bluuebunny/crossref_metadata_2025 huggingface dataset:
Adult cardiovascular surgery and the coronavirus disease 2019 (COVID-19) pandemic: the Italian experience
Authors: Donatelli Francesco , Miceli Antonio , Glauber Mattia , Cirri Silvia , Maiello Ciro , Coscioni Enrico , Napoli Claudio
Published: August 2020

The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected all health care professionals. The outbreak required a thorough reorganization of the Italian regional local health care system to preserve resources such as ventilators, beds in intensive care units and surgical and anaesthesiological staff. Levels of priority were created, together with a rigorous triage procedure for patients with COVID-19, which led to postponement of all elective procedures. Urgent cases were discussed with the local heart team and percutaneous approaches were selected as the first treatment option to reduce hospital stay. COVID-19 and COVID-19-free pathways were created, including adequate preparation of the operating room, management of anaesthesiological procedures, transportation of patients and disinfection. It was determined that patients with chronic diseases were at increased risk of adverse outcomes. Systemic inflammation, cytokine storm and hypercoagulability associated with COVID-19 increased the risk of heart failure and cardiac death. In this regard, the early use of extracorporeal membrane oxygenation could be life-saving in patients with severe forms of acute respiratory distress syndrome or refractory heart failure. The goal of this paper was to report the Italian experience during the COVID-19 pandemic in the setting of cardiovascular surgery.
Putting the social back into sociotechnical: Case studies of co-design in digital health
Authors: Papoutsi Chrysanthi , Wherton Joseph , Shaw Sara , Morrison Clare , Greenhalgh Trisha
Published: August 2020

Objective

We sought to examine co-design in 3 contrasting case studies of technology-supported change in health care and explain its role in influencing project success.

Materials and Methods

Longitudinal case studies of a seizure detection and reporting technology for epilepsy (Southern England, 2018-2019), a telehealth service for heart failure (7 UK sites, 2016-2018), and a remote video consultation service (Scotland-wide, 2019-2020). We carried out interviews with 158 participants and collected more than 200 pages of field notes from observations. Within- and cross-case analysis was informed by sociotechnical theory.

Results

In the epilepsy case, co-design prioritized patient-facing features and focused closely around a specific clinic, which led to challenges with sustainability and mainstreaming. In the heart failure case, patient-focused co-design produced an accessible and usable patient portal but resulted in variation in uptake between clinical sites. Successful scale-up of video consultations was explained by a co-design process involving not only the technical interface, but also careful reshaping of work practices.

Discussion

A shift is needed from co-designing with technology users to co-designing with patients as service users, and with healthcare staff as professionals. Good co-design needs to involve users, including those who engage with the technology-supported service bothdirectly and indirectly. It requires sensitivity to emergence and unpredictability in complex systems. Healthcare staff need to be supported to accommodate iterative change in the service. Adequate resourcing and infrastructures for systems-focused co-design are essential.

Conclusions

If co-design focuses narrowly on the technology, opportunities will be missed to coevolve technologies alongside clinical practices and organizational routines.
Transcriptomic, Morphological, and Developmental Comparison of Adult Honey Bee Queens (Apis mellifera) Reared From Eggs or Worker Larvae of Differing Ages
Authors: Yi Yao , Liu Yi Bo , Barron Andrew B , Zeng Zhi Jiang
Published: August 2020

Queens and workers are very distinct phenotypes that develop from the same genome. Larvae from worker cells up to 3.5 d old can be transferred to larger queen cells and will subsequently be reared as queens and develop into functional queens. This has become a very popular queen rearing practice in contemporary apiculture. Here we used RNA-Seq to study the consequences of rearing queens from transplanted worker larvae on the transcriptome of the adult queens. We found that queens reared from transferred older larvae developed slower, weighted less, and had fewer ovarioles than queens reared from transferred eggs, indicating queens were cryptically intercaste. RNA-Seq analysis revealed differentially expressed genes between queens reared from transferred larvae compared with queens reared from transferred eggs: the older the larvae transferred, the greater the number of differentially expressed genes. Many of the differentially expressed genes had functions related to reproduction, longevity, immunity, or metabolism, suggesting that the health and long-term viability of queens was compromised. Our finds verify the previous studies that adult queens reared from older transferred larvae were of lower quality than queens reared from transferred eggs or younger larvae.
Evaluating Behavioral Responses of Selected Stink Bugs (Hemiptera: Pentatomidae) to Spinosad
Authors: Hernowo Kukuh , Kamminga Kathy , Davis Jeffrey A
Published: August 2020

