bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression screening and clinical outcomes among adults initiating maintenance hemodialysis
Authors: Fischer Michael J , Streja Elani , Hsiung Jui-Ting , Crowley Susan T , Kovesdy Csaba P , Kalantar-Zadeh Kamyar , Kourany Wissam M
Published: June 2021

Background

Transitioning to maintenance hemodialysis (HD) is a vulnerable period for persons with end-stage renal disease (ESRD), punctuated by high rates of depression, hospitalizations and death. Screening for depression during this time may help to improve patient outcomes but formal inquiry has yet to be conducted. Among a national Veteran cohort, we examined whether depression screening in the year prior to HD initiation led to improved outcomes in the year thereafter.

Methods

Associations between pre-ESRD depression screening and post-ESRD outcomes were examined with Cox proportional hazards models (mortality) and Poisson regression models (hospitalization). Hierarchal adjustment models accounted for sociodemographic, clinical, pre-ESRD care and dialysis characteristics.

Results

The final analytic cohort of the study was 30 013 Veterans of whom 64% underwent pre-ESRD depression screening. During the 12 months post-transition, the crude all-cause mortality rate was 0.32 person-year for those screened and 0.35 person-year for those not screened, while the median (interquartile range) hospitalizations were 2 (2, 2) per year for both groups. In fully adjusted models, pre-ESRD depression screening was associated with a lower risk of mortality [hazard ratio (95% confidence interval): 0.94 (0.90–0.99)] and hospitalization [incidence rate ratio (95% confidence interval): 0.97 (0.9–0.99)].

Conclusion

Depression screening among adults prior to maintenance HD transition may be associated with better outcomes during the following year.
Serum anti-CRP antibodies differentiate etiology and predict relapse in acute tubulointerstitial nephritis
Authors: Huang Jun-Wen , Su Tao , Tan Ying , Wang Jin-Wei , Tang Jia-Wei , Wang Su-Xia , Liu Gang , Zhao Ming-Hui , Yang Li
Published: June 2021

Introduction

Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury with various etiologies. It has been shown that autoimmune-related ATIN (AI-ATIN) has a higher recurrence rate and a greater likelihood of developing into chronic kidney disease compared with drug-induced ATIN, yet misdiagnosis at renal biopsy is not uncommon.

Methods

Patients who were clinicopathologically diagnosed as ATIN from January 2006 to December 2015 in Peking University First Hospital were enrolled. Clinical, pathological and follow-up data were collected. Serum samples on the day of renal biopsy were collected and tested for anti-C-reactive protein (CRP) antibodies. CRP and its linear peptides were used as coating antigens to detect antibodies. Statistical analysis was used to assess the diagnostic value of the antibodies.

Results

Altogether 146 patients were enrolled. The receiver operating characteristic–area under the curve of the anti-CRP antibody for the identification of late-onset AI-ATIN was 0.750 (95% confidence interval 0.641–0.860, P < 0.001) and the positivity was associated with ATIN relapse (adjusted hazard ratio = 4.321, 95% confidence interval 2.402–7.775, P < 0.001). Antibodies detected by CRP linear peptide 6 (PT6) were superior with regard to differentiating patients with AI-ATIN, while antibodies detected by peptide 17 (PT17) could predict ATIN relapse. Antibodies detected by these two peptides were positively correlated with the severity of tubular dysfunction and pathological injury.

Conclusions

Serum anti-CRP antibody could be used to differentiate late-onset AI-ATIN and predict relapse of ATIN at the time of renal biopsy. The CRP linear peptides PT6 and PT17 could be used as coating antigens to detect anti-CRP antibodies, which may provide more information for the clinical assessment of ATIN.
Non-parametric estimation of the preferential attachment function from one network snapshot
Authors: Pham Thong , Sheridan Paul , Shimodaira Hidetoshi
Published: June 2021

Preferential attachment is commonly invoked to explain the emergence of those heavy-tailed degree distributions characteristic of growing network representations of diverse real-world phenomena. Experimentally confirming this hypothesis in real-world growing networks is an important frontier in network science research. Conventional preferential attachment estimation methods require that a growing network be observed across at least two snapshots in time. Numerous publicly available growing network datasets are, however, only available as single snapshots, leaving the applied network scientist with no means of measuring preferential attachment in these cases. We propose a nonparametric method, called PAFit-oneshot, for estimating preferential attachment in a growing network from one snapshot. PAFit-oneshot corrects for a previously unnoticed bias that arises when estimating preferential attachment values only for degrees observed in the single snapshot. Our work provides a means of measuring preferential attachment in a large number of publicly available one-snapshot networks. As a demonstration, we estimated preferential attachment in three such networks, and found sublinear preferential attachment in all cases. PAFit-oneshot is implemented in the $\textsf{R}$ package $\texttt{PAFit}$.
Revisiting the lipid paradox in ST-elevation myocardial infarction in the Chinese population: findings from the CCC-ACS project
Authors: Sun Haonan , Li Ziping , Song Xiwen , Liu Hangkuan , Li Yongle , Hao Yongchen , Teng Tianmin , Liu Jun , Liu Jing , Zhao Dong , Zhou Xin , Yang Qing ,   the CCC-ACS Investigators
Published: June 2021

Aims

Previous observations revealed a negative association between low-density lipoprotein cholesterol (LDL-C) and clinical outcomes following myocardial infarction, i.e., the lower level the higher mortality, which was referred to as lipid paradox. We sought to re-evaluate this association in ST-elevation myocardial infarction (STEMI) in contemporary practice.

