bluuebunny/crossref_metadata_2025 huggingface dataset:
Linking population performance to nutritional condition in an alpine ungulate
Authors: Stephenson Thomas R , German David W , Cassirer E Frances , Walsh Daniel P , Blum Marcus E , Cox Mike , Stewart Kelley M , Monteith Kevin L
Published: July 2020

Bighorn sheep (Ovis canadensis) can live in extremely harsh environments and subsist on submaintenance diets for much of the year. Under these conditions, energy stored as body fat serves as an essential reserve for supplementing dietary intake to meet metabolic demands of survival and reproduction. We developed equations to predict ingesta-free body fat in bighorn sheep using ultrasonography and condition scores in vivo and carcass measurements postmortem. We then used in vivo equations to investigate the relationships between body fat, pregnancy, overwinter survival, and population growth in free-ranging bighorn sheep in California and Nevada. Among 11 subpopulations that included alpine winter residents and migrants, mean ingesta-free body fat of lactating adult females during autumn ranged between 8.8% and 15.0%; mean body fat for nonlactating females ranged from 16.4% to 20.9%. In adult females, ingesta-free body fat > 7.7% during January (early in the second trimester) corresponded with a > 90% probability of pregnancy and ingesta-free body fat > 13.5% during autumn yielded a probability of overwinter survival > 90%. Mean ingesta-free body fat of lactating females in autumn was positively associated with finite rate of population increase (λ) over the subsequent year in bighorn sheep subpopulations that wintered in alpine landscapes. Bighorn sheep with ingesta-free body fat of 26% in autumn and living in alpine environments possess energy reserves sufficient to meet resting metabolism for 83 days on fat reserves alone. We demonstrated that nutritional condition can be a pervasive mechanism underlying demography in bighorn sheep and characterizes the nutritional value of their occupied ranges. Mountain sheep are capital survivors in addition to being capital breeders, and because they inhabit landscapes with extreme seasonal forage scarcity, they also can be fat reserve obligates. Quantifying nutritional condition is essential for understanding the quality of habitats, how it underpins demography, and the proximity of a population to a nutritional threshold.
Explaining mammalian abundance and elevational range size with body mass and niche characteristics
Authors: Wen Zhixin , Feijó Anderson , Cheng Jilong , Du Yuanbao , Ge Deyan , Xia Lin , Yang Qisen
Published: July 2020

Recent work on tropical montane small mammals and birds has shown that abundance–elevational range size relationships (i.e., the relationship between abundance of a species and its elevational range size) can be manifested in a number of distinct generalized patterns. To understand why different patterns occur, one first must understand the causal mechanisms behind patterns of interspecific variation in species abundance and elevational range size. Using small mammal data along five elevational gradients in Southwest China, we assessed the relative importance of body mass, niche position (i.e., how typical the environmental conditions in which a species occurs are of the full set of conditions under consideration) and niche breadth in explaining the interspecific variation in mean abundance of species of small mammals, and elevational range size. Niche position and niche breadth were calculated using outlying mean index analysis based on 24 environmental variables. The relative importance of body mass, niche position, and niche breadth, in explaining the mean abundance and elevational range size of species were examined using phylogenetic regression and phylogenetic path analyses. Along each of five elevational gradients, body mass maintained a nonsignificant (P > 0.05) relationship both with mean abundance and elevational range size when the effects of phylogeny were taken into account. Niche position had a negative effect on mean abundance and elevational range size (species with a niche position close to edge environmental conditions were rarer and had smaller elevational range sizes) across five gradients (significant negative effect: three gradients for mean abundance; five gradients for elevational range size). Conversely, a positive effect of niche breadth on mean abundance and elevational range size was observed consistently, yet the effect was significant only for some gradients (mean abundance: two gradients; elevational range size: four gradients). Our study suggests that niche position and niche breadth both are good predictors of abundance and elevational range size of montane small mammals; niche position and niche breadth therefore play a strong role in the formation of abundance–elevational range size relationship.
Evaluation of accuracy in the determination of crystal structure factors using large-angle convergent-beam electron diffraction patterns
Authors: Morikawa Daisuke , Tsuda Kenji
Published: July 2020

The accuracy of electron density distribution analysis using large-angle convergent-beam electron diffraction (LACBED) patterns is evaluated for different convergence angles. An orbital ordered state of FeCr2O4 is used as an example of the analysis. Ideal orbital-ordered and non-ordered states are simulated by using orbital scattering factors. LACBED patterns calculated for the orbital-ordered state were used as hypothetical experimental data sets. Electron density distribution of the Fe 3d orbitals has been successfully reconstructed with a higher accuracy from LACBED patterns with convergence angles larger than 15.2 mrad, which is 4 times as large as that for conventional convergent-beam electron diffraction patterns. Excitation of particular Bloch waves with the aid of LACBED patterns has a key role in the accurate analysis of electron density distributions.
Resource enrichment combined with biomass removal maintains plant diversity and community stability in a long-term grazed grassland
Authors: Xu Feng-Wei , Li Jian-Jun , Wu Li-Ji , Lu Xiao-Ming , Xing Wen , Chen Di-Ma , Zhu Biao , Wang Shao-Peng , Jiang Lin , Bai Yong-Fei
Published: July 2020

Aims

Long-term heavy grazing reduces plant diversity and ecosystem function by intensifying nitrogen (N) and water limitation. In contrast, the absence of biomass removal can cause species loss by elevating light competition and weakening community stability, which is exacerbated by N and water enrichment. Hence, how to maintain species diversity and community stability is still a huge challenge for sustainable management of worldwide grasslands.

