bluuebunny/crossref_metadata_2025 huggingface dataset:
Laboratory Management and Quality Control Practice of SARS-CoV-2 Nucleic Acid Detection
Authors: Xiao Shiwei , Yue Junqiu , Zhang Tianming , Wang Mingwei , Jin Su , Zhang Junfei , Zhang Sheng , Xu Pengfei , Wu De , Hu Jianhua , Guo Fang
Published: August 2020

Objective

A positive result of SARS-CoV-2 nucleic acid detection provides critical laboratory evidence for clinical confirmed diagnosis, pandemic status evaluation, a pandemic prevention plan, treatment of infected people with symptoms, and protection of uninfected people. This study aims to provide a practical reference for SARS-CoV-2 nucleic acid–related research and detection.

Methods

Our laboratory has established policies combining personnel management and quality control practices for SARS-CoV-2 nucleic acid detection during the pandemic.

Results

In this article, we describe cross-department personnel management and key points of personal protection and quality control in the testing process. We also report on the differences in detection and the compatibility between different brand kits.

Conclusion

It is critical to maintain a standard and accurate laboratory operation for nucleic acid testing.
Dynamical state for 964 galaxy clusters from Chandra X-ray images
Authors: Yuan Z S , Han J L
Published: August 2020

The dynamical state of galaxy clusters describes if clusters are relaxed dynamically or in a merging process of subclusters. Using archival images from the Chandra X-ray Observatory, we derive a set of parameters to describe the dynamical state for 964 galaxy clusters. Three widely used indicators for dynamical state, the concentration index c, the centroid shift ω, and the power ratio P3/P0 are calculated in the circular central region with a radius of 500 kpc. We also derive two adaptive parameters, the profile parameter κ and the asymmetry factor α, in the best fitted elliptical region. The morphology index δ is then defined by combining these two adaptive parameters, which indicates the dynamical state of galaxy clusters and has good correlations to the concentration index c, the centroid shift ω, the power ratio P3/P0, and the optical relaxation factor Γ. For a large sample of clusters, the dynamical parameters are continuously distributed from the disturbed to relaxed states with a peak in the between, rather than the bimodal distribution for the two states. We find that the newly derived morphology index δ works for the similar fundamental plane between the radio power, cluster mass, and the dynamical state for clusters with diffuse radio giant-haloes and mini-haloes. The offset between masses estimated from the Sunyaev–Zeld́ovich effect and X-ray images depends on dynamical parameters. All dynamical parameters for galaxy clusters derived from the Chandra archival images are available on http://zmtt.bao.ac.cn/galaxy_clusters/dyXimages/.
The role of the mass ratio in ballistic capture
Authors: Luo Zong-Fu
Published: August 2020

A massless particle can be naturally captured by a celestial body with the aid of a third body. In this work, the influence of the mass ratio on ballistic capture is investigated in the planar circular restricted three-body problem (CR3BP) model. Four typical dynamical environments with decreasing mass ratios, that is, the Pluto–Charon, Earth–Moon, Sun–Jupiter, and Saturn–Titan systems, are considered. A generalized method is introduced to derive ballistic capture orbits by starting from a set of initial conditions and integrating backward in time. Particular attention is paid to the backward escape orbits, following which a test particle can be temporarily trapped by a three-body gravity system, although the particle will eventually deviate away from the system. This approach is applied to the four candidate systems with a series of Jacobi constant levels to survey and compare the capture probability (quantitatively) and capture capability (qualitatively) when the mass ratio varies. Capture mechanisms inducing favourable ballistic capture are discussed. Moreover, the possibility and stability of capture by secondary celestial bodies are analysed. The obtained results may be useful in explaining the capture phenomena of minor bodies or in designing mission trajectories for interplanetary probes.
Tidally trapped pulsations in binary stars
Authors: Fuller J , Kurtz D W , Handler G , Rappaport S
Published: August 2020

A new class of pulsating binary stars was recently discovered, whose pulsation amplitudes are strongly modulated with orbital phase. Stars in close binaries are tidally distorted, so we examine how a star’s tidally induced asphericity affects its oscillation mode frequencies and eigenfunctions. We explain the pulsation amplitude modulation via tidal mode coupling such that the pulsations are effectively confined to certain regions of the star, e.g. the tidal pole or the tidal equator. In addition to a rigorous mathematical formalism to compute this coupling, we provide a more intuitive semi-analytic description of the process. We discuss three resulting effects: (1) Tidal alignment, i.e. the alignment of oscillation modes about the tidal axis rather than the rotation axis; (2) Tidal trapping, e.g. the confinement of oscillations near the tidal poles or the tidal equator; (3) Tidal amplification, i.e. increased flux perturbations near the tidal poles where acoustic modes can propagate closer to the surface of the star. Together, these phenomena can account for the pulsation amplitude and phase modulation of the recently discovered class of ‘tidally tilted pulsators.’ We compare our theory to the three tidally tilted pulsators HD 74423, CO Cam, and TIC 63328020, finding that tidally trapped modes that are axisymmetric about the tidal axis can largely explain the first two, while a non-axisymmetric tidally aligned mode is present in the latter. Finally, we discuss implications and limitations of the theory, and we make predictions for the many new tidally tilted pulsators likely to be discovered in the near future.
Kinematic modelling of clusters with Gaia: the death throes of the Hyades
Authors: Oh Semyeong , Evans Neil Wyn
Published: August 2020

