bluuebunny/crossref_metadata_2025 huggingface dataset:
The Sedation Continuum
Authors: van der Jagt Élise W.
Published: January 2019

When patients undergo procedural sedation/analgesia, they enter into a sedation continuum. Several levels have been formally defined along this continuum: minimal sedation/anxiolysis, moderate sedation, deep sedation, and at the deepest level, general anesthesia. An additional and somewhat separate level in the sedation continuum is dissociative sedation, which has its own unique characteristics. Given the dynamic nature of the sedation process, a patient will move in and out of these defined levels (as well as intermediate ones) depending on the agents and dosing used, the procedures being performed, and a patient’s own unique characteristics and physiologic responses. At all times, the provider of procedural sedation/analgesia must be able to recognize the sedation levels attained by the patient and be ready to manage any potential adverse events.
Risk Assessment
Authors: Buckmaster Mark A.
Published: January 2019

Evaluation of patient risk is a critical aspect of the presedation phase of care. For scheduled procedures and tests, information obtained during the prescreening process is incorporated into the formal assessment of the patient at the time of the procedure. If the prescreening process has been sufficiently rigorous, the patient is likely to be appropriately prepared for sedation and the day-of-procedure evaluation (procedure screen) should be able to be done quickly, efficiently, and safely. The presedation evaluation represents the final step prior to the initiation of sedation. This is where all interval information and findings are fused to develop the overall sedation plan. Appropriate integration of a rigorous prescreening process with a careful presedation review allows for the most comprehensive and safe approach to pediatric procedural sedation. Specific patient conditions that pose additional significant risk during procedural sedation are further discussed.
Ventilation—Observation, Capnography, and Precordial Stethoscope
Authors: Couloures Kevin G.
Published: January 2019

A variety of monitoring techniques can be used to ensure adequate ventilation during sedation. Three of the methods are direct observation, precordial/pretracheal stethoscope, and end-tidal CO2 monitoring. Direct observation is simple and effective but may miss subtle changes and is difficult when the room is darkened or the patient is covered. Precordial stethoscopes are frequently utilized during dental procedures and can help detect changes in respiration or the need for suctioning. MRI-compatible versions are available, but the practitioner needs to be within 4 feet of the patient. End-tidal CO2 monitoring gives the most information about the adequacy of ventilation but requires costly equipment and placement of a specialized nasal cannula or mask on the child’s face. The benefit of utilizing any of these modalities is that changes in ventilation will precede changes in oxygenation. Hence, early recognition of change can help prevent respiratory compromise.
Cardiology
Authors: Phelps Janey
Published: January 2019

Congenital heart disease is the most common type of birth defect and is estimated to affect nearly 1% of all births per year in the United States. Echocardiograms are necessary to fully evaluate these defects, and depending on the age of the child, sedation may be required to ensure optimal imaging. This chapter discusses the sedation/anesthesia options for transthoracic echocardiography, transesophageal echocardiography, and cardioversion. For all of these procedures high-risk patients should be triaged to a pediatric anesthesia provider and in some cases, a pediatric cardiac anesthesiologist. Transthoracic echocardiograms can be completed with distraction and/or minimal sedation with oral or intranasal midazolam. If moderate sedation is required due to patient characteristics or previous history of failure with minimal sedation, intranasal dexmedetomidine is a good option. Transesophageal echocardiography is an invasive procedure; patients <2 years of age should be intubated and those >2 years of age can maintain a native airway with deep sedation with propofol. The need for cardioversion is infrequent in pediatrics but when needed, propofol is a good choice.
Child Life Specialists and Nonpharmacologic Interventions
Authors: Mitchell Laura , Tatem Christine
Published: January 2019

This chapter discusses the role of the child life specialist in the multidisciplinary pediatric sedation team and the various nonpharmacologic techniques that may be used to attenuate the fear, anxiety, and pain responses of children undergoing procedural care. Child life specialists are an integral component of the sedation team. Their assessments can help the team develop a plan of care, and they offer insight into how to provide developmentally appropriate education as well as psychosocial and emotional support to pediatric patients and their families. Nonpharmacologic techniques that have been shown to be effective in reducing pain and anxiety for children undergoing medical procedure include setting up the environment, parental presence, positioning for comfort, and distraction. Considerations for infants are also discussed. The chapter includes a table of appropriate language to use with children and another with a summary of age-appropriate distraction techniques. The ONE VOICE© model is included as a reference for practitioners to use in daily practice.
Atrial Fibrillation
Authors: Sheerer Christopher , Ruetzler Kurt
Published: January 2019

Atrial fibrillation is the most common arrhythmia worldwide and carries a high rate of mortality if not properly treated. Numerous theories exist in terms of its pathophysiology, with the leading theory demonstrating abnormalities in ectopic electrical pathways originating from the pulmonary veins leading into the atria. The anesthesiologist must be familiar with this arrhythmia as it commonly presents in the perioperative period. Atrial fibrillation arising during surgery requires prompt attention and treatment, and the anesthesiologist should know how to respond accordingly. Catheter ablation is a common non-operating room procedure that requires the anesthesiologist’s knowledge and attention about the procedure, patient positioning, intraoperative monitoring, and complications that may arise from the procedure. Furthermore, an anesthesiologist should be adept to caring for patients in the postoperative period who develop atrial fibrillation and understand the various treatment options.
Lower Extremity Claudication
Authors: Kothari Perin , Diehl Rachel , Argalious Maged
Published: January 2019

