bluuebunny/crossref_metadata_2025 huggingface dataset:
Successive matings affect copulatory courtship but not sperm transfer in a spider model
Authors: Cargnelutti Franco , Calbacho-Rosa Lucia , Córdoba-Aguilar Alex , Peretti Alfredo Vicente
Published: November 2021

Previous studies have reported that males augment their reproductive success by increasing the number of females with which they copulate, and that such copulations are not energetically demanding in terms of trivial sperm production costs. However, we now know that males do pay reproductive costs. As males mate successively, a reduction in the performance of copulatory behaviours would be expected, as well as in the number of sperm transferred. Here we compared the duration of courtship, mating and post-insemination phase, the number of genital and non-genital copulatory courtship occurrences, and the number of sperm transferred in successive matings in Holocnemus pluchei spider males. As matings increased in males, there was no effect on the duration of courtship, mating or post-insemination phase. Interestingly, genital copulatory courtship varied in successive copulations depending on male size, but there was no change in the number of sperm transferred. In addition, the occurrence of non-genital copulatory courtship decreased along successive copulations. The negative effects of successive matings on copulatory courtship indicate that these behaviours are costly for males, except for the number of sperm transferred. Our research lays the foundation for future studies on male costs as a function of mating history in spiders.
Dissociating value-based neurocomputation from subsequent selection-related activations in human decision-making
Authors: Liu Zhiyuan , Liu Sijia , Li Shuang , Li Lin , Zheng Li , Weng Xue , Guo Xiuyan , Lu Yang , Men Weiwei , Gao Jiahong , You Xuqun
Published: November 2021

Human decision-making requires the brain to fulfill neural computation of benefit and risk and therewith a selection between options. It remains unclear how value-based neural computation and subsequent brain activity evolve to achieve a final decision and which process is modulated by irrational factors. We adopted a sequential risk-taking task that asked participants to successively decide whether to open a box with potential reward/punishment in an eight-box trial, or not to open. With time-resolved multivariate pattern analyses, we decoded electroencephalography and magnetoencephalography responses to two successive low- and high-risk boxes before open-box action. Referencing the specificity of decoding-accuracy peak to a first-stage processing completion, we set it as the demarcation and dissociated the neural time course of decision-making into valuation and selection stages. The behavioral hierarchical drift diffusion modeling confirmed different information processing in two stages, that is, the valuation stage was related to the drift rate of evidence accumulation, while the selection stage was related to the nondecision time spent in response-producing. We further observed that medial orbitofrontal cortex participated in the valuation stage, while superior frontal gyrus engaged in the selection stage of irrational open-box decisions. Afterward, we revealed that irrational factors influenced decision-making through the selection stage rather than the valuation stage.
Separation and Characterization of the Related Substances of Bedaquiline Fumarate Using HPLC and Spectral Methods
Authors: Baksam Vijaya Kumar , Nimmakayala Saritha , Pocha Vasundara Reddy , Gouri Bhattacharyya , Shandilya Sanjeev , Kumar Pramod
Published: November 2021

The study focuses on isolating and characterizing the potential degradation products (DPs) and impurities of Bedaquiline fumarate in bulk drug form. A stability-indicating related substance method was developed and validated using high-performance liquid chromatography. Agilent Poroshell 120EC- C18 (150 mm × 4.6 mm, 2.7 μm) column showed an optimum separation of 10 analytes. The mobile phase contained 0.05% trifluoroacetic acid, acetonitrile and methanol in a time gradient mode. Bedaquiline fumarate was susceptible to acid hydrolysis, oxidation, base hydrolysis and showed three potential DPs, including DP-1, DP-2 and Impurity-8. Degradation products, DP-1 and DP-2, were isolated and characterized by ESI-MS, 1H, NMR and 13C NMR spectroscopy. The developed method was validated according to ICH tripartite guidelines and showed adequate specificity, accuracy and linearity. The limit of detection and limit of quantitation were 0.05 and 0.15 μg/mL, respectively.
Pleural effusion in Klippel–Trenaunay syndrome: an uncommon manifestation
Authors: Levy Faber Dan , Galili Ronen , Sharoni Erez
Published: November 2021

Klippel–Trenaunay syndrome is characterized by a combination of vascular abnormalities and limb hypertrophy. Pleural effusion as a manifestation of this syndrome is almost never mentioned in the literature. We present a case of persistent bilateral pleural effusion in a patient with Klippel–Trenaunay syndrome and share our experiences treating this scenario.
On Weak and Viscosity Solutions of Nonlocal Double Phase Equations
Authors: Fang Yuzhou , Zhang Chao
Published: November 2021

We consider the nonlocal double phase equation $$\begin{align*} \textrm{P.V.} &\int_{\mathbb{R}^n}|u(x)-u(y)|^{p-2}(u(x)-u(y))K_{sp}(x,y)\,\textrm{d}y\\ &+\textrm{P.V.} \int_{\mathbb{R}^n} a(x,y)|u(x)-u(y)|^{q-2}(u(x)-u(y))K_{tq}(x,y)\,\textrm{d}y=0, \end{align*}$$where $1<p\leq q$ and the modulating coefficient $a(\cdot ,\cdot )\geq 0$. Under some suitable hypotheses, we first use the De Giorgi–Nash–Moser methods to derive the local Hölder continuity for bounded weak solutions and then establish the relationship between weak solutions and viscosity solutions to such equations.
A ‘Sufi’ epistle on spiritual poverty, and its authors: authenticity, authority, and genre in textual reproduction
Authors: Kars Aydogan
Published: November 2021

