bluuebunny/crossref_metadata_2025 huggingface dataset:
Investment Wars: Contestation and Confusion in Debate About Investment Liberalization
Authors: Bonnitcha Jonathan
Published: November 2019

Questions of investment governance are central to current trade wars. The USA complains of China’s use of restrictions on US investment as a lever to force technology transfer, while China complains of the review of investment in the USA on national security grounds. This article examines the place of these debates about investment liberalization within the trade wars. The focus is on US conduct, as the instigator of the trade wars. I argue that the USA is pursuing diverse and partially inconsistent in relation to investment liberalization. In some contexts, the USA is continuing to pursue the objective of removing impediments to outward investment, which was the principal objective of US investment policy for the decades prior to the Trump administration. In other contexts, the USA is seeking to encourage the repatriation of US outward investment and to regulate inward and outward investment according to ill-defined security rationales. I argue that prevailing materialist accounts of the trade wars struggle to explain these inconsistencies. Instead, I suggest that constructivist political economy provides a more promising explanatory framework. According to this view, inconsistency in policy objectives stems from foundational uncertainty about the nature of the ‘problem’ of investment liberalization.
Globular clusters in the inner Galaxy classified from dynamical orbital criteria
Authors: Pérez-Villegas Angeles , Barbuy Beatriz , Kerber Leandro , Ortolani Sergio , Souza Stefano O , Bica Eduardo
Published: November 2019

Globular clusters (GCs) are the most ancient stellar systems in the Milky Way. Therefore, they play a key role in the understanding of the early chemical and dynamical evolution of our Galaxy. Around 40% of them are placed within ∼4 kpc from the Galactic center. In that region, all Galactic components overlap, making their disentanglement a challenging task. With Gaia DR2, we have accurate absolute proper motions for the entire sample of known GCs that have been associated with the bulge/bar region. Combining them with distances, from RR Lyrae when available, as well as radial velocities from spectroscopy, we can perform an orbital analysis of the sample, employing a steady Galactic potential with a bar. We applied a clustering algorithm to the orbital parameters apogalactic distance and the maximum vertical excursion from the plane, in order to identify the clusters that have high probability to belong to the bulge/bar, thick disk, inner halo, or outer halo component. We found that $\sim 30\%$ of the clusters classified as bulge GCs based on their location are just passing by the inner Galaxy, they appear to belong to the inner halo or thick disk component, instead. Most of GCs that are confirmed to be bulge GCs are not following the bar structure and are older than the epoch of the bar formation.
Somatic Mutations and Genome Stability Maintenance in Clonal Coral Colonies
Authors: López Elora H , Palumbi Stephen R
Published: November 2019

One challenge for multicellular organisms is maintaining genome stability in the face of mutagens across long life spans. Imperfect genome maintenance leads to mutation accumulation in somatic cells, which is associated with tumors and senescence in vertebrates. Colonial reef-building corals are often large, can live for hundreds of years, rarely develop recognizable tumors, and are thought to convert somatic cells into gamete producers, so they are a pivotal group in which to understand long-term genome maintenance. To measure rates and patterns of somatic mutations, we analyzed transcriptomes from 17 to 22 branches from each of four Acropora hyacinthus colonies, determined putative single nucleotide variants, and verified them with Sanger resequencing. Unlike for human skin carcinomas, there is no signature of mutations caused by UV damage, indicating either higher efficiency of repair than in vertebrates, or strong sunscreen protection in these shallow water tropical animals. The somatic mutation frequency per nucleotide in A. hyacinthus is on the same order of magnitude (10−7) as noncancerous human somatic cells, and accumulation of mutations with age is similar. Loss of heterozygosity variants outnumber gain of heterozygosity mutations ∼2:1. Although the mutation frequency is similar in mammals and corals, the preponderance of loss of heterozygosity changes and potential selection may reduce the frequency of deleterious mutations in colonial animals like corals. This may limit the deleterious effects of somatic mutations on the coral organism as well as potential offspring.
Toward Precision Medicine for Smoking Cessation: Developing a Neuroimaging-Based Classification Algorithm to Identify Smokers at Higher Risk for Relapse
Authors: Frank David W , Cinciripini Paul M , Deweese Menton M , Karam-Hage Maher , Kypriotakis George , Lerman Caryn , Robinson Jason D , Tyndale Rachel F , Vidrine Damon J , Versace Francesco
Published: November 2019

Introduction

By improving our understanding of the neurobiological mechanisms underlying addiction, neuroimaging research is helping to identify new targets for personalized treatment interventions. When trying to quit, smokers with larger electrophysiological responses to cigarette-related, compared with pleasant, stimuli (“C > P”) are more likely to relapse than smokers with the opposite brain reactivity profile (“P > C”).

Aim and Method

The goal was to (1) build a classification algorithm to identify smokers characterized by P > C or C > P neuroaffective profiles and (2) validate the algorithm’s classification outcomes in an independent data set where we assessed both smokers’ electrophysiological responses at baseline and smoking abstinence during a quit attempt. We built the classification algorithm applying discriminant function analysis on the event-related potentials evoked by emotional images in 180 smokers.

