bluuebunny/crossref_metadata_2025 huggingface dataset:
The Readiness Of The Stakeholders In The Implementation Of Low Carbon Cities Framework (Lccf) In An Urban Area: Methodology Of Research
Authors: Juhari Siti Kartina , Omar Dasimah Binti , Hoon Leh Oliver Ling , Kamarudin Siti Mazwin , Marzukhi Marlyana Azzyati
Published: November 2019

In the awareness of global climate challenges, Malaysian local authorities are inspired to apply Low Carbon City Framework (LCCF) to mitigate the carbon emission at city, project and regional scale. Effective implementation measure is believed will enable the private sector to emulate the LCCF implementation at a given scale. However, within the boundary of intense industrialization 4.0, it is observed that the LCCF implementation measures in local authorities are moving slowly. LCCF Checklist is readied, however, its effectiveness is unknown. The aim of this paper is to seek the readiness of local authorities and related stakeholders in implementing the LCCF. The methodology of this research is a mixed method namely qualitative and quantitative approaches. The survey methods are by interview, questionnaire and observation. Town planners, who will be interviewed, are the subject matter expert in managing the planning permission submission for the development control of their areas. Descriptive statistical analysis will be used to show the willingness of the stakeholders namely the developers and planning consultants in implementing the LCCF. Cross-tabulation and correlations tests will be used to improve the understanding of the willingness of the stakeholders. The contribution of this research will gauge the readiness of the major construction industry stakeholder in applying the LCCF at a major local authority in Malaysia. It is also may reflect a large portion perception of industry on the LCCF implementation and its readiness at local authorities’ level. This research is anticipated to be a very useful tool through the LCCF Checklist to assist local authority in achieves sustainable development and environment.
Prevalence and associations of orofacial pain and oral health factors in nursing home residents with and without dementia
Authors: van de Rijt Liza Jm , Feast Alexandra R , Vickerstaff Victoria , Lobbezoo Frank , Sampson Elizabeth L
Published: November 2019

Objectives

determine and compare the prevalence of orofacial pain in older nursing home residents with and without dementia and explore the association between orofacial pain and health factors.

Methods

cross-sectional study conducted in four UK nursing homes. We used the Orofacial-Pain Scale for Non-Verbal Individuals (OPS-NVI) to identify orofacial pain in residents with dementia. Residents who were able to communicate self-reported orofacial pain. A brief oral examination was conducted. Information on demographics, Clinical Dementia Rating, Charlson Comorbidity Index, Cohen Mansfield Agitation Inventory, Barthel Index, 5-level Euroqol 5 Dimension, Oral Health Impact Profile 14, Mini Nutritional Assessment Short Form and medication was collected. Chi-squared tests, independent sample t-tests and Mann-Whitney U-tests were used to compare outcomes between groups. Multivariable logistic regression was used to evaluate predictors of orofacial pain.

Results

orofacial pain, assessed with the OPS-NVI, was present in 48.8% (95% confidence interval [C.I.] 36.1–50.7) of residents with dementia. Self-reported orofacial pain was present in 37.8% (95% C.I. 20.4–53.7) of residents with dementia and in 14.8% (95% C.I. 0.5–30.4) residents without dementia. Orofacial pain was significantly more prevalent in residents with dementia than those without (OPS-NVI; P = 0.002, self-report; P = 0.04). Having a soft diet, xerostomia, being dentate, and poor oral hygiene in dentate residents were significant predictors of orofacial pain in residents with dementia.

Conclusion

orofacial pain was more prevalent in residents with dementia. Oral health care should be part of routine care for residents, especially for those with dementia, to improve oral health and decrease the risk of developing orofacial pain.
Perspectives on Public Sector Outsourcing: Quasi-markets and Prices
Authors: Jordahl Henrik
Published: November 2019

Public sector outsourcing, in the form of private production of tax-financed services, is on the increase with economic and social consequences for consumers, taxpayers, and employees. The development has given rise to so-called quasi-markets with choice and competition between public, for-profit, and non-profit providers. By introducing the main characteristics of quasi-markets with a focus on prices, this article provides background perspectives. It sets the stage for the other six articles on public sector outsourcing in this special issue of the journal. (JEL codes: D23, H11, H44, L33).
Incidence and Persistence of High-risk Anogenital Human Papillomavirus Infection Among Female Youth With and Without Perinatally Acquired Human Immunodefiency Virus Infection: A 3-year Observational Cohort Study
Authors: Phanuphak Nittaya , Teeraananchai Sirinya , Hansudewechakul Rawiwan , Gatechompol Sivaporn , Chokephaibulkit Kulkanya , Dang Hanh Le Dung , Tran Dan Ngoc Hanh , Achalapong Jullapong , Teeratakulpisarn Nipat , Chalermchockcharoenkit Amphan , Thamkhantho Manopchai , Pankam Tippawan , Singtoroj Thida , Termrungruanglert Wichai , Chaithongwongwatthana Surasith , Kerr Stephen J , Sohn Annette H
Published: November 2019

Background

Female youth with perinatally acquired human immunodeficiency virus (PHIV) may be at higher risk than uninfected youth for persistent anogenital human papillomavirus (HPV) infection, due to prolonged immunodeficiency.

