bluuebunny/crossref_metadata_2025 huggingface dataset:
Music, Leisure, and Education
Authors: Mantie Roger
Published: February 2022

Chapter 1 lays out the basic premise and background for the book by asking how formal education, under the thumb of neoliberalism, can continue to support the learning of endeavors like music making that are not “work-focused” or “productive.” Building upon the Ancient Greek problem of how to live (i.e., conduct or “the art of living”), the chapter lays out background information on leisure studies, Weber’s work ethic, methods inspired by Michel Foucault, the theoretical concepts of governmentality and pastoral power, and the social construction of school music. The chapter concludes by foreshadowing the arguments on music, leisure, and education that unfold in the rest of the book.
Leisure and Living
Authors: Mantie Roger
Published: February 2022

Chapter 2 serves primarily to provide background and context for readers less familiar with the concepts, histories, and etymologies of leisure (scholē), recreation (recreare), and play. The chapter also lays out the three classic understandings of leisure: time use, activity, and state of mind. Significantly, the chapter outlines one of the main rhetorical devices used in the book to problematize conduct, the art of living, and the ethics of leisure: that is, the interaction between the interrogative, How should one live? and the imperative, How one should live. The elaborated discussion of time and activity at the end of the chapter serves to underscore the work-and-play dualism that percolates throughout the book.
ANATOMY
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

The annelid body consists of three fundamental regions. There is always a presegmental region derived from the larval episphere, anterior to the prototroch region around the mouth.
SYLLIDAE GRUBE, 1850
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Syllidae constitutes a large and variable, but nevertheless highly characteristic group of polychaetes. The name comes from Syllis, a nymph in Greek mythology, who was the lover of the god Apollo and the mother of king Zeuxippos of Sikyon.
PHYLLODOCIDA INCERTAE SEDIS
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Pontodora is a small and poorly known holopelagic group including only the two described taxa Pontodora pelagica Greeff, 1879 and Epitoka pelagica Treadwell, 1943.
OENONIDAE KINBERG, 1865
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Oenonidae are an unusual group of annelids in that many of them are parasitic or have a parasitic phase in their life, often in other polychaetes. Most Oenonidae adults are medium- to large-sized annelids, ranging from 1 to 90 cm long with over 1000 segments (Paxton, 2000a) but usually thin. Externally many of them resemble Lumbrineridae, from which they can be separated by jaw structure and chaetae.
ONUPHIDAE KINBERG, 1865
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Quillworms (Hyalinoecia) and the Australian beachworms (Australonuphis) are among the better known Onuphidae; the former with highly characteristic tubes (Pl. 6f) and the latter for their size (up to several metres) and occurrence on sandy beaches and their importance as bait in fisheries. Overall, Onuphidae vary in size from a few millimetres to several metres, although sizes around a few centimetres are common. The anteriormost part is often cylindrical and widest, becoming medially and posteriorly more flattened. Many of these animals are tubicolous. Some (e.g. Australonuphis) have a thin and ephemeral tube. In others the tube is tough and may be highly characteristic, such as in Hyalinoecia, which construct a cylindrical, translucent, and quill-like tube (Pl. 6f), or in Nothria conchylega where it is distinctly flattened with an inner lining of parchment and large pieces of shells on the outside (Pl. 6h). Live specimens are iridescent and may have characteristic red or brown pigmentation patterns, often as transverse segmental bands; others are unpigmented (Pl. 6f–h).
DORVILLEIDAE CHAMBERLIN, 1919
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Dorvilleidae is a morphologically heterogeneous group, including some of the smallest described annelids with adult length of only a few hundred µm and only a few segments (Neotenotrocha). Others may attain a size up to 10 cm and have many segments (e.g. Dorvillea). The colour of live animals is variable, transparent to whitish being common (Pl. 7b–d; Fig. 31.2a), but sometimes with bright red or other pigmentation (Pl. 7a). Within Dorvilleidae, Ophryotrocha is well known through a series of studies (Sella and Ramella, 1999 and references within) for an impressive variation in mating systems. Interestingly, taxa showing no apparent morphological differentiation are separated by their differing reproductive habits. Some Dorvilleidae (e.g. Ophryotrocha) are also easily kept in culture and so provide excellent subjects for experimental studies.
HRABEIELLA PIZL AND CHALUPSKY, 1984
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Hrabeiella is an enigmatic terrestrial member of Annelida that appears to be the sister group to Aeolosomatidae.
OPHELIIDAE MALMGREN, 1867
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Opheliidae are commonly found in sandy or muddy substrates from intertidal regions down to more than 7000 m. They are often noticed when disturbed by rapidly swimming in an energetic way and some
CIRRATULIDAE RYCKHOLDT, 1851
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Compared with most annelid groups, Cirratulidae has been well studied in terms of biology, physiology, and population structure, but the overall systematics and taxonomy of the group remains quite problematic.
FLABELLIGERIDAE SAINT-JOSEPH, 1894
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Flabelligeridae, with a common name of bristle-cage worms, are generally recognizable by their papillose body, often coated with thick covering of sediment and the fact that the head is retractable between anterior segments which may project forward a ‘cage’ of chaetae (Pl. 14b–d).
FAUVELIOPSIDAE HARTMAN, 1971
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Fauveliopsidae is a small group of only around 30 species, best known for some Fauveliopsis taxa living in the empty shells of gastropods or scaphopods.
SIBOGLINIDAE CAULLERY, 1914
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Siboglinidae is among the most famous and well-studied clades of Annelida, though until recently they were treated as one or two phyla, Pogonophora and Vestimentifera, separated from Annelida.
SIPUNCULA STEPHEN, 1964
Authors: Rouse Greg W. , Pleijel Fredrik , Ekin Tilic
Published: February 2022

