bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent Work in Early Modern Women’s Philosophy: Some Implications for the Canon
Authors: Broad Jacqueline
Published: July 2021

In this article, I critically examine a number of recent editions of philosophical works by early modern women. I argue that the proliferation of such texts is likely to have positive implications for the study of early modern philosophy. By taking a historical-contextualist approach to women’s writings, these editions contribute to the goal of a thorough, unbiased, and impartial account of early modern thought. Their accessibility and teachability also draw attention to historical-philosophical ideas, methods, and genres that could have worth and relevance today. Above all, these texts are valuable for helping to correct a one-sided, male-biased understanding of the philosophical past.
Molecular epidemiology of aspergillosis in Magellanic penguins and susceptibility patterns of clinical isolates
Authors: Melo Aryse Martins , Poester Vanice Rodrigues , Canabarro Paula Lima , Sampaio Daniel Ataíde , Stevens David A , Veríssimo Cristina , Sabino Raquel , Xavier Melissa Orzechowski
Published: July 2021

Aspergillus section Fumigati is reported in up to 99% of aspergillosis cases in penguins. So far, no data regarding molecular epidemiology and azole resistance are available for A. fumigatus isolates collected from Magellanic penguins. The aim of this work was to perform molecular identification of Aspergillus section Fumigati at species level, to genotype those isolates using microsatellite markers, to evaluate the in vitro susceptibility patterns of A. fumigatus sensu stricto, and to characterize the cyp51A gene in clinical A. fumigatus strains isolated from Magellanic penguins with proven aspergillosis. All 34 isolates included in the study were identified as A. fumigatus sensu stricto. Analyzing the genetic diversity of the isolates of A. fumigatus sensu stricto, we identified two possible outbreaks in the rehabilitation center and we also observed the maintenance of clonal strains through the years. One A. fumigatus sensu stricto isolate was resistant to posaconazole, but the mutations found in the cyp51A gene of this isolate have not been described as conferring phenotypic resistance, suggesting that other mechanisms of resistance could be involved in the resistance of this isolate. With this study, we were able to understand the molecular diversity of Aspergillus fumigatus isolates collected from Magellanic penguins, to characterize them and to associate them with the described global population of Aspergillus fumigatus.
Introducing SPHINX-MHD: the impact of primordial magnetic fields on the first galaxies, reionization, and the global 21-cm signal
Authors: Katz Harley , Martin-Alvarez Sergio , Rosdahl Joakim , Kimm Taysun , Blaizot Jérémy , Haehnelt Martin G , Michel-Dansac Léo , Garel Thibault , Oñorbe Jose , Devriendt Julien , Slyz Adrianne , Attia Mara , Teyssier Romain
Published: July 2021

We present the first results from SPHINX-MHD, a suite of cosmological radiation-magnetohydrodynamics simulations designed to study the impact of primordial magnetic fields (PMFs) on galaxy formation and the evolution of the intergalactic medium (IGM) during the epoch of reionization. The simulations are among the first to employ multifrequency, on-the-fly radiation transfer and constrained transport ideal MHD in a cosmological context to simultaneously model the inhomogeneous process of reionization as well as the growth of primordial magnetic fields. We run a series of $(5\, \text{cMpc})^3$ cosmological volumes, varying both the strength of the seed magnetic field and its spectral index. We find that PMFs with a spectral index (nB) and a comoving amplitude (B0) that have $\scriptstyle{n_B \gt -0.562\log _{10}\left(\frac{B_0}{1{\rm n}G}\right) - 3.35}$ produce electron optical depths (τe) that are inconsistent with CMB constraints due to the unrealistically early collapse of low-mass dwarf galaxies. For nB ≥ −2.9, our constraints are considerably tighter than the ∼nG constraints from Planck. PMFs that do not satisfy our constraints have little impact on the reionization history or the shape of the UV luminosity function. Likewise, detecting changes in the Ly α forest due to PMFs will be challenging because photoionization and photoheating efficiently smooth the density field. However, we find that the first absorption feature in the global 21-cm signal is a particularly sensitive indicator of the properties of the PMFs, even for those that satisfy our τe constraint. Furthermore, strong PMFs can marginally increase the escape of LyC photons by up to 25 per cent and shrink the effective radii of galaxies by $\sim 44{{\ \rm per\ cent}}$ which could increase the completeness fraction of galaxy surveys. Finally, our simulations show that surveys with a magnitude limit of ${\rm \mathit{ M}_{UV,1500\,\mathring{\rm A}}=-13}$ can probe the sources that provide the majority of photons for reionization out to z = 12.
MusE GAs FLOw and Wind (MEGAFLOW) VIII. Discovery of a Mgii emission halo probed by a quasar sightline
Authors: Zabl Johannes , Bouché Nicolas F , Wisotzki Lutz , Schaye Joop , Leclercq Floriane , Garel Thibault , Wendt Martin , Schroetter Ilane , Muzahid Sowgat , Cantalupo Sebastiano , Contini Thierry , Bacon Roland , Brinchmann Jarle , Richard Johan
Published: July 2021

