bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards a More Competitive Mobile Payment Industry: Standardization And Beyond
Authors: Yan Xingyu
Published: October 2020

Mobile payments are becoming increasingly popular around the world. In countries like China, they appear in the form of barcode payments and are poised to replace cash and bank card payments for day-to-day consumer purchases. Against that backdrop, this paper analyzes the availability of barcode standardization as an approach to interoperability and ultimately to enhanced competition in the mobile payment industry. It uses the Chinese industry as a study case, which features a duopoly structure and shifting competitive dynamics among three definable groups of market players. This paper confirms that standardization can enhance competition and argues that, in this case, a government-mandated standardization is preferable to a voluntary one because the latter is prone to financial market failures. Along this line, this paper makes three suggestions for furthering the barcode standardization. It also advises prudence and competitive neutrality for the financial regulator and calls for more active involvements of the competition and data protection authorities.
Virchow’s node as the initial presentation of metastatic prostate cancer: a case series of a common cancer in uncommon location
Authors: Mbwambo Orgeness J , Mremi Alex , Mbwambo Jasper S , Bright Frank , Mteta Alfred K , Ngowi Bartholomeo N
Published: October 2020

Prostate cancer is one of the commonest cancers among men contributing significantly to the overall cancer burden globally. Most patients present with lower urinary tract symptoms. Metastasis to supraclavicular lymph nodes is unusual presentation, which has been rarely reported particularly as the primary presentation. We report two rare cases of advanced prostatic adenocarcinoma presenting with firm, non-tender lump in the left supraclavicular region between the two heads of the sternocleidomastoid muscle, (that is Virchow’s node) as initial primary symptom. Examination of the patients revealed an elevated prostatic-specific antigen (PSA) of > 100 ng/ml levels, and the diagnosis was confirmed by histological evaluation and immunostaining with PSA of the supraclavicular lymph nodes and prostate biopsies. This case series emphasizes the importance of considering prostate cancer in the differential diagnosis of male patients with supraclavicular lymphadenopathy.
Visuality of a treaty: reflection on Versailles
Authors: Miles Kate
Published: October 2020

This article revisits one moment in international law through the prism of visual culture, analysing paintings, photographs and political cartoons of the signing of the Treaty of Versailles. It considers the historical representation of treaty-making, narratives of international law as beneficent universal regulator and spectacle, and the projection of ‘successful’ international law through image. It reflects on photographs that capture working, ‘behind-the-scenes’ moments and portrayals of a more agitated, restless visual international law. And it explores the idea that visuality contributes to the construction of international legal reality and is a specific site of meaning for our understanding of treaty-making at Versailles.
Long-term evolution of surviving companion stars of Type Iax supernovae
Authors: Liu Zheng-Wei , Zeng Yaotian
Published: October 2020

The nature of the progenitors and explosion mechanism of Type Iax supernovae (SNe Iax) remain a mystery. The single-degenerate (SD) systems that involve the incomplete pure deflagration explosions of near-Chandrasekhar-mass white dwarfs (WDs) have recently been proposed for producing SNe Iax in which non-degenerate companions are expected to survive from SN explosions. In this work, we concentrate on the main-sequence (MS) donor SD progenitor systems. By mapping the computed companion models from three-dimensional hydrodynamical simulations of ejecta-companion interaction into a one-dimensional stellar evolution code mesa, we investigate the long-term appearance and observational signatures of surviving MS companions of SNe Iax by tracing their post-impact evolution. Depending on different MS companion models, it is found that the shocked surviving companion stars can significantly expand and evolve to be more luminous (5–$500\, L_{\odot }$) for a time-scale of 10–104 yr. Comparing with the late-time light curve of an observed SN Iax (SN 2005hk), it is suggested that surviving MS companions of SNe Iax would expect to be visible about 1000 d after the explosion when SN itself has been faded.
Impacts of pre-initial conditions on anisotropic separate universe simulations: a boosted tidal response in the epoch of reionization
Authors: Masaki Shogo , Nishimichi Takahiro , Takada Masahiro
Published: October 2020

To generate initial conditions for cosmological N-body simulations, one needs to prepare a uniform distribution of simulation particles, the so-called pre-initial condition (pre-IC). The standard method to construct the pre-IC is to place the particles on the lattice grids evenly spaced in the three-dimensional spatial coordinates. However, even after the initial displacement of each particle according to cosmological perturbations, the particle distribution remains to display an artificial anisotropy. Such an artefact causes systematic effects in simulations at later time until the evolved particle distribution sufficiently erases the initial anisotropy. In this paper, we study the impacts of the pre-IC on the anisotropic separate universe simulation, where the effect of large-scale tidal field on structure formation is taken into account using the anisotropic expansion in a local background (simulation volume). To quantify the impacts, we compare the simulations employing the standard grid pre-IC and the glass one, where the latter is supposed to suppress the initial anisotropy. We show that the artificial features in the grid pre-IC simulations are seen until z ∼ 9, while the glass pre-IC simulations appear to be stable and accurate over the range of scales we study. From these results we find that a coupling of the large-scale tidal field with matter clustering is enhanced compared to the leading-order prediction of perturbation theory in the quasi-non-linear regime in the redshift range 5 ≲ z ≲ 15, indicating the importance of tidal field on structure formation at such high redshifts, e.g. during the epoch of reionization.
The effect of a magnetic field on the dynamics of debris discs around white dwarfs
Authors: Hogg M A , Cutter R , Wynn G A
Published: October 2020

