bluuebunny/crossref_metadata_2025 huggingface dataset:
Imaging in Chronic Pancreatitis
Authors: Sood Shikha , Kandasamy Devasenathipathy , Sharma Raju
Published: April 2020

Chronic pancreatitis (CP) is a chronic progressive process which can cause irreversible damage to both the exocrine and endocrine systems of pancreas. There are various imaging modalities available to evaluate CP of which ultrasonography ( USG), computed tomography (CT), and magnetic resonance imaging (MRI) are most commonly used. USG is used as a screening modality which can show various changes of CP and its complications. However, the information obtained from USG can be limited because of the patient’s body habitus. CT is the workhorse modality which can provide comprehensive information and it is the best modality to detect calcification. MRI, on the other hand, is excellent in demonstrating the pancreatic parenchyma and the ductal system. Alcohol-related pancreatitis is the commonest cause which can show gland atrophy, ductal dilatation, and calcifications. Other less common causes include hereditary and genetic mutation–related pancreatitis. There are other special types of pancreatitis such as autoimmune pancreatitis and groove pancreatitis that have characteristic features on imaging.
Impacto da desnutrição na qualidade de vida de pacientes com cirrose hepática
Authors: Petean-Barros Iara Marcato , Miyazaki Maria Cristina De Oliveira Santos , Fucuta Patrícia da Silva
Published: April 2020

Cirrose hepática apresenta alta morbidade e mortalidade, redução da qualidade de vida (QV) e desnutrição. O presente estudo avaliou o impacto da desnutrição na QV de pacientes internados com cirrose. Os instrumentos utilizados foram Avaliação Nutricional Subjetiva Global (ANSG) e Qualidade de vida Short-Form (SF-36). Foram incluídos 92 pacientes. A desnutrição teve alta prevalência e a QV em todos os seus domínios foi prejudicada, principalmente o domínio aspectos físicos. A desnutrição foi associada com baixa QV nos domínios aspectos físicos e emocionais. A abordagem diagnóstica precoce pode fornecer valiosas informações para o melhor manejo nutricional e psicológico dos doentes, diante da necessidade de maior humanização no tratamento, perante o sofrimento físico e emocional desses pacientes.
Glucocorticoid Receptor Polymorphisms in Children Undergoing Congenital Heart Surgery with Cardiopulmonary Bypass
Authors: Flores Saul , Iliopoulos Ilias , Loomba Rohit S. , Opoka Amy M. , Sahay Rashmi D. , Fei Lin , Cooper David S.
Published: April 2020

We conducted a candidate gene association study to test the hypothesis that different gene polymorphisms will be associated with corticosteroid responsiveness and study outcomes among children undergoing congenital heart surgery. This is a prospective observational cohort study at a large, tertiary pediatric cardiac center on children undergoing corrective or palliative congenital heart surgery. A total of 83 children were enrolled. DNA was isolated for three polymorphisms of interest namely N363 (rs56149945) and 9β (rs6198) associated with increased sensitivity to corticosteroids and BclI (rs41423247) associated with decreased sensitivity to corticosteroids. Duration of inotropic use, low cardiac output scores (LCOS), and vasoactive inotrope scores were examined in relation to these three polymorphisms. Using Kaplan–Meier analysis, heterozygous individuals showed longer transcriptional intermediary factor (TIF) compared with wild type for N363 polymorphism (p = 0.05). In multivariable Cox regression, heterozygous alleles for 9β polymorphism showed significantly shorter TIF compared with wild type (hazard ratio = 2.04 [1.08–3.87], p = 0.03). The relationship between lower LCOS scores and alleles groups was significant for 9β heterozygous polymorphism only (1.5 [1–2.2], p = 0.01) in comparison to wild type and homozygous. The presence of heterozygote alleles for the increased corticosteroid sensitivity is associated with longer TIF compared with wild type. Conversely, the presence of heterozygous alleles for the decreased sensitivity to corticosteroids is associated with shorter TIF compared with wild type.
Aspectos comportamentais e ambientais associados às dificuldades alimentares na infância: Estudo com grupo controle
Authors: Maximino Priscila , Machado Rachel Helena Vieira , Fontanezi Nathália Moretti , Nogueira Luana Romão , Ramos Cláudia de Cássia , Fisberg Mauro
Published: April 2020

Objetivos Investigar os fatores associados à presença de dificuldades alimentares (DAs) na infância, dentre dinâmicas de refeições e práticas parentais.

Métodos Trata-se de um estudo observacional caso-controle. Para o grupo de crianças com queixas de DA, as informações foram retiradas dos prontuários dos pacientes. Para o grupo de crianças sem queixas de DA, a amostragem foi constituída por conveniência (abordagem de famílias nas unidades de pronto atendimento). As entrevistas foram baseadas em questionário estruturado e aplicado na mesma versão para grupo caso e grupo controle.

