bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation Science
Authors: Proctor Enola , Bunger Alicia
Published: July 2020

Implementation science seeks to inform how to deliver evidence-based interventions, programs, and policies in real-world settings so their benefits can be realized and sustained. The aim of implementation science is building a base of evidence about the most effective processes and strategies for improving service delivery. Implementation research builds upon effectiveness research and then seeks to discover how to use specific implementation strategies and to move interventions into specific settings, extending their availability, reach, and benefits to clients and communities. This article provides an overview of implementation science as a component of research translation with an emphasis on traditional social work practice settings. The article begins by defining key terms, including implementation and evidence-based interventions. To inform conceptualization of implementation studies, the article continues with an overview of guiding implementation theories, models, and frameworks that explain the role of the multi-level practice context for implementation. Next, the article defines implementation strategies, identifies sources of implementation strategies, and provides recommendations for specifying and describing strategies that allow for replication. The article then describes methodological issues, including variable measurement, research design, and stakeholder engagement. Given the importance of designing implementation studies that optimize both internal and external validity, there is special attention to creative alternatives to traditional randomized controlled trials, and the potential for participatory and systems approaches. Finally, the article concludes with a discussion of future directions for implementation science in social work.
The National Association of Black Social Workers
Authors: Reid-Merritt Patricia
Published: July 2020

Founded in May 1968, in San Francisco, California, the National Association of Black Social Workers (NABSW) is the premiere organization of Black social service and social welfare workers devoted exclusively to the development of professional social workers in the Black community. Committed to a philosophy of self-help and self-determination, the mission of the NABSW is to prepare workers to assume responsibility as advocates of social change and social justice, and to actively engage in the fight for racial equality and social liberation for the African ascendant community. The organization is open to all members of the African diasporic community, regardless of educational achievement, occupational status or political, religious, institutional or social affiliations.
Cross-Cultural Measurement in Social Work Research and Evaluation
Authors: Chan Keith
Published: July 2020

Cross-cultural measurement is an important topic in social work research and evaluation. Measuring health related concepts accurately is necessary for researchers and practitioners who work with culturally diverse populations. Social workers use measurements or instruments to assess health-related outcomes in order to identify risk and protective factors for vulnerable, disadvantaged populations. Culturally validated instruments are necessary, first, to identify the evidence of health disparities for vulnerable populations. Second, measurements are required to accurately capture health outcomes in order to evaluate the effectiveness of interventions for cross-cultural populations. Meaningful, appropriate, and practical research instruments, however, are not always readily available. They may have bias when used for populations from different racial and ethnic groups, tribal groups, immigration and refugee status, gender identities, religious affiliations, social class, and mental or physical abilities. Social work researchers must have culturally reliable and valid research instruments to accurately measure social constructs and ensure the validity of outcomes with cultural populations of interest. . In addition, culturally reliable and valid instruments are necessary for research which involves comparisons with different cultural groups. Instruments must capture the same conceptual understanding in outcomes across different cultural groups to create a basis for comparison. Cross-cultural instruments must also detect and ascertain the same magnitude in the changes in health outcomes, in order to accurately determine the impact of factors in the social environment as well as the influence of micro, mezzo, and macro-level interventions.

This reference provides an overview of issues and techniques of cross-cultural measurement in social work research and evaluation. Applying systematic, methodological approaches to develop, collect, and assess cross-cultural measurements will lead to more reliable and valid data for cross-cultural groups.
Intimate Partner Violence and Reproductive Coercion
Authors: Sutton Amber , Beech Haley , Nelson-Gardell Debra
Published: July 2020

Intimate partner violence (IPV) affects millions of individuals yearly, both domestically and globally. Direct linkages exist between experiencing IPV and adverse health outcomes. No matter the type of service arena, social workers encounter IPV; for that reason, all social workers need to be familiar with IPV, its consequences, and potential interventions. One form of IPV that is often undetected and underreported is reproductive coercion (RC). Reproductive coercion, a relatively new term, focuses on birth control sabotage and pregnancy coercion. Reproductive coercion is directly associated with IPV in that power and control are maintained by stripping away autonomy and decision-making ability concerning one’s reproductive and sexual health. Although many victims of IPV will experience this type of sexual abuse, RC is a less discussed form of violence and is often difficult to detect through traditional screening processes, further delaying effective intervention. Reproductive coercion affects the overall emotional, physical, and psychological health of survivors, therefore social workers need to be able to identify specific RC behaviors and know how to appropriately intervene and advocate. A thorough review of the existing literature on the link between IPV and RC has been organized into practical application methods that social workers can use to inform micro, mezzo, and macro levels of practice. All practice methods are designed to aid in reducing harm caused by RC and to help increase survivors’ control over their own bodies and reproductive health. Such applications will include screening for potential abuse, recognizing risk and protective factors, introducing culturally sensitive interventions, and policy implications and recommendations.
Vigilante, Florence Wexler
Authors: Logan Sadye L. M.
Published: July 2020

Florence Wexler Vigilante (1918–2011) served on the faculty of the Hunter College School of Social Work (now Silberman School of Social Work) for 42 years. She pioneered the development of the Employee Assistance Program (EAP) in schools of social work in university-based settings. She was known nationally for her groundbreaking work in employment settings.
Hendricks, Carmen Ortiz
Authors: Logan Sadye L. M.
Published: July 2020

