bluuebunny/crossref_metadata_2025 huggingface dataset:
Space in Modern Hebrew Literature
Authors: Grumberg Karen
Published: March 2020

The complex relationship between space and modern Hebrew literature proceeds from key spatial paradigms of the Hebrew Bible: Egypt, the desert, and Zion. Over centuries, Jews dispersed around the globe used Hebrew to express different modes of spatial engagement: rabbis considered the places and placelessness of God; medieval Andalusian poets longed for Zion; communist Jews in Baghdad and Jewish polyglots in Odessa used Hebrew to narrate their relationship to places their families inhabited for generations; Israeli Jews and Israeli Palestinians, in an era when Hebrew is no longer the sole purview of Jews, share Hebrew to reflect on homeland and diaspora in poetry and prose. Though “space” is by no means a novel phenomenon, the “spatial turn” in the humanities and social sciences offered scholars of Hebrew culture conceptual and theoretical tools for addressing the diverse spatial configurations they encountered. The theorization of space and place in literature emphasized their active role in social relations and called for new conceptualizations of the construction and subversion of identities. Works by Gaston Bachelard, Michel de Certeau, Henri Lefebvre, Doreen Massey, Edward Said, Edward Soja, and Yi-Fu Tuan, among others, have undergirded investigations of space and place in modern Hebrew literature. Because most of the critical work on space in Hebrew literature addresses Hebrew texts from the twentieth century, this entry focuses on this period, though it also provides citations of scholarship analyzing biblical, rabbinic, Andalusian, and Haskalah texts. The citations mostly refer to literary texts but also include spatial analyses in cultural studies and history contexts. While many of the texts cited address the nation and territory or, alternatively, spatial paradigms that coalesce in resistance to the national, others investigate spatial paradigms in Hebrew that circumvent the national to consider fluid spatialities such as diaspora, migration, transnationalism, and travel, as well as historical spatial configurations that exist as memories, dreams, or specters. The preponderance of concrete investigations of specific places such as the city, the desert, and the kibbutz indicates the materiality of much of Hebrew literary spatiality. As the final section on modernity demonstrates, the spatial has opened fruitful avenues of inquiry within the existing historical discourse on Hebrew culture. There is, inevitably, some overlap in these categories: entries under The City, for example, might feel at home under Modernism and Place, while the line demarcating Borders and Beyond is appropriately penetrable, bleeding into Spatialities of Center and Margins. Finally, this entry should by no means be taken to represent all the scholarship on space in modern Hebrew literature, but rather to provide a sense of significant contributions and recent research.
Photography
Authors: Gunckel Colin
Published: March 2020

This bibliography reflects the multifaceted relationship between Latina/os and various photographic traditions. As individuals and groups placed in front of the camera lens, Latino/as have often found themselves stigmatized, marginalized, or criminalized. Photographs taken by reformers, the police, and documentarians since the late 19th century, for instance, have often generated harmful or homogenizing visions of the US Latina/o population that frame them as racially different or otherwise problematic. Since the early decades of the 20th century, however, Latino/a photographers have produced bodies of work that challenge these limited visions to craft new images of identity, community, and history. Some of these individuals have harnessed the capacity of photography to fulfill an evidentiary or realist function as either social documentation, a political organizing tool, or a challenge to exclusionary mainstream media coverage. Others have explored the aesthetic and formal potential of photography by engaging in conceptual art practices, crafting speculative reimaginings of history, using it as an extension of performance, integrating it into other media, or mobilizing it as a complex mechanism of community- or self-representation. This bibliography covers the major works of scholarship that have attended to these key photographic tendencies and the places where they overlap, considering works that discuss Latina/os both in front of and behind the lens. Also included here are key exhibition catalogues and photographic essays that provide a representative sampling of visual tendencies or traditions mobilized by practicing Latina/o photographers, with particular attention to regional and ethnic diversity.
Impact of Physical Training Programs on Physical Fitness in People With Class II and III Obesity: A Systematic Review and Meta-Analysis
Authors: Pazzianotto-Forti Eli Maria , Moreno Marlene Aparecida , Plater Emma , Baruki Silvia Beatriz Serra , Rasera-Junior Irineu , Reid W Darlene
Published: March 2020

Background

Physical training, regardless of the presence of concurrent weight loss, provides numerous health benefits for individuals who are overweight and obese and have or are at risk for cardiovascular disease.

Purpose

The purpose of this review was to identify different types of physical training programs (aerobic, resistance, or combined), with or without counseling/diet modifications, and their impact on physical fitness in individuals who have class II and III obesity.

Data Sources

Medline and Medline In-Process, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Web of Science, LILACS, CINAHL, SPORTDiscus, PEDro, and PubMed were searched up to June 2017.

Study Selection

This review had the following inclusion criteria: body mass index of ≥35 kg/m2 and age 18 years or older; supervised physical training program; randomized controlled trial; physical fitness outcome (muscular strength, muscular endurance, cardiovascular endurance, and/or flexibility); in English or Portuguese; and available full-text article.

Data Extraction

Three reviewers independently extracted data, assessed study risk of bias using the Cochrane tool, and discussed disagreements until consensus was reached.

Data Synthesis

Of the 9460 identified articles, 26 were included and 8 were used in a meta-analysis. The meta-analysis showed improvements in walking speed and maximal oxygen uptake but not knee extension strength in the intervention groups. The Cochrane risk-of-bias score indicated that the majority of the data were from randomized controlled trials with a low or unclear risk of bias.

