bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutrition in surgical patients: how soon is too soon?
Authors: Khan Muhammad , Latifi Rifat 
Published: October 2019

Purpose of review
Preoperative nutrition support has been extensively studied; however, data on the timing of postoperative nutrition initiation are scarce. The current review focuses on the importance of early nutritional support in surgical patients and their impact on outcomes.

Recent findings
Early nutrition support during the postoperative course may be the most important step that can be taken toward preventing subsequent malnutrition-related complications. European Society for Parenteral and Enteral Nutrition guidelines recommends early nutrition to improve outcomes after surgery and accelerates the recovery. Moreover, nutritional support should be personalized, and disease process-based.

Summary
Existing studies appear to focus mostly on abdominal and gastrointestinal surgery. Further prospective observational and randomized clinical trials across different surgical populations will aid surgeons to better understand how early feeds in either form can reduce morbidity, quality of life, and increase recovery rates.
Sleep–Wake States and Feeding Progression in Preterm Infants
Authors: Park Jinhee , Silva Susan G. , Thoyre Suzanne M. , Brandon Debra H. 
Published: October 2019

Background
Previous studies demonstrated a short-term relationship between infant sleep–wake states and oral feeding performance, with state being an indication of infants’ neurobehavioral readiness for feeding. However, the relationship between sleep–wake states and feeding skills has not been evaluated longitudinally during hospitalization.

Objectives
The purpose of this study was to examine preterm infants’ sleep–wake state developmental trajectories and their associations with feeding progression during hospitalization.

Methods
This descriptive and exploratory study was a secondary analysis using data from a longitudinal two-group, randomized controlled trial evaluating the effects of early and late cycled light on health and developmental outcomes among extremely preterm infants who were born ≤28 weeks of gestational age. Sleep–wake states were assessed for two 2-hour interfeeding periods per day (day and night hours), 30 weeks postmenstrual age, and every 3 weeks until discharge. Occurrences of active sleep, quiet sleep, and waking were recorded every 10 seconds. Feeding progression was assessed based on an infant’s postmenstrual age at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. Trajectory analyses were used to describe developmental changes in sleep–wake states, feeding progression patterns, and associations between feeding progression and sleep–wake trajectories.

Results
Active sleep decreased while waking, and quiet sleep increased during hospitalization. Two distinct feeding groups were identified: typical and delayed feeding progression. In infants with delayed feeding progression, rates of active and quiet sleep development during the day were delayed compared to those with typical feeding progression. We also found that infants with delayed feeding progression were more likely to be awake more often during the night compared to infants with typical feeding progression.

Discussions
Findings suggest that delays in sleep–wake state development may be associated with delays in feeding progression during hospitalization. Infants with delayed feeding skill development may require more environmental protection to further support their sleep development.
Moderator Effects in Intervention Studies
Authors: Becker Heather , Stuifbergen Alexa K. , Zhang Wenhui , Sales Adam C. 
Published: October 2019

Background
Although nursing intervention studies typically focus on testing hypothesized differences between intervention and control groups, moderator variables can reveal for whom or under what circumstances an intervention may be most effective.

Objectives
The aim of the study was to explain and illustrate moderator effects using data from a nursing intervention study to improve cognitive abilities in those with a chronic health condition.

Methods
The sample consisted of 178 individuals with multiple sclerosis participating in an experimental study of a cognitive intervention. General linear models were used for analyses. Interaction terms were created to represent moderator effects on three outcomes: self-reported cognitive abilities, use of memory strategies, and verbal memory performance.

Results
The Charlson comorbidity index significantly moderated the intervention effect on self-perceived cognitive abilities. Years of education significantly moderated the intervention effect on use of memory strategies. Scores on a general self-efficacy measure significantly moderated the intervention effect on the Controlled Verbal Learning Test–Second Edition.