Using deep ($11.2\, \rm{h}$) VLT/MUSE data from the MEGAFLOW survey, we report the first detection of extended $\rm{Mg\, \small {II}}$ emission from a galaxy’s halo that is probed by a quasar sightline. The $\rm{Mg\, \small {II}}\, \lambda \lambda \, 2796, 2803$ emission around the z = 0.702 galaxy ($\log (M_*/\rm{M_\odot })=10.05_{-0.11}^{+0.15}{}$) is detected out to $\approx 25\, \hbox{kpc}$ from the central galaxy and covers $1.0\times 10^3\, \hbox{kpc}^2$ above a surface brightness of $14\times 10^{-19}\, \rm{erg}\, \rm{s}^{-1}\, \rm{cm}^{-2}\, \rm{arcsec}^{-2}{}$ ($2\, \sigma$; integrated over $1200\, \rm{km\, s}^{-1}= 19\mathring{\rm A}$ and averaged over $1.5\, \rm{arcsec}^{2}$). The $\rm{Mg\, \small {II}}$ emission around this highly inclined galaxy (i ≃ 75 deg) is strongest along the galaxy’s projected minor axis, consistent with the $\rm{Mg\, \small {II}}$ gas having been ejected from the galaxy into a bi-conical structure. The quasar sightline, which is aligned with the galaxy’s minor axis, shows strong $\rm{Mg\, \small {II}}$ absorption ($\hbox{$EW_0^{\lambda 2796}$}{}=1.8{}\, \mathring{\rm A}$) at an impact parameter of $39{}\, \hbox{kpc}$ from the galaxy. Comparing the kinematics of both the emission and the absorption − probed with VLT/UVES − to the expectation from a simple toy model of a bi-conical outflow, we find good consistency when assuming a relatively slow outflow ($v_\rm{out}=130{}\, \rm{km\, s}^{-1}$). We investigate potential origins of the extended $\rm{Mg\, \small {II}}$ emission using simple toy models. With continuum scattering models we encounter serious difficulties in explaining the luminosity of the $\rm{Mg\, \small {II}}$ halo and in reconciling density estimates from emission and absorption. Instead, we find that shocks might be a more viable source to power the extended $\rm{Mg\, \small {II}}$ (and non-resonant $[\rm{O\, \small {II}}]$) emission.
An Ancient Clade of Penelope-Like Retroelements with Permuted Domains Is Present in the Green Lineage and Protists, and Dominates Many Invertebrate Genomes
Authors: Craig Rory J , Yushenova Irina A , Rodriguez Fernando , Arkhipova Irina R
Published: July 2021

Penelope-like elements (PLEs) are an enigmatic clade of retrotransposons whose reverse transcriptases (RTs) share a most recent common ancestor with telomerase RTs. The single ORF of canonical endonuclease (EN)+ PLEs encodes RT and a C-terminal GIY–YIG EN that enables intrachromosomal integration, whereas EN− PLEs lack EN and are generally restricted to chromosome termini. EN+ PLEs have only been found in animals, except for one case of horizontal transfer to conifers, whereas EN− PLEs occur in several kingdoms. Here, we report a new, deep-branching PLE clade with a permuted domain order, whereby an N-terminal GIY–YIG EN is linked to a C-terminal RT by a short domain with a characteristic CxC motif. These N-terminal EN+ PLEs share a structural organization, including pseudo-LTRs and complex tandem/inverted insertions, with canonical EN+ PLEs from Penelope/Poseidon, Neptune, and Nematis clades, and show insertion bias for microsatellites, but lack canonical hammerhead ribozyme motifs. However, their phylogenetic distribution is much broader. The Naiads, found in numerous invertebrate phyla, can reach tens of thousands of copies per genome. In spiders and clams, Naiads independently evolved to encode selenoproteins containing multiple selenocysteines. Chlamys, which lack the CCHH motif universal to PLE ENs, occur in green algae, spike mosses (targeting ribosomal DNA), and slime molds. Unlike canonical PLEs, RTs of N-terminal EN+ PLEs contain the insertion-in-fingers domain (IFD), strengthening the link between PLEs and telomerases. Additionally, we describe Hydra, a novel metazoan C-terminal EN+ clade. Overall, we conclude that PLE diversity, taxonomic distribution, and abundance are comparable with non-LTR and LTR-retrotransposons.
Electronic Nicotine Product Cessation and Cigarette Smoking: Analysis of Waves 3 and 4 From the PATH Study
Authors: Krishnan Nandita , Abroms Lorien C , Berg Carla J
Published: July 2021

Introduction

Identifying predictors of electronic nicotine product (ENP) cessation can inform ENP cessation interventions. High rates of cooccurring ENP and cigarette (dual) use and transitions between these products underscore the importance of considering cigarette smoking status when assessing and addressing ENP cessation.

Aims and Methods

We analyzed waves 3 (W3) and 4 (W4) of the Population Assessment of Tobacco and Health (PATH) study to identify (1) W3 socio-demographics, tobacco and ENP use characteristics, and psychosocial correlates of W3 cigarette smoking status (non-smoker, former, and current) among W3 adult ENP users, and (2) W3 predictors of W4 combined ENP and cigarette smoking abstinence relative to use of one or both products.

Results

At W3, 65.6% of ENP users concurrently smoked cigarettes. Adjusted multinomial regression results indicated that different W3 socio-demographics, tobacco and ENP use characteristics, and psychosocial correlates were significantly associated with distinct W3 cigarette use profiles. At W4, 9.9% of individuals were abstinent from both products. These individuals were less likely to: (1) be current smokers (vs. non-smokers) or be advised to quit using tobacco, compared with cigarette only or dual users, and (2) use ENPs daily or live in a household allowing ENP use, compared with ENP only or dual users (p < .05).

Conclusions

ENP cessation approaches need to be tailored to the distinct cigarette use profiles of ENP users. Dual users and daily ENP users may require more intensive interventions to achieve the cessation of both products. Supportive physical environments, such as home vape-free policies, may facilitate ENP cessation.