A range of widely copied Arabic works on asceticism and spiritual poverty attributed to prominent Muslim scholars, Najm al-Dīn al-Kubrā, ʿUmar al-Suhrawardī, Yaḥyā al-Suhrawardī, Athīr al-Dīn al-Abharī, and Aḥmad Zarrūq, are either identical, or contain significant overlaps. This paper analyses the content and reception of this work, and the 36 manuscripts of it available, in order to clarify the issues around its authenticity, authorship, and genre. It makes four key arguments. First, it argues that Minhāj al-sālikīn widely attributed to al-Kubrā is not an authentic work. It is a recent ascription that invents this title and changes the creedal content of an originally longer work. Second, a shorter version of this work can be ascribed to ʿUmar al-Suhrawardī in a particular sense of pre-modern authorship. He compiled a selection from the longer work that was penned by someone else––in the same way his Irshād al-murīdīn is mostly selections from al-Qushayrī’s Risāla. Third, different versions of the treatise are mistakenly attributed to Zarrūq, Athīr al-Dīn al-Abharī, and Yaḥyā al-Suhrawardī in various publications and manuscripts. Finally, the original version was penned by one of the less-known teachers of Ibn al-ʿArabī, Abū ʿAmr ʿUthmān al-Abharī, and soon attributed to more celebrated figures. Through these later agents and their attributions, reproductions, redactions, and publications, the text came to be situated within a Sufi framework and genre. Thus, the epistle on poverty exemplifies not only the construction of ‘Sufism’ as a genre beyond the authorial intention, but also the dispersal of the author-function typical for this genre.
Women at the Table: Identifying Factors through Which Women Have the Opportunity to Influence Peace Agreement Design
Authors: Aduda Levke , Liesch Johanna
Published: November 2021

United Nations Resolution 1325 asks all participants of peace talks to take on a gender perspective during negotiations. Consequently, the overall proportion of women participating in peace negotiations has increased; with this increase, more gender-specific topics are placed on the agenda of peace talks. However, because women are often invited to the negotiation table for window-dressing purposes only, the question arises: how do women at the negotiation table influence the scope and specificity of peace agreements regarding gender provisions? We argue that to influence peace agreements regarding gender provisions, delegates need to have the willingness and the opportunity to push for their inclusion. In our theoretical argument, we identify different factors through which female delegates have the opportunity to do so. Analyzing the peace processes in the Democratic Republic of the Congo, the Philippines, South Sudan, and Nepal we find that a combination of factors at and aside the negotiation table allows women to influence peace talks regarding the inclusion and specificity of gender provisions in peace agreements. Our findings imply that women need to have the opportunity to influence the talks; their sole presence does not suffice for the implementation of Resolution 1325.
A case of haemorrhagic cholecystitis with no risk factors
Authors: Khan Hotak Mirwais , Joseph Christo
Published: November 2021

Haemorrhagic cholecystitis (HC) is a rare cause of cholecystitis that can be fatal if management is delayed. HC could present in the setting of trauma, malignancy and bleeding diathesis, such as renal failure, cirrhosis and anticoagulation. Its symptoms are easily confused with acute calculous or acalculous cholecystitis and might include haemobilia or hematemesis as blood drains from the gallbladder into the gastrointestinal tract. Imaging of HC can be misleading unless the possibility of this diagnosis is considered. In this report, we present an interesting case of HC in a patient with none of the above comorbidities and the patient who was not on anticoagulation neither anti platelets. The case includes relevant imaging and a review of the literature on this rare subject.
A case of naevus sebaceus of Jadassohn of the scalp in Jamaica
Authors: Williams Geoffrey , Diaz Gabriella , Blake Garfield
Published: November 2021

Naevus sebaceus (NS), also referred to as NS of Jadassohn, is a rare non-melanocytic congenital cutaneous hamartoma with mainly sebaceous differentiation. NS has pluripotent potential with the possible evolution of benign and/or malignant neoplastic transformation. Literature of clinical audit and retrospective analyses conclude that there is no need for prophylactic excision except for cases in which malignant transformation is suspected. Although malignant transformation is rare, there are psychosocial issues with which to contend. We present a case of a 5 year-old girl with a cerebriform mass to her right parietal scalp, which was present at birth.
CmFSI8/CmOFP13 encoding an OVATE family protein controls fruit shape in melon
Authors: Ma Jian , Li Congcong , Zong Mei , Qiu Yanhong , Liu Yuemin , Huang Yating , Xie Yuli , Zhang Huijun , Wang Jianshe
Published: November 2021

