bluuebunny/crossref_metadata_2025 huggingface dataset:
Proto-neutron stars with heavy baryons and universal relations
Authors: Raduta Adriana R , Oertel Micaela , Sedrakian Armen
Published: August 2020

We use covariant density functional theory to obtain the equation of state (EoS) of matter in compact stars at non-zero temperature, including the full baryon octet as well as the Δ(1232) resonance states. Global properties of hot Δ-admixed hypernuclear stars are computed for fixed values of entropy per baryon (S/A) and lepton fraction (YL). Universal relations between the moment of inertia, quadrupole moment, tidal deformability, and compactness of compact stars are established for fixed values of S/A and YL that are analogous to those known for cold catalyzed compact stars. We also verify that the I–Love–Q relations hold at finite temperature for constant values of S/A and YL.
A catalogue of Locus Algorithm pointings for optimal differential photometry for 23 779 quasars
Authors: Creaner Oisín , Nolan Kevin , Smith Niall , Grennan David , Hickey Eugene
Published: August 2020

This paper presents a catalogue of optimized pointings for differential photometry of 23 779 quasars extracted from the Sloan Digital Sky Survey (SDSS) Catalogue and a Score for each indicating the quality of the Field of View (FoV) associated with that pointing. Observation of millimagnitude variability on a time-scale of minutes typically requires differential observations with reference to an ensemble of reference stars. For optimal performance, these reference stars should have similar colour and magnitude to the target quasar. In addition, the greatest quantity and quality of suitable reference stars may be found by using a telescope pointing which offsets the target object from the centre of the FoV. By comparing each quasar with the stars which appear close to it on the sky in the SDSS Catalogue, an optimum pointing can be calculated, and a figure of merit, referred to as the ‘Score’ is calculated for that pointing. Highly flexible software has been developed to enable this process to be automated and implemented in a distributed computing paradigm, which enables the creation of catalogues of pointings given a set of input targets. Applying this technique to a sample of 40 000 targets from the fourth SDSS quasar catalogue resulted in the production of pointings and Scores for 23 779 quasars based on their magnitudes in the SDSS r-band. This catalogue is a useful resource for observers planning differential photometry studies and surveys of quasars to select those which have many suitable celestial neighbours for differential photometry.
Unravelling the complex magnetosphere of the B star HD 133880 via wideband observation of coherent radio emission
Authors: Das Barnali , Chandra Poonam , Wade Gregg A
Published: August 2020

HD 133880 is one of the six hot magnetic stars known to produce coherent pulsed radio emission by the process of electron cyclotron maser emission (ECME). In this paper, we present observations of ECME from this star over a wide frequency range, covering nearly 300–4000 MHz with the Giant Metrewave Radio Telescope (GMRT) and the Karl G. Jansky Very Large Array (VLA). This study, which is the first of its kind, has led to the discovery of several interesting characteristics of the phenomenon and also of the host star. We find that the observable properties of ECME pulses, e.g. the time lag between right and left circularly polarized pulses, the amplitudes of the pulses, and their upper cut-off frequencies, appear to be dependent on the stellar orientation with respect to the line of sight. We suggest that all these phenomena, which are beyond the ideal picture, can be attributed to a highly azimuthally asymmetric matter distribution in the magnetosphere about the magnetic field axis, which is a consequence of both the high obliquity (the angle between rotation axis and the magnetic field axis) of the star and the deviation of the stellar magnetic field from a dipolar topology.
Heavy-metal Jupiters by major mergers: metallicity versus mass for giant planets
Authors: Ginzburg Sivan , Chiang Eugene
Published: August 2020

Some Jupiter-mass exoplanets contain ${\sim}100\, {\rm M}_{\hbox{$\oplus $}}$ of metals, well above the ${\sim}10\, {\rm M}_{\hbox{$\oplus $}}$ typically needed in a solid core to trigger giant planet formation by runaway gas accretion. We demonstrate that such ‘heavy-metal Jupiters’ can result from planetary mergers near ∼10 au. Multiple cores accreting gas at runaway rates gravitationally perturb one another on to crossing orbits such that the average merger rate equals the gas accretion rate. Concurrent mergers and gas accretion implies the core mass scales with the total planet mass as Mcore ∝ M1/5 – heavier planets harbour heavier cores, in agreement with the observed relation between total mass and metal mass. While the average gas giant merges about once to double its core, others may merge multiple times, as merger trees grow chaotically. We show that the dispersion of outcomes inherent in mergers can reproduce the large scatter in observed planet metallicities, assuming $3{-}30\, {\rm M}_{\hbox{$\oplus $}}$ pre-runaway cores. Mergers potentially correlate metallicity, eccentricity, and spin.
CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2013–2017
Authors: Ostrom Quinn T , Patil Nirav , Cioffi Gino , Waite Kristin , Kruchko Carol , Barnholtz-Sloan Jill S
Published: August 2020