Southern green stink bug, Nezara viridula (L.) and redbanded stink bug, Piezodorus guildinii (Westwood) are two of the most important seed sucking pests affecting Louisiana soybean production and rice stink bug, Oebalus pugnax (F.) is an important late season pest in Louisiana rice. Exploration of chemicals that exhibit attraction or repellent activities toward major stink bug species would be beneficial in developing push–pull strategies. Spinosad is a commercially available natural insecticide that may have arrestant, attractant, or phagostimulant properties against stink bugs. To test this, a series of laboratory experiments were conducted to investigate the tactile, olfactory, and feeding responses of these stink bugs toward two commercial spinosad products (Entrust and Tracer) and technical grade spinosad. In tactile assays, female and male redbanded stink bug were arrested by Entrust, Tracer, and technical grade spinosad, whereas only rice stink bug and southern green stink bug males were arrested by Entrust. Y-tube assays revealed no attraction to any of the products by either male or female rice stink bug, redbanded stink bug, or southern green stink bug. In paired (treated or untreated soybean seed) feeding preference experiments, southern green stink bug showed no preference for any treatment, whereas redbanded stink bug fed more on Entrust- and Tracer-treated seed. From these results, spinosad appears to have an arrestant and phagostimulant effect on redbanded stink bug in the laboratory.
Return to School for Pediatric Solid Organ Transplant Recipients in the United States During the Coronavirus Disease 2019 Pandemic: Expert Opinion on Key Considerations and Best Practices
Authors: Downes Kevin J , Danziger-Isakov Lara A , Cousino Melissa K , Green Michael , Michaels Marian G , Muller William J , Orscheln Rachel C , Sharma Tanvi S , Statler Victoria A , Wattier Rachel L , Ardura Monica I
Published: August 2020

The coronavirus disease 2019 (COVID-19) pandemic has created many challenges for pediatric solid organ transplant (SOT) recipients and their families. As the pandemic persists, patients and their families struggle to identify the best and safest practices for resuming activities as areas reopen. Notably, decisions about returning to school remain difficult. We assembled a team of pediatric infectious diseases (ID), transplant ID, public health, transplant psychology, and infection prevention and control specialists to address the primary concerns about school reentry for pediatric SOT recipients in the United States. Based on available literature and guidance from national organizations, we generated consensus statements pertaining to school reentry specific to pediatric SOT recipients. Although data are limited and the COVID-19 pandemic is highly dynamic, our goal was to create a framework from which providers and caregivers can identify the most important considerations for each pediatric SOT recipient to promote a safe return to school.
An Experimental Evaluation of an Online Interview Scheduler: Effects on Fieldwork Outcomes
Authors: McGonagle Katherine , Sastry Narayan
Published: August 2020

In recent years, household surveys have expended significant effort to counter well-documented increases in direct refusals and greater difficulty contacting survey respondents. A substantial amount of fieldwork effort in panel surveys using telephone interviewing is devoted to the task of contacting the respondent to schedule the day and time of the interview. Higher fieldwork effort leads to greater costs and is associated with lower response rates. A new approach was experimentally evaluated in the 2017 wave of the Panel Study of Income Dynamics (PSID) Transition into Adulthood Supplement (TAS) that allowed a randomly selected subset of respondents to choose their own day and time of their telephone interview through the use of an online appointment scheduler. TAS is a nationally representative study of US young adults aged 18–28 years embedded within the worlds’ longest running panel study, the PSID. This paper experimentally evaluates the effect of offering the online appointment scheduler on fieldwork outcomes, including number of interviewer contact attempts and interview sessions, number of days to complete the interview, and response rates. We describe panel study members’ characteristics associated with uptake of the online scheduler and examine differences in the effectiveness of the treatment across subgroups. Finally, potential cost-savings of fieldwork effort due to the online appointment scheduler are evaluated.
An Aide Memoire for a Balancing Act? Critiquing The ‘Balance Sheet’ Approach to Best Interests Decision-Making
Authors: Kong Camillia , Coggon John , Dunn Michael , Keene Alex Ruck
Published: August 2020

The balance sheet is commonly used as a deliberative approach to decide best interests in Court of Protection cases in England and Wales, since Thorpe LJ in Re A (Male Sterilisation) described the balance sheet as a tool to enable judges and best interests decision-makers to quantify, compare, and calculate the different options at play. Recent judgments have critically reflected on the substance and practical function of the balance sheet approach, highlighting the practical stakes of its implicit conceptual assumptions and normative commitments. Using parallel debates in proportionality, we show that the balance sheet imports problematic assumptions of commensurability and aggregation, which can both overdetermine the outcome of best interests decisions and obfuscate the actual process of judicial deliberation. This means that the decision-making of judges and best interests assessors more generally could fail to properly reflect the nature of values at stake, as well as the skills of practical judgment needed to compare such values with sensitivity and nuance. The article argues that critical reflection of the balance sheet makes vital space for a more contextualised, substantive mode of deliberation which emphasises skills of qualitative evaluation towards enhancing conditions of articulation around the range of values involved in best interests decision-making.
TYC 8327-1678-1: a new super lithium-rich K giant
Authors: Holanda N , Drake N A , Pereira C B
Published: August 2020

