bluuebunny/crossref_metadata_2025 huggingface dataset:
No es tan simple como parece
Authors: Melero-García Fernando , Cisneros Alejandro
Published: June 2020

This study analyzes the effect of duration on the perception of Spanish /ɾ/ and /r/. A total of 143 participants completed a questionnaire with 183 stimuli. The stimuli were Spanish words with one single intervocalic tap whose duration was manipulated. Participants listened to each stimulus once, selected the word they heard, and rated its pronunciation. The results suggest that the perception of /r/ significantly increases as duration increases. However, those stimuli identified as /r/ were not considered good exemplars of such category. The stimuli identified as /ɾ/ that had shorter duration were perceived as good instances of such category, but as duration increased, the ratings for /ɾ/ decreased. The phonological implications of these results are discussed in this article.
The acquisition of obligatory and variable mood selection in epistemic predicates by L2 learners and heritage speakers of Spanish
Authors: Lustres Eduardo , Cuza Alejandro , García-Tejada Aída
Published: June 2020

The present study examines the extent to which L2 learners and HS of Spanish acquire target knowledge of subjunctive mood selection in Spanish. Specifically, we analyze obligatory and variable selection in temporal and concessive constructions. Ten HS of Spanish, ten English-speaking L2 learners and fifteen controls from Mexico completed a sentence completion task. Results indicate significant differences between the two experimental groups and the monolingual control group. The HS outperformed the L2 learners in three of the six conditions-tested. No significant differences were found between obligatory and variable subjunctive selection within the epistemic modality. Results suggest that the obligatory nature of mood selection does not play a role in the acquisition of the Spanish subjunctive within the epistemic modality.
Detecting a forced signal in satellite-era sea-level change
Authors: Richter Kristin , Meyssignac Benoit , Slangen Aimée B A , Melet Angélique , Church John A , Fettweis Xavier , Marzeion Ben , Agosta Cécile , Ligtenberg Stefan R M , Spada Giorgio , Palmer Matthew D , Roberts Christopher D , Champollion Nicolas
Published: June 2020

In this study, we compare the spatial patterns of simulated geocentric sea-level change to observations from satellite altimetry over the period 1993–2015 to assess whether a forced signal is detectable. This is challenging, as on these time scales internal variability plays an important role and may dominate the observed spatial patterns of regional sea-level change. Model simulations of regional sea-level change associated with sterodynamic sea level, atmospheric loading, glacier mass change, and ice-sheet surface mass balance changes are combined with observations of groundwater depletion, reservoir storage, and dynamic ice-sheet mass changes. The resulting total geocentric regional sea-level change is then compared to independent measurements from satellite altimeter observations. The detectability of the climate-forced signal is assessed by comparing the model ensemble mean of the ‘historical’ simulations with the characteristics of sea-level variability in pre-industrial control simulations. To further minimize the impact of internal variability, zonal averages were produced. We find that, in all ocean basins, zonally averaged simulated sea-level changes are consistent with observations within sampling uncertainties associated with simulated internal variability of the sterodynamic component. Furthermore, the simulated zonally averaged sea-level change cannot be explained by internal variability alone—thus we conclude that the observations include a forced contribution that is detectable at basin scales.
Environmental impacts of extreme fast charging
Authors: Jenn Alan , Clark-Sutton Kyle , Gallaher Michael , Petrusa Jeffrey
Published: June 2020

As electric vehicles and their associated charging infrastructure continue to evolve, there is potential to simultaneous alleviate range and recharge concerns with the development of extreme fast chargers (XFC) that can fully charge batteries in PEVs in the span of a few minutes. Recent announcements from EVSE providers and vehicle manufacturers suggest that XFC charging stations, which can recharge a BEV at roughly 20 to 25 miles per minute of charging, and XFC-capable BEVs, could be commercially available within the next 5 years. Our study investigates the potential emission impacts of widespread use of extreme fast charging (350 kW) for electric vehicles in 2030. We conduct a novel vehicle charging simulation model by combining empirical charging behavior data across several data sources. These charging demands are then added as exogenous load to the Grid Optimized Operation Dispatch (GOOD) model, which simulates the operation of generators across the Untied States. We find that XFC can increase both greenhouse gas emissions and local air pollutants, though the results are sensitive to local contexts and grid composition.
Katz, Arthur J.
Authors: Logan Sadye L. M.
Published: June 2020

Arthur J. Katz (1924–2018) had a distinguished career in social work. He made outstanding contributions to social work as a practitioner, advocate, educator, author, consultant, administrator, teacher, and dean. He held a variety and combination of unique and significant roles in social-work leadership.
High-quantile regression for tail-dependent time series
Authors: Zhang Ting
Published: June 2020

Quantile regression is a popular and powerful method for studying the effect of regressors on quantiles of a response distribution. However, existing results on quantile regression were mainly developed for cases in which the quantile level is fixed, and the data are often assumed to be independent. Motivated by recent applications, we consider the situation where (i) the quantile level is not fixed and can grow with the sample size to capture the tail phenomena, and (ii) the data are no longer independent, but collected as a time series that can exhibit serial dependence in both tail and non-tail regions. To study the asymptotic theory for high-quantile regression estimators in the time series setting, we introduce a tail adversarial stability condition, which had not previously been described, and show that it leads to an interpretable and convenient framework for obtaining limit theorems for time series that exhibit serial dependence in the tail region, but are not necessarily strongly mixing. Numerical experiments are conducted to illustrate the effect of tail dependence on high-quantile regression estimators, for which simply ignoring the tail dependence may yield misleading $p$-values.
Model-Based Comparison of Cloud-Edge Computing Resource Allocation Policies
Authors: Jiang Lili , Chang Xiaolin , Yang Runkai , Mišić Jelena , Mišić Vojislav B
Published: June 2020

