bluuebunny/crossref_metadata_2025 huggingface dataset:
Partitioning the Universe into gravitational basins using the cosmic velocity field
Authors: Dupuy Alexandra , Courtois Helene M , Dupont Florent , Denis Florence , Graziani Romain , Copin Yannick , Pomarède Daniel , Libeskind Noam , Carlesi Edoardo , Tully Brent , Guinet Daniel
Published: August 2019

This letter presents a new approach using the cosmic peculiar velocity field to characterize the morphology and size of large-scale structures in the local Universe. The algorithm developed uses the three-dimensional peculiar velocity field to compute flow lines, or streamlines. The local Universe is then partitioned into volumes corresponding to gravitational basins, also called watersheds, among the different end points of the velocity flow lines. This new methodology is first tested on numerical cosmological simulations, used as benchmark for the method, and then applied to the Cosmic-Flows project observational data in order to pay particular attention to the nearby superclusters including ours. More extensive tests on both simulated and observational data will be discussed in an accompanying paper.
Global review of heart health claims for oat beta-glucan products
Authors: Mathews Rebecca , Kamil Alison , Chu YiFang
Published: August 2019

Coronary heart disease (CHD) is the leading cause of death globally. Consumption of whole grains and cereal fiber, as part of a healthy diet, can lower the risk of CHD. Health claims on food products are effective in helping consumers select healthful diets. The US Food and Drug Administration was the first to approve a health claim, in 1997, between beta-glucan soluble fiber from whole oats, oat bran, and whole oat flour and reduced risk of CHD. Only a few countries have approved similar claims. Since 1997, a significant amount of additional evidence has been published on the relationship between oat beta-glucan and CHD. To assist other jurisdictions in potentially utilizing this claim, the full extent of data that supports this claim (ie, the evidence utilized by the US Food and Drug Administration to substantiate the claim, as well as the results of 49 clinical trials published since 1997) are reviewed here. The complexities involved in authoring evidence-based health claims, including the impact of processing on beta-glucan cholesterol-lowering efficacy in approving eligible beta-glucan products, are also discussed.
Stereoencephalography Electrode Placement Accuracy and Utility Using a Frameless Insertion Platform Without a Rigid Cannula
Authors: D’Agostino Erin , Kanter John , Song Yinchen , Aronson Joshua P
Published: August 2019

BACKGROUND

Implantation of depth electrodes to localize epileptogenic foci in patients with drug-resistant epilepsy can be accomplished using traditional rigid frame-based, custom frameless, and robotic stereotactic systems.

OBJECTIVE

To evaluate the accuracy of electrode implantation using the FHC microTargeting platform, a custom frameless platform, without a rigid insertion cannula.

METHODS

A total of 182 depth electrodes were implanted in 13 consecutive patients who underwent stereoelectroencephalography (SEEG) for drug-resistant epilepsy using the microTargeting platform and depth electrodes without a rigid guide cannula. MATLAB was utilized to evaluate targeting accuracy. Three manual coordinate measurements with high inter-rater reliability were averaged.

RESULTS

Patients were predominantly male (77%) with average age 35.62 (SD 11.0, range 21-57) and average age of epilepsy onset at 13.4 (SD 7.2, range 3-26). A mean of 14 electrodes were implanted (range 10-18). Mean operative time was 144 min (range 104-176). Implantation of 3 out of 182 electrodes resulted in nonoperative hemorrhage (2 small subdural hematomas and one small subarachnoid hemorrhage). Putative location of onset was identified in all patients. We demonstrated a median lateral target point localization error (LTPLE) of 3.95 mm (IQR 2.18-6.23), a lateral entry point localization error (LEPLE) of 1.98 mm (IQR 1.2-2.85), a target depth error of 1.71 mm (IQR 1.03-2.33), and total target point localization error (TPLE) of 4.95 mm (IQR 2.98-6.85).

CONCLUSION

Utilization of the FHC microTargeting platform without the use of insertion cannulae is safe, effective, and accurate. Localization of seizure foci was accomplished in all patients and accuracy of depth electrode placement was satisfactory.
Chairing UK Select Committees: Walking Between Friends and Foes
Authors: Crewe Emma , Sarra Nicholas
Published: August 2019

In this article, we aim to look at the political, social and emotional world created by the UK’s House of Commons select committees and the part played by their chairs. Drawing upon the theoretical traditions of political anthropology (Spencer (2004, Anthropology, Politics and the State: Democracy and Violence in South Asia, Cambridge, Cambridge University Press)), group analytical theory (Foulkes (1948, Group Analytic Psychotherapy: Method and Principles, London, William Heinemann Medical Books)) and pragmatic philosophy (Dewey (1922, Human Nature and Conduct: An Introduction to Social Psychology, New York, NY, Henry Holt and Company)), we view the experience of individuals as relational, created in their interaction with other individuals and groups. The context is that select committees aspire to consider evidence impartially and work cohesively to hold government to account. Our focus is on the political work of the chairs of Commons’ select committees. Committee chairs, members and staff are constrained by the architecture, rules and rituals in their bid to achieve plausibility, but at the same time find the room to express individuality in the ways that they manage emotions and communicate with others through words, silence, bodily movements or facial expressions. By embodying the committee, and mediating between those involved, the work of chair involves walking between friends and enemies—forming alliances, dealing with disagreements and disciplining the unruly—to create the impression that select committees are above party politics.
Ontogenetic vertical migration of the mesopelagic carnivorous copepod Paraeuchaeta spp. is related to their increase in body mass
Authors: Yamaguchi Atsushi , Ashjian Carin J , Campbell Robert G , Abe Yoshiyuki
Published: August 2019

