bluuebunny/crossref_metadata_2025 huggingface dataset:
Waiting to make an impact: a probable excess of near-Earth asteroids in 2018 LA-like orbits
Authors: de la Fuente Marcos C. , de la Fuente Marcos R.
Published: December 2018

Context.The discovery and tracking of 2018 LA marks only the third instance in history that the parent body of a fireball has been identified before its eventual disintegration in our atmosphere. The subsequent recovery of meteorites from 2018 LA was only the second time materials from outer space that reached the ground could be linked with certitude to a particular minor body. However, meteoroids like 2018 LA and its forerunners, 2008 TC3and 2014 AA, are perhaps fragments of larger members of the near-Earth object (NEO) population. As the processes leading to the production of such fragments are unlikely to spawn just one meteoroid per event, it is important to identify putative siblings and plausible candidates from which the observed meteoroids might have originated.

Aims.Here, we study the pre-impact orbital evolution of 2018 LA to place this meteoroid within the dynamical context of other NEOs that follow similar trajectories.

Methods.Our statistical analyses are based on the results of directN-body calculations that use the latest orbit determinations and include perturbations by the eight major planets, the Moon, the barycentre of the Pluto–Charon system, and the three largest asteroids. A state-of-the-art NEO orbit model was used to interpret our findings and a randomization test was applied to estimate their statistical significance.

Results.We find a statistically significant excess of NEOs in 2018 LA-like orbits; among these objects, we find one impactor, 2018 LA, and the fourth closest known passer-by, 2018 UA. A possible connection with theχ-Scorpiids meteor shower is also discussed. The largest known NEO with an orbit similar to that of 2018 LA is the potentially hazardous asteroid (454100) 2013 BO73and we speculate that they both originate from a common precursor via a collisional cascade.

Conclusions.Future spectroscopic observations of 454100 and other NEOs in similar orbits may confirm or deny a possible physical relationship with 2018 LA.
Disappearance of the extended main sequence turn-off in intermediate age clusters as a consequence of magnetic braking
Authors: Georgy C. , Charbonnel C. , Amard L. , Bastian N. , Ekström S. , Lardo C. , Palacios A. , Eggenberger P. , Cabrera-Ziri I. , Gallet F. , Lagarde N.
Published: December 2018

Context. Extended main sequence turn-offs are features commonly found in the colour-magnitude diagrams of young and intermediate age (less than about 2 Gyr) massive star clusters, where the main sequence turn-off is broader than can be explained by photometric uncertainties, crowding, or binarity. Rotation is suspected to be the cause of this feature, by accumulating fast rotating stars, strongly affected by gravity darkening and rotation-induced mixing, near the main sequence turn-off. This scenario successfully reproduces the tight relation between the age and the actual extent in luminosity of the extended main sequence turn-off of observed clusters.

Aims. Below a given mass (dependent on the metallicity), stars are efficiently braked early on the main sequence due to the interaction of stellar winds and the surface magnetic field, making their tracks converge towards those of non-rotating tracks in the Hertzsprung-Russell diagram. When these stars are located at the turn-off of a cluster, their slow rotation causes the extended main sequence turn-off feature to disappear. We investigate the maximal mass for which this braking occurs at different metallicities, and determine the age above which no extended main sequence turn-off is expected in clusters.

Methods. We used two sets of stellar models (computed with two different stellar evolution codes: STAREVOL and the Geneva stellar evolution code) including the effects of rotation and magnetic braking, at three different metallicities. We implemented them in the SYCLIST toolbox to compute isochrones and then determined the extent of the extended main sequence turn-off at different ages.

Results. Our models predict that the extended main sequence turn-off phenomenon disappears at ages older than about 2 Gyr. There is a trend with the metallicity, the age at which the disappearance occurs becoming older at higher metallicity. These results are robust between the two codes used in this work, despite some differences in the input physics and in particular in the detailed description of rotation-induced internal processes and of angular momentum extraction by stellar winds.

Conclusions. Comparing our results with clusters in the Large Magellanic Cloud and Galaxy shows a very good fit to the observations. This strengthens the rotation scenario to explain the cause of the extended main sequence turn-off phenomenon.
Associations between Maternal Exposure to Bisphenol A or Triclosan and Gestational Hypertension and Preeclampsia: The MIREC Study
Authors: Camara Louopou Rosalie , Arbuckle Tye Elaine , Trottier Helen , Fraser William Donald
Published: December 2018

Background Little is known about the association between bisphenol A (BPA) or triclosan (TCS) exposure and hypertension in pregnancy.

Objective To investigate potential associations between maternal urinary concentrations of BPA or TCS and gestational hypertension (GH) and preeclampsia.

Study Design Among 1,909 pregnant women participating in the maternal-infant research on environmental chemicals (MIREC) study, urinary concentrations of BPA and TCS were measured in the first trimester by liquid chromatography-tandem mass spectrometry using isotope dilution. Blood pressure was measured during each trimester. Multinomial regression was performed to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) for the associations between these phenols and GH and preeclampsia.

Results BPA and TCS were not associated with GH or preeclampsia. However, in multiparous women, BPA (0.50–1.30 µg/L) was associated with decreased risk of GH (aOR =0.45; 95%CI: 0.21–0.98) while among nulliparous women, TCS was associated with an increased risk of GH (3.60–32.60 µg/L; aOR = 2.58; 95% CI: 1.09–6.13 and > 32.60 µg/L: aOR = 2.74; 95% CI: 1.15–6.51).

