bluuebunny/crossref_metadata_2025 huggingface dataset:
Why Integrative Gastroenterology?
Authors: Mullin Gerard E. , Parian Alyssa M. , Singh Marvin
Published: May 2020

Digestive diseases encompass numerous acute and chronic conditions of the gastrointestinal tract, ranging from common digestive disorders to serious, life-threatening diseases. Over 60 million Americans are afflicted with known digestive diseases with the association of many other adverse health conditions and disability. The annual economic impact on the US economy is more than $141 billion. The Western diet and lifestyle contribute to this high prevalence of digestive disease in America and worldwide. The most common digestive conditions in the United States, Canada, and Europe were uncommon in Asia and Africa until recently, with the expansion of fast food franchises and heightened availability of processed foods worldwide. Digestive diseases have a complex underlying pathogenesis that involves a number of influences, including environmental factors, genetics, inflammation, and the gut microbiome. The risk of developing a digestive disease is modifiable by making key dietary and lifestyle modifications. Adopting a personalized approach to digestive illness can achieve improved patient satisfaction and quality of life for patients.
The Gut Microbiome in Integrative Gastroenterology
Authors: Mullin Gerard E.
Published: May 2020

The gut microbiome consists of trillions of bacteria that play an essential role in human metabolism. Environmental factors play a role in the development of the gut microbiome. Hygiene, antibiotic usage, urbanization, mode of birth, breast-feeding, and family size influence the development of the gut microbiota in early life. Distortion in the gut microbial ecology has been linked to the pathophysiology of many diseases via disruption of the gut barrier lining, promoting local and systemic inflammation, and by the systemic dissemination of bacteria-derived byproducts, and other luminal antigens that set into motion a cascade of deleterious events. Manipulation of the gut flora through diet, prebiotics and probiotics, antibiotics, and fecal transplantation has the potential to influence digestive disease health outcomes.
Integrative Gastroenterology for Children, Adolescents, and Parents
Authors: Russell Alexandra
Published: May 2020

Gastrointestinal complaints are common among pediatric patients. Many of these disorders are chronic and complex, resulting from an interplay of biology, psychopathology, genetics, microbiome disruption, and diet. There is a growing interest among patients, parents, and providers in using an integrative approach for the treatment of these disorders. Mind–body practices, including yoga, hypnotherapy, and cognitive behavioral therapy, can improve quality of life for children with a variety of GI complaints. Iberogast and licorice supplements may benefit those with dyspepsia; enteric-coated peppermint can reduce pain in children with irritable bowel syndrome. Curcumin, probiotics, and dietary interventions have evidence for use in children with inflammatory bowel disease. Dietary changes, exercise, and probiotics can impact the course of pediatric non-alcoholic liver disease. Integrative medicine approaches to pediatric GI disorders, when used in conjunction with standard medical care, are safe and well tolerated.
An Osteopathic Approach to Functional Digestive Disorders
Authors: Nazareth Deirdre , Orchard Daniel
Published: May 2020

Alternative treatments for gastrointestinal (GI) diseases, of which irritable bowel syndrome (IBS) ranks as one of the most common functional GI disorders, are needed because the current medical treatments have deleterious side effects and do not significantly improve quality of life (QOL). Furthermore, symptoms relapse and disease incidence have risen, underscoring its complex nature and substantial burden on the economy, hospitals, patients, and families. This chapter will discuss how an osteopathic approach embraces the concept of the biopsychosocial model, which allows a multipronged strategy for treating chronic pain conditions, using IBS as a model of chronic pain, poor QOL, and disability, and how the understanding of pain neurophysiology can further aid this approach as a viable treatment option for long-term patient satisfaction and improvement in QOL.
Chiropractic
Authors: Young Kristofer
Published: May 2020

From its inception in 1895, chiropractic has overwhelmingly been a spine-focused discipline. The central connection between chiropractic and gastroenterology is the anatomy and physiology of viscerosomatic and somatovisceral reflexes. The profound anatomical and physiological interconnection of the gastrointestinal and musculoskeletal systems calls doctors of gastroenterology and chiropractic to understand this potent interface. Gut issues often cause back problems, and vice versa, through viscerosomatic and somatovisceral reflexes. Chiropractors, through spinal manipulation and other modalities, influence both systems. Root-cause gastrointestinal treatments also influence both systems. Recognizing these relationships better positions any health care practitioner to discern causative elements of presenting cases. This chapter explores the intersections between these two systems and two medical disciplines.
Acupuncture for Gastrointestinal Disorders
Authors: Taw Malcolm B. , Shubov Andrew
Published: May 2020

This chapter provides an introduction to acupuncture, elucidates known neurobiological mechanisms of action, and summarizes the current evidence base for the use of acupuncture in the treatment of various gastrointestinal (GI) disorders. It reviews how acupuncture can increase esophageal and GI motility, reduce transient lower esophageal sphincter relaxations, stimulate gastric emptying, accelerate antral contractions, regulate neurohormonal mediators, promote autonomic and vagal tone, and modulate different regions of the brain-gut-microbiota axis. The therapeutic rationale for acupuncture as well as basic theories and concepts from a traditional Chinese medicine (TCM) perspective are also described. This chapter concludes with a discussion about the potential therapeutic combination of integrative East-West medicine to treat GI disorders.
Homeopathy for Gastrointestinal Disorders
Authors: Whitmont Ronald D.
Published: May 2020

