bluuebunny/crossref_metadata_2025 huggingface dataset:
564 Managing California’s Creek Fire Mass Casualty’s Incident
Authors: Henry Shana M , Kopari Nicole M , Wolfe Mary
Published: April 2021

Introduction

California’s Creek Fire is not only the largest single wildfire in a state known for huge and destructive blazes, it spawned two rare fire tornados with winds over 100mph, a day after the fire started in early September. Huntington Lake and Mammoth Pool were the sites of these rare events leading to hundreds of trapped campers. An air rescue operation airlifted hundreds of trapped people to safety. Twenty days after the start of the fire, it had burned >300,000 acres with only 36% containment by fire crews. This review is an evaluation of our hospitals response team and the events surrounding that night.

Methods

Our on-call surgeon had called in the back-up surgeon to run a second trauma operating room. It was at this time, the news had reported trapped campers near Mammoth Pool. The burn surgeon was notified and reported to the emergency department (ED) as word of 65 possible victims spread. Local disaster response planning was initiated with an ED physician triaging patients at the regional airport. Initial calls were made to the division chief and burn medical director. The nursing director was notified along with any available nursing staff with 8 ICU nurses volunteering to report. Immediately, lateral transfer orders were placed for all burn patients housed in the burn center which has 10 ICU bed capabilities.

Results

The first helicopter landed with 5 of the burn victims presenting to our hospital. 4 of the victims were male and 1 female with ages ranging from 17 to 27. Total body surface area burn was estimated on each with 2 minor burns < 10% and 3 moderate sized burns of roughly 25%. These patients were quickly triaged in the ED and traumatic injuries evaluated. 3 of the patients were placed in ICU level care with the 2 remaining patients housed in the ED as word trickled in about another rescue effort with an additional 95 people. By morning, an additional 2 patients were transferred to our burn center from the surrounding hospitals and another 2 patients evaluated for burns sustained in separate events. All patients were taken to the operating room over the next 24–48 hours for excision and autologous spray on skin cells (ASCS) in combination with widely meshed skin grafts or ASCS alone.

Conclusions

Communication, teamwork, and personnel that are dedicated to the care of burn patients made this tragic incident manageable. The Creek Fire hit home for many of the burn staff not only because of the patients that were cared for, but because this area of California was a beloved respite for many. A debriefing with a chaplain, grief counselor, and psychotherapist, was held within 2 weeks of the incident to provide support to the staff during this devastating time.
611 Measuring Health Outcomes in Pediatric Burn Survivors: A Systematic Review
Authors: Patel Khushbu F , Rodríguez-Mercedes Silvanys L , Rencken Camerin A , Grant Gabrielle G , Kinney Erin M , Austen Amelia , Hou Carina N , Brady Keri J , Schneider Jeffrey C , Kazis Lewis E , Ryan Colleen M
Published: April 2021

Introduction

Acute burn injuries often result in chronic sequelae that affect functional and psychosocial outcomes. Few prior reviews on pediatric populations report on outcomes across multiple domains. The aim of this systematic review was to identify study characteristics and design of published burn literature that focus on the impact of burns on physical and psychosocial outcomes.

Methods

We included literature published after 1980, focusing on multifunctional burn outcomes in children aged 5–18 years. PubMed and Web of Science were searched with keywords covering broad and domain specific terms (e.g., “pediatric burns”, “outcomes”, “psychosocial recovery”) along with a manual reference check. After screening 751 potential abstracts, each eligible study was systematically reviewed using the McMaster Critical Review Form and assigned a score by two coordinators. Dyad discussions resolved inconsistencies. Extracted data elements included study designs, participant types, measurements, outcomes, clinical and demographic information, and main findings of each study.

Results

Sixty-two studies met inclusion criteria, and outcomes were classified into physical (n=31), psychological (n=53), and social (n=38) domains. The majority of studies were cross-sectional designs (n=33) and received a complete critical review score on all applicable categories (n=42). Study population ranged from six to 678 patients. Half of the studies did not have a comparison group. Patient- and parent-report measures were used in 43 and 41 studies respectively, with 25 studies using both types of measures. Across 62 studies, 85 different measures used, with only nine used in more than three studies. Parents and children generally reported better functioning in social and physical domains compared to age-matched groups, and worse psychological outcomes compared to non-burned population. Physical disabilities were associated with psychosocial functioning in 16 studies. Physical and social functioning improved where follow-up data was reported in six studies. Examples of selected factors that significantly impacted physical and psychosocial outcomes across domains included burn size, pain and itch, visible scars, body image satisfaction, athletic competence, peer relations, and adjustment skills.

Conclusions

This review demonstrated important associations with physical health and psychosocial status as outcomes. Additionally, there is a need for a standardized burn-specific measurement tool. These findings are relevant to burn clinicians and researchers to understand pathways and outcomes that affect quality of life in pediatrics post-burns.
615 The Effects of the COVID-19 Pandemic on Implementation of a Psychological Distress Screening Program after Burn Injury
Authors: Brown Nathan H , Carter Jeffrey E , Nakonezny Paul A , Phelan Herb A
Published: April 2021

Introduction

The relationship between psychiatric conditions and burn injury is complex, as disorders in thought or mood can both predispose to as well as result from thermal injury. We sought to describe our center’s experience with implementation of a psychological distress screening program in the run-up to and during the COVID-19 pandemic.

