bluuebunny/crossref_metadata_2025 huggingface dataset:
A hypomorphic allele of telomerase uncovers the minimal functional length of telomeres in Arabidopsis
Authors: Watson J Matthew , Trieb Johanna , Troestl Martina , Renfrew Kyle , Mandakova Terezie , Fulnecek Jaroslav , Shippen Dorothy E , Riha Karel
Published: August 2021

Despite the essential requirement of telomeric DNA for genome stability, the length of telomere tracts between species substantially differs, raising the question of the minimal length of telomeric DNA necessary for proper function. Here, we address this question using a hypomorphic allele of the telomerase catalytic subunit, TERT. We show that although this construct partially restored telomerase activity to a tert mutant, telomeres continued to shorten over several generations, ultimately stabilizing at a bimodal size distribution. Telomeres on two chromosome arms were maintained at a length of 1 kb, while the remaining telomeres were maintained at 400 bp. The longest telomeres identified in this background were also significantly longer in wild-type populations, suggesting cis-acting elements on these arms either promote telomerase processivity or recruitment. Genetically disrupting telomerase processivity in this background resulted in immediate lethality. Thus, telomeres of 400 bp are both necessary and sufficient for Arabidopsis viability. As this length is the estimated minimal length for t-loop formation, our data suggest that telomeres long enough to form a t-loop constitute the minimal functional length.
Cytoplasmic TDP-43 is involved in cell fate during stress recovery
Authors: Lee Youn-Bok , Scotter Emma L , Lee Do-Young , Troakes Claire , Mitchell Jacqueline , Rogelj Boris , Gallo Jean-Marc , Shaw Christopher E
Published: August 2021

Transactive response DNA binding protein 43 (TDP-43) is an RNA processing protein central to the pathogenesis of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Nuclear TDP-43 mislocalizes in patients to the cytoplasm, where it forms ubiquitin-positive inclusions in affected neurons and glia. Physiologically, cytoplasmic TDP-43 is associated with stress granules (SGs). Here, we explored TDP-43 cytoplasmic accumulation and stress granule formation following osmotic and oxidative stress. We show that sorbitol drives TDP-43 redistribution to the cytoplasm, while arsenite induces the recruitment of cytoplasmic TDP-43 to TIA-1 positive SGs. We demonstrate that inducing acute oxidative stress after TDP-43 cytoplasmic relocalization by osmotic shock induces poly (ADP-ribose) polymerase (PARP) cleavage, which triggers cellular toxicity. Recruitment of cytoplasmic TDP-43 to polyribosomes occurs in an SH-SY5Y cellular stress model and is observed in FTD brain lysate. Moreover, the processing body (P-body) marker DCP1a is detected in TDP-43 granules during recovery from stress. Overall, this study supports a central role for cytoplasmic TDP-43 in controlling protein translation in stressed cells.
Disproportionate Surveillance: Technology-Assisted and Automated Decisions in Asylum Applications in the EU?
Authors: Jasmontaite-Zaniewicz Lina , Zomignani Barboza Júlia
Published: August 2021

Since the terrorist attacks of 11 September 2001 in the United States, the association between migration and security has been continuously strengthened, with multiple States working to tighten their border controls. In the European Union (EU), this trend has been shown by the frequent overlap between asylum application and migration policies and the agenda concerning border control, security, and terrorism. This securitization of migration discourse is claimed to justify the use of controversial practices to examine asylum applications. Against this background, the article reflects on the use of technology-assisted and automated decisions in this area. In particular, it questions whether the existing safeguards provided in the EU data protection framework ensure asylum seekers’ rights to privacy and the protection of personal data. In doing so, the article seeks to offer a more nuanced understanding of European asylum policy and the potential flaws therein that allow individuals’ fundamental rights – enshrined in the EU Charter and the European Convention on Human Rights – to be infringed. In conclusion, the article engages with the debate relating to the use of automated decisions, in particular those based on artificial intelligence, and whether they should be excluded from certain policy areas, such as migration.
Characterizing phenotypic abnormalities associated with high-risk individuals developing lung cancer using electronic health records from the All of Us researcher workbench
Authors: Na Jie , Zong Nansu , Wang Chen , Midthun David E , Luo Yuan , Yang Ping , Jiang Guoqian
Published: August 2021

Objective

The study sought to test the feasibility of conducting a phenome-wide association study to characterize phenotypic abnormalities associated with individuals at high risk for lung cancer using electronic health records.

Materials and Methods

We used the beta release of the All of Us Researcher Workbench with clinical and survey data from a population of 225 000 subjects. We identified 3 cohorts of individuals at high risk to develop lung cancer based on (1) the 2013 U.S. Preventive Services Task Force criteria, (2) the long-term quitters of cigarette smoking criteria, and (3) the younger age of onset criteria. We applied the logistic regression analysis to identify the significant associations between individuals’ phenotypes and their risk categories. We validated our findings against a lung cancer cohort from the same population and conducted an expert review to understand whether these associations are known or potentially novel.

Results

We found a total of 214 statistically significant associations (P < .05 with a Bonferroni correction and odds ratio > 1.5) enriched in the high-risk individuals from 3 cohorts, and 15 enriched in the low-risk individuals. Forty significant associations enriched in the high-risk individuals and 13 enriched in the low-risk individuals were validated in the cancer cohort. Expert review identified 15 potentially new associations enriched in the high-risk individuals.

