bluuebunny/crossref_metadata_2025 huggingface dataset:
AI-enabled business models in legal services: from traditional law firms to next-generation law companies?
Authors: Armour John , Sako Mari
Published: January 2020

What will happen to law firms and the legal profession when the use of artificial intelligence (AI) becomes prevalent in legal services? We address this question by considering three related levels of analysis: tasks, business models, and organizations. First, we review AI’s technical capabilities in relation to tasks, to identify contexts where it is likely to replace or augment humans. AI is capable of doing some, but not all, legal tasks better than lawyers and is augmented by multidisciplinary human inputs. Second, we identify new business models for creating value in legal services by applying AI. These differ from law firms’ traditional legal advisory business model, because they require technological (non-human) assets and multidisciplinary human inputs. Third, we analyze the organizational structure that complements the old and new business models: the professional partnership (P2) is well-adapted to delivering the legal advisory business model, but the centralized management, access to outside capital, and employee incentives offered by the corporate form appear better to complement the new AI-enabled business models. Some law firms are experimenting with pursuing new and old business models in parallel. However, differences in complements create conflicts when business models are combined. These conflicts are partially externalized via contracting and segregated and realigned via vertical integration. Our analysis suggests that law firm experimentation with aligning different business models to distinct organizational entities, along with ethical concerns, will affect the extent to which the legal profession will become ‘hybrid professionals’.
xGASS: Robust quantification of asymmetries in global H i spectra and their relationship to environmental processes
Authors: Watts Adam B , Catinella Barbara , Cortese Luca , Power Chris
Published: January 2020

We present an analysis of asymmetries in global H i spectra from the extended GALEX Arecibo SDSS Survey (xGASS), a stellar mass-selected and gas fraction-limited survey which is representative of the H i properties of galaxies in the local Universe. We demonstrate that the asymmetry in a H i spectrum is strongly linked to its signal-to-noise meaning that, contrary to what was done in previous works, asymmetry distributions for different samples cannot be compared at face value. We develop a method to account for noise-induced asymmetry and find that the typical galaxy detected by xGASS exhibits higher asymmetry than what can be attributed to noise alone, with 37 per cent of the sample showing asymmetry greater than 10 per cent at an 80 per cent confidence level. We find that asymmetric galaxies contain, on average, 29 per cent less H i mass compared to their symmetric counterparts matched in both stellar mass and signal-to-noise. We also present clear evidence that satellite galaxies, as a population, exhibit more asymmetric H i spectra than centrals and that group central galaxies show a slightly higher rate of H i asymmetries compared to isolated centrals. All these results support a scenario in which environmental processes, in particular those responsible for gas removal, are the dominant driver of asymmetry in xGASS.
Bubble mapping with the Square Kilometre Array – I. Detecting galaxies with Euclid, JWST, WFIRST, and ELT within ionized bubbles in the intergalactic medium at z > 6
Authors: Zackrisson Erik , Majumdar Suman , Mondal Rajesh , Binggeli Christian , Sahlén Martin , Choudhury Tirthankar Roy , Ciardi Benedetta , Datta Abhirup , Datta Kanan K , Dayal Pratika , Ferrara Andrea , Giri Sambit K , Maio Umberto , Malhotra Sangeeta , Mellema Garrelt , Mesinger Andrei , Rhoads James , Rydberg Claes-Erik , Shimizu Ikkoh
Published: January 2020

The Square Kilometre Array (SKA) is expected to provide the first tomographic observations of the neutral intergalactic medium at redshifts z > 6 and pinpoint the locations of individual ionized bubbles during early stages of cosmic reionization. In scenarios where star-forming galaxies provide most of the ionizing photons required for cosmic reionization, one expects the first ionized bubbles to be centred on overdensities of such galaxies. Here, we model the properties of galaxy populations within isolated, ionized bubbles that SKA-1 should be able to resolve at z ≈ 7–10, and explore the prospects for galaxy counts within such structures with various upcoming near-infrared telescopes. We find that, for the bubbles that are within reach of SKA-1 tomography, the bubble volume is closely tied to the number of ionizing photons that have escaped from the galaxies within. In the case of galaxy-dominated reionization, galaxies are expected to turn up above the spectroscopic detection threshold of JWST and ELT in even the smallest resolvable bubbles at z ≤ 10. The prospects of detecting galaxies within these structures in purely photometric surveys with Euclid, WFIRST, JWST, or ELT are also discussed. While spectroscopy is preferable towards the end of reionization to provide a robust sample of bubble members, multiband imaging may be a competitive option for bubbles at z ≈ 10, due to the very small number of line-of-sight interlopers expected at these redshifts.
Perturbation dynamics in Keplerian flow under external stochastic forcing
Authors: Razdoburdin D N
Published: January 2020

We investigate the dynamics of linear perturbations in Keplerian flow under external stochastic force. To abstract from the details of flow structure and boundary conditions, we consider the problem in the shearing box approximation. An external force is assumed to have zero mean, even so, induced perturbations form a steady state, which provides angular momentum transfer to the periphery of the flow. The most effective scenario is based on the transient amplification of induced vortices with the following emission of a shearing sound wave, wherein the maximum of the flux linearly depends on Reynolds number. Thus such a mechanism is significant for astrophysical flows, for which enormous Reynolds numbers are typical. At the same time, addressing the problem analytically, we find that for incompressible fluid in the shearing box approximation stochastic forcing does not lead to average angular momentum transfer. Thus the compressibility of the fluid plays an important role here, and one cannot neglect it.
Spectral and temporal properties of Compton scattering by mildly relativistic thermal electrons
Authors: Zdziarski Andrzej A , Szanecki Michał , Poutanen Juri , Gierliński Marek , Biernacki Paweł
Published: January 2020