Methods

A 3-year cohort study was conducted between 2013 and 2017 among Thai and Vietnamese PHIV and HIV-uninfected females 12–24 years, matched by age group and number of lifetime sexual partners. For HPV genotyping, cervical and anal samples were obtained at baseline and annually. Vaginal samples were collected at baseline and every 6 months. Factors associated with high-risk HPV (HR-HPV) persistence and incidence were assessed.

Results

We enrolled 93 PHIV and 99 HIV-uninfected females. Median age was 19 (interquartile range [IQR] 18–20) years. For the 7 HR-HPV types (16, 18, 31, 33, 45, 52, 58) in the nonavalent HPV vaccine, PHIV had significantly higher incidence (P = .03) and persistence (P = .01) than HIV-uninfected youth over a 3-year period. Having HIV (adjusted hazard ratio [aHR] 2.1, 95% confidence interval [CI] 1.1–3.9) and ever using illegal substances (aHR 4.8, 95% CI 1.8–13.0) were associated with incident 7 HR-HPV infections. HIV-positive status (adjusted prevalence ratio [aPR] 2.2, 95% CI 1.5–3.2), recent alcohol use (aPR 1.75, 95% CI 1.2–2.5), and higher number of lifetime partners (aPR 2.0, 95% CI 1.4–3.1, for 3–5 partners; aPR 1.93, 95% CI 1.2–3.2, for ≥6 partners) were significantly associated with persistent 7 HR-HPV infections.

Conclusions

Female PHIV were at higher risk of having anogenital HR-HPV acquisition and persistence. Primary and secondary prevention programs for HPV infection and HPV-related diseases should be prioritized for PHIV children and youth.
Clostridioides difficile Infection in Children With Inflammatory Bowel Disease
Authors: Chandrakumar Abin , Zohni Hussein , El-Matary Wael
Published: November 2019

Background

The study’s objective was to investigate the incidence and risk factors associated with Clostridioides difficile (previously known as Clostridium) infection (CDI) in children with inflammatory bowel disease (IBD) in the province of Manitoba.

Methods

Our longitudinal population-based cohort was comprised of all children and young adults aged <17 years diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. The Fisher exact test was used to examine the relationship between categorical variables. A Cox regression model was used to estimate the risk of CDI development in IBD patients.

Results

Among 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years, and the median age at diagnosis (interquartile range) was 12.96 (9.33–15.81) years. The incidence rates of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (P = 0.46). Compared with children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (adjusted hazard ratio [aHR], 4.38; 95% confidence interval [CI], 1.46–13.10) and anti–tumor necrosis factor (anti-TNF) biologics (aHR, 3.31; 95% CI, 1.11–9.90). The recurrence rate of CDI in our pediatric IBD population was 25%.

Conclusions

Our findings confirm that children with IBD are at high risk of developing CDI, which may predict future escalation of IBD therapy.
Potential Use of Trichogramma pintoi as a Biocontrol Agent Against Heortia vitessoides (Lepidoptera: Pyralidae)
Authors: Yan Zhen , Yue Jian-Jun , Yang Chun-Yong
Published: November 2019

Heortia vitessoides Moore is the most serious insect defoliator of Aquilaria sinensis (Lour.) Gilg, an endangered and economically important plant that produces highly prized agarwood. Samples from recently identified indigenous natural populations of Trichogramma pintoi Voegele were collected from H. vitessoides eggs in A. sinensis forests in Yunnan Province, China. To assess the potential capacity of this parasitoid for use as a biological control agent, its functional response, female reproductive potential, and male insemination capacity were investigated in this study. Females successfully parasitized 1- to 4-d-old eggs of H. vitessoides but failed to parasitize 5- to 8-d-old eggs. The parasitoid exhibited a Holling type II functional response, and the estimated maximum numbers of 1- to 4-d-old H. vitessoides eggs parasitized by a single T. pintoi female were 38.1, 29.8, 26.0, and 22.2 eggs over a 24-h period, respectively. Additionally, the parasitoid’s average lifetime fecundity was 89.8 ± 2.5 eggs, of which 66.26% were laid within the first 2 d. The average number of total females that mated with a male in his lifetime (4.70 ± 0.13 d) was 10.4, and the average number of total daughters of a male was 292.1. On day 1 of male adult life, the greatest number of females were inseminated by males, and the most daughters were produced; however, the number of copulations and insemination ability decreased rapidly with male age. These results suggest that T. pintoi is a promising candidate for inundative release against H. vitessoides in China, and these findings will guide efforts in achieving mass production of this parasitoid.
Antimicrobial resistance: a global public health emergency further exacerbated by international travel
Authors: Holubar Marisa
Published: November 2019

This is an invited editorial for the JTM issue focused on antimicrobial resistance.
Transcriptome Analysis of Apple Leaves Infected by the Rust FungusGymnosporangium yamadaeat Two Sporulation Stages
Authors: Tao Si-Qi , Auer Lucas , Morin Emmanuelle , Liang Ying-Mei , Duplessis Sébastien
Published: November 2019