Methods

We undertook an analysis of de-identified data as part of a quality improvement review focusing on the results of psychological screening of our outpatient burn population. In the spring of 2019, our verified burn center implemented an outpatient screening program consisting of a registered nurse administering three validated test to screen for Post-Traumatic Stress Disorder screen, depression and anxiety, and problematic alcohol consumption to all patients at the time of physically checking in for their first burn clinic appointment. All outpatients triggering a positive screen are subsequently referred to the burn unit PsyD while a negative screen results in monthly repeat screenings until discharge from the burn clinic or a positive screen, whichever comes first. We analyzed data from the last twelve months of normal outpatient workflow. Loess regression was used to analyze the monthly proportions of patients screening positive.

Results

During the peak of COVID-19 in our region, clinic staff were reduced, and screening procedures suspended for the months of March and April 2020. Therefore, the study period consisted of 01 July 2019 to 31 August 2020. A median of 36.5 screens were conducted per month [interquartile range 27.75, 44.75]. Of these screens, 26.5% were positive, with 94.2% successfully referred to the burn unit’s postdoctoral fellow. The Loess regression showed the proportion of patients screening positive for psychological stressors from July 2019 until a peak in November 2019. A downtrend was then noted in the proportion screening positive from December 2019 to date (Figure).

Conclusions

Psychological stressors are prevalent in burn outpatients. We attribute the decrease in positive responses beginning in December 2019 to a combination of a decrease in the frequency of repeat administrations of the screening test in patients after screening positive, and a reluctance of anxious patients to present to the burn clinic for fear of COVID exposure while at the facility.
632 How A Recurring Problem Prompted the Combination of Technologies. Our Institutional Experience with The Simultaneous Application of Poly Lactic Acid Polymer Dressings After Application of Suspension Epidermal Autografts.
Authors: Short Tracee
Published: April 2021

Introduction

Our institution has utilized the suspension epidermal autograft solution since a first application with FDA compassionate use protocol. We have since used this commercially available technology for the management of deep partial thickness and full thickness burn wounds. There is a non-adherent dressing in the commercially available kits to cover the suspension in a semi-porous fashion. We often would have beautifully dressed extremities and trunks only to find that in positions of function the non-adherent layer would pop through the intact staples. We then investigated the source of this discrepancy and found the non-elastic property of the dressing the likely culprit. We then began the process to determine an alternative dressing that could work more efficiently.

Methods

In an effort to determine if the institutional standard of care could be benefitted by this patient-based observation, the charts of patients that underwent simultaneous application of the epidermal autograft suspension and the poly lactic acid polymer dressing were interrogated. The data was identified by the institutional tissue tracker. Once the patient was identified, the chart was then reviewed to determine the desired data points. We evaluated the charts of patients that were recorded as utilizing the suspension epidermal autograft charge as wells charges for the poly lactic acid polymer skin substitute. The charts were then evaluated to determine if there were any deviations from our expected outcomes using the suspension alone.

Results

Our preliminary results indicate that the patients were able to discharge sooner as the wound care associated with the polymer skin substitute is more streamlined. It did not reflect any areas of graft loss but did in 2 instances remained in place longer than our standard. The wound was healed beneath but the skin substitute remained adhered.

Conclusions

The simultaneous use of suspension epidermal autografts and poly lactic acid skin substitutes has become common place for our institution. A quick review as a QI project has resulted in the desire to delve further into comparative data points. A formal retrospective review of the charts will be undertaken for a case series of about 20 patients.
633 Use of an ICU Rounding Tool Enhances Critical Care Learning for Trainees on a Burn Surgery Rotation
Authors: Nosanov Lauren B , Libraro Kaitlyn , Heffernan Jamie , Chang Philip H , Houng Abraham , Gallagher James
Published: April 2021

Introduction

An institutional Burn Intensive Care Unit (ICU) Rounding Tool was implemented for both quality improvement data collection and trainee education. Forms are completed by trainee team members daily for all critically ill patients prior to teaching rounds. Gathered data are structured to facilitate evaluation of patient volume status, sepsis risk and ventilator management. The forms are then used to guide discussion among students, residents, mid-level providers, fellows, attending surgeons and other members of the multi-disciplinary rounding team. We conducted a series of interviews with trainees regarding their user experience to assess the tool’s educational utility.

Methods

A convenience sample of residents who had recently completed their Burn Surgery rotation were interviewed in a structured format. Questions focused on the form’s ease of use and comprehensibility. Emphasis was placed on the extent to which it stimulates learning while rounding. Additional feedback was sought for the purpose of improving the tool for continued use.

Results

Participants were post-graduate year one or two resident physicians training in General Surgery, Urology, Emergency Medicine or Anesthesia. Prior experience and comfort with ICU level care ranged from very little to moderate. All interviewees found the tool helpful in their patient assessments, though the current layout of the form was a frustration for many. Overall, they unanimously found the forms beneficial for preparation of patient presentations and felt that utilization during rounds facilitated learning.

