bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphological and Chromatic Variation in Four Populations of Triatoma mexicana (Hemiptera: Reduviidae)
Authors: Rivas Nancy , Sánchez-Cordero Victor , Camacho Alejandro D , Alejandre-Aguilar Ricardo
Published: September 2020

Triatoma mexicana is an endemic species of Mexico and is distributed in the states of Hidalgo, Queretaro, Guanajuato, and San Luis Potosi, being naturally infected with Trypanosoma cruzi, which increases its importance in the region. The species description was made in 1848, but there are only a few studies on its morphology, biology, and behavior. The present manuscript shows the presence of morphological and chromatic variations among populations of T. mexicana from the states of Hidalgo (Valle del Mezquital and Meztitlan), Guanajuato and Queretaro. The study employed 136 specimens collected in four locations. Scanning electron microscopy was used to study the morphological characteristics of the head, pronotum, and scutellum; also, we measured the width of the abdomen and the total length in the specimens of each population. The morphometric analysis considered 19 variables in the previous structures. Significant differences were found in the dimensions of the head and pronotum, but not in the scutellum; there is clear discrimination among the four proposed populations. The chromatic patterns observed in the connexivum go from yellow to brown and show some significant differences related to geographical origin. The set of evaluated characters showed a higher degree of difference in the population of Guanajuato, clearly separating from the rest of the populations, indicating the possibility of a divergence process. The characteristics observed in the remaining populations could be adaptive responses to their habitat.
Average cometary ion flow pattern in the vicinity of comet 67P from moment data
Authors: Nilsson Hans , Williamson Hayley , Bergman Sofia , Stenberg Wieser Gabriella , Wieser Martin , Behar Etienne , Eriksson Anders I , Johansson Fredrik L , Richter Ingo , Goetz Charlotte
Published: September 2020

Average flow patterns of ions around comet 67P detected by the RPC-ICA instrument onboard Rosetta are presented both as a time series and as a spatial distribution of the average flow in the plane perpendicular to the comet – Sun direction (Y–Z plane in the coordinate systems used). Cometary ions in the energy range up to 60 eV flow radially away from the nucleus in the Y–Z plane, irrespective of the direction of the magnetic field, throughout the mission. These ions may however be strongly affected by the spacecraft potential, the uncertainty due to this is briefly discussed. Inside the solar wind ion cavity and in the periods just before and after, the cometary pick up ions moving antisunward are deflected against the inferred solar wind electric field direction. This is opposite to what is observed for lower levels of mass-loading. These pick up ions are behaving in a similar way to the solar wind ions and are deflected due to mass-loading. A spatial asymmetry can be seen in the observations of deflected pick up ions, with motion against the electric field primarily within a radius of 200 km of the nucleus and also in the negative electric field hemisphere. Cometary ions observed by RPC-ICA typically move in the antisunward direction throughout the mission. These are average patterns, full-resolution data show very much variability.
Daytime optical turbulence profiling with a profiler of the differential solar limb
Authors: Song Tengfei , Cai Zhanchuan , Liu Yu , Zhao Mingyu , Fang Yuliang , Zhang Xuefei , Wang Jingxing , Li Xiaobo , Song Qiwu , Du Zhimao
Published: September 2020

Atmospheric turbulence reduces the image quality and resolution of ground-based optical telescopes. Future large solar telescopes (e.g. the CGST, China Giant Solar Telescope) should be equipped with adaptive optics (AO) systems. The design of AO systems is associated with atmospheric optical turbulence parameters, especially the profile of the refractive index structure $C_{n}^{2}(h)$. With the solar differential image motion monitor (S-DIMM) and the profiler of the moon limb (PML), a simplified version of a PML, termed a profiler of the differential solar limb (PDSL), was built in order to determine the daytime $C_{n}^{2}(h)$ and other atmospheric turbulence parameters. A PDSL with differential solar limb fluctuations was used to determine the turbulence profiling, and the extended solar limb extends the range of separation angles for a higher resolution of the height profile. The PDSL structure and its performance are described. In addition, numerical simulations were conducted to verify the effectiveness of the method. As revealed from the simulation results, the layered integral coefficient matrix is capable of solving the discretization error and enhancing the inversion accuracy of the turbulence contour. The first test results at Mt Wumingshan (a candidate site for the CGST) are presented.
Are the Milky Way and Andromeda unusual? A comparison with Milky Way and Andromeda analogues
Authors: Boardman N , Zasowski G , Newman J A , Andrews B , Fielder C , Bershady M , Brinkmann J , Drory N , Krishnarao D , Lane R R , Mackereth T , Masters K , Stringfellow G S
Published: September 2020

