bluuebunny/crossref_metadata_2025 huggingface dataset:
Studying Post-Traumatic Growth Across the Adult Life Span
Authors: Staben Omar E. , Gardner Molly J. , Infurna Frank J. , Luthar Suniya S. , Grimm Kevin J.
Published: August 2021

This chapter discusses conceptual and methodological considerations for studying post-traumatic growth across adulthood and into old age. Conceptual considerations that the authors focus on include examining character strengths and virtues longitudinally across multiple age groups and also the stability of these strengths and virtues across the life span. Methodological considerations elaborated are the use of convenience sampling in scale development and the importance of measurement invariance when examining character strengths in the context of post-traumatic growth. The authors provide examples from previous research on post-traumatic growth and discuss methods of measurement that could be utilized to enhance the validity of current measures. The chapter highlights the importance of character strengths and virtues and aims to solidify their role in the scientific community. Additionally, it highlights the need for more rigorous lines of scientific inquiry in this area due to its potential to impact healthy aging outcomes for persons across the adult life span.
Openness to Experience and Post-Traumatic Growth
Authors: Forgeard Marie , Bayer-Pacht Elana , Silvia Paul J. , Roepke Ann Marie , Björgvinsson Thröstur
Published: August 2021

Although many individuals retrospectively report feeling more open and receptive to new ideas and possibilities after experiencing adverse events, research specifically examining growth on this dimension of character (as opposed to more general psychological growth) remains scarce. To stimulate future theoretical and empirical work in this area, this chapter reviews and discusses existing scientific research pertaining to changes in the personality trait of openness to new experience following adversity. Studies using retrospective self-reports have shown that people judge themselves as more open following highly stressful events. Such research also suggests that changes in openness could even help foster more general psychological growth. It is, however, possible that people involuntarily distort their self-perceptions to cope with difficulties, and several other lines of research have produced contradictory findings. Correlational and experimental evidence has shown that stressful experiences can decrease openness. Most longitudinal studies examining changes in personality over time have found no changes in openness following negative events. To help reconcile previous contradictory findings, the authors propose a methodological agenda including using multiple methods to assess openness, complementing correlational with longitudinal methods to examine changes over time, studying everyday manifestations of openness (including how people deal with everyday stressors), and investigating potential moderators and mediators of growth in this trait. Such research will help increase clarity about the circumstances under which people may (or may not) become more open as a result of adversity.
Pathways from Adversity to Wisdom
Authors: Dorfman Anna , Moscovitch David A. , Grossmann Igor
Published: August 2021

Focusing on one’s adversity can be a source of strength, facilitating meaning-making and growth. However, adversity can also lead to depression, anxiety, and trauma-related stress. The authors propose that the self-perspective one takes while reflecting on adversity—that is, self-distanced (third-person perspective on one’s experiences) versus self-immersed (first-person perspective)—modulates the effects of adversity for subsequent developmental trajectories in character strengths. The authors specifically focus on wisdom-related character strengths—open-mindedness, humility, and empathy—which they have previously associated with greater self-distancing in the lab. They discuss how multimethod prospective studies can allow for effectively testing whether self-distancing prospectively facilitates expression and growth in open-mindedness, humility, and empathy after a wide range of adverse experiences.
Scope of the Issue
Authors: Newins Amie R. , Wilson Laura C.
Published: August 2021

The worldwide frequency of sexual assault and the associated psychosocial difficulties have led to sexual violence being deemed a serious public health issue. There is a growing understanding in the field that survivors’ outcomes following sexual assault follow unique trajectories and professionals need to conduct thorough, unbiased assessment to adequately capture survivors’ presenting problems and their person-specific contributing factors. Although survivors are increasingly disclosing their victimization, they still experience obstacles to reporting victimization and receiving services. For example, many survivors report that formal sources of support are unhelpful or even potentially harmful. With the goal of increasing access to affirming and supportive services, the remaining chapters of this book highlight many of the common issues that emerge when working with sexual assault survivors and cover best practices for receiving disclosures of sexual assault.
The Role of Reactions to Disclosure in Mental Health Among Survivors of Sexual Assault
Authors: Newins Amie R. , Wilson Laura C.
Published: August 2021

Although services and support have the potential to be helpful, a survivor’s trajectory toward recovery is contingent on the social reactions they receive. Given that fear of negative social reactions is the primary reason that sexual assault survivors delay disclosing or fail to disclose their victimization to others, we review numerous correlates of when and why survivors disclose their assault, typical social reactions survivors receive, the psychosocial impact of social reactions on survivors, and recommendations for ways providers can provide services that are more survivor-centered. Because nondisclosure limits the resources, services, and support available to survivors, it is important to understand what contributes to survivors’ decisions regarding if and when they tell others about their victimization. Furthermore, given the link between negative reactions and psychosocial difficulties, it is important to minimize the potential for a survivor to receive a harmful response from a provider.
Assessing Sexual Assault and Reacting to Client Disclosures During Assessment
Authors: Newins Amie R. , Wilson Laura C.
Published: August 2021

