bluuebunny/crossref_metadata_2025 huggingface dataset:
Trachoma Prevalence After Discontinuation of Mass Azithromycin Distribution
Authors: Godwin William , Prada Joaquin M , Emerson Paul , Hooper P J , Bakhtiari Ana , Deiner Michael , Porco Travis C , Mahmud Hamidah , Landskroner Emma , Hollingsworth T Déirdre , Medley Graham F , Pinsent Amy , Bailey Robin , Lietman Thomas M , Oldenburg Catherine E
Published: December 2019

Background

As the World Health Organization seeks to eliminate trachoma by 2020, countries are beginning to control the transmission of trachomatous inflammation–follicular (TF) and discontinue mass drug administration (MDA) with oral azithromycin. We evaluated the effect of MDA discontinuation on TF1–9 prevalence at the district level.

Methods

We extracted from the available data districts with an impact survey at the end of their program cycle that initiated discontinuation of MDA (TF1–9 prevalence <5%), followed by a surveillance survey conducted to determine whether TF1–9 prevalence remained below the 5% threshold, warranting discontinuation of MDA. Two independent analyses were performed, 1 regression based and 1 simulation based, that assessed the change in TF1–9 from the impact survey to the surveillance survey.

Results

Of the 220 districts included, TF1–9 prevalence increased to >5% from impact to surveillance survey in 9% of districts. Regression analysis indicated that impact survey TF1–9 prevalence was a significant predictor of surveillance survey TF1–9 prevalence. The proportion of simulations with >5% TF1–9 prevalence in the surveillance survey was 2%, assuming the survey was conducted 4 years after MDA.

Conclusion

An increase in TF1–9 prevalence may represent disease resurgence but could also be due to measurement error. Improved diagnostic tests are crucial to elimination of TF1–9 as a public health problem.
Trained Immunity Confers Broad-Spectrum Protection Against Bacterial Infections
Authors: Ciarlo Eleonora , Heinonen Tytti , Théroude Charlotte , Asgari Fatemeh , Le Roy Didier , Netea Mihai G , Roger Thierry
Published: December 2019

Background

The innate immune system recalls a challenge to adapt to a secondary challenge, a phenomenon called trained immunity. Training involves cellular metabolic, epigenetic and functional reprogramming, but how broadly trained immunity protects from infections is unknown. For the first time, we addressed whether trained immunity provides protection in a large panel of preclinical models of infections.

Methods

Mice were trained and subjected to systemic infections, peritonitis, enteritis, and pneumonia induced by Staphylococcus aureus, Listeria monocytogenes, Escherichia coli, Citrobacter rodentium, and Pseudomonas aeruginosa. Bacteria, cytokines, leukocytes, and hematopoietic precursors were quantified in blood, bone marrow, and organs. The role of monocytes/macrophages, granulocytes, and interleukin 1 signaling was investigated using depletion or blocking approaches.

Results

Induction of trained immunity protected mice in all preclinical models, including when training and infection were initiated in distant organs. Trained immunity increased bone marrow hematopoietic progenitors, blood Ly6Chigh inflammatory monocytes and granulocytes, and sustained blood antimicrobial responses. Monocytes/macrophages and interleukin 1 signaling were required to protect trained mice from listeriosis. Trained mice were efficiently protected from peritonitis and listeriosis for up to 5 weeks.

Conclusions

Trained immunity confers broad-spectrum protection against lethal bacterial infections. These observations support the development of trained immunity-based strategies to improve host defenses.
Patterns of patient experience with primary care access in Australia, Canada, New Zealand and Switzerland: a comparative study
Authors: Senn Nicolas , Cohidon Christine , Breton Mylaine , Levesque Jean-Fréderic , Zuchuat Jean-Christophe
Published: December 2019

Objective

Access to primary care (PC) is vital, but complex to define and compare between settings. We aimed to generate a typology of patients’ access patterns across countries using a novel inductive approach.

Design

Cross-sectional surveys.

Setting

Australia, Canada, New Zealand and Switzerland between 2012 and 2014 as part of the QUALICO-PC project.

Participants

Data were collected from 1306 general practices and 10 000+ patients, with nine patients per practice.

Intervention(s)

None.

Main Outcome Measure(s)

Typology of access.

Results

Three axes were retained, explaining 23% of the total variance: (i) ‘temporal and geographical access’; (ii) ‘frequency of access and unmet healthcare needs’; and (iii) ‘affordability and frequency of access’.

Based on the three axes, we identified four clusters of patients: (i) patients reporting overall good access to PC; (ii) frequent users with unmet healthcare needs; (iii) under-users with financial barriers; and (iv) users with poor time/geographical access.

Better access to PC was experienced in Switzerland and New Zealand, while worst access was reported in Canada, where most of the time and geographical barriers were reported. Most financial barriers were observed in Australia and New Zealand. Frequent users with some level of unmet healthcare needs are prevalent in all four countries.

Conclusions

Four main groups of patients with different patterns of access were identified: (i) good access; (ii) geographical and time barriers; (iii) financial barriers; and (iv) frequent users with unmet healthcare needs. Differences in access between the four countries are substantial.
Sensitivity of comorbidity network analysis
Authors: Brunson Jason Cory , Agresta Thomas P , Laubenbacher Reinhard C
Published: December 2019

Objectives

Comorbidity network analysis (CNA) is a graph-theoretic approach to systems medicine based on associations revealed from disease co-occurrence data. Researchers have used CNA to explore epidemiological patterns, differentiate populations, characterize disorders, and more; but these techniques have not been comprehensively evaluated. Our objectives were to assess the stability of common CNA techniques.