Lower extremity claudication is an extremely common symptom of peripheral vascular disease. Advancements in revascularization therapies often bring patients with this condition to the operating room, making this disease relevant for anesthesiologists. It is important to understand the comorbidities associated with this disease in order to assess the patient for readiness for the operating room. In addition, the dynamics of the procedure often necessitate certain intraoperative monitoring requirements. There is controversy regarding the best anesthetic management for these patients, whether it be general or neuraxial anesthesia. Finally, postoperative pitfalls and complications that can arise in the postoperative recovery area are discussed.
Active Pheochromacytoma
Authors: Joseph Vilma , Okafor Chukwuemeka
Published: January 2019

Pheochromocytomas present themselves as a management challenge not only to anesthesiologists but to surgeons and nonoperative medical professionals. From determining the initial diagnosis to its removal, the effects this tumor has on the body must be appreciated. This chapter provides an overview of pheochromocytoma and its background but, more importantly, goes into depth about its perioperative treatment and management in the perioperative setting. The chapter uses a case study of a 45-year-old patient who has been diagnosed with a pheochromocytoma and is presenting for a right partial adrenalectomy. In addition to anesthesia concerns, topics covered include metanephrine levels, paraganglioma, and endocrine neoplasia syndromes.
Anesthetic Management of a Patient with Multiple Laryngeal Papillomatosis
Authors: Rao Shilpa
Published: January 2019

Laryngeal papillomatosis is a rare disease, caused by human papilloma virus infection. It can present with various respiratory signs and symptoms, including but not limited to hoarseness, respiratory distress, and stridor. Anesthetic management of this condition is challenging due to multiple factors such as shared airway with the ear, nose, and throat surgeon, potential difficult airway, and associated complications related to jet ventilation and/or laser use in the airway. The chapter discusses the most important and clinically relevant facts related to this condition. Topics covered include difficult airway, airway laser airway fire, jet ventilation, and barotrauma. A case study of a 55-year-old overweight male patient who presents to the operating room for an elective removal of his recurrent laryngeal papillomas is used as an example.
Anesthesia for Carpal Tunnel Surgery
Authors: Choice Curtis
Published: January 2019

Carpal tunnel surgery to release the entrapped median nerve is a common outpatient procedure performed in ambulatory surgery centers. The more common, traditional technique is the open carpal tunnel release. The newer minimally invasive surgical technique is the endoscopic carpal tunnel release. The most common anesthetic technique is monitored anesthesia care consisting of intravenous sedation with local anesthetic infiltration by the surgeon. Intravenous local anesthesia, the Bier block, was previously offered as an alternative to general anesthesia. Wide awake local anesthesia no tourniquet surgery or wide awake hand surgery is an option growing in popularity. Finally, ultrasound-guided peripheral nerve blocks can be performed for procedures on the upper extremity. The shifting of outpatient surgeries from the hospital to ambulatory surgery centers has placed an emphasis on patient selection and utilizing monitored anesthesia care and regional anesthesia in place of general anesthesia for outpatient procedures.
Integrative Nursing and Care of the Human Spirit
Authors: Quinn Janet F.
Published: January 2019

Life’s big questions and the search for meaning underlie all spiritual issues in healthcare, and so, conscious or not, the issues are already there. Thus, while the symptom of “spiritual distress” can arise in the healthcare context, it is important to identify it as a subset of a much larger focus for integrative nurses, namely, tending the human spirit. This chapter explores an integrative nursing approach to spirituality: how the integrative nurse tends the human spirit and addresses the symptom of spiritual distress if and when it arises. Issues covered include the moral, human, legal and ethical, and evidence imperatives to engage in an integrative approach. Tools for an integrative nursing approach and a case example are presented.
Integrative Nursing Management of Grief
Authors: O’Conner-Von Susan
Published: January 2019

Everyone has experienced grief as a response to a significant loss or change. This chapter presents an integrative nursing approach to grief. Types of grief are described, including anticipatory grief, uncomplicated grief, and complicated grief. These different types of grief are explained and differentiated from normal grief. Assessment of grief using assessment tools such as the Inventory of Complicated Grief, Brief Grief Questionnaire Marwit-Meuser Caregiver Grief Inventory, Marwit-Meuser Caregiver Grief—short form, Hogan Grief Reaction Checklist, and Texas Revised Inventory of Grief are discussed, and selected integrative therapy approaches are described. A patient exemplar is offered that illustrates the use of integrative therapies and whole-person care.
Whole-Systems Leadership and Healing
Authors: Kreitzer Mary Jo
Published: January 2019

