bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-residue Analysis of Pesticides in Turmeric (Powder and Rhizome) Using Gas Chromatography Tandem Mass Spectrometry
Authors: Ghosh Bappa , Kamble Narayan , Bhattacharyya Arijita , Kandaswamy Chandrasekar , Banerjee Kaushik
Published: June 2020

Background and objectives

Turmeric is widely used as an ingredient of food and medicinal products. There exists no validated method for multi-residue analysis of pesticides in turmeric.

Objective

This study was undertaken to develop a simple and robust method for the quantitative determination of multi-class pesticides in turmeric powder and rhizome by GC-MS/MS.

Method

Initially, the samples were soaked in water for 30 min and homogenized to a fine paste. A portion of this paste (2 g) was extracted with acetonitrile (2 mL) and partitioned with hexane (2 mL) after adding 5 mL of 20% NaCl. The cleanup step involved dispersive solid phase extraction with graphitized carbon black (GCB, 5 mg/mL). Its performance was evaluated against primary secondary amine (PSA) and C18 sorbents. The cleaned extract was evaporated to dryness and reconstituted in ethyl acetate before GC-MS/MS analysis. The method was validated for a mixture of 208 multi-class pesticides at 10 ng/g and higher levels (i.e., 20 and 50 ng/g).

Results

The findings, which demonstrated a satisfactory recovery and precision (RSDs <20%) for all compounds at 10 ng/g and higher spiking levels, are aligned with the analytical quality control criteria of SANTE/12682/2019 guidelines. The cleanup effect of GCB was much superior to that of PSA, C18, and their combinations. The solvent exchange step with hexane was effective in removing co-extractives and minimizing matrix effects.

Conclusions

This method complies with the regulatory requirements and is fit-for-purpose for pesticide residue monitoring in turmeric.

Highlights

The study reports a validated GC-MS/MS method for multi-residue analysis of pesticides in turmeric for the first time. The method provided a high throughput analysis of multi-class pesticides in turmeric rhizome and powder matrices with satisfactory selectivity, sensitivity, accuracy, and precision.
A Novel Bioanalytical Method for the Determination of Opioids in Blood and Pericardial Fluid
Authors: Ferreira Elisa , Corte Real Francisco , Pinho e Melo Teresa , Margalho Cláudia
Published: June 2020

Opioids are the drugs most commonly detected in overdose deaths and the second most consumed worldwide. An analytical methodology has been optimized and fully validated for the determination of codeine, morphine, 6-acetylmorphine, 6-acetylcodeine, oxycodone, oxymorphone and fentanyl in whole blood and pericardial fluid. The internal standards used were codeine-d3, morphine-d3, 6-acetylmorphine-d3 and fentanyl-d5. Before solid-phase extraction, volumes of 250 μL of blood and pericardial fluid were subjected to a protein precipitation (with 750 μL of ice-cold acetonitrile) and a microwave-induced oximation was performed using a solution of 1% aqueous hydroxylamine hydrochloride in phosphate-buffered saline (1:2, v/v). Finally, the dried extracts were further derivatized with a solution of n-methyl-n-(trimethylsilyl) trifluoroacetamide + 5% trimethylchlorosilane under microwave irradiation. The chromatographic analysis was carried out using gas chromatography–mass spectrometry operating in electron impact and selected ion monitoring mode. For all analytes, the method was linear between 5 and 1,000 ng/mL with determination coefficients (r2) >0.99. Depending on the analyte and matrix, the limit of detection varies between 3 and 4 ng/mL. Intra- and intermediate precision (<20%) and bias (±20%) were acceptable for all analytes in both matrices. The stability of the substances in the studied matrices was guaranteed, at least, 24 h in the autosampler, 4 h at room temperature and 30 days after three freeze/thaw cycles. This methodology was applied to real samples from the Laboratory of Chemistry and Forensic Toxicology, Centre Branch, of the National Institute of Legal Medicine and Forensic Sciences, Portugal.
Incidence Rates of Gynecologic Cancers in the U.S. Active Duty Military Population
Authors: Owens Steffanie , Blando Tara , Tesema Yohannes B , Butts Elizabeth , Newton Jessica , Bristow Robert , Randall Leslie M
Published: June 2020

Introduction

Despite an increasing number of female service members, incidence rates of gynecologic cancers (other than cervical cancer) have not been previously documented in the U.S. active duty military population. This study sought to determine the incidence rates of all gynecologic, including peritoneal, malignancies in the U.S. Active Duty population compared to the general US population as reported in the Surveillance, Epidemiology, and End Results Program database.

Materials and Methods

Gynecologic cancers diagnosed in U.S. Active Duty women aged 20–59 between 2004 and 2013 were retrospectively ascertained. Cancer cases were identified in both the Automated Central Tumor Registry and the Military Health System Data Repository. All cases in Automated Central Tumor Registry plus cases recorded in Military Health System Data Repository, but not duplicative of Automated Central Tumor Registry cases, were included. Age-specific and age-adjusted incidence rates were calculated in military and Surveillance, Epidemiology, and End Results cases.