Conclusions

It is feasible to conduct a phenome-wide association study to characterize phenotypic abnormalities associated in high-risk individuals developing lung cancer using electronic health records. The All of Us Research Workbench is a promising resource for the research studies to evaluate and optimize lung cancer screening criteria.
Reconstructing the “Femme-Fleur”: Floral Modernism in the Work of Madeleine Vionnet and Jeanne Lanvin
Authors: Elenowitz-Hess Caroline
Published: August 2021

The seeds of modernism had been planted before the First World War, but it was in the post-war period that there was a true blossoming of self-consciously “modern” aesthetics and the new, “modern” woman. Although modernism is often associated with the masculine, urban, and geometric—indeed, women’s fashion took a more androgynous turn—influential couturières Madeleine Vionnet and Jeanne Lanvin still drew upon traditionally feminine floral and pastoral themes to create their modern fashions.

Fashion designers were not alone in this use of the floral in a “modern” context. Writers, visual artists, architects, and garden designers of the period were also renegotiating ideas of the natural world and reinterpreting the pastoral in the context of the devastating effect of the First World War upon the people and the landscape of France. In particular, the legacy of the femme-fleur (“flower-woman”) in art, literature, and performance found new relevance in 1920s fashion, uniting ideas of modernity and renewal. For Vionnet and Lanvin, the use of floral motifs in conjunction with modernist fashions, signalled a desire to draw upon and reinterpret these long-held signals of femininity, allowing for a new understanding of womanhood while evoking the familiar, eternal and procreative elements of flowers.
Integrating Qualitative Methods and Open Science: Five Principles for More Trustworthy Research*
Authors: Humphreys Lee , Lewis Neil A , Sender Katherine , Won Andrea Stevenson
Published: August 2021

Recent initiatives toward open science in communication have prompted vigorous debate. In this article, we draw on qualitative and interpretive research methods to expand the key priorities that the open science framework addresses, namely producing trustworthy and quality research. This article contributes to communication research by integrating qualitative methodological literature with open communication science research to identify five broader commitments for all communication research: validity, transparency, ethics, reflexivity, and collaboration. We identify key opportunities where qualitative and quantitative communication scholars can leverage the momentum of open science to critically reflect on and improve our knowledge production processes. We also examine competing values that incentivize dubious practices in communication research, and discuss several metascience initiatives to enhance diversity, equity, and inclusion in our field and value multiple ways of knowing.
Neutron contamination in radiotherapy processes: a review study
Authors: Banaee Nooshin , Goodarzi Kiarash , Nedaie Hassan Ali
Published: August 2021

Using high-energy photon beams is one of the most practical methods in radiotherapy treatment of cases in deep site located tumors. In such treatments, neutron contamination induced through photoneutron interaction of high energy photons (>8 MeV) with high Z materials of LINAC structures is the most crucial issue which should be considered. Generated neutrons will affect shielding calculations and cause extra doses to the patient and the probability of increase induced secondary cancer risks. In this study, different parameters of neutron production in radiotherapy processes will be reviewed.
Biogenic volatile organic compounds in the grapevine response to pathogens, beneficial microorganisms, resistance inducers, and abiotic factors
Authors: Lazazzara Valentina , Avesani Sara , Robatscher Peter , Oberhuber Michael , Pertot Ilaria , Schuhmacher Rainer , Perazzolli Michele
Published: August 2021

The synthesis of volatile organic compounds (VOCs) in plants is triggered in response to external stimuli, and these compounds can migrate to distal tissues and neighbouring receivers. Although grapevine VOCs responsible for wine aroma and plant–insect communications are well characterized, functional properties of VOCs produced in response to phytopathogens, beneficial microorganisms, resistance inducers, and abiotic factors have been less studied. In this review, we focused on the emission patterns and potential biological functions of VOCs produced by grapevines in response to stimuli. Specific grapevine VOCs are emitted in response to the exogenous stimulus, suggesting their precise involvement in plant defence response. VOCs with inhibitory activities against pathogens and responsible for plant resistance induction are reported, and some of them can also be used as biomarkers of grapevine resistance. Likewise, VOCs produced in response to beneficial microorganisms and environmental factors are possible mediators of grapevine–microbe communications and abiotic stress tolerance. Although further functional studies may improve our knowledge, the existing literature suggests that VOCs have an underestimated potential application as pathogen inhibitors, resistance inducers against biotic or abiotic stresses, signalling molecules, membrane stabilizers, and modulators of reactive oxygen species. VOC patterns could also be used to screen for resistant traits or to monitor the plant physiological status.
Practicing Diagnostic Justice
Authors: Graham Kennedy Ashley
Published: August 2021

Via an analysis of the coronavirus disease 2019 pandemic, this chapter addresses the various uses of diagnostic testing that go beyond clinical patient care, such as the promotion of public health (via either prevention strategies or research studies). Furthermore, it addresses the question of what to do when diagnostic tests are scarce: For the physician, testing allocations should be made, in the first instance, on the basis of the needs of the individual patient, and societal concerns should be considered to be secondary. For a medical researcher, on the other hand, the priority is reversed: When acquisition of knowledge is the primary goal, considerations of individual patients and their care will necessarily be secondary.
Conclusion
Authors: Graham Kennedy Ashley
Published: August 2021

