bluuebunny/crossref_metadata_2025 huggingface dataset:
Convergent Adaptation in Mitochondria of Phylogenetically Distant Birds: Does it Exist?
Authors: Burskaia Valentina , Artyushin Ilja , Potapova Nadezhda A , Konovalov Kirill , Bazykin Georgii A
Published: May 2021

In a wide range of taxa, proteins encoded by mitochondrial genomes are involved in adaptation to lifestyle that requires oxygen starvation or elevation of metabolism rate. It remains poorly understood to what extent adaptation to similar conditions is associated with parallel changes in these proteins. We search for a genetic signal of parallel or convergent evolution in recurrent molecular adaptation to high altitude, migration, diving, wintering, unusual flight abilities, or loss of flight in mitochondrial genomes of birds. Developing on previous work, we design an approach for the detection of recurrent coincident changes in genotype and phenotype, indicative of an association between the two. We describe a number of candidate sites involved in recurrent adaptation in ND genes. However, we find that the majority of convergence events can be explained by random coincidences without invoking adaptation.
A Longitudinal Investigation Into Marital Quality as a Mediator Linking Childhood Abuse to Affective Symptoms
Authors: Fitzgerald Michael , Berthiaume Kelly
Published: May 2021

Objective

Childhood abuse is positively associated with adult mental health problems and adult interpersonal relationships have been previously suggested to be a mediator. The role of marital partners, however, is less well understood. The current study will investigate marital quality as a mediator linking childhood abuse and positive and negative affective symptoms.

Method

The current study utilized 3 waves of data from the Midlife Development in the United States. Using a sample of 1,104 married adults (95.4% White), structural equation modeling examined the mediating effect of marital quality linking childhood abuse to positive and negative affective symptoms over a 20-year period.

Results

Structural equation modeling revealed that childhood abuse was inversely associated with marital quality but was not directly associated with positive or negative affective symptoms. Marital quality was positively associated with greater positive affect and negatively associated with lower negative affect over a 9-year period, controlling for prior symptoms. Tests of indirect effects indicate that marital quality mediated the relationship between childhood abuse to both positive and negative affective symptoms, fully accounting for the association.

Discussion

It appears that childhood abuse impacts the quality of adults’ marriages, which may have significant implications for both positive and negative aspects of adult mental health. Marriages may be an important factor in understanding mental health in midlife and older adults among adults who were abused. Interventions should target the quality of adult marriages, and focusing on marital support, strain, and disagreement may be particularly effective.
Co-evolutionary game of manufacturers’ abatement behavior under carbon tax-subsidy policy
Authors: Zhang Suyong , Wang Chuanxu , Pardalos Panos M
Published: May 2021

In the context of carbon tax-subsidy policy, our paper develops the models of the tripartite evolutionary game between consumers, manufacturers and local governments and analyzes the impacts of carbon tax-subsidy policy on the strategies of consumers, manufacturers and local governments. Through the construction of replicated dynamic equations, we get the evolutionary stable strategy. Then, the numerical analysis is performed with system dynamics simulation. The results show that (i) the local governments should strengthen the consumers’ awareness of environmental protection through higher financial subsidies, (ii) the taxation intensity coefficient accelerates the dynamic system to evolve into a stable state and (iii) an appropriate punishment by the government accelerates the dynamic system to evolve into a stable state. Our research is expected to provide a reference for local governments to implement effective carbon tax-subsidy policy on manufacturers.
On the 𝔸1-Euler Characteristic of the Variety of Maximal Tori in a Reductive Group
Authors: Ananyevskiy Alexey
Published: May 2021

We show that for a reductive group $G$ over a field $k$ the $\mathbb{A}^1$-Euler characteristic of the variety of maximal tori in $G$ is an invertible element of the Grothendieck–Witt ring ${\textrm{GW}}(k)$, settling the weak form of a conjecture by Fabien Morel. As an application we obtain a generalized splitting principle that allows one to reduce the structure group of a Nisnevich locally trivial $G$-torsor to the normalizer of a maximal torus.
Separation of Three Phenanthrenes and Two Bibenzyls from Chloroform Fractions of Pholidota Articulata Lindl. Using HPLC
Authors: Zhu Xiuying , Yan Hegui , Yang Minghui , Yang Xiaoqiong , He Lu
Published: May 2021

Background

Pholidota articulata Lindl has been used as a traditional medicine and Yi-nationality herbal medicine for the treatment of various diseases. Phenanthrenes and bibenzyls commonly found in the genus Pholidota are one of their most important natural ingredients, due to their various biological activities.

Objective

This study aimed to establish an HPLC method for determination of the levels of three phenenthrenes (flavidin, lusianthridin, coelonin) and two bibenzyls (batatasin III, cirrhopetalidin) in rhizomes of P. articulata Lindl.

Method

The separated and elucidated compounds from chloroform fractions of P. articulata Lindl were used as standards and analyzed by gradient elution HPLC with a variable wavelength detector at 274 nm.

Results

The calibration curves exhibited good linearity (R2 = 0.9999), ranging from 20 to 960 ng/mL, the average recoveries were between 91.5 and 102.9%, and the RSD values of precision, stability, and repeatability were <2.34%. There were significant differences in the content of phenenthrenes and bibenzyls from the plants of genus Pholidota, Dendrobium, and Bulbophyllum. Furthermore, this is the first report on the validation of a method for the quantitative analysis of flavidin and cirrhopetalidin.

