bluuebunny/crossref_metadata_2025 huggingface dataset:
A273 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN A TERTIARY CANADIAN HOSPITAL: OPTIMIZING TISSUE SAMPLING TECHNIQUES
Authors: Taylor S A , Bak A W , Lin T , Jowhari F , Savard M , Parker B , Dick J , Perini R
Published: February 2020

Background

Pancreatic and biliary cancer can be difficult to definitively diagnose, and tissue diagnosis defines clinical management in both early and late disease. The majority of patients with pancreaticobiliary malignancy present with late disease and only 30% have resectable tumours, contributing to poor prognosis and outcome. Endoscopic retrograde cholangiopancreatography (ERCP) is a mainstay for diagnosing and treating conditions of the bile and pancreatic duct.

Aims

This study aimed to provide data on the diagnostic performance of ERCP utilizing conventional methods for tissue acquisition particularly in the setting of an indeterminate stricture. In particular, this was a quality assurance review to determine our centre’s baseline performance as a reference so new methods of tissue acquisition such as SpyglassTM can be benchmarked against.

Methods

In a tertiary care hospital, 3723 ERCP procedures were performed between 2013 and 2017. Demographic and clinical information was retrospectively collected. Demographic and clinical information was collected. Three ERCP techniques of tissue sampling were analyzed: brushing alone (BiA), biopsy alone (BrA), and brushing and biopsy dual-modality approach (BrBi). The diagnostic performances (sensitivity, specificity, and accuracy) were calculated with data from post-sampling clinical reports, surgical pathological reports, and diagnostic imaging reports.

Results

222 patients (285 ERCP procedure) met the study criteria and received fluoroscopy-guided ERCP sampling with cytology brushing and/or tissue biopsies. 36 (13%) patients had BiA, 85 (29%) patients had BrA, and 164 (58%) patients had BrBi. The sensitivities, specificities, and accuracies of the three sampling techniques respectively were: 56%, 93%, and 85% for BiA; 73%, 96%, and 83% for BrA; and 79%, 94%, and 86% for BrBi.

Conclusions

Our retrospective analysis of fluoroscopic-guided tissue acquisition shows accuracy as high as current published data on direct visualization cholangiosopy guided techniques. A prospective study looking not only at clinical yield but a cost analysis should be put in place prior to a commitment to purchase new equipment such as the SpyglassTM.

Funding Agencies

None
Dementia Care
Authors: Kaplan Daniel B.
Published: February 2020

Social workers occupy positions in a broad array of practice settings. They utilize a range of practice skills to effect positive change and growth to address social problems and this work is done in partnership with individuals, couples, families, groups, and communities. Their work is informed by a unique set of values which balance competent service and integrity with a deep commitment to social justice, upholding the dignity and worth of each person, and celebrating the importance of human relationships. Neurocognitive disorder, or dementia, is a syndrome creating devastation in nearly every domain of human existence for those afflicted, with serious negative impacts which reverberate through families, communities, and society. As such, dementia should be understood as a bio-psycho-social-environmental phenomenon. The overall purpose of this entry is to prepare readers for effective practice with diverse individuals with dementia and their families from across practice settings. In order to understand and to respond effectively to the needs of their clients, social workers must appreciate the complex interactions of disease pathology, individual strengths, environmental conditions, informal supports, formal resources, and societal influences. For those social workers who serve people living with dementia, a comprehensive knowledge of dementia causes, symptoms, progressive prognosis, assessment and care techniques, and biopsychosocial-environmental considerations is an essential complement to the social work practice knowledge base. They must be able to identify the most appropriate, evidence-informed intervention options for clients throughout the unpredictable stages of dementia, as well as the benefits and limitations of the full array of formal support systems. This bibliography entry is organized into lists of essential texts and articles on social work practice skills and principles of dementia care, formal care services and family caregiving, effective and evidence-based interventions and communication techniques, safety assessment, stimulating activities, environmental considerations, and self-care and social support for the person with dementia. Many of the books and articles listed herein are written by the leading scholars in the area of dementia care, and any reader who is familiar with this area of practice is likely to recognize many of these authors’ names from the large body of literature which has informed dementia care for the past three decades.
John Trevisa
Authors: Twomey Michael
Published: February 2020

The English translator John Trevisa (b. c. 1342–d. 1402) was an exact contemporary of the poet Geoffrey Chaucer. As is the case with Chaucer, very little of Trevisa’s life can be reconstructed from extant documents. Like Chaucer, Trevisa observed social and political events but referred only obliquely to them, and like Chaucer he staked his legacy to a body of work in English only. If Chaucer’s achievement was to elevate English poetry to a status rivaling that of poetry in Latin, Italian, and French, Trevisa’s was to prove English prose capable of conveying nuanced theological, political, and historical arguments. Trevisa’s known translations are of the apocryphal Gospel of Nicodemus; the Dialogus inter militem et clericum (“Dialogue between a knight and a cleric”), a defense of temporal power; Archbishop Richard FitzRalph’s antifraternal sermon, Defensio curatorum (“Defense of secular priests”); Aegidius Romanus’s De regimine principum (“On the rule of princes”); Ranulph Higden’s universal history, Polychronicon; and Bartholomaeus Anglicus’s encyclopedia, De proprietatibus rerum (“On the properties of things”). Early modern antiquarians believed that Trevisa translated the Bible into English, but hard evidence is lacking (see under Trevisa, the Bible, and the Wycliffite Movement). Under his own name, Trevisa wrote a Dialogue between a Lord and a Clerk on Translation and an Epistle to Lord Berkeley upon Translation as prefaces to his translation of the Polychronicon. He also composed one original poem, with which he prefaced his translation of Bartholomaeus Anglicus. No longer attributed to Trevisa are the Middle English version of the Revelationes of Pseudo-Methodius, a translation of Vegetius’s De re militari that accompanies De regimine principum in its sole manuscript witness, and Apocalypse texts in Anglo-Norman French painted on the ceiling and walls of Berkeley Chapel, Gloucestershire, England.
Early Italian Humanists
Authors: Maxson Brian
Published: February 2020

