bluuebunny/crossref_metadata_2025 huggingface dataset:
Motivational Interviewing: A Communication Tool to Promote Positive Behavior Change and Optimal Health Outcomes
Authors: Beckwith Vickie Z. , Beckwith Jennifer
Published: April 2020

Motivational interviewing (MI) is a collaborative communication style that can be integrated into everyday practice to improve conversations and serve as a catalyst for behavior change. This article reviews the fundamental principles and basic skills of MI. It discusses how MI has evolved from a therapeutic modality to a conversational style, applicable in the school setting and specifically for school nurses. The article provides an overview of how MI can be used by school nurses, challenges they may face, and resources to support implementation.
Are gene polymorphisms related to adverse events of methotrexate in patients with rheumatoid arthritis? A retrospective cohort study based on an updated meta-analysis
Authors: Huang Jing , Fan Huizhen , Qiu Qi , Liu Kunpeng , Lv Shuang , Li Jiang , Yang Hui , Shu Xiaoming , Xu Yuan , Lu Xiangchen , Lu Cheng , Zhang Yunnan , Xiao Cheng
Published: April 2020

Aims:

We performed an updated meta-analysis to verify correlations between gene polymorphisms and adverse events in methotrexate (MTX)-treated rheumatoid arthritis (RA) patients. Then, we conducted a retrospective cohort study of Han Chinese in China.

Methods:

Relevant studies were collected from the PubMed database and the EMBASE database until December 2017. Pre-allele, dominant, recessive, codominant, and homozygotic models were applied. In addition, a retrospective cohort study enrolling 162 RA patients treated with MTX was conducted. Single nucleotide polymorphism (SNP) genotyping was analyzed by PCR and product sequencing.

Results:

A total of 39 studies were included in 20 meta-analyses; meta-analysis showed a significant association between MTX-related toxicity and 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C>T(rs1801133) polymorphism in East Asian RA patients, and significant associations were observed between MTX-related toxicity and 5-aminoimidazole-4-carboxamide ribonucleotide formyltransferase/IMP cyclohydrolase (ATIC) 347C>G (rs2372536), reduced folate carrier 1 (RFC-1) 80G>A (rs1051266), and adenosine triphosphate-binding cassette B1 (ABCB1) 3435C>T(rs1045642) polymorphisms in European RA patients but not in East Asian RA patients. Moreover, in our retrospective cohort study, ATIC 347C>G(rs2372536) and ABCB1 3435C>T(rs1045642) polymorphisms were not associated with MTX-related toxicity. However, a significant association was observed between MTX-related toxicity and RFC-1 80G>A (rs1051266) polymorphism in Chinese Han RA patients.

Conclusion:

Evidence-based results suggest that the MTHFR 677C>T(rs1801133), ATIC 347C>G(rs2372536), RFC-1 80G>A (rs1051266), ABCB1 3435C>T(rs1045642) polymorphisms are associated with MTX-related toxicity. Larger and more stringent study designs may provide more accurate findings for the effects of these SNPs on MTX-related toxicity, and larger sample-size studies of the Chinese Han population should be conducted for further validation.
Adhering to antiretroviral therapy: A qualitative analysis of motivations for and obstacles to consistent use of antiretroviral therapy in people living with HIV
Authors: Fleischer Lisa , Avery Ann
Published: April 2020

Objectives:

Based on the 2015 U.S. Centers for Disease Control and Prevention data, 40% of people living with HIV in the United States with an HIV diagnosis and 18.5% of people living with HIV in HIV care in the United States are not virally suppressed. Many HIV care clinics have implemented recommendations to improve the percentage of people living with HIV on antiretroviral therapy. To understand what more could be done, we examine patients’ motivations and obstacles to maintaining adherence to antiretroviral therapy.

Methods:

We conducted qualitative analysis using a qualitative description framework of in-depth interviews with people living with HIV receiving care at an urban HIV care clinic in the midwestern United States.

Results:

We found that while many traditional barriers to care have been addressed by existing programs, there are key differences between those consistent with antiretroviral therapy and those inconsistent with antiretroviral therapy. In particular, self-motivation, diagnosis acceptance, treatment for depression, spiritual beliefs, perceived value of the HIV care team, and prior experience with health care distinguish these two groups. Most significantly, we found that people living with HIV consistent with antiretroviral therapy describe their main motivation as coming from themselves, whereas people living with HIV inconsistent with antiretroviral therapy more often describe their main motivation as coming from the HIV care team.

Conclusion:

Our results highlight the importance of the HIV care team’s encouragement of maintaining antiretroviral adherence, as well as encouraging treatment for depression.
Facebook’s Ideal User: Healthy Habits, Social Capital, and the Politics of Well-Being Online
Authors: Docherty Niall
Published: April 2020

