bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex differences in obstructive sleep apnea phenotypes, the multi-ethnic study of atherosclerosis
Authors: Won Christine H J , Reid Michelle , Sofer Tamar , Azarbarzin Ali , Purcell Shaun , White David , Wellman Andrew , Sands Scott , Redline Susan 
Published: November 2019

Abstract

Study Objectives
The bases for sex disparities in obstructive sleep apnea (OSA), is poorly understood. We quantified the influences of event definitions, sleep-state, and body position on apnea–hypopnea indices (AHIs) in men and women, and evaluated sex differences in pathophysiological endotypes.

Methods
Polysomnography (PSG) data were analyzed from 2057 participants from the multi-ethnic study of atherosclerosis. Alternative AHIs were compared using various desaturation and arousal criteria. Endotypes (loop gain, airway collapsibility, arousal threshold) were derived using breath-by-breath analysis of PSG signals. Regression models estimated the extent to which endotypes explained sex differences in AHI.

Results
The sample (mean 68.5 ± 9.2 years) included 54% women. OSA (AHI4P ≥15/h, defined by events with ≥4% desaturations) was found in 41.1% men and 21.8% women. Compared to AHI4P, male/female AHI ratios decreased by 5%–10% when using 3%-desaturation and/or arousal criteria; p &lt; 0.05. REM-OSA (REM-AHI ≥15/h) was similar in men and women regardless of event desaturation criteria. REM-AHI4P ≥15/h was observed in 57% of men and women each. In NREM, AHI4P in men was 2.49 (CI95: 2.25, 2.76) of that in women. Women demonstrated lower loop gain, less airway collapsibility, and lower arousal threshold in NREM (ps &lt; 0.0005). Endotypes explained 30% of the relative sex differences in NREM-AHI4P.

Conclusions
There are significant sex differences in NREM-AHI levels and in physiological endotypes. Physiological endotypes explained a significant portion of the relative sex differences in NREM-AHI. Definitions that use 4%-desaturation criteria under-estimate AHI in women. Combining NREM and REM events obscures OSA prevalence in REM in women.
Analyzing State Action on Women’s Rights: Institutions, Actors, and Issues
Authors: Waylen Georgina 
Published: November 2019

AbstractHtun and Weldon’s thought-provoking book The Logics of Gender Justice makes an important contribution to gender and politics scholarship in three areas: its methods and scope; its analytical framing; and its empirical findings. It significantly advances our understanding in these key areas. In this commentary, I outline the numerous positive aspects of the book before discussing some of the research’s potential limitations, primarily from an institutionalist perspective; and I conclude by asking how this book might serve as a jumping-off point for further research that will help us better understand the current conjuncture, particularly backlash and retrenchment.
Minimum Age Regulation and Child Labor: New Evidence from Brazil
Authors: Bargain Olivier , Boutin Delphine 
Published: November 2019

Abstract
This study presents new evidence on the effects of minimum age regulations obtained from a natural experiment. In 1998, a constitutional reform in Brazil changed the minimum working age from 14 to 16. The reform was the legislative counterpart of a broad set of measures taken by a government strongly committed to eliminating child labor. This article investigates the role of the minimum working age in this context. The setting allows for improvements upon past approaches based on comparing employment rates of children at different ages. A discontinuity in treatment is exploited, namely the fact that only children who turned 14 after the enactment date (mid-December 1998) are banned from work. According to regression discontinuity and difference-in-discontinuity designs, the null hypothesis of no overall effect of the ban cannot be rejected. Throughout the methods and specifications, an employment effect in a confidence interval of $[-0.06, \, 0.03]$ (in percentage points) is found. A detailed heterogeneity analysis is performed and provides suggestive evidence of diminishing child labor trends in regions characterized by higher labor inspection intensity, which is interpreted as a trace of there being a law. However, contrary to what has been claimed in recent studies, the law seems not to have produced sizeable effects overall, at least in the short run. Power calculations and extensive sensitivity checks support these conclusions.
Asthma/obstructive pulmonary disease overlap: update on definition, biomarkers, and therapeutics
Authors: Generoso August , Oppenheimer John 
Published: November 2019

Purpose of review
Asthma/chronic obstructive pulmonary disease overlap (ACO) continues to be a poorly understood condition. This review discusses newly proposed criteria and potential biomarkers in ACO, to aid in diagnosis and research studies, and prudent therapeutic approaches.

