bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between Neuraxial Labor Analgesia and Neonatal Morbidity after Operative Vaginal Delivery
Authors: Butwick Alexander J. , Wong Cynthia A. , Lee Henry C. , Blumenfeld Yair J. , Guo Nan
Published: October 2020

Background

Up to 84% of women who undergo operative vaginal delivery receive neuraxial analgesia. However, little is known about the association between neuraxial analgesia and neonatal morbidity in women who undergo operative vaginal delivery. The authors hypothesized that neuraxial analgesia is associated with a reduced risk of neonatal morbidity among women undergoing operative vaginal delivery.

Methods

Using United States birth certificate data, the study identified women with singleton pregnancies who underwent operative vaginal (forceps- or vacuum-assisted delivery) in 2017. The authors examined the relationships between neuraxial labor analgesia and neonatal morbidity, the latter defined by any of the following: 5-min Apgar score less than 7, immediate assisted ventilation, assisted ventilation greater than 6 h, neonatal intensive care unit admission, neonatal transfer to a different facility within 24 h of delivery, and neonatal seizure or serious neurologic dysfunction. The authors accounted for sociodemographic and obstetric factors as potential confounders in their analysis.

Results

The study cohort comprised 106,845 women who underwent operative vaginal delivery, of whom 92,518 (86.6%) received neuraxial analgesia. The proportion of neonates with morbidity was higher in the neuraxial analgesia group than the nonneuraxial group (10,409 of 92,518 [11.3%] vs. 1,271 of 14,327 [8.9%], respectively; P < 0.001). The unadjusted relative risk was 1.27 (95% CI, 1.20 to 1.34; P < 0.001); after accounting for confounders using a multivariable model, the adjusted relative risk was 1.19 (95% CI, 1.12 to 1.26; P < 0.001). In a post hoc analysis, after excluding neonatal intensive care unit admission and neonatal transfer from the composite outcome, the effect of neuraxial analgesia on neonatal morbidity was not statistically significant (adjusted relative risk, 1.07; 95% CI, 1.00 to 1.16; P = 0.054).

Conclusions

In this population-based cross-sectional study, a neonatal benefit of neuraxial analgesia for operative vaginal delivery was not observed. Confounding by indication may explain the observed association between neuraxial analgesia and neonatal morbidity, however this dataset was not designed to evaluate such considerations.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Science of Learning Strategy Series: Article 1, Distributed Practice
Authors: Van Hoof Thomas J. , Sumeracki Megan A. , Madan Christopher R.
Published: October 2020

Distributed practice is an evidence-based, learning-science strategy that is relevant to the planning and implementation of continuing professional development (CPD). Spacing-out study or practice over time allows the brain multiple opportunities to process new and complex information in an efficient way, thus increasing the likelihood of mastery and memory. Research from cognitive psychology and neuroscience provide the rationale for distributed practice, and examples of its implementation in health professions education have begun to appear in the literature. If used appropriately or extended creatively, some common CPD interventions can fully leverage distributed practice. Through increased understanding, CPD planners can benefit from distributed practice in efforts to improve educational activities, and CPD participants can benefit by making more informed educational choices.
Newer risk assessment strategies in hypertrophic cardiomyopathy
Authors: Chaudhry-Waterman Nadia , Cohen Mitchell I.
Published: October 2020

Purpose of review

The present article serves to review current risk assessment guidelines for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) and to discuss how these guidelines can be applied to patients with childhood HCM. New diagnostic techniques that could lead to more accurate risk assessment tools are also discussed.

Recent findings

Current guidelines for risk assessment in childhood HCM are extrapolated from adult guidelines and lack background research to validate their use. Continuous variables, such as wall thickness, are converted to binary variables, which is particularly concerning in pediatric patients’ where weight gain and linear growth is likely to lead to more significant hemodynamic changes in shorter periods of time. Some studies have even shown that risk factors concerning in adults may actually be protective in pediatric patients. Additionally, large gaps still remain between genotype and phenotype expression in HCM.

A better understanding of the relationship between cause, phenotype, and outcomes is needed to truly be able to determine risk for SCD in childhood HCM. Larger studies, including newer technologies and quantitative models, similar to the European HCM Risk-SCD model, which allows for a quantitative risk diagnosis, are needed as well.
Effect of Ketamine on Rumination in Treatment-Resistant Depressive Patients
Authors: Vidal Sonia , Jermann Françoise , Aubry Jean-Michel , Richard-Lepouriel Hélène , Kosel Markus
Published: October 2020

Background

A rapid antidepressant effect of ketamine has repeatedly been documented in the literature, and identifying clinical features associated with a better response to this treatment is currently an essential question. Considering the relationship between rumination and depression and the need to identify potential predictors of response to ketamine, we analyzed the effect of a single injection of ketamine 0.5 mg/kg on rumination in treatment-resistant depressive (TRD) patients and explored whether baseline ruminative style and early improvements of rumination would predict a greater antidepressant effect of ketamine.

Methods

Ten TRD outpatients who participated in a 4-week open study on the antidepressant effect of ketamine also completed the Ruminative Response Scale the day before, the day after, and a week after ketamine administration.