The precision of the Gaia data offers a unique opportunity to study the internal velocity field of star clusters. We develop and validate a forward-modelling method for the internal motions of stars in a cluster. The model allows an anisotropic velocity dispersion matrix and linear velocity gradient describing rotation and shear, combines radial velocities available for a subset of stars, and accounts for contamination from background sources via a mixture model. We apply the method to Gaia DR2 data of the Hyades cluster and its tidal tails, dividing and comparing the kinematics of stars within and beyond 10 pc, which is roughly the tidal radius of the cluster. While the velocity dispersion for the cluster is nearly isotropic, the velocity ellipsoid for the tails is clearly elongated with the major axis pointing towards the Galactic centre. We find positive and negative expansions at ≈2σ significance in Galactic azimuthal and vertical directions for the cluster but no rotation. The tidal tails are stretching in a direction tilted from the Galactic centre while equally contracting as the cluster in Galactic vertical direction. The tails have a shear (A) of 16.90 ± 0.92 $\mathrm{m}\, \mathrm{s}^{-1}\, \mathrm{pc}^{-1}$ and a vorticity (B) of −6.48 ± 1.15 $\mathrm{m}\, \mathrm{s}^{-1}\, \mathrm{pc}^{-1}$, values distinct from the local Oort constants. By solving the Jeans equations for flattened models of the Hyades, we show that the observed velocity dispersions are a factor of ≈2 greater than required for virial equilibrium due to tidal heating and disruption. From simple models of the mass loss, we estimate that the Hyades is close to final dissolution with only a further ≲30 Myr left.
Inverted metallicity gradients in two Virgo cluster star-forming dwarf galaxies: evidence of recent merging?
Authors: Grossi M , García-Benito R , Cortesi A , Gonçalves D R , Gonçalves T S , Lopes P A A , Menéndez-Delmestre K , Telles E
Published: August 2020

We present integral field spectroscopy observations of two star-forming dwarf galaxies in the Virgo cluster (VCC 135 and VCC 324) obtained with Potsdam Multi-Aperture Spectrograph/PPak at the Calar Alto 3.5 m telescope. We derive metallicity maps using the N2 empirical calibrator. The galaxies show positive gas metallicity gradients, contrarily to what is usually found in other dwarfs or spiral galaxies. We measure gradient slopes of 0.20 ± 0.06 and 0.15 ± 0.03 dex/Re for VCC 135 and VCC 324, respectively. Such a trend has been only observed in few, very isolated galaxies or at higher redshifts (z > 1). It is thought to be associated with the accretion of metal-poor gas from the intergalactic medium, a mechanism that would be less likely to occur in a high-density environment like Virgo. We combine emission-line observations with deep optical images to investigate the origin of the peculiar metallicity gradient. The presence of weak underlying substructures in both galaxies and the analysis of morphological diagnostics and ionized gas kinematics suggest that the inflow of metal-poor gas to the central regions of the dwarfs may be related to a recent merging event with a gas-rich companion.
Detecting neutral hydrogen at z ≳ 3 in large spectroscopic surveys of quasars
Authors: Fumagalli Michele , Fotopoulou Sotiria , Thomson Laura
Published: August 2020

We present a pipeline based on a random forest classifier for the identification of high column density clouds of neutral hydrogen (i.e. the Lyman limit systems, LLSs) in absorption within large spectroscopic surveys of z ≳ 3 quasars. We test the performance of this method on mock quasar spectra that reproduce the expected data quality of the Dark Energy Spectroscopic Instrument and the WHT (William Herschel Telescope) Enhanced Area Velocity Explorer surveys, finding ${\gtrsim}90{{\ \rm per\ cent}}$ completeness and purity for $N_{\rm H\,\rm{\small I}} \gtrsim 10^{17.2}~\rm cm^{-2}$ LLSs against quasars of g < 23 mag at z ≈ 3.5–3.7. After training and applying our method on 10 000 quasar spectra at z ≈ 3.5–4.0 from the Sloan Digital Sky Survey (Data Release 16), we identify ≈6600 LLSs with $N_{\rm H\,\rm{\small I}} \gtrsim 10^{17.5}~\rm cm^{-2}$ between z ≈ 3.1 and 4.0 with a completeness and purity of ${\gtrsim}90{{\ \rm per\ cent}}$ for the classification of LLSs. Using this sample, we measure a number of LLSs per unit redshift of ℓ(z) = 2.32 ± 0.08 at z = [3.3, 3.6]. We also present results on the performance of random forest for the measurement of the LLS redshifts and H i column densities, and for the identification of broad absorption line quasars.
Feedback between Sgr A and B: AGN–starburst connection in the galactic centre
Authors: Sofue Yoshiaki
Published: August 2020

Propagation of fast-mode magnetohydrodynamic (MHD) compression waves is traced in the Galactic Centre. MHD waves produced by the active Galactic nucleus (Sgr A) focus on the molecular clouds such as Sgr B in the central molecular zone, which will trigger star formation, or possibly starburst. MHD waves newly excited by the starburst propagate backwards, and focus on the nucleus (Sgr A), where implosive waves compress the nuclear gas to promote fuelling the nucleus and may trigger nucleus activity. Echoing focusing of MHD waves between Sgr A (active galactic nucleus: AGN) and Sgr B (starburst) trigger each other at high efficiency by minimal energy requirement. It also solves the problem of angular momentum for AGN fuelling, as the focusing waves do not require global gas flow.
Occurrence rates of planets orbiting M Stars: applying ABC to Kepler DR25, Gaia DR2, and 2MASS data
Authors: Hsu Danley C , Ford Eric B , Terrien Ryan
Published: August 2020