Methods and results

We examined the association between admission LDL-C and in-hospital mortality among 44 563 STEMI patients enrolled from 2014 to 2019 in a nationwide registry in China. A total of 43 covariates, which were temporally classified into the following three domains were used for adjustment: (i) pre-admission characteristics; (ii) percutaneous coronary intervention (PCI)-related variables; and (iii) other in-hospital medications. In-hospital mortality was 2.01% (897/44 563). When no covariate adjustment was performed, an inversely ‘J-shaped’ curve was observed between admission LDL-C levels and in-hospital mortality by restricted cubic spline in logistic regression, with a threshold value of <75 mg/dL that associated with increased risk for in-hospital mortality. However, a gradual attenuation for this association was noted when step-wise adjustments were performed, with the threshold values for LDL-C decreasing from 75 mg/dL to 70 mg/dL after accounting for pre-admission characteristics, further to 65 mg/dL after accounting for PCI-related variables, and finally to no statistical association after further adjustment for other in-hospital medications.

Conclusions

In a nationwide registry in China, our findings do not support the lipid paradox in terms of in-hospital mortality in STEMI patients in contemporary practice. Previous findings in this scenario are possibly due to inadequate control for confounders.
PCSK9 deficiency rewires heart metabolism and drives heart failure with preserved ejection fraction
Authors: Da Dalt Lorenzo , Castiglioni Laura , Baragetti Andrea , Audano Matteo , Svecla Monika , Bonacina Fabrizia , Pedretti Silvia , Uboldi Patrizia , Benzoni Patrizia , Giannetti Federica , Barbuti Andrea , Pellegatta Fabio , Indino Serena , Donetti Elena , Sironi Luigi , Mitro Nico , Catapano Alberico Luigi , Norata Giuseppe Danilo
Published: June 2021

Aims

PCSK9 is secreted into the circulation, mainly by the liver, and interacts with low-density lipoprotein receptor (LDLR) homologous and non-homologous receptors, including CD36, thus favouring their intracellular degradation. As PCSK9 deficiency increases the expression of lipids and lipoprotein receptors, thus contributing to cellular lipid accumulation, we investigated whether this could affect heart metabolism and function.

Methods and results

Wild-type (WT), Pcsk9 KO, Liver conditional Pcsk9 KO and Pcsk9/Ldlr double KO male mice were fed for 20 weeks with a standard fat diet and then exercise resistance, muscle strength, and heart characteristics were evaluated. Pcsk9 KO presented reduced running resistance coupled to echocardiographic abnormalities suggestive of heart failure with preserved ejection fraction (HFpEF). Heart mitochondrial activity, following maximal coupled and uncoupled respiration, was reduced in Pcsk9 KO mice compared to WT mice and was coupled to major changes in cardiac metabolism together with increased expression of LDLR and CD36 and with lipid accumulation. A similar phenotype was observed in Pcsk9/Ldlr DKO, thus excluding a contribution for LDLR to cardiac impairment observed in Pcsk9 KO mice. Heart function profiling of the liver selective Pcsk9 KO model further excluded the involvement of circulating PCSK9 in the development of HFpEF, pointing to a possible role locally produced PCSK9. Concordantly, carriers of the R46L loss-of-function variant for PCSK9 presented increased left ventricular mass but similar ejection fraction compared to matched control subjects.

Conclusion

PCSK9 deficiency impacts cardiac lipid metabolism in an LDLR independent manner and contributes to the development of HFpEF.
Heterologous expression of equol biosynthesis genes fromAdlercreutzia equolifaciens
Authors: Vázquez Lucía , Flórez Ana Belén , Rodríguez Javier , Mayo Baltasar
Published: June 2021

Equol is the isoflavone-derived metabolite with the greatest estrogenic and antioxidant activity. It is produced from daidzein by fastidious and oxygen-susceptible intestinal bacteria, which hinders their use at an industrial scale. Therefore, expressing the equol production machinery into easily-cultivable hosts would expedite the heterologous production of this compound. In this work, four genes (racemase, tdr, ddr and dzr) coding for key enzymes involved in equol production in Adlercreutzia equolifaciens DSM19450T were synthesized and cloned in a pUC-derived vector (pUC57-equol) that was introduced in Escherichia coli. Recombinant clones of E. coli produced equol in cultures supplemented with daidzein (equol precursor) and dihydrodaidzein (intermediate compound). To check whether equol genes were expressed in Gram-positive bacteria, the pUC57-equol construct was cloned into the low-copy-number vector pIL252, and the new construct (pIL252-pUC57-equol) introduced into model strains of Lacticaseibacillus casei and Lactococcus lactis. L. casei clones carrying pIL252-pUC57-equol produced a small amount of equol from dihydrodaidzein but not from daidzein, while L. lactis recombinant clones produced no equol from either of the substrates. This is the first time that A. equolifaciens equol genes have been cloned and expressed in heterologous hosts. E. coli clones harboring pUC57-equol could be used for biotechnological production of equol.
High-Quality Genome Assembly and Comprehensive Transcriptome of the Painted Lady ButterflyVanessa cardui
Authors: Zhang Linlin , Steward Rachel A , Wheat Christopher W , Reed Robert D
Published: June 2021

