bluuebunny/crossref_metadata_2025 huggingface dataset:
The Concept of Disorder Revisited: Robustly Value-Laden Despite Change
Authors: Cooper I—Rachel
Published: May 2020

Our concept of disorder is changing. This causes problems for projects of descriptive conceptual analysis. Conceptual change means that a criterion that was necessary for a condition to be a disorder at one time may cease to be necessary a relatively short time later. Nevertheless, some conceptually based claims will be fairly robust. In particular, the claim that no adequate account of disorder can appeal only to biological facts can be maintained for the foreseeable future. This is because our current concept of disorder continues to be laden with ethical and political values in multiple ways.
The making of a category of economic understanding in Great Britain (1880–1931): ‘the unemployed’
Authors: Lagneau-Ymonet Paul , Reynaud Bénédicte
Published: May 2020

Evidence-based policy relies on measurement to trigger actions and to manage and evaluate programmes. Yet measurement requires classification: the making of categories of understanding that approximate or represent collective phenomena. In 1931, two decades after implementing the first compulsory unemployment benefits in 1911, the British Government began to carry out a census of out-of-work individuals. Why such an inversion, at odds with the exercise of rational-legal authority, and unlike to its French or German counterparts? To solve this puzzle, we document the making of ‘the unemployed’ as a category of scientific analysis and of public policy in nineteenth-century Great Britain. Our circumscribed contribution to the history of economic thought and methodology informs today’s controversies on the future of work, the weakening of wage labour through the rise in the number of part-time contracts and self-employed workers, as well as the rivalry between the welfare state and private charities with regard to providing impoverished people with some kind of relief.
Pregnancies in kidney transplant recipients with complement gene variant-mediated thrombotic microangiopathy
Authors: Haninger-Vacariu Natalja , Aigner Christof , Gaggl Martina , Kain Renate , Prohászka Zoltán , Böhmig Georg A , Sunder-Plassmann Raute , Sunder-Plassmann Gere , Schmidt Alice
Published: May 2020

Background

Pregnancies in patients with complement gene variant-mediated thrombotic microangiopathy (cTMA) are challenging, and pregnancies in such patients after kidney transplantation (KTX) are even more so.

Methods

We identified nine pregnancies following KTX of three genetically high-risk cTMA patients enrolled in the Vienna thrombotic microangiopathy cohort. Preventive plasma therapy was used in three pregnancies, and one patient had ongoing eculizumab (ECU) therapy during two pregnancies.

Results

Seven out of nine pregnancies (78%) resulted in the delivery of healthy children. The other two included one early abortion at gestational Week 12 during ongoing ECU therapy and one late foetal death at gestational Week 33 + 3, most likely not related to complement dysregulation. Kidney transplant function after delivery remained stable in all but one pregnancy. In the aforementioned case, a severe cTMA flare occurred after delivery despite use of preventive plasma infusions. Kidney graft function could be rescued in this patient by ECU. As such, successful pregnancies can be accomplished in kidney transplant recipients (KTRs) with a history of cTMA. We used preemptive plasma therapy or ongoing ECU treatment in selected cases.

Conclusions

Thus, becoming pregnant can be encouraged in KTRs with native kidney cTMA. Extensive preconception counselling, however, is mandatory in such cases.
ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma
Authors: Opitz Isabelle , Scherpereel Arnaud , Berghmans Thierry , Psallidas Ioannis , Glatzer Markus , Rigau David , Astoul Philippe , Bölükbas Servet , Boyd Jeanette , Coolen Johan , De Bondt Charlotte , De Ruysscher Dirk , Durieux Valerie , Faivre-Finn Corinne , Fennell Dean A , Galateau-Salle Francoise , Greillier Laurent , Hoda Mir Ali , Klepetko Walter , Lacourt Aude , McElnay Phil , Maskell Nick A , Mutti Luciano , Pairon Jean-Claude , Van Schil Paul , van Meerbeeck Jan P , Waller David , Weder Walter , Putora Paul Martin , Cardillo Giuseppe
Published: May 2020

The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009–2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ∼10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pretherapeutic assessment. Monitoring: patient’s performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.
Do oral amino acid supplements facilitate the healing of rat lung injuries?
Authors: Ersöz Hasan , Ağababaoğlu İsmail , Taylan İbrahim , Çakır Ebru , Aksun Saliha , Güneli Ensari
Published: May 2020

OBJECTIVES

Prolonged air leaks following lung injury cause extended hospital stays. This study investigated the effect of nutritional supplements containing arginine, glutamine and β-hydroxy β-methyl butyrate, which were theoretically proven to accelerate wound healing, on air leak and wound healing parameters in a rat lung injury model.

METHODS

Twenty-eight female rats were randomly divided into 4 groups. Experimental groups were given glutamine (Resource Glutamine®) or a mixture of arginine, glutamine and β-hydroxy β-methyl butyrate (Abound®) as a dietary supplement at isonitrogenous and isocaloric doses. On day 3, standard sized lung injuries were created in all rats except the sham group. The rats were sacrificed on day 6, and the lungs were removed for air-leak threshold pressure measurement and histopathological and biochemical analyses.