Results

We found that in our patients, a single rapid 1-minute intravenous injection of ketamine 0.5 mg/kg was efficacious in reducing rumination, but neither severity of rumination at baseline nor early improvements of rumination after ketamine injection predicted antidepressant response.

Conclusions

Our preliminary data suggest that a single injection of ketamine 0.5 mg/kg can be efficacious in reducing rumination in TRD patients but rumination does not seem to be a useful clinical predictor of response to ketamine. Larger studies are necessary to confirm these results.
The past the present and the future of face transplantation
Authors: Siemionow Maria
Published: October 2020

Purpose of review

Face transplantation represents vascularized composite allotransplantation (VCA) organ and became one of the most rewarding reconstructive options for severely disfigured patients. This review summarizes the past, current and future challenges of face transplantation, based on our experience and literature reports.

Recent findings

In 2005, first partial face transplantation was reported by French team. In 2008, we have performed the US first near-total face transplantation. Currently, more than 40 face transplant cases were reported worldwide. Based on the outcomes of our three patients and the literature reports, face transplantation improved aesthetics, function and the quality of life of face transplant patients. However, there are still many challenges encountered including the side effects of immunosuppressive protocols, the psychological and social problems as well as the financial challenges which need to be address in the near future to maintain face transplantation in the armamentarium of reconstructive surgery.

Currently, feasibility of face transplantation was confirmed; however, the life-long immunosuppressive protocols bearing serious side effects are still required to prevent face rejection. Thus, for the future of face and other VCA, novel approaches of cell-based therapies or engineered scaffolds should be developed to make face transplantation safer.
Donor-specific antibodies in kidney transplantation: the University of Wisconsin experience
Authors: Garg Neetika , Parajuli Sandesh , Mandelbrot Didier A. , Djamali Arjang
Published: October 2020

Purpose of review

Antibody-mediated rejection (ABMR) is the leading cause of allograft failure in kidney transplant recipients. This article provides a summary of the clinical research relating to donor-specific antibodies (DSA) and ABMR in kidney transplant recipients at the University of Wisconsin-Madison Transplant Center.

Recent findings

Over 40% of the kidney transplant candidates on the UNOS waitlist are sensitized, and both preformed and de novo DSA are associated with increased risk of rejection and graft loss. We have developed graded induction-desensitization treatment and monitoring protocols based on the degree of immunologic risk. We have also implemented standard treatment and surveillance strategies for patients with ABMR. Additional important observations from our studies include high rates of ABMR in patients with positive C4d staining in postreperfusion biopsies and rise in DSA at 1 week after transplant, and increased risk of kidney allograft failure in patients with de novo DSA and ABMR, as well as in patients with HLA-DSA undetectable ABMR. We also found worse outcomes with de novo DSA following simultaneous pancreas--kidney and liver--kidney transplantation. Notably, favorable long-term graft outcomes were observed in patients with DSA who do not present the classic histopathological findings of ABMR.

In order to improve long-term outcomes for kidney transplant recipients, further research focusing on the pathogenic mechanisms elicited by HLA and non-HLA DSA, and novel therapies targeting these pathways is needed.
Evaluation of Self-efficacy and Confidence Levels Among Newly Graduated Nurses Exposed to an End-of-Life Simulation
Authors: Edwards Catherine , Hardin-Pierce Melanie , Anderson Debra , Rexford Tracy
Published: October 2020

Self-efficacy and confidence levels among newly graduated nurses who participated in an end-of-life simulation were compared with nurses who had been practicing for no more than a year but had not participated in an end-of-life simulation. The study included a pretest-and-posttest evaluation of an end-of-life simulation intervention during a new graduate residency program among newly graduated nurses to improve self-efficacy and confidence with end-of-life care. Nurses who had been in practice for no more than a year but had not been exposed to an end-of-life simulation intervention were also surveyed. The Palliative Care Evaluation Tool Kit was adapted and used for this project. The 2 groups of nurses were compared in terms of self-efficacy and confidence levels regarding end-of-life care. An end-of-life simulation intervention was successful in improving self-efficacy and confidence levels among newly graduated nurses, in regard to views about end of life and death and dying compared with the nurses who did not receive the end-of-life simulation intervention. The results of this study have implications for both schools of nursing and hospital training programs.
Early application of topical antibiotic powder in open-fracture wounds
Authors: Burbank Kimberly M. , Schauer Steven G. , De Lorenzo Robert A. , Wenke Joseph C.
Published: October 2020

