bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Bacillus subtilis C-3102 on sow and progeny performance, fecal consistency, and fecal microbes during gestation, lactation, and nursery periods1,2
Authors: Menegat Mariana B , DeRouchey Joel M , Woodworth Jason C , Dritz Steve S , Tokach Mike D , Goodband Robert D
Published: July 2019

This study evaluated the effects of providing a dietary probiotic, Bacillus subtilis C-3102, to sows during gestation and lactation and to progeny after weaning on performance, fecal consistency, and fecal microbes. For the sow portion of the study, 29 sows and litters were used from day 30 of gestation until weaning. Sow treatments consisted of control diet or probiotic diet with B. subtilis C-3102 at 500,000 cfu/g of gestation feed and 1,000,000 cfu/g of lactation feed. For the nursery portion of the study, 358 weaned pigs, progeny of sows on study, were used in a 42-d nursery study. Nursery treatments consisted of control diet or probiotic diet with B. subtilis C-3102 and prebiotics at 500,000 cfu/g of nursery feed. Treatments were arranged in a split-plot design with sow treatment (control or probiotic diet) as main plot and nursery treatment (control or probiotic diet) as subplot. Performance, fecal consistency by fecal score method, and fecal microbes by isolation and enumeration method were assessed. In lactation, probiotic-fed sows tended (P = 0.057) to have increased feed intake, but it did not improve (P > 0.05) sow or litter performance in lactation. In the nursery, there were no (P > 0.10) interactions or main effects of sow or nursery treatments on overall growth performance. However, pigs born from control-fed sows had greater (P < 0.05) average daily gain, average daily feed intake, and body weight in late nursery than pigs born from probiotic-fed sows. Fecal score evaluation of nursing and nursery pigs indicated no influence (P > 0.05) of sow or nursery treatments on fecal consistency. Fecal microbial analysis revealed a modest modification in fecal microbial population by increasing (P < 0.05) the number of total Bacillus sp. in probiotic-fed sows and nursery pigs. Nursing piglets born from probiotic-fed sows carried over (P < 0.05) this modification in fecal microbial population preweaning. In conclusion, providing a probiotic based on B. subtilis C-3102 to sows during gestation and lactation and to progeny after weaning did not elicit noteworthy improvements in performance or fecal consistency, but there was a benefit on sow lactation feed intake. Fecal microbial analysis indicated a maternal-progeny intestinal microbiota relationship with pigs born from probiotic-fed sows displaying similar fecal microbial population as sows. However, pigs born from probiotic-fed sows demonstrated reduced growth rate and feed consumption in late nursery.
Impact of dietary zinc:copper ratio on the postprandial net portal appearance of these minerals in pigs1
Authors: Dalto Danyel Bueno , Audet Isabelle , Matte J Jacques
Published: July 2019

The present study compared the net intestinal absorption of zinc (Zn) and copper (Cu) after meals containing different dietary ratios among these trace elements. Ten 46-kg pigs were used in a cross-over design to assess the 10-h net portal-drained viscera (PDV) flux of serum Cu and Zn after ingestion of boluses containing ZnSO4 and CuSO4 in different Zn:Cu ratios (mg:mg): 120:20; 200:20; 120:8; and 200:8. Arterial Zn concentrations peaked within the first hour post-meal and responses were greater with 200 (0.9 to 1.8 mg/L) than with 120 mg (0.9 to 1.6 mg/L) of dietary Zn (dietary Zn × time, P = 0.05). Net PDV flux of Zn was greater (P = 0.02) with 200 than with 120 mg of dietary Zn and tended to be greater (P = 0.10) with 20 than with 8 mg of dietary Cu. The cumulative PDV appearance of Zn (% of dietary intake) was greater with 120 than 200 mg of dietary Zn from 8 h post-meal (P ≤ 0.04) and with 20 than 8 mg of dietary Cu from 7 h post-meal (P ≤ 0.05). At the end of the postprandial period (10 h), estimated PDV appearance of Zn was 16.0%, 18.4%, 12.0%, and 15.3% of Zn intake for 120:8, 120:20, 200:8, and 200:20 ratios, respectively. For Cu, irrespective of treatment, arterial values varied (P < 0.01) by less than 5% across postmeal times. Net PDV flux was not affected by treatments (P ≥ 0.12), but the value for ratio 120:20 was different from zero (P = 0.03). There was an interaction dietary Zn × dietary Cu on cumulative PDV appearance of Cu (% of dietary intake) at 30 min post-meal (P = 0.04) and thereafter at 3 h post-meal (P = 0.04). For the whole postprandial period (10 h), estimated PDV appearance of Cu was 61.9%, 42.1%, −17.1%, and 23.6% of Cu intake for 120:8, 120:20, 200:8, and 200:20 ratios, respectively. In conclusion, the present dietary amounts and ratios of Zn and Cu can affect the metabolic availability of both trace minerals for pigs. Ratios with 120 mg of dietary Zn maximized the postintestinal availability of both Zn and Cu.
The Influence of Obesity on Treatment and Outcome of Severely Burned Patients
Authors: Tapking Christian , Houschyar Khosrow S , Rontoyanni Victoria G , Hundeshagen Gabriel , Kowalewski Karl-Friedrich , Hirche Christoph , Popp Daniel , Wolf Steven E , Herndon David N , Branski Ludwik K
Published: July 2019