Implications

This analysis contributes to advancing the nascent literature on predictors of electronic nicotine product (ENP) cessation, which can guide the development of ENP cessation interventions by indicating which populations, psychosocial and environmental constructs, and cooccurring behaviors interventions should target. This research also highlights the importance of considering cigarette smoking status when designing ENP cessation interventions and defining intervention outcomes.
Fifteenth-Century Compilation Methods: The Case of Oxford, Trinity College, MS 29
Authors: Gillhammer Cosima Clara
Published: July 2021

The late-fifteenth-century Middle English manuscript Oxford, Trinity College, MS 29 contains a universal history of the world, compiled from diverse religious and secular texts. Written by a single compiler-scribe, the text offers an opportunity to examine in detail late medieval methods of compilation. One of the main sources used by the compiler is Caxton’s print of Ranulf Higden’s Polychronicon, thus allowing a detailed comparison with the printed source text. This article investigates the strategies which the compiler uses to copy, edit, and amend his sources, whilst integrating them into a new textual framework. Comprehensive collation reveals different ways of copying and revising the printed source text. The strategies used by the compiler range from close copying to extensive additions, substitutions, corrections, and omissions. A close analysis of these compilation methods allows conclusions not only about the compilatory process but also about the mindset behind the focus and features of the resulting new text. The results of this detailed case study of compilation strategies in Oxford, Trinity College, MS 29, reveal this text to be a case of detailed adaptation of sources to create a unified and consistent new textual whole, which is comparable to other late-medieval compilations but unusual in the meticulousness and complexity of its textual strategies.
A Model of Two Days: Discrete News and Asset Prices
Authors: Wachter Jessica A , Zhu Yicheng
Published: July 2021

Empirical studies demonstrate striking patterns in stock returns related to scheduled macroeconomic announcements. A large proportion of the total equity premium is realized on days with macroeconomic announcements. The relation between market betas and expected returns is far stronger on announcement days as compared with nonannouncement days. Finally, these results hold for fixed-income investments as well as for stocks. We present a model in which agents learn the probability of an adverse economic state on announcement days. We show that the model quantitatively accounts for the empirical findings. Evidence from options data provides support for the model’s mechanism.
Feasibility and efficacy estimate of an emotion-focused version of Cognitive Behavior Therapy (CBT-E) for delusions in comparison to wait list in a single-blinded randomized-controlled pilot trial
Authors: Mehl Stephanie , Hautmann Christopher , Nittel Clara Marie , Rief Winfried , Kircher Tilo , Lincoln Tania Marie
Published: July 2021

Background

Cognitive Behavior Therapy for psychosis (CBTp) effectively reduces positive symptoms, but the effects for delusions are small. Using approaches that focus on improving putative causal factors of delusions (emotion regulation (ER) and negative self-schemata) may be a way to improve CBTp for delusions.

Objectives

To pilot an emotion-focused CBTp intervention comprised of elements of different third wave approaches targeting ER and negative self-schemata (CBT-E) to investigate its feasibility and its potential efficacy.

Methods

A single-blind two-centered randomized wait-list controlled trial was performed. Patients with delusions in the context of a psychotic disorder (n=64) were randomized to CBT-E (treatment group (TG): n=35) or wait list (WL: n=29). TG received individual CBT-E in weekly sessions over six months, WL received CBT-E after a 6-months waiting time. Assessments were performed at baseline, after six months, and after 12 months.

Results

Rates of patients who consented and retained in CBT-E suggest acceptable feasibility and high acceptance of CBT-E. Multiple regression analysis in the intent-to-treat sample revealed no significant advantage in favor of TG in the primary outcome delusions (PSYRATS delusions), no effect on ER or negative self-schemata and a significant advantage in only one of the eight additional secondary outcome variables, namely general psychopathology.

Discussion

Although the intervention was feasible and acceptable, its effects on delusions did not hold up with the effects found for ‘targeted’ approaches in previous research and it needs to be improved to produce a stronger effect on the targets ER and self-schemata, before proceeding to a large-scale RCT.
Evaluation of Geranium Cultivars and Biorational Products to Control Botrytis Blight in the Greenhouse
Authors: Shrestha Sunil , Hausbeck Mary K.
Published: July 2021

Botrytis blight caused by the fungus Botrytis cinerea is an important disease of geranium, affecting leaves, stems, and flowers, and decreasing the crop’s marketability. Our objectives were to evaluate (i) susceptibility of geranium cultivars to B. cinerea and (ii) efficacy of biorational products for control of Botrytis blight on geranium. Disease assessment included the number of blighted leaves, foliar lesions, and leaves with B. cinerea sporulation. The area under the disease progress curve (AUDPC) was calculated. Among the 10 geranium cultivars evaluated, ‘Pinto Premium Orange’, ‘Horizon Coral Spice’, and ‘Ivy Tornado White’ had significantly less disease than ‘Ringo 2000 Violet’ and ‘Maverick Scarlet Picotee’ for all measured parameters. When 11 treatments were compared in the efficacy trial of biorational products, Botector (Aureobasidium pullulans) and Prestop (Gliocladium catenulatum) effectively controlled the disease according to AUDPC for blighted leaves and leaves with sporulating B. cinerea in both Ringo 2000 Violet and Pinto Premium Orange. Zio (Pseudomonas chlororaphis), Serifel (Bacillus amyloliquefaciens), Serenade Opti (B. subtilis), and LifeGard (B. mycoides) were also effective when combined with the geranium cultivar Pinto Premium Orange, one of the least susceptible cultivars in our study based on AUDPC values for all measured parameters. AUDPC for leaves with sporulating B. cinerea showed that all biorational products included in the study effectively limited B. cinerea except Actinovate (Streptomyces lydicus) in Pinto Premium Orange geranium. A sustainable management approach could combine one of the least Botrytis-susceptible geranium cultivars identified with biorational controls for effective Botrytis blight control.
Relationship Between Working Conditions, Worker Outcomes, and Patient Care
Authors: Zarska Aleksandra , Avgar Ariel C. , Sterling Madeline R.
Published: July 2021

