bluuebunny/crossref_metadata_2025 huggingface dataset:
Action Research in Age Management: The Quality of Ageing at Work Model
Authors: Garavaglia Emma , Marcaletti Francesco , Iñiguez-Berrozpe Tatiana
Published: October 2020

This article discusses the introduction of age management practices within organizations and the possible resistance to their implementation, linked to the persistence of stereotypes and barriers associated with employee age and the presence of hostile organizational cultures. The article proposes to adopt an action research approach to facilitate the implementation of these practices, presenting for this purpose an action research model, the Quality of Ageing at Work, tested in 31 organizations in Italy and Spain. In light of a review of the literature on age management and action research, it describes the methodology of the Quality of Ageing at Work model and discusses it through the presentation of an organizational case. The Quality of Ageing at Work model consists of alternate phases of action and reflection through which researchers, in constant dialogue with field actors (in this case, managers, work councils, and workers), analyze organizational needs, by applying qualitative and quantitative tools, discuss them, and propose solutions. The main result of the intervention can be considered the increased awareness and autonomy of the organization in implementing an age management plan. This result confirms the effectiveness of interventions built on the dialogical and iterative principles of action research, generating, in a democratic way, new awareness and knowledge and producing organizational change.
EFSA under Revision: Transparency and Sustainability in the Food Chain
Authors: Leone Luca
Published: October 2020

In a time of structural challenges to the integrity, validity, and reliability of science, the new Regulation 2019/1381 aims to rethink the risk assessment phase for greater transparency and sustainability in the food chain. The novel set of provisions calls, inter alia, for Member States’ and civil society’s involvement in the management structure and scientific panels of the European Food Safety Authority (EFSA). Using the European process of ‘agencification’ as a theoretical background, this analysis addresses which problems the reformed legal framework aims to solve as regards EFSA’s governance and which new questions it simultaneously brings to the forefront.
Survey of Trunk Pathogens in South African Olive Nurseries
Authors: van Dyk Meagan , Spies Christoffel F. J. , Mostert Lizel , Halleen Francois
Published: October 2020

Several fungal trunk pathogens are associated with olive trunk diseases in South Africa. Little is known regarding the inoculum sources of these pathogens in the olive industry, and no specific management strategies are in place. The aim of this study was to investigate the status of olive nurseries in South Africa, with regard to the presence of trunk pathogens in olive plant material, to determine whether nursery material can be considered inoculum sources contributing to long-distance dispersal of these pathogens. Isolations were made from asymptomatic cuttings from mother blocks (stage 1), asymptomatic and symptomatic rooted cuttings (stage 2), and 1- to 2-year-old trees (stage 3) of eight cultivars in two nurseries. Known olive trunk pathogens of Nectriaceae, Diaporthaceae, Botrysphaeriaceae, Togniniaceae, Phaeomoniellaceae, and Pleurostomataceae were recovered. Neofusicoccum australe was detected in a single stage 1 cutting. Stage 3 material showed the highest incidence of fungi from these families, with Pleurostoma richardsiae having the highest incidence in both nurseries (82.2 and 36.7% of the 1- to 2-year-old trees). Phaeoacremonium parasiticum was present in 28.9% of the trees from one nursery (stage 3). The remaining pathogens occurred in ≤13.3% of the material. These results indicate that nursery propagation material from mother blocks harbors low levels of trunk pathogens and that additional infections occur during the nursery process. Management strategies should focus on the prevention and elimination of infections in mother blocks as well as during the propagation process to ensure that pathogen-free material is delivered to producers.
Occurrence of Copper-Resistant Xanthomonas perforans and X. gardneri in Illinois Tomato Fields
Authors: Khanal Sabin , Hind Sarah R. , Babadoost Mohammad
Published: October 2020

This study was conducted to determine whether currently prevailing isolates of Xanthomonas perforans and X. gardneri, the causal agents of tomato bacterial spot in Illinois, were resistant to copper. First, 133 isolates from each pathogen were tested for their multiplication on mannitol glutamate yeast agar (MGYA) amended with 0.8 mM of laboratory-grade copper sulfate. Results showed that 59% of X. perforans and 38% of X. gardneri isolates formed colonies on the copper-amended culture. Then, six isolates of X. perforans and five isolates of X. gardneri were tested for their multiplication on MGYA amended with 0.2, 0.8, 1.2, 1.6, and 2.0 mM of laboratory-grade of either copper hydroxide or copper sulfate. All 11 isolates formed colonies on cultures with 1.2 mM or lower rates of either copper compound. Molecular analysis revealed the presence of the copper-resistance genes copA and copM in the isolates. In vitro assays showed that both X. perforans and X. gardneri formed colonies when grown on Luria–Bertani agar containing low concentrations of copper hydroxide (Kocide-3000 46.1DF) and copper sulfate pentahydrate (Instill). Double Nickel LC, a biopesticide containing Bacillus amyloliquefaciens strain D747, was the most effective in preventing multiplication of copper-resistant isolates of both pathogens on the culture media.
Elucidating Anthracnose Resistance Mechanisms in Sorghum—A Review
Authors: Stutts Lauren R. , Vermerris Wilfred
Published: October 2020