Obesity and the related medical, social, and economic impacts are relevant multifactorial and chronic conditions that also have a meaningful impact on outcomes following a severe injury, including burns. In addition to burn-specific difficulties, such as adequate hypermetabolic response, fluid resuscitation, and early wound coverage, obese patients also present with common comorbidities, such as arterial hypertension, diabetes mellitus, or nonalcoholic fatty liver disease. In addition, the pathophysiologic response to severe burns can be enhanced. Besides the increased morbidity and mortality compared to burn patients with normal weight, obese patients present a challenge in fluid resuscitation, perioperative management, and difficulties in wound healing. The present work is an in-depth review of the current understanding of the influence of obesity on the management and outcome of severe burns.
On-animal acoustic monitoring provides insight to ungulate foraging behavior
Authors: Northrup Joseph M , Avrin Alexandra , Anderson Charles R , Brown Emma , Wittemyer George
Published: July 2019

Foraging behavior underpins many ecological processes; however, robust assessments of this behavior for free-ranging animals are rare due to limitations to direct observations. We leveraged acoustic monitoring and GPS tracking to assess the factors influencing foraging behavior of mule deer (Odocoileus hemionus). We deployed custom-built acoustic collars with GPS radiocollars on mule deer to measure location-specific foraging. We quantified individual bites and steps taken by deer, and quantified two metrics of foraging behavior: the number of bites taken per step and the number of bites taken per unit time, which relate to foraging intensity and efficiency. We fit statistical models to these metrics to examine the individual, environmental, and anthropogenic factors influencing foraging. Deer in poorer body condition took more bites per step and per minute and foraged for longer irrespective of landscape properties. Other patterns varied seasonally with major changes in deer condition. In December, when deer were in better condition, they took fewer bites per step and more bites per minute. Deer also foraged more intensely and efficiently in areas of greater forage availability and greater movement costs. During March, when deer were in poorer condition, foraging was not influenced by landscape features. Anthropogenic factors weakly structured foraging behavior in December with no relationship in March. Most research on animal foraging is interpreted under the framework of optimal foraging theory. Departures from predictions developed under this framework provide insight to unrecognized factors influencing the evolution of foraging. Our results only conformed to our predictions when deer were in better condition and ecological conditions were declining, suggesting foraging strategies were state-dependent. These results advance our understanding of foraging patterns in wild animals and highlight novel observational approaches for studying animal behavior.
Arrested development? Investigating the role of bamboo in Araucaria Forest succession in Southern Brazil
Authors: Kellermann Betina , Lacerda André Eduardo Biscaia
Published: July 2019

Aims

Assessing the role of a dominant native bamboo species on tree species diversity and structure in the medium term.

Methods

Over a 7-year period, we studied the natural regeneration of two dominant forest types in Southern Brazil (Araucaria Forest or AF; Bamboo Forest or BF) after a bamboo (Merostachys skvortzovii Send.) die-off between 2004 and 2006. The study was carried out in the Embrapa Research Station in Caçador, Santa Catarina State, Brazil.

