bluuebunny/crossref_metadata_2025 huggingface dataset:
To Look or Not to Look? Axillary Imaging: Less May Be More
Authors: Mango Victoria L , Pilewskie Melissa , Jochelson Maxine S
Published: October 2021

Axillary lymph node status in patients with breast cancer is an important prognostic indicator and often guides vital treatment decisions. Although in many cases imaging plays a crucial role in the assessment of the axilla, it is essential that targeted axillary US and/or image-guided biopsy of an axillary lymph node be performed by the radiologist only when clinically appropriate. This decision-making process requires multidisciplinary communication and collaboration among radiologists, surgeons, medical oncologists, and radiation oncologists. Our goal is to review axillary imaging for patients with breast cancer in two distinct clinical settings, the patient with newly diagnosed breast cancer who meets American College of Surgeons Oncology Group Z0011 criteria and patients undergoing neoadjuvant chemotherapy, with a specific focus on potential reasons to not perform axillary US and/or image-guided biopsy in these settings.
On theĀtmanThesis Concerning Fundamental Reality
Authors: Fasching Wolfgang
Published: October 2021

The central thesis of the philosophy of Advaita Vedānta is the doctrine of the identity of brahman (the absolute) and ātman (the self). Brahman is essentially sat, being as such in the sense of the dimension of existence in which all worldly goings-on take place. The ātman is conceived as the “seer,” i.e., as the pure subject qua the to-whom of any experiential givenness; and this subject, in turn, is understood not as some entity that performs the seeing but as nothing but the very seeing itself, i.e., as consciousness in the sense of the abiding presence-realm in which permanently changing experiential contents come to givenness. The Advaitic thesis is that this presence-realm—the seeing that takes place “in us”—is ultimately nothing other than the universal being-dimension—brahman—itself, (seemingly) modified by the mental contents of an innerworldly individual. This paper attempts to vindicate this doctrine by a series of reflections on the nature of the I and of reality as such. It argues that Advaita Vedānta can be viewed as a version of cosmopsychism in its idealist version which does not view consciousness as one of the features of the cosmos as a whole, but as its exclusive intrinsic nature, i.e., as the very essence of being as such.
Optimizing the Management of Uncomplicated Gram-Negative Bloodstream Infections: Consensus Guidance Using a Modified Delphi Process
Authors: Heil Emily L , Bork Jacqueline T , Abbo Lilian M , Barlam Tamar F , Cosgrove Sara E , Davis Angelina , Ha David R , Jenkins Timothy C , Kaye Keith S , Lewis James S , Ortwine Jessica K , Pogue Jason M , Spivak Emily S , Stevens Michael P , Vaezi Liza , Tamma Pranita D
Published: October 2021

Background

Guidance on the recommended durations of antibiotic therapy, the use of oral antibiotic therapy, and the need for repeat blood cultures remain incomplete for gram-negative bloodstream infections. We convened a panel of infectious diseases specialists to develop a consensus definition of uncomplicated gram-negative bloodstream infections to assist clinicians with management decisions.

Methods

Panelists, who were all blinded to the identity of other members of the panel, used a modified Delphi technique to develop a list of statements describing preferred management approaches for uncomplicated gram-negative bloodstream infections. Panelists provided level of agreement and feedback on consensus statements generated and refined them from the first round of open-ended questions through 3 subsequent rounds.

Results

Thirteen infectious diseases specialists (7 physicians and 6 pharmacists) from across the United States participated in the consensus process. A definition of uncomplicated gram-negative bloodstream infection was developed. Considerations cited by panelists in determining if a bloodstream infection was uncomplicated included host immune status, response to therapy, organism identified, source of the bacteremia, and source control measures. For patients meeting this definition, panelists largely agreed that a duration of therapy of ~7 days, transitioning to oral antibiotic therapy, and forgoing repeat blood cultures, was reasonable.

Conclusions

In the absence of professional guidelines for the management of uncomplicated gram-negative bloodstream infections, the consensus statements developed by a panel of infectious diseases specialists can provide guidance to practitioners for a common clinical scenario.
Credit policy and the ‘debt shift’ in advanced economies
Authors: Bezemer Dirk , Ryan-Collins Josh , van Lerven Frank , Zhang Lu
Published: October 2021

The decline in the share of bank credit to non-financial firms since the 1990s, relative to credit for real estate and financial asset markets, has raised concerns over economic growth and financial stability and sparked renewed interest in credit policies, instruments and institutions. We examine their theoretical case and post-war use, and trace their demise during the wider market-oriented policy reconfiguration from the 1980s. Notably, this included home ownership polices favouring mortgage markets. We then examine the empirical relationship between credit policy and credit allocation in the 1973–2005 period for 17 advanced economies. Taking account of co-integration, we present evidence that the decline of credit policies is significantly associated with a lower share of lending to non-financial firms. It may be worth revisiting the potential of credit policies to support adequate financing for goals such as innovation, industrial development and the transition to a low-carbon economy.
Reducing Stress and Increasing Mindfulness in Nursing Students: An Online Mindfulness Intervention Study
Authors: Garmaise-Yee Joy S. , LeBlanc Raeann G.
Published: October 2021