Despite the integral role that frontline health care workers play in providing care to older adults and those with chronic conditions and disabilities, few studies have examined the relationships between the working conditions endured by this workforce, the quality of the care they deliver, and the outcomes of patients for whom they care. Thus, the authors: (1) developed a novel conceptual framework that highlights these relationships and (2) performed a comprehensive search and analysis of the literature (PubMed, AgeLine, Cumulative Index to Nursing and Allied Health Literature (CINAHL), JSTOR, Scopus, Web of Science) to assess the relationships proposed in the framework. A total of 31 studies were included. The results suggest that working conditions affect workers themselves, the care they deliver, and their patients’ outcomes. Additional studies, as well as policy solutions, are needed to address the issues faced by this workforce in order to improve health care delivery.
Advancing Measurement of the Sources and Consequences of Burnout in a Comprehensive Cancer Center
Authors: Ash Marcia J. , Baer Wendy , Peacock Caroline , Haardörfer Regine , Mascaro Jennifer S.
Published: July 2021

Burnout is endemic among oncology clinicians and impacts quality of care. In order to develop institutional strategies to address burnout, psychometrically sensitive measurement within local cancer organizations is necessary to identify embedded causes of burnout and resulting effects. The authors administered the Mini-Z burnout survey to clinicians and staff (n = 160) at a National Cancer Institute-designated comprehensive cancer center. Structural equation modeling was used to examine workplace stressors that predicted burnout, and the pathway between burnout and 2 meaningful quality outcomes was tested: (1) lack of compassion and (2) thoughts of leaving one’s job or specialty. Females and advanced practice practitioners had the highest prevalence of burnout. The structural equation model achieved excellent model fit, and indicated that workplace atmosphere, control over workload, values alignment, time for documentation, and team efficiency underlie burnout in this sample. The pathways from burnout to lack of compassion and to thoughts of leaving one’s job were significant.
A Cohort Model of Mentoring as Facilitator to the Transition to an Academic Nurse Faculty Position Following Completion of a PhD
Authors: Viveiros Jennifer , Schuler Monika , Chung Joohyun , D’Esmond Lynn
Published: July 2021

Successful transition to an academic nurse educator role is challenging; it is necessary to identify facilitators and barriers that aide or hinder this process. This study used an autoethnographic qualitative design to explore the lived experiences of a cohort of faculty during their transition into a tenure-track role. Three facilitators (noncompetitive environment, resource sharing, and cohort approach) and two barriers (work-life balance and intrusion of old habits) emerged as themes. A cohort model can be a valuable facilitator for a successful transition. Multitiered mentoring further aided in the transition.
Using Augmented Reality to Foster Clinical Readiness and Critical Thinking in Nursing Education
Authors: McCafferty Kandis L. , Flott Beth , Hadenfeldt Cynthia
Published: July 2021

This pilot study utilized augmented reality (AR) case scenario posters in foundational coursework to determine if the use of AR posters is an effective teaching strategy when compared with traditional paper case studies. Seventy-nine students participated in this descriptive, comparative study. Overall, the number of correct student responses increased from the pretest to the posttest in all groups; the experimental group was very satisfied with the AR teaching methodology. Because of the increase in knowledge and high student satisfaction, findings suggest that AR posters may be useful in the education of nursing students.
The importance of supportive leadership following an unplanned event
Authors: Grossman Valerie Aarne
Published: July 2021

Although the goal is always to have no errors, the fact is that they will occur. Compassion during the event investigation is crucial for the nurses involved.
Length of Cervical Stenosis, Admission ASIA Motor Scores, and BASIC Scores Are Predictors of Recovery Rate Following Central Cord Syndrome
Authors: Zhang Changmeng , Lee Victor Kam Ho , Yu Jeremy Man Leung , Cheung Jason Pui Yin , Koljonen Paul Aarne , Shea Graham Ka Hon
Published: July 2021

Study Design.

A retrospective cohort study.

Objective.

This study aims to determine whether quantitative magnetic resonance imaging (MRI) parameters and radiological scoring systems could be used as a reliable assessment tool for predicting neurological recovery trajectory following acute traumatic central cord injury syndrome (CCS).

Summary of Background Data.

Controversy remains in whether CCS should be managed conservatively or by early surgical decompression. It is essential to understand how clinical and radiological parameters correlate with neurological deficits and how they predict recovery trajectories.

Methods.

We identified patients with CCS admitted between 2011 and 2018 with a minimum of 1-year follow-up. Cervical MRIs were analyzed for cord/canal dimensions, Brain and Spinal Injury Center (BASIC) scores and sagittal grading as ordinal scales of intraparenchymal cord injury. Japanese Orthopaedic Association (JOA) recovery rates (≥50% as good, < 50% as poor) were analyzed against these variables by logistic regression and receiver operator characteristic (ROC) curves. Additionally, we evaluated American Spinal Injury Association motor scale (AMS) scores/recovery rates.

Results.

