bluuebunny/crossref_metadata_2025 huggingface dataset:
Standard versus non-standard CP phases in neutrino oscillation in matter with non-unitarity
Authors: Martinez-Soler Ivan , Minakata Hisakazu
Published: April 2020

We formulate a perturbative framework for the flavor transformation of the standard active three neutrinos but with a non-unitary flavor mixing matrix, a system which may be relevant for the leptonic unitarity test. We use the $\alpha$ parametrization of the non-unitary matrix and take its elements $\alpha_{\beta \gamma}$ ($\beta,\gamma = e,\mu,\tau$) and the ratio $\epsilon \simeq \Delta m^2_{21} / \Delta m^2_{31}$ as the small expansion parameters. Two qualitatively new features that hold in all the oscillation channels are uncovered in the probability formula obtained to first order in the expansion: (1) The phases of the complex $\alpha$ elements always come into the observable in the particular combination with the $\nu$SM CP phase $\delta$ in the form $[e^{- i \delta } \bar{\alpha}_{\mu e}, ~e^{ - i \delta} \bar{\alpha}_{\tau e}, ~\bar{\alpha}_{\tau \mu}]$ under the Particle Data Group convention of a unitary $\nu$SM mixing matrix. (2) The diagonal $\alpha$ parameters appear in particular combinations $\left( a/b - 1 \right) \alpha_{ee} + \alpha_{\mu \mu}$ and $\alpha_{\mu \mu} - \alpha_{\tau \tau}$, where $a$ and $b$ denote, respectively, the matter potential due to charged current and neutral current reactions. This property holds only in the unitary evolution part of the probability, and there is no such feature in the genuine non-unitary part, while the $\delta$–$\alpha$ parameter phase correlation exists for both. The reason for such remarkable stability of the phase correlation is discussed.
What You See Is All There Is*
Authors: Enke Benjamin
Published: April 2020

News reports and communication are inherently constrained by space, time, and attention. As a result, news sources often condition the decision of whether to share a piece of information on the similarity between the signal and the prior belief of the audience, which generates a sample selection problem. This article experimentally studies how people form beliefs in these contexts, in particular the mechanisms behind errors in statistical reasoning. I document that a substantial fraction of experimental participants follows a simple “what you see is all there is” heuristic, according to which participants exclusively consider information that is right in front of them, and directly use the sample mean to estimate the population mean. A series of treatments aimed at identifying mechanisms suggests that for many participants, unobserved signals do not even come to mind. I provide causal evidence that the frequency of such incorrect mental models is a function of the computational complexity of the decision problem. These results point to the context dependence of what comes to mind and the resulting errors in belief updating.
Identification of microRNAs and their target gene networks implicated in arterial wall remodelling in giant cell arteritis
Authors: Bolha Luka , Pižem Jože , Frank-Bertoncelj Mojca , Hočevar Alojzija , Tomšič Matija , Jurčić Vesna
Published: April 2020

Objectives

To identify dysregulated microRNAs (miRNAs) and their gene targets in temporal arteries from GCA patients, and determine their association with GCA pathogenesis and related arterial wall remodelling.

Methods

We included 93 formalin-fixed, paraffin-embedded temporal artery biopsies (TABs) from treatment-naïve patients: 54 positive and 17 negative TABs from clinically proven GCA patients, and 22 negative TABs from non-GCA patients. miRNA expression analysis was performed with miRCURY LNA miRNome Human PCR Panels and quantitative real-time PCR. miRNA target gene prediction and pathway enrichment analysis was performed using the miRDB and Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) databases, respectively.

Results

Dysregulation of 356 miRNAs was determined in TAB-positive GCA arteries, among which 78 were significantly under-expressed and 22 significantly overexpressed above 2-fold, when compared with non-GCA controls. Specifically, TAB-positive GCA arteries were characterized by a significant overexpression of ‘pro-synthetic’ (miR-21-3p/-21-5p/-146a-5p/-146b-5p/-424-5p) and under-expression of ‘pro-contractile’ (miR-23b-3p/-125a-5p/-143-3p/-143-5p/-145-3p/-145-5p/-195-5p/-365a-3p) vascular smooth muscle cell phenotype-associated regulatory miRNAs. These miRNAs targeted gene pathways involved in the arterial remodelling and regulation of the immune system, and their expression correlated with the extent of intimal hyperplasia in TABs from GCA patients. Notably, the expression of miR-21-3p/-21-5p/-146a-5p/-146b-5p/-365a-3p differentiated between TAB-negative GCA arteries and non-GCA temporal arteries, revealing these miRNAs as potential biomarkers of GCA.

Conclusion

Identification of dysregulated miRNAs involved in the regulation of the vascular smooth muscle cell phenotype and intimal hyperplasia in GCA arterial lesions, and detection of their expression profiles, enables a novel insight into the complexity of GCA pathogenesis and implies their potential utilization as diagnostic and prognostic biomarkers of GCA.
Safety and efficacy of anti-interleukin-1 treatment in 40 patients, followed in a single centre, with AA amyloidosis secondary to familial Mediterranean fever
Authors: Ugurlu Serdal , Ergezen Bilgesu , Egeli Bugra Han , Selvi Oguzhan , Ozdogan Huri
Published: April 2020

Objective

The main devastating complication of FMF is AA amyloidosis. Approximately 10–15% of the patients are either intolerant or have an insufficient response to colchicine treatment. The most promising alternative treatment approach is anti-IL-1 agents. The aim of this study was to evaluate the efficacy and safety of anti-IL-1 therapy in FMF amyloidosis.

