bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-energy dynamics and the mode-specific phonon threshold effect in Kekulé-ordered graphene
Authors: Zhang Hongyun , Bao Changhua , Schüler Michael , Zhou Shaohua , Li Qian , Luo Laipeng , Yao Wei , Wang Zhong , Devereaux Thomas P , Zhou Shuyun
Published: September 2021

Electron-phonon interaction and related self-energy are fundamental to both the equilibrium properties and non-equilibrium relaxation dynamics of solids. Although electron-phonon interaction has been suggested by various time-resolved measurements to be important for the relaxation dynamics of graphene, the lack of energy- and momentum-resolved self-energy dynamics prohibits direct identification of the role of specific phonon modes in the relaxation dynamics. Here, by performing time- and angle-resolved photoemission spectroscopy measurements on Kekulé-ordered graphene with folded Dirac cones at the Γ point, we have succeeded in resolving the self-energy effect induced by the coupling of electrons to two phonons at Ω1 = 177 meV and Ω2 = 54 meV, and revealing its dynamical change in the time domain. Moreover, these strongly coupled phonons define energy thresholds, which separate the hierarchical relaxation dynamics from ultrafast, fast to slow, thereby providing direct experimental evidence for the dominant role of mode-specific phonons in the relaxation dynamics.
Physiological Characteristics and Transcriptomic Dissection in Two Root Segments with Contrasting Net Fluxes of Ammonium and Nitrate of Poplar Under Low Nitrogen Availability
Authors: Lu Yan , Deng Shurong , Li Zhuorong , Wu Jiangting , Zhu Dongyue , Shi Wenguang , Zhou Jing , Fayyaz Payam , Luo Zhi-Bin
Published: September 2021

To investigate physiological and transcriptomic regulation mechanisms underlying the distinct net fluxes of NH4+ and NO3− in different root segments of Populus species under low nitrogen (N) conditions, we used saplings of Populus × canescens supplied with either 500 (normal N) or 50 (low N) μM NH4NO3. The net fluxes of NH4+ and NO3−, the concentrations of NH4+, amino acids and organic acids and the enzymatic activities of nitrite reductase (NiR) and glutamine synthetase (GS) in root segment II (SII, 35–70 mm to the apex) were lower than those in root segment I (SI, 0–35 mm to the apex). The net NH4+ influxes and the concentrations of organic acids were elevated, whereas the concentrations of NH4+ and NO3− and the activities of NiR and GS were reduced in SI and SII in response to low N. A number of genes were significantly differentially expressed in SII vs SI and in both segments grown under low vs normal N conditions, and these genes were mainly involved in the transport of NH4+ and NO3−, N metabolism and adenosine triphosphate synthesis. Moreover, the hub gene coexpression networks were dissected and correlated with N physiological processes in SI and SII under normal and low N conditions. These results suggest that the hub gene coexpression networks play pivotal roles in regulating N uptake and assimilation, amino acid metabolism and the levels of organic acids from the tricarboxylic acid cycle in the two root segments of poplars in acclimation to low N availability.
Myosin XI drives polarized growth by vesicle focusing and local enrichment of F-actin inPhyscomitrium patens
Authors: Galotto Giulia , Wisanpitayakorn Pattipong , Bibeau Jeffrey P , Liu Yen-Chun , Furt Fabienne , Pierce Ellen C , Simpson Parker J , Tüzel Erkan , Vidali Luis
Published: September 2021

In tip-growing plant cells, growth results from myosin XI and F-actin-mediated deposition of cell wall polysaccharides contained in secretory vesicles. Previous evidence showed that myosin XI anticipates F-actin accumulation at the cell’s tip, suggesting a mechanism where vesicle clustering via myosin XI increases F-actin polymerization. To evaluate this model, we used a conditional loss-of-function strategy by generating moss (Physcomitrium patens) plants harboring a myosin XI temperature-sensitive allele. We found that loss of myosin XI function alters tip cell morphology, vacuolar homeostasis, and cell viability but not following F-actin depolymerization. Importantly, our conditional loss-of-function analysis shows that myosin XI focuses and directs vesicles at the tip of the cell, which induces formin-dependent F-actin polymerization, increasing F-actin’s local concentration. Our findings support the role of myosin XI in vesicle focusing, possibly via clustering and F-actin organization, necessary for tip growth, and deepen our understanding of additional myosin XI functions.
‘All disease begins in the gut’—the role of the intestinal microbiome in ankylosing spondylitis
Authors: Harkins Patricia , Burke Eoghan , Swales Catherine , Silman Alan
Published: September 2021

Ankylosing spondylitis is a chronic, debilitating arthritis with a predilection for the axial skeleton. It has a strong genetic predisposition, but the precise pathogenetic mechanisms involved in its development have not yet been fully elucidated. This has implications both for early diagnosis and for effective management. Recently, alterations in the intestinal microbiome have been implicated in disease pathogenesis. In this review, we summarize studies assessing the intestinal microbiome in AS pathogenesis, in addition to synthesizing the literature exploring the postulated mechanisms by which it exerts it pathogenic potential. Finally, we review studies analysing manipulation of the microbiome as a potential therapeutic avenue in AS management.
Long-term efficacy and safety of canakinumab in patients with mevalonate kinase deficiency: results from the randomised Phase 3 CLUSTER trial
Authors: Jeyaratnam Jerold , Simon Anna , Calvo Inmaculada , Constantin Tamas , Shcherbina Anna , Hofer Michael , Gattorno Marco , Martini Alberto , Bader-Meunier Brigitte , Vastert Bas , Levy Jeremy , Dekker Elise , de Benedetti Fabrizio , Frenkel Joost
Published: September 2021

Objectives

To evaluate the long-term efficacy and safety of canakinumab in patients with mevalonate kinase deficiency during the open label extension (weeks 41–113) of the randomized controlled CLUSTER trial.

