bluuebunny/crossref_metadata_2025 huggingface dataset:
Donor risk analysis and validation in heart transplants: a single-centre experience
Authors: Murana Giacomo , Fiorentino Mariafrancesca , Gliozzi Gregorio , Di Marco Luca , Potena Luciano , Martin Suarez Sofia , Pacini Davide , Loforte Antonio
Published: September 2020

OBJECTIVES

A heart transplant (Htx) remains the gold standard treatment for patients with advanced heart failure. Considering the limited availability of organs, donor risk scores might improve organ selection and allocation. The objective of the study was to compare United Network for Organ Sharing, RADIAL and Eurotransplant scoring models in calculating post-Htx outcomes in an Italian Htx population.

METHODS

Between January 2000 and December 2017, a total of 461 adult patients underwent Htxs. United Network for Organ Sharing, RADIAL and Eurotransplant scores were calculated. Clinical features and donor risk scores were tested to identify preoperative, intraoperative and postoperative risk variables and eventually validate the scores on our population.

RESULTS

Early graft failure was detected in 16.1% (74/461). Post-Htx extracorporeal life support was used in 11.1% (51/461). Of the donor-related factors, the use of noradrenaline (P = 0.015) negatively influenced early outcomes, whereas an ischaemic time >240 min (P = 0.037) influenced early graft failure occurrence. The Eurotransplant donor score did not impact outcomes; the RADIAL score significantly influenced both early and late mortality; and the United Network for Organ Sharing score influenced only late mortality. On the multivariable analysis, after adjustment of scores per cohort, noradrenaline infusion was the main independent predictor of in-hospital mortality for the donors, whereas age of the recipient [odds ratio (OR) 1.003, 1.003–1.081; P = 0.032] and use of preoperative extracorporeal membrane oxygenation (OR 3.320, 1.124–9.805; P = 0.030) were the main independent predictors for the recipients.

CONCLUSIONS

None of the validated donor scoring systems fully behave as reliable predictors of transplant outcomes. According to our ‘local only’ graft selection, specific donor and recipient risk variables should be monitored in order to predict early and late outcomes satisfactorily.
Tight recovery guarantees for orthogonal matching pursuit under Gaussian noise
Authors: Amiraz Chen , Krauthgamer Robert , Nadler Boaz
Published: September 2020

Orthogonal matching pursuit (OMP) is a popular algorithm to estimate an unknown sparse vector from multiple linear measurements of it. Assuming exact sparsity and that the measurements are corrupted by additive Gaussian noise, the success of OMP is often formulated as exactly recovering the support of the sparse vector. Several authors derived a sufficient condition for exact support recovery by OMP with high probability depending on the signal-to-noise ratio, defined as the magnitude of the smallest non-zero coefficient of the vector divided by the noise level. We make two contributions. First, we derive a slightly sharper sufficient condition for two variants of OMP, in which either the sparsity level or the noise level is known. Next, we show that this sharper sufficient condition is tight, in the following sense: for a wide range of problem parameters, there exist a dictionary of linear measurements and a sparse vector with a signal-to-noise ratio slightly below that of the sufficient condition, for which with high probability OMP fails to recover its support. Finally, we present simulations that illustrate that our condition is tight for a much broader range of dictionaries.
We Must Do Better: Addressing HCV Treatment Barriers in Persons Who Inject Drugs in the United States
Authors: Trooskin Stacey B , Dore Gregory , Kostman Jay
Published: September 2020

The opioid epidemic in the United States, along with a lack of adequate harm reduction services, has contributed to a sharp rise in hepatitis C virus (HCV) infections. Despite considerable evidence of the effectiveness of HCV treatment in people who inject drugs (PWID), and recommendations from clinical guidelines to prioritize treatment in PWID, there are multiple barriers to broad uptake of HCV treatment. These barriers exist at the systems level, as well as at the level of medical providers and patients. Interventions to remove treatment barriers in the United States include harm reduction services, simplifying HCV testing algorithms, improved linkage to HCV care services, and application of new treatment models including colocating services at substance use disorder treatment programs. By following the lead of other countries who have addressed the barriers to HCV treatment, the United States has opportunities to do better in addressing the consequences of the opioid epidemic, including chronic HCV infection.
Modernizing health information technology: lessons from healthcare delivery systems
Authors: Amlung Joseph , Huth Hannah , Cullen Theresa , Sequist Thomas
Published: September 2020

Objective

To identify recurrent themes, insights, and process recommendations from stakeholders in US organizations during the health information technology (HIT) modernization of an existing electronic health record (EHR) to a commercial-off-the-shelf product in both resource-plentiful settings and in a resource-constrained environment, the US Indian Health Service.

Materials and Methods

Thirteen qualitative interviews with stakeholders in various organizations were conducted about HIT modernization efforts. Using a Theory of Change framework, recurring themes were identified and analyzed.

Results

The interviewees emphasized the importance of organizational and process revision during modernization, converting historical data, and clinical and leadership involvement. HIT implementation required technological and infrastructure redesign, additional training, and workflow reconfiguration. Motivations for modernization included EHR usability dissatisfaction, revenue enhancements, and improved clinical operations. Decision-making strategies, primarily during HIT selection, included meetings with stakeholders. Successful modernization resulted in improvements in clinical operations, patient experience, and financial outlay.

