bluuebunny/crossref_metadata_2025 huggingface dataset:
Burnout and compassion fatigue among Exercise Physiologists in mental healthcare
Authors: Lederman O , Cashin A G , Fibbins H , Gaston J , Rosenbaum S , Stanton R
Published: September 2020

Background

Burnout and compassion fatigue (CF) are common among mental health practitioners. Accredited Exercise Physiologists (AEPs) provide clinical services to individuals experiencing mental illness, increasing their likelihood of experiencing burnout and CF.

Aims

To examine the prevalence of burnout and CF among AEPs working with people experiencing mental illness.

Methods

An anonymous online cross-sectional survey of AEPs working with people experiencing mental illness was distributed via the Exercise and Sports Science Australia Mental Health Special Interest Group Facebook page between July and November 2019. In addition to demographics and caseload data, respondents completed the Professional Quality of Life scale and Oldenburg Burnout Inventory (OLBI). Results are reported using descriptive statistics.

Results

Sixty-two AEPs (68%, n = 42 female) completed the survey. Most (n = 53, 86%) reported delivering services to consumers with severe mental health conditions. Less than half (n = 27, 44%) reported working in a dedicated mental health facility. Moderate levels of burnout and CF were experienced by 60% and 30% of respondents, respectively.

Conclusions

The prevalence of moderate burnout and CF symptoms in AEPs is comparable with other mental health professionals. Strategies to preserve psychological well-being such as enhancing mental health training for undergraduates and formalized supervision structures discussed.
Disseminated form of the Kaposi sarcoma in HIV-negative patient associated with Hodgkin’s lymphoma
Authors: Tutaeva V V , Bobin A N , Ovsiannikova M R , Bulgakova M V , Kuchma Y M , Kryukov E V , Rukavitsyn O A
Published: September 2020

We report a case of a 35-year-old, non-HIV-infected male diagnosed simultaneously with a disseminated form of Kaposi’s sarcoma (KS; skin, stomach and colon are involved) and Hodgkin’s lymphoma. There is no sign of changes in the immune status, but three herpes viruses were detected in the patient’s blood (EBV, HHV6 and HHV8). He received ABVD chemotherapy and achieved complete metabolic remission for Hodgkin’s lymphoma. Moreover, the signs of the disseminated KS were resolved. Our observations indicate that a combination of distinct types of viruses may play an important role in triggering the development of angio- and lymphoproliferative disorders in the same person. In addition, treatment with chemotherapy cycles, which included doxorubicin and vinblastine, led to the stable remission of both diseases.
Wisdom
Authors: Kekes John
Published: September 2020

This book develops and defends a humanistic conception of wisdom as a personal attitude that guides how we evaluate the possibilities and limits of life in the context in which we live. The attitude is formed of our beliefs, emotions, desires, evaluations, and experiences that make our inner life what it is. It is personal, pluralistic, and fallible. Its components differ from person to person and each may be mistaken. It is a wise attitude if it is based on a critical enough understanding of the reasons for and against its components; if its basic factual and evaluative assumptions are realistic; and if it involves a sufficiently reflective and deep understanding of the prevailing conditions, personal and social problems and possibilities, and of the strengths and weaknesses of the available evaluative resources. We all have some attitude of how we should live, but it is difficult to have a wise attitude. That is why wisdom is at once rare and precious because the sense we can make of our life depends on it. This humanistic conception of wisdom is personal, pluralistic, and fallible. It is a radical departure from traditional conceptions of wisdom understood as knowledge of the ideal of The Good that holds for everyone, always, everywhere. It is a conception that is personal, not theoretical; anthropocentric, not metaphysical; context-dependent, not universal; and humanistic, not scientific. The conception that emerges from this book is intended to be a contribution to philosophy as a humanistic discipline
Taxon-specific prey response to the invasion of a pelagic invertebrate predator, revealed by comparison of pre- and post-invasion time series
Authors: Einberg Heli , Klais-Peets Riina , Põllumäe Arno , Ojaveer Henn
Published: September 2020

Quantification and attribution of the food web changes associated with the invasion of non-indigenous species in the marine realm often remain a challenge. One of the pelagic non-indigenous species of concern in the recent history of aquatic bioinvasions is the predatory cladoceran Cercopagis pengoi, which invaded the Baltic Sea in the early 1990s. While several studies have reported immediate declines in abundances of its potential prey, the long-term effects of C. pengoi on the food webs remain to be examined. Based on the long-term time series (1968–2018) in the Gulf of Riga (Baltic Sea), we found significant declines in abundance of the cladoceran Pleopis spp. and copepod Eurytemora affinis by 90 and 80%, respectively, are associated with the invasion of C. pengoi as well as significant alterations in seasonal abundance patterns of Pleopis spp., E. affinis and cladoceran Bosmina spp. The invasion of the non-indigenous predator has led to the changed prey abundance–temperature relationships. Special caution was taken in data preprocessing, to minimize the likelihood that observed changes in the zooplankton prey could be associated with factors other than the invasion of C. pengoi, such as temperature and storminess.
Health, spirituality and Covid-19: Themes and insights
Authors: del Castillo Fides A
Published: September 2020

Current researches reveal the intimate link between health and spirituality. Among vulnerable populations, spirituality serves a critical purpose in a person’s well-being. One of the many established values of spirituality is that it helps people to deal with major life stressors. This has become more pronounced as the world grapples with the challenges brought by the Covid-19 pandemic. This paper explores the themes and insights from recent scholarly articles on health and spirituality as well as highlights the importance of spiritual care to human well-being.
Personal protective equipment and infection prevention and control: a national survey of UK medical students and interim foundation doctors during the COVID-19 pandemic
Authors: Norton Emma Jane , Georgiou Ioannis , Fung Alex , Nazari Armin , Bandyopadhyay Soham , Saunders Kate E A
Published: September 2020

Background

The adequacy of personal protective equipment (PPE) and infection prevention and control (IPC) training in UK medical students and interim Foundation Year 1 (FiY1) doctors during the COVID-19 pandemic is unknown, as is its impact on COVID-19-related anxiety.