Our Milky Way provides a unique test case for galaxy evolution models because of our privileged position within the Milky Way’s disc. This position also complicates comparisons between the Milky Way and external galaxies, due to our inability to observe the Milky Way from an external point of view. Milky Way analogue galaxies offer us a chance to bridge this divide by providing the external perspective that we otherwise lack. However, overprecise definitions of ‘analogue’ yield little-to-no galaxies, so it is vital to understand which selection criteria produce the most meaningful analogue samples. To address this, we compare the properties of complementary samples of Milky Way analogues selected using different criteria. We find the Milky Way to be within 1σ of its analogues in terms of star formation rate and bulge-to-total ratio in most cases, but we find larger offsets between the Milky Way and its analogues in terms of disc scale length; this suggests that scale length must be included in analogue selections in addition to other criteria if the most accurate analogues are to be selected. We also apply our methodology to the neighbouring Andromeda galaxy. We find analogues selected on the basis of strong morphological features to display much higher star formation rates than Andromeda, and we also find analogues selected on Andromeda’s star formation rate to overpredict Andromeda’s bulge extent. This suggests both structure and star formation rate should be considered when selecting the most stringent Andromeda analogues.
Tracing circumnuclear dense gas in H2O maser galaxies
Authors: Farhan A , Ercan E N , Tombesi F
Published: September 2020

A sample of 30 H$_{2}$O extra-galactic maser galaxies with their published HCN(J = 1 − 0) and HCO + (J = 1 − 0) observations has been compiled to investigate the dense gas correlation with H2O maser emission. Our sample number exceeds the size of the previous HCN samples studied so far by a factor of 3, and it is the first study on the possible relation with the dense gas tracer HCO + . We find a strong correlation between normalized H2O maser emission luminosity (LH2O/LCO) and normalized HCO + line luminosity (LHCO + /LCO). Moreover, a weak correlation has been found between LH2O/LCO and normalized HCN line luminosity (LHCN/LCO). The sample is also studied after excluding Luminous and ultraluminous infrared galaxy (U)LIRG sources, and the mentioned correlations are noticeably stronger. We show that ‘dense gas’ fractions as obtained from HCN and HCO + molecules tightly correlate with maser emission, especially for galaxies with normal IR luminosity (LIR < 1011 L⊙) and we show that HCO + is a better ‘dense gas’ tracer than HCN. Further systematic studies of these dense gas tracers with higher transition level lines are vital to probe megamaser physical conditions and to accurately determining how maser emission interrelates with the dense gas.
Readthrough of stop codons under limiting ABCE1 concentration involves frameshifting and inhibits nonsense-mediated mRNA decay
Authors: Annibaldis Giuditta , Domanski Michal , Dreos René , Contu Lara , Carl Sarah , Kläy Nina , Mühlemann Oliver
Published: September 2020

To gain insight into the mechanistic link between translation termination and nonsense-mediated mRNA decay (NMD), we depleted the ribosome recycling factor ABCE1 in human cells, resulting in an upregulation of NMD-sensitive mRNAs. Suppression of NMD on these mRNAs occurs prior to their SMG6-mediated endonucleolytic cleavage. ABCE1 depletion caused ribosome stalling at termination codons (TCs) and increased ribosome occupancy in 3′ UTRs, implying enhanced TC readthrough. ABCE1 knockdown indeed increased the rate of readthrough and continuation of translation in different reading frames, providing a possible explanation for the observed NMD inhibition, since enhanced readthrough displaces NMD activating proteins from the 3′ UTR. Our results indicate that stalling at TCs triggers ribosome collisions and activates ribosome quality control. Collectively, we show that improper translation termination can lead to readthrough of the TC, presumably due to ribosome collisions pushing the stalled ribosomes into the 3′ UTR, where it can resume translation in-frame as well as out-of-frame.
NuA3 HAT antagonizes the Rpd3S and Rpd3L HDACs to optimize mRNA and lncRNA expression dynamics
Authors: Kim Ji Hyun , Yoon Chae Young , Jun Yukyung , Lee Bo Bae , Lee Ji Eun , Ha So Dam , Woo Hyeonju , Choi Ahyoung , Lee Sanghyuk , Jeong Woojin , Kim Ji Hyung , Kim TaeSoo
Published: September 2020

In yeast, NuA3 histone acetyltransferase (NuA3 HAT) promotes acetylation of histone H3 lysine 14 (H3K14) and transcription of a subset of genes through interaction between the Yng1 plant homeodomain (PHD) finger and H3K4me3. Although NuA3 HAT has multiple chromatin binding modules with distinct specificities, their interdependence and combinatorial actions in chromatin binding and transcription remain unknown. Modified peptide pulldown assays reveal that the Yng1 N-terminal region is important for the integrity of NuA3 HAT by mediating the interaction between core subunits and two methyl-binding proteins, Yng1 and Pdp3. We further uncover that NuA3 HAT contributes to the regulation of mRNA and lncRNA expression dynamics by antagonizing the histone deacetylases (HDACs) Rpd3S and Rpd3L. The Yng1 N-terminal region, the Nto1 PHD finger and Pdp3 are important for optimal induction of mRNA and lncRNA transcription repressed by the Set2-Rpd3S HDAC pathway, whereas the Yng1 PHD finger–H3K4me3 interaction affects transcriptional repression memory regulated by Rpd3L HDAC. These findings suggest that NuA3 HAT uses distinct chromatin readers to compete with two Rpd3-containing HDACs to optimize mRNA and lncRNA expression dynamics.
Electronic Cigarette Liquid Constituents Induce Nasal and Tracheal Sensory Irritation in Mice in Regionally Dependent Fashion
Authors: Ni Fenge , Ogura Tatsuya , Lin Weihong
Published: September 2020

Introduction

Electronic cigarettes (e-cigs) are currently used by millions of adults and adolescents worldwide. Major respiratory symptoms, such as coughing reported by e-cig users, including patients with e-cig, or vaping, product use-associated lung injury (EVALI), indicate e-cig constituent-induced sensory irritation. However, e-cig constituent-induced nociceptive activity in nasal and tracheal respiratory epithelia (RE) and neuronal activation in the trigeminal ganglia and brainstem nuclei, which receive airway chemosensory inputs have not been examined and compared. Comparisons of physiological responses between freebase nicotine and nicotine salts are also missing.

