bluuebunny/crossref_metadata_2025 huggingface dataset:
Semi-analytical orbital dynamics around the primary of a binary asteroid system
Authors: Wang Yue , Fu Tao
Published: May 2020

The orbital dynamics in the vicinity of a binary asteroid system has been studied extensively, motivated by the special dynamical environment and possible exploration missions. Equilibrium points, periodic orbits, and invariant manifolds have been investigated in many studies based on the model of the Restricted Full Three Body Problem (RF3BP). In this paper, a new semi-analytical orbital dynamical model around the primary of a binary system is developed as a perturbed two-body problem. The solution includes the effect of the primary's oblateness and the secondary's third-body gravity. The semi-analytical dynamical model, also denoted as the averaged model, is obtained by using the averaging process and Lagrange planetary equations in terms of the Milankovitch orbital elements. This semi-analytical model enables much faster orbital propagations than the non-averaged counterpart, and is particularly useful in orbital stability analysis and the design of long-term passively stable orbits and orbits with specific performance, e.g. frozen orbits. The applicability of the semi-analytical model is then discussed. Two parameters describing relative magnitudes of both perturbations w.r.t. the primary's point mass gravity and the third parameter related to the orbital period ratio w.r.t. the secondary are defined to provide indicators for the validity of the averaged model. The validity boundaries in terms of the three parameters are given based on numerical simulations, by comparing with the full orbital model. The application to a real binary system, 2003 YT1, has shown that the averaged solution has a high precision in the long-term orbital propagation.
Confronting missing observations with probability weights: Fourier space and generalized formalism
Authors: Bianchi Davide , Verde Licia
Published: May 2020

Due to instrumental limitations, spectroscopic galaxy surveys usually do not collect redshifts for the whole population of potential targets. Especially problematic is the entanglement between this incompleteness and the true cosmological signal, arising from the fact that the proportion of successful observations is typically lower in regions with higher galaxy density. The result is a fictitious suppression of the galaxy clustering that can impact severely on cosmological parameter inference. Recent developments have shown that an unbiased estimate of the two-point correlation in the presence of missing observations can be obtained by weighting each pair by its inverse probability of being targeted. In this work, we expand on the concept of probability weights by developing a more mature statistical formalism, which provides us with a deeper understanding of their fundamental properties. We take advantage of this novel perspective to handle the problem of estimating the inverse probability, specifically, we discuss how to efficiently determine the weights from a finite set of realizations of the targeting and how to model exactly the resulting sampling effects. This allows us to derive an inverse-probability-based power-spectrum estimator, which is the main result of this work, but also to improve robustness and computational efficiency of the already existing configuration-space estimator. Finally, we propose a strategy to further extend the inverse-probability prescription, providing examples of how traditional missing-observation countermeasures can be included in this more general picture. The effectiveness of models and weighting schemes discussed in this work is demonstrated using realizations of an idealized survey strategy.
Asteroseismology of 36Keplersubgiants – II. Determining ages from detailed modelling
Authors: Li Tanda , Bedding Timothy R , Christensen-Dalsgaard Jørgen , Stello Dennis , Li Yaguang , Keen Matthew A
Published: May 2020

Detailed modelling of stellar oscillations is able to give precise estimates for stellar ages, but the inferred results typically depend on the adopted model parameters used for the age inference. High-quality asteroseismic data with precise measurements of mixed modes are available for 36 Kepler subgiants. To obtain a handle on the robustness of the ages for these stars, we first study the dependencies of seismic ages on three model input parameters. We find that inferred ages do not change systematically with the helium fraction (Y) or the mixing-length parameter (αMLT) but depend strongly on the metallicity ([M/H]) of the model. The results indicate that age estimates of subgiants have less model dependence and hence are more reliable than those of main-sequence stars or red giants. We then model individual oscillation frequencies of the same 36 Kepler subgiants, using observed metallicities, and obtain their ages with an average precision of ${\sim}15{{\ \rm per\ cent}}$. The comparison with previous age estimates with different stellar codes or input physics shows good agreement (mostly within 2σ). We hence suggest that seismology-determined ages of subgiants are not greatly model dependent.
Genetically encoded betaxanthin-based small-molecular fluorescent reporter for mammalian cells
Authors: Stücheli Pascal , Sieber Simon , Fuchs David W , Scheller Leo , Strittmatter Tobias , Saxena Pratik , Gademann Karl , Fussenegger Martin
Published: May 2020

We designed and engineered a dye production cassette encoding a heterologous pathway, including human tyrosine hydroxylase and Amanita muscaria 4,5-DOPA dioxygenase, for the biosynthesis of the betaxanthin family of plant and fungal pigments in mammalian cells. The system does not impair cell viability, and can be used as a non-protein reporter system to directly visualize the dynamics of gene expression by profiling absorbance or fluorescence in the supernatant of cell cultures, as well as for fluorescence labeling of individual cells. Pigment profiling can also be multiplexed with reporter proteins such as mCherry or the human model glycoprotein SEAP (secreted alkaline phosphatase). Furthermore, absorbance measurement with a smartphone camera using standard application software enables inexpensive, low-tech reporter quantification.
Modular protein-oligonucleotide signal exchange
Authors: Agrawal Deepak K , Schulman Rebecca
Published: May 2020