Observational estimates of the lifetimes and inferred accretion rates from debris discs around polluted white dwarfs are often inconsistent with the predictions of models of shielded Poynting–Robertson drag on the dust particles in the discs. Moreover, many cool polluted white dwarfs do not show any observational evidence of accompanying discs. This may be explained, in part, if the debris discs had shorter lifetimes and higher accretion rates than predicted by Poynting–Robertson drag alone. We consider the role of a magnetic field on tidally disrupted diamagnetic debris and its subsequent effect on the formation, evolution, and accretion rate of a debris disc. We estimate that magnetic field strengths greater than ∼10 kG may decrease the time needed for circularization and the disc lifetimes by several orders of magnitude and increase the associated accretion rates by a similar factor, relative to Poynting–Robertson drag. We suggest some polluted white dwarfs may host magnetic fields below the typical detectable limit and that these fields may account for a proportion of polluted white dwarfs with missing debris discs. We also suggest that diamagnetic drag may account for the higher accretion rate estimates among polluted white dwarfs that cannot be predicted solely by Poynting–Robertson drag and find a dependence on magnetic field strength, orbital pericentre distance, and particle size on predicted disc lifetimes and accretion rates.
A Descriptive Analysis of Music Therapy Employment from 2013 to 2019
Authors: Oden Jonathon
Published: October 2020

The purpose of this study was to descriptively analyze music therapy employment data from 2013 to 2019, including years in the field, gender, age, ethnicity, hours worked, jobs created, number of new board-certified music therapists (MT-BCs), funding sources, and wages. A database was created to analyze descriptive data from the 2013–2019 American Music Therapy Association Workforce Analysis Surveys as well as data from the Certification Board for Music Therapists. Results indicate a large portion of music therapists (MTs) have been in the field for five years or less. Though the majority of MTs work full time, there is a high rate of part-time employment. An estimate of the total number of new full-time jobs represented a ratio of 57% of new MT-BCs during the period. Private pay was the most reported funding source for music therapy services. Music therapy wages tended to be higher for those with higher levels of education. Limitations of the study and suggestions for future research are provided.
A simplified strategy for titrating gene expression reveals new relationships between genotype, environment, and bacterial growth
Authors: Mathis Andrew D , Otto Ryan M , Reynolds Kimberly A
Published: October 2020

A lack of high-throughput techniques for making titrated, gene-specific changes in expression limits our understanding of the relationship between gene expression and cell phenotype. Here, we present a generalizable approach for quantifying growth rate as a function of titrated changes in gene expression level. The approach works by performing CRISPRi with a series of mutated single guide RNAs (sgRNAs) that modulate gene expression. To evaluate sgRNA mutation strategies, we constructed a library of 5927 sgRNAs targeting 88 genes in Escherichia coli MG1655 and measured the effects on growth rate. We found that a compounding mutational strategy, through which mutations are incrementally added to the sgRNA, presented a straightforward way to generate a monotonic and gradated relationship between mutation number and growth rate effect. We also implemented molecular barcoding to detect and correct for mutations that ‘escape’ the CRISPRi targeting machinery; this strategy unmasked deleterious growth rate effects obscured by the standard approach of ignoring escapers. Finally, we performed controlled environmental variations and observed that many gene-by-environment interactions go completely undetected at the limit of maximum knockdown, but instead manifest at intermediate expression perturbation strengths. Overall, our work provides an experimental platform for quantifying the phenotypic response to gene expression variation.
PINA 3.0: mining cancer interactome
Authors: Du Yang , Cai Meng , Xing Xiaofang , Ji Jiafu , Yang Ence , Wu Jianmin
Published: October 2020

Protein–protein interactions (PPIs) are crucial to mediate biological functions, and understanding PPIs in cancer type-specific context could help decipher the underlying molecular mechanisms of tumorigenesis and identify potential therapeutic options. Therefore, we update the Protein Interaction Network Analysis (PINA) platform to version 3.0, to integrate the unified human interactome with RNA-seq transcriptomes and mass spectrometry-based proteomes across tens of cancer types. A number of new analytical utilities were developed to help characterize the cancer context for a PPI network, which includes inferring proteins with expression specificity and identifying candidate prognosis biomarkers, putative cancer drivers, and therapeutic targets for a specific cancer type; as well as identifying pairs of co-expressing interacting proteins across cancer types. Furthermore, a brand-new web interface has been designed to integrate these new utilities within an interactive network visualization environment, which allows users to quickly and comprehensively investigate the roles of human interacting proteins in a cancer type-specific context. PINA is freely available at https://omics.bjcancer.org/pina/.
Integration of the Drug–Gene Interaction Database (DGIdb 4.0) with open crowdsource efforts
Authors: Freshour Sharon L , Kiwala Susanna , Cotto Kelsy C , Coffman Adam C , McMichael Joshua F , Song Jonathan J , Griffith Malachi , Griffith Obi L , Wagner Alex H
Published: October 2020