RESULTS

Loss of body mass was greater in the glutamine group than in the other groups (P = 0.004). Rats that received the amino acid mixture had better results for mature collagen fibre density (P = 0.002) and inflammation suppression (P = 0.003). The sham group had higher values for air-leak threshold pressure and all other histochemical parameters compared to the other groups. Hydroxyproline level did not differ significantly in any of the groups.

CONCLUSIONS

Our results indicated that an oral amino acid mixture was effective in the healing of lung injuries. Isolated glutamine supplementation had an adverse impact on body mass. Randomized clinical studies including larger series are needed. Hydroxyproline does not seem to be a suitable marker for this purpose.
Learning about fiscal multipliers during the European sovereign debt crisis: evidence from a quasi-natural experiment
Authors: Górnicka Lucyna , Kamps Christophe , Koester Gerrit , Leiner-Killinger Nadine
Published: May 2020

Identifying fiscal multipliers, that is, the effect of discretionary fiscal actions on growth, is challenging. It requires comparing the realization of growth after a fiscal action to a hypothetical growth path that would have prevailed in the absence of such action. Deriving the hypothetical path usually involves very strong assumptions. This paper helps to relax some of the assumptions, using a unique new data set on the European Commission’s recommendations under the so-called excessive deficit procedure (EDP). These recommendations provide information on both output growth in a no-policy-change baseline forecast and an alternative forecast of growth incorporating the size of fiscal consolidation recommended under the EDP. A comparison of these two alternative scenarios allows us to infer country-specific fiscal multipliers implicitly applied by the Commission in its EDP recommendations for a sample of 24 countries over the period 2009–2015. Our results confirm Blanchard and Leigh’s (2013, 2014) presumption that fiscal multipliers used by forecasters were adjusted upwards during the European sovereign debt crisis, albeit starting from lower than commonly assumed levels. Contrary to Blanchard and Leigh (2013, 2014), we do not find evidence that the ‘true’ ex-post fiscal multipliers systematically exceeded 1 in the early crisis years.
Clinical Correlates and Outcome of Major Depressive Disorder and Comorbid Migraine: A Report of the European Group for the Study of Resistant Depression
Authors: Fugger Gernot , Dold Markus , Bartova Lucie , Mitschek Marleen M M , Souery Daniel , Mendlewicz Julien , Serretti Alessandro , Zohar Joseph , Montgomery Stuart , Fabbri Chiara , Frey Richard , Kasper Siegfried
Published: May 2020

Background

The present multicenter study aimed at defining the clinical profile of patients with major depressive disorder (MDD) and comorbid migraine.

Methods

Demographic and clinical information for 1410 MDD patients with vs without concurrent migraine were compared by descriptive statistics, analyses of covariance, and binary logistic regression analyses.

Results

The point prevalence rate for comorbid migraine was 13.5% for female and 6.2% for male patients. MDD + migraine patients were significantly younger, heavier, more likely female, of non-Caucasian origin, outpatient, and suffering from asthma. The presence of MDD + migraine resulted in a significantly higher functional disability. First-line antidepressant treatment strategy revealed a trend towards agomelatine. Second-generation antipsychotics were significantly less often administered for augmentation treatment in migraineurs. Overall, MDD + migraine patients tended to respond worse to their pharmacotherapy.

Conclusion

Treatment guidelines for comorbid depression and migraine are warranted to ensure optimal efficacy and avoid possible pitfalls in psychopharmacotherapy, including serotonin syndrome.
A Sharp Multidimensional Hermite–Hadamard Inequality
Authors: Larson Simon
Published: May 2020

Let $\Omega \subset {\mathbb{R}}^d $, $d \geq 2$, be a bounded convex domain and $f\colon \Omega \to{\mathbb{R}}$ be a non-negative subharmonic function. In this paper, we prove the inequality $$\begin{equation*} \frac{1}{|\Omega|}\int_{\Omega} f(x)\, \textrm{d}x \leq \frac{d}{|\partial\Omega|}\int_{\partial\Omega} f(x)\, \textrm{d}\sigma(x)\,. \end{equation*}$$Equivalently, the result can be stated as a bound for the gradient of the Saint Venant torsion function. Specifically, if $\Omega \subset{\mathbb{R}}^d$ is a bounded convex domain and $u$ is the solution of $-\Delta u =1$ with homogeneous Dirichlet boundary conditions, then $$\begin{equation*} \|\nabla u\|_{L^\infty(\Omega)} < d\frac{|\Omega|}{|\partial\Omega|}\,. \end{equation*}$$Moreover, both inequalities are sharp in the sense that if the constant $d$ is replaced by something smaller there exist convex domains for which the inequalities fail. This improves upon the recent result that the optimal constant is bounded from above by $d^{3/2}$ due to Beck et al. [2].
Toward a Volitional Definition of Religion
Authors: Nemec John
Published: May 2020

