bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of gas fraction and feedback in the stability and evolution of galactic discs: implications for cosmological galaxy formation models
Authors: Fensch Jérémy , Bournaud Frédéric
Published: May 2021

High-redshift star-forming galaxies often have irregular morphologies with giant clumps containing up to 108−109 solar masses of gas and stars. The origin and evolution of giant clumps are debated both theoretically and observationally. In most cosmological simulations, high-redshift galaxies have regular spiral structures or short-lived clumps, in contradiction with many idealized high-redshift disc models. Here, we test whether this discrepancy can be explained by the low gas fractions of galaxies in cosmological simulations. We present a series of simulations with varying gas fractions, from 25 per cent, typical of galaxies in most cosmological simulations, to 50 per cent, typical of observed galaxies at 1.5 < z < 3. We find that gas-poor models have short-lived clumps, that are unbound and mostly destroyed by galactic shear, even with weak stellar feedback. In contrast, gas-rich models form long-lived clumps even with boosted stellar feedback. This shows that the gas mass fraction is the primary physical parameter driving violent disc instabilities and the evolution of giant clumps on ∼108 yr time-scales, with lower impact from the calibration of the stellar feedback. Many cosmological simulations of galaxy formation have relatively gas-poor galactic discs, which could explain why giant clumps are absent or short-lived in such models. Similar baryonic and dark matter mass distribution could produce clumpy galaxies with long-lived clumps at z ∼ 2 if the gas fraction was in better agreement with observations.
Where infall meets outflows: turbulent dissipation probed by CH+ and Lyα in the starburst/AGN galaxy group SMM J02399−0136 at z ∼ 2.8
Authors: Vidal-García A , Falgarone E , Arrigoni Battaia F , Godard B , Ivison R J , Zwaan M A , Herrera C , Frayer D , Andreani P , Li Q , Gavazzi R
Published: May 2021

We present a comparative analysis of the $\rm CH^+$(1–0) and Lyα lines, observed with the Atacama Large Millimeter Array and Keck telescope, respectively, in the field of the submillimetre-selected galaxy SMM J02399−0136 at z ∼ 2.8, which comprises a heavily obscured starburst galaxy and a broad absorption line quasar, immersed in a large Lyα nebula. This comparison highlights the critical role played by turbulence in channelling the energy across gas phases and scales, splitting the energy trail between hot/thermal and cool/turbulent phases in the circumgalactic medium (CGM). The unique chemical and spectroscopic properties of $\rm CH^+$ are used to infer the existence of a massive (∼3.5 × 1010 M⊙), highly turbulent reservoir of diffuse molecular gas of radius ∼20 kpc coinciding with the core of the Lyα nebula. The whole cool and cold CGM is shown to be inflowing towards the galaxies at a velocity ∼ 400 km s−1. Several kpc-scale shocks are detected tentatively in $\rm CH^+$ emission. Their linewidth and specific location in space and velocity with respect to the high-velocity Lyα emission suggest that they lie at the interface of the inflowing CGM and the high-velocity outflowing gas. They signpost the feeding of CGM turbulence by active galactic nuclei- and stellar-driven outflows. The mass and energy budgets of the CGM require net mass accretion at a rate commensurate with the star formation rate. From this similarity, we infer that the merger-driven burst of star formation and black-hole growth are ultimately fuelled by large-scale gas accretion.
Detecting subparsec supermassive binary black holes: Long-term monitoring perspective
Authors: Popović L Č , Simić S , Kovačević A , Ilić D
Published: May 2021

Here we consider the perspective to detect sub-pc supermassive binary black hole (SMBBH) systems using long-term photometric and spectroscopic monitoring campaigns of active galactic nuclei. This work explores the nature of long-term spectral variability caused by the dynamical effects of SMBBH systems. We describe in great detail a model of SMBBH system which considers that both black holes have their accretion disc and additional line emitting region(s). We simulate the H β spectral band (continuum+broad H β line) for different mass ratios of components and different total masses of the SMBBH systems (106–108 M⊙). We analyse the set of continuum and broad line light curves for several full orbits of SMBBHs with different parameters, to test the possibility to extract the periodicity of the system. We consider different levels of the signal-to-noise ratio, which is added to the simulated spectra. Our analysis showed that the continuum and broad line profiles emitted from an SMBBH system are strongly dependent, not only on the mass ratio of the components but also on the total mass of the system. We found that the mean broad line profile and its rms could indicate the presence of an SMBBH. However, some effects caused by the dynamics of a binary system could be hidden due to a low signal-to-noise ratio. Finally, we can conclude that the long-term AGN monitoring campaigns could be beneficial for the detection of SMBBH candidates.
Hydrogenation of small aromatic heterocycles at low temperatures
Authors: Miksch April M , Riffelt Annalena , Oliveira Ricardo , Kästner Johannes , Molpeceres Germán
Published: May 2021

The recent wave of detections of interstellar aromatic molecules has sparked interest in the chemical behaviour of aromatic molecules under astrophysical conditions. In most cases, these detections have been made through chemically related molecules, called proxies, that implicitly indicate the presence of a parent molecule. In this study, we present the results of the theoretical evaluation of the hydrogenation reactions of different aromatic molecules (benzene, pyridine, pyrrole, furan, thiophene, silabenzene, and phosphorine). The viability of these reactions allows us to evaluate the resilience of these molecules to the most important reducing agent in the interstellar medium, the hydrogen atom (H). All significant reactions are exothermic and most of them present activation barriers, which are, in several cases, overcome by quantum tunnelling. Instanton reaction rate constants are provided between 50 and 500 K. For the most efficiently formed radicals, a second hydrogenation step has been studied. We propose that hydrogenated derivatives of furan and pyrrole, especially 2,3-dihydropyrrole, 2,5-dihydropyrrole, 2,3-dihydrofuran, and 2,5-dihydrofuran, are promising candidates for future interstellar detections.
Detection of a 20-min time lag observed from Sgr A* between 8 and 10 GHz with the VLA
Authors: Michail Joseph M , Yusef-Zadeh Farhad , Wardle Mark
Published: May 2021