While many methods are available to measure the concentrations of proteins in solution, the development of a method to quantitatively report both increases and decreases in different protein concentrations in real-time using changes in the concentrations of other molecules, such as DNA outputs, has remained a challenge. Here, we present a biomolecular reaction process that reports the concentration of an input protein in situ as the concentration of an output DNA oligonucleotide strand. This method uses DNA oligonucleotide aptamers that bind either to a specific protein selectively or to a complementary DNA oligonucleotide reversibly using toehold-mediated DNA strand-displacement. It is possible to choose the sequence of output strand almost independent of the sensing protein. Using this strategy, we implemented four different exchange processes to report the concentrations of clinically relevant human α-thrombin and vascular endothelial growth factor using changes in concentrations of DNA oligonucleotide outputs. These exchange processes can operate in tandem such that the same or different output signals can indicate changes in concentration of distinct or identical input proteins. The simplicity of our approach suggests a pathway to build devices that can direct diverse output responses in response to changes in concentrations of specific proteins.
Translation at first sight: the influence of leading codons
Authors: Osterman Ilya A , Chervontseva Zoe S , Evfratov Sergey A , Sorokina Alena V , Rodin Vladimir A , Rubtsova Maria P , Komarova Ekaterina S , Zatsepin Timofei S , Kabilov Marsel R , Bogdanov Alexey A , Gelfand Mikhail S , Dontsova Olga A , Sergiev Petr V
Published: May 2020

First triplets of mRNA coding region affect the yield of translation. We have applied the flowseq method to analyze >30 000 variants of the codons 2–11 of the fluorescent protein reporter to identify factors affecting the protein synthesis. While the negative influence of mRNA secondary structure on translation has been confirmed, a positive role of rare codons at the beginning of a coding sequence for gene expression has not been observed. The identity of triplets proximal to the start codon contributes more to the protein yield then more distant ones. Additional in-frame start codons enhance translation, while Shine–Dalgarno-like motifs downstream the initiation codon are inhibitory. The metabolic cost of amino acids affects the yield of protein in the poor medium. The most efficient translation was observed for variants with features resembling those of native Escherichia coli genes.
PaCRISPR: a server for predicting and visualizing anti-CRISPR proteins
Authors: Wang Jiawei , Dai Wei , Li Jiahui , Xie Ruopeng , Dunstan Rhys A , Stubenrauch Christopher , Zhang Yanju , Lithgow Trevor
Published: May 2020

Anti-CRISPRs are widespread amongst bacteriophage and promote bacteriophage infection by inactivating the bacterial host's CRISPR–Cas defence system. Identifying and characterizing anti-CRISPR proteins opens an avenue to explore and control CRISPR–Cas machineries for the development of new CRISPR–Cas based biotechnological and therapeutic tools. Past studies have identified anti-CRISPRs in several model phage genomes, but a challenge exists to comprehensively screen for anti-CRISPRs accurately and efficiently from genome and metagenome sequence data. Here, we have developed an ensemble learning based predictor, PaCRISPR, to accurately identify anti-CRISPRs from protein datasets derived from genome and metagenome sequencing projects. PaCRISPR employs different types of feature recognition united within an ensemble framework. Extensive cross-validation and independent tests show that PaCRISPR achieves a significantly more accurate performance compared with homology-based baseline predictors and an existing toolkit. The performance of PaCRISPR was further validated in discovering anti-CRISPRs that were not part of the training for PaCRISPR, but which were recently demonstrated to function as anti-CRISPRs for phage infections. Data visualization on anti-CRISPR relationships, highlighting sequence similarity and phylogenetic considerations, is part of the output from the PaCRISPR toolkit, which is freely available at http://pacrispr.erc.monash.edu/.
GeneMark-EP+: eukaryotic gene prediction with self-training in the space of genes and proteins
Authors: Brůna Tomáš , Lomsadze Alexandre , Borodovsky Mark
Published: May 2020

We have made several steps toward creating a fast and accurate algorithm for gene prediction in eukaryotic genomes. First, we introduced an automated method for efficient ab initio gene finding, GeneMark-ES, with parameters trained in iterative unsupervised mode. Next, in GeneMark-ET we proposed a method of integration of unsupervised training with information on intron positions revealed by mapping short RNA reads. Now we describe GeneMark-EP, a tool that utilizes another source of external information, a protein database, readily available prior to the start of a sequencing project. A new specialized pipeline, ProtHint, initiates massive protein mapping to genome and extracts hints to splice sites and translation start and stop sites of potential genes. GeneMark-EP uses the hints to improve estimation of model parameters as well as to adjust coordinates of predicted genes if they disagree with the most reliable hints (the -EP+ mode). Tests of GeneMark-EP and -EP+ demonstrated improvements in gene prediction accuracy in comparison with GeneMark-ES, while the GeneMark-EP+ showed higher accuracy than GeneMark-ET. We have observed that the most pronounced improvements in gene prediction accuracy happened in large eukaryotic genomes.
Acute kidney injury in patients treated with anti-programmed death receptor-1 for advanced melanoma: a real-life study in a single-centre cohort
Authors: Stein Claire , Burtey Stéphane , Mancini Julien , Pelletier Marion , Sallée Marion , Brunet Philippe , Berbis Philippe , Grob Jean Jacques , Honoré Stéphane , Gaudy Caroline , Jourde-Chiche Noémie
Published: May 2020