Aims and Methods

Event-related potential (ERP) was recorded electrophysiologically to assess mouse nasal and tracheal RE chemosensory responses to various flavorings, nicotine, including freebase and nicotine salts, e-liquid mixtures, and tussigenic stimuli. Also, mice were subjected to inhalation exposure to aerosol of a vanilla-flavored e-liquid or air (control), and the activated-trigeminal nociceptive neurons and brainstem neurons were examined using immunohistochemistry.

Results

Individual constituents and mixtures of e-liquids, capsaicin, and citric and acetic acids evoked significantly larger ERP in the nose than in the trachea with the exception of menthol. ERP responses to freebase nicotine were significantly larger than protonated nicotine. Four nicotine salts (benzoate, lactate, levulinate, and salicylate) induced similar responses. Compared with air-exposed mice, e-liquid aerosol-exposed mice showed a significant increase in numbers of activated trigeminal nociceptive neurons and brainstem neurons in the spinal trigeminal nucleus, paratrigeminal nucleus, and nucleus tractus solitarius.

Conclusions

E-liquid constituents region-dependently stimulate airway nociceptive chemosensory systems, and freebase nicotine is more potent than protonated nicotine.

Implications

Neural abnormalities have been implicated in the development of nasal and respiratory illnesses. The higher sensitivity of the nasal nociceptive chemosensory system to nicotine and flavorings may indicate a health risk for e-liquid aerosol-induced upper airway illnesses via neurogenic alteration and warrants further investigation.
Unlocking the Legal Deadlock over Dreadlocks in Kenyan Schools: Constitutional Law, Rastafarians, and Religious Freedom
Authors: Sang YK Brian
Published: September 2020

Legal recognition of Rastafari as a religion is a crucial step in enabling its adherents to enjoy the full scope of their religious freedom. This article considers and critiques the legal implications of the High Court of Kenya’s decision in JWM (alias P) v Board of Management O High School. In JWM, the headteacher of a secondary school decided that a Rastafarian girl who wore dreadlocks for religious reasons should be excluded from the school and only be readmitted once she had cut them as her hairstyle breached school rules. The High Court concluded that this was a violation of the student’s right to education and religious freedom. Though welcoming the JWM verdict as legally correct, this article reflects critically on how the Court arrived at its conclusion. It reviews the High Court’s reasoning in JWM and offers a constructive analysis of the likely effect of JWM on Kenyan education institutions and their uniform policies. The article advocates the need for principled, context-sensitive and methodical approaches to adjudicating freedom of religion claims so as to protect the rights of religious believers and secularists alike.
COVID-19 and Public Policy Imperatives: A Trainee Call to Action
Authors: Blum James R. , Feuerbach Alec M. , Fox Jacob A. , Rook Jordan M.
Published: September 2020

The COVID-19 pandemic has exacerbated the flaws in the U.S. employer-based health insurance system, magnified racial disparities in health and health care, and overwhelmed the country’s underfunded public health infrastructure. These are the same systematic failures that have always harmed and killed the nation’s most vulnerable. While everyone wishes for an end to this national tragedy, the authors believe a new normal must be defined for the postpandemic period.

In the postpandemic period, policies that were once labeled radical and impossible will be urgent and necessary. Examples of such policies include providing universal health care, dismantling the structures that propagate racism and injustice, and reinvesting in public health. Previous research by the authors has shown that their medical student colleagues recognize that it is their responsibility to address policies that harm patients and to support reforms at the scale the authors propose. This commitment to a better future is reflected in the widespread mobilization of medical students seen across the United States. Recognizing that the old normal is unsustainable, the authors call on those who previously benefited from the status quo to instead seek a new postpandemic normal that works for all.
Age-Dependent and Seasonal Changes in Menstrual Cycle Length and Body Temperature Based on Big Data
Authors: Tatsumi Takayuki , Sampei Makiko , Saito Kazuki , Honda Yuka , Okazaki Yuka , Arata Naoko , Narumi Kanako , Morisaki Naho , Ishikawa Tomonori , Narumi Satoshi
Published: September 2020

OBJECTIVE:

To evaluate the effects of age and season on menstrual cycle length and basal body temperature (BBT). We also examined the effects of climate on cycle length and BBT, taking into account Japanese geographic and social characteristics.

METHODS:

In this retrospective cohort study, we analyzed data from 6 million menstrual cycles entered into a smartphone application from 310,000 females from 2016 to 2017. Only those who entered more than 10 cycles in 2 years were included. Generalized estimation equations were used to adjust for confounding factors and for within-person correlations of multiple records. Multiple regression analysis was conducted, with age, external average temperature, precipitation amount, and sunshine hours as confounding factors.

RESULTS:

The mean menstrual cycle length increased from age 15–23 years, subsequently decreased up to age 45 years, and then increased again. Average follicular phase body temperature showed no significant age-dependent changes, but luteal phase body temperature gradually increased up to 29 years and then stabilized and started to decrease after age 42 years. A significant association between external temperature and body temperature (follicular and luteal phase) was observed, though menstrual cycle length did not show such an association.