Important Findings

The die-off provided ideal conditions for the establishment of several species and it kickstarted forest succession dynamics, which in turn affected regeneration diversity. Tree species richness was relatively stable with a transitory increase between 2007 and 2014 in both AF and BF. However, species richness rose in BF because of a relative increase in abundance of some species (especially late and secondary species) while a plunge in some pioneer species drove an increase in diversity. Overall, we found that BF has a lower diversity of recruits and that density declined over time, while AF is more diverse, with a more stable density. In BF, the bamboo die-off created optimal conditions for initial regeneration development (mainly fast-growing pioneer trees), which quickly transited to higher size classes. Yet, after this initial stage of pioneer recruitment, the number of recruits dropped followed by a virtual absence of growth regardless of the species group as a result of a quick bamboo reestablishment. As bamboo recreated a dense understory it reduced species diversity to original levels, suggesting a self-maintaining cycle that halts forest succession. On the other hand, the bamboo die-off had little impact on AF where a slow recruitment process typical of old-growth forests was observed. The results indicate that the die-off event had a temporary effect on species diversity i.e. restricted to forests where bamboos are dominant in a similar process described in other southern South American forests. As the first study to observe the medium-term forest dynamics related to bamboo die-off, we can conclude that when being dominant, native bamboos can hinder forest regeneration, maintaining lower levels of diversity and arresting forest succession that lasts well beyond the short-term, post-die-off effects. Many forest fragments in the region are dominated by bamboos, thus their potential for conservation is at risk and requires appropriate management.
Evidence of a fast bar in the weakly-interacting galaxy NGC 4264 with MUSE
Authors: Cuomo V , Corsini E M , Aguerri J A L , Debattista V P , Coccato L , Costantin L , Dalla Bontà E , Iodice E , Méndez-Abreu J , Morelli L , Pagotto I , Pizzella A
Published: July 2019

We present surface photometry and stellar kinematics of NGC 4264, a barred lenticular galaxy in the region of the Virgo Cluster undergoing a tidal interaction with one of its neighbours, NGC 4261. We measured the bar radius (abar = 3.2 ± 0.5 kpc) and strength (Sbar = 0.31 ± 0.04) of NGC 4264 from Sloan Digital Sky Survey imaging and its bar pattern speed (Ωbar = 71 ± 4 km s−1 kpc−1) using the Tremaine–Weinberg method with stellar-absorption integral-field spectroscopy performed with the Multi Unit Spectroscopic Explorer at the Very Large Telescope. We derived the circular velocity (Vcirc = 189 ± 10 km s−1) by correcting the stellar streaming velocity for asymmetric drift and calculated the corotation radius (Rcor = 2.8 ± 0.2 kpc) from the bar pattern speed. Finally, we estimated the bar rotation rate (Rcor/abar = 0.88 ± 0.23). We find that NGC 4264 hosts a strong and large bar extending out to the corotation radius. This means that the bar is rotating as fast as it can like nearly all the other bars measured so far even when the systematic error due to the uncertainty on the disc position angle is taken into account. The accurate measurement of the bar rotation rate allows us to infer that the formation of the bar of NGC 4264 was due to self-generated internal processes and not triggered by the ongoing interaction.
Free-form Grale reconstruction of Abell 2744: robustness of uncertainties against changes in lensing data
Authors: Sebesta Kevin , Williams Liliya L R , Liesenborgs Jori , Medezinski Elinor , Okabe Nobuhiro
Published: July 2019

Abell 2744, a massive Hubble Frontier Fields merging galaxy cluster with many multiple images in the core has been the subject of many lens inversions using different methods. While most existing studies compare various inversion methods, we focus on a comparison of reconstructions that use different input lensing data. Since the quantity and quality of lensing data is constantly improving, it makes sense to ask if the estimated uncertainties are robust against changes in the data. We address this question using free-form Grale, which takes only image information as input, and nothing pertaining to cluster galaxies. We reconstruct Abell 2744 using two sets of strong lensing data from the Hubble Frontier Fields community. Our first and second reconstructions use 55 and 91 images, respectively, and only 10 of the 91 images have the same positions and redshifts as in the first reconstruction. Comparison of the two mass maps shows that Grale uncertainties are robust against these changes, as well as small modifications in the inversion routine. Additionally, applying the methods used in Sebesta et al. (2016) for MACS J0416, we conclude that, in a statistical sense, light follows mass in Abell 2744, with brighter galaxies clustering stronger with the recovered mass than the fainter ones. We also show that the faintest galaxies are anti-correlated with mass, which is likely the result of light contamination from bright galaxies, and lensing magnification bias acting on galaxies background to the cluster.
Outcome of children with Shiga toxin-associated haemolytic uraemic syndrome treated with eculizumab: a matched cohort study
Authors: Monet-Didailler Catherine , Chevallier Audrey , Godron-Dubrasquet Astrid , Allard Lise , Delmas Yahsou , Contin-Bordes Cécile , Brissaud Olivier , Llanas Brigitte , Harambat Jérôme
Published: July 2019

Background

Treatment with eculizumab in Shiga toxin–associated haemolytic and uraemic syndrome (STEC-HUS) remains controversial despite its increasing utilization. The aim of our study was to evaluate the outcomes of children treated with eculizumab for STEC-HUS in a single-centre matched cohort study.