Background

Immune checkpoints inhibitors have transformed the prognosis of advanced melanoma but are associated with immune-related adverse events (irAEs). We evaluated the incidence, risk factors and causes of acute kidney injury (AKI) in a monocentric real-life cohort of patients treated with anti-programmed death receptor-1 (anti-PD1) antibodies for advanced melanoma.

Methods

Retrospective collection of medical charts and comprehensive analysis of lab results from patients treated with nivolumab or pembrolizumab for advanced melanoma between 2014 and 2018 was carried out. AKI was defined by Kidney Disease Improving Global Outcomes criteria, and causes were determined by chart review. Overall survival, survival without AKI and impact of AKI on survival were analysed. Risk factors for death and for AKI were identified.

Results

Two hundred and thirty-nine patients were included. Forty-one (17%) had at least one episode of AKI. Independent risk factors for AKI were treatment with renin–angiotensin–aldosterone system inhibitors (RAASi), pre-existing chronic kidney disease (CKD) and cumulated doses of anti-PD1. The main cause of AKI was prerenal, and only eight patients (3.3%) developed acute interstitial nephritis; 8% of patients developed CKD. The median overall survival was 13.4 months and was not affected by AKI. In multivariate analysis, the overall mortality was lower in overweight and obese patients and higher in patients treated with proton-pump inhibitors (PPI) or corticosteroids.

Conclusions

AKI is common in patients treated with anti-PD1 for advanced melanoma but is mostly prerenal and favoured by the use of RAASi; renal irAE is rare. PPI and corticosteroids were associated with poor survival in this population, while overweight/obesity was protective.
Home-Based Outpatient Parenteral Antibiotic Therapy at an Urban Safety Net Hospital: Comparing Outcomes in Persons With and Without Noninjection Drug Use
Authors: Appa Ayesha , Marquez Carina , Jain Vivek
Published: May 2020

As stimulant use and infections among persons using drugs rise nationally, evidence remains limited on how best to deliver outpatient parenteral antimicrobial therapy (OPAT) to persons using noninjection drugs. In an urban safety net population including persons using noninjection drugs, home-based OPAT completion rates were similarly high as those of non-drug-using individuals.
From low-skilled to key workers: the implications of emergencies for immigration policy
Authors: Fernández-Reino Mariña , Sumption Madeleine , Vargas-Silva Carlos
Published: May 2020

The COVID-19 pandemic has increased public awareness of the extent to which the economy relies on a low-wage workforce. Many of those lower-waged occupations that have been recognized as essential in the emergency are heavily dependent on migrant workers. We explore the implications of the COVID-19 pandemic for future immigration policies and provide an example using data for the UK. We suggest that there are three key considerations for governments in this context. First, whether the management of emergencies themselves requires a certain type of immigration policy. Second, whether the experience of the current pandemic brings to light new information about the ‘value’ of certain types of immigration. Finally, whether immigration is the right response to pandemic-driven increases in labour demand.
A numerical light curve model for interaction-powered supernovae
Authors: Takei Yuki , Shigeyama Toshikazu
Published: May 2020

We construct a numerical light curve model for interaction-powered supernovae that arise from an interaction between the ejecta and the circumstellar matter (CSM). In order to resolve the shocked region of an interaction-powered supernova, we solve the fluid equations and radiative transfer equation assuming steady states in the rest frames of the reverse and forward shocks at each time step. Then we numerically solve the radiative transfer equation and the energy equation in the CSM with the radiative flux obtained from the forward shock as a radiation source. We also compare the results of our models with observational data of two supernovae, 2005kj and 2005ip, classified as type IIn, and discuss the validity of our assumptions. We conclude that our model can predict the physical parameters associated with supernova ejecta and the CSM from the observed features of the light curve as long as the CSM is sufficiently dense. Furthermore, we found that the absorption of radiation in the CSM is an important factor in calculating the luminosity.
Strategy, Structure, and the Administration of Complex Geographies
Authors: Whitford Andrew B
Published: May 2020

All countries with complex geographies must extend national power to local areas. Field administration is a primitive in government: it is inevitable in modern national governments, but its variety and impact is rarely discussed in modern public administration. Building on the work of James Fesler and formal results on agenda-setting in organizations, this article demonstrates dilemmas in the use of historically important, widespread mechanisms for designing the field operations of national governments. The experiences of different nation-states provide context for these dilemmas. How governments address these dilemmas shapes policy implementation and the performance of national governments.
The Taiji program: A concise overview
Authors: Luo Ziren , Wang Yan , Wu Yueliang , Hu Wenrui , Jin Gang
Published: May 2020

Taiji is a Chinese space mission to detect gravitational waves in the frequency band 0.1 mHz to 1.0 Hz, which aims at detecting super (intermediate) mass black hole mergers and extreme (intermediate) mass ratio in-spirals. A brief introduction of its mission overview, scientific objectives, and payload design is presented. A roadmap is also given in which the launching time is set to the 2030s.
Chest wall muscle atrophy as a contributory factor for forced vital capacity decline in systemic sclerosis-associated interstitial lung disease
Authors: Nawata Takashi , Shirai Yuichiro , Suzuki Mikito , Kuwana Masataka
Published: May 2020

Objective

To investigate the potential contribution of accessory respiratory muscle atrophy to the decline of forced vital capacity (FVC) in patients with SSc-associated interstitial lung disease (ILD).