We have obtained new solutions and methods for the process of thermal Comptonization. We modify the solution to the kinetic equation of Sunyaev and Titarchuk to allow its application up to mildly relativistic electron temperatures and optical depths $\gtrsim {1}$. The solution can be used for spectral fitting of X-ray spectra from astrophysical sources. We also have developed an accurate Monte Carlo method for calculating spectra and timing properties of thermal Comptonization sources. The accuracy of our kinetic equation solution is verified by comparison with the Monte Carlo results. We also compare our results with those of other publicly available methods. Furthermore, based on our Monte Carlo code, we present distributions of the photon emission times and the evolution of the average photon energy for both up and down scattering.
Comparative gonadotoxicity of the chemotherapy drugs cisplatin and carboplatin on prepubertal mouse gonads
Authors: Allen Caroline M , Lopes Federica , Mitchell Rod T , Spears Norah
Published: January 2020

The treatment of childhood cancer with chemotherapy drugs can result in infertility in adulthood. Newer generations of drugs are developed to replace parent drugs, with the potential benefits of less toxic side effects. For platinum alkylating-like drugs, in contrast to the parent compound cisplatin, the newer-generation drug carboplatin is reported to have reduced toxicity in some respects, despite being administered at 5–15 times higher than the cisplatin dose. Whether carboplatin is also less toxic than cisplatin to the reproductive system is unknown. Here we compare the gonadotoxic impact of cisplatin and carboplatin on female and male mouse prepubertal gonads. In vitro cultured CD1 mouse ovaries or testis fragments were exposed to either cisplatin or carboplatin for 24 h on Day 2 of culture and analysed by Day 6. A dose response for each drug was determined for the ovary (0.5, 1 & 5 μg/ml cisplatin and 1, 5 & 10 μg/ml carboplatin) and the testis (0.01, 0.05 & 0.1 μg/ml cisplatin and 0.1, 0.5 & 1 μg/ml carboplatin). For the ovary, unhealthy follicles were evident from 1 μg/ml cisplatin (73% unhealthy, P = 0.001) and 5 μg/ml carboplatin (84% unhealthy, P = 0.001), with a concomitant reduction in follicle number (P = 0.001). For the testis, the proliferating germ cell population was significantly reduced from 0.05 μg/ml cisplatin (73% reduction, P = 0.001) and 0.5 μg/ml carboplatin (75% reduction, P = 0.001), with no significant impact on the Sertoli cell population. Overall, results from this in vitro animal model study indicate that, at patient equivalent concentrations, carboplatin is no less gonadotoxic than cisplatin.
Ethical Considerations in Music Therapy Private Practice: A Review of the Literature
Authors: Wilhelm Kyle
Published: January 2020

For music therapists in private practice, ethical choices are embedded within every professional action and interaction. While many of these ethical choices are common to all clinicians, some are specific to private practice. Literature from music therapy and other healthcare professions, as well as business literature, were reviewed to identify ethical dilemmas commonly found in private practice, discuss potential reasons for unethical behavior, and explore how music therapists in private practice can work through ethical dilemmas.
A single-component light sensor system allows highly tunable and direct activation of gene expression in bacterial cells
Authors: Li Xie , Zhang Changcheng , Xu Xiaopei , Miao Jun , Yao Jing , Liu Renmei , Zhao Yuzheng , Chen Xianjun , Yang Yi
Published: January 2020

Light-regulated modules offer unprecedented new ways to control cellular behaviour with precise spatial and temporal resolution. Among a variety of bacterial light-switchable gene expression systems, single-component systems consisting of single transcription factors would be more useful due to the advantages of speed, simplicity, and versatility. In the present study, we developed a single-component light-activated bacterial gene expression system (eLightOn) based on a novel LOV domain from Rhodobacter sphaeroides (RsLOV). The eLightOn system showed significant improvements over the existing single-component bacterial light-activated expression systems, with benefits including a high ON/OFF ratio of >500-fold, a high activation level, fast activation kinetics, and/or good adaptability. Additionally, the induction characteristics, including regulatory windows, activation kinetics and light sensitivities, were highly tunable by altering the expression level of LexRO. We demonstrated the usefulness of the eLightOn system in regulating cell division and swimming by controlling the expression of the FtsZ and CheZ genes, respectively, as well as constructing synthetic Boolean logic gates using light and arabinose as the two inputs. Taken together, our data indicate that the eLightOn system is a robust and highly tunable tool for quantitative and spatiotemporal control of bacterial gene expression.
Noninvasive quantification of SIRT1 expression–activity and pharmacologic inhibition in a rat model of intracerebral glioma using 2-[18F]BzAHA PET/CT/MRI
Authors: Laws Maxwell T , Bonomi Robin E , Gelovani David J , Llaniguez Jeremy , Lu Xin , Mangner Thomas , Gelovani Juri G
Published: January 2020

Background

Several studies demonstrated that glioblastoma multiforme progression and recurrence is linked to epigenetic regulatory mechanisms. Sirtuin 1 (SIRT1) plays an important role in glioma progression, invasion, and treatment response and is a potential therapeutic target. The aim of this study is to test the feasibility of 2-[18F]BzAHA for quantitative imaging of SIRT1 expression–activity and monitoring pharmacologic inhibition in a rat model of intracerebral glioma.