Sorghum (Sorghum bicolor) is the fifth most cultivated cereal crop in the world, traditionally providing food, feed, and fodder, but more recently also fermentable sugars for the production of renewable fuels and chemicals. The hemibiotrophic fungal pathogen Colletotrichum sublineola, the causal agent of anthracnose disease in sorghum, is prevalent in the warm and humid climates where much of the sorghum is cultivated and poses a serious threat to sorghum production. The use of anthracnose-resistant sorghum germplasm is the most environmentally and economically sustainable way to protect sorghum against this pathogen. Even though multiple anthracnose resistance loci have been mapped in diverse sorghum germplasm in recent years, the diversity in C. sublineola pathotypes at the local and regional levels means that these resistance genes are not equally effective in different areas of cultivation. This review summarizes the genetic and cytological data underlying sorghum’s defense response and describes recent developments that will enable a better understanding of the interactions between sorghum and C. sublineola at the molecular level. This includes releases of the sorghum genome and the draft genome of C. sublineola, the use of next-generation sequencing technologies to identify gene expression networks activated in response to infection, and improvements in methodologies to validate resistance genes, notably virus-induced and transgenic gene silencing approaches.
Alcohol Consumption in Response to the COVID-19 Pandemic in the United States
Authors: Barbosa Carolina , Cowell Alexander J. , Dowd William N.
Published: October 2020

Objectives:

Excessive alcohol use is a serious and growing public health problem. Alcoholic beverage sales in the United States increased greatly immediately after the stay-at-home orders and relaxing of alcohol restrictions associated with the COVID-19 pandemic. However, it is not known to what degree alcohol consumption changed. This study assesses differences in alcohol drinking patterns before and after the enactment of stay-at-home orders.

Methods:

In May 2020, a cross-sectional online survey of 993 individuals using a probability-based panel designed to be representative of the US population aged 21 and older was used to assess alcohol drinking patterns before (February, 2020) and after (April, 2020) the enactment of stay-at-home orders among those who consumed alcohol in February, 2020 (n = 555). Reported differences in alcohol consumption were computed, and associations between differences in consumption patterns and individual characteristics were examined.

Results:

Compared to February, respondents reported consuming more drinks per day in April (+29%, P < 0.001), and a greater proportion reported exceeding recommended drinking limits (+20%, P < 0.001) and binge drinking (+21%, P = 0.001) in April. These differences were found for all sociodemographic subgroups assessed. February to April differences in the proportion exceeding drinking limits were larger for women than men (P = 0.026) and for Black, non-Hispanic people than White, non-Hispanic people (P = 0.028).

Conclusions:

There is an association among the COVID-19 pandemic, the public health response to it, changes in alcohol policy, and alcohol consumption. Public health monitoring of alcohol consumption during the pandemic is warranted.
Can Upstream Patient Education Improve Fracture Care in a Digital World? Use of a Decision Aid for the Treatment of Displaced Diaphyseal Clavicle Fractures
Authors: Lai Cara H. , DeBaun Malcolm R. , Van Rysselberghe Noelle , Abrams Geoffrey D. , Kamal Robin N. , Bishop Julius A. , Gardner Michael J.
Published: October 2020

Background:

The increasing proportion of telemedicine and virtual care in orthopaedic surgery presents an opportunity for upstream delivery of patient facing tools, such as decision aids. Displaced diaphyseal clavicle fractures (DDCFs) are ideal for a targeted intervention because there is no superior treatment, and decisions are often dependent on patient's preference. A decision aid provided before consultation may educate a patient and minimize decisional conflict similarly to inperson consultation with an orthopaedic traumatologist.

Methods:

Patients with DDCF were enrolled into 2 groups. The usual care group participated in a discussion with a trauma fellowship-trained orthopaedic surgeon. Patients in the intervention group were administered a DDCF decision aid designed with the International Patient Decision Aid Standards. Primary comparisons were made based on a decisional conflict score. Secondary outcomes included treatment choice, pain score, QuickDASH, and opinion toward cosmetic appearance.

Results:

A total of 41 patients were enrolled. Decisional conflict scores were similar and low between the 2 groups: 11.8 (usual care) and 11.4 (decision aid). There were no differences in secondary outcomes between usual care and the decision aid.

Discussion:

Our decision aid for the management of DDCF produces a similarly low decisional conflict score to consultation with an orthopaedic trauma surgeon. This decision aid could be a useful resource for surgeons who infrequently treat this injury or whose practices are shifting toward telemedicine visits. Providing a decision aid before consultation may help incorporate patient's values and preferences into the decision-making process between surgery and nonoperative management.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Utility of Common Biomarkers for Diagnosing Infection in Nonunion
Authors: Brinker Mark R. , Macek Jenny , Laughlin Mitzi , Dunn Warren R.
Published: October 2020

Objectives:

To evaluate the diagnostic utility of leukocyte count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for distinguishing between septic and aseptic nonunions.

Design:

A single-gate (cohort) design was used, using 1 set of eligibility criteria applied to a consecutive sample of nonunions.

Setting:

Private quaternary referral center.

Patients/Participants:

Inclusion criteria were consecutive patients (≥18 years) with a nonunion requiring surgery that allowed for direct or medullary canal tissue sampling from the nonunion site. The cohort included 204 subjects with 211 nonunions.

Intervention:

Blood samples were drawn for laboratory analysis of WBC, ESR, and CRP before surgery.