Apple rust disease caused by Gymnosporangium yamadae is one of the major threats to apple orchards. In this study, dual RNA-seq analysis was conducted to simultaneously monitor gene expression profiles of G. yamadae and infected apple leaves during the formation of rust spermogonia and aecia. The molecular mechanisms underlying this compatible interaction at 10 and 30 days postinoculation (dpi) indicate a significant reaction from the host plant and comprise detoxication pathways at the earliest stage and the induction of secondary metabolism pathways at 30 dpi. Such host reactions have been previously reported in other rust pathosystems and may represent a general reaction to rust infection. G. yamadae transcript profiling indicates a conserved genetic program in spermogonia and aecia that is shared with other rust fungi, whereas secretome prediction reveals the presence of specific secreted candidate effector proteins expressed during apple infection. Unexpectedly, the survey of fungal unigenes in the transcriptome assemblies of inoculated and mock-inoculated apple leaves reveals that G. yamadae infection may modify the fungal community composition in the apple phyllosphere at 30 dpi. Collectively, our results provide novel insights into the compatible apple–G. yamadae interaction and advance the knowledge of this heteroecious demicyclic rust fungus.
Epitranscriptomic profiling in human placenta: N6‐methyladenosine modification at the 5′‐untranslated region is related to fetal growth and preeclampsia
Authors: Taniguchi Kosuke , Kawai Tomoko , Kitawaki Jo , Tomikawa Junko , Nakabayashi Kazuhiko , Okamura Kohji , Sago Haruhiko , Hata Kenichiro
Published: November 2019

Intracellular mRNA levels are not always proportional to their respective protein levels, especially in the placenta. This discrepancy may be attributed to various factors including post‐transcriptional regulation, such as mRNA methylation (N6‐methyladenosine: m6A). Here, we conducted a comprehensive m6A analysis of human placental tissue from neonates with various birth weights to clarify the involvement of m6A in placental biology. The augmented m6A levels at the 5′‐untranslated region (UTR) in mRNAs of small‐for‐date placenta samples were dominant compared to reduction of m6A levels, whereas a decrease in m6A in the vicinity of stop codons was common in heavy‐for‐date placenta samples. Notably, most of these genes showed similar expression levels between the different birth weight categories. In particular, preeclampsia placenta samples showed consistently upregulated SMPD1 protein levels and increased m6A at 5′‐UTR but did not show increased mRNA levels. Mutagenesis of adenosines at 5′‐UTR of SMPD1 mRNAs actually decreased protein levels in luciferase assay. Collectively, our findings suggest that m6A both at the 5′‐UTR and in the vicinity of stop codon in placental mRNA may play important roles in fetal growth and disease.
ROCK2 inhibition enhances the thermogenic program in white and brown fat tissue in mice
Authors: Wei Lei , Surma Michelle , Yang Yang , Tersey Sarah , Shi Jianjian
Published: November 2019

The RhoA/ROCK‐mediated actin cytoskeleton dynamics have been implicated in adipogenesis. The two ROCK isoforms, ROCK1 and ROCK2, are highly homologous. The contribution of ROCK2 to adipogenesis in vivo has not been elucidated. The present study aimed at the in vivo and in vitro roles of ROCK2 in the regulation of adipogenesis and the development of obesity. We performed molecular, histological, and metabolic analyses in ROCK2+/− and ROCK2+/KD mouse models, the latter harboring an allele with a kinase‐dead (KD) mutation. Both ROCK2+/− and ROCK2+/KD mouse models showed a lean body mass phenotype during aging, associated with increased amounts of beige cells in subcutaneous white adipose tissue (sWAT) and increased thermogenic gene expression in all fat depots. ROCK2+/− mice on a high‐fat diet showed increased energy expenditure accompanying by reduced obesity, and improved insulin sensitivity. In vitro differentiated ROCK2+/− stromal‐vascular (SV) cells revealed increased beige adipogenesis associated with increased thermogenic gene expressions. Treatment with a selective ROCK2 inhibitor, KD025, to inhibit ROCK2 activity in differentiated SV cells reproduced the pro‐beige phenotype of ROCK2+/− SV cells. In conclusion, ROCK2 activity‐mediated actin cytoskeleton dynamics contribute to the inhibition of beige adipogenesis in WAT, and also promotes age‐related and diet‐induced fat mass gain and insulin resistance.
Species‐specific consequences of an E40K missense mutation in superoxide dismutase 1 (SOD1)
Authors: Draper Alexandra C. E. , Wilson Zoe , Maile Charlotte , Faccenda Danilo , Campanella Michelangelo , Piercy Richard J.
Published: November 2019

A glutamic acid to lysine (E40K) residue substitution in superoxide dismutase 1 (SOD1) is associated with canine degenerative myelopathy: the only naturally occurring large animal model of amyotrophic lateral sclerosis (ALS). The E40 residue is highly conserved across mammals, except the horse, which naturally carries the (dog mutant) K40 residue. Here we hypothesized that in vitro expression of mutant dog SOD1 would recapitulate features of human ALS (ie, SOD1 protein aggregation, reduced cell viability, perturbations in mitochondrial morphology and membrane potential, reduced ATP production, and increased superoxide ion levels); further, we hypothesized that an equivalent equine SOD1 variant would share similar perturbations in vitro, thereby explain horses’ susceptibility to certain neurodegenerative diseases. As in human ALS, expression of mutant dog SOD1 was associated with statistically significant increased aggregate formation, raised superoxide levels (ROS), and altered mitochondrial morphology (increased branching (form factor)), when compared to wild‐type dog SOD1‐expressing cells. Similar deficits were not detected in cells expressing the equivalent horse SOD1 variant. Our data helps explain the ALS‐associated cellular phenotype of dogs expressing the mutant SOD1 protein and reveals that species‐specific sequence conservation does not necessarily predict pathogenicity. The work improves understanding of the etiopathogenesis of canine degenerative myelopathy.
Management of Postpartum Haemorrhage: From Research into Practice, a Narrative Review of the Literature and the Cardiff Experience
Authors: Collins P.W. , Bell S.F. , de Lloyd L. , Collis R.E.
Published: November 2019