Two dominant mesopelagic carnivorous Paraeuchaeta copepods, Paraeuchaeta glacialis in the western Arctic Ocean and Paraeuchaeta elongata in the western subarctic Pacific, exhibited specialized ontogenetic vertical migration patterns with deeper occurrences of early copepodids (C1) and adults (C6F/M) and shallower occurrences of older copepodids C3−C5. Molt increments in body masses (wet, dry and ash-free dry masses) exhibited highly significant negative correlations with habitat depth. These facts suggest that both Paraeuchaeta species spend their reproductive (C6F/M) and early developmental (C1) stages in deeper layers to avoid predation and migrate upwards to where prey is abundant during the middle-late copepodid stages (C3−C5) to achieve greater mass growth.
Sleep Disturbance Predicts Less Improvement in Pain Outcomes: Secondary Analysis of the SPACE Randomized Clinical Trial
Authors: Koffel Erin , Kats Allyson M , Kroenke Kurt , Bair Matthew J , Gravely Amy , DeRonne Beth , Donaldson Melvin T , Goldsmith Elizabeth S , Noorbaloochi Siamak , Krebs Erin E
Published: August 2019

Objective

Sleep disturbance may limit improvement in pain outcomes if not directly addressed in treatment. Moreover, sleep problems may be exacerbated by opioid therapy. This study examined the effects of baseline sleep disturbance on improvement in pain outcomes using data from the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial, a pragmatic 12-month randomized trial of opioid vs nonopioid medication therapy.

Design

Participants with chronic back pain or hip or knee osteoarthritis pain were randomized to either opioid therapy (N = 120) or nonopioid medication therapy (N = 120).

Methods

We used mixed models for repeated measures to 1) test whether baseline sleep disturbance scores modified the effect of opioid vs nonopioid treatment on pain outcomes and 2) test baseline sleep disturbance scores as a predictor of less improvement in pain outcomes across both treatment groups.

Results

The tests for interaction of sleep disturbance by treatment group were not significant. Higher sleep disturbance scores at baseline predicted less improvement in Brief Pain Inventory (BPI) interference (β = 0.058, P = 0.0002) and BPI severity (β = 0.026, P = 0.0164).

Conclusions

Baseline sleep disturbance adversely affects pain response to treatment regardless of analgesic regimen. Recognition and treatment of sleep impairments that frequently co-occur with pain may optimize outcomes.
Treatment of resistant Raynaud’s phenomenon with single-port thoracoscopic sympathicotomy: a novel minimally invasive endoscopic technique
Authors: van Roon Anniek M , Kuijpers Michiel , van de Zande Saskia C , Abdulle Amaal Eman , van Roon Arie M , Bos Reinhard , Bouma Wobbe , Klinkenberg Theo J , Bootsma Hendrika , DeJongste Mike J L , Mariani Massimo A , Smit Andries J , Mulder Douwe J
Published: August 2019

Objective

To assess the minimally invasive single-port thoracoscopic sympathicotomy feasibility and efficacy in patients with treatment-resistant RP.

Methods

Single-port thoracoscopic sympathicotomy was performed unilaterally on the left side in eight patients with RP (six males, two females, with a median age of 45.2 years). Five patients had primary and three had secondary RP. Perfusion effects in the hands were assessed at baseline and after 1 month by using a cooling and recovery procedure, and by using laser speckle contrast analysis. Number and duration of RP attacks were reported over a 2-week period.

Results

Patient satisfaction was 100% after surgery. After surgery, a unilateral improvement in perfusion was observed in the left hand compared with the right hand, with cooling and recovery (P = 0.008) and with laser speckle contrast analysis (P = 0.023). In addition, the number and duration of the attacks in the left hand decreased compared with the right hand (both P = 0.028). No serious adverse events occurred in a follow-up period of at least 10 months.

Conclusion

Single-port thoracoscopic sympathicotomy is feasible and can be effective in improving hand perfusion in patients with RP. However, long-term efficacy needs to be established.

Clinical trial registration number

NCT02680509.
Writing in Race: Evidence against Employers’ Assumptions about Race and Soft Skills
Authors: Streib Jessi , Rochmes Jane , Arriaga Felicia , Tavares Carlos , Weed Emi
Published: August 2019

Hiring managers and segments of the American public believe that white, black, and Hispanic job-seekers present distinct soft skills to employers. Sociologists have not tested this belief and provide competing theories about whether it is likely to be true. Structural theories maintain that different resources and networks inhibit racial groups from displaying similar non-technical skills and experiences, while cultural approaches posit that all groups can access and display a variety of soft skills. Based on a content analysis of 1,124 applications that white, black, and Hispanic job-seekers used to apply for the same job, we find little evidence supporting the belief in racial distinctions in soft skills. Instead, white, black, and Hispanic applicants in our sample presented the same top reasons for applying, the same top personal characteristics, the same top college activities, and were equally likely to follow professional norms. We discuss the generalizability of our findings and their implications for theories of access to these skills.
Specific spatio-temporal dynamics of absorptive fine roots in response to neighbor species identity in a mixed beech–spruce forest
Authors: Zwetsloot Marie J , Goebel Marc , Paya Alex , Grams Thorsten E E , Bauerle Taryn L
Published: August 2019