Carmen Ortiz Hendricks (1947–2016) was Professor and first Latina Dean of Social Work in New York City at Yeshiva University’s Wurzweiler School of Social Work. She was a social work pioneer advocating for and developing paths for culturally responsive social work in the Latina community.
Ikeda, Tsuguo “Ike”
Authors: Logan Sadye L. M.
Published: July 2020

Tsuguo “Ike” Ikeda (1924–2015) served for more than 30 years as the first Asian American executive director of a non-profit in the United States. He was hired as the first professional director of the Atlantic Street Center, a non-profit social service agency that has been operating since 1910 in Seattle, Washington. Ikeda was a pioneer who built multiracial relations; he was a visionary and a pacesetter, always ahead of his time.
Battle, Marcus “Mark” Garvey
Authors: Logan Sadye L. M.
Published: July 2020

As chief executive director of the National Association of Social Workers (NASW), Battle demonstrated a pioneering leadership that stimulated the organization and the social work profession to broader areas of social concerns. He was a social worker, educator, consultant, businessman, and former government official. Throughout his career, he blended expertise in management and labor issues with social work skills and knowledge.
Intranasal esketamine: A novel drug for treatment-resistant depression
Authors: Khorassani Farah , Talreja Om
Published: July 2020

Purpose

To review the efficacy, safety, and place in therapy of intranasal esketamine, a treatment modality for treatment-resistant depression.

An electronic literature search of PubMed, MEDLINE, and the ClinicalTrials.gov and Food and Drug Administration (FDA) websites covering the period April 2015 through June 2020 was performed using the following search terms: esketamine, intranasal esketamine, depression, and treatment-resistant depression. Other resources included review articles and the manufacturer’s product labeling. All relevant English-language articles and reports on clinical trials conducted in humans were included. Esketamine (Spravato, Janssen Pharmaceuticals) is an intranasal antidepressant approved by FDA for management of treatment-resistant depression (TRD) in patients with inadequate response to traditional antidepressant therapy. Esketamine is self-administered under the supervision of a healthcare provider and is used as an adjunct to oral antidepressant therapy. Patients are supervised for 2 hours after self-administering the medication to monitor for sedation, dizziness, dissociation reactions, and increased blood pressure. Esketamine has a favorable risk-to-benefit profile, with demonstrated efficacy in reducing depressive symptoms more rapidly than monotherapy with traditional oral antidepressants. Reported adverse effects include sedation, dizziness, dissociation reactions, and blood pressure elevations, but these effects are primarily confined to the 2-hour postdose monitoring window.

Conclusion

Patients with moderate to severe depression who are not sufficiently responsive to traditional strategies for managing TRD may benefit from adjunctive esketamine therapy.
A case report of unusually long episodes of asystole in a severe COVID-19 patient treated with a leadless pacemaker
Authors: Cakulev Ivan , Sahadevan Jayakumar , Osman Mohammed Najeeb
Published: July 2020

Background

Experience has been emerging about cardiac manifestations of COVID-19-positive patients. The full cardiac spectrum is still unknown, and management of these patients is challenging.

Case summary

We report a COVID-19 patient who developed unusually long asystolic pauses associated with atriventricular block (AV) block and atrial fibrillation who underwent leadless pacemaker implantation.

Discussion

Asystole may be a manifestation of COVID-19 infection. A leadless pacemaker is a secure remedy, with limited requirements for follow-up, close interactions, and number of procedures in a COVID-19 patient.
Frequency of injuries associated with syncope in the prevention of syncope trials
Authors: Jorge Juliana G , Pournazari Payam , Raj Satish R , Maxey Connor , Sheldon Robert S
Published: July 2020

Aims

Syncope can lead to injuries. We determined the frequency, severity, and predictors of injuries due to syncope in cohorts of syncope patients.

Methods and results

Participants were enrolled in the POST2 (fludrocortisone) and POST4 (midodrine) vasovagal syncope (VVS) randomized trials, and POST3 enrolled patients with bifascicular block and syncope. Injury was defined as minor (bruising, abrasions), moderate (lacerations), and severe (fractures, burns, joint pain), and recorded up to 1 year after enrolment. A total of 459 patients (median 39 years) were analysed. There were 710 faints occurred in 186 patients during a 1-year follow-up. Fully 56/186 (30%) of patients were injured with syncope (12% of overall group). There were 102 injuries associated with the 710 faints (14%), of which 19% were moderate or severe injuries. Neither patient age, sex, nor the presence of prodromal symptoms associated with injury-free survival. Patients with bifascicular block were more prone to injury (relative risk 1.98, P = 0.018). Patients with ≥4 faints in the prior year had more injuries than those with fewer faints (relative risk 2.97, P < 0.0001), but this was due to more frequent syncope, and not more injuries per faint. In VVS patients, pharmacological therapy significantly reduced the likelihood of an injury due to a syncopal spell (relative risk 0.64, P = 0.015). Injury severity did not associate with age, sex, or prior-year syncope frequency.