Materials and Methods

We obtained seven co-occurrence data sets, most from previous CNAs, coded using several ontologies. We constructed comorbidity networks under various modeling procedures and calculated summary statistics and centrality rankings. We used regression, ordination, and rank correlation to assess these properties’ sensitivity to the source of data and construction parameters.

Results

Most summary statistics were robust to variation in link determination but somewhere sensitive to the association measure. Some more effectively than others discriminated among networks constructed from different data sets. Centrality rankings, especially among hubs, were somewhat sensitive to link determination and highly sensitive to ontology. As multivariate models incorporated additional effects, comorbid associations among low-prevalence disorders weakened while those between high-prevalence disorders shifted negative.

Discussion

Pairwise CNA techniques are generally robust, but some analyses are highly sensitive to certain parameters. Multivariate approaches expose additional conceptual and technical limitations to the usual pairwise approach.

Conclusion

We conclude with a set of recommendations we believe will help CNA researchers improve the robustness of results and the potential of follow-up research.
Co-occurrence of kdr Mutations V1016I and F1534C and Its Association With Phenotypic Resistance to Pyrethroids in Aedes aegypti (Diptera: Culicidae) Populations From Costa Rica
Authors: Zardkoohi Aryana , Castañeda David , Lol Juan C , Castillo Carmen , Lopez Francisco , Marín Rodriguez Rodrigo , Padilla Norma
Published: December 2019

Aedes aegypti (Linnaeus, 1762) is considered the most important mosquito vector species for several arboviruses (e.g., dengue, chikungunya, Zika) in Costa Rica. The primary strategy for the control and prevention of Aedes-borne diseases relies on insecticide-based vector control. However, the emergence of insecticide resistance in the mosquito populations presents a significant threat to these prevention actions. The characterization of the mechanisms driving the insecticide resistance in Ae. aegypti is vital for decision making in vector control programs. Therefore, we analyzed the voltage-gated sodium channel (VGSC) gene for the presence of the V1016I and F1534C kdr mutations in Ae. aegypti populations from Puntarenas and Limon provinces, Costa Rica. The CDC bottle bioassays showed that both Costa Rican Ae. aegypti populations were resistant to permethrin and deltamethrin. In the case of kdr genotyping, results revealed the co-occurrence of V1016I and F1534C mutations in permethrin and deltamethrin-resistant populations, as well as the fixation of the 1534C allele. A strong association between these mutations and permethrin and deltamethrin resistance was found in Puntarenas. Limon did not show this association; however, our results indicate that the Limon population analyzed is not under the same selective pressure as Puntarenas for the VGSC gene. Therefore, our findings make an urgent call to expand the knowledge about the insecticide resistance status and mechanisms in the Costa Rican populations of Ae. aegypti, which must be a priority to develop an effective resistance management plan.
Association Between Outdoor Air Pollution and Risk of Malignant and Benign Brain Tumors: The Multiethnic Cohort Study
Authors: Wu Anna H , Wu Jun , Tseng Chiuchen , Yang Juan , Shariff-Marco Salma , Fruin Scott , Larson Timothy , Setiawan Veronica W , Masri Shahir , Porcel Jacqueline , Jain Jennifer , Chen Thomas C , Stram Daniel O , Marchand Loïc Le , Ritz Beate , Cheng Iona
Published: December 2019

Background

There are increasing concerns about the potential impact of air pollution on chronic brain inflammation and microglia cell activation, but evidence of its carcinogenic effects is limited.

Methods

We used kriging interpolation and land use regression models to estimate long-term air pollutant exposures of oxides of nitrogen (NOx, NO2), kriging interpolation for ozone (O3), carbon monoxide, and particulate matter (PM2.5, PM10), and nearest monitoring station measurements for benzene for 103 308 men and women from the Multiethnic Cohort, residing largely in Los Angeles County from recruitment (1993–1996) through 2013. We used Cox proportional hazards models to examine the associations between time-varying pollutants and risk of malignant brain cancer (94 men, 116 women) and meningioma (130 men, 425 women) with adjustment for sex, race and ethnicity, neighborhood socioeconomic status, smoking, occupation, and other covariates. Stratified analyses were conducted by sex and race and ethnicity.

Results

Brain cancer risk in men increased in association with exposure to benzene (hazard ratio [HR] = 3.52, 95% confidence interval [CI] = 1.55 to 7.55) and PM10 (HR = 1.80, 95% CI = 1.00 to 3.23). Stronger associations with PM10 (HR = 3.02, 95% CI = 1.26 to 7.23), O3 (HR = 2.93, 95% CI = 1.09 to 7.88), and benzene (HR = 4.06, 95% CI = 1.17 to 18.2) were observed among Latino men. Air pollution was unrelated to risk of meningioma except that O3 exposure was associated with risk in men (HR = 1.77, 95% CI = 1.02 to 3.06). Brain cancer risk in women was unrelated to air pollution exposures.