Through an analysis of Facebook design blogs, funded social psychology and human–computer interaction (HCI) research, this article will demonstrate how Facebook “scripts” a discursive material configuration of ideal use. It will show how users are prompted toward habits of “healthy” active usership—commenting on posts, direct messaging, and liking, for instance, through the design of the News Feed’s user interface. This article will detail how Facebook users are technologically nudged to choose practices of active behavior on the News Feed for the sake of their own health. This socio-technical configuration brings together contingent evolutionary psychology and neoliberal theories of social capital to construct a model of eudaimonic well-being—normative descriptions of what it means to live well as a human in time. In this way, Facebook will be shown to conceptualize well-being as an outcome of user choice, raising pertinent links to modalities of neoliberal responsibilization as a result. The conclusion will argue that Facebook’s configuration of its ideal user ought to be situated within a historical lineage of governance through habit, and will critically assess the extent to which the discursive and material scripting of the News Feed, which seeks to channel user behavior along “healthy,” predictable, and profitable avenues of interaction, operates as a technology of power entwined with contemporary relations of digital capitalism.
Radiographic scoring systems for psoriatic arthritis are insufficient for psoriatic arthritis mutilans: results from the Nordic PAM Study
Authors: Laasonen Leena , Lindqvist Ulla , Iversen Lars , Ejstrup Leif , Jonmundsson Thorarinn , Ståhle Mona , Gudbjornsson Bjorn
Published: April 2020

Background

Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis (PsA).

Purpose

To describe the radiological features in PAM and explore whether existing scoring systems for radiological damage in psoriatic arthritis are applicable for PAM.

Material and Methods

Radiographs were scored according to the modified Sharp-van der Heijde (mSvdH) and the Psoriatic Arthritis Ratingen Score (PARS) systems for PsA.

Results

At inclusion, 55 PAM patients (49% women, mean age 58 ± 12 years) had conventional radiographs of both hands and feet. A total of 869 PAM joints were detected and 193 joints with ankylosis. The mean total mSvdH score was 213.7 ± 137.8 (41% of maximum) with a higher score for hands than for feet: 136.6 ± 90.1 vs. 79.1 ± 60.9. However, the total score was relatively higher in the feet than in the hands when compared to the highest possible scoring (47% vs. 38% of max). The mean total PARS score was 126.3 ± 79.6 (35% of max). Scoring for joint destruction was higher than for proliferation (22% vs. 11% of max). Strong correlation was found between mSvdH and PARS (r2 = 0.913). A significant correlation was found between scoring and duration of arthritis and the Health Assessment Questionnaire. History of smoking, BMI, and gender did not influence the scoring values.

Conclusions

The two scoring systems studied may not be ideal to indicate progression of PAM in advanced disease since they reach ceiling effects rather early. Therefore, reporting early signs suggestive of PAM, e.g. signs of pencil-in-cup deformities or osteolysis, is crucial. This would reveal the presence of PAM and might lead to improved treatment in order to minimize joint damage.
Application of a Positioning Wedge During Colonoscopy of Obese Patients to Mitigate Nurse Pain
Authors: Fetzer Susan J.
Published: April 2020

Background: The application of external abdominal pressure by endoscopy nurses has long been recognized to facilitate passage of the endoscope during colonoscopy. Applying sustained abdominal pressure during a colonoscopy for an obese patient is especially challenging and may result in musculoskeletal injury for the endoscopy nurse. Methods: Four experienced endoscopy nurses cared for 100 obese adult patients scheduled for colonoscopy who had a body mass index (BMI) greater than 25 kg/m2. Duration of applied pressure, as well as nurse pain and fatigue were examined after they cared for 50 patients with and 50 patients without a positioning wedge. Findings: No difference in the mean fatigue score between nurses providing standard care versus those using the positing wedge was observed (mean score: 2.6 vs. 2.0, respectively); however, self-reported pain was higher for those providing standard care relative to those using the positioning wedge (mean score: 2.9 vs. 1.3, p = .0143). In 18 patients who required both the wedge and pressure, these nurses still reported lower pain scores relative to nurses who provided care without a wedge ( M = 1.3 vs. 2.9, respectively). Conclusion/Application to practice: A positioning wedge for obese patients undergoing a colonoscopy can reduce the need for external abdominal pressure applied by endoscopy nurses. Occupational health nurses should endorse the use of a gel wedge to promote safe patient handling and reduce the potential for musculoskeletal injury among endoscopy nurses.
Supporting Public Health Employee Engagement and Retention: One U.S. National Center’s Analysis and Approach
Authors: Smith C. Kay , Spears-Jones Crystal , Acker Carolyn , Dean Hazel D.
Published: April 2020

Background: Employee engagement, exemplified by positive perceptions of supervisors, workplace, and job, improves productivity and employee retention. We identified the extent of and barriers to employee engagement at Centers for Disease Control and Prevention’s (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). Methods: In 2015, NCHHSTP’s leadership collected baseline data through a centerwide Employee Engagement Pulse Survey (EEPS) from NCHHSTP’s full-time Civil Service employees, U.S. Public Health Service Commissioned Corps officers, and Title 42 service fellows. EEPS included six demographic questions; nine Likert-type scale questions measuring 26 perceptions related to immediate supervisors, the work environment, and job satisfaction; and four open-ended questions soliciting recommendations for improvement. Findings: Among 727 of 1,171 staff (response rate = 62%), positive perceptions of supervisors ranged from a high of 94% (supervisor conducts performance reviews) to a low of 63% (supervisor assists employees with career development). Perceptions of work experience ranged from 98% (respondents were willing to put in extra effort to get a job done) to 68% (respondents’ talents were used well in the workplace). Perceptions of job satisfaction ranged from 87% (support from their coworkers) to 69% (satisfaction with opportunities to learn or grow professionally). Conclusion/Application to Practice: Overall, NCHHSTP staff have positive perceptions of their work, their leaders, and the agency. Other public- and private-sector employers might be able to improve their employees’ engagement and retention by listening to their opinions and needs and frequently recognizing their individual achievements. NCHHSTP’s workforce development initiatives can be used as a model for assessing a baseline of their employees’ engagement.
Comparison between hook plate fixation with and without coracoclavicular ligament suture for acute acromioclavicular joint dislocations
Authors: Seo Joong-Bae , Kim Seong-Jun , Ham Hee-Jung , Yoo Jae-Sung
Published: April 2020