Methods

During a 72-week period, patients received open-label canakinumab 150 or 300 mg, every 4 or 8 weeks. The disease activity was evaluated every 8 weeks using physician global assessment and counting the number of flares. Concentrations of CRP and serum amyloid A protein were measured. The safety was studied by determination and classification of observed adverse events. The safety and efficacy were analysed separately in three subgroups of patients receiving a cumulative dose of less than <35 mg/kg, ≥35 to <70 mg/kg or ≥70 mg/kg.

Results

Of the 74 patients who started the CLUSTER study, 66 entered Epoch 4 and 65 completed it. During the 72-week period, 42 (64%) patients experienced no flares, while 13 (20%) had one flare, as compared with a median of 12 flares per year reported at baseline. Low physician global assessment scores were seen at the end of the study for all groups with >90% reporting minimal disease activity or none at all. Median CRP concentrations were consistently equal or lower than 10 mg/l, while median serum amyloid A concentrations remained only slightly above the normal range of 10 mg/l. The study showed no new or unexpected adverse events.

Conclusion

Canakinumab proved effective to control disease activity and prevent flares in mevalonate kinase deficiency during the 72-week study period. No new safety concerns were reported.

Trial registration

NCT02059291. https://clinicaltrials.gov.
Biofoundry-assisted expression and characterization of plant proteins
Authors: Dudley Quentin M , Cai Yao-Min , Kallam Kalyani , Debreyne Hubert , Carrasco Lopez Jose A , Patron Nicola J
Published: September 2021

Many goals in synthetic biology, including the elucidation and refactoring of biosynthetic pathways and the engineering of regulatory circuits and networks, require knowledge of protein function. In plants, the prevalence of large gene families means it can be particularly challenging to link specific functions to individual proteins. However, protein characterization has remained a technical bottleneck, often requiring significant effort to optimize expression and purification protocols. To leverage the ability of biofoundries to accelerate design–built–test–learn cycles, we present a workflow for automated DNA assembly and cell-free expression of plant proteins that accelerates optimization and enables rapid screening of enzyme activity. First, we developed a phytobrick-compatible Golden Gate DNA assembly toolbox containing plasmid acceptors for cell-free expression using Escherichiacoli or wheat germ lysates as well as a set of N- and C-terminal tag parts for detection, purification and improved expression/folding. We next optimized automated assembly of miniaturized cell-free reactions using an acoustic liquid handling platform and then compared tag configurations to identify those that increase expression. We additionally developed a luciferase-based system for rapid quantification that requires a minimal 11–amino acid tag and demonstrate facile removal of tags following synthesis. Finally, we show that several functional assays can be performed with cell-free protein synthesis reactions without the need for protein purification. Together, the combination of automated assembly of DNA parts and cell-free expression reactions should significantly increase the throughput of experiments to test and understand plant protein function and enable the direct reuse of DNA parts in downstream plant engineering workflows.
Review and prospect of maintenance technology for traction system of high-speed train
Authors: Xu Shaolong , Chen Chunyang , Lin Zhenjun , Zhang Xiao , Dai Jisheng , Liu Liangjie
Published: September 2021

In the past few decades, high-speed trains have witnessed tremendous and vigorous development with the appearance of the oil crisis and industrialization, which became a significant trend in the transportation industry the world over. With the increase of high-speed railway mileage, the amount of high-speed train has grown sharply, the service life of the trains has increased gradually and the components of the vehicle traction system have become worn and aged as a result. Therefore, advanced maintenance technology and its application are key factors to reduce maintenance cost, human resource input and ensure safe, stable and reliable operation of trains. This paper summarizes and discusses the development, application mode, maintenance management and maintenance technology of high-speed railways of the major countries in the world, especially discusses the condition-based maintenance and the key technology of the traction electrical system, and offers the prospect of research direction and the development of traction maintenance technology.
Unraveling gene content variation across eukaryotic giant viruses based on network analyses and host associations
Authors: Sun Tsu-Wang , Ku Chuan
Published: September 2021

The nucleocytoplasmic large DNA viruses (NCLDVs, phylum Nucleocytoviricota) infect vertebrates, invertebrates, algae, amoebae, and other unicellular organisms across supergroups of eukaryotes and in various ecosystems. The expanding collection of their genome sequences has revolutionized our view of virus genome size and coding capacity. Phylogenetic trees based on a few core genes are commonly used as a model to understand their evolution. However, the tree topology can differ between analyses, and the vast majority of encoded genes might not share a common evolutionary history. To explore the whole-genome variation and evolution of NCLDVs, we dissected their gene contents using clustering, network, and comparative analyses. Our updated core-gene tree served as a framework to classify NCLDVs into families and intrafamilial lineages, but networks of individual genomes and family pangenomes showed patterns of gene sharing that contradict with the tree topology, in particular at higher taxonomic levels. Clustering of NCLDV genomes revealed variable granularity and degrees of gene sharing within each family, which cannot be inferred from the tree. At the level of NCLDV families, a correlation exists between gene content variation, but not core-gene sequence divergence, and host supergroup diversity. In addition, there is significantly higher gene sharing between divergent viruses that infect similar host types. The identified shared genes would be a useful resource for further functional analyses of NCLDV–host interactions. Overall this study provides a comprehensive view of gene repertoire variation in NCLDVs at different taxonomic levels, as well as a novel approach to studying the extremely diverse giant virus genomes.
Risk Reduction Recommendations for Upper Quadrant Side Effects After Breast Cancer Surgery and Treatments: A Delphi Survey to Evaluate Consensus Among Expert Physical Therapists and Alignment With Current Evidence
Authors: Jacob Tamar , Bracha Jillian , Peleg Ruth , Epstein Amit , Yosha Ilana
Published: September 2021