Discussion

Existing implementation frameworks fail to provide experiential feedback, such as implementation challenges, like data conversion, regulatory, functionality, and interoperability requirements. Regardless of the healthcare environment, HIT modernization requires the engagement of leadership and end-users during HIT selection and through all stages of the implementation to prepare people, processes, and technology. Organizations must iteratively define the technological, infrastructure, organizational, and workflow changes required for a successful HIT modernization effort.

Conclusions

HIT modernization is an opportunity for organizational and technological change. Successful modernization requires a comprehensive, intentional, well-communicated, and multidisciplinary approach. Resource-constrained environments have the additional challenges of financial burdens, limited staffing, and unstable infrastructure.
Induction of Wnt signaling antagonists and p21-activated kinase enhances cardiomyocyte proliferation during zebrafish heart regeneration
Authors: Peng Xiangwen , Lai Kaa Seng , She Peilu , Kang Junsu , Wang Tingting , Li Guobao , Zhou Yating , Sun Jianjian , Jin Daqing , Xu Xiaolei , Liao Lujian , Liu Jiandong , Lee Ethan , Poss Kenneth D , Zhong Tao P
Published: September 2020

Heart regeneration occurs by dedifferentiation and proliferation of pre-existing cardiomyocytes (CMs). However, the signaling mechanisms by which injury induces CM renewal remain incompletely understood. Here, we find that cardiac injury in zebrafish induces expression of the secreted Wnt inhibitors, including Dickkopf 1 (Dkk1), Dkk3, secreted Frizzled-related protein 1 (sFrp1), and sFrp2, in cardiac tissue adjacent to injury sites. Experimental blocking of Wnt activity via Dkk1 overexpression enhances CM proliferation and heart regeneration, whereas ectopic activation of Wnt8 signaling blunts injury-induced CM dedifferentiation and proliferation. Although Wnt signaling is dampened upon injury, the cytoplasmic β-catenin is unexpectedly increased at disarrayed CM sarcomeres in myocardial wound edges. Our analyses indicated that p21-activated kinase 2 (Pak2) is induced at regenerating CMs, where it phosphorylates cytoplasmic β-catenin at Ser 675 and increases its stability at disassembled sarcomeres. Myocardial-specific induction of the phospho-mimetic β-catenin (S675E) enhances CM dedifferentiation and sarcomere disassembly in response to injury. Conversely, inactivation of Pak2 kinase activity reduces the Ser 675-phosphorylated β-catenin (pS675-β-catenin) and attenuates CM sarcomere disorganization and dedifferentiation. Taken together, these findings demonstrate that coordination of Wnt signaling inhibition and Pak2/pS675-β-catenin signaling enhances zebrafish heart regeneration by supporting CM dedifferentiation and proliferation.
Environmental Drivers of Adult Seasonality and Abundance of Biting Midges Culicoides (Diptera: Ceratopogonidae), Bluetongue Vector Species in Spain
Authors: Barceló Carlos , Purse Bethan V , Estrada Rosa , Lucientes Javier , Miranda Miguel Á , Searle Kate R
Published: September 2020

Bluetongue is a viral disease affecting wild and domestic ruminants transmitted by several species of biting midges Culicoides Latreille. The phenology of these insects were analyzed in relation to potential environmental drivers. Data from 329 sites in Spain were analyzed using Bayesian Generalized Linear Mixed Model (GLMM) approaches. The effects of environmental factors on adult female seasonality were contrasted. Obsoletus complex species (Diptera: Ceratopogonidae) were the most prevalent across sites, followed by Culicoides newsteadi Austen (Diptera: Ceratopogonidae). Activity of female Obsoletus complex species was longest in sites at low elevation, with warmer spring average temperatures and precipitation, as well as in sites with high abundance of cattle. The length of the Culicoides imicola Kieffer (Diptera: Ceratopogonidae) female adult season was also longest in sites at low elevation with higher coverage of broad-leaved vegetation. Long adult seasons of C. newsteadi were found in sites with warmer autumns and higher precipitation, high abundance of sheep. Culicoides pulicaris (Linnaeus) (Diptera: Ceratopogonidae) had longer adult periods in sites with a greater number of accumulated degree days over 10°C during winter. These results demonstrate the eco-climatic and seasonal differences among these four taxa in Spain, which may contribute to determining sites with suitable environmental circumstances for each particular species to inform assessments of the risk of Bluetongue virus outbreaks in this region.
Evaluation of the NG-Test CARBA 5 Kit for Rapid Detection of Carbapenemase Resistant Enterobacteriaceae
Authors: Ben-Haim Or , Azrad Maya , Saleh Nora , Tkhawkho Linda , Peretz Avi
Published: September 2020

Objective

We evaluated NG-Test CARBA 5, a new phenotypic carbapenemase detection assay, and compared it to the routine Xpert CARBA-R polymerase chain reaction assay. Furthermore, we tested the kit’s performance after bacterial growth on 4 different solid media.

Methods

Seventy carbapenem resistant Enterobacteriaceae (CRE) isolates (60 were carbapenemase producers) were collected at the Poriya Baruch Padeh Medical Center. All isolates were grown on 4 types of agar media—BD BBL CHROMagar carbapenem resistant Enterobacteriaceae, BD CHROMagar Orientation, BD MacConkey II agar, and BD Trypticase Soy Agar II with 5% sheep blood—and were then subjected to NG-Test CARBA 5 kit analysis.

Results

The NG-Test CARBA 5 specificity was 100% for all 4 media. However, the sensitivity was higher when bacteria were grown on TSA with 5% sheep blood (98.3%) as compared with the Orientation medium (88.3%), the CPE medium (84.7%), and the MacConkey medium (83.6%). In addition, some of the carbapenemase mechanisms such as Verona Integron-Mediated Metallo-β-lactamase were detected with low agreement levels in specific media but higher agreement levels in the other media.