Background:

Hook plates are widely used for repair of acromioclavicular joint (ACJ) dislocations. However, it is unclear whether repair of torn coracoclavicular (CC) ligament is necessary. The purpose of this study was to evaluate the outcomes of the hook plate fixation with direct CC ligament repair for acute ACJ dislocation in comparison with the hook plate fixation without direct CC ligament repair.

Methods:

The study included 120 patients with acute ACJ dislocations who underwent surgery. The patients were divided into 73 patient groups with Arbeitsgemeinschaft für Osteosynthesefragen (AO) hook plate fixation and direct CC ligament repair and 47 patient groups without direct CC ligament repair. For clinical assessments, the American Shoulder and Elbow Surgeons score, constant score, and time for implant removal were recorded. The corcoclavicular distance (CCD) and the CCD ratio were used for the evaluation of reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, and postoperative ACJ arthrosis, were also analyzed.

Results:

There were no differences in the clinical outcomes between the two groups. There was no difference in the timing of implant removal between the two groups. The last follow-up CCD was not statistically significant between group with direct CC ligament repair and without repair (9.1 ± 3.3 vs. 9.0 ± 2.8, respectively, p > 0.05). The last follow-up CCD ratio showed significant differences between the two groups (12.6 ± 25.5% vs. 26.3 ± 39.7, respectively, p < 0.05). There was no statistically significant difference in the complication rate between the two groups.

Conclusion:

The hook plate fixation with direct CC ligament repair group was better for maintenance of reduction than that of the hook plate fixation without direct CC ligament repair group. Although, there were no differences of clinical outcomes and complications between two groups.

Level of Evidence:

Level III, Retrospective Study.
Comparison of medial and lateral tibial tunnel in pullout repair of posterior root tear of medial meniscus: Radiologic, clinical, and arthroscopic outcomes
Authors: Kwon Sai-Won , Kim Jun Bum , Kim Chang Hyun , Hong Si John , Hong Yong Cheol , Jang Byung-Woong
Published: April 2020

Purpose:

Medial meniscus posterior root tear (MMPRT) should be repaired to the correct position as possible to maintain hoop tension of the meniscus. In this study, we propose a comparison of the outcome between the medial tunnel and the lateral tunnel in the pullout suture technique using the tibial tunnel for anatomical repair of posterior root tear of medial meniscus.

Methods:

From April 2010, of patients who underwent pullout suture, 51 cases (24 medial tunnel group (MTG) and 27 lateral tunnel group (LTG)) were able to follow-up with second look arthroscopy. Original Coronal Ratio of Root Attachment (CRORA) was defined as the ratio of the distance from the medial edge of the tibial plateau to the root attach site divided by the entire tibial medial–lateral width on preoperative computed tomography. Error between postoperative CRORA and original CRORA was calculated. We compared this error, clinical outcome, and arthroscopic finding between MTG and LTG.

Results:

The mean error ratio of postoperative CRORA divided by original CRORA was 0.86 ± 0.11 in MTG, which was significantly ( p = 0.001) lower than that (1.02 ± 0.06) in LTG. The mean value of the root attach point in the MTG with a post/original CRORA value of 0.86 ± 0.11 means statistically significant medialization after the operation. There was no statistically significant difference in changes of International Knee Documentation Committee (IKDC) and Lysholom score between MTG and LTG. The difference between the two groups of arthritis progression was not statistically significant.

Conclusion:

In patients with MMPRT, CRORA may provide a basis for coronal assessment of root repair position before and after surgery, and lateral tibial tunnel technique can help anatomical repair by reducing technical error due to guide pin slip medially compared to medial tibial tunnel technique.
Anterior knee pain after total knee arthroplasty: A multifactorial analysis
Authors: Laubach Markus , Hellmann Julian TR , Dirrichs Timm , Gatz Matthias , Quack Valentin , Tingart Markus , Betsch Marcel
Published: April 2020

Purpose:

Dissatisfaction and an impaired quality of life after total knee arthroplasty (TKA) is often associated with postsurgical anterior knee pain (AKP). The underlying pathological mechanisms are not yet fully understood. Therefore, a multifactorial approach encompassing clinical and radiological parameters seemed reasonable and promising to investigate postsurgical AKP.

Methods:

In this cross-sectional study, 25 patients without and 25 patients with postsurgical AKP after unilateral TKA were randomly recruited from a larger cohort of patients. Multiple clinical and radiological parameters—including real-time shear wave elastography (SWE) to measure the patellar and quadriceps tendon elasticity—were acquired and subsequently associated with AKP. For statistical analysis, SPSS (IBM, version 25) was used.