The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control (CDC) and National Cancer Institute (NCI), is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors (malignant and non-malignant) and supersedes all previous CBTRUS reports in terms of completeness and accuracy. All rates (incidence and mortality) are age-adjusted using the 2000 US standard population and presented per 100,000 population. The average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 23.79 (Malignant AAAIR=7.08, non-Malignant AAAIR=16.71). This rate was higher in females compared to males (26.31 versus 21.09), Blacks compared to Whites (23.88 versus 23.83), and non-Hispanics compared to Hispanics (24.23 versus 21.48). The most commonly occurring malignant brain and other CNS tumor was glioblastoma (14.5% of all tumors), and the most common non-malignant tumor was meningioma (38.3% of all tumors). Glioblastoma was more common in males, and meningioma was more common in females. In children and adolescents (age 0-19 years), the incidence rate of all primary brain and other CNS tumors was 6.14. An estimated 83,830 new cases of malignant and non-malignant brain and other CNS tumors are expected to be diagnosed in the US in 2020 (24,970 malignant and 58,860 non-malignant). There were 81,246 deaths attributed to malignant brain and other CNS tumors between 2013 and 2017. This represents an average annual mortality rate of 4.42. The 5-year relative survival rate following diagnosis of a malignant brain and other CNS tumor was 23.5% and for a non-malignant brain and other CNS tumor was 82.4%.
Organizational Characteristics and Readiness for Tobacco-Free Workplace Program Implementation Moderates Changes in Clinician’s Delivery of Smoking Interventions within Behavioral Health Treatment Clinics
Authors: Nitturi Vijay , Chen Tzu-An , Kyburz Bryce , Martinez Leal Isabel , Correa-Fernandez Virmarie , O’Connor Daniel P , Williams Teresa , Garey Lorra , Stacey Tim , Wilson William T , Lam Cho , Reitzel Lorraine R
Published: August 2020

Background

Smoking is elevated amongst individuals with behavioral health disorders, but not commonly addressed. Taking Texas Tobacco Free is an evidence-based, tobacco-free workplace program that addresses this, in-part, by providing clinician training to treat tobacco use in local mental health authorities (LMHAs). This study examined organizational moderators of change in intervention delivery from pre- to post-program implementation.

Methods

LMHA leaders completed the Organizational Readiness for Implementing Change (ORIC) and provided organization demographics pre-implementation. Clinicians (N = 1237) were anonymously surveyed about their consistent use of the 5As (Asking about smoking; Advising clientele to quit; Assessing willingness to quit; Assisting them to quit; Arranging follow-up) pre- and post-program implementation. Adjusted generalized linear mixed models were used for analyses (responses nested within LMHAs), with interaction terms used to assess moderation effects.

Results

Clinician delivery of 5As increased pre- to post-implementation (p < .001). LMHAs with fewer employees (ref = ≤300) demonstrated greater increases in Asking, Assessing, and Assisting over time. LMHAs with fewer patients (ref = ≤10 000) evinced greater changes in Asking over time. Less initial ORIC Change Efficacy, Change Commitment, and Task Knowledge were each associated with greater pre- to post-implementation changes in Asking. Less initial Task Knowledge was associated with greater increases in Advising, Assessing, and Assisting. Finally, less initial Resource Availability was associated with greater increases in Assisting (all moderation term ps < .025).

Conclusion

The smallest and least ready LMHAs showed the largest gains in tobacco cessation intervention delivery; thus, low initial readiness was not a barrier for program implementation, particularly when efficacy-building training and resources are provided.

Implications

This study examined organizational moderators of increases in tobacco cessation treatment delivery over time following the implementation of a comprehensive tobacco-free workplace program within 20 of 39 LMHAs across Texas (hundreds of clinics; servicing >50% of the state) from 2013 to 2018. Overall, LMHAs with fewer employees and patients, and that demonstrated the least initial readiness for change, evinced greater gains in intervention delivery. Findings add to dissemination and implementation science by supporting that low initial readiness was not a barrier for this aspect of tobacco-free workplace program implementation when resources and clinician training sessions were provided.
Dose–response relationship between protein intake and muscle mass increase: a systematic review and meta-analysis of randomized controlled trials
Authors: Tagawa Ryoichi , Watanabe Daiki , Ito Kyoko , Ueda Keisuke , Nakayama Kyosuke , Sanbongi Chiaki , Miyachi Motohiko
Published: August 2020

Context

Lean body mass is essential for health, yet consensus regarding the effectiveness of protein interventions in increasing lean body mass is lacking.

Objective

The aim of this systematic review was to evaluate the dose–response relationship of the effects of protein intake on lean body mass.

Data Sources

The PubMed and Ichushi-Web databases were searched electronically, and reference lists of the literature included here and in other meta-analyses were searched manually.

Study Selection

Randomized controlled trials evaluating the effects of protein intake on lean body mass were included.

Data Extraction

Two authors independently screened the abstracts; 5 reviewed the full texts.

Results

A total of 5402 study participants from 105 articles were included. In the multivariate spline model, the mean increase in lean body mass associated with an increase in protein intake of 0.1 g/kg of body weight per day was 0.39 kg (95%CI, 0.36–0.41) and 0.12 kg (95%CI, 0.11–0.14) below and above the total protein intake of 1.3 g/kg/d, respectively.

Conclusions

These findings suggest that slightly increasing current protein intake for several months by 0.1 g/kg/d in a dose-dependent manner over a range of doses from 0.5 to 3.5 g/kg/d may increase or maintain lean body mass.