Resultados O grupo caso foi composto majoritariamente por indivíduos do sexo masculino, enquanto o grupo controle apresentou-se dividido igualmente entre os gêneros. A média de idade foi menor no grupo caso quando comparado ao controle. Verificou-se menor frequência de refeições compartilhadas nas famílias de crianças com DA, especialmente por motivos de estresse, assim como maior ocorrência de refeições mais longas. Observou-se ainda maior risco de desenvolver DA em crianças que realizavam refeições em ambientes inadequados, com menor autonomia, e os cuidadores do grupo caso demonstraram maior chance de não respeitar os sinais de fome da criança, de usarem estratégias como coerção e distração durante as refeições.

Conclusão O estilo autoritário foi associado à presença de DA. Práticas parentais e todos os fatores que envolvem a dinâmica das refeições devem ser avaliados e acompanhados. A dinâmica familiar e de refeições apresentou-se modificada no grupo com DA. Tais comportamentos devem ser avaliados e orientados durante o acompanhamento da queixa alimentar, pois compõem o cenário da queixa.
When was silcrete heat treatment invented in South Africa?
Authors: Schmidt Patrick , Stynder Deano , Conard Nicholas J. , Parkington John E.
Published: April 2020

Silcrete heat treatment, along with a suit of other innovations, have been used to argue for an early onset of modern or complex behaviours in Middle Stone Age hominins. This practice was confined to South Africa’s southern and western Cape regions where it was continuously practised since the Still Bay industry. However, the exact moment that this technological advancement occurred still remains unclear. This is partly due to the scarcity of silcrete assemblages dating to the first half of the Middle Stone Age. To determine when silcrete heat treatment began to be well-established, we compare the silcrete assemblages from two archaeological sites situated along the south western coast of South Africa: Hoedjiespunt 1, one of the earliest Middle Stone Age silcrete assemblages dating to 119–130 ka, and Duinefontein 2, one of the latest Early Stone Age assemblages dating to 200–400 ka. Our results suggest that the invention of heat treatment occurred sometime between 130 ka and 200–400 ka, as it is still absent in the earlier assemblage but fully mastered and well-integrated in the recent one. This period corresponds to the time that Homo sapiens became the major hominin species in the southern African subcontinent and it is roughly the time that silcrete use became widespread in the second half of the Cape-coastal Middle Stone Age. This opens interesting new questions on the relation between silcrete use and heat treatment and on why early modern humans spontaneously invented heat treatment when they began using silcrete in the Cape region.
What are we missing? How the delay-period setting on camera traps affects mesopredator detection
Authors: Sparkes Jessica , Fleming Peter J. S. , McSorley Adam , Mitchell Bruce
Published: April 2020

Trigger-delays are often set on camera traps to save labour costs involved with servicing camera traps and reviewing images. However, the effects that delays of various length could have on data quantity and quality are unmeasured. Here, we aimed to assess how varying trigger-delays (5, 10, 30 and 60 min) or using an ‘independent event’ classification (i.e. a series of images taken less than 5 min apart on the same camera trap) affects detection rates and the number of individuals per trigger for feral cats and European red foxes. Using real camera trap images, we simulated trigger-delays of between 5 min and 60 min and compared with the independent events. Trigger-delays caused inaccuracies in detection frequencies of 3.6–22.0% for feral cats and 3.1–24.0% for foxes. Further, 68% of independent events in which two individual foxes were present were reduced to a single fox trigger when implementing a 5-min trigger-delay (n = 65). Using trigger-delays likely reduces accuracy and reliability of data generated for wildlife monitoring programs and could affect the types of observations and analyses able to be made from imagery so obtained.
Multi-faceted nature of the tRNA isopentenyltransferase
Authors: Dabravolski Siarhei
Published: April 2020

Transfer RNA isopentenylation an adenine 37 position (A37) is a universal modification known in prokaryotes and eukaryotes. A set of highly homologous enzymes catalyse a series of reactions, leading to tRNA modifications, aimed to increase adaptation to environmental condition through the control of translation efficiency and reading frame maintenance. Transfer RNA-isopentenylation-related (TI-related) functions are well studied in bacteria, mitochondria of yeast and human, but completely unexplored in plants. Transfer RNA-isopentenylation-unrelated (TI-unrelated) functions participate in adaptation to environmental stresses via the regulation of sterol metabolism, gene silencing/suppression and amyloid fibrils formation. TI-unrelated functions are mostly studied in yeast. Finally, the degradation of A37-modified tRNA releases a set of bioactive compounds known as cis-cytokinins. Although all organisms are able to produce cis-cytokinins, its physiological role is still a matter of debates. For several species of bacteria and fungi, cis-cytokinins are known to play a crucial role in pathogenesis. In mammalian and human models cis-cytokinins have tumour-suppressing and anti-inflammation effects. This review aims to summarise current knowledge of the TI-related and TI-unrelated functions and main bioactive by-products of isopentenylated tRNA degradation.
Fibroblast rejuvenation by mechanical reprogramming and redifferentiation
Authors: Roy Bibhas , Yuan Luezhen , Lee Yaelim , Bharti Aradhana , Mitra Aninda , Shivashankar G. V.
Published: April 2020

