bluuebunny/crossref_metadata_2025 huggingface dataset:
Automatic extraction of cancer registry reportable information from free-text pathology reports using multitask convolutional neural networks
Authors: Alawad Mohammed , Gao Shang , Qiu John X , Yoon Hong Jun , Blair Christian J , Penberthy Lynne , Mumphrey Brent , Wu Xiao-Cheng , Coyle Linda , Tourassi Georgia
Published: August 2019

Objective

We implement 2 different multitask learning (MTL) techniques, hard parameter sharing and cross-stitch, to train a word-level convolutional neural network (CNN) specifically designed for automatic extraction of cancer data from unstructured text in pathology reports. We show the importance of learning related information extraction (IE) tasks leveraging shared representations across the tasks to achieve state-of-the-art performance in classification accuracy and computational efficiency.

Materials and Methods

Multitask CNN (MTCNN) attempts to tackle document information extraction by learning to extract multiple key cancer characteristics simultaneously. We trained our MTCNN to perform 5 information extraction tasks: (1) primary cancer site (65 classes), (2) laterality (4 classes), (3) behavior (3 classes), (4) histological type (63 classes), and (5) histological grade (5 classes). We evaluated the performance on a corpus of 95 231 pathology documents (71 223 unique tumors) obtained from the Louisiana Tumor Registry. We compared the performance of the MTCNN models against single-task CNN models and 2 traditional machine learning approaches, namely support vector machine (SVM) and random forest classifier (RFC).

Results

MTCNNs offered superior performance across all 5 tasks in terms of classification accuracy as compared with the other machine learning models. Based on retrospective evaluation, the hard parameter sharing and cross-stitch MTCNN models correctly classified 59.04% and 57.93% of the pathology reports respectively across all 5 tasks. The baseline models achieved 53.68% (CNN), 46.37% (RFC), and 36.75% (SVM). Based on prospective evaluation, the percentages of correctly classified cases across the 5 tasks were 60.11% (hard parameter sharing), 58.13% (cross-stitch), 51.30% (single-task CNN), 42.07% (RFC), and 35.16% (SVM). Moreover, hard parameter sharing MTCNNs outperformed the other models in computational efficiency by using about the same number of trainable parameters as a single-task CNN.

Conclusions

The hard parameter sharing MTCNN offers superior classification accuracy for automated coding support of pathology documents across a wide range of cancers and multiple information extraction tasks while maintaining similar training and inference time as those of a single task–specific model.
Usage of query-based health information exchange after event notifications
Authors: Vest Joshua R , Hilts Katy Ellis , Ancker Jessica S , Unruh Mark Aaron , Jung Hye-Young
Published: August 2019

Objectives

This study sought to quantify the association between event notifications and subsequent query-based health information exchange (HIE) use among end users of three different community health information organizations.

Materials and Methods

Using system-log data merged with user characteristics, regression-adjusted estimates were used to describe the association between event notifications and subsequent query-based HIE usage.

Results

Approximately 5% of event notifications were associated with query-based HIE usage within 30 days. In adjusted models, odds of query-based HIE usage following an event notification were higher for older patients and for alerts triggered by a discharge event. Query-based HIE usage was more common among specialty clinics and Federally Qualified Health Centers than primary care organizations.

Discussion and Conclusion

In this novel combination of data, 1 in 20 event notifications resulted in subsequent query-based HIE usage. Results from this study suggest that event notifications and query-based HIE can be applied together to address clinical and population health use cases.
Environmental Drivers of Questing Activity of Juvenile Black-Legged Ticks (Acari: Ixodidae): Temperature, Desiccation Risk, and Diel Cycles
Authors: Thomas Christina E , Burton Emily S , Brunner Jesse L
Published: August 2019

Vector feeding behavior can have a profound influence on the transmission of vector-borne diseases. In the case of black-legged ticks, Ixodes scapularis Say, which vectors the agents of Lyme disease, babesiosis, and other pathogens, the timing and propensity of questing can determine which hosts are fed upon as well as the risk of contact with humans. Yet we know little about the controls and constraints on tick host-finding behavior under natural conditions. Ticks must balance the need to quest for blood meal hosts with the risk of desiccation, all on a fixed energy budget. Prior research, primarily in the laboratory, has shown that questing activity varies with conditions (e.g., temperature, relative humidity), light-dark cycles, and energy reserves, but the findings have been idiosyncratic and the dominant factor(s) in nature remains unknown. We measured questing activity of nymphs and larvae throughout the day and night and over several weeks in enclosures across a range of suitable tick habitats within a site in the Northeast. Activity of nymphs increased slightly during dawn and dusk, opposite of larvae, and declined slightly with air temperature and rain, but these patterns were weak and inconsistent among replicate sites. Rather it appears a fraction of ticks were questing most of the time, regardless of conditions. Our study suggests neither climatic conditions or light-dark cycles have appreciable influence on tick questing behavior.
Integrative analysis of hexaploid wheat roots identifies signature components during iron starvation
Authors: Kaur Gazaldeep , Shukla Vishnu , Kumar Anil , Kaur Mandeep , Goel Parul , Singh Palvinder , Shukla Anuj , Meena Varsha , Kaur Jaspreet , Singh Jagtar , Mantri Shrikant , Rouached Hatem , Pandey Ajay Kumar
Published: August 2019