Systematic Review Registration

UMIN registration number UMIN000039285.
Scalar scattering amplitude in the Gaussian wave-packet formalism
Authors: Ishikawa Kenzo , Nishiwaki Kenji , Oda Kin-ya
Published: August 2020

We compute an $s$-channel $2\to2$ scalar scattering $\phi\phi\to\Phi\to\phi\phi$ in the Gaussian wave-packet formalism at the tree level. We find that wave-packet effects, including shifts of the pole and the width of the propagator of $\Phi$, persist even when we do not take into account the time boundary effect for $2\to2$ proposed earlier. An interpretation of the result is that a heavy scalar $1\to2$ decay $\Phi\to\phi\phi$, taking into account the production of $\Phi$, does not exhibit the in-state time boundary effect unless we further take into account in-boundary effects for the $2\to2$ scattering. We also show various plane-wave limits.
Cystic fibrosis-related diabetes: an update
Authors: Frost F , Walshaw M J , Nazareth D
Published: August 2020

Cystic fibrosis (CF) is the most common life-threatening inherited condition in the Caucasian population, where mutations in the CF transmembrane conductance regulator gene result in a multifactorial syndrome, with pulmonary disease representing the largest contributor to morbidity and mortality. Life expectancy has improved and the recent development of disease-modifying CF transmembrane conductance regulator modulator therapies is likely to further improve survival. However, increasing life expectancy brings new challenges related to the complications of a chronic disease including an increasing prevalence of CF-related diabetes, itself associated with increased morbidity and early mortality. This review provides an update as regards the underlying mechanisms, investigation and management of CF-related diabetes.
Understanding and evaluating the impact of integrated problem-oriented research programmes: Concepts and considerations
Authors: Belcher Brian M , Hughes Karl
Published: August 2020

Researchers and research organizations are under increasing pressure to demonstrate that their work contributes to positive change and helps solve pressing societal challenges. There is a simultaneous trend towards more engaged transdisciplinary research that is complexity-aware and appreciates that change happens through systems transformation, not only through technological innovation. Appropriate evaluation approaches are needed to evidence research impact and generate learning for continual improvement. This is challenging in any research field, but especially for research that crosses disciplinary boundaries and intervenes in complex systems. Moreover, evaluation challenges at the project scale are compounded at the programme scale. The Forest, Trees and Agroforestry (FTA) research programme serves as an example of this evolution in research approach and the resulting evaluation challenges. FTA research is responding to the demand for greater impact with more engaged research following multiple pathways. However, research impact assessment in the CGIAR (Consultative Group on International Agricultural Research) was developed in a technology-centric context where counterfactual approaches of causal inference (experimental and quasi-experimental) predominate. Relying solely on such approaches is inappropriate for evaluating research contributions that target policy and institutional change and systems transformation. Instead, we propose a multifaceted, multi-scale, theory-based evaluation approach. This includes nested project- and programme-scale theories of change (ToCs); research quality assessment; theory-based outcome evaluations to empirically test ToCs and assess policy, institutional, and practice influence; experimental and quasi-experimental impact of FTA-informed ‘large n’ innovations; ex ante impact assessment to estimate potential impacts at scale; and logically and plausibly linking programme-level outcomes to secondary data on development and conservation status.
All Bark, No Bite: Section 11 of India’s Animal Welfare Legislation
Authors: Banyal Aakarsh , Shelke Atmaram
Published: August 2020

Speciesism is a bias that causes humans to accord themselves moral superiority in their dealings with non-humans. When speciesism permeates legislative thought, it leads to statutes that sacrifice the interests of non-humans to those of humans. The Prevention of Cruelty to Animals Act, 1960 (‘PCA Act’) is no exception. Section 11 of this Act enumerates specific instances that qualify as animal cruelty and prescribes punishment for the same. However, this section is riddled with statutory flaws, some owing their origin to speciesism: inadequate and sweeping punishments, the defective incorporation of the ‘Doctrine of Necessity’, and the limited recognition of cruel acts. This article seeks to analyse each of the aforementioned faults and prescribe solutions which would strengthen the animal welfare regime as a whole. While stressing on broadening the scope of punishable acts under section 11, along with the need for statutory language to reflect ‘severity’ of punishment, the article also argues for differentiated punishment drawn from a consequence-based model which acknowledges the trauma and suffering of the animal. The intention is to prompt a discourse on the ideal drafting of animal welfare legislation.
Clinical syndromes associated with Viperidae family snake envenomation in southwestern Colombia
Authors: Cañas Carlos A , Castro-Herrera Fernando , Castaño-Valencia Santiago
Published: August 2020

Background

In southwestern Colombia there is a notable variety of snakes that belong to the Viperidae family (vipers). The particular clinical manifestation related to species is poorly reported.

Methods

Based on a prospective study about envenomation caused by vipers from 2011 to 2019 at the Fundación Valle del Lili Hospital, Cali, in southwest Colombia, we selected cases of admitted patients in which the snakes responsible were fully identified. They were cataloged by clinical syndrome according to prevalent signs (edema-inducing, necrotizing, blister-inducing, procoagulant, anticoagulant or myotoxic) and were related to the species that caused the envenomation.

Results

From a cohort of 53 patients, 21 patients (16 males [72.7%]) with an average age of 35 (3–69) y were included. The syndromes associated with envenomation were anticoagulant and necrotizing effects of Bothrops asper (five patients [22.7%]), blister-inducing and anticoagulant effects of Bothrops rhombeatus (five [22.7%]), anticoagulant effects of Bothrops punctatus (three patients [13.6%]), edema-inducing and anticoagulant effects of Bothriechis schlegelii (five [22.7%]), edema-inducing and myotoxic effects of Bothrocophias colombianus (one [4.5%]), edema-inducing and myotoxic effects of Bothrocophias myersi (one [4.5%]) and edema-inducing effects of Porthidium nasutum (one [4.5%]).

