bluuebunny/crossref_metadata_2025 huggingface dataset:
Low optical polarization at the core of the optically thin jet of M87
Authors: Fresco A Y , Fernández-Ontiveros J A , Prieto M A , Acosta-Pulido J A , Merloni A
Published: June 2020

We study the optical linear and circular polarization in the optically thin regime of the core and jet of M87. Observations were acquired two days before the Event Horizon Telescope (EHT) campaign in early 2017 April. A high degree (∼20 per cent) of linear polarization (Plin) is detected in the bright jet knots resolved at $\sim 10\,\mathrm{ to}\,23\, \rm {arcsec}$ ($0.8{-}1.8\, \rm {kpc}$) from the centre, whereas the nucleus and inner jet show Plin ≲ 5 per cent. The position angle of the linear polarization shifts by ∼90° from each knot to the adjacent ones, with the core angle perpendicular to the first knot. The nucleus was in a low level of activity (Plin ∼ 2–3 per cent), and no emission was detected from HST-1. No circular polarization was detected either in the nucleus or the jet above a 3 σ level of Pcirc ≤ 1.5 per cent, discarding the conversion of Plin into Pcirc. A disordered magnetic field configuration or a mix of unresolved knots polarized along axes with different orientations could explain the low Plin. The latter implies a smaller size of the core knots, in line with current interferometric observations. Polarimetry with EHT can probe this scenario in the future. A steep increase of both Plin and Pcirc with increasing frequency is expected for the optically thin domain, above the turnover point. This work describes the methodology to recover the four Stokes parameters using a λ/4 waveplate polarimeter.
P1868TO INVESTIGATE THE EFFICACY AND SAFETY OF MOLIDUSTAT IN NON-DIALYSIS PATIENTS WITH RENAL ANEMIA WHO ARE TREATED WITH ERYTHROPOIESIS-STIMULATING AGENTS: MIYABI ND-M
Authors: Yamamoto Hiroyasu , Taguchi Megumi , Nobori Kiyoshi , Matsuda Yoshimi , Iekushi Kazuma , Akizawa Tadao
Published: June 2020

Background and Aims

Treatment with subcutaneous erythropoiesis-stimulating agent (ESA) is the standard of care for renal anemia in non-dialysis patients. A hypoxia-inducible factor prolyl-hydroxylase (HF-PH) inhibitor is an oral medication and might be a new treatment option of renal anemia. Molidustat mimics the physiological response to hypoxia, thereby stimulating endogenous EPO production by the kidneys. The phase III program entitled MolIdustat once dailY improves renal Anemia By Inducing EPO (MIYABI) was conducted in Japan.

Method

MIYABI Non-Dialysis- Maintenance (ND-M) of Hb study (up to 52 weeks, randomized, darbepoetin-controlled, open-label) was conducted to investigate the efficacy and safety of molidustat (MO) in non-dialysis patients with renal anemia who are treated with ESAs. A starting dose was in accordance with previous ESA dose and study drug doses were titrated regularly with the aim of maintaining the patients’ Hb values between the target range (11.0-13.0 g/dL). The primary efficacy variables were the mean Hb values during the evaluation period (30-36 weeks) and its change from baseline to demonstrate the non-inferiority of MO to darbepoetin alfa (DA) using a non-inferiority margin of 1.0 g/dL. Safety variables included adverse events. Prespecified primary analysis results up to 36 weeks are presented here.

Results

82 patients were treated with MO, starting doses were 25 mg for 27 patients and 50 mg in 55 patients. 82 patients were treated with DA, starting doses were in accordance with previous ESA dose and interval. The mean of baseline Hb values were 11.31 g/dL and 11.27 g/dL in the MO and DA group, respectively. For the mean Hb values during the evaluation period in MO, the mean was 11.67 g/dL (95%CI; 11.48, 11.85) and the mean Hb values of 66 patients (80.5%) were within the target range. As the primary efficacy variables (the changes from baseline of mean Hb values during the evaluation period), the means were 0.35 g/dL (95%CI; 0.12, 0.58) and 0.26 g/dL (95%CI; 0.04, 0.48) in the MO and DA group, respectively. The LS mean difference was 0.13 (95%CI; -0.15, 0.40), therefore the non-inferiority of MO to DA was established. The mean (SD) doses during the study period were 52.16 (32.58) mg/day of MO and 21.33 (12.33) μg/week of DA. AEs were experienced in 87.8% of patients in the MO group and 89.0% of patients in the DA group up to 36 weeks. The most common AEs occurred ≥ 5% of patients in any group were nasopharyngitis (29.3% and 30.5%, respectively) and worsening of chronic kidney disease (12.2% and 7.3%, respectively).

Conclusion

Maintenance effect of MO on the Hb values was investigated and the non-inferiority of MO to DA was established in non-dialysis patients with anemia treated with ESAs. The MO showed no new safety concern but further longitudinal investigation will be needed.
Early-Morning vs Spot Posterior Oropharyngeal Saliva for Diagnosis of SARS-CoV-2 Infection: Implication of Timing of Specimen Collection for Community-Wide Screening
Authors: Hung Derek Ling-Lung , Li Xin , Chiu Kelvin Hei-Yeung , Yip Cyril Chik-Yan , To Kelvin Kai-Wang , Chan Jasper Fuk-Woo , Sridhar Siddharth , Chung Tom Wai-Hin , Lung Kwok-Cheung , Liu Raymond Wai- To , Kwan Grace Sze-Wai , Hung Ivan Fan-Ngai , Cheng Vincent Chi-Chung , Yuen Kwok-Yung
Published: June 2020

Background

Posterior oropharyngeal saliva is increasingly recognized as a valid respiratory specimen for SARS-CoV-2 diagnosis. It is easy to collect and suitable for community-wide screening. The optimal timing of collection is currently unknown, and we speculate that an early-morning specimen before oral hygiene and breakfast would increase the diagnostic yield.