Iron (Fe) is an essential micronutrient for all organisms. In crop plants, Fe deficiency can decrease crop yield significantly; however, our current understanding of how major crops respond to Fe deficiency remains limited. Herein, the effect of Fe deprivation at both the transcriptomic and metabolic level in hexaploid wheat was investigated. Genome-wide gene expression reprogramming was observed in wheat roots subjected to Fe starvation, with a total of 5854 genes differentially expressed. Homoeologue and subgenome-specific analysis unveiled the induction-biased contribution from the A and B genomes. In general, the predominance of genes coding for nicotianamine synthase, yellow stripe-like transporters, metal transporters, ABC transporters, and zinc-induced facilitator-like protein was noted. Expression of genes related to the Strategy II mode of Fe uptake was also predominant. Our transcriptomic data were in agreement with the GC-MS analysis that showed the enhanced accumulation of various metabolites such as fumarate, malonate, succinate, and xylofuranose, which could be contributing to Fe mobilization. Interestingly, Fe starvation leads to a significant temporal increase of glutathione S-transferase at both the transcriptional level and enzymatic activity level, which indicates the involvement of glutathione in response to Fe stress in wheat roots. Taken together, our result provides new insight into the wheat response to Fe starvation at the molecular level and lays the foundation to design new strategies for the improvement of Fe nutrition in crops.
Evidence for Residual Immunity to Smallpox After Vaccination and Implications for Re-emergence
Authors: Kunasekaran Mohana Priya , Chen Xin , Costantino Valentina , Chughtai Abrar Ahmad , MacIntyre Chandini Raina
Published: August 2019

Introduction

Smallpox has been eradicated but advances in synthetic biology have increased the risk of its re-emergence. Residual immunity in individuals who were previously vaccinated may mitigate the impact of an outbreak, but there is a high degree of uncertainty about the duration and degree of residual immunity. Both cell-mediated and humoral immunity are thought to be important but the exact mechanisms of protection are unclear. Guidelines usually suggest vaccine-induced immunity wanes to zero after 3–10 years post vaccination, whereas other estimates show long term immunity over decades.

Materials and Methods

A systematic review of the literature was conducted to quantify the duration and extent of residual immunity to smallpox after vaccination.

Results

Twenty-nine papers related to quantifying residual immunity to smallpox after vaccination were identified: neutralizing antibody levels were used as immune correlates of protection in 11/16 retrospective cross-sectional studies, 2/3 epidemiological studies, 6/7 prospective vaccine trials and 0/3 modeling studies. Duration of protection of >20 years was consistently shown in the 16 retrospective cross-sectional studies, while the lowest estimated duration of protection was 11.7 years among the modeling studies. Childhood vaccination conferred longer duration of protection than vaccination in adulthood, and multiple vaccinations did not appear to improve immunity.

Conclusions

Most studies suggest a longer duration of residual immunity (at least 20 years) than assumed in smallpox guidelines. Estimates from modeling studies were less but still greater than the 3–10 years suggested by the WHO Committee on International Quarantine or US CDC guidelines. These recommendations were probably based on observations and studies conducted while smallpox was endemic. The cut-off values for pre-existing antibody levels of >1:20 and >1:32 reported during the period of endemic smallpox circulation may not be relevant to the contemporary population, but have been used as a threshold for identifying people with residual immunity in post-eradication era studies. Of the total antibodies produced in response to smallpox vaccination, neutralizing antibodies have shown to contribute significantly to immunological memory. Although the mechanism of immunological memory and boosting is unclear, revaccination is likely to result in a more robust response. There is a need to improve the evidence base for estimates on residual immunity to better inform planning and preparedness for re-emergent smallpox.
Constraining cold accretion on to supermassive black holes: molecular gas in the cores of eight brightest cluster galaxies revealed by joint CO and CN absorption
Authors: Rose Tom , Edge A C , Combes F , Gaspari M , Hamer S , Nesvadba N , Peck A B , Sarazin C , Tremblay G R , Baum S A , Bremer M N , McNamara B R , O’Dea C , Oonk J B R , Russell H , Salomé P , Donahue M , Fabian A C , Ferland G , Mittal R , Vantyghem A
Published: August 2019

To advance our understanding of the fuelling and feedback processes which power the Universe’s most massive black holes, we require a significant increase in our knowledge of the molecular gas which exists in their immediate surroundings. However, the behaviour of this gas is poorly understood due to the difficulties associated with observing it directly. We report on a survey of 18 brightest cluster galaxies lying in cool cores, from which we detect molecular gas in the core regions of eight via carbon monoxide (CO), cyanide (CN) and silicon monoxide (SiO) absorption lines. These absorption lines are produced by cold molecular gas clouds which lie along the line of sight to the bright continuum sources at the galaxy centres. As such, they can be used to determine many properties of the molecular gas which may go on to fuel supermassive black hole accretion and AGN feedback mechanisms. The absorption regions detected have velocities ranging from −45 to 283 km s−1 relative to the systemic velocity of the galaxy, and have a bias for motion towards the host supermassive black hole. We find that the CN N = 0 − 1 absorption lines are typically 10 times stronger than those of CO J  = 0 − 1. This is due to the higher electric dipole moment of the CN molecule, which enhances its absorption strength. In terms of molecular number density CO remains the more prevalent molecule with a ratio of CO/CN ∼10, similar to that of nearby galaxies. Comparison of CO, CN, and H i observations for these systems shows many different combinations of these absorption lines being detected.
A new possible accretion scenario for ultra-luminous X-ray sources
Authors: Kobayashi Shogo B , Nakazawa K , Makishima K
Published: August 2019