Methods

Data were retrospectively collected from medical records of children diagnosed with STEC-HUS. The outcomes of patients treated with eculizumab for STEC-HUS were compared with those of a control group of untreated patients matched for age, sex and severity of acute kidney injury with a 1:2 matching scheme.

Results

Eighteen children (median age 40.6 months) with STEC-HUS treated with eculizumab were compared with 36 matched control patients (median age 36.4 months) who did not receive eculizumab. All patients survived in the two groups. Within 1 month of HUS onset, the evolution of haematological and renal parameters did not differ between the two groups. At 12 months of follow-up, renal outcome was not significantly different between the two groups. At the last follow-up, the prevalence of decreased glomerular filtration rate in the eculizumab group (27%) was not statistically different from that in controls (38%), as was the prevalence of proteinuria and high blood pressure. Children who received eculizumab more often had extrarenal sequelae during follow-up. Eculizumab treatment appeared to be safe in children with STEC-HUS.

Conclusion

The benefit of eculizumab on renal and extrarenal outcomes in STEC-HUS could not be established based on our findings. However, efficacy and safety are not best assessed by the observational design and small sample size of our study. Randomized controlled trials are thus required to determine the efficacy of eculizumab in this indication.
Resident duty hours: Families’ knowledge and perceptions in the paediatric intensive care unit
Authors: Gupta Ronish , Eady Kaylee , Moreau Katherine , Frank Jason R , Writer Hilary K
Published: July 2019

Background and Objectives: Resident duty hours remain a controversial topic in the literature. Competing interests include patient safety, resident education, and resident well-being. No studies, however, have sought family members’ perspectives on duty hours in the paediatric context. This study aimed to explore family members’ knowledge of trainee duty hours, and their perspectives on the balance between shift duration and hand-off frequency.

Methods: We surveyed family members of patients admitted ≥ 24 hours in the paediatric intensive care unit at an academic center. We simultaneously collected daily logs of hours worked by trainees. Descriptive statistics were used to analyze survey responses and trainee duty hours.

Results: One-hundred and one family members responded (75%). Respondents demonstrated knowledge of trainees working long duty hours but reported lower averages than the trainee logs (55 versus 66 hours per week and 16 versus 24 hours per shift). Elements related to both potential trainee fatigue and hand-offs raised concern in more than half of respondents. When asked to choose between a familiar trainee working a prolonged shift, or an unfamiliar trainee at the start of their shift, respondents were divided (52% versus 48%, respectively).

Conclusions: Family members of critically ill paediatric patients are aware that trainees provide patient care while working long duty hours with minimal sleep. Despite this awareness, long shifts retain value with some families, possibly due to continuity. Changes to duty hours and hand-off frequency may pose an unrealized harm on family-centered care, as well as patient–provider relationships, and further study is warranted.
Quantitative Sensory Testing in Patients with Multisomatoform Disorder with Chronic Pain as the Leading Bodily Symptom—a Matched Case–Control Study
Authors: Achenbach Johannes , Tran Anh-Thu , Jaeger Burkhardt , Kapitza Karl , Bernateck Michael , Karst Matthias
Published: July 2019

Objective

Chronic pain is a debilitating condition of multifactorial origin, often without physical findings to explain the presenting symptoms. Of the possible etiologies of persisting painful symptoms, somatoform disorders and functional somatic syndromes (FSS) are among the most challenging, with a prevalence of 8–20%. Many different somatoform disorders and FSS have overlapping symptoms, with pain being the most prevalent one. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We hypothesized that the concept of MSD will be reflected in a distinct sensory profile of patients compared with healthy controls and possibly provide insight into the type and pathophysiology of the pain commonly experienced by patients.

Design

We performed comprehensive quantitative sensory testing (QST) in 151 patients and 149 matched controls.

Results

There were significant differences in the sensory profiles of patients compared with controls. Patients with MSD showed a combination of tactile and thermal hypesthesia combined with mechanical and cold hyperalgesia. This was true for measurements at test and control sites, with the exception of vibration detection threshold and mechanical pain threshold. Among the observed changes, a marked sensory loss of function, as evidenced by an increase in cold detection threshold, and a marked gain of function, as evidenced by a decrease of pressure pain threshold, were most notable. There was no evidence of concurrent medication influencing QST results.

