bluuebunny/crossref_metadata_2025 huggingface dataset:
Staffing Models and Training Opportunities
Authors: Falk Avital , Bennett Shannon , Rozenman Michelle , Mohatt Justin , Bergman R. Lindsey
Published: April 2023

“Staffing Models and Training Opportunities” describes staffing models across a variety of treatment settings, providing details on sustaining intensive clinical work as a single practitioner, group of clinicians, or in a training program with licensed clinicians providing supervision to unlicensed trainees. This chapter discusses the mutual benefit of using an intensive treatment program as an opportunity for clinical training, which also provides a staffing model for supporting patients and sustaining programs. Intensive treatment programs provide students of all levels in psychology, psychiatry, and allied disciplines a concentrated work experience to develop expertise in the treatment of obsessive compulsive disorder (OCD) and related disorders. Trainees can extend the work of licensed clinicians in a way that is cost-effective to clinical programs and for patients, and the variety offered with different staff members helps patients generalize the work of treatment. Models of supervision, patient safety, and quality assurance are described.
Treating a Child Requires Treating the Family and Community
Authors: Falk Avital , Bennett Shannon , Rozenman Michelle , Mohatt Justin , Bergman R. Lindsey
Published: April 2023

“Treating a Child Requires Treating the Family and Community” details the rationale and process for including family members and other important care providers in the treatment of obsessive compulsive disorder (OCD), particularly for child and adolescent patients. Parents and others adapt their behaviors or environments to minimize OCD triggers, which then becomes a frequently repeated cycle that can cause conflict and high emotions. This chapter describes options for including parents, siblings, teachers, and other important people in the intensive treatment process, with appropriate consent, in order to address these symptoms. Specific examples of family involvement in OCD treatment are provided, including how to support parents and others in managing their own emotions throughout the treatment process. Parental participation in exposure and response prevention is highlighted.
Psychoeducation
Authors: Falk Avital , Bennett Shannon , Rozenman Michelle , Mohatt Justin , Bergman R. Lindsey
Published: April 2023

This chapter, “Psychoeducation,” describes this important initial component of intensive treatment. Psychoeducation reviews the important components of education for patients, including how to understand obsessive compulsive disorder (OCD) and the rationale, process, and benefits of intensive exposure and response prevention (ERP). Psychoeducation about OCD and common comorbid symptoms is important to reduce anxiety, shame, stigma, and blame around the symptom presentation for patients and their families. Early education about the process of intensive ERP prepares patients and families that this treatment can be quite challenging and uncomfortable and simultaneously allows them to understand how it will benefit and help. This chapter clearly lays out the key information to include in psychoeducation and describes the benefits of this intervention.
Treating Episodic Breathlessness
Authors: Eisenmann Yvonne , Simon Steffen
Published: April 2023

Episodic breathlessness, a time-limited worsening of breathlessness intensity, occurs frequently in patients with advanced disease despite optimal treatment of underlying disease. It requires symptomatic treatment. Breathlessness episodes are often associated with anxiety. Due to the short average duration of episodes, nonpharmacological strategies are the first-line treatment and facilitate self-management. Breathing techniques and body positioning help the patient to ease breathing. Cooling the face (e.g., by a handheld fan), activity pacing, and cognitive-behavioral strategies such as relaxation techniques and distraction can help the patient to manage episodes. Educating the patient and the family is crucial; teaching topics include information about breathlessness, underlying disease, average length of episodes, triggers, and strategies to manage episodes. For prolonged breathlessness episodes, opioids can provide symptomatic relief and benzodiazepines may reduce breathlessness-related anxiety.
Reducing Episodic Dyspnea in Heart Failure
Authors: Fahlberg Beth B. , Laramee Ann S.
Published: April 2023

Dyspnea is a common and distressing problem for patients with heart failure (HF), yet with comorbid conditions, diagnosis and prompt treatment can be challenging. Targeted assessment findings specific to HF include orthopnea, jugular vein distention, bibasilar crackles, ascites, peripheral edema, and weight gain. Diagnostic test findings in HF-related dyspnea include elevated brain natriuretic peptide levels and pulmonary congestion on chest x-ray. Diuresis is the primary focus of treatment, while guideline-directed medical therapies including procedures, surgeries, devices, and medications can promote improved heart function and prevent future episodes of dyspnea, with consideration for the patient’s prognosis and goals of care. Home monitoring for worsening HF symptoms and increasing weight and use of patient-focused symptom management plans are also essential to reducing episodes of dyspnea in HF, while advance care planning with HF-specific decision-making can promote appropriate concordant care in this population.
Dyspnea in Pediatric Congenital Heart Disease
Authors: Wright Jennifer , Spruit Jessica L.
Published: April 2023

This chapter discusses dyspnea, which is a common and potentially underrecognized symptom in infants, children, and adolescents who have complex congenital heart defects. The clinician caring for these children should strive to identify and relieve the experience of dyspnea through a combination of nonpharmacological and pharmacological interventions. Diagnostic evaluation and treatment of the underlying problem, including diuretic therapy for fluid management and agents to achieve afterload reduction, may be warranted. Environmental modifications including a cool airflow from a fan as well as pharmacological interventions such as opioids may be effective. Anxiety secondary to dyspnea should also be considered and addressed.
Treating Dyspnea in Lung Cancer with Noninvasive Ventilation
Authors: Comellini Vittoria , Nava Stefano
Published: April 2023