Conclusion

Injuries are frequent in syncope patients, but only 4% of injuries were severe. None of age, sex, and prodromal symptoms associate with injury.
Altruism and Risk Sharing in Networks
Authors: Bourlès Renaud , Bramoullé Yann , Perez-Richet Eduardo
Published: July 2020

We provide the first analysis of the risk-sharing implications of altruism networks. Agents are embedded in a fixed network and care about each other. We explore whether altruistic transfers help smooth consumption and how this depends on the shape of the network. We find that altruism networks have a first-order impact on risk. Altruistic transfers generate efficient insurance when the network of perfect altruistic ties is strongly connected. We uncover two specific empirical implications of altruism networks. First, bridges can generate good overall risk sharing, and, more generally, the quality of informal insurance depends on the average path length of the network. Second, large shocks are well-insured by connected altruism networks. By contrast, large shocks tend to be badly insured in models of informal insurance with frictions. We characterize what happens for shocks that leave the structure of giving relationships unchanged. We further explore the relationship between consumption variance and centrality, correlation in consumption streams across agents, and the impact of adding links.
A New Chinese Economic Order?
Authors: Shaffer Gregory , Gao Henry
Published: July 2020

China is incrementally developing a new, decentralized model of trade governance through a web of finance, trade, and investment initiatives involving memorandum of understanding, contracts, and trade and investment treaties, supported by an indigenous innovation policy that is transnational in its reach. In this way, China could create a vast, Sino-centric, legal order in which the Chinese state plays the nodal role. It is a hub and spokes model, with China at the hub. In this article, we first examine China’s export of an infrastructure-based development model, implemented through Chinese state-owned and private enterprise investments and commercial contracts (Part B), before turning to China’s development of a complementary web of free trade and investment agreements (Part C), and an indigenous innovation policy (Part D). The paper theorizes and empirically traces how these Chinese initiatives shape the evolving ecology of the transnational legal order for trade.
Using an Adjunctive Treatment to Address Psychological Distress in a National Weight Management Program: Results of an Integrated Pilot Study
Authors: Evans-Hudnall Gina , Odafe Mary O , Johnson Adrienne , Armenti Nicholas , O’Neil Jennifer , Lawson Evan , Trahan Lisa H , Rassu Fenan S
Published: July 2020

Introduction

Obesity is highly comorbid with psychological symptoms in veterans, particularly post-traumatic stress disorder (PTSD), depression, and anxiety. Obese veterans with comorbid psychological symptoms often display suboptimal weight loss and poor physical functioning when participating in weight management programs. The MOVE! program aims to increase healthy eating and physical activity to promote weight loss in obese veterans. Adequately addressing psychological barriers is necessary to maximize outcomes in MOVE! for veterans with PTSD, depression, and anxiety. We examined the preliminary outcomes of administering the Healthy Emotions and Improving Health BehavioR Outcomes (HERO) intervention. HERO is adjunctive cognitive-behavioral therapy to MOVE! that addresses PTSD, depression, and anxiety symptom barriers to engagement in physical activity.

Materials and Methods

All recruitment and study procedures were approved by the institutional review board and research and development committees of the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston, Texas. Participants gave written informed consent before enrollment. Thirty-four obese veterans with a diagnosis of PTSD, depression, and/or anxiety who were attending MOVE! were assigned to the 8-session HERO group or the usual care (UC) group. Veterans completed assessments of PTSD, depression and anxiety symptoms, physical activity, physical functioning, and weight at baseline, 8 and 16 weeks post treatment. Changes from baseline to 8- and 16-week follow-up on the self-report and clinician-rated measures were assessed, using independent samples t-tests and analyses of covariance.

Results

At 8 weeks post treatment, participants in the HERO group had significantly higher step counts per day than participants in the UC group. Similarly, at 16 weeks post-treatment, participants in the HERO group continued to experience a significant increase in daily steps taken per day, as well as statistically and clinically significantly lower scores on the depression symptom and PTSD symptom severity. Participants in the HERO group also demonstrated significantly higher scores on the physical functioning inventory than participants in the UC group (44.1 ± 12.1 vs. 35.7 ± 10.7, P = 0.04) at 16 weeks post treatment.

Conclusions

Findings of this small trial have important implications pending replication in a more rigorously designed large-scale study. Providing an adjunctive treatment to MOVE! that addresses psychological distress has potential benefits for psychological symptom reduction, engagement in healthy dietary habits, and greater physical activity for individuals who traditionally experience barriers to making positive weight management changes.
Prescription and Prescriber Specialty Characteristics of Initial Opioid Prescriptions Associated with Chronic Use
Authors: Weiner Scott G , Chou Shih-Chuan , Chang Cindy Y , Garner Chad , El Ibrahimi Sanae , Hallvik Sara , Hendricks Michelle , Baker Olesya
Published: July 2020

Objective

This study evaluated the characteristics of opioid prescriptions, including prescriber specialty, given to opioid-naïve patients and their association with chronic use.

Design

Cross-sectional analysis of the Ohio prescription drug monitoring program from January 2010 to November 2017.

Setting

Ohio, USA.

Subjects

Patients who had no opioid prescriptions from 2010 to 2012 and a first-time prescription from January 2013 to November 2016.

Methods

Chronic use was defined as at least six opioid prescriptions in one year and either one or more years between the first and last prescription or an average of ≤30 days not covered by an opioid during that year.