Social issues in education, housing, employment and the environment are linked and have a major impact on health comes. Effective leadership is collaborative and grounded in the shared values of people who work together to effect positive change. Whole-systems leadership builds capacity for adaptability, learning, and innovation. In displaying whole-system leadership, integrative nurses much engage in deep listening, have an awareness of the systems in which they are operating, have an awareness of self, seek diverse perspectives, suspend and embrace uncertainty when appropriate, and be ready take adaptive action. This chapter discusses whole-systems leadership in the context of integrative nursing and healing.
Building an Integrative Health Program
Authors: Kreitzer Mary Jo
Published: January 2019

Aligning an integrative health initiative or program with the organization’s mission, vision, and values is critical. Implementation of integrative therapies is an effective strategy to achieve organizational goals. Understanding the needs of stakeholders and end users is a critical first step. This chapter discusses building an integrative health program in the context of organizational and system change. The emphasis is on the Triple Aim initiative, which focuses on the simultaneous pursuit of three aims: improving the health of the population, enhancing the patient experience of care (including quality, access, and reliability), and reducing the per capita cost of care. Design, implementation, and evaluation are covered.
War-Related PTSD in Black, Hispanic, and Majority White Vietnam Veterans
Authors: Dohrenwend Bruce P. , Turner J. Blake , Turse Nick , Lewis-Fernández Roberto , Yager Thomas J.
Published: January 2019

This chapter investigates elevated prevalence of chronic PTSD for black and Hispanic Vietnam veterans. Previous research relied on retrospective reports of war-zone stress and on PTSD assessments that failed to distinguish between prevalence and incidence. This chapter addresses these limitations using record-based exposure measures and clinical diagnoses on a subsample of NVVRS veterans. Compared with majority white, it explains the black elevation by blacks’ greater exposure to combat and the Hispanic elevation by Hispanics’ greater exposure, younger age, lesser education, and lower Armed Forces Qualification Test (AFQT) scores. Hispanics’ younger age mainly accounts for the PTSD elevation in Hispanics versus blacks. The main reason for the group differences in severity of exposure appears to be racial-ethnic contrasts in the military branches in which the veterans served.
Families of Veterans
Authors: Yager Thomas J. , Gerszberg Nicole , Dohrenwend Bruce P.
Published: January 2019

This chapter focuses on wives or partners and offspring of a subsample of 115 clinically diagnosed male Vietnam veterans who had one or more children aged 6–16 at the time of the NVVRS. It defines veteran traumatization as meeting criteria for lifetime war-related PTSD. Secondary traumatization is operationalized by elevated scores on children’s internalizing or externalizing behavior problems and on wives’ demoralization. This chapter reports evidence of secondary traumatization in the veterans’ sons. Current PTSD in the veterans is associated with demoralization in their wives or partners, which in turn is associated with behavior problems in their daughters. Demoralization of the wife or partner is also associated with current alcoholism in the veterans. Even with the degree of secondary traumatization present, the veterans’ children appear at least as healthy as their counterparts in the general population.
Veterans’ Appraisals of the Impact of the War on Their Lives 10-Plus Years After the War Ended
Authors: Dohrenwend Bruce P. , Yager Thomas J. , Neria Yuval , Turner J. Blake , Turse Nick , Marshall Randall , Lewis-Fernández Roberto , Koenen Karestan C.
Published: January 2019

This chapter presents findings that the large majority (between 61.8% and 70.9%) of U.S. male veterans in the NVVRS sample appraised the impact of Vietnam service on their personal lives as mainly positive, and that negative appraisals, especially those with high salience (i.e., importance), are strongly associated with PTSD onset and current PTSD. A substantial minority (41.7%) judged the effects to be highly salient in their present lives. It investigates the valence and salience of these appraisals in relation to PTSD and other indicators of wartime and post-war functioning. The results are consistent with the hypothesis that mainly positive appraisals are affirmations of successful wartime and post-war adaptation rather than defensive denials related to maladaptive outcomes. It discusses the possibility that mainly positive appraisals, especially those with low salience, also contribute to successful post-war adaptation.
Variability Versus Diversity in Variety
Authors: Montgomery Erwin B.
Published: January 2019

Making sense of the enormous variety of patient phenomena creates the epistemic conundrum. Is each and every patient taken as a unique entity, or is there an economical set of principles and facts from which each and every patient can be reconstructed? Empiric medicine favors the former, risking Solipsism of the Present Moment. Rationalist/allopathic medicine favors the latter but makes application of knowledge to the individual patient problematic. The conundrum cannot be resolved by simply taking the “average” of all patients or some other measure of central tendency. While it is possible to find the average weight of animals in Dundas, Ontario, it would have little meaning, except perhaps in exceptional circumstance. A central question in statistics is whether the mean (average) reflects the true nature of the phenomenon or does its range (variance)? Assuming the former is greatly enabling in medical decision-making and research but may be misleading.
Necessary Presuppositions
Authors: Montgomery Erwin B.
Published: January 2019