We present robust planet occurrence rates for Kepler planet candidates around M stars for planet radii Rp = 0.5–4 R⊕ and orbital periods P = 0.5–256 d using the approximate Bayesian computation technique. This work incorporates the final Kepler DR25 planet candidate catalogue and data products and augments them with updated stellar properties using Gaia DR2 and 2MASS point source catalogue. We apply a set of selection criteria to select a sample of 1746 Kepler M dwarf targets that host 89 associated planet candidates. These early-type M dwarfs and late K dwarfs were selected from cross-referenced targets using several photometric quality flags from Gaia DR2 and colour–magnitude cuts using 2MASS magnitudes. We estimate a habitable zone occurrence rate of $f_{\textrm {M,HZ}} = 0.33^{+0.10}_{-0.12}$ for planets with 0.75–1.5 R⊕ size. We caution that occurrence rate estimates for Kepler M stars are sensitive to the choice of prior due to the small sample of target stars and planet candidates. For example, we find an occurrence rate of $4.2^{+0.6}_{-0.6}$ or $8.4^{+1.2}_{-1.1}$ planets per M dwarf (integrating over Rp = 0.5–4 R⊕ and P = 0.5–256 d) for our two choices of prior. These occurrence rates are greater than those for FGK dwarf target when compared at the same range of orbital periods, but similar to occurrence rates when computed as a function of equivalent stellar insolation. Combining our result with recent studies of exoplanet architectures indicates that most, and potentially all, early-type M dwarfs harbour planetary systems.
Drifting through the medium: kicks and self-propulsion of binaries within accretion discs and other environments
Authors: Cardoso Vitor , Macedo Caio F B
Published: August 2020

Compact binaries are within the reach of gravitational and electromagnetic wave detectors, and are important for our understanding of astrophysical environments and the composition of compact objects. There is a vast body of work devoted to the evolution of such binaries in background media, such as in common-envelope evolution, accretion discs and dark matter mini spikes. Here, we explore further gravitationally bound binaries evolving within an environment. We show that dissipative effects such as gravitational drag and accretion impart a momentum to the centre of mass (CM) of asymmetric binaries. We numerically evolve the binaries in a Newtonian setup and show that, depending on the medium density, the CM can accelerate to high speeds – in some cases $300\, {\rm km\, s^{-1}}$ or more – during inspiral, with potentially observable signatures. Our numerical results are fully consistent with an analytical result for the CM evolution at first order in the medium density.
Compliance of Oral Snuff (Naswar) Packaging and Sales Practices with National Tobacco Control Laws and the Relevant Articles of Framework Convention on Tobacco Control in Khyber Pakhtunkhwa Pakistan
Authors: Ahmad Fayaz , Khan Zohaib , Siddiqi Kamran , Khan Muhammad Naseem , Boeckman Melanie , Dregger Steffen , Bauld Linda , Zeeb Hajo , Forberger Sarah
Published: August 2020

Introduction

Smokeless tobacco (SLT) is a significant contributor to tobacco-related harm in Pakistan but its control has lags behind that of combustible tobacco. We assessed the compliance of Naswar’s (a widely used SLT product in the Southeast Asia) packaging and sales practices with the national legislations and relevant articles of the WHO framework convention on tobacco control (FCTC).

Aims and Methods

A cross-sectional observational audit was conducted in three districts of Pakistan. We recruited 286 general point of sale (GPOS) and exclusive Naswar sellers (ENS) through a multistage cluster sampling strategy. Data were gathered on packaging and labeling practices of Naswar and advertisement and promotion practices inside and outside the shops. Statistical tests for association between the dependent variable-advertisement practices, and independent variables-area and vendor types were conducted.

Results

We analyzed 133 and 49 unique Naswar products sold in 229 GPOS and by 57 ENS, respectively. None of the local products had any written or pictorial health warning. More than half of retailers used one or two methods of advertising Naswar inside the shops while only 9% advertised outside the shops. ENS were more likely to be noncompliant with tobacco advertisement and promotion compared with GPOS.

Conclusions

The study presents first insights on the compliance of Naswar packaging and sale practices with local regulations and WHO FCTC provisions in Pakistan. Almost all products were on display in the shops and none of the local products had any health warning or contents disclosure on the packages.