Conclusion

In southwestern Colombia there is notable variety in species of snakes belonging to the family Viperidae (vipers) whose envenomation causes various clinical syndromes.
XIII The Victorian Period
Authors: Pond Kristen , Parker Elizabeth , Burke Lois , Garza Ana Alicia , Williams Helen , Radcliffe Caroline , Baker William
Published: August 2020

This chapter has six sections: 1. General and Prose; 2. The Novel; 3.Poetry; 4. Periodicals and Publishing History; 5. Drama; 6. Miscellaneous and Cross-Genre. Section 1 is by Kristen Pond with the assistance of Elizabeth Parker; section 2 is by Lois Burke with the assistance of Ana Alicia Garza, who writes on Dickens; section 3 is by Ana Alicia Garza; section 4 is by Helen Williams; section 5 is by Caroline Radcliffe; section 6 is by William Baker. In a departure from previous years, and in order to avoid confusion as to who has contributed what to this chapter, section 6 contains material on George Borrow, Thomas and Jane Welsh Carlyle, and Richard Jefferies previously found in the General and Prose section, and on Wilkie Collins, George Eliot, George Henry Lewes, Elizabeth Gaskell, George Gissing, Meredith, Thackeray, Anthony Trollope, and Walter Pater previously found in other sections. Also included in section 6 are miscellaneous and cross-genre items and additional items that arrived too late to be included elsewhere in this chapter. Thanks for assistance with this chapter must go to Dominic Edwards, Nancy S. Weyant, the bibliographer of Mrs Gaskell, and Patrick Scott.
Tissue microRNA expression profiling in hepatic and pulmonary metastatic melanoma
Authors: DiVincenzo Mallory J. , Latchana Nicholas , Abrams Zachary , Moufawad Maribelle , Regan-Fendt Kelly , Courtney Nicholas B. , Howard J. Harrison , Gru Alejandro A. , Zhang Xiaoli , Fadda Paolo , Carson William E.
Published: August 2020

Malignant melanoma has a propensity for the development of hepatic and pulmonary metastases. MicroRNAs (miRs) are small, noncoding RNA molecules containing about 22 nucleotides that mediate protein expression and can contribute to cancer progression. We aim to identify clinically useful differences in miR expression in metastatic melanoma tissue. RNA was extracted from formalin-fixed, paraffin-embedded samples of hepatic and pulmonary metastatic melanoma, benign, nevi, and primary cutaneous melanoma. Assessment of miR expression was performed on purified RNA using the NanoString nCounter miRNA assay. miRs with greater than twofold change in expression when compared to other tumor sites (P value ≤ 0.05, modified t-test) were identified as dysregulated. Common gene targets were then identified among dysregulated miRs unique to each metastatic site. Melanoma metastatic to the liver had differential expression of 26 miRs compared to benign nevi and 16 miRs compared to primary melanoma (P < 0.048). Melanoma metastatic to the lung had differential expression of 19 miRs compared to benign nevi and 10 miRs compared to primary melanoma (P < 0.024). Compared to lung metastases, liver metastases had greater than twofold upregulation of four miRs, and 4.2-fold downregulation of miR-200c-3p (P < 0.0081). These findings indicate that sites of metastatic melanoma have unique miR profiles that may contribute to their development and localization. Further investigation of the utility of these miRs as diagnostic and prognostic biomarkers and their impact on the development of metastatic melanoma is warranted.
GLYCEMIC VARIABILITY IS ASSOCIATED WITH TREATMENT REQUIRING RETINOPATHY OF PREMATURITY
Authors: Jagła Mateusz , Szymońska Izabela , Starzec Katarzyna , Kwinta Przemko
Published: August 2020

Purpose:

To assess the association between glycemic variability (GV) and Type 1 retinopathy of prematurity (ROP) in infants with birth weights of less than 1,251 g.

Methods:

A case–control study of infants with birth weights of less than 1,251 g who developed Type 1 ROP (n = 20) was conducted. Controls had a less severe ROP or no eye disease and were individually matched for gestational age and birth weight (n = 40). Odds ratios of ROP were calculated based on multiple factors including oxygen exposure, respiratory support, incidence of hyperglycemia, and GV. For glucose measurements, a continuous glucose monitoring system was used.

Results:

There were no significant differences in gender, antenatal steroid administration, severity of illness, and Apgar score. Univariate analyses suggest increased risk for the development of Type 1 ROP based on incidence of intraventricular hemorrhage Grade 3 or 4 (P= 0.048), duration of oxygen exposure (P= 0.003), incidence of hyperglycemia over 150 mg/dL (P= 0.01), and GV according to significantly higher SD (P= 0.002), coefficient of variation (P= 0.001), and mean amplitude of glucose excursion (P= 0.008). Using a multiple regression model, increased risk of Type 1 ROP was only found to be associated with duration of oxygen exposure and higher GV.

