bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic Factors for Inguinal Lymph Node Involvement and Tumor Recurrence in Squamous Cell Carcinoma of the Penis
Authors: Ramos J. Gustavo , Ramírez Angie , Varela Rodolfo , Robledo Daniela , De la Hoz-Valle José , Vargas Rafael , Forero Jorge , Godoy Fabián , Cabrera Marino , Ochoa Claudia , López Byron , Donoso Wilfredo , Giraldo Sergio , Pinzón Carolina , Peralta Sara , Calderón Andrés
Published: April 2020

Introduction Penile carcinoma is an aggressive disease with catastrophic consequences that frequently lead to death. Therefore, further knowledge on the prognostic factors that can help identify patients in need of more aggressive treatments becomes essential.

Objective To identify the prognostic factors for lymph node (LN) involvement and tumor recurrence in patients diagnosed with squamous cell carcinoma of the penis (SCCP).

Methods A retrospective cohort study was conducted. Patients diagnosed and treated for SCCP at Instituto Nacional de Cancerología between 2008 and 2015 were included in the sample. Cases in which no information on recurrence was available for the follow-up were excluded, as well as patients with no initial pathology and those getting penile reconstructions after cancer.

Relevant data was retrieved from the medical records of each patient, and a descriptive analysis was performed. Subsequently, this data was used to apply a logistic regression model to determine the potential clinical and histopathological prognostic factors.

Results A total of 104 patients were included in the present study. The average age of the sample was 59 years, while the follow-up averaged 24 months per patient. Inguinal lymphadenectomy was performed on 61 patients (59%) during the follow-up. The logistic regression model showed that lymphovascular invasion (odds ratio [OR]: 6.7; 95% confidence interval [95%CI]: 1.2–35) and poor tumor differentiation (OR: 17; 95%CI: 3.2–92) were associated with tumor recurrence. Likewise, the lymphadenectomy procedures showed that lymphovascular invasion was associated with LN involvement (OR: 3.3; 95%CI: 1.1–10).

Conclusion Lymphovascular invasion was the strongest prognostic factor observed in our sample, aiding in the prediction of inguinal LN involvement and tumor recurrence in SCCP patients.
Osteotomias de encurtamento da ulna: A nossa experiência
Authors: Cardoso Afonso Nobre Pinto , Viegas Rui , Gamelas Patrícia , Falcão Pedro , Baptista Carolina , Silva Filipa Santos
Published: April 2020

Objetivo O objetivo do presente estudo foi avaliar os resultados clínicos e radiográficos da nossa casuística relativamente a osteotomias de encurtamento da ulna, bem como rever sumariamente a patologia, as indicações e as opções cirúrgicas do conflito ulnocárpico.

Métodos Realizamos uma análise retrospectiva de pacientes consecutivos que foram tratados com osteotomia de encurtamento da ulna entre janeiro de 2012 e junho de 2017 no nosso hospital. Avaliamos clinicamente a dor, amplitude articular, força da garra e resultados funcionais recorrendo ao questionário quick-DASH. Medimos radiograficamente a variância ulnar pré- e pós-operatória e o encurtamento realizado.

Resultados Identificamos oito pacientes operados, tendo sido possível avaliar sete destes. Nesta população, obtivemos uma diminuição da dor (escala analógica visual [VAS, na sigla em inglês] de 7 para 2.6, p < 0,05), uma diminuição do quick-DASH (64 para 28, p < 0,05) e constatamos uma diminuição da amplitude articular ∼ 7° para a flexão (p = 0.2), de 5.5° para a supinação (p = 0,3), bem como diminuição da força da garra para cerca de 86% do lado contralateral (p = 0,07). A variância ulnar foi alterada de uma média de + 5.5 mm para −1.1 mm (p < 0,05). Dois em 8 pacientes (25%) apresentaram sintomatologia relacionada com a placa, sendo que um deles foi submetido a nova intervenção para extração do material.

Conclusões A osteotomia de encurtamento da ulna é um procedimento cirúrgico eficaz, tanto no tratamento do conflito ulnocárpico, como na descarga da ulna. Os resultados apresentados vão ao encontro aos demais publicados na literatura, tendo-se obtido bons resultados clínicos e radiográficos.
Análise retrospectiva de 20 pacientes acometidos por schwannoma nos membros superior e inferior
Authors: Galbiatti José Antonio , Milhomens Gabriel Rodrigues dos Santos , Bertozzo Lara Giovanetti , Escames Letícia , Milhomens Neto Pedro de Alcântara , Galbiatti Marilia Gabriela Palacio
Published: April 2020

Objetivo Analisar o perfil epidemiológico e a evolução de 20 pacientes diagnosticados com schwannoma nos membros superiores e inferiores.

Métodos Definiu-se um grupo de pacientes para avaliação retrospectiva, compreendendo o período entre fevereiro de 2002 e junho de 2018, no qual foram estudados e avaliados 20 prontuários de pacientes submetidos a procedimento cirúrgico devido a schwannoma; a confirmação diagnóstica foi feita pelo exame anatomopatológico.

Resultados Tanto os pacientes do sexo masculino quanto do feminino foram igualmente acometidos, e a média de idade foi de 50,85 anos, variando de 12 a 77 anos. Houve predomínio do membro superior e da face flexora. O nervo mais acometido foi o ulnar, e 6 (30%) pacientes apresentaram complicações pós-operatórias transitórias. Não foi identificado nenhum caso de recidiva tumoral.