Conclusions

Confirmation of these sex differences in air pollution–brain cancer associations and the stronger findings in Latino men in additional diverse populations is warranted.
China’s International Commercial Court: Background, Obstacles and the Road Ahead
Authors: Zhang Sheng
Published: December 2019

The establishments of international commercial courts reflect the closer alignment of commercial transactions and the development of dispute resolution mechanisms. To mainly facilitate the developments of the ‘Belt and Road Initiative’, China established the China international commercial court (CICC) in 2018. It marked a significant step in the development of China’s judicial system. However, compared with other international commercial courts in the world, the construction of the CICC still has much room for improvement in the areas of jurisdiction, internationalization, and the recognition and enforcement of judgments. The China’s Supreme People’s Court (SPC) needs to consider how to refine the working procedures, enhance the internationalization, and promote the recognition and enforcement of the awards by the CICC. The SPC may need to update the current legal regime for the CICC based on the operation and the experience of trials. In addition to the efforts of the SPC to pave the way for developments, China needs to consider modifying the relevant rules and actively expand its judicial cooperation with other countries.
Low temperature synergistically promotes wounding-induced indole accumulation by INDUCER OF CBF EXPRESSION-mediated alterations of jasmonic acid signaling in Camellia sinensis
Authors: Zhou Ying , Zeng Lanting , Hou Xingliang , Liao Yinyin , Yang Ziyin
Published: December 2019

Plants have to cope with various environmental stress factors which significantly impact plant physiology and secondary metabolism. Individual stresses, such as low temperature, are known to activate plant volatile compounds as a defense. However, less is known about the effect of multiple stresses on plant volatile formation. Here, the effect of dual stresses (wounding and low temperature) on volatile compounds in tea (Camellia sinensis) plants and the underlying signalling mechanisms were investigated. Indole, an insect resistance volatile, was maintained at a higher content and for a longer time under dual stresses compared with wounding alone. CsMYC2a, a jasmonate (JA)-responsive transcription factor, was the major regulator of CsTSB2, a gene encoding a tryptophan synthase β-subunit essential for indole synthesis. During the recovery phase after tea wounding, low temperature helped to maintain a higher JA level. Further study showed that CsICE2 interacted directly with CsJAZ2 to relieve inhibition of CsMYC2a, thereby promoting JA biosynthesis and downstream expression of the responsive gene CsTSB2 ultimately enhancing indole biosynthesis. These findings shed light on the role of low temperature in promoting plant damage responses and advance knowledge of the molecular mechanisms by which multiple stresses coordinately regulate plant responses to the biotic and abiotic environment.
Regulation of accretion by its outflow in a symbiotic star: the 2016 outflow fast state of MWC 560
Authors: Lucy Adrian B , Sokoloski J L , Munari U , Roy Nirupam , Kuin N Paul M , Rupen Michael P , Knigge Christian , Darnley M J , Luna G J M , Somogyi Péter , Valisa P , Milani A , Sollecchia U , Weston Jennifer H S
Published: December 2019

How are accretion discs affected by their outflows? To address this question for white dwarfs accreting from cool giants, we performed optical, radio, X-ray, and ultraviolet observations of the outflow-driving symbiotic star MWC 560 (≡V694 Mon) during its 2016 optical high state. We tracked multi-wavelength changes that signalled an abrupt increase in outflow power at the initiation of a months-long outflow fast state, just as the optical flux peaked: (1) an abrupt doubling of Balmer absorption velocities; (2) the onset of a 20 μJy per month increase in radio flux; and (3) an order-of-magnitude increase in soft X-ray flux. Juxtaposing to prior X-ray observations and their coeval optical spectra, we infer that both high-velocity and low-velocity optical outflow components must be simultaneously present to yield a large soft X-ray flux, which may originate in shocks where these fast and slow absorbers collide. Our optical and ultraviolet spectra indicate that the broad absorption-line gas was fast, stable, and dense (≳106.5  cm−3) throughout the 2016 outflow fast state, steadily feeding a lower density (≲105.5 cm−3) region of radio-emitting gas. Persistent optical and ultraviolet flickering indicate that the accretion disc remained intact. The stability of these properties in 2016 contrasts to their instability during MWC 560’s 1990 outburst, even though the disc reached a similar accretion rate. We propose that the self-regulatory effect of a steady fast outflow from the disc in 2016 prevented a catastrophic ejection of the inner disc. This behaviour in a symbiotic binary resembles disc/outflow relationships governing accretion state changes in X-ray binaries.
Characterization of unresolved and unclassified sources detected in radio continuum surveys of the Galactic plane
Authors: Chakraborty Arnab , Roy Nirupam , Wang Y , Datta Abhirup , Beuther H , Medina S-N X , Menten K M , Urquhart J S , Brunthaler A , Dzib S A
Published: December 2019

The continuum emission from 1 to 2 GHz of The H i/OH/Recombination line survey of the inner Milky Way (THOR) at ≲18 arcsec resolution covers ∼132 deg2 of the Galactic plane and detects 10 387 sources. Similarly, the first data release of the Global View of Star Formation in the Milky Way (GLOSTAR) survey covers ∼16 deg2 of the Galactic plane from 4 to 8 GHz at 18 arcsec resolution and detects 1575 sources. However, a large fraction of the unresolved discrete sources detected in these radio continuum surveys of the Galactic plane remain unclassified. Here, we study the Euclidean-normalized differential source counts of unclassified and unresolved sources detected in these surveys and compare them with simulated extragalactic radio source populations and previously established source counts. We find that the differential source counts for THOR and GLOSTAR surveys are in excellent agreement with both simulation and previous observations. We also estimate the angular two-point correlation function of unclassified and unresolved sources detected in THOR survey. We find a higher clustering amplitude in comparison with the Faint Images of the Radio Sky at Twenty-cm (FIRST) survey up to the angular separation of 5°. The decrease in angular correlation with increasing flux cut and the excellent agreement of clustering pattern of sources above 1 mJy with high-z samples (z > 0.5) of the FIRST survey indicates that these sources might be high-z extragalactic compact objects. The similar pattern of one-point and two-point statistics of unclassified and compact sources with extragalactic surveys and simulations confirms the extragalactic origin of these sources.
NVST observations of collision-induced apparent fan-shaped jets
Authors: Li Ting , Hou Yijun , Zhang Jun , Xiang Yongyuan
Published: December 2019

