bluuebunny/crossref_metadata_2025 huggingface dataset:
Last mile delivery drone selection and evaluation using the interval-valued inferential fuzzy TOPSIS
Authors: Nur Farjana , Alrahahleh Ayat , Burch Reuben , Babski-Reeves Kari , Marufuzzaman Mohammad
Published: February 2020

The last mile delivery option has become a focal point of academic research and industrial development in recent years. Multiple factors such as increased demands on delivery flexibility, customer requirements, delivery urgency, and many others are enforcing to adopt this option. For fulfilling this paradigm shift in delivery and providing additional flexibility, drones can be considered as a viable option to use for last mile delivery cases. Numerous drones are available in the market with varying capacities and functionalities, posing a significant challenge for decision-makers to select the most appropriate drone type for a specific application. In this purpose, this study proposes a comprehensive list of criterions that can be used to compare a set of available last mile delivery drones. Additionally, we introduced a systematic multi-criterion, multi-personnel decision making approach, referred to as interval-valued inferential fuzzy TOPSIS method. This method is robust and can handle the fuzziness in decision making, thereby providing quality drone selection decisions under different applications. We then apply this method to a real-life test setting. Results suggest that smaller drones or quadcopters are considered viable to use in urban environments while long-range drones are preferred for the last mile delivery needs in rural settings.
Electron tomography imaging methods with diffraction contrast for materials research
Authors: Hata Satoshi , Furukawa Hiromitsu , Gondo Takashi , Hirakami Daisuke , Horii Noritaka , Ikeda Ken-Ichi , Kawamoto Katsumi , Kimura Kosuke , Matsumura Syo , Mitsuhara Masatoshi , Miyazaki Hiroya , Miyazaki Shinsuke , Murayama Mitsu Mitsuhiro , Nakashima Hideharu , Saito Hikaru , Sakamoto Masashi , Yamasaki Shigeto
Published: January 2020

Transmission electron microscopy (TEM) and scanning transmission electron microscopy (STEM) enable the visualization of three-dimensional (3D) microstructures ranging from atomic to micrometer scales using 3D reconstruction techniques based on computed tomography algorithms. This 3D microscopy method is called electron tomography (ET) and has been utilized in the fields of materials science and engineering for more than two decades. Although atomic resolution is one of the current topics in ET research, the development and deployment of intermediate-resolution (non-atomic-resolution) ET imaging methods have garnered considerable attention from researchers. This research trend is probably not irrelevant due to the fact that the spatial resolution and functionality of 3D imaging methods of scanning electron microscopy (SEM) and X-ray microscopy have come to overlap with those of ET. In other words, there may be multiple ways to carry out 3D visualization using different microscopy methods for nanometer-scale objects in materials. From the above standpoint, this review paper aims to (i) describe the current status and issues of intermediate-resolution ET with regard to enhancing the effectiveness of TEM/STEM imaging and (ii) discuss promising applications of state-of-the-art intermediate-resolution ET for materials research with a particular focus on diffraction contrast ET for crystalline microstructures (superlattice domains and dislocations) including a demonstration of in situ dislocation tomography.
Religion and Identity De/Construction among Forced Migrants: The Case of the Congolese Refugees in Durban, South Africa
Authors: Makanda Joseph , Naidu Maheshvari
Published: February 2020

The current study unravels religious practices, politics and perceptions as forms of multiple identities within and amongst different types of migrant groups in South Africa. Using purpose sampling from members of the Christ Assembly Church of Africa, we explore how the appeal to religion is a form of identity construction that differentiates Congolese from other groups of migrants. We utilized social identity theory in showing how Congolese use religious practices at the mentioned church to assert and reaffirm their identity and use it as a form of resilience to any external threat to the existence of their ‘culture’. Our findings reveal that there exists a complex relationship between religion and Congolese refugees in Durban that is an identity maker that acts as a form of mobilization and resilience to any form of external threats to the identity of the Congolese community in Durban. Furthermore, our findings reveal that the negotiation and construction of Congolese identity through religious practices at Christ Assemblies Church of Africa can play an important role in determining how prejudices and behaviour that reject, exclude and often vilify persons based on the perception that they are outsiders or foreigners to the community are constructed.
The role of travel agents in travel medicine—a study with agencies from São Paulo, Brazil
Authors: Nascimento Giovanna M , Sartori Ana M C , Lopes Marta H , Medeiros Carlos R , Lara Amanda N
Published: January 2020

A survey in São Paulo, Brazil, assessed travel agents’ knowledge on travellers’ health. Data were collected using an online questionnaire. Of 200 agencies contacted, 32 answered (34 agents). Most consultants reported discussing personal safety, health insurance and vaccination. Few provided information on water and food diseases or sexually transmitted infections.
Quantifying the redshift space distortion of the bispectrum I: primordial non-Gaussianity
Authors: Bharadwaj Somnath , Mazumdar Arindam , Sarkar Debanjan
Published: January 2020