Sixty patients were included, of which 30 were managed conservatively and 30 via surgical decompression. The average follow-up duration for the entire cohort was (51.1 ± 25.7) months. Upon admission, sagittal grading correlated with AMS and JOA scores (P < 0.01, β = 0.48). Volume of the C2 to C7 canal and axial cord area over the site of maximal compression correlated with AMS and JOA scores respectively (P = 0.04, β = 0.26; P = 0.01, β = 0.28). We determined admission AMS more than 61 to be a clinical cutoff for good recovery (area under the receiver operating curve [AUC] = 0.74, 95% confidence interval [CI]: 0.61–0.85, sensitivity 80.9%, specificity 69.2%, P < 0.01). Radiological cutoffs to identify patients with poor recovery rates were length of cervical spinal stenosis more than 3.9 cm (AUC = 0.76, 95% CI: 0.63–0.87, specificity 91.7%, sensitivity 52.2%, P < 0.01), BASIC score of more than 1 (AUC = 0.69, 95% CI: 0.56–0.81, specificity 80.5%, sensitivity 51.1%, P = 0.02). Surgical decompression performed as a salvage procedure upon plateau of recovery did not improve neurological outcomes.

Conclusion.

Clinical and radiological parameters upon presentation were prognosticative of neurological recovery rates in CCS. Surgery performed beyond the acute post-injury period failed to improve outcomes.

Level of Evidence: 3
Stability of Direct Oral Anticoagulants and Antiarrhythmic Drugs in Serum Collected in Standard (Nongel) Serum Tubes Versus Tubes Containing Gel Separators
Authors: Hegstad Solfrid , Fuskevåg Ole-Martin , Amundsen Siri , Gule Marina , Spigset Olav , Helland Arne
Published: July 2021

Background:

Separation gels are often used in collection tubes, but adsorption of drugs onto the gel may cause falsely low concentrations in therapeutic drug monitoring. In this study, the stability of apixaban, edoxaban, rivaroxaban, flecainide, amiodarone, and desethylamiodarone was assessed in tubes, with and without gel separators.

Methods:

Drug-free blood was spiked and stored for up to 7 days in nongel tubes and gel tubes from 2 manufacturers (Vacuette and Vacutainer). The samples were analyzed in triplicates using ultra-high-pressure liquid chromatography–tandem mass spectrometry.

Results:

At ambient temperature conditions, the serum concentrations of apixaban, edoxaban, and rivaroxaban in a tube with acrylic-based gel had already decreased at baseline, whereas it took 6 hours to observe the same result in a tube with olefin-based gel. At 4°C, the reduction in serum concentration was considerably slower. For flecainide, the gel tube concentrations were stable at ambient temperature for 3 days, but decreased after 7 days in acrylic-based gel tubes. Amiodarone and desethylamiodarone stored in gel tubes at 4°C showed decrease in concentrations after 24 hours and 6 hours, respectively.

Conclusions:

Acrylic-based gel tubes should not be used for any of the tested drugs. Although olefin-based gel tubes may be used for anticoagulants and flecainide, it is advisable to prefer nongel tubes as a general precaution.
Selective Estrogen Receptor Modulators in Gynecology Practice
Authors: Pinkerton JoAnn V.
Published: July 2021

Selective estrogen receptor (ER) modulators have variable tissue specific estrogen agonist and antagonist activities. Tamoxifen is approved for treatment and prevention of breast cancer; acts as an endometrial estrogen agonist. Raloxifene is approved for prevention and treatment of osteoporosis and prevention of breast cancer. The selective ER modulators bazedoxifene paired with conjugated estrogens relieves vasomotor symptoms and prevents bone loss with neutral effects on breast and amenorrhea similar to placebo. Ospemifene is approved to treat dyspareunia. Lasofoxifene is in development for resistant ER positive breast cancer. Estetrol (E4), synthesized by human fetal liver, has dual weak-estrogenic/antiestrogenic features, now approved as a contraceptive.
Description and management of retinopathy of prematurity reactivation after intravitreal antivascular endothelial growth factor therapy
Authors: Valikodath Nita G. , Chiang Michael F. , Chan R.V. Paul
Published: July 2021

Purpose of review

To review the literature regarding reactivation of retinopathy of prematurity (ROP) after treatment with antivascular endothelial growth factor (anti-VEGF) agents.

Recent findings

Reactivation can occur after anti-VEGF or laser. Risk factors for reactivation include patient and disease-related factors. Various studies are evaluating the use of different anti-VEGF agents and reactivation rates. However, the definition of reactivation varies between studies.

The literature has varied definitions of reactivation, which is often used interchangeably with recurrence. It is important to recognize features of reactivation of ROP to appropriately manage patients and conduct clinical trials. The International Classification of ROP 3rd edition has established a consensus guideline regarding terminology describing reactivation.
Answering the Call to Action: A Multimodal Wellness Response to Psychological Distress in Health Care Workers During the COVID-19 Pandemic in the Bronx
Authors: Geiss Donna , Confino Marni , Wei Eric , Reyes Mariela , Coll Jantra , Rodriguez Tiffany , Foster-Mahfuz Aasha , Foote Barbara A. , Segall Jeremy , Mastromano Christopher , Bajaj Komal
Published: July 2021

The emotional and psychological toll of the COVID-19 pandemic has been characterized as a parallel pandemic, disproportionately affecting health care workers when compared to the general population. Recognizing the tragic effects that the pandemic was having on the psyche of our health care workers, a multidisciplinary peer-support program called Helping Healers Heal was augmented to address these complex needs in a large, urban, academic medical center in the Bronx, NY. A multimodal approach including wellness events, emotional support rounds, fast-tracked connections with therapeutic support, and coalition building was used to reach 80% of staff from May through August, 2020. The multidisciplinary team planned events and interventions to appeal to the myriad ways people cope and build resilience, and by utilizing existing resources, it proved extremely cost-effective. In a survey of the program’s participants, 94% of respondents “agreed” or “strongly agreed” that their participation helped alleviate stress.
A Specialized Acute COVID-19 Outpatient Clinic at an Academic Medical Center
Authors: Artandi Maja , Barman Linda , Srinivasan Malathi , Thomas Sam , Singh Jaiveer , Asch Steven M. , Vilendrer Stacie
Published: July 2021

