, and Huangsangkou sections, which are located in non-reserves, were identified in the MRYR.

Conclusions

The Chenglingji, Dengjiakou, Zhuankou, Hankou, Yangluo, and Huangsangkou sections, which are located in non-reserves, play equally important roles in the conservation of fish populations in the MRYR. Our results indicated that further optimization is urgently needed for the currently protected areas in this region. These areas should be designated as reserves, and classification protection mechanisms should be adopted to strengthen the effectiveness of fish conservation in the MRYR.
Combining serological and contact data to derive target immunity levels for achieving and maintaining measles elimination
Authors: Funk Sebastian , Knapp Jennifer K. , Lebo Emmaculate , Reef Susan E. , Dabbagh Alya J. , Kretsinger Katrina , Jit Mark , Edmunds W. John , Strebel Peter M.
Published: September 2019

Background

Vaccination has reduced the global incidence of measles to the lowest rates in history. However, local interruption of measles virus transmission requires sustained high levels of population immunity that can be challenging to achieve and maintain. The herd immunity threshold for measles is typically stipulated at 90–95%. This figure does not easily translate into age-specific immunity levels required to interrupt transmission. Previous estimates of such levels were based on speculative contact patterns based on historical data from high-income countries. The aim of this study was to determine age-specific immunity levels that would ensure elimination of measles when taking into account empirically observed contact patterns.

Methods

We combined estimated immunity levels from serological data in 17 countries with studies of age-specific mixing patterns to derive contact-adjusted immunity levels. We then compared these to case data from the 10 years following the seroprevalence studies to establish a contact-adjusted immunity threshold for elimination. We lastly combined a range of hypothetical immunity profiles with contact data from a wide range of socioeconomic and demographic settings to determine whether they would be sufficient for elimination.

Results

We found that contact-adjusted immunity levels were able to predict whether countries would experience outbreaks in the decade following the serological studies in about 70% of countries. The corresponding threshold level of contact-adjusted immunity was found to be 93%, corresponding to an average basic reproduction number of approximately 14. Testing different scenarios of immunity with this threshold level using contact studies from around the world, we found that 95% immunity would have to be achieved by the age of five and maintained across older age groups to guarantee elimination. This reflects a greater level of immunity required in 5–9-year-olds than established previously.

Conclusions

The immunity levels we found necessary for measles elimination are higher than previous guidance. The importance of achieving high immunity levels in 5–9-year-olds presents both a challenge and an opportunity. While such high levels can be difficult to achieve, school entry provides an opportunity to ensure sufficient vaccination coverage. Combined with observations of contact patterns, further national and sub-national serological studies could serve to highlight key gaps in immunity that need to be filled in order to achieve national and regional measles elimination.
Phasin PhaP1 is involved in polyhydroxybutyrate granules morphology and in controlling early biopolymer accumulation in Azospirillum brasilense Sp7
Authors: Martínez-Martínez María de los Angeles , González-Pedrajo Bertha , Dreyfus Georges , Soto-Urzúa Lucía , Martínez-Morales Luis Javier
Published: September 2019

Phasins are amphiphilic proteins involved in the regulation of the number and size of polyhydroxybutyrate (PHB) granules. The plant growth promoting bacterium Azospirillum brasilense Sp7 accumulates high quantities of bioplastic PHB as carbon and energy source. By analyzing the genome, we identified six genes that code for proteins with a Phasin_2 domain. To understand the role of A. brasilense Sp7 PhaP1 (PhaP1Abs) on PHB synthesis, the phaP1 gene (AMK58_RS17065) was deleted. The morphology of the PHB granules was analyzed by transmission electron microscopy (TEM) and the PHB produced was quantified under three different C:N ratios in cultures subjected to null or low-oxygen transfer. The results showed that PhaP1Abs is involved in PHB granules morphology and in controlling early biopolymer accumulation. Using RT-PCR it was found that phasin genes, except phaP4, are transcribed in accordance with the C:N ratio used for the growth of A. brasilense. phaP1, phaP2 and phaP3 genes were able to respond to the growth conditions tested. This study reports the first analysis of a phasin protein in A. brasilense Sp7.
Developing a Highly Specific Biomarker for Germ Cell Malignancies: Plasma miR371 Expression Across the Germ Cell Malignancy Spectrum
Authors: Nappi Lucia , Thi Marisa , Lum Amy , Huntsman David , Eigl Bernie J. , Martin Christopher , O’Neil Brock , Maughan Benjamin L. , Chi Kim , So Alan , Black Peter C. , Gleave Martin , Wyatt Alex W. , Lavoie Jean Michel , Khalaf Daniel , Bell Robert , Daneshmand Siamak , Hamilton Robert J. , Leao Ricardo R.N. , Nichols Craig , Kollmannsberger Christian
Published: September 2019

