bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of an ongoing pharmacist service to reduce medicine-induced deterioration and adverse reactions in aged-care facilities (nursing homes): a multicentre, randomised controlled trial (the ReMInDAR trial)
Authors: Roughead Elizabeth E , Pratt Nicole L , Parfitt Gaynor , Rowett Debra , Kalisch-Ellett Lisa M , Bereznicki Luke , Merlin Tracy , Corlis Megan , Kang Ai Choo , Whitehouse Joseph , Bilton Rebecca , Schubert Camille , Torode Stacey , Kelly Thu-Lan , Andrade Andre Q , Post Dannielle , Dorj Gereltuya , Cousins Justin , Williams Mackenzie , Lim Renly
Published: March 2022

Objective

To assess the effectiveness of a pharmacist-led intervention using validated tools to reduce medicine-induced deterioration and adverse reactions.

Design and setting

Multicenter, open-label parallel randomised controlled trial involving 39 Australian aged-care facilities.

Participants

Residents on ≥4 medicines or ≥1 anticholinergic or sedative medicine.

Intervention

Pharmacist-led intervention using validated tools to detect signs and symptoms of medicine-induced deterioration which occurred every 8 weeks over 12 months.

Comparator

Usual care (Residential Medication Management Review) provided by accredited pharmacists.

Outcomes

Primary outcome was change in Frailty Index at 12 months. Secondary outcomes included changes in cognition, 24-hour movement behaviour by accelerometry, grip strength, weight, adverse events and quality of life.

Results

248 persons (median age 87 years) completed the study; 120 in the interventionand, 128 in control arms. In total 575 pharmacist, sessions were undertaken in the intervention arm. There was no statistically significant difference for change in frailty between groups (mean difference: 0.009, 95% CI: −0.028, 0.009, P = 0.320). A significant difference for cognition was observed, with a mean difference of 1.36 point change at 12 months (95% CI: 0.01, 2.72, P = 0.048). Changes in 24-hour movement behaviour, grip strength, adverse events and quality of life were not significantly different between groups. Point estimates favoured the intervention arm at 12 months for frailty, 24-hour movement behaviour and grip strength.

Conclusions

The use of validated tools by pharmacists to detect signs of medicine-induced deterioration is a model of practice that requires further research, with promising results from this trial, particularly with regards to improved cognition.
Engines of innovation: biological origins of genome evolution
Authors: Shapiro James A
Published: March 2022

Genome change does not occur accidentally. The conventional Modern Synthesis view of gradual evolution guided solely by natural selection fails to incorporate many important lessons from direct examination of genome structure by cytogeneticists and modern genomic sequencers. Among other discoveries is the major role that interspecific hybridization has played in the rapid generation of new species. Interspecific hybrids display altered epigenetic regulation and genome expression, great genome variability (including activation of transposable elements and chromosome rearrangements), and frequently whole genome duplication (WGD) as well. These changes produce novel species with adaptively altered phenotypes and reproductive isolation due to meiotic incompatibility with the progenitor species. Genomics has revealed that hybrid speciation and WGD have been widespread among all types of eukaryotes, from yeast and diatoms to flowering plants and primates. The maintenance of the biological responses to interspecific hybridization across virtually all eukaryotic history indicates that eukaryotes have continuously inheritted a capability for rapid evolutionary change. In other words, the best-documented path to the origin of species we have is an inherited biological process, not a series of accidents.
Conditional knockout of leptin receptor in the female reproductive tract reduces fertility due to parturition defects in mice
Authors: Pennington Kathleen A , Oestreich Arin K , Cataldo Kylie H , Fogliatti Candace M , Lightner Celeste , Lydon John P , Schulz Laura C
Published: March 2022

Leptin is required for fertility, including initiation of estrous cycles. It is therefore challenging to assess the role of leptin signaling during pregnancy. Although neuron-specific transgene approaches suggest that leptin signaling in the central nervous system is most important, experiments with pharmacologic inhibition of leptin in the uterus or global replacement of leptin during pregnancy suggest leptin signaling in the reproductive tract may be required. Here, conditional leptin receptor knockout (Lepr cKO) with a progesterone receptor-driven Cre recombinase was used to examine the importance of leptin signaling in pregnancy. Lepr cKO mice have almost no leptin receptor in uterus or cervix, and slightly reduced leptin receptor levels in corpus luteum. Estrous cycles and progesterone concentrations were not affected by Lepr cKO. Numbers of viable embryos did not differ between primiparous control and Lepr cKO dams on Days 6.5 and 17.5 of pregnancy, despite a slight reduction in the ratio of embryos to corpora lutea, showing that uterine leptin receptor signaling is not required for embryo implantation. Placentas of Lepr cKO dams had normal weight and structure. However, over four parities, Lepr cKO mice produced 22% fewer live pups than controls, and took more time from pairing to delivery by their fourth parity. Abnormal birth outcomes of either dystocia or dead pups occurred in 33% of Lepr cKO deliveries but zero control deliveries, and the average time to deliver each pup after crouching was significantly increased. Thus, leptin receptor signaling in the reproductive tract is required for normal labor and delivery.
Modulation effects of danshen-honghua herb pair on gut microbiota of acute myocardial ischemia model rat
Authors: Du Shao-Bing , Zhou Hui-Hui , Wang Peng-Fei , Wang Xiao-Ping , Xue Zhi-Peng , Li Jing , Gao Su , Li Na , Bai Ji-Qing , Xie Li-hong
Published: March 2022