Sipuncula is a group of animals that for a long time was considered a distinct clade outside Annelida and the issue of their phylogenetic affinity has been a controversial and much disputed subject (Saiz-Salinas, 2018, for references).
Covid (in)equalities: labor market protection, health, and residential care in Germany, Sweden, and the UK
Authors: Ellison Nick , Blomqvist Paula , Fleckenstein Timo
Published: February 2022

How have differently institutionalized welfare regimes dealt with the Covid-19 crisis? In particular, how have they confronted the social and economic inequalities exposed by the virus? Taking three European countries—Germany, Sweden, and the UK, corresponding broadly to conservative-continental, social democratic, and liberal regime types—this paper tracks the virus response in the areas of income and employment protection and health and residential care. With attention paid to issues of “capacity” and the institutional arrangements in each case, we find that institutional histories in Germany and Sweden permitted a certain recidivistic reliance on established practices in the areas of employment and social protection. In sum, certain social and economic inequalities were mitigated as these countries set aside recent trends toward “liberalization” and mobilized longer-standing institutional capacities to protect some groups, although by no means all. Evidence of this trend is less clear in the health and residential care sectors, where Germany had existing capacity, allowing its older population to weather the crisis in better order than its counterparts in Sweden and the UK. In the UK, welfare liberalization has led to increased social and economic inequalities and funding reductions in health and residential care—all of which have reduced the country’s ability to deal with severe crisis. The Covid response in this case was agile, but also chaotic, with little being done to ameliorate the positions of the most vulnerable groups.
Legacies of Mistrust?
Authors: Silber Mohamed Heather , Heidt-Forsythe Erin
Published: February 2022

On average, over 1 in 10 women in the United States have difficulty getting pregnant and carrying a pregnancy to full term, with women of color experiencing infertility at nearly twice the rate of non-Hispanic white women. Although infertility rates are significantly higher within Black and Latino communities, treatment and success rates are significantly lower. We seek to understand whether views of in vitro fertilization (IVF, a common reproductive technology), particularly within communities of color, are shaped by a broader skepticism about new medical technology. Using data from a 2013 national survey conducted by the Pew Research Center, we measure medical mistrust across racial/ethnic groups and test whether these beliefs are associated with views toward IVF.
Stabilization of the SARS-CoV-2 receptor binding domain by protein core redesign and deep mutational scanning
Authors: Leonard Alison C , Weinstein Jonathan J , Steiner Paul J , Erbse Annette H , Fleishman Sarel J , Whitehead Timothy A
Published: February 2022

Stabilizing antigenic proteins as vaccine immunogens or diagnostic reagents is a stringent case of protein engineering and design as the exterior surface must maintain recognition by receptor(s) and antigen—specific antibodies at multiple distinct epitopes. This is a challenge, as stability enhancing mutations must be focused on the protein core, whereas successful computational stabilization algorithms typically select mutations at solvent-facing positions. In this study, we report the stabilization of SARS-CoV-2 Wuhan Hu-1 Spike receptor binding domain using a combination of deep mutational scanning and computational design, including the FuncLib algorithm. Our most successful design encodes I358F, Y365W, T430I, and I513L receptor binding domain mutations, maintains recognition by the receptor ACE2 and a panel of different anti-receptor binding domain monoclonal antibodies, is between 1 and 2°C more thermally stable than the original receptor binding domain using a thermal shift assay, and is less proteolytically sensitive to chymotrypsin and thermolysin than the original receptor binding domain. Our approach could be applied to the computational stabilization of a wide range of proteins without requiring detailed knowledge of active sites or binding epitopes. We envision that this strategy may be particularly powerful for cases when there are multiple or unknown binding sites.
Rights vs. Lived Realities: Women’s Views of Gender Equality in Relationships in Rural South Africa
Authors: Sennott Christie , Kane Danielle
Published: February 2022

South Africa’s constitution is among the world’s most ambitious in promoting gender equality, but the country continues to be marked by inequality and gender-based violence. Given this context, we analyze 43 interviews with Black women aged 18–55 in rural South Africa to explore how the constitutional ideal of gender equality—or “50/50”—has been interpreted and applied in women’s intimate relationships. Overall, we found that inequality and gender hierarchy were common in relationships. Women relied on two logics to explain the persistence of inequality in their relationships. First, women offered ideological support for gender norms supporting hierarchy by linking 50/50 to the abandonment of culture, tradition, and respect. Second, women viewed reaffirmation of gender inequality within relationships as a pragmatic way to avoid men’s violence and infidelity, thus protecting women from abandonment and HIV. Women’s views about equality in relationships were shaped by dominant gender norms, precarity in the local political economy, and the risks of violence and HIV/AIDS. Our findings expand theories of social change by highlighting how longstanding social norms, but also local political-economic and health conditions can influence views of equality and, ultimately, the local adoption or dismissal of international standards of rights and equality.
Identification of Mahonia Species as Alternate Hosts for Puccinia striiformis f. sp. tritici and Determination of Existence of Sexual Propagation of the Rust Pathogen on Mahonia Under Natural Conditions in China
Authors: Cheng Xiangrui , Zhuang Hua , Zhao Jing , Zhan Gangming , Kang Zhensheng , Zhao Jie
Published: February 2022