The anisotropy of the redshift space bispectrum contains a wealth of cosmological information. This anisotropy depends on the orientation of three vectors $\boldsymbol {k_1},\boldsymbol {k_2},\boldsymbol {k_3}$ with respect to the line of sight. Here, we have decomposed the redshift space bispectrum in spherical harmonics which completely quantify this anisotropy. To illustrate this, we consider linear redshift space distortion of the bispectrum arising from primordial non-Gaussianity. In the plane-parallel approximation, only the first four even ℓ multipoles have non-zero values, and we present explicit analytical expressions for all the non-zero multipoles, that is, upto ℓ = 6 and m = 4. The ratio of the different multipole moments to the real-space bispectrum depends only on β1 the linear redshift distortion parameter and the shape of the triangle. Considering triangles of all possible shapes, we have studied how this ratio depends on the shape of the triangle for β1 = 1. We have also studied the β1 dependence for some of the extreme triangle shapes. If measured in future, these multipole moments hold the potential of constraining β1. The results presented here are also important if one wishes to constrain fNL using redshift surveys.
Asteroseismology of luminous red giants with Kepler I: long-period variables with radial and non-radial modes
Authors: Yu Jie , Bedding Timothy R , Stello Dennis , Huber Daniel , Compton Douglas L , Gizon Laurent , Hekker Saskia
Published: January 2020

While long-period variables (LPVs) have been extensively investigated, especially with MACHO and OGLE data for the Magellanic Clouds, there still exist open questions in their pulsations regarding the excitation mechanisms, radial order, and angular degree assignment. Here, we perform asteroseismic analyses on LPVs observed by the 4-year Kepler mission. Using a cross-correlation method, we detect unambiguous pulsation ridges associated with radial fundamental modes (n = 1) and overtones (n ≥ 2), where the radial order assignment is made using theoretical frequencies and observed frequencies. Our results confirm that the amplitude variability seen in semiregulars is consistent with oscillations being solar-like. We identify that the dipole modes, l = 1, are dominant in the radial orders of 3 ≤ n ≤ 6, and that quadrupole modes, l = 2, are dominant in the first overtone n = 2. A test of seismic scaling relations using Gaia DR2 parallaxes reveals the possibility that the relations break down when νmax ≲ 3 $\mu {\rm Hz}$ (R ≳ 40 R⊙, or log $\rm L/L_{\odot }$ ≳ 2.6). Our homogeneous measurements of pulsation amplitude and period for 3213 LPVs will be valuable for probing effects of pulsation on mass-loss, in particular in those stars with periods around 60 d, which has been argued as a threshold of substantial pulsation-triggered mass-loss.
Structural and stellar-population properties versus bulge types in Sloan Digital Sky Survey central galaxies
Authors: Luo Yifei , Faber S M , Rodríguez-Puebla Aldo , Woo Joanna , Guo Yicheng , Koo David C , Primack Joel R , Chen Zhu , Yesuf Hassen M , Lin Lin , Barro Guillermo , Fang Jerome J , Pandya Viraj , Huertas-Company M , Mao Shude
Published: February 2020

This paper studies pseudo-bulges (P-bulges) and classical bulges (C-bulges) in Sloan Digital Sky Survey (SDSS) central galaxies using the new bulge indicator ΔΣ1, which measures relative central stellar-mass surface density within 1 kpc. We compare ΔΣ1 to the established bulge-type indicator Δ〈μe〉 from Gadotti (2009) and show that classifying by ΔΣ1 agrees well with Δ〈μe〉. ΔΣ1 requires no bulge–disc decomposition and can be measured on SDSS images out to z = 0.07. Bulge types using it are mapped on to 20 different structural and stellar-population properties for 12 000 SDSS central galaxies with masses 10.0 < log M*/M⊙ < 10.4. New trends emerge from this large sample. Structural parameters show fairly linear log–log relations versus ΔΣ1 and Δ〈μe〉 with only moderate scatter, while stellar-population parameters show a highly non-linear ‘elbow’ in which specific star formation rate remains roughly flat with increasing central density and then falls rapidly at the elbow, where galaxies begin to quench. P-bulges occupy the low-density end of the horizontal arm of the elbow and are universally star forming, while C-bulges occupy the elbow and the vertical branch and exhibit a wide range of star formation rates at a fixed density. The non-linear relation between central density and star formation rate has been seen before, but this mapping on to bulge class is new. The wide range of star formation rates in C-bulges helps to explain why bulge classifications using different parameters have sometimes disagreed in the past. The elbow-shaped relation between density and stellar indices suggests that central structure and stellar populations evolve at different rates as galaxies begin to quench.
Exploratory Evaluation of Bezlotoxumab on Outcomes Associated With Clostridioides difficile Infection in MODIFY I/II Participants With Cancer
Authors: Cornely Oliver A , Mullane Kathleen M , Birch Thomas , Hazan-Steinberg Sabine , Nathan Richard , Bouza Emilio , Calfee David P , Ellison Misoo Chung , Wong Michael T , Dorr Mary Beth
Published: January 2020

Background

The incidence of Clostridioides difficile infection (CDI) is reportedly higher and the cure rate lower in individuals with cancer vs those without cancer. An exploratory post hoc analysis of the MODIFY I/II trials (NCT01241552/NCT01513239) investigated how bezlotoxumab affected the rate of CDI-related outcomes in participants with cancer.

Methods

Participants received a single infusion of bezlotoxumab (10 mg/kg) or placebo during anti-CDI antibacterial treatment. A post hoc analysis of CDI-related outcomes was conducted in subgroups of MODIFY I/II participants with and without cancer.