Using archival data from Suzaku, XMM–Newton, and NuSTAR, nine representative ultra-luminous X-ray sources (ULXs) in nearby galaxies were studied. Their X-ray spectra were all reproduced with a multicolour disc emission model plus its Comptonization. However, the spectral shapes of individual sources changed systematically depending on the luminosity, and defined three typical spectral states. These states differ either in the ratio between the Comptonizing electron temperature and the innermost disc temperature, or in the product of Compton y-parameter and fraction of the Comptonized disc photons. The luminosity range at which a particular state emerges was found to scatter by a factor of up to 16 among the eight ULXs. By further assuming that the spectral state is uniquely determined by the Eddington ratio, the sample ULXs are inferred to exhibit a similar scatter in their masses. This gives a model-independent support to the interpretation of ULXs in terms of relatively massive black holes. None of the spectra showed noticeable local structures. Especially, no Fe K-shell absorption/emission lines were detected, with upper limits of 30–40 eV in equivalent width from the brightest three among the sample: NGC 1313 X-1, Holmberg IX X-1, and IC 342 X-1. These properties disfavour ordinary mass accretion from a massive companion star, and suggest direct Bondi–Hoyle accretion from dense parts of the interstellar medium.
Polymerization retardation isothermal amplification (PRIA): a strategy enables sensitively quantify genome-wide 5-methylcytosine oxides rapidly on handy instruments with nanoscale sample input
Authors: Chen Danping , Wang Yang , Mo Mingming , Zhang Junjie , Zhang Yanfei , Xu Yuzhi , Liu Si-Yang , Chen Jun , Ma Yingjun , Zhang Li , Dai Zong , Cai Chun , Zou Xiaoyong
Published: August 2019

The current methods for quantifying genome-wide 5-methylcytosine (5mC) oxides are still scarce, mostly restricted with two limitations: assay sensitivity is seriously compromised with cost, assay time and sample input; epigenetic information is irreproducible during polymerase chain reaction (PCR) amplification without bisulfite pretreatment. Here, we propose a novel Polymerization Retardation Isothermal Amplification (PRIA) strategy to directly amplify the minute differences between epigenetic bases and others by arranging DNA polymerase to repetitively pass large electron-withdrawing groups tagged 5mC-oxides. We demonstrate that low abundant 5-hydroxymethylcytosine (5hmC), 5-formylcytosine (5fC) and 5-carboxycytosine (5caC) in genomic DNA can be accurately quantified within 10 h with 100 ng sample input on a laboratory real-time quantitative PCR instrument, and even multiple samples can be analyzed simultaneously in microplates. The global levels of 5hmC and 5fC in mouse and human brain tissues, rat hippocampal neuronal tissue, mouse kidney tissue and mouse embryonic stem cells were quantified and the observations not only confirm the widespread presence of 5hmC and 5fC but also indicate their significant variation in different tissues and cells. The strategy is easily performed in almost all research and medical laboratories, and would provide the potential capability to other candidate modifications in nucleotides.
Log-periodic quantum magneto-oscillations and discrete-scale invariance in topological material HfTe5
Authors: Wang Huichao , Liu Yanzhao , Liu Yongjie , Xi Chuanying , Wang Junfeng , Liu Jun , Wang Yong , Li Liang , Lau Shu Ping , Tian Mingliang , Yan Jiaqiang , Mandrus David , Dai Ji-Yan , Liu Haiwen , Xie Xincheng , Wang Jian
Published: August 2019

Discrete-scale invariance (DSI) is a phenomenon featuring intriguing log-periodicity that can be rarely observed in quantum systems. Here, we report the log-periodic quantum oscillations in the longitudinal magnetoresistivity (ρxx) and the Hall traces (ρyx) of HfTe5 crystals, which reveal the DSI in the transport-coefficients matrix. The oscillations in ρxx and ρyx show the consistent logB-periodicity with a phase shift. The finding of the logB oscillations in the Hall resistance supports the physical mechanism as a general quantum effect originating from the resonant scattering. Combined with theoretical simulations, we further clarify the origin of the log-periodic oscillations and the DSI in the topological materials. This work evidences the universality of the DSI in the Dirac materials and provides indispensable information for a full understanding of this novel phenomenon.
Models of Mental Health Triage for Individuals Coming to the Attention of the Police Who May Be Experiencing Mental Health Crisis: A Scoping Review
Authors: Park Alice , Booth Alison , Parker Adwoa J , Scantlebury Arabella , Wright Kath , Webber Martin
Published: August 2019

Police routinely encounter individuals experiencing mental distress, despite being ill-equipped to do so. Mental health triage aims to address these concerns. A range of approaches to triage has been introduced; however, no overview exists. We conducted a systematic scoping review of mental health triage co-responding schemes. Eleven databases were searched to identify the literature; each scheme was charted and described. Thirty-three studies describing 47 schemes were included. Intervention details were generally poorly reported, however, differences in personnel, training and information sharing were identified. There are multiple schemes in practice based on the co-responding model. Robust research into the cost and effectiveness of mental health triage is needed.
Patients With Greater Stroke Severity and Premorbid Disability Are Less Likely to Receive Therapist Consultations and Intervention During Acute Care Hospitalization
Authors: Capo-Lugo Carmen E , Askew Robert L , Naidech Andrew , Prabhakaran Shyam
Published: August 2019

Background

A substantial number of patients with stroke never receive acute care therapy services, despite the fact that therapy after stroke reduces the odds of death and disability and improves patients’ functioning.

