bluuebunny/crossref_metadata_2025 huggingface dataset:
11. Conservation of Nature, Ecosystems, and Biodiversity
Authors: Boyle Alan , Redgwell Catherine
Published: September 2021

Our survival on earth, this chapter argues, depends on the conservation of the world’s natural resources. These resources comprise of soil, water, the atmosphere, plants, trees, and other life forms. The chapter looks at the earth’s current ‘ecological footprint’ and the future of that ecological footprint as it stands now. There is now widespread scientific consensus that biodiversity is being lost, and that pressures on biodiversity are increasing. The chapter asks what we can do about this, in terms of international law. The chapter identifies how international law seeks to ensure the protection and conservation and sustainable use of nature, its ecosystems and biodiversity, and the effectiveness of measures developed to conserve land?based living resources, forests, and deserts.
13. International Trade and Environmental Protection
Authors: Boyle Alan , Redgwell Catherine
Published: September 2021

This chapter looks at the relationship between the World Trade Organization (WTO) and international trade in terms of international environmental law. Twenty-five years after the WTO system came into operation it appears that neither trade law nor environmental law have trumped each other. Rather, there has been a process of accommodation which is still ongoing. The chapter ends by making some conclusions on the arguments presented in this book and the issues currently being faced. The current policy of encouraging free trade cannot always be made environmentally friendly and this will always be the case. The problem becomes clear if we consider climate change. Free trade and globalisation by nature exacerbates the difficulties of regulating environmental issues. In addition, one of the key problems with sustainable development as a concept is that there has been too much emphasis on development, and not nearly enough on sustainability, then a policy of promoting free trade is part of that problem.
3. Arrest
Authors: Parmar Alpa
Published: September 2021

This chapter examines how far the police are, and should be, allowed to infringe the freedom of the individual through arrest. It considers the legal rules that the police must follow when deciding to, and during, arrest, as well as their effectiveness in controlling the use of this power. This chapter considers the purpose of arrest and what reasons for arrest are lawful. The use of arrest in the context of suspected terrorism is explored, and ‘citizen arrest’ is also evaluated. Discussion about how the police use their discretion when exercising the power of arrest is situated in our understanding of police ‘working rules’. The chapter shows that arrest is used for many purposes, some more legitimate than others.
4. Detention in the police station
Authors: Welsh Lucy , Skinns Layla , Sanders Andrew
Published: September 2021

This chapter examines the effectiveness of the checks, controls, and safeguards provided for suspects in police detention, including for suspects considered to be vulnerable by the police. It also evaluates the effect of the European Convention on Human Rights and the Human Rights Act 1998. The discussions cover the powers and duties of custody officers and detention officers; length of detention without charge; suspects’ rights including the right to legal advice and the rights of vulnerable suspects; the purpose of and experiences of police detention; and deaths in police custody.
5. Police questioning of suspects
Authors: Welsh Lucy , Skinns Layla , Sanders Andrew
Published: September 2021

This chapter examines the power of the police to question suspects, both in theory and in practice. It discusses the expanding powers of the police to interrogate, reflecting the drift from due process to crime control; the multiple aims of police interviews; the dwindling away of the right to silence, for example as a result of the introduction of adverse inferences and the ‘sidelining’ of legal advice; the (inadequate) regulation of interrogation, for example, through trial remedies founded on interviews being ‘unfair’ or ‘oppressive’ ; traditional police interview tactics; the development of investigative interviewing, based on the PEACE model; why the innocent confess and the role of coercion and suggestibility in this; and the need for a corroboration rule.
6. Non-interrogatory evidence and covert policing
Authors: Cape Ed
Published: September 2021

This chapter examines the main types of non-interrogatory evidence gathered through criminal justice processes. First we look at witness and identification evidence; like the interviewing of suspects, this is not as straightforward as it might appear. We then move onto entry of premises (eg suspects’ homes, places of work, etc), search of those places and seizure of ‘suspicious’ goods discovered by searches. Whereas most entry and search is known to the suspects and/or owners of the premises concerned, ‘covert’ policing is, by definition, not made known to the subjects of the policing. Covert policing takes many forms: eg, surveillance, ‘undercover’ policing, use of informers, interception of communications. Finally we examine scientific evidence which, like witness evidence, is far from straightforward. There are many problems common to all these types of information-gathering. These include the fragility and ambiguity of what often appears solid and objective; the way they erode human rights; the effect of ‘police culture’ on what is gathered and how it is interpreted; and the lack of accountability for what is done and how it is done.
7. Prosecutions and constructing guilt
Authors: Welsh Lucy , Skinns Layla , Sanders Andrew
Published: September 2021

This chapter examines whether the combination of laws, policies, and procedures of different prosecuting and enforcement agencies is fair and effective, and why an overwhelming proportion of defendants plead guilty. It discusses the respective roles of the police and Crown Prosecution Service in prosecution decision-making; how cases are constructed for prosecution; the criteria for prosecution decision-making; diversion from prosecution; review of prosecution decisions; the different treatment of ‘regulatory’ offences and ‘real’ crime; the roles of police, prosecutors, judges and defence lawyers in persuading defendants to plead guilty; the incentives, even for the innocent, to plead guilty; whether plea bargaining should be abolished.
8. Summary justice in the magistrates’ court
Authors: Welsh Lucy , Skinns Layla , Sanders Andrew
Published: September 2021