In the recent years, a growing number of studies have shown that the occurrence of myocardial ischemia (MI) is closely related to the gut microbiota (GM). The Danshen-Honghua herb pair (DHHP), a classic combination in traditional Chinese herbal formulas, has been widely applied throughout history to cure cardiovascular disease, exhibiting remarkable clinical efficacy to treat ischemic heart disease (IHD). However, the intrinsic regulation mechanism of DHHP in treating MI remains unclear. This study aims to investigate the possible protective mechanism of DHHP in rats with acute myocardial ischemia (AMI) induced by isoproterenol (ISO) through 16S rRNA gene sequencing technique. Pharmacodynamic results showed that DHHP significantly ameliorated the pathological changes and improved the abnormal cardiac enzymes levels in the AMI rats. In addition, GM analysis demonstrated that DHHP effectively ameliorated the ISO-induced dysbiosis of the GM community, mainly by enhancing the GM diversity and increasing the relative abundance of Bacteroides, Roseburia, unclassified_f__Lachnospiraceae, and Lachnospiraceae_NK4A136_group, the abundance ratio of Bacteroidetes to Firmicutes, and decreasing the relative abundance of Escherichia-Shigella and Enterococcus. In summary, this study revealed that DHHP could improve ischemic myocardial injury in rats, and that its regulation mechanism is associated with significantly ameliorating the composition of GM, thus contributing to further our understanding of the anti-MI mechanisms of DHHP.
Genetics and Material Culture Support Repeated Expansions into Paleolithic Eurasia from a Population Hub Out of Africa
Authors: Vallini Leonardo , Marciani Giulia , Aneli Serena , Bortolini Eugenio , Benazzi Stefano , Pievani Telmo , Pagani Luca
Published: March 2022

The population dynamics that followed the Out of Africa (OoA) expansion and the whereabouts of the early migrants before the differentiation that ultimately led to the formation of Oceanian, West and East Eurasian macropopulations have long been debated. Shedding light on these events may, in turn, provide clues to better understand the cultural evolution in Eurasia between 50 and 35 ka. Here, we analyze Eurasian Paleolithic DNA evidence to provide a comprehensive population model and validate it in light of available material culture. Leveraging on our integrated approach we propose the existence of a Eurasian population Hub, where Homo sapiens lived between the OoA and the broader colonization of Eurasia, which was characterized by multiple events of expansion and local extinction. A major population wave out of Hub, of which Ust’Ishim, Bacho Kiro, and Tianyuan are unadmixed representatives, is broadly associated with Initial Upper Paleolithic lithics and populated West and East Eurasia before or around 45 ka, before getting largely extinct in Europe. In this light, we suggest a parsimonious placement of Oase1 as an individual related to Bacho Kiro who experienced additional Neanderthal introgression. Another expansion, started before 38 ka, is broadly associated with Upper Paleolithic industries and repopulated Europe with sporadic admixtures with the previous wave (GoyetQ116-1) and more systematic ones, whereas moving through Siberia (Yana, Mal’ta). Before these events, we also confirm Zlatý Kůň as the most basal human lineage sequenced to date OoA, potentially representing an earlier wave of expansion out of the Hub.
Transformative diplomacy? Micro-sociological observations from the Philippine peace talks
Authors: Bramsen Isabel
Published: March 2022

How do adversaries build social bonds in peace talks and how decisive are such bonds for the success of peace processes? The article investigates the micro-sociological thesis that diplomatic face-to-face interaction can generate social bonds. It is based on direct observations from peace talks between the Philippine government and the communist party (NDFP) in January 2017 and backchannel talks in 2020. The article shows that the talks took the form of friendly and disengaged interaction with very little dominating or conflictual interaction. Observations and interviews with participants show that social bonds were generated at the negotiations. However, the talks broke down immediately after the third round and has not been running since, apart from back-channel negotiations. The article discusses the remarkable contrast between the good atmosphere at the table and the breakdown of negotiations, arguing that while face-to-face interaction holds transformative potential, the right people need to be at the table for it to bring peace. As neither the president of the Philippines, Rodrigo Duterte, nor the hardliners of his government were present at the table, the transformative potential was limited. The article therefore questions the transformative potential of peace talks, if leaders and hardliners are not present.
Natural History of New-onset Inflammatory Bowel Disease Among Patients With Multiple Sclerosis
Authors: Gandhi Shiv , Zelman Sara , De Armas Ricardo Eduardo , Hemond Christopher , Levy Alexander N , Singh Siddharth , Korzenik Joshua , Jangi Sushrut
Published: March 2022

Lay Summary

Patients with MS and IBD were as likely to have stricturing, fistulizing, and extensive IBD as IBD controls. Although MS-IBD patients were less likely to initiate anti-TNF therapy, they did not have worsened risk of progression to surgery on follow-up.
Spatially explicit food web modelling to consider fisheries impacts and ecosystem representation within Marine Protected Areas on the Kerguelen Plateau
Authors: Subramaniam Roshni C , Corney Stuart P , Melbourne-Thomas Jessica , Péron Clara , Ziegler Philippe , Swadling Kerrie M
Published: March 2022

