bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of results of social rehabilitation programs for young people with behavioural problems
Authors: Moors Martins , Osis Juris
Published: November 2019

New targeted social service – social rehabilitation program for young people with behavioural problems is implemented in Riga since 2016. The program beneficiaries are young people from social risk families with multiple social problems – learning difficulties, delinquency, low communication skills, difficulties in problem and conflict resolution, addictions, social isolation, etc. The program is provided by two organizations – “The Samaritan Association of Latvia” and the “Social Services Agency”. The duration of the programs is 6 months and 8 months respectively, each Program provides services for 15 young people aged 13 to 18 years. The study analyses results of the Program implemented by the “Social Service Agency” for 15 young people. The main objective was to determine if the implementation of the Program improves the social functioning of young people having behavioural problems.
Management of Wage-To-Labor Productivity Correlation as a Factor of Samara Region Economic Development
Authors: Bogatyreva I.V. , Kozhukhova N.V. , Acopyan D.A.
Published: November 2019

The paper considers the problems in management of the wage-to-labor productivity correlation as the most important element in the strategic development of Samara region economy. The rational correlation between labor productivity and wages growth affects production cost reduction, and increases profitability and production efficiency. This explains the relevance of the study on the wage-to-labor productivity correlation in the digital economy. The authors present the results of the research on the dynamics of labor productivity and wages in Samara region in 2010 – 2017. They calculated the correlation figures of average wages growth in Samara region economy, described the model and developed the mechanism to manage the wage-to-labor productivity correlation.
Forming Legal Definitions of Modern Information Technologies under Economic Digitalization
Authors: Taran K. K.
Published: November 2019

During the intensive development of information technologies (IT), the need for their regulation gradually arises. For forming basic regulation of IT-sphere a basis is needed, which determines the subject of regulation. It’s a complicated task, but its solution will help to determine legal relations stemming from IT-usage. The existing technical definitions are accurate, since they are technical in nature. In some situations there are difficulties in their legal application, it complicates the legal analysis of a specific situation. The legal definition of a particular technology will assist legal professionals and theorists, as it will clarify the essence of relations, help to avoid misconception, support Internet law developing. This study discusses a short list of technologies used in practice in legal, medical and other fields. The author provides an overview of legal definitions at various levels: international, regional and national. The author examines the formation of definitions in Russia and the USA. A comparative analysis of terminology allows us to highlight the laws and features inherent in these countries. The author discusses the definitions of well-known, basic concepts such as the Internet, the user and the definition of technology that is currently widely used - a cloud storage of information.
The Strategy for the Development of Digital Education in Russia
Authors: Kolbachev E.B. , Pakhomova А.А. , Lomachenko T.I. , Кokodey T.А.
Published: November 2019

In a wide range of works of domestic and foreign scientists only some aspects of the digital economy are touched upon, which in the long run should develop into broader research. The authors' researches are aimed at forming a strategy for the development of digital education in Russia as the basis for implementing the national concept of "digital economy". To meet the requirements, the authors of the MBIC should pay more attention to the principles of management based on a cost approach, as well as to the interests of stakeholders in the planning and control of the achievement of goals. Stakeholders may be individuals, groups of individuals, institutions and organizations that influence the achievement of SSC goals and the implementation of their own goals, which in turn depend on the success of each SSCC author's activities.
Data Inventory as the Development and Promotion Basis of Universities Educational Programs
Authors: Zhelev P. , Svetkina I. A. , Zotova A.S. , Chudaeva A.A.
Published: November 2019

Digitalization affects universities, including management decision-making processes. Different management decisions require different data sets. The paper studies the issues of making managerial decisions at the university on the development and promotion of basic educational programs at the educational services market based on the results of data inventory. Two approaches are proposed: the study of data belonging to the university, and the search for the necessary data in the external environment. The article identifies the areas that need to be studied in order to make managerial decisions on ways to promote the main educational programs at the university, and analyzes the information accumulated both inside the university and in the external environment. The authors of the article proposed an algorithm for database inventory, which involves the identification of data sources, including digital traces, the analysis of the authority to use databases with the necessary registries of information systems and website directories. The result of data inventory should be the design of updating systems for the development and promotion of a university educational program. These actions will lead to the creation of an information system that will collect and process the diverse information needed to adjust the university’s strategy. As a result, the university should expand the functional system that accumulates and systematizes various data required to promote the university educational programs at the market.
Informationsfluss und Prozessgestaltung im Team verbessern
Authors: Widdel Franziska , Schneider Wencke
Published: November 2019

Damit im hektischen Arbeitsalltag keine wichtigen Informationen mehr verloren gehen, stellen wir Ihnen das Teaming Board vor. Es ist ein lösungsorientiertes Führungsinstrument, mit dem sich die Informationsweitergabe und Prozessgestaltung in der Patientenversorgung verbessern lassen. Dabei bringt es Leitungen und Mitarbeitende aller Qualifikationsstufen zusammen und hält Beratungsergebnisse tagesaktuell und strukturiert fest.
Statistics of coherent structures in two-dimensional turbulent Rayleigh-Bénard convection
Authors: Chand Krishan , Sharma Mukesh , Vishnu Venugopal T. , De Arnab Kr.
Published: November 2019