Using high-quality H α observations from the New Vacuum Solar Telescope, we first report apparent fan-shaped jets (AFJs) generated during the interaction between primary fan-shaped jets (FJs) and nearby facula magnetic structure. The primary FJs were intermittently launched from a sunspot penumbra with negative-polarity magnetic fields in active region 12740 on 2019 May 6, accompanied by impulsive brightenings at the base. While the propagating FJ encountered and collided with the negative-polarity magnetic structure of the west facula, the density of jet material was enhanced to the east of the facula. Meanwhile, the jet structures exhibited a deflection towards the north-west at the jet–facula collision location. Then the primary FJ evolved into two parts, with one part being reflected away from the facula and the other part forming an AFJ. Easily distinguished from the primary FJ, the ejecting AFJ was more ordered and had an apparent end at the facula. The AFJ was impulsively accelerated to speeds of 100 km s−1, and reached lengths of up to 40 Mm. The observed AFJ had a similar morphology to the fan-shaped quasi-separatrix layer (QSL) between the penumbra and facula magnetic systems, implying that the material of the AFJ was mainly guided by the fan plane of the QSL. We suggest that the collision does not cause a change in the field-line connectivity and only leads to the redistribution of jet material.
Finding singularities in gravitational lensing
Authors: Meena Ashish Kumar , Bagla J S
Published: December 2019

The number of strong lens systems is expected to increase significantly in ongoing and upcoming surveys. With an increase in the total number of such systems, we expect to discover many configurations that correspond to unstable caustics. In such cases, the instability can be used to our advantage for constraining the lens model. We have implemented algorithms for detection of different types of singularities in gravitational lensing. We apply our approach on a variety of lens models and then go on to test it with the inferred mass distribution for Abell 697 as an example application. We propose to represent lenses using A3-lines and singular points (A4 and D4) in the image plane. We propose this as a compact representation of complex lens systems that can capture all the details in a single snapshot.
Difficulties in mid-infrared selection of AGNs in dwarf galaxies
Authors: Lupi Alessandro , Sbarrato Tullia , Carniani Stefano
Published: December 2019

While massive black holes (MBHs) are known to inhabit all massive galaxies, their ubiquitous presence in dwarf galaxies has not been confirmed yet, with only a limited number of sources detected so far. Recently, some studies proposed infrared emission as an alternative way to identify MBHs in dwarfs, based on a similar approach usually applied to quasars. In this study, by accurately combining optical and infrared data taking into account resolution effects and source overlapping, we investigate in detail the possible limitations of this approach with current ground-based facilities, finding a quite low (∼0.4 per cent) fraction of active MBH in dwarfs that are luminous in mid-infrared, consistent with several previous results. Our results suggest that the infrared selection is strongly affected by several limitations that make the identification of MBHs in dwarf galaxies currently prohibitive, especially because of the very poor resolution compared to optical surveys, and the likely contamination by nearby sources, although we find a few good candidates worth further follow-ups. Optical, X-ray, and radio observations therefore still represent the most secure way to search for MBH in dwarfs.
Potassium channels as potential drug targets for limb wound repair and regeneration
Authors: Zhang Wengeng , Das Pragnya , Kelangi Sarah , Bei Marianna
Published: December 2019

Background

Ion channels are a large family of transmembrane proteins, accessible by soluble membrane-impermeable molecules, and thus are targets for development of therapeutic drugs. Ion channels are the second most common target for existing drugs, after G protein-coupled receptors, and are expected to make a big impact on precision medicine in many different diseases including wound repair and regeneration. Research has shown that endogenous bioelectric signaling mediated by ion channels is critical in non-mammalian limb regeneration. However, the role of ion channels in regeneration of limbs in mammalian systems is not yet defined.

Methods

To explore the role of potassium channels in limb wound repair and regeneration, the hindlimbs of mouse embryos were amputated at E12.5 when the wound is expected to regenerate and E15.5 when the wound is not expected to regenerate, and gene expression of potassium channels was studied.

Results

Most of the potassium channels were downregulated, except for the potassium channel kcnj8 (Kir6.1) which was upregulated in E12.5 embryos after amputation.