Conclusions

The present study provides an alternative method for the rapid separation of phenanthrenes and bibenzyls from natural products and lays a foundation for the study of biological activity.

Highlights

When using developed method in this study for separation of phenanthrenes and bibenzyls in genus Pholidota, chemicalin formation was more abundant from chloroform fractions.
Learning from Tribal Leadership and the Anchor Forest Concept for Implementing Cross-Boundary Forest Management
Authors: Jacobson Meredith A , Hajjar Reem , Davis Emily Jane , Hoagland Serra
Published: May 2021

In response to the increasing scale of wildfire and forest health challenges in the West, the Intertribal Timber Council, a nonprofit consortium of American Indian Tribes and Alaska Native corporations, proposed creating “Anchor Forests,” where a Tribe would convene neighboring landowners to collectively manage the landscape across property boundaries. This concept has sparked conversation but has not been fully implemented. Amid shifts toward both collaborative decision making and Tribal partnerships on federal forestlands, we asked, “why did the Anchor Forest concept emerge, and what can the field of forest governance learn from its development?” Through qualitative analysis of documents and interviews, we show how Anchor Forests could expand spatial-temporal scales of forest management. We highlight how Tribal leadership could overcome past governance barriers through their sovereign authority and long-term forestry expertise and knowledge. We describe how this concept could function as a tool to enact change within rigid forest-management institutions.
Fatal complications after an interrupted gastric bypass operation in a patient with non-alcoholic fatty liver disease and massive obesity: a case report
Authors: Käkelä Pirjo , Rantanen Tuomo , Paajanen Hannu , Virtanen Kirsi A
Published: May 2021

Obesity is closely linked to non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH), the latter now being the most common cause of cirrhosis in Western countries. Only a few cases have been described, such as the unexpected death after interrupted obesity surgery in a patient due to inaccurate preoperative imaging assessment. We describe a 53-year-old male patient with multiple comorbidities partly related to his obesity. A laparoscopic Roux-en-Y gastric bypass (LRYGB) was attempted. During anaesthesia, the patient had a cardiac arrhythmia and a short asystole. Intra-operative findings indicated a giant spleen and, unexpectedly, a cirrhotic liver. The LRYGB operation was interrupted. After 19 months, the patient died due to his severe comorbidities. Preoperative imaging missed the diagnosis of liver cirrhosis and related NASH. Since a challenging liver failure diagnosis cannot only rely on current imaging, we suggest that a liver biopsy is performed prior to LRYGB if preoperative imaging indicates cirrhotic liver.
A rare sporadic pancreatic desmoid fibromatosis with splenic vein invasion diagnosed by CT scan-guided core needle biopsy: a case report with possible differential diagnosis from metastatic colorectal or renal cancer
Authors: Meyer Alberto , Szajnbok Paulo , Koszka Andreas Johann Molnar , Pezzutti Daniela , Segatelli Vanderlei , Monteiro José
Published: May 2021

Desmoid tumor is a rare fibroblastic proliferation with a variable and often unpredictable clinical course that arises in the deep soft tissues and is characterized by infiltrative growth with tendency to local recurrence but not to metastasize. A 49-year-old man was referred for a second opinion regarding a pancreatic mass. With a personal neoplastic background of two different tumors, we considered as a high probability of being metastatic of his previous colorectal or renal cancers, in a peritoneal implant. Due to the unclear origin and nature of the mass, we opted for requesting a computed tomography (CT)-guided core needle biopsy that could eventually lead to a surgical and/or chemotherapy treatment. So far, this is the first case of pancreatic desmoid fibromatosis with splenic vein invasion diagnosed by CT scan-guided core needle biopsy. Surgery should be performed by an experienced surgeon as first-line therapy, provided expected surgical morbidity is limited.
Accurate Quantification of Monoclonal Immunoglobulins Migrating in the Beta Region on Protein Electrophoresis
Authors: Omar Nivin , Madwani Kiran , Moideen Pramila , Manthei David M , Keren David F , Singh Gurmukh
Published: May 2021

Background

The concentration of monoclonal immunoglobulins (Igs) in neoplastic monoclonal gammopathic manifestations is generally measured by densitometric scanning of the monoclonal peaks on gel or by measuring absorbance at 210 nm in capillary electrophoresis (CE). For monoclonal Igs migrating in the beta region, measurement is complicated by the major beta-region proteins, namely, transferrin and C3.

Methods

C3 interference in densitometry was eliminated by heat treatment of serum, and monoclonal Igs were quantified by densitometry of the residual band. The immunochemical measurement of transferrin was converted to its equivalent densitometric quantity. For monoclonal Ig migrating with transferrin, the contribution of the latter was removed by subtracting the converted transferrin concentration from the combined densitometric quantification of the band. With CE, monoclonal Ig was measured by using immunosubtraction (ISUB) to guide demarcation.

Results

The results obtained using the C3 depletion and transferrin subtraction method were lower and yet comparable to the results derived from using CE measurement guided by ISUB. As we expected, the results from both methods were lower than those derived from a perpendicular drop measurement of the peak or via nephelometric assay of the involved isotype.