Conclusion BPA and TCS urinary concentrations were not associated with GH or preeclampsia; however, our results suggest an association between TCS and GH in nulliparous women. Additional studies are required to confirm our results.
Phototaxis in a wild isolate of the cyanobacterium
Synechococcus elongatus
Authors: Yang Yiling , Lam Vinson , Adomako Marie , Simkovsky Ryan , Jakob Annik , Rockwell Nathan C. , Cohen Susan E. , Taton Arnaud , Wang Jingtong , Lagarias J. Clark , Wilde Annegret , Nobles David R. , Brand Jerry J. , Golden Susan S.
Published: December 2018

Many cyanobacteria, which use light as an energy source via photosynthesis, have evolved the ability to guide their movement toward or away from a light source. This process, termed “phototaxis,” enables organisms to localize in optimal light environments for improved growth and fitness. Mechanisms of phototaxis have been studied in the coccoid cyanobacterium
Synechocystis
sp. strain PCC 6803, but the rod-shaped
Synechococcus elongatus
PCC 7942, studied for circadian rhythms and metabolic engineering, has no phototactic motility. In this study we report a recent environmental isolate of
S. elongatus
, the strain UTEX 3055, whose genome is 98.5% identical to that of PCC 7942 but which is motile and phototactic. A six-gene operon encoding chemotaxis-like proteins was confirmed to be involved in phototaxis. Environmental light signals are perceived by a cyanobacteriochrome, PixJ
Se
(Synpcc7942_0858), which carries five GAF domains that are responsive to blue/green light and resemble those of PixJ from
Synechocystis
. Plate-based phototaxis assays indicate that UTEX 3055 uses PixJ
Se
to sense blue and green light. Mutation of conserved functional cysteine residues in different GAF domains indicates that PixJ
Se
controls both positive and negative phototaxis, in contrast to the multiple proteins that are employed for implementing bidirectional phototaxis in
Synechocystis
.
Experimental evaluation of strain and strain rate during rapid cooling friction stir welding of pure copper
Authors: Liu X. C. , Sun Y. F. , Nagira T. , Ushioda K. , Fujii H.
Published: December 2018

The strain and strain rate during friction stir welding was evaluated by measuring the distortion of the marker material. A thin Cu-40Zn foil as marker was inserted into the butting surface of two pure copper workpieces and the tool ‘stop action’ was employed. The results show that the strain in the shoulder-affected zone increases in a two stair-step shape as the material flows from the front to the rear of the tool, corresponding to the first accelerated and then decelerated flow stages. However, the strain at the two stages has opposite directions. In other words, a strain reversal occurs. Accordingly, the strain rate in the shoulder-affected zone varies in a sinusoidal shape. In the probe-affected zone, there is no obvious strain reverse occurring due to the formation of banded structures. The average strain rate during the band formation is significantly higher than the maximum strain rate in the shoulder-affected zone.
Sports mega‐event legacies and adult physical activity: A systematic literature review and research agenda
Authors: Annear Michael J. , Shimizu Yasuo , Kidokoro Tetsuhiro
Published: December 2018

Sports mega‐events, such as the Olympic and Paralympic Games, have the potential to inspire increases in population physical activity, yet investigations concerning such legacy outcomes have been inconclusive. This may be due to research design limitations or inconsistent leveraging of potential hosting benefits by event organizers. This systematic review aims to identify current knowledge about the capacity of sports mega‐events to inspire increases in physical activity participation among adult populations and develop a research agenda to guide future legacy evaluations. Peer‐reviewed, English‐language studies published on or after the year 2000 were considered. Six academic databases and grey literature sources were searched, and articles were assessed for methodological quality. Reporting followed PRISMA conventions for systematic reviews. Nine studies were selected after quality evaluation, including previous reviews, quantitative and qualitative research. Most studies found no evidence for long‐term physical activity outcomes associated with hosting sports mega‐events, although limitations and gaps were identified. These included lack of longitudinal or cohort studies, limited differentiation of subpopulations, use of non‐validated instruments, and lack of triangulation for qualitative findings. Only one cohort study from Japan identified sustainable and significant physical activity increases resulting from a previous sports mega‐event. Considering theory, the commonly cited Demonstration Effect was reportedly an unreliable framework, although the Festival Effect and Social Ecological Model appear more promising for anticipating and explaining legacy effects. With less than two years until the Tokyo 2020 Olympiad, it is appropriate to commence high‐quality legacy research drawing on lessons learned from previous studies.
Transcending the tribalism of the culture wars spectrum
Authors: Jersak Bradley
Published: December 2018