Methods

Sprague Dawley rats bearing 9L (N = 12) intracerebral gliomas were injected with 2-[18F]BzAHA (300–500 µCi/animal i.v.) and dynamic positron-emission tomography (PET) imaging was performed for 60 min. Then, SIRT1 expression in 9L tumors (N = 6) was studied by immunofluorescence microscopy (IF). Two days later, rats with 9L gliomas were treated either with SIRT1 specific inhibitor EX-527 (5 mg/kg, i.p.; N = 3) or with histone deacetylases class IIa specific inhibitor MC1568 (30 mg/kg, i.p.; N = 3) and 30 min later were injected i.v. with 2-[18F]BzAHA. PET-computerized tomography-magnetic resonance (PET/CT/MR) images acquired after EX-527 and MC1568 treatments were co-registered with baseline images.

Results

Standard uptake values (SUVs) of 2-[18F]BzAHA in 9L tumors measured at 20 min post-radiotracer administration were 1.11 ± 0.058 and had a tumor-to-brainstem SUV ratio of 2.73 ± 0.141. IF of 9L gliomas revealed heterogeneous upregulation of SIRT1, especially in hypoxic and peri-necrotic regions. Significant reduction in 2-[18F]BzAHA SUV and distribution volume in 9L tumors was observed after administration of EX-527, but not MC1568.

Conclusions

PET/CT/MRI with 2-[18F]BzAHA can facilitate studies to elucidate the roles of SIRT1 in gliomagenesis and progression, as well as to optimize therapeutic doses of novel SIRT1 inhibitors.
Escherichia coli O8:H8 Carrying a Novel Variant of the Heat-Labile Enterotoxin LT2 Gene Caused Outbreaks of Diarrhea
Authors: Ishimaru Kai , Sasaki Mari , Narimatsu Hiroshi , Arimizu Yoko , Gotoh Yasuhiro , Nakamura Keiji , Hayashi Tetsuya , Ogura Yoshitoshi
Published: January 2020

No outbreaks caused by Escherichia coli–producing heat-labile enterotoxin LT2 have been reported to date. Here, we revealed that the E. coli O8:H8 strains isolated from patients in 2 independent diarrhea outbreaks were negative for any known virulence determinants in routine microbiological tests, were very closely related, and carried a prophage-encoded gene for a novel LT2 variant (LT2d) and the genes for colonization factor antigen III. We also showed that LT2d has a cytotonic activity similar to LT1. These data indicate the importance of E. coli strains producing LT2d as a human pathogen.
Technologies of Crime Prediction: The Reception of Algorithms in Policing and Criminal Courts
Authors: Brayne Sarah , Christin Angèle
Published: January 2020

The number of predictive technologies used in the U.S. criminal justice system is on the rise. Yet there is little research to date on the reception of algorithms in criminal justice institutions. We draw on ethnographic fieldwork conducted within a large urban police department and a midsized criminal court to assess the impact of predictive technologies at different stages of the criminal justice process. We first show that similar arguments are mobilized to justify the adoption of predictive algorithms in law enforcement and criminal courts. In both cases, algorithms are described as more objective and efficient than humans’ discretionary judgment. We then study how predictive algorithms are used, documenting similar processes of professional resistance among law enforcement and legal professionals. In both cases, resentment toward predictive algorithms is fueled by fears of deskilling and heightened managerial surveillance. Two practical strategies of resistance emerge: foot-dragging and data obfuscation. We conclude by discussing how predictive technologies do not replace, but rather displace discretion to less visible—and therefore less accountable—areas within organizations, a shift which has important implications for inequality and the administration of justice in the age of big data.
The Impact of Cross-Species Gene Flow on Species Tree Estimation
Authors: Jiao Xiyun , Flouri Tomáš , Rannala Bruce , Yang Ziheng
Published: January 2020

Recent analyses of genomic sequence data suggest cross-species gene flow is common in both plants and animals, posing challenges to species tree estimation. We examine the levels of gene flow needed to mislead species tree estimation with three species and either episodic introgressive hybridization or continuous migration between an outgroup and one ingroup species. Several species tree estimation methods are examined, including the majority-vote method based on the most common gene tree topology (with either the true or reconstructed gene trees used), the UPGMA method based on the average sequence distances (or average coalescent times) between species, and the full-likelihood method based on multilocus sequence data. Our results suggest that the majority-vote method based on gene tree topologies is more robust to gene flow than the UPGMA method based on coalescent times and both are more robust than likelihood assuming a multispecies coalescent (MSC) model with no cross-species gene flow. Comparison of the continuous migration model with the episodic introgression model suggests that a small amount of gene flow per generation can cause drastic changes to the genetic history of the species and mislead species tree methods, especially if the species diverged through radiative speciation events. Estimates of parameters under the MSC with gene flow suggest that African mosquito species in the Anopheles gambiae species complex constitute such an example of extreme impact of gene flow on species phylogeny. [IM; introgression; migration; MSci; multispecies coalescent; species tree.]
Hearing thresholds of small native Australian mammals – red-tailed phascogale (Phascogale calura), kultarr (Antechinomys laniger) and spinifex hopping-mouse (Notomys alexis)
Authors: Old Julie M , Parsons Carl , Tulk Melissa L
Published: January 2020

