bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic aetiology of blood pressure relates to aortic stiffness with bi-directional causality: evidence from heritability, blood pressure polymorphisms, and Mendelian randomization
Authors: Cecelja Marina , Keehn Louise , Ye Li , Spector Tim D , Hughes Alun D , Chowienczyk Phil
Published: March 2020

Aims

Haemodynamic determinants of blood pressure (BP) include cardiac output (CO), systemic vascular resistance (SVR), and arterial stiffness. We investigated the heritability of these phenotypes, their association with BP-related single-nucleotide polymorphisms (SNPs), and the causal association between BP and arterial stiffness.

Methods and results

We assessed BP, central BP components, and haemodynamic properties (during a single visit) including CO, SVR, and pulse wave velocity (PWV, measure of arterial stiffness) in 3531 (1934 monozygotic, 1586 dizygotic) female TwinsUK participants. Heritability was estimated using structural equation modelling. Association with 984 BP-associated SNP was examined using least absolute shrinkage and selection operator (LASSO) and generalized estimating equation regression. One and two-sample Mendelian randomization (MR) was used to estimate the causal direction between BP and arterial stiffness including data on 436 419 UK Biobank participants. We found high heritability for systolic and pulsatile components of BP (>50%) and PWV (65%) with overlapping genes accounting for >50% of their observed correlation. Environmental factors explained most of the variability of CO and SVR (>80%). Regression identified SNPs (n = 5) known to be associated with BP to also be associated with PWV. One-sample MR showed evidence of bi-directional causal association between BP and PWV in TwinsUK participants. Two-sample MR, confirmed a bi-directional causal effect of PWV on BP (inverse variance weighted (IVW) beta = 0.11, P < 0.02) and BP on arterial stiffness (IVW beta = 0.004, P < 0.0001).

Conclusion

The genetic basis of BP is mediated not only by genes regulating BP but also by genes that influence arterial stiffness. Mendelian randomization indicates a bi-directional causal association between BP and arterial stiffness.
Influence of microbiota on immunity and immunotherapy for gastric and esophageal cancers
Authors: Zhang Xiaoli , Pan Zui
Published: March 2020

Gastric and esophageal cancers are multifactorial and multistage-involved malignancy. While the impact of gut microbiota on overall human health and diseases has been well documented, the influence of gastric and esophageal microbiota on gastric and esophageal cancers remains unclear. This review will discuss the reported alteration in the composition of gastric and esophageal microbiota in normal and disease conditions, and the potential role of dysbiosis in carcinogenesis and tumorigenesis. This review will also discuss how dysbiosis stimulates local and systemic immunity, which may impact on the immunotherapy for cancer.
Participation of Latinos in the Diabetes Self-Management Program and Programa de Manejo Personal de la Diabetes
Authors: Mendez-Luck Carolyn A , Govier Diana J , Luck Jeff , Julyan Esmeralda J , Mahakalanda Shyama , Herrera-Venson Angelica P
Published: March 2020

Background and Objectives

The Diabetes Self-Management Program (DSMP) and Programa de Manejo Personal de la Diabetes (PMPD) have been shown to reduce complications from poorly controlled diabetes. Only a few research studies have examined Latino individuals’ participation in them. This study examines workshop completion among DSMP and PMPD participants and the effects of race/ethnicity, workshop language, workshop type, and workshop site on program completion rates by participants.

Research Design and Methods

We used data from the National Council on Aging’s data repository of individuals who participated in DSMP or PMPD between January 2010 and March 2019. Using a pooled cross-sectional study design, we examined workshop completion among 8,321 Latino and 23,537 non-Latino white (NLW) participants. We utilized linear probability models to estimate the effects of race/ethnicity and workshop language/type among the full sample; a stratified model estimated the separate effects of workshop language, type, and delivery site among Latinos. Participant characteristics included age, sex, education, number of chronic health conditions, living arrangement, health insurance status, and geographic location of workshop.

Results

Compared to NLW participants in DSMP English workshops, Latinos enrolled in any workshop had a higher probability of completing at least four workshop sessions, and Latinos enrolled in PMPD Spanish workshops had a higher probability of completing six of six sessions. Among the Latino subsample, participation in PMPD Spanish or English workshops was associated with completing at least four sessions or all six sessions compared with participation in DSMP Spanish or English workshops. Among Latino participants, the effects of workshop site on completion rates were mixed.

Discussion and Implications

Diabetes self-management education programs tailored for Latino participants had higher completion rates. Further research is warranted to better understand the effect of workshop site and participant characteristics on completion of DSMP and PMPD programs.
The Humanities and Arts in The Gerontological Society of America
Authors: Achenbaum W Andrew
Published: March 2020

Perspectives from the humanities and arts (H&A) on old age have deep roots in history; they emerged over the centuries along with concurrent scientific investigations. Provisionally invited into the scientific ranks of The Gerontological Society of America (GSA) during the late 1970s, H&A prospered, but grew amid tensions. During 75th-anniversary celebrations, Society members will assess H&A’s role in GSA. How can H&A continue to enrich scientific research? How can H&A further advance its own meaningful contributions? Or, should H&A and GSA reconfigure its partnership?
Seismotectonics and 1-D velocity model of the Greater Geneva Basin, France–Switzerland
Authors: Antunes Verónica , Planès Thomas , Zahradník Jiří , Obermann Anne , Alvizuri Celso , Carrier Aurore , Lupi Matteo
Published: March 2020