Despite meticulous surgical care and systemic antibiotics, open fracture wounds have high rates of infection leading to increased morbidity. To reduce infection rates, orthopaedic surgeons may administer local antibiotics using various carriers that may be ineffective due to poor antibiotic release from carriers, subsequent surgery to remove nondegradable carriers, and mismatch between release kinetics and material degradation. Biofilms form rapidly as bacteria that are within the wound multiply quickly and transform from the antibiotic-susceptible planktonic phenotype to the antibiotic-tolerant biofilm phenotype. This tolerance to antibiotics can occur within hours. Currently, local antibiotics are placed in the wounds using a carrier such as polymethylmethacrylate beads; however, this occurs after surgical debridement that can be hours to even a day after initial injury allowing bacteria enough time to form a biofilm that makes the antibiotic containing polymethylmethacrylate beads less effective. In contrast, emerging practices in elective surgical procedures, such as spine fusion, place antibiotic powder (e.g. vancomycin) in the wound at the time of closure. This has been shown to be extremely effective, presumably because of the very small-time period between potential contamination and local antibiotic application. There is evidence that suggests that the ineffectiveness of local antibiotic use in open fractures is primarily due to the delay in application of local antibiotics from the time of injury and propose a concept of topical antibiotic powder application in the prehospital or emergency department setting.
Did Pre-exposure Prophylaxis Roll-Out Influence the Epidemic of Rectal Lymphogranuloma Venereum in Belgium? Results From the National Surveillance System
Authors: De Baetselier Irith , Tsoumanis Achilleas , Florence Eric , Van den Berghe Wim , Crucitti Tania , Van den Bossche Dorien , Kenyon Chris
Published: October 2020

Background:

An increase of lymphogranuloma venereum (LGV) in HIV negative men who have sex with men is reported in several European countries including Belgium before the implementation of pre-exposure prophylaxis (PrEP).

Setting:

The epidemiological characteristics of the male rectal LGV epidemic in Belgium were explored before and after the introduction of PrEP.

Methods:

Segmented regression models were used to examine a change in trends before and after the introduction of PrEP in the male rectal LGV epidemic in Belgium and among men attending a large HIV/sexually transmitted infection clinic in Antwerp, Belgium.

Results:

Although an increase of 69% was noted in absolute numbers in 2019 compared with 2018 (140 vs 83 cases) in Belgium, models showed that the rate of increase did not change after the introduction of PrEP. More than half of the cases were found in HIV-negative men (56.2%) in 2019, but no difference in the magnitude of the trend was found after the introduction of PrEP. Nevertheless, the data reveal that a statistical significant increase of LGV prevalence was noted among non–HIV-positive men in an HIV/sexually transmitted infection clinic after the implementation of PrEP. Indeed, LGV prevalence in the Antwerp male PrEP cohort increased from 0.8% in 2017 to 2.4% in 2019.

Conclusions:

The trend of LGV increase did not accelerate after the introduction of PrEP. Continued surveillance in men who have sex with men irrespective of their HIV status is required for the management and control of the LGV epidemic.
Gray matter changes in chronic heavy cannabis users: a voxel-level study using multivariate pattern analysis approach
Authors: Wu Yue-Fen , Yang Bo
Published: October 2020

Recent structural MRI studies on gray matter (GM) volumes using group-level mass-univariate statistical analysis suggest that chronic and heavy cannabis exposure may affect brain region-based morphology. In this prospective study, we use a multivariate pattern analysis approach to investigate the voxel-level change of GM densities in chronic heavy cannabis users. Principal component analysis and linear support vector machine are used in this study, resulting in an 88.1% separation between chronic heavy cannabis users (N = 20) and non-cannabis healthy controls (HCs, N = 22) through leave-one-out cross-validation. The model’s discriminative pattern showed that GM density decreases in the part of middle frontal gyrus, inferior frontal gyrus, middle temporal gyrus, inferior temporal gyrus and left occipital lobe in heavy cannabis users with respect to HCs and increases in the part of lentiform nucleus, left cerebellum and right parietal lobe. These results suggest that GM densities alteration has taken place on chronic heavy cannabis users compared with HCs at voxel level.
The relationship between perceptual priming and subsequent recognition memory: an event-related potential study
Authors: Li Bingbing , Jiang Luyao
Published: October 2020

This study investigated the relationship between perceptual priming and subsequent recognition memory using conceptually impoverished kaleidoscope images as stimuli. Event-related potentials (ERPs) were recorded to explore the ERPs related to perceptual priming and their relationship with subsequent recognition memory. The results revealed that the early ERP perceptual priming effect between 100 and 300 ms, which might reflect perceptual fluency, was significant for both subsequent remembered and forgotten images. Both the latter ERP perceptual priming effects between 300–500 ms and 500–800 ms and the behavioral priming effect were significant for subsequent remembered images but not for subsequent forgotten images. These results indicated that brain activities between 300–500 ms and 500–800 ms could be predictive of both subsequent perceptual priming and recognition memory. Thus, the results of the present study demonstrate that perceptual priming and recognition memory share encoding factors.
How might controlled fusion fit into the emerging low-carbon energy system of the mid-twenty-first century?
Authors: Tynan G. R. , Abdulla A.
Published: October 2020

We examine the characteristics that fusion-based generation technologies will need to have if they are to compete in the emerging low-carbon energy system of the mid-twenty-first century. It is likely that the majority of future electric energy demand will be provided by the lowest marginal cost energy technology—which in many regions will be stochastically varying renewable solar and wind electric generation coupled to systems that provide up to a few days of energy storage. Firm low-carbon or zero-carbon resources based on gas-fired turbines with carbon capture, advanced fission reactors, hydroelectric and perhaps engineered geothermal systems will then be used to provide the balance of load in a highly dynamic system operating in competitive markets governed by merit-order pricing mechanisms that select the lowest-cost supplies to meet demand. These firm sources will have overnight capital costs in the range of a few $/Watt, be capable of cycling down to a fraction of their maximum power output, operate profitably at low utilization fraction, and have a suitable unit size of order 100 MWe. If controlled fusion using either magnetic confinement or inertial confinement approaches is to have any chance of providing a material contribution to future electrical energy needs, it must demonstrate these key qualities and at the same time prove robust safety characteristics that avoid the perceived dread risk that plagues nuclear fission power, avoid the generation of long-lived radioactive waste and demonstrate highly reliable operations.