Results

A total of 4,252,809 opioid-naïve patients received their first opioid prescription between 2013 and 2016; 364,947 (8.6%) met the definition for chronic use. Those who developed chronic use were older (51.7 vs 45.6 years) and more likely to be female (53.6% vs 52.8%), and their first prescription had higher pill quantities (44.9 vs 30.2), higher morphine milligram equivalents (MME; 355.3 vs 200.0), and was more likely to be an extended-release formulation (2.9% vs 0.7%, all P < 0.001). When compared with internal medicine, the adjusted odds of chronic use were highest with anesthesiology (odds ratio [OR] = 1.46) and neurology (OR = 1.43) and lowest with ophthalmology (OR = 0.33) and gynecology (OR = 0.37).

Conclusions

Eight point six percent of opioid-naïve individuals who received an opioid prescription developed chronic use. This rate varied depending on the specialty of the provider who wrote the prescription. The risk of chronic use increased with higher MME content of the initial prescription and use of extended-release opioids.
Difenoconazole Resistance Shift in Botrytis cinerea From Tomato in China Associated With Inducible Expression of CYP51
Authors: Zhang Can , Imran Muhammad , Xiao Lu , Hu Zhihong , Li Guixiang , Zhang Fan , Liu Xili
Published: July 2020

Gray mold caused by Botrytis cinerea is one of the most important diseases in tomato. It can be controlled effectively by demethylation inhibitor (DMI) fungicides, but their resistance status after long-term use in the field is unclear. The baseline sensitivity to difenoconazole of 142 B. cinerea isolates from China with no history of DMI usage was characterized, with a mean effective concentration for 50% mycelial growth inhibition (EC50) of 0.97 ± 0.50 μg/ml. EC50 values for difenoconazole sensitivity of another 248 isolates collected in 2011 and 2016 ranged from 0.04 to 11.99 μg/ml, and the frequency of difenoconazole sensitivity formed a nonnormal distribution curve. Detached fruit studies revealed that isolates with EC50 values of approximately 6.00 μg/ml were not controlled effectively. The mean EC50 of the resistant isolates changed from 6.74 to 8.65 μg/ml between 2011 and 2016. Positive cross-resistance was only observed between difenoconazole and two DMIs. One dual resistant isolate and one triple resistant isolate were found among the difenoconazole-resistant isolates collected in 2016, associated with point mutations in corresponding target proteins of the fungicides azoxystrobin and fludioxonil. This indicated that B. cinerea not only showed higher difenoconazole resistance levels but gradually changed from single to multiple fungicide resistance over time. No amino acid variation was found in the CYP51 protein. In the absence of difenoconazole, the relative expression of CYP51 was not significantly different in sensitive and resistant isolates. Induced expression of CYP51 is an important determinant of DMI resistance in B. cinerea from tomato. However, nucleotide variants found in the upstream region had no association with the fungicide resistance phenotype. These results will be helpful for the management of B. cinerea in the field.
Spatial Variation and Temporal Dynamics of Fungicide Sensitivity in Venturia effusa Within a Pecan Orchard
Authors: Standish J. R. , Brenneman T. B. , Bock C. H. , Stevenson K. L.
Published: July 2020

An 18-ha commercial pecan orchard was sampled over 3 years to study the spatial and temporal variation in fungicide sensitivity of Venturia effusa, cause of pecan scab. The orchard was divided into a two-dimensional, 8 × 8 grid of 64 quadrats, each containing nine trees (unless there were missing trees), and samples were collected once per year from each quadrat to be tested for sensitivity to fentin hydroxide, propiconazole, and thiophanate-methyl. Averaged across the orchard, insensitivity to all three fungicides was significantly lower in 2016 compared with 2015, but significantly greater for fentin hydroxide and thiophanate-methyl in 2017. Although significant spatial autocorrelation was observed for sensitivity to propiconazole in 2017 and for thiophanate-methyl in 2015 and 2017, indicating clustering, all other fungicide-by-year combinations were not significant. Omnidirectional spatial dependence was observed for sensitivity to propiconazole and thiophanate-methyl in 2017. In both instances, the semivariance increased linearly with lag distance; however, the range of spatial dependence was >276.5 m and could not be estimated accurately. Additionally, a separate sampling was conducted in all 3 years to identify an appropriate sampling size and pattern for fungicide sensitivity screening. A leaflet sample size of 165 in 11 groups of 15 allowed for accurate sensitivity testing for the three fungicides in all 3 years; however, a sample size of 45 leaflets in three groups of 15 was sufficient for quantifying sensitivity for propiconazole and thiophanate-methyl, in most cases. These results indicate that considerable biological variation in fungicide sensitivity exists in orchard-scale populations of V. effusa and that the spatial characteristics of those populations may differ in two-dimensional space depending on the growing season.
Thromboprophylaxis in Critically Ill Coronavirus Disease 2019 Patients
Authors: Piagnerelli Michaël , Cauchie Philippe , Vancutsem Maxime , Thooft Aurélie , Zouaoui Boudjeltia Karim , Biston Patrick , Wautrecht Jean-Claude
Published: July 2020

