bluuebunny/crossref_metadata_2025 huggingface dataset:
The Third Paralogism
Authors: Proops Ian
Published: May 2021

This chapter analyses the third paralogism of ‘personality’ (or, equivalently, of ‘personhood’), situating the paralogistic argument in its Wolffian context. The chapter contends that Kant treats personality as an epistemic state. It offers accounts of Kant’s envisaged ‘practical use’ of the concept of a person and of his conception of what immortality would have to consist in if there were to be such a state. It scrutinizes in detail Kant’s criticisms of the separate arguments of Moses Mendelssohn and of David Fordyce for the immortality of the soul. Finally, it examines Kant’s sympathetic adaptation of Fordyce’s argument to his own, rather less ambitious, purposes—namely, the justification, or, more accurately, production and stabilization, of a ‘doctrinal belief’ in an afterlife. It offers an evaluation of the argument when it is so construed.
The Third Antinomy Resolved
Authors: Proops Ian
Published: May 2021

This chapter examines the resolution of the third antinomy. Kant argues that the thesis and antithesis are (roughly speaking) sub-contraries rather than contradictories. However, the sense in which he maintains that the thesis and antithesis ‘can both be true’ is delicate. He holds that the truth of neither claim excludes the truth of the other; but this is compatible with necessary falsehood of the thesis, which affirms the existence of human freedom. Importantly, Kant does not take himself to show on theoretical grounds that freedom is even logically possible. The chapter also discusses: Kant’s conceptions of intelligible causality and of empirical and intelligible character; moral responsibility; moral growth; the rationality of blame; Kant’s criticisms of Leibniz’s compatibilism; the third antinomy as an indirect argument for Transcendental Idealism; and the first-Critique’s version of a moral argument for freedom. Kant emerges as a ‘soft determinist’ of a highly unusual stripe.
The First Critique on the Physico-Theological Argument
Authors: Proops Ian
Published: May 2021

This chapter examines Kant’s criticisms of physico-theology as they are developed in the first Critique and in his pre-critcal work, The Only Possible Basis for a Demonstration of the Existence of God. By ‘physico-theology’ Kant means the project of arguing from the (apparent) fact that the world contains end-directed or ‘purposive’ natural features and arrangements to the existence of God conceived of as an all-powerful, perfectly wise, and benevolent creator—an ‘Author of Nature’, who brings the world into existence through His wisdom and free choice. Kant’s attitude to this project is complex: while he rejects physico-theology in its traditional, crude form (the so-called ‘ordinary’ physico-theology), he nonetheless endorses a more sophisticated, ‘revised’ physico-theology. However, the argument he defends aims to produce, not knowledge, but only a justified ‘doctrinal belief’ in a wise and great (but not perfect) creator of matter ex nihilo: a creator-god with a small ‘g’.
Closing Reflections
Authors: Proops Ian
Published: May 2021

In this concluding chapter the main lessons of the book are reviewed, and some further problems for Kant raised. The chapter reflects once again on Kant’s confession that he had found it necessary to deny knowledge in order to make room for faith, offering a deeper explanation of this claim than was given in the introduction. It then considers the consequences of his having regarded Transcendental Realism as not just false, but rather logically impossible. It asks whether such a view can be reconciled—given Kant’s views on contradiction—with the supposed contentfulness of transcendental illusion or with Transcendental Idealism itself. It raises a problem for Kant’s account of metaphysical error as arising from transcendental illusion. Finally, it evaluates Kant’s claim to have offered an exhaustive critique of speculative metaphysics, arguing that this is unfortunately not the case.
A new photometric study of B[e] stars in the infrared
Authors: Chen Pei-Sheng , Liu Jie-Ying , Shan Hong-Guang
Published: May 2021

We have collected almost all B[e] stars (120 stars in total) listed in the literature up to the present time. We have then photometrically studied their infrared properties by using data from IRAS, WISE, and 2MASS. From several two-color diagrams we found that infrared radiation for the majority of B[e] stars shows a power law distribution from dusty/gaseous circumstellar disks in the 1–60 μm region. We also found that, possibly due to the influence of polycyclic aromatic hydrocarbon and silicate emissions, some B[e] stars have a blackbody distribution in the 3–12 μm region, and due to the influence of clouds/nebulae nearby some B[e] stars also show blackbody distributions in the IRAS wavelengths. Furthermore, we compared infrared properties between B[e] stars and Be stars, and between B[e] stars and HAeBe stars. We show that the infrared excess of B[e] stars is much larger than for Be stars in the 1–25 μm region, while both B[e] and HAeBe stars have similar infrared color properties in the 1–25 μm region.
Under siege: virus control in plant meristems and progeny
Authors: Bradamante Gabriele , Mittelsten Scheid Ortrun , Incarbone Marco
Published: May 2021

