bluuebunny/crossref_metadata_2025 huggingface dataset:
Intergenerational Educational Mobility and Life-Course Income Trajectories in the United States
Authors: Yaish Meir , Shiffer-Sebba Doron , Gabay-Egozi Limor , Park Hyunjoon
Published: November 2020

Atheoretical formulation derived from the cumulative advantage literature, that intergenerational educational mobility has enduring life-course income effects above and beyond individuals’ education, is empirically tested. This formulation contrasts sharply with both the human capital model, which does not consider parental education as a determinant of children’s income, and the sociological research on social mobility, which mostly relies on a snapshot view to study the economic consequences of educational mobility. To test this theory, we use NLSY79 survey data (with Panel Study of Income Dynamics data serving for robustness checks). We apply growth models to the data to estimate if and how the different intergenerational educational mobility groups that are produced by the intersection of parental and respondent education shape life-course income trajectories. Results provide evidence in support of the argument that the intersection of parental and respondent education bears important long-term income consequences, mainly for men. These results, moreover, do not vary by race. We discuss the theoretical and policy implications of our results.
Measuring birth weight and umbilical cord diameter at birth to predict subsequent performance in swine
Authors: Fordyce Amanda L , Hines Elizabeth A , Edwards Erika M , Plaengkaeo Suppasit , Stalder Kenneth J , Colpoys Jessie D , Bundy Jennifer M , Johnson Anna K , Tyler Howard D
Published: November 2020

In the swine industry, pre-weaning mortality, umbilical hernia incidence and pig market weight are a few contributing factors affecting profitability and welfare on farm. Therefore, the ability to reliably predict any of these outcomes is valuable to swine operations. Mortality during the pre-weaning phase, umbilical hernia incidence and poor-quality finisher pigs can represent a multi-million dollar loss and increase in welfare concerns to the producer. Consequently, the objective of this study was to evaluate whether birth weight (BW), umbilical cord diameter at birth (UCD), and the calculated umbilical diameter at birth to birth weight ratio (UCD:BW), are potential indicators of both placental efficiency and relative defect size in the abdominal musculature as well as reliable predictors of pre-weaning mortality, umbilical hernia incidence, and pig body weight at 150 d of age in a commercial facility. Mixed sex commercial piglets were followed through production. Four hundred sixty-five piglets were weighed within 1 h of birth, and the UCD was determined using digital calipers, these animals were followed through weaning. Three hundred eighty-five pigs of the 465 were followed through the post-wean phase in the nursery facility and checked for umbilical hernia incidence. Finally, of the 385 pigs, 177 pigs were assessed for umbilical hernia incidence and weighed a final time at the grower-finisher facility. All data were analyzed using PROC Logistic and PROC GLM procedures. The variables of UCD:BW and BW were significantly associated with the probability of increased pre-weaning mortality (P < 0.001). For example, piglets with a low UCD:BW, but an increased BW had the greatest survival rate. Umbilical diameter (UCD) was not significantly associated with pre-weaning mortality. Post-weaning mortality was not significantly affected by UCD:BW, BW, or UCD variables. Umbilical hernia incidence was not significantly affected by UCD:BW at the nursery phase or growing-finishing phase. Pig body weight at 150 d of age was significantly affected by UCD:BW, BW, and UCD variables (P < 0.001). For example, piglets that had a larger UCD weighed more at 150 d of age. In conclusion, measuring the calculated UCD:BW has the potential to be a novel tool for future research looking into the impacts of umbilical measurements as it relates to placental function, fetal development, piglet survivability and impacts on future performance of the animal.
Regeneration responses to water and temperature stress drive recruitment success in hemiepiphytic fig species
Authors: Chen Huayang , Geekiyanage Nalaka , Wen Bin , Cao Kun-Fang , Goodale Uromi Manage
Published: November 2020

Mechanisms for surviving water and temperature stress in epiphytes are essential adaptations for successful regeneration in forest canopies. Hemiepiphytes start their life cycle as epiphytes, eventually establishing aerial root connections to the ground. This strategy allows for greater light capture, while benefitting from minimized risk of fire, flooding and damage by terrestrial herbivores, but exposes the vulnerable seedling stage to heat and drought stress. However, the response to temperature and water stress during early regeneration in hemiepiphytes is not known. In this study, we tested the effect of temperature (15/5, 25/15 and 35/25 °C; day/night diurnal variation) and water availability, as substrate moisture (0.00, −0.20 and −0.35 MPa) and water vapor (18.5–99.5% relative humidity), on seed germination, seedling emergence and survival in six hemiepiphytic and nine non-hemiepiphytic Ficus species. Under high-temperature conditions (35/25 °C), hemiepiphytes had higher gemination and seedling survival, achieved peak germination slower and extended germination. Greater water stress (−0.35 MPa) in the growth substrate resulted in higher germination of non-hemiepiphytes; hemiepiphytes, in contrast, took a shorter time to complete germination, but had higher seedling emergence and survival. Hemiepiphytes germinated at 99.5% relative humidity more readily compared with non-hemiepiphytes. These findings provide the first comprehensive evidence that hemiepiphytic Ficus species are better adapted to drier and warmer conditions during the critical transition from seed to seedling. Through greater flexibility in achieving peak germination and duration of regeneration activity, hemiepiphytes modulate their recruitment process to be more resilient under abiotic stressors. This may allow them to be more successful in regenerating in forest canopies under ambient conditions that are transient. These results support previous work showing greater drought tolerance of hemiepiphytic Ficus species in larger size classes and extend this finding to show that physiological adaptations for drought and heat tolerance start from the early seedling emergence stage.
An overview of cleft lip and palate
Authors: Alois Corinne I. , Ruotolo Rachel A.
Published: November 2020

