bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the quality of mortality review equity reporting: Development of an indigenous Māori responsiveness rubric
Authors: Wilson Denise , Crengle Sue , Cram Fiona
Published: July 2020

Objective

To improve consistency in New Zealand’s Mortality Review Committees’ (MRCs) analysis, interpretation and recommendations, specifically related to equity and Māori (the Indigenous peoples of Aotearoa New Zealand) mortality.

Design

A qualitative Plan-Do-Check-Act design informed by Māori expertise to develop a rubric and guidelines. The rubric and guidelines aimed to improve MRCs’ capability to analyse mortality data, its interpretation and the recommendations for preventing deaths.

Setting

New Zealand’s MRCs make recommendations to address preventable deaths. Variation existed between the MRCs’ understanding of equity, and its application to reduce avoidable mortality for Māori, which subsequently influenced their analysis, reporting and the recommendations generated. Improving the quality and robustness of MRCs’ recommendations and reporting are crucial for improving equity.

Participants

Māori Caucus (comprising MRC members with Māori health and wellbeing expertise) designed the rubric and guidelines with input from the secretariat and other MRC Chairs and members.

Intervention(s)

None.

Main Outcome Measure(s)

None.

Results

The rubric comprises four key ‘pou’ (metaphorical posts or domains) ‘Tika’ (doing things right); ‘Manaakitanga’ (caring compassionately); ‘Mana’ (status, authority); and ‘Mahi tahi’ (working collaboratively); and criteria for three levels of practice. Evaluation of the efficacy of the use of the rubric and its implementation showed further education and support was required.

Conclusions

A shared understanding of equity about mortality is required. Effective implementation of a quality-based rubric into practice requires careful planning and ongoing education and support for staff and committee members at multiple levels. Follow-up support is needed to support its implementation into practice.
Biological, Ecological, and Distributional Aspects of Two Native Species of Lucilia Genus (Diptera: Calliphoridae) of Forensic Interest in Yungas Environments of Argentina
Authors: Acosta X , González-Reyes A X , Centeno N D , Corronca J A
Published: July 2020

This study determined the spatial and temporal dynamics of two native neotropical species flies of forensic interest, belonging to the Lucilia (Robineau-Desvoidy) genus. The study focused on their abundance and reproductive behaviors associated with different habitats and phenological parameters. In the Province of Salta, Argentina, monthly samplings were performed over 1 yr in urban, rural, and native habitats, at morning, mid-day, and afternoon periods, controlling the oviposition of captured specimens. Environmental variables were also assessed: cloudiness, precipitation, relative humidity, temperature, and tree cover. Lucilia purpurascens (Walker) appeared to be associated with native habitats, whereas Lucilia ochricornis (Wiedemann) was mainly associated with rural habitats, exhibiting distinct habitat preferences. Two ecotones were also identified: rural–urban and rural–native, suggesting rural habitats promoted habitable conditions at its margins. Both species were recorded at the end of winter to the middle of autumn, with an initial peak in early spring, and a second peak at late summer. These peaks were associated with the highest numbers of laid eggs. Lucilia purpurascens preferred high tree coverings, whereas L. ochricornis resisted areas with intermediate sun, suggesting limited sun exposure was important. The latter was also associated with daily flight activities; during the warm season, the densest catches occurred at morning and afternoon periods, whereas during the cold season, they occurred at mid-day. Climatic variables explained 77% of variability in terms of abundance and oviposition. Synergistic effects were observed between these variables, suggesting that these variables conditioned insect distribution and reproduction, and not just temperature per se.
Distal radial artery ligation for treatment of steal syndrome associated with radiocephalic arteriovenous fistula
Authors: Tolba Mahmoud , Maresch Martin , Kamal Dhafer
Published: July 2020

We present a case of dialysis associated steal syndrome in a hemodialysis patient with left radiocephalic arteriovenous fistula that caused him severe rest pain. Angiography showed retrograde flow from the ulnar artery to the distal radial artery through a hypertrophied palmar arch. The problem was solved by surgical ligation of the distal radial artery leading to complete relief of patient symptoms without any notable complications.
COVID-19: Exposing and addressing health disparities among ethnic minorities and migrants
Authors: Greenaway Christina , Hargreaves Sally , Barkati Sapha , Coyle Christina M , Gobbi Federico , Veizis Apostolos , Douglas Paul
Published: July 2020

COVID-19 disproportionately affects vulnerable and marginalized populations such as ethnic minorities and migrant groups. In this perspective we review the complex interaction of the many factors driving these inequities and suggest several possible solutions to mitigate the negative impact of COVID-19 on these populations.
FAUST I. The hot corino at the heart of the prototypical Class I protostar L1551 IRS5
Authors: Bianchi E , Chandler C J , Ceccarelli C , Codella C , Sakai N , López-Sepulcre A , Maud L T , Moellenbrock G , Svoboda B , Watanabe Y , Sakai T , Ménard F , Aikawa Y , Alves F , Balucani N , Bouvier M , Caselli P , Caux E , Charnley S , Choudhury S , De Simone M , Dulieu F , Durán A , Evans L , Favre C , Fedele D , Feng S , Fontani F , Francis L , Hama T , Hanawa T , Herbst E , Hirota T , Imai M , Isella A , Jiménez-Serra I , Johnstone D , Kahane C , Lefloch B , Loinard L , Maureira M J , Mercimek S , Miotello A , Mori S , Nakatani R , Nomura H , Oba Y , Ohashi S , Okoda Y , Ospina-Zamudio J , Oya Y , Pineda J , Podio L , Rimola A , Segura Cox D , Shirley Y , Taquet V , Testi L , Vastel C , Viti S , Watanabe N , Witzel A , Xue C , Zhang Y , Zhao B , Yamamoto S
Published: July 2020