In the arms race between plants and viruses, two frontiers have been utilized for decades to combat viral infections in agriculture. First, many pathogenic viruses are excluded from plant meristems, which allows the regeneration of virus-free plant material by tissue culture. Second, vertical transmission of viruses to the host progeny is often inefficient, thereby reducing the danger of viral transmission through seeds. Numerous reports point to the existence of tightly linked meristematic and transgenerational antiviral barriers that remain poorly understood. In this review, we summarize the current understanding of the molecular mechanisms that exclude viruses from plant stem cells and progeny. We also discuss the evidence connecting viral invasion of meristematic cells and the ability of plants to recover from acute infections. Research spanning decades performed on a variety of virus/host combinations has made clear that, beside morphological barriers, RNA interference (RNAi) plays a crucial role in preventing—or allowing—meristem invasion and vertical transmission. How a virus interacts with plant RNAi pathways in the meristem has profound effects on its symptomatology, persistence, replication rates, and, ultimately, entry into the host progeny.
Innate Immune and Neuronal Genetic Markers Are Highly Predictive of Postoperative Pain and Morphine Patient-Controlled Analgesia Requirements in Indian but Not Chinese or Malay Hysterectomy Patients
Authors: Barratt Daniel T , Sia Alex T , Tan Ene-Choo , Somogyi Andrew A
Published: May 2021

Objective

Pain severity and opioid requirements in the postoperative period show substantial and clinically significant inter-patient variation due mainly to factors such as age, surgery type, and duration. Genetic factors have not been adequately assessed except for the neuronal OPRM1 rs1799971 and COMT rs4680, whereas the contribution of innate immune signaling pathway genetics has seldom been investigated.

Setting

Hospital surgical ward.

Subjects

Women (107 Indian, 184 Malay, and 750 Han Chinese) undergoing total hysterectomy surgery.

Methods

Morphine consumption, preoperative pain, and postoperative pain were evaluated in relation to genetic variability comprising 19 single-nucleotide polymorphisms (SNPs) in 14 genes involved in glial activation, inflammatory signaling, and neuronal regulation, plus OPRM1 (1 SNP) and COMT (3 SNPs).

Results

Pre- and postoperative pain and age were associated with increased and decreased morphine consumption, respectively. In Chinese patients, only 8% of the variability in consumption could be explained by these nongenetic and genetic (BDNF, IL1B, IL6R, CRP, OPRM1, COMT, MYD88) factors. However, in Indian patients, 41% of morphine consumption variability could be explained by age (explaining <3%) and variants in OPRM1 rs1799971, CRP rs2794521, TLR4 rs4986790, IL2 rs2069762, COMT rs4818, TGFB1 rs1800469, and IL6R rs8192284 without controlling for postoperative pain.

Conclusions

This is the highest known value reported for genetic contributions (38%) to morphine use in the acute postoperative pain setting. Our findings highlight the need to incorporate both genetic and nongenetic factors and consider ethnicity-dependent and nonadditive genotypic models in the assessment of factors that contribute to variability in opioid use.
Recent developments in engineering protein–protein interactions using phage display
Authors: Liang Chen T , Roscow Olivia M A , Zhang Wei
Published: May 2021

Targeted inhibition of misregulated protein–protein interactions (PPIs) has been a promising area of investigation in drug discovery and development for human diseases. However, many constraints remain, including shallow binding surfaces and dynamic conformation changes upon interaction. A particularly challenging aspect is the undesirable off-target effects caused by inherent structural similarity among the protein families. To tackle this problem, phage display has been used to engineer PPIs for high-specificity binders with improved binding affinity and greatly reduced undesirable interactions with closely related proteins. Although general steps of phage display are standardized, library design is highly variable depending on experimental contexts. Here in this review, we examined recent advances in the structure-based combinatorial library design and the advantages and limitations of different approaches. The strategies described here can be explored for other protein–protein interactions and aid in designing new libraries or improving on previous libraries.
Protein engineering for natural product biosynthesis and synthetic biology applications
Authors: Calzini Miles A , Malico Alexandra A , Mitchler Melissa M , Williams Gavin J
Published: May 2021

As protein engineering grows more salient, many strategies have emerged to alter protein structure and function, with the goal of redesigning and optimizing natural product biosynthesis. Computational tools, including machine learning and molecular dynamics simulations, have enabled the rational mutagenesis of key catalytic residues for enhanced or altered biocatalysis. Semi-rational, directed evolution and microenvironment engineering strategies have optimized catalysis for native substrates and increased enzyme promiscuity beyond the scope of traditional rational approaches. These advances are made possible using novel high-throughput screens, including designer protein-based biosensors with engineered ligand specificity. Herein, we detail the most recent of these advances, focusing on polyketides, non-ribosomal peptides and isoprenoids, including their native biosynthetic logic to provide clarity for future applications of these technologies for natural product synthetic biology.
A dignified death: management of dead bodies during COVID-19
Authors: Corpuz Jeff Clyde G
Published: May 2021

The emergence of coronavirus disease-2019 (COVID-19) has caused unprecedented challenge to manage the bodies of the dead. The disposal of the dead becomes a challenge as there is a shortage of coffins, and crematoriums are overwhelmed. A recent correspondence published in the Journal of Public Health highlighted the importance of performing the last rites in a time of COVID-19 pandemic. This paper argues that the bodies of those who have died because of COVID-19 should be treated with respect and dignity.
Odds stacked against workers: datafied gamification on Chinese and American food delivery platforms
Authors: van Doorn Niels , Chen Julie Yujie
Published: May 2021