Cleft lip and palate are types of craniofacial birth defects that affect thousands of children worldwide each year. These conditions are sensitive topics of conversations, often affected by the stigma of physical birth deformities and cultural myths. This article reviews the pathophysiology of cleft lip and palate, and describes the traditional management of patients with oral-facial clefts, including the extensive supportive care and an interprofessional team or cleft team approach that extends beyond the surgical correction.
Managing loneliness and chronic illness in older adults
Authors: Hammond Lori , Pullen Richard L.
Published: November 2020

An increased lifespan does not necessarily equate to a high quality of life. This article discusses strategies to help older adult patients cope with loneliness, social isolation, and chronic illness to improve their health and quality of life.
How the COVID-19 pandemic can teach educators a few lessons
Authors: Ruth-Sahd Lisa A.
Published: November 2020

In this article, a nurse educator argues that the COVID-19 pandemic provides educators with an opportunity to refocus and include some essential concepts and hard lessons learned from the pandemic into their teachings.
Long-Term Outcome of Postmenopausal Women With Proliferative Endometrium on Endometrial Sampling
Authors: Rotenberg Ohad , Doulaveris Georgios , Fridman Dmitry , Renz Malte , Kaplan Julie , Xie Xianhong , Goldberg Gary L. , Dar Pe'er
Published: November 2020

(Abstracted from Am J Obstet Gynecol 2020; doi: 10.1016/j.ajog.2020.06.045)

The most common gynecologic malignancy is endometrial cancer. Endometrial hyperplasia (EH) is associated with increased risk of endometrial cancer in postmenopausal women.
Risk of Cerebral Palsy by Gestational Age Among Pregnancies At-Risk for Preterm Birth
Authors: Smith Devin D. , Sagaram Deepika , Miller Russell , Gyamfi-Bannerman Cynthia
Published: November 2020

(Abstracted from J Matern Fetal Neonatal Med 2020;33:2059–2063)

Cerebral palsy (CP) is one of the long-term developmental risks of preterm birth, occurring in approximately 1 to 2 of 1000 births. An increased risk of CP has been associated with lower gestational age (GA), and many studies have been conducted to elucidate this relationship.
Apgar Score and Risk of Neonatal Death Among Preterm Infants
Authors: Cnattingius Sven , Johansson Stefan , Razaz Neda
Published: November 2020

(Abstracted from N Engl J Med 2020;383:49–57)

Preterm birth, defined as birth ≤36 weeks' gestational age (GA), is the main cause of neonatal death, although numerous other factors can affect this risk. For example, studies have shown that very preterm infants (infants born at ≤31 weeks' gestation) have a lower risk of neonatal death if they have a normal birth weight, are female, receive antenatal corticosteroids, and have a high 5-minute Apgar score.
Feasibility of Ultra-Rapid Exome Sequencing in Critically Ill Infants and Children With Suspected Monogenic Conditions in the Australian Public Health Care System
Authors: Lunke Sebastian , Eggers Stefanie , Wilson Meredith , Patel Chirag , Barnett Christopher P. , Pinner Jason , Sandaradura Sarah A. , Buckley Michael F. , Krzesinski Emma I. , de Silva Michelle G. , Brett Gemma R. , Boggs Kirsten , Mowat David , Kirk Edwin P. , Adès Lesley C. , Akesson Lauren S. , Amor David J. , Ayres Samantha , Baxendale Anne , Borrie Sarah , Bray Alessandra , Brown Natasha J. , Chan Cheng Yee , Chong Belinda , Cliffe Corrina , Delatycki Martin B. , Edwards Matthew , Elakis George , Fahey Michael C. , Fennell Andrew , Fowles Lindsay , Gallacher Lyndon , Higgins Megan , Howell Katherine B. , Hunt Lauren , Hunter Matthew F. , Jones Kristi J. , King Sarah , Kumble Smitha , Lang Sarah , Le Moing Maelle , Ma Alan , Phelan Dean , Quinn Michael C. J. , Richards Anna , Richmond Christopher M. , Riseley Jessica , Rodgers Jonathan , Sachdev Rani , Sadedin Simon , Schlapbach Luregn J. , Smith Janine , Springer Amanda , Tan Natalie B. , Tan Tiong Y. , Temple Suzanna L. , Theda Christiane , Vasudevan Anand , White Susan M. , Yeung Alison , Zhu Ying , Martyn Melissa , Best Stephanie , Roscioli Tony , Christodoulou John , Stark Zornitza
Published: November 2020

(Abstracted from JAMA 2020;323(24):2503–2511)

Multiple studies have shown that genomic testing has a high diagnostic yield and an impact on clinical management for patients with suspected genetic conditions. Therefore, there has been a push worldwide to apply rapid genomic sequencing in critically ill neonatal and pediatric patients.
Inclusion of Olecranon Osteotomy With the Posterior Approach for Fixation of Distal Humerus Fractures (OTA/AO 13) Does Not Increase Surgical Complications
Authors: Wilson Erin S. , Buckwalter Joseph A. , Henning Grant , Davison John , Fleury Ignacio G. , Willey Michael C.
Published: November 2020

Objectives:

To determine if inclusion of an olecranon osteotomy to the posterior paratricipital approach for operative fixation of distal humerus fractures significantly affects surgical complication rates (OTA/AO 13).