Fruit shape is an important quality and yield trait in melon (Cucumis melo). Although some quantitative trait loci for fruit shape have been reported in in this species, the genes responsible and the underlying mechanisms remain poorly understood. Here, we identified and characterized a gene controlling fruit shape from two melon inbred lines, B8 with long-horn fruit and HP22 with flat-round fruit. Genetic analysis suggested that the shape was controlled by a single and incompletely dominant locus, which we designate as CmFSI8/CmOFP13. This gene was finely mapped to a 53.7-kb interval on chromosome 8 based on bulked-segregant analysis sequencing and map-based cloning strategies. CmFSI8/CmOFP13 encodes an OVATE family protein (OFP) and is orthologous to AtOFP1 and SlOFP20. The transcription level of CmFSI8/CmOFP13 in the ovary of HP22 was significantly higher than that in B8, and sequence analysis showed that a 12.5-kb genomic variation with a retrotransposon insertion identified in the promoter was responsible for elevating the expression, and this ultimately caused the differences in fruit shape. Ectopic overexpression of CmFSI8/CmOFP13 in Arabidopsis led to multiple phenotypic changes, including kidney-shaped leaves and shortened siliques. Taken together, our results demonstrate the involvement of an OFP in regulating fruit shape in melon, and our improved understanding of the molecular mechanisms will enable us to better manipulate fruit shape in breeding.
Gödelian sentences, Rosserian sentences and truth
Authors: Assadi Ziba , Salehi Saeed
Published: November 2021

There is a long-standing debate in the logico-philosophical community as to if/why the Gödelian sentences of a consistent and sufficiently strong theory are true ($\gamma $ is a Gödelian sentence of $T$ when $\gamma $ is equivalent to the $T$-unprovability of $\gamma $ inside $T$). The prevalent argument seems to be something like the following: since every one of the Gödelian sentences of such a theory is equivalent to the consistency statement of the theory, even provably so inside the theory, the truth of those sentences follows from the consistency of the theory in question; so, Gödelian sentences of consistent and sufficiently strong theories are true. In this paper, we critically examine this argument and present necessary and sufficient conditions for the truth of Gödelian sentences (and Rosserian sentences) of consistent and sufficiently strong arithmetical theories.
Origin of cool cores, cold fronts, and spiral structures in cool core clusters of galaxies
Authors: Inoue Hajime
Published: November 2021

We consider a situation in which a brightest cluster galaxy (BCG) moves in ambient hot gas in the central region of a cool core cluster of galaxies, following the study by Inoue (2014, PASJ, 66, 60). In the rest frame of the BCG, the hot gas is supposed to flow toward the BCG in parallel from a sufficiently large distance. Then, it is expected that only the gas flowing with an impact parameter less than a critical value is trapped by the gravitation field of the BCG because of the efficient radiative cooling, getting a cooling flow, and that the remaining outer gas can get over the potential well. In such a circumstance, we can draw the following picture: A boundary layer between the out-flowing gas and the trapped gas arises around the stagnation point at the back side of the BCG. Since the boundary temperature is so low as to be X-ray dim, the boundary could be observed as the cold front in X-rays. The trapped gas stagnates on the inner side of the boundary and starts in-falling toward the BCG. Since the wandering motion of the BCG is likely to have a rotational component, the Coriolis force induces a rotational motion in the in-falling flow from the stagnation place to the BCG, forming a spiral structure around the BCG. The spiraling flow turns the BCG on the up stream side of the main flow from the far outside, and another boundary layer arises that has contact discontinuity with the main hot gas flow. These pictures reproduce the observed features such as cool cores, cold fronts, and spiral structures well. It can also be resolved how the cooling flow is suppressed from what the cooling flow hypothesis predicts, without any heating mechanism.
EEG alpha and theta signatures of socially and non-socially cued working memory in virtual reality
Authors: Gregory Samantha E A , Wang Hongfang , Kessler Klaus
Published: November 2021

In this preregistered study (https://osf.io/s4rm9) we investigated the behavioural and neurological [electroencephalography; alpha (attention) and theta (effort)] effects of dynamic non-predictive social and non-social cues on working memory. In a virtual environment realistic human-avatars dynamically looked to the left or right side of a table. A moving stick served as a non-social control cue. Kitchen items were presented in the valid cued or invalid un-cued location for encoding. Behavioural findings showed a similar influence of the cues on working memory performance. Alpha power changes were equivalent for the cues during cueing and encoding, reflecting similar attentional processing. However, theta power changes revealed different patterns for the cues. Theta power increased more strongly for the non-social cue compared to the social cue during initial cueing. Furthermore, while for the non-social cue there was a significantly larger increase in theta power for valid compared to invalid conditions during encoding, this was reversed for the social cue, with a significantly larger increase in theta power for the invalid compared to valid conditions, indicating differences in the cues’ effects on cognitive effort. Therefore, while social and non-social attention cues impact working memory performance in a similar fashion, the underlying neural mechanisms appear to differ.
Telehealth Professionalism Education for Advanced Practice Nursing Students
Authors: Chike-Harris Katherine E. , Lauerer Joy , Powers Angie , Stanley Angela
Published: November 2021

Telehealth professionalism is an often-overlooked element when performing telehealth visits, but it is one that can impact patient and provider satisfaction with this health care delivery modality. This article describes a telehealth professionalism activity that was integrated into the education of advanced practice registered nursing students as one part of their telehealth education. Attainment in knowledge with this activity, in conjunction with positive student feedback, shows promise regarding the impact of the educational intervention and its sustainability.
Diotic and Antiphasic Digits-in-noise Testing as a Hearing Screening and Triage Tool to Classify Type of Hearing Loss
Authors: De Sousa Karina C. , Smits Cas , Moore David R. , Myburgh Hermanus C. , Swanepoel De Wet
Published: November 2021