This article presents a cross-national comparative study examining how American and Chinese platform companies approach the gamification of on-demand food delivery. The study, based on ethnographic fieldwork in New York City and Beijing, shows how couriers in these cities negotiate the gamified app-based systems designed to convince them to log in and keep working. We argue that such systems are not only a salient form of ‘algorithmic management’—as has been argued before—but also demonstrate the central importance of datafication within the organizational strategies of food delivery companies operating under conditions of financialized platform capitalism. Indeed, the deeply financialized nature of the on-demand food delivery industry creates conditions in which companies experiment with data-driven gamification techniques in an effort to manipulate their flexible labor supply in an agile and cost-effective way—to thereby elicit higher productivity and meet expectations of investors and shareholders. Our comparative analysis challenges assumptions of a universal mode of gamification and highlights the differences between such situated techniques and their impacts on workers, identifying two distinct design approaches that we term ‘Deal or No Deal’ in New York and ‘Grab-and-Stack’ in Beijing.
Economic impact of digital dermatitis, foot rot, and bovine respiratory disease in feedlot cattle
Authors: Cortes Julian Alberto , Hendrick Steve , Janzen Eugene , Pajor Ed A , Orsel Karin
Published: May 2021

Digital dermatitis (DD) has emerged in North American feedlots, although production and economic impacts are not fully understood. Objectives of this study were to: (1) estimate the economic impact of a single case of DD, foot rot (FR), and bovine respiratory disease (BRD) in feedlot cattle and (2) determine its impact on average daily gain (ADG). Feedlot cattle health and production records were available from two feedlots for a 3-yr interval. The dataset consisted of 77,115 animal records, with 19.3% (14,900) diagnosed with a disease. Diseased animals were categorized into five groups: DD, FR, BRD, other diseases (OT), and two or more diseases (TM), with a treatment cumulative incidence of 6.0%, 59.1%, 10.7%, 12.7%, and 11.5%, respectively. FR was the disease with the highest cumulative incidence in both heifers and steers (58.8% and 59.6%, respectively). Of all fall-placed cattle diagnosed with any disease, 48.1% of the cases were FR. DD affected the partial budget in five out of the eight groups of cattle, with the highest impact of DD seen in grass yearling heifers and grass yearling steers: $-98 and $-96 CAD, respectively, relative to their healthier counterparts. Healthy cattle had a significantly higher ADG when compared with DD cattle in five of the eight categories, ranging from 0.11 kg/d in winter-placed heifers to 0.17 kg/d in fall-placed steers. In the economic analysis, it was concluded that on an individual animal basis, BRD was the most impactful of all analyzed diseases, whereas DD was second, marking the importance of controlling and mitigating this foot condition. Identifying differential effects of diseases on a partial budget analysis and ADG of the types of cattle stratified by sex enables feedlot producers to focus control and mitigation strategies on specific groups.
Using the behavior change wheel to develop text messages to promote diet and physical activity adherence following a diabetes prevention program
Authors: MacPherson Megan M , Cranston Kaela D , Locke Sean R , Bourne Jessica E , Jung Mary E
Published: May 2021

Lay Summary

Making changes to one’s physical activity and diet can reduce future risk of developing type 2 diabetes. That being said, making life-long changes to complex behaviors such as diet or physical activity is easier said than done. Text messages can be used to improve long-term diet and physical activity changes; however, it can be difficult to identify what should be said in a text message to nudge those behaviors. To improve utility and reduce cost of sending unnecessary messages, theory should be used in developing text messaging content. The current study used the Behavior Change Wheel to develop a library of text messages that can be used to improve diet and physical activity in individuals who have taken part in an effective community-based diabetes prevention program. The Behavior Change Wheel guides researchers to develop real-world interventions based on evidence and theory. Overall, we created a library of 124 theory-based messages which can be further tested following a diabetes prevention program.
Rapid testing of gut permeability using oral fluorescein and confocal laser endomicroscopy in Zambian adults
Authors: Mbuki Reuben , Chileya Sandra , Thompson Alex J , Kelly Paul , Kayamba Violet
Published: May 2021

Background

Dual sugar testing for gut permeability is time-consuming and complex. We explored the utility of fluorescein as a simple and inexpensive alternative method.

Methods

We used a confocal laser endomicroscopy probe placed at the fingertip of participants who had ingested sodium fluorescein to measure the fluorescence at various time points.

Results

In 10 patients with diarrhoea, but not in 10 controls, fluorescence was detected quickly. By 6 min fluorescence was detected in all diarrhoea patients but only 1 control (p=0.0004). After 15 min there was no difference between the groups.

Conclusions

This simple oral fluorescein test may be useful to study gut permeability in low-resource settings.
Should Iran join the United Nations Convention on Contracts for the International Sale of Goods?
Authors: Moghaddam Abrishami Ali
Published: May 2021

After 40 years of the United Nations Convention on Contracts for the International Sale of Goods (CISG), it is still controversial whether the CISG has been a successful uniform law in practice. It is, nevertheless, evident that the number of ratifications of the CISG has been increasing. This article aims to highlight the important question of whether Iran should implement the CISG. In addition, it argues that irrespective of the possible ratification of the CISG, the Iranian contract law needs to be modernized. In particular, advantages and disadvantages of the possible adoption of the CISG in Iran are explored. This article argues that acceding to the CISG will provide Iran with a number of opportunities, including the promotion of international trade with its trading partners. In proposing a model for the modernization of the Iranian Civil Code (CCI), the author, however, argues that the CISG is not the best option. Instead, the Unidroit Principles of International Commercial Contracts (PICC) is the most appropriate model for reforming the Iranian contract law. This article concludes by suggesting that the combination of the CISG and the PICC is the best way forward for the Iranian legal system.
Quantifying Regional and Health Care Variations to Identify Ways to Improve Hemodialysis Service Quality and Survival Outcomes
Authors: Jamal Aziz , Babazono Akira , Li Yunfei , Yoshida Shinichiro , Fujita Takako , Kim Sung-A
Published: May 2021