Dyspnea is a common and distressing symptom that is experienced by many patients with advanced cancer, in particular those who are approaching the end of their lives. Despite this, very little attention has been paid to the distress associated with breathlessness, and the condition frequently remains unrecognized, undetected, and consequently untreated. As cancer patients advance in their disease process, palliative therapies may be necessary for symptom relief. Both pharmacological and nonpharmacological treatments can be administered to assist patients and to improve the quality of their lives. This chapter defines the possible and promising fields of application of noninvasive mechanical ventilation in the treatment of dyspnea in lung cancer patients.
Palliative Care for Infants with Bronchopulmonary Dysplasia
Authors: Fortney Christine A. , Ulloa Jodi A.
Published: April 2023

This chapter reviews the approach to an infant who has developed a complex chronic condition, bronchopulmonary dysplasia (BPD), as a result of her prematurity and continues to experience respiratory distress requiring conventional mechanical ventilation and sedation that is affecting her growth and development, as well as her ability to bond with her family. Diagnostic criteria and management for BPD are discussed. Early introduction of a combination of primary and consultative palliative care is advocated in the context of providing integrated and individualized services that meet the specific needs of the infant and family from hospital admission through discharge to home, as well as at end of life.
Palliative Sedation for Intractable Dyspnea
Authors: Bramati Patricia , Bruera Eduardo
Published: April 2023

Palliative sedation, the intentional lowering of awareness, is a well-established intervention at the end of life in patients who are terminally ill, in whom death is imminent, and in whom suffering persists after maximization of standard medical treatments. Palliative sedation is an ethically and legally accepted intervention that can be distinguished from assisted suicide and euthanasia. Proportionality is crucial to the ethics of this practice and consent should be obtained. Consultation with palliative care experts is highly recommended. Sedation should be started at the lowest possible dosage and titrated up until controlling the symptom with frequent assessment relative to achieving the treatment goal.
Sialorrhea in Amyotrophic Lateral Sclerosis
Authors: Bromberg Mark B.
Published: April 2023

Sialorrhea can be defined as pooling of saliva due to inefficient swallowing. In amyotrophic lateral sclerosis (ALS), weakness and poor coordination of cheek and tongue muscles and muscles involved with swallowing prevent clearing the 1-plus quarts or liters of saliva produced daily. Sialorrhea occurs in most ALS patients who have bulbar involvement and is a source of social distress, thus reducing quality of life. Treatment options focus on drugs with anticholinergic properties, followed by botulinum toxin injections into salivary glands, and lastly on irradiation of the glands. A reasonable degree of saliva control can be achieved for most ALS patients.
Perioperative Considerations for Success of Regional Anesthesia
Authors: Wardhan Richa , Jira Janet
Published: April 2023

Nerve block procedures are placed utilizing nerve stimulation, ultrasound, or both. The advent of ultrasound and nerve stimulation were both met with great enthusiasm when they were first introduced in their own respective eras; however, a thorough knowledge of ultrasound and/or nerve stimulation is required to deliver a safe and successful outcome every time. This chapter will discuss the perioperative considerations for placing a nerve block starting from the steps that lead to the decision to place it, to consent, time out, sedation, equipment, till sending some patients home with a nerve block catheter. Good understanding of the ultrasound machine and nerve stimulator will result in the optimal use of them. Ergonomics also plays an equally important role in improving the efficiency of a procedure and in preventing operator fatigue.
Shoulder Arthroplasty Analgesic Strategies
Authors: Nin Olga “Kiki” , Grosh Taras
Published: April 2023

Total shoulder arthroplasty is a common procedure performed for patients suffering from rotator cuff tears, severe fractures, avascular necrosis, severe osteoarthritis, rheumatoid arthritis, or failed previous shoulder surgery. There are three types of total shoulder surgery depending on the indication. These are: hemiarthroplasty, anatomical total shoulder replacement, and reverse shoulder arthroplasty. Postoperative pain control is an important component of the anesthetic plan as this will facilitate recovery as well as discharge home. Multimodal pain approaches utilizing a combination of nonsteroidal anti-inflammatory drugs, acetaminophen, gabapentinoids, N-methyl-D-aspartate (NMDA) antagonists, opioids, and local anesthetic through surgical site infiltration or nerve blockade have proven to be superior to use of a single pharmacologic modality. The innervation of the shoulder is derived from the brachial plexus, which is composed of three trunks (superior [C5–C6], middle [C7], and inferior [C8–T1]). The glenohumeral joint is innervated by the axillary, suprascapular, supraclavicular, and lateral pectoral nerves. Establishing an enhanced recovery after surgery (ERAS) protocol for total shoulder arthroplasty has been shown to help standardize patient care, decrease length of stay, reduce medical errors and complications, and increase patient satisfaction.
Regional Anesthesia and Pain Management for Total Hip Arthroplasty
Authors: Lee Bradley H. , Mamic Marko , Liu Jiabin
Published: April 2023