Methods

Posterior oropharyngeal saliva was collected at 5 different time points within the same day from 18 patients with previously confirmed SARS-CoV-2 infection by molecular testing. Cycle threshold (Ct) values were compared.

Results

There was an overall trend of lower Ct values from specimens collected in the early morning, with a gradual decrease of viral load towards nighttime, but reaching statistical significance only when compared with the specimens collected at bedtime. Eight out of 13 subjects had a higher viral load in the early morning than the rest of the 4 time points (before lunch, before teatime at 3 pm, before dinner, before bedtime).

Conclusions

The result suggests a diurnal variation of viral shedding from the upper respiratory tract with a trend showing higher viral load in the early morning. For community screening purposes, posterior oropharyngeal saliva could be taken throughout the day, but preferably in the early morning to maximize the yield.
Association of Hepatitis B Core-Related Antigen and Antihepatitis B Core Antibody With Liver Fibrosis Evolution in Human Immunodeficiency Virus-Hepatitis B Virus Coinfected Patients During Treatment With Tenofovir
Authors: Cruchet Romuald , Dezanet Lorenza N C , Maylin Sarah , Gabassi Audrey , Rougier Hayette , Miailhes Patrick , Lascoux-Combe Caroline , Chas Julie , Girard Pierre-Marie , Delaugerre Constance , Lacombe Karine , Boyd Anders
Published: June 2020

Background

Quantitative hepatitis B core-related antigen (qHBcrAg) or antihepatitis B core antibody (qAnti-HBc) could be useful in monitoring liver fibrosis evolution during chronic hepatitis B virus (HBV) infection, yet it has not been assessed in human immunodeficiency virus (HIV)-HBV-coinfected patients undergoing treatment with tenofovir (TDF).

Methods

One hundred fifty-four HIV-HBV-infected patients initiating a TDF-containing antiretroviral regimen were prospectively followed. The qHBcrAg and qAnti-HBc and liver fibrosis assessment were collected every 6–12 months during TDF. Hazard ratios (HRs) assessing the association between qHBcrAg/qAnti-HBc and transitions from none/mild/significant fibrosis to advanced fibrosis/cirrhosis (progression) and from advanced fibrosis/cirrhosis to none/mild/significant fibrosis (regression) were estimated using a time-homogeneous Markov model.

Results

At baseline, advanced liver fibrosis/cirrhosis was observed in 40 (26%) patients. During a median follow-up of 48 months (interquartile range, 31–90), 38 transitions of progression (IR = 7/100 person-years) and 34 transitions of regression (IR = 6/100 person-years) were observed. Baseline levels of qHBcrAg and qAnti-HBc were not associated with liver fibrosis progression (adjusted-HR per log10 U/mL = 1.07, 95% confidence interval [CI] = 0.93–1.24; adjusted-HR per log10 Paul-Ehrlich-Institute [PEI] U/mL = 0.85, 95% CI = 0.70–1.04, respectively) or regression (adjusted-HR per log10 U/mL = 1.17, 95% CI = 0.95–1.46; adjusted-HR per log10 PEI U/mL = 0.97, 95% CI = 0.78–1.22, respectively) after adjusting for age, gender, duration of antiretroviral therapy, protease inhibitor-containing antiretroviral therapy, and CD4+/CD8+ ratio. Nevertheless, changes from the previous visit of qAnti-HBc levels were associated with liver fibrosis regression (adjusted-HR per log10 PEIU/mL change = 5.46, 95% CI = 1.56–19.16).

Conclusions

Baseline qHBcrAg and qAnti-HBc levels are not associated with liver fibrosis evolution in TDF-treated HIV-HBV coinfected patients. The link between changes in qAnti-HBc levels during follow-up and liver fibrosis regression merits further study.
A Higher Grey Matter Density in the Amygdala and Midbrain Is Associated with Persistent Pain Following Total Knee Arthroplasty
Authors: Lewis Gwyn N , Wartolowska Karolina A , Parker Rosalind S , Sharma Sheena , Rice David A , Kluger Michal , McNair Peter J
Published: June 2020

Objective

The development of persistent pain following total knee arthroplasty (TKA) is common, but its underlying mechanisms are unknown. The goal of the study was to assess brain grey matter structure and its correlation with function of the nociceptive system in people with good and poor outcomes following TKA.

Subjects

Thirty-one people with LOW_PAIN (<3/10 on the numerical ratings scale [NRS]) at six months following TKA and 15 people with HIGH_PAIN (≥3/10 on the NRS) were recruited into the study.

Methods

Grey matter in key brain areas related to nociception was analyzed using voxel-based morphometry (VBM). Nociceptive facilitatory and inhibitory processes were evaluated using quantitative sensory testing (QST). QST scores and grey matter density in prespecified brain regions were compared between the LOW_PAIN and HIGH_PAIN groups. Regression analyses were used to analyze the associations between the grey matter and QST scores.

Results

There were no between-group differences in QST measures. In the VBM analysis, the HIGH_PAIN group had a higher grey matter density in the right amygdala, right nucleus accumbens, and in the periaqueductal grey (PAG), but lower grey matter density in the dorsal part of the left caudate nucleus. Grey matter density in the right amygdala and PAG correlated positively with temporal summation of pain.