Recent findings
A global expert panel proposed an operational definition consisting of major and minor criteria as a step toward defining ACO. Serum periostin and YKL-40 may serve as biomarkers for ACO. Clinically, a reasonable therapeutic approach to ACO is the early addition of a long-acting β-agonist (LABA) and/or a long-acting muscarinic antagonist (LAMA) to an inhaled corticosteroid (ICS).

Summary
Both the proposed criteria and the described biomarkers for ACO can help guide clinicians in identifying this condition as well as aid researchers in designing much needed future studies. In the meantime, clinicians can treat potential ACO patients using the above approach, until therapeutic studies in clearly defined ACO patients are performed.
Ex-vivo lung perfusion
Authors: Moreno Garijo Jacobo , Roscoe Andrew 
Published: November 2019

Purpose of review
Ex-vivo lung perfusion (EVLP) has been developed to expand the donor pool for lung transplantation recipients. The role of EVLP in organ preservation, evaluation and potential reconditioning is reviewed.

Recent findings
EVLP has been shown to significantly increase the utilization of donor lungs for transplantation. Evidence suggests that patient outcomes from EVLP lungs are comparable to standard procurement technique. Novel strategies are being developed to treat and recondition injured donor lungs. EVLP may also prove to be a tool for translational research of lung diseases.

Summary
EVLP has been shown to be an effective system to expand donor pool for lung transplantation without detriment to recipients. Future potential ex-vivo developments may further improve patient outcomes as well as increasing availability of donor organs.
A call to action: Building evidence for use of simulation in nurse practitioner education
Authors: Jeffries Pamela R. , Bigley Mary Beth , McNelis Angela M. , Cartier Jeanne M. , Pintz Christine , Slaven-Lee Pamela W. , Zychowicz Michael E. 
Published: November 2019

ABSTRACT
Leaders from national nursing organizations, nursing schools, and health care simulation vendors convened in early 2019 to discuss simulation in nurse practitioner (NP) education. Nurse practitioner clinical education needs a more standardized, efficient, and sustainable model to prepare NPs to provide quality care in complex health care systems. Currently, a major shortage of clinical sites and preceptors to educate students creates challenges for NP programs and nursing faculty. One strategy used by nursing programs to overcome this challenge is using simulation to provide clinical training for NP students in a safe, controlled environment. There remains, however, a lack of evidence linking these simulation experiences with clinical skills acquisition and program outcomes. Implementing competency-based education through standardized simulations has the potential to demonstrate quality, safety, and accountability across NP education programs. Ultimately, the expansion and acceptance of simulation hours in NP education is dependent on strong and favorable evidence from rigorous, high-quality studies.
Platelets as key players in inflammation and infection
Authors: Nicolai Leo , Massberg Steffen 
Published: November 2019

Purpose of review
This review highlights recent insights into the role of platelets in acute inflammation and infection.

Recent findings
Platelets exhibit intravascular crawling behavior and can collect and bundle bacteria. In addition, platelets are key in promoting intravascular thrombus formation in infection, a process termed ‘immunothrombosis’, which contributes to pathogen containment, but also potentially damages the host. Platelets are at the nexus of leukocyte recruitment and activation, yet they are at the same time crucial in preventing inflammation-associated hemorrhage and tissue damage. This multitasking requires specific receptors and pathways, depending on stimulus, organ and effector function.

Summary
New findings highlight the complex interplay of innate immunity, coagulation and platelets in inflammation and infection, and unravel novel molecular pathways and effector functions. These offer new potential therapeutic approaches, but require further extensive research to distinguish treatable proinflammatory from host–protective pathways.
Transcription factor and cytokine regulation of eosinophil lineage commitment
Authors: Mack Ethan A. , Pear Warren S. 
Published: November 2019

Purpose of review
Lineage commitment is governed by instructive and stochastic signals, which drive both active induction of the lineage program and repression of alternative fates. Eosinophil lineage commitment is driven by the ordered interaction of transcription factors, supported by cytokine signals. This review summarizes key findings in the study of eosinophil lineage commitment and examines new data investigating the factors that regulate this process.