Metaphysics has been a pejorative term since rejection of the medieval scholastic natural philosophers by the early modern scientists. Since that time, there has been the presumption that “data” speak for themselves and that data are self-evident. Metaphysics was seen as just so much philosophical speculation—science was above that, as was the rationalist/allopathic physician. However, the antipathy to enjoining metaphysics likely is due to a misunderstanding of metaphysics. Any time a theory or hypothesis is invoked, it necessarily goes beyond the data and consequently is a metaphysical exercise. Indeed, responses to the epistemic conundrum are metaphysical choices. Importantly, the metaphysical presumptions shape observations, such as what observations are relevant to a clinical or research question (the a priori problem of induction). Notable examples of metaphysical presuppositions are seen in the development of the cell theory and the derivative pathological–clinical correlations that propelled allopathic medicine.
The researchers’ role in re-constructing patient narratives to present them as patient experiences
Authors: Koschack Janka , Himmel Wolfgang
Published: January 2019

According to Arthur W. Frank, illness is a call for stories. It is widely accepted that a narrative approach in medicine improves health care outcomes and there is some evidence that listening to illness stories of others has a positive effect also on fellow patients. However, when researchers collect patient narratives and prepare them to be used by, and to help, patients or other sufferers, they may change the nature of the narratives. This chapter shows how illness narratives are arranged on DIPEx websites as short statements and summarized under certain topics—with the aim to represent the whole range of patient experiences. It then discusses why people may listen to patient experiences, for example, to make informed choices on the basis of evidence-based experiential information, and/or to use experiences of others as ‘companion stories’ to complete their own illness narrative and to give it a ‘gestalt’.
An illness narrative or a social injustice narrative?
Authors: Lavie-Ajayi Maya , Nakash Ora
Published: January 2019

This chapter discusses the difficulty faced by therapists when, instead of a story of emotional problems, they are presented in the course of a professional consultation with a narrative about social injustice. The chapter includes a detailed analysis of a single intake session and subsequent post-intake interviews, taken from a large study on intakes in mental health clinics with culturally diverse populations in Israel. The client–subject of this chapter presented herself to a mental health facility, claiming a state of crisis due to the downgrading of her employment status, which she attributed to systematic corporate injustice. During the intake interview, there were a number of disagreements between the client and the therapist. While the client sought to relate a narrative of injustice, the therapist insisted on identifying an illness narrative. This chapter argues that the battle of narratives is a political battle, and highlights the political power wielded by therapists in defining diagnoses and treatment recommendations.
Scope of epidemiological enquiry and overview of main problem areas
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

Epidemiology can be considered as a suite of methodologies designed to inform on aspects of health and disease in human populations. They have been designed to cope with the variability between people in the risk for diseases and their course and response to treatments. There are many aspects of epidemiological study that are challenging and the successful study requires attention to the design, conduct of the study, and analysis of the data generated. There is another view of epidemiology, which is that it is a tool for studying diseases as they occur in human populations. The focus can also be on diagnosis, outcome, and results of interventions, as well as on causes. This broader definition allows a greater scope for the kinds of question that can be addressed both by those studying the health of populations and by those whose main focus is the study of disease in patient groups.
Comparing rates between and within populations
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

In comparing rates between populations, it is important that one is comparing ‘like with like’. One population may be considerably older than a population to which it is compared and therefore it would not be surprising that mortality rates were higher. Instead it is more useful to make comparisons taking account of differences in characteristics such as age or gender. The same considerations apply to examining disease rates over time in a given population. If the characteristics of the population change over time (e.g. the population gets older), this needs to be considered. To formulate hypotheses, the rate of a disease under study in a population may be compared with the rate in other populations, or in the same population at difierent time points. If the rates vary significantly between populations or are changing within a population, then this provides impetus for investigating the reasons underlying these differences or changes.
Repeatability
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

There are many sources of variability in measures in epidemiology. Subjects can vary in their response because of real change. Alternatively, the method of collecting data may be subject to variability because of differences in techniques or the inherent difficulty in some measures in ensuring consistency. Too much variability can introduce ‘noise’, making it difficult to find differences between populations. There may be a variety of reasons for failure to obtain consistent or reproducible results. This chapter describes various methods which can be employed to calculate the level of variability in measures used and how to minimize the sources of this.
Confounding
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

An apparent relationship between a disease and a risk factor may be explained (confounded) by their joint association with an intermediate third ‘true’ risk factor. The issue here is not one of impaired validity; if the study had been carefully conducted then the relationship observed was correct and the problem of confounding is therefore one of interpretation. Confounding can only be proved after appropriate analysis. Further confounding as an explanation of an association is not (or is only extremely rarely) an all-or-nothing phenomenon. The effect of confounding will be, more usually, to alter the strength of an apparent relationship between two variables (e.g. risk factor and disease).
EQ-5D Quality-of-Life Analysis and Cost-Effectiveness After Skull Base Meningioma Resection
Authors: Karsy Michael , Jensen Michael R , Guan Jian , Ravindra Vijay M , Bisson Erica F , Couldwell William T
Published: January 2019

BACKGROUND

Skull base meningioma management is complicated by their proximity to intracranial neurovascular structures because complete resection may pose a risk of worsening morbidity.

OBJECTIVE

To assess the influence of clinical outcomes and surgical management on patient-perceived quality-of-life outcomes, value, and cost-effectiveness.