Hearing is essential for communication, to locate prey and to avoid predators. We addressed the paucity of information regarding hearing in Australian native mammals by specifically assessing the hearing range and sensitivity of the red-tailed phascogale (Phascogale calura), the kultarr (Antechinomys laniger) and the spinifex hopping-mouse (Notomys alexis). Auditory brainstem response (ABR) audiograms were used to estimate hearing thresholds within the range of 1–84 kHz, over a dynamic range of 0–80 dB sound pressure level (SPL). Phascogales had a hearing range of 1–40 kHz, kultarrs 1–35 kHz and hopping-mice 1–35 kHz, with a dynamic range of 17–59 dB SPL, 20–80 dB SPL and 30–73 dB SPL, respectively. Hearing for all species was most sensitive at 8 kHz. Age showed no influence on optimal hearing, but younger animals had more diverse optimal hearing frequencies. There was a relationship between males and their optimal hearing frequency, and greater interaural distances of individual males may be related to optimal hearing frequency. Because nocturnal animals use high-range hearing for prey or predator detection, our study suggests this may also be the case for the species examined in this study. Future studies should investigate their vocalizations and behaviour in their natural environments, and by exposing them to different auditory stimuli.
Recent mitochondrial lineage extinction in the critically endangered Javan rhinoceros
Authors: Margaryan Ashot , Sinding Mikkel-Holger S , Liu Shanlin , Vieira Filipe Garrett , Chan Yvonne L , Nathan Senthilvel K S S , Moodley Yoshan , Bruford Michael W , Gilbert M Thomas P
Published: January 2020

The Javan rhinoceros (Rhinoceros sondaicus) is one of five extant rhinoceros species and among the rarest large mammals on Earth. Once widespread across Southeast Asia, it is now on the verge of extinction, with only one wild population remaining (estimated at ~60 individuals) on the island of Java, Indonesia. To assess the past genetic diversity of the female lineage of R. sondaicus, we generated mitochondrial genome data from eight museum specimens dating back to the 19th century, before the range of the Javan rhinoceros was dramatically reduced, for comparison against mitochondrial DNA (mtDNA) sequences of current R. sondaicus and other rhinoceros species. We succeeded in reconstructing five full and three partial ancient mitogenomes from the eight samples. We used BEAST to assess the phylogenetic relationship of the five extant rhinoceros species and the historical samples. The results show that the oldest and most diverse mtDNA lineages of R. sondaicus are found in historical samples, indicating a significant reduction of mtDNA diversity in modern Javan rhinos. We anticipate that the newly sequenced data will represent a useful resource for improving our understanding of evolutionary history of this species, should future studies be able to increase the available dataset. We hope this information may help in conservation efforts for this species.
Reflections on a Crisis in Graduate Medical Education: The Closure of Hahnemann University Hospital
Authors: Berns Jeffrey S. , Coull Susan , Paskin David , Spevetz Antoinette , Boyer William C.
Published: January 2020

In June 2019, Hahnemann University Hospital (HUH) in Philadelphia became the largest U.S. teaching hospital to announce its closure and the closure of all of its graduate medical education (GME) programs, which displaced more than 550 residents, fellows, and other trainees. In addition to the displaced trainees, the HUH closure involved many stakeholders at both the closing hospital and hospitals willing to accept transferred residents and fellows—program directors and coordinators, designated institutional officials (DIOs), and hospital executives—as well as the Accreditation Council for Graduate Medical Education, the Centers for Medicare and Medicaid Services, the National Resident Matching Program, and other organizations. Given the rarity of such events, those involved had little experience or expertise in dealing with the closure of so many GME programs at one time. In this Invited Commentary, the DIOs of HUH and 4 other area teaching hospitals detail their experiences working to find new training opportunities for the displaced residents and fellows, discussing lessons learned and providing recommendations to prepare for any future teaching hospital closures. Stakeholder organizations should work together to develop a “playbook” for use during future closures so that the chaos that occurred this time can be avoided.
Association Between Recent Cannabis Consumption and Withdrawal-Related Symptoms During Early Abstinence Among Females With Smoked Cocaine Use Disorder
Authors: Viola Thiago Wendt , Sanvicente-Vieira Breno , Kluwe-Schiavon Bruno , Rothmann Leonardo Melo , Mélo-Pereira João Vítor Nóbrega e , Bicca Carla , Ottolia Niederauer João Paulo , Schmitz Joy , Grassi-Oliveira Rodrigo
Published: January 2020

Background:

The effects of cannabis on clinical outcomes of treatment services for other drug use disorders remains unclear. The primary aim of the current study was to investigate the effects of recent cannabis consumption on the severity of cocaine withdrawal and depressive symptoms during a 3-week inpatient treatment program for women with cocaine use disorder. The second goal of this study was to test the effect of recent alcohol or tobacco use on the aforementioned outcomes.