Significance

The mechanical reprogramming of fibroblasts, followed by their redifferentiation into rejuvenated fibroblasts in an optimized 3D collagen matrix, made these cells more contractile and more efficient at synthesizing matrix components including laminin, fibronectin, and collagen-IV. Moreover, the rejuvenated fibroblasts obtained through this approach exhibited a decrease in DNA damage. The rejuvenated fibroblasts derived from this method precisely align into tissue architectures, suggesting its potential application as clinical implants in tissue engineering and regenerative medicine.
Silently Structured Silent Argument
Authors: Sakamoto Yuta
Published: April 2020

Theoretical linguistics in the generative tradition has payed much attention to issues related to silence ? children know the syntax of silence despite the fact that they do not have direct access to it throughout their language acquisition process. One of the issues that have been hotly discussed regarding silence in natural languages is whether it involves syntactic structure or not. This book is concerned with a particular instance of silence in natural languages, what is called radical pro-drop, showing that it is silently structured on the basis of novel data from Japanese as well as Chinese, Korean, Mongolian, and Turkish. The discussion in this book also has consequences for the dichotomy between PF-deletion vs. LF-copying, shedding a new light on the proper analysis of several syntactic phenomena in Japanese, including wh-in-situ and control.
Mechanical Interface of Flywheel Kinetic Energy Recovery System on Motorized Tricycles
Authors: Atienza A. H. , Cariño A. , Jacinto N. , Tapia S.
Published: April 2020

In the Philippines, motorized tricycle was subjected to repetitive utilization of brakes due to traffic and road condition. To address the problem regarding the energy loss due to the application of brakes, Kinetic Energy Recovery System or KERS was introduced. KERS serves as the medium to recover and store the momentum of the vehicle. The study was aimed to design a mechanical interface of the kinetic energy recovery system applicable on motorized tricycles. This also aimed to determine the optimal dimensions and material of the flywheel that can maximize the recovery and storage of the lost kinetic energy of tricycles during braking. The triggering mechanism used was a combination of an actuator mechanism and a hand brake lever. The study was able to accomplish and design the appropriate triggering mechanism in order to utilize KERS. The group was able to prove the prototype’s cost- effectiveness of the system with the percent of fuel saved with the application of KERS. It is determined in the study that by utilizing the Flywheel KERS on the motorized tricycle, fuel savings of 2.93%, 4.28% and 5.93% were obtained for uniform velocities of 30 kph, 40 kph and 50 kph, respectively. In this study the group was able to design and fabricate a functional Flywheel Kinetic Energy Recovery system on a Motorized Tricycle.
Thermodynamics Analysis of Roots Vacuum Pump
Authors: Zhao Fan , Zhang Shi-wei , Han Feng , Li Run-da
Published: April 2020

As a kind of fluid machinery, the roots vacuum pump is widely used in the metallurgical industry and semiconductor industry. The double-blade roots vacuum pump is widely used in the vacuum system due to its easy manufacture and low cost. The pumping process can be divided into four distinctive processes (i.e. sucking process, transferring process, backlashing process and exhausting process). The characteristics of each process are illustrated sufficiently in this paper. Based on the ideal gas laws, a thermodynamics model of pumping process is established and the influence of gas leakage on the pumping process is taken into consideration. Using this model, quantificational expressions of five gas thermodynamic parameters (volume, mass, pressure, temperature and internal energy) are given. The performance curves are plotted by MATLAB and the pumping characteristics of double-blade roots vacuum pump are discussed at last. This research can provide a theoretical reference on the design of double-blade roots vacuum pump.
Application of ImageJ program for the Analysis of Pupil Reaction in Security Systems
Authors: Oksana Isaeva , Marina Boronenko
Published: April 2020

One of the tools of eye tracking technology is the eyetracker, which recognizes and records the position of the pupils and eye movements. The existing interconnection of saccades, microsaccades, the center of attention with the diameter of the pupils and the psychophysical state of a person gives prerequisites for the use of pupillography in security systems controlled by artificial intelligence. It is important to solve the problem of accurately distinguishing pupil boundaries. An algorithm for pupil extraction using the ImageJ program has been developed.
Structural and electronic properties of chromium carbides and Fe-substituted chromium carbides
Authors: Ganguly Anindya , Murthy Vinuthaa , Kannoorpatti Krishnan
Published: April 2020

Chromium carbides are coated over base metal (Fe) to increase wear and corrosion resistance. The electronic structure and bonding properties for chromium carbide bulk phases (Cr3C2, Cr7C3 and Cr23C6) and Fe-substituted chromium carbides is investigated using Density Functional Theory (DFT). The bonding in these carbides has been interpreted in the form of partial density of states, electron density distribution and Mulliken population method. Cr3C2 exhibits the strongest covalent character while Cr7C3 displays the highest metallicity. Cr3C2 showed the highest stability among the chromium carbide phases. In the Fe-substituted chromium carbides (Cr2FeC2), the site preference of Fe in Cr3C2 system has been reported. In Fe-substituted chromium carbides also show both of metallic and covalent character and Cr2Fe3C2 is found to be the most stable Fe-substituted chromium carbide system.
Assessment on the microhardness and corrosion resistance characteristics of Ni-SiC and Ni-MWCNT coatings by pulse reverse electrodeposition technique
Authors: ShathishKumar J S , Jegan A
Published: April 2020