Conclusions

Interviews with trainees on their burn surgery rotation demonstrate that implementation of an ICU Rounding Tool has provided educational benefit, particularly for those less experienced in intensive care. Feedback from this cohort will be used to improve the tool’s usability. Our next steps will include a more formal survey of all trainees involved since the inception of this project.
648 The Negative Impression Makes a Positive Impact
Authors: O’Rourke Cassandra
Published: April 2021

Introduction

Providing timely and appropriate pressure to prevent/address hypertrophic scarring for burn survivors is an ongoing challenge. From time of measurement to obtaining a custom compression garment can be several weeks requiring creative solutions to providing interim pressure, particularly in the pediatric population and even more challenging for a facial burn scar. Historically, fabric custom garments were ordered, then with the advancement of silicone lined materials, clear facial masks could be fabricated. This process started with taking a plaster cast of the survivors’ face, frequently using sedation to allow for optimal fitting, but sedation can change the tone of the facial muscles adding to the challenge. With the advancements in technology, less invasive, more accurate, and more timely fabrication of face masks is possible.

Methods

A 3D picture was taken of a 14-month-old pediatric burn survivor with hypertrophic scarring on the face. This image was uploaded to a 3D printer and a positive print (facial surface down) was completed. The positive print was used to make an alginate mask and plaster was poured to create a casting of the positive printed face. A check mask was pulled from this positive plaster cast (+ mask). This check mask was too large for the patient’s face. To have a better fitting mask, another approach to the mask fabrication was completed. From the same 3D picture, a negative print (facial surface up) was completed. Plaster was poured directly into this negative print to create a casting of the negative printed face. A check mask was pulled from this negative plaster cast (- mask). Both check masks were fit to the patient to assess for accuracy of fit and estimation of required adjustments for optimal fit.

Results

There was a significant difference in the fit of the two masks created from the same 3D picture. The mask pulled on the positive casting was too large. The required adjustments to have the mask fit properly to provide appropriate compression to the hypertrophic scarring on the face would have been extremely difficult and time consuming to complete. The mask pulled on the negative casting fit well and only required small adjustments to ensure adequate pressure would be provided to the focused areas of hypertrophic scars on the face.

Conclusions

With advances in technology, 3D photography partnered with 3D printing allow for significant improvement in the accuracy of fitting facial masks, improve timeliness of compression, and improve the patient experience in the process of obtaining a facial mask.
650 Factors Influencing the Rising Trends in US Physician and Surgeon Suicide Rates 2003–2017: Analysis of the CDC-National Violent Death Reporting System
Authors: Kinslow Kyle , Elkbuli Adel
Published: April 2021

Introduction

With the rate of physician suicide increasing, more research is needed in order to implement adequate prevention interventions. This study aims to identify trends and patterns in physician/surgeon suicide and the key factors influencing physician suicide from 2003–2017.

Methods

Retrospective review of physician and dentists listed as dying by suicide as reported to the CDCs National Violent Death Reporting System (NVDRS) for 2003–2017. Twenty-eight different medical, surgical, and dental specialties were included in our search.

Results

905 reported suicides were reviewed. Physician suicides increased from 2003–2017. Majority of reported surgeons dying by suicide were middle-aged, Caucasian males. Majority of physicians were from North Carolina and 53.5% died by firearms. Orthopedic surgeons had the highest incidence of suicide among surgical fields (28.2%). Compared to the general population, surgeons were 6% more likely to die by suicide at an older age (OR=1.06, 95% CI: 1.04–1.08). Black/African American surgeons were 56% less likely (OR=0.44, 95% CI: 0.06–3.16) and Asian/Pacific Islander were 438% more likely (OR=5.38, 95% CI: 2.13–13.56) to die by suicide. Surgeons were 362% more likely to have a history of a mental disorder (OR=4.62, 95% CI: 2.71–7.85), were 139% more likely to use alcohol prior to dying (OR=2.39, 95% CI: 1.36–4.21), and were 289% more likely to have experienced civil/legal issues (OR=3.89, 95% CI: 1.36–11.11).

Conclusions

The incidence of physician suicide increased over the 2003–2017 time frame with over a third of deaths occurring from 2015–2017. Among surgeons, orthopedics has the highest incidence of reported suicide. Surgeon suicide risk factors include Asian/Pacific Islander race/ethnicity, older age, history of mental disorder, alcohol use, and civil/legal issues.
657 Bilayer Dermal Substitute in Management of Deep Hand Burns
Authors: Hillebrecht Karalyn E , Ziembicki Jenny A
Published: April 2021

Introduction

Bilayer dermal substitutes, composed of bovine collagen cross-linked with glycosaminoglycan and silicone, have become increasingly integrated into the algorithm for management of complex burns. In complex hand burns, dermal substitutes improve functional and aesthetic outcomes while also allowing early excision in high percentage TBSA burns. We detail the outcomes of 17 patients with 25 cases of complex hand burns managed at our center using a staged procedure of cadaveric allografting followed by dermal substitute placement and early definitive STSG.

Methods

Between Jan 2018 and Aug 2019, all patients who sustained deep partial/full thickness burns to their hands managed with dermal substitution were identified. Patients less than 18 yo, with additional non-burn trauma to the hands, and with initial operative management at another center prior to transfer were excluded. A retrospective chart review was used to collect data regarding time to operative excision, placement of allografts and substitutes, definitive STSG, and functional outcome.

