bluuebunny/crossref_metadata_2025 huggingface dataset:
PSXIV-11 Silage source, physically effective neutral detergent fiber, and undigested neutral detergent fiber concentrations affect eating behavior, ruminal pH and reticular motility of finishing heifers
Authors: Pereira Murillo C , Beauchemin Karen A , McAllister Tim A , Yang Wenzhu , Van Donkersgoed Joyce , Gibb Darryl , Wood Katharine M , Penner Gregory B
Published: October 2021

This study evaluated the effects of silage source, physically effective neutral detergent fiber (peNDF), and undigested neutral detergent fiber (uNDF) concentrations on eating behavior, ruminal pH, and reticular contractions for finishing beef heifers. Six Hereford′Simmental heifers (579±51.2 kg) were used in a replicated 6×6 Latin square (21-d periods) balanced for carry-over effects with 2×2 + 2 factorial treatment arrangement. Barley grain-based diets included barley (BarS) or wheat silage (WhS) at 10% of dietary DM. Silages were harvested at two chop lengths to yield low (LpeNDF) vs. high peNDF (HpeNDF) silage. For both BarS and WhS, chopped wheat straw was included (5% of DM) by replacing an equal proportion of LpeNDF silages to evaluate low vs. high uNDF (7.3 vs. 8.2% dietary DM) concentrations. Heifers fed HpeNDF WhS had greater DMI (silage′peNDF; P < 0.01) than those fed HpeNDF BarS, but DMI did not differ for LpeNDF treatments. Ruminating and eating time increased for heifers fed HpeNDF WhS relative to LpeNDF WhS, but were not different for BarS (silage′peNDF; P ≤ 0.02). Increasing uNDF increased eating and ruminating times for heifers fed WhS, but not BarS (silage′uNDF; P ≤ 0.03). Mean ruminal pH averaged 5.97 and was not affected by silage, peNDF, uNDF, or the interactions (P ≥ 0.12). Feeding BarS increased the duration (384 vs. 256 min/d; P = 0.02) and area (84.5 vs. 43.8 pH×min/d; P = 0.02) that pH was < 5.5 relative to WhS. Increasing peNDF numerically reduced the frequency of reticular contractions when fed BarS but numerically increased them when fed WhS (silage′peNDF; P < 0.01). Reticular contractions were not affected by dietary uNDF concentration (P ≥ 0.13). These data highlight that at a constant inclusion rate, silage source and chop length interact to affect DMI, eating behavior, ruminal pH, and reticular motility indicating the need to account for silage type, peNDF, and uNDF in diet formulation for finishing cattle.
PSXIV-21 Performance of hair lambs maintained on stockpiled permanent pasture mixed with Cleome gynandra L. at multiple stocking densities
Authors: Gekara Ondieki J , Sycip Oliver , Brundage Cord , Chaichi Mohammad
Published: October 2021

Stockpiled forage may extend the grazing season for sheep, reducing feeding costs. Additionally, internal parasites are a problem in sheep managed under grazing conditions. Plants high in phenolic compounds have potential to reduce parasite problems. Cleome gynandra is one such plant that has traditionally been used to treat worms in humans. Thirty-six Katahdin × Dorper lambs (38.8 ± 0.7 kg) were used to investigate the effect of stockpiled forages on lamb performance at different stocking densities: (i) 23 lambs/ha (LOW), (ii) 46 lambs/ha (MED), and (iii) 92 lambs/ha (HIGH). To test C. gynandra for anthelmintic properties, lambs were assigned to (i) permanent pastures (PP), and (ii) PP inter-seeded with C. gynandra (CL). The LOW lambs had the highest ADG (83.8 ± 10.5 g/day), MED lambs were intermediate (48.4 ± 11.6 g/day) and HIGH lambs were lowest (11.0 ± 10.6 g/day; P < 0.001). Lamb BCS did not differ between stocking densities or pasture types (P > 0.10). Fecal egg counts did not differ (P > 0.10) between pasture treatments. In conclusion, stockpiled forages may extend the grazing season for yearling lambs in Southern California. The lack of effect on parasite egg counts may be attributed to grazing C. gynandra at mature stage when nutritional and medicinal values were at their lowest. Future research can clarify the economics of grazing stockpiled forages for sheep at different stages of production, and nutritional effect of C. gynandra on carcass quality.
Axillary Ultrasound Evaluation in Breast Cancer Patients: A Multidisciplinary Viewpoint and Middle Ground
Authors: Saksena Mansi , Jimenez Rachel , Coopey Suzanne , Harris Katherine
Published: October 2021