Conclusions

Persistent pain at six months after TKA is associated with a higher grey matter density in the regions involved in central sensitization and pain-related fear, which may contribute to the development of persistent pain after surgery.
The Origins and Real Effects of the Gender Gap: Evidence from CEOs’ Formative Years
Authors: Duchin Ran , Simutin Mikhail , Sosyura Denis
Published: June 2020

Using individual census records, we provide novel evidence on CEOs’ socioeconomic backgrounds and study their role in investment decisions. Male CEOs allocate more investment capital to male than female division managers. This gender gap is driven by CEOs who grew up in male-dominated families where the father was the only income earner and had more education than the mother. The gender gap also increases for CEOs who attended all-male high schools and grew up in neighborhoods with greater gender inequality. The effect of gender on capital budgeting introduces frictions and erodes investment efficiency.
In vitro glistening formation in IOLs: automated method for assessing the volumetric density and depth distribution of microvacuoles
Authors: Borghesi Simone , Colciago Sara , Zeri Fabrizio , Scialdone Antonio , Tavazzi Silvia
Published: June 2020

Purpose:

To develop a method to measure the depth profile of microvacuoles (MVs) in intraocular lenses (IOLs) and to characterize, after accelerated aging, the glistening of an acrylic hydrophobic IOL.

Setting:

University of Milano-Bicocca, Milan, Italy.

Design:

In vitro study.

Methods:

A heat treatment was applied in vitro to Basis V IOLs exposed to deionized water (24 hours at 45 ± 1°C, rapid cooling, and 24 hours at 24 ± 1°C). Thirty images (area 1.2 mm2) of each IOL were acquired by a microscope, focusing on sequential planes every 23 ± 2 μm. By tracking the traces of each MV in consecutive images, the coordinates of the MV centroids along the IOL thickness were construed by an automated procedure, and in the generated single-focus stacked image, MVs were counted by an automated method.

Results:

MV density was found normally distributed along the IOL depth profile (Jarque-Bera test). In focus-stacked images, the MV automated counting was found accurate within 5% vs manual counting, and MV volume density of the order of 103 mm−3 was estimated. It was observed that stacks of 15 images provided a 4% lower MV volume density compared with the stacking of 30 images.

Conclusions:

The assessment of the number of MVs by the acquisition of a single image of an IOL was influenced by the distance of the selected plane from the IOL surface. The decrease in MV density approaching the IOL edges can be explained as a consequence of the diffusion of water toward the external environment after accelerated aging.
Effectiveness of a Home-Based Telehealth Exercise Training Program for Patients With Cardiometabolic Multimorbidity
Authors: Chiang Shang-Lin , Shen Chien-Lung , Chen Liang-Cheng , Lo Yi-Pang , Lin Chueh-Ho , Lin Chia-Huei
Published: June 2020

Background

Exercise training has positive effects on the management of cardiometabolic conditions. Little is known about the effectiveness of home-based telehealth exercise training programs among patients with cardiometabolic multimorbidity, which is associated with functional decline and decreased health-related quality of life.

Objective

The aim of this study was to determine the effectiveness of a 12-week home-based telehealth exercise training program designed to increase physical activity and exercise capacity and improve health-related quality of life in patients with cardiometabolic multimorbidity.

Methods

A randomized controlled trial was conducted. Fifty eligible patients with 2 or more cardiometabolic conditions from outpatient clinics of a medical center in Northern Taiwan were randomized to either an experimental group (EG; received a 12-week home-based telehealth exercise training program) or a control group (CG; maintained usual lifestyles). The home-based telehealth exercise training program consisted of 36 individualized home-based exercise training sessions and a weekly reminder for maintenance of exercise and providing patient support. Amounts of physical activity, exercise capacity, and health-related quality of life were assessed at baseline and 12 weeks. Generalized estimating equations were used to examine the intervention effects via the interaction of time and group.

Results

The EG had higher amounts of physical activity (β = 1333, P = .004) and moderate-intensity physical activity (β = 330, P = .04) than the CG after the intervention. The EG had increased exercise capacity (VO2peak, β = 4.43, P = .04), as well as improved health-related quality of life (physical function, β = 7.55, P = .03; and physical component summary, β = 4.42, P = .03) compared with those in the CG.

Conclusions

A 12-week home-based telehealth exercise training program is feasible and effective in increasing amounts of physical activity, elevating exercise capacity, and improving health-related quality of life in patients with cardiometabolic multimorbidity.
Psychometric Characteristics of the Caregiver Contribution to Self-care of Heart Failure Index in a South American Population
Authors: Ávila Christiane Wahast , De Maria Maddalena , Vellone Ercole , Riegel Barbara , Bernardes Daniela , Silveira Luana Jacoby , Rabelo-Silva Eneida Rejane
Published: June 2020

Background

Caregivers can contribute enormously to the self-care of patients with heart failure (HF). The Caregiver Contribution to Self-care of Heart Failure Index (CC-SCHFI) measures these contributions across 3 scales: self-care maintenance, which evaluates caregiver contributions to symptom monitoring and treatment adherence; self-care management, which evaluates caregiver contributions in dealing with symptoms; and caregiver confidence, which assesses caregiver self-efficacy in managing all contributions to self-care. Although the CC-SCHFI has been used in several investigations, only 1 study has evaluated its psychometric characteristics.