Results

Of 1554 participants in the modified intent-to-treat (mITT) population, 382 (24.6%) were diagnosed with cancer (bezlotoxumab 190, placebo 192). Of participants without cancer, 591 and 581 received bezlotoxumab and placebo, respectively. In the placebo group, initial clinical cure (ICC) was achieved by fewer cancer participants vs participants without cancer (71.9% vs 83.1%; absolute difference, –11.3%; 95% CI, –18.6% to –4.5%); however, CDI recurrence (rCDI) rates were similar in cancer (30.4%) and noncancer (34.0%) participants. In participants with cancer, bezlotoxumab treatment had no effect on ICC rate compared with placebo (76.8% vs 71.9%), but resulted in a statistically significant reduction in rCDI vs placebo (17.8% vs 30.4%; absolute difference, –12.6%; 95% CI, –22.5% to –2.7%).

Conclusions

In this post hoc analysis of participants with cancer enrolled in MODIFY I/II, the rate of rCDI in bezlotoxumab-treated participants was lower than in placebo-treated participants. Additional studies are needed to confirm these results.

Clinical Trial Registration

MODIFY I (NCT01241552), MODIFY II (NCT01513239).
The Fall of the Labor Share and the Rise of Superstar Firms*
Authors: Autor David , Dorn David , Katz Lawrence F , Patterson Christina , Van Reenen John
Published: January 2020

The fall of labor’s share of GDP in the United States and many other countries in recent decades is well documented but its causes remain uncertain. Existing empirical assessments typically rely on industry or macro data, obscuring heterogeneity among firms. In this article, we analyze micro panel data from the U.S. Economic Census since 1982 and document empirical patterns to assess a new interpretation of the fall in the labor share based on the rise of “superstar firms.” If globalization or technological changes push sales toward the most productive firms in each industry, product market concentration will rise as industries become increasingly dominated by superstar firms, which have high markups and a low labor share of value added. We empirically assess seven predictions of this hypothesis: (i) industry sales will increasingly concentrate in a small number of firms; (ii) industries where concentration rises most will have the largest declines in the labor share; (iii) the fall in the labor share will be driven largely by reallocation rather than a fall in the unweighted mean labor share across all firms; (iv) the between-firm reallocation component of the fall in the labor share will be greatest in the sectors with the largest increases in market concentration; (v) the industries that are becoming more concentrated will exhibit faster growth of productivity; (vi) the aggregate markup will rise more than the typical firm’s markup; and (vii) these patterns should be observed not only in U.S. firms but also internationally. We find support for all of these predictions.
Study on repairing canine mandibular defect with porous Mg–Sr alloy combined with Mg–Sr alloy membrane
Authors: Zhang Shanning , Sun Xirao , Kang Chunyu , Yang Man , Zhao Yuan , Wang Chengyue
Published: January 2020

To discuss the feasibility of the application of porous Mg–Sr alloy combined with Mg–Sr alloy membrane in the repair of mandibular defects in dogs. The second and third mandibular premolars on both sides were extracted from six dogs. The model of mandible buccal fenestration bone defects were prepared after the sockets healed. Twelve bone defects were randomly divided into groups A and B, then Mg–Sr alloy was implanted in bone defects of group A and covered by Mg–Sr alloy membrane while Mg–Sr alloy was implanted in bone defects of group B and covered by mineralized collagen membrane. Bone defects observed on cone beam computed tomographic images and comparing the gray value of the two groups after 4, 8 and 12 weeks. After 12 weeks, the healing of bone defects were evaluated by gross observation, X-ray microscopes and histological observation of hard tissue. Bone defects in each group were repaired. At 8 and 12 weeks, the gray value of group A was higher than that of group B (P < 0.05). At 12 weeks, the bone volume fraction of group A was higher than that of group B (P < 0.05). The newly woven bone in group A is thick and arranged staggered, which was better than that of group B. Porous Mg–Sr alloy combined with Mg–Sr alloy membrane could further promote the repair of mandibular defects, and obtain good osteogenic effect.
Peer support in Shanghai’s Commitment to diabetes and chronic disease self-management: program development, program expansion, and policy
Authors: Liu Yuexing , Wu Xiaoyu , Cai Chun , Tang Patrick Y , Coufal Muchieh Maggy , Qian Yiqing , Luu Samantha Ling , Fisher Edwin B , Jia Weiping
Published: February 2020

Identifying organizational settings for sustainable, scalable implementation of peer support (PS) is a challenge. Development, initial evaluation, and community expansion of PS for populations with diabetes staged in the context of the Shanghai Integration Model integrating primary and specialty care for diabetes. Development Phase with 9 Community Health Centers (CHCs) leading to Community Expansion Phase with additional 12 communities. Development Phase peer leaders (PLs) co-led meetings on diabetes management, led neighborhood activities, and followed up with individuals and families. Among 1,284 participants, changes in HbA1c, other clinical markers, and diabetes distress were significant (ps from 0.001 to 0.041), pronounced among those with elevated levels, for example, HbA1c reduction from 9.09% to 8.50% among those ≥8% at baseline (p < 0.001). Ratings of Implementation were associated with reduced HbA1c and diabetes distress and increased neighborhood support. In particular, linking with community resources and utilization of neighborhood Residential Committees were associated with improved HbA1c, indicating the value of PS programs including community resources. Thus, the Community Expansion Phase includes district- and community-level health staff, Community Self Management Groups, and Residential Committees along with CHCs in 12 communities, all of which have implemented activities during the first 6 months. PS programs are feasible and appear to add value among populations with diabetes in community settings such as Shanghai. Recognition by the Shanghai government has included PS as a key strategy for achieving self-management of chronic disease in its 2030 health goals.
Scale-up of the Kerala Diabetes Prevention Program (K-DPP) in Kerala, India: implementation evaluation findings
Authors: Ravindranath Ranjana , Oldenburg Brian , Balachandran Sajitha , Mini Gomathyamma Krishnakurup , Mahat Kishori , Sathish Thirunavukkarasu , Thankappan Kavumpurathu Raman
Published: February 2020