CONCLUSION:

These results, derived from data self-entered into a smartphone application, revealed underrecognized age-dependent and seasonal changes in menstrual cycle length and BBT, which will contribute to a better understanding of female reproductive health in the modern world.
Occupational Exposure to Human Papillomavirus and Vaccination for Health Care Workers
Authors: Harrison Ross , Huh Warner
Published: September 2020

Multiple studies suggest that health care workers treating human papillomavirus (HPV)–associated conditions may experience occupational exposure to the virus. Case reports describe the development of cancer and other disease in health care professionals at low risk for such conditions except for their work. Despite limited data, vaccination can be a safe and effective method to reduce this uncertain risk. We argue that health care workers, including physicians, nurses, and others, who participate in the treatment of HPV-associated disease should consider vaccination.
Immediate Postoperative Pelvic Organ Prolapse Quantification Measures and 2-Year Risk of Prolapse Recurrence
Authors: Siff Lauren N. , Barber Matthew D. , Zyczynski Halina M. , Rardin Charles R. , Jakus-Waldman Sharon , Rahn David D. , Smith Ariana L. , Mazloomdoost Donna , Sridhar Amaanti , Gantz Marie G. ,   for the NICHD Pelvic Floor Disorders Network
Published: September 2020

OBJECTIVE:

To assess whether resting genital hiatus, perineal body, and total vaginal length measured intraoperatively at the conclusion of surgery are associated with prolapse recurrence 2 years after native tissue pelvic organ prolapse reconstruction.

METHODS:

This ancillary analysis of the OPTIMAL (Operations and Pelvic Muscle Training in the Management of Apical Support Loss) trial included women who had an immediate postoperative pelvic organ prolapse quantification (POP-Q) examination and 2-year follow-up. Primary outcome was bothersome bulge symptoms. Secondary outcomes were anatomic failure, surgical failure (either anatomic failure or bothersome bulge symptoms), and sexual function. Descriptive statistics assessed relationships between postprocedure POP-Q measures and these four outcomes. Multivariable models were fit to the data to control for baseline differences in bivariate comparisons. Receiver operating characteristic curves were generated to identify an optimal genital hiatus cut point associated with bothersome bulge, and this threshold was explored.

RESULTS:

This analysis included 368 participants. Bivariate analyses identified age, body mass index, vaginal deliveries, baseline genital hiatus, perineal body, and advanced POP-Q stage (3 or higher vs 2) as clinically relevant variables to include in multivariable models. After adjusting for these variables, the association between immediate postoperative genital hiatus and bothersome bulge (adjusted odds ratio [aOR] 1.4; 95% CI 0.9–2.1) was not significant at the P<.05 level; however, immediate postoperative genital hiatus was associated with anatomic (aOR 1.6; 95% CI 1.1–2.3) and surgical failure (aOR 1.5; 95% CI 1.0–2.1). Immediate postoperative genital hiatus of 3.5 cm was the selected cutoff (area under the curve 0.58, 95% CI 0.50–0.66 from the bothersome bulge model). Women with genital hiatus 3.5 cm or greater were more likely to have anatomic and surgical failures at 2 years. No POP-Q measures were correlated with 2-year sexual function.

CONCLUSION:

A larger immediate postoperative genital hiatus measurement of 3.5 cm or greater is not associated with bothersome bulge symptoms or sexual dysfunction but is associated with anatomic and surgical failures 2 years after native tissue vaginal reconstructive surgery.
Mifepristone Combination Therapy Compared With Misoprostol Monotherapy for the Management of Miscarriage
Authors: Berkley Holly H. , Greene Howard L. , Wittenberger Michael D.
Published: September 2020

OBJECTIVE:

To assess whether mifepristone pretreatment adversely affects the cost of medical management of miscarriage.

METHODS:

Decision tree analyses were constructed, and Monte Carlo simulations were run comparing costs of combination therapy (mifepristone and misoprostol) with monotherapy (misoprostol alone) for medical management of miscarriage in multiple scenarios weighing clinical practice, patient income, and surgical evacuation modalities for failed medical management. Rates of completed medical evacuation for each were obtained from a recent randomized controlled trial.

RESULTS:

In every scenario, combination therapy offered a significant cost advantage over monotherapy. Using a Monte Carlo analysis, cost differences favoring combination therapy ranged from 6.3% to 19.5% in patients making federal minimum wage. The cost savings associated with combination therapy were greatest in scenarios using a staged approach to misoprostol administration and in scenarios using in–operating room dilation and curettage as the only modality for uterine evacuation, a savings of $190.20 (99% CI 189.35–191.07) and $217.85 (99% CI 217.19–218.50) per patient in a low-income wage group, respectively. A smaller difference was seen in scenarios using in-office manual vacuum aspiration to complete medical management failures. As patients' wages increased, the difference in cost between combination therapy and monotherapy increased.