Total hip replacement is a very common procedure. Anesthesiologists should be familiar with the indications and the surgical approaches. Postoperative pain relief is important in this group of patients for enhanced recovery after surgery. Strategies for postoperative pain management in patients undergoing total hip arthroplasty include multimodal pain management including various regional techniques. Regional anesthesia requires a good understanding of hip innervation and anatomy. Basics of hip replacement surgery, innervation of the hip joint, and its anatomy are reviewed, along with specific regional techniques and the associated evidence for postoperative pain control, as well as advantages and limitations of each.
Regional Anesthesia for Open Reduction and Internal Fixation of an Ankle Fracture
Authors: Nilforoshan Maryam , Huang Stephanie , Elkassabany Nabil
Published: April 2023

Ankle fracture is a very common orthopedic injury, and its incidence is expected to continually rise. A thorough understanding of ankle joint anatomy and various ankle fracture classification systems provides a foundation to evaluate such injuries and to determine the most appropriate treatment for an ankle fracture. Ankle fractures requiring ORIF present the challenge of postoperative pain control. Although parenteral opioids and neuraxial anesthesia have been used for ankle surgery, regional anesthesia in the form of the popliteal sciatic nerve block and the saphenous nerve block have been shown to be particularly effective. These peripheral nerve blocks have been successfully used for both postoperative analgesia as well as primary regional anesthetics for ankle surgery. The chapter explores the indications, anatomy, and ultrasound-guided technique required for both of these peripheral nerve blocks.
Epidural for Labor in a Morbidly Obese Patient and Neuraxial Ultrasound
Authors: Vallejo Manuel C.
Published: April 2023

Point of care pre-procedure neuraxial ultrasound imaging of the lower lumbar vertebrae is becoming the gold standard in labor and delivery neuraxial analgesia and anesthesia. Pre-procedure ultrasound imaging can be used to facilitate successful neuraxial placement by determining the optimal vertebral interspace, identification of the midline, locating the optimal insertion point as well as the best angle for needle insertion, and to provide an accurate measurement depth for needle advancement to the epidural or intrathecal space. Neuraxial ultrasound can enhance the parturient’s overall comfort, experience, and satisfaction by reducing the risk for failed or traumatic lumbar punctures and epidural catheterizations, the number of insertion attempts, and needle redirections. Furthermore, neuraxial ultrasound imaging can be of particular benefit in parturients with difficult anatomy or landmarks.
Post-Dural Puncture Headache
Authors: Sayre Lauren , Gaiser Robert
Published: April 2023

Post-dural puncture headache is a positional bilateral frontal-occipital headache that occurs after the dura is punctured. The etiology is felt to be loss of cerebrospinal fluid resulting in possible sagging of the brain with traction on the dura in the frontal and occipital areas. Factors that increase the risk of the development of a headache after dural puncture include age (younger patients at greater risk), vaginal delivery, and use of a Quincke needle (applies only to spinal anesthesia). Following an accidental dural puncture with an epidural needle, there is no effective means that will prevent the patient from developing a headache, even an intrathecal catheter. Caffeine is not effective for the treatment or the prevention of headache. The best treatment is an epidural blood patch, which involves injecting autologous whole blood in the epidural space. A sphenopalatine block is effective for relieving the symptoms of the headache; it does not treat the etiology.
Orthopedic Trauma in a Patient With Complex Regional Pain Syndrome
Authors: Tolba Reda , Fayed Mohamed
Published: April 2023

Complex regional pain syndrome (CRPS) is a chronic neurological disorder involving a region characterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor function. It mostly occurs acutely in patients who have limb fractures or limb surgery. Possible pathophysiological mechanisms include neurogenic inflammation, peripheral and central sensitization, brain plasticity, sympatho-afferent coupling, genetic or psychological factors. The syndrome is diagnosed based on clinical signs and symptoms. Effective management of the chronic form of the syndrome is often challenging. It mainly involves multidisciplinary clinical care, which centers around controlling pain and intensive rehabilitation therapies. Elective surgery should be performed when features of previous episodes of CRPS have improved and when the patient is stable; surgery should be avoided during exacerbations.
The Painful Vaso-Occlusive Sickle Cell Episode
Authors: Orr Amberly , Elmofty Dalia , Kohan Lynn
Published: April 2023

Sickle cell disease (SCD) is an inherited blood disorder. The disease affects approximately 100,000 Americans and is most prevalent among African Americans. SCD is an autosomal recessive disorder caused by mutations of the gene that encodes the β-globin chain of hemoglobin. Acute vaso-occlusive (VOC) pain episodes are the hallmark of the disease presentation. Pain is the most common reason that patients with SCD are admitted to the hospital. A multidisciplinary care team model and use of multimodal analgesic regimens can provide optimal pain management in patients with SCD. Lines of management include pharmacologic and non-pharmacologic modalities for pain control. It is important to distinguish between VOC pain and pain that signifies more serious complications of the disease.
Sleep, Immune Function, and Vaccinations in Military Personnel: Challenges and Future Directions
Authors: Anderson Melissa S , Chinoy Evan D , Harrison Elizabeth M , Myers Christopher A , Markwald Rachel R
Published: April 2023