Conclusão O schwannoma é uma lesão rara e de difícil diagnóstico. Deve sempre ser considerada como hipótese quando se estiver diante de um tumor de partes moles acometendo os membros. O sinal de Tinel deve ser levado em consideração por conta de sua maior correlação com as complicações. Os pacientes devem ser informados quanto às possíveis complicações pós-operatórias, que são frequentes, mas, geralmente, transitórias.
Ventricular-Peritoneal Shunt in Newborns in a High-Risk Maternity Unit: Case Series
Authors: Barbosa Amanda Ferreira , de Carvalho Neto José Nolasco , Lyra Carlos Alberto Miranda , Cavalcante Tiago de Paiva , Morais Rilton Marcus , Oliveira Arthur Maynart Pereira
Published: April 2020

Objective To identify factors related to ventricular-peritoneal shunt (VPS) complications in pediatric patients at a high-risk maternity hospital.

Methods Prospective study, conducted between September/2018 and June/2019, with selected newborns without previous ventricular bypass who underwent neurosurgery for VPS placement in a high-risk maternity hospital in the state of Sergipe, Brazil. Diagnosis of hydrocephalus occurred by transfontanelle ultrasound. The variables were analyzed by Student t-test, adopting p < 0.05 as statistical significance.

Results Seven newborns participated in the study, 3 male and 4 female. Folic acid supplementation during pregnancy was considered a positive influencing factor in the 1st minute Apgar. Hydrocephalus secondary to premature hemorrhage was present in most newborns. Prematurity, 1st minute Apgar score < 7, and birth weight < 2,500 g did not represent a significant negative risk factor for prolonged hospitalization after neurosurgery. One newborn had cerebrospinal fluid infection and was the only one with heart disease.

Conclusion This is the first scientific research that associates the benefits of maternal use of folic acid during pregnancy to better newborn Apgar scores. Only one newborn developed complications after neurosurgery, the only one with an associated comorbidity. Further studies are needed to provide more evidence on risk factors related to complications of VPS implantation in newborns. This neurosurgical procedure in a high-risk maternity contributed to the early management of hydrocephalus.
A metasurface absorber based on the slow-wave effect
Authors: Li Zeyan , Li Bo , Zhao Qian , Zhou Ji
Published: April 2020

A metasurface absorber based on the slow-wave effect has the advantages of long interaction time and high absorption. A slow-wave metasurface absorber is constructed using the periodic arrangement of the Jerusalem cross, which achieves a reflectivity of −15.0 dB at 5.0 GHz. Furthermore, dual-frequency absorption is realized by the coupling of two unit cells with different sizes. The calculated delay time of metasurfaces further confirms the underlying absorption. The design of metasurfaces through the slow-wave effect provides new ideas to the field of absorbing metasurfaces and creates broad application prospects.
Optimal dispatch of combined heat and power units based on particle swarm optimization with genetic algorithm
Authors: Hu Pinduan , Cao Cheng , Dai Shuailong
Published: April 2020

The main purpose of this paper is to optimize the consumption of renewable energy and minimize the total cost of system operation, and a combined heat and power unit is added to the wind, water, and water combined dispatching model to solve typical daily dispatch problems in different seasons. Initially, a combined wind–solar–water-fired optimal scheduling model containing cogeneration units and renewable energy preferential consumption is constructed, and the model is solved using particle swarm optimization with the genetic algorithm. The simulation analysis of typical electrical load and heat load during summer and winter in a certain area is implemented as an example to verify the feasibility of the model and algorithm. Compared with the traditional vertical integrated electric-heated coordinated dispatch, the proposed method reflects the willingness of the combined heat and power to actively participate in the paid peak regulation of the power grid under economic incentives.
Half-occupation approach for the ab initio calculation of strained Ga(AsSb)/GaAs valence band offsets
Authors: Weseloh Maria J. , Oelerich Jan Oliver , Koch Stephan W.
Published: April 2020

An ab initio based scheme for the determination of the valence band offset between different III–V semiconductor systems is presented on the example of GaAs and Ga(AsSb) pseudomorphically strained to GaAs for Sb concentrations up to 37.5%. Modified core-to-valence band maximum calculations are used in combination with the half-occupation technique. The valence band offsets between GaAs and Ga(AsSb) are needed for the predictive design of optically active quantum well heterostructures emitting in the near-infrared region of the electromagnetic spectrum.
Approximately h-preinvex functions, associated Hermite–Hadamard-like inequality, new q-identity, and estimation of its bounds with applications
Authors: Talib Sadia , Awan Muhammad Uzair , Noor Muhammad Aslam , Noor Khalida Inayat
Published: April 2020

The main objective of this paper is to introduce and investigate a new class of preinvex functions, called approximately h-preinvex functions, which depend on a given bifunction ε(·, ·). It is observed that this class includes several other new and known classes of preinvexity. We derive a new refinement of Hermite–Hadamard-like inequalities using the class of approximately preinvex functions. We also derive a new q-integral identity using the q-differentiable function. Using this auxiliary result, we obtain several new estimates of quantum bounds. We also discuss several new special cases of the obtained results. Certain applications of the main results are also discussed.
Construction of microgrooves on the surface of alumina ceramic insulator to enhance its flashover strength
Authors: Liu Wenyuan , Guo Yuewen , Huo Yankun , Ke Changfeng , Cheng Jun , Chen Changhua
Published: April 2020