Main Outcome Measurements:

The reference standard used to define infection was the fracture-related infection confirmatory criteria. Measures of diagnostic accuracy were calculated. To assess the additional diagnostic gain of each index lab test while simultaneously considering the others, logistic regression models were fit.

Results:

The prevalence of infection was 19% (40 of 211 nonunion sites). The positive likelihood ratios (95% confidence interval) for WBC, ESR, and CRP were 1.07 (0.38–3.02), 1.27 (0.88–1.82) and 1.57 (0.94–2.60), respectively. Multivariable modeling adjusted for the effect of preoperative antibiotics showed that WBC (P = 0.42), ESR (P = 0.48), and CRP (P = 0.23) were not significant predictors of infection.

Conclusions:

In this consecutive sample of 211 nonunions in whom standard clinical practice would be to obtain index lab tests, our findings showed that WBC, ESR, and CRP were not significant predictors of infection.

Level of Evidence:

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Methods to Mitigate Industry Influence in Industry Sponsored Research
Authors: McDonnell Jake M. , Dalton David M. , Ahern Daniel P. , Welch-Phillips Adanna , Butler Joseph S.
Published: October 2020

Medical and surgical research has always had a long-standing relationship with industry-based funding from sources, such as drug and device companies. Concerns exist surrounding the association between funding sources, outcome from studies and publication bias. Studies demonstrating increased odds ratios associated with positive results in industry sponsored studies across medicine have stimulated Cochrane reviews, literature reviews and other articles to examine this relationship further. In spine surgery in particular, studies with positive results have an odds ratio of 3.3 of being published. This article discusses the biases associated with industry sponsorship, possible ways to reduce such biases and ways to improve transparency in research relationships. This article explores the types of bias that can be encountered at different stages of research including previous trials in spine surgery. The means of improving transparency including the Physician Payment Sunshine Act of 2010 and International Committee of Medical Journal Editors (ICJME) accreditation are discussed. We recognize that physicians undertaking industry sponsored research should be protected and not be liable to perverse incentives. We conclude that mitigating bias in industry sponsored research is a multistep process and needs a multifaceted approach. The main beneficiary of research should be patients and as such a collective effort from medical professionals, health care institutions, journals and industry should approach research, and publications with that in mind.
Vascular Complications of Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Regression Analysis
Authors: Jia Deng , Yang Isabelle Xiaorui , Ling Ryan Ruiyang , Syn Nicholas , Poon Wynne Hsing , Murughan Kavita , Tan Chuen Seng , Choong Andrew M. T. L. , MacLaren Graeme , Ramanathan Kollengode
Published: October 2020

Objectives:

Perform a systematic review and meta-analysis of vascular complications associated with extracorporeal membrane oxygenation and identify prognostic and predictive factors.

Data Sources:

Systematic search for publications reporting vascular complications on extracorporeal membrane oxygenation, published from 1972 to January 31, 2020, was conducted via PubMed, Scopus, and Embase.

Study Selection:

Of 4,076 references screened, 47 studies with 6,583 patients were included in final analyses. Studies with fewer than 10 patients were excluded.

Data Extraction:

Relevant data, including demographics, comorbidities, extracorporeal membrane oxygenation and cannulation characteristics, occurrence rates of early and late vascular complications, patient outcomes, and use of distal perfusion cannula, were extracted from selected articles into an excel sheet specifically designed for this review.

Data Synthesis:

Random-effects meta-analyses and meta-regression analyses were undertaken. Overall pooled estimate of vascular complications in our meta-analysis was 29.5% (95% CI, 23.6–35.9%). Two-thousand three-hundred forty-seven vascular complications in 6,124 venoarterial extracorporeal membrane oxygenation patients compared with 95 in 459 venovenous extracorporeal membrane oxygenation patients (odds ratio, 2.35; 95% CI, 1.87–2.96; p < 0.0001) were analyzed. Successful weaning off extracorporeal membrane oxygenation occurred in 60.6% of pooled patients; 46.2% were eventually discharged. Pooled prevalences of vascular complications like significant bleeding, limb ischemia, and cannula site bleeding were 15.4% (95% CI, 8.6–23.7%), 12.6% (95% CI, 10.0–15.5%), and 12.6% (95% CI, 9.6–18.5%), respectively. Meta-analysis showed that the use of distal perfusion cannula was associated with lower odds of limb ischemia (odds ratio, 1.93; 95% CI, 1.17–2.47; p = 0.03) Meta-regression showed that male sex, smoking, advanced age, and comorbidities contributed to higher in-hospital mortality, while distal perfusion cannula was protective.

Conclusions:

Nearly a third of patients on extracorporeal membrane oxygenation develop vascular complications; elderly males with comorbidities appear vulnerable. The use of distal perfusion cannulas caused significant reduction in limb ischemia and mortality.
Dexamethasone Does Not Inhibit Treadmill Training–Induced Angiogenesis in Myocardium: Role of MicroRNA-126 Pathway
Authors: Herrera Naiara A. , Duchatsch Francine , Tardelli Lidieli P. , Dionísio Thiago J. , Santos Carlos F. , Amaral Sandra L.
Published: October 2020