The cluster-randomized controlled trial of the Kerala Diabetes Prevention Program (K-DPP) demonstrated some significant improvements in cardiometabolic risk factors and other outcomes. We aimed to refine and improve K-DPP for wider implementation in the Kerala state of India. The specific objectives of the scale-up program were (a) to develop a scalable program delivery model and related capacity building in Kerala and (b) to achieve significant improvements in cardiometabolic risk factors in the target population. A total of 118 key trainers of a large women’s organization trained 15,000 peer leaders in three districts of Kerala. Each of these peer leaders was required to deliver 12 monthly sessions to ~25 people, reaching an estimated total of 375,000 adults over 12 months. We evaluated the number of sessions conducted, the participation of men, and program reach. We also assessed the effectiveness of the program in a random sample of 1,200 adults before and after the intervention and performed a biochemical evaluation on a subsample of 321. Of the 15,222 peer leaders who were trained, 1,475 (9.7%) returned their evaluation forms, of which, 98% reported conducting at least 1 session, 88% ≥6 sessions, and 74% all 12 sessions. Tobacco use among men reduced from 30% to 25% (p = .02) and alcohol use from 40% to 32% (p = .001). Overall, mean waist circumference reduced from 89.5 to 87.5 cm (p < .001). Although there were some study shortcomings, the approach to scale-up and its implementation was quite effective in reaching a large population in Kerala and there were also some significant improvements in key cardiometabolic risk factors following the 1 year intervention.
Phylogeny and anatomy of marine mussels (Bivalvia: Mytilidae) reveal convergent evolution of siphon traits
Authors: Audino Jorge A , Serb Jeanne M , Marian José Eduardo A R
Published: January 2020

Convergent morphology is a strong indication of an adaptive trait. Marine mussels (Mytilidae) have long been studied for their ecology and economic importance. However, variation in lifestyle and phenotype also make them suitable models for studies focused on ecomorphological correlation and adaptation. The present study investigates mantle margin diversity and ecological transitions in the Mytilidae to identify macroevolutionary patterns and test for convergent evolution. A fossil-calibrated phylogenetic hypothesis of Mytilidae is inferred based on five genes for 33 species (19 genera). Morphological variation in the mantle margin is examined in 43 preserved species (25 genera) and four focal species are examined for detailed anatomy. Trait evolution is investigated by ancestral state estimation and correlation tests. Our phylogeny recovers two main clades derived from an epifaunal ancestor. Subsequently, different lineages convergently shifted to other lifestyles: semi-infaunal or boring into hard substrate. Such transitions are correlated with the development of long siphons in the posterior mantle region. Two independent origins are reconstructed for the posterior lobules on the inner fold, which are associated with intense mucociliary transport, suggesting an important cleansing role in epifaunal mussels. Our results reveal new examples of convergent morphological evolution associated with lifestyle transitions in marine mussels.
Rapid Detection of Cercospora beticola in Sugar Beet and Mutations Associated with Fungicide Resistance Using LAMP or Probe-Based qPCR
Authors: Shrestha Subidhya , Neubauer Jonathan , Spanner Rebecca , Natwick Mari , Rios Joshua , Metz Nicholas , Secor Gary A. , Bolton Melvin D.
Published: February 2020

Cercospora leaf spot (CLS), caused by the fungal pathogen Cercospora beticola, is the most destructive disease of sugar beet worldwide. Although growing CLS-tolerant varieties is helpful, disease management currently requires timely application of fungicides. However, overreliance on fungicides has led to the emergence of fungicide resistance in many C. beticola populations, resulting in multiple epidemics in recent years. Therefore, this study focused on developing a fungicide resistance detection “toolbox” for early detection of C. beticola in sugar beet leaves and mutations associated with different fungicides in the pathogen population. A loop-mediated isothermal amplification (LAMP) method was developed for rapid detection of C. beticola in infected sugar beet leaves. The LAMP primers specific to C. beticola (Cb-LAMP) assay was able to detect C. beticola in inoculated sugar beet leaves as early as 1 day postinoculation. A quinone outside inhibitor (QoI)-LAMP assay was also developed to detect the G143A mutation in cytochrome b associated with QoI resistance in C. beticola. The assay detected the mutation in C. beticola both in vitro and in planta with 100% accuracy. We also developed a probe-based quantitative PCR (qPCR) assay for detecting an E198A mutation in β-tubulin associated with benzimidazole resistance and a probe-based qPCR assay for detection of mutations in cytochrome P450-dependent sterol 14α-demethylase (Cyp51) associated with resistance to sterol demethylation inhibitor fungicides. The primers and probes used in the assay were highly efficient and precise in differentiating the corresponding fungicide-resistant mutants from sensitive wild-type isolates.
Sensitivity of Colletotrichum acutatum Isolates from Citrus to Carbendazim, Difenoconazole, Tebuconazole, and Trifloxystrobin
Authors: Gama Andre B. , Baggio Juliana S. , Rebello Carolina S. , Lourenço Silvia de Afonseca , Gasparoto Maria Cândida de G. , da Silva Junior Geraldo José , Peres Natalia A. , Amorim Lilian
Published: February 2020

