bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of supplemental zinc and dietary fiber concentration on mineral retention of beef steers1
Authors: Carmichael Remy N , Genther-Schroeder Olivia N , Deters Erin L , Jackson Trey D , Messersmith Elizabeth M , VanValin Katherine R , Hansen Stephanie L
Published: March 2019

The objective was to determine if zinc (Zn) retention improved with supplemental Zn above recommended concentrations with increasing dietary fiber concentration. Angus steers (n = 32; 309 ± 4.2 kg body weight [BW]) with GeneMax gain scores of 3, 4, or 5 were utilized in a 2 × 2 factorial arrangement (8 steers per treatment). Steers were stagger started (four blocks of eight steers) and stratified by BW within growing diets to one of two Zn strategies (ZNTRT), no supplemental Zn (analyzed 36 mg Zn/kg dry matter [DM]; CON) or supranutritional Zn (CON + 60 mg Zn/kg DM as ZnSO4 + 60 mg Zn/kg DM as Zn–amino acid complex; SUPZN). Dietary fiber strategies (FIBER) were formulated to target two fiber supplementation rates representing high fiber (HF; ~35% neutral detergent fiber [NDF]) or low fiber (LF; ~25% NDF). Within block, steers received HF for 60 d; then pens were randomly assigned to LF or HF for finishing. Steers fed LF were transitioned for 15 d; on day 75, steers were moved to metabolism crates and adapted for 10 d, followed by 5 d of total fecal and urine collection. Retention of Zn, Mn, Fe, Cu, and N were calculated. The model for analysis of metabolism data included the fixed effects of ZNTRT, FIBER, block, and the interaction of ZNTRT × FIBER, with the three-way interaction of ZNTRT × FIBER × block as random. Steer was the experimental unit (n = 8 per treatment combination). Zinc did not affect initial 60-d performance (P ≥ 0.62). DM and organic matter digestibility were lesser (P = 0.02) and N digestibility tended to be lesser (P = 0.07) in CON vs. SUPZN. Intake and digestibility of NDF and acid detergent fiber were greater (P ≤ 0.01) in HF vs. LF. Digestibility and retention of N as a percentage of intake were greater (P ≤ 0.04) whereas N retention as grams per day tended to be greater in HF vs. LF (P = 0.06). Apparent absorption of Zn tended to be greater (P = 0.06) in CON vs. SUPZN. A ZNTRT × FIBER effect was identified for Zn retention (milligrams per day; P = 0.01) where within SUPZN Zn retention was greater in HF vs. LF (P < 0.01). Apparent absorption and retention of Zn were greater (% of intake; P ≤ 0.02) in HF vs. LF. Apparent absorption of Cu, Fe, and Mn was unaffected by ZNTRT or FIBER (P ≥ 0.24). Increasing dietary Zn increased Zn retained regardless of changes in coefficient of absorption. In addition, dietary fiber content may impact trace mineral and N metabolism by steers, potentially due to increased release of these nutrients from feed as fiber digestibility increases. It appears dietary Zn concentrations and diet composition influence trace mineral absorption in beef steers.
A Pilot Study of Oxytocin in Low-Income Women With a Low Birth-Weight Infant
Authors: Garfield Lindsey , Holditch-Davis Diane , Carter C. Sue , McFarlin Barbara L. , Seng Julia S. , Giurgescu Carmen , White-Traut Rosemary
Published: March 2019

Background:

Negative outcomes related to prematurity may lead to maternal distress. Mothers of premature/low birth-weight infants report increased posttraumatic stress (50%) and depressive symptoms (63%) compared with mothers of full-term infants. Low-income, minority mothers with greater posttraumatic stress and depression have an increased risk for premature/low birth-weight delivery compared with their white counterparts. Variations in the neuropeptide oxytocin are implicated in lactation, perinatal depression, and maternal behavior.

Purpose:

To examine the associations among posttraumatic stress, depressive symptoms, and oxytocin in a pilot sample of minority mothers with premature/low birth-weight infants in the neonatal intensive care unit (NICU).

Methods:

This study employed a descriptive, correlational pilot design of 8 minority, low-income mothers with premature/low birth-weight infants. Participants answered questionnaires pertaining to posttraumatic stress, depression, lactation, and demographics and oxytocin was measured. This is a substudy that added oxytocin values.

Results:

Four participants had elevated depressive symptoms and 5 supplied their own milk. Women who provided their own milk had lower depressive (t = 3.03, P = .023) and posttraumatic stress (t = 3.39, P = .015) symptoms compared with women not supplying their own milk. Women with elevated posttraumatic stress had higher levels of depressive symptoms (r
(8) = 0.8, P = .006) and lower levels of oxytocin (r
(8) = 0.77, P = .026).

Implications for Practice:

These results are congruent with previous literature on providing human milk and maternal mental health. In addition, we found a possible relationship between postpartum posttraumatic stress and oxytocin in minority women with premature/low birth-weight infants. NICU nurses should encourage lactation and assess mothers for posttraumatic stress and depressive symptoms.

Implications for Research:

Research is needed to identify the biologic milieu associated with posttraumatic stress and depression in at-risk mothers.
Surgical Outcomes of Prepectoral Versus Subpectoral Implant-based Breast Reconstruction in Young Women
Authors: Manrique Oscar J. , Banuelos Joseph , Abu-Ghname Amjed , Nguyen Minh-Doan , Tran Nho V. , Martinez-Jorge Jorys , Harless Christin , Sharaf Basel , Jakub James W. , Degnim Amy C. , Boughey Judy C. , Jacobson Steven R.
Published: March 2019

Background:

Two-staged implant-based reconstruction (IBR) is the most common breast reconstructive modality. Recently, technological and surgical advances have encouraged surgeons to revisit prepectoral IBR. Data comparing prepectoral against subpectoral IBR in women under the age of 40 are lacking.