The fabrication method of grooves on the surface of alumina and their influence on the surface flashover characteristics of the alumina insulator were studied in this paper. To prepare grooves with a regular surface structure, the UV laser was applied to carve grooves on the surface of alumina ceramic, and dilute hydrochloric acid was used to corrode and remove the residual materials produced in the laser carving process. By adjusting the laser parameters, periodic grooves were prepared on the surface of a cylindrical alumina insulator with a groove depth of 60 µm and a groove width of approximately 50 µm on the laser spinning carving platform. Then, alumina insulators with different periods were prepared, and their vacuum surface flashover voltages were tested on a short pulsed high-voltage test platform. The test results indicated that the flashover voltages of the alumina insulators with laser carved periodic grooves were increased over 200%, and the improvement did not change much with the groove periods. A further study of the groove parameters showed that several grooves fabricated on the cathode end of the insulators were able to improve the flashover voltage of the alumina insulator to the voltage-withstand level of the fully grooved insulators.
Analytical computation of the magnetic field of a conical permanent magnet with arbitrarily uniform magnetization
Authors: Nguyen Van Tai
Published: April 2020

This study presents a fast-computed analytical model to compute the magnetic field generated by a cone with arbitrarily uniform magnetization. Based on the charge model, algebraic and geometrical analyses, the analytical expressions of the axial, azimuthal, and radial components of the magnetic field produced by the cone at any given point in space are derived. The model was in excellent agreement with the Finite Element Model (FEM), as is proved in this research. It is demonstrated that it took an average of less than 1 ms to execute each expression at a single point on the modern personal computer, whereas the FEM simulation consumed 779 s. Moreover, using the developed model, the magnetic field distribution of a cone used in magnetic resonance imaging with varying magnetization is analyzed. As a result, the distributions of the axial and radial components are a cosine-like wave with opposite directions, except for the case where the slope angle of the magnetization is equal to π/2; or, in other words, the magnetization is axial. On the other hand, the distribution of the azimuthal component is a sine-like wave, except for the noted case where the magnetization is axial.
An extended view of conceptual metaphor theory
Authors: Kövecses Zoltán
Published: April 2020

A major insight of Conceptual Metaphor Theory (CMT) is that it added a strong, empirically testable cognitive dimension to the study of metaphor that is capable of changing the way we think about metaphor not only in language, but also thought and action, and, ultimately, the way we do philosophy (Lakoff & Johnson, 1980,1999). In the paper, I argue that CMT itself needs to be changed in several ways. In particular, I suggest (1) that it has to be given a much more elaborate contextual component than is currently available, (2) that even its cognitive dimension needs to be refined, (3) that it requires a component that can explain the actual usages of metaphors in natural discourse, and (4), and most significantly, that it needs to be changed in such a way that the modifications under (1), (2), and (3) can be integrated into a unified and coherent theory of metaphor. The paper is based on my forthcoming bookExtended Conceptual Metaphor Theory(Kövecses, 2020).
Virtual reality as a tool for promoting reading via enhanced narrative absorption and empathy
Authors: Pianzola Federico , Bálint Katalin , Weller Jessica
Published: April 2020

Reading fiction is beneficial for various social skills, although reading has become less and less popular with younger generations. This study investigated whether reading a chapter of a fictional story in virtual reality (VR) can make the reading experience more appealing and increase intention to read the story further. A between-subject experiment (N = 83) was conducted to compare the effect of a printed book and a VR reading environment on narrative absorption, empathy with fictional characters, and intention to read. The results show that VR enhances intention to read, via a serial mediation of transportation into the story world and affective empathy. These findings indicate that VR can be effectively exploited for promoting reading.
Abnormal grain growth during annealing in the Al/Al2O3 composite produced by accumulative roll bonding
Authors: Shamanian Morteza , Nasresfahani Mohamad reza , Szpunar Jerzy A
Published: April 2020

The mechanical and physical properties of composites are related to the matrix microstructure and reinforcements dispersion. Microstructural evolution during annealing can change the properties of the composites. Consequently, in this paper, the microstructural evolution of Al/Al2O3 composite during annealing and the interpretation of metallurgical phenomena were investigated. Accumulative roll bonding technique was used for manufacturing the Al/Al2O3 composite. The Al/Al2O3 composite specimens were further annealed at 375 °C for 15, 30 and 60 min without any protected atmosphere. The grain orientation (texture) and the grain size of the composites were investigated. Results showed that by increasing the annealing time to 60 min, abnormal grain growth started. Moreover, the frequency of low angle boundaries (1.5–5) increased, while the frequency of ∑3 Coincident Site Lattice boundaries decreased. In fact, grain boundaries with low Coincident Site Lattice were less prone to reinforcement pinning. Then low Coincident Site Lattice boundaries were more susceptible to formation and growth of abnormal grains.
Single-stranded oligodeoxynucleotides induce plant defence in Arabidopsis thaliana
Authors: Toum Laila , Conti Gabriela , Guerriero Francesca Coppola , Conforte Valeria P , Garolla Franco A , Asurmendi Sebastián , Vojnov Adrián A , Gudesblat Gustavo E
Published: April 2020

Background and Aims

Single-stranded DNA oligodeoxynucleotides (ssODNs) have been shown to elicit immune responses in mammals. In plants, RNA and genomic DNA can activate immunity, although the exact mechanism through which they are sensed is not clear. The aim of this work was to study the possible effect of ssODNs on plant immunity.