This chapter focuses on the magistrates’ courts. It discusses the importance of the magistracy and the work that they do; the involvement (and funding) of lawyers in summary justice; major pre-trial decisions such as bail and whether a case can be dealt with in the magistrates’ court or is so serious that it needs to be sent to the Crown court (mode of trial/allocation); how magistrates and their legal advisors measure up to the crime control/due process models of criminal justice; and the future of summary justice (including the impact of managerialist and ‘victim rights’ reforms and trends that encourage dealing with much lower court business away from the courtroom itself).
9. Trial by judge and jury
Authors: Welsh Lucy , Skinns Layla , Sanders Andrew
Published: September 2021

This chapter discusses how cases are processed in the Crown courts and trial by jury. It discusses the role and powers of the judge in relation to the management of cases, trial process and outcomes. It also discusses the jury system and how jury composition affects perceptions of the fairness and legitimacy of jury trial. Research about the impact of jury composition and juror attitudes on verdicts is discussed. The chapter goes on to consider whether key evidential rules unduly favour the defence or prosecution and attempts to further erode the practical significance of jury trial through the use of judge-only trials.
11. When things go wrong in the criminal justice process
Authors: Welsh Lucy , Skinns Layla , Sanders Andrew
Published: September 2021

In this chapter, we identify and critically evaluate the kind of things that can go wrong in the criminal justice process and describe the institutional architecture used to regulate the actions and effects of criminal justice practitioners and to hold them to account. The focus of the chapter is on the organisational, legal and democratic regulatory and accountability mechanisms associated with the police, courts and CPS. Specifically the chapter covers: Police and Crime Commissioners; citizen- and volunteer-led forms of accountability/regulation; royal commissions, public inquiries and independent inquiries; police complaints processes and inspectorates; trial remedies and appeals; the Criminal Cases Review Commission; civil proceedings; inquests and Coronial Courts.
Widespread translational control regulates retinal development in mouse
Authors: Chen Kaining , Chen Congying , Li Huihui , Yang Jiaqi , Xiang Mengqing , Wang Hongwei , Xie Zhi
Published: September 2021

Retinal development is tightly regulated to ensure the generation of appropriate cell types and the assembly of functional neuronal circuitry. Despite remarkable advances have been made in understanding regulation of gene expression during retinal development, how translational regulation guides retinogenesis is less understood. Here, we conduct a comprehensive translatome and transcriptome survey to the mouse retinogenesis from the embryonic to the adult stages. We discover thousands of genes that have dynamic changes at the translational level and pervasive translational regulation in a developmental stage-specific manner with specific biological functions. We further identify genes whose translational efficiencies are frequently controlled by changing usage in upstream open reading frame during retinal development. These genes are enriched for biological functions highly important to neurons, such as neuron projection organization and microtubule-based protein transport. Surprisingly, we discover hundreds of previously uncharacterized micropeptides, translated from putative long non-coding RNAs and circular RNAs. We validate their protein products in vitro and in vivo and demonstrate their potentials in regulating retinal development. Together, our study presents a rich and complex landscape of translational regulation and provides novel insights into their roles during retinogenesis.
Opioid-Free Anesthesia for Craniotomy
Authors: McCullough Ian L. , Shteamer Jack W. , Erwood Andrew M. , Spektor Boris , Boorman David W. , Sharifpour Milad , Olson Jeffery J. , Papangelou Alexander
Published: September 2021

Background:

Perioperative opioids are problematic following craniotomy as they can impede neurological examination because of excessive sedation and mask surgical complications. Multimodal anesthetic techniques including nerve blocks have been used successfully to deliver opioid-free anesthesia in other surgical populations; however, no clinical data evaluating opioid-free anesthesia for craniotomy exists within the current body of literature.

Materials and Methods:

Six prospectively identified patients underwent supratentorial craniotomy at Emory University Hospital using a multimodal opioid-free anesthetic (OFA) technique consisting of preoperative scalp block, dexmedetomidine and intravenous acetaminophen. These opioid-free patients were matched by age, sex, incision length, and incision location to 18 retrospectively identified control patients who underwent craniotomy using conventional, opioid-based anesthetic techniques. Postoperative opioid consumption and pain scores were compared and analyzed for noninferiority.

Results:

Noninferiority of the OFA technique was demonstrated for opioid consumption at all measured intervals from postanesthesia care unit arrival to 24 hours postoperatively. Noninferiority was also demonstrated with respect to average postoperative pain scores from 0 to 12 hours, 0 to 24 hours, as well as length of postanesthesia care unit stay. Noninferiority was not shown for time to first rescue opioid postoperatively, pain scores for the 12 to 24 hours postoperative period, or time to emergence from anesthesia.