In mental health settings, not all survivors of sexual assault will present due to concerns related to their sexual assault, and even among those who do, some may not disclose this history without prompting. Given the prevalence of sexual abuse and sexual assault, all clients should be screened for a history of exposure to these experiences. A wide range of self-report and interview measures are available for this purpose; a brief overview of measures available for both child and adult populations is provided. In this chapter, considerations for choosing assessment measures are discussed to help providers select appropriate measures to use in their clinical practice. In particular, this chapter provides information about how language in assessment measures may affect disclosure from clients. Finally, this chapter provides recommendations for reacting to client disclosures during an assessment.
Psychotherapy with Sexual Assault Survivors
Authors: Newins Amie R. , Wilson Laura C.
Published: August 2021

Sexual assault is associated with an increased risk of a wide range of mental health problems; therefore, treatment should be targeted to address the client’s primary presenting concerns. In this chapter, specific recommendations are provided for using psychotherapy to treat survivors of sexual assault. In particular, suggestions are given for using exposure-based treatments and cognitive-based treatments with these clients. These recommendations focus on how to increase disclosure of details of the assault and to address negative reactions that clients may have received from other disclosure recipients. Furthermore, suggestions are offered related to the terminology and language used during these discussions in treatment.
Final Thoughts on Best Practices
Authors: Newins Amie R. , Wilson Laura C.
Published: August 2021

Throughout the book, the authors have argued that it is important to use a contextual model to consider all of the factors that influence how survivors conceptualize what happened to them, whether or not they disclose the incident to others, and how others respond to their disclosures. It is also imperative that professionals understand how these factors may serve as barriers to survivors seeking and receiving high-quality and affirming services. In light of this, in this chapter, the authors offer more general recommendations for ways formal sources of support can improve their service delivery when working with sexual assault survivors. Overall, there have been recent gains and improvements within the disciplines that serve sexual assault survivors, as well as within society as a whole. Despite this progress, there is still more work to do.
Empirically Supported Treatment for Obsessive-Compulsive Disorder
Authors: Franklin Martin E. , Turk Karan Sarah G.
Published: August 2021

This chapter assesses which treatment should be chosen as the first-line intervention for obsessive-compulsive disorder (OCD). Cognitive Behavioral Therapy (CBT) involving Exposure Plus Response Prevention (ERP) is the treatment with the most empirical support, and its effects appear to be both robust and durable. The chapter then reviews the data on predictors and moderators of differential ERP outcomes. Contemporary ERP manuals emphasize the following core procedures: (1) psychoeducation; (2) hierarchy development; (3) in vivo and imaginal exposure; (4) response prevention; and (5) relapse prevention. The chapter looks at situations in which clinical circumstances dictate a deviation or modification of the protocol from the way these procedures are described in the manual or customarily implemented—being flexible while maintaining fidelity. Therapist experience appears to play a role in how comfortable clinicians are in being flexible, and how successful they are likely to be when they do so.
How to Bend but Not Break an Empirically Supported Treatment for Anxiety in Youth
Authors: Rifkin Lara S. , Myerberg Lindsay , Gosch Elizabeth A. , Norris Lesley A. , Crane Margaret E. , Kendall Philip C.
Published: August 2021

This chapter addresses the treatment of youth anxiety. Cognitive behavioral therapy (CBT) for youth anxiety, as illustrated by the Coping Cat program, is implemented flexibly based on considerations including age/developmental level, co-occurring disorders, socioeconomic status, and cultural factors to enhance outcomes. For fidelity, the program adheres to key components: building rapport, providing psychoeducation about anxiety, addressing anxious self-talk, conducting exposures, assigning homework, and providing rewards/praise. The essential components, however, are applied with flexibility. Ultimately, research is needed to evaluate strategies to increase continued fidelity to the core components of treatment. Peer consultation and supervision may be valuable for maintaining fidelity while flexibly applying the program to a specific client.
Tourette and Trichotillomania
Authors: Alexander Jennifer R. , Stiede Jordan T. , Woods Douglas W.
Published: August 2021

This chapter explores the treatment of trichotillomania (TTM; also referred to as hair pulling disorder) and Tourette disorder (TD). TTM and TD exist in separate diagnostic categories but exhibit functional similarities and respond to similar treatments. The chapter reviews the characteristics of each disorder. It then describes habit reversal training (HRT) and function-based interventions, which serve as core therapeutic elements in the treatment of both TTM and TD. The chapter also discusses additional treatment strategies that occur as part of standard protocols for both disorders, before looking at the treatment efficacy research. It considers the key features of the manual-based treatments (behavior therapy protocols), as well as ways these protocols can be flexibly implemented for those with TTM and TD. Finally, consistent with the call for “flexibility within fidelity,” the chapter provides an example of a flexible implementation of these treatments.
Generalization of the Menegozzi and Lamb maser algorithm to the transient superradiance regime
Authors: Wyenberg C M , Lankhaar B , Rajabi F , Chamma M A , Houde M
Published: August 2021