Survivors of breast cancer (BC) face various upper quadrant side effects (UQSEs) after surgery and treatments. This study aims to develop consensus for recommendations for side effect (SE) risk reduction. A team of physical therapists certified in lymphedema treatment (PTCLTs) conducted a narrative literature review and developed a questionnaire (topics included post-BC UQSE risk reduction instruction), which was then used in a Delphi survey to understand perceptions of a representative sample of Israeli PTCLTs (study participants). Thirty studies on post-BC upper quadrant (UQ) and other SE risk reduction recommendations and 29 studies on protocols for risk reduction instruction provision were identified. The levels of evidence of the studies varied widely. A 2-round Delphi questionnaire was completed by 130 and 101 study participants, respectively. The main general recommendations were: (1) instruction provision and referral to PTCLTs for all women after BC surgery; (2) information provision about individual risk for SEs and controversies; and (3) stress avoidance. Lymphedema and other UQ risk reduction recommendations were infection prevention, early shoulder mobility, physical activity, and normal body mass index. Instruction should be provided: pre-surgery, before hospital discharge, a few weeks after discharge, and during prospective surveillance. Instruction content would depend on timing and individual need. Although the literature review was comprehensive, it was not systematic. The study population excluded other health care staff. These recommendations may assist health care providers to give individually tailored instructions for patients after BC surgery and treatments.
Trends in Mortality Due to Stimulants Use in Adolescents and Young Adults
Authors: Walia Namrata , Lat Jessica O. , Tariq Rabeet , Tyagi Surbhi , Qazi Adam M. , Salari Syeda W. , Jafar Amina , Kousar Tasneem , Renzu Mahvish , Leszkowitz David , Abreu Rafael , Rodriguez Ivan
Published: September 2021

Objectives:

Stimulant medications including illegal use of Methamphetamine (MA) continues to rise in adolescents and young adults. This study aims to examine mortality trends because of the stimulant overdose in this age group (15 to 34 years).

Methods:

Age-adjusted mortality data, including 95% confidence intervals and standard errors, were extracted using publicly available multiple causes of death files from the United States Centers for Disease Control Wide-ranging ONline Data for Epidemiologic Research (WONDER). The data was filtered using International Classification of Disease (ICD-10) codes: F15.0 (Mental and behavioral disorders because of use of other stimulants, acute intoxication), F15.1 (Mental and behavioral disorders because of use of other stimulants, harmful use), T43.6 (Psychostimulants with abuse potential). The trends analysis for 1999 to 2019 was conducted using Joinpoint regression statistical software.

Results:

The mortality rate has been consistently increasing in the last decade across all races and ethnicities in adolescents and young adults. Non-Hispanic White population had the highest mortality rates (7.6 per 100,000 in 2019) compared with non-Hispanic Black (3.08 per 100,000 in 2019) and Hispanic population (3.33 per 100,000 in 2019). But the annual percent change in mortality was shown to be highest in non-Hispanic Black population (34.3% between 2009 and 2019).

Conclusion:

The increase in overall mortality rate because of stimulants use reflects the increase of MA use in this age group. The difference in the rate of change shows worsening racial inequality. Public health policies should be implemented to include evidence-based strategies to prevent MA misuse or overdose.
Data Analytics for Diagnosis and Prediction of Central Line–Associated Bloodstream Infections in Critical Care Units
Authors: Hooshmand Mary A. , Toledo Christine Susana , Moghaddas Ramin , Skordilis Erotokritos
Published: September 2021

Central line–associated bloodstream infections are among the leading causes of in-hospital deaths in the United States and are a significant factor for increased morbidity, mortality, and healthcare costs. This study integrates several hospital data systems into a case-controlled database to use data analytics for the identification of significant central line–associated bloodstream infection risk factors and develop time-varying patient risk scores for central line–associated bloodstream infections. A case-control study was performed utilizing patient data collected from various sources then gathered and organized into a case-controlled dataset for analysis examining various patient-specific attributes for central line–associated bloodstream infections. Training and testing sets were created, and multivariate logistic regressions were used to identify risk factors for central line–associated bloodstream infection. Furthermore, the Cox proportional hazards model was used to infer the hazard rate and risk score for central line–associated bloodstream infections for each individual patient during hospitalization. Significant attributes for central line–associated bloodstream infection cases were the ICU location (P = .008), time from insertion (P ≤ .001), number of surgeries (P = .003), and number of central line manipulations (P = .003). Real-time data analytics and point of care at the bedside can facilitate precision care for patients with an elevated central line–associated bloodstream infection risk, subsequently changing the way healthcare prevents hospital-acquired infections.
Mobile Health to Improve Hypertension and Diabetes Health Literacy Among Asian Indian Migrants to Hong Kong
Authors: Garner Shelby L. , Wong Cho Lee , Young Phil , Fendt Matthew , Hitchcock Julia , George Carolin Elizabeth
Published: September 2021