Conclusions:

This pilot study demonstrates the feasibility of an OFA technique for patients undergoing supratentorial craniotomy and suggests that larger prospective randomized controlled trials are indicated to examine the role of multimodal anesthetic techniques for craniotomy.
What’s New in Pain Management for Pediatric Orthopaedic Surgery
Authors: Johnson Mitchell A. , Andras Lindsay M. , Andras Lydia E. , Ellington Matthew D. , Upasani Vidyadhar V. , Shah Apurva S.
Published: September 2021

Background:

Improving pain control and decreasing opioid prescription and usage continue to be emphasized across both pediatric and adult populations. The purpose of this review is to provide a comprehensive assessment of recent literature and highlight new advancements pertaining to pain control in pediatric orthopaedic surgery.

Methods:

An electronic search of the PubMed database was performed for keywords relating to perioperative pain management of pediatric orthopaedic surgery. Search results were filtered by publication date for articles published between January 1, 2015 and December 1, 2020 and yielded 404 papers.

Results:

A total of 32 papers were selected for review based upon new findings and significant contributions in the following categories: risk factors for increased opioid usage, opioid overprescribing and disposal, nonpharmacologic interventions, nonsteroidal anti-inflammatory drugs, peripheral nerve blocks, spine surgery specific considerations, surgical pathway modifications, and future directions.

Conclusions:

There have been many advances in pain management for pediatric patients following orthopaedic surgery. Rapid recovery surgical care pathways are associated with shorter length of stay and improved pain control in pediatric spine surgery. Opioid overprescribing continues to be common and information regarding safe opioid disposal practices should be routinely provided for pediatric patients undergoing surgery.

Level of Evidence:

Level IV—literature review.
No Tourniquet Technique of Surgery for Macrodactyly
Authors: Prasetyono Theddeus O.H. , Santoso Timothy A.
Published: September 2021

The tourniquet technique in limb surgery has traditionally been performed to produce bloodless operative fields. Nevertheless, there are limitations derived from the tourniquet itself; either the complications that may occur because of the ischemic effects, or the constraint of time because of the ischemic time. As no surgeon expects dreadful adverse events in their practices, an alternative technique may fill up the demand. The implementation of epinephrine, which was previously believed to be dangerous, has been performed in end-artery organs such as toes and fingers. In this article, the authors apply the tumescent technique with the use of 1:1,000,000 epinephrine or shortly termed as one-per-mil solution, without using the pneumatic tourniquet. The technique presents relatively clear operative fields, yet safe. Although the risk of bleeding is higher because of the enlarged vascular caliber and all structures around the affected digits, the technique facilitates clear visualization of important structures. In addition, the long action of the one-per-mil tumescent solution notably provides a much longer surgery duration, which facilitates complex surgery for macrodactyly.

Level of Evidence: Treatment level of evidence IV—case series. See Instructions for Authors for a complete description of levels of evidence.
Operative Treatment of Medial and Lateral Sesamoid AVN Through an Isolated Medial Approach
Authors: Powell Charlie , Miles Daniel T. , Fraser Tyler , Doty Jesse
Published: September 2021

Hallucal avascular necrosis can impose a significant burden upon the affected individual. When nonoperative interventions fail, sesamoidectomy is indicated. In the rare case of both medial and lateral sesamoid avascular necrosis, previous literature recommends a staged procedure through a combination of plantar and dorsal based approaches. In this case, we present a technique for single-staged medial and lateral sesamoidectomy through a single medial approach with subsequent capsular repair, abductor tendon advancement, and flexor hallucis longus tenodesis. Preoperative and postoperative radiographic analysis as well as 1-year postoperative functional scores were completed. This single-staged medial approach may provide excellent clinical and radiographic outcomes while providing a reduction of cost, anesthesia, and rehabilitation requirements.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Rates of Upstaging, Between Diagnosis and Surgery, and Clinical Management of Metastatic Cutaneous Squamous Cell Carcinoma: A Case–Control Study
Authors: Costello Collin M. , Cumsky Helen J. L. , Severson Kevin J. , Mi Lanyu , DiCaudo David J. , Ochoa Shari A. , Baum Christian L. , Mangold Aaron R.
Published: September 2021

BACKGROUND

Cutaneous squamous cell carcinomas (cSCC) have upstage rates of approximately 10.3% to 11.1%. Data are currently limited on the rate of upstaging for metastatic cSCC.

OBJECTIVE

The aim of this study was to determine the rates of upstaging, between diagnosis and surgery, and differences in management for metastatic and non-metastatic high-risk cSCC.

MATERIALS AND METHODS

This was a retrospective, case–control, single institution, multi-center study. Univariate analysis was used.

RESULTS

Sixty-eight subjects (34 metastatic & 34 non-metastatic) with 69 tumors were included. The overall rate of upstaging was 46.4%. The most common reasons for upstage were undocumented tumor size and under-diagnosis of poor differentiation. There were no differences in rates of upstaging. Preoperative imaging was performed in 43.6% of wide local excisions (WLE) versus 3.3% of Mohs micrographic surgery (MMS; p < .001). The median days from surgery to sentinel lymph node biopsy (SLNB), or nodal dissection was shorter for WLE versus MMS (0 vs 221 days, p < .001).