Limitations

The large variability of outcomes and interventions made comparisons difficult.

Conclusions

A combination of aerobic exercise and resistance exercise, in addition to diet modifications, may improve cardiovascular and muscular endurance in individuals with class II and III obesity. However, conclusions must be interpreted with caution because of the heterogeneity in interventions and outcome measures among the studies and an unclear risk of bias in several studies.
A laboratory study on the effects of wind turbine noise on sleep: results of the polysomnographic WiTNES study
Authors: Smith Michael G , Ögren Mikael , Thorsson Pontus , Hussain-Alkhateeb Laith , Pedersen Eja , Forssén Jens , Ageborg Morsing Julia , Persson Waye Kerstin
Published: March 2020

Study Objectives

Assess the physiologic and self-reported effects of wind turbine noise (WTN) on sleep.

Methods

Laboratory sleep study (n = 50 participants: n = 24 living close to wind turbines and n = 26 as a reference group) using polysomnography, electrocardiography, salivary cortisol, and questionnaire endpoints. Three consecutive nights (23:00–07:00): one habituation followed by a randomized quiet Control and an intervention night with synthesized 32 dB LAEq WTN. Noise in WTN nights simulated closed and ajar windows and low and high amplitude modulation depth.

Results

There was a longer rapid eye movement (REM) sleep latency (+16.8 min) and lower amount of REM sleep (−11.1 min, −2.2%) in WTN nights. Other measures of objective sleep did not differ significantly between nights, including key indicators of sleep disturbance (sleep efficiency: Control 86.6%, WTN 84.2%; wakefulness after sleep onset: Control 45.2 min, WTN 52.3 min; awakenings: Control n = 11.4, WTN n = 11.5) or the cortisol awakening response. Self-reported sleep was consistently rated as worse following WTN nights, and individuals living close to wind turbines had worse self-reported sleep in both the Control and WTN nights than the reference group.

Conclusions

Amplitude-modulated continuous WTN may impact on self-assessed and some aspects of physiologic sleep. Future studies are needed to generalize these findings outside of the laboratory and should include more exposure nights and further examine possible habituation or sensitization.
An emergent clade of SARS-CoV-2 linked to returned travellers from Iran
Authors: Eden John-Sebastian , Rockett Rebecca , Carter Ian , Rahman Hossinur , de Ligt Joep , Hadfield James , Storey Matthew , Ren Xiaoyun , Tulloch Rachel , Basile Kerri , Wells Jessica , Byun Roy , Gilroy Nicky , O’Sullivan Matthew V , Sintchenko Vitali , Chen Sharon C , Maddocks Susan , Sorrell Tania C , Holmes Edward C , Dwyer Dominic E , Kok Jen ,   for the 2019-nCoV Study Group, Donovan Linda , Kumar Shanil , Tran Tyna , Ko Danny , Ngo Christine , Sivaruban Tharshini , Timms Verlaine , Lam Connie , Gall Mailie , Gray Karen-Ann , Sadsad Rosemarie , Arnott Alicia
Published: March 2020

The SARS-CoV-2 epidemic has rapidly spread outside China with major outbreaks occurring in Italy, South Korea, and Iran. Phylogenetic analyses of whole-genome sequencing data identified a distinct SARS-CoV-2 clade linked to travellers returning from Iran to Australia and New Zealand. This study highlights potential viral diversity driving the epidemic in Iran, and underscores the power of rapid genome sequencing and public data sharing to improve the detection and management of emerging infectious diseases.
The discriminative stimulus effects of epibatidine in C57BL/6J mice
Authors: de Moura Fernando B. , Hiranita Takato , McMahon Lance R.
Published: March 2020

The α4β2* nicotinic acetylcholine receptor (nAChR) subtypes are targeted for the development of smoking cessation aids, and the use of drug discrimination in mice provides a robust screening tool for the identification of drugs acting through nAChRs. Here, we established that the α4β2* nAChR agonist epibatidine can function as a discriminative stimulus in mice. Male C57BL/6J mice discriminated epibatidine (0.0032 mg/kg, subcutaneously) and were tested with agonists varying in selectivity and efficacy for α4β2* nAChRs. The discriminative stimulus effects of epibatidine were characterized with the nonselective, noncompetitive nicotinic antagonist mecamylamine, with the selective β2-substype-containing nAChR antagonist dihydro-β-erythroidine hydrobromide (DHβE), and the α7 antagonist methyllycaconitine (MLA). Nicotine (0.32–1.0 mg/kg, subcutaneously), the partial nAChR agonist cytisine (1.0–5.6 mg/kg, subcutaneously), and the α7 nAChR agonist N-[(3R)-1-azabicyclo[2.2.2]oct-3-yl]-4-chlorobenzamide (10–56 mg/kg, intraperitoneally) produced no more than 33% epibatidine-appropriate responding. The partial α4β2* nAChR agonists varenicline and 2′-fluoro-3′-(4-nitro-phenyl)deschloroepibatidine produced 61 and 69% epibatidine-appropriate responding, respectively. DHβE and mecamylamine, but not MLA, significantly antagonized the discriminative stimulus effects of epibatidine. These results show that epibatidine may be trained as a discriminative stimulus in mice and has utility in elucidating the in-vivo pharmacology of α4β2* nAChR ligands.
Therapeutic Mammoplasty and Dermal Flap: A Novel Hybrid Approach for Chest Wall Reconstruction
Authors: Khalil Haitham H. , Kalkat Maninder
Published: March 2020

Background:

Breast reduction techniques in management of breast cancer have been described since 1980 mainly to resect a large tumor in large breasts. Driven by the demand for more aesthetically acceptable results without compromising oncological safety, these oncoplastic approaches have become more popular. In addition, the utilization of redundant lower pole dermal flap has been a widely practiced tool in the armamentarium of implant-based breast reconstruction in patients with large ptotic breasts. The authors advocate a novel hybrid technique utilizing both therapeutic mammoplasty and lower breast pole dermal flap to provide coverage for anterior chest wall defect posttumor resection in patients with large or ptotic breasts.