Discussion

Accurate measurement of monoclonal Igs is important for the diagnosis and monitoring of monoclonal gammopathic manifestations. Determination of serum free light chain concentration per gram of monoclonal Ig is an essential measure for the diagnosis of light chain–predominant multiple myeloma. The method described herein improves accuracy of measurements for monoclonal Igs migrating in the beta region, without the need for special reagents or equipment.
Veterans’ Experiences With Accessing Community Emergency Care
Authors: Nevedal Andrea L , Wong Emily P , Urech Tracy H , Peppiatt Jennifer L , Sorie Michelle R , Vashi Anita A
Published: May 2021

Introduction

Under current regulations, there are three separate authorities for which the Veterans Health Administration (VHA) can pay for emergency medical care received by Veterans in the community. The three VHA authorities have overlapping criteria and eligibility requirements that contribute to a complex and confusing landscape for Veterans when they obtain emergency care in the community. Given the intricacies in how VHA provides coverage for community emergency care and the desire to provide seamless Veteran-centric care, it is imperative to understand Veterans’ experiences with navigating coverage for community emergency care. The purpose of this study was to elicit feedback from Veterans about their experiences with and perceptions of community emergency care coverage paid for by VHA.

Materials and Methods

Veterans Health Administration data were used to identify geographically diverse Veterans who recently used emergency care. We conducted semi-structured, qualitative interviews with 50 Veterans to understand their VHA coverage and experiences with accessing community emergency care. Interviews were audio recorded and transcribed verbatim. We conducted directed content analysis of interview transcripts.

Results

Veterans emphasized three major concerns with navigating community emergency care: (1) they lack information about benefits and eligibility when they need it most, (2) they require assistance with medical billing to avoid financial hardship and future delays in care, and (3) they desire multimodal communication about VHA policies or updates in emergency coverage.

Conclusions

Our results highlight the challenges Veterans experience in understanding VHA coverage for community emergency care. Feedback suggests that improving information, support, and communication may help Veterans make timely, informed decisions when experiencing unexpected illness or injury.
Vestibular Physical Therapy Treatment of Individuals Exposed to Directed Energy
Authors: Hoppes Carrie W , Lambert Karen H , Klatt Brooke N , Harvard Orlando D , Whitney Susan L
Published: May 2021

Introduction

Following suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. Directed energy has been described as exposure to a unique sound/pressure phenomenon such as infrasonic or ultrasonic acoustic or electromagnetic energy. The Joint Force does not have an established protocol to guide vestibular physical therapy for individuals exposed to directed energy. Therefore, we have provided evidence-based guidance for the treatment of oculomotor- and vestibular-related impairments from similar populations.

Materials and Methods

Published evidence was used to inform suggestions for clinical best practice. We offer resources for the management of non-oculomotor- and non-vestibular-related impairments, before discussing physical therapy interventions for dizziness and imbalance.

Results

The physical therapist should design a treatment program that addresses the individual’s health condition(s), body structure and function impairments, activity limitations, and participation restrictions after suspected directed energy exposure. This treatment program may include static standing, compliant surface standing, weight shifting, modified center of gravity, gait, and gaze stabilization or vestibular-ocular reflex training. Habituation may also be prescribed. Interventions were selected that require little to no specialized equipment, as such equipment may not be available in all settings (i.e., operational environments).

Conclusions

Evidence-based guidance for prescribing a comprehensive vestibular physical therapy regimen for individuals exposed to directed energy may aid in their rehabilitation and return to duty. This standardized approach can help physical therapists to treat complaints that do not match any previously known medical conditions but resemble brain injury or vestibular pathology.
Scleral Discoloration Because of Minocycline Use: A Case Report and Review of the Literature
Authors: F.K. Islam Yasmin , P. Horn Erich
Published: May 2021

In this case report, we highlight minocycline-induced scleral hyperpigmentation, combined with ear and fingernail discoloration that developed after over 15 years of use for rosacea in a 78-year-old male with multiple medical comorbidities. Minocycline, a tetracycline antibiotic, is used to treat rosacea and acne as well as some orthopedic infections. It is typically used for extended periods of time; long-term use of minocycline is associated with hyperpigmentation of the sclera, conjunctiva, retina, teeth, skin, subcutaneous fat, oral mucosa, tympanic membrane, and gingiva. This case highlights that hyperpigmentation is more likely to occur in older patients than in younger patients. Scleral hyperpigmentation is not associated with vision loss; however, cosmetic concerns can prompt discontinuation of minocycline. Nonetheless, after cessation, the lesions persist in some patients. Monitoring for hyperpigmentation in patients using minocycline is important, as the hyperpigmentation is more likely to be permanent with long-term use.
SARS-CoV-2 Epidemic in the Israeli Defense Force—Lessons Learned From Our rt-PCR Screening Policy
Authors: Tsur Adili , Furer Arik , Avramovich Eva , Karp Erez , Twig Gilad , Bader Tarif , Almakias Miki , Fink Noam
Published: May 2021

Background

During the SARS-CoV-2 pandemic, multiple preventative measures were used to prevent the virus from spreading in the population. The Israeli defense force deployed further means to contain the disease, including putting units in quarantine, physical distancing and using masks, gowns and disinfectants when in contact with suspected patients.

Methods

We used reverse transcriptase-polymerase chain reaction (rt-PCR) tests to screen for patients among asymptomatic soldiers within units participating in civilian aid or in close contact with known patients, using personal protective equipment. Positive results were repeated and followed with serological testing to verify the nature of results.