This pilot study evaluated the outcomes of stress and mindfulness among a convenience sample (n = 60) of nursing students. Students participated in an online mindfulness-based intervention and completed the Perceived Stress Scale and the Five Facet Mindfulness Questionnaire. Although mean stress scores lowered, there was no statistically significant reduction in stress. There were significant increases in mindfulness scores (posttest, p = .000) that were sustained at four-week follow-up (p = .012). Larger increases in mindfulness were associated with larger decreases in stress.
Simulation to Develop Teaching Competencies in Health Professions Educators: A Scoping Review
Authors: Monsivais Diane B. , Nunez Franchesca
Published: October 2021

AIM

The aim of this study was to determine what is known about using simulation as an intervention to develop teaching competencies in health professions educators.

BACKGROUND

No reviews are available that integrate the body of evidence about simulation to develop role competency in clinical educators.

METHOD

Scoping review methodology was used to identify interventions that used simulation to develop teaching competencies for health professions educators.

RESULTS

Thirteen articles met inclusion criteria. Simulation contexts were academic settings, either as a single activity or being embedded in larger curriculum. Backgrounds were tied to specific objectives related to faculty role expectations. Facilitator and educational strategies varied from loosely to highly structured. Outcomes were primarily posteducational self-assessments.

CONCLUSION

Simulation to develop teaching competencies is a promising strategy and an important area of future research for nursing education.
Patient and Spine Surgeon Perceptions on Shared Decision-Making in the Treatment of Older Adults Undergoing Corrective Surgery for Adult Spinal Deformity
Authors: Deme Palvasha , Perera Anjali , Chilakapati Sai , Stutzman Sonja , Singh Ravinderjit , Eldridge Cody M. , Caruso James , Vira Shaleen , Aoun Salah G. , Makris Una E. , Bagley Carlos A. , Adogwa Owoicho
Published: October 2021

Study Design.

Retrospective.

Objective.

To understand patients’ and spine surgeons’ perspectives about decision-making around surgery for adult spinal deformity.

Summary of Background Data.

Surgery for correction of adult spinal deformity is often beneficial; however, in over 20% of older adults (≥ 65 yrs of age), outcomes from surgery are less desirable.

Materials and Methods.

We conducted semistructured, in-depth interviews with six patients and five spine surgeons. Two investigators independently coded the transcripts using constant comparative method, as well as an integrative, team-based approach to identify themes.

Results.

Patients themes: 1) patients felt surgery was their only choice because they were running out of time to undergo invasive procedures; 2) patients mentally committed to surgery prior to the initial encounter with their surgeon and contextualized the desired benefits while minimizing the potential risks; 3) patients felt that the current decision support tools were ineffective in preparing them for surgery; and 4) patients felt that pain management was the most difficult part of recovery from surgery. Surgeons themes: 1) surgeons varied substantially in their interpretations of shared decision-making; 2) surgeons did not consider patients’ chronological age as a major contraindication to undergoing surgery; 3) there is a goal mismatch between patients and surgeons in the desired outcomes from surgery, where patients prioritize complete pain relief whereas surgeons prioritize concrete functional improvement; and 4) surgeons felt that patient expectations from surgery were often established prior to their initial surgery visit, and frequently required recalibration.

Conclusion.

Older adult patients viewed the decision to have surgery as time-sensitive, whereas spine surgeons expressed the need for recalibrating patient expectations and balancing the risks and benefits when considering surgery. These findings highlight the need for improved understanding of both sides of shared decision-making which should involve the needs and priorities of older adults to help convey patient-specific risks and choice awareness.

Level of Evidence.

3
PREOPERATIVE GAS FOR PARS PLANA VITRECTOMY: A SURGICAL TECHNIQUE FOR REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENTS WITH MULTIPLE, LARGE, OR INFERIOR BREAKS
Authors: Felfeli Tina , Mandelcorn Mark S. , Trussart Rachel , Mandelcorn Efrem D.
Published: October 2021

Purpose:

To describe the role of preoperative gas for pars plana vitrectomy (PGP) as an adjunct to surgical repair of rhegmatogenous retinal detachment (RRD).

Methods:

This is a retrospective consecutive case series of all rhegmatogenous retinal detachments with multiple breaks in more than one quadrant, large breaks extending greater than one clock hour, and/or inferior breaks requiring PPV, who received intravitreal injection of sulfur hexafluoride (SF6) or perfluoropropane (C3F8) 1–2 weeks before PPV between 2016 and 2020 at a tertiary care center.

Results:

A total of 109 eyes underwent the PGP technique, 73% of which had macular involvement. The rhegmatogenous retinal detachments on average involved 5.5 (SD 2.1) clock hours with inferior retinal breaks in 51%. Based on clinical examination, subretinal fluid was noted to be dissipated in parts of the detached retina before PPV in 57% of cases. The use of perfluorocarbon heavy liquid or posterior drainage retinotomy was required in 16% of cases. A 95% primary anatomical success rate was achieved over the median 177 (interquartile range 105–526) follow-up days. A final visual acuity of 20/50 or better was achieved in 65%.