This article is part of a discussion meeting issue ‘Prospects for high gain inertial fusion energy (part 1)’.
Double-cone ignition scheme for inertial confinement fusion
Authors: Zhang J. , Wang W. M. , Yang X. H. , Wu D. , Ma Y. Y. , Jiao J. L. , Zhang Z. , Wu F. Y. , Yuan X. H. , Li Y. T. , Zhu J. Q.
Published: October 2020

While major progress has been made in the research of inertial confinement fusion, significant challenges remain in the pursuit of ignition. To tackle the challenges, we propose a double-cone ignition (DCI) scheme, in which two head-on gold cones are used to confine deuterium–tritium (DT) shells imploded by high-power laser pulses. The scheme is composed of four progressive controllable processes: quasi-isentropic compression, acceleration, head-on collision and fast heating of the compressed fuel. The quasi-isentropic compression is performed inside two head-on cones. At the later stage of the compression, the DT shells in the cones are accelerated to forward velocities of hundreds of km s
–1
. The head-on collision of the compressed and accelerated fuels from the cone tips transfer the forward kinetic energy to the thermal energy of the colliding fuel with an increased density. The preheated high-density fuel can keep its status for a period of approximately 200 ps. Within this period, MeV electrons generated by ps heating laser pulses, guided by a ns laser-produced strong magnetic field further heat the fuel efficiently. Our simulations show that the implosion inside the head-on cones can greatly mitigate the energy requirement for compression; the collision can preheat the compressed fuel of approximately 300 g cm
−3
to a temperature above keV. The fuel can then reach an ignition temperature of greater than 5 keV with magnetically assisted heating of MeV electrons generated by the heating laser pulses. Experimental campaigns to demonstrate the scheme have already begun.

This article is part of a discussion meeting issue ‘Prospects for high gain inertial fusion energy (part 1)’.
Crossed beam energy transfer between optically smoothed laser beams in inhomogeneous plasmas
Authors: Hüller Stefan , Raj Gaurav , Luo Mufei , Rozmus Wojciech , Pesme Denis
Published: October 2020

Crossed beam energy transfer, CBET, in high-intensity laser–plasma interaction is investigated for the case of optically smoothed laser beams. In the two approaches to laser-driven inertial confinement fusion experiments, the direct-drive and the indirect-drive, CBET is of great importance because it governs the coupling of laser energy to the plasma. We use the two-dimensional wave-coupling code H
armony
to simulate the transfer between two laser beams with speckle structure that overlap in a plasma with an inhomogeneous flow profile. We compare the CBET dynamics for laser beams with spatial incoherence and with spatio-temporal incoherence; in particular we apply the smoothing techniques using random phase plates (RPPs) and smoothing by spectral dispersion (SSD), respectively. It is found that for laser beams (wavelength
λ
0
) with intensities (
I

L

) above
I

L

 ∼ 2 × 10
15
 W cm
−2
(
λ
0
/0.35 µm)
−2
(
T

e

/keV), both the so-called plasma-induced smoothing as well as self-focusing in intense laser speckles induce temporal incoherence; the latter affects the CBET and the angular distribution of the light transmitted behind the zone of beam overlap. For RPP-smoothed incident beams, the resulting band width of the transmitted light can already be of the same order as the effective band width of the SSD available at major laser facilities. We examine the conditions when spatio-temporal smoothing techniques become efficient for CBET.

This article is part of a discussion meeting issue ‘Prospects for high gain inertial fusion energy (part 1)’.
Agromyces kandeliae sp. nov., isolated from rhizosphere soil of Kandelia candel in a mangrove
Authors: Wang Ruijun , Ye Yanghui , Huang Yanfen , Nie Yanfang , Han ShuaiBo , Yu Xiaoyun , Wu Choufei , Li Yang , Wu Min , Zhang Liqin
Published: October 2020

A novel, Gram-stain-positive, aerobic, non-spore-forming, non-motile and irregular rod-shaped bacterium designated Q22T was isolated from the rhizosphere soil of mangrove plant, Kandelia candel collected in Zhangzhou, Fujian province, China. Strain Q22T was able to grow at 10–40 °C (optimum 30 °C), pH 5.5–9.0 (optimum 7.0–8.0) and with 0–5.0% (w/v) NaCl (optimum 1.0 %). The genomic DNA G+C content was 71.9%. The average nucleotide identity, and in silico DNA–DNA hybridization values between strain Q22T and the reference strains were 79.7–88.9% and 22.6–37.4%, respectively. The predominant isoprenoid quinone was MK-12 and the major fatty acids were anteiso-C15:0, iso-C16:0 and anteiso-C17:0. The major polar lipids of strain Q22T were diphosphatidylglycerol, phosphatidylglycerol, one glycolipid and three unidentified lipids. The strain Q22T contained 2,4-diaminobutyric acid, alanine acid, glutamic acid and glycine in the peptidoglycans. The phylogenetic analysis and genotypic features, along with the phenotypic and chemotaxonomic characteristics, indicate that strain Q22T represents a novel species of the genus