This concluding chapter reiterates the point that being a good diagnostician requires not only an understanding of probability theory and statistical analysis but also learning to listen to your patients, learning how to interpret the results of diagnostic tests by taking into account clinical considerations, learning how to manage and communicate diagnostic uncertainty in the clinical setting, understanding the potential reasons to conduct diagnostic tests or not, and being concerned with issues of diagnostic justice while keeping in mind the concerns of the actual patient who is in front of you.
Samantha Thimmaya v Lancashire NHS Foundation Trust v Mr Firas Jamil
Authors: Stanton Catherine
Published: August 2021

In Samantha Thimmaya v Lancashire NHS Trust v Mr Firas Jamal (Thimmaya), Mr Jamil, an expert witness acting for the Claimant in a clinical negligence action, was ordered to pay part of the Defendant’s costs, amounting to over £88,000. The court determined that his conduct as an expert had been ‘improper, unreasonable, or negligent’, thus enabling the court to make a third-party costs order against him. Although the case must have raised alarm amongst medical experts, the facts of the case show that it concerned a very unusual set of circumstances. Additionally, the more recent case of Walker and Walker v Tui UK Ltd v Dr Timothy Leigh (Walker), also discussed below, suggests that the threshold to be applied in determining whether costs orders should be made against experts will be higher than that applied in Thimmaya. Both cases serve as a reminder of the duties owed by experts to the court.
Linear spectropolarimetric analysis of fairall 9 with VLT/FORS2
Authors: Jiang Bo-Wei , Marziani Paola , Savić Đorđe , Shablovinskaya Elena , Popović Luka Č , Afanasiev Victor L , Czerny Bożena , Wang Jian-Min , del Olmo Ascensión , D’Onofrio Mauro , Śniegowska Marzena , Mazzei Paola , Panda Swayamtrupta
Published: August 2021

The quasar main sequence appears to be an incredibly powerful tool to organize the diversity in large samples of type-1 quasars but the most important physical parameters governing it are still unclear. Here, we investigate the origin of the broadening and of a defining feature of Population B sources: a strong redward asymmetry of the Balmer emission lines. We focus on a prototypical source, Fairall 9. Spectropolarimetric data of the Fairall 9 broad H β and H α profiles allowed for a view of the geometric and dynamical complexity of the line emitting regions. Measurements (1) provided evidence of rotational motion; (2) were helpful to test the presence of polar and equatorial scatterers, and their association with non-virial motions. However, we suggest that the polarization properties appear to be more consistent with a warped disc geometry induced by Lense–Thirring precession.
The nucleation fraction of local volume galaxies
Authors: Hoyer Nils , Neumayer Nadine , Georgiev Iskren Y , Seth Anil C , Greene Jenny E
Published: August 2021

Nuclear star clusters (NSCs) are a common phenomenon in galaxy centres and are found in a vast majority of galaxies of intermediate stellar mass $\approx 10^9\, \mathrm{M}_{\odot }$. Recent investigations suggest that they are rarely found in the least and most massive galaxies and that the nucleation fraction increases in dense environments. It is unclear whether this trend holds true for field galaxies due to the limited data currently available. Here we present our results on the nucleation fraction for 601 galaxies in the Local Volume ($\lesssim {12}{\, \mathrm{Mpc}}$). Covering more than eight orders of magnitude in stellar mass, this is the largest sample of galaxies analysed in a low-density environment. Within the Local Volume sample we find a strong dependence of the nucleation fraction on galaxy stellar mass, in agreement with previous work. We also find that for galaxies with $M_{\star } \lt 10^{9}\, \mathrm{M}_{\odot }$, early-type galaxies have a higher nucleation fraction than late-types. The nucleation fraction in the Local Volume correlates independently with stellar mass, Hubble type, and local environmental density. We compare our data to those in galaxy cluster environments (Coma, Fornax, and Virgo) by compiling previous results and calculating stellar masses in a homogeneous way. We find significantly lower nucleation fractions (up to 40 per cent) in galaxies with $M_{\star } \lesssim 10^{9.5}\, \mathrm{M}_{\odot }$, in agreement with previous work. Our results reinforce the connection between globular clusters and NSCs, but it remains unclear if it can explain the observed trends with Hubble type and local environment. We speculate that correlation between the nucleation fraction and cluster environment weakens for the densest clusters like Coma and Virgo.
Active bayerite underpinned Ag2O/Ag: an efficient antibacterial nanohybrid combating microbial contamination
Authors: Aazem Irthasa , Rathinam Prasanth , Pillai Saju , Honey Gopinathan , Vengellur Ajith , Bhat Sarita G , Sailaja G S
Published: August 2021