METHODS

Patients who underwent resection of a skull base meningioma, had adequate clinical follow-up, and completed EQ-5D-3L questionnaires preoperatively and at 1 mo and 1 yr postoperatively were identified in a retrospective review. Cost data from the Value Driven Outcomes database were analyzed.

RESULTS

A total of 52 patients (83.0% women, mean age 51.9 yr) were categorized by worsened (n = 7), unchanged (n = 24), or improved (n = 21) EQ-5D-3L index scores at 1-mo follow-up. No difference in subcategory cost contribution or total cost was seen in the 3 groups. Patients with improved scores showed a steady improvement through each follow-up period, whereas those with unchanged or worsened scores did not. Mean quality-adjusted life years (QALYs) and cost per QALY improved for all groups but at a higher rate for patients with better outcomes at 30-d follow-up. Female sex, absence of proptosis, nonfrontotemporal approaches, no optic nerve decompression, and absence of surgical complications demonstrated improved EQ-5D-3L scores at 1-yr follow-up. A mean cost per QALY of $27 731.06 ± 22 050.58 was observed for the whole group and did not significantly differ among patient groups (P = .1)

CONCLUSION

Patients undergoing resection of skull base meningiomas and who experience an immediate improvement in EQ-5D are likely to show continued improvement at 1 yr, with improved QALY and reduced cost per QALY.
The Spectrum of Trigeminal Neuralgia Without Neurovascular Compression
Authors: Magown Philippe , Ko Andrew L , Burchiel Kim J
Published: January 2019

BACKGROUND

In trigeminal neuralgia type 1 (TN1), neurovascular compression (NVC) is often assumed to be the pain initiating mechanism. NVC can be surgically addressed by microvascular decompression (MVD). However, some patients with TN1 present without NVC (WONVC).

OBJECTIVE

To characterize and analyze the clinical spectrum of a TN1 patient population WONVC.

METHODS

A retrospective chart review of patients presenting with TN1 between 2007 and 2017 was performed. Patients who were potential candidates for MVD surgery underwent high-resolution imaging with 3-dimensional (3D) reconstruction to address the presence, or absence, of NVC. Demographic data about the populations with NVC (WNVC) and WONVC were collected.

RESULTS

Of 242 patients with TN1, 32% did not have NVC. Patients WONVC were on average 10.6 yr younger than those WNVC. TN1 onset in patients WONVC was more frequent below 48.7 yr, and the opposite was found in patients WNVC. Compared to patients WNVC, those WONVC were predominantly female (odds ratio 4.8), on average were 4 yr younger at symptom onset (34.7 yr) and 7.8 yr younger at first clinic visit, and had a 3.7 yr shorter symptom duration.

CONCLUSION

Patients presenting with TN1 WONVC were predominantly females in their mid-30s with short symptom duration. In the absence of NVC, this subgroup of TN1 patients has limited surgical options, and potentially a longer condition duration that must be managed medically or surgically. This population WONVC might provide insights into the true pathophysiology of TN1.
Infrared luminosity functions based on 18 mid-infrared bands: revealing cosmic star formation history with AKARI and Hyper Suprime-Cam
Authors: Goto Tomotsugu , Oi Nagisa , Utsumi Yousuke , Momose Rieko , Matsuhara Hideo , Hashimoto Tetsuya , Toba Yoshiki , Ohyama Youichi , Takagi Toshinobu , Chiang Chia-Ying , Kim Seong Jin , Kilerci Eser Ece , Malkan Matthew , Kim Helen , Miyaji Takamitsu , Im Myungshin , Nakagawa Takao , Jeong Woong-Seob , Pearson Chris , Barrufet Laia , Sedgwick Chris , Burgarella Denis , Buat Veronique , Ikeda Hiroyuki
Published: January 2019

Much of star formation is obscured by dust. For a complete understanding of the cosmic star formation history (CSFH), infrared (IR) census is indispensable. AKARI carried out deep mid-infrared observations using its continuous nine-band filters in the North Ecliptic Pole (NEP) field (5.4 deg2). This took a significant amount of the satellite’s lifetime, ∼10% of the entire pointed observations. By combining archival Spitzer (five bands) and WISE (four bands) mid-IR photometry, we have, in total, 18-band mid-IR photometry, which is the most comprehensive photometric coverage in the mid-IR for thousands of galaxies. However, we only had shallow optical imaging (∼25.9 AB magnitude) in a small area, 1.0 deg2. As a result, thousands of AKARI’s infrared sources remained undetected in the optical. Using the new Hyper Suprime-Cam on the Subaru telescope, we obtained deep enough optical images of the entire AKARI NEP field in five broad bands (g ∼ 27.5 mag). These provided photometric redshift, and thereby IR luminosity, for the previously undetected faint AKARI IR sources. Combined with the accurate mid-IR luminosity measurement, we constructed mid-IR luminosity functions (LFs), and thereby performed a census of dust-obscured CSFH in the entire AKARI NEP field. We have measured rest-frame 8 μm and 12 μm LFs, and estimated total infrared LFs at 0.35 < $z$ < 2.2. Our results are consistent with our previous work, but with much reduced statistical errors thanks to the large-area coverage of the new data. We have possibly witnessed the turnover of CSFH at $z$ ∼ 2.
Matching in Housing Markets: The Role of Ethnic Social Networks
Authors: Agarwal Sumit , Choi Hyun-Soo , He Jia , Sing Tien Foo
Published: January 2019