Methods:

This was a longitudinal study with 2 assessment time points: at enrollment and upon discharge from a medically managed intensive inpatient unit. The sample was composed of 214 early abstinence females with cocaine use disorder. Cocaine withdrawal and depressive symptoms were measured using the Cocaine Selective Severity Assessment (CSSA) and the Beck Depressive Inventory (BDI-II). Recent substance use was evaluated using the Addiction Severity Index (ASI-6).

Results:

Patients with cocaine use disorder and with frequent recent cannabis use reported higher severity of cocaine withdrawal and depressive symptoms after 3 weeks of inpatient treatment. Neither recent alcohol nor tobacco use was associated with increased CSSA or BDI outcomes, suggesting these substances play a minor role compared to recent cannabis use in affecting withdrawal-related symptoms.

Conclusions:

The assessment of recent cannabis use may help identify patients in need of additional treatment to manage severe cocaine withdrawal symptoms and depressive symptoms during early abstinence.
Non-medical Use of Naphazoline (Naphthyzin): Two Case Reports
Authors: Skryabin Valentin Yurievich , Vinnikova Maria Alekseevna , Komarov Sergey Dmitrievich , Khvan Albert Grigorievich
Published: January 2020

The paper describes 2 case reports of non-medical use of Naphazoline (Naphthyzin). Both demonstrate that the peripherally acting alpha-adrenergic agonist Naphazoline obtains some addictive potential. The drug produces a feeling of euphoria, which resembles the perceived effects of psychostimulants. Both patients and people who consume Naphazoline for intoxication report increased tolerance after repeated use which indicates the addictive potential of the substance. To the best of our knowledge, this is the first examination of non-medical Naphazoline use and the first attempt to describe its addictive potential. Clinical psychiatrists should be aware of this phenomenon when addressing polysubstance use behavior.
Plate-Assisted Intramedullary Nailing of Gustilo Type IIIB Open Tibial Diaphyseal Fractures: Does Adjunctive Plate Retention Affect Complication Rate?
Authors: Stoddart Michael T. , Al-Hourani Khalid , Fowler Tim , Khan Umraz , Kelly Michael B.
Published: January 2020

Objectives:

To investigate the complication rates after use of retained adjunctive plate (RAP) fixation with intramedullary nailing of Gustilo–Anderson type IIIB open tibia fractures, as part of a 2-stage orthoplastic approach.

Design:

Consecutive cohort study.

Patients/Participants:

One hundred and thirty-seven consecutive patients with a Gustilo–Anderson type IIIB open diaphyseal tibia fracture (OTA/AO 42) treated between May 2014 and January 2018. Ninety-eight patients (RAP = 67; non-RAP = 31) met the inclusion criteria and underwent 2-stage reconstruction. All patients were treated using a small fragment adjunctive plate to hold the fracture reduced before intramedullary nailing.

Intervention:

At stage 2, the temporary small fragment (in-fix) plate was removed and the site further thoroughly debrided. After this, the fracture is reduced and held with a new small fragment plate to facilitate the definitive intramedullary nailing. This new plate was either retained (RAP) as part of the definitive fixation at second stage or removed before wound coverage.

Main Outcome Measurement:

The main outcome measures were reoperation rate, deep infection, nonunion, and flap-related complication.

Results:

Six patients (6/98, 6.1%) proceeded to nonunion (RAP 5/67, non-RAP 1/31). This was not significant (P = 0.416). Two hundred twelve operations were undertaken, and the median was 2. Sixteen (16/212, 7.5%) complication-related reoperations were undertaken, affecting 8 patients (8/67, 11.9%) in the RAP group. Eight patients (8/98, 8.2%) developed a deep infection (RAP 6/67, non-RAP 2/31). This was not significant (P = 0.674).

Conclusions:

In the context of an orthoplastic approach, the use of a RAP with definitive intramedullary nailing does not seem to significantly increase the rate of deep infection or nonunion in patients with type IIIB open tibial shaft fractures.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Plantar Pressures Following Surgical Release in Children With Clubfoot: Comparison of Posterior Release, Posteromedial Release, and Nonoperative Correction
Authors: Erdman Ashley L. , Jeans Kelly A. , Karol Lori A.
Published: January 2020

Background:

Functional deficits observed at long-term follow-up in surgically released clubfeet have led to the adoption of a nonoperative approach. Gait results reported at age 5 years found ankle motion was limited in clubfeet treated by posteromedial release (PMR), compared with those that required posterior release (PR) or remained nonoperative. The purpose of this study was to assess plantar pressures in clubfeet that required surgical correction by 5 years of age.

Methods:

Pedobarograph data were collected at age 5 years on patients with clubfeet that underwent surgical correction due to residual deformity or recurrence. Plantar pressures were assessed by subdividing the foot into the medial/lateral hindfoot, midfoot, and forefoot regions. Variables included maximum force, contact area%, contact time% (CT%), the hindfoot-forefoot angle, and displacement of the center of pressure line. Surgical feet were divided into those that underwent an isolated PR versus PMR. A group of 72 clubfeet that remained nonoperative were matched by initial severity and used for comparison.

Results:

Pedobarograph data from 53 patients (72 clubfeet; 25 PR and 47 PMR) showed minimal differences between the PR and PMR feet. Compared with the nonoperative group, both surgical groups had increased CT% in the medial hindfoot and medial midfoot regions. An increase in lateral hindfoot CT% was observed in the PMR group. In addition, CT% in the first metatarsal region in the PMR group was reduced compared with the nonoperative group. Lateralization is present across both surgical groups in the center of pressure line and hindfoot-forefoot angle.