The Greater Geneva Basin (GGB), located in southwestern Switzerland and neighboring France, is enclosed by the rotating northwestern edge of the Alpine front and the Jura mountains chain. Recently, this basin has received increasing attention as a target for geothermal exploration. Historical and instrumental seismicity suggest that faults affecting the basin may still be active. Moderate-magnitude earthquakes have been located along the Vuache fault, a major strike-slip structure crossing the basin. Before geothermal exploration starts, it is key to evaluate the seismic rate in the region and identify possible seismogenic areas. In this context, we deployed a temporary seismic network of 20 broad-band stations (from September 2016 to January 2018) to investigate the ongoing seismic activity, its relationship with local tectonic structures, and the large-scale kinematics of the area. Our network lowered the magnitude of completeness of the permanent Swiss and French networks from 2.0 to a theoretical value of 0.5. Using a new coherence-based detector (LASSIE - particularly effective to detect microseismicity in noisy environments), we recorded scarce seismicity in the basin with local magnitudes ranging from 0.7 to 2.1 ML. No earthquakes were found in the Canton of Geneva where geothermal activities will take place. We constructed a local ’minimum 1-D P-wave velocity model’ adapted to the GGB using earthquakes from surrounding regions. We relocated the events of our catalogue obtaining deeper hypocentres compared to the locations obtained using the available regional velocity models. We also retrieved eight new focal mechanisms using a combination of polarities and waveform inversion techniques (CSPS). The stress inversion shows a pure strike-slip stress regime, which is in agreement with structural and geological data. Combining the background seismicity with our catalogue, we identified seismogenic areas offsetting the basin.
Serendipity and me
Authors: Waples Robin S
Published: March 2020

How much of your scientific career has unfolded as you planned, and how much has been shaped by blind luck? I suspect the latter has been more important than many of us realize, or at least acknowledge, but as Louis Pasteur said, “Chance favors only the prepared mind”—implying that we have at least some control over how random events affect our lives. Here, I discuss how large and small chance events have affected the trajectory of my scientific career.
The effects of dictionary use on second language vocabulary acquisition: A meta-analysis
Authors: Zhang Songshan , Xu Hai , Zhang Xian
Published: March 2020

This study reports on the results of a meta-analysis which investigates the effects of dictionary use on second language (L2) vocabulary acquisition, as well as the magnitude of the moderating effect of a number of moderator variables on the effectiveness of dictionary use in improving L2 vocabulary knowledge. A total of 125 effect sizes were gleaned from 44 studies, which represented 87 independent samples and included 3,475 participants. A random-effects model of the meta-analysis shows that the overall effect of dictionary use on L2 vocabulary acquisition is g = 2.10 (p < .01) for within-group studies and g = 1.03 (p < .01) for between-group studies respectively, which are both large in the domain of second language research. Subsequent moderator variable analysis reveals how treatment-related variables (timepoint, dictionary form, dictionary type, target lexical unit, vocabulary knowledge type, learning condition, and research setting), methodological variables (type of experimental design, presence of pretest, and assessment type), as well as learner-related variables (age and proficiency) might contribute to the variation across studies. Implications of the findings are discussed.
The ‘Range of Reasonable Responses’ Test: A Poor Substitution for the Statutory Language
Authors: Baker Aaron
Published: March 2020

The ‘range of reasonable responses’ (RORR) test for assessing the fairness of a dismissal under section 98(4) ERA 1996 started life as a mistake and never recovered. Where the statute tells judges a dismissal is unfair if an employer acted ‘unreasonably’, the RORR tells them this refers to a special kind of ‘employer reasonableness’. In a setting where the only question is whether a dismissal is too harsh or not it is senseless to ask anyone, including a judge, to behave as if a dismissal they consider too harsh is nevertheless not too harsh. Yet this is what the RORR has always asked Employment Tribunal judges to do, with predictable results. Because they are told that they may not use their own idea of what counts as reasonable, they have no choice but to assume that ‘employer reasonableness’ tolerates more harshness than ‘reasonableness’. Lady Hale, possibly viewing the matter in the same light, appears to have invited a Supreme Court challenge to the RORR in Reilly v Sandwell Metropolitan Borough Council. This article argues that the Supreme Court must do away with the RORR because it artificially makes it harder to succeed in an unfair dismissal claim, it is doctrinally confused, and incremental efforts by the lower courts to resolve these problems within the RORR framework inevitably fail. The answer must involve distinguishing between a ‘standard for decision’ and a ‘standard of review’. The RORR tried to perform both functions by distorting the standard for decision to address standard of review concerns. Recent Supreme Court case law on proportionality, however, has made it clear this is the wrong approach. What the Court should install, in place of the RORR, is (a) a clear standard for decision, not subject to modification over standard of review concerns, and (b) targeted guidance about how tribunals should focus their inquiry and where to give deference to employers.
Comparison and Refinement of Integrated Pest Management Tactics for Halyomorpha halys (Hemiptera: Pentatomidae) Management in Apple Orchards
Authors: Leskey Tracy C , Short Brent D , Ludwick Dalton
Published: March 2020

