bluuebunny/crossref_metadata_2025 huggingface dataset:
EDGE: from quiescent to gas-rich to star-forming low-mass dwarf galaxies
Authors: Rey Martin P , Pontzen Andrew , Agertz Oscar , Orkney Matthew D A , Read Justin I , Rosdahl Joakim
Published: June 2020

We study how star formation is regulated in low-mass field dwarf galaxies ($10^5 \le M_{\star } \le 10^6 \, \mbox{M}_\mathrm{\odot }$), using cosmological high-resolution ($3 \, \mathrm{pc}$) hydrodynamical simulations. Cosmic reionization quenches star formation in all our simulated dwarfs, but three galaxies with final dynamical masses of $3 \times 10^{9} \, \mbox{M}_\mathrm{\odot }$ are subsequently able to replenish their interstellar medium by slowly accreting gas. Two of these galaxies reignite and sustain star formation until the present day at an average rate of $10^{-5} \, \mbox{M}_\mathrm{\odot } \, \text{yr}^{-1}$, highly reminiscent of observed low-mass star-forming dwarf irregulars such as Leo T. The resumption of star formation is delayed by several billion years due to residual feedback from stellar winds and Type Ia supernovae; even at z = 0, the third galaxy remains in a temporary equilibrium with a large gas content but without any ongoing star formation. Using the ‘genetic modification’ approach, we create an alternative mass growth history for this gas-rich quiescent dwarf and show how a small $(0.2\, \mathrm{dex})$ increase in dynamical mass can overcome residual stellar feedback, reigniting star formation. The interaction between feedback and mass build-up produces a diversity in the stellar ages and gas content of low-mass dwarfs, which will be probed by combining next-generation H i and imaging surveys.
Binary-induced spiral arms inside the disc cavity of AB Aurigae
Authors: Poblete Pedro P , Calcino Josh , Cuello Nicolás , Macías Enrique , Ribas Álvaro , Price Daniel J , Cuadra Jorge , Pinte Christophe
Published: June 2020

In this work we demonstrate that the inner spiral structure observed in AB Aurigae can be created by a binary star orbiting inside the dust cavity. We find that a companion with a mass-ratio of 0.25, semimajor axis of 40 au, eccentricity of 0.5, and inclination of 90° produces gaseous spirals closely matching the ones observed in 12CO (2-1) line emission. Based on dust dynamics in circumbinary discs (Poblete, Cuello & Cuadra 2019), we constrain the inclination of the binary with respect to the circumbinary disc to range between 60° and 90°. We predict that the stellar companion is located roughly 0.18 arcsec from the central star towards the east-southeast, above the plane of the disc. Should this companion be detected in the near future, our model indicates that it should be moving away from the primary star at a rate of 6 mas yr−1 on the plane of the sky. Since our companion is inclined, we also predict that the spiral structure will appear to change with time, and not simply corotate with the companion.
Radio constraints on dark matter annihilation in Canes Venatici I with LOFAR†
Authors: Vollmann Martin , Heesen Volker , W. Shimwell Timothy , Hardcastle Martin J , Brüggen Marcus , Sigl Günter , J. A. Röttgering Huub
Published: June 2020

Dwarf galaxies are dark matter (DM) dominated and therefore promising targets for the search for weakly interacting massive particles (WIMPs), which are well-known candidates for DM. The annihilation of WIMPs produces ultrarelativistic cosmic ray electrons and positrons that emit synchrotron radiation in the presence of magnetic fields. For typical magnetic field strengths (few μG) and $\mathcal {O}$(GeV–TeV) WIMP masses, this emission peaks at hundreds of MHz. Here, we use the non-detection of 150-MHz radio continuum emission from the dwarf spheroidal galaxy Canes Venatici I with the Low-Frequency Array to derive constraints on the annihilation cross-section of WIMPs into primary electron–positron and other fundamental particle–antiparticle pairs. Our main underlying assumption is that the transport of the cosmic rays can be described by the diffusion approximation, thus requiring a non-zero magnetic field strength with small-scale structure. In particular, by adopting magnetic field strengths of $\mathcal {O}(1\, \mu$G) and diffusion coefficients $\sim \!10^{27}~\rm cm^2\, s^{-1}$, we obtain limits that are comparable with those set by the Fermi Large Area Telescope using gamma-ray observations of this particular galaxy. Assuming s-wave annihilation and WIMPs making up 100 per cent of the DM density, our benchmark limits exclude several thermal WIMP realizations in the [2, 20]-GeV mass range. We caution, however, that our limits for the cross-section are subject to enormous uncertainties that we also quantitatively assess. In particular, variations on the propagation parameters or on the DM halo can shift our limits up by several orders of magnitude (in the pessimistic scenario).
The imprint of arms and bars on rotation curves: in-plane and off-plane
Authors: Martinez-Medina Luis A , Pichardo Barbara , Peimbert Antonio
Published: June 2020