Objective

The aim of this study was to estimate the proportion of and factors associated with receipt of therapist consultations and interventions during acute care hospitalization following ischemic and hemorrhagic stroke.

Design

This was a single-center longitudinal observational study.

Methods

Adults with a diagnosis of ischemic or hemorrhagic stroke (N = 1366) were enrolled during their hospitalization in an acute stroke center in a large metropolitan area. The main outcomes were receipt of therapist consultations, interventions, or both.

Results

Participants with acute hemorrhagic stroke (intracerebral: odds ratio [OR] = 0.34 [95% CI = 0.19–0.60]; subarachnoid: OR = 0.52 [95% CI = 0.28–0.99]) and with greater stroke severity by National Institutes of Health Stroke Scale (NIHSS) score (NIHSS score of > 15: OR = 0.34 [95% CI = 0.23–0.51]) were less likely to receive therapist consultations. Participants with moderate stroke severity (NIHSS score of 6–15: OR = 1.43 [95% CI = 1.01–2.33]) were more likely to receive therapy interventions. Those who were able to ambulate before admission were more than 5 times as likely to receive therapy interventions (OR = 5.08 [95% CI = 1.91–13.52]). Also, participants with longer lengths of stay (ie, more intensive care unit and non–intensive care unit days) were more likely to receive therapist consultations and interventions. Tests or procedures were the most common reasons for unsuccessful attempts to complete therapist consultations.

Limitations

Lack of operational and qualitative data prohibited detailed explorations of barriers to delivery of therapist consultations and interventions.

Conclusions

Approximately 1 in 4 participants with acute stroke received neither a consultation nor an intervention. Efforts to improve the delivery of acute care therapy services are needed to optimize care for these people.
How economics frames political debates: macroeconomic forecasting in the French planning commissions
Authors: Angeletti Thomas
Published: August 2019

This article analyzes how economics can frame political debates using economic policy devices. It examines the FIFI macroeconomic model’s introduction into the French planning processes of the mid-1960s and argues that economists perform two operations, selection and qualification, which play a key role in structuring political debates on the French economy’s future. Building on archives and in-depth interviews, I show how the FIFI model was a central component of the Sixth Plan (1971–1975): it was designed to produce simulations of state intervention in the French economy and organize planning commissions debates. Studying the struggles and controversies surrounding this model and the economic policies promoted by it, the article ultimately shows how certain political options are made publicly available while others are discarded.
Society of Behavioral Medicine Position Statement: Congress should protect immigrants seeking health care
Authors: Behrman Pamela , Fitzgibbon Marian , Buscemi Joanna , Sanchez-Johnsen Lisa , Laroche Helena , Yanez Betina , Gonzales Rubi , Gwede Clement K , Raja Sheela , Jacobson Lisette , Gil-Rivas Virginia , Tam-Ashing Kimlin
Published: August 2019

To protect the health of the immigrants, their families, their communities, and the general public, the Society of Behavioral Medicine joins other organizagtions in recommending Congress impose restrictions on ICE interventions in or around medical facilities.
Agricultural Management Affects Root-Associated Microbiome Recruitment Over Maize Development
Authors: Wattenburger Cassandra J. , Halverson Larry J. , Hofmockel Kirsten S.
Published: August 2019

Diversified cropping systems provide yield benefits that may result from enhanced nutrient availability via the root microbiome. We hypothesized that root-associated microbial communities in diversified and conventional systems would differ most during high plant nitrogen demand, reflecting microbiome-derived benefits, and that these effects would be greatest nearest the root. We compared maize bulk soil, rhizosphere, and rhizoplane prokaryotic and fungal communities in diversified and conventional systems at four plant developmental stages using amplicon sequencing. The greatest differences between systems in root-selected prokaryotic community composition occurred within the rhizoplane during vegetative stage 11 (high nitrogen demand). During this period, the rhizoplane of maize from the diversified, compared with the conventional, cropping system hosted higher abundances of bacteria implicated in complex organic matter decomposition (Verrucomicrobia and Acidobacteria). In contrast, fungal root-associated communities differed most between cropping systems during vegetative stage 4 (low nitrogen demand) and became more similar over time. Unexpectedly, prokaryotic rhizosphere communities, unlike rhizoplane communities, did not always differentiate from bulk soil communities, indicating value in differentiating between root compartments to understand root−microbiome−management interactions. For example, the diversified system rhizosphere and bulk soil prokaryotic communities were not well differentiated compared with the conventional system, indicating the possibility of a camouflage effect.
Fusarium Head Blight in Durum Wheat: Recent Status, Breeding Directions, and Future Research Prospects
Authors: Haile Jemanesh K. , N’Diaye Amidou , Walkowiak Sean , Nilsen Kirby T. , Clarke John M. , Kutcher Hadley R. , Steiner Barbara , Buerstmayr Hermann , Pozniak Curtis J.
Published: August 2019