Key Results

The ssODNs IMT504 and 2006 increased protection against the pathogens Pseudomonas syringae pv. tomato DC3000 and Botrytis cinerea but not against tobacco mosaic virus-Cg when infiltrated in Arabidopsis thaliana. In addition, ssODNs inhibited root growth and promoted stomatal closure in a concentration-dependent manner, with half-maximal effective concentrations between 0.79 and 2.06 µm. Promotion of stomatal closure by ssODNs was reduced by DNase I treatment. It was also diminished by the NADPH oxidase inhibitor diphenyleneiodonium and by coronatine, a bacterial toxin that inhibits NADPH oxidase-dependent reactive oxygen species (ROS) synthesis in guard cells. In addition it was found that ssODN-mediated stomatal closure was impaired in bak1-5, bak1-5/bkk1, mpk3 and npr1-3 mutants. ssODNs also induced early expression of MPK3, WRKY33, PROPEP1 and FRK1 genes involved in plant defence, an effect that was reduced in bak1-5 and bak1-5/bkk1 mutants.

Conclusions

ssODNs are capable of inducing protection against pathogens through the activation of defence genes and promotion of stomatal closure through a mechanism similar to that of other elicitors of plant immunity, which involves the BAK1 co-receptor, and ROS synthesis.
On the Margins of the Margins: #CommunicationSoWhite—Canadian Style
Authors: Hirji Faiza , Jiwani Yasmin , McAllister Kirsten Emiko
Published: April 2020

Canada is defined by its commitment to multicultural diversity, tolerance and liberalism that belie the dominant whiteness of our institutions, including academia. Canadian Communication Studies, despite its history of attending to the power dynamics of the center and the margins, is no exception to this rule. Studies of racism and colonialism are confined to the corners of the discipline, reflecting the lack of representation in communication departments, the canon, and in the field’s flagship journal. This sharply contrasts the prevalence of contemporary issues concerning race, religion, nationalism, nationwide Indigenous movements and anti-racist campaigns, as well as mobilizations against police violence, Islamophobia, and pipelines. Colonialism, race and racialization are central to the framing of these issues and demand urgent attention.
Overinterpretation of Research Findings: Evaluation of “Spin” in Systematic Reviews of Diagnostic Accuracy Studies in High–Impact Factor Journals
Authors: McGrath Trevor A , Bowdridge Joshua C , Prager Ross , Frank Robert A , Treanor Lee , Dehmoobad Sharifabadi Ana , Salameh Jean-Paul , Leeflang Mariska , Korevaar Daniël A , Bossuyt Patrick M , McInnes Matthew D F
Published: April 2020

Background

To compare the frequency of “spin” in systematic reviews of diagnostic accuracy studies in high-impact journals with the frequency a previously assessed series of reviews.

Methods

Medline was searched from January 2010 to January 2019. Systematic reviews of diagnostic accuracy studies were included if they reported a meta-analysis and were published in a journal with an impact factor >5. Two investigators independently scored each included systematic review for positivity of conclusions and for actual and potential overinterpretation practices.

Results

Of 137 included systematic reviews, actual overinterpretation was present in ≥1 form in the abstract in 63 (46%) and in the full-text report in 52 (38%); 108 (79%) contained a form of potential overinterpretation. Compared with the previously assessed series (reviews published 2015–2016), reviews in this series were less likely to contain ≥1 form of actual overinterpretation in the abstract and full-text report or ≥1 form of potential overinterpretation (P < 0.001 for all comparisons). The significance of these comparisons did not persist for actual overinterpretation in sensitivity analysis in which Cochrane systematic reviews were removed. Reviews published in the Cochrane Database of Systematic Reviews were less likely to contain actual overinterpretation in the abstract or the full-text report than reviews in other high-impact journals (P < 0.001 for both comparisons).

Conclusions

Reviews of diagnostic accuracy studies in high-impact journals are less likely to contain overinterpretation or spin. This difference is largely due to the reviews published in the Cochrane Database of Systematic Reviews, which contain spin less often than reviews published in other high-impact journals.
Avoiding the Coup-Proofing Dilemma: Consolidating Political Control While Maximizing Military Power
Authors: Reiter Dan
Published: April 2020

Civil-military relations scholarship forecasts that governments fearing coups d’état and facing belligerent external and internal adversaries face a dilemma. Governments can coup-proof to reduce coup risk, but such measures reduce military effectiveness. Conversely, if they eschew coup-proofing to maintain military effectiveness, they risk coups. This paper explains how governments facing coup threats and belligerent adversaries can alleviate this dilemma. It first describes five coup-proofing measures that generally reduce military effectiveness, such as politicized promotion and reduced training, and two other coup-proofing measures that do not reduce effectiveness, bribery and indoctrination. Because leaders can pick and choose which coup-proofing measures to employ, leaders facing coup and belligerent adversary threats can reduce the coup-proofing dilemma by adopting those coup-proofing measures that do not reduce effectiveness and avoiding those measures that reduce effectiveness, within availability and dependence constraints. The paper presents a case study of coup-proofing in Nazi Germany, a deviant case for coup-proofing theory and democratic victory theory because Adolf Hitler avoided being overthrown in a coup and fielded an effective military. The case study demonstrates support for the theory that a leader can simultaneously reduce coup risk and optimize military effectiveness by employing some coup-proofing tactics but not others.
Getting the Balance Right: Medical Futility, Scientific Advancement, and the Role of Law
Authors: Glover-Thomas Nicola
Published: April 2020