The study of hot corinos in solar-like protostars has been so far mostly limited to the Class 0 phase, hampering our understanding of their origin and evolution. In addition, recent evidence suggests that planet formation starts already during Class I phase, which therefore represents a crucial step in the future planetary system chemical composition. Hence, the study of hot corinos in Class I protostars has become of paramount importance. Here, we report the discovery of a hot corino towards the prototypical Class I protostar L1551 IRS5, obtained within the ALMA (Atacama Large Millimeter/submillimeter Array) Large Program FAUST (Fifty AU STudy of the chemistry in the disc/envelope system of solar-like protostars). We detected several lines from methanol and its isotopologues (13CH3OH and CH2DOH), methyl formate, and ethanol. Lines are bright towards the north component of the IRS5 binary system, and a possible second hot corino may be associated with the south component. The methanol lines' non-LTE analysis constrains the gas temperature (∼100 K), density (≥1.5 × 108 cm−3), and emitting size (∼10 au in radius). All CH3OH and 13CH3OH lines are optically thick, preventing a reliable measure of the deuteration. The methyl formate and ethanol relative abundances are compatible with those measured in Class 0 hot corinos. Thus, based on this work, little chemical evolution from Class 0 to I hot corinos occurs.
The cis-regulatory codes of response to combined heat and drought stress in Arabidopsis thaliana
Authors: Azodi Christina B , Lloyd John P , Shiu Shin-Han
Published: July 2020

Plants respond to their environment by dynamically modulating gene expression. A powerful approach for understanding how these responses are regulated is to integrate information about cis-regulatory elements (CREs) into models called cis-regulatory codes. Transcriptional response to combined stress is typically not the sum of the responses to the individual stresses. However, cis-regulatory codes underlying combined stress response have not been established. Here we modeled transcriptional response to single and combined heat and drought stress in Arabidopsis thaliana. We grouped genes by their pattern of response (independent, antagonistic and synergistic) and trained machine learning models to predict their response using putative CREs (pCREs) as features (median F-measure = 0.64). We then developed a deep learning approach to integrate additional omics information (sequence conservation, chromatin accessibility and histone modification) into our models, improving performance by 6.2%. While pCREs important for predicting independent and antagonistic responses tended to resemble binding motifs of transcription factors associated with heat and/or drought stress, important synergistic pCREs resembled binding motifs of transcription factors not known to be associated with stress. These findings demonstrate how in silico approaches can improve our understanding of the complex codes regulating response to combined stress and help us identify prime targets for future characterization.
Model-based joint visualization of multiple compositional omics datasets
Authors: Hawinkel Stijn , Bijnens Luc , Cao Kim-Anh Lê , Thas Olivier
Published: July 2020

The integration of multiple omics datasets measured on the same samples is a challenging task: data come from heterogeneous sources and vary in signal quality. In addition, some omics data are inherently compositional, e.g. sequence count data. Most integrative methods are limited in their ability to handle covariates, missing values, compositional structure and heteroscedasticity. In this article we introduce a flexible model-based approach to data integration to address these current limitations: COMBI. We combine concepts, such as compositional biplots and log-ratio link functions with latent variable models, and propose an attractive visualization through multiplots to improve interpretation. Using real data examples and simulations, we illustrate and compare our method with other data integration techniques. Our algorithm is available in the R-package combi.
Musculoskeletal pain among Finnish orchestra musicians versus core workforce
Authors: Vastamäki M , Ristolainen L , Heliövaara M , Vastamäki H
Published: July 2020

Background

Professional musicians show a high prevalence of musculoskeletal pain, but information is limited about prevalence of pain compared to the general populations.

Aims

Our cross-sectional epidemiological study compared the prevalence of musculoskeletal pain between professional orchestra musicians and the working population in Finland.

Methods

Musicians with a permanent contract with all domestic professional symphony and philharmonic orchestras and a population sample of the workforce in Finland completed questionnaires including the same questions on musculoskeletal pain and on various other issues. Cross-sectional data from two population-based and two orchestra-musician studies were analysed by logistic regression model adjusting for confounding factors.

Results

In 2002, 345 musicians completed questionnaires (40% response rate), and in 2010, 195 (23%). The Health 2000 study sample comprised 5956 employed participants and in 2011, 5942. Musicians reported, in 2002 and in 2010, back pain during the past 30 days more often than did controls, 39% versus 27%, adjusted odds ratio (95% confidence interval, CI) 1.5 (1.2–1.9); shoulder pain, 21% versus 9%, 2.6 (1.9–2.5); elbow pain, 14% versus 5%, 2.9 (2.0–4.2); wrist pain 14% versus 7%, 2.2 (1.5–3.1); and finger pain 13% versus 9%, 2.8 (2.0–3.9). Prevalence of musculoskeletal pain increased with age in controls but not in musicians.