Methods

This single-centre, retrospective study enrolled 36 patients with SSc-ILD who underwent serial pulmonary function tests and chest high-resolution CT (HRCT) simultaneously at an interval of 1–3 years. The total extent of ILD and chest wall muscle area at the level of the ninth thoracic vertebra on CT images were evaluated by two independent evaluators blinded to the patient information. Changes in the FVC, ILD extent, and chest wall muscle area between the two measurements were assessed in terms of their correlations. Multiple regression analysis was conducted to identify the independent contributors to FVC decline.

Results

Interval changes in FVC and total ILD extent were variable among patients, whereas chest wall muscle area decreased significantly with time (P=0.0008). The FVC change was negatively correlated with the change in ILD extent (r=−0.48, P=0.003) and was positively correlated with the change in the chest wall muscle area (r = 0.53, P=0.001). Multivariate analysis revealed that changes in total ILD extent and chest wall muscle area were independent contributors to FVC decline.

Conclusion

In patients with SSc-ILD, FVC decline is attributable not only to the progression of ILD but also to the atrophy of accessory respiratory muscles. Our findings call attention to the interpretation of FVC changes in patients with SSc-ILD.
Predictors of Treatment Response to Electroconvulsive Therapy in Schizophrenia—A Nationwide Registry-Based Study
Authors: Stenmark Linnea , Popiolek Katarzyna , Bodén Robert , Brus Ole , Hammar Åsa , Landén Mikael , Lundberg Johan , Nordanskog Pia , Nordenskjöld Axel
Published: May 2020

Introduction

Up to 30% of patients with schizophrenia respond insufficiently to antipsychotic drugs. Electroconvulsive therapy (ECT) has been reported to effectively augment the effects of antipsychotics in some of these patients. To date, there are few established predictors of treatment response to ECT in patients with schizophrenia.

Aims

The primary aim was to determine the response rate to ECT in patients with schizophrenia. The secondary aim was to investigate predictors of treatment response.

Methods

All patients admitted to any Swedish hospital for schizophrenia from 2011 to 2017, who were treated with ECT while in inpatient care, were included in the Swedish National Quality Registry for ECT (Q-ECT), and were assessed using the Clinical Global Impression – Improvement (CGI-I) scale after treatment were included. CGI-I scores of 1 or 2 were considered a response to treatment. Multiple national registries were used to obtain information on demographics and clinical variables.

Results

The study included 285 patients who were concurrently treated with antipsychotic drugs. The response rate to ECT was 73.0%. Among those patients with outcome data, treatment with long-acting injectable antipsychotics was predictive of a better response, whereas comorbid substance use disorders were predictive of a worse response.

Conclusion

This study provides new evidence on predictors of who might respond among patients with schizophrenia treated by ECT. Additional studies of ECT in schizophrenia are needed.
Social Stratification and Choice-Based Policy Programs: The Case of Early Withdrawal of Retirement Savings during the Great Recession
Authors: Kline Zachary D , Pais Jeremy
Published: May 2020

Access to emergency funds during times of need is increasingly dependent on a “choice-based” retirement system in the United States. This study examines the operation of this choice-based retirement system across a socioeconomically stratified population impacted by the Great Recession. Using data from the Panel Study of Income Dynamics collected between 2005 and 2011, we first assess how socioeconomic status shapes access to different types of retirement plans. We then examine the varied pathways that lead to the early withdrawal of retirement savings. The results depict a multistage selection process through which socioeconomic resources structure the process of withdrawal. This occurs first through the availability of retirement funds and the makeup of the retirement portfolio and then through the likelihood of hardship. The results also reveal the importance of education in getting access to retirement savings during a hardship. The general implications for choice-based programs are discussed.
Effects of agomelatine and mirtazapine on sleep disturbances in major depressive disorder: evidence from polysomnographic and resting-state functional connectivity analyses
Authors: Mi Wei-Feng , Tabarak Serik , Wang Li , Zhang Su-Zhen , Lin Xiao , Du Lan-Ting , Liu Zhen , Bao Yan-Ping , Gao Xue-Jiao , Zhang Wei-Hua , Wang Xue-Qin , Fan Teng-Teng , Li Ling-Zhi , Hao Xiao-Nan , Fu Yi , Shi Ying , Guo Li-Hua , Sun Hong-Qiang , Liu Lin , Si Tian-Mei , Zhang Hong-Yan , Lu Lin , Li Su-Xia
Published: May 2020