Characterization of coherent structures in turbulent Rayleigh-Bénard convection using statistical measures is presented in the present work. Numerical simulations are carried out in a two-dimensional (2D) rectangular cell with aspect ratio 2 using air as the working fluid across four decades of Rayleigh number. The absence of one lateral dimension leads to entrapment of plumes which are consequently emitted in the form of thermal jets. Axial nonuniformity in thermal boundary layers is eliminated at high Rayleigh numbers. The so-called slope and 99% methods produce identical boundary layer thicknesses whose power law variation confirms theoretical inverse-Nu scaling. Turbulent kinetic energy budget unveils a transport-dissipation balance near the walls with buoyancy production nearly sustaining turbulent fluctuations in the bulk region. A higher threshold for the correlation between the vertical velocity and temperature results in faster convergence of plume and background share of dissipation, while decay in the volume fraction of the plume region continues. Exponential distribution of temperature fluctuations suggests the presence of hard turbulence at very large Rayleigh numbers with wider tails recording extreme fluctuating events. Changes in plume emission and its subsequent motion not only influence boundary layer instabilities but also cause departure from the −5/3 law in the frequency spectra.
The role of trapped water on electroresponsive microspheres is revealed
Authors: Mandel Savannah
Published: November 2019

Scientists develop a scalable and easy approach to achieve electroresponsive microspheres through evaporation-induced assembly.
Assessing equine embryo developmental competency by time-lapse image analysis
Authors: Brooks Kelsey E. , Daughtry Brittany L. , Metcalf Elizabeth , Masterson Keith , Battaglia David , Gao Lina , Park Byung , Chavez Shawn L.
Published: November 2019

The timing of early mitotic events during preimplantation embryo development is important for subsequent embryogenesis in many mammalian species, including mouse and human, but, to date, no study has closely examined mitotic timing in equine embryos from oocytes obtained by ovum pick-up. Here, cumulus–oocyte complexes were collected by transvaginal follicular aspiration, matured invitro and fertilised via intracytoplasmic sperm injection. Each fertilised oocyte was cultured up to the blastocyst stage and monitored by time-lapse imaging for the measurement of cell cycle intervals and identification of morphological criteria indicative of developmental potential. Of the 56 fertilised oocytes, 35 initiated mitosis and 11 progressed to the blastocyst stage. Analysis of the first three mitotic divisions in embryos that formed blastocysts determined that typical blastocyst timing (median±IQR) is 30.0±17.5min, 8.8±1.7h and 0.6±1.4h respectively. Frequent cellular fragmentation, multipolar divisions and blastomere exclusion suggested that equine embryos likely contend with a high incidence of chromosomal missegregation. Indeed, chromosome-containing micronuclei and multinuclei with extensive DNA damage were observed throughout preimplantation embryogenesis. This indicates that time-lapse image analysis may be used as a non-invasive method to assess equine embryo quality in future studies.
Molecular breeding approaches for production of disease-resilient commercially important tobacco
Authors: Kakar Kaleem U , Nawaz Zarqa , Cui Zhouqi , Ahemd Nazeer , Ren Xueliang
Published: November 2019

Tobacco is one of the most widely cultivated nonfood cash crops, a source of income, model organism for plant molecular research, a natural pesticide and of pharmaceutical importance. First domesticated in South Americas, the modern-day tobacco (Nicotiana tabacum) is now cultivated in more than 125 countries to generate revenues worth billions of dollars each year. However, the production of this crop is highly threatened by the global presence of devastating infectious agents, which cause huge fiscal loss. These threats have been battled through breeding for acquiring disease resilience in tobacco plants, first, via conventional and now with the use of modern molecular breeding approaches. For efficacy and precision, the characterization of the genetic components underlying disease resistance is the key tool in tobacco for resistance breeding programs. The past few decades have witnessed significant progress in resilience breeding through advanced molecular techniques. The current review discusses history of tobacco breeding since its time of origin till date, highlighting the most widely used techniques and recent advances in molecular research and strategies for resistance breeding. In addition, we narrate the budding possibilities for the future. This review will provide a comprehensive and valuable information for the tobacco growers and researchers to deal with the destructive infectious diseases.
Annotated Draft Genomes of Two Caddisfly Species Plectrocnemia conspersa CURTIS and Hydropsyche tenuis NAVAS (Insecta: Trichoptera)
Authors: Heckenhauer Jacqueline , Frandsen Paul B , Gupta Deepak K , Paule Juraj , Prost Stefan , Schell Tilman , Schneider Julio V , Stewart Russell J , Pauls Steffen U
Published: November 2019

