bluuebunny/crossref_metadata_2025 huggingface dataset:
Sciaphila kozushimensis (Triuridaceae), a new mycoheterotrophic plant from Kozu Island, Izu Islands, Japan, based on morphological and molecular data

Authors: SUETSUGU KENJI , KINOSHITA AKIHIKO
Published: March 2020

A new species of Sciaphila (Triuridaceae), S. kozushimensis Suetsugu, is described from Kozu Island, Izu Islands, Japan. The new species is similar to S. tosaensis in having unisexual flowers (the female towards the base of the rachis), perianth-segments without any appendages and club-shaped style that is as long as or slightly exceeds ovary in the flowering stage. However, it is distinguishable by smaller male flowers, wide and acuminate male perianth segments and somewhat dissimilar perianth segments. An illustration and molecular analysis based on ITS sequences of the new species are provided. A key to the Japanese Sciaphila is also provided for identification of these rare mycoheterotrophic plants.
Each 0.5°C of Warming Increases Annual Flood Losses in China by More than US$60 Billion
Authors: Jiang Tong , Su Buda , Huang Jinlong , Zhai Jianqing , Xia Jun , Tao Hui , Wang Yanjun , Sun Hemin , Luo Yong , Zhang Liping , Wang Guojie , Zhan Chesheng , Xiong Ming , Kundzewicz Zbigniew W.
Published: March 2020

In the warming climate, flood risk is likely to increase over much of the globe. We present projections of changes of flood losses in China for a range of global warming scenarios, from 1.5° to 4.0°C above the preindustrial temperature, with a 0.5°C step. Projections of flood losses in China are based on river runoff simulations by a distributed hydrological model driven by multiple downscaled general circulation models, the national GDP projected at shared socioeconomic pathways, and the “intensity–loss rate” function. When interpreting changes caused by the combined effect of economic and climatic conditions, flood losses in China are projected to soar in the future, particularly in lowland regions subject to rapid economic growth. Under global warming of 1.5° and 4.0°C, in an average year, flood losses are projected to be, respectively, 4 and 17 times that at present. Pursuing the international climate policy target of limiting global warming is projected to reduce exposure to floods in China. In this way, flood losses in China can be reduced by tens of billions of U.S. dollars (on average, US$67 billion and up to 0.04% of GDP) for each 0.5°C that warming is reduced. Our study improves understanding of the impact of climatic and nonclimatic changes on flood risk. Our scientific contribution is the first study to quantify flood impacts across China under different development pathways (shared socioeconomic pathways) for a broad range of global warming levels.
Interdecadal Variation of Winter Cold Surge Path in East Asia and Its Relationship with Arctic Sea Ice
Authors: Yang Xiaoye , Zeng Gang , Zhang Guwei , Li Zhongxian
Published: March 2020

The paths of winter cold surge (CS) events in East Asia (EA) from 1979 to 2017 are tracked by the Flexible Particle (FLEXPART) model using ERA-Interim daily datasets, and the probability density distribution of the paths is calculated by the kernel density estimation (KDE) method. The results showed that the paths of CSs are significantly correlated with the intensity of the CSs, which shows an interdecadal transition from weak to strong around 1995. CS paths can be classified into two types, namely, the western path type and the northern path type, which were more likely to occur before and after 1995, respectively. Before 1995, the cold air mainly originated from Europe and moved from west to east, and the synoptic features were associated with the zonal wave train. After 1995, cold air accumulated over western Siberia and then invaded EA along the northern path, and the synoptic features were mainly associated with the blocking structure. The geopotential height (GPH) anomalies over the Arctic were abnormally strong. This paper further analyzes the relationship between CSs and winter sea ice concentration (SIC) in the Arctic. The results show that the intensity of CSs is negatively correlated with the Barents SIC (BSIC). When the BSIC declines, the upward wave flux over the Barents Sea is enhanced and expanded to the midlatitude region. GPH anomalies over the Arctic are positive and form a negative AO-like pattern, which is conducive to the formation of the northern path CS. Furthermore, the observed results are supported by numerical experiments with the NCAR Community Atmosphere Model, version 5.3 (CAM5.3).
Hues of Martyrdom: Monastic and Lay Asceticism in Two Homilies of Gregory the Great on the Gospels
Authors: Hoel Nikolas O
Published: March 2020

Pope Gregory I was the first monk to hold the office of Bishop of Rome, and he was one of the most prolific papal writers of the Middle Ages. It should not be a surprise that his views on monasticism can be found in everything that he wrote, including the Homiliae in Evangelia. This text includes lessons that would be heard by both monks and lay people, because both would have been listening to the sermons. By looking at the first two of these homilies, it can be determined that Gregory urged his audience to strive for asceticism, which he equated to martyrdom. Yet, the asceticism of the monk could not be the same as that of the lay person. This article argues that Gregory conceived of two types on non-red martyrdom: the white martyrdom of the monks which served as the model for the blue martyrdom of the laity.
What Should Be the Objective of an Emancipatory Project?
Authors: Navarro Vicente
Published: March 2020