Methods

Cross-sectional, multi-centre study analysing self-reported adequacy of PPE and IPC training and correlation to a modified pandemic anxiety scale. Participants were current medical students and FiY1 doctors in the UK. Data were collected by an online survey.

Results

Participants reported that they received insufficient PPE information (43%) and IPC training (56%). Significantly, fewer participants identifying as women or BAME/mixed ethnicity reported receiving sufficient PPE information, compared with those identifying as men and White British/White Other, respectively. COVID-19-related anxiety was significantly higher in those without sufficient reported PPE or IPC training, in women compared with men, and in FiY1 doctors compared with medical students.

Conclusions

With medical students currently volunteering in and imminently returning to hospitals in an educational capacity, levels of self-reported PPE and IPC training are sub-optimal. Better training is paramount to avoid harm to patients and healthcare professionals and to reduce COVID-19-related anxiety among medical students and FiY1 doctors.
Acquired low immunoglobulin levels and risk of clinically relevant infection in adult patients with systemic lupus erythematosus: a cohort study
Authors: Almaghlouth Ibrahim , Su Jiandong , Johnson Sindhu R , Pullenayegum Eleanor , Gladman Dafna , Urowitz Murray
Published: September 2020

Objective

Infection is a leading cause of death in the SLE population. Low immunoglobulin levels might be a potential risk for infection. We aimed to assess whether acquired low levels of any type of immunoglobulin increase the risk of clinically relevant infection in adult patients with SLE.

Methods

We compared adult SLE patients who had acquired any low immunoglobulin levels (IgA, IgM or IgG) for 2 years with patients with normal or high levels with respect to clinically relevant infection (defined as infections requiring intravenous or oral antibiotics) in a prospective cohort study. Group balance was achieved using propensity score adjustment, matching and inverse probability weighting. Primary analysis was time to event using Cox-regression modelling adjusting for potential confounders. Sensitivity analyses were conducted to examine several exposure and outcome definitions.

Results

Patients with hypogammaglobulinaemia had longer disease duration, more lupus nephritis history, higher proteinuria and more accumulated damage. Low IgA level was associated with increased risk of clinically relevant infection [hazard ratio (HR): 2.24, 95% CI: 1.61, 3.12] while low IgG (HR: 1.15, 95% CI: 0.84, 1.59) or low IgM (HR: 0.95, 95% CI: 0.73, 1.23) was not. Low immunoglobulin recovery in the first year was 2.5% (11), second year 8.2% (36), third year 10.1% (44) and fourth year 18.4% (80), and 60% (263) of acquired hypogammaglobulinaemia recovered over 4 years.

Conclusion

The majority of acquired hypogammaglobulinaemia in adult patients with SLE is transient. Only low acquired IgA was associated with increased risk of infection among adult patients with SLE. Whether immunoglobulin replacement provides additional protective effect requires further investigation.
Response to placebo in non-renal, non-neuropsychiatric systemic lupus erythematosus: a systematic review and pooled analysis
Authors: Tselios Konstantinos , Wakani Laura , Gladman Dafna D , Su Jiandong , Urowitz Murray B
Published: September 2020

Objectives

Most randomized controlled trials (RCTs) in SLE have failed to reach their respective end points, with the rates of response to placebo (plus standard-of-care treatment) being unexpectedly high. The aim of this systematic review was to quantify the response to placebo in non-renal, non-neuropsychiatric lupus.

Methods

The PubMed database was searched (from 2000 to December 2019) for phase II/III RCTs assessing the efficacy and safety of biologics in non-renal, non-neuropsychiatric SLE. Data on the efficacy and safety of the placebo-treated patients were collected in a pre-established data retrieval form. Descriptive statistics were used.

Results

A total of 24 RCTs (n = 11128 in total) were included. Placebo-treated patients (n = 3899) were mostly females (93.5%), Caucasians (60.2%), of mean age 39.7 years, and having a mean disease duration of 7.4 years. Their mean initial SLEDAI 2000 was 10.4, whereas 60.5% had positive anti-dsDNA antibodies, 41.9% low C3 and 35.6% low C4 at randomization. Standard-of-care treatment included glucocorticosteroids in 85.9%, antimalarials in 72.8% and immunosuppressives in 48.5%. The response to placebo was 36.2% for the primary end point (as defined in each study), 39.8% for the SLE Responder Index-4 (SRI-4), 29.2% for SRI-5, 28.4% for SRI-6 and 30.9% for BILAG-based Combined Lupus Assessment response. Regarding safety, there were serious adverse events in 16.3% of patients, serious infections in 5.5% and malignancies in 0.3%, and death occurred in 0.56% of patients.