The authors examined variations in hemodialysis care and quantified the effect of these variations on all-cause mortality. Insurance claims data from April 1, 2017 to March 30, 2018 were reviewed. In total, 2895 hospital patients were identified, among whom 398 died from various causes. Controlling effects of the facility and secondary medical care areas, all-cause mortality was associated with older age, heart failure, malignancy, cerebral stroke, severe comorbidity, and the first and ninth centile of physician density. Multilevel analyses indicated a significant variation at facility level (σ2
2 0.27, 95% confidence interval: 0.09-0.49). Inclusion of all covariates in the final model significantly reduced facility-level variance. Physician density emerged as an important factor affecting survival outcome; thus, a review of workforce and resource allocation policies is needed. Better clinical management and standardized work processes are necessary to attenuate differences in hospital practice patterns.
Supporting the Patient on LSD Day
Authors: Todd Betsy
Published: May 2021

Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.

During the 1960s, the therapeutic effects of lysergic acid diethylamide (LSD) were studied in psychiatric clinical settings. In this February 1964 article, nurse Kay Parley writes enthusiastically about this work at one such research hospital. She describes the benefits of LSD therapy for patients with alcoholism, as well as the richness of the experience for the nurse who guides the patient through treatment. “No role is so welcomed on our psychiatric unit than that of ‘sitting’ with a patient during LSD therapy.”

Parley vividly describes the nurse's role in these treatments. Her own long hospitalization for “manic-depressive psychosis” and treatment with LSD undoubtedly framed her approach to this therapy.

Today there is renewed interest in the therapeutic use of psychoactive substances such as LSD. Penn and colleagues provide an update in “Psychedelic-Assisted Therapy” in this issue.—Betsy Todd, MPH, RN
Preventing Shoulder Injury Related to Vaccine Administration
Authors: Shoemaker Scarlett
Published: May 2021

Shoulder injury related to vaccine administration (SIRVA) is a preventable complication caused by improper needle placement. It is associated with persistent shoulder pain and limited range of motion that occur within hours of vaccination and can last for months or longer. This article provides a brief overview of SIRVA and explains how vaccinators can prevent it by using proper injection technique.
Measurement in Nursing Research
Authors: Curtis Alexa Colgrove , Keeler Courtney
Published: May 2021

Editor's note: This is the fourth article in a series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice—from research design to data interpretation. The articles will be accompanied by a podcast offering more insight and context from the authors. To see all the articles in the series, go to http://links.lww.com/AJN/A204.
Health-Related Quality of Life Declines for Survivors of Congenital Heart Disease
Authors: Rosenberg Karen
Published: May 2021

According to this study:

Health-related quality of life declined over a brief period in adolescent and young adult survivors of congenital heart disease.
Mindfulness Meditation has Benefits for Migraine Sufferers
Authors: Rosenberg Karen
Published: May 2021

According to this study:

Mindfulness-based stress reduction may help to manage total migraine burden.
Intrauterine Versus External Tocodynamometry in Monitoring Labour: A Randomised Controlled Clinical Trial
Authors: Hautakangas T. , Uotila J. , Huhtala H. , Palomäki O.
Published: May 2021

(Abstracted from BJOG 2020;127:1677–1686)

Intrauterine tocodynamometry (IT) and external tocodynamometry (ET) are used clinically to monitor contractions during labor and guide the use of oxytocin in prolonged labor. Four randomized controlled trials (RCTs), conducted over 20 years ago, compared IT with ET in women who were given oxytocin to induce or augment labor but did not have a previous cesarean delivery (CD).
The World Ovarian Cancer Coalition Every Woman Study: Identifying Challenges and Opportunities to Improve Survival and Quality of Life
Authors: Reid Frances , Bhatla Neerja , Oza Amit M. , Blank Stephanie V. , Cohen Robin , Adams Tracey , Benites Amanda , Gardiner Diane , Gregory Sylvia , Suzuki Makiko , Jones Annwen
Published: May 2021

(Abstracted from Int J Gynecol Cancer 2021;31:238–244)

The prognosis for ovarian cancer remains poor even in highly developed countries such as the United States, with approximately 1 in 6 women dying within 3 months of diagnosis and 1 in 2 dying within 5 years. Given that the global incidence of ovarian cancer is set to rise 55% by 2035, urgent action is required to improve survival and quality of life in this patient population.
Self-management Factors Associated With Quality of Life Among Women With Endometriosis: A Cross-sectional Australian Survey
Authors: O'Hara Rebecca , Rowe Heather , Fisher Jane
Published: May 2021

(Abstracted from Hum Reprod 2021;36(3):647–655)

Endometriosis is a chronic inflammatory condition characterized by endometrial tissue growing outside of the uterus, resulting in chronic pain and reduced quality of life requiring long-term multimodal management including surgery, analgesic medications, and hormonal therapy. Self-management of one's chronic disease is a concept defined as the active participation of the patient in planning decision-making and undertaking tasks to manage the symptoms, treatment, and physical and psychological changes involved in living with a chronic disease.
Work-Related Factors and Pregnancy Outcomes in Female Surgeons
Authors: Malcolm Rebecca J. , Pilkington Mercedes , Merchant Shaila J. , Velez Maria P. , Brogly Susan B.
Published: May 2021

Objective:

To describe work-related factors, pregnancy, and pregnancy outcomes in female surgeons is the objective of this study.

