bluuebunny/crossref_metadata_2025 huggingface dataset:
The Programmed Death Pathway in Ocular Adnexal Sebaceous Carcinoma
Authors: Bowen Randy C. , Lawson Brendan M. , Jody Nicole M. , Potter Heather D. , Lucarelli Mark J.
Published: October 2019

Sebaceous carcinoma of the ocular and periocular regions showed expression of immune checkpoint ligands PD-1, PD-L1, and PD-L2, which suggests PD blockade may provide benefit as an adjuvant therapy for patients with sebaceous carcinoma.

Purpose:

Sebaceous carcinoma can be highly malignant and difficult to treat. Surgical excision followed by periocular reconstruction is the primary method of treatment. In aggressive cases, radiation, topical chemotherapy, and systemic chemotherapy have been explored as adjuvant therapy. Immunotherapy, through immune checkpoint inhibitors, has proven to have significant antitumor effect in many cancer types, including melanoma, non-small cell lung cancer, renal cell carcinoma, and cutaneous squamous cell carcinoma. Little is known about endogenous immune response directed against sebaceous carcinoma. In this study, we aim to characterize the expression pattern of PD-1 and its ligands PD-L1 and PD-L2 in both sebaceous carcinoma and in infiltrating immune cells to explore the potential use of checkpoint blockade as therapy.

Methods:

We performed a retrospective chart and histology review of patients with sebaceous carcinoma between 1990 and 2017 at the University of Wisconsin. Tissue microarrays were made from paraffin blocks. Immunohistochemistry was performed for evaluation of tumor and immune cell infiltration for expression of PD-1, PD-L1, and PD-L2. Tumor or infiltrating immune cells were considered positive if ≥5% of cells had membranous (cell surface) expression.

Results:

Twenty-eight patients were included. PD-L1 and PD-1 were not significantly expressed on tumor cells; however, PD-L1 and PD-1 were expressed on infiltrating immune cells in 46% and 25% of patients, respectively. In contrast, PD-L2 demonstrated positive expression on tumor cells in 46% of the cases along with positive expression on infiltrating immune cells in 38% of the cases.

Conclusions:

Sebaceous carcinoma currently has few effective adjuvant treatment options. The expression of PD-1, PD-L1, and PD-L2 on infiltrating immune cells and PD-L2 on tumor cells restrains T-cells from full activation and proliferation, therefore limiting the antitumor effect of T-cells, tipping the balance toward unopposed tumor progression. Consequently, PD-1 or PD-L1 inhibitors may have a role in sebaceous carcinoma treatment. Given the prevalence of PD-L2 expression in sebaceous carcinoma and the lack of PD-L2 blockade therapy available, PD-1 blockade may provide benefit over PD-L1 inhibitors. PD-1 blockade in combination with current methods may be a viable therapeutic option for patients with sebaceous carcinoma and deserves further study.
Giant Bilateral Cysts of the Accessory Lacrimal Glands of Wolfring in a Child
Authors: Feijó Eduardo Damous , Alencastro Landim George , de Melo Dias Mirna , Alves de Souza Bruna Angelina , Murillo Limongi Roberto , Matayoshi Suzana
Published: October 2019

Ductal cysts of the accessory lacrimal glands of Wolfring are rare clinical entities. They typically present as mobile and translucent lesions on the superior or inferior tarsal borders. Here, the authors describe a 7-year-old male child presenting with giant bilateral cysts of Wolfring. Management of such cysts is primarily surgical and the preferred route for excision is transconjunctival. To the best of the authors' knowledge, this is the first report of a bilateral Wolfring dacryops affecting a child.

Cysts of the accessory lacrimal glands of Wolfring are rare clinical entities. To the authors’ knowledge, here the authors describe the first report of a bilateral Wolfring dacryops affecting a child.
Relationship Between Intervertebral Disc Morphology and Adolescent Idiopathic Scoliosis
Authors: Nakhaee Koorosh , Tavakoli Golpaygani Ali , Abedi Rasoul
Published: October 2019

Adolescent idiopathic scoliosis (AIS) is an abnormal 3-dimensional curvature of the spine that appears in youth. In progressive cases, a small curve may be augmented rapidly and leads the victim to a high-risk surgical operation. Recognition of the AIS in the early stage can help in treating it with noninvasive methods. The goal of the study was to examine the relationship between intervertebral disc morphology and AIS as an applicable index and useful method for developing the screening and recognition of AIS before the start of disease. Based on a biomechanical model, we examined the relationship between AIS and intervertebral disc morphology in the thoracic and lumbar region separately and comparatively. For this purpose, the mean disc height (MDH) in the thoracic (MDHT) and lumbar (MDHL) regions and mean ratio of disc height per vertebral radius (MDHPVR) in the thoracic (MDHPVRT) and lumbar (MDHPVRL) regions were compared between 20 girls with AIS and 20 normal girls as the control group by using magnetic resonance imaging. Although there was a significant difference between the AIS and control group in MDHT (P = .004) and MDHPVRT (P = .006), this difference was more significant in the lumbar region (MDHL, P < .0001, and MDHPVRL, P < .0001). According to obtained results, the relation of MDHPVR and scoliosis can be established and used to develop as a screening method for diagnosis and treatment of adolescents who are exposed to scoliosis disorder at an early stage.
Glaucoma Detection Using Retinal Nerve Fiber Layer Texture Features
Authors: Gasm Elseid Arwa A. , Hamza Alnazier O.
Published: October 2019