Within rotation curves (RCs) is encoded the kinematical state of the stellar disc as well as information about the dynamical mechanisms driving the secular evolution of galaxies. To explain the characteristic features of RCs which arise by the influence of spiral patterns and bar, we study the kinematics of the stellar disc in a set of spiral galaxy models specifically tailored for this purpose. We find that, for our models, the induced non-circular motions are more prominent for spirals with larger pitch angle, the ones typical in late-type galaxies. Moreover, inside corotation, stars rotate slower along the spiral arms than along the interarm, which translates into a local minima or maxima in the RC, respectively. We also see, from off-plane RC, that the rotation is faster for stars that at observed closer to the plane, and diminishes as one looks farther off plane; this trend is more noticeable in our Sa galaxy model than our Sc galaxy model. Additionally, in a previous work we found that the diagonal ridges in the Vϕ–R plane, revealed through the GaiaDR2, have a resonant origin due to the spiral arms and bar and that these ridges project themselves as wiggles in the RC; here, we further notice that the development of these ridges, and the development of high orbital eccentricities in the stellar disc are the same. Hence, we conclude that, the following explanations of bumps and wiggles in RCs are equivalent: they are manifestations of diagonal ridges in the Vϕ–R plane, or of the rearrangement of the orbital eccentricities in the stellar disc.
The genotoxic effects in the leukocytes of workers handling nanocomposite materials
Authors: Novotna Bozena , Pelclova Daniela , Rossnerova Andrea , Zdimal Vladimir , Ondracek Jakub , Lischkova Lucie , Vlckova Stepanka , Fenclova Zdenka , Klusackova Pavlina , Zavodna Tana , Topinka Jan , Komarc Martin , Dvorackova Stepanka , Rossner Pavel
Published: June 2020

The extensive development of nanotechnologies and nanomaterials poses a number of questions to toxicologists about the potential health risks of exposure to nanoparticles (NP). In this study, we analysed DNA damage in the leukocytes of 20 workers who were long-term exposed (18 ± 10 years) to NP in their working environment. Blood samples were collected in September 2016, before and after a shift, to assess (i) the chronic effects of NP on DNA (pre-shift samples) and (ii) the acute effects of exposure during the shift (the difference between pre- and post-shift samples). The samples from matched controls were taken in parallel with workers before the shift. Leukocytes were isolated from heparinised blood on a Ficoll gradient. The enzyme-modified comet assay (DNA formamido-pyrimidine-glycosylase and endonuclease III) demonstrated a considerable increase of both single- and double-strand breaks in DNA (DNA-SB) and oxidised bases when compared with the controls (2.4× and 2×, respectively). Acute exposure induced a further increase of DNA-SB. The welding and smelting of nanocomposites represented a higher genotoxic risk than milling and grinding of nanocomposite surfaces. Obesity appeared to be a factor contributing to an increased risk of oxidative damage to DNA. The data also indicated a higher susceptibility of males vs. females to NP exposure. The study was repeated in September 2017. The results exhibited similar trend, but the levels of DNA damage in the exposed subjects were lower compared to previous year. This was probably associated with lower exposure to NP in consequence of changes in nanomaterial composition and working operations. The further study involving also monitoring of personal exposures to NP is necessary to identify (i) the main aerosol components responsible for genotoxic effects in workers handling nanocomposites and (ii) the primary cause of gender differences in response to NP action.
Oligonucleotides DNA containing 8-trifluoromethyl-2′-deoxyguanosine for observing Z-DNA structure
Authors: Bao Hong-Liang , Masuzawa Tatsuki , Oyoshi Takanori , Xu Yan
Published: June 2020

Z-DNA is known to be a left-handed alternative form of DNA and has important biological roles as well as being related to cancer and other genetic diseases. It is therefore important to investigate Z-DNA structure and related biological events in living cells. However, the development of molecular probes for the observation of Z-DNA structures inside living cells has not yet been realized. Here, we have succeeded in developing site-specific trifluoromethyl oligonucleotide DNA by incorporation of 8-trifluoromethyl-2′-deoxyguanosine (FG). 2D NMR strongly suggested that FG adopted a syn conformation. Trifluoromethyl oligonucleotides dramatically stabilized Z-DNA, even under physiological salt concentrations. Furthermore, the trifluoromethyl DNA can be used to directly observe Z-form DNA structure and interaction of DNA with proteins in vitro, as well as in living human cells by19F NMR spectroscopy for the first time. These results provide valuable information to allow understanding of the structure and function of Z-DNA.
DeepCLIP: predicting the effect of mutations on protein–RNA binding with deep learning
Authors: Grønning Alexander Gulliver Bjørnholt , Doktor Thomas Koed , Larsen Simon Jonas , Petersen Ulrika Simone Spangsberg , Holm Lise Lolle , Bruun Gitte Hoffmann , Hansen Michael Birkerod , Hartung Anne-Mette , Baumbach Jan , Andresen Brage Storstein
Published: June 2020