PURPOSE

Our objective was to evaluate operating characteristics, particularly specificity and positive predictive value (PPV), by mapping plasma miR371 expression to actual clinical events in patients with a history of germ cell tumor.

PATIENTS AND METHODS

One hundred eleven male patients with a history of or newly diagnosed germ cell tumors were evaluable. Biospecimens obtained before confirmed clinical events were analyzed for miR371 expression with blinding of providers and laboratory personnel to analytic results or clinical status, respectively. Cases (patients with clinically confirmed active germ cell malignancy [aGCM]) and controls (patients with no clinically confirmed aGCM) were assigned over the course of the management. Patients were assigned risk status (high, low, or moderate) based on the composite clinical picture at time points in management.

RESULTS

Considering all cases and controls and results of prospectively obtained biosamples analyzed for miR371 expression, 46 (35%) of 132 samples had clinically confirmed aGCM over the course of management; 44 (96%) of these 46 patients had plasma miR371 expression (true positives) with no false positives. Two (4%) of 46 patients had no miRNA expression despite pathologic confirmation of aGCM (false negatives). Plasma miR371 expression in confirmed aGCM had a specificity, sensitivity, positive predictive value, and negative predictive value of 100%, 96%, 100%, and 98%, respectively. Interpretation of sensitivity and negative predictive value is limited by modest follow-up. Specificity and sensitivity were 100% and 98%, 100% and 92%, and 100% and 97% in the low-, moderate-, and high-risk groups, respectively, with a median follow-up time of 15 months.

CONCLUSION

Plasma miR371 expression predicts aGCM with high specificity and positive predictive value. Although other operating characteristics of miR371 await longer follow-up for more complete definition, the findings of a highly specific liquid biopsy strongly support moving forward with large-scale, real-world clinical trials to further define full operating characteristics and to identify clinical utility and areas of patient benefit.
Treatment of Childhood Nasopharyngeal Carcinoma With Induction Chemotherapy and Concurrent Chemoradiotherapy: Results of the Children’s Oncology Group ARAR0331 Study
Authors: Rodriguez-Galindo Carlos , Krailo Mark D. , Krasin Matthew J. , Huang Li , McCarville M. Beth , Hicks John , Pashankar Farzana , Pappo Alberto S.
Published: September 2019

PURPOSE

The treatment of childhood nasopharyngeal carcinoma has been adapted from adult regimens; pediatric-specific studies are limited. The ARAR0331 study sought to evaluate the impact of induction chemotherapy (IC) and concurrent chemoradiotherapy (CCR).

PATIENTS AND METHODS

Patients with American Joint Committee on Cancer stages IIb to IV were scheduled to receive three cycles of IC with cisplatin and fluorouracil, followed by CCR with three cycles of cisplatin. Patients with complete or partial response to IC received 61.2 Gy to the nasopharynx and neck, and patients with stable disease received 71.2 Gy.

RESULTS

Between February 2006 and January 2012, 111 patients (75 male) were enrolled. Median age was 15 years, and 46.8% of the patients were African American. After a feasibility analysis, the study was amended to reduce cisplatin to two cycles during CCR. The 5-year event-free survival (EFS) and overall survival estimates were 84.3% and 89.2%, respectively. The 5-year EFS for stages IIb, III, and IV were 100%, 82.8%, and 82.7%, respectively. The 5-year cumulative incidence estimates of local, distant, and combined relapse were 3.7%, 8.7%, and 1.8%, respectively. Patients treated with three versus two CCR cycles of cisplatin had improved 5-year postinduction EFS (90.7% v 81.2%, P = .14).