Objectives:

The digits-in-noise test (DIN) is a popular self-test measure that has traditionally been used to screen for hearing loss by providing either a pass or refer result. Standard approaches either tested each ear monaurally or used a binaural diotic version where identical digits and noise were presented simultaneously to both ears. Recently, a dichotic, antiphasic version was developed, increasing sensitivity of the DIN to unilateral or asymmetric sensorineural hearing loss (SNHL) and conductive hearing loss (CHL). The purpose of this study was to determine predictors and normative ranges of the antiphasic and diotic DIN and to determine if a combination of diotic and antiphasic DIN could accurately categorize hearing into (1) normal, (2) bilateral SNHL, or (3) unilateral SNHL or CHL.

Design:

The analytical sample consisted of 489 participants between the ages of 18 and 92 years with varying types, symmetry, and degrees of hearing loss. Degree and type of hearing loss were determined based on standard clinical four-frequency (0.5–4 kHz) pure-tone air and bone conduction threshold averages. The sample consisted of bilateral normal hearing (n = 293), bilateral SNHL (n = 172), unilateral SNHL (n = 42), and CHL (n = 32). All participants (n = 489) first completed an antiphasic DIN (digit stimuli 180° out-of-phase between ears), while 393 of the sample also completed a diotic DIN. Two procedures were assessed for their ability to categorize hearing into one of the three hearing groups. The first used a fixed antiphasic cutoff combined with a cutoff formed by a linear combination of antiphasic and diotic speech recognition threshold (SRT) or binaural intelligibility-level difference.

Results:

Poorer ear pure-tone average was the strongest predictor of antiphasic DIN score, whereas better ear pure-tone average explained more of the variance in diotic SRT. The antiphasic DIN sensitivity and specificity was 90% and 84%, respectively, for detecting hearing loss, with outstanding area under the receiver operating characteristics values exceeding 0.93 to identify hearing loss in the poorer ear. The first fixed SRT cutoff procedure could categorize 75% of all participants correctly, while the second procedure increased correct categorization to 79%. False negative rates for both procedures were below 10%.

Conclusions:

A sequential antiphasic and diotic DIN could categorize hearing to a reasonable degree into three groups of (1) normal hearing; (2) bilateral SNHL; and (3) unilateral asymmetric SNHL or CHL. This type of approach could optimize care pathways using remote and contactless testing, by identifying unilateral SNHL and CHL as cases requiring medical referral. In contrast, bilateral SNHL cases could be referred directly to an audiologist, or nontraditional models like OTC hearing aids.
Methods of Quantifying Intraoperative Blood Loss in Orthopaedic Trauma Surgery: A Systematic Review
Authors: McKibben Natasha S. , Lindsay Sarah E. , Friess Darin M. , Zusman Natalie L. , Working Zachary M.
Published: November 2021

Objectives:

To collect and present the recently published methods of quantifying blood loss (BL) in orthopaedic trauma.

Data Sources:

A systematic review of English-language literature in PubMed, Cochrane Library, and Scopus databases was conducted according to the PRISMA guidelines on articles describing the methods of determining BL in orthopaedic trauma published since 2010.

Study Selection:

English, full-text, peer-reviewed articles documenting intraoperative BL in an adult patient population undergoing orthopaedic trauma surgery were eligible for inclusion.

Data Extraction:

Two authors independently extracted data from the included studies. Articles were assessed for quality and risk of bias using the Cochrane Collaboration's tool for assessing risk of bias and ROBINS-I.

Data Synthesis:

The included studies proved to be heterogeneous in nature with insufficient data to make data pooling and analysis feasible.

Conclusions:

Eleven methods were identified: 6 unique formulas with multiple variations, changes in hemoglobin and hematocrit levels, measured suction volume and weighed surgical gauze, transfusion quantification, cell salvage volumes, and hematoma evacuation frequency. Formulas included those of Gross, Mercuriali, Lisander, Sehat, Foss, and Stahl, with Gross being the most common (25%). All formulas used blood volume estimation, determined by equations from Nadler (94%) or Moore (6%), and measure change in preoperative and postoperative blood counts. This systematic review highlights the variability in BL estimation methods published in current orthopaedic trauma literature. Methods of quantifying BL should be taken into consideration when designing and evaluating research.
Normal Humeral Head Ossification in Pediatric and Adolescent Shoulders Can Mimic Hill-Sachs Lesions: A Magnetic Resonance Imaging–based Study
Authors: Kelly Alexander , Heath Madison R. , Amoroso Elizabeth E. , Mackie Alexandra T. , Greditzer Harry G. , Owens Brett D. , Fabricant Peter D.
Published: November 2021

Background:

The sequential maturation of the humeral head (HH) as viewed on magnetic resonance imaging (MRI) has not been described to date. Proper assessment may be complicated by the presence of physeal tissue in pediatric patients. Past studies suggest that skeletally immature patients may also have a higher risk of a false-positive diagnosis of Hill-Sachs lesion on MRI. The purpose of this study was to define pediatric HH developmental patterns using MRI and to investigate for any associations with findings of known false-positive Hill-Sachs.