Methods:

Retrospective chart review of patients under the age of 40 years old, who underwent immediate 2-staged IBR at our institution, was performed. Patient’s demographics, clinical characteristics, operative details, and early surgical outcomes of prepectoral and subpectoral reconstruction were compared. Data with values of P < 0.05 were considered statistically significant.

Results:

Between 2012 and 2016, 100 patients (187 breasts) who underwent prepectoral and 69 patients (124 breasts) who underwent subpectoral IBR were included. Median follow-up was 17.9 and 17.5 months in the prepectoral and subpectoral groups, respectively. Total number of complications including both stages of reconstruction was 20 (10.7%) and 19 (15.3%) in the prepectoral and subpectoral groups, respectively (P = 0.227). Specific complications, including hematoma, seroma, skin flap necrosis, wound dehiscence, and breast infections, were not significantly different among groups. Ten (5.4%) devices, including implants and tissue expander, required explantation in the prepectoral group and 8 (6.5%) in the subpectoral group (P = 0.683). Explantation was most commonly due to infection (n = 14), and all of them occurred during the first stage (P < 0.001).

Conclusions:

Early complications and implant explantation rates are comparable among prepectoral and subpectoral breast reconstruction in women under 40 years old. Based on these results, we believe that prepectoral IBR is a safe, reliable, and promising reconstructive option.
Toward a More Definitive Goldilocks Mastectomy: Simultaneous Addition of the Lateral Intercostal Perforator Flap
Authors: Schwartz Jean-Claude D.
Published: March 2019

The Goldilocks mastectomy was originally described as a safe technique that allowed for a single-stage autologous reconstruction in the patient who either was a poor candidate or was not interested in traditional multistage postmastectomy reconstructive approaches. This technique involved a skin-sparing mastectomy through Wise incisions and utilized the residual cutaneous flaps to create a breast mound. The final result was often less than optimal with regards to volume as the surgeon was limited by the amount of residual skin and fat that remained after the mastectomy. The best results were obtained in women with ptosis and an elevated body mass index. Here, we improve on these results by combining the Goldilocks mastectomy and the lateral intercostal artery perforator (LICAP) flap to provide a more definitive, autologous, single-stage, reconstructive option after mastectomy. Fourteen consecutive women underwent simultaneous bilateral Goldilocks mastectomy with bilateral LICAP flap augmentation. All patients successfully completed their reconstruction and were healed by 10 weeks postoperatively. The combination of the Goldilocks mastectomy and LICAP flap provides reconstructive surgeons an opportunity to provide a greater proportion of women a more definitive, safe, single-stage autologous reconstructive option after mastectomy.
Nerve Diameter in the Hand: A Cadaveric Study
Authors: Amador Ricardo O. , Westenberg Ritsaart F. , Langhammer Christopher G. , Knaus William J. , Chen Neal C. , Eberlin Kyle R.
Published: March 2019

Background:

Nerve injuries in the hand are common and often pose a challenge for the upper extremity surgeon. A range of reconstructive options exist for nerve repair, but proper matching of nerve diameter is important for many of these techniques. The purposes of this study were to (1) describe the nerve diameters of the hand and their relative differences and (2) investigate whether there is a relationship between nerve diameter and external hand dimensions or body mass index.

Methods:

We utilized 18 freshly frozen cadaveric hands from adult donors aged 20–86 of both sexes for this study. Two independent observers measured each nerve diameter to the nearest 0.1 mm using a digital caliper.

Results:

Using the flexor zones as boundaries, a total of 33 nerve measurements were performed for each cadaveric hand. Nerve diameter increased from the distal to the proximal flexor zones. The internal common digital nerves in flexor zone 3 were larger than the external digital nerves. The median nerve was found to be nearly 2 times larger than the ulnar nerve at 2 locations within the wrist. There was a positive correlation between body mass index, hand span, hand width, and nerve diameter at several measured locations.

Conclusions:

This study provides reference values for nerve diameters of the hand and wrist and describes their relative differences. It is important for surgeons to be aware of these differences and to consider this information as we advance our efforts to reconstruct the hand and develop technologies for nerve repair.
Carpal Malalignment as a Predictor of Delayed Carpal Tunnel Syndrome after Colles’ Fracture
Authors: Watanabe Kentaro , Ota Hideyuki
Published: March 2019

Background:

The present study aimed to clarify whether carpal malalignment associated with distal radius malunion after Colles’ fracture is involved in the onset of delayed carpal tunnel syndrome (DCTS) in elderly women.

Methods:

This retrospective case–control study was conducted in 40 female patients with Colles’ fracture treated with a cast, including 10 patients (mean age, 71.6 years) who developed DCTS from 6 weeks to 6 months after injury (DCTS group) and 30 patients (mean age, 73.4 years) without DCTS (control group). Radiological parameters, including the radiocapitate distance (RCD), volar prominence height (VPH), and volar tilt (VT) were measured. Relationships between the RCD and both the VPH and VT were examined, and the involvement of the RCD in the onset of DCTS was analyzed.