Over the past decade, there has been a trend toward de-escalation of axillary surgery. Certain patients may now forego axillary lymph node dissection even in the setting of a positive sentinel lymph node biopsy (SLNB), and some patients may not even undergo a SLNB. However, there is wide variability in the imaging approach to assessing axillary lymph nodes in patients with breast cancer. Approaches range from performing axillary US in all patients with newly diagnosed breast cancer to omitting axillary imaging evaluation in all patients. This article provides a multidisciplinary middle ground approach for axillary nodal evaluation. The clinical impact and rationale for appropriate axillary nodal imaging are discussed and an imaging algorithm is proposed.
To Look or Not to Look? Yes to Nodal Ultrasound!
Authors: Rauch Gaiane M , Kuerer Henry M , Jochelson Maxine S
Published: October 2021

Knowledge of axillary nodal status is highly important for correct staging and treatment planning in patients with breast cancer. Axillary US is a recognized highly specific and cost-effective tool for assessing nodal status and guiding appropriate treatment. Axillary US imaging with US-guided biopsy is routinely performed throughout the world. However, because of recent developments in the surgical management of the axilla in patients with newly diagnosed breast cancer (American College of Surgeons Oncology Group [ACOSOG] Z0011 trial) and in patients with breast cancer receiving neoadjuvant systemic therapy (ACOSOG Z1071, SENTinel NeoAdjuvant [SENTINA] and Sentinel Node biopsy aFter NeoAdjuvant Chemotherapy [SN FNAC] trials), some have questioned the utility of axillary US for nodal staging. Here, we review the evidence to date supporting the additional value of axillary US for patients with breast cancer. Nodal US in patients with newly diagnosed breast cancer is useful for staging; in a significant proportion of patients, nodal US identifies additional axillary level II or level III nodal disease, which allows for appropriate treatment of disease. Furthermore, ongoing clinical trials may show that axillary surgery can be omitted in patients with negative findings on axillary US. In patients with lymph node–positive disease undergoing neoadjuvant systemic therapy, nodal US can guide the approach to axillary surgery. A more personalized patient approach, taking into the account tumor biology, among other factors, may help to mitigate the controversy surrounding the role of axillary US in breast cancer patients.
The Ethical Duty to Reduce the Ecological Footprint of Industrialized Healthcare Services and Facilities
Authors: Katz Corey
Published: October 2021

According to the widely accepted principles of beneficence and distributive justice, I argue that healthcare providers and facilities have an ethical duty to reduce the ecological footprint of the services they provide. I also address the question of whether the reductions in footprint need or should be patient-facing. I review Andrew Jameton and Jessica Pierce’s claim that achieving ecological sustainability in the healthcare sector requires rationing the treatment options offered to patients. I present a number of reasons to think that we should not ration health care to achieve sufficient reductions in a society’s overall consumption of ecological goods. Moreover, given the complexities of ecological rationing, I argue that there are good reasons to think that the ethical duty to reduce the ecological footprint of health care should focus on only nonpatient-facing changes. I review a number of case studies of hospitals who have successfully retrofitted facilities to make them more efficient and reduced their resource and waste streams.
Upper limb gangrene due to a subclavian arterial thrombosis associated with thoracic outlet syndrome following cervical spondylotic amyotrophy
Authors: Yamada Tsuyoshi , Kudo Toshifumi , Kawabata Atsuyuki , Yoshii Toshitaka
Published: October 2021

Thoracic outlet syndrome (TOS) refers to an abnormal compression of the subclavian vessels and the brachial plexus at the base of the neck or thoracic outlet. The authors described a novel case of a 66-year-old male with arterial TOS and unilateral upper rib dysplasia following cervical spine disease. Owing to the comorbidity of cervical spondylotic amyotrophy and a history of sloping shoulder due to rib dysplasia, TOS occurred, which subsequently led to subclavian arterial thrombosis and eventually resulted in the gangrene of the hand. Thrombectomy and surgical resection of the first and second ribs avoided the progression of further neurovascular disorder.

When treating a cervical spondylotic patient, concurrent TOS can be obscured by symptoms caused by cervical lesions, leading to difficulty in identifying the origin of these neurovascular findings. The possibility of subsequent thromboembolic events based on TOS should be considered, especially in cases with dysplasia of the upper ribs.
The costs of urban living: human–wildlife interactions increase parasite risk and self-directed behaviour in urban vervet monkeys
Authors: Thatcher Harriet R , Downs Colleen T , Koyama Nicola F
Published: October 2021

The urban landscape is a complex mosaic of costs and benefits for urban wildlife. Although many species may adapt and thrive in the urban mosaic, the complexity of this landscape can be stressful and have health implications for urban wildlife, raising concerns for zoonosis and biodiversity. In this study, we assessed how human–primate interactions influenced parasite risk and anxiety-related behaviour of urban vervet monkeys in KwaZulu-Natal, South Africa. Over 1 year, we collected and analysed faecal samples, assessing eggs per gram, species richness, and Shannon’s diversity index. In addition, using behavioural sampling, we recorded self-directed scratching behaviour, as an indicator of anxiety, and human–primate interactions, both positive (human-food consumption) and negative (human–monkey aggression). To assess parasite risk in the urban mosaic, we ran three models with our parasite measures as dependent variables. Results showed that negative human interactions significantly increased with eggs per gram, species richness, and Shannon’s diversity index and positive human interactions increased with both eggs per gram and species richness. Furthermore, eggs per gram significantly increased with higher scratching rate. We also tested the relationship between scratching and human interactions, finding that scratching significantly increased under higher rates of negative human incidents. Overall, results suggest that there are costs to urban living that increase anxiety-related behaviour and parasite risk despite increased food availability. Our findings are important for developing effective management strategies that focus on cohabitation rather than conflict, for the benefit of human and wildlife health.
Maternal selenium deficiency suppresses proliferation, induces autophagy dysfunction and apoptosis in the placenta of mice
Authors: Li Mengdi , Cheng Wanpeng , Zhang Lantian
Published: October 2021