CONCLUSION

Patients in ARAR0331 were characterized by advanced disease and by a high proportion of black children and adolescents. Treatment with IC and CRT resulted in excellent outcomes. A radiation dose reduction is possible for patients responding to IC. Although the outcomes are comparable, we observed a trend toward decreased EFS for patients assigned to receive fewer doses of cisplatin during CCR.
Relationship Between Number of Multiple Risk Factors and Coronary Artery Disease Risk With and Without Diabetes Mellitus
Authors: Yamada-Harada Mayuko , Fujihara Kazuya , Osawa Taeko , Yamamoto Masahiko , Kaneko Masanori , Kitazawa Masaru , Matsubayashi Yasuhiro , Yamada Takaho , Yamanaka Nauta , Seida Hiroyasu , Ogawa Wataru , Sone Hirohito
Published: September 2019

Purpose

To determine the degree of control of multiple risk factors under real-world conditions for coronary artery disease (CAD) according to the presence or absence of diabetes mellitus (DM) and to determine whether reaching multifactorial targets for blood pressure (BP), low-density lipoprotein-cholesterol (LDL-C), HbA1c, and current smoking is associated with lower risks for CAD.

Methods

We investigated the effects on subsequent CAD of the number of controlled risk factors among BP, LDL-C, HbA1c, and current smoking in a prospective cohort study using a nationwide claims database of 220,894 individuals in Japan. Cox regression examined risks over a 4.8-year follow-up.

Results

The largest percentage of participants had two risk factors at target in patients with DM (39.6%) and subjects without DM (36.4%). Compared with those who had two targets achieved, the risks of CAD among those who had any one and no target achieved were two and four times greater, respectively, regardless of the presence of DM. The effect of composite control was sufficient to bring CAD risk in patients with DM below that for subjects without DM with any two targets achieved, whereas the risk of CAD in the DM group with all four risk factors uncontrolled was 9.4 times more than in the non-DM group who had achieved two targets.

Conclusions

These findings show that composite control of modifiable risk factors has a large effect in patients with and without DM. The effect was sufficient to bring CAD risk in patients with DM below that in the non-DM group who had two targets achieved.
Exon size and sequence conservation improves identification of splice-altering nucleotides
Authors: Movassat Maliheh , Forouzmand Elmira , Reese Fairlie , Hertel Klemens J.
Published: September 2019

Pre-mRNA splicing is regulated through multiple trans-acting splicing factors. These regulators interact with the pre-mRNA at intronic and exonic positions. Given that most exons are protein coding, the evolution of exons must be modulated by a combination of selective coding and splicing pressures. It has previously been demonstrated that selective splicing pressures are more easily deconvoluted when phylogenetic comparisons are made for exons of identical size, suggesting that exon size–filtered sequence alignments may improve identification of nucleotides evolved to mediate efficient exon ligation. To test this hypothesis, an exon size database was created, filtering 76 vertebrate sequence alignments based on exon size conservation. In addition to other genomic parameters, such as splice-site strength, gene position, or flanking intron length, this database permits the identification of exons that are size- and/or sequence-conserved. Highly size-conserved exons are always sequence-conserved. However, sequence conservation does not necessitate exon size conservation. Our analysis identified evolutionarily young exons and demonstrated that length conservation is a strong predictor of alternative splicing. A published data set of approximately 5000 exonic SNPs associated with disease was analyzed to test the hypothesis that exon size–filtered sequence comparisons increase detection of splice-altering nucleotides. Improved splice predictions could be achieved when mutations occur at the third codon position, especially when a mutation decreases exon inclusion efficiency. The results demonstrate that coding pressures dominate nucleotide composition at invariable codon positions and that exon size–filtered sequence alignments permit identification of splice-altering nucleotides at wobble positions.