The characteristics of Silicon carbide (SiC) and multi-walled carbon nanotube (MWCNT) nano composite coatings by a Pulse Reverse Electrodeposition (PRE) method is investigated in detail to enhance the microhardness (MH) and corrosion resistance characteristics of AISI 304 stainless steel substrate. The electrodeposition nature, dissolution behavior, surface characteristics are assessed by Scanning Electron Microscopy (SEM) with energy dispersive x-ray (EDX), x-Ray Diffraction (XRD), Atomic Force Microscopy (AFM), Microhardness (MH) Test and Electrochemical studies. The coatings are prepared in the watts type bath using pulse reverse electrodepositions (PRE) method of varying the electrolyte deposition parameters in different combinations. Present results clearly reveal that, there is a drastic improvement in the magnitude of microhardness of coated specimens, silicon carbide (SiC) and multi-walled carbon nanotube (MWCNT) composite coatings yield a maximum hike of 91.6% and 168% respectively. Furthermore, the Nyquist and impedance plots clearly depict that, multi-walled carbon nanotube (MWCNT) exhibits higher corrosion resistance characteristics.
Compression and fracture behavior of leather particulate reinforced polymer composites
Authors: Surana Iva , Bedi Harpreet S , Bhinder Jasdeep , Ghai Viney , Chauhan Ankit , Agnihotri Prabhat K
Published: April 2020

Strategies are suggested for the waste utilization of industrial leather by preparing composites with epoxy and high-density polyethylene (HDPE). The addition of leather improves the average specific compression toughness of epoxy by 29%. The fracture surface analysis suggests the incorporation of leather microparticles leads to a transition of failure mode of epoxy from brittle to ductile. In addition, the dynamic strength of the leather/epoxy composite is found to be 69% higher than that of neat epoxy. However, no significant changes are observed when HDPE is infiltrated with leather. Apart from dispersing the leather particles directly in polymer, a novel strategy is presented here in which leather/HDPE microfibers are prepared and then used to reinforce the epoxy matrix. The specific compression modulus of this composite blend is 8% and 65% higher than epoxy and HDPE, respectively. Fractography is further carried out on the failed specimens to understand the failure mechanism in each composite. A change in the failure mode is observed when epoxy is reinforced either with leather particles or the microfiber. While the failure strength of the microfiber is found to be higher than epoxy, the strength of microfiber/epoxy interface is lower than that of epoxy.
The modal argument improved
Authors: Cutter Brian
Published: April 2020

The modal argument against materialism, in its most standard form, relies on a compatibility thesis to the effect that the physical truths are compatible with the absence of consciousness. I propose an alternative modal argument that relies on an incompatibility thesis: The existence of consciousness is incompatible with the proposition that the physical truths provide (in a sense to be clarified) a complete description of reality. I show that everyone who accepts the premises of the standard modal argument must accept the premises of the revised modal argument, but not vice versa.
Efficient exact inference for dynamical systems with noisy measurements using sequential approximate Bayesian computation
Authors: Schälte Yannik , Hasenauer Jan
Published: April 2020

Motivation

Approximate Bayesian computation (ABC) is an increasingly popular method for likelihood-free parameter inference in systems biology and other fields of research, as it allows analyzing complex stochastic models. However, the introduced approximation error is often not clear. It has been shown that ABC actually gives exact inference under the implicit assumption of a measurement noise model. Noise being common in biological systems, it is intriguing to exploit this insight. But this is difficult in practice, as ABC is in general highly computationally demanding. Thus, the question we want to answer here is how to efficiently account for measurement noise in ABC.

Results

We illustrate exemplarily how ABC yields erroneous parameter estimates when neglecting measurement noise. Then, we discuss practical ways of correctly including the measurement noise in the analysis. We present an efficient adaptive sequential importance sampling-based algorithm applicable to various model types and noise models. We test and compare it on several models, including ordinary and stochastic differential equations, Markov jump processes and stochastically interacting agents, and noise models including normal, Laplace and Poisson noise. We conclude that the proposed algorithm could improve the accuracy of parameter estimates for a broad spectrum of applications.

Availability and implementation

The developed algorithms are made publicly available as part of the open-source python toolbox pyABC (https://github.com/icb-dcm/pyabc).

Supplementary information

Supplementary data are available at Bioinformatics online.
Keeping Race at the Center of School Discipline Practices and Trauma-Informed Care: An Interprofessional Framework
Authors: Joseph Andrea Asha , Wilcox Serena M , Hnilica Rebecca J , Hansen Mary C
Published: April 2020

Given the unique forms of trauma that some Black and Brown youths are exposed to, and the salience of race and racial bias in discipline decision making, this article proposes that discipline interventions should be both race centered and trauma informed. Using critical race theory (CRT), trauma-informed practice literature, and restorative practice philosophies, this article presents a framework that highlights how schools can incorporate racial equity into mental health practices and discipline decision making with students. Namely, CRT tenets such as the centrality of race and racism, challenging the dominant perspective, valuing experiential knowledge, and the commitment to social justice guide authors’ recommendations on discipline decision making. Using an interprofessional perspective, this framework delineates how school social workers, school psychologists, and school counselors can support their schools to integrate interprofessional, trauma-informed, and race-centered practices into a behavioral intervention. Ultimately, this article provides interpersonal, practice, and structural recommendations that can help practitioners engage in equitable discipline decision making.
Dismantling the School-to-Prison Pipeline: A Trauma-Informed, Critical Race Perspective on School Discipline
Authors: Dutil Stacey
Published: April 2020