This article advocates for the production of stipulative definitions of religion, a type of nominal definition that articulates new ways of applying a word to a thing. I propose that scholars look to sites where phenomena historically have been labeled “religion” on lexical or real understandings of the term, this to query how religious agents there chose, implicitly or explicitly, to systematize thought, speech, emotion, and action. Such self-consciously ordered systems, I argue, may properly be labeled “religion.” Next, I apply this method to premodern South Asia, suggesting “religion” refers to the second-order structuring there that links normative social relations to normative states of subjectivity, any innovation in the one demanding innovation in the other. I conclude by inviting other efforts at stipulative definition, all with an eye toward an inductive approach, allowing that the myriad locations of religion present mutually distinguishable systems that may all properly be so labeled.
Xanthogranulomatous cholecystitis complicated by a cholecysto-colonic fistula and liver abscesses†
Authors: Morare Nolitha , Mpuku Lwazi , Ally Zain
Published: May 2020

A 57-year-old male presented to the emergency department with right upper quadrant pain and constitutional symptoms. Initial investigation revealed biliary sepsis with features of chronic cholecystitis, multiple liver abscesses and a fistulous connection between the gallbladder and colon. He was subsequently diagnosed with a cholecysto-colonic fistula, an unusual complication of biliary pathology, with an incidence of 0.06–0.14% at cholecystectomy. It is the second most common form of cholecystoenteric fistula, the first of which is cholecystoduodenal. A preoperative diagnosis was suggested using computed tomography and sinogram imaging. The associated liver abscesses together with the xanthogranulomatous inflammation found on histopathology, makes the case particularly exceptional.
Malaria in the Pregnant Traveler
Authors: McKinney Kimberly L , Wu Henry M , Tan Kathrine R , Gutman Julie R
Published: May 2020

Pregnant travelers face numerous risks, notably increased susceptibility to or severity of multiple infections, including malaria. Because pregnant women residing in areas non-endemic for malaria are unlikely to have protective immunity, travel to endemic areas poses risk of severe illness and pregnancy complications, such as low birthweight and fetal loss. If travel to malaria endemic areas cannot be avoided, preventive measures are critical. However, malaria chemoprophylaxis in pregnancy can be challenging, since commonly used regimens have varying levels of safety data, and national guidelines differ. Furthermore, although chloroquine and mefloquine have wide acceptance for use in pregnancy, regional malaria resistance and non-pregnancy contraindications limit their use. Mosquito repellents, including DEET and permethrin treatment of clothing, are considered safe in pregnancy and important to prevent malaria as well as other arthropod-borne infections such as Zika virus infection. Pregnant travelers at risk for malaria exposure should be advised to seek medical attention immediately if any symptoms of illness, particularly fever, develop.
NATpare: a pipeline for high-throughput prediction and functional analysis of nat-siRNAs
Authors: Thody Joshua , Folkes Leighton , Moulton Vincent
Published: May 2020

Natural antisense transcript-derived small interfering RNAs (nat-siRNAs) are a class of functional small RNA (sRNA) that have been found in both plant and animals kingdoms. In plants, these sRNAs have been shown to suppress the translation of messenger RNAs (mRNAs) by directing the RNA-induced silencing complex (RISC) to their sequence-specific mRNA target(s). Current computational tools for classification of nat-siRNAs are limited in number and can be computationally infeasible to use. In addition, current methods do not provide any indication of the function of the predicted nat-siRNAs. Here, we present a new software pipeline, called NATpare, for prediction and functional analysis of nat-siRNAs using sRNA and degradome sequencing data. Based on our benchmarking in multiple plant species, NATpare substantially reduces the time required to perform prediction with minimal resource requirements allowing for comprehensive analysis of nat-siRNAs in larger and more complex organisms for the first time. We then exemplify the use of NATpare by identifying tissue and stress specific nat-siRNAs in multiple Arabidopsis thaliana datasets.
Specific Features of Criminal Proceeding Regarding Criminal Misdemeanours
Authors: Vapniarchuk Viacheslav V , Bespalko Inna L , Motoryhina Maryna G
Published: May 2020

The urgency of the problem stated in the article is conditioned by amendments to the criminal procedural legislation, which in a new way regulate the procedure of criminal proceedings concerning criminal offences. The aim of the article is to investigate the procedure for conducting criminal proceedings for criminal offences and to make suggestions for improving its regulatory framework. The basic approach to the study of this problem was to conduct a critical analysis of the rules of the current criminal procedural legislation, which regulate criminal proceedings for criminal offences, and to express views on rules’ proper understanding and application. Based on the analysis of the features of the normative regulation of criminal proceedings concerning criminal offences, the publication comments on a number of norms of the current Criminal Procedure Code of Ukraine, which regulate both pre-trial investigation of criminal offences in the form of enquiries and court proceedings against them; approaches to their elimination have been proposed. The materials of the article represent both theoretical and practical values. They can be used for further scientific investigation of the features of criminal proceedings regarding criminal offences, as well as for the proper understanding and implementation of law enforcement criminal proceedings.
Overexpression of Populus transcription factor PtrTALE12 increases axillary shoot development by regulating WUSCHEL expression
Authors: Bae So-Young , Kim Min-Ha , Cho Jin-Seong , Park Eung-Jun , Lee Hyoshin , Kim Jeong-Hoe , Ko Jae-Heung
Published: May 2020