Methods:

A retrospective review was conducted on patients who underwent chest wall resection and reconstruction using therapeutic mammoplasty and dermal flap to provide soft tissue coverage in the period between 2012 and 2018. Patient’s demographics, clinicopathological, radiological, operative details, postoperative morbidity, and follow-up data were recorded.

Results:

Nine patients with chondrosarcoma (7/9) and giant cell tumor (2/9) were managed with a mean age 44.1 years (range 28–73). Complete oncological resection was achieved in all patients followed by rigid/nonrigid skeletal reconstructions. All procedures were completed successfully with no nipple areolar complex (NAC) necrosis or prosthesis failure experienced during the follow-up period (range 12–72 months). Excellent functional and aesthetic outcomes were reported in all patients.

Conclusion:

The authors’ results demonstrate that this technique could be safely planned for soft tissue coverage postchest wall resection with superior aesthetic and durable outcomes.
National Survey of US Plastic Surgeon Experience with Female Genital Mutilation
Authors: Calvert Catherine , Nathan Shelby , Sakers Alexander , Akinbiyi Takintope , Percec Ivona
Published: March 2020

Background:

Female genital mutilation (FGM) is a growing problem in the United States, with the past few decades showing a dramatic increase in prevalence. This study aims to understand the plastic surgeon experience with FGM and inform preparedness for this rising problem.

Methods:

A 26-question survey was developed and electronically distributed to a random cohort of 2,508 active American Society of Plastic Surgeons members. It was sent three times over a 3-week period in 2018. χ2 statistical tests were used to analyze outcomes, assuming a P < 0.05 level for statistical significance.

Results:

There was a 7% survey response rate (n=180). Demographic profiles reflected a range of practice types, geographical distribution, and years of experience. Ninety-five percent of respondents had heard of FGM (n=169). Sixty-seven percent were aware that surgical reconstructive options exist for FGM (n=115), with only 5% reporting any formal training on the topic (n=10). Only 13.6% of those surveyed felt prepared to care for a woman with FGM (n=23).

Conclusions:

After surveying plastic surgeons, responses demonstrate that while the majority are familiar with FGM, very few are comfortable or prepared for the care and surgical management of this patient population. Although this study is limited by a low response rate, we believe that the results reflect an existing knowledge gap and demonstrate the need for formal training. This may help to bridge this gap and prepare surgeons to care for this population.
Reduction Mammaplasty in a Patient with Kniest Dysplasia: Case Report and Literature Review
Authors: Cuellar Trajan A. , Erdmann-Sager Jessica
Published: March 2020

Collagen plays a fundamental role in wound healing and consequently defective collagen can impair normal wound healing processes. Kniest dysplasia (KD) is a collagenopathy that results from a pathogenic mutation in a gene that codes for type II collagen. Clinical manifestations of the dysplasia include short-trunk dwarfism, kyphoscoliosis, hand arthropathy, cleft palate, hearing loss, and ocular abnormalities. We present the case of a 21-year-old woman who desired reduction mammaplasty. A review of the literature was performed, and there were no published reports of any plastic surgery procedures in patients with KD. The patient proceeded with surgery and healed without any complications. Given that wound healing appears normal in this patient population, it is reasonable to consider elective plastic surgical procedures in patients with KD.
Breast Reconstruction with a Lateral Breast Free Flap: A New Application of Breast-sharing
Authors: Lopez Carlos E. , Caicedo Jose J. , Pizano Alejandro , Hoyos María E.
Published: March 2020

Breast reconstruction using contralateral autologous tissue, also known as breast sharing, is a viable option previously described in the literature, whereby flaps based on perforators of the internal mammary artery (internal mammary artery pedicle) are used. We report a postoncological breast reconstruction case using a microvascular flap taken from the lateral pole of the contralateral breast. We highlight the importance of preserving the medial pole of the donor breast for improving cosmesis, avoiding symmastia, and preserving the intermammary sulcus, as a difference with flaps based on the internal mammary artery pedicle flaps. Breast sensation could be recovered by neurotization of the lateral intercostal nerve, which may be included in the contralateral breast flap to be transferred. Contralateral breast free flaps could be an alternative to reconstruct the breast in selected patients. Oncological risk factors are discussed. Advances in genetic testing and tumor cell biology could help us to select the accurate candidates for this reconstructive technique.
Therapeutic Reversal of Radiotherapy Injury to Pro-fibrotic Dysfunctional Fibroblasts In Vitro Using Adipose-derived Stem Cells
Authors: Shukla Lipi , Luwor Rodney , Ritchie Matthew E. , Akbarzadeh Shiva , Zhu Hong-Jian , Morrison Wayne , Karnezis Tara , Shayan Ramin
Published: March 2020

Background:

Cancer patients often require radiotherapy (RTx) to enhance their survival. Unfortunately, RTx also damages nearby healthy non-cancer tissues, leading to progressive fibrotic soft-tissue injury, consisting of pain, contracture, tissue-breakdown, infection, and lymphoedema. Mechanisms underlying the clinically observed ability of fat grafting to ameliorate some of these effects, however, are poorly understood. It was hypothesized that RTx significantly alters fibroblast cell function and the paracrine secretome of adipose-derived stem cells (ADSC) may mitigate these changes.