Results

17 patients from 18 and 89 yo presented with 25 deep partial/full thickness hand burns. TBSA varied from 0.75 to 78% (mean 17.7%). On average, patients underwent first excision 5.3 (2–16) days after initial burn or 4.2 days after presentation. Our protocol often uses allografting prior to placement of the dermal substitute, therefore, 22 of 25 burned hands received cadaver allografts at initial excision. Dermal substitute was placed an average of 9.2 days later. 3 of 25 burns had immediate application of dermal substitute at first excision. Following substitute, non-meshed, split-thickness autografts were placed on 18 hands. 5 of the burns did not require STSG and two hands were not further evaluated due to loss of patient follow-up. Of the 25 cases, all had near complete incorporation of the substitute without need for revision. In follow-up, patients who did not require STSG have shown no major limitations in ROM/scarring. Of those who underwent STSG, 6 hands underwent contracture release, with 2 of these progressing to amputation. One hand required repeat autografting due to graft loss. All remaining 18 hands healed well with near complete graft take and minimal scarring or functional limitation.

Conclusions

Dermal substitutes assist in the closure of complex deep hand burns. Cadaveric allografting prior to placement of the substitute ensures an appropriately excised wound base, allowing for near complete integration without need for reapplication. Autografting following dermal substitution placement may be initiated earlier than previously pursued and occasionally allows for healing without STSG.
671 Burn Wound Healing Effect of Bromelain-loaded Chitosan Nanofibers
Authors: Kalalinia Fatemeh , Aamiri Nafise , Bayat Samaneh , Movaffagh Jebrail , Hahsemi Maryam
Published: April 2021

Introduction

Bromelain is a mixture of proteolytic enzymes present in all tissues of pineapple (Ananas comosus). It is known as an efficient debriding agent in burn treatment and has been shown to effectively and selectively debride burn eschar. In this study, the efficiency of bromelain-loaded chitosan nanofibers for burn wounds repair was investigated in animal model.

Methods

Chitosan nanofibers containing bromelain were prepared by electrospinning method. The physicochemical characteristics of the synthetized nanofibers, release profile and activity of bromelain loaded in nanofibers were evaluated. The burn healing effect of bromelain-loaded nanofibers were studied in the induced burn wounds in rats for 21 days. The efficacy of treatment was assessed by evaluating changes in wound closer and histological analysis at different time point.

Results

Successful electrospinning of bromelain-loaded chitosan nanofibers resulted in uniform and bead-less nanofibers which released bromelain up to 48h. The formulation kept bromelain enzyme activity after 6-month storage at 4 °C and did not show any cytotoxicity on human dermal fibroblasts. Moreover, in vivo study in a rat burn model confirmed the safety and efficacy of applying bromelain loaded nanofibers in burn wound healing when a significant improve in wound closer was observed in bromelain loaded group and histopathological studies showed more effects on re-epithelialization, debridement and more reduction of necrosis compared to chitosan alone.

Conclusions

Together, these results suggest that bromelain chitosan nanofiber possesses great wound healing activity and could be considered as an effective natural topical burn wound healing treatment.
Cyclophosphamide-Free Adjuvant Chemotherapy for Ovarian Protection in Young Women With Breast Cancer: A Randomized Phase 3 Trial
Authors: Yu Ke-Da , Ge Jing-Yu , Liu Xi-Yu , Mo Miao , He Min , Shao Zhi-Ming ,   SPECTRUM Investigators
Published: April 2021

Background

Chemotherapy-induced premature menopause leads to some consequences, including infertility. We initiated this randomized phase III trial to determine whether a cyclophosphamide-free adjuvant chemotherapy regimen would increase the likelihood of menses resumption and improve survival outcomes.

Methods

Young women with operable estrogen receptor-positive HER2-negative breast cancer after definitive surgery were randomly assigned to receive adjuvant epirubicin and cyclophosphamidefollowed by weekly paclitaxel (EC-wP) or epirubicin and paclitaxel followed by weekly paclitaxel (EP-wP). All patients received at least 5-year adjuvant endocrine therapy after chemotherapy. Two coprimary endpoints were the rate of menstrual resumption at 12 months after chemotherapy and 5-year disease-free survival in the intention-to-treat population. This study is registered at ClinicalTrials.gov (NCT01026116). All statistical tests were 2-sided.

Results

Between January 2011 and December 2016, 521 patients (median age = 34 years; interquartile range = 31-38 years) were enrolled, with 261 in the EC-wP group and 260 in the EP-wP group. The rate of menstrual resumption at 12 months after chemotherapy was 48.3% in EC-wP (95% confidence interval [CI] = 42.2% to 54.3%) and 63.1% in EP-wP (95% CI = 57.2% to 68.9%), with an absolute difference of 14.8% (95% CI = 6.37% to 23.2%, P < .001). The posthoc exploratory analysis by patient-reported outcome questionnaires indicated that pregnancy might occur in fewer women in the EC-wP group than in the EP-wP group. At a median follow-up of 62 months, the 5-year disease-free survival was 78.3% (95% CI = 72.2% to 83.3%) in EC-wP and 84.7% (95% CI = 79.3% to 88.8%) in EP-wP (stratified log-rank P = .07). The safety data were consistent with the known safety profiles of relevant drugs.