The Drug-Gene Interaction Database (DGIdb, www.dgidb.org) is a web resource that provides information on drug-gene interactions and druggable genes from publications, databases, and other web-based sources. Drug, gene, and interaction data are normalized and merged into conceptual groups. The information contained in this resource is available to users through a straightforward search interface, an application programming interface (API), and TSV data downloads. DGIdb 4.0 is the latest major version release of this database. A primary focus of this update was integration with crowdsourced efforts, leveraging the Drug Target Commons for community-contributed interaction data, Wikidata to facilitate term normalization, and export to NDEx for drug-gene interaction network representations. Seven new sources have been added since the last major version release, bringing the total number of sources included to 41. Of the previously aggregated sources, 15 have been updated. DGIdb 4.0 also includes improvements to the process of drug normalization and grouping of imported sources. Other notable updates include the introduction of a more sophisticated Query Score for interaction search results, an updated Interaction Score, the inclusion of interaction directionality, and several additional improvements to search features, data releases, licensing documentation and the application framework.
Prevalence of phase variable epigenetic invertons among host-associated bacteria
Authors: Huang Xueting , Wang Juanjuan , Li Jing , Liu Yanni , Liu Xue , Li Zeyao , Kurniyati Kurni , Deng Yijie , Wang Guilin , Ralph Joseph D , De Ste Croix Megan , Escobar-Gonzalez Sara , Roberts Richard J , Veening Jan-Willem , Lan Xun , Oggioni Marco R , Li Chunhao , Zhang Jing-Ren
Published: October 2020

Type I restriction-modification (R-M) systems consist of a DNA endonuclease (HsdR, HsdM and HsdS subunits) and methyltransferase (HsdM and HsdS subunits). The hsdS sequences flanked by inverted repeats (referred to as epigenetic invertons) in certain Type I R-M systems undergo invertase-catalyzed inversions. Previous studies in Streptococcus pneumoniae have shown that hsdS inversions within clonal populations produce subpopulations with profound differences in the methylome, cellular physiology and virulence. In this study, we bioinformatically identified six major clades of the tyrosine and serine family invertases homologs from 16 bacterial phyla, which potentially catalyze hsdS inversions in the epigenetic invertons. In particular, the epigenetic invertons are highly enriched in host-associated bacteria. We further verified hsdS inversions in the Type I R-M systems of four representative host-associated bacteria and found that each of the resultant hsdS allelic variants specifies methylation of a unique DNA sequence. In addition, transcriptome analysis revealed that hsdS allelic variations in Enterococcus faecalis exert significant impact on gene expression. These findings indicate that epigenetic switches driven by invertases in the epigenetic invertons broadly operate in the host-associated bacteria, which may broadly contribute to bacterial host adaptation and virulence beyond the role of the Type I R-M systems against phage infection.
The InterPro protein families and domains database: 20 years on
Authors: Blum Matthias , Chang Hsin-Yu , Chuguransky Sara , Grego Tiago , Kandasaamy Swaathi , Mitchell Alex , Nuka Gift , Paysan-Lafosse Typhaine , Qureshi Matloob , Raj Shriya , Richardson Lorna , Salazar Gustavo A , Williams Lowri , Bork Peer , Bridge Alan , Gough Julian , Haft Daniel H , Letunic Ivica , Marchler-Bauer Aron , Mi Huaiyu , Natale Darren A , Necci Marco , Orengo Christine A , Pandurangan Arun P , Rivoire Catherine , Sigrist Christian J A , Sillitoe Ian , Thanki Narmada , Thomas Paul D , Tosatto Silvio C E , Wu Cathy H , Bateman Alex , Finn Robert D
Published: October 2020

The InterPro database (https://www.ebi.ac.uk/interpro/) provides an integrative classification of protein sequences into families, and identifies functionally important domains and conserved sites. InterProScan is the underlying software that allows protein and nucleic acid sequences to be searched against InterPro's signatures. Signatures are predictive models which describe protein families, domains or sites, and are provided by multiple databases. InterPro combines signatures representing equivalent families, domains or sites, and provides additional information such as descriptions, literature references and Gene Ontology (GO) terms, to produce a comprehensive resource for protein classification. Founded in 1999, InterPro has become one of the most widely used resources for protein family annotation. Here, we report the status of InterPro (version 81.0) in its 20th year of operation, and its associated software, including updates to database content, the release of a new website and REST API, and performance improvements in InterProScan.
Determinants of Physical Activity Engagement in Patients With Nonalcoholic Fatty Liver Disease: The Need for an Individualized Approach to Lifestyle Interventions
Authors: O’Gorman Philip , Monaghan Ann , McGrath Marie , Naimimohasses Sara , Gormley John , Norris Suzanne
Published: October 2020

Objectives

Physical activity (PA) is an important non-pharmacological treatment for non-alcoholic fatty liver disease (NAFLD). This study investigated the determinants of PA engagement and awareness of the World Health Organization (WHO) PA guidelines in patients with NAFLD.