CONCLUSION

Improved clinical documentation, including documenting tumor size, and the identification of pathologic risk factors, including poor differentiation and depth of invasion, are needed for proper staging. Preoperative imaging and discussion of SLNB may be beneficial for high-risk T2b and T3 tumors.
Estimating Vaccine Efficacy Against Transmission via Effect on Viral Load
Authors: Kennedy-Shaffer Lee , Kahn Rebecca , Lipsitch Marc
Published: September 2021

Determining policies to end the SARS-CoV-2 pandemic will require an understanding of the efficacy and effectiveness (hereafter, efficacy) of vaccines. Beyond the efficacy against severe disease and symptomatic and asymptomatic infection, understanding vaccine efficacy against virus transmission, including efficacy against transmission of different viral variants, will help model epidemic trajectory and determine appropriate control measures. Recent studies have proposed using random virologic testing in individual randomized controlled trials to improve estimation of vaccine efficacy against infection. We propose to further use the viral load measures from these tests to estimate efficacy against transmission. This estimation requires a model of the relationship between viral load and transmissibility and assumptions about the vaccine effect on transmission and the progress of the epidemic. We describe these key assumptions, potential violations of them, and solutions that can be implemented to mitigate these violations. Assessing these assumptions and implementing this random sampling, with viral load measures, will enable better estimation of the crucial measure of vaccine efficacy against transmission.
Drug–Drug Interactions With Over-The-Counter Medicines: Mind the Unprescribed
Authors: Scherf-Clavel Oliver
Published: September 2021

Background:

This review provides a summary of the currently available clinical data on drug–drug interactions (DDIs) involving over-the-counter (OTC) medicines. It aims to educate and increase awareness among health care providers and to support decisions in daily practice.

Methods:

An extensive literature search was performed using bibliographic databases available through PubMed.gov. An initial structured search was performed using the keywords “drug-drug-interaction AND (over-the-counter OR OTC),” without further restrictions except for the language. The initial results were screened for all described DDIs involving OTC drugs, and further information was gathered specifically on these drugs using dedicated database searches and references found in the bibliography from the initial hits.

Results:

From more than 1200 initial hits (1972–June 2021), 408 relevant publications were screened for DDIs involving OTC drugs, leading to 2 major findings: first, certain types of drug regimens are more prone to DDIs or have more serious DDI-related consequences, such as antiretroviral, anti-infective, and oral anticancer therapies. Second, although most DDIs involve OTC drugs as the perpetrators, some prescription drugs (statins or phosphodiesterase-5 inhibitors) that currently have OTC status can be identified as the victims in DDIs. The following groups were identified to be frequently involved in DDIs: nonsteroidal anti-inflammatory drugs, food supplements, antacids, proton-pump inhibitors, H2 antihistamines, laxatives, antidiarrheal drugs, and herbal drugs.

Conclusions:

The most significant finding was the lack of high-quality evidence for commonly acknowledged interactions. High-quality interaction studies involving different phenotypes in drug metabolism (cytochrome P450) and distribution (transporters) are urgently needed. This should include modern and critical drugs, such as oral anticancer medications and direct oral anticoagulants.
IMMEDIATE SUBRETINAL FLUID DISPLACEMENT FROM THE BUOYANT FORCE OF A SMALL GAS BUBBLE IN PNEUMATIC RETINOPEXY: INSIGHTS INTO THE POTENTIAL MECHANISM OF RETINAL DISPLACEMENT AFTER RETINAL DETACHMENT REPAIR
Authors: Lee Wei Wei , Ramachandran Arun , Hamli Hesham , Escaf Luis C. , Bansal Aditya , Muni Rajeev H.
Published: September 2021

Purpose:

To demonstrate how a small gas bubble injected into the vitreous cavity in pneumatic retinopexy for rhegmatogenous retinal detachment causes immediate displacement of subretinal fluid and to gain insights into the potential mechanism of retinal displacement.

Methods:

Three patients with rhegmatogenous retinal detachment who underwent pneumatic retinopexy were enrolled and prospectively followed. All patients underwent ultra-widefield fundus photography at baseline and at 1 to 2 minutes after intravitreal gas injection.

Results:

In all cases, the ultra-widefield fundus photograph demonstrated immediate displacement of subretinal fluid, suggesting that the buoyant force applied to the retina by the bubble was responsible for the displacement of subretinal fluid. The results were extrapolated to determine the buoyant force applied by a small and large gas bubble as in pneumatic retinopexy and pars plana vitrectomy. We determined that the buoyant force applied with a larger bubble in pars plana vitrectomy was substantially greater, and this may lead to retinal displacement.

Conclusion:

Intravitreal gas applies significant buoyant force to the detached retina and subretinal fluid that leads to substantial and rapid displacement of subretinal fluid. Understanding the affect of the buoyant force of the gas bubble on the detached retina can provide insight into possible mechanisms of retinal displacement.
Improving smoking cessation education and documentation
Authors: Gennette Ryan L.
Published: September 2021

Background:

New lung cancer cases and annual deaths caused by lung cancers are significantly associated with tobacco smoking. Continued, routine smoking cessation prevention education has been linked with a decrease in lung cancer prevalence, resulting in a decline in new lung cancer diagnoses annually and ultimately less lung cancer–associated deaths in the United States.

Local problem:

An independent review of core measures revealed inadequate smoking cessation education documentation and no established system-based monitoring protocols, including formal education of health care providers. The lack of education and understanding contributed to a low compliance rate of 25% in core measure documentation.