The Kerguelen Plateau in the Indian sector of the Southern Ocean is a highly dynamic region for Southern Ocean ecosystems and an important region for the Patagonian toothfish fishery. Fished regions overlap with foraging regions for predators; however, no study has explored the spatial impacts of fishing on ecosystem dynamics. We developed two spatially explicit ecosystem models to (i) explore the spatial effects of fishing on the Patagonian toothfish and the ecosystem in scenarios with and without fishing; and (ii) use modelled distributions to compare ecosystem representation in Marine Protected Areas (MPAs) with existing studies. Consistent with other studies, we found decreases in Patagonian toothfish biomass in scenarios with fishing activity. In contrast, we found no spatial fishing impacts on ecosystem interactions. A majority of functional group distributions were positively correlated with phytoplankton and well distributed within no-take areas. This could indicate a high level of representation of species in MPAs. Our study provides valuable insights into spatial ecosystem dynamics on the Kerguelen Plateau; however, our interpretations were limited and more research is needed to disentangle the natural variation from fishing impacts and further explore spatio-temporal changes in phytoplankton on the ecosystem.
What constitutes compliance? Legislative responses to Constitutional Court decisions in Indonesia
Authors: Butt Simon , Murharjanti Prayekti
Published: March 2022

This article examines how the government responds to decisions of the Indonesian Constitutional Court, focusing on the legislature. While Indonesian law requires that Constitutional Court decisions be followed up by legislation, we argue that most of them in fact require no legislative response, despite consistent complaints of legislative inaction from commentators and even the Court itself. Instead, if these decisions are followed up at all, they are more commonly reflected in regulatory instruments and judicial decisions, some of which have been inconsistent and have therefore undermined the effectiveness of the Court’s constitutional review function. We show that reliance on the legislature for a response can even be dangerous. Using two case studies, we demonstrate how the legislature has simply revived provisions the Court invalidated. The legislature has even added provisions that were inconsistent with the tenor of the Court’s decisions and that appear to reflect the commercial or institutional interests of drafters and worsen the constitutional damage the challenge was brought to address. This suggests that constitutional review can be counterproductive in the Indonesian context, if the legislative response is at odds with the interests of those bringing the challenge.
The Character and Origins of Military Attitudes on the Use of Force
Authors: Jost Tyler , Meshkin Kaine , Schub Robert
Published: March 2022

Do military and civilian attitudes on the use of force differ and, if so, why? Past scholarship is divided not only on whether decision-makers with military experience are more hawkish but also in whether differences stem from organizational selection or socialization. We contribute to these debates through a unique opportunity to survey incoming military officers at the US Military Academy before and after basic training and pair the results with simultaneous surveys of a nationally representative sample. We find that future military elites are more hawkish than civilians, the gap is evident upon arrival, and initial socializing experiences cannot explain the gap. Numerous tests addressing potential socialization effects over a longer period reveal that experience may attenuate hawkishness but that it is insufficient to offset initial differences. The results indicate that preexisting attitudes shape the groups into which elites select as much as experiences in those groups shape attitudes.
Defending Society, Building the Nation: Rebel Governance as Competing Biopolitics
Authors: Brenner David , Tazzioli Martina
Published: March 2022

Rebel groups govern significant parts of territory worldwide. They often deliver crucial public goods and services to populations under their control. Scholarship on rebel governance commonly explains this with the need for armed groups to generate local and international legitimacy. We argue that this understanding of rebel governance as an instrumental means to power is insufficient. Instead, we propose a novel conceptualization of rebel governance as competing biopolitics. Tracing biopolitical technologies of rebel rule reveals the productive functions of war-time social orders for molding populations into imagined communities in direct opposition to the existing nation state. We develop this perspective by mobilizing Foucault's work in conjunction with Chatterjee's postcolonial understanding of governmentality in contexts of postcolonial state- and nation-formation, and empirical research on the Pat Jasan in northern Myanmar. Linked to the Kachin rebellion, this movement has fought against a devastating narcotics crisis with biopolitical interventions that form the Kachin nation body amidst protracted ethnonational conflict. Beyond shedding light on one of the world's longest running but least-researched civil wars, this offers three distinct contributions to international studies: exploring non-state armed groups as actors of public health, theorizing the sociological underpinnings of rebel governance, and developing the concept of biopolitics beyond the nation state.
Complete genome of the extensively antibiotic-resistant GC1 Acinetobacter baumannii isolate MRSN 56 reveals a novel route to fluoroquinolone resistance
Authors: Harmer Christopher J , Lebreton Francois , Stam Jason , McGann Patrick T , Hall Ruth M
Published: March 2022

Objectives

To examine the causes of antibiotic resistance in the extensively resistant global clone 1 (GC1) Acinetobacter baumannii isolate MRSN 56 recovered at a US military treatment facility.

Methods

MRSN 56 was sequenced using MinION (Oxford Nanopore) and the reads combined with available Illumina MiSeq data using Unicycler. Acquired resistance genes were identified using ABRicate and their environment examined. ISAba1 and ISAba125 copies were located.