The concept of medical futility as an applied ethical framework has seen a rise and fall in its popularity over the last 30 years. It is a term used in relation to the assessment of a patient’s health condition that is deemed untreatable, irreversible, and unresolvable. In four recent cases, Gard, Evans, Haastrup, and Raqeeb, the concept has been brought to the fore once again. These cases highlight a mounting tension between clinicians and families. Parental desires to see their child’s treatment continued, while understandable, should not dominate treatment planning. This article analyses judicial interpretation of the factors which determine an assessment of futility and in doing so, argues that the role of medical futility in judicial decisions of this kind is gaining prominence and will continue to do so as scientific advancement blurs the limits of medicine even further.
The Utility of the Sit-to-Stand Test for Inpatients in the Acute Hospital Setting After Lung Transplantation
Authors: Tarrant Benjamin J , Robinson Rebecca , Le Maitre Caitlin , Poulsen Megan , Corbett Monique , Snell Greg , Thompson Bruce R , Button Brenda M , Holland Anne E
Published: April 2020

Objective

Measurement of physical function is important to guide physical therapy for patients post-lung transplantation (LTx). The Sit-to-Stand (STS) test has proven utility in chronic disease, but psychometric properties post-LTx are unknown. The study aimed to assess reliability, validity, responsiveness, and feasibility of the 60-second STS post-LTx.

Methods

This was a measurement study in 62 inpatients post-LTx (31 acute postoperative; 31 medical readmissions). Interrater reliability was assessed with 2 STS tests undertaken by different assessors at baseline. Known group validity was assessed by comparing STS repetitions in postoperative and medical groups. Content validity was assessed using comparisons to knee extensor and grip strength, measured with hand-held dynamometry. Criterion validity was assessed by comparison of STS repetitions and 6-minute walk distance postoperatively. Responsiveness was assessed using effect sizes over inpatient admission.

Results

Median (interquartile range) age was 62 (56–67) years; time post-LTx was 5 (5–7) days postoperative and 696 (244–1849) days for medical readmissions. Interrater reliability was excellent (intraclass correlation coefficient type 2,1 = 0.96), with a mean learning effect of 2 repetitions. Repetitions were greater for medical at baseline (mean 18 vs 8). More STS repetitions were associated with greater knee extensor strength (postoperative r = 0.57; medical r = 0.47) and 6-minute walk distance (postoperative r = 0.68). Effect sizes were 0.94 and 0.09, with a floor effect of 23% and 3% at baseline (postoperative/medical) improving to 10% at discharge. Patients incapable of attempting a STS test were excluded, reducing generalizability to critical care. Physical rehabilitation was not standardized, possibly reducing responsiveness.

Conclusions

The 60-second STS demonstrated excellent interrater reliability and moderate validity and was responsive to change postoperatively.

Impact

The 60-second STS represents a safe, feasible functional performance tool for inpatients post-LTx. Two tests should be completed at each time point.
Performance and Profitability of Rain-Based Thresholds for Timing Fungicide Applications in Soybean Rust Control
Authors: Beruski Gustavo C. , Del Ponte Emerson M. , Pereira André. B. , Gleason Mark L. , Câmara Gil M. S. , Araújo Junior Ivan P. , Sentelhas Paulo C.
Published: April 2020

Soybean rust (SBR), caused by the fungus Phakopsora pachyrhizi, is the most damaging disease of soybean in Brazil. Effective management is achieved by means of calendar-timed sprays of fungicide mixtures, which do not explicitly consider weather-associated disease risk. Two rain-based action thresholds of disease severity values (DSV50 and DSV80) were proposed and compared with two leaf wetness duration-temperature thresholds of daily values of infection probability (DVIP6 and DVIP9) and with a calendar program, with regard to performance and profitability. An unsprayed check treatment plot was included for calculating relative control. Disease severity and yield data were obtained from 29 experiments conducted at six sites across four states in Brazil during the 2012–13, 2014–15, and 2015–16 growing seasons, which represented different growing regions and climatic conditions. The less conservative rainfall action threshold (DSV80) resulted in fewer fungicide sprays compared with the other treatments, and the more conservative one (DSV50) resulted in fewer sprays than the DVIP thresholds. Yield was generally higher with the increase in spray number, but the economic analysis showed no significant differences in the risk of not offsetting the costs of fungicide sprays regardless of the system. Therefore, based on the simplicity and the profitability of the rain-based model, the system is a good candidate for incorporating into the management of SBR in soybean production fields in Brazil.
Nonclinical Factors in Autism Diagnosis: Results From a National Health Care Provider Survey
Authors: Azim Aniqa , Rdesinski Rebecca E. , Phelps Randall , Zuckerman Katharine E.
Published: April 2020

Objective:

The prevalence of autism spectrum disorder (ASD) has increased 10-fold in the past 40 years, and disparities have been noted by race/ethnicity and socioeconomic status, prompting concern about diagnostic accuracy. Provider perceptions of ASD diagnostic accuracy are not known. We conducted a survey of providers who diagnose ASD assessing how nonclinical factors might affect ASD diagnostic rates.