Conclusion

This study provides a new mouse limb regeneration model and demonstrates that potassium channels are potential drug targets for limb wound healing and regeneration.
PHOTON FIELD OF ~100–200 KEV FOR ENVIRONMENTAL DOSEMETER CALIBRATION
Authors: Tajudin S M , Namito Y , Sanami T , Hirayama H
Published: December 2019

As a reference photon field, several radionuclides have been used frequently, such as 241Am,137Cs and60 Co for calibration. These nuclides provide mono-energy photons for dosemeters covering few tens of keV–MeV. The main energy around 200 keV is important for both environmental and medical fields since the former should consider scattering photons and the later should measure photons from X-ray generator. In our previous work, a backscattered layout can provide a uniform photon field spectra and dose rate with an energy of 190 keV by using an affordable intensity 137 Cs gamma source. Several other quasi-monoenergetic photon fields in the range of 100–200 keV could be obtained by using several available gamma sources. Two calibrated environmental CsI(Tl) survey meters, Horiba PA-1000 and Mr. Gamma A2700, had been measured with the developed backscattered photon field to understand energy-dependent features in order to confirm dosemeter readings. Consequently, both scintillator instruments are sensitive for measurements of the relatively low dose rates at 190 keV.
PROMIS PF in the Evaluation of Postoperative Outcomes in Workers’ Compensation Patients Following Anterior Cervical Discectomy and Fusion
Authors: Yoo Joon S. , Parrish James M. , Jenkins Nathaniel W. , Brundage Thomas S. , Hrynewycz Nadia M. , Patel Dillon S. , Singh Kern
Published: December 2019

Study Design:

This was a retrospective cohort study.

Objective:

To determine the improvement of clinical outcomes in Workers’ Compensation (WC) patients compared with non-WC patients utilizing Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF) following anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

To our knowledge, there has not been a study to evaluate clinical outcomes of WC patients utilizing the PROMIS PF survey.

Methods and Materials:

Patients undergoing a primary, 1 to 3-level ACDF were retrospectively reviewed and stratified according to insurance (WC and non-WC). Demographic and perioperative characteristics were compared using χ2 test and independent t tests. Change in PROMIS PF scores was calculated using paired t tests. Differences in postoperative PROMIS PF scores and changes in PROMIS PF from baseline were compared using linear regression.

Results:

In total, 124 1 to 3-level ACDF patients were included: 36 had WC insurance and 88 had non-WC insurance. WC patients were younger and more likely to be obese. WC patients reported significantly lower PROMIS PF scores preoperatively and at 6 weeks, 12 weeks, and 6 months timepoints. However, both cohorts reported comparable PROMIS PF scores at the 1-year timepoint. WC patients demonstrated similar improvements from baseline through 1-year postoperatively compared with non-WC patients. For both non-WC and WC cohort, the change in the postoperative PROMIS PF score from baseline was significant at 3 months, 6 months, and 1 year. However, in both cohorts, the change in the postoperative PROMIS PF score from baseline was not significantly different at 6 weeks.

Conclusions:

In our study, WC patients had worse baseline physical function as indicated by lower preoperative PROMIS PF scores and reported lower PROMIS PF scores postoperatively. However, there were no significant differences when comparing the postoperative change from baseline between the cohorts. Both cohorts experienced significant postoperative improvements from baseline. This study established that PROMIS PF is an effective tool to evaluate recovery of WC patients following ACDF.
Stanford head and neck anesthesia and advanced airway management program
Authors: Nekhendzy Vladimir , Mittal Brita
Published: December 2019

The Head and Neck (H&N) anesthesia subspecialty is developing and expanding rapidly, placing increased demands on training anesthesiologists with a special expertise in the field. We present the structure and experience of the formal Stanford H&N Anesthesia and Advanced Airway Management Training Program, which includes a 20-year history of conducting subspecialized residency training and a 10-year history of fellowship training. The highlights of the Stanford H&N anesthesia training include a structured program, a large group of enthusiastic and dedicated faculty, high and diverse surgical volume, state-of-the-art anesthetic techniques, extensive advanced airway management teaching and training, and excellent research and scholarly opportunities. We offer the Stanford H&N anesthesia learning objectives and milestones, as well as the Stanford Learning Portfolio and the Portfolio Evaluation for download, sharing and modification. On the basis of our experience, we also summarize the essential requirements for successful subspecialty training in H&N anesthesia and advanced airway management.
The Effect of Kangaroo Mother Care, Provided in the Early Postpartum Period, on the Breastfeeding Self-Efficacy Level of Mothers and the Perceived Insufficient Milk Supply
Authors: Yilmaz Fatma , Küçükoğlu Sibel , Aytekin Özdemir Aynur , Oğul Tanju , Aşki Nesrin
Published: December 2019

The aim of this study was to determine the effect of kangaroo mother care, provided in the early postpartum period, on the breastfeeding self-efficacy level and the perceived insufficient milk supply. This study was conducted as the quasi-experimental design. The population of the study consisted of the mothers and their infants, to whom they gave birth in a university hospitals located in either eastern or western Turkey, between December 2016 and June 2017. In this study, mothers and their infants were randomly assigned to the experimental group (kangaroo mother care, n = 30) and the control group (n = 30). This study included 2500 to 4000 g birth weight infants who had no serious health problems and no sucking problems. The Introductory Information Form, the Breastfeeding Self-Efficacy Scale, and the Perception of Insufficient Milk Questionnaire were used to collect the data. In this study, kangaroo mother care was provided as a nursing intervention for the mothers in the experimental group twice a day until they were discharged. Any other application was not performed in the control group's mothers apart from the routine application. Ethical principles were adhered in all stages of the study. The breastfeeding self-efficacy mean score (65.50 ± 3.95) of the mothers who performed kangaroo mother care was higher than the mean score of the mothers who did not perform kangaroo mother care (55.50 ± 7.00) (P < .001). In addition, mothers in the experimental group (46.60 ± 3.40) perceived their milk more sufficiently than mothers in the control group (30.17 ± 11.37) (P < .001). In the study, a statistically significant correlation was determined between breastfeeding self-efficacy levels of mothers in the experimental group and the perceived insufficient milk supply (P ˂ .05). In the study, kangaroo mother care increased breastfeeding self-efficacy perception of the mothers and reduced the perceived insufficient milk supply. This shows that kangaroo mother care can potentially have an important effect on breastfeeding perceptions.
The Economic and Clinical Impact of an Early Mobility Program in the Trauma Intensive Care Unit: A Quality Improvement Project
Authors: Falkenstein Beth A. , Skalkowski Chelsea K. , Lodise Kathleen D. , Moore Marian , Olkowski Brian F. , Rojavin Yuri
Published: December 2019