Active surfaces with bactericidal properties are of paramount importance in health care sector as a judicious approach to confront prevalent challenges presented by disastrous pathogenic infections and antibiotic-resistant microbes. Herein, we present Bayerite underpinned Ag2O/Ag (ALD), a nanohybrid with excellent antibacterial and antibiofilm functionalities against tested standard strains and clinical isolates. The multicomponent system coexists and complement each other with respect to phase and functionalities, demonstrated by XRD, XPS, and TEM analyses. In situ reduction of Ag+ ions to Ag0 over Bayerite as a stable bound phase is favoured by pH of the reaction, yielding 60–80% bound Ag protruding outwards facilitating active surface for interaction with microbes. ALD has a minimum inhibitory concentration (MIC) of 0.068 mg/ml against clinical isolates: Pseudomonas aeruginosa RRLP1, RRLP2, Acinetobactor baumannii C78 and C80. Disc diffusion assay demonstrated excellent antibacterial activity against standard strains (positive control: standard antibiotic disc, Amikacin). ALD incorporated PMMA films (5 and 10 wt%; PALD-5 and PALD-10) exhibited significant contact killing (99.9%) of clinical isolates in drop-test besides strong antibacterial activity (disc diffusion assay) comparable to that of ALD. ALD exemplified a dose (0.034 and 0.017 mg/ml) dependent biofilm inhibition (P < 0.001) and significant eradication of pre-formed biofilms (P < 0.001) by clinical isolates. PALD 5 and PALD 10 significantly declined the number of viable biofilm associated bacteria (99.9%) compared to control. Both ALD and PALD samples are proposed as green antibacterial materials with antibiofilm properties. Results also present ample opportunity to explore PALD as antibacterial and/or antibiofilm coating formulations.
ELTD1 deletion reduces vascular abnormality and improves T-cell recruitment after PD-1 blockade in glioma
Authors: Huang Hua , Georganaki Maria , Conze Lei Liu , Laviña Bàrbara , van Hooren Luuk , Vemuri Kalyani , van de Walle Tiarne , Ramachandran Mohanraj , Zhang Lei , Pontén Fredrik , Bergqvist Michael , Smits Anja , Betsholtz Christer , Dejana Elisabetta , Magnusson Peetra U , He Liqun , Lugano Roberta , Dimberg Anna
Published: August 2021

Background

Tumor vessels in glioma are molecularly and functionally abnormal, contributing to treatment resistance. Proteins differentially expressed in glioma vessels can change vessel phenotype and be targeted for therapy. ELTD1 (Adgrl4) is an orphan member of the adhesion G-protein-coupled receptor family upregulated in glioma vessels and has been suggested as a potential therapeutic target. However, the role of ELTD1 in regulating vessel function in glioblastoma is poorly understood.

Methods

ELTD1 expression in human gliomas and its association with patient survival was determined using tissue microarrays and public databases. The role of ELTD1 in regulating tumor vessel phenotype was analyzed using orthotopic glioma models and ELTD1−/− mice. Endothelial cells isolated from murine gliomas were transcriptionally profiled to determine differentially expressed genes and pathways. The consequence of ELTD1 deletion on glioma immunity was determined by treating tumor-bearing mice with PD-1-blocking antibodies.

Results

ELTD1 levels were upregulated in human glioma vessels, increased with tumor malignancy, and were associated with poor patient survival. Progression of orthotopic gliomas was not affected by ELTD1 deletion, however, tumor vascular function was improved in ELTD1−/− mice. Bioinformatic analysis of differentially expressed genes indicated increased inflammatory response and decreased proliferation in tumor endothelium in ELTD1−/− mice. Consistent with an enhanced inflammatory response, ELTD1 deletion improved T-cell infiltration in GL261-bearing mice after PD-1 checkpoint blockade.

Conclusion

Our data demonstrate that ELTD1 participates in inducing vascular dysfunction in glioma, and suggest that targeting of ELTD1 may normalize the vessels and improve the response to immunotherapy.
Improving perinatal depression screening and management: results from a federally qualified health center
Authors: Bruney Talitha L , Zhang Xueting
Published: August 2021

Introduction

Perinatal depression affects 8.5–20% of women. In a systematic review 22% of women with a positive depression screen use mental health services. The objective of this study was to examine the effectiveness of on-site management in the perinatal setting and barriers to care.

Methods

This is a retrospective chart review of 1042 women who received perinatal care between 1 January to 31 December 2019. Primary outcome was percentage of patients who were assessed after a positive depression screen. The secondary outcome was to determine factors affecting patients’ receptiveness to assessment/treatment.

Results

9.52% of women screened positive. Sixty-two (63.9%) met with an on-site social worker for assessment, 6 (6.2%) misunderstood the screening questions, and 33 (34.0%) met criteria for depression. Of those, 9 (27.3%) attended at least one follow-up, 8 (24.2%) were referred to or already in care, 7 (21.2%) no-showed, and 9 (27.3%) declined further care. English speaking patients were more likely to meet with a social worker for diagnostic assessment (69.9% versus 45.8%, P = 0.033).

Conclusion

On-site management of a positive depression screen yielded a follow-up rate of 64% versus 49% in other studies. Non-English language may be a barrier to accessing mental health car.
GROUNDWATER AND DRINKING WATER RADON CONCENTRATIONS IN THE COASTAL AND INTERIOR AREAS OF CHENNAI METRO CITY AND ITS IMPACT ON PUBLIC HEALTH
Authors: Banerjee Kakolee , Saravanan C , Fernandes Maria C , Kannan Vaidyanathan , Purvaja Ramachandran , Ramesh R
Published: August 2021