This article covers a very central issue in the discussions of the implications of exploitation for the health, quality of life, and well-being of populations. Essentially, the objective of any emancipatory project should be the elimination of any form of exploitation, whether of class, gender, race, nation, or the environment. This article explores the interrelatedness between different types of exploitation and demonstrates how all forms of exploitation are impacted by the political context within which they exist. It compares the levels of class and gender exploitation (as well as environmental exploitation) in countries governed by different political traditions, underlining the enormous importance this political context has in shaping not only each form of exploitation but how they are related. The article concludes that those countries which have an ideological project that connects all these different projects of liberation have less exploitation of each type of discrimination.
Family Letter Writing in Terminal Cancer
Authors: Nirk Tina L.
Published: March 2020

In this article, I examine relational dynamics within a family who exchange letters after the experience of terminal cancer. The collected letters of a terminally ill husband and father to his children are presented as documents for growth. The letters are explored as a meaning making narrative of a family affected by loss and uncharted territory. As a participant researcher, I composed a letter to my husband 2 years after his death using autoethnography as a method of inquiry. Our children also created letters for their father 2 years after his death. Intentional references are made to the transformative value of letters as narrations of reflections, anxieties, and paradigm shifts. The value of family letter writing within terminal cancer is offered as collaboration, connection despite death, and re/writing a future with a loving regard for shared stories.
Immediate and 1‐Year Outcomes with a Slim Modiolar Cochlear Implant Electrode Array
Authors: Durakovic Nedim , Kallogjeri Dorina , Wick Cameron C. , McJunkin Jonathan L. , Buchman Craig A. , Herzog Jacques
Published: March 2020

Objective

To explore the immediate and 1‐year outcomes of patients who underwent implantation with the slim modiolar electrode (SME).

Study Design

Consecutive case series with chart review.

Setting

Tertiary referral academic center.

Subject and Methods

Between May 2016 and August 2018, a total of 326 cochlear implantations (CIs) were performed. Intraoperative x‐rays were performed in all cases to identify tip rollovers. Scalar location was identified for 76 CIs that had postoperative computed tomography reconstructions. Speech outcomes were measured at 3, 6, and 12 months with consonant‐nucleus‐consonant word and AzBio sentences in quiet and noise (+10‐dB signal‐to‐noise ratio). Preservation of hearing was defined as maintaining a low‐frequency pure tone average ≤80 dB at 250 and 500 Hz.

Results

Among 326 CIs, 23 (7%) had tip rollovers. Postoperative reconstructions revealed 5 of 76 (6.6%) scalar translocations. A subset of 177 cases met criteria for evaluation of speech perception scores. The marginal mean differences between presurgery and 12 months for speech tests were as follows: consonant‐nucleus‐consonant, 43.7 (95% CI, 39.8‐47.6); AzBio in quiet, 49.7 (95% CI, 44.9‐54.4); and AzBio in noise, 29.9 (95% CI, 25.2‐34.7). Sixty‐one patients were identified with preservable hearing (low‐frequency pure tone average ≤80 dB), and 12 of 61 (20%) preserved hearing at 1 year.

Conclusion

CI with SME provides reliable scala tympani insertion in a consistent perimodiolar position. An initially increased tip rollover rate improved with case volume and sheath design improvement. For long‐term outcomes, speech performance was comparable to that of other cochlear implants. While hearing preservation for the SME may be better than prior perimodiolar electrodes, consistent outcomes are unlikely.
Long‐Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience
Authors: Vora Amy , Holt Shelby , Haque Wasim , Lingvay Ildiko
Published: March 2020

Objective

To assess outcomes of thyroid nodules analyzed with the AFIRMA gene expression classifier (GEC) and to perform a comprehensive literature review.

Study Design

Retrospective analysis of patients with thyroid nodules who underwent AFIRMA GEC testing at our institution.

Settings

A tertiary care academic institution.

Subjects and Methods

We collected clinical outcomes for 416 thyroid nodules that were analyzed with AFIRMA GEC between 2011 and 2015, including long‐term follow‐up through 2019. We performed a comprehensive literature review.

Results

The resection rate for nodules with “suspicious” GEC results was 85% with a positive predictive value of 37%. The resection rate for nodules with “benign” GEC results was 24% with a negative predictive value of 90%. The prevalence of thyroid malignancy in patients with thyroid nodules with indeterminate cytology at our institution during this timeframe was 41%, thus lowering our negative predictive value. Mean follow‐up duration for unresected nodules was 27.8 months. Our resection rates for nodules with “benign” GEC were among the highest reported in the literature.

Conclusions

Molecular marker testing of thyroid nodules with indeterminate cytology can aid in the surgical decision making by obviating the need for diagnostic surgery and/or guiding extent of resection. Patients with other indications for surgery may not benefit from such costly testing.
Supportive Care Needs of Patients with Head and Neck Cancer Referred to Palliative Medicine
Authors: Lin Chen , Kang Stephen Y. , Donermeyer Samantha , Teknos Theodoros N. , Wells‐Di Gregorio Sharla M.
Published: March 2020

Objective

Patients with head and neck cancer (HNC) face a unique set of unmet needs. A subset of these patients experience symptom control challenges related to their disease burden and treatments. A multidisciplinary approach involving palliative medicine is underutilized but crucial to identify and address these concerns. There is limited information on palliative integration with head and neck oncology.