Design:

Retrospective comparative cohort study.

Setting:

Level 1 trauma center.

Patients/Participants:

Three hundred four patients underwent open reduction internal fixation of a distal humerus fracture between 2007 and 2017. Of those, 134 met inclusion criteria (≥15 years, OTA/AO fracture type 13A, B, or C, and posterior surgical approach) for the study (n = 64 with olecranon osteotomy; n = 70 without olecranon osteotomy).

Intervention:

Open reduction internal fixation of distal humerus fractures performed using a posterior paratricipital approach with or without olecranon osteotomy.

Main Outcome Measure:

Ulnar neuropathy (UN), fracture site bony nonunion, and surgical site infection (SSI).

Results:

Thirty-one (33.3%) who underwent the paratricipital approach without olecranon osteotomy, and 15 patients (26.8%) who underwent olecranon osteotomy reported postoperative UN with no significant difference between approaches (P = 0.438). There was no significant difference in rates of SSI (P = 0.418) or fracture site nonunion (P = 0.263) when comparing the approaches. Subjects with Charlson comorbidity index ≥2 were more likely to not undergo an olecranon osteotomy (P = 0.01), whereas subjects with more complex fractures by OTA/AO classification were more likely to have an olecranon osteotomy approach (P = 0.001).

Conclusions:

Addition of an olecranon osteotomy with the paratricipital approach for fixation of distal humerus fractures does not result in higher rates of UN, fracture site nonunion, or SSI.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Can You Believe Your Patients If They Say They Have Quit Smoking?
Authors: Matuszewski Paul E. , Raffetto Michael , Joseph Katherine , O'Toole Robert V.
Published: November 2020

Objectives:

To determine the reliability of self-reported smoking status in the orthopaedic trauma population and determine if certain patient factors might predispose inaccurate self-reported smoking cessation.

Design:

Prospective.

Setting:

Level I trauma center.

Patients:

Two hundred forty-seven orthopaedic trauma patients were included in the study.

Intervention:

In-office measurement of exhaled carbon monoxide (CO).

Main Outcome Measurements:

Self-reported smoking cessation with exhaled CO measurements.

Results:

A total of 906 self-reported surveys were completed over 4 follow-up visits. Of the responses indicating smoking cessation (n = 174), 12.6% [95% confidence interval (CI), 0.081–0.185] reported smoking cessation with positive CO readings, suggesting inaccurate self-reporting of smoking status. Over 20% of those patients inaccurately reporting abstinence did so more than once. The odds of inaccurate self-reporting was 3 times higher in patients with no insurance or government insurance [odds ratio (OR), 3.5; 95% CI, 1.1–11.0; P = 0.043] and in the unemployed (OR, 3.3; 95% CI, 0.97–8.57; P = 0.049).

Conclusions:

Self-reported smoking status in the orthopaedic population is fairly reliable, with 13% of patient's inaccurately self-reporting smoking cessation despite knowing their smoking status was being measured. Clinicians should be aware of the potential for inaccuracy in self-reported smoking cessation, particularly in patients with the identified socioeconomic factors. Point-of-care testing before elective trauma procedures to confirm smoking status might have a role if the procedure outcome is highly dependent on smoking status.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
An International Study Exploring the Experience of Survivors of Critical Illness as Volunteers Within ICU Recovery Services
Authors: Robinson Carly , Hibbert Elizabeth , Bastin Anthony J. , Meyer Joel , Montgomery-Yates Ashley , Quasim Tara , Slack Andrew , Mikkelsen Mark E. , Iwashyna Theodore J. , Haines Kimberley J. , Sevin Carla M. , McPeake Joanne , Boehm Leanne M.
Published: November 2020

Objectives:

Many clinicians have implemented follow-up and aftercare to support patients following ICU. Some of this care is supported and facilitated by peer volunteers. There is limited contemporary work that has explicitly explored volunteer roles within ICU recovery services or the experience of volunteers undertaking these roles. We sought to explore the experience of survivors of critical illness, as volunteers, involved in ICU recovery services and understand their motivation for undertaking these roles.

Design:

Qualitative exploration using in-depth semistructured interviews. The study design used an inductive content analysis process. We also documented the roles that were adopted by volunteers in each site involved in the study.

Setting:

Patients and caregivers were sampled from seven sites across three continents.

Patients and Subjects:

Patients and caregivers who had adopted peer-volunteering roles were undertaken.

Interventions:

None.

Measurements and Main Results:

Twelve patient and caregiver peer volunteers were interviewed. Four key themes were identified. These themes related to the experience of volunteers within ICU recovery services and their motivation for undertaking these roles: 1) self-belief and acceptance, 2) developing peer support, 3) social roles and a sense of purpose, and 4) giving back. Overwhelmingly, participants were positive about the role of the volunteer in the critical care setting.