Disciplinary policies in schools throughout the United States disproportionately affect students of color through exclusionary policies. A punitive approach can have detrimental effects on a population that also experiences higher rates of trauma. This article identifies school disciplinary practices that may retraumatize and criminalize youths and suggests replacing exclusionary discipline practices with trauma-informed ones that prioritize social–emotional support to students. Critical race theory (CRT) is an appropriate theoretical framework to guide the development of trauma-informed schools. Suggestions are provided for school social workers as key change agents in the issue of school discipline. The integration of CRT and trauma-informed practice is emphasized, as both are essential tools for dismantling the school-to-prison pipeline.
Silk Spinning Behavior Varies from Species-Specific to Individualistic in Embioptera: Do Environmental Correlates Account for this Diversity?
Authors: Edgerly Janice S , Sandel Brody , Regoli Isabel , Okolo Onyekachi
Published: April 2020

String sequence analysis revealed that silk spinning behavior of adult female Embioptera varies from species-specific to individualistic. This analysis included 26 species from ten taxonomic families with a total of 115 individuals. Spin-steps, 28 possible positions of the front feet during spinning, were scored from hour-long DVD recordings produced in the laboratory. Entire transcripts of hundreds to thousands of spin-steps per individual were compared by computing Levenshtein edit distances between all possible pairs of subsequences, with lengths ranging from 5 to 25—intraspecific similarity scores were then computed. Silk gallery characteristics and architecture, body size, climatic variables, and phylogenetic relationships were tested as possible drivers of intraspecific similarity in spinning behavior. Significant differences in intraspecific similarity aligned most strongly with climatic variables such that those species living in regions with high temperature seasonality, low annual precipitation, and high annual temperatures displayed more species-stereotypical spinning sequences than those from other regions, such as tropical forests. Phylogenetic signal was significant but weakly so, suggesting that environmental drivers play a stronger role in shaping the evolution of silk spinning. Body size also appears to play a role in that those of similar size are more like each other, even if not related.
Inherent colistin resistance in genogroups of the Enterobacter cloacae complex: epidemiological, genetic and biochemical analysis from the BSAC Resistance Surveillance Programme
Authors: Mushtaq Shazad , Reynolds Rosy , Gilmore Michael C , Esho Olubukola , Adkin Rachael , García-Romero Inmaculada , Chaudhry Aiysha , Horner Carolyne , Bartholomew Toby L , Valvano Miguel A , Dry Magdalena , Murray John , Pichon Bruno , Livermore David M
Published: April 2020

Background

Polymyxins have re-entered use against problem Gram-negative bacteria. Resistance rates are uncertain, with estimates confounded by selective testing.

Methods

The BSAC Resistance Surveillance Programme has routinely tested colistin since 2010; we reviewed data up to 2017 for relevant Enterobacterales (n = 10 914). Unexpectedly frequent resistance was seen among the Enterobacter cloacae complex isolates (n = 1749); for these, we investigated relationships to species, genome, carbon source utilization and LPS structure.

Results

Annual colistin resistance rates among E. cloacae complex isolates were 4.4%–20%, with a rising trend among bloodstream organisms; in contrast, annual rates for Escherichia coli and Klebsiella spp. (including K. aerogenes) generally remained <2%. WGS split the E. cloacae complex isolates into seven genogroup clusters, designated A–G. Among isolates assigned to genogroups A–D, 47/50 sequenced were colistin resistant, and many of those belonging to genogroups A–C identified as E. asburiae. Isolates belonging to genogroups E–G consistently identified as E. cloacae and were rarely (only 3/45 representatives sequenced) colistin resistant. Genogroups F and G, the predominant colistin-susceptible clusters, were metabolically distinct from other clusters, notably regarding utilization or not of l-fucose, formic acid, d-serine, adonitol, myo-inositol, l-lyxose and polysorbates. LPS from resistant organisms grown without colistin pressure lacked substitutions with 4-amino-arabinose or ethanolamine but was more structurally complex, with more molecular species present.

Conclusions

Colistin resistance is frequent in the E. cloacae complex and increasing among bloodstream isolates. It is associated with: (i) particular genomic and metabolic clusters; (ii) identification as E. asburiae; and (iii) with more complex LPS architectures.
Impact of integrated graphical display on expert and novice diagnostic performance in critical care
Authors: Reese Thomas J , Del Fiol Guilherme , Tonna Joseph E , Kawamoto Kensaku , Segall Noa , Weir Charlene , Macpherson Brekk C , Kukhareva Polina , Wright Melanie C
Published: April 2020

Objective

To determine the impact of a graphical information display on diagnosing circulatory shock.