It is now reported that coronavirus disease 2019 ICU patients are at increased risk of thrombosis. Expert opinion and scientific societies recommend a higher dose of low-molecular-weight heparin, but definitive data is lacking. We report our adapted thromboprophylaxis practice of low-molecular-weight heparin administration in coronavirus disease 2019 ICU patients. One-hundred six measurements in 19 ICU patients were collected. Despite enoxaparin 60 mg once daily, only two measurements of the trough anti-Xa were in the upper end of prophylactic range. Anti-Xa activity peaks increased significantly after administration, but all measurements were under the optimal prophylactic ranges. Despite an adapted protocol, three of the 19 patients (16%) developed venous thromboembolism. We show in coronavirus disease 2019 ICU patients, despite higher prophylactic low-molecular-weight heparin administration due to body mass index, anti-Xa activity was well below peak serum levels in our cohort of critically ill coronavirus disease 2019 patients. This evaluation suggests the need for rapid studies on adequate thromboprophylaxis in these patients.
Ultrasound and Magnetic Responsive Drug Delivery Systems for Cardiovascular Application
Authors: Qian Bei , Zhao Qiang , Ye Xiaofeng
Published: July 2020

With the increasing insight into molecular mechanisms of cardiovascular disease, a promising solution involves directly delivering genes, cells, and chemicals to the infarcted myocardium or impaired endothelium. However, the limited delivery efficiency after administration fails to reach the therapeutic dose and the adverse off-target effect even causes serious safety concerns. Controlled drug release via external stimuli seems to be a promising method to overcome the drawbacks of conventional drug delivery systems (DDSs). Microbubbles and magnetic nanoparticles responding to ultrasound and magnetic fields respectively have been developed as an important component of novel DDSs. In particular, several attempts have also been made for the design and fabrication of dual-responsive DDS. This review presents the recent advances in the ultrasound and magnetic fields responsive DDSs in cardiovascular application, followed by their current problems and future reformation.
Role of Bempedoic Acid in Dyslipidemia Management
Authors: Kelly Michael S. , Sulaica Elisabeth M. , Beavers Craig J.
Published: July 2020

Statins remain the preferred agent to reduce low-density lipoprotein cholesterol (LDL-C) and lower atherosclerotic cardiovascular disease (ASCVD) risk. Additional nonstatin agents are recommended to further lower LDL-C among patients at high-risk of ASCVD or those with heterozygous familial hypercholesterolemia, despite statin therapy. Patients unable to tolerate recommended doses of statin therapy due to adverse effects, including statin-associated muscle symptoms, may also require additional nonstatin agents to lower LDL-C and ASCVD risk. Bempedoic acid is a first-in-class, once-daily oral agent, recently approved as monotherapy and in combination with ezetimibe, as an adjunct to maximally tolerated statin therapy in patients with ASCVD or heterozygous familial hypercholesterolemia who require additional LDL-C lowering. Its novel mechanism is reported to avoid adverse muscle symptoms associated with statins. The effectiveness and safety of bempedoic acid and bempedoic acid/ezetimibe combination have been reported in multiple phase 2 and 3 trials. In this review, we report the lipid-lowering effects associated with bempedoic acid, and the safety profile from multiple clinical trials. Based on available data, bempedoic acid significantly lowers LDL-C and other atherogenic lipoprotein measures, and high-sensitivity C-reactive protein when added to background lipid-lowering therapy in patients with and without statin intolerance. Overall safety of bempedoic acid seems to be comparable to placebo, except for increased serum uric acid and tendon rupture. Ongoing clinical trials assessing the long-term safety and cardiovascular outcomes will provide additional insight into the role of bempedoic acid as an adjunct lipid-lowering medication.
AABIP Evidence-informed Guidelines and Expert Panel Report for the Management of Indwelling Pleural Catheters
Authors: Miller Russell J. , Chrissian Ara A. , Lee Y.C. Gary , Rahman Najib M. , Wahidi Momen M. , Tremblay Alain , Hsia David W. , Almeida Francisco A. , Shojaee Samira , Mudambi Lakshmi , Belanger Adam R. , Bedi Harmeet , Gesthalter Yaron B. , Gaynor Margaret , MacKenney Karen L. , Lewis Sandra Z. , Casal Roberto F.
Published: July 2020

Background:

While the efficacy of Indwelling pleural catheters for palliation of malignant pleural effusions is supported by relatively robust evidence, there is less clarity surrounding the postinsertion management.

Methods:

The Trustworthy Consensus-Based Statement approach was utilized to develop unbiased, scientifically valid guidance for the management of patients with malignant effusions treated with indwelling pleural catheters. A comprehensive electronic database search of PubMed was performed based on a priori crafted PICO questions (Population/Intervention/Comparator/Outcomes paradigm). Manual searches of the literature were performed to identify additional relevant literature. Dual screenings at the title, abstract, and full-text levels were performed. Identified studies were then assessed for quality based on a combination of validated tools. Appropriateness for data pooling and formation of evidence-based recommendations was assessed using predetermined criteria. All panel members participated in development of the final recommendations utilizing the modified Delphi technique.

Results:

A total of 7 studies were identified for formal quality assessment, all of which were deemed to have a high risk of bias. There was insufficient evidence to allow for data pooling and formation of any evidence-based recommendations. Panel consensus resulted in 11 ungraded consensus-based recommendations.