Methods

Study participants were 101 patients with NAFLD (median age: 54 [IQR = 15] y; 53 men and 48 women) who completed 4 questionnaires: (1) a PA guideline awareness questionnaire; (2) a PA questionnaire assessing PA levels; and (3) 2 questionnaires assessing perceived barriers and motivators for engaging in PA. Binary logistic regression was performed to assess predictors of PA levels.

Results

Twenty-four percent of participants correctly identified the recommended WHO weekly PA guidelines, and 39% adhered to the guidelines. Lack of willpower, time, and energy were the most frequently cited barrier domains. Scores for lack of willpower (odds ratio [OR] = 1.445, 95% CI = 1.088–1.919) and lack of resources (OR = 1.378, 95% CI = 1.003–1.893), and reporting 3 or more “significant” barrier domains (OR = 5.348, 95% CI = 1.792–15.873) were significant predictors of PA levels. Maintaining health and fitness was the most cited motivator domain and was a significant predictor (OR = 2.551, 95% CI = 1.253–5.208) of PA levels.

Conclusions

This study highlights the lack of awareness of the WHO PA guidelines and the key determinants of PA participation in patients with NAFLD. Determinants of PA should be identified at the individual level to create a personalized approach for PA maintenance for people with NAFLD to promote lifelong participation in PA.

Impact

This study closes a gap in the published data on the determinants of PA engagement in patients with NAFLD.

Lay Summary

Physical inactivity is the fourth leading cause of global mortality and contributes to many chronic inflammatory diseases, including obesity, type 2 diabetes, cardiovascular disease, and nonalcoholic fatty liver disease (NAFLD). People with NAFLD engage in less physical activity compared with people who are healthy, and this study provides new information that clinicians can use to help these patients increase their physical activity participation.
AIRBORNE RADIOMETRIC MAPPING FOR NATURAL RADIATION ASSESSMENT OVER OKITIPUPA SOUTHEAST BELT OF THE BITUMINOUS SAND FIELD OF NIGERIA
Authors: Faruwa Ajibola Richard , Qian Wei , Agbele Alaba Tolulope , Babinisi Ayodeji Bodunde , Yekeen Bolaji Ahmed
Published: October 2020

Airborne radiometric data were used for natural radiation assessment with the view to assess its likely environmental and health impact, which is one of the major factors that may pose some dangers to both physical and biological components especially during the exploitation of bitumen and also use the assessment as a baseline study that could be useful in planning appropriate environmental management programs that will reduce the potential negative effect of exploiting the resources on the environment. To determine the radiation source effects of humans, exposure rate, absorbed dose rate and annual effective dose rate were computed. The results obtained over Okitipupa southeast belt bituminous sand field indicate that the average levels of natural background radiations are generally not considered harmful. The natural activity levels were not above average and the does appear to be well within recommended limits and norms for naturally occurring activity.
Paediatric COVID-19: Milder Presentation—A Silver Lining in Dark Cloud
Authors: Ramteke Sharmila , Tikkas Rajesh , Goel Manjusha , Mandraha Shipra , Shrivastava Jyotsna
Published: October 2020

Objective

To assess the clinico-epidemiological profile of paediatric patients with Corona virus disease 2019 (COVID-19) infection during the pandemic.

Methods

Clinico-epidemiological and laboratory profile of children between 1 month and 14 years were studied between 15 May and 31 July 2020, who had positive nasopharyngeal and oropharyngeal swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by reverse transcriptase–polymerase chain reaction (RT-PCR).

Results

A total of 30 children with median age of 10.5 years (8 months to 14 years) were included in the present study. Sixty percent were boys. Twenty-seven (90%) belonged to an urban area and all 30 children were from a containment area. All were belonging to Kuppuswamy upper lower and lower socioeconomic class. Twenty-one (70%) were asymptomatic. All children had a positive household contact. Symptomatic children had only mild symptoms of fever, dry cough and rhinitis. All were fully vaccinated as per age. Nine (30%) had anaemia. The mean leucocyte count was 7470 ± 2427 (4300–14 100). Leucocytosis was seen in 3 (9%) children. C-reactive protein was found to be raised in only 4 (13%) children. We did not find alteration in sense of smell and taste. No mortality was reported.