Traumatic injury survivors often face a difficult recovery. Surgical and invasive procedures, prolonged monitoring in the intensive care unit (ICU), and constant preventive vigilance by medical staff guide standards of care to promote positive outcomes. Recently, patients with traumatic injuries have benefited from early mobilization, a multidisciplinary approach to increasing participation in upright activity and walking. The purpose of this project was to determine the impact of an early mobility program in the trauma ICU on length of stay (LOS), ventilator days, cost, functional milestones, and rehabilitation utilization. A quality improvement project compared outcomes and cost before and after the implementation of an early mobility program. The trauma team assigned daily mobility levels to trauma ICU patients. Nursing and rehabilitation staff collaborated to set daily goals and provide mobility-based interventions. Forty-four patients were included in the preintervention group and 43 patients in the early mobility group. Physical therapy and occupational therapy were initiated earlier in the early mobilization group (p = .044 and p = .026, respectively). Improvements in LOS, duration of mechanical ventilation, time to out-of-bed activity and walking, and discharge disposition were not significant. There were no adverse events related to the early mobility initiative. Activity intolerance resulted in termination of 7.1% of mobility sessions. The development and initiation of a trauma-specific early mobility program proved to be safe and reduce patient care costs. In addition, the program facilitated earlier initiation of physician and occupational therapies. Although not statistically significant, retrospective data abstraction provides evidence of fewer ICU and total hospital days, earlier extubations, and greater proactive participation in functional activities.
Sex Differences in the Risk of Barrett’s Esophagus Associated With the Metabolic Effects of Obesity
Authors: Kendall Bradley J. , Macdonald Graeme A. , Prins Johannes B. , O’Brien Suzanne , Thrift Aaron P. , Whiteman David C.
Published: December 2019

Goal:

The goal of this study was to determine if there is an association between the insulin–insulin-like growth factor axis, the metabolic syndrome (MetS), type 2 diabetes mellitus and risk of Barrett’s esophagus (BE), and if these associations are modified by sex.

Background:

BE is more common in males. Gastroesophageal reflux disease, the major risk factor for BE occurs at similar frequencies in both sexes, suggesting that sex-related factors such as the metabolic effects of abdominal obesity may be important in the causation of BE.

Materials and Methods:

A structured interview, anthropometric measures, and fasting blood were collected within a population-based case-control study. We recruited 227 BE cases (70% male) and 241 population controls, frequency matched by age and sex. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for association with BE using multivariable logistic regression models.

Results:

Hyperinsulinemia (highest vs. lowest tertile, OR=1.9; 95% CI: 1.2-3.1), Homeostatic Model Assessment of Insulin Resistance (OR=1.9; 95% CI: 1.2-3.1) and the MetS (OR=1.8; 95% CI: 1.2-2.6) were independently associated with an increased risk of BE. With each additional MetS criterion, there was a 20% increased risk of BE (OR=1.2; 95% CI: 1.0-1.4). When stratified by sex, these associations were found in males but not females. We found no association with serum measures of insulin-like growth factors or interleukin-6 and risk of BE.

Conclusion:

Hyperinsulinemia, insulin resistance, and the MetS are associated with the risk of BE in males but not females, suggesting these factors may contribute to the higher prevalence of BE in males.
Refeeding syndrome: update and clinical advice for prevention, diagnosis and treatment
Authors: Friedli Natalie , Odermatt Jonas , Reber Emilie , Schuetz Philipp , Stanga Zeno
Published: December 2019

Purpose of review

The aim of this review is to provide a brief overview of the refeeding syndrome, to discuss more recent advice on diagnosis and treatment, and to raise awareness of this still poorly understood metabolic condition.

Recent findings

To date, evidence regarding the refeeding syndrome has been very limited. A number of reviews and case reports exist, but only a few are randomized trials. Recently, it has been shown that the vast majority of physicians are unaware of this metabolic condition. Precise guidelines for diagnosis and treatment of this syndrome were lacking for a long time. Now, a consensus statement is available, providing guidance from experts in the field on the management of patients at increased risk of refeeding syndrome (RFS) receiving nutritional therapy.

Due to the increased use of nutritional therapy in inpatient settings, physicians should be aware of possible side effects, particularly in connection with the refeeding syndrome. In this context, every patient should undergo a risk assessment for refeeding syndrome and stratification before starting nutritional therapy. For patients at high risk, nutritional support should be administered with adapted energy and fluid support during the replenishment phase. In addition, the occurrence of RFS during nutritional therapy must be continuously evaluated, and appropriate steps taken if necessary.
Dosage of 6-Mercaptopurine in Relation to Genetic TPMT and ITPA Variants: Toward Individualized Pediatric Acute Lymphoblastic Leukemia Maintenance Treatment
Authors: Kouwenberg Theodorus W. , van den Bosch Bianca J.C. , Bierau Jörgen , te Loo Dunja Maroeska W.M. , Coenen Marieke J.H. , Hagleitner Melanie M.
Published: December 2019