Halyomorpha halys (Stål) (Hemiptera: Pentatomidae) has been managed primarily with broad-spectrum insecticides in orchard systems. Recently, IPM techniques have been developed specifically for managing H. halys in apple orchards to reduce insecticide inputs and take advantage of its perimeter-driven behavior. In 2015 and 2016, we compared these IPM tactics to one another and an untreated control to measure differences in overall crop protection and insecticide inputs. Tactics included trap-based threshold-triggered spray applications, perimeter-based attract-and-kill (AK) trees treated every 7- and 14-d, and perimeter spray applications applied every 7- and 14-d. All plots were monitored with baited black pyramid traps deployed in plot interiors. In both years, mean number of H. halys captured in untreated control plot traps was significantly greater than plots managed using IPM tactics. In 2015, significantly more insecticide applications were made in 7- and 14-d perimeter and AK plots compared with trap-based threshold plots. There was no significant difference in the percentage of injured fruit in plot interiors among IPM tactics; all were significantly lower than the control. In 2016, significantly more insecticide applications were made in 7-d perimeter spray and AK plots compared with all other treatments. Significantly less injury was detected in plot interiors for 7- and 14-d perimeter and trap-based threshold plots compared with the control and 7- and 14-d AK plots. Although all IPM tactics reduced H. halys injury in apples using a trap-based treatment threshold required fewer insecticide inputs and only during brief periods of the season, while all others required season-long maintenance.
Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Rationale and Framework for the Monograph and Overview of Eligible Studies
Authors: Berrington de Gonzalez Amy , Daniels Robert D , Cardis Elisabeth , Cullings Harry M , Gilbert Ethel , Hauptmann Michael , Kendall Gerald , Laurier Dominique , Linet Martha S , Little Mark P , Lubin Jay H , Preston Dale L , Richardson David B , Stram Daniel , Thierry-Chef Isabelle , Schubauer-Berigan Mary K
Published: March 2020

Whether low-dose ionizing radiation can cause cancer is a critical and long-debated question in radiation protection. Since the Biological Effects of Ionizing Radiation report by the National Academies in 2006, new publications from large, well-powered epidemiological studies of low doses have reported positive dose-response relationships. It has been suggested, however, that biases could explain these findings. We conducted a systematic review of epidemiological studies with mean doses less than 100 mGy published 2006–2017. We required individualized doses and dose-response estimates with confidence intervals. We identified 26 eligible studies (eight environmental, four medical, and 14 occupational), including 91 000 solid cancers and 13 000 leukemias. Mean doses ranged from 0.1 to 82 mGy. The excess relative risk at 100 mGy was positive for 16 of 22 solid cancer studies and 17 of 20 leukemia studies. The aim of this monograph was to systematically review the potential biases in these studies (including dose uncertainty, confounding, and outcome misclassification) and to assess whether the subset of minimally biased studies provides evidence for cancer risks from low-dose radiation. Here, we describe the framework for the systematic bias review and provide an overview of the eligible studies.
Pathways by which Maternal Factors are Associated With Youth Spina Bifida-Related Responsibility
Authors: Driscoll Colleen F Bechtel , Ohanian Diana M , Ridosh Monique M , Stern Alexa , Wartman Elicia C , Starnes Meredith , Holmbeck Grayson N
Published: March 2020

Objective

Achieving condition-related autonomy is an important developmental milestone for youth with spina bifida (SB). However, the transfer of condition-related responsibility to these youth can be delayed due to parent factors. This study aimed to investigate two potential pathways by which maternal factors may be associated with condition-related responsibility among youth with SB: (a) Maternal adjustment → perception of child vulnerability (PPCV) → youth condition-related responsibility; and (b) Maternal PPCV → overprotection → youth condition-related responsibility.

Methods

Participating youth with SB (N = 140; Mage=11.4 years, range = 8–15 years) were recruited as part of a longitudinal study; data from three time points (each spaced 2 years apart) from the larger study were used. Mothers reported on personal adjustment factors, PPCV, and overprotection. An observational measure of overprotection was also included. Mothers, fathers, and youth with SB reported on youths’ degree of responsibility for condition-related tasks. Analyses included age, lesion level, IQ, and the dependent variables at the prior wave as covariates.

Results

Bootstrapped mediation analyses revealed that PPCV significantly mediated the relationship between maternal distress and youth responsibility for medical tasks such that higher levels of distress at Time 1 predicted higher levels of PPCV at Time 2 and lower youth medical responsibility at Time 3. Furthermore, self-reported maternal overprotection significantly mediated the relationship between maternal PPCV and youth responsibility for medical tasks.

Conclusions

Maternal personal distress, PPCV, and self-reported overprotection are interrelated and affect youth’s condition-related responsibility. Interventions for mothers of youth with SB that target these factors may improve both maternal and youth outcomes.
On monolithic supermassive stars
Authors: Woods Tyrone E , Heger Alexander , Haemmerlé Lionel
Published: March 2020