In this work, we show that TYC 8327-1678-1 is a low-mass red giant star with a super lithium abundance in its atmosphere. For this, we used high-resolution spectroscopy to determine atmospheric parameters, the chemical abundances of the light elements and the isotopic ratio 12C/13C using the spectral synthesis techniques and the equivalent width measurements. Also, we used theoretical evolutionary tracks to find out the mass and the evolutionary stage of TYC 8327-1678-1. The lithium abundance was determined using the Li i resonance doublet at  6708 Å  and the subordinate line at  6104 Å that yielding a mean value of $\log \, \epsilon {\rm (Li)_{NLTE}}\, =\, 3.48$. The projected rotational velocity ($v\, \sin \, i$) has been determined using spectral synthesis based on the isolated Fe i lines. Our results show that TYC 8327-1678-1 has a mass of $M\, =\, 1.60$ $\pm \, 0.20\, {\rm M}_{\odot }$, a low rotational velocity ($v\, \sin \, i$ = 2.35 ± 0.24 km s−1) and metallicity of [Fe/H] = +0.23 ± 0.09. Finally, we discuss the possibility that TYC 8327-1678-1 became a lithium-rich star after a merging event involving a red giant and a helium white dwarf.
Trans-Alfvénic magnetohydrodynamic turbulence in the vicinity of supernova remnant Cassiopeia-A shocks
Authors: Vishwakarma Pavan Kumar , Kumar Jais
Published: August 2020

Statistics of the magnetic field disturbances in supernova remnants (SNRs) can be accessed using the second-order correlation function of the synchrotron intensities. Here we measure the magnetic energy spectra in the supernova remnant Cassiopeia-A by two-point correlation of the synchrotron intensities, using a recently developed unbiased method. The measured magnetic energy spectra in the vicinity of supernova remnant shocks are found to be a 2/3 power law over the decade of range scales, showing the developed trans-Alfvénic magnetohydrodynamic turbulence. Our results are globally consistent with the theoretical prediction of trans-Alfvénic Mach number in developed magnetohydrodynamic turbulence and can be explained by amplification of the magnetic field in the vicinity of SNR shocks. The magnetic energy spectra predict SNR Cassiopeia-A to have an additional subshock in the radio frequency observation along with forward and reverse shocks, with a radial window of the amplified magnetic field of ∼ 0.115 pc near the shocks.
Multiwavelength investigation of extended green object G19.88-0.53: revealing a protocluster
Authors: Issac Namitha , Tej Anandmayee , Liu Tie , Varricatt Watson , Vig Sarita , Ishwara Chandra C H , Schultheis Mathias , Nandakumar Govind
Published: August 2020

A multiwavelength analysis of star formation associated with the extended green object, G19.88-0.53 is presented in this paper. With multiple detected radio and millimetre components, G19.88-0.53 unveils as harbouring a protocluster rather than a single massive young stellar object. We detect an ionized thermal jet using the upgraded Giant Meterwave Radio Telescope, India, which is found to be associated with a massive, dense and hot ALMA 2.7 mm core driving a bipolar CO outflow. Near-infrared spectroscopy with UKIRT–UIST shows the presence of multiple shock-excited H2 lines concurrent with the nature of this region. Detailed investigation of the gas kinematics using ALMA data reveals G19.88-0.53 as an active protocluster with high-mass star-forming components spanning a wide evolutionary spectrum from hot cores in accretion phase to cores driving multiple outflows to possible UCH ii regions.
Quantifying the statistics of CMB-lensing-derived galaxy cluster mass measurements with simulations
Authors: Zubeldia Íñigo , Challinor Anthony
Published: August 2020

Cosmic microwave background (CMB) lensing is a promising, novel way to measure galaxy cluster masses that can be used, e.g. for mass calibration in galaxy cluster counts analyses. Understanding the statistics of the galaxy cluster mass observable obtained with such measurements is essential if their use in subsequent analyses is not to lead to biased results. We study the statistics of a CMB lensing galaxy cluster mass observable for a Planck-like experiment with mock observations obtained from an N-body simulation. We quantify the bias and intrinsic scatter associated with this observable following two different approaches, one in which the signal due to the cluster and nearby correlated large-scale structure is isolated, and another one in which the variation due to uncorrelated large-scale structure is also taken into account. For our first approach, we also quantify deviations from lognormality in the scatter, finding them to have a negligible impact on mass calibration for our Planck-like experiment. We briefly discuss how some of our results change for experiments with higher angular resolution and lower noise levels, such as the current generation of surveys obtained with ground-based, large-aperture telescopes.
Divergent Evolution of a Protein–Protein Interaction Revealed through Ancestral Sequence Reconstruction and Resurrection
Authors: Laursen Louise , Čalyševa Jelena , Gibson Toby J , Jemth Per
Published: August 2020

The postsynaptic density extends across the postsynaptic dendritic spine with discs large (DLG) as the most abundant scaffolding protein. DLG dynamically alters the structure of the postsynaptic density, thus controlling the function and distribution of specific receptors at the synapse. DLG contains three PDZ domains and one important interaction governing postsynaptic architecture is that between the PDZ3 domain from DLG and a protein called cysteine-rich interactor of PDZ3 (CRIPT). However, little is known regarding functional evolution of the PDZ3:CRIPT interaction. Here, we subjected PDZ3 and CRIPT to ancestral sequence reconstruction, resurrection, and biophysical experiments. We show that the PDZ3:CRIPT interaction is an ancient interaction, which was likely present in the last common ancestor of Eukaryotes, and that high affinity is maintained in most extant animal phyla. However, affinity is low in nematodes and insects, raising questions about the physiological function of the interaction in species from these animal groups. Our findings demonstrate how an apparently established protein–protein interaction involved in cellular scaffolding in bilaterians can suddenly be subject to dynamic evolution including possible loss of function.
Community-Based Referential Music Making with Limited-Resource Adolescents: A Pilot Study
Authors: Thomas Natasha
Published: August 2020