To investigate effects of agomelatine and mirtazapine on sleep disturbances in patients with major depressive disorder. A total of 30 depressed patients with sleep disturbances, 27 of which completed the study, took agomelatine or mirtazapine for 8 weeks. Subjective scales were administered, and polysomnography was performed at baseline and at the end of week 1 and 8. Functional magnetic resonance imaging was performed at baseline and at the end of week 8. Compared with baseline, scores on the Hamilton Depression Scale, Hamilton Anxiety Scale, Pittsburgh Sleep Quality Index, Sleep Dysfunction Rating Scale, and Insomnia Severity Index after 8 weeks of treatment significantly decreased in both groups, with no significant differences between groups, accompanied by significant increases in total sleep time, sleep efficiency, and rapid eye movement (REM) sleep and significant decrease in wake after sleep onset. Mirtazapine treatment increased N3 sleep at week 1 compared with agomelatine treatment, but this difference disappeared at week 8. The increases in the percentage and duration of N3 sleep were positively correlated with increases in connectivity between right dorsal lateral prefrontal cortex (dlPFC) and right precuneus and between left posterior cingulate cortex and right precuneus in both groups, respectively. Functional connectivity (FC) between right dlPFC and left precuneus in mirtazapine group was higher compared with agomelatine group after 8 weeks of treatment. These findings indicated that both agomelatine and mirtazapine improved sleep in depressed patients, and the effect of mirtazapine was greater than agomelatine with regard to rapidly increasing N3 sleep and gradually improving FC in the brain.
A Richer Community of Botryosphaeriaceae Within a Less Diverse Community of Fungal Endophytes in Grapevines than in Adjacent Forest Trees Revealed by a Mixed Metabarcoding Strategy
Authors: Laurent Benoit , Marchand Marylise , Chancerel Emilie , Saint-Jean Gilles , Capdevielle Xavier , Poeydebat Charlotte , Bellée Anthony , Comont Gwenaëlle , Villate Laure , Desprez-Loustau Marie-Laure
Published: May 2020

Botryosphaeriaceae are a diverse group of endophytic fungi colonizing the inner tissue of many woody species. As opportunist pathogens, they have been increasingly involved in diebacks worldwide. Nonetheless, the diversity of Botryosphaeriaceae, especially in asymptomatic plants, remains largely unknown. Using an innovative and mixed strategy of metabarcoding, this study aims to investigate the diversity of the fungal endophyte community, with a focus on Botryosphaeriaceae, which colonize grapevine and adjacent oak and pine trees in a French landscape. These data were used to test if the differentiation between hosts is more important than geographical effects for shaping the Botryosphaeriaceae communities and whether that similarity is higher between communities of grapevine and oak (both Angiosperms) than between oak and pine trees. We revealed a high level of diversity in Botryosphaeriaceae fungi, in both grapevines and forest trees, with a greater richness for grapevines. Contrasting results were obtained for the endophytic community, which was more diverse in forest trees. Our results support the hypothesis that host factors prevail on geographic effects to explain the diversity of Botryosphaeriaceae at the studied spatial scale. However, the features of the agroecosystem, such as management practices, were suggested to be more important than phylogeny to structure the fungal community. This highlights the importance of management practices for the microbiome of plants.

[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Topography-Driven Shape, Spread, and Retention of Leaf Surface Water Impacts Microbial Dispersion and Activity in the Phyllosphere
Authors: Doan Hung K. , Ngassam Viviane N. , Gilmore Sean F. , Tecon Robin , Parikh Atul N. , Leveau Johan H. J.
Published: May 2020

To study the impact of lateral variation in surface topography on the microbial colonization of plant leaves, we used a two-step casting process to generate topomimetic “replicasts” in polydimethylsiloxane which faithfully resembled leaf surface topography at submicrometer scale. This process revealed that the shape and size of the phyllotelma—the collective body of standing water on a leaf surface—was a function of wetting method and presence of surface features, in particular leaf veins. The use of dyes and fluorescently labeled bacteria showed that these veins, especially on the abaxial side, contributed to the pooling, retention, and lateral spread of water and microorganisms. Bodies of water along veins acted as conduits that allowed bacterial cells to sense chemicals over distances exceeding their body length by four orders of magnitude. Bacterial survival rates under conditions of low relative humidity were twice as high on leaf replicasts as on flat surfaces, suggesting topography-dependent protection from desiccation. Our findings highlight the need for greater quantitative understanding of the impact of leaf surface topography on phyllotelma connectivity and the outcomes of interactions between microorganisms and with their plant host. Such understanding benefits both theory and practice of phyllosphere microbiology in areas such as foliar disease management and food safety of leafy greens.
A Stepping Stone Toward Necessary Change: How the New USMLE Step 1 Scoring System Could Affect the Residency Application Process
Authors: Salari Salomeh , Deng Francis
Published: May 2020