Discussion
These analyses highlight the key role that moderator effects can play in nursing research. Although random assignment to groups can control potentially biasing effects of extraneous differences among individuals in intervention and control groups, those very differences may suggest fruitful avenues for hypothesis generating research about what works best for whom in intervention studies.
The Vital Role of Professionalism in Physical Medicine and Rehabilitation
Authors: Silver Julie K. , Cuccurullo Sara , Weiss Lyn D. , Visco Christopher , Oh-Park Mooyeon , Karimi Danielle Perret , Frontera Walter R. , Fleming Talya K. , Bosques Glendaliz , Bhatnagar Saurabha , Ambrose Anne Felicia , Nguyen Vu Q.C. 
Published: October 2019

Abstract
Professionalism in medicine is universally embraced, and it is the foundation for core competencies in medical education, clinical practice, and research. Physical medicine and rehabilitation physicians must master a complex body of knowledge and use this to responsibly care for patients. Rehabilitation professionals work in various settings; however, each one must establish and maintain ethical standards consistent with the specialty and national standards. For example, the Accreditation Council for Graduate Medical Education lists professionalism as one of its six core competencies, which trainees must master. There is a growing interest in professionalism and some of the ethical issues that it encompasses. This report provides a general overview of professionalism. Future reports are needed, and there is an opportunity to consider many facets of professionalism in greater detail.
The Mediating Effect of Life-style Behaviors on the Association Between Personality Traits and Cardiovascular Disease Mortality Among 29,766 Community-Dwelling Japanese
Authors: Narita Mamoru , Tanji Fumiya , Tomata Yasutake , Mori Kentaro , Tsuji Ichiro 
Published: October 2019

ABSTRACT

Objective
Personality traits have been associated with an increased risk of cardiovascular disease (CVD) mortality as well as life-style–related cardiovascular risk factors. However, the mediating effects of life-style behaviors in the association between personality factors and CVD mortality remain insufficiently understood. The aim of the present study was to examine the mediating effect of life-style behaviors on the association between personality traits and CVD mortality.

Methods
We conducted a prospective cohort study of 29,766 Japanese adults aged 40 to 64 years at the baseline and followed them up for 20.8 years from 1990 to 2011. Personality was measured using the Japanese version of the Eysenck Personality Questionnaire – Revised Short Form in 1990. We estimated the multivariable hazard ratio and 95% confidence interval for CVD mortality using Cox proportional hazards models, and explored the mediating effects of life-style behaviors (smoking, drinking, body mass index, and time spent walking) on the association between personality traits and CVD mortality.

Results
We documented 1033 deaths due to CVD during 562,446 person-years of follow-up. Psychoticism represents tough-mindedness, aggressiveness, coldness, a lack of deliberateness, and egocentricity. After adjusting for confounding variables, higher psychoticism was associated with CVD mortality (base model hazard ratio = 1.36, 95% confidence interval = 1.14–1.61, p trend < .001). All the life-style behaviors together mediated this association by 19.2%, with smoking having the greatest effect at 15.7%. For the other personality traits, no significant associations with CVD mortality were found.

Conclusion
The present study demonstrated that life-style behaviors, especially smoking, partially mediate the association between psychoticism and CVD mortality.
Placebo Effects in the Neuroendocrine System: Conditioning of the Oxytocin Responses
Authors: Skvortsova Aleksandrina , Veldhuijzen Dieuwke S. , Pacheco-Lopez Gustavo , Bakermans-Kranenburg Marian , van IJzendoorn Marinus , Smeets Monique A.M. , Wilderjans Tom F. , Dahan Albert , van den Bergh Omer , Chavannes Niels H. , van der Wee Nic J.A. , Grewen Karen M. , van Middendorp Henriët , Evers Andrea W.M. 
Published: October 2019