The painted lady butterfly, Vanessa cardui, has the longest migration routes, the widest hostplant diversity, and one of the most complex wing patterns of any insect. Due to minimal culturing requirements, easily characterized wing pattern elements, and technical feasibility of CRISPR/Cas9 genome editing, V. cardui is emerging as a functional genomics model for diverse research programs. Here, we report a high-quality, annotated genome assembly of the V. cardui genome, generated using 84× coverage of PacBio long-read data, which we assembled into 205 contigs with a total length of 425.4 Mb (N50 = 10.3 Mb). The genome was very complete (single-copy complete Benchmarking Universal Single-Copy Orthologs [BUSCO] 97%), with contigs assembled into presumptive chromosomes using synteny analyses. Our annotation used embryonic, larval, and pupal transcriptomes, and 20 transcriptomes across five different wing developmental stages. Gene annotations showed a high level of accuracy and completeness, with 14,437 predicted protein-coding genes. This annotated genome assembly constitutes an important resource for diverse functional genomic studies ranging from the developmental genetic basis of butterfly color pattern, to coevolution with diverse hostplants.
On backflow associated with oceanic and continental subduction
Authors: Moulas Evangelos , Brandon Mark T , Vaughan Hammon Joshua D , Schmalholz Stefan M
Published: June 2021

A popular idea is that accretion of sediment at a subduction zone commonly leads to the formation of a subduction channel, which is envisioned as a narrow zone located above a subducting plate and filled with vigorously circulating accreted sediment and exotic blocks. The circulation can be viewed as a forced convection, with downward flow in the lower part of the channel due to entrainment by the subducting plate, and a ‘backflow’ in the upper part of the channel. The backflow is often cited as an explanation for the exhumation of high-pressure/low-temperature metamorphic rocks from depths of 30 to 50 km. Previous analyses of this problem have mainly focused on the restricted case where the walls bounding the flow are artificially held fixed and rigid. A key question is if this configuration can be sustained on a geologically relevant timescale. We address this question using a coupled pair of corner flows. The pro-corner accounts for accretion and deformation directly above the subducting plate, and the retro-corner corresponds to a deformable region in the overlying plate. The two corners share a medial boundary, which is fully coupled but is otherwise free to rotate and deform. Our results indicate that the maintenance of a stable circulating flow in a narrow pro-corner (<15°) requires an unusually large viscosity ratio, μretro/μpro > 103. For lower viscosity ratios, the medial boundary would rotate rearwards, converting the initially narrow pro-corner into an obtuse geometry. For a stable narrow corner, we show that the backflow within the corner is caused by downward convergence of the incoming flow and an associated downward increase in dynamic pressure, which reaches a maximum at the corner point. The total pressure is thus expected to be much greater than predicted using a lithostatic gradient, which means that estimates of depth from metamorphic pressure would have to be adjusted accordingly. In addition, we show that the velocity fields associated with a forced corner flow and a buoyancy-assisted channel flow are nearly identical. As such, structural geology studies are not sufficient to distinguish between these two processes.
SARS-CoV-2 Serology Status Detected by Commercialized Platforms Distinguishes Previous Infection and Vaccination Adaptive Immune Responses
Authors: Suhandynata Raymond T , Bevins Nicholas J , Tran Jenny T , Huang Deli , Hoffman Melissa A , Lund Kyle , Kelner Michael J , McLawhon Ronald W , Gonias Steven L , Nemazee David , Fitzgerald Robert L
Published: June 2021

Background

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected over 110 million individuals and led to 2.5 million deaths worldwide. As more individuals are vaccinated, the clinical performance and utility of SARS-CoV-2 serology platforms needs to be evaluated.

Methods

The ability of 4 commercial SARS-CoV-2 serology platforms to detect previous infection or vaccination were evaluated using a cohort of 53 patients who were SARS-CoV-2 PCR positive, 89 SARS-CoV-2-vaccinated healthcare workers (Pfizer or Moderna), and 127 patients who were SARS-CoV-2 negative. Serology results were compared to a cell-based SARS-CoV-2 pseudovirus (PSV) neutralizing antibodies assay.

Results

The Roche S-(spike) antibody and Diazyme neutralizing antibodies (NAbs) assays detected adaptive immune response in 100.0% and 90.1% of vaccinated individuals who received 2 doses of vaccine (initial and booster), respectively. The Roche N-(nucleocapsid) antibody assay and Diazyme IgG assay did not detect adaptive immune response in vaccinated individuals. The Diazyme NAbs assay correlated with the PSV SARS-CoV-2 median infective dose (ID50) neutralization titers (R2 = 0.70), while correlation of the Roche S-antibody assay was weaker (R2 = 0.39). Median PSV SARS-CoV-2 ID50 titers more than doubled in vaccinated individuals who received 2 doses of the Moderna vaccine (ID50, 597) compared to individuals who received a single dose (ID50, 284).