Results

In U.S. Active Duty women, 327 incident cases of gynecologic cancer were identified. There were 110 cases of cervical cancer, 40 cases of endometrial cancer, 152 cases of ovarian cancer, and 25 other gynecologic malignancies. Of the 327 cases, 154 were ascertained from the Automated Central Tumor Registry database and the remainder from Military Health System Data Repository claims data. The age-adjusted rate of all gynecologic cancers for U.S. Active Duty women was 49.17 per 105 (95%CI 37.58, 65.12), while the age-adjusted rate for Surveillance, Epidemiology, and End Results −18 was 42.09 per 105 (95%CI 41.83, 42.35). The kappa coefficient assessing the overlap between the data sources was −0.1937. Though insufficient in numbers for statistical analysis, the observed proportion of ovarian to cervical cancer cases in active duty women < 45 years of age was substantially greater than in the general population.

Conclusions

U.S. Active Duty women exhibited a similar age-adjusted rate of gynecologic cancer as the general US population. There was suboptimal overlap between the Automated Central Tumor Registry and Military Health System Data Repository databases, indicating the necessity of using both databases in order to obtain reliable data in the active duty population. This study is the current best estimate of a baseline rate of gynecologic cancer in U.S. active duty military women. This rate might change over time as women’s roles and exposures in recent and future military conflicts evolve.
Factors Considered When Ranking Military Orthopedic Surgery Residency Candidates
Authors: Wells Matthew , Polmear Michael , Nesti Leon J , Dunn John C
Published: June 2020

Introduction

The intangible personal characteristic grit has become a popular topic of concentration within contemporary psychology studies. Grit is defined as persistent work on a focused topic for an extended period of time until a desired goal is achieved. Its application to physician selection and development is not well known. We sought to determine which factors were considered most important among leadership within the U.S. Army’s orthopedic surgical training programs when selecting applications and ascertain if grit was one of the primary factors.

Materials and Methods

A standardized, 18-question survey was sent to all program chairs, program directors, and assistant program directors at the six U.S. Army orthopedic surgery residency programs. Questions included demographic factors pertaining to both the individual and their respective training program. Participants were asked to rank, in order, the 10 most important variables when considering applicants. Each variable was ranked using a point system (1–10 with 10 as the best score), referred to as the factor score (FS). Further statistical analyses using descriptive statistics, paired t-test, and ANOVA were performed and reported.

Results

The response rate was 83% (15/18). The most important variable considered was the applicant’s performance on their audition rotation (FS = 9.8), which was significantly more important than any other variable (P = 0.001). The second most important variable was the applicant’s USMLE scores (FS = 7.13), followed by involvement in research (FS = 5.60) and conscientiousness (FS = 4.73), respectively. Grit was considered the fifth most important variable (FS = 4.27). There was no significant difference in the ranking of grit among the different programs (P = 0.282). In applicants with low United States Medical Licensing Examination scores according to leadership idiosyncrasy, their audition rotation was considered a redeeming portion of their application (P = 0.02) followed by their level of grit.

Conclusions

The most important factor when considering an orthopedic surgery applicant was how well the applicant performed on an audition rotation, followed by their United States Medical Licensing Examination scores. Grit has become an important consideration in resident selection.
Does resource availability influence the vital rates of the tropical copepod Apocyclops royi (Lindberg, 1940) under changing salinities?
Authors: Van Someren Gréve Hans , Jepsen Per Meyer , Hansen Benni Winding
Published: June 2020

The physiology of invertebrates inhabiting many coastal ecosystems is challenged by strong temporal fluctuations in salinity. We investigated how food availability influences vital rates in the tropical cyclopoid copepod Apocyclops royi subjected to different salinities (5–32 PSU). We hypothesized that (i) mortality decreases and egg production rate increases with food availability; (ii) under suboptimal salinity, mortality increases and the egg production rate is reduced and (iii) the threshold concentration for egg production (the lowest food concentration where egg production is initiated) shifts to higher food concentrations when challenged by salinity. Surprisingly, A. royi survived, ingested food and produced eggs at all tested salinities. Mortality rate was, however, dependent on salinity level, but not on food availability. Mortality increased (~12% h−1) during short-term (1 h) salinity acclimatization to 5 PSU and during the following 24-h incubations (~5% d−1) compared with higher salinities. Feeding and egg production rates increased with food availability up to an optimum at all salinity levels, with no effect of salinity on the lowest food concentration initiating egg production. This reveals a high-salinity tolerance by A. royi and may partly explain why this particular copepod is so successful compared with its congeners in occupying extreme habitats.
THE POLARISED PARTITION RELATION FOR ORDER TYPES
Authors: Klausner L D , Weinert T
Published: June 2020

We analyse partitions of products with two ordered factors in two classes where both factors are countable or well-ordered and at least one of them is countable. This relates the partition properties of these products to cardinal characteristics of the continuum. We build on work by Erd̋s, Garti, Jones, Orr, Rado, Shelah and Szemerédi. In particular, we show that a theorem of Jones extends from the natural numbers to the rational ones, but consistently extends only to three further equimorphism classes of countable orderings. This is made possible by applying a 13-year-old theorem of Orr about embedding a given order into a sum of finite orders indexed over the given order.
Study of miRNA interactome in active rheumatoid arthritis patients reveals key pathogenic roles of dysbiosis in the infection–immune network
Authors: Guo Donggeng , Lv Jinhan , Chen Xi , Yan Xiaoxu , Ma Fenglian , Liu Yuanyuan , Chen Xu , Xie Jing , Zhang Mingzhu , Jin Zheyu , Cai Lijun , Sun Xichun , Niu Dongsheng , Duan Dayue D
Published: June 2020

Objectives

To characterize serum microRNA (miR) and the miR interactome of active RA patients in RA aetiology and pathogenesis.