Conclusion

NG-Test CARBA 5 may enable faster detection of carbapenemase producing CRE, which will be of value for treatment adjustment and prevention control. However, the medium type on which the bacteria are grown affects kit sensitivity.
Effect of the environment on star formation activity and stellar mass for star-forming galaxies in the COSMOS field
Authors: Randriamampandry S M , Vaccari M , Hess K M
Published: September 2020

We investigate the relationship between the environment and the galaxy main sequence (the relationship between stellar mass and star formation rate), as well as the relationship between the environment and radio luminosity ($P_{\rm 1.4\, GHz}$), to shed new light on the effects of the environment on galaxies. We use the VLA-COSMOS 3-GHz catalogue, which consists of star-forming galaxies and quiescent galaxies (active galactic nuclei) in three different environments (field, filament, cluster) and for three different galaxy types (satellite, central, isolated). We perform for the first time a comparative analysis of the distribution of star-forming galaxies with respect to the main-sequence consensus region from the literature, taking into account galaxy environment and using radio observations at 0.1 ≤ z ≤ 1.2. Our results corroborate that the star formation rate is declining with cosmic time, which is consistent with the literature. We find that the slope of the main sequence for different z and M* bins is shallower than the main-sequence consensus, with a gradual evolution towards higher redshift bins, irrespective of environment. We see no trends for star formation rate in either environment or galaxy type, given the large errors. In addition, we note that the environment does not seem to be the cause of the flattening of the main sequence at high stellar masses for our sample.
Eclipses of jets and discs of X-ray binaries as a powerful tool for understanding jet physics and binary parameters
Authors: Maccarone Thomas J , van den Eijnden Jakob , Russell Thomas D , Degenaar Nathalie
Published: September 2020

We calculate the expected effects on the spectral energy distributions and light curves in X-ray binary jets from eclipses by the donor stars. Jets will be eclipsed for all inclination angles, with just the height along the jet where the eclipse takes place being set by the orbital parameters. Typically, eclipses will lead to 5–10 per cent reductions in the jet emission over a range of a factor of few in wavelength with a periodic modulation. In ideal systems with high inclination angles, relatively even mass ratios, and modest jet speeds, the eclipses may be deeper. We discuss how eclipses can be used to measure binary system parameters, as well as the height of the bases of the jets. We also discuss how, with data sets that will likely require future facilities, more detailed tests of models of jet physics could be made by establishing deviations from the standard recipes for compact conical flat spectrum jets and by determining the ingress and egress durations of the eclipses and measuring the transverse size of the jets. We provide representative calculations of expectations for different classes of systems, demonstrating that the most promising target for showing this effect in the radio band is the longer period ‘atoll’-class neutron star X-ray binaries, while in the optical and infrared bands, the best candidates are likely to be the most edge-on black hole X-ray binaries. We also discuss the effects of the outer accretion disc eclipsing the inner jet.
Dark Energy Survey Year 3 results: cosmology with moments of weak lensing mass maps – validation on simulations
Authors: Gatti M , Chang C , Friedrich O , Jain B , Bacon D , Crocce M , DeRose J , Ferrero I , Fosalba P , Gaztanaga E , Gruen D , Harrison I , Jeffrey N , MacCrann N , McClintock T , Secco L , Whiteway L , Abbott T M C , Allam S , Annis J , Avila S , Brooks D , Buckley-Geer E , Burke D L , Carnero Rosell A , Carrasco Kind M , Carretero J , Cawthon R , da Costa L N , De Vicente J , Desai S , Diehl H T , Doel P , Eifler T F , Estrada J , Everett S , Evrard A E , Frieman J , García-Bellido J , Gerdes D W , Gruendl R A , Gschwend J , Gutierrez G , James D J , Johnson M D , Krause E , Kuehn K , Lima M , Maia M A G , March M , Marshall J L , Melchior P , Menanteau F , Miquel R , Palmese A , Paz-Chinchón F , Plazas A A , Sánchez C , Sanchez E , Scarpine V , Schubnell M , Santiago S , Sevilla-Noarbe I , Smith M , Soares-Santos M , Suchyta E , Swanson M E C , Tarle G , Thomas D , Troxel M A , Zuntz J ,   (Des Collaboration)
Published: September 2020

We present a simulated cosmology analysis using the second and third moments of the weak lensing mass (convergence) maps. The second moment, or variances, of the convergence as a function of smoothing scale contains information similar to standard shear two-point statistics. The third moment, or the skewness, contains additional non-Gaussian information. The analysis is geared towards the third year (Y3) data from the Dark Energy Survey (DES), but the methodology can be applied to other weak lensing data sets. We present the formalism for obtaining the convergence maps from the measured shear and for obtaining the second and third moments of these maps given partial sky coverage. We estimate the covariance matrix from a large suite of numerical simulations. We test our pipeline through a simulated likelihood analyses varying 5 cosmological parameters and 10 nuisance parameters and identify the scales where systematic or modelling uncertainties are not expected to affect the cosmological analysis. Our simulated likelihood analysis shows that the combination of second and third moments provides a 1.5 per cent constraint on S8 ≡ σ8(Ωm/0.3)0.5 for DES Year 3 data. This is 20 per cent better than an analysis using a simulated DES Y3 shear two-point statistics, owing to the non-Gaussian information captured by the inclusion of higher order statistics. This paper validates our methodology for constraining cosmology with DES Year 3 data, which will be presented in a subsequent paper.
Relativistic accretion disc reflection in AGN X-ray spectra at z = 0.5–4: a study of four Chandra Deep Fields
Authors: Baronchelli L , Nandra K , Buchner J
Published: September 2020

