bluuebunny/crossref_metadata_2025 huggingface dataset:
Telemammography: Technical Advances Improve Patient Access in Breast Care
Authors: Chung Hannah L , Parikh Jay R
Published: January 2020

Screening mammography’s efficacy in reducing breast cancer deaths depends on patient compliance with screening recommendations and the radiologist’s interpretative skills. Reasons for suboptimal screening compliance may be multifactorial, including possible limitations in access. Additionally, while studies show experienced breast radiologists are more accurate in their mammographic interpretation, only a minority of the nation’s mammograms are interpreted by breast imaging specialists. To simultaneously optimize the benefit of early breast cancer detection while minimizing the harms associated with a false positive interpretation, delivery models that help improve access to breast expertise should be considered. Telemammography is one such delivery model that may be underutilized in current practice. While radiologists and other stakeholders of healthcare have accepted teleradiology interpretation of non-mammography studies as routine, telemammography use and acceptance is less well known. In this article, we review the operational components of a telemammography practice in today’s information- and technology-dependent society. Current use of telemammography and remaining potential challenges are discussed. Telemammography can improve healthcare delivery and access by bringing together patients and breast expertise. If accepted, use of telemammography can help meet Centers for Disease Control’s Healthy People 2020 goals related to breast cancer.
Relative Abundance of the Stink Bug (Hemiptera: Pentatomidae) Complex Infesting Rice in the Everglades Agricultural Area of Florida
Authors: VanWeelden Matthew T , Cherry Ronald H , Karounos Michael
Published: January 2020

Florida’s rice stink bug complex comprises three species; Oebalus pugnax (F.), O. insularis (Stal), and O. ypsilongriseus (DeGeer), the latter two of which are invasive and exclusive to Florida within the United States. A series of surveys were conducted in 2017 and 2018 to determine the relative abundance of the three species throughout Florida’s rice growing region within the Everglades Agricultural Area, in addition to comparing their seasonality within crop and noncrop habitats. Sampling occurred in commercial rice fields and adjacent transects of graminaceous noncrop hosts using sweep nets. Oebalus pugnax (52.7%) and O. insularis (61.7%) were the most abundant species in 2017 and 2018, respectively. Both species were more prevalent in rice fields compared to transects of noncrop hosts. Oebalus ypsilongriseus remained in low abundance relative to O. pugnax and O. insularis, and did not differ in numbers collected among rice and noncrop hosts. Of the noncrop hosts in transects, Panicum dichotomiflorum (fall panicum) was the most abundant across both years. This study is the first report of Oebalus species feeding on Echinochloa crus-galli (common barnyardgrass) in Florida. This study shows that the invasive O. insularis continues to increase in abundance, and has surpassed O. pugnax in terms of regional populations. These results emphasize the need for additional studies to assess the interactions among O. insularis and other Oebalus species in addition to its feeding behavior in Florida rice.
Does pain and hip function improve 2 years after reverse periacetabular osteotomy? A follow-up study of 74 patients
Authors: Bræmer Christina Nielsen , Langberg Sarah Ankjær , Jakobsen Stig Storgaard , Jakobsen Søren Reinhold , Aleixo Hugo , Søballe Kjeld , Mechlenburg Inger
Published: January 2020

Data on outcome in patients with acetabular retroversion (AR) treated with reverse periacetabular osteotomy (reverse PAO) are sparse. The aim of the study was to investigate changes in pain and hip function among patients with AR 2 years after reverse PAO and to examine whether changes in pain were associated with changes in hip function. In addition, to evaluate patient satisfaction and changes in quality of life (QoL). We present a prospective follow-up study with patient-reported outcome data from Aarhus University Hospital in Denmark. Pain at rest and during activity was measured with a Visual Analogue Scale (VAS), hip function with the Hip disability and Osteoarthritis Outcome Score (HOOS) and QoL with the Short-Form 36, pre-operatively and 2 years after reverse PAO in 74 patients. Changes were analysed using paired t-test and multiple linear regressions. Significant and clinically relevant mean improvements in pain and hip function were found. The numbers of responders achieving a minimal clinically important difference varied from 51 to 73%. Positive significant association between changes in pain and changes in hip function were found. Significant mean improvement in QoL was found. The study had a loss to follow-up of 23%. Two years after reverse PAO, patients diagnosed with AR showed significant and clinically relevant mean improvements in pain and hip function. Decreased pain was significantly associated with improved hip function. The majority of patients were satisfied with the result of surgery and QoL was similar to the Danish background population.
Usefulness of carbon-11-labeled methionine positron-emission tomography for assessing the treatment response of primary central nervous system lymphoma
Authors: Miyakita Yasuji , Ohno Makoto , Takahashi Masamichi , Kurihara Hiroaki , Katai Hitoshi , Narita Yoshitaka
Published: January 2020

Background

Primary central nervous system lymphoma (PCNSL) responds relatively quickly to chemotherapy or radiotherapy. However, determination of a complete response after treatment is often difficult because of extremely light residual contrast enhancement on magnetic resonance images due to the effects of microhemorrhages and scar tissue formation. These small enhancing lesions define an unconfirmed complete response. The aim of this study was to investigate the usefulness of carbon-11-labeled methionine (11C-Met) positron-emission tomography (PET) for determining the treatment response of PCNSL.