Study Design

Case series with planned data collection.

Setting

Academic quaternary care center.

Subjects and Methods

We provide descriptive analyses of patients with HNC, including psychodiagnostic assessment and validated quality‐of‐life screening, from patients’ first encounter at outpatient palliative medicine.

Results

HNC (N = 80) contributed the greatest number of palliative referrals (25%) between 2010 and 2012. This cohort was 74% male and 79% Caucasian with a mean age of 53 years (95% CI, 51.1‐54.9) and with stage IV disease of the oral cavity (28%) or oropharynx (31%). Sixty‐three percent of patients had no evidence of disease. Seventy‐five percent had a psychological history based on DSM‐IV criteria (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and 70% had a history of substance use disorder. The most distressing quality‐of‐life concerns were pain, housing and financial problems, and xerostomia.

Conclusions

Patients with HNC who were referred to palliative medicine are burdened by multiple physical, psychological, substance use, and social challenges. We recommend comprehensive cancer‐specific screening, such as the James Supportive Care Screening, to triage patients to appropriate supportive care services. Palliative care is one of many services that these patients may need, and it should be utilized at any point of the disease trajectory rather than reserved for end‐of‐life care.
Influence of Sevoflurane‐Based Anesthesia versus Total Intravenous Anesthesia on Intraoperative Neuromonitoring during Thyroidectomy
Authors: Li Xiaoxi , Zhang Bin , Yu Ling , Yang Jiaonan , Tan Hongyu
Published: March 2020

Objective

To examine the influence of sevoflurane‐based combined intravenous and inhaled anesthesia versus propofol‐based total intravenous anesthesia (TIVA) on intraoperative neuromonitoring (IONM) during thyroidectomy.

Study Design

A randomized controlled trial.

Setting

The present study was conducted in a tertiary hospital.

Subjects and Methods

Forty patients were randomly assigned to a sevoflurane‐based combined intravenous and inhalation group (group S) or a propofol‐based total intravenous group (group P). Anesthesia was induced with midazolam, sufentanil, propofol, and cisatracurium in both groups and was maintained with sevoflurane and remifentanil in group S and with TIVA with propofol and remifentanil in group P. IONM was performed intermittently according to the IONM formula standard.

Results

The time until detection of the first positive electromyographic (EMG) signal was significantly longer in group S (median, 41.0 minutes [interquartile range, 37.5‐49.3]) than in group P (37.0 minutes [33.3‐41.5], P =. 028). All patients in group P had a positive EMG signal at initial monitoring, whereas 8 patients (40.0%) in group S did not. The rate of positive EMG signal at initial monitoring was significantly higher in group P than in group S (P =. 006). The amplitude of the evoked potentials at V1, R1, R2, and V2 were similar between the groups.

Conclusion

Combined intravenous and inhaled anesthesia based on sevoflurane‐remifentanil prolonged the time until detection of a positive EMG signal during IONM as compared with TIVA with propofol‐remifentanil in patients undergoing thyroidectomy.
Determinants of nutritional knowledge, attitude, and practice among southwestern Iranian households: A community-based study
Authors: Naghashpour Mahshid , Mansouri Samaneh , Vadizadeh Ali , Cheraghian Bahman , Fallahi Reza , Vaziri Fateme
Published: March 2020

Background:

Malnutrition is generally due to a lack of nutritional information rather than food deficiency. Therefore, the current knowledge, attitudes, and practice (KAP) of the target audience should be evaluated to eliminate malnutrition. However, KAP varies across demographic status and socioeconomic status (SES).

Aim:

The associations of nutritional KAP with demographic and socioeconomic variables were evaluated among households living in urban and rural areas of southwestern Iran.

Methods:

A cross-sectional, population-based study was conducted on 842 household heads (492 urban and 350 rural) using a standardized NUTRIKAP Household Questionnaire. The data evaluating nutritional KAP as well as demographic and socioeconomic information were obtained using a multi-stage cluster sampling method. SES score was also computed.

Results:

Urban households had a higher level of nutritional knowledge ( p < 0.05) but a lower level of nutritional attitude ( p < 0.001) and practice ( p < 0.001) compared with the rural ones. Rural households with the poorest quintiles of SES were 0.4 times less likely to have good nutritional knowledge (adjusted odds ratio = 0.4, confidence interval: 0.2, 0.9; p < 0.05), compared with higher quintiles. Households with an over-60-years-old household head had significantly higher nutritional attitude ( p < 0.05) and practice ( p <0.01) scores than households with younger ones. Households with male household heads had a higher nutritional practice score compared with households with female ones.