Methods

We conducted a 4-year manipulated experiment in six long-term grazing blocks to explore combination of resource additions and biomass removal (increased water, N and light availability) on species richness and community stability in semiarid grasslands of Inner Mongolia, China.

Important Findings

In all blocks treated with the combination of resource additions and biomass removal, primary productivity increased and species richness and community stability were maintained over 4 years of experiment. At both species and plant functional group (PFG) levels, the aboveground biomass of treated plants remained temporally stable in treatments with the combination of N and/or water addition and biomass removal. The maintenance of species richness was primarily caused by the biomass removal, which could increase the amount of light exposure for grasses under resource enrichment. Both species asynchrony and stability of PFGs contributed to the high temporal stability observed in these communities. Our results indicate that management practices of combined resource enrichment with biomass removal, such as grazing or mowing, could not only enhance primary productivity but also maintain plant species diversity, species asynchrony and community stability. Furthermore, as overgrazing-induced degradation and resource enrichment-induced biodiversity loss continue to be major problems worldwide, our findings have important implications for adaptive management in semiarid grasslands and beyond.
Lung herniation through the thoracic wall after persistent sneezing and coughing in an obesity and COPD Patient
Authors: Ibrahim Mohammed , Linsmeier Bernd
Published: July 2020

We present the case of a 61-year-old male patient with a known medical history of morbid obesity, chronic obstructive pulmonary disease and atrial fibrillation, who was receiving anticoagulation therapy with enoxaparin natrium prescribed by his family physician. The patient presented himself to the emergency department of our hospital with a complaint of severe pain in the right hemithorax, dyspnea, and diffuse cutaneous and subcutaneous haematoma in the inferior part of the right hemithoracic region. The patient underwent right-side video-assisted thoracic surgery on the second day to evacuate the haematothorax. Thoracic wall repair was achieved using a sandwich technique with a sublay reinforced with pericostal sutures and onlay insertion of bovine pericardium mesh.
Dirofilaria repens infection of the eye with concomitant microfilaremia in a traveller
Authors: Frenzen Frederik Stephan , Loewe Ines , Müller Gernot , Schoenlebe Jacqueline , Tappe Dennis , Teichmann Dieter
Published: July 2020

Dirofilaria repens is the main causative agent of human and canine dirofilariosis. This form of zoonotic parasitosis usually manifests with an involvement of the skin or the eye. Human dirofilariosis is considered as an emerging infectious disease. We report the first case of proven microfilariemic dirofilariosis in peripheral blood in Germany.
New types of topological superconductors under local magnetic symmetries
Authors: Zou Jinyu , Xie Qing , Song Zhida , Xu Gang
Published: July 2020

We classify gapped topological superconducting (TSC) phases of one-dimensional quantum wires with local magnetic symmetries, in which the time-reversal symmetry $\mathcal {T}$ is broken, but its combinations with certain crystalline symmetries, such as $M_x \mathcal {T}$, $C_{2z} \mathcal {T}$, $C_{4z}\mathcal {T}$ and $C_{6z}\mathcal {T}$, are preserved. Our results demonstrate that an equivalent BDI class TSC can be realized in the $M_x \mathcal {T}$ or $C_{2z} \mathcal {T}$ superconducting wire, which is characterized by a chiral Zc invariant. More interestingly, we also find two types of totally new TSC phases in the $C_{4z}\mathcal {T}$ and $C_{6z}\mathcal {T}$ superinducting wires, which are beyond the known AZ class, and are characterized by a helical Zh invariant and Zh⊕Zc invariants, respectively. In the Zh TSC phase, Z pairs of Majorana zero modes (MZMs) are protected at each end. In the $C_{6z}\mathcal {T}$ case, the MZMs can be either chiral or helical, and even helical-chiral coexisting. The minimal models preserving $C_{4z}\mathcal {T}$ or $C_{6z}\mathcal {T}$ symmetry are presented to illustrate their novel TSC properties and MZMs.
Personal networks and mortality in later life: racial and ethnic differences
Authors: Roth Adam R
Published: July 2020

Background

Social network characteristics are associated with health outcomes in later life, including mortality. Moreover, there are well-established mortality disparities across race and ethnicity. Although previous studies have documented these associations separately, limited research considers the two in tandem. The present study addressed how the associations between social network characteristics and mortality differ across race and ethnicity in later life.

Methods

Data were from the National Social Life, Health, and Aging Project. At baseline, 3005 respondents were interviewed with regards to their health and social networks. Five years later, 430 respondents had died. Logistic regression models were used to estimate the odds of all-cause mortality over the study period.

Results

Network size and kin composition were negatively associated with mortality, whereas density was positively associated with mortality. There was a stronger negative association between the kin composition and mortality for Hispanic respondents compared with white and Black respondents.

Conclusion

The present study contributes to the large literature documenting the link between social networks and health by highlighting the importance of analyzing networks through a sociocultural lens.
The Effect of Sunflower Seed and Almond Oil on Preterm Infant Skin: A Randomized Controlled Trial
Authors: Caglar Seda , Yildiz Gizem Kerimoglu , Bakoglu Ilkay , Salihoglu Ozgul
Published: July 2020

OBJECTIVE

To investigate the effect of sunflower seed oil (SSO) and almond oil (AO) on stratum corneum hydration and Neonatal Skin Condition Scores (NSCSs) of preterm infants.