Objective

The aim of this study was to evaluate the psychometric properties of the CC-SCHFI in Brazil.

Methods

A cross-sectional design was used in this study. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability.

Results

The sample comprised 99 caregivers of patients with HF. Most were women (73%), with a mean age of 48 ± 14 years; 57% were patients' spouses. Confirmatory factor analysis confirmed the original factor structure of the instrument, with supportive fit indices for all 3 scales (comparative fit index, 0.95–1.00; root-mean-square error of approximation, 0.00–0.057). Reliability estimates were adequate for each CC-SCHFI scale (0.77–0.96).

Conclusions

The CC-SCHFI is a valid and reliable scale to measure caregiver contributions to self-care maintenance, caregiver contributions to self-care management, and caregiver confidence in HF.
Assessing Motor Function in Congenital Muscular Dystrophy Patients Using Accelerometry
Authors: Lawal Tokunbor A. , Todd Joshua J. , Elliott Jeffrey S. , Linton Melody M. , Andres Megan , Witherspoon Jessica W. , Collins John P. , Chrismer Irene C. , Tounkara Fatoumata , Waite Melissa R. , Nichols Carmel , Bönnemann Carsten G. , Vuillerot Carole , Bendixen Roxanna , Jain Minal S. , Meilleur Katherine G.
Published: June 2020

BACKGROUND

When tested in a controlled clinic environment, individuals with neuromuscular-related symptoms may complete motor tasks within normal predicted ranges. However, measuring activity at home may better reflect typical motor performance. The accuracy of accelerometry measurements in individuals with congenital muscular dystrophy (CMD) is unknown. We aimed to compare accelerometry and manual step counts and assess free-living physical activity intensity in individuals with CMD using accelerometry.

METHODS

Ambulatory pediatric CMD participants (n = 9) performed the 6-minute walk test in clinic while wearing ActiGraph GT3X accelerometer devices. During the test, manual step counting was conducted to assess concurrent validity of the ActiGraph step count in this population using Bland-Altman analysis. In addition, activity intensity of 6 pediatric CMD participants was monitored at home with accelerometer devices for an average of 7 days. Cut-point values previously validated for neuromuscular disorders were used for data analysis.

RESULTS

Bland-Altman and intraclass correlation analyses showed no concurrent validity between manual and ActiGraph-recorded step counts. Fewer steps were recorded by ActiGraph step counts compared with manual step counts (411 ± 74 vs 699 ± 43, respectively; P = .004). Although improved, results were in the same direction with the application of low-frequency extension filters (587 ± 40 vs 699 ± 43, P = .03). ActiGraph step-count data did not correlate with manual step count (Spearman ρ = 0.32, P = .41; with low-frequency extension: Spearman ρ = 0.45, P = .22). Seven-day physical activity monitoring showed that participants spent more than 80% of their time in the sedentary activity level.

CONCLUSIONS

In a controlled clinic setting, step count was significantly lower by ActiGraph GT3X than by manual step counting, possibly because of the abnormal gait in this population. Additional studies using triaxial assessment are needed to validate accelerometry measurement of activity intensity in individuals with CMD. Accelerometry outcomes may provide valuable measures and complement the 6-minute walk test in the assessment of treatment efficacy in CMD.
Initial User Testing of Decision Aids for Multiple Sclerosis Disease-Modifying Therapies
Authors: Hakim Hasna , Newland Pamela , Oliver Brant J.
Published: June 2020

BACKGROUND

Disease-modifying therapies (DMTs) are the cornerstone of multiple sclerosis (MS) treatment. DMT treatment is a preference-sensitive decision in which shared decision making is indicated.

METHODS

We used qualitative methods to explore usability of MS decision aids in people aged 18 to 70 years diagnosed with MS. Semistructured interviews aimed to assess patients' overall reaction to using the decision aids. This included specific aspects of the user experience to improve readability, format, content, and patient opinions about whether the integration of the decision aids into visits with MS clinicians would be feasible and assist with making better DMT selections.

RESULTS

Twenty-three interviews were completed with eligible patients with MS aged 18 to 70 years to improve readability. Using thematic analysis, 5 themes emerged from the analysis including decision aids are easy and understandable, include cost, prioritize side effects and tests, increase font size, and have a simpler injectable grid. We also identified areas for improvement including formatting, side effects of DMT options, transparency of data sources, research, and development.

CONCLUSION

Overall findings suggest that the decision aids are usable, easy to understand, and helpful to facilitate shared decision making for DMT selection. This work will help guide further modifications to the prototype MS decision aids before publication and can inform the growing body of knowledge regarding the development of high-quality decision aids.
Psychosocial Sequelae of Stroke in Working-Age Adults: A Pilot Study
Authors: Rhudy Lori M. , Wells-Pittman Jennifer , Flemming Kelly D.
Published: June 2020

OBJECTIVE

Few prospective studies have examined psychosocial symptoms in young adult stroke survivors. The purpose of this pilot study was to examine the feasibility of methods to assess and describe the presence of symptoms and their characteristics in young adult stroke survivors.

METHODS

A prospective descriptive design using PROMIS and NeuroQoL patient-reported outcomes was used. Stroke survivors aged 18 to 65 years admitted for acute ischemic stroke completed baseline measures before hospital discharge; the same measures were collected by telephone interview 6 months later.

RESULTS

Thirty patients were recruited, and 18 (60%) completed follow-up measures. There was wide variability in scores across patients for each patient-reported outcome that persisted at 6 months. NeuroQoL cognitive function was the only patient-reported outcome to have a statistically significant change from baseline to 6 months (P = .045).