CONCLUSION:

Mifepristone combined with misoprostol is, overall, more cost effective than monotherapy, and therefore cost should not be a deterrent to its adoption in the management of miscarriage.
Cochrane Review Summaries—October 2020
Authors: O’Mathuna Donal , Berghella Vincenzo , Bellussi Federica , Kumar Nimisha , Haas David M.
Published: September 2020

With the current issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we focus on potential interventions to improve pregnancy outcomes for women with recurrent pregnancy loss and antiphospholipid antibodies, the utility of pelvic floor muscle training in the perinatal period to prevent incontinence, and the use of adhesion barriers in gynecologic surgery. The summaries are published below, and the complete references with hyperlinks are listed in Box 1.

Box 1. Abstracts Discussed in This Summary

Hamulyák EN, Scheres LJJ, Marijnen MC, Goddijn M, Middeldorp S. Aspirin or heparin or both for improving pregnancy outcomes in women with persistent antiphospholipid antibodies and recurrent pregnancy loss. The Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD012852. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012852.pub2/full.

Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. The Cochrane Database of Systematic Reviews 2020, Issue 55. Art. No.: CD007471. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007471.pub4/full.

Ahmad G, Kim K, Thompson M, Agarwal P, O'Flynn H, Hindocha A, Watson A. Barrier agents for adhesion prevention after gynaecological surgery. The Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD000475. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000475.pub4/full.
Impact of Body Mass Index on Serum Concentrations of Antidepressants and Antipsychotics
Authors: Warrings Bodo , Samanski Lydia , Deckert Jürgen , Unterecker Stefan , Scherf-Clavel Maike
Published: September 2020

Background:

Rates of overweight and obesity are higher in patients suffering from psychiatric disorders than in the general population. Body composition and enzyme functions are affected by overweight, and consequently, the pharmacokinetics of drugs may vary in overweight patients. Thus, overweight and obesity are important factors in psychiatric disorders and their treatment. This analysis aimed to investigate the impact of body mass index (BMI) on serum concentrations of the antidepressant drugs amitriptyline, doxepin, escitalopram, mirtazapine, and venlafaxine, and the antipsychotic drugs clozapine, quetiapine, and risperidone, taking into account the following confounding parameters: age, sex, and smoking habit.

Methods:

Inpatients and outpatients (N = 1657) who took at least one of the target drugs were included in this retrospective analysis. Serum concentrations of the target drugs and their metabolites were determined at the Department of Psychiatry, Psychosomatics, and Psychotherapy of the University Hospital of Würzburg during routine therapeutic drug monitoring (January 2009–December 2010), which was performed in the morning (trough level) at steady state.

Results:

Dose-corrected serum concentrations (CD) of the active moiety of doxepin and venlafaxine and of O-desmethylvenlafaxine were negatively associated with BMI (partial Pearson correlation, R = −0.267, P = 0.002; R = −0.206, P ≤ 0.001; R = −0.258, P ≤ 0.001), and the CDs were different in normal weight, overweight, and obese patients (analysis of covariance, P = 0.004, P < 0.001, P ≤ 0.001). No association was found between BMI and serum concentrations of amitriptyline, escitalopram, mirtazapine, clozapine, quetiapine, and risperidone.

Conclusions:

In obese patients, higher doses of doxepin and venlafaxine are necessary to achieve similar serum concentrations as in normal weight patients and to avoid treatment-resistant depression.
Developing a COVID-19 emergency airway team
Authors: Mehta Arpan , Aziz Michael F.
Published: September 2020

The COVID-19 disease pandemic has changed the world of medicine as we know it, with inevitable long-standing repercussions. The impact to the anesthesiologist is profound, resulting in modification to multiple areas of practice. With the high contagiousness of the disease from droplets, but also aerosolization being a significant factor, the whole process of airway management carries significant risk to the health care provider. During troubled times, response teams for acute events are often developed. We focus this short piece on the development and implementation of an airway response team for COVID-19 patients.
Physical Function Outcomes in Patients with Lower-Limb Amputations Due to Trauma: A Systematic Review
Authors: Kaur Yuvreet , Cimino Stephanie R. , Albarico Mikhaela , Mayo Amanda L. , Guilcher Sara J.T. , Robinson Lawrence R. , Hanada Ed , Hitzig Sander L.
Published: September 2020

Introduction

Lower-limb amputation (LLA) due to trauma is a life-changing medical event that challenges daily physical functioning. The aim of this systematic review was to summarize the physical function outcomes in patients with major traumatic LLA.

Methods

A literature search was conducted using MEDLINE, EMBASE, CINAHL, and PsycINFO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for the review methodology. Observational studies on physical function outcomes post major traumatic LLA, with sample sizes of at least 10 adults in an outpatient setting and published in English were included. The Downs and Black scale was used to assess methodological quality and articles were assigned a level of evidence.

Results

The initial search retrieved 4626 articles, and 69 met the inclusion criteria. On average, papers had poor methodological quality. The traumatic LLA population was found to have numerous mobility challenges and reduced physical fitness, with unilateral transtibial amputation resulting in the best outcomes. There was a lack of literature on female populations, civilians, and patients from low- and middle-income countries.