Results:

In total 50 participants (58.0% men, mean age 63.42 years, mean body mass index 29.75 kg/m2), having different prosthetic designs implanted, were included. Independently of key covariates, the strength of the quadriceps muscle ( p = 0.021), a thinner inlay ( p = 0.041), and a lower position of the patella ( p = 0.041) were associated with AKP. Although no correlation with AKP was found ( p = 0.346, resp. p = 0.154), we observed significantly decreased Young’s modulus of the patellar and quadriceps tendons for the involved knee compared to the uninvolved knee ( p < 0.001).

Conclusion:

In conclusion, quadriceps muscle strength, inlay thickness, and the patella position might be of particular relevance in avoiding postsurgical AKP. Future studies with larger sample sizes are needed to clarify the impact of quadriceps muscle strength and the postoperative patella position as well as the role of SWE as a personalized modifiable prediction marker.
Perceptual Evaluation of Binaural MVDR-Based Algorithms to Preserve the Interaural Coherence of Diffuse Noise Fields
Authors: Gößling Nico , Marquardt Daniel , Doclo Simon
Published: April 2020

Besides improving speech intelligibility in background noise, another important objective of noise reduction algorithms for binaural hearing devices is preserving the spatial impression for the listener. In this study, we evaluate the performance of several recently proposed noise reduction algorithms based on the binaural minimum-variance-distortionless-response (MVDR) beamformer, which trade-off between noise reduction performance and preservation of the interaural coherence (IC) for diffuse noise fields. Aiming at a perceptually optimized result, this trade-off is determined based on the IC discrimination ability of the human auditory system. The algorithms are evaluated with normal-hearing participants for an anechoic scenario and a reverberant cafeteria scenario, in terms of both speech intelligibility using a matrix sentence test and spatial quality using a MUlti Stimulus test with Hidden Reference and Anchor (MUSHRA). The results show that all the binaural noise reduction algorithms are able to improve speech intelligibility compared with the unprocessed microphone signals, where partially preserving the IC of the diffuse noise field leads to a significant improvement in perceived spatial quality compared with the binaural MVDR beamformer while hardly affecting speech intelligibility.
Approximations to the Voice of a Cochlear Implant: Explorations With Single-Sided Deaf Listeners
Authors: Dorman Michael F. , Natale Sarah Cook , Baxter Leslie , Zeitler Daniel M. , Carlson Matthew L. , Lorens Artur , Skarzynski Henryk , Peters Jeroen P. M. , Torres Jennifer H. , Noble Jack H.
Published: April 2020

Fourteen single-sided deaf listeners fit with an MED-EL cochlear implant (CI) judged the similarity of clean signals presented to their CI and modified signals presented to their normal-hearing ear. The signals to the normal-hearing ear were created by (a) filtering, (b) spectral smearing, (c) changing overall fundamental frequency (F0), (d) F0 contour flattening, (e) changing formant frequencies, (f) altering resonances and ring times to create a metallic sound quality, (g) using a noise vocoder, or (h) using a sine vocoder. The operations could be used singly or in any combination. On a scale of 1 to 10 where 10 was a complete match to the sound of the CI, the mean match score was 8.8. Over half of the matches were 9.0 or higher. The most common alterations to a clean signal were band-pass or low-pass filtering, spectral peak smearing, and F0 contour flattening. On average, 3.4 operations were used to create a match. Upshifts in formant frequencies were implemented most often for electrode insertion angles less than approximately 500°. A relatively small set of operations can produce signals that approximate the sound of the MED-EL CI. There are large individual differences in the combination of operations needed. The sound files in Supplemental Material approximate the sound of the MED-EL CI for patients fit with 28-mm electrode arrays.
Subthreshold Exudative Choroidal Neovascularization Associated With Age-Related Macular Degeneration Identified by Optical Coherence Tomography Angiography
Authors: Roh Miin , Miller Joan W. , Jeng-Miller Karen W. , Wang Jay C. , Laíns Inês , Silverman Rebecca F. , Loewenstein John I. , Husain Deeba , Vavvas Demetrios G. , Miller John B.
Published: April 2020

Purpose:

This article describes the clinical and multimodal imaging characteristics of subthreshold exudative choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD).

Methods:

Among 3773 patients with AMD, 8 eyes (6 patients) were identified with the clinical phenotype of interest. Dilated fundus examinations, color fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and OCT angiography (OCTA) were performed.

Results:

OCT typically showed a moderately reflective irregular pigment epithelial detachment with overlying subretinal fluid (SRF). Traditional FA did not show leakage and ICGA showed no definitive neovascular network or hot spots. However, OCTA clearly demonstrated a CNV within the pigment epithelial detachment. The majority of our cases (7 of 8) did not receive antivascular endothelial growth factor (anti-VEGF) injections, and visual acuity remained stable over the available follow-up period of 1 to 10 years.