6-mercaptopurine (6-MP) is the mainstay in pediatric acute lymphoblastic leukemia (ALL) maintenance treatment. Variants in genes coding for thiopurine S-methyl transferase (TPMT) and inosine triphosphate pyrophosphatase (ITPA) are known to influence 6-MP metabolism. We determined TPMT and ITPA genotype and enzyme activity and the mean 6-MP doses during maintenance treatment in 40 children treated for ALL according to the Dutch Childhood Oncology Group (DCOG)-ALL11 protocol in the Radboudumc Amalia Children’s Hospital, Nijmegen, The Netherlands. Patients with genetic variants in TPMT (N=3) had significantly lower TPMT enzyme activity (mean 0.46 vs. 0.72 µmol/mmol hemoglobin/h, P=0.005). Although the difference was not statistically significant, they were treated with lower mean 6-MP doses (28.1 mg/m2 [SD 25.5 mg/m2] vs. 41.3 mg/m2 [SD 17.2 mg/m2], P=0.375). In patients with genetic ITPA variants (N=21), ITPA enzyme activity was significantly lowered (mean 3.67 vs. 6.84 mmol/mmol hemoglobin/h, P<0.0005). The mean 6-MP doses did not differ between patients with and without variants in ITPA (40.0 mg/m2 [SD 20.3 mg/m2] vs. 40.6 mg/m2 [SD 14.9 mg/m2], P=0.663). The TPMT genotype, but not the ITPA genotype, should be considered as part of standard evaluation before starting ALL maintenance treatment.
The Lived Experience of Persons With Malignant Pleural Mesothelioma in the United States
Authors: Walker Suzanne L. , Crist Janice D. , Shea Kimberly , Holland Sara , Cacchione Pamela Z.
Published: December 2019

Background

Malignant pleural mesothelioma (MPM) is a rare but deadly cancer. Although there is an emerging picture of the individual MPM experience, the United States is underrepresented in this literature. With the United States contributing more deaths from MPM than any other country, findings from this study will enhance a global body of literature on the lived experience of this devastating cancer.

Objective

The aims of this descriptive phenomenological research study were to explore the lived experience of MPM in the United States and identify unmet patient needs.

Interventions/Methods

This was a descriptive phenomenology study employing semi-structured individual interviews with persons with MPM.

Results

A total of 7 persons with MPM from a large northeastern US medical center participated. Three major themes about the MPM lived experience emerged: (1) uncertainty/worry about the future, (2) value in relationships, and (3) adapting to a new norm.

Conclusions

Findings from this study are consistent with other MPM research, noting a high symptom burden, lifestyle changes, and feelings of uncertainty about the future. However, participants also expressed feelings of hope and optimism. Particularly salient to the MPM experience was the role of communication with the healthcare team as well as other persons with MPM.

Implications for Practice

Timely, coordinated, and personalized care as well as skilled communication should be the cornerstone of care for persons with MPM. Supportive care strategies that address uncertainty, the high symptom burden, feelings of isolation, and existential concerns are also integral to quality care.
Obstructive Sleep Apnea and Keratoconus: A Systematic Review and Meta-analysis
Authors: Pellegrini Marco , Bernabei Federico , Friehmann Asaf , Giannaccare Giuseppe
Published: December 2019

BACKGROUND

Despite the increasing number of studies focused on the association between obstructive sleep apnea (OSA) and keratoconus (KC), to date, no comprehensive meta-analysis or systematic review was published.

OBJECTIVE

The objective of this study was to evaluate the association between OSA and KC.

DATA SOURCES

Sources of data were PubMed, Scopus, and Web of Science databases.

STUDY ELIGIBILITY CRITERIA

The criteria for study eligibility were case-control studies and cohort studies reporting data on the association of OSA with KC with risk ratio, odds ratio, or hazard ratio with 95% confidence intervals or sufficient raw data for calculation.

STUDY APPRAISAL AND SYNTHESIS METHODS

Meta-analysis was conducted with a random-effects model using odds ratio with 95% confidence interval as the effect size. Heterogeneity was evaluated using the Q and I
2 tests. Sensitivity analysis and assessment of publication bias were performed.

RESULTS

Five studies (four case-control studies and one cohort study) published between 2012 and 2016 and involving 33,844 subjects (16,922 patients with KC, 16,922 controls) were included in this meta-analysis. A significant association between OSA and KC has been shown (pooled odds ratio, 1.841; 95% confidence interval, 1.163 to 2.914; P = .009). A significant heterogeneity was observed (Q = 15.8, I
2 = 74.6%). There was no evidence of significant publication bias (P = .07). The sensitivity analyses indicated the stability of results.

LIMITATIONS

Heterogeneity across the studies was observed. Data from four hospital-based case-control studies and one large population-based cohort study were combined. Most of the included studies ascertained OSA by the Berlin Questionnaire, which is a screening tool.

CONCLUSIONS

This meta-analysis provides significant evidence that OSA is associated with KC. Therefore, a proper screening for OSA is warned for KC patients for the prevention of various cardiovascular comorbidities. Further prospective studies are warranted to explore more in-depth the casual relationship between the two conditions.
A Descriptive Analysis of Pediatric Prehospital Refusal of Medical Assistance Within a Single Service Provider System
Authors: Mix Felicia M. , Myers Lucas A. , Luke Anurahda , Sztajnkrycer Matthew D.
Published: December 2019

Objectives

Pediatric refusal of medical assistance (RMA) is a potentially high-risk event with implications for both individual patient outcomes and greater emergency medical services system efficiency. The purpose of this study was to describe characteristics of pediatric RMA calls and outcomes.