Recent findings
Recent and past studies highlight how intrinsic and extrinsic signals modulate transcription factor network and lineage decisions. Early action of the transcription factors C/EBPα and GATA binding protein-1 along with C/EBPε supports lineage commitment and eosinophil differentiation. This process is regulated and enforced by the pseudokinase Trib1, a regulator of C/EBPα levels. The cytokines interleukin (IL)-5 and IL-33 also support early eosinophil development. However, current studies suggest that these cytokines are not specifically required for lineage commitment.

Summary
Together, recent evidence suggests a model where early transcription factor activity drives expression of key eosinophil genes and cytokine receptors to prime lineage commitment. Understanding the factors and signals that control eosinophil lineage commitment may guide therapeutic development for eosinophil-mediated diseases and provide examples for fate choices in other lineages.
Genetic and epigenetic factors interacting with clonal hematopoiesis resulting in chronic myelomonocytic leukemia
Authors: Carr Ryan M. , Patnaik Mrinal M. 
Published: November 2019

Purpose of review
Since 2016, the WHO has recognized the significant phenotypic heterogeneity of chronic myelomonocytic leukemia (CMML) as a myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) overlap disease. Although sharing many somatic mutations with MDS and MPN, the purpose of this review is to put recent biological findings of CMML in the context of evolutionary theory, highlighting it as a distinct evolutionary trajectory occurring in the context of clonal hematopoiesis.

Recent findings
Clonal hematopoiesis of indeterminate potential (CHIP), with a mutational spectrum and prevalence correlated with age, has been defined. Enriched in DNMT3A, TET2, and ASXL1 mutations, clonal evolution can progress into various evolutionary trajectories including CMML. Impact of founder mutations (primarily TET2) on increased hematopoietic stem cell fitness has been well characterized. Epistatic interactions between mutations and epigenetic events have been explored, both in CMML and its pediatric counterpart juvenile myelomonocytic leukemia, including CMML transformation to acute myeloid leukemia. Together, these findings have contributed significantly toward CMML evolutionary dynamics.

Summary
Despite relatively few ‘driver’ mutations in CMML, evolutionary development of chronic leukemia remains incompletely understood. Recent studies have shed light on the importance of studying epigenetic consequences of mutations and epistasis between key mutations to better understand clonal architecture and evolutionary dynamics.
Catheter-Directed Pharmacologic Thrombolysis for Acute Submassive and Massive Pulmonary Emboli in Children and Adolescents—An Exploratory Report
Authors: Ji Dabin , Gill Anne E. , Durrence Wesley W. , Shah Jay H. , Paden Matthew L. , Patel Kavita N. , Williamson Julie L. , Hawkins C. Matthew 
Published: November 2019

Objectives:
The objective of this study is to report a single-center experience of the safety and efficacy of pulmonary artery catheter-directed thrombolysis for both massive and submassive pulmonary emboli in the pediatric and adolescent population.

Design:
A 22-month retrospective review of the electronic medical record and picture archiving and communication system was performed of patients less than 21 years old, presenting with massive or submassive pulmonary emboli treated with pulmonary artery catheter-directed thrombolysis at a single, tertiary care pediatric hospital. Multiple variables were analyzed including indications, technical success, clinical efficacy, and complications.

Setting:
A single, tertiary care pediatric hospital.

Patients:
Nine patients (mean 13.9 yr; range 6–19 yr) with massive and/or submassive pulmonary emboli who underwent pulmonary artery catheter-directed thrombolysis met inclusion criteria.

Interventions:
Catheter-directed thrombolysis.

Measurements and Main Results:
Pulmonary emboli was diagnosed by CT angiography in all cases. Catheter-directed thrombolysis alone was clinically successful (defined as improved cardiopulmonary function following catheter-directed thrombolysis) in seven patients (78%) with two patients not improving following catheter-directed thrombolysis. There were no immediate bleeding complications from catheter-directed thrombolysis therapy. All patients were maintained on anticoagulation treatment following catheter-directed thrombolysis. Catheter-directed thrombolysis was technically successful (defined as successful placement of pulmonary artery infusion catheters with full or partial resolution of thrombus) in all cases. Follow-up pulmonary angiography at the cessation of catheter-directed thrombolysis revealed complete thrombus resolution in four patients (44%) and partial resolution in five patients (55%). Mean pulmonary artery pressures decreased in all patients (mean precatheter-directed thrombolysis pulmonary artery pressure = 37 ± 11 mm Hg; mean postcatheter-directed thrombolysis pulmonary artery pressure = 28 ± 10 mm Hg; p = 0.0164).