Methods:

Picture Archiving and Communication System (PACS) records at an urban academic tertiary care musculoskeletal facility from 2014 to 2020 were queried for shoulder MRI in patients aged 0 to 15 years. Patients were excluded if they had a history of glenohumeral instability, fracture, growth arrest, brachial plexus injury, surgery, or infection. All images were independently evaluated by a musculoskeletal fellowship-trained radiologist. Each HH was staged based on skeletal maturity.

Results:

For both sexes, HHs matured in a predictable manner with increasing chronological age associated with a higher ossification stage. False Hill-Sachs lesions were observed in girls aged 4 to 7 and boys aged 5 to 14, exclusively during stage I to II ossification.

Conclusions:

False Hill-Sachs lesions were visualized on MRI in stage I to II proximal humerus ossification. Due to differential timing of skeletal maturation, males present with false Hill-Sachs lesions at a later age than females on average. When interpreting shoulder MRI for glenohumeral instability, clinicians should be cautious of false Hill-Sachs lesions, especially in younger patients with distinct greater tuberosity and HH ossification centers (stage I to II ossification).

Level of Evidence:

Level III.
Peer Review Processes for Quality Improvement in Health Care Settings and Their Implications for Health Care Professionals: A Meta-Ethnography
Authors: Tang Sammer , Bowles Alexandra , Minns Lowe Catherine
Published: November 2021

Introduction:

Peer review processes are used to improve professional practice in health care, although no synthesis of existing studies has yet been undertaken. These processes are included in the UK professional revalidation processes for medical practitioners and nurses and midwives but not for allied health professionals. The purpose of this review was to identify, appraise, and synthesize the available qualitative evidence regarding health care professionals' experiences and views about peer review processes and to explore the implications for health care professionals in the United Kingdom.

Methods:

Qualitative review using meta-ethnography, reported according to Meta-ethnography Reporting Guidance guidance. Search strategy was developed using MeSH headings. The following data sources were searched: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Ovid full text (between May 2007 and May 2019) (one reviewer with librarian support) plus manual searching. Screening, data extraction, and evaluation were undertaken independently by two reviewers. Studies were independently appraised for quality by two reviewers to identify concepts which were compared and developed into a conceptual model by the team.

Results:

Thirteen studies (937 participants) were included. Findings explored peer review processes and three key components, namely, purpose, process, and peers. Participants' perceptions of peer review processes were categorized by four main concepts: value/benefits, reflection/shared learning, anxiety about the process, and how to improve “buy-in.”

Discussion:

Evidence supports the introduction and use of peer review processes as a quality improvement tool. Further research exploring whether/how to incorporate peer review processes into the process of assessing continuing fitness to practice for allied health professionals seems appropriate. The time and resources required to implement peer review processes are considered barriers to implementation.
Developing Innovative Virtual Reality Simulations to Increase Health Care Providers' Understanding of Social Determinants of Health
Authors: Brammer Susan V. , Regan Saundra L. , Collins Chris M. , Gillespie Gordon L.
Published: November 2021

Introduction:

Health care providers (HCPs) who work primarily with Medicaid patients must be competent in identifying and addressing social determinants of health (SDH). A curricular gap exists between promoting an understanding of SDH and teaching HCPs how to recognize and increase empathy to manage them. The project aim was to develop two virtual reality simulations (VRSs) as innovative methods to teach HCPs to identify and manage SDH. A secondary aim was to decrease unconscious bias and increase empathy by experiencing SDH from their patients' perspective.

Methods:

Scripts for two VRSs were created by two HCP educators and clinicians. Scripts were evaluated by experts using an index of content validity (CVI). An advisory panel critiqued the scripts for appropriateness for VRSs, adequacy of evidence-based practice, and use of VRS equipment and software. The panel participated in a focus group and completed a final evaluation. The VRSs then were pilot tested with five HCPs who assessed content and utility and participated in interviews. This led to iterative improvements. Qualitative data were analyzed using a content analysis approach.

Results:

The VRS scripts demonstrated adequate content-related validity evidence with CVI scores of 0.81 and 0.75. The expert panel found the VRS easy to use, useful as an educational tool, while promoting empathy for patients. Overall, participants were satisfied with using the VRS as an educational experience.

Discussion:

Through VRS technology, this project addresses a curricular gap in HCP training on SDH. VRS can be a useful tool to increase HCPs' understanding of SDH and, potentially, their empathy for patients.
Paradox of Patient-Centered Care and the Implications for Patient Involvement in Continuing Professional Development
Authors: Wong René , Kitto Simon , Kumagai Arno K. , Whitehead Cynthia R.
Published: November 2021

Introduction:

Patient-centered care (PCC) is widely considered as essential in chronic disease management. As the underlying rationale for engaging patients in continuing professional development (CPD) is commonly described as fostering care that is more patient-centered, we hoped to understand the discursive conditions for how educators and health professionals can (or cannot) learn with, from, and about patients.

Methods:

Using diabetes as a case, we conducted a Foucauldian discourse analysis of an archive of relevant policy documents, professional and educational texts, to explore different conceptualizations of practice and the implications for PCC. We also conducted in-depth interviews with a purposive sample of physicians to understand their experiences in providing and teaching PCC. We sought to understand: How has PCC been discursively constructed? Whose interests does advocating PCC serve? What are the implications for patient involvement in CPD?