Conclusions:

These results can indicate the role of demographic and socioeconomic determinants in KAP of Iranian households towards the principle of nutrition and can be effective in prioritizing the implementation of nutritional interventions including nutrition education for them.
Adnexal masses in pregnancy: an updated review on diagnosis and treatment
Authors: D’Ambrosio Valentina , Brunelli Roberto , Musacchio Lucia , Del Negro Valentina , Vena Flaminia , Boccuzzi Gaia , Boccherini Chiara , Di Donato Violante , Piccioni Maria Grazia , Benedetti Panici Pierluigi , Giancotti Antonella
Published: March 2020

Adnexal masses are not common in pregnancy. They are often discovered incidentally during routine ultrasound examinations. In general, 24%–40% of the cases are benign tumors; up to 8% are malignant tumors. Adnexal masses are usually asymptomatic, but sometimes can be responsible for abdominal or pelvic pain. Transvaginal and transabdominal ultrasound is essential to define the morphology of pelvic masses and to distinguish between benign and malignant cases. Magnetic resonance imaging can be a complementary examination when ultrasound findings are equivocal and a useful additional examination to better define tissue planes and relations with other organs. Patient counseling can be challenging because there is no clear consensus on the management of adnexal masses during pregnancy. Treatment options consist of observational management (in case of asymptomatic women with reassuring instrumental findings) or surgery (via laparoscopy or laparotomy). Surgery can be offered as a primary tool when cancer is suspected or when acute complications such as ovarian torsion occur.
Associations Between Initial Clinical Examination and Imaging Findings and Return-to-Sport in Male Athletes With Acute Adductor Injuries: A Prospective Cohort Study
Authors: Serner Andreas , Weir Adam , Tol Johannes L. , Thorborg Kristian , Yamashiro Eduardo , Guermazi Ali , Roemer Frank W. , Hölmich Per
Published: March 2020

Background:

Time to return-to-sport (RTS) after acute adductor injuries varies among athletes, yet we know little about which factors determine this variance.

Purpose:

To investigate the association between initial clinical and imaging examination findings and time to RTS in male athletes with acute adductor injuries.

Study Design:

Cohort study (Prognosis); Level of evidence, 2.

Methods:

Male adult athletes with an acute adductor injury were included within 7 days of injury. Standardized patient history and clinical and magnetic resonance imaging (MRI) examinations were conducted for all athletes. Athletes performed a supervised standardized criteria-based exercise treatment program. Three RTS milestones were defined: (1) clinically pain-free, (2) completed controlled sports training, and (3) first full team training. Univariate and multiple regression analyses were performed to determine the association between the specific candidate variables of the initial examinations and the RTS milestones.

Results:

We included 81 male adult athletes. The median duration for the 3 RTS milestones were 15 days (interquartile range, 12-28 days), 24 days (16-32 days), and 22 days (15-31 days), respectively. Clinical examination including patient history was able to explain 63%, 74%, and 68% of the variance in time to RTS. The strongest predictors for longer time to RTS were pain on palpation of the proximal adductor longus insertion or a palpable defect. The addition of MRI increased the explained variance with 7%, 0%, and 7%. The strongest MRI predictor was injury at the bone-tendon junction. Post hoc multiple regression analyses of players without the 2 most important clinical findings were able to explain 24% to 31% of the variance, with no added value of the MRI findings.

Conclusion:

The strongest predictors of a longer time to RTS after acute adductor injury were palpation pain at the proximal adductor longus insertion, a palpable defect, and/or an injury at the bone-tendon junction on MRI. For athletes without any of these findings, even extensive clinical and MRI examination does not assist considerably in providing a more precise estimate of time to RTS.
Synthesis and properties of soluble polyimides containing tert-butyl, ether linkages, and triphenylmethane units
Authors: Qin Zhuwei , Lv Suyun , Wu Yixuan , Wang Cong , Zhang Siyu , Ban Sa , Yin Daxue
Published: March 2020

A molecular theory design was carried out to synthesize a diamine monomer 1-(4-tert-butylphenyl)-1,1-bis[4-(4-aminophenoxy)] phenylethane containing tert-butyl, ether linkage, and triphenylmethane units. Then it was polymerized with several commercial aromatic dianhydrides, including diphenyl hexafluoroisopropylidene tetraic acid dianhydride (6FDA), diphenyl ether tetracarboxylic dianhydride (ODPA), biphenyltetracarboxylic dianhydride (BPDA), and benzophenone tetraacid dianhydride (BTDA), via the conventional two-step method to afford a series of aromatic polyimides (PIs). The structure and properties of the polymer were characterized by Fourier transform infrared (FTIR) spectroscopy, solubility test, thermogravimetric analysis, differential scanning calorimetry, ultraviolet–visible spectroscopy, and tensile tests. The results showed that there were characteristic peaks of PI around 1776, 1720, and 1378 cm−1 in the FTIR spectra; 6FDA-, ODPA-, and BPDA-based PI are easily soluble in N-methylpyrrolidone (NMP), concentrated sulfuric acid, N,N-dimethylacetamide (DMAc), pyridine, Tetrahydrofuran (THF), Trichloromethane (CHCl3), and other common organic solvents showing excellent solubility. In a nitrogen atmosphere, the glass transition temperature of the PI films are between 246°C and 275°C, the temperature of 5% weight loss is above 501°C, and the residual mass fraction at 750°C is 53–61%. The mechanical properties range from 67.2 MPa to 88.6 MPa. In addition to the BTDA-based PI film, the other three types of PI have good transparency. The simultaneous introduction of tert-butyl, ether linkages, and triphenylmethane units has a synergistic effect, which greatly improves the solubility of PI and maintains good thermal stability, mechanical properties, and optical properties of PI at the same time.
Characterization of surface electromyography signals of biceps brachii muscle in fatigue using symbolic motif features
Authors: Makaram Navaneethakrishna , Swaminathan Ramakrishnan
Published: March 2020