Many Berberis species have been identified as alternate hosts for Puccinia striiformis f. sp. tritici. Importantly, susceptible Berberis species are determined to play an important role in the occurrence of sexual reproduction, generation of new races of the rust pathogen. However, little is known about Mahonia serving as alternate hosts for P. striiformis f. sp. tritici and their role to commence sexual reproduction of the rust fungus under natural conditions. Herein, three Mahonia species or subspecies, Mahonia fortunei, M. eurybracteata subsp. ganpinensis, and M. sheridaniana, were identified as alternate hosts for P. striiformis f. sp. tritici, and seven Mahonia species were highly resistant to the rust pathogen. We recovered seven samples of P. striiformis f. sp. tritici from naturally rusted Mahonia cardiophylla plants. Totally, 54 single uredinium (SU) isolates, derived from the seven samples, generated 20 different race types, including one known race type, and 19 new race types. SNP markers analysis showed that all SU isolates displayed high phenotype diversity (H = 0.32) with a high Shannon’s information index (I = 0.49). Analysis of linkage disequilibrium indicated an insignificant rbarD value (rbarD = 0.003, P < 0.1). As a result, all SU isolates are sexually produced, suggesting that P. striiformis f. sp. tritici parasitizes susceptible Mahonia to complete sexual reproduction under natural conditions. The role of Mahonia in occurrence of wheat stripe rust are needed to study for management of the disease.
Outcomes of Telehealth for Wound Care: A Scoping Review
Authors: Kostovich Carol T. , Etingen Bella , Wirth Marissa , Patrianakos Jamie , Kartje Rebecca , Baharestani Mona , Weaver Frances M.
Published: February 2022

OBJECTIVE

To synthesize the literature on delivering wound care via telehealth and compare clinical, healthcare utilization, and cost outcomes when wound care is provided via telehealth (telewound) modalities compared with in-person care.

DATA SOURCES

An electronic search of PubMed, CINAHL, and Cochrane Clinical Trials databases for articles published from 1999 to 2019 was conducted using the following MeSH search terms: telewound, wound, wound care, remote care, telehealth, telemedicine, eHealth, mobile health, pressure injury, and ulcer.

STUDY SELECTION

Articles were included if they were a scientific report of a single study; evaluated a telehealth method; identified the type of wound of focus; and provided data on clinical, healthcare utilization, or cost outcomes of telewound care. In total, 26 articles met these criteria.

DATA EXTRACTION

Data were extracted and grouped into 13 categories, including study design, wound type, telehealth modality, treatment intervention, and outcomes measured, among others.

DATA SYNTHESIS

Of the 26 studies, 19 reported on clinical outcomes including overall healing and healing time; 17 studies reported on healthcare utilization including hospitalizations and length of stay; and 12 studies reported costs.

CONCLUSIONS

Evidence regarding the use of telewound care is weak, and findings related to the impact of telewound care on outcomes are inconsistent but indicate that it is not inferior to in-person care. Greater use of telehealth as a result of the COVID-19 pandemic points to further development of navigation and education models of telehealth for wound care. However, additional studies using rigorous research design and leveraging robust sample sizes are needed to demonstrate value.
Maladaptive coping mechanisms of sleep
Authors: Winegar Rhonda
Published: February 2022

Patients with insomnia have been shown to use many maladaptive coping mechanisms. This article examines the effect of such coping mechanisms on sleep quality by reviewing results of polysomnography and the Epworth Sleepiness Scale among 137 patients. The study showed that sleep quality was affected by these mechanisms.
Blade plate versus locking plate fixation of proximal femoral varus osteotomy in children with cerebral palsy
Authors: Oladeji Afolayan K. , Cummings Jason , Minaie Arya , Landau Andrew J. , Gordon Joe Eric , Hosseinzadeh Pooya
Published: February 2022

