bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-Ablation Cavity Evaluation: A Prospective Multicenter Observational Clinical Study to Evaluate Hysteroscopic Access to the Uterine Cavity 4 Years After Water Vapor Endometrial Ablation for the Treatment of Heavy Menstrual Bleeding
Authors: Johns D. Alan , Garza-Leal Jose G. , Diamond Michael P. , Harris Micah
Published: January 2021

(Abstracted from J Minim Invasive Gynecol 2020;27:1273–1280)

A minimally invasive treatment for heavy menstrual bleeding (HMB) due to benign causes in women who have completed childbearing is endometrial ablation (EA). Intracavity scarring following EA may result in recurrent heavy bleeding, cyclic pelvic pain with or without bleeding, and postmenopausal bleeding, often manifesting many years after the original treatment.
Immunotherapy in Triple-Negative Breast Cancer
Authors: Emens Leisha A.
Published: January 2021

Triple-negative breast cancer (TNBC) is an aggressive subtype of mammary carcinoma. A subset of TNBC is immune activated, suggesting that immunotherapy may be a viable treatment strategy. Phase III clinical trials have shown that atezolizumab or pembrolizumab is well-tolerated in combination with chemotherapy, with progression-free survival benefit in metastatic programmed death ligand-1 (PD-L1)–positive TNBC patients treated first line. Based on IMpassion130, the combination of atezolizumab and nab-paclitaxel is now considered a standard of care for the treatment of PD-L1–positive advanced TNBC. In early TNBC, pembrolizumab and atezolizumab have been tested in combination with standard neoadjuvant chemotherapy, resulting in a higher complete pathologic response rate than standard neoadjuvant chemotherapy alone, regardless of disease PD-L1 status. These findings establish proof of principle for immunotherapy in both early and advanced TNBC. High priorities for the field include developing more active immunotherapy combination regimens and more refined biomarkers that optimally identify patients most likely to benefit from immunotherapy.
Pneumonia in older adults
Authors: Furman Christian Davis , Leinenbach Angela , Usher Ronnita , Elikkottil Jaseena , Arnold Forest W.
Published: January 2021

Purpose of review

The purpose of this review is to address the relevant issues surrounding older adults with community-acquired pneumonia (CAP) today.

Recent findings

Approximately 1 million people >65 years have CAP in the US per year, which is more than previously reported (or realized). Older adults are vulnerable to the increasing prevalence of viral CAP, as the SARS-CoV-2 pandemic emphasizes, but pneumococcus is still the most common pathogen to cause CAP. Racial disparities continue to need to be addressed in order to improve early and late outcomes of older adults with CAP.

The epidemiology of CAP, specifically for older adults is changing. More recent pathogen incidence studies have included culture, as well as newer microbiological methods to determine etiology. Current disparities among disadvantaged populations, including African-Americans, result in more comorbidities which predisposes to more severe CAP. However, outcomes in the hospital between races tend to be similar, and outcomes between age groups tends to be worse for older compared to younger adults. Finally, the cost of CAP is significant compared to diabetes mellitus, myocardial infarction and stroke.
Comparison of Radiomics Analyses Based on Different Magnetic Resonance Imaging Sequences in Grading and Molecular Genomic Typing of Glioma
Authors: Huang Wei-yuan , Wen Ling-hua , Wu Gang , Hu Ming-zheng , Zhang Chao-cai , Chen Feng , Zhao Jian-nong
Published: January 2021

Objective

To investigate the value of radiomics analyses based on different magnetic resonance (MR) sequences in the noninvasive evaluation of glioma characteristics for the differentiation of low-grade glioma versus high-grade glioma, isocitrate dehydrogenase (IDH)1 mutation versus IDH1 wild-type, and mutation status and 6-methylguanine-DNA methyltransferase (MGMT) promoter methylation (+) versus MGMT promoter methylation (−) glioma.

Methods

Fifty-nine patients with untreated glioma who underwent a standard 3T-MR tumor protocol were included in the study. A total of 396 radiomics features were extracted from the MR images, with the manually delineated tumor as the volume of interest. Clinical imaging diagnostic features (tumor location, necrosis/cyst change, crossing midline, and the degree of enhancement or peritumoral edema) were analyzed by univariate logistic regression to select independent clinical factors. Radiomics and combined clinical-radiomics models were established for grading and molecular genomic typing of glioma by multiple logistic regression and cross-validation. The performance of the models based on different sequences was evaluated by using receiver operating characteristic curves, nomograms, and decision curves.

Results

The radiomics model based on T1-CE performed better than models based on other sequences in predicting the tumor grade and the IDH1 status of the glioma. The radiomics model based on T2 performed better than models based on other sequences in predicting the MGMT methylation status of glioma. Only the T1 combined clinical-radiomics model showed improved prediction performance in predicting tumor grade and the IDH1 status.