Conclusion

More than one-third of the placebo-treated patients achieved their respective primary end points in RCTs with biologics in non-renal, non-neuropsychiatric SLE. The response rate was higher for certain end points, such as the SRI-4, while it decreased with more stringent end points.
Differing time-orders of inflammation decrease between ACPA subsets in RA patients suggest differences in underlying inflammatory pathways
Authors: Matthijssen Xanthe M E , Niemantsverdriet Ellis , Le Cessie Saskia , van der Helm-van Mil Annette H M
Published: September 2020

Objectives

Advanced imaging modalities have shown that not only joints but also bones and tendon sheaths can be inflamed at diagnosis of RA. We aimed to better understand the time-order in which the inflamed tissues respond to DMARD treatment. Also, because ACPA status may reflect a different pathophysiology, differences in time-order of inflammation decrease were hypothesized between these disease types.

Methods

A total of 216 consecutive patients presenting with RA (n = 176) or undifferentiated arthritis (n = 40), who all started with conventional synthetic DMARD treatment, were studied. 1.5T contrast-enhanced hand and foot MRIs were performed before treatment and after 4, 12 and 24 months. Cross-lagged models evaluated the influence of two time patterns: a simultaneous pattern (‘change in one inflammatory feature associated with change in another feature’) and a subsequent pattern (‘change in one inflammatory feature preceded change in another feature’). ACPA stratification was performed.

Results

The median symptom duration at presentation was 13 weeks. Forty-four percent of patients was ACPA-positive. All pairs of inflammatory features decreased simultaneously in all time intervals (0–4/4–12/12–24 months; P < 0.05). Moreover, time-orders were identified: synovitis decrease preceded tenosynovitis decrease (0–4 to >4–12 months; P = 0.02 and 4–12 to >12–24 months; P = 0.03). Largely similar results were obtained in both ACPA subgroups. Additionally, in ACPA-positive but not ACPA-negative patients, synovitis decrease preceded osteitis decrease (4–12 to >12–24 moths; P = 0.002).

Conclusion

This study increased the understanding of the response to treatment on the tissue level. In addition to simultaneous decrease of inflammation, synovitis decrease preceded tenosynovitis decrease. Differences in time-order of inflammation decrease between ACPA subgroups suggest differences in underlying inflammatory pathways.
Persistent premature mortality gap in dermatomyositis and polymyositis: a United Kingdom general population-based cohort study
Authors: D’Silva Kristin M , Li Lingyi , Lu Na , Ogdie Alexis , Avina-Zubieta J Antonio , Choi Hyon K
Published: September 2020

Objective

DM and PM are associated with substantial morbidity and mortality. We aimed to examine recent trends.

Methods

Using The Health Improvement Network, we identified patients with incident DM/PM (defined by ≥1 Read diagnosis code) aged 18–89 years with ≥1 year of continuous enrolment prior to the cohort entry date and up to 10 comparators matched on age, sex and entry year. The cohort was divided in two based on the year of DM/PM diagnosis: the early cohort (1999–2006) and late cohort (2007–2014). We calculated multivariable hazard ratios (HR) for death using a Cox-proportional hazards model and multivariable rate differences (RD) using an additive hazard model.

Results

We identified 410 DM cases (mean age: 58 years, 66% female) and 407 PM cases (mean age: 59 years, 61% female). Both DM cohorts had excess mortality compared with the comparison cohorts (71.5 vs 12.9 deaths/1000 person-years [PY] in the early cohort and 49.1 vs 10.4 deaths/1000 PY in the late cohort). The multivariable HRs were 7.51 (95% CI: 4.20, 13.42) in the early cohort and 5.42 (95% CI: 3.11, 9.45) in the late cohort (P-value for interaction = 0.59), and multivariable RDs were 56.2 (95% CI: 31.8, 81.2) in the early cohort and 36.3 (95% CI: 19.6, 53.0) in the late cohort (P-value for interaction = 0.15). A similar trend existed in PM.

Conclusion

The premature mortality gap in DM/PM has not considerably improved in recent years, highlighting an unmet need for therapeutic improvement.
Race, Religious Tradition, and Environmental Conservation
Authors: Brown R Khari , Brown Ronald E , Kaiser Angela
Published: September 2020

Using four national probability studies between the years 2010 and 2015, this study examines how religious beliefs help explain American support for or opposition to governmental efforts to protect the environment. We do so by investigating how race moderates this relationship. We find that religious beliefs associate with and likely inform the environmental policy attitudes of non-Hispanic Whites. We have less evidence that the same holds true for Hispanics and Blacks.
Systematics of the Neotropical spider genera Jalapyphantes and Selenyphantes and the circumscription of the Pocobletus clade (Araneae: Linyphiidae)
Authors: da Silva Moreira Thiago , Hormiga Gustavo
Published: September 2020

We have revised the linyphiid genera Jalapyphantes and Selenyphantes. Jalapyphantes now includes five species, one of them new (J. tricolor sp. nov.). Selenyphantes now consists of six species of which five are new (S. costaricensis sp. nov., S. gaimani sp. nov., S. iztactepetl sp. nov., S. orizabae sp. nov. and S. volcanicus sp. nov.). To infer the phylogenetic position of Jalapyphantes and Selenyphantes, we analysed nucleotide sequence data from five markers (16S,18S, 28S, COI and histone H3) combined with morphological and behavioural data. Both genera are monophyletic and sister to each other. Both Jalapyphantes and Selenyphantes are included within the newly circumscribed Pocobletus clade, which includes all known species of Pocobletus plus several undescribed species. Pocobletus has nomenclatural priority over the junior synonyms Exechopsis, Exocora and Graphomoa.
Cercospora nicotianae Isolates from Flue-Cured Tobacco in North Carolina Found with G143A and F129L Mutations in Cytochrome b Gene
Authors: Ernst Andrew , Thiessen Lindsey
Published: September 2020