Methods:

The mixed-mode survey was sent to the members of the Society of Developmental and Behavioral Pediatrics with clinical interest in ASD (n = 400). Respondents used a Likert-type scale to address how often they and their colleagues overdiagnosed or underdiagnosed ASD. They were also asked how families grouped by race/ethnicity, education, socioeconomic status, and urbanicity perceived an ASD diagnosis.

Results:

Sixty-three percent of providers completed the survey. Eight point seven percent of providers self-reported that they overdiagnose ASD at least sometimes. However, 58% of providers reported that local colleagues overdiagnose ASD at least sometimes. Seven point eight percent of providers self-reported underdiagnosing ASD at least sometimes and cited parents not wanting a diagnosis as one of the most common reasons they may underdiagnose. Providers reported that non-white and rural families were more likely to think that ASD diagnosis was “a bad thing” than “a good thing” than white and urban and suburban families, respectively.

Conclusion:

Providers report moderate rates of ASD misdiagnosis and perceive differences in diagnostic preferences according to family characteristics. The study results may help explain the trends and disparities in ASD diagnosis.
Effect Decomposition in the Presence of Treatment-induced Confounding
Authors: Wodtke Geoffrey T. , Zhou Xiang
Published: April 2020

Analyses of causal mediation are often complicated by treatment-induced confounders of the mediator–outcome relationship. In the presence of such confounders, the natural direct and indirect effects of treatment on the outcome, into which the total effect can be additively decomposed, are not identified. An alternative but similar set of effects, known as randomized intervention analogues to the natural direct effect (rNDE) and the natural indirect effect (rNIE), can still be identified in this situation, but existing estimators for these effects require a complicated weighting procedure that is difficult to use in practice. We introduce a new method for estimating the rNDE and rNIE that involves only a minor adaptation of the comparatively simple regression methods used to perform effect decomposition in the absence of treatment-induced confounding. It involves fitting (a) a generalized linear model for the conditional mean of the mediator given treatment and a set of baseline confounders and (b) a linear model for the conditional mean of the outcome given the treatment, mediator, baseline confounders, and a set of treatment-induced confounders that have been residualized with respect to the observed past. The rNDE and rNIE are simple functions of the parameters in these models when they are correctly specified and when there are no unobserved variables that confound the treatment–outcome, treatment–mediator, or mediator–outcome relationships. We illustrate the method by decomposing the effect of education on depression at midlife into components operating through income versus alternative factors. R and Stata packages are available for implementing the proposed method.
Maternal Thyroid Disorders and Risk of Autism Spectrum Disorder in Progeny
Authors: Rotem Ran S. , Chodick Gabriel , Shalev Varda , Davidovitch Michael , Koren Gideon , Hauser Russ , Coull Brent A. , Seely Ellen W. , Nguyen Vy T. , Weisskopf Marc G.
Published: April 2020

Background:

Maternal thyroid dysfunction is suspected of causing adverse neurodevelopmental effects, but current evidence is inconclusive. Epidemiologic investigations generally suggest an association between maternal thyroid dysfunction and neurodevelopment impairments in progeny, but clinical trials of thyroid treatment during pregnancy reported null effects. To better understand these discrepant findings, we evaluated the association between maternal thyroid conditions and autism spectrum disorder (ASD), including examining the role of gestational thyroid-related hormone concentrations and thyroid medications use.

Methods:

Analyses considered 437,222 singleton live births occurring in a large Israeli health fund in 1999–2013, followed through 2016. Thyroid conditions and ASD cases were identified through International Classification of Diseases-9 codes with subsequent validation through review of medical records. Laboratory gestational thyroid hormone measurements were also considered.

Results:

Children of mothers who ever experienced hypothyroidism had a higher risk of ASD compared with children of mothers without hypothyroidism (adjusted odds ratio [aOR] = 1.26, 95% confidence interval [CI] = 1.12, 1.42). The association with hyperthyroidism was less consistent, but elevated in main analyses (aOR = 1.42, 95% CI = 1.04, 1.94). These associations were not explained by maternal gestational thyroid hormones levels nor mitigated by gestational use of thyroid medications.

Conclusions:

Results indicate that maternal thyroid conditions are associated with increased ASD risk in progeny, but suggestively not due to direct effects of thyroid hormones. Instead, factors that influence maternal thyroid function could have etiologic roles in ASD through pathways independent of maternal gestational thyroid hormones and thus be unaffected by medication treatment. Factors known to disrupt thyroid function should be examined for possible involvement in ASD etiology.
A traveling fellowship to build surgical capacity in Ethiopia: the Jimma University specialized hospital and operation smile partnership
Authors: McCullough Meghan , Bradshaw Allison , Getachew Daniel , Eshetu Yonas , Raghuram Anjali , Stoneburner Jacqueline , Ariani Rojine , Magee William P. , Hall Per N.
Published: April 2020