Homeopathy is a two-century-old medical specialty that provides many distinct advantages in the treatment of a wide range of gastrointestinal disorders. Although its emergence predates the discovery of the human microbiome, it appears to be fully compatible with microbiome ecology and integrative immune functioning. Homeopathic treatment supports natural homeostatic mechanisms that work to reestablish symbiosis between the microbiome and the immune system, lowering local and systemic inflammation, and thereby benefiting the entire superorganism. The gastrointestinal microbiome is briefly reviewed here with respect to its pertinence to systemic health. The fundamental concepts of classical homeopathic medicine are summarized, and its scientific evidence-base is considered. The homeopathic treatment of several GI tract disorders is presented with evidence of its effectiveness.
Naturopathic Medicine and Gastrointestinal Health
Authors: Brady David M.
Published: May 2020

Naturopathic medical physicians are licensed/registered providers who are trained as distinct primary health care professionals, emphasizing prevention, treatment, and fostering optimal health through the use of therapeutic methods and substances that encourage individuals’ inherent self-healing process. This chapter examines the current definition of naturopathic medicine, including the principles and paradigms of care that the modern naturopathic physicians generally subscribe to, with a particular focus on the naturopathic approach to diagnosis and treatment of gastrointestinal disorders. Educational and licensure/registration of the naturopathic doctor (ND) is also reviewed, along with typical work settings and practice environments. Traditional and historical and current therapeutic approaches to GI disorders are discussed and typical intervention protocols are offered.
Liver Disease
Authors: Antunes Catiele , Dadabhai Alia S.
Published: May 2020

Herbal and dietary supplements (HDS) have been increasingly popularized by the internet to augment or serve as alternatives to standard medical treatment in a variety of diseases. With respect to the liver, milk thistle is among the most popular, but a wide range of other therapies are also being used to treat liver diseases, from fatty liver to viral hepatitis. In this chapter, the effects of natural remedies on the liver are outlined as solo or complementary therapies. Hepatotoxicity and acute liver failure from unregulated use of these HDS are also discussed. Natural alternatives used to treat other medical conditions that can adversely affect the liver (via metabolic breakdown or direct hepatic injury) are summarized, along with the proposed mechanism of injury. Increased awareness on the part of the hepatologist or PCP to include an HDS evaluation can be a valuable tool to treat and diagnose liver injury.
Applying Genomics for Personalized Nutrition in Clinical Practice
Authors: Guest Nanci , Jamnik Joseph , García-Bailo Bibiana , Nielsen Daiva E. , El-Sohemy Ahmed
Published: May 2020

The role of genetic variation in influencing an individual’s response to diet and nutritional interventions is being increasingly recognized in nutrition research and practice. Discoveries in the field of nutrigenomics and nutrigenetics have paved the way for personalized nutrition by enabling us to tailor dietary recommendations to an individual’s genotype. This level of personalization is expected to hold great benefit by better aligning dietary recommendations with an individual’s requirements and potentially motivating favorable dietary changes that impact chronic disease risk. In this review, we discuss key findings in the field of nutritional genomics, issues surrounding genetic testing for personalized nutrition, and the role health care providers will play in delivering the science to individuals.
The Mouse in the Room
Authors: Garner Joseph P.
Published: May 2020

Animal research scientists often dismiss ethical thinking as a waste of time either because it seems indeterminate or because there appears to be a yawning gap between regulations, which they must follow, and ethical treatment of animals. By outlining a framework of clearly articulated ethical principles, Beauchamp and DeGrazia provide an invaluable bridge. They examine our current regulatory system through the lens of their framework, exposing both its strengths and weaknesses. The first half of this commentary argues for the value of this exercise. The second half provides case examples where applying these ethical principles empowers us to change how we approach current regulatory problems.
The Six Principles, Philosophy, and Applying Human Ethics to Animals
Authors: Savulescu Julian
Published: May 2020

Beauchamp and DeGrazia’s framework of six principles of animal research ethics is arguably the most constructive step forward in the ethics of animal experimentation in the past fifty years. Their advance beyond the influential Three-Rs framework is due to their display of the core values and basic principles in animal research ethics. Further work on the practical implementation of their principles can start by focusing on how to better weigh human interests against animal interests. This is where a great fudge can loom large: either human benefit is overestimated or harm to animals is underestimated. How benefits and harms can be more precisely understood, evaluated, and balanced is critical. To this end, this commentary expands on Beauchamp and DeGrazia’s principle of sufficient value to justify harm, principle of basic needs, and principle of upper limits to harm.
Types of Mental Disorders in People with Intellectual Disability
Authors: Cooper Sally-Ann
Published: May 2020