Conclusions

The cyclophosphamide-free chemotherapy regimen might be associated with a higher probability of menses resumption.
The competition possibility between renewable energy and fossil energy in Vietnam in the future
Authors: Minh Thong Le , Van Hiep Tran , Thi Thu Thuy Bui , Huu Tung Do
Published: April 2021

With high economic growth, Vietnam is now witnessing an increasing energy demand, having much potential for renewable sources such as wind energy, solar energy or biomass energy. The nation is heavily dependent on fossil energy sources such as coal and oil. This situation raises concerns about both energy security and the environment. Therefore, a question arises if Vietnam can develop renewable energy to solve energy demand, energy security and reduce climate change impacts as committed. This article analyses a considerable potential for renewable energy sources (especially wind and solar energy). The analysis also indicates competitiveness between these renewable energy sources compared to the traditional energy sources that Vietnam is dependent on, especially when there are policies to encourage the development of renewable energy and limit emissions. This article proposes some recommendations to develop renewable energy sources, with an overview of replacing fossil energy in Vietnam.
A better mousetrap to guard against anthracnose disease in bean
Authors: Cannon Steven B , Innes Roger W
Published: April 2021

This article comments on:

Richard MSM, Gratias A, Alvarez Diaz JC, Thareau V, Pflieger S, Meziadi C, Blanchet S, Marande W, Bitochi E, Papa R, Miklas PN, Geffroy V. 2021. A common bean truncated CRINKLY4 kinase controls gene-for-gene resistance to the fungus Colletotrichum lindemuthianum. Journal of Experimental Botany 72, 3569–3581.
Plant signals differentially affect rhizosphere nematode populations
Authors: Mathesius Ulrike , Costa Sofia R
Published: April 2021

This article comments on:

Sikder MM, Vestergård M, Kyndt T, Fomsgaard IS, Kudjordjie EN, Nicolaisen M. 2021. Benzoxazinoids selectively affect maize root-associated nematode taxa. Journal of Experimental Botany 72,3835–3845.
Epistemic extensions of substructural inquisitive logics
Authors: Punčochář Vít , Sedlár Igor
Published: April 2021

In this paper, we study the epistemic extensions of distributive substructural inquisitive logics. Substructural inquisitive logics are logics of questions based on substructural logics of declarative sentences. They generalize basic inquisitive logic which is based on the classical logic of declaratives. We show that if the underlying substructural logic is distributive, the generalization can be extended to embrace also the epistemic modalities ‘knowing whether’ and ‘wondering whether’ that are applicable to questions. We construct a semantic framework for a language of propositional substructural logics enriched with a question-forming operator (inquisitive disjunction) and epistemic modalities. We show that within this framework, one can define a canonical model with suitable properties for any (syntactically defined) epistemic inquisitive logic. This leads to a general approach to completeness proofs for such logics. A deductive system for the weakest epistemic inquisitive logic is described and completeness proved for this special case using the general method.
Cosmological bulk flow in the QCDM model: (in)consistency with ΛCDM
Authors: Salehi A , Yarahmadi M , Fathi S , Bamba Kazuharu
Published: April 2021

We study the bulk flow of the local universe with Type Ia supernova data (a compilation of Union2 and Pantheon data) in the spatially flat homogeneous and isotropic space–time. In particular, we take the so-called QCDM models, which consist of cold dark matter (CDM) and a Q-component described by a scalar field with its self-interactions determined by an exponential potential. We use different cumulative redshift slices of the Union2 and Pantheon catalogues. A maximum-likelihood analysis of peculiar velocities confirms that, at low redshifts 0.015 < z < 0.1, the bulk flow is moving in the $l=272^{+17}_{-17}, b=33^{+12}_{-12}$, and $302^{+20}_{-20},3^{+10}_{-10}$ directions with $v _\mathrm{bulk} = 225^{+38}_{-35}$ and $246^{+64}_{-46}$ km s−1 for the Pantheon and Union2 data respectively, in good agreement with the direction of the cosmic microwave background dipole and with a number of previous studies at 1σ. However, for high redshifts 0.1 < z < 0.2, we get $v _\mathrm{bulk} = 708^{+110}_{-110}$ and $v_\mathrm{bulk}=1014^{+86}_{-114}\,\text{km\,s}^{-1}$ towards l = 318 ± 10°, b = −15 ± 9° and $l=254^{+16}_{-14},\ b=6^{+7}_{-10}$ for the Pantheon and Union2 data respectively. This indicates that for low redshifts our results are approximately consistent with the ΛCDM model; however, for high redshifts they disagree with ΛCDM and support the results of those studies that report a large bulk flow for the universe.
On the AGN nature of broad balmer emission in four low-redshift metal-poor galaxies
Authors: Burke Colin J , Liu Xin , Chen Yu-Ching , Shen Yue , Guo Hengxiao
Published: April 2021