We confirm that the spectra are best fit by a model containing two Compton reflection components, one from distant material, and the other displaying relativistic broadening, most likely from the inner accretion disc. The degree of relativistic broadening indicates a preference for high black hole spin, but the reflection is weaker than that expected for a flat disc illuminated by a point source. We investigate the Compton reflection signatures as a function of luminosity, redshift, and obscuration, confirming an X-ray Baldwin effect for both the narrow and broad components of the iron line. Anticorrelations are also seen with redshift and obscuring column density, but are difficult to disentangle from the Baldwin effect. Our methodology is able to extract information from multiple spectra with low signal-to-noise ratio (SN), and can be applied to future data sets such as eROSITA. We show using simulations, however, that it is necessary to apply an appropriate S/N cut to the samples to ensure the spectra add useful information.
Herbig–Haro flows around the BBWo 192E (GM 1–23) nebula
Authors: Magakian T Yu , Movsessian T A , Andreasyan H R , Bally J , Rastorguev A S
Published: September 2020

Looking for evidence of recent star formation, we have studied a small comet-shaped reflection nebula, known as BBWo 192E (GM 1–23), which is located in the dark cloud SL 4 in the Vela Molecular Ridge cloud C, and a young infrared cluster embedded into the nebula. We obtained the images of BBWo 192E in Hα and [S ii] lines and in a Sloan Digital Sky Survey i ′ filter with the Blanco telescope at the Cerro Tololo Inter-American Observatory in order to discover new Herbig–Haro (HH) flows. We used the Two-Micron All-Sky Survey and the Wide-field Infrared Survey Explorer to search for additional member stars of the cluster. We also studied the proper motions and parallaxes of the cluster members using GAIA Data Release 2. Five new groups containing at least nine HH objects, tracing several distinct outflows, were revealed. A previously unreported reflection nebula and a number of probable outflow sources were found in the infrared range. The proper motions allowed us to select eight probable member stars in the visual range. Their parallaxes correspond to a mean distance 800 ± 100 pc for this cluster. The bolometric luminosities of the brightest cluster members are 1010 L⊙ (IRAS 08513−4201, the strong source in the centre of the cluster) and 2–6 L⊙ for the five other stars. The existence of optical HH flows around the infrared cluster of young stellar objects suggests that star formation in this cloud is ongoing around the more massive Herbig Ae/Be star. Considering its morphology and other features, this star-forming region is similar to the zone of star formation near CPM 19.
External Validation of the Timed Up and Go Test as Measure of Objective Functional Impairment in Patients With Lumbar Degenerative Disc Disease
Authors: Stienen Martin N , Maldaner Nicolai , Sosnova Marketa , Zeitlberger Anna M , Ziga Michal , Weyerbrock Astrid , Bozinov Oliver , Gautschi Oliver P
Published: September 2020

BACKGROUND

The Timed Up and Go (TUG) test is the most commonly applied objective measure of functional impairment in patients with lumbar degenerative disc disease (DDD).

OBJECTIVE

To demonstrate external content validity of the TUG test.

METHODS

Consecutive adult patients, scheduled for elective lumbar spine surgery, were screened for enrollment into a prospective observational study. Disease severity was estimated by patient-reported outcome measures (PROMs; Visual Analog Scales [VAS], Core Outcome Measures Index [COMI] back, Zurich Claudication Questionnaire [ZCQ]) and the TUG test. Pearson correlation coefficients (PCCs) were used to describe the relationship between logarithmic TUG test raw values and PROMs

RESULTS

A total of 70 patients (mean age 55.9 ± 15.4 yr; 38.6% female; 27.1% previous spine surgery; 28.6% lower extremity motor deficits) with lumbar disc herniation (50%), lumbar spinal stenosis (34.3%), or instability requiring spinal fusion (15.7%) were included. The mean TUG test time was 10.8 ± 4.4 s; age- and sex-adjusted objective functional impairment (OFI) T-score was 134.2 ± 36.9. A total of 12 (17.1%) patients had mild, 14 (20%) moderate, and 9 (12.9%) severe OFI, while 35 (50%) had TUG test results within the normal population range (no OFI). PCCs between TUG test time and VAS back pain were r = 0.37 (P = .002), VAS leg pain r = 0.37 (P = .002), COMI back r = 0.50 (P < .001), ZCQ symptom severity r = 0.41 (P < .001), and ZCQ physical function r = 0.36 (P = .002).