Agromyces

, for which the name Agromyces kandeliae sp. nov. is proposed. The type strain is Q22T (=MCCC 1K03340T= KCTC 39961T).
Rapid detection of SARS-CoV2 by Ambient Mass Spectrometry Techniques
Authors: Ford L. , Simon D. , Balog J. , Jiwa N. , Higginson J. , Jones E. , Mason S. , Wu V. , Manoli E. , Stavrakaki S. M. , McKenzie J. , McGill D. , Koguna H. , Kinross J. , Takats Z.
Published: October 2020

Ambient Ionisation Mass Spectrometry techniques: Desorption Electrospray Ionisation (DESI) and Laser Desorption – Rapid Evaporative Ionisation Mass Spectrometry (LD-REIMS) were used to detect the SARS-CoV-2 in dry nasal swabs. 45 patients were studied from samples collected between April – June 2020 in a clinical feasibility study. Diagnostic accuracy was calculated as 86.7% and 84% for DESI and LD-REIMS respectively. Results can be acquired in seconds providing robust and quick analysis of COVID-19 status which could be carried out without the need for a centralised laboratory. This technology has the potential to provide an alternative to population testing and enable the track and trace objectives set by governments and curtail the effects of a second surge in COVID-19 positive cases. In contrast to current PCR testing, using this technique there is no requirement of specific reagents which can cause devastating delays upon breakdowns of supply chains, thus providing a promising alternative testing method.
Determinants of Time to Convalescence among COVID-19 Patients at Millennium COVID-19 Care Center in Ethiopia: A prospective cohort study
Authors: Leulseged Tigist W. , Hassen Ishmael S. , Maru Endalkachew H. , Zewde Wuletaw C. , Chamesew Nigat W. , Yegile Kalkidan T. , Bayisa Abdi B. , Jagema Tariku B. , Admasu Teketel T. , Edo Mesay G. , Gurara Eyosias K. , Hassen Meseret D. , Menyelshewa Etsegenet Y. , Abdi Firaol M. , Tefera Mahlet B. , Ali Siham S.
Published: October 2020

Aim

To estimate time to recovery/convalescence and identify determinants among COVID-19 infected patients admitted to Millennium COVID-19 Care Center in Addis Ababa, Ethiopia.

Methods

A prospective cohort study was conducted among a randomly selected sample of 360 COVID-19 patients who were on follow up from 2ndJune to 5thJuly 2020. Kaplan Meier plots, median survival times, and Log-rank test were used to describe the data and compare survival distribution between groups. Association between time to recovery/ convalescence and determinants was assessed using the Cox proportional hazard survival model, where hazard ratio, P-value, and 95% CI for hazard ratio were used for testing significance.

Results

The mean age of the participants was 32.4 years (± 12.5 years). On admission, 86.9 % had mild COVID-19, 78.6% were asymptomatic and 11.4% of the patients had a history of pre-existing co-morbid illness. The Median time to recovery/ convalescence among the study population was 16 days. The log-rank test shows that having non-mild (moderate and severe) disease, having one or more symptoms at presentation, and presenting with respiratory and constitutional symptoms seems to extend the time needed to achieve recovery. The Final Cox regression result shows that the presence of symptom at presentation was found to be a significant factor that affects time to recovery/ convalescence, the rate of achieving recovery/ convalescence among symptomatic patients was 44% lower than patients who were asymptomatic at presentation (HR= 0.560, 95% CI= 0.322-0.975, p-value=0.040).

Conclusions

Presence of symptom was found to be associated with delayed viral clearance. This implies symptomatic patients are more likely to be infectious because of the prolonged viral shedding in addition to the presence of a more concentrated virus in the upper respiratory tract that enhances the transmission. Therefore, attention should be given in the isolation and treatment practice of COVID-19 patients with regard to presence of symptom.

Key Messages

The study assessed the time to RT-PCR proven recovery (two consecutive negative viral shedding) and identified determinants that affected the time.

Symptomatic infection is associated with delayed viral clearance.

The finding of the study could be used to guide the isolation and treatment practice.
Changes in the position of the hyoid bone in skeletal Class II children post-functional Activator therapy
Authors: Medina Cynthia Concepcion , Ueda Hiroshi , Kunimatsu Ryo , Tanimoto Kotaro
Published: October 2020

Introduction

The hyoid bone is deeply involved in three important body functions: deglutition, phonation and respiration. Several studies have shown that changes in the position of the hyoid bone may influence in pharyngeal size with mandibular advancement, thus a forward positioned hyoid bone may be an indicator of wide upper airways.