Frogeye leaf spot of tobacco caused by Cercospora nicotianae (Ellis & Everhart) is a widespread disease of cultivated tobacco. Recently, flue-cured tobacco producers in North Carolina reported losses due to frogeye leaf spot disease despite the use of strobilurin fungicides. Isolates (n = 4) were obtained in 2018 from affected tobacco leaves from Cumberland, Lenoir, and Nash counties. In 2019, isolates (n = 28) were collected from a field in Wilson county. After sequencing the cytb region of 32 isolates, 30 contained a single point mutation conferring a G143A or F129L amino acid change that resulted in quinone outside inhibitor (QoI) fungicide resistance. Although these resistance mutations have been found in air-cured tobacco in Kentucky, to the best of our knowledge, the present study is the first to report QoI resistance mutations in C. nicotianae populations in flue-cured tobacco and a first report in North Carolina.
Early Amniotomy After Cervical Ripening for Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: De Vivo Valentino , Carbone Luigi , Saccone Gabriele , Magoga Giulia , De Vivo Generoso , Locci Mariavittoria , Zullo Fulvio , Berghella Vincenzo
Published: September 2020

(Abstracted from Am J Obstet Gynecol 2020;222(4):320–329)

Induction of labor (IOL) is performed in approximately 20% of pregnant women in the Unites States. For induction, amniotomy, an artificial rupture of membranes to stimulate contractions, can be performed during vaginal examination and does not require anesthesia.
Screening for Gestational Diabetes Mellitus: One Step Versus Two Step Approach. A Meta-analysis of Randomized Trials
Authors: Saccone Gabriele , Khalifeh Adeeb , Al-Kouatly Huda B. , Sendek Kerri , Berghella Vincenzo
Published: September 2020

(Abstracted from J Matern Fetal Neonatal Med 2020;33(9):1616–1624)

There has been controversy on how to best screen for and diagnose gestational diabetes mellitus (GDM). On the one hand, organizations such as the International Association of Diabetes and Pregnancy Study Group (IADPSG) and the International Federation of Gynecology and Obstetrics recommend the 1-step approach.
Twin Pregnancy With Two Live Fetuses at 11–13 Weeks: Effect of One Fetal Death on Pregnancy Outcome
Authors: Cimpoca B. , Syngelaki A. , Mu A. Chi , Savvoulidou E. , Nicolaides K. H.
Published: September 2020

(Abstracted from Ultrasound Obstet Gynecol 2020;55:482–488)

Monochorionic (MC) and dichorionic (DC) twin pregnancies have been associated with higher rates of fetal loss, perinatal death, and early preterm birth. A previous systematic review of 16 studies reported that the risk of death of the cotwin in pregnancies with a single fetal death was 13.4% in 149 MC and 3.0% in 166 DC pregnancies.
Antimullerian Hormone and Impending Menopause in Late Reproductive Age: The Study of Women's Health Across the Nation
Authors: Finkelstein Joel S. , Lee Hang , Karlamangla Arun , Neer Robert M. , Sluss Patrick M. , Burnett-Bowie Sherri-Ann M. , Darakananda Karin , Donahoe Patricia K. , Harlow Sioban D. , Prizand Sarah H. , Joffe Hadine , Kumar Ajay , Martin Deborah E. , McConnell Daniel , Merrilat Steffenie , Morrison Anthony , Pastore Lisa M. , Randolph John F. , Greendale Gail A. , Santoro Nanette
Published: September 2020

(Abstracted from J Clin Endocrinol Metab 2020;105(4):e1862–e1871)

Follicle-stimulating hormone (FSH) is a widely used biomarker of ovarian age and indirectly of ovarian reserve; however, it has significant limitations. Antimullerian hormone (AMH) provides a more direct index of ovarian activity and remains at a stable level throughout the menstrual cycle, unlike FSH, allowing measurement at any time without affecting interpretation.
Circulating tumor DNA in lung cancer: real-time monitoring of disease evolution and treatment response
Authors: Li Rui-Yu , Liang Zhi-Yong
Published: September 2020

Lung cancer is one of the leading causes of all cancer-related deaths. Circulating tumor DNA (ctDNA) is released from apoptotic and necrotic tumor cells. Several sensitive techniques have been invented and adapted to quantify ctDNA genomic alterations. Applications of ctDNA in lung cancer include early diagnosis and detection, prognosis prediction, detecting mutations and structural alterations, minimal residual disease, tumor mutational burden, and tumor evolution tracking. Compared to surgical biopsy and radiographic imaging, the advantages of ctDNA are that it is a non-invasive procedure, allows real-time monitoring, and has relatively high sensitivity and specificity. Given the massive research on non-small cell lung cancer, attention should be paid to small cell lung cancer.
A Direct Injection Technique to Improve Biosafety to Analyze Levetiracetam Concentrations in Human Serum and Its Application in Therapeutic Drug Monitoring
Authors: Dong Wei-chong , Guo Jia-liang , Yang Xiu-ling , Wang Shu-mei , Yuan Ye , Zhao Meng-qiang , Jiang Ye , Zhang Zhi-qing
Published: September 2020

Background:

With the outbreak of COVID-19, it has become very important to improve biosafety measures taken by medical staff. Fewer pretreatment steps correspond to lower chances of infection. The authors established a direct injection technique to analyze levetiracetam (LEV) concentrations in human serum and studied its application in therapeutic drug monitoring.