(Int J Obstet Anesth. 2019;37:106–117)

The incidence of postpartum hemorrhage (PPH) continues to rise in many countries. Worldwide, PPH remains the most common cause of maternal death. Although most postpartum bleeding results from obstetric complications, the presence of hemostatic impairment can result in more excessive blood loss. The goal of this review was to summarize the evidence regarding coagulation profiles in women with PPH, describe how algorithms used in conjunction with point-of-care (POC) testing can provide timely information to assist clinicians with appropriate transfusion strategies during PPH, and describe how protocols developed for research studies could also have a positive impact on all patients with PPH.
Obstetric Anesthesia Management of the Patient With Cardiac Disease
Authors: Arendt K.W. , Lindley K.J.
Published: November 2019

(Int J Obstet Anesth. 2019;37:73–85)

Cardiovascular disease is now the leading cause of maternal mortality in much of the developed world. This has occurred for a variety of reasons, including the increasing frequency of cardiovascular risk factors among women of childbearing age and the improved treatment for congenital heart disease that allows most of these patients to reach adulthood. The level of care required to address the needs of parturients with cardiovascular conditions requires a coordinated effort among experts in cardiology, obstetrics, perinatology, neonatology, and anesthesiology.
Safety of Spinal Anesthesia in Thrombocytopenic Patients: Are There Lessons to be Learnt From Oncology?
Authors: Ho A.M. , Mizubuti G.B. , Ho A.K.
Published: November 2019

(Reg Anesth Pain Med. 2019;44(1):29–31)

Lumbar puncture (LP) is commonly performed for diagnostic and therapeutic purposes in patients with leukemia and lymphoma, who often develop thrombocytopenia. Oncologists are typically cautious to expose patients to unnecessary blood products for fear of alloimmunization, and therefore will perform LP at thrombocytopenic levels beyond that which anesthesiologists would deem acceptable for neuraxial procedures. There may be lessons anesthesiologists can learn from oncologists regarding spinal anesthesia in thrombocytopenic patients and the lowest platelet count at which regional blocks can be “safely” performed.
Acute Fatty Liver of Pregnancy: Pathophysiology, Anesthetic Implications, and Obstetrical Management
Authors: Naoum E.E. , Leffert L.R. , Chitilian H.V. , Gray K.J. , Bateman B.T.
Published: November 2019

(Anesthesiology. 2019;130:446–461)

As health care providers become more aware of acute fatty liver of pregnancy, more mild cases have been diagnosed and diagnosis is occurring earlier. Anesthesiologists must understand the pathophysiology and the obstetric impact to properly manage this condition.
Interventions to Prevent Perinatal Depression Evidence Report and Systematic Review for the US Preventive Services Task Force
Authors: O’Connor E. , Senger C.A. , Henninger M.L. , Coppola E. , Gaynes B.N.
Published: November 2019

(JAMA. 2019;321(6):588–601)

Perinatal depression is defined as a major or minor depressive episode during pregnancy or up to 1 year after childbirth, and is estimated to affect >180,000 new mothers annually in the United States. There are numerous risk factors that indicate a higher likelihood of developing perinatal depression after childbirth, but there is no standard practice in place for care providers for perinatal depression prevention. This systematic review study aimed to examine various perinatal depression interventions to develop a new US Preventive Services Task Force (USPSTF) recommendation.
Role of Maternal Age and Pregnancy History in Risk of Miscarriage: Prospective Register-based Study
Authors: Magnus M.C. , Wilcox A.J. , Morken N.H. , Weinberg C.R. , Håberg S.E.
Published: November 2019

(BMJ. 2019;364:I869)

Miscarriage is unfortunately a relatively common pregnancy outcome. Various studies have reported that 12% to 15% of pregnancies end in miscarriage. However, these rates may not be accurate as some women experience miscarriage without ever realizing they were pregnant and differences exist among studies regarding the definition of miscarriage versus stillbirth. Several risk factors for miscarriage have been reported, but maternal age seems to have the strongest association. The youngest mothers have a slightly increased risk while older women have a much greater risk than younger women. There might also be an association between previous pregnancy complications and miscarriage risk. This population-based study aimed to evaluate the rate of miscarriage and its association with maternal age and pregnancy history among Norwegian women.
An Overview of Advances in Global Maternal Health: From Broad to Specific Improvements
Authors: Khorrami N. , Stone J. , Small M.J. , Stringer E.M. , Ahmadzia H.K.
Published: November 2019

(Int J Gynaecol Obstet. 2019;146(1):126–131)

Over the past 3 decades, many advances have been made in the field of maternal health. This work intends to highlight 10 of the landmark health system, clinical, and technology-based advancements that have occurred over this time frame.
Cost-effectiveness of Opportunistic Salpingectomy vs Tubal Ligation at the Time of Cesarean Delivery
Authors: Venkatesh K.K. , Clark L.H. , Stamilio D.M.
Published: November 2019