ABSTRACTObjectiveThere is evidence that placebo effects may influence hormone secretion. However, few studies have examined placebo effects in the endocrine system, including oxytocin placebo effects. We studied whether it is possible to trigger oxytocin placebo effects using a classical conditioning paradigm.MethodsNinety-nine women were assigned to a conditioned, control, or drug control group. In the two-phase conditioning paradigm, participants in the conditioned and drug control groups received an oxytocin nasal spray combined with a distinctive smell (conditioned stimulus [CS]) for three acquisition days, whereas the control group received placebo spray. Subsequently, the conditioned and control groups received placebo spray with the CS and the drug control group received oxytocin spray for three evocation days. Salivary oxytocin was measured several times during each day. Pain sensitivity and facial evaluation tests previously used in oxytocin research were also administered.ResultsOn evocation day 1, in the conditioned group, oxytocin significantly increased from baseline to 5 minutes after CS (B[slope] = 19.55, SE = 5.88,p< .001) and remained increased from 5 to 20 (B= −10.42, SE = 5.81,p= .071) and 50 minutes (B= −0.70, SE = 3.37,p= .84). On evocation day 2, a trend for increase in oxytocin was found at 5 minutes (B= 15.22, SE = 8.14,p= .062). No placebo effect was found on evocation day 3 (B= 3.57, SE = 3.26,p= .28). Neither exogenous nor conditioned oxytocin affected pain or facial tasks.ConclusionsResults indicate that oxytocin release can be conditioned and that this response extinguishes over time. Triggering hormonal release by placebo manipulation offers various clinical possibilities, such as enhancing effects of pharmacological treatments or reducing dosages of medications.Trial Registration:The study was registered as a clinical trial on www.trialregister.nl (number NTR5596).
Decreased growth among antiretroviral drug and HIV-exposed uninfected versus unexposed children in Malawi and Uganda
Authors: Aizire Jim , Sikorskii Alla , Ogwang Lillian Wambuzi , Kawalazira Rachel , Mutebe Alex , Familiar-Lopez Itziar , Mallewa MacPherson , Taha Taha , Boivin Michael J. , Fowler Mary Glenn 
Published: October 2019

Objective:
To compare growth among antiretroviral drug and maternal HIV-exposed uninfected (AHEU) versus age-matched and sex-matched HIV-unexposed uninfected (HUU) children.

Design:
Prospective cohort of AHEU children identified from the PROMISE trial (NCT01061151: clinicaltrials.gov registry) and age-matched and sex-matched HUU controls from child-wellness clinics, enrolled (September 2013 to October 2014) in Malawi and Uganda.

Methods:
Weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ), and head-circumference-for-age (HCAZ) z-scores were derived at 12 months and 24 months of age. Wilcoxon Rank-Sum and Fisher's exact tests were used for unadjusted exposure group comparisons. Generalized Estimating Equations models estimated adjusted relative risks (aRR) for poor growth outcomes.

Results:
Overall, 471 (50.5%) AHEU and 462 (49.5%) HUU children were assessed. Ugandan AHEU compared with HUU children had significantly lower mean LAZ (P < 0.001) and WAZ (P < 0.001) at 12 and 24 months of age and HCAZ (P = 0.016) at 24 months, with similar but not significant differences among Malawian AHEU and HUU children. The risk of stunting (more than two standard deviations below the WHO population LAZ median) was increased among AHEU versus HUU children: aRR = 2.13 (95% confidence interval (CI): 1.36–3.33), P = 0.001 at 12 months, and aRR = 1.67 (95% CI 1.16–2.41), P = 0.006 at 24 months of age in Uganda; and aRR = 1.32 (95% CI 1.10–1.66), P = 0.018, at 24 months of age in Malawi. The risk of HCAZ below WHO median was increased among AHEU versus HUU children at 24 months of age, aRR = 1.35 (95% CI 1.02–1.79), P = 0.038 in Uganda; and aRR = 1.35 (95% CI 0.91–2.02), P = 0.139 in Malawi.

Conclusion:
Perinatal exposures to maternal HIV and antiretroviral drugs were associated with lower LAZ (including stunting), WAZ and HCAZ at 24 months of age compared with HUU children.
Effectiveness of Transmitted Drug Resistance Testing Before Initiation of Antiretroviral Therapy in HIV-Positive Individuals
Authors: Lodi Sara , Günthard Huldrych F. , Gill John , Phillips Andrew N. , Dunn David , Vu Quang , Siemieniuk Reed , Garcia Federico , Logan Roger , Jose Sophie , Bucher Heiner C. , Scherrer Alexandra U. , Reiss Peter , van Sighem Ard , Boender T. Sonia , Porter Kholoud , Gilson Richard , Paraskevis Dimitrios , Simeon Metallidis , Vourli Georgia , Moreno Santiago , Jarrin Inmaculada , Sabin Caroline , Hernán Miguel A. ,   on behalf of the HIV-CAUSAL Collaboration
Published: October 2019

Background:
For people living with HIV, major guidelines in high-income countries recommend testing for transmitted drug resistance (TDR) to guide the choice of first-line antiretroviral therapy (ART). However, individuals who fail a first-line regimen can now be switched to one of several effective regimens. Therefore, the virological and clinical benefit of TDR testing needs to be evaluated.