Fusarium head blight (FHB) is a major fungal disease affecting wheat production worldwide. Since the early 1990s, FHB, caused primarily by Fusarium graminearum, has become one of the most significant diseases faced by wheat producers in Canada and the United States. The increasing FHB problem is likely due to the increased adoption of conservation tillage practices, expansion of maize production, use of susceptible wheat varieties in rotation, and climate variability. Durum wheat (Triticum turgidum sp. durum) is notorious for its extreme susceptibility to FHB and breeding for resistance is complicated because sources of FHB resistance are rare in the primary gene pool of tetraploid wheat. Losses due to this disease include yield, test weight, seed quality, food and feed quality, and when severe, market access. More importantly, it is the contamination with mycotoxins, such as deoxynivalenol, in Fusarium-infected durum kernels that causes the most serious economic as well as food and feed safety concerns. Several studies and thorough reviews have been published on germplasm development and breeding for FHB resistance and the genetics and genomics of FHB resistance in bread or common wheat (T. aestivum); however, similar reviews have not been conducted in durum wheat. Thus, the aim of this review is to summarize and discuss the recent research efforts to mitigate FHB in durum wheat, including quantitative trait locus mapping, genome-wide association studies, genomic prediction, mutagenesis and characterization of genes and pathways involved in FHB resistance. It also highlights future directions, FHB-resistant germplasm, and the potential role of morphological traits to enhance FHB resistance in durum wheat.
Comparative Proteomic Analysis of Plant–Pathogen Interactions in Resistant and Susceptible Poplar Ecotypes Infected with Botryosphaeria dothidea
Authors: Li Yongxia , Feng Yuqian , Lü Quan , Yan Donghui , Liu Zhenyu , Zhang Xingyao
Published: August 2019

Poplar are important forestry species in China, but the Botryosphaeria dothidea pathogen causes serious economic losses worldwide. To identify candidate B. dothidea resistance proteins and explore the molecular mechanisms involved in poplar–pathogen interactions, proteomic responses of stem samples from resistant and susceptible poplar ecotypes to B. dothidea were investigated using nanoflow liquid chromatography-tandem mass spectrometry with label-free quantitative analysis. We identified 588 proteins, divided into 21 biological process categories including 48 oxidoreductases, 72 hydrolytic enzymes, 80 metabolic enzymes, and 29 proteins of unknown function. Differential proteome analysis revealed large differences between resistant Populus tomentosa Carr and susceptible Populus beijingensis Hsu ecotypes before and after inoculation. Among 102 identified proteins, 22 were highly upregulated in the resistant genotype but downregulated in the susceptible genotype. Proteins induced in P. tomentosa Carr in response to B. dothidea are associated with plant defenses including oxidoreductase activity (catalase, isocitrate dehydrogenase, and superoxide dismutase), phenylpropanoid biosynthesis and phenylalanine metabolism (alcohol dehydrogenase), photosynthesis (ATP synthase subunit alpha, ATP synthase gamma chain, photosystem I P700 chlorophyll a apoprotein A2, photosystem II CP47 chlorophyll apoprotein), carbon fixation (pyruvate kinase, triosephosphate isomerase, malic enzyme, phosphoglycerate kinase, ribulose-1,5-bisphosphate carboxylase, and ribulose bisphosphate carboxylase small chain), and glycolysis/gluconeogenesis (fructose-bisphosphate aldolase). Kyoto Encyclopedia of Genes and Genomes pathway analysis identified 168 proteins related to metabolic pathways, 41 proteins related to the biosynthesis of phenylpropanoids, and 36 proteins related to the biosynthesis of plant hormones, the biosynthesis of alkaloids derived from ornithine, lysine, and nicotinic acid, and photosynthesis in response to B. dothidea. Our findings provide insight into plant–pathogen interactions in resistant and susceptible poplar ecotypes infected with B. dothidea and could assist the development of novel strategies for fighting poplar canker disease.
Growth hormone enhances the recovery of hypoglycemia via ventromedial hypothalamic neurons
Authors: Furigo Isadora C. , de Souza Gabriel O. , Teixeira Pryscila D. S. , Guadagnini Dioze , Frazão Renata , List Edward O. , Kopchick John J. , Prada Patricia O. , Jr. Jose Donato
Published: August 2019

Growth hormone (GH) is secreted during hypoglycemia, and GH‐responsive neurons are found in brain areas containing glucose‐sensing neurons that regulate the counter‐regulatory response (CRR). However, whether GH modulates the CRR to hypoglycemia via specific neuronal populations is currently unknown. Mice carrying ablation of GH receptor (GHR) either in leptin receptor (LepR)‐ or steroidogenic factor‐1 (SF1)‐expressing cells were studied. We also investigated the importance of signal transducer and activator of transcription 5 (STAT5) signaling in SF1 cells for the CRR. GHR ablation in LepR cells led to impaired capacity to recover from insulin‐induced hypoglycemia and to a blunted CRR caused by 2‐deoxy‐d‐glucose (2DG) administration. GHR inactivation in SF1 cells, which include ventromedial hypothalamic neurons, also attenuated the CRR. The reduced CRR was prevented by parasympathetic blockers. Additionally, infusion of 2DG produced an abnormal hyperactivity of parasympathetic preganglionic neurons, whereas the 2DG‐induced activation of anterior bed nucleus of the stria terminalis neurons was reduced in mice without GHR in SF1 cells. Mice carrying ablation of Stat5a/b genes in SF1 cells showed no defects in the CRR. In summary, GHR expression in SF1 cells is required for a normal CRR, and these effects are largely independent of STAT5 pathway.—Furigo, I. C., de Souza, G. O., Teixeira, P. D. S., Guadagnini, D., Frazão, R., List, E. O., Kopchick, J. J., Prada, P. O., Donato, J., Jr. Growth hormone enhances the recovery of hypoglycemia via ventromedial hypothalamic neurons. FASEB J. 33, 11909–11924 (2019). www.fasebj.org
NLN Core Competencies for Nurse Educators: Are They Present in the Course Descriptions of Academic Nurse Educator Programs?
Authors: Fitzgerald Ann , McNelis Angela M. , Billings Diane M.
Published: August 2019

AIM

As an initial approach to determining representation of the NLN Core Competencies for Nurse Educators in Master’s of Science in Nursing Education and Post-Master’s Certificate programs, the study identified the presence of the competencies in course descriptions.