Supermassive stars have been proposed as the progenitors of the massive ($\sim \!10^{9}\, \mathrm{M}_{\odot }$) quasars observed at z ∼ 7. Prospects for directly detecting supermassive stars with next-generation facilities depend critically on their intrinsic lifetimes, as well as their formation rates. We use the one-dimensional stellar evolution code kepler to explore the theoretical limiting case of zero-metallicity non-rotating stars, formed monolithically with initial masses between $10$ and $190\, \mathrm{kM}_{\odot }$. We find that stars born with masses between $\sim\! 60$ and $\sim\! 150\, \mathrm{kM}_{\odot }$ collapse at the end of the main sequence, burning stably for $\sim\! 1.5\, \mathrm{Myr}$. More massive stars collapse directly through the general relativistic instability after only a thermal time-scale of $\sim\! 3$–$4\, \mathrm{kyr}$. The expected difficulty in producing such massive thermally relaxed objects, together with recent results for currently preferred rapidly accreting formation models, suggests that such ‘truly direct’ or ‘dark’ collapses may not be typical for supermassive objects in the early Universe. We close by discussing the evolution of supermassive stars in the broader context of massive primordial stellar evolution and the possibility of supermassive stellar explosions.
Testing broad-line region models with reverberation mapping
Authors: Netzer Hagai
Published: March 2020

New reverberation mapping (RM) measurements, combined with accurate luminosities and line ratios, provide strong constraints on the location of the line emitting gas in the broad-line region (BLR) of active galactic nuclei (AGNs). In this paper, I present new calculations of radiation pressure and magnetic pressure confined clouds and apply them to a ‘generic AGN’ and to NGC 5548. The new calculations are in good agreement with the observed lags of all broad emission lines, and with the luminosities of Ly α, C iv 1549, O vi 1035, and He ii 1640. They are also in reasonable agreement with the luminosities of Mg ii 2798 and the 1990 Å blend of C iii] and Si iii] lines for high-metallicity gas. They explain the changes in time-lag following an increase in continuum luminosity and their dependencies on the inner and outer boundaries of the BLR. They also predict very strong Balmer and Paschen continua with important implications to continuum RM experiments. However, the calculated Balmer and Paschen line luminosities are too weak, by factors of 2–5. This ‘Balmer line crisis’ was noted in several earlier works and is now confirmed and constrained by RM measurements that were not available in the past. It seems that present photoionization codes that use the escape probability formalism fail to correctly compute the Balmer line luminosities in high-density, large optical depth gas.
Origin of giant stellar clumps in high-redshift galaxies
Authors: Meng Xi , Gnedin Oleg Y
Published: March 2020

We examine the nature of kpc-scale clumps seen in high-redshift galaxies using a suite of cosmological simulations of galaxy formation. We identify rest-frame UV clumps in mock HST images smoothed to 500 pc resolution, and compare them with the intrinsic 3D clumps of young stars identified in the simulations with 100 pc resolution. According to this comparison for the progenitors of Milky Way-sized galaxies probed by our simulations, we expect that the stellar masses of the observed clumps are overestimated by as much as an order of magnitude, and that the sizes of these clumps are also overestimated by factor of several, due to a combination of spatial resolution and projection. The masses of young stars contributing most of the UV emission can also be overestimated by factor of a few. We find that most clumps of young stars present in a simulation at one time dissolve on a timescale shorter than ∼150 Myr. Some clumps with dense cores can last longer but eventually disperse. Most of the clumps are not bound structures, with virial parameter αvir > 1. We find similar results for clumps identified in mock maps of H α emission measure. We examine the predictions for effective clump sizes from the linear theory of gravitational perturbations and conclude that they are inconsistent with being formed by global disc instabilities. Instead, the observed clumps represent random projections of multiple compact star-forming regions.
Jansky VLA observations of synchrotron emitting optical hotspots of 3C 227 and 3C 445 radio galaxies
Authors: Orienti M , Migliori G , Brunetti G , Nagai H , D’Ammando F , Mack K-H , Prieto M A
Published: March 2020

We report results on deep Jansky Very Large Array (VLA) A-configuration observations at 22 GHz of the hotspots of the radio galaxies 3C 227 and 3C 445. Synchrotron emission in the optical on scales up to a few kpc was reported for the four hotspots. Our VLA observations point out the presence of unresolved regions with upper limit to their linear size of about 100 pc. This is the first time that such compact components in hotspots have been detected in a mini-sample, indicating that they are not a peculiar characteristic of a few individual hotspots. The polarization may reach values up to 70 per cent in compact (about 0.1 kpc scale) regions within the hotspot, indicating a highly ordered magnetic field with size up to a hundred parsecs. On larger scales, the average polarization of the hotspot component is about 30–45 per cent, suggesting the presence of a significant random field component, rather than an ordered magnetic field. This is further supported by the displacement between the peaks in polarized intensity and in total intensity images that is observed in all the four hotspots. The electric vector position angle is not constant, but changes arbitrarily in the central part of the hotspot regions, whereas it is usually perpendicular to the total intensity contours of the outermost edge of the hotspot structure, likely marking the large-scale shock front. The misalignment between X-ray and radio-to-optical emission suggests that the former is tracing the current particle acceleration, whereas the latter marks older shock fronts.
Pteronotus gymnonotus(Chiroptera: Mormoopidae)
Authors: Pavan Ana Carolina , da C. Tavares Valeria
Published: March 2020