Black/African American adolescents from limited-resource communities face challenges and circumstances that are unique to their racialization and socioeconomic status; this merits community-engaged resources, such as community music therapy, that are equally unique in creating culturally responsive opportunities for limited-resource adolescents to engage socially with peers and experience meaningful success in a safe, supportive environment. The purpose of this study was to pilot and explore the feasibility of and behavioral processes in a community-based referential music-making intervention for limited-resource adolescents labeled as “at-risk.” The methods consisted of a concurrent nested (embedded) mixed methods design based on the principles of participatory actions research (PAR), during which qualitative data were collected during 8 focus group style music-making sessions. Quantitative data assessing self-efficacy were collected prior to first and following the 8th music-making session. The validity of quantitative results was challenged by the lowered reading level of participants and a high amount of mis-labeled (and thus unusable) data. Qualitative data suggest 3 themes, including creating community, artistic prioritization, and pride. All results were impacted by issues, such as inconsistent attendance and malfunctioning recording equipment. Nevertheless, participants expressed a collective desire to share their work with their community group. Discussion points are raised including how participants in this community music therapy-based approach were able to create and direct their own stories. The implementation of community music therapy approaches seems a valuable way to bring authentic representations of limited-resource adolescent participants into clinical practice.
Investigating the pharmacodynamic durability of GalNAc–siRNA conjugates
Authors: Brown Christopher R , Gupta Swati , Qin June , Racie Timothy , He Guo , Lentini Scott , Malone Ryan , Yu Mikyung , Matsuda Shigeo , Shulga-Morskaya Svetlana , Nair Anil V , Theile Christopher S , Schmidt Karyn , Shahraz Azar , Goel Varun , Parmar Rubina G , Zlatev Ivan , Schlegel Mark K , Nair Jayaprakash K , Jayaraman Muthusamy , Manoharan Muthiah , Brown Dennis , Maier Martin A , Jadhav Vasant
Published: August 2020

One hallmark of trivalent N-acetylgalactosamine (GalNAc)-conjugated siRNAs is the remarkable durability of silencing that can persist for months in preclinical species and humans. Here, we investigated the underlying biology supporting this extended duration of pharmacological activity. We found that siRNA accumulation and stability in acidic intracellular compartments is critical for long-term activity. We show that functional siRNA can be liberated from these compartments and loaded into newly generated Argonaute 2 protein complexes weeks after dosing, enabling continuous RNAi activity over time. Identical siRNAs delivered in lipid nanoparticles or as GalNAc conjugates were dose-adjusted to achieve similar knockdown, but only GalNAc–siRNAs supported an extended duration of activity, illustrating the importance of receptor-mediated siRNA trafficking in the process. Taken together, we provide several lines of evidence that acidic intracellular compartments serve as a long-term depot for GalNAc–siRNA conjugates and are the major contributor to the extended duration of activity observed in vivo.
Structural basis for transcription inhibition by E. coli SspA
Authors: Wang Fulin , Shi Jing , He Dingwei , Tong Bei , Zhang Chao , Wen Aijia , Zhang Yu , Feng Yu , Lin Wei
Published: August 2020

Stringent starvation protein A (SspA) is an RNA polymerase (RNAP)-associated protein involved in nucleotide metabolism, acid tolerance and virulence of bacteria. Despite extensive biochemical and genetic analyses, the precise regulatory role of SspA in transcription is still unknown, in part, because of a lack of structural information for bacterial RNAP in complex with SspA. Here, we report a 3.68 Å cryo-EM structure of an Escherichia coli RNAP-promoter open complex (RPo) with SspA. Unexpectedly, the structure reveals that SspA binds to the E. coli σ70-RNAP holoenzyme as a homodimer, interacting with σ70 region 4 and the zinc binding domain of EcoRNAP β′ subunit simultaneously. Results from fluorescent polarization assays indicate the specific interactions between SspA and σ70 region 4 confer its σ selectivity, thereby avoiding its interactions with σs or other alternative σ factors. In addition, results from in vitro transcription assays verify that SspA inhibits transcription probably through suppressing promoter escape. Together, the results here provide a foundation for understanding the unique physiological function of SspA in transcription regulation in bacteria.
XRCC1 promotes replication restart, nascent fork degradation and mutagenic DNA repair in BRCA2-deficient cells
Authors: Eckelmann Bradley J , Bacolla Albino , Wang Haibo , Ye Zu , Guerrero Erika N , Jiang Wei , El-Zein Randa , Hegde Muralidhar L , Tomkinson Alan E , Tainer John A , Mitra Sankar
Published: August 2020