Conclusion:

PGP as an adjunct to PPV may facilitate ease of surgery, as well as anatomical and functional success for rhegmatogenous retinal detachments with multiple, large, and/or inferior breaks.
CALRETICULIN MUTATION ASSOCIATED WITH BILATERAL CENTRAL RETINAL VEIN OCCLUSION IN A YOUNG WOMAN
Authors: Kabanovski Anna , Donaldson Laura , Koushan Keyvan , Margolin Edward
Published: October 2021

Background:

Bilateral central retinal vein occlusion (CRVO) is rare and is usually associated with an underlying systemic illness such as hypercoagulable state or systemic inflammatory disease. We present a case of bilateral CRVO in a young patent who was found to have a mutation in the calreticulin gene, which was presumed to be the culprit.

Methods:

Case report.

Results:

We report a 24-year-old woman with bilateral CRVO. Hypercoagulability work-up was positive for in-frame deletion in exon 9 of the calreticulin gene.

Conclusion:

We suggest that all young patients presenting with CRVO or any patient with bilateral CRVO have genetic testing for a limited set of known, prothrombotic mutations including the recently identified calreticulin gene.
HYPERREFLECTIVE FOCI PRECEDE MACULAR NEOVASCULARIZATION FORMATION IN ANGIOID STREAKS
Authors: Arrigo Alessandro , Antropoli Alessio , Bianco Lorenzo , Rosolia Andrea , Vuturo Alessia , Bandello Francesco , Battaglia Parodi Maurizio
Published: October 2021

Purpose:

To describe the steps leading to the development and progression of macular neovascularization (MNV) in angioid streaks.

Methods:

The study was designed as retrospective, longitudinal case series. Patients with angioid streaks were investigated by means of multimodal imaging, including fundus autofluorescence and structural optical coherence tomography. Main outcome measures were hyperreflective foci and MNV progression steps.

Results:

Overall, 40 eyes (20 patients) affected by angioid streaks were evaluated. Over the follow-up, five eyes of five patients developed MNV. The mean follow-up was of 1.6 years. The mean number of anti–vascular endothelial growth factor injections was 4.35 ± 1.4. Mean best-corrected visual acuity was 0.53 ± 0.38 LogMAR at the MNV onset, improving to 0.42 ± 0.40 LogMAR at the end of the follow-up (P > 0.05). Intraretinal hyperreflective foci onset and coalescence represented the first alterations occurring before the onset of the MNV. Anti–vascular endothelial growth factor treatment was associated with exudation relapsing and remitting, with still present intraretinal hyperreflective foci and pigment accumulation. The longitudinal analysis of our cohort of eyes outlined the event timeline: 1.2 months to find concentrated hyperreflective foci, 4.5 months to observe pigment organization through the outer nuclear layer, and 1.5 years to detect MNV.

Conclusion:

Hyperreflective foci formation, concentration, and migration represent early alterations occurring before the onset of the MNV in angioid streaks.
Extensive Sclerosis (“mummification”) in Lacrimal Gland Pleomorphic Adenoma May Indicate Neighboring Malignant Transformation
Authors: Vahdani Kaveh , Luthert Philip J. , Verity David H. , Rose Geoffrey E.
Published: October 2021

Salivary gland pleomorphic adenomas not uncommonly show extensive sclerosis (“dense hyalinization,” “coagulative necrosis,” or “mummification”), which arise spontaneously or after prior surgery, and this change is considered a high-risk factor for malignant transformation of benign salivary adenomas. While minor hyalinization is common in lacrimal gland adenomas, massive sclerosis—where almost all (90% or more) of the tumor is replaced by an amorphous hyaline material—is extremely rare. Four patients (2 males) are described in whom, despite not having an acute inflammatory episode, their lacrimal gland tumor showed marked sclerotic necrosis within the majority of either the benign or malignant parts of the tumor. Three tumors had evidence of malignant change, 2 to adenocarcinoma, and 1 to mucoepidermoid carcinoma, but none of the malignant areas showed perineural or endovascular invasion. Extensive sclerosis in association with a lacrimal gland pleomorphic adenoma (LGPA) is rare (4/110 of the cases) and—as with salivary adenomas—appears to be associated with a high chance of associated malignant change. Both the surgeon and the histopathologist should regard extensive sclerotic necrosis as a harbinger for malignant change in association with benign pleomorphic adenomas of the lacrimal gland.
Corneal Neurotization via Dual Nerve Autografting
Authors: Charlson Emily Sarah , Pepper John Paul , Kossler Andrea Lora
Published: October 2021

Corneal neurotization is a fast-evolving surgical procedure for sensory reinnervation in neurotrophic keratopathy. After neurotization, prior reports document return of corneal sensation on average 8 months after surgery with 38 mm of sensation gain measured via cochet bonnet esthesiometer testing. Here, the authors describe a dual nerve grafting approach via simultaneous parallel sural nerve grafts from both the supratrochelar and supraorbital nerves to the affected contralateral cornea with return of sensation by postoperative week 11.
The Effect of Sleep Position Preference on Eyelid and Eyebrow Symmetry
Authors: Tran Charlene , Choi Dabin , Ko Audrey C. , Carter Keith D. , Shriver Erin M.
Published: October 2021

Purpose:

To investigate the relationship between sleep position preference and eyebrow and eyelid position and degree of upper eyelid dermatochalasis.

