bluuebunny/crossref_metadata_2025 huggingface dataset:
Late onset apical hypertrophic cardiomyopathy: a case report
Authors: Doeblin Patrick , Gebker Rolf , Pieske Burkert , Kelle Sebastian
Published: December 2020

Background

Apical hypertrophic cardiomyopathy provides diagnostic challenges through varying presentation, impaired visualization on echocardiography and dissent on diagnostic criteria. While hypertrophic cardiomyopathy in general requires an absolute wall thickness ≥15 mm, a threshold for relative apical hypertrophy (ratio 1.5) has been proposed.

Case summary

We report the case of a 57-year-old man with newly arisen chest pain and slight T-wave inversions. Serial cardiac magnetic resonance imaging over 9 years documented the gradual evolvement of late-onset apical hypertrophy with apical fibrosis and strain abnormalities. Symptoms, electrocardiographic changes, and relative apical hypertrophy preceded the traditional imaging criteria of hypertrophic cardiomyopathy.

Discussion

Relative apical hypertrophy can be an early manifestation of apical hypertrophic cardiomyopathy. Persistent cardiac signs and symptoms warrant a follow-up, as apical hypertrophic cardiomyopathy can evolve over time. Cardiac magnetic resonance imaging readily visualizes apical hypertrophic cardiomyopathy and associated changes in tissue composition and function.
Recognition of Elder Abuse by Chinese Nursing Undergraduates: Evaluation by the Caregiving Scenario Questionnaire
Authors: Wang Zhuzhu , Zhuang Jiayuan , Zhang Qiaoxian , Lai Xiaolan , Liu Qixi , Xie Baoyuan , Tang Qinmei
Published: December 2020

This study aimed to evaluate the recognition of elder abuse (EA) among nursing undergraduates in China and determine whether recognition is related to sociodemographic factors and education. We conducted a cross-sectional study with stratified random sampling, using the Caregiving Scenario Questionnaire of Chinese version (CSQ-CV). Questionnaires were disseminated to 343 nursing undergraduates ranged from 1st to 4th year at Fujian Medical University, China. The content validity of CSQ-CV is 0.97. 340 students (99.1%) effectively responded. 223(65.6%) of them identified trapping someone in an armchair; 108(31.8%) locking someone alone; and 3(0.9%) accepting someone was not clean as abusive. The majority correctly identified four out of five non-abusive (NA) items, while 210(61.8%) incorrectly identified camouflaging the door to prevent wondering outdoors. With respect to potential-abusive (PA) items, less than half of the students made right judgements. Only 30(8.8%) correctly identified not taking her to family gatherings; 46(13.5%) telling her only having breakfast after bathing; and 50(14.7%) hiding tablets in someone’s cereal or tea. Mann-Whitney and Kruskal-Wallis tests indicated no significance related to correct recognition of the three abusive items with sociodemographic factors and education. The students who were female, caring older adults at home or had detected EA cases were more likely to correctly recognize NA items (Z=-2.428,P=0.015;Z=-2.028,P=0.043;Z=-2.534,P=0.011). Besides, female students got higher scores of CSQ-CV (Z=-2.000, P=0.045). Nursing undergraduates’ recognition of EA, especially in neglect and PA are still at a low level in China. Education about EA in nursing undergraduates’ curriculum and training program should be encouraged.
Lifelong Bilingualism and Literacy Skills Use Among Hispanic Adults
Authors: Millar Roberto , Sahoo Shalini , Yamashita Taka , Cummins Phyllis
Published: December 2020

Literacy skills use in everyday life is associated with social (e.g., civic participation) and economic (e.g., higher wages) benefits throughout the life course. Yet, the use of literacy skills may be lower among immigrants and those with limited language proficiency. No prior research examined associations between bilingualism in early life — a critical period for language acquisition — English literacy skills, and the use of literacy skills in later life of Hispanic adults. The objective of this study is to determine whether lifelong bilingualism (i.e., learning a second language in childhood and still understanding today) is associated with Hispanics’ everyday use of literacy skills later in life. Nationally representative data (n = 412) of Hispanics 35 years and older were obtained from the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC). A series of logistic regression models were used to examine the associations between lifelong bilingualism and several measures of literacy skills use in everyday life. Results showed that lifelong bilingualism (vs. being monolingual) was negatively associated with the daily use of letters, notes, and e-mails (Odds Ratio = 0.426, p< 0.05), reading financial statements (Odds Ratio = 0.474, p< 0.05), and reading diagrams (Odds Ratio = 0.391, p< 0.05). Additionally, literacy was a consistent predictor of skill use. While bilingualism is generally beneficial for aging adults, our findings suggest that, among Hispanics, lifelong bilingualism is associated with the less frequent use of literacy skills later in life. We discuss the possible theoretical and practice implications of these findings.
Do Older People Expect Reciprocity When Providing Care? Evidence From a National Cohort
Authors: Shi Cheng , Zhu Yajing , Wong Gloria Hoi Yan
Published: December 2020