(Am J Obstet Gynecol. 2019;220:106.e1–106.e10)

More than 100,000 women in the United States undergo bilateral tubal ligation during cesarean delivery surgery each year. Because of its association with decreased ovarian cancer risk, opportunistic salpingectomy is becoming a more common procedure. There is a lack of evidence, however, regarding the risk-benefit tradeoff for salpingectomy with cesarean delivery. Salpingectomy has been reported to have lower completion rates compared with tubal ligations (67% vs. 95%) but the sample size in this trial was small. This study aimed to analyze the cost-effectiveness of salpingectomy compared with tubal ligation for sterilization and ovarian cancer prevention in women undergoing cesarean delivery and seeking permanent sterilization.
Progesterone for Threatened Abortion (a Commentary on a Randomized Trial of Progesterone in Women With Bleeding in Early Pregnancy
Authors: Greene M.F.
Published: November 2019

(N Engl J Med. 2019;380(19):1867–1868)

Threatened abortion is a condition in which a pregnant woman experiences bleeding through the vagina and closed cervix before a fetus has reached a viable gestational age. Although most women who experience bleeding early in their pregnancies do not experience miscarriage, there remains a justifiable interest in determining treatments to improve the chances of a healthy live-born baby from such a high-risk pregnancy. The original study was to determine whether the widely accepted hormonal treatment method of progesterone effectively produces the desired live births.
Effect of Maternal Oxygen Inhalation on Fetal Free Radical Activity: A Prospective, Randomized Trial
Authors: Ahuja V. , Gombar S. , Jaswal S. , Kaur J. , Gupta P. , Chawla D. , Huria A. , Singh S.
Published: November 2019

(Acta Anaesthesiol Scand. 2018;62(1):26–37)

There is no clear uniformity in the practice of oxygen supplementation during a cesarean section (CS). It is recommended that oxygen be administered during these operations, but the percentage of oxygen supplied can cause harmful effects. Although 35% to 40% oxygen concentration has no measurable effect, 60% to 100% oxygen concentration results in an elevated level of free radical activity. In this study, the investigators aimed to examine the effects and benefits of 50% maternal oxygen concentration on fetal oxygenation, oxidant stress, and total antioxidant status (TAS).
Early or Late Pregnancy Loss and Development of Clinical Cardiovascular Disease Risk Factors: A Prospective Cohort Study
Authors: Horn J. , Tanz L.J. , Stuart J.J. , Markovitz A.R. , Skurnik G. , Rimm E.B. , Missmer S.A. , Rich-Edwards J.W.
Published: November 2019

(BJOG. 2019;126:33–42)

Certain pregnancy complications, including preterm birth, preeclampsia and gestational hypertension, are female-specific risk factors for cardiovascular disease (CVD), the leading cause of death for both men and women. Pregnancy loss has been suggested as a possible risk factor for CVD. Although stillbirth and spontaneous abortion have been associated with an increased risk of stroke and ischemic heart disease, there is a lack of information regarding increased risk of CVD in women with a history of spontaneous pregnancy loss. This study aimed to assess the associations of pregnancy loss and risk of hypertension, type 2 diabetes (T2D), and hypercholesterolemia.
Development and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa
Authors: Alexander L.A. , Newton M.W. , McEvoy K.G. , Newton M.J. , Mungai M. , DiMiceli-Zsigmond M. , Sileshi B. , Watkins S.C. , McEvoy M.D.
Published: November 2019

(Anesth Analg. 2019;128(5):993–998)

Maternal mortality rates in low and middle-income countries are 20 times higher than in developed countries, at a rate of 239 deaths per 100,000 live births. Sub-Saharan Africa in particular is reported by the World Health Organization (WHO) to be the most dangerous place in the world for a woman to bear a child. This study developed a context-sensitive obstetric anesthesia checklist for cesarean delivery (CD) in East Africa, with the hypothesis that such a list would improve adherence to best practice guidelines in the management of anesthesia for elective and emergent CD in low and middle-income countries.
Ephedrine Versus Phenylephrine as a Vasopressor for Spinal Anaesthesia-induced Hypotension in Parturients Undergoing High-risk Caesarean Section: Meta-analysis, Meta-regression, and Trial Sequential Analysis
Authors: Heesen M. , Rijs K. , Hilber N. , Ngan Kee W.D. , Rossaint R. , van der Marel C. , Klimek M.
Published: November 2019

(Int J Obstet Anesth. 2019;37:16–28)

Hypotension is a common adverse effect of spinal anesthesia for cesarean section. In this setting, phenylephrine is the preferred vasopressor for the treatment of spinal-induced hypotension because it has been associated with a lower rate of fetal acidosis compared with ephedrine. However, this conclusion was based on studies performed in low-risk healthy parturients. Some studies in high-risk parturients undergoing spinal anesthesia for cesarean section, have since been performed. They have not found a difference in umbilical artery pH when ephedrine as compared with phenylephrine was used to treat hypotension. However, the retrospective design of some of these studies is prone to bias. Therefore, the current investigators decided to conduct a meta-analysis of prospective, randomized controlled trials comparing ephedrine versus phenylephrine for the treatment or prevention of spinal-induced hypotension during high-risk cesarean sections.
Plantar Cutaneous Sensory Stimulation Improves Foot Sensibility and Gait Speed in Older Adults With Diabetes: A Clinical Trial
Authors: Navarro-Peternella Fabiana Magalhães , Teston Elen Ferraz , dos Santos Santiago Ribeiro Beatriz Maria , Marcon Sonia Silva
Published: November 2019

OBJECTIVE

To determine the effect of an intervention involving muscular ankle strengthening and feet sensory stimuli to improve gait speed and balance in older adults with diabetes mellitus type 2 (DM2).