Dexamethasone (DEX) has important anti-inflammatory activities; however, it induces hypertension and skeletal muscle microcirculation rarefaction. Nevertheless, nothing is known about DEX outcomes on cardiac microcirculation. By contrast, exercise training prevents skeletal and cardiac microvessel loss because of microRNA expression and a better balance between their related angiogenic and apoptotic proteins in spontaneously hypertensive rats. The purpose of this study was to investigate whether DEX and/or exercise training could induce microRNA alterations leading to cardiac angiogenesis or microvascular rarefaction. Animals performed 8 weeks of exercise training and were treated with DEX (50 μg/kg per day, subcutaneously) for 14 days. Cardiovascular parameters were measured, and the left ventricle muscle was collected for analyses. DEX treatment increased arterial pressure and did not cause cardiac microcirculation rarefaction. Treadmill training prevented the DEX-induced increase in arterial pressure. In addition, training, regardless of DEX treatment, increased microRNA-126 expression, phospho-protein kinase B/protein kinase B, and endothelial nitric oxide synthase levels associated with cardiac angiogenesis. In conclusion, this study suggests, for the first time, that treadmill training induces myocardial angiogenesis because of angiogenic pathway improvement associated with an increase in microRNA-126. Furthermore, DEX, per se, did not cause capillary density alterations and did not attenuate cardiac angiogenesis induced by training.
The Use of Voltage Sensitive Dye di-4-ANEPPS and Video-Based Contractility Measurements to Assess Drug Effects on Excitation–Contraction Coupling in Human-Induced Pluripotent Stem Cell–Derived Cardiomyocytes
Authors: Hortigon-Vinagre Maria Pura , Zamora Victor , Burton Francis L. , Smith Godfrey L.
Published: October 2020

Because cardiotoxicity is one of the leading causes of drug failure and attrition, the design of new protocols and technologies to assess proarrhythmic risks on cardiac cells is in continuous development by different laboratories. Current methodologies use electrical, intracellular Ca2+, or contractility assays to evaluate cardiotoxicity. Increasingly, the human-induced pluripotent stem cell–derived cardiomyocytes (hiPSC-CMs) are the in vitro tissue model used in commercial assays because it is believed to recapitulate many aspects of human cardiac physiology. In this work, we demonstrate that the combination of a contractility and voltage measurements, using video-based imaging and fluorescence microscopy, on hiPSC-CMs allows the investigation of mechanistic links between electrical and mechanical effects in an assay design that can address medium throughput scales necessary for drug screening, offering a view of the mechanisms underlying drug toxicity. To assess the accuracy of this novel technique, 10 commercially available inotropic drugs were tested (5 positive and 5 negative). Included were drugs with simple and specific mechanisms, such as nifedipine, Bay K8644, and blebbistatin, and others with a more complex action such as isoproterenol, pimobendan, digoxin, and amrinone, among others. In addition, the results provide a mechanism for the toxicity of itraconazole in a human model, a drug with reported side effects on the heart. The data demonstrate a strong negative inotropic effect because of the blockade of L-type Ca2+ channels and additional action on the cardiac myofilaments. We can conclude that the combination of contractility and action potential measurements can provide wider mechanistic knowledge of drug cardiotoxicity for preclinical assays.
Impact of the Potential Antitumor Agent 2-(4-Hydroxyphenyl) Amino-1,4-Naphthoquinone (Q7) on Vasomotion Is Mediated by the Vascular Endothelium, But Not Vascular Smooth Muscle Cell Metabolism
Authors: Palacios Javier , Benites Julio , Owen Gareth I. , Morales Pablo , Chiong Mario , Nwokocha Chukwuemeka R. , Paredes Adrián , Cifuentes Fredi
Published: October 2020

Vasomotion is defined as rhythmic oscillations in arterial diameter that regulate the blood flow and blood pressure. Because antitumor treatment may impair vascular functions and increase the blood pressure, we sought to evaluate whether a new naphthoquinone derivative, postulated as an antitumor agent, manifests adverse effects on vascular function. In this article, we evaluated the toxicity of 2-(4-hydroxyphenyl) amino-1,4-naphthoquinone (Q7) and its effects on vascular vasomotion in 3 models of vascular structure: endothelial cells, aortic ring, and smooth muscle cells. Although showing nontoxic effects, Q7 inhibited the formation of capillary-like structures of the EA.hy926 endothelial cell line grown on Matrigel. In exvivo experiments with aortic rings precontracted with phenylephrine (PE, 10−6 M), Q7 (10−5 M) significantly (P < 0.05) reduced vascular rhythmic contractions induced by the acetylcholine (ACh; 10−7-10−5 M), whereas sodium nitroprusside (a nitric oxide donor; 10−8 M) recovered the vasomotion. Furthermore, Q7 (10−5 M) did not decrease KCl-induced vascular rhythmic contractions in the aortic rings precontracted with BaCl2 (a nonselective K+ channel blocker; 10−3 M). Vascular smooth muscle cells (A7r5) preincubated with Q7 (10−5 M) for 3 hours also demonstrated a reduced glucose uptake. However, the Adenosine Triphosphate content was unaffected, suggesting that the rapid reduction in vasomotion observed in vascular reactivity experiments did not involve cellular metabolism but may be due to faster mechanisms involving endothelial nitric oxide and K+ channels leading to oscillations in intracellular Ca2+. In summary, the naphthoquinone derivative Q7 presents low cytotoxicity yet may alter the endothelial cell response and vasomotion in the absence of changes in smooth muscle cell metabolism.
Evaluating the Benefits of Exercise Training in HFrEF or COPD Patients
Authors: Gudjonsdottir Marta , Thoroddsen Egill , Karlsdottir Arna E. , Kristjansdottir Asdis , Jonasson Magnus R. , Asgeirsdottir Magdalena , Sigurdsson Stefan B. , Kristjansson Karl
Published: October 2020

Background:

Heart failure with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) are relatively common conditions with similar symptoms of exercise intolerance and dyspnea. The aim of this study was to compare exercise capacity, ventilatory response, and breathing pattern in patient groups with either advanced HFrEF or COPD before and after exercise training.