Score reporting for the United States Medical Licensing Examination Step 1 will change from a 3-digit number to pass/fail as soon as January 1, 2022. The shift is meant to prevent residency program directors from using Step 1 scores to select applicants for interviews, a purpose for which the exam was not designed. Using Step 1 scores in this way also has put undue stress on medical students applying to residency. However, the score reporting change represents only one stepping stone toward an improved transition from undergraduate to graduate medical education. To enable a more reliable and holistic review of applicants, residency program directors and medical school administrators must promote other standardized evaluation tools and address the hypercompetitive and frenzied state of the residency application process. For example, medical schools should provide program directors with assessments of students’ fit and readiness for residency that are not burdensome to understand and compare. In addition, residency programs should implement “traffic rules” to improve the interview process for applicants. These changes will significantly mitigate the burden on all stakeholders. As residents who recently experienced this transition, the authors of this Invited Commentary argue that now is the opportune time to redefine selection criteria and reemphasize the characteristics that truly matter in training competent future physicians.
The Conscientious Use of Images Illustrating Diversity in Medical Education Marketing
Authors: Hernandez Rachael , Hoffmann-Longtin Krista , Patrick Shawn , Tucker-Edmonds Brownsyne , Rucker Sydney , Livingston Nikki
Published: May 2020

An institution’s marketing materials are an important part of presenting its culture. In 2018, communication professionals in the Office of Faculty Affairs, Professional Development, and Diversity at the Indiana University School of Medicine recognized after reviewing the literature that using images illustrating diversity in marketing materials may have unintended negative consequences and could potentially reflect poorly on the institution. Representations of diversity that are discordant with the actual demographics of an institution can create distrust among faculty, students, and staff who discover an institution is not as diverse or supportive of diversity as their marketing materials suggest. If institutions adopt an aspirational approach to images and depict more diversity than actual demographics reflect, the authors of this Perspective recommend that they both develop marketing materials that present a widely diverse selection of images and demonstrate transparency in their communication strategies.

To improve their promotional materials, the authors conducted an analysis of their institution’s strategy for selecting images for these materials, identified institutional goals related to the strategic use of images, created training materials for staff, and drafted a public-facing statement about diversity in images. These measures are a significant step forward in cultivating the ethical use of images illustrating diversity. In the future, institutions should highlight their approaches to using images to portray diversity, as well as photograph and document a wide range of events that represent diverse topics and individuals. When these images are used for marketing purposes, it is also important to ensure that they are used in an appropriate context and not selected with the single goal of presenting diversity. Future research should focus on how underrepresented students and faculty interpret the use of diverse images in marketing, as well as their preferences for the use of their own images in marketing materials portraying diversity.
Optimizing Medication Treatment of Opioid Use Disorder During COVID-19 (SARS-CoV-2)
Authors: Leppla Idris E. , Gross Marielle S.
Published: May 2020

The COVID-19 health crisis joined, rather than supplanted, the opioid crisis as the most acutely pressing threats to US public health. In the setting of COVID-19, opioid use disorder treatment paradigms are being disrupted, including the fact that methadone clinics are scrambling to give “take-home” doses where they would typically not. The rapid transition away from in-person examination, dosing and group therapy in an era of social isolation calls for adjustments to clinical practice, including emphasizing patient-provider communication, favoring new inductees on buprenorphine and leveraging technology to optimize safety of medication treatment.
Opioid Use Disorder and COVID-19: Crashing of the Crises
Authors: Khatri Utsha G. , Perrone Jeanmarie
Published: May 2020

The COVID19 crisis has created many additional challenges for patients with opioid use disorder, including those seeking treatment with medications for OUD. Some of these challenges include closure of substance use treatment clinics, focus of emergency departments on COVID-19 patients, social distancing and shelter in place orders affecting mental health, bystander overdose rescue, threats to income and supply of substances for people who use drugs. While the initial changes in regulation allowing buprenorphine prescribing by telehealth are welcomed by providers and patients, many additional innovations are required to ensure that additional vulnerabilities and hurdles created by this pandemic scenario do not further fan the flames of the opioid epidemic.
Normal Wrist Development in Children and Adolescents: A Geometrical Observational Analysis Based on Plain Radiographs
Authors: Sallam Asser A. , Briffa Nikolai , Mahmoud Samer S. , Imam Mohamed A.
Published: May 2020

Background:

To investigate the geometric development of the wrist in relation to the changes in its ossification pattern. This study will help the treating surgeon to identify early deviations from normal in children with musculoskeletal disorders and provide a template for anatomic reduction after trauma scenarios.

Methods:

A retrospective multicenter analysis was carried out of radiographs of 896 children (896 posteroanterior and 896 lateral views) with normal wrists from January 1996 till April 2016. We stratified patients into different yearly age groups; these included 16 age groups from 1 to 16 years, and 2 sex groups: males and females. We evaluated, depending on the wrist ossification pattern, the ulnar variance, radial and carpal heights, carpal height ratio, radial inclination, volar tilt, together with radiocarpal, scapholunate, and capitate-lunate angles and scapholunate distance.

Results:

Our analysis showed that the ulna minus variance predominates in children. Radial height, radial inclination, and radiocarpal angle increase steadily during growth and reach their respective expected values at the beginning of the pubertal growth spurt. The scapholunate and capitolunate angles showed a downward trend with growth till reaching the adult values at puberty. Carpal height increased constantly, whereas the carpal height ratio was similar to that in adults. Volar tilt was not developed until the age of 12 years, when it started to increase gradually to reach the adult values by puberty. Both sexes have similar measurements.