BACKGROUND

The competencies are the gold standard to ensure academic nurse educators have the knowledge and skill to teach, assist learners, develop curricula, and implement effective evaluation methods.

METHOD

A descriptive design that applied web scraping techniques was used to collect data from school web pages, including course descriptions, credit hours, practica information, distance accessibility, and Certified Nurse Educator exam preparation.

RESULTS

Four competencies were well represented (≥85 percent), and four competencies were poorly represented (<50 percent) in a sample of 529 schools.

CONCLUSION

Programs should review courses and course descriptions for inclusion of all competency areas that prepare nurse educators and make revisions to address poorly represented competencies.
The multiple roles of mite allergens in allergic diseases
Authors: Vitiello Gianfranco , Biagioni Benedetta , Parronchi Paola
Published: August 2019

Purpose of review

Mites are the most worldwide spread allergens and relevant causative of respiratory allergies. Life cycle, component allergens, biological activity and immunogenicity are discussed in depth.

Recent findings

It is now known that mite allergens are able to stimulate the innate immune system through different receptors, for example, TLRs and PARs. The activation of the cells in the airway mucosa is followed by type 2 polarizing cytokine production in predisposed individuals. This complex network plays a pivotal role into the promotion of Th2 differentiation.

This is a comprehensive review regarding all the mite allergens known so far, including their location within dust mites, composition, biological activities and binding receptors relevant to the fate of the immunological response.
Antibiotic- and Fluid-Focused Bundles Potentially Improve Sepsis Management, but High-Quality Evidence Is Lacking for the Specificity Required in the Centers for Medicare and Medicaid Service’s Sepsis Bundle (SEP-1)*
Authors: Pepper Dominique J. , Sun Junfeng , Cui Xizhong , Welsh Judith , Natanson Charles , Eichacker Peter Q.
Published: August 2019

Objective:

To address three controversial components in the Centers for Medicare and Medicaid Service’s sepsis bundle for performance measure (SEP-1): antibiotics within 3 hours, a 30 mL/kg fluid infusion for all hypotensive patients, and repeat lactate measurements within 6 hours if initially elevated. We hypothesized that antibiotic- and fluid-focused bundles like SEP-1 would probably show benefit, but evidence supporting specific antibiotic timing, fluid dosing, or serial lactate requirements would not be concordant. Therefore, we performed a meta-analysis of studies of sepsis bundles like SEP-1.

Data Sources:

PubMed, Embase, ClinicalTrials.gov through March 15, 2018.

Study Selection:

Studies comparing survival in septic adults receiving versus not receiving antibiotic- and fluid-focused bundles.

Data Extraction:

Two investigators (D.J.P., P.Q.E.).

Data Synthesis:

Seventeen observational studies (11,303 controls and 4,977 bundle subjects) met inclusion criteria. Bundles were associated with increased odds ratios of survival (odds ratio [95% CI]) in 15 studies with substantial heterogeneity (I
2 = 61%; p < 0.01). Survival benefits were consistent in the five largest (1,697–12,486 patients per study) (1.20 [1.11–1.30]; I
2 = 0%) and six medium-sized studies (167–1,029) (2.03 [1.52–2.71]; I
2 = 8%) but not the six smallest (64–137) (1.25 [0.42–3.66]; I
2 = 57%). Bundles were associated with similarly increased survival benefits whether requiring antibiotics within 1 hour (n = 7 studies) versus 3 hours (n = 8) versus no specified time (n = 2); or 30 mL/kg fluid (n = 7) versus another volume (≥ 2 L, n = 1; ≥ 20 mL/kg, n = 2; 1.5–2 L or 500 mL, n = 1 each; none specified, n = 4) (p = 0.19 for each comparison). In the only study employing serial lactate measurements, survival was not increased versus others. No study had a low risk of bias or assessed potential adverse bundle effects.

Conclusions:

Available studies support the notion that antibiotic- and fluid-focused sepsis bundles like SEP-1 improve survival but do not demonstrate the superiority of any specific antibiotic time or fluid volume or of serial lactate measurements. Until strong reproducible evidence demonstrates the safety and benefit of any fixed requirement for these interventions, the present findings support the revision of SEP-1 to allow flexibility in treatment according to physician judgment.
Continuous Renal Replacement Therapy in Pediatric Severe Sepsis: A Propensity Score-Matched Prospective Multicenter Cohort Study in the PICU
Authors: Miao Huijie , Shi Jingyi , Wang Chunxia , Lu Guoping , Zhu Xiaodong , Wang Ying , Cui Yun , Zhang Yucai
Published: August 2019

Objectives:

Continuous renal replacement therapy becomes available utilization for pediatric critically ill, but the impact of mortality rate in severe sepsis remains no consistent conclusion. The aim of the study is to assess the effect of continuous renal replacement therapy in pediatric patients with severe sepsis and the impact this therapy may have on their mortality.

Design:

Propensity score-matched cohort study analyzing data prospectively collected by the PICUs over 2 years (2016–2018).

Setting:

Four PICUs of tertiary university children’s hospital in China.