Methods

Forty-four patients with amyloidosis who had been treated with anti-IL-1 agents, anakinra and/or canakinumab, were assessed retrospectively for efficacy and safety. Five patients were on haemodialysis and four had received a renal transplant.

Results

The mean duration of anti-IL-1 treatment was 21.4  (18) months. Among 35 patients who were not on dialysis, renal function was maintained or improved in 79.4% but deteriorated in 20.6%. Patients with creatinine levels below 1.5 mg/dl at onset benefitted more from IL-1 inhibition with regard to their kidney functions and acute phase reactants. No additional side effects were observed in patients with renal replacement treatments. The major side effect of anakinra was injection-site reaction observed in four patients.

Conclusion

Anti-IL-1 agents are well tolerated and effective in the treatment of amyloidosis secondary to FMF, including patients on dialysis and renal transplant recipients. This approach may improve the lifespan of transplanted kidneys in FMF patients.
Early recognition of patients with axial spondyloarthritis—evaluation of referral strategies in primary care
Authors: Baraliakos Xenofon , Tsiami Styliani , Redeker Imke , Tsimopoulos Konstantinos , Marashi Ali , Ruetten Sebastian , Fedorov Kyril , Avram Annalina , Morzeck Doris , Fruth Martin , Braun Juergen
Published: April 2020

Objective

Chronic inflammatory back pain (IBP) is frequently reported in axial SpA (axSpA) but also in the general population. We evaluated a recently proposed two-step referral system for early recognition of axSpA in primary care and compare it with other combinations of symptoms and SpA-related items.

Methods

Consecutive chronic back pain patients ≤45 years of age answered a questionnaire and were seen by a primary care physician who decided whether HLA-B27 needed to be determined. They were then referred to a rheumatologist who made the diagnosis. Generally sticking to the two-step system with HLA-B27 as an additional option, combinations with a sensitivity ≥90% and a likelihood ratio >4 were compared.

Results

A total of 326 patients were included, 46 of whom were diagnosed with axSpA (14.1%). The sensitivity of the strategy was 87%, the specificity was 56.8% and the positive and negative predictive values were 24.8% and 96.4%, respectively. A ‘good response to NSAIDs’, ‘morning stiffness >30 min’ and ‘elevated C-reactive protein’ performed best, with a sensitivity of 91%, specificity of 67%, positive predictive value of 31% and negative predictive value of 98%. On that basis, only three patients had to be seen by a rheumatologist to diagnose one.

Conclusion

The earlier proposed referral system worked well but was outperformed by other combinations with high sensitivity and better specificity, which deserve to be prospectively studied.
Leadership Development for Future Medical School Deans: Outcomes of the AAMC Council of Deans Fellowship Program
Authors: Steele Margaret M. , Pennell Steve , Prescott John E. , Sweeney Nicole , Steinecke Ann , Buckley Peter F.
Published: April 2020

Purpose

To determine the outcomes of the Association of American Medical Colleges (AAMC) Council of Deans (COD) Fellowship Program with respect to participants’ achieving the goals of becoming a medical school dean and developing leadership skills, and to ascertain fellows’ views about the program’s value, beneficial aspects, and areas for improvement.

Method

The 37 COD fellows from 2002 to 2016 were invited to participate in a 2017 survey addressing demographics, training, current leadership position, and value of the program. The survey also included 3 open-ended questions. A 2018 web-based search was conducted to determine fellows’ senior leadership roles since their program participation.

Results

The survey response rate was 73% (27/37). The majority of respondents were male (82%, 22), aged 51–70 (89%, 25), and white (82%, 22). The top 5 medical specialties reported were internal medicine, pediatrics, anesthesiology, psychiatry, and surgery. Most respondents (63%, 17) reported having a graduate degree. All reported being in leadership positions in academia and/or health care. The web-based search found that 27% (10/37) of the fellows became medical school deans (average tenure 5.6 years); 2 fellows became deans of other types of schools. Overall, survey respondents perceived the program as valuable. Respondents identified shadowing a dean mentor, attending COD meetings, and attending the AAMC Executive Development Seminar for Deans as the most valuable program components. The majority (88%, 23/26) indicated their fellow experience persuaded them to pursue being a dean; 2 (8%) indicated it did not. Respondents identified 4 key opportunities for program improvement: more sponsorship by deans, development of a learning community, enhanced mentoring, and coaching.

Conclusions

The COD Fellowship Program appears to be successful in preparing senior faculty to become deans and assume other senior leadership roles in academia and/or health care. Fellows’ feedback will be used to inform future revisions to the program.
Associations Between Medical Education Assessments and American Board of Family Medicine Certification Examination Score and Failure to Obtain Certification
Authors: Peterson Lars E. , Boulet John R. , Clauser Brian
Published: April 2020

Purpose

Family medicine residency programs can be cited for low pass or take rates on the American Board of Family Medicine (ABFM) certification examination, and the relationships among standardized medical education assessments and performance on board certification examinations and eventual board certification have not been comprehensively studied. The objective of this study was to evaluate the associations of all required standardized examinations in medical education with ABFM certification examination scores and eventual ABFM certification.