The use of mobile technologies to improve health outcomes or mobile health is rapidly evolving, and culturally relevant resources are needed to address health disparities among vulnerable populations. Noncommunicable disease health disparities among Asian Indian migrants to Hong Kong are prevalent. A mobile health application designed to improve hypertension and type 2 diabetes mellitus health literacy was tested using a mixed-methods design to determine its impact on improving health literacy among this subpopulation. Quantitative findings indicated the mobile health application was effective in improving health literacy. Qualitative findings revealed participant perceptions about the application explored its informative nature, usability and likability of application components, and its ability to initiate intentionality for a healthier lifestyle among users. This feedback was valuable to ensure future modifications that will promote the application's scalability and sustainability.
How to Support the Nursing Informatics Leadership Pipeline
Authors: Backonja Uba , Langford Laura Heermann , Mook Patricia Joppich
Published: September 2021

There is a need for nursing informatics leaders. However, there are not enough people educated and trained in informatics and leadership to fill that need. Therefore, the purpose of this study was to understand how professional organizations and nurse leaders support nursing informatics leadership development. This cross-sectional, descriptive study collected data via a scan of Web sites for eight nursing, informatics, and/or leadership professional organizations; interviews and surveys with nursing informatics leaders within the eight organizations; and a review of Web site, interview, and survey findings by nursing informatics leaders involved in leadership development. We found that nursing informatics leaders and professional organizations can support the nursing informatics leadership pipeline several ways. Examples included mentoring, education/training, and providing opportunities for networking and engagement in leadership roles. To help meet the need for nursing informatics leaders, professional organizations and current leaders can engage in various activities that provide training, education, and experiences for emerging leaders.
Cardiotoxic Effects of the Antineoplastic Doxorubicin in a Model of Metabolic Syndrome: Oxidative Stress and Transporter Expression in the Heart
Authors: Ogonowski Natalia , Rukavina Mikusic Natalia Lucía , Kouyoumdzian Nicolás Martín , Choi Marcelo Roberto , Fellet Andrea , Balaszczuk Ana María , Celuch Stella Maris
Published: September 2021

The aim of the present work was to examine whether metabolic syndrome–like conditions in rats with fructose (F) overload modify the cardiotoxic effects induced by doxorubicin (DOX) and whether the treatment altered the expression of P-gp, breast cancer resistance protein, and organic cation/carnitine transporters in the heart. Male Sprague–Dawley rats received either tap water (control group [C]; n = 16) or water with F 10% wt/vol (n = 16) during 8 weeks. Three days before being killed, the animals received a single dose of DOX (6 mg/kg, ip, md) (C-DOX and F-DOX groups) or vehicle (VEH; ISS 1 mL/kg BW; ip) (C-VEH and F-VEH groups) (n = 8 per group). F overload enhanced thiobarbituric acid–reactive substance levels in the left ventricle, and DOX injection further increased those values. DOX did not alter thiobarbituric acid–reactive substance production in C animals. DOX caused a decrease of 30% in the ejection fraction and a nearly 40% reduction in the fractional shortening in F animals, but not in C rats. Cardiac tissue levels of P-gp decreased by about 30% in F rats compared with the C groups. DOX did not modify cardiac P-gp expression. Breast cancer resistance protein and organic cation/carnitine transporter (OCTN 1/2/3) protein levels did not change with either F or DOX. It is suggested that DOX could cause greater cardiotoxicity in rats receiving F, probably due to enhanced cardiac lipid peroxidation and lower expression of cardiac P-gp. These results support the hypothesis that the cardiotoxicity of DOX could be increased under metabolic syndrome–like conditions or in other health disorders that involve cardiovascular risk factors.
Selective Progesterone Receptor Modulators (SPRMs) and Androgen Receptor Modulators (SARMs) as Treatment for Benign Gynecologic Diseases
Authors: Islam Md Soriful , Chen Lena W. , Segars James H.
Published: September 2021

Common benign gynecologic conditions such as uterine fibroids and endometriosis are linked to chronic pelvic pain, abnormal and heavy uterine bleeding, and infertility. Effective medical management of these diseases is an unmet need. The steroid hormones progesterone (P4), estrogen (E2), and testosterone play a major role in reproductive physiology and uterine pathologies. Notably, selective progesterone receptor modulators have shown considerable promise as treatment options for some hormone-dependent conditions. More limited data are available regarding the safety and efficacy of selective androgen receptor modulators. In this report we review current evidence for selective progesterone receptor modulators and selective androgen receptor modulators as treatment options for benign gynecologic conditions.
Catheter-based therapies in acute and chronic pulmonary embolism
Authors: Michaud Erinleigh , Pan Michael , Aggarwal Vikas
Published: September 2021

Purpose of review

The aim of this study is to summarize currently available catheter-based therapies in acute and chronic pulmonary embolic disease.

Recent findings

Catheter-based therapies to treat acute pulmonary embolism and its sequelae such as chronic thromboembolic pulmonary hypertension (CTEPH) are emerging as the next frontier within interventional cardiology. However, the true benefit of these catheter-based therapies in intermediate-risk and high-risk pulmonary embolism and CTEPH remains unclear. The current evidence supporting such interventions comes primarily from small single-arm studies in acute pulmonary embolism and case series in CTEPH.