Members of the speciose insect order Trichoptera (caddisflies) provide important ecosystem services, for example, nutrient cycling through breaking down of organic matter. They are also of industrial interest due to their larval silk secretions. These form the basis for their diverse case-making behavior that allows them to exploit a wide range of ecological niches. Only five genomes of this order have been published thus far, with variable qualities regarding contiguity and completeness. A low-cost sequencing strategy, that is, using a single Oxford Nanopore flow cell per individual along with Illumina sequence reads was successfully used to generate high-quality genomes of two Trichoptera species, Plectrocnemia conspersa and Hydropsyche tenuis. Of the de novo assembly methods compared, assembly of low coverage Nanopore reads (∼18×) and subsequent polishing with long reads followed by Illumina short reads (∼80–170× coverage) yielded the highest genome quality both in terms of contiguity and BUSCO completeness. The presented genomes are the shortest to date and extend our knowledge of genome size across caddisfly families. The genomic region that encodes for light (L)-chain fibroin, a protein component of larval caddisfly silk was identified and compared with existing L-fibroin gene clusters. The new genomic resources presented in this paper are among the highest quality Trichoptera genomes and will increase the knowledge of this important insect order by serving as the basis for phylogenomic and comparative genomic studies.
“It’s My Time”: Older Adults’ Experiences and Perceived Benefits of Participation in an Intergenerational Rock Band
Authors: Wlodarczyk Natalie
Published: November 2019

The purpose of this qualitative content analysis was to explore the experiences and perceived benefits for older adult members who participated in an intergenerational rock band (IGRB) pairing older adults with college students. Participants (n = 29) were first-time older adult IGRB members who completed semi-structured interviews over the course of 5 years. Interviews were completed within 1 week of the conclusion of the semester-long participation in the IGRB. Each interview was digitally recorded, manually transcribed, and analyzed using an iterative approach to thematic analysis. Experiences and perceived benefits associated with participation in the IGRB for these older adults were encompassed by four themes: Staying Active, Wanting to Try Something New, Feeling Connected, and Seeking Positive Experiences. Findings indicate that an IGRB is an innovative, collaborative, and inclusive intergenerational music-making experience that leaves a multifaceted and overall positive impact on its older adult members. Themes suggest that older adults with musical backgrounds may enjoy an experience like an IGRB because it brings a level of familiarity coupled with the opportunity to try something new and different from their previous experiences with music. A key contribution of this study is the importance of promoting a judgment-free environment for singing that is inclusive of all ability levels. Developing a better understanding of older adults’ motivations for participating in an IGRB may help us to plan future music experiences for older adults and broaden our reach to the older adult community.
Safety and efficacy of supplements in pregnancy
Authors: Brown Benjamin , Wright Ciara
Published: November 2019

Pregnancy is a time where expectant mothers often focus on their diet to improve their own health and to preserve the future health of their children. There is much conflicting information in the public domain about the safety and/or efficacy of nutritional supplements during pregnancy. Despite this, the market for supplements is growing. This review discusses the roles of critical nutrients in pregnancy and the available evidence on the use of supplements to reduce risks and improve maternal and fetal outcomes. Recommendations are made for pregnant women, taking into account safety data and tolerable upper intakes set for pregnant women. It is important for dieticians, nutritionists, physicians, and other healthcare providers to be able to offer accurate and evidence-based advice on supplement use in pregnancy. Routine supplementation may not be necessary for all, but individuals at risk are identified.
Interprofessional Provider Attitudes Toward the Initiation of Epidural Analgesia in the Laboring Patient: Are We All on the Same Page?
Authors: Lipps J. , Lawrence A. , Palettas M. , Small R.H. , Soma L. , Coffman J.C.
Published: November 2019

(Int J Obstet Anesth. 2019;37:57–67)

During labor and delivery, the initiation of labor epidural analgesia should ultimately be determined by the patient’s preference. Practice guidelines from both the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists state that epidural analgesia can be offered early in labor and maternal request should be a legitimate indication for performing the procedure. However, different healthcare providers may prioritize different factors when counseling patients on the subject of the “best” time during labor to request epidural analgesia. In fact, information is limited about the attitudes of different types of health care providers regarding the timing of epidural placement during labor. This study surveyed a variety of providers to determine how patient factors or circumstances might affect their decision-making about the timing of epidural labor analgesia initiation. Their goal was to use this survey data to identify differences among provider types and ultimately improve understanding and education on the topic to promote patient-centered care.
Population-based Cohort Study of Hospital Delivery Volume, Geographic Accessibility, and Obstetric Outcomes
Authors: Aubrey-Bassler F.K. , Cullen R.M. , Simms A. , Asghari S. , Crane J. , Wang P.P. , Godwin M.
Published: November 2019

(Int J Gynecol Obstet. 2019;146:95–102)

There is no consensus on the ideal distribution of maternal health care between rural and urban areas. Studies on this topic have been mixed, sometimes showing poorer outcomes for women in rural areas and for those who travel further to obstetric services. Studies have also suggested women delivering at higher-volume hospitals experienced improved outcomes. These studies, however, may not consider women who travel farther distances to high-volume hospitals. In Canada, high-risk women are often referred to high-volume and high-level medical centers, which confounds the relationship among delivery volume, geographic accessibility and obstetric outcomes. This study aimed to quantify the effect of geographic accessibility and delivery volume on outcomes for both mother and child, in an effort to inform policy decisions.
A Systematic Review of the Cost-effectiveness of Uterotonic Agents for the Prevention of Postpartum Hemorrhage
Authors: Lawri T.A. , Rogozińska E. , Sobiesuo P. , Vogel J.P. , Ternent L. , Oladapo T.
Published: November 2019

(Int J Gynecol Obstet. 2019;146:56–64)