Methods

The differentially expressed miRs (DEmiRs) in serum of naïve active RA patients (NARAPs, n = 9, into three pools) vs healthy controls (HCs, n = 15, into five pools) were identified with Agilent human miR microarray analysis. Candidate driver genes in epigenetic and pathogenic signalling pathway modules for RA were analysed using miRTarBase and a molecular complex detection algorithm. The interactome of these DEmiRs in RA pathogenesis were further characterized with gene ontology and Kyoto Encyclopaedia of Genes and Genomes.

Results

Three upregulated DEmiRs (hsa-miR-187-5p, -4532, -4516) and eight downregulated DEmiRs (hsa-miR-125a-3p, -575, -191-3p, -6865-3p, -197-3p, -6886-3p, -1237-3p, -4436b-5p) were identified in NARAPs. Interactomic analysis from heterogeneous experimentally validated sources yielded 1719 miR–target interactions containing 5.67% strong and 94.33% less strong experimental evidence. Gene ontology and Kyoto Encyclopaedia of Genes and Genomes analyses allocated the upregulated DEmiRs in the infection modules and the downregulated DEmiRs in the immune signalling pathways. Specifically, these DEmiRs revealed the significant contributions of the intestinal microbiome dysbiosis in the infection–inflammation–immune network for activation of T cells, immune pathways of IL-17, Toll-like receptor, TNF, Janus kinase-signal transducer and activator of transcription, osteoclast cell differentiation pathway and IgA production to the active RA pathogenesis.

Conclusions

Our experiment-based interactomic study of DEmiRs in serum of NARAPs revealed novel clinically relevant miRs interactomes in the infection–inflammation–immune network of RA. These results provide valuable resources for understanding the integrated function of the miR network in RA pathogenesis and the application of circulating miRs as biomarkers for early aetiologic RA diagnosis.
Dissociable neural signatures of passive extinction and instrumental control over threatening events
Authors: Wanke Nadine , Schwabe Lars
Published: June 2020

Aberrant fear learning processes are assumed to be a key factor in the pathogenesis of anxiety disorders. Thus, effective behavioral interventions to reduce dysfunctional fear responding are needed. Beyond passive extinction learning, instrumental control over threatening events is thought to diminish fear. However, the neural mechanisms underlying instrumental control—and to what extent these differ from extinction—are not well understood. We therefore contrasted the neural signatures of instrumental control and passive extinction using an aversive learning task, relative to a control condition. Participants (n = 64) could either learn to exert instrumental control over electric shocks, received a yoked number and sequence of shocks without instrumental control or did not receive any shocks. While both passive extinction and instrumental control reduced threat-related skin conductance responses (SCRs) relative to pre-extinction/control, instrumental control resulted in a significantly more pronounced decrease of SCRs. Instrumental control was further linked to decreased striatal activation and increased cross talk of the ventromedial prefrontal cortex (vmPFC) with the amygdala, whereas passive extinction was associated with increased vmPFC activation. Our findings demonstrate that instrumental learning processes may shape Pavlovian fear responses and that the neural underpinnings of instrumental control are critically distinct from those of passive extinction learning.
Population variability in social brain morphology for social support, household size and friendship satisfaction
Authors: Taebi Arezoo , Kiesow Hannah , Vogeley Kai , Schilbach Leonhard , Bernhardt Boris C , Bzdok Danilo
Published: June 2020

The social brain hypothesis proposes that the complexity of human brains has coevolved with increasing complexity of social interactions in primate societies. The present study explored the possible relationships between brain morphology and the richness of more intimate ‘inner’ and wider ‘outer’ social circles by integrating Bayesian hierarchical modeling with a large cohort sample from the UK Biobank resource (n = 10 000). In this way, we examined population volume effects in 36 regions of the ‘social brain’, ranging from lower sensory to higher associative cortices. We observed strong volume effects in the visual sensory network for the group of individuals with satisfying friendships. Further, the limbic network displayed several brain regions with substantial volume variations in individuals with a lack of social support. Our population neuroscience approach thus showed that distinct networks of the social brain show different patterns of volume variations linked to the examined social indices.
Relational Memory in the Early Stage of Psychosis: A 2-Year Follow-up Study
Authors: Avery Suzanne N , Armstrong Kristan , McHugo Maureen , Vandekar Simon , Blackford Jennifer Urbano , Woodward Neil D , Heckers Stephan
Published: June 2020

Background

Relational memory, the ability to bind information into complex memories, is moderately impaired in early psychosis and severely impaired in chronic schizophrenia, suggesting relational memory may worsen throughout the course of illness.

Methods

We examined relational memory in 66 early psychosis patients and 64 healthy control subjects, with 59 patients and 52 control subjects assessed longitudinally at baseline and 2-year follow-up. Relational memory was assessed with 2 complementary tasks, to test how individuals learn relationships between items (face-scene binding task) and make inferences about trained relationships (associative inference task).