Nucleotide variants can cause functional changes by altering protein–RNA binding in various ways that are not easy to predict. This can affect processes such as splicing, nuclear shuttling, and stability of the transcript. Therefore, correct modeling of protein–RNA binding is critical when predicting the effects of sequence variations. Many RNA-binding proteins recognize a diverse set of motifs and binding is typically also dependent on the genomic context, making this task particularly challenging. Here, we present DeepCLIP, the first method for context-aware modeling and predicting protein binding to RNA nucleic acids using exclusively sequence data as input. We show that DeepCLIP outperforms existing methods for modeling RNA-protein binding. Importantly, we demonstrate that DeepCLIP predictions correlate with the functional outcomes of nucleotide variants in independent wet lab experiments. Furthermore, we show how DeepCLIP binding profiles can be used in the design of therapeutically relevant antisense oligonucleotides, and to uncover possible position-dependent regulation in a tissue-specific manner. DeepCLIP is freely available as a stand-alone application and as a webtool at http://deepclip.compbio.sdu.dk.
Impact of 3-Dimensional Versus 2-Dimensional Image Distortion Correction on Stereotactic Neurosurgical Navigation Image Fusion Reliability for Images Acquired With Intraoperative Magnetic Resonance Imaging
Authors: Yahanda Alexander T , Goble Timothy J , Sylvester Peter T , Lessman Gretchen , Goddard Stanley , McCollough Bridget , Shah Amar , Andrews Trevor , Benzinger Tammie L S , Chicoine Michael R
Published: June 2020

BACKGROUND

Fusion of preoperative and intraoperative magnetic resonance imaging (iMRI) studies during stereotactic navigation may be very useful for procedures such as tumor resections but can be subject to error because of image distortion.

OBJECTIVE

To assess the impact of 3-dimensional (3D) vs 2-dimensional (2D) image distortion correction on the accuracy of auto-merge image fusion for stereotactic neurosurgical images acquired with iMRI using a head phantom in different surgical positions.

METHODS

T1-weighted intraoperative images of the head phantom were obtained using 1.5T iMRI. Images were postprocessed with 2D and 3D image distortion correction. These studies were fused to T1-weighted preoperative MRI studies performed on a 1.5T diagnostic MRI. The reliability of the auto-merge fusion of these images for 2D and 3D correction techniques was assessed both manually using the stereotactic navigation system and via image analysis software.

RESULTS

Eight surgical positions of the head phantom were imaged with iMRI. Greater image distortion occurred with increased distance from isocenter in all 3 axes, reducing accuracy of image fusion to preoperative images. Visually reliable image fusions were accomplished in 2/8 surgical positions using 2D distortion correction and 5/8 using 3D correction. Three-dimensional correction yielded superior image registration quality as defined by higher maximum mutual information values, with improvements ranging between 2.3% and 14.3% over 2D correction.

CONCLUSION

Using 3D distortion correction enhanced the reliability of surgical navigation auto-merge fusion of phantom images acquired with iMRI across a wider range of head positions and may improve the accuracy of stereotactic navigation using iMRI images.
Two Novel PLS-Class Pentatricopeptide Repeat Proteins Are Involved in the Group II Intron Splicing of Mitochondrial Transcripts in the Moss Physcomitrella patens
Authors: Ichinose Mizuho , Ishimaru Airi , Sugita Chieko , Nakajima Kensaku , Kawaguchi Yasuhiro , Sugita Mamoru
Published: June 2020

Pentatricopeptide repeat (PPR) proteins are RNA-binding proteins that function in posttranscriptional regulation as gene-specific regulators of RNA metabolism in plant organelles. Plant PPR proteins are divided into four classes: P, PLS, E and DYW. The E- and DYW-class proteins are mainly implicated in RNA editing, whereas most of the P-class proteins predominantly participate in RNA cleavage, splicing and stabilization. In contrast, the functions of PLS-class proteins still remain obscure. Here, we report the function of PLS-class PpPPR_31 and PpPPR_9 in Physcomitrella patens. The knockout (KO) mutants of PpPPR_31 and PpPPR_9 exhibited slower protonema growth compared to the wild type. The PpPPR_31 KO mutants showed a considerable reduction in the splicing of nad5 intron 3 and atp9 intron 1. The PpPPR_9 KO mutants displayed severely reduced splicing of cox1 intron 3. An RNA electrophoresis mobility shift assay showed that the recombinant PpPPR_31 protein bound to the 5′ region of nad5 exon 4 and the bulged A region in domain VI of atp9 group II intron 1 while the recombinant PpPPR_9 bound to the translated region of ORF622 in cox1 intron 3. These results suggest that a certain set of PLS-class PPR proteins may influence the splicing efficiency of mitochondrial group II introns.
Extended Perineural Analgesia After Hip and Knee Replacement When Buprenorphine-Clonidine-Dexamethasone Is Added to Bupivacaine: Preliminary Report from a Randomized Clinical Trial
Authors: Williams Brian A , Ibinson James W , Ritter Marsha E , Ezaru Catalin S , Rakesh Hulimangala R , Paiste Henry J , Gilbert Karen L , Mikolic Joseph M , Muluk Visala S , Piva Sara R
Published: June 2020

Objective

We tested the hypothesis that buprenorphine-clonidine-dexamethasone (BCD) extends perineural analgesia compared with plain bupivacaine (BPV) nerve blocks used for hip and knee replacement surgery.

Design

Prospective, parallel-arms, randomized, double-blind trial.

Setting

A single veterans’ hospital.

Subjects

Seventy-eight veterans scheduled for total hip or knee replacement with plans for spinal as the primary anesthetic.

Methods

Participants underwent nerve/plexus blocks at L2–L4 and L4–S3 in advance of hip or knee joint replacement surgery. Patients were randomized to receive BPV-BCD or plain BPV in a 4:1 allocation ratio. Patients answered four block duration questions (listed below). Time differences between treatments were analyzed using the t test.