Exercise-induced muscle damage is a condition which results in the loss of muscle function due to overexertion. Muscle fatigue is a precursor of this phenomenon. The characterization of muscle fatigue plays a crucial role in preventing muscle damage. In this work, an attempt is made to develop signal processing methods to understand the dynamics of the muscle’s electrical properties. Surface electromyography signals are recorded from 50 healthy adult volunteers under dynamic curl exercise. The signals are preprocessed, and the first difference signal is computed. Furthermore, ascending and descending slopes are used to generate a binary sequence. The binary sequence of various motif lengths is analyzed using features such as the average symbolic occurrence, modified Shannon entropy, chi-square value, time irreversibility, maximum probability of pattern and forbidden pattern ratio. The progression of muscle fatigue is assessed using trend analysis techniques. The motif length is optimized to maximize the rho value of features. In addition, the first and the last zones of the signal are compared with standard statistical tests. The results indicate that the recorded signals differ in both frequency and amplitude in both inter- and intra-subjects along the period of the experiment. The binary sequence generated has information related to the complexity of the signal. The presence of more repetitive patterns across the motif lengths in the case of fatigue indicates that the signal has lower complexity. In most cases, larger motif length resulted in better rho values. In a comparison of the first and the last zones, most of the extracted features are statistically significant with p < 0.05. It is observed that at the motif length of 13 all the extracted features are significant. This analysis method can be extended to diagnose other neuromuscular conditions.
Bayesian cluster hierarchical model for subgroup borrowing in the design and analysis of basket trials with binary endpoints
Authors: Chen Nan , Lee J Jack
Published: March 2020

Master protocol designs are often proposed to improve the efficiency of drug development with multiple subgroups. In the basket trial design, different subgroups can have similar biological pathogenesis pathways. Hence, a target therapy can result in similar responses. A good information sharing strategy between different subgroups can potentially improve the efficiency of evaluating treatment efficacy. In traditional hierarchical models, based on the exchangeability assumption, all subgroups are placed into the same sharing pool for cross subgroup information sharing. However, due to the heterogeneity between subgroups, there can be large differences in drug efficacy. Under such cases, strong borrowing across all subgroups is not suitable and no borrowing can be inefficient, because the treatment effect is analyzed in each subgroup separately. We propose a Bayesian cluster hierarchical model (BCHM) to improve the operating characteristics of estimating the treatment effect in multiple subgroups in basket trials. Bayesian nonparametric method is applied to dynamically calculate the number of clusters by conducting a multiple cluster classification based on subgroup outcomes. A hierarchical model is used to compute the posterior probability of the treatment effect, with the borrowing strength determined by the Bayesian nonparametric clustering and the similarities between subgroups. We apply the BCHM to clinical trials with binary endpoints. For treatment effect estimation, the BCHM yields lower mean squared error values, when compared to the independent analyses. In scenarios with a heterogeneous treatment effect, the BCHM provides lower mean squared error values compared to traditional hierarchical models. In addition, we can construct a loss function to optimize the design parameters. BCHM provides a balanced approach and smart borrowing, which yields better results in assessing the treatment effect in different scenarios compared to other conventional methods.
Understanding Desire for Food and Drink: A Grounded-Cognition Approach
Authors: Papies Esther K. , Barsalou Lawrence W. , Rusz Dorottya
Published: March 2020

How does desire for food and drink arise in the human mind? We suggest that rewarding simulations, which are based on previous experiences, play a key role. In other words, people think about food and drink in terms of what it feels like to consume them, and this leads to desire. We illustrate this with research using behavioral, physiological, and neuroimaging methods. This work shows that food and drink cues (e.g., words, eating contexts, labels) trigger spontaneous eating and drinking simulations (e.g., thoughts about taste, texture, and enjoyment) and that these simulations affect desire and eating experiences (e.g., cravings, salivation, taste ratings). These simulations can be disrupted or diffused through working memory load or through mindfulness, thus reducing desire. We discuss these findings in the context of simulations in motivated behavior more generally and suggest directions for future research.
Book review: Shibashis Chatterjee, India’s Spatial Imaginations of South Asia: Power, Commerce and Community
Authors: Kurian Nimmi
Published: March 2020

Shibashis Chatterjee, India’s Spatial Imaginations of South Asia: Power, Commerce and Community. Oxford: Oxford University Press, 2019, pp. 268. ₹995 ISBN 0-19-948988-2
Does Time for (in)Direct Nursing Care Activities at the End of Life for Patients With or Without Specialized Palliative Care in a University Hospital Differ? A Retrospective Analysis
Authors: Fliedner Monica C. , Hagemann Monika , Eychmüller Steffen , King Cynthia , Lohrmann Christa , Halfens Ruud J. G. , Schols Jos M. G. A.
Published: March 2020

Background:

Nurses’ end of life (EoL) care focuses on direct (eg, physical) and indirect (e,g, coordination) care. Little is known about how much time nurses actually devote to these activities and if activities change due to support by specialized palliative care (SPC) in hospitalized patients.