Results

The early psychosis group showed impaired relational memory in both tasks relative to the healthy control group. The ability to learn relationships between items remained impaired in early psychosis patients, while the ability to make inferences about trained relationships improved, although never reaching the level of healthy control performance. Early psychosis patients who did not progress to schizophrenia at follow-up had better relational memory than patients who did.

Conclusions

Relational memory impairments, some of which improve and are less severe in patients who do not progress to schizophrenia, are a target for intervention in early psychosis.
Draft Genome Resources Sequences of Six Pseudomonas syringae pv. actinidiae Strains Isolated from Actinidia chinensis var. deliciosa Leaves in Portugal
Authors: Ares Aitana , Tacão Marta , Figueira Daniela , Garcia Eva , Costa Joana
Published: June 2020

Pseudomonas syringae pv. actinidiae is a quarantine bacterium affecting all the Portuguese main areas of kiwifruit production. We report the draft genome of six P. syringae pv. actinidiae strains isolated from symptomatic leaves of Actinidia chinensis var. deliciosa in a study that determined the genetic population structure of the endophytic and epiphytic populations in two consecutive seasons. Average nucleotide identity values were above 99% similarity with reference strains from P. syringae pv. actinidiae biovar 3. The genomic differences found between these strains confirm the genetic diversity described for P. syringae pv. actinidiae population in Portugal. Furthermore, data provide evidence that the initial clonal expansion of P. syringae pv. actinidiae in Europe was followed by a genomic diversification constituting a valuable resource for epidemiological and evolutionary studies, namely when adopting strategies for epidemics management.
A first episode of psychosis
Authors: Smith Erin Murphy
Published: June 2020

Helping loved ones cope and care for patients who have a lack of insight
Does Educational Handover Influence Subsequent Assessment?
Authors: Dory Valérie , Danoff Deborah , Plotnick Laurie H. , Cummings Beth-Ann , Gomez-Garibello Carlos , Pal Nicole E. , Gumuchian Stephanie T. , Young Meredith
Published: June 2020

Purpose

Educational handover (i.e., providing information about learners’ past performance) is controversial. Proponents argue handover could help tailor learning opportunities. Opponents fear it could bias subsequent assessments and lead to self-fulfilling prophecies. This study examined whether raters provided with reports describing learners’ minor weaknesses would generate different assessment scores or narrative comments than those who did not receive such reports.

Method

In this 2018 mixed-methods, randomized, controlled, experimental study, clinical supervisors from 5 postgraduate (residency) programs were randomized into 3 groups receiving no educational handover (control), educational handover describing weaknesses in medical expertise, and educational handover describing weaknesses in communication. All participants watched the same videos of 2 simulated resident–patient encounters and assessed performance using a shortened mini-clinical evaluation exercise form. The authors compared mean scores, percentages of negative comments, comments focusing on medical expertise, and comments focusing on communication across experimental groups using analyses of variance. They examined potential moderating effects of supervisor experience, gender, and mindsets (fixed vs growth).

Results

Seventy-two supervisors participated. There was no effect of handover report on assessment scores (F(2, 69) = 0.31, P = .74) or percentage of negative comments (F(2, 60) = 0.33, P = .72). Participants who received a report indicating weaknesses in communication generated a higher percentage of comments on communication than the control group (63% vs 50%, P = .03). Participants who received a report indicating weaknesses in medical expertise generated a similar percentage of comments on expertise compared to the controls (46% vs 47%, P = .98).

Conclusions

This study provides initial empirical data about the effects of educational handover and suggests it can—in some circumstances—lead to more targeted feedback without influencing scores. Further studies are required to examine the influence of reports for a variety of performance levels, areas of weakness, and learners.
Pause, Persist, Pivot: Key Decisions Health Professions Education Researchers Must Make About Conducting Studies During Extreme Events
Authors: O’Brien Bridget C. , Teherani Arianne , Boscardin Christy K. , O’Sullivan Patricia S.
Published: June 2020

When extreme events occur, some research becomes a clear priority, but what becomes of all other research? Does it stop indefinitely, or can it be paused with plans to resume, persist with modifications, or pivot to address new priorities? Facing this dilemma and witnessing it among their fellow health professions education researchers, the authors recognized a need for guidance. This Invited Commentary presents a framework, organized as key questions related to the research stage and process, to assist health professions education researchers in making decisions about how to proceed with research that was planned or in progress when an extreme event occurred. Although at the time of this writing, the COVID-19 pandemic was the extreme event at hand, the authors intentionally created questions and discussed considerations that can be helpful for thinking through decisions in a variety of disruptions in health professions education research—many of which require similar difficult decisions and creative solutions to carry important research forward and maintain high quality.
Oil and gas production and spontaneous preterm birth in the San Joaquin Valley, CA
Authors: Gonzalez David J. X. , Sherris Allison R. , Yang Wei , Stevenson David K. , Padula Amy M. , Baiocchi Michael , Burke Marshall , Cullen Mark R. , Shaw Gary M.
Published: June 2020

Background:

Recent studies report an association between preterm birth and exposure to unconventional oil and gas wells. There has been limited previous study on exposure to conventional wells, which are common in California. Our objective was to determine whether exposure to well sites was associated with increased odds of spontaneous preterm birth (delivery at <37 weeks).