The hip is commonly affected in children with cerebral palsy (CP), requiring proximal femoral varus derotational osteotomies. Novel locking plates afford a popular alternative to traditional blade plates. The purpose of this study was to compare the effectiveness of blade plate versus locking plate fixation in children with CP undergoing proximal femoral osteotomy. We conducted a retrospective review of patients who underwent proximal femoral osteotomy over an 8-year period. Incidence of healing, failure of the procedure, and loss of varus correction were compared between the two groups (blade plate vs. locking plate). Independent samples t-tests and Chi-square analysis were employed to compare differences between continuous and categorical variables, respectively. A total of 268 hips [137 right (51.1%)] met inclusion criteria. Ninety-eight hips (36.6%) were fixed with blade plates [170 (63.4%) locking plates]. Although those in the blade plate cohort were more likely to achieve complete radiographic healing by 6 weeks postoperatively (41.09% vs. 18.84%; P < 0.050), there was no significant difference (P > 0.050) between the two groups for healing at 3, 6, and 12 months (P > 0.050). There was no significant difference between the two cohorts regarding the number of patients experiencing migration percentage at least 50% at 6 (3.06% vs. 3.53%) and 12 (3.06% vs. 5.88%) months (P > 0.050) or in those undergoing revision surgery at 12 (5.33% vs. 1.18%) and 24 (2.04% vs. 1.76%) months (P > 0.050). The findings of this retrospective study show similar outcomes between blade plate and proximal femoral locking plates in proximal femoral varus osteotomy in children with CP.
Aberrant Fibrin Clot Structure Visualized Ex Vivo in Critically Ill Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection
Authors: Brubaker Lisa S. , Saini Arun , Nguyen Trung C. , Martinez-Vargas Marina , Lam Fong W. , Yao Qizhi , Loor Michele M. , Rosengart Todd K. , Cruz Miguel A.
Published: February 2022

OBJECTIVES:

Disseminated fibrin-rich microthrombi have been reported in patients who died from COVID-19. Our objective is to determine whether the fibrin clot structure and function differ between critically ill patients with or without COVID-19 and to correlate the structure with clinical coagulation biomarkers.

DESIGN:

A cross-sectional observational study. Platelet poor plasma was used to analyze fibrin clot structure; the functional implications were determined by quantifying clot turbidity and porosity.

SETTING:

ICU at an academic medical center and an academic laboratory.

PATIENTS:

Patients admitted from July 1 to August 1, 2020, to the ICU with severe acute respiratory syndrome coronavirus 2 infection confirmed by reverse transcription-polymerase chain reaction or patients admitted to the ICU with sepsis.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Blood was collected from 36 patients including 26 ICU patients with COVID-19 and 10 ICU patients with sepsis but without COVID-19 at a median of 11 days after ICU admission (interquartile range, 3–16). The cohorts were similar in age, gender, body mass index, comorbidities, Sequential Organ Failure Assessment (SOFA) score, and mortality. More patients with COVID-19 (100% vs 70%; p = 0.003) required anticoagulation. Ex vivo fibrin clots formed from patients with COVID-19 appeared to be denser and to have smaller pores than those from patients with sepsis but without COVID-19 (percent area of fluorescent fibrin 48.1% [SD, 16%] vs 24.9% [SD, 18.8%]; p = 0.049). The turbidity and flow-through assays corroborated these data; fibrin clots had a higher maximum turbidity in patients with COVID-19 compared with patients without COVID-19 (0.168 vs 0.089 OD units; p = 0.003), and it took longer for buffer to flow through these clots (216 vs 103 min; p = 0.003). In patients with COVID-19, d-dimer levels were positively correlated with percent area of fluorescent fibrin (ρ = 0.714, p = 0.047). Denser clots (assessed by turbidity and thromboelastography) and higher SOFA scores were independently associated with delayed clot lysis.

CONCLUSIONS:

We found aberrant fibrin clot structure and function in critically ill patients with COVID-19. These findings may contribute to the poor outcomes observed in COVID-19 patients with widespread fibrin deposition.
A broadly neutralizing human monoclonal antibody against the hemagglutinin of avian influenza virus H7N9
Authors: Li Jingxin , Zhang Li , Bao Linlin , Wang Yuxiao , Qiu Lin , Hu Jialei , Tang Rong , Yu Huiyan , Shan Jun , Li Yan , Qin Chuan , Zhu Fengcai
Published: February 2022

Background:

The new emerging avian influenza A H7N9 virus, causing severe human infection with a mortality rate of around 41%. This study aims to provide a novel treatment option for the prevention and control of H7N9.

Methods:

H7 hemagglutinin (HA)-specific B cells were isolated from peripheral blood plasma cells of the patients previously infected by H7N9 in Jiangsu Province, China. The human monoclonal antibodies (mAbs) were generated by amplification and cloning of these HA-specific B cells. First, all human mAbs were screened for binding activity by enzyme-linked immunosorbent assay. Then, those mAbs, exhibiting potent affinity to recognize H7 HAs were further evaluated by hemagglutination-inhibiting (HAI) and microneutralization in vitro assays. Finally, the lead mAb candidate was selected and tested against the lethal challenge of the H7N9 virus using murine models.

Results:

The mAb 6-137 was able to recognize a panel of H7 HAs with high affinity but not HA of other subtypes, including H1N1 and H3N2. The mAb 6-137 can efficiently inhibit the HA activity in the inactivated H7N9 virus and neutralize 100 tissue culture infectious dose 50 (TCID50) of H7N9 virus (influenza A/Nanjing/1/2013) in vitro, with neutralizing activity as low as 78 ng/mL. In addition, the mAb 6-137 protected the mice against the lethal challenge of H7N9 prophylactically and therapeutically.

Conclusion:

The mAb 6-137 could be an effective antibody as a prophylactic or therapeutic biological treatment for the H7N9 exposure or infection.
Association between sex hormone-binding globulin and kidney function in men: results from the SPECT-China study
Authors: Zhang Haojie , Chen Chi , Zhang Xuan , Wang Yuying , Wan Heng , Chen Yi , Zhang Wen , Xia Fangzhen , Lu Yingli , Wang Ningjian
Published: February 2022

Background:

The association between sex hormone-binding globulin (SHBG) and renal function has rarely been reported in men. We aimed to investigate the above association in a community-based Chinese population.