Health systems are challenged to provide equitable access to coronavirus disease 2019 (COVID-19) outpatient care during the pandemic. Infected patients may have difficulties accessing regular care and rely on emergency rooms. With the goal to improve system efficiencies and access to care, Stanford launched a designated outpatient COVID-19 “Care and Respiratory Observation of Patients With Novel Coronavirus” clinic in April 2020 in which all adult Stanford patients with newly diagnosed severe acute respiratory syndrome coronavirus 2 were offered follow-up for 2–3 weeks through video, telephone, and in-person encounters. Patients were triaged into risk categories and received home pulse oximeters based on a standardized protocol. Between April 15, 2020, and March 26, 2021, the Care and Respiratory Observation of Patients With Novel Coronavirus clinic enrolled 1317 patients. The clinic provided evaluation of Patients under Investigation, management of acute COVID-19 symptoms, care for COVID-19 patients after hospital discharge, clinical advice, and opportunities for research. The authors share crucial implementation lessons related to team agility, care personalization, and resource optimization.
Efficacy and safety of chuna manual treatment as an adjunctive therapy after total knee arthroplasty
Authors: Kim Hyun-Ju , Ko Youme , Park Tae-Yong , Lee Jin-Hyun , Do Kwang-Sun , Chae Dong-Sik , Han Seong-Nim , Park Jung Sik , Song Yun-Kyung
Published: July 2021

Background:

The frequency of patients undergoing total knee arthroplasty (TKA) continues to increase with population aging and prolonged life expectancy. Although the outcomes of TKA are usually good, not all patients gain complete relief from discomfort after surgery. The elderly, having long-term knee arthritis, form the majority of patients undergoing surgery; hence, muscle atrophy and loss of muscle strength around the knee are reported in several cases. We plan to examine the effectiveness and safety of the Chuna Manual Treatment in patients undergoing TKA.

Methods:

This study will be conducted as an assessor-blind, randomized, single-center, parallel clinical trial. Fifty patients with knee pain who underwent TKA within the last 3 months will be recruited and randomly assigned (in a 1:1 ratio) to receive either the standard treatment (group A) or a combination of both the standard and Chuna Manual Treatment (group B) twice weekly for 4 weeks. The primary endpoint will be a change in the K-WOMAC score. The secondary evaluation variables will be K-WOMAC, numeric pain rating scale, range of movement, fall risk, and economic parameters.

Discussion:

The results of this study will provide valuable information on the clinical efficacy and safety of adjunctive Chuna Manual Treatment following TKA.

Trial registration:

This trial has been registered at ClinicalTrials.gov (identifier, NCT03625050; date of registration, August 10, 2018).
Multiple myeloma-associated light chain amyloidosis involving heart, kidneys, and peripheral nerves
Authors: Lee In Hee , Kim Chang-Yeon , Kang Sungmin , Ahn Dong Jik , Kim Min-Kyung
Published: July 2021

Introduction:

Multiple myeloma (MM) is a hematologic malignancy characterized by the clonal proliferation of monoclonal protein-producing plasma cells and can cause immunoglobulin light chain (AL) amyloidosis. Although MM-associated AL amyloidosis is rare, it can significantly increase patient mortality, as its various non-specific symptoms can delay diagnosis and treatment.

Patient concerns:

A 77-year-old female patient visited a renal clinic with complaints of generalized edema and dyspnea (New York Heart Association class III) persisting for three weeks. The patient had hypoalbuminemia, mild anemia, and nephrotic-range proteinuria. Echocardiography revealed concentric hypertrophy of the left ventricle and sparkling textures in the myocardium. Serum protein immunofixation revealed monoclonal gammopathy of immunoglobulin G/lambda light chain. A bone marrow biopsy showed 30% plasmacytosis scattered with cluster of differentiation 138-positive plasma cells. A kidney biopsy demonstrated a mesangial matrix positive for Congo red staining and deposition of amyloid fibrils on electron microscopy. Sensorimotor polyneuropathy was noted on the nerve conduction studies of both lower extremities.

Diagnosis:

The patient was diagnosed with heart failure, nephrotic syndrome, and peripheral neuropathy caused by MM-associated AL amyloidosis.

Interventions:

She was given supportive treatment upon admission, including administration of diuretics, albumin, and vasopressors, followed by combination chemotherapy (melphalan and dexamethasone).

Outcomes:

The patient's condition deteriorated due to heart failure and azotemia. She died from multiple organ failure on the 28th day of hospitalization.

Conclusion:

MM-associated AL amyloidosis can rapidly progress to fatal multiple organ failure. Therefore, if AL amyloidosis is suspected in patients with MM, prompt assessment of organ dysfunction and early initiation of intensive care including proper chemotherapy are required.
Dual osteochondromas arising from the coracoid process and the glenoid of scapula
Authors: Ham Dong Hun , Wang Sung Il
Published: July 2021

Introduction:

Scapular osteochondromas represent 3% to 4% of all osteochondromas. Although many cases of osteochondromas affecting the body of the scapula have been reported in the first three decades of life, case reports of osteochondroma affecting the coracoid process or the glenoid of the scapula are limited.