Methods:

We conducted a case–control study using data on 27,913 preterm birth cases and 197,461 term birth controls. All births were without maternal comorbidities and were located in the San Joaquin Valley, CA, between 1998 and 2011. We obtained data for 83,559 wells in preproduction or production during the study period. We assessed exposure using inverse distance-squared weighting and, for each birth and trimester, we assigned an exposure tertile. Using logistic regression, we estimated adjusted odds ratios (ORs) for the association between exposure to well sites and preterm birth at 20–27, 28–31, and 32–36 weeks.

Results:

We observed increased ORs for preterm birth with high exposure to wells in the first and second trimesters for births delivered at ≤31 weeks (adjusted ORs, 1.08–1.14). In stratified analyses, the associations were confined to births to Hispanic and non-Hispanic Black women and to women with ≤12 years of educational attainment. In a secondary analysis, we found evidence that exposure to wells in preproduction is associated with higher concentrations of particulate matter.

Conclusions:

We found evidence that exposure to oil and gas well sites is associated with increased risk of spontaneous preterm birth.
Clinical Manifestations in Children with Staphylococcal Bacteremia Positive for Panton-Valentine Leucocidin
Authors: Bybeck Nielsen Allan , Larsen Anders Rhod , Petersen Andreas , Schønheyder Henrik Carl , Westh Henrik , Benfield Thomas , Nygaard Ulrikka
Published: June 2020

A total of 714 pediatric cases of Staphylococcus aureus bacteremia were identified from 2008 to 2015 in Denmark; 98% were methicillin-susceptible S. aureus (MSSA). Fifteen isolates (2,1%) were Panton-Valentine leucocidin positive (0.17/100,000 children/year) and 87% MSSA. Eight cases (53%) were severe, including all pneumonia cases. Panton-Valentine leucocidin positive Staphylococcus aureus bacteremia is rare in our setting with high MSSA-prevalence. Half of the cases were uncomplicated.
School-based Streptococcal A Sore-throat Treatment Programs and Acute Rheumatic Fever Amongst Indigenous Māori: A Retrospective Cohort Study
Authors: Walsh Liam , Innes-Smith Sandra , Wright Janine , Michniewicz Thanjon , Tozer Megan , Humby Jonathan , Ngata Richard , Lennon Diana , Scott-Jones Joseph , Malcolm John
Published: June 2020

Background:

Acute rheumatic fever (ARF) predominantly affects indigenous Māori schoolchildren in Bay of Plenty region, and more so male Māori students, especially when socioeconomically deprived. We evaluated the effectiveness of strategies for reducing ARF with group A streptococcal pharyngitis treatment in 2011–18.

Methods:

We retrospectively assessed outcomes of 3 open cohorts of Māori schoolchildren receiving different interventions: Eastern Bay rural Cohort 1, mean deprivation decile 9.80, received school-based sore-throat programs with nurse and general practice (GP) support; Eastern Whakatane township/surrounds Cohort 2, mean deprivation 7.25, GP management; Western Bay Cohort 3, mean deprivation 5.98, received predominantly GP care, but 3 highest-risk schools received school-based programs. Cases were identified from ICD10 ARF-coded hospital discharges, notifications to Ministry of Health, and a secondary-prevention penicillin database. Primary outcomes were first-presentation ARF cohorts’ incidence preintervention (2000–10) and postintervention (2011–18) with cases over annual school rolls’ Māori students-year denominators.

Results:

Overall, ARF in Maori schoolchildren declined in the cohorts with school-based programs. Cohort 1 saw a postintervention (2011–18) decline of 60%, 148 to 59/100,000/year, rate ratio (RR) = 0.40(CI 0.22–0.73) P = 0.002. Males’ incidence declined 190 to 78 × 100,000/year RR = 0.41(CI 0.19–0.85) P = 0.013 and females too, narrowing gender disparities. Cohort 3 ARF incidence decreased 48%, 50 to 26/100,000/year RR = 0.52(CI 0.27–0.99) P = 0.044. In contrast, ARF doubled in Cohort 2 students with GP-only care without school-based programs increasing 30 to 69/100,000/year RR = 2.28(CI 0.99–5.27) P = 0.047, especially for males 39/100,000/year to 107/100,000/year RR = 2.71(CI 1.00–7.33) P = 0.0405.

Conclusions:

School-based programs with indigenous Māori health workers’ sore-throat swabbing and GP/Nurse support reduced first-presentation ARF incidence in Māori students in highest-risk settings.
The Epidemiology and Clinical Characteristics of Pediatric Tuberculosis in Denmark 2009–2014 Highlights Targets for Prevention
Authors: Nordholm Anne Christine , Holden Inge Kristine , Hartling Ulla Birgitte , Andersen Peter Henrik , Lillbaek Troels , Johansen Isik Somuncu
Published: June 2020

Background:

In Western Europe, most pediatric tuberculosis (TB) cases occur among immigrants; however, data are rarely stratified by first/second-generation immigrants and many cases may be preventable.