Methods:

Serum samples were prepared by hollow fiber centrifugal ultrafiltration and the filtrate was directly injected into a ultra-high performance liquid chromatography apparatus (Waters UPLC BEH C18 column: 50 × 2.1 mm, 1.7 μm) for analysis. The mobile phase consisted of acetonitrile and water (8:92) at a flow rate of 1.0 mL/min. The column temperature was maintained at 30°C. The detected wavelength was 210 nm.

Results:

A linear relationship was obtained for LEV from 0.625 to 80 mcg/mL (r
2 = 0.999). The limit of detection for the analysis of LEV was 0.125 mcg/mL. The analysis time was shortened to 4 minutes. The recovery rate of LEV based on the current method was 96.6%–100.1%, whereas the absolute recovery rate was 93.2%–96.8%. The relative SD of intraday and interday precision was <7.3%. Stability was achieved at room temperature for 24 hours after 3 freeze–thaw cycles and at −80°C for 21 days. The method was successfully applied to determine LEV concentrations in the serum of 19 patients.

Conclusions:

The present method is simple, accurate, and sensitive, and can improve biosafety with the direct injection technique. It is suitable for the analysis of LEV concentrations in therapeutic drug monitoring.
Oral Glutathione and Growth in Cystic Fibrosis
Authors: Bozic Molly , Goss Christopher H. , Tirouvanziam Rabindra M. , Baines Arthur , Kloster Margaret , Antoine Liebe , Borowitz Drucy , Schwarzenberg Sarah Jane ,   GROW study group
Published: September 2020

Objectives:

The nutritional status of children with cystic fibrosis (CF) is associated with mortality and morbidity. Intestinal inflammation may contribute to impaired digestion, absorption, and nutrient utilization in patients with CF and oral glutathione may reduce inflammation, promoting improved nutritional status in patients with CF.

Methods:

The GROW study was a prospective, multicenter, randomized, placebo‐controlled, double‐blind, phase II clinical trial in pancreatic insufficient patients with CF between the ages of 2 and 10 years. Patients received reduced glutathione or placebo orally daily for 24 weeks. The primary endpoint was the difference in change in weight‐for‐age z‐scores from baseline through week 24 between treatment groups. Secondary endpoints included other anthropometrics, serum, and fecal inflammatory markers in addition to other clinical outcomes.

Results:

Fifty‐eight participants completed the study. No significant differences were seen between glutathione (n = 30) and placebo (n = 28) groups in the 6‐month change in weight‐for‐age z‐score (−0.08; 95% CI: −0.22 to 0.06; P = 0.25); absolute change in weight (kg) (−0.18; 95% CI: −0.55 to 0.20; P = 0.35); or absolute change in BMI kg/m2 (−0.06; 95% CI: −0.37 to 0.25; P = 0.69). There were no significant differences in other secondary endpoints. Overall, glutathione was safe and well tolerated.

Conclusions:

Oral glutathione supplementation did not impact growth or change serum or fecal inflammatory markers in pancreatic insufficient children with CF when compared with placebo.
Accrual Trends for Children’s Oncology Group Clinical Trials: A Single Center Experience
Authors: Anderson Bailey , Wolfe Ian , Muruganand Ashwath , Mody Rajen
Published: September 2020

Children’s Oncology Group (COG) has been highly successful in improving childhood cancer survival through well-designed multi-institutional clinical trials. However, our center has recognized a decline in the number of enrollments on COG therapeutic clinical trials over recent years. Our single center, retrospective analysis evaluated in detail the patient enrollment rates, annual number of available clinical trials and reason for nonenrollment over the last decade. We found a 61% decrease in enrollment for phase II to III trials of newly diagnosed patients at our center (2011-2018) along a 29% decrease in the number of open COG studies annually. The primary reason for nonenrollment was unavailability of a suitable trial (76%). We also recognized a decrease in number of adolescent and young adult enrollment particularly in the last 8 years (2010-2018); however, the enrollment rate for adolescent and young adults was not substantially different than enrollment of children. The reasons for reduced enrollments are most likely multifactorial and complex. It is imperative that we continue to develop novel clinical studies using a portfolio of federal, investigator-initiated, and industry trials for pediatric oncology patients to continue to advance outcomes, study survivorship, and improve quality of life for these patients.
Increased Risk of Aortic Dissection Associated With Pregnancy in Women With Turner Syndrome: A Systematic Review
Authors: Hynes Jenna S. , Kuller Jeffrey A. , Goldstein Sarah A. , Ward Cary C. , Muasher Suheil J.
Published: September 2020

Importance

Turner syndrome (TS) is one of the most common chromosomal abnormalities in women. The condition is characterized by gonadal dysgenesis and is associated with structural cardiac abnormalities. Assisted reproductive technology with oocyte donation may be successful but places women with TS at increased risk of aortic dissection and death.

Objective

To summarize all cases of aortic dissection associated with pregnancy in women with TS and provide guidance regarding the safety of pregnancy.