Early Italian humanists already were pursuing many of the innovations and themes characteristic of their better-known counterparts of the 15th and 16th centuries. Decades before the traditional “father of humanism” Francesco Petrarca (Petrarch), writers such as Lovato dei Lovati and Albertino Mussato were fascinated by the study, emulation, and critical assessment of the classical world. Sparked by the needs of the urban societies of the 13th-century Italian Peninsula, Lovato dei Lovati turned toward Antiquity for stylistic models to follow. From his more localized influence, the numbers of early humanists expanded, especially in Padua and Verona. By the early trecento at the latest their writings were generating acclaim across the Veneto, as evidenced by the coronation with the poet’s laurel of Albertino Mussato in Padua in 1315. Works of poetry, history, drama, and others flowed from their pens, even as many of their writings are no longer extant. These late duecento and early trecento figures differed from later writers in several important ways, even as they established a foundation and context for later, better known humanists like Petrarch, Coluccio Salutati, and Leonardo Bruni. Early Italian humanists, for example, made some important manuscript discoveries. They read and critically assessed new and familiar classical works. They tried to emulate the style of classical works in their original writings. However, key differences remained between these early humanists and their later counterparts. Unlike 15th-century humanists, early Italian humanists lacked knowledge of Greek and, thus, were limited to classical writings available in Latin. Philological developments by early Italian humanists were rudimentary, and most manuscript discoveries were to come only later. Humanists in the 15th century mostly rejected these earlier writers as part of their movement’s history. Much of the 20th-century scholarship argues for the inclusion of these writers within the humanist canon and assesses the innovations of early Italian humanists in relation to the work of Petrarch or later writers. More recent work has turned to analyzing their lives and writings on their own terms and publishing new editions of texts.
Non-Renewable Resource Depletion and Use
Authors: Jowitt Simon M.
Published: February 2020

Modern society relies on an increasing number of minerals and metals, meaning that over time production of these commodities has significantly increased, especially within the last fifty years. However, metals and minerals are dominantly produced from ore or mineral deposits that are inherently non-renewable as the geological processes that form these resources (and if necessary exhume them to nearer surface environments where they can be exploited) occur at much slower rates (often over thousands or millions of years) than they are being consumed. This at a basic level indicates that at some point we will “run out” of these non-renewable resources. Although this may be true on a very long timescale, this simple view does not take into account a number of different factors, such as changes in the types, sizes, and grades of mineral deposits that are being exploited. Past changes in the mineral and mining sectors have led to a global increase in mineral and metal production throughout the 20th and 21st centuries that has been (more than) matched by an increase in global mineral and metal resources and reserves. This increase in the amount of material available for exploitation has reflected the decreasing cost of mining and energy, the development of new mining and mineral processing technologies, continued exploration success that has led to the discovery of new resources and reserves, and increasing demand, which in real terms has increased the prices of the majority of commodities. However, the potential lifespan of these historic patterns remains unclear, especially given that mineral resources are finite and other aspects that influence metal and mineral production, such as energy costs and environmental and social issues, are becoming increasingly important. This has led to recent concerns focused on a variety of metals and minerals considered to be at potential supply risk, including base metals such as zinc as well as a the so-called critical metals; metals that are associated with supply risk as a result of their concentration of supply, political instability in source countries, or production (and hence reliance) as by-products to primary metals such as Cu or Zn. These risks are compounded by the fact that these critical metals and minerals are essential for numerous often advanced technologies as well as defense and energy production requirements. This review focuses on the key considerations in estimating metal and mineral resources, aspects that need to be considered when estimating current resources and reserves and determining whether we can meet current and future demand. The dynamic nature of global metal and mineral resources means that an in-depth analysis of these data is not within the scope of this review, although the references provided form a comprehensive bibliography for this topic.
NAGPRA and Repatriation of Native American Human Remains and Cultural Objects
Authors: Thornton Russell , Vela Jamie Geronimo
Published: February 2020