Selenium deficiency is thought to be associated with the occurrence of gestational complications. However, the underlying mechanism of selenium deficiency impairs placental function remains unclear. In this study, female mice were separately supplemented with a Se-deficient (0.02 mg/kg Se) or control diet (0.2 mg/kg Se) for 12 weeks before mating and throughout gestation. Maternal liver and placentas were collected at embryonic day 15.5 and analyzed for Se content. Oxidative stress status, proliferation capability, autophagy, and apoptosis of the placenta were determined. We found that maternal selenium deficiency decreased placental Se concentration and some antioxidant selenoproteins expressions. The concentrations of catalase and glutathione in selenium-deficient placentas were reduced, along with an increase in hydrogen peroxide (H2O2) content. Selenium deficiency inhibited the expression of proliferating cell nuclear antigen. Autophagosomes, autophagolysosomes, and upregulation of autophagy-related protein microtubule-associated protein 1 light chain 3 alpha II (LC3B), Beclin1, PTEN-induced putative kinase 1 (PINK1), and Parkin were found in the selenium-deficient trophoblasts. Autophagic substrate p62/sequestosome 1 was surprisingly increased, indicating autophagy flux dysfunction. Selenium deficiency increased expressions of B cell leukemia/lymphoma 2 associated X protein (Bax), cleaved caspase-9/-3, and decreased the B cell leukemia/lymphoma 2 (Bcl2) level. Moreover, typical apoptotic ultrastructure and apoptosis-positive cells were observed in the selenium-deficient placenta. Our results suggested that maternal selenium deficiency impaired placental proliferation, induced autophagy dysfunction and apoptosis via increasing oxidative stress, and the Akt/mechanistic target of rapamycin (mTOR) pathway involved in this process. This study revealed a novel mechanism by which maternal selenium deficiency caused impairment of the placenta.
Comparison of Pericranial Autograft and AlloDerm for Duraplasty in Patients With Type I Chiari Malformation: Retrospective Cohort Analysis
Authors: Hoffman Haydn , Bunch Katherine M , Paul Tyler , Krishnamurthy Satish
Published: October 2021

BACKGROUND

Pericranial autograft is a popular option for duraplasty during Chiari decompression with several theoretical advantages, but comparisons to other materials have yielded mixed results.

OBJECTIVE

To compare outcomes between pericranial autograft and AlloDerm (BioHorizons).

METHODS

Consecutive suboccipital craniectomies for patients with type I Chiari malformation (CM-I) over an 8-yr period at a single institution were identified. Exclusion criteria included revision surgeries and suboccipital decompressions without duraplasty. Outcomes included incisional cerebrospinal fluid (CSF) leakage, length of stay (LOS), wound complication, aseptic meningitis, syrinx improvement, and symptomatic improvement.

RESULTS

A total of 101 patients (70 females and 31 males) with a median (interquartile range) age of 17 yr (11-32) met the inclusion criteria. There were 51 (50%) patients who underwent duraplasty with pericranial autograft, and the remainder underwent duraplasty with AlloDerm. There were 9 (9%) patients who experienced a postoperative CSF leak. After adjusting for confounding factors, obesity (odds ratio [OR]: 4.69, 95% CI: 1.03-25.6) and use of AlloDerm (OR: 10.54, 95% CI: 1.7-206.12) were associated with CSF leak. Wound complication occurred in 8 (8%) patients but was not associated with graft type (P = .8). Graft type was not associated with LOS, syrinx improvement, or symptom improvement. Reoperations occurred in 10 patients with 4 in the autograft group and 6 in the AlloDerm group (P = .71).

CONCLUSION

In patients with CM-I, expansile duraplasty with AlloDerm was associated with greater odds of CSF leakage than pericranial autograft. Obesity was also associated with increased odds of CSF leakage.
Development of a New Image-Guided Neuronavigation System: Mixed-Reality Projection Mapping Is Accurate and Feasible
Authors: Koike Tsukasa , Kin Taichi , Tanaka Shota , Sato Katsuya , Uchida Tatsuya , Takeda Yasuhiro , Uchikawa Hiroki , Kiyofuji Satoshi , Saito Toki , Takami Hirokazu , Takayanagi Shunsaku , Mukasa Akitake , Oyama Hiroshi , Saito Nobuhito
Published: October 2021

BACKGROUND

Image-guided systems improve the safety, functional outcome, and overall survival of neurosurgery but require extensive equipment.

