bluuebunny/crossref_metadata_2025 huggingface dataset:
Short gamma-ray bursts within 200 Mpc
Authors: Dichiara S , Troja E , O’Connor B , Marshall F E , Beniamini P , Cannizzo J K , Lien A Y , Sakamoto T
Published: January 2020

We present a systematic search for short-duration gamma-ray bursts (GRBs) in the local Universe based on 14 yr of observations with the Neil Gehrels Swift Observatory. We cross-correlate the GRB positions with the GLADE catalogue of nearby galaxies, and find no event at a distance ≲100 Mpc and four plausible candidates in the range 100 Mpc ≲ D ≲ 200 Mpc. Although affected by low statistics, this number is higher than the one expected for chance alignments to random galaxies, and possibly suggests a physical association between these bursts and nearby galaxies. By assuming a local origin, we use these events to constrain the range of properties for X-ray counterparts of neutron star mergers. Optical upper limits place tight constraints on the onset of a blue kilonova, and imply either low masses ($\lesssim 10^{-3}\, \mathrm{M}_{\odot }$) of lanthanide-poor ejecta or unfavorable orientations (θobs ≳ 30 deg). Finally, we derive that the all-sky rate of detectable short GRBs within 200 Mpc is $1.3^{+1.7}_{-0.8}$ yr−1 (68 per cent confidence interval), and discuss the implications for the GRB outflow structure. If these candidates are instead of cosmological origin, we set a upper limit of ≲2.0 yr−1 (90 per cent confidence interval) to the rate of nearby events detectable with operating gamma-ray observatories, such as Swift and Fermi.
Stratified disc wind models for the AGN broad-line region: ultraviolet, optical, and X-ray properties
Authors: Matthews James H , Knigge Christian , Higginbottom Nick , Long Knox S , Sim Stuart A , Mangham Samuel W , Parkinson Edward J , Hewitt Henrietta A
Published: January 2020

The origin, geometry, and kinematics of the broad-line region (BLR) gas in quasars and active galactic nuclei (AGN) are uncertain. We demonstrate that clumpy biconical disc winds illuminated by an AGN continuum can produce BLR-like spectra. We first use a simple toy model to illustrate that disc winds make quite good BLR candidates, because they are self-shielded flows and can cover a large portion of the ionizing flux-density (ϕH-nH) plane. We then conduct Monte Carlo radiative transfer and photoionization calculations, which fully account for self-shielding and multiple scattering in a non-spherical geometry. The emergent model spectra show broad emission lines with equivalent widths and line ratios comparable to those observed in AGN, provided that the wind has a volume filling factor of fV ≲ 0.1. Similar emission line spectra are produced for a variety of wind geometries (polar or equatorial) and for launch radii that differ by an order of magnitude. The line emission arises almost exclusively from plasma travelling below the escape velocity, implying that ‘failed winds’ are important BLR candidates. The behaviour of a line-emitting wind (and possibly any ‘smooth flow’ BLR model) is similar to that of the locally optimally emitting cloud model originally proposed by Baldwin et al. (1995), except that the gradients in ionization state and temperature are large-scale and continuous, rather than within or between distinct clouds. Our models also produce UV absorption lines and X-ray absorption features, and the stratified ionization structure can partially explain the different classes of broad absorption line quasars.
Measuring mRNA translation in neuronal processes and somata by tRNA-FRET
Authors: Koltun Bella , Ironi Sivan , Gershoni-Emek Noga , Barrera Iliana , Hleihil Mohammad , Nanguneri Siddharth , Sasmal Ranjan , Agasti Sarit S , Nair Deepak , Rosenblum Kobi
Published: January 2020

In neurons, the specific spatial and temporal localization of protein synthesis is of great importance for function and survival. Here, we visualized tRNA and protein synthesis events in fixed and live mouse primary cortical culture using fluorescently-labeled tRNAs. We were able to characterize the distribution and transport of tRNAs in different neuronal sub-compartments and to study their association with the ribosome. We found that tRNA mobility in neural processes is lower than in somata and corresponds to patterns of slow transport mechanisms, and that larger tRNA puncta co-localize with translational machinery components and are likely the functional fraction. Furthermore, chemical induction of long-term potentiation (LTP) in culture revealed up-regulation of mRNA translation with a similar effect in dendrites and somata, which appeared to be GluR-dependent 6 h post-activation. Importantly, measurement of protein synthesis in neurons with high resolutions offers new insights into neuronal function in health and disease states.
Does non-invasive brain stimulation modulate emotional stress reactivity?
Authors: Smits Fenne M , Schutter Dennis J L G , van Honk Jack , Geuze Elbert
Published: January 2020

Excessive emotional responses to stressful events can detrimentally affect psychological functioning and mental health. Recent studies have provided evidence that non-invasive brain stimulation (NBS) targeting the prefrontal cortex (PFC) can affect the regulation of stress-related emotional responses. However, the reliability and effect sizes have not been systematically analyzed. In the present study, we reviewed and meta-analyzed the effects of repetitive transcranial magnetic (rTMS) and transcranial direct current stimulation (tDCS) over the PFC on acute emotional stress reactivity in healthy individuals. Forty sham-controlled single-session rTMS and tDCS studies were included. Separate random effects models were performed to estimate the mean effect sizes of emotional reactivity. Twelve rTMS studies together showed no evidence that rTMS over the PFC influenced emotional reactivity. Twenty-six anodal tDCS studies yielded a weak beneficial effect on stress-related emotional reactivity (Hedges’ g = −0.16, CI95% = [−0.33, 0.00]). These findings suggest that a single session of NBS is insufficient to induce reliable, clinically significant effects but also provide preliminary evidence that specific NBS methods can affect emotional reactivity. This may motivate further research into augmenting the efficacy of NBS protocols on stress-related processes.
‘“These Findings Confirm Conclusions Many Have Arrived at by Intuition or Common Sense”: Water, Quantification and Cost-effectiveness at the World Bank, ca. 1960 to 1995’
Authors: McMillen Christian
Published: January 2020