Mental disorders are common in people with intellectual disability, with a reported point prevalence of 36% in children and young people (including challenging behaviours), and 40.9% in adults (or 28.3% excluding challenging behaviours). People with intellectual disability experience all types of mental disorders, some more commonly than the general population, e.g. autism, attention-deficit hyperactivity disorder, schizophrenia, bipolar affective disorder, and dementia. Challenging behaviours are also common, and have no clear general population equivalent. Multi-morbidity of mental and physical disorders is typical. Mental disorder assessments are complex due to multi-morbidity and polypharmacy, in addition to impairments in communication, understanding, vision, and hearing, and the need to work with family and paid carers as well as the person with intellectual disability. Mental disorder classificatory systems have been developed for people with intellectual disability, in view of under-reporting when using general population manuals: DC-LD was designed to complement ICD-10, and DM-ID 2 to interpret DSM-5.
Attention Deficit Hyperactivity Disorder (ADHD) in People with Intellectual Disability
Authors: Xenitidis Kiriakos , Zahid Shazia , Marshall Caryl
Published: May 2020

People with intellectual disability (ID) are more susceptible to mental disorders including mental illness and developmental disorders, such as autism and attention-deficit hyperactivity disorder (ADHD). The identification of comorbidities is an important task for the clinician as, in addition to clarifying the diagnosis, it carries implications for the treatment and prognosis. This chapter aims to explore the association between ID and ADHD and review the key research findings. The validity of the diagnosis of ADHD in ID is considered. The assessment issues relating to the diagnosis of ADHD in this population are discussed. The questions around treatment and management are summarized and, finally, the clinical implications are highlighted.
Depressive Disorders in People with Intellectual Disability
Authors: Tromans Samuel , Umar Atiq , Torr Jennifer , Alexander Regi , Bhaumik Sabyasachi
Published: May 2020

Depressive disorders are common in people with intellectual disability (ID), and may sometimes pose difficulties in identification and appropriate treatment, mainly due to associated comorbid conditions and significant impairment in communication. This chapter describes both typical and atypical presentations of depression in people with intellectual disability, along with associated aetiopathological factors that might influence the presentation. Depressive disorders are common in people with intellectual disability, causing individual suffering, additional impairments in adaptive behaviour and functioning, disruption of interpersonal relationships, social exclusion, poor physical health outcomes, and sometimes death. The issue of overshadowing and influence of comorbid conditions leading to lack of identification has also been considered. Management approaches, including that of pharmacological and psychological therapies and their applicability to persons with intellectual disability have been highlighted, with case examples. Special consideration, including drug interactions and the effect of treatment on comorbid conditions have been discussed.
Bipolar Affective Disorder in Intellectual Disability
Authors: Tromans Samuel , Jones Ian , Gunaratna Ignatius , Orr Natalie , Bhaumik Sabyasachi
Published: May 2020

People with Intellectual Disability (ID) experience Bipolar Affective Disorder (BPAD) at a rate probably similar to that of the general population, though diagnosis may be delayed or missed owing to numerous factors, including communication deficits and atypical clinical presentations, especially in those with more severe ID. BPAD is caused by an interaction of genetic and environmental factors, and associated with numerous other forms of psychiatric and physical illness. Diagnostic criteria used for the general population may have clinical utility for those with milder ID, though ID-specific classification systems may be more useful in those with moderate-severe ID. There has been limited research regarding treatment of BPAD in individuals with ID. However, NICE guidelines have recommended treatment in line with that of the general adult population. Treatment decisions should be a collaborative process wherever possible, involving the patient, carer, clinician, and other health professionals. Factors specific to the individual patient should be taken into account in any subsequent therapeutic approach, including the acceptability of blood test monitoring and comorbid illness, among other factors.
Challenging Behaviours in People with Intellectual Disabilities
Authors: Murphy Glynis H. , McGill Peter
Published: May 2020

Challenging behavior is not a diagnosis. It is behaviour of such an intensity, frequency or duration as to threaten the quality of life and/or the physical safety of the individual or others and is likely to lead to responses that are restrictive, aversive or result in exclusion. This definition is less pejorative, makes fewer assumptions about causality and reminds us that such behaviour is a challenge to services. Challenging behavior is more prevalent in those with an intellectual disability than those without with overall prevalence figures of 10–15% in those known to services. A number of long term high risk factors have been identified and evidence based interventions have included parent training and behavioural interventions. Positive Behavioural Support (PBS) is an intervention technology based on social, behavioural, educational, and biomedical science that combines evidence-based practices with formal systems change strategies, focused on both improving the valued lifestyle options available for an individual and reducing problem behaviours.
Offending Behaviours in People with Intellectual Disabilities
Authors: Taylor John L. , Lindsay William R. , Devapriam John
Published: May 2020

Offending behaviour and intellectual disability has long been—erroneously—associated in the literature and this misattribution has shaped services for this population. In this chapter, the relationship between intellectual disability and criminality is described along with the impact on the care and treatment of people in this population. Developments in the assessment of risk are outlined and clinical interventions for fire setting, sexually aggressive and violent behaviour are detailed, along with consideration of service level outcomes. Over the last 20 years or so there have been significant developments in clinical assessment and treatment approaches for people with intellectual disabilities who offend, however more rigorous and larger scale research is required to support further advances.
The stellar mass Fundamental Plane: the virial relation and a very thin plane for slow rotators
Authors: Bernardi M , Domínguez Sánchez H , Margalef-Bentabol B , Nikakhtar F , Sheth R K
Published: May 2020