Patient concerns:

We report a case of a 56-year-old male with progressive pain and swelling of the left shoulder for six months.

Diagnoses:

The diagnosis was dual osteochondromas arising from the coracoid process and the glenoid of the left scapula.

Interventions:

Complete excision was performed.

Outcomes:

The patient was discharged without any complications after 10 days of postoperative wound care. His symptoms relieved at three months after surgery. At the last follow-up (two years postoperatively), the patient remained in good condition. He had full range of motion of the shoulder without any signs of recurrence.

Conclusion:

Dual osteochondromas arising from the glenoid and the coracoid process can cause severe dysfunction with coracoid impingement syndrome of the ipsilateral shoulder. In older individuals, it is necessary to differentiate osteochondroma from a malignant tumor.
Effect of low carbohydrate diets on insulin resistance and the metabolic syndrome
Authors: Foley Peter J.
Published: July 2021

Purpose of review

This review outlines recent research in the application of low carbohydrate diets (LCD) for insulin resistance (IR) and metabolic syndrome (MetS).

Recent findings

Studies included in this review explore how a LCD can be used in the management of patients with IR and MetS. LCDs have been shown to result in Type 2 Diabetes Mellitus (T2DM) remission, improve lipid profiles and dramatically reduce intrahepatic fat.

The field of nutritional science is notoriously complex. The LCD has a simple narrative, which can easily and safely be applied in clinical practice. Current guidelines recognise and encourage the use of LCD as a valid option for patients with T2DM and obesity. Structured, evidence-based education should be available for all clinicians to increase confidence and ensure consistency and quality control. Further real-world evidence into the application and scalability of a LCD are required. The use of digital health solutions and improved health technology should see significant advances in this field, with dietary habit being driven by patient-derived health data in response to food, and not population-based food guidelines. The narrative around MetS and IR needs to change from progression to remission, with a LCD being a valid option for this.
Proton‐Pump Inhibitors
Authors: Tavares Marta , Amil‐Dias Jorge
Published: July 2021

The risk of bone fracture in children under proton‐pump inhibitors (PPI) treatment has been the subject of recent publications and naturally raises concerns among prescribing doctors, patients and their parents.

Currently, there is no consistency in those risk claims according to the available evidence and an update on it is beneficial to reduce anxiety on one hand, and prompt for well‐planned studies addressing the issue on the other. Furthermore, common sense and well‐founded prescriptions must be the general rule for this as for any other therapeutic drug.
Presentation and Outcomes of Infants With Idiopathic Cholestasis: A Multicenter Prospective Study
Authors: Hertel Paula M. , Hawthorne Kieran , Kim Sehee , Finegold Milton J. , Shneider Benjamin L. , Squires James E. , Gupta Nitika A. , Bull Laura N. , Murray Karen F. , Kerkar Nanda , Ng Vicky L. , Molleston Jean P. , Bezerra Jorge A. , Loomes Kathleen M. , Taylor Sarah A. , Schwarz Kathleen B. , Turmelle Yumirle P. , Rosenthal Philip , Magee John C. , Sokol Ronald J.
Published: July 2021

Objectives:

The aim of the study was to determine the frequency and natural history of infantile idiopathic cholestasis (IC) in a large, prospective, multicenter cohort of infants.

Methods:

We studied 94 cholestatic infants enrolled up to 6 months of age in the NIDDK ChiLDReN (Childhood Liver Disease Research Network) “PROBE” protocol with a final diagnosis of IC; they were followed up to 30 months of age.

Results:

Male sex (66/94; 70%), preterm birth (22/90 with data; 24% born at < 37 weeks’ gestational age), and low birth weight (25/89; 28% born at <2500 g) were frequent, with no significant differences between outcomes. Clinical outcomes included death (n = 1), liver transplant (n = 1), biochemical resolution (total bilirubin [TB] ≤1 mg/dL and ALT < 35 U/L; n = 51), partial resolution (TB > 1 mg/dL and/or ALT > 35 U/L; n = 7), and exited healthy (resolved disease per study site report but without documented biochemical resolution; n = 34). Biochemical resolution occurred at median of 9 months of age. GGT was <100 U/L at baseline in 34 of 83 participants (41%).

Conclusions:

Frequency of IC and of death or liver transplant was less common in this cohort than in previously published cohorts, likely because of recent discovery and diagnosis of genetic etiologies of severe/persistent cholestasis that previously were labeled as idiopathic. Preterm birth and other factors associated with increased vulnerability in neonates are relatively frequent and may contribute to IC. Overall outcome in IC is excellent. Low/normal GGT was common, possibly indicating a role for variants in genes associated with low-GGT cholestasis—this warrants further study.
Safety, Feasibility, Yield, Diagnostic and Prognostic Implications of Transjugular Liver Biopsy in Children and Adolescents
Authors: Lal Bikrant Bihari , Sood Vikrant , Rastogi Archana , Mukund Amar , Khanna Rajeev , Sharma Manoj Kumar , Alam Seema
Published: July 2021

Objectives:

The objectives of the study were to evaluate the indications, feasibility, complications and clinical implications of transjugular liver biopsy (TJLB) in children.

Methods:

Data of all TJLB performed in children <18 years old was retrieved from the computerized hospital information system. TJLB was done using a 19 G quick‐core needle biopsy system with 20 mm throw length. Hepatic venous pressure gradient was additionally measured in children with portal hypertension. A single pathologist reviewed all the biopsies again and provided structured information.