This paper investigates the role of ethnic matching between buyers and sellers in Singapore’s public housing market. We find that sellers sell homes in blocks with a high concentration of their own (other) ethnic group(s) at significant premiums (discounts). Chinese sellers earn 1.7% higher premiums when selling homes to Chinese buyers in high Chinese concentrations housing blocks, but Malay sellers accept 1.6% discounts from Malay buyers in the same blocks. We find that the high volume of within-ethnicity transactions with the price discounts is supported by the ethnic social networks, that is, through ethnicity-specialized real estate agents.

Received May 3, 2017; editorial decision July 4, 2018 by Editor Stijn Van Nieuwerburgh.
Polypharmacy is associated with treatment response and serious adverse events: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis
Authors: Bechman Katie , Clarke Benjamin D , Rutherford Andrew I , Yates Mark , Nikiphorou Elena , Molokhia Mariam , Norton Sam , Cope Andrew P , Hyrich Kimme L , Galloway James B
Published: January 2019

Objective

To evaluate whether polypharmacy is associated with treatment response and serious adverse events (SAEs) in patients with RA using data from the British Society for Rheumatology Biologics Register (BSRBR-RA).

Methods

The BSRBR-RA is a prospective observational cohort study of biologic therapy starters and a DMARD comparator arm. A logistic regression model was used to calculate the odds of a EULAR ‘good response’ after 12 months of biologic therapy by medication count. Cox proportional hazards models were used to identify risk of SAEs. The utility of the models were compared with the Rheumatic Disease Comorbidity Index using Receiver Operator Characteristic and Harrell’s C statistic.

Results

The analysis included 22 005 patients, of which 83% were initiated on biologics. Each additional medication reduced the odds of a EULAR good response by 8% [odds ratios 0.92 (95% CI 0.91, 0.93) P < 0.001] and 3% in the adjusted model [adjusted odds ratios 0.97 (95% CI 0.95, 0.98) P < 0.001]. The Receiver Operator Characteristic demonstrated significantly greater areas under the curve with the polypharmacy model than the Rheumatic Disease Comorbidity Index. There were 12 547 SAEs reported in 7286 patients. Each additional medication equated to a 13% increased risk of an SAE [hazard ratio 1.13 (95% CI 1.12, 1.13) P < 0.001] and 6% in the adjusted model [adjusted hazard ratio 1.06 (95% CI 1.05, 1.07) P < 0.001]. Predictive values for SAEs were comparable between the polypharmacy and Rheumatic Disease Comorbidity Index model.

Conclusion

Polypharmacy is a simple but valuable predictor of clinical outcomes in patients with RA. This study supports medication count as a valid measure for use in epidemiologic analyses.
Migrant and/or Care Workers? Debating the Ethnicization of the Elderly Care Market in Italy and the United Kingdom
Authors: Ranci Costanzo , Arlotti Marco , Cerea Stefania , Cordini Marta
Published: January 2019

Care marketization has generally supported ethnicization of care work in many countries. While economic and institutional theories have explained how migrants have been included as functional workers, the social inclusion of them in the hosting societies has been largely neglected. Focusing on the role of ideas and public discourse, this article considers through a content analysis of newspaper articles how the role of migrant care workers has been the object of public discussion in two countries characterized by care marketization: Italy and the United Kingdom. It shows how ethnicized care markets have been differently legitimized through distinct social and cultural dynamics
Pathophysiological responses of pine defensive metabolites largely lack differences between pine species but vary with eliciting ophiostomatoid fungal species
Authors: Cale Jonathan A , Klutsch Jennifer G , Dykstra Christien B , Peters Brosnon , Erbilgin Nadir
Published: January 2019

Phytopathogenic ophiostomatoid fungi are common associates of bark beetles and contribute to beetle-associated mortality of trees. Mountain pine beetle outbreaks in Canada are facilitating novel associations between its vectored fungi (Grosmannia clavigera, Leptographium longiclavatum and Ophiostoma montium) and jack pine. How the induced defense-related metabolite responses of jack and lodgepole pines vary in response to the fungi is unknown. Understanding this variation is important to clarifying pine susceptibility to and the physiological impacts of infection. We used a comparative metabolite profiling approach to investigate the defense-related signaling, carbon utilization/mobilization, and synthesis responses of both pines to the fungi. Both pine species largely exhibited similar metabolite responses to the fungi. The magnitude of pine metabolite responses positively reflected pathogen virulence. Our findings indicate that pines can recognize and metabolomically respond to novel pathogens, likely due to signals common between the novel fungi and fungi coevolved with the pine. Thus, jack pine is likely as susceptible as lodgepole pine to infections by each of the MPB-vectored fungi. Furthermore, the magnitude of the metabolite responses of both pines varied by the eliciting fungal species, with the most virulent pathogen causing the greatest reduction in carbohydrates and the highest accumulation of defensive terpenes.
Contributions of day length, temperature and individual variability on the rate and timing of leaf senescence in the common lilac Syringa vulgaris
Authors: Aikio Sami , Taulavuori Kari , Hurskainen Sonja , Taulavuori Erja , Tuomi Juha
Published: January 2019