Postbloom fruit drop (PFD) of citrus is caused by the Colletotrichum acutatum and C. gloeosporioides species complexes. The disease is important when frequent rainfall occurs during the flowering period of citrus trees. In Brazil, until 2012, PFD was mainly controlled by preventive applications of the methyl-benzimidazole carbamate (MBC) carbendazim and demethylation-inhibitor (DMI) fungicides such as difenoconazole. Since then, mixtures containing the DMI tebuconazole and the quinone-outside inhibitor (QoI) trifloxystrobin have been commonly used. Fungicides are often applied preventively, sometimes even when conditions are not conducive for PFD development. Excessive fungicide applications may favor the selection of resistant populations of Colletotrichum spp. In this study, we assessed the fungicide sensitivity of C. acutatum isolates collected during the two distinct periods of PFD management in Brazil: before and after the trifloxystrobin and tebuconazole mixture became widely employed. The sensitivity of 254 C. acutatum isolates to carbendazim and difenoconazole and of 164 isolates to tebuconazole and trifloxystrobin was assessed. Mycelial growth inhibition of these isolates was evaluated for all the fungicides using either serial dilution of fungicide rates or the spiral gradient dilution method. In addition, inhibition of conidial germination was also assessed for trifloxystrobin. Analysis of partial β-tub, cytb, and cyp51b gene sequences did not reveal any mutations related to resistance to MBCs, QoIs, and DMIs, respectively. In mycelial growth assays, mean EC50 values were 0.14, 0.11, and 0.21 μg/ml for difenoconazole, tebuconazole, and trifloxystrobin, respectively. The conidial germination inhibition by trifloxystrobin was similar among the tested isolates, and the mean EC50 value was 0.002 μg/ml. All isolates had similar mean mycelial growth inhibition for carbendazim, regardless of the fungicide concentrations. Therefore, based on similar EC50 values and molecular analyses, no shift in the sensitivity of isolates has been observed to the fungicides commonly used in different citrus-producing areas in Brazil.
Countering Opioid-induced Respiratory Depression in Male Rats with Nicotinic Acetylcholine Receptor Partial Agonists Varenicline and ABT 594
Authors: Ren Jun , Ding Xiuqing , Greer John J.
Published: January 2020

Background

Opioids can induce significant respiratory depression when administered as analgesics for the treatment of acute, postoperative, and chronic pain. There are currently no pharmacologic means of reversing opioid-induced respiratory depression without interfering with analgesia. Further, there is a growing epidemic of opioid overdose that could benefit from therapeutic advancements. The aim of this study was to test the ability of two partial agonists of α4β2 nicotinic acetylcholine receptors, varenicline (used clinically for smoking cessation) and ABT 594 (tebanicline, developed as an analgesic), to reduce respiratory depression induced by fentanyl, remifentanil, morphine, and a combination of fentanyl and diazepam.

Methods

Whole body plethysmographic recordings, nociception testing, and righting reflex testing were used to examine ventilation, analgesia, and sedation in adult male Sprague–Dawley rats.

Results

Pre-, co-, or postadministration of varenicline or ABT 594 did not alter baseline breathing but markedly reduced opioid-induced respiratory depression. Varenicline had no effect on fentanyl-induced analgesia and ABT 594 potentiated fentanyl-induced analgesia. Specifically, 10-min administration of fentanyl induced a decrease in respiratory rate to 43 ± 32% of control in vehicle group, which was alleviated by preadministration of varenicline (85 ± 14% of control, n = 8, P < 0.001) or ABT 594 (81 ± 36% of control, n = 8, P = 0.001). ABT 594 or varenicline with a low dose of naloxone (1 µg/kg), but not varenicline alone, partially reversed fentanyl-induced lethal apnea, but neither compound provided the very rapid and complete reversal of apnea achieved with high doses of naloxone (0.03 to 1 mg/kg). Administration of varenicline (n = 4, P = 0.034) or ABT 594 (n = 4, P = 0.034) prevented lethal apneas induced by the combination of fentanyl and diazepam.

Conclusions

Activation of α4β2 nicotinic acetylcholine receptors by varenicline and ABT 594 counters opioid-induced respiratory depression without interfering with analgesia.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Multimodal Analgesic Regimen for Spine Surgery
Authors: Maheshwari Kamal , Avitsian Rafi , Sessler Daniel I. , Makarova Natalya , Tanios Marianne , Raza Syed , Traul David , Rajan Shobana , Manlapaz Mariel , Machado Sandra , Krishnaney Ajit , Machado Andre , Rosenquist Richard , Kurz Andrea
Published: January 2020

Background

Various multimodal analgesic approaches have been proposed for spine surgery. The authors evaluated the effect of using a combination of four nonopioid analgesics versus placebo on Quality of Recovery, postoperative opioid consumption, and pain scores.

Methods

Adults having multilevel spine surgery who were at high risk for postoperative pain were double-blind randomized to placebos or the combination of single preoperative oral doses of acetaminophen 1,000 mg and gabapentin 600 mg, an infusion of ketamine 5 µg/kg/min throughout surgery, and an infusion of lidocaine 1.5 mg/kg/h intraoperatively and during the initial hour of recovery. Postoperative analgesia included acetaminophen, gabapentin, and opioids. The primary outcome was the Quality of Recovery 15-questionnaire (0 to 150 points, with 15% considered to be a clinically important difference) assessed on the third postoperative day. Secondary outcomes were opioid use in morphine equivalents (with 20% considered to be a clinically important change) and verbal-response pain scores (0 to 10, with a 1-point change considered important) over the initial postoperative 48 h.