Around 5% of women giving birth worldwide experience postpartum hemorrhage (PPH). PPH is defined as blood loss of ≥500 mL within a day of birth and most often occurs when the uterus does not contract following delivery. All women giving birth should be offered a uterotonic agent in the third stage of labor, according to World Health Organization (WHO) guidelines. Uterotonic agents for PPH prevention include oxytocin, ergometrine, misoprostol, carbetocin, injectable prostaglandins and syntometrine (a combination of ergometrine and oxytocin). WHO recommends oxytocin as a first-choice uterotonic for the prevention of PPH. Previous single-setting studies have assessed single uterotonics for cost-effectiveness. This review aimed to assess the cost-effectiveness of all available options of uterotonic agents for the prevention of PPH.
Consultation, Surveillance, Monitoring, and Intensive Care (COSMIC): A Novel 4-Tier Program to Identify and Monitor High-Risk Obstetric Patients From the Clinic to Critical Care
Authors: Lockhart E.M. , Hincker A. , Klumpner T.T. , Hofer J. , Cahill A.G. , Palanisamy A. , Boyle W. , Ginosar Y.
Published: November 2019

(Anesth Analg. 2019;128(6):1354–1360)

The majority of obstetric patients experience good outcomes from the birthing process. However, a small group of women develop serious morbidity or even die during pregnancy, labor, or delivery. This article described the consultation, surveillance, monitoring, and intensive care (COSMIC) program that has been implemented in the authors’ institution to escalate serious obstetric patient issues to the appropriate level of medical care. The goal of the COSMIC program is to optimize available resources for high-risk obstetrical patients in the most cost effective and efficient manner.
Plasma and Cerebrospinal Fluid Inflammatory Cytokines in Perinatal Depression
Authors: Miller E.S. , Sakowicz A. , Roy A. , Yang A. , Sullivan J.T. , Grobman W.A. , Wisner K.L.
Published: November 2019

(Am J Obstet Gynecol. 2019;220:271.e1–271.e10)

Perinatal depression affects 1 in 7 women, and there is a clear need for more effective and accessible interventions. Depression outside of pregnancy has been increasingly considered a disorder of immune hyperactivation, yet there is not a clear understanding of the mechanisms of perinatal depression. Although peripheral inflammatory cytokines have been associated with depression, cytokines are large molecules that cannot freely cross the blood-brain barrier. Inflammation in the cerebrospinal fluid may provide greater insights into alterations in brain function. This study aimed to investigate the association between perinatal depression and inflammatory cytokines in plasma and in cerebrospinal fluid, hypothesizing that higher concentrations of inflammatory cytokines would appear in women with perinatal depression, compared with women without perinatal depression.
Planned Delivery Route of Preterm Breech Singletons, and Neonatal and 2-Year Outcomes: A Population-based Cohort Study
Authors: Lorthe E. , Sentilhes L. , Quere M. , Lebeaux C. , Winer N. , Torchin H. , Goffinet F. , Delorme P. , Kayem G.
Published: November 2019

(BJOG. 2019;126(1):73–82)

Choosing the mode of delivery for preterm breech infants can be challenging for clinicians, as there is a lack of evidence-based literature on the subject. Some previous studies have evaluated actual delivery route rather than planned route, or only considered short-term outcomes. This study aimed to determine whether planned delivery route was associated with perinatal and 2-year outcomes in breech preterm infants. The authors hypothesized planned cesarean delivery (PCD) would be associated with improved outcomes.
Granisetron Reduces the Need for Uterotonics but not Sympathomimetics During Cesarean Delivery
Authors: Raimann F.J. , Baldauf H.P. , Louwen F. , Jennewein L. , Fischer D. , Zacharowski K. , Weber C.F.
Published: November 2019

(Int J Gynecol Obstet. 2019;145:361–366)

Although spinal anesthesia (SPA) for cesarean delivery might improve outcomes for mother and child, it does carry the frequent side effects of hypotension and bradycardia, which in turn can lead to reduced uteroplacental perfusion. There are a few possible causes of hypotension during SPA and several strategies for its treatment. One possible option for preventing hypotension is the use of 5-HT3 receptor antagonists. Previous studies have found that ondansetron, a 5-HT3 receptor, had a positive effect on hemodynamic stability in obstetric studies. There is a lack of evidence for the use of 5-HT3 receptor antagonists to preemptively attenuate the adverse effects of SPA, however. This study aimed to evaluate a 5-HT3 receptor antagonist, granisetron, for its effects on the need for uterotonic agents and sympathomimetics after SPA.
Adverse Effects of Dexamethasone in Surgical Patients
Authors: Blanchard Denise , Wissen Kim van
Published: November 2019

Editor's note: This is a summary of a nursing care–related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.
Parkinson's Drug Doesn't Increase Prostate Cancer Risk
Authors: Aschenbrenner Diane S.
Published: November 2019

The Food and Drug Administration (FDA) has determined that entacapone, used in the management of Parkinson's disease, does not increase the risk of prostate cancer or death from prostate cancer.