Conclusions:

Peer volunteers undertake a variety of roles in ICU recovery services and during recovery more generally. These roles appear to be of direct benefit to those in these roles. Future research is needed to develop these roles and fully understand the potential impact on the service, including the impact on other patients.
Variability of anesthetic depth in total intravenous anesthesia vs balanced anesthesia using entropy indices: a randomized, crossover, controlled clinical trial
Authors: Oliveros Henry , Ríos Fernando , Botero-Rosas Daniel A. , Quiroga Sandra C. , Cifuentes Freddy C. , Rodríguez Gloria A. , Morales María P.
Published: November 2020

Introduction: Total intravenous anesthesia (TIVA) and balanced anesthesia (BA) are the most commonly used anesthetic techniques. The differences are the variability of the depth of anesthesia between these techniques that might predict which one is safer for patients and presents a lower risk of intraoperative awakening.

Objective: To determine whether a difference exists in the variability of depth of anesthesia obtained by response entropy (RE). 

Methods: A crossover clinical trial was conducted on 20 healthy patients receiving upper or lower limb ambulatory orthopedic surgery. Patients were randomly assigned to (a) target-controlled infusion of propofol using the Schnider model at a target concentration of 2.5mg/mL for 15minutes and a 10-minute washout, followed by sevoflurane administration at 0.8 minimal alveolar concentration (MAC) for the reminder of the surgery, or (b) the reverse sequence. Differences in the variability of the depth of anesthesia using RE were evaluated using paired t test.

Results: The treatment effect showed no significant difference in the average values of RE, during TIVA=97.23 vs BA 97.04 (P=0.39). Carry Over (-4.98 vs 4.08) and Period (100.3 vs 94.68) effects were not significantly different.

Conclusion: The present study suggests that both anesthetic techniques are equivalent in terms of the stability of the depth of anesthesia. It is important to keep testing the determinants of the efficacy of different populations because the individual behaviors of patients might ultimately tip the scale.
Update on biological risk for anesthetists taking care of patients affected by SARS-CoV-2, COVID-19
Authors: Calabrese Gustavo
Published: November 2020

Biological risks are currently of great interest and concern due to the coronavirus disease 19 (COVID-19) pandemic. In this setting, the exposure of anesthetists and healthcare personnel to patients infected with severe acute respiratory syndrome-CoV-2 causing COVID-19 in their professional practice makes an update in the knowledge of the subject essential. The aim is prevention and protection during procedures entailing a higher risk, as is the case of the so-called aerosol generators (by inhalation of droplets). Therefore, we recommend extreme standard precautions focused on hand washing and barrier protection through the use of personal protective equipment in accordance with comprehensive prevention and protection protocols for anesthetists, patients, and operating rooms.
Older Adult Alcohol Use in Relation to Cognition: An Exploratory Analysis
Authors: Mochrie Kirk D.
Published: November 2020

Objectives:

Substance use in the older adult population is expected to dramatically increase over the next decade as baby-boomers age. Of marked concern, are the cognitive effects of alcohol use and how these may manifest differently among older compared to younger adults. The present study evaluated the relationship of alcohol use among older adults to working memory and attention by assessing cognitive task performance on the Operation Span (OSPAN) and Simon tasks.

Methods:

Participants included 94 community dwelling older adults between the ages of 55 and 85 (females = 54), predominately Caucasian and well educated, recruited from southeastern US.

Results:

Approximately 89% of the sample reported drinking at least once in the past 90 days, and 29.0% reported drinking every day in the past 90. Frequency of drinking did not correlate with task performance on any of the cognitive measures. Alcohol use increased with age in this sample, contrary to prior findings. Females scored higher than males on both measures of the OSPAN. Also, participants reported more alcohol-related negative consequences over the lifetime, as their drinking frequency increased.

Conclusions:

Further research is required to determine under what circumstances alcohol may produce a cognitive decrement. Clinical and research implications are discussed.

Objectifs:

La consommation de substances chez les adultes plus âgés devrait augmenter considérablement au cours de la prochaine décennie à mesure que les baby-boomers vieilliront. Les effets cognitifs de la consommation d’alcool et la façon dont ils peuvent se manifester différemment chez les adultes plus âgés sont particulièrement préoccupants. La présente étude a évalué la relation entre la consommation d’alcool chez les personnes âgées et la mémoire de travail et l’attention en évaluant la performance des tâches cognitives sur les tâches OSPAN et Simon.

Méthodes:

Les participants comprenaient 94 adultes âgés de 55 à 85 ans vivant dans la communauté (femmes = 54), principalement de race blanche et bien éduqués, recrutés dans le sud-est des États-Unis.

Résultats:

Environ 89% de l’échantillon ont déclaré avoir bu au moins une fois au cours des 90 derniers jours, et 29,0% ont déclaré avoir bu chaque jour au cours des 90 derniers. La consommation d’alcool augmentait avec l’âge dans cet échantillon, contrairement aux résultats antérieurs. Les femmes ont obtenu des scores plus élevés que les hommes sur les deux mesures de l’OSPAN. De plus, les participants ont signalé plus de conséquences négatives liées à l’alcool au cours de leur vie si leur fréquence de consommation augmentait.