METHODS

This randomized controlled trial recruited 90 preterm infants whose gestational ages were between 32 and 37 weeks in the neonatal ICU. Infants were randomly assigned to three groups (SSO, AO, or control). The oils were applied to the whole body of each infant except for the head and face by a nurse researcher four times a day (4 mL/kg) for 5 days.

MAIN OUTCOME MEASURES

Skin condition of the infants as evaluated with the NSCS; hydration as measured by a skin moisture meter before and after application.

MAIN RESULTS

When average stratum corneum hydration was compared, infants in the SSO and AO groups had better hydration than infants in the control group. The NSCS scores in the control group were significantly higher than in the intervention groups, but there was no difference between the SSO and AO groups.

CONCLUSIONS

Neither SSO nor AO has harmful effects on the skin, and their use may improve stratum corneum hydration. These oils can be used by nurses to hydrate the skin of preterm infants. Further studies are needed to evaluate the efficacy of natural oils on infant skin.
Bronchopulmonary Dysplasia: From Neonate to Adult
Authors: Tsai Emily B. , Stenback Melanie , Newman Beverley
Published: July 2020

“Bronchopulmonary dysplasia” is a term devised in 1967 to describe chronic lung disease in premature infants treated for respiratory distress syndrome. With improving management techniques, younger and lower birth-weight infants now are surviving after they are born at increasingly premature stages of lung development. Despite improving management techniques, the overall incidence of bronchopulmonary dysplasia has not changed significantly over time, but the clinical definition and radiographic features have evolved accordingly.1
Rejection of Patients With Opioid Use Disorder Referred for Post-acute Medical Care Before and After an Anti-discrimination Settlement in Massachusetts
Authors: Kimmel Simeon D. , Rosenmoss Sophie , Bearnot Benjamin , Larochelle Marc , Walley Alexander Y.
Published: July 2020

Objectives:

To determine how commonly medical inpatients with opioid use disorder (OUD) referred for postacute medical care were rejected due to substance use or treatment with opioid agonist therapy (OAT). Additionally, to assess for changes in rejection rates following the United States Attorney's May 2018 settlement with a Massachusetts nursing facility for violating anti-discrimination laws for such rejections.

Methods:

We linked electronic referrals to private Massachusetts postacute medical care facilities from Boston Medical Center in 2018 with clinical data. We included referrals with evidence of OUD using ICD-10 diagnosis codes or OAT receipt. We identified the frequency of referrals where the stated rejection reason was substance use or OAT and classified these as discriminatory. We used segmented regression to assess for changes in proportion of referrals with substance use and OAT-related rejections before and after the settlement.

Results:

In 2018, 219 OUD-associated hospitalizations resulted in 1648 referrals to 285 facilities; 81.8% (1348) were rejected. Among hospitalizations, 37.4% (82) received at least 1 discriminatory rejection. Among rejections, 15.1% (203) were discriminatory (105 for OAT and 98 for substance use). Among facilities, 29.1% (83) had at least one discriminatory rejection. We found no differences in proportion of discriminatory rejections before and after the settlement.

Conclusions:

Individuals hospitalized with OUD frequently experience explicit discrimination when rejected from postacute care despite federal and state protections. Efforts are needed to enhance enforcement of anti-discrimination laws, regulations, and policies to ensure access to postacute medical care for people with OUD and ongoing medical needs.
Immunotherapy in gynecological cancers: where are we?
Authors: Polastro Laura , Closset Celine , Kerger Joseph
Published: July 2020

Purpose of review

This manuscript discusses the clinical evidence on immunotherapy for ovarian, endometrial, and cervical cancer. We report here the results of the clinical trials and present the ongoing trial in this area.

Recent findings

Immunotherapy has become a pillar of cancer treatment improving the prognosis of many patients with a broad variety of solid malignancies. Unfortunately, until recently the progress achieved in some other tumors has not been seen in the majority of patients with gynecological cancer. Except for some subgroups of endometrial cancers the immune checkpoint inhibitors in monotherapy have shown unsatisfactory results. However, several combinations of immunotherapy with other drugs are under investigation and are very promising. It is essential, to develop tools to select the patients who will response best to immunotherapy.

Combined immune checkpoint inhibitors with targeted therapies are awaited in gynecological cancers and could provide additional benefit.
Hitting the sweet spot: exploiting HIV-1 glycan shield for induction of broadly neutralizing antibodies
Authors: Wagh Kshitij , Hahn Beatrice H. , Korber Bette
Published: July 2020

Purpose of review

The surface of the HIV-1 Env glycoprotein, the target of neutralizing antibodies, is extensively covered by N-linked glycans that create a glycan shield. Broadly neutralizing antibodies (bNAbs), the primary targets of HIV-1 vaccine design, have to negotiate this glycan shield. Here, we review the barriers and opportunities that the HIV-1 glycan shield presents for vaccine induction of bNAbs.

Recent findings

Glycan shields can impact the nature of the antibody response and influence the development of neutralization breadth in HIV-1 infections. The architecture of the glycan shield arising from glycan interactions and dynamics have been modeled, and its fine structure, that is, the site-wise glycan heterogeneity, has been determined for some isolates. Although the extent of glycan shielding is conserved, the precise number, location and processing of glycans, however, is strain-dependent. New insights continue to reveal how such differences can impact bNAb activity and development. Novel approaches have exploited the glycan shield for designing immunogens that bind the germline precursors of bNAbs, a critical roadblock for vaccine-induction of bNAbs.