Conclusion:

This manuscript was developed to provide clinicians with guidance on the management of patients with indwelling pleural catheters placed for palliation of malignant pleural effusions. Through a systematic and rigorous process, management suggestions were developed based on the best available evidence with augmentation by expert opinion when necessary. In addition, these guidelines highlight important gaps in knowledge which require further study.
Sucrase‐isomaltase Gene Variants in Patients With Abnormal Sucrase Activity and Functional Gastrointestinal Disorders
Authors: Deb Chirajyoti , Campion Stephani , Derrick Veronica , Ruiz Vanessa , Abomoelak Bassam , Avdella Angelina , Zou Baiming , Horvath Karoly , Mehta Devendra I.
Published: July 2020

Objectives:

The aim of the study was to determine prevalence and characterize sucrase‐isomaltase (SI) gene variants of congenital sucrase‐isomaltase deficiency in non‐Hispanic white pediatric and young adult patients with functional gastrointestinal disorders (FGIDs), and abnormal sucrase activity on histologically normal duodenal biopsy.

Methods:

Clinical symptoms and disaccharidase activities data were collected for an abnormal (low) sucrase (≤25.8 U, n = 125) activity group, and 2 normal sucrase activity groups with moderate (≥25.8–≤55 U, n = 250) and high (>55 U, n = 250) sucrase activities. SI gene variants were detected by next‐generation sequencing of DNA from formalin‐fixed paraffin‐embedded tissues of these patients. FGIDs symptoms based on Rome IV criteria and subsequent clinical management of abnormal sucrase activity cases with pathogenic SI gene variants were analyzed.

Results:

Thirteen SI gene variants were found to be significantly higher in abnormal sucrase cases with FGIDs symptoms (36/125, 29%; 71% did not have a pathogenic variant) compared to moderate normal (16/250, 6.4%, P < 0.001) or high normal (5/250, 2.0%, P < 0.001) sucrase groups. Clinical management data were available in 26 of abnormal sucrase cases, and only 10 (38%) were correctly diagnosed and managed by the clinicians. Concomitant lactase deficiency (24%; 23/97) and pan‐disaccharidase deficiency (25%; 13/51) were found in the abnormal sucrase group.

Conclusions:

Heterozygous and compound heterozygous mutations in the SI gene were more prevalent in cases with abnormal sucrase activity presenting with FGIDs, and normal histopathology. This suggests heterozygous pathogenic variants of congenital sucrase‐isomaltase deficiency may present as FGIDs. Concomitant lactase or pan‐disaccharidase deficiencies were common in abnormal sucrase cases with SI gene variants.
Prevalence and Predictors of Compromised Bone Mineral Density in Pediatric Eosinophilic Esophagitis
Authors: Henderson Anna F. , Khan Soofia M. , Hornung Lindsey N. , Mukkada Vincent A. , Kalkwarf Heidi J.
Published: July 2020

Objectives:

The aim of the study was to determine whether patients with eosinophilic esophagitis (EoE) have lower bone mineral density (BMD) than expected and if bone deficits are more pronounced in subgroups of patients according to comorbidities (atopic disease and joint hypermobility) or treatments (dietary restriction, medication exposure).

Study Design:

Retrospective chart review was performed to obtain clinical data, including length of diagnosis, comorbidities, and methods of treatment for patients with EoE ages 3 to 21 years who had a lumbar spine dual‐energy x‐ray absorptiometry scan performed between 2014 and 2017. BMD was standardized by calculation of age, sex, and race‐specific z scores.

Results:

A total of 269 patients met study criteria. The mean BMD z score (−0.55, 95% confidence interval: −0.68, −0.42) was lower than expected (P < 0.0001), and the prevalence of low BMD z score (≤−2.0) was higher than expected (8.5%, 95% confidence interval: 5.2%–11.9%, P < 0.0001). In multivariable regression models, BMD z scores were −0.27 lower among those following an elimination diet and −0.65 lower among those with any lifetime use of a proton pump inhibitor (93% of the sample). There was no association with swallowed steroid use.

Conclusions:

In our sample, pediatric patients with EoE had a slightly lower BMD z score compared to peers, and the prevalence of low BMD was higher than expected. Taken cautiously given the limitations of our sample, risk factors for bone deficits included any lifetime use of proton pump inhibitor and a restrictive elimination diet, but not swallowed steroid use. Larger prospective studies are needed to better characterize risk factors for low BMD to help inform screening, selection of therapies, and provide appropriate anticipatory guidance for patients with EoE.
Nephrocalcinosis and Renal Dysfunction in Pediatric Intestinal Failure
Authors: Roberts Amin J. , Belza Christina , Wales Paul W. , Courtney‐Martin Glenda , Harvey Elizabeth , Avitzur Yaron
Published: July 2020

Background:

Outcomes of pediatric intestinal failure (PIF) have improved recently, with other comorbidities, such as increased echogenicity/nephrocalcinosis on ultrasound (US) in long‐term survivors now evident. We evaluated the significance of nephrocalcinosis over time in PIF and its impact on renal function.

Methods:

Retrospective analysis on a cohort of PIF patients was performed. Presence of nephrocalcinosis and/or increased renal echogenicity (identified on US), estimated glomerular filtration rate (eGFR; ml · min−1 · 1.73 m−2), renal tubular function, PN volume (ml · kg−1 · day−1) and PN exposure time (hours/day) were reviewed annually over a follow‐up period of 2 years. Outcomes in the nephrocalcinosis versus normal US groups were compared.