DESIGN

A clinical trial with concealed allocation, assessor blinding, and intention-to-treat analysis.

PARTICIPANTS

The trial enrolled 66 people 60 years or older with DM2 who were physically independent (did not require assistance with activities of daily living).

INTERVENTION

The experimental group performed 12 weeks of plantiflexor and dorsiflexor muscle strengthening exercises with resistance bands, proprioceptive exercises on balance boards and a buoy, and plantar sensory stimulation with bristle brushes and cloths, as well as general foot care instructions. The control group received foot care instructions only.

OUTCOME MEASURES

The primary outcome was plantar cutaneous sensibility as measured with Semmes-Weinstein monofilaments. Secondary outcomes included muscular strength (plantar flexion and dorsiflexion torque as measured with an isokinetic dynamometer), gait speed, and balance (total displacement area, mediolateral displacement, anteroposterior displacement, mediolateral displacement speed, and anteroposterior displacement speed) on right and left bipedal and unipedal supports.

RESULTS

In comparison with the control group, the experimental group demonstrated improved plantar cutaneous sensibility on the right foot (3.46 points; 95% confidence interval [CI], 3.85–9.80), left foot (3.46 points; 95% CI, 4.06–9.76), and an increase in gait speed (0.15 m/s; 95% CI 0.12–0.42). There were no meaningful changes in participants’ ankle muscle strength or balance.

CONCLUSIONS

This study showed that plantar cutaneous sensory stimulation can improve foot sensibility and increase the gait speed of older adults with DM2. However, there were no meaningful dorsiflexor or plantiflexor gains after 12 weeks.
The Opioid Epidemic and the Role of Radiology: History, Current Status, Controversies, and Appropriately Managing Pain in the Image-Guided Procedural Arena
Authors: Madsen Laura B. , Yun Jung H. , Koneru Sirisha , Sasson Arielle , Foresto Christopher , Hoffmann Jason C.
Published: November 2019

Because of the enormity of the opioid epidemic, it is critical for radiologists and radiology trainees to be aware of how patients who misuse opioids may present to the emergency department and the relevant imaging findings to impact patient care efficiently and effectively. Diagnostic and interventional radiologists who perform procedures and manage patients with procedural and postprocedural pain must have a keen, current knowledge of pain management strategies to minimize the risk of their patients developing opioid addiction.
New Drug Targets Key Genetic Driver of Cancer
Authors: Aschenbrenner Diane S.
Published: November 2019

Entrectinib (Rozlytrek) has been approved by the Food and Drug Administration to treat adolescent and adult patients whose solid tumor cancers are related to a specific genetic defect known as neurotrophic tyrosine receptor kinase gene fusion, and for whom there are no effective treatments.

Several warnings and precautions are listed on entrectinib's labeling, including congestive heart failure, central nervous system effects, skeletal fractures, hepatotoxicity, hyperuricemia, QT interval prolongation, vision disorders, and embryo–fetal toxicity.
CE: Hematologic Childhood Cancers: An Evidence-Based Review
Authors: Spruit Jessica Lynne
Published: November 2019

Every year in the United States, thousands of children and adolescents are diagnosed with a hematologic cancer. That diagnosis and the prescribed course of treatment profoundly affect both the child and the family. This article provides a brief overview of the therapies used to treat such cancers, describes the presentations and diagnoses of the various hematologic cancers, and explains the treatments specific to each. Nursing care of the child and family is discussed, with an emphasis on education and supportive care.
Air Pollution Associated with Emphysema, Worsening Lung Function
Authors: Rosenberg Karen
Published: November 2019

According to this study:

Long-term exposure to ambient air pollutants is significantly associated with the progression of emphysema and worsening lung function.

The authors note that the increased progression of emphysema secondary to ozone exposure was equal to that of 29 pack-years of smoking.
EBP 2.0: Implementing and Sustaining Change: The Malnutrition Readmission Prevention Protocol
Authors: Gallagher-Ford Lynn , Tucker Sharon J. , Beckett Cynthia D.
Published: November 2019

This is the fifth article in a new series about evidence-based practice (EBP) that builds on AJN's award-winning previous series—Evidence-Based Practice, Step by Step—published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series features exemplars illustrating the various strategies that can be used to implement EBP changes—one of the most challenging steps in the EBP process.
Alpha Omega Alpha Honor Medical Society: A Commitment to Inclusion, Diversity, Equity, and Service in the Profession of Medicine
Authors: Byyny Richard L. , Martinez Dee , Cleary Lynn , Ballard Billy , Barth Bradley E. , Christensen Sean , Eidson-Ton Wetona , Estevez-Ordonez Dagoberto , Fuhrer Jack , Kinzie J. Mark , Lee Amy L. , Lynch Catherine , Pfeil Sheryl , Schoenbaum Ellie
Published: November 2019

With a motto of “Be Worthy to Serve the Suffering,” Alpha Omega Alpha Honor Medical Society (AΩA) supports the importance, inclusion, and development of a culturally and ethnically diverse medical profession with equitable access for all. The underrepresentation of minorities in medical schools and medicine continues to be a challenge for the medical profession, medical education, and AΩA. AΩA has worked, and continues to work, to ensure the development of diverse leaders, fostering within them the objectivity and equity to be inclusive servant leaders who understand and embrace diversity in all its forms.