Results

MRSN 56 is ST1IP:ST231Ox:KL1:OCL1 and the complete genome includes four small plasmids, none of which carry resistance genes. The acquired resistance genes were found at four locations in the chromosome in addition to AbaR28 (aphA1, aacC1, aadA1, sul1) in comM. Tn2006 (oxa23, carbapenem resistance) was both in AbaR4 and alone elsewhere. Two copies of Tn7 (dfrA1, sat, aadA1) were identified. One was associated with a 22 852 bp adjacent segment [tetA(B), sul2] derived from the AbGRI1 island, and this novel configuration was designated Tn7+. Tn7+ was incorporated in the position preferred by Tn7, downstream of glmS, by transposition using a sequence in AbGRI1 resembling the Tn7 terminal inverted repeats. Tn7 was found at a secondary site. Fluoroquinolone resistance appears to involve a mutation in gyrA combined with inactivation by ISAba1 of the marR gene in the mar operon and constitutive expression of marA from the promoter internal to ISAba1.

Conclusions

MRSN 56 represents a new sublineage of GC1 lineage 1 with novel features that had not been detected previously. The involvement of the mar operon in fluoroquinolone resistance has not been noted previously.
A Call for the Development of a Sustainable Pest Management Program for the Economically Important Pest Flies of Livestock: a Beef Cattle Perspective
Authors: Smith K V , DeLong K L , Boyer C N , Thompson J M , Lenhart S M , Strickland W C , Burgess E R , Tian Y , Talley J , Machtinger E T , Trout Fryxell R T
Published: March 2022

Filth fly pests have a substantial impact on livestock production; annual losses from filth flies were estimated at over US$1.5 billion in 1981. Knowing filth fly management and animal production have changed significantly over the past 40 yr, our objective is to lay the foundation for the development of a transdisciplinary integrated pest management (IPM) approach that considers the economics of controlling flies in animal production, with most of the examples provided towards beef cattle production systems. By performing an in-depth literature review, it is our goal to highlight losses and expenditures associated with the damages caused by these flies, discuss current management strategies for the system, and propose industry needs in terms of research gaps and producer education to enhance sustainable livestock production. Immediate industry needs include: (1) developing dynamic economic thresholds incorporating animal welfare, economics, impacts of chemical use, and climate-related responses; (2) improving monitoring methods to improve surveillance efforts for flies as a system and how all types collectively shape the system; and (3) updating economic loss assessments to account for losses due to animal defensive behaviors, reduced feed efficiency, and unplanned expenditures. While we focus on the beef cattle system in the United States, this paper is meant to provide an argument for research in worldwide livestock production (e.g., dairy, poultry, swine, and small ruminant).
Adverse Neonatal Outcomes Associated With Maternal Sexually Transmitted Infections From a Public Health Clinic Cohort in Southern Brazil
Authors: Dong Huan Vinh , Leng Mei , Kreitchmann Regis , Klausner Jeffrey D , Nielsen-Saines Karin , Yeganeh Nava
Published: March 2022

Pregnant women at public medical centers in Porto Alegre, Brazil, were recruited for a study on screening and treatment of sexually transmitted infections (STIs). STIs were detected in 79 (23%) of 350 pregnant women and were found to be associated with infant low birth weight (adjusted odds ratio 5.8; 95% confidence interval 1.9-18).
Coraco-clavicular endobutton and fiber tape fixation for Neer’s type II unstable lateral clavicular fracture: a case series with literature review
Authors: Dalei Tushar Ranjan , Samal Barada Prasanna , Gupta Asish Kumar , Senapati Rajesh , Sahoo Tarini Prasad
Published: March 2022

Neer’s type II lateral end clavicle fracture is inherently unstable due to coraco-clavicular ligament disruption. Timely surgery can avoid complications of conservative management. Our study is based on open reduction and fixation with double endobutton and fibre tape in 12 patients. Radiological and functional outcome were assessed using Quick DASH score and SPADI score at regular interval. All the fractures achieved both clinical and radiological union. No intra-operative or post-operative complication was noted. Functional out come and range of motion at 1-year follow-up was quite satisfactory. Open reduction and fixation with double endobutton and fibre tape for lateral end clavicle fracture is a quite rewarding surgery with less steep learning curve, economical and enough stable fixations leading to union and good functional outcome without need of re-surgery for implant removal.
Coordination and Harmony in Bilateral Logic
Authors: del Valle-Inclan Pedro , Schlöder Julian J
Published: March 2022

Ian Rumfitt (2000) developed a bilateralist account of logic in which the meaning of the connectives is given by conditions on asserted and rejected sentences. An additional set of inference rules, the coordination principles, determines the interaction of assertion and rejection. Fernando Ferreira (2008) found this account defective, as Rumfitt must state the coordination principles for arbitrary complex sentences. Rumfitt (2008) has a reply, but we argue that the problem runs deeper than he acknowledges and is in fact related to the challenge of establishing proof-theoretic harmony. We motivate a distinctively bilateral criterion for harmony and show how the bilateralist can meet it. This also resolves Ferreira's complaint.
Collisional and radiative pumping in 22-GHz water masers
Authors: Gray M D , Etoka S , Richards A M S , Pimpanuwat B
Published: March 2022