Implications

Naswar is a form of SLT used extensively in Pakistan, Central Asia, and Pashtun populations across the globe. This study provides an important insight into the Naswar retail environment in a geographical setting where the use of Naswar is endemic. The study brings to fore previously unreported issues like an urban–rural disparity, and differences between exclusive and nonENS, with regards to Naswar advertisement and promotion. These findings have potential implication on the implementation of tobacco control retail policies. The lack of health warnings and free display of Naswar brands call for alignment of tobacco control efforts with the FCTC.
Repurposing Metformin in Nondiabetic People With HIV: Influence on Weight and Gut Microbiota
Authors: Isnard Stéphane , Lin John , Fombuena Brandon , Ouyang Jing , Varin Thibault V , Richard Corentin , Marette André , Ramendra Rayoun , Planas Delphine , Raymond Marchand Laurence , Messaoudene Meriem , Van der Ley Claude P , Kema Ido P , Sohail Ahmed Darakhshan , Zhang Yonglong , Finkelman Malcolm , Routy Bertrand , Angel Jonathan , Ancuta Petronela , Routy Jean-Pierre
Published: August 2020

Background

People with HIV (PWH) taking antiretroviral therapy (ART) may experience weight gain, dyslipidemia, increased risk of non-AIDS comorbidities, and long-term alteration of the gut microbiota. Both low CD4/CD8 ratio and chronic inflammation have been associated with changes in the gut microbiota of PWH. The antidiabetic drug metformin has been shown to improve gut microbiota composition while decreasing weight and inflammation in diabetes and polycystic ovary syndrome. Nevertheless, it remains unknown whether metformin may benefit PWH receiving ART, especially those with a low CD4/CD8 ratio.

Methods

In the Lilac pilot trial, we recruited 23 nondiabetic PWH receiving ART for more than 2 years with a low CD4/CD8 ratio (<0.7). Blood and stool samples were collected during study visits at baseline, after a 12-week metformin treatment, and 12 weeks after discontinuation. Microbiota composition was analyzed by 16S rDNA gene sequencing, and markers of inflammation were assessed in plasma.

Results

Metformin decreased weight in PWH, and weight loss was inversely correlated with plasma levels of the satiety factor GDF-15. Furthermore, metformin changed the gut microbiota composition by increasing the abundance of anti-inflammatory bacteria such as butyrate-producing species and the protective Akkermansia muciniphila.

Conclusions

Our study provides the first evidence that a 12-week metformin treatment decreased weight and favored anti-inflammatory bacteria abundance in the microbiota of nondiabetic ART-treated PWH. Larger randomized placebo-controlled clinical trials with longer metformin treatment will be needed to further investigate the role of metformin in reducing inflammation and the risk of non-AIDS comorbidities in ART-treated PWH.
Sleep quality relates to emotional reactivity via intracortical myelination
Authors: Toschi Nicola , Passamonti Luca , Bellesi Michele
Published: August 2020

A good quality and amount of sleep are fundamental to preserve cognition and affect. New evidence also indicates that poor sleep is detrimental to brain myelination. In this study, we test the hypothesis that sleep quality and/or quantity relate to variability in cognitive and emotional function via the mediating effect of interindividual differences in proxy neuroimaging measures of white matter integrity and intracortical myelination. By employing a demographically and neuropsychologically well-characterized sample of healthy people drawn from the Human Connectome Project (n = 974), we found that quality and amount of sleep were only marginally linked to cognitive performance. In contrast, poor quality and short sleep increased negative affect (i.e. anger, fear, and perceived stress) and reduced life satisfaction and positive emotionality. At the brain level, poorer sleep quality and shorter sleep duration related to lower intracortical myelin in the mid-posterior cingulate cortex (p = 0.038), middle temporal cortex (p = 0.024), and anterior orbitofrontal cortex (OFC, p = 0.034) but did not significantly affect different measures of white matter integrity. Finally, lower intracortical myelin in the OFC mediated the association between poor sleep quality and negative emotionality (p < 0.05). We conclude that intracortical myelination is an important mediator of the negative consequences of poor sleep on affective behavior.
Do Alignment and Trimming Methods Matter for Phylogenomic (UCE) Analyses?
Authors: Portik Daniel M , Wiens John J
Published: August 2020

Alignment is a crucial issue in molecular phylogenetics because different alignment methods can potentially yield very different topologies for individual genes. But it is unclear if the choice of alignment methods remains important in phylogenomic analyses, which incorporate data from hundreds or thousands of genes. For example, problematic biases in alignment might be multiplied across many loci, whereas alignment errors in individual genes might become irrelevant. The issue of alignment trimming (i.e., removing poorly aligned regions or missing data from individual genes) is also poorly explored. Here, we test the impact of 12 different combinations of alignment and trimming methods on phylogenomic analyses. We compare these methods using published phylogenomic data from ultraconserved elements (UCEs) from squamate reptiles (lizards and snakes), birds, and tetrapods. We compare the properties of alignments generated by different alignment and trimming methods (e.g., length, informative sites, missing data). We also test whether these data sets can recover well-established clades when analyzed with concatenated (RAxML) and species-tree methods (ASTRAL-III), using the full data ($\sim $5000 loci) and subsampled data sets (10% and 1% of loci). We show that different alignment and trimming methods can significantly impact various aspects of phylogenomic data sets (e.g., length, informative sites). However, these different methods generally had little impact on the recovery and support values for well-established clades, even across very different numbers of loci. Nevertheless, our results suggest several “best practices” for alignment and trimming. Intriguingly, the choice of phylogenetic methods impacted the phylogenetic results most strongly, with concatenated analyses recovering significantly more well-established clades (with stronger support) than the species-tree analyses. [Alignment; concatenated analysis; phylogenomics; sequence length heterogeneity; species-tree analysis; trimming]
A new elasmosaurid plesiosaurian from the Early Cretaceous of Russia marks an early attempt at neck elongation
Authors: Fischer Valentin , Zverkov Nikolay G , Arkhangelsky Maxim S , Stenshin Ilya M , Blagovetshensky Ivan V , Uspensky Gleb N
Published: August 2020