Objective

To determine the changes in the position of the hyoid bone after functional appliance treatment.

Subjects and methods

20 children (aged 9-13) that currently visit Hiroshima University Hospital actively undergoing FKO activator therapy volunteered for this study. Several lateral cephalometric radiographs were indicated and traced to assess hyoid bone position changes that might have occurred when actively complying with the FKO therapy, said radiographs were procured before active functional treatment (T0), during it (T1), and a year after continuous use of this appliance (T2). ANOVA tests were done to find statistical significance.

Results

The results of these tests were analyzed and compared; it was found that, the hyoid bone is at a lower position from the mandibular plane and Frankfurt horizontal plane after FKO treatment, also the mandible is more forward after activator therapy, bringing the hyoid bone forward with it thus widening the lowest section of the upper airways.

Conclusion

The FKO not only induces the proper development of the mandible, it also potentially advances the position of the hyoid bone, thus affecting positively in the opening of airways providing an improvement in the children’s breathing functions.

Authors report no conflict of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest/Competing interests

the authors have no conflicts of interest to declare.

Ethics approval

This research has been approved by the Ethics Review Committee of Hiroshima University (No. E – 56).

Consent to participate

All subjects needed to have provided informed consent from the parent or guardian prior all evaluations. This study has followed the guidelines stated in the Helsinki Declaration for clinical investigations.

Consent for publication

All subjects have provided informed consent from the parent or guardian to allow publication of acquired data.
Predicted Infection Risk for Aerosol Transmission of SARS-CoV-2
Authors: Kriegel Martin , Buchholz Udo , Gastmeier Petra , Bischoff Peter , Abdelgawad Inas , Hartmann Anne
Published: October 2020

Currently, the respiratory route is seen as the most important transmission path for SARS-CoV-2. In this investigation, models of other researchers which had the aim of predicting an infection risk for exposed persons in a room through aerosols emitted by an infectious case-patient were extended. As a novelty – usually neglected – parameters or boundary conditions, namely the non-stationarity of aerosols and the half-life of the aerosolized virus, were included and a new method for determining the quanta emission rate based on measurements of the particle emission rate and respiratory rate at different types of activities was implemented.

As a second step, the model was applied to twelve outbreaks to compare the predicted infection risk with the observed attack rate. To estimate a “credible interval” of the predicted infection risk, the quanta emission rate, the respiratory rate as well as the air volume flow were varied.

In nine out of twelve outbreaks, the calculated predicted infection risk via aerosols was found to be in the range of the attack rate (with the variation of the boundary conditions) and reasons for the observed larger divergence were discussed.

The validation was considered successful and therefore the use of the model could be recommended to predict the risk of an infection via aerosols in given situations. Furthermore, appropriate preventive measures can be designed.
Does sensory modulation dysfunction contribute to emotional dysregulation in children with ADHD?: Analysis plan
Authors: Bruton Alisha , Senders Angela , Leung Brenda , Hatsu Irene , Arnold L. Eugene , Johnstone Jeanette
Published: October 2020

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. Up to 50% of children with ADHD may also experience symptoms of emotional dysregulation, such as anger, irritability, and aggression. Emotional dysregulation contributes to adverse health outcomes such as depression and peer problems, yet it is poorly understood, and effective treatment options are lacking. Emerging evidence suggests that sensory processing may play a role in emotional dysregulation. Forty to 50% of children with ADHD may also experience sensory modulation dysfunction, or SMD. SMD is characterized by hypo- or hyperreactivity to pain and sensation. Only one study investigated the relationship of SMD and emotional dysregulation in ADHD; they found a correlation of r=0.45. If SMD drives emotional dysregulation in ADHD, treating SMD has the potential to improve emotional regulation. Further evaluating the relationship between SMD and emotional dysregulation in ADHD is the crucial first step in developing effective treatment options.

Methods

Data for this analysis are derived from the baseline assessment of a multi-site, randomized, controlled trial: The Micronutrients for ADHD in Youth (MADDY) Study. The study enrolled children aged 6-12 with a diagnosis of ADHD and symptoms of emotional dysregulation. Using a cross-sectional study design, we will measure the association between emotional dysregulation and SMD at baseline. Emotional dysregulation was measured using the Strengths and Difficulties Questionnaire (SDQ) and a composite score from the Child and Adolescent Symptom Inventory, Version-5 (CASI-5). SMD will be assessed using two subscales from the Temperament in Middle Childhood Questionnaire (TMCQ). To test our hypothesis, we will use simple linear regression. Models will be adjusted for potential confounding variables.