Results:

We describe three discursive constructions of PCC, each extending the reach of biomedical power. PCC as a disease intervention emphasizes knowing and relating to patients to normalize laboratory test results. PCC as a form of confession promotes patients to come to their own realizations to become responsible for their own health, but through the lens and evaluation of physicians. PCC as a disciplinary technique makes visible the possibility of using a checklist to judge physician competency in providing PCC.

Discussion:

PCC may be constructed in ways that paradoxically reinforce rather than challenge conventional, provider-centric paradigms. Our results challenge educators to acknowledge the existence and effects of discourses when involving patients in the planning and delivery of CPD.
Defining and Redefining Family Involvement in Practice: An Implementation Trial of a Locally Adaptable Patient-Centered Professional Development Tool in Two Ontario Intensive Care Units
Authors: Alexanian Janet , Fraser Ian , Smith Orla , Kitto Simon
Published: November 2021

Research on best practices for family member involvement has shown that such involvement improves care quality in critical care settings and helps to reduce medical errors leading to adverse events. Although many critical care units promote the principle of “patient-centered care” and family member involvement, there can be a significant gap between knowledge about these processes and their translation into practice. This article is based on an implementation trial of a patient and family involvement knowledge-based tool that involves an educational component for frontline health care workers. By combining ethnographic observation, semistructured interviews, focus groups, and document analysis, we were able to not only examine health care provider views on family involvement but also explore the areas of tension that arose in practice because the introduction of the family involvement tool exposed local factors that shaped the conditions of possibility of family involvement. In particular, unspoken preferences, assumptions, and concerns about family involvement were brought to the fore because this intervention disrupted well-entrenched power dynamics related to family involvement and professional boundaries. Through this ethnographic research, we found that the concept of patient-centered care is not uncontroversial among health care providers and that the form of its practice was largely up for individual interpretation. Interventions and policies that aim to promote patient-centered and family-centered care would benefit from addressing the ways in which these ideas affect the work of different health care professionals and incorporating nursing concerns around family involvement.
A new paradigm for antiretroviral delivery: long-acting cabotegravir and rilpivirine for the treatment and prevention of HIV
Authors: Bares Sara H. , Scarsi Kimberly K.
Published: November 2021

Purpose of review

Cabotegravir (CAB) and rilpivirine (RPV) is the first long-acting injectable antiretroviral therapy (ART) option approved for virologically suppressed adults with HIV-1. In addition, long-acting CAB is a promising agent for HIV preexposure prophylaxis (PrEP). This review focuses on phase 3 clinical trial results and implementation considerations for these long-acting ART and PrEP strategies.

Recent findings

Long-acting CAB and RPV administered every 4 weeks demonstrated noninferiority to oral ART through week 96 in both the ATLAS and FLAIR studies, whereas ATLAS-2M found similar efficacy through 96 weeks when the long-acting injectable ART was administered every 8 weeks instead of every 4 weeks. For prevention, two phase 3 trials were stopped early due to fewer incident HIV infections in participants receiving long-acting CAB every 8 weeks compared with daily oral tenofovir disoproxil fumarate–emtricitabine for PrEP. The long-acting therapies were well tolerated across all clinical trials.

Clinical trial results support the use of long-acting CAB for HIV PrEP and long-acting CAB and RPV as a switch strategy for adults with HIV-1 who are first virologically suppressed with oral ART. Implementation challenges persist, and data are urgently needed in populations who may benefit most from long-acting therapy, including adolescents, pregnant individuals, and those with barriers to medication adherence.
Explaining the Variance in Cardiovascular Disease Risk Factors
Authors: Hamad Rita , Glymour M. Maria , Calmasini Camilla , Nguyen Thu T. , Walter Stefan , Rehkopf David H.
Published: November 2021

Background:

Efforts to explain the burden of cardiovascular disease (CVD) often focus on genetic factors or social determinants of health. There is little evidence on the comparative predictive value of each, which could guide clinical and public health investments in measuring genetic versus social information. We compared the variance in CVD-related outcomes explained by genetic versus socioeconomic predictors.

Methods:

Data were drawn from the Health and Retirement Study (N = 8,720). We examined self-reported diabetes, heart disease, depression, smoking, and body mass index, and objectively measured total and high-density lipoprotein cholesterol. For each outcome, we compared the variance explained by demographic characteristics, socioeconomic position (SEP), and genetic characteristics including a polygenic score for each outcome and principal components (PCs) for genetic ancestry. We used R-squared values derived from race-stratified multivariable linear regressions to evaluate the variance explained.

Results:

The variance explained by models including all predictors ranged from 3.7% to 14.3%. Demographic characteristics explained more than half this variance for most outcomes. SEP explained comparable or greater variance relative to the combination of the polygenic score and PCs for most conditions among both white and Black participants. The combination of SEP, polygenic score, and PCs performed substantially better, suggesting that each set of characteristics may independently contribute to the prediction of CVD-related outcomes. Philip R. Lee Institute for Health Policy Studies, Department of Family & Community Medicine, UCSF,

Conclusions:

Focusing on genetic inputs into personalized medicine predictive models, without considering measures of social context that have clear predictive value, needlessly ignores relevant information that is more feasible and affordable to collect on patients in clinical settings. See video abstract at, http://links.lww.com/EDE/B879.
Association Between Medical Diagnoses and Suicide in a Medicaid Beneficiary Population, North Carolina 2014–2017
Authors: Sivaraman Josie J. Caves , Greene Sandra B. , Naumann Rebecca B. , Proescholdbell Scott , Ranapurwala Shabbar I. , Marshall Stephen W.
Published: November 2021

Background:

Firearms are used in about half of U.S. suicides. This study investigated how various medical diagnoses are associated with firearm and nonfirearm suicide.