Inclusion of talented individuals from different backgrounds benefits patient care, population health, education, and scientific discovery. AΩA values an inclusive, diverse, fair, and equitable work and learning environment for all and supports the medical profession in its work to achieve a welcoming, inclusive environment in teaching, learning, caring for patients, and collaboration.

The diversity of medical schools is changing and will continue to change. AΩA is committed to continuing to work with its members, medical school deans, and AΩA chapters to assure that AΩA elections are unbiased and based on the values of AΩA and the profession of medicine in service to patients and the profession.

Progress toward diversity, inclusion, and equity is more than simply checking off a box or responding to criticism—it is about being and developing diverse excellent physicians. AΩA and all those in the medical profession must continue to guide medicine to be unbiased, open, accepting, inclusive, and culturally aware in order to “Be Worthy to Serve the Suffering.”
Should it Stay or Should it Go? Thinking Critically About Posterior Tibial Tendon Excision in Flatfoot Correction
Authors: Dunham Alexandra M. , de Cesar Netto Cesar , Godoy-Santos Alexandre L. , Schon Lew C.
Published: November 2019

Stage II adult acquired flatfoot deformity is characterized by painful, progressive collapse long thought to be driven by posterior tibialis tendon (PTT) deficiency or insufficiency. In this article, we discuss the history of our understanding the role of the PTT in the development of adult acquired flatfoot deformity, and considerations in tendon excision in flatfoot correction. We argue that routine excision of the PTT should be rethought and instead the tendon should be critically assessed in each case and debridement with repair should be attempted when appropriate. Technique for flexor digitorum longus transfer is detailed as well as preoperative evaluation, imaging, nonoperative treatment, and adjuvants including biologics.
The Triceps Traction Test: A Decision Tool for the Choice of Stabilizing Flap After In Situ Decompression of the Ulnar Nerve
Authors: Curran Matthew W.T. , Power Hollie A. , Chan K. Ming , Morhart Michael J.
Published: November 2019

Purpose:

Recent evidence demonstrates that in situ decompression has comparable outcomes to other surgical techniques for cubital tunnel syndrome. However, this technique does not address the instability of the ulnar nerve, a common indication to transpose the ulnar nerve. Transposition of the ulnar nerve can potentially devascularize the ulnar nerve, stabilizing flaps block subluxation of the ulnar nerve and thereby negate the need for transposition. Flaps originating from the triceps and the flexor-pronator fascia could be used to stabilize the ulnar nerve. Herein, we present a novel intraoperative test, the “triceps traction test” and our algorithm for choosing a stabilizing flap when ulnar nerve instability is encountered after in situ decompression.
Will My Fracture Surgery Get Infected? Evidence-based Risk Factors
Authors: Wise Brent , Castillo Renan , Joshi Manjari , O’Toole Robert V.
Published: November 2019

Postoperative surgical site infection (SSI) is a growing problem in orthopedic trauma surgery. Consequently, emphasis on identifying risk factors has increased. We present a narrative review of the literature to facilitate evidence-based risk stratification for patients undergoing fracture fixation. Risk factors, including diabetes, hyperglycemia, end-stage renal disease requiring hemodialysis, human immunodeficiency virus, acquired immunodeficiency syndrome, hepatitis C, and alcohol abuse, have consistently been shown to increase infection risk in orthopedic surgery. Other risk factors, including smoking, obesity, and the use of immunomodulatory medications, have been shown to have varying direct impact on postoperative SSI depending on the study and the specific fractures examined. Factors such as increasing age, male sex, and ballistic injuries have very limited data implicating them in increasing risk of postoperative SSI. Fracture characteristics, including fracture region, open injury, compartment syndrome, and the need for flap coverage, increase the risk of SSI to varying degrees. Interventions such as blood transfusion and angioembolization can also increase the risk of infection. Although data on many of the risk factors for infection in orthopedic trauma are conflicting and larger scale studies are needed, an understanding of the available research is helpful to guide clinicians as they inform patients and attempt to optimize care.
Fertility drugs and cutaneous melanoma risk: a French prospective cohort study
Authors: Cervenka Iris , Al Rahmoun Marie , Mahamat-Saleh Yahya , Boutron-Ruault Marie-Christine , Fournier Agnès , Kvaskoff Marina
Published: November 2019