Methods:

This was a nationwide study of children <18 years with TB from 2009 to 2014 in Denmark. Demographic, clinical, microbiologic and treatment outcome data were obtained from registers and medical records.

Results:

We identified 145 cases; 99 were immigrants (68%) of which 54 (55%) were second-generation immigrants. Most first-generation immigrants (73%) were diagnosed by passive case finding as was half the second-generation immigrants (52%), in contrast to Danish children who were mostly diagnosed by active case finding (70%). Symptoms were often nonspecific, and one-third of the children had normal blood tests at time of diagnosis. First-generation immigrants were most often infected abroad (84%) as opposed to Danish children (9%) and second-generation immigrants (30%). Approximately one-third of the children represented cases of TB disease that could possibly have been prevented by screening or rigorous contact tracing. The overall treatment success rate was 97%, and cases of unsuccessful treatment were restricted to immigrant adolescents.

Conclusions:

The majority of pediatric TB in Denmark occurred among immigrant children with symptomatic TB, whereas more Danish children were diagnosed at earlier disease stages. Almost one-third of TB cases may represent missed opportunities to prevent TB disease. Improvements include enhanced adult case detection with comprehensive contact investigation among children, tailored screening and vaccination of immigrant children, and raised awareness of diagnosing and treating latent TB infection in children.
Patterns of Heart Failure Dyadic Illness Management
Authors: Lee Christopher S. , Sethares Kristen A. , Thompson Jessica Harman , Faulkner Kenneth M. , Aarons Emily , Lyons Karen S.
Published: June 2020

Background

The ways in which patients with heart failure (HF) and their care partners work together to manage HF are often overlooked.

Objective

The aim of this study was to identify and compare different patterns of HF dyadic illness management.

Methods

This was a secondary analysis of data on HF dyads. Heart failure management was measured using patient and care partner versions of the Self-Care of HF Index and European HF Self-care Behavior Scale. Latent class modeling was used to identify patterns of HF dyadic management.

Results

The mean age of the 62 patients and their care partners was 59.7 ± 11.8 and 58.1 ± 11.9 years, respectively. A majority of patients (71.0%) had class III/IV HF, and a majority of the couples (95.2%) were married. Two distinct dyadic patterns were observed, 1 collaborative management type (n = 42, 67.7%) and 1 autonomous management type (n = 20, 32.3%). Dyads in the autonomous pattern were mostly female patients with male care partners; patients in this pattern also were more anxious and depressed, and reported worse relationship quality compared with collaborative dyads.

Conclusion

There is an engendered spectrum of collaboration in how HF patient–care partner dyads work together to manage HF that needs to be considered in clinical care and research.
Hemodynamic and Hemostatic Response to Blood Flow Restriction Resistance Exercise in Coronary Artery Disease
Authors: Kambič Tim , Novaković Marko , Tomažin Katja , Strojnik Vojko , Božič-Mijovski Mojca , Jug Borut
Published: June 2020

Background

Blood flow–restricted resistance training (BFR-RT) has been proven to be safe and efficacious in healthy older adults, but not in cardiovascular disease.

Objective

The aim of this study was to investigate the acute and training induced effects of BFR-RT on hemostatic and hemodynamic responses in patients with coronary artery disease (CAD).

Methods

Stable patients with CAD were randomized to 8 weeks of BFR-RT (30%–40% 1-repetition maximum unilateral knee extension) combined with aerobic training or aerobic training alone (control group). At baseline and after 4 and 8 weeks, blood samples were taken before and after BFR exercise, whereas hemodynamic parameters were monitored throughout the exercise.

Results

Twenty-four patients (12 per group; mean age, 60 ± 2 years; mostly male [75%]) completed the study. The BFR-RT significantly improved systolic blood pressure (−10 mm Hg; P = .020) and tended to lower diastolic blood pressure (−2 mm Hg; P = .066). In contrast, no posttraining alterations were observed in N-terminal prohormone B-type natriuretic hormone, fibrinogen, and D-dimer values. During BFR exercise, all hemodynamic variables significantly increased after the first and second set, whereas blood pressure immediately lowered after the cuff was released in the third set. Last, significant interaction was only observed for repetitions × intensity (P < .001; partial η
2 = 0.908) of diastolic blood pressure at higher exercise intensity (40% 1-repetition maximum).

Conclusions

The BFR-RT was proven to be safe, with favorable hemodynamic and hemostatic responses in patients with CAD, and can be recommended as an additional exercise modality in cardiac rehabilitation.

Trial Registration:
ClinicalTrial.gov Identifier: NCT03087292
Identification of Cardiovascular Patient Groups at Risk for Poor Medication Adherence
Authors: Sieben Angelien , A.W. van Onzenoort Hein , J.H.M. van Laarhoven Kees , Bredie Sebastian J.H. , van Dulmen Sandra
Published: June 2020

Background

Poor medication adherence limits the secondary prevention of cardiovascular diseases (CVDs) and leads to increased morbidity, mortality, and costs. Identifying groups of patients at risk of poor adherence behavior could enable an intervention to be developed and target patients appropriately.

Objective

The first aim of this study was to identify homogeneous subgroups of cardiovascular outpatients based on their cardiovascular risk factors. Subsequently, differences in medication adherence between these groups were examined.