We investigate the application of the conventional quasi-steady state maser modelling algorithm of Menegozzi & Lamb (ML) to the high field transient regime of the one-dimensional Maxwell-Bloch (MB) equations for a velocity distribution of atoms or molecules. We quantify the performance of a first order perturbation approximation available within the ML framework when modelling regions of increasing electric field strength, and we show that the ML algorithm is unable to accurately describe the key transient features of R. H. Dicke’s superradiance (SR). We extend the existing approximation to one of variable fidelity, and we derive a generalization of the ML algorithm convergent in the transient SR regime by performing an integration on the MB equations prior to their Fourier representation. We obtain a manifestly unique integral Fourier representation of the MB equations which is $\mathcal {O}\left(N\right)$ complex in the number of velocity channels N and which is capable of simulating transient SR processes at varying degrees of fidelity. As a proof of operation, we demonstrate our algorithm’s accuracy against reference time domain simulations of the MB equations for transient SR responses to the sudden inversion of a sample possessing a velocity distribution of moderate width. We investigate the performance of our algorithm at varying degrees of approximation fidelity, and we prescribe fidelity requirements for future work simulating SR processes across wider velocity distributions.
Long-term dynamical survival of deep Earth co-orbitals
Authors: Christou Apostolos A , Georgakarakos Nikolaos
Published: August 2021

We investigate the long-term dynamical survival of Earth co-orbital asteroids, focusing on near-circular, near-planar orbits that existing studies suggest are the most stable. Through numerical integration of test particles, we show that about a quarter of an initial population can survive for at least 50 per cent of the age of the Solar system with horseshoe particles being four to five times more likely to survive than L4/L5 Trojans. From the end state statistics, we constrain the existence of planetesimal-sized objects originally in co-orbital libration, finding that typically $5^{-2}_{+7}$ such planetesimals and no more than $27^{-9}_{+30}$ (95 per cent confidence) could have been present. Our simulations also suggest that episodic variations in the terrestrial orbital eccentricity may have caused bulk escape of co-orbitals, though variations large enough (>0.01) to generate such episodes are statistically unlikely. We then consider the orbital evolution of co-orbital asteroids of sizes down to D = 50 m under the Yarkovsky effect and find that objects with D < 1 km should escape over 4 Gyr with the smallest asteroids escaping after 200 Myr. Further, we test whether the Earth’s co-orbital region may be populated by asteroids arriving via outward Yarkovsky drift, as conjectured by Zhou et al. We find this is an inefficient process, as planetary close encounters rapidly scatter the orbits far from the Earth’s and towards the asteroid belt. Finally, we discuss how the destabilizing action of Yarkovsky may be mitigated through spin state evolution or late collisional comminution of large parent asteroids.
Possibility of primordial black holes collision with Earth and the consequences of this collision
Authors: Rahvar Sohrab
Published: August 2021

In the context of the existence of primordial black holes (PBHs), they may compose a fraction of the dark matter of the Universe. Assuming that PBHs fill the dark content of the Milky Way Galaxy in the Galactic halo and the dark disc, we calculate the probability of collision of the PBHs with Earth. This collision has different consequences as heating the interior of the Earth through dynamical friction and accretion processes. In this work, we calculate the rate of collisions and a fraction of black holes that can be trapped inside the Earth. Finally, we compare the danger of PBH collision with the asteroid impacts on Earth.
Minimal physicalism as a scale-free substrate for cognition and consciousness
Authors: Fields Chris , Glazebrook James F , Levin Michael
Published: August 2021

Theories of consciousness and cognition that assume a neural substrate automatically regard phylogenetically basal, nonneural systems as nonconscious and noncognitive. Here, we advance a scale-free characterization of consciousness and cognition that regards basal systems, including synthetic constructs, as not only informative about the structure and function of experience in more complex systems but also as offering distinct advantages for experimental manipulation. Our “minimal physicalist” approach makes no assumptions beyond those of quantum information theory, and hence is applicable from the molecular scale upwards. We show that standard concepts including integrated information, state broadcasting via small-world networks, and hierarchical Bayesian inference emerge naturally in this setting, and that common phenomena including stigmergic memory, perceptual coarse-graining, and attention switching follow directly from the thermodynamic requirements of classical computation. We show that the self-representation that lies at the heart of human autonoetic awareness can be traced as far back as, and serves the same basic functions as, the stress response in bacteria and other basal systems.
Case Report: Reversal of Integrase Inhibitor– and Tenofovir Alafenamide–Related Weight Gain After Switching Back to Efavirenz/Emtricitabine/Tenofovir DF
Authors: Pohlman F Will , McGee Kara S , McKellar Mehri S
Published: August 2021

We report a case of substantial weight gain in a virologically suppressed patient with HIV after changing his antiretroviral therapy from efavirenz/emtricitabine/tenofovir DF to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide with subsequent rapid weight loss upon switching back. The role of antiretrovirals in weight gain and loss and patient- and HIV-specific factors are discussed.
Building the BBC-branded NGO: Overseas Development, the World Service, and the Marshall Plan of the Mind, c.1965–99
Authors: Westlake Steve
Published: August 2021