The rapid and widespread adoption of internet of things-related services advances the development of the cloud-edge framework, including multiple cloud datacenters (CDCs) and edge micro-datacenters (EDCs). This paper aims to apply analytical modeling techniques to assess the effectiveness of cloud-edge computing resource allocation policies from the perspective of improving the performance of cloud-edge service. We focus on two types of physical device (PD)-allocation policies that define how to select a PD from a CDC/EDC for service provision. The first is randomly selecting a PD, denoted as RandAvail. The other is denoted as SEQ, in which an available idle PD is selected to serve client requests only after the waiting queues of all busy PDs are full. We first present the models in the case of an On–Off request arrival process and verify the approximate accuracy of the proposed models through simulations. Then, we apply analytical models for comparing RandAvail and SEQ policies, in terms of request rejection probability and mean response time, under various system parameter settings.
Avian mortality risk during heat waves will increase greatly in arid Australia during the 21st century
Authors: Conradie Shannon R , Woodborne Stephan M , Wolf Blair O , Pessato Anaïs , Mariette Mylene M , McKechnie Andrew E
Published: June 2020

Intense heat waves are occurring more frequently, with concomitant increases in the risk of catastrophic avian mortality events via lethal dehydration or hyperthermia. We quantified the risks of lethal hyperthermia and dehydration for 10 Australian arid-zone avifauna species during the 21st century, by synthesizing thermal physiology data on evaporative water losses and heat tolerance limits. We evaluated risks of lethal hyperthermia or exceedance of dehydration tolerance limits in the absence of drinking during the hottest part of the day under recent climatic conditions, compared to those predicted for the end of this century across Australia. Increases in mortality risk via lethal dehydration and hyperthermia vary among the species modelled here but will generally increase greatly, particularly in smaller species (~10–42 g) and those inhabiting the far western parts of the continent. By 2100 CE, zebra finches’ potential exposure to acute lethal dehydration risk will reach ~ 100 d y−1 in the far northwest of Australia and will exceed 20 d y−1 over > 50% of this species’ current range. Risks of dehydration and hyperthermia will remain much lower for large non-passerines such as crested pigeons. Risks of lethal hyperthermia will also increase substantially for smaller species, particularly if they are forced to visit exposed water sources at very high air temperatures to avoid dehydration. An analysis of atlas data for zebra finches suggests that population declines associated with very hot conditions are already occurring in the hottest areas. Our findings suggest that the likelihood of persistence within current species ranges, and the potential for range shifts, will become increasingly constrained by temperature and access to drinking water. Our model adds to an increasing body of literature suggesting that arid environments globally will experience considerable losses of avifauna and biodiversity under unmitigated climate change scenarios.
Recommendations to enhance rigor and reproducibility in biomedical research
Authors: Brito Jaqueline J , Li Jun , Moore Jason H , Greene Casey S , Nogoy Nicole A , Garmire Lana X , Mangul Serghei
Published: June 2020

Biomedical research depends increasingly on computational tools, but mechanisms ensuring open data, open software, and reproducibility are variably enforced by academic institutions, funders, and publishers. Publications may present software for which source code or documentation are or become unavailable; this compromises the role of peer review in evaluating technical strength and scientific contribution. Incomplete ancillary information for an academic software package may bias or limit subsequent work. We provide 8 recommendations to improve reproducibility, transparency, and rigor in computational biology—precisely the values that should be emphasized in life science curricula. Our recommendations for improving software availability, usability, and archival stability aim to foster a sustainable data science ecosystem in life science research.
Performance Evaluation of Thyroid Function Tests on a Novel Chemiluminescent Microparticle Immunoassay System
Authors: Ahn Sunyoung , Cho Yonggeun , Lee Sang-Guk , Kim Jeong-Ho
Published: June 2020

Background

The Alinity i system (Abbott), a recently developed automated immunoassay analyzer, has a compact footprint and a throughput of 200 tests per hour. Here, we present the first performance evaluation of thyroid function test (TFT) on the Alinity i system.

Methods

We performed precision, linearity, comparison, functional sensitivity, carryover, and reference interval verification of 4 hormones (Thyroid Stimulation Hormone; TSH, total T3, free T4, and total T4) using the reagents provided by the manufacturer following the guidelines of the Clinical Laboratory Standards Institute. The performance of Alinity i was compared to that of the Architect i2000 immunoassay analyzer (Abbott, US).

Results

The within-laboratory coefficients of variation for all the hormones were 1.6–3.6%. Linearity was observed for all the hormones over the entire tested analytical range (R2 ≥ 0.99). The results for all the evaluated hormones using Alinity i system strongly correlated (r ≥ 0.978) with those from Architect i2000. Functional sensitivity was lower than the lower limit of the analytical measurement range. Sample carryover was less than 1.0%.