Method

All graduates of U.S. MD-granting family medicine residency programs from 2008 to 2012 were included. Data on ABFM certification examination score, ABFM certification status (as of December 31, 2014), Medical College Admission Test (MCAT) section scores, undergraduate grade point average, all United States Medical Licensing Examination (USMLE) Step scores, and all ABFM in-training examination scores were linked. Nested logistic and linear regression models, controlling for clustering by residency program, determined associations between assessments and both certification examination scores and board certification status. As many international medical graduates (IMGs) do not take the MCAT, separate models for U.S. medical graduates (USMG) and IMGs were run.

Results

The study sample was 15,902 family medicine graduates, of whom 92.1% (14,648/15,902) obtained board certification. In models for both IMGs and USMGs, the addition of more recent assessments weakened the associations of earlier assessments. USMLE Step 2 Clinical Knowledge was predictive of certification examination scores and certification status in all models in which it was included.

Conclusions

For family medicine residents, more recent assessments generally have stronger associations with board certification score and status than earlier assessments. Solely using medical school admissions (grade point average and MCAT) and licensure (USMLE) scores for resident selection may not adequately predict ultimate board certification.
Pregnancy and Parenthood Remain Challenging During Surgical Residency: A Systematic Review
Authors: Todd Anna R. , Cawthorn Thomas R. , Temple-Oberle Claire
Published: April 2020

Purpose

To examine common themes and synthesize data surrounding pregnancy and parenthood during surgical residency training.

Method

The authors conducted a systematic search of the literature in March 2019. They searched MEDLINE, EMBASE, and Scopus, seeking articles published from 2003 to 2018 that focused on pregnancy, parenthood, and the experience of surgical residents. They excluded articles that examined nonsurgical programs, as well as editorials, abstracts, and commentaries. Two investigators independently reviewed all citations, selected articles for full-text review, and extracted data from the selected articles.

Results

Of 523 titles and abstracts screened, 27 were included. Overall, female surgical residents had fewer children during residency training than their male counterparts (18%–28% vs 32%–54%). As compared with the general population, surgical residents had their first child later in life (30–34 vs 25 years old), and had fewer children overall (0.6–2.1 vs 2.7). Infertility rates were higher among female surgeons than in the general population (30%–32% vs 11%), as were assisted reproductive technology rates (8%–13% vs 1.7%). Pregnant surgical residents experienced a high rate of obstetrical complications; working more than 6 overnight calls shifts per month or 60 hours per week were predictors of increased complication rates. The authors noted no differences in attrition, caseload, or exam pass rates amongst female surgical residents who had become pregnant as compared with other residents. Despite these similar academic outcomes, negative attitudes and perceptions toward pregnancy during residency were consistently identified.

Conclusions

Female surgical residents experience high rates of infertility and obstetrical complications, contend with negative attitudes and stigma during their pregnancies, and voluntarily delay childbearing. Formal maternity policies, a shift in surgical culture, and ongoing discussion with all stakeholders are needed to attract and retain female surgical residents.
Clinical Teachers’ Perceptions of Their Role in Professional Identity Formation
Authors: Sternszus Robert , Boudreau J. Donald , Cruess Richard L. , Cruess Sylvia R. , Macdonald Mary Ellen , Steinert Yvonne
Published: April 2020

Purpose

A fundamental goal of medical education is supporting learners in forming a professional identity. While it is known that learners perceive clinical teachers to be critically important in this process, the latter’s perspective is unknown. This study sought to understand how clinical teachers perceive their influence on the professional identity formation of learners.

Method

In 2017, a research assistant conducted 16 semistructured interviews of clinical teachers from 8 specialties at McGill University. The research assistant audiorecorded and subsequently transcribed interviews for analysis. Following principles of qualitative description, the research team developed a coding scheme using both inductive codes (from the words of the participants) and deductive codes (based on the literature and the theory of communities of practice). Through a cross-case analysis, the team then identified salient themes.

Results

Participants struggled to describe their influence on learners’ professional identity without first being prompted to focus on their own identity and its formation. Once prompted, clinical teachers reported viewing their personal and professional identities as integrated and believed that caring for patients was integral to forming their professional identity. They identified explicit role modeling, engaging in difficult conversations, and providing graded autonomy as ways in which they could influence the identity development of learners. However, they had difficulty discerning the magnitude of their influence.

Conclusions

This study was the first to explore professional identity formation from the perspective of clinical teachers. The 2010 Carnegie Foundation report called for an increased focus on professional identity formation. Giving clinical teachers the space and guidance to reflect on this process, helping them make the implicit explicit, and supporting them in using their own experiences as learners to inform their teaching appear to be critical steps in achieving this goal.
Innovation in Response to the COVID-19 Pandemic Crisis
Authors: Woolliscroft James O.
Published: April 2020

The COVID-19 pandemic has disrupted all aspects of academic medical center missions. The number and rapidity of innovative responses to the crisis are extraordinary. When the pandemic has subsided, the world of academic medicine will have changed. The author of this Invited Commentary anticipates that at least some of these innovations will become part of academic medicine’s everyday clinical and educational operations. Here, he considers the implications of exemplary innovations—virtual care, hospital at home, advances in diagnosis and therapy, virtual learning, and virtual clinical learning—for regulators, academic medical centers, faculty, and students.
Pressure Pain Tolerance Predicts the Success of Emotional Awareness and Expression Therapy in Patients With Fibromyalgia
Authors: Bellomo Tiffany R. , Schrepf Andrew , Kruger Grant H. , Lumley Mark A. , Schubiner Howard , Clauw Daniel J. , Williams David A. , Harte Steven E.
Published: April 2020

Objectives:

Quantitative sensory testing may help predict treatment responses in individuals with chronic pain. Our objective was to determine whether evoked pain sensitivity at baseline predicted preferential treatment responses to either emotional awareness and expression therapy (EAET) or cognitive behavioral therapy (CBT) in individuals with fibromyalgia (FM).