Aims:

(1) Comparing care time for EoL patients receiving SPC to usual palliative care (UPC);(2) Comparing time spent for direct/indirect care in the SPC group before and after SPC.

Methods:

Retrospective observational study; nursing care time for EoL patients based on tacs® data using nonparametric and parametric tests. The Swiss data method tacs measures (in)direct nursing care time for monitoring and cost analyses.

Results:

Analysis of tacs® data (UPC, n = 642; SPC, n = 104) during hospitalization before death in 2015. Overall, SPC patients had higher tacs® than UPC patients by 40 direct (95% confidence interval [CI]: 5.7-75, P = .023) and 14 indirect tacs® (95% CI: 6.0-23, P < .001). No difference for tacs® by day, as SPC patients were treated for a longer time (mean number of days 7.2 vs 16, P < .001).Subanalysis for SPC patients showed increased direct care time on the day of and after SPC ( P < .001), whereas indirect care time increased only on the day of SPC.

Conclusions:

This study gives insight into nurses’ time for (in)direct care activities with/without SPC before death. The higher (in)direct nursing care time in SPC patients compared to UPC may reflect higher complexity. Consensus-based measurements to monitor nurses’ care activities may be helpful for benchmarking or reimbursement analysis.
LGBTQ+ Students’ Experiences of Junior High School Nursing in Finland: A Qualitative Study
Authors: Laiti Minna , Parisod Heidi , Pakarinen Anni , Sariola Salla , Hayter Mark , Salanterä Sanna
Published: March 2020

Previous research shows that lesbian, gay, bisexual, transgender, queer/questioning, and other (LGBTQ+) students can experience substantial emotional- and health-related issues at school, but research into LGBTQ+ students’ experiences of school nursing is limited. This qualitative study describes the experiences of Finnish LGBTQ+ students engaging with junior high school nurses. Data were collected from 35 LGBTQ+ students using an online survey tool comprising of a set of open-ended questions. Two interconnecting themes were identified following thematic analysis: (1) junior high school nurse engagement: a mixed or unsatisfactory experience and (2) LGBTQ+ students’ needs for diversity-affirming junior high school nursing. Findings show that LGBQT+ students felt junior high school nurse engagement was often unsupportive with issues around their sexuality and gender identity. LGBTQ+ students expressed the need for diversity-affirming information and support in school settings. Further research from school nurses’ perspective is needed to increase understanding of this topic.
Stability of freeze-dried plasma rich in growth factors eye drops stored for 3 months at different temperature conditions
Authors: Anitua Eduardo , de la Fuente María , Muruzábal Francisco , Merayo-Lloves Jesús
Published: March 2020

Purpose:

The purpose of this study was to analyze the biological content and activity of freeze-dried plasma rich in growth factors eye drops after their storage at 4°C and at room temperature for 3 months with respect to fresh samples (time 0).

Methods:

Plasma rich in growth factors was obtained after blood centrifugation from three healthy donors. After platelet activation, the obtained plasma rich in growth factors eye drops were lyophilized alone or in combination with lyoprotectant (trehalose), then they were stored for 3 months at room temperature or at 4°C. Several growth factors were analyzed at each storage time and condition. Furthermore, the proliferative and migratory potential of freeze-dried plasma rich in growth factors eye drops kept for 3 months at different temperature conditions was evaluated on primary human keratocytes.

Results:

The different growth factors analyzed maintained their levels at each time and storage condition. Freeze-dried plasma rich in growth factors eye drops stored at room temperature or 4°C for 3 months showed no significant differences on the proliferative activity of keratocytes in comparison with fresh samples. However, the number of migratory human keratocytes increased significantly after treatment with lyophilized plasma rich in growth factors eye drops kept for 3 months compared to those obtained at time 0. No significant differences were observed between the freeze-dried plasma rich in growth factors eye drops whether mixed or not with lyoprotectant.

Conclusion:

Freeze-dried plasma rich in growth factors eye drops preserve the main growth factors and their biological activity after storage at room temperature or 4°C for up to 3 months. Lyophilized plasma rich in growth factors eye drops conserve their biological features even without the use of lyoprotectants for at least 3 months.
Comparison of rituximab originator (MabThera®) to biosimilar (Truxima®) in patients with multiple sclerosis
Authors: Perez Thomas , Rico Audrey , Boutière Clémence , Maarouf Adil , Roudot Marjorie , Honoré Stéphane , Pelletier Jean , Bertault-Peres Pierre , Audoin Bertrand
Published: March 2020

Background:

Rituximab’s originator MabThera® or Rituxan® has demonstrated high efficacy in multiple sclerosis (MS). Because of the patent expiration, rituximab biosimilars have been developed. However, because a biosimilar is not the exact copy of the originator, the efficacy and safety of a biosimilar may significantly differ.

Objectives:

To compare the efficacy and safety of the biosimilar Truxima® and the originator MabThera® in MS.

Methods:

Consecutive MS patients receiving MabThera® or Truxima® were prospectively followed during 1 year after treatment introduction. Allocation to each treatment depended on the period of introduction and not the physician’s choice. Lymphocyte count, clinical and magnetic resonance imaging (MRI) activity, Expanded Disability Status Scale (EDSS), and adverse events were compared.