Conclusions

TFTs on the Alinity i system showed acceptable performance in terms of precision, linearity, comparison, functional sensitivity, and carryover. Therefore, this system could be a useful laboratory tool for performing TFTs.
Understanding Autonomy: An Urgent Intervention
Authors: Reis-Dennis Samuel
Published: June 2020

In this paper, I argue that the principle of respect for autonomy can serve as the basis for laws that significantly limit conduct, including orders mandating isolation and quarantine. This thesis is fundamentally at odds with an overwhelming consensus in contemporary bioethics that the principle of respect for autonomy, while important in everyday clinical encounters, must be ‘curtailed’, ‘constrained’, or ‘overridden’ by other principles in times of crisis. I contend that bioethicists have embraced an indefensibly ‘thin’ notion of autonomy that uproots the concept from its foundations in Kantian ethics. According to this thin conception, respect for autonomy, if unconditioned by competing principles (beneficence, justice, non-maleficence) would give competent adults the right to do anything they desired to do so long as they satisfied certain baseline psychological conditions. I argue that the dominant ‘principlist’ model of bioethical reasoning depends on this thin view of autonomy and show how it deprives us of powerful analytical tools that would help us to think seriously about the foundations of human rights, justice, and law. Then, I offer a brief sketch of a ‘thick’, historically grounded notion of autonomy and show what we could gain by taking it seriously.
Evaluating Mergers and Divestitures: A Casino Case Study
Authors: Osinski F David , Sandford Jeremy A
Published: June 2020

Despite frequent use in practice, merger remedies receive little attention in the economics literature. We analyze the 2013 merger of two casino operators and the subsequent divestiture of one St. Louis casino. Using public data from the Missouri Gaming Commission, we employ a difference-in-difference framework with other Missouri casinos as the control group to estimate separate effects of the merger and divestiture on each St. Louis casino. Results indicate the merged firm benefited from efficiencies, resulting in lower prices and higher quantity; however, the divested casino performed worse than before the merger. Synthetic control estimates confirm these results. This study raises questions about whether to assess remedies by the performance of the divested asset or the consumer welfare of the entire merger. It also raises questions regarding remedy endogeneity: do firms face incentives to offer declining assets? Both have applicability beyond this case, supporting the need for further research. (JEL L1, L4)
WordNet construction for under-resourced languages using personalized PageRank
Authors: Berangi Parisa , Mousavi Zahra , Faili Heshaam , Shakery Azadeh
Published: June 2020

Wordnet development is an active research area among NLP researchers. Since the manual construction of the English wordnet was very costly both in terms of time and human expertise, automatic approaches have become very popular for wordnet development in languages other than English. Automatic methods usually benefit from an existing wordnet of a high resource language and use it as the backbone of their work. In this article, we present an unsupervised approach for automatic wordnet construction using a combination of Expectation–Maximization and personalized PageRank algorithms. Our method uses some typical and available language resources, so it is applicable to many languages including under-resourced ones. The proposed method needs just a bilingual dictionary and a monolingual corpus for developing a wordnet. In order to evaluate the proposed method, we apply it to the Persian language which is identified as an under-resourced language in NLP tasks. Evaluation results properly indicate the power of the proposed method to construct a high quality and large-scale wordnet for poor-resource languages. According to experiments, we achieve a precision of higher than 93% with a recall of 50%.
Pulsation in the white dwarf HE 1017−1352: confirmation of the class of hot DAV stars
Authors: Romero Alejandra D , Antunes Amaral L , Kepler S O , Fraga L , Kurtz D , Shibahashi H
Published: June 2020

We report the detection of periodic variations on the $T_\mathrm{eff}\simeq 32\, 000$ K DA white dwarf star HE 1017−1352. We obtained time series photometry using the 4.1-m Southern Astrophysical Research telescope on three separate nights for a total of 16.8 h. From the frequency analysis, we found four periods of 605, 556, 508, and 869 s with significant amplitudes above the 1/1000 false alarm probability detection limit. The detected modes are compatible with low harmonic degree g-mode non-radial pulsations with radial order higher than ∼9. This detection confirms the pulsation nature of HE 1017−1352 and thus the existence of the new pulsating class of hot DA white dwarf stars. In addition, we detect a long period of 1.52 h, compatible with a rotation period of DA white dwarf stars.
Determining Safe Participation in Aerobic Exercise Early After Stroke Through a Graded Submaximal Exercise Test
Authors: Inness Elizabeth L , Aqui Anthony , Foster Evan , Fraser Julia , Danells Cynthia J , Biasin Louis , Brunton Karen , Howe Jo-Anne , Poon Vivien , Tang Ada , Mansfield Avril , Marzolini Susan , Oh Paul , Bayley Mark
Published: June 2020

Objective

The benefits of aerobic exercise early after stroke are well known, but concerns about cardiovascular risk are a barrier to clinical implementation. Symptom-limited exercise testing with electrocardiography (ECG) is recommended but not always feasible. The purpose of this study was to determine the frequency of and corresponding exercise intensities at which ECG abnormalities occurred during submaximal exercise testing that would limit safe exercise prescription beyond those intensities.

Methods

This study was a retrospective analysis of ECGs from 195 patients who completed submaximal exercise testing during stroke rehabilitation. A graded submaximal exercise test was conducted with a 5- or 12-lead ECG and was terminated on the basis of predetermined endpoint criteria (heart rate, perceived exertion, signs, or symptoms). ECGs were retrospectively reviewed for exercise-induced abnormalities and their associated heart rates.