We report the detection and analysis of a radio flare observed on 17 April 2014 from Sgr A* at 9 GHz using the VLA in its A-array configuration. This is the first reported simultaneous radio observation of Sgr A* across 16 frequency windows between 8 and 10 GHz. We cross-correlate the lowest and highest spectral windows centred at 8.0 and 9.9 GHz, respectively, and find the 8.0 GHz light-curve lagging $18.37^{+2.17}_{-2.18}$ min behind the 9.9 GHz light curve. This is the first time lag found in Sgr A*’s light curve across a narrow radio frequency bandwidth. We separate the quiescent and flaring components of Sgr A* via flux offsets at each spectral window. The emission is consistent with an adiabatically expanding synchrotron plasma, which we fit to the light curves to characterize the two components. The flaring emission has an equipartition magnetic field strength of 2.2 Gauss, size of 14 Schwarzschild radii, average speed of 12 000 km s−1, and electron energy spectrum index (N(E) ∝ E−p), p = 0.18. The peak flare flux at 10 GHz is approximately 25 per cent of the quiescent emission. This flare is abnormal as the inferred magnetic field strength and size are typically about 10 Gauss and few Schwarzschild radii. The properties of this flare are consistent with a transient warm spot in the accretion flow at a distance of 10–100 Schwarzschild radii from Sgr A*. Our analysis allows for independent characterization of the variable and quiescent components, which is significant for studying temporal variations in these components.
Momentum feedback from marginally resolved H iiregions in isolated disc galaxies
Authors: Jeffreson Sarah M R , Krumholz Mark R , Fujimoto Yusuke , Armillotta Lucia , Keller Benjamin W , Chevance Mélanie , Kruijssen J M Diederik
Published: May 2021

We present a novel, physically motivated sub-grid model for H ii region feedback within the moving mesh code arepo, accounting for both the radiation pressure-driven and thermal expansion of the ionized gas surrounding young stellar clusters. We apply this framework to isolated disc galaxy simulations with mass resolutions between 103 and 105 M⊙ per gas cell. Each simulation accounts for the self-gravity of the gas, the momentum and thermal energy from supernovae, the injection of mass by stellar winds, and the non-equilibrium chemistry of hydrogen, carbon, and oxygen. We reduce the resolution dependence of our model by grouping those H ii regions with overlapping ionization front radii. The Strömgren radii of the grouped H ii regions are at best marginally resolved, so that the injection of purely thermal energy within these radii has no effect on the interstellar medium. By contrast, the injection of momentum increases the fraction of cold and molecular gas by more than 50 per cent at mass resolutions of 103 M⊙, and decreases its turbulent velocity dispersion by ∼10 km s−1. The mass-loading of galactic outflows is decreased by an order of magnitude. The characteristic lifetime of the least-massive molecular clouds ($M/{\rm M}_\odot \lesssim 5.6 \times 10^4$) is reduced from ∼18 to $\lesssim 10$ Myr, indicating that H ii region feedback is effective in destroying these clouds. Conversely, the lifetimes of intermediate-mass clouds ($5.6 \times 10^4 \lesssim M/{\rm M}_\odot \lesssim 5 \times 10^5$) are elongated by ∼7 Myr, likely due to a reduction in supernova clustering. The derived cloud lifetimes span the range from 10 to 40 Myr, in agreement with observations. All results are independent of whether the momentum is injected from a ‘spherical’ or a ‘blister-type’ H ii region.
Linear bias and halo occupation distribution of emission-line galaxies from Nancy Grace Roman Space Telescope
Authors: Zhai Zhongxu , Wang Yun , Benson Andrew , Chuang Chia-Hsun , Yepes Gustavo
Published: May 2021

We present measurements of the linear galaxy bias of Hα and [O iii] emission-line galaxies (ELGs) for the High Latitude Spectroscopic Survey (HLSS) of Nancy Grace Roman Space Telescope (or Roman), using galaxy mocks constructed using semi-analytical model for galaxy formation, Galacticus, with a large cosmic volume and redshift coverage. We compute the two-point statistics of galaxies in configuration space and measure linear bias within scales of 10–50 h−1 Mpc. We adopt different selection algorithms to investigate the impact of the Roman line flux cut, as well as the effect of dust model used to calibrate Galacticus, on the bias measurements. We consider galaxies with Hα and [O iii] emissions over the redshift range 1 < z < 3, as specified by the current baseline for the Roman HLSS. We find that the linear bias for the Hα and [O iii] ELGs can be expressed as a linear function with respect to redshift: b ≃ 0.9z + 0.5 for H$\alpha \, (1\lt z\lt 2)$, and b ≃ z + 0.5 for [O iii] (2 < z < 3). We have also measured the halo occupation distributions of these Hα and [O iii] ELGs to understand their distribution within dark matter haloes. Our results provide key input to enable the reliable forecast of dark energy and cosmology constraints from Roman.
Chemical abundances in seven metal-poor H ii regions and a determination of the primordial helium abundance
Authors: Valerdi Mabel , Peimbert Antonio , Peimbert Manuel
Published: May 2021