Background: The debate on whether caregiving is selfless or self-serving is unresolved. From the perspective of caregiving as a moral responsibility, the motivation to provide care is altruistic. The exchange or reciprocity perspective suggests that care is provided with an expectation to be cared for in the future. The context of filial obligation and rapid socio-economic transformation in recent decades in urban and rural China provided a unique opportunity to investigate these two driving forces. Methods: We tested the effects of caregiving experience in older persons on their care expectation from their children using data from the China Longitudinal Aging Social Survey (n=8,308). Using a multiple-indicator multiple-cause model, a special form of structural equation modelling, we examined the effect of caring for one’s older parents, helping adult children with housework, and caring for grandchildren on older persons’ care expectation from their children. Results: Older persons in urban areas had higher expectation for future care from their children if they have helped them with housework or took care of their grandchildren, whereas their experience of taking care of their own parents is related to a lower care expectation from their children. Although a similar pattern was observed in rural areas, only the experience of helping adult children with housework significantly increased care expectation. Discussion: Both altruistic and exchange motivations are involved in caregiving. Caring for older parents was more likely altruistic. Caring for an adult child in both urban and rural areas, and grandparenting in urban areas, were motivated by reciprocity.
Pathways to Mental Health–Related Treatment Among Caregiving Spouses
Authors: Choi Hyojin , Litzelman Kristin , Maher Molly , Harnish Autumn
Published: December 2020

Spouses of cancer survivors are 33% less likely to receive guideline-concordant depression treatment than other married adults. However, depression is only one of many manifestations of psychological distress for caregivers. This exploratory study sought to assess the paths by which caregivers access mental health-related treatment. Using nationally representative data from the Medical Expenditures Panel Survey, we assessed the proportion of caregivers who received a mental health-related prescription or psychotherapy visit across care settings (office based versus outpatient hospital, emergency room, or inpatient visit), provider type (psychiatric, primary care, other specialty, or other), and visit purpose (regular checkup, diagnosis and treatment, follow-up, psychotherapy, other). In addition, we assessed the health condition(s) associated with the treatment. The findings indicate that a plurality of caregivers accessed mental health-related treatment through an office-based visit (90%) with a primary care provider (47%). A minority accessed this care through a psychologist or psychiatrist (11%) or a physician with another specialty (12%) or other provider types. Nearly a third accessed treatment as part of a regular check-up (32%). These patterns did not differ from the general population after controlling for sociodemographic characteristics. Interestingly, mental health-related treatments were associated with a mental health diagnosis in only a minority of caregivers. The findings confirm the importance of regular primary care as a door way to mental healthcare, and highlight the range of potential paths to care. Future research will examine the correlates of accessing care across path types.
Factors That Promote Vulnerability Versus Resilience Among Older Disaster Survivors
Authors: Phillips Judith Robertson , Pruchno Rachel
Published: December 2020

Catastrophic environmental events, such as floods and hurricanes, are associated with widespread destruction and loss of life. Older adults, who often have health challenges and medical co-morbidities, appear to be at greater risk for adverse post-disaster outcomes, such as depression, worry, and medical uncertainty, than younger adults impacted by the same disaster. Researchers, therefore, are interested in identifying factors that tend to bring about vulnerability and adverse outcomes for older adults during and after a disaster, as well as factors that may generate resilience and psychological well-being for older adults. The purpose of this symposium is to present research based on multiple disaster experiences and to examine factors associated with vulnerability and resilience. The first two speakers introduce empirical findings from research that addresses flooding, the 2016 Baton Rouge flooding and the frequent flooding of coastal Louisiana brought about by coastal erosion. The next two presenters explore successful VA and Non-VA Home-Based programs during and after the 2017 Hurricane Maria in Puerto Rico and during the 2017 Atlantic hurricane season. The final speaker highlights the impact of lifetime trauma on the recovery of older adults following a natural disaster. Collectively, these presenters will provide evidence of how lifetime adversity is a factor promoting vulnerability for older adults after a disaster. Critically, they will also examine how age, disaster preparedness, intense patient tracking, VA support networks, and community resources and programs are protective factors generating resilience post-disaster for older adult populations.
From Defeat to Empowerment: User Experiences From a Health Promotion Intervention for People With Dementia
Authors: Kajander Martine , Gjestsen Martha Therese , Testad Ingelin
Published: December 2020

Empowering people with early-stage dementia through the provision of information and support has gained an increasing focus as the number of people with dementia increases worldwide. Health Promotion is a mean to empower the person affected to take an active role in the situation, and taking steps themselves to adjust and cope with the condition. The aim of this study was to explore the experiences of people with early-stage dementia provided with support and information through a 12-week Health Promotion course. Data comprises separate individual semi-structured interviews with 32 people with dementia after attending the course. For each participant, a carer was also interviewed. Interviews were analysed using systematic text condensation. Four categories emerged from the analysis. These were: (I) bridging the post- diagnostic information gap, (II) promoting healthy behaviours, (III) meeting others with early-stage dementia, and (IV) coming to terms with the diagnosis. The results demonstrated that the intervention was well received by participants; learning about dementia, meeting others in the same situation and focussing on maintaining a healthy lifestyle empowered and motivated participants. The participants’ carers found the course booklet especially useful and it improved family communication. In conclusion, a 12-week Health Promotion course has the potential to empower people with dementia to cope with their condition through the provision of information, peer-support, which in turn can improve family communication and ease the process of accepting the diagnosis.
Older Adults’ Subjective Well-being Following an Exergame Intervention “Bandit the Dolphin”: Focus Group Findings
Authors: Drazich Brittany , Crane Breanna , Moored Kyle , Shieh Karl , Taylor Janiece , Carlson Michelle
Published: December 2020