Results

The predictive validity of the classifier showed promise in an independent data set that included new data from 177 smokers interested in quitting; the algorithm classified 111 smokers as P > C and 66 as C > P. The overall abstinence rate was low; 15 individuals (8.5% of the sample) achieved CO-verified 12-month abstinence. Although individuals classified as P > C were nearly 2.5 times more likely to be abstinent than smokers classified as C > P (12 vs. 3, or 11% vs. 4.5%), this result was nonsignificant, preliminary, and in need of confirmation in larger trials.

Conclusion

These results suggest that psychophysiological techniques have the potential to advance our knowledge of the neurobiological underpinnings of nicotine addiction and improve clinical applications. However, larger sample sizes are necessary to reliably assess the predictive ability of our algorithm.

Implications

We assessed the clinical relevance of a neuroimaging-based classification algorithm on an independent sample of smokers enrolled in a smoking cessation trial and found those with the tendency to attribute more relevance to rewards than cues were nearly 2.5 times more likely to be abstinent than smokers with the opposite brain reactivity profile (11% vs. 4.5%). Although this result was not statistically significant, it suggests our neuroimaging-based classification algorithm can potentially contribute to the development of new precision medicine interventions aimed at treating substance use disorders. Regardless, these findings are still preliminary and in need of confirmation in larger trials.
Time and Work in Rural England, 1500–1700*
Authors: Hailwood Mark
Published: November 2019

‘Free of haste, careless of exactitude, unconcerned by productivity.’ This is how Jacques Le Goff characterized the temporality of pre-industrial rural working life. In E. P. Thompson’s famous argument, it was only with the arrival of the factory and the industrial age that the erratic rhythms of English working people were abruptly swept away by a new imperative for long and regular working hours controlled by the clock. It is a thesis that has been much debated in relation to pre- and non-industrial cities, and with regard to the impact of industrialization when it arrived. There has, however, been very little scrutiny of its account of the relationship between time and work in rural England before industrialization. This article therefore offers the first extensive empirical study of both time consciousness and work-related time-use in sixteenth- and seventeenth-century rural England. It does so by drawing on the testimony that ordinary women and men gave before the courts, testimony that often divulged both how those people told the time of day, and how they used it. What emerges is that English rural society in this period had a relatively high degree of clock-time awareness, and that everyday patterns of work followed more consistent and regular rhythms than Thompson’s thesis allows. As a consequence, the article argues that we need to question the assumption that the long hours and work discipline of ‘modernity’ had no roots in ‘traditional’ English rural life.
Identification of Two Arabidopsis thaliana Plasma Membrane Transporters Able to Transport Glucose 1-Phosphate
Authors: Malinova Irina , Kössler Stella , Orawetz Tom , Matthes Ulrike , Orzechowski Slawomir , Koch Anke , Fettke Joerg
Published: November 2019

Primary carbohydrate metabolism in plants includes several sugar and sugar-derivative transport processes. Over recent years, evidences have shown that in starch-related transport processes, in addition to glucose 6-phosphate, maltose, glucose and triose-phosphates, glucose 1-phosphate also plays a role and thereby increases the possible fluxes of sugar metabolites in planta. In this study, we report the characterization of two highly similar transporters, At1g34020 and At4g09810, in Arabidopsis thaliana, which allow the import of glucose 1-phosphate through the plasma membrane. Both transporters were expressed in yeast and were biochemically analyzed to reveal an antiport of glucose 1-phosphate/phosphate. Furthermore, we showed that the apoplast of Arabidopsis leaves contained glucose 1-phosphate and that the corresponding mutant of these transporters had higher glucose 1-phosphate amounts in the apoplast and alterations in starch and starch-related metabolism.
High-Dose Intravenous Immunoglobulin Is Effective in Painful Diabetic Polyneuropathy Resistant to Conventional Treatments. Results of a Double-Blind, Randomized, Placebo-Controlled, Multicenter Trial
Authors: Jann Stefano , Fazio Raffaella , Cocito Dario , Toscano Antonio , Schenone Angelo , Marfia Gerolama Alessandra , Antonini Giovanni , De Toni Franceschini Luisa , Mazzeo Anna , Grandis Marina , Velardo Daniele , Mataluni Giorgia , Peci Erdita
Published: November 2019

Objectives

The efficacy and safety of high-dose intravenous immunoglobulin (IVIG) in treatment-resistant diabetic painful polyneuropathy (DPN) were assessed.

Design

This was a randomized, double-blind, placebo-controlled, multicenter trial (EudraCT 2010–023883–42).

Setting

This trial was conducted at eight sites in Italy with a neurology specialist level of care.

Subjects

Twenty-six diabetic patients with DPN who reported baseline severity of pain >60 units (mm) on a VAS scale at enrollment and were resistant to antidepressants and antiepileptic drugs were enrolled; 23 were randomized (11 in the IVIG arm and 12 in the placebo arm). All patients completed the study and were evaluated. All patients were Caucasian, 15 were male, and 21 had a diagnosis of type II diabetes.

Methods

IVIG (0.4 g/kg/d) or placebo was given for five consecutive days. Pain intensity (visual analog scale, Neuropathic Pain Symptom Inventory) and quality of life (36-Item Short-Form Health Survey, Clinical/Patient Global Impression of Change questionnaires) assessments were performed at visits: baseline, start of therapy (one week later), end of therapy (five days later), and follow-up (four and eight weeks later).