Early-type galaxies – slow and fast rotating ellipticals (E-SRs and E-FRs) and S0s/lenticulars – define a Fundamental Plane (FP) in the space of half-light radius Re, enclosed surface brightness Ie, and velocity dispersion σe. Since Ie and σe are distance-independent measurements, the thickness of the FP is often expressed in terms of the accuracy with which Ie and σe can be used to estimate sizes Re. We show that: (1) The thickness of the FP depends strongly on morphology. If the sample only includes E-SRs, then the observed scatter in Re is $\sim 16{{\ \rm per\ cent}}$, of which only $\sim 9{{\ \rm per\ cent}}$ is intrinsic. Removing galaxies with M* < 1011 M⊙ further reduces the observed scatter to $\sim 13{{\ \rm per\ cent}}$ ($\sim 4{{\ \rm per\ cent}}$ intrinsic). The observed scatter increases to $\sim 25{{\ \rm per\ cent}}$ usually quoted in the literature if E-FRs and S0s are added. If the FP is defined using the eigenvectors of the covariance matrix of the observables, then the E-SRs again define an exceptionally thin FP, with intrinsic scatter of only 5 per cent orthogonal to the plane. (2) The structure within the FP is most easily understood as arising from the fact that Ie and σe are nearly independent, whereas the Re−Ie and Re−σe correlations are nearly equal and opposite. (3) If the coefficients of the FP differ from those associated with the virial theorem the plane is said to be ‘tilted’. If we multiply Ie by the global stellar mass-to-light ratio M*/L and we account for non-homology across the population by using Sérsic photometry, then the resulting stellar mass FP is less tilted. Accounting self-consistently for M*/L gradients will change the tilt. The tilt we currently see suggests that the efficiency of turning baryons into stars increases and/or the dark matter fraction decreases as stellar surface brightness increases.
Spectral variability of the 3C 390.3 nucleus for more than 20 years – II.  Variability of the broad emission-line profiles and He ii λ4686 Å emission-line fluxes
Authors: Sergeev S G
Published: May 2020

Results of the analysis of the variability of the H β and H α broad emission-line profiles and the He ii λ4686 Å emission-line fluxes in the 3C 390.3 nucleus during 1992–2014 are present. The observed velocity-dependent lag for the Balmer lines is similar to that expected from the Keplerian disc configuration, although there are some differences. Probably, a radial infall motion can be present in the broad-line region of 3C 390.3 in addition to the Keplerian rotation. The lag of the broad He ii line is 26 ± 8 d, significantly less than that of the Balmer lines, so the He ii emission region is much smaller in size. In terms of the power-law relationship between line and optical continuum fluxes with slowly varying scale factor c(t): $F_{\rm line}\propto c(t)\, F_{\rm cont}^a$, the power a is 1.03 for the broad He ii line, while according to Paper I, the power is equal to 0.77 and 0.54 for the broad H β and H α lines, respectively. It means that the variability amplitude is the largest in the He ii, less in H β, and more less in H α. However, the Balmer lines contain a long-term trend that is not seen in the helium line. The narrow He ii line is variable with the amplitude (max-to-min ratio) Rmax ≈ 3, which is much greater than the variability amplitudes of both the narrow Balmer lines and the narrow [O iii] λ5007 Å line.
Hydrodynamical backflow in X-shaped radio galaxy PKS 2014−55
Authors: Cotton W D , Thorat K , Condon J J , Frank B S , Józsa G I G , White S V , Deane R , Oozeer N , Atemkeng M , Bester L , Fanaroff B , Kupa R S , Smirnov O M , Mauch T , Krishnan V , Camilo F
Published: May 2020

We present MeerKAT 1.28 GHz total-intensity, polarization, and spectral-index images covering the giant (projected length l ≈ 1.57 Mpc) X-shaped radio source PKS 2014−55 with an unprecedented combination of brightness sensitivity and angular resolution. They show the clear ‘double boomerang’ morphology of hydrodynamical backflows from the straight main jets deflected by the large and oblique hot-gas halo of the host galaxy PGC 064440. The magnetic field orientation in PKS 2014−55 follows the flow lines from the jets through the secondary wings. The radio source is embedded in faint ($T_\mathrm{b} \approx 0.5 \mathrm{\, K}$) cocoons having the uniform brightness temperature and sharp outer edges characteristic of subsonic expansion into the ambient intragroup medium. The position angle of the much smaller (l ∼ 25 kpc) restarted central source is within 5° of the main jets, ruling out models that invoke jet re-orientation or two independent jets. Compression and turbulence in the backflows probably produce the irregular and low polarization bright region behind the apex of each boomerang as well as several features in the flow with bright heads and dark tails.
PolyA-miner: accurate assessment of differential alternative poly-adenylation from 3′Seq data using vector projections and non-negative matrix factorization
Authors: Yalamanchili Hari Krishna , Alcott Callison E , Ji Ping , Wagner Eric J , Zoghbi Huda Y , Liu Zhandong
Published: May 2020