Results:

The RCD showed strong correlations with both the VPH and VT. The mean RCD was significantly lower in the DCTS group than in the control group (−12.8 mm versus −8.4 mm). Logistic regression analysis showed involvement of the RCD in the onset of DCTS, and the threshold value according to receiver operating characteristic curve analysis was −9.9 mm, with an odds ratio of 21.

Conclusions:

Dorsal displacement of the capitate due to Colles’ fracture malunion is involved in DCTS accompanied with anatomical alteration of the carpal tunnel. When the center of the head of the capitate is located more than 1 cm dorsally behind the volar cortical line of the radius, careful follow-up should be performed as DCTS may occur within 6 months after injury.
The Influence of Aerosol Density and Shape Factor on the Assessment of Internal Exposure to 239Pu
Authors: Zhang Bin , Sheng Wei , Xu Ming , Zhang Yang , Lei Jie-Ying , Ma Huai-Cheng
Published: March 2019

Internal exposure due to inhalation of aerosols depends on the ratio of aerodynamic shape factor (χ) to aerosol mass density (ρ). Inhaled aerosol parameters may differ from the default ρ and χ values provided by the International Commission on Radiological Protection, which are adopted for the assessment of internal exposures. This paper focuses on the influences of χ/ρ on the assessment of internal exposure to 239Pu for reference workers. Regional deposition fractions are found to decrease with increasing χ/ρ, and larger decreases are observed with smaller activity median aerodynamic diameter aerosols, while the slow clearance fractions (f
s) in the tracheobronchial region are more sensitive for larger activity median aerodynamic diameter aerosols. Results from biokinetics calculations reveal that both the time-dependent content (excretion) and cumulative activities are determined mainly for particles initially deposited in the alveolar-interstitial region, while f
s affects the local cumulative activities in the tracheobronchial region. χ/ρ is proven to have different influences for aerosols with different activity median aerodynamic diameters. The default χ/ρ values can be used when activity median aerodynamic diameters are greater than 1 μm, while one should pay attention to the value of χ/ρ when activity median aerodynamic diameters are less than 1 μm, where significant influence may be anticipated.
Innovation in Flow Cytometry Analysis: A New Paradigm Delineating Normal or Diseased Bone Marrow Subsets Through Machine Learning
Authors: Lacombe Francis , Dupont Benoît , Lechevalier Nicolas , Vial Jean Philippe , Béné Marie C.
Published: March 2019

Supplemental Digital Content is available in the text
CAR‐T Cell Therapy in Diffuse Large B Cell Lymphoma: Hype and Hope
Authors: Hopfinger Georg , Jäger Ulrich , Worel Nina
Published: March 2019

Patients with non‐Hodgkin lymphomas (NHLs) resistant to standard therapies have a dismal prognosis. The outcome is even poorer in patients relapsing after autologous stem cell transplantation. Most of these patients do not qualify for an allogeneic hematopoietic cell transplantation (HCT) due to refractory disease, lack of a suitable allogeneic donor, higher age, or cumulative toxicity of previous chemotherapy. Despite patients undergoing allogeneic HCT normally profit from a graft‐versus‐lymphoma effect, overall survival in patients with NHL after HCT remains short. Therefore, novel treatment modalities are urgently needed. Chimeric antigen receptor (CAR)‐T cells, a new class of cellular immunotherapy involving ex vivo genetic modification of T cells to incorporate an engineered CAR have been used in clinical trials. In the majority of studies, B cell malignancies treated with CD19 targeting CAR‐T cells have been analyzed.

Recently, results from 2 CD19 directed CAR‐T cell trials with an increased follow‐up of patients led to Food and Drug Administration and European Medicines Agency approval of tisagenlecleucel and axicabtagene ciloleucel. Common adverse events (AEs) include cytokine release syndrome and neurological toxicity, which may require admission to an intensive care unit, B cell aplasia and hemophagocytic lymphohistiocytosis. These AEs are manageable when treated by an appropriately trained team following established algorithm. In this review, we summarize the results of 3 large phase II CD19 CAR‐T cell trials and focus on AEs. We also provide a perspective of ongoing activity in this field with the intend to improve the potency of this emerging novel therapy.
Analysis of Spontaneous Eyelid Blink Dynamics Using a 240 Frames per Second Smartphone Camera
Authors: Godfrey Kyle J. , Wilsen Craig , Satterfield Kellie , Korn Bobby S. , Kikkawa Don O.
Published: March 2019

Purpose:

To report initial results using a native 240 frames per second smartphone camera for 2-dimensional videographic analysis of eyelid dynamics during spontaneous blinking.

Methods:

Spontaneous blinking was prospectively recorded in volunteers using a smartphone camera recording at 240 frames per second in 720p. A standardized recording setup was used in which the smartphone was mounted on a tripod stand at 0.5 m in the Frankfort horizontal plane. Subjects viewed a nature documentary video in primary gaze while their spontaneous blinking was recorded for 3 minutes. Exclusion criteria included known eyelid malposition or ocular surface pathology, including dry eye syndrome, contact lens use, prior eyelid or intraocular surgery, prior periocular trauma, or craniofacial abnormality. Primary outcome measures were spontaneous interblink interval, blink rate in blinks per minute, percentage of incomplete blinks, and blink velocity.