Results

The study achieved its prespecified primary end point of ≥50% pain reduction at four weeks after IVIG, achieved in seven of 11 patients (63.6%) in the IVIG group vs zero of 12 in the placebo group (P = 0.0013). Only two adverse events were reported during the study: one patient in the treatment arm reported a mild “dermatitis psoriasiform,” whereas one patient from the placebo group reported a mild “influenza.”

Conclusions

Treatment with IVIG at the dose given was efficacious and safe for patients with DPN resistant to standard therapies.
Long-term surveillance of biologic therapies in systemic-onset juvenile idiopathic arthritis: data from the German BIKER registry
Authors: Klein Ariane , Klotsche Jens , Hügle Boris , Minden Kirsten , Hospach Anton , Weller-Heinemann Frank , Schwarz Tobias , Dressler Frank , Trauzeddel Ralf , Hufnagel Markus , Foeldvari Ivan , Borte Michael , Kuemmerle-Deschner Jasmin , Brunner Jürgen , Oommen Prasad Thomas , Föll Dirk , Tenbrock Klaus , Urban Andreas , Horneff Gerd
Published: November 2019

Objective

Using data from the German Biologics JIA Registry (BIKER), long-term safety of biologics for systemic-onset JIA with regard to adverse events of special interest was assessed.

Methods

Safety assessments were based on adverse event reports after first dose through 90 days after last dose. Rates of adverse event, serious adverse event and 25 predefined adverse events of special interest were analysed. Incidence rates were compared for each biologic against all other biologics combined applying a mixed-effect Poisson model.

Results

Of 260 systemic-onset JIA patients in this analysis, 151 patients received etanercept, 109 tocilizumab, 71 anakinra and 51 canakinumab. Patients with etanercept had higher clinical Juvenile Arthritis Disease Activity Score 10 scores, active joint counts and steroid use at therapy start. Serious adverse events were reported with higher frequency in patients receiving canakinumab [20/100 patient years (PY)] and tocilizumab (21/100 PY). Cytopenia and hepatic events occurred with a higher frequency with tocilizumab and canakinumab. Medically important infections were seen more often in patients with IL-6 or IL-1 inhibition. Macrophage activation syndrome occurred in all cohorts with a higher frequency in patients with canakinumab (3.2/100 PY) and tocilizumab (2.5/100 PY) vs anakinra (0.83/100 PY) and etanercept (0.5/100 PY). After adjustment only an elevated risk for infections in anakinra-treated patients remained significant. Three definite malignancies were reported in patients ever exposed to biologics. Two deaths occurred in patients treated with etanercept.

Conclusion

Surveillance of pharmacotherapy as provided by BIKER is an import approach especially for patients on long-term treatment. Overall, tolerance was acceptable. Differences between several biologics were noted and should be considered in daily patient care.
Genome-Scale Model-Based Identification of Metabolite Indicators for Early Detection of Kidney Toxicity
Authors: Pannala Venkat R , Vinnakota Kalyan C , Estes Shanea K , Trenary Irina , OˈBrien Tracy P , Printz Richard L , Papin Jason A , Reifman Jaques , Oyama Tatsuya , Shiota Masakazu , Young Jamey D , Wallqvist Anders
Published: November 2019

Identifying early indicators of toxicant-induced organ damage is critical to provide effective treatment. To discover such indicators and the underlying mechanisms of toxicity, we used gentamicin as an exemplar kidney toxicant and performed systematic perturbation studies in Sprague Dawley rats. We obtained high-throughput data 7 and 13 h after administration of a single dose of gentamicin (0.5 g/kg) and identified global changes in genes in the liver and kidneys, metabolites in the plasma and urine, and absolute fluxes in central carbon metabolism. We used these measured changes in genes in the liver and kidney as constraints to a rat multitissue genome-scale metabolic network model to investigate the mechanism of gentamicin-induced kidney toxicity and identify metabolites associated with changes in tissue gene expression. Our experimental analysis revealed that gentamicin-induced metabolic perturbations could be detected as early as 7 h postexposure. Our integrated systems-level analyses suggest that changes in kidney gene expression drive most of the significant metabolite alterations in the urine. The analyses thus allowed us to identify several significantly enriched injury-specific pathways in the kidney underlying gentamicin-induced toxicity, as well as metabolites in these pathways that could serve as potential early indicators of kidney damage.
Evaluating low back pain in adolescents
Authors: Garvick Sarah J. , Creecy Candice , Miller Megan , Schafer Lorae , Spooner Alex , Tazewell Ann Wallace , Gregory Tanya
Published: November 2019

Low back pain in adolescents is a common complaint in primary care. With an average prevalence rate of 40%, adolescent low back pain correlates with greater healthcare use, higher incidences of adult back pain, and negative effects on overall well-being. A thorough history and physical examination can increase early detection and accurate diagnosis while ensuring the judicious use of diagnostic modalities. Although underlying serious pathology is rare in adolescents with low back pain, clinicians should recognize specific signs and symptoms that necessitate urgent evaluation and intervention. This article emphasizes the value of using a thorough history and physical examination to guide the initial diagnostic workup and to enhance the early detection and accurate diagnosis of adolescents who present with low back pain.
Cardiac auscultation
Authors: Klocko David J. , Hanifin Christopher
Published: November 2019