Results

Between April and May 2020, we screened a total of 1,453 soldiers in 13 different units. We found 11 false positive results, leading to unnecessary measures until resolution, and three true positive results (0.2%). All true positive results had unreported symptoms concomitant with SARS-CoV-2 disease. These results led to the resolution of this screening policy.

Conclusion

Screening asymptomatic army personnel in this setting with rt-PCR test for SARS-CoV-2 is not warranted and leads to unnecessary false positive results. Efforts should be directed at identifying symptomatic patients.
Response to Bannenberg and Rice
Authors: Satokar Vidit V , Cutfield Wayne S , Cameron-Smith David , Albert Benjamin B
Published: May 2021

This manuscript is a response to concerns expressed in a letter by industry-based scientists Bannenberg and Rice in response to our recent narrative review. In the review, we largely discussed why supplementation with n-3 PUFA rich oils might have benefits to the body composition and metabolism of the offspring of overweight or obese pregnant women. Bannenberg and Rice raised concerns about a number of points that may be perceived as negative about the quality and functionality of commercial fish oils. We provide a refutation to their comments and a brief review of recent evidence regarding the n-3 PUFA content, and oxidative state of supplements available to consumers. From a clinical research perspective, there remains a need to exercise caution. An oil containing less n-3 PUFAs than expected may be ineffective, and lead to incorrect conclusions that n-3 PUFAs lack efficacy. Oxidized fish oil may be ineffective or even cause unwanted harm. Although we must not overinterpret limited evidence from animal models, we have a responsibility to minimize risk to study participants, especially those most vulnerable, such as pregnant women. Prior to selecting a fish oil to be used in a clinical trial, it is essential to independently verify the n-3 PUFA content of the oil, and that the oil is unoxidized.
Artificial intelligence as a general-purpose technology: an historical perspective
Authors: Crafts Nicholas
Published: May 2021

This paper looks at the impact on productivity of general-purpose technologies such as steam, electricity, and ICT. It finds they had big effects but only with a lag which was substantial in the first two cases. The experience of the First Industrial Revolution is explored and it is found that this is not a template for a general-purpose technology having a major adverse effect on workers’ living standards. The essence of that industrial revolution was not rapid productivity growth in the short run, but the ‘invention of a new method of invention’ which increased technological progress in the long run. Since artificial intelligence is potentially a general-purpose technology that raises the productivity of research and development, it may be the basis for a Fourth Industrial Revolution.
Suzaku observations of Jovian diffuse hard X-ray emission
Authors: Numazawa Masaki , Ezoe Yuichiro , Ohashi Takaya , Ishikawa Kumi , Miyoshi Yoshizumi , Shiota Daikou , Uchiyama Yasunobu , Kimura Tomoki , Branduardi-Raymont Graziella
Published: May 2021

We report on results of systematic analyses of the entire three X-ray data sets of Jupiter taken by Suzaku in 2006, 2012, and 2014. Jovian diffuse hard X-ray emission was discovered by Suzaku in 2006 when the solar activity went toward its minimum. The diffuse emission was spatially consistent with the Jovian inner magnetosphere and was spectrally fitted with a flat power-law function suggesting non-thermal emission. Thus, a scenario in which ultra-relativistic (tens of MeV) electrons in the Jovian inner magnetosphere inverse-Comptonize solar visible photons into X-ray bands has been hypothetically proposed. We focused on the dependence of the Jovian diffuse hard X-ray emission on the solar activity to verify this scenario. The solar activity in 2012 and 2014 was around the maximum of the 24th solar cycle. By combining the imaging and spectral analyses for the three data sets, we successfully separated the contribution of the diffuse emission from the emission of Jupiter’s body (i.e., the aurora and disk emission). The 1–5 keV luminosity of the diffuse emission has been stable and did not vary significantly, and did not simply depend on the solar activity, which is also known to affect the high-energy electron distribution in the Jovian inner magnetosphere scarcely. The luminosity of the body emission both in 0.2–1 and 1–5 keV, in contrast, probably depended on the solar activity and varied by a factor of 2–5. These results strongly supported the inverse-Compton scattering scenario by the ultra-relativistic electrons. In this paper, we estimate spatial and spectral distributions of the inverse-Compton scattering X-rays by Jovian magnetospheric high-energy electrons with reference to the Divine–Garrett model and found a possible agreement in an inner region (≲10 RJ) for the X-ray observations.
Hot molecular core candidates in the Galactic center 50 km s−1 molecular cloud
Authors: Miyawaki Ryosuke , Tsuboi Masato , Uehara Kenta , Miyazaki Atsushi
Published: May 2021

We present results based on ${2{^{\prime \prime}_{.}}5}$-resolution observations using the Atacama Large Millimeter/Submillmeter Array (ALMA) of the Galactic center molecular cloud G−0.02−0.07, or the 50 km s−1 molecular cloud (50 MC), in the SO (NJ = 22–11) line and 86 GHz continuum emission, the combination of which is considered to trace “hot molecular core candidates” (HMCCs) appearing in the early stage of massive-star formation. In the 86 GHz continuum image, we identified nine dust cores in the central part of the 50 MC, in which four famous compact H ii regions are located. No new ultra-compact H ii regions were found. We also identified 28 HMCCs in the 50 MC with the SO line. The overall SO distribution had no clear positional correlation with the identified H ii regions. The HMCCs in the 50 MC showed a variety of association and non-association with dust and Class I CH3OH maser emissions. The variety suggests that they are not in a single evolutionary stage or environment. Nevertheless, the masses of the identified HMCCs were found to be well approximated by a single power law of their radii, MLTE/(M⊙) = 5.44 × 105 [r/(pc)]2.17 at Tex = 50–100 K. The derived HMCC masses were larger than those of the molecular cores with the same radii in the 50 MC, and also than those of the molecular clumps in the Galactic disk. Additional observations are needed to confirm the nature of these HMCCs in the 50 MC.
The sacrament of confession during Covid-19 pandemic
Authors: Macaraan Willard Enrique R
Published: May 2021