Conclusions

Professional orchestra musicians reported more pain in the back and upper extremity than other working people. Future research should focus on explaining differences in the occurrence of musculoskeletal disorders between musicians and the general population.
A Harm Reduction Approach to the Ethical Management of the COVID-19 Pandemic
Authors: Weinstock Daniel
Published: July 2020

The post-confinement phase of the COVID-19 pandemic will require that governments navigate more complex ethical questions than had occurred in the initial, ‘curve-flattening’ phase, and that will occur when the pandemic is in the past. By looking at the unavoidable harms involved in the confinement and quarantine methods employed during the initial phase of the pandemic, we can develop a harm reduction approach to managing the phase during which society will be gradually reopened in a context of managed risk. The principles that are at the heart of such an approach include a reckoning with all of the harms involved in policy choice, including harms that might be given rise to by policy implementation itself; a focus on the harms to which already vulnerable populations are susceptible; and a strong preference for policies that economize on the use of prohibitions and of coercive state enforcement, and that instead emphasize the agency of citizens in realizing health-promoting behavior change. This framework is applied to a policy proposal that has been discussed in policy circles in a number of countries, that of immunity ‘passports’, and to policies that emphasize the creative use of space and time to achieve physical distancing goals.
How Does Household Spending Respond to an Epidemic? Consumption during the 2020 COVID-19 Pandemic
Authors: Baker Scott R , Farrokhnia Robert A , Meyer Steffen , Pagel Michaela , Yannelis Constantine
Published: July 2020

Utilizing transaction-level financial data, we explore how household consumption responded to the onset of the COVID-19 pandemic. As case numbers grew and cities and states enacted shelter-in-place orders, Americans began to radically alter their typical spending across a number of major categories. In the first half of March 2020, individuals increased total spending by over 40% across a wide range of categories. This was followed by a decrease in overall spending of 25%–30% during the second half of March coinciding with the disease spreading, with only food delivery and grocery spending as major exceptions to the decline. Spending responded most strongly in states with active shelter-in-place orders, though individuals in all states had sizable responses. We find few differences across individuals with differing political beliefs, but households with children or low levels of liquidity saw the largest declines in spending during the latter part of March.
Investigating Morphological Complexes Using Informational Dissonance and Bayes Factors: A Case Study in Corbiculate Bees
Authors: Porto Diego S , Almeida Eduardo A B , Pennell Matthew W
Published: July 2020

It is widely recognized that different regions of a genome often have different evolutionary histories and that ignoring this variation when estimating phylogenies can be misleading. However, the extent to which this is also true for morphological data is still largely unknown. Discordance among morphological traits might plausibly arise due to either variable convergent selection pressures or else phenomena such as hemiplasy. Here, we investigate patterns of discordance among 282 morphological characters, which we scored for 50 bee species particularly targeting corbiculate bees, a group that includes the well-known eusocial honeybees and bumblebees. As a starting point for selecting the most meaningful partitions in the data, we grouped characters as morphological modules, highly integrated trait complexes that as a result of developmental constraints or coordinated selection we expect to share an evolutionary history and trajectory. In order to assess conflict and coherence across and within these morphological modules, we used recently developed approaches for computing Bayesian phylogenetic information allied with model comparisons using Bayes factors. We found that despite considerable conflict among morphological complexes, accounting for among-character and among-partition rate variation with individual gamma distributions, rate multipliers, and linked branch lengths can lead to coherent phylogenetic inference using morphological data. We suggest that evaluating information content and dissonance among partitions is a useful step in estimating phylogenies from morphological data, just as it is with molecular data. Furthermore, we argue that adopting emerging approaches for investigating dissonance in genomic datasets may provide new insights into the integration and evolution of anatomical complexes. [Apidae; entropy; morphological modules; phenotypic integration; phylogenetic information.]
Impact of Soil Salinity on the Cowpea Nodule-Microbiome and the Isolation of Halotolerant PGPR Strains to Promote Plant Growth under Salinity Stress
Authors: Mukhtar Salma , Hirsch Ann M. , Khan Noor , Malik Kauser A. , Humm Ethan A. , Pellegrini Matteo , Shi Baochen , Briscoe Leah , Huntemann Marcel , Clum Alicia , Foster Brian , Foster Bryce , Roux Simon , Palaniappan Krishnaveni , Varghese Neha , Mukherjee Supratim , Reddy T.B.K. , Daum Chris , Copeland Alex , Ivanova Natalia N. , Kyrpides Nikos C. , Shapiro Nicole , Eloe-Fadrosh Emiley A. , Maymon Maskit , Mirza Muhammad S. , Mehnaz Samina
Published: July 2020

Cowpea is one of the major legumes cultivated in arid and semiarid regions of the world. Four soil-microbial samples (SS-1 through SS-4) collected from semiarid soils in Punjab, Pakistan were planted with cowpea (Vigna unguiculata) crops, which were grown under salinity stress to analyze bacterial composition in the rhizosphere and within nodules using cultivation-dependent and -independent methods. Two varieties, 603 and the salt-tolerant CB 46, were each inoculated with or without the four different native soil samples or grown in medium either N-deficient (−N) or supplemented with N (+N). Plants inoculated with soil samples SS-2 and SS-4 grew better than plants inoculated with SS-1- and SS-3 and grew comparably with the +N controls. Environmental DNA (eDNA) was isolated from SS-1 and SS-4, and, by 16S ribosomal RNA sequencing, the soil microbiomes consisted mainly of Actinobacteria, Firmicutes, Proteobacteria, and other nonproteobacterial genera. However, analysis of eDNA isolated from cowpea nodules established by the trap plants showed that the nodule microbiome consisted almost exclusively of proteobacterial sequences, particularly species of Bradyrhizobium. Bacteria were isolated from both soils and nodules, and 34 of the 51 isolates tested positive for plant-growth-promoting rhizobacteria traits in plate assays. Many could serve as future inocula for crops in arid soils. The discrepancy between the types of bacteria isolated by culturing bacteria isolated from surface-sterilized cowpea nodules (proteobacteria and nonproteobacteria) versus those detected by sequencing DNA isolated from the nodules (proteobacteria) from cowpea nodules (proteobacteria and nonproteobacteria) versus those detected in the nodule microbiome (proteobacteria) needs further study.
Current-Season Infection With Ordinary and Recombinant Strains of Potato virus Y Has Detrimental Effects on Chipping Potato Yield and Tuber Quality
Authors: Weber Erin L. , Busse James S. , Bethke Paul C.
Published: July 2020