Almost 70% of human genes undergo alternative polyadenylation (APA) and generate mRNA transcripts with varying lengths, typically of the 3′ untranslated regions (UTR). APA plays an important role in development and cellular differentiation, and its dysregulation can cause neuropsychiatric diseases and increase cancer severity. Increasing awareness of APA’s role in human health and disease has propelled the development of several 3′ sequencing (3′Seq) techniques that allow for precise identification of APA sites. However, despite the recent data explosion, there are no robust computational tools that are precisely designed to analyze 3′Seq data. Analytical approaches that have been used to analyze these data predominantly use proximal to distal usage. With about 50% of human genes having more than two APA isoforms, current methods fail to capture the entirety of APA changes and do not account for non-proximal to non-distal changes. Addressing these key challenges, this study demonstrates PolyA-miner, an algorithm to accurately detect and assess differential alternative polyadenylation specifically from 3′Seq data. Genes are abstracted as APA matrices, and differential APA usage is inferred using iterative consensus non-negative matrix factorization (NMF) based clustering. PolyA-miner accounts for all non-proximal to non-distal APA switches using vector projections and reflects precise gene-level 3′UTR changes. It can also effectively identify novel APA sites that are otherwise undetected when using reference-based approaches. Evaluation on multiple datasets—first-generation MicroArray Quality Control (MAQC) brain and Universal Human Reference (UHR) PolyA-seq data, recent glioblastoma cell line NUDT21 knockdown Poly(A)-ClickSeq (PAC-seq) data, and our own mouse hippocampal and human stem cell-derived neuron PAC-seq data—strongly supports the value and protocol-independent applicability of PolyA-miner. Strikingly, in the glioblastoma cell line data, PolyA-miner identified more than twice the number of genes with APA changes than initially reported. With the emerging importance of APA in human development and disease, PolyA-miner can significantly improve data analysis and help decode the underlying APA dynamics.
MR-LDP: a two-sample Mendelian randomization for GWAS summary statistics accounting for linkage disequilibrium and horizontal pleiotropy
Authors: Cheng Qing , Yang Yi , Shi Xingjie , Yeung Kar-Fu , Yang Can , Peng Heng , Liu Jin
Published: May 2020

The proliferation of genome-wide association studies (GWAS) has prompted the use of two-sample Mendelian randomization (MR) with genetic variants as instrumental variables (IVs) for drawing reliable causal relationships between health risk factors and disease outcomes. However, the unique features of GWAS demand that MR methods account for both linkage disequilibrium (LD) and ubiquitously existing horizontal pleiotropy among complex traits, which is the phenomenon wherein a variant affects the outcome through mechanisms other than exclusively through the exposure. Therefore, statistical methods that fail to consider LD and horizontal pleiotropy can lead to biased estimates and false-positive causal relationships. To overcome these limitations, we proposed a probabilistic model for MR analysis in identifying the causal effects between risk factors and disease outcomes using GWAS summary statistics in the presence of LD and to properly account for horizontal pleiotropy among genetic variants (MR-LDP) and develop a computationally efficient algorithm to make the causal inference. We then conducted comprehensive simulation studies to demonstrate the advantages of MR-LDP over the existing methods. Moreover, we used two real exposure–outcome pairs to validate the results from MR-LDP compared with alternative methods, showing that our method is more efficient in using all-instrumental variants in LD. By further applying MR-LDP to lipid traits and body mass index (BMI) as risk factors for complex diseases, we identified multiple pairs of significant causal relationships, including a protective effect of high-density lipoprotein cholesterol on peripheral vascular disease and a positive causal effect of BMI on hemorrhoids.
Science communication in China: a critical component of the global science powerhouse
Authors: Qiu Jane
Published: May 2020

China has attached a great significance to bringing science to the public—known as kepu (科普, ‘science popularization’) or kexue chuanbo (科学传播, ‘science dissemination’)—in recent years, partly in response to its unprecedented push for innovation in science and technology. In 2018, it spent 16 billion yuan (US$2.3 billion) on such endeavours, nearly 80% of which was government funding, according to a survey conducted by the Ministry of Science and Technology. With one science-education venue for every million people, approximately 76 million visits were made to the country's 518 general-science museums and 142 million visits were made to 943 museums dedicated to a specific subject matter, such as the Geological Museum of China.

In a forum chaired by National Science Review’s executive editor-in-chief, Mu-ming Poo, scientists, journalists and public-information officers discussed the differences in science communication between China and developed nations, the challenges and opportunities of raising scientific literacy in China, how it has played out in a wide range of controversial topics, from stem-cell research to climate change, and the importance of international collaboration.