Hundreds of thousands—some say 1 million—Native American skeletal remains are held in institutions around the world. Probably half are in the United States. How many tribal objects are held is unknown, but the number is in the many millions. Hundreds of remains and thousands of objects are uncovered every year in the United States, mostly by construction projects. That Native American tribes and individuals have been disenfranchised from ancestral remains and important tribal objects is a terrible facet of American history; it is also of great discomfort to Native Americans. The situation is exacerbated as some remains and objects are from atrocities in American Indian history, e.g., the 1890 Wounded Knee and 1864 Sand Creek Massacres. Many objects are symbolic and sacred, necessary in Native American ceremonies and rituals. On occasion, repatriation requests were granted by museums; but Native Americans were virtually at their mercy. Native Americans lobbied for the eventual passage of two federal laws preventing further disenfranchisement from remains and objects, and requiring their repatriation. In 1990, the Native American Graves Protection and Repatriation Act (NAGPRA) was passed. It provided legal protection to Native American and Native Hawaiian graves. It also mandated repatriations to lineal descendants or federally recognized tribes of culturally affiliated human remains, funerary objects (objects associated with burials), objects of cultural patrimony, and sacred objects held in institutions receiving federal funding. A year earlier, the National Museum of the American Indian (NMAI) Act of 1989 had passed. It called for only the return of human remains and funerary objects held at the Smithsonian. (Given this act, the Smithsonian was excluded from NAGPRA; the NMAI Act was amended in 1996 to include objects of cultural patrimony and sacred objects.) State laws at this time were limited in scope or not applicable, and mostly referred to burials. The most well-known are Iowa’s Burial Protection Act of 1976, and Nebraska’s Unmarked Human Burial Site and Skeletal Remains Protection Act of 1989. Subsequent to NAGPRA, repatriation state laws were enacted, e.g., California developed a law along the lines of NAGPRA. Most relevant institutions now have created repatriation policies in line with, and sometimes going beyond, NAGPRA and state laws. While causation is hard to ascertain, these developments—especially NAGPRA—have influenced international repatriation, either within or between countries. Too, international events have influenced the United States, and the United States has repatriated to other countries, and they to the United States.
Debbie Friedman
Authors: Cohen Judah M.
Published: February 2020

Song leader, composer, and liturgist Debbie Friedman (also Deborah Lynn Friedman, b. 1951–d. 2011) played a significant role in liberal American Jewish music circles over a career that began in the late 1960s, and ended with her premature death from pneumonia on 9 January 2011. Born in Utica, New York, Friedman grew up in St. Paul, Minnesota, where she premiered her service Sing Unto God in 1972 with the choir from her alma mater, Highland Park High School. In the era just before American Jewish seminaries accepted women into cantorial training programs, Friedman parlayed her work with youth groups and summer camps into broader professional opportunities. A season at the Olin-Sang-Ruby Union Institute, a Reform Jewish summer camp in Wisconsin, led to an artist-in-residence position at Chicago Sinai congregation (1972–1977). From there she moved on to positions as a youth group leader at Houston’s Congregation Beth Israel (1978–1984); cantor/soloist at The New Reform Congregation in southern California’s San Fernando Valley (1984–1987); and co-leader of monthly healing services on New York City’s Upper West Side in the 1990s and 2000s. In addition to an active concertizing career, Friedman recorded twenty-two albums, many of which comprised complete, multipart, religious rituals created in collaboration with progressive religious organizations. Although Friedman’s music has become ubiquitous in liberal Jewish settings around the world, scholarship has proceeded slowly due to ambivalence about Friedman’s lack of formal Jewish music training, perceptions of her “outsider” status related to Jewish institutional life, and concerns that the more popular style of her music symbolized spiritual shallowness—matters made more complicated by Friedman’s own repeated claims that she could not read sheet music. Even when New York’s Hebrew Union College School of Sacred Music hired Friedman to instruct its cantorial students in 2007, and when the school itself officially took Friedman’s name just after her death, due to a sizeable anonymous donation in her memory, concerns about her role as a representative of Jewish musical tradition persisted. Thus, most research on Friedman tends to focus on historical and social issues, while struggling to address her music on its own terms. The entries in this article consequently include a significant number of primary and journalistic sources useful for future scholarship.
An Evaluation of the Defined Observer Role in Simulation With Baccalaureate Nursing Students
Authors: Howard Sheri
Published: February 2020

The purpose of this study was to compare satisfaction, self-confidence, and engagement of baccalaureate nursing students using defined observer roles versus traditional observer role and to evaluate student perceptions of these constructs. A quasi-experimental comparative mixed-method design was utilized for the study with a convenience sample of 132 students. Data analysis indicates a statistically significant difference between overall scores for satisfaction, self-confidence, and engagement for defined observer roles (n = 67) versus traditional observer roles (n = 65). Students’ perceptions of satisfaction, self-confidence, and engagement were increased with the use of defined observer roles.
Reconstituted High-density Lipoprotein Therapy Improves Survival in Mouse Models of Sepsis
Authors: Tanaka Sébastien , Genève Claire , Zappella Nathalie , Yong-Sang Jennyfer , Planesse Cynthia , Louedec Liliane , Viranaïcken Wildriss , Bringart Matthieu , Montravers Philippe , Denamur Erick , Duranteau Jacques , Couret David , Meilhac Olivier
Published: February 2020

Background

High-density lipoproteins exert pleiotropic effects including antiinflammatory, antiapoptotic, and lipopolysaccharide-neutralizing properties. The authors assessed the effects of reconstituted high-density lipoproteins (CSL-111) intravenous injection in different models of sepsis.