The decision was based on an analysis of data from a postmarketing clinical trial conducted by the drug manufacturer and an FDA review of data from the Department of Veterans Affairs.
What She Leaves Behind
Authors: Brown Theresa
Published: November 2019

Cystic fibrosis and an unfinished life.
Caring for the hospitalized patient with opioid use disorder
Authors: Moore Dorothy J.
Published: November 2019

During your career, it's likely that you'll care for individuals with opioid dependence or addiction. Knowing the basics will help you understand these patients and improve their outcomes.
Conditioned Pain Modulation in Chronic Low Back Pain
Authors: Neelapala Y. V. Raghava , Bhagat Madhura , Frey-Law Laura
Published: November 2019

Objective:

The objective of the review is to determine whether conditioned pain modulation (CPM) is impaired in adults with chronic low back pain (CLBP) when compared with pain-free individuals.

Methods:

A a systematic search of the literature was undertaken using the databases: MEDLINE, Scopus, CINAHL and Web of Science. The citations of included studies were reviewed for additional studies. Observational, cross-sectional, case-control studies published in English between January 1990 and August 2019 were considered. Studies that investigated the efficiency of standardized CPM regimens among defined cases of CLBP and in comparison, with pain-free controls were included. After initial title and abstract screening, 2 authors reviewed the full texts of the eligible articles independently. Risk of bias was carried out using assessment of 4 categories: blinding of the outcome assessors, representativeness of cases to the specified population, comparability of cases and controls, and control of confounding variables.

Results:

In total, 643 records were identified, of which 7 studies were included. Overall, the results of the studies reported mixed conclusions on the efficiency of CPM in CLBP. Three studies identified significant differences for CPM between CLBP and pain-free controls and the other 4 studies reported no significant differences. The common methodological limitations were unclear reporting about blinding of the outcome assessors and inadequate control of confounding factors.

Conclusions:

High-quality research is strongly recommended to determine the function of endogenous pain modulatory mechanisms in CLBP.
Anticoagulation Management and Antithrombin Supplementation Practice during Veno-venous Extracorporeal Membrane Oxygenation
Authors: Protti Alessandro , Iapichino Giacomo E. , Di Nardo Matteo , Panigada Mauro , Gattinoni Luciano
Published: November 2019

Background

There is a lack of consensus on how to manage anticoagulation during veno-venous extracorporeal membrane oxygenation, including antithrombin monitoring and supplementation. The authors’ aim was to determine current practice in a large number of extracorporeal membrane oxygenation centers around the world.

Methods

This was an electronic survey disseminated in 2018 to directors and coordinators of extracorporeal membrane oxygenation centers as well as to extracorporeal membrane oxygenation experts. Participating centers were classified according to some covariates that may affect practice, including 2017 gross national income per capita, primary patient population, and annual extracorporeal membrane oxygenation patient volume.

Results

The authors analyzed 273 unique responses from 50 countries. Systemic anticoagulation was routinely prescribed in 264 (96.7%) centers, with unfractionated heparin being the drug of choice in 255 (96.6%) of them. The preferred method to monitor anticoagulation was activated partial thromboplastin time in 114 (41.8%) centers, activated clotting time in 82 (30.0%) centers, and anti-factor Xa activity in 62 (22.7%) centers. Circulating antithrombin activity was routinely monitored in 133 (48.7%) centers. Antithrombin supplementation was routinely prescribed in 104 (38.1%) centers. At multivariable analyzes, routine antithrombin supplementation was associated with national income, being less likely in lower- than in higher-income countries (odds ratio, 0.099 [95% CI, 0.022 to 0.45]; P = 0.003); with primary patient population being more frequent in mixed (odds ratio, 2.73 [1.23 to 6.0]; P = 0.013) and pediatric-only centers (odds ratio, 6.3 [2.98 to 13.2]; P < 0.001) than in adult-only centers; but not with annual volume of extracorporeal membrane oxygenation cases, being similarly common in smaller and larger centers (odds ratio, 1.00 [0.48 to 2.08]; P = 0.997).

Conclusions

There is large practice variation among institutions regarding anticoagulation management and antithrombin supplementation during veno-venous extracorporeal membrane oxygenation. The paucity of prospective studies and differences across institutions based on national income and primary patient population may contribute to these findings.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
A Descriptive Study of the Attitudes, Perceptions, and Experiences of Human Milk Donation
Authors: Wambach Karen , Bateson Tiffany , Matheny Paige , Easter-Brown Kristan
Published: November 2019

Background:

The use of pasteurized human donor milk has increased in recent years due to health benefits and rising number of infants who need pasteurized human donor milk. Little is known about milk donors' experiences or what contributes to their motivation to donate.

Purpose:

Using existing evidence and the theory of planned behavior as a guide, our purpose was to describe the personal and social aspects of mothers' milk donation to a milk bank in the Midwest United States.

Methods:

A convenience sample of 50 current human milk donors enrolled in this cross-sectional descriptive study. The investigator-designed online survey consisted of open and closed questions based upon existing evidence and theory of planned behavior for assessing reasons for donation, beliefs about benefits and barriers, social support for donation, donation history, and current experiences. We used the Iowa Infant Feeding Attitude Survey to characterize general breastfeeding attitudes. Data analysis consisted of content analysis for narrative data and descriptive statistics for continuous and dichotomous variables.