We conducted a long-slit spectrophotometry analysis to obtain the chemical abundances of seven metal-poor H ii regions in three galaxies: UM 160, UM 420, and TOL 0513−393. The data have been taken with the Focal Reducer Low Dispersion Spectrograph 1 (FORS1) at the 8.2-m Very Large Telescope. We derived the physical conditions and the chemical abundances of N, O, Ne, S, Ar, and Cl. We also performed a detailed analysis that involves abundance determinations using the t2 formalism. Based on He i recombination line intensity ratios, together with the {\sc HELIO 14} code, we derived the abundance of He. In addition, for a value $\Delta Y/\Delta Z_O \rm =3.3\pm 0.7$, we have estimated that the primordial helium abundance by mass is YP = 0.2448 ± 0.0033. This value agrees with values derived from Standard Big Bang Nucleosynthesis and with other recent determinations of YP.
Optimal serum ferritin level range: iron status measure and inflammatory biomarker
Authors: DePalma Ralph G , Hayes Virginia W , O'Leary Timothy J
Published: May 2021

This report provides perspectives concerning dual roles of serum ferritin as a measure of both iron status and inflammation. We suggest benefits of a lower range of serum ferritin as has occurred for total serum cholesterol and fasting blood glucose levels. Observations during a prospective randomized study using phlebotomy in patients with peripheral arterial disease offered unique insights into dual roles of serum ferritin both as an iron status marker and acute phase reactant. Robust positive associations between serum ferritin, interleukin 6 [IL-6], tissue necrosis factor-alpha, and high sensitivity C-reactive protein were discovered. Elevated serum ferritin and IL-6 levels associated with increased mortality and with reduced mortality at ferritin levels <100 ng mL−1. Epidemiologic studies demonstrate similar outcomes. Extremely elevated ferritin and IL-6 levels also occur in individuals with high mortality due to SARS-CoV-2 infection. Disordered iron metabolism reflected by a high range of serum ferritin level signals disease severity and outcomes. Based upon experimental and epidemiologic data, we suggest testing the hypotheses that optimal ferritin levels for cardiovascular mortality reduction range from 20 to 100 ng mL−1 with % transferrin levels from 20 to 50%, to ensure adequate iron status and that ferritin levels above 194 ng mL−1 associate with all-cause mortality in population cohorts.
RNA sequence analysis reveals ITGAL/CD11A as a stromal regulator of murine low-grade glioma growth
Authors: De Andrade Costa Amanda , Chatterjee Jit , Cobb Olivia , Sanapala Shilpa , Scheaffer Suzanne , Guo Xiaofan , Dahiya Sonika , Gutmann David H
Published: May 2021

Background

Emerging insights from numerous laboratories have revealed important roles for nonneoplastic cells in the development and progression of brain tumors. One of these nonneoplastic cellular constituents, glioma-associated microglia (GAM), represents a unique population of brain monocytes within the tumor microenvironment that have been reported to both promote and inhibit glioma proliferation. To elucidate the role of GAM in the setting of low-grade glioma (LGG), we leveraged RNA sequencing meta-analysis, genetically engineered mouse strains, and human biospecimens.

Methods

Publicly available disease-associated microglia (DAM) RNA-seq datasets were used, followed by immunohistochemistry and RNAScope validation. CD11a-deficient mouse microglia were used for in vitro functional studies, while LGG growth in mice was assessed using anti-CD11a neutralizing antibody treatment of Neurofibromatosis type 1 (Nf1) optic glioma mice in vivo.

Results

We identified Itgal/CD11a enrichment in GAM relative to other DAM populations, which was confirmed in several independently generated murine models of Nf1 optic glioma. Moreover, ITGAL/CD11A expression was similarly increased in human LGG (pilocytic astrocytoma) specimens from several different datasets, specifically in microglia from these tumors. Using CD11a-knockout mice, CD11a expression was shown to be critical for murine microglia CX3CL1 receptor (Cx3cr1) expression and CX3CL1-directed motility, as well as glioma mitogen (Ccl5) production. Consistent with an instructive role for CD11a+ microglia in stromal control of LGG growth, antibody-mediated CD11a inhibition reduced mouse Nf1 LGG growth in vivo.

Conclusions

Collectively, these findings establish ITGAL/CD11A as a critical microglia regulator of LGG biology relevant to future stroma-targeted brain tumor treatment strategies.
For or Against Tobacco Control: Sponsored Tobacco Advocacy Messages on Facebook and Instagram
Authors: Majmundar Anuja , Moran Meghan Bridgid
Published: May 2021

Introduction

This study explores sponsored tobacco advocacy messages on Facebook and Instagram by: (1) Examining differences in message performance metrics, funding sources, and audience characteristics of anti- and protobacco messages in the United States, and (2) Characterizing audience exposure to anti- and protobacco message themes across different age-groups and by gender.

Methods

The analysis sample consisting of 375 tobacco-advocacy related messages on Instagram and/or Facebook in the United States from May 29, 2020 to July 26, 2020 was obtained from the Facebook Ad Library Application Programming Interface. Chi-square tests compared differences in anti- and protobacco messages by potential reach, impressions, approximate spend ($), social media platform type, average duration of delivery, type of funding sources, and audience age and gender exposure. Percentage distribution of message themes and audience exposure by age and gender were also examined.