Methods

Ten-week-old C57BL/6 mice were subjected to sepsis by cecal ligation and puncture or intraperitoneal injection of Escherichia coli or Pseudomonas aeruginosa pneumonia. CSL-111 or saline solution was administrated 2 h after the sepsis. Primary outcome was survival. Secondary outcomes were plasma cell-free DNA and cytokine concentrations, histology, bacterial count, and biodistribution.

Results

Compared with saline, CSL-111 improved survival in cecal ligation and puncture and intraperitoneal models (13 of 16 [81%] survival rate vs. 6 of 16 [38%] in the cecal ligation and puncture model; P = 0.011; 4 of 10 [40%] vs. 0 of 10 [0%] in the intraperitoneal model; P = 0.011). Cell-free DNA concentration was lower in CSL-111 relative to saline groups (68 [24 to 123] pg/ml vs. 351 [333 to 683] pg/ml; P < 0.001). Mice injected with CSL-111 presented a decreased bacterial count at 24 h after the cecal ligation and puncture model both in plasma (200 [28 to 2,302] vs. 2,500 [953 to 3,636] colony-forming unit/ml; P = 0.021) and in the liver (1,359 [360 to 1,648] vs. 1,808 [1,464 to 2,720] colony-forming unit/ml; P = 0.031). In the pneumonia model, fewer bacteria accumulated in liver and lung of the CSL-111 group. CSL-111–injected mice had also less lung inflammation versus saline mice (CD68+ to total cells ratio: saline, 0.24 [0.22 to 0.27]; CSL-111, 0.07 [0.01 to 0.09]; P < 0.01). In all models, no difference was found for cytokine concentration. 111Indium bacterial labeling underlined a potential hepatic bacterial clearance possibly promoted by high-density lipoprotein uptake.

Conclusions

CSL-111 infusion improved survival in different experimental mouse models of sepsis. It reduced inflammation in both plasma and organs and decreased bacterial count. These results emphasized the key role for high-density lipoproteins in endothelial and organ protection, but also in lipopolysaccharide/bacteria clearance. This suggests an opportunity to explore the therapeutic potential of high-density lipoproteins in septic conditions.

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Desflurane Anesthesia Alters Cortical Layer–specific Hierarchical Interactions in Rat Cerebral Cortex
Authors: Hudetz Anthony G. , Pillay Siveshigan , Wang Shiyong , Lee Heonsoo
Published: February 2020

Background

Neurocognitive investigations suggest that conscious sensory perception depends on recurrent neuronal interactions among sensory, parietal, and frontal cortical regions, which are suppressed by general anesthetics. The purpose of this work was to investigate if local interactions in sensory cortex are also altered by anesthetics. The authors hypothesized that desflurane would reduce recurrent neuronal interactions in cortical layer–specific manner consistent with the anatomical disposition of feedforward and feedback pathways.

Methods

Single-unit neuronal activity was measured in freely moving adult male rats (268 units; 10 animals) using microelectrode arrays chronically implanted in primary and secondary visual cortex. Layer-specific directional interactions were estimated by mutual information and transfer entropy of multineuron spike patterns within and between cortical layers three and five. The effect of incrementally increasing and decreasing steady-state concentrations of desflurane (0 to 8% to 0%) was tested for statistically significant quadratic trend across the successive anesthetic states.

Results

Desflurane produced robust, state-dependent reduction (P = 0.001) of neuronal interactions between primary and secondary visual areas and between layers three and five, as indicated by mutual information (37 and 41% decrease at 8% desflurane from wakeful baseline at [mean ± SD] 0.52 ± 0.51 and 0.53 ± 0.51 a.u., respectively) and transfer entropy (77 and 78% decrease at 8% desflurane from wakeful baseline at 1.86 ± 1.56 a.u. and 1.87 ± 1.67 a.u., respectively). In addition, a preferential suppression of feedback between secondary and primary visual cortex was suggested by the reduction of directional index of transfer entropy overall (P = 0.001; 89% decrease at 8% desflurane from 0.11 ± 0.18 a.u. at baseline) and specifically, in layer five (P = 0.001; 108% decrease at 8% desflurane from 0.12 ± 0.19 a.u. at baseline).

Conclusions

Desflurane anesthesia reduces neuronal interactions in visual cortex with a preferential effect on feedback. The findings suggest that neuronal disconnection occurs locally, among hierarchical sensory regions, which may contribute to global functional disconnection underlying anesthetic-induced unconsciousness.

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Diastolic Heart Failure
Authors: Goldstein Don , Frishman William H.
Published: February 2020

Heart failure with preserved ejection fraction (HFpEF), often referred to as diastolic heart failure, remains one of the more challenging forms of heart failure to treat. This is a condition in which patients may or may not have signs and symptoms of heart failure, and retain a left ventricular ejection fraction greater than 50%. The challenge to treating HFpEF is due to the paucity of clinical trials with specific therapies, and those that have been completed have yielded relatively neutral results. This has resulted in treatments that are aimed more towards associated conditions, such as hypertension, rather than the underlying pathophysiology. This article will review the epidemiology and pathophysiology of HFpEF, and discuss the current therapeutic modalities, and clinical trials. In addition, we will discuss an ongoing clinical trial and the impact it may hold on future treatment options.
Epidermal growth factor receptor mutations in non–small cell lung cancer undetected by high-sensitivity allele-specific real-time polymerase chain reaction–based assays
Authors: Shen Chia-I , Ho Hsiang-Ling , Yeh Yi-Chen , Chiu Chao-Hua , Chou Teh-Ying
Published: February 2020

Background:

Identifying epidermal growth factor receptor (EGFR) mutation status is critical for planning lung cancer treatment. Sanger sequencing detects both known and novel mutations but shows poor sensitivity. High-sensitivity allele-specific real-time polymerase chain reaction (ASRP)-based assays offer quick and reliable results, but may overlook uncommon mutations. We aimed to define the rate at which high-sensitivity ASRP-based assays missed uncommon EGFR mutations.