Conclusions

The results demonstrate that state-of-the-art radiomics analysis methods based on multiparametric MR image data and radiomics features can significantly contribute to pretreatment glioma grading and molecular subtype classification.
Risk of Pneumothorax With Internal Mammary Vessel Utilization in Autologous Breast Reconstruction
Authors: Kelling Joseph A. , Meade Anna , Adkins Morgan , Zhang Andrew Y.
Published: January 2021

Background

Complications associated with autologous breast reconstruction are well reported in the literature. Regardless of the type of free flap harvested, the anastomosis is most commonly performed to the recipient internal mammary vessels. Although pneumothorax is a known possible complication of breast surgery, incidence of pneumothorax in breast reconstruction involving the use of the internal mammary vessels is rarely discussed. The aim of our study was to determine the incidence of pneumothorax in deep inferior epigastric perforator (DIEP) flap breast reconstruction.

Methods

A single-institution review was performed examining the incidence of pneumothorax in cases of DIEP flap breast reconstruction with anastomosis to the internal mammary vessels over a 4-year period. Intraoperative irrigation was used to visually assess for evidence of pneumothorax during recipient vessel dissection and anastomosis. Anteroposterior chest radiographs were obtained on the first postoperative day to assess for pneumothorax. Additional variables analyzed included type of retractor used during recipient vessel dissection and history of radiation.

Results

A total of 180 patients underwent autologous DIEP breast reconstruction at our institution. The overall incidence of pneumothorax was 1.4 per 100 recipient vessel dissections and 2.2 per 100 patients undergoing breast reconstruction. There was a total of 4 cases of pneumothorax. Three were attributed to unknown causes, and 1 was due to direct injury to the parietal pleura via electrocautery.

Conclusion

The use of the internal mammary artery and vein as recipient vessels continues to be the most common and reliable recipient for autologous breast reconstruction. Based on our data, pneumothorax does not seem to be a common complication of this procedure. If concern for iatrogenic injury to the pleura arises intraoperatively, we suggest the use of a saline bubble test to investigate the possible injury. Routine postoperative radiographs are not indicated unless the patient develops symptoms suggestive of pneumothorax.
Gender-Affirming Health Insurance Reform in the United States
Authors: Ngaage Ledibabari Mildred , Xue Shan , Borrelli Mimi R. , Safa Bauback , Berli Jens U. , Bluebond-Langner Rachel , Rasko Yvonne M.
Published: January 2021

Introduction

In May 2014, the US Department of Health and Human Services prohibited insurance discrimination of transgender individuals. Despite this, insurance plans often lack explicit guidelines on gender transition-related care and coverage of surgical procedures is extremely varied. We evaluated the evolution of insurance coverage of gender-affirming care following the 2014 legislative change.

Methods

Insurance providers were selected based on company market share. We conducted a Web-based search and telephone interviews to identify the corresponding policies related to gender-affirming health care. We compared policy changes made before and after the 2014 US Department of Health and Human Services decision.

Results

Of the 92 insurers surveyed, 7% did not have a policy, and 315 policy revisions were documented. After the legislation, a significantly higher proportion of policy revisions were related to coverage of services (36% vs 11%, P < 0.0001), removal of existing criteria significantly decreased (23% vs 49%, P = 0.0044), and addition of criteria unrelated to international standards sharply increased (32% vs 2%, P = 0.0002). This resulted in reduced coverage of facial feminization, hair transplantation, laryngochondroplasty, and voice modification surgery. However, nipple reconstruction experienced increased coverage. The percentage of revisions to add preauthorization criteria to meet international standards (49% vs 45%, P = 0.6714) or to change terminology (37% vs 27%, P = 0.1055) were similar before and after the legislation.

Conclusions

After the transformative legislation in 2014, an increasing number of insurance companies established gender transition–related policies. As more patients seek gender-affirming care, insurers deviate from international guidelines and create additional benchmarks that may act as barriers to care.
Combined Liposuction and Physiologic Treatment Achieves Durable Limb Volume Normalization in Class II–III Lymphedema
Authors: Brazio Philip S. , Nguyen Dung H.
Published: January 2021

Introduction

Outcomes of surgical lymphedema treatment are currently suboptimal. Physiologic procedures including lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) reestablish lymphatic flow but cannot correct fibroadipose deposition, whereas liposuction alone cannot prevent disease progression. We propose a treatment algorithm combining liposuction with LVA or VLNT that can achieve normal limb volumes and prevent disease progression in stage II–III lymphedema.

Methods

We performed a retrospective chart review of patients undergoing liposuction and physiologic lymphedema operations at our institution between January 2016 and June 2019. Patients were assigned to treatment groups according to their clinical presentation: physiologic first, followed by no further treatment (physiologic only) or liposuction (physiologic then liposuction); liposuction then physiologic; or simultaneous. Preoperative patient characteristics and sequence of operations were recorded. Compression garment usage was self-reported. Limb volumes were approximated as a truncated cone.

Results

Twenty-one patients met the inclusion criteria. The liposuction then physiologic group had significantly higher stage and excess limb volume at baseline, whereas the physiologic first groups had lower excess volume. While the physiologic only group had predominantly stage I disease, the patients who later required liposuction (physiologic then liposuction group) all had stage II disease. All groups achieved 82% to 106% mean excess volume reduction, and volume reduction was maintained for up to 2.4 years. Compression garment class was not reduced, but mean postoperative compression duration decreased from 12.5 to 7.5 h/d (P = 0.003). Ten of 11 patients with history of cellulitis had no further recurrence.