Absorptive fine roots are an important driver of soil biogeochemical cycles. Yet, the spatio-temporal dynamics of those roots in the presence of neighboring species remain poorly understood. The aim of this study was to analyze shifts in absorptive fine-root traits in monoculture or mixtures of Fagus sylvatica [L.] and Picea abies [L.] Karst. We hypothesized that root competition would be higher under single-species than mixed-species interactions, leading to changes in (i) root survivorship, diameter and respiration and (ii) spatio-temporal patterns of root growth and death. Using minirhizotron methods, we monitored the timing and location of absorptive fine-root growth and death at an experimental forest in southern Germany from 2011 to 2013. We also measured root respiration in the spring and fall seasons of 2012 and 2013. Our findings show that the absorptive fine roots of F. sylvatica had a 50% higher risk of root mortality and higher respiration rates in the single-species compared to mixed-species zones. These results support our hypothesis that root competition is less intense for F. sylvatica in mixture versus monoculture. We were unable to find confirmation for the same hypothesis for P. abies. To analyze spatio-temporal patterns of absorptive fine-root production and mortality, we used a mixed-effects model considering root depth (space) and seasons (time) simultaneously. This analysis showed that F. sylvatica shifts root production towards shallower soil layers in mixed-species stands, besides significant seasonal fluctuations in root production depths for both species. Ultimately, the impact of neighbor species identity on root traits observed in this study has important implications for where, when and how fast root-facilitated carbon cycling takes place in single-species versus mixed-species forests. In addition, our study highlights the need for inclusion of absorptive fine-root spatio-temporal dynamics when examining belowground plant interactions and biogeochemical cycles.
The early evolution of the sabre-toothed felid killing bite: the significance of the cervical morphology of Machairodus aphanistus (Carnivora: Felidae: Machairodontinae)
Authors: Antón Mauricio , Siliceo Gema , Pastor Juan Francisco , Morales Jorge , Salesa Manuel J
Published: August 2019

The study of cervical anatomy in the Miocene machairodontine felid Machairodus aphanistus reveals the early stages of evolution of the sabre-toothed adaptations in the homotherin lineage. The cervical vertebrae of M. aphanistus show a surprising mosaic of features, combining a more primitive atlas than its derived relative Homotherium, with a set of elongated, caudal cervical vertebrae that display well-developed transverse processes with complex and strong muscle insertion areas. In spite of its primitive morphology, the atlas of M. aphanistus does show a slight caudal projection of the atlas wings, indicating an emphasis on vertical motions of the cranial portion of the neck and skull. The rest of the cervical vertebrae of M. aphanistus show clear adaptations for strength, flexibility and precise control of neck motions compatible with the canine shear-bite model and comparable to those of Homotherium. Such a powerful and flexible neck could provide additional stability to partly compensate for the risk of canine breakage created by the less specialized adaptations of the skull and cranial cervical vertebrae for the machairodontine bite.
Exploring the impact of morphology, multiple sequence alignment and choice of optimality criteria in phylogenetic inference: a case study with the Neotropical orb-weaving spider genus Wagneriana (Araneae: Araneidae)
Authors: Cabra-García Jimmy , Hormiga Gustavo
Published: August 2019

We present a total evidence phylogenetic analysis of the Neotropical orb-weaving spider genus Wagneriana and discuss the phylogenetic impacts of methodological choices. We analysed 167 phenotypic characters and nine loci scored for 115 Wagneriana and outgroups, including 46 newly sequenced species. We compared total evidence analyses and molecular-only analyses to evaluate the impact of phenotypic evidence, and we performed analyses using the programs POY, TNT, RAxML, GARLI, IQ-TREE and MrBayes to evaluate the effects of multiple sequence alignment and optimality criteria. In all analyses, Wagneriana carimagua and Wagneriana uropygialis were nested in the genera Parawixia and Alpaida, respectively, and the remaining species of Wagneriana fell into three main clades, none of which formed a pair of sister taxa. However, sister-group relationships among the main clades and their internal relationships were strongly influenced by methodological choices. Alignment methods had comparable topological effects to those of optimality criteria in terms of ‘subtree pruning and regrafting’ moves. The inclusion of phenotypic evidence, 2.80–3.05% of the total evidence matrices, increased support irrespective of the optimality criterion used. The monophyly of some groups was recovered only after the addition of morphological characters. A new araneid genus, Popperaneus gen. nov., is erected, and Paraverrucosa is resurrected. Four new synonymies and seven new combinations are proposed.
Enhancing PCR Capacity To Detect ‘Candidatus Liberibacter asiaticus’ Utilizing Whole Genome Sequence Information
Authors: Bao Minli , Zheng Zheng , Sun Xiaoan , Chen Jianchi , Deng Xiaoling
Published: August 2019