Conclusions

The Roche S-antibody and Diazyme NAbs assays robustly detected adaptive immune responses in SARS-CoV-2 vaccinated individuals and SARS-CoV-2 infected individuals. The Diazyme NAbs assay strongly correlates with the PSV SARS-CoV-2 NAbs in vaccinated individuals. Understanding the reactivity of commercially available serology platforms is important when distinguishing vaccination response versus natural infection.
Strategic Decision-Making by a Forensic Toxicology Laboratory in Response to an Emerging NPS: Detection, Quantitation and Interpretation of Carfentanil in Death Investigations in Ontario, Canada, July 2017 to June 2018
Authors: Solbeck Patricia , Woodall Karen L , Martin Teri L
Published: June 2021

The proliferation of novel psychoactive substances (NPS) and the current opioid epidemic creates challenges for a toxicology laboratory. Methods capable of detecting and quantitating emerging compounds must be established despite limited information on toxicologically relevant concentrations. This paper will (i) describe how a publicly funded forensic laboratory reacted to the emergence of carfentanil as a public safety concern and (ii) contribute to the existing forensic literature by presenting a series of deaths involving carfentanil between July 2017 and June 2018. The Centre of Forensic Sciences is the primary provider of forensic toxicology testing in medicolegal death investigations in the province of Ontario. When carfentanil was first identified in the illicit drug supply, routine screening methods used by this laboratory were not sufficiently sensitive to detect the drug at concentrations expected in blood samples. Previously validated, multi-target liquid chromatography–tandem mass spectrometry (LC–MS-MS) quantitative methods already in use by the laboratory did show improved detectability for carfentanil. Thus, an existing LC–MS-MS method was adapted to include carfentanil, achieving improved sensitivity while also providing quantitation in suspected drug-related deaths. This approach had the added benefit that the LC–MS-MS method selected for modification was used in all death investigations requiring toxicology analysis in Ontario, thereby providing an opportunity for surveillance. Using this method, 4,953 cases were analyzed with carfentanil detected at a concentration greater than the limit of detection (0.05 ng/mL) in 160 decedents. Postmortem blood carfentanil concentrations ranged from less than 0.1 to 9.2 ng/mL. Of the 160 carfentanil-positive cases, 156 were classified as either mixed drug toxicity or carfentanil overdose. The approach described enabled this laboratory to efficiently implement a quantitative test for carfentanil in all death investigations, providing a useful template for modifying existing methods when a new psychoactive substance becomes available in the population.
The Carbon Cost of Travel to a Medical Conference: Modelling the Annual Meeting of the Canadian Association of Gastroenterology
Authors: Leddin Desmond , Galts Ciaran , McRobert Elizabeth , Igoe John , Singh Harminder , Sinclair Paul
Published: June 2021

Objectives

We estimated and compared the travel related carbon emissions of the annual meeting of the Canadian Association of Gastroenterology between the two most common geographical locations of the meeting.

Methods

We modelled the car, train and flight travel journey of each registrant to two annual meetings. One was held in Toronto, close to where the majority of Gastroenterogists live, the other in Banff in the west of the country. We used validated carbon emission outputs per kilometer of travel.

Results

The average per capita distance travelled to the Toronto meeting was 2845 km, resulting in 0.540 tonnes (t) of CO2equivalent (CO2e) emitted per person. When the meeting was held in Banff emissions were 41% higher than those in Toronto with an average distance travelled of 3949 km and 0.760t of CO2e emitted per person. Almost all of the travel related carbon emissions for both meetings were generated by flying.

Conclusions

Even when held close to the largest population centre, there is a large environmental impact from travel to annual meetings. Importantly, choice of meeting location has a very big impact on difference in carbon emissions. Societies need to consider the site of meetings and reduce the number of in-person attendees if they wish to reduce their carbon footprint. Hybrid models participants should be considered. Our analysis also suggests, other medical societies who wish to model their annual meetings can use a simplified model, using flying distance only, to estimate travel-related emissions.
The Galleria mellonella-Enteropathogenic Escherichia coli Model System: Characterization of Pathogen Virulence and Insect Immune Responses
Authors: Chen Robin Y , Keddie B Andrew
Published: June 2021

The use of Galleria mellonella (Linnaeus) (Lepidoptera: Pyralidae), an economical insect model, for the study of enteropathogenic Escherichia coli (Migula) (EPEC), a diarrheagenic human pathogen, has been demonstrated previously but remains poorly understood. The present study characterizes the Galleria-EPEC system extensively for future studies using this system. We found that EPEC causes disease in G. mellonella larvae when injected intrahemocoelically but not orally. Disease manifests as increased mortality, decreased survival time, delayed pupation, decreased pupal mass, increased pupal duration, and hemocytopenia. Disease symptoms are dose-dependent and can be used as metrics for measuring EPEC virulence in future studies. The type III secretion system was only partially responsible for EPEC virulence in G. mellonella while the majority of the virulence remains unknown in origin. EPEC elicits insect anti-bacterial immune responses including melanization, hemolymph coagulation, nodulation, and phagocytosis. The immune responses were unable to control EPEC replication in the early stage of infection (≤3 h post-injection). EPEC clearance from the hemocoel does not guarantee insect survival. Overall, this study provided insights into EPEC virulence and pathogenesis in G. mellonella and identified areas of future research using this system.
Use of over-the-counter medicines by privately insured patients with common chronic conditions in South Africa
Authors: Padayachee Neelaveni , Rothberg Alan D , Truter Ilse , Butkow Neil
Published: June 2021

Objectives

The study measured access to commonly used over-the-counter (OTC) medicines (OTCMs) by individuals who were insured for the management of chronic diseases and considered reasons for selection of the medicines in addition to mainstream drugs usually prescribed for treatment.