Auscultation of heart sounds and murmurs often is taught in a simulated environment with optimal listening conditions. Clinicians' auscultation skills can wither if they do not have contact with patients with valvular heart disease during clinical practice, or if they rely on handheld ultrasound devices or echocardiography. This article reviews heart murmurs and how to use physiologic maneuvers during the cardiac examination to assist in identifying murmurs.
A Review of Clinical Informatics Competencies in Nursing to Inform Best Practices in Education and Nurse Faculty Development
Authors: Forman Tracia M. , Armor David A. , Miller Ava S.
Published: November 2019

AIM

The aim of this literature review was to determine the state of the science related to clinical informatics competencies of registered nurses and to determine best practices in educational strategies for both nursing students and faculty.

BACKGROUND

Continued emphasis on the provision of evidence-based patient care has implications for requisite informatics-focused competencies to be threaded throughout all levels of nursing educational programs.

METHOD

Whittemore and Knalf’s five-step integrative review process guided this research. An extensive search yielded 69 publications for critical appraisal.

RESULTS

Results suggest nursing educational programs do not adhere to standardized criteria for teaching nursing informatics competencies. Another identified literature gap was the scarcity of research related to informatics training requirements for nurse educators.

CONCLUSION

Findings support the need for continued research to provide clear direction about the expected clinical informatics competencies of graduate nurses and what training faculty need to facilitate student learning.
Hormonal and reproductive factors and reduction in the risk of colorectal cancer
Authors: Rennert Gad , Rennert Hedy S. , Pinchev Mila , Gruber Stephen B. , Lavie Ofer
Published: November 2019

Females differ from males in incidence and clinical characteristics of colorectal cancer. Understanding the differences can lead to development of preventive approaches. To identify reproductive factors currently associated with the risk of colorectal cancer. Consecutively diagnosed female colorectal cancer cases and randomly chosen colorectal cancer-free controls matched on age/ethnicity/primary care clinic within the molecular epidemiology of colorectal cancer study, a population-based case-control study in Northern Israel, were included. A total of 2867 female cases and 2333 controls participated in this analysis. Participants were interviewed on reproductive history: ages at menarche, menopause, first birth, terminations of pregnancies, miscarriages, births, use of oral contraceptives. Among 5200 women, spontaneous miscarriages (odds ratio = 0.71, 0.61–0.83 for ever/never in Jews; odds ratio = 0.76, 0.53–1.08 in Arabs) and number of miscarriages, but not termination of pregnancies, as well as use, and duration of use, of oral contraceptives (Jews: odds ratio = 0.49, 0.39–0.62 for ever/never; Arabs: odds ratio = 0.14, 0.04–0.47) were strongly inversely associated with colorectal cancer risk. Up to 5 pregnancies were associated with increased risk while ages at menarche, at menopause and at first birth were not associated with colorectal cancer risk. Miscarriages but not terminations of pregnancy or full-term pregnancies, and use of oral contraceptives, were strongly associated with reduced odds of developing colorectal cancer suggesting unique hormonal influences on colorectal cancer.
Bridge Flaps: A Hybrid Family of Bipedicled Flaps for the Forehead, Temple, and Scalp: Experience With 103 Cases
Authors: Salmon Paul J.M.
Published: November 2019

BACKGROUND

Medium-sized defects of the scalp, temple, and forehead can be challenging to reconstruct in an aesthetic fashion. The author proposes the use of a hybrid flap that is at times bipedicled, perforator, and/or axially supplied.

OBJECTIVE

To describe the author's experience with the bridge flap and its various subtypes.

METHODS

An IRB-approved retrospective database review of all bridge flaps was performed at all Skin Cancer Institute facilities. The design and method of dissection are detailed and illustrated, including that of each hybrid of the bridge flap.

RESULTS

The bridge flap is a single-stage local flap that provides appropriate tissue match by harnessing adjacent laxity of tissues to recreate the original anatomy of the surgical site without disturbance of free margins or aesthetic landmarks.

CONCLUSION

The bridge flap is simple to perform and a reliable and robust method of obtaining immediate tissue reconstruction for medium sized defects of the scalp, temple, and forehead.
Role of Left Ventricle Function in Cardiac Rehabilitation Outcomes in Stage B Heart Failure Patients
Authors: Braga Marta , Nascimento Helena , Nunes Alzira , Araújo Paulo , Pinto Roberto , Rodrigues Joana , Araújo Vítor , Parada-Pereira Fernando , Maciel Maria Júlia , Rocha Afonso
Published: November 2019

Purpose:

To study the role of left ventricle systolic function in cardiac rehabilitation program (CRP) response in stage B heart failure patients.

Methods:

A retrospective analysis was completed of 691 patients with previous myocardial infarction that underwent a CRP, classified in 3 groups: preserved ejection fraction (pEF), mid-range ejection fraction (mrEF), and reduced ejection fraction (rEF). We compared the response to CRP analyzing the relative changes of estimated cardiorespiratory fitness (CRFe), resting heart rate (HR), and chronotropic index (CI).