Conclusions:

CNV is often associated with SRF and vision loss in AMD, usually requiring frequent anti-VEGF injections. OCTA allowed us to better identify CNV not readily detected on FA and ICGA. Although some have suggested early clinical intervention with anti-VEGF injections in any case with fluid and confirmed CNV on OCTA, we describe a subset of AMD patients with SRF who may be better managed by observation. These cases may represent a more indolent, mature, and stable vascular network.
‘Only Connect!’: Exploring the Critical Dialectical Turn in Leadership Studies
Authors: Collinson David L
Published: April 2020

This article considers the value of critical dialectical perspectives for leadership research. Surfacing under-explored issues about power, paradox and contradiction, critical dialectical approaches challenge the tendency to dichotomize that frequently characterizes leadership studies. They argue that leadership power dynamics typically take multiple, simultaneous forms, interconnecting in ways that are often mutually reinforcing but sometimes in tension. Revealing the importance, for example, of gender, embodiment and other intersecting diversities and inequalities, these perspectives also highlight how power can be productive as well as oppressive, covert as well as overt. Careful to avoid treating leaders’ control and influence as all-determining and monolithic, they also recognize that different forms of power and control may produce unintended and unanticipated effects such as follower resistance. Critical approaches hold that followers’ practices are frequently more proactive, knowledgeable and oppositional than is often appreciated. By addressing the dialectics of power, conformity and resistance as a set of dynamic, shifting and interconnected processes, the article concludes that critical dialectical perspectives have the potential to open up new ways of understanding and researching leadership and followership.
Evaluation of the compressive and anti-penetration properties of Ti-Al3Ti-Al laminated composites
Authors: Yuan Meini , Yao Yuhang , Han Fangzhou , Wang Zhijun
Published: April 2020

In order to further improve the mechanical properties of Ti-Al3Ti laminated composites, the endothermic semisolid reaction was used to fabricate Ti-Al3Ti-Al laminated composites, and the quasi-static compressive test, dynamic compressive test, and the ballistic penetration test were conducted on these composites. The results showed that the compressive strength and failure strain of Ti-Al3Ti-Al laminated composites prepared at 660°C are 1432 MPa and 35%, respectively. The dynamic response of these composites has obvious strain rate effect, and the crack grows in the shape of “Z.” The V50 of Ti-Al3Ti-Al targets is 509 m s−1. To sum up, Ti-Al3Ti-Al laminated composites have better mechanical properties and anti-penetration properties compared to Ti-Al3Ti laminated composites.
Systematic review of observational studies reporting antiphospholipid antibodies in patients with solid tumors
Authors: Abdel-Wahab Noha , Tayar Jean H. , Fa'ak Faisal , Sharma Gaurav , Lopez-Olivo Maria A. , Yousif Abdelrahman , Shagroni Tasneam , Al-Hawamdeh Sami , Rojas-Hernandez Cristhiam M. , Suarez-Almazor Maria E.
Published: April 2020

This review summarizes the evidence on antiphospholipid (aPL) antibodies and related thromboembolic events in patients with solid tumors. Data sources included Medline, EMBASE, Web of Science, PubMed ePubs, and the Cochrane Central Register of Controlled Trials through August 2019 without restrictions. Observational studies that evaluated patients with solid tumors for the presence of aPL antibodies were included. Data were extracted and quality was assessed by one reviewer and cross-checked by another. Thirty-three studies were identified. Gastrointestinal (GI) and genitourinary (GU) cancers were the most frequently reported. Compared with healthy patients, patients with GI cancer were more likely to develop anticardiolipin antibodies (risk ratio [RR], 5.1; 95% confidence interval [CI], 2.6-9.95), as were those with GU (RR, 7.3; 95% CI, 3.3-16.2) and lung cancer (RR, 5.2; 95% CI, 1.3-20.6). The increased risk for anti-β2-glycoprotein I or lupus anticoagulant was not statistically significant. Patients with lung cancer who had positive aPL antibodies had higher risk of developing thromboembolic events than those who had negative antibodies (RR, 3.8%; 95% CI, 1.2-12.2), while the increased risk in patients with GU cancer was not statistically significant. Deaths due to thromboembolic events were more common among patients with lung cancer who had elevated aPL antibodies. A limitation of this review is that the results are contingent on the reported information. We found an increased risk of developing aPL antibodies in patients with GI, GU, and lung cancers resulting in thromboembolic events and death. Further studies are needed to better understand the pathogenesis and development of aPL antibodies in cancer.
Pulmonary arterial hypertension with below threshold pulmonary vascular resistance
Authors: Ratwatte Seshika , Anderson James , Strange Geoffrey , Corrigan Carolyn , Collins Nicholas , Celermajer David S. , Dwyer Nathan , Feenstra John , Keating Dominic , Kotlyar Eugene , Lavender Melanie , Whitford Helen , Whyte Ken , Williams Trevor , Wrobel Jeremy P. , Keogh Anne , Lau Edmund M.
Published: April 2020

Pulmonary vascular resistance (PVR) >3 Wood units is a criterion of the haemodynamic definition of pulmonary arterial hypertension (PAH). However, this cut-off is conservative and arbitrarily defined. Data is lacking on the natural history, response to therapy and survival of patients diagnosed with precapillary pulmonary hypertension (PH) with mild or borderline elevation of PVR.

In Australia, PAH therapy could be prescribed solely on mean pulmonary arterial pressure (PAP) and pulmonary arterial wedge pressure (PAWP) criteria. Using the Australian and New Zealand Pulmonary Hypertension Registry, we aimed to study a population diagnosed with PAH between January 2004 and December 2017 with the pre-defined haemodynamic characteristics of mean PAP ≥25 mmHg, PAWP ≤15 mmHg and PVR <3 Wood units.