Appropriately powered randomized controlled trials with meaningful clinical outcomes as endpoints are needed to elucidate the true benefit of catheter-based therapies in pulmonary embolism compared with other treatment modalities such as anticoagulation and systemic thrombolysis in acute pulmonary embolism and riociguat and pulmonary endarterectomy in CTEPH.
Intensive Cardiac Rehabilitation Is Markedly Underutilized by Medicare Beneficiaries
Authors: Husaini Mustafa , Deych Elena , Racette Susan B. , Rich Michael W. , Joynt Maddox Karen E. , Peterson Linda R.
Published: September 2021

Purpose:

Intensive cardiac rehabilitation (ICR) was developed to enhance traditional cardiac rehabilitation (CR) by adding sessions focused on nutrition, lifestyle behaviors, and stress management. Intensive CR has been Medicare-approved since 2010, yet little is known about national utilization rates of ICR in the Medicare population or characteristics associated with its use.

Methods:

A 5% sample of Medicare claims data from 2012 to 2016 was used to identify beneficiaries with a qualifying indication for ICR/CR and to quantify utilization of ICR or CR within 1 yr of the qualifying diagnosis.

Results:

From 2012 to 2015, there were 107 246 patients with a qualifying indication. Overall, only 0.1% of qualifying patients participated in ICR and 16.2% in CR from 2012 to 2016, though utilization rates of both ICR and CR increased during this period (ICR 0.06 to 0.17%, CR 14.3 to 18.2%). The number of ICR centers increased from 15 to 50 over the same period. There were no differences between ICR and CR enrollees with respect to age, sex, race, discharge location, median income, dual enrollment, or number of comorbidities. Compared with eligible beneficiaries who did not attend ICR or CR, those who attended either program were younger, more likely to be male and White, and had higher median income.

Conclusions:

Although ICR and CR have a class 1 indication for the treatment of cardiovascular disease and the number of ICR centers has increased, ICR is not widely available and remains markedly underutilized. Continued research is needed to understand the barriers to program development and patient participation.
Diffractive optic intraocular lens exchange: indications and outcomes
Authors: Alsetri Hasan , Pham Don , Masket Samuel , Fram Nicole R. , Naids Steven , Lee Aron
Published: September 2021

Purpose:

To assess indications and outcomes of surgical exchange of diffractive optic multifocal and extended depth-of-focus intraocular lenses (IOLs) in favor of monofocal IOLs.

Setting:

Private practice, Los Angeles, California.

Design:

Retrospective chart review.

Methods:

All cases of diffractive optic IOL exchange between June 2007 and October 2020 for diffractive optic dysphotopsia (DOD) (ie, light-induced concentric circles and spider web patterns), poor visual quality, or night vision symptoms were evaluated retrospectively regarding surgical indications, comorbidities, surgical methods, surgical complications, and visual outcomes. Ocular surface disease and ametropia were managed prior to consideration of IOL exchange.

Results:

The charts of 64 eyes of 46 patients were included. 53/64 (83%) had DOD, 50/64 (78%) experienced reduced quality of vision, and 12/64 (19%) complained of night vision difficulties. 27/64 (42%) of eyes had no ocular comorbidities; 15/64 (23%) of eyes had more than 1 comorbid condition, and 12/64 (19%) were post–laser refractive surgery. Laser posterior capsulotomy had been performed in 15/64 (23%) of eyes. There were a variety of inciting diffractive optic IOLs and various monofocal exchange lenses and fixation techniques were used based on symptoms, comorbidities, and status of the posterior capsule. After IOL exchange, all eyes were relieved of DOD, and all eyes had improved or unchanged corrected distance visual acuity.

Conclusions:

Diffractive optic IOLs may induce unsatisfactory visual outcomes. However, in this large series of IOL exchanges, DOD and reduced visual function can be overcome with exchange for a monofocal IOL, despite comorbidities or an open posterior capsule.
Reframing Intersectional Stigma for a South African Context Integrating Tuberculosis, HIV and Poverty Stigmas
Authors: Bergman Alanna , Farley Jason E. , Agarwalla Vidisha , Relf Michael
Published: September 2021

Intersectionality is closely intertwined with Black feminism within the context of the United States. As a result, intersectionality is often overlooked in non-Western contexts where racial homogeneity may reduce some of the impact of race on marginalization. This article will look at intersectional stigma from the South African context using the tuberculosis/HIV (TB/HIV) treatment environment in South Africa to exemplify intersectionality's versatility as an analytic method outside of the United States. We will use colonial history and contemporary research to reframe intersectionality considering a new set of stigmatized identities, including HIV stigma, TB stigma, and poverty stigma, to create a situation-specific framework adapted from a model by Bulent Turan and colleagues.
The World Restart a Heart Initiative: how to save hundreds of thousands of lives worldwide
Authors: Rott Nadine , Böttiger Bernd W. , Lockey Andrew
Published: September 2021

Purpose of review

Sudden out-of-hospital cardiac arrest (OHCA) is still one of the top reasons for death in industrialized countries. Bystander resuscitation rates differ significantly across the world despite bystanders being easily able to save lives in this situation. In the 4 years since initiation of the International Liaison Committee on Resuscitation (ILCOR) World Restart a Heart (WRAH), the initiative helped educating millions of people and thus enabled them to save lives.