Methods:

A total of 5027 men were included from the survey on prevalence for metabolic diseases and risk factors, which is a population-based study conducted from 2014 to 2016 in Eastern China. The estimated glomerular filtration rate (eGFR) was calculated according to the chronic kidney disease Epidemiology Collaboration equation. Low eGFR was defined as eGFR <60 mL·min−1·1.73 m−2.

Results:

After adjusting for age, smoking, metabolic factors, and testosterone, through increasing quartiles of SHBG, a significantly positive association between SHBG quartiles and eGFR was detected in men (Q1 vs. Q4, β −2.53, 95% confidence interval −3.89, −1.17, P
trend < 0.001). Compared with the highest quartile of SHBG, SHBG in the lowest quartile was associated with 96% higher odds of low eGFR (odds ratio 1.96, 95% confidence interval 1.10, 3.48) in the model after full adjustment. According to the stratified analyses, the associations between a 1-standard deviation increase in serum SHBG and the prevalence of low eGFR were significant in men aged ≥60 years old, waist circumference <90 cm, diabetes (no), hypertension (yes), dyslipidemia (no), and nonalcoholic fatty liver disease (no).

Conclusions:

Lower serum SHBG levels were significantly associated with lower eGFR and a higher prevalence of low eGFR in Chinese men independent of demographics, lifestyle, metabolic-related risk factors, and testosterone. Large prospective cohort and basic mechanistic studies are warranted in the future.
The Utility of Myoepithelial Cell Layer Identification in Adnexal Carcinomas
Authors: Plaza Jose A. , Chung Catherine , Wick Mark , Sangueza Martin , Gru Alejandro
Published: February 2022

The distinction of metastatic carcinomas to the skin (MCS) from cutaneous adnexal carcinomas can pose a significant diagnostic challenge. The differentiation between (MCS) from a primary cutaneous adnexal tumor is one of the most difficult tasks in the field of dermatopathology, and immunohistochemistry has only been partially helpful in solving this problem. In routine diagnostic surgical pathology, it is essential to identify the myoepithelial cell layer by immunohistochemistry to distinguish between an in situ and invasive breast carcinomas and when establishing the presence of microinvasion. The purpose of this study was to evaluate the role of myoepithelial cell layer expression in difficult cases of cutaneous adnexal carcinomas in which histologically it was challenging to separate them from MCS. We studied 38 adnexal carcinomas and evaluated them for myoepithelial markers to confirm the primary nature of the neoplasm. The used markers to search for myoepithelial cell layer retention included calponin, p63, and smooth muscle actin. Of the 38 cases, we found that 13 cases showed myoepithelial layer retention, confirming the primary cutaneous origin of the neoplastic process. The results of our study suggest that the presence of an identifiable retention of the myoepithelial cell layer in adnexal carcinomas could be a useful adjunct observation in the diagnosis of primary adnexal carcinomas, especially in the clinical setting of a questionable primary adnexal versus metastatic neoplasm.
The Impact of Preinjury and Secondary Attention-Deficit/Hyperactivity Disorder on Outcomes After Pediatric Traumatic Brain Injury
Authors: Narad Megan E. , Kaizar Eloise E. , Zhang Nanhua , Taylor H. Gerry , Yeates Keith Owen , Kurowski Brad G. , Wade Shari L.
Published: February 2022

Objective:

The objective of this study was to examine the impact of preinjury attention-deficit/hyperactivity disorder (PADHD) and secondary ADHD (SADHD) on outcomes after pediatric traumatic brain injury (TBI).

Methods:

Two hundred eighty-four individuals aged 11 to 18 years hospitalized overnight for a moderate-to-severe TBI were included in this study. Parents completed measures of child behavior and functioning and their own functioning. Linear models examined the effect of ADHD status (PADHD vs SADHD vs no ADHD) on the child's executive functioning (EF), social competence, and functional impairment, and parental depression and distress.

Results:

ADHD status had a significant effect on EF [F(2,269] = 9.19, p = 0.0001), social competence (F[2,263] = 32.28, p < 0.0001), functional impairment (F[2,269] = 16.82, p < 0.0001), parental depression (F[2,263] = 5.53, p = 0.005), and parental distress (F[2,259] = 3.57, p = 0.03). PADHD and SADHD groups had greater EF deficits, poorer social competence, and greater functional impairment than the no ADHD group. The SADHD group had greater levels of parental depression than the no ADHD and PADHD groups, and the SADHD group had higher parental distress than the no ADHD group.