The U.S. military invests substantial resources to vaccinate all personnel, including recruits, against operationally important infectious disease threats. However, research suggests that vaccine immune response and, therefore, vaccine effectiveness may be inadvertently reduced because of chronic and/or acute sleep deficiency experienced by recipients around the time of vaccination. Because sleep deficiency is expected and even necessary in deployed and training contexts, research investigations of the impacts of sleep and related physiological systems such as circadian rhythms on vaccine effectiveness in military settings are needed. Specifically, research should be aimed at understanding the effects of sleep deficiency, as well as vaccine administration schedules, on response to vaccination and clinical protection. Furthermore, knowledge gaps among military medical leadership on sleep, vaccines, and immune health should be assessed. This area of research may benefit the health and readiness of service members while also decreasing health care utilization and associated costs from illness.
Does the distance to the cancer center affect psycho-oncological care and emergency visits of patients with IDH wild-type gliomas? A retrospective study
Authors: Fischl Anna , Gerken Michael , Roos Philipp , Haedenkamp Tareq , Hillberg Andrea , Klinkhammer-Schalke Monika , Kölbl Oliver , Linker Ralf , Proescholdt Martin , Pukrop Tobias , Riemenschneider Markus J , Schmidt Nils Ole , Schön Ingrid , Vogelhuber Martin , Hau Peter , Bumes Elisabeth
Published: April 2023

Background

Malignant isocitrate dehydrogenase wild-type (IDHwt) gliomas impose a high symptomatic and psychological burden. Wide distances from patients’ homes to cancer centers may affect the delivery of psycho-oncological care. Here, we investigated, in a large brain tumor center with a rural outreach, the initiation of psycho-oncological care depending on spatial distance and impact of psycho-oncological care on emergency visits.

Methods

Electronic patient charts, the regional tumor registry, and interviews with the primary care physicians were used to investigate clinical data, psycho-oncological care, and emergency unit visits. Interrelations with socio-demographic, clinical, and treatment aspects were investigated using univariable and multivariable binary logistic regression analysis and the Pearson’s Chi-square test.

Results

Of 491, 229 adult patients of this retrospective cohort fulfilled the inclusion criteria for analysis. During the last three months of their lives, 48.9% received at least one psycho-oncological consultation, and 37.1% visited the emergency unit at least once. The distance from the cancer center did neither affect the initiation of psycho-oncological care nor the rate of emergency unit visits. Receiving psycho-oncological care did not correlate with the frequency of emergency unit visits in the last three months of life.

Conclusion

We conclude that the distance of IDHwt glioma patients’ homes from their cancer center, even in a rural area, does not significantly influence the rate of psycho-oncological care.
Factors influencing medium- and long-term occupational impact following COVID-19
Authors: O’Sullivan O , Houston A , Ladlow P , Barker-Davies R M , Chamley R , Bennett A N , Nicol E D , Holdsworth D A
Published: April 2023

Background

Significant numbers of individuals struggle to return to work following acute coronavirus disease 2019 (COVID-19). The UK Military developed an integrated medical and occupational pathway (Defence COVID-19 Recovery Service, DCRS) to ensure safe return to work for those with initially severe disease or persistent COVID-19 sequalae. Medical deployment status (MDS) is used to determine ability to perform job role without restriction (‘fully deployable’, FD) or with limitations (‘medically downgraded’, MDG).

Aims

To identify which variables differ between those who are FD and MDG 6 months after acute COVID-19. Within the downgraded cohort, a secondary aim is to understand which early factors are associated with persistent downgrading at 12 and 18 months.

Methods

Individuals undergoing DCRS had comprehensive clinical assessment. Following this, their electronic medical records were reviewed and MDS extracted at 6, 12 and 18 months. Fifty-seven predictors taken from DCRS were analysed. Associations were sought between initial and prolonged MDG.

Results

Three hundred and twenty-five participants were screened, with 222 included in the initial analysis. Those who were initially downgraded were more likely to have post-acute shortness of breath (SoB), fatigue and exercise intolerance (objective and subjective), cognitive impairment and report mental health symptoms. The presence of fatigue and SoB, cognitive impairment and mental health symptoms was associated with MDG at 12 months, and the latter two, at 18 months. There were also modest associations between cardiopulmonary function and sustained downgrading.

Conclusions

Understanding the factors that are associated with initial and sustained inability to return to work allows individualized, targeted interventions to be utilized.
Paclitaxel With or Without Cixutumumab as Second-Line Treatment of Metastatic Esophageal or Gastroesophageal Junction Cancer: A Randomized Phase II ECOG-ACRIN Trial
Authors: Stockton Shannon , Catalano Paul , Cohen Steven J , Burtness Barbara A , Mitchell Edith P , Dotan Efrat , Lubner Sam J , Kumar Pankaj , Mulcahy Mary F , Fisher George A , Crandall Theodore L , Benson Al
Published: April 2023

Background

Patients with advanced esophageal cancer carry poor prognoses; limited data exist to guide second-line therapy in the metastatic setting. Paclitaxel has been used yet is associated with limited efficacy. There is preclinical evidence of synergy between paclitaxel and cixutumumab, a monoclonal antibody targeting insulin-like growth factor-1 receptor. We conducted a randomized phase II trial of paclitaxel (arm A) versus paclitaxel plus cixutumumab (arm B) in the second-line for patients with metastatic esophageal or gastroesophageal junction (GEJ) cancers.