Conclusions:

Most radiologic parameters showed reproducible anatomic changes till the 12-year-old time-point. After that, there are minimal changes till adulthood.

Clinical Relevance:

The study findings offer a template of pediatric normal values guiding hand and pediatric surgeons in treatment of children with wrist pathology.
Three Principles Informing Simulation-Based Continuing Education to Promote Effective Interprofessional Collaboration: Reorganizing, Reframing, and Recontextualizing
Authors: Hopwood Nick , Blomberg Marie , Dahlberg Johanna , Abrandt Dahlgren Madeleine
Published: May 2020

Introduction:

Shoulder dystocia is a complex birth emergency where patient outcomes remain a concern. This article investigates the detailed processes of simulation-based continuing education in a hospital where evidence over 10 years demonstrates improvements in practitioner knowledge, enacted practices, and maternal and child outcomes.

Methods:

Data were collected by video recording teams participating in a shoulder dystocia simulation and debrief. Analysis combined grounded thematic development with purposive coding of enactments of a relevant protocol (the ALSO HELPERR).

Results:

Three themes were identified (three Rs) that capture how effective interprofessional collaboration is promoted through collectively oriented reflection: Reorganizing roles and responsibilities between team members; Reframing the problem of shoulder dystocia from individuals correctly following a protocol, to a team of professionals who need to attune to, respond to, and support one another; and Recontextualizing by collectively “commingling” theoretical knowledge with practical experience to reflect on actions and judgements.

Discussion:

The three Rs are relevant to diverse clinical settings and address gaps in knowledge relating to the process of interprofessional simulation. Together, they constitute a set of principles to inform the design and conduct of continuing education for interprofessional practice through simulation.
Energizing the Conversation
Authors: Sakowski Stacey A. , Feldman Eva L. , Jagsi Reshma , Singer Kanakadurga
Published: May 2020

Gender inequality exists in advanced faculty and leadership positions at academic medical centers; however, despite growing awareness, how to best approach and rectify the issue is unknown. To energize the conversation on gender inequality at one academic medical center, chairs and women faculty were surveyed to identify barriers faced by women navigating their careers. A symposium with short talks to increase awareness, a panel with University leaders to discuss issues and successful strategies to overcome gaps, and focus groups to delve further into key areas that underlie inequity through an active café style format were planned and implemented. This multifaceted approach resulted in a wealth of knowledge. The symposium and panel highlighted important relevant issues and offered personal strategies for successful career advancement, while the focus group discussions further identified barriers and inspired ongoing efforts across departments and novel approaches to overcome three key issues (work-life integration, deliberate promotion of mentor/sponsor relationships, and overcoming unconscious bias) identified through the initial surveys. Compiled data were then disseminated to participants and University leaders to enhance awareness of available programs and prompt action in critical areas lacking support. Overall, the approach indicated that securing support from leaders and the academic community alike are pertinent to emphasize actions needed to overcome issues affecting women in academic medicine. Moreover, bringing leaders and faculty together for an informational session and brainstorming appears to energize the conversation. Such efforts can ultimately instill change and establish an inclusive environment where all members of the academic medicine community can thrive.
Nursing Informatics
Authors: Blažun Vošner Helena , Carter-Templeton Heather , Završnik Jernej , Kokol Peter
Published: May 2020

Computers were introduced into nursing care areas in the early 1950s; however, nursing informatics' historical roots emerged much earlier. Contrary to previous studies, which used manual review of the nursing informatics literature, we employed an automated, electronic approach with specialized software to identify its historical roots. The corpus of nursing informatics literature was harvested from Scopus using “informatic*” in information source titles, abstracts, and keywords, limited to the “subject area = nursing.” The search resulted in 3805 publications containing 57 057 valid references. Fifteen historical sources were identified, the two oldest written by nursing pioneer Florence Nightingale. Other historical roots represent specific foundational and core scholarly works offering insight into the genesis and sustainment of particular bodies of literature in the field of informatics. Our study revealed that the field of nursing informatics has sought to respond to global health concerns and that through intensive development nursing informatics has become an independent research area affecting nursing advancements in general. Additionally, nursing informatics has influenced other disciplines. This study offered an in-depth look at nursing informatics literature, using a systematic approach to identify historical roots and analyze the evolution of topics and themes to gain more information about knowledge development in nursing informatics.
The Prognostic Role of High Blood Cholesterol in Advanced Cancer Patients Treated With Immune Checkpoint Inhibitors
Authors: Perrone Fabiana , Minari Roberta , Bersanelli Melissa , Bordi Paola , Tiseo Marcello , Favari Elda , Sabato Roberto , Buti Sebastiano
Published: May 2020