Evidence Acquisition

Systematic review of PubMed for reports of women with TS, aortic dissection, and pregnancy.

Results

There are 14 total reported cases of aortic dissection associated with pregnancy in women with TS. Ten of these cases occurred during pregnancy or in the first month postpartum. The majority of affected pregnancies resulted from oocyte donation, 2 of which were multiple gestations. Two women had a documented history of hypertension, and 3 pregnancies were complicated by preeclampsia. Bicuspid aortic valve and coarctation of the aorta were the most common associated cardiac anomalies. More than half of women had some degree of aortic dilatation. Two women had no identifiable risk factors.

Conclusions and Relevance

Women with TS who desire pregnancy must be thoroughly counseled regarding the increased risk of aortic dissection during pregnancy and postpartum. Preconception consultation with maternal-fetal medicine, reproductive endocrinology, and cardiology is necessary along with a comprehensive physical evaluation. If women with TS choose to pursue pregnancy, they require rigorous cardiac monitoring each trimester during pregnancy and postpartum.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be able to describe the presentation of Turner syndrome, including the associated cardiovascular anomalies; identify the increased risk of aortic dissection associated with pregnancy in women with Turner syndrome; and recommend appropriate preconception consultation and optimal cardiac monitoring.
Intraoperative Tranexamic Acid to Decrease Blood Loss During Myomectomy: A Randomized, Double-blind, Placebo-Controlled Trial
Authors: Opoku-Anane Jessica , Vargas Maria V. , Marfori Cherie Q. , Moawad Gaby , Maasen Marloes S. , Robinson James K.
Published: September 2020

(Abstracted from Am J Obstet Gynecol 2020;223:413.e1–413.e7)

Worldwide, more than 70% of women will develop uterine leiomyomas in their lifetime. Although most myomas are asymptomatic, 25% of women develop symptoms requiring treatment.
Confirmatory Trial for Drug to Prevent Preterm Birth Finds No Benefit, So Why Is it Still Prescribed?
Authors: Rubin Rita
Published: September 2020

(Abstracted from JAMA 2020;323(13):1229–1232)

In 2011, the US Food and Drug Administration (FDA) approved Makena (hydroxyprogesterone caproate) for the prevention of preterm birth (PTB) in pregnant women with a history of spontaneous preterm delivery. The drug received accelerated approval based on one study demonstrating a benefit in reducing the risk of delivery before 37 weeks, on the condition that additional studies would be conducted to confirm the clinical benefit.
Nongenetic Factors Associated with Dupuytren’s Disease: A Systematic Review
Authors: Alser Osaid H. , Kuo Rachel Y. L. , Furniss Dominic
Published: September 2020

Background:

Dupuytren’s disease is a common complex disease caused by genetic and nongenetic factors. The role of many nongenetic risk factors is still unclear and debatable. This study aimed to systematically review the association between Dupuytren’s disease and nongenetic risk factors.

Methods:

A search strategy was developed based on the Population, Exposure, Comparison, Outcomes and Study framework. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses–compliant literature search was conducted in MEDLINE, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception to November of 2018. Title and abstract and then full-text screening against eligibility criteria was performed independently by two reviewers, and consensus was achieved by a third reviewer. The Effective Public Health Practice Project and the Oxford Centre for Evidence Based Medicine tools were used to assess study quality and to evaluate the level of evidence of included studies, respectively.

Results:

Reviewers identified 4434 studies, of which 54 were included in the analysis. There was strong evidence for the association between Dupuytren’s disease and advanced age, male sex, family history of Dupuytren’s disease, and diabetes mellitus. Furthermore, heavy alcohol drinking, cigarette smoking, and manual work exposure showed a significant dose-response relationship. The quality of the included studies was mainly low or moderate, and most studies were level 3 or 4 on the Oxford Centre for Evidence Based Medicine scale.

Conclusions:

The study results show a strong association between Dupuytren’s disease and advanced age, male sex, family history of Dupuytren’s disease, diabetes mellitus, heavy alcohol drinking, cigarette smoking, and manual work exposure. Further studies are required to explain the causal relationship of these associations.
Avoiding Inferior Alveolar Nerve Injury during Osseous Genioplasty: A Guide for the Safe Zone by Three-Dimensional Virtual Imaging
Authors: Lin Hsiu-Hsia , Denadai Rafael , Sato Nobuhiro , Hung Yi-Tan , Pai Betty C. J. , Lo Lun-Jou
Published: September 2020

Background:

No consensus exists about the safest position for performing the osseous genioplasty, with 5 to 6 mm below the mental foramen being the most frequently recommended position. This study intends to generate a safe distance guide to minimize the risk of inferior alveolar nerve injury during osteotomy.

Methods:

Pretreatment cone-beam computed tomography–derived three-dimensional models from adult patients with skeletal class I to III patterns and cleft lip/palate deformity who underwent orthodontic-surgical interventions (n = 317) were analyzed. A three-dimensional vertical distance between the inferior margin of the mental foramen and the lowest point of the inferior alveolar nerve canal was measured in each three-dimensional hemimandible (n = 634). Statistical analysis was performed to generate the safe distance guide in a stepwise fashion at 95, 99, and 99.99 percent confidence levels.