Methods

Data for 36 patients who were treated for PCNSL between 2011 and 2015 and underwent magnetic resonance imaging and 11C-Met PET were reviewed. Magnetic resonance imaging findings were classified as complete response, unconfirmed complete response, and tumor mass (a composite of partial response, stable disease and progressive disease). PET images were evaluated, standardized uptake values were quantified, and the tumor-to-normal tissue count ratio (TNR) was calculated. Receiver operating characteristic curves were generated to determine the optimal cutoff TNRs.

Results

The optimal TNRs for differentiating complete response and unconfirmed complete response from tumor mass were 1.83 (area under the curve, 0.951) and 1.80 (area under the curve, 0.932), respectively. The corresponding sensitivity and specificity values for the diagnosis of tumor mass were 82.4 and 100%, respectively, in the complete response group and 85.3 and 85%, respectively, in the unconfirmed complete response group.

Conclusions

A TNR of ≥1.80 can aid in the detection of active PCNSL using 11C-Met PET. Thus, 11C-Met-PET may be a useful tool for accurate evaluation of the treatment efficacy in PCNSL.
The impact of AGN feedback on galaxy intrinsic alignments in the Horizon simulations
Authors: Soussana Adam , Chisari Nora Elisa , Codis Sandrine , Beckmann Ricarda S , Dubois Yohan , Devriendt Julien , Peirani Sebastien , Laigle Clotilde , Pichon Christophe , Slyz Adrianne
Published: January 2020

The intrinsic correlations of galaxy shapes and orientations across the large-scale structure of the Universe are a known contaminant to weak gravitational lensing. They are known to be dependent on galaxy properties, such as their mass and morphologies. The complex interplay between alignments and the physical processes that drive galaxy evolution remains vastly unexplored. We assess the sensitivity of intrinsic alignments (shapes and angular momenta) to active galactic nuclei (AGN) feedback by comparing galaxy alignment in twin runs of the cosmological hydrodynamical Horizon simulation, which do and do not include AGN feedback, respectively. We measure intrinsic alignments in three dimensions and in projection at $z$ = 0 and $z$ = 1. We find that the projected alignment signal of all galaxies with resolved shapes with respect to the density field in the simulation is robust to AGN feedback, thus giving similar predictions for contamination to weak lensing. The relative alignment of galaxy shapes around galaxy positions is however significantly impacted, especially when considering high-mass ellipsoids. Using a sample of galaxy ‘twins’ across simulations, we determine that AGN changes both the galaxy selection and their actual alignments. Finally, we measure the alignments of angular momenta of galaxies with their nearest filament. Overall, these are more significant in the presence of AGN as a result of the higher abundance of massive pressure-supported galaxies.
The observational anatomy of externally photoevaporating planet-forming discs – I. Atomic carbon
Authors: Haworth Thomas J , Owen James E
Published: January 2020

We demonstrate the utility of C i as a tracer of photoevaporative winds that are being driven from discs by their ambient UV environment. Commonly observed CO lines only trace these winds in relatively weak UV environments and are otherwise dissociated in the wind at the intermediate to high UV fields that most young stars experience. However, C i traces unsubtle kinematic signatures of a wind in intermediate UV environments (∼1000 G0) and can be used to place constraints on the kinematics and temperature of the wind. In C i position–velocity (PV) diagrams external photoevaporation results in velocities that are faster than those from Keplerian rotation alone, as well as emission from quadrants of PV space in which there would be no Keplerian emission. This is independent of viewing angle because the wind has components that are perpendicular to the azimuthal rotation of the disc. At intermediate viewing angles (∼30–60°) moment 1 maps also exhibit a twisted morphology over large scales (unlike other processes that result in twists, which are typically towards the inner disc). C i is readily observable with ALMA, which means that it is now possible to identify and characterize the effect of external photoevaporation on planet-forming discs in intermediate UV environments.
Classification of pulsars with Dirichlet process Gaussian mixture model
Authors: Ay Fahrettin , İnce Gökhan , Kamaşak Mustafa E , Ekşi K Yavuz
Published: January 2020

Young isolated neutron stars (INSs) most commonly manifest themselves as rotationally powered pulsars that involve conventional radio pulsars as well as gamma-ray pulsars and rotating radio transients. Some other young INS families manifest themselves as anomalous X-ray pulsars and soft gamma-ray repeaters that are commonly accepted as magnetars, i.e. magnetically powered neutron stars with decaying super-strong fields. Yet some other young INSs are identified as central compact objects and X-ray dim isolated neutron stars that are cooling objects powered by their thermal energy. Older pulsars, as a result of a previous long episode of accretion from a companion, manifest themselves as millisecond pulsars and more commonly appear in binary systems. We use Dirichlet process Gaussian mixture model (DPGMM), an unsupervised machine learning algorithm, for analysing the distribution of these pulsar families in the parameter space of period and period derivative. We compare the average values of the characteristic age, magnetic dipole field strength, surface temperature, and transverse velocity of all discovered clusters. We verify that DPGMM is robust and provide hints for inferring relations between different classes of pulsars. We discuss the implications of our findings for the magnetothermal spin evolution models and fallback discs.
Differential evolution in 3′UTRs leads to specific gene expression in Staphylococcus
Authors: Menendez-Gil Pilar , Caballero Carlos J , Catalan-Moreno Arancha , Irurzun Naiara , Barrio-Hernandez Inigo , Caldelari Isabelle , Toledo-Arana Alejandro
Published: January 2020