Providing clean water and sanitation was based on the common-sense notion that each had obvious benefits. Overcoming uncertainty, achieving precision, and quantifying the effects of clean water and sanitation came to dominate thinking on water and sanitation in the 1980s. As cost effectiveness analysis infiltrated global health the broad goal of providing clean water and adequate sanitation diminished in importance as short term solutions like Oral Rehydration Therapy prevailed. Seeking cost-effective solutions to large scale problems in global health while also wanting to quantify their benefits has common-sense appeal. But when it comes to water and sanitation cost effectiveness analysis has confronted at least one insurmountable challenge: quantifying the benefits of water and sanitation is, and has always, been notoriously difficult. It is intuitive that clean water and adequate sanitation contribute to good health. Quantifying the effects, as we will see, are all but impossible.
Mitigation of Long-Term Human Capital Losses from Natural Disasters: Evidence from the Philippines
Authors: Herrera-Almanza Catalina , Cas Ava
Published: January 2020

The detrimental effects of natural disasters on human capital during childhood are well-documented. However, little is known about whether, and to what extent, these impacts can be mitigated in the long term. This study analyzes whether a school infrastructure program can mitigate the adverse effects of extreme weather shocks on long-term children's education and labor market outcomes. This article uses a triple difference model that exploits the geographic variation of super-typhoons combined with the age-cohort exposure to, and spatial variation of, a secondary school infrastructure program in the Philippines. This study finds that the school infrastructure program almost entirely mitigated the negative effect of typhoons on educational attainment. These differential effects of the program on education among typhoon-affected children are also associated with their higher likelihood of working in a high-skilled occupation, in the non-agricultural sector, and of migrating overseas.
Resistance of New Zealand Provenance Leptospermum scoparium, Kunzea robusta, Kunzea linearis, and Metrosideros excelsa to Austropuccinia psidii
Authors: Smith Grant R. , Ganley Beccy J. , Chagné David , Nadarajan Jayanthi , Pathirana Ranjith N. , Ryan Julie , Arnst Elise A. , Sutherland Roanne , Soewarto Julia , Houliston Gary , Marsh Alby T. , Koot Emily , Carnegie Angus J. , Menzies Tracey , Lee David J. , Shuey Louise S. , Pegg Geoff S.
Published: January 2020

Resistance to the pandemic strain of Austropuccinia psidii was identified in New Zealand provenance Leptospermum scoparium, Kunzea robusta, and K. linearis plants. Only 1 Metrosideros excelsa-resistant plant was found (of the 570 tested) and no resistant plants of either Lophomyrtus bullata or L. obcordata were found. Three types of resistance were identified in Leptospermum scoparium. The first two, a putative immune response and a hypersensitive response, are leaf resistance mechanisms found in other myrtaceous species while on the lateral and main stems a putative immune stem resistance was also observed. Both leaf and stem infection were found on K. robusta and K. linearis plants as well as branch tip dieback that developed on almost 50% of the plants. L. scoparium, K. robusta, and K. linearis are the first myrtaceous species where consistent infection of stems has been observed in artificial inoculation trials. This new finding and the first observation of significant branch tip dieback of plants of the two Kunzea spp. resulted in the development of two new myrtle rust disease severity assessment scales. Significant seed family and provenance effects were found in L. scoparium, K. robusta, and K. linearis: some families produced significantly more plants with leaf, stem, and (in Kunzea spp.) branch tip dieback resistance, and provenances provided different percentages of resistant families and plants. The distribution of the disease symptoms on plants from the same seed family, and between plants from different seed families, suggested that the leaf, stem, and branch tip dieback resistances were the result of independent disease resistance mechanisms.
Navicular Body Fractures—Surgical Treatment and Radiographic Results
Authors: Sanders Roy , Serrano Rafael
Published: January 2020

Objective:

To assess injury patterns and outcomes after navicular fractures.

Design:

Retrospective radiographic review using the Schmid classification.

Setting:

Academic Level 1 Trauma Center;

Patients/Participants:

Thirty-nine navicular fractures associated with additional foot injuries.

Intervention:

Open reduction internal fixation.

Main Outcome Measurements:

Radiographic evaluation of nonunion, malunion, and post-traumatic arthritis; secondary operations.

Results:

A total of 12/18 (67%) Schmid type II fractures healed without complications. Ten fractures were treated with tension band plates (56%) and 8 with screws (44%). Three complications were in cases treated with screws (3/8 = 37.5%). No case went on to develop avascular necrosis. In the 21 Schmid type III fractures, radiographic results were uniformly poor. Only 3 healed after the index procedure without evidence of radiographic post-traumatic arthritis. Four required a primary talonavicular (TN) fusion for an unreconstructable articulation found at the time of the index surgical treatment. The remaining 14 (67%) all had radiographic evidence of severe collapse, end-stage post-traumatic arthritis, and/or a significant midfoot deformity at the time of follow-up examination. Three of these required a late triple arthrodesis.