‘Candidatus Liberibacter asiaticus’ (CLas) is an unculturable α-proteobacterium associated with citrus Huanglongbing (HLB; yellow shoot disease). PCR procedures that accurately confirm or exclude CLas infection in citrus tissue/Asian citrus psyllid (ACP) samples are critical for HLB management. When CLas was described in 1994, a 23-bp signature oligonucleotide sequence (OI1) in the 16S rRNA gene (rrs, three genomic copies) was identified based on Sanger sequencing. OI1 contains single nucleotide polymorphisms (SNPs) distinguishing CLas from non-CLas species. The SNPs were used to design the primer HLBas, a key primer for a commonly used TaqMan PCR system (HLBas-PCR) for CLas detection. Recent developments in next-generation sequencing technology have led to the identification of 15 CLas whole genome sequence strains (WGSs). Analyses of CLas WGSs have generated a significant amount of biological information that could help to improve CLas detection. Utilizing the WGS information, this study re-evaluated the sequence integrity of OI1/HLBas and identified and/or confirmed a missing nucleotide G in the two primers. Replacement primers for OI1 and HLBas are proposed. At low cycle threshold (Ct) values (e.g., <30), HLBas-PCR remained reliable in CLas determination. At high Ct values (e.g., >30), HLBas-PCR alone was unreliable in differentiating whether samples contain low CLas titers or whether CLas is not present. The availability of ribonucleotide reductase (RNR)-PCR derived from the five-copy nrdB gene helped to resolve this problem. To further enhance low CLas titer detection, a 4CP-PCR system, based on a four-copy genomic locus, was developed. Evaluation of 107 HLB samples (94 citrus and 13 ACP) showed that 4CP-PCR was more sensitive than HLBas-PCR and shared similar sensitivity with RNR-PCR.
Immunoglobulin A and microbiota in primary immunodeficiency diseases
Authors: Berbers Roos-Marijn , Franken Ingrid Aukje , Leavis Helen Louisa
Published: August 2019

Purpose of review

With the emergence of the microbiota as a potential driver of host inflammation, the role of iIgA is becoming increasingly important. This review discusses the current evidence regarding the effects of clinical IgA deficiency on the microbiota, and the possible role of microbial dysbiosis in driving inflammation in PID patients.

Recent findings

The gut microbiota has been investigated in selective IgA deficiency and common variable immunodeficiency, revealing an important role for IgA in maintaining gut microbiota homeostasis, with disparate effects of IgA on symbionts and pathobionts. Although IgA deficiency is associated with microbial translocation and systemic inflammation, this may be partially compensated by adequate IgG and IgM induction in IgA deficiency but not in common variable immunodeficiency. Therapeutic strategies aimed at correction of the microbiota mostly focus on fecal microbiota transplantation. Whether this may reduce systemic inflammation in PID is currently unknown.

Clinical IgA deficiency is associated with microbial dysbiosis and systemic inflammation. The evidence for microbiota-targeted therapies in PID is scarce, but indicates that IgA-based therapies may be beneficial, and that fecal microbiota transplantation is well tolerated in patients with antibody deficiency.
Indications, contraindications, and safety aspects of procedural sedation
Authors: van Haperen Maartje , Preckel Benedikt , Eberl Susanne
Published: August 2019

Purpose of review

There is a steadily increasing demand for procedural sedation outside the operating room, frequently performed in comorbid high-risk adult patients. This review evaluates the feasibility and advantages of sedation vs. general anesthesia for some of these new procedures.

Recent findings

Generally, sedation performed by experienced staff is safe. Although for some endoscopic or transcatheter interventions sedation is feasible, results of the intervention might be improved when performed under general anesthesia. For elected procedures like intra-arterial treatment after acute ischemic stroke, avoiding general anesthesia and sedation at all might be the optimal treatment.

Anesthesiologists are facing continuously new indications for procedural sedation in sometimes sophisticated diagnostic or therapeutic procedures. Timely availability of anesthesia staff will mainly influence who is performing sedation, anesthesia or nonanesthesia personal. While the number of absolute contraindications for sedation decreased to almost zero, relative contraindications are becoming more relevant and should be tailored to the individual procedure and patient.
Gastrointestinal involvement in systemic sclerosis: an update
Authors: McMahan Zsuzsanna H.
Published: August 2019

Purpose of review

This review provides important updates in systemic sclerosis (SSc)-related gastrointestinal disease, specifically focusing on the most recent literature.

Recent findings

In the past year, several studies were published that present interesting insights into SSc and gastrointestinal disease. Studies focusing on newly identified risk factors, novel approaches to diagnosis and assessment of disease activity, survival and quality of life demonstrate progress in our understanding of this challenging area. Additional data on specific SSc gastrointestinal-related topics, such as the link between gastrointestinal and pulmonary disease, nutrition, and the microbiome, are also now available.

SSc gastrointestinal disease is heterogeneous in its clinical presentation, which presents a challenge in diagnosis and management. In the past year, several studies have evaluated risk factors and clinical features associated with specific gastrointestinal complications in SSc. Objective gastrointestinal testing may help to identify specific SSc gastrointestinal subgroups and provide diagnostic accuracy to guide targeted therapies. Survival in very early SSc is affected by the severity of gastrointestinal involvement. Other important gastrointestinal subsets, including patients with esophageal disease and interstitial lung disease, should carefully be considered when developing a management plan for this patient population.
End-of-Life Decision-Making for ICU Patients With Limited English Proficiency: A Qualitative Study of Healthcare Team Insights
Authors: Barwise Amelia K. , Nyquist Christina A. , Espinoza Suarez Nataly R. , Jaramillo Carolina , Thorsteinsdottir Bjorg , Gajic Ognjen , Wilson Michael E.
Published: August 2019

Objectives:

Research indicates that the increasing population of over 25 million people in the United States who have limited English proficiency experience differences in decision-making and subsequent care at end of life in the ICU when compared with the general population. The objective of this study was to assess the perceptions of healthcare team members about the factors that influence discussions and decision-making about end of life for patients and family members with limited English proficiency in the ICU.

Design:

Qualitative study using semistructured interviews with ICU physicians, nurses, and interpreters.

Setting:

Three ICUs at Mayo Clinic Rochester.

Subjects:

Sixteen ICU physicians, 12 ICU nurses, and 12 interpreters.

Intervention:

None.