Results

Antitobacco messages (n = 334, 89.07%) exceeded protobacco messages (n = 41, 10.93%) overall. Antitobacco messages had lower potential reach, received a lower proportion of impressions, and spent a lower proportion of money per message. Protobacco advocacy was funded primarily by the tobacco industry and advocacy groups. A small fraction of antitobacco advocacy messages reached young adults and men. Among protobacco advocacy messages, a majority of messages highlighting tobacco regulations, addiction, citizen advocacy, flavors, and impact on economy reached mostly men.

Conclusion

Results illustrate important gaps in current sponsored antitobacco advocacy efforts, demonstrate the feasibility of monitoring sponsored tobacco advocacy on these platforms, and offer insights for future antitobacco advocacy campaigns.

Implications

Future antitobacco advocacy efforts on social media may consider more focused efforts in reaching young adults and men and in leveraging strategic social media analytics to improve their overall potential reach and impressions.
How plants protect themselves from ultraviolet-B radiation stress
Authors: Shi Chen , Liu Hongtao
Published: May 2021

Ultraviolet-B (UV-B) radiation has a wavelength range of 280–315 nm. Plants perceive UV-B as an environmental signal and a potential abiotic stress factor that affects development and acclimation. UV-B regulates photomorphogenesis including hypocotyl elongation inhibition, cotyledon expansion, and flavonoid accumulation, but high intensity UV-B can also harm plants by damaging DNA, triggering accumulation of reactive oxygen species, and impairing photosynthesis. Plants have evolved “sunscreen” flavonoids that accumulate under UV-B stress to prevent or limit damage. The UV-B receptor UV RESISTANCE LOCUS 8 (UVR8) plays a critical role in promoting flavonoid biosynthesis to enhance UV-B stress tolerance. Recent studies have clarified several UVR8-mediated and UVR8-independent pathways that regulate UV-B stress tolerance. Here, we review these additions to our understanding of the molecular pathways involved in UV-B stress tolerance, highlighting the important roles of ELONGATED HYPOCOTYL 5, BRI1-EMS-SUPPRESSOR1, MYB DOMAIN PROTEIN 13, MAP KINASE PHOSPHATASE 1, and ATM- and RAD3-RELATED. We also summarize the known interactions with visible light receptors and the contribution of melatonin to UV-B stress responses. Finally, we update a working model of the UV-B stress tolerance pathway.
Incorporating an unincorporated charity
Authors: Mills Matthew
Published: May 2021

Every year, a substantial number of trustees ‘convert’ their unincorporated charities to incorporated charities. However, there is surprisingly little guidance in charity law books on the powers that trustees have to make and give effect to the decision to incorporate. This article seeks to redress the balance. It will explain what incorporating a charity involves and why it is so popular. It will then set out the powers which charity trustees might have to incorporate an unincorporated charity and the methods for transferring the unincorporated charity’s assets.
Patterns of Seed-to-Seedling Transmission of Xanthomonas citri pv. malvacearum, the Causal Agent of Cotton Bacterial Blight
Authors: Mijatović Jovana , Severns Paul M. , Kemerait Robert C. , Walcott Ron R. , Kvitko Brian H.
Published: May 2021

Cotton bacterial blight (CBB), caused by Xanthomonas citri pv. malvacearum, was a major disease of cotton in the United States in the early part of the twentieth century. The reemergence of CBB revealed many gaps in our understanding of this important disease. In this study, we employed a wild-type (WT) field isolate of X. citri pv. malvacearum from Georgia (U.S.A.) to generate a nonpathogenic hrcV mutant lacking a functional type-III secretion system (T3SS−). We tagged the WT and T3SS− strains with an auto-bioluminescent Tn7 reporter and compared colonization patterns of CBB-susceptible and CBB-resistant cotton seedlings using macroscopic image analysis and bacterial load enumeration. WT and T3SS− X. citri pv. malvacearum strains colonized cotton cotyledons of CBB-resistant and CBB-susceptible cotton cultivars. However, X. citri pv. malvacearum populations were significantly higher in CBB-susceptible seedlings inoculated with the WT strain. Additionally, WT and T3SS− X. citri pv. malvacearum strains systemically colonized true leaves, although at different rates. Finally, we observed that seed-to-seedling transmission of X. citri pv. malvacearum may involve systemic spread through the vascular tissue of cotton plants. These findings yield novel insights into potential X. citri pv. malvacearum reservoirs for CBB outbreaks.
Characterization ofErwinia tracheiphilaBacteriophage FBB1 Isolated from Spotted Cucumber Beetles that VectorE. tracheiphila
Authors: Fu Benzhong , Zhai Yingyan , Gleason Mark , Beattie Gwyn A.
Published: May 2021

Erwinia tracheiphila, the causal pathogen of bacterial wilt of cucurbit crops, is disseminated by cucumber beetles. A bacteriophage, designated FBB1 (Fu-Beattie-Beetle-1), was isolated from spotted cucumber beetles (Diabrotica undecimpunctata) that were collected from a field in which E. tracheiphila is endemic. FBB1 was classified into the Myoviridae family based on its morphology, which includes an elongated icosahedral head (106 × 82 nm) and a putatively contractile tail (120 nm). FBB1 infected all 62 E. tracheiphila strains examined and three Pantoea spp. strains. FBB1 virions were stable at 55°C for 1 h and tolerated a pH range from 3 to 12. FBB1 has a genome of 175,994 bp with 316 predicted coding sequences and a GC content of 36.5%. The genome contains genes for a major bacterial outer-membrane protein, a putative exopolysaccharide depolymerase, and 22 predicted transfer RNAs. The morphology and genome indicate that FBB1 is a T4-like virus and thus in the Tevenvirinae subfamily. FBB1 is the first virulent phage of E. tracheiphila to be reported and, to date, is one of only two bacteriophages to be isolated from insect vectors of phytopathogens. Collectively, the results support FBB1 as a promising candidate for biocontrol of E. tracheiphila based on its virulent (lytic) rather than lysogenic lifestyle, its infection of all E. tracheiphila strains examined to date, and its infection of a few nonpathogenic bacteria that could be used to support phage populations when pathogen numbers are low.
Nonischemic cardiomyopathy with reduced ejection fraction secondary to hyperthyroidism
Authors: Martin Melanie M. , Collins Megan R.
Published: May 2021