In this article, I lament, problematize and illustrate the inviolability of the culture wars spectrum(s) as a modernist/ubermodern matrix in which we’re trapped in ideological groupthink and exclusion of the other. Intrinsic to the binary language constructs of left-right, liberal-conservative, etc. is an us-them assumption of polarization that is impotent in creating a justice society or achieving a greater good. The spectrum is ideological, depending on demonizing the other, in the name of opposing notions of ‘freedom’– a euphemism for autonomous self-will. The self-will and othering of any us-them cannot be resolved by changing sides without changing spirits. ‘Calling out’ is easy; ‘calling in’ much harder. Having grieved and critiqued spectrum ideology, I propose an alternative vision adapted from George P. Grant (Canadian political philosopher) and Simon Weil (French philosopher/activist/mystic). To do so, I appropriate Grant's interpretation of the Socrates’ ‘Good’ fulfilled in Christ's such that Love/the Good are given primacy rather than freedom as self-will. That vision attempts to transcend spectrum groupthink and strives for an alternative society that invites divergent streams beyond their partisan zeal to draw near for a conversation concerning the greater goods of restorative justice and inclusive care.
Interspecific aggression among parapatric and sympatric songbirds on a tropical elevational gradient
Authors: Boyce Andy J , Martin Thomas E
Published: December 2018

Interspecific competition is hypothesized to be a strong force that sets species range limits and drives parapatric distributions of closely related species on tropical mountains. Yet, experimental evidence that competition drives spatial segregation of closely related species on elevational gradients is rare. To test whether competition limits elevational ranges of tropical songbirds, we conducted reciprocal playback experiments on 2 pairs of species with adjacent but nonoverlapping (parapatric) distributions and 1 pair of sympatric species. We found asymmetric interspecific aggression in one parapatric pair (Pycnonotidae) and a complete absence of interspecific aggression in the other (Zosteropidae). We also found asymmetric interspecies aggression in a pair of sympatric flycatchers (Muscicapidae). Our results indicate that interspecific aggression may set range limits in some cases, but it is not a prerequisite for parapatry. Furthermore, the presence of interspecific aggression between co-occurring relatives suggests that while competition may play a role in limiting species distributions, interspecific aggression alone is not sufficient evidence to assert that competition is the primary driver of parapatric distributions.
Transcriptome alterations in myotonic dystrophy skeletal muscle and heart
Authors: Wang Eric T , Treacy Daniel , Eichinger Katy , Struck Adam , Estabrook Joseph , Olafson Hailey , Wang Thomas T , Bhatt Kirti , Westbrook Tony , Sedehizadeh Sam , Ward Amanda , Day John , Brook David , Berglund J Andrew , Cooper Thomas , Housman David , Thornton Charles , Burge Christopher
Published: December 2018

Myotonic dystrophy (dystrophia myotonica, DM) is a multi-systemic disease caused by expanded CTG or CCTG microsatellite repeats. Characterized by symptoms in muscle, heart and central nervous system, among others, it is one of the most variable diseases known. A major pathogenic event in DM is the sequestration of muscleblind-like proteins by CUG or CCUG repeat-containing RNAs transcribed from expanded repeats, and differences in the extent of MBNL sequestration dependent on repeat length and expression level may account for some portion of the variability. However, many other cellular pathways are reported to be perturbed in DM, and the severity of specific disease symptoms varies among individuals. To help understand this variability and facilitate research into DM, we generated 120 RNASeq transcriptomes from skeletal and heart muscle derived from healthy and DM1 biopsies and autopsies. A limited number of DM2 and Duchenne muscular dystrophy samples were also sequenced. We analyzed splicing and gene expression, identified tissue-specific changes in RNA processing and uncovered transcriptome changes strongly correlating with muscle strength. We created a web resource at http://DMseq.org that hosts raw and processed transcriptome data and provides a lightweight, responsive interface that enables browsing of processed data across the genome.
Rational Links and DT Invariants of Quivers
Authors: Stošić Marko , Wedrich Paul
Published: December 2018

We prove that the generating functions for the colored HOMFLY-PT polynomials of rational links are specializations of the generating functions of the motivic Donaldson–Thomas invariants of appropriate quivers that we naturally associate with these links. This shows that the conjectural links–quivers correspondence of Kucharski–Reineke–Stošić–Sułkowski as well as the LMOV conjecture holds for all rational links. Along the way, we extend the links–quivers correspondence to tangles and, thus, explore elements of a skein theory for motivic Donaldson–Thomas invariants.
Resolutions of Proper Riemannian Lie Groupoids
Authors: Posthuma Hessel , Tang Xiang , Wang Kirsten
Published: December 2018

In this paper we prove that every proper Lie groupoid admits a regularization to a regular proper Lie groupoid. When equipped with a Riemannian metric, we show that it admits regularization to a regular Riemannian proper Lie groupoid, arbitrarily close to the original one in the Gromov–Hausdorff distance between the quotient spaces. We construct the regularization via a successive blow-up construction on a proper Lie groupoid. We also prove that our construction of the regularization is invariant under Morita equivalence of groupoids, showing that it is a desingularization of the underlying differentiable stack.
Dramatic spectral transition of X-ray pulsar GX 304−1 in low luminous state
Authors: Tsygankov Sergey S , Rouco Escorial Alicia , Suleimanov Valery F , Mushtukov Alexander A , Doroshenko Victor , Lutovinov Alexander A , Wijnands Rudy , Poutanen Juri
Published: December 2018