Results:

The authors studied 10 subjects, 5 men and 5 women. Average age was 34 (range 19–58). Mean interblink interval was found to be 7.4 seconds (SD: 5.2, range: 1.9–17.6), corresponding to a mean blink rate of 13 blinks per minute (SD: 7.8, range: 3.4–32.0). Mean percentage of incomplete blinks was 49.8% (SD: 33.3, range: 0–100). Mean blink closure velocity was 93 mm/seconds (SD: 31, range: 40–160). These numbers are consistent with previously published results of spontaneous eyelid blink parameters.

Conclusions:

This study demonstrates that 240 frames per second videography native to modern smartphone cameras captures anatomic detail and blink dynamics with sufficient resolution and clarity to provide objective clinical information about spontaneous eyelid blink rate, dynamics, and function.
The Flip-Back Myocutaneous Advancement Flap for Periocular Reconstruction
Authors: Ko Marcus J. , Erickson Benjamin P. , Blessing Nathan W. , Tse David T.
Published: March 2019

The flip-back myocutaneous flap offers a novel alternative to skin grafting or more extensive cheek rotational flaps for reconstruction of challenging anterior lamellar defects involving the eyelids and adjacent periocular tissues.

Purpose:

To present a novel myocutaneous flap for anterior lamellar reconstruction.

Methods:

Retrospective interventional case series of consecutive patients who underwent Mohs reconstruction using the flip-back flap. Operations were performed by a single surgeon (DTT) between January 2012 and May 2016. For lower eyelid defects, an extended subciliary incision was made and a skin-muscle flap developed and suspended in the manner of lower eyelid blepharoplasty. A back-cut was used to develop a pedicle from the overlapping tissue, which was then rotated 180 degrees into the defect. A similar method was employed in an inverted manner for upper eyelid defects. Postoperative eyelid function, cosmesis, complications, and need for further interventions were assessed.

Results:

Ten patients—8 with lower and 2 with upper eyelid defects—were reconstructed using this method. Mean follow up was 18.3 ± 15.5 months with a minimum interval of 4 months. Despite the 180-degree rotation of a relatively narrow pedicle, none of the patients experienced flap necrosis. Postoperative function and cosmesis was satisfactory, with no tissue puckering, notching, or symptomatic retraction. No antimetabolite/steroid injection or surgical revision was required.

Conclusions:

The flip-back flap expands the armamentarium of the periocular reconstructive surgeon. Its particular forte is in addressing broad and relatively shallow anterior lamellar defects where sufficient tissues are not available for transposition via a uni- or bipedicle flap. By leveraging the robust periocular vascular plexus and defying traditional guidelines governing pedicle formation and rotation, it permits creation of a local flap in cases where skin grafts or extensive Mustarde-style flaps might otherwise be required.
Pediatric Prehospital Intraosseous Access During Combat Operations in Iraq and Afghanistan
Authors: Schauer Steven G. , Ng Patrick C. , April Michael D. , Hill Guyon J. , Arana Allyson A. , Bebarta Vikhyat S.
Published: March 2019

Background

Vascular access in critically ill pediatric patients can be challenging with delays potentially leading to worse outcomes. Intraosseous (IO) access has a low rate of complications and can be utilized to administer lifesaving medications. Combat medics are trained to treat adults but may also be required to treat children in the deployed setting. Vascular access in children can be challenging, especially in a hypovolemic state. There are limited data on prehospital lifesaving interventions in children in the combat setting. We sought to characterize the use of IO access in pediatric patients who sustained trauma in the combat setting.

Methods

We queried the Department of Defense Trauma Registry for all pediatric patients admitted to fixed-facilities and forward surgical teams in Iraq and Afghanistan from January 2007 to January 2016. Within that population, we searched for all subjects with a documented prehospital IO or intravenous (IV) access obtained. Subjects with both an IO and IV documented were placed into the IO category. We separated subjects by age groupings: younger than 1, 1 to 4, 5 to 9, 10 to 14, and 15 to 17 years.

Results

During the study period, there were 3439 subjects 17 years or younger. There were 177 in the IO cohort and 803 in the IV cohort. Most subjects in the IO cohort were in the 10- to 14-year-old age group (35.6%), male (79.1%), located in Afghanistan (95.5%), and injured by explosive (52.0%), with lower survival rates than the IV cohort (68.9% vs 90.7%, P < 0.001). Hemostatic dressing application, tourniquet application, intubation, cardiopulmonary resuscitation, sedative administration, ketamine administration, and paralytic administration were all higher in the IO cohort.

Conclusions

Pediatric IO placement in the prehospital setting occurred infrequently. Pediatric subjects receiving an IO had higher injury severity scores and higher mortality rates compared with those who received an IV only. Intraosseous use appears to be used more often in critically ill pediatric subjects.
Early Intervention and Postural Adjustments During Reaching in Infants at Risk of Cerebral Palsy
Authors: van Balen Lieke C. , Dijkstra Linze-Jaap , Dirks Tineke , Bos Arend F. , Hadders-Algra Mijna
Published: March 2019

Purpose:

To investigate postural effects of the family-centered program, COPing with and CAring for infants with special needs (COPCA), applied at 3 to 6 months' corrected age in infants at high risk of cerebral palsy. Previously, we reported postural differences between the infants at risk of CP in the control group of the current study and a group of infants developing typically. Now we focus on differences between 2 intervention groups.

Methods:

We explored postural adjustments during reaching in seated infants at 4, 6, and 18 months using surface electromyography of arm, neck, and trunk muscles. Infants randomly received the family-centered program or another infant physical therapy. Using videotaped intervention sessions, we investigated correlations between time spent on specific physical therapeutic actions and direction specificity, recruitment order, and anticipatory activation at 18 months.