Pteronotus gymnonotus (Wagner, 1843) is a medium-sized mormoopid commonly called the big naked-backed bat because of its wing membranes attached on the dorsal midline of the body, giving the appearance of a naked dorsum, and its large size in comparison to the other two species of naked-backed Pteronotus. The species is distributed across most of the Neotropical mainlands, ranging from southeastern Mexico through Central and South America south to northeastern Bolivia and central Brazil. P. gymnonotus has been considered as an uncommon species in most parts of its geographic distribution but there are some reports of more numerous local populations. It is an aerial insectivore that forages in open areas and gallery forests. Like other mormoopids P. gymnonotus usually forms large colonies roosting preferentially in hot and humid caves. It is currently listed as “Least Concern” according to the International Union for Conservation of Nature and Natural Resources Red List.
Are there alternatives to over-the-counter diabetes-care glucose-gels for transitional neonatal hypoglycemia?
Authors: Solimano Alfonso , Osiovich Horacio , Kwan Eddie , Metzger Daniel L , Everett Rob
Published: March 2020

Transitional neonatal hypoglycemia is common in at-risk well newborns, requires immediate attention, interferes with breastfeeding, and frequently results in separation of mothers from their babies. Breastfeeding shortly after birth and screening at-risk newborns at 2 hours of age is standard practice in Canada. In the Sugar Babies Trial, a custom-made 40% glucose-gel massaged to the buccal mucosa in at-risk infants decreased intravenous glucose treatment, but not neonatal intensive care unit admission. It increased the rate of full breastfeeding after discharge but experts suggest that additional evidence is needed. Further, commercially available neonatal glucose-gels do not exist, so practitioners around the world have started using diabetes-care products, which do not meet standards for use in newborns. Here, we provide a condensed summary of the topic and of management alternatives.
Effects of Adding Motor Imagery to Early Physical Therapy in Patients with Knee Osteoarthritis who Had Received Total Knee Arthroplasty: A Randomized Clinical Trial
Authors: Briones-Cantero María , Fernández-de-las-Peñas César , Lluch-Girbés Enrique , Osuna-Pérez María C , Navarro-Santana Marcos J , Plaza-Manzano Gustavo , Martín-Casas Patricia
Published: March 2020

Objective

To investigate the effects of the inclusion of motor imagery (MI) principles into early physical therapy on pain, disability, pressure pain thresholds (PPTs), and range of motion in the early postsurgical phase after total knee arthroplasty (TKA).

Methods

A randomized clinical trial including patients with knee osteoarthritis who have received TKA was conducted. Participants were randomized to receive five treatment sessions of either physical therapy with or without MI principles in an early postsurgical phase after a TKA (five days after surgery). Pain intensity (visual analog scale [VAS], 0–100), pain-related disability (short-form Western Ontario McMaster Universities Osteoarthritis Index [WOMAC], 0–32), pressure pain thresholds (PPTs), and knee range of motion were assessed before and after five daily treatment sessions by an assessor blinded to the subject’s condition.

Results

Twenty-four participants completed data collection and treatment. The adjusted analysis revealed significant group*time interactions for WOMAC (F = 17.29, P = 0.001, η2 = 0.48) and VAS (F = 14.56, P < 0.001, η2 = 0.45); patients receiving physiotherapy and MI principles experienced greater improvements in pain (Δ –28.0, 95% confidence interval [CI] = –43.0 to –13.0) and pain-related disability (Δ –6.0, 95% CI = –8.3 to –3.7) than those receiving physiotherapy alone. No significant group*time interactions for knee range of motion and PPTs were observed (all, P  > 0.30).

Conclusions

The application of MI to early physiotherapy was effective for improving pain and disability, but not range of motion or pressure pain sensitivity, in the early postsurgical phase after TKA in people with knee osteoarthritis.
Heavy baryon production with an instanton interaction
Authors: Shim Sang-In , Hosaka Atsushi , Kim Hyun-Chul
Published: March 2020

We propose a new reaction mechanism for the study of strange and charmed baryon production. In this mechanism we consider the correlation of two quarks in baryons, so it can be called the two-quark process. As in the previously studied one-quark process, we find large production rates for charmed baryons in comparison with strange baryons. Moreover, the new mechanism causes the excitation of both the $\rho$ mode and the $\lambda$ mode. Using the wave functions for baryons from a quark model, we compute the production rates of various baryon states. We find that the production rates reflect the structure of the wave functions that imply the usefulness of the reactions for the study of baryon structures.
The Effects of Competition in Consumer Credit Markets
Authors: Gissler Stefan , Ramcharan Rodney , Yu Edison
Published: March 2020

This paper finds that banks and nonbanks respond differently to increased competition in consumer credit markets. Increased competition and a greater threat of failure induces banks to specialize in relationship business lending, and surviving banks are more profitable. However, nonbanks change their credit policy when faced with more competition and expand credit to riskier borrowers at the extensive margin, resulting in higher default rates. These results show how the effects of competition depend on the form of intermediation. They also suggest that increased competition can cause credit risk to migrate outside the traditional supervisory umbrella.
Alternative Hosts in the Families Poaceae and Cyperaceae for Xanthomonas vasicola pv. vasculorum, Causal Agent of Bacterial Leaf Streak of Corn
Authors: Hartman T. , Tharnish B. , Harbour J. , Yuen G. Y. , Jackson-Ziems T. A.
Published: March 2020