Conclusion

Lymphedema represents a continuum of fluid and fibroadipose disease. Accurate staging and timely treatment with physiologic procedures and liposuction can normalize limb volume. We propose a treatment algorithm to optimize outcomes. Patients with predominantly nonpitting presentation benefit from liposuction to maximize removal of fibroadipose tissue and optimize postoperative compression, followed by LVA or VLNT to improve lymphatic drainage. Patients with primarily pitting edema are best treated with physiologic procedures initially, reserving selective liposuction as a second stage. Patients with mixed presentation are best served by single-stage combination procedures.
Limitations of Available Blood Products for Massive Transfusion During Mass Casualty Events at US Level 1 Trauma Centers
Authors: Williams James , Gustafson Michael , Bai Yu , Prater Samuel , Wade Charles E. , Guillamondegui Oscar D. , Khan Mansoor , Brenner Megan , Ferrada Paula , Roberts Derek , Horer Tal , Kauvar David , Kirkpatrick Andrew , Ordonez Carlos , Perreira Bruno , Priouzram Artai , Duchesne Juan , Cotton Bryan A.
Published: January 2021

Introduction:

Exsanguination remains a leading cause of preventable death in traumatically injured patients. To better treat hemorrhagic shock, hospitals have adopted massive transfusion protocols (MTPs) which accelerate the delivery of blood products to patients. There has been an increase in mass casualty events (MCE) worldwide over the past two decades. These events can overwhelm a responding hospital's supply of blood products. Using a computerized model, this study investigated the ability of US trauma centers (TCs) to meet the blood product requirements of MCEs.

Methods:

Cross-sectional survey data of on-hand blood products were collected from 16 US level-1 TCs. A discrete event simulation model of a TC was developed based on historic data of blood product consumption during MCEs. Each hospital's blood bank was evaluated across increasingly more demanding MCEs using modern MTPs to guide resuscitation efforts in massive transfusion (MT) patients.

Results:

A total of 9,000 simulations were performed on each TC's data. Under the least demanding MCE scenario, the median size MCE in which TCs failed to adequately meet blood product demand was 50 patients (IQR 20–90), considering platelets. Ten TCs exhaust their supply of platelets prior to red blood cells (RBCs) or plasma. Disregarding platelets, five TCs exhausted their supply of O- packed RBCs, six exhausted their AB plasma supply, and five had a mixed exhaustion picture.

Conclusion:

Assuming a TC's ability to treat patients is limited only by their supply of blood products, US level-1 TCs lack the on-hand blood products required to adequately treat patients following a MCE. Use of non-traditional blood products, which have a longer shelf life, may allow TCs to better meet the blood product requirement needs of patients following larger MCEs.
Making Concepts Material
Authors: Cheung Jeffrey J. H. , Kulasegaram Kulamakan M. , Woods Nicole N. , Brydges Ryan
Published: January 2021

Background

Simulation affords opportunities to represent functional relationships between conceptual (eg, anatomy) and procedural knowledge (eg, needle insertion technique) in ways that make them accessible to our many senses. Despite deprioritizing realism, such simulations may encourage trainees to create cognitive connections between these knowledge (ie, cognitive integration), which may improve transfer of learning. However, the impact of such “integrated instruction” has not been examined in simulation-based training. We developed integrated video- and simulator-based instructional modules for lumbar puncture training and compared their impacts on participants' retention, transfer, and conceptual knowledge.

Methods

During 1 hour of simulation-based training, we randomized 66 medical students to receive either (a) video-based procedural-only instruction, (b) integrated video-based instruction, or (c) integrated simulator-based instruction. One week later, we tested participants' retention and transfer performances and their conceptual knowledge on a written test.

Results

Simple mediation analyses revealed that compared with participants receiving procedural-only instruction, participants receiving integrated instruction had superior retention and transfer outcomes, mediated by gains in conceptual knowledge (all P < 0.01). We found no significant differences between the integrated groups for retention, transfer, or conceptual knowledge (all P > 0.01).

Conclusions

We extended previous findings, showing integrated instruction (video- or simulator-based) improved trainees' conceptual knowledge, which mediated their improved retention and transfer. As an innovation, we demonstrated how simulators can facilitate cognitive integration by making abstract conceptual-procedural relationships material. In suggesting how researchers might capitalize further on simulator-based integration, we offer an alternative framework for designing simulations that emphasizes cognitive processes rather than simulator fidelity.
Development and Validation of a Patient-reported Outcome Measure for Gastrointestinal Obstruction in the Setting of Advanced Malignancy
Authors: Badgwell Brian , Williams Loretta A. , Chen Tsun Hsuan , Cleeland Charles , Mendoza Tito
Published: January 2021

Objective:

We sought to construct a valid and reliable patient-reported outcome measure for patients with advanced malignancy and GIO.

Background:

Bowel obstruction is the most common indication for palliative surgical consultation in patients with advanced cancer; however, no validated patient-reported outcome measures exist for this population.

Methods:

A total of 125 patients with GIO and 64 patients without GIO who underwent palliative surgical consultation completed the MDASI-GIO questionnaire and a single global quality-of-life question. Summary statistics were used to assess the symptom burden of GIO patients. Outcome measures were validity (construct and criterion) and reliability (internal and test-retest) for the MDASI-GIO.