Results

Significant (P < 0.001) prolongation of the time parameters was reported by patients after the BPV-BCD blocks (N = 62) vs plain BPV (N = 16). The time until start of postoperative pain was 26 vs 11 hours (mean difference = 15 hours, 95% CI = 8 to 21). The time until no pain relief from the blocks was 32 vs 15 hours (mean difference = 17 hours, 95% CI = 10 to 24). The time until the numbness wore off was 37 vs 21 hours (mean difference = 16 hours, 95% CI = 8 to 23). The time until the worst postoperative pain was 39 vs 20 hours (mean difference = 19 hours, 95% CI = 11 to 27).

Conclusions

BPV-BCD provided 26–39 hours of perineural analgesia in the L2–L4 and L4–S3 nerve distributions after hip/knee replacement surgery, compared with 11–21 hours for plain BPV.
Instruments for Measuring Satisfaction With Physical Therapy Care: A Systematic Review
Authors: Gutiérrez-Sánchez Daniel , Pérez-Cruzado David , Cuesta-Vargas Antonio I
Published: June 2020

Objective

Several instruments to measure patient satisfaction have been developed to assess satisfaction with physical therapy care. The selection of the most appropriate instrument is very important. The purpose of this study was to identify instruments for assessing satisfaction with physical therapy care and their psychometric properties and to evaluate the methodological quality of studies on psychometric properties.

Methods

A systematic search was conducted in ProQuest Medline, SciELO, ProQuest PsycINFO, Theseus, Cochrane Library, and Google Scholar. Articles published from 1990 to 2019, in English and Spanish, were used as limits. This systematic review followed the Consensus-based Standards for the Selection of Health Measurement Instruments and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. The articles were evaluated by 2 independent reviewers using the Consensus-based Standards for the Selection of Health Measurement Instruments 4-point checklist. Eighteen studies were included.

Results

Nine instruments were found to be specifically designed to assess satisfaction with physical therapy care. The methodological quality of the studies was “fair” for most of the psychometric characteristics analyzed (43 items), with 24 properties scored as “poor,” 5 as “good,” and 3 as “excellent.”

Conclusions

Different instrument characteristics—such as the scope and population with which the instrument will be used, its dimensions, the number of items, and the evidence shown in the evaluation of each psychometric property—should be considered by clinicians and researchers to decide which instrument is the best to measure the construct of patient satisfaction with physical therapy.

Impact

Evaluating patient satisfaction is very useful in clinical practice at the hospital, community, and primary care levels. Physical therapist clinicians and researchers can use this systematic review to select instruments whose characteristics will best measure their patients’ satisfaction with physical therapy care.
Gender Regime Change in Decentralized States: The Case of Spain
Authors: Lombardo Emanuela , Alonso Alba
Published: June 2020

This article applies Walby’s systemic theory of gender regime to Spain’s decentralized state, to capture changes in the gender regime. Locating the “hegemon” at different levels of government for each domain (economy, polity, violence, and civil society) and considering interactions between governmental levels provided a clear understanding of changes in the gender regime. The relationship between governmental level acting as hegemon in specific domains and variations in political majorities across governmental levels explained changes toward a neoliberal–conservative type in the economy domain. Shifts toward a neoliberal gender regime in violence and polity, and toward a conservative type in civil society, were contested.
The Origins and Transformations of Conservative Gender Regimes in Germany and Japan
Authors: Shire Karen A , Nemoto Kumiko
Published: June 2020

In this article, we extend Walby’s analysis of gender transformations to theorize gender relations in conservative modernizations. We draw insights from a historical comparison of gender inequalities in Germany and Japan, to draw a distinction between conservative authoritarian and conservative democratic gender regimes, and their transformations. Conservative gender regimes, we argue, constitute the domestic as a public sphere and transform through social and family policies, which reinforce a gendered division of labor. The concept of conservative gender regimes, we argue, is relevant for analyzing transformations in other European and non-European world regions.
Prevention, Management and Risk Factors for Diarrhoeal Disease in under-Fives in Cape Town
Authors: Freer Joseph , Mahomed Hassan , Westwood Anthony
Published: June 2020

Background

In South Africa, Cape Town’s health facilities are stretched by the volume of cases of diarrhoea during the summer months, particularly with severely dehydrated children, who often require complex inpatient management. The prevalence of severe disease in children living in the settlements around Cape Town is particularly high.

Methods

An observational study of a systematic sample of children under 5 who presented to any primary care facility in Khayelitsha, an informal settlement of Cape Town, with diarrhoea and referred to secondary care between 1 November 2015 and 30 April 2016. We recruited participants from the sub-district office and identified risk factors associated with the index presentation, captured the triage and management of patients in primary care and investigated post-discharge follow-up.

Results

We recruited 87 children into the study, out of a total of 115 cases of severe dehydration. There was a significantly higher number of households in this group with no income than in Khayelitsha overall (65% vs. 47.4%; p < 0.001). In the sample, HIV-exposed, uninfected children were younger than unexposed children (median 9.44 months in exposed vs. 17.36 months in unexposed; p = 0.0015) and were more likely to be malnourished (weight-for-age Z-score; WAZ score < −2) [13 cases exposed vs. 8 cases unexposed (p = 0.04)]. Outreach staff were able to trace only 33.3% of children at home following discharge, yet 65% of children attended follow-up appointments in clinics.