Potato virus Y (PVY) is the most economically important virus infecting potatoes worldwide. Current-season spread of PVY occurs when aphids transmit the virus from infected to noninfected plants during the growing season. The impact of current-season PVY infection on yield and quality of chip processing potatoes is not well documented. In a replicated, greenhouse experiment conducted over 2 years, we measured the effect of current-season infection with four PVY strains (PVYO, PVYN-Wi, PVYNTN, and PVYN:O) on chip processing varieties Atlantic, Lamoka, and Snowden. PVY infection decreased yield and tuber specific gravity for some combinations of potato variety and virus strain but did not affect the appearance of chips including the prevalence of stem-end chip defects. This work suggests that current-season infection of chipping potatoes imposes a cost on producers and emphasizes the need for continued investment in seed certification and development of PVY-resistant cultivars.
Genome Resources for Seven Fungal Isolates That Cause Dollar Spot Disease in Turfgrass, Including Clarireedia jacksonii and C. monteithiana
Authors: Crouch Jo Anne , Beirn Lisa A. , Boehm Michael J. , Carbone Ignazio , Clarke Bruce B. , Kerns James P. , Malapi-Wight Martha , Mitchell Thomas K. , Venu R. C. , Tredway Lane P.
Published: July 2020

Fungi in the genus Clarireedia are widespread and destructive pathogens of grasses worldwide, and are best known as the causal agents of dollar spot disease in turfgrass. Here, we report genome assemblies of seven Clarireedia isolates, including ex-types of the two most widespread species, Clarireedia jacksonii and C. monteithiana. These datasets provide a valuable resource for ongoing studies of the dollar spot pathogens that include population diversity, host–pathogen interactions, marker development, and disease control.
Accessory Chromosomes in Fusarium oxysporum
Authors: Yang He , Yu Houlin , Ma Li-Jun
Published: July 2020

Most genomes within the species complex of Fusarium oxysporum are organized into two compartments: the core chromosomes (CCs) and accessory chromosomes (ACs). As opposed to CCs, which are conserved and vertically transmitted to carry out essential housekeeping functions, lineage- or strain-specific ACs are believed to be initially horizontally acquired through unclear mechanisms. These two genomic compartments are different in terms of gene density, the distribution of transposable elements, and epigenetic markers. Although common in eukaryotes, the functional importance of ACs is uniquely emphasized among fungal species, specifically in relationship to fungal pathogenicity and their adaptation to diverse hosts. With a focus on the cross-kingdom fungal pathogen F. oxysporum, this review provides a summary of the differences between CCs and ACs based on current knowledge of gene functions, genome structures, and epigenetic signatures, and explores the transcriptional crosstalk between the core and accessory genomes.
Comprehensive Cardiac Rehabilitation Effectiveness in a Middle-Income Setting
Authors: Ghisi Gabriela Lima de Melo , Chaves Gabriela S. S. , Ribeiro Antonio L. , Oh Paul , Britto Raquel R. , Grace Sherry L.
Published: July 2020

Purpose:

The impact of comprehensive cardiac rehabilitation (CCR) in Latin America is not well known. Herein, the pre-specified tertiary outcomes of a cardiac rehabilitation (CR) trial are reported: disease-related knowledge, depressive symptoms, and heart-health behaviors (exercise, diet, and smoking).

Methods:

This was a single-blinded, single-center (Brazil) randomized trial with three parallel arms: CCR (exercise + education) versus exercise-only CR versus wait-list control. Eligible patients were randomized in blocks of four with 1:1:1 concealed allocation. The CR program was 6 mo long. Participants randomized to exercise-only CR received 36 exercise classes; the CCR group also received 24 educational sessions, including a workbook. All outcomes were assessed at pre-test and 6-mo later (blinded). Analysis of covariance was performed by intention-to-treat (ITT) and per-protocol (PP).

Results:

A total of 115 (89%) patients were randomized; 93 (81%) were retained. There were significant improvements in knowledge with CCR (ITT [51.2 ± 11.9 pre and 60.8 ± 13.2 post] and PP; P < .01), with significantly greater knowledge with CCR versus control (ITT mean difference [MD] = 9.5, 95% CI, 2.3-16.8) and CCR vs exercise-only CR at post-test (ITT MD = 6.8, 95% CI, 0.3-14.0). There were also significant improvements in self-reported exercise with CCR (ITT [13.7 ± 15.8 pre and 32.1 ± 2 5.7 post] and PP; P < .001), with significantly greater exercise with CCR versus control at post-test (ITT MD = 7.6, 95% CI, 3.8-11.4). Also, there were significant improvements in diet with CCR (PP: 3.4 ± 7.5 pre and 8.0 ± 7.0 post; P < .05).

Conclusions:

In this first-ever randomized trial of CR for coronary artery disease in Latin America, the benefits of CCR have been supported.
Visit-to-visit blood pressure variability and renal outcomes: results from ONTARGET and TRANSCEND trials
Authors: Mancia Giuseppe , Schumacher Helmut , Böhm Michael , Mann Johannes F.E. , Redon Josep , Facchetti Rita , Schmieder Roland E. , Lonn Eva M. , Teo Koon K. , Yusuf Salim
Published: July 2020

Aims:

There is conflicting evidence on whether in treated hypertensive patients the risk of renal outcomes is associated with visit-to-visit SBP variability. Furthermore, limited evidence is available on how important is SBP variability for prediction of renal outcomes compared with on-treatment mean SBP. We addressed these issues in 28 790 participants of the Ongoing Treatment Alone and in combination with Ramipril Global End point Trial and Telmisartan Randomized AssessmeNt Study in ACE iNtolerant Subjects with Cardiovascular Disease trials.