Methods:

To investigate cellular changes resulting in the fibrotic side-effects of RTx, cultured normal human dermal fibroblasts (NHDF) were irradiated (10Gy), then studied using functional assays that reflect key fibroblast functions, and compared with unirradiated controls. RNA-Seq and targeted microarrays (with specific examination of TGFβ) were performed to elucidate altered gene pathways. Finally, conditioned-media from ADSC was used to treat irradiated fibroblasts and model fat graft surgery.

Results:

RTx altered NHDF morphology, with cellular functional changes reflecting transition into a more invasive phenotype: increased migration, adhesion, contractility, and disordered invasion. Changes in genes regulating collagen and MMP homeostasis and cell-cycle progression were also detected. However, TGFβ was not identified as a key intracellular regulator of the fibroblast response. Finally, treatment with ADSC-conditioned media reversed the RTx-induced hypermigratory state of NHDF.

Conclusions:

Our findings regarding cellular and molecular changes in irradiated fibroblasts help explain clinical manifestations of debilitating RTx-induced fibrosis. ADSC-secretome-mediated reversal indicated that these constituents may be used to combat the devastating side-effects of excessive unwanted fibrosis in RTx and other human fibrotic diseases.
Pneumothorax with Liposuction: Spreading Awareness
Authors: Taha Ahmed A. , Tahseen Hossam
Published: March 2020

Complications with liposuction are not uncommon; some of these are very serious and can be life-threatening. In this case report we present a case of pneumothorax following liposuction.
Effective Secondary Reconstruction of Refractory Urethrocutaneous Fistula after Metoidioplasty Using Folded Superficial Circumflex Iliac Artery Perforator Flap
Authors: Hattori Yoshitsugu , Yamashita Shuji , Morishita Yuya , Iida Takuya
Published: March 2020

One of the primary goals of penile reconstruction for female-to-male transsexuals is to enable voiding while standing. Metoidioplasty represents a viable option, but it is associated with a high rate of postoperative fistula formation and recurrence, which affects the aesthetic and functional outcomes. Subsequent surgical repair using scarred and inadequate local tissue may contribute to fistula recurrence. The folded superficial circumflex iliac artery perforator (SCIP) island flap offers sufficient well-vascularized tissue and skin envelope for the reconstruction of the urethra and outer skin after failed metoidioplasty. The SCIP flap can be elevated as a hairless thin flap, making it useful in urethral reconstruction even when it is folded. We describe a case of a 44-year-old female-to-male transsexual patient who developed a refractory urethrocutaneous fistula after metoidioplasty. Surgical repairs were attempted using local tissue 4 times without success. The patient presented to our hospital, and we performed urethral reconstruction using a folded, pedicled SCIP flap for both urethra and skin augmentation. The postoperative course was uneventful, with satisfactory functional results and low donor-site morbidity. No fistula recurrence was observed during the 2 years of follow-up. This novel procedure offers a viable alternative technique for refractory urethrocutaneous fistula repair.
Community-based Implementation of Centers for Disease Control and Prevention's Recommended Screening for Sexually Transmitted Infections Among Youth at High Risk for HIV Infection in Los Angeles and New Orleans
Authors: Lee Sung-Jae , Ocasio Manuel A. , Goldbeck Cameron S. , Koussa Maryann , Comulada Warren Scott , Swendeman Dallas , Klausner Jeffrey D. , Rotheram-Borus Mary Jane
Published: March 2020

We examined whether the implementation of the Centers for Disease Control and Prevention's recommended screening of Chlamydia trachomatis/Neisseria gonorrhoeae with proactive follow-up among high-risk youth recruited from community and clinic settings reduced future C. trachomatis/N. gonorrhoeae diagnoses. After the Centers for Disease Control and Prevention's recommendations demonstrated a 41% decline in sexually transmitted infections; 3 tests in 1 year resulted in a 10% decline.
Somatically Derived Yolk Sac Tumor of the Ovary in a Young Woman
Authors: Hodgson Anjelica , Ghorab Zeina , Parra-Herran Carlos
Published: March 2020

Ovarian carcinoma with a somatically derived yolk sac tumor component is a phenomenon known to mostly occur in postmenopausal women. Herein, we report an ovarian endometriosis-associated somatic yolk sac tumor arising in the background of a low-grade endometrioid adenocarcinoma in a young woman. A 27-yr-old woman presented with abdominal pain, subsequently recognized to be caused by a right ovarian mass undergoing torsion. Following operative management, microscopic examination of the salpingo-oophorectomy specimen showed endometriosis and a predominantly cystic ovarian neoplasm with 2 distinct phenotypic areas: (1) a yolk sac tumor component containing Schiller-Duval bodies and (2) a low-grade endometrioid carcinoma component with squamous metaplasia. Immunohistochemical evaluation showed distinct profiles in the yolk sac tumor (estrogen receptor/progesterone receptor/PAX8 negative, SALL4/Glypican 3 positive) and endometrioid (estrogen receptor/progesterone receptor/PAX8 positive, SALL4/Glypican 3 negative) components. Given these findings, the diagnosis of an endometriosis-associated endometrioid adenocarcinoma with a somatically derived yolk sac tumor was rendered. The tumor was staged as pT1c1 due to intraoperative spillage. The patient underwent chemotherapeutic treatment and after 15 mo of follow-up, she was alive with no evidence of recurrence. This example demonstrates that somatic yolk sac tumor differentiation in ovarian epithelial neoplasia can occur in young patients; awareness of this phenomenon is important as somatic and germ cell yolk sac neoplasia have different behavior and therapy.
Differences in Safety Report Event Types Submitted by Graduate Medical Education Trainees Compared With Other Healthcare Team Members
Authors: Cohen Sarah P. , McLean Heather S. , Milne Judy , Parente Victoria
Published: March 2020