Methods:

This was a secondary analysis of a previous randomized clinical trial, in which individuals with FM were randomized to EAET, CBT, or Education as a control intervention. Only females who completed baseline and post-treatment assessments were analyzed (n=196). The primary outcome was change in overall clinical pain severity from pretreatment to posttreatment, and the primary predictor of interest was pressure pain tolerance at baseline.

Results:

Among patients with low pain tolerance at baseline (n=154), both EAET and CBT led to small but significant improvements in clinical pain severity (CBT mean=0.66, 95% confidence interval [0.24-1.07]; EAET mean=0.76 [0.34-1.17]). Conversely, in patients with normal pain tolerance (n=42), there was no significant improvement in clinical pain after CBT (0.13 [−0.88 to 1.14]), a small improvement after FM Education (0.81 [0.14-1.48]), but a much larger and statistically significant improvement after EAET (2.14 [1.23-3.04]).

Discussion:

Normal levels of pressure pain tolerance at baseline predicted greater improvement in clinical pain severity after EAET than CBT. Quantitative sensory testing may provide insights about individual responses to psychologically based therapies for individuals with chronic pain.
Comparison of Adductor Canal Block and Femoral Triangle Block for Total Knee Arthroplasty
Authors: Wang Chun-Guang , Ding Yan-Ling , Wang Yuan-Yuan , Liu Jia-Yun , Zhang Qian
Published: April 2020

Objectives:

Adductor canal block (ACB) could provide effective postoperative pain control for patients after total knee arthroplasty (TKA). However, some authors pointed out that the ACB as originally described may be more similar to a femoral triangle block (FTB). Recent neuroanatomic evidences made the authors conjecture that the “true” ACB would provide superior analgesia compared with FTB. Therefore, the study was designed to determine the hypothesis that postoperative analgesia after TKA could be improved by a “true” ACB compared with FTB.

Materials and Methods:

Patients undergoing unilateral, primary TKA were randomized into the ACB group or FTB group. The primary outcome was postoperative pain during active flexion at 8 hours after surgery measured by the visual analog scale (VAS). In addition, pain scores at other time points, quadriceps strength, morphine consumption, satisfaction of the patient, and side effects of morphine were also evaluated.

Results:

Sixty participants completed the research. The VAS scores were lower in the ACB group than the FTB group at 8 and 24 hours at rest (P<0.05). The VAS scores were lower in the ACB group than the FTB group at 4, 8, 24, and 48 hours during active flexion (P<0.05). The quadriceps strength was superior in the ACB group than the FTB group at 4, 8, and 24 hours (P<0.05). The consumption of morphine was lower in the ACB group than the FTB group (P<0.05). However, there were no significant differences for both patient satisfaction and the incidence of adverse reactions (P>0.05).

Discussion:

ACB can provide superior analgesia and preserve more quadriceps strength than FTB. ACB facilitates functional recovery in the early stages and is compatible with the highly recognized concept of rapid rehabilitation, which should be promoted in the clinic.
Displaced Distal Radius Fracture Treatment: A Survey of POSNA Membership
Authors: Georgiadis Andrew G. , Burgess Jamie K. , Truong Walter H. , Janicki Joseph A.
Published: April 2020

Background:

Distal radius fractures (DRFs) are the most common pediatric orthopaedic fracture, of which 20% are displaced injuries. Displaced metaphyseal DRFs are often treated with sedated or anesthetized reduction. The necessity of reduction treatment of displaced fractures to achieve good clinical outcomes is unclear. The purpose of this investigation was to determine the treatment preferences for DRFs among pediatric orthopaedic surgeons and to determine whether they were uncertain enough in their decisions to randomize treatment.

Methods:

Twenty-eight DRF scenarios in children aged 3 to 10 years were constructed in an electronic survey to represent a spectrum of age, angulation in sagittal and coronal planes, and displacement. The survey was disseminated to the full membership of the Pediatric Orthopaedic Society of North America (POSNA). Respondents could select either a treatment of (a) attempt anatomic reduction with sedation or (b) nonsedated immobilization. Respondents also denoted whether they would be willing to randomize the treatment of each injury scenario. Patient, fracture, and surgeon characteristics were analyzed to develop predictors of treatment recommendations and willingness to randomize treatment.

Results:

A total of 319 surgeons responded (23% of POSNA membership). Respondents were a characteristic representation of POSNA membership (well distributed by years in practice, 78% academic, 91% whose work is >80% pediatrics, and 84% work with residents). Predictors of sedated reduction were complete displacement [odds ratio (OR), 9.23; 95% confidence interval (CI), 2.27-37.51; P=0.002] and coronal angulation (per 1-degree increase, OR, 1.09; 95% CI, 1.02-1.17; P=0.016), Willingness to randomize was inversely related to larger coronal plane angulation (per 1-degree increase, OR, 0.96; 95% CI, 0.93-0.99; P=0.01). A majority of surgeons were willing to randomize 7 of the 8 scenarios involving complete displacement and shortening, and >64% of surgeons were willing to randomize 5 of these 8 scenarios.