CONCLUSIONS

It is feasible to recruit and retain young adult stroke survivors in a prospective study. Wide variability in scores across patients suggests different trajectories of recovery in the first 6 months after stroke. Neuroscience nurses can assess for these symptoms and provide individualized interventions to aid in self-management of burdensome symptoms.
Death Self-efficacy, Attitudes Toward Death and Burnout Among Oncology Nurses
Authors: Zheng Ruishuang , Guo Qiaohong , Dong Fengqi , Gao Li
Published: June 2020

Background

To effectively care for dying patients, nurses need to possess death self-efficacy—the state of having both a range of skills and capabilities to provide care to dying patients and confidence in one’s ability to do so. A paucity of death self-efficacy may lead to burnout.

Objectives

The aims of this study are to clarify oncology nurses’ death self-efficacy and to explore its relationships with attitudes toward death and burnout.

Methods

A cross-sectional study was performed in 7 cancer hospitals across mainland China between June and July 2019. Oncology nurses completed an online survey consisting of the Death Self-efficacy Scale, Death Attitude Profile–Revised Scale, and Maslach Burnout Inventory.

Results

The 755 oncology nurses completing the survey reported low death self-efficacy and high levels of burnout. Those who had more years of clinical experience, had the highest professional rank, talked death quite often, and have received palliative care trainings, doing no shift work, scored higher on death self-efficacy. Death self-efficacy was positively correlated with positive attitudes toward death and negatively correlated with levels of burnout. The multiple regression analysis showed that death self-efficacy and attitudes toward death were independent, significant predictors of oncology nurses’ burnout.

Conclusions

Chinese oncology nurses are not well prepared to care for dying cancer patients and cope with death-related issues.

Implications for Practice

Improvement in death self-efficacy among oncology nurses is necessary, especially for those who are young, are unmarried, are doing shift work, and never received palliative care training. Enhanced death self-efficacy may be realized through self-reflective practice and palliative care education.
Virtual Reality Intervention Targeting Pain and Anxiety Among Pediatric Cancer Patients Undergoing Peripheral Intravenous Cannulation
Authors: Wong Cho Lee , Li Chi Kong , Chan Carmen W. H. , Choi Kai Chow , Chen Jieling , Yeung Man Ting , Chan On Na
Published: June 2020

Background

Peripheral intravenous cannulation (PIC) is commonly performed in cancer treatment and causes pain and anxiety to children with cancer.

Objective

The aim of this study was to determine whether virtual reality distraction intervention can alleviate pain and anxiety and reduce length of procedure among pediatric cancer patients undergoing PIC.

Methods

One hundred eight pediatric cancer patients aged 6 to 17 years were recruited from a regional public hospital in Hong Kong to participate in this randomized controlled trial. The intervention group received virtual reality distraction intervention, and the control group received standard care. The primary outcome was child-reported pain. Secondary outcomes included child-reported anxiety, pulse rate, and length of procedure. Outcome measurements were conducted at 5 minutes before, during, and immediately after the procedure.

Results

Pediatric cancer patients in the intervention group demonstrated a significantly greater reduction in pain (estimated mean difference = −1.69, P = .007) and anxiety levels (estimated mean difference = −3.50, P < .001) compared with the control group. The mean duration (in minutes) for the PIC procedure was significantly shorter among participants receiving virtual reality intervention compared with the control counterparts (estimated mean difference = −0.75, P = .017). However, no significant difference was observed in pulse rate during and after the procedure between groups.

Conclusions

Findings indicate that virtual reality is safe and effective to alleviate pain and anxiety among pediatric cancer patients undergoing PIC procedure.

Implications for Practice

Virtual reality can be considered as an adjunctive treatment to manage pain and anxiety in pediatric cancer patients before and during PIC procedure.
The Design and Impact of an Interprofessional Education Event Among Pharmacy and Nursing Students in Palliative Care—RnRx
Authors: Houle Sherilyn K. D. , Lillie Elaine , Richard Cynthia L. , Slivecka Jenn , Miller Andrea
Published: June 2020

Nearly all reports of interprofessional education (IPE) in palliative care have excluded pharmacy students. This article describes an IPE event between pharmacy and nursing students and assesses its impact on IPE competencies. Second-year nursing students and third-year pharmacy students participated in an evening-long event, focused on a married couple who each require palliative care—one for end-of-life planning and one for chronic disease progression. The impact of the event was assessed using the Interprofessional Collaborative Competency Attainment Scale (ICCAS) and qualitative feedback. Two hundred nine (96.7%) completed the ICCAS, and 16 of the 20 statements of the ICCAS showed large positive effect sizes (Cohen d ≥ 0.8), with the remaining 4 showing moderate positive effect sizes (Cohen d ≥ 0.5). The greatest effect sizes were related to improved awareness of complementary skillsets and knowledge between the professions. Addressing team conflict and including the patient/family in decision-making showed the least improvement. While ongoing interactions are ideal for the development of skills related to conflict and team development, this article demonstrates that even a 1-time activity can have an impact on students' interprofessional care competence.
Implementing a New Capstone Leadership Clinical Course
Authors: Novotny Nancy L. , Jarvill Melissa , Nielsen Sandra D. , Morris Kathleen A.
Published: June 2020

Background

Nurse educators are challenged to ensure clinical education meets the changing health care environments and needs.

Problem

New nurses remain unprepared for practice, have insufficient foundational leadership capacities, and lack systems-thinking awareness.