Homologous recombination/end joining (HR/HEJ)-deficient cancers with BRCA mutations utilize alternative DNA double-strand break repair pathways, particularly alternative non-homologous end joining or microhomology-mediated end joining (alt-EJ/MMEJ) during S and G2 cell cycle phases. Depletion of alt-EJ factors, including XRCC1, PARP1 and POLQ, is synthetically lethal with BRCA2 deficiency; yet, XRCC1 roles in HR-deficient cancers and replication stress are enigmatic. Here, we show that after replication stress, XRCC1 forms an active repair complex with POLQ and MRE11 that supports alt-EJ activity in vitro. BRCA2 limits XRCC1 recruitment and repair complex formation to suppress alt-EJ at stalled forks. Without BRCA2 fork protection, XRCC1 enables cells to complete DNA replication at the expense of increased genome instability by promoting MRE11-dependent fork resection and restart. High XRCC1 and MRE11 gene expression negatively impacts Kaplan–Meier survival curves and hazard ratios for HR-deficient breast cancer patients in The Cancer Genome Atlas. The additive effects of depleting both BRCA2 and XRCC1 indicate distinct pathways for replication restart. Our collective data show that XRCC1-mediated processing contributes to replication fork degradation, replication restart and chromosome aberrations in BRCA2-deficient cells, uncovering new roles of XRCC1 and microhomology-mediated repair mechanisms in HR-deficient cancers, with implications for chemotherapeutic strategies targeting POLQ and PARP activities.
Thoracolumbar Junction Orientation: A Novel Guide for Sagittal Correction and Proximal Junctional Kyphosis Prediction in Adult Spinal Deformity Patients
Authors: Moon Hong Joo , Bridwell Keith H , Theologis Alekos A , Kelly Micheal P , Lertudomphonwanit Thamrong , Lenke Lawrence G , Gupta Munish C
Published: August 2020

BACKGROUND

Novel radiographic sagittal parameters of the thoracolumbar junction orientation (TLJO, thoracolumbar slope [TLS] and thoracolumbar tilt [TLT]) have been introduced and correlated with lumbopelvic parameters and thoracic kyphosis.

OBJECTIVE

To determine a predictive model for reciprocal thoracic kyphosis and proximal junctional kyphosis (PJK) based on the TLJO.

METHODS

A total of 127 patients who had fusion from sacrum to T10-L2 from 2004 to 2014 were reviewed. TK (T5-T12), PI, SS, PT, LL, and proximal junctional angle (PJA) were measured preoperatively, 6 wk postoperatively, and at final follow-up. TLJO was measured by TLS and TLT. Changes between time points were determined (preop-6 wk = ΔParameterPre6wk and preop-final follow/up = ΔParameterPreFinal). Scoliosis Research Society (SRS) and Oswestry Disability Index (ODI) questionnaires were evaluated at final follow-up. Patients were divided into 2 groups based on the presence of PJK (ΔPJAPreFinal >15°). Independent t-tests and receiver operating characteristic (ROC) curves were used to investigate the significance of differences and cut-off values. Pearson correlations and linear regressions were used to analyze the entire cohort to determine the relationship between the changes in parameters.

RESULTS

Compared to patients without PJK (n = 100), those with PJK (n = 27) had significantly lower SRS scores and significantly greater ΔTKPreFinal, ΔLLPre6wk, and ΔTLSPre6wk. To maintain in the nonPJK group, ROC curves demonstrated a cut-off value of −9.4° for ΔTLSPre6wk. PJK was significantly correlated with ΔTKPreFinal and ΔTLSPre6wk. The linear correlation revealed that ΔTLSPre6wk < −25.3° is the risk factor of PJK > 15°.

CONCLUSION

As change of TLS reflects lumbopelvic realignment and influences reciprocal TK, reducing the change of TLS may be a sagittal realignment guideline to reduce the risk of PJK.
Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia in preterm infants
Authors: Lemyre Brigitte , Dunn Michael , Thebaud Bernard
Published: August 2020

Historically, postnatal corticosteroids have been used to prevent and treat bronchopulmonary dysplasia (BPD), a significant cause of morbidity and mortality in preterm infants. Administering dexamethasone to prevent BPD in the first 7 days post-birth has been associated with increasing risk for cerebral palsy, while early inhaled corticosteroids appear to be associated with an increased risk of mortality. Neither medication is presently recommended to prevent BPD. New evidence suggests that prophylactic hydrocortisone, when initiated in the first 48 hours post-birth, at a physiological dose, and in the absence of indomethacin, improves survival without BPD, with no adverse neurodevelopmental effects at 2 years. This therapy may be considered by clinicians for infants at highest risk for BPD. Routine dexamethasone therapy for all ventilator-dependent infants is not recommended, but after the first week post-birth, clinicians may consider a short course of low-dose dexamethasone (0.15 mg/kg/day to 0.2 mg/kg/day) for individual infants at high risk for, or with evolving, BPD. There is no evidence that hydrocortisone is an effective or safe alternative to dexamethasone for treating evolving or established BPD. Current evidence does not support inhaled corticosteroids for the treatment of BPD.
From Cancer Rehabilitation to Recreation: A Coordinated Approach to Increasing Physical Activity
Authors: Dennett Amy M , Peiris Casey L , Shields Nora , Taylor Nicholas F
Published: August 2020