Conclusion:

Type II navicular body fractures are substantial injuries in which the amount of comminution belies the amount of damage to the talonavicular articulation. Tension band plate augmentation seemed to keep the navicular fracture secure and prevent lag screw loosening. Schmid type III navicular body fractures are devastating injuries. They are associated with additional severe trauma to the foot and require extensive surgical reconstruction of the medial column, lateral column, or both. Residual problems should be expected and may not be due to the navicular injury, but rather to the associated fractures and dislocations. Patients should be aware that their foot will be stiff and may require further reconstructive treatment.

Level of Evidence:

Level IV. See Instructions for Authors for a complete description of levels of evidence.
Effect of Elevated Calcium Score on Normal Myocardial Perfusion Study on Clinician Management of Coronary Artery Disease Risk Factors
Authors: Wokhlu Anita , Wymer David , Taasan Vicente , Winchester David E.
Published: January 2020

Elevated coronary artery calcification (CAC) scores are associated with higher cardiovascular (CV) risk even with normal stress myocardial perfusion imaging (MPI). Whether referring providers appropriately manage subclinical CV disease is unclear. We hypothesized that ordering clinicians would intensify medical therapy for CV disease in response to normal MPI and CAC ≥ 300. We conducted a cohort study on patients without known CV disease who underwent MPI and CAC scoring. Medical management of CV disease and clinical outcomes were assessed. Of 299 patients who underwent stress MPI, 62 patients had normal MPI and CAC ≥ 300. Documentation of elevated CAC score was noted in the final interpretation for 52% (n = 32) of MPI reports. During follow-up, treatment change in aspirin, cholesterol medications, and/or antihypertensive medication was made in 40% of these patients. Aspirin use increased from 71% to 82% (P < 0.001); statin use increased from 68% to 76% (P < 0.001). Several patients remained on suboptimal lipid or antiplatelet regimens without documented contraindication. Among patients with normal MPI, many have CAC ≥ 300. Not all MPI reports adequately call attention to this finding associated with elevated CV risk. Despite the elevated CAC score, some patients were not optimized medically.
Successful Treatment of a Severe Vision-Threatening Paradoxical Tuberculous Reaction with Infliximab
Authors: Abo Yara-Natalie , Curtis Nigel , Butters Coen , Rozen Thomas H. , Marais Ben J. , Gwee Amanda
Published: January 2020

A 7-year-old girl with tuberculous (TB) meningitis developed optochiasmatic arachnoiditis, a vision-threatening paradoxical reaction, after starting TB treatment including adjunctive steroid therapy. She was treated with infliximab with complete recovery. This is the first report of the use of a tissue necrosis factor α inhibitor for the treatment of a severe paradoxical TB reaction in a child.
A Systematic Review of Cochlear Implant Outcomes in Prelingually-deafened, Late-implanted Patients
Authors: Pattisapu Prasanth , Lindquist Nathan R. , Appelbaum Eric N. , Silva Rodrigo C. , Vrabec Jeffrey T. , Sweeney Alex D.
Published: January 2020

Objective:

To analyze outcomes of cochlear implantation (CI) in prelingually-deafened, late-implanted patients.

Data Sources:

A search of MEDLINE and EMBASE was performed in February 2018 using SCOPUS for the intersection of “cochlear implant,” “prelingual,” “deaf,” and “delay.”

Review Methods:

Two independent reviewers screened all abstracts and titles for relevance, with conflicts resolved by either the primary or senior author. All articles passing this screen were subjected to a full-text review, during which the primary and senior author each examined manuscripts for inclusion and exclusion criteria. The Cochrane Risk of Bias Assessment Tool was used to assess potential sources of systematic error, and postoperative clinical outcomes were collected at the latest clinical follow-up.

Results:

Twenty-eight articles were yielded in the final systematic review, accounting for 542 patients. For open-set sentence scores, 10 studies representing 240 patients showed an overall estimated improvement of 44.6% (95% CI: 38.0–51.2%). In terms of quality of life, studies generally showed improvement when looking at specific emotional, social, or hearing-specific domains, but not in global measures. Nonuser rates ranged from 0 to 9.5%.

Conclusion:

Despite performance that is generally poorer than what is generally seen in “traditional” candidates, prelingually-deafened, late-implanted (PL-LI) CI users can experience benefit in terms of both QOL and audiometric scores. The wide range of performance that is reported in the literature highlights the importance of careful patient counseling.
Contextualizing the Modern Epidemiology of Neurofibromatosis Type 2 in an Era of Heightened Detection of Sporadic Vestibular Schwannoma
Authors: Dowling Eric M. , Marinelli John P. , Lohse Christine M. , Carlson Matthew L.
Published: January 2020

Objective:

Closely paralleling previous radiologic studies, recent population-based prevalence data suggest sporadic vestibular schwannoma (VS) affects over one in 2,000 adults and up to one in 500 in those aged 70 years or older. Attributable to increased utilization of magnetic resonance imaging and screening protocols for asymmetrical sensorineural hearing loss, the increasing detection rate of sporadic VS fundamentally changes the perception of VS as a whole. The primary objective of the current study was to contextualize modern epidemiological trends in neurofibromatosis type 2 (NF2) in light of these recent advancements in the understanding of sporadic VS.

Study Design:

Population-based study.