Eighty-two patients met the pre-defined haemodynamic inclusion criteria (mean age 63±11 years; 67 females). Underlying aetiologies included idiopathic disease (n=39), connective tissue disease (CTD; n=42) and HIV infection (n=1). At diagnosis, mean PAP was 27 mmHg (interquartile range (IQR) 25–30 mmHg), PAWP 13 mmHg (IQR 11–14 mmHg) and PVR 2.2 Wood units (IQR 1.9–2.7 Wood units). Baseline 6-min walk distance (6MWD) was 352 m (IQR 280–416 m) and 77% of subjects were in New York Heart Association (NYHA) functional class 3 or 4. All patients were commenced on initial monotherapy with an endothelin receptor antagonist (ERA; n=66) or phosphodiesterase type-5 inhibitor (PDE5i; n=16). At first re-evaluation, 6MWD increased by 46 m (IQR 7–96 m) and 35% of subjects demonstrated improvement in NYHA functional class. After a median follow-up of 65 months (IQR 32–101 months), 18 out of 82 subjects (22.0%) had died, with estimated 1-year and 5-year survival rates of 98% and 84%, respectively. Death attributed to PAH occurred in six out of these 18 patients (33.3%, 7% of total cohort).

Patients with precapillary PH and “borderline” PVR falling outside the current definition have adverse outcomes. Such patients appear to respond to PAH therapy; however, this requires further study in randomised trials.
Maternal smoking during pregnancy affects adult onset of asthma in offspring: a follow up from birth to age 46 years
Authors: Toppila-Salmi Sanna , Luukkainen Annika T. , Xu Baizhuang , Lampi Jussi , Auvinen Juha , Dhaygude Kishor , Järvelin Marjo-Riitta , Pekkanen Juha
Published: April 2020

Rationale

Environmental tobacco smoke (ETS) exposure increases asthma risk in children. There is limited knowledge of prenatal ETS for adult-onset asthma.

Objectives

To determine the association between prenatal ETS and adult onset asthma.

Measurements and main results

The questionnaire and clinical data of 5200 people, free of physician-diagnosed asthma by 31 years of age, who were included in the Northern Finland Birth Cohort 1966 Study was used. The association of maternal smoking during the last 3 months of pregnancy with onset of physician-diagnosed asthma and with lung function in adult offspring was studied using adjusted multivariate regression analyses. The cumulative incidence of physician-diagnosed asthma between the ages of 31 and 46 years was 5.1% among men and 8.8% among women. Gestational smoke exposure was associated with adult-onset asthma among offspring (adjusted OR 1.54, 95% CI 1.04–2.29), namely among offspring who reported either past non-diagnosed asthma (OR 9.63, 95% CI 2.28–40.67) or past cough with wheeze (3.21, 95% CI 1.71–6.05). A significant association was detected between gestational smoke exposure and the offspring's forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio at 31 years of age. In offspring with the haplotype rs11702779-AA ofRUNX1, gestational smoke exposure was associated with adult-onset asthma (5.53, 95% CI 2.11–14.52, adjusted p-value for interaction 0.10).

Conclusion

Maternal smoking during pregnancy is associated with the cumulative incidence of asthma in offspring between the ages of 31 and 46 years. The association was accentuated in offspring who at age 31, reported having past respiratory problems and/or who had haplotype rs11702779-AA. A reduction in FEV1/FVC ratio was also observed at age 31 years in offspring with gestational smoke exposure. These results could reflect the early vulnerability of offspring's airways to ETS and its putative long-term effects.
Vertical pons hyperintensity and hot cross bun sign in cerebellar-type multiple system atrophy and spinocerebellar ataxia type 3
Authors: Sugiyama Atsuhiko , Yokota Hajime , Yamanaka Yoshitaka , Mukai Hiroki , Yamamoto Tatsuya , Hirano Shigeki , Koide Kyosuke , Ito Shoichi , Kuwabara Satoshi
Published: April 2020

Background

The “hot cross bun” (HCB) sign, a cruciform hyperintensity in the pons on magnetic resonance imaging (MRI), has gradually been identified as a typical finding in multiple system atrophy, cerebellar-type (MSA-C). Few reports have evaluated the sensitivity of an HCB, including a cruciform hyperintensity and vertical line in the pons, which precedes a cruciform hyperintensity, in the early stages of MSA-C. Moreover, the difference in frequency and timing of appearance of an HCB between MSA-C and spinocerebellar ataxia type 3 (SCA3) has not been fully investigated.

Methods

This study investigated the time at which an HCB and orthostatic hypotension (OH) appeared in 41 patients with MSA-C, based on brain MRI and head-up tilt test. The MRI findings were compared with those of 26 patients with SCA3. The pontine signal findings on T2-weighted MRI were graded as 0 (no change), 1 (a vertical T2 high-intensity line), or 2 (a cruciform T2 high-intensity line), with grades 1 or 2 considered as an HCB. OH 30/15 was defined as a decrease in systolic blood pressure of > 30 mmHg or diastolic blood pressure of > 15 mmHg.

Results

Among the 24 patients with MSA-C within 2 years from the onset of motor symptoms, an HCB was detected in 91.7%, whereas OH 30/15 was present in 60.0%. Among the 36 patients with MSA-C within 3 years from the onset of motor symptoms, a grade 2 HCB was detected in 66.7% of those with MSA-C but in none of those with SCA-3.