Methods:

A prospective study evaluating the impact of sleep position on facial asymmetry was conducted at an academic ophthalmology department. Eligibility criteria included the absence of periocular-altering trauma or surgery, contact lens use, or other periorbital disease processes. Patients reported their sleep position preference on a questionnaire. Standardized digital photographs of patients were obtained, and Image J software was used for measurements and converted into millimeters based on a standard corneal limbus-to-limbus ratio. Upper and lower eyelid position, upper eyelid dermatochalasis, and eyebrow position were assessed by the following image-derived measurements: marginal reflex distance 1 (iMRD1), marginal reflex distance 2 (iMRD2), tarsal platform show (iTPS), and central brow position (iBP). These results were compared with the patient reported sleep position preference to determine correlation.

Results:

Seventy-one patients were enrolled and reported the following sleep position preferences: 28 (right), 24 (left), 13 (both), and 6 (supine). Patients with a right- or left-sided preference demonstrated lower iMRD1 measurements for the preferred sleep side (p < 0.0004) with no other significant difference in periorbital measurements. A larger degree of upper eyelid height (iMRD1) asymmetry was observed among patients with a sleep side preference.

Conclusion:

Patients with a predominant sleep side preference demonstrate a significant increase in ipsilateral upper eyelid asymmetry and an inferior upper eyelid position on the sleep side. There were no differences noted in lower eyelid position, central eyebrow position, or amount of upper eyelid dermatochalasis.
Echographic Assessment of Extraocular Muscle Response to Teprotumumab
Authors: Tran Charlene , Pham Chau M. , Simmons Brittany A. , Warner Laura L. , Fuhrmeister Laura J. , Shriver Erin M.
Published: October 2021

Purpose:

To evaluate extraocular muscle response to teprotumumab using orbital echography in thyroid eye disease.

Methods:

This retrospective study included adult thyroid eye disease patients with pre- and post-teprotumumab orbital echography. Data collected included: age, Hertel measurements, clinical activity score, Gorman diplopia scores, ocular motility, and recti muscle diameters measured by echography. The patient’s more proptotic eye before treatment initiation was designated as the study orbit. Ocular motility was assessed by totaling the ductions in all 4 cardinal directions. Orbital echography was obtained pre- and post-treatment to assess response of extraocular muscle diameters.

Results:

Six patients with a mean age of 67 years were included. There was a mean improvement in proptosis of 4.3 mm in the study eye with 11/12 orbits showing improvement in globe position (p < 0.05). All patients had a decrease in clinical activity score with a mean reduction of 2.5. Four patients had an improvement in Gorman diplopia score. Ocular motility in the study orbits improved by a total mean of 26.9° (p < 0.05). Mean total extraocular muscle diameter was reduced from 27.4 to 23.4 mm (p < 0.001). On average, superior recti were largest pre- and post-treatment, followed by inferior, medial, then lateral recti. However, inferior recti showed the greatest reduction of 23% (p < 0.02).

Conclusions:

Orbital echography demonstrated extraocular muscle reduction in all patients after teprotumumab, correlating with improved clinical activity score, ocular motility, and proptosis. Orbital echography is a safe and cost-effective imaging alternative to monitor therapeutic response to teprotumumab.
Congenital Eyelid Imbrication and Floppy Eyelid Syndrome in a Patient With Cat Eye Syndrome
Authors: Kozlova Anna , DeMaria Lauren N. , Tran Ann Q. , North Victoria S. , Belinsky Irina
Published: October 2021

A newborn male with cat eye syndrome presented with progressively worsening bilateral upper eyelid imbrication, floppy eyelids, and ptosis. Despite conservative management, he remained unable to open his eyelids. Surgical correction was planned to prevent bilateral sensory deprivation amblyopia and was delayed until 5 months of age due to systemic health concerns. Bilateral full-thickness wedge excision and frontalis suspension with silicone rods in a double rhomboid fashion was performed. Postoperatively, the patient demonstrated spontaneous eyelid opening, resolution of spastic eversion of the upper eyelids, and adequate eyelid closure. The authors present the first case of concurrent floppy eyelid syndrome and upper eyelid imbrication reported in a cat eye syndrome patient.
Pediatric Subcutaneous Panniculitis-like T-cell Lymphoma of the Orbit
Authors: Tong Jessica Y. , Powys Madeleine , Phan Tracey , Krivanek Michael , Kellie Stewart J. , Tumuluri Krishna
Published: October 2021