Conclusion

Our results will serve to better characterize the relationship between SMD and emotional dysregulation in children with ADHD, which may inform treatment options and diminish adverse health outcomes.
Optical Tweezer Stretching of Miniature Coarse-Grained Red Blood Cells
Authors: Appshaw P. , Seddon A. M. , Hanna S.
Published: October 2020

Due to the high computational cost of full-cell coarse-grained molecular dynamics modelling, being able to simulate “miniature” cells that effectively represent their full-sized counterparts would be highly advantageous. To accurately represent the morphological and elastic properties of a human red blood cellin silico, such a model is employed utilising the molecular dynamics package LAMMPS. The scale invariance of the model is first tested qualitatively by following the shape evolution of red blood cells of various diameters, then quantitatively by evaluating the membrane shear modulus from simulations of optical tweezer-style stretching. Cells of physical diameter of at least 0.5µm were able to form the characteristic biconcave shape of human red blood cells, though smaller cells instead equilibrated to bowl-shaped stomatocytes. A positive correlation was found between the cell size and both magnitude of deformation from optical tweezer stretching and scaled shear modulus, indicating a lack of scale invariance in the models elastic response. However, the stable morphology and measured shear modulus of the 0.5 − 1.0µm diameter cells are deemed close enough to pastin vitrostudies on human red blood cells for them to still offer valuable use in making simplified predictions of whole-cell mechanics.

SIGNIFICANCE

The study tests the invariance of a coarse-grained molecular dynamics red blood cell (RBC) model to system scale, asking whether it is qualitatively and quantitatively viable to perform whole-cell simulations in “miniature”. Simulating cells at a reduced scale greatly improves computational speed, making possible computational experiments that would otherwise be too computationally demanding. This facilitates the simulation of larger systems, both in number of whole-cells, and cells of greater structural complexity than the RBC. More generally, the accurate and efficient modelling of biological cells allows computational experimentation of real-world systems that would be very challenging or impossible to performin vitro. Therefore, miniature-cell modelling could help both direct development in whole-cell modelling, and also developments in more widespread bio-physical studies.
Single-dose intranasal administration of AdCOVID elicits systemic and mucosal immunity against SARS-CoV-2 in mice
Authors: King Rodney G , Silva-Sanchez Aaron , Peel Jessica N. , Botta Davide , Meza-Perez Selene , Allie S. Rameeza , Schultz Michael D. , Liu Mingyong , Bradley John E. , Qiu Shihong , Yang Guang , Zhou Fen , Zumaquero Esther , Simpler Thomas S. , Mousseau Betty , Killian John T. , Dean Brittany , Shang Qiao , Tipper Jennifer L. , Risley Christopher , Harrod Kevin S. , Feng Ray , Lee Young , Shiberu Bethlehem , Krishnan Vyjayanthi , Peguillet Isabelle , Zhang Jianfeng , Green J. Todd , Randall Troy D. , Georges Bertrand , Lund Frances E. , Roberts Scot
Published: October 2020

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the urgent need for effective preventive vaccination to reduce burden and spread of severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) in humans. Intranasal vaccination is an attractive strategy to prevent COVID-19 as the nasal mucosa represents the first-line barrier to SARS-CoV-2 entry before viral spread to the lung. Although SARS-CoV-2 vaccine development is rapidly progressing, the current intramuscular vaccines are designed to elicit systemic immunity without conferring mucosal immunity. Here, we show that AdCOVID, an intranasal adenovirus type 5 (Ad5)-vectored vaccine encoding the receptor binding domain (RBD) of the SARS-CoV-2 spike protein, elicits a strong and focused immune response against RBD through the induction of mucosal IgA, serum neutralizing antibodies and CD4+ and CD8+ T cells with a Th1-like cytokine expression profile. Therefore, AdCOVID, which promotes concomitant systemic and local mucosal immunity, represents a promising COVID-19 vaccine candidate.
Summer School Holidays and the Growth Rate in Sars-CoV-2 Infections Across German Districts
Authors: Plümper Thomas , Neumayer Eric
Published: October 2020

Objectives

To estimate the effect that summer school holidays had on the growth rate in Sars-CoV-2 infections across German districts. The Robert-Koch-Institute reports that during the summer holiday period a foreign country is stated as the most likely place of infection for an average of 27 and a maximum of 49 percent of new Sars-CoV-2 infections in Germany. Yet, infection may have taken place elsewhere, not all international travel is holiday-related and any impact of holiday-related travel will not be restricted to holidays abroad.

Design

Cross-sectional study on observational data. In Germany, summer school holidays are coordinated between states and spread out over 13 weeks. We analyse the association between these holidays and the weekly infection growth rate in SARS-CoV-2 infections across 401 German districts. Employing a dynamic model with district fixed effects, we test whether the holiday season results in a statistically significantly higher infection growth rate than the period of two weeks before holidays start, our presumed counterfactual.

Results

We find effects of the holiday period equal in size to almost 50 percent of the average district growth rate in new infections in Germany during their respective final week of holidays and the two weeks after holidays end. States in the West of Germany tend to experience stronger effects than those in the East. This is consistent with another result, namely that we find statistically significant interaction effects of school holidays with per capita taxable income and the share of foreign residents in a district’s population, with both factors hypothesised to increase holiday-related travels.

Conclusions

Our results suggest that changed behaviour during the holiday season accelerated the pandemic and made it considerably more difficult for public health authorities to contain the spread of the virus by means of contact tracing. Governments did not prepare adequately or timely for this acceleration.
Which electronic health record system should we use? – a systematic review
Authors: Al Ani Mohammed , Garas George , Hollingshead James , Cheetham Drostan , Athanasiou Thanos , Patel Vanash
Published: October 2020

Objectives

This is the first systematic review to look at all published data on EHRs to determine which systems are advantageous.