Results:

The majority of patients rated the severity of each of the 5 following GIO-specific symptoms as moderate to severe (rating of ≥5 on a 0 to 10 scale): “being unable to eat’’ (72%), “being unable to have a bowel movement’’ (65%), “abdominal discomfort’’ (62%), “stomach feeling full’’ (55%), and “abdominal cramping’’ (54%). The MDASI-GIO subscale Cronbach coefficient alpha values were 0.80–0.91, and intraclass correlations were 0.72–0.84. Correlations between MDASI-GIO subscales and global quality of life were –0.39 to–0.49 (P < 0.001 for all comparisons). GIO patients had significantly worse symptoms and higher interference than did non-GIO patients (all P < 0.05) with effect-size differences of ≥0.36, supporting known-group validity.

Conclusions:

The MDASI-GIO shows initial validity and reliability for assessing the severity of symptoms of patients with GIO and the interference of these symptoms in patients’ daily functioning.
Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room
Authors: Yates Elizabeth F. , Bowder Alexis N. , Roa Lina , Velin Lotta , Goodman Andrea S. , Nguyen Louis L. , McClain Craig D. , Meara John G. , Cooper Zara
Published: January 2021

Objective:

We review the existing research on environmentally sustainable surgical practices to enable SAO to advocate for improved environmental sustainability in operating rooms across the country.

Summary of Background Data:

Climate change refers to the impact of greenhouse gases emitted as a byproduct of human activities, trapped within our atmosphere and resulting in hotter and more variable climate patterns.1 As of 2013, the US healthcare industry was responsible for 9.8% of the country's emissions2; if it were itself a nation, US healthcare would rank 13th globally in emissions.3 As one of the most energy-intensive and wasteful areas of the hospital, ORs drive this trend. ORs are 3 to 6 times more energy intensive than clinical wards.4 Further, ORs and labor/delivery suites produce 50%–70% of waste across the hospital.5,6 Due to the adverse health impacts of climate change, the Lancet Climate Change Commission (2009) declared climate change “the biggest global health threat of the 21st century” and predicted it would exacerbate existing health disparities for minority groups, children and low socioeconomic patients.7

Methods/Results:

We provide a comprehensive narrative review of published efforts to improve environmental sustainability in the OR while simultaneously achieving cost-savings, and highlight resources for clinicians interested in pursuing this work.

Conclusion:

Climate change adversely impacts patient health, and disproportionately impacts the most vulnerable patients. SAO contribute to the problem through their resource-intensive work in the OR and are uniquely positioned to lead efforts to improve the environmental sustainability of the OR.
Patient Perceptions of Audio and Video Recording in the Operating Room
Authors: Gallant Jean-Nicolas , Brelsford Kathleen , Sharma Sahil , Grantcharov Teodor , Langerman Alexander
Published: January 2021

Objective:

The goal of this study was to determine surgical patients’ perceptions of hypothetical continuous audio-video OR recording (ORR).

Summary of Background Data:

Continuous audio-video recording of the operating room (OR), akin to the aviation industry's black box, has been proposed as a means to enhance training, supplement the medical record, and allow large-scale analysis of surgical performance and safety. These recordings would include patients' bodies; yet, understanding of patient perceptions regarding such technology is limited.

Methods:

Semi-structured interviews were conducted during elective surgery preoperative appointments during a 2-week period in August 2018 at a quaternary care center. Deidentified transcripts were analyzed using thematic analysis.

Results:

Forty-nine subjects were interviewed. Subjects recognized the potential for recording to improve surgical quality, safety and training. Subjects also desired access to an objective record of their own surgery, for the purposes of future care, medical-legal evidence, and to satisfy their own curiosity and understanding. Subjects had mixed perceptions regarding OR decorum and thus, differing views on the potential effect of ORR on OR behavior; some imagined that ORR would discourage bad behavior and others worried that it would cause unnecessary anxiety to the surgical team.

Conclusions:

Patients have a diverse set of views about the potential benefits, risks, and uses for OR data and consider themselves to be important stakeholders. Our study identifies pathways and potential challenges to implementation of continuous audio/video recording in ORs.
Effects of Power on Balance and Fall Prevention in Aging and Older Adults
Authors: Chen Tzurei , Yoshida Yuri
Published: January 2021

Falls are a common health issue among older adults. Muscle weakness, limited physical function, and balance impairment have been identified as the modifiable risk factors for falls. The purpose of this review is to analyze current evidence about the efficacy of power training in improving physical function, improving balance, and preventing falls in older adults. We also provide recommendations regarding power training protocols for older adults. This review suggests that power training is effective in reducing several risk factors for falls. Future interdisciplinary studies are needed to provide evidence about how to incorporate power training in a fall prevention program.
Antibody Development in Patients Treated Long-Term With OnabotulinumtoxinA for Benign Essential Blepharospasm and Hemifacial Spasm
Authors: Czyz Craig N. , Burns John A. , Bergstrom Reece E.
Published: January 2021

Background:

Report the development of onabotulinumtoxinA neutralizing antibodies in patients treated consecutively for 20 years or longer for benign essential blepharospasm (BEB), hemifacial spasm (HFS), and Meige Syndrome.