Background:

Some data suggest surgeon workload may deter pregnancy and adversely affect pregnancy outcomes in female surgeons.

Methods:

A cross-sectional, web-based survey was distributed via e-mail to members of the Society of Obstetrics and Gynaecologists of Canada and to surgical departments of 6 Canadian universities from October 2019 to January 2020.

Results:

A total of 223 surgeons with 451 pregnancies participated. Work hours were reduced in 33.3% of pregnancies, and 28.0% had a policy for pregnancy in their workplace. A total of 57% of surgeons intentionally delayed pregnancy due to heavy workload and 39% to career concerns, and 31% reported work adversely affected their pregnancy. Adverse maternal outcomes included miscarriage (14.9%), preterm labor (6.2%), hypertension (5.5%), pre-eclampsia (2.9%), and placenta praevia (1.3%). Adverse infant outcomes included preterm birth (6.9%), small for gestational age at birth (6.9%), and neonatal intensive care unit admission (4%). Congenital anomalies occurred in 4.2% of pregnancies. Surgeons who reported a policy for working while pregnant were more likely to have reduced their work hours than those without a policy (48.4% vs 28.5% respectively, P < 0.0001). In unadjusted models, those who reduced their work hours while pregnant were less likely to have a miscarriage than those who did not (odds ratio = 0.2, 95% confidence interval, 0.1–0.4).

Conclusions:

Female surgeons reported delays in pregnancy due to work, adverse effects of work on pregnancy, and some elevated rates of adverse outcomes. These data support policies for pregnancy in surgeons and surgical trainees.
Be Part of the Conversation: Audiology Messaging During a Hearing Screening
Authors: St. Jean Craig Richard , Cummine Jacqueline , Singh Gurjit , Hodgetts William E.
Published: May 2021

Objectives:

The moment patients learn the results from a hearing assessment can be a critical juncture on their journey to rehabilitation. Message framing (e.g., the positive or negative manner in which information is presented) has been explored in a wide range of health contexts as a method for shaping patients’ decision-making. This study investigated whether attitudes toward hearing loss treatment varied as a function of how messages about treatment were framed, and whether such attitudes differed as a function of participants being led to believe they had failed a hearing screening.

Methods:

Sixty-four participants (18 to 39 years of age) took the Hearing in Noise Test. In the sound booth, participants saw a poster bearing either a gain-framed or loss-framed message about hearing loss treatment. During the test, half the participants were interrupted by the researcher who stated that their performance appeared to suggest a hearing loss, with the caveat that it might be due to an equipment malfunction. While the researcher investigated the problem, the participants completed an 11-item questionnaire asking about their attitudes toward help seeking for hearing loss. Participants in the control group completed the same questionnaire with no interruption.

Results:

Statistical analyses revealed no significant interaction effect between message type and experimenter feedback condition, though a significant main effect was present for message type. Post hoc testing showed medium to large effect sizes as a function of message type on five of the 11-questionnaire items. These data indicated that participants were more likely to endorse health-positive responses (i.e., greater interest in hearing treatment) when exposed to the gain-framed message than the loss-framed message.

Conclusions:

The greater likelihood of health-positive responses in the presence of the gain-framed message suggests that this framing strategy may have a positive influence on attitudes toward hearing health behaviors among individuals under 40 years of age with no history of hearing loss.
Trends in Leadership at Pediatric Orthopaedic Fellowships
Authors: Cohen Lara L. , Sama Andrew J. , Schiller Nicholas C. , Spielman Amanda F. , Donnally Chester J. , Shore Benjamin J. , Glotzbecker Michael P.
Published: May 2021

Background:

Pediatric orthopaedic fellowship directors (FDs) have a valuable impact on the education of trainees and future leaders in the field. There is currently no research on the characteristics of pediatric orthopaedic FDs.

Methods:

Programs were identified using the Pediatric Orthopaedic Society of North America fellowship directory. Operative, nonoperative, and specialty programs were included. Data was collected through Qualtrics survey, e-mail, telephone, and online searches. Variables included demographics (age, sex, race/ethnicity), Hirsch index (h-index) as a measure of research productivity, graduate education, residency and fellowship training, years of hire at current institution and as FD, and leadership roles.

Results:

Fifty-five FDs were identified. The majority (49/55, 89%) were male and 77% (27/35) were Caucasian. The mean age at survey was 51.1±8.2 years. The mean h-index was 17.2. Older age correlated with higher h-index (r=0.48, P=0.0002). The average duration from fellowship graduation to FD appointment was 9.6±6.7 and 6.9±6.1 years from institutional hire. Sixteen FDs (29%) had additional graduate level degrees. Almost all (52/55, 95%) FDs completed orthopaedic surgery residencies and all graduated fellowship training. Twenty-nine percent (16/55) completed more than 1 fellowship. Most FDs (51/55, 93%) completed a fellowship in pediatric orthopaedic surgery. Ten FDs (18%) completed pediatric orthopaedic surgery fellowships that included spine-specific training. One-third of all current FDs were fellowship-trained at either Boston Children’s Hospital (9/55, 16%) or Texas Scottish Rite Hospital for Children (9/55, 16%).