Conclusions

The observed somatosensory profile of patients with MSD resembles that of patients suffering from neuropathic pain with evidence of central sensitization.
Protein A superantigen: structure, engineering and molecular basis of antibody recognition
Authors: Mazigi Ohan , Schofield Peter , Langley David B , Christ Daniel
Published: July 2019

Staphylococcus aureus interacts with the human immune system through the production of secreted factors. Key among these is protein A, a B-cell superantigen capable of interacting with both antibody Fc and VH regions. Here, we review structural and molecular features of this important example of naturally occurring bacterial superantigens, as well as engineered variants and their application in biotechnology.
Low Back Pain--Related Disability in Parkinson Disease: Impact on Functional Mobility, Physical Activity, and Quality of Life
Authors: Duncan Ryan P , Van Dillen Linda R , Garbutt Jane M , Earhart Gammon M , Perlmutter Joel S
Published: July 2019

Background

People with Parkinson disease (PD) frequently experience low back pain (LBP), yet the impact of LBP on functional mobility, physical activity, and quality of life (QOL) has not been described in PD.

Objective

The objectives of this study were to describe body positions and functional activities associated with LBP and to determine the relationships between LBP-related disability and PD motor sign severity, physical activity level, and QOL.

Design

The study was a cross-sectional study.

Methods

Thirty participants with idiopathic PD (mean age = 64.6 years [SD = 10.3]; 15 women) completed the Revised Oswestry Disability Questionnaire (RODQ), a measure of LBP-related disability. PD motor symptom severity was measured using the Movement Disorder Society-Unified Parkinson Disease Rating Scale Part III (MDS-UPRDS III). The Physical Activity Scale for the Elderly (PASE) was used to measure self-reported physical activity. The Parkinson Disease Questionnaire-39 (PDQ-39) was used to measure QOL. Descriptive statistics were used to characterize LBP intensity and LBP-related disability. Spearman correlations were used to determine relationships between the RODQ and the MDS-UPDRS III, PASE, and PDQ-39.

Results

LBP was reported to be of at least moderate intensity by 63.3% of participants. LBP most frequently impaired standing, sleeping, lifting, and walking. The RODQ was significantly related to the MDS-UPDRS III (r = 0.38), PASE (r = −0.37), PDQ-39 summary index (r = 0.55), PDQ-39 mobility subdomain (r = 0.54), and PDQ-39 bodily pain subdomain (r = 0.44).

Limitations

Limitations included a small sample of people with mild to moderate PD severity, the fact that RODQ is a less frequently used measure of LBP-related disability, and the lack of a non-PD control group.

Conclusions

LBP affected walking, sleeping, standing, and lifting in this small sample of people with mild to moderate PD. Greater LBP-related disability was associated with greater motor sign severity, lower physical activity level, and lower QOL in people with PD.
Displacements representations for the problems with spherical and circular material surfaces
Authors: Mogilevskaya Sofia G , Kushch Volodymyr I , Zemlyanova Anna Y
Published: July 2019

The displacements representations of the type used by Christensen and Lo (J. Mech. Phys. Solids27, 1979) are modified to allow for analytical treatment of problems involving spherical and circular material surfaces that possess constant surface tension. The modified representations are used to derive closed-form expressions for the local elastic fields and effective moduli of macroscopically isotropic composite materials containing spherical and circular inhomogeneities with the interfaces described by the complete Gurtin–Murdoch and Steigmann–Ogden models.
Considering religion and spirituality in precision medicine
Authors: Yeary Karen H K , Alcaraz Kassandra I , Ashing Kimlin Tam , Chiu Chungyi , Christy Shannon M , Felsted Katarina Friberg , Lu Qian , Lumpkins Crystal Y , Masters Kevin S , Newton Robert L , Park Crystal L , Shen Megan J , Silfee Valerie J , Yanez Betina , Yi Jean
Published: July 2019

The emerging era of precision medicine (PM) holds great promise for patient care by considering individual, environmental, and lifestyle factors to optimize treatment. Context is centrally important to PM, yet, to date, little attention has been given to the unique context of religion and spirituality (R/S) and their applicability to PM. R/S can support and reinforce health beliefs and behaviors that affect health outcomes. The purpose of this article is to discuss how R/S can be considered in PM at multiple levels of context and recommend strategies for integrating R/S in PM. We conducted a descriptive, integrative literature review of R/S at the individual, institutional, and societal levels, with the aim of focusing on R/S factors with a high level of salience to PM. We discuss the utility of considering R/S in the suitability and uptake of PM prevention and treatment strategies by providing specific examples of how R/S influences health beliefs and practices at each level. We also propose future directions in research and practice to foster greater understanding and integration of R/S to enhance the acceptability and patient responsiveness of PM research approaches and clinical practices. Elucidating the context of R/S and its value to PM can advance efforts toward a more whole-person and patient-centered approach to improve individual and population health.
15Disability Studies
Authors: Quirici Marion
Published: July 2019