A lack of trained providers is an important contributor to the unmet burden of surgical disease treatment in low- and middle-income countries. The World Health Organization’s Commission on the International Recruitment of Health Personnel lays out guiding principles for addressing this workforce crisis. However, for surgical subspecialties such as plastic surgery, in-country training opportunities remain limited and there is a clear need for effective strategies to retain providers and develop sustainable solutions. We report the design and early implementation of a traveling fellowship in plastic surgery for providers at Jimma University Specialized Hospital in Jimma, Ethiopia. This fellowship is supported by Operation Smile and its network of international surgical volunteers. Since its inception, the program has trained 2 general surgeons with a commitment to helping train a total of 6 surgeons to establish a self-sustaining service. Key innovations include multiple international sites to facilitate broad subspecialty training, commitment of participants to return to Jimma upon completion of the program to establish a local training service, and coordination with national governing bodies to ensure program recognition and support. Ongoing challenges include physical resource limitations and coordination with a wide array of stakeholders. Nongovernmental organizations also have a role to play in supporting the Ministries of Health in scaling up human resources for improved health within their countries. Operation Smile’s traveling fellowship demonstrates a feasible method of addressing the health workforce crisis by providing specialized training and facilitating the development of surgical teaching programs capable of sustainably serving local communities.
Apparent treatment-resistant hypertension: characteristics and prevalence in a real-world environment of an integrated health system
Authors: An Jaejin , Sim John J. , Calhoun David A. , Liu Ran , Wei Rong , Zhou Hui , Luong Tiffany , Reynolds Kristi
Published: April 2020

Objectives:

We compared the prevalence of apparent treatment-resistant hypertension (aTRH) according to the seventh report of the Joint National Committee (JNC 7) and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline in an integrated healthcare delivery system.

Methods:

We identified individuals aged at least 18 years with hypertension from Kaiser Permanente Southern California between 1 July 2014 and 30 June 2015. aTRH was defined as either blood pressure (BP) above goal (≥140/90 mmHg per JNC7, and ≥130/80 mmHg per 2017 ACC/AHA for most adults with hypertension) while taking at least 3 classes of antihypertensive medication or taking at least four classes regardless of BP level. A secondary analysis was conducted requiring use of a diuretic for the definition of aTRH. Patient clinical characteristics and antihypertensive medication use were described using electronic health records.

Results:

We included 469 509 patients with treated hypertension [mean (SD) age 65 years (12), 46% white, 26% Hispanic, 13% black, and 12% Asian]. The prevalence of aTRH was 16.9 and 21.8% according to the JNC 7 and the 2017 ACC/AHA guidelines, respectively [Δ = 4.9% (95% CI: 4.7--5.1%)]. By requiring a diuretic to be considered as aTRH, the prevalence of aTRH decreased to 13.4 and 17.2% according to the JNC 7 and the 2017 ACC/AHA guidelines, respectively. Among patients with aTRH, 1.9% received a long-acting thiazide-like diuretic, and 5.6% received a mineralocorticoid receptor blocker.

Conclusion:

The prevalence of aTRH increased using the more stringent BP goals of the 2017 ACC/AHA guideline. The use of recommended therapy for aTRH was suboptimal suggesting a potential area for improvement.
Attended versus unattended automated office blood pressure measurement in the diagnosis and treatment of hypertension
Authors: Myers Martin G. , Sierra Alejandro de La , Roerecke Michael , Kaczorowski Janusz
Published: April 2020

The main advantage of automated office (AO)BP in hypertension screening is that it eliminates white-coat effect seen in routine office practice, with readings similar to awake ambulatory (A)BP. Recent studies examining the possible equivalence between AOBP recorded with and without research staff present have reported attended systolic AOBP to be 5.8 mmHg higher. Moreover, attended automated SBP readings in 27 211 patients in clinical practice were 25 mmHg higher than awake ABP. These data are consistent with the presence of staff increasing AOBP. In research studies, all types of office BP measurement at target SBP less than 130 mmHg were generally lower than awake ABP, whereas, in clinical practice, attended automated office BP was slightly higher than awake ABP. However, AOBP may still be preferred, if target BP is to be similar to 24-h ABP. Further research is needed to determine the optimum technique for recording office BP at target.
Analysis of Graft Failure After Primary Penetrating Keratoplasty in Children With Peters Anomaly
Authors: Sun Yajie , Lin Qi , Miao Sen , Wang Wenying , Pan Zhiqiang
Published: April 2020

Purpose:

To investigate the causes of graft failure and risk factors associated with total graft opacity after primary penetrating keratoplasty (PK) in children with Peters anomaly (PA).

Methods:

In this retrospective study, patients with PA (younger than 5 years) who received primary PK in Beijing Tongren Hospital were reviewed. The follow-up period was a minimum of 6 months. A modified PA classification system was used, and all failed grafts were categorized into partial and total opacity groups. Patient demographics, PA classification, operation details, degree of graft opacity, and causes of graft failure were recorded.

Results:

Of the 165 eyes, 54 eyes (32.7%) demonstrated graft failure along with various degrees of graft opacity. Approximately half of the grafts applied failed within 6 months postoperatively. The partial and total opacity groups did not demonstrate any significant differences regarding diagnosis distribution. Irreversible immune rejection accounted for 61.1% of all graft failures; furthermore, it had a significantly higher proportion in the partial opacity group than in the total opacity group (71.0% and 47.8%, respectively; P = 0.058). The degree of graft opacity was significantly associated with patient age at surgery (P = 0.002), preoperative corneal vascularization (P = 0.009), and iris defects (P = 0.001). However, administration of intensive topical corticosteroids could reduce the risk of total opacity in the rejected grafts.