Findings/Results:

Six themes represented experiences of discovering donation, reasons and motivations for donating, benefits and barriers to donation, confidence in donating, and support for donation. Practical and altruistic motivations for donation were prevalent. Confidence for donation was instilled by adequate milk supply, growth of the infant, and the milk bank process and professionalism. Support from others was universal.

Implications for Practice:

Findings can inform education regarding human milk donation. Human milk banks may benefit from identified donation barriers to improve support for donors.

Implications for Research:

Findings are being used for instrument development for research regarding women's intentions and donor behavior.
An Observational Study on Early Dyadic Interactive Behaviors of Mothers With Early-Preterm, Late-Preterm, and Full-Term Infants in Malawi
Authors: Gondwe Kaboni Whitney , Brandon Debra , Yang Qing , Malcolm William F. , Small Maria J. , Holditch-Davis Diane
Published: November 2019

Background:

Mother–infant interactions are necessary for infant growth and development. However, preterm birth is associated with less positive mother–infant interactions than full-term birth. Malawi has the highest preterm birth rate in the world, but studies of the mother–infant relationship in Malawi are limited and studies that observed mother–infant interactions could not be located.

Purpose:

This study explored mother–infant interactions among Malawian mothers of early-preterm, late-preterm, and full-term infants.

Methods:

This observational study explored maternal and infant interactive behaviors. We recruited 83 mother–infant dyads (27 early-preterm, 29 late-preterm, and 27 full-term dyads).

Findings:

Mothers of early-preterm infants looked at and rocked their infants less, and their infants looked at their mothers less, than mothers of either late-preterm infants or full-term infants. The infants in all groups were asleep most of the time, which contributed to low levels of interactive behaviors. Factors that were related to infant behaviors included marital status, maternal occupation, maternal education, infant medical complications, infant gender, history of neonatal deaths, and multiple births.

Implications for Practice:

Our findings provide evidence about the need to encourage mothers to engage interactive behaviors with their infants.

Implications for Research:

Future studies of factors that contribute to positive interactions in Malawi are needed.
The evolution of hand function during remodelling in nonreduced angulated paediatric forearm fractures: a prospective cohort study
Authors: Barvelink Britt , Ploegmakers Joris J.W. , Harsevoort Arjan G.J. , Stevens Martin , Verheyen Cees C. , Hepping Ann M. , Bulstra Sjoerd K.
Published: November 2019

Forearm fractures are very common orthopaedic injuries in children. Most of these fractures are forgiving due to the unique and excellent remodelling capacity of the juvenile skeleton. However, significant evidence stating the limits of acceptable angulations and taking functional outcome into consideration is scarce. The aim of this study is, therefore, to get a first impression of the remodelling capacity in nonreduced paediatric forearm fractures based on radiological and functional outcome. Children aged 0–14 years with a traumatic angular deformation of the radius or both the radius and ulna, treated conservatively without reduction, were included in this prospective cohort study. Radiographs were taken and functional outcome was assessed at five fixed follow-up appointments throughout a period of one year. Outcome measurements comprised radiographic angular alignment, grip strength and wrist mobility. A total of 26 children (aged 3–13 years) with a traumatic angulation of the forearm were included. Mean dorsal angulation at the time of presentation amounted to 12° (5–18) and diminished after one year to a mean angulation of 4° (0–13). Grip strength, pronation and supination were significantly diminished compared to the unaffected hand up to 6 months after injury. After one year, no significant differences in function between the affected and the unaffected arm were found. Nonreduced angulated paediatric forearm fractures have the potential to remodel in time and have good radiographic and functional outcome one year after trauma, where pronation and grip strength take the longest to recover.
A cross-sectional study of acute cor pulmonale in acute respiratory distress syndrome patients in China
Authors: Su Long-Xiang , Shang Xiu-Ling , Zhu Ran , He Wei , Pan Pan , Zhang Hong-Min , Zhang Li-Na , Liu Da-Wei , Yu Rong-Guo , Wang Xiao-Ting
Published: November 2019

Background:

Increased right ventricle afterload during acute respiratory distress syndrome (ARDS) may induce acute cor pulmonale (ACP), which is associated with a poor clinical outcome. Echocardiography is now considered as a rapid and non-invasive tool for diagnosis of ACP. The aims of this study were to investigate the morbidity and mortality rates of ACP in ARDS patients in intensive care units (ICUs) across the mainland of China and to determine the severity and prognosis of ACP in ARDS patients through an ultrasound protocol (TRIP). And the association between ACP related factors and the ICU mortality will be revealed.

Methods:

This study is a multicenter and cross-sectional study in China which will include ICU participants when diagnosed as ARDS. The ultrasound protocol, known as the TRIP, is proposed as severity assessment for ACP, which includes tricuspid regurgitation velocity (T), right ventricular size (R), inferior vena cava diameter fluctuation (I), and pulmonary regurgitation velocity (P). The 28-day mortality, ICU/hospital mortality, the length of stay in ICU, mechanical ventilation days, hemodynamic parameters and lab parameters of liver function and kidney function are all recorded.

Discussion:

This large-scale study would give a sufficient epidemic investigation of ACP in ARDS patients in China. In addition, with the TRIP protocol, we expect that we could stratify ACP with more echocardiography parameters.