We briefly discuss the history of pumping schemes for the common 22-GHz maser transition in o-H2O, and note that radiative mechanisms have been considered in the past, as well as the better known collisional pumping mechanisms associated with shock waves. Substantial IR irradiation is indeed destructive to inversion at 22-GHz under a wide range of physical conditions. We identify a small number of transitions, including 22 GHz, that can be pumped by both collisional and radiative schemes, and, through radiative transfer modelling over a grid of values in kinetic temperature, number density, and dust temperature, identify loci in density-kinetic temperature space where these schemes lead to strong inversions. The radiative pumping scheme generally operates at higher dust temperature, and lower kinetic temperature, than the collisional scheme. We identify a small network of transitions that form a radiative pumping scheme for the 22-GHz maser, involving radiative transitions of wavelength approximately 6 $\mu$m. This network is capable of supplying more than 50 per cent of the 22-GHz inversion under typical radiative pumping conditions, and it is consistent with the need for high dust and low kinetic temperatures determined from the modelling. We identify a probable case of radiative pumping in a massive star-forming region from the observation of a positive correlation between the flux densities of 22-GHz H2O masers and 6.7-GHz methanol masers. We discuss possibilities for finding radiatively pumped H2O maser lines in other source types.
Formation of non-base-pairing DNA microgels using directed phase transition of amphiphilic monomers
Authors: Lee Chanseok , Do Sungho , Lee Jae Young , Kim Minju , Kim Sang Moon , Shin Yongdae , Kim Do-Nyun
Published: March 2022

Programmability of DNA sequences enables the formation of synthetic DNA nanostructures and their macromolecular assemblies such as DNA hydrogels. The base pair-level interaction of DNA is a foundational and powerful mechanism to build DNA structures at the nanoscale; however, its temperature sensitivity and weak interaction force remain a barrier for the facile and scalable assembly of DNA structures toward higher-order structures. We conducted this study to provide an alternative, non-base-pairing approach to connect nanoscale DNA units to yield micrometer-sized gels based on the sequential phase transition of amphiphilic unit structures. Strong electrostatic interactions between DNA nanostructures and polyelectrolyte spermines led to the formation of giant phase-separated aggregates of monomer units. Gelation could be initiated by the addition of NaCl, which weakened the electrostatic DNA-spermine interaction while attractive interactions between cholesterols created stable networks by crosslinking DNA monomers. In contrast to the conventional DNA gelation techniques, our system used solid aggregates as a precursor for DNA microgels. Therefore, in situ gelation could be achieved by depositing aggregates on the desired substrate and subsequently initiating a phase transition. Our approach can expand the utility and functionality of DNA hydrogels by using more complex nucleic acid assemblies as unit structures and combining the technique with top-down microfabrication methods.
WashU Epigenome Browser update 2022
Authors: Li Daofeng , Purushotham Deepak , Harrison Jessica K , Hsu Silas , Zhuo Xiaoyu , Fan Changxu , Liu Shane , Xu Vincent , Chen Samuel , Xu Jason , Ouyang Shinyi , Wu Angela S , Wang Ting
Published: March 2022

WashU Epigenome Browser (https://epigenomegateway.wustl.edu/browser/) is a web-based genomic data exploration tool that provides visualization, integration, and analysis of epigenomic datasets. The newly renovated user interface and functions have enabled researchers to engage with the browser and genomic data more efficiently and effectively since 2018. Here, we introduce a new integrated panel design in the browser that allows users to interact with 1D (genomic features), 2D (such as Hi-C), 3D (genome structure), and 4D (time series) data in a single web page. The browser can display three-dimensional chromatin structures with the 3D viewer module. The 4D tracks, called ‘Dynamic’ tracks, animatedly display time-series data, allowing for a more striking visual impact to identify the gene or genomic region candidates as a function of time. Genomic data, such as annotation features, numerical values, and chromatin interaction data can all be viewed in the dynamic track mode. Imaging data from microscopy experiments can also be displayed in the browser. In addition to software development, we continue to service and expand the data hubs we host for large consortia including 4DN, Roadmap Epigenomics, TaRGET and ENCODE, among others. Our growing user/developer community developed additional track types as plugins, such as qBed and dynseq tracks, which extend the utility of the browser. The browser serves as a foundation for additional genomics platforms including the WashU Virus Genome Browser (for COVID-19 research) and the Comparative Genome Browser. The WashU Epigenome Browser can also be accessed freely through Amazon Web Services at https://epigenomegateway.org/.
How Smokers of Menthol Cigarettes and Flavored Cigars Might Respond to FDA’s Proposed Bans
Authors: Yang Yong , Lindblom Eric N , Ward Kenneth D , Salloum Ramzi G
Published: March 2022

Introduction

A ban on menthol cigarettes and flavored cigars may reduce smoking and tobacco-related disparities.

Aims and Methods

We aimed to examine the response of current smokers to a hypothetical ban on menthol cigarettes and flavored cigars. Current smokers were recruited online and reported the alternative products that they may switch to under a hypothetical ban, if they would try to obtain the banned products from illicit channels, and their support to the ban.