Results

The peak heart rate achieved was 65.4% (SD = 10.5%) of the predicted maximum heart rate or 29.1% (SD = 15.5%) of the heart rate reserve (adjusted for beta-blocker medications). The test was terminated more often because of perceived exertion (93/195) than because of heart rate limits (60/195). Four patients (2.1%) exhibited exercise-induced horizontal or downsloping ST segment depression of ≥1 mm. Except for 1 patient, the heart rate at test termination was comparable with the heart rate associated with the onset of the ECG abnormality.

Conclusion

A graded submaximal exercise test without ECG but with symptom monitoring and conservative heart rate and perceived exertion endpoints may facilitate safe exercise intensities early after stroke. Symptom-limited exercise testing with ECG is still recommended when progressing to higher intensity exercise.

Impact

Concerns about cardiovascular risk are a barrier to physical therapists implementing aerobic exercise in stroke rehabilitation. This study showed that, in the absence of access to exercise testing with ECG, submaximal testing with conservative heart rate and perceived exertion endpoints and symptom monitoring can support physical therapists in the safe prescription of aerobic exercise early after stroke.

Lay Summary

It is recommended that people with stroke participate in aerobic exercise as early as possible during their rehabilitation. A submaximal exercise test with monitoring of heart rate, perceived exertion, blood pressure, and symptoms can support physical therapists in safely prescribing that exercise.
The Drape Tower: A “Hands-Free” Draping Technique for Intraoperative Lateral Fluoroscopy Views
Authors: Lin Carol A.
Published: June 2020

Maintaining surgical field sterility during fracture surgery is critical for reducing the likelihood of postoperative infection. Lateral fluoroscopic views are frequently obtained by rotating the emitter under the bed and up immediately adjacent to the sterile field on the side of the injured limb. Contamination can be prevented by sterilely covering the emitter with each rotation from the upright to the lateral positions. Here, we describe a novel draping setup, which maintains fluoroscopic coverage in a “hands-free” manner. The technique uses widely available materials and allows the surgeon to proceed with surgery without the need for additional hands to manage the drape.
Increased Mortality and Major Complications in Hip Fracture Care During the COVID-19 Pandemic: A New York City Perspective
Authors: Egol Kenneth A. , Konda Sanjit R. , Bird Mackenzie L. , Dedhia Nicket , Landes Emma K. , Ranson Rachel A. , Solasz Sara J. , Aggarwal Vinay K. , Bosco Joseph A. , Furgiuele David L. , Ganta Abhishek , Gould Jason , Lyon Thomas R. , McLaurin Toni M. , Tejwani Nirmal C. , Zuckerman Joseph D. , Leucht Philipp ,   for The NYU COVID Hip Fracture Research Group
Published: June 2020

Objectives:

To examine one health system's response to the essential care of its hip fracture population during the COVID-19 pandemic and report on its effect on patient outcomes.

Design:

Prospective cohort study.

Setting:

Seven musculoskeletal care centers within New York City and Long Island.

Patients/Participants:

One hundred thirty-eight recent and 115 historical hip fracture patients.

Intervention:

Patients with hip fractures occurring between February 1, 2020, and April 15, 2020, or between February 1, 2019, and April 15, 2019, were prospectively enrolled in an orthopaedic trauma registry and chart reviewed for demographic and hospital quality measures. Patients with recent hip fractures were identified as COVID positive (C+), COVID suspected (Cs), or COVID negative (C−).

Main Outcome Measurements:

Hospital quality measures, inpatient complications, and mortality rates.

Results:

Seventeen (12.2%) patients were confirmed C+ by testing, and another 14 (10.1%) were suspected (Cs) of having had the virus but were never tested. The C+ cohort, when compared with Cs and C− cohorts, had an increased mortality rate (35.3% vs. 7.1% vs. 0.9%), increased length of hospital stay, a greater major complication rate, and a greater incidence of ventilator need postoperatively.

Conclusions:

COVID-19 had a devastating effect on the care of patients with hip fracture during the pandemic. Although practice patterns generally remained unchanged, treating physicians need to understand the increased morbidity and mortality in patients with hip fracture complicated by COVID-19.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.
Pediatric Anxiety in Practice: A Knowledge and Needs Assessment of Pediatricians and Nurses
Authors: Rozenman Michelle , Patarino Kassidy M.
Published: June 2020

Objective:

To assess pediatric primary care providers' (PCPs) knowledge, perceived barriers, and needs related to child and adolescent anxiety in their practice.

Methods:

Primary care providers licensed and practicing in the state of Colorado were invited to complete an online knowledge and needs assessment. The survey queried their knowledge of pediatric anxiety, experience in assessing and treating anxiety, perceived barriers in their practice setting to adequately addressing youth anxiety, and interest in additional training on this topic.

Results:

Survey completers included 115 PCPs (51 medical doctors and 64 nurses/nurse practitioners). PCPs had been practicing with their current medical license with pediatric patients for an average of 14 years (SD = 10.45), and 70% reported that they regularly discuss anxiety with patients and parents. Although PCPs had a basic knowledge of youth anxiety, there appeared to be significant gaps in PCP knowledge. Specifically, knowledge gaps included evidence-based assessment and treatment, how to differentiate between developmentally appropriate, transient episodes of anxiety versus anxiety disorders, and where and how to refer youth for specialty services. Nearly all (80%) PCPs indicated that they would be “extremely interested” in additional training in pediatric anxiety, particularly if it occurred in their organizational setting, at a nearby community setting, or online.