Plesiosaurian marine reptiles evolved a wide range of body shapes during the Jurassic and Cretaceous, including long-necked forms. Many Late Cretaceous members of the clade Elasmosauridae epitomized this part of the plesiosaurian morphological spectrum by evolving extremely long necks through somitogenesis (resulting in an increase in the number of cervical centra) and differential growth (resulting in the elongation of cervical centra). However, the early evolution of elasmosaurids remains poorly understood because of a generally poor Lower Cretaceous fossil record. We describe a new elasmosaurid, Jucha squalea gen. et sp. nov., from the upper Hauterivian (Lower Cretaceous) of Ulyanovsk (European Russia), in addition to other elasmosaurid remains from the same area. Jucha squalea is one of the oldest and basalmost elasmosaurids known and lacks a series of features that otherwise characterize the group, such as the heart-shaped intercoracoid fenestra and the median pectoral bar. However, Jucha squalea marks an early attempt at cervical elongation through differential growth. The data we gathered on the shape of cervical centra among elasmosaurids suggest multiple episodes of elongation and shortening. However, the precise patterns are obscured by an unstable phylogenetic signal.
Innovation in Nurse Residency: Blazing a Trail With Online Technology
Authors: Weathers Nicole M. , Forneris Lori A.
Published: August 2020

To prepare new graduate nurses for the work of the future, the Iowa Action Coalition identified implementation of nurse residency as a top priority. A taskforce of Iowa nurse leaders developed a turn-key program for all sizes and types of health care organizations, available as all online and blended options. Implementation provided statistically significant outcomes similar to traditional programs. Innovation continues to drive the program with transition to an RN residency apprenticeship. This work is a testament to how innovation can be used to prepare our nursing workforce for the future, foster collaboration through partnerships, and advance nursing research.
Lessons Learned: Utilizing the NEWS Tool in High-Fidelity Simulation
Authors: Wiles Brenda , Alfes Celeste M. , Dolansky Mary
Published: August 2020

Nurse educators can enhance students’ clinical judgment by providing cues to guide decision-making during simulation. The purpose of this experimental feasibility study was to evaluate the effectiveness of using the National Early Warning Score as a set of cues during high-fidelity simulation to guide students in the development of clinical judgment, resulting in early detection of patient deterioration. Differences in clinical judgment scores and speed of detection of patient deterioration between groups of junior-level nursing students trained in the use of National Early Warning Score versus those who were not were evaluated. No significant differences were detected between the groups; however, valuable lessons were learned.
Initial Patterns of Prescription Opioid Supply and Risk of Mortality Among Insured Adults in the United States
Authors: Aroke Hilary A. , Buchanan Ashley L. , Bratberg Jeffrey , Hogan Joseph W. , Rich Josiah D. , Wen Xuerong , Kogut Stephen J.
Published: August 2020

Objective:

To examine the association between initial patterns of prescription opioid supply (POS) and risk of all-cause mortality among an insured opioid-naïve patient population in the United States (US).

Methods:

This retrospective observational cohort study used de-identified, administrative health care claims data from a large national insurer (Optum Clinformatics Data Mart) from 2010 to 2015. Participants included insured, cancer-free adults prescribed opioid analgesics. Prescription opioids received during the first 6 months of therapy were used to categorize initial patterns of POS as daily or nondaily. Cox regression was used to estimate the association of initial patterns of POS with all-cause mortality within one year of follow-up, adjusting for baseline covariates to control for confounding.

Results:

A total of 4,054,417 patients were included, of which 2.75% had incident daily POS; 54.8% were female; median age was 50 years; mean Charlson comorbidity index (CCI) was 0.21 (standard deviation = 0.77); and mean daily morphine milligram equivalent was 34.61 (95% confidence intervals: 34.59, 34.63). There were 2068 more deaths per 100,000 person-years among patients who were prescribed opioids daily than nondaily. After adjusting for baseline covariates, the hazard of all-cause mortality among patients with incident daily POS was nearly twice that among those prescribed nondaily (hazard ratio [HR] = 1.94; 95% confidence intervals: 1.84, 2.04).

Conclusions:

Among insured adult patients with noncancer pain, incident chronic POS was associated with a significantly increased risk of all-cause mortality over at most 1 year of follow-up. Because these results may be susceptible to bias, more research is needed to establish causality.
Hospital Initiated Injectable Opioid Agonist Therapy for the Treatment of Severe Opioid Use Disorder: A Case Series
Authors: Brar Rupinder , Fairbairn Nadia , Colizza Kate , Ryan Andrea , Nolan Seonaid
Published: August 2020

Background:

Across North America, there is an unprecedented opioid overdose epidemic. Approximately 15% of individuals with severe opioid use disorder (OUD) do not benefit from opioid agonist therapy (OAT) such as buprenorphine/naloxone or methadone and are considered treatment refractory. Of those who inject, injectable OAT (iOAT), with hydromorphone or diacetylmorphine, offered in community settings has demonstrated improved retention to treatment and decreased nonprescription opioid use. This case series seeks to describe iOAT initiation and titration in a hospital setting for treatment refractory individuals with OUD and examine impacts of iOAT on leaving hospital against medical advice (AMA).