The Covid-19 pandemic has drastically changed the way of life where measures and strategies to adapt and adopt have become normative. In a recent correspondence, the author explores the adaptation of the Last Rites within the pandemic. On this note, the paper explores another sacrament that has also adapted and has adopted new ways to deal with a strong restriction against in-person meetups and gatherings. The sacrament of Confession provides a venue for people to seek healing and counseling. While face-to-face and confessional confessions are still disallowed, the Church has found ways to adapt the sacrament within the context of the pandemic.
Comparison of Nodule Endophyte Composition, Diversity, and Gene Content Between Medicago truncatula Genotypes
Authors: Burns Mannix , Epstein Brendan , Burghardt Liana T.
Published: May 2021

Leguminous plants form symbiotic relationships with rhizobia. These nitrogen-fixing bacteria live in specialized root organs called nodules. Although rhizobia form the most notable host relationship within root nodules, other bacterial endophytes also inhabit nodules and can influence host–rhizobia interactions as well as exert effects of their own. In this study, we elucidate the effect of intraspecific host genetic variation and between generational legacies on root nodule endophyte communities in Medicago truncatula. Although the diversity of endophytes in nodules was similar across hosts, both nodule endophyte composition and gene functional groups differed. In contrast, neither the presence nor identity of a host in the previous generation (either A17 or R108) had a significant effect on the nodule endophyte diversity or composition. However, whether or not a host was present significantly altered gene functional groups. We conclude that genetic variation within a legume host species can play both direct and indirect effects on establishment of nodule microbiomes. Further studies, including genome-wide association studies and functional assays, can open the door for engineering and optimizing nodule endophyte communities that promote growth or have other beneficial qualities.
Controlling High Blood Pressure
Authors: Casey Donald E. , Daniel Donna M. , Bhatt Jay , Carey Robert M. , Commodore-Mensah Yvonne , Holmes Aline , Smith Alison P. , Wozniak Gregory , Wright Jackson T.
Published: May 2021

Recently published national data demonstrate inadequate and worsening control of high blood pressure (HBP) in the United States, outcomes that likely have been made even worse by the coronavirus disease 2019 (COVID-19) pandemic. This major public health crisis exposes shortcomings of the US health care delivery system and creates an urgent opportunity to reduce mortality, major cardiovascular events, and costs for 115 million Americans. Ending this crisis will require a more coherent and systemic change to traditional patterns of care. The authors present an evidence-based Blueprint for Change for comprehensive health delivery system redesign based on current national clinical practice guidelines and quality measures. This innovative model includes a systems-based approach to ensuring proper BP measurement, assessment of cardiovascular risk, effective patient-centered team-based care, addressing social determinants of health, and shared decision-making. The authors also propose building on current national quality improvement initiatives designed to better control HBP.
Toolkit for Best Practice Use of Electronic Health Record Data in Quality Improvement
Authors: Omary Courtney , Cox-Henley Michelle , Hertzberg Vicki Stover , Cranmer John N. , Simpson Roy L.
Published: May 2021

This project piloted an educational intervention focused on use and management of EHR data by Doctor of Nursing Practice students in quality improvement initiatives. Recommendations from academic and clinical nursing promote the integration of EHR data findings into practice. Nursing's general lack of understanding about how to use and manage data is a barrier to using EHR data to guide quality improvement initiatives. Doctor of Nursing Practice students at a hospital-affiliated university participated in a pre-test, training, and post-test through an online learning management system. Training content and assessments focused on data and planning for its use in quality improvement initiatives. Sixteen students experienced a median of 17.6% increase in scores after completing the post-test. There was a statistically significant increase in scores between the pre-test and post-test (P = .0006). These results suggest educational content included in the Doctor of Nursing Practice Quality Improvement Toolkit increases knowledge about use and management of EHR data. Future considerations include use for educating a variety of students and healthcare staff.
Is there any predictive value of the ratio of the upper to the lower diameter of the ureter for ureteral stone impaction?
Authors: Abat Deniz , Börekoğlu Ali , Altunkol Adem , Köse Ilgaz Çağatay , Boğa Mehmet Salih
Published: May 2021

Background:

We aimed to determine if the ratio of the upper to the lower diameter of the ureter could have any predictive value for ureteral stone impaction.

Materials and methods:

Patients who had a solitary unilateral ureteric stone, determined by noncontrast computerized tomography, were assessed if they had undergone ureteroscopic lithotripsy. A total of 111 patients, 84 males (76%), and 27 females (24%), were recruited to the study. Demographic data of the patients and preoperative radiological parameters based on noncontrast computerized tomography were recorded. The impaction status was also assessed during the operation.