Recent findings

WRAH Day has gained more and more reach, partners and impact over the years. It has the potential of saving hundreds of thousands of lives, changing legislation and inspiring research. During the last year, new strategies had to be developed because of the COVID-pandemic. The importance of educating laypeople is underlined in recent publications and international guidelines.

The WRAH awareness campaign has reached 194 countries and more than 200 million people in the last years. The success of it could even be kept going in the pandemic due to social media and digital/virtual programmes. International guidelines recommend raising awareness and name ILCOR WRAH as a way to do it.
Intestinal Guanylate Cyclase‐C mRNA Expression in Duodenum and Colon of Children
Authors: Cohen Mitchell B. , Gold Benjamin D. , Xanthakos Stavra A. , CaJacob Nicholas , Weissman Taryn , Bartolini Wilmin , Boinpally Ramesh , Mallick Madhuja , Reasner David S. , O'Dea Christopher R. , Kwak Hanna , Ge Pei
Published: September 2021

Objectives:

Guanylate cyclase‐C (GC‐C) agonists, which increase intestinal secretion and accelerate transit, are used to treat chronic constipation and constipation‐predominant irritable bowel syndrome and are being evaluated for pediatric use. Prior studies suggest GC‐C receptor density may be higher in young children, potentially amplifying GC‐C agonism with treatment implications. We aimed to quantitate duodenal and colonic GC‐C mRNA expression in children.

Methods:

Mucosal biopsies were obtained from subjects aged 6 months to 18 years during clinically indicated upper, that is, esophago‐gastro‐duodenal, and/or colonic endoscopy. Tissue samples without histologic abnormalities were grouped by subject age (<24 months, 24 months to <6 years, 6 to <12 years, and 12 to <18 years) and analyzed for GC‐C mRNA expression by qPCR. The relationship between GC‐C mRNA levels and age was modeled using regression analyses.

Results:

Ninety‐nine subjects underwent upper endoscopy/colonoscopy; 93 had evaluable samples. Mean relative GC‐C mRNA expression was 2.36 (range 2.21–2.46) for duodenal samples and 1.56 (range 1.22–1.91) for colonic samples. Predicted and observed normalized GC‐C mRNA expression in each region were comparable among age groups. Pooled expression by region demonstrated lower expression in colonic versus duodenal samples.

Conclusions:

Uniform levels of GC‐C mRNA expression were detected in children aged >6 months in the duodenum and >12 months in the colon. Higher expression was observed in all age groups in duodenal versus colonic samples, indicating regional variability in GC‐C receptor density. These data are reassuring for further studies of GC‐C agonists in children.
Fracture reduction has a dominant effect over cerclage wiring in increasing stiffness of intertrochanteric OTA/AO 31-A3.1 (reverse oblique) fractures managed with cephalomedullary osteosynthesis
Authors: Hoskins Wayne , Moniz Sheldon , Day Robert , Hayes Alex , Bingham Roger , Kuster Markus
Published: September 2021

Objectives:

To investigate the mechanical properties of cephalomedullary nailing of intertrochanteric OTA/AO 31-A3.1 (reverse oblique) fractures and to test the hypothesis that anatomical reduction and augmentation with cerclage wire produces a more stable construct.

Methods:

A standardized fracture model in composite saw bone was created to stimulate an intertrochaneric 31-A3.1 fracture, using a 3D printed cutting guide. Simulated osteosynthesis was performed with 12 femurs divided into anatomically reduced and varus malreduced groups. Each femur was tested with and without cerclage wire augmentation. All femurs were fixed with a 215 mm, 130 degree, 11.5 mm nail. An Instron 8874 biaxial materials testing machine was used to assess the axial stiffness. Cyclic loading consisted of 5000 cycles of sinusoidal combined axial-torsion loading at 3 Hz. Axial load was 100 N to 2000 N and torsion −4.5 Nm to +4.5 Nm. Stiffness was measured before and after cyclic loading.

Results:

Reduced constructs were stiffer than residual varus constructs. The mean overall fracture stiffness was 508.7 N/mm for reduced constructs and 379.2 N/mm for varus constructs. Removing the cables significantly decreased the fracture stiffness for both constructs (mean difference 60.0 N/mm, 95% CI 7.7–112.3, P = .032).

Conclusions:

Anatomical reduction has a dominant effect on facture stiffness. Anatomically reduced fractures are stiffer than varus malreduced fractures. A cerclage wire further improves construct stiffness if anatomical reduction is achieved. Cerclage wiring is less effective if anatomical reduction is not achieved.
High Burden of Active Syphilis and Human Immunodeficiency Virus/Syphilis Coinfection Among Men Who Have Sex With Men, Transwomen, and Genderqueer Individuals in Zimbabwe
Authors: Parmley Lauren E. , Chingombe Innocent , Wu Yingfeng , Mapingure Munyaradzi , Mugurungi Owen , Samba Chesterfield , Rogers John H. , Hakim Avi J. , Gozhora Perpetua , Miller Sophia S. , Musuka Godfrey , Harris Tiffany G.
Published: September 2021

Background

Syphilis increases human immunodeficiency virus (HIV) acquisition risk and impacts the immunologic and virologic response among people living with HIV (PLHIV). We assessed the prevalence of active or current syphilis and HIV/syphilis and their correlates among men who have sex with men (MSM), transwomen, and genderqueer (TGW/GQ) individuals in Zimbabwe.