Results

51% of current smokers would use nonflavored cigarettes and cigars as alternatives, 45% would switch to flavored heated tobacco products or e-cigarettes or quit smoking. 17% would try to obtain the banned flavored products from illicit markets. A majority of menthol only smokers opposed the ban. Daily smokers would be more likely to switch to nonflavored smoking, to try illicit market products, and were less supportive of the ban. Black smokers would be less likely to switch to nonflavored smoking and were more supportive of the ban. Smokers who used menthol cigarettes only would be more likely to switch to nonflavored smoking, less likely to try illicit market sellers, and were the least supportive of the ban.

Conclusions

In response to a ban of all added flavors for cigarettes or cigars, nearly half of the current smokers would quit smoking, largely by switching to nonsmoking products. However, smokers with more chronic use and those who used only menthol cigarettes would be more likely to switch to nonflavored smoking, diminishing the harm reduction potential. The ban may decrease the relatively higher prevalence of menthol cigarette smoking among Blacks compared with other groups.

Implications

A ban on the sale of menthol cigarettes and flavored cigars may decrease the prevalence of smoking because some current smokers may quit smoking and switch to nonsmoking products. However, smokers with more chronic use and those who used menthol cigarettes only were more likely to switch to nonflavored cigarettes or cigars, diminishing the harm reduction potential of the ban. Black smokers would be more likely to switch to products other than cigarettes and cigars thus decreasing their relatively higher prevalence of smoking compared with other groups.
Osteophytes’ position in subjects with DISH and right-sided aorta: verification of the ‘aortic pulsation protective effect’ theory
Authors: Gliner-Ron Masha , Bercovich Eyal , Herman Amir , Lidar Merav , Militianu Daniela , Eshed Iris
Published: March 2022

Objectives

To validate in a large cohort with right-sided aorta the theory that thoracic right-sided flowing osteophytes in DISH results from a ‘protective’ effect of the pulsating descending left-sided thoracic aorta.

Methods

Chest CTs of patients with DISH and right-sided aorta and controls with DISH and left-sided aorta were evaluated and compared on each intervertebral space (IS) for the location of the aorta (right, left, centre) and the location of the osteophyte relative to the aorta (contralateral, ipsilateral, bilateral).

Results

The study and control cohorts included 31 and 35 subjects, respectively (male 22/9 and female 27/8; median age 64.8/65.3 years; P = 0.86). Osteophytes contralateral to the aorta’s location were recorded in the majority of ISs in both the study and control groups (47% and 60%, respectively; P > 0.05), while ipsilateral osteophytes were recorded in 6.9% and 7.7%, respectively (P = 0.002). Bilateral osteophytes located to the right and the left of the aorta were significantly more prevalent in the study group compared with the controls (17.2% and 5.4%, respectively; P = 0.04).

Conclusions

Aortic pulsation plays an important role in inhibiting the development of osteophytes and results in the majority of contralateral osteophytes on both right-sided and left-sided aortas. However, since both ipsilateral and bilateral osteophytes were not at all rare in both groups, other parameters, which are yet to be established, probably contribute to the location of osteophytes.
Clinical integration of patient-reported outcome measures to enhance the care of patients with SLE: a multi-centre prospective cohort study
Authors: Kasturi Shanthini , Price Lori Lyn , LeClair Amy , Patel Neena , Shetty Shreya , Sheira Dina , Weber Serena , Curtis David , Nowell W Benjamin , Salmon Jane , Terrin Norma , McAlindon Timothy E , Mandl Lisa A
Published: March 2022

Objective

To assess the feasibility and impact of integrating electronic patient-reported outcome measures (PROMs) into the routine outpatient care of patients with SLE.

Methods

We conducted a prospective cohort study, utilizing a mixed-methods sequential explanatory design, of SLE outpatients receiving rheumatology care at two academic medical centres. Participants completed electronic PROMs at enrolment and then prior to their next two routine rheumatology visits. PROM score reports were shared with patients and rheumatologists before visits. Patients and rheumatologists completed post-visit surveys evaluating the utility of PROMs in the clinical encounters. Focus groups of patients and interviews with treating rheumatologists were conducted to further explore their experience utilizing PROMs.

Results

A total of 105 SLE patients and 17 rheumatologists participated in the study. Patients completed PROMs in 159 of 184 encounters (86%), with 93% of surveys completed remotely. Patients reported that PROMs were ‘quite a bit’ or ‘very’ useful (55% of encounters) and beneficial to communication (55% of encounters). In contrast, physicians found PROMs useful (20%) and beneficial to communication (17%) less frequently. There was no significant change in visit length, health-related quality of life or disease activity after implementation of PROMs; however, patient satisfaction improved slightly. Qualitative analyses revealed that patients felt PROMs provided utility primarily by facilitating communication, particularly when physicians discussed the surveys.