Conclusions

This cohort of children with diarrhoeal disease complicated by severe dehydration was a particularly socially deprived group. The results demonstrating zero vertical transmission of HIV in this very socioeconomically deprived area of Cape Town are encouraging. In the HIV-exposed, uninfected group, children were younger and had a higher prevalence of malnutrition, which should be the subject of future research, especially given existing evidence for immunological differences in children exposed to HIV in utero. Locating children with severe diarrhoea post-discharge was challenging and further research is needed on the cost-effectiveness and outcomes of different follow-up approaches.
Kawasaki disease
Authors: Galuppo Jana , Kowker Alexandra , Rolfs Jenna , Nicholas Joyce , Schmidt Eric
Published: June 2020

Kawasaki disease is an acute systemic febrile vasculitis of medium and small arteries, most often occurring in children under age 5 years. This condition is the most common cause of acquired heart disease in children in the developed world. The cause is unclear but is thought to be a hyperimmune reaction to an infectious agent. Diagnosis is clinical; the classic presentation includes persistent fever, lymphadenopathy, oral mucosal changes, conjunctivitis, and rash. Although the disease technically is self-limiting, treatment with IV immunoglobulin (IVIG) and high-dose aspirin is necessary to prevent cardiac complications, such as coronary artery aneurysm, pericarditis, or myocarditis. This article reviews the pathophysiology, clinical presentation, diagnosis, and treatment of Kawasaki disease.
Adverse Childhood Experiences in Trainees and Physicians With Professionalism Lapses: Implications for Medical Education and Remediation
Authors: Williams Betsy White , Welindt Dillon , Hafferty Frederic W. , Stumps Anna , Flanders Philip , Williams Michael V.
Published: June 2020

Purpose

Unprofessional behavior, which can include failure to engage, dishonest and/or disrespectful behavior, and poor self-awareness, can be demonstrated by medical trainees and practicing physicians. In the authors’ experience, these types of behaviors are associated with exposure to adverse childhood experiences (ACEs). Given this overlap, the authors studied the percentage of ACEs among trainees and physicians referred for fitness-for-duty evaluations and patterns between the types of ACEs experienced and the reason for referral.

Method

A final sample of 123 cases of U.S. trainees and physicians who had been referred to a Midwestern center for assessment and/or remediation of professionalism issues from 2013 to 2018 was created. Included professionalism lapses fell within 3 categories: boundary violation, disruptive behavior, or potential substance use disorder concerns. All participants completed a psychosocial developmental interview, which includes questions about ACE exposure. Overall rate of reported ACEs and types of ACEs reported were explored.

Results

Eighty-six (70%) participants reported at least 1 ACE, while 27 (22%) reported 4 or more. Compared with national data, these results show significantly higher occurrence rates of 1 or more ACEs and a lower occurrence rate of 0 ACEs. ACEs that predicted reasons for referral were physical or sexual abuse, feeling unwanted or unloved, witnessing abuse of their mother or stepmother, or caretaker substance use.

Conclusions

In this sample, ACE exposure was associated with professionalism issues. Remediating individuals with professionalism issues and exposure to ACEs can be complicated by heightened responses to stressful stimuli, difficulties with collaboration and trust, and decreased self-efficacy. Adoption of a trauma-informed medical education approach may help those that have been impacted by trauma rebuild a sense of control and empowerment. The findings of this study may be useful predictors in identifying those at risk of problematic behavior and recidivism before a sentinel event.
Evidence for Continuing Buprenorphine in the Perioperative Period
Authors: Li Alice H. , Schmiesing Cliff , Aggarwal Anuj K.
Published: June 2020

Objective:

Given there are conflicting recommendations for the perioperative management of buprenorphine, we conducted a retrospective cohort study of our surgery patients on buprenorphine whose baseline dose had been preoperatively continued, tapered, or discontinued.

Materials and Methods:

We reviewed charts of patients on buprenorphine who had received elective surgery at Stanford Healthcare from January 1, 2013 to June 30, 2016. Our primary outcome of interest was the change in pain score, defined as mean postoperative pain score—preoperative pain score. We also collected data on patients’ tapering procedure and any postoperative nonbuprenorphine opioid requirements.

Results:

Out of ∼1200 patients on buprenorphine, 121 had surgery of which 50 were admitted and included in the study. Perioperative continuation of transdermal buprenorphine resulted in a significantly lower change in pain score postoperatively (0.606±0.878) than discontinuation (4.83±1.23, P=0.012). Among sublingual patients, there was no statistically significant difference in the change in pain score between those who were tapered to a nonzero dose versus discontinued (P=0.55). Continuation of sublingual buprenorphine resulted in fewer nonbuprenorphine scheduled opioid prescriptions than its taper or discontinuation (P=0.028). Finally, tapers were performed with great variability in the tapering team and rate of taper.