Methods

Among a respondent-driven sample of MSM and TGW/GQ who were tested for HIV and syphilis in Harare and Bulawayo, Zimbabwe in 2019 (n = 1511), multiple logistic regression was used to assess correlates of active syphilis. Unadjusted logistic regression was used among PLHIV (n = 340) due to small sample size. All analyses were unweighted as data did not reach convergence for HIV.

Results

Prevalence of active syphilis overall and among PLHIV was 5.5% and 10.1%, respectively, in Harare, and 5.6% and 11.0%, respectively, in Bulawayo. Participants were more likely to have active syphilis if they were PLHIV (adjusted odds ratio [aOR], 2.2; 95% confidence interval [CI], 1.4–3.6), aged 25–34 years (aOR, 2.2 years; 95% CI, 1.3–3.8 years; reference, 18–24 years), or self-report sexually transmitted infection symptoms (aOR, 1.8; 95% CI, 1.1–3.0). Compared with Bulawayo TGW/GQ, MSM in Harare (aOR, 0.2; 95% CI, 0.1–0.5) and Bulawayo (aOR, 0.2; 95% CI, 0.1–0.4), and TGW/GQ in Harare (aOR, 0.2; 95% CI, 0.1–0.6) were less likely to have active syphilis. Among PLHIV, coinfection was 13.0% among TGW/GQ and 9.7% among MSM. Odds of coinfection were higher for those aged 25 to 34 years (OR, 3.7 years; 95% CI, 1.2–11.1 years) and lower among Harare MSM (OR, 0.2; 95% CI, 0.1–0.7), Bulawayo MSM (OR, 0.1; 95% CI, 0.0–0.4), and Harare TGW/GQ (OR, 0.1; 95% CI, 0.0–0.4) compared with Bulawayo TGW/GQ.

Conclusions

Findings highlight a high burden of syphilis among MSM and TGW/GQ and underscore the importance of HIV/syphilis detection and improved service delivery for these groups.
Amyand Hernia
Authors: Chiang Elaine , Belfer Joshua , Baker Meredith A. , Ng Lorraine , Fenster Daniel
Published: September 2021

Amyand hernia is a rare type of inguinal hernia defined by the presence of the appendix in the inguinal hernia sac. Clinical diagnosis of Amyand hernia can be challenging because this diagnosis is typically made intraoperatively, often as an incidental finding. Preoperative diagnosis by computed tomography and radiology ultrasound has previously been reported; however, there exists no reports of the diagnosis being made by point-of-care ultrasound. We present a case of Amyand hernia visible on point-of-care ultrasound performed by a pediatric emergency medicine physician.
Evaluating Housing Characteristics Associated With Childhood Lead Exposure in Providence, Rhode Island
Authors: Vasil Taylor-Marie , Rogers Michelle L. , Singleton Cindy , Vivier Patrick M.
Published: September 2021

Objective:

This research aims to take an in-depth look into the child, housing, and neighborhood characteristics associated with Providence children's likelihood of having elevated blood lead levels (BLLs).

Design and Setting:

The 2019 Providence, Rhode Island, Property Tax Assessor's database, containing each property owner's address, was geocoded and spatially joined with the 2017-2019 blood lead tests for children aged 0 to 6 years from the Rhode Island Department of Health.

Main Outcome Measures:

The prevalence of elevated BLLs (≥5 μg/dL) overall, as well as by property type, number of properties owned, owner occupancy, assessed value, and neighborhood rates of old housing and poverty, was computed. We assessed the relationship between having elevated BLLs and these housing and neighborhood characteristics, adjusting for gender, age at test, and test method.

Results:

We found that, compared with children living in properties with landlords who owned only one property, children living in properties with landlords who owned 4 or more properties had lower odds of having elevated BLLs (odds ratio = 0.98; 95% confidence interval, 0.97-0.99). The proportion of houses built pre-1950 in the neighborhood was associated with increased odds of elevated BLLs. There was no significant association between owner-occupancy status and property type with children having elevated BLLs.

Conclusions:

Children living in properties with landlords who owned 4 or more properties were less likely to have elevated BLLs. This association may suggest that the current lead legislation is having some impact, but public health efforts should address lead exposure in properties that are currently exempt from the law.
Do External Supports Influence Proprioception in Patients With Chronic Ankle Instability?
Authors: Xue Xiao’ao , Chen Ziyi , Xu Xiaoyun , Tao Weichu , Hua Yinghui
Published: September 2021

Objective

Individuals with chronic ankle instability experience recurring sprains and impaired proprioception, and the effect of external support in the proprioception of injured ankles is still inconsistent in existing studies. Therefore, this study aimed to investigate whether external support could enhance the proprioception of injured ankles in patients with chronic ankle instability.

Design

This was a systematic review and meta-analysis.

Results

Eight studies from PubMed, Embase, Cochrane Library, Web of Science, SPORTDiscus, Scopus, and CINAHL were finally included after applying the exclusion criteria. Meta-analyses revealed a significantly higher joint position sense on inversion with a weighted mean difference of 1.25 degrees and plantar flexion (weighted mean difference, 1.74 degrees) and lower kinesthesia in eversion (weighted mean difference = −0.70 degrees) with the application of external support in the injured ankles of patients with chronic ankle instability.