The evolution of gene expression regulation has contributed to species differentiation. The 3′ untranslated regions (3′UTRs) of mRNAs include regulatory elements that modulate gene expression; however, our knowledge of their implications in the divergence of bacterial species is currently limited. In this study, we performed genome-wide comparative analyses of mRNAs encoding orthologous proteins from the genus Staphylococcus and found that mRNA conservation was lost mostly downstream of the coding sequence (CDS), indicating the presence of high sequence diversity in the 3′UTRs of orthologous genes. Transcriptomic mapping of different staphylococcal species confirmed that 3′UTRs were also variable in length. We constructed chimeric mRNAs carrying the 3′UTR of orthologous genes and demonstrated that 3′UTR sequence variations affect protein production. This suggested that species-specific functional 3′UTRs might be specifically selected during evolution. 3′UTR variations may occur through different processes, including gene rearrangements, local nucleotide changes, and the transposition of insertion sequences. By extending the conservation analyses to specific 3′UTRs, as well as the entire set of Escherichia coli and Bacillus subtilis mRNAs, we showed that 3′UTR variability is widespread in bacteria. In summary, our work unveils an evolutionary bias within 3′UTRs that results in species-specific non-coding sequences that may contribute to bacterial diversity.
Secondary nucleotide messenger c-di-GMP exerts a global control on natural product biosynthesis in streptomycetes
Authors: Makitrynskyy Roman , Tsypik Olga , Nuzzo Desirèe , Paululat Thomas , Zechel David L , Bechthold Andreas
Published: January 2020

Cyclic dimeric 3′-5′ guanosine monophosphate, c-di-GMP, is a ubiquitous second messenger controlling diverse cellular processes in bacteria. In streptomycetes, c-di-GMP plays a crucial role in a complex morphological differentiation by modulating an activity of the pleiotropic regulator BldD. Here we report that c-di-GMP plays a key role in regulating secondary metabolite production in streptomycetes by altering the expression levels of bldD. Deletion of cdgB encoding a diguanylate cyclase in Streptomycesghanaensis reduced c-di-GMP levels and the production of the peptidoglycan glycosyltransferase inhibitor moenomycin A. In contrast to the cdgB mutant, inactivation of rmdB, encoding a phosphodiesterase for the c-di-GMP hydrolysis, positively correlated with the c-di-GMP and moenomycin A accumulation. Deletion of bldD adversely affected the synthesis of secondary metabolites in S. ghanaensis, including the production of moenomycin A. The bldD-deficient phenotype is partly mediated by an increase in expression of the pleiotropic regulatory gene wblA. Genetic and biochemical analyses demonstrate that a complex of c-di-GMP and BldD effectively represses transcription of wblA, thus preventing sporogenesis and sustaining antibiotic synthesis. These results show that manipulation of the expression of genes controlling c-di-GMP pool has the potential to improve antibiotic production as well as activate the expression of silent gene clusters.
Ferrimagnetic mPEG-b-PHEP copolymer micelles loaded with iron oxide nanocubes and emodin for enhanced magnetic hyperthermia–chemotherapy
Authors: Song Yonghong , Li Dongdong , Lu Yang , Jiang Kun , Yang Yi , Xu Yunjun , Dong Liang , Yan Xu , Ling Daishun , Yang Xianzhu , Yu Shu-Hong
Published: January 2020

As a non-invasive therapeutic method without penetration-depth limitation, magnetic hyperthermia therapy (MHT) under alternating magnetic field (AMF) is a clinically promising thermal therapy. However, the poor heating conversion efficiency and lack of stimulus–response obstruct the clinical application of magnetofluid-mediated MHT. Here, we develop a ferrimagnetic polyethylene glycol-poly(2-hexoxy-2-oxo-1,3,2-dioxaphospholane) (mPEG-b-PHEP) copolymer micelle loaded with hydrophobic iron oxide nanocubes and emodin (denoted as EMM). Besides an enhanced magnetic resonance (MR) contrast ability (r2 = 271 mM−1 s−1) due to the high magnetization, the specific absorption rate (2518 W/g at 35 kA/m) and intrinsic loss power (6.5 nHm2/kg) of EMM are dozens of times higher than the clinically available iron oxide nanoagents (Feridex and Resovist), indicating the high heating conversion efficiency. Furthermore, this composite micelle with a flowable core exhibits a rapid response to magnetic hyperthermia, leading to an AMF-activated supersensitive drug release. With the high magnetic response, thermal sensitivity and magnetic targeting, this supersensitive ferrimagnetic nanocomposite realizes an above 70% tumor cell killing effect at an extremely low dosage (10 μg Fe/mL), and the tumors on mice are completely eliminated after the combined MHT–chemotherapy.
Recurrent Giant Anterior Cerebral Artery (ACA) Aneurysm With Previous Coiling, Attempted Clipping Then Direct ACA-to-ACA Bypass: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F
Published: January 2020