Methods:

An educational program was designed to increase smoking cessation documentation core measures adherence. A preimplementation and postimplementation design was used to compare smoking cessation documentation compliance rates.

Intervention:

The program included education in the form of guided handouts, practical demonstrations, and one-on-one teaching sessions. Compliance, under guidance set forth by the Quality Oncology Practice Initiative, was calculated over a quarterly period including all practice providers.

Results:

Results revealed a smoking cessation documentation compliance rate of 25% preimplementation and 77% postimplementation, reflecting a 52% increase in rate of smoking cessation documentation adherence over a 6-month project period.

Conclusion: :

Z-test analysis showed statistical significance determining the interventions are a successful method to help increase smoking cessation core measure compliance. The smoking cessation education program led to better understanding of core measures, improved documentation, increased revenue, and increased level of patient smoking cessation.
Study of glucagon response and its association with glycemic control and variability after administration of ipragliflozin as an adjunctive to insulin treatment in patients with type 1 diabetes (Suglat-AID)
Authors: Nakamura Yuta , Horie Ichiro , Tashiro Shigeki , Kobayashi Masaki , Kitamura Tadahiro , Kusunoki Yoshiki , Nishida Kenro , Yamamoto Akane , Hirota Yushi , Fukui Tomoyasu , Sekiguchi Dan , Maeda Yasutaka , Minami Masae , Matsui Takanori , Kawakami Atsushi , Abiru Norio
Published: September 2021

Background:

Despite advances in insulin preparation, insulin delivery systems and glucose monitoring, it is extremely difficult to maintain glucose levels within the non-diabetic range in patients with type 1 diabetes (T1D). Sodium-glucose cotransporter 2 (SGLT2) inhibitors have recently raised the prospect of improving glucometabolic outcomes in an insulin-independent manner. SGLT2 inhibitors adjunctive to insulin treatment have been shown in T1D clinical trials to improve glycemic variability without increasing hypoglycemia. Conversely, some meta-analyses raised valid concerns regarding increased risk of euglycemic ketoacidosis after treatment of SGLT2 inhibitors in T1D. Increased hepatic ketogenesis caused by elevated glucagon secretion in patients receiving SGLT2 inhibitors has been discussed as a potential mechanism for euglycemic ketoacidosis in insulinopenic T1D, but the mechanism has not been fully elucidated. In this study, we investigate 1) whether glucagon secretions are altered by treatment with the SGLT2 inhibitor ipragliflozin as an adjunctive to insulin therapy in T1D patients, and 2) whether the glucagon responses are associated with amelioration/deterioration in glycemic control and serum ketone levels.

Methods/design:

This is a single-arm, multicenter, open-label, prospective exploratory trial designated Suglat-AID. Eligible participants are absolute-insulin-deficient T1D patients with glycated hemoglobin levels over 7.5%, who are receiving intensive insulin therapy using intermittently scanned continuous glucose monitoring. Thirty patients will be recruited and will take orally administered ipragliflozin as an add-on to insulin therapy. The primary endpoint is the change in glucagon levels during a mixed meal tolerance test between before and 12 weeks after initiation of ipragliflozin. Secondary endpoints include the changes in insulin and glucose levels during mixed meal tolerance test, the change in the patients’ glycemic control, change in the intermittently scanned continuous glucose monitoring-based profile and others.

Discussion:

To the best of our knowledge, this will be the first study assessing changes in glucagon response to an SGLT2 inhibitor in patients with T1D in a clinical setting. This study may help to clarify the pathophysiological role of glucagon in glycemia and ketogenesis in patients with T1D receiving SGLT2 inhibitors.

Trial registration:

This study was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (https://umin.ac.jp) on 24 March, 2020 under registration no. UMIN000039635.
Catching Fire: Are Operating Room Fires a Concern in Orthopedics?
Authors: Jardaly Achraf , Arguello Alexandra , Ponce Brent A. , Leitch Kellie , McGwin Gerald , Gilbert Shawn R.
Published: September 2021

Objective

Operating room (OR) fires are considered “never events,” but approximately 650 events occur annually in the United States. Our aim was to detail fires occurring during orthopedic procedures via a questionnaire because of the limited information present on this topic.

Methods

A 25-question survey on witnessing surgical fires, hospital policies on surgical fires, and surgeons’ perspective on OR fires was sent to 617 orthopedic surgeons in 18 institutions whose residency program is a member of the Collaborative Orthopaedic Educational Research Group. The response rate was 28%, with 172 surgeons having completed the survey.

Results

Twelve of the 172 orthopedic surgeons surveyed reported witnessing at least 1 surgical fire in an OR setting. Electrocautery was the leading ignition source, causing fires in 7 events. A saw, laser, and light source were reported to have caused 1 fire each. Regarding fuel source for the fires, bone cement was a common culprit (n = 4), followed by gauze (n = 3). Oxygen delivery to patients was via a closed system in most cases (n = 9). No patient harm was reported in any of these cases.

Just under half of the respondents (47.7%) reported not receiving any formal OR fire prevention or response training. The most common answer for frequency of concern about a surgical fire was “never” (42.4%).