Setting:

Olmsted County, Minnesota. Population size on January 1, 2017: 159,689 people.

Patients:

All patients with NF2 diagnosed between Jan 1, 1966 and Dec 31, 2016, identified using the Rochester Epidemiology Project.

Main Outcome Measures:

Incidence, prevalence.

Results:

Six incident cases were identified over the past 50 years. From 1966 to 2016, the age- and sex-adjusted incidence rate was 0.10 per 100,000 person-years. The incidence rate remained at 0.12 over the most recent decade. Five cases met disease prevalence criteria, and the age- and sex-adjusted prevalence of NF2 on Jan 1, 2017 was 3.1 per 100,000 persons. All prevalent cases were women, and the resultant prevalence among women only was 6.0 per 100,000 persons.

Conclusions:

The modern age- and sex-adjusted incidence rate and prevalence of NF2 is 0.10 per 100,000 person-years and 3.1 per 100,000 persons, respectively. In contrast to trends in incidence rates of sporadic VS over the last half-century, this study demonstrates that the incidence of NF2 has remained relatively stable since 1966. This divergence in epidemiological trends is likely attributed to the nature of NF2, with early clinical manifestations resulting in diagnosis regardless of modern advances, whereas the increased incidence of sporadic VS is heavily influenced by improved detection in a greater population of patients with minimally symptomatic or asymptomatic tumors.
Trends in Age of Cochlear Implant Recipients, and the Impact on Perioperative Complication Rates
Authors: Fakurnejad Shayan , Vail Daniel , Song Yohan , Alyono Jennifer , Blevins Nikolas H.
Published: January 2020

Objective:

The aim of the study is to examine trends in the age of patients receiving cochlear implants and to determine the effect of age on the rate of perioperative complications.

Study Design:

Retrospective analysis of deidentified administrative claims data from a US commercial insurance database (Optum).

Patients:

Individuals undergoing cochlear implantation between 2003 and 2016.

Setting:

US hospital and outpatient facilities serving commercially insured patients.

Intervention:

Cochlear implantation.

Main Outcome Measures:

Age at implantation, incidence of perioperative complications within 30 days identified by ICD9/10 codes including device problems, myocardial infarction, stroke, venous thromboembolism, local infection, meningitis, stroke, cerebrospinal fluid leak, and facial weakness.

Results:

Between 2003 and 2016, 3420 patients underwent a total of 4154 cochlear implants. The number of implants per year increased annually from 171 in 2003 to 531 in 2016, with the greatest growth demonstrated in those aged 60 and older.

The age of patients undergoing implantation increased annually from an average of 26.6–57.2 years (p < 0.001). The implantation rates from 2003 to 2016, per 100,000 enrollees, increased from 1.64 to 6.82 for patients 60–79 years of age, and 0 to 11.57 for patients greater than 80 years of age (p < 0.001). No significant differences in 30-day complication rates were found between patients when grouped by age in decades, except for device related problems, which was significantly higher in younger patients (<18 years).

Conclusion:

Over the past decade and a half, cochlear implantation is more frequently being performed, and in an increasingly aging population. This trend does not seem to alter the risk of perioperative complications.
Aggressive Hydration With Lactated Ringer Solution in Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis
Authors: Zhang Zhi-Feng , Duan Zhi-Jun , Wang Li-Xia , Zhao Gang , Deng Wu-Guo
Published: January 2020

Background:

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The results of previous studies evaluating aggressive hydration with lactated Ringer solution for reducing the incidence of post-ERCP pancreatitis (PEP) are inconsistent.

Aim:

We performed a meta-analysis to determine whether aggressive hydration with lactated Ringer solution reduced PEP.

Methods:

Randomized controlled trials (RCTs) comparing aggressive hydration with standard hydration with the same lactated Ringer solution for prophylaxis of PEP were searched in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. ClinicalTrial.gov and International Standard Randomised Controlled Trial Number registry were also searched for unpublished studies. A meta-analysis was conducted in accordance with the Cochrane Handbook for Systemic Reviews of Intervention.

Results:

A total of 7 RCTs with 1047 participants were included into this meta-analysis. Meta-analysis showed that aggressive hydration reduced the incidence of PEP as compared with standard hydration [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.30-0.72; P=0.0006]. Aggressive hydration also reduced the incidence of post-ERCP hyperamylasemia as compared with standard hydration (OR, 0.38; 95% CI, 0.25-0.59; P<0.00001). No difference of adverse effects was found between aggressive hydration and standard hydration (OR, 0.48; 95% CI, 0.15-1.57; P=0.23). Sensitivity analyses showed that neither alternative effect measures nor statistical models regarding heterogeneity affected the conclusions of this meta-analysis. Sensitivity analyses also showed that omitting 1 study from analysis did not change the conclusion of this meta-analysis.

Conclusions:

On the basis of this meta-analysis of RCTs, aggressive hydration with lactated Ringer solution is an effective and safe therapy for prophylaxis of PEP.
Comparison of Two Diagnostic Criteria for Hepatopulmonary Syndrome–High Prevalence in Biliary Atresia
Authors: Snehavardhan Pandey , Khanna Rajeev , Lal Bikrant B. , Sood Vikrant , Sood Arun K. , Alam Seema
Published: January 2020

Objectives:

There is lack of clarity regarding the exact prevalence of hepatopulmonary syndrome (HPS) in pediatric liver diseases owing to lack of standardized diagnostic criteria. Thus, we aimed to do a comparative study of HPS with respect to its prevalence using the available diagnostic criteria.