Conclusions

Given the changes in mobility and physical health, multidisciplinary care teams are essential to manage traumatic LLA individuals' rehabilitation programs and health. Higher-quality research is needed to support evidence-based clinical recommendations.
Roll-Over Shape–Based Design of Novel Biomimetic Ankle-Foot Prosthesis
Authors: Schlafly Millicent , Reed Kyle B.
Published: September 2020

Introduction

Past research suggests that able-bodied individuals actively control their gait kinematics to produce one invariant roll-over shape (ROS). The ROS is a spatial representation of the center of pressure in a shank-based coordinate system. Because individuals with an amputation do not have adaptive control over their center of pressure during gait, the ankle-foot prosthesis determines the resultant ROS. This study aimed to design the mechanical properties of ankle-foot prostheses to achieve specific ROSs during gait.

Methods

The authors developed a mathematical model that, when used in combination with ground reaction force and shank angle experimental data, predicts the ROS created by the novel Compliant and Articulating Prosthetic Ankle (CAPA) foot. The CAPA consists of four articulating components connected by torsion springs. Able-bodied individuals walked wearing a prosthetic simulator with the solid ankle cushioned heel foot, a dynamic response foot (the Renegade AT), and versions of the CAPA with distinctly different predicted ROSs. The experimental ROS of each trial was presented, and quantitative ROS characteristics were evaluated for statistical significance. Predicted and experimental shapes for each version of the CAPA were compared by computing the distance between the shapes and ROS characteristics. Finally, we evaluated whether our method predicts the same ROS regardless of the experimental data used for the prediction.

Results

Changes to the mechanical properties of the CAPA resulted in statistically significant differences in ROS characteristics, notably forward position, forward length, and orientation (P < 0.05). The mean distance between points on the predicted and experimental ROSs is 1.54% of the length of the CAPA. We demonstrated that experimental ROSs can be predicted using gait data from a different version of the CAPA and a different individual.

Conclusions

This study presents and experimentally validates a method to predict the ROSs created by eight versions of the CAPA during gait. The method enables prosthetists and researchers to design ankle-foot prostheses based on the ROS created during gait.
Network meta-analysis of efficacy and safety of chlorthalidone and hydrochlorothiazide in hypertensive patients
Authors: Dineva Stela , Uzunova Katya , Pavlova Velichka , Filipova Elena , Kalinov Krassimir , Vekov Toni
Published: September 2020

Hypertension is a chronic condition leading to increased stress on the heart and blood vessels, a critical risk factor for clinically significant events such as myocardial infarction heart failure, stroke and death. Chlorthalidone and hydrochlorothiazide are first-line antihypertensive agents for most patients with hypertension. The aim of our meta-analysis was to compare the efficacy and safety of both therapies in patients with hypertension. Searches of electronic databases PubMed, MEDLINE, Scopus, PsycInfo and eLIBRARY.ru, were performed. We used network meta-analysis to combine direct and indirect evidence. Forest plots and closed loops depict estimated results from studies included in our meta-analysis. Of 1289 identified sources, only 37 were included in our meta-analysis. Our analysis has demonstrated a slight superiority for chlorthalidone regarding SBP and not statistically significant differences regarding DBP. Simultaneously, hydrochlorothiazide seems to be a safer choice of therapy, as evidenced by the levels of serum potassium. The two diuretics can be used interchangeably.
Implementing High-Reliability Organization Principles Into Practice: A Rapid Evidence Review
Authors: Veazie Stephanie , Peterson Kim , Bourne Donald , Anderson Johanna , Damschroder Laura , Gunnar William
Published: September 2020

Objective

To promote a safety culture and reduce harm, health care systems are adopting high-reliability organization (HRO) principles. This rapid review synthesizes HRO frameworks, metrics, and implementation effects to help inform health systems’ efforts toward becoming HROs.

Methods

Bibliographic databases were searched from 2010 to 2019. One reviewer used prespecified criteria to assess articles for inclusion, evaluate study quality, extract data, and grade strength of evidence with second reviewer checking.

Results

Twenty-three articles were identified: 8 described frameworks, 9 examined metrics, and 9 evaluated implementation outcomes. Five common strategies for HRO implementation emerged (developing leadership, supporting a culture of safety, providing training and learning, building data systems, and implementing quality improvement interventions). The Joint Commission’s and Institute for Healthcare Improvement’s frameworks emerged as the most comprehensive and widely applicable. The Joint Commission’s Oro 2.0 metric for evaluating HRO progress similarly stood out as it was developed through broad stakeholder input and was validated by external researchers. Multicomponent HRO interventions delivered for at least 2 years were associated with improved process and patient safety outcomes. Because each HRO intervention was only supported by a single poor or fair-quality study—none of which contained a concurrent control group—a causal relationship between any HRO initiative and outcomes could not be established.

Conclusions

Health care system adoption of HRO principles is associated with improved safety outcomes, yet the level of evidence is low. Priorities for future HRO studies include use of concurrent control groups and examination of specific outcomes measurements.
Associations between methamphetamine use and lack of viral suppression among a cohort of HIV-positive persons who inject drugs in Hai Phong, Vietnam
Authors: Feelemyer Jonathan , Arasteh Kamyar , Huong Duong T. , Oanh Khuat T.H. , Khue Pham M. , Giang Hoang T. , Thanh Nham T.T. , Moles Jean Pierre , Vinh Vu H. , Vallo Roselyne , Quillet Catherine , Rapoud Delphine , Le Sao M. , Michel Laurent , Laureillard Didier , Nagot Nicolas , Des Jarlais Don C.
Published: September 2020

Objective:

We assessed the association between methamphetamine use and lack of viral suppression among a cohort of HIV-seropositive persons who inject drugs (PWID) in Hai Phong, Vietnam.