The HIV-1 glycan shield can significantly impact the induction and maturation of bNAbs, and a better understanding of how to manipulate it will improve immunogen design.
Aggressive CD4/CD8 Double-Negative Primary Cutaneous T-Cell Lymphoma With Dural Invasion: A Rare Presentation of Mycosis Fungoides?
Authors: Haghayeghi Koorosh , Robinson-Bostom Leslie , Olszewski Adam , Jackson Cynthia L. , Patel Nimesh R. , Sewastianik Tomasz , Carrasco Ruben D. , Shanmugam Vignesh , Treaba Diana O.
Published: July 2020

Mycosis fungoides (MF) is primarily characterized by epidermotropic CD3+/CD4+/CD45RO+ memory T cells. CD4/CD8 double-negative MF is an uncommon variant with no presumed prognostic significance. Despite the variability in the clinical course and presentation of MF, most cases behave indolently. About 5% of patients, however, advance to stage IV with visceral organ involvement. Central nervous system metastasis in MF is rare with no known cases of direct central nervous system invasion by MF to date. We report an exceedingly rare locally aggressive case of CD4/CD8 double-negative MF with direct dural invasion and underline pertinent diagnostic challenges encountered in our case.
Atypical BCL6/GATA3+ Primary Cutaneous Acral CD8-Positive T-Cell Lymphoma: A Diagnostic Challenge
Authors: Prieto-Torres Lucia , Camacho-García Diana , Piris Miguel Ángel , Requena Luis , Rodríguez-Pinilla Socorro María
Published: July 2020

Primary cutaneous acral CD8-positive T-cell lymphoma consists of slow-growing nodules in acral sites with a histopathology, suggesting high-grade lymphoma despite the indolent clinical course. It has been recently included in WHO-EORTC classification for primary cutaneous lymphomas as a provisional entity. A correct diagnosis of this entity is important because its differential diagnosis include more aggressive cutaneous lymphomas. We present a 53-year-old woman with an indolent solitary nodule on her right leg, which histopathologically showed features of CD8-positive T-cell lymphoma, although with some peculiarities, including epidermotropism, absence of CD68 expression, and positivity for GATA3 and Bcl6 in neoplastic cells. This case could contribute to better define the spectrum of this rare cutaneous lymphoma.
Surgical management of positive dysphotopsia: U.S. perspective
Authors: Masket Samuel , Rupnick Zsofia , Fram Nicole R. , Kwong Stephen , McLachlan Jessie
Published: July 2020

Purpose:

To evaluate clinical outcomes of intraocular lens (IOL) exchange for intolerable positive dysphotopsia (PD).

Setting:

Private practice, Advanced Vision Care, Los Angeles, California, USA.

Design:

Retrospective review, case series.

Methods:

Fifty-six eyes of 46 pseudophakic patients requiring surgical management of PD between 2013 and 2019 were reviewed. Thirty-seven eyes had PD alone and 19 had combined negative dysphotopsia and PD. Inclusion criteria: corrected distance visual acuity of 20/30 or better without significant corneal, retinal, or optic nerve pathology. Exclusion criteria: corneal, macular, or optic nerve disease and multifocal dysphotopsia alone (defined patterns of concentric multiple halos or spider web patterns when looking at a point source of light). Primary outcome measure was improvement or resolution of self-reported PD symptoms by 3 months postoperatively. Secondary outcome measures included analysis of intraocular lenses (IOLs) that induced PD for IOL material, index of refraction, and edge design.

Results:

IOL materials successful in the alleviation of PD symptoms were as follows: 20 (87.8%) of 33 silicone, 15 (76.2%) of 21 copolymer, and 2 poly(methyl methacrylate) (100%). However, when considering IOL exchange for an acrylic to silicone optic or acrylic to collamer optic, the percentages of improvement are indistinguishable at 87% and 88%, respectively.

Conclusions:

PD symptoms might be improved by changing the IOL material and, therefore, index of refraction. Although edge design plays an important role in etiology, changing the IOL material to a lower index of refraction may prove to be an effective surgical strategy to improve intolerable PD.
Fluid-jet technique to polish the posterior capsule for phacoemulsification surgeries: efficacy and safety evaluation
Authors: Liu Zhenzhen , Cao Qianzhong , Qu Bo , Wang Wei , Ruan Xiaoting , Zheng Danying , Jin Guangming , Tan Xuhua , Jin Ling , He Mingguang , Congdon Nathan , Lin Haotian , Luo Lixia , Liu Yizhi
Published: July 2020

Purpose:

To compare the efficacy and safety of a fluid-jet technique with capsular polish in reducing residual lens fibers (RLFs) in phacoemulsification surgery.

Setting:

Single center.

Design:

Prospective nonrandomized comparative study.

Methods:

Patients receiving phacoemulsification were included. Consecutive eligible patients alternately underwent either removal of RLFs on the posterior capsule using capsular polish after irrigation and aspiration, and before intraocular lens (IOL) implantation, or RLF removal using a fluid-jet technique after IOL implantation. Posterior capsular images were used to quantify RLFs. Visual parameters were evaluated at 1 day, 1 week, and 1 year postoperatively. The proportion of capsule occupied by posterior capsule opacification (PCO) (area %) and incidence of protocol-driven laser posterior capsulotomy were recorded at 1 year in masked fashion.