Participation in adequate physical activity improves the health status of cancer survivors, enhances their survival, and reduces their risk of cancer recurrence. However, cancer survivors engage in low levels of physical activity and have limited access to rehabilitation services that could increase their participation. No optimal framework has been developed that supports physical activity participation among cancer survivors. Given the growth in numbers of cancer survivors, development of a framework may provide a pathway to facilitate timely and appropriate care. This perspective paper describes the development of the Cancer Rehabilitation to Recreation (CaReR) Framework and its practical implications. The CaReR Framework uses a tailored, stepped approach to guide health services and clinicians on the design and implementation of interventions to promote physical activity among cancer survivors. Implementation of the CaReR Framework will improve continuity and quality of care for cancer survivors and promote physical activity with the ultimate aim of improving health outcomes.
Factors Associated With Rehabilitation Outcomes in Patients With Unilateral Vestibular Hypofunction: A Prospective Cohort Study
Authors: Herdman Susan J , Hall Courtney D , Heusel-Gillig Lisa
Published: August 2020

Objective

The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR).

Methods

In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, percent of time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge.

Results

There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure, most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed, and falls after the onset of the unilateral vestibular hypofunction (UVH) predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of Dynamic Gait Index scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk.

Conclusions

Therapists may use these findings for patient education or to determine the need for adjunct therapy, such as counseling.

Impact

Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR; these findings will help therapists create better predictive models.
Diagnostic Accuracy of Clinical Tests for the Indirect Assessment of Hip Abductor Muscle Strength in Community-Dwelling Older Women
Authors: Porto Jaqueline Mello , Cangussu-Oliveira Luciana Mendes , Freire Junior Renato Campos , Vieira Flávio Tavares , Martins Pâmela Precinotto , Bandeira Anne Caroline Lima , de Abreu Daniela Cristina Carvalho
Published: August 2020

Objective

The objective of this study was to determine the accuracy of 3 clinical tests (lateral step [LS], tandem gait [TG], and single-leg stance [SS]) in identifying older women with reduced hip abductor muscle strength and to determine the post-test probability of each test and of their combination in changing the certainty of diagnosis.

Methods

In this cross-sectional study, a total of 123 older women received clinical testing to obtain the variables LS height, time for TG execution, percentage of errors in TG, and time of permanence on SS and were tested for isometric hip abductor peak torque using an isokinetic dynamometer. Only the dominant lower limb was evaluated. Multiple linear regression analysis with adjustment was performed to determine the association among variables, followed by the receiver operating characteristic curve to identify clinical variables that can discriminate older women with reduced abductor muscle strength. Post-test probability was then calculated based on the receiver operating characteristic curve data.

Results

Although the 4 clinical variables showed correlation with abductor peak torque, only LS and TG time were able to discriminate reduced abductor muscle strength with low accuracy (area under the curve was between 0.5 and 0.7). However, the combination of LS and TG time increased post-test probability from 47% (prevalence of weakness in the population) to 76% when both tests were positive and reduced it from 47% to 18% when both tests were negative.

Conclusion

The combination of the LS test and TG time is useful for the indirect assessment of hip abductor strength in community-dwelling older women.

Impact

Hip abductor muscle strength is extremely important for function in older women. This study presents clinicians with simple, fast, and inexpensive methods for assessing hip abductor muscle strength.
Magnetic Resonance Imaging Studies in Duchenne Muscular Dystrophy: Linking Findings to the Physical Therapy Clinic
Authors: Senesac Claudia R , Barnard Alison M , Lott Donovan J , Nair Kavya S , Harrington Ann T , Willcocks Rebecca J , Zilke Kirsten L , Rooney William D , Walter Glenn A , Vandenborne Krista
Published: August 2020

Duchenne muscular dystrophy (DMD) is a muscle degenerative disorder that manifests in early childhood and results in progressive muscle weakness. Physical therapists have long been an important component of the multidisciplinary team caring for people with DMD, providing expertise in areas of disease assessment, contracture management, assistive device prescription, and exercise prescription. Over the last decade, magnetic resonance imaging of muscles in people with DMD has led to an improved understanding of the muscle pathology underlying the clinical manifestations of DMD. Findings from magnetic resonance imaging (MRI) studies in DMD, paired with the clinical expertise of physical therapists, can help guide research that leads to improved physical therapist care for this unique patient population. The 2 main goals of this perspective article are to (1) summarize muscle pathology and disease progression findings from qualitative and quantitative muscle MRI studies in DMD and (2) link MRI findings of muscle pathology to the clinical manifestations observed by physical therapists with discussion of any potential implications of MRI findings on physical therapy management.
Multimodal Balance Training Supported by Rhythmic Auditory Stimuli in Parkinson Disease: Effects in Freezers and Nonfreezers
Authors: Capato Tamine T C , de Vries Nienke M , IntHout Joanna , Ramjith Jordache , Barbosa Egberto R , Nonnekes Jorik , Bloem Bastiaan R
Published: August 2020

Objective

To fulfill the potential of nonpharmacological interventions for people with Parkinson disease (PD), individually tailored treatment is needed. Multimodal balance training supported by rhythmic auditory stimuli (RAS) can improve balance and gait in people with PD. The purpose of this study was to determine whether both freezers and nonfreezers benefit.