Giant aneurysms are defined as lesions with a widest diameter of 2.5 cm or greater and account for 2% to 5% of all intracranial aneurysms. These lesions are challenging entities for microsurgical management with techniques such as direct aneurysmal neck clipping, aneurysm neck reconstructions, aneurysmotomy, and aneurysmectomy. This patient had a previously coiled, unruptured, superiorly projecting giant anterior communicating artery (ACom) aneurysm, eccentric toward the left, for which surgical intervention was undertaken. A left orbitozygomatic craniotomy was performed, and a temporary clip was applied to the bilateral proximal A1 segments. Aneurysmotomy was then performed with internal debulking of the aneurysmal thrombus. Aneurysmectomy and removal of the coil mass were performed. Next, the aneurysm neck was reconstructed using multiple surgical clips. After anticipated aneurysm neck reconstruction, indocyanine green (ICG) angiography demonstrated a lack of flow in the ipsilateral A2. The ACom was then transected along the aneurysm neck, and an end-to-end anastomosis of the distal A1 and proximal A2 was performed. Repeat ICG angiography demonstrated patency of the A1-A2 anastomosis. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Comparison of the Efficacy Between Intradiscal Gelified Ethanol (Discogel) Injection and Intradiscal Combination of Pulsed Radiofrequency and Gelified Ethanol (Discogel) Injection for Chronic Discogenic Low Back Pain Treatment. A Randomized Double-Blind Clinical Study
Authors: Papadopoulos Dimitrios , Batistaki Chrysanthi , Kostopanagiotou Georgia
Published: January 2020

Objective

The aim of the present study was to compare two new techniques, intradiscal gelified ethanol injection (Discogel) and the combination of intradiscal pulsed radiofrequency and gelified ethanol injection (PRF+Discogel), regarding their efficacy in discogenic low back pain treatment.

Design

Randomized, double-blind, clinical study.

Methods

The final sample was randomized into group A (N = 18, D) and group B (N = 18, PRF+D). During the procedure, four patients from group B were excluded from the study. Groups A and B were assessed regarding the pain score (VAS 0–10), before the interventional procedures, and one, three, six, and 12 months after. Secondary objectives of the study were to compare the two groups regarding the results of the Roland Morris Disability Questionnaire, Lanss score, and quality of life score (EQ-5D).

Results

There was no significant evidence for an overall difference in pain score between the two groups (analysis of variance, F = 3.24, df = 1, P = 0.084), except for the sixth and 12th months, when group B presented a statistically important difference compared with group A (Wilcoxon test). Group B appeared to be more effective, with a statistically significant difference, compared with group A regarding the secondary objectives of the study.

Conclusions

After rigorous and comprehensive assessment by an independent observer, both Discogel alone and Discogel in combination with pulsed radiofrequency produced tangible improvements in pain, function, quality of life, and consumption of analgesics, which were sustained at 12 months.
Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrospective Clinical Data Analysis
Authors: Sturgeon John A , Sullivan Mark D , Parker-Shames Simon , Tauben David , Coelho Paul
Published: January 2020

Background

There are significant medical risks of long-term opioid therapy (LTOT) for chronic pain. Consequently, there is a need to identify effective interventions for the reduction of high-dose full-agonist opioid medication use.

Methods

The current study details a retrospective review of 240 patients with chronic pain and LTOT presenting for treatment at a specialty opioid refill clinic. Patients first were initiated on an outpatient taper or, if taper was not tolerated, transitioned to buprenorphine. This study analyzes potential predictors of successful tapering, successful buprenorphine transition, or failure to complete either intervention and the effects of this clinical approach on pain intensity scores.

Results

One hundred seven patients (44.6%) successfully tapered their opioid medications under the Centers for Disease Control and Prevention guideline target dose (90 mg morphine-equianalgesic dosage), 45 patients (18.8%) were successfully transitioned to buprenorphine, and 88 patients (36.6%) dropped out of treatment: 11 patients during taper, eight during buprenorphine transition, and 69 before initiating either treatment. Conclusions. Higher initial doses of opioids predicted a higher likelihood of requiring buprenorphine transition, and a co-occurring benzodiazepine or z-drug prescription predicted a greater likelihood of dropout from both interventions. Patterns of change in pain intensity according to treatment were mixed: among successfully tapered patients, 52.8% reported greater pain and 23.6% reported reduced pain, whereas 41.8% reported increased pain intensity and 48.8% reported decreased pain after buprenorphine transition. Further research is needed on predictors of treatment retention and dropout, as well as factors that may mitigate elevated pain scores after reduction of opioid dosing.
Application of biomaterials for the repair and treatment of osteonecrosis of the femoral head
Authors: Zhao Dewei , Ma Zhijie
Published: January 2020

Osteonecrosis of the femoral head (ONFH) is one of the most common causes of hip disability in young adults. However, its cause and pathogenesis remain unclear, and might be caused by a variety of factors. ONFH mainly occurs in young adults. If not treated, 70–80% of patients would progress into femoral head collapse in 3 years, and eventually require hip arthroplasty. Since these patients are younger and more physically active, multiple revision hip arthroplasty might be needed in their life. Repeated revision hip arthroplasty is difficult and risky, and has many complications, which inevitably affects the physical and mental health of patients. To delay the time of total hip arthroplasty for young adult patients with ONFH, biomaterials are used for its repair, which has a high clinical and social value for the retention of the patient’s own hip function. At present, there are many types of biomaterials used in repairing the femoral head, there is no uniform standard of use and the clinical effects are different. In this review, the main biomaterials used in the repair of ONFH are summarized and analyzed, and the prospects are also described.
Information Revealed through the Regulatory Process: Interactions between the SEC and Companies ahead of Their IPO
Authors: Lowry Michelle , Michaely Roni , Volkova Ekaterina
Published: January 2020