Conclusion:

While there were minimal differences between surgical groups, patients who underwent PR exhibited pressure variables that were more comparable to the nonoperative group while the PMR group had greater deviations.

Level of Evidence:

Level II—therapeutic.
Trends in prevalence in human papillomavirus types and their association with cervical dysplasia: an analysis on 15 138 women over 20 years
Authors: Bogani Giorgio , Chiappa Valentina , Pinelli Ciro , Lopez Salvatore , Signorelli Mauro , Taverna Francesca , Lombardo Claudia , Ditto Antonino , Raspagliesi Francesco
Published: January 2020

To investigate trends in prevalence of various human papillomavirus types in order to assess the unmet clinical needs for women affected by human papillomavirus-related disease. Data of consecutive 15 138 patients undergoing human papillomavirus DNA testing from 1998 to 2018 were retrospectively identified. Human papillomavirus types were classified at high-risk according to the classification of the International Agency for Research on Cancer. The International Agency for Research on Cancer included seven human papillomavirus types covered by nine-valent vaccine and five not yet covered by any available vaccines. Overall, 4159 (65.3%), 1500 (23.5%) and 714 (11.2%) women had human papillomavirus types covered by nine-valent vaccination, not covered by nine-valent vaccination and co-infections of human papillomavirus types of both groups. At least one high-risk human papillomavirus type(s) was detected in 1241 patients with genital dysplasia: 832 (67.1%), 291 (23.4%) and 118 (9.5%) women had human papillomavirus types covered by nine-valent vaccination, not covered by nine-valent vaccination and co-infections of human papillomavirus types of both groups. Over the twenty-year study period, the number of human papillomavirus types not covered by nine-valent vaccine increased dramatically (from 4 to 16%; P < 0.001, P for trend). Similarly, looking at patients with genital dysplasia, high-risk human papillomavirus types not covered by nine-valent vaccine increased from 3 to 13% (P < 0.001, P for trend). Our data highlight that human papillomavirus types covered by nine-valent vaccine represent are the main types associated with genital dysplasia. However, over the study period, we observed an increasing prevalence of confections and high-risk human papillomavirus types not covered by the nine-valent vaccine, thus suggesting the need of developing more complete vaccines against human papillomavirus.
Factors Associated With Attendance at a 1-yr Post–Cardiac Rehabilitation Risk Factor Check
Authors: Giannoccaro Justin D. , Aggarwal Sandeep , Grace Sherry L. , Campbell Tavis S. , Hauer Trina , Arena Ross , Rouleau Codie R.
Published: January 2020

Purpose:

Patients with coronary artery disease (CAD) often fail to maintain secondary prevention gains after completing cardiac rehabilitation (CR). Follow-up appointments aimed at assessing cardiac status and encouraging maintenance of health behaviors after CR completion are generally offered but not well-attended. This study explored patient characteristics and barriers associated with nonattendance at a 1-yr follow-up visit following CR completion.

Methods:

Forty-five patients with CAD who completed a 12-wk outpatient CR program but did not attend the 1-yr follow-up appointment were included. Participants responded to a survey consisting of open-ended questions about follow-up attendance, a modified version of the Cardiac Rehabilitation Barriers Scale, and self-report items regarding current health practices and perceived strength of recommendation to attend. Thematic analysis was used to derive categories from open-ended questionnaire responses. Linear regression was used to assess characteristics associated with appointment attendance barriers.

Results:

Barrier themes were as follows: (1) lack of awareness; (2) perception of appointment as unnecessary; (3) practical or scheduling issues; (4) comorbid health issues; and (5) anticipated an unpleasant experience at the appointment. Greater self-reported barriers (mean ± SD = 1.97/5.00 ± 0.57) were significantly associated with lower perceived strength of recommendation to attend the follow-up appointment (2.82/5.00 ± 1.45), P = .005.

Conclusions:

Providing a stronger recommendation to attend, enhancing patient awareness, highlighting potential benefits, and supporting self-efficacy might increase 1-yr follow-up appointment attendance and, in turn, support long-term adherence to cardiovascular risk reduction behaviors.
Validity of the Past-day Adults' Sedentary Time Questionnaire in a Cardiac Rehabilitation Population
Authors: Freene Nicole , McManus Margaret , Mair Tarryn , Tan Ren , Clark Bronwyn , Davey Rachel
Published: January 2020

Purpose:

Self-report measures of sedentary behavior are easier to use in a clinical setting; yet, no self-report measures of sedentary behavior appear to be validated in cardiac rehabilitation over time. The aim of this study was to assess the validity of the Past-day Adults' Sedentary Time (PAST) questionnaire in a cardiac rehabilitation population over 12 mo.

Methods:

Seventy-two cardiac rehabilitation participants were recruited to a prospective cohort study. Participants wore an ActiGraph ActiSleep accelerometer (sedentary time <100 counts/min) for 7 consecutive days and completed the self-administered PAST questionnaire at baseline, 6 wk, and 6 and 12 mo. Total daily sedentary time from both methods were compared using Bland-Altman plots and Spearman rank-order correlations.