Materials and Methods

This was an experimental study comparing integrated and conventional information displays. Participants were intensivists or critical care fellows (experts) and first-year medical residents (novices).

Results

The integrated display was associated with higher performance (87% vs 82%; P < .001), less time (2.9 vs 3.5 min; P = .008), and more accurate etiology (67% vs 54%; P = .048) compared to the conventional display. When stratified by experience, novice physicians using the integrated display had higher performance (86% vs 69%; P < .001), less time (2.9 vs 3.7 min; P = .03), and more accurate etiology (65% vs 42%; P = .02); expert physicians using the integrated display had nonsignificantly improved performance (87% vs 82%; P = .09), time (2.9 vs 3.3; P = .28), and etiology (69% vs 67%; P = .81).

Discussion

The integrated display appeared to support efficient information processing, which resulted in more rapid and accurate circulatory shock diagnosis. Evidence more strongly supported a difference for novices, suggesting that graphical displays may help reduce expert–novice performance gaps.
The Colombian Special Jurisdiction for Peace
Authors: Valiñas Marta
Published: April 2020

The Colombian Special Jurisdiction for Peace (Jurisdicción Especial para la Paz, SJP) is the judicial component of the Comprehensive System of Truth, Justice, Reparation and Non-Repetition created by the Peace Agreement signed between the Government of Colombia and the Revolutionary Armed Forces of Colombia — People’s Army in November 2016. The SJP started functioning in March 2018 and has already selected a few priority cases, some of which include sexual and gender-based crimes. It is to be expected that more cases involving these crimes will be initiated in the future. This article aims to offer some considerations for the SJP as it begins its investigation and adjudication of cases involving sexual and gender-based crimes. These considerations relate to ensuring that the full scope of sexual and gender-based violence is captured, including the experiences of male victims and the gender components of non-sexual crimes; and that the contextualization of sexual violence is prioritized over unnecessary considerations about the personal motives of the perpetrators.
Topical Corticosteroids for Herpes Simplex Stromal Keratitis
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Herpetic Eye Disease Study (HEDS) was a randomized, double-masked, placebo-controlled, clinical trial to determine the efficacy of topical corticosteroids as adjunctive therapy in the treatment of herpes simplex stromal keratitis in patients who had not received any corticosteroids for at least 10 days before study enrollment. The study showed that topical corticosteroids can be used judiciously with protective antiviral cover in the acute treatment of patients with herpes simplex stromal keratitis who have not recently received corticosteroid therapy. Treatment reduced persistence or progression of stromal inflammation and shortened the duration of herpes simplex stromal keratitis. Postponing steroids during careful observation for a few weeks delayed resolution of stromal keratitis but did not worsen visual outcome at 6 months.
Topical Natamycin Versus Voriconazole for Fungal Corneal Ulcer
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Mycotic Ulcer Treatment Trial (MUTT) was a randomized, active comparator–controlled, double-masked, clinical trial carried out in South India to determine whether topical treatment with natamycin gave better clinical and microbiological outcomes than voriconazole in patients with smear-positive filamentous fungal keratitis and visual acuity of 20/40 to 20/400. Treatments were applied topically every hour while awake until reepithelialization, then 4 times daily for at least 3 weeks. The study showed that natamycin treatment was associated with significantly better clinical and microbiological outcomes than voriconazole treatment for smear-positive filamentous fungal keratitis, with much of the difference attributed to improved results in Fusarium cases.
High-Dose Supplementation with Vitamins C and E and Beta Carotene for Age-Related Cataract and Vision Loss
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Age-Related Eye Disease Study (AREDS) was a multicenter study of the natural history of age-related cataract and macular degeneration (AMD) in a relatively well-nourished older adult cohort that comprised two clinical trials sharing one pool of participants. The study was designed to determine whether a high-dose antioxidant formulation affected the development and progression of age-related lens opacities and visual acuity loss. The cataract trial showed that use of a high-dose formulation of vitamins having antioxidant characteristics (vitamin C, vitamin E, and beta carotene) had no apparent effect on the 7-year risk of development or progression of age-related lens opacities or visual acuity loss.
The Relationship Between Control of Intraocular Pressure After Surgical Intervention for Glaucoma and Visual Field Deterioration
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Advanced Glaucoma Intervention Study (AGIS) was a randomized clinical trial in patients with open-angle glaucoma (OAG) that could no longer be adequately controlled by medications alone, despite maximum accepted and tolerated medical therapy. The study compared different sequences of surgical treatments, supplemented by medical treatment, with the goal of reducing intraocular pressure (IOP) to less than 18 mm Hg. A pooled analysis of patients (eyes), disregarding their original randomized allocation, showed that low IOP is associated with reduced progression of visual field defect, supporting evidence from earlier studies of a protective role for low IOP in visual field deterioration; however, maintaining IOP less than 18 mm Hg does not ensure the preservation of the VF.
Photocoagulation for Diabetic Macular Edema
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Early Treatment Diabetic Retinopathy Study (ETDRS) was a randomized clinical trial involving nearly four thousand diabetic patients with early proliferative retinopathy, moderate to severe nonproliferative retinopathy, and/or diabetic macular edema in each eye. This paper (ETDRS report number 1) describes the findings in the subgroup of eyes in the ETDRS that were identified as having mild to moderate nonproliferative diabetic retinopathy and macular edema. The analysis showed that immediate focal argon laser photocoagulation of “clinically significant” diabetic macular edema substantially reduced the risk of visual loss, increased the chance of visual improvement, decreased the frequency of persistent macular edema, and caused only minor visual field losses. The authors recommended immediate focal argon laser photocoagulation for all eyes with clinically significant macular edema and mild or moderate nonproliferative diabetic retinopathy, regardless of the level of visual acuity.
Will My Baby Learn to Walk?
Authors: Miller Elissa G.
Published: April 2020