Conclusion

COVID-19 in paediatric patients is usually mild. Severe acute respiratory infection is not a major manifestation of COVID 19 infection in children. All children infected by the novel Corona virus-2 in this study, have a documented household contact.
The Politicization of COVID-19
Authors: Halpern Lucy Wang
Published: October 2020

How politics is impeding the U.S. pandemic response.
Do Work Requirements Benefit Medicaid, SNAP, and TANF Recipients?
Authors: Myers Carole R.
Published: October 2020

Data suggest not in Arkansas, the first state to implement such requirements.
A Night in Neurosciences
Authors: Grady Allison
Published: October 2020

A clinical instructor finds herself haunted by disquieting impressions.
Selecting Scenarios for Hearing-Related Laboratory Testing
Authors: Smeds Karolina , Gotowiec Sarah , Wolters Florian , Herrlin Petra , Larsson Josefina , Dahlquist Martin
Published: October 2020

For hearing aid users to experience everyday benefit from their hearing aids, research, development, and fitting of hearing aids must be performed using evaluation methods that are indicative of everyday performance. These evaluations can take place both in peoples’ ordinary lives and in laboratory settings. For the results of laboratory testing to be ecologically valid, the selected test scenarios must capture the essence of everyday listening. The present article discusses the selection of these laboratory test scenarios in three parts. Part 1 reviews prior research on the selection of everyday listening situations for laboratory testing and discusses realistic test scenarios as important research tools. Part 2 presents findings from an ecological momentary assessments study in which 19 experienced hearing aid users reported real-time auditory reality data, including their current listening activity and their current sound environment. Participants categorized their listening situations according to the common sound scenarios framework and rated how often each situation occurred, how important it was to hear well, and how difficult it was to hear in the situation. These ratings made it possible to filter the data according to three criteria (occurrence, importance, and difficulty). The filtered data could potentially be used for selecting laboratory test scenarios. Part 3 uses the data from Part 2 and data from the studies reviewed in Part 1 to broadly explore the test scenarios that various selection criteria lead to. Further, implementation of test scenarios in the laboratory, and the strengths and limitations of data collection methods for investigating auditory reality are briefly discussed. The article concludes with a summary of the collected study.
Global Reports of Intussusception in Infants With SARS-CoV-2 Infection
Authors: Giovanni Jennifer E. , Hrapcak Susan , Melgar Michael , Godfred-Cato Shana
Published: October 2020

Idiopathic intussusception is a common cause of bowel obstruction in infants, presenting as refractory abdominal pain or mass, vomiting, lethargy, and currant jelly stool. Coronavirus disease 2019 is not well characterized in children, especially infants, but symptoms in children have included nausea, vomiting, diarrhea, and abdominal pain. From January to July 2020, intussusception was reported in 5 infants 4–10 months of age who had laboratory-confirmed SARS-CoV-2 infection. All 5 infants presented with currant jelly stool and at least 1 other abdominal symptom, and none presented with respiratory symptoms. Four infants recovered but the fifth infant progressed to a critical illness and death. While an association between SARS-CoV-2 infection and intussusception has not been established, infants with symptoms consistent with intussusception may warrant testing for viral pathogens, including SARS-CoV-2, especially if presenting to healthcare with a history of SARS-CoV-2 exposure or with signs and symptoms of COVID-19. More investigation is needed to determine whether intussusception is part of the clinical spectrum of COVID-19 in infants or a coincidental finding among infants with SARS-CoV-2 infection.
Outcomes From Re-Treatment and Cerebrospinal Fluid Analyses in Patients With Syphilis Who Had Serological Nonresponse or Lack of Seroreversion After Initial Therapy
Authors: Zhang Xiaohui , Shahum Andrea , Yang Li-Gang , Xue Yaohua , Wang Liuyuan , Yang Bin , Zheng Heping , Chen Jane S. , Radolf Justin D. , Seña Arlene C.
Published: October 2020

Background

We conducted an observational study to determine whether patients with syphilis who do not demonstrate serological cure or lack of seroreversion in nontreponemal (NT) antibody titers after initial therapy benefit from re-treatment and cerebrospinal fluid (CSF) analysis.

Methods

We enrolled patients with syphilis from sexually transmitted disease clinics in Guangzhou, China, who had persistent NT titers after therapy. Serological nonresponse was defined as a <4-fold decline in baseline NT titers after therapy. Lack of seroreversion was defined as demonstrating a ≥4-fold NT titer decline but without seroreversion to negative, or having persistent low-level titers (i.e., 1:1–1:2) after therapy. After consent, we abstracted medical record data regarding syphilis diagnoses, initial and re-treatment regimens, and serological outcomes. Nontreponemal titers were obtained from participants at enrollment and follow-up. We evaluated CSF findings among a subgroup of participants relative to re-treatment.

Results

From March 2012 to February 2016, we enrolled 135 HIV-negative patients with syphilis with persistent NT titers after initial therapy. Among 116 participants with ≥12 months of follow-up, 60 (52%) received re-treatment of syphilis. Overall, there were no significant differences in serological response between those who were re-treated and those who were not among serological nonresponders (29% vs. 27%; P = 1.0) or among participants without seroconversion (41% vs. 37%; P = 0.8). Of 60 participants who underwent CSF analyses, 8 (13%) had CSF abnormalities, but only 2 (3%) met the neurosyphilis criteria after re-treatment.