We analyze communications between the SEC and firms prior to IPOs using LDA analysis and KL divergence. The SEC’s concerns closely map onto the regulator’s stated mandate: companies increase prospectus disclosures on precise topics of SEC concern. Revenue recognition is the dominant topic of SEC concern, and it is not independently discovered by investors. Increased SEC concern about it is associated with greater secondary sales, lower post-IPO liquidity, lower post-IPO returns, and a higher probability of withdrawal. The regulator’s role during the capital raising process results in increased transparency but contributes to delays in the going public process.
Ultrasound verified enthesophytes are associated with radiographic progression at entheses in psoriatic arthritis
Authors: Lackner Angelika , Heber Daniel , Bosch Philipp , Adelsmayr Gabriel , Duftner Christina , Ficjan Anja , Gretler Judith , Hermann Josef , Husic Rusmir , Graninger Winfried B , Dejaco Christian
Published: January 2020

Objectives

The aim of this prospective study was to examine whether ultrasound or clinical abnormalities at enthesal sites predict radiographic progression at entheses in psoriatic arthritis (PsA).

Methods

Consecutive PsA patients were included and subjected to clinical and ultrasound assessments at 14 entheses at baseline, 6 and 12 months. Radiographs were performed at 0 and 12 months. By US, we investigated structural (erosions, osteophytes) and inflammatory changes [grey scale (0–32) and power Doppler (0–14, range global ultrasound score 0–140)], and radiographs were evaluated for enthesophytes and erosions (score range 0–56). Multivariate regression models were conducted to identify the possible association of clinical and ultrasound findings with radiographic progression.

Results

We examined 83 patients at baseline, of whom 43 (51.8%) had complete clinical, ultrasound and X-ray data. Twenty-four of 43 patients (55.8%) developed radiographic progression of entheses. These patients were younger (49.6 vs 59.3, P =0.005), had shorter disease duration (9.7 vs 17.9 years, P=0.015) and lower clinical disease activity at 6-months [disease activity in psoriatic arthritis (DAPSA) 6.7 vs 17.0, P=0.018] as compared with patients without progression. Non-progressors had higher ultrasound enthesophyte scores at baseline than progressors (20 vs 15, P<0.05). The multivariate regression analysis revealed that 48.6% of the variance of the X-ray score at 12-months follow-up (RegcoeffB = 0.827, P=0.000) could be explained by the baseline US enthesophyte score.

Conclusion

Our data indicate that radiographic progression at entheses is linked with age, disease duration and ultrasound verified enthesophytes at baseline. No other ultrasound parameter predicted radiographic progression at entheses.
Dynamic surface tension of xylem sap lipids
Authors: Yang Jinlong , M Michaud Joseph , Jansen Steven , Schenk H Jochen , Zuo Yi Y
Published: January 2020

The surface tension of xylem sap has been traditionally assumed to be close to that of the pure water because decreasing surface tension is thought to increase vulnerability to air seeding and embolism. However, xylem sap contains insoluble lipid-based surfactants, which also coat vessel and pit membrane surfaces, where gas bubbles can enter xylem under negative pressure in the process known as air seeding. Because of the insolubility of amphiphilic lipids, the surface tension influencing air seeding in pit pores is not the equilibrium surface tension of extracted bulk sap but the local surface tension at gas–liquid interfaces, which depends dynamically on the local concentration of lipids per surface area. To estimate the dynamic surface tension in lipid layers that line surfaces in the xylem apoplast, we studied the time-dependent and surface area-regulated surface tensions of apoplastic lipids extracted from xylem sap of four woody angiosperm plants using constrained drop surfactometry. Xylem lipids were found to demonstrate potent surface activity, with surface tensions reaching an equilibrium at ~25 mN m-1 and varying between a minimum of 19 mN m-1 and a maximum of 68 mN m-1 when changing the surface area between 50 and 160% around the equilibrium surface area. It is concluded that xylem lipid films in natural conditions most likely range from nonequilibrium metastable conditions of a supersaturated compression state to an undersaturated expansion state, depending on the local surface areas of gas–liquid interfaces. Together with findings that maximum pore constrictions in angiosperm pit membranes are much smaller than previously assumed, low dynamic surface tension in xylem turns out to be entirely compatible with the cohesion–tension and air-seeding theories, as well as with the existence of lipid-coated nanobubbles in xylem sap, and with the range of vulnerabilities to embolism observed in plants.
Huanglongbing, Caused by ‘Candidatus Liberibacter asiaticus,’ Detected in New Locations Across Southern and Coastal Georgia
Authors: Oliver Jonathan E. , Ali Md Emran , Waliullah Sumyya , Price Jake , Warren Jessica , Jacobs James , Hoppers Ashley , Evans Richard , Dowdy Michasia , Curry Shane
Published: January 2020