Results:

Of the 111 patients, ureteral stones in 63 (57%) patients were determined to be impacted, and ureteral stones in 48 (43%) were nonimpacted. Impacted stones were more common in older patients, female patients, and patients with an American Society of Anesthesiologists score of 2.

Conclusions:

Significant relationships were found between the impaction status and transverse stone length, longest stone length, upper diameter of the ureter, ratio (upper diameter of the ureter/lower diameter of the ureter), and anteroposterior diameter of the pelvis. These parameters were higher in patients with impacted stones.
Potential Mechanisms of In-stent Neointimal Atherosclerotic Plaque Formation
Authors: Zhang Dai-Min , Chen Shao-Liang
Published: May 2021

Percutaneous coronary intervention has become the main revascularization strategy for coronary artery disease. Compared with early percutaneous coronary angioplasty and the extensive clinical application of bare metal stents, drug-eluting stents can significantly reduce the stenosis caused by the elastic retraction of plaque and neoatherosclerosis (NA), but there is still a high incidence of in-stent restenosis (ISR), which restricts the clinical efficacy of stent implantation. In-stent neoatherosclerosis (ISNA), defined as atherosclerotic lesions in the neointima, is one of the main causes of late stent failure. ISNA plays an important role in stent thrombosis and ISR. The rate of target lesion revascularization and in-stent thrombosis is high when NA arises. Therefore, it is of great clinical significance to explore the occurrence of NA and its development mechanism after stent implantation to prevent ISR and improve stent implantation efficacy and associated clinical prognosis. In this article, we systematically reviewed the existing clinical research on ISNA and the role of optical coherence tomography in its evaluation.
CD40L/CD40 Regulates Adipokines and Cytokines by H3K4me3 Modification in Epicardial Adipocytes
Authors: Yuan Ming , Wu Bin , Zhang Liang , Wang Huan , Yang Yongjun
Published: May 2021

Epicardial adipose tissue (EAT) dysfunction mediates chronic inflammation by regulating inflammation-related adipokines and cytokines, and it further promotes coronary artery disease (CAD) development. CD40L/CD40 is involved in multiple inflammatory pathways that contribute to various pathophysiological processes. However, the function of CD40L/CD40 in the expression and production of adipokines and cytokines in epicardial adipocytes remains unclear. The purpose of the present study was to explore the role and underlying mechanisms of CD40L/CD40 in adipokine and cytokine expression and production. We isolated adipocytes from EAT tissues of CAD and non-CAD patients. We noticed that CD40 was dramatically increased in EAT tissues of CAD patients. Loss-of-function and gain-of-function studies were performed. The results showed that CD40 silencing reduced recombinant CD40 ligand (rCD40L)–induced upregulation of plasminogen activator inhibitor-1, leptin, interleukin-6, and monocyte chemotactic protein-1 messenger RNA levels and secretion. Overexpression of CD40 displayed the opposite results. In addition, rCD40L triggered mixed lineage leukemia protein-1 (MLL1) expression both in messenger RNA and protein levels. CD40 depletion apparently blocked MLL1 expression, whereas gain of function of CD40 resulted in augmentation of MLL1 levels. Interestingly, chromatin immunoprecipitation-quantitative real-time polymerase chain reaction analysis revealed that CD40 elimination dampened histone H3 lysine 4 trimethylation enrichment at plasminogen activator inhibitor-1, leptin, interleukin-6, and monocyte chemotactic protein-1 promoter regions in the presence of rCD40L. The reverse pattern was observed upon ectopic expression of CD40. Most important, MLL1 silencing effectively reversed the promotive effects of CD40 on adipokine and cytokine secretion. Taken together, our findings suggest that CD40L/CD40 regulates adipokine and cytokine expression by H3 lysine 4 trimethylation modification in adipocytes.
Anisotropy of the Radiation Field Following Canine Sn-117m Treatment
Authors: Arno Matthew G. , Simon Jaime , Stevenson Nigel , Donecker John
Published: May 2021

Tin-117m (117mSn) is used to treated dogs with osteoarthritic joints by radiosynoviorthesis. The internal conversion and Auger electrons emitted by the 117mSn provide the therapeutic effect. Sn-117m also emits gamma rays, of which the most significant is 158.6 keV. The external radiation field around a treated dog is of interest to limit the dose to the owners/caretakers of the dog. The dog’s torso attenuates the radiation being emitted toward the opposite side of the dog’s body. This leads to a radiation field that is significantly non-isotropic. This study characterizes the anisotropy of this field to permit maximum dose rate measurements to be used to calculate the dose to individuals in the vicinity of the dog. Measurements were made in nine directions and at two distances, 0.3 and 1.0 m, to characterize common distances and spatial orientations for human-dog interactions. From these measurements, the percent reduction in the average dose rate compared to the maximum dose rate was determined. From a radiation safety perspective, the important factor is the minimum amount of shielding effectiveness or percent reduction that can be expected. A reasonable measure for this value is the fifth percentile of the shielding effectiveness distribution. The fifth percentile shielding effectiveness measures are 27% and 21% at 0.3 and 1.0 m, respectively.
Central sensitization inventory in endometriosis
Authors: Orr Natasha L. , Wahl Kate J. , Lisonek Michelle , Joannou Angela , Noga Heather , Albert Arianne , Bedaiwy Mohamed A. , Williams Christina , Allaire Catherine , Yong Paul J.
Published: May 2021