Methods

Data were extracted from a large corporate database. Eligible subjects were aged ≥40 years and registered for management of one of the prevalent non-communicable diseases. Utilization of aspirin, inhaled corticosteroids and bronchodilators was assessed.

Key findings

The study population included 12 108 controls and 4149 individuals with one of 11 common chronic conditions that were categorized as metabolic, respiratory, cardiovascular or glaucoma. There was high utilization of bronchodilators in the respiratory group, possibly indicative of poor control of the primary condition and moderate access to bronchodilators by controls, possibly self-medicating for an undiagnosed chronic condition. Aspirin was not only utilized for primary or secondary prevention in the cardiovascular and metabolic groups but also appeared to be used to treat glaucoma. Bronchodilators may also have been used to treat side effects of drugs used to treat hypertension.

Conclusions

Reasons for use of OTCMs in the treatment of a chronic condition include poor control, treatment of a side-effect of a drug used to treat the chronic condition and self-medication for an undiagnosed condition. To gain further insight, insurers should routinely analyse claims and develop performance-enhancing interventions.
Three millimeter needlescopic splenectomy using three-port technique: report of three cases
Authors: Matsushita Koji , Tagaya Nobumi , Nakajima Ryuichirou , Yagi Masayuki , Obana Yuichi , Nakano Yuhei , Suzuki Junpei , Mizoguchi Masako , Yoshimura Yukino , Arai Takashi , Hasegawa Yako , Suzuki Junichi , Haku Kyokun , Arai Toshifumi , Kurosaki Tetsuya , Saito Kazuyuki
Published: June 2021

We report our experience with needlescopic splenectomy (NS) for the surgical treatment of idiopathic thrombocytopenic purpura using a 3-mm needlescope with three ports. One patient was male and two were females, and their mean age was 58 years. The patient was placed in the right lateral decubitus position. The first 12-mm port was introduced through the lateral margin of the left rectus abdominis muscle, and the other two 3-mm ports were inserted in the left upper quadrant. NS was performed by a standard technique under the observation of 3.3-mm needlescope. The surgical procedure was successfully completed in all the patients. The mean duration of surgery, intra-operative bleeding volume and post-operative hospital stay were 176 min, 70 ml and 4.7 days, respectively. There were no particular peri-operative complications in spite of dense adhesions or simultaneous laparoscopic procedures. Our method is safe and feasible with low morbidity and without impairing cosmetic benefits.
Ionized gas kinematics of cluster AGN at z ∼ 0.8 with KMOS
Authors: Paillalef Marcela G , Flores Hector , Demarco Ricardo , Rettura Alessando , Jaffé Yara , Lidman Chris , Nantais Julie , Puech Mathieu , Rosati Piero
Published: June 2021

We present an integral field spectroscopy study of two active galactic nuclei (AGN) in the galaxy cluster RXJ0152–137 at z = 0.84. We have combined integrated and 3D spectra with HST images to perform a complete morpho-kinematical analysis of each galaxy. For G557, we detect narrow and broad H α and [N ii] emission. The broad H α component is redshifted by v ∼ 939 km s−1 concerning the narrow component. The kinematics analysis and VLT/FORS2 data indicate that G557 presents evidence of radial outflows. For G300, it was possible to detect only the broad H α emission. The spectral properties of both galaxies are equivalent to those of local AGN. We also compare the results obtained for each AGN with their location within the cluster. We found a possible connection of the environment with the properties inferred for each of them, and the possible interaction of G557 with an unconfirmed neighboring galaxy, for which a bridge-like structure is observed in the HST images. This work shows evidence of how the same type of AGN can show differences in their spectroscopic properties depending on the region of the cluster in which they develop, which is important to understand how the environment affects AGN and, consequently, the evolution of galaxies.
The ionized gas outflow in the Circinus galaxy: kinematics and physical conditions
Authors: Fonseca-Faria M A , Rodríguez-Ardila A , Contini M , Reynaldi V
Published: June 2021

We employ MUSE/VLT data to study the ionized and highly ionized gas phases of the feedback in Circinus, the closest Seyfert 2 galaxy to us. The analysis of the nebular emission allowed us to detect a remarkable high-ionization gas outflow beyond the galaxy plane traced by the coronal lines [Fe vii] λ6089 and [Fe x] λ6374, extending up to 700 and 350 pc NW from the nucleus, respectively. This is the first time that the [Fe x] emission is observed at such distances from the central engine in an active galactic nucleus (AGN). The gas kinematics reveals expanding gas shells with velocities of a few hundred km s−1, spatially coincident with prominent hard X-ray emission detected by Chandra. Density and temperature sensitive line ratios show that the extended high-ionization gas is characterized by a temperature reaching 25 000 K and an electron density >102 cm−3. We found that local gas excitation by shocks produced by the passage of a radio jet leads to the spectacular high-ionization emission in this object. This hypothesis is fully supported by photoionization models that account for the combined effects of the central engine and shocks. They reproduce the observed emission line spectrum at different locations inside and outside of the NW ionization cone. The energetic outflow produced by the radio jet is spatially located close to an extended molecular outflow recently reported using ALMA which suggests that they both represent different phases of the same feedback process acting on the AGN.
A Turbulent Magmatic Density Current and the Origin of the Anastomosing UG-1 Chromitites at Dwars River in the Bushveld Complex
Authors: Maghdour-Mashhour Reza , Hayes Ben
Published: June 2021