Methods:

All consecutive children with biliary atresia (BA) and other chronic liver diseases (CLDs) were studied. Prevalence of HPS was compared using the 2 available criteria: demonstration of intrapulmonary vascular dilatation along with either alveolar‐arterial oxygen difference (P [A‐a] O2) on arterial blood gas analysis of more than 15 mmHg (criteria 1), or higher than age‐appropriate calculated value for P (A‐a) O2 (criteria 2).

Results:

A total of 42 children in BA group and 62 in the non‐BA CLD group were included. Using the criteria 1, the prevalence of HPS was 42.3%: 57.1% in the BA group and 32.2% in the CLD group, whereas using criteria 2, the prevalence was 48.1%: 61.9% in the BA group and 38.7% in the CLD group. Criteria 2 diagnosed 6 additional patients with HPS compared to criteria 1 (P value 0.405). BA subjects had higher risk (2.9–3 folds) of developing HPS compared to other CLDs.

Conclusion:

There is high prevalence of HPS in pediatric liver disease subjects. Age‐appropriate formula for HPS diagnosis may be better applicable in pediatric population. BA subjects have a higher risk of developing HPS compared to other CLDs overall, irrespective of the severity of liver disease and/or portal hypertension.
Aberrant Distributions of Collagen I, III, and IV in Hirschsprung Disease
Authors: Gao Ni , Wang Jian , Zhang Qiangye , Zhou Tingting , Mu Weijing , Hou Peimin , Wang Dongming , Lv Xiaona , Li Aiwu
Published: January 2020

Background:

Hirschsprung disease (HSCR) is the most common congenital gut motility disorder, involving a severe anomaly of the enteric nervous system, and is characterized by functional intestinal obstruction due to lack of intrinsic innervation (aganglionosis) in the distal bowel.

Objective:

The aim of this study was to examine the distribution patterns of collagens I (Col I), III (Col III), and IV (Col IV) in the enteric nervous system of HSCR patients, to determine whether or not collagen levels are altered in the aganglionic bowel.

Methods:

We measured the expression levels of Col I, Col III, and Col IV in colonic muscle from 129 children with HSCR. The localizations of the 3 collagens and myenteric ganglia were assessed morphologically by immunofluorescence staining. western blots and real‐time fluorescence quantitative polymerase chain reaction were performed to examine the relative levels of these collagens in aganglionic, transitional, and ganglionic colon segments.

Results:

Immunoreactivities of Col I and Col III were high around and within myenteric ganglia in the ganglionic segment, moderate in the transitional segment, and weak in the aganglionic segment. Col IV immunoreactivity showed the opposite pattern, being lowest in the ganglionic segment and highest in the aganglionic segment.

Conclusion:

Col I and Col III are decreased and Col IV is increased in the distal colon of patients with HSCR.
PrEP Implementation Behaviors of Community-Based HIV Testing Staff: A Mixed-Methods Approach Using Latent Class Analysis
Authors: Turner DeAnne , Lockhart Elizabeth , Wang Wei , Shore Robert , Daley Ellen M. , Marhefka Stephanie L.
Published: January 2020

Background:

Pre-exposure Prophylaxis (PrEP) is an important option for HIV prevention, but the approach has reached a limited number of people at risk of HIV infection.

Methods:

A mixed-methods concurrent triangulation design was used to investigate unobserved subgroups of staff who provide community-based, publicly funded HIV testing in Florida (USA). PrEP implementation groups, or classes, were determined using latent class analysis. Generalized linear mixed models were used to estimate PrEP implementation as a function of staff characteristics. In-depth interviews based on the Consolidated Framework for Implementation Research were analyzed thematically.

Results:

Based on fit statistics and theoretical relevance, a 3-class latent class analysis was selected. Class 1 (“Universal”) staff were highly likely to talk about PrEP with their clients, regardless of client eligibility. Class 2 (“Eligibility dependent”) staff were most likely to discuss PrEP if they believed their client was eligible. Class 3 (“Limited”) staff sometimes spoke to clients about PrEP, but not systematically. In multivariate analyses, only race and sexual orientation remained significant predictors of the PrEP implementation group. Staff who identified as a racial or sexual minority were less likely to be in the Limited group than their heterosexual or white counterparts. Age, gender, ever having taken PrEP, and HIV status did not impact the odds of being in a specific PrEP implementation group.

Conclusions:

A subset of HIV testing staff differentially discuss PrEP based on perceived client eligibility; others inconsistently talk to clients about PrEP. Targeted training based on PrEP implementation groups may be beneficial.
Spectrum of Early Postoperative Multidetector Computed Tomography Findings Following Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy
Authors: Boegel Kevin H. , Gaertner Wolfgang , Sharma Sandeep , Sanghvi Tina , Spilseth Benjamin
Published: January 2020

Objective

To review and describe imaging findings on multidetector computed tomography in the early postoperative period after cytoreductive surgery with concomitant hyperthermic intraperitoneal chemotherapy (CRS + HIPEC).

Methods

This was a retrospective review of consecutive patients undergoing early (≤60 days) postoperative abdominopelvic multidetector computed tomography scans after CRS + HIPEC from 2014 to 2018 at a single institution. Two radiologists separately assessed bowel wall thickening, bowel wall enhancement, bowel dilation, ascites, and pleural effusion(s) and identified any other significant finding(s).