Methods:

An observational study was conducted with parallel groups of 25 HFrEF and 25 COPD patients who took part in 6 wk of inpatient rehabilitation with exercise training. All patients underwent cardiopulmonary exercise tests at the start and end of the training, with resting arterial blood gas measurements.

Results:

The average peak oxygen uptake (V˙o2) was low at the start of the study but increased significantly after training in both groups, or by 2.2 ± 2.1 mL/kg/min in HFrEF patients and 1.2 ± 2.2 mL/kg/min in COPD patients. At ISO-V˙o2 (ie, same level of V˙o2 in pre- and post-exercise tests), carbon dioxide production (V˙co2) decreased after exercise training in both groups. Similarly, at ISO-V˙E (ie, same level of ventilation), breathing frequency (f) decreased and tidal volume (VT) increased, resulting in an improved breathing pattern (lower f/VT ratio) after training.

Conclusion:

The findings of this study show that exercise training in severely affected patient groups with HFrEF or COPD led to an increase in maximal exercise capacity, a more favorable breathing pattern, and a diminished V˙co2 during exercise. Therefore, comparisons of V˙co2 and breathing pattern at ISO-levels of V˙o2 or V˙E before and after training are valuable and underutilized outcome measures in treatment studies.
Identification of Optimal Measures of Human Abuse Potential
Authors: Shram Megan J. , Levy-Cooperman Naama , Ratcliffe Sian , Mills Catherine , Bartlett Cynthia , Chen Nancy , Setnik Beatrice , Sellers Edward M. , Schoedel Kerri A.
Published: October 2020

Background

Human abuse potential studies include multiple measures to assess the subjective effects of central nervous system–active drugs. In this retrospective analysis, measurement properties of commonly used measures were assessed, and factor analysis was conducted to identify a core battery of measures.

Methods

Measures of positive, negative and other effects, for example, bipolar “at-the-moment” Drug Liking visual analog scale (VAS), were derived for active controls and placebo from 19 studies in recreational drug users (N = 570). Distribution, placebo response, variability, convergent/discriminant validity, parameter effect sizes (eg, maximum effect [E
max], time-averaged area under the effect curve), and predictive validity were evaluated. A factor analysis was conducted with 9 studies.

Results

Most parameters were not normally distributed. Bipolar VAS exhibited the lowest variability. Drug Liking VAS E
max was very sensitive, showed large effect sizes (>1.0), and was moderately to strongly correlated with E
max of other positive effects measures (r > 0.5), but weaker with less specific scales (eg, high, Any Effects VAS); time-averaged area under the effect curve showed higher variability and lower effect sizes. Maximum effect at any dose (E
maxD) was significantly correlated with E
max across all selected measures and showed higher effect sizes. In the overall factor analysis, factors could be categorized into positive effects/euphoria (77% of variance), negative effects (17.9%), and pharmacologic effects (5%). For predictive validity, effect sizes for Drug Liking VAS E
max/E
maxD were moderately correlated with postmarket adverse events related to abuse (R
2 = 0.52).

Conclusions

A core battery of 7 subjective measures was proposed, with additional measures added based on pharmacologic effects.
Sunscreen and Tanning Bed Use in High-Risk College-Aged Students
Authors: Graham Emily M. , Merrill Katreena C.
Published: October 2020

Skin cancer is the most prevalent cancer in the United States. Contributing factors include phenotypic exposure to ultraviolet radiation, lack of protective measures, and using high-risk behaviors. Protective measures (sunblock/protective clothing) are not popular with college-aged individuals, whereas tanning bed use is highly prevalent. The purpose of this study was to describe phenotypic risk factors for skin cancer, application of sunscreen, and tanning bed use in college students. A convenience sample of 673 students (55% male) completed a descriptive survey during winter, spring, and summer months. Researchers collected information about phenotypic risk factors using the Fitzpatrick Skin Scale, use of sunscreen, previous tanning bed use, and gender. Furthermore, 9.5% of college-aged individuals reported using sunscreen. Sunscreen use varied by season (p = .009) but not by skin type. Women reported higher sunscreen use (p = .0001). In addition, 12.6% disclosed a history of tanning bed use (M = 1.2). Male participants were more likely to use tanning beds during winter months (p = .015). Skin type did not influence tanning bed use. College-aged individuals are not sufficiently protecting themselves from the sun. More attention is needed to help melano-compromised individuals, especially men, understand how risk factors influence the development of skin cancer.
Update on Dermatoporosis
Authors: Vanzi Valentina , Toma Elena
Published: October 2020

Skin fragility caused by structural and functional deterioration is ubiquitous especially in older people, and it determines a significant impact on quality of life. Dermatoporosis is a relatively new term used to describe the chronic skin insufficiency and fragility syndrome marked by morphological and functional manifestations. It is much more than a merely cosmetic problem. Dermatoporosis' manifestations may determine an increased risk of morbidity and mortality. Severe stages of dermatoporosis may determine skin lacerations, deep dissecting hematomas, and skin necrosis. Most patients affected by dermatoporosis are between 70 and 90 years old, but first clinical signs may start at around 40–60 years. Nurses have a key role in preventing dermatoporosis and managing its complications, promoting patients' safety and skin integrity.
Assessment of High Flow Nasal Cannula Oxygenation in Endobronchial Ultrasound Bronchoscopy
Authors: Irfan Mujammil , Ahmed Mohammed , Breen David
Published: October 2020

Background:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely implemented in evaluating mediastinal disease. EBUS-TBNA is performed with low flow oxygen systems or general anesthesia. Little data exist on use of high flow nasal cannula (HFNC) in EBUS-TBNA.