Conclusion:

Our study demonstrates a relationship between GV and the development of severe ROP.
EARLY SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS TO CONFIRM FELLOW EYE CHANGES IN ASYMMETRIC TYPE-2 MACULAR TELANGIECTASIA
Authors: Alex Divya , Giridhar Anantharaman , Gopalakrishnan Mahesh , Manayath George , Amar Sreelakshmi , Raman Rajiv , Sreenivasan Ramya , Ayachit Apoorva , Sivaprasad Sobha
Published: August 2020

Purpose:

To evaluate the earliest spectral-domain optical coherence tomography markers in fellow eyes of asymmetric Type-2 macular telangiectasia (MacTel).

Methods:

A multicentered case–control study of spectral-domain optical coherence tomography images captured on Spectralis Heidelberg Engineering, Germany, comparing features of fellow eyes of patients with asymmetric clinical presentation of MacTel with 50 age-matched control subjects.

Results:

Of 649 patients, 28 (4.3%) with MacTel presented with asymmetric features. The mean age of the MacTel patients was 63.5 (12.4) years with female predilection (4:1). Mean best-corrected visual acuity of the unaffected eye was 0.2 logarithm of the minimum angle of resolution (20/32 Snellen equivalent). The mean central subfoveal thickness in the unaffected MacTel eyes was 194 (SD, 38) µm, and the temporal retinal thickness was 204 (SD, 43) µm. These parameters were significantly thinner than those of control subjects in whom mean central subfoveal thickness was 273 (SD, 26) µm (P = 0.001). Presence of hyperreflective outer retinal dots was found in 92.8% of the unaffected MacTel eyes. These hyperreflective dots were scattered, punctate, nonconfluent, and confined to the outer retinal layers of foveal and parafoveal region.

Conclusion:

Although these cases presented with advanced presentation of MacTel features in only one eye, temporal retinal thinning and presence of hyperreflective outer retinal dots in the fellow eye can be considered as the earliest signs of MacTel.
Comparing the Analgesic Effects of 4 Nonpharmacologic Interventions on Term Newborns Undergoing Heel Lance
Authors: Chang Jie , Filoteo Lourdes , Nasr Annette S.
Published: August 2020

This randomized trial compared the analgesic effect of 4 nonpharmacologic interventions (breastfeeding, oral sucrose, nonnutritive sucking, and skin-to-skin contact) on term newborns between 24 and 48 hours of age who underwent a heel lance. The Neonatal Pain, Agitation, and Sedation Scale was used to evaluate pain. The newborns (N = 226) were assigned to one of 4 intervention groups (n = 176) or a control group without pain intervention (n = 50). The results indicate that all intervention groups showed decreased pain levels when compared with the control group (P < .01). The oral sucrose group experienced a superior analgesic effect when compared with the skin-to-skin contact group (P < .01), but no difference was observed when compared with the breastfeeding group (P > .05) or the nonnutritive sucking group (P > .05). All intervention groups showed a shortened crying time (P < .01) and reduced procedural duration (P < .01) compared with the control group. All of these interventions are clinically applicable and acceptable when caring for a newborn during a minor painful procedure.
Lifestyle Modification Improves Insulin Resistance and Carotid Intima‐Media Thickness in a Metabolically Healthy Obese Prepubescent Population
Authors: Gallardo‐Escribano Cristina , Vargas‐Candela Antonio , Vilches‐Perez Alberto , Muñoz‐Melero Maite , Ruiz‐Moreno M. Isabel , Benitez‐Porres Javier , Romance‐Garcia Angel Ramon , Rodriguez‐Ortega Rocío , Rosa‐López Andrés , Rosales‐Jaime Antonio , Diaz‐Ruiz Juan , Tinahones Francisco J. , Gómez‐Huelgas Ricardo , Bernal‐Lopez M. Rosa
Published: August 2020

Objectives:

The aim of this study was to analyze effects of a 12‐month lifestyle modification that involved a Mediterranean diet (MedDiet) and physical activity (PA) program in a population of metabolically healthy obese children (MHOCh).

Methods:

We included a population of MHOCh with ≤1 of the following criteria: waist circumference and blood pressure ≥90 percentile, triglycerides >150 mg/dL, high‐density lipoprotein‐cholesterol (HDL‐c) <40 mg/dL, or impaired fasting glucose. After 12 months of intensive lifestyle modification, anthropometric measurements, glycemic and lipid profiles, adherence to the MedDiet, energy intake, PA, body composition, and carotid intima‐media thickness (cIMT) were analyzed.

Results:

One hundred thirty‐one MHOCh (70 boys and 61 girls; P = 0.65, age: 7.9 ± 1.3 years, body mass index [BMI]: 24.7 ± 3.5 kg/m2) were included. After 12 months of intervention, a significant decrease in standard deviation (SD) units of body weight (−0.5 ± 0.1; P < 0.001) and BMI (−0.5 ± 0.1; P < 0.001) were observed in the total population. A significant improvement in adherence to the MedDiet (+2 points) and a significant reduction in protein, fatty acids, total fat, and cholesterol intake in the entire population were observed. All participants did more moderate‐vigorous PA, which led to a significant increase in lean and total mass and decrease in total fat. Significant improvements in the glycemic profile (insulin levels [−6.6 μIU/mL, P < 0.001] and HOMA index [−1.2, P < 0.001]) were observed. Participants with pathological cIMT values reduced this cardiovascular predictor to normal values.