Methods

The primary endpoint was progression-free survival (PFS); 87 patients (43 in arm A, 44 in arm B) were treated.

Results

Median PFS was 2.6 months in arm A [90% CL 1.8-3.5] and 2.3 months in arm B [90% 2.0-3.5], P = .86. Stable disease was observed in 29 (33%) patients. Objective response rates for Arms A and B were 12% [90% CI, 5-23%] and 14% [90% CI, 6-25%]. Median overall survival was 6.7 months [90% CL 4.9-9.5] in arm A and 7.2 months [90% CL 4.9-8.1] in arm B, P = 56.

Conclusion

The addition of cixutumumab to paclitaxel in second-line therapy of metastatic esophageal/GEJ cancer was well tolerated but did not improve clinical outcomes relative to standard of care (ClinicalTrials.gov Identifier: NCT01142388).
Sex, body size, and winter weather explain migration strategies in a partial migrant population of American Kestrels
Authors: Ranck Sadie C , Garsvo Christina M , Schwartz Darin M , Reynard Linda M , Kohn Matthew J , Heath Julie A
Published: April 2023

Given increasing evidence that climate change affects the annual cycles of birds, it is important to understand the mechanisms underlying individual migration strategies and population-level patterns in partial migrants. In this study, we found that thermoregulation (body size and winter temperatures) was a key driver of American Kestrel (Falco sparverius) migration decisions. The annual proportion of migrants in the population, however, was not explained by winter weather and may be the result of differential survival. We measured stable hydrogen isotope values (δD) of talon tissues collected from 501 breeding and overwintering birds to distinguish migrant from resident kestrels in a partially migratory population of American Kestrels in southwestern Idaho in 2013–2021. We then evaluated drivers of migration decisions by assessing potential correlates of migration strategies, whether individuals switched migration strategies between years, and whether the proportion of migrants in the population changed over time or was correlated with winter weather. Male kestrels were 1.6 times more likely to migrate than females, and in colder than average winters, smaller birds of both sexes were more likely to migrate than larger birds. Only 27% of 26 recaptured individuals showed evidence of switching their migration strategies on an annual basis. There was no temporal trend in the proportion of migrants in the population, but proportions varied between years. Interestingly, there was no association between winter minimum temperature anomalies and annual migrant proportions in the population, suggesting that differential over-winter survival, or other stochastic processes, may play an important role in population composition. As winters continue to warm, fewer kestrels may migrate and more may remain resident on breeding grounds. However, it is unclear how changes in migration strategies might affect population-level patterns and resilience to climate change.
Investigation of the Mid-Age (65–34 ka) Period of Taranaki Volcano, New Zealand: Indications for the Effect of Volcano Growth
Authors: Zemeny Aliz , Zellmer Georg Florian , Ubide Teresa , Smith Ian Ernest Masterman , Procter Jonathan , Tapu Al-Tamini , Zernack Anke Verena
Published: April 2023

Many stratovolcanoes are characterised by cycles of edifice growth interrupted by collapse events. The long-term record of the evolution of such magmatic systems is mainly preserved in the deposits of the volcanic apron surrounding the active cone. Taranaki Volcano in New Zealand provides an unusually detailed example of these processes due to excellent coastal ring-plain and young cone exposures. In this study, we investigate the magmatic system of this volcano through three consecutive growth phases by sampling a detailed, stratigraphically controlled selection of volcanic clasts from volcaniclastic mass-flow deposits in the medial ring-plain. The clasts from three growth phases (GP1, 65–55 ka; GP2, 55–40 ka; GP3, 40–34 ka) differ in bulk composition and form geochemically distinct trends on variation diagrams. These trends can be modelled by mainly dacitic melt mixing with gabbroic and ultramafic xenolith compositions representing the plutonic assemblages beneath the edifice. Within short-term growth cycles (104 years), the geochemical differences between lower and upper sequences of GP units indicate that closer to an edifice collapse, both whole-rock major and trace element compositions display more evolved and scattered trends compared to post-collapse stages. Considering the long-term magmatic evolution of Taranaki Volcano, it is apparent that the pre-collapse compositions are more evolved than bulk rock compositions of the growth phases, indicating active upper-crustal reservoir conditions in pre-collapse states. Furthermore, the volume losses caused by sector collapses prior to GP2 and GP3 could decrease the pressure in the upper-crustal reservoir. Overall, the data obtained from the mid-age Taranaki volcanic system elucidate the mid- to upper-crustal magmatic processes and reservoir conditions throughout growth cycles. Further, it demonstrates the top-down control of volcanic edifice load change on the magmatic plumbing system expressed by the evolvement of whole-rock compositions towards the end of a growth cycle.
Response of germanium detectors for high-energy γ-rays by 27Al(p, γ)28Si at Ep = 992 keV
Authors: Mizuno Rurie , Niikura Megumi , Ikeda Tokihiro , Matsuzaki Teiichiro , Go Shintaro , Saito Takeshi Y , Michimasa Shin’ichiro , Sakurai Hiroyoshi
Published: April 2023