Conclusions:

POSNA members recommend sedated reduction of DRFs primarily based on existence of complete displacement. Although most completely displaced DRFs would undergo reduction, most surgeons would be willing to randomize the treatment of these injuries. This suggests that most POSNA members do not know whether their recommended treatment for displaced DRFs is necessary or correct. This survey establishes the groundwork for a randomized, prospective trial comparing nonsedated immobilization with sedated/anesthetized reduction in the treatment of displaced pediatric DRFs.

Levels of Evidence:

Level II—survey study.
Cost-effectiveness Applications of Patient-reported Outcome Measures (PROMs) in Spine Surgery
Authors: Lee Thomas J. , Thomas Alexander A. , Grandhi Nikhil R. , Galetta Matthew S. , Goyal Dhruv K.C. , Fang Taolin , Schroeder Gregory D. , Kepler Christopher K. , Vaccaro Alexander R.
Published: April 2020

Because of the rising health care costs in the United States, there has been a focus on value-based care and improving the cost-effectiveness of surgical procedures. Patient-reported outcome measures (PROMs) can not only give physicians and health care providers immediate feedback on the well-being of the patients but also be used to assess health and determine outcomes for surgical research purposes. Recently, PROMs have become a prominent tool to assess the cost-effectiveness of spine surgery by calculating the improvement in quality-adjusted life years (QALY). The cost of a procedure per QALY gained is an essential metric to determine cost-effectiveness in universal health care systems. Common patient-reported outcome questionnaires to calculate QALY include the EuroQol-5 dimensions, the SF-36, and the SF-12. On the basis of the health-related quality of life outcomes, the cost-effectiveness of various spine surgeries can be determined, such as cervical fusions, lumbar fusions, microdiscectomies. As the United States attempts to reduce costs and emphasize value-based care, PROMs may serve a critical role in spine surgery moving forward. In addition, PROM-driven QALYs may be used to analyze novel spine surgical techniques for value-based improvements.
The Association Between Neighborhood Socioeconomic Disadvantage and Readmissions for Patients Hospitalized With Sepsis
Authors: Galiatsatos Panagis , Follin Amber , Alghanim Fahid , Sherry Melissa , Sylvester Carol , Daniel Yamisi , Chanmugam Arjun , Townsend Jennifer , Saria Suchi , Kind Amy J. , Chen Edward
Published: April 2020

Objectives:

To evaluate associations between a readily availvable composite measurement of neighborhood socioeconomic disadvantage (the area deprivation index) and 30-day readmissions for patients who were previously hospitalized with sepsis.

Design:

A retrospective study.

Setting:

An urban, academic medical institution.

Patients:

The authors conducted a manual audit for adult patients (18 yr old or older) discharged with an International Classification of Diseases, 10th edition code of sepsis during the 2017 fiscal year to confirm that they met SEP-3 criteria.

Interventions:

None.

Measurements and Main Results:

The area deprivation index is a publicly available composite score constructed from socioeconomic components (e.g., income, poverty, education, housing characteristics) based on census block level, where higher scores are associated with more disadvantaged areas (range, 1–100). Using discharge data from the hospital population health database, residential addresses were geocoded and linked to their respective area deprivation index. Patient characteristics, contextual-level variables, and readmissions were compared by t tests for continuous variables and Fisher exact test for categorical variables. The associations between readmissions and area deprivation index were explored using logistic regression models. A total of 647 patients had an International Classification of Diseases, 10th edition diagnosis code of sepsis. Of these 647, 116 (17.9%) either died in hospital or were discharged to hospice and were excluded from our analysis. Of the remaining 531 patients, the mean age was 61.0 years (± 17.6 yr), 281 were females (52.9%), and 164 (30.9%) were active smokers. The mean length of stay was 6.9 days (± 5.6 d) with the mean Sequential Organ Failure Assessment score 4.9 (± 2.5). The mean area deprivation index was 54.2 (± 23.8). The mean area deprivation index of patients who were readmitted was 62.5 (± 27.4), which was significantly larger than the area deprivation index of patients not readmitted (51.8 [± 22.2]) (p < 0.001). In adjusted logistic regression models, a greater area deprivation index was significantly associated with readmissions (β, 0.03; p < 0.001).