Overseas broadcasting has been an integral part of the BBC’s remit since the creation of its Empire Service in 1932. Throughout its history, the BBC has consistently argued that its services for overseas listeners should not be classified as a form of British propaganda, but instead understood as a fundamentally benevolent undertaking, providing objective, impartial, and trustworthy news and information to hundreds of millions of listeners worldwide. In the post-imperial era, the World Service increasingly depicted itself as not just a ‘global public service broadcaster’, but also as a kind of humanitarian endeavour, an ‘Oxfam of the Mind’ which made a significant contribution to Britain’s wider efforts in the field of overseas development. This article critically evaluates this vision of the BBC World Service as a post-imperial ‘gift to the world’. It outlines how, in the early 1990s, the World Service created the first BBC-branded overseas development NGO, the Marshall Plan of the Mind (MPM), which used both UK government and external philanthropic funding to help promote British commercial and diplomatic interests in post-communist Eastern Europe. MPM is then contextualized in relation to the World Service’s longer (and largely overlooked) history of overseas development work and its relationship with the NGO sector, both before and after the end of the Cold War. By exploring how and why the World Service inserted itself into the NGO sphere, this work contributes to ongoing historical debates regarding the BBC’s relationship with the state and the role(s) that global development NGOs have played in shaping Britain’s post-imperial ‘place in the world’.
A dimension-reduced neural network-assisted approximate Bayesian computation for inverse heat conduction problems
Authors: Zeng Yang
Published: August 2021

Due to the flexibility and feasibility of addressing ill-posed problems, the Bayesian method has been widely used in inverse heat conduction problems (IHCPs). However, in the real science and engineering IHCPs, the likelihood function of the Bayesian method is commonly computationally expensive or analytically unavailable. In this study, in order to circumvent this intractable likelihood function, the approximate Bayesian computation (ABC) is expanded to the IHCPs. In ABC, the high dimensional observations in the intractable likelihood function are equalized by their low dimensional summary statistics. Thus, the performance of the ABC depends on the selection of summary statistics. In this study, a machine learning-based ABC (ML-ABC) is proposed to address the complicated selections of the summary statistics. The Auto-Encoder (AE) is a powerful Machine Learning (ML) framework which can compress the observations into very low dimensional summary statistics with little information loss. In addition, in order to accelerate the calculation of the proposed framework, another neural network (NN) is utilized to construct the mapping between the unknowns and the summary statistics. With this mapping, given arbitrary unknowns, the summary statistics can be obtained efficiently without solving the time-consuming forward problem with numerical method. Furthermore, an adaptive nested sampling method (ANSM) is developed to further improve the efficiency of sampling. The performance of the proposed method is demonstrated with two IHCP cases.
Anaphylaxis and Coronavirus Disease 2019 vaccine: a danger relationship?
Authors: Tanno Luciana Kase , Castells Mariana , Caminati Marco , Senna Gianenrico , Demoly Pascal
Published: August 2021

Purpose of review

Anaphylactic reactions reported after Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) RNA vaccines were expected to be more frequent in atopic subjects and attributed to its polyethylene glycol component.

Recent findings

Anaphylaxis to SARS-CoV2 RNA vaccines is no more frequent than in any vaccine and direct proofs for the role of its polyethylene glycol component are lacking.

Vaccines against coronavirus disease 2019 (COVID-19) are an essential global intervention to control the current pandemic situation. Anaphylactic reactions have rapidly been reported after SARS-CoV2 RNA vaccines. This risk is now measured at 2.5–11/1 000 000 in the context of vaccine safety surveillance programs and only one case was documented to be due to polyethylene glycol. Suggestions for its role are indirect. The COVID-19 vaccination is rolling out vastly and surveillance programs are key to monitor severe adverse reactions, such as anaphylaxis. Anaphylaxis due to vaccine is extremely rare and specific cases should receive individualized investigation and care, highlighting the key role of allergists in the vaccination programmes.
Preconception Substance Use and Risk of Unintended Pregnancy: Pregnancy Risk Assessment Monitoring System 2016–17
Authors: Shafique Saima , Umer Amna , Innes Kim E. , Rudisill Toni Marie , Fang Wei , Cottrell Lesley
Published: August 2021

Objective

This study examined the association between preconception substance use and unintended pregnancy in a large, nationally representative sample of women.

Methods

In this cross-sectional study, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) comprising, 74,543women who had birth during 2016–17. Logistic regression was used to assess the independent association of unintended pregnancy overall and by subtypes to preconception substance use (smoking and other nicotine/tobacco use, alcohol consumption, and use of cannabis, illicit/recreational drugs) and specific medication including prescription opioids, antidepressants and over the counter pain relief.

Results

Overall, 41% of pregnancies were unintended. Nearly 57% of participants reported alcohol consumption during the preconception period, with 32% indicating binge drinking, 17% reported preconception smoking, and 10% cannabis use. Unintended pregnancy was significantly associated with substance use, including smoking (adjusted odds ratio [AOR]:1.5, 95% confidence interval [CI]: 1.4–1.6); as well as the use of other nicotine/tobacco (AOR:1.4, 95% CI: 1.3–1.5); cannabis (AOR: 1.9, 95% CI: 1.5–2.3); illicit/recreational drugs (AOR:1.7, 95% CI: 1.2–2.4), prescription opioids (AOR:1.4, 95% CI: 1.02–1.9), and prescription antidepressants (AOR 1.8, 95% CI: 1.1–3.0). The likelihood of unintended pregnancy was significantly elevated with heavy smoking, heavy alcohol consumption, and binge drinking. Analyses by unintended pregnancy subtype yielded similar results.