The retinal nerve fiber layer (RNFL) is one of the most affected parts of the eye retina by glaucoma disease. Progression of this disease results in RNFL texture changes and can be observed from the fundus images and RNFL thickness; thus, the glaucoma is one of the ocular diseases contributing to most of the blindness worldwide. There are increasing demands for medical image–based computer-aided diagnosis system based on fundus image for glaucoma detection. Thus, the RNFL thickness changes can be assessed by optical coherence tomography. However, an examination using the optical coherence tomography device is rather expensive and still not widely available in resource-poor countries. On the other hand, a fundus camera is a fundamental diagnostic device and can be used for diagnosing other diseases. In this article, we introduce glaucoma detection using fundus images. This algorithm uses texture analysis based on co-occurrence matrix and Tamara features. The texture measures are extracted from the RNFL segmented part. The method was tested on a set of 158 images composed of 118 healthy retina images and 40 glaucomatous images and achieved an area under the curve of 93% and accuracy of 89.5%.
Work Stations on Wheels Are Workhorses of Clinical Care
Authors: Carlson Bradley
Published: October 2019

The global medical cart/workstation market is expected to reach $5439.4 million by 2020, with the increased use of electronic health records being the largest driver, according to a recent report (Research and Markets, Global Medical Carts/Workstations Market Outlook 2015-2020; https://www.researchandmarkets.com/reports/3615944/global-medical-cartsworkstations-market-outlook). Another market report noted that “Growing need for quick access to mobile electronic health records at the point of care has led to surge in demand for medical carts globally. In addition, increasing demand for improving operational efficiency in the healthcare industry is projected to impact the global market growth of medical carts positively.” This report put the compounded annual growth rate of the market at 11.0% over its forecast period out to 2026 (Future Market Insights; https://www.globenewswire.com/news-release/2018/01/15/1289141/0/en/Medical-Carts-Market-will-Register-a-CAGR-of-11-0-through-2017-2026-globally-Future-Market-Insights.html).
Brace Compliance, Sex, and Initial Cobb Angle as Predictors of Immediate In-Brace Curve Correction in Adolescents With Scheuermann’s Kyphosis
Authors: Babaee Taher , Kamyab Mojtaba , Sanjari Mohammad Ali , Ahmadi Amir , Ganjavian Mohammad Saleh
Published: October 2019

INTRODUCTION

Bracing is the most effective nonoperative treatment for adolescents with Scheuermann’s kyphosis; however, its outcome is not equal for all patients. The effects of potential predictive parameters for the outcome of bracing have not been well evaluated in the literature. The aim of the study was to investigate the potential prognostic factors that affect in-brace curve correction in adolescents with Scheuermann's kyphosis.

MATERIALS AND METHODS

In this prospective cohort study, patients with thoracic Scheuermann’s kyphosis treated with the Milwaukee brace with a curve of 55° to 86° were included. The primary prognostic factors for in-brace curve correction, including brace compliance and daily exercise by log book, pad pressure by a modified sphygmomanometer, joint hypermobility by Beighton's scale, patients’ sex, and initial Cobb angle were measured. Analyses considered multiple linear regression and independent sample t-test.

RESULTS

Nineteen boys (13.74 ± 1.55 years) and 33 girls (13.67 ± 1.61 years) were included in the study. The results of the multiple linear regression analysis showed that the degrees of in-brace curve correction were significantly associated with brace compliance and initial Cobb angle (R
2 = 0.48). The results of the independent t-test showed a significant difference in average curve correction, brace compliance, and in-brace pressure between girls and boys.

CONCLUSIONS

Results of the current study indicated that the amount of in-brace curve correction is primarily affected by brace compliance and initial Cobb angle. Brace compliance, curve correction, and pad pressure in boys were significantly higher than in girls.
Paget disease of the vulva an analysis of 24 cases
Authors: Loiacono Rosalia Maria Rita , Traversi Paola , Deliso Maria Assunta , Gargano Giulio , Kardhashi Anila , Francescato Roberta , Loizzi Vera , Spinelli Marta , Lovascio Serena , Fiorito Maura , Resta Leonardo , Popescu Ondina , Cicinelli Ettore , Cormio Gennaro
Published: October 2019

Paget's disease can arise in the breast (mammary Paget disease) or in other locations (extramammary Paget disease) such as anogenital skin in both males and females (Paget disease of the vulva [PDV]). Underlying adenocarcinoma can be found in some cases. This study aims to report clinical aspects, surgical procedures, outcomes, and recurrences of patients with PDV.

A retrospective chart review was conducted on patients with pathologically confirmed diagnosis of PDV managed at the Department of Obstetrics and Gynecology, University of Bari, and the “Giovanni Paolo II” National Cancer Institute in Bari, between 1998 and 2018.