Results:

Postural adjustments in both groups were similar, but development of direction specificity and anticipatory activation in COPCA infants better mimicked typical development. These 2 parameters were associated with COPCA-type physical therapeutic actions.

Conclusions:

Postural control was similar after both interventions. Positive outcomes were associated with fewer intervening actions of the therapist and greater allowance of spontaneous movements.
Physical Therapy Outcome Measures for Assessment of Lower Extremity Chronic Pain-Related Function in Pediatrics
Authors: Mirek Elizabeth , Logan Deirdre , Boullard Kimberly , Hall Amber M. , Staffa Steven J. , Sethna Navil
Published: March 2019

Purpose:

To assess the clinical utility of 5 physical therapy (PT) outcome measures in quantifying functional changes in pediatric lower extremity chronic pain treated at a hospital-based interdisciplinary rehabilitation center.

Design:

This was a cross-sectional study with retrospective review of 173 individuals, 8 to 18 years old, treated from June 2008 to 2013.

Methods:

The measures used were the Timed Up and Go, Timed Up and Down Stairs, Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, 6-minute walk test, and Lower Extremity Functional Scale. Participant performance was correlated with demographic characteristics, the Functional Disability Index, Multidimensional Anxiety Scale for Children, Child Depression Inventory, and Canadian Occupational Performance Measure.

Results:

Scores from all 5 PT measures showed significant improvement following treatment. Functional Disability Index correlated to every PT measure except the 6-minute walk test.

Conclusions:

This study supports the clinical use of these PT measures to track functional progress after rehabilitative treatment of lower extremity chronic pain-related disability.
Daily and Weekly Rehabilitation Delivery for Young Children With Gross Motor Delay: A Randomized Clinical Trial Protocol (the DRIVE Study)
Authors: Ferrante Rachel , Hendershot Sarah , Baranet Kathy , Barbosa Gardenia , Carey Helen , Maitre Nathalie , Lo Warren , Pan Jeff , Heathcock Jill
Published: March 2019

Purpose:

The proposed project tests the principle that frequency of rehabilitation is an important regulator of therapeutic response in infants.

Methods:

We will randomize 75 infants with cerebral palsy, 6 to 24 months of age and/or Gross Motor Function Classification System levels III to V (higher severity), to determine the short-term and long-term effects of 3 dosing protocols consisting of an identical number of 2-hour sessions of the same motor learning-based therapy applied over a different total number of calendar weeks.

Results and Conclusions:

The results will inform clinicians, families, and scientists about dosing and will provide needed recommendations for frequency of rehabilitation to optimize motor function and development of young children with cerebral palsy.
Goal Attainment Scaling Made Easy With an App: GOALed
Authors: Gaffney Erin , Gaffney Kevin , Bartleson Lori , Dodds Cindy
Published: March 2019

Pediatric physical therapists use Goal Attainment Scaling (GAS) in a variety of clinical settings to objectively measure change in individual-, patient- and family-centered goals. Creating, recording, storing, scoring, and interpreting GAS goals have been manually completed. Recently developed GOALed, a GAS app, provides an improved, streamlined approach. The purpose of this special communication is to introduce the GOALed app and demonstrate its use with a case example.
Examination and Management of a 4-Year-Old Following a Femoral Aneurysmal Bone Cyst: A Case Report
Authors: Kirker Kaitlin , Masaracchio Michael , Freeland Megan
Published: March 2019

Purpose:

The literature lacks recommendations for postoperative rehabilitation following removal of aneurysmal bone cysts (ABCs). This case report describes the rehabilitation with return to age-appropriate functional activities for a 4-year-old following surgical fixation of a femoral ABC, with emphasis on clinical decision-making in the absence of definitive treatment algorithms.

Summary of Key Points:

The child improved in range of motion, strength, balance, transfers, gait, stair negotiation, and percentile rank on the Test of Gross Motor Development 2.

Conclusion:

This case is successful outcomes of a 4-year-old girl (GP) following surgical fixation for an ABC.

Recommendations for Clinical Practice:

This case fills a current void in the literature emphasizing clinical decision-making and attainment of GP-specific functional goals. A goal-driven approach incorporating key elements of the International Classification of Function model resulted in successful return to age-appropriate activity following surgical fixation of a femoral fracture due to an ABC.
Hospital Surveys by the Centers for Medicare and Medicaid Services: An Analysis of More Than 34,000 Deficiencies
Authors: Antognini Joseph F.
Published: March 2019

Objectives

The aims of the study were to analyze hospital deficiencies reported by the Centers for Medicare and Medicaid Services (CMS) for a 10-year period (2007–2017) and thereby determine the specific conditions of participation (CoP) cited in each deficiency.

Methods

Deficiency data from the CMS Web site was downloaded and analyzed. A determination was made regarding the CoP assigned to each deficiency. In addition, deficiencies were analyzed according to the presence or absence of an immediate jeopardy (the most serious potential risk) and whether there was state-to-state variation.

Results

A total of 30,808 of 34,522 deficiencies were assigned specific “tags” related to a COP, with 77% of the A tags assigned to the following six CoP: patient rights, nursing services, quality improvement, medical records, governing body, and emergency services. Immediate jeopardy was assigned in 730 tags, and a patient death was more likely to be associated with the determination of immediate jeopardy; actual patient deaths were associated with 21% of surveys that resulted in immediate jeopardy. Survey rates varied state-to-state; 14.3 surveys per 1 million population at the 80th percentile and 6.0 surveys per million at the 20th percentile, respectively. Utah and Vermont had the least (1.7) and greatest (70.3) rates, respectively, a 41-fold difference.