We report on continued, ∼15-yr long, broad Balmer emission lines in three metal-poor dwarf emission-line galaxies selected from Sloan Digital Sky Survey spectroscopy. The persistent luminosity of the broad Balmer emission indicates the galaxies are active galactic nuclei (AGNs) with virial black hole masses of ∼106.7–107.0 M⊙. The lack of observed hard X-ray emission and the possibility that the Balmer emission could be due to a long-lived stellar transient motivated additional follow-up spectroscopy. We also identify a previously unreported blueshifted narrow absorption line in the broad H α feature in one of the AGNs, indicating an AGN-driven outflow with hydrogen column densities of order 1017 cm−2. We also extract light curves from the Catalina Real-Time Transient Survey and the Zwicky Transient Facility. We detect probable AGN-like variability in three galaxies, further supporting the AGN scenario. This also suggests the AGNs are not strongly obscured. This sample of galaxies are among the most metal-poor that host an AGN (Z = 0.05–0.16 Z⊙). We speculate they may be analogues to seed black holes which formed in unevolved galaxies at high redshift. Given the rarity of metal-poor AGNs and small sample size available, we investigate prospects for their identification in future spectroscopic and photometric surveys.
Three ultraluminous X-ray sources hosted by globular clusters in NGC 1316
Authors: Dage Kristen C , Kundu Arunav , Thygesen Erica , Bahramian Arash , Haggard Daryl , Irwin Jimmy A , Maccarone Thomas J , Nair Sneha , Peacock Mark B , Strader Jay , Zepf Stephen E
Published: April 2021

We have identified three ultraluminous X-ray sources (ULXs) hosted by globular clusters (GCs) within NGC 1316’s stellar system. These discoveries bring the total number of known ULXs in GCs up to 20. We find that the X-ray spectra of the three new sources do not deviate from the established pattern of spectral behaviour of the other known GC ULXs. The consistency of the X-ray spectral behaviour for these sources points to multiple paths of formation and evolution mechanisms for these rare and unique sources. Using the now larger sample of GC ULXs, we compare the optical properties of the entire known population of GC ULXs to other GCs across five galaxies and find that the properties of clusters that host ULXs are quite different from the typical clusters. Lastly, any trend of GC ULXs being preferentially hosted by metal-rich clusters is not strongly significant in this sample.
Systematic uncertainties in models of the cosmic dawn
Authors: Mirocha Jordan , Lamarre Henri , Liu Adrian
Published: April 2021

Models of the reionization and reheating of the intergalactic medium (IGM) at redshifts z ≳ 6 continue to grow more sophisticated in anticipation of near-future 21-cm, cosmic microwave background, and galaxy survey measurements. However, there are many potential sources of systematic uncertainty in models that could bias and/or degrade upcoming constraints if left unaccounted for. In this work, we examine three commonly ignored sources of uncertainty in models for the mean reionization and thermal histories of the IGM: the underlying cosmology, halo mass function (HMF), and choice of stellar population synthesis (SPS) model. We find that cosmological uncertainties affect the Thomson scattering optical depth at the few per cent level and the amplitude of the global 21-cm signal at the ∼5–10 mK level. The differences brought about by choice of HMF and SPS models are more dramatic, comparable to the 1σ error bar on τe and an ∼20 mK effect on the global 21-cm signal amplitude. Finally, we jointly fit galaxy luminosity functions and global 21-cm signals for all HMF/SPS combinations and find that (i) doing so requires additional free parameters to compensate for modelling systematics and (ii) the spread in constraints on parameters of interest for different HMF and SPS choices, assuming 5 mK noise in the global signal, is comparable to those obtained when adopting the 'true' HMF and SPS with ≳20 mK errors. Our work highlights the need for dedicated efforts to reduce modelling uncertainties in order to enable precision inference with future data sets.
Structural variation affecting DNA backbone interactions underlies adaptation of B3 DNA binding domains to constraints imposed by protein architecture
Authors: Jia Haiyan , Suzuki Masaharu , McCarty Donald R
Published: April 2021

Functional and architectural diversification of transcription factor families has played a central role in the independent evolution of complex development in plants and animals. Here, we investigate the role of architectural constraints on evolution of B3 DNA binding domains that regulate plant embryogenesis. B3 domains of ABI3, FUS3, LEC2 and VAL1 proteins recognize the same cis-element. Complex architectures of ABI3 and VAL1 integrate cis-element recognition with other signals, whereas LEC2 and FUS3 have reduced architectures conducive to roles as pioneer activators. In yeast and plant in vivo assays, B3 domain functions correlate with architectural complexity of the parent transcription factor rather than phylogenetic relatedness. In a complex architecture, attenuated ABI3-B3 and VAL1-B3 activities enable integration of cis-element recognition with hormone signaling, whereas hyper-active LEC2-B3 and FUS3-B3 over-ride hormonal control. Three clade-specific amino acid substitutions (β4-triad) implicated in interactions with the DNA backbone account for divergence of LEC2-B3 and ABI3-B3. We find a striking correlation between differences in in vitro DNA binding affinity and in vivo activities of B3 domains in plants and yeast. Our results highlight the role of DNA backbone interactions that preserve DNA sequence specificity in adaptation of B3 domains to functional constraints associated with domain architecture.
DELLA degradation by gibberellin promotes flowering via GAF1-TPR-dependent repression of floral repressors in Arabidopsis
Authors: Fukazawa Jutarou , Ohashi Yuki , Takahashi Ryuhei , Nakai Kanako , Takahashi Yohsuke
Published: April 2021