Methods:
We included individuals from the HIV-CAUSAL Collaboration who enrolled <6 months of HIV diagnosis between 2006 and 2015, were ART-naive, and had measured CD4 count and HIV-RNA. Follow-up started at the date when all inclusion criteria were first met (baseline). We compared 2 strategies: (1) TDR testing within 3 months of baseline versus (2) no TDR testing. We used inverse probability weighting to estimate the 5-year proportion and hazard ratios (HRs) of virological suppression (confirmed HIV-RNA <50 copies/mL), and of AIDS or death under both strategies.

Results:
Of 25,672 eligible individuals (82% males, 52% diagnosed in 2010 or later), 17,189 (67%) were tested for TDR within 3 months of baseline. Of these, 6% had intermediate- or high-level TDR to any antiretroviral drug. The estimated 5-year proportion virologically suppressed was 77% under TDR testing and 74% under no TDR testing; HR 1.06 (95% confidence interval: 1.03 to 1.19). The estimated 5-year risk of AIDS or death was 6% under both strategies; HR 1.03 (95% confidence interval: 0.95 to 1.12).

Conclusions:
TDR prevalence was low. Although TDR testing improved virological response, we found no evidence that it reduced the incidence of AIDS or death in first 5 years after diagnosis.
Herpetic Corneal Keratopathy Management Using Ipsilateral Supratrochlear Nerve Transfer for Corneal Neurotization
Authors: Lin Chih-Hung , Lai Li-Ju 
Published: October 2019

Background
Neurotrophic keratopathy (NK) is a potentially sight-threatening condition caused by impairment in the trigeminal corneal innervations with decrease or loss of corneal sensitivity. This prospective study aimed to evaluate the outcomes of surgical neurotization of the cornea using ipsilateral supratrochlear nerve transfer in patients with herpes-induced NK.

Methods
An ophthalmologist and a plastic surgeon performed an interdisciplinary corneal neurotization in 13 eyes of 13 patients after preoperative exclusion of forehead sensation impairment. A 3-cm supra-eyebrow incision allowed for microsurgical supratrochlear nerve dissection, and a subconjunctival tunneling was performed for the nerve transfer. Neurotrophic keratopathy was assessed preoperatively and every 3 months postoperatively using slit-lamp microscopy, the corneal sensitivity test, specular microscopy, and in vivo confocal microscopy.

Results
The surgeries had no major complications. The average disease duration from cornea denervation to surgery was 15.2 years. The mean follow-up duration was 18.5 ± 6 months. The symptoms exhibited subjectively improved visual acuity, and objectively improved visual analog scale and NK grading. The subepithelial corneal nerve plexus was found at 9 months postoperatively. The corneal thickness decreased and the corneal endothelial count increased postoperatively.

Conclusions
This is the largest series of corneal neurotization using direct ipsilateral supratrochlear nerve transfer. It is a minimally invasive method to restore corneal sensitivity and treat NK successfully within 1 year without a sural nerve graft. A long-term follow-up is needed for further assessment.
Clinical and Optic Disc Characteristics of Patients Showing Visual Recovery in Leber Hereditary Optic Neuropathy
Authors: Moon Yeji , Kim Ungsoo S. , Han Jinu , Ahn Hyosook , Lim Hyun Taek 
Published: October 2019

Background:
The visual prognosis in Leber hereditary optic neuropathy (LHON) is generally poor. However, some individuals can have spontaneous visual recovery (VR) in one or both eyes by a mechanism that is not yet clearly understood. The purpose of this study was to determine whether certain clinical and optic disc features are associated with VR in patients with LHON.

Methods:
We retrospectively examined 80 eyes of 40 patients with LHON using clinical databases, fundus photographs, and high-definition spectral-domain optical coherence tomography (OCT) images. VR was defined as a gain of 3 or more lines of logarithm of the minimum angle of resolution (logMAR)–scaled visual acuity from nadir; this represents a doubling of the visual angle. Patients were divided into VR and nonrecovery (NR) groups. Using fundus photographs, we measured optic disc size and evaluated for the presence of optic disc features, including peripapillary telangiectasia, disc hyperemia, and swelling. We also measured the disc area, cup-to-disc ratio, and rim area of the optic disc using OCT.