The bacterial pathogen Xanthomonas vasicola pv. vasculorum was first reported in the United States causing bacterial leaf streak on Nebraska corn (Zea mays) in 2016. The bacterium is also known to cause disease in sugarcane, grain sorghum, broom bamboo, and various palm species. The objective of this study was to identify alternative hosts for X. vasicola pv. vasculorum among plants commonly found in corn growing areas of the United States. In repeated greenhouse experiments, 53 species of plants found in the United States that had not been tested previously for susceptibility to X. vasicola pv. vasculorum were inoculated with the pathogen and monitored for symptom development. Eleven species in the family Poaceae exhibited symptoms: oat (Avena sativa), rice (Oryza sativa), orchardgrass (Dactylis glomerata), indiangrass (Sorghastrum nutans), big bluestem (Andropogon gerardii), little bluestem (Schizachyrium scoparium), timothy (Phleum pratense), sand bluestem (Andropogon hallii), green foxtail (Setaria viridis), bristly foxtail (Setaria verticillata), and johnsongrass (Sorghum halepense). Yellow nutsedge (Cyperus esculentus) in the Cyperaceae also was a symptomatic host. In addition, endophytic colonization by X. vasicola pv. vasculorum was found in three asymptomatic alternative hosts: downy brome (Bromus tectorum), tall fescue (Festuca arundinacea), and western wheatgrass (Pascopyum smithii). Experiments were also conducted in the field to determine the potential for alternative hosts to become infected by natural inoculum. Symptoms developed only in big bluestem and bristly foxtail in field experiments. These results suggest that infection of alternative hosts by X. vasicola pv. vasculorum can occur, but infection rates might be limited by environmental conditions.
Naloxone Training From Nonmedical Personnel: Benefits Before, During, and After Overdose Events
Authors: Chichester Keith , Sisson Michelle L. , Schiavon Samantha P. , Hugley Mickeah J. , Hendricks Peter S. , Shelton Richard C. , Cropsey Karen L.
Published: March 2020

Objectives:

Drug overdose death rates in the United States have increased exponentially over the past 2 decades, primarily driven by fatal opioid overdoses. To combat this epidemic, naloxone training programs have become prevalent, but still remain widely underutilized. The purpose of the current study was to assess the benefits of a brief training with differing educational approaches (individual training versus training in dyads) as well as the outcomes following overdose reversals.

Methods:

Persons who use opioids (N = 448) were recruited from 4 sites including treatment facilities, inpatient hospitals, and criminal justice locations over a 3-year period. Training was delivered by nonmedical personnel and focused on safe naloxone usage and recognizing overdose signs. Overdose and naloxone knowledge were assessed before and following training with a 10-item questionnaire. Participants were trained individually, in a dyad with a partner who used opioids (PO), or in a dyad with a partner who did not use opioids (PNO).

Results:

All training groups displayed an increased knowledge of naloxone and overdose situations following training. Approximately 11% of participants (n = 47) reported using their naloxone kit and 97.7% of those resulted in successful overdose reversals. Kits were primarily used by the trained participant on a third-party individual.

Conclusions:

The results of the current study substantiate the effectiveness of naloxone in reversing overdose symptoms. A brief, 15-minute naloxone training delivered by nonmedical personnel enhanced overdose knowledge and led to positive reversal outcomes. Training persons who use opioids in dyads may offer additional benefits and improve follow-up reporting.
Is posterolateral plating better for fixation of Weber B distal fibular fractures than lateral plating: A randomized controlled clinical trial and a review of the literature
Authors: Elwahab Mohammed Reda Abd , Salem Eid Ahmed , Kotb Ahmed , El-ghammaz Shady
Published: March 2020

Background:

The overall outcomes of Weber B lateral malleolar fracture fixation are good. Fixation can be achieved using different methods; however, lag screw fixation combined with a lateral one-third tubular plate is the most popular option. The purpose of this randomized study was to assess clinical, radiographic, and functional outcomes in a cohort of patients who sustained unstable Weber B ankle fracture and were treated surgically with the technique using posterolateral plating and to compare this technique with the conventional lateral plating.

Methods:

Twenty patients were included in group 1 and managed with conventional lateral plating, and 20 patients (group 2) had posterolateral plating. Patients were evaluated clinically, radiographically, and at the end point according to the ankle module of the American College of Foot and Ankle Surgeons (ACFAS). Both groups were comparable in terms of age, sex, fracture side, and type of injury.

Results:

No statistically significant difference was noted between the groups in regard to individual scoring parameters and total score (P>0.05). Among all injury types, 80% of group 1 had well to excellent final outcomes compared with 95% of group 2 (P>0.05). Fifteen patients (37.5% of all patients) had complications.

Conclusions:

Excellent and good results obtainable with posterolateral plating without the problems commonly associated with lateral plating (short screws and intraarticular penetration) and antiglide plating (peroneal tendinitis) lead us to consider this technique as an option among the methods of choice for managing Weber B fractures.

Level of Evidence:

Level I.
The Frequency of Various “Myelopathic Symptoms” in Cervical Myelopathy
Authors: Niu Shuo , Anastasio Albert T. , Maidman Samuel D. , Faraj Razan R. , Rhee John M.
Published: March 2020

Study Design:

A retrospective cohort of prospective data.

Objective:

Determine the frequency of various symptoms in a surgical cohort of cervical myelopathy (CM).

Summary of Background Data:

CM can be difficult to diagnose as there is no sine qua non “myelopathic symptom.” Despite extensive literature, the likelihood or frequency of symptoms at presentation remains unclear.