Conclusion

The remote capture and integration of electronic PROMs into clinical care was feasible in a diverse cohort of SLE outpatients. PROMs were useful to patients and enhanced their clinical experience primarily by facilitating communication.
A rare breast cancer in a patient with pierced nipples
Authors: Barreto Raquel
Published: March 2022

Paget disease of the breast is a rare form of breast cancer that affects the nipple and areolar complex. Clinicians should have a high suspicion for this condition in patients who fail conservative treatment for benign-appearing dermatologic findings regardless of age or sex. This article describes a patient with whose presumed nipple infection was initially thought to be related to her nipple piercing.
Microsurgical Reconstruction for Reanimation of Foot Dorsiflexion in Children
Authors: Allen Luke C.E. , Bourke Grainne
Published: March 2022

Foot drop is a debilitating condition, which causes physical disability and psychological challenges associated with difficulties walking. We report the indications, novel technique, and successful outcomes of two children (three limbs) who underwent free functional gracilis muscle transfers coaptated to the common peroneal nerve to reanimate active foot dorsiflexion and correct foot drop secondary to loss of the anterior compartment.
An Improvised Approach to Relative Motion Extension Splinting in the Emergency Room
Authors: Miller Jonathan E. , Le Brian Q.
Published: March 2022

Lacerations to the dorsum of the hand are frequently complicated by involvement of extensor tendons. Bedside repair of these injuries in the emergency room decreases time to treatment and avoids operating room expenses and anesthetic associated risks. Optimal outcomes require prompt follow-up and initiation of hand therapy to promote tendon gliding and prevent tethering of scar tissue. Here, we present our improvised relative motion extension splint utilized in treatment of zone five and six extensor tendon lacerations. This orthosis is preferred in isolated extensor tendon injuries that are amenable to primary repair at the bedside in the appropriately compliant and motivated patient. Our design is comprised of readily available supplies in the emergency room setting. Our improvised relative motion extension splint is lighter weight versus a traditional plaster orthosis and frees the patient to engage in activities of daily living with the injured hand on day four following tendon repair. With repeated application we have become facile with this design, which also permits flexibility such as placement of a wrist extension splint component if needed. Relative motion extension splinting is an established method of treatment following extensor tendon repair. Here, we present a straightforward method of fabricating such a device in the emergency room without the availability of thermoplastic materials. Future study will be needed to establish the efficacy of this device versus its thermoplastic counterpart.
Cytogenetics in Chronic Lymphocytic Leukemia: ERIC Perspectives and Recommendations
Authors: Baliakas Panagiotis , Espinet Blanca , Mellink Clemens , Jarosova Marie , Athanasiadou Anastasia , Ghia Paolo , Kater Arnon P. , Oscier David , Haferlach Claudia , Stamatopoulos Kostas ,   on behalf of ERIC, the European Research Initiative on CLL
Published: March 2022

Mounting evidence underscores the clinical value of cytogenetic analysis in chronic lymphocytic leukemia (CLL), particularly as it allows the identification of complex karyotype, that has recently emerged as a prognostic and potentially predictive biomarker. That said, explicit recommendations regarding the methodology and clinical interpretation of either chromosome banding analysis (CBA) or chromosome microarray analysis (CMA) are still lacking. We herein present the consensus of the Cytogenetic Steering Scientific Committee of ERIC, the European Research Initiative on CLL, regarding methodological issues as well as clinical interpretation of CBA/CMA and discuss their relevance in CLL. ERIC considers CBA standardized and feasible for CLL on the condition that standards are met, extending from the use of novel mitogens to the accurate interpretation of the findings. On the other hand, CMA, is also standardized, however, robust data on its clinical utility are still scarce. In conclusion, cytogenetic analysis is not yet mature enough to guide treatment choices in CLL. That notwithstanding, ERIC encourages the wide application of CBA, and potentially also CMA, in clinical trials in order to obtain robust evidence regarding the predictive value of specific cytogenetic profiles towards refining risk stratification and improving the management of patients with CLL.
The Significant Predictors for Breast, Cervical, Colorectal, or Oral Cancer Screening Intention and Behavior in Taiwan
Authors: Huang Hsiu-Chen , Chang Pei-Chi , Li Sin-Fong , Wang Cing-Ya , Huang Wan-Ting , Chen Wei , Fan Sheng-Yu
Published: March 2022

Background

Cancer screening can improve outcomes in patients with cancer. Accordingly, under the direction of the National Health Insurance program, the Taiwan government conducts screenings for breast cancer, cervical cancer, oral cancer, and colorectal cancer.

Objective

The aim of this study was to identify the primary predictors of cancer screening intention and behavior at 1 and 6 months after patients are provided information and an invitation by telephone to attend cancer screenings.

Methods

In this prospective longitudinal study, 339 participants meeting the screening criteria were recruited. At baseline, telephone interviews were used to collect information on demographic characteristics, exercise and smoking habits, family cancer history, screening beliefs, and screening intention. Screening behavior was followed up at 1 and 6 months after the telephone interviews.

Results

At baseline, 87.02% of the participants intended to undergo screening, and 31.86% and 63.42% had undergone screening after 1 and 6 months, respectively. The predictors of screening intention were awareness of the screening policy, willingness to learn about screening, and believing in the health benefits of screening. The predictor of screening behavior after 1 month was screening intention at baseline, and the predictors of behavior after 6 months were screening intention, marital status, and belief that cancer is a hereditary disease.

Conclusion

Adults with screening intention tended to undergo cancer screenings.