Huanglongbing (HLB) or citrus greening disease is the most devastating disease of citrus worldwide. This disease, caused by the bacterium ‘Candidatus Liberibacter asiaticus’ (CLas), leads to low fruit quality and unproductive trees. In 2008, HLB was found in a residential citrus tree in Savannah, Georgia, and, as a result, the state has been quarantined for this disease since 2009. Nonetheless, little is known about the distribution of CLas within Georgia, even though the commercial planting of citrus in Georgia has increased exponentially in recent years. In 2019, 94 samples from commercial and residential citrus trees within 11 counties in coastal and southern Georgia were collected and tested for the presence of CLas. Molecular testing results revealed the presence of CLas in three counties where HLB had not been previously reported and in 9% of samples overall. This is the first definitive report confirming HLB in southern Georgia counties besides those along the coast.
Phyllachora maydis Ascospore Release and Germination from Overwintered Corn Residue
Authors: Groves Carol L. , Kleczewski Nathan M. , Telenko Darcy E. P. , Chilvers Martin I. , Smith Damon L.
Published: January 2020

Tar spot of corn, caused by Phyllachora maydis, has been reported in several upper Midwest states in the United States. This has led to expanded efforts to more thoroughly understand the biology of P. maydis and the epidemiology of tar spot. This study determined the potential for P. maydis ascospore release and germination from overwintered P. maydis-infected corn residues from various locations in the upper Midwest. Corn residue samples collected in the spring of 2019 from 12 fields in four states were examined. Ascospore release and germination were observed in all residue samples collected. The mean total number of ascospores released per milliliter of water ranged from 3.6 × 103 to 4.8 × 106 after 4-h incubation and 3.7 × 103 to 4.4 × 106 after 24-h incubation. The mean percent spore germination ranged from 0.7 to 24.1% after 4-h incubation and 2.4 to 24.9% after 24-h incubation. There was a significant inverse relationship between total numbers of ascospores released and the percent germination of the ascospores. Samples from Illinois consistently yielded the greatest total ascospore release but were also consistently among the samples with the lowest percent ascospore germination. Samples from Wisconsin and Indiana were among the lowest for total ascospore numbers but were among the highest for total ascospore germination. These findings provide evidence that P. maydis can overwinter in multiple areas of the upper Midwest. Future research should focus on reducing infested corn residue to reduce initial infection by P. maydis.
Think Twice: Effects on Diagnostic Accuracy of Returning to the Case to Reflect Upon the Initial Diagnosis
Authors: Mamede Sílvia , Hautz Wolf E. , Berendonk Christoph , Hautz Stefanie C. , Sauter Thomas C. , Rotgans Jerome , Zwaan Laura , Schmidt Henk G.
Published: January 2020

Purpose

Diagnostic errors have been attributed to failure to sufficiently reflect on initial diagnoses. However, evidence of the benefits of reflection is conflicting. This study examined whether reflection upon initial diagnoses on difficult cases improved diagnostic accuracy and whether reflection triggered by confrontation with case evidence was more beneficial than simply revising initial diagnoses.

Method

Participants were physicians in Bern, Switzerland, registered for the 2018 Swiss internal medicine certification exam. They diagnosed written clinical cases, providing an initial diagnosis by following the same instructions and returning to the case to provide a final diagnosis. The latter required different types of reflection depending on the physician’s experimental condition: return without instructions, identify confirmatory evidence, identify contradictory evidence, or identify both confirmatory and contradictory evidence. The authors examined diagnostic accuracy scores (range 0–1) as a function of diagnostic phase and reflection type.

Results

One hundred and sixty-seven physicians participated. Diagnostic accuracy scores did not significantly differ between the 4 groups of physicians in the initial (I) or the final (F) diagnostic phase (mean [95% CI]: return without instructions, I: 0.21 [0.17, 0.26], F: 0.23 [0.18, 0.28]; confirmatory evidence, I: 0.24 [0.19, 0.29], F: 0.31 [0.25, 0.37]; contradictory evidence, I: 0.22 [0.17, 0.26], F: 0.26 [0.22, 0.30]; confirmatory and contradictory evidence, I: 0.19 [0.15, 0.23], F: 0.25 [0.20, 0.31]). Regardless of type of reflection employed while revising the case, accuracy increased significantly between initial and final diagnosis, I: 0.22 (0.19, 0.24) vs F: 0.26 (0.24, 0.29); P < .001.

Conclusions

Physicians’ diagnostic accuracy improved after reflecting upon initial diagnoses provided for difficult cases, independently of the evidence searched for while reflecting. The findings support the importance attributed to reflection in clinical teaching. Future research should investigate whether revising the case can become more beneficial by triggering additional reflection.
Team-Based Learning Analytics: An Empirical Case Study
Authors: Koh Ying Yun Juliana , Schmidt Henk G. , Low-Beer Naomi , Rotgans Jerome I.
Published: January 2020