Methods:

Non–small cell lung cancer specimens that were diagnosed as EGFR wild-type (EGFR-WT) by high-sensitivity ASRP-based assays and had residual DNA samples were sent for Sanger sequencing. Patient characteristics and clinical features were evaluated by chart review, and outcomes of EGFR-tyrosine kinase inhibitor (EGFR-TKI) therapy were studied.

Results:

Hundred DNA specimens diagnosed by high-sensitivity ASRP-based assays as EGFR-WT were rechecked by Sanger sequencing. Two samples which were re-biopsy specimens from patients with EGFR mutations were excluded from the analysis. Sanger sequencing was failed in 24 samples. Among the remaining 74 samples, 6 (8.1%) had EGFR mutations—one exhibited exon 19 deletion (delT751_I759insS), two exhibited substitution mutations (S768I+V769L and L861Q), and three exhibited exon 20 insertions (N771_P772insN, P772_H773insHP, and H773_V774insAH). Only the patient with the exon 19 deletion had received EGFR-TKI therapy. Although the best tumor response was only stable disease, this was maintained for >10 months.

Conclusion:

High-sensitivity ASRP-based assays can overlook uncommon mutations. This detection failure rate is worth noting, especially when treating patients from regions known to have a high prevalence of EGFR mutation. Patients carrying uncommon mutations may still benefit from EGFR-TKI therapy.
Efficacy of Using Available Data to Examine Nurse Staffing Ratios and Quality of Care Metrics
Authors: Carlisle Byron , Perera Anjali , Stutzman Sonja E. , Brown-Cleere Shelley , Parwaiz Aatika , Olson DaiWai M.
Published: February 2020

BACKGROUND: Nurse staffing ratios impact both the quality and safety of care on a particular unit. Most hospitals have access to a large volume of nurse-sensitive outcomes. We hypothesized that these data could be used to explore the impact of changing the nurse-to-patient ratio on patient-reported outcomes, nurse satisfaction scores, and quality of care metrics. METHODS: Retrospective data from hospital resources (eg, Press Ganey reports) were linked to daily staffing records (eg, assignment sheets) in a pre-post study. Before September 2017, the nurse-to-patient ratio was 1:1.75 (pre); afterward, the ratio was reduced to 1:1.5 (post). RESULTS: Press Ganey National Database of Nursing Quality Indicators scores were improved, staffing turnover rates were reduced, and falls were linked to periods of high nurse-to-patient ratios. CONCLUSION: This study shows the efficacy of using readily available metrics to explore for associations between nurse staffing and nurse-sensitive outcomes at the nursing care unit level. This provides a unique perspective to optimize staffing ratios based on personalized (unit-level) metrics.
Impact of Induction Immunosuppression on Post-Transplant Outcomes of Patients Bridged with Contemporary Left Ventricular Assist Devices
Authors: Truby Lauren K. , Batra Jaya , Jennings Douglas L. , Takeda Koji , DeFilippis Ersilia M. , Takayama Hiroo , Naka Yoshifumi , Farr Maryjane A. , Topkara Veli K.
Published: February 2020

For patients bridged to transplant (BTT) with left ventricular assist devices (LVAD), data regarding the use of induction immunosuppressive therapy remain limited. The objectives of the current study were to describe the current trends and clinical consequences of IT in patients BTT with LVAD. The United Network of Organ Sharing database was queried to identify adult, single-organ heart transplant recipients who were BTT with LVAD between 2008 and 2018. Propensity score matching was then used to balance clinical covariates between those patient who did and did not receive IT. The primary outcomes of interest were graft survival, hospitalization for rejection and infection, and freedom from transplant coronary artery disease (TCAD). In the overall cohort, 49.1% (n = 3,978) received IT, with basiliximab being the most commonly used agent followed by antithymocyte globulin. After propensity score matching, 4,388 patients (2,194 without induction and 2,194 with induction) were identified. Between those who did and did not receive IT, there was no significant difference in graft survival, freedom from hospitalization for rejection, and freedom from hospitalization for infection. Patients who received IT experienced increased freedom from TCAD (p = 0.004) with unadjusted hazard ratio of 0.81 (95% Cardiac Index: 0.70–0.93). For freedom from TCAD, antithymocyte globulin was associated with better outcomes than basiliximab (80.2% vs. 73.1% at 5 years, log rank p value = 0.004). In a sensitivity analysis, there was no significant increase in hospitalization for infection in those patients with an infected LVAD before transplant. Use of induction therapy in patients BTT with LVAD appears to be safe and feasible, without a significant increase in the risk of infection or rejection, even in those patients with pretransplant device-related infections. IT, particularly antithymocyte globulin, was associated with increased time to development of TCAD. Routine use of IT in patients BTT with LVAD may be considered, and further randomized control trials are warranted to further support these data.
The utility of thrombophilia testing in patients with newly diagnosed portal vein thrombosis
Authors: Tremblay Douglas , Naymagon Leonard , Troy Kevin , Cromwell Caroline , Edwards Colleen , Schiano Thomas , Kremyanskaya Marina , Mascarenhas John
Published: February 2020