Conclusions

Preconception substance use was significantly and positively associated with unintended pregnancy. Evidence-based interventions are needed addressing substance use behavior and effective contraceptive use to prevent unintended pregnancy and related adverse effects on maternal and child health.
Impact of Hearing Aid Use on Falls and Falls-Related Injury: Results From the Health and Retirement Study
Authors: Riska Kristal M. , Peskoe Sarah B. , Kuchibhatla Maragatha , Gordee Alexander , Pavon Juliessa M. , Kim Se Eun , West Jessica S. , Smith Sherri L.
Published: August 2021

Objectives:

Falls are considered a significant public health issue and falls risk increases with age. There are many age-related physiologic changes that occur that increase postural instability and the risk for falls (i.e., age-related sensory declines in vision, vestibular, somatosensation, age-related orthopedic changes, and polypharmacy). Hearing loss has been shown to be an independent risk factor for falls. The primary objective of this study was to determine if hearing aid use modified (reduced) the association between self-reported hearing status and falls or falls-related injury. We hypothesized that hearing aid use would reduce the impact of hearing loss on the odds of falling and falls-related injury. If hearing aid users have reduced odds of falling compared with nonhearing aid users, then that would have an important implications for falls prevention healthcare.

Design:

Data were drawn from the 2004-2016 surveys of the Health and Retirement Study (HRS). A generalized estimating equation approach was used to fit logistic regression models to determine whether or not hearing aid use modifies the odds of falling and falls injury associated with self-reported hearing status.

Results:

A total of 17,923 individuals were grouped based on a self-reported history of falls. Self-reported hearing status was significantly associated with odds of falling and with falls-related injury when controlling for demographic factors and important health characteristics. Hearing aid use was included as an interaction in the fully-adjusted models and the results showed that there was no difference in the association between hearing aid users and nonusers for either falls or falls-related injury.

Conclusions:

The results of the present study show that when examining self-reported hearing status in a longitudinal sample, hearing aid use does not impact the association between self-reported hearing status and the odds of falls or falls-related injury.
LncRNA AFAP1-AS1/miR-27b-3p/VEGF-C axis modulates stemness characteristics in cervical cancer cells
Authors: Xia Meng , Duan Li-Jun , Lu Bi-Nan , Pang Yu-Zhou , Pang Zong-Ran
Published: August 2021

Background:

Long non-coding RNA (lncRNA) actin filament-associated protein 1 antisense RNA 1 (AFAP1-AS1) functions as a competing endogenous RNA to regulate target genes expression by sponging microRNAs (miRs) to play cancer-promoting roles in cancer stem cells. However, the regulatory mechanism of AFAP1-AS1 in cervical cancer (CC) stem cells is unknown. The present study aimed to provide a new therapeutic target for the clinical treatment of CC.

Methods:

Hyaluronic acid receptor cluster of differentiation 44 variant exon 6 (CD44v6)(+) CC cells were isolated by flow cytometry (FCM). Small interfering RNAs of AFAP1-AS1 (siAFAP1-AS1) were transfected into the (CD44v6)(+) cells. The levels of AFAP1-AS1 were measured by quantitative real-time PCR (qRT-PCR). Sphere formation assay, cell cycle analysis, and Western blotting were used to detect the effect of siAFAP1-AS1. RNA pull-down and luciferase reporter assay were used to verify the relationship between miR-27b-3p and AFAP1-AS1 or vascular endothelial growth factor (VEGF)-C.

Results:

CD44v6(+) CC cells had remarkable stemness and a high level of AFAP1-AS1. However, AFAP1-AS1 knockdown with siAFAP1-AS1 suppressed the cell cycle transition of G(1)/S phase and inhibited self-renewal of CD44v6(+) CC cells, the levels of the stemness markers octamer-binding transcription factor 4 (OCT4), osteopontin (OPN), and cluster of differentiation 133 (CD133), and the epithelial-mesenchymal transition (EMT)-related proteins Twist1, matrix metalloprotease (MMP)-9, and VEGF-C. In the mechanism study, miR-27b-3p/VEGF-C signaling was demonstrated to be a key downstream of AFAP1-AS1 in the CD44v6(+) CC cells.

Conclusions:

LncRNA AFAP1-AS1 knockdown inhibits the CC cell stemness by upregulating miR-27b-3p to suppress VEGF-C.
A review on management of caesarean scar pregnancy
Authors: Gulino Ferdinando Antonio , Ettore Carla , Ettore Giuseppe
Published: July 2021

Purpose of review

To review the current literature on management of cesarean scar pregnancy.