Results:

After exercise training (median [interquartile range]) mrEF (23.9% [9.7, 40.8]) and rEF (23.9% [9.7, 41.2]) groups had a better CRFe response to CRP than pEF groups (17.6% [0.0, 35.9]), P = .009. CI increased similarly in all groups. We found a small effect of CRP on resting HR.

Conclusion:

Exercise-based CRP yields notable benefits to mrEF and rEF groups and the magnitude of its benefits is, at least, similar to that found in pEF patients.
Double-Dissociation Studies in Psychiatric Research: A Scoping Review
Authors: Kilçiksiz Can Mişel , Öngür Dost
Published: November 2019

Learning objectives

After participating in this activity, learners should be better able to:

• Evaluate the double-dissociation approach to research in neuropsychology

• Assess research aiming to provide evidence of double dissociation between neurobiological abnormalities and clinical presentations in psychiatry

Background

Psychiatric neuroscience research has grown exponentially, but it has not generated the desired breakthroughs in diagnosis, treatment development, or treatment selection. In many instances a given neurobiological abnormality is found in multiple clinical syndromes, and conversely, a clinical syndrome is associated with multiple neurobiological abnormalities. To the extent that neurobiology research is conducted to explain psychiatric manifestations, however, it should also provide insight into how certain brain abnormalities lead to one and not another specific clinical presentation—that is, “double-dissociation.” We hypothesized that most psychiatric research studies are not designed to identify such double dissociations.

Methods

We selected three leading psychiatric journals (American Journal of Psychiatry, JAMA Psychiatry, and Molecular Psychiatry) that are representative of high-quality psychiatry research and that also provided a sample size that was feasible to screen. We screened all original research manuscripts published over the course of one calendar year (2017) to identify those measuring brain function or biological parameters (which, collectively, we term neurobiological measures) in psychiatric disorders. We asked whether such biological research could provide evidence for a double dissociation of any kind.

Results

We found that only 7 of 403 articles published in three psychiatry journals, constituting approximately 2% of publications, examined the dissociation of neurobiological measures relating to two psychiatric disorders or symptom clusters. Of these 7 studies, 5 used imaging as research tool; 1 used genotype array; and 1 used polymerase chain reaction (PCR). Sample sizes of the 7 studies ranged from 100 to 2876.

Conclusion

We report on a striking paucity of research aiming to provide evidence of double dissociation between neurobiological abnormalities and clinical presentations in psychiatry. We conclude that this paucity represents a missed opportunity for the field. Double-dissociation approaches have been used successfully in many studies in neurology and psychiatry in the past, and more widespread and explicit adoption of this design may improve the mechanistic insights obtained in psychiatry research.
Implementation of Off-Site Integrated Care for Children: A Scoping Review
Authors: Spencer Andrea E. , Platt Rheanna E. , Bettencourt Amie F. , Serhal Eva , Burkey Matthew D. , Sikov Jennifer , Vidal Carol , Stratton Julia , Polk Sarah , Jain Sonal , Wissow Lawrence
Published: November 2019

Background

As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. Our goal is to review the existing literature on implementing off-site pediatric integrated care.

Methods

We systematically searched the literature for peer-reviewed publications on off-site pediatric integrated care interventions. We included studies that involved systematic data collection and analysis, both qualitative and quantitative, of implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability).

Results

We found 39 original articles from 24 off-site programs with a variety of study designs, most with secondary implementation outcomes. Models of off-site integration varied primarily along two dimensions: direct vs. indirect, and in-person vs. remote. Overall, off-site models were acceptable to providers, particularly when the following were present: strong interdisciplinary communication, timely availability and reliability of services, additional support beyond one-time consultation, and standardized care algorithms. Adoption and penetration were facilitated by enhanced program visibility, including on-site champions. Certain clinical populations (e.g., school-age, less complicated ADHD) seemed more amenable to off-site integrated models than others (e.g., preschool-age, conduct disorders). Lack of funding and inadequate reimbursement limited sustainability in all models.

Conclusions

Off-site interventions are feasible, acceptable, and often adopted widely with adequate planning, administrative support, and interprofessional communication. Studies that focus primarily on implementation and that consider the perspectives of specialty providers and patients are needed.
Treatment of Acute Corneal Hydrops With Combined Intracameral Gas and Approximation Sutures in Patients With Corneal Ectasia
Authors: Mohebbi Masomeh , Pilafkan Hadi , Nabavi Amin , Mirghorbani Masoud , Naderan Morteza
Published: November 2019

Purpose:

To assess the efficacy and safety of combined intracameral sulfur hexafluoride and full-thickness corneal sutures in the treatment of acute corneal hydrops (CH).

Methods:

This is an uncontrolled series of cases with keratoconus (KC), keratoglobus (KG), and pellucid marginal degeneration that presented with CH of recent onset.