A key clinical problem is identifying the patient with endometriosis whose pain is complicated by central nervous system sensitization, where conventional gynecologic treatment (eg, hormonal therapy or surgery) may not completely alleviate the pain. The Central Sensitization Inventory (CSI) is a questionnaire previously validated in the chronic pain population. The objective of this study was an exploratory proof-of-concept to identify a CSI cutoff in the endometriosis population to discriminate between individuals with significant central contributors (identified by central sensitivity syndromes [CSS]) to their pain compared to those without. We analyzed a prospective data registry at a tertiary referral center for endometriosis, and included subjects aged 18 to 50 years with endometriosis who were newly or re-referred to the center in 2018. The study sample consisted of 335 subjects with a mean age of 36.0 ± 7.0 years. An increasing number of CSS was significantly correlated with dysmenorrhea, deep dyspareunia, dyschezia, and chronic pelvic pain scores (P < 0.001), and with the CSI score (0-100) (r = 0.731, P < 0.001). Receiver operating characteristic analysis indicated that a CSI cutoff of 40 had a sensitivity of 78% (95% CI: 72.7%-84.6%) and a specificity of 80% (95% CI: 70.3%-84.5%) for identifying a patient with endometriosis with ≥3 CSS. In the group with CSI ≥ 40, 18% retrospectively self-reported pain nonresponsive to hormonal therapy and 40% self-reported daily pain, compared with 6% and 20% in the CSI < 40 group (P = 0.003 and 0.002, respectively). In conclusion, a CSI ≥ 40 may be a practical tool to help identify patients with endometriosis with pain contributors related to central nervous system sensitization.
The role of patient records in research: A bibliometric analysis of publications from an academic medical center in Taiwan
Authors: Li Hui-Chun , Chen Yu-Wen , Chen Tzeng-Ji , Chiou Shih-Hwa , Hwang Shinn-Jang
Published: May 2021

Background:

This study aimed to assess the use of medical record items in clinical research in one large academic medical center in Taiwan.

Methods:

A descriptive survey design was adopted to collect the data. Articles published in 2018 by Taipei Veterans General Hospital (TVGH) staff as the first author were obtained. The types of specialties and types of research were analyzed. To understand the conditions for the use of medical records, the retrospective research using hospital’s medical records were analyzed. Each article was read in entirety to realize the use and number of patients and the medical record items.

Results:

Among the 362 articles first-authored by TVGH staff in 2018, 219 (60.4%) were classified as clinical studies, 60 (16.6%) as basic studies, 53 (14.6%) as database studies, and 30 (8.2%) as other categories. About 50% of the retrospective research using TVGH medical records had a case number <100 (67 cases, 49.6%) with an average number of 41 cases and 13 studies (9.6%) had a case number >1000. Analysis of the number of medical record items used in 135 retrospective research studies based on TVGH medical records showed that 118 (87.4%) used basic patient information. In addition to basic information, notes written by professionals were used most frequently (73 cases, 54.0%), whereas medication information was used in 50 cases (37.0%); laboratory test data were used in 49 cases (36.2%); and body measurements was used in 27 cases (20%).

Conclusion:

More than one-third of publications utilized medical records, but the patient numbers and record items in use were relatively limited. In the era of digitalization and big data analytics, the potential of medical records in research deserves attention. Investment in establishing a more accessible database of medical records to access nonstructural, descriptive medical records could be considered.
3D Exoscope Navigation-Guided Approach to Middle Cranial Fossa
Authors: Kaul Vivian F. , Fan Caleb J. , Perez Enrique , Schwam Zachary G. , Hadjipanayis Constantinos , Wanna George B.
Published: May 2021

Objective:

To test the feasibility and efficacy of a 3D exoscope navigation-guided middle cranial fossa (MCF) approach to the internal auditory canal (IAC); to potentially obviate the need to use dissection landmarks and instead, use the navigation probe as a guide to find structures and drill down to the IAC.

Patients:

Cadaveric dissection of six temporal bones.

Intervention:

Computed tomography temporal bone was performed with fiducials on each specimen before the dissection to employ the navigation system. Using a 3D exoscope with navigation by Synaptive (Toronto, Ontario, Canada), the MCF approach was performed.

Main Outcome Measures:

Navigation accuracy, ability to identify critical structures, and ability to drill out the IAC successfully.

Results:

All six specimens had the IAC successfully drilled out using the 3D exoscope. All dissections were performed with navigation and did not require dissecting out the greater superficial petrosal nerve and superior semicircular canal. One specimen used landmark dissection to confirm the IAC after navigation had been used to locate the IAC first. Navigation accuracy mean was 1.86 mm (range, 1.56–2.05 mm).

Conclusion:

A 3D exoscope navigation-guided MCF approach to the IAC is feasible without landmark dissection.
The Quality, Reliability, and Popularity of YouTube Education Videos for Vestibular Rehabilitation: A Cross-sectional Study
Authors: Yildiz Selçuk , Toros Sema Zer
Published: May 2021

Hypothesis:

Vestibular rehabilitation (VR) education videos on YouTube are poor-quality and unreliable.

Background:

YouTube has become a health information source. Recent studies have determined that videos on YouTube contain misleading and inappropriate information for different medical conditions. The aim of the present study was to assess the quality and reliability of VR education videos.