Methods:

Prospective, randomized, cross-sectional study of 12 randomly selected patients from a single clinical practice that have been treated consecutively for 20 or more years with onabotulinumtoxinA for BEB, HFS, or Meige Syndrome. Serum samples were collected from each subject and analyzed for neutralizing antibody formation using the Mouse Protection Assay.

Results:

None of the tested patients (0%) displayed neutralizing antibodies to onabotulinumtoxinA. The mean duration of treatment was 27.5 years (range 22.1–34.1, SD 3.1, 95% confidence interval 25.45–29.50). Nine of the patients had a diagnosis of BEB, 2 HFS, and one Meige. Eleven of the 12 patients were women. There was no statistically significant difference in treatment dosage or interval over the course of treatment.

Conclusions:

The data support previous studies showing low incidence of antibody formation for botulinum A toxins with this subset of long-term treated patients. The results also provide further evidence for studies that have suggested increased onabotulinumtoxinA treatment volumes and/or decreased intervals between treatments are not due to neutralizing antibody formation and secondary non-response, but rather study designs that do not consider the titration phase of initial treatments. This study is specific to long-term treated patients, and the results cannot be generalized to patients naive to treatment.
Which kind of feedback has a greater impact on individuals with social anxiety: facial or textual? An ERP study
Authors: Yu Xianglian , Lin Wuji , Kong Xiangtian , Chen Danwen , Zheng Minxiao , Wei Qiang , Gao Chao
Published: January 2021

The present study is the first to compare the examined electrophysiological activity of facial and textual feedback of students with social anxiety after they finished a visual search task. Compared to textual feedback, facial feedback is much more effective. Specifically speaking, positive facial feedback caused stronger feedback-related negativity (FRN), and negative facial feedback caused late positive potential (LPP) of stronger amplitude. These changes in the FRN component (associated with feedback) and LPP (related to controlled attention engagement) provide clues about the interplay between anxiety and attention allocation in processing facial feedback. The results have implications for identifying the feedback format that will be most helpful for individuals with social anxiety.
Sleep quality and cortical amyloid-β deposition in postmenopausal women of the Kronos early estrogen prevention study
Authors: Zeydan Burcu , Lowe Val J. , Tosakulwong Nirubol , Lesnick Timothy G. , Senjem Matthew L. , Jack Clifford R. , Fields Julie A. , James Taryn T. , Gleason Carey E. , Dowling N. Maritza , Miller Virginia M. , Kantarci Kejal
Published: January 2021

Hormone therapy improves sleep in menopausal women and recent data suggest that transdermal 17β-estradiol may reduce the accumulation of cortical amyloid-β. However, how menopausal hormone therapies modify the associations of amyloid-β accumulation with sleep quality is not known. In this study, associations of sleep quality with cortical amyloid-β deposition and cognitive function were assessed in a subset of women who had participated in the Kronos early estrogen prevention study. It was a randomized, placebo-controlled trial in which recently menopausal women (age, 42–58; 5–36 months past menopause) were randomized to (1) oral conjugated equine estrogen (n = 19); (2) transdermal 17β-estradiol (tE2, n = 21); (3) placebo pills and patch (n = 32) for 4 years. Global sleep quality score was calculated using Pittsburgh sleep quality index, cortical amyloid-β deposition was measured with Pittsburgh compound-B positron emission tomography standard uptake value ratio and cognitive function was assessed in four cognitive domains 3 years after completion of trial treatments. Lower global sleep quality score (i.e., better sleep quality) correlated with lower cortical Pittsburgh compound-B standard uptake value ratio only in the tE2 group (r = 0.45, P = 0.047). Better global sleep quality also correlated with higher visual attention and executive function scores in the tE2 group (r = −0.54, P = 0.02) and in the oral conjugated equine estrogen group (r = −0.65, P = 0.005). Menopausal hormone therapies may influence the effects of sleep on cognitive function, specifically, visual attention and executive function. There also appears to be a complex relationship between sleep, menopausal hormone therapies, cortical amyloid-β accumulation and cognitive function, and tE2 formulation may modify the relationship between sleep and amyloid-β accumulation.
A new somasteroid from the Fezouata Lagerstätte in Morocco and the Early Ordovician origin of Asterozoa
Authors: Hunter Aaron W. , Ortega-Hernández Javier
Published: January 2021