Tao Deng

Director of the Institute of Vertebrate Paleontology and Paleoanthropology, Chinese Academy of Sciences, Beijing, China

Hepeng Jia

Science journalist and science-communication scholar at Soochow University, Suzhou, China

Brian Lin

Director of the Editorial Content Strategy, EurekAlert!, American Association of the Advancement of Science, Washington DC, USA

Joy Ma

Manager of the Editorial Content, EurekAlert!, American Association of the Advancement of Science, Washington DC, USA

Lai Xu

Former chief editor of Guokr.com, Beijing, China

Shi Yan

Deputy director of the China Research Institute for Science Popularisation, Chinese Association of Science and Technology, Beijing, China

Mu-ming Poo (Chair)

Director of the Insitute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
Implementation and analysis of a telephone support service during COVID-19
Authors: Matthewson J , Tiplady A , Gerakios F , Foley A , Murphy E
Published: May 2020

Background

During the COVID-19 pandemic, it has been essential for occupational health services (OHS) providers to react rapidly to increased demand and to utilize resources in novel ways. The impact of the COVID-19 pandemic on the psychological well-being of staff is already identified as an area of high risk; therefore, providing timely access to psychological support may be vital, although limited evidence is available on how these risks are best managed.

Aims

To describe implementation and analysis of a psychology-led COVID-19 telephone support line in a National Health Service OHS.

Methods

Data from calls made to the support line were collected over the first 4 weeks of service implementation. Numerical data including frequency of calls and average waiting time were first considered. A content analysis was then conducted on call notes to identify prevalence of themes.

Results

Six hundred and fifty-five calls were received, and 362 notes included sufficient information for use within the content analysis. Frequency of calls peaked within the first week followed by a reduction in the number of calls received per day over time. Most calls included discussion around clarification of guidance (68%) with a smaller subset of calls offering support around anxiety (29%). Prevalence of themes did not appear to change over time.

Conclusions

Clear and timely information is vital to support the well-being of healthcare staff. A psychologically informed telephone support line was a good use of occupational health service resources in the interim while more tailored advice and services could be established.
The Making of the Modern Metropolis: Evidence from London*
Authors: Heblich Stephan , Redding Stephen J , Sturm Daniel M
Published: May 2020

Using newly constructed spatially disaggregated data for London from 1801 to 1921, we show that the invention of the steam railway led to the first large-scale separation of workplace and residence. We show that a class of quantitative urban models is remarkably successful in explaining this reorganization of economic activity. We structurally estimate one of the models in this class and find substantial agglomeration forces in both production and residence. In counterfactuals, we find that removing the whole railway network reduces the population and the value of land and buildings in London by up to 51.5% and 53.3% respectively, and decreases net commuting into the historical center of London by more than 300,000 workers.
Mullen Scales of Early Learning Adaptation for Assessment of Indian Children and Application to Tuberculous Meningitis
Authors: Nimkar Smita , Joshi Suvarna , Kinikar Aarti , Valvi Chhaya , Devaleenal D Bella , Thakur Kiran , Bendre Manjushree , Khwaja Saltanat , Ithape Mahesh , Kattagoni Krishna , Paradkar Mandar , Gupte Nikhil , Gupta Amita , Suryavanshi Nishi , Mave Vidya , Dooley Kelly E , Arenivas Ana
Published: May 2020

Introduction

Tuberculous meningitis (TBM) results in significant morbidity and mortality among children worldwide. Associated neurocognitive complications are common but not well characterized. The Mullen Scales of Early Learning (MSEL), a well-established measure for assessment of neurodevelopment, has not yet been adapted for use in India. This study’s goal was to adapt the MSEL for local language and culture to assess neurocognition among children in India, and apply the adapted measure for assessment of children with TBM.

Methods

Administration of MSEL domains was culturally adapted. Robust translation procedures for instructions took place for three local languages: Marathi, Hindi and Tamil. Multilingual staff compared instructions against the original version for accuracy. The MSEL stimuli and instructions were reviewed by psychologists and pediatricians in India to identify items concerning for cultural bias.

Results

MSEL stimuli unfamiliar to children in this setting were identified and modified within Visual Reception, Fine-Motor, Receptive Language and Expressive Language Scales. Item category was maintained for adaptations of items visually or linguistically different from those observed in daily life. Adjusted items were administered to six typically developing children to determine modification utility. Two children diagnosed with confirmed TBM (ages 11 and 29 months) were evaluated with the adapted MSEL before receiving study medications. Skills were below age-expectation across visual reception, fine motor and expressive language domains.

Conclusions

This is the first study to assess children with TBM using the MSEL adapted for use in India. Future studies in larger groups of Indian children are warranted to validate the adapted measure.
Patterns of Parenting Confidence Among Infants With Medical Complexity
Authors: Vance Ashlee J. , Knafl Kathleen , Brandon Debra H.
Published: May 2020

Background:

Parenting confidence is an important factor in fostering optimal health and development of infants with medical complexity. However, our understanding of how parents of medically complex infants describe development of confidence is limited. The purpose of this mixed-methods study was to describe the nature and development of parenting confidence.

Methods:

A mixed-method design was used to examine how parents described their level of confidence. Ten parents of infants with medical complexity. Quantitative measures provided patterns of confidence and qualitative data focused on parent descriptions of confidence. Parents completed online surveys at 3 time points: (1) study enrollment, (2) infant discharge from hospital, and (3) 3 months after discharge. Parents were purposively sampled, using their confidence patterns, for qualitative phone interviews.

Results:

Our analysis of quantitative findings revealed 3 confidence patterns: (1) increasing, (2) stable, and (3) varying. Parents described their confidence as either (1) a state of being confident or (2) how they behaved in the parenting role. Parents felt both certain and uncertain in their level of confidence and described confidence as being situationally dependent.