Results

The trial was stopped early for futility per a priori guidelines. The average duration ± SD of surgery was 5.4 ± 2.1 h. The mean ± SD Quality of Recovery score was 109 ± 25 in the pathway patients (n = 150) versus 109 ± 23 in the placebo group (n = 149); estimated difference in means was 0 (95% CI, –6 to 6, P = 0.920). Pain management within the initial 48 postoperative hours was not superior in analgesic pathway group: 48-h opioid consumption median (Q1, Q3) was 72 (48, 113) mg in the analgesic pathway group and 75 (50, 152) mg in the placebo group, with the difference in medians being –9 (97.5% CI, –23 to 5, P = 0.175) mg. Mean 48-h pain scores were 4.8 ± 1.8 in the analgesic pathway group versus 5.2 ± 1.9 in the placebo group, with the difference in means being –0.4 (97.5% CI; –0.8, 0.1, P = 0.094).

Conclusions

An analgesic pathway based on preoperative acetaminophen and gabapentin, combined with intraoperative infusions of lidocaine and ketamine, did not improve recovery in patients who had multilevel spine surgery.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Predictors and Clinical Importance of Postoperative Coronal Malalignment After Surgery to Correct Adult Spinal Deformity
Authors: Tanaka Nobuki , Ebata Shigeto , Oda Kotaro , Oba Hiroki , Haro Hirotaka , Ohba Tetsuro
Published: January 2020

Study Design:

A retrospective observational study of a cohort of consecutive patients.

Objective:

The objective of this study was to determine the correlations between clinical outcomes of spinal surgery to correct adult spinal deformity (ASD) including mechanical complications and coronal malalignment and clarify the risk factors for postoperative coronal malalignment.

Summary of Background Data:

Despite the coronal malalignment seen regularly in adult patients who have undergone spinal surgery to correct spinal deformity, the associations between coronal malalignment, and clinical outcomes including mechanical complications after the surgery have remained unclear until now. To understand the associations between coronal malalignment and outcomes of surgery to correct ASD, and risk factors for postoperative coronal malalignment has substantial clinical importance.

Materials and Methods:

We included data from 121 consecutive patients who had undergone spinal surgery to correct ASD and were followed up for a minimum of 2 years. Iliac screws were used for pelvic fixation in all cases. The coronal balance was defined as the horizontal distance between the midpoint of C7 and the center of the sacrum on the coronal plane, and coronal malalignment was defined as when the absolute coronal balance was >20 mm. Preoperative radiographic parameters, surgical features, and clinical outcomes including mechanical complications were compared between groups of patients with coronal balance and those with malalignment. Univariate and multivariate regression analysis were used to clarify risk factors for postoperative coronal malalignment.

Results:

Postoperative coronal malalignment had no significant association with the clinical outcome as evaluated by a Roland-Morris Disability Questionnaire and Oswestry Disability Index but had a significant association with the frequency of rod fracture. A large preoperative coronal imbalance (malalignment), L5 coronal tilt angle, and use of lateral lumbar interbody fusion were found as risk factors for postoperative coronal malalignment.

Conclusion:

Postoperative coronal malalignment had no significant association with the clinical outcome as evaluated by the Oswestry Disability Index and Roland-Morris Disability Questionnaire but was significantly associated with the frequency of rod fracture.

Level of Evidence:

Level III.
A Case of Dendritic Cell Neurofibroma With Pseudorosettes
Authors: Kubota Riko , Nishida Haruto , Kodo Yoshihiko , Oyama Yuzo , Kusaba Takahiro , Kadowaki Hiroko , Arakane Motoki , Daa Tsutomu
Published: January 2020

Dendritic cell neurofibroma with pseudorosettes (DCNP) is a rare benign peripheral nerve sheath tumor. Till date, 34 cases of DCNP arising from various sites have been reported. Histopathologically, DCNP is known to present with characteristic pseudorosettes, in which a type II cell is surrounded by type I cells. In the present report, we discuss the rare case of a 63-year-old man diagnosed with DCNP on the left flank (size: approximately 10 mm). On microscopic examination of the resected lesion, we observed the characteristic pseudorosettes with centrally placed type I cells, which exhibited small, dark, slightly irregular oval nuclei with nuclear inclusions, surrounded by type II cells, which showed a large pale nucleus with a constriction, a small nucleolus, and mildly eosinophilic cytoplasm. The type II cells were positive for S-100, CD57, LAMP2, fascin, and factor XIIIa. Although previous reports have suggested that type II cells exhibit a dendritic form, our immunohistochemical analyses revealed that these cells were dermal interstitial dendritic cells.
Critical-Care Nurses' Perceptions of Hope
Authors: Fowler Susan B.
Published: January 2020

Background

Nurses can be a source of inspiring hope in patients and families. There is limited investigation of hope-inspiring actions of critical-care nurses, particularly in the United States.

Objective

The aim of this study was to explore critical-care nurses' perceptions of hope-inspiring strategies in adult patients and families.

Methods

Qualitative description was used to explore perceptions.

Results

A convenience sample of critical-care nurses participated (n = 14) in one-on-one interviews. Themes were identified from transcripts of audiotapes. Participants described hope as something to “hang on to” and “move” you forward or toward something. Assessment of hope was identified as a “verbal and nonverbal connection,” often done subconsciously. Hope was inspired through “communication.” Patient and/or family behaviors signified that hope-inspiring strategies may be working.