Patients:

The consecutive patients with severe sepsis admitted to study PICUs were enrolled from July 2016 to June 2018.

Interventions:

The patients were divided into the continuous renal replacement therapy group and the conventional (noncontinuous renal replacement therapy) group.

Measurements and Main Results:

A total of 324 patients with severe sepsis were enrolled. The hospital mortality rate was 35.6% (64/180) in the continuous renal replacement therapy group and 47.9% (69/144) in the noncontinuous renal replacement therapy group. After propensity score adjustment, the hospital mortality rate was 21.3% (29/136) in the continuous renal replacement therapy group and 32.4% (44/136) in the noncontinuous renal replacement therapy group. In subgroup analysis, the relative risk of dying was 0.447 (95% CI, 0.208–0.961) only in patients complicated by acute respiratory distress syndrome (p = 0.037), but not in patients with shock, acute kidney injury, acute liver dysfunction, encephalopathy, and fluid overload greater than 10%. The mean duration of continuous renal replacement therapy was 45 hours (26–83 hr) with an ultrafiltration rate of 50 mL/kg/hr. The level of interleukin-6 was decreased, and the percent of natural killer cells (%) was improved in the continuous renal replacement therapy group compared with the noncontinuous renal replacement therapy group. Furthermore, continuous renal replacement therapy was an independently significant risk factor for hospital mortality in pediatric patients with severe sepsis, and the interval between continuous renal replacement therapy initiation and PICU admission was an independent risk factor for hospital mortality in patients receiving continuous renal replacement therapy.

Conclusions:

Continuous renal replacement therapy with an ultrafiltration rate of 50 mL/kg/hr decreases hospital mortality rate in pediatric severe sepsis, especially in patients with acute respiratory distress syndrome.
Behavior Problems in Physically Ill Children in Rwanda
Authors: Rukabyarwema Jean Paul , McCall Natalie , Ngambe Tharcisse , Kanyembari Xavier Butoto , Needlman Robert
Published: August 2019

Objectives:

Childhood behavior problems are underidentified in low- and middle-income countries. This study sought to systematically screen for behavior problems among children receiving medical care in Rwanda and investigate factors associated with behavior problems in this cohort.

Methods:

The Pediatric Symptom Checklist (PSC) was translated into Kinyarwanda, following best practices. Children aged 5.9 to 16 years admitted to the inpatient ward of a referral hospital or seen in the outpatient department (OPD) were screened using the PSC. All PSC-positive children and every third PSC-negative child were referred for definitive assessment by a child mental health specialist.

Results:

Among 300 eligible children, 235 were recruited; none refused. PSC scores were positive in 74 of 234 cases (32%, 95% confidence interval 26%–38%); a total of 28 of 74 (40%) PSC-positive children completed mental health assessments. Of these, 16 (57% of those assessed, and 7% of the 235 who were screened) required treatment or further assessment; none of the PSC-negative children did. Screening sensitivity was 100%, and specificity was 71%, with favorable receiver operating characteristics curve and internal consistency. In a multivariate analysis, higher PSC scores were associated with OPD care, central nervous system trauma or infection, and indices of malnutrition and with the use of traditional, complementary, and alternative medicine (TCAM).

Conclusion:

Behavior problems are common among Rwanda children seen in a referral hospital, particularly in the OPD, and are associated with use of TCAM. The Kinyarwanda PSC showed favorable screening characteristics and resulted in some 7% of children accessing needed mental health care.
Clinical Properties and Risk Factors for Descemet Membrane Folds After Deep Anterior Lamellar Keratoplasty in Patients With Keratoconus
Authors: Li Xia , Zhao Yujin , Chen Huiyu , Li Yue , Hong Jiaxu , Xu Jianjiang
Published: August 2019

Purpose:

To report the clinical properties and risk factors for corneal Descemet membrane (DM) folds after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus.

Methods:

This is a retrospective case–control study. Study participants—experimental group: 44 eyes with DM folds after DALK; control group: 135 eyes without DM folds after DALK.

Results:

Forty eyes with DM folds were displayed as 1 or 2 translucent lines in the DM layer. Three eyes appeared as several arcuate shape lines, and 1 eye presented as a radial shape. DM folds impaired corrected visual acuity after DALK (P = 0.018). Age older than 20.5 years at surgery and disease duration longer than 5.5 years were independent risk factors for DM fold formation after DALK surgery (odds ratio 5.39, 95% confidence interval: 2.11–13.73, P < 0.001; 6.60, 95% confidence interval: 2.92–14.94, P < 0.001). Preoperative Kmean, Kmax, central corneal thickness, anterior chamber depth, sex, history of rigid gas permeable contact lens wearing, Vogt striae, stromal scar, and intraoperative microperforation had no influence on the occurrence of DM folds (P

1
= 0.775, P

2
= 0.896, P

3
= 0.555, P

4
= 0.182, P

5
= 0.656, P

6
= 0.237, P

7
= 1.000, P

8
= 0.587, and P

9
= 0.798).

Conclusions:

DM folds impaired postoperative corrected visual acuity. The risk factors for DM folds included age older than 20.5 years and disease duration longer than 5.5 years.
Differences in Meibum and Tear Lipid Composition and Conformation
Authors: Borchman Douglas , Ramakrishnan Varun , Henry Collin , Ramasubramanian Aparna
Published: August 2019

Purpose:

The compositional, structural, and functional relationships of meibum may provide insights into the loss of tear film stability. Although the conformation of meibum lipids has been studied rigorously, that of tear lipids has not.