Conclusions:

Pediatric orthopaedic FDs are typically early-career to mid-career when appointed, with a strong research background. Nearly a third completed additional graduate degrees or multiple fellowships. Although male dominated, there are more female FDs leading pediatric orthopaedic programs compared with adult reconstruction, trauma, and spine fellowships. As fellowships continue to grow and diversify, this research will provide a baseline to determine changes in FD leadership.
Gynecological sarcomas: literature review of 2020
Authors: Hanvic Brunhilde , Ray-Coquard Isabelle
Published: May 2021

Purpose of review

This article, focus on recently published data of the last 18 months on the management of gynecologic sarcomas.

Recent findings

Different tools have been studied to identify the differences between benign from malignant uterine conjonctive tumor.

Molecular biology impact more and more on the diagnosis of uterine sarcoma with new definitions of very specific groups. This will make it possible to better define the last group of endometrial sarcoma which has been defined as undifferentiated.

In several articles, surgical approaches and fertility-sparing surgery were described including the role of surgery for recurrences.

Some other articles have evaluated the potential benefice of adjuvant therapy for uterine sarcoma with early stages.

Several new targeted therapies are in development. Notably deoxyribonucleic acid repair machinery in uterine leiomyosarcoma and also immune therapies, transforming growth factor beta pathway, mechanistic target of rapamycin inhibitor, anti angiogenics, etc.

This last year the potential interest for uterine sarcoma increased, demonstrated by the increasing number of publications in the literature compared to previous years. Despite this greater interest over time, the standard of care for uterine sarcoma does not change and we are always waiting for new innovative therapies able to change routine practice and survival of patients. Currently, the result of different clinical trials, which include new options as targeted molecular approach or immune checkpoint inhibitors are closed to be reported.
ADCY2 rs10059539 C>T polymorphism confers a decreased risk of hepatocellular carcinoma in Chinese Han women
Authors: Chao Xu , Miao Feng , Feng Xuesong , Shi Hailong , Wang Yuewen , Wu Jieqiong , Zhao Luyan , Zhang Wei , Jiang Chao
Published: May 2021

Objective

Hepatocellular carcinoma (HCC) poses a serious threat to human health. ADCY2 gene polymorphisms may be related to HCC susceptibility. Therefore, we investigated whether ADCY2 gene polymorphisms are correlated to the risk of HCC in a Chinese Han population.

Methods

In a case-control study, we examined the associations between single nucleotide polymorphisms (SNPs) in ADCY2 and HCC risk. In 434 HCC cases and 442 healthy controls, we used the Agena MassARRAY platform to select and genotype four tag SNPs in ADCY2. We used logistic regression after adjusting for age and sex to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Results

The results showed that ADCY2 rs10059539 polymorphism was associated with a reduced susceptibility to HCC in women under the dominant model (TC/TT vs. CC; OR = 0.32; 95% CI = 0.13–0.83; P = 0.018) and the log-additive model (OR = 0.32; 95% CI = 0.13–0.83; P = 0.018).

Conclusions

Our results support the hypothesis that ADCY2 gene polymorphisms influence the genetic susceptibility to HCC.
Prognostic Value of the Tumor Immune Microenvironment for Early-stage, Non−Small Cell Lung Cancer
Authors: Tuminello Stephanie , Petralia Francesca , Veluswamy Rajwanth , Wang Pei , Flores Raja , Taioli Emanuela
Published: May 2021

Introduction:

The role of specific immune cell types within the tumor immune microenvironment in non−small cell lung cancer survival is unclear. The potential of these immune cells to become predictive biomarkers of prognosis, and to define subpopulations who will benefit of additional treatment is urgently needed.

Methods:

Stage I to IIIA non−small cell lung cancer patients who underwent surgical resection were queried from the Cancer Genome Atlas; RNAseq data as well as clinical information was extracted. Sample-specific scores for different immune cells were computed via xCell. The association between each cell type and survival was assessed with Cox regression, both unadjusted and adjusted for sex, stage, smoking status, and tumor purity. Models were stratified by lung adenocarcinoma and lung squamous cell carcinoma.

Results:

There were 383 lung adenocarcinoma and 328 lung squamous cell carcinoma samples, and 161 (42%) and 124 (38%) deaths respectively. There was no association between any immune cell infiltrations and survival in the combined unadjusted Cox regression model. After adjustment, the presence of CD8+ cytotoxic T cells (adjusted hazard ratio [HRajd]: 0.84; 95% confidence interval [CI]: 0.71-0.99; P=0.03), CD4+ helper T cells (HRajd: 0.79; 95% CI: 0.66-0.95; P=0.01) and CD20+ B cells (HRajd: 0.80; 95% CI: 0.66-0.97; P=0.02) were significant predictors of decreased risk of death.

Conclusions:

This study shows that the adjustment for clinical characteristics is key when evaluating tumor immune infiltration and its association with cancer outcomes. Adjustment for confounding factors modified the prognostic significance of specific immune cell populations in early-stage surgically resected NSCLC cases; clinical attributes may have high relevance on immune infiltration composition.
Measurement and Identification of Parenting Behaviors Associated with Social-Emotional Outcomes in Children: The Racial and Cultural Appropriateness of a Commonly Used Parenting Measure
Authors: Guerrero Alma D. , Biely Christopher , Dudovitz Rebecca , Coker Tumaini , Iyer Sai , Barnert Elizabeth , Szilagyi Peter , Szilagyi Moira , Chung Paul J.
Published: May 2021

Objective:

The objective of this study was to examine parenting styles (observed parent-child interactions via the Two-Bag Task) associated with young children's socioemotional outcomes, comparing children from Mexican-American and African American families with children from their White counterparts.