Many medical schools that have implemented team-based learning (TBL) have also incorporated an electronic learning architecture, commonly referred to as a learning management system (LMS), to support the instructional process. However, one LMS feature that is often overlooked is the LMS’s ability to record data that can be used for further analysis. In this article, the authors present a case study illustrating how one medical school used data that are routinely collected via the school’s LMS to make informed decisions. The case study started with one instructor’s observation that some teams in one of the undergraduate medical education learning modules appeared to be struggling during one of the team activities; that is, some teams seemed unable to explain or justify their responses to items on the team readiness assurance test (tRAT). Following this observation, the authors conducted 4 analyses. Their analyses demonstrate how LMS-generated and recorded data can be used in a systematic manner to investigate issues in the real educational environment. The first analysis identified a team that performed significantly poorer on the tRAT. A subsequent analysis investigated whether the weaker team’s poorer performance was consistent over a whole module. Findings revealed that the weaker team performed poorer on the majority of the TBL sessions. Further investigation using LMS data showed that the weaker performance was due to the lack of preparation of one individual team member (rather than a collective poor tRAT performance). Using the findings obtained from this case study, the authors hope to convey how LMS data are powerful and may form the basis of evidence-based educational decision making.
Lessons to Learn From Hahnemann University Hospital’s Closure
Authors: Orlowski Janis M. , Thompson Thalia
Published: January 2020

Despite the number of hospital closures over the past decade, the June 2019 announcement of the closing of Hahnemann University Hospital (HUH) in downtown Philadelphia has greatly impacted the academic medicine community. Several factors contributed to the collapse of the hospital; however, the operational approach throughout the period leading up to and during the hospital’s closing left faculty, students, and especially residents with many questions as they scrambled to determine how to continue their careers. This Invited Commentary examines factors that contributed to the crisis following the hospital’s closure, such as the influence of HUH’s ownership history and the complicated landscape of graduate medical education, and discusses the lessons that can be learned from this cataclysmic event. Above all, the academic medicine community must consider lessons learned from HUH’s closure and make a firm commitment to preserve and protect the educational mission of our institutions.
Association Between E-cigarette Use and Depression in US Adults
Authors: Saeed Omar B. , Chavan Bhakti , Haile Zelalem T.
Published: January 2020

Objectives:

Electronic cigarette (e-cigarette) use has recently increased among adults in the United States. Previous studies have identified physical health outcomes associated with e-cigarettes. Few studies have examined the relationship between e-cigarette use and mental health outcomes. This study aimed to investigate the relationship between e-cigarette use and depression.

Methods:

The present cross-sectional study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) in the United States (n = 11918).

Results:

Overall, 3.7% and 11.2% of the participants were current and former e-cigarette users, respectively. A significantly higher proportion of current e-cigarette users reported having depression (32.4%) than former users (27.3%) and non-users (16.0%). In the multivariable model, we found significant interactions between marital status, employment status, marijuana use and e-cigarette use on depression. Compared to people who do not use e-cigarettes, the odds of self-reported depression were higher among unemployed current e-cigarette users (OR = 2.85, 95% CI = 1.63, 4.97) and unemployed former e-cigarette users (OR = 1.89, 95% CI = 1.26, 2.84). Compared to people who do not use marijuana, the odds of self-reported depression were higher among marijuana users who were also current e-cigarette users (OR = 1.68, 95% CI = 1.08, 2.61) and former e-cigarette users (OR = 1.35, 95% CI = 1.07, 1.71). Compared to people who do not use e-cigarettes, the odds of self-reported depression were higher among widowed/divorced/separated participants who were current e-cigarette users (OR = 3.42, 95% CI = 1.60, 7.29) and former e-cigarette users (OR = 1.55, 95% CI = 1.03, 2.34).

Conclusion:

In a representative sample of adults in the United States e-cigarette use is associated with depression, predominantly in widowed/divorced/separated, unemployed and people who use marijuana. This association was independent of potential cofounders.
Avoiding NICU Transfers for Newborns With Neonatal Opioid Withdrawal Syndrome (NOWS): A Quality Improvement Initiative to Manage NOWS on the Mother-baby Unit
Authors: Spence Kimberly , Boedeker Rebecca , Harhausen Mary , Kaushal Gauri , Buchanan Paula , Josephsen Justin
Published: January 2020

Objectives:

To reduce transfers to the neonatal intensive care unit (NICU) for neonates with opioid withdrawal while also reducing length of stay and pharmacologic intervention, and maintaining standards of safety.

Patients and methods:

This was a single-center quality-improvement (QI) initiative in a free-standing maternity hospital comparing outcomes for neonatal opioid withdrawal syndrome (NOWS) before and after a series of QI bundles in infants >36 weeks’ gestation age (GA). We compared outcomes to our preintervention period (January, 2013 to December, 2013; n = 42) with outcomes postintervention cycle 1 (October, 2016 to September, 2017; n = 126), and postintervention cycle 2 (November, 2017 to October, 2018; n = 160). Cycle 1 included organizing a multidisciplinary task force who focused on emphasis on nonpharmacologic and dyad-centered care, and also standardized pharmacologic management. Cycle 2 reflects the transition to a functional assessment tool and as-needed morphine administration on the postpartum floor.

Results:

Transfer to the NICU for management of NOWS dropped from 71.4% before the quality improvement project down to 5.6% (P < 0.001), with the remainder managed on the mother-baby unit. Length of stay decreased from 17.8 days to 7.2 days, and opioid replacement dropped from 60% down to 16% (P < 0.001 for both). There were no adverse events from morphine administration for any of the infants in this series.