Results:

Agreement between the 2 measures of sedentary time improved over 12 mo. At 6 and 12 mo, there was a good level of agreement between measures (mean difference between accelerometer and PAST 57 and −0.7 min, respectively), although the dispersion of the differences was wide (95% limits of agreement −428 to 541 and −500 to 498 min, respectively). There were weak correlations between the PAST questionnaire and average accelerometer measured sedentary time at all time points (α = −0.249 to 0.188).

Conclusions:

Following repeated assessments, the PAST questionnaire may be useful to determine sedentary time in cardiac rehabilitation participants at a group level, with participants appearing to more accurately recall their time spent in sedentary behavior. Further research is indicated to assess the validity of sedentary behavior questionnaires in cardiac rehabilitation, with a combination of objective and self-reported measures currently recommended.
A Radon Background-subtraction Algorithm for Electronic Personal Dosimeters
Authors: Fabian R. , Bell J. , Brandl A.
Published: January 2020

Many first responders are outfitted with electronic personal dosimeters to recognize and be alerted to radiological hazards during their response operations. These dosimeters provide invaluable measurement data for force protection, allowing the first responder to assess a response situation and take protective measures for themselves and other individuals involved based on instrument readings of dose rate or cumulative dose. However, capabilities of common electronic personal dosimeters to identify and distinguish various contributions to the instrument reading, in particular from natural radiological sources, are rather limited. An algorithm has been developed for two-channel electronic personal dosimeters that quantifies the signal contribution from radon progeny and allows for background subtraction from radon and radon progeny in the instrument reading. This algorithm will be particularly useful in operational scenarios where first responders may be subject to rapidly changing levels of natural background radiation, which could mimic the presence of anthropogenic sources of ionizing radiation.
HIGH-POWERED BLUE-LIGHT LASER-INDUCED MACULOPATHY IN AN ADOLESCENT: MULTI-MODAL IMAGING, EVOLUTION, AND MANAGEMENT
Authors: Botsford Benjamin W. , Williams Andrew M. , Martel Joseph N.
Published: January 2020

Purpose:

To characterize evolution of macular injury from a high-powered blue handheld laser using multimodal imaging and describe successful surgical treatment.

Methods:

Observational clinical case report.

Results:

A 17-year-old boy presented with unilateral acute loss of vision with discrete white macular lesions, full-thickness disruption of retinal layers, and hyperreflective material at the fovea on optical coherence tomography caused by exposure to a 445 nm blue-light handheld laser with power up to 2,000 mW characterized as a Class IV laser. The injury evolved into an approximately 950-μm full-thickness macular hole 3 weeks later with visual acuity of 20/400. Vitrectomy and internal limiting membrane peel resulted in anatomic success and final vision at 4 months of 20/25.

Conclusion:

High-powered lasers can induce significant disruption of retinal layers, inflammatory debris, and full-thickness macular holes with momentary exposure that, despite poor anatomic prognostic factors, can have successful surgical outcomes.
Reframing the Care of Children With Epidermolysis Bullosa Through the Lens of Medical Trauma
Authors: Bodán Rebecca Cross
Published: January 2020

Epidermolysis bullosa (EB) is a group of rare inherited genetic connective tissue disorders causing blisters and skin erosions, in addition to a number of other extracutaneous complications. There is currently no Food and Drug Administration-approved treatment for EB, and the current mainstay of disease management involves frequent, prolonged, and extensive wound care, which is often traumatic for the child and caregivers alike. Because of the potential for extensive wounds and other complications, children with moderate to severe forms of EB experience significant amounts of medical trauma related to their condition, both in a medical setting and in the community. Exposure to pediatric medical trauma has been linked to poor health outcomes and increased psychosocial sequelae. Thus, this article seeks to provide an in-depth discussion of the potential sources of trauma children with EB face on a daily basis, along with some practical trauma-informed interventions that healthcare providers may consider implementing in an attempt to alleviate some of the suffering and build resilience among those affected by this potentially devastating and life-limiting condition.
Impact of lack of surgery on outcomes in elderly women with nonmetastatic breast cancer—A surveillance, epidemiology, and end results 18 population based study
Authors: Yin Ming , Verschraegen Claire , Vincent Vinh-Hung , Patel Sandipkumar M. , George Tiffany , Truica Cristina I.
Published: January 2020

Elderly women with early-stage, nonmetastatic breast cancer do not always receive recommendations for definitive surgical treatment. The reasons vary and include patient and provider-related reasons.

We queried the surveillance, epidemiology, and end results database from 2010 to 2013 for women age 60 and older with stage I/II/III invasive breast cancer for whom local treatment was known. We divided the patients into 3 groups: patients for whom surgery was performed; patients for whom surgery was recommended but not performed; patients for whom surgery was not recommended and not performed. We used Kaplan–Meier method to generate OS curves and the Cox proportional hazard test to compare survival outcomes.

A total of 119,404 patients were eligible for study with a median age between 70 and 74 years old. Compared with patients who received breast surgery, patients who did not receive surgery had a worse overall survival (OS) (hazard ratio [HR], 7.39; 95% confidence interval [CI], 6.98–7.83, P < .001). Patients who were recommended but ultimately did not undergo surgery had better OS than those who were recommended against surgery (adjusted HR, 0.60; 95% CI, 0.53–0.69). However, their survival was significantly inferior to patients who underwent surgery (adjusted HR, 2.81; 95% CI 2.48–3.19). Similar results were found regardless of age, tumor stage, estrogen receptor, or human epidermal growth factor receptor 2 status and were recapitulated in analyses of cancer-specific survival.