Results

Thirty-two patients met the inclusion criteria. The majority of patients demonstrated bowel wall thickening (53%; n = 17) and ascites (72%; n = 23), whereas postoperative ileus (35%; n = 10), pleural effusion(s) (24%; n = 7), and bowel wall hyperenhancement (6%; n = 1) were less common. Significant findings included anastomotic leak/perforation (13%; n = 4), fistula (13%; n = 4), abscess (13%; n = 4), and bladder leak (6%; n = 2).

Conclusions

Multidetector computed tomography is an excellent imaging modality to identify common postoperative findings as well as complications following CRS + HIPEC.
Semiautomated Renal Cortex Volumetry in Spectral Computed Tomography: Effect of Monoenergetic Reconstructions on Measurement Precision and Interobserver Variability
Authors: Houbois Christian , Haneder Stefan , Merkt Martin , Morelli John , Weiss Kilian , Hellmich Martin , Chon Seung-Hun , Maintz David , Püsken Michael
Published: January 2020

Objective

The aim of this study was to determine the influence of virtual monoenergetic images (vMEIs) on renal cortex volumetry (RCV) and estimation of split-renal function.

Methods

Twenty-five patients (mean ± SD, 64.7 ± 9.9 years) underwent a contrast-enhanced dual-layer spectral detector computed tomography. Images were reconstructed with a reference standard (iterative model reconstruction, IMRRef), a newly spectral detector computed tomography algorithm (SPcon) and vMEI at 40, 60, 80, 100, and 120 keV. Two blinded independent readers performed RCV on all data sets with a semiautomated tool.

Results

Total kidney volume was up to 15% higher in vMEI at 40/60 keV compared with IMRRef (P < 0.001). Total kidney volume with vMEI at 80/100 keV was similar to IMRRef (P < 0.001). Split-renal function was similar in all reconstructions at approximately 50% ± 3%. Bland-Altman analysis showed no significant differences (P > 0.05), except for 40 keV versus SPcon (P < 0.05). The time required to perform RCV was reasonable, approximately 4 minutes, and showed no significant differences among reconstructions. Interreader agreement was greatest with vMEI at 80 keV (r = 0.68; 95% confidence interval, 0.39–0.85; P < 0.0002) followed by IMRRef images (r = 0.67; 95% confidence interval, 0.37–0.84; P < 0.0003). IMRRef showed the highest mean Hounsfield unit for cortex/medulla of 223.4 ± 73.7/62.5 ± 19.7 and a ratio of 3.7.

Conclusions

Semiautomated RCV performed with vMEI and IMRRef/SPcon is feasible and showed no clinically relevant differences with regard to split-renal function. Low–kiloelectron volt vMEI showed greater tissue contrast and total kidney volume but no benefit for RCV. Moderate–kiloelectron volt vMEI (80 keV) results were similar to IMRRef with a faster postprocessing time.
Contribution of Reformatted Multislice Temporal Computed Tomography Images in the Planes of Stenvers and Pöschl to the Diagnosis of Superior Semicircular Canal Dehiscence
Authors: Duman Ismail Sinan , Dogan Sebahat Nacar
Published: January 2020

Objective

In the diagnosis of superior semicircular canal dehiscence (SSCD), computed tomography (CT) is the only imaging method. The aims of the study were to show that reformat images are more accurate than standard planes for diagnosis of SSCD and to determine the prevalence of SSCD.

Methods

The retrospective review yielded 1309 temporal CTs performed in our radiology department for any reason. Two radiologist interpreted CTs in standard planes collaboratively. Patients with SSCD were reinterpreted in Pöschl and Stenvers planes by 2 radiologists separately.

Results

Statistical analysis was made by accepting that 2 radiologists diagnosis were accurate in Pöschl plane. Coronal plane sensitivity 86%, specificity 64%, Stenvers plane sensitivity 96%, and specificity 52% have been found in the mean result of 2 observers (P < 0.001).

Conclusions

In the diagnosis of SSCD, standard and Stenvers planes can cause false-negative and false-positive diagnoses. Interpretation in Pöschl plane can significantly increase sensitivity, specificity, negative, and positive predictive values for diagnosing dehiscence.
Patient Based Bull's Eye Map Display of Coronary Artery and Ventricles From Coronary Computed Tomography Angiography
Authors: Fukushima Kenji , Matsuo Yuka , Nagao Michinobu , Sakai Akiko , Kihara Nobuyuki , Onishi Koji , Sakai Shuji
Published: January 2020

Coronary computed tomography angiography is widely used in clinical practice. Although 3-dimensional (D) volume rendering is useful for interpretation of coronary path and territory, 2D output is common for image interpretation. Most picture archiving and communication system is incapable of manipulating 3D due to insufficient graphic specification. Thus, 2D bull's eye map display is frequently used in cardiac imaging. We developed a bull's eye map which emulated the anatomical information of individual coronary path and dominancy.
Quantitative Analysis of Lower Leg Muscle Enhancement Measured From Dynamic Computed Tomographic Angiography for Diagnosis of Peripheral Arterial Occlusive Disease
Authors: Zhou Xueyan , Zhang Daming , Zhang Haiping , Lin Zehong , Fan Xiaobing , Jin Zhengyu
Published: January 2020

Objectives

The purpose of this study was to evaluate whether quantitative analysis of lower leg muscle enhancement measured from dynamic computed tomographic angiography (dyn-CTA) could be used for diagnosis of peripheral arterial occlusive disease.