Results:

Forty patients (28 boys, median age 2.7 years) were followed for 2 years. Fifteen (38%) had either increased echogenicity or nephrocalcinosis (group 1) at initial US. US were normal in the remaining 25 (62%) on initial assessment (group 2). eGFR did not differ between group 1 and group 2 at baseline (118 vs 133, P = 0.51) and year 2 (130 vs 131, P = 1.00). The percentage of patients with abnormal markers of tubular function was similar in both groups at year 2 (high urine calcium: creatinine 33 versus 30, P = 0.83; high urine calcium: citrate 39 versus 42, P = 0.87; low urine citrate: creatinine 15 versus 17, P = 1.00; high urine oxalate: creatinine 39 versus 25, P = 0.77).

Conclusions:

A large proportion of PIF patients with a history of parenteral nutrition (PN) exposure have nephrocalcinosis and/or increased echogenicity on US. Over a 2‐year follow‐up period, however, these abnormalities had no impact on eGFR or renal tubular function.
Cardiovascular Risk Assessment in Children With Chronic Cholestatic Liver Diseases
Authors: Janowski Kamil , Obrycki Łukasz , Litwin Mieczysław , Czubkowski Piotr , Wierzbicka-Rucińska Aldona , Gliwicz-Miedzińska Dorota , Jankowska Irena , Kostewicz Krzysztof , Socha Piotr
Published: July 2020

Objectives:

Chronic cholestatic liver diseases are often associated with disturbed lipid metabolism, which may potentially increase cardiovascular (CV) risk but the evidence is scarce. The aim of the study was to assess factors associated with increased CV risk in children with Alagille syndrome (AGS) and biliary atresia (BA).

Methods:

We investigated 17 patients with AGS, ages 11.0 years (8.4–13.4) and 19 with BA, ages 13.5 years (10.4–15.1) in whom we performed thorough biochemical assessment including lipid profiles and oxidative stress biomarkers, blood pressure (BP)—systolic, diastolic and mean, carotid intima-media thickness (cIMT), and pulse wave velocity (PWV).

Results:

There were abnormal lipid profiles in 82% of children with AGS and 52.6% with BA. In AGS group, we observed significantly higher levels of TC, LDL C, APO B, lower glutathione concentration and glutathione peroxidase activity and lower blood pressure, lower cIMT (P = 0.02), cIMT-SDS (P = 0.04), and PWV (P = 0.04). We, however, observed elevated blood pressure in 2/19 patients with BA and none-with AGS (BA vs AGS: P = 0.12), whereas cIMT-SDS was increased only in 2/17 patients with AGS and in 6/19 with BA (P = 0.24), and abnormal PWV-SDS values were detected in 3/17 of AGS and 8/19 of BA patients (P = 0.15). Neither presence of dyslipidemia nor Lp-X correlated with vascular parameters.

Conclusions:

Children with BA and AGS may present with increased cardiovascular risk factors but vascular parameters are not directly related to lipid abnormalities. cIMT and BP should be considered for clinical practice in these cholestatic disorders so as to determine individuals with potential CV risk.
Physical Function and Frailty Tools in Mortality Prediction of Middle-Aged Adults With HIV
Authors: Pelloquin Regan , Abdo Mona , MaWhinney Samantha , Jankowski Catherine M. , Erlandson Kristine M.
Published: July 2020

Background:

Frailty and physical function impairments occur at an earlier than expected age in people with HIV (PWH). The goal of this study was to determine which tools or combination of tools assessing frailty/physical function were most predictive of mortality in a middle-aged population of PWH.

Methods:

Using electronic health records, we determined survival, death, or loss to follow-up for 359 PWH, aged 45–65 years originally enrolled in a 2009–2010 cross-sectional cohort study. The predictive accuracy of various physical function measures [frailty score, Veterans Aging Cohort Study (VACS) index, 400-m walk, Short Physical Performance Battery (SPPB), grip strength, and falls] were compared using integrated time-dependent receiver operating characteristic area under the curve (AUC) in single variable models. Two-variable models were compared with the best single-variable model to determine if AUC improved with additional physical function variables.

Results:

At 8-year follow-up, frailty, 400-m walk pace, SPPB, chair rise pace, VACS score, and falls were associated with increased hazard of mortality; grip strength was only predictive in sex-adjusted models. The VACS index and 400-m walk pace were the best individual predictors of mortality with time-dependent receiver operating characteristic AUC scores of 0.82, followed by SPPB (0.73), chair-rise pace (0.68), falls (0.65), frailty (0.63), and grip strength (0.55). Addition of the 400-m walk to VACS index yielded the only significant improvement in the prediction of survival compared with the VACS index alone (P = 0.04).

Conclusion:

Our study highlights several clinically applicable physical function measures predictive of mortality in middle-aged PWH that can be tailored to specific patient subpopulations and clinical or research encounters.
Brief Report: Cystatin C-Based Estimation of Glomerular Filtration Rate and Association With Atherosclerosis Imaging Markers in People Living With HIV
Authors: McClean Mitchell , Buzkova Petra , Budoff Matthew , Estrella Michelle , Freiberg Matthew , Hodis Howard N. , Palella Frank , Shikuma Cecilia , Post Wendy S. , Gupta Samir
Published: July 2020

Introduction:

Reduced estimated glomerular filtration rate (eGFR) is associated with increased risk of cardiovascular disease among people living with HIV (PLWH). It is unclear whether eGFR equations incorporating cystatin C (CysC) measurements are more predictive of preclinical cardiovascular disease than those using only creatinine (Cr).