Measurements and Main Results:

We conducted 40 semistructured interviews. We identified six key differences in end-of-life decision-making for patients with limited English proficiency compared with patients without limited English proficiency: 1) clinician communication is modified and less frequent; 2) clinician ability to assess patient and family understanding is impaired; 3) relationship building is impaired; 4) patient and family understanding of decision-making concepts (e.g., palliative care) is impaired; 5) treatment limitations are often perceived to be unacceptable due to faith-based and cultural beliefs; and 6) patient and family decision-making styles are different. Facilitators of high-quality decision-making in patients with limited English proficiency included: 1) premeeting between clinician and interpreter; 2) interpretation that communicates empathy and caring; 3) bidirectional communication of cultural perspectives; 4) interpretation that improves messaging including appropriate word choice; and 5) clinician cultural humility.

Conclusions:

End-of-life decision-making is significantly different for ICU patients with limited English proficiency. Participants identified several barriers and facilitators to high-quality end-of-life decision-making for ICU patients and families with limited English proficiency. Awareness of these factors can facilitate interventions to improve high-quality, compassionate, and culturally sensitive decision-making for patients and families with limited English proficiency.
Δ9-Tetrahydrocannabinol and Cannabidiol Time Courses in the Sera of “Light Cannabis” Smokers: Discriminating Light Cannabis Use from Illegal and Medical Cannabis Use
Authors: Pichini Simona , Mannocchi Giulio , Berretta Paolo , Zaami Simona , Pirani Filippo , Pacifici Roberta , Busardò Francesco P.
Published: August 2019

Background:

Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) time courses in serum and physiological and behavioral effects associated with smoking 1 or 4 “light cannabis” cigarettes were studied. Biomarkers to differentiate light cannabis versus illegal and medical cannabis use were also investigated.

Methods:

Sera were obtained at different times from 6 healthy light cannabis consumers and 6 individuals who smoked 1 and 4 cigarettes, within 4 hours through a liquid–liquid method and analyzed by liquid chromatography–tandem mass spectrometry.

Results:

In serum, minimal THC concentration was observed after a single cigarette smoke, while repeated smoking increased it by 1 order of magnitude. CBD concentrations were higher, but did not increase linearly, probably because it does not preferentially volatilize compared with THC. The highest THC and CBD concentrations were observed 0.5 hours after the start of the smoking of 1 cigarette. Serum THC ranged from 2.7 to 5.9 ng/mL, while serum CBD varied from 5.7 to 48.2 ng/mL. Similarly, the highest THC and CBD concentrations were observed 0.5 hours after the smoking of 4 cigarettes. Specifically, the ranges were THC: 11.0–21.8 ng/mL and CBD: 19.4–35.3 ng/mL. In both cases, the mean THC/CBD concentration ratio ranged from 0.2 to 0.9. There were no significant changes in blood pressure, heart rate, and body temperature, but participants who smoked 4 cigarettes experienced severe drowsiness.

Conclusions:

THC and CBD time courses in the sera of light cannabis smokers were similar to those previously observed in oral fluid and blood. Serum THC/CBD concentration ratio not higher than the mean value of 0.9 might be a useful biomarker to identify use of light cannabis versus that of illegal THC cannabis (where THC/CBD concentration ratios are generally greater than 10) or versus that of medical cannabis (where ratios are greater than 1). Consumers should be advised of possible drowsiness after he repeated smoking of light cannabis cigarettes.
Improving outcomes through care coordination: Measuring care coordination of nurse practitioners
Authors: Ruggiero Kristine , Pratt Patricia , Antonelli Richard
Published: August 2019

Background:

Gaps in care coordination (CC) between inpatient and outpatient settings for children with medical complexity (CMC) can result in treatment delays, gaps in communication, missed appointments, medication discrepancies, and ultimately impacts the provision of quality care.

Local problem:

As care for pediatric patients with medical complexity moves into community settings, various ambulatory settings, including infusion settings, are caring for patients who would otherwise often require inpatient hospitalization to receive their care. To better accommodate this growing demand, nurse practitioners (NPs) have been used to support these nurse-led infusion programs. The purpose of this quality improvement (QI) project was to quantify and describe the outcomes of CC by NPs in this ambulatory setting.

Methods:

A quantitative design was used.

Interventions:

We captured nonreimbursable CC activities provided by NPs and associated outcome(s) among pediatric patients seen in two ambulatory infusion clinics, at Boston Children's Hospital between January and April 2017, and generated summary statistics for this QI project.

Results:

There were 259 nonreimbursable CC encounters. Most of the CC activities prevented delays in treatment (38%), adverse reaction to medicine because of medication discrepancies (8%), need for additional subspecialist visits (10%), missed infusion appointments (5%), and emergency department visits (2%).

Conclusion:

Nonreimbursable CC provided by NPs in a tertiary hospital-based ambulatory program improved outcomes of care for CMC and helped facilitate health care use. This project quantified and described the outcomes of CC provided by NPs, and the value of CC on CMC.
Stress and a sedentary lifestyle are associated with irritable bowel syndrome in medical students from Peru: a cross-sectional study
Authors: Vasquez-Rios George , Machicado Jorge D. , Ticse Ray , Ruiz Eloy F. , Gamero Maria T. , Pezua Adriana , Marcos Luis A. , Tagle Martin
Published: August 2019

Background

Previous studies suggest that medical students may have higher rates of irritable bowel syndrome as compared to the general population. We hypothesized lifestyle characteristics may be associated to irritable bowel syndrome.