Recent findings

Caesarean scar pregnancy (CSP) is a complex pathologic condition, which is strictly related to a previous caesarean section. It is an iatrogenic disorder, that has had an exponential increase over the last few years linked to the parallel increase in the number of caesarean sections. The Society for Maternal-Fetal Medicine (SMFM) confirmed the presence of surgical, medical, and minimally invasive therapies for caesarean scar pregnancy management but the optimal treatment is not known; the main recommendation is to avoid expectant management of CSP (GRADE 1B). The treatments for Caesarean scar pregnancy are multiple, and they include a surgical management, a medical management and a combination between these two types of treatments. Despite the recommendation of SMFM in this review, we also included some cases of conservative management published in the last months.

Considering all the different approaches on CSP, the management has to be individualized mainly on gestational age and it has to be discussed by a multidisciplinary team, to choose the safest clinical option.
Adjunctive Volasertib in Patients With Acute Myeloid Leukemia not Eligible for Standard Induction Therapy: A Randomized, Phase 3 Trial
Authors: Döhner Hartmut , Symeonidis Argiris , Deeren Dries , Demeter Judit , Sanz Miguel A. , Anagnostopoulos Achilles , Esteve Jordi , Fiedler Walter , Porkka Kimmo , Kim Hee-Je , Lee Je-Hwan , Usuki Kensuke , D'Ardia Stefano , Won Jung Chul , Salamero Olga , Horst Heinz-August , Recher Christian , Rousselot Philippe , Sandhu Irwindeep , Theunissen Koen , Thol Felicitas , Döhner Konstanze , Teleanu Veronica , DeAngelo Daniel J. , Naoe Tomoki , Sekeres Mikkael A. , Belsack Valerie , Ge Miaomiao , Taube Tillmann , Ottmann Oliver G.
Published: August 2021

In this phase 3 trial, older patients with acute myeloid leukemia ineligible for intensive chemotherapy were randomized 2:1 to receive the polo-like kinase inhibitor, volasertib (V; 350 mg intravenous on days 1 and 15 in 4-wk cycles), combined with low-dose cytarabine (LDAC; 20 mg subcutaneous, twice daily, days 1–10; n = 444), or LDAC plus placebo (P; n = 222). Primary endpoint was objective response rate (ORR); key secondary endpoint was overall survival (OS). Primary ORR analysis at recruitment completion included patients randomized ≥5 months beforehand; ORR was 25.2% for V+LDAC and 16.8% for P+LDAC (n = 371; odds ratio 1.66 [95% confidence interval (CI), 0.95–2.89]; P = 0.071). At final analysis (≥574 OS events), median OS was 5.6 months for V+LDAC and 6.5 months for P+LDAC (n = 666; hazard ratio 0.97 [95% CI, 0.8–1.2]; P = 0.757). The most common adverse events (AEs) were infections/infestations (grouped term; V+LDAC, 81.3%; P+LDAC, 63.5%) and febrile neutropenia (V+LDAC, 60.4%; P+LDAC, 29.3%). Fatal AEs occurred in 31.2% with V+LDAC versus 18.0% with P+LDAC, most commonly infections/infestations (V+LDAC, 17.1%; P+LDAC, 6.3%). Lack of OS benefit with V+LDAC versus P+LDAC may reflect increased early mortality with V+LDAC from myelosuppression and infections.
Intraoperative OCT for the assessment of posterior capsular integrity in pediatric cataract surgery
Authors: Chen Wan , Lin Zhuangling , Zhu Qiaolin , Lin Duoru , Chen Hui , Wang Jinghui , Chen Jingjing , Wang Qiwei , Wu Xianghua , Lin Zhuoling , Lin Xiaoshan , Li Xiaoyan , Li Jing , Lin Haotian , Chen Weirong
Published: August 2021

Purpose:

To study the morphology of the posterior lens cortex and posterior capsules (PCs) in pediatric patients with posterior lens opacities using intraoperative optical coherence tomography (iOCT).

Setting:

Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Design:

Prospective observational study.

Methods:

Pediatric patients with posterior lens opacities were imaged using iOCT during cataract surgery. The morphology of the posterior lens cortex and PC, along with the common patterns to indicate PC integrity, was assessed. Moreover, PC rent during surgery was observed.

Results:

A total of 62 eyes from 53 patients were included. The mean age of patients was 3.8 years. 4 morphological variants of posterior lens opacity were observed: type I (34/62 [54.8%]) with an intact PC; type II (20/62 [32.3%]) with an intact PC, which protruded into the anterior vitreous; type III (3/62 [4.8%]) with a deficient PC and an inability to delineate the PC; and type IV (5/62 [8.1%]) with dense opacity and an inability to characterize the posterior cortex and PC. Phacoemulsification could be performed in types I and II. In types III and IV, manual nucleus removal was performed instead of phacoemulsification. 3 cases (100%) of type III PC dehiscence developed during surgery, whereas no cases developed PC dehiscence of other types.