Conclusions:

Our study demonstrates how care can be safely provided to most infants with neonatal opioid withdrawal on a postpartum unit without needing transfer to another unit or a higher level of care facility.
Acceptability and Feasibility of a Mobile Health Application for Video Directly Observed Therapy of Buprenorphine for Opioid Use Disorders in an Office-based Setting
Authors: Godersky Margo E. , Klein Jared W. , Merrill Joseph O. , Blalock Kendra L. , Saxon Andrew J. , Samet Jeffrey H. , Tsui Judith I.
Published: January 2020

Introduction/Background:

Video directly observed therapy (video-DOT) through a mobile health platform may improve buprenorphine adherence and decrease diversion. This pilot study tested the acceptability and feasibility of using this technology among patients receiving buprenorphine in an office-based setting.

Methods:

Participants were instructed to record videos of themselves taking buprenorphine. Data were collected from weekly in-person visits over a 4-week period; assessments included self-report of medication adherence, substance use, satisfaction with treatment and use of the application, and also urine drug testing. Open-ended questions at the final visit solicited feedback on patients’ experiences using the mobile health application.

Results:

The sample consisted of 14 patients; a majority were male (86%) and White (79%). All participants except 1 (93%) were able to use the application successfully to upload videos. Among those who successfully used the application, the percentage of daily videos uploaded per participant ranged from 18% to 96%; on average, daily videos were submitted by participants 72% of the time. Most participants (10/14; 71%) reported being “very satisfied” with the application; of the remaining 4 participants, 2 were “satisfied” and 2 were “neutral.” Participants reported liking the accountability and structure of the application provided and its ease of use. Negative feedback included minor discomfort at viewing one's self during recording and the time required.

Conclusions:

Based on these results, use of a mobile health application for video-DOT of buprenorphine appears feasible and acceptable for patients who are treated in an office-based setting. Further research is needed to test whether use of such an application can improve treatment delivery and health outcomes.
Targeting Occipital Headache Pain
Authors: Vanterpool Stephanie G. , Heidel Robert E. , Rejoub Lina R.
Published: January 2020

Background and Objectives:

Occipital nerve block (ONB) is an effective procedure for treating occipital headache pain. However, traditional suboccipital approaches to ONB remain underutilized in acute and chronic settings. An alternative location for ONB is the superior nuchal line, where anatomic studies show a reliable relationship between the occipital artery (OA) and greater occipital nerve. This study evaluated the efficacy and validity of an alternative, single skin insertion, paresthesia-based approach to block both the greater and lesser occipital nerve.

Materials and Methods:

Patients with a clinical diagnosis of occipital headache were included in this study. External landmarks of the cervical spinous process and ipsilateral tragus were used to predict the location of the OA pulse at the superior nuchal line. Alternative ONB technique was used to block both the greater and lesser occipital nerves using single skin insertion and paresthesia confirmation. Demographic data, preprocedure, and postprocedure pain scores were collected, along with the incidence of procedural outcomes, including OA pulse palpation, paresthesia, and postprocedure numbness.

Results:

Data were obtained prospectively from 50 patients. Mean pain scores for the sample decreased by 54.64% postprocedure (P<0.001). Greater occipital nerve paresthesia was confirmed 90.0% on the left (95% confidence interval [CI]: 76.3-97.2) and 90.9% on the right side (95% CI: 78.3-97.5). Postprocedure numbness in greater occipital nerve distribution was reported 80.6% on left (95% CI: 64.0-91.8) and 90% on right (95% CI: 76.3-97.2).

Discussion:

The results suggest that this alternative approach to ONB effectively reduces occipital headache pain and reliably predicts OA pulse and related greater occipital nerve location as confirmed by paresthesia.
Loudness Perception and Dynamic Range Depending on Interphase Gaps of Biphasic Pulses in Cochlear Implants
Authors: Pieper Sabrina H. , Brill Stefan , Bahmer Andreas
Published: January 2020

Objectives:

The human auditory nerve can be electrically stimulated by cochlear implants (CIs) with pulse trains consisting of biphasic pulses with small interphase gaps (IPGs). In animal experiments, lower electrically evoked compound action potential (ECAP) thresholds in implanted animals were found for increasing IPGs (2.1, 10, 20, 30 μs). ECAP thresholds may correlate with loudness thresholds. Therefore, in this study, the IPG effect on loudness and dynamic range was investigated in nine CI subjects.

Design:

A loudness-matching procedure was designed with three different IPGs (2.1, 10, 30 μs) at three different pulse rates (200, 600, 1000 pps). An adaptive loudness-balancing test was performed at the 50% stimulus amplitude level of the dynamic range and most comfortable loudness level (MCL).

Results:

Increasing the IPG or increasing the pulse rate led to a significant decrease in stimulus amplitude for 50% level and MCL in the adaptive test. Because the stimulus amplitudes for 50% level and MCL decreased in a different manner, the calculated upper dynamic range between MCL and 50% level significantly decreased for increasing IPG between 0.24 and 0.38 dB. This decrease in the upper dynamic range was observed for all pulse rates.

Conclusions:

It is possible to reduce the stimulus amplitude level for the same loudness impression using larger IPGs in CIs; however, larger IPGs decrease the dynamic range. These findings could help during the fitting process of CIs to find the balance between saving battery and a proper dynamic range.