Objectives

Graduate medical education (GME) trainees have a unique perspective from which to identify and report patient safety concerns. However, it is not known how safety reports submitted by GME trainees differ from those submitted by other clinical staff. We hypothesized that GME trainees were more likely to submit safety reports regarding transitions of care, delays in care, and lapses in communication, and reports of higher severity compared with other frontline staff such as nurses, pharmacists, and other providers.

Methods

Patient safety reports submitted by clinical staff for 1 year at an academic tertiary care children’s hospital were retrospectively reviewed and categorized by reporter type. Severity level and event type were analyzed by reporter type, and repeat χ2 tests were used to compare the percentage of reports at each severity level and in each event type submitted by GME trainees compared with each other reporter type.

Results

Graduate medical education trainees submitted reports of greater severity (level E/F/G) compared with nurses (10% versus 5%, P = 0.021) and pharmacists (10% versus 2%, P = 0.001). A greater percent of GME trainees’ reports were categorized as errors in transitions of care, diagnosis, ordering, laboratory collection, and care delays compared with several other reporter types.

Conclusions

Graduate medical education trainees identify system vulnerabilities not detected by other personnel, supporting efforts to increase safety reporting by GME trainees.
The Impact of Surgical Count Technology on Retained Surgical Items Rates in the Veterans Health Administration
Authors: Gunnar William , Soncrant Christina , Lynn Marilyn M. , Neily Julia , Tesema Yohannes , Nylander William
Published: March 2020

Objectives

The aim of the study was to compare retained surgical item (RSI) rates for 137 Veterans Health Administration Surgery Programs with and without surgical count technology and the root cause analysis (RCA) for soft good RSI events between October 1, 2009 and December 31, 2016. A 2017 survey identified 46 programs to have independently acquired surgical count technology.

Methods

Retained surgical item rates were calculated by the sum of events (sharp, soft good, instrument) divided by the total procedures performed. The RCAs for RSI events were analyzed using codebooks for procedure type/location and root cause characterization.

Results

One hundred twenty-four RSI events occurred in 2,964,472 procedures for an overall RSI rate of 1/23,908 procedures. The RSI rates for 46 programs with surgical count technology were significantly higher in comparison with 91 programs without a surgical count technology system (1/18,221 versus 1/30,593, P = 0.0026). The RSI rates before and after acquiring the surgical count technology were not significantly different (1/17,508 versus 1/18,673, P = 0.8015). Root cause analyses for 42 soft good RSI events identified multiple associated disciplines (general surgery 26, urology 5, cardiac 4, neurosurgery 3, vascular 2, thoracic 1, gynecology 1) and locations (abdomen 26, thorax 7, retroperitoneal 4, paraspinal 2, extremity 1, pelvis 1, and head/neck 1). Human factors (n = 24), failure of policy/procedure (n = 21), and communication (n = 19) accounted for 64 (65%) of the 98 root causes identified.

Conclusions

Acquisition of surgical count technology did not significantly improve RSI rates. Soft good RSI events are associated with multiple disciplines and locations and the following dominant root causes: human factors, failure to follow policy/procedure, and communication.
Psychometric Testing of the Chinese Version of Second Victim Experience and Support Tool
Authors: Zhang Xin , Chen Jingli , Lee Shih-Yu
Published: March 2020

Objectives

The Second Victim Experience and Support Tool (SVEST) is a 29-item, nine-subscale questionnaire, which measures the second-victim experience and quality of support resources after the health professionals involved with medical errors. Second victim is common among the registered nurses (RNs) in China; however, no Chinese version of the SVEST is available. This study aimed to evaluate the psychometric properties of the Chinese version of the SVEST (C-SVEST) among RNs.

Methods

The SVEST was forward and backward translated. The reliability and validity of the final C-SVEST were tested by using 625 RNs in Beijing, China. Internal consistency and split-half analysis were used to examine reliability, content validity was evaluated by expert committee, and validity was assessed via exploratory factory analysis and confirmatory factor analysis.

Results

The Cronbach α coefficient (0.59–0.92) and split-half analysis (Spearman-Brown coefficient = 0.88) were acceptable. The item-level content validity index (I-CVI) ranged from 0.85 to 0.97. The average of scale-level content validity index was 0.91. Eight factors were extracted by exploratory factory analysis, which explained 70.8% of the total variance of second-victim experience and support in the C-SVEST. The confirmatory factor analysis showed a good fit for a nine-factor structure and the values were acceptable: root mean square error approximation = 0.07; comparative fit index = 0.90; goodness-of-fit index = 0.84; and χ2/df = 2.19.