The somasteroids are Lower Palaeozoic star-shaped animals widely regarded as ancestors of Asterozoa, the group of echinoderms that includes brittle stars and starfish. However, the origin of asterozoans, the assembly of their distinctive body organization, and their relationships with other Cambrian and Ordovician echinoderms remain problematic owing to the difficulties of comparing the endoskeleton between disparate groups. Here, we describe the new somasteroid
Cantabrigiaster fezouataensis
, a primitive asterozoan from the Early Ordovician Fezouata Lagerstätte in Morocco.
Cantabrigiaster
shares with other somasteroids a unique endoskeletal arm organization and the presence of rod-like virgal ossicles that articulate with the ambulacrals, but differs from all other known asterozoans in the absence of adambulacral ossicles defining the arm margins, evoking parallels with non-asterozoan echinoderms. Developmentally informed Bayesian and parsimony phylogenetic analyses, which reflect the homology of the biserial ambulacral ossicles in Palaeozoic echinoderms according to the extraxial–axial theory, recover
Cantabrigiaster
as the earliest divergent stem-group asterozoan. Our results illuminate the ancestral morphology of Asterozoa, and clarify the affinities of problematic Ordovician Asterozoa. Bayesian inference and parsimony demonstrate that somasteroids represent a paraphyletic grade within stem- and crown-group Asterozoa, whereas stenuroids are paraphyletic within stem-group Ophiuroidea. Our results also offer potential insights on the evolutionary relationships between asterozoans, crinoids and potential Cambrian stem-group representatives.
Male coercion and female injury in a sexually cannibalistic mantis
Authors: Burke Nathan W. , Holwell Gregory I.
Published: January 2021

Sexual conflict can generate coercive traits in males that enhance mating success at the expense of female fitness. Pre-copulatory sexual cannibalism—where females consume males without mating—typically favours cautious rather than coercive mating tactics, and few examples of the latter are known. Here, we show that males of the highly cannibalistic springbok mantis,Miomantis caffra, wrestle females during pre-mating interactions. We find that most initial contacts between males and females involve a violent struggle whereby each sex tries be the first to grasp hold of the other with their raptorial forelegs. When females win the struggle, they always cannibalize males. However, when males grasp females first, they dramatically increase the chance of mating. We also find striking evidence that, on some occasions, males wound females with their fore-tibial claws during struggles, resulting in haemolymph loss and scar tissue formation. Taken together, our results show how males can overcome the threat of cannibalism by coercively wrestling females. We argue that pre-copulatory injury in this species is likely to be a negative pleiotropic side-effect of coercive mating behaviour and foraging morphology.
Spread of COVID-19 in urban neighbourhoods and slums of the developing world
Authors: Sahasranaman Anand , Jensen Henrik Jeldtoft
Published: January 2021

We study the spread of COVID-19 across neighbourhoods of cities in the developing world and find that small numbers of neighbourhoods account for a majority of cases (k-index approx. 0.7). We also find that the countrywide distribution of cases across states/provinces in these nations also displays similar inequality, indicating self-similarity across scales. Neighbourhoods with slums are found to contain the highest density of cases across all cities under consideration, revealing that slums constitute the most at-risk urban locations in this epidemic. We present a stochastic network model to study the spread of a respiratory epidemic through physically proximate and accidental daily human contacts in a city, and simulate outcomes for a city with two kinds of neighbourhoods—slum and non-slum. The model reproduces observed empirical outcomes for a broad set of parameter values—reflecting the potential validity of these findings for epidemic spread in general, especially across cities of the developing world. We also find that distribution of cases becomes less unequal as the epidemic runs its course, and that both peak and cumulative caseloads are worse for slum neighbourhoods than non-slums at the end of an epidemic. Large slums in the developing world, therefore, contain the most vulnerable populations in an outbreak, and the continuing growth of metropolises in Asia and Africa presents significant challenges for future respiratory outbreaks from perspectives of public health and socioeconomic equity.
A biphasic approach for characterizing tensile, compressive and hydraulic properties of the sclera
Authors: Brown Dillon M. , Pardue Machelle T. , Ethier C. Ross
Published: January 2021

Measuring the biomechanical properties of the mouse sclera is of great interest: altered scleral properties are features of many common ocular pathologies, and the mouse is a powerful tool for studying genetic factors in disease, yet the small size of the mouse eye and its thin sclera make experimental measurements in the mouse difficult. Here, a poroelastic material model is used to analyse data from unconfined compression testing of both pig and mouse sclera, and the tensile modulus, compressive modulus and permeability of the sclera are obtained at three levels of compressive strain. Values for all three properties were comparable to previously reported values measured by tests specific for each property. The repeatability of the approach was evaluated using a test–retest experimental paradigm on pig sclera, and tensile stiffness and permeability measurements were found to be reasonably repeatable. The intrinsic material properties of the mouse sclera were measured for the first time. Tensile stiffness and permeability of the sclera in both species were seen to be dependent on the state of compressive strain. We conclude that unconfined compression testing of sclera, when analysed with poroelastic theory, is a powerful tool to phenotype mouse scleral changes in future genotype–phenotype association studies.
Occupational mobility and automation: a data-driven network model
Authors: del Rio-Chanona R. Maria , Mealy Penny , Beguerisse-Díaz Mariano , Lafond François , Farmer J. Doyne
Published: January 2021

The potential impact of automation on the labour market is a topic that has generated significant interest and concern amongst scholars, policymakers and the broader public. A number of studies have estimated occupation-specific risk profiles by examining how suitable associated skills and tasks are for automation. However, little work has sought to take a more holistic view on the process of labour reallocation and how employment prospects are impacted as displaced workers transition into new jobs. In this article, we develop a data-driven model to analyse how workers move through an empirically derived occupational mobility network in response to automation scenarios. At a macro level, our model reproduces the Beveridge curve, a key stylized fact in the labour market. At a micro level, our model provides occupation-specific estimates of changes in short and long-term unemployment corresponding to specific automation shocks. We find that the network structure plays an important role in determining unemployment levels, with occupations in particular areas of the network having few job transition opportunities. In an automation scenario where low wage occupations are more likely to be automated than high wage occupations, the network effects are also more likely to increase the long-term unemployment of low-wage occupations.
Hallmarks of cancer—the new testament
Authors: Senga Sasi S. , Grose Richard P.
Published: January 2021