Methods

In this retrospective, observational study, patients with an established CVD were included. Well-known cardiovascular risk factors such as smoking, diet, exercise, blood lipid levels, blood pressure, and body mass index were collected. To identify patient subgroups, a 2-step cluster analytic procedure was performed. Differences between the groups on medication adherence were determined on the outcome of the Modified Morisky Scale. Data collection took place between October 2011 and January 2013.

Results

Cardiovascular risk factors of 530 patients were included in the cluster analysis. Three groups were identified. Compared with other clusters (clusters 1 and 2), cluster 3 contained significantly fewer patients who could be classified as highly adherent and more patients classified as medium adherent (23% and 57%, respectively; P = .024). This group was characterized by a younger age (53% were <55 years old) and using a relatively low number of different medications (41% used <4 different medications). Besides, in this subgroup the most smokers (37%), unhealthy alcohol users (27%), and patients with unhealthy eating habits (14%) were present.

Conclusion

This study showed that cardiovascular patients who are relatively young and have an unhealthy lifestyle are at risk for nonadherent behavior.
Nurse-Led Initiative to Improve Addiction Services
Authors: Fiore-Lopez Nicolette , Shea-Lewis Anne
Published: June 2020

Local efforts to provide treatment for individuals with substance use disorder have had some success in addressing the continued nationwide drug epidemic. A nurse-led withdrawal and stabilization program was developed that includes an interdisciplinary team of physicians, advanced practice providers, nurses, social workers, and substance abuse counselors. Utilizing a shared vision of optimal patient care, we describe how principles of high reliability were incorporated to build a successful program within a community hospital setting from the design of the unit, development of treatment protocols, staffing, and ongoing program refinement that is based on patient and program staff feedback to final thoughts for future program changes.
Clinical Nurses
Authors: Parchment Joy , Stinson Allan
Published: June 2020

The global crime of human trafficking, has nursing leaders urgently assessing, developing, and implementing various strategies to ensure the safety and well-being of human trafficked victims and their teams. The complex elements of human trafficking and the impact of associated consequences on victims and teams, coupled with needed resources to serve trafficked victims, could overwhelm any health care organization and community agencies. As the call for action surrounding this victimization grows, nurses are well-positioned to lead through the complexity. This article describes an improvement project led by clinical nurses and a nurse leader that involved interdisciplinary groups, the local nonprofit community, and state agencies. The ensuing partnership created a system-wide trauma-informed human trafficking program that identified and holistically addressed the health care needs of trafficked victims throughout the risk continuum.
A Complexity-Informed Model to Guide Nurse Manager Practice
Authors: Warshawsky Nora E.
Published: June 2020

Nurse manager practice is a broad concept that reflects the defined role responsibilities and the manner in which nurse managers perform their role. The outcome of nurse manager practice is commonly known as their job performance. The job performance of nurse managers reflects their effectiveness and is assessed by organizational, staff, and patient outcomes. There is strong evidence that nurse managers with relational leadership styles are the key drivers of positive practice environments and job satisfaction among nurses. Concluding that the solution to positive environments and satisfied nurses rests solely on the leadership style of the nurse manager seems logical; however, it ignores the role of the larger organizational context. This article applies a complexity lens to understand nurse manager practice and other organizational factors influencing job performance. The evidence developed thus far yielded the identification of dimensions of the organizational context that support nurse manager practice and nurse manager job performance. Additional research is needed to identify the essential ingredients to support nurse manager practice. Organizational success depends on developing synergy among the administrative, adaptive, and enabling leadership functions of organizations.
Sustainability of an Interprofessional Collaborative Practice Model for Population Health
Authors: Shirey Maria R. , Selleck Cynthia S. , White-Williams Connie , Talley Michele , Harper Doreen C.
Published: June 2020

Sustainability is an important concept in implementation science, yet little about sustainability is published in leadership journals. Leaders are charged on a daily basis with initiating programs that make a difference; however, they are often not well prepared to design effective strategies to sustain their efforts. In a value-based health care industry where facilitating access to care, enhancing the patient experience, improving health outcomes, and reducing the cost of care are imperative, creating sustainability strategies that achieve these results is key. In this article, we describe the successful efforts within an academic-practice partnership to implement a sustainable interprofessional collaborative practice model emphasizing transitional care coordination in chronic disease management for advancing population health with underserved populations. A sustainability framework is presented along with lessons learned.
Missed Nursing Care During Labor and Birth and Exclusive Breast Milk Feeding During Hospitalization for Childbirth
Authors: Simpson Kathleen Rice , Lyndon Audrey , Spetz Joanne , Gay Caryl L. , Landstrom Gay L.
Published: June 2020

Purpose:

The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge.

Study Design and Methods:

Labor and birth nurses in three states were surveyed about missed nursing care and their maternity units' adherence to the AWHONN (2010) nurse staffing guidelines for care during labor and birth, using the Perinatal Misscare Survey. Nursing responses were aggregated to the hospital level and estimated associations between missed nursing care, nurse staffing, and hospitals' exclusive breast milk feeding rates were measured using The Joint Commission's Perinatal Care Measure (PC-05).