Conclusions

Fires pose a risk in surgery, even in an orthopedics setting. Room oxygen can supply enough oxidizing power for a fire to occur, especially with the ubiquitous nature of ignition sources and fuels in the OR. Prevention is key with these events. Operating room personnel education must be sought, and surgeons should be mindful of the fire components in the OR.
Classification of Distinct Patterns of Ischemic Cholangiopathy Following DCD Liver Transplantation: Distinct Clinical Courses and Long-term Outcomes From a Multicenter Cohort
Authors: Croome Kristopher P. , Mathur Amit K. , Aqel Bashar , Yang Liu , Taner Timucin , Heimbach Julie K. , Rosen Charles B. , Paz-Fumagalli Ricardo , Taner C. Burcin
Published: September 2021

Background.

As the number of donation after circulatory death (DCD) liver transplants (LTs) performed in the United States continues to increase annually, there has been interest by policy makers to develop a more robust exception point safety net for patients who develop ischemic cholangiopathy (IC) following DCD LT. As such, there is a need for better understanding of the clinical course and long-term outcomes in patients who develop IC, as well as determining if IC can be classified into distinct categories with distinctly different clinical outcomes.

Methods.

All DCD LT performed at Mayo Clinic Florida, Mayo Clinic Arizona, and Mayo Clinic Rochester from January 1999 to March 2020 were included (N = 770). Outcomes were compared between 4 distinct radiologic patterns of IC: diffuse necrosis, multifocal progressive, confluence dominant, and minor form.

Results.

In total, 88 (11.4%) patients developed IC, of which 42 (5.5%) were listed for retransplantation of liver (ReLT). Patients with diffuse necrosis and multifocal progressive patterns suffered from frequent hospital admissions for cholangitis in the first year following DCD LT (median 3 and 2), were largely stent dependent (100% and 85.7%), and almost universally required ReLT. Patients with confluence dominant disease were managed with multiple stents and frequently recovered, ultimately becoming stent free without need for ReLT. Patients with the minor form IC did well with limited need for stent placement or repeat procedures and did not require ReLT. Graft survival was different between the 4 distinct IC patterns (P < 0.001).

Conclusions.

The present analysis provides a detailed analysis on the natural history and clinical course of IC. Patients developing IC can be classified into 4 distinct patterns with distinct clinical courses.
Chemotherapy in Cases of Trypanosoma cruzi Reinfection: Assessing for Chagas Disease Endemic Areas
Authors: Rebouças Mônica Cardozo , Silva Guerreiro Marcos Lázaro da , Eduardo Anderson Aires , Andrade Sonia Gumes
Published: September 2021

People living in endemic areas of Chagas disease are submitted to multiple infections during their lives. This is an important factor in the development and morbidity of the disease. In the present investigation, evaluate the treatment outcome of triple infection mice with 21SF clones compared to the parental strain and with clones were investigated. Mice were infected and divided into groups: G1, infected with 21SF strain; G2, infected with 3 clones’s 21SF strain; and G3, infected with each clone alone. Subsequently, the groups were subdivided in treated and untreated controls. After the treatment the mice were euthanized. Serological tests and parasitological tests were performed. Sections of the heart and skeletal muscle were collected, fixed and then processed for the histopathological study in sections stained with Hematoxilin end Eosin. Parasitological tests for animals treated have shown positive results that varied from 25 to 66.7% and the serology titers varied from 1:10 a 1:280 in treated mice. Cure rates ranged from 11.1 to 30.8%. Histopathological examination revealed that treated animals presented clear reduction of lesions in myocardium and in skeletal muscle. Animals subjected to multiple infections have low rates of cure and worsening of tissue lesions.
Non-additive QTL mapping of lactation traits in 124,000 sequence-imputed cattle reveals novel recessive loci
Authors: Reynolds Edwardo GM , Lopdell Thomas , Wang Yu , Tiplady Kathryn M , Harland Chad S , Johnson Thomas JJ , Neeley Catherine , Carnie Katie , Sherlock Richard G , Couldrey Christine , Davis Stephen R , Harris Bevin L , Spelman Richard J , Garrick Dorian J , Littlejohn Mathew D
Published: September 2021

Deleterious recessive conditions have primarily been studied in a Mendelian disease context. Recently, several large effect, deleterious recessive mutations were discovered via non-additive GWAS of quantitative growth and developmental traits in cattle. This showed quantitative traits can be used as proxies of genetic disorders if they are indicative of whole animal health status and susceptible to underlying genetic conditions. Lactation traits might also reflect genetic disorders in cattle, given the increased energy demands of lactation and the substantial stresses imposed on the animal. Here, we report a screen of over 124,000 cows for recessive effects based on lactation traits. We discovered novel loci associated with five large recessive impacts on milk yield traits represented by missense variants (DOCK8, IL4R, KIAA0556, and SLC25A4) or premature stop variants (ITGAL, LRCH4, and RBM34) as candidate causal mutations. On milk composition traits, we identified several small effect dominance contributions to previously reported additive QTL. In contrasting analyses of milk yield and milk composition phenotypes, we note differing genetic architectures. Milk yield phenotypes presented lower heritabilities and fewer additive QTL, but higher non-additive genetic variance and a higher proportion of loci exhibiting dominance compared to milk composition phenotypes. Large-effect recessive QTL are segregating at surprisingly high frequencies in cattle. We speculate that the differences in genetic architecture between milk yield and milk composition phenotypes derive from underlying dissimilarities in the cellular and molecular representation of these traits. Lactation yields may act as a better proxy than milk composition traits for a wide range of underlying biological disorders affecting animal fitness
Distribution and habitat use of the Madagascar Peregrine Falcon: first estimates for area of habitat and population size
Authors: Sutton Luke J. , Réné de Roland Lily-Arison , Thorstrom Russell , McClure Christopher J.W.
Published: September 2021