Discussion

Nurses have the power to assess, inspire, and evaluate hope. Nurses use similar hope-inspiring strategies regardless of their specialty area of critical-care practice. Findings from this qualitative study added to knowledge on hope-inspiring strategies of critical-care nurses.
Rural–Urban Differences in Adult Life Expectancy in Indonesia
Authors: Sudharsanan Nikkil , Ho Jessica Y.
Published: January 2020

Background:

Evidence on rural–urban differences in adult mortality in low- and middle-income countries (LMICs) is limited and mixed. We examined the size of and factors contributing to rural–urban life expectancy differences among adults in Indonesia, the third most populous LMIC.

Methods:

Data come from the 2000, 2007, and 2014/2015 waves of the Indonesian Family Life Survey, a population-representative longitudinal study with mortality follow-up. We used Poisson regression and life tables to estimate rural–urban differences in life expectancy among 18,867 adult respondents ≥30 years. We then used a novel g-formula–based decomposition to quantify the contribution of rural–urban differences in blood pressure (BP), body mass index (BMI), and smoking to life expectancy differences.

Results:

Compared with urban adults, life expectancy at age 30 was 2.2 (95% confidence interval [CI] = 0.4, 3.9) years higher for rural men and 1.2 (95% CI = −0.4, 2.7) years higher for rural women. Setting the BMI and systolic BP distribution equal in urban and rural adults reduced the urban mortality penalty by 22% for men and 78% for women, with the majority of this reduction coming from the contribution of rural–urban differences in BMI. Smoking did not contribute to the urban mortality penalty for either men or women.

Conclusions:

Adult life expectancy is lower in urban than in rural areas in Indonesia and we estimate that this difference is partly related to differences in BMI and systolic BP.
The Pediatric Acute Leukemia Fusion Oncogene ETO2‐GLIS2 Increases Self‐Renewal and Alters Differentiation in a Human Induced Pluripotent Stem Cells‐Derived Model
Authors: Bertuccio Salvatore Nicola , Boudia Fabien , Cambot Marie , Lopez Cécile K. , Lordier Larissa , Donada Alessandro , Robert Elie , Thirant Cécile , Aid Zakia , Serravalle Salvatore , Astolfi Annalisa , Indio Valentina , Locatelli Franco , Pession Andrea , Vainchenker William , Masetti Riccardo , Raslova Hana , Mercher Thomas
Published: February 2020

Supplemental Digital Content is available in the text
From Early Childhood to Adolescence: Lessons About Traumatic Brain Injury From the Ohio Head Injury Outcomes Study
Authors: Petranovich Christine L. , Smith-Paine Julia , Wade Shari L. , Yeates Keith Owen , Taylor H. Gerry , Stancin Terry , Kurowski Brad G.
Published: January 2020

Objective:

The Ohio Head Injury Outcomes study was a 12-year longitudinal study of early childhood traumatic brain injury (TBI). This article reviewed the findings pertaining to caregiver and family functioning and child cognition, behavior, social competence, emotional functioning, and academics. We further considered individual and social-environmental influences on recovery and interventions.

Setting:

Recruitment was completed at 3 children's hospitals and 1 general hospital.

Participants:

Children aged 3 to 7 years at the time of injury with complicated mild to moderate and severe TBI or orthopedic injury requiring hospitalization were included.

Design:

A concurrent cohort/prospective research design was used. A baseline assessment was completed shortly after the injury. Follow-up assessments were completed at 6, 12, and 18 months and at an average of 38 and 82 months postinjury.

Main Measures:

At baseline, parents/guardians completed retrospective ratings of their child's behavioral, emotional, and social functioning preinjury. At the subsequent assessments, ratings reflected current functioning. Information about current family and caregiver functioning was collected at each time point and cognitive testing was completed at selected time points.

Results and Conclusions:

Recovery after TBI is complex, varies over time, and involves injury-related and premorbid influences, cognition, genetics, and caregiver and family functioning. A sizable number of children with TBI have persisting unmet clinical needs.
Determining vault size in implantable collamer lenses: preoperative anatomy and lens parameters
Authors: Trancón Angel Sánchez , Manito Santiago Cerpa , Sierra Oscar Torrado , Baptista António Manuel , Serra Pedro Miguel
Published: January 2020

Purpose:

To determine patient preoperative anatomical features and the parameters of implantable collamer lenses (ICLs) relevant in explaining vault variability.

Setting:

Ophthalmology Clinic Vista Sánchez Trancón, Badajoz, Spain.

Design:

Retrospective case series.

Methods:

This study comprised 360 eyes of 360 patients implanted with myopic or toric ICLs. Pentacam imaging was used for assessing white-to-white (WTW) diameter, central keratometry, and central corneal thickness. Anterior-segment optical coherence tomography was used to measure the horizontal anterior chamber angle distance (ATA), internal anterior chamber (ACQ), crystalline lens rise (CLR), anterior chamber angle (ACA), and vault. The sample was divided according to the implanted lens size (12.6 mm, 13.2 mm, and 13.7 mm). Vault predictors were identified from the variables above using multivariate regression analysis.

Results:

The groups showed significant statistical differences for WTW, ATA, ACQ, ACA, and vault (P < .007 for all). In general, bigger lenses were implanted in eyes with larger transverse sizes (WTW and ATA) and deeper ACQ. Also, larger ICL diameters were associated with higher vaults. Multivariate regression analysis identified the lens size (13.2 mm as reference; 12.6 mm: β [standardized coefficients] = −0.33; 13.7 mm: β = 0.42), ATA (β = −0.42), and CLR (β = −0.25), ICL spherical equivalent (β = −0.22) and patient age (β = −0.12) as predictors of the vault size (adjusted-R
2 = 0.34 P < .001).