OBJECTIVE

To develop an image-guided surgery system that combines the brain surface photographic texture (BSP-T) captured during surgery with 3-dimensional computer graphics (3DCG) using projection mapping.

METHODS

Patients who underwent initial surgery with brain tumors were prospectively enrolled. The texture of the 3DCG (3DCG-T) was obtained from 3DCG under similar conditions as those when capturing the brain surface photographs. The position and orientation at the time of 3DCG-T acquisition were used as the reference. The correct position and orientation of the BSP-T were obtained by aligning the BSP-T with the 3DCG-T using normalized mutual information. The BSP-T was combined with and displayed on the 3DCG using projection mapping. This mixed-reality projection mapping (MRPM) was used prospectively in 15 patients (mean age 46.6 yr, 6 males). The difference between the centerlines of surface blood vessels on the BSP-T and 3DCG constituted the target registration error (TRE) and was measured in 16 fields of the craniotomy area. We also measured the time required for image processing.

RESULTS

The TRE was measured at 158 locations in the 15 patients, with an average of 1.19 ± 0.14 mm (mean ± standard error). The average image processing time was 16.58 min.

CONCLUSION

Our MRPM method does not require extensive equipment while presenting information of patients’ anatomy together with medical images in the same coordinate system. It has the potential to improve patient safety.
The clinical effect of glucose meter selection upon the detection of neonatal hypoglycemia
Authors: Parker Kayla , Lyon Martha E , Kyle Barry D , Strueby Lannae , Inman Mark
Published: October 2021

Neonatal hypoglycemia is a common, transitional metabolic state that may lead to poor neurodevelopmental outcomes if unrecognized or managed inadequately. Given its frequency of presentation and immense clinical significance, a myriad of clinical practice guidelines have been published outlining appropriate screening, diagnosis, and treatment principles—many endorsing the use of glucose point-of-care testing (POCT). Unfortunately, the well-intended ‘march’ toward POCT, with bedside glucose meters as screening devices in the NICU, has resulted in unintended consequences with critical implications: a lack of international traceability to the ‘gold’ standard glucose method by POCT devices, under-recognition of POCT limitations, and a reliance upon a technology primarily driven to detect hyperglycemia in the adult population as opposed to neonatal hypoglycemia. As providers continue to advocate for improved POCT, there must be robust communication between providers and the clinical laboratory in the selection, standardization, and interpretation of glucose POCT to ensure optimal neonatal glucose detection.
Pediatric hypertension screening and recognition in primary care clinics in Canada
Authors: Ding Linda , Singer Alexander , Kosowan Leanne , Dart Allison
Published: October 2021

Objectives

Screening for hypertension in children is recommended by pediatric consensus guidelines. However, current practice is unknown. We evaluated rates of blood pressure assessment and hypertension recognition in primary care.

Methods

This retrospective cohort study evaluated electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network between 2011 and 2017. Children aged 3 to <18 years with at least one clinical encounter were included. Screening, follow-up, and hypertension recognition rates were evaluated. Descriptive statistics and multivariate logistical regression were used to determine patient and provider characteristics associated with increased screening and recognition of pediatric hypertension.

Results

Among 378,002 children, blood pressure was documented in 33.3% of all encounters, increasing from 26.7% in 2011 to 36.2% in 2017; P=0.007. Blood pressure was documented in 76.0% of well child visits. Follow-up visits occurred within 6 months for 26.4% of children with elevated blood pressure, 57.1% of children with hypertension, and within 1 month for 7.2% of children with hypertension. Patient factors associated with increased blood pressure screening include being overweight (OR 2.15, CI 2.09 to 2.22), having diabetes (OR 1.69, CI 1.37 to 2.08), chronic kidney disease (OR 7.51, CI 6.54 to 8.62), increased social deprivation (OR 1.10, CI 1.09 to 1.11), and urban residence (OR 1.27, CI 1.15 to 1.4). Overall prevalence of hypertension was 1.9% (n=715) and of those, 5.6% (n=40) had recognized hypertension. Factors associated with increased recognition include male sex, overweight, and hyperlipidemia.

Conclusions

Rates of hypertension screening and recognition are low in primary care settings in Canada, suggesting pediatric hypertension should be a priority for implementation and dissemination of interventions.
Prevalence of Walking Limitation After Acute Stroke and Its Impact on Discharge to Home
Authors: Louie Dennis R , Simpson Lisa A , Mortenson W Ben , Field Thalia S , Yao Jennifer , Eng Janice J
Published: October 2021

Objective

The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization.

Methods

In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization.

Results

For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R2 = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11–14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R2 = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82–2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission.

Conclusion

Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability.

Impact

An early assessment of walking function within days of stroke admission can help to streamline discharge planning.