Due to generational mental illness stigma and under diagnosis of mental illness, older adults do not always receive the mental health help that they need. One unique technology that has the potential to improve mood in older adults is exergames, or exercise video games. The objective of this sub-study (main study: Stimulation With Intricate Movements “SWIM” Study) was to explore older adults’ mood following an exergame intervention called “Bandit the Dolphin,” created by the Johns Hopkins KATA Studio. Researchers conducted three focus groups with 14 community-dwelling older adult participants who took part in the SWIM Study exergame intervention. The semi-structured focus groups were transcribed, coded, and analyzed using deductive and inductive techniques described by Ray Maietta’s “sort and sift, think and shift” method. Three themes related to playing “Bandit the Dolphin” and mood emerged. First, participants described their perceived association between activity and mood. Participants felt that both active and passive activities, “Bandit the Dolphin” and otherwise, improved their mood through the “fun” factor, and through feelings of achievement. Second, the participants described that the competition and frustration of playing “Bandit the Dolphin” increased eventual feelings of achievement. Third, participants described how feelings of immersion, or being absorbed in the game, helped them forget their other life concerns. These findings provide a better understanding of older adults’ perceived relationship between an exergame intervention, “Bandit the Dolphin,” and short-term improved mood. Future health and engineering researchers should explore exergames as a potential tool to improve the mental health of older adults.
The Impact of the Risk for Sarcopenia on Frailty Among Older Adults With Physical Functional Dependency
Authors: Ning Hongting , Zhao Yinan , Chen Huijing , Liao Lulu , Hu Hengyu , Feng Hui
Published: December 2020

Objective: 1) to assess the prevalence of the risk for sarcopenia, as well as frailty among older adults with physical functional dependency in a nationally representative sample; and 2) to identify the impact of the risk for sarcopenia on frailty in this vulnerable population in China. Methods: A total of 2,323 participants (age ≥ 60 years old) with physical functional dependency in five provinces in China were enrolled using a multistage cluster sampling scheme. Physical function was measured by the Barthel Index (BI), the risk for sarcopenia was defined as “calf circumference (< 34 cm in men, < 33 cm in women)” according to the 2019 consensus proposed by the Asian Working Group for Sarcopenia, and frailty was assessed by the FRAIL scale. Multivariate binary logistic regression was used to assess the impact of the risk for sarcopenia on frailty. Results: The prevalence of the risk for sarcopenia and frailty were 41.0% and 30.9%, respectively. Logistic regression analysis shows that the risk for sarcopenia was signiﬁcantly associated with frailty (odds ratio 1.51, 95% conﬁdence interval 1.19-1.90, p = 0.001) after adjustment for demographic and psychosocial factors, as well as health-related factors. Conclusion: This study shows that the risk of sarcopenia and frailty are prevalent, and the presence of the risk of sarcopenia increased the risk of frailty in older Chinese adults with physical functional dependency. Key Words: the risk for sarcopenia; frailty; older adults; physical functional dependency.
Direct Care Workforce: Where the Boys Really Are
Authors: Kelly Christopher , Deichert Jerome , Holley Lyn
Published: December 2020

Purpose: This study describes the continued growth of male direct care workers (DCWs) and identifies the occupations with the greatest concentrations of male DCWs by utilizing the expanded information available in the 2018 American Community Survey (ACS). Design and Methods: Data were taken from the 1% Public Use Microdata Sample (PUMS) from the 2018 ACS. Beginning in 2018, the ACS separated the single occupation category nursing, psychiatric, and home health aides into three categories: home health aides, nursing assistants, and orderlies and psychiatric aides. Results: Between 2000 and 2018, the total number of male DCWs in the U.S. increased 118% to 474,925, with more than half (52.6%) in 2018 employed as nursing, psychiatric, and home health aides. Among these 250,139 aides, 62% (154,557) were employed as nursing assistants, 23% (57,126) worked as home health aides, and 15% (38,456) were employed as orderlies and psychiatric aides. However, 60% of all orderlies and psychiatric aides were male; this was the only occupation in the direct care workforce in which men were in the majority. Implications: The majority of male DCWs work as nursing, psychiatric, and home health aides and the new occupation classifications in the ACS reveal that while most work as nursing assistants and home health aides, the one occupation with a majority male workforce was orderlies and psychiatric aides. These findings suggest that the greatest need for male DCWs may be as orderlies and psychiatric aides, occupations in which size and physical strength are important factors.
The Influence of Multiple Frailties on Institutionalization and Mortality in Community-Living Older Adults
Authors: Lee Yunhwan
Published: December 2020