Trial registration:

NCT03827863, https://clinicaltrials.gov/ct2/show/NCT03827863
A Limited-Versus-Extensive Staging Strategy for Small Cell Prostate Cancer
Authors: Syed Salman , Basourakos Spyridon P. , Ali Faisal S. , Garcia Jessica L. , Zurita-Saavedra Amado , Gong Zimu
Published: November 2019

Introduction:

Small cell prostate cancer (SCPC) is a rare histologic subtype of prostate cancer, for which the optimal staging strategy remains unclear.

Method:

The Surveillance, Epidemiology, and End Results database was used to analyze the incidence and outcomes of SCPC between the years 2004 through 2016. Limited-stage SCPC (LS-SCPC) was defined as SCPC without any metastasis regardless of local invasion. Extensive stage SCPC (ES-SCPC) was defined as any metastasis to lymph nodes and/or to distant organs.

Result:

A total of 403 SCPC patients were included in the study cohort, accounting for 0.056% of all prostate cancer cases (n=719,655). Of the 358 patients with known metastasis status, 275 (76.8%) patients had ES-SCPC, whereas 83 (23.2%) patients had LS-SCPC. LS-SCPC was associated with better overall survival (17 vs. 9 mo, P<0.001) and disease-specific survival (25 vs. 10 mo, P<0.001) compared with ES-SCPC. All LS-SCPC patients had a similar overall survival regardless of T stage. Similarly, all ES-SCPC patients had similar outcomes regardless of metastasis sites. High prostate-specific antigen (PSA) is paradoxically associated with superior outcome in both localized stage patients (PSA≥4 vs. PSA<4, 19 vs. 10 mo, P=0.002) and extensive stage patients (PSA≥20 vs. PSA<20, 13 vs. 9 mo, P=0.02). Multivariate analysis of treatment showed that chemotherapy was associated with improved survival in ES-SCPC with hazard ratio of 0.52.

Conclusion:

Similar to small cell lung cancer, SCPC can be staged into LS-SCPC or ES-SCPC. The binary staging system correlates well with prognosis.
Mohs Surgery for Advanced Tumors of the Scalp
Authors: Yu Wesley Y. , Salmon Paul , Thuener Jason , Bordeaux Jeremy S.
Published: November 2019

BACKGROUND

The scalp presents unique surgical challenges, and specialized techniques are sometimes required to achieve optimal results. Tumors arising on the scalp may also be at increased risk of complications such as in-transit metastasis and perineural invasion.

OBJECTIVE

To review challenges to Mohs micrographic surgery on the scalp and techniques for successful tumor extirpation and reconstruction.

METHODS AND MATERIALS

This article reviews our experience with tumors of the scalp including techniques that we have found helpful both for tumor removal and for reconstruction.

CONCLUSION

Familiarity with the anatomy of the scalp as well as common challenges encountered during Mohs surgery may help improve outcomes and impart increase confidence to the practicing surgeon.
Mohs Micrographic Surgery Pearls for the Nose and Lips
Authors: Stiegel Evan , Leach Brian , Albertini John G.
Published: November 2019

BACKGROUND

Failure to perform Mohs micrographic surgery (MMS) meticulously on the nose and lips can lead to larger defects and tumor recurrence, which can have aesthetic and functional repercussions for patients.

OBJECTIVE

To review pre-, intra-, and postoperative techniques and pearls for performing MMS on the nose and lips to optimize outcomes.

MATERIALS AND METHODS

Technical nuances and pearls cultured from the authors' own practice, those acquired from mentors and colleagues, and information identified from the literature are discussed to provide a logical approach to performing effective MMS on the nose and lips.

RESULTS

When performing MMS on the nose and lips, sound preoperative preparation, precise surgical technique, and particular attention to reducing false-positives and false-negatives while harvesting Mohs layers enhances the fidelity of the MMS procedure, minimizing defect sizes and reducing tumor recurrence.

CONCLUSION

Refining Mohs technique on the nose and lips allows more effective performance of tumor extirpation, improved microscopic evaluation, and more conservative reconstruction, leading to better patient outcomes.
Medicaid Instability and Mental Health of Teen Parent Families
Authors: Fife Donney Julie , Mitchell Stephanie J. , Lewin Amy
Published: November 2019

This study examines the effect of inconsistent Medicaid coverage on parenting stress, maternal depression, and child behavior in a sample of teen mothers and their children. The majority (54%) of mothers experienced inconsistent coverage. After 24 months, mothers experiencing inconsistent coverage had significantly higher parenting stress and depressive symptoms, and their children had more internalizing behaviors than families with consistent Medicaid. These differences existed despite no initial differences and controlling for numerous covariates. Policies and practices that stabilize Medicaid coverage for teen parent families may reduce unnecessary stress, depressive symptoms, and early childhood behavior problems.
Introducing Health and Medical Physics to Young Learners in Preschool to Fifth Grade
Authors: Fagerstrom Jessica M.
Published: November 2019

A hands-on learning activity was developed to introduce young learners to concepts and careers in health and medical physics. Inexpensive materials were used to create a work station with learning tools that were designed to be approachable and accessible for this audience. Visitors to a local independent, nonprofit science museum may interact with the activity work station to learn basic information regarding radiation in everyday life and to hear about careers in radiation sciences. Approximately 60 volunteer hours have been contributed associated with the activity. Interested physicists may adapt the lesson plan as a simple and straightforward way to participate in public education efforts in their own communities. A detailed lesson plan, equipment list, and electronic media are available upon request.
Epidemiological Association Between Systemic Diseases and Keratoconus in a Korean Population: A 10-Year Nationwide Cohort Study
Authors: Lee Hyo Kyung , Jung Eun Hye , Cho Bum-Joo
Published: November 2019

Purpose:

To investigate the association of systemic diseases with keratoconus in the general Korean population.