Methods:

A retrospective chart review of 4 patients initiated on iOAT during hospitalization at St. Paul's Hospital in Vancouver, BC was completed between July 2017 to May 2018. Outcomes of interest included: (1) dose titration schedules of hydromorphone; and (2) reports of leaving hospital AMA; and (3) continuation of iOAT in community postdischarge.

Results:

Of the 4 participants, 2 were female and the mean age was 42 years. Despite a history of AMA, all participants stayed until the recommended the discharge after iOAT initiation. The average total doses of intravenous hydromorphone used during titration were: day 1: 100 mg and days 2 to 3: 200 mg. All continued iOAT in the community and one participant was readmitted within 30 days postdischarge.

Interpretation:

This case series describes a novel approach to the management of treatment refractory individuals with severe OUD during hospitalization. Prescribing iOAT in acute care settings is feasible and may reduce rates of leaving hospital AMA.
Why do Patients Engage in Pain Behaviors? A Qualitative Study Examining the Perspective of Patients and Partners
Authors: Akbari Fatemeh , Dehghani Mohsen , Mohammadi Somayyeh , Goubert Liesbet , Sanderman Robbert , Hagedoorn Mariёt
Published: August 2020

Objectives:

Patients’ pain behavior plays an important role in the interaction between patients and their partners, as acknowledged in operant models of pain. However, despite the considerable research attention to pain behaviors, the underlying motives of such behaviors are still unclear. The current study explores the motives to engage in pain behaviors and the possible discrepancies between individuals experiencing pain and partners’ perceptions of those motives.

Methods:

A qualitative study was performed, comprising semistructured interviews with 27 patients with chronic low back pain and their partners. They were recruited through purposive sampling at 2 pain clinics located in Tehran, Iran.

Results:

Patients and partners mentioned a variety of motives for pain behaviors, including protecting oneself against more pain, regulating negative emotions, informing others about the pain severity, seeking validation or intimacy, gaining advantages from pain, and expressing anger. Patients and partners revealed the most similarities in motives such as protecting oneself against more pain and informing others about the pain severity. However, partners rarely acknowledged patients’ motives for seeking validation and they were more likely to mention negative motives (eg, expressing anger).

Discussion:

In conclusion, partners are more likely to attribute negative motives to the patient’s pain behaviors, which may lead to their hostility toward patients. The findings of this study provide new insights into motives of pain behaviors from the perspective of patients and partners, which can inform couple-based interventions in terms of effective pain communication.
Is It Worth It? A Comparison of an Intensive Interdisciplinary Pain Treatment and a Multimodal Treatment for Youths With Pain-related Disability
Authors: Hurtubise Karen , Blais Samuel , Noel Melanie , Brousselle Astrid , Dallaire Frederic , Rasic Nivez , Camden Chantal
Published: August 2020

Objective:

The objective of this study was to evaluate the effectiveness of an intensive interdisciplinary pain treatment (IIPT) day-hospital program as compared with an outpatient multimodal treatment (MMT) for youth with chronic pain.

Materials and Methods:

A nonrandomized pretest posttest with control group design was used. A battery of patient-oriented measures assessing pain interference, quality of life, and depressive symptoms were completed at treatment commencement and at 3, 6, and 12 months after treatment by 44 youths enrolled in the IIPT and 138 youths engaged in the MMT, with various chronic pain conditions. Data were analyzed using longitudinal mixed-effects models.

Results:

The main outcomes were the score difference from baseline of patient-oriented measures across 3 timepoints within 12 months of intervention initiation for both treatment groups. IIPT participants demonstrated greater improvement in pain interference, as compared with MMT at 3 and 12 months. Initially, health-related quality of life scores improved similarly in both groups, but greater improvement was seen in the MMT group at 12 months. Depressive symptom scores did not improve with either intervention. Only pain interference scores reached statistically and clinically significant difference levels.

Discussion:

This study supports the benefits of specialized rehabilitation interventions, including both MMT and IIPT programs, for youths with chronic pain. The findings also suggest that IIPT might have a greater long-term effect for helping youths, in particular those with high pain interference scores.
Multidisciplinary-based Rehabilitation (MBR) Compared With Active Physical Interventions for Pain and Disability in Adults With Chronic Pain
Authors: Casey Máire-Bríd , Smart Keith M. , Segurado Ricardo , Doody Catherine
Published: August 2020

Objective:

This systematic review and meta-analysis examined the effectiveness of multidisciplinary-based rehabilitation (MBR) in comparison with active physical interventions for adults with chronic pain.

Materials and Methods:

The review was conducted in line with the recommendations provided in the Cochrane Handbook for Systematic Reviews and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 8 electronic databases were searched from inception to November 2018. Only randomized controlled trials were eligible for inclusion. In total, 31 trials were identified, and most studies involved patients with chronic low back pain (25 trials). The main outcomes considered were pain intensity and disability at short-term follow-up (≤3 mo after treatment), medium-term follow-up (>3 and <12 mo), and long-term follow-up (≥12 mo). The quality of the evidence was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach

Results:

A total of 27 studies were included in the meta-analysis. Statistically significant differences in favor of MBR were found for pain intensity and disability at short-term follow-up (standardized mean difference=0.53 and 0.50) and long-term follow-up (standardized mean difference=0.56 and 0.77), but the quality of the evidence was low. There was no significant difference between MBR and active physical interventions in the medium-term follow-up.