Conclusions

These data indicate that (a) hospital surveys result in most deficiencies being assigned to a subset of CoP; (b) a patient death is more likely to be associated with a finding of immediate jeopardy, and (c) there is significant state-to-state variation in survey rates.
Care Coordination for Patients on Chronic Opioid Therapy Following Surgery
Authors: Lagisetty Pooja , Bohnert Amy , Goesling Jenna , Hu Hsou Mei , Travis Breanna , Lagisetty Kiran , Brummett Chad M. , Englesbe Michael J. , Waljee Jennifer
Published: March 2019

Objective:

To describe if patients with chronic opioid use with a consistent usual prescriber (UP) prior to surgery and if early return to that UP (<30 d) would be associated with fewer high risk prescribing events in the postoperative period.

Summary Background Data:

Over 10 million people each year are prescribed opioids for chronic pain. There is little evidence regarding coordination of opioid management and best practices for patients on long-term opioid therapy patients following surgery.

Methods:

The study design is a retrospective cohort study. We identified 5749 commercially insured patients aged 18 to 64 with chronic opioid use who underwent elective surgery between January 2008 and March 2015. The predictors were presence of a UP and early return (<30 d from surgery) to a UP. The primary outcome was new high-risk opioid prescribing in the 90-day postoperative period (multiple prescribers, overlapping opioid and/or benzodiazepine prescriptions, new long acting opioid prescriptions, or new dose escalations to > 100 mg OME).

Results:

In this cohort, 73.8% of patients were exposed to high risk prescribing postoperatively. Overall, 10% of patients did not have a UP preoperatively, and were more likely to have prescriptions from multiple prescribers (OR 2.23 95% CI 1.75–2.83) and new long acting opioid prescriptions (OR 1.69, 95% CI 1.05–2.71). Among patients with a UP, earlier return was associated with decreased odds of receiving prescriptions from multiple prescribers (OR 0.80, 95% CI 0.68–0.95).

Conclusion:

Patients without a UP prior to surgery are more likely to be exposed to high-risk opioid prescribing following surgery. Among patients who have a UP, early return visits may enhance care coordination with fewer prescribers.
Prior Resection of the Primary Tumor Prolongs Survival After Peptide Receptor Radionuclide Therapy of Advanced Neuroendocrine Neoplasms
Authors: Kaemmerer Daniel , Twrznik Matthias , Kulkarni Harshad R. , Hörsch Dieter , Sehner Susanne , Baum Richard P. , Hommann Merten
Published: March 2019

Objective:

The aim of the study was to compare impact on survival after resection of primary tumors (PTs) after peptide receptor radionuclide therapy (PRRT).

Background:

PRRT is a highly effective therapeutic option to treat locally advanced or metastatic neuroendocrine neoplasms (NENs).

Methods:

We retrospectively analyzed the data of 889 patients with advanced NEN (G1-G3, stage IV) treated with at least 1 cycle of PRRT. In 486 of 889 patients (55%, group 1), PT had been removed before PRRT. Group 2 constituted 403 patients (45%) with no prior PT resection. Progression-free survival (PFS) and overall survival (OS) was determined by 68Ga SSTR-PET/CT in all patients applying RECIST and EORTC.

Results:

Most patients had their PT in pancreas (n = 335; 38%) and small intestine (n = 284; 32%). Both groups received a mean of 4 cycles of PRRT (P = 0.835) with a mean cumulative administered radioactivity of 21.6 ± 11.7 versus 22.2 ± 11.2 GBq (P = 0.407). Median OS in group 1 was 134.0 months [confidence interval (CI): 118–147], whereas OS in group 2 was 67.0 months (CI: 60–80; hazard ratio 2.79); P < 0.001. Likewise, the median progression-free survival after first PRRT was longer in group 1 with 18.0 (CI: 15–20) months as compared to group 2 with 14.0 (CI: 15–18; hazard ratio 1.21) months; P = 0.012.

Conclusions:

A previous resection of the PT before PRRT provides a significant survival benefit in patients with NENs stage IV.
The American College of Surgeons Entering Resident Readiness Assessment Program
Authors: Sullivan Maura E. , Park Yoon Soo , Liscum Kathy , Sachdeva Ajit K. , Blair Patrice Gabler , Gesbeck Melissa , Bordage Georges
Published: March 2019

Objective:

To assess the readiness of entering residents for clinical responsibilities, the American College of Surgeons (ACS) Division of Education developed the “Entering Resident Readiness Assessment” (ACS-ERRA) Program.

Summary Background:

ACS-ERRA is an online formative assessment that uses a key features approach to measure clinical decision-making skills and focuses on cases encountered at the beginning of residency. Results can be used to develop learning plans to address areas that may need reinforcement.

Methods:

A national panel of 16 content experts, 3 medical educators, and a psychometrician developed 98 short, key features cases. Each case required medical knowledge to be applied appropriately at challenging decision points during case management. Four pilot testing studies were conducted sequentially to gather validity evidence.