Methods:

This is a nationwide population-based retrospective cohort study using the Korean National Health Insurance Service-National Sample Cohort database from 2002 to 2015, involving 1,108,369 individuals. Patients with keratoconus were identified using the Korean standard classification of diseases code H18.6. The prevalence and annual incidence rates were estimated. To examine the risk factors, 5 controls were matched per patient with keratoconus by propensity score matching using age and household income. Univariate and multivariate regression analyses were performed to assess the association between relevant factors and keratoconus.

Results:

A total of 613 subjects were identified as patients with keratoconus from the cohort database. The prevalence rate was 55.31 cases per 100,000 people [95% confidence interval (CI): 51.01–59.86]. The annual incidence rate, calculated using a predate 1-year washout period, was 4.47 cases per 100,000 person-years (95% CI: 4.11–4.85). People with allergic conjunctivitis had a 37% increased odds of being diagnosed with keratoconus [odds ratio: 1.37 (95% CI: 1.12–1.67), P = 0.002] compared with those without allergic conjunctivitis. By contrast, people with allergic rhinitis had a 52% reduced odds of being diagnosed with keratoconus [odds ratio: 0.48 (95% CI: 0.38–0.59), P < 0.001]. Atopy and eczema, asthma, connective tissue disorders, diabetes mellitus, sleep apnea, and inflammatory bowel disease had no significant association with a positive keratoconus diagnosis.

Conclusions:

Allergic conjunctivitis may increase the risk of developing keratoconus in Koreans.
Common Determinants of Absence From Work in Employees and Workers
Authors: Mayer Benjamin , Guenther Steffen
Published: November 2019

Objective:

The aim of this longitudinal retrospective study was to identify possible determinants of absence from work in a productive company in Tyrol/Austria.

Methods:

Data of 974 workers and employees were analyzed. Times of absence were analyzed descriptively and the impact of their possible determinants was evaluated by means of hierarchical linear models.

Results:

The extent of absence was constant during the observed period, that is, former measures of health promotion were not effective. The number of sick days was, among others, significantly associated with working status (worker/employee, P < 0.001) and the company's department (commercial division, P < 0.001).

Conclusions:

A number of determinants for increased operational absence were identified. These may be considered specifically when adapting workplace health management. Since the observed times of absence mostly not normally distributed, future reports shall use nonparametric methods.
Nakao mesenteric approach in pancreatoduodenectomy for pancreatic head cancer
Authors: Nakao Akimasa
Published: November 2019

The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy (PD); that is, en bloc resection using a non-touch isolation technique. We have been developing isolated PD for pancreatic cancer since 1981, when we developed an anti-thrombogenic bypass catheter for the portal vein. In this operation, the first and most important step is the use of a mesenteric approach instead of Kocher's maneuver. The mesenteric approach allows dissection from the non-cancer infiltrating side and determination of cancer-free surgical margins and resectability, followed by systemic lymphadenectomy around the superior mesenteric artery. This approach enables early ligation of the inferior pancreatoduodenal artery and mesopancreas excision. The mesopancreas is the second portion of the pancreatic head nerve plexus. Isolated PD is the ideal surgery for pancreatic head cancer from both surgical and oncological viewpoints. In patients with resectable pancreatic head cancer, isolated PD using the mesenteric approach is suspected to have a higher survival rate than conventional PD using Kocher's maneuver. The precise surgical techniques of the mesenteric approach are herein described.
Pancreatic cystic neoplasms: current and future approaches to identify patients at risk
Authors: Zhang Qi , Chen Yiwen , Bai Xueli , Liang Tingbo
Published: November 2019

Pancreatic cystic neoplasms (PCNs) are a group of entities with distinct risks and various treatments. Identification of the PCN patients at risk is thus critical. A correct diagnosis is the key to select high-risk patients. However, the misdiagnosis rate is extremely high even computer tomography, magnetic resonance imaging, and endoscopic ultrasonography were applied. Current approaches for differential diagnosis and identifying high-risk patients in certain types of PCNs are not powerful enough to make a clinical acceptable accuracy of diagnosis. The approaches mainly rely on imaging and tumor marker test. We here summarized the current approaches, and reviewed novel approaches under development. For instance, cyst fluid test of glucose or vascular endothelial growth factor A shows the best performance in identifying mucinous cystic neoplasms or serous cystic neoplasms. Multidisciplinary team (MDT) discussion is another way to improve the accuracy of diagnosis. Combination of MDT with validated novel approaches with high sensitivity and specificity is the best way to select truly high-risk patients with PCNs.