Prognostication in pediatric palliative care can be extremely difficult. This is due in large part to lack of data because of the broad diversity of underlying diagnoses. Despite the difficulty prognosticating, families often request prognostic information. When a patient’s prognosis is poor, many health care providers worry about taking away hope by sharing information about poor prognosis. However, data show that honesty from providers, even when a child’s prognosis is poor, helps parents maintain realistic hope even in the face of devastating illness. This chapter provides an outline for thinking about patient prognosis in the setting of severe neurologic injury. It also discusses standard approaches to delivering prognostic information to patients and their families.
In the Eye of the Beholder
Authors: Miller Elissa G.
Published: April 2020

Quality of life is an important part of health, health care, and disease management. As disease progresses, health-related quality of life often declines and may decline significantly. Patients with a poor prognosis for survival may choose to limit disease-directed therapy based on quality of life considerations. In pediatrics, parents are often asked to determine their child’s quality of life, and in palliative care, the quality of life assessment may be used to help establish goals of care and determine the medical plan of care. This chapter discusses quality of life, how to assess it, and how to combine quality of life with patient prognosis in order to determine a plan of care.
You Can’t Tell Him That!
Authors: Miller Elissa G.
Published: April 2020

Truth telling, also known as prognostic disclosure, is not always the norm in pediatric health care. With children who have limited understanding of illness and parents who make medical decisions on behalf of their children, pediatricians are accustomed to excluding their pediatric patients from medical discussions. However, as children become adolescents and adolescents become young adults, they have an increasing role in medical decision-making and therefore need increased prognostic disclosure. When dealing with a terminal prognosis, families may try to prevent providers from talking with their child about death. This chapter discusses the history and ethics of prognostic disclosure in pediatric health care with a focus on adolescents and families who are resistant to open conversation.
I Won’t Let You!
Authors: Miller Elissa G.
Published: April 2020

Conflicts between patient families and medical providers arise frequently. Providers and families may disagree about a patient’s prognosis, the use of life-sustaining medical treatment, the treatment plan, and other issues. Such conflicts may be exacerbated at end of life, especially at end of life for a pediatric patient. Working through such conflicts is a common role for the palliative care team. As with much of the team’s work, it relies on establishing goals of care and partnering with families to resolve conflict as well as engaging the hospital ethics committee when conflict persists. This chapter discusses the multiple ways conflicts may arise in caring for a dying child and makes recommendations for how to resolve them.
Time to Stop
Authors: Miller Elissa G.
Published: April 2020

Withdrawal of life-sustaining medical technologies occurs frequently in children’s hospitals. It has been reported that more than 65% of pediatric patients die following withholding (nonescalation) or withdrawal of medical technology. As a result, pediatric providers must understand the nuances involved in the withdrawal of various forms of medical technology so they may counsel families appropriately. Prior to withdrawing any life-sustaining medical technology, it is important to provide anticipatory guidance to the family. This chapter discusses the withdrawal of life-sustaining medical technology and how to help families as well as staff who are coping with the impending death of a child.
Stuck on Life Support
Authors: Miller Elissa G.
Published: April 2020

Children with medical complexity are living longer with greater technology dependence. However, with each new technology, families face a new decision with new benefits and burdens. Parents in online communities share details of their child’s medical care, which sometimes leads them to inquire about medical interventions they may have learned about from another parent whose child has the same disease. Palliative care teams often help families make decisions with regard to new medical technology. This chapter discusses common decisions families face concerning initiating new medical technology and what families want to hear from their providers before making these difficult decisions.
Always Putting My Needs Last
Authors: Ragsdale Lindsay B.
Published: April 2020

Caring for an ailing child can have significant impacts on a caregiver’s physical, spiritual, emotional, and socioeconomic domains of life. Comprehensive care of the whole family includes an assessment and plan for the caregiver’s well-being. Interval evaluation of caregiver well-being can help anticipate future needs such as home care, respite, and counseling. Palliative care interventions should include caregiver assessments and creation of layered support for the whole family. Close attention should be paid to signs of caregiver fatigue, burnout, grief, and neglect of basic needs. Caregiver support can affect downstream care for the ailing child by fortifying the people who are responsible for the medical care.
No Access and Still in Pain
Authors: Ragsdale Lindsay B.
Published: April 2020