Conclusions:

Overall, the results suggest that MBR may lead to greater improvements in pain intensity and disability compared with active physical interventions, and the effects appear to be sustained in the long term. However, these findings should be interpreted with caution in light of the low quality of the evidence, with all but one trial judged to be at high risk of bias. Further research is required to assess the effectiveness of MBR for people with chronic pain conditions other than low back pain.
The Effect of Auditory Residual Inhibition on Tinnitus and the Electroencephalogram
Authors: King Rohan O. C. , Singh Shekhawat Giriraj , King Chris , Chan Emily , Kobayashi Kei , Searchfield Grant D.
Published: August 2020

Objectives:

Tinnitus is the perception of sound in the absence of an external physical sound source, for some people it can severely reduce the quality of life. Acoustic residual inhibition (ARI) is a suppression of tinnitus following the cessation of a sound. The present study investigated the effect of ARI on brain activity measured using EEG.

Design:

Thirty adult participants (mean age of 58 years) experiencing chronic tinnitus (minimum 2 years) participated. Participants were presented broad band noise at 10 dB above minimum masking level (1 min followed by 4 min of silence, 4 times) counterbalanced with a control treatment of broad band noise at threshold (1 min followed by 4 min of silence, 4 times) while 64-channel EEG was simultaneously recorded. Tinnitus loudness was measured using a 9-point tinnitus loudness rating scale.

Results:

The ARI stimulation resulted in a self-reported reduction in tinnitus loudness in 17 of the 30 participants. Tinnitus rating reduced following stimulation but gradually returned to near baseline during 4 min of silence post sound exposure; successive sound exposures resulted in lower loudness ratings. No significant reductions in loudness rating were found with the control stimulation. The EEG showed increases in power spectral density, particularly in the alpha and gamma bands, during ARI compared to the control periods.

Conclusions:

These results contribute to the understanding of ARI and tinnitus. We recommend that there be a closer examination of the relationship between onset and offset of sound in both tinnitus and nontinnitus control participants to ascertain if EEG changes seen with ARI relate to tinnitus suppression or general postsound activity.
Acclimatization to Hearing Aids by Older Adults
Authors: Wright Dominique , Gagné Jean-Pierre
Published: August 2020

Objectives:

Audiologists and hearing aid users (HAUs) generally agree that an adaptation period is needed following the first hearing aid (HA) experience. The main purpose of this study is to investigate the acclimatization of older adult listeners with hearing loss to HAs using listening effort and behavioral measures.

Design:

Participants (N=47) were older adults with mild to moderately severe sensorineural hearing loss. Thirty-two participants were new HAUs and 15 participants were experienced HAUs. New HAUs were randomly assigned to one of two groups: noise reduction algorithms and directional microphones activated or noise reduction algorithms and directional microphones deactivated. Speech recognition in noise and listening effort were assessed on 8 different occasions during a 10-month period. A dual-task paradigm was used to measure the listening effort deployed to recognize speech in noise. The primary task consisted of the Hearing in Noise Test which also served as the behavioral speech in noise measure. The secondary task was a tactile pattern-recognition task in which participants had to identify a sequence of three tactile stimuli that varied in duration. The two listening effort outcomes were the proportional dual-task cost and the response time on the secondary task. Cognitive abilities, including working memory and speed of processing, were evaluated using the Reading Span Test and the Digit Symbol Substitution Test, respectively.

Results:

Results show a significant time*group interaction. Both groups of new HAUs showed improvement over time in speech in noise performances (change of ~2 dB signal to noise ratio) and the experienced HAUs did not improve over time. The acclimatization effect was observed over a period of 4 weeks. There was no significant change over time on both measures of listening effort. There was no association between amplitude of acclimatization and the cognitive abilities measured.

Conclusion:

An acclimatization effect following HA experience was observed. Specifically, the new HAUs displayed a clinically significant change of 2 dB in signal to noise ratio on the Hearing in Noise Test 4 weeks following their initial fitting. The acclimatization effect is not correlated to cognitive abilities.
Do Impedance Changes Correlate With a Delayed Hearing Loss After Hybrid L24 Implantation?
Authors: Konrad Simon , Framke Theodor , Kludt Eugen , Büchner Andreas , Lenarz Thomas , Paasche Gerrit
Published: August 2020

Objectives:

Preservation of residual hearing is one of the main goals in present cochlear implantation surgery. Especially for this purpose, smaller and softer electrode carriers were developed that are to be inserted through the round window membrane to minimize trauma. By using these electrodes and insertion technique, residual hearing can be preserved in a large number of patients. Unfortunately, some of these patients with initially preserved residual hearing after cochlear implantation lose it later on. The reason for this is unknown but it is speculated about a correlation with an increase in impedance, since increased impedance values are linked to intracochlear inflammation and tissue reaction. Our hypothesis for this study design was that an increase in impedance predicts changes in residual hearing under clinical conditions.

Design:

Data of all adult patients (N = 122) receiving a Hybrid-L24 cochlear implant at our center between 2005 and early 2015 were retrospectively evaluated. Impedance values in Common Ground mode as measured during clinical routine and referring audiological test data (audiometric thresholds under headphones) were collected. Changes between consecutive measurements were calculated for impedance values and hearing thresholds for each patient. Correlations between changes in impedances and acoustic hearing thresholds were calculated. Average values were compared as well as patients with largest impedance changes within the observation period were evaluated separately.