Conclusions

HCB is a highly sensitive finding for MSA-C, even in the early stages of the disease. A grade 2 HCB in the early stage is an extremely specific finding for differentiating MSA-C from SCA-3.
Epigenetic regulation in human cancer: the potential role of epi-drug in cancer therapy
Authors: Lu Yuanjun , Chan Yau-Tuen , Tan Hor-Yue , Li Sha , Wang Ning , Feng Yibin
Published: April 2020

Epigenetics is dynamic and heritable modifications to the genome that occur independently of DNA sequence. It requires interactions cohesively with various enzymes and other molecular components. Aberrant epigenetic alterations can lead to inappropriate onset of genetic expressions and promote tumorigenesis. As the epigenetic modifiers are susceptible to extrinsic factors and reversible, they are becoming promising targets in multiple cancer therapies. Recently, various epi-drugs have been developed and implicated in clinical use. The use of epi-drugs alone, or in combination with chemotherapy or immunotherapy, has shown compelling outcomes, including augmentation of anti-tumoral effects, overcoming drug resistance, and activation of host immune response.
Trans fatty acid intake among Chinese population: a longitudinal study from 1991 to 2011
Authors: Jiang Liying , Shen Junjie , Zhao Yuxia , Li Jianwen , Liu Sana , Liu Yujie , Wang Huijun , Su Chang , Zhuang Xun , Chen Nianhong , Liu Aidong
Published: April 2020

Objective

This study was aimed to roughly describe individual Trans Fatty Acids (TFAs) intake and the percentage of energy intake(E%), and identify major food sources in the Chinese population, taking gender, age, and regional distribution into the consideration, as well as examining temporal changes over the course of 20 years.

Method

This multi-center study, covering nine provinces among populations aged ≥ 3 in China, was conducted to collect food consumption information from 1991 to 2011. A classical assessment method was used to estimate the level of dietary TFA intake.

Results

Over the 20-year period, the intake of TFAs in Chinese populations had increased, but remained at a relatively lower level (from 0.25 g/d(0.11% for E%) to 0.53 g/d(0.24% for E%)) compared with that of other countries and the World Health Organization (WHO) recommended level. Collectively, males and participants aged 19–60 generally consumed more TFA-containing foods. People in eastern regions consumed more TFAs and had a higher E% than those in western area. Industrial sources of TFAs, especially vegetable oil, ranked as the principal food sources of TFAs in the Chinese population. Natural sources of TFAs have gradually increased in proportion among children and adolescents.

Conclusions

TFA intake and the E% are commonly under the recommended level in the general population in China. Presently, restriction of vegetable oil could be a crucial method to reduce TFA intake. It would be critical to facilitate and promote public health that food recommendations might be based on the dietary preferences for population separated by different ages and regions.
Feasibility and acceptability of an innovative adherence intervention for young adults with childhood-onset systemic Lupus Erythematosus
Authors: Harry Onengiya , Crosby Lori E. , Mara Constance , Ting Tracy V. , Huggins Jennifer L. , Modi Avani C.
Published: April 2020

Background

In Childhood-Onset Systemic Lupus Erythematosus (cSLE), poor medication adherence rates are very high. Interventions targeting this problem in cSLE are limited thus effective interventions are needed. The objective of this study is to examine the feasibility and acceptability an intervention (automated digital reminders + personalized prescribed treatment plan (pPTP)) to improve medication adherence in young adults with cSLE over 3 months.

Method

This is a proof-of-concept randomized controlled study. All participants received SimpleMed+ pillboxes that track adherence. The treatment group received a pPTP, and in month 2, preselected digital reminders for missed doses. Reminders were discontinued after 30 days and adherence data collected. Data analysis was done using t-tests.

Results

Twenty-one participants were approached and nineteen consented to participate, yielding a recruitment rate of 86%. Participants were on average 20.5 years, mostly black (58%) and female (84%). Of the nineteen consented, eleven were randomized to control (57%) and eight to treatment (42%) groups respectively. All participants in the treatment group rated the pillbox as easy to use, notably; none reported boredom with the pillbox or reminders. Also, 88% of participants in the treatment group rated the pillbox as helpful, however, only 50% reported the pPTP taught them new information about lupus or made them more interested in their lupus management.

Conclusions

This is the first use of an electronic pillbox to track adherence to multiple medications in cSLE. The high rating of the pillbox makes it an acceptable method of measuring adherence. Feasibility and acceptability ratings for the intervention were mixed suggesting a there is a subset of cSLE patients for whom this intervention would be beneficial. Future research should focus on a larger trial.
Maternal depression is associated with altered functional connectivity between neural circuits related to visual, auditory, and cognitive processing during stories listening in preschoolers
Authors: Farah Rola , Greenwood Paige , Dudley Johnathan , Hutton John , Ammerman Robert T. , Phelan Kieran , Holland Scott , Horowitz-Kraus Tzipi
Published: April 2020

Background

Maternal depression can influence the early activity of a mother reading stories to a young child, as depressed mothers are less likely to read to their children. Here, maternal depression association to neurobiological circuitry of narrative comprehension, visualization, and executive functions during stories listening was examined in 21 4-year-old girls and their mothers. Maternal depression scores were collected from the mothers, and functional MRI during stories listening was collected from the children.

Results

Increased maternal depression was related to decreased functional connectivity between visualization and auditory regions and increased connectivity between the right visual cortex and dorsolateral prefrontal cortex in the children.