Conclusions

Most HIV-negative patients with syphilis who have serological nonresponse or lack of seroreversion after therapy do not benefit from re-treatment in the short term, and neurosyphilis is uncommon.
Implementation of a Ponseti Clubfoot Program Decreases Major Surgery: A Quality Improvement Initiative
Authors: Carry Patrick M. , Graham Susan , Whalen Karen , Burke Deborah , Baschal Robin , Holmes Kaley S. , Kohuth Brian , Georgopoulos Gaia , Miller Nancy Hadley
Published: October 2020

Introduction:

Clubfoot describes a congenital condition. If untreated, clubfoot can cause long-term functional issues. The Ponseti method is the gold-standard treatment; it emphasizes casting over surgery. We identified a high rate of major recurrence in patients with isolated clubfoot at our institution. We implemented a quality improvement intervention to address the recurrences.

Methods:

We established a clubfoot program that aimed to (1) develop a standardized treatment pathway; (2) improve care team education; (3) improve coordination of care with families; and (4) improve documentation. The purpose of this study was to outline our quality improvement intervention and evaluate its success. Data were retrospectively collected from isolated clubfeet before (2003–2007, phase I) and after (2012–2014, phase II) implementation of the clubfoot program. We compared the differences in treatment and major recurrence between the 2 phases using generalized logistic or linear mixed models. Modified Poisson regression models were used to evaluate the association between provider nonadherence and recurrence.

Results:

The pre- (phase I) and post- (phase II) implementation groups included 91 patients (131 feet) and 68 patients (101 feet), respectively. The incidence of major recurrence (odds ratio: 59.5, 95% confidence interval: 7.8–454.4, P < 0.0001) was lower during phase II compared to phase I. Nonadherence with the care pathway was associated with an increased risk of recurrence (risk ratio: 4.1, 95% confidence interval: 1.2–14.3, P = 0.0274).

Conclusions:

The implementation of a clubfoot program was associated with a decrease in major clubfoot surgery and improved adherence to established guidelines for clubfoot management.
Collagenase Treatment of Dupuytren’s Disease with Minimum 5-Year Follow-Up: Recurrence, Reintervention, and Satisfaction
Authors: Zhang Dafang , Earp Brandon E. , Benavent Kyra A. , Blazar Philip
Published: October 2020

Background:

The objective of this study was to determine the rates of patient satisfaction, perceived recurrence of flexion deformity, and additional treatment after collagenase clostridium histolyticum treatment for Dupuytren’s contracture at a minimum of 5-year follow-up.

Methods:

A retrospective study was performed of 199 digits in 142 patients who underwent collagenase clostridium histolyticum treatments from April of 2010 to December of 2013 with a minimum of 5-year follow-up. Patients were contacted by telephone regarding perceived recurrence, additional treatment, satisfaction, and willingness to undergo this treatment again.

Results:

At an average 7.2-year follow-up, 160 of 199 digits (80 percent) had perceived recurrence, and 105 of 199 digits (53 percent) underwent additional treatment. Average satisfaction was 6.5 on a Likert scale ranging from 1 to 10, and 67 percent would undergo collagenase clostridium histolyticum treatment again. Multivariable logistic regression analysis showed that higher Charlson Comorbidity Index (OR, 0.77; 95 percent CI, 0.63 to 0.93) and isolated metacarpophalangeal joint involvement (OR, 0.53; 95 percent CI, 0.29 to 0.97) were associated with decreased odds of additional treatment, and higher American Society of Anesthesiologists physical status classification (OR, 2.49; 95 percent CI, 1.35 to 4.48) and nonsmoker status (OR, 0.23; 95 percent CI, 0.09 to 0.59) were associated with willingness to undergo the treatment again.

Conclusions:

Patients may be counseled that the long-term perceived recurrence rate of Dupuytren’s contractures after collagenase clostridium histolyticum treatment is high, and more than half of patients seek additional treatment. Satisfaction and willingness to undergo collagenase clostridium histolyticum treatment decrease with perceived recurrence.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation
Authors: Levites Heather A. , Sergesketter Amanda R. , Sharif-Askary Banafesh , Hollenbeck Scott T. , Allori Alexander C. , Marcus Jeffrey R.
Published: October 2020

Limited visibility characteristic of cleft palate repair presents both ergonomic and educational challenges to cleft surgeons. Despite widespread recognition and reporting, posture-related spine disorders continue to represent a significant and potentially career-limiting problem for cleft/craniofacial surgeons. In addition, education and participation during palate repairs is difficult because of visual field constraints. At the authors’ institution, a novel videoscope system was designed and implemented to (1) provide visualization for all surgical team members during palate operations, (2) facilitate active resident education, and (3) improve surgeon ergonomics. The authors’ prior report demonstrated proof of concept for this method, which is now used in all cleft palate operations at their center. The purpose of this report is to share the detailed methodology to facilitate implementation by others and a retrospective review of the authors’ experience before and after implementation. Video demonstration of the videoscope setup and a representative, recorded case are provided. The use of the videoscope was feasible in palatoplasties regardless of palatal phenotype and repair technique and did not have an effect on operative time. Subjectively, the authors report reduced procedure time in cervical flexion and subjectively improved musculoskeletal strain associated with videoscope use. Importantly, use of this system also provided complete visualization for all operating room team members and enabled enhanced resident autonomy during palate operations. Finally, it has facilitated the creation and archive of high-definition educational videos with unparalleled perspective. The equipment required to implement the system is likely already available in many medical centers. Adoption of this system may provide an opportunity to improve posture and teaching capabilities for cleft surgeons.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Valproic Acid in the Treatment of Migraines
Authors: Brown Brandy L. , Craycraft Lauren K. , Justice Stephanie Baker
Published: October 2020