Methods:

Tear lipids (TLHSCT) and meibum (MHSCT) from patients who had hematopoietic stem cell transplantation were pooled prospectively. The infrared spectra of meibum from donors with (MMGD) and without (Mn) meibomian gland dysfunction were retrospectively analyzed to measure the lipid composition and structure. The infrared CH stretching region was used to measure the relative content of CH3 and CH2 moieties in the meibum.

Results:

The 3 major findings of the current study are as follows: 1) compared with Mn, MHSCT and MMGD had 18% fewer CH3 moieties; 2) compared with MHSCT, the phase transition temperature, cooperativity, and order were approximately 20% greater for TLHSCT; and 3) compared with Mn and MMGD, MHSCT and TLHSCT contained fewer double bonds.

Conclusions:

Tear lipids are more ordered than meibum lipids, which could have functional consequences. The human meibum peak height ratio of the CH3/CH2 bands is not a factor related to tear film stability with age or sex. The amount of CH3 moieties relative to CH2 moieties and saturation could contribute to a higher meibum lipid order associated with a younger age, meibomian gland dysfunction, and dry eye from hematopoietic stem cell transplantation. Therefore, the hydrocarbon order may be a marker of or contribute to an unstable tear film layer.
Changes in the Matrix Metalloproteinase 9 Point-of-Care Test Positivity According to MMP-9 Concentration and Loading Volume
Authors: Huh Jungah , Choi Soo Youn , Eom Youngsub , Kim Hyo Myung , Song Jong Suk
Published: August 2019

Purpose:

To measure changes in the matrix metalloproteinase 9 (MMP-9) point-of-care test, InflammaDry (Rapid Pathogen Screening, Inc, Sarasota, FL) positivity, based on ocular surface MMP-9 concentrations and loading volume.

Methods:

Two different MMP-9 products, preform and active, were analyzed using the InflammaDry test, detecting MMP-9 levels of more than 40 ng/mL of both preform and active MMP-9. Preform MMP-9 (Natural human MMP-9 protein; Abcam, Cambridge, UK) was analyzed at different concentrations (50, 100, 500, 1000, and 1500 ng/mL) and loading volumes (5, 10, and 20 μL). Active MMP-9 (Human MMP-9 protein; Novus Biologicals, Littleton, CO) was also analyzed using the InflammaDry test at different concentrations (50 and 100 ng/mL) and loading volumes (10, 20, and 40 μL).

Results:

Natural human MMP-9 protein (preform) of 50, 100, and 500 ng/mL exhibited negative results for every loading volume. At 1000 ng/mL, the 20 μL volume was positive, whereas the 5 and 10 μL volumes were negative. At 1500 ng/mL, all loading volumes were positive, but the density of positive bands varied depending on the loading volume; larger loading volumes had higher band density. Human MMP-9 protein (active) of 50 ng/mL was negative for every loading volume. In 100 ng/mL, the 20 and 40 μL volumes showed positive results with similar positive band densities.

Conclusions:

The InflammaDry test had a different detection range depending on MMP-9 formulas; higher concentrations of preform MMP-9 protein were needed to yield positive results. In addition, InflammaDry positivity varied based on the loading volumes. Clinicians should be aware of the possibility of false negatives with low tear volumes despite elevated MMP-9 concentrations.
Orthostatic and Exertional Hypotension: Review and Implications for Physical Therapy
Authors: Sutter Jonathan R. , Matson Andrew W.
Published: August 2019

Physical therapy involves caring for patients at risk for experiencing abnormal hypotension that develops during upright activities or exercise. A patient experiencing an abnormal drop in blood pressure during physical therapy may be at increased risk for injury resulting from a fall or a syncopal event. Alternatively, the context of the drop in blood pressure may indicate that the patient may have an undiagnosed pathology that may need further medical workup. Therefore, an understanding of orthostatic hypotension and exertional hypotension is critical to the physical therapy clinician. An overview of these distinct forms of hypotension is provided, and implications for the practicing clinician are described. A case study of each condition has been incorporated to help the reader integrate the concepts presented into clinical practice.
Try-It-On: Preparing family nurse practitioners to use holistic integrative interventions to reduce opioid prescriptions in chronic pain management
Authors: Gregg S. Renee , Brown Angela , Pasvogel Alice
Published: August 2019

In the United States, more than 130 people die each day from an opioid overdose. Nonopioid chronic pain management options are necessary in primary care. This educational innovation describes a new curriculum to teach future family nurse practitioner (FNP) prescribers holistic integrative interventions to decrease overprescribing of opioids for chronic pain management. The Modeling and Role Modeling theory and Kirkpatrick Evaluation Model guided the development and implementation of the curriculum innovation using a Try-It-On teaching-learning strategy, which focuses on immersion experience. The focus was to teach students to communicate effectively with patients in an effort to increase patient awareness of the pathophysiology of pain, risks of opioid use, and holistic integrative pain management options. Students learned to manage chronic pain within a holistic focus through immersion within integrative modalities, such as yoga, meditation, mindfulness, and guided imagery. Pre and post participation evaluations documented students' increased comfort level managing patients with chronic pain. Students reported they were much more likely to prescribe holistic integrative modalities after completing the Try-It-On learning modules. Holistic integrative interventions are a viable treatment option and/or adjunct treatment for chronic pain management. In conclusion, using the Try-It-On, teaching-learning strategy provided FNP students with the tools needed to prescribe nonopioid holistic integrative interventions to manage chronic pain.