Thrombophilia testing is frequently performed in both seemingly provoked and unprovoked portal vein thrombosis (PVT), yet the clinical implications of these expensive laboratory tests are unknown. We investigated the frequency of clinical management changes in patients with newly diagnosed PVT. This is a retrospective analysis of adult patients with a newly diagnosed PVT at a single institution. The primary outcome is change in clinical management, defined as documented change in choice, dose, or duration of anticoagulation, future thromboprophylaxis, or counseling of asymptomatic family members. Five-hundred and forty-four patients with PVT were identified, 438 (80.5%) of whom had an identifiable pretesting provoking factor, most commonly cirrhosis (39.2%). Two-hundred ninety-one patients (53.5%) had at least one hypercoagulable laboratory test performed. The most frequently positive test was PAI-1 polymorphism, followed by elevated homocysteine and MTHFR mutational analysis. However, the only test that was frequently positive and consistently altered management was JAK2 mutational analysis (15.3%). Factor V Leiden was commonly positive but rarely changed clinical decision-making (1.5%), as was flow cytometric testing for paroxysmal nocturnal hemoglobinuria (0.8%), and antiphospholipid antibodies (0.7%). Patients with cirrhosis rarely had thrombophilia testing results that were clinically significant. A rough cost estimate was dramatically reduced from $231 000 to $76 000 if only clinically meaningful tests were employed in the hypercoagulable work-up. These results highlight the need for focused thrombophilia testing in patients with PVT.
Clinical impression for identification of vulnerable older patients in the emergency department
Authors: Calf Agneta H. , Lubbers Sonja , van den Berg Annemarie A. , van den Berg Else , Jansen Carolien J. , van Munster Barbara C. , de Rooij Sophia E. , ter Maaten Jan C.
Published: February 2020

Objectives:

To investigate whether the clinical impression of vulnerability and the Dutch Safety Management Program (VMS), a screening instrument on four geriatric domains (activities in daily living, falls, malnutrition, delirium) are useful predictors of 1-year mortality in older patients in the emergency department.

Methods:

This was a prospective observational study in the emergency department of a tertiary care teaching hospital. Patients aged 65 years and older visiting the emergency department, and their attending physicians and nurses were included. Clinical impression of vulnerability appraised by physician and nurse and the VMS-screening were recorded.

Results:

We included 196 patients of whom 64.8%, 61.7%, and 52.6% were considered vulnerable based on the clinical impression of vulnerability of physicians, nurses, and VMS-screening, respectively. Agreement between clinical impression of vulnerability of physicians and nurses, and VMS-screening were both fair (overall agreement 63.3% for both, and respectively kappa 0.32 and kappa 0.31). Clinical impression of vulnerability of physicians, nurses, and VMS-screening had a sensitivity of respectively 94%, 86%, and 73% for predicting 1-year mortality. A positive clinical impression of vulnerability was associated mostly with factors which can be observed directly during first patient contact after arrival to the emergency department, such as age, nutritional status, and functional impairment.

Conclusion:

The clinical impression of vulnerability is a simple dichotomous question which can be used as a first step in the identification of vulnerable older emergency department patients, whereas the more time-consuming VMS-screening is more specific for detection of vulnerability. The clinical impression of vulnerability is therefore useful in a busy emergency department environment where time and resources are limited.
The use of 3D virtual surgical planning and computer aided design in reconstruction of maxillary surgical defects
Authors: Glas Haye H. , Vosselman Nathalie , de Visscher Sebastiaan A.H.J.
Published: February 2020

Purpose of review

The present review describes the latest development of 3D virtual surgical planning (VSP) and computer aided design (CAD) for reconstruction of maxillary defects with an aim of fully prosthetic rehabilitation. The purpose is to give an overview of different methods that use CAD in maxillary reconstruction in patients with head and neck cancer.

Recent findings

3D VSP enables preoperative planning of resection margins and osteotomies. The current 3D VSP workflow is expanded with multimodal imaging, merging decision supportive information. Development of more personalized implants is possible using CAD, individualized virtual muscle modelling and topology optimization. Meanwhile the translation of the 3D VSP towards surgery is improved by techniques like intraoperative imaging and augmented reality. Recent improvements of preoperative 3D VSP enables surgical reconstruction and/or prosthetic rehabilitation of the surgical defect in one combined procedure.