Methods:

The Early Childhood Longitudinal Study Birth Cohort data were used to examine 6 global parenting styles with socioemotional outcomes at 48 months of age while controlling for both time-independent and time-depending sociodemographic, maternal mental health, and child characteristics. Data were stratified by race and ethnicity, and weighted longitudinal linear regressions models were estimated using STATA/Xtmixed.

Results:

The 6 global parenting scores from the Two-Bag Task measures differed across White, African American, and Mexican-American groups of parents. White parents on average scored higher on parenting styles related to sensitivity, positive regard, and cognitive stimulation, whereas Mexican-American and African American parents scored lower. These parenting styles were associated with both approach to learning and social competence outcomes among White children but were nearly nonexistent for Mexican-American and African American children when adjusting for covariates.

Conclusion:

Our results highlight the need to critically evaluate measures of parenting behaviors used in research studies with racially and ethnically diverse families. Examining the comprehensive psychometric properties and cultural appropriateness of parenting measures for diverse families is important to optimally support child development for non-White children. Furthermore, a critical lens is important to mitigate the perpetuation of inaccurate research findings for Mexican-American and African American children.
Comparison of topical fractional CO2 laser and vaginal estrogen for the treatment of genitourinary syndrome in postmenopausal women: a randomized controlled trial
Authors: Dutra Paula Fernanda Santos Pallone , Heinke Thais , Pinho Stella Catunda , Focchi Gustavo Rubino Azevedo , Tso Fernanda Kesselring , de Almeida Bruna Cristine , Silva Ivaldo , Speck Neila Maria Góis
Published: May 2021

Objective:

To compare the efficacy of fractional CO2 laser therapy with topical estrogen therapy for the treatment of postmenopausal genitourinary syndrome of menopause.

Methods:

We conducted a randomized controlled clinical trial involving 25 postmenopausal women. Participants were aged between 50 and 65 years with at least 1 year of amenorrhea and follicle-stimulating hormone levels of >40 IU/L. The women were randomized into two groups: the laser therapy group (n = 13) and the vaginal topical estrogen therapy group (n = 12). Changes in the vaginal epithelium thickness, Frost index, and cell maturation were analyzed in both the groups. The female sexual quotient of each woman was also evaluated. Subjective evaluation was performed through a physical examination.

Results:

Histological analysis showed a significant increase in the vaginal epithelium thickness at the end of treatment in females in both the laser therapy (P < 0.001) and topical estrogen therapy (P = 0.001) groups. The topical estrogen therapy group tended to present a higher maturation index at the end of treatment when compared with that of the other group. Sexual function increased significantly over time in both the topical estrogen therapy (P < 0.001) and laser therapy (P < 0.001) groups. Subjective evaluation through physical examination showed a significant improvement in atrophy in both the groups.

Conclusion:

Despite the nonequivalence with topical estrogen therapy, our data suggest that laser therapy is an effective method for the treatment of vulvovaginal atrophy.
Is climacterium by the mid-40s associated with thyroid dysfunction or autoimmunity? A population-based study
Authors: Savukoski Susanna M. , Niinimäki Maarit J. , Pesonen Paula R.O. , Auvinen Juha P. , Männistö Tuija , Puukka Katri S. , Ebeling Tapani , Suvanto Eila T.J.
Published: May 2021

Objective:

We investigated whether more advanced climacteric stage in the mid-40s is associated with thyroid autoimmunity and dysfunction.

Methods:

This cross-sectional cohort study included 2,569 46-year-old women. Thyroid hormone, thyroid peroxidase antibodies, and follicle-stimulating hormone levels were determined. Using menstrual history and follicle-stimulating hormone levels, the participants were divided into climacteric (n = 340) and preclimacteric (n = 2,229) groups. Women diagnosed with premature ovarian insufficiency (menopause by 40 y of age) were excluded. The use of thyroid medication was evaluated from the medication reimbursement register. The prevalence of thyroid medication use, laboratory-based thyroid dysfunction, and thyroid peroxidase antibody positivity was compared between the two groups. The association between climacteric status and thyroid disorders was investigated using a logistic regression model including smoking and thyroid antibody status.

Results:

At 46 years old, climacteric women used thyroid medication more often than preclimacteric women (9.1% vs 6.1%; P = 0.04). There was no difference in the prevalence of subclinical or clinical hypothyroidism and hyperthyroidism in nonmedicated participants (5.5% vs 5.0%; P = 0.7) or thyroid peroxidase antibody positivity (14.0% vs 15.0%, P = 0.7). In the regression model, being climacteric (OR = 1.6; 95% CI 1.1-2.3; P = 0.02) and antibody positivity (OR 4.9; 95% CI 3.6-6.6; P < 0.001) were associated with a higher prevalence of thyroid dysfunction.

Conclusions:

More advanced climacteric stage in the mid-40s was slightly associated with thyroid dysfunction but not thyroid autoimmunity.