Methods and results:

SBP variability was expressed as the coefficient of variation of the mean with which it showed no relationship. SBP variability and mean values were obtained from five visits during the first 2 years of treatment after the end of the titration phase. Incidence of several renal outcomes (end-stage renal disease, doubling of serum creatinine, new microalbuminuria, new macroalbuminuria and their composite) was calculated from the third year of treatment onward. Patients were divided in quintiles of SBP-coefficient of variation (SBP-CV) or mean SBP, which exhibited superimposable mean blood pressure and SBP-CV values, respectively. A progressive increase of SBP-CV was not accompanied by a parallel increase in a widely adjusted (baseline and on-treatment confounders) risk of most renal outcomes (end-stage renal disease, new macroalbuminuria, new microalbuminuria and their composite) in the subsequent on-treatment years. In contrast, the adjusted risk of most renal outcomes increased progressively from the lowest to the highest quintile of on-treatment mean SBP. Progression from lowest to highest mean on-treatment SBP, but not SBP-CV, was also associated with a less frequent return to normoalbuminuria in patients with initial micro or macroalbuminuria. Renal outcome prediction was slightly improved by the combined use of SBP-CV and mean SBP quintiles.

Conclusion:

Visit-to-visit SBP variability had no major predictive value for the risk of renal outcomes, which, in contrast, was sensitively predicted by mean on-treatment SBP. A further slight increase in prediction of renal outcomes was seen by combining on-treatment mean SBP and variability.
Teleophthalmology: an essential tool in the era of the novel coronavirus 2019
Authors: Kalavar Meghana , Hua Hong-Uyen , Sridhar Jayanth
Published: July 2020

Purpose of review

The aim of this article is to assess the current state of teleophthalmology given the sudden surge in telemedicine demand in response to the novel coronavirus 2019 (COVID-19).

Recent findings

Recommendations and policies from government and national health organizations, combined with social distancing, have led to exponential increases in telemedicine use. Teleophthalmology can be integrated into ophthalmic care delivery. In the emergency room, teleophthalmology can be utilized to triage patients and diagnose common ophthalmic eye diseases. Ophthalmology practices can utilize real-time medicine to conduct many parts of an in-person exam. In cases where more complex diagnostic tools are warranted, a model incorporating telemedicine and focused in-person visits may still be beneficial. Innovative technologies emerging in the market allow for increased remote monitoring, screening, and management of adult and pediatric patients for common eye diseases.

COVID-19 created a demand for healthcare delivery that limits in-person examination and potential viral exposure. Teleophthalmology allows ophthalmologists to continue caring for patients while keeping physicians and patients safe. Although challenges still exist, the pandemic has accelerated the adoption of teleophthalmology. As a result, teleophthalmology will play an integral role in providing high-quality efficient care in the near future.
Effects of Predischarge Patient Education Combined With Postdischarge Follow-Ups on Self-Care, Readmission, Sleep, and Depression in Patients With Heart Failure
Authors: CHEN Hsing-Mei , WANG Shan-Tair , WU Shyh-Jong , LEE Chee-Siong , FETZER Susan J. , TSAI Liang-Miin
Published: July 2020

Background

Patients with heart failure rarely engage in adequate self-care. Greater emphasis on self-care discharge readiness is needed.

Purpose

This study examined the effects of a predischarge educational program combined with 1 year of postdischarge follow-up on self-care behaviors, readmission, sleep quality, and depression in patients with heart failure.

Methods

A longitudinal, nonequivalent two-group pretest–posttest design was used. The intervention group received tailored education and follow-ups, whereas the control group received routine predischarge heart-failure education from direct care nurses only. Measurements included the self-care maintenance and self-care management subscales of the Self-Care of Heart Failure Index, Pittsburg Sleep Quality Index, Patient Health Questionnaire-9, and readmission rate. Data obtained at baseline and at 1, 3, 6, and 12 months postdischarge were analyzed using linear mixed models with both intention-to-treat and per-protocol approaches. The propensity score was used to adjust for the confounding effects of the New York Heart Association functional class and left ventricular ejection fraction.

Results

Of the 62 patients with heart failure (28 in the intervention group and 34 in the control group) who were sampled at baseline, 47 (n = 25 vs. n = 22) provided data over the entire course of this 1-year study (76% retention rate). The per-protocol analysis did not find significant differences for any variables. However, the intention-to-treat analysis showed that the intervention group significantly improved in self-care maintenance at 6 months and self-care management at 12 months after hospital discharge, with fewer, albeit not significantly fewer, first and subsequent hospital readmissions than the control group.