Methods:

This was a single center parallel group randomized controlled trial comparing oxygenation through HFNC (Optiflow) against nasal prongs during EBUS. The primary end-point was the drop in oxygen saturations from procedure commencement, recorded by pulse oximetry, to the lowest level during EBUS-TBNA. Secondary end-points included changes in venous blood carbon dioxide, lowest oxygen saturation, changes in end-tidal CO2 during the procedure, intubation within 8 hours of the procedure and patient experience reported on a visual analog scale.

Results:

We randomized 20 patients to each study arm. The primary outcome of oxygen desaturation during the procedure was statistically significant with a difference of 7.7 percentage points (95% confidence interval, 4.91-10.49, P<0.001). The secondary outcome measure of lowest oxygen saturation was also statistically significant with a difference of −9.2 (95% confidence interval, −11.96 to −6.44, P<0.001). There was no difference in safety outcomes, visual analog scale score or in their willingness to return for repeat procedure.

Conclusion:

This single institution study in a university, tertiary referral center confirms that EBUS-TBNA performed with HFNC is associated with a statistically significant lower drop in oxygen saturation. Additional studies are needed to assess if this translates into improved clinical outcomes postprocedure.
Diagnostic Criteria for Differentiated Vulvar Intraepithelial Neoplasia and Vulvar Aberrant Maturation
Authors: Heller Debra S. , Day Tania , Allbritton Jill I. , Scurry James , Radici Gianluigi , Welch Kathryn , Preti Mario ,   for the ISSVD Difficult Pathologic Diagnoses Committee
Published: October 2020

Objective

The aim of the study was to describe the features required for diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar aberrant maturation (VAM).

Materials and Methods

The International Society of the Study of Vulvovaginal Diseases tasked the difficult pathologic diagnoses committee to develop consensus recommendations for clinicopathologic diagnosis of vulvar lichen planus, lichen sclerosus, and dVIN. The dVIN subgroup reviewed the literature and formulated diagnostic criteria that were reviewed by the committee and then approved by the International Society of the Study of Vulvovaginal Diseases membership.

Results

Differentiated vulvar intraepithelial neoplasia is the immediate precursor of human papillomavirus (HPV)–independent vulvar squamous cell carcinoma and shows a spectrum of clinical and microscopic appearances, some overlapping with HPV-related neoplasia. The histopathologic definition of dVIN is basal atypia combined with negative or nonblock-positive p16 and basal overexpressed, aberrant negative, or wild-type p53. The most common pattern of dVIN is keratinizing with acanthosis, aberrant rete ridge pattern, and premature maturation. The morphologic spectrum of keratinizing dVIN includes hypertrophic, atrophic, acantholytic, and subtle forms. A few dVIN cases are nonkeratinizing, with basaloid cells replacing more than 60% of epithelium. Vulvar aberrant maturation is an umbrella term for lesions with aberrant maturation that arise out of lichenoid dermatitis and lack the basal atypia required for dVIN.

Conclusions

Evaluation of women at risk for dVIN and VAM requires a collaborative approach by clinicians and pathologists experienced in vulvar disorders. Close surveillance of women with lichen sclerosus and use of these recommendations may assist in prevention of HPV-independent squamous cell carcinoma through detection and treatment of dVIN and VAM.
Migration and Psychosis
Authors: di Giacomo Ester , Giampieri Emanuela D. , Pellicioli Cristian , Rabboni Massimo , Clerici Massimo
Published: October 2020

In the last years, there has been a huge migratory flow to Italy. Migration is a risk factor for the development of psychopathology, especially psychosis and posttraumatic stress disorder. We aimed at investigating the burden and characteristics of psychotic features among immigrants in Lombardy, one of the most involved regions. A total of 7819 patients had at least one psychiatric appointment in 2013, 10.3% of them where immigrants. Patients from Africa showed a significant higher rate of psychosis, psychiatric onset, compulsory admissions, and number of professional appointments. Our result can confirm a cultural specificity of psychotic manifestations and their burden on the mental health system.
The Problem of Aggregating Validators for Psychiatric Disorders
Authors: Solomon Miriam , Kendler Kenneth S.
Published: October 2020

Since the time of the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, evidence for the validity of psychiatric disorders has been expressed in the form of validators, which are instances of particular kinds of evidence. There has never been an explicit discussion of how the validators should be aggregated to come to an overall conclusion about the strength of the evidence for a psychiatric category. We include both the challenges of aggregating validators of the same type and the challenges of aggregating different types of validators. We consider five different alternatives: informal aggregation, weighted informal aggregation (simple evidence hierarchy), formal aggregation, underdetermination, and inclusion of values. Each of the alternatives has different implications. We suggest that, going forward, aggregation of validators should be more explicit, maximizing rigor and reproducibility.
Clinicopathologic Features and Diagnostic Implications of Pyloric Gland Metaplasia in Intestinal Specimens
Authors: Tokuyama Minami , Dhingra Sadhna , Polydorides Alexandros D.
Published: October 2020