Conclusions:

Patients who reside in more disadvantaged neighborhoods have a significantly higher risk for 30-day readmission following a hospitalization for sepsis. The insight provided by neighborhood disadvantage scores, such as the area deprivation index, may help to better understand how contextual-level socioeconomic status affects the burden of sepsis-related morbidity.
Cardiovascular Safety and Benefits of Noninsulin Antihyperglycemic Drugs for the Treatment of Type 2 Diabetes Mellitus: Part 2
Authors: Yandrapalli Srikanth , Malik Aaqib , Horblitt Adam , Pemmasani Gayatri , Aronow Wilbert S. , Frishman William H.
Published: April 2020

Ideal drugs to improve outcomes in type 2 diabetes mellitus (T2DM) are those with antiglycemic efficacy, as well as cardiovascular safety that has to be determined in appropriately designed cardiovascular outcome trials as mandated by regulatory agencies. The more recent antihyperglycemic medications have shown promise with regards to cardiovascular disease (CVD) risk reduction in T2DM patients at a high cardiovascular risk. Sodium glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists are associated with better cardiovascular outcomes and mortality in T2DM patients than are dipeptidylpeptidase-4 inhibitors, leading to the Food and Drug Administration’s approval of empagliflozin to reduce mortality, and of liraglutide to reduce CVD risk in high-risk T2DM patients. For heart failure outcomes, sodium glucose cotransporter-2 inhibitors are beneficial, while glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors are neutral. Ongoing and planned randomized controlled trials of these newer drugs should clarify the possibility of class effects and of CVD risk reduction benefits in low–moderate cardiovascular risk patients. While we eagerly await the results on ongoing studies, these medications should be appropriately prescribed in T2DM patients with baseline CVD or those at a high CVD risk after carefully evaluating the elevated risk for adverse events like gastrointestinal disturbances, bladder cancer, genital infections, and amputations. Studies to understand the pleotropic and novel pathophysiological mechanisms demonstrated by the sodium glucose cotransporter-2 inhibitors will shed light on the effects of the modulation of microvascular, inflammatory, and thrombotic milieu for improving the CVD risk in T2DM patients. This is part 2 of the series on noninsulin antihyperglycemic drugs for the treatment of T2DM.
Three Types of Nodal Melanocytic Nevi in Sentinel Lymph Nodes of Patients With Melanoma: Pitfalls, Immunohistochemistry, and a Review of the Literature
Authors: Gonzàlez-Farré Mònica , Ronen Shira , Keiser Elizabeth , Prieto Victor G. , Aung Phyu P.
Published: April 2020

The presence or absence of metastasis in sentinel lymph nodes often drives melanoma staging, prognosis, and treatment. However, distinguishing between metastatic melanoma cells and clusters of benign melanocytic nevus cells is not always straightforward. When morphologic hematoxylin and eosin interpretation alone is not sufficient, additional hematoxylin and eosin sections and immunohistochemical (IHC) studies may be beneficial. This review and small cases series of 3 diagnostically challenging melanocytic sentinel lymph node cases highlights the IHC approach to evaluate intraparenchymal nodal melanocytic nevi, coexistent metastatic melanoma with adjacent melanocytic nevi cells, and nodal blue nevi. In challenging cases, cytological morphology of the melanocytes, location within the lymph node, and IHC studies may assist in diagnosis. If these tools yield conflicting results, expert opinion is recommended.
Longstanding Eccrine Syringofibroadenoma With Evidence of Carcinomatous Transformation
Authors: Pagliuca Francesca , Moscarella Elvira , Argenziano Giuseppe , Ronchi Andrea , Franco Renato
Published: April 2020

Eccrine syringofibroadenoma (ESFA) is a cutaneous proliferation of eccrine ducts, mainly encountered in association with other dermatoses or skin tumors. Although a benign condition, either considered as a hamartoma or a reactive hyperplasia rather than a real neoplasm, some evidence suggests that longstanding ESFA can undergo malignant change. The recognition of such opportunity could have important therapeutic implications. We present a case of ESFA showing areas of carcinomatous transformation, discussing its morphological and immunohistochemical findings.
Recurrence and Mortality of Melanoma In Situ of the Trunk or Extremities: A Surveillance, Epidemiology, and End Results Analysis
Authors: Daniel Vijaya T. , Crawford Allison , Kiefe Catarina I. , Mahmoud Bassel H.
Published: April 2020

BACKGROUND

Recent studies demonstrate comparable outcomes of Mohs micrographic surgery (MMS) versus local excision (LE) for melanoma in situ. These studies are limited by their focus on the head and neck.

OBJECTIVE

The primary objective was to compare 5-year overall and melanoma-specific mortality among patients with melanoma in situ of the trunk or extremities who undergo MMS versus LE. The secondary objective was to compare 5-year local recurrence among the same cohort of patients who undergo MMS versus LE.

MATERIALS AND METHODS

The Surveillance, Epidemiology, and End Results (SEER) database (2000–2015) was queried to identify patients who underwent MMS versus LE for melanoma in situ of the trunk, upper extremities, or lower extremities. Outcomes were 5-year recurrence, melanoma-specific mortality, and overall mortality. Multivariable regression analyses were performed.

RESULTS

Thirty three thousand nine hundred eighty-three patients underwent surgical treatment (MMS 3%; LE 97%). In adjusted analyses, there was no difference in local recurrence (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.56–1.78), melanoma-specific mortality (HR 0.89, 95% CI 0.12–6.47), nor overall mortality (HR 1.10, 95% CI 0.82–1.48) between MMS versus LE.

CONCLUSION

There is no difference of 5-year local recurrence, melanoma-specific mortality, nor overall mortality associated with MMS versus LE for melanoma in situ of the trunk or extremities.
Health care professionals’ motivation, their behaviors, and the quality of hospital care: A mixed-methods systematic review
Authors: Veenstra Gepke L. , Dabekaussen Kirsten F. A. A. , Molleman Eric , Heineman Erik , Welker Gera A.
Published: April 2020

Background

Health care professionals’ work motivation is assumed to be crucial for the quality of hospital care, but it is unclear which type of motivation ought to be stimulated to improve quality. Motivation and similar concepts are aligned along a motivational continuum that ranges from (intrinsic) autonomous motivation to (extrinsic) controlled motivation to provide a framework for this mixed-methods systematic review.