One hundred forty-eight water samples were collected from in and around Chennai and 222Rn concentrations were measured using radon emanometry method. The average 222Rn concentration was estimated to be 6.88, 2.01, 1.17, 0.19 and 0.10 Bq L−1 for borewell water, openwell water, tank water, metro water and lake water, respectively, which were within the U.S. Environmental Protection Agency’s (USEPA) Standard limit of 11.1 Bq L−1 and World Health Organization (WHO) global average 10 Bq L−1. The total effective dose obtained has varied from 0 to 157.57 μSv y−1 with ±10% standard deviation. The mean values were 19.608, 8.092, 4.692, 0.761 and 0.423 μSv y−1 for closed borewell, open well water, tank water, metro water and for lake water, respectively. All these values were below the reference point 0.1 mSv y−1 (100 μSv y−1) set by WHO.
Forest and Plantation Soil Microbiomes Differ in Their Capacity to Suppress Feedback Between Geosmithia morbida and Rhizosphere Pathogens of Juglans nigra Seedlings
Authors: Williams Geoffrey M. , Ginzel Matthew D.
Published: August 2021

Thousand cankers disease (TCD) is hypothesized to have a greater impact on eastern black walnut (Juglans nigra) in urban forests and plantations compared with natural forest stands. Along with other factors such as resource availability, the phytobiome could partly account for observed differences in disease severity across management regimes. We investigated the extent to which J. nigra-associated soil microbiomes from plantations and natural forests modulate (i) the amount of necrosis caused by Geosmithia morbida in 1-year-old seedlings, and (ii) relative abundance of rhizosphere endophytes and opportunistic pathogens Fusarium and Rhizoctonia in response to aboveground inoculation with G. morbida. Our results suggest that the microbiome from natural forest soil in central Indiana suppresses Fusarium spp. and is indirectly suppressive of G. morbida. Natural forest soil had a greater ability to reduce the size of necrotic area caused by G. morbida compared with steam-treated soil. Inoculating stems of seedlings with G. morbida induced a shift in fungal community composition in the rhizosphere, including Fusarium and Rhizoctonia spp.; however, the direction and magnitude of the shift depended on whether seedlings were amended with forest, plantation, or steam-treated soil. In a companion experiment, necrotic area in G. morbida-inoculated seedlings was twice as high in seedlings grown from seeds that were treated with Fusarium solani relative to those grown from seed treated with water. Our findings support the hypothesis that TCD severity can be modulated by host-mediated feedback between above- and belowground pathogens, as well as by microbial interactions in the rhizosphere.
Renal cell carcinoma, part 2
Authors: Pullen Richard L.
Published: August 2021

Renal cell carcinoma (RCC) accounts for most renal malignancies. This article, the second in a three-part series, addresses how renal masses are classified, signs and symptoms of RCC, medical treatments for RCC, and priority nursing interventions for patients with RCC.
Delusional infestation
Authors: Windbiel-Rojas Karey , Matuskey Rachel , Parilo Denise Wall
Published: August 2021

Patients with delusional infestation, a rare psychiatric disorder, have a false and fixed belief that insects or other organisms are crawling in or on their skin. This article describes signs and symptoms, available treatments, and appropriate nursing interventions for patients with primary delusional infestation.
Validity Evidence Supporting the Comunicación y Habilidades Interpersonales (CAI) Scale for Medical Spanish Communication and Interpersonal Skills Assessment
Authors: Ortega Pilar , Moxon Nathaniel R. , Chokshi Anuj K. , Pérez-Cordón Cristina , Park Yoon Soo
Published: August 2021

Purpose

While many schools teach medical Spanish to improve communication with the growing Spanish-speaking population, a standardized assessment methodology is lacking. This study evaluates validity evidence for a newly developed Spanish Communication and Interpersonal Skills (CIS) scale.

Method

The authors developed the Comunicación y Habilidades Interpersonales (CAI, pronounced /kī/) scale by culturally and linguistically adapting a 14-item validated English CIS scale. Sources of validity evidence were gathered targeting content, response process, internal structure, relations to other variables, and consequences. The CAI was administered as part of an objective structured clinical examination at 2 medical schools from April to June 2020.

Results

The authors mapped CAI items onto USMLE Step 2 CIS behavioral functions and medical Spanish learner competencies to examine content validity. The mean item difficulty and item discrimination estimates are 2.86 (SD = 0.34) and 0.81 (SD = 0.08), respectively, demonstrating good psychometric properties at the item level. Internal-consistency reliability for a single case was 0.96. Learner variance accounted for 12% of total variance, demonstrating ability to differentiate higher and lower performing learners; the person–case interaction accounted for 44% of total variance, indicating strong case specificity.

Conclusions

The CAI has higher case specificity than previously reported in English, suggesting that the nuanced contextual elements of individual cases may matter even more when learners are using limited language skills. Implementing the CAI more widely may promote inclusion of patient-centered communication skills as part of curricular content and activities. This study’s validity evidence may inform the development of a future medical Spanish certification examination.
Supported Independence: The Role of Supervision to Help Trainees Manage Uncertainty
Authors: Ilgen Jonathan S. , de Bruin Anique B.H. , Teunissen Pim W. , Sherbino Jonathan , Regehr Glenn
Published: August 2021

Purpose

Safe and effective supervised practice requires a negotiated partnership between trainees and their supervisors. Substantial work has explored how supervisors make judgments about trainees’ readiness to safely engage in critical professional activities, yet less is known about how trainees leverage the support of supervisors when they perceive themselves to be at the limits of their abilities. The purpose of this study is to explore how trainees use supervisory support to navigate experiences of clinical uncertainty.