The performance of germanium detectors for high-energy γ-rays was evaluated using a 992-keV resonance in the 27Al(p, γ)28Si reaction. The measurement was conducted at the RIKEN tandem accelerator. The energy of the excited state from the resonance was evaluated as 12540.7(2) keV. Using newly evaluated excitation energy, an energy calibration function and a photo peak efficiency of Ge detectors up to 10.8-MeV photons were deduced. Energy accuracy is achieved at 0.3 keV for the overall energy region. This reaction provides reliable energy and efficiency standards for high-energy γ-rays.
Understanding Lifelong Factors and Prediction Models of Social Functioning After Psychosis Onset Using the Large-Scale GROUP Cohort Study
Authors: Tiles-Sar Natalia , Habtewold Tesfa Dejenie , Liemburg Edith J , van der Meer Lisette , Bruggeman Richard , Alizadeh Behrooz Z ,   GROUP investigators, Bruggeman Richard , Alizadeh Behrooz Z , van Amelsvoort Therese , Bartels-Velthuis Agna A , de Haan Lieuwe , Schirmbeck Frederike , Simons Claudia J P , van Os Jim
Published: April 2023

Background and hypothesis

Current rates of poor social functioning (SF) in people with psychosis history reach 80% worldwide. We aimed to identify a core set of lifelong predictors and build prediction models of SF after psychosis onset.

Study design

We utilized data of 1119 patients from the Genetic Risk and Outcome in Psychosis (GROUP) longitudinal Dutch cohort. First, we applied group-based trajectory modeling to identify premorbid adjustment trajectories. We further investigated the association between the premorbid adjustment trajectories, six-year-long cognitive deficits, positive, and negative symptoms trajectories, and SF at 3-year and 6-year follow-ups. Next, we checked associations between demographics, clinical, and environmental factors measured at the baseline and SF at follow-up. Finally, we built and internally validated 2 predictive models of SF.

Study results

We found all trajectories were significantly associated with SF (P < .01), explaining up to 16% of SF variation (R2 0.15 for 3- and 0.16 for 6-year follow-up). Demographics (sex, ethnicity, age, education), clinical parameters (genetic predisposition, illness duration, psychotic episodes, cannabis use), and environment (childhood trauma, number of moves, marriage, employment, urbanicity, unmet needs of social support) were also significantly associated with SF. After validation, final prediction models explained a variance up to 27% (95% CI: 0.23, 0.30) at 3-year and 26% (95% CI: 0.22, 0.31) at 6-year follow-up.

Conclusions

We found a core set of lifelong predictors of SF. Yet, the performance of our prediction models was moderate.
Genetic analysis of probable sleep bruxism and its associations with clinical and behavioral traits
Authors: Strausz Tommi , Strausz Satu ,   FinnGen, Palotie Tuula , Ahlberg Jari , Ollila Hanna M
Published: April 2023

Study Objectives

Sleep bruxism (SB) can cause damage on teeth, headache and severe pain affecting both sleep and daily functioning. Yet despite the growing interest into bruxism, the underlying clinically relevant biological mechanisms remain unresolved. The aim of our study was to understand biological mechanisms and clinical correlates of SB including previously reported disease associations.

Methods

We used data from the FinnGen release R9 (N = 377 277 individuals) that are linked with Finnish hospital and primary care registries. We identified 12 297 (3.26%) individuals with International Classification of Diseases (ICD)-10 codes used for SB. In addition, we used logistic regression to examine the association between probable SB and its clinically diagnosed risk factors and comorbidities using ICD-10 codes. Furthermore, we examined medication purchases using prescription registry. Finally, we performed the first genome-wide association analysis for probable SB and computed genetic correlations using questionnaire, lifestyle, and clinical traits.

Results

The genome-wide association analysis revealed one significant association: rs10193179 intronic to Myosin IIIB (MYO3B) gene. In addition, we observed phenotypic associations and high genetic correlations with pain diagnoses, sleep apnea, reflux disease, upper respiratory diseases, psychiatric traits, and also their related medications such as antidepressants and sleep medication (p < 1e-4 for each trait).

Conclusions

Our study provides a large-scale genetic framework to understand risk factors for SB and suggests potential biological mechanisms. Furthermore, our work strengthens the important earlier work that highlights SB as a trait that is associated with multiple axes of health. As part of this study, we provide genome-wide summary statistics that we hope will be useful for the scientific community studying SB.
In the Name of Love: White Organizations and Racialized Emotions
Authors: Diefendorf Sarah , Pascoe C J
Published: April 2023

This article bridges the gap between insights from a theory of racialized organizations and insights from a theory of racialized emotions by asking what role these emotions play in organizations. Drawing on a combined four years of ethnographic data from two predominantly White organizations in the Pacific Northwest – a conservative evangelical mega-church and a progressive public high school – we argue that these two organizations address racial inequality with a set of racialized emotions that we call a “love discourse.” A love discourse is a seemingly apolitical way of addressing inequality that frames the solution to it as a matter of individual feelings of love and kindness rather than as a social problem that requires collective, political, or systemic solutions. A love discourse is grounded in and supports White racial ignorance. By providing a way to avoid politics, a love discourse allows two organizations with different political cultures and value systems to engage in diversity work that seems to address racial inequality, without actually challenging it. Love, in this sense, is a racialized emotion that appears to address racial inequality while also sustaining it.
Personalized versus generic digital weight loss interventions delivered on university campuses: a 6-month cost-benefit analysis
Authors: Napolitano Melissa A , Bailey Caitlin P , Mavredes Meghan N , Neighbors Charles J , Whiteley Jessica A , Long Michael W , Hayman Laura L , Malin Steven K , DiPietro Loretta
Published: April 2023