With the use of 3D VSP and CAD, ablation surgery, reconstructive surgery, and prosthetic rehabilitation can be planned preoperatively. Many reconstruction possibilities exist and a choice depends on patient characteristics, tumour location and experience of the surgeon. The overall objective in patients with maxillary defects is to follow a prosthetic-driven reconstruction with the aim to restore facial form, oral function, and do so in accordance with the individual needs of the patient.
Health Literacy Assessment of Detained Individuals and Correctional Officers Within a Large Urban Jail
Authors: Welvers Alecia , Rosenberger Kelly D. , Corbridge Susan J.
Published: February 2020

Background:

Little research has been done to address the health literacy level of detained individuals and correctional officers.

Purpose:

The aim of this pilot project was to describe the health literacy of individuals detained or working within a large urban jail to inform their health education.

Methods:

Health literacy assessments were conducted using the Rapid Estimate of Adult Literacy in Medicine–Short Form (REALM-SF) and the Newest Vital Sign (NVS) tools.

Results:

Of the 48 participants, 17% (n = 8) exhibited low health literacy on the REALM-SF, whereas 38% (n = 18) demonstrated the need for improved health literacy when assessed with the NVS. Detained individuals from the women's tiers were more likely to have lower health literacy than the detained veterans or correctional officers.

Conclusions:

Results indicate that tailored health education programming, using evidence-based health literacy improvement techniques, should be offered to the individuals detained or working within a correctional facility.
Angiotensin II Type-1 Receptor Antibodies Are Associated With Active Allograft Dysfunction Following Pediatric Liver Transplantation
Authors: Wozniak Laura J. , Hickey Michelle J. , Chan Alvin P. , Venick Robert S. , Farmer Douglas G. , Busuttil Ronald W. , Reed Elaine F. , McDiarmid Sue V.
Published: February 2020

Background.

Angiotensin II type-1 receptor (AT1R) antibodies have been associated with rejection and allograft loss in solid organ transplantation and may act synergistically with HLA donor-specific antibodies (DSA). Our aims were to assess the prevalence of AT1R antibodies and determine if they were associated with allograft dysfunction in pediatric liver transplant recipients.

Methods.

We performed a retrospective, cross-sectional study of HLA DSA and AT1R antibodies in 2 cohorts of pediatric liver transplant recipients: a stable control cohort with normal allograft function (n = 70) who consented to have serum samples collected for research purposes during a routine clinic visit and a cohort with active allograft dysfunction (n = 9) whose serum samples were collected as part of clinical care.

Results.

AT1R antibodies >17 U/mL were detected in 29% of stable control patients and 89% of patients with active allograft dysfunction (P = 0.001). In stable control patients, AT1R antibodies were associated with younger age at transplant (P = 0.010), younger age at time of sample collection (P < 0.001), shorter interval since transplant (P = 0.090), and presence of HLA DSA (P = 0.003). AT1R antibodies in stable control patients were not associated with rejection or allograft loss. However, AT1R antibodies combined with HLA DSA in patients with active allograft dysfunction were associated with rejection and allograft loss.

Conclusions.

Our results suggest that AT1R antibodies are more common in patients with active allograft dysfunction and may be a risk factor for worse outcomes. Further research is needed to longitudinally assess the clinical impact of HLA DSA and AT1R antibodies.
Wnt5b integrates Fak1a to mediate gastrulation cell movements via Rac1 and Cdc42
Authors: Hung I-Chen , Chen Tsung-Ming , Lin Jing-Ping , Tai Yu-Ling , Shen Tang-Long , Lee Shyh-Jye
Published: February 2020

Focal adhesion kinase (FAK) mediates vital cellular pathways during development. Despite its necessity, how FAK regulates and integrates with other signals during early embryogenesis remains poorly understood. We found that the loss of Fak1a impaired epiboly, convergent extension and hypoblast cell migration in zebrafish embryos. We also observed a clear disturbance in cortical actin at the blastoderm margin and distribution of yolk syncytial nuclei. In addition, we investigated a possible link between Fak1a and a well-known gastrulation regulator, Wnt5b, and revealed that the overexpression of
fak1a
or
wnt5b
could cross-rescue convergence defects induced by a
wnt5b
or
fak1a
antisense morpholino (MO), respectively. Wnt5b and Fak1a were shown to converge in regulating Rac1 and Cdc42, which could synergistically rescue
wnt5b
and
fak1a
morphant phenotypes. Furthermore, we generated several alleles of
fak1a
mutants using CRISPR/Cas9, but those mutants only revealed mild gastrulation defects. However, injection of a subthreshold level of the
wnt5b
MO induced severe gastrulation defects in
fak1a
mutants, which suggested that the upregulated expression of
wnt5b
might complement the loss of Fak1a. Collectively, we demonstrated that a functional interaction between Wnt and FAK signalling mediates gastrulation cell movements via the possible regulation of Rac1 and Cdc42 and subsequent actin dynamics.
CAP-MAP: cap analysis protocol with minimal analyte processing, a rapid and sensitive approach to analysing mRNA cap structures
Authors: Galloway Alison , Atrih Abdelmadjid , Grzela Renata , Darzynkiewicz Edward , Ferguson Michael A. J. , Cowling Victoria H.
Published: February 2020