Conclusions:

A 12‐month lifestyle modification intervention involving weight loss with MedDiet and PA in MHOCh yielded improvements in MedDiet adherence, lipid intake, moderate‐vigorous PA, body composition, insulin resistance, and cIMT.
Factors Associated With Nonadherence in an Emergency Department‐based Multicenter Randomized Clinical Trial of a Probiotic in Children With Acute Gastroenteritis
Authors: Schnadower David , Roskind Cindy G. , VanBuren John M. , Powell Elizabeth C. , Norris Jesse G. , Tarr Phillip I. , Sapien Robert E. , O’Connell Karen J. , Chun Thomas H. , Rogers Alexander J. , Bhatt Seema R. , Mahajan Prashant , Gorelick Marc H. , Vance Cheryl , Dean J. Michael , Freedman Stephen B. ,   Pediatric Emergency Care Applied Research Network (PECARN)
Published: August 2020

Nonadherence in clinical trials affects safety and efficacy determinations. Predictors of nonadherence in pediatric acute illness trials are unknown. We sought to examine predictors of nonadherence in a multicenter randomized trial of 971 children with acute gastroenteritis receiving a 5‐day oral course of Lactobacillus rhamnosus GG or placebo. Adherence, defined as consuming all doses of the product, was reported by the parents and recorded during daily follow‐up contacts. Of 943 patients with follow‐up data, 766 (81.2%) were adherent. On multivariate analysis, older age (OR 1.19; 95% CI: 1.00–1.43), increased vomiting duration (OR 1.23; 95% CI: 1.05–1.45), higher dehydration score (OR 1.23, 95% CI: 1.07–1.42), and hospitalization following ED discharge (OR 4.16, 95% CI: 1.21‐‐14.30) were factors associated with nonadherence; however, those with highest severity scores were more likely to adhere (OR 0.87, 95% CI: 0.80–0.95). These data may inform strategies and specific targets to maximize adherence in future pediatric trials.
Chlorhexidine Bathing Strategies for Multidrug-Resistant Organisms: A Summary of Recent Evidence
Authors: Gall Elizabeth , Long Anna , Hall Kendall K.
Published: August 2020

Objective

The aim of the study was to summarize the latest evidence for patient bathing with a 2% to 4% chlorhexidine gluconate solution to reduce multidrug-resistant organism (MDRO) transmission and infection.

Methods

We searched 3 databases (CINAHL, MEDLINE, and Cochrane) for a combination of the key words “chlorhexidine bathing” and MeSH terms “cross-infection prevention,” “drug resistance, multiple, bacterial,” and “drug resistance, microbial.” Articles from January 1, 2008, to December 31, 2018, were included, as well as any key articles published after December 31.

Results

Our findings focused on health care–associated infections (HAIs) and 3 categories of MDROs: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant Enterobacteriaceae (CRE). Chlorhexidine bathing reduces MRSA acquisition and carriage, but not all studies found significant reductions in MRSA infections. Several studies found that chlorhexidine bathing reduced VRE acquisition and carriage, and one study showed lower VRE infections in the bathing group. Two studies found that bathing reduced CRE carriage (no studies examined CRE infections). Two very large studies (more than 140,000 total patients) found bathing significantly reduced HAIs, but these reductions may be smaller when HAIs are already well controlled by other means.

Conclusions

There is a high level of evidence supporting chlorhexidine bathing to reduce MDRO acquisition; less evidence is available on reducing infections. Chlorhexidine bathing is low cost to implement, and adverse events are rare and resolve when chlorhexidine use is stopped. There is evidence of chlorhexidine resistance, but not at concentrations in typical use. Further research is needed on chlorhexidine bathing’s impact on outcomes, such as mortality and length of stay.
Improving Team Performance and Patient Safety on the Job Through Team Training and Performance Support Tools: A Systematic Review
Authors: Costar Dana Milanovich , Hall Kendall K.
Published: August 2020

Introduction

Efforts to improve teamwork in health care have received considerable attention. The current systematic review was conducted to identify recent studies that implemented practices to improve teamwork and were associated with positive improvements on the job.

Methods

Electronic searches of 2 databases (i.e., CINAHL and MEDLINE) were conducted to identify relevant articles published between 2008 and 2018.

Results

Twenty articles were selected for inclusion in this review. The studies most often used quasiexperimental designs and interventions were applied in a variety of hospital settings including labor and delivery, operating rooms, and emergency departments. Across studies, measures assessing teamwork skills on the job were most often collected and showed sustained improvements up to 12 months. Moreover, evidence of improved clinical processes (e.g., compliance with guidelines and efficiency) and increased patient safety (e.g., reduction in adverse events) was found in both studies of team training interventions, as well as in those that introduced performance support tools (e.g., checklist).

Conclusions

The results of the current review are consistent with previous research and add to the evidence base on the practices to improve teamwork within hospital settings. Although efforts to improve teamwork have spread to other health care settings such as office-based care, published studies are lagging behind.
Using Deprescribing Practices and the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions Criteria to Reduce Harm and Preventable Adverse Drug Events in Older Adults
Authors: Earl Tara R. , Katapodis Nicole D. , Schneiderman Stephanie R. , Shoemaker-Hunt Sarah J.
Published: August 2020

Objectives

Approximately 98% of older Americans are simultaneously taking 5—or more—medications to manage at least 2 chronic conditions. Polypharmacy and the use of potentially inappropriate medications (PIMs) are a concern for older adults because they pose a risk for adverse drug events (ADEs), which are associated with emergency department visits and hospitalizations and are an important patient safety priority. We sought to review the evidence of patient safety practices aimed at reducing preventable ADEs in older adults, specifically (i) deprescribing interventions to reduce polypharmacy and (ii) use of the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) to reduce PIMs.