Pyloric gland metaplasia (PGM) is a histopathologic change usually seen after inflammatory injury and, although described in association with inflammatory bowel disease (IBD) and particularly Crohn disease (CD), its significance is still debated. We evaluated long-term correlates of PGM in a large cohort of 601 intestinal specimens, 227 (37.8%) biopsies, and 374 (62.2%) resections, from 567 different patients, 328 (57.8%) male and 239 (42.2%) female, with a mean age of 43.4±15.8 years. During mean clinical follow-up of 83.5±48.1 months, 511 (90.1%) patients were diagnosed with IBD, 457 (89.4%) with CD, and 53 (10.4%) with ulcerative colitis. In multivariate analysis, IBD patients with PGM were younger (P<0.001) and more often had severely active inflammation (P=0.002) compared with non-IBD patients, whereas, among IBD patients, those with ulcerative colitis were more likely to have PGM in a biopsy (P<0.001) or in the colorectum (P=0.009), compared with CD patients. Kaplan-Meier analyses showed that incidental PGM in a biopsy was more likely to predict IBD in patients younger than 50 years (P<0.001) and those without a history of bowel surgery (P<0.001) and also more likely to signify CD in patients younger than 50 years (P=0.004), those without a history of bowel surgery (P=0.020), and when identified in the small intestine (P=0.032). In conclusion, intestinal PGM warrants a high suspicion for IBD and specifically CD, however, it should be interpreted with caution, especially in older patients or those with a history of prior intestinal surgery and in colorectal biopsies or specimens lacking severely active inflammation.
Handlebar Hernia
Authors: García Sánchez Paula , Bote Gascón Patricia , González Bertolín Isabel , Bueno Barriocanal Marta , López López Rosario , de Ceano-Vivas la Calle María
Published: October 2020

Handlebar hernia is a type of traumatic abdominal wall hernia caused by the impact of a bicycle handlebar against the abdominal wall. A good anamnesis and physical examination are important for the correct diagnosis, and ultrasonography is an accessible tool in the emergency department for imaging confirmation. We describe a case of an 11-year-old girl who presented to the emergency department after an abdominal trauma caused by a handlebar. Ultrasonography revealed an abdominal wall defect with herniation of omentum and bowel loops. Conservative management was initially established, followed by surgical treatment due to persistent symptoms.
Does Postmortem Imaging Provide Additional Findings After Unexpected Deaths in Infants and Children?
Authors: Yurkovich Chelsey , Nazer Dena , Farooqi Ahmad , Kannikeswaran Nirupama
Published: October 2020

Objectives

The yield of postmortem imaging (PMI) after sudden unexpected deaths in children has not been well studied. Findings consistent with physical abuse detected on PMI may alert the physician to this diagnosis before the autopsy results. Our objectives are to describe the PMI performed and their diagnostic yield after unexpected deaths in children and to adherence to the American Academy of Pediatrics guidelines regarding performance of skeletal survey and autopsy in infants at our institution.

Methods

We performed a retrospective study of unexpected deaths in children 2 years or younger between 2008 and 2018. Children with known traumatic deaths and those transferred after a cardiopulmonary arrest at an outside institution were excluded. We collected patient demographics, physical examination findings, and type of PMI performed along with their results.

Results

We analyzed 150 deaths with majority (128; 85.3%) being infants. No PMI was performed in 20 children (13.3%). An autopsy was not performed in 22 children (14.6%). A skeletal survey and an autopsy were performed only in 72.6% (93/128) infants. PMI provided additional findings in 51 infants (34%) and 13 children (59.1%) aged 13 to 24 months. PMI identified abuse in 11 children with a negative physical examination result, 3 of whom had a negative autopsy.

Conclusions

The American Academy of Pediatrics recommendations of performance of a skeletal survey and an autopsy were not adhered to after all infant deaths. PMI is useful in identification of additional findings in children 2 years or younger, especially those concerning for physical abuse in infants with a negative physical examination.
Determining Intentionality of Pediatric Firearm Injuries by International Classification of Disease Code
Authors: Donnelly Katie A. , Badolato Gia M. , Goyal Monika K.
Published: October 2020

Objective

Firearm injuries are a leading cause of serious injury and death in childhood. The accuracy of International Classification of Disease (ICD) codes to assign intent is unclear. The objective of this study was to assess the validity of documented ICD codes for firearm injury intent compared with chart review.

Methods

We performed a retrospective cohort study of children (<= 18 years) presenting to a tertiary care level 1 pediatric trauma center with firearm injuries between 2006 and 2017. We compared agreement between ICD codes and intent of injury determined by medical record review using Cohen κ. Intent for medical record review was assigned via the injury spectrum of intentionality (suicide attempt, accidental firing, mistaken target, firearm assault and unknown). For comparison with ICD codes, all medical record review cases marked as mistaken target were classified as accidental. A sensitivity analysis was then performed, coding all mistaken targets as assault.