We report on the discovery of a dramatic change in the energy spectrum of the X-ray pulsar GX 304−1 appearing at low luminosity. Particularly, we found that the cut-off power-law spectrum typical for accreting pulsars, including GX 304−1 at higher luminosities of LX ∼ 1036–1037 erg s−1, transformed at lower luminosity of LX ∼ 1034 erg s−1 to a two-component spectrum peaking around 5 and 40 keV. We suggest that the observed transition corresponds to a change of the dominant mechanism responsible for the deceleration of the accretion flow. We argue that the accretion flow energy at low accretion rates is released in the atmosphere of the neutron star, and the low-energy component in the source spectrum corresponds to the thermal emission of the optically thick, heated atmospheric layers. The most plausible explanations for the high-energy component are either the cyclotron emission reprocessed by the magnetic Compton scattering or the thermal radiation of deep atmospheric layers partly Comptonized in the overheated upper layers. Alternative scenarios are also discussed.
beRBP: binding estimation for human RNA-binding proteins
Authors: Yu Hui , Wang Jing , Sheng Quanhu , Liu Qi , Shyr Yu
Published: December 2018

Identifying binding targets of RNA-binding proteins (RBPs) can greatly facilitate our understanding of their functional mechanisms. Most computational methods employ machine learning to train classifiers on either RBP-specific targets or pooled RBP–RNA interactions. The former strategy is more powerful, but it only applies to a few RBPs with a large number of known targets; conversely, the latter strategy sacrifices prediction accuracy for a wider application, since specific interaction features are inevitably obscured through pooling heterogeneous datasets. Here, we present beRBP, a dual approach to predict human RBP–RNA interaction given PWM of a RBP and one RNA sequence. Based on Random Forests, beRBP not only builds a specific model for each RBP with a decent number of known targets, but also develops a general model for RBPs with limited or null known targets. The specific and general models both compared well with existing methods on three benchmark datasets. Notably, the general model achieved a better performance than existing methods on most novel RBPs. Overall, as a composite solution overarching the RBP-specific and RBP-General strategies, beRBP is a promising tool for human RBP binding estimation with good prediction accuracy and a broad application scope.
Eruptive cherry angiomas and skin melanoma: a fortuitous association?
Authors: Corazza Monica , Dika Emi , Maietti Elisa , Musmeci Dario , Patrizi Annalisa , Borghi Alessandro
Published: December 2018

The aim of the study was to assess the association between eruptive cherry angiomas (CAs) and malignant melanoma (MM). Secondary objectives included investigating (i) this association in different age subgroups, and (ii) the association of eruptive CAs with other variables such as malignant tumours, in general, and immunosuppressive treatments. This cross-sectional study involved all patients referred to the outpatient Dermatology-Oncology Units of the universities of Ferrara and Bologna, Italy, and submitted to total body skin examination. These patients were included in a previously collected series. We recorded age, sex, cutaneous and noncutaneous malignancies, immunosuppressive treatments, and presence of CAs. CAs were arbitrarily considered as ‘eruptive’ when more than or equal to 10. Variables significantly associated with eruptive CAs were included in the logistic regression analysis, also stratified by age. A total of 1693 patients were included in the present study: 500 patients had malignancies, 460 malignant skin tumours, 263 had MM; 150 patients were immunosuppressed; 804 (47.49%) patients had eruptive CAs. In the whole study population, age, immunosuppressive treatment, MM, other skin and nonskin malignant tumours were significantly associated with eruptive CAs at the multivariate analysis. Multivariate analysis in each age subgroup revealed that the association between MM and eruptive CAs was highly significant in younger patients (≤50 years), significant in the 51–70 year-old subgroup, whereas it lost significance in older patients. These findings suggest an association between MM and eruptive CAs, particularly in the lower and intermediate age groups. Both the nature of this association and its possible impact in clinical practice, especially in MM screening, are yet to be established.
How Educational Theory Can Inform the Training and Practice of Plastic Surgeons
Authors: Sadideen Hazim , Plonczak Agata , Saadeddin Munir , Kneebone Roger
Published: December 2018

It is important to optimize our current learning and teaching models, particularly in a climate of decreased clinical exposure. With technical advancements and clinical care now more accountable, traditional methods of skill acquisition need to be revisited. The past decade has seen changes in plastic surgery curricula. There has also been a shift toward competency-based training programs reflecting the growing emphasis on outcomes-based surgical education. This review explores the role of educational theory in promoting effective learning in practical skills teaching. Key models of educational theory are presented and their application to plastic surgery training to an expert level are highlighted. These models include (1) learning within communities of practice (Lave and Wenger’s theory); (2) the role of the zone of proximal development and importance of the availability of expert assistance (Vygotsky’s theory); (3) skill acquisition and retention (Dreyfus’ and Dreyfus’, and Fitts’ and Posner’s theories); (4) development of expertise after repeated practice and regular reinforcement (Ericsson’s theory); and (5) the assessment of competence (Miller’s triangle). Future plastic surgeons need to possess a thorough understanding of the technical and nontechnical skills required to manage patients effectively. Surgical educators are therefore compelled to develop practical training programs that can teach each of these skills in a safe, learner-centric manner. It is hoped that new approaches to surgical skills training are designed in light of our understanding of educational theory to optimize the training of the next generation of plastic surgeons.
QUANTIFICATION OF CHOROIDAL VASCULATURE BY HIGH-QUALITY STRUCTURE EN FACE SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY IMAGES IN EYES WITH CENTRAL SEROUS CHORIORETINOPATHY
Authors: Ogawa Yuki , Maruko Ichiro , Koizumi Hideki , Iida Tomohiro
Published: December 2018

Purpose:

To determine the density of the choroidal vasculature by high-quality structure en face optical coherence tomography (OCT) scanned at the same time as OCT angiography in eyes with central serous chorioretinopathy (CSC).