This chapter reviews three books published in 2018 centering on disability and resistance. It is organized into five sections. The first, ‘Resistance, Disability, and Democracy’, summarizes debates about the political obligations of disability studies, and outlines how disability justice is replacing the former emphasis on rights. The second section, ‘Academic Perspectives’, reviews the provocative collection Manifestos for the Future of Critical Disability Studies, volume 1, identifying areas of contention and raising questions about the field’s current direction. The third section, ‘Activist Perspectives’, reviews Alice Wong’s collection Resistance and Hope: Essays by Disabled People. The fourth section, ‘Beyond Identity’, reviews Robert McRuer’s Crip Times: Disability, Globalization, and Resistance. The concluding section, ‘An Abbreviated Manifesto’, asserts the vital role of disability justice in establishing alternatives to neoliberalism, resisting tyranny, and achieving democracy.
Integration and diversity of the caviomorph mandible (Rodentia: Hystricomorpha): assessing the evolutionary history through fossils and ancestral shape reconstructions
Authors: Álvarez Alicia , Ercoli Marcos D , Verzi Diego H
Published: July 2019

Caviomorph rodents constitute a highly diverse clade of Neotropical mammals. They are recorded since at least the late Middle Eocene and have a long and complex evolutionary history. Using geometric morphometric data, we analysed the variation in mandibular shape of this clade through integration analyses, allometry and shape optimizations onto a phylogenetic tree of 104 extant and extinct species. The analyses of shape variation revealed a strong influence of phylogenetic structure and life habits. A remarkable allometric effect was observed for specific mandibular traits. Morphological changes occurring in the alveolar and muscular functional units were moderately associated. Interestingly, the coordinated evolution of these two functional units was decoupled in the clade of extant abrocomids. A sequential and nearly synchronic acquisition of convergent traits has occurred in chinchillids and derived cavioids since at least the early Middle Oligocene, probably derived from grass-feeding habits or similar adaptations to other abrasive items. Convergences between fossorial taxa evolved in two main events through the Oligocene and middle Late Miocene. Morphological analysis of the fossil representatives allowed a better understanding of the timing of trait acquisitions during the evolutionary history of caviomorphs and its relationship with global and regional palaeoenvironmental changes.
A Plant Nutrient- and Microbial Protein-Based Resistance Inducer Elicits Wheat Cultivar-Dependent Resistance Against Zymoseptoria tritici
Authors: Ors M. , Randoux B. , Siah A. , Couleaud G. , Maumené C. , Sahmer K. , Reignault P. , Halama P. , Selim S.
Published: July 2019

The induction of plant defense mechanisms by resistance inducers is an attractive and innovative alternative to reduce the use of fungicides on wheat against Zymoseptoria tritici, the responsible agent of Septoria tritici blotch (STB). Under controlled conditions, we investigated the resistance induction in three wheat cultivars with different susceptible levels to STB as a response to a treatment with a sulfur, manganese sulfate, and protein-based resistance inducer (NECTAR Céréales). While no direct antigermination effect of the product was observed in planta, more than 50% reduction of both symptoms and sporulation were recorded on the three tested cultivars. However, an impact of the wheat genotype on resistance induction was highlighted, which affects host penetration, cell colonization, and the production of cell-wall degrading enzymes by the fungus. Moreover, in the most susceptible cultivar Alixan, the product upregulated POX2, PAL, PR1, and GLUC gene expression in both noninoculated and inoculated plants and CHIT2 in noninoculated plants only. In contrast, defense responses induced in Altigo, the most resistant cultivar, seem to be more specifically mediated by the phenylpropanoid pathway in noninoculated as well as inoculated plants, since PAL and CHS were most specifically upregulated in this cultivar. In Premio, the moderate resistant cultivar, NECTAR Céréales elicits mainly the octadecanoid pathway, via LOX and AOS induction in noninoculated plants. We concluded that this complex resistance-inducing product protects wheat against Z. tritici by stimulating the cultivar-dependent plant defense mechanisms.
An Interprofessional Substance Use Disorder Course to Improve Students’ Educational Outcomes and Patients’ Treatment Decisions
Authors: Muzyk Andrew , Mullan Patricia , Andolsek Kathryn M. , Derouin Anne , Smothers Zachary P.W. , Sanders Charles , Holmer Shelley
Published: July 2019

Purpose

Substance use is a public health concern. Health professions organizations recommend improvements in substance use disorder (SUD) education. Mezirow’s transformative learning theory was used as the educational framework to develop a course that would provide students with opportunities to improve their understanding of SUDs; to assess, challenge, and reflect on their attitudes toward patients with SUDs; to receive direct observation, assessment, and feedback on behavior change counseling; and to engage in interprofessional education. The study’s purpose was to evaluate the impact of an interprofessional SUD course on students’ educational outcomes and their attitudes toward interprofessionalism.