Cost-effectiveness analyses of weight loss programs for university students can inform administrator decision-making. This study quantifies and compares the costs and cost-effectiveness of implementing two digitally-delivered weight loss interventions designed for university populations. Healthy Body Healthy U (HBHU) was a randomized controlled trial comparing TAILORED (personalized) versus TARGETED (generic) weight loss interventions adapted specifically for young adults to a CONTROL intervention. Participants (N = 459; 23.3 ± 4.4 years; mean BMI 31.2 ± 4.4 kg/m2) were recruited from two universities. Implementation costs were examined from a payer (i.e., university) perspective, comparing both the average cost effectiveness ratio (ACER) and the incremental cost effectiveness ratio (ICER) of the two interventions. Cost-effectiveness measures were calculated for changes in body weight, abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c. The overall 6-month implementation costs were $105.66 per person for the TAILORED intervention and $91.44 per person for the TARGETED intervention. The ACER for weight change was $107.82 for the TAILORED and $179.29 for the TARGETED interventions. The ICER comparing TAILORED with TARGETED for change in body weight was $5.05, and was even lower ($2.28) when including only those with overweight and not obesity. The ICERs for change in abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c were $3.49, $59.37, $1.57, $2.64, and $47.49, respectively. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention, particularly among those with overweight. Young adults with obesity may require more resource-intensive precision-based approaches.
The dietary regulation of LEAP2 depends on meal composition in mice
Authors: Gradel Anna Katrina Jógvansdóttir , Holm Stephanie K. , Byberg Sarah , Merkestein Myrte , Hogendorf Wouter Frederik Johan , Lund Mari Lilith , Buijink Jesse Arnold , Damgaard Jesper , Lykkesfeldt Jens , Holst Birgitte
Published: April 2023

Ghrelin represents a key hormone regulating energy balance. Upon activation of the growth hormone secretagogue receptor (GHSR), ghrelin increases blood glucose levels, food intake, and promotes weight gain. The liver‐expressed antimicrobial peptide 2 (LEAP2) acts as an endogenous antagonist of the GHSR. While the regulation of LEAP2 and its effect on the GHSR likely occur in an opposite pattern to that of ghrelin, the dietary regulation of LEAP2 remains to be described. We, therefore, examined the regulation of LEAP2 by different acute meal challenges (glucose, mixed meal, olive, lard, and fish oil) and diets (chow vs. high‐fat) in C57BL/6 male mice. In addition, the effect of specific fatty acids (oleic, docosahexaenoic, and linoleic acid) on LEAP2 was assessed in murine intestinal organoids. While only mixed meal increased liver Leap2 expression, all meal challenges except fish oil increased jejunal Leap2 expression compared to water. Leap2 expression correlated with levels of hepatic glycogen and jejunal lipids. Lipid versus water dosing increased LEAP2 levels in the systemic circulation and portal vein where fish oil was associated with the smallest increase. In line with this, oleic acid, but not docosahexaenoic acid increased Leap2 expression in intestinal organoids. Feeding mice with high‐fat versus chow diet not only increased plasma LEAP2 levels, but also the increment in plasma LEAP2 upon dosing with olive oil versus water. Taken together, these results show that LEAP2 is regulated by meal ingestion in both the small intestine and the liver according to the meal/diet of interest and local energy stores.
The Experience of Facilitating Inclusive Research Advisory Groups With Parents and People With Intellectual Disability and/or Autism Spectrum Disorder
Authors: Cashin Andrew , Kersten Michelle , Howie Virginia , Pracilio Amy , Morphet Julia , Griffin Ken , Trollor Julian N. , Wilson Nathan J.
Published: April 2023

There is little nursing research about process issues in conducting inclusive project advisory groups of people with autism and/or intellectual disability or those who are parents/carers of this cohort. Through a descriptive qualitative design, this article aims to analyze the processes, challenges, and solutions when facilitating these groups for a nursing project in Australia. Reflexive thematic analysis was utilized to analyze field notes and meeting minutes. Results highlight the need for a defined, robust communication process between researchers and advisory groups, skilled facilitators, and careful planning of when in the life of the project the groups can contribute meaningfully. This project offers a proposed framework for the valuable contribution of lived experiences from research advisory groups.
Patient Adherence to Wide Abduction Brace Treatment for Legg-Calvé-Perthes Disease
Authors: Prasadh Jai G. , Jo Chan-Hee , Kim Harry K.W.
Published: April 2023

Background:

A wide abduction brace called the A-frame brace is used to contain the deformed femoral head and improve femoral head remodeling in patients with Legg-Calvé-Perthes disease (LCPD). While there is some data showing the efficacy of brace treatment, little is known about patient adherence. The purpose of this study was to measure A-frame brace adherence using temperature sensors and to identify factors that influence adherence.