Conclusions/Implications for Practice

The effect of this intervention was not found to be substantial, indicating a need to design more efficacious and powerful interventions. Hospitalized patients must receive patient education before discharge to foster their self-care knowledge and skills regarding self-care at home. Strategies are needed to help nurses provide patient education in a time-efficient manner.
Treatment of Cytokine Storm in COVID-19 Patients With Immunomodulatory Therapy
Authors: Yessayan Lenar , Szamosfalvi Balazs , Napolitano Lena , Singer Benjamin , Kurabayashi Katsuo , Song Yujing , Westover Angela , Humes H. David
Published: July 2020

Observational evidence suggests that excessive inflammation with cytokine storm may play a critical role in development of acute respiratory distress syndrome (ARDS) in COVID-19. We report the emergency use of immunomodulatory therapy utilizing an extracorporeal selective cytopheretic device (SCD) in two patients with elevated serum interleukin (IL)-6 levels and refractory COVID-19 ARDS requiring extracorporeal membrane oxygenation (ECMO). The two patients were selected based on clinical criteria and elevated levels of IL-6 (>100 pg/ml) as a biomarker of inflammation. Once identified, emergency/expanded use permission for SCD treatment was obtained and patient consented. Six COVID-19 patients (four on ECMO) with severe ARDS were also screened with IL-6 levels less than 100 pg/ml and were not treated with SCD. The two enrolled patients’ PaO2/FiO2 ratios increased from 55 and 58 to 200 and 192 at 52 and 50 hours, respectively. Inflammatory indices also declined with IL-6 falling from 231 and 598 pg/ml to 3.32 and 116 pg/ml, respectively. IL-6/IL-10 ratios also decreased from 11.8 and 18 to 0.7 and 0.62, respectively. The two patients were successfully weaned off ECMO after 17 and 16 days of SCD therapy, respectively. The results observed with SCD therapy on these two critically ill COVID-19 patients with severe ARDS and elevated IL-6 is encouraging. A multicenter clinical trial is underway with an FDA-approved investigational device exemption to evaluate the potential of SCD therapy to effectively treat COVID-19 intensive care unit patients.
Effectiveness of extracorporeal shock wave therapy in patients with tennis elbow
Authors: Zheng Chenxiao , Zeng Dongjie , Chen Jiayi , Liu Sijing , Li Jianyi , Ruan Zhaohai , Liang Wusheng
Published: July 2020

Background:

The aim of the present study was to investigate the effectiveness of Extracorporeal Shock Wave (ECSW) in the treatment of lateral epicondylitis (LE) of humerus.

Hypothesis:

ECSW therapy in people with LE effectively reduces the pain and gains functional rehabilitation.

Materials/Methods:

Databases of PubMed, EMBASE, Web of Science and the Cochrane Library from inception to April 2020 was searched to identify all relevant RCTs comparing ECSW therapy with any other conservative treatment, including injection and local anesthetic versus placebo or control in patients aged 18 with LE. The primary outcome is the mean overall pain score at 12 weeks after treatment. Another secondary outcome mainly included Thomsen test, 50% pain reduction, grip strength and adverse effect at 12 weeks after treatment.

Results:

Nine studies were included in the meta-analysis. Compared with the placebo group, ECSW cannot significantly reduce the pain score (mean deviation [MD] = -4.23, 95% confidence interval [CI]: -8.78 to 0.32, P = .07), but make more people acquire 50% pain reduction (MD = 1.38, 95% CI: 1.09 to 1.75, P = .008). There was no significant difference between ECSW and control in decreasing the pain score of Thomsen test (MD = -3.22, 95% CI: -14.06 to 7.62, P = .56). ECSW was more effective in Grip strength as compared with control at 12 weeks-3 months (MD = 3.52, 95% CI: 2.43 to 4.60, P < .00001)

Conclusions:

Results suggested that ECSW cannot effectively reduce the mean overall pain, but it showed more people acquire 50% pain reduction and might be a better option for the treatment of LE. Because of study limitations, additional high level of evidence, more rigorously designed large-samples and high-quality randomized controlled trials are needed to guide clinical practice.
Epidural steroid injection versus conservative treatment for patients with lumbosacral radicular pain
Authors: Yang Seoyon , Kim Won , Kong Hyun Ho , Do Kyung Hee , Choi Kyoung Hyo
Published: July 2020

Background:

Previous systemic reviews have examined the efficacy of individual therapeutic agents, but which type of treatment is superior to another has not been pooled or analyzed. The objective of the current study was to compare the clinical effectiveness of epidural steroid injection (ESI) versus conservative treatment for patients with lumbosacral radicular pain.

Methods:

A systematic search was conducted with MEDLINE, EMBASE, and CENTRAL databases with a double-extraction technique for relevant studies published between 2000 and January 10, 2019. The randomized controlled trials which directly compared the efficacy of ESI with conservative treatment in patients with lumbosacral radicular pain were included. Outcomes included visual analog scale, numeric rating scale, Oswetry disability index, or successful events. Two reviewers extracted data and evaluated the methodological quality of papers using the Cochrane Collaboration Handbook. A meta-analysis was performed using Revman 5.2 software. The heterogeneity of the meta-analysis was also assessed.

Results:

Of 1071 titles initially identified, 6 randomized controlled trials (249 patients with ESI and 241 patients with conservative treatment) were identified and included in this meta-analysis. The outcome of the pooled analysis showed that ESI was beneficial for pain relief at short-term and intermediate-term follow-up when compared with conservative treatment, but this effect was not maintained at long-term follow-up. Successful event rates were significantly higher in patients who received ESI than in patients who received conservative treatment. There were no statistically significant differences in functional improvement after ESI and conservative treatment at short-term and intermediate-term follow-up. The limitations of this meta-analysis resulted from the variation in types of interventions and small sample size.