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare and distinct subtype of peripheral T-cell lymphoma, representing <1% of all non-Hodgkin lymphomas. SPTCL usually arises in the fourth decade of life with multifocal involvement of the limbs and trunk. Orbital disease is uncommon. We present the youngest known case of orbital SPTCL in a 3-year-old child, where the diagnosis was initially confounded by a lower eyelid mass masquerading as preseptal cellulitis. MRI revealed a poorly defined anterior orbital mass. Immunophenotyping and histological analysis of an orbital biopsy specimen confirmed SPTCL, which was managed by the pediatric oncology team with multiagent chemotherapy. This case is unique due to the young age of presentation and primary orbital involvement. Nonresolving or atypical periorbital cellulitis needs to be investigated, as malignancy can mimic such conditions.
Congenital Nasolacrimal Duct Obstruction Update Study (CUP Study): Paper 4—Infantile Acute Dacryocystitis (InAD)—Presentation, Management, and Outcomes
Authors: Bothra Nandini , Ali Mohammad Javed
Published: October 2021

Purpose:

To study the presentation, management, and outcomes of infantile acute dacryocystitis.

Methods:

Retrospective study of infants diagnosed with acute dacryocystitis over a period from June 2016 to December 2019. Data collected include demographics, clinical history, presenting features, management, complications, and outcomes. Treatment provided was intensive medical care followed by early probing under endoscopic guidance. Further interventions, where needed, were performed based on intraoperative findings during probing. Successful outcomes were defined as resolution of infection, subjective relief from epiphora, and anatomical patency determined by a normal fluorescein dye disappearance test.

Results:

Twenty-seven eyes of 27 infants were analyzed during the study period. The mean age of infants was 3.26 months, and males were more affected than females (male:female 15:12). The mean duration of symptoms was 4.66 weeks, with 96% (26/27) presenting with symptoms of redness, watering, discharge, and swelling. Preseptal cellulitis was seen in 74% (20/27) infants, lacrimal abscess in 67% (18/27) infants, and lacrimal fistula in 37% (10/27). Most infants had complex congenital nasolacrimal duct obstruction (62%, 13/27), of which 7 also had intranasal cysts. One infant successfully underwent endoscopic dacryocystorhinostomy. At a mean follow-up period of 7.95 months, successful outcomes were observed in 90.4% (19/21) infants. The 2 failed cases were complex congenital nasolacrimal duct obstruction with associated sac diverticula and are scheduled for an endoscopic dacryocystorhinostomy.

Conclusion:

Infantile acute dacryocystitis is a distinct clinical entity. The outcomes of systemic antibiotics and early probing are excellent.
Rifle Blast Exacerbating Hearing Loss in a Patient Treated With Teprotumumab for Thyroid Eye Disease
Authors: Reed Donovan S. , Kostosky Nicole , Davies Brett W. , Epstein Aliza , Durairaj Vikram D.
Published: October 2021

Teprotumumab is a promising new immunomodulatory therapy for thyroid eye disease. One unique adverse effect observed in clinical trials was hearing impairment; however, all adverse auditory effects in prior clinical trials resolved spontaneously after completion of teprotumumab therapy. The authors present a case of a patient on teprotumumab for thyroid eye disease who experienced sustained hearing loss secondary to shooting a rifle without ear protection. In this case, it is suspected the teprotumumab infusions resulted in increased susceptibility of the inner ear hair cells to noise-induced trauma secondary to IGF-IR inhibition. Specific ear protection protocols may need to be implemented in the future for patients on teprotumumab therapy to prevent sustained hearing loss, especially for susceptible patient populations.
A policy analysis of nurse practitioner scope of practice in Massachusetts
Authors: Cuccovia Barbara Ann , Heelan-Fancher Lisa , Aronowitz Teri
Published: October 2021

Nurse practitioner (NP) practice has evolved since inception of the role in 1965. Educational requirements have been standardized requiring a master's degree, yet variation in NPs scope of practice exists across the United States. As the population ages and more Americans have health insurance coverage, the demand for health care continues to increase. Shortages of clinical providers and changes in hospital models of care continue to burden the health care system. Nurse practitioners have been found to provide safe, high-quality patient care and are a potential solution to ease the burden on our health care system. Nurse practitioner scope of practice restrictions limit the ability for NPs to practice independently. The purpose of this article was to analyze the advanced practice registered nurse's (APRNs) scope of practice policy in Massachusetts (MA) where APRNs just recently obtained full practice authority. Legislation to remove NP scope of practice restrictions in MA had been presented several times but was met with resistance from physician advocacy groups stating that NPs lack the education requirements to practice independently. A recent report from the MA Health Policy Commission demonstrates the impact that NPs have on lowering health care costs and servicing individuals in underserved areas of the state. During the pandemic, restrictions on NP scope of practice in MA were temporarily removed. It was realized that if NPs can practice independently during a pandemic, then they certainly are competent to practice independently at other times. A reassessment of NP scope of practice to allow for full authority should be completed nationally.
Precision medicine in chronic obstructive pulmonary disease: how far have we come?
Authors: Khan Malik M. Khurram S. , Cole Adam G. , Mannino David M.
Published: October 2021

Purpose of review

In this review, we will discuss the current status and recent developments in precision medicine in chronic obstructive pulmonary disease (COPD) through the lens of treatable traits.