Pain management for children can be intimidating for providers unfamiliar with pediatric practice. Finding the correct dose can involve weight-based dosing and calculations of suspensions, which are overall more involved than adult dosing strategies. When there is a lack of intravenous access or the inability to use the gastrointestinal tract, finding the correct route of pain medication for children can be challenging. However, following simple strategies can help find the best option for pain relief. The least invasive route of medication administration should be selected first, and nonpharmacologic strategies should be layered in to enhance pain control. Pain should be assessed regularly, and therapy should be escalated when indicated. The pain medication should be matched with the type of pain and anticipated duration of painful stimulus. Skin integrity, weight-based dosing limitations, and prognosis should be considered in the selection of agents. Comfort position, supportive caregiver, and distraction and integrative therapies depending on age should be integrated into any treatment regimen.
She Won’t Stop Vomiting
Authors: Levy Carly , Dickerman Mindy
Published: April 2020

Seriously ill pediatric patients may experience nausea and/or vomiting as a distressing symptom. Nausea and vomiting occur in almost half of children with cancer during their end-of-life period. There are multiple triggers that can lead to nausea and/or vomiting, including a variety of diseases and commonly used medications to treat serious illness including opiates. Identifying the source of nausea and/or vomiting, if possible, can dictate a targeted and effective treatment approach. This chapter reviews the pathophysiology thought to be responsible for eliciting nausea and/or vomiting, outlines a stepwise framework for evaluating patients with this symptom, and reviews targeted therapies including pharmacologic as well as supportive and integrative therapies.
Why Isn’t She Looking at Me?
Authors: Jacobowski Natalie
Published: April 2020

Pediatric patients receiving palliative care are a population at high risk for delirium. Pediatric delirium is an acute change in mental status that manifests as impaired attention, consciousness, cognition, and often with abnormalities of perception. Delirium is due to an underlying medical etiology and/or medications and occurs in the setting of acute and critical illness as well as at the end of life. When delirium is identified, treatment begins with addressing the underlying cause when able, environmental interventions to address factors that can exacerbate delirium, and occasionally additional medications to treat symptoms of delirium. This chapter provides a developmental framework for mental status assessment in even the youngest patients, recommendations for screening and identification of risk factors, and recommendations for nonpharmacologic and pharmacologic management of delirium.
Teenage “Bleh”
Authors: Moore Dominic , Marty Colleen
Published: April 2020

Fatigue is a common and troubling symptom in children with serious illness. Coping with fatigue impacts and diminishes quality of life in multiple ways. Despite the well-established impact of fatigue, clinicians tend to underrecognize and undertreat this symptom. This chapter examines fatigue as it presents in pediatric patients and suggests best practices for evaluation and treatment. Common causes of fatigue include anemia, medications, pain, disordered sleep, nutritional imbalance, changes in physical activity, emotional and/or spiritual distress, and medical comorbidities. Each case should be evaluated separately, with a focus on treating the underlying cause of the fatigue when possible. An interdisciplinary approach is often required to fully address the factors contributing to a patient’s fatigue. Nonpharmacologic approaches have been shown to be effective and may be used in concert with pharmacologic agents.
Saying Hello and Goodbye
Authors: Ragsdale Lindsay B.
Published: April 2020

Perinatal birth planning can help parents who are facing a difficult fetal diagnosis understand the prognosis, identify central goals, and focus on their infant. Planning during pregnancy can help align the care that the mother and the infant receive with their goals of care. Plans can include delivery options, resuscitative efforts, code status, goals of care, symptom management, family involvement, memory-making, and grief support. Resuscitative efforts for the neonate can be clarified before birth and the birth plan can give direction to the resuscitation team about boundaries of interventions. Perinatal palliative care can help families clarify their goals and ensure collaborative communication with providers from obstetrics and neonatology/newborn care.
Tiny Fingers, Tiny Toes
Authors: Ragsdale Lindsay B.
Published: April 2020

Preterm birth is defined as birth prior to 37 weeks of gestation. Preterm birth can have a significant impact on the infant’s survival and neurodevelopmental outcomes. Extremely preterm infants have the highest risk for mortality and severe disabilities. Medical teams should have honest conversations about outcomes and expectations with parents and elicit their perspectives on quality of life and family goals. Neonatal intensive care unit (NICU) admissions can have phases: the crisis admission phase, the middle marathon phase, and the discharge phase. Parents can experience significant distress during a NICU admission, and they are at higher risk for mental health difficulties. Medical teams should layer in support during the different phases of NICU admission.
I Just Want to Feel Normal!
Authors: Gross-Toalson Jami , Linebarger Jennifer
Published: April 2020

Medication nonadherence is common in adolescents and places patients at higher risk of significant health complications. Medication nonadherence should be considered whenever a patient’s medical condition is not under control. Common barriers to treatment adherence include disease frustration, adolescent development, medication regimen issues, and cognitive or mental health concerns. Routinely assessing treatment adherence helps clinicians identify barriers and develop strategies with the patient for addressing those barriers. A collaborative team approach can create a safety net to support the patient’s treatment adherence. This chapter describes the factors associated with adherence, offers strategies and tools for assessing and identifying the barriers to adherence, and outlines a collaborative process for improving adherence.