The TALE (Three Amino acid Loop Extension) transcription factor family has been shown to control meristem formation and organogenesis in plants. To understand the functional roles of the TALE family in woody perennials, each of the TALE members of Populus trichocarpa was overexpressed in Arabidopsis as a proxy. Among them, the overexpression of PtrTALE12 (i.e., 35S::PtrTALE12) resulted in a dramatic increase of axillary shoot development with early flowering. Interestingly, expression of WUSCHEL (WUS), a central regulator of both apical and axillary meristem formation, was significantly increased in the 35S::PtrTALE12 Arabidopsis plants. Conversely, WUS expression was downregulated in 35S::PtrTALE12-SRDX (short transcriptional repressor domain) plants. Further analysis found that PtrTALE12, expressed preferentially in meristem tissues, directly regulates WUS expression in transient activation assays using Arabidopsis leaf protoplast. Yeast two-hybrid assays showed that PtrTALE12 interacts with SHOOT MERISTEMLESS (STM); however, the interaction does not affect the WUS expression. In addition, expression of both CIRCADIAN CLOCK ASSOCIATED1 (CCA1) and LATE ELONGATED HYPOCOTYL (LHY) genes was suppressed accordingly for early flowering 35S::PtrTALE12 Arabidopsis. Indeed, transgenic poplars overexpressing PtrTALE12 as well as Arabidopsis plants overexpressing AtBLH11, a close homolog of PtrTALE12, phenocopied the 35S::PtrTALE12 Arabidopsis (i.e., increased axillary shoot development). Taken together, our results suggest that PtrTALE12 functions as a positive regulator of axillary shoot formation in both Arabidopsis and poplar.
Managing Colletotrichum on Fruit Crops: A “Complex” Challenge
Authors: Dowling Madeline , Peres Natalia , Villani Sara , Schnabel Guido
Published: May 2020

The fungal genus Colletotrichum includes numerous important plant pathogenic species and species complexes that infect a wide variety of hosts. Its taxonomy is particularly complex because species’ phenotypes and genotypes are difficult to differentiate. Two notable complexes, C. acutatum and C. gloeosporioides, are known for infecting temperate fruit crops worldwide. Even species within these complexes vary in traits such as tissue specificity, aggressiveness, geographic distribution, and fungicide sensitivity. With few effective chemicals available to control these pathogens, and the persistent threat of fungicide resistance, there is a need for greater understanding of this destructive genus and the methods that can be used for disease management. This review summarizes current research on diseases caused by Colletotrichum spp. on major fruit crops in the United States, focusing on the taxonomy of species involved, disease management strategies, and future management outlook.
Different Sequevars of Ralstonia pseudosolanacearum Causing Bacterial Wilt of Bidens pilosa in China
Authors: He Yonglin , Mo Yixue , Zheng Dehong , Li Qiqin , Lin Wei , Yuan Gaoqing
Published: May 2020

Bidens pilosa is an invasive weed that threatens the growth of crops and biodiversity in China. In 2017, suspected bacterial wilt of B. pilosa was discovered in Qinzhou and Beihai, Guangxi, China. A variety of weeds are considered as reservoirs harboring bacterial wilt pathogens, but most do not show obvious symptoms in the field. Identifying the classification status of the B. pilosa bacterial wilt pathogen and exploring its geographical origin might be helpful for clarifying the role of weeds in the circulation of the disease. Phylotyping, sequevar analysis, and cross inoculation of pathogens isolated from B. pilosa and nearby peanut (Arachis hypogaea), balsam gourd (Momordica charantia), and eucalyptus (Eucalyptus robusta) plants were carried out. Three isolates of B. pilosa (Bp01, Bp02, and Bp03) were identified as Ralstonia pseudosolanacearum, race 1, biovar 3, and phylotype I, and belonged to sequevars 17 and 44, and an unknown sequevar. The sequevars isolated from B. pilosa were not completely consistent with those of the nearby hosts, and the virulence of these isolates differed when cross inoculated. The Bp03 sequevar was different from peanut isolate sequevars in the same field and was not identical to any previously designated sequevars. The isolates from B. pilosa and other nearby hosts displayed low or no virulence toward their cross hosts (with wilt incidences less than 33.33%). An exception to this was the isolates from B. pilosa, which displayed high virulence toward eucalyptus (with a wilt incidence of 70.00 to 100.00%). This is the first report of different sequevars of R. pseudosolanacearum causing typical bacterial wilt symptoms in B. pilosa in the field.
Adjuvant chemotherapy in pancreatic cancer: state of the art and future perspectives
Authors: Mas Léo , Schwarz Lilian , Bachet Jean-Baptiste
Published: May 2020

Purpose of review

The modalities of management of resectable pancreatic ductal adenocarcinoma (PDAC) have evolved in recent years with new practice guidelines on adjuvant chemotherapy and results of randomized phase III trials. The aim of this review is to describe the state of the art in this setting and to highlight future possible perspectives.