Recent findings

Although the term ‘treatable traits’ in the treatment of COPD is relatively recent, this concept has been used for many years if one considers interventions such as long-term oxygen therapy or alpha-1 antitrypsin replacement therapy. Recent advances have included expanding the definition of COPD to include a broader population of people with lower respiratory disease but not meeting the strict criteria for obstruction, advances in imaging to aid in the diagnosis and treatment of COPD, advances in understanding symptoms and exacerbations to define severity, using biomarkers to guide therapy and better understanding and addressing polymorbidity and frailty. In addition, there is a concerted effort to use these concepts to identify COPD patients earlier in the disease process wherein disease modification may be possible.

Focusing on subsets of patients with COPD with certain characteristics should lead to better outcomes and fewer adverse effects from treatment.

Video abstract

http://links.lww.com/COPM/A30.
By wind or wing: pollination syndromes and alternate bearing in horticultural systems
Authors: Garcia Gabriela , Re Bridget , Orians Colin , Crone Elizabeth
Published: October 2021

Cyclical fluctuations in reproductive output are widespread among perennial plants, from multi-year masting cycles in forest trees to alternate bearing in horticultural crops. In natural systems, ecological drivers such as climate and pollen limitation can result in synchrony among plants. Agricultural practices are generally assumed to outweigh ecological drivers that might synchronize alternate-bearing individuals, but this assumption has not been rigorously assessed and little is known about the role of pollen limitation as a driver of synchrony in alternate-bearing crops. We tested whether alternate-bearing perennial crops show signs of alternate bearing at a national scale and whether the magnitude of national-scale alternate bearing differs across pollination syndromes. We analysed the Food and Agriculture Organization of the United Nations time series (1961–2018) of national crop yields across the top-producing countries of 27 alternate-bearing taxa, 6 wind-pollinated and 21 insect-pollinated. Alternate bearing was common in these national data and more pronounced in wind-pollinated taxa, which exhibited a more negative lag-1 autocorrelation and a higher coefficient of variation (CV). We highlight the mutual benefits of integrating ecological theory and agricultural data for (i) advancing our understanding of perennial plant reproduction across time, space and taxa, and (ii) promoting stable farmer livelihoods and global food supply.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
Macroevolutionary consequences of mast seeding
Authors: Dale Esther E. , Foest Jessie J. , Hacket-Pain Andrew , Bogdziewicz Michał , Tanentzap Andrew J.
Published: October 2021

Masting characterizes large, intermittent and highly synchronous seeding events among individual plants and is found throughout the plant Tree of Life (ToL). Although masting can increase plant fitness, little is known about whether it results in evolutionary changes across entire clades, such as by promoting speciation or enhanced trait selection. Here, we tested if masting has macroevolutionary consequences by combining the largest existing dataset of population-level reproductive time series and time-calibrated phylogenetic tree of vascular plants. We found that the coefficient of variation (CVp) of reproductive output for 307 species covaried with evolutionary history, and more so within clades than expected by random. Speciation rates estimated at the species level were highest at intermediate values of CVpand regional-scale synchrony (Sr) in seed production, that is, there were unimodal correlations. There was no support for monotonic correlations between either CVpor Srand rates of speciation or seed size evolution. These results were robust to different sampling decisions, and we found little bias in our dataset compared with the wider plant ToL. While masting is often adaptive and encompasses a rich diversity of reproductive behaviours, we suggest it may have few consequences beyond the species level.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
An assessment of temporal variability in mast seeding of North American Pinaceae
Authors: LaMontagne Jalene M. , Redmond Miranda D. , Wion Andreas P. , Greene David F.
Published: October 2021

Our overall objective is to synthesize mast-seeding data on North American Pinaceae to detect characteristic features of reproduction (i.e. development cycle length, serotiny, dispersal agents), and test for patterns in temporal variation based on weather variables. We use a large dataset (n= 286 time series; mean length = 18.9 years) on crop sizes in four conifer genera (Abies,Picea,Pinus,Tsuga) collected between 1960 and 2014. Temporal variability in mast seeding (CVp) for 2 year genera (Abies,Picea,Tsuga) was higher than forPinus(3 year), and serotinous species had lower CVp than non-serotinous species; there were no relationships of CVp with elevation or latitude. There was no difference in family-wide CVp across four tree regions of North America. Across all genera, July temperature differences between bud initiation and the prior year (ΔT) was more strongly associated with reproduction than absolute temperature. Both CVp and ΔTremained steady over time, while absolute temperature increased by 0.09°C per decade. Our use of the ΔTmodel included a modification forPinus, which initiates cone primordia 2 years before seedfall, as opposed to 1 year. These findings have implications for how mast-seeding patterns may change with future increases in temperature, and the adaptive benefits of mast seeding.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
The effects of ENSO and the North American monsoon on mast seeding in two Rocky Mountain conifer species
Authors: Wion Andreas P. , Pearse Ian S. , Rodman Kyle C. , Veblen Thomas T. , Redmond Miranda D.
Published: October 2021