Dilated cardiomyopathy is a form of heart failure characterized by left ventricular dilation with impaired systolic function. Causes may include ischemic heart disease, hypertensive heart disease, valvular heart disease, endocrine disorders, substance use, and viral diseases. This case report describes a patient with new-onset heart failure, initially diagnosed as idiopathic dilated cardiomyopathy with pericarditis secondary to a virus but later found to be secondary to hyperthyroidism.
Narcolepsy
Authors: Anderson Diana
Published: May 2021

Narcolepsy continues to be a significantly underdiagnosed/misdiagnosed condition worldwide. According to the National Institutes of Health (NIH), an estimated 135,000 to 200,000 patients in the United States are living with narcolepsy. However, due to the number of patients who either do not seek medical advice for their symptoms or receive an incorrect initial diagnosis at onset, this number may be higher. This article reviews the different subtypes of narcolepsy along with the pathophysiology, screening guidelines, clinical features, diagnosis, and management of the disorder. Educational awareness from a healthcare and patient standpoint can enhance early detection and accurate diagnosis of narcolepsy and improve patient quality of life.
PA job satisfaction and career plans
Authors: Halasy Michael P. , West Colin P. , Shanafelt Tait , O'Laughlin Danielle J. , Satele Daniel , Dyrbye Liselotte N.
Published: May 2021

Objective:

To understand the relationships between burnout, job satisfaction, and career plans among physician assistants in the United States.

Methods:

The authors surveyed PAs in 2016. The survey included the Maslach Burnout Inventory and items on job satisfaction and career plans.

Results:

Overall 82.7% of PAs were satisfied with their job, 32.2% indicated intent to leave their current position, and 19.5% reported intent to reduce work hours. On multivariate analysis, burnout increased the odds of job dissatisfaction, intent to reduce work hours within the next year, and intent to leave the current practice in the next 2 years.

Conclusions:

About a third of PAs indicated intent to leave their current practice and one in five indicated intent to reduce their clinical hours. Burnout was an independent predictor of job satisfaction and career plans.
External Validation of the Minimum Clinically Important Difference in the Timed-up-and-go Test After Surgery for Lumbar Degenerative Disc Disease
Authors: Maldaner Nicolai , Sosnova Marketa , Ziga Michal , Zeitlberger Anna M. , Bozinov Oliver , Gautschi Oliver P. , Weyerbrock Astrid , Regli Luca , Stienen Martin N.
Published: May 2021

Study Design.

Prospective observational cohort study.

Objective.

The aim of this study was to provide external validation of the minimum clinically important difference (MCID) of the Timed-up-and-go (TUG) test.

Summary of Background Data.

The TUG test is one of the best explored and most frequently applied objective task-based functional outcome measure in patients with lumbar degenerative disc disease (DDD). The increased use of the TUG test is based on its solid psychometric properties; however, an external validation of the originally determined MCID is lacking.

Methods.

Forty-nine patients with lumbar DDD, scheduled for elective spine surgery, were assessed pre- and 6-weeks (W6) postoperative. MCID values were calculate for raw TUG test times (seconds) and standardized TUG z scores using three different computation methods and the following established patient-reported outcome measures (PROMs) as anchors: Visual Analog Scales (VAS), Core Outcome Measures Index Back, Zurich Claudication Questionnaire (ZCQ).

Results.

The three computation methods generated a range of MCID values, depending on the PROM used as anchor, from 0.9 s (z score of 0.3) based on the VAS leg pain to 3.0 seconds (z score of 2.7) based on the ZCQ physical function scale. The average MCID of the TUG test across all anchors and computation methods was 2.1 s (z score of 1.5). According to the average MCID of raw TUG test values or TUG z scores, 41% and 43% of patients classified as W6 responders to surgery, respectively.

Conclusion.

This study confirms the ordinally reported TUG MCID values in patients undergoing surgery for lumbar. A TUG test time change of 2.1 seconds (or TUG z score change of 1.5) indicates an objective and clinically meaningful change in functional status. This report facilitates the interpretation of TUG test results in clinical routine as well as in research.

Level of Evidence: 3
Using Simulation to Teach Transitions of Care for Hospitalized Patients
Authors: Price Deborah M. , Ursuy Peggy A. , Bathish Melissa A.
Published: May 2021

Background

Understanding and facilitating the seamless and safe transitions of patients across high-acuity hospital settings are important for students to grasp in order to meet patient and family care needs.

Problem

Clinical placements do not always give students the opportunity to care for patients in various hospital settings or apply complex knowledge and skills learned in their didactic courses. Furthermore, the global pandemic has limited student clinical experiences in health care settings, underscoring the need for simulated clinical learning opportunities.

Approach

A multiscenario simulation using a high-fidelity human patient simulation manikin was incorporated into a senior-level capstone course. Simulated hospital settings included the (1) emergency department, (2) critical care unit, and (3) progressive care unit.