Implications for Practice:

Parenting confidence needs to be cultivated through encouragement and repeated exposure to parenting behaviors. Nurses are well-suited to help identify parents with low confidence to support parents so that they can develop confidence.

Implications for Research:

Because there is variability in parent confidence during this critical early period of life, future research should consider a larger cohort of parents that compares confidence in diverse parent groups (ie, married vs living together couples, same-sex couples, and single parents). Research should also examine effective strategies to promote confidence and associated long-term health and developmental outcomes.
A New Proximal Dorsal Approach for DIP Arthroplasty
Authors: Besmens Inga S. , Giesen Thomas , Guidi Marco , Calcagni Maurizio
Published: May 2020

Degenerative changes of the distal interphalangeal (DIP) joints can be painful, disabling, and disfiguring. Swanson spacers can be used for DIP arthroplasty. The standard approach for Swanson spacer implantation at the DIP joint involves transecting the extensor tendon close to its insertion, which necessitates a 6-week period of postoperative immobilization. Another DIP approach involves sparing the extensor tendons, as already published. Both techniques lead to a similar range of motion of the replaced DIP joints. We present a novel approach for DIP joint arthroplasty with division of the extensor tendon in zone 2 with only 2 weeks of postoperative immobilization. Optimizing the motion-preserving operative approaches is of value to our high-demand patients. Postoperative results do not differ from the postoperative range of motion published in the literature for both tendon-sparing and standard approaches. But our approach is technically easy and requires a significantly shorter time of immobilization.
Therapeutic Monitoring of Lacosamide in Japanese Patients With Epilepsy: Clinical Response, Tolerability, and Optimal Therapeutic Range
Authors: Yamamoto Yoshiaki , Terada Kiyohito , Araki Yasukiyo , Fukushima Yutaro , Imai Katsumi , Kagawa Yoshiyuki , Takahashi Yukitoshi
Published: May 2020

Background:

Lacosamide is a novel anticonvulsant that acts by enhancing sodium channel slow inactivation. The aims of this study were to evaluate the influence of concomitant antiepileptic drugs (AEDs) on serum lacosamide concentration and explore the relationship between lacosamide serum concentration and both clinical response and adverse effects.

Methods:

The authors analyzed 649 serum samples from 426 Japanese patients with epilepsy. The concentration-to-dose (CD) ratio of lacosamide was compared among patients on various AED regimens. Clinical information about seizure frequency and adverse events was obtained from clinical records.

Results:

In patients who did not receive enzyme-inducing AEDs, the CD ratio (mean ± SD) of lacosamide was 1.84 ± 0.68. By contrast, the CD ratio in patients who received phenytoin, carbamazepine, and phenobarbital was 1.42 ± 0.66 (22.8% lower), 1.46 ± 0.40 (20.7% lower), and 1.36 ± 0.38 (26.1% lower), respectively. Seventy-four patients (17.3%) achieved >50% seizure reduction. The median lacosamide concentration in patients who received and did not receive a sodium channel blocker was 6.6 mcg/mL (26.4 μmol/L) and 8.4 mcg/mL (33.6 μmol/L), respectively. Adverse events, including dizziness, somnolence, diplopia, and anorexia, were reported by 70 patients (16.4%). The incidence rate in patients treated with sodium channel blockers was significantly higher than that in patients not treated with these drugs (21.1% vs. 10.3%; P < 0.005), and the median lacosamide concentration in these patient groups was 5.1 (20.4 μmol/L) and 7.5 mcg/mL (30 μmol/L), respectively.

Conclusions:

Therapeutic drug monitoring of lacosamide is clinically useful because it allows physicians to estimate the extent of drug interactions and adjust the dose in individual AED regimens.
Sexual Abuse in Children: What the General Practice Ob/Gyn Needs to Know
Authors: ADAMS JOYCE A.
Published: May 2020

The medical evaluation of a child who may have been sexually abused can be a challenge for physicians who are unfamiliar with the wide variation in normal genital anatomy in prepubertal girls. Signs of injury are rarely found, unless the child is examined within 72 hours of the event. This article will provide some history about how guidelines for medical care of these children have been developed, and list some of the findings that are normal or normal variants, caused by other conditions, or due to trauma or infection.
On the relations between focus, experience, and hospital performance
Authors: Zepeda E. David , Nyaga Gilbert N. , Young Gary J.
Published: May 2020

Background

In the United States, a long-standing debate has existed over advantages/disadvantages of general versus specialty hospitals. A recent stream of research has investigated whether general hospitals accrue performance benefits from a focus strategy; a strategy of specializing in certain clinical conditions while remaining a multiproduct firm. In contrast, a substantial and long-standing body of research on hospitals has been concerned with the absolute volume of cases in a service area as an indication of experience based largely on the idea that absolute volume confers learning opportunities.

Purpose

We investigated whether hospital focus and experience in a service area have complementary effects or are largely substitutive for hospital performance.