Frailty is a hallmark of accelerated aging, predisposing the older person to increased vulnerability to adverse health outcomes. Physical frailty is closely linked to other health dimensions, such as cognitive, psychological, and social functions. This study aims to examine the influence of multiple dimensions of frailty in predicting institutionalization and mortality. A nationally representative sample of Koreans 65 years or older from the Living Profiles of Older People Survey in 2008 was followed up for three years (n = 11,265). Physical frailty was defined as being prefrail or frail using the Fried phenotype model. Those with cognitive impairment, depressive symptoms, and social vulnerabilities, in addition to physical frailty, were considered to have cognitive frailty, psychological frailty, and social frailty, respectively. The proportional hazards model was used to analyze the risk of institutionalization and mortality by the total number and different combinations of frailties, adjusting for covariates. More than half (50.1%) of the participants exhibited multiple frailties, with 8.1% concurrently displaying frailty in all four domains (mixed frailty). The risk of adverse outcomes was elevated with a higher number of frailties, with hazard ratios of 2.59 (95% confidence interval [CI]: 1.52, 4.42) for institutionalization and 3.40 (95% CI: 2.50, 4.63) for mortality among those presenting mixed frailty. Whereas psychological frailty demonstrated a stronger predictive ability of mortality than institutionalization, the reverse was observed for social frailty. Multiple frailties are prevalent in late life. Acquiring more frailties raises the risk of adverse outcomes, with varying effects according to multidimensional frailty profiles.
Historical analysis of the diagnosis and management of femoroacetabular impingement prior to the year 2000: a systematic review
Authors: Tejpal Tushar , Shanmugaraj Ajaykumar , Kay Jeffery , Simunovic Nicole , Ayeni Olufemi R
Published: December 2020

This systematic review aims to assess the diagnosis, indications and treatment of femoroacetabular impingement (FAI) prior to the year 2000 and to determine if historical concepts remain applicable today. PUBMED, MEDLINE and EMBASE were searched for literature evaluating the diagnosis/treatment of FAI prior to 2000. Cadaver/non-human, non-English and review studies were excluded. Quality assessment was performed using the Methodological Index for Non-Randomized Studies. Nine studies comprising 307 patients [315 hips; mean age of 32.6 ± 2.4 years (range, 12–58)] were included. Patients reported groin pain. Magnetic resonance arthrography (MRA; n = 76) and the anterior impingement test (AIT) (n = 88) were used to diagnose impingement. Surgical dislocation with a trochanteric flip osteotomy (n = 237) and Bernese periacetabular osteotomy (n = 40) were common treatments. Pain and range of motion improved for patients. Overall complication rate was 35% (n = 99), with heterotopic ossification (n = 79) most commonly reported. Prior to 2000, there was low quantity and quality of research on the diagnosis/management of FAI. Diagnostic evaluation was primarily through clinical examination (i.e. groin pain and AIT). MRA was occasionally used to detect labral degeneration; however, utilization of computed tomography (CT) and diagnostic injections were not reported. Surgical dislocation and osteotomies of the acetabulum yielded desirable short-term clinical outcomes with a moderate complication rate. No study reported using arthroscopy for FAI management prior to 2000. Clinicians today can learn from historical principles (i.e. clinical diagnosis of FAI, management with surgical correction of femoral head–neck offset) while applying novel techniques (i.e. CT, injections, arthroscopic surgical techniques and rehabilitation) to improve patient outcomes.

Level of Evidence

IV (systematic review of III and IV evidence).
Granulocyte Macrophage Colony-Stimulating Factor-Specific Autoantibodies and Cerebral Nocardia With Pulmonary Alveolar Proteinosis
Authors: Berthoux Charlotte , Mailhe Morgane , Vély Frédéric , Gauthier Clarisse , Mège Jean-Louis , Lagier Jean-Christophe , Melenotte Cléa
Published: December 2020

In this study, we report the history of a 40-year-old man with a primary cerebral abscess caused by Nocardia abscessus that led to the discovery of autoimmune pulmonary alveolar lipoproteinosis (anti-granulocyte-macrophage colony-stimulating factor [GM-CSF] autoantibodies). Anti-GM-CSF autoantibodies promote immunodeficiency and should be monitored to prevent opportunistic and disseminated infections and to diagnose asymptomatic pulmonary alveolar lipoproteinosis.
Rhythmicity of patient flow in an acute medical unit: relationship to hospital occupancy, 7-day working and the effect of COVID-19
Authors: Dauncey S J , Kelly P A , Baykov D , Skeldon A C , Whyte M B
Published: December 2020

Background

The Acute Medical Unit (AMU) provides care for unscheduled hospital admissions. Seven-day consultant presence and morning AMU discharges have been advocated to improve hospital bed management.

Aims

To determine whether a later time of daily peak AMU occupancy correlates with measures of hospital stress; whether 7-day consultant presence, for COVID-19, abolished weekly periodicity of discharges.

Design

Retrospective cohort analysis.