Methods

A secondary analysis was conducted on a large randomized controlled trial that included 154 patients with PD (Hoehn & Yahr Stages 1–3 while ON-medication) who were assigned randomly to 3 groups: (1) multimodal balance training with RAS delivered by a metronome (RAS-supported multimodal balance training); (2) regular multimodal balance training without rhythmic auditory cues; and (3) a control intervention (involving an educational program). Training was performed for 5 weeks, twice per week. The primary outcome was the Mini-BESTest score directly after the training period. Assessments were performed by a single, masked assessor at baseline, directly postintervention, and after 1-month and 6-month follow-up. Outcomes were analyzed in 1 analysis, and the results were presented separately for freezers and nonfreezers with a linear mixed model, adjusted for baseline Mini-BESTest scores, Unified Parkinson’s Disease Rating Scale scores, and levodopa equivalent dose.

Results

In both freezers and nonfreezers, both RAS-supported multimodal training and regular training significantly improved the Mini-BESTest scores compared with baseline scores and with the control group scores. The improvement was larger for RAS-supported training compared with regular training, for both freezers and nonfreezers. Only the RAS-supported training group retained the improvements compared with baseline measurements at 6-month follow-up, and this was true for both freezers and nonfreezers.

Conclusions

RAS-supported multimodal training is effective in improving balance performance in both freezers and nonfreezers.

Impact

Until this study, it was unknown whether both freezers and nonfreezers could benefit from multimodal balance training. With this information, clinicians who work with people with PD will be better able to apply personalized gait rehabilitation.

Lay Summary

Adding rhythmic auditory stimuli (RAS) to balance training is beneficial for both freezers and nonfreezers, at least in persons with mild to moderate disease stages. This RAS-supported multimodal training has good potential for a wider clinical implementation with good long-term effects.
Factors associated with variation in emergency diagnoses of cancer at general practice level in England
Authors: Joyce Kevin , Zermanos Terezija , Badrinath Padmanabhan
Published: August 2020

Background

Cancer patients diagnosed following an emergency presentation have poorer outcomes. We explore whether practice characteristics are associated with differences in the proportion of emergency presentations.

Methods

Univariable and multivariable logistic regression models were fitted to investigate the relationships between 2017–18 emergency cancer presentations at practice level in England and access and continuity in primary care, trust in healthcare professionals, 2-week-wait (2WW) referrals, quality and outcomes framework (QOF) achievements and socio-demographic factors (age, gender and deprivation).

Results

Our analysis using comprehensive nationwide data found that the following practice level factors have significant associations with a lower proportion of emergency diagnosis of cancer: increased trust and confidence in the practice healthcare professionals; higher 2WW referral and conversion rate; higher total practice QOF score and higher satisfaction with appointment times or higher proportion able to see preferred GP. Our results also show that practices in more deprived areas are significantly associated with a higher proportion of emergency diagnoses of cancer.

Conclusions

Regional cancer networks should focus their efforts in increasing both the quantity and appropriateness of 2WW referrals from primary care. In addition, primary care clinicians should be supported to undertake high quality consultations, thus building trust with patients and ensuring continuity of care.
Clinical value of amyloid-beta1-40 as a marker of thrombo-inflammation in antiphospholipid syndrome
Authors: Tektonidou Maria G , Kravvariti Evrydiki , Vlachogiannis Nikolaos I , Georgiopoulos Georgios , Mantzou Aimilia , Sfikakis Petros P , Stellos Konstantinos , Stamatelopoulos Kimon
Published: August 2020

Objective

Amyloid-beta1-40 (Aβ40) is a pro-inflammatory peptide under investigation as a novel biomarker of vascular inflammation, endothelial dysfunction and atherothrombosis in the general population. Herein we tested the hypothesis that Aβ40 is deregulated in APS, a systemic autoimmune disease characterized by a thrombo-inflammatory state.

Methods

Between January 2016 and July 2017, we consecutively recruited 80 regularly followed thrombotic APS patients (44 primary, 36 SLE/APS) and 80 age- and sex-matched controls. Plasma Aβ40 levels were measured using ELISA and APS-related clinical and laboratory characteristics were recorded. The adjusted Global Anti-Phospholipid Syndrome Score (aGAPSS), a validated risk score in APS, was calculated as a comparator to Aβ40 performance to detect arterial thrombotic APS-related events.

Results

Higher Aβ40 levels were significantly associated with the presence of APS [odds ratio (OR) 1.024 per 1 pg/ml (95% CI 1.007, 1.041)] after adjustment for cardiovascular risk factors (CVRFs), including smoking, arterial hypertension, dyslipidaemia and BMI, and for estimated glomerular filtration rate (eGFR). Among APS patients, increased high-sensitivity CRP (hs-CRP) serum levels was the only independent determinant of Aβ40 levels. Importantly, Aβ40 levels above the optimal receiver operating characteristics (ROC)-derived cut-off value were independently associated with recurrent arterial events [OR 4.93 (95% CI 1.31, 18.51)] after adjustment for age, sex, CVRFs, hs-CRP and high anti-β2 glycoprotein I IgG titres. Finally, by ROC curve analysis, Aβ40 provided incremental additive value over the aGAPSS by significantly improving its discrimination ability for recurrent arterial thromboses.