CONCLUSION

This external validation demonstrated similar OFI rates and PCCs between logarithmic TUG test results and PROMs compared to the original article from 2016. These findings support the TUG test being a quick, easy-to-use objective test, which provides the physician with a robust estimate of pain and functional impairment.
Interval
Authors: Klumpenhouwer Henry
Published: September 2020

In the Western music-theoretical tradition, intervals are basic and foundational. They are also transhistorical, occupying theorists continually from classical origins to the present. Considering their foundational position, one might assume that intervals have a primitive, elementary character with little ideational content, and that the relevant literature is weakly innovative. Intervals appear within systems that reflect certain styles of thinking about musical objects and musical spaces. There are various modes of movement in those spaces, expressed as various counting rules, complicated by a tension between theoretical conventions that regard intervals as magnitudes and theoretical conventions that regard intervals as directed magnitudes. Reflecting on the relevant intuitions and exploring the systems associated with these conventions teaches us important lessons about foundational music-theoretical constructs in Western music theory.
Tonal Harmony
Authors: Quinn Ian
Published: September 2020

This chapter introduces a novel explanatory model for the tonal grammar of music from the thoroughbass era, encompassing baroque and galant practices. The framework models the internalized knowledge of a skilled continuo player improvising at the keyboard prior to Rameau’s invention of the fundamental-bass concept. It makes predictions about the tonal tendency of a chord based on the interaction of its constituent scale-degrees. The framework models something like Schenker’s “will of the tones,” predicting whether individual tones in a chord will tend to “feel” stabilized or mobilized. Stabilized tones tend to remain in place, and mobilized tones tend to move by step. These tendencies are regulated by the intervallic relations among notes in a chord, and can be expressed as two simple laws: a Law of Counterpoint that applies to generic pitch-class intervals regardless of which specific scale degrees they span, and a Law of Harmony that makes scale-degree-specific predictions.
Meter
Authors: Cohn Richard
Published: September 2020

This chapter presents a sketch of an analytical model of musical meter, focused on sound rather than notation. A meter is defined as a set of pulses, and classified as an ordered set of adjacent pulse pairs, or minimal meters. The model encourages a view of meter as ever-changing and form-shaping. Metric change is defined as pulse substitution. Scripts of metric change are illustrated through analyses of brief passages of Schumann, Glass, and Ghanian dance-drumming. Hypermeter and quasi-meter (that is, non-isochronous or additive meter) are conceived as complementary ways to generalize meter.
Monocytic MDSCs skew Th17 cells toward a pro-osteoclastogenic phenotype and potentiate bone erosion in rheumatoid arthritis
Authors: Chen Shixian , Guo Chunqing , Wang Ran , Feng Zhitao , Liu Zheng , Wu Lisheng , Zhao Di , Zheng Songyuan , Chen Feilong , Zhang Dingding , Xu Juan , Zhu Junqing , Chen Xiaoguang , Li Zhanguo , Wise Christopher M , Li Juan , Wang Xiang-Yang
Published: September 2020

Objectives

While myeloid-derived suppressor cells (MDSCs) were previously shown to promote a proinflammatory T helper (Th) 17 response in autoimmune conditions, a potential impact of the MDSC-Th17 immune axis on abnormal bone destruction in RA remains largely unknown.

Methods

We investigated the correlation between the frequency of MDSCs or its subsets and joint destruction in RA patients. The reciprocal actions of patient-derived MDSCs and Th17 cells were studied using osteoclast (OC) differentiation and bone resorption assays in vitro, which were further validated using mouse models of RA. Contribution of MDSCs to osteoclastogenesis and bone erosion in vivo was determined by depletion or transfer of MDSCs.

Results

Human MDSCs, particularly monocytic MDSCs (M-MDSCs), exhibit inherent OC-differentiating capacity and positively correlate with clinical bone erosion in RA patients. Strikingly, patient-derived M-MDSCs can program Th17 cells towards a pro-osteoclastogenic phenotype, which in return potentiates OC differentiation via the receptor activator of nuclear factor κΒ ligand (RANK-L)-RANK signalling. This enhanced osteolysis driven by the reciprocal actions of M-MDSCs and Th17 cells is further confirmed using mouse models of RA. Selective depletion of M-MDSCs significantly ameliorates osteoclastogenesis and disease severity in arthritic mice, whereas transfer of M-MDSCs aggravates bone erosion associated with increased OCs in recipient mice.

Conclusion

Our findings highlight the functional plasticity of MDSCs and identify a novel pro-osteoclastogenic pathway governed by interplay between myeloid cells and T lymphocytes in autoimmune RA.
Sleep duration and breast cancer incidence: results from the Million Women Study and meta-analysis of published prospective studies
Authors: Wong Angel T Y , Heath Alicia K , Tong Tammy Y N , Reeves Gillian K , Floud Sarah , Beral Valerie , Travis Ruth C
Published: September 2020

Study Objectives

To investigate the association between sleep duration and breast cancer incidence, we examined the association in a large UK prospective study and conducted a meta-analysis of prospective studies.

Methods

In the Million Women Study, usual sleep duration over a 24-h period was collected in 2001 for 713,150 participants without prior cancer, heart problems, stroke, or diabetes (mean age = 60 years). Follow-up for breast cancer was by record linkage to national cancer registry data for 14.3 years on average from the 3-year resurvey. Cox regression models yielded multivariable-adjusted breast cancer relative risks (RR) and 95% confidence intervals (CIs) for sleep duration categories. Published prospective studies of sleep duration and breast cancer risk were included in a meta-analysis, which estimated the inverse-variance weighted average of study-specific log RRs for short and for long versus average duration sleep.

Results

After excluding the first 5 years to minimize reverse causation bias in the Million Women Study, 24,476 women developed breast cancer. Compared with 7–8 h of sleep, the RRs for <6, 6, 9, and >9 h of sleep were 1.01 (95% CI, 0.95–1.07), 0.99 (0.96–1.03), 1.01 (0.96–1.06), and 1.03 (0.95–1.12), respectively. In a meta-analysis of 14 prospective studies plus the Million Women Study, including 65,410 breast cancer cases, neither short (RR < 7 h = 0.99 [0.98–1.01]) nor long (RR > 8 h = 1.01 [0.98–1.04]) versus average duration sleep was associated with breast cancer risk.