Results:

In total, 105 and 40 patients received MabThera® and Truxima®, respectively. The two groups did not differ in baseline characteristics. Effect on CD19+ lymphocytes and disease activity were similar during follow-up. EDSS remained stable, with no difference between groups. Adverse events were similar between groups.

Conclusion:

The efficacy and safety of the rituximab biosimilar Truxima® seem equivalent to the originator MabThera® in MS patients. Truxima® could represent a relatively cheap and safe therapeutic alternative to MabThera® and could improve access to highly efficient therapy for MS in low- or middle-income countries.
Asymmetric relationship between tourist arrivals and employment
Authors: Sharma Jitendra , Mitra Subrata Kumar
Published: March 2020

This article explores the relationship between the arrival of tourists and its impact on tourism-related employment. Considering the impact of tourist arrival on employment being asymmetric, we have analyzed the relationship using the nonlinear autoregressive distributed lag method proposed by Shin et al. The article analyzed how arrivals impact on employment taking Sri Lanka as a reference country and have used annual data of the variables obtained from the Sri Lanka Tourism Development Authority. It is found that for an increase in the tourist arrival by 1000, the tourism-related job employment rises by 83.8. On the contrary, with the decline in tourist arrival by the same number, the corresponding reduction in job employment is 29.8. The relatively lower reduction in employment with the fall of tourist arrival provides relative stability of employment to the tourism workforce and is a socially desirable outcome.
Reorganizing and integrating public health, health care, social care and wider public services: a theory-based framework for collaborative adaptive health networks to achieve the triple aim
Authors: Steenkamer Betty , Drewes Hanneke , Putters Kim , van Oers Hans , Baan Caroline
Published: March 2020

Objective

Population health management (PHM) refers to large-scale transformation efforts by collaborative adaptive health networks that reorganize and integrate services across public health, health care, social care and wider public services in order to improve population health and quality of care while at the same time reducing cost growth. However, a theory-based framework that can guide place-based approaches towards a comprehensive understanding of how and why strategies contribute to the development of PHM is lacking, and this review aims to contribute to closing this gap by identifying the key components considered to be key to successful PHM development.

Methods

We carried out a scoping realist review to identify configurations of strategies (S), their outcomes (O), and the contextual factors (C) and mechanisms (M) that explain how and why these outcomes were achieved. We extracted theories put forward in included studies and that underpinned the formulated strategy-context-mechanism-outcome (SCMO) configurations. Iterative axial coding of the SCMOs and the theories that underpin these configurations revealed PHM themes.

Results

Forty-one studies were included. Eight components were identified: social forces, resources, finance, relations, regulations, market, leadership, and accountability. Each component consists of three or more subcomponents, providing insight into (1) the (sub)component-specific strategies that accelerate PHM development, (2) the necessary contextual factors and mechanisms for these strategies to be successful and (3) the extracted theories that underlie the (sub)component-specific SCMO configurations. These theories originate from a wide variety of scientific disciplines. We bring these (sub)components together into what we call the Collabroative Adaptive Health Network (CAHN) framework.

Conclusions

This review presents the strategies that are required for the successful development of PHM. Future research should study the applicability of the CAHN framework in practice to refine and enrich identified relationships and identify PHM guiding principles.
Grandparental Childcare for Biological, Adopted, and Step-Offspring: Findings From Cross-National Surveys
Authors: Tanskanen Antti O. , Danielsbacka Mirkka , Rotkirch Anna
Published: March 2020

Based on kin selection theory, amounts of grandparental investment should reflect the probability to share common genes with offspring. Adoption may represent a special case, however, yet grandparental investment in adopted children has previously been both theoretically misconstrued and little investigated. Here, we study for the first time how grandparental childcare provision is distributed between biological, adopted, and step-offspring. Using Generations and Gender Surveys ( n = 15,168 adult child–grandmother and 12,193 adult child–grandfather dyads) and the Survey of Health, Ageing, and Retirement in Europe ( n = 17,233 grandmother–adult child and 13,000 grandfather–adult child dyads), we find that grandparents were less likely to provide care to stepchildren than to adopted and biological children, but no difference between adopted and biological children. These findings were present in both data sets and for both grandmothers and grandfathers, after several potentially confounding factors were taken into account. The stepchild disadvantage is in line with kin selection theory. The congruent amounts of care provided to adopted and biological children may reflect similar levels of adult–child attachment, selection effects, and greater need in adoptive families, as well as some degree of genetical relatedness in the case of kin adoption. The study provides new evidence of biased kin investments in contemporary societies and stresses the importance of psychological motivation and attachment in evolutionary studies of kin investment.
Added value of strain elastography in the characterisation of breast lesions: A prospective study
Authors: Sinha Dimpi , Sharma Sukrity , Kundaragi Nischal G , Kale Sudhir Kumar
Published: March 2020

Background

Elastography is a new promising ultrasonographic technique which is used to differentiate benign and malignant breast lesions based on the stiffness of the lesion.