Design

A systematic review was performed by searching EMBASE and Ovid MEDLINE between 1974 and November 2019.

Participants

All original studies that appraised EHR systems were included.

Main outcome measures

EHR system comparison, implementation, user satisfaction, efficiency and performance, documentation, and research and development.

Results

The search strategy identified 701 studies, which were filtered down to 46 relevant studies. Level of evidence ranged from 1 to 4 according to the Oxford Centre for Evidence-based Medicine. The majority of the studies were performed in the USA (n = 44). N=6 studies compared more than one EHR, and Epic followed by Cerner were the most favourable through direct comparison. N=17 studies evaluated implementation which highlighted that it was challenging, and productivity dipped in the early phase. N=5 studies reflected on user satisfaction, with women demonstrating higher satisfaction than men. Efficiency and performance issues were the driving force behind user dissatisfaction. N=26 studies addressed efficiency and performance, which improved with long-term use and familiarity. N=18 studies considered documentation and showed that EHRs had a positive impact with basic and speciality tasks. N=29 studies assessed research and development which revealed vast capabilities and positive implications.

Conclusion

Epic is the most studied EHR system and the most commonly used vendor on the market. There is limited comparative data between EHR vendors, so it is difficult to assess which is the most advantageous system.
Structure Specific Neuro-toxicity of α-Synuclein Oligomer
Authors: Mondal Animesh , Dolui Sandip , Dhabal Sukhamoy , Bhattacharjee Ashish , Maiti Nakul C
Published: October 2020

Parkinson’s disease (PD) is linked to α-synuclein (aS) aggregation and deposition of amyloid in the substantia nigra region of the brain tissues. Recent reports suggested that oligomeric assembly structure could be neurotoxic to neuronal cells. In the current investigation we produced two distinct classes of aS oligomers and link the protein conformation state and stability to neuronal cell toxicity. Natural oligomers (NO) enriched with alpha-helical folds are produced in storage of aS at below −20°C for 7 days. Induced oligomer (IO), often observed in the aggregation pathway of aS were made incubating the protein solution at 37°C. Natural oligomers remained stable and did not transform into β-sheet rich amyloid fiber and exhibited higher toxicity (80% cell death) compared to induced oligomers. Natural oligomers were ovular shape and the size ranged between 4-5.5 nm. It maintained significant number (∼ 60%) of residues in α-helical conformational space. However, initiation of hydrophobic zipping with beta sheet conformation was evidenced in induced oligomer (IO) and a lesser number residues (45%) remained with preference to α-helical secondary structure. Hydrophobic collapse leads the transformation of IO into thermodynamically most stable β-sheet rich amyloid fibril. Molten globule like secondary structure stabilized by H-bonding in natural oligomers caused enhanced stability and cellular toxicity compared to induced oligomer. Thus off-pathway/natural oligomers could be plausible reason of neuronal cell death and possible cause of Parkinson’s disease.
Medial prefrontal cortex has a causal role in selectively enhanced consolidation of emotional memories after a 24-hour delay: A TBS study
Authors: Yeh Nicholas , Payne Jessica D. , Kim Sara Y. , Kensinger Elizabeth A. , Koen Joshua D. , Rose Nathan S.
Published: October 2020

Previous research points to an association between retrieval-related activity in the medial prefrontal cortex (mPFC) and preservation of emotional information compared to co-occurring neutral information following sleep. Although the role of the mPFC in emotional memory likely begins at encoding, little research has examined how mPFC activity during encoding interacts with consolidation processes to enhance emotional memory. This issue was addressed in the present study using transcranial magnetic stimulation in conjunction with an emotional memory paradigm. Healthy young adults encoded negative and neutral scenes while undergoing concurrent TMS with a modified short intermittent theta burst stimulation (sTBS) protocol. Participants received stimulation to either the mPFC or an active control site (motor cortex) during the encoding phase. Recognition memory for scene components (objects and backgrounds) was assessed after a short (30-minute) and a long delay (24-hour, including a night of sleep) to obtain measures of specific and gist-based memory processes. The results demonstrated that, relative to control stimulation, sTBS to the mPFC enhanced memory for negative objects on the long delay test (collapsed across specific and gist-based memory measures). mPFC stimulation had no discernable effect on memory for objects on the short delay test nor on the background images at either test. These results suggest that mPFC activity occurring during encoding interacts with consolidation processes to preferentially preserve negatively salient information.

Significance Statement

Understanding how emotional information is remembered over time is critical to understanding memory in the real world. The present study used noninvasive brain stimulation (repetitive transcranial magnetic stimulation, rTMS) to investigate the interplay between mPFC activity that occurs during memory encoding and its subsequent interactions with consolidation processes. rTMS delivered to the mPFC during encoding enhanced memory for negatively valenced pictures on a test following a 24-hr delay, with no such effect on a test occurring shortly after the encoding phase. These results are consistent with the hypothesis that emotional aspects of memories are differentially subjected to consolidation processes, and that the mPFC might contribute to this “tag-and-capture” mechanism during the initial formation of such memories.