Methods:

Thirty-five eyes of 30 patients with CSC (20 men and 10 women; average age, 48.4 years) were studied. Volume scans (12 × 12 mm-square) were obtained at the same time as OCT angiographic scans (Plex Elite 9000; Swept-Source OCT, Zeiss). High-quality structure en face images were flattened at Bruch membrane and binarized to identify and quantify the choroidal vascular density by the Bernsen method of the segmentation slab of one-half of the choroidal thickness. Similarly, high-quality structure en face choroidal images of 35 healthy eyes of 29 patients (18 men and 11 women; average age, 51.7 years) were binarized and analyzed as controls. The en face images were cropped to exclude the optic disk.

Results:

The mean cropped image size was 9.57 mm × 9.57 mm in the eyes with CSC and 9.48 mm × 9.48 mm in the healthy eyes (P = 0.41). In the eyes with CSC, the choroidal vascular density was 61.6 ± 7.5% of the choroid, which was significantly greater than that in the healthy eyes at 49.4 ± 7.5% (P < 0.01).

Conclusion:

High-quality structure en face OCT can be used to assess the density of the choroidal vessels quantitatively and noninvasively in eyes with CSC.
Optic Disc Segmentation Using Manual Thresholding Technique
Authors: Ahmed Arwa , Osman Alnazeer
Published: December 2018

Optic disc segmentation is a very important step in diagnosing glaucoma disease, where untreated glaucoma leads to irreversible loss of vision. Glaucoma is the second cause of blindness around the world. In this work, manual thresholding technique in optic disc segmentation is applied, evaluated, and compared with other segmentation techniques. The optic disc segmented by thresholding level 180 after vessel removal by morphological operation to improve segmentation process, and then boundary smoothed by dilating and eroding operation and border clearing; at final segmentation step, the segmented part was shaped to construct full circle to minimize segmentation error due to the main vessel and presence of parapapillary atrophy around the disc. The algorithm was evaluated on rim:one database, which has a ground truth from 5 experts, and achieved best Dice coefficient results with experts, 90%, and structural similarity, 83%. It was concluded that a novel optic disc segmentation algorithm by manual thresholding technique is easy, fast, and inexpensive computationally and obtained good segmentation results and would help in early detection of glaucoma by the ophthalmologist.
Creating a Mock Environment for the Real World
Authors: Berkey Maggie , Koepke Katherine , Gruwell Cindy
Published: December 2018

College programs have many needs and often minimal funding. The purpose of this collaborative project was to creatively meet the needs of the St Cloud Technical and Community College’s biomedical equipment technology students’ hands-on learning experience and at the same time the maintenance of equipment in the St Cloud State University Nursing Department and St Cloud Technical and Community College Clinical Departments. This working collaborative established between the 2 schools resulted in a win-win situation for all. Biomedical equipment technology students repaired equipment and created an inventory while providing real-time customer service, and the nursing/clinical departments appreciated quick and consistent repair of broken and defective equipment.
Exploring the Delivery of Healthcare in the Police Detention Center Through Remote Presence Technology
Authors: Woods Phil , Leidl Don , Luimes Janet , Butler Lorna
Published: December 2018

Introduction:

There is overwhelming evidence to support the delivery of high-quality health service at a lower cost with the use of advanced technologies. Implementing remote presence technology to expand clinical care has been fraught with barriers that limit interprofessional collaboration and optimal client outcomes. In Canada, government ministries responsible for correctional services, policing, and health are well positioned to link federal, provincial, and regional services to enhance service delivery at the point of care for individuals detained within the justice system. Using remote presence technology to link the detention center with relevant health services such as the emergency room has the potential to open up a new care pathway.

Research Question:

The key research question was how a new intervention pathway for individuals detained in police service detention centers could be implemented.

Research Design:

Utilizing an exploratory qualitative research design, interviews were undertaken with 12 police service and six healthcare participants. Data were transcribed and thematically analyzed.

Findings:

Four main themes emerged and included role conflict, risk management, resource management, and access to services. A number of collaborative learning partnerships were identified by the participants.

Implications:

These themes reveal important facilitators and barriers to attending to the health needs of detainees within the police detention center through the utilization of remote presence.
Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study, 2011–2014
Authors: Dobson Allen , Murray Kennan , Manolov Nikolay , DaVanzo Joan E.
Published: December 2018

Background

There are few studies of the economic value of orthotic and prosthetic services. A prior cohort study of orthotic and prosthetic Medicare beneficiaries based on Medicare Parts A and B claims from 2007–2010 concluded that patients who received timely orthotic or prosthetic care had comparable or lower total health care costs than a comparison group of untreated patients. This follow-up study reports on a parallel analysis based on Medicare claims from 2011–2014 and includes Part D in addition to Parts A and B services and expenditures. Its purpose is to validate earlier findings on the extent to which Medicare patients who received select orthotic and prosthetic services had less health care utilization, lower Medicare payments, and potentially fewer negative outcomes compared to matched patients not receiving these services.

Methods

This is a retrospective cohort analysis of 78,707 matched pairs of Medicare beneficiaries with clinical need for orthotic and prosthetic services (N = 157,414) using 2011–2014 Medicare claims data. It uses propensity score matching techniques to control for observable selection bias. Economically, a cost-consequence evaluation over a four-year time horizon was performed.