Conclusions:

The morphology of the PC and posterior lens cortex in pediatric posterior lens opacities could be categorized, and PC integrity could be assessed using iOCT, which was useful to guide surgical strategies and increase safety in pre-existing PC dehiscence in pediatric cataract surgery.
Racial disparities in observers' attention to and estimations of others' pain
Authors: Kissi Ama , Van Ryckeghem Dimitri M.L. , Mende-Siedlecki Peter , Hirsh Adam , Vervoort Tine
Published: August 2021

Research has demonstrated racial disparities in pain care such that Black patients often receive poorer pain care than White patients. Little is known about mechanisms accounting for the emergence of such disparities. The present study had 2 aims. First, we examined whether White observers' attentional processing of pain (using a visual search task [VST] indexing attentional engagement to and attentional disengagement from pain) and estimation of pain experience differed between White vs Black faces. Second, we examined whether these differences were moderated by (1) racially biased beliefs about pain experience and (2) the level of pain expressed by Black vs White faces. Participants consisted of 102 observers (87 females) who performed a VST assessing pain-related attention to White vs Black avatar pain faces. Participants also reported on racially biased beliefs about White vs Black individuals' pain experience and rated the pain intensities expressed by White and Black avatar faces. Results indicated facilitated attentional engagement towards Black (vs White) pain faces. Furthermore, observers who more strongly endorsed the belief that White individuals experience pain more easily than Black individuals had less difficulty disengaging from Black (vs White) pain faces. Regarding pain estimations, observers gave higher pain ratings to Black (vs White) faces expressing high pain and White (vs Black) faces expressing no pain. The current findings attest to the importance of future research into the role of observer attentional processing of sufferers' pain in understanding racial disparities in pain care. Theoretical and clinical implications are discussed, and future research directions are outlined.
Quality-of-Care Implications of Antimicrobial Prescription Patterns for Acute Respiratory Tract Infections
Authors: Singh Vansha , Sinvani Liron , Hirsch Bruce , Finuf Kayla , Popplewell Claire , Qiu Michael , Pisano Michele , Kohn Nina , Pekmezaris Renee , Wolf-Klein Gisele
Published: August 2021

The Centers for Disease Control and Prevention estimates that half of the antibiotic prescriptions for acute respiratory tract infections (ARTIs) in ambulatory care settings are unnecessary. To better understand the quality-of-care implications of prescription patterns for ARTIs, we conducted a retrospective chart review of outpatient ARTI visits, across a large integrated health system, and examined the association of patient characteristics with receiving antimicrobials, as well as the association between receiving antimicrobials and healthcare utilization (outpatient and emergency department visits). We found that 55.4% of all ARTI outpatients were treated with antimicrobials. There was no association between patient demographics and antimicrobial prescriptions on either the first (p < .0771) or follow-up (p < .6316) visits. A lower comorbidity score was significantly associated with receiving antimicrobials (p < .0022). Patients who received antimicrobials at the first visit had significantly higher number of follow-up visits (p < .005) and more follow-up antimicrobial prescriptions (p < .0066) as compared with patients who did not receive antimicrobials at the first visit. Our results highlight the potential for clinicians to improve quality of care in ARTI management.
Investigating practice-level and individual factors of advanced practice registered nurses and physician assistants and their relationship to resilience
Authors: Klein Colleen J. , Weinzimmer Laurence G. , Dalstrom Matthew , Lizer Shannon , Cooling Melinda , Pierce Lisa
Published: August 2021

Background:

Gaps in research persist related to practitioners' resilience, although much has been written about the need for strategies to strengthen personal resilience.

Purpose:

The study's purpose was to examine practice-level (quality of physician relationship, physician presence, and autonomy) and individual factors and how they affect resilience.

Methodology:

An online survey invited advanced practice registered nurses (APRNs) and physician assistants (PAs) from four states to participate in a cross-sectional study. Hierarchical ordinary least squares regression was used to test the impact of main effect variables in the context of identified control variables.

Sample:

A sample of 1,138 APRNs and PAs completed the survey questions.

Results:

Findings from the covariate model (model 1) and the main effect model (model 2) show that both models were significant at the p < .01 level, with the adjusted R
2 differing from 0.02 to 0.13, respectively. Regression results show a significant positive association between quality of the physician relationship and APRN/PA resilience (b = 0.09, p < .01). A negative association between the lack of autonomy and higher levels of resilience (b = −0.14, p < .01) was also demonstrated.

Conclusions:

Advanced practice registered nurse/PA resilience is affected by both practice-level and personal factors, suggesting that workplace interventions could increase resilience.

Implications for practice:

Work environments allowing APRNs and PAs to function autonomously and with professional support from physician colleagues are favorable contributors to their resilience. Future studies need to investigate the meaning of physician presence/availability and organizational interventions that extend beyond individual resilience.
How cutting-edge trial design can assess outcomes
Authors: Serpa Neto Ary , Goligher Ewan C. , Hodgson Carol L.
Published: August 2021

Purpose of review

Randomized clinical trials (RCTs) have come to be accepted as the gold standard for assessing the efficacy and effectiveness of therapeutics and interventions in medicine. In this paper, we aim to describe some evolving concepts associated with the design and conduct of RCTs and outline new approaches aiming to increase efficiency and reduce costs.

Recent findings

A well-powered and performed RCT is usually a study involving several different centers from different geographical areas that enrolls a large number of patients in diverse clinical settings. Altogether, these features increase the generalizability of the study and make the rapid implementation of the findings more likely. However, this does not come without cost. Among several possible alternatives to conventional RCTs, the most important ones are related to the unit of randomization (individual vs. cluster), study design (conventional vs. adaptive), randomization scheme (fixed vs. response-adaptive), data collection (conventional case report forms vs. registry-embedded) and statistical approach (frequentist vs. Bayesian).