Results:

Class III (4.35 ± 1.42 mm) and cleft lip/palate (4.42 ± 1.53 mm) groups presented significantly (p < 0.001) larger three-dimensional distances than class I (3.44 ± 1.54 mm) and class II (3.66 ± 1.51 mm) groups. By considering the 5- to 6-mm safe distance parameter, 6.4, 5.0, 10.6, 16, and 9.9 percent of hemimandibles were at risk of osteotomy-induced nerve injury in the class I, class II, class III, cleft lip/palate, and overall cohorts, respectively. Overall, the safe distance zone to perform the osteotomy was set at 7.06, 8.01, and 9.12 mm below the mental foramen, with risk probabilities of 2.5, 0.5, and 0.0005 percent, respectively.

Conclusion:

This study contributes to patient safety and surgeon practice by proving a safe distance guide for genioplasty.
Practical Strategies for Identifying and Managing Burnout in Plastic Surgeons
Authors: Santos Pauline Joy F. , Evans Gregory R. D.
Published: September 2020

Background:

Physician burnout is a well-known problem and widespread issue in the field of medicine. Recently, more attention has been given to the significance of burnout among plastic surgeons. The cause of burnout is multifactorial, with emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment all playing a role. The objective of this article is to provide practical measures to help plastic surgeons in identifying the signs of burnout, thereby mitigating its consequences.

Methods:

A literature review was performed to determine the comprehensive findings of previous research conducted on burnout among plastic surgeons. Particular interest was given to successful tactics used in managing work-related stress. Wellness strategies and resources from both academic and private medical settings were also obtained to further review methods for burnout management.

Results:

There is a wide range of causes and risk factors for burnout among plastic surgeons. The majority of cases correlate with increased workload, loss of physician autonomy, and, in the context of trainees, lack of mentorship. Managing burnout can be supported by identification through survey tools. Establishing a wellness committee is also useful to develop institution-specific interventions. Equally as important, individuals must take steps to manage and minimize their burnout.

Conclusions:

This article provides practical strategies for institutions to identify and manage burnout among plastic surgeons. It is obvious that causes of burnout vary in different settings such as academic and community hospitals; therefore, it is critical for institutions to individualize their approach to burnout.
The Effect of Absorbent Pad Design on Skin Wetness, Skin/Pad Microclimate, and Skin Barrier Function
Authors: Koudounas Sofoklis , Abbas Shabira , Voegeli David
Published: September 2020

PURPOSE:

The main aims of this study were to describe the effects of incontinence pad composition on skin wetness, the skin/pad microclimate, and skin barrier function. We also evaluated the potential utility of our methods for future clinical investigation of absorbent pad design.

DESIGN:

Single-blind, quasi-experimental, open cohort design.

SUBJECTS AND SETTING:

Twenty healthy older volunteers (mean age = 72.8 years, SD = 5.8 years; 8 male and 12 female) tested 2 absorbent pad types, with acquisition layers of different compositions (A and B) applied to different sites on the volar aspect of the forearms. One type A pad served as control (A dry) versus 3 pad samples wetted with 3 volumes of saline (A 15 mL, A 35 mL, and B 15 mL). The study was conducted within the clinical laboratory of a university nursing research group in the United Kingdom.

METHODS:

Skin barrier function was assessed by measuring transepidermal water loss (TEWL), stratum corneum (SC) hydration by corneometry, and skin surface pH using a standard skin pH electrode. Skin water loading (excess water penetration into the skin) was quantified by measuring TEWL and creating a desorption curve of the water vapor flux density. Calculating the area under the curve of the desorption curve to give skin surface water loss reflected excess water penetration into the skin. In a subgroup of the sample, the temperature and relative humidity (microclimate) at the interface between the skin and test pads were measured using a wafer-thin sensor placed between the skin and pad sample. Proinflammatory cytokine release from the SC was assessed using a noninvasive lipophilic film. The main outcome measures in this study were the differences in biophysical measurements of skin barrier function (TEWL, corneometer, and pH) before and after the application of the different pads.

RESULTS:

Mean ± SD baseline TEWL across all test sites was 10.4 ± 4.4 g/h/m2. This increased to 10.6 ± 3.8 g/h/m2 at the control site, 15.3 ± 6.3 g/h/m2 for the A 15-mL pad, 15.3 ± 3.9 g/h/m2 for the A 35-mL pad, and 15.6 ± 3.2 g/h/m2 for the B 15-mL pad. The mean baseline skin surface pH was 5.9 ± 0.04; cutaneous pH increased to a mean of 6.1 ± 0.06 following all pad applications (P = .16). Mean SC hydration remained unchanged at the control site (A dry). In contrast, SC hydration increased following the application of all wetted pads. Target cytokines were detected in all samples we analyzed. The IL-1RA/IL-1α ratio increased following pad application, except for the wettest pad.

CONCLUSION:

Study findings suggest that absorbent pad design and composition, particularly the acquisition layer, affect performance and may influence skin health. Based on our experience with this study, we believe the methods we used provide a simple and objective means to evaluate product performance that could be used to guide the future development of products and applied to clinical settings.
Healing Rates of Venous Leg Ulcers Managed With Compression Therapy
Authors: Rajhathy Erin M. , Murray Heather D. , Roberge Veronica A. , Woo Kevin Y.
Published: September 2020

PURPOSE:

The purpose of this study was to explore average time to heal for patients with venous leg ulcers (VLUs) receiving standard of care that included compression and advanced wound dressings.

DESIGN:

Secondary analysis of an existing electronic database.