Methods

Patients (N = 35) with known peripheral arterial occlusive disease underwent the dyn-CTA of calves first. Five minutes later, standard CTA of the peripheral runoff from the diaphragm to the toes was performed. A runoff score was assigned by radiologists as a reference standard for each of 4 lower leg artery segments. The lower leg muscle enhancement measured from the dyn-CTA was analyzed by using quantitative kinetic parameters, including initial enhancement (E
1), peak enhancement (E
peak), and enhancement ratio (E
R) calculated from average time attenuation curves. In addition, histogram of lower leg muscle enhancement was evaluated by using the first enhanced phase images.

Results

Lower extremities were diagnosed as a normal group (n = 22) with each vessel segment score equals to 1 or lower and runoff score, 7 or lower, and otherwise as an ischemia group (n = 48). Average ± SD E
1 is 91.4% ± 8.5% and 82.3% ± 10.7%, E
peak is 122.7% ± 10.4% and 115.6% ± 11.1%, and E
R is 0.75 ± 0.05 and 0.72 ± 0.09 for normal and ischemia group, respectively. Statistical analysis showed that average E
1 and E
peak for the ischemia group were significantly lower (P < 0.05) than the normal group. The histogram analysis demonstrated that mean and median of muscle enhancement in the ischemia group were significantly smaller (P < 0.05), and coefficient of variation (CV) was significantly larger (P < 0.05) than the normal group. There were weak negative correlations (r = −0.42, P < 0.05) between runoff scores and E
1 and E
peak, and weak positive correlation (r = 0.40, P < 0.05) between runoff scores and CV. The receiver operating characteristics analysis between the 2 groups had area under the curve of 0.77 and 0.76 for E
1 and CV, respectively.

Conclusions

Lower leg muscle enhancement measured from the dyn-CTA could be assessed quantitatively to assist diagnosis of ischemia in clinical practice.
Computed Tomography–Based Radiomic Features for Diagnosis of Indeterminate Small Pulmonary Nodules
Authors: Liu Qin , Huang Yan , Chen Huai , Liu Yanwen , Liang Ruihong , Zeng Qingsi
Published: January 2020

Objective

This study aimed to determine the potential of radiomic features extracted from preoperative computed tomography to discriminate malignant from benign indeterminate small (≤10 mm) pulmonary nodules.

Methods

A total of 197 patients with 210 nodules who underwent surgical resections between January 2011 and March 2017 were analyzed. Three hundred eighty-five radiomic features were extracted from the computed tomographic images. Feature selection and data dimension reduction were performed using the Kruskal-Wallis test, Spearman correlation analysis, and principal component analysis. The random forest was used for radiomic signature building. The receiver operating characteristic curve analysis was used to evaluate the model performance.

Results

Fifteen principal component features were selected for modeling. The area under the curve, sensitivity, specificity, and accuracy of the prediction model were 0.877 (95% confidence interval [CI], 0.795–0.959), 81.8% (95% CI, 72.0%–90.9%), 77.4% (95% CI, 63.9%–89.3%), and 80.0% (95% CI, 72.0%–86.7%) in the validation cohort, respectively.

Conclusions

Computed tomography–based radiomic features showed good discriminative power for benign and malignant indeterminate small pulmonary nodules.
En-Bloc Simultaneous Heart–Liver Transplantation in Adult Patients
Authors: Brozzi Nicolas A. , Loebe Matthias , Souki Fouad Ghazi , Beduschi Thiago , Ghodzisad Ali , Tekin Akin , Nicolau-Raducu Ramona , Vianna Rodrigo M.
Published: January 2020

Introduction:

Complexity of combined heart–liver transplantation has resulted in low adoption rates. We report a case series of adult patients receiving en-bloc heart–liver transplantation (HLTx), describe technical aspects, and discuss benefits of the technique.

Methods:

Retrospective review of patients receiving en-bloc HLTx over 18 months, with clinical follow up to 1 year. Primary outcomes included postoperative mortality and major complications. Secondary outcomes included 1-year survival, cardiac or hepatic allograft rejection, and infection.

Results:

Five patients received en-bloc HLTx. Mean recipient age was 43 years (26–63), and 3 patients were male. Total operative time was 430 minutes (393–480), cold and warm ischemic times of 85 (32–136) and 37.5 (31–47) minutes. Hospital survival was 80%. One patient died on postoperative day 55 due to fungal sepsis. Major postoperative complications included prolonged mechanical ventilation in 2 of 5 patients (40%), and renal insufficiency requiring hemodialysis in 2 of 5 patients (40%). Among patients discharged from hospital 1-year survival was 100%, with no evidence of rejection or infectious complications.

Conclusion:

En-bloc HLTx technique is a safe and effective strategy, decreasing operative times, and allograft ischemic times, whereas offering protection of implanted allografts during early stages of reperfusion while patient is hemodynamically supported on cardiopulmonary bypass.
Influence of Intraoperative Transesophageal Echocardiography and Pulmonary Artery Catheter Monitoring on Outcomes in Liver Transplantation
Authors: Hofer Ryan E. , Vogt Matthew N.P. , Taner Timucin , Findlay James Y.
Published: January 2020

Background.

Anesthetic management of orthotopic liver transplantation (OLT) can be challenging. Management involves responding to sudden hemodynamic shifts, addressing instability, and performing ongoing volume assessment. To best prepare for these perturbations, various monitors are used intraoperatively. We sought to explore the impact of transesophageal echocardiography (TEE) and pulmonary artery catheter (PAC) use on outcomes of patients undergoing OLT.