Result:

Thirteen patients completed the study. The mean corneal thickness before treatment was 1,310

JOURNAL/corne/04.03/00003226-202002000-00023/inline-formula1/v/2023-09-12T173541Z/r/image-tiff

556 μm, which significantly reduced to 660 ± 148 μm at week 1 postoperatively (P = 0.001). It took 11.5 ± 6.5 days for corneal edema to resolve with a minimum and maximum of 5 and 24 days, respectively. Corrected distance Snellen visual acuity (CDVA) significantly improved from 0.04 ± 0.03 before treatment to 0.08 ± 0.06 at week 1 (P = 0.035) and continued to improve through month 1 [(0.11 ± 0.05), P = 0.007] and month 3 [(0.15 ± 0.08), P = 0.002]. No patient needed re-treatment with gas injection, and no complication was detected during the follow-up period.

Conclusions:

Combined intracameral gas injection and approximation sutures are probably effective and safe for the treatment of acute CH. This treatment results in rapid recovery with very rare complications.
A Fixed-Depth Microneedle Enhances Reproducibility and Safety for Corneal Gene Therapy
Authors: Gilger Brian C. , Crabtree Elizabeth , Song Liujiang , Llanga Telmo , Cullen Megan , Blanchard Allison , Salmon Jacklyn , Patel Samirkumar , Zarnitsyn Vladimir , Hirsch Matthew
Published: November 2019

Purpose:

Drug delivery directly to the corneal stroma currently relies on microscopic injections that demonstrate low reproducibility and clinician-dependent variability. With use of biological drugs such as adeno-associated viral (AAV) vectors, precise and consistent drug deposition is critical to reduce concerns related to off-target transduction and the host's immune response to the viral capsid and/or transgene-derived product. Therefore, a precise corneal injection (PCI) microneedle was designed to allow accurate depth-specific injections into the corneal stroma in a macroscopic setting.

Methods:

High-frequency ultrasound and confocal microscopy demonstrated the consistent ability to predetermine the precise injection depth using PCI needles of varying sizes. Next, a comparison between a standard 31-G needle and PCI needles was performed in vivo using AAV vector gene delivery.

Results:

Intrastromal corneal injections using the PCI microneedle resulted in less vector leakage at the site of injection and fewer anterior chamber penetrations compared with a standard 31-G needle. Although reporter gene expression appeared similar when the vector was administered with either needle type, a trend toward increased vector genomes was noted in the PCI-injected corneas at the experimental conclusion. As hypothesized, corneal perforation resulted in increased detection of AAV vector genomes in nontarget tissues, highlighting the importance of consistency for biological drug applications in the cornea.

Conclusions:

Further development of the PCI microneedle is warranted especially for AAV corneal gene therapy and offers the potential to enhance transduction while significantly reducing safety concerns and intraclinician and interclinician injection variability.
Suprachoroidal Hemorrhage During Descemet Membrane Endothelial Keratoplasty
Authors: Dockery Philip W. , Joubert Katelyn , Parker John S. , Parker Jack S.
Published: November 2019

Purpose:

To describe two cases of suprachoroidal hemorrhage during Descemet membrane endothelial keratoplasty (DMEK).

Methods:

Two patients with pseudophakic bullous keratopathy (PBK) underwent DMEK and proceeded to develop intraoperative suprachoroidal hemorrhage. Reports of both cases are documented, including potential risk factors, intraoperative events, and postoperative outcomes and interventions.

Results:

Both cases required premature abortion of the operation following the abrupt onset of significant posterior pressure indicating potential suprachoroidal hemorrhage. Postoperative visual acuity measured light perception or worse, and both patients declined further intervention.

Conclusions:

Suprachoroidal hemorrhage is a rare but potentially devastating intraoperative complication which may occur during DMEK, particularly in eyes with relevant risk factors. An inability to deepen the anterior chamber following graft implantation may signify the condition.
How Does Light Intensity of the Recording Room Affect the Evaluation of Lens and Corneal Clarity by Scheimpflug Tomography?
Authors: Bahar Alperen , Pekel Gökhan
Published: November 2019

Purpose:

To investigate the effects of the light intensity of the recording room where eye examinations are conducted on the evaluation of lens and corneal clarity.

Method:

This cross-sectional and comparative study used 63 eyes of 32 participants. Corneal and lenticular optical densitometries, pachymetry, corneal volume, anterior segment volume, and anterior chamber depth measurements were taken with the Scheimpflug imaging system when the lights in the recording room were on (80 lux) and off (3 lux). The results were statistically compared.

Results:

The mean lens density when the lights were on was 13.61 ± 2.03, whereas that when the lights were off was 8.48 ± 1.48 (P < 0.001). Similarly, the mean corneal density when the lights were on was 15.87 ± 1.36, whereas that when the lights were off was 11.13 ± 0.90 (P < 0.001). The pachymetry, corneal volume, anterior segment volume, and anterior chamber depth measurements did not differ under the different light conditions.