Recent findings

Resectable PDAC is the tumor without vascular contact or a limited venous contact without vein irregularity. Several pathologic and biologic robust prognostic factors such as an R0 resection defined by a margin at least 1 mm have been validated. In phase III trials, the doublet gemcitabine-capecitabine provided a statistically significant, albeit modest overall survival benefit, but failed to show an improvement in relapse-free survival. Similarly, gemcitabine plus nab-paclitaxel did not increase disease-free survival. Modified FOLFIRINOX led to improved disease-free survival, overall survival, and metastasis-free survival, with acceptable toxicity. In the future, prognostic and/or predictive biomarkers could lead the optimization of therapeutic strategies and neoadjuvant treatment could become a standard of care in PDAC.

After curative intent resection, modified FOLFIRINOX is the standard of care in adjuvant in fit patients with PDAC. Others regimens (monotherapy or gemcitabine-based) are an option in unfit patients.
Adjuvant chemotherapy in biliary tract cancer: state of the art and future perspectives
Authors: Akhoundova Sanoyan Dilara , McNamara Mairéad G. , Lamarca Angela , Valle Juan W.
Published: May 2020

Purpose of review

Biliary tract cancers (BTCs) have a poor prognosis; most patients present with advanced disease and, even after surgical resection for early-stage disease local and distant relapses are frequent. Involved resection margins and lymph node involvement are the most relevant known adverse prognostic factors. Historically clinicians have made clinical decisions based on data from institutional series and uncontrolled studies, with their inherent limitations. In this review, data from recently-reported prospective randomized trials are reviewed and clinical implications discussed.

Recent findings

Results from prospective randomized phase III trials (namely BILCAP, PRODIGE-12, and BCAT) are reviewed: none of the studies met their primary endpoint by intention-to-treat analysis. However, following a per-protocol sensitivity analysis of the BILCAP study, adjuvant capecitabine (for 6 months) showed a clinically-relevant improvement in overall survival and provides reference data for future clinical trials.

Adjuvant chemotherapy with capecitabine should be considered following curative resection of BTC. Identification of benefit in anatomical subgroups is ongoing and future trials should also consider the implication of molecular subtypes of BTC (for prognostic impact and on-target therapeutic options).
Immunotherapy in sarcoma: combinations or single agents? In whom?
Authors: Dufresne Armelle , Brahmi Mehdi
Published: May 2020

Purpose of review

First clinical trials investigating immune check point (ICP) inhibitors in patients with sarcoma, regardless histological or molecular subtypes did not demonstrate any prolonged benefit. To maximize the chance of benefit from immunotherapy, recent strategies explore the combination of treatments and aim to improve identification of responsive histological subtypes.

Recent findings

Combination of several ICP inhibitors tends to increase toxicity and efficacy. Mechanisms of synergistic action remain unclear. Combination of ICP blockade with tyrosine kinase inhibitor increases efficacy in specific histological subtypes already identified as sensitive to each drug separately. The role of the combination is not established yet. Several ongoing trials assess the combination of ICP blockade with chemotherapy or radiotherapy. ICP blockade seems highly effective in some selected histological subtypes like alveolar soft part sarcoma, chordoma, malignant rhabdoid tumor, and angiosarcoma. Encouraging preliminary results need to be confirmed in larger cohorts and biological mechanisms that sustain this efficacy should be further explored. Adoptive cell therapy seems very promising in synovialosarcoma.

Significant efforts are underway to efficiently develop immunotherapy in patients with sarcoma and better characterize patients who would benefit the most from it.
An Exploration of Health Behaviors in a Mind-Body Resilience Intervention for Parents of Children with Developmental Disabilities
Authors: Millstein Rachel A. , Lindly Olivia J. , Luberto Christina M. , Perez Giselle K. , Schwartz Gabrielle N. , Kuhlthau Karen , Park Elyse R.
Published: May 2020

Objective:

Parents of children with special needs such as learning and attentional disabilities (LADs) and autism spectrum disorder (ASD) are at high risk for stress-related disorders. The demands of parenting may compete with time for self-care behaviors such as physical activity, healthy eating, and adequate sleep. The objective was to describe health behaviors among this understudied population and assess the changes after a resilience intervention.

Methods:

This was a secondary data analysis of a randomized controlled pilot virtual mind-body resilience intervention (Stress Management and Resiliency Training: A Relaxation Response Resiliency Program) trial for parents of children with LADs (n = 52) and ASD (n = 47). Parents completed self-report questionnaires about their weekly physical activity, eating behaviors, sleep duration, and fatigue before and after the 8-week intervention. Descriptive statistics and pre-post intervention effect sizes (Cohen's d) were calculated.

Results:

Both parent groups reported suboptimal levels of health behaviors at baseline, but ASD parents reported lower health behaviors than LAD parents. LAD parents improved more on physical activity, with a higher percentage meeting recommendations at postintervention follow-up (d = 0.71) than ASD parents (d = 0.01). Eating behaviors showed small effect size improvements for both groups. Although sleep duration improved only with small or medium effect sizes for both groups, ASD parents rated their fatigue lower after the intervention (d = 0.81).

Conclusion:

Parents of children with special needs who participated in a virtual resilience intervention demonstrated suboptimal health behaviors. There is a need for targeted interventions for health behaviors that can promote resilience in these high-stress populations.
Reliability of the Quality of Life Inventory-Disability Measure in Children with Intellectual Disability
Authors: Jacoby Peter , Epstein Amy , Kim Rachel , Murphy Nada , Leonard Helen , Williams Katrina , Reddihough Dinah , Whitehouse Andrew , Downs Jenny
Published: May 2020

Objective:

To assess responsiveness and reproducibility using the estimates of test-retest reliability for the Quality of Life Inventory-Disability (QI-Disability), accounting for changes in child health and parental stress.