Conclusion:

The results highlight the importance of early identification and management of ADHD symptoms after injury to mitigate downstream functional problems. Supporting parents managing new-onset ADHD symptoms may also be important.
Muscarinic Receptor Activation Reduces Force and Arrhythmias in Human Atria Independent of IK,ACh
Authors: Petersen Johannes , Castro Liesa , Bengaard Anne K. P. , Pecha Simon , Ismaili Djemail , Schulz Carl , Sahni Jascha , Steenpass Anna , Meier Christian , Reichenspurner Hermann , Jespersen Thomas , Eschenhagen Thomas , Christ Torsten
Published: February 2022

In human hearts, muscarinic receptors (M-R) are expressed in ventricular and atrial tissue, but the acetylcholine-activated potassium current (IK,ACh) is expressed mainly in the atrium. M-R activation decreases force and increases electrical stability in human atrium, but the impact of IK,ACh to both effects remains unclear. We used a new selective blocker of IK,ACh to elaborate the contribution of IK,ACh to M-R activation-mediated effects in human atrium. Force and action potentials were measured in rat atria and in human right atrial trabeculae. Cumulative concentration–effect curves for norepinephrine-induced force and arrhythmias were measured in the presence of carbachol (CCh; 1 µM) or CCh together with the IK,ACh –blocker XAF-1407 (1 µM) or in time-matched controls. To investigate the vulnerability to arrhythmias, we performed some experiments also in the presence of cilostamide (0.3 µM) and rolipram (1 µM), inhibiting PDE3 and PDE4. In rat atria and human right atrial trabeculae, CCh shortened the action potential duration persistently. However, the direct negative inotropy of CCh was only transient in human, but stable in rat atria. In rat and human atria, the negative inotropic effect was insensitive to blockage of IK,ACh by XAF-1407. In the presence of cilostamide and rolipram about 40% of trabeculae developed arrhythmias when exposed to norepinephrine. CCh prevented these concentration-dependent norepinephrine-induced arrhythmias, again insensitive to XAF-1407. Maximum catecholamine-induced force was not depressed by CCh. In human atrium, the direct and the indirect negative inotropic effect of CCh are independent of IK,ACh. The same applies to the CCh-mediated suppression of norepinephrine/PDE-inhibition-induced arrhythmias.
Effect of IL-1 Blockade With Anakinra on Heart Failure Outcomes in Patients With Anterior Versus Nonanterior ST Elevation Myocardial Infarction
Authors: Del Buono Marco Giuseppe , Damonte Juan Ignacio , Chiabrando Juan Guido , Markley Roshanak , Turlington Jeremy , Trankle Cory R. , Kang Le , Biondi-Zoccai Giuseppe , Van Tassell Benjamin W. , Abbate Antonio
Published: February 2022

Patients with ST elevation myocardial infarction (STEMI) are at risk of future heart failure (HF), particularly those with anterior STEMI. Interleukin-1 (IL-1) is a key mediator of the inflammatory response, and its blockade has emerged as a potential therapeutic strategy to prevent HF events. The aim of this analysis was to explore the effects of anakinra, an IL-1 receptor antagonist, on HF outcomes based on anterior versus nonanterior location STEMI and to explore whether this effect is mediated through the amelioration of left ventricular systolic function and cardiac remodeling. We pooled data from 3 early phase randomized clinical trials. The primary end point was a composite of all-cause death and new-onset HF at 1-year follow-up. The left anterior descending coronary artery as culprit vessel was used to identify anterior STEMI. We included 139 patients, 47 (34%) with anterior STEMI and 92 (66%) with nonanterior STEMI. Anakinra significantly reduced the combined end point of death or new-onset HF in patients with anterior STEMI [4 (13%) vs. 7 (42%), log-rank P value = 0.049] and in patients with nonanterior STEMI [3 (6%) vs. 9 (24%), log-rank P value = 0.014]. We found no significant differences comparing anakinra versus placebo in interval changes in left ventricular ejection fraction and volumes in anterior and nonanterior STEMI. In conclusion, anakinra is associated with a reduction of HF events in patients with STEMI, irrespective of anterior or nonanterior location, or of changes in left ventricular ejection fraction or cardiac remodeling.
RP2 X-LINKED RETINITIS PIGMENTOSA CARRIER STATE PRESENTING WITH VASCULAR LEAKAGE AND UNILATERAL MACULAR ATROPHY
Authors: Raparia Eva , Ballios Brian G. , Place Emily M. , Husain Deeba , Huckfeldt Rachel M.
Published: February 2022

Purpose:

We describe the unusual clinical presentation of a 33-year-old woman subsequently identified as a carrier of RP2-associated X-linked retinitis pigmentosa.

Methods:

Case report.

Results:

A 33-year-old woman without a known family history of retinal disease presented with unilateral reduced visual acuity and central scotoma in the left eye. Examination showed underlying macular atrophy in the left eye and a bilateral tapetal-like reflex. Full-field electroretinogram was abnormal in the left eye but normal in the right eye. Notable findings on wide-field imaging included bilateral peripheral vascular leakage on fluorescein angiography and a bilaterally symmetric radial pattern of hyperfluorescence on fundus autofluorescence. Genetic testing demonstrated a pathogenic variant in the gene RP2 confirming that she was a carrier of X-linked retinitis pigmentosa.