Records of 24 cases of PDV were examined. Median age of the patients at diagnosis was 69.3 (range 38–84), diagnosis of synchronous cancer was made in 2 cases and in 2 other cases of metachronous disease. Three patients had previously been diagnosed with other oncological diseases. All patients underwent surgery including wide local excision (6), simple vulvectomy (8), and extended vulvectomy (10). Lymphadenectomy was performed in 2 cases and reconstructions with advancement flaps in 7 cases. Four patients were found to have invasive disease and 1 had inguinal node involvement. Positive margins were found in 11 patients. Wound dehiscence and urethral stenosis were found in 4 and 1 case each. Eight recurrences (33.33%) were observed, regardless of positive surgical margins.

PDV has a low rate of malignancy but a high rate of recurrence. It should be diagnosed early to avoid repeated surgery and to reduce symptoms and morbidity.
Effect of NO inhalation on ECMO use rate and mortality in infants born at or near term with respiratory failure
Authors: Wang Xiaoqing , Li Bowen , Ma Yuqing , Zhang Hong
Published: October 2019

Background:

The molecular studies showed that Nitric oxide (NO) is an essential factor which regulates pulmonary artery tension. However, the conclusions of existing clinical studies were inconsistent.

Objective:

This meta-analysis is aimed to determine whether the inhalation of NO could improve oxygenation and reduce rate of death and use of extracorporeal membrane oxygenation (ECMO).

Methods:

The strategies used to search PubMed, The Cochrane Central Register of Controlled trials in the Cochrane Library, Embase, Web of science, Clinical Trials Registry, and China Biology Medicine disc, from inception to February, 2018. The primary outcomes were death or use of ECMO, death before hospital discharge, use of ECMO before hospital discharge, change in PaO2 after treatment. We assess the risk of bias in each included study by Cochrane Handbook, and calculated typical estimates of RR, each with its 95% CI, and for continuous outcomes, WMD or a summary estimate for SMD, each with its 95% CI.

Results:

Nine randomized controlled trials (RCTs) with a total of 856 participants were included in this meta-analysis. This meta-analysis revealed that the experimental group had significantly lower death or use of ECMO (RR 0.66, 95% CI 0.57–0.77, I
2 = 0%, P < .00001) and lower use of ECMO before hospital discharge (RR 0.89, 95% CI 0.50–0.71, I
2 = 0%, P < .00001) compared to control group. And in the infants without diaphragmatic hernia, experimental group had significantly higher change in PaO2 after treatment (MD 50.40, 95% CI 32.14–68.66, P < .00001). The meta-analysis also showing a tendency to improve in the death before hospital discharge (RR 0.89, 95% CI 0.60–1.31, I
2 = 0%, P = .55) and the change in PaO2 after treatment of the infants with diaphragmatic hernia (MD 6.70, 95% CI −2.32 to 15.72, P < .00001, P = .15), but no difference between experimental group and control group.

Conclusion:

We found that NO inhalation can improve oxygenation and reduce rate of death and use of ECMO in this meta-analysis. Therefore, we recommend the use of NO inhalation for infants born at or near term with respiratory failure.
Type 2 myocardial infarction in general medical wards
Authors: Furie Nadav , Israel Ariel , Gilad Lee , Neuman Gil , Assad Fadia , Ben-Zvi Ilan , Grossman Chagai
Published: October 2019

Type 2 myocardial infarction (MI) is defined as myocardial necrosis due to imbalance between myocardial oxygen supply and demand. The objective of this study was to assess the features, treatments, and outcomes of patients with type 2 MI in comparison with patients with type 1 MI hospitalized in general medical wards. A retrospective review was performed on patients admitted to general medicine wards diagnosed with MI in Sheba Medical Center between January 1, 2016 and December 31, 2016. Comparative analysis between patients with type 1 and type 2 MI was performed. The study included 349 patients with type 1 MI and 206 patients with type 2 MI. The main provoking factors for type 2 MI were sepsis (38.1%), anemia (29.1%), and hypoxia (23.8%). Patients with type 2 MI were older (79.1 ± 11.9 vs 75.2 ± 11.7, P < .001) and had a lower rate of prior MI (23.3% vs 38.1%, P < .001) and percutaneous coronary intervention (PCI) (34% vs 48.7%, P = .023) compared with patients with type 1 MI. Patients with type 2 MI were significantly less prescribed antiplatelet therapy (79.1% vs 96%, P < .001) and statins (60.7% vs 80.2%, P < .001), and were less referred to coronary angiography (10.7% vs 54.4%, P < .001). Type 2 MI was associated with a significantly higher 1-year mortality rate compared with type 1 MI (38.8% vs 26.6%, P = .004), but after accounting for age and sex differences, this association lacked statistical significance. In conclusion, type 2 MI patients were older and had similar comorbidities compared with those with type 1 MI. These patients were less prescribed medical therapy and coronary intervention, and had a higher 1-year mortality rate. Establishing a clear therapeutic approach for type 2 MI is required.
Midazolam anaphylaxis during general anesthesia
Authors: Jeon Yeon Su , Shim JinWoo , Jun Eun Hwa , Choi Seung Tae , Jung Hong Soo
Published: October 2019

Rationale:

Midazolam is known as a safe drug and is widely used as a sedative and an anesthetic adjuvant. Therefore, there is a lack of awareness that midazolam can cause anaphylaxis. Midazolam anaphylaxis is rare, and only a few cases have been reported, but such a risk is always present. In this study, we report a case of midazolam anaphylaxis by an intravenous injection, in the prone position, during general anesthesia.