Eukaryotic messenger RNA (mRNA) is modified by the addition of an inverted guanosine cap to the 5′ triphosphate. The cap guanosine and initial transcribed nucleotides are further methylated by a series of cap methyltransferases to generate the mature cap structures which protect RNA from degradation and recruit proteins involved in RNA processing and translation. Research demonstrating that the cap methyltransferases are regulated has generated interest in determining the methylation status of the mRNA cap structures present in cells. Here, we present CAP-MAP: cap analysis protocol with minimal analyte processing, a rapid and sensitive method for detecting cap structures present in mRNA isolated from tissues or cultured cells.
Man's best friends: attitudes towards the use of different kinds of animal depend on belief in different species' mental capacities and purpose of use
Authors: Higgs Matthew J. , Bipin Sasha , Cassaday Helen J.
Published: February 2020

The animal purpose questionnaire (APQ) is a new instrument to measure human attitudes to animal use systematically across both species and purpose of use. This offers a more fine-grained approach to our understanding of how the belief in a specific animal's mental capacities relates to (dis-)agreement with their use for different human purposes. In the present study, 317 participants completed an online survey containing the APQ and the belief in animal mind (BAM) scale in a species-specific format, to test the prediction that levels of (dis-)agreement with animal use should mirror participants' judgements of animal sentience. The results obtained with the APQ confirmed that attitudes to animal use differed significantly across both purpose and species. Key findings included a relatively greater concern for dolphins and dogs over chimpanzees (suggesting that phylogenetic position is not the only determinant of attitudes to animal use). Across the purposes examined, respondents were largely negative about animal usage, with the exception that there was less disagreement if this was for medical research. Participants were also asked to provide demographic details such as gender and dietary preference. Regression analyses revealed high predictive power for species-specific BAM across five different kinds of animal use. General BAM scores, non-meat-eating and being female accounted for 31.5% of the total variability in APQ scores. The results indicate that BAM is a strong predictor of self-reported attitudes for using particular animals. However, the results showed some exceptions in the case of culturally typical ‘produce’ animals.
Long-tailed distributions of inter-event times as mixtures of exponential distributions
Authors: Okada Makoto , Yamanishi Kenji , Masuda Naoki
Published: February 2020

Inter-event times of various human behaviour are apparently non-Poissonian and obey long-tailed distributions as opposed to exponential distributions, which correspond to Poisson processes. It has been suggested that human individuals may switch between different states, in each of which they are regarded to generate events obeying a Poisson process. If this is the case, inter-event times should approximately obey a mixture of exponential distributions with different parameter values. In the present study, we introduce the minimum description length principle to compare mixtures of exponential distributions with different numbers of components (i.e. constituent exponential distributions). Because these distributions violate the identifiability property, one is mathematically not allowed to apply the Akaike or Bayes information criteria to their maximum-likelihood estimator to carry out model selection. We overcome this theoretical barrier by applying a minimum description principle to joint likelihoods of the data and latent variables. We show that mixtures of exponential distributions with a few components are selected, as opposed to more complex mixtures in various datasets, and that the fitting accuracy is comparable to that of state-of-the-art algorithms to fit power-law distributions to data. Our results lend support to Poissonian explanations of apparently non-Poissonian human behaviour.
Nutritional regulation of glucose metabolism-related genes in the emerging teleost model Mexican tetra surface fish: a first exploration
Authors: Marandel Lucie , Plagnes-Juan Elisabeth , Marchand Michael , Callet Therese , Dias Karine , Terrier Frederic , Père Stéphane , Vernier Louise , Panserat Stephane , Rétaux Sylvie
Published: February 2020

Astyanax mexicanushas gained importance as a laboratory model organism for evolutionary biology. However, little is known about its intermediary metabolism, and feeding regimes remain variable between laboratories holding this species. We thus aimed to evaluate the intermediary metabolism response to nutritional status and to low (NC) or high (HC) carbohydrate diets in various organs of the surface-dwelling form of the species. As expected, glycaemia increased after feeding. Fish fed the HC diet had higher glycaemia than fish fed the NC diet, but without displaying hyperglycaemia, suggesting that carbohydrates are efficiently used as an energy source. At molecular level, onlyfasn(Fatty Acid Synthase) transcripts increased in tissues after refeeding, suggesting an activation of lipogenesis. On the other hand, we monitored only moderate changes in glucose-related transcripts. Most changes observed were related to the nutritional status, but not to the NC versus HC diet. Such a metabolic pattern is suggestive of an omnivorous-related metabolism, and this species, at least at adult stage, may adapt to a fish meal-substituted diet with high carbohydrate content and low protein supply. Investigation to identify molecular actors explaining the efficient use of such a diet should be pursued to deepen our knowledge on this species.
Identification and characterization of invasive multi-drug-resistant (MDR) Bacteroides genomospecies in Canada
Authors: Graham Christopher , Eshaghi Alireza , Sarabia Alicia , Zittermann Sandra , Stapleton Patrick , Kus Julianne V. , Patel Samir N.
Published: February 2020

We identified and characterized a genome of the multi-drug-resistant

Bacteroides

genomospecies recovered from an invasive specimen from a hospitalized patient in Canada. The strain was resistant to penicillin, pipercillin-tazobactam, meropenem, clindaymycin and metronidazole. The strain harboured a plasmid containing the nimE gene, which has been shown to be associated with metronidazole resistance. The study highlights the importance of being vigilant in suspecting antimicrobial drug resistance when a patient is not improving on therapy.