Conclusions

The C-SVEST is a valid and reliable tool to assess the extent of second-victim distress and support resources in Chinese health care workers. In Asian culture, nurses are hesitant to express emotional distress and instead they express physical discomfort and turnover intentions.
Body of Evidence: Do Autopsy Findings Impact Medical Malpractice Claim Outcomes?
Authors: Gartland Rajshri M. , Myers Laura C. , Iorgulescu J. Bryan , Nguyen Anthony T. , Yu-Moe C. Winnie , Falcone Bianca , Mitchell Richard , Kachalia Allen , Mort Elizabeth
Published: March 2020

Objective

Clinicians may hesitate to advocate for autopsies out of concern for increased malpractice risk if the pathological findings at time of death differ from the clinical findings. We aimed to understand the impact of autopsy findings on malpractice claim outcomes.

Methods

Closed malpractice claims with loss dates between 1995 and 2015 involving death related to inpatient care at 3 Harvard Medical School hospitals were extracted from a captive malpractice insurer’s database. These claims were linked to patients’ electronic health records and their autopsy reports. Using the Goldman classification system, 2 physician reviewers blinded to claim outcome determined whether there was major, minor, or no discordance between the final clinical diagnoses and pathologic diagnoses. Claims were compared depending on whether an autopsy was performed and whether there was major versus minor/no clinical-pathologic discordance. Primary outcomes included percentage of claims paid through settlement or plaintiff verdict and the amount of indemnity paid, inflation adjusted.

Results

Of 293 malpractice claims related to an inpatient death that could be linked to patients’ electronic health records, 89 claims (30%) had an autopsy performed by either the hospital or medical examiner. The most common claim allegation was an issue with clinician diagnosis, which was statistically less common in the autopsy group (18% versus 38%, P = 0.001). There was no difference in percentage of claims paid whether an autopsy was performed or not (42% versus 41%, P = 0.90) and no difference in median indemnity of paid claims after adjusting for number of defendants ($1,180,537 versus $906,518, P = 0.15). Thirty-one percent of claims with hospital autopsies performed demonstrated major discordance between autopsy and clinical findings. Claims with major clinical-pathologic discordance also did not have a statistically significant difference in percentage paid (44% versus 41%, P > 0.99) or amount paid ($895,954 versus $1,494,120, P = 0.10) compared with claims with minor or no discordance.

Conclusions

Although multiple factors determine malpractice claim outcome, in this cohort, claims in which an autopsy was performed did not result in more paid outcomes, even when there was major discordance between clinical and pathologic diagnoses.
Characteristics of Critical Incident Reporting Systems in Primary Care: An International Survey
Authors: Höcherl Andreas , Lüttel Dagmar , Schütze Dania , Blazejewski Tatjana , González-González Ana Isabel , Gerlach Ferdinand M. , Müller Beate S.
Published: March 2020

Objective

The aim of the study was to support the development of future critical incident reporting systems (CIRS) in primary care by collecting information on existing systems. Our focus was on processes used to report and analyze incidents, as well as strategies used to overcome difficulties.

Methods

Based on literature from throughout the world, we identified existing CIRS in primary care. We developed a questionnaire and sent it to operators of a purposeful sample of 17 CIRS in primary care. We used cross-case analysis to compare the answers and pinpoint important similarities and differences in the CIRS in our sample.

Results

Ten CIRS operators filled out the questionnaire, and 9 systems met our inclusion criteria. The sample of CIRS came from 8 different countries and was rather heterogeneous. The reporting systems invited a broad range of professions to report, with some also including reports by patients. In most cases, reporting was voluntary and conducted via an online reporting form. Reports were analyzed locally, centrally, or both. The various CIRS used interesting ideas to deal with barriers. Some, for example, used confidential reporting modes as a compromise between anonymity and the need for follow-up investigations, whereas others used smartphone applications and call centers to speed up the reporting process.

Conclusions

We found multiple CIRS that have operated in primary care for many years and have received a high number of reports. They were largely developed in accordance with recommendations found in literature. Developers of future systems may find this overview useful.
Effect of synaptic cell-to-cell transmission and recombination on the evolution of double mutants in HIV
Authors: Kreger Jesse , Komarova Natalia L. , Wodarz Dominik
Published: March 2020

Recombination in HIV infection can impact virus evolutionin vivoin complex ways, as has been shown both experimentally and mathematically. The effect of free virus versus synaptic, cell-to-cell transmission on the evolution of double mutants, however, has not been investigated. Here, we do so by using a stochastic agent-based model. Consistent with data, we assume spatial constraints for synaptic but not for free-virus transmission. Two important effects of the viral spread mode are observed: (i) for disadvantageous mutants, synaptic transmission protects against detrimental effects of recombination on double mutant persistence. Under free virus transmission, recombination increases double mutant levels for negative epistasis, but reduces them for positive epistasis. This reduction for positive epistasis is much diminished under predominantly synaptic transmission, and recombination can, in fact, lead to increased mutant levels. (ii) The mode of virus spread also directly influences the evolutionary fate of double mutants. For disadvantageous mutants, double mutant production is the predominant driving force, and hence synaptic transmission leads to highest double mutant levels due to increased transmission efficiency. For advantageous mutants, double mutant spread is the most important force, and hence free virus transmission leads to fastest invasion due to better mixing. For neutral mutants, both production and spread of double mutants are important, and hence an optimal mixture of free virus and synaptic transmission maximizes double mutant fractions. Therefore, both free virus and synaptic transmission can enhance or delay double mutant evolution. Implications for drug resistance in HIV are discussed.
Trait-specific dispersal of bacteria in heterogeneous porous environments: from pore to porous medium scale
Authors: Scheidweiler David , Miele Filippo , Peter Hannes , Battin Tom J. , de Anna Pietro
Published: March 2020