Conclusions:

Des recherches supplémentaires sont nécessaires pour déterminer dans quelles circonstances l’alcool peut entraîner une diminution cognitive. Les implications cliniques et de recherche sont discutées.
Neuroendocrine Differentiation of Skin Tumors: A Comprehensive Review
Authors: Hamie Lamiaa , Abbas Ossama , Bhawan Jag
Published: November 2020

Neuroendocrine differentiation is characterized by endocrine and neuronal features with prominent dense secretory granules and neuropeptides. Neuroendocrine differentiation of skin tumors is of unknown clinical significance. Nonetheless, the acknowledgment of this line of differentiation is important to prevent diagnostic pitfalls and subsequent inappropriate management. This review aims at summarizing the skin neoplasms that can express neuroendocrine markers.
Overview of Ventricular Assist Devices and the Total Artificial Heart
Authors: Presti Carmen Rosa , Crenshaw Nichole A.
Published: November 2020

Background

Patients with isolated left ventricular failure may have positive outcomes after being implanted with a left ventricular assist device. Unfortunately, almost half of patients with heart failure and reduced ejection fraction also have evidence of right ventricular dysfunction. For a subset of this population with severe biventricular failure, or those who develop right ventricular dysfunction after left ventricular assist device implantation, patients may necessitate biventricular assist devices or the total artificial heart.

Objectives

This overview of mechanical circulatory support devices will enhance nurses' ability to differentiate criteria for implantation, current practice, and outcomes with a focus on durable ventricular assist devices and the total artificial heart.

Methods

A review of the literature involved searching CINAHL and PubMed databases using keywords biventricular assist devices, total artificial heart, and durable mechanical circulatory support. Results were narrowed to articles based on adults, 18 years or older. Seventy-eight relevant articles were identified, and 8 articles compared the durable biventricular assist devices.

Results

Similar patient outcomes were found when comparing the use of left ventricular assist devices as biventricular support versus the total artificial heart.

Discussion

The decision to implant the appropriate durable mechanical circulatory support for a patient in biventricular failure is complex and dependent on patient factors.
Reimagining Ambulatory Care as a Key to Population Health
Authors: Allen Robert W.
Published: November 2020

Ambulatory care is a key to achieving better population health—not traditional ambulatory (outpatient) care, but rather ambulatory care reimagined. Ambulatory care is so vital that we at Intermountain Healthcare redesigned our entire organization to prioritize it and give it the attention it deserves.

Historically, outpatient care was a point of access that connected many patients with specialty care, where hospitals made their money. Doctors in private practices referred their patients to the hospitals with which they were affiliated, and that arrangement provided the hospitals with a stream of patients on which they relied financially. Today, ambulatory care plays an entirely different role in the context of population health. Healthcare providers are paid a flat fee per person and gain a benefit when people stay healthy. In this new context, ambulatory care is a mechanism to get ahead of health problems and avoid more extensive treatments.

This change then begs a question: How do healthcare providers support their essential services if ambulatory care is working to reduce the stream of patients to hospitals? The answer has three parts, and it is the reason we redesigned Intermountain Healthcare and began to roll out a series of new products and initiatives to implement that redesign.
Evaluating Negative Attributions in Persons With Brain Injury: A Comparison of 2 Measures
Authors: Neumann Dawn , Sander Angelle M. , Witwer Noelle , Jang Jeong Hoon , Bhamidipalli Surya Sruthi , Hammond Flora M.
Published: November 2020

Objectives:

To compare construct and predictive validity, readability, and time-to-administer of 2 negative attribution measures in participants with traumatic brain injury (TBI).

Setting:

Two TBI rehabilitation hospitals.

Participants:

Eighty-five adults with complicated mild to severe TBI.

Main Measures:

Negative attributions (intent, hostility, and blame) and anger responses to hypothetical scenarios were measured with the Epps scenarios and the Ambiguous Intention Hostility Questionnaire (AIHQ). Trait aggression was measured with the Buss-Perry Aggression Questionnaire (BPAQ).

Results:

Associations between attributions and anger responses (ie, construct validity) within each measure were significant (Epps: r = 0.61-0.74; AIHQ: r = 0.39-0.71); however, associations were stronger for Epps (Ps < .001). Receiver operating characteristics (ROC) revealed attributions from both measures predicted BPAQ scores (area under the ROC curves = 0.6-0.8); predictive validity did not statistically differ between the 2 measures. Both had comparable readability (fifth- to sixth-grade levels), but Epps required longer administration times.

Conclusion:

Negative attributions affect anger and aggression after TBI, making it important to identify suitable assessments for the TBI population. While psychometric properties of the AIHQ and Epps scenarios should be further explored, this study offers early support for the use of either instrument in persons with TBI. Advantages and disadvantages of the AIHQ and Epps scenarios are highlighted.
Overview of Neurotrophic Keratopathy and a Stage-Based Approach to Its Management
Authors: Safi Mustafa , Rose-Nussbaumer Jennifer
Published: November 2020

Neurotrophic keratopathy (NK) occurs because of disruption of corneal sensory innervation. There are many etiologies that can lead to NK, such as infection, trauma, topical medication use, cornea surgery, and intracranial tumors among others. We review the current available treatment options and provide a stage-based approach to its management.
Gundersen Flap Removal to Restore Eyesight Without Limbal Transplantation—A Case Report
Authors: Fogla Rajesh , Indumathy Thazethaeveetil R.
Published: November 2020

Purpose:

To report a case of Gundersen flap removal where the ocular surface was restored without the need for additional limbal stem cell transplantation.

Methods:

We describe a case of 57-year-old man who underwent Gundersen flap for a nonhealing corneal ulcer in right eye 17 years ago. He recently lost eyesight in left eye after blunt trauma. Gundersen flap removal was performed in right eye along with amniotic membrane transplantation.