Results:

A total of 102 children, including 5 with acute liver failure underwent TJLB with technical success in 101 (99%). A mean of 2.3 ± 0.9 passes (range: 1–5) was taken for the biopsy. The most common indications for TJLB in our cohort were elevated international normalized ratio >1.5 (66, 64.7%), ascites (46, 45.1%) and thrombocytopenia (platelet count < 60,000/mm3) (42, 41.2%). Mean size of the tissue received was 14.5 ± 5.6 mm with an average of 10.2 ± 4.7 portal tracts. Only one child developed major (category D) complication (hemobilia) and 12 (11.8%) developed minor complications post‐procedure. Etiological diagnosis could be made in a total of 64 (63.9%) children undergoing TJLB, the most common diagnosis being autoimmune hepatitis (n = 31), non‐cirrhotic portal fibrosis (n = 16) and drug‐induced liver injury (n = 4).

Conclusion:

TJLB is well tolerated, feasible and helps make a diagnosis in close to 64% children allowing timely medical and/or surgical intervention. It is especially useful for diagnosis of autoimmune liver diseases, drug‐induced liver injury and non‐cirrhotic portal fibrosis.
Desmoplastic Small Round Cell Tumors With EWS-WT1 Transcript Expression: Should We Consider Children and Adult Patients Differently?
Authors: Olivier-Gougenheim Laura , Orbach Daniel , Atallah Vincent , Marec-Berard Perrine , Bertrand Amandine
Published: July 2021

Desmoplastic small round cell tumor (DSRCT) is an aggressive sarcoma occurring in the young, teenager, and adult populations. The aim of this study is to compare initial tumor presentation, therapeutic management and scalability between pediatric and adult DSRCT patients and investigate the possibility of specific therapeutic approaches. A multicenter retrospective study of 81 Franco-Belgian medical files with DSRCT harboring Ewing sarcoma-Wilm tumor transcript was made. Median age was 17 years (3 to 58) with 42 children (13.5 y [3;17]) and 39 adults (28 y [18;58]). No significant differences were found between the 2 groups regarding initial symptoms and metastasis at diagnosis. The therapeutic approaches were similar for both groups: use of neoadjuvant chemotherapy (78.6% vs. 79.5%, P=1), primary surgery (71.4% vs. 69.2%, P=0.73), adjuvant chemotherapy (54.8% vs. 61.5%, P=0.99), radiotherapy (23.8% and 10.3%, P=0.11) and intraperitoneal chemotherapy (14.3% vs. 2.6%; P=0.11). Median time to recurrence was 12 versus 18 months (P=0.13). Overall survival at 2 years and recurrence free were 46.4% versus 60.1% (P=0.83) and 14.3% versus 16%, respectively (P=0.16). Clinical presentation, initial therapeutics and outcome of DSRCT are equivalent suggesting that similar management should be considered for children and adults with DSRCT.
Factors Affecting Quality of Life in Patients Receiving Autologous Hematopoietic Stem Cell Transplantation
Authors: Mohanraj Lathika , Sargent Lana , Elswick R. K. , Toor Amir , Swift-Scanlan Theresa
Published: July 2021

Background

Hematopoietic stem cell transplant (HSCT) is a potentially curative treatment for hematologic malignancies, with 22 000 HSCTs performed annually in the United States. However, decreased quality of life (QoL) is a frequent and concerning state reported by HSCT recipients.

Objectives

We sought to determine if measurements of frailty and cognitive impairment were associated with fatigue and QoL in adult HSCT recipients after autologous HSCT.

Methods

Using a longitudinal study design, 32 participants 18 years or older receiving autologous HSCT were recruited from a bone marrow transplant clinic. Each participant completed 2 visits: pre-HSCT and post-HSCT. At each visit, participants completed assessment tools to measure frailty, cognitive impairment, fatigue, and QoL (assesses physical, social/family, emotional, functional, and transplant-related well-being).

Results

Participants with increased fatigue scores reported decreased QoL pre- and post-HSCT. Participants with increased frailty showed decreased functional well-being before HSCT and showed correlations with decreased physical, social, and transplant-related well-being post-HSCT. As expected, fatigued participants also showed increased frailty post-HSCT. Participants showed significant changes in physical well-being and fatigue between pre-HSCT and post-HSCT visits.

Conclusion

Data analyses from this pilot study show significant correlations between subsets of QoL with fatigue and frailty in autologous HSCT participants pre- and post-HSCT.

Implications for Practice

Understanding the impact of frailty on fatigue and QoL in HSCT recipients is critical to assist nurses in initiating educational and behavioral interventions to help mitigate the effects of HSCT.
Hypertension and Its Associated Mental Health Challenges Among Female African Refugees in Durban, South Africa
Authors: Munezero Tresor , Tomita Andrew
Published: July 2021

Hypertension is a serious medical condition that leads to various adverse health complications when left untreated. In addition to psychological challenge that female migrant refugees are exposed to premigration, they encounter barriers to care postmigration from xenophobia that affects their hypertension. We investigated the extent and mental health drivers of hypertension in refugees in Durban, South Africa. We interviewed 178 adult female African help-seeking refugees/migrants for hypertension (blood pressure ≥130/90 mm Hg) and mental health challenges (e.g., adverse childhood experience [ACE] and depression using the Center for Epidemiologic Studies–Depression scale). Eighty-six percent (n = 153) of participants were hypertensive, and based on the adjusted regression models, exposure to at least one ACE (adjusted odds ratio [aOR], 2.83; 95% confidence interval [CI], 1.11–7.26) and depression (aOR, 3.54; 95% CI, 1.10–11.37) were associated with hypertension, independent of smoking, alcohol, obesity, and physical exercise status. Hypertension and its associated mental health challenges are overlooked conditions in this population, with further efforts for screening being needed.