The dispersal of organisms controls the structure and dynamics of populations and communities, and can regulate ecosystem functioning. Predicting dispersal patterns across scales is important to understand microbial life in heterogeneous porous environments such as soils and sediments. We developed a multi-scale approach, combining experiments with microfluidic devices and time-lapse microscopy to track individual bacterial trajectories and measure the overall breakthrough curves and bacterial deposition profiles: we, then, linked the two scales with a novel stochastic model. We show that motile cells of
Pseudomonas putida
disperse more efficiently than non-motile mutants through a designed heterogeneous porous system. Motile cells can evade flow-imposed trajectories, enabling them to explore larger pore areas than non-motile cells. While transported cells exhibited a rotation in response to hydrodynamic shear, motile cells were less susceptible to the torque, maintaining their body oriented towards the flow direction and thus changing the population velocity distribution with a significant impact on the overall transport properties. We also found, in a separate set of experiments, that if the suspension flows through a porous system already colonized by a biofilm,
P. putida
cells are channelled into preferential flow paths and the cell attachment rate is increased. These two effects were more pronounced for non-motile than for motile cells. Our findings suggest that motility coupled with heterogeneous flows can be beneficial to motile bacteria in confined environments as it enables them to actively explore the space for resources or evade regions with unfavourable conditions. Our study also underlines the benefit of a multi-scale approach to the study of bacterial dispersal in porous systems.
Gradient diffusion susceptibility testing for Neisseria gonorrhoeae: an accurate alternative to agar dilution in high-MIC strains?
Authors: Desjardins Michaël , Lefebvre Brigitte , Lavallée Christian , Labbé Annie-Claude , Mauffrey Florian , Martin Irene , Longtin Jean , Fortin Claude
Published: March 2020

Introduction. The correlation of antimicrobial susceptibility testing (AST) between agar dilution and gradient diffusion for

Neisseria gonorrhoeae

is not well established, especially in strains with high MICs.

Aim. The objective of this study was to evaluate the accuracy of gradient diffusion for

N. gonorrhoeae

.

Methods. Fifty strains of

N. gonorrhoeae

, all tested by the agar dilution method according to CLSI methods and confirmed to be genetically distinct using molecular typing (NG-MAST), were selected. Isolates with high MICs were targeted. Gradient diffusion was performed for ceftriaxone (CRO), cefixime (CFX), azithromycin (AZT), tetracycline (TET) and fosfomycin (FOS) using two different commercial antimicrobial strips on different culture media (a non-commercial GC agar base with 1 % defined growth supplement and two commercial media). The performance of agar gradient diffusion was assessed based on accuracy, using essential and category agreements (EA and CA).

Results. Essential and categorical agreement were over 90 % for CRO, CFX and AZT on the two commercial agar media tested. Category disagreements were seen for CFX and AZT, mostly just very major errors. For TET, EA ranged from 80 to 96 % and CA ranged from 38 to 76 %, most of the misclassifications being minor errors. Finally, EA for FOS ranged between 80 and 98 %.

Conclusion. Gradient diffusion is an accurate and acceptable alternative for CRO, CFX and AZT. Caution is advised when MICs are reported by gradient diffusion approach breakpoints because of the possibility of very major errors. The use of gradient diffusion is limited for TET because of the high rate of minor errors.
Roseibium aestuarii sp. nov., isolated from Pearl River Estuary
Authors: Duan Li , Li Jia-ling , Li Xin , Dong Lei , Fang Bao-Zhu , Xiao Min , Mou Xiaozhen , Li Wen-Jun
Published: March 2020

A novel bacterium, designated strain SYSU M00256-3T, was isolated from a water sample collected from Pearl River Estuary at Guangzhou, PR China. Its taxonomic position was determined by using a polyphasic approach. Cells of the strain were Gram-staining-negative, motile, aerobic and rod-shaped with peritrichous flagella. It could grow at 15–45 °C, pH 4.0–10.0 and in the presence of 0–7.5 % (w/v) NaCl. The chemotaxonomic features of strain SYSU M00256-3T included ubiquinone-10 (Q-10) as the sole respiratory quinone; phosphatidylcholine, phosphatidylmethylethanolamine, phosphatidylglycerol, diphosphatidylglycerol, phosphatidylethanolamine and an unidentified phospholipid as major polar lipids; summed feature 8 (C18 : 1
 ω7c and C18 : 1
 ω6c) as the predominant fatty acids (>70 %). On the basis of 16S rRNA gene sequence analysis, strain SYSU M00256-3T was most closely related to the type strains of

Roseibium hamelinense

CGMCC 1.12584T (97.7 %) and

R. aquae

CGMCC 1.12426T (97.2 %),

R. sediminis

KCTC 52373T (96.7 %),

R. denhamense

CGMCC 1.12583T (96.4 %). The average nucleotide identity (ANI) values between R. aestuarii SYSU M00256-3T and