Lay Summary

Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.
Reopening after lockdown: the influence of working-from-home and digital device use on sleep, physical activity, and wellbeing following COVID-19 lockdown and reopening
Authors: Massar Stijn A A , Ng Alyssa S C , Soon Chun Siong , Ong Ju Lynn , Chua Xin Yu , Chee Nicholas I Y N , Lee Tih Shih , Chee Michael W L
Published: October 2021

Study Objectives

COVID-19 lockdowns drastically affected sleep, physical activity, and wellbeing. We studied how these behaviors evolved during reopening the possible contributions of continued working from home and smartphone usage.

Methods

Participants (N = 198) were studied through the lockdown and subsequent reopening period, using a wearable sleep/activity tracker, smartphone-delivered ecological momentary assessment (EMA), and passive smartphone usage tracking. Work/study location was obtained through daily EMA ascertainment.

Results

Upon reopening, earlier, shorter sleep and increased physical activity were observed, alongside increased self-rated stress and poorer evening mood ratings. These reopening changes were affected by post-lockdown work arrangements and patterns of smartphone usage. Individuals who returned to work or school in-person tended toward larger shifts to earlier sleep and wake timings. Returning to in-person work/school also correlated with more physical activity. Contrary to expectation, there was no decrease in objectively measured smartphone usage after reopening. A cluster analysis showed that persons with relatively heavier smartphone use prior to bedtime had later sleep timings and lower physical activity.

Conclusions

These observations indicate that the reopening after lockdown was accompanied by earlier sleep timing, increased physical activity, and altered mental wellbeing. Moreover, these changes were affected by work/study arrangements and smartphone usage patterns.
The substratum rule—where to now?
Authors: Alexander Stephen , Lewis Paul
Published: October 2021

In Representation of Rysaffe Fiduciaires Sarl [2021] JRC 230 (Rysaffe), the Royal Court of Jersey has handed down a judgment which provides important clarification in relation to the scope of a trustee’s powers to amend and to add beneficiaries. This is the first time that the Royal Court has considered the substratum rule in the context of a trustee wishing to exercise a power to add a beneficiary. This decision is of particular note coming as it does in the wake of the decision of the Court of Appeal in Bermuda to reject the substratum rule in Grand View Private Trust Company Limited v Wong & Ors Civil Appeal No. 5A of 2019.
Influenza Virus Associated Pediatric Acute Respiratory Distress Syndrome: Clinical Characteristics and Outcomes
Authors: Yener Nazik , Üdürgücü Muhammed , Yılmaz Resul , Kendirli Tanıl , Tekerek Nazan Ülgen , Evren Gültaç , Arı Hatice Feray , Yıldızdaş Dinçer , Demirkol Demet , Pişkin Ethem , Duyu Muhterem , Dalkıran Tahir , Akçay Nihal , Yalındağ Öztürk Nilüfer , Yeşilbaş Osman , Bozan Gürkan , Gurbanov Anar , Albayrak Hatice
Published: October 2021

Background and Objective

The aim of this multicenter retrospective study was to determine the clinical characteristics, treatment approaches and the course of pediatric acute respiratory distress syndrome (PARDS) which developed associated with the influenza virus in the 2019–20 season.

Methods

Patients included 1 month to 18 years who were diagnosed with PARDS associated with the influenza virus in the 2019–20 season.

Results

Sixty-seven patients were included in the study. The mean age of the patients was 64.16 ± 6.53 months, with 60% of the group <5 years. Influenza A was determined in 54 (80.5%) patients and Influenza B in 13 (19.5%). The majority of patients (73.1%) had a comorbidity. Fifty-eight (86.6%) patients were applied with invasive mechanical ventilation, Pediatric Acute Lung Injury Consensus Conference classification was mild in 5 (8.6%), moderate in 22 (37.9%) and severe in 31 (52.5%) patients. Ventilation was applied in the prone position to 40.3% of the patients, and in nonconventional modes to 24.1%. A total of 22 (33%) patients died, of which 4 had been previously healthy. Of the surviving 45 patients, 38 were discharged without support and 7 patients with a new morbidity.

Conclusion

Both Influenza A and Influenza B cause severe PARDS with similar characteristics and at high rates. Influenza-related PARDS cause 33% mortality and 15.5% morbidity among the study group. Healthy children, especially those aged younger than 5 years, are also at risk.
A Quantitative Research Study Protocol to Advance Simulation Science in Nursing Education
Authors: Cantrell Mary Ann , Mariani Bette , Lengetti Evelyn
Published: October 2021

AIM

This article describes a quantitative simulation study protocol and identifies important methodological considerations for future high-level, rigorous quantitative simulation studies.

BACKGROUND

Quantitative simulation research studies have been found to be lacking in their conceptualization, study design, and measurement of outcomes, with small samples and lack of rigor in overall study methods.

METHOD

This protocol reflects research priorities of organizations that drive simulation science and nursing education, published standards of simulation best practice, and use of research methodology within and outside the simulation literature, which includes psychometrically sound instruments and outcomes of importance to cognitive and simulation science.