Method

Students from several health professions—medicine, pharmacy, physician assistant, nursing, and social work—attended a monthly interprofessional education SUD course starting in spring 2018. The course, taught by an interprofessional faculty, consisted of 4 interactive classes focused on empathy and recognizing personal bias; behavioral change counseling; and recognition, screening, and treatment of SUDs. Students attended a 12-step recovery meeting and had an optional opportunity to counsel a patient using behavioral change counseling.

Results

Seventy-eight students completed the course. Students demonstrated significant improvements in their attitudes toward patients with SUDs and toward interprofessionalism, as measured by the Substance Abuse Attitude Survey and the Student Perceptions of Interprofessional Clinical Education survey. Nearly 70% of students counseled a patient with an SUD, and 93% of counseled patients agreed to follow-up care.

Conclusions

The course (1) enriched students’ understanding, attitudes, and behaviors toward patients with SUDs and toward interprofessional collaboration and (2) positively influenced patients’ treatment decisions.
Supporting New Physicians and New Parents: A Call to Create a Standard Parental Leave Policy for Residents
Authors: Ortiz Worthington Rebeca , Feld Lauren D. , Volerman Anna
Published: July 2019

Parents taking leave after the birth of a child is associated with significant benefits for infants, mothers, and fathers. Although nearly 40% of residents have or plan to have children during residency, there is no standard parental leave policy for these trainees. In this Perspective, the authors discuss the benefits of parental leave, synthesize findings about maternity bias and other negative effects of the current variable approaches to parental leave during residency, and explore underlying causes of the lack of a standard parental leave policy for residents. They also call on the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties to work together to address this issue, recommending a standard parental leave policy that ensures a minimum of 8 weeks of paid leave for all residents without requiring them to extend training or making them ineligible to sit for board certification exams. Creating evidence-based and family-friendly guidelines for parental leave is important to the progress of academic medicine in the modern era, as it supports parental and child health, promotes resident wellness, and reduces gender disparities in medicine to the benefit of all.
What Makes the “Perfect” Inpatient Consultation? A Qualitative Analysis of Resident and Fellow Perspectives
Authors: Pavitt Sara , Bogetz Alyssa , Blankenburg Rebecca
Published: July 2019

Purpose

To characterize the methods of inpatient consult communication, given new communication modalities; to explore residents’ and fellows’ perspectives on the ideal consult and how this consult could affect their teaching, learning, and patient safety; and to identify barriers to and strategies for optimizing consultations.

Method

Using qualitative grounded theory, the authors conducted semistructured focus groups with pediatric residents and fellows at Lucile Packard Children’s Hospital at Stanford University from October 2016 to September 2017, using questions developed by expert consensus to address study objectives. Sessions were audiorecorded and transcribed verbatim. Two authors independently coded the transcripts and reconciled codes to develop categories and themes using constant comparison. The third author validated the codes, categories, and themes. To ensure trustworthiness, participants edited the themes for accuracy.

Results

Twenty-seven residents and 16 fellows participated in 7 focus groups (3 with residents, 4 with fellows). Four themes emerged: (1) Many forms of communication are successfully used for initial inpatient consult recommendations (in person, phone, text messages, notes in electronic medical records); (2) residents and fellows prefer in-person communication for consults, believing it leads to improved teaching, learning, and patient safety; (3) multiple strategies can optimize consults regardless of communication modality; and (4) how residents frame the initial consult affects the interaction and can increase fellow engagement, which leads to more fellow teaching, residents’ improved understanding, and better patient care.

Conclusions

Residents and fellows believe that structured initial consults conducted in person improve teaching, learning, and patient care. Several strategies exist to optimize this process.
Learners as Leaders: A Global Groundswell of Students Leading Choosing Wisely Initiatives in Medical Education
Authors: Born Karen B. , Moriates Christopher , Valencia Victoria , Kerssens Marlou , Wong Brian M.
Published: July 2019

Resource stewardship and reducing low-value care have emerged as urgent priorities for health care delivery systems worldwide. However, few medical schools’ curricula include adequate content to allow learners to master the knowledge, skills, and attitudes needed to contribute to this transformation toward value-based health care. This article describes a program to launch student-led curriculum enhancement initiatives in 7 countries. The program, called STARS (Students and Trainees Advocating for Resource Stewardship), was inspired by Choosing Wisely, a campaign by the American Board of Internal Medicine Foundation that seeks to promote conversations on avoiding unnecessary medical tests, treatments, and procedures.