SUBJECT AND SETTINGS:

A convenience sample consisting of 1323 patients with VLUs from various community care sectors (homecare and clinics) across Canada.

METHODS:

The Wound Studies database used in the analysis consisted of data from 6 studies conducted prospectively between 1999 and 2009 in which the treatment and delivery of care for all lower leg ulcers (venous, arterial, and mixed) in Canada was examined. From these studies, only patients with VLUs, with an ankle-brachial pressure index of greater than 0.8, and surface area measurements of the ulcers at baseline, 3 months, and 6 months were included. Descriptive statistics were used to determine the proportion of patients who achieved closure at 3 and 6 months and explore the weekly and monthly healing rates for those who did and did not achieve closure. Logistic regression analysis was performed to identify predictive factors for healing.

RESULTS:

A total of 777 patients (mean age 69 years) met inclusion criteria. The proportion of patients who achieved closure at 3 and 6 months was 42.2% and 48.6%, respectively. Of the participants who achieved wound closure, monthly mean healing rate, measured by percentage of reduction in surface area, was 33.4% (0.56 cm2, SD 1.4 [median 0.15 cm2]) through month 3, and 31.0% (0.70 cm2, SD 1.6 [median 0.08 cm2]) through month 6. The overall monthly surface area reduction was 30%.

CONCLUSION:

Study findings suggest a monthly surface area reduction of 30% provides a baseline healing rate for VLUs managed with compression therapy and advanced dressings. Findings also suggest standard of care is not sufficient for healing in over 50% of the population, as the proportion of those who achieved closure at 3 and 6 months was 42.2% and 48.6%, respectively.
Broadening Our Bandwidth
Authors: Engels Dawn , Austin Melody , Doty Sherry , Sanders Karen , McNichol Laurie
Published: September 2020

BACKGROUND:

Managing patients during the coronavirus disease-2019 (COVID-19) pandemic, and the associated severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) in particular, required the nimble responsiveness for which WOC nurses are known. Problem-solving skills were needed to continue the level of WOC nursing services expected by patients, families, and professional colleagues, while reducing the hours we were physically present at our clinical facility. In order to respond to these demands, our team realized it must create an innovative approach to provide efficient, cost-effective consultations during this global crisis. This Challenges in Practice article summarizes our experience with use of telemedicine technologies to perform remote consultations within the acute care setting.

CASES:

Case 1 was a 52-year-old woman with a history of paraplegia. She had several pressure injuries but had not received topical care for these wounds prior to admission. A consultation for the WOC nurse was requested and performed via telehealth services on a day our team was working off-site. This case illustrates the process our team used to perform a virtual consultation and demonstrates how the use of images placed in the electronic medical record aided in developing an effective plan of care. Case 2 was a 48-year-old man who tested positive for COVID-19. He developed bilateral unstageable pressure injuries on his cheeks after being placed in the prone position for a prolonged period while critically ill. This case describes multiple technologic platforms used for telemedicine consults in a patient with COVID-19 requiring isolation.

CONCLUSIONS:

Remote consultation by WOC nurses was possible in our healthcare system because of previous experience using telemedicine technology and well-established collaborative relationships with providers and bedside nurses. By expanding our use of telemedicine technology, we were able to provide ongoing care to a patient without COVID-19 who had WOC consultation needs, and a patient with strict isolation demands due to COVID-19.
Individual and age-related variation of cellular brain composition in a squamate reptile
Authors: Kverková Kristina , Polonyiová Alexandra , Kubička Lukáš , Němec Pavel
Published: September 2020

Within-species variation in the number of neurons, other brain cells and their allocation to different brain parts is poorly studied. Here, we assess these numbers in a squamate reptile, the Madagascar ground gecko (Paroedura picta). We examined adults from two captive populations and three age groups within one population. Even though reptiles exhibit extensive adult neurogenesis, intrapopulation variation in the number of neurons is similar to that in mice. However, the two populations differed significantly in most measures, highlighting the fact that using only one population can underestimate within-species variation. There is a substantial increase in the number of neurons and decrease in neuronal density in adult geckos relative to hatchlings and an increase in the number of neurons in the telencephalon in fully grown adults relative to sexually mature young adults. This finding implies that adult neurogenesis does not only replace worn out but also adds new telencephalic neurons in reptiles during adulthood. This markedly contrasts with the situation in mammals, where the number of cortical neurons declines with age.
Just kidding: the evolutionary roots of playful teasing
Authors: Eckert Johanna , Winkler Sasha L. , Cartmill Erica A.
Published: September 2020

Accounts of teasing have a long history in psychological and sociological research, yet teasing itself is vastly underdeveloped as a topic of study. As a phenomenon that moves along the border between aggression and play, teasing presents an opportunity to investigate key foundations of social and mental life. Developmental studies suggest that preverbal human infants already playfully tease their parents by performing ‘the unexpected,’ apparently deliberately violating the recipient's expectations to create a shared humorous experience. Teasing behaviour may be phylogenetically old and perhaps an evolutionary precursor to joking. In this review, we present preliminary evidence suggesting that non-human primates also exhibit playful teasing. In particular, we argue that great apes display three types of playful teasing described in preverbal human infants: teasing with offer and withdrawal, provocative non-compliance and disrupting others' activities. We highlight the potential of this behaviour to provide a window into complex socio-cognitive processes such as attribution of others’ expectations and, finally, we propose directions for future research and call for systematic studies of teasing behaviour in non-human primates.