Methodology/Approach

Key data sources were patient discharge records and hospital discharge profiles from California’s Office of Statewide Health Policy and Development for years 2010–2014. We specified hospital focus as the proportion of total cardiology-related discharges and hospital experience as the cumulative volume of cardiology-related discharges for each hospital. Performance was specified using quality (inpatient mortality and 30-day readmission) and efficiency (length of stay and cost) patient-level performance metrics. We analyzed the data using logistic and log-linear ordinary least squares regression models.

Results

Study results generally supported our hypotheses that focus and experience are related to better quality and efficiency performance and that the effects are largely substitutive for hospitals.

Conclusion

Our study extends the literature by finding that hospitals exhibit distinct and stable patterns regarding their positioning on focus and experience and that these patterns have important implications for hospitals’ performance in terms of quality and efficiency.

Practice Implications

Many general hospitals in the United States may be stretched too thin across service areas for which they lack necessary patient volumes for clinical proficiency. A viable alternative is to select a limited set of service areas on which to focus.
Impact of COVID‐19 on Pediatric Gastroenterology Fellow Training in North America
Authors: Mallon Daniel , Pohl John F. , Phatak Uma P. , Fernandes Melissa , Rosen John M. , Lusman Sarah S. , Nylund Cade M. , Jump Candi S. , Solomon Aliza B. , Srinath Arvind , Singer Andrew , Harb Rula , Rodriguez‐Baez Norberto , Whitfield Van Buren Kristin L. , Koyfman Shifra , Bhatt Riha , Soler‐Rodriguez Dellys M. , Sivagnanam Mamata , Lee Christine K. ,   NASPGHAN Training Committee COVID‐19 Survey Working Group
Published: May 2020

Background:

The COVID‐19 pandemic has drastically changed healthcare systems and training around the world. The Training Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition sought to understand how COVID‐19 has affected pediatric gastroenterology fellowship training.

Methods:

A 21 question survey was distributed to all 77 pediatric gastroenterology fellowship program directors (PDs) in the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition program director database via email on April 7. Responses collected through April 19, 2020 were analyzed using descriptive statistics.

Results:

Fifty‐one of 77 (66%) PDs from the United States, Canada, and Mexico responded to the survey. Forty‐six of 51 (90%) PDs reported that they were under a “stay‐at‐home” order for a median of 4 weeks at the time of the survey. Two of the 51 (4%) programs had fellows participating in outpatient telehealth before COVID‐19 and 39 of 51 (76%) at the time of the survey. Fellows stopped participating in outpatient clinics in 22 of 51 (43%) programs and endoscopy in 26 of 51 (52%) programs. Changes to inpatient care included reduced fellow staffing, limiting who entered patient rooms, and rounding remotely. Fellows in 3 New York programs were deployed to adult medicine units. Didactics were moved to virtual conferences in 47 of 51 (94%) programs, and fellows used various online resources. Clinical research and, disproportionately, bench research were restricted.

Conclusions:

This report provides early information of the impact of COVID‐19 on pediatric fellowship training. Rapid adoption of telehealth and reduced clinical and research experiences were important changes. Survey information may spur communication and innovation to help educators adapt.
Coincidental Expression of Classic Hodgkin Lymphoma and Neurofibromatosis Type I and Literature Review
Authors: Cabrera Trevor B. , Wang Wei , Yedururi Sireesha , Slopis John M. , Steiner Raphael E. , Rytting Michael E. , Cuglievan Branko
Published: May 2020

Neurofibromatosis Type 1 (NF1) is a genetic disorder with an incidence of 1 in 2600 to 3000 individuals. It is a clinical diagnosis characterized by café-au-lait macules, neurofibromas, and axillary and/or groin freckling. Because of genetic mutations in the NF1 gene affecting the Ras/mitogen-activated protein kinase pathway, there is also risk of associated soft tissue sarcomas and hematologic malignancies. However, reports of classic Hodgkin lymphoma in patients with NF1 are sparse. We report an adolescent with NF1 who developed classic Hodgkin lymphoma. Although there is an unclear association between mutations in the NF1 gene and classic Hodgkin lymphoma, further studies are warranted.
Sexual Arousal in Obsessive-Compulsive Disorder With and Without Contamination/Washing Symptoms
Authors: Pozza Andrea , Marazziti Donatella , Mucci Federico , Grassi Giacomo , Prestia Davide , Dèttore Davide
Published: May 2020

Different findings would indicate that obsessive-compulsive disorder (OCD), a common psychiatric condition, might significantly impair intimate relationships and sexual well-being. The aim of the present study was to ascertain whether OCD outpatients with contamination/washing symptoms experience a lower sexual arousal than those experiencing other symptoms. In addition, we explored whether a higher disgust propensity/sensitivity might moderate the relation between contamination/washing symptoms and impaired sexual arousal. A total of 72 outpatients (27 with contamination/washing symptoms and 45 with other obsessive-compulsive symptoms) were selected for this study and assessed by a battery of specific rating scales. The results highlighted how OCD patients with contamination/washing symptoms and higher disgust sensitivity showed an increased propensity to inhibition due to threat of sexual performance failure and consequences. It may be speculated that the disgust sensitivity may be a mechanism involved in the impairment of this well-being domain. In conclusion, these findings suggest that the sexual wellbeing should be evaluated during routine clinical evaluation of OCD patients.