Conclusions

This study highlights the need to monitor maternal depression and provide interventions to ensure positive linguistic outcomes in children.
Lessons learned from an evaluation of referrals to the emergency department
Authors: Gorodetzer Roee , Alpert Evan Avraham , Orr Zvika , Unger Shifra , Zalut Todd
Published: April 2020

Background

Emergency department (ED) crowding is an international phenomenon dependent on input, throughput, and output factors. This study aims to determine whether patterns of potentially unnecessary referrals from either primary care physicians (PCPs) or urgent care centers (UCCs) can be identified, thereby to reduce ED visits by patients who could be treated elsewhere. Literature from the United States reports up to 35% unnecessary referrals from UCCs.

Methods

A retrospective cohort study was conducted of patients referred to an ED in Jerusalem by either their PCP or a group of UCCs with a full range of laboratory tests and basic imaging capabilities between January 2017 and December 2017. The data were analyzed to identify referrals involving diagnoses, specialist consultations, and examinations unavailable in the PCP’s office or UCC (e.g., ultrasound, CT, echocardiogram, or stress test); these referrals were considered necessary for completion of the patient work-up. If patients were evaluated by an ED physician and sent home after an examination or laboratory test available at least in the UCC, the referrals were considered potentially unnecessary.

Results

Significantly more referrals were made by PCPs than UCCs (1712 vs. 280, p < 0.001). Significant differences were observed for orthopedics, general surgery, and obstetrics/gynecology referrals (p = 0.039, p < 0.001, p = 0.003). A higher percentage of patients referred by PCPs had potentially unnecessary visits compared to patients referred by UCCs (13.9% vs. 7.9%, p = 0.005).

Conclusion

A robust UCC system may help further reduce potentially unnecessary visits (including complex patients) to the ED.
Adaption and pilot implementation of an autism executive functioning intervention in children’s mental health services: a mixed-methods study protocol
Authors: Dickson Kelsey S. , Aarons Gregory A. , Anthony Laura Gutermuth , Kenworthy Lauren , Crandal Brent R. , Williams Katherine , Brookman-Frazee Lauren
Published: April 2020

Background

Youth with autism spectrum disorder (ASD) represent a growing population with significant service needs. Prominent among these needs are high rates of co-occurring psychiatric conditions that contribute to increased functional impairments and often necessitate mental health services. Executive functioning deficits are associated with ASD as well as common co-occurring conditions (e.g., attention-deficit/hyperactivity disorder) and an evidence-based intervention has been developed and tested to address executive functioning within the school context. There is an urgent need to implement indicated evidence-based interventions for youth with ASD receiving care in community mental health settings. Interventions that optimally “fit” the mental health services context as well as the complex and co-occurring mental health needs of these youth have the potential to improve key clinical outcomes for this high priority population.

Methods

This mixed-methods developmental study will apply the Exploration, Preparation, Implementation, Sustainment implementation framework and a community-academic partnership approach to systematically adapt and test an evidence-based executive functioning intervention for youth with ASD for delivery in community mental health settings. Specific aims are to (1) conduct a need and context assessment to inform the systematic adaptation an executive functioning evidence-based intervention; (2) systematically adapt the clinical intervention and develop a corresponding implementation plan, together entitled “Executive Functioning for Enhancing Community-based Treatment for ASD,” (EFFECT for ASD); and (3) conduct a feasibility pilot test of EFFECT for ASD in community mental health settings.

Discussion

Tailoring evidence-based interventions for delivery in community-based mental health services for youth with ASD has the potential to increase quality of care and improve child outcomes. Results from the current study will serve as the foundation for large-scale hybrid implementation and effectiveness trials and a generalizable approach for different service systems of care and clinical populations.

Trial registration

Clinicaltrials.gov, NCT04295512.
Effect of tuberculosis infection on mortality of HIV-infected patients in Northern Tanzania
Authors: Mollel Edson W. , Todd Jim , Mahande Michael J. , Msuya Sia E.
Published: April 2020

Background

TB and HIV are public health problems, which have a synergistic effect to each other. Despite the decreasing burden of these two diseases they still make a significant contribution to mortality. Tanzania is among the 30 high TB and HIV burden countries.

Methods

Routine data over 6 years from people living with HIV (PLHIV) attending health facilities in three regions of Northern Tanzania were analyzed, showing mortality trends from 2012 to 2017 for HIV and HIV/TB subpopulations. Poisson regression with frailty model adjusting for clustering at health facility level was used to analyze the data to determine mortality rate ratios (RR) and 95% confidence intervals (95%CI).

Results

Among all PLHIV the overall mortality rate was 28.4 (95% CI 27.6–29.2) deaths per 1000 person-years. For PLHIV with no evidence of TB the mortality rates was 26.2 (95% CI 25.4–27.0) per 1000 person-years, and for those with HIV/TB co-infection 57.8 (95% CI 55.6–62.3) per 1000 person-years. After adjusting for age, sex, residence, WHO stage, and bodyweight, PLHIV with TB co-infection had 40% higher mortality than those without TB (RR 1.4; 95% CI 1.24–1.67).

Conclusions

Over the 6-year period mortality rates for HIV/TB patients were consistently higher than for PLHIV who have no TB. More efforts should be directed into improving nutritional status among HIV patients, as it has destructive interaction with TB for mortality. This will improve patients’ body weight and CD4 counts which are protective against mortality. Among PLHIV attention should be given to those who are in WHO HIV stage 3 or 4 and having TB co-infection.