Conclusion:

Primary care providers reported that a substantial proportion of the patients they see struggle with anxiety. PCPs also reported a growing need for training in how to assess, treat, and refer anxious youth. This needs assessment supports a need for the development of easily accessible training and resources for PCPs to better support their pediatric patients.
Validity of Antineoplastic Procedure Codes in the Danish National Patient Registry
Authors: Broe Martin Oskar , Jensen Peter Bjødstrup , Mattsson Thea Otto , Pottegård Anton
Published: June 2020

Background:

Procedure codes in the Danish National Patient Registry are used for administrative purposes and are a potentially valuable resource for epidemiologic research. To our knowledge, the validity of antineoplastic procedure codes has only been evaluated in one study.

Methods:

We randomly extracted a sample of 420 patients in the Southern Region of Denmark with a diagnosis of colorectal cancer and an oncology contact during 2016–2018. Using the medical record as gold standard, we computed the positive predictive value (PPV) and sensitivity of antineoplastic procedure codes recorded in the Danish National Patient Registry.

Results:

We identified 2,243 codes for antineoplastic treatments in the registry and 2,299 in the medical records. We confirmed that 213 of 214 patients with registered therapies in the Danish National Patient Registry received therapy, corresponding to a PPV of “any registration” of 1.00 (95% confidence interval [CI] = 0.97, 1.00). Considering single registrations, the overall PPV was 0.95 (95% CI = 0.94, 0.95), and the overall sensitivity was 0.90 (95% CI = 0.89, 0.91). Number of recorded treatments and treatments administered were strongly correlated. Considering the most frequent single antineoplastic regimens, PPV ranged from 0.90 (95% CI = 0.87, 0.92) for capecitabine to 0.98 (95% CI = 0.95, 1.00) for cetuximab, whereas sensitivity ranged from 0.81 (95% CI = 0.75, 0.87) for 5-fluorouracil and irinotecan (FOLFIRI) regimen to 0.97 (95% CI = 0.94, 0.99) for bevacizumab. Analysis per hospital showed the highest validity of registrations at the University Hospital.

Conclusion:

The validity of antineoplastic procedure codes in the Danish National Patient Registry is generally high and thus usable for epidemiologic research.
Adaptive Validation Design
Authors: Collin Lindsay J. , MacLehose Richard F. , Ahern Thomas P. , Nash Rebecca , Getahun Darios , Roblin Douglas , Silverberg Michael J. , Goodman Michael , Lash Timothy L.
Published: June 2020

An internal validation substudy compares an imperfect measurement of a variable with a gold-standard measurement in a subset of the study population. Validation data permit calculation of a bias-adjusted estimate, which has the same expected value as the association that would have been observed had the gold-standard measurement been available for the entire study population. Existing guidance on optimal sampling for validation substudies assumes complete enrollment and follow-up of the target cohort. No guidance exists for validation substudy design while cohort data are actively being collected. In this article, we use the framework of Bayesian monitoring methods to develop an adaptive approach to validation study design. This method monitors whether sufficient validation data have been collected to meet predefined criteria for estimation of the positive and negative predictive values. We demonstrate the utility of this method using the Study of Transition, Outcomes and Gender—a cohort study of transgender and gender nonconforming people. We demonstrate the method’s ability to determine efficacy (when sufficient validation data have accumulated to obtain estimates of the predictive values that fall above a threshold value) and futility (when sufficient validation data have accumulated to conclude the mismeasured variable is an untenable substitute for the gold-standard measurement). This proposed method can be applied within the context of any parent epidemiologic study design and modified to meet alternative criteria given specific study or validation study objectives. Our method provides a novel approach to effective and efficient estimation of classification parameters as validation data accrue.
Ionizing Radiation Alters the Transition/Transversion Ratio in the Exome of Human Gingiva Fibroblasts
Authors: Nath Neetika , Hagenau Lisa , Weiss Stefan , Tzvetkova Ana , Jensen Lars R. , Kaderali Lars , Port Matthias , Scherthan Harry , Kuss Andreas W.
Published: June 2020

Little is known about the mutational impact of ionizing radiation (IR) exposure on a genome-wide level in mammalian tissues. Recent advancements in sequencing technology have provided powerful tools to perform exome-wide analyses of genetic variation. This also opened up new avenues for studying and characterizing global genomic IR-induced effects. However, genotypes generated by next generation sequencing (NGS) studies can contain errors, which may significantly impact the power to detect signals in common and rare variant analyses. These genotyping errors are not explicitly detected by the standard Genotype Analysis ToolKit (GATK) and Variant Quality Score Recalibration (VQSR) tool and thus remain a potential source of false-positive variants in whole exome sequencing (WES) datasets. In this context, the transition-transversion ratio (Ti/Tv) is commonly used as an additional quality check. In case of IR experiments, this is problematic when Ti/Tv itself might be influenced by IR treatment. It was the aim of this study to determine a suitable threshold for variant filters for NGS datasets from irradiated cells in order to achieve high data quality using Ti/Tv, while at the same time being able to investigate radiation-specific effects on the Ti/Tv ratio for different radiation doses. By testing a variety of filter settings and comparing the obtained results with publicly available datasets, we observe that a coverage filter setting of depth (DP) 3 and genotype quality (GQ) 20 is sufficient for high quality single nucleotide variants (SNVs) calling in an analysis combining GATK and VSQR and that Ti/Tv values are a consistent and useful indicator for data quality assessment for all tested NGS platforms. Furthermore, we report a reduction in Ti/Tv in IR-induced mutations in primary human gingiva fibroblasts (HGFs), which points to an elevated proportion of transversions among IR-induced SNVs and thus might imply that mismatch repair (MMR) plays a role in the cellular damage response to IR-induced DNA lesions.
Gene Expression and Cellular Markers of Occupational Radiation Exposure in Chernobyl Shelter Construction Workers
Authors: Bazyka Dimitry , Ilienko Iryna , Golyarnik Natalya , Belyaev Oleg , Lyaskivska Olena
Published: June 2020