Objectives:

The study aimed to determine which of the 3 Chronic Kidney Disease Epidemiology (CKD-EPI) eGFR equations is most associated with carotid intima media thickness (CIMT) and coronary artery calcium (CAC) score.

Methods:

This cross-sectional analysis of pooled data from 3 large cohorts compared the associations between the 3 CKD-EPI eGFR equations (Cr, CysC, and Cr-CysC) with CIMT and CAC score using multivariable regression analysis. eGFR and CIMT were analyzed as continuous variables. CAC scores were analyzed as a binary variable (detectable calcification versus nondetectable) and as a log10 Agatston score in those with detectable CAC.

Results:

Thousand four hundred eighty-seven participants were included, and of these 910 (562 HIV+ and 348 HIV−) had CIMT measurements and 366 (296 HIV+ and 70 HIV−) had CAC measurements available. In HIV− participants, GFR estimated by any CKD-EPI equation did not significantly correlate with CIMT or CAC scores. When PLWH were analyzed separately including HIV-specific factors, only GFR estimated using Cr-Cys C correlated with CIMT [β= −0.90, 95% CI: (−1.67 to −0.13) μm; P = 0.023]. Similarly, eGFR correlated with Agatston scores only when using cystatin C-based eGFR [β= −8.63, 95% CI: (−16.49 to −0.77) HU; P = 0.034]. Associations between other eGFR formulas and CAC did not reach statistical significance.

Conclusions:

In PLWH, preclinical atherosclerosis may be more closely correlated with eGFR using formulae that incorporate CysC measurements than Cr alone.
Office-Based Forehead Flaps
Authors: Beederman Maureen , Jaffe Jennifer , Kuchta Kristine , Warner Jeremy
Published: July 2020

Background

Forehead flaps are one of the workhorse flaps for nasal reconstruction, especially for large defects involving the nasal tip, ala, or multiple nasal subunits. Forehead flaps are often performed on older patients who have accompanying comorbidities and who may be at higher risk for anesthetic complications. The aim of this retrospective study was to compare the safety and success of forehead flap nasal reconstruction in 2 different clinical settings: those performed under local anesthesia in an office-based procedure room, compared with those performed in the operating room under either general anesthesia or intravenous sedation.

Methods

A retrospective chart review was performed on all patients who underwent forehead flap reconstruction between the years of 2011 and 2018 by the senior author. Patient demographics, operative details, and postoperative complications were recorded and analyzed. Patients were followed for 1 year postoperatively or until the end of the study period. Patients were excluded if they had an accompanying unrelated cosmetic procedures performed during first-stage forehead flap reconstruction.

Results

A total of 96 forehead flaps were performed, 35 of which (36.5%) were done in an office-based procedure room using local anesthesia only. Patient ages ranged from 45 to 92 years, with an average age of 71.9 years. The majority of flaps (n = 81, 85.3%) were divided at the second-stage procedure. There was no statistically significant difference in time elapsed between first- and second-stage procedures between groups (procedure room: 22.6 days; operating room: 23.8 days). There were 13 total postoperative complications (13.5%), but there was no statistically significant difference in complication rate between groups (office-based: 3 complications, 8.6%; operating room: 10 complications, 16.4%).

Conclusions

Our data suggest that forehead flap reconstruction can be done safely with acceptable postoperative results when performed under local anesthesia in an office-based outpatient setting.
Paranasal Augmentation With Composite Graft Transfer in Overresection of Alar Base and Nostril Contracture
Authors: Yen Cheng-I , Chang Chun-Shin , Chen Hung-Chang , Yang Shih-Yi , Chang Shu-Yin , Yang Jui-Yung , Chuang Shiow-Shuh , Hsiao Yen-Chang
Published: July 2020

Background

Many Asian patients desire a narrower nasal base with less flaring of the alar lobules. However, patients who underwent multiple rhinoplasty surgeries with nostril contracture or an overreduction of the alar base may experience nostril contracture and deformity, which may lead to further airway obstruction. We present a technique that combines paranasal augmentation with composite chondrocutaneous graft transfer to overcome this problem.

Methods

Nine patients underwent composite chondrocutaneous graft transfer to the soft triangle or alar base combined with paranasal augmentation using preshaped porous polyethylene implants to correct nostril contracture and airway obstruction between September of 2014 and May of 2018. Preoperative and postoperative alar base distances and cross-sectional areas of the nostrils were measured and compared.

Results

The average thickness of paranasal augmentation was 5.5 mm (range, 4.0–7.0 mm). Eighteen composite grafts were located over the soft triangle (n = 3) and the alar base (n = 15). The average number of composite grafts for each person was 2 (range, 1–4). All composite grafts survived totally or partially, and no graft failed. The average follow-up was 10.9 months (range, 3–28 months). The alar base increased 13.9% (range, 2.2%–23.9%), and the nostril area increased an average of 78.1% (range, 4.5%–316.8%) postoperatively. Patients had satisfactory aesthetic and functional outcomes.

Conclusions

Combining paranasal augmentation and composite graft transfer increased the cross-sectional area of the external valve and improved nostril contracture and airway obstruction after the overresection of the alar base or nose contracture after multiple rhinoplasty surgeries.