Method

Using a constructivist grounded theory approach, the authors explored how novice emergency medicine trainees conceptualized the role of their supervisors during experiences of clinical uncertainty. They employed a critical incident technique to elicit stories from participants immediately following clinical shifts between July and September 2020, and asked participants to describe their experiences of uncertainty within the context of supervised practice. Using constant comparison, 2 investigators coded line-by-line and organized these stories into focused codes. The relationships between these codes were discussed by the research team, and this enabled them to theorize about the relationships between the emergent themes.

Results

Participants reported a strong desire for supported independence, where predictable and accessible supervisory structures enabled them to work semiautonomously through challenging clinical situations. They described a process of borrowing their supervisors’ comfort during moments of uncertainty and mechanisms to strategically broadcast their evolving understanding of a situation to implicitly invoke (the right level of) support from their supervisors. They also highlighted challenges they faced when they felt insufficiently supported.

Conclusions

By borrowing comfort from—or deliberately projecting their thinking to—supervisors, trainees aimed to strike the appropriate balance between independence for the purposes of learning and support to ensure safety. Understanding these strategic efforts could help educators to better support trainees in their growth toward self-regulation.
No Difference in Reoperation Rates for Adjacent Segment Disease (Operative Adjacent Segment Disease) in Posterior Cervical Fusions Stopping at C7 Versus T1/T2
Authors: Guppy Kern H. , Royse Kathryn E. , Fennessy Jacob , Norheim Elizabeth P. , Harris Jessica E. , Brara Harsimran S.
Published: August 2021

Study Design.

A retrospective cohort study with chart review.

Objective.

To determine whether there is a difference in reoperation rates for adjacent segment disease ([ASD] operative ASD) in posterior cervical fusions (PCFs) that stop at –C7 versus –T1/T2.

Summary of Background Data.

There are surgical treatment challenges to the anatomical complexities of the cervicothoracic junction. Current posterior cervical spine surgery is based on the belief that ASD occurs if fusions are stopped at C7 although there is varying evidence to support this assumption.

Methods.

Patients were followed until validated reoperations for ASD, membership termination, death, or March 31, 2020. Descriptive statistics and 5-year crude incidence rates and 95% confidence intervals for operative ASD for PCF ending at –C7 or –T1/T2 were reported. Time-dependent crude and adjusted multivariable Cox-Proportional Hazards models were used to evaluate operative ASD rates with adjustment for covariates or risk change estimates more than 10%.

Results.

We identified 875 patients with PCFs (beginning at C3 or C4 or C5 or C6) stopping at either –C7 (n = 470) or –T1/T2 (n = 405) with average follow-up time of 4.6 (±3.3) years and average time to operative ASD of 2.7 (±2.8) years. Crude overall incidence rates for stopping at –C7 (2.12% [1.02%–3.86%]) and –T1/T2 (2.48% [1.25%–4.40%]) were comparable with no statistical difference in risk (adjusted hazard ratio = 1.47, 95% confidence interval = 0.61–3.53, P = 0.39). In addition, we observed no differences in the probability of operative ASD in competing risk time-dependent models (Grey test P 
= 0.448).

Conclusion.

A large cohort of 875 patients with PCFs stopping at –C7 or –T1/T2 with an average follow-up of more than 4 years found no statistical difference in reoperation rates for ASD (operative ASD).

Level of Evidence: 3
Communicating Data, Information, and Knowledge in the Nursing Handoff
Authors: Galatzan Benjamin J. , Carrington Jane M.
Published: August 2021

Miscommunication occurring during the nursing handoff continues to be a primary cause of sentinel events and adverse patient outcomes. The primary purpose of the nursing handoff is to communicate essential patient data, information, and knowledge to ensure the safe continued continuity of care. The aim of this study was to examine the content of the nurse-to-nurse change-of-shift handoff communication in terms of data, information, and knowledge for both bedside and nonbedside handoffs of a patient who has experienced a clinical event. The setting was an urban medical center on a medical-surgical floor. The sample consisted of one nurse giving and one nurse receiving the handoff (n = 19 registered nurses). Five bedside and five nonbedside handoffs were audio recorded and analyzed using content analysis. The handoff overall contained 34.7% data, 51.7% information, and 13.6% knowledge. The nonbedside handoff compared with the bedside handoff contained a substantially higher percentage of data and less information. The percentage of knowledge being communicated in both the nonbedside and bedside handoff was low at 13.6% and 13.7%, respectively. The percentage of data compared with the percentage of knowledge in the handoff places the nurses at greater risk of experiencing cognitive lapses due to cognitive overload.
Development and Implementation of a Pediatric Nursing-Clinical Decision Support System for Hyperthermia
Authors: Zhao Yongxin , Hu Jing , Gu Ying , Wan Yanmin , Liu Fang , Ye Chengjie , Zhang Xiaobo
Published: August 2021