Approach

Responding to educational gaps, increased enrollment, and scarce clinical placements, faculty used an eclectic education model to develop a new capstone leadership clinical course that included 5 types of experiences. The total acute care clinical hours were reduced, while adding leadership-focused experiences and simulated learning.

Outcomes

Stakeholders' evaluations indicate the pilot provided opportunities to strengthen students' leadership capacity, systems thinking, and professional identity while still providing sufficient practice managing care of multiple patients, engaging in teamwork, and applying evidence.

Conclusion

The new clinical course addressed students' transition into practice needs and enrollment capacity issues. Thoughtful planning by invested stakeholders, communication among faculty, and clear expectations are necessary to implement eclectic clinical models.
A Vital Sign-Based Model to Predict Clinical Deterioration in Hospitalized Children*
Authors: Mayampurath Anoop , Jani Priti , Dai Yangyang , Gibbons Robert , Edelson Dana , Churpek Matthew M.
Published: June 2020

Objectives:

Clinical deterioration in hospitalized children is associated with increased risk of mortality and morbidity. A prediction model capable of accurate and early identification of pediatric patients at risk of deterioration can facilitate timely assessment and intervention, potentially improving survival and long-term outcomes. The objective of this study was to develop a model utilizing vital signs from electronic health record data for predicting clinical deterioration in pediatric ward patients.

Design:

Observational cohort study.

Setting:

An urban, tertiary-care medical center.

Patients:

Patients less than 18 years admitted to the general ward during years 2009–2018.

Interventions:

None.

Measurements and Main Results:

The primary outcome of clinical deterioration was defined as a direct ward-to-ICU transfer. A discrete-time logistic regression model utilizing six vital signs along with patient characteristics was developed to predict ICU transfers several hours in advance. Among 31,899 pediatric admissions, 1,375 (3.7%) experienced the outcome. Data were split into independent derivation (yr 2009–2014) and prospective validation (yr 2015–2018) cohorts. In the prospective validation cohort, the vital sign model significantly outperformed a modified version of the Bedside Pediatric Early Warning System score in predicting ICU transfers 12 hours prior to the event (C-statistic 0.78 vs 0.72; p < 0.01).

Conclusions:

We developed a model utilizing six commonly used vital signs to predict risk of deterioration in hospitalized children. Our model demonstrated greater accuracy in predicting ICU transfers than the modified Bedside Pediatric Early Warning System. Our model may promote opportunities for timelier intervention and risk mitigation, thereby decreasing preventable death and improving long-term health.
Practical Considerations for Radiologists in Implementing a Patient-friendly MRI Experience
Authors: Oztek Murat Alp , Brunnquell Christina L. , Hoff Michael N. , Boulter Daniel J. , Mossa-Basha Mahmud , Beauchamp Luke H. , Haynor David L. , Nguyen Xuan V.
Published: June 2020

For many patients, numerous unpleasant features of the magnetic resonance imaging (MRI) experience such as scan duration, auditory noise, spatial confinement, and motion restrictions can lead to premature termination or low diagnostic quality of imaging studies. This article discusses practical, patient-oriented considerations that are helpful for radiologists contemplating ways to improve the MRI experience for patients. Patient friendly scanner properties are discussed, with an emphasis on literature findings of effectiveness in mitigating patient claustrophobia, other anxiety, or motion and on reducing scan incompletion rates or need for sedation. As shorter scanning protocols designed to answer specific diagnostic questions may be more practical and tolerable to the patient than a full-length standard-of-care examination, a few select protocol adjustments potentially useful for specific clinical settings are discussed. In addition, adjunctive devices such as audiovisual or other sensory aides that can be useful distractive approaches to reduce patient discomfort are considered. These modifications to the MRI scanning process not only allow for a more pleasant experience for patients, but they may also increase patient compliance and decrease patient movement to allow more efficient acquisition of diagnostic-quality images.
Virtual Reality to Relieve Pain in Burn Patients Undergoing Imaging and Treatment
Authors: Bermo Mohammed S. , Patterson David , Sharar Sam R. , Hoffman Hunter , Lewis David H.
Published: June 2020

Pain from burn injuries is among the most excruciating encountered in clinical practice. Pharmacological methods often fail to achieve acceptable level of analgesia in these patients, especially during burn wound dressing and debridement. Virtual reality (VR) distraction is a promising analgesic technique that progressed significantly in the last decade with development of commercially available, low-cost, high-resolution, wide field-of-view, standalone VR devices that can be used in many clinical scenarios. VR has demonstrated clinical benefit as an adjunctive analgesic during burn wound dressing and other painful medical procedures. The technique has proven useful also in preparing patients for magnetic resonance imaging scans, particularly in claustrophobic patients. Modulation of pain-related brain activity at cortical and subcortical levels by VR, and its correlation with subjective improvement in various laboratory and clinical pain experiences has been demonstrated using multiple functional brain imaging studies including functional magnetic resonance imaging and brain perfusion single photon emission computed tomography.
Applying Artificial Intelligence to Mitigate Effects of Patient Motion or Other Complicating Factors on Image Quality
Authors: Nguyen Xuan V. , Oztek Murat Alp , Nelakurti Devi D. , Brunnquell Christina L. , Mossa-Basha Mahmud , Haynor David R. , Prevedello Luciano M.
Published: June 2020