Results:

The ocular surface recovered completely after surgery without any evidence of limbal stem cell deficiency. His corrected distance visual acuity improved to 20/60 along with a stable ocular surface, which was maintained till last follow-up of 12 months.

Conclusions:

A normal ocular surface can be restored after Gundersen flap surgery if removal of limbal epithelium is not performed during the primary procedure. Additional corneal surgery might be required depending on corneal clarity.
Corticosteroids Versus Cyclosporine for Subepithelial Infiltrates Secondary to Epidemic Keratoconjunctivitis: A Prospective Randomized Double-Blind Study
Authors: Gouider Dhouha , Khallouli Asma , Maalej Afef , Yousfi Mohamed Ali , Ksiaa Imen , Bouguerra Chaker , Ajili Faida , Khairallah Moncef
Published: November 2020

Purpose:

To compare efficiency and tolerance between topical 0.5% cyclosporine A (CSA) and fluorometholone (FML) for subepithelial infiltrates (SEI) complicating epidemic keratoconjunctivitis.

Methods:

We conducted a prospective double-blind randomized study involving 72 eyes with SEI. Thirty-eight eyes were treated with topical FML (FML group) and 34 eyes with CSA 0.5% eye drops (CSA group). Treatment was considered successful in case of SEI reduction and visual acuity improvement. Tolerance was evaluated by Schirmer test value, burning on eye drops instillation, and conjunctival injection.

Results:

Baseline characteristics of both groups were similar (P > 0.05). After 3 months of the regimen, resolution of SEI was 3 times more observed in the FML group than that in the CSA group (P = 0.026). After 6 months, resolution of SEI was observed in 70% of the FML group and in 47% of the CSA group (P = 0.068). The recurrence of SEI was almost twice higher in the FML group than that in the CSA group (16% vs. 9%). FML was better tolerated during the first 3 months: a higher Schirmer test value (P = 0.0003), less burning on instillation (P = 0.242), and less conjunctival injection (P = 0.003). For the rest of the follow-up period, the 2 groups were comparable in tolerance. No ocular hypertension was noted.

Conclusions:

Epidemic keratoconjunctivitis can evolve favorably under both FML and CSA. The effect of FML is faster and CSA is more durable with fewer recurrences. Both are safe therapeutic options for long-term control of SEI.
Ocular Surface Impairment After Coronavirus Disease 2019: A Cohort Study
Authors: Gambini Gloria , Savastano Maria Cristina , Savastano Alfonso , De Vico Umberto , Crincoli Emanuele , Cozzupoli Grazia Maria , Culiersi Carola , Rizzo Stanislao
Published: November 2020

Purpose:

This is a cohort study to evaluate the presence of objective signs and subjective symptoms of dry eye disease in postcoronavirus disease 2019 (COVID-19) patients compared with the control.

Methods:

Prospective, observational, single-ctenter, cohort study. Sixty-four post-COVID-19 patients and 50 control were recruited. All participants underwent a complete ophthalmological examination including Ocular Surface Disease Index Questionnaire (OSDI), best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, Schirmer test type 1, tear break-up time test (tBUT), evaluation of conjunctival hyperemia, corneal staining, and tear film osmolarity test.

Results:

The OSDI score was higher in the post-COVID-19 group in the quantitative and qualitative analysis (P < 0.001 and P =0.012, respectively). The mean tBUT in post-COVID-19 patients was 6.95 ± 4.07 seconds compared with a mean tBUT of 10.12 ± 3.90 seconds in the control group. The post-COVID-19 group showed a higher number of patients with a simultaneous impairment of the OSDI score and tBUT (P = 0.019). The Schirmer test results were strikingly significant both in the quantitative analysis and qualitative analysis (P <0.001 and P = 0.0014, respectively). Both quantitative analysis and qualitative analysis revealed a significant difference in tear osmolarity in the 2 groups.

Conclusions:

Comparing the ocular surface assessment of post-COVID-19 patients with heathy control, a statistically significant increase of dry eye disease has emerged both in subjective and objective evaluations. Our clinical results support the findings that suggested a susceptibility of the ocular surface to the virus, and it underlines the importance of the ocular surface assessment in post-COVID-19 patients for a correct diagnosis and therapy.
Challenging Behaviors and Executive Function in Preschool-Aged Children
Authors: Kuhn Miriam , Boise Courtney , Marvin Christine A. , Knoche Lisa L.
Published: November 2020

Although the literature regarding associations between young children's social emotional competencies and their executive functions (EF) is growing, there continue to be divergent accounts of the relationship between specific challenging behaviors (e.g., impulsivity, aggression, defiance, short attention span, withdrawal) and particular EF deficits (e.g., poor attentional control, flexibility, inhibitory self-control, working memory, and/or planning/organization) in young children. This mixed-methods study explores this relationship for a population of 19 preschool children. The study includes analysis of interviews with parents, teachers, and early childhood coaches for 4 of the children. Results demonstrated a significant relationship between teacher reports of challenging behaviors and deficits in global EF skills. In addition, participants provided a rich qualitative description of the children's challenges with inhibitory self-control, flexibility, and attention control. Oppositional or defiant behaviors were also prevalent within this group of 4 children. The constellation of difficulties for these children has implications for adults aiming to support positive social development and suggests next steps for research regarding behavioral targets and strategies and the collaborative parent–professional team efforts needed to address the children's needs.
Effects of a nursing care program focused on basic self-care in older acute medical in-patients: a randomized controlled trial
Authors: Rodrigues Cecília , Mendonça Denisa , Martins Maria M.
Published: November 2020

Background:

Acute illness and hospitalization are often associated with decreased independence in basic activities of daily living. The aim of this study was to test the hypothesis that a nursing care program focused on basic self-care (N_BSC) improves functional outcomes in older patients admitted to an acute medical unit.