Results

Patients who received lower extremity orthotics had 18-month episode costs that were $1,939 lower than comparable patients who did not receive orthotic treatment ($22,734 vs $24,673). Patients who received spinal orthotic treatment had 18-month episode costs that were $2,094 lower than comparable non-treated patients ($23,560 vs $25,655). Study group beneficiaries receiving both types of orthotics had significantly lower Part D spending than those not receiving treatment (p<0.05). Patients who received lower extremity prostheses had comparable 15-month episode payments to matched beneficiaries not receiving prostheses ($68,877 vs $68,893) despite the relatively high cost of the prosthesis.

Conclusions

These results were consistent with those found in the prior study and suggest that orthotic and prosthetic services provide value to the Medicare program and to the patient.
Doctor of Physical Therapy Student Experiences During Clinical Education: Patient Safety, Error, and the System
Authors: Struessel Tamara , Forster Jeri E. , Van Zytveld Chelsea
Published: December 2018

Introduction/Review of Literature:

Medical error is inevitable due to complex environments and human fallibility. Other professions have published extensively on error reduction and students as a contributing aspect of clinical error. The physical therapy profession has lagged behind.

Purpose:

To explore doctor of physical therapy (DPT) student experiences with patient safety during clinical education, including factors that could potentially contribute to error.

Subjects:

Seventy DPT students at the University of Colorado.

Methods:

Sequential explanatory mixed methods design including quantitative (survey) and qualitative (focus group) data collection.

Results and Conclusion:

Ninety-one percent of students participated in the survey, and 13% in the focus groups. Five themes were identified, including 1) Facility safety culture, 2) Communication methods and frequency, 3) Widespread clinical education/clinical instructor variability, 4) Dual identity as student and clinician, and 5) Student stress. These themes all have the potential to increase patient safety risk.

Discussion and Conclusion:

Some issues identified in this paper are specific to students and need to be addressed at the clinical education level but with a focus on patient safety risk. However, many of the issues were related to the broader system and clinical environment and may have occurred without the student present. There are many opportunities for better academic and clinical partnerships with dual goals of improving educational excellence and reducing patient safety risk.
Acupuncture for hyperlipidemia
Authors: Peng Qinyan , Yao Xiaobin , Xiang Jiexiang , Wang Yuanping , Lin Xinmei
Published: December 2018

Background:

Hyperlipidemia is a major risk factor for cardiovascular and cerebrovascular diseases. Acupuncture has been widely applied in the treatment of hyperlipidemia. But its efficacy has not been evaluated scientifically and systematically. Therefore, we provide a protocol of systematic evaluation to assess the effectiveness and safety of acupuncture treatment on patient with hyperlipidemia.

Methods:

We will search the following databases electronically, including 3 English literature databases (i.e., PubMed, Embase, and Cochrane Library) and 4 Chinese literature databases (i.e., Chinese Biological and Medical database, China National Knowledge Infrastructure, VIP, and Wanfang Database). We will also search randomized-controlled trials about acupuncture treatment for hyperlipidemia and the search time limit is from its establishment to October 2018. The primary outcome is lipid-lowering efficacy. Secondary outcomes are total cholesterol, low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol levels. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed.

Results:

This study will provide a high-quality synthesis to assess the effectiveness and safety of acupuncture treatment on patient with hyperlipidemia.

Conclusion:

The conclusion of our systematic review will provide evidence to judge whether acupuncture is an effective intervention for patient with hyperlipidemia.
Telerehabilitation in individuals with severe acquired brain injury
Authors: Calabrò Rocco Salvatore , Bramanti Alessia , Garzon Martina , Celesti Antonio , Russo Margherita , Portaro Simona , Naro Antonino , Manuli Alfredo , Tonin Paolo , Bramanti Placido
Published: December 2018

Background:

Severe acquired brain injury (SABI) rehabilitation should be as intensive and long as to allow the patients get the best independence and quality of life (QoL), but facing with the rehabilitation socioeconomic burden. Telerehabilitation (TR) could supply frail subjects requiring long-term rehabilitation.

Methods:

A multicenter, prospective, parallel design, single-blind trial will be conducted at the IRCCS Neurolesi Bonino Pulejo (Messina, Italy) and IRCCS Hospital San Camillo (Venice, Italy) involving patients suffering from SABI and requiring home motor and cognitive rehabilitation. We will investigate the use of TR, based on advanced Information and Communication Technology (ICT) solutions, taking into account that the supervision of rehabilitation at home will be enriched with the counseling and vital parameters monitoring. The enrolled patients will be balanced for pathology, and randomized in 2 groups, performing TR (G1) or standard rehabilitation training (G2), respectively, according to a pc-generated random assignment. TR will be delivered by means of an advanced video-conferencing system, whereas the patient will be provided with low-cost monitoring devices, able to collect data about his/her health status and QoL. In both the groups each treatment (either cognitive or motor, or both as per patient functional status) will last about 1 hour a day, 5 days/week, for 12 weeks. Two structured telephone interviews will be administered to the patients (when possible) and/or their caregivers, and to all the healthcare professionals involved in the patient management, 1 week after the beginning and at the end of the TR. All the patients will undergo a complete neurological and cognitive examination performed by skilled physicians and psychologists, blindly. Clinical evaluations will be administered blindly, before and after the treatments.