Artificial intelligence, particularly deep learning, offers several possibilities to improve the quality or speed of image acquisition in magnetic resonance imaging (MRI). In this article, we briefly review basic machine learning concepts and discuss commonly used neural network architectures for image-to-image translation. Recent examples in the literature describing application of machine learning techniques to clinical MR image acquisition or postprocessing are discussed. Machine learning can contribute to better image quality by improving spatial resolution, reducing image noise, and removing undesired motion or other artifacts. As patients occasionally are unable to tolerate lengthy acquisition times or gadolinium agents, machine learning can potentially assist MRI workflow and patient comfort by facilitating faster acquisitions or reducing exogenous contrast dosage. Although artificial intelligence approaches often have limitations, such as problems with generalizability or explainability, there is potential for these techniques to improve diagnostic utility, throughput, and patient experience in clinical MRI practice.
A National Survey of Motor Vehicle Crashes Among General Surgery Residents
Authors: Schlick Cary Jo R. , Hewitt Daniel Brock , Quinn Christopher M. , Ellis Ryan J. , Shapiro Katherine E. , Jones Andrew , Bilimoria Karl Y. , Yang Anthony D.
Published: June 2020

Objectives:

Evaluate the frequency of self-reported, post-call hazardous driving events in a national cohort of general surgery residents and determine the associations between duty hour policy violations, psychiatric well-being, and hazardous driving events.

Summary of Background Data:

MVCs are a leading cause of resident mortality. Extended work shifts and poor psychiatric well-being are risk factors for MVCs, placing general surgery residents at risk.

Methods:

General surgery residents from US programs were surveyed after the 2017 American Board of Surgery In-Training Examination. Outcomes included self-reported nodding off while driving, near-miss MVCs, and MVCs. Group-adjusted cluster Chi-square and hierarchical regression models with program-level intercepts measured associations between resident- and program-level factors and outcomes.

Results:

Among 7391 general surgery residents from 260 programs (response rate 99.3%), 34.7% reported nodding off while driving, 26.6% a near-miss MVC, and 5.0% an MVC over the preceding 6 months. More frequent 80-hour rule violations were associated with all hazardous driving events: nodding off while driving {59.8% with ≥5 months with violations vs 27.2% with 0, adjusted odds ratio (AOR) 2.86 [95% confidence interval (CI) 2.21–3.69]}, near-miss MVCs, [53.6% vs 19.2%, AOR 3.28 (95% CI 2.53–4.24)], and MVCs [14.0% vs 3.5%, AOR 2.46 (95% CI 1.65–3.67)]. Similarly, poor psychiatric well-being was associated with all 3 outcomes [eg, 8.0% with poor psychiatric well-being reported MVCs vs 2.6% without, odds ratio 2.55 (95% CI 2.00–3.24)].

Conclusions:

Hazardous driving events are prevalent among general surgery residents and associated with frequent duty hour violations and poor psychiatric well-being. Greater adherence to duty hour standards and efforts to improve well-being may improve driving safety.
Mental Health Burden After Injury
Authors: Herrera-Escobar Juan P. , Seshadri Anupamaa J. , Stanek Ewelina , Lu Kaye , Han Kelsey , Sanchez Sabrina , Kaafarani Haytham M. A. , Salim Ali , Levy-Carrick Nomi C. , Nehra Deepika
Published: June 2020

Objective:

Assess the prevalence of anxiety, depression, and posttraumatic stress disorder (PTSD) after injury and their association with long-term functional outcomes.

Background:

Mental health disorders (MHD) after injury have been associated with worse long-term outcomes. However, prior studies almost exclusively focused on PTSD.

Methods:

Trauma patients with an injury severity score ≥9 treated at 3 Level-I trauma centers were contacted 6–12 months post-injury to screen for anxiety (generalized anxiety disorder-7), depression (patient health questionnaire-8), PTSD (8Q-PCL-5), pain, and functional outcomes (trauma quality of life instrument, and short-form health survey)). Associations between mental and physical outcomes were established using adjusted multivariable logistic regression models.

Results:

Of the 531 patients followed, 108 (20%) screened positive for any MHD: of those who screened positive for PTSD (7.9%, N = 42), all had co-morbid depression and/or anxiety. In contrast, 66 patients (12.4%) screened negative for PTSD but positive for depression and/or anxiety. Compared to patients with no MHD, patients who screened positive for PTSD were more likely to have chronic pain {odds ratio (OR): 8.79 [95% confidence interval (CI): 3.21, 24.08]}, functional limitations [OR: 7.99 (95% CI: 3.50, 18.25)] and reduced physical health [β: −9.3 (95% CI: −13.2, −5.3)]. Similarly, patients who screened positive for depression/anxiety (without PTSD) were more likely to have chronic pain [OR: 5.06 (95% CI: 2.49, 10.46)], functional limitations [OR: 2.20 (95% CI: 1.12, 4.32)] and reduced physical health [β: −5.1 (95% CI: −8.2, −2.0)] compared to those with no MHD.

Conclusions:

The mental health burden after injury is significant and not limited to PTSD. Distinguishing among MHD and identifying symptom-clusters that overlap among these diagnoses, may help stratify risk of poor outcomes, and provide opportunities for more focused screening and treatment interventions.
Latency-associated Peptide Identifies Immunoevasive Subtype Gastric Cancer With Poor Prognosis and Inferior Chemotherapeutic Responsiveness
Authors: Cao Yifan , He Hongyong , Li Ruochen , Liu Xin , Chen Yifan , Qi Yangyang , Yu Kuan , Wang Jieti , Lin Chao , Liu Hao , Zhang Heng , Li He , Chen Lingli , Zhang Peipei , Shen Zhenbin , Huang Hua , Sun Yihong , Zhang Weijuan , Qin Jing , Xu Jiejie
Published: June 2020

Objective:

To examine the clinical significance of LAP to predict survival outcomes and chemotherapeutic responsiveness in gastric cancer.