Conclusion

Applying external support has statistically significant negative effects on kinesthesia and a positive effect on the active joint position sense in the injured ankles of patients with chronic ankle instability. However, this study did not support the restoration of proprioception deficits as a mechanism of external support in preventing reinjuries, owing to its potentially negative effect on kinesthesia, clinically small changes in proprioception, and poor methodologic quality of existing studies.
A Model of Collaboration Can Expand the Opportunities in Adaptive Sports Equipment
Authors: Heasley Victoria , Meyer Daniel , Foster Timothy , Blauwet Cheri
Published: September 2021

Physical medicine and rehabilitation requires teamwork and innovation to help patients reach their goals and to optimize their quality of life, and one way is through participation in sports (Sports Med Arthrosc Rev. 2019;27:73–82; PM R. 2015;7(10):1081–8; PM R. 2012;4(11):851–6; Phys Med Rehabil Clin N Am. 2019;30(1):289–99). Unfortunately, people with disabilities participate in sports ~20% less than their peers, and reasons for this disparity include equipment cost and availability (Sports Med Arthrosc Rev. 2019;27:73–82; PM R. 2015;7(10):1081–8; Pediatrics. 2008;121(5):1057–61; Res Dev Disabil. 2017;67:9–18). A unique way for physical medicine and rehabilitation clinicians to aid in overcoming these barriers is to collaborate with other fields to make adaptive equipment that meets patients’ needs.

A multidisciplinary team including a physical medicine and rehabilitation resident physician and biomedical engineer, physical therapist, and machinist collaborated through a local nonprofit organization to design and build adaptive equipment solutions. This team designed two types of adaptive putters that are useable by golfers of various ages and functional ranges and a removable golf club grip for a player with limited grip strength.

Implementation of a design team for creating adaptive equipment solutions is possible and can be done in the community setting or as part of a hospital system. In the authors’ experience, taking a multidisciplinary team approach allowed developing more innovative and diverse solutions, and the athletes benefited by being able to participate in their desired sports activities.
Factors Associated With Ambulation and Transfer Ability
Authors: Benjamin Nicholas L. , McKernan Gina , Izzo Sara , Crytzer Theresa M. , Clayton Gerald H. , Wilson Pamela E. , Houtrow Amy J. , Dicianno Brad E.
Published: September 2021

Objectives

This study used a spina bifida electronic medical record and the National Spina Bifida Patient Registry to explore the relationship between neurosurgical/orthopedic surgeries and other variables on ambulation and transfer ability over time in individuals with spina bifida.

Design

This study was an analysis of longitudinal data collected within the National Spina Bifida Patient Registry and spina bifida electronic medical record. Logistic regression models were used to determine which variables were associated with ambulation/transfer ability in the myelomeningocele (MMC) and non-MMC populations.

Results

Longitudinal data from 806 individuals were collected. In the MMC group, decreased ambulation ability was associated with higher motor levels, tethered cord releases, spine/scoliosis surgeries, hip orthopedic surgeries, and having supplemental insurance. Increased ambulatory ability was associated with lower motor levels, tibial torsion/related surgeries, ankle/foot surgeries, being female, and being non-Hispanic/Latinx. Decreased transfer ability was associated with being Hispanic/Latinx and having higher motor levels. Lower motor level and ankle/foot surgeries were associated with increased transfer ability. No significant associations were found in the non-MMC group.

Conclusions

Motor level is an important predictor of ambulation and transfer ability in MMC. Surgeries distal to the knee were associated with higher levels of function; surgeries proximal to the knee were associated with lower functional levels.
Multifactorial Interventions to Reduce Duration and Variability in Delays to Identification of Serious Injury After Falls in Hospital Inpatients
Authors: Saleem Jawaad , Sarma Dhruv , Wright Hannah , Fisher Kelly , Pinnington Benjamin , Kostas Valandis , Chua Kia-Chong , Sommerville Peter
Published: September 2021

Objectives

Inpatient falls are the most commonly reported safety incidents and are associated with serious injuries. This study aimed to use multifactorial interventions to reduce the delays to the diagnosis of serious injury in a time series analysis after serious incidents relating to falls within a central London Trust.

Methods

A multiprofessional project team undertook process mapping to identify opportunities for improvement at different stages in the management of a fall. The interventions included an educational teaching session aimed at doctors, a lanyard card designed by doctors using the plan-do-study-act methodology, a falls-specific pager for radiographers, and a new system to refer to portering. Quantitative data were obtained using an serious incident database where serious injury occurred (SI data; n = 65) and routinely collected incident reporting database on falls regardless of injury (IR data; n = 178). Qualitative questionnaire data (n = 70) were also used to evaluate doctors’ confidence in falls assessment before and after interventions.

Results

Results in the IR data demonstrated a significant reduction in the median (interquartile range) minutes delay in the time to review a patient after a fall from 81 (43–180) to 51 (26–112; P = 0.003) and the time to order imaging from 102 (45–370) to 50 (33–96; P = 0.04). Analysis of the SI database demonstrated a nonstatistically significant reduction in the overall time taken to detect serious injury after a fall from 348 (126–756) to 192 (108–384) minutes (P = 0.070). Furthermore, analysis using statistical process control charts showed evidence of special cause variation and a shift in the process in detecting serious harm after a fall. Junior doctors’ confidence in investigations improved from 53% to 76% (P = 0.04) after the intervention.

Conclusions

The cumulative application of multiple interventions with small individual effects resulted in a substantial positive effect on delays and variability in diagnosis of serious harm. Given a similar institutional context, the more effective interventions in our study could be adopted elsewhere.