We aimed to disentangle the patterns of synchronous and variable cone production (i.e. masting) and its relationship to climate in two conifer species native to dry forests of western North America. We used cone abscission scars to reconstructca15 years of recent cone production inPinus edulisandPinus ponderosa, and used redundancy analysis to relate time series of annual cone production to climate indices describing the North American monsoon and the El Niño Southern Oscillation (ENSO). We show that the sensitivity to climate and resulting synchrony in cone production varies substantially between species. Cone production among populations ofP. eduliswas much more spatially synchronous and more closely related to large-scale modes of climate variability than among populations ofP. ponderosa. Large-scale synchrony inP. eduliscone production was associated with the North American monsoon and we identified a dipole pattern of regional cone production associated with ENSO phase. InP. ponderosa, these climate indices were not strongly associated with cone production, resulting in asynchronous masting patterns among populations. This study helps frame our understanding of mast seeding as a life-history strategy and has implications for our ability to forecast mast years in these species.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
Climate change and plant reproduction: trends and drivers of mast seeding change
Authors: Hacket-Pain Andrew , Bogdziewicz Michał
Published: October 2021

Climate change is reshaping global vegetation through its impacts on plant mortality, but recruitment creates the next generation of plants and will determine the structure and composition of future communities. Recruitment depends on mean seed production, but also on the interannual variability and among-plant synchrony in seed production, the phenomenon known as mast seeding. Thus, predicting the long-term response of global vegetation dynamics to climate change requires understanding the response of masting to changing climate. Recently, data and methods have become available allowing the first assessments of long-term changes in masting. Reviewing the literature, we evaluate evidence for a fingerprint of climate change on mast seeding and discuss the drivers and impacts of these changes. We divide our discussion into the main characteristics of mast seeding: interannual variation, synchrony, temporal autocorrelation and mast frequency. Data indicate that masting patterns are changing but the direction of that change varies, likely reflecting the diversity of proximate factors underlying masting across taxa. Experiments to understand the proximate mechanisms underlying masting, in combination with the analysis of long-term datasets, will enable us to understand this observed variability in the response of masting. This will allow us to predict future shifts in masting patterns, and consequently ecosystem impacts of climate change via its impacts on masting.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
Modes of climate variability bridge proximate and evolutionary mechanisms of masting
Authors: Ascoli Davide , Hacket-Pain Andrew , Pearse Ian S. , Vacchiano Giorgio , Corti Susanna , Davini Paolo
Published: October 2021

There is evidence that variable and synchronous reproduction in seed plants (masting) correlates to modes of climate variability, e.g. El Niño Southern Oscillation and North Atlantic Oscillation. In this perspective, we explore the breadth of knowledge on how climate modes control reproduction in major masting species throughout Earth's biomes. We posit that intrinsic properties of climate modes (periodicity, persistence and trends) drive interannual and decadal variability of plant reproduction, as well as the spatial extent of its synchrony, aligning multiple proximate causes of masting through space and time. Moreover, climate modes force lagged but in-phase ecological processes that interact synergistically with multiple stages of plant reproductive cycles. This sets up adaptive benefits by increasing offspring fitness through either economies of scale or environmental prediction. Community-wide links between climate modes and masting across plant taxa suggest an evolutionary role of climate variability. We argue that climate modes may ‘bridge’ proximate and ultimate causes of masting selecting for variable and synchronous reproduction. The future of such interaction is uncertain: processes that improve reproductive fitness may remain coupled with climate modes even under changing climates, but chances are that abrupt global warming will affect Earth's climate modes so rapidly as to alter ecological and evolutionary links.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
Fire history and weather interact to determine extent and synchrony of mast-seeding in rhizomatous scrub oaks of Florida
Authors: Pesendorfer Mario B. , Bowman Reed , Gratzer Georg , Pruett Shane , Tringali Angela , Fitzpatrick John W.
Published: October 2021

In disturbance-prone ecosystems, fitness consequences of plant reproductive strategies are often determined by the relative timing of seed production and disturbance events, but the role of disturbances as proximate drivers of seed production has been overlooked. We use long-term data on seed production in
Quercus chapmanii
,
Q. geminata
and
Q. inopina
, rhizomatous oaks found in south central Florida's oak scrub, to investigate the role of fire history and its interaction with weather in shaping acorn production and its synchrony
.
Acorn production increased with the time since last fire, combined with additive or interactive effects of spring precipitation (+) or drought (–). Furthermore, multiple matrix regression models revealed that ramet pairs with shared fire history were more synchronous in seed production than ones that burned in different years. Long-term trends suggest that increasingly drier spring weather, in interaction with fire frequency, may drive a decline of seed production. Such declines could affect the community of acorn-reliant vertebrates in the Florida scrub, including endangered Florida scrub-jays (
Aphelocoma coerulescens
). These results illustrate that fire can function as a proximate driver of seed production in mast-seeding species, highlighting the increasingly recognized importance of interactions among reproductive strategies and disturbance regimes in structuring plant populations and communities.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
Natural disturbances and masting: from mechanisms to fitness consequences
Authors: Vacchiano Giorgio , Pesendorfer Mario B. , Conedera Marco , Gratzer Georg , Rossi Lorenzo , Ascoli Davide
Published: October 2021