Conclusions:
Pulmonary artery catheter-directed thrombolysis is a technically feasible therapeutic option for children and adolescents with submassive and massive pulmonary emboli.
Changes in Provider Perceptions Regarding Early Mobility in the PICU*
Authors: Hanna Eriny S. , Zhao Shilin , Shannon Chevis N. , Betters Kristina A. 
Published: November 2019

Objectives:
Early mobility in the PICU is safe and feasible. However, PICUs continue to meet barriers to implementing early mobility. PICU providers were surveyed before and after initiating an early mobility protocol to determine perceived barriers and continued challenges in performing early mobility.

Design:
This single-center prospective study surveyed PICU providers regarding 26 potential barriers to early mobility using a five-point Likert scale. A survey was distributed 1 month prior to and 6 months after beginning an early mobility protocol.

Setting:
Free-standing academic tertiary care children’s hospital.

Subjects:
PICU providers of various professions.

Interventions:
Implementation of PICU-wide early mobility protocol.

Measurements and Main Results:
Paired pre- and post-early mobility protocol implementation surveys from 97 providers were compared. System-based barriers decreased after implementation of the early mobility protocol, such as lack of guidelines (75–20%; p < 0.01), inadequate training (74–33%; p < 0.01), lack of early mobility orders (72–30%; p < 0.01), and delayed recognition of early mobility candidates (68–35%; p < 0.01). Difficulty coordinating early mobility sessions, although significantly decreased, still remained a concern for 66% of providers in the postsurvey. Lack of resources, specifically staff (85–82%; p = 0.68) and equipment (67–60%; p = 0.36), also remained significant barriers. Presence of an endotracheal tube was a barrier for only 29% of providers’ post-early mobility protocol, compared with 69% prior (p < 0.01). Clinical instability remained a top concern (82–79%; p = 0.63) as well as agitation (74–67%; p = 0.23). Day shift providers, with more early mobility exposure, perceived fewer barriers compared with night shift providers. Ninety percentage of post-early mobility survey participants felt that early mobility positively impacted their patients.

Conclusions:
Implementation of an early mobility protocol significantly changed provider perceptions regarding barriers to early mobility. Certain factors, such as staff availability, coordination difficulty, equipment shortage, and patient clinical factors, continue to be significant challenges to early mobility in the PICU population.
Evaluating the Use of a Computerized CBT Program for Outpatients on a Waitlist in a University CBT Unit
Authors: VILLEMAIRE-KRAJDEN ROSANNE , MYHR GAIL 
Published: November 2019

Objectives and Design:
The goal of this pilot randomized controlled trial was to determine whether a computerized cognitive-behavioral therapy (cCBT) program for depression and anxiety could reduce symptoms in outpatients on a waitlist for face-to-face CBT for a variety of mental health complaints.

Methods:
Sixty-seven outpatients referred for CBT for disparate problems (eg, anxiety, depression, obsessions or compulsions) were randomized to 1 of 2 conditions: (1) the cCBT program “Good Days Ahead,” which included weekly guidance and support, or (2) a control condition where patients were referred to a freely available online CBT workbook. Measures of psychological distress were administered at the start of study and at the end of the waiting period, when participants were formally diagnosed and assessed for face-to-face therapy.

Results:
For the most part, mixed-design analyses of variances revealed no statistically significant changes in symptom measures over time. Nonsignificant interactions and modest effect sizes between groups across time suggest that the cCBT group did not do better than the control group. The majority of cCBT participants reported that the program was “very” or “extremely useful,” while only a portion of the control group felt the same about the workbook. There were notable differences in the completion rates of the 2 groups in favor of the cCBT program.

Conclusions:
Offering a general cCBT program to waiting list patients may not confer an advantage over referring them to an online workbook, at least in terms of symptom reduction. Results could be partly explained by difficulties translating knowledge into practice, especially if participants’ main problem was not directly addressed by the intervention.
Canalicular Incisional Approach for Recanalization of Punctum: A Modified Surgical Treatment for Acquired Complete Upper and Lower Punctum Occlusions as an Alternative to Bypass Methods
Authors: Demirel Soner , Ozturk Emrah , Dikci Seyhan , Firat Penpe Gül 
Published: November 2019

Purpose:
To define the success of surgical technique used in the treatment of epiphora that is caused by bi-canalicular acquired complete punctum occlusion.