Method:

Quality of Life Inventory-Disability was administered twice over a 1-month period to a sample of 55 primary caregivers of children (aged 5–19 years) with intellectual disability. Caregivers also reported their child's physical and mental health and completed a 4-item Perceived Stress Scale to assess parental stress. Fixed-effects linear regression models examined responsiveness of QI-Disability to the reported change in child health and parental stress. Reliability was then assessed using intraclass correlations (ICCs) calculated from QI-Disability scores adjusted for changes in child health and parental stress.

Results:

Five of 7 unadjusted ICC values indicated at least moderate agreement (>0.70), and 2 values indicated fair agreement. After accounting for changes in child health and parental stress, adjusted ICC values showed substantial agreement for the total QI-Disability score and 4 domain scores (adjusted ICC ≥ 0.80). Adjusted ICC scores indicated moderate agreement for the Physical Health domain (adjusted ICC = 0.68) and fair agreement for the Positive Emotions domain (adjusted ICC = 0.58). Improvements in a child's physical health rating were associated with higher total, Physical Health, and Positive Emotion domain scores, whereas improvements in mental health were associated with higher total and Negative Emotions domain scores, indicating better quality of life. Changes in parental stress did not have a statistically significant relationship with quality of life.

Conclusion:

Satisfactory test-retest reliability was shown. Preliminary evidence indicates that QI-Disability is responsive to changes in child health, but not to differing levels of parental stress.
Towards integrative neuromonitoring of the surgical newborn
Authors: Costerus Sophie A. , van Hoorn Camille E. , Hendrikx Dries , Kortenbout Jorinde , Hunfeld Maayke , Vlot John , Naulaers Gunnar , Tibboel Dick , de Graaff Jurgen C.
Published: May 2020

BACKGROUND

The altered neurodevelopment of children operated on during the neonatal period might be due to peri-operative changes in the homeostasis of brain perfusion. Monitoring of vital signs is a standard of care, but it does not usually include monitoring of the brain.

OBJECTIVES

To evaluate methods of monitoring the brain that might be of value. We also wanted to clarify if there are specific risk factors that result in peri-operative changes and how this might be evaluated.

DESIGN

Systematic review.

DATA SOURCES

A structured literature search was performed in MEDLINE in Ovid, Embase, Cochrane CENTRAL, Web of Science and Google Scholar.

ELIGIBILITY CRITERIA

Studies in neonates who received peri-operative neuromonitoring were eligible for inclusion; studies on neurosurgical procedures or cardiac surgery with cardiopulmonary bypass and/or deep hypothermia cardiac arrest were excluded.

RESULTS

Nineteen of the 24 included studies, totalling 374 infants, reported the use of near-infrared spectroscopy. Baseline values of cerebral oxygenation greatly varied (mean 53 to 91%) and consequently, no coherent results were found. Two studies found a correlation between cerebral oxygenation and mean arterial blood pressure. Five studies, with in total 388 infants, used (amplitude-integrated) electro-encephalography to study peri-operative brain activity. Overall, the brain activity decreased during anaesthesia and epileptic activity was more frequent in the peri-operative phase. The association between intra-operative cerebral saturation or activity and neuro-imaging abnormalities and/or neurodevelopmental outcome was investigated in six studies, but no association was found.

CONCLUSION

Neuromonitoring with the techniques currently used will neither help our understanding of the altered neonatal pathophysiology, nor enable early detection of deviation from the norm. The modalities lack specificity and are not related to clinical (long-term) outcome or prognosis. Accordingly, we were unable to draw up a monitoring guideline.
Role of TFA-1 adhesive forehead sensors in predicting fluid responsiveness in anaesthetised children
Authors: Kim Eun-Hee , Kim Hansol , Lee Ji-Hyun , Kim Jin-Tae , Jang Young-Eun , Ji Sang-Hwan , Kim Hee-Soo
Published: May 2020

BACKGROUND

The TFA-1 adhesive forehead sensor is a newly developed pulse oximeter for the measurement of the plethysmographic variability index (PVI) at the forehead, and for the rapid detection of changes in oxygen saturation during low perfusion.

OBJECTIVES

We evaluated the ability of the TFA-1 sensor to predict fluid responsiveness in children under general anaesthesia.

DESIGN

Prospective cohort study.

SETTING

Single tertiary care children's hospital.

PATIENTS

Thirty-seven children aged 1 to 5 years under general anaesthesia and requiring invasive arterial pressure monitoring.

MAIN OUTCOME MEASURES

The baseline PVI of TFA-1 and finger sensors, respiratory variation of aorta blood flow peak velocity (ΔV
peak) and stroke volume index (SVI) obtained using transthoracic echocardiography were assessed. After fluid loading of 10 ml kg−1 crystalloids over 10 min, SVI was reassessed. Responders were defined as those with an increase in SVI greater than 15% from the baseline. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive ability of the PVI of TFA-1 and finger sensors and ΔV
peak for fluid responsiveness.