Discussion:

On the basis of our findings, we implemented a policy at our institution for the continuation of perioperative buprenorphine whenever possible. Our work reveals crucial targets for the education of perioperative healthcare providers and the importance of coordination among all perioperative services and providers.
Using Clinical Simulations to Train Healthcare Professionals to Use Electronic Health Records
Authors: Wilbanks Bryan A. , Aroke Edwin N.
Published: June 2020

Unintended consequences are adverse events directly related to information technology and may result from inappropriate use of electronic health records by healthcare professionals. Electronic health record competency training has historically used didactic lectures with hands-on experience in a live classroom, and this method fails to teach learners proficiency because the sociotechnical factors that are present in real-world settings are excluded. Additionally, on-the-job training to gain competency can impair patient safety because it distracts clinicians from patient care activities. Clinical simulation-based electronic health record training allows learners to acquire technical and nontechnical skills in a safe environment that will not compromise patient safety. The purpose of this literature review was to summarize the current state-of-the-science on the use of clinical simulations to train healthcare professionals to use electronic health records. The benefits of using simulation-based training that incorporates an organization's contextual factors include improvement of interdisciplinary team communication, clinical performance, clinician-patient-technology communication skills, and recognition of patient safety issues. Design considerations for electronic health record training using clinical simulations involve establishing course objectives, identifying outcome measures, establishing content requirements of both the clinical simulation and electronic health record, and providing adequate debriefing.
Integrated Technology Implementation Model
Authors: Schoville Rhonda , Titler Marita G.
Published: June 2020

The Integrated Technology Implementation Model introduced in 2015 highlighted elements that affect the process of integrating technology into healthcare practice and guide the selection of interventions leading the user to adopt. The Integrated Technology Implementation Model provides a conceptual guide for nursing leadership, vendors, and engineers to focus their work on technology adoption. The purpose of this exploratory qualitative study was to examine organizational and individual implementation themes and whether these themes were represented in the Integrated Technology Implementation Model. The study used focus groups and one-on-one interviews. The unit of analysis was the informants focusing on experiences of electronic health record technology implementation, leading to the adoption of a certified, Web-hosted electronic health record enterprise system. The study setting was three Michigan nonprofit long-term care facilities. The population consisted of nursing directors, nurses (RNs and LPNs), and certified nurse aides. The recruitment target was 30 participants, which was attained in the study. The ground theory method approach was used to analyze the data. From the data analysis, it was determined that workflow was not a comprehensive enough concept. The model was enhanced by adding the new work process concept, which is described as the sequence of activities and use of technology to achieve quality care for patients.
ACR–ASTRO Practice Parameter for Communication
Authors: Schechter Naomi R. , Brown Derek W. , Bovi Joseph A. , Dominello Michael M. , Liu Arthur K. , Mattes Malcolm D. , Michalski Jeff M. , Shih Helen A. , Strom Eric , Wilkinson J.B. , Rosenthal Seth A. , Hartford Alan
Published: June 2020

Aim/Objectives/Background:

Timely, accurate, and effective communications are critical to quality in contemporary medical practices. Radiation oncology incorporates the science and technology of complex integrated radiation treatment delivery and the art of managing individual patients. Through written physical and/or electronic reports and direct communication, radiation oncologists convey critical information regarding patient care, services provided, and quality of care. Applicable practice parameters need to be revised periodically regarding medical record documentation for professional and technical components of services delivered.

Methods:

The ACR–ASTRO Practice Parameter for Communication: Radiation Oncology was revised according to the process described on the American College of Radiology (ACR) Web site (“The Process for Developing ACR Practice Parameters and Technical Standards,” www.acr.org/ClinicalResources/Practice-Parametersand-Technical-Standards) by the Committee on Practice Parameters of the ACR Commission on Radiation Oncology in collaboration with the American Society for Radiation Oncology (ASTRO). Both societies then reviewed and approved the document.

Results:

This practice parameter addresses radiation oncology communications in general, including (a) medical record, (b) electronic, and (c) doctor-patient communications, as well as specific documentation for radiation oncology reports such as (a) consultation, (b) clinical treatment management notes (including inpatient communication), (c) treatment (completion) summary, and (d) follow-up visits.

Conclusions:

The radiation oncologist’s participation in the multidisciplinary management of patients is reflected in timely, medically appropriate, and informative communication with the referring physician and other members of the health care team. The ACR–ASTRO Practice Parameter for Communication: Radiation Oncology is an educational tool designed to assist practitioners in providing appropriate communication regarding radiation oncology care for patients.
Interpretation of chronic pain clinical trial outcomes: IMMPACT recommended considerations
Authors: Smith Shannon M. , Dworkin Robert H. , Turk Dennis C. , McDermott Michael P. , Eccleston Christopher , Farrar John T. , Rowbotham Michael C. , Bhagwagar Zubin , Burke Laurie B. , Cowan Penney , Ellenberg Susan S. , Evans Scott R. , Freeman Roy L. , Garrison Louis P. , Iyengar Smriti , Jadad Alejandro , Jensen Mark P. , Junor Roderick , Kamp Cornelia , Katz Nathaniel P. , Kesslak James Patrick , Kopecky Ernest A. , Lissin Dmitri , Markman John D. , Mease Philip J. , O'Connor Alec B. , Patel Kushang V. , Raja Srinivasa N. , Sampaio Cristina , Schoenfeld David , Singh Jasvinder , Steigerwald Ilona , Strand Vibeke , Tive Leslie A. , Tobias Jeffrey , Wasan Ajay D. , Wilson Hilary D.
Published: June 2020