Conclusions

The totality of the prospective evidence does not support an association between sleep duration and breast cancer risk.
Myositis autoantibodies: recent perspectives
Authors: Riddell Victoria , Bagby Stefan , McHugh Neil
Published: September 2020

Purpose of review

To provide an overview of recent discoveries related to myositis-specific autoantibodies (MSAs) and assays used for their measurement.

Recent findings

New autoantibody specificities have been reported including a MSA directed against eukaryotic initiation factor 3 and a myositis-associated autoantibody directed against heat shock factor 1. The association of anti-TIF1γ with cancer-associated dermatomyositis dependent on age has been confirmed in several large cohorts. Despite MSAs being almost entirely mutually exclusive, several myositis autoantigens are overexpressed in regenerating muscle and do not correlate with the corresponding MSA in any one patient. Further mechanisms may determine the final MSA specificity and are likely to include the need for autoantigen processing and presentation with adaptive T-cell help. The presence of CD4-positive T cells specific for histidyl tRNA synthetase protein in bronchial lavage fluid from antisynthetase patients lends support to this view. Finally, it is widely held that MSA do play an important role in clinical practice among some evidence and concern about commercial assay reliability.

MSAs continue to provide important tools for clinical diagnosis and management as well as insights into disease mechanisms. Further improvement in the standardization and reliability of routine detection of MSAs is a high priority.
Monitoring disease activity and damage in adult and juvenile idiopathic inflammatory myopathy
Authors: Gupta Latika , Chinoy Hector
Published: September 2020

Purpose of review

We have reviewed the literature to identify significant advances related to disease activity and damage in the idiopathic inflammatory myopathies (IIMs) from January 2019 to July 2020.

Recent findings

New observations in the field from 2019 to 2020 have resulted in a better understanding of the clinical association and pathogenic origins of IIM. The use of patient-reported outcome measures and perspectives, identifying biomarkers and making better use of autoantibody testing are summarized. Basic sciences have led to an improved understanding of the role of NETosis in calcinosis, and of interferon type 1, in IIM. Preliminary insights are offered into Covid-19 in the setting of IIM, and the use of potential tools for monitoring disease remotely, which may assume larger importance for optimal disease management during a global pandemic. The wider exploration of newer imaging modalities and the use of nailfold capillaroscopy is a further step in better management of the condition.

The summarized research in IIM is a step forward in being able to further define, and to distinguish disease activity from damage, in order to potentially aid future clinical diagnosis and management in this challenging disease.
Faith Community Nursing
Authors: Long Sharon E. Plutko
Published: September 2020

As the incidence of diabetes rises in the United States, education on diabetes prevention and management is paramount. Diabetes programs offered in churches or community settings have reported positive outcomes such as weight loss and improved glucose control. Delphi Survey technique was used to identify spiritual interventions used by faith-based and community-based coaches in leading Diabetes Prevention Program (DPP) courses. Results showed that faith-based coaches reported using prayer, active listening, and emotional support in their DPP course; giving hope, incorporating humor, and using spiritual/sacramental activities were rated as important or very important by most coaches and can be used by faith community nurses in their practice.
Battling Stigma in Mental Health
Authors: Jones Moniaree P. , Wynn Stephanie T.
Published: September 2020

Stigma is consistently recognized as a major barrier in the recovery from mental illness (MI). In addition to stigma among the general population, the MI-related stigma among healthcare providers often creates critical obstacles to access and quality care. Nursing educators who used the photovoice participatory learning activity to teach students how to identify labeling and stigma observed an increase in mental health awareness.
The Greatest of These
Authors: Nelan Philip J.
Published: September 2020

Nurses have put themselves in precarious situations by caring for COVID-19 patients. Through the grid of faith, hope, and love as depicted in 1 Corinthians, the author commends the selfless work of nurses and esteems God's faithfulness to nurses who acknowledge him.
Spiritual Well-Being in Older Adults
Authors: Jones Christina L. Cummins
Published: September 2020

This concept analysis of spiritual well-being (SWB) in the older adult seeks to improve nurses' integration of spiritual care. Using Walker and Avant's method, the author identified five defining attributes of SWB: personal faith, religious practices, spiritual contentment, productive engagement, and healthy interpersonal relationships. Antecedents to SWB include awareness of one's spiritual needs and seeking to live a meaningful and purposeful life. Model, borderline, and contrary cases are presented to illustrate the defining attributes of SWB. Nursing implications for practice are discussed.
Food Intake During Cancer Therapy
Authors: Conigliaro Teresa , Boyce Lindsay M. , Lopez Carlos A. , Tonorezos Emily S.
Published: September 2020

Aim:

Conduct a systematic review of available evidence on food and beverage intake during cancer treatment.

Objective:

Determine what food or beverages consumed during cancer treatment might prevent recurrence, subsequent malignancies, treatment-related toxicity, or death.

Background:

Food and beverage intake, as well as weight status, can integrate with cancer treatment to mitigate treatment-related toxicities, support treatment success, and prevent recurrence. Yet, evidence-based recommendations are lacking.

Methods:

We searched PubMed, Embase, and Cochran for research studies conducted within the last 10 years on food and beverage consumption during cancer treatment, with no restrictions on age or cancer type. Two reviewers independently extracted information on intervention type, diet, and outcomes; these data were confirmed by a third reviewer.