Results

There were 122 cases identified over the study period. The most common intent by ICD code was assault (n = 80, 65.6%). Medical record review categorized most injuries as mistaken targets. When mistaken target was categorized as accidental, most firearm injuries were coded as accidental (n = 89, 72.9%) Similar results were seen when mistaken target was categorized as assault, most injuries were categorized as assault (n = 79, 79.5%) Cohen κ was 0.15 when mistaken targets were categorized as accident and 0.30 when categorized as assault.

Conclusions

The ICD codes do not fully describe the intent of firearm injury. Revising ICD codes to account for mistaken targets could help to improve the validity of ICD codes for intent.
Morphological and Functional Changes of the Tibialis Anterior Muscle After Combined Mirror Visual Feedback and Electromyographic Biofeedback in Poststroke Patients
Authors: Liu Meikuai , Xu Leyi , Li Haiyan , Chen Shunping , Chen Bin
Published: October 2020

Objective

The aim of the study was to investigate the morphological and functional changes of the tibialis anterior muscle after mirror visual feedback combined with electromyographic biofeedback in poststroke patients.

Design

A total of 46 poststroke patients were randomly divided into three groups: a mirror visual feedback + electromyographic biofeedback group, a mirror visual feedback group, and a control group. The mirror visual feedback + electromyographic biofeedback group was treated with both mirror visual feedback and electromyographic biofeedback, and the mirror visual feedback group was treated with mirror visual feedback alone. The morphological parameters, including the pennation angle, muscle thickness, and fascicle length, were assessed.

Results

After 4 wks of treatment, the pennation angle and muscle thickness values were significantly increased in the mirror visual feedback + electromyographic biofeedback and mirror visual feedback groups (P < 0.05). The increase of these values in the mirror visual feedback + electromyographic biofeedback group was significantly greater than that in both metrics in the mirror visual feedback and control groups (P < 0.05), and those in the mirror visual feedback group were greater than those in the control group (P < 0.05). There was no significant difference in the fascicle length value among the three groups as a result of the treatment. After the treatment, the neurological functions were all increased in three groups (P < 0.05).

Conclusions

A combination of mirror visual feedback and electromyographic biofeedback seems to be an effective therapy for improving the motor function of the tibialis anterior muscle in poststroke patients.

Clinical trial registration number: ChiCTR1800017050.
Covert Subclinical Neurocognitive Sequelae During the Rehabilitation Course of Severe Coronavirus Disease 2019
Authors: Tay Matthew Rong Jie , Low Yee Hong , Lim Choie Cheio Tchoyoson , Umapathi Thirugnanam , Thio Jocelyn Mei Lin , Lui Wen Li , Chan Wai Lim William , Chua Karen Sui Geok
Published: October 2020

Apart from respiratory symptoms, encephalopathy and a range of central nervous system complications have been described in coronavirus disease 2019. However, there is a lack of published literature on the rehabilitative course and functional outcomes of severe coronavirus disease 2019 with encephalopathy. In addition, the presence of subclinical neurocognitive sequelae during postacute rehabilitation has not been described and may be underrecognized by rehabilitation providers. We report the rehabilitative course of a middle-aged male patient with severe coronavirus disease 2019 who required intensive care and mechanical ventilation. During postacute inpatient rehabilitation for severe intensive care unit–related weakness, an abnormal cognitive screen prompted brain magnetic resonance imaging, which revealed destructive leukoencephalopathy. Subsequently, detailed psychometric evaluation revealed significant impairments in the domains of processing speed and executive function. After 40 days of intensive inpatient rehabilitation, he was discharged home with independent function. This report highlights the need for an increased awareness of covert subclinical neurocognitive sequelae, the role of comprehensive rehabilitation, and value of routine cognitive screening therein and describes the neurocognitive features in severe COVID-19.
Increasing Primary Care Follow-up after Preparticipation Physical Evaluations
Authors: Kennedy Melanie , Comer Frances , Young Julie A. , Valasek Amy E.
Published: October 2020

Background:

Preparticipation physical evaluations (PPEs) strive to prevent injuries and sudden death in athletes. Ideally, the medical home is the best setting for completion. However, many school systems request large PPE screenings for their student-athletes. This quality-improvement project aimed to increase primary care provider (PCP) follow-up for athletes “cleared with recommendation” (CR) or “disqualified” (DQ) during our mass PPEs.

Methods:

Our team evaluated prior PPE data for athlete clearance and PCP follow-up for CR or DQ athletes. The prominent gaps in our PPEs were resident education, PCP or medical home identification, and communication. Our team implemented interventions during the 2018 PPEs to increase both CR and DQ athlete follow-up at the medical home.

Results:

Retrospective baseline data revealed that physicians categorized 11% (67/582) of athletes at our PPEs as CR or DQ. Of these athletes, the PCP and specialist follow-up rate was 13% (9/67). Our process changed to enhance athlete follow-up, but the rate only increased slightly to 15% (18/120). Medical home identification improved. Successful interventions included resident education, medical home identification, and increased communication.

Conclusions:

Despite our interventions, this quality-improvement initiative was unsuccessful in reaching the aim. This project found small achievements in educational opportunities, improved documentation, medial home identification for student-athletes, and lead to local changes in our standard operating procedures. Although our aim was ambitious, 100% athlete follow-up with the PCP or medical home ensures athletic safety and decreases liability for all.