Conclusions:

According to the results of this meta-analysis, the use of ESI is more effective for alleviating lumbosacral radicular pain than conservative treatments in terms of short-term and intermediate-term. Patients also reported more successful outcomes after receiving ESI when compared to conservative treatment. However, this effect was not maintained at long-term follow-up. This meta-analysis will help guide clinicians in making decisions for the treatment of patients with lumbosacral radicular pain, including the use of ESI, particularly in the management of pain at short-term.
Intraindividual Variability in Sleep and Levels of Systemic Inflammation in Nurses
Authors: Slavish Danica C. , Taylor Daniel J. , Dietch Jessica R. , Wardle-Pinkston Sophie , Messman Brett , Ruggero Camilo J. , Kohut Marian , Kelly Kimberly
Published: July 2020

Objective

Disturbed sleep is common among nurses and is associated with morbidity and mortality. Inflammation may be one mechanism linking sleep and disease. However, most studies rely on retrospective questionnaires to assess sleep, which fail to account for night-to-night fluctuations in sleep across time (i.e., intraindividual variability [IIV]). We examined prospective associations between mean and IIV in sleep with inflammation markers in nurses.

Methods

Participants were 392 nurses (mean age = 39.54 years, 92% female, 23% night-shift working) who completed 7 days of sleep diaries and actigraphy to assess mean and IIV in total sleep time and sleep efficiency. Blood was drawn on day 7 to assess inflammation markers C-reactive protein, interleukin (IL)-6, tumor necrosis factor α, and IL-1β.

Results

Greater IIV in total sleep time—measured via both actigraphy and sleep diary—was associated with higher IL-6 (actigraphy: b = 0.05, p = .046, sr2 = 0.01; diary: b = 0.04, p = .030, sr2 = 0.01) and IL-1β (actigraphy: b = 0.12, p = .008, sr2 = 0.02; diary: b = 0.09, p = .025, sr2 = 0.01), but not C-reactive protein or tumor necrosis factor α. IIV in actigraphy- and sleep diary-determined sleep efficiency was not associated with inflammation biomarkers, nor were any mean sleep variables. Shift work did not moderate any associations.

Conclusions

Nurses with more variable sleep durations had elevated levels of inflammation, which may increase risk for development of inflammatory-related diseases. Research should investigate how sleep regularization may change levels of inflammation and improve health.
Secondary Rhinoplasty in Binder Syndrome: Considerations and Management of Complex Problem With Heterologous Bone Graft
Authors: Barbera Giorgio , Raponi Ingrid , Nocini Riccardo , Della Monaca Marco , Priore Paolo , Valentini Valentino
Published: July 2020

Binder Syndrome occurs in less than 1 per 10,000 live births. Mean features of the syndrome include arhinoid face, abnormal position of the nasal bones, intermaxillary hypoplasia with associated malocclusion, reduced or absent anterior nasal spine, atrophy of the nasal mucosa and absence of the frontal sinus. Treatment of these facial deformities is obviously surgical. In the present work, the authors describe, step by step, their technique in secondary rhinoplasty in a 36-years-old patient affected by Binder Syndrome. In this case, the authors used autologous cartilage graft and heterologous bone graft.

Satisfying results are achieved in 12 months of follow-up: graft resorption is acceptable, position of the graft is stable, the authors have no signs of infection and the patient is satisfied with the aesthetical and functional results. The authors believe that the first option, in complex nose's reconstruction, is the use of autologous grafts but, the use of cartilage heterologous bone graft should be taken in account, in the future, as a secondary option in Binder Syndrome and in malformed patients.
Macrophage Efferocytosis in Cardiac Pathophysiology and Repair
Authors: Li Yutian , Li Qianqian , Fan Guo-Chang
Published: July 2020

As an integral component of cardiac tissue, macrophages are critical for cardiac development, adult heart homeostasis, as well as cardiac healing. One fundamental function of macrophages involves the clearance of dying cells or debris, a process termed efferocytosis. Current literature primarily pays attention to the impact of efferocytosis on apoptotic cells. However, emerging evidence suggests that necrotic cells and their released cellular debris can also be removed by cardiac macrophages through efferocytosis. Importantly, recent studies have demonstrated that macrophage efferocytosis plays an essential role in cardiac pathophysiology and repair. Therefore, understanding macrophage efferocytosis would provide valuable insights on cardiac health, and may offer new therapeutic strategies for the treatment of patients with heart failure. In this review, we first summarize the molecular signals that are associated with macrophage efferocytosis of apoptotic and necrotic cells, and then discuss how the linkage of efferocytosis to the resolution of inflammation affects cardiac function and recovery under normal and diseased conditions. Lastly, we highlight new discoveries related to the effects of macrophage efferocytosis on cardiac injury and repair.
Role of Serum Carcinoma Embryonic Antigen (CEA) Level in Localized Pancreatic Adenocarcinoma: CEA Level Before Operation is a Significant Prognostic Indicator in Patients With Locally Advanced Pancreatic Cancer Treated With Neoadjuvant Therapy Followed by Surgical Resection
Authors: Kato Hiroyuki , Kishiwada Masashi , Hayasaki Aoi , Chipaila Jackson , Maeda Koki , Noguchi Daisuke , Gyoten Kazuyuki , Fujii Takehiro , Iizawa Yusuke , Tanemura Akihiro , Murata Yasuhiro , Kuriyama Naohisa , Usui Masanobu , Sakurai Hiroyuki , Isaji Shuji , Mizuno Shugo
Published: July 2020

Objective:

The aim of the study was to identify the prognostic factors before neoadjuvant chemoradiotherapy (NCRT) in the patients with localized PDAC. Furthermore, to identify the post-surgical survival predictors of patients with LAPC.

Summary of background data:

Surgical resection may occupy an important position in multimodal therapy for patients with LAPC; however, its indication and who obtains the true benefits, is still uncovered.