Immune checkpoint inhibitors (ICI) have improved survival in numerous types of cancer. However, a great number of unselected patients still do not respond to ICI. Moreover, there is a need to identify biomarkers that could predict the prognosis of immunotherapy-treated patients. The aim of our study is to evaluate the prognostic value of baseline plasmatic cholesterol levels in metastatic cancer patients treated with immunotherapy. We retrospectively enrolled advanced cancer patients consecutively treated with ICI at our center between October 2013 and October 2018 to correlate the blood cholesterol level before treatment with overall survival (OS, primary endpoint). The secondary endpoints were the correlation between baseline cholesterol and progression-free survival (PFS), objective response rate, and toxicity (immune-related adverse events). Among 187 patients with availability of baseline plasmatic cholesterol, 58 had cholesterol levels >200 mg/dL. The median age was 70 years. Primary tumors were as follows: non–small cell lung cancer (70.0%), melanoma (15.0%), renal cell carcinoma (9.1%), urothelial cancer (4.6%), head-neck carcinoma (0.9%), and others (0.4%). The median follow-up was 21.3 months. Both OS and PFS were better in patients with high plasmatic cholesterol levels: the median OS was 19.4 versus 5.5 months (P=0.001) and the median PFS was 6.1 versus 2.4 months (P=0.002). The multivariate analysis confirmed the prognostic role of hypercholesterolemia in terms of OS, but not PFS. Hypercholesterolemia was associated with better outcomes in ICI-treated cancer patients and, as an expression of low-grade inflammation state, it could identify tumors more likely to be responsive to immunotherapy.
Factors associated with counseling and postoperative hormone therapy use in surgically menopausal women
Authors: Verrilli Lauren , Brown Heidi , Williams Makeba
Published: May 2020

Objective:

To determine the rates of and factors associated with preoperative counseling about menopausal symptoms and use of hormone therapy postoperatively in surgically menopausal women.

Methods:

This retrospective chart review included patients who underwent bilateral oophorectomies before age 52 at an academic institution during a 3-year period. We used descriptive analyses to characterize the sample and logistic regression to identify factors associated with preoperative counseling about and postoperative systemic hormone therapy for menopausal symptoms.

Results:

This review included 152 patients with a mean age of 44 ± 5 years (range 28-51). The indications for surgery were risk reduction (66%), BRCA positive (35%), and history of breast cancer (38%). One-third of women were not counseled preoperatively about menopausal symptoms. Women with cardiovascular disease and older age were less likely to receive preoperative counseling. Preoperative counseling was positively associated with risk reducing surgery.

Out of 124 women with postoperative data regarding symptoms and treatment, 90 (73%) experienced vasomotor symptoms, 33 (27%) received hormone therapy (systemic or vaginal), 61 (49%) received other therapies, and 41 (33%) did not receive therapy. Younger age and negative history of breast cancer were significantly associated with systemic estrogen therapy use.

Conclusions:

Within our cohort, 66% had no documentation of counseling about menopausal symptoms before surgical menopause. Most women experienced symptoms postoperatively, but less than one-third of symptomatic women received hormone therapy. We have an opportunity to improve anticipatory guidance and informed consent for women undergoing surgical menopause.
Trends of Acute Kidney Injury Requiring Dialysis Among Hospitalized Patients Undergoing Invasive Electrophysiology Procedures
Authors: Wen Yumeng , Hosseini Dehkordi Seyed Hamed , Wei Xin , Lucas Claire Huang , Paranjpe Ishan , Yan Dexi , Gholitabar Farid , Mehta Davendra , Chan Lili , Meisels Ira
Published: May 2020

Electrophysiology (EP) procedures carry the risk of kidney injury due to contrast/hemodynamic fluctuations. We aim to evaluate the national epidemiology of acute kidney injury requiring dialysis (AKI-D) in patients undergoing EP procedures. Using the National Inpatient Sample, we included 2,747,605 adult hospitalizations undergoing invasive diagnostic EP procedures, ablation and implantable device placement from 2006 to 2014. We examined the temporal trend of AKI-D and outcomes associated with AKI-D. The rate of AKI-D increased significantly in both diagnostic/ablation group (8–21/10,000 hospitalizations from 2006 to 2014, P = 0.02) and implanted device group (19–44/10,000 hospitalizations from 2006 to 2014, P < 0.01), but it was explained by temporal changes in demographics and comorbidities. Cardiac resynchronization therapy and pacemaker placement had higher risk of AKI-D compared to implantable cardioverter-defibrillator placement (23 vs. 31 vs. 14/10,000 hospitalizations in cardiac resynchronization therapy, pacemaker placement, and implantable cardioverter-defibrillator group, respectively). Development of AKI-D was associated with significant increase in in-hospital mortality (adjusted odds ratio, 9.6 in diagnostic/ablation group, P < 0.01; adjusted odds ratio, 5.1 in device implantation group, P < 0.01) and with longer length of stay (22.5 vs. 4.5 days in diagnostic/ablation group, 21.1 vs. 5.7 days in implanted device group) and higher cost (282,775 vs. 94,076 USD in diagnostic/ablation group, 295,660 vs. 102,007 USD in implanted device group). The incidence of AKI-D after EP procedures increased over time but largely explained by the change of demographics and comorbidities. This increasing trend, however, was associated with significant increase in resource utilization and in-hospital mortality in these patients.