Methods

A cross-sectional survey was conducted in 2015 among students in their fourth, fifth, sixth and seven years of a medical school in Peru. Volunteer participants responded to questions pertaining to demographics, surveys including the Rome III criteria and the Self-reported Stress questionnaire. Regression models were performed to establish variables independently associated with irritable bowel syndrome.

Results

Out of 452 students, 346 responded the survey (response rate: 76.5%; female rate: 47%; median age: 22 years). The irritable bowel syndrome prevalence in respondents was 9.5% (95% confidence interval: 6.7%–13.1%). On univariate analysis, being a senior medical student (odds ratio: 2.8; 95% confidence interval: 1.3–5.9; P < 0.01), mental illness (odds ratio: 3.3; 95% confidence interval: 1.6–6.8; P = 0.002), psychiatric medication use (odds ratio: 2.8; 95% confidence interval: 1.4–5.9; P = 0.005), sedentary lifestyle (odds ratio: 4.4; 95% confidence interval: 1.8–11; P = 0.001) and stress (odds ratio: 4.4; 95% confidence interval: 2.1–9.3; P < 0.001) were associated to irritable bowel syndrome. On a multivariate analysis, a sedentary lifestyle (odds ratio: 3.2; 95% confidence interval: 1.25–8.20; P = 0.01) and stress (odds ratio: 3.0; 95% confidence interval: 1.35–6.67; P < 0.01) were independently associated with irritable bowel syndrome.

Conclusion

The prevalence of irritable bowel syndrome in medical students from Peru is slightly lower compared to the global prevalence of irritable bowel syndrome. Stress and a sedentary lifestyle were independent risk factors associated with irritable bowel syndrome. Our study suggests that lifestyle modifications and stress coping techniques could have an impact to reduce the rates of irritable bowel syndrome in medical students.
Paediatric traumatic brain injury
Authors: Coulter Ian C. , Forsyth Rob J.
Published: August 2019

Purpose of review

To provide a summary of recent developments in the field of paediatric traumatic brain injury (TBI).

Recent findings

The epidemiology of paediatric TBI with falling rates of severe TBI, and increasing presentations of apparently minor TBI. There is growing interest in the pathophysiology and outcomes of concussion in children, and detection of ‘significant’ injury, arising from concern about risks of long-term chronic traumatic encephalopathy. The role of decompressive craniectomy in children is still clarifying.

Paediatric TBI remains a major public health issue.
The health literacy of hospitalized trauma patients: We should be screening for deficiencies
Authors: Weinberg Jordan A. , Shehada Mahmoud Z. , Chapple Kristina M. , Israr Sharjeel , Jones Michael D. , Jacobs Jordan V. , Bogert James N.
Published: August 2019

BACKGROUND

Although the impact of health literacy (HL) on trauma patient outcomes remains unclear, recent studies have demonstrated that trauma patients with deficient HL have poor understanding of their injuries, are less likely to comply with follow-up, and are relatively less satisfied with physician communication. In this study, we sought to determine if HL deficiency was associated with comprehension of discharge instructions.

METHODS

In this prospective study, hospitalized trauma patients underwent evaluation of HL prior to discharge. Newest Vital Sign (NVS) instrument was used to score HL as deficient, marginal, or proficient. Three days postdischarge, patients were telephonically administered a six-point scored questionnaire regarding comprehension of discharge instructions. A general linear model was used to determine the association between HL and comprehension of discharge instructions.

RESULTS

Sixty-three patients were administered both NVS and discharge instruction questionnaire. Ten (15.9%) patients scored as deficient in HL on the NVS screen, 16 (25.4%) as marginally proficient, and 37 (58.7%) as proficient. The HL proficiency significantly predicted follow-up score with increasing proficiency associated with higher scores on the discharge comprehension assessment (p < 0.001). Adjusted mean scores (± SE) for deficient, marginal, and proficient patients were 2.8 ± 0.5, 3.2 ± 0.4, and 4.7 ± 0.2. Post hoc comparisons demonstrated significant differences between proficient with marginal proficiency (p = 0.002) and deficient proficiency (p = 0.001).

CONCLUSION

Performance on bedside test of HL among trauma inpatients predicted ability to comprehend instructions following hospital discharge. This study supports the value of HL screening prior to discharge. The HL-deficient patients may benefit from a transitional care program to improve comprehension of discharge instructions after leaving the hospital.

LEVEL OF EVIDENCE

Therapeutic/Care Management, level III.
End-tidal carbon dioxide underestimates plasma carbon dioxide during emergent trauma laparotomy leading to hypoventilation and misguided resuscitation: A Western Trauma Association Multicenter Study
Authors: Campion Eric M. , Robinson Caitlin K. , Brant Nicholson , Ferrigno Lisa , McIntyre Robert , Biesterveld Ben , Alam Hasan , Callcut Rachael , Mishra Somya , Platt Blake , Moore Margaret M. , Nahmias Jeffry , Grigorian Areg , Dance Sarah , Britton Linda , Schroeppel Thomas , Rodriquez Jennifer , Shatz David , Becker James , Spalding M. Chance , Wolff Timothy W. , Privette Alicia R. , Eriksson Evert , Sahi Saad Liaqat , Patel Anish , Moore Scott M. , Stiles Anquonette L. , Moore Ernest E. , Cohen Mitchell J. , Sauaia Angela , Burlew Clay Cothren , Urban Shane , Osi Udekwu Pascal , Nguyen Megan , Dibbert Ashley , Conroy Amanda , Ross Erin , Nunez Garcia Brenda , Albertson Spencer , Dunn Julie , Alnachaoukati Omar , Stillman Zachery , Decker Cassandra , Heise Holly , Burton Josh S.
Published: August 2019

BACKGROUND

End-tidal carbon dioxide (ETCO2) is routinely used during elective surgery to monitor ventilation. The role of ETCO2 monitoring in emergent trauma operations is poorly understood. We hypothesized that ETCO2 values underestimate plasma carbon dioxide (pCO2) values during resuscitation for hemorrhagic shock.