Methods:

This was a 2-group randomized controlled trial with repeated measures: 182 older patients admitted to an acute medical unit were randomly allocated to the usual care group (n = 91) and intervention group (n = 91). The intervention consisted of nursing care centered on basic self-care that includes promotion of daily walking and all daytime meals seated, out of bed. The main outcome was changes in the number of independent basic activities of daily living (BADL) from 2 weeks before admission (baseline) to discharge.

Results:

There was significant effect of the N_BSC on the outcomes. Changes from baseline to discharge in the number of independent BADL differ significantly between the intervention and usual care group. Intervention group patients were discharged with a superior functional status than usual care group. On discharge they were able to perform independently 2.93 BADL, whereas usual care patients performed independently 1.90 BADL (P < .001).

Conclusions:

N_BSC for hospitalized older adults was feasible and program participants were discharged with better functional status than a clinically similar comparison group. N_BSC could be readily adapted for use in other hospitals and warrants further evaluation as a potential new tool for improving outcomes for hospitalized older patients.
Experience of a Portuguese radiation therapy department in the treatment of synchronous and metachronous head, neck, and oesophageal cancers
Authors: Garcia Sofia C.M. , Tavares Alda , Pinto Maria G. , Fontes Maria P.P.L. , Águas Lúcia , Vendeira Maria L.A.
Published: November 2020

Background:

Multiple primary cancers in patients with head and neck squamous cell carcinoma (HNSCC) and oesophageal squamous cell carcinoma (ESCC) share common features. Their treatment approach can be a challenge. This retrospective study aims to estimate the cumulative incidence and to describe the outcome of patients with multiple primary cancers, treated in a Tertiary Centre in Portugal.

Methods:

The study includes patients with HNSCC, ESCC, and multiple tumours (synchronous or metachronous), treated with curative intent in a Centre, between 2004 and 2019. The analysis is focused on the clinical baseline characteristics, the treatment approach, and the outcomes. Patients with distant metastasis at tumour diagnosis were excluded.

Results:

Of a total of 820 cases, 31 had multiple tumours. In 15.8 years, the cumulative incidence of multiple tumours was 6.45%. Twenty-seven patients were treated with curative intent (n = 7 synchronous, n = 20 metachronous). The most frequent HNSCC cancers in synchronous tumours were oropharynx and hypopharynx tumours (n = 4); oral cavity was the most frequent HNSCC cancer (n = 12) in metachronous tumours. The primary treatment included surgery, adjuvant or definitive radiation therapy or chemoradiation. With a median follow-up time of 73 months, the median overall survival was 51.8 months for synchronous and 102 months for metachronous tumours.

Conclusions:

Multiple tumours of HNSCC and ESCC are uncommon. In the small group of Portuguese patients analysed, there is a potential pattern of occurrence and treatment outcome. Due to the limited number of patients this study has included, the authors have considered that additional prospective studies with large samples are needed.
Flipped Classrooms in Physician Assistant Education
Authors: Vajravelu Bathri N. , Kelley Alicia , Moktar Afsoon , Orrahood Scott
Published: November 2020

Purpose

This study assessed the impact of flipped classrooms on physician assistant (PA) students' performance and opinions.

Methods

Students completed quizzes and an opinion survey in Genetics, Human Pathophysiology (HPP), Clinical Medicine (CM) (n = 105) and Physical Exam (PE) (n = 98) courses.

Results

In Genetics and PE, the quiz scores were significantly higher for flipped classrooms (Genetics 95.00 ± 6.56; PE 83.09 ± 11.47) compared to the traditional lectures (Genetics 90.00 ± 10.53; PE 55.43 ± 16.66). In HPP, students performed better with traditional lectures (86.54 ± 8.82) compared to the flipped classrooms (75.12 ± 8.54). In CM, students' gain score was significantly higher for flipped classrooms (37.85 ± 16.73) than for traditional lectures (20.97 ± 15.55). The opinion surveys showed that the students surveyed preferred traditional lectures over flipped classrooms in Genetics (4.58 ± 0.46 vs. 2.29 ± 0.71) and HPP (4.14 ± 0.35 vs. 2.09 ± 0.53).

Conclusion

Flipped classrooms improved the quality of learning in courses that deliver a hands-on skill or use case-based scenarios. They may not be an ideal choice for courses that require explanation of intricate scientific concepts.
Physical Therapy in Addition to Standard of Care Improves Patient Satisfaction and Recovery Post-cesarean Section
Authors: Stone Jennifer , Skibiski Katie , Hwang Sarah , Barnes Courtney
Published: November 2020

Background:

Cesarean section represents the most commonly performed inpatient surgical procedure in the United States. The few studies currently available regarding the role of physical therapy in postoperative recovery only look at the first few days or weeks postpartum. The goal of this pilot randomized controlled trial was to assess the impact of physical therapy post-cesarean delivery and to serve as a potential basis for future research.

Objective:

To evaluate the short- and long-term impact of an individualized, comprehensive physical therapy program on post-cesarean delivery recovery.