Low-dose radiation effects were studied in Ukrainian personnel of the Chernobyl exclusion zone. The aim of this study was to determine the influence of borderline exposure to annual professional limits and age on expression of molecular markers. Study groups included 300 radiation workers performing construction work on the New Safe Confinement (Arch) upon the Chernobyl “Shelter” [external dose, 26.1 ± 18.1 mSv; age, 43.1 ± 10.3 y overall and 48.7 ± 5.9 y for 69 control persons]. Methods included gene expression using RT-PCR, flow cytometry of lymphocyte antigens, gamma-H2AX, Cyclin D1 expression, and relative telomere length using flow-FISH. A statistically significant upregulation of VEGFA BAX, DDB2, NFKB1 was shown at doses below 35 mSv. In workers aged under 40 y with doses higher than 35 mSv, an upregulation of 16 genes was revealed—VEGFA, TERF2, TERF1, BIRC5, BAX, TP53, DDB2, CDKN1B, CDKN2A, NFKB2, MAPK14, TGFBR1, MKNK2, CDKN1A, NFKB1, TP53I3; and four genes were downregulated—MADD, FASL, CSF2, and TERT. In workers older than 40 y, 8 genes were upregulated and 12 were downregulated. All groups showed an increased and dose-dependent gamma-H2AX expression. Downregulation of CCND1 genes in older groups was accompanied by lower numbers of Cyclin D1 protein expression and lower CD3+ and CD4+ cell counts. Upregulation of CSF2 in those over 40 y old positively correlated with B-cell and NK-cell counts. A non-linear type of gene expression response was demonstrated: in doses over 35 mSv for those over 40 y, the increased expression of gamma-H2AX is associated with upregulation of cell survival positive regulators—BIRC5, BRCA1, DDB2, CCND1, TERT genes, and longer telomeres; the younger age group was characterized by TERF1 and TERF2 upregulation and telomere shortening.
Traumatic Brain Injury-Related Emergency Department Visits Among American Indian and Alaska Native Persons—National Patient Information Reporting System, 2005-2014
Authors: Sarmiento Kelly , Kennedy Jordan , Daugherty Jill , Peterson Alexis B. , Evans Mary E. , Haberling Dana L. , Billie Holly
Published: June 2020

Objective:

The American Indian/Alaska Native (AI/AN) population has a disproportionately high rate of traumatic brain injuries (TBIs). However, there is little known about incidence and common mechanisms of injury among AI/AN persons who seek care in an Indian Health Service (IHS) or tribally managed facility.

Methods:

Using the IHS National Patient Information Reporting System, we assessed the incidence of TBI-related emergency department visits among AI/AN children and adults seen in IHS or tribally managed facilities over a 10-year period (2005-2014).

Results:

There were 44 918 TBI-related emergency department visits during the study period. Males and persons aged 18 to 34 years and 75 years and older had the highest rates of TBI-related emergency department visits. Unintentional falls and assaults contributed to the highest number and proportion of TBI-related emergency department visits. The number and age-adjusted rate of emergency department visits for TBI were highest among persons living in the Southwest and Northern Plains when compared with other IHS regions.

Conclusion:

Thousands of AI/AN children and adults are seen each year in emergency departments for TBI and the numbers increased over the 10-year period examined. Evidence-based interventions to prevent TBI-related emergency department visits, such as programs to reduce the risk for older adult falls and assault, are warranted.
Assessing Negative Attributions After Brain Injury With the Ambiguous Intentions Hostility Questionnaire
Authors: Neumann Dawn , Sander Angelle M. , Perkins Susan M. , Bhamidipalli Surya Sruthi , Witwer Noelle , Combs Dennis , Hammond Flora M.
Published: June 2020

Objectives:

(1) To explore the construct validity of the Ambiguous Intentions Hostility Questionnaire (AIHQ) in participants with traumatic brain injury (TBI) (ie, confirm negative attributions are associated with anger and aggression); and (2) use the AIHQ to examine negative attribution differences between participants with and without TBI.

Setting:

Two rehabilitation hospitals.

Participants:

Eighty-five adults with TBI and 86 healthy controls (HCs).

Design:

Cross-sectional survey.

Main Measures:

The AIHQ, a measure of negative attributions (intent, hostility, and blame), anger, and aggressive responses to hypothetical scenarios.

Results:

Attributions were significantly correlated with anticipated anger and aggressive responses to AIHQ scenarios. Compared with HCs, participants with TBI reported stronger negative attributions (P ≤ .001), anger (P = .021), and aggressive responses (P = .002) to the scenarios.