Materials and Methods:

A total of 484 patients treated at a single academic center were reviewed. Preoperative symptoms included: axial neck pain; upper extremity (UE) pain; UE sensory or motor deficit; lower extremity (LE) sensory or motor deficit; and sphincter dysfunction. It was noted whether a symptom was the chief complaint (CC) and/or one of a list of overall symptoms (OS) reported by the patient. Magnetic resonance imaging was assessed for the maximal cord compression level and T2 hyperintensity.

Results:

The most common CC was UE sensory deficit (46.5%), whereas the most common OS were UE and LE motor deficits (82.6% and 81.2%). Neck pain was significantly less common (32.6% CC, 55.4% OS), and sphincter dysfunction was rare (0.6% CC, 16.5% OS). UE pain as a CC was significantly higher when the maximal compression involved a more distal level. The presence of T2 hyperintensity was negatively associated with neck pain but positively associated with sensory and motor deficits of LE.

Conclusions:

The most common CC in CM related to UE sensation, whereas the most common OS related to upper and lower motor function. UE pain was more common with more distal cord compression. Those with T2 hyperintensity had worse myelopathy and were less likely to have neck pain, but more likely to have LE symptoms. To our knowledge, this study is the largest to quantify the frequency of myelopathic symptom presentation in a surgical population. These findings provide valuable insight into the symptomatic presentation of CM in clinical practice and can be used to better inform diagnosis and treatment in this complex patient population.

Level of Evidence:

Level II—retrospective study.
Patient Perceptions of Physician Ownership in Spine Care
Authors: Hirsch Brandon P. , Parrish James M. , Jenkins Nathaniel W. , Khechen Benjamin , Haws Brittany E. , Patel Dil V. , Yoo Joon S. , Lamoutte Eric H. , Karmarkar Sailee S. , Colman Matthew W. , Phillips Frank M. , Singh Kern
Published: March 2020

Study Design:

This was a prospective study.

Objective:

This study aims to determine the perspectives of patients seeking spine care in regard to physician ownership of surgical facilities and to understand the importance of disclosing financial conflicts.

Summary of Background Data:

There has been limited investigation regarding patient perceptions of the proprietary structure of surgical facilities.

Methods:

Patients seeking treatment for spine pathology completed an 8-item survey. The questions assessed if patients acknowledged the owners of surgical facilities, if the patient thought knowledge of ownership is important, who they perceived as most qualified to own surgical facilities, preference of communication of ownership, and impact of facility ownership on care.

Results:

A total of 200 patients completed the survey. When patients were asked whom they thought owned the hospital, most reported private hospital corporations followed by universities/medical schools and insurance companies. With regard to whom patients thought owned an ambulatory surgical center, most reported physicians, followed by private hospital corporations and individual investors. When asked how important it is to know the financial stakeholders of a surgical facility, 73.5% of patients stated “very important” or “somewhat important.” Most patients reported they were not aware of who owned the facility. Regarding how facility owners should be communicated, 31.0% answered “written document,” whereas 25.0% preferred verbal communication with the staff/surgeon. When asked how much impact the owner of a surgical facility has on their care, 38.0% of patients responded, “strong impact,” followed by “moderate impact,” (43.0%), and “little or no impact” (19.0%). Patients thought that physicians were the most qualified to own an ambulatory surgical center, followed by universities/medical schools and private hospital corporations.

Conclusions:

The pretreatment perception of patients referred to a spine clinic favored the opinion that physicians were the most qualified to own and manage surgical facilities. Therefore, physicians should be encouraged to share disclosures with patients as their ownership of surgical facilities is viewed favorably.
Do Equivalence Trials Display Superiority Over the Traditional Comparative Study Methods in Orthopedic Surgery?
Authors: Hughes Andrew J. , Temperley Hugo C. , Ahern Daniel P. , McDonnell Jake , Butler Joseph S.
Published: March 2020

Superiority and equivalence trials are 2 commonly encountered methods of designing randomized controlled trials. Traditionally, the goal of a randomized controlled trial is to show superiority. However, in more recent times, there has been a tendency to show equivalence in clinical randomized trials. These differing conclusions at first glance seem to be drawn on the basis of the results of the respective trials. However, to accurately reach these conclusions, there are stark contrasts in the methodologies of these different study types. This article provides a brief overview of superiority and equivalence trials, highlights the differences between the 2, and their relevance to orthopedic surgery.
Outcomes and Utilization of Adjuvant Chemotherapy for Stage II Colon Cancer in the Oxaliplatin Period
Authors: Jiao Xiayu , Hay Joel W. , Sadeghi Sarmad , Barzi Afsaneh
Published: March 2020

Purpose:

Previous SEER (Surveillance, Epidemiology, and End Results)-Medicare analyses have shown no definitive survival benefit for adjuvant chemotherapy (AC) with fluoropyrimidines. Impact of oxaliplatin-containing regimens for elderly stage II patients in real-world setting is unknown. We explored the utilization and outcome of AC after the Food and Drug Administration (FDA) approval of oxaliplatin.

Patients and Methods:

Patients with stage II colon cancer (2004-2011) who underwent resection were selected for this analysis. Medicare claims data were used to ascertain the administration of AC within 120 days after surgery. The primary endpoint of the analysis was overall survival. We used the Cox proportional hazards model to estimate the effect of AC while adjusting for clinical and sociodemographic variables available in SEER. To adjust for referral pattern, a source of selection bias, we conducted an instrumental variable analysis using the surgeon of record and health service area.