RESULTS

The protocol was a multisite, longitudinal study, guided by the integrative model of clinical judgment, with a high degree of intervention fidelity to measure the study outcomes of clinical judgment and clinical competence.

CONCLUSION

To advance simulation science, rigorous study protocols, reflective of the one described in this article, are needed.
Active Learning: A Concept Analysis With Implications for Nursing Education
Authors: Franco-Tantuico Monina A.
Published: October 2021

AIM

The aim of this study was to understand the concept of active learning and its potential use in nursing academia.

BACKGROUND

The demands for innovative teaching-learning strategies in higher education increased in the past decade to foster higher level of thinking. The nurse educator must prepare students entering the nursing profession, which mandates safe patient care, using a pedagogical learning process such as active learning.

METHOD

The Walker and Avant method guided this concept analysis.

RESULTS

The attributes of the concept are learner-centered; dynamic, meaningful, and engaging learning environment; bidirectional collaborative interaction between educator and learner; and ongoing constructive and nonjudgmental feedback. The identified antecedents include the educator’s active learning expertise and the learner’s capacity for higher order thinking.

CONCLUSION

Nurse educators are responsible for providing effective learning environments based on a sound pedagogical approach. Active learning’s desirable outcomes call for educator support as experts in implementation.
Prenatal Gene Therapy for Metabolic Disorders
Authors: Coons Barbara , Peranteau William H.
Published: October 2021

Gene therapy has traditionally involved the delivery of exogenous genetic material to a cell—most commonly to replace defective genes causing monogenic disorders. This allows cells to produce proteins that are otherwise absent in sufficient quantities, ideally for a therapeutic purpose. Since its inception over 40 years ago, the field of gene therapy has significantly expanded and now includes targeted gene editing strategies, including, but not limited to, clustered regularly interspaced palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9), transcription activator–like effector nucleases (TALENs), and zinc-finger nucleases (ZFNs).
Prosthetic Rehabilitation in a Patient With Orbital Exenteration: The First Hybrid System With Miniplates and Magnetic Retention Described in Humans
Authors: Gallón Marco A. , Echeverry Laura J. , Rojas Ricardo , Caicedo Margarita R.
Published: October 2021

The authors report the case of an 80-year-old male patient who had a modified left orbit exenteration with preservation of myocutaneus eyelid flap. The radical surgical treatment was performed due to high-grade recurrent pleomorphic conjunctival sarcoma with extension to the sclera and medial orbit. Five previous resection surgeries were performed, until the exenteration was considered. Prosthetic rehabilitation was planned integrating interdisciplinary biomedical knowledge, to create a new hybrid osteointegrated method with costume-made titanium miniplates and magnetic retention. During the second-year follow up, the system appeared osteointegrated. No failures from the retention mechanism have been reported. The patient reported to have a functional role inside and outside his house. Social interactions have not been limited by the anatomical facial defect. This new hybrid system is a feasible option to rehabilitate patients with orbital or facial defects, even for the elderly.
Targeted Neoadjuvant Intra-arterial Chemotherapy in Lacrimal Gland Adenoid Cystic Carcinoma: A Histological Correlation Using Apoptotic Tumor Markers
Authors: Maniar Arpita , Saqi Anjali , Troob Scott H. , Belinsky Irina , Charles Norman C. , Gobin Y. Pierre , Marr Brian P.
Published: October 2021

Neoadjuvant intra-arterial cytoreductive chemotherapy is used for the treatment of lacrimal gland adenoid cystic carcinomas (ACC) to improve outcomes in this condition with an otherwise dismal prognosis. We share our experience in the management of an advanced case of ACC using a novel, highly targeted intra-arterial cytoreductive chemotherapy delivery technique involving both the internal and external carotid circulation, with an attempt to correlate the effect histologically. Refinement of the chemotherapy delivery using the tumor’s vascular anatomy and appropriate blood vessel selection may lead to future globe sparing procedures without compromising survival.
A ladder that matters: Conceptual development of a clinical ladder program for nurse practitioners and physician assistants
Authors: Kauffman Katie R. , Cline Genieveve J. , Hays Stacia M.
Published: October 2021

Clinical ladders are professional enhancement models that encourage and reward participants for continued professional engagement and leadership development. They have the potential to affect patient care through improved provider retention, advanced and refined clinical skills, and increased engagement. Recent literature has demonstrated development and implementation of clinical ladder models for nurse practitioners (NPs) in the acute care setting. A free standing pediatric academic hospital in Florida identified the need for such a program for nurse practitioners and given its increased utilization of physician assistants, these providers were also targeted for inclusion. This new clinical ladder included development strategies appropriate and attainable for both NP and PA scopes of practice. Consistent with Benner's theory of novice to expert (1982), each advancing rung in the ladder contains more stringent criteria and additional competencies demonstrating increased engagement, learning, and leadership. As this was a development project only, future directions for the new model include implementation and evaluation of various metrics including nurse practitioner and physician assistant retention and satisfaction. This model has laid the foundation for ladder development for additional health care professions within the institution.
Chronic obstructive pulmonary disease risk assessment tools: is one better than the others?
Authors: Wang Jennifer M. , Han MeiLan K. , Labaki Wassim W.
Published: October 2021

Purpose of review

Risk assessment tools are essential in COPD care to help clinicians identify patients at higher risk of accelerated lung function decline, respiratory exacerbations, hospitalizations, and death.