Migraine headaches can be a disabling condition for patients. Fortunately, most patients can be successfully managed in the outpatient setting, however, there are a number of patients who may not respond to the abortive treatments that they have been prescribed. These patients often present to the emergency department (ED) for further assistance with the management of their condition. Migraines are the fourth most common cause of ED visits and are associated with an estimated annual cost of $17 billion in the United States. Familiarity with abortive treatments is critical for providers in the ED as are treatments, such as valproic acid, that may be considered in patients who do not respond to other treatment options. Many providers are more familiar with the role of valproic acid in the treatment of mood and seizure disorders, but its tolerability and the successes reported in the primary literature make it a reasonable consideration for patients with migraine who fail to respond to other therapies. This article briefly summarizes the therapies considered first line for abortive treatment in the setting of migraines and provides an overview of the primary literature describing the use of valproic acid in these patients.
The general stress response of Staphylococcus aureus promotes tolerance of antibiotics and survival in whole human blood
Authors: Ranganathan Nisha , Johnson Rebecca , Edwards Andrew M.
Published: October 2020

Staphylococcus aureus

is a frequent cause of invasive human infections such as bacteraemia and infective endocarditis. These infections frequently relapse or become chronic, suggesting that the pathogen has mechanisms to tolerate the twin threats of therapeutic antibiotics and host immunity. The general stress response of

S. aureus

is regulated by the alternative sigma factor B (σB) and provides protection from multiple stresses including oxidative, acidic and heat. σB also contributes to virulence, intracellular persistence and chronic infection. However, the protective effect of σB on bacterial survival during exposure to antibiotics or host immune defences is poorly characterized. We found that σB promotes the survival of

S. aureus

exposed to the antibiotics gentamicin, ciprofloxacin, vancomycin and daptomycin, but not oxacillin or clindamycin. We also found that σB promoted staphylococcal survival in whole human blood, most likely via its contribution to oxidative stress resistance. Therefore, we conclude that the general stress response of

S. aureus

may contribute to the development of chronic infection by conferring tolerance to both antibiotics and host immune defences.
Identifying barriers and facilitators to physical activity for people with scleroderma: A nominal group technique study
Authors: Harb Sami , Cumin Julie , Rice Danielle B. , Peláez Sandra , Hudson Marie , Bartlett Susan J. , Roren Alexandra , Furst Daniel E. , Frech Tracy M. , Nguyen Christelle , Nielson Warren R. , Thombs Brett D. , Shrier Ian ,   SPIN-PACE Patient Advisory Team
Published: October 2020

Purpose

To identify physical activity barriers and facilitators experienced by people with systemic sclerosis (SSc; scleroderma).

Materials and Methods

We conducted nominal group technique sessions with SSc patients who shared barriers to physical activities, barrier-specific facilitators, and general facilitators. Participants rated importance of barriers and likelihood of using facilitators from 0-10, and indicated whether they had tried facilitators. Barriers and facilitators across sessions were subsequently merged to eliminate overlap; edited based on feedback from investigators, patient advisors, and clinicians; and categorized.

Results

We conducted nine sessions (n=41 total participants) and initially generated 181 barriers, 457 barrier-specific facilitators, and 20 general facilitators. The number of consolidated barriers (barrier-specific facilitators in parentheses) for each category were: 14 (61) for health and medical; 4 (23) for social and personal; 1 (3) for time, work, and lifestyle; and 1 (4) for environmental. There were 12 consolidated general facilitators. The consolidated items with ≥ 1/3 of participants’ ratings ≥ 8 were: 15 barriers, 69 barrier-specific facilitators, and 9 general facilitators.

Conclusions

People with SSc reported many barriers related to health and medical aspects of SSc and several barriers in other categories. They reported facilitators to remain physically active despite the barriers.

Implications for Rehabilitation

People with scleroderma experience difficulty being physically active due to the diverse and often severe manifestations of the disease, including involvement of the skin, musculoskeletal system, and internal organs.

In addition to regular care of scleroderma-related symptoms, patients overcome many exercise challenges by selecting physical activities that are comfortable for them, adjusting the intensity and duration of activities, adapting activities, and using adapted equipment or other materials to reduce discomfort.