R. hamelinense

CGMCC 1.12584T,

R. aquae

CGMCC 1.12426T,

R. denhamense

CGMCC 1.12583T and

R. sediminis

KCTC 52373T were 78.0, 78.2, 77.7 and 78.8, and the dDDH value is 20.0, 20.8, 20.1 and 20.6 correspondingly. Based on the analyses of the phenotypic, genotypic and phylogenetic characteristics, strain SYSU M00256-3T is characterized to represent a novel species of the genus

Roseibium

, for which the name Roseibium aestuarii sp. nov. is proposed. The type strain is SYSU M00256-3T (=NBRC 112946T=CGMCC 1.16156T).
The role of MTHFDL in mediating intracellular lipogenesis in oleaginous Mortierella alpina
Authors: Wang Hongchao , Wang Qizai , Zhang Chen , Chen Haiqin , Lu Wenwei , Gu Zhennan , Zhao Jianxin , Zhang Hao , Chen Yong Q. , Chen Wei
Published: March 2020

The oleaginous fungus Mortierella alpina can synthesize a variety of polyunsaturated fatty acids, which are used extensively in industry for the production of arachidonic acid (AA). NADPH is the limiting factor and critical reducing agent in lipid biosynthesis. In the folate cycle, methylenetetrahydrofolate dehydrogenase (MTHFDL) catalyzes the conversion of methylene tetrahydrofolate into 10-formyl-tetrahydrofolate with the reduction of NADP+ to NADPH. MTHFDL RNAi was used to investigate the role of the folate cycle in lipogenesis. Gene knockdown decreased the transcript levels of MTHFDL by about 50 % and attenuated cell fatty acid synthesis. The observation of decreased NADPH levels and downregulated NADPH-producing genes in response to MTHFDL RNAi indicates a novel aspect of the NADPH regulatory mechanism. Thus, our study demonstrates that MTHFDL plays key role in the mediation of NADPH in lipogenesis in M. alpina.
A glucose-stimulated BOLD fMRI study of hypothalamic dysfunction in mice fed a high-fat and high-sucrose diet
Authors: Mohr Adélaïde A. , Garcia-Serrano Alba M. , Vieira João P.P. , Skoug Cecilia , Davidsson Henrik , Duarte João M.N.
Published: March 2020

The hypothalamus is the central regulator of energy homeostasis. Hypothalamic neuronal circuits are disrupted upon overfeeding, and play a role in the development of metabolic disorders. While mouse models have been extensively employed for understanding mechanisms of hypothalamic dysfunction, functional magnetic resonance imaging (fMRI) on hypothalamic nuclei has been challenging. We implemented a robust glucose-induced fMRI paradigm that allows to repeatedly investigate hypothalamic responses to glucose. This approach was used to test the hypothesis that hypothalamic nuclei functioning is impaired in mice exposed to a high-fat and high-sucrose diet (HFHSD) for 7 days. The blood oxygen level-dependent (BOLD) fMRI signal was measured from brains of mice under light isoflurane anaesthesia, during which a 2.6 g/kg glucose load was administered. The mouse hypothalamus responded to glucose but not saline administration with a biphasic BOLD fMRI signal reduction. Relative to controls, HFHSD-fed mice showed attenuated or blunted responses in arcuate nucleus, lateral hypothalamus, ventromedial nucleus and dorsomedial nucleus, but not in paraventricular nucleus. In sum, we have developed an fMRI paradigm that is able to determine dysfunction of glucose-sensing neuronal circuits within the mouse hypothalamus in a non-invasive manner.
Chronic antidepressant treatments rescue reduced REM sleep theta power in a rat social defeat stress model of depression
Authors: Matsuda Yoshiki , Ozawa Nobuyuki , Shinozaki Takiko , Aoki Kazuhisa , Nihonmatsu-Kikuchi Naomi , Shinba Toshikazu , Tatebayashi Yoshitaka
Published: March 2020

Although It is widely recognized that virtually all antidepressants (ADs) suppress rapid eye movement (REM) sleep, the effects of chronic AD treatments on sleep abnormalities, especially those of REM sleep, have rarely been investigated comprehensively in animal models of major depressive disorder (MDD). Here, we show that chronic social defeat stress (SDS) in rats induces prolonged social avoidance and MDD-like alterations in sleep architecture (increased REM sleep durations, bouts, and shortened REM latency) even a month after the last SDS. These abnormalities were associated with changes in electroencephalography (EEG) spectra powers, such as reduced REM sleep theta powers during the light phase. Chronic AD treatments significantly ameliorated these behavioral, sleep, and EEG abnormalities, although in some cases not to control levels. Interestingly, the social interaction ratios a month after the last SDS most strongly correlated with the REM sleep theta powers. These results suggest that chronic AD treatments suppress REM sleep durations and bouts as observed in human MDD patients, but, at the same time, increase REM sleep theta power. The latter is an EEG parameter that has never been directly investigated in humans, and which may be responsible for the therapeutic effects of ADs.

Significance Statement

Disturbed sleep is one of nine diagnostic criteria for major depressive disorder (MDD), which usually resolves with adequate treatment. However, little is known about how antidepressants (AD) work in MDD animal models. Here, we developed a novel rat social defeat stress model demonstrating long-lasting MDD-like sleep disturbances. We found that chronic AD treatments suppressed REM durations and bouts as reported previously, but, at the same time, increased REM sleep theta power. Interestingly, among several sleep parameters, only REM sleep theta power strongly correlated with depressive symptoms at 1M. Thus, REM sleep theta power, an EEG parameter that has never been investigated directly in humans, could be a novel indicator for MDD and/or AD effects.