Accurately demarcating species distributions has long been at the core of ecology. Yet our understanding of the factors limiting species range limits is incomplete, especially for tropical species in the Global South. Human-driven threats to the survival of many taxa are increasing, particularly habitat loss and climate change. Identifying distributional range limits of at-risk and data-limited species using Species Distribution Models (SDMs) can thus inform spatial conservation planning to mitigate these threats. The Madagascar Peregrine Falcon (Falco peregrinus radama) is the resident sub-species of the Peregrine Falcon complex distributed across Madagascar, Mayotte, and the Comoros Islands. Currently, there are significant knowledge gaps regarding its distribution, habitat preferences and population size. Here, we use point process regression models and ordination to identify Madagascar Peregrine Falcon environmental range limits and propose a population size estimate based on inferred habitat. From our models, the core range of the Madagascar Peregrine Falcon extends across the central upland plateau of Madagascar with a patchier range across coastal and low-elevation areas. Range-wide habitat use indicated that the Madagascar Peregrine Falcon prefers areas of high elevation and aridity, coupled with high vegetation heterogeneity and > 95 % herbaceous landcover, but generally avoids areas of > 30 % cultivated land and > 10 % mosaic forest. Based on inferred high-class habitat, we estimate this habitat area could potentially support a population size ranging between 150-300 pairs. Following International Union for Conservation of Nature Red List guidelines, we recommend this sub-species be classed as Vulnerable, due to its small population size. Despite its potentially large range, the Madagascar Peregrine has specialized habitat requirements and would benefit from targeted conservation measures based on spatial models in order to maintain viable populations.
De NovoPrediction of RNA 3D Structures with Deep Learning
Authors: Ramakers Julius , Blum Christopher Frederik , König Sabrina , Harmeling Stefan , Kollmann Markus
Published: September 2021

We present a Deep Learning approach to predict 3D folding structures of RNAs from their nucleic acid sequence. Our approach combines an autoregressive Deep Generative Model, Monte Carlo Tree Search, and a Score Model to find and rank the most likely folding structures for a given RNA sequence. We confirm the predictive power of our approach by setting new benchmarks for some longer sequences in a simulated blind test of the RNA Puzzles prediction challenge.
Edible fire buffers: mitigation of wildfire with multifunctional landscapes
Authors: Fu Xiao , Lidar Abigail , Kantar Michael , Raghavan Barath
Published: September 2021

Wildfires ravage lands in seasonally-dry regions, imposing high costs on infrastructure maintenance and human habitation at the wildland-urban interface (WUI). Current fire mitigation approaches present upfront costs with uncertain long-term payoffs. Instead, we show that a simple landscape intervention on human-managed wildlands – buffers of a low-flammability crop species such as banana irrigated using recycled water – can mitigate wildfires, produce food profitably, and provide additional ecosystem services. Recreating a recent, major fire in simulation, we find that a medium-sized banana buffer decreases fireline intensity by 96%, similar to prescribed burns and mechanical thinning combined, and delays the fire by 316 minutes, enabling safe and effective firefighting. We find that under climate change, despite worsened fires, banana buffers will still have a protective effect. We also find that banana buffers with average yield could produce a profit of $56k USD/hectare through fruit sales, in addition to fire mitigation and other benefits.
Evaluating host to host transplants as a method to study plant bacterial assembly
Authors: Baldock Christopher , Wilson Neil , Deaker Rosalind
Published: September 2021

The ability to predict plant microbiome assembly will enable new bacterial-based technologies for agriculture. A major step towards this is quantifying the roles of ecological processes on community assembly. This is challenging, in part because individual plants are colonised by different communities of soil bacteria and it is difficult to estimate if the absence of a given species was a) because it was not present in the soil to colonise a given plant or b) it went locally extinct from competition, predation or similar. To minimise this uncertainty, the authors develop a mesocosm system to study bacterial communities of individual plants by replicated transplantation to a recipient host plant population, ensuring new hosts receive a homogenous species pool for colonisation. We sought to understand which factors affected the transplant and, what the main drivers of variation in the model communities were. A nested factorial design was used to investigate the transplantation of cultured or total, root or leaf associated bacterial communities from donor host species to surrogate host species. Specific metrics were developed to quantify colonisation efficiency of communities. The results show the root communities were more effectively transplanted than leaf communities, with leaf communities more susceptible to contamination. For root communities the strongest driver of beta diversity was the donor host species, and for leaves it was the surrogate host species. Overall, the results reveal that root, but not leaf communities are amenable to transplant reflecting their differing ecological drivers. This work provides the basis to develop a plant microbiome transplant system.
Immunogenicity and efficacy of Heat Inactivated Whole-Cell Vaccine to increase murine survival after Extensively drug-resistant Acinetobacter baumannii infection
Authors: Sharmin Nazmun , Khoda Mahbub E , Shamsuzzaman SM , Uddin Mohammad Nazim
Published: September 2021