Results:

Group mean values of impedances were between 5 and 7 kΩ and stable over time with higher values on basal electrode contacts compared with apical contacts. Average hearing thresholds at the time of initial fitting were between 40 to 50 dB (250 Hz) and 90 dB (1 kHz) with a loss of about 10 dB compared with preoperative values. Correlation between impedance changes and threshold changes was found, but too inconsistently to imply a true relationship. When evaluating the 20 patients with the largest impedance changes during the observation period (all >1 kΩ from one appointment to the next one), some patients were found where hearing loss is timely connected and highly correlated with an unusual impedance change. But large impedance changes were also observed without affecting hearing thresholds and hearing loss was found without impedance change.

Conclusions:

Changes in impedance as measured during clinical routine cannot be taken as an indicator for a late acoustic hearing loss.
Distal Femoral Physeal Bar Resection Combined With Guided Growth for the Treatment of Angular Limb Deformity Associated With Growth Arrest: A Preliminary Report
Authors: Masquijo J. Javier , Allende Victoria , Ferreyra Andrés , Hernández Bueno Juan C.
Published: August 2020

Purpose:

Distal femoral growth arrest can result in progressive deformities and functional disability. The treatment is challenging given the significant growth potential of the distal femoral physis. This study addresses the short-term outcomes after distal femoral physeal bar resection combined with guided growth for the treatment of angular limb deformity.

Methods:

We conducted a retrospective analysis of patients treated with distal femoral physeal bar resection, fat graft interposition, and growth modulation with a tension-band plate. Data recorded included patient demographics, growth arrest cause, physeal bar size, time-to-surgery, details of the operative procedure, and complications. The mechanical axis zones, tibiofemoral angle, and the anatomic lateral distal femoral angle were assessed on 51-inch anteroposterior standing radiographs.

Results:

Five patients (3 male individuals) with valgus (n=4) and varus deformities (n=1) due to physeal arrests of the distal femur were analyzed. The cause of the physeal arrest was trauma (n=3) and infection (n=2). The average age at the time of surgery was 6.6 years (range: 2 to 11 y). Average size of the physeal bar was 413.4 mm2, which represented 16.8% of the total distal femoral physis (range: 12% to 26%). Four of the 5 patients had a total correction of the deformity in 14.3 months (range: 9 to 22 mo). One patient required correction by osteotomy and external fixation. Postoperatively, 1 patient presented no improvement, and 4 had restoration of the longitudinal bone growth and alignment. Two patients had rebound valgus: one is being observed and another has undergone a repeat guided growth procedure.

Conclusions:

Distal femoral physeal bar resection combined with tension-band hemiepiphysiodesis provides a viable option for the correction of angular deformities associated with physeal arrest. Longer follow-up is required to evaluate future growth of the distal femoral physis after this combined procedure.

Level of Evidence:

Level IV—therapeutic study.
An Explainable Artificial Intelligence Predictor for Early Detection of Sepsis
Authors: Yang Meicheng , Liu Chengyu , Wang Xingyao , Li Yuwen , Gao Hongxiang , Liu Xing , Li Jianqing
Published: August 2020

Objectives:

Early detection of sepsis is critical in clinical practice since each hour of delayed treatment has been associated with an increase in mortality due to irreversible organ damage. This study aimed to develop an explainable artificial intelligence model for early predicting sepsis by analyzing the electronic health record data from ICU provided by the PhysioNet/Computing in Cardiology Challenge 2019.

Design:

Retrospective observational study.

Setting:

We developed our model on the shared ICUs publicly data and verified on the full hidden populations for challenge scoring.

Patients:

Public database included 40,336 patients’ electronic health records sourced from Beth Israel Deaconess Medical Center (hospital system A) and Emory University Hospital (hospital system B). A total of 24,819 patients from hospital systems A, B, and C (an unidentified hospital system) were sequestered as full hidden test sets.

Interventions:

None.

Measurements and Main Results:

A total of 168 features were extracted on hourly basis. Explainable artificial intelligence sepsis predictor model was trained to predict sepsis in real time. Impact of each feature on hourly sepsis prediction was explored in-depth to show the interpretability. The algorithm demonstrated the final clinical utility score of 0.364 in this challenge when tested on the full hidden test sets, and the scores on three separate test sets were 0.430, 0.422, and –0.048, respectively.

Conclusions:

Explainable artificial intelligence sepsis predictor model achieves superior performance for predicting sepsis risk in a real-time way and provides interpretable information for understanding sepsis risk in ICU.
Pelvic Reirradiation Utilizing Pulsed Low-dose Rate Radiation Therapy
Authors: Paly Jonathan J. , Deng Mengying , Lee Charles T. , Hayes Shelly B. , Galloway Thomas J. , Hallman Mark A. , Weiss Stephanie E. , Horwitz Eric M. , Price Robert A. , Ma C-M Charlie , Meyer Joshua E.
Published: August 2020

Pulsed low-dose rate radiation therapy has been shown to reduce normal tissue damage while decreasing DNA damage repair in tumor cells. In a cohort of patients treated with palliative or definitive pelvic reirradiation using pulsed low-dose rate radiation therapy, we observed substantial local control and low rates of toxicity.