Methods

: Anonymised AMU admission and discharge times were retrieved from the Profile Information Management System (PIMS), at a large, urban hospital from 14 April 2014 to 31 December 2018 and 20 March to 2 May 2020 (COVID-19 peak). Minute-by-minute admission and discharge times were combined to construct a running total of AMU bed occupancy. Fourier transforms were used to determine periodicity. We tested association between (i) average AMU occupancy and (ii) time of peak AMU occupancy, with measures of hospital stress (total medical bed occupancy and ‘medical outliers’ on non-medical wards).

Results

: Daily, weekly and seasonal patterns of AMU bed occupancy were evident. Timing of AMU peak occupancy was unrelated to each measure of hospital stress: total medical inpatients (Spearman’s rho, rs = 0.04, P = 0.24); number of medical outliers (rs = −0.06, P = 0.05). During COVID-19, daily bed occupancy was similar, with continuation of greater Friday and Monday discharges than the weekend.

Conclusions

: Timing of peak AMU occupancy did not alter with hospital stress. Efforts to increase morning AMU discharges are likely to have little effect on hospital performance. Seven-day consultant presence did not abolish weekly periodicity of discharges—other factors influence weekend discharges.
Effects of a blend of mannan and glucan on growth performance, apparent nutrient digestibility, energy status, and whole-blood immune gene expression of beef steers during a 42-d receiving period
Authors: Ogunade Ibukun M , Taiwo Godstime , Estrada-Reyes Zaira M , Yun Jiang , Pech-Cervantes Andres A , Peters Sunday O
Published: December 2020

We examined the effects of dietary supplementation of a blend of mannan and glucan on the growth performance, energy status, and whole-blood immune gene expression of newly weaned beef steers during a 42-d receiving period. Forty-eight newly weaned Angus crossbred steers (2-d post-weaning; 199 ± 13 kg of initial body weight [BW]) from a single source were stratified by BW and randomly assigned to one of the two treatments: basal diet with no additive (CON; n = 24) or a basal diet top-dressed with 5 g of a blend of mannan and glucan (MANGLU; n = 24). Average daily gain (ADG) and feed efficiency (FE) from days 1 to 14, 15 to 42, and 1 to 42 were calculated from daily dry matter intake (DMI) and weekly BW. Blood samples were collected on days 0, 14, and 42 for measurement of plasma glucose and nonesterified fatty acids (NEFA). Blood samples collected on days 14 and 42 were composited for each steer for untargeted carbonyl-metabolome analysis (measurement of carbonyl-containing metabolites). Expression of 84 immune-related genes was analyzed on blood samples collected on day 42. Beginning on days 37 to 42, total mixed ration, refusals, and fecal samples were collected once daily to determine apparent total tract digestibility of DM, CP, NDF, and ADF using indigestible NDF as an internal marker. Over the 42-d feeding trial, supplemental MANGLU tended to increase final BW (P = 0.07) and ADG (P = 0.06). Compared to CON, beef steers fed supplemental MANGLU had greater (P = 0.01) DMI during the first 14 d, greater DM digestibility (P = 0.03), and tended to have greater NDF digestibility (P = 0.09). No treatment effects (P > 0.10) on plasma glucose and NEFA on days 14 and 42 were detected; however, carbonyl-metabolome analysis revealed increased (FDR ≤ 0.05) plasma concentrations of galactose and glyceraldehydes, and altered (FDR ≤ 0.05) concentrations of some microbiome-derived metabolites in beef steers fed MANGLU. Compared with CON, MANGLU increased (P ≤ 0.05) the expression of five immune-related genes involved in recognition of and mounting immune defense against microbial pathogens. In conclusion, the results of this study demonstrated that supplemental MANGLU enhances beef cattle immunocompetence and productivity during feedlot receiving period.
International Trade
Authors: Krueger Anne O.
Published: December 2020

International trade and trade policy have become increasingly important and complex in recent years. In this comprehensive introduction to the key aspects of international trade policy, noted authority Anne O. Krueger explains what has happened and why these issues are so difficult. With evidence-based analysis and an even-handed approach, International Trade: What Everyone Needs to Know lays the foundation to understand what trade does and does not do. Focusing on the importance of trade in both goods and services, Krueger explores the effects of various trade policies step-by-step and demonstrates why economists generally support free trade. Krueger considers the historical experience, highlighting how technological changes and reduction of trade barriers helped transform the world economy. Tariffs, antidumping and countervailing duties, government procurement policies, preferential trading arrangements, trade with developing countries and emerging markets, and the World Trade Organization are examined. Krueger tackles the fundamental questions surrounding trade including: What are the benefits and costs? What are trade deficits and do they matter? Why do some people favor protectionism and barriers to trade? How does trade policy affect workers? Written in question-and-answer format, this non-technical introduction to the policies of international trade provides an indispensable guide to one of the most crucial elements of the global economy.
The Philippines
Authors: Rood Steven
Published: December 2020