Deciduous trees prepare for winter by breaking up chlorophyll and other nitrogen-rich compounds, which are resorbed for storage. Timing is important as senescence too early will waste growing season, while senescence too late risks the loss of the leaf resources to frost. While plants of temperate and boreal regions use decreasing day length as a cue of approaching winter, we show that decreasing temperature may also play a role in the variability of leaf senescence. We investigated the timing of autumnal decrease in photosynthetic efficiency and the concentration of chlorophyll and total carotenoids in nine common lilac (Syringa vulgaris L.) trees over two consecutive years. Day length explained a greater proportion of photosynthetic efficiency, but temperature had a significant additional role, which seems to be related to individual differences. Precipitation and cloudiness did not explain photosynthetic efficiency. Photosynthetic efficiency was higher outside the canopy and at high and middle elevations than inside and low elevations of the canopy. Late onset of senescence led to a steeper decline in photosynthetic efficiency than early senescence. The onset of decline in photosynthetic efficiency differed between years, but there was no difference in the steepest rate of change in photosynthetic efficiency with respect to sampling year or location. Contributions of day-length vs temperature to leaf senescence have important consequences for the adaptability and invasibility of deciduous trees in a changing climate, especially at the edge of species distributions.
Utilizing Information Technology to Improve Influenza Vaccination in Pediatric Patients With Inflammatory Bowel Disease
Authors: Shores Darla , Wilson Lindsay , Oliva-Hemker Maria
Published: January 2019

Pediatric patients with inflammatory bowel disease are undervaccinated against influenza. Gastroenterology nurses are ideally situated to assist in improving vaccination in this population. The objective of this quality improvement project was to evaluate the implementation of information technology prompts within the electronic medical record to improve influenza vaccination during specialty clinic visits. The proportion of patients with yearly influenza vaccination was evaluated at baseline, Year 1, and Year 2 following implementation. At baseline, only 10% of a random sample had documented influenza vaccination. Vaccination documentation improved to 39% (96/246) by Year 1 and to 61% (175/287) by Year 2 (p < .001). Vaccine counseling improved from 27% to 77% by Year 2 for unvaccinated patients (p < .001). Among patients seen by gastroenterology nurses, the proportion of patients with either documented vaccination or counseling was 94% by Year 2 compared with 70% if seen only by a physician (p < .001). Documentation of influenza vaccination improved with the use of customized prompts. Patients seen by a gastroenterology nurse had higher vaccination documentation and vaccine counseling than those who were seen by a physician alone.
A Single-Molecule Long-Read Survey of Human Transcriptomes using LoopSeq Synthetic Long Read Sequencing
Authors: Wu Indira , Ben-Yehezkel Tuval
Published: January 2019

State-of-the-art short-read transcriptome sequencing methods employ unique molecular identifier (UMI) to accurately classify and count mRNA transcripts. A fundamental limitation of UMI-based short-read transcriptome sequencing is that each read typically covers a small fraction of the transcript sequence. Efforts to accurately characterize splicing isoforms, arguably the largest source of variation in Human gene expression, using short read sequencing have therefore largely relied on computational predictions of transcript isoforms based on indirect observations. Here we describe a transcript counting, synthetic long read method for sequencing whole transcriptomes using short read sequencing platforms and no additional hardware. The method enables full-length mRNA sequence reconstruction at single-nucleotide resolutions with high-throughput, low error rates and UMI based transcript counting using any Illumina sequencer. We describe results from whole transcriptome sequencing from total RNA extracted from 3 human tissue samples: brain, liver, and blood. Reconstructed transcript sequences are characterized and annotated using SQANTI, an analysis pipeline for assessing the sequence quality of long-read transcriptomes. Our results demonstrate that LoopSeq synthetic long-read sequencing can reconstruct contigs up to 3,900nt full-length transcripts using tissue extracted RNA, as well as identify novel splice variants of known junction donors and acceptors.
Inference and analysis of population-specific fine-scale recombination maps across 26 diverse human populations
Authors: Spence Jeffrey P. , Song Yun S.
Published: January 2019

Fine-scale rates of meiotic recombination vary by several orders of magnitude across the genome, and are known to differ between species and even between populations. Studying the differences in recombination maps across populations has been stymied by the confounding effect of differences in demographic history. To address this problem, we developed a method that infers fine-scale recombination rates while taking demography into account and applied our method to infer population-specific recombination maps for each of 26 diverse human populations. These maps recapitulate many aspects of the history of these populations including signatures of the trans-Atlantic slave trade and the Iberian colonization of the Americas. We also investigated modulators of the local recombination rate, finding an unexpected role for Polycomb-group proteins and the tri-methylation of H3K27 in elevating recombination rates. Further differences in the recombination landscape across the genome and between populations are driven by variation in the gene that encodes the DNA-binding protein PRDM9, and we quantify the weak effect of meiotic drive acting to remove its binding sites.
catch22: CAnonical Time-series CHaracteristics selected through highly comparative time-series analysis
Authors: Lubba Carl H , Sethi Sarab S , Knaute Philip , Schultz Simon R , Fulcher Ben D , Jones Nick S
Published: January 2019