Results:

Nineteen studies were selected from 1551 potential studies. Nine were randomized controlled trials, analyzing high protein diets, short-term fasting, low-fat diets, FODMAP diet, or comparing consumption of 1 specific food or nutrient, including Concord grape juice, onions, and fiber. The remaining 10 studies were observational or retrospective and tracked treatment symptoms, general dietary intake, or weight status as well as consumption of specific foods including nuts, coffee, sugar-sweetened beverages.

Conclusions:

Available evidence suggests food can be effective at ameliorating cancer treatment-related toxicities and improving prognosis, but more research is needed.
Glycerin-preserved Human-donor Corneoscleral Patch Grafts for Glaucoma Drainage Devices
Authors: Kitnarong Naris , Srikulsasitorn Benjawan , Aurboonsong Tanakorn
Published: September 2020

Precis:

Glycerin-preserved, human-donor, corneoscleral patch grafts are effective and safe for glaucoma drainage device (GDD) implantation, and they are comparable to previously reported materials. It can be preserved with the sterile technique for up to 12 months.

Purpose:

To evaluate the efficacy and safety of glycerin-preserved human donor corneoscleral tissue as the patch graft for GDD implantation.

Patients and Methods:

This was a retrospective noncomparative study from the medical records of 102 eyes from 102 glaucoma patients who underwent GDD implantation by or under supervision of a single surgeon (N.K.) at the Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand between January 2006 and December 2016. The glycerin-preserved human-donor corneoscleral tissue was used as the patch graft to cover the tube portion of GDD over the sclera. The primary outcome measure was the occurrence of patch graft–related complications.

Results:

There were 64 males and 38 females with the mean age of 52.8±18.5 years. The underlying diseases included failed filtration surgery with primary open-angle glaucoma 32 eyes and primary angle-closure glaucoma 15 eyes, congenital glaucoma 3 eyes and secondary glaucoma 52 eyes. The mean of ocular surgeries before GDD implantation was 2.3±1.1. Patch graft–related complications included tube exposure in 4 eyes (3.9%) and wound leakage in 4 eyes (3.9%). Eyes with tube exposure underwent regrafting 3 eyes and tube reposition 1 eye. Eyes with wound leaking resolved spontaneously 2 eyes and underwent conjunctival resuturing 2 eyes. The 5-year survival rate of the corneoscleral graft was 95.7%. There was no recurrence of graft-related complications after surgical procedure to correct the complications. Postoperatively, the mean of intraocular pressure and antiglaucoma medications decreased significantly from 27.4±9.8 mm Hg and 3.8±0.93 to 13.8±6.4 mm Hg (P<0.001) and 1.6±1.5 (P<0.001) at the last visit, respectively. The mean follow-up time was 59.9 months (range, 1 to 144.7 mo).

Conclusion:

The glycerin-preserved human-donor corneoscleral tissue using as the patch graft was a safe alternative for GDD tube coverage. The patch graft–related complications was comparable to other materials.
A Geodemographic Service Coverage Analysis of Travel Time to Glaucoma Specialists in Florida
Authors: Rothman Adam L. , Stoler Justin B. , Vu Daniel M. , Chang Ta C.
Published: September 2020

Precis:

Approximately 1 in 9 Florida residents over the age of 65 years (438,642 people) live more than an hour away from a glaucoma specialist, which represents a significant barrier to care.

Purpose:

To describe access to glaucoma care for Florida’s elderly population using travel time to American Glaucoma Society (AGS) member offices.

Methods:

For this cross-sectional service coverage analysis, a list of AGS member locations was extracted from the AGS website, and addresses were geocoded using ArcGIS Online. Driving time regions were created using the service area tool in ArcGIS Pro 2.4 and overlaid with 2010 United States Census and 2016 American Community Survey data for all Florida residents age 65 or older.

Results:

Fifty-eight AGS member providers with 65 locations were identified and geocoded. There were 3,797,625 individuals aged over 65 years in Florida, of which 1,153,320 (30.4%) lived within 15 minutes of driving time from an AGS provider’s office, 2,586,825 (68.1%) within 30 minutes, 3,358,983 (88.4%) within 60 minutes, and 3,491,815 (91.9%) within 120 minutes. The areas with the lowest access include rural areas near Lake Okeechobee and the Florida Panhandle. The population living beyond a 60-minute drive was more likely to be White, non-Hispanic and older, but less likely to be living below the federal poverty level or receiving public assistance than the population living within a 60-minute drive.

Conclusions:

There is a significant travel burden for the elderly community of Florida to reach AGS providers. Additional studies could help identify other social barriers to accessing glaucoma providers in Florida and beyond in an effort to improve patient compliance and, ultimately, vision outcomes.
New pharmacologic agents for insomnia and hypersomnia
Authors: Earl David C. , Van Tyle Kendall M.
Published: September 2020

Purpose of review

Insomnia and hypersomnia are conditions with multifactorial causes that can be difficult to treat. There have been recent developments and changes in the treatment of both conditions, including the addition of some agents that have a novel mechanism of action. This review summarizes recent changes and highlights pertinent updates.

Recent findings

Benzodiazepine receptor agonists received a warning in 2019 regarding the possibility of complex sleep behaviors, such as sleepwalking. Zolpidem has been marketed in new dosage forms that include sublingual tablets and oral spray formulations. Orexin receptor antagonists appear to be well tolerated with a good safety profile. Suvorexant received an approval for the treatment of patients with comorbid insomnia and dementia. Lemborexant was demonstrated to be effective for maintenance insomnia. Trazodone was shown to affect the oligomerization of tau proteins thus suggesting potential implications in attenuating dementia pathology. Pitolisant, a novel histamine-3 receptor antagonist/inverse agonist, gained approval for the treatment of excessive daytime sleepiness in adults with narcolepsy as well as obstructive sleep apnea. Solriamfetol, a new norepinephrine and dopamine reuptake inhibitor, was approved for hypersomnolence based on good efficacy, but with cardiovascular warnings.