Methods:

We used a case–control design including n = 691 North Carolina Medicaid beneficiaries who died from suicide between 1 January 2014 and 31 December 2017 as cases. We selected a total of n = 68,682 controls (~1:100 case–control ratio from North Carolina Medicaid member files using incidence density sampling methods). We linked Medicaid claims to the North Carolina Violent Death Reporting System to ascertain suicide and means (firearm or nonfirearm). We matched cases and controls on number of months covered by Medicaid over the past 36 months. Analyses adjusted for sex, race, age, Supplemental Security Income status, the Charlson Comorbidity Index, and frequency of health care encounters.

Results:

The case–control odds ratios for any mental health disorder were 4.2 (95% confidence interval [CI]: 3.3, 5.2) for nonfirearm suicide and 2.2 (95% CI: 1.7, 2.9) for firearm suicide. There was effect measure modification by sex and race. Behavioral health diagnoses were more strongly associated with nonfirearm suicides than firearm suicide in men but did not differ substantially in women. The association of mental health and substance use diagnoses with suicides appeared to be weaker in Blacks (vs. non-Blacks), but the estimates were imprecise.

Conclusion:

Behavioral health diagnoses are important indicators of risk of suicide. However, these associations differ by means of suicide and sex, and associations for firearm-related suicide are weaker in men than women.
Misclassification of Neonatal Abstinence Syndrome Surveillance Estimates
Authors: Labgold Katie , Collin Lindsay J. , Howards Penelope P.
Published: November 2021

Background:

Validation studies estimating the positive predictive value (PPV) of neonatal abstinence syndrome (NAS) have consistently suggested overreporting in hospital discharge records. However, few studies estimate the negative predictive value (NPV). Even slightly imperfect NPVs have the potential to bias estimated prevalences of rare outcomes like NAS. Given the challenges in estimating NPV, our objective was to evaluate whether the PPV was sufficient to understand the influence of NAS misclassification bias on conclusions of the NAS prevalence in surveillance research.

Methods:

We used hospital discharge data from the 2016 New Jersey State Inpatient Databases, Healthcare Cost and Utilization Project. We adjusted surveillance data for misclassification using quantitative bias analysis models to estimate the expected NAS prevalence under a range of PPV and NPV bias scenarios.

Results:

The 2016 observed NAS prevalence was 0.61%. The misclassification-adjusted prevalence estimates ranged from 0.31% to 0.91%. When PPV was assumed to be ≥90%, the misclassification-adjusted prevalence was typically greater than the observed prevalence but the reverse was true for PPV ≤70%. Under PPV 80%, the misclassification-adjusted prevalence was less than the observed prevalence for NPV >99.9% but flipped for NPV <99.9%.

Conclusions:

When we varied the NPV below 100%, our results suggested that the direction of bias (over or underestimation) was dependent on the PPV, and sometimes dependent on the NPV. However, NPV was important for understanding the magnitude of bias. This study serves as an example of how quantitative bias analysis methods can be applied in NAS surveillance to supplement existing validation data when NPV estimates are unavailable.
Health Outcomes Associated With Clinician-initiated Delivery for Hypertensive Disorders at 34–38 Weeks’ Gestation
Authors: Savitz David A. , Danilack Valery A. , Cochancela Jerson , Hughes Brenna L. , Rouse Dwight J. , Gutmann Roee
Published: November 2021

Background:

Clinicians caring for the nearly 10% of patients in the United States with nonsevere hypertensive disorders in late pregnancy need better evidence to balance risks and benefits of clinician-initiated delivery.

Methods:

We conducted a record-based cohort study of maternal and infant health outcomes among deliveries from 2002–2013 at Women & Infants Hospital of Rhode Island. Participants had gestational hypertension or nonsevere preeclampsia before 39 weeks’ gestation (N=4,295). For each gestational week from 34 to 38, we compared outcomes between clinician-initiated deliveries (induction of labor or prelabor cesarean) and those not initiated in that week, using propensity score models to control confounding by indication.

Results:

The analysis predicted an increment in risk of adverse maternal and infant outcomes sustained through week 37 if all patients underwent clinician-initiated delivery, with risk differences on the order of 0.2 for maternal outcomes and 0.3 for infant outcomes weeks 34 and 35. For women undergoing clinician-initiated delivery, the analysis identified increased risk of progression to severe disease in weeks 35 and 36, increases in all adverse infant outcomes only in week 34, increases in Neonatal Intensive Care Unit admission and infant hospital stay in weeks 35 and 36, and no meaningful increase in any of the adverse outcomes in weeks 37 or 38.