Materials and Method:

From 2005 to 2017, 319 patients with localized PDAC who underwent NCRT were reviewed. Only 159 patients were diagnosed with LAPC, of these 72 patients underwent surgical resection. We examined the pre-NCRT prognostic factors in the entire cohort and conducted further subgroup analysis for evaluating the post-surgical prognostic factors in LAPC patients under the pretext of favorable local tumor control.

Results:

In the entire cohort, pre-NCRT CEA value was recognized as the most significant prognostic indicator by multivariate analysis. In the 72 LAPC patients who underwent surgical resection, only high CEA level was identified as an independent dismal prognostic factor before surgery. At the cut-off value: 7.2ng/mL, survival of the 15 patients whose CEA value >7.2 ng/mL was significantly unfavorable compared to those of 57 patients with <7.2 ng/mL: Median disease-specific survival time: 8.0 versus 24.0 months (P < 0.00001). Moreover, the median recurrence-free survival time of the high CEA group was only 5.4 months and there was no 1-year recurrence-free survivor.

Conclusions:

CEA before NCRT is a crucial prognostic indicator for localized PDAC. Moreover, LAPC with a high CEA level, especially more than 7.2 ng/mL, should still be recognized as a systemic disease, and we should be careful to decide the indication of surgery even if tumor local control seems to be durable.
Yield of Screening for COVID-19 in Asymptomatic Patients Before Elective or Emergency Surgery Using Chest CT and RT-PCR (SCOUT)
Authors: Puylaert Carl A. J. , Scheijmans Jochem C. G. , Borgstein Alexander B. J. , Andeweg Caroline S. , Bartels-Rutten Annemarieke , Beets Geerard L. , van Berge Henegouwen Mark I. , Braak Sicco J. , Couvreur Roy , Daams Freek , van Es Hendrik W. , Franken Lotte C. , Grotenhuis Brechtje A. , Hendriks Eduard R. , de Hingh Ignace H. J. T. , Hoeijmakers Fieke , ten Holder Joris T. , Huisman Peter M. , Kazemier Geert , van Kesteren Floortje , van Kesteren Jurre , Keywani Kammy , Kuiper Sara Z. , Lange Maurits D. J. , Lobatto Mark E. , du Mée Arthur W. F. , Poeze Martijn , van Praag Elise M. , van Rossen Jorit , van Santvoort Hjalmar C. , Sedee Wouter J. A. , Seelen Leonard W. F. , Sharabiany Sarah , Sosef Nico L. , Quanjel Marian J. R. , Veltman Jeroen , Verhagen Tim , van de Vlasakker Vincent C. J. , Weeder Pepijn D. , van Werven Jochem R. , Wesdorp Nina J. , van Dieren Susan , Han Alvin X. , Russell Colin A. , de Jong Menno D. , Bossuyt Patrick M. M. , Quarles van Ufford Jet M. E. , Prokop Mathias W. , Gisbertz Suzanne S. , Prins Jan M. , Besselink Marc G. , Boermeester Marja A. , Gietema Hester A. , Stoker Jaap
Published: July 2020

Objective:

To determine the yield of preoperative screening for COVID-19 with chest CT and RT-PCR in patients without COVID-19 symptoms.

Summary of Background Data:

Many centers are currently screening surgical patients for COVID-19 using either chest CT, RT-PCR or both, due to the risk for worsened surgical outcomes and nosocomial spread. The optimal design and yield of such a strategy are currently unknown.

Methods:

This multicenter study included consecutive adult patients without COVID-19 symptoms who underwent preoperative screening using chest CT and RT-PCR before elective or emergency surgery under general anesthesia.

Results:

A total of 2093 patients without COVID-19 symptoms were included in 14 participating centers; 1224 were screened by CT and RT-PCR and 869 by chest CT only. The positive yield of screening using a combination of chest CT and RT-PCR was 1.5% [95% confidence interval (CI): 0.8–2.1]. Individual yields were 0.7% (95% CI: 0.2–1.1) for chest CT and 1.1% (95% CI: 0.6–1.7) for RT-PCR; the incremental yield of chest CT was 0.4%. In relation to COVID-19 community prevalence, up to ∼6% positive RT-PCR was found for a daily hospital admission rate >1.5 per 100,000 inhabitants, and around 1.0% for lower prevalence.

Conclusions:

One in every 100 patients without COVID-19 symptoms tested positive for SARS-CoV-2 with RT-PCR; this yield increased in conjunction with community prevalence. The added value of chest CT was limited. Preoperative screening allowed us to take adequate precautions for SARS-CoV-2 positive patients in a surgical population, whereas negative patients needed only routine procedures.
SARS-Cov-2 Was Not Found in the Peritoneal Fluid of an Asymptomatic Patient Undergoing Laparoscopic Appendectomy
Authors: Romero-Velez Gustavo , Pereira Xavier , Zenilman Ariela , Camacho Diego
Published: July 2020

Background:

The safety of laparoscopic surgery in SARS-CoV-2 positive patients remains unclear. The presence of the virus within peritoneal fluid and the peritoneal tissues is not known. We report an asymptomatic COVID-19 positive patient who underwent laparoscopic appendectomy with negative peritoneal sampling for SARS-CoV-2.

Materials and Methods:

During a standard 3 port laparoscopic surgery samples peritoneal fluid, peritoneal brushings, and surgical smoke plum were collected. Specific real-time reverse transcriptase-polymerase chain reaction targeting SARS-CoV-2 were used to detect the presence of the virus in the samples.

Results:

SARS-CoV-2 was not detected on multiple samples of the peritoneum in an asymptomatic patient.

Conclusions:

SARS-CoV-2 was not found in the peritoneum of a single patient with asymptomatic infection. Further studies comparing SARS-CoV-2 surgical candidates are needed to address safety concerns.