Since the colonization of the Philippines by Spain in the sixteenth century, the island chain has been at the center of global trade flows, imperial rivalries, and the globalization process. From its role as the main base of Spain’s Pacific Galleon trade to its conquest centuries later by the United States and Japan, the Philippines has been a focal point of economic and military rivalry. Decolonized in 1946, the Philippines is growing economically after years of stagnation, is ruled today by a modern populist, President Rodrigo Duterte, and is embroiled in disputes with the East Asia region’s rising superpower, China. In The Philippines: What Everyone Needs to Know®, Steven Rood draws from more than 30 years of residence in and study of the Philippines in order to provide a concise overview of the nation. Arranged in a question-and-answer format, this guide shares concise, nuanced analysis and helps readers find exactly what they seek to learn about Filipino geography and geology, history, culture, economy, politics through the ages, and prospects for the future. This book is an ideal primer on an enormously diverse country that has been and will likely remain a key site in world affairs.
Biocontrol Potential of Bacillus amyloliquefaciens LYZ69 Against Anthracnose of Alfalfa (Medicago sativa)
Authors: Hu Jinling , Zheng Mingzhu , Dang Shuzhong , Shi Min , Zhang Jinlin , Li Yanzhong
Published: December 2020

Anthracnose is a destructive disease of alfalfa (Medicago sativa) that causes severe yield losses. Biological control can be an effective and eco-friendly approach to control this alfalfa disease. In the present study, Bacillus amyloliquefaciens LYZ69, previously isolated from healthy alfalfa roots, showed a strong in vitro antifungal activity against Colletotrichum truncatum, an important causal agent of anthracnose of alfalfa. The strain LYZ69 protected alfalfa plants (biocontrol efficacy of 82.59%) from anthracnose under greenhouse conditions. The cell-free culture (CFC) of LYZ69 (20%, vol/vol) caused 60 and 100% inhibition of mycelial growth and conidial germination, respectively. High-performance liquid chromatography tandem mass spectrometry separated and identified cyclic lipopeptides (LPs) such as bacillomycin D and fengycin in the CFC of LYZ69. Light microscopy and scanning electron microscopy revealed that the mixture of cyclic LPs produced by LYZ69 caused drastic changes in mycelial morphology. Fluorescence microscopy showed that the LPs induced reactive oxygen species accumulation and caused apoptosis-like cell death in C. truncatum hyphae. In summary, our findings provide evidence to support B. amyloliquefaciens LYZ69 as a promising candidate for the biological control of anthracnose in alfalfa.
Guidelines for screening and managing hypertension in children
Authors: Garvick Sarah , Ballen Eliza , Brasher Danielle , St. Amand Elizabeth , Ray Olivia , Vera Natalie , Gregory Tanya
Published: December 2020

Pediatric hypertension has risen to an overall prevalence of 16.3%. If left untreated, hypertension in children and adolescents can have significant implications for cardiovascular and renal health into adulthood, including stroke, coronary artery disease, kidney disease, and heart failure. In 2017, the American Academy of Pediatrics (AAP) released updated guidelines for the screening, evaluation, and management of pediatric hypertension. This article reviews the definition of pediatric hypertension, describes why the guidelines were updated, and defines treatment protocol. By familiarizing themselves with and applying these guidelines, clinicians will be able to appropriately screen and manage hypertension in children to prevent morbidity into adulthood.
Managing tumor lysis syndrome
Authors: Greguska Chloe
Published: December 2020

Tumor lysis syndrome (TLS) is one of the most common oncologic emergencies, occurring when tumor cell contents are rapidly released into the bloodstream. This release of cellular contents, including uric acid, phosphate, and potassium, can rapidly overwhelm the body's homeostasis mechanisms, leading to renal failure, seizures, cardiac dysrhythmias, or death. With an estimated 1.8 million new diagnoses of cancer projected in 2020 and an increase in the use of targeted agents for treatment, healthcare providers must be able to recognize, diagnose, and manage patients presenting with TLS.
Regional anaesthesia in the elderly patient a current perspective
Authors: Corcoran Eva , Kinirons Brian
Published: December 2020

Purpose of review

The world's population is ageing. Although regional anaesthesia is well established, it seems there is limited evidence to support its use over general anaesthesia in the elderly. This review aims to examine recent publications of regional anaesthesia in relation to this specific patient subgroup.

Recent Findings

There is a paucity of evidence specifically relating to regional anaesthesia in the elderly patient. Studies tend to be small, retrospective and can combine assessment of multiple surgical and anaesthetic techniques in single studies. Surgical stimulus and the associated stress response are linked with an increased risk of morbidity in elderly patients. Regional anaesthesia is associated with reduced morbidity, improved pain scores, improved patient satisfaction and reduced resource allocation. Regional anaesthesia can potentially offset some of the surgical stress response and should be considered as part of a multimodal and, where possible, the primary approach to anaesthesia and analgesia in the elderly patient.