Patient concerns:

A 62-year-old woman was intravenously administered 1 mg midazolam during general anesthesia, and sudden severe hypotension, bronchospasm, decreased oxygen saturation, erythema, and diarrhea occurred.

Diagnosis:

Midazolam anaphylaxis was presumptively diagnosed by clinical symptoms and was confirmed by an intradermal test after 9 weeks.

Interventions:

The patient was treated with 100% oxygen, large volume of fluid, epinephrine, phenylephrine, ephedrine, dexamethasone and prednisolone, ranitidine, and flumazenil.

Outcomes:

Severe hypotension and decreased oxygen saturation were resolved within 20 minutes of the onset of anaphylaxis, and the patient was discharged after 3 days without any sequelae.

Lessons:

Midazolam anaphylaxis is very rare, but it can happen always. Therefore, the possibility of anaphylaxis due to midazolam should be considered and always be prepared for treatment.
Open ligamentous complex disruption of the lateral ankle without dislocation or fracture
Authors: Chun Dong-Il , Kim Jahyung , Won Sung Hun , Yi Young , Kim Yong-Been , Cho Jaeho
Published: October 2019

Introduction:

Lateral ligamentous complex injury without fracture or dislocation is rare in the literature. Due to the rare injury, it is not clear yet about the proper treatment. This case report suggests a specific diagnosis of this injury as well as an appropriate surgical method.

Patient concerns:

In one-month period of time, 2 male soldiers participating in recreational basketball game presented with open wound on the lateral aspect of ankle without associated dislocation or fracture when they attempted to rebound the ball which consequently made them land on another player's foot.

Diagnosis:

Total rupture of the lateral ligament complex with open wound was found without any associated fracture or dislocation.

Interventions:

Open repair of the ruptured ligaments and capsule was performed.

Outcomes:

Patients returned to his own job's duty with none to minimal limitation in sport and activities of daily living at 9 to 10 months after the injury.

Conclusion:

Although open disruption of the lateral ligamentous complex without fracture or dislocation is rare, an adequate assessment and prompt surgical repair led to satisfactory outcome.
Microtia epigenetics
Authors: Chen Xia , Zhang Ruhong
Published: October 2019

Introduction:

Microtia is a congenital malformation of the external and middle ear caused by the abnormal development of the first and second zygomatic arch and the first sulcus. There is currently no consensus concerning the pathogenesis and etiology of microtia; genetic and environmental factors may play a role. Gene-based studies have focused on finding the genes that cause microtia and on gene function defects. However, no clear pathogenic genes have so far been identified. Microtia is multifactorial; gene function defects cannot completely explain its pathogenesis. In recent years, the epigenetic aspects of microtia have begun to receive attention.

Conclusions:

Analysis of the existing data suggests that certain key genes and pathways may be the underlying cause of congenital microtia. However, further exploration is needed.
Sex-specific association of monocyte count to high-density lipoprotein ratio with SYNTAX score in patients with suspected stable coronary artery disease
Authors: Xu Weifeng , Guan Haiwang , Gao Da , Pan Jingnan , Wang Zicheng , Alam Mahboob , Lian Jiangfang , Zhou Jianqing
Published: October 2019

Recently, the monocyte count to high-density lipoprotein cholesterol ratio (MHR) was found to be associated with the SYNTAX score in patients with both stable coronary artery disease (CAD) and acute coronary syndrome (ACS). The MHR was significantly higher in male patients. However, the sex-specific association of MHR with SYNTAX score in stable CAD was not well explored. Thus, the present study aimed to investigate the association of MHR and presence and severity of CAD evaluated by coronary angiography and the SYNTAX score in males and females.

In total, 873 patients who received selective coronary angiography between March 2017 and July 2018 were included in the present study. Patients were divided into 3 groups according to MHR tertiles. The MHR was calculated by dividing the monocyte count by the high-density lipoprotein cholesterol level. CAD was defined as at least 50% diameter stenosis of a major coronary artery, including the right coronary, left main coronary, left anterior descending, and left circumflex arteries. The SYNTAX score was calculated by 2 experienced interventional cardiologists. SYNTAX score ≥23 was defined as a high SYNTAX score.

Males showed a significantly higher MHR (12.2 [8.9–15.5] vs 9.3 [6.2–12.1], P < .001), accompanied by a higher prevalence of CAD (68.1% vs 53.4%, P < .001). Male sex remained an independent predictor of elevated MHR after correction for confounding factors (adjusted odds ratio [OR] 3.102, P = .001). The association between MHR and SYNTAX score was confirmed only in male stable patients with CAD (r = 0.113, P = .036). Multivariate logistic regression analysis showed that MHR was an independent predictor of SYNTAX score ≥23 only in male patients with CAD. The receiver-operating characteristic curve showed a predictive value of MHR for high SYNTAX score only in males.