Design:

Cohort study with random effects logit modeling and mediation analysis for antiretroviral therapy (ART) adherence.

Methods:

PWID were recruited from October 2016 to October 2017; HIV-seropositive PWID were enrolled in a cohort to assess HIV viral loads, changes in drug use, risk behaviors, and ART adherence during 24-month follow-up. Methamphetamine use in last 30 days was divided into three categories: 0 days (no use), 1–19 days (intermediate), and 20 or more days (heavy). Bivariate and a multivariable random effects logit models were used to assess the relationship between methamphetamine use and not being virally suppressed. We also assessed self-reported ART adherence as a mediating factor.

Results:

A total of 645 HIV-seropositive PWID were included at baseline; 95% male, average age 40 (SD = 6.4). At baseline, methamphetamine use in last 30 days was 64% no use, 32% intermediate use, 4% heavy use. Approximately 74% of PWID reported high/complete adherence; 76% were at viral suppression. In random effects analysis, recent methamphetamine use was associated with not being virally suppressed during follow-up (adjusted odds ratio: 1.84, 95% confidence interval: 1.06, 3.17); the effect was not explained by a mediating effect of self-reported adherence to ART.

Conclusion:

Recent methamphetamine use is associated with not being virally suppressed among PWID. The results of this study indicate the need for targeted interventions for methamphetamine use with special focus on those with HIV infection.
Mechanistic differences underlying HIV latency in the gut and blood contribute to differential responses to latency-reversing agents
Authors: Telwatte Sushama , Kim Peggy , Chen Tsui-Hua , Milush Jeffrey M. , Somsouk Ma , Deeks Steven G. , Hunt Peter W. , Wong Joseph K. , Yukl Steven A.
Published: September 2020

Objective:

While latently HIV-infected cells have been described in the blood, it is unclear whether a similar inducible reservoir exists in the gut, where most HIV-infected cells reside. Tissue-specific environments may contribute to differences in the mechanisms that govern latent HIV infection and amenability to reactivation. We sought to determine whether HIV-infected cells from the blood and gut differ in their responses to T-cell activation and mechanistically distinct latency reversing agents (LRAs).

Design:

Cross sectional study using samples from HIV-infected individuals (n = 11).

Methods:

Matched peripheral blood mononuclear cells (PBMC) and dissociated total cells from rectum ± ileum were treated ex vivo for 24 h with anti-CD3/CD28 or LRAs in the presence of antiretrovirals. HIV DNA and ‘read-through’, initiated, 5′ elongated, completed, and multiply-spliced HIV transcripts were quantified using droplet digital PCR.

Results:

T-cell activation increased levels of all HIV transcripts in PBMC and gut cells, and was the only treatment that increased multiply-spliced HIV RNA. Disulfiram increased initiated HIV transcripts in PBMC but not gut cells, while ingenol mebutate increased HIV transcription more in gut cells. Romidepsin increased HIV transcription in PBMC and gut cells, but the increase in transcription initiation was greater in PBMC.

Conclusion:

The gut harbors HIV-infected cells in a latent-like state that can be reversed by T-cell activation involving CD3/CD28 signaling. Histone deacetylation and protein kinase B may contribute less to HIV transcriptional initiation in the gut, whereas protein kinase C may contribute more. New LRAs or combinations are needed to induce multiply-spliced HIV and should be tested on both blood and gut.
The Impact of a Comprehensive Simulation-Based Training and Certification Program on Resident Central Venous Catheter Complication Rates
Authors: Day Jonathan , Winchester Zachary B. , Cairns Cassandra A. , Goyal Munish , Kumar Anagha , Bell Jacob , Katz Jared , Fitzgibbons Shimae C.
Published: September 2020

Introduction

Millions of central venous catheters (CVCs) are placed annually in the United States, many by resident physicians. Simulation training has been proposed as a means to increase resident physician competence with CVC placement and decrease the incidence of line-associated mechanical complications. We aimed to evaluate the impact of a novel simulation-based CVC training program for resident physicians on CVC-associated mechanical complication rates. We hypothesized that the CVC-related mechanical complication rates would be lower among simulation-trained residents (STRs) compared with nonsimulation, traditionally trained residents (TTRs).

Methods

A retrospective chart review was performed of patients with a CVC placed by a resident physician between October 2014 and January 2017 at MedStar Georgetown University Hospital in Washington, DC. Incidence of CVC mechanical complications, including pneumothorax, hemothorax, arterial injury, or retained guidewire, were extracted from the electronic medical record and compared between STR and TTR cohorts. In contrast to TTRs who were trained to place CVCs in a supervised clinical setting, STRs underwent a CVC training program using online modules, a hands-on simulation training and testing checklist, and a series of successful supervised insertions before being credentialed to place lines independently.

Results

Nine hundred twenty-four CVCs placed by resident physicians during the study period were analyzed. There was no statistically significant difference in total mechanical complication rates between the STRs and TTRs in this study period (2.4% vs. 2.2%, P = 1). Simulation-trained residents were more likely to use ultrasound guidance when indicated during CVC insertion compared with TTRs (94.8% vs. 70.5%, P < 0.001).