Conclusions:

The densitometry values increased with an increase in light intensity. This study revealed that the lens and corneal densitometry evaluations were significantly affected by the lighting in the recording room.
Meditation: A Polypill for Comprehensive Management of Glaucoma Patients
Authors: Dada Tanuj , Ramesh Priyanka , Shakrawal Jyoti
Published: November 2019

Meditation is an ancient behavioral intervention, however, its benefits for achieving holistic health have been highlighted in recent times with rigorous scientific studies revealing its benefits in many chronic diseases. It has been specially found useful in neurodegenerative diseases and recent evidence points to the positive effects of meditation in preserving gray and white matter in the adult brain. It is also a potential therapy to downregulate processes implicated in brain aging and confer “neuroprotection”—something we all look forward to for our glaucoma patients. In the current review, we evaluate the benefits of meditation practice for the glaucoma patient and support for its candidature as adjunctive therapy for glaucoma patients. It has multiple potential benefits for normal-pressure and high-pressure glaucoma patients including a reduction in intraocular pressure, increasing cerebral blood flow and oxygenation, and decreasing action of the sympathetic nervous system with a corresponding increase in parasympathetic nervous system activity. Meditation leads to a “relaxation response” mediated by nitric oxide with decrease in the stress hormone cortisol, increase in neurotrophins and mitochondrial energy production, and improves the overall quality of life of glaucoma patients. It can also benefit caregivers of glaucoma patients and health care providers. It appears that meditation can function as a multifaceted management approach for glaucoma using the natural potential of the human body and target not only the eye but the patient behind the eye to ameliorate this “sick eye in a sick body” condition.
Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis
Authors: Kuan Ai Seon , Chen Tzeng-Ji , Lee Wui-Chiang
Published: November 2019

Background:

While migrants in Taiwan are entitled to universal health care, barriers to health care services exist. We aimed to explore challenges encountered by migrants when accessing health care services and potential strategies to overcome these barriers.

Methods:

Invitations to participate in the study were sent to all hospitals, 12 migrant organizations, one language school, and one language service company in Taiwan, and convenience sampling was used to recruit study participants. Focus group interviews were held with 111 migrants, clinicians, migrant organization coordinators, and representatives from the medical institutions, language school and language service company. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using a thematic approach.

Results:

The study participants acknowledged that the current support system for migrants in the health care sector is inadequate. Barriers to health care services were noted in three areas - language and information, sociocultural and economic, and policy and resources. Potential strategies to overcome these barriers included the provision of on-site or distant interpreting services, provision of multilingual instruction notes and forms, and establishing a multilingual medical assistance hotline.

Conclusion:

While migrants benefit from the current support and welfare system, our study found substantial gaps that need to be filled including a lack of professional medical interpreters and training programs, a lack of legal framework for medical interpreting, and inadequacy in the dispersal of information on existing resources that may facilitate the integration of migrants into society and the health care system. Overcoming these barriers may improve migrants’ access to health services.
The Lived Experiences of Indonesian Nurses Who Worked as Care Workers in Taiwan
Authors: NURSALAM Nursalam , CHEN Ching-Min , EFENDI Ferry , HAS Eka Misbahatul Mar’ah , HIDAYATI Laily , HADISUYATMANA Setho
Published: November 2019

Background

Despite the large number of Indonesian nurses currently working as migrant care workers in Taiwan, no studies in the literature have been found that explore this phenomenon or assess the working situation of Indonesian nurses working in care facilities in Taiwan.

Purpose

This study aimed to elicit and describe the lived experiences of Indonesian nurses serving as care workers in Taiwan.

Methods

Phenomenological research was used to explore the experiences of Indonesian nurses working in long-term care facilities. The participants were recruited from care facilities in Taiwan. This study utilized semistructured interviews conducted with 16 Indonesian nurses in a suitable setting. All of the interviews were transcribed, and the work of Van Manen was used to analyze the data.

Results

Four main themes were identified, including motives for working abroad, feelings of being trapped, experiencing a difficult journey, and the feeling of being supported. These themes reflect the lived experiences of Indonesian nurses who work in Taiwan's long-term care industry.

Conclusions

Nurses from Indonesia choose to who work as nurses in Taiwan because of poor financial background and the chance of gaining a better life. However, the participants in this study felt stressed, challenged, and disappointed when faced with the unmet expectations of being employed as care workers without a clear career path. Furthermore, the need to communicate in an unfamiliar language was mentioned as a significant barrier to fulfilling their role. Better policies should be put in place to achieve improved outcomes for both countries.
Evaluation of an After-Hours Child Passenger Safety Resource Guide
Authors: Pollok Lindsay J. , Barczyk Amanda N. , Piper Karen , Burg Brianna , Garcia Nilda M.
Published: November 2019

Motor vehicle crashes are a leading cause of unintentional injury deaths for children in the United States. Child safety seats are effective in reducing the rate and severity of injury for children. Families seen in an emergency department (ED) outside of injury prevention (IP) operational hours may not have the same opportunity to obtain a child safety seat due to the unavailability of IP resources. This study evaluated the effectiveness of a resource guide that assists the ED staff to screen and provide the appropriate child safety seat. Two retrospective cohort analyses were conducted to assess the following: (1) patients seen in the ED who were eligible to be screened through the resource guide; and (2) patients who were screened and received a restraint system through the resource guide. Records for both cohorts were reviewed from May 1, 2015, to February 29, 2016. Descriptive statistics were used to describe each cohort. In Cohort 1, 10.6% of the 113 patients meeting criteria were screened for a restraint system. In Cohort 2, 20 patients received a restraint system through the resource guide and 90% of these received the appropriate restraint system for their age and weight. Our results demonstrate the need for an algorithm to increase consistency of the resource guide's utilization. Algorithm development to identify screening candidates, further refinement of the guide's restraint identification process, and staff training may improve this tool to ensure that all patients, despite the availability of IP staff, are screened for the appropriate child safety seat.
Measurement reliability of automated oscillometric blood pressure monitor in the elderly with atrial fibrillation: a systematic review and meta-analysis
Authors: Park Seong-Hi , Choi Yun-Kyoung
Published: November 2019

Objectives

This study aimed to identify whether automated oscillometric blood pressure monitor (AOBPM) is a reliable blood pressure (BP) measurement tool in geriatric patients with atrial fibrillation (AF) with high variability in BP and to evaluate whether it can be applied in practice.