Purpose

This mixed-methods systematic review aims to link various types of health care professionals’ motivation directly and through their work-related behaviors to quality of care.

Methods

Six databases were searched from January 1990 to August 2016. Qualitative and quantitative studies were included if they reported on work motivation in relationship to work behavior and/or quality, and study participants were health care professionals working in hospitals in high-income countries. Study bias was evaluated using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. The review protocol was registered in the PROSPERO database (CRD42016043284).

Results

A total of 84 out of 6,525 unique records met the inclusion criteria. Results show that health care professionals’ autonomous motivation improves their quality perceptions and work-related behaviors. Controlled motivation inhibits voicing behavior, but when balanced with autonomous motivation, it stimulates core task and proactive behavior. Proactivity is associated with increased quality of care perceptions.

Practice Implications

To improve quality of care, policy makers and managers need to support health care professionals’ autonomous motivation and recognize and facilitate proactivity as an essential part of health care professionals’ jobs. Incentive-based quality improvements need to be complemented with aspects that stimulate autonomous motivation.
ADAPTIVE OPTICS OPTICAL COHERENCE TOMOGRAPHY IN A CASE OF ACUTE ZONAL OCCULT OUTER RETINOPATHY
Authors: Xu Qinyuan (Alis) , Athwal Arman , Heisler Morgan , Ju Myeong Jin , Vanzan Vinicius , Ferrara Daniela , Sarunic Marinko , Navajas Eduardo V.
Published: April 2020

Purpose:

To report a case of acute zonal occult outer retinopathy in which adaptive optics (AO) facilitated visualization of abnormal photoreceptors previously thought to be in an area of normal retina on conventional optical coherence tomography (OCT).

Methods:

Case report.

Results:

A 51-year-old woman presents with 11-month history of photopsias and scotoma in the temporal visual field of her left eye. Ocular imaging including fluorescein angiography, fundus autofluorescence and OCT suggested the diagnosis of acute zonal occult outer retinopathy in the left eye. Adaptive optics optical coherence tomography (AO-OCT) revealed photoreceptor abnormalities not previously identified in conventional OCT, in areas apparently normal on multimodal imaging. On enface and cross-sectional AO-OCT, round and evenly spaced hyperreflectivity corresponding to normal cone mosaic (Pattern 1) was adjacent to unevenly and disrupted cone hyperreflectivity (Pattern 2) and areas with hyporeflectivity or no cone reflectivity (Pattern 3). Cross-sectional AO-OCT of Patterns 2 and 3 also revealed attenuation of ellipsoid zone with loss of interdigitation zone.

Conclusion:

Adaptive optics OCT documented cone photoreceptors in finer details than conventional OCT and revealed early changes in a patient with acute zonal occult outer retinopathy, in an area of the retina thought to be normal on conventional multimodal imaging. These findings may provide important insight into pathogenesis and progression of the disease.
The pseudo-allergic/neurogenic route of mast cell activation via MRGPRX2: discovery, functional programs, regulation, relevance to disease, and relation with allergic stimulation
Authors: Babina Magda
Published: April 2020

Mast cells (MCs) form operating units with sensory nerves and can contribute to sensations of itch and pain. However, it remained enigmatic for decades how MCs are actually activated in the absence of atopy. MRGPRX2 was discovered only recently but has already changed our view of MC biology. As the receptor of multiple endogenous and exogenous ligands, including substance P and various drugs, MRGPRX2 can be viewed as the missing link underlying clinically relevant MC degranulation in the context of drug-triggered pseudo-allergy and autonomous (eg, neuronal) MC activation in disease. Its existence explains previous findings that remained inexplicable for a long time. The confinement of MRGPRX2 to MCs, and even only to the subgroup of MCTC-type MCs, makes research in this field exciting from a theoretical as well as from a translational or pharmacological perspective alike. In this review, I will first give a brief overview of MCs, their subsets and modes of activation, then briefly touch on the history of MRGPRX2 discovery, summarize some recent advances regarding ligands, functional aspects and regulation by extracellular cues, and recapitulate the emerging role of the MRGPRX2 system in health and disease. Finally, a concise comparison between MRGPRX2 and FcεRI will be presented, contrasting key characteristics of the 2 dominant ways of MC activation. There is a huge disproportion in our understanding of FcεRI-triggered versus MRGPRX2-triggered events, but since research into the latter is in full swing, some of the missing pieces of the puzzle are likely to be filled in soon.
Loss of S1PR3 attenuates scratching behaviors in mice in the imiquimod model of psoriasis, but not in the MC903 model of atopic dermatitis
Authors: Hill Rose Z. , Rifi Ziad , Vuong Cliff , Bautista Diana M.
Published: April 2020

Here we examine the role of sphingosine 1-phosphate receptor 3 (S1PR3) in chronic itch. We used 2 mouse models—the MC903 model of atopic dermatitis and the imiquimod model of psoriasis—to examine the contribution of S1PR3 to chronic itch. We measured scratching behaviors in these mouse models in S1PR3−/−, +/−, and +/+ animals. Whereas we observed no effect of loss of S1PR3 on itch behaviors in the MC903 model, imiquimod-evoked itch behaviors were reduced in S1PR3−/− animals. Overall, the data support a role for S1PR3 signaling in the development of psoriatic but not atopic itch.
Pupil expansion device use and operative outcomes with topical dilation vs intracameral epinephrine in resident-performed cataract surgery
Authors: Wilson Caroline W. , Hock Lauren E. , Oetting Thomas , Kennedy Sean , Terveen Daniel
Published: April 2020

Purpose:

To compare the use of topical dilation drops vs topical drops with the addition of intracameral epinephrine in resident-performed cataract surgery and the effects on pupil expansion device (PED) use, surgical costs, and surgical times.