A higher MHR in males and a positive correlation of MHR with SYNTAX score were observed only in male stable patients with CAD. Such an easily obtained index may help interventional cardiologists detect high-risk patients before coronary catheterization, but its application may be restricted to males.
A case report of pelviscopic resection of invasive hydatidiform mole
Authors: Lee Hyun Joo , Kim Yun Sook
Published: October 2019

Rationale:

Invasive moles occur in the fertile period, with about 95% occurring after previous mole removal and the remaining 5% occurring after several other pregnancies.

Patient concerns:

A 27-year-old patient developed a rare invasive mole two months after a missed abortion.

Diagnoses:

A transvaginal ultrasound scan revealed a 3.6 × 2.9 × 2.4 cm sized lesion with cystic vascular areas within it, within the myometrium of the right fundal posterior region of the uterus. There was no metastasis to other organs.

Interventions:

After administration of methotrexate, the level of beta-human chorionic gonadotropin (ß-hCG) was elevated and liver enzymes were also markedly elevated. She wanted to retain fertility for future pregnancies. After laparoscopic removal of the myometrial invasive mole, the incision site was sutured with a 3-0 V-LocTM.

Outcomes:

One year later, a natural pregnancy occurred and a cesarean section was performed at 36 weeks.

Lessons:

This is the first reported case of its type. Our case demonstrated that pelviscopic removal of an invasive mole is possible if there are no other metastases, and that future pregnancy and childbirth are still feasible in women of reproductive age.
Detection and management of atypical femur fractures
Authors: Divan Vidita , Rao Sudhaker D. , Dhaliwal Ruban
Published: October 2019

Purpose of review

This article summarizes the risk factors for atypical femur fractures (AFF), discusses current and emerging imaging modalities for early identification of AFF, and offers recommendations for prevention and management of AFFs based on the current concepts.

Recent findings

Antiresorptive therapies are widely recommended for prevention and treatment of osteoporosis. Despite their well established effectiveness to reduce fracture risk, emerging concerns related to potential adverse effects have led to a substantial decline in the use of bisphosphonates. Although, the pathogenesis of AFF has not yet been elucidated, the bulk of evidence supports that the well known therapeutic benefits of bisphosphonate far outweigh the relatively low risk of AFFs. Recommendations for early identification of patients at risk for AFF using radiographic imaging have been established. Consensus on the management of AFF and osteoporosis in patients with AFF needs to be formulated.

AFF is a rare event associated with long-term bisphosphonate therapy, which represents an apparent paradox in the management of osteoporosis. Improved understanding of pathogenetic mechanisms will be helpful in further refining of screening guidelines and standardization of management and treatment strategies.
What is the Outcome of Patients Affected by Intraductal Papillary Mucinous Neoplasms Without High-Risk Stigmata?
Authors: Ricci Claudio , Ingaldi Carlo , Migliori Marina , Pagano Nico , Santini Donatella , Alberici Laura , Serra Carla , Calculli Lucia , Di Marco Mariacristina , Minni Francesco , Casadei Riccardo
Published: October 2019

Objectives

The objectives of the study were to define the natural history of intraductal papillary mucinous neoplasms (IPMNs) without high-risk stigmata (HRS) and to identify factors capable of influencing outcome and management.

Methods

This is a retrospective study of patients affected by IPMNs without HRS. Survival analyses included overall survival, disease-specific survival, and years of life lost. Uni- and multivariate analyses were carried out to identify factors capable of predicting years of life lost.

Results

Three hundred fifty-six patients were analyzed. Fifty-three patients (14.9%) died: no postoperative mortality, 6 (1.7%) patients from pancreatic cancer and 47 (13.2%) from reasons not related to the disease. Mean overall survival and disease-specific survival were 199.4 (SD, 16.6) and 281 months (SD, 6.9), respectively. The years of life lost of the sample observed with respect to the general population were 2 years and 3 months (15 years and 3 months vs 17 years and 6 months). Younger age, length of follow-up more than 3 years, and surgery significantly increased the years of life lost.

Conclusions

The patients affected by IPMNs without HRS rarely died from the disease. Young age (<65 years) and follow-up more than 3 years seemed to be the only factors capable of influencing the outcome and management.
Standardization of Reading Charts: A Review of Recent Developments
Authors: Radner Wolfgang
Published: October 2019

This review gives an overview of the current status of standardization by statistical evaluation of reading charts. First begun only 20 years ago, the statistical evaluation of reading charts now reflects an increasing clinical and scientific interest in standardized, comparable, and reproducible reading charts.