Conclusions:

Irreversible immune rejection is the most common cause of graft failure after primary PK in pediatric patients with PA. The degree of graft opacity is closely related to patient age at surgery, preoperative corneal vascularization, and iris defects.
The Relationship Between Intraocular Pressure and Rates of Central Versus Peripheral Visual Field Progression
Authors: Shukla Aakriti G. , De Moraes C. Gustavo , Cioffi George A. , Girkin Christopher A. , Weinreb Robert N. , Zangwill Linda M. , Liebmann Jeffrey M.
Published: April 2020

Precis:

In this longitudinal prospective cohort study of open-angle glaucoma patients, intraocular pressure (IOP) parameters (mean, fluctuation, and maximum) had a similar effect on glaucomatous progression in the central and peripheral visual field (VF) regions.

Purpose:

To study the effects of IOP on rates of glaucomatous central versus peripheral VF progression.

Methods:

The African Descent and Glaucoma Evaluation Study (ADAGES) is a longitudinal prospective cohort study that recruited patients from 3 centers. A sample of those with established glaucoma were included in this study. The mean peripheral sensitivity (MPS) and the mean central sensitivity (MCS) were defined based upon the average total deviation of the peripheral and central (10 degrees) points of the 24-2 VF, respectively. Progression was based upon central and peripheral change from linear mixed-effects models. The relationships between VF progression and IOP mean, maximum, and fluctuation as continuous variables were also investigated. Main outcome measures were MPS and MCS progression rates.

Results:

A total of 452 eyes of 344 patients were studied. The mean number of VFs (SD) for each eye was 13.3 (6.4) over 9.1 (3.7) years. The mean baseline MD was −5.1 (3.9) dB and the mean rate of MD change was −0.26 dB/y [95% confidence interval (CI): −0.33 to −0.20, P<0.001]. Mean rates of MPS (−0.27 dB/y, 95% CI: −0.33 to −0.22, P<0.001) and MCS change (−0.26 dB/y, 95% CI: −0.31 to −0.21, P<0.001) were similar (P=0.351). Mean, fluctuation, and maximum IOP were significantly associated with MPS and MCS (all P<0.025).

Conclusions:

The effect of IOP parameters on VF progression was statistically similar between central and peripheral VF regions.
Early Bacterial Infections After Pediatric Liver Transplantation in the Era of Multidrug-resistant Bacteria
Authors: Béranger Agathe , Capito Carmen , Lacaille Florence , Ferroni Agnès , Bouazza Naïm , Girard Muriel , Oualha Mehdi , Renolleau Sylvain , Debray Dominique , Chardot Christophe , Frange Pierre , Moulin Florence
Published: April 2020

Background:

Early bacterial infection is a major and severe complication after liver transplantation (LT). The rise of antimicrobial resistance, especially extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), is a growing concern for these patients. This study aimed to assess the epidemiology of early bacterial infections in a pediatric population, including those caused by multidrug-resistant (MDR) pathogens, and to identify risk factors for infection.

Methods:

We conducted a monocentric retrospective study including 142 consecutive LTs performed in 137 children between 2009 and 2017.

Results:

Ninety-three bacterial infections occurred after 67 (47%) LTs. Among the 82 isolated pathogens, the most common was Klebsiella pneumoniae (n = 19, 23%). Independent risk factors for early bacterial infection were low weight [odds ratio (OR) = 0.96; 95% confidence interval (CI): 0.9–0.99; P = 0.03] and the presence of a prosthetic mesh (OR = 2.4; 95% CI: 1.1–5.4; P = 0.046). Sixty-one children (45%) carried MDR bacteria and 16 infections were caused by MDR pathogens, especially ESBL-producing K. pneumoniae (n = 12). ESBL-PE stool carriage was associated with ESBL-PE infection (OR = 4.5; 95% CI: 1.4–17.4; P = 0.02). Four children died from an infection, three due to ESBL-producing K. pneumoniae.

Conclusions:

This study confirmed a shift toward a predominance of Gram-negative early bacterial infections after pediatric LT. The risk factors for infection were low weight and the presence of a prosthetic mesh. ESBL-PE stool carriage was associated with ESBL-PE infection. Adapted antimicrobial prophylaxis and personalized antibiotherapy are mandatory to reduce infection prevalence and mortality.
Isavuconazole As Successful Salvage Therapy for Mucormycosis in Pediatric Patients
Authors: Ashkenazi-Hoffnung Liat , Bilavsky Efraim , Levy Itzhak , Grisaru Galia , Sadot Efraim , Ben-Ami Ronen , Novikov Anna , Fischer Salvador , Nahum Elhanan , Scheuerman Oded
Published: April 2020

Background:

Mucormycosis is a rare but emerging life-threatening fungal disease with limited treatment options. Isavuconazole is a new triazole that has shown efficacy in adults for primary and salvage treatment of mucormycosis. However, data in children are scarce.

Methods:

The demographic and clinical data of pediatric patients with proven mucormycosis who were treated with isavuconazole in 2015 to 2019 at 2 centers were collected.

Results:

Four children of median age 10.5 years (range 7–14) met the study criteria. Three had underlying hematologic malignancies, and 1 had sustained major trauma. Isavuconazole was used as salvage therapy in all: in 3 patients for refractory disease, and in 1 after intolerance to another antifungal drug. Isavuconazole was administered alone or combined with other antifungal agents. Following treatment and surgical intervention, complete clinical, radiologic and mycologic responses were documented in all patients. A literature review identified 8 children with mucormycosis who were successfully treated with isavuconazole, as salvage therapy in the majority.

Conclusion:

Our limited experience supports the use of isavuconazole as salvage therapy in pediatric mucormycosis.