Results:

Surveys from 512 labor nurses in 36 hospitals were included in the analysis. The mean exclusive breast milk feeding rate was 53% (range 13%–76%). Skin-to-skin care, breastfeeding within 1 hour of birth, and appropriate recovery care were on average occasionally missed (2.33 to 2.46 out of 4; 1 = rarely, 2 = occasionally, 3 = frequently, or 4 = always) and were associated with PC-05 [B(CI) -17.1(-29, -6.3), -17.9(-30.5, -6.2), and -15.4(-28.7, -2.1), respectively]. Adherence with overall staffing guidelines was associated with PC-05 [12.9(3.4, 24.3)]. Missed nursing care was an independent predictor of PC-05 [-14.6(-26.4, -2.7)] in a multilevel model adjusting for staffing guideline adherence, perceived quality, mean age of respondents, and nurse burnout.

Clinical Implications:

Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. These results support exclusive breast milk feeding (PC-05) as a nurse-sensitive quality indicator.
Neural Processing and Perceived Discrimination Stress in African Americans
Authors: Wright Kathy D. , Jack Anthony I. , Friedman Jared P. , Jones Lenette M. , Sattar Abdus , Fresco David M. , Moore Shirley M.
Published: June 2020

Background

Racial discrimination is one of many barriers experienced by African Americans that interfere with health self-care management. Discrimination stress may decrease the tendency for individuals to resonate with the social–emotional appeals embedded in persuasive health information, which are known to play a key role in producing behavior change. Understanding the neurobehavioral underpinnings of discrimination stress experienced by African Americans may help reduce or resolve this important health disparity.

Objectives

The purpose of this secondary analysis was to examine the association between neural processing of health information and perceived discrimination. In particular, we focused on three previously identified measures of health information processing associated with distinct brain areas: analytic network, empathy network, and the ventral medial prefrontal cortex.

Methods

Data were obtained from 24 African Americans enrolled in a blood pressure self-care management study. Participants completed surveys assessing racial discrimination and global stress, as well as a 40-minute functional magnetic resonance imaging protocol used to measure neural activation associated with processing different types of health information.

Results

Discrimination stress was significantly related to reduced activation of the empathy network and ventral medial prefrontal cortex, whereas there was a nonsignificant positive relationship with activity in the analytic network.

Discussion

Uncovering associations between patient experiences, such as racial discrimination, and their neural processing of health information can lead to the development of tailored health messages and self-care management interventions. This may inform strategies to close the gap on health outcomes.
Adaptation and Acceptability of a Digitally Delivered Intervention for Parents of Very Low Birth Weight Infants
Authors: Greene Michelle M. , Patra Kousiki , Czyzewski Patryk , Gonring Kelsey , Breitenstein Susan
Published: June 2020

Background

Very low birth weight (VLBW) infants are at elevated risk for behavioral problems as early as the second year of life. The purpose of this feasibility study was to evaluate the adaptation and acceptability of an existing digitally delivered behavioral parent training program—the ezParent program, with the addition of weekly coaching calls—for parents of former VLBW infants in their second year of life.

Objectives

To assess the adaptation of ezParent for this population, we assessed parent access and use of ezParent and coaching calls, parent learning of strategies from ezParent, and changes in parenting practices or child behavior after using ezParent plus coaching calls. For acceptability, we assessed if parents viewed ezParent content as applicable to their experiences of parenting a former VLBW infant and how parents viewed coaching calls.

Methods

Ten parents of VLBW infants (20 months of age adjusted for prematurity) were recruited from a neonatal intensive care follow-up clinic. Parents completed the six modules of ezParent plus weekly coaching calls over 10-week intervention period. ezParent usage data were electronically uploaded to secure servers. Completion and timing of coaching calls were monitored using a tracking log. Parents completed child behavior and parenting belief and practice questionnaires pre- and postintervention. Calls were recorded and transcribed to assess for learning of parenting strategies, acceptability with the VLBW population, and acceptability of coaching calls.

Results

On average, parents completed 85% of the ezParent modules and 89% of the scheduled coaching calls, respectively. Parents spontaneously introduced 44% of the ezParent strategies during their coaching calls. Modest within-group effect sizes were detected for improvement in parenting self-efficacy and child externalizing behavior. Parents felt the ezParent content applied to their experiences parenting a preterm infant and had high satisfaction with coaching calls as a method of reinforcing program content and assessing knowledge and supporting accountability for program participation.

Discussion

ezParent with coaching calls is a feasible method of delivering behavioral parent training to parents of former VLBW infants in their second year of life. Coaching calls have high potential to be a low-cost, time-efficient component of digitally delivered programs that would allow for rapid integration into clinical practice.
Sex Abroad Among Men Who Have Sex With Men and Its Association With Chemsex, Sexual Risk Behavior, and Sexually Transmitted Diseases: A Cross-Sectional Study in the Netherlands
Authors: Evers Ymke J. , Dukers-Muijrers Nicole H.T.M. , Van Liere Geneviève A.F.S. , Hoebe Christian J.P.A.
Published: June 2020

Almost half of men who have sex with men visiting Dutch sexually transmitted disease clinics reported sex abroad in the past 6 months, mainly in Western countries. One in 4 men who have sex with men who had sex abroad used drugs during sex (“chemsex”) abroad. Having sex abroad was associated with having multiple sex partners and casual sex partner(s).