Conclusions

Mechanical complication rates associated with CVC insertion were similar between the simulation and TTRs and were consistent with previously published literature. These findings suggest that residents who underwent simulation training and certification demonstrated performance on par with more experienced TTRs. In addition, they were more likely to use best practices including ultrasound guidance in line placement.
Pelvic Organ Prolapse Severity and Genital Hiatus Size With Long-Term Pessary Use
Authors: Boyd Sarah S. , Subramanian Divya , Propst Katie , O’Sullivan David , Tulikangas Paul
Published: September 2020

Objectives

To evaluate the association between pessary use more than 1 year and change in prolapse severity.

Methods

This is a secondary analysis of a previously published randomized controlled trial of women undergoing office management of pessaries for management of symptomatic pelvic organ prolapse and incontinence. Primary outcome was change in pelvic organ prolapse quantification measurement genital hiatus (GH). Secondary outcomes included change in prolapse stage, type of pessary, size of pessary, number of pessary changes, and duration of use. Baseline data were collected from the earliest documented examination within the hospital record before pessary placement and compared with their final study visit. Demographics were analyzed using descriptive statistics. Student t test and Mann-Whitney tests were used for categorical comparisons. Pearson and Spearman correlation coefficients were used to evaluate change over time.

Results

The cohort was 132 predominantly non-Hispanic White (75%) women with symptomatic prolapse >stage 2 (70.5%). All were postmenopausal. Median duration of pessary use was 39.5 months (interquartile range, 17–64.5 months). Genital hiatus (P = 0.014) and prolapse stage (P = 0.001) decreased as duration of pessary use increased. Those with baseline stages ≥3 had a significant decrease in GH as duration of pessary use increased compared with stages <3 (−0.5 cm vs 0 cm, P < 0.001). There was no difference in change in GH when comparing women with baseline GH less than 3 to 3 cm or greater.

Conclusions

Pessary use by women with pelvic organ prolapse causes a change in vaginal anatomy over time as seen by decreasing stage and point GH.
Early Evidence of Effectiveness of Digital Contact Tracing for SARS-CoV-2 in Switzerland
Authors: Salathé Marcel , Althaus Christian L. , Anderegg Nanina , Antonioli Daniele , Ballauz Tala , Edouard Bugnion , Čapkun Srdjan , Jackson Dennis , Kim Sang-Il , Larus James R. , Low Nicola , Lueks Wouter , Menges Dominik , Moullet Cédric , Payer Mathias , Riou Julien , Stadler Theresa , Troncoso Carmela , Vayena Effy , Wyl Viktor von
Published: September 2020

In the wake of the pandemic of coronavirus disease 2019 (COVID-19), contact tracing has become a key element of strategies to control the spread of severe acute respiratory syndrome coronavirus 2019 (SARS-CoV-2). Given the rapid and intense spread of SARS-CoV-2, digital contact tracing has emerged as a potential complementary tool to support containment and mitigation efforts. Early modelling studies highlighted the potential of digital contact tracing to break transmission chains, and Google and Apple subsequently developed the Exposure Notification (EN) framework, making it available to the vast majority of smartphones. A growing number of governments have launched or announced EN-based contact tracing apps, but their effectiveness remains unknown. Here, we report early findings of the digital contact tracing app deployment in Switzerland. We demonstrate proof-of-principle that digital contact tracing reaches exposed contacts, who then test positive for SARS-CoV-2. This indicates that digital contact tracing is an effective complementary tool for controlling the spread of SARS-CoV-2. Continued technical improvement and international compatibility can further increase the efficacy, particularly also across country borders.
Seasonal and long-term consequences of esca on grapevine stem xylem integrity
Authors: Bortolami G. , Farolfi E. , Badel E. , Burlett R. , Cochard H. , Ferrer N. , King A. , Lamarque L.J. , Lecomte P. , Marchesseau-Marchal M. , Pouzoulet J. , Torres-Ruiz J.M. , Trueba S. , Delzon S. , Gambetta G.A. , Delmas C.E.L.
Published: September 2020

Hydraulic failure has been extensively studied during drought-induced plant dieback, but its role in plant-pathogen interactions is under debate. During esca, a grapevine (Vitis vinifera) disease, symptomatic leaves are prone to irreversible hydraulic dysfunctions but little is known about the hydraulic integrity of perennial organs over the short- and long-term. We investigated the effects of esca on stem hydraulic integrity in naturally infected plants within a single season and across season(s). We coupled direct (ks) and indirect (kth) hydraulic conductivity measurements, and tylose and vascular pathogen detection with in vivo X-ray microtomography visualizations. We found xylem occlusions (tyloses), and subsequent loss of stemks, in all of the shoots with severe symptoms (apoplexy) and in more than 60% of the shoots with moderate symptoms (tiger-stripe), and no tyloses in shoots that were currently asymptomatic. In vivo stem observations demonstrated that tyloses were observed only when leaf symptoms appeared, and resulted in more than 50% PLC in 40% of symptomatic stems, unrelated to symptom age. The impact of esca on xylem integrity was only seasonal and no long-term impact of disease history was recorded. Our study demonstrated how and to what extent a vascular disease such as esca, affecting xylem integrity, could amplify plant mortality by hydraulic failure.

Highlight

Our study reveals that esca can critically affect xylem water movement in grapevine perennial organs, by the presence of plant-derived tyloses.