Implications for Practice

The use of strategies based on screening intention, beliefs, and information can be used to improve participation in cancer screening in Taiwan.
De-escalation Training as Part of a Workplace Violence Prevention Program
Authors: Thompson Shannon L. , Zurmehly Joyce , Bauldoff Gerene , Rosselet Robin
Published: March 2022

Workplace violence, including verbal and physical abuse, is escalating nationwide. As healthcare workers try to enforce COVID-19 prevention policies and practices, this phenomenon is exacerbated. De-escalation training is a method to prepare nurses through increased situational awareness, leading to early recognition and improved coping and confidence in dealing with aggression. Outcomes are presented, suggesting education of nurses may have a positive influence on the number of security calls and incident reports.
Ovarian Combined Serous Borderline Tumor/Low-grade Serous Carcinoma and Mesonephric-like Lesion: Report of 2 Cases With New Observations
Authors: Nilforoushan Neshat , Liu Lian , Finkelman Brian S. , Andersen John , Liu Ying , James Jeffrey , Hung Chien-Fu , Wu T.-C. , Vang Russell , Xing Deyin
Published: March 2022

Ovarian combined serous borderline tumor/low-grade serous carcinomas (SBT/LGSC) and mesonephric-like adenocarcinomas (MLA) have been previously reported and the presence of identical oncogenic somatic mutations in both components supports the concept that at least some of MLAs arise from a Müllerian origin. We report 2 cases of ovarian combined SBT/LGSC and mesonephric-like lesion. Case 1 was a 70-yr-old woman presented with a liver lesion and omental carcinomatosis. Histologic examination revealed biphasic tumors in bilateral ovaries consisting of conventional SBT and invasive MLA with extraovarian spread. The right ovary also had a component of cribriform variant of SBT/noninvasive LGSC. The SBT/LGSC component was diffusely positive for Pax8, WT-1, and ER, focally positive for PR, and negative for GATA3, while the MLA component was diffusely positive for GATA3 but negative for WT-1, ER, and PR. Molecular analysis revealed a KRAS G12V mutation in both the SBT/LGSC and MLA components, indicating their clonal origin. Case 2 was a 58-yr-old woman who presented with conventional type SBT in both ovaries. In addition, the left ovarian tumor demonstrated a few areas (each <5 mm) of mesonephric-like differentiation/hyperplasia in close proximity to the serous-type epithelium, with an immunophenotype of focal GATA3 expression, luminal pattern of CD10 staining and negative WT-1, ER, and PR staining. This phenomenon has been reported in endometrioid borderline tumor but not in any serous type lesions. The findings in case 1 provide further evidence to demonstrate the clonal relationship between these morphologically and immunophenotypically distinct components. It also supports the theory that, unlike cervical mesonephric carcinomas originating from mesonephric remnants, MLAs are derived from a Müllerian-type lesion with differentiation into mesonephric lineage. The presence of a hyperplastic mesonephric-like lesion/differentiation in case 2 indicates that a precursor lesion in the same lineage with the potential to develop into MLA exists in the ovary.
The Crooked Nose: A Practical Guide to Successful Management
Authors: Block Lisa , Pfaff Miles J. , Harris Alexandria , Goldstein Jesse A. , Losee Joseph E.
Published: March 2022

Learning Objectives:

After studying this article, the participant should be able to: (1) Preoperatively evaluate the patient with a crooked nose. (2) Develop a comprehensive preoperative plan specific to the patient. (3) Effectively “deconstruct” and rebuild the crooked nose to address both aesthetic and functional concerns. (4) Use postoperative techniques to maximize outcomes.

Correction of the crooked nose requires a detailed understanding of the relevant surgical anatomy, identification of the deforming forces—both intrinsic and extrinsic—contributing to the deformity, and knowledge of techniques needed to effect the desired change. This continuing medical education article takes the reader through the evaluation and formulation processes to develop a patient-specific plan and provides surgical pearls necessary to get the best results possible. Most importantly, this article emphasizes the need to treat the crooked nose as a reconstructive rather than routine aesthetic operation.
Visual Evoked Potentials in Patients With Vitamin B12 Deficiency
Authors: Yıldız Onur , Erdem Tilki Hacer
Published: March 2022

Purpose:

The aim of this study was to investigate the subclinical involvement of the optic nerve in asymptomatic patients with vitamin B12 deficiency using visual evoked potentials.

Methods:

This study included 40 asymptomatic patients diagnosed with vitamin B12 deficiency (considered as serum levels below 150 pg/mL) and a control group of 40 healthy individuals. All participants underwent a visual evoked potential examination. Routine screening for homocysteine was performed for patients with vitamin B12 deficiency. The levels of vitamin B12 and homocysteine and the presence of megaloblastic anemia were analyzed statistically compared with P100, N75, and N135 latencies and amplitudes.

Results:

The mean vitamin B12 level was 96 pg/mL in the patient group and 374 pg/mL in the control group. In the patient group, 24 (60%) patients had hyperhomocysteinemia and 8 (20%) patients had megaloblastic anemia. The P100 wave latency of patients with vitamin B12 deficiency was significantly prolonged compared with the control group (P < 0.01). There was no significant difference in the P100 amplitude between the patient group and the control group. P100 latencies were significantly longer in patients with hyperhomocysteinemia (P = 0.002).

Conclusions:

Our study showed that patients with vitamin B12 deficiency may have visual evoked potential abnormalities without visual symptoms or examination findings. In addition, high homocysteine levels led to a prolonged P100 latency in the patient group independent of vitamin B12 levels.