Interpreting randomized clinical trials (RCTs) is crucial to making decisions regarding the use of analgesic treatments in clinical practice. In this article, we report on an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, the purpose of which was to recommend approaches that facilitate interpretation of analgesic RCTs. We review issues to consider when drawing conclusions from RCTs, as well as common methods for reporting RCT results and the limitations of each method. These issues include the type of trial, study design, statistical analysis methods, magnitude of the estimated beneficial and harmful effects and associated precision, availability of alternative treatments and their benefit–risk profile, clinical importance of the change from baseline both within and between groups, presentation of the outcome data, and the limitations of the approaches used.
Preemptive light sedation in intensive care unit may reduce pulmonary complications in geriatrics receiving pancreaticoduodenectomy
Authors: Chen Tien-Hua , Su Cheng-Hsi , Hsiao Chen-Yuan , Kao Shih-Yi , Tsai Pei-Jiun
Published: June 2020

Background:

Patients undergoing pancreaticoduodenectomy (PD) for periampullary lesions are usually elderly with a high risk of postoperative morbidity and mortality. This retrospective cohort study investigated whether postoperative preemptive light sedation aids in recovery of elderly patients following PD.

Methods:

Ninety-nine geriatric patients undergoing PD at one hospital were enrolled from 2009 to 2018. Patients in the sedation group received mechanical ventilation support and preemptively light sedation with fentanyl and propofol or dexmedetomidine in the first 5 days postoperatively in the intensive care unit (ICU). Patients in the control group underwent early extubation and received morphine for pain control but no postoperative sedatives in the ordinary ward. Patients in the two groups were matched 1:1 using propensity scoring. The postoperative complication rate, surgical mortality, and postoperative hospital length of stay (LOS) were recorded. We also tested inflammation in an immortal human bronchial epithelial cell line.

Results:

After 1:1 matching, 40 patients in the sedation group were compared with 40 patients in the control group. The sedation group had a significantly lower pulmonary complication rate and fewer patients with postoperative gastroparesis. Both groups had similar postoperative hospital LOS and identical surgical mortality rates. Patients in the sedation group had significantly better postoperative quality of life, including less pain and less heartbeat variation. In vitro cell experiments supported the above clinical observations, showing that adequate use of sedatives could significantly elevate the cell viability rate, protect cells from damage, decrease interleukin-6 production, and reduce inflammation.

Conclusion:

Postoperative preemptive light sedation in the ICU in geriatric patients following PD may not only reduce the rates of postoperative pulmonary complications and gastroparesis but also improve postoperative quality of life without prolonging the postoperative hospital LOS.
Smartphone-based diabetic macula edema screening with an offline artificial intelligence
Authors: Hwang De-Kuang , Yu Wei-Kuang , Lin Tai-Chi , Chou Shih-Jie , Yarmishyn Aliaksandr , Kao Zih-Kai , Kao Chung-Lan , Yang Yi-Ping , Chen Shih-Jen , Hsu Chih-Chien , Jheng Ying-Chun
Published: June 2020

Background:

Diabetic macular edema (DME) is a sight-threatening condition that needs regular examinations and remedies. Optical coherence tomography (OCT) is the most common used examination to evaluate the structure and thickness of the macula, but the software in the OCT machine does not tell the clinicians whether DME exists directly. Recently, artificial intelligence (AI) is expected to aid in diagnosis generation and therapy selection. We thus develop a smartphone-based offline AI system that provides diagnostic suggestions and medical strategies through analyzing OCT images from diabetic patients at the risk of developing DME.

Methods:

DME patients receiving treatments in 2017 at Taipei Veterans General Hospital were included in this study. We retrospectively collected the OCT images of these patients from January 2008 to July 2018. We established the AI model based on MobileNet architecture to classify the OCT images conditions. The confusion matrix has been applied to present the performance of the trained AI model.

Results:

Based on the convolutional neural network with the MobileNet model, our AI system achieved a high DME diagnostic accuracy of 90.02%, which is comparable to other AI systems such as InceptionV3 and VGG16. We further developed a mobile-application based on this AI model available at https://aicl.ddns.net/DME.apk.

Conclusion:

We successful integrated an AI model into the mobile device to provide an offline method to provide the diagnosis for quickly screening the risk of developing DME. With the offline property, our model could help those nonophthalmological healthcare providers in offshore islands or underdeveloped countries.
Emerging trends in gene-modified-based chimeric antigen receptor–engineered T-cellular therapy for malignant tumors: The lesson from leukemia to pediatric brain tumors
Authors: Lin Wen-Ying , Chen Yi-Wei , Lin Chun-Fu , Yang Yi-Ping , Wang Mong-Lien , Hung Kai-Feng , Huang Pin-I , Lee Yi-Yen , Chiou Shih-Hwa
Published: June 2020