Results:

Seven hundred forty eyes were allocated to polishing (n = 370) or fluid-jet technique (n = 370). Polishing required 70.4 ± 17.5 seconds and fluid-jet 32.2 ± 9.9 seconds (P≤ 0.001). Compared with the polishing group, capsular area occupied by RLFs in the fluid-jet group was significantly smaller (3.5% vs 0.5%,P= .031) at the end of surgery. One day postoperatively, the fluid-jet group had more desirable corrected distance visual acuity, objective scattering index, and Strehl ratio (allP< .05). PCO area percentage did not differ between groups (6.5% vs 4.5%,P= .252) 1 year postoperatively, but incidence of posterior capsulotomy was lower in the fluid-jet group (3.2% vs 0.8%,P= .019).

Conclusions:

Fluid-jet removed RLFs effectively and had lower incidence of postoperative capsulotomy than capsular polishing.
Concomitant decrease of double-positive lymphocyte population CD4CD8αα and Faecalibacterium prausnitzii in patients with colorectal cancer
Authors: Touchefeu Yann , Duchalais Emilie , Bruley des Varannes Stanislas , Alameddine Joudy , Mirallie Eric , Matysiak-Budnik Tamara , Le Bastard Quentin , Javaudin François , Rimbert Marie , Jotereau Francine , Montassier Emmanuel
Published: July 2020

Introduction and aims

Changes in the composition of the gut microbiota in patients with colorectal cancer (CRC) compatible with a contribution of the gut microbiota in carcinogenesis have been reported. In particular, a decrease Faecalibacterium prausnitzii has been identified. A CD4CD8αα, double-positive lymphocyte population (DP8α) has recently been demonstrated in the human colon and blood with regulatory functions and specificity for F. prausnitzii. Here, we aimed to detect dysbiosis in the fecal microbiome of patients with CRC by metagenomic analysis, and to look for changes in the levels of DP8α circulating T cells specific for F. prausnitzii in these patients.

Patients and methods

Patients with CRC and control subjects were prospectively included. None had received antibiotics in the previous month or any anti-tumor treatment. A stool sample was collected for each participant, and analyzed by shotgun sequencing. The DP8α T cell population was identified and quantified on fresh whole blood by flow cytometry with anti-CD45, anti-CD3, anti-CD4 and anti-CD8α co-labeling.

Results

Twenty-one patients with CRC and 20 controls subjects were included. We found that mean relative abundance of five species was significantly decreased in CRC patients compared with controls, including F. prausnitzii, Barnesiella intestinihominis, Alistipes finegoldii, Bacteroides eggerthii and Eubacterium siraeum. We also found that the DP8α T cell population was significantly decreased in the blood of CRC patients compared with controls.

Conclusion

In our work, we showed that a reduced abundance of F. prausnitzii in CRC patients was associated to a significant decrease in the circulating DP8α Treg population, suggesting a potential involvement of reduced activity of DP8α T cells in colonic carcinogenesis. These findings open new diagnostic and therapeutic strategies for CRC.
Development and Evaluation of a Nurse Leadership Succession Planning Strategy in an Academic Medical Center
Authors: Morris Matthew , Wood Felecia , Dang Deborah
Published: July 2020

Absence of nurse manager succession planning in an academic medical center necessitated a quality improvement project to identify, select, and enroll emerging leaders into a development program. The authors used organizational competencies and an evidence-based approach to effectively identify barriers, select future nurse leaders, and discover opportunities for process improvement.
Implementing TeamSTEPPS to Facilitate Workplace Civility and Nurse Retention
Authors: Krivanek Mary Jo , Dolansky Mary A. , Goliat Laura , Petty Gayle
Published: July 2020

Teamwork contributes to quality and may also reduce incivility and improve nurse retention. An evaluation of a TeamSTEPPS implementation in an intensive care unit included an assessment of teamwork, retention, and incivility. Teamwork improvement occurred from the initial assessment to 3 months later (U = 650, p = .001). Nurses planning to stay increased from 58% in 2016 to 89% in 2018. There was no change in incivility. The study provides strategies and lessons learned.
Analysis of Missed Sepsis Patients in a Pediatric Emergency Department With a Vital Sign-Based Electronic Sepsis Alert
Authors: Souganidis Ellie , Abbadessa Mary Kate , Ku Brandon , Minich Christian , Lavelle Jane , Zorc Joseph , Balamuth Fran
Published: July 2020

Objective

To characterize the cohort of missed sepsis patients since implementation of an electronic sepsis alert in a pediatric emergency department (ED).

Methods

Retrospective cohort study in a tertiary care children's hospital ED from July 1, 2014, to June 30, 2017. Missed patients met international consensus criteria for severe sepsis requiring intensive care unit admission within 24 hours of ED stay but were not treated with the sepsis pathway/order set in the ED. We evaluated characteristics of missed patients compared with sepsis pathway patients including alert positivity, prior intensive care unit admission, and laboratory testing via medical record review. Outcomes included timeliness of antibiotic therapy and need for vasoactive medications.

Results

There were 919 sepsis pathway patients and 53 (5%) missed patients during the study period. Of the missed patients, 41 (77%) had vital signs that flagged the sepsis alert. Of these 41 patients, 13 (32%) had a documented sepsis huddle where the team determined that the sepsis pathway was not indicated and 28 (68%) had no sepsis alert-related documentation. Missed patients were less likely to receive timely antibiotics (relative risk, 0.4; 95% confidence interval, 0.3–0.7) and more likely to require vasoactive medications (relative risk, 4.3; 95% confidence interval, 2.9–6.5) compared with sepsis patients.