Conclusion:

We describe clinical features of the carrier state of RP2-XLRP and expand potential findings to include peripheral vascular leakage. This case highlights the importance of awareness of the carrier state, particularly if a family history cannot be provided.
Skin Cancer Back to Basics
Authors: Dhillon Soneet , Lake Eden
Published: February 2022

Anogenital squamous cell carcinoma is rare but an often-invasive malignancy that is becoming an increasingly prevalent public health problem. Infection with high-risk human papillomavirus variants plays a critical role in disease progression and occurrence. Immunosuppressive treatment, positive HIV status, number of sexual partners, and history of smoking increase neoplastic progression. Early diagnosis and treatment are pivotal in managing anogenital malignancies to improve quality of life and minimize extensive surgical excision. This article reviews lesion categorization, epidemiology, human-papillomavirus-driven dysplastic epithelial changes, risk factors, diagnostic criteria, treatment options, and prophylactic measures to improve patient outcomes.
Physician Assistant Student Training in Question Formulation: A Quasi-Experiment
Authors: Eldredge Jonathan , Nogar Carmella
Published: February 2022

Purpose

To measure improvement in evidence-based practice (EBP) question formulation skills in physician assistant (PA) students using a new approach that included a rubric.

Methods

Quasi-experiment study design featuring pre- and posttests in which the participants are their own controls using a paired t-test to measure skills improvement.

Results

Physician assistant students increased their skills in formulating EBP questions by a statistically significant margin.

Conclusions

This new approach to teaching EBP question formulation with its rubric offers a vehicle for training PA students in question formulation skills that is potentially more versatile than the conventional PICO (Population, Intervention, Comparison, and Outcomes) approach.
Pipeline to the Physician Assistant Profession: A Look to the Future
Authors: VanderMeulen Stephane , Snyder Jennifer A. , Kohlhepp William , Mustone Alexander Lisa , Straker Howard , Bowser Jonathan , Bondy Mary Jo
Published: February 2022

The current pipeline of physician assistant (PA) school applicants reflects the future workforce of the profession, which is why the admissions process with all its components and variables is so important. Many studies have shown that a workforce that represents the patients it cares for leads to improved health outcomes, especially among underrepresented minority populations. Yet, PA programs have made little progress over the past 2 decades in increasing the diversity of matriculants and graduates. As a profession, it is our collective responsibility to intentionally advance diversity, equity, and inclusion, and examining the admissions process would be the most logical place to start.
The Effect of Sex, Sport, and Preexisting Histories on Baseline Concussion Test Performance in College Lacrosse and Soccer Athletes
Authors: Mihalik Jason P. , Teel Elizabeth F. , Ford Cassie B. , Amalfe Stephanie A. , Barczak-Scarboro Nikki E. , Lynall Robert C. , Riegler Kaitlin E. , Wasserman Erin B. , Putukian Margot
Published: February 2022

Objective:

To study sex and sport differences in baseline clinical concussion assessments. A secondary purpose was to determine if these same assessments are affected by self-reported histories of (1) concussion; (2) learning disability; (3) anxiety and/or depression; and (4) migraine.

Design:

Prospective cohort.

Setting:

National Collegiate Athletic Association D1 Universities.

Participants:

Male and female soccer and lacrosse athletes (n = 237; age = 19.8 ± 1.3 years).

Assessment of Risk Factors:

Sport, sex, history of (1) concussion; (2) learning disability; (3) anxiety and/or depression; and (4) migraine.

Main Outcome Measures:

Sport Concussion Assessment Tool 22-item symptom checklist, Standardized Assessment of Concussion, Balance Error Scoring System (BESS), Generalized Anxiety Disorder 7-item scale, and Patient Health Questionnaire.

Results:

Female athletes had significantly higher total symptoms endorsed (P = 0.02), total symptom severity (P < 0.001), and BESS total errors (P = 0.01) than male athletes. No other sex, sport, or sex-by-sport interactions were observed (P > 0.05). Previous concussion and migraine history were related to greater total symptoms endorsed (concussion: P = 0.03; migraine: P = 0.01) and total symptom severity (concussion: P = 0.04; migraine: P = 0.02). Athletes with a migraine history also self-reported higher anxiety (P = 0.004) and depression (P = 0.01) scores. No other associations between preexisting histories and clinical concussion outcomes were observed (P > 0.05).

Conclusions:

Our findings reinforce the need to individualize concussion assessment and management. This is highlighted by the findings involving sex differences and preexisting concussion and migraine histories.

Clinical Relevance:

Clinicians should fully inventory athletes' personal and medical histories to better understand variability in measures, which may be used to inform return-to-participation decisions following injury.
Estimating the optimum number of colon biopsies for diagnosing microscopic colitis: a systematic review
Authors: Malik Adnan , Nadeem Mahum , Javaid Sadia , Malik Muhammad Imran , Enofe Ikponmwosa , Abegunde Ayokunle T.
Published: February 2022

Microscopic colitis (MC) is an inflammatory disease of the colon characterized by persistent watery, nonbloody diarrhea. Subtypes of MC include collagenous and lymphocytic MC. Microscopic examination of colon tissue is crucial to confirming the diagnosis because the colonic mucosa often appears normal during flexible sigmoidoscopy or colonoscopy. We aim to determine the optimal sites and minimum number of colon biopsies required to diagnose MC from published studies. We systematically searched PubMed, Web of Science, Scopus, and Cochrane databases from inception until October 2020 using the following keywords: microscopic, lymphocytic, collagenous, colitis, biopsy, and biopsies. We screened the search results for eligibility and extracted data from the included studies. We pooled the numbers of biopsies provided by each study to calculate the mean number of biopsies, SD, and SEM. We included three retrospective cohort studies with 356 patients (148 collagenous, 192 lymphocytic, and 16 mixed), and the total number of biopsies were 1854. The mean number of biopsies that were recommended by the included studies are 4, 4, and 9, respectively. The pooled mean ± SD is 5.67 ± 2.89. The included studies reported that biopsies from the ascending colon (AC) and descending colon (DC) had the highest diagnostic rates. To ensure a high level of certainty in diagnosing MC, a total of six biopsies should be taken from the AC and DC (3 AC and 3 DC). However, special care should be directed toward differentiating MC from other forms of colitis. In addition, detailed and comparative studies are needed to provide stronger recommendations to diagnose MC.
Pharmacological Management of Heroin Withdrawal Syndrome
Authors: Manu Peter , Rogozea Liliana M. , Shulman Matisyahu
Published: February 2022