The timing of seed production and release is highly relevant for successful plant reproduction. Ecological disturbances, if synchronized with reproductive effort, can increase the chances of seeds and seedlings to germinate and establish. This can be especially true under variable and synchronous seed production (masting). Several observational studies have reported worldwide evidence for co-occurrence of disturbances and seed bumper crops in forests. Here, we review the evidence for interaction between disturbances and masting in global plant communities; we highlight feedbacks between these two ecological processes and posit an evolutionary pathway leading to the selection of traits that allow trees to synchronize seed crops with disturbances. Finally, we highlight relevant questions to be tested on the functional and evolutionary relationship between disturbances and masting.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
Delayed fertilization facilitates flowering time diversity in Fagaceae
Authors: Satake Akiko , Kelly Dave
Published: October 2021

Fagaceae includes typical masting species that exhibit highly synchronized and fluctuating acorn production. Fagaceae shows an interesting feature in that fertilization is delayed by several weeks to more than 1 year after pollination. Although delayed fertilization was recorded over a century ago, the evolutionary advantage of delayed fertilization is still poorly understood. Here, we present a new hypothesis that delayed fertilization facilitates temporal niche differentiation via non-overlapping flowering times among species. Comparing flowering and fruiting times in 228 species from five genera in Fagaceae, we first show that there is a close association between a wider spread of flowering times and the likelihood of a 2-year fruiting habit in which there is a long delay from pollination to fertilization. To study the coevolution of flowering time and delayed fertilization, we developed a mathematical model that incorporates the effects of competition for pollinators, seed predator satiation and unfavourable season for reproduction on fitness. The model shows that delayed fertilization facilitates the diversification of flowering time in a population, which is advantageous for animal-pollinated trees that compete over pollinators. Our new hypothesis about the coevolution of delayed fertilization and flowering time will provide new insight into the evolution of masting.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
Studying the genetic basis of masting
Authors: Satake Akiko , Kelly Dave
Published: October 2021

The mechanisms underlying mast seeding have traditionally been studied by collecting long-term observational data on seed crops and correlating seedfall with environmental variables. Significant progress in ecological genomics will improve our understanding of the evolution of masting by clarifying the genetic basis of masting traits and the role of natural selection in shaping those traits. Here, we summarize three important aspects in studying the evolution of masting at the genetic level: which traits govern masting, whether those traits are genetically regulated, and which taxa show wide variation in these traits. We then introduce recent studies on the molecular mechanisms of masting. Those studies measure seasonal changes in gene expression in natural conditions to quantify how multiple environmental factors combine to regulate floral initiation, which in many masting plant species is the single largest contributor to among-year variation in seed crops. We show that Fagaceae offers exceptional opportunities for evolutionary investigations because of its diversity at both the phenotypic and genetic levels and existing documented genome sequences.

This article is part of the theme issue ‘The ecology and evolution of synchronized seed production in plants’.
‘I had no life. I was only existing’. Factors shaping the mental health and wellbeing of people experiencing long Covid: a qualitative study
Authors: Burton Alexandra , Aughterson Henry , Fancourt Daisy , Philip Keir EJ
Published: October 2021

Background

Around one in 10 people who have COVID-19 report persistent symptoms or ‘long Covid’. Impaired mental health and wellbeing is commonly reported including anxiety, depression and reduced quality of life. There is however, limited in-depth research exploring why mental health and wellbeing have been impacted among people experiencing long Covid.

Aims

To explore factors impacting mental health and wellbeing, from the perspective of people with long Covid.

Method

Semi-structured qualitative interviews that were audio-recorded and transcribed. Data were analysed using reflexive thematic analysis. 21 people with long Covid participated in the study. Participants were eligible to take part if they self-reported a positive swab test/antibody test, or one or more commonly reported COVID-19 symptoms at illness onset and experiences of one or more long Covid symptom three or more weeks following illness onset.

Results

Five themes were identified across participant accounts regarding factors impacting mental health and wellbeing including i) experiences of care and understanding from others; ii) lack of service and treatment options; iii) severe disruption to daily life iv) uncertainty of illness trajectories and v) changes to identity.

Conclusions

People with long Covid experience a range of factors that negatively impact their mental health and wellbeing. Providing patient centred health services that integrate the rapidly evolving research in this area is important, as are peer support groups and supported approaches to self-management.