Conclusion

In APS, Aβ40 plasma levels are elevated and associated with an adverse thrombo-inflammatory profile. The pathophysiological and prognostic role of Aβ40 in APS merits further investigation.
Why Public Sector Union Members Support Their Unions: Survey and Experimental Evidence
Authors: Hertel-Fernandez Alexander , Porter Ethan
Published: August 2020

Despite their decline, unions, and especially public sector unions, remain important civic and economic associations. Yet, we lack an understanding of why public sector union members voluntarily support unions. We report on a field experiment conducted during a 2017 Iowa teachers union recertification election. We randomly assigned union members to receive emails describing union benefits and measured effects on turnout effort (N = 10,461). Members were more likely to try to vote when reminded of the unions’ professional benefits and community—but not legal protections or political representation. A follow-up survey identified the specific aspects of professional identity and benefits that members most valued and why. In a context where union membership and support is voluntary among professionalized workers, our findings emphasize the possibility of training for fostering shared identities and encouraging support for public sector unions. Our results have broader implications for understanding the public sector labor movement in a context of legal retrenchment.
Evaluation of the effects of various force configurations and magnitudes on scoliotic curve correction by use of finite element analysis: A case study
Authors: Karimi Mohammad Taghi , Rabczuk Timon , Luthfi Mauludin
Published: August 2020

Background:

Scoliosis is a three-dimensional (3-D) spinal deformity that is associated with changes in the alignment of the spine in sagittal, frontal, and transverse planes. Various treatment approaches have been used to control scoliotic curve progression and decrease the curve. Although various braces have been used in this regard, it would be difficult to check the effects of multiple types of braces on scoliotic curve correction for each scoliotic patient. Therefore, the aim of this study was to evaluate the effects of various force magnitudes and configurations on scoliotic curve correction.

Methods:

A 3-D model of a scoliotic patient was produced based on CT scan images of the total spine. The scoliotic curves were 21 and 45 degrees in lumbar and thoracic parts, respectively. Mimics software was used to produce a 3-D model of the spine. The stress developed in the spine structure and the magnitude of correction achieved were evaluated following the use of various force configurations and magnitudes by use of finite element analysis (FEA).

Results:

The results of this analysis showed that vertical forces were more effective than transversely directed forces in decreasing scoliotic curve. There was an inverse relationship between the corrections of lumbar and thoracic curves. However, use of vertically directed forces decreased both lumbar and thoracic curves. An increase in the magnitude of transverse forces did not increase the correction, but it did increase the stress developed in the structure.

Conclusions:

The results of this case study confirmed the efficiency of vertically directed forces to decrease scoliotic curves of lumbar and thoracic spinal parts. The results of this analysis confirmed the results of the available literature, which support the efficiency of some braces such as Boston, Lyon, and Cheneau, which were mostly designed based on full contact and vertical traction. The results of this study also support the feasibility of finite element analysis to predict the output of brace treatment by use of various force configurations.

Level of Evidence:

Level IV.
Sublaminar decompression and fusion versus transforaminal lumbar interbody fusion in management of lumbar degenerative disorders: a retrospective cohort study
Authors: Khalid Saleh Mohammed , Elhewala Tarek A.
Published: August 2020

Introduction:

Sublaminar decompression is a new technique that includes partial laminectomy and facetectomy providing a wide central, foraminal, and lateral recess decompression and leaving maximal bone posterior and posterolateral to allow adequate fusion. The aim of this study was to evaluate the efficacy and safety of sublaminar decompression in comparison to standard transforaminal lumbar interbody fusion (TLIF).

Methods:

Forty patients with degenerative lumbar disorders were managed with spinal fusion at the Zagazig University Hospital. The patients were divided into two groups. Group 1 included 20 patients managed with sublaminar decompression and instrumented fusion with a mean patient age of 47.7±10.4 yr. The patients in group 2 had a mean age of 45.3±10.3 yr and were managed with TLIF. The patients were assessed clinically and by radiographs, and using a visual analogue scale (VAS) of pain and Owestry Disability Index (ODI) as outcome measures. Statistically significant differences between preoperative and the final follow-up means were assessed using paired t-test test. P<0.05 was statistically significant.

Results:

In comparing the two groups regarding correction rate for different radiographic and clinical parameters, this study found significant changes in anteroposterior thecal diameter (P=0.002) and right foraminal height (P=0.004) and highly significant differences in left foraminal height (P<0.001) and thecal sac area (P<0.001) in favor of the sublaminar group. There were no significant differences in VAS for leg (P=0.979) and back pain (P=0.119) or ODI (P=0.0.497).

Conclusion:

When compared to TLIF, sublaminar decompression and fusion is a safe and effective procedure in the treatment of stenotic degenerative spinal disorders.

Level of Evidence:

Level III.