Background:

Opioid use disorder continues to have a significant impact on public health morbidity and mortality throughout the United States and elsewhere. Managing opioid withdrawal is a critical treatment goal in individuals entering treatment with an active opioid use.

Study Question:

What are the milestones of the changes in the expert approach to the pharmacological management of heroin withdrawal syndrome in the past century?

Study Design:

To determine the changes in the expert approach to the management of heroin withdrawal syndrome, as presented in a widely used textbook in the United States.

Data Sources:

The chapters on opioid dependence in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020.

Results:

Opioid replacement taper with morphine (1927–1947), codeine (1931–1943), and methadone (1951–present) administered for 3–10 days has remained the main intervention. The anticholinergic drugs, scopolamine and atropine, were recommended from 1927 to 1943, but their use has never been backed by scientific evidence. Newer approaches relied on clonidine, an alpha-2 receptor agonist used since 1982, and buprenorphine, an opioid agonist/antagonist endorsed for the treatment of heroin withdrawal in 2000.

Conclusions:

The pharmacological management of heroin withdrawal syndrome in the past century has progressed from the introduction of methadone to the utilization of clonidine and buprenorphine. More recent advances in treating opioid use disorder have changed the goals of opioid withdrawal management to achievement of abstinence from all opioids to facilitation of long-term treatment with medications for opioid use disorder.
Lessons Learned in Providing Just-in-Time Simulation Education on Manual Pronation to Medical-Surgical/Telemetry Registered Nurses
Authors: Hall Debra S. , Allen Kelsea R. , Massey Beverly A.
Published: February 2022

Patients hospitalized with COVID-19 may require manual pronation therapy while receiving mechanical ventilation. In preparation of a pandemic admission surge, nurses with medical-surgical and telemetry experience can be provided just-in-time education to support the care of these patients and other critically ill patients. A description of the assessment, plan, implementation, and evaluation of just-in-time simulation education activities using the ADDIE model assists staff development educators to develop education in similar circumstances.
Detecting Language Associated With Home Healthcare Patient’s Risk for Hospitalization and Emergency Department Visit
Authors: Song Jiyoun , Ojo Marietta , Bowles Kathryn H. , McDonald Margaret V. , Cato Kenrick , Rossetti Sarah Collins , Adams Victoria , Chae Sena , Hobensack Mollie , Kennedy Erin , Tark Aluem , Kang Min-Jeoung , Woo Kyungmi , Barrón Yolanda , Sridharan Sridevi , Topaz Maxim
Published: February 2022

Background

About one in five patients receiving home healthcare (HHC) services are hospitalized or visit an emergency department (ED) during a home care episode. Early identification of at-risk patients can prevent these negative outcomes. However, risk indicators, including language in clinical notes that indicate a concern about a patient, are often hidden in narrative documentation throughout their HHC episode.

Objective

The aim of the study was to develop an automated natural language processing (NLP) algorithm to identify concerning language indicative of HHC patients’ risk of hospitalizations or ED visits.

Methods

This study used the Omaha System—a standardized nursing terminology that describes problems/signs/symptoms that can occur in the community setting. First, five HHC experts iteratively reviewed the Omaha System and identified concerning concepts indicative of HHC patients’ risk of hospitalizations or ED visits. Next, we developed and tested an NLP algorithm to identify these concerning concepts in HHC clinical notes automatically. The resulting NLP algorithm was applied on a large subset of narrative notes (2.3 million notes) documented for 66,317 unique patients (n = 87,966 HHC episodes) admitted to one large HHC agency in the Northeast United States between 2015 and 2017.

Results

A total of 160 Omaha System signs/symptoms were identified as concerning concepts for hospitalizations or ED visits in HHC. These signs/symptoms belong to 31 of the 42 available Omaha System problems. Overall, the NLP algorithm showed good performance in identifying concerning concepts in clinical notes. More than 18% of clinical notes were detected as having at least one concerning concept, and more than 90% of HHC episodes included at least one Omaha System problem. The most frequently documented concerning concepts were pain, followed by issues related to neuromusculoskeletal function, circulation, mental health, and communicable/infectious conditions.

Conclusion

Our findings suggest that concerning problems or symptoms that could increase the risk of hospitalization or ED visit were frequently documented in narrative clinical notes. NLP can automatically extract information from narrative clinical notes to improve our understanding of care needs in HHC. Next steps are to evaluate which concerning concepts identified in clinical notes predict hospitalization or ED visit.