Results:
Twenty-one of 80 eyes (26%) had a VR. The VR occurred within 2 years after onset in 81% of cases. The VR group showed younger age at onset (21 vs 29 years, P = 0.017) and better visual acuity at the nadir (1.39 vs 2.16 logMAR, P < 0.001) compared with the NR group. Optic disc features, particularly peripapillary telangiectasia (P = 0.027) and disc hyperemia (P = 0.006), were more prominent in the NR group. The cup-to-disc ratio was significantly smaller (0.64 vs 0.71, P = 0.004) and the rim area was significantly greater (1.17 vs 0.85 mm2, P < 0.001) in the VR group compared with the NR group.

Conclusions:
A younger age at onset and a less severe reduction of visual acuity at the nadir were associated with a higher probability of VR. Presence of peripapillary telangiectasia and optic disc hyperemia may serve as predictive factors for poor visual prognosis in patients with LHON.
Referral Patterns in Neuro-Ophthalmology
Authors: Stunkel Leanne , Mackay Devin D. , Bruce Beau B. , Newman Nancy J. , Biousse Valérie 
Published: October 2019

Background:
Neuro-ophthalmologists specialize in complex, urgent, vision- and life-threatening problems, diagnostic dilemmas, and management of complex work-ups. Access is currently limited by the relatively small number of neuro-ophthalmologists, and consequently, patients may be affected by incorrect or delayed diagnosis. The objective of this study is to analyze referral patterns to neuro-ophthalmologists, characterize rates of misdiagnoses and delayed diagnoses in patients ultimately referred, and delineate outcomes after neuro-ophthalmologic evaluation.

Methods:
Retrospective chart review of 300 new patients seen over 45 randomly chosen days between June 2011 and June 2015 in one tertiary care neuro-ophthalmology clinic. Demographics, distance traveled, time between onset and neuro-ophthalmology consultation (NOC), time between appointment request and NOC, number and types of providers seen before referral, unnecessary tests before referral, referral diagnoses, final diagnoses, and impact of the NOC on outcome were collected.

Results:
Patients traveled a median of 36.5 miles (interquartile range [IQR]: 20–85). Median time from symptom onset was 210 days (IQR: 70–1,100). Median time from referral to NOC was 34 days (IQR: 7–86), with peaks at one week (urgent requests) and 13 weeks (routine requests). Median number of previous providers seen was 2 (IQR: 2–4; range:0–10), and 102 patients (34%) had seen multiple providers within the same specialty before referral. Patients were most commonly referred for NOC by ophthalmologists (41% of referrals). Eighty-one percent (242/300) of referrals to neuro-ophthalmology were appropriate referrals. Of the 300 patients referred, 247 (82%) were complex or very complex; 119 (40%) were misdiagnosed; 147 (49%) were at least partially misdiagnosed; and 22 (7%) had unknown diagnoses. Women were more likely to be at least partially misdiagnosed—108 of 188 (57%) vs 39 of 112 (35%) of men (P < 0.001). Mismanagement or delay in care occurred in 85 (28%), unnecessary tests in 56 (19%), unnecessary consultations in 64 (22%), and imaging misinterpretation in 16 (5%). Neuro-ophthalmologists played a major role in directing treatment, such as preserving vision, preventing life-threatening complications, or avoiding harmful treatment in 62 (21%) patients.

Conclusions:
Most referrals to neuro-ophthalmologists are appropriate, but many are delayed. Misdiagnosis before referral is common. Neuro-ophthalmologists often prevent vision- and life-threatening complications.
A phenomenological approach to jet noise: the two-source model
Authors: Tam Christopher K. W. 
Published: October 2019

This is a review of the two-source model of jet noise. The model was developed phenomenologically a number of years ago. One of the principal results associated with this model was the identification of two similarity jet noise spectra. This was accomplished through extensive comparisons with a large set of NASA spectrum data. It was found that these two noise spectra when combined appropriately would fit measured noise spectra of jets in any direction regardless of jet temperature and Mach number. Other experimental data in support of the two-source model have since been found. They are discussed in this paper. One of the purposes of this paper is to elaborate on the flow physics of turbulence, noise generation mechanisms and directivity that are the underpinnings of the model. More recent works show the similarity spectra are applicable, well beyond their original database, to noise of military jets, rockets and even volcanoes.
This article is part of the theme issue ‘Frontiers of aeroacoustics research: theory, computation and experiment’.