Diagnosis and treatment of disease demand a sound understanding of the underlying mechanisms, determining any Achilles' heel that can be targeted in effective therapies. Throughout history, this endeavour to decipher the origin and mechanism of transformation of a normal cell into cancer has led to various theories—from cancer as a curse to an understanding at the level of single-cell heterogeneity, meaning even among a single sub-type of cancer there are myriad molecular challenges to overcome. With increasing insight into cancer genetics and biology, the disease has become ever more complex to understand. The complexity of cancer as a disease was distilled into key traits by Hanahan and Weinberg in their seminal ‘Hallmarks of Cancer' reviews. This lucid conceptualization of complex cancer biology is widely accepted and has helped advance cancer therapeutics by targeting the various hallmarks but, with the advancement in technologies, there is greater granularity in how we view cancer as a disease, and the additional understanding over the past decade requires us to revisit the hallmarks of cancer. Based on extensive study of the cancer research literature, we propose four novel hallmarks of cancer, namely, the ability of cells to regress from a specific specialized functional state, epigenetic changes that can affect gene expression, the role of microorganisms and neuronal signalling, to be included in the hallmark conceptualization along with evidence of various means to exploit them therapeutically.
Data-driven prediction and origin identification of epidemics in population networks
Authors: Larson Karen , Arampatzis Georgios , Bowman Clark , Chen Zhizhong , Hadjidoukas Panagiotis , Papadimitriou Costas , Koumoutsakos Petros , Matzavinos Anastasios
Published: January 2021

Effective intervention strategies for epidemics rely on the identification of their origin and on the robustness of the predictions made by network disease models. We introduce a Bayesian uncertainty quantification framework to infer model parameters for a disease spreading on a network of communities from limited, noisy observations; the state-of-the-art computational framework compensates for the model complexity by exploiting massively parallel computing architectures. Using noisy, synthetic data, we show the potential of the approach to perform robust model fitting and additionally demonstrate that we can effectively identify the disease origin via Bayesian model selection. As disease-related data are increasingly available, the proposed framework has broad practical relevance for the prediction and management of epidemics.
Short-term prediction through ordinal patterns
Authors: Neuman Yair , Cohen Yochai , Tamir Boaz
Published: January 2021

Prediction in natural environments is a challenging task, and there is a lack of clarity around how a myopic organism can make short-term predictions given limited data availability and cognitive resources. In this context, we may ask what kind of resources are available to the organism to help it address the challenge of short-term prediction within its own cognitive limits. We point to one potentially important resource:ordinal patterns, which are extensively used in physics but not in the study of cognitive processes. We explain the potential importance of ordinal patterns for short-term prediction, and how natural constraints imposed through (i) ordinal pattern types, (ii) their transition probabilities and (iii) their irreversibility signature may support short-term prediction. Having tested these ideas on a massive dataset of Bitcoin prices representing a highly fluctuating environment, we provide preliminary empirical support showing how organisms characterized by bounded rationality may generate short-term predictions by relying on ordinal patterns.
Drosophila suzukiiavoidance of microbes in oviposition choice
Authors: Sato Airi , Tanaka Kentaro M. , Yew Joanne Y. , Takahashi Aya
Published: January 2021

While the majority ofDrosophilaspecies lays eggs onto fermented fruits, females ofDrosophila suzukiipierce the skin and lay eggs into ripening fruits using their serrated ovipositors. The changes of oviposition site preference must have accompanied this niche exploitation. In this study, we established an oviposition assay to investigate the effects of commensal microbes deposited by conspecific and heterospecific individuals and showed that the presence of microbes on the oviposition substrate enhances egg laying ofDrosophila melanogasterandDrosophila biarmipes, but discourages that ofD. suzukii. This result suggests that a drastic change has taken place in the lineage leading toD. suzukiiin how females respond to chemical cues produced by microbes. We also found that hardness of the substrate, resembling that of either ripening or damaged and fermenting fruits, affects the response to microbial growth, indicating that mechanosensory stimuli interact with chemosensory-guided decisions to select or avoid oviposition sites.
RETRACTED: Enemies mediate distance- and density-dependent mortality of tree seeds and seedlings: a meta-analysis of fungicide, insecticide and exclosure studies
Authors: Song Xiaoyang , Corlett Richard T.
Published: January 2021