Conclusion:

Negative attributions were associated with anger and aggression responses, demonstrating construct validity of the AIHQ in the TBI population. Participants with TBI judged others' behaviors more severely than HCs, similar to prior research using a different attribution measure. The AIHQ has promise as a practical instrument for assessing negative attributions after TBI.
Visual outcomes and corneal biomechanics after V4c implantable collamer lens implantation in subclinical keratoconus
Authors: Li Kangjun , Wang Zheng , Zhang Dexiu , Wang Shanshan , Song Xiaocui , Li Yaxin , Wang Ming X.
Published: June 2020

Purpose:

To quantitatively evaluate the safety, efficacy, stability, predictability, and corneal biomechanical parameters after V4c implantable collamer lens (ICL) implantation in subclinical keratoconus.

Setting:

Xi'an AIER Eye Hospital, Xi'an, China.

Design:

Retrospective case series.

Methods:

Patients undergoing V4c ICL/toric ICL implantation were examined. Scheimpflug tomography (Pentacam) was used to measure the Belin-Ambrosio enhanced ectasia total deviation index. Dynamic Scheimpflug biomechanical analysis (CorVis ST) was used to measure the corneal biomechanical parameters and Corvis Biomechanical Index. The Tomographic and Biomechanical Index was measured by combined Pentacam with CorVis ST. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, and adverse effects were also investigated.

Results:

A total of 60 eyes of 60 patients (mean age ± SD, 27.21 ± 7.24 years) were included. The mean preoperative UDVA and CDVA were 1.08 ± 0.25 and 0.12 ± 0.04 logarithm of the minimum angle of resolution (logMAR) (20/230 and 20/28 Snellen VA), respectively. After 2 years, the mean postoperative UDVA and CDVA were 0.01 ± 0.06 and −0.05 ± 0.03 logMAR (20/20 and 20/18 Snellen VA), respectively. The mean difference between the intended and achieved spherical equivalent (SE) was −0.08 ± 0.47 diopter (D), and the SE was within ±1.00 D of the intended correction in 57 eyes (95%), and 58 eyes (97%) had astigmatism less than 0.50 D. The refractive results were stable 2 years postoperatively, and the corneal biomechanical parameters returned to their preoperative levels at 3 months.

Conclusions:

The V4c ICL/toric ICL in subclinical keratoconus offered predictable correction of SE refractive error. Refractive results and corneal biomechanics were stable at the 2-year follow-up.
Clinicians Report Barriers and Facilitators to High-Quality Ambulatory Oncology Care
Authors: Lafferty Megan , Manojlovich Milisa , Griggs Jennifer J. , Wright Nathan , Harrod Molly , Friese Christopher R.
Published: June 2020

Background

Ambulatory oncology practices treat thousands of Americans on a daily basis with high-risk and high-cost antineoplastic agents. However, we know relatively little about these diverse practices and the organizational structures influencing care delivery.

Objective

The aim of this study was to examine clinician-reported factors within ambulatory oncology practices that affect care delivery processes and outcomes for patients and clinicians.

Methods

Survey data were collected in 2017 from 298 clinicians (nurses, physicians, nurse practitioners, and physician assistants) across 29 ambulatory practices in Michigan. Clinicians provided written comments about favorable and unfavorable aspects of their work environments that affected their ability to deliver high-quality care. We conducted inductive content analysis and used the Systems Engineering Initiative for Patient Safety work system model to organize and explain our findings.

Results

Clinicians reported factors within all 5 work-system components of the Systems Engineering Initiative for Patient Safety model that affected care delivery and outcomes. Common themes surfaced, such as unfavorable aspects including staffing inadequacy and high patient volume, limited physical space, electronic health record usability issues, and order entry. Frequent favorable aspects focused on the skills of colleagues, collaboration, and teamwork. Some clinicians explicitly reported how work system factors were relational and influenced patient, clinician, and organizational outcomes.

Conclusions

These findings show how work-system components are interactive and relational reflecting the complex nature of care delivery.

Implications for Nursing Practice

Data obtained from frontline clinicians can support leaders in making organizational changes that are congruent with clinician observations of practices’ strengths and opportunities for improvement.
A 2020 Vision Into Hodgkin Lymphoma Biology
Authors: Hurwitz Stephanie N. , Bagg Adam
Published: June 2020

Hodgkin lymphomas (HLs) are lymphoid neoplasms uniquely characterized by a paucity of neoplastic cells embedded in a supportive heterogenous cellular microenvironment. Although first described in the 19th century, systematic biological understanding of HLs has been hindered due to the challenges presented in studying the complex tumor microenvironment and scarce tumorigenic cells. Recent advances in single-cell isolation and characterization, sensitive mutational analytic tools, and multiplex immunohistochemical strategies have allowed further advances in understanding the development and progression of HL. Here we provide a current update on the chromosomal and mutational abnormalities seen in HL, the impact of Epstein-Barr virus infection on driving a subset of HLs, and the possibility of disease monitoring via high-sensitivity detection of genetic aberrations. We also discuss recent developments in understanding the intricate microenvironment through intercellular cross-talk, and describe novel potential biomarkers to aid in distinction of HL from other overlapping entities.
Cholinesterases and Anticholinergic Medications in Postoperative Pediatric Delirium
Authors: Meyburg Jochen , Ritsert Mona-Lisa , Traube Chani , Plaschke Konstanze , von Haken Rebecca
Published: June 2020

Objectives:

To describe the relationships between anticholinergic drug exposure, cholinesterase enzyme activity, inflammation, and the development of postoperative delirium in children.