Results:

Residents from programs across the United States participated in the studies (n = 58, 20, 87, 154, respectively). Results from the pilot studies enabled improvements after each pilot test. For the psychometric pilot (final pilot test), 2 parallel test forms of the ACS-ERRA were administered, each containing 40 cases, resulting in overall mean testing time of 2 hours 2 minutes (SD = 43 min). The mean test score was 61% (SD = 9%) and the G-coefficient reliability was 0.90.

Conclusions:

Results can be used to identify strengths and weaknesses in residents’ decision-making skills and yield valuable information to create individualized learning plans. The data can also support efforts directed at the transition into residency training and inform discussions about levels of supervision. In addition, surgery program directors can use the aggregate test results to make curricular changes.
Conspecific sperm precedence is reinforced, but postcopulatory sexual selection weakened, in sympatric populations ofDrosophila
Authors: Castillo Dean M. , Moyle Leonie C.
Published: March 2019

Sexual selection can accelerate speciation by driving the evolution of reproductive isolation, but forces driving speciation could also reciprocally feedback on sexual selection. This might be particularly important in the context of ‘reinforcement’, where selection acts directly to increase prezygotic barriers to reduce the cost of heterospecific matings. Using assays of sperm competition within and between two sister species, we show a signature of reinforcement where these species interact: populations ofDrosophila pseudoobscurathat co-occur with sister speciesD. persimilishave an elevated ability to outcompete heterospecific sperm, consistent with selection for increased postcopulatory isolation. We also find theseD. pseudoobscurapopulations have decreased sperm competitive ability against conspecifics, reducing the opportunity for sexual selection within these populations. Our findings demonstrate that direct selection to increase reproductive isolation against other species can compromise the efficacy of sexual selection within species, a collateral effect of reproductive traits responding to heterospecific interactions.
Long-term trends in wild-capture and population dynamics point to an uncertain future for captive elephants
Authors: Jackson John , Childs Dylan Z. , Mar Khyne U. , Htut Win , Lummaa Virpi
Published: March 2019

Maintaining sustainable populations in captivity without supplementation through wild-capture is a major challenge in conservation that zoos and aquaria are working towards. However, the capture of wild animals continues for many purposes where conservation is not the primary focus. Wild-capture hinders long-term conservation goals by reducing remaining wild populations, but the direct and long-term indirect consequences of wild-capture for captive population viability are rarely addressed using longitudinal data. We explored the implications of changes in wild-capture on population dynamics in captivity over 54 years using a multi-generational studbook of working Asian elephants (Elephas maximus) from Myanmar, the largest remaining captive elephant population. Here we show that population growth and birth rates declined between 1960 and 2014 with declines in wild-capture. Importantly, wild-caught females had reduced birth rates and a higher mortality risk. However, despite the disadvantages of wild-capture, the population may not be sustainable without it, with immediate declines owing to an unstable age-structure that may last for 50 years. Our results highlight the need to assess the long-term demographic consequences of wild-capture to ensure the sustainability of captive and wild populations as species are increasingly managed and conserved in altered or novel environments.
In silicodesign of glyco-D,L-peptide antiviral molecules
Authors: Agostini Luigi , Morosetti Stefano
Published: March 2019

Background

most licensed antiviral drugs are nucleoside analogs. A recent research focuses on blocking a virus from entering the cells in the viral cell adsorption/entry stage. In this entry mechanism the glycans present on the viral surface play a fundamental role. Homochiral L-peptides acting this fusion mechanism have shown some inhibition of viral infection. Peptides with regularly alternating enantiomeric sequence (L,D-peptides) can assume structures, which are not accessible to the corresponding homochiral molecules. Further, L,D-peptides are less sensitive to the enzymatic digestion.

Aim

in silicodesign a L,D-peptide with a high affinity for the viral surface glycans, and consequently able to interfere with its fusion mechanism.

Methods

a 3α,6α-Mannopentaose (3-6MP) molecule was used to simulate a viral surface glycan. Molecular Dynamics (MD) simulations of 3-6MP and D,L-peptide in water are performed using the force field AMBER12-GLYCAM06i. The binding constant was evaluated from trajectories. The D,L-peptide molecule was modified over the sequence, the length, the terminals and finally glycosylated to attain a very high binding constant value for 3-6MP.

In addition, the specific interaction between T lymphocyte CD4 glycoprotein and HIV envelope gp120 glycoprotein was studied through MD simulations between a D,L-peptide, bounded to a typical CD4 glycan, and a highly conserved HIV gp120 glycan.

Results

in the case of interaction with 3-6MP molecule, the very effective molecule obtained was H-D-Trp-L-Pro-D-Asn-L-Pro-D-Trp-L-Pro-D-Asn-L-Pro-OH where the Asn residues in position 3 and 7 are glycosylated with alpha-D-Mannopyranosyl-(1->3)-[alpha-D-mannopyranosyl-(1->6)]-alpha-D-mannopyranosyl-(1->4)-N-acetyl-beta-D-glucopyranosyl-(1->4)-N-acetyl-beta-D-glucopyranosyl-1-OH.