RESULTS

Seventeen (56.6%) patients responded to volume expansion. Before fluid loading, the PVI of TFA-1 and finger sensors and ΔV
peak (mean ± SD) of the responders were 11.2 ± 4.4, 11.4 ± 5.1 and 14.8 ± 3.9%, respectively, and those of the nonresponders were 7.4 ± 3.9, 8.1 ± 3.6 and 11.0 ± 3.3%, respectively. ROC curve analysis indicated that the PVI of TFA-1 and finger sensors and ΔV
peak could predict fluid responsiveness. The areas under the curve were 0.8 [P = 0.00; 95% confidence interval (CI) 0.60 to 0.91], 0.7 (P = 0.02; 95% CI 0.53 to 0.87) and 0.8 (P = 0.00; 95% CI 0.59 to 0.91), respectively. The cut-off values for the PVI of TFA-1 and finger sensors and ΔV
peak were 6.0, 9.0 and 10.6%, respectively.

CONCLUSION

The PVI of TFA-1 forehead sensor is a good alternative, but is not superior to the finger sensor and ΔV
peak in evaluating fluid responsiveness in mechanically ventilated children under general anaesthesia.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov, NCT03132480.
The year in review: advances in interventional cardiology in 2019
Authors: Galougahi Keyvan Karimi , Petrossian Gregory , Stone Gregg W. , Ali Ziad A.
Published: May 2020

Purpose of review

Major studies in interventional cardiology in 2019 have added substantial new evidence for pharmaco-invasive management of coronary artery disease. The review highlights the main findings of a selection of these trials and summarizes their impact on clinical practice.

Recent findings

Recent randomized studies examining the efficacy of revascularization or medical treatment in stable ischemic heart disease (SIHD), treatment of acute coronary syndromes, emerging interventional devices, adjunctive pharmacotherapy, and intravascular imaging and physiology guidance have substantially advanced the evidenced-based knowledge in interventional cardiology.

Patients with SIHD and at least moderate myocardial ischemia have similar event-free survival after an initial conservative strategy of optimal medical therapy versus an upfront invasive strategy. Quality of life and angina-free status are significantly improved with revascularization. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting provide similar 5-year outcomes in patients with left main coronary artery disease and low or intermediate disease complexity. An initially conservative management is equally effective as an early invasive approach in patients with out-of-hospital cardiac arrest without ongoing ischemia. Patients with ST-segment elevation myocardial infarction and multivessel disease benefit from staged complete revascularization after primary PCI. Post-PCI, patients with atrial fibrillation requiring anticoagulation can safely and effectively be treated with P2Y12 inhibitor monotherapy without aspirin. Lastly, intravascular imaging guidance improves post-PCI outcomes, warranting increased use in clinical practice.
2019 clinical trials in lipid lowering
Authors: Feldman David I. , Pacor Justin M. , Blumenthal Roger S. , Nasir Khurram
Published: May 2020

Purpose of review

Lipid-lowering therapies play a major role in reducing atherosclerotic cardiovascular disease (ASCVD). This article reviews the most recent lipid-lowering therapy trials, many of which provide a unique opportunity to further reduce low-density lipoprotein cholesterol (LDL-C) levels and ASCVD risk on top of statin therapy, and in doing so further decrease the number of future major adverse cardiovascular events.

Recent findings

Although statin therapy has been the mainstay of treatment for lowering LDL-C levels for many years, many individuals require additional or alternative options for further reducing their risk. Trials on previously studied therapies, such as PCSK9 inhibitors, and new therapies, including inclisiran, bempedoic acid and icosapent ethyl demonstrate significant potential for further lowering of LDL-C levels and risk for events on top of maximally tolerated statin therapy with favourable side effect profiles.

As therapies for ASCVD prevention continue to emerge, clinicians will need to identify the appropriate treatment for individuals based on their estimated risk and risk-enhancing factors. When statin therapy is either not sufficient or patients do not tolerate adequate statin therapy, relying on newer therapies, such as PCSK9-inhibitors, inclisiran, bempedoic acid and icosapent ethyl, will be critical to maximize risk factor profiles to reduce adverse outcomes.
Potential benefits of modified corneal tissue grafts for keratoconus: Bowman layer ‘inlay’ and ‘onlay’ transplantation, and allogenic tissue ring segments
Authors: Dapena Isabel , Parker Jack S. , Melles Gerrit R.J.
Published: May 2020

Purpose of review

Keratoconus can be surgically challenging, especially in advanced cases. Classic corneal transplantation techniques, may often be associated with complications. New alternative procedures like isolated Bowman layer transplantation (as a corneal stromal inlay or as a corneal onlay) and corneal allogenic intrastromal ring segments (CAIRS) have recently shown promising results. The aim of this review is to describe the main new surgical developments for treating keratoconus.

Recent findings

Intrastromal Bowman layer transplantation has recently shown to be effective in halting keratoconus progression and maintaining visual acuity with contact lenses, at least up to 5–7 years postoperatively. Because intrastromal dissection can be challenging, we have recently developed a technique that allows using Bowman layer grafts as an onlay, that is positioned onto the patient's anatomical Bowman layer or anterior stroma, achieving comparable results as with Bowman layer inlay transplantation. CAIRS may also be an effective treatment, improving visual acuity, corneal surface parameters and keratoconus progression.