Due to the rapid emergence of extensively drug-resistant (XDR) strains worldwide there is a necessity for greater consideration for the role of preventive vaccines to combat these pathogens. The study reported the effectiveness of a heat-inactivated whole-cell vaccine (HI-WCV) against A. baumannii to produce protective immunity with evaluation of the bactericidal antibody responses in mice after intramuscular inoculation with different XDR strains of A. baumannii. Six XDR A. baumannii strains emulsified with complete freund’s adjuvant (CFA) were used for intramuscular inoculation in the experimental group of mice (n=4) in three different phases on 14 days interval whereas placebo-controlled mice (n=4) received phosphate-buffered saline emulsified with CFA in same the schedule. Serum was collected from tail blood of each mouse on 10th day after each inoculation and by cardiac puncture on 14th day after lethal dose from the experimental group and after death of the placebo-controlled group. Mice inoculated with heat-inactivated whole-cell vaccine survived and showed a higher neutralizing (IgG) antibody response after 2nd (>7-fold titre) and 3rd inoculation (>12-fold titre) whereas all mice from placebo-controlled group did not survived. Sera from experimental group of mice collected (38th day) after 3rd inoculation resulted in higher serum bactericidal killing index (42.12) after three hours incubation with an XDR A. baumannii over sera collected after 1st and 2nd inoculation (50% cutoff value=14.5). These results suggest that intramuscular vaccination with heat-inactivated whole-cell vaccine stimulated IgG antibody responses that can increase murine survival after XDR A. baumannii infection.
Evaluation of patient experience for a computationally-guided intranasal spray protocol to augment therapeutic penetration
Authors: Basu Saikat , Khawaja Uzzam Ahmed , Rizvi Syed A A , Gong BoLiang , Yeung Waiman , Sanchez-Gonzalez Marcos A , Ferrer Gustavo
Published: September 2021

The global respiratory outbreak in the form of COVID-19 has underlined the necessity to devise more effective and reproducible intranasal drug delivery modalities, that would also be user-friendly for adoption compliance. In this study, we have collected evaluation feedback from a cohort of 13 healthy volunteers, who assessed two different nasal spray administration techniques, namely the vertical placement protocol (or, VP), wherein the nozzle is held vertically upright at a shallow insertion depth of 0.5 cm inside the nasal vestibule; and the shallow angle protocol (or, SA), wherein the spray axis is angled at 45° to the vertical, with a vestibular insertion depth of 1.5 cm. The SA protocol is derived from published findings on alternate spray orientations that have been shown to enhance targeted delivery at posterior infection sites, e.g., the ostiomeatal complex and the nasopharynx. All study participants reported that the SA protocol offered a more gentle and soothing delivery experience, with less impact pressure. Additionally, 60% participants opined that the VP technique caused painful irritation. We also tracked the drug transport processes for the two spray techniques in a computed tomography-based nasal reconstruction; the SA protocol marked a distinct improvement in therapeutic penetration when compared to the VP protocol.
Nanomechanical and molecular characterization of aging in dentinal collagen
Authors: Schuh Christina MAP , Leiva-Sabadini Camila , Huang Sophia , Barrera Nelson P , Bozec Laurent , Aguayo Sebastian
Published: September 2021

Methylglyoxal (MGO) is an important molecule derived from glucose metabolism with the capacity of attaching to collagen and generating advanced glycation end-products (AGEs), which accumulate in tissues over time and are associated to aging and diseases. However, the accumulation of MGO-derived AGEs in dentin and their effect on the nanomechanical properties of dentinal collagen remain unknown. Thus, the aim of the present study was to quantify MGO-based AGEs in the organic matrix of human dentin as a function of age and associate these changes with alterations in the nanomechanical and ultrastructural properties of dentinal collagen. For this, twelve healthy teeth from <26 year-old and >50 year-old patients were collected and prepared to obtain crown and root dentin discs. Following demineralization, MGO-derived AGEs were quantified with a competitive ELISA assay. In addition, atomic force microscopy (AFM) nano-indentation was utilized to measure changes in elastic modulus in both peritubular (PT) and intertubular (IT) collagen fibrils. Finally, principal component analysis (PCA) was carried out to determine aging profiles for both crown and root dentin. Results showed increased presence of MGO AGEs in the organic matrix of dentin in the >50 year-old compared to <26 year-old samples in both crown and root. Furthermore, an overall increase in PT and IT collagen elasticity was observed in the >50 year-old group associated to ultrastructural changes in the organic matrix determined by AFM analysis. Furthermore, PCA loading plots suggested different ‘aging profiles’ in both crown and root dentin, which could potentially have important therapeutic implications in restorative and adhesive dentistry approaches. Overall, these results demonstrate that the organic matrix of human dentin undergoes aging-related changes due to MGO-derived AGEs with important changes in nanomechanical behavior of collagen that may impact diagnostic and restorative procedures in the elderly.