Methods

We conducted a systematic review of literature published between 2008 and 2018 that studied examined the effect of these interventions to reduce preventable ADEs in older adults.

Results

Twenty-six studies and 1 systematic review were included (14 for deprescribing and 12 for STOPP and the systematic review). The deprescribing interventions involved decision support tools, educational interventions, and medication reviews by pharmacists and/or providers. Deprescribing studies primarily examined the effect of interventions on process outcomes and observed reductions in polypharmacy, often significantly. A few studies also examined clinical and economic outcomes. Studies of the use of the STOPP screening criteria most commonly reported changes in PIMs, as well as some economic outcomes.

Conclusions

Deprescribing interventions and interventions using the STOPP criteria seem effective in reducing polypharmacy and PIMs in older adults, respectively. Future research on the effectiveness of these approaches on clinical outcomes, the comparative effectiveness of different multicomponent interventions using these approaches, and how to most effectively implement them to improve uptake and evidence-based care is needed.
The Use of Rapid Response Teams to Reduce Failure to Rescue Events: A Systematic Review
Authors: Hall Kendall K. , Lim Andrea , Gale Bryan
Published: August 2020

Objective

The aim of this systematic review was to synthesize the evidence on the impact of rapid response teams (RRTs) on failure to rescue events.

Methods

Systematic searches were conducted using CINAHL, MEDLINE, PsychINFO, and Cochrane, for articles published from 2008 to 2018. English-language, peer-reviewed articles reporting the impact of RRTs on failure to rescue events, including hospital mortality and in-hospital cardiac arrest events, were included. For selected articles, the authors abstracted information, with the study designed to be compliant with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Results

Ten articles were identified for inclusion: 3 meta-analyses, 3 systematic reviews, and 4 single studies. The systematic reviews and meta-analyses were of moderate-to-high quality, limited by the methodological quality of the included individual studies. The single studies were both observational and investigational in design. Patient outcomes included hospital mortality (8 studies), in-hospital cardiac arrests (9 studies), and intensive care unit (ICU) transfer rates (5 studies). There was variation in the composition of RRTs, and 4 studies conducted subanalyses to examine the effect of physician inclusion on patient outcomes.

Conclusions

There is moderate evidence linking the implementation of RRTs with decreased mortality and non-ICU cardiac arrest rates. Results linking RRT to ICU transfer rates are inconclusive and challenging to interpret. There is some evidence to support the use of physician-led teams, although evaluation of team composition was variable. Lastly, the benefits of RRTs may take a significant period after implementation to be realized, owing to the need for change in safety culture.
The Use of Patient Monitoring Systems to Improve Sepsis Recognition and Outcomes: A Systematic Review
Authors: Gale Bryan M. , Hall Kendall K.
Published: August 2020

Introduction

The aim of this systematic review was to determine the impact of automated patient monitoring systems (PMSs) on sepsis recognition and outcomes.

Methods

Systematic searches were conducted using CINAHL, MEDLINE, and Cochrane, for articles published from 2008 through 2018. English-language, peer-reviewed articles that reported the impact of PMS on sepsis care were included. For selected articles, the authors abstracted information, with the study designed to be compliant with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Results

Nineteen articles were identified for inclusion: 4 systematic reviews and 15 individual studies. Study design and quality varied, with some randomized controlled trials and quasiexperimental studies, as well as many observational studies. Study results for outcome measures (e.g., mortality, intensive care unit [ICU] length of stay, ICU transfer) were mixed, with more than half of the studies showing a significant improvement in at least one measure. Evidence for process measure (e.g., time to antibiotic administration, lactate measurement, etc.) improvement was of moderate strength across multiple types of hospital units, and evidence was most consistent outside the ICU.

Conclusions

Automated sepsis PMSs have the potential to improve sepsis recognition and outcomes, but current evidence is mixed on their effectiveness. More high-quality studies are needed to understand the effects of PMSs on important sepsis-related process and outcome measures in different hospital units.
Application of Digital Subtraction Angiography in Reconstruction of Plantar Forefoot With Reverse Medial Plantar Flap
Authors: Cang Zheng-Qiang , Xu Yuan , Wang Min , Xu Meng-Nan , Yuan Si-Ming
Published: August 2020

The reverse medial plantar flap (RMPF) raised from the nonweight-bearing region of the plantar foot represents a viable option for the soft tissue defect in planter forefoot. The anatomical basis of RMPF is the complex anastomotic branches between medial plantar artery (MPA) and deep plantar arch. Those anastomotic branches have high variation rate and may be damaged by trauma such as electric injury. Therefore, it is very important to know whether those anastomotic branches are present and intact before harvesting RMPF. Five patients with soft tissue defect in planter forefoot were enrolled into the study. The digital subtraction angiography (DSA) was performed to evaluate the plantar hemodynamics in the ipsilateral foot. The RMPF was harvested only after the anastomotic connections between MPA and deep plantar arch was confirmed. Anastomosis between superficial branch of MPA and deep plantar arch was observed in all DSA examinations. All 5 patients received the repair of soft tissue defect in plantar forefoot with RMPF. All flaps survived completely. The DSA can effectively evaluate the blood supply basis of RMPF and provide imaging evidence for the design and harvest of the flap. The main anatomical basis of RMPF is the anastomotic connections between superficial branch of MPA and deep plantar arch.
COVID-19: a review
Authors: Papadopoulos Constantinos , Chong Sebastian Jen Kin , Jaunoo Shameen
Published: August 2020

Severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) has been at the center of global attention recently, ever since its initial appearance in Wuhan, China, in December of 2019. This novel disease has been a source of growing concern which has been shared internationally by social communities and health care professionals alike, due to its exponentially increasing rate of infection and difficulty to control. Currently, no definitive or effective treatment has been found for COVID-19, but there are several ongoing trials investigating whether a certain medication, vaccination, or supportive therapy might prove to be effective. Coincidentally, SARS-CoV-2 may be a new pathogen, but it resembles SARS-CoV and MERS-CoV coronaviruses in its genome, structure, modes of transmission, and pathogenesis. This has contributed to an advantageous understanding of the virus and has served as the basis of decision-making for infection control plans, research, and management of the disease. As of July, 2020, SARS-CoV-2 has spread to every continent excluding Antarctica, with confirmed cases of COVID-19 in virtually every country, and is responsible for over 500,000 deaths worldwide. This review of the COVID-19 pandemic aims to offer a comprehensive and thorough explanation of the disease, including its significance and impact on surgery, by drawing information from the most up to date and relevant sources available.
Factors Associated with Disparities in Appropriate Statin Therapy in an Outpatient Inner City Population
Authors: Suero-Abreu Giselle A. , Karatasakis Aris , Rashid Sana , Tysarowski Maciej , Douglas Analise Y. , Patel Richa , Siddiqui Emaad , Bhardwaj Aishwarya , Gerula Christine M. , Matassa Daniel
Published: August 2020

Introduction

Appropriate lipid-lowering therapies are essential for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). The aim of this study is to identify discrepancies between cholesterol management guidelines and current practice in an underserved population, with a focus on statin treatment.

Methods

We reviewed the records of 1,042 consecutive patients seen between August 2018 and August 2019 in an outpatient academic primary care clinic. Eligibility for statin and other lipid-lowering therapies was determined based on the 2018 American Heart Association and American College of Cardiology (AHA/ACC) guideline on the management of blood cholesterol.

Results

Among 464 statin-eligible patients, age was 61.1 ± 10.4 years and 53.9% were female. Most patients were Black (47.2%), followed by Hispanic (45.7%), and White (5.0%). Overall, 82.1% of patients were prescribed a statin. Statin-eligible patients who qualified based only on a 10-year ASCVD risk > 7.5% were less likely to be prescribed a statin (32.8%, p<0.001). After adjustment for gender and health insurance status, appropriate statin treatment was associated with age > 55 years (OR = 4.59 [95% CI 1.09 - 16.66], p = 0.026), hypertension (OR = 2.38 [95% CI 1.29 - 4.38], p = 0.005) and chronic kidney disease (OR = 3.95 [95% CI 1.42 - 14.30], p = 0.017). Factors independently associated with statin undertreatment were Black race (OR = 0.42 [95% CI 0.23 - 0.77], p = 0.005), and statin- eligibility based solely on an elevated 10-year ASCVD risk (OR = 0.14 [95% CI 0.07 - 0.25], p < 0.001). Hispanic patients were more likely to be on appropriate statin therapy when compared to Black patients (86.8% vs 77.2%).

Conclusion

Statin underprescription is seen in approximately one out of five eligible patients, and is independently associated with Black race, younger age, fewer comorbidities, and eligibility via 10-year ASCVD risk only. Hispanic patients are more likely to be on appropriate statin therapy compared to Black patients.
G protein subunit gamma 4 expression has potential of detection, prediction, and therapeutic target for liver metastasis of gastric cancer
Authors: Tanaka Haruyoshi , Kanda Mitsuro , Miwa Takashi , Umeda Shinichi , Sawaki Koichi , Tanaka Chie , Kobayashi Daisuke , Hayashi Masamichi , Yamada Suguru , Nakayama Goro , Koike Masahiko , Kodera Yasuhiro
Published: August 2020

Liver metastasis of gastric cancer is the most common for hematogenous metastases and so fatal, that the identification of novel markers and targets for therapy are crucial. We conducted transcriptome analyses between synchronous liver metastasis, primary tumor, and adjacent tissues from four patients with metastasis confined to the liver to discover thatGNG4upregulated substantially in primary gastric cancer tissues. Quantitative RT-qPCR assay for 300 gastric cancer patients revealed that higher levels ofGNG4in primary cancer were associated with shorter overall survival and a higher risk of liver recurrence. The oncogenic phenotypes ofGNG4were determined by knockout and forced expression ofGNG4. Tumor formation byGNG4knockout cells was more strikingly attenuated in a liver metastasis mouse model compared with a subcutaneous model.GNG4is a candidate for a therapeutic target for liver metastasis, and its expression may enable us to provide better disease monitoring for liver metastasis.