Methods.

We retrospectively reviewed records of patients who underwent OLT at a single institution and included all who were monitored intraoperatively with TEE alone, PAC alone, or both methods concurrently (TEE + PAC). We determined whether these groups had differences in length of hospitalization (primary outcome), 30-day mortality rate, and other outcomes.

Results.

Three hundred eighteen liver transplant operations were included in the study. Patients in the TEE + PAC group had the shortest median length of hospitalization (TEE + PAC, 8.6 days; TEE, 10.3; PAC, 9.1; P = 0.04). The TEE + PAC group also had the lowest 30-day mortality rate (TEE + PAC, n = 1 [1.3%]; TEE, n = 5 [12.8%]; PAC, n = 7 [3.5%]; P = 0.009). However, the TEE + PAC group also had the highest rate of a new postoperative need for dialysis (TEE + PAC, n = 8 [10.3%]; TEE, n = 2 [5.1%]; PAC, n = 1 [0.5%]; P < 0.001).

Conclusions.

Compared with either TEE alone or PAC alone, intraoperative monitoring with TEE + PAC during OLT was associated with the shortest length of hospitalization and lowest 30-day mortality rate. Transplant anesthesiologists should be aware of the potential benefit on patient mortality and hospital length of stay with concurrent intraoperative TEE + PAC monitoring and the increased need for new postoperative dialysis.
Cost-effectiveness of Deceased-donor Renal Transplant Versus Dialysis to Treat End-stage Renal Disease: A Systematic Review
Authors: Fu Rui , Sekercioglu Nigar , Berta Whitney , Coyte Peter C.
Published: January 2020

Deceased-donor renal transplant (DDRT) is an expensive and potentially risky health intervention with the prospect of improved life and lower long-term costs compared with dialysis. Due to the increasing shortage of kidneys and the associated rise of transplantation costs, certain patient groups may not benefit from transplantation in a cost-effective manner compared with dialysis. The objective of this systematic review was to provide a comprehensive synthesis of evidence on the cost-effectiveness of DDRT relative to dialysis to treat adults with end-stage renal disease and patient-, donor-, and system-level factors that may modify the conclusion. A systematic search of articles was conducted on major databases including MEDLINE, Embase, Scopus, EconLit, and the Health Economic Evaluations Database. Eligible articles were restricted to those published in 2001 or thereafter. Two reviewers independently assessed the suitability of studies and excluded studies that focused on recipients with age <18 years old and those of a living-donor or multiorgan transplant. We show that while DDRT is generally a cost-effective treatment relative to dialysis at conventional willingness-to-pay thresholds, a range of drivers including older patient age, comorbidity, and long wait times significantly reduce the benefit of DDRT while escalating healthcare costs. These findings suggest that the performance of DDRT on older patients with comorbidities should be carefully evaluated to avoid adverse results as evidence suggests that it is not cost-effective. Delayed transplantation may reduce the economic benefits of transplant which necessitates targeted policies that aim to shorten wait times. More recent findings have demonstrated that transplantation using high-risk donors may be a cost-effective and promising alternative to dialysis in the face of a lack of organ availability and fiscal constraints. This review highlights key concepts of health economic evaluations and the relevance of cost-effectiveness to inform care and decision-making in renal programs.
Egg incubation temperature does not influence adult heat tolerance in the lizard
Anolis sagrei
Authors: Gunderson Alex R. , Fargevieille Amélie , Warner Daniel A.
Published: January 2020

Extreme heat events are becoming more common as a result of anthropogenic global change. Developmental plasticity in physiological thermal limits could help mitigate the consequences of thermal extremes, but data on the effects of early temperature exposure on thermal limits later in life are rare, especially for vertebrate ectotherms. We conducted an experiment that to our knowledge is the first to isolate the effect of egg (i.e. embryonic) thermal conditions on adult heat tolerance in a reptile. Eggs of the lizard
Anolis sagrei
were incubated under one of three fluctuating thermal regimes that mimicked natural nest environments and differed in mean and maximum temperatures. After emergence, all hatchlings were raised under common garden conditions until reproductive maturity, at which point heat tolerance was measured. Egg mortality was highest in the warmest treatment, and hatchlings from the warmest treatment tended to have greater mortality than those from the cooler treatments. Despite evidence that incubation temperatures were stressful, we found no evidence that incubation treatment influenced adult heat tolerance. Our results are consistent with a low capacity for organisms to increase their physiological heat tolerance via plasticity, and emphasize the importance of behavioural and evolutionary processes as mechanisms of resilience to extreme heat.
Characterizing reservoirs of infection and the maintenance of pathogens in ecosystems
Authors: Roberts M. G. , Heesterbeek J. A. P.
Published: January 2020

We use a previously published compartmental model of the dynamics of pathogens in ecosystems to define and explore the concepts of maintenance host, maintenance community and reservoir of infection in a full ecological context of interacting host and non-host species. We show that, contrary to their current use in the literature, these concepts can only be characterized relative to the ecosystem in which the host species are embedded, and are not ‘life-history traits’ of (groups of) species. We give a number of examples to demonstrate that the same (group of) host species can lose or gain maintenance or reservoir capability as a result of a changing ecosystem context, even when these changes primarily affect non-hosts. One therefore has to be careful in designating host species as either maintenance or reservoir in absolute terms.