Results:

the data of this study should demonstrate that TR is at least non-inferior in comparison with the same amount of usual territorial rehabilitative physical treatments, taking into account patients’ functional recovery, psychological well-being, caregiver burden, and healthcare costs.

Conclusion:

data coming from this study could demonstrate the usefulness of TR in facing the rehabilitation socioeconomic burden of managing patients with SABI, so to allow the patients get the best independence and quality of life (QoL).
Several genes involved in the JAK-STAT pathway may act as prognostic markers in pancreatic cancer identified by microarray data analysis
Authors: Pang Chun , Gu Yuan , Ding Yuechao , Ma Chao , Yv Wei , Wang Qian , Meng Bo
Published: December 2018

Purpose:

This study aimed to identify the underlying mechanisms in pancreatic cancer (PC) carcinogenesis and those as potential prognostic biomarkers, which can also be served as new therapeutic targets of PC.

Methods:

Differentially expressed genes (DEGs) were identified between PC tumor tissues and adjacent normal tissue samples from a public GSE62452 dataset, followed by functional and pathway enrichment analysis. Then, protein–protein interaction (PPI) network was constructed and prognosis-related genes were screened based on genes in the PPI network, before which prognostic gene-related miRNA regulatory network was constructed. Functions of the prognostic gene in the network were enriched before which Kaplan–Meier plots were calculated for significant genes. Moreover, we predicted related drug molecules based on target genes in the miRNA regulatory network. Furthermore, another independent GSE60979 dataset was downloaded to validate the potentially significant genes.

Results:

In the GSE62452 dataset, 1017 significant DEGs were identified. Twenty-six important prognostic-related genes were found using multivariate Cox regression analysis. Through pathway enrichment analysis and miRNA regulatory analysis, we found that the 5 genes, such as Interleukin 22 Receptor Subunit Alpha 1 (IL22RA1), BCL2 Like 1 (BCL2L1), STAT1, MYC Proto-Oncogene (MYC), and Signal Transducer And Activator Of Transcription 2 (STAT2), involved in the Jak-STAT signaling pathway were significantly associated with prognosis. Moreover, the expression change of these 5 genes was further validated using another microarray dataset. Additionally, we identified camptothecin as an effective drug for PC.

Conclusion:

IL22RA1, BCL2L1, STAT1, MYC, and STAT2 involved in the Jak-STAT signaling pathway may be significantly associated with prognosis of PC.
Prognostic value of tumor-infiltrating lymphocytes in hepatocellular carcinoma
Authors: Ding Wei , Xu Xuezhong , Qian Yan , Xue Wenbo , Wang Yibo , Du Jianguo , Jin Lei , Tan Yulin
Published: December 2018

Background:

In patients with hepatocellular carcinoma (HCC), the prognostic role of tumor-infiltrating lymphocytes (TILs) for survival is still controversial. A meta-analysis was performed to investigate the prognostic effect of TILs in HCC.

Methods:

We identify studies from PubMed, Embase, and the Cochrane Library to evaluate the prognostic value of TILs in patients with HCC. A meta-analysis was conducted to estimate overall survival and disease-free survival. The hazard ratio (HR) and 95% confidence interval (CI) were calculated employing fixed-effect or random-effect models depending on the heterogeneity of the included trials.

Results:

A total of 7905 patients from 46 observational studies were enrolled. For TILs subsets, the density of CD8+, FOXP3+, CD3+, and Granzyme B+ lymphocytes was significantly associated with improved survival (P < .05). The density of FOXP3+ TILs in intratumor (IT) was the most significant prognostic marker (pooled HR = 1.894; 95% CI = 1.659–2.164; P < .001). Patients with high infiltration of CD8+ TILs in IT (pooled HR = 0.676; 95% CI = 0.540–0.845; P = .001) or in margin of tumor (MT) (pooled HR = 0.577; 95% CI = 0.437–0.760; P < .001) had better OS. The pooled analysis revealed that high density of Granzyme B+ T-lymphocytes in IT was statistically significant associated with better OS (pooled HR = 0.621; 95% CI = 0.516–0.748; P < .001) and DFS (pooled HR = 0.678; 95% CI = 0.563–0.815; P < .001). It was interesting that high density of CD3+ in IT foreboded worse OS (pooled HR = 1.008; 95% CI = 1.000–1.015; P = .037), but better DFS (pooled HR = 0.596; 95% CI = 0.374–0.948; P = .029).

Conclusion:

Our findings suggested that some TIL subsets could serve as prognostic biomarkers in HCC. High-quality randomized controlled trials are needed to determine if these TILs could serve as targets for immunotherapy in HCC.
Intensity-modulated radiotherapy combined with sequential cisplatin and fluorouracil chemotherapy for locoregionally advanced nasopharyngeal carcinoma
Authors: Wu Mingyao , He Xiayun , Hu Chaosu
Published: December 2018

To investigate the efficacy and toxicity of intensity-modulated radiotherapy (IMRT) combined with induction-adjuvant cisplatin and fluorouracil (PF) in locoregionally advanced nasopharyngeal carcinoma (NPC).