Methods

Electronic searches were performed in databases including MEDLINE, EMBASE, the Cochrane Library, and CINAHL by using the following keywords: ‘atrial fibrillation,’ ‘atrial flutter, ‘blood pressure monitor’, ‘sphygmomanometer.’ The QUADAS-2 was applied to assess the internal validity of selected studies. Meta-analysis was performed using RevMan 5.3 program. Design: Systematic review.

Results

We identified 10 studies, including 938 geriatric patients with AF. We compared with the previously used BP measurement method (mainly office) and AOBPM, and the patients with AF were divided into the AF-AF (atrial fibrillation rhythm continued) and AF-SR groups (sinus rhythm recovered). The difference in the systolic BP was −3.0 mmHg [95% confidence interval (CI): −6.58 to 0.59] and −1.62 (95% CI: −6.08 to 2.84) mmHg in the AF-AF and AF-SR groups, respectively. The difference in the diastolic BP was 0.17 (95% CI: −2.90 to 3.25) mmHg and −0.23 (95% CI: −5.11 to 4.65) mmHg, respectively.

Conclusion

This review showed that the BP difference from AOBPM compared with the auscultatory BP method was less than 5 mmHg in the elderly with AF. This difference is acceptable in clinical practice. However, AOBPM compared with invasive arterial BP in the diastolic BP was a difference of 5 mmHg or more, and so its accuracy cannot be assured.
Asthma–COPD overlap: review of diagnosis and management
Authors: Venkata Anand N.
Published: November 2019

Purpose of review

Asthma and chronic obstructive pulmonary disease are both commonly encountered respiratory conditions. The term asthma--COPD overlap (ACO) has been used to identify patients presenting with features of both conditions. Controversy exists regarding its definition, approach to diagnosis and management. In this publication, recent evidence has been reviewed that provides insight into diagnosis and management of this condition.

Recent findings

Previously, multiple criteria were used to define Asthma--COPD overlap. In this publication, the most recent guidelines to identify this condition have been reviewed. This publication provides a summary of the recent evidence with regard to the role of various diagnostic modalities including the use of biomarkers, such as exhaled nitric oxide, serum IgE and provides updated evidence on available treatment choices for this condition.

ACO is a commonly encountered clinical condition with patients experiencing frequent exacerbations and resulting in increased healthcare resource utilization. Recent interest in ACO has led to development of a framework towards diagnosis and management of this condition. Therapeutic choices for ACO range from bronchodilator therapy to immunomodulatory therapy, highlighting the heterogeneity of this condition. Additional research is required to improve understanding of pathogenesis and improve outcomes in ACO.
Sarcopenia as prognostic factor for survival after orthotopic liver transplantation
Authors: Pinto Dos Santos Daniel , Kloeckner Roman , Koch Sandra , Hoppe-Lotichius Maria , Zöller Daniela , Toenges Gerrit , Kremer Wolfgang Maximilian , Zimmermann Tim , Mittler Jens , Lang Hauke , Düber Christoph , Galle Peter Robert , Weinmann Arndt , Sprinzl Martin Franz
Published: November 2019

Background and aim

Body composition has emerged as a prognostic factor for end-stage liver disease. We therefore investigated muscle mass, body fat and other clinical–pathological variables as predictors of posttransplant survival.

Methods

A total of 368 patients, who underwent orthotopic liver transplantation (OLT) at our institution, were assessed prior to OLT and followed for a median of 9.0 years (range 2.0–10.0 years) after OLT. Psoas, erector spinae and the combined paraspinal muscle area, as well as the corresponding indices normalized by body-height squared, were quantified by a lumbar (L3) cross-sectional computed tomography. In addition, absolute body fat and bone density were estimated by the same computed tomography approach.

Results

Paraspinal muscle index (PSMI) (hazard ratio 0.955, P = 0.039) and hepatitis C (hazard rati 1.498, P = 0.038) were independently associated with post-OLT mortality. In contrast, body fat and bone density did not significantly affect post-OLT outcome (P > 0.05). The PSMI also predicted one-year posttransplant mortality with a receiver operating characteristics-area under the curve of 0.671 [95% confidence interval (CI) 0.589–0.753, P < 0.001) in male patients and outperformed individual psoas and erector spinae muscle group assessments in this regard. In male patients, a defined PSMI cutoff (<18.41 cm2/m2) was identified as suitable determinant for sarcopenia and posttransplant one-year mortality. In female OLT-recipients, however, sarcopenia was not predictive for patient survival und a women-specific cutoff could not be derived from this study.

Conclusions

Taken together this analysis provides evidence, which PSMI is a relevant marker for muscle mass and that sarcopenia is an independent predictor of early post-OLT survival in male patients.