There are currently some new alternative treatments such as isolated Bowman layer inlay or onlay transplantation and CAIRS, both of which seem effective at treating keratoconus and which may offer a less invasive surgical approach.
Pediatric Microbial Keratitis
Authors: Hepschke Jenny L. , Ung Lawson , Cabrera-Aguas Maria , Ross Carolyn , Kumar Nikhil , Lahra Monica M. , Watson Stephanie
Published: May 2020

Aims:

The purpose of this study was to report the epidemiology, etiology, microbiologic profile and management of pediatric microbial keratitis in a quaternary and 3 tertiary ophthalmic referral centers across Sydney, New South Wales, Australia.

Methods:

This is a retrospective cohort study of patients ≤ 18 years of age with a clinical diagnosis of microbial keratitis presenting between 1 January 2010 and 31 December 2016 identified from hospital coding and pathology databases. Data were extracted from the medical records. Epidemiology, predisposing factors, referral patterns, microbial profile and treatment outcomes were analyzed.

Results:

Eighty eyes from 80 pediatric patients with microbial keratitis were included in the study (10% had bilateral disease). The mean age was 11 ± 5.3 years (range 0–18 years), and 44 were male (55%). Thirty-six percent of patients had ocular and 13.5% systemic comorbidities. The most common risk factor overall was contact lens wear in 26%, trauma (24%), and external lid and eye disease (20%). Overall, 74 organisms were identified, and of those, the most common isolates were Gram-positive organism. Antimicrobial resistance to common antibiotics was low across all isolates. Visual acuity following treatment was worse than 6/60 for 7 patients (11.3%%), 6/15–6/60 for 15 patients (24.2%) and better than 6/12 for 40 patients (64.5%). Preexisting corneal disease and delay of presentation were associated with worse visual prognosis. Serious complications were noted in 16 (21.3%) of patients.

Conclusions:

Contact lens wear, trauma and existing ocular disease remain the most significant risk factors in the pediatric population. Preexisting corneal disease and delay in presentation were associated with poor visual acuity. The majority of patients have a good visual outcome although serious complications are not uncommon and may cause lifelong visual disability.
Pediatric Life-Threatening Coronavirus Disease 2019 With Myocarditis
Authors: Oberweis Marie-Laure , Codreanu Andrei , Boehm Wolfgang , Olivier Damien , Pierron Charlotte , Tsobo Chantal , Kohnen Michel , Abdelrahman Tamir T. , Nguyen Nguyen T. , Wagner Kerstin , de la Fuente Garcia Isabel
Published: May 2020

We report the case of a pediatric life-threatening coronavirus disease 2019 who presented as myocarditis with heart failure. Clinicians should be aware of this severe presentation of the disease in children, possibly linked to an exaggerated inflammatory host immune response to severe acute respiratory syndrome coronavirus 2.
Evaluation of a National Care Coordination Program to Reduce Utilization Among High-cost, High-need Medicaid Beneficiaries With Diabetes
Authors: Duru O. Kenrik , Harwood Jessica , Moin Tannaz , Jackson Nicholas J. , Ettner Susan L. , Vasilyev Arseniy , Mosley David G. , O’Shea Donna L. , Ho Sam , Mangione Carol M.
Published: May 2020

Background:

Medical, behavioral, and social determinants of health are each associated with high levels of emergency department (ED) visits and hospitalizations.

Objective:

The objective of this study was to evaluate a care coordination program designed to provide combined “whole-person care,” integrating medical, behavioral, and social support for high-cost, high-need Medicaid beneficiaries by targeting access barriers and social determinants.

Research Design:

Individual-level interrupted time series with a comparator group, using person-month as the unit of analysis.

Subjects:

A total of 42,214 UnitedHealthcare Medicaid beneficiaries (194,834 person-months) age 21 years or above with diabetes, with Temporary Assistance to Needy Families, Medicaid expansion, Supplemental Security Income without Medicare, or dual Medicaid/Medicare.

Measures:

Our outcome measures were any hospitalizations and any ED visits in a given month. Covariates of interest included an indicator for intervention versus comparator group and indicator and spline variables measuring changes in an outcome’s time trend after program enrollment.

Results:

Overall, 6 of the 8 examined comparisons were not statistically significant. Among Supplemental Security Income beneficiaries, we observed a larger projected decrease in ED visit risk among the intervention sample versus the comparator sample at 12 months postenrollment (difference-in-difference: −6.6%; 95% confidence interval: −11.2%, −2.1%). Among expansion beneficiaries, we observed a greater decrease in hospitalization risk among the intervention sample versus the comparator sample at 12 months postenrollment (difference-in-difference: −5.8%; 95% confidence interval: −11.4%, −0.2%).

Conclusion:

A care coordination program designed to reduce utilization among high-cost, high-need Medicaid beneficiaries was associated with fewer ED visits and hospitalizations for patients with diabetes in selected Medicaid programs but not others.