A total of 91 biopsy-proven NPC patients treated with IMRT were retrospectively analyzed. All patients received induction chemotherapy (IC) consisting of cisplatin 25 mg/m2 on day 1 to 3, and 5-Fu 2500 mg/m2 as an intravenous infusion over 120 hours every 3 weeks for 2 cycles. Adjuvant chemotherapy of the same regime was given 28 days after the end of IMRT.

A total of 87 patients completed 2 cycles of IC. During adjuvant chemotherapy phase, 74.7% patients received at least 1 cycle. With a median follow-up time of 45 months (10–123 months), the 5-year local control, regional control, distant metastasis-free (DMF) and overall survival (OS) rates were 84.1%, 86.9%, 81.3%, and 74.4%, respectively. The 5-year local control rates for patients with Stage T1-2 and T3-4 was 94.6% and 76.5%, respectively (P = .045). The 5-year DMF rates for patients with N0-1 and N2-3 diseases were 90.6% and 73.3%, respectively (P = .072). During radiotherapy (RT), 24.2% patients suffered severe acute mucositis (grade 3–4). Severe late toxicities included cranial nerve palsy in 1 patient and grade 3 hearing impairment in 1 patient.

IMRT combined with induction-adjuvant chemotherapy consisting of PF regimen is well tolerated and provides satisfactory local-regional control for locoregionally advanced NPC. Further treatment strategies to control distant metastasis are needed in the future.
The impact of pre-existing cancer on survival of prostate cancer patients
Authors: Zhou Yuan , Guan Han , Fu Yong , Mao Likai , Ge Jiyue , Liu Lutan , Cheng Lei , Guan Chao
Published: December 2018

Prostate cancer (PCa) is the second most common malignant tumors for male patients worldwide. However, whether a history of pre-existing cancer cases may affect the survival of prostate cancer patients is still not fully understood.

We identified patients diagnosed with PCa between 2000 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) linked database. We further made propensity score matching and then compared all-cause and cancer-specific survival between patients with and those without a pre-existing cancer. Cox proportional hazards models and Kaplan–Meier analysis were used for survival comparison.

A total of 153,255 patients with PCa were included for analysis, of whom 5939 had a history of pre-existing cancer, including hematologic and lymph (11%), intestine (19%), urinary system (36%), head and neck (9%), lung (5%), skin (12%), and others (8%). Patients with a pre-existing cancer had a worse prognosis compared with those without a pre-existing cancer [all-cause death: hazard ratio (HR) = 2.74, P 
< .001; cancer-special death: HR = 3.98, P 
< .001]. Importantly, cancers in urinary bladder prior to PCa had a most adverse impact on all-cause (HR = 5.00, P 
< .001) and cancer-specific death risk (HR = 10.45, P 
< .001). Time between the pre-existing cancer and PCa had a dose-dependent effect on survival of PCa patients, with a decreased death risk as the increase of the interval time.

Pre-existing cancer has a negative impact on the prognosis of patients with PCa, which is most evident in the presence of a pre-existing urinary bladder cancer. Our results provide epidemiologic evidence with low between-group bias, large sample size, and long-term follow-up, highlighting the need for site-, and interval-time-based clinical management for patients with PCa who had a pre-existing cancer.
Echogenic alteration in the raphe nuclei measured by transcranial sonography in patients with Parkinson disease and depression
Authors: Liu Xue Jiao , Zhang Li , Zhang Yong Fang , Xu Wen , Hu Yang , Liu Ying , Bai Jing
Published: December 2018

Background:

Recently, several studies using transcranial sonography (TCS) have demonstrated reduced echogenicity of the mesencephalic midline in unipolar depression and patients with comorbid depression and Parkinson disease (PD). However, there is no consensus on the conclusion that raphe nuclei (RN) hypoechogenicity is associated with depression in PD. The methods used in previous studies lack quantitative and objective indicators to some extent; therefore, the present study used the level of platelet 5-hydroxytryptamine (5-HT) as an objective indicator of depression. Additionally, the reason for the reduced echogenicity of the brainstem raphe is still unclear.

Objectives:

The purpose of the present study was to assess the correlation between alterations in RN echogenicity and depressive symptoms in patients with PD using transcranial sonography (TCS). This information could provide a meaningful clinical reference for the antidiastole between depressive symptoms in PD and unipolar depression in patients with PD in whom depressive symptoms occur before motor symptoms.

Methods:

TCS was performed in patients with PD, patients with PD and depression, patients with depression and no PD, and healthy controls. Using the red nucleus as a reference, the RN was rated from grades 0 to 1 (grade 0: invisible, slightly echogenic, or interrupted RN; grade 1: hyperechogenicity in the RN observed as a continuous line).

Results:

The rate of abnormal RN (grade 0) was found to be 16.67% in patients with PD (5/30) and 14.29% in healthy controls (4/28). The presence of abnormal RN was significantly higher (χ
2 = 15.983, P < .05) in patients with depression and PD (40%, 12/30) and in patients with depression only (58.33%, 14/24) than in those without depression and healthy controls. No correlation was found between RN changes and depression severity (P > .05). There were no statistical differences in the concentration of platelet serotonin among the 4 groups (P > .05).

Conclusions:

TCS of the mesencephalic midline may be useful for detecting depression, which is an early symptom of PD. However, further neuropathological studies are needed to understand the principles underlying the use of platelet serotonin as a peripheral biomarker, as well as the connection between PD and depression.