In the case of interaction with HIV envelope, the very effective molecule obtained, able to antagonize the CD4 glycoprotein, was H-D-Trp-L-Pro-D-Asn-L-Pro-D-Trp-L-Pro-D-Asn-L-Pro-OH where the Asn residue in position 3 is glycosylated with alpha-D-galactopyranosyl-(1->4)-N-acetyl-beta-D-glucopyranosyl-(1->2)-alpha-D-Mannopyranosyl-(1->3)-[alpha-D-galactopyranosyl-(1->4)-N-acetyl-beta-D-glucopyranosyl-(1->2)-alpha-D-Mannopyranosyl-(1->6)]-beta-D-mannopyranosyl-(1->4)-N-acetyl-beta-D-glucopyranosyl-(1->4)-N-acetyl-beta-D-glucopyranosyl-1-OH

Conclusion

these glycosylated D,L-peptide molecules are very promising representatives of a new class of antiviral agents.
Impairment but not abolishment of express saccades after unilateral- or bilateral cryogenic FEF inactivation
Authors: Dash Suryadeep , Peel Tyler R. , Lomber Stephen G. , Corneil Brian D.
Published: March 2019

Express saccades (ESs) are a manifestation of a visual grasp reflex triggered when visual information arrives in the intermediate layers of the superior colliculus (SCi), which in turn orchestrates the lower level brainstem saccade generator to evoke a saccade with a very short latency (∼100ms). A prominent theory regarding express saccades generation is that they are facilitated by preparatory signals, presumably from cortical areas, which prime the SCi prior to the arrival of visual information. Here, we test this theory by reversibly inactivating a key cortical input to the SCi, the frontal eye fields (FEF), while monkeys perform an oculomotor task that promotes ES generation. Across three tasks with a different combination of potential target locations and uni- or bilateral FEF inactivation, we found a spared ability for monkeys to generate ESs, despite decreases in ES frequency during FEF inactivation. This result is consistent with the FEF having a facilitatory but not critical role in ES generation, likely because other cortical areas compensate for the loss of preparatory input to the SCi. However, we did find decreases in the accuracy and peak velocity of ESs generated during FEF inactivation, which argues for an influence of the FEF on the saccadic burst generator even during ESs. Overall, our results shed further light on the role of the FEF in the shortest-latency visually-guided eye movements.

New & Noteworthy

Express saccades (ESs) are the shortest-latency visually-guided saccade. The frontal eye fields (FEF) is thought to promote ES by establishing the necessary preconditions in the superior colliculus. Here, by reversibly inactivate the FEF either unilaterally or bilaterally, we support this view by showing that the FEF plays an assistive but not critical role in ES generation. We also found that FEF inactivation lowered ES peak velocity, emphasizing a contribution of the FEF to ES kinematics.
Noise in neurons and synapses enables reliable associative memory storage in local cortical circuits
Authors: Zhang Chi , Zhang Danke , Stepanyants Armen
Published: March 2019

Neural networks in the brain can function reliably despite various sources of errors and noise present at every step of signal transmission. These sources include errors in the presynaptic inputs to the neurons, noise in synaptic transmission, and fluctuations in the neurons’ postsynaptic potentials. Collectively they lead to errors in the neurons’ outputs which are, in turn, injected into the network. Does unreliable network activity hinder fundamental functions of the brain, such as learning and memory retrieval? To explore this question, this article examines the effects of errors and noise on properties of biologically constrained networks of inhibitory and excitatory neurons involved in associative sequence learning. The associative learning problem is solved analytically and numerically, and it is also shown how memory sequences can be loaded into the network with a more biologically plausible perceptron-type learning rule. Interestingly, the results reveal that errors and noise during learning increase the probability of memory recall. There is a tradeoff between the capacity and reliability of stored memories, and, noise during learning is required for optimal retrieval of stored information. What is more, networks loaded with associative memories to capacity display many structural and dynamical features observed in local cortical circuits. Due to the similarities between the associative and brain networks, this article predicts that the connections originating from unreliable inhibitory and excitatory neurons or neuron classes in the cortex must be depressed or eliminated during learning, while the connections onto noisy neurons or neuron classes must have lower probabilities and higher weights.
Tracking human population structure through time from whole genome sequences
Authors: Wang Ke , Mathieson Iain , O’Connell Jared , Schiffels Stephan
Published: March 2019

The genetic diversity of humans, like many species, has been shaped by a complex pattern of population separations followed by isolation and subsequent admixture. This pattern, reaching at least as far back as the appearance of our species in the paleontological record, has left its traces in our genomes. Reconstructing a population’s history from these traces is a challenging problem. Here we present a novel approach based on the Multiple Sequentially Markovian Coalescent (MSMC) to analyse the population separation history. Our approach, called MSMC-IM, uses an improved implementation of the MSMC (MSMC2) to estimate coalescence rates within and across pairs of populations, and then fits a continuous Isolation-Migration model to these rates to obtain a time-dependent estimate of gene flow. We show, using simulations, that our method can identify complex demographic scenarios involving post-split admixture or archaic introgression. We apply MSMC-IM to whole genome sequences from 15 worldwide populations, tracking the process of human genetic diversification. We detect traces of extremely deep ancestry between some African populations, with around 1% of ancestry dating to divergences older than a million years ago.

Author Summary

Human demographic history is reflected in specific patterns of shared mutations between the genomes from different populations. Here we aim to unravel this pattern to infer population structure through time with a new approach, called MSMC-IM. Based on estimates of coalescence rates within and across populations, MSMC-IM fits a time-dependent migration model to the pairwise rate of coalescences. We implemented this approach as an extension to existing software (MSMC2), and tested it with simulations exhibiting different histories of admixture and gene flow. We then applied it to the genomes from 15 worldwide populations to reveal their pairwise separation history ranging from a few thousand up to several million years ago. Among other results, we find evidence for remarkably deep population structure in some African population pairs, suggesting that deep ancestry dating to one million years ago and older is still present in human populations in small amounts today.