Results:

A total of 16,468 patients were identified and 12.1% received AC. AC recipients were significantly younger, more likely to be male, nonwhite, married, and had lower comorbidity index. Their tumors had a more advanced stage, more likely to be left sided, and were less differentiated. The hazard ratio (HR) from the Cox model showed a statistically significant survival advantage for AC (HR=0.847, 95% confidence interval: 0.782-0.916). However, results from the instrumental variable analysis indicated that there was no definitive benefit of survival in AC recipients (HR=1.779, 95% confidence interval: 0.927-3.415). AC use decreased over time.

Conclusions:

After controlling for referral patterns, administration of AC provided no definitive survival benefit. Future studies may elucidate the elderly population who may benefit from AC.
Investigation of eNOS gene polymorphism exposes a genetic association between endothelial dysfunction and osteoporosis in postmenopausal women
Authors: Singh Puneetpal , Singh Monica , Valecha Srishti , Khinda Rubanpal , Kumar Nitin , Mastana Sarabjit , Singh Surinderpal , Juneja Pawan K. , Kaur Taranpal
Published: March 2020

Objectives:

To investigate the association of genetic polymorphisms of endothelial nitric oxide synthase (eNOS) gene with endothelial dysfunction associated osteoporosis in postmenopausal women of Punjab, India.

Methods:

The study involved 456 postmenopausal women having endothelial dysfunction categorized according to women with (n = 236) and without osteoporosis (n = 220). Bone mineral density (BMD) and reactive hyperemia index (RHI) were evaluated together with six single-nucleotide polymorphisms (SNPs) within the eNOS gene (rs2070744, rs1799983, rs1800780, rs3918181, rs891512, and rs1808593).

Results:

A moderate association between RHI and BMD at femoral neck (r
2 = 0.213, P = 0.002) and lumbar spine (r
2 = 0.267, P < 0.001) was observed. Minor alleles C and T of SNPs rs2070744 and rs1799983 were associated with chances of osteoporosis in both co-dominant (odds ratio [OR] 2.13, P = 0.017; OR 2.77, P = 0.009) and dominant (OR 2.10, P = 0.011; OR 2.45, P = 0.007) modes, whereas minor allele A of SNP rs891512 showed marginal probability in dominant model (OR 1.68, P = 0.047). A susceptibility haplotype (CTAAAT) was observed within the eNOS gene which conferred 2.32 times higher chances of osteoporosis (OR 2.32, 95% confidence interval 1.18-4.54, P = 0.021) after adjusting for the effect of confounders. Genetic model analysis revealed that each copy of susceptibility haplotype increased the possibility of osteoporosis by a factor of 2.11 ± 0.63 (P < 0.001). RHI was significantly associated with susceptibility haplotype CTAAAT in a dose-dependent manner, whereby the severity of endothelial dysfunction increased significantly in women having two copies over women having one copy or no copy (β = 2.13, P < 0.001) of susceptibility haplotype.

Conclusion:

A susceptibility haplotype CTAAAT within the eNOS gene is associated with double the possibility of endothelial dysfunction affiliated osteoporosis in postmenopausal women of Punjab, India.
Intraoperative Fetal Monitoring for Nonobstetric Surgery
Authors: McCURDY REBEKAH J.
Published: March 2020

Necessary nonobstetric surgical procedures should not be withheld from pregnant women for fear of risks to the women and their pregnancies; however, careful preoperative planning should be undertaken to mitigate risks that may be present. Fetal monitoring recommendations will be dependent on the woman’s preferences, gestational age of the pregnancy, and situational-specific risks (including anticipated risk of cardiovascular instability). Some fetal heart rate changes (lower baseline, less variability) can be anticipated, depending on anesthetic agents utilized during the procedure, and should not routinely prompt delivery.
Clinical Characteristics of Pediatric Pyelonephritis Without Pyuria or Bacteriuria
Authors: Yokoyama Tadafumi , Takemura Yuta , Irabu Hitoshi , Taniguchi Chihiro , Jinkawa Asumi , Yamamiya Mari , Obata Misato , Miyashita Kengo , Inoue Mika , Sakazume Shinobu , Ohta Kazuhide
Published: March 2020

Background:

The gold standard for the diagnosis of acute pyelonephritis (APN) in children is the finding of both pyuria (P) and bacteriuria (B); however, some APN patients have neither of these findings [APN(P(−);B(−))].

Methods:

In this study, we investigated APN patients who visited our hospital over 14 years to identify specific clinical characteristics of APN(P(−);B(−)).

Results:

A total of 171 APN patients were included in the study, and of these 29 were APN(P(−);B(−)). Of the APN(P(−);B(−)) patients, 25.9% had vesicoureteral reflux (VUR), the same percentage as the APN(P(+);B(+)) patients, and 69.0% of APN(P(−);B(−)) patients had already taken antibiotics before diagnosis. APN(P(−);B(−)) patients were older and had a longer duration between onset of fever and diagnosis than the patients with pyuria and/or bacteriuria. In addition, they showed higher C-reactive protein levels. APN(P(−);B(−)) patients had high levels of urinary α-1 microglobulin and urinary β-2 microglobulin.

Conclusions:

APN is difficult to diagnose in febrile patients who display neither pyuria nor bacteriuria, but as these patients have the same risk for VUR as APN patients with pyuria and bacteriuria, a detailed history establishing the clinical course as well as urinary chemistry investigations, may assist in diagnosis.