For clinical or research purposes in human subjects, standardization of psychophysical tests and their test items by statistical evaluation is mandatory because it provides experimental control. Initial attempts at reading chart standardization were made by characterizing the test items, either in terms of a selection of unrelated words or in terms of sentences representing a constant number of characters, including spaces. As initiated by the RADNER Reading Charts, standardization of reading charts (and test items) by statistical evaluation has gained increasing clinical and scientific interest in the last two decades and has later also been applied to some of the other modern reading charts. A literature search was performed with respect to reading charts that (a) have been produced in accordance with the recommendations of the International Council of Ophthalmology (geometrical print size progression), (b) have been statistically analyzed, and/or (c) use clearly characterized test items (conceptually and statistically). These reading charts are as follows: the Bailey-Lovie Word Reading Charts, the Colenbrander Cards, the RADNER Reading Charts, the MNREAD Acuity Charts, the Smith-Kettlewell Reading Test (SKread Test), the C-Read Charts, and the Balsam Alabdulkader-Leat (BAL) Chart. The test items of these charts have been characterized either empirically or by statistical analysis and selection. The extent of the statistical evaluation of the reading charts varies. Despite their different methodological approaches, these reading charts represent an advancement that has made possible the useful comparison and reproducible evaluation of near visual performance.
The Impact of Exposure Therapy on Resting Heart Rate and Heart Rate Reactivity Among Active-Duty Soldiers With Posttraumatic Stress Disorder
Authors: Bourassa Kyle J. , Stevens Elizabeth S. , Katz Andrea C. , Rothbaum Barbara O. , Reger Greg M. , Norr Aaron M.
Published: October 2019

Objective

Posttraumatic stress disorder (PTSD) is linked to poor health, including cardiovascular disease. These effects may be a result of increased tonic cardiovascular function and cardiovascular reactivity. Despite PTSD’s negative health burden, relatively little is known about whether frontline treatments for PTSD may alleviate cardiovascular risk.

Methods

The current study was a secondary analysis of a larger intervention study of active-duty soldiers with PTSD (n = 104; mean [SD] age = 30.6 [6.7] years; 6% women) randomized to an exposure therapy—either prolonged exposure (PE) or virtual reality exposure (VRE)—or a waitlist control condition. We examined change in participants’ resting heart rate (HR) and HR reactivity from baseline (before randomization) to midtreatment and posttreatment using residualized change regression models.

Results

The results of the study demonstrated decreased resting HR (B = −5.06, p = .024) and HR reactivity (B = −2.46, p = .005) from baseline to posttreatment of PE and VRE relative to waitlist. Exploratory analyses found that changes in resting HR and HR reactivity were not significantly correlated with either self-reported or clinician-rated PTSD symptom change.

Conclusions

These results suggest that PE and VRE for PTSD may alleviate some cardiovascular health risk associated with PTSD, improving cardiovascular functioning.

RCT Registration:
ClinicalTrials.gov (identifier: NCT01193725).
Implementation of nursing process in Ethiopia and its association with working environment and knowledge: a systematic review and meta-analysis
Authors: Shibabaw Wondimeneh , Asmare Yared , Yirga Tadesse , Dargie Abate
Published: October 2019

Background

Nursing Process is a scientific problem solving approach to direct nurses in caring for clients effectively and to improve quality of health care service. In Ethiopia, the national pooled prevalence of implementation of nursing process remains unknown. Hence, the objective of this systematic review and meta-analysis was to estimate the level of implementation of nursing process and it association with knowledge and working environment.

Methods

PubMed, Scopus, Cochrane Library, Google Scholar, PsycINFO and CINAHL were systematically searched online to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. To investigate heterogeneity across the included studies, I2test was employed. Publication bias was examined using funnel plot and Egger’s regression test statistic. The random-effect model was fitted to estimate the summary effects, and odds ratios (ORs). All statistical analysis was done using STATA version 14 software for windows.

Results

Seven studies which comprises of 1,268 participants were included in this meta-analysis. The estimated pooled prevalence of implementation of nursing process in Ethiopia was 42.44% (95% CI (36.91, 47.97%)). Based on the subgroup analysis, the highest implementation of nursing process was observed sample size greater than or equals to two hundred, 44.69% (95% CI: 35.34, 54.04). Nurses who have been work in the stressful environment [(OR 0.41, 95%CI (0.08, 2.12)] and having good knowledge about nursing process [(OR 2.44, 95%CI (0.34,17.34)] was not significant associated with the implementation of nursing process.

Conclusion

The overall implementation of nursing process in Ethiopia is relatively low. Nurses who have been work in the stressful environment have less likely implement nursing process. On the other hand, Nurses who had good knowledge on nursing process were more likely to implement nursing process. Therefore, policymakers (FMOH) and other concerned body need give special attention to improve the implementation of nursing process.
Clinical Impact of Metagenomic Next-Generation Sequencing of Plasma Cell-Free DNA for the Diagnosis of Infectious Diseases: A Multicenter Retrospective Cohort Study
Authors: Hogan Catherine A. , Yang Shangxin , Garner Omai B. , Green Daniel A. , Gomez Carlos A. , Bard Jennifer Dien , Pinsky Benjamin A. , Banaei Niaz
Published: October 2019

Background

Metagenomic next-generation sequencing (mNGS) of plasma cell-free DNA has emerged as an attractive diagnostic modality allowing broad-range pathogen detection, noninvasive sampling, and earlier diagnosis. However, little is known about its real-world clinical impact as used in routine practice.

Methods

We performed a retrospective cohort study of all patients for whom plasma mNGS (Karius test) was performed for all indications at 5 U.S. institutions over 1.5 years. Comprehensive chart review was performed, and standardized assessment of clinical impact of the mNGS based on the treating team’s interpretation of Karius results and patient management was established.