Background:

LAP has been shown to possess significant immunoregulatory roles in several malignancies. However, the role and clinical significance of LAP in gastric cancer still remains unknown.

Methods:

Four hundred and fifty-six tumor tissue microarray specimens, 80 fresh tumor tissue samples of gastric cancer patients from Zhongshan Hospital, Fudan University and transcriptomic and clinical data of 328 gastric cancer patients from the Cancer Genome Atlas were analyzed. LAP expression and immune contexture were examined by immunohistochemistry, CIBERSORT, and flow cytometry. Clinical outcomes of patient subgroups were compared by Kaplan-Meier curves, Cox model and interaction test.

Results:

High LAP expression predicted poor overall survival (P < 0.001, P < 0.001, and P = 0.022) and inferior therapeutic responsiveness to fluorouracil-based adjuvant chemotherapy (P = 0.008 for interaction) in gastric cancer. LAP was associated with immunoevasive tumor microenvironment featured by dysfunctional CD8+ T cells infiltration (P < 0.001). The LAP-associated dysfunctional CD8+ T cells had an exhausted phenotype with decreased effector molecules such as interferon-γ, granzyme B, and perforin, but also elevated programmed cell death protein-1, which resulted in poor prognosis and inferior therapeutic responsiveness.

Conclusions:

This study revealed that LAP could identify immunoevasive subtype gastric cancer, indicating LAP might be a potential immunotherapeutic target and facilitate patient counseling on individualized adjuvant therapy and follow-up scheduling in gastric cancer.
The Quality of Operative Performance Narrative Feedback
Authors: Ahle Samantha L. , Eskender Mickyas , Schuller Mary , Carnes Emily , Chen Xilin , Koehler Jeanne , Willey Gabrielle , Latif Ahmed , Doyle Jennifer , Wnuk Gregory , Fryer Jonathan P. , Mellinger John D. , George Brian C.
Published: June 2020

Objective:

To describe the quality of operative performance feedback using evaluation tools commonly used by general surgery residency training programs.

Summary of Background Data:

The majority of surgical training programs administer an evaluation through which faculty members may rate and comment on trainee operative performance at the end of the rotation (EOR). Many programs have also implemented the system for improving and measuring procedural learning (SIMPL), a workplace-based assessment tool with which faculty can rate and comment on a trainee's operative performance immediately after a case. It is unknown how the quality of narrative operative performance feedback delivered with these tools compares.

Methods:

The authors collected EOR evaluations and SIMPL narrative comments on trainees’ operative performance from 3 university-based surgery training programs during the 2016–2017 academic year. Two surgeon raters categorized comments relating to operative skills as being specific or general and as encouraging and/or corrective. Comments were then classified as effective, mediocre, ineffective, or irrelevant. The frequencies with which comments were rated as effective were compared using Chi-square analysis.

Results:

The authors analyzed a total of 600 comments. 10.7% of EOR and 58.3% of SIMPL operative performance evaluation comments were deemed effective (P < 0.0001).

Conclusions:

Evaluators give significantly higher quality operative performance feedback when using workplace-based assessment tools rather than EOR evaluations.
Development and Validation of a Modified Eighth AJCC Staging System for Primary Pancreatic Neuroendocrine Tumors
Authors: Zhang Xu-Feng , Xue Feng , Wu Zheng , Lopez-Aguiar Alexandra G. , Poultsides George , Makris Eleftherios , Rocha Flavio , Kanji Zaheer , Weber Sharon , Fisher Alexander , Fields Ryan , Krasnick Bradley A. , Idrees Kamran , Smith Paula M. , Cho Cliff , Beems Megan , Lyu Yi , Maithel Shishir K. , Pawlik Timothy M.
Published: June 2020

Objective:

To improve the prognostic accuracy of the eighth edition of AJCC staging system for pNETs with establishment and validation of a new staging system.

Background:

Validation of the updated eighth AJCC staging system for pNETs has been limited and controversial.

Methods:

Data from the SEER registry (1975–2016) (n = 3303) and a multi-institutional database (2000–2016) (n = 825) was used as development and validation cohorts, respectively. A mTNM was proposed by maintaining the eighth AJCC T and M definitions, and the recently proposed N status as N0 (no LNM), N1 (1–3 LNM), and N2 (≥4 LNM), but adopting a new stage classification.

Results:

The eighth TNM staging system failed to stratify patients with stage I versus IIA, stage IIB versus IIIA, and overall stage I versus II relative to long-term OS in both database. There was a monotonic decrement in survival based on the proposed mTNM staging classification among patients derived from both the SEER (5-year OS, stage I 87.0% vs stage II 80.3% vs stage III 72.9% vs stage IV 57.2%, all P < 0.001), and multi-institutional (5-year OS, stage I 97.6% vs stage II 82.7% vs stage III 78.4% vs stage IV 50.0%, all P < 0.05) datasets. On multivariable analysis, mTNM staging remained strongly associated with prognosis, as the hazard of death incrementally increased with each stage among patients in the 2 cohorts.

Conclusion:

A mTNM pNETs clinical staging system using N0, N1, N2 nodal categories was better at stratifying patients relative to long-term OS than the eighth AJCC staging.