Cutaneous melanoma has been suspected to be influenced by female sex hormones. A review of the literature in 2018 indicated that fertility drug (FD) use was associated with increased melanoma risk among parous women only. However, most studies so far were based on a retrospective design and the current evidence is unclear. We sought to prospectively investigate the associations between FD use and melanoma risk in women. E3N is a prospective cohort of 98 995 French women aged 40–65 years at inclusion in 1990. Information on use of FDs, including duration and time of administration, was assessed through self-administered questionnaires. We used Cox proportional hazards regression models adjusted for age and melanoma risk factors. Over 1990–2008, about 611 melanoma cases were ascertained among 86 653 women. Compared with never use, ever use of FDs was not associated with melanoma risk overall [hazard ratio (HR) = 1.15; 95% confidence interval (CI) = 0.75–1.74], or among parous women (HR = 1.08; 95% CI = 0.67–1.73). Among ever users of FDs, duration of use and age at first use were not associated with melanoma risk. Associations were similar after adjustment for UV exposure, although FD users were more likely to report tanning bed use than never-users (odds ratio = 1.50; CI = 1.01–2.22) in a subsample with recreational UV exposure data. Our data do not support an association between FD use and melanoma risk, but underlie the importance of taking into consideration potential confounding from sun exposure in future research.
Cardiac complications in systemic sclerosis: early diagnosis and treatment
Authors: Nie Liu-Yan , Wang Xiao-Dong , Zhang Ting , Xue Jing
Published: November 2019

Objective:

Systemic sclerosis (SSc) is a remarkably systemic heterogeneous connective tissue disease with many organs involved. The heart is one of the major organs involved, carrying the threat of sudden cardiac death, especially in diffuse cutaneous SSc. This review summarizes the pathophysiology, types, new diagnostic approaches, and imaging and novel therapies of primary cardiac complications while underlining the effects of recently developed non-contrast cardiovascular magnetic resonance (CMR) in early diagnosis.

Data sources:

Medline and Embase were searched for articles published up to July 2019. A combination of Medical Subject Headings (MeSH) terms and keywords pertaining to SSc (“Scleroderma, Systemic” OR “Systemic sclerosis” OR" SSc”), AND cardiology (“cardiology” OR “heart” OR “cardiac”) were applied to the search strategies.

Study selection:

Literature was mainly printed in English and Chinese about cardiac complications in systemic sclerosis. After selected simply on the title and abstract, the articles were included for the full text. Article type was not limited.

Results:

Relevant cardiac manifestations are complex, including arrhythmias, pericardial effusion, myocardial dysfunction, and valvular diseases. Even though the symptoms of cardiac complications are well known, unfortunately, they appear to be poor prognostic factors. As systemic sclerosis with cardiac complications has a high mortality rate and patients might have a poor quality of life, it is essential to promote early diagnosis and treatment. With the advent of non-invasive imaging techniques, such as CMR, early diagnosis of cardiac complications in SSc is becoming more effective.

Conclusions:

Cardiac complications play an essential role in SSc and carry the threat of sudden cardiac death. More basic and clinical studies are warranted to develop better management of cardiac involvement in patients with SSc.
Significance of alternative splicing in cancer cells
Authors: Qi Fei , Li Yong , Yang Xue , Wu Yan-Ping , Lin Lian-Jun , Liu Xin-Min
Published: November 2019

Objective

Alternative splicing can generate various structural and functional protein isoforms. Recently, accumulating evidence shows a relationship between alternative splicing and cancer. Cancer is a complex and chronic disease that involves malignant transformation. In this review, we consider alternative splicing events in relation to the hallmarks of cancer cells, and discuss current therapies to treat cancer-related to alternative splicing.

Data sources

Data cited in this article are from the PubMed and Embase database, primarily focusing on research published from 2000 to 2018.

Study selection

Articles were selected with the search terms “alternative splicing,” “cancer cell,” “tumor microenvironment,” and “therapy.”

Results

Alternative splicing plays an important role in tumorigenesis, development, and escape from cell death. Taking this trait of cancer cells into consideration will allow more definite diagnoses of cancer, and allow the development of more effective medicines to intervene in cancer that could focus on controlling alternative splicing or competitively binding to the final products.

Conclusions

Alternative splicing is common in cancer cells. Consideration of alternative splicing may allow different strategies for cancer therapy or the identification of novel biomarkers for cancer diagnosis.
Mohs Surgery for Periocular Tumors
Authors: Monheit Gary , Hrynewycz Katherine
Published: November 2019

BACKGROUND

Skin cancers of the periorbital area present unique challenges to Mohs surgeons.

OBJECTIVE

The need for precise and high-quality Mohs micrographic surgery (MMS) is paramount because of the complex anatomy, vital structures, and potential threat to vision.

METHODS

A thorough comprehension of anatomy is essential to help predict tumor behavior and ensure successful outcomes for patients.

RESULTS

Tumors occurring at the medial and lateral canthi are of greatest concern for deeper orbital penetration.

CONCLUSION

In this study, we present our experience with MMS of periorbital tumors, including clinical pearls and techniques to aid the Mohs surgeon.
Family Weight Teasing, LGBTQ Attitudes, and Well-being Among LGBTQ Adolescents
Authors: Eisenberg Marla E. , Puhl Rebecca , Watson Ryan J.
Published: November 2019

This study explored weight-based victimization by family members, accepting lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) attitudes, and family connectedness, and how these experiences are associated with health, self-esteem, and depressive symptoms among LGBTQ adolescents. Data came from the LGBTQ National Teen Survey (N = 9261, mean age = 15.6 years). The 3 key variables were significantly associated with poorer self-rated health, self-esteem, and depressive symptoms. For example, weight-based victimization was associated with approximately 2 more points on the depressive symptoms scale (β = 1.81, P < .001), adjusting for covariates. Findings highlight the negative impact of weight-based victimization among LGBTQ youth, even in the context of other types of family support.