Flowering is the developmental transition from the vegetative to the reproductive phase. FLOWERING LOCUS T (FT), SUPPRESSOR OF OVEREXPRESSION OF CONSTANS1 (SOC1), and LEAFY (LFY) are floral integrators. These genes are repressed by several floral repressors including EARLY FLOWERING3 (ELF3), SHORT VEGETATIVE PHASE (SVP), TEMPRANILLO1 (TEM1), and TEM2. Although gibberellin (GA) promotes flowering by activating the floral integrator genes, the exact molecular mechanism remains unclear. DELLAs are negative regulators in GA signaling and act as coactivators of the transcription factor GAI ASSOCIATED FACTOR 1 (GAF1). GAs convert the GAF1 complex from a transcriptional activator to a repressor. Here, we show that GAF1 functions in the GA-dependent flowering pathway by regulating FT and SOC1 expression in Arabidopsis thaliana. We identified four flowering repressors, ELF3, SVP, TEM1, and TEM2, as GAF1-target genes. In response to GAs, GAF1 forms a transcriptional repressor complex and promotes the expression of FT and SOC1 through the repression of four flowering repressor genes, ELF3, SVP, TEM1, and TEM2.
Efficacy of Anodal Suboccipital Direct Current Stimulation for Endogenous Pain Modulation and Tonic Thermal Pain Control in Healthy Participants: A Randomized Controlled Clinical Trial
Authors: García-Barajas Guillermo , Serrano-Muñoz Diego , Gómez-Soriano Julio , Avendaño-Coy Juan , Fernández-Carnero Josue , Megía García Alvaro , Segura-Fragosa Antonio , Taylor Julian
Published: April 2021

Objective

The aim of this study was to assess whether anodal DCS applied to the suboccipital (SO) target area could potentiate antinociception assessed primarily with conditioned pain modulation of tonic thermal test stimuli.

Design

Randomized double-blinded control trial.

Setting

Rehabilitation hospital.

Subjects

Healthy participants.

Methods

Forty healthy participants were randomized to receive either SO-DCS or M1-DCS. The 20-minute 1.5 mA anodal or sham DCS intervention were applied to each participant in randomized order during two test sessions. The primary outcome measure included heterotopic cold-pressor conditioned pain modulation (CPM) of tonic heat pain. Secondary measures included pressure pain threshold and tonic thermal pain intensity.

Results

Heterotopic CPM of tonic heat pain intensity was unaffected by either SO-DCS or active M1, including the secondary measures of pressure pain threshold and tonic thermal pain intensity. Although low-power non-significant interactions were identified for DCS intervention (active versus sham) and time (before and after), a significant within-group inhibition of tonic cold pain was identified following SO-DCS (P = .011, mean [SD]: −0.76 ± 0.88 points) and M1-DCS (P < .002: −0.84 ± 0.82 points), without a significant change following sham DCS.

Conclusions

Although heterotopic CPM was not facilitated with either SO-DCS or M1-DCS, a general significant inhibition of tonic cold pain intensity was demonstrated following both interventions. The general effects of active DCS compared to sham on tonic cold pain—irrespective of the M1 or SO target—need to be confirmed using standard quantitative sensory testing.
Substantial anti-gout effect conferred by common and rare dysfunctional variants of URAT1/SLC22A12
Authors: Toyoda Yu , Kawamura Yusuke , Nakayama Akiyoshi , Nakaoka Hirofumi , Higashino Toshihide , Shimizu Seiko , Ooyama Hiroshi , Morimoto Keito , Uchida Naohiro , Shigesawa Ryuichiro , Takeuchi Kenji , Inoue Ituro , Ichida Kimiyoshi , Suzuki Hiroshi , Shinomiya Nariyoshi , Takada Tappei , Matsuo Hirotaka
Published: April 2021

Objectives

Gout, caused by chronic elevation of serum uric acid levels, is the commonest form of inflammatory arthritis. The causative effect of common and rare variants of ATP-binding cassette transporter G2 (ABCG2/BCRP) on gout risk has been studied, but little attention has been paid to the effect of common (rs121907892, p.W258X) and rare variants of urate transporter 1 (URAT1/SLC22A12) on gout, despite dysfunctional variants of URAT1 having been identified as pathophysiological causes of renal hypouricaemia.

Methods

To address this important but overlooked issue, we investigated the effects of these URAT1 variants on gout susceptibility, using targeted exon sequencing on 480 clinically defined gout cases and 480 controls of Japanese males in combination with a series of functional analyses of newly identified URAT1 variants.

Results

Our results show that both common and rare dysfunctional variants of URAT1 markedly decrease the risk of gout (OR 0.0338, reciprocal OR 29.6, P = 7.66 × 10−8). Interestingly, we also found that the URAT1-related protective effect on gout eclipsed the ABCG2-related causative effect (OR 2.30–3.32). Our findings reveal only one dysfunctional variant of URAT1 to have a substantial anti-gout effect, even in the presence of causative variants of ABCG2, a ‘gout gene’.