Methods:

A search was performed using the keywords vertigo, vertigo treatment, vertigo exercise, and vestibular rehabilitation, on YouTube. The first 50 videos for each keyword were analyzed. Videos were divided into four groups according to the video source: Group 1: universities/occupational organizations, Group 2: medical ad/profit-oriented companies, Group 3: independent users, and Group 4: others (news/media/state institution). The quality and reliability of videos were evaluated regarding the modified DISCERN criteria, the modified Journal of the American Medical Association (JAMA) benchmark criteria, and global quality scores (GQS).

Results:

Among the 200 videos analyzed, 103 were included. The main video source was medical ad/profit-oriented companies (60.2%). The mean modified DISCERN criteria score, the mean modified JAMA benchmark criteria score, and the mean GQS value of the videos were found as low (2.46 ± 1.37, 2.09 ± 1.23, and 2.67 ± 1.38, respectively). Videos uploaded by universities/occupational organizations (25.2%) had statistically significant higher modified DISCERN criteria scores, modified JAMA benchmark criteria scores, and GQS values compared with the other groups (p < 0.001).

Conclusion:

Online information about VR education on YouTube was of poor quality and unreliable. Expert vestibular providers should be aware of these inappropriate sources and educate patients regarding the poor-quality of videos and also aim to provide more quality and reliable sources of information.
Detection of Treponema pallidum DNA in Oropharyngeal Swabs and Whole Blood for Syphilis Diagnosis
Authors: Tantalo Lauren C. , Mendoza Haley , Katz David A. , Sahi Sharon K. , Marra Christina M.
Published: May 2021

Background

Syphilis diagnosis relies on serological tests, which may be falsely nonreactive or may be reactive but not reflect current syphilis.

Methods

Polymerase chain reaction for detection of T. pallidum DNA was performed on 123 oropharyngeal swabs, 120 whole bloods, and 46 lesion exudate swabs from 123 untreated individuals with syphilis (cases); oropharyngeal swabs from 148 at-risk controls without syphilis; and 73 oropharyngeal swabs and 36 whole bloods from 73 individuals recently treated for syphilis.

Results

Most (90.2%) cases had early syphilis. T. pallidum DNA was detected in 33 (26.8%) of 123 oropharyngeal swabs, 32 (26.7%) of 120 bloods, and 30 (65.2%) of 46 lesion exudate swabs. T. pallidum DNA was detected in 49 (40.8%) of 120 individuals in whom both oropharyngeal swabs and blood were tested. T. pallidum was more likely to be amplified from oropharyngeal swabs when it was amplified from blood than when it was not (15 of 32 [46.9%] vs. 17 of 88 [19.3%], P = 0.003). For each 2-fold increase in serum rapid plasma reagin titer, the odds of detection of T. pallidum DNA in oropharyngeal swabs increased by 1.44 (95% confidence interval, 1.14–1.82, P = 0.003). T. pallidum DNA was not detected in oropharyngeal samples from controls, but it was detected in 3 (8.3%) of 36 bloods from individuals recently treated for syphilis: 2 at 1 day and 1 at 5 days after initiation of syphilis treatment.

Conclusions

Nucleic amplification tests can identify recent T. pallidum infection and may be particularly useful for diagnosis of very early or asymptomatic syphilis.
Population-Level Outcomes of Partner Notification Among Gay, Bisexual, and Other Men Who Report Sex With Men Diagnosed With Infectious Syphilis in British Columbia, Canada
Authors: Lukac Christine D. , Consolacion Theodora , Ryan Venessa , Cumming Emma , Mercado Janyn ,   BCCDC Syphilis Nurses, Ford Geoffrey , Ogilvie Gina S. , Gilbert Mark , Grennan Troy , Wong Jason
Published: May 2021

Background

Syphilis testing, treatment, and partner notification (PN) are centrally coordinated in British Columbia (BC), Canada. Public health (PH) nurses (PHNs) contact almost all syphilis patients and either notify partners of syphilis exposure (PH-initiated PN) or support patients to notify their own partners (patient-initiated PN). In the context of an ongoing syphilis epidemic among gay, bisexual, and other men who report sex with men (gbMSM), we measured population-level yields and compared PN approaches to inform prevention and control efforts.

Methods

All gbMSM diagnosed with infectious syphilis in 2016 in BC were included. We calculated indicators of engagement with PN among patients and PN outcomes among notifiable partners using a cascade-of-care framework. χ2 Tests compared indicators between PN approaches.

Results

Of the 759 syphilis diagnoses, 85.4% (648/759) were among gbMSM and 94.7% (614/648) were treated within 30 days of testing (mean [SD], 5.5 [5.2] days). Among patients, 87.7% (568/648) discussed PN with PHNs and 49.5% (281/568) named at least 1 notifiable partner, for a total of 1094 partners (mean [SD], 3.9 [5.5] partners/patient). Compared with PH-initiated PN, patient-initiated PN resulted in a greater proportion of partners notified (70.1% [573/817] vs. 89.8% [211/235]; P = 1.88 × 10−9), but there was no difference in the proportion of partners tested and/or treated (90.2% [517/573] vs. 86.7% [183/211]; P = 0.203), and diagnosed (12.8% [66/517] vs. 16.4% [30/183]; P > 0.271).

Conclusions

Public health– and patient-initiated PN had similarly high yields of partners tested and/or treated, and diagnosed, demonstrating that gbMSM can contribute to syphilis PN when supported by resource-equipped PHNs.