Upfront definitive breast surgery should be performed in medically-fit elderly patients with early-stage, nonmetastatic breast cancer given significant survival benefit.
Cystic intraductal papillary neoplasms with infiltrating carcinoma of the intrahepatic bile duct
Authors: Ma Zhoupeng , Zhao Fang , Pan Jiangfeng , Lin Guansheng , Chen Bingye , Fu Wenbing
Published: January 2020

Introduction:

Intraductal papillary neoplasms of the bile duct (IPNB) is a kind of rare disorder with low incidence but high misdiagnosis due to untypical symptoms and non-specific laboratory indicators. Herein, we report a case of cystic type IPNB with infiltrating carcinoma of the intrahepatic bile duct presented as a single giant cystic mass of the liver.

Patient concerns:

A 51-year-old woman was admitted due to right upper abdominal discomfort for 10 months. Physical examination indicated no specific finding. Laboratory tests showed that serum total bilirubin and carcinoembryonic antigen level was mildly elevated. Ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) of abdomen indicated a giant lobulated cystic lesion involving the left, right and the caudate lobes of liver. There were multiple small nodules of different sizes with papillary or coral reef-like pattern protruding into the cystic lumen from the inner wall.

Diagnosis:

The patient was diagnosed as malignant tumors of intrahepatic bile duct.

Interventions:

She received radical resection of the lesion by hepatectomy.

Outcomes:

The postoperative pathological examination revealed an IPNB with infiltrating carcinoma of the intrahepatic bile duct. This patient had an uneventful postoperative recovery and was discharged on day 21 post-surgery. Until 35 months after surgery, there is no recurrence or metastasis.

Conclusion:

The CT and MRI can show certain morphologic features including the segmental cystic dilatation of intrahepatic bile ducts and the pathological details of papillary tumors inside the lesion. Cystic IPNB with infiltrating carcinoma of the intrahepatic bile duct can be treated with surgery.
Neoadjuvant apatinib plus S-1 in locally advanced pulmonary adenocarcinoma
Authors: Zhang Chu , Wang Xiang , Zhang Miao , Liu Dong , Yang Dun-Peng
Published: January 2020

Rationale:

About one-third of the lung tumors are staged as locally advanced at the time of initial diagnosis; however, the optimal induction treatment before curative resection has not been elucidated. To date, the evidence regarding the preoperative apatinib plus S-1 for locally advanced pulmonary adenocarcinoma is scarce.

Patient concerns:

A 29-year-old female was admitted because of persistent cough, sputum, and chest distress for 2 months.

Diagnoses:

Primary pulmonary adenocarcinoma (cT3N2M0, IIIB) with unknown driver gene mutation status.

Interventions:

The patient had received 4 months of neoadjuvant therapy using oral apatinib (425 mg daily) plus S-1 (60 mg, twice daily for 4 weeks with a 2-week drug-free interval), followed by anatomical lobectomy with curative intent. Adjuvant apatinib (425 mg daily for a month, and 250 mg daily for another month) plus S-1 at the same dosage were administered for 2 months. Thereafter, maintenance of low-dose S-1 monotherapy (40 mg, twice daily for 4 weeks with a 2-week drug-free interval) was continued for 6 months.

Outcomes:

The adverse events were tolerable and well-controlled. A postoperative recurrence-free survival for 2 years and a half up to now was indicated.

Lessons:

Preoperative apatinib plus S-1 showed efficacy in locally advanced pulmonary adenocarcinoma. However, high-quality trials are warranted before the recommendation of this therapeutic regimen.
Deontological examination as a criterion for the assessment of personal healthcare professional quality
Authors: Mazeikiene Sandra , Stasiuniene Jurgita , Vasiljevaite Diana , Laima Sigitas , Chmieliauskas Sigitas , Fomin Dmitrij , Simakauskas Rokas , Jasulaitis Algimantas
Published: January 2020

Discrepancies between clinical and autopsy diagnoses range from 30% to 37%. The significance of deontological examinations remains high. In the pursuit of proper evaluation of diagnostic discrepancies, the establishment of pathogenesis, the mechanism of death, and a correct diagnosis are of particular importance.

A retrospective study of deontological examinations, aimed at the detection of medical errors and carried out by the State Forensic Medicine Service during the period 1989 to 2016, was performed. The clinical and autopsy data from 1007 cases were collected in compliance with the research protocol.

The number of deontological examinations tends to increase. In 60% of cases, the deceased were men. Most cases were in the age group of 50 to 59 years. Most examinations were carried out in relation to improperly provided healthcare services and the patient's death in surgery, admission, intensive care and obstetrics-gynecology departments. In 13% of cases, the diagnosis did not coincide and, in 79% of cases, the diagnoses fully coincided. In 68% of cases, the medical error was disproved.

The number of deontological examinations is increasing. In most cases, clinical and autopsy diagnoses fully matched. Incorrectly clinically diagnosed intracranial injuries were the most common diagnostic mistakes. The data are similar to the results of research in other countries and would be relevant to ensuring the prevention of medical mistakes and the improvement of healthcare quality.