While conventional RCTs remain the gold standard for generating evidence, new trial designs may be considered to reduce sample size and costs while improving trial efficiency and power. However, they raise new challenges for testing feasibility, conduct, ethical oversight and statistical analysis.
Evaluation of Endoscopic Practices and Outcomes in Follow-up of Gastric Ulcers
Authors: Yang Linda S. , Hartley Imogen , Thompson Alexander J. , Desmond Paul , Taylor Andrew C.F. , Moss Alan , Holt Bronte A.
Published: August 2021

Goal:

The aim of this study was to evaluate current practice in gastric ulcer follow-up to establish diagnostic yield and predictors of malignancy.

Background:

Repeat gastroscopy is routinely performed to confirm gastric ulcer healing and exclude malignancy. However, the incidence of malignancy at follow-up endoscopy is low, without consensus regarding case selection and timing.

Study:

New gastric ulcers diagnosed on gastroscopy at 2 institutions in Australia were identified through keyword search of endoscopy reports over a 5-year period (2013 to 2017). Data collected included patient demographics, clinical presentation, and endoscopic and histologic findings from initial and subsequent gastroscopies.

Results:

Of 795 patients, repeat gastroscopy was performed in 440 (55%). Malignancy was diagnosed in 52 (7%) with 83% identified at initial gastroscopy. Eight cancers were identified at repeat gastroscopy with malignancy yield of 2% (8/440). Three were diagnosed in patients with benign initial ulcer histology (3/286, 1%). One cancer was diagnosed during follow-up in a patient with benign histology but no repeat gastroscopy (1/286, 0.3%). Predictors of benign ulcers were absence of endoscopic suspicion [odds ratio (OR) 0.1 (0.03-0.13), P≤0.005], complete healing on repeat gastroscopy [OR 0.5 (0.34-0.70), P=0.036] and benign initial histology [OR 0.12 (0.43-0.90), P≤0.005].

Conclusions:

Seven percent of new gastric ulcers were malignant with most identified with biopsy on initial gastroscopy. Malignancy yield from follow-up gastroscopy was 2%. Diagnostic yield of endoscopic follow-up may be low in ulcers with benign appearance and adequate histology. However, current practice of repeat gastroscopy is warranted in the absence of patient-based and lesion-based predictors of malignancy.
Gastroscopy in younger patients: an analysis of referrals and pathologies
Authors: Räsänen Noora , van Nieuwenhoven Michiel
Published: August 2021

Background and aim

Diagnostic guidelines for the investigation of dyspepsia for patients <50 years have been implemented. However, it is unsure whether these guidelines are used appropriately. We aimed to investigate the adherence to the national guidelines of uninvestigated dyspepsia and to examine the prevalence of upper gastrointestinal pathology in patients 18–50 years. We also aimed to detect any possible risk factors for pathology in esophagogastroduodenoscopy referrals and to evaluate differences between referrals from the hospital and primary health care.

Method

This is a retrospective review of medical records including patients who underwent esophagogastroduodenoscopy between January 2019 and April 2020 (n = 1809). Odds ratios (OR), positive predictive values (PPV), negative predictive values (NPV), chi-square and Mann–Whitney U-tests were applied.

Results

In total 1708 patients were included, of whom 43.6% (n = 744) had a pathologic finding. Age group 41–50 years showed the highest prevalence with an OR 1.34 [95% confidence interval (CI), 1.07–1.69]. Helicobacter pylori testing was performed in 21.1% (n = 167) of patients with dyspepsia lacking alarm symptoms (n = 791). PPV and OR were generally low for a pathologic esophagogastroduodenoscopy. The absence of alarm symptoms showed a high NPV for significant pathology (98.7–99.6%). Significant pathology was almost exclusively found in hospital-based referrals.

Conclusions

Esophagogastroduodenoscopy is widely performed in young adults, often without significant findings. Adherence to the national guidelines was poor. No referral factors were associated with a significant risk for a pathologic finding. Esophagogastroduodenoscopy based on primary healthcare referrals demonstrated almost exclusively benign pathology. Significant pathology was only found via hospital-based referrals.
Head and neck free-flap salvage
Authors: Olinde Lindsay M. , Farber Nicole I. , Kain Joshua J.
Published: August 2021

Purpose of review

To highlight three clinical arenas in which head and neck free-flap compromise is encountered and acted upon: nonoperative, operative and postoperative realms.

Recent findings

Time to identification and intervention is paramount to successful free-flap salvage. Surgical microvascular revision remains chief amongst strategies to revert vascular compromise of a free-flap. Adjuncts, such as thrombolytics and systemic anticoagulation have an important role in the complex work of microvascular free tissue care. Venous congestion of free flaps holds favorable for salvage when compared with arterial insufficiency.

Vascular compromise of head and neck free flaps is a rare and feared event for microvascular surgeons, with successful transfers rates approaching above 95%. Success in salvage is dependent on prompt identification of tissue compromise and timely, directed interventions to re-establish tissue perfusion.