METHODS

Multicenter trial was performed analyzing the correlation between ETCO2 and pCO2 levels.

RESULTS

Two hundred fifty-six patients resulted in 587 matched pairs of ETCO2 and pCO2. Correlation between these two values was very poor with an R
2 of 0.04. 40.2% of patients presented to the operating room acidotic and hypercarbic with a pH less than 7.30 and a pCO2 greater than 45 mm Hg. Correlation was worse in patients that were either acidotic or hypercarbic. Forty-five percent of patients have a difference greater than 10 mm Hg between ETCO2 and pCO2. A pH less than 7.30 was predictive of an ETCO2 to pCO2 difference greater than 10 mm Hg. A difference greater than 10 mm Hg was predictive of mortality independent of confounders.

CONCLUSION

Nearly one half (45%) of patients were found to have an ETCO2 level greater than 10 mm Hg discordant from their PCO2 level. Reliance on the discordant values may have contributed to the 40% of patients in the operating room that were both acidotic and hypercarbic. Early blood gas analysis is warranted, and a lower early goal of ETCO2 should be considered.

LEVEL OF EVIDENCE

Therapeutic, level IV.
A novel protocol to maintain continuous access to thawed plasma at a rural trauma center
Authors: Hannigan Cara , Ologun Gabriel , Trecartin Andrew , Colom Lauren , Bloomdahl Ry , Seyer Amanda , LaRock Lisa , Tubby Barbara , Cagir Burt , Granet Jason , Behm Robert
Published: August 2019

BACKGROUND

Early administration of plasma improves mortality in massively transfused patients, but the thawing process causes delay. Small rural centers have been reluctant to maintain thawed plasma due to waste concerns. Our 254-bed rural Level II trauma center initiated a protocol allowing continuous access to thawed plasma, and we hypothesized its implementation would not increase waste or cost.

METHODS

Two units of thawed plasma are continuously maintained in the trauma bay blood refrigerator. After 3 days, these units are replaced with freshly thawed plasma and returned to the blood bank for utilization prior to their 5-day expiration date. The blood bank monitors and rotates the plasma. Only trauma surgeons can use the plasma stored in the trauma bay. Wasted units and cost were measured over a 12-month period and compared with the previous 2 years.

RESULTS

The blood bank thawed 1127 units of plasma during the study period assigning 274 to the trauma bay. When compared with previous years, we found a significant increase in waste (p < 0.001) and cost (p = 0.020) after implementing our protocol. It cost approximately US $125/month extra to maintain continuous access to thawed plasma during the study period.

DISCUSSION

A protocol to maintain thawed plasma in the trauma bay at a rural Level II trauma center resulted in a miniscule increase in waste and cost when considering the scope of maintaining a trauma center. We think this cost is also minimal when compared with the value of having immediate access to thawed plasma. Constant availability of thawed plasma can be offered at smaller rural centers without a meaningful impact on cost.

LEVEL OF EVIDENCE

Economic and Value-based Evaluations, Level III.
De novo genome assembly of the meadow brown butterfly, Maniola jurtina
Authors: Singh Kumar Saurabh , Hosken David J. , Wedell Nina , ffrench-Constant Richard , Bass Chris , Baxter Simon , Paszkiewicz Konrad , Sharma Manmohan D
Published: August 2019

Background

Meadow brown butterflies (Maniola jurtina) on the Isles of Scilly represent an ideal model in which to dissect the links between genotype, phenotype and long-term patterns of selection in the wild - a largely unfulfilled but fundamental aim of modern biology. To meet this aim, a clear description of genotype is required.

Findings

Here we present the draft genome sequence of M. jurtina to serve as an initial genetic resource for this species. Seven libraries were constructed using DNA from multiple wild caught females and sequenced using Illumina, PacBio RSII and MinION technology. A novel hybrid assembly approach was employed to generate a final assembly with an N50 of 214 kb (longest scaffold 2.9 Mb). The genome encodes a total of 36,294 genes. 90.3% and 88.7% of core BUSCO (Benchmarking Universal Single-Copy Orthologs) Arthropoda and Insecta gene sets were recovered as complete single-copies from this assembly. Comparisons with 17 other Lepidopteran species placed 86.5% of the assembled genes in orthogroups.