The origin of the enigmatic UG-1 chromitites at Dwars River in the eastern limb of the Bushveld Complex has been vigorously debated. The UG-1 chromitites form an anastomosing network of multiple layers that are hosted in poikilitic anorthosites and their formation has previously been explained by depositional, erosional, and intrusive processes. We propose that the UG-1 chromitites formed in response to the emplacement of a turbulent magmatic density current into the developing chamber. We use theoretical constraints in fluid mechanics to describe the evolution of the current and in this context, we provide an explanation for the enigmatic igneous features that are preserved at Dwars River. The current was emplaced as an instantaneous single pulse (fixed volume) of dense plagioclase-charged magma (i.e. a plagioclase slurry) that turbulently propagated along the chamber floor. Settling of the initial cargo of entrained plagioclase laths resulted in the formation of a thick sequence of feldspathic mush. The remaining melt turbulently outruns on the chamber floor ahead of the feldspathic mush. This led to the density current becoming stratified into two layers: (1) a basal granular layer, and (2) an upper melt-rich layer. Both layers evolved in a viscous-dominated regime from a Newtonian to a non-Newtonian behaviour (i.e. a power law fluid). In the current’s propagation stage, the resident magma in the chamber was entrained and efficiently admixed into the melt-dominated upper layer, producing a superheated chromite-saturated hybrid melt. Chromite precipitation from this hybrid melt led to the formation of a series of chromite-laden slurries that flowed in the turbulent current and were split (‘bifurcated’) as they passed around rising buoyant plagioclase diapirs that were developing in the back of the current. This led to the anastomosing and bifurcating nature of the UG-1 chromitites. The chromite slurries merged in the tail of the current and eventually back-injected into the deposited plagioclase cumulates on the chamber floor—forming the main ∼2-m thick UG-1 chromitite layer. The cooling and crystallization of the propagating upper layer of the current led to an increase in its viscosity that slowed its velocity until it eventually stagnated on the chamber floor. The mechanical sorting of crystals in plume structures became dominant at the stagnation stage. We argue that spatial variations in crystal packing controlled the heterogeneous distribution of brittle and ductile deformation features that are observed at Dwars River. In situ crystallization of trapped pore melts led to the nucleation of large orthopyroxene and plagioclase oikocrysts that cemented the anorthosite and the chromitite layers, respectively. The emplacement of magmatic density currents and intra-chamber magma mixing may be pertinent to the development of stratiform chromitites in incrementally constructed magma chambers.
Reasonable But Non-Liberal: Another Route to Polycentrism
Authors: Schaefer Alexander
Published: June 2021

In an influential article, Brian Kogelmann argues that a polycentric political order offers an appealing way of reconciling deep diversity with Rawls’ ideal of the well-ordered society. Although I agree with this conclusion, I suggest an amendment to Kogelmann's argument. In particular, his argument abandons the deep diversity that originally motivates the project by stipulating that all citizens will accept liberal political conceptions of justice. I offer an alternative defence of polycentrism, one that shows its ability to achieve the goals of the well-ordered society without assuming that all citizens endorse a liberal political conception.
Interexaminer Agreement and Reliability of an Internationally Endorsed Screening Framework for Cervical Vascular Risks Following Manual Therapy and Exercise: The Go4Safe Project
Authors: de Best Rogier F , Coppieters Michel W , van Trijffel Emie , Compter Annette , Uyttenboogaart Maarten , Bot Joost C , Castien Rene , Pool Jan J M , Cagnie Barbara , Scholten-Peeters Gwendolyne G M
Published: June 2021

Objective

Clinicians are recommended to use the clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) to provide guidance regarding assessment of the cervical spine and potential for cervical artery dysfunction prior to manual therapy and exercise. However, the interexaminer agreement and reliability of this framework is unknown. This study aimed to estimate the interexaminer agreement and reliability of the IFOMPT framework among physical therapists in primary care.

Methods

Ninety-six patients who consulted a physical therapist for neck pain or headache were included in the study. Each patient was tested independently by 2 physical therapists, from a group of 17 physical therapists (10 pairs) across The Netherlands. Patients and examiners were blinded to the test results. The overall interexaminer agreement, specific agreement per risk category (high-, intermediate-, and low-risk), and interexaminer reliability (weighted κ) were calculated.

Results

Overall agreement was 71% (specific agreement in high-risk category = 63%; specific agreement in intermediate-risk category = 38%; specific agreement in low-risk category = 84%). Overall reliability was moderate (weighted κ = 0.39; 95% CI = 0.21–0.57) and varied considerably between pairs of physical therapists (κ = 0.14–1.00).

Conclusion

The IFOMPT framework showed an insufficient interexaminer agreement and fair interexaminer reliability among physical therapists when screening the increased risks for vascular complications following manual therapy and exercise prior to treatment.