Results

A total of 82 Karius tests were evaluated, from 39 (47.6%) adults and 43 (52.4%) children and a total of 53 (64.6%) immunocompromised patients. Karius positivity rate was 50/82 (61.0%), with 24 (48.0%) showing two or more organisms (range, 2-8). The Karius test results led to positive impact in 6 (7.3%), negative impact in 3 (3.7%), no impact in 70 (85.4%), and was indeterminate in 3 (3.7%). Cases with positive Karius result and clinical impact involved bacteria and/or fungi but not DNA viruses or parasites. In 10 patients who underwent 16 additional repeated tests, only one was associated with clinical impact.

Conclusions

The real-world impact of the Karius test as currently used in routine clinical practice is limited. Further studies are needed to identify high-yield patient populations, define the complementary role of mNGS to conventional microbiological methods, and how best to integrate mNGS into current testing algorithms.

In a multicenter retrospective cohort study, we show that the real-world clinical impact of plasma metagenomic next-generation sequencing (mNGS) for the noninvasive diagnosis of infections is limited (positive impact 7.3%). Further studies are needed to optimize the impact of mNGS.
Stable neutralization of virulent bacteria using temperate phage in the mammalian gut
Authors: Hsu Bryan B. , Way Jeffrey C. , Silver Pamela A.
Published: October 2019

Elimination or alteration of select members of the gut microbiota is key to therapeutic efficacy. However, the complexity of these microbial inhabitants makes it challenging to precisely target bacteria without unexpected cascading effects. Here, we use bacteriophage to deliver exogenous genes to specific bacteria by genomic integration of temperate phage for long-lasting modification. As a real-world therapeutic test, we engineered λ phage to transcriptionally-repress shigatoxin by using genetic hybrids between λ and other lambdoid phages to overcome resistance encoded by the virulent prophage derived from enterohemorrhagicE. coli. We show that a single dose of engineered phage propagates throughout the bacterial community and reduces shigatoxin production in an enteric mouse model of infection without markedly affecting bacterial concentrations. We thus minimize the selection for resistance by relying on anti-virulence and not anti-bacterial action. Our work reveals a new framework for transferring functions to bacteria within their native environment.
A global indicator of the capacity of terrestrial ecosystems to retain biological diversity under climate change: the Bioclimatic Ecosystem Resilience Index
Authors: Ferrier Simon , Harwood Thomas D , Ware Chris , Hoskins Andrew J
Published: October 2019

An important element of the Convention on Biological Diversity’s Aichi Target 15 – i.e. to enhance “ecosystem resilience … through conservation and restoration” – remains largely unaddressed by existing indicators. We here develop an indicator addressing just one of many possible dimensions of ecosystem resilience, by focusing on the capacity of ecosystems to retain biological diversity in the face of ongoing, and uncertain, climate change. The Bioclimatic Ecosystem Resilience Index (BERI) assesses the extent to which a given spatial configuration of natural habitat will promote or hinder climate-induced shifts in biological distributions. The approach uses existing global modelling of spatial turnover in species composition within three broad biological groups (plants, invertebrates and vertebrates) to scale projected changes in composition under a plausible range of climate scenarios. These projections serve as filters through which to analyse the configuration of habitat observed at a given point in time (e.g. for a particular year) – represented as a grid in which cells are scored in terms of habitat condition. BERI is then calculated, for each cell in this grid, as a function of the connectedness of that cell to areas of natural habitat in the surrounding landscape which are projected to support a similar composition of species under climate change to that currently associated with the focal cell. All analyses are performed at 30-arcsecond grid resolution (approximately 1km cells at the equator). Results can then be aggregated to report on status and trends for any desired set of reporting units – e.g. ecoregions, countries, or ecosystem types. We present example outputs for the Moist Tropical Forest Biome, based on a habitat-condition time series derived from the Global Forest Change dataset. We also describe how BERI is now being extended to cover all biomes (forest and non-forest) across the entire terrestrial surface of the planet.
Testicular toxicity following chronic codeine administration is via oxidative DNA damage and up-regulation of NO and caspase 3
Authors: Akhigbe RE , Ajayi A.F
Published: October 2019

Background

Codeine, a 3-methylmorphine, and other related opioids have been implicated in androgen suppression, although the associated mechanisms remain unclear.

Aim

Therefore, the objective of the current study was to elucidate the in vivo molecular mechanisms underlying codeine-induced androgen suppression.

Methods

This study made use of Twenty-one healthy male rabbits, distributed into three groups randomly, control and codeine-treated groups. The control had 1ml of normal saline dailyp.o. The codeine-treated groups received either 4mg/kg b.w of codeine or 10mg/kg b.w of codeinep.o. for six weeks. Reproductive hormonal profile, testicular weight, enzymes, oxidative and inflammatory parameters, histological examination and apoptosis marker were evaluated to examine the effects of codeine use.

Key findings

Oral administration of codeine resulted in testicular atrophy and alterations in testicular histomorphology, elevated testicular enzymes, and suppression of circulatory and intra-testicular testosterone. These changes were associated with a marked rise in oxidative markers, including oxidative DNA damage, inflammatory response, and caspase-dependent apoptosis.