Recent advancements in the treatment of insomnia includes agents with novel mechanisms, new indications, and new dosage forms. Risk of complex sleep behaviors, and possible next-day driving impairment, should be discussed for all agents used for insomnia, including orexin receptor antagonists. Novel agents also are available for hypersomnia and there are options beyond traditional stimulants that may have great utility.
Plasma TNFα and Unknown Factor/s Potentially Impede Erythroblast Enucleation Obstructing Terminal Maturation of Red Blood Cells in Burn Patients
Authors: Walczak Julia , Hasan Shirin , Shoaee Navid , Tromblay Dylan , Muthumalaiappan Kuzhali
Published: September 2020

Introduction:

In this study, using burn patient's peripheral blood mononuclear cells (PBMCs), we have shown that the Epo independent stage of terminal enucleation to reticulocyte formation is impeded in the presence of autologous plasma (BP). Furthermore, substitution with allogeneic control plasma (CP) from the healthy individual in place of BP rectified this enucleation defect. The exclusive role of burn microenvironment in late-stage erythropoiesis defect was further demarcated through control healthy human bone marrow cells cultured in the presence of CP, BP, and cytokines.

Methods:

PBMCs and human bone marrow (huBM) were differentiated ex vivo to enucleated reticulocytes in the presence of required growth factors and 5% CP or BP. Effect of systemic mediators in burn microenvironment like IL-6, IL-15, and TNFα was also explored. Neutralization experiments were carried out by adding varying concentrations (25 ng–400 ng/mL) of Anti-TNFα Ab to either CP+TNFα or BP.

Results:

Reticulocyte proportion and maturation index were significantly improved upon substituting BP with CP during differentiation of burn PBMCs. In the huBM ex vivo culture, addition of IL-6 and IL-15 to CP inhibited the proliferation stages of erythropoiesis, whereas TNFα supplementation caused maximum diminution at erythroblast enucleation stage. Supplementation with anti-TNFα in the BP showed significant but partial restoration in the enucleation process, revealing the possibility of other crucial microenvironmental factors that could impact RBC production in burn patients.

Conclusion:

Exogenous TNFα impairs late-stage erythropoiesis by blocking enucleation, but neutralization of TNFα in BP only partially restored terminal enucleation indicating additional plasma factor(s) impair(s) late-stage RBC maturation in burn patients.
Healthcare Provider Stress and Virtual Reality Simulation: A Scoping Review
Authors: Meese Merrick M. , O'Hagan Emma C. , Chang Todd P.
Published: September 2020

Summary Statement

Despite the significant role that stress plays in clinical care and education and the potential benefit of virtual reality (VR) as a simulation modality, there is a dearth of literature on stress and VR. The results of this scoping review have shown the positive effect that VR simulation can have on mitigating the negative aspects of stress during simulation and clinical training as well as improving provider performance and affect. Virtual reality technology, and immersive VR specifically, has the potential to powerfully transform how simulation education is being conducted. Because of this, the authors encourage researchers to put more focus into this topic and in determining how VR can be used to provide simulations with excellent training and a strong sense of presence for the purpose of addressing how stress can impact learners' clinical training and performance.
Do Women Who Self-report More Exercise Have Increased Rates of Symptomatic Stress Urinary Incontinence After Midurethral Slings?
Authors: Ferrante Kimberly L. , Gantz Marie G. , Sridhar Amaanti , Smith Ariana , Rahn David D. , Ellington David R. , Weidner Alison C. , Wohlrab Kyle , Mazloomdoost Donna , Moalli Pamela , Lukacz Emily S. ,   for the NICHD Pelvic Floor Disorders Network
Published: September 2020

Objectives

There is a paucity of data on postoperative exercise and how it relates to surgical failure, specifically after midurethral sling (MUS) surgery. We aimed to assess if women with higher self-reported activity levels as measured by strenuous exercise are more likely to experience stress urinary incontinence (SUI) symptoms after MUS than women with lower self-reported activity.

Methods

This is a secondary analysis of Operations and Pelvic Muscle Training in the Management of Apical Support Loss: the OPTIMAL Trial, a randomized trial comparing sacrospinous ligament suspension versus uterosacral ligament suspension, both with concomitant retropubic MUS. Participants completed a validated assessment of activity preoperatively and postoperatively. Women in the upper quartile for strenuous exercise (≥90 minutes per week) were compared with the remaining participants. Symptomatic SUI was defined as retreatment or reoperation for SUI and/or any positive response to Pelvic Floor Disorders Inventory stress incontinence questions 20 to 22.

Results

A total of 351 participants in the OPTIMAL study received MUS along with their prolapse repair and had postoperative exercise and Pelvic Floor Disorders Inventory data. At 2 years, 87 (29%) of 305 exercised strenuously for at least 90 minutes per week, and 63 (23%) of 277 experienced SUI. Women who were less active at 2 years were significantly more likely to experience SUI than women who were more active (26.6% vs 12.8%, P = 0.0138).

Conclusions

In this study, symptomatic SUI occurred more frequently in women with lower self-reported exercise levels 2 years after MUS surgery.