This article describes the development process and application of the Pediatric Nursing-Clinical Decision Support System for Hyperthermia. Firstly, we formed the Pediatric Nursing-Knowledge Base for Hyperthermia, which combines publicly available clinical practice guidelines and nursing routines of hyperthermia management. Then, following the nursing process framework, the system was developed using clinical decision support technology. Finally, a pre- and post-test were adopted to examine the effectiveness, usability, and feasibility before (1st to 31st of August 2018) and after (1st to 31st of December 2019) using the system. Its effectiveness was examined by analysis of nursing records' quality, including completeness of nursing assessment, timeliness of nursing diagnosis, individualization of nursing interventions, and timeliness of nursing evaluation. Its usability and feasibility were assessed using the Clinical Nursing Information System Effectiveness Evaluation Scale. There was a significant difference between the two groups in effectiveness, usability, and feasibility. Although the system was developed specifically for our hospital workflow and processes, the Pediatric Nursing-Knowledge Base for Hyperthermia and workflow for hyperthermia management in this study can be used as a reference to other hospitals.
Nuclear Dbf2-related Kinase 1 functions as tumor suppressor in glioblastoma by phosphorylation of Yes-associated protein
Authors: Chen Bin , Liu Bin , Yu Tao , Han Yun-Feng , Wu Chao , Wang Zhen-Yu
Published: August 2021

Background:

The Nuclear Dbf2-related (NDR1) kinase is a member of the NDR/LATS family, which was a supplementary of Hippo pathway. However, whether NDR1 could inhibit glioblastoma (GBM) growth by phosphorylating Yes-associated protein (YAP) remains unknown. Meanwhile, the role of NDR1 in GBM was not clear. This study aimed to investigate the role of NDR1-YAP pathway in GBM.

Methods:

Bioinformation analysis and immunohistochemistry (IHC) were performed to identify the expression of NDR1 in GBM. The effect of NDR1 on cell proliferation and cell cycle was analyzed utilizing CCK-8, clone formation, immunofluorescence and flow cytometry, respectively. In addition, the xenograft tumor model was established as well. Protein interaction was examined by Co-immunoprecipitation and immunofluorescence to observe co-localization.

Results:

Bioinformation analysis and IHC of our patients’ tumor tissues showed that expression of NDR1 in tumor tissue was relatively lower than that in normal tissues and was positively related to a lower survival rate. NDR1 could markedly reduce the proliferation and colony formation of U87 and U251. Furthermore, the results of flow cytometry showed that NDR1 led to cell cycle arrest at the G1 phase. Tumor growth was also inhibited in xenograft nude mouse models in NDR1-overexpression group. Western blotting and immunofluorescence showed that NDR1 could integrate with and phosphorylate YAP at S127 site. Meanwhile, NDR1 could mediate apoptosis process.

Conclusion:

In summary, our findings point out that NDR1 functions as a tumor suppressor in GBM. NDR1 is identified as a novel regulator of YAP, which gives us an in-depth comprehension of the Hippo signaling pathway.
Cyanoacrylate Granuloma After Cyanoacrylate Closure of Incompetent Saphenous Veins
Authors: Sermsathanasawadi Nuttawut , Pruekprasert Kanin , Chinsakchai Khamin , Wongwanit Chumpol , Ruangsetakit Chanean
Published: August 2021

BACKGROUND

Cyanoacrylate closure (CAC) is a minimally invasive surgery to treat incompetent saphenous veins.

OBJECTIVE

To evaluate the incidence, the risk factors for, and the management of cyanoacrylate granuloma (CAG) after CAC of incompetent saphenous veins in patients with chronic venous disease.

MATERIALS AND METHODS

Data specific to incompetent saphenous veins, including great saphenous veins, anterior accessory saphenous veins, and small saphenous veins, that were treated with CAC were retrospectively evaluated.

RESULTS

A total of 126 saphenous veins from 101 patients were included. Recapture of the delivery catheter before withdrawal was not performed in all patients. Cyanoacrylate granuloma occurred in 3 of 101 (2.9%) patients, and in 3 of 126 (2.3%) treated saphenous veins. All patients with CAG presented with granuloma and abscess at the puncture site 3 to 5 months after CAC. All patients were treated with incision, drainage, and removal of the glue foreign body. No recurrent granuloma was observed during the study period. No patient or procedural predictive factor for CAG was identified.

CONCLUSION

Cyanoacrylate granuloma is not a rare complication after CAC when recapture of the delivery catheter is not performed. Patients should be advised of the possibility of CAG after CAC.
Role of the Pedicled Mentalis Muscle Flap in Closure of Chin Implants in Genioplasty
Authors: Mrad Mohamed Amir , Kattan Abdullah E. , Shah Mardan Qutaiba N. M. , Almarghoub Mohammed A. , Yaremchuk Michael J.
Published: August 2021

With the purpose of obtaining an aesthetically pleasing chin appearance, genioplasty or chin augmentation can be performed through osteotomy or chin implantation, with the latter available in different sizes and materials such as silicone and porous polyethylene. The implants are traditionally placed in a subperiosteal or supraperiosteal plane with different advantages and disadvantages to each. This procedure has evolved through time with many techniques and modifications; and this article is an addition to this ongoing refinement by advocating for closure of the mentalis muscle (a paired chin muscle originating from the incisor fossa to the chin skin) over the implant after securing its position with screws (in the case of porous polyethylene) or creating a snug pocket (in the case of silicone). In this retrospective analysis, 15 patients underwent this procedure with an excellent outcome. A single patient developed numbness in the mandibular nerve territory, while another one developed a fistulating radicular cyst that was unrelated to this technique. In addition to the simple learning curve, the potential advantages of this technique include less chances of fistula formation, implant exposure, infection, extrusion, or malpositioning. Prospective studies with more subjects are required to cement our findings.
The Effectiveness of Immediate Triamcinolone Acetonide Injection after Auricular Keloid Surgery: A Prospective Randomized Controlled Trial
Authors: Burusapat Chairat , Wanichjaroen Nutthapong , Wongprakob Nuttadon , Sapruangthong Rapeepat
Published: August 2021

Background:

The earlobe and helix are common sites for keloids following ear piercing. First-line therapy involves intra-keloidal excision followed by triamcinolone acetonide (TA) injection. Yet, the optimal timing for TA injection after keloid excision remains debated. The objective of this study was to compare outcomes between immediate and delayed TA injection after auricular keloid excision.