Materials and Methods:
The study is a retrospective consecutive case series, who underwent canalicular incisional approach for recanalization (CIAFOR) for acquired bi-canalicular punctum occlusions. The authors have used this technique in the cases not possible to perform a punctum dilatation and not possible to determine the punctum location exactly due to severe fibrosis. Functional and anatomical success was evaluated by the absence of epiphora and with lavage at post-operative 6th months.

Results:
Seven eyes of 5 patients (3 males and 2 females) were included in the study. The ages of the patients were 70, 65, 45, 64, and 70 years, respectively. Current follow-up periods vary between 6 and 23 months. Although functional and anatomical success achieved in all eyes, complication such as accessory punctum observed.

Conclusions:
CIAFOR seems to be a successful and simple surgical technique to treat acquired total punctum occlusion.
Splenectomy associated with increased risk of herpes zoster in a population-based cohort study
Authors: Lai Shih-Wei , Lin Cheng-Li , Liao Kuan-Fu 
Published: November 2019

ABSTRACT

Background/Objective:
No systematic research focuses on the association between splenectomy and herpes zoster. This study aimed to investigate the association between splenectomy and herpes zoster in Taiwan.

Methods:
A population-based cohort study was conducted using the database of Taiwan National Health Insurance Program. There were 640 individuals aged 20–84 years who were newly diagnosed with splenectomy in 2000–2012 as the splenectomy group and 2546 sex-matched and age-matched individuals without splenectomy as the nonsplenectomy group. The incidence of herpes zoster at the end of 2013 was estimated. The multivariable Cox proportional hazards regression model was used to estimate the hazard ratio and 95% confidence interval (CI) for herpes zoster associated with splenectomy.

Results:
The overall incidence of herpes zoster was 1.41-fold higher in the splenectomy group than in the nonsplenectomy group (11.3 vs. 8.05 per 1000 person-years, 95% CI 1.11–1.78). After multivariable adjustments, the adjusted hazard ratio of herpes zoster was 1.57 for individuals with splenectomy (95% CI 1.08–2.29), compared with individuals without splenectomy.

Conclusion:
Individuals with splenectomy are associated with 1.57-fold increased risk for developing herpes zoster in Taiwan. Vaccination against herpes zoster may be considered among these high-risk individuals.
Transient Receptor Potential Ankyrin 1 Mediates Afferent Signals in the Inflammatory Reflex
Authors: Silverman Harold A. , Gunasekaran Manojkumar , Chang Eric H. , Chang Qing , Addorisio Meghan E. , Stiegler Andrew , Kressel Adam M. , Li Jian Hua , Tsaava Tea , Huerta Tomas S. , Pavlov Valentin A. , Andersson Ulf , Chavan Sangeeta S. , Tracey Kevin J. 
Published: November 2019

ABSTRACTSurvival of an organism requires mechanisms to sense damaging factors in the environment. In mammals, bacterial toxins and inflammatory mediators stimulate nociceptive sensory neurons to activate protective reflexes. Whereas the vagus nerve reflex circuit that protects against damaging inflammation, termed the “inflammatory reflex,” was described more than twenty years ago1,2, how the vagus nerve detects inflammation to initiate the inflammatory reflex has remained unknown. Here we show that transient receptor potential ankyrin 1 (TRPA1) in sensory vagus neurons is required to sense interleukin-1β (IL-1β), a central cytokine mediator of inflammation and injury. Selective activation of vagus nerve TRPA1 using optopharmacology stimulated the inflammatory reflex to inhibit innate inflammatory responses to bacterial lipopolysaccharide and IL-1β. Proximity ligation assay and immunohistochemistry revealed that IL-1 receptors are co-expressed with TRPA1 in vagus sensory neurons. Whole-cell patch-clamp recordings reveal that TRPA1 is required to mediate IL-1β-dependent depolarization of vagus sensory neurons. Further, TRPA1-deficient mice lack inflammatory reflex attenuation of inflammation, fail to restrain cytokine release, and have significantly enhanced lethality to bacterial sepsis. Therefore, vagus neurons expressing TRPA1 are necessary and sufficient to activate the sensory arc of the inflammatory reflex to protect against harmful inflammation.