Methods:

This is an IRB-approved retrospective study of 61 patients with LCPD treated with an A-frame brace between ages 5 and 11. Brace wear was measured using built-in temperature sensors. Pearson correlation coefficient and multiple regression were used to determine relationships between patient characteristics and brace adherence.

Results:

Of 61 patients, 80% were male. Mean age at LCPD onset was 5.9±1.8 years and the mean age at initiation of brace treatment was 7.1±1.5 years. Fifty-eight patients (95%) were in the fragmentation or reossification stage at the start of bracing, with 23 patients (38%) having lateral pillar B, 7 (11%) lateral pillar B/C, and 31 (51%) lateral pillar C. Forty-two (69%) patients were treated with a Petrie cast for 6 weeks before the A-frame brace. Mean adherence, defined as the ratio of measured over prescribed brace wear, was 0.69±0.32. Mean adherence improved with age (P<0.05), increasing from 0.57 in patients less than 6 to 0.84 in patients aged 8 to 11. Patients first treated with a Petrie cast had significantly better adherence than those without (0.77 vs. 0.50; P<0.005). Adherence was negatively associated with the amount of prescribed brace wear per day (P<0.005). Adherence did not change significantly between the start and end of treatment and was not significantly associated with sex or attention deficit hyperactivity disorder.

Conclusions:

A-frame brace adherence was significantly associated with age at treatment, prior Petrie casting, and the amount of daily prescribed brace wear. These findings provide new insight into A-frame brace treatment, which will lead to better patient selection and counseling to optimize adherence.

Level of Evidence:

III Therapeutic Study.
Scoliosis Treatment With Growth-Friendly Spinal Implants (GFSI) Relates to Low Bone Mineral Mass in Children With Spinal Muscular Atrophy
Authors: Soini Venla , Hell Anna K. , Metzger Luise , Jäckle Katharina , Braunschweig Lena , Lüders Katja A. , Lorenz Heiko M. , Tsaknakis Konstantinos
Published: April 2023

Background:

Children with spinal muscular atrophy (SMA) frequently develop neuromuscular scoliosis at an early age, requiring surgical treatment with growth-friendly spinal implants (GFSI), such as magnetically controlled growing rods. This study investigated the effect of GFSI on the volumetric bone mineral density (vBMD) of the spine in SMA children.

Methods:

Seventeen children (age 13.2±1.2 y) with SMA and GFSI-treated spinal deformity were compared with 25 scoliotic SMA children (age 12.9±1.7 y) without prior surgical treatment as well as age-matched healthy controls (n=29; age 13.3±2.0). Clinical, radiologic, and demographic data were analyzed. For the calculation of the vBMD Z-scores of the thoracic and lumbar vertebrae, phantom precalibrated spinal computed tomography scans were analyzed using quantitative computed tomography (QCT).

Results:

Average vBMD was lower in SMA patients with GFSI (82.1±8.4 mg/cm3) compared with those without prior treatment (108.0±6.8 mg/cm3). The difference was more prominent in and around the thoracolumbar region. The vBMD of all SMA patients was significantly lower in comparison with healthy controls, especially in SMA patients with previous fragility fractures.

Conclusions:

The results of this study support the hypothesis of reduced vertebral bone mineral mass in SMA children with scoliosis at the end of GFSI treatment in comparison with SMA patients undergoing primary spinal fusion. Improving vBMD through pharmaceutical therapy in SMA patients could have a beneficial effect on the surgical outcome of scoliosis correction while reducing complications.

Level of Evidence:

Therapeutic Level III.
Supplementary Fibular-guided Growth in Treatment of Late-onset Blount Disease
Authors: Emara Khaled Mohamed , Diab Ramy Ahmed , Fathy Ayman , Essa Mohamed N. , Eisa Mohamed , Elshobaky Mahmoud Ahmed , Emara Ahmed K. , Rashid Kyrillos , Gemeah Mostafa
Published: April 2023

Purpose:

Blount disease is due to an idiopathic defect in the posteromedial proximal tibial physis resulting in increasing bowing of the leg in addition to lateral knee thrust with lateral collateral ligament laxity. Our rationale is that Blount disease has a bony and ligamentous laxity element of the lateral collateral ligament that can be corrected simultaneously through hemiepiphysiodesis of the tibia and epiphysiodesis of proximal fibula physis by cannulated screws.

Patients and Methods:

This is a retrospective study conducted on 23 limbs with tibia vara treated between 2010 and 2017 followed up for 2 to 6 years. Ages ranged from 9 to 13 years with a late-onset type of Blount disease. We used a percutaneous transphyseal fully threaded screws traversing the proximal tibial lateral hemiepiphysis, and another screw inserted traversing the proximal fibular epiphysis.

Results:

There was a statistically significant improvement of the radiographic parameters, especially in the form of joint line congruence angle in both supine and standing positions. All patients were clinically and radiographically completely corrected without complications, except 1 patient with a surgical site superficial infection, treated medically.

Conclusion:

Fibular-guided growth surgery with lateral proximal tibia epiphysiodesis is a minimally invasive technique that improves the corrective power of hemiepyphysiodesis of the posterolateral compartment of the knee.

Level of Evidence:

Level IV, retrospective case series.