Significance

In conclusion, chronic codeine use resulted in testicular degeneration and testosterone suppression, which may be attributable to nitric oxide-/oxidativestress-mediated caspase-dependent apoptotic testicular cell death.
Tertiary education and innovation in the Greater Bay Area
Authors: Chow Man-Kong , Hua Jingbo , Hung Wing-Lok
Published: October 2019

Purpose

The purpose of this paper is to discuss the necessity of tertiary education in promoting innovations of the Guangdong-Hong Kong-Macau Greater Bay Area by using cases from other well-developed bay areas.

Design/methodology/approach

The paper used cases from bay areas of the USA and Japan to discover approaches that have been used to strengthen collaborations between tertiary education and industries by innovations.

Findings

This paper found that bay areas in the USA and Japan have adopted or developed various approaches to enhancing collaborations between tertiary education and industries. In the San Francisco Bay Area, the well-established knowledge transfer offices in universities help scholars to discover the commercial value of academic findings and help business in reverse. In New York Bay Area, big corporations built research institutes for universities with considerable findings. In Tokyo Bay Area, corporations and universities have developed various internship programs for different levels of students and also provide funds for universities to conduct research works.

Originality/value

This paper analysed approaches that using by other well-developed bay areas through real cases, and suggested that the Guangdong-Hong Kong-Macau Greater Bay Area should adopt these experiences in order to strengthen collaborations between tertiary education and industries to promote innovations.
Performing the performance assessment
Authors: Schmier Stephanie Anne
Published: October 2019

Purpose

In this paper, the author extends the current research on standardized performance assessments in preservice education by moving with novice teachers from their student teaching experiences into their first years as fully certified classroom teachers. Here, the author draws on scholarship that conceptualizes literacies as performative (Alexander, 2005; Youdell, 2010) to examine how engaging in a standardized performance assessment process shaped the teaching identities that participants carried into their first years of teaching in the field.

Design/methodology/approach

Through a qualitative case study, the author investigates the experiences of a group of six novice elementary educators in their first years in the classroom after completing the standardized performance assessment Educative Performance Assessment as a major component of their certification program. Data, which included focus group and individual interviews and artifacts (instructional handouts, teaching videos, lesson plans, written reflective commentaries), were analyzed through a performance lens.

Findings

Findings highlight how engaging with a standardized performance assessment shaped the meanings that participants made of their teaching practices, including lesson planning and implementation for and with students from diverse linguistic and cultural backgrounds.

Originality/value

This paper offers insights that can support teacher educators working toward preparing teachers for work with diverse students in public school classrooms that might produce more equitable policies, practices and transformative reforms, particularly for historically marginalized groups.
“United in diversity” public sector financial, statistical and budgetary reporting in the European Union
Authors: Tiron-Tudor Adriana , Nistor Cristina Silvia , Stefanescu Cristina Alexandrina
Published: October 2019

Purpose

The purpose of this paper is to approach, both theoretically and empirically, public sector reporting at European Union (EU) level. It contributes to the accounting harmonisation literature by revealing the actual status of governmental reporting at the national level.

Design/methodology/approach

The paper carried out an exploratory data analysis of the harmonisation of statistical, budgetary and financial reporting at the EU level. A mapping visualisation offers a comprehensive overview of the current state of connections between these reporting systems.

Findings

The results reveal the complexity of governments’ reporting systems homogeneity, although all stakeholders recognise the struggle for the principles of performance and transparency in the public sector. Thus, these are following the EU Commission’s study, which concludes that there is significant heterogeneity in the accounting and reporting practices applied transversely throughout all Member States.

Research limitations/implications

The relevance of the study is comprehensive, from the economic environment to the practitioners, from the international regulatory bodies to the national ones, all can assess and quantify the significance of the past, present and future changes, considering their needs. The limitations of the research regard the documentation background because uniformly accessing some information presented by the EU Member States is relatively tricky. Future research might focus on the effects of these changes as they occur.

Originality/value

The study contributes to the scientific literature in the public sector through a comprehensive, well-supported and statistically grounded analysis performed at EU level, able to provide reliable results and to support valuable future recommendations towards harmonised reporting. Moreover, it supports and encourages all national and international efforts for improving the comparability of financial, budgetary and aggregated statistical reports.
Effectiveness of education program on hospital waste management
Authors: Abdo Naglaa M. , Hamza Wafaa S. , Al-Fadhli Mariam A.
Published: October 2019

Purpose

The purpose of this paper is to assess the effectiveness of Kuwait Infection Control Directorate educational program in improving knowledge, attitude and practices (KAP) of environmental service workers (ESWs) regarding the management of infectious and sharps waste.

Design/methodology/approach

An interventional educational pre-test/post-test study was conducted over seven months, on a sample of 102 ESWs in Farwaniya General Government Hospital, Kuwait. Educational sessions and practical training using the KAP approach were applied during the intervention phase. The KAP of the participants were assessed using a questionnaire and observation checklist in the pre- and post-intervention phases.

Findings

Improvement in all aspects of the KAP regarding infectious and sharps waste management was observed among the participants after implementation of the intervention, with a statistically significant difference between pre- and post-test results (p<0.01).

Originality/value

The applied multi-component educational program in the current study can be successfully implemented for ESWs in all government hospitals in Kuwait and other countries with similar settings.