Conspecific negative distance- and density-dependence is often assumed to be one of the most important mechanisms controlling forest community assembly and species diversity globally. Plant pathogens, and insect and mammalian herbivores, are the most common natural enemy types that have been implicated in this phenomenon, but their general effects at different plant life stages are still unclear. Here, we conduct a meta-analysis of studies that involved robust manipulative experiments, using fungicides, insecticides and exclosures, to assess the contributions of different natural enemy types to distance- and density-dependent effects at seed and seedling stages. We found that distance- and density-dependent mortality caused by natural enemies was most likely at the seedling stage and was greater at higher mean annual temperatures. Conspecific negative distance- and density-dependence at the seedling stage is significantly weakened when fungicides were applied. By contrast, negative conspecific distance- and density-dependence is not a general pattern at the seed stage. High seed mass reduced distance- and density-dependent mortality at the seed stage. Seed studies excluding only large mammals found significant negative conspecific distance-dependent mortality, but exclusion of all mammals resulted in a non-significant effect of conspecifics. Our study suggests that plant pathogens are a major cause of distance- and density-dependent mortality at the seedling stage, while the impacts of herbivores on seedlings have been understudied. At the seed stage, large and small mammals, respectively, weaken and enhance negative conspecific distance-dependent mortality. Future research should identify specific agents of mortality, investigate the interactions among different enemy types and assess how global change may affect natural enemies and thus influence the strength of conspecific distance- and density-dependence.
Supplemented nutrition decreases helminth burden and increases drug efficacy in a natural host–helminth system
Authors: Sweeny Amy R. , Clerc Melanie , Pontifes Paulina A. , Venkatesan Saudamini , Babayan Simon A. , Pedersen Amy B.
Published: January 2021

Gastrointestinal (GI) helminths are common parasites of humans, wildlife, and livestock, causing chronic infections. In humans and wildlife, poor nutrition or limited resources can compromise an individual's immune response, predisposing them to higher helminth burdens. This relationship has been tested in laboratory models by investigating infection outcomes following reductions of specific nutrients. However, much less is known about how diet supplementation can impact susceptibility to infection, acquisition of immunity, and drug efficacy in natural host–helminth systems. We experimentally supplemented the diet of wood mice (
Apodemus sylvaticus
) with high-quality nutrition and measured resistance to the common GI nematode
Heligmosomoides polygyrus
. To test whether diet can enhance immunity to reinfection, we also administered anthelmintic treatment in both natural and captive populations. Supplemented wood mice were more resistant to
H. polygyrus
infection, cleared worms more efficiently after treatment, avoided a post-treatment infection rebound, produced stronger general and parasite-specific antibody responses, and maintained better body condition. In addition, when applied in conjunction with anthelmintic treatment, supplemented nutrition significantly reduced
H. polygyrus
transmission potential. These results show the rapid and extensive benefits of a well-balanced diet and have important implications for both disease control and wildlife health under changing environmental conditions.
Reclassification of Streptomyces costaricanus and Streptomyces phaeogriseichromatogenes as later heterotypic synonyms of Streptomyces murinus
Authors: Komaki Hisayuki
Published: January 2021

This study aimed to clarify the taxonomic relationships among

Streptomyces costaricanus

, Streptomyces graminearus, Streptomyces murinus and

Streptomyces phaeogriseichromatogenes

. These strains share the same 16S rRNA gene sequence. Multilocus sequence analysis revealed that

S. costaricanus

,

S. murinus

and

S. phaeogriseichromatogenes

belong to the same species, but

S. graminearus

does not. Digital DNA–DNA relatedness and average nucleotide identity among S. costaricanus, S. murinus and

S. phaeogriseichromatogenes

were 70.9–74.6% and 96.5–97.0 %, respectively. In addition to the previously reported phenotypic data, the presence of a similar set of secondary metabolite-biosynthetic gene clusters for polyketides and nonribosomal peptides supported the similarity among the three species. Therefore,

S. costaricanus

and

S. phaeogriseichromatogenes

should be reclassified as later heterotypic synonyms of

S. murinus

.
Streptomyces scabichelini sp. nov., isolated from soil
Authors: Gencbay Talha , Saygin Hayrettin , Guven Kiymet , Topkara Ahmet Ridvan , Saricaoglu Salih , Sahin Nevzat , Isik Kamil
Published: January 2021

A novel actinomycete, designated strain HC44T, was isolated from a soil sample collected from Hacibektaş, Turkey, and characterized using a polyphasic approach. The strain had morphological characteristics and chemotaxonomic properties identical to those of members of the genus

Streptomyces

. Phylogenetic analyses based on 16S rRNA gene sequence comparisons revealed that HC44T clustered with members of the genus

Streptomyces

and the highest 16S rRNA gene sequence similarity values were obtained with

Streptomyces vastus

NBRC 13094T (97.6 %) and

Streptomyces kalpinensis

TRM 46509T (96.9 %). Multi-locus sequence analysis (MLSA) based on five housekeeping genes (atpD, gyrB, recA, rpoB and trpB) showed that the MLSA evolutionary distance value was 0.043 between strain HC44T and

S. vastus

NBRC 13094T. Whole-cell hydrolysates contained ll-diaminopimelic acid, glucose, mannose and ribose. The predominant menaquinones were MK-9(H6) and MK-9(H8). The major polar lipids were diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylinositol and phosphatidylinositol mannoside. The DNA G+C content of the draft genome sequence, consisting of 11.2 Mbp, was 69.8 mol%. On the basis of polyphasic taxonomic evidence, strain HC44T represents a novel species of the genus

Streptomyces

, for which the name Streptomyces scabichelini sp. nov. is proposed. The type strain is HC44T (=DSM 106874T=KCTC 39872T).