Conclusions

In an ED with an electronic sepsis alert, missed patients often had positive sepsis alerts but were not treated for sepsis. Missed patients were more likely than sepsis pathway patients to require escalation of care after admission and less likely to receive timely antibiotics.
Descriptive Analysis of Patients Living With HIV Affected by COVID-19
Authors: Gudipati Smitha , Brar Indira , Murray Shannon , McKinnon John E. , Yared Nicholas , Markowitz Norman
Published: July 2020

Background:

COVID-19 disease has spread globally and was declared a pandemic on March 11, 2020, by the World Health Organization. On March 10, the State of Michigan confirmed its first 2 cases of COVID-19, and the number of confirmed cases has reached 47,182 as of May 11, 2020, with 4555 deaths.

Setting:

Currently, little is known if patients living with HIV (PLWH) are at a higher risk of severe COVID-19 or if their antiretrovirals are protective. This study presents epidemiologic and clinical features of COVID-19 infected PLWH in Detroit, Michigan.

Methods:

This is a case series that included 14 PLWH with laboratory-confirmed COVID-19 infection who were evaluated at Henry Ford Hospital in Detroit, Michigan, between March 20, 2020, and April 30, 2020.

Results:

Fourteen PLWH were diagnosed with COVID-19. Twelve patients were men and 2 were women; 13 patients were virally suppressed. Eight patients were hospitalized, and 6 patients were told to self-quarantine at home after their diagnoses. Three patients who were admitted expired during their hospital stay. No patient required bilevel positive airway pressure or nebulizer use in the emergency department, and none developed acute respiratory distress syndrome, pulmonary embolism, deep venous thrombosis, or a cytokine storm while on therapy for COVID-19.

Conclusion:

Although the clinical spectrum of COVID-19 among PLWH cannot be fully ascertained by this report, it adds to the data that suggest that HIV-positive patients with SARS-CoV-2 infection are not at a greater risk of severe disease or death as compared to HIV-negative patients.
Open Reduction and Internal Fixation Strategy For Treatment of Comminuted Mandibular Fracture
Authors: Ma Yanbo , Hao Xiuyan , Zhao Yantao
Published: July 2020

Purpose:

The aim of this study was to evaluate the treatment strategy of open reduction and internal fixation (ORIF) for comminuted mandibular fracture (CMF).

Methods:

Clinical studies about CMF were collected. Detailed information was extracted, and data were analyzed and merged from included articles.

Results:

Twelve studies, including 338 patients with CMF, were reported. A total of 256 patients receive ORIF among these 338 patients, and exhibited followed characteristics: ORIF usually were performed several days after injury; the extraoral approach for ORIF was used for 103 patients among 205 patients who received ORIF with definite information about surgical approach; titanium mesh, or reconstruction plate, combined with mini-plates was used in 17 and 194 patients, respectively; intermaxillary fixation (IMF) usually persisted about 1 to 3 weeks after ORIF; most patients exhibited satisfactory effect without serious complications, and the complication rate varied from 0 to 42%.

Conclusions:

ORIF strategy for treatment of CMF including: ORIF was a priority choice for CMF. ORIF usually was performed at several days after injury. Reconstruction plate, or titanium mesh, combined with mini-plates was recommended for ORIF surgery. After ORIF, IMF usually was recommended for about 1 to 3 weeks.
Ultrasound-Activated Bioresorbable Osteosynthesis in the Treatment of Craniosynostosis
Authors: Chen Youbai , Niu Zehao , Zhang Haizhong , Zhang Qixu , August Meredith , Han Yan
Published: July 2020

The purpose of this study is to estimate the incidence of fixation-related complications following ultrasound-activated biodegradable osteosynthesis (UBO) in the treatment of craniosynostosis. The authors searched MEDLINE, PubMed, Embase, Google Scholar, and Cochrane Library from January 2005 to January 2020 for clinical studies reporting the use of UBO for fixation in the treatment of craniosynostosis. The primary outcome was the incidence of fixation-related complications, including unstable fixation; swelling, plate visibility, or palpability; infection; inflammation, sinus formation, and discharge; implant exposure; reoperation or implant removal. The pooled incidence rates were estimated using random-effects models. Of 155 studies identified, 10 were included, representing 371 patients. Forty-six (12.4%) patients presented fixation-related complications. The incidence rates of swelling/visibility/palpability, infection, and reoperation/implant removal were pooled based on the available data. The pooled incidence rate of chronic swelling/visibility/palpability was 0.21 (95% confidence interval [CI], 0.05–0.43). Sensitivity analysis by omitting the outlier study demonstrates that the incidence of swelling/visibility/palpability was 0.07 (95% CI, 0.04–0.11). The pooled incidence rate of infection and reoperation/implant removal was 0.07 (95% CI, 0.01–0.16) and 0.04 (95% CI, 0.01–0.09), respectively. Results show that although UBO can provide stable fixation, chronic swelling/visibility/palpability, infection, and reoperation for removal are not uncommon. Based on the literature, the authors recommend judicious use of UBO in patients with large frontorbital advancement and in the area of the coronal suture or other sites with thin overlying skin/subcutaneous tissue. The high possibility of chronic swelling/palpability/visibility during degradation, needs to be discussed preoperatively.
Which Cholecystectomy Technique Would Surgeons Prefer on Themselves?
Authors: Lima Diego L. , Lima Raquel Nogueira C.L. , dos Santos Dalmir C. , Shadduck Phillip P. , Carvalho Gustavo L. , Malcher Flavio
Published: July 2020

Background:

As the minimally invasive surgery revolution approaches 30 years, many techniques are now available for cholecystectomy: open, conventional laparoscopy, ini-laparoscopy, single incision, robotic, and natural orifice. Although much has been published about patient preferences regarding these techniques, less is known about surgeon perceptions and preferences. The aim of this study was to survey attending and trainee surgeons about which cholecystectomy technique they would prefer for themselves and what factors determine their decision.