Impact

The IFOMPT framework contributes to the safety of manual therapy and exercise. It is widely adopted in clinical practice and educational programs, but the measurement properties are unknown. This project describes the agreement and reliability of the IFOMPT framework.
Police Legitimacy and Hybrid Security Orders in Central America
Authors: Cruz José Miguel
Published: June 2021

This article examines the relationship between hybrid security orders and police legitimacy. Hybrid orders are operationalized through the presence of non-state armed groups who participate in local governance. In some developing countries, police forces are not the only enforcers of laws and local norms. The prominence of non-state armed groups in security tasks at the local level questions police authority. The article uses cross-sectional, national-based survey data from Central America. These countries have been struggling to contain criminal violence while reforming their police forces after years of military control and corruption. The findings indicate that although the police presence in the community helps to build police legitimacy, in some cases, the latter is also associated with the presence of other non-state groups. The article discusses how police forces relate to other non-state groups to retain legitimacy.
Neck fat and obstructive sleep apnea in obese adolescents
Authors: Cielo Christopher M , Keenan Brendan T , Wiemken Andrew , Tapia Ignacio E , Kelly Andrea , Schwab Richard J
Published: June 2021

Study Objectives

Increased neck circumference, a surrogate for the neck fat that can narrow the upper airway in obese individuals, is a risk factor for obstructive sleep apnea syndrome (OSAS) in adults, but the association between neck fat and OSAS in adolescent males and females is unknown. We hypothesized that obese adolescents with OSAS have more neck fat than controls, females more neck fat than males, and that neck fat correlates with obesity and OSAS severity.

Methods

Obese adolescents with OSAS and obese and normal-weight controls underwent upper airway magnetic resonance imaging, polysomnography, and anthropometrics, including neck circumference measurement. Intra-neck and subcutaneous neck fat measurements were manually segmented and compared among the three groups using ANOVA and between males and females using t-tests. The relationship between polysomnographic parameters and neck fat measurements was assessed in adolescents with OSAS using Pearson correlations.

Results

One-hundred nineteen adolescents (38 females) were studied: 39 obese with OSAS, 34 obese controls, and 46 normal-weight controls. Neck fat was not greater in adolescents with OSAS compared to obese controls (p=0.35), and neck fat volume was not related to OSAS severity (p = 0.36). However, obese adolescents had more neck fat than normal-weight controls (p < 0.001), and neck fat volume correlated with neck circumference (r = 0.53, p < 0.001). Females had significantly greater cross-sectional neck fat than males (p < 0.001).

Conclusions

While neck fat is associated with obesity and neck circumference in adolescents and is greater in females versus males, it does not appear to correlate with presence and severity of OSAS.
Molecular epidemiology of peste des petits ruminants virus emergence in critically endangered Mongolian saiga antelope and other wild ungulates
Authors: Benfield Camilla T O , Hill Sarah , Shatar Munkduuren , Shiilegdamba Enkhtuvshin , Damdinjav Batchuluun , Fine Amanda , Willett Brian , Kock Richard , Bataille Arnaud
Published: June 2021

Peste des petits ruminants virus (PPRV) causes disease in domestic and wild ungulates, is the target of a Global Eradication Programme, and threatens biodiversity. Understanding the epidemiology and evolution of PPRV in wildlife is important but hampered by the paucity of wildlife-origin PPRV genomes. In this study, full PPRV genomes were generated from three Mongolian saiga antelope, one Siberian ibex, and one goitered gazelle from the 2016–2017 PPRV outbreak. Phylogenetic analysis showed that for Mongolian and Chinese PPRV since 2013, the wildlife and livestock-origin genomes were closely related and interspersed. There was strong phylogenetic support for a monophyletic group of PPRV from Mongolian wildlife and livestock, belonging to a clade of lineage IV PPRV from livestock and wildlife from China since 2013. Discrete diffusion analysis found strong support for PPRV spread into Mongolia from China, and phylogeographic analysis indicated Xinjiang Province as the most likely origin, although genomic surveillance for PPRV is poor and lack of sampling from other regions could bias this result. Times of most recent common ancestor (TMRCA) were June 2015 (95 per cent highest posterior density (HPD): August 2014 to March 2016) for all Mongolian PPRV genomes and May 2016 (95 per cent HPD: October 2015 to October 2016) for Mongolian wildlife-origin PPRV. This suggests that PPRV was circulating undetected in Mongolia for at least 6 months before the first reported outbreak in August 2016 and that wildlife were likely infected before livestock vaccination began in October 2016. Finally, genetic variation and positively selected sites were identified that might be related to PPRV emergence in Mongolian wildlife. This study is the first to sequence multiple PPRV genomes from a wildlife outbreak, across several host species. Additional full PPRV genomes and associated metadata from the livestock–wildlife interface are needed to enhance the power of molecular epidemiology, support PPRV eradication, and safeguard the health of the whole ungulate community.
Fusarium verticillioides Induces Maize-Derived Ethylene to Promote Virulence by Engaging Fungal G-Protein Signaling
Authors: Park Yong-Soon , Borrego Eli J. , Gao Xiquan , Christensen Shawn A. , Schmelz Eric , Lanubile Alessandra , Drab Dillon A. , Cody Will , Yan Huijuan , Shim Won-Bo , Kolomiets Michael V.
Published: June 2021