Conclusions

Our results provide the first high-quality draft genome and annotation of the butterfly M. jurtina.
Attentional Networks during the Menstrual Cycle
Authors: Cohen Zahira Z. , Gotlieb Neta , Erez Offer , Wiznitzer Arnon , Arbel Oded , Matas Devorah , Koren Lee , Henik Avishai
Published: August 2019

The menstrual cycle is characterized partially by fluctuations of the ovarian hormones estradiol (E2) and progesterone (P4), which are implicated in the regulation of cognition. Research on attention in the different stages of the menstrual cycle is sparse, and the three attentional networks (alerting, orienting and executive) and their interaction were not explored during the menstrual cycle. In the current study, we used the ANT-I (attentional network test – interactions) to examine two groups of women: naturally cycling (NC) – those with a regular menstrual cycle, and oral contraceptives (OC) – those using OC and characterized with low and steady ovarian hormone levels. We tested their performance at two time points that fit, in natural cycles, the early follicular phase and the early luteal phase. We found no differences in performance between NC and OC in low ovarian hormone states (Both phases for the OC group and early follicular phase for the NC group). However, the NC group in the early luteal phase exhibited the same pattern of responses for alerting and no-alerting conditions, resulting in a better conflict resolution (executive) when attention is oriented to the target. Results-driven exploratory regression analysis of E2 and P4 suggested that change in P4 from early follicular to early luteal phases was a mediator for the alerting effect found. In conclusion, the alerting state found with or without alertness manipulation suggests that there is a progesterone mediated activation of the alerting system during the mid-luteal phase.
Structure of the host cell recognition and penetration machinery of a Staphylococcus aureus bacteriophage
Authors: Kizziah James L. , Manning Keith A. , Dearborn Altaira D. , Dokland Terje
Published: August 2019

Staphylococcus aureus is a common cause of infections in humans. The emergence of virulent, antibiotic-resistant strains of S. aureus is a significant public health concern. Most virulence and resistance factors in S. aureus are encoded by mobile genetic elements, and transduction by bacteriophages represents the main mechanism for horizontal gene transfer. The baseplate is a specialized structure at the tip of bacteriophage tails that plays key roles in host recognition, cell wall penetration, and DNA ejection. We have used high-resolution cryo-electron microscopy to determine the structure of the S. aureus bacteriophage 80α baseplate at 3.7 Å resolution, allowing atomic models to be built for most of the major tail and baseplate proteins, including two tail fibers, a trimeric receptor binding protein, and part of the tape measure protein. Our structure provides a structural basis for understanding host recognition, cell wall penetration and DNA ejection in viruses infecting Gram-positive bacteria. Comparison to other phages demonstrate the modular design of baseplate proteins, and the adaptations to the host that take place during the evolution of staphylococci and other pathogens.
Effects of pathogenic CNVs on biochemical markers: a study on the UK Biobank
Authors: Bracher-Smith Matthew , Kendall Kimberley M , Rees Elliott , Einon Mark , O’Donovan Michael C , Owen Michael J , Kirov George
Published: August 2019

Background

Pathogenic copy number variants (CNVs) increase risk for medical disorders, even among carriers free from neurodevelopmental disorders. The UK Biobank recruited half a million adults who provided samples for biochemical and haematology tests which have recently been released. We wanted to assess how the presence of pathogenic CNVs affects these biochemical test results.

Methods

We called all CNVs from the Affymetrix microarrays and selected a set of 54 CNVs implicated as pathogenic (including their reciprocal deletions/duplications) and present in five or more persons. We used linear regression analysis to establish their association with 28 biochemical and 23 haematology tests.

Results

We analysed 421k participants who passed our CNV quality control filters and self-reported as white British or Irish descent. There were 268 associations between CNVs and biomarkers that were significant at a false discovery rate of 0.05. Deletions at 16p11.2 had the highest number of significant associations, but several rare CNVs had higher effect sizes indicating that the lack of significance was likely due to the reduced statistical power for rarer events. The distribution of values can be visualised on our interactive website:http://kirov.psycm.cf.ac.uk/.

Conclusions

Carriers of many pathogenic CNVs have changes in biochemical and haematology tests, and many of those are associated with adverse health consequences. These changes did not always correlate with increases in diagnosed medical disorders in this population. Carriers should have regular blood tests in order to identify and treat adverse medical consequences early. Levels of cholesterol and related lipids were unexpectedly lower in carriers of CNVs associated with increased weight gain, most likely due to the use of statins by such people.
Light-entrained and brain-tuned circadian circuits regulate ILC3 and gut homeostasis
Authors: Godinho-Silva Cristina , Domingues Rita G. , Rendas Miguel , Raposo Bruno , Ribeiro Hélder , da Silva Joaquim Alves , Vieira Ana , Costa Rui M. , Barbosa-Morais Nuno L. , Carvalho Tânia , Veiga-Fernandes Henrique
Published: August 2019

Group 3 innate lymphoid cells (ILC3) are major regulators of inflammation, infection, microbiota composition and metabolism1. ILC3 and neuronal cells were shown to interact at discrete mucosal locations to steer mucosal defence2,3. Nevertheless, whether neuroimmune circuits operate at an organismal level, integrating extrinsic environmental signals to orchestrate ILC3 responses remains elusive. Here we show that light-entrained and brain-tuned circadian circuits regulate enteric ILC3, intestinal homeostasis, gut defence and the host lipid metabolism. We found that enteric ILC3 display circadian expression of clock genes and ILC3-related transcription factors. ILC3-autonomous ablation of the circadian regulatorArntlled to disrupted gut ILC3 homeostasis, impaired epithelial reactivity, deregulated microbiome, increased susceptibility to bowel infection and disrupted lipid metabolism. Loss of ILC3-intrinsicArntlshaped the gut postcode receptors of ILC3. Strikingly, light-dark cycles, feeding rhythms and microbial cues differentially regulated ILC3 clocks, with light signals as major entraining cues of ILC3. Accordingly, surgical- and genetically-induced deregulation of brain rhythmicity led to disrupted circadian ILC3 oscillations, deregulated microbiome and altered lipid metabolism. Our work reveals a circadian circuitry that translates environmental light cues into enteric ILC3, shaping intestinal health, metabolism and organismal homeostasis.