Setting:

Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA.

Design:

Retrospective chart review.

Methods:

Resident-performed primary cataract surgical cases using topical dilation drops only or drops with the addition of intracameral epinephrine were analyzed for PED use, surgical time, and costs in all patients and in patients with a history of tamsulosin use.

Results:

In the topical group, PEDs were used in 31.1% of cases compared with 13.5% of cases in the intracameral group (P < .0001). History of tamsulosin use was noted in about one third of cases in both groups. For patients with a history of tamsulosin use, PED use decreased from 52.7% in the topical cases to 17.9% in the intracameral group (P < .0001). Surgical times were on average 7.1 minutes slower with PED use than without PED use. There was a medication savings of $50.44 USD per case in the intracameral group compared with the topical group. Factoring in the $100 to $130 USD per PED used, total surgical costs were $19 267 USD less in the intracameral group over 6 months.

Conclusions:

Intracameral epinephrine with lidocaine decreases the need for PED use during cataract surgery, lowers intraoperative costs, and improves efficiency compared with topical dilation drops alone.
Subjective Loudness Using External Noise Reflects the Loudness and Distress of Tinnitus: A Cross-Sectional Study
Authors: Yamamoto Yuta , Tamagawa Shunji , Tanioka Kensuke , Suzuki Takuya , Hotomi Muneki , Ukai Satoshi , Ueyama Takashi
Published: April 2020

Objectives:

Subjective tinnitus loudness has been measured using loudness matches, which compare tinnitus loudness with pure tones from an audiometer. When patients compare the sound pressure of certain noises with the tinnitus loudness, however, there may be remarkable differences from the measurements according to loudness matches. Subjective loudness (SubL) is an estimation of the sound pressure of tinnitus loudness by comparison of noises considered to be most similar to tinnitus loudness of patient. We examine whether SubL is inferior to loudness matches in measurement of subjective tinnitus loudness.

Design:

Single-group cross-sectional study.

Patients:

Included in this study were a clinical group of 111 patients with the chief complaint of subjective tinnitus. Seven of the 111 patients were excluded due to missing audiometry or questionnaire data.

Methods:

Patients assessed the tinnitus loudness and related distress using visual analogue scales (VAS-L and VAS-S) and answered the Tinnitus Handicap Inventory (THI). Hearing acuity, tinnitus pitch, and loudness were then measured using an audiometer.

Results:

VAS-L, VAS-S, and THI scores significantly correlated with loudness match using Goodwin's method (SL2) and SubL. Subgroup analysis based on patient ages indicated that all correlations of SL2 with VAS-L, VAS-S, and THI scores were no longer seen in patients more than 60 years of age. Meanwhile, SubL correlated with VAS-L, VAS-S, and THI scores in all subgroups.

Conclusions:

SubL was a good reflection of self-reported loudness and distress of tinnitus. It may therefore be a simple and easy means of assessing tinnitus loudness and associated distress during pre-examination without an audiometer.
Synthesis and antithrombotic activity of 1-benzyl-N′-benzylidenepiperidine-3-carbohydrazide derivatives
Authors: Tosan Fatemeh , Hashemi Mohammad M. , Kobarfard Farzad , Monajjemi Majid , Ayatollahi Seyed A.
Published: April 2020

Platelet aggregation inhibition and interfering with clot formation are essential tools for antithrombotic therapy and there is a need for discovering new antithrombotic agents. In this study, we synthesized a series of benzylidenepiperidine-3-carbohydrazide derivatives (1f–11f), bearing various selected substituents on both the piperidine ring nitrogen and the hydrazide nitrogen. The synthesized compounds were characterized by FTIR, 1HNMR spectroscopic techniques, CHN/O elemental analysis and electrospray ionization mass spectra. All new 1-benzyl-N′-benzylidenepiperidine-3-carbohydrazides were evaluated for their antiplatelet aggregation activities (against platelet aggregation induced by AA, ADP and collagen separately) and anticoagulant activities [protrombin time (PT) and partial thromboplastin time (PTT)]. Antiplatelet aggregation activity of the new derivatives was measured using human plasma on an APACT 4004 aggregometer. All the compounds were mainly effective on ADP pathway of platelet aggregation compared with collagen and AA pathways. The most potent compound on platelet aggregation induced by ADP is compound 2f with 87% aggregation inhibition activity at 0.5 mmol/l concentration. The synthesized compounds were further investigated for their anticoagulant action via the two PT and PTT models. They all showed higher PT and PTT values compared with the blank control sample. The most potent compounds are 5f, 6f, 7f and 1f. All compounds were obtained in good yield and further evaluated for their antiplatelet and anticoagulant activity.