In 2017 and 2018, Food and Drug Administration has approved YESCARTA (axicabtagene ciloleucel) and KYMRIAH (tisagenlecleucel), two chimeric antigen receptor (CAR)-engineered T-cell products, for B-cell malignancies. It also marked a watershed moment in the development of immunotherapies for cancer. Despite the successes in adults, it remains clinically applicable only in B-cell acute lymphoblastic leukemia in pediatrics. Notably, multiple clinical trials and recent case reports about childhood central nervous system (CNS) tumors, the leading cause of deaths in children, have emerged and granted promising results. With the growing consideration of the biological responses in the interaction of human immunity, the major technical obstacles such as on-target off-tumor toxicity in widespread solid tumors, antigenic heterogeneity, adaptive resistance, difficult T-cell (CD4/CD8) trafficking, and immunosuppressive environments in CNS are gradually approached and ameliorated. The new spotlights of this review are focusing on current development, and emerging treatments for pediatric CNS tumors integrating molecular research with the mainstream of CAR-T therapeutic strategies to sketch a main axis and pathway forward in the improvement of novel gene-modified–based cellular platform.
Overview of coronavirus disease 2019: Treatment updates and advances
Authors: Luo Yung-Hung , Chiu Hwa-Yen , Weng Chia-Sui , Chen Yuh-Min
Published: June 2020

In late December 2019, several cases of pneumonia with unknown cause were reported in Wuhan, China, and this new type of pneumonia spread rapidly to across provinces during the subsequent weeks. The pathogen was identified quickly and was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infectious disease caused by this virus is referred to as coronavirus disease 2019 (COVID-19). Within months, it has caused a global pandemic and posed a major threat to public health worldwide. As of May 23, 2020, 5 252 452 patients have been confirmed to have the disease, and 339 026 deaths have been reported. Multiple therapeutic trials are ongoing, and some promising results have been released. A vaccine would provide the most effective approach to fight the virus by preventing infection, but none are currently available. To control the COVID-19 outbreak, large-scale measures have been applied to reduce human-to-human transmission of SARS-CoV-2. Susceptible populations, including older adults, children, and healthcare providers, warrant particular attention to avoid transmission and infection. This review introduces current understanding of SARS-CoV-2 infection and treatment strategies, emphasizing the relevant challenges associated with prevention, diagnosis, and management.
A novelty route for smartphone-based artificial intelligence approach to ophthalmic screening
Authors: Jheng Ying-Chun , Chou Yu-Bai , Kao Chung-Lan , Yarmishyn Aliaksandr A. , Hsu Chih-Chien , Lin Tai-Chi , Chen Po-Yin , Kao Zih-Kai , Chen Shih-Jen , Hwang De-Kuang
Published: June 2020

Artificial intelligence (AI) has been widely applied in the medical field and achieved enormous milestones in helping specialists to make diagnosis and remedy decisions, particularly in the field of eye diseases and ophthalmic screening. With the development of AI-based systems, the enormous hardware and software resources are required for optimal performance. In reality, there are many places on the planet where such resources are highly limited. Hence, the smartphone-based AI systems can be used to provide a remote control route to quickly screen eye diseases such as diabetic-related retinopathy or diabetic macular edema. However, the performance of such mobile-based AI systems is still uncharted territory. In this article, we discuss the issues of computing resource consumption and performance of the mobile device-based AI systems and highlight recent research on the feasibility and future potential of application of the mobile device-based AI systems in telemedicine.
How to assess the severity of heart failure?
Authors: Kabra Nitin , Cooper Howard A. , Naidu Srihari S.
Published: June 2020

Purpose of review

Mortality rates for acute decompensated heart failure and cardiogenic shock remain unacceptably high despite advances in medical therapy and mechanical circulatory support. Systems designed to quickly and accurately identify and risk stratify these patients are needed in order to improve survival.

Recent findings

The Society for Cardiovascular Angiography and Interventions developed an expert consensus statement aimed at early identification and assessment of patients with advanced heart failure and cardiogenic shock. Recent studies have validated this novel classification system within several large patient cohorts.

Assessing the severity of heart failure is a critical step in enabling the targeting of appropriate therapies to the appropriate patients. A novel classification system allows for accurate and reproducible identification and risk stratification.
Kidney and liver dysfunction in cardiogenic shock
Authors: Lassus Johan
Published: June 2020

Purpose of review

Organ dysfunction is a key feature of cardiogenic shock. Active revascularization and contemporary management in intensive care has improved prognosis in cardiogenic shock, but mortality is still unacceptably high. This review will discuss the prevalence, manifestation, management and clinical impact of kidney and liver dysfunction in cardiogenic shock.

Recent findings

Patients with cardiogenic shock more frequently have several comorbidities that make them at risk of developing multiorgan failure, including renal and liver dysfunction. Kidney and liver injury and dysfunction will markedly increase mortality of patients with cardiogenic shock. Management requires active monitoring of organ function and knowledge of criteria for detection and classification of organ injury. The SOFA score for prediction of mortality in the critically ill incorporates organ injury and can be used also in cardiogenic shock, but risk prediction models specific for cardiogenic shock exist. Biomarkers reflecting different pathways activated in cardiogenic shock correlate with severity of organ dysfunction and may improve risk prediction in cardiogenic shock. Preliminary data suggest that they can even be future treatment targets.

Monitoring renal and hepatic function and identifying injury and dysfunction of these organs is essential for the management and mortality risk assessment of patients in cardiogenic shock.