Undoubtedly, peripheral nerve blocks improve analgesia and reduce opioid consumption and their associated side effects. This is beneficial in the perioperative care of elderly patients who may have less physiologic reserve to withstand these side effects. Future large prospective trials are required to evaluate the duration of action and safety profile of local anaesthetic agents and adjunct agents in the older patient.
COVID in obstetrics: labor analgesia and cesarean section
Authors: Guasch Emilia , Brogly Nicolas , Gilsanz Fernando
Published: December 2020

Purpose of review

This review is based on the latest evidence to provide a good standard of care for COVID-19 parturients and protection to healthcare givers.

Recent findings

COVID-19 by itself is not an indication for cesarean section. Different publications demonstrated the efficacy of neuraxial analgesia/anesthesia for delivery. Although SARS-CoV-2 was associated with a certain neurotropism, neuraxial block was not associated with neurological damage in COVID-19 parturients, and seems as safe and effective as in normal situations. It permits to avoid a general anesthesia in case of intrapartum cesarean section. Epidural failure is a concern: it may lead to a general anesthesia in case of emergency cesarean section. Local protocols and well-trained anesthesiologists will be helpful. COVID-19 patients require special circuits and every step (transfer to and from theatre, recovery, analgesia, and so on) should be planned in advance. For cesarean section under general anesthesia, personal protection equipment must be enhanced. Postoperative analgesia with neuraxial opioids, NSAIDs, or regional blocks are recommended. COVID-19 and pregnancy increase the risk of thrombosis, so thromboprophylaxis has to be considered and protocolized.

Anesthetic care for delivery in COVID-19 parturients should include neuraxial blocks. Special attention should be paid on the risk of thrombosis.
Determining the Effect of Transcranial Direct Current Stimulation on Depression and Anxiety in Methadone Consumers: A Randomized Controlled
Authors: Naeim Mahdi , Rezaeisharif Ali , Bagvand Samira Ghobadi
Published: December 2020

Background:

Preliminary evidence suggests transcranial direct current stimulation (tDCS) has antidepressant and antianxiety efficacy. Because its effects have not been tested on methadone consumers, we investigated its efficacy.

Objectives:

This research is aimed at determining the effect of tDCS on depression and anxiety in methadone consumers.

Methods:

The present study was conducted in a pretest-posttest design. In this research, 40 people were studied as a group. These people took a test before and after the 8 days of tDCS. After the primary test, people received device simulation for 8 consecutive days at a specific time. Kolmogorov-Smirnov and Wilcoxon tests were used for analyzing the data.

Results:

The results show that with the score of 1.69 for the first variable, the patients’ anxiety level is much lower at the time of the electric stimulation. Also, regarding the score of 1.62 in the second hypothesis, it can be stated that the depression level was much lower at the time of performing the simulation.

Conclusions:

It seems that tDCS can improve the severity of depression and anxiety symptoms. It can be used as an effective treatment.
Integrity of Databases for Literature Searches in Nursing
Authors: Oermann Marilyn H. , Wrigley Jordan , Nicoll Leslie H. , Ledbetter Leila S. , Carter-Templeton Heather , Edie Alison H.
Published: December 2020

The quality of literature used as the foundation to any research or scholarly project is critical. The purpose of this study was to analyze the extent to which predatory nursing journals were included in credible databases, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus, commonly used by nurse scholars when searching for information. Findings indicated that no predatory nursing journals were currently indexed in MEDLINE or CINAHL, and only one journal was in Scopus. Citations to articles published in predatory nursing journals are not likely found in a search using these curated databases but rather through Google or Google Scholar search engines.
Motion laboratory gait analysis and orthopedic resident education: preliminary results
Authors: Malone Jason B. , Burns Jessica D. , Belthur Mohan V. , Karlen Judson W.
Published: December 2020

Gait analysis in the pediatric and adult orthopedic patient populations can adjunct the diagnosis and treatment of a multitude of musculoskeletal conditions. Understanding of normal and abnormal gait biomechanics is an important aspect of orthopedic residency; yet, there is great variability in the time residency programs dedicate to gait analysis education. The purpose of this study was to investigate if formal gait analysis education during residency improves an orthopedic resident’s understanding of normal and pathologic gait. Five residency programs consisting of 81 resident subjects were surveyed at the beginning of the 2016–2017 academic year. The residents were divided into those with formal gait analysis education (group A) and those without (group B). Each resident was sent an online survey with 11 questions from former orthopedic in-training exams (OITE) regarding gait pattern analysis. The average number of correct questions was compared between the two groups with Student’s t-test. Fifty-three of the 81 surveys sent out were completed. There were 23 subjects in group A and 30 in group B. All five programs and all postgraduate years (PGYs) were represented (PGY1: 10, PGY2: 12, PGY3: 12, PGY4: 6, PGY5 12). The average score for all residents was 5.6 out of 11 correct (51%). The residents from group A averaged a significantly higher score (6.3) than group B (5.0) (P = 0.017). Understanding gait biomechanics is a critical skill for orthopedic surgeons, and residency training often lacks sufficient training in their curriculum. A good understanding of gait analysis allows orthopedic surgeons to analyze gait disturbances and develop patient-specific treatment plans in adult and pediatric populations. This study found improved knowledge of gait patterns amongst orthopedic residents with formal education. Even though the residents with formal education fared better than their counterparts, the overall percent correct was still low (51%). Evidence: Level 3: Prospective Cohort Study.
Association between abductor hallucis abductory force and navicular drop index, a predictive correlational study
Authors: Sarcevic Zoran Z. , Tepavcevic Andreja P.
Published: December 2020