Conclusion

Our findings provide a better understanding of gout/hyperuricaemia and its aetiology that is highly relevant to personalized health care. The substantial anti-gout effect of common and rare variants of URAT1 identified in the present study support the genetic concept of a ‘Common Disease, Multiple Common and Rare Variant’ model.
Extended Spaces of Environmental Injustice: Hydrocarbon Pipelines in the Age of Planetary Urbanization
Authors: Braswell Taylor Harris
Published: April 2021

Hydrocarbon pipelines have emerged as a highly contentious political issue in recent years. In this paper, I conduct spatial regression analyses at national and regional scales to determine whether the locations of hydrocarbon pipelines constitute a systemic environmental justice issue throughout the contiguous US transmission pipeline system. National-level analyses show that counties with higher percentages of non-White residents are associated with more kilometers of hydrocarbon pipeline, whereas counties with a higher percentage of residents with a four-year college degree are associated with fewer kilometers of hydrocarbon pipeline. Regional analyses reveal further complexity, showing only degrees of consistency with national-level results. Situating these results within the emergent literature on planetary urbanization, I develop a multiscalar environmental justice framework that I call extended spaces of environmental injustice. Extended spaces of environmental injustice describe the places through which infrastructures of extended urbanization, which are built across vast geographical distances and operate to meet the material needs of urban society, materialize as spatially variegated environmental justice issues at the local scale. I conclude by arguing that the extended spaces of environmental injustice framework can open new pathways for research related to environmental justice and scale, both in analyzing the geography of existing infrastructures of extended urbanization and the construction of future infrastructure as efforts to decarbonize the economy manifest spatially.
Reflection on the Fly: Development of the Team Reflection Behavioral Observation (TuRBO) System for Acute Care Teams
Authors: Schmutz Jan B. , Lei Zhike , Eppich Walter J.
Published: April 2021

Purpose

Acute care teams work in dynamic and complex environments and must adapt to changing circumstances. A team process that helps teams process information and adapt is in-action team reflection (TR), defined as concurrent collective reflection on group objectives, strategies, or processes during an ongoing care event. However, the health care field lacks a means for systematically observing and ultimately training in-action TR in acute care teams. To bridge this gap, the authors developed a theoretically and empirically informed framework, Team Reflection Behavioral Observation (TuRBO), for measuring in-action TR.

Method

In 2018 at ETH, Zurich, Switzerland, the authors developed a theoretical framework based on the literature and theory. They then conducted exploratory reviews of preexisting videos of acute care teams training simulated emergencies. The authors adapted observation codes using an iterative approach. Using the developed coding framework, they coded 23 video recordings of acute care teams and provided validity evidence from the 3 sources: content, internal structure (interrater reliability), and relations to other variables.

Results

The final TuRBO framework consists of 3 general dimensions—seeking information, evaluating information, and planning—that are further specified in 7 subcodes. Interrater agreement of the coding was substantial (κ = 0.80). As hypothesized, the data showed a positive relationship between in-action TR and team performance. Also, physicians spent significantly more time on in-action TR than nurses.

Conclusions

The TuRBO framework for assessing in-action TR in acute care teams provides positive validity evidence of the data. TuRBO integrates different team communication and calibration processes under the overarching concept of in-action TR and provides descriptive behavioral markers. TuRBO taps into powerful cultural and normative components of patient safety. This tool can augment team training that allows all team members to serve as an important resource for flexible, resilient, and safer patient care.
Intravesical docetaxel for high-risk non-muscle invasive bladder cancer after Bacillus Calmette-Guérin failure
Authors: Shantharam Govind , Amin Ali , Pereira Jorge , Kott Ohad , Mueller-Leonhard Catrina , Mega Anthony , Golijanin Dragan , Gershman Boris
Published: April 2021

Background:

There are limited bladder-preserving therapeutic options for patients with high-risk non-muscle invasive bladder cancer (NMIBC) after failed Bacillus Calmette-Guérin (BCG) therapy. Salvage intravesical docetaxel therapy was described in 2006 but has not been validated outside of the original institution. In this study, we presented the first external report on the oncologic outcomes of intravesical docetaxel.

Materials and methods:

We identified 13 patients with high-risk NMIBC treated with ≥1 course of intravesical BCG who received salvage intravesical docetaxel. Recurrence-free survival (RFS) was estimated using the Kaplan–Meier method. Associations of clinicopathologic features with RFS were evaluated using Cox regression.

Results:

Median age was 75.2 years, and 46.2% of patients were male. Of the patients 92.3% had a prior diagnosis of high-grade T1 disease, 38.5% had a prior diagnosis of carcinoma in situ, and 46.2% had received ≥2 courses of BCG. Only 1 (7.7%) patient experienced docetaxel-related toxicity. Nine (69.2%) patients had a complete response at initial post-docetaxel cystoscopy. During a median follow-up of 12.0 (interquartile range 5.0–18.1) months, a total of 7 (53.8%) patients developed recurrence. Median time to recurrence was 10.1 (interquartile range 4.8–11.6) months. Estimated RFS at 6-, 12-, 18-, and 24-months was 75%, 50%, 50%, and 25%. Three (23.1%) patients ultimately underwent cystectomy. On univariable analysis, multiple courses of induction BCG were associated with decreased RFS, although this did not reach statistical significance (hazard ratio 4.69, p = 0.08).

Conclusions:

In this first external validation study, intravesical docetaxel was associated with excellent response rates and intermediate-term RFS among patients with high-risk NMIBC after failed BCG therapy.