Capturing the dynamical properties of time series concisely as interpretable feature vectors can enable efficient clustering and classification for time-series applications across science and industry. Selecting an appropriate feature-based representation of time series for a given application can be achieved through systematic comparison across a comprehensive time-series feature library, such as those in the hctsa toolbox. However, this approach is computationally expensive and involves evaluating many similar features, limiting the widespread adoption of feature-based representations of time series for real-world applications. In this work, we introduce a method to infer small sets of time-series features that (i) exhibit strong classification performance across a given collection of time-series problems, and (ii) are minimally redundant. Applying our method to a set of 93 time-series classification datasets (containing over 147 000 time series, including biomedical datasets) and using a filtered version of the hctsa feature library (4791 features), we introduce a generically useful set of 22 CAnonical Time-series CHaracteristics, catch22. This dimensionality reduction, from 4791 to 22, is associated with an approximately 1000-fold reduction in computation time and near linear scaling with time-series length, despite an average reduction in classification accuracy of just 7%. catch22 captures a diverse and interpretable signature of time series in terms of their properties, including linear and non-linear autocorrelation, successive differences, value distributions and outliers, and fluctuation scaling properties. We provide an efficient implementation of catch22, accessible from many programming environments, that facilitates feature-based time-series analysis for scientific, industrial, financial and medical applications using a common language of interpretable time-series properties.
A Plant Protein NbP3IP Induces Autophagy and Mediates the Autophagic Degradation of RSV p3 to Inhibit Viral Infection
Authors: Jiang Liangliang , Lu Yuwen , Zheng Xiyin , Yang Xue , Chen Ying , Zhang Tianhao , Zhao Xing , Wang Shu , Zhao Xia , Song Xijiao , Zhang Xiangxiang , Peng Jiejun , Zheng Hongying , Lin Lin , MacFarlane Stuart , Chen Jianping , Liu Yule , Yan Fei
Published: January 2019

In plants, autophagy is involved in responses to viral infection. However, understanding of new host factors mediating autophagic clearance of plant viruses is very limited. We here identified a new host factor NbP3IP participating in autophagy-mediated plant defense against viral infection. NbP3IP interacted with p3, a RNA silencing suppressor encoded by Rice stripe virus (RSV), a negative-strand RNA virus, and mediated its autophagic degradation. NbP3IP could also interact with NbATG8f, which was required for NbP3IP-miediated p3 degradation. Overexpression of NbP3IP induced autophagy and down-regulation of NbP3IP reduced autophagy. Both overexpression of NbP3IP and silencing of GAPC, which also induces autophagy, inhibited RSV infection. In contrast, silencing of ATG7 promoted RSV infection. Thus, through identification of a new potential selective autophagy receptor P3IP, we revealed a new mechanism of autophagy-mediated plant defense against plant viruses and provided the first evidence that plant autophagy can also play an antiviral role against negative-strand RNA viruses.
Visual imagery and visual perception induce similar changes in occipital slow waves of sleep
Authors: Bernardi Giulio , Betta Monica , Cataldi Jacinthe , Leo Andrea , Haba-Rubio José , Heinzer Raphael , Cirelli Chiara , Tononi Giulio , Pietrini Pietro , Ricciardi Emiliano , Siclari Francesca
Published: January 2019

Previous studies have shown that regional slow wave activity (SWA) during NREM-sleep is modulated by prior experience and learning. While this effect has been convincingly demonstrated for the sensorimotor domain, attempts to extend these findings to the visual system have provided mixed results. Here we asked whether depriving subjects of external visual stimuli during daytime would lead to regional changes in slow waves during sleep and whether the degree of ‘internal visual stimulation’ (spontaneous imagery) would influence such changes. In two 8h-long sessions spaced one-week apart, twelve healthy volunteers either were blindfolded while listening to audiobooks or watched movies (control condition), after which their sleep was recorded with high-density EEG. We found that during NREM-sleep the number of small, local slow waves in the occipital cortex decreased after listening with blindfolding relative to movie watching in a way that depended on the degree of visual imagery subjects reported during blindfolding: subjects with low visual imagery showed a significant reduction of occipital sleep slow waves, while those who reported a high degree of visual imagery did not. We also found a positive relationship between the reliance on visual imagery during blindfolding and audiobook listening and the degree of correlation in sleep SWA between visual areas and language-related areas. These preliminary results demonstrate that short-term alterations in visual experience may trigger slow wave changes in cortical visual areas. Furthermore, they suggest that plasticity-related EEG changes during sleep may reflect externally induced (‘bottom-up’) visual experiences, as well as internally generated (‘top-down’) processes.