The role of intrinsic muscles of the foot in the medial longitudinal arch mechanism was investigated in several recent studies. It is determined that the abductor hallucis muscle (AHM) has an important role in dynamic support of the arch. Objective of our preliminary study was to establish a relationship between the navicular drop index (NDI) and the AHM abduction force. A single group exploratory design was used. The participants were 127 athletes aged 8–16 years (m/f 74/53; 11.99 ± 2.11 years; 156.21 cm ± 15.51 cm; 47.61 kg ± 13.96 kg; 2–5 training h/week), examined at a regular sport medical checkup. Abductor hallucis force was measured by a digital Algometer FPX 25/220, which is a newly developed approach that should be properly assessed in further studies to establish standardization and qualification of the algometer for this specific use. Navicular drop test has been performed as originally developed by Brody. Data were analyzed using Student’s t-test, Mann–Whitney U test, contingency coefficients and logistic regression. Average NDI was found to be significantly different comparing the group with positive abduction force and the group that cannot perform the active abduction. Logistic regression indicated that the variable representing impossible active abduction was significantly associated with NDI. Preliminary results showed that there was a strong relationship between the hallux active abduction force and NDI in young athletes: the higher abduction force correlates to lower NDI. To determine clinical relevance of our investigation, further study is planned in which hallux active abduction force and NDI would be compared and correlated pre- and postspecific strengthening program.
Effect of rotational deformities after pediatric femoral fracture on clinical outcome
Authors: İğrek Servet , Akgülle Ahmet H. , Kesimer Mehmet D.
Published: December 2020

Femoral shaft fractures are the most common pediatric injuries that require hospitalization. Early closed reduction and spica casting are one of the most popular treatment options. One of the significant complications of spica casting is rotational deformities of the fracture. The present study aimed to determine the potential effects of rotational deformities in pediatric patients who underwent early spica casting after a femoral shaft fracture. Pediatric patients who underwent early spica casting following femoral shaft fractures were screened retrospectively. Radiological measurements were made on the patients’ initial postop radiographs who could be measured rotationally according to the defined radiological method. Twenty-three patients with more than 10° of rotation in their measurements were included in the study. Differences in leg length and rotation between both legs were calculated with clinical examination methods for all patients in the study. The gaits of the patients were observed; patient and family complaints were obtained. We found a strong and positive correlation between the rotational measurement made on the X-ray and the clinical measurement (R: 0.634, P: 0.001). For measurements made on X-ray, the mean rotational value was calculated as 27.2 ± 6.9 degrees. After the patients’ clinical examination, an average of 3.0 ± 1.7 degrees rotational difference was found between the broken limb and the healthy limb. No patient or family complained of trauma. Early spica casting, according to the age of the patient, is an effective treatment method. There may still be certain degrees of deformity after treatment, but patients well tolerate them even at high degrees. Accordingly, it was concluded that the rotational deformities less than 30 degrees would not cause clinical problems on children under 4 years of age which may require postoperative revisions or the use of various costly imaging techniques and include radiation.
The Hidden Cost of the Opioid Epidemic in the United States: Drug Screening in Insurance Claims
Authors: Day-Storms Jeremy J. , Kren Erin M. , Bush Jason , Souslova Tatiana , Kerr William , Baird Geoffrey S.
Published: December 2020

Background:

The opioid crisis has had a substantial financial impact on the health care system in the United States. This study evaluates how health plans have been affected financially and shows how a laboratory benefit management (LBM) program can be used to address related drug testing in an outpatient setting.

Methods:

Monthly claims data from private health plans were collected from June 1, 2016 to February 29, 2020. The total number of claims (units) for definitive and presumptive drug testing were calculated and the number of paid claims recorded. Claims distribution by laboratory type and medical code billed, the paid rate and compound annual growth rate, and the test distribution and paid rate of rendering providers who had submitted a minimum of 1000 claims were determined.

Results:

In total, 2,004,230 drug testing claims were submitted. After the LBM program was implemented, the percentage of paid claims for definitive drug testing (Healthcare Common Procedure Coding System code G0483) decreased and the paid rate for the low-cost tests (HCPCS code G0480) in physician office and independent laboratory settings increased. The compound annual growth rate for G0483 claims submitted indicated a 70.5% and 31.9% decrease in payments to physician offices and independent laboratories, respectively, for the period ending February 2020.

Conclusions:

An LBM program can positively address policy enforcement while reducing unnecessarily complex tests and limiting potential fraud, waste, and abuse by directing testing toward laboratories amenable to cost-efficient contractual savings. Moreover, for definitive drug testing, the enforcement of the use of Healthcare Common Procedure Coding System codes and a move toward more cost-efficient tests (G0480), when clinically applicable, supported by clinical practice guidelines, or evidence-based medicine, is an approach to providing medical benefits while maintaining health costs.