Study Design:

Unblinded randomized controlled trial.

Methods:

The intervention group went through an individualized 6-week physical therapy program, which included in-clinic treatment and home exercises in addition to usual postoperative care. Outcome measures used were a visual pain rating scale, Oswestry Disability Index, patient satisfaction questionnaire, and self-rated exercise confidence scale.

Results:

Seventy-two participants were included in final analysis. Satisfaction was significantly higher at 14 weeks (P = .048) and 6 months (P = .047) in the intervention group. Pain rating was significantly lower at 14 weeks (P = .049) in the intervention group. A significant change was found between baseline and 14-week/6-month follow up for Oswestry (P < .0001), patient satisfaction (P = .024), and self-efficacy with exercise (P = .034) in the intervention group. A significant main effect for self-efficacy with exercise (P = .025) in the intervention group was found at all time points compared with standard of care. Significant differences between variables were found for the Oswestry intervention group [8-14 weeks (P = .003), 8 weeks to 6 months (P = .001), and 8 weeks to 1 year (P = .007)] and the standard of care group [8 weeks to 6 months (P = .001) and 8 weeks to 1 year (P = .006)].

Conclusions:

Participants who received physical therapy had significantly improved outcomes compared with the standard of care group. This suggests that physical therapy may be a helpful adjunct to cesarean delivery recovery, although larger studies should be done for definitive conclusions.
Current Fertility Preservation Options for Female Patients With Hodgkin Lymphoma
Authors: Hutchcraft Megan L. , McCracken Kate , Whiteside Stacy , Lustberg Maryam , Lindheim Steven R. , Nahata Leena , Appiah Leslie C.
Published: November 2020

Importance

Many adolescents and young adults diagnosed with Hodgkin lymphoma (HL) experience disease progression requiring high-dose alkylating salvage therapy, which often results in permanent infertility.

Objective

The aim of this report is to discuss fertility preservation options in female patients with consideration of chemotherapeutic agents in HL.

Evidence Acquisition

An electronic literature review was performed utilizing a combination of the terms “Hodgkin lymphoma,” “fertility preservation,” “ovarian tissue cryopreservation,” “oocyte cryopreservation,” “embryo cryopreservation,” and “gonadotropin-releasing hormone agonist.” References and data from identified sources were searched and compiled to complete this review.

Results

Initial treatment of HL is often nonsterilizing; however, salvage therapy and conditioning for stem cell transplantation confer significant gonadotoxicity. Established fertility preservation options for pubertal females include embryo cryopreservation and oocyte cryopreservation. These options are contraindicated within 6 months of receipt of chemotherapy. Ovarian tissue cryopreservation is an option for patients who require salvage therapy within 6 months of first-line therapy.

Conclusions

Timing and choice of fertility preservation techniques depends on planned first-line chemotherapy and response to treatment. In patients initially treated with low-risk chemotherapy, it is reasonable to defer invasive fertility techniques until treatment failure; however, upfront fertility preservation should be considered in patients planning to undergo primary treatment with high-risk therapy.

Relevance

As advances in cancer therapy are made, the number of survivors of reproductive age increases. The ability to recognize risks for infertility and offer options for fertility preservation is paramount for optimizing quality of life in those with HL.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, the learner should be better able to distinguish cure and progression rates of HL in reproductive-aged women; describe fertility preservation options for front-line and salvage therapy in HL; and explain the importance of longitudinal fertility preservation management for reproductive-aged patients with HL.
Nutrition in Pregnancy: A Comparative Review of Major Guidelines
Authors: Tsakiridis Ioannis , Kasapidou Eirini , Dagklis Themistoklis , Leonida Ioannis , Leonida Christos , Bakaloudi Dimitra Rafailia , Chourdakis Michail
Published: November 2020

Importance

Nutrition patterns in pregnancy play a decisive role in the well-being of the mother and the fetus.

Objective

The aim of this review was to summarize and compare guidelines and recommendations on nutrition in pregnancy.

Evidence Acquisition

A descriptive review of major guidelines on antenatal nutrition was conducted, including the most recently published guidelines, namely, by the Australian Government Department of Health (2018); the Canadian Nutrition Working Group and Society of Obstetricians and Gynaecologists of Canada (2016); the World Health Organization (2016); the Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland (2016); the International Federation of Gynecology and Obstetrics (2015); the Academy of Nutrition and Dietetics (2014); and the National Institute for Health and Care Excellence (2008).

Results

There is almost universal agreement regarding macronutrient requirements during pregnancy. The WHO, FIGO, and the NICE guidelines make no recommendation on fluid intake. Almost all guidelines state that weight gain during pregnancy should be closely monitored. Folic acid supplementation is universally recommended from the preconception period, but there are controversies regarding other vitamins' supplementation. Multiple micronutrient supplementation could be an option in specific settings according only to the FIGO. Probiotics are not routinely recommended in pregnancy.

Conclusions

There is wide agreement among the reviewed guidelines regarding nutrition in pregnancy, but still there are controversies. Evaluation and classification of influential guidelines can be beneficial for establishing a universal consensus on nutrition during pregnancy, in order to achieve more favorable perinatal outcomes.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After participating in this activity, the learner should be better able to identify all aspects of recommended macronutrients intake during pregnancy; assess the need for vitamin supplementation in pregnancy; and describe potential micronutrient supplementation in the antenatal period, in order to achieve a favorable perinatal outcome.