Methods:

Attending fellow and resident surgeons globally completed a Google Forms online questionnaire that was posted in 3 closed groups for surgeons on Facebook and WhatsApp.

Results:

The online questionnaire was completed by 600 surgeons (453 attending surgeons and 147 residents/fellows). Most respondents were male individuals (87.6% of attending surgeons, 78.2% of trainee surgeons). The most common age range of respondents was 31 to 40 years. Surgeon response was global, with especially good representation from North American, Asian, and European physicians. When conventional laparoscopy, mini-laparoscopy, and robotic surgery were the options offered for cholecystectomy, 58.5% of trainees and 45.7% of surgeons chose conventional laparoscopy. When asked if they would consider a single-incision or natural orifice transluminal endoscopic surgery approach, 91.5% answered no. When asked which technique they would prefer if hypothetically all techniques were equally safe, about three-fourths chose either conventional laparoscopy (46%) or mini-laparoscopy (27%). When asked to rank which factors they considered most important in choosing a surgical technique, surgeon experience (52%) and safety of the procedure (45%) were the 2 most important factors.

Conclusions:

When an international sample of 600 attending and trainee surgeons were asked about undergoing a cholecystectomy on themselves, most chose either conventional laparoscopy or mini-laparoscopy as their preferred access technique. Single-incision and natural orifice transluminal endoscopic surgery approaches were unpopular. Surgeons ranked the experience of the operating surgeon and safety of the procedure as the most important factors guiding their decision.
Genomic insights into a novel species Rhodoferax aquaticus sp. nov., isolated from freshwater
Authors: Li Taihua , Zhuo Ye , Jin Chun-Zhi , Wu Xuewen , Ko So-Ra , Jin Feng-Jie , Ahn Chi-Yong , Oh Hee-Mock , Lee Hyung-Gwan , Jin Long
Published: July 2020

A novel non-phototrophic member of the genus

Rhodoferax

was obtained from freshwater. The purpose of this study was to analyse the genome of a nonphototrophic strain and propose a new species based on its phylogenetic, genomic, physiological and chemotaxonomic characteristics. The results of phylogenetic analysis based on 16S rRNA gene sequences supports that the strain, designated Gr-4T, has a close relationship to the genus

Rhodoferax

. The observed average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) values between strain Gr-4T and its closest related strains were 72.3–74.6 % and 21.9–22.8 %, respectively. These values were much lower than the species separation thresholds for ANI or dDDH of 95–96 and 70 %, respectively, and in fact fall in the intergeneric range. Strain Gr-4T does not contain RuBisCO-related genes, but does contain GS/GOGAT pathway-related genes enabling nitrate ammonification. A polyphasic study and a genomic-level investigation were done to establish the taxonomic status of strain Gr-4T. Based on the phylogenetic, genomic and physiological differences, it is proposed that the isolate be classified to the genus

Rhodoferax

as Rhodoferax aquaticus sp. nov. with isolate Gr-4T (=KCTC 32394T=JCM 19166T) as the type strain.
ACDC: Automated Cell Detection and Counting for Time-lapse Fluorescence Microscopy
Authors: Rundo Leonardo , Tangherloni Andrea , Tyson Darren R. , Betta Riccardo , Militello Carmelo , Spolaor Simone , Nobile Marco S. , Besozzi Daniela , Lubbock Alexander L. R. , Quaranta Vito , Mauri Giancarlo , Lopez Carlos F. , Cazzaniga Paolo
Published: July 2020

Advances in microscopy imaging technologies have enabled the visualization of live-cell dynamic processes using time-lapse microscopy imaging. However, modern methods exhibit several limitations related to the training phases and to time constraints, hindering their application in the laboratory practice. In this work, we present a novel method, named Automated Cell Detection and Counting (ACDC), designed for activity detection of fluorescent labeled cell nuclei in time-lapse microscopy. ACDC overcomes the limitations of the literature methods, by first applying bilateral filtering on the original image to smooth the input cell images while preserving edge sharpness, and then by exploiting the watershed transform and morphological filtering. Moreover, ACDC represents a feasible solution for the laboratory practice, as it can leverage multi-core architectures in computer clusters to efficiently handle large-scale imaging datasets. Indeed, our Parent-Workers implementation of ACDC allows to obtain up to a 3.7× speed-up compared to the sequential counterpart. ACDC was tested on two distinct cell imaging datasets to assess its accuracy and effectiveness on images with different characteristics. We achieved an accurate cell-count and nuclei segmentation without relying on large-scale annotated datasets, a result confirmed by the average Dice Similarity Coefficients of 76.84 and 88.64 and the Pearson coefficients of 0.99 and 0.96, calculated against the manual cell counting, on the two tested datasets.
Pseudomonas aeruginosadetachment from surfaces via a self-made small molecule
Authors: Scheffler Robert J. , Sugimoto Yuki , Bratton Benjamin P. , Ellison Courtney K. , Koch Matthias D. , Donia Mohamed S. , Gitai Zemer
Published: July 2020