Purpose

To determine the role of strain elastography in characterisation of breast lesions and to compare the diagnostic performances of strain elastography and conventional ultrasound (US).

Methods

In total, 113 breast lesions in 100 women were prospectively evaluated by US and strain elastography followed by the histopathological examination. Elastography score based on the Tsukuba colour scale and strain ratio were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for each modality and the diagnostic performances were compared. The best cut-off point was calculated for each of the elastography parameters using the receiver operator curve analysis.

Results

Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). The area under the curve for elastography score showed significant difference with that of US: 0.98 versus 0.90 (Difference = 0.08, p =0.02). The elastography parameters were more specific as compared to US (ES-95 and SR-93% vs. 63%, p < 0.05) with a high negative predictive value. The combined use of elastography and US gave better results with 95% sensitivity, 94% specificity, 94% accuracy and negative predictive value reaching 97%.

Conclusion

Strain elastography is a useful adjunct to conventional ultrasonography. The combined use of strain elastography and ultrasound improves the characterisation of breast lesions and helps in down-staging of assigned BI-RADS category, thereby avoiding unnecessary biopsies. ES is the most useful elastography parameter to differentiate between benign and malignant breast lesions.
Cohort Study of Features Used by Experts to Diagnose Transient Ischemic Attack
Authors: Fitzpatrick Tess , Gocan Sophia , Wang Chu Qi , Bourgoin Aline , Taljaard Monica , Cheng Wei , Dowlatshahi Dar , Stotts Grant , Shamy Michel
Published: March 2020

Background and Purpose:

The diagnosis of transient ischemic attack (TIA) is largely dependent on a process of clinical decision-making that remains poorly characterized in the absence of a validated and accessible biomarker or imaging test. We performed a retrospective chart review to identify variables associated with a final neurologist diagnosis of TIA/stroke.

Methods:

Records for all patients seen in The Ottawa Hospital’s Stroke Prevention Clinic in 2015 were analyzed for patient and referral characteristics, features of the presenting neurological event, and final diagnosis by a stroke neurologist (classified as definite, possible, or definite not TIA/stroke). Multinomial logistic regression analysis with backward elimination was used to identify variables associated with the final diagnosis.

Results:

Our inclusion criteria were met by 1894 patients. After backward elimination, 23 potentially important variables were identified, including monocular vision loss (odds ratio [OR]: 30.4, 95% confidence interval [CI]: 14.6-63.3), symptoms of sudden onset (OR: 28.3, 95% CI: 14.2-56.2), unilateral weakness affecting 2 or 3 of face, arm, or leg (OR: 17.7, 95% CI: 9.8-31.7), and homonymous hemianopia (OR: 16.6, 95% CI: 8.1-34.0).

Conclusions:

Accurate diagnosis of TIA is essential to initiating appropriate secondary stroke prevention therapies. A focus on elements of the patient history most commonly associated with a final diagnosis of TIA/stroke may help to identify patients in greatest need of urgent SPC assessment and allow for the provision of effective and efficient stroke prevention services.
Advances at the interface of cancer and systemic sclerosis
Authors: Mecoli Christopher A , Rosen Antony , Casciola-Rosen Livia , Shah Ami A
Published: March 2020

The interface between systemic sclerosis and cancer has offered valuable insights into our understanding of systemic sclerosis disease pathogenesis. Defining systemic sclerosis subgroups both temporally and serologically has been instrumental in stratifying cancer risk, with autoantibodies to RNA polymerase 3, RNA polymerase 1 large subunit, RNA binding region containing 3, and centromere identifying subgroups at increased or decreased risk of cancer. Clinically, improved subgrouping of systemic sclerosis patients provides the opportunity to detect cancer at earlier stages of disease while increasing our efficiency of cancer assessment. Additional studies are needed to define the optimal approach to cancer screening in systemic sclerosis, and validation studies in different cohorts will be needed to confirm all findings.
Aesthetics of Globalization in Daya Pawar’s Baluta: Reflexivity and Social Change in Critical Perspective
Authors: Murage Peter Ndambiri , Makokha Justus K. S.
Published: March 2020

This article seeks to discuss the point of intersection between globalization and localization. The study is aimed at discussing the effects of globalization on the lives and the characters exposed in Daya Pawar’s powerful book Baluta (translated in English under the same title in 2015 by Jerry Pinto). The characters, who are otherwise well rooted in the traditions practised in their localities, are forced to adapt to the strong waves of change occasioned by modernity. Globalization has occasioned migrants to settle in the localities of Kawakhana and the neighbouring regions. Consequently, popular social joints have sprung up in these localities, prompting the lives of characters to change drastically. Social vices such as betting, alcoholism and prostitution have risen drastically with the increase in clubs, betting dens and brothels. The individual lives of the dwellers of Kawakhana have deteriorated with increased modernization and urbanization. On the brighter side, modern schools have become more popular, with the parents seeing the need of taking their children to school. This element of social change has resulted to the emancipation of the people in the lower castes—the Mahar. Through education, the children of the Mahar have gained economic empowerment, enabling them to break the yoke of tradition that has relegated them to the inferior social position. It is in light of these drastic social changes that this article seeks to explore the aesthetic manifestation of globality, reflexivity and social change.