Design:

Single-center prospective cohort study.

Setting:

Twenty-two bed PICU in a tertiary-care academic medical center in Germany.

Patients:

A consecutive cohort of children admitted after major elective surgery.

Interventions:

Children were screened for delirium bid over 5 consecutive postoperative days. Acetylcholinesterase and butyrylcholinesterase plasma activity levels were measured prior to surgery and once daily during the 5 day study period. Number of anticholinergic drugs and Anticholinergic Drug Scale score were calculated for each patient.

Measurements and Main Results:

Ninety-three children (age range, 0–17 yr) were included. The number of anticholinergic drugs as well as the Anticholinergic Drug Scale score were significantly correlated with development of postoperative delirium, independently of disease severity. Baseline cholinesterase enzyme levels did not differ between patients who did and did not develop postoperative delirium. Butyrylcholinesterase levels, but not acetylcholinesterase levels, dropped by 33% postoperatively, independent of the presence of postoperative delirium. Postoperative butyrylcholinesterase levels were inversely related to number of anticholinergic drugs, Anticholinergic Drug Scale score, and C-reactive protein levels.

Conclusions:

Anticholinergic drug exposure was related to development of postoperative delirium in this cohort, with demonstration of a dose-response relationship. As there are alternative options available for many of these medications, it may be reasonable to avoid anticholinergic exposure in the PICU whenever possible.
Brief Resolved Unexplained Event
Authors: Gerber Nicole L. , Fawcett Kelsey J. , Weber Emily G. , Patel Roshni , Glick Alexander F. , Farkas Jonathan S. , Mojica Michael A.
Published: June 2020

Objectives

This study aimed to evaluate patients who presented to the pediatric emergency department with an apparent life-threatening event (ALTE) to (1) determine if these patients would meet the criteria for brief resolved unexplained event (BRUE), a new term coined by the American Academy of Pediatrics in May, 2016; (2) risk stratify these patients to determine if they meet the BRUE low-risk criteria; and (3) evaluate outcomes of patients meeting the criteria for BRUE.

Methods

We conducted a retrospective chart review of patients who presented to a large urban academic center pediatric emergency department with an ALTE from January 2013 to May 2015 (before the publication of the BRUE guideline). Children ≤12 months of age were identified by the International Classification of Diseases, Ninth/Tenth Revision. Two physician reviews were performed to determine if patients met the ALTE diagnostic criteria. Data were then extracted from these charts to complete objectives.

Results

Seventy-eight patients met the diagnostic criteria for ALTE. Only 1 of those patients met the diagnostic criteria for BRUE, but not for low-risk BRUE. This patient underwent an extensive inpatient evaluation and was eventually discharged after monitoring with a benign diagnosis. Most patients did not meet the criteria for BRUE because the event was not unexplained.

Conclusions

Only 1 patient who presented to the ED with ALTE met the criteria for BRUE, and this patient did not meet the low-risk criteria. This study corroborates previous research on BRUE and continues to highlight the importance of conducting a thorough history and physical examination on all patients presenting to the ED with concerning events.
Interactions Between Acute Infarcts and Cerebrovascular Pathology Predict Poststroke Dementia
Authors: Yatawara Chathuri , Guevarra Anne , Ng Kok Pin , Chander Russell , Kandiah Nagaendran
Published: June 2020

Background:

Chronic cerebrovascular pathology accelerates the incidence of poststroke dementia (PSD). Whether the risk of PSD varies according to different types of chronic cerebrovascular pathology remains unclear.

Objectives:

We investigated whether PSD is associated with a unique pattern of interactions between chronic cerebrovascular pathologies and acute stroke lesions.

Materials and Method:

In this case-control study of acute mild stroke patients (n=185), cases included patients who developed PSD at a 6-month poststroke follow-up, and controls included patients who remained nondemented at 6 months, matched on prestroke cognitive status. Magnetic resonance imaging was performed at initial stroke presentation; neuropsychological assessments were performed 6 months after the stroke.

Results:

White matter hyperintensities (WMH), chronic lacunes, microbleeds, and acute infarcts were not associated with PSD after controlling for demographics, cardiovascular risk, and global cortical atrophy. The risk of PSD was largest for patients with acute large subcortical infarcts (>15 mm) and concomitant periventricular WMH compared with patients with large subcortical infarcts and punctate/absent periventricular WMH [odds ratio (OR)=5.85, 95% confidence interval (CI)=1.85-40.04]. A moderate risk of PSD was observed for patients with acute multiple small infarcts (3 to 15 mm) and concomitant lacunes (OR=2.48, 95% CI=0.94-6.51) or concomitant lobar microbleeds (OR=2.20, 95% CI=0.89-5.41), compared with patients with acute multiple small infarcts and absent lacunes or microbleeds. Single small infarcts did not interact with cerebrovascular pathology to affect PSD.

Conclusions:

The risk of PSD varies depending on the presence of chronic cerebrovascular pathologies and type of acute infarcts. Clinical implications support a precision medicine approach for stratifying those at highest risk of PSD.