Methods:

This was a prospective, controlled trial with patients randomized into immediate or delayed groups. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to evaluate scar quality. The number of recurrent keloid cases was recorded, defined as a VSS height of 3, POSAS thickness greater than 5, or an increase in VSS height or POSAS thickness after keloid excision. Overall complications were recorded. A P value less than 0.05 was considered statistically significant.

Results:

The immediate group contained 18 patients, and the delayed group had 16 patients. The mean age of patients was 25.52 years, and the mean maximum keloid diameter was 14.49 mm (7–32.5 mm). The immediate group reported a statistically significant lower recurrence rate than did the delayed group at 5 months (P = 0.042). No significant differences were noted between VSS and POSAS scores at 3 months, and no complications were recorded during the study.

Conclusions:

Immediate TA injection is an acceptable option for auricular keloid treatment. Here, it was associated with a lower recurrence rate than with delayed injection and resulted in no complications. The immediate and delayed groups had similar outcomes for VSS and POSAS.
Inaccuracy of brachial blood pressure and its potential impact on treatment and aortic blood pressure estimation
Authors: Kowalski Cédric , Yang Katie , Charron Thierry , Doucet Michel , Hatem Raja , Kouz Rémi , Palisaitis Donald , Schampaert Erick , Terriault Paul , Tessier Pierre , Agharazii Mohsen , Goupil Rémi
Published: August 2021

Objective:

Although brachial cuff SBP is universally used to guide hypertension management, it can differ significantly from intraarterial SBP. We examine the potential impacts of cuff-to-intraarterial brachial SBP (bSBP) mismatch on hypertension treatment and accuracy towards central SBP.

Methods:

In 303 individuals, cuff bSBP (CUFF-bSBP) and central SBP were measured using a Mobil-o-Graph simultaneously to intraarterial bSBP (IA-bSBP) and aortic SBP. According to the difference between CUFF-bSBP and IA-bSBP, we identified three phenotypes: Underestimation (CUFF-bSBP < IA-bSBP by >10 mmHg); No Mismatch (CUFF-bSBP within 10 mmHg of IA-bSBP); Overestimation (CUFF-bSBP > IA-bSBP by >10 mmHg) phenotypes. Risk of overtreatment and undertreatment, and accuracy (ARTERY society criteria: mean difference ≤5 ± 8 mmHg) were determined. A multiple linear regression model was used to assess variables associated with the bSBP difference.

Results:

Underestimation (n = 142), No Mismatch (n = 136) and Overestimation (n = 25) phenotypes had relatively similar characteristics and CUFF-bSBP (124 ± 17, 122 ± 14, 127 ± 19 mmHg, P = 0.19) but different aortic SBP (133 ± 21, 120 ± 16, 112 ± 18 mmHg, P < 0.001). In the underestimation phenotype, 59% were at risk of undertreatment (14% in No Mismatch), whereas 50% in the Overestimation phenotype were at risk of overtreatment (17% in No Mismatch). CUFF-bSBP accurately estimated aortic SBP only in the No Mismatch Group (mean difference 1.6 ± 8.2 mmHg) whereas central BP never met the accuracy criteria. Male sex, higher height and active smoking were associated with lesser underestimation of bSBP difference.

Conclusion:

The brachial cuff lacks accuracy towards intraarterial BP in a significant proportion of patients, potentially leading to increased risks of BP mismanagement and inaccurate determination of central BP. This illustrates the need to improve the accuracy of cuff-based BP monitors.
Mass Spectrometry Analysis of SARS-CoV-2 Nucleocapsid Protein Reveals Camouflaging Glycans and Unique Post-Translational Modifications
Authors: Sun Zeyu , Zheng Xiaoqin , Ji Feiyang , Zhou Menghao , Su Xiaoling , Ren Keyi , Li Lanjuan
Published: August 2021

The devastating coronavirus disease 2019 (COVID-19) pandemic has prompted worldwide efforts to study structural biological traits of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its viral components. Compared to the Spike protein, which is the primary target for currently available vaccines or antibodies, knowledge about other virion structural components is incomplete. Using high-resolution mass spectrometry, we report a comprehensive post-translational modification (PTM) analysis of nucleocapsid phosphoprotein (NCP), the most abundant structural component of the SARS-CoV-2 virion. In addition to phosphoryl groups, we show that the SARS-CoV-2 NCP is decorated with a variety of PTMs, including N-glycans and ubiquitin. Based on newly identified PTMs, refined protein structural models of SARS-CoV-2 NCP were proposed and potential immune recognition epitopes of NCP were aligned with PTMs. These data can facilitate the design of novel vaccines or therapeutics targeting NCP, as valuable alternatives to the current vaccination and treatment paradigm that is under threat of the ever-mutating SARS-CoV-2 Spike protein.