Video Summary:

http://links.lww.com/MENO/A771.
TAP AND INJECT VERSUS PARS PLANA VITRECTOMY FOR POSTPROCEDURAL ENDOPHTHALMITIS
Authors: Far Parsa M. , Yeung Shanna C. , Farimani Pedram L. , Qian Jenny , Zhang Angela Q. , Kertes Peter J. , You Yuyi , Yan Peng
Published: May 2021

Purpose:

To compare the visual outcomes after prompt pars plana vitrectomy (PPV) with tap biopsy and intravitreal antimicrobial injection to treat postinjection and postsurgery endophthalmitis.

Methods:

The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Ovid Embase databases were searched for articles published between January 2010 and November 2020. Two independent reviewers selected articles and extracted data. We analyzed data in RevMan 5.3 and assessed methodological quality using the Cochrane ROBINS-I tool. The mean improvement in visual outcome was compared between PPV and intravitreal antimicrobial injection as a relative risk of improving ≥2 lines and a mean logarithm of the minimal angle of resolution difference in improvement.

Results:

Fifteen retrospective case series (1,355 eyes), of which 739 eyes (55%) received intravitreal antimicrobial injection and 616 (45%) received PPV as initial treatment, were included. The overall relative risk of improving 2 or more lines in PPV in comparison with intravitreal antimicrobial injection was 1.04 (95% CI 0.88–1.23; P = 0.61; I2 = 0%) with a mean difference of 0.04 (95% CI −0.18 to 0.27; P = 0.69; I2 = 0%). The results stayed robust when subgroup analysis based on causative procedure for endophthalmitis was performed.

Conclusion:

Intravitreal antimicrobial injection is noninferior to PPV for the treatment of postcataract operation, postinjection, and post-PPV endophthalmitis.
MÜLLER CELL CONE–ASSOCIATED FOVEAL DETACHMENT AS A RISK FACTOR FOR VISUAL ACUITY LOSS AFTER GLAUCOMA FILTERING SURGERY
Authors: Chihara Etsuo , Chihara Tomoyuki , Matsuzaki Shoko
Published: May 2021

Purpose:

To examine hypotony-associated foveal lesions (FovLs) using optical coherence tomography, and to assess the risk factors of visual deterioration after glaucoma filtering surgery.

Methods:

Parameters that may be associated with postsurgical deterioration of visual acuity were retrospectively studied in 44 eyes of 44 patients who experienced postsurgical intraocular hypotension ≤6 mmHg between 2015 and 2019.

Results:

Six eyes (14%) had FovLs, such as detachment of photoreceptors (5 eyes, 11%) and acquired vitelliform lesions (1 eye, 2%) at 3 months after trabeculectomy. Logistic regression analysis revealed that hypotony maculopathy (P = 0.0141 at 3 months) and FovLs (P = 0.0486 and 0.0296 at 3 and 12 months, respectively) were significant risk factors for Visual acuity loss after trabeculectomy. The FovLs were located just behind the Müller cell cone. Visual acuity at 3 and 12 months after surgery in patients with FovLs was significantly lower than in those without FovLs (P = 0.0013 and P = 0.006, respectively). Epiretinal membrane was more common in eyes with FovLs (5 of 6 eyes, 83%) than in eyes without FovLs (7 of 38 eyes, 18%; P = 0.0037).

Conclusion:

Müller cell cone–associated FovLs lead to long-lasting visual acuity loss after filtering surgery.
Comparison of Topical Instillation From Single-dose and Multidose Eye Drop Containers in Glaucoma: A Multicenter Randomized Cross-sectional Trial
Authors: Aptel Florent , Villemont Anne-Sophie , Cunnac Pierre , Sallit Rébecca , Rabilloud Muriel , Poli Muriel , Denis Philippe
Published: May 2021

Precis:

We compared the quality of instillation of topical treatments from single-dose (SGD) or multidose (MTD) containers in glaucoma patients and showed neither a significant difference between the type of container nor a significant relationship to upper limb mobility.

Purpose:

To describe and compare the quality of instillation of topical treatments with SGD or MTD containers in glaucoma patients. To assess factors likely to influence instillation, particularly the upper limb mobility.

Materials and Methods:

This multicenter, cross-sectional study included open-angle glaucoma patients with the same self-instilled treatment over at least 3 months. Patients were asked to successively self-administer a drop of artificial tears from SGD and MTD containers in front of an observer. The order of instillation (eye and container) was randomized. Correct instillation was defined as the administration of 1 drop in the lower fornix, without any contact between the tip of the device and the ocular surface. The Quick Disabilities of the Arm, Shoulder, and Hand self-questionnaire assessed upper limb mobility.

Results:

A total of 239 eyes from 173 patients were included. For the worst eye group 33% of patients performed correct instillation with MTD versus 32% using SGD (P=1). In the best eye group, 31.7% patients performed a correct instillation with MTD administration versus 27.5% with SGD (P=0.327). Multivariate analysis showed a significant association between an inadequate SGD instillation, old age (P=0.021), the severity of the visual field deficits (P=0.035), and a low quality of life score (P=0.028). No association existed between the Quick Disabilities of the Arm, Shoulder, and Hand score and the quality of instillation.

Conclusions:

These results suggest that the handling of single-use containers should be practiced by patients and evaluated by physicians, especially for the elderly population and those with advanced glaucoma. No difference in instillation quality was found between SGD and MTD.