Outcome

Student evaluations revealed positive perceptions of learning, enhanced proficiency of clinical skills, and increased confidence regarding transitions of care. Faculty held agreeable opinions of the simulation's ease of facilitation and effectiveness as a teaching tool.

Conclusion

Application of complex knowledge and skills, understanding the use of bundles of care, and an appreciation for transitions of care hospitalized patients were successfully achieved.
Differential Diagnosis of Low Hemoglobin
Authors: Ianni Colleen M. , McDowall Megan P. , Zuska Inez A.
Published: May 2021

Background

A low hemoglobin level, commonly referred to as anemia, is frequently encountered in the acute care setting among patients with different comorbidities. It is essential that clinicians understand the pathophysiology of anemia to develop a practical differential diagnosis of the cause of the low hemoglobin level. A systematic approach should be used when determining the diagnosis to provide the correct treatment for the patient.

Objective

This article highlights the equal importance of the patient's history and laboratory values in arriving at the correct diagnosis of low hemoglobin level. The approach to diagnosis is described along with an algorithm to enable the clinician to quickly and effectively diagnose their patients.

Discussion

The differential diagnosis of low hemoglobin level is extensive, and some may be overlooked if an organized approach is not taken. For unstable patients, the diagnosis is usually clearer to the clinician. However, for a stable patient, the diagnosis may be difficult to obtain owing to the many causes of low hemoglobin level. The algorithm allows for easier navigation of the diagnostic process.
Eyebrow Transplantation Using Long Hair Follicular Unit Excision Technique
Authors: Park Jae Hyun , Kim Na Rae , Manonukul Kotchamol
Published: May 2021

Background:

Long hair follicular unit excision (LHF) allows surgeons to fully visualize hair curliness, which is crucial in eyebrow transplantation where matching curliness is a matter of utmost importance. In this study, we aimed to evaluate the clinical importance of LHF in eyebrow transplantation.

Methods:

A total of 36 patients who had undergone eyebrow transplantation surgery with LHF were enrolled. Twelve of the 36 patients had previously undergone unsatisfactory surgery at another clinic. Of these, 2 patients underwent complete laser eyebrow removal, and 3 patients underwent selective electro-cautery with unmatched hair curliness before surgery. The remaining 7 patients underwent surgery to increase eyebrow hair density or to reshape their eyebrows. A satisfaction survey was administered to patients > 6 months after the procedure.

Results:

All patients showed natural eyebrow transplant results at their follow-up visits and were satisfied with the results. Patient and surgeon satisfaction scores were 4.7 and 4.3, respectively. Four patients underwent a touch-up procedure to increase hair density with 21, 43, 12, and 45 follicular units, respectively, and were satisfied with the results. There were no cases of asymmetry or adverse events, such as folliculitis.

Conclusions:

The authors derived satisfactory results from the patients who underwent eyebrow transplantation by the LHF method. Therefore, we conclude that LHF is a suitable surgical method for eyebrow hair transplantation.
A Case of a Giant Congenital Melanocytic Nevus Treated by Curettage with the Application of Cultured Epidermal Autografts before 6 Months of Age
Authors: Fujito Hikaru , Yamanaka Hiroki , Tsuge Itaru , Katsube Motoki , Sakamoto Michiharu , Fujimoto Masakazu , Morimoto Naoki
Published: May 2021

Curettage is common in the treatment of a giant congenital melanocytic nevus (GCMN) in infants and should generally be performed before 6 months of age. Post-curettage retarded epithelialization often interferes with the ability to perform multiple operations within a short interval, and thus, it is difficult to treat large lesions in the neonatal period. We herein report a case of a GCMN comprising 20% of the total body surface area, which required multi-stage curettage, in which a cultured epithelial autograft was used to promote epithelialization of the post-curettage wound. The patient was a 1-month-old boy with a GCMN in his head, neck, chest, back, buttock, left upper arm, and a few satellite lesions. A four-stage operation was performed between 3 and 6 months of age; the cultured epithelial autograft took well after each operation, and complete epithelialization was observed at postoperative days 20, 23, 27, and 12, respectively. Seven months after the last surgery, hypertrophic scar formation was only observed in a small area of the left upper arm without axillary contracture. The color of the treated area improved, except for slight partial re-pigmentation. A skin biopsy was obtained from the re-pigmented area. The results demonstrated that nevus cells remained in the basal layer of the epidermis, hair follicles, and deep layer of the remaining dermis, suggesting that the recurrent nevus cells in the regenerated epidermis migrated from hair follicles. We conclude that the combination of curettage and the application of a cultured epithelial autograft is a promising option for GCMN treatment.
Composite Reparative Surgery of a Postoperative Through-and-through Facial Defect: Case Report
Authors: Abugaliyev Kabylbek R. , Anapiya Baurzhan B. , Samenova Dinara E.
Published: May 2021

We report our positive experience on the treatment of a patient with a composite facial maxillary defect. The stoma was formed following the removal of the adenoid cystic carcinoma of the maxillary sinus. We propose reconstruction repair of the postoperative facial maxillary defect using an inverted cutaneous flap and a split-thickness skin graft.
Essential Elements of Forensic Assertive Community Treatment
Authors: Lamberti J. Steven , Weisman Robert L.
Published: May 2021

Learning objective

After participating in this activity, learners should be better able to:

• Assess characteristics of forensic assertive community treatment programs

Forensic assertive community treatment (FACT) has emerged internationally as an intervention strategy for people with serious mental disorders who are involved with the criminal justice system. Studies to date have shown marked variability, however, in FACT program design and operation. Based upon a literature review and relevant experience, the authors present their perspective on the essential elements of FACT. Given that FACT is an adaptation of the evidence-based assertive community treatment (ACT) model, it is recommended that FACT programs maintain a high-fidelity ACT component. FACT programs should also have both mental health and criminal justice admission criteria because service recipients are involved in both service systems. For optimal effectiveness, FACT team clinicians must partner with criminal justice agencies that provide community-based supervision to their patients. Prospective FACT enrollees should receive a clear explanation of the program, including how their respective mental health and criminal justice service providers will work collaboratively with them to prevent incarceration. FACT programs should also use risk/need assessment to inform treatment planning, evidence-based mental health and community correctional practices to promote both wellness and public safety, and shared training to promote effective collaboration. Additional elements to consider include housing, medical care, and transitional services. These elements are presented and discussed, including a rationale and evidence to support each component. The article concludes with introduction of a FACT fidelity scale, the Rochester Forensic Assertive Community Treatment Scale (R-FACTS). By operationalizing essential FACT elements, the R-FACTS is designed to support FACT program development, implementation, and dissemination in a more consistent and measurable manner.
BILATERAL SPONTANEOUS VITREOUS BASE DETACHMENT IN A FEMALE PATIENT WITH NEUROFIBROMATOSIS TYPE 1
Authors: Jordan Valence A. , Gordon-Bennett Patel S. C.
Published: May 2021

Purpose:

We describe a unique case of bilateral spontaneous vitreous base detachment in a female patient with neurofibromatosis Type 1 and no known history of ocular injury. This serves to add further to the medical literature.

Discussion:

Vitreous base detachments usually occur after significant ocular trauma. There is only one other published case of this occurring spontaneously also in a female patient with neurofibromatosis Type 1.

Conclusion:

This suggests a rare association between neurofibromatosis Type 1 and spontaneous detachment of the vitreous base.
Atypical Pylephlebitis
Authors: Vanaparthy Rachana , Greene John N.
Published: May 2021

Pylephlebitis is also called suppurative thrombophlebitis of the portal venous mesenteric system. It is often seen as a complication of intra-abdominal infection, mainly diverticulitis and appendicitis. It is a rare disease with high mortality. Because of its nonspecific presentation, diagnosis is usually missed. So, it is important to consider pylephlebitis as one of the differential diagnoses if the patient presents with signs of abdominal sepsis. Pylephlebitis usually begins with thrombophlebitis of small veins draining an area of intra-abdominal infection and extends into larger veins that cause septic thrombophlebitis of the portal vein and further extending to mesenteric veins. Here, we present the case series of 6 patients older than 60 years who have underlying abdominal cancer at the Moffitt Cancer Center and Research Institute and review the literature.
Clinical characteristics, treatment, and prognosis of 74 2019 novel coronavirus disease patients in Hefei
Authors: Yang Jiazhao , Wu Kerong , Ding Ao , Li Li , Lu Hui , Zhu Wanbo , Xie Kai , Yao Ziqin , Fang Shiyuan
Published: May 2021

Since December 2019, pneumonia caused by a novel coronavirus (SARS-CoV-2), namely 2019 novel coronavirus disease (COVID-19), has rapidly spread from Wuhan city to other cities across China. The present study was designed to describe the epidemiology, clinical characteristics, treatment, and prognosis of 74 hospitalized patients with COVID-19.

Clinical data of 74 COVID-19 patients were collected to analyze the epidemiological, demographic, laboratory, radiological, and treatment data. Thirty-two patients were followed up and tested for the presence of the viral nucleic acid and by pulmonary computed tomography (CT) scan at 7 and 14 days after they were discharged.

Among all COVID-19 patients, the median incubation period for patients and the median period from symptom onset to admission was all 6 days; the median length of hospitalization was 13 days. Fever symptoms were presented in 83.78% of the patients, and the second most common symptom was cough (74.32%), followed by fatigue and expectoration (27.03%). Inflammatory indicators, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) of the intensive care unit (ICU) patients were significantly higher than that of the non-ICU patients (P < .05). However, 50.00% of the ICU patients had their the ratio of T helper cells to cytotoxic T cells (CD4/CD8) ratio lower than 1.1, whose proportion is much higher than that in non-ICU patients (P < .01).

Compared with patients in Wuhan, COVID-19 patients in Anhui Province seemed to have milder symptoms of infection, suggesting that there may be some regional differences in the transmission of SARS-CoV-2 between different cities.
Importance of early detection of infantile inflammatory bowel disease with defective IL-10 pathway
Authors: Hung Hua-Hsi , Lee Hung-Chang , Yeung Chun-Yan , Wang Nien-Lu , Tang Tzu-Yin , Winter Harland S. , Kelsen Judith R. , Jiang Chuen-Bin
Published: May 2021

Rationale:

Infantile inflammatory bowel disease (IBD) is an extremely rare subgroup of IBD that includes patients whose age of onset is younger than 2 years old. These patients can have more surgical interventions, and a severe and refractory disease course with higher rates of conventional treatment failure. Monogenic defects play an important role in this subgroup of IBD, and identification of the underlying defect can guide the therapeutic approach.

Patient concerns:

In 2007, a 4-month-old girl from a nonconsanguineous family presenting with anal fistula, chronic diarrhea, and failure to thrive. She underwent multiple surgical repairs but continued to have persistent colitis and perianal fistulas.

Diagnosis:

Crohn's disease was confirmed by endoscopic and histologic finding.

Intervention:

Conventional pediatric IBD therapy including multiple surgical interventions and antitumor necrosis factor alpha agents were applied.