Pseudomonas aeruginosais a significant threat in both healthcare and industrial biofouling. Surface attachment ofP. aeruginosais particularly problematic as surface association induces virulence and biofilm formation, which hamper later antibiotic treatments. Previous efforts have searched for biofilm dispersal agents, but there are no known factors that specifically disperse surface-attachedP. aeruginosa. In this study we develop a quantitative surface-dispersal assay and use it to show thatP. aeruginosaitself produces factors that can stimulate its dispersal. Through bioactivity-guided fractionation, Mass Spectrometry, and Nuclear Magnetic Resonance, we elucidated the structure of one such factor, 2-methyl-4-hydroxyquinoline (MHQ). MHQ is an alkyl-quinolone with a previously unknown activity and is synthesized by the PqsABC enzymes. Pure MHQ is sufficient to disperseP. aeruginosa, but the dispersal activity of naturalP. aeruginosaconditioned media requires additional factors. Whereas other alkyl quinolones have been shown to act as antibiotics or membrane depolarizers, MHQ lacks these activities and known antibiotics do not induce dispersal. In contrast, we show that MHQ inhibits the activity of Type IV Pili (TFP) and that TFP targeting can explain its dispersal activity. Our work thus identifies surface dispersal as a new activity ofP. aeruginosa-produced small molecules, characterizes MHQ as a promising dispersal agent, and establishes TFP inhibition as a viable mechanism forP. aeruginosadispersal.

Significance Statement

We discovered that the clinically relevant human bacterial pathogenP. aeruginosa, typically associated with surface-based infections, is dispersed by a small molecule that the bacteria themselves produce. We elucidate the chemical structure of this molecule and find that mechanistically it functions to inhibit the activity of theP. aeruginosaextra cellular surface motility appendage, the type IV pilus.
Glycine receptor subunit-ß -deficiency in a mouse model of spasticity results in attenuated physical performance, growth and muscle strength
Authors: Rivares Cintia , Vignaud Alban , Noort Wendy , Koopmans Bastijn , Loos Maarten , Kalinichev Mikhail , Jaspers Richard T
Published: July 2020

Spasticity is the most common neurological disorder associated with increased muscle contraction causing impaired movement and gait. The aim of this study was to characterize physical performance and skeletal muscle function and phenotype of mice with a hereditary spastic mutation (B6.Cg-Glrbspa/J). Motor function, gait and physical activity of juvenile and adult spastic mice and the morphological, histological and mechanical characteristics of their soleus (SO) and gastrocnemius medialis (GM) muscles were compared with their wild-type (WT) littermates. Spastic mice showed attenuated growth, impaired motor function and low physical activity. Gait of spastic mice was characterized by a typical hopping pattern. Spastic mice showed lower muscle forces, which were related to the smaller physiological cross-sectional area of spastic muscles. The muscle-tendon complex length-force relationship of adult GM was shifted towards shorter lengths, which was explained by attenuated longitudinal tibia growth. Spastic GM was more fatigue resistant than WT GM. This was largely explained by a higher mitochondrial content in muscle fibers and relatively higher percentage of slow type muscle fibers. Muscles of juvenile spastic mice showed similar differences compared to WT juvenile mice, but these were less pronounced than between adult mice. This study shows that in spastic mice, disturbed motor function and gait is likely the result hyperactivity of skeletal muscle and impaired skeletal muscle growth, which progress with age.
COVID-19 transmission in the U.S. before vs. after relaxation of state social distancing measures
Authors: Tsai Alexander C. , Harling Guy , Reynolds Zahra , Gilbert Rebecca F. , Siedner Mark J.
Published: July 2020

Background

Weeks after issuing social distancing orders, all U.S. states and the District of Columbia at least partially relaxed these measures. Critical unanswered questions remain about the timing of relaxation, and if and how unregulated social distancing measures can be sustained while effectively maintaining epidemic control.

Methods

We identified all statewide social distancing measures that were implemented and/or relaxed in the U.S. between March 10-July 15, 2020, triangulating data from state government and third-party sources. Using segmented linear regression, we evaluated the extent to which social distancing measure relaxation affected epidemic control, as indicated by the time-varying, state-specific effective reproduction number (Rt).

Results

In the eight weeks prior to relaxation, mean Rt declined by 0.012 units per day (95% CI, -0.013 to -0.012), and 46/51 jurisdictions achieved Rt < 1.0 by the date of relaxation. After relaxation of social distancing, Rt reversed course and began increasing by 0.007 units per day (95% CI, 0.006-0.007), reaching a mean Rt of 1.16 eight weeks later, with only 9/51 jurisdictions maintaining Rt <1.0. Indicators often used to motivate relaxation at the time of relaxation (e.g. test positivity rate <5%) predicted greater post-relaxation epidemic growth.

Conclusions

We detected an immediate and significant reversal in epidemic growth gains after relaxation of social distancing measures across the U.S. These results illustrate the potential pitfalls of premature relaxation of social distancing measures in the U.S.
Improved COVID-19 Serology Test Performance by Integrating Multiple Lateral Flow Assays using Machine Learning
Authors: Mowery Cody T. , Marson Alexander , Song Yun S. , Ye Chun Jimmie
Published: July 2020

Mitigating transmission of SARS-CoV-2 has been complicated by the inaccessibility and, in some cases, inadequacy of testing options to detect present or past infection. Immunochromatographic lateral flow assays (LFAs) are a cheap and scalable modality for tracking viral transmission by testing for serological immunity, though systematic evaluations have revealed the low performance of some SARS-CoV-2 LFAs. Here, we re-analyzed existing data to present a proof-of-principle machine learning framework that may be used to inform the pairing of LFAs to achieve superior classification performance while enabling tunable False Positive Rates optimized for the estimated seroprevalence of the population being tested.