Recent findings

Conventional methods of assessing risk have focused on spirometry, patient-reported symptoms, functional status, and a combination of these tools in composite indices. More recently, qualitatively and quantitatively assessed chest imaging findings, such as emphysema, large and small airways disease, and pulmonary vascular abnormalities have been associated with poor long-term outcomes in COPD patients. Although several blood and sputum biomarkers have been investigated for risk assessment in COPD, most still warrant further validation. Finally, novel remote digital monitoring technologies may be valuable to predict exacerbations but their large-scale performance, ease of implementation, and cost effectiveness remain to be determined.

Given the complex heterogeneity of COPD, any single metric is unlikely to fully capture the risk of poor long-term outcomes. Therefore, clinicians should review all available clinical data, including spirometry, symptom severity, functional status, chest imaging, and bloodwork, to guide personalized preventive care of COPD patients. The potential of machine learning tools and remote monitoring technologies to refine COPD risk assessment is promising but remains largely untapped pending further investigation.
Obstructive lung diseases burden and COVID-19 in developing countries: a perspective
Authors: Aggarwal Ashutosh N. , Prasad Kuruswamy Thurai , Muthu Valliappan
Published: October 2021

Purpose of review

Asthma and chronic obstructive pulmonary disease (COPD) are widely prevalent disorders, and important contributors to morbidity and mortality, in both developing and developed countries. It is conjectured that these obstructive lung diseases may have had more deleterious effects in developing nations during the 2019 coronavirus disease (COVID-19) pandemic. We provide an evidence-based perspective on the relationship between asthma/COPD prevalence and COVID-19 burden, and the impact of comorbid asthma/COPD on selected COVID-19 outcomes and healthcare utilization, with special reference to developing countries.

Recent findings

Developing countries with higher COPD (but not asthma) prevalence appear to have higher COVID-19 related mortality. Patients with asthma (but not COPD) in developing countries may be less likely to acquire COVID-19. Published literature suggests that the overall impact of comorbid asthma or COPD on adverse COVID-19 outcomes may be broadly similar between developed and developing nations.

There is paucity of information on interaction between asthma/COPD and COVID-19 in developing countries. Limited data suggest minor differences between developed and developing nations. In view of inadequacies in healthcare preparedness and delivery in several developing countries, there is a need to generate quality evidence to assess impact of obstructive lung diseases and COVID-19 on each other.
Long-acting cabotegravir and rilpivirine for HIV-1 suppression: switch to 2-monthly dosing after 5 years of daily oral therapy
Authors: Mills Anthony , Richmond Gary J. , Newman Cheryl , Osiyemi Olayemi , Cade Jerry , Brinson Cynthia , De Vente Jerome , Margolis David A. , Sutton Kenneth C. , Wilches Viviana , Hatch Sarah , Roberts Jeremy , McCoig Cynthia , Garris Cindy , Vandermeulen Kati , Spreen William R.
Published: October 2021

Objectives:

Long-acting formulations of cabotegravir (CAB) and rilpivirine (RPV) have demonstrated efficacy in Phase 3 studies. POLAR (NCT03639311) assessed antiviral activity and safety of CAB+RPV long-acting administered every 2 months (Q2M) in adults living with HIV-1 who previously received daily oral CAB+RPV in LATTE (NCT01641809).

Design:

A Phase 2b, multicenter, open-label, rollover study.

Methods:

LATTE participants with plasma HIV-1 RNA less than 50 copies/ml who completed at least 300 weeks on study were eligible. Participants elected to switch to either CAB+RPV long-acting Q2M or daily oral dolutegravir/RPV for maintenance of virologic suppression. The primary endpoint was the proportion of participants with HIV-1 RNA greater than or equal to 50 copies/ml at Month 12 (M12) per the Food and Drug Administration Snapshot algorithm. The incidence of confirmed virologic failure (CVF, two consecutive HIV-1 RNA measurements greater than or equal to 200 copies/ml), as well as safety, laboratory, and patient-reported outcomes (HIV Treatment Satisfaction and preference questionnaires) were also assessed.

Results:

Of 97 participants enrolled, 90 chose to receive CAB+RPV long-acting and seven chose dolutegravir/RPV. At M12, no participant had HIV-1 RNA greater than or equal to 50 copies/ml or met the CVF criterion in either treatment group. No new safety signals were identified. Total treatment satisfaction was high at Baseline and remained stable through M12 across both treatment groups. Overall, 88% (n = 77/88) of long-acting arm participants preferred CAB+RPV long-acting to oral CAB+RPV.