Outcomes:

The patient did not respond to conventional pediatric IBD therapy. Interleukin-10 (IL-10) receptor mutation was discovered by whole-exome sequencing and defective IL-10 signaling was proved by functional test of IL-10 signaling pathway by the age of 12. The patient is currently awaiting hematopoietic stem cell transplantation.

Lessons:

Early detection of underlying genetic causes of patients with infantile-IBD is crucial, since it may prevent patients from undergoing unnecessary surgeries and adverse effects from ineffective medical therapies. Moreover, infantile-IBD patients with complex perianal disease, intractable early onset enterocolitis and extraintestinal manifestations including oral ulcers and skin folliculitis, should undergo genetic and functional testing for IL-10 pathway defect.
The efficacy and safety of acupuncture in the treatment of erectile dysfunction
Authors: Zhou Yuliang , Chen Shenghui , Zhang Duanjun , Lu Huiyu , Yao Wenliang , Jiang Wanxue , Yu Yinglv , Jiang Chaoren
Published: May 2021

Background:

Erectile dysfunction (ED) can negatively affect men's mental health, interpersonal relationships, and overall well-being. ED has affected >150 million men worldwide, and this number will reach approximately 322 million by 2025. Although PDE5-Is is a landmark in the treatment of erectile dysfunction, it may have side effects such as penile pain, cardiovascular dysfunction, and deafness. Some studies have shown that acupuncture may have a positive effect on the pathophysiology of ED. Therefore, we will select all randomized controlled trials related to evaluate the efficacy and safety of acupuncture treatment of ED.

Methods:

This study will systematically search 7 digital databases including China National Knowledge Infrastructure, Wanfang, VIP, China Biology Medicine, Cochrane Library, PubMed, and Embase for randomized controlled trials without language restrictions. Two researchers will independently read the title, abstract, and full text to screen for studies that can be included in the meta-analysis. If there is any dispute, the third party will be required to reach a consensus.

Results:

The purpose of this study is to evaluate the efficacy and safety of acupuncture in the treatment of ED and the difference in the impact of different types of acupuncture on ED.

Conclusion:

Judge whether acupuncture and moxibustion can help improve the symptoms of ED by evaluating relevant literatures, and make up for the lack of relevant research.

INPLASY registration number:

INPLASY 202140040
Prevalence and influencing factors of anxiety and depression symptoms among the first-line medical staff in Wuhan mobile cabin hospital during the COVID-19 epidemic
Authors: Zhang Xiao-Bo , Xiao Wei , Lei Jing , Li Ming-Xia , Wang Xin , Hong Yun-Jun , Xu Ping , Sun Juan
Published: May 2021

To investigate the prevalence of anxiety and depressive symptoms and the associated risk factors among first-line medical staff in Wuhan during the coronavirus disease 2019 (COVID-19) epidemic.

From March 5 to 15, 2020, the Hamilton Anxiety Scale and Hamilton Depression scale were used to investigate the anxiety and depression status of medical staff in Wuhan Cabin Hospital (a Hospital). Two hundred seventy-six questionnaires were received from 96 doctors and 180 nurses, including 79 males and 197 females.

During the COVID-19 epidemic, the prevalence rate of anxiety and depression was 27.9% and 18.1%, respectively, among 276 front-line medical staff in Wuhan. The prevalence rate of anxiety and depression among doctors was 19.8% and 11.5%, respectively, and the prevalence rate of anxiety and depression among nurses was 32.2% and 21.7%, respectively. Females recorded higher total scores for anxiety and depression than males, and nurses recorded higher scores for anxiety and depression than doctors.

During the COVID-19 epidemic, some first-line medical staff experienced mental health problems such as depression and anxiety. Nurses were more prone to anxiety and depression than doctors. Effective strategies toward to improving the mental health should be provided to first-line medical staff, especially female medical staff and nurses.
Graft kidney hydronephrosis caused by transplant ureter inguinal hernia
Authors: Chang Tian-You , Chang Chao-Hsiang , Lai Ping-Chin , Lin Wei-Ching
Published: May 2021

Rationale:

Ureteral obstruction of the graft kidney is a common complication of kidney transplantation. However, ureteral obstruction caused by inguinal hernia has rarely been reported. We present a rare case of ureteral obstruction with allograft dysfunction caused by an inguinal hernia.

Patient concerns:

A 76-year-old man, who was a renal transplant recipient, presented with bilateral pitting oedema, reduced urine output, and right inguinal hernia.

Diagnoses:

Abdominal computed tomography revealed severe hydroureteronephrosis of the kidney allograft. A right inguinal hernia with ureteral incarceration was observed.

Interventions:

The patient underwent graft percutaneous nephrostomy, followed by antegrade insertion of a double-J tube (DJ). Gradual improvement was observed in his renal function. Right inguinal herniorrhaphy was performed 5 days later.

Outcomes:

The renal function returned to normal after percutaneous nephrostomy and insertion of the DJ. A right inguinal direct-type hernia with ureter adhesion to the hernial sac was observed during the surgery. The posterior wall defect was repaired by the McVay technique. The DJ was removed after 1 month. The patient's renal function remained stable at 6-month follow-up.

Lessons:

The orientation of the graft kidney has a significant influence on the location of the ureter. Upward orientation of the hilum will result in superficial location of the ureter, rendering it close to the hernial sac and susceptible to incarceration. The transplant surgeon should be aware of such a presentation of graft dysfunction with inguinal hernia to prevent a delay in the diagnosis and graft loss.