Rehabilitation professionals should help people with scleroderma to tailor activity options to their capacity and needs when providing care and advice to promote physical activity.
Comparison of three nasopharyngeal swab types and the impact of physiochemical properties for optimal SARS-CoV-2 detection
Authors: Kahamba Trish R. , Noble Lara , Stevens Wendy , Scott Lesley
Published: October 2020

Adequate swab specimen collection, release and detection of nucleic acids by molecular diagnostic assays is largely attributed to the physical and chemical characteristics of different swab types. We investigated properties of three types of commercial nasopharyngeal swabs (nylon flocked: Type 1-Media Merge; Type 2-Kang Jian Medical Apparatus, China and Type 3-Wuxi NEST Biotechnology Co. Ltd, China) used in clinical diagnostics with the aim to establish if different swab designs and configurations had any effect on swab performance. Properties investigated included viral absorption, release, capture, extraction and recovery efficiency from each swab for the detection of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). All swab types (n=18) were inoculated with different amounts of SARS-CoV-2 live viral cultures (1:10, 1:100 and 1:1000 copies/ml) and eluted in sterile phosphate buffer saline. RNA was extracted from all swab eluates using a fully automated system (BD MAX™ System) and cycle threshold (Ct) values were compared. RNA stability was also investigated after dry storage of swabs at room temperature for 72 hours. Statistically significant differences (p<0.05) were observed in the absorption and release capabilities between Type 1 and 3 as well as between Type 2 and 3 swabs, however, no significant difference was observed between Type 1 and 2. Ct values and extraction efficiency amounts of SARS-CoV-2 varied amongst the swab types. We conclude that in order to facilitate accurate SARS-CoV-2 diagnosis, assessment of NP swab characteristics is of importance before implementation for specimen collection in the clinical setting.
Supervised self-collected SARS-CoV-2 testing in indoor summer camps to inform school reopening
Authors: Cooch Peter , Watson Annalisa , Olarte Apryl , Crawford Emily ,   CLIAhub Consortium, DeRisi Joe , Greenhouse Bryan , Hakim Jill , Turcios Keirstinne , Atkinson-McEvoy Lee , Hirsch Raphael , Keller Roberta L. , Ruel Theodore , Cohen-Ross Auritte , Leon Araceli , Bardach Naomi
Published: October 2020

Background and Objectives

Testing strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in school settings are needed to assess the efficacy of infection mitigation strategies and inform school reopening policies. We hypothesized that supervised serial self-collected non-nasopharyngeal testing in summer camp settings would be acceptable and feasible.

Methods

We performed a cohort study at two urban day camps for kindergarten-8th graders in June and July 2020. Eligible participants were campers, up to two adult household contacts, and camp staff. We assessed participation rates for providing, at two time points, supervised, self-collected anterior nares samples for reverse transcription polymerase chain reaction (RT-PCR) and saliva samples for antibody testing. We qualitatively assessed testing feasibility and adherence to stated camp infection mitigation strategies.

Results

76% (186/246) of eligible participants consented. The cohort completing both rounds of testing (n=163) comprised 67 campers, 76 household contacts, and 20 staff. Among those present, 100% of campers and staff completed test collection at both time points. Testing was feasible to implement, including staff participation supervising camper test collection. No virus was detected by RT-PCR; seven participants had antibodies. Observed adherence to stated camp mitigation policies for masking, physical distancing, and stable cohorting was generally high.

Conclusions

Supervised, self-collected serial anterior nasal and saliva-based SARS-CoV-2 testing was acceptable, with successful repeated participation by children ages 5-14. This strategy for testing and the observed infection mitigation practices comprise potential core components for safe school reopening.
Survey of Attitudes on Personal Protection Interventions Against COVID-19 Including MMR Vaccination and Future Anti-COVID Vaccines
Authors: Schulman Joseph D. , Cooper James N. , Crooks Gary W.
Published: October 2020

An electronic survey was conducted in October, 2020 among individuals primarily age 60 and older regarding their degree of confidence of deriving personal protection from 8 different anti-COVID interventions – social isolation, lockdowns, avoiding restaurants, taking MMR vaccine, wearing masks when indoors with others, avoiding hotels, avoiding commercial air travel, and using the first future specific anti-COVID vaccine. Responses were received from 135 persons from many different U.S. regions and 5 foreign countries. Respondents were generally individuals with very high levels of education and personal achievement. Results demonstrated wide diversity of responses regarding each of these interventions. None were strongly supported by a majority of respondents, but those receiving the largest proportions of strong support were social isolation (41%), wearing masks indoors (41%), and using the first anti-COVID vaccine (41%). MMR (measles-mumps-rubella) vaccination was viewed much more positively than negatively but had the highest proportion of individuals who felt they had insufficient data to formulate an opinion. The largest number of strong negative assessments were toward lockdowns (37%). We speculate that the wide variation in perception of possible benefits from the surveyed interventions, most of which have been widely practiced by or imposed upon millions of individuals, in this highly accomplished older population at increased personal risk from COVID-19 reflects the current absence of rigorous scientific proof of the efficacy of any these interventions, and the continuation of the epidemic despite the widespread utilization of most of them.