Conclusion:

CAB+RPV long-acting maintained virologic suppression in participants who had previously received daily oral CAB+RPV for at least 5 years in LATTE, with a favorable safety profile. Most participants preferred CAB+RPV long-acting to their prior oral CAB+RPV regimen at M12.
The ecology and evolution of synchronized reproduction in long-lived plants
Authors: Pesendorfer Mario B. , Ascoli Davide , Bogdziewicz Michał , Hacket-Pain Andrew , Pearse Ian S. , Vacchiano Giorgio
Published: October 2021

Populations of many long-lived plants exhibit spatially synchronized seed production that varies extensively over time, so that seed production in some years is much higher than on average, while in others, it is much lower or absent. This phenomenon termed
masting
or
mast seeding
has important consequences for plant reproductive success, ecosystem dynamics and plant–human interactions. Inspired by recent advances in the field, this special issue presents a series of articles that advance the current understanding of the ecology and evolution of masting. To provide a broad overview, we reflect on the state-of-the-art of masting research in terms of underlying proximate mechanisms, ontogeny, adaptations, phylogeny and applications to conservation. While the mechanistic drivers and fitness consequences of masting have received most attention, the evolutionary history, ontogenetic trajectory and applications to plant–human interactions are poorly understood. With increased availability of long-term datasets across broader geographical and taxonomic scales, as well as advances in molecular approaches, we expect that many mysteries of masting will be solved soon. The increased understanding of this global phenomenon will provide the foundation for predictive modelling of seed crops, which will improve our ability to manage forests and agricultural fruit and nut crops in the Anthropocene.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
Mast seeding promotes evolution of scatter-hoarding
Authors: Zwolak Rafał , Clement Dale , Sih Andrew , Schreiber Sebastian J.
Published: October 2021

Many plant species worldwide are dispersed by scatter-hoarding granivores: animals that hide seeds in numerous, small caches for future consumption. Yet, the evolution of scatter-hoarding is difficult to explain because undefended caches are at high risk of pilferage. Previous models have attempted to solve this problem by giving cache owners large advantages in cache recovery, by kin selection, or by introducing reciprocal pilferage of ‘shared’ seed resources. However, the role of environmental variability has been so far overlooked in this context. One important form of such variability is masting, which is displayed by many plant species dispersed by scatterhoarders. We use a mathematical model to investigate the influence of masting on the evolution of scatter-hoarding. The model accounts for periodically varying annual seed fall, caching and pilfering behaviour, and the demography of scatterhoarders. The parameter values are based mostly on research on European beech (Fagus sylvatica) and yellow-necked mice (Apodemus flavicollis). Starvation of scatterhoarders between mast years decreases the population density that enters masting events, which leads to reduced seed pilferage. Satiation of scatterhoarders during mast events lowers the reproductive cost of caching (i.e. the cost of caching for the future rather than using seeds for current reproduction). These reductions promote the evolution of scatter-hoarding behaviour especially when interannual variation in seed fall and the period between masting events are large.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
Understanding mast seeding for conservation and land management
Authors: Pearse Ian S. , Wion Andreas P. , Gonzalez Angela D. , Pesendorfer Mario B.
Published: October 2021

Masting, the intermittent and synchronous production of large seed crops, can have profound consequences for plant populations and the food webs that are built on their seeds. For centuries, people have recorded mast crops because of their importance in managing wildlife populations. In the past 30 years, we have begun to recognize the importance of masting in conserving and managing many other aspects of the environment: promoting the regeneration of forests following fire or other disturbance, conserving rare plants, conscientiously developing the use of edible seeds as non-timber forest products, coping with the consequences of extinctions on seed dispersal, reducing the impacts of plant invasions with biological control, suppressing zoonotic diseases and preventing depredation of endemic fauna. We summarize current instances and future possibilities of a broad set of applications of masting. By exploring in detail several case studies, we develop new perspectives on how solutions to pressing conservation and land management problems may benefit by better understanding the dynamics of seed production. A lesson common to these examples is that masting can be used to time management, and often, to do this effectively, we need models that explicitly forecast masting and the dynamics of seed-eating animals into the near-term future.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
A brief history of masting research
Authors: Koenig Walter D.
Published: October 2021

Although it has long been recognized that seed production by many forest trees varies greatly from year to year, masting (along with ‘mast fruiting’, ‘mast seeding’ and ‘masting behaviour’) as a concept referring to such variability is a relatively recent development. Here, I provide a brief history of masting research, highlighting some of the early contributions by foresters, zoologists and others that paved the way for the burgeoning number of studies currently being conducted by researchers around the world. Of particular current interest is work attempting to understand the proximate mechanisms, evolutionary drivers and community effects of this important ecological phenomenon as well as the ways that climate change may influence masting behaviour in the future.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants'.