Conclusions:

We estimate that hypertensive pregnancies chosen for intervention were minimally harmed by early delivery after 34 weeks’ gestation but predict benefit from extension to 37 weeks. Our study also showed adverse infant health consequences associated with routine delivery prior to 37 weeks.
Prevalence and Predictors of Cardiovascular Disease and Risk Factors in Transgender Persons in the United States
Authors: Malhotra Aditi , Kort Smadar , Lauther Tara , Mann Noelle , Skopicki Hal A. , Parikh Puja B.
Published: November 2021

Background:

The cardiovascular health of transgender and gender diverse (TGD) persons, a growing population in the United States, has become a subject of heightened interest. We sought to assess the prevalence and predictors of cardiovascular disease (CVD) in transgender men, transgender women, and gender nonconforming persons in the United States.

Methods:

A cohort of individuals self-identified as TGD (ie, transgender or gender nonconforming) in the United States was identified using the 2018 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey.

Results:

Among the 1019 TGD individuals studied, 378 (37.1%) identified their transition status as male-to-female, 394 (38.7%) as female-to-male, and the remaining 247 (24.2%) as gender nonconforming. A total of 138 (13.5%) had reported CVD, while 881 (86.5%) did not. The prevalence of CVD in TGD individuals identified as male-to-female, female-to-male, and gender nonconforming were noted to be similar (14.6% vs. 13.5% vs. 12.1%; P = 0.69). TGD persons with CVD were older with lower annual income. They also had higher rates of smoking, lower rates of regular exercise, and higher rates of smoking and chronic medical comorbidities. Independent predictors of CVD in TGD persons included older age, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, and depressive disorder.

Conclusions:

In this contemporary cross-sectional nationally representative survey, CVD was prevalent in nearly 14% of TGD persons. Further studies examining interventions to reduce CV risk and enhance access to medical care in the TGD population are warranted.
Evaluation of the Lubricating Effect of Hyaluronic Acid on Contact Lenses Using a Pendulum-Type Friction Tester Under Mimicking Physiological Conditions
Authors: Iwashita Hiroko , Mabuchi Kiyoshi , Itokawa Takashi , Okajima Yukinobu , Suzuki Takashi , Hori Yuichi
Published: November 2021

Objective:

To evaluate the lubricating effect of hyaluronic acid (HA) on soft contact lenses (SCLs) measured using a pendulum-type friction tester.

Methods:

We measured the coefficient of friction (CoF) of narafilcon A, delefilcon A, and etafilcon A with polyvinylpyrrolidone (PVP), daily disposable SCL material, using a modified pendulum-type friction tester. Sample SCLs were set on an acrylic plastic half-ball and placed into the polyethylene terephthalate hemisphere cup filled with 0.4 mL of test lubricants that included saline and 0.05%, 0.1%, 0.2%, 0.3%, 0.4%, and 0.5% (wt/vol) HA (molecular weight, 850 kDa). The viscosities of saline and HA were measured using an Ubbelohde viscometer.

Results:

The CoF of the SCL under a low concentration (0.05%) of HA was the lowest and significantly lower than saline in narafilcon A and delefilcon A (P<0.05, Steel multiple comparison test). Under higher HA concentrations (0.3%, 0.4%, and 0.5%), the CoF was significantly higher than that of saline (P<0.01, Steel' multiple comparison test) in all three SCLs. There were no significant differences of CoF among three SCLs in saline and all concentrations of HA. The HA viscosities increased exponentially with the concentration (Y=1.2829e9.286X).

Conclusion:

The viscosity of a high concentration of HA may increase the friction of SCLs, which may have a deleterious effect on the ocular surface.
Recurrence of Distensible Orbital Venous-dominant Venolymphatic Malformations After Sclerotherapy Versus Embolization With Excision
Authors: Cohen Liza M. , Goldberg Robert A. , Rootman Daniel B.
Published: November 2021

Purpose:

Treatment for orbital venolymphatic malformations (VLMs) commonly includes 3 major options: sclerotherapy, surgery, and embolization followed by surgical excision. Each has certain advantages, although it is not clear whether all are effective. The authors characterize the clinical course for a series of patients with distensible orbital venous-dominant VLM treated with sclerotherapy and/or embolization with excision.

Methods:

In this cross-sectional cohort study, patients affected by distensible orbital venous-dominant VLM presenting to the orbital and ophthalmic plastic surgery service from 2014 to 2020 were identified. Patients were included if they presented with a moderate-flow, distensible venous-dominant malformation associated with Valsalva-related symptoms (e.g., pain, proptosis, and diplopia).

Results:

Six cases were treated with sclerotherapy. Four underwent multiple treatments, with a mean ± SD of 3.5 ± 2.3 (range 1–7). All patients in this group failed to improve or experienced recurrence of symptoms after sclerotherapy. Twelve cases were treated with embolization and excision. Resolution of symptoms in all 12 cases was noted and maintained for a mean of 3.4 ± 2.1 years. There have been no cases of recurrence. Patients treated with sclerotherapy were more likely to experience recurrence of symptoms compared to those treated with embolization and excision (p < 0.001).

Conclusions:

Treatment of distensible venous-dominant moderate-flow orbital VLM with sclerotherapy may provide temporary improvement in some cases. However, in the medium to long term, recurrence was universal in this series. Embolization with excision appears to provide more definitive management, avoiding recurrence in all cases for a mean follow-up of 3 years.