Methods

Single emergency medical services agency retrospective study of calls between January 1, 2011, and December 31, 2015, for pediatric patients resulting in RMA was performed. Dispatch complaint-matched case-control group was generated from transported patients.

Results

The percentage of pediatric calls that resulted in RMA was 12.7%, compared with 5% adult calls (P < 0.0001). The 3 most common RMA dispatch complaints were seizures, difficulty breathing, and traffic accidents. Furthermore, 65.1% pediatric RMA calls were emergently dispatched, compared with 56.4% of transported pediatric patients (P = 0.01). Medical control was contacted for 4.6% RMA calls. The average ± SD word count for RMA patient care narratives was 179 ± 99 words, compared with 164 ± 139 words for controls (P = 0.11). Documentation of risk-benefit discussion occurred in 28.6% RMA narratives. Outcome data were available for 83.8% RMA patients. The percentage of RMA patients with documented alternative plans who completed the alternative plan was 61.6%. Within 72 hours of RMA, 5.0% of calls with known outcome resulted in unexpected emergency department visit. No unexpected emergency department visits resulted in admission. Five percent of RMA patients were admitted; 1 patient was admitted to the intensive care unit. No emergent surgeries or deaths occurred during the study period.

Conclusions

Pediatric RMA is common within our study population, and two thirds involve emergent dispatch. Although outcomes are generally good, refusal documentation is sparse and medical control is seldom contacted. Multiple opportunities for systems improvement exist.
Preexposure prophylaxis for men who have sex with men in the Netherlands: impact on HIV and Neisseria gonorrhoeae transmission and cost-effectiveness
Authors: Reitsema Maarten , Hoek Albert Jan van , van der Loeff Maarten Schim , Hoornenborg Elske , van Sighem Ard , Wallinga Jacco , van Benthem Birgit , Xiridou Maria
Published: December 2019

Objectives:

To assess the impact of a preexposure prophylaxis (PrEP) programme for high-risk men who have sex with men (MSM), which includes gonorrhoea testing and treatment, on the transmission of HIV and Neisseria among MSM in the Netherlands and the cost-effectiveness of such programme with and without risk compensation (in the form of reduced condom use).

Methods:

We developed a stochastic agent-based transmission model of HIV and gonorrhoea. We simulated a capped (max 2.5% of MSM) and uncapped (5.5% of MSM in 2018 declining to 3% in 2027) daily PrEP programme for high-risk MSM, with 3-monthly HIV and gonorrhoea testing, with and without risk compensation. Epidemiological outcomes were calculated from the transmission model and used in an economic model to calculate costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICER), over 2018–2027, taking a healthcare payer perspective.

Results:

Without risk compensation, PrEP can lead to a reduction of 61 or 49% in the total number of new HIV infections in 2018–2027, if the programme is uncapped or capped to 2.5% of MSM, respectively. With risk compensation, this reduction can be 63 or 46% in the uncapped and capped programmes, respectively. In all scenarios, gonorrhoea prevalence decreased after introducing PrEP. Without risk compensation, 92% of simulations were cost-effective (of which 52% cost-saving). With risk compensation, 73% of simulations were cost-effective (of which 23% was cost-saving).

Conclusion:

A nationwide PrEP programme for high-risk MSM can result in substantial reductions in HIV and gonorrhoea transmission and be cost-effective, even with risk compensation.
Peripheral Donor-specific Antibodies Are Associated With Histology and Cellular Subtypes in Protocol Liver Biopsies of Pediatric Recipients
Authors: Cousin Vladimir L. , Rougemont Anne-Laure , Rubbia-Brandt Laura , Wildhaber Barbara E. , Villard Jean , Ferrari-Lacraz Sylvie , McLin Valérie A.
Published: December 2019

Background.

The cellular infiltrate in protocol liver biopsies (PB) following pediatric liver transplantation remains mostly uncharacterized, yet there is increasing concern about the role of inflammation and fibrosis in long-term liver allografts. We aimed to define cell types in PB and to analyze their relationship with donor-specific antibodies (DSA) and histological phenotype.

Methods.

PB were performed at least 1 year after transplantation. We identified 4 phenotypes: normal, fibrosis, inflammation, inflammation with fibrosis. Cell types were counted after immunostaining for CD3, CD4, CD8, CD68, CD20, MUM1, and FoxP3.

Results.

Forty-four patients underwent 1 PB between 2000 and 2015. Eleven percent (5/44) of PB displayed normal histology, 13.6% (6/44) fibrosis, 34.1% (15/44) inflammation, and 40.9% (18/44) inflammation and fibrosis. The main cell types in the portal tracts and lobules were CD3+ and CD68+ cells. Frequency of de novo DSA was 63% (27/44). The presence of CD8+ cells in the lobules was associated with fibrosis. Inflammation and fibrosis in PB were associated with the presence of circulating de novo DSA, number of de novo DSA, and C1q binding activity when compared to other phenotypes.

Conclusions.

T cells (CD3+) and macrophages (CD68+) were the most prevalent cell-types in PB. In the presence of inflammation, portal tracts were enriched in CD3+, CD20+ but displayed fewer CD68+. This coincided with the presence and number of de novo DSA. How these cellular and humoral actors interact is unclear, but peripheral DSA may be a marker of immune cellular activity in the seemingly quiescent allograft.