Seed maceration and contamination with mycotoxin fumonisin inflicted by Fusarium verticillioides is a major disease concern for maize producers worldwide. Meta-analyses of quantitative trait loci for Fusarium ear rot resistance uncovered several ethylene (ET) biosynthesis and signaling genes within them, implicating ET in maize interactions with F. verticillioides. We tested this hypothesis using maize knockout mutants of the 1-aminocyclopropane-1-carboxylate (ACC) synthases ZmACS2 and ZmACS6. Infected wild-type seed emitted five-fold higher ET levels compared with controls, whereas ET was abolished in the acs2 and acs6 single and double mutants. The mutants supported reduced fungal biomass, conidia, and fumonisin content. Normal susceptibility was restored in the acs6 mutant with exogenous treatment of ET precursor ACC. Subsequently, we showed that fungal G-protein signaling is required for virulence via induction of maize-produced ET. F. verticillioides Gβ subunit and two regulators of G-protein signaling mutants displayed reduced seed colonization and decreased ET levels. These defects were rescued by exogenous application of ACC. We concluded that pathogen-induced ET facilitates F. verticillioides colonization of seed, and, in turn, host ET production is manipulated via G-protein signaling of F. verticillioides to facilitate pathogenesis.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Preoperative assessment of patients undergoing elective noncardiac surgery
Authors: Bodner Gayle , Cabel Emily , Kaiser Chris , Murphy Mackenzie , Tastad Laura
Published: June 2021

Patient comorbidities and risk factors are important to the success of any operation, and knowing about them before surgery can help clinicians anticipate perioperative complications and optimize patient conditions. This article describes key considerations in the preoperative assessment of patients undergoing elective noncardiac surgery and describes risk stratification for common conditions.
Diagnosis and management of atopic dermatitis
Authors: Johnson Kory M. , Will Brett M. , Johnson Douglas W.
Published: June 2021

Atopic dermatitis is a chronic inflammatory skin condition that affects patients of all ages. The disease is characterized by xerosis (dry skin) and intensely pruritic lesions distributed throughout the body. This article reviews diagnostic features and treatments for atopic dermatitis.
Evolution of Clinical Skills Assessment in the USMLE: Looking to the Future After Step 2 CS Discontinuation
Authors: Katsufrakis Peter J. , Chaudhry Humayun J.
Published: June 2021

The COVID-19 pandemic interrupted administration of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam in March 2020 due to public health concerns. As the scope and magnitude of the pandemic became clearer, the initial plans by the USMLE program’s sponsoring organizations (NBME and Federation of State Medical Boards) to resume Step 2 CS in the short-term shifted to long-range plans to relaunch an exam that could harness technology and reduce infection risk. Insights about ongoing changes in undergraduate and graduate medical education and practice environments, coupled with challenges in delivering a transformed examination during a pandemic, led to the January 2021 decision to permanently discontinue Step 2 CS. Despite this, the USMLE program considers assessment of clinical skills to be critically important. The authors believe this decision will facilitate important advances in assessing clinical skills.

Factors contributing to the decision included concerns about achieving desired goals within desired time frames; a review of enhancements to clinical skills training and assessment that have occurred since the launch of Step 2 CS in 2004; an opportunity to address safety and health concerns, including those related to examinee stress and wellness during a pandemic; a review of advances in the education, training, practice, and delivery of medicine; and a commitment to pursuing innovative assessments of clinical skills. USMLE program staff continue to seek input from varied stakeholders to shape and prioritize technological and methodological enhancements to guide development of clinical skills assessment. The USMLE program’s continued exploration of constructs and methods by which communication skills, clinical reasoning, and physical examination may be better assessed within the remaining components of the exam provides opportunities for examinees, educators, regulators, the public, and other stakeholders to provide input.
Obstetrician–Gynecologists' Practices in Postpartum Sterilization Without a Valid Medicaid Consent Form
Authors: Arora Kavita Shah , Ponsaran Roselle , Morello Laura , Katabi Leila , Behmer Hansen Rosemary T. , Zite Nikki , White Kari
Published: June 2021

OBJECTIVE:

To explore the practices of obstetrician–gynecologists (ob-gyns) in the United States surrounding postpartum sterilization when the Medicaid consent form was not valid.

METHODS:

Using the American College of Obstetricians and Gynecologists' online directory, we conducted a qualitative study where we recruited ob-gyns practicing in 10 geographically diverse U.S. states for a qualitative study using semi-structured interviews conducted by telephone. We analyzed interview transcripts using the constant comparative method and principles of grounded theory.

RESULTS:

Thirty ob-gyns (63% women, 77% nonsubspecialized, and 53% academic setting) were interviewed. Although most physicians stated that they did not perform sterilizations without a valid Medicaid sterilization form, others noted that they sometimes did due to a sense of ethical obligation toward their patient's health, being in a role with more authority or seniority, interpreting the emergency justification section of the form more broadly, or backdating the form. The physicians who said that they never went ahead without a signed form tended to work at large institutions and were concerned with losing funding and engaging in potentially illegal or fraudulent behavior.

CONCLUSION:

Physicians' varied behaviors related to providing postpartum sterilization without a valid Medicaid consent form demonstrate that the policy is in need of revision. Unclear terminology and ramifications of the Medicaid sterilization policy need to be addressed to ensure equitable care.