Conclusions:

The multivariate model explained 34% of vault variability. The predictors indicated the presence of different mechanisms regulating the vault. These involved the difference between the transverse size of the eye and the ICL, the crystalline lens protrusion, and the ICL properties, such as power and size.
Parent-Targeted Education Regarding Infant Pain Management Delivered During the Perinatal Period
Authors: Richardson Brianna , Falconer Allyson , Shrestha Joshna , Cassidy Christine , Campbell-Yeo Marsha , Curran Janet A.
Published: January 2020

All infants experience pain in early life from procedures. Parents recognize pain as a prevalent issue, reporting a strong desire for more information on infant pain. The aim of this study was to explore and map the current evidence of parent-targeted educational interventions about infant pain, delivered throughout the perinatal period. Records were identified in PubMed, CINAHL, EMBASE, and ERIC databases and hand searching recent publications in 3 relevant journals. Records in English that described or evaluated educational interventions on infant pain management aimed at parents during the perinatal period were eligible for review and those not related to pain or aimed at healthcare providers were excluded. Evaluation was completed following the Methodology for JBI Scoping Reviews and standardized critical appraisal instruments from the Joanna Briggs Institute. Initial search yielded 6946 records, with 9 included in analysis. Six studies were quantitative, 2 qualitative, and 1 mixed methods. Included interventions contained information about parent-led pain management strategies for infants in the neonatal intensive care unit (n = 4), full term (n = 4), or both (n = 1). Despite being an area of high concern for parents of newborns, few studies addressed parent-targeted education regarding infant pain. Future research examining the impact and efficacy of these interventions addressing parental and neonatal outcomes is warranted.
Schwannoma of the thyroid bed
Authors: Kang Ji Yun , Yi Kyung Sik , Cha Sang-Hoon , Choi Chi-Hoon , Kim Yook , Lee Jisun , Son Seung-Myoung
Published: January 2020

Rationale:

Schwannomas involving the thyroid gland are very rare and only a few cases have been reported in the literature. However, previous reports did not distinguish between thyroid bed schwannomas and intrathyroidal schwannomas. Here, we report a thyroid bed schwannoma mimicking a malignant thyroid nodule and review the literature on thyroid bed schwannomas.

Patient concerns:

A 33-year-old woman presented at our hospital with mild neck swelling.

Diagnosis:

Thyroid ultrasound revealed a well-defined, oval-shaped, markedly hypoechoic solid nodule with echogenic foci suggesting macro- and microcalcifications in the left thyroid gland. The lesion was considered a “highly suspicious” intrathyroidal nodule, based on the guidelines for the assessment of thyroid nodules. Fine needle aspiration was performed twice, but the cytological results were nondiagnostic.

Interventions:

Left thyroidectomy was performed, and schwannoma of the thyroid bed was confirmed on histopathologic analysis.

Outcomes:

The patient was in a stable condition after surgery, and the thyroid function test results were within the normal range.

Lessons:

Diagnosis of a schwannoma of the thyroid bed is challenging because its incidence is extremely low, and it is often misdiagnosed as an intrathyroidal nodule on ultrasonography. Therefore, it is advisable to adopt a diagnostic strategy to perform additional core needle biopsy in cases of thyroid nodules with nondiagnostic fine needle aspiration results and to consider the location of the lesion more carefully to determine the suitable therapy.
Use of nitroglycerin for parallel transverse uterine cesarean section in patients with pernicious placenta previa and placenta accrete and predicted difficult airway
Authors: Ma Yushan , You Yong , Jiang Xiaoqin , Lin Xuemei
Published: January 2020

Rationale:

The incidence of obstetric hemorrhage due to pernicious placenta previa (PPP) and placenta accreta is currently increasing in China. Parallel transverse uterine incision (PTUI) cesarean section (CS) is a novel technique designed to avoid transecting the placenta and control postpartum hemorrhage during CS in these patients in our hospital. A key point of anesthesia management related to PTUI CS involves keeping the uterus relaxed. General anesthesia (GA) has often been performed, and inhaled volatile anesthetics have traditionally been recommended for this purpose; however, GA may be contraindicated in patients with difficult airways.

Patient concerns:

The patient was predicted to have a difficult airway, and GA may have resulted in potentially life-threatening complications. An alternative and safer method of achieving uterine relaxation during PTUI CS was thus required.

Diagnoses:

The patient was diagnosed with PPP, and a predicted difficult airway was suspected preoperatively.

Interventions:

PTUI CS was planned to control postpartum hemorrhage and preserve fertility during CS. Uterine relaxation during PTUI CS was achieved with intravenous nitroglycerin under combined spinal-epidural anesthesia.

Outcome:

Intravenous nitroglycerin and combined spinal-epidural anesthesia achieved uterine relaxation during the time from delivery of the neonate to making the second transverse incision in the lower segment of the uterus during PTUI CS. Both the parturient and neonate were well and were discharged 4 days later.

Lessions:

Intravenous nitroglycerin and combined spinal-epidural anesthesia may offer an alternative to GA for achieving uterine relaxation in patients with PPP and a predicted difficult airway undergoing PTUI CS to control postpartum hemorrhage.