The initial STARS model, which originated in Canada in 2015, included a leadership summit, where students from multiple medical schools learned about Choosing Wisely principles, leadership, and advocacy. These students then led grassroots efforts at their local medical schools with faculty and other students to raise awareness and advocate for changes related to resource stewardship. Student-led efforts resulted in the integration of Choosing Wisely principles into case-based learning, the creation of student interest groups and electives, the launch of social media campaigns, and the organization of special presentations by local experts.

The rapid spread of similar programs in 6 other countries (Italy, Japan, the Netherlands, New Zealand, Norway, and the United States) by 2018 suggests that STARS resonates across multiple settings and signals the potential for such a model to advance other important areas in medical education. This article documents results and lessons learned from the first 4 years of the program.
Assessment of the ECG T-Wave in Patients With Subarachnoid Hemorrhage
Authors: Komatsuzaki Makoto , Takasusuki Toshifumi , Kimura Yoshiyuki , Yamaguchi Shigeki
Published: July 2019

Background:

Prolongation of the interval from the peak to the end of the T wave (Tp-Te) on a 12-lead electrocardiogram (ECG) is associated with ventricular arrhythmias. The aim of this study was to clarify associations between Tp-Te, Tp-Te/QT, and Tp-Te/rate-corrected QT (QTc) with clinical severity of subarachnoid hemorrhage (SAH) and clinical outcomes.

Methods:

This retrospective study included 222 patients with acute SAH (group S) and 306 patients with unruptured cerebral aneurysms (group U). Tp-Te, Tp-Te/QT, and Tp-Te/QTc were manually measured in standard 12-lead ECG recordings on admission and comparisons made between patients in groups S and U. The relationships of these ECG parameters with Hunt and Hess grade and Glasgow outcome scale were analyzed using multiple logistic regression analysis after adjustment for confounding factors.

Results:

Tp-Te, Tp-Te/QT, and Tp-Te/QTc were significantly greater in group S than in group U (group S: 109±30, 0.26±0.07, and 0.24±0.06 ms; group U: 84±12, 0.22±0.03, and 0.21±0.03 ms, respectively; P < 0.0001). In addition, in the multiple logistic regression analyses these variables were positively correlated with the Hunt and Hess grade (Tp-Te odds ratio [95% confidence interval], 2.414 [1.375-4.238], P=0.002; Tp-Te/QT, 1.886 [1.085-3.277], P = 0.024; Tp-Te/QTc, 1.873 [1.07-3.278], P=0.028, and negatively correlated with Glasgow outcome scale Tp-Te odds ratio [95% confidence interval], 4.168 [2.409-7.209], P<0.001; Tp-Te/QT, 2.434 [1.413-4.192], P=0.001; Tp-Te/QTc 2.953 [1.703-5.123], P<0.001).

Conclusions:

Tp-Te, Tp-Te/QT, and Tp-Te/QTc are associated with disease severity and clinical outcome in patients with SAH.
Analyzing Patients' Complaints
Authors: Ming Yan , Wei Holly , Cheng Hong , Ming Jie , Beck Mark
Published: July 2019

Nursing ethics are fundamental principles to nursing practice. The purpose of this study is to analyze patients' complaints filed against nurses from a nursing ethics perspective. This is a qualitative study. The data source is the patients' complaints filed in a university-affiliated hospital in China. The complaints are categorized into 4 themes: uncompassionate attitudes, unprofessional communication, disrespect of patient rights, and unsatisfactory quality of nursing care. The ethic of belonging reflects nurse-patient relations. Patients expect to be treated with dignity. This study sends out a call for nurse leaders and educators to reevaluate the practice and education of the nursing professional identity.
Epistemic Injustice
Authors: Narruhn Robin , Clark Terri
Published: July 2019

Epistemology is the study of the grounds of knowledge. We illustrate through case studies how epistemic injustice is manifested in the delivery of reproductive health care services for women from Somalia, even though it may not be intended or recognized as injustice. Testimonial injustice occurs when women are not believed or are discredited in their aim to receive care. Hermeneutic injustice occurs when a significant area of one's social experience is obscured from understanding owing to flaws in group knowledge resources for understanding. For example, women from Somalia may not receive full disclosure about the diagnostic or treatment services that are recommended in the reproductive health care setting. We explore how the many intersections in a person's identity can give rise to epistemic injustice and we suggest more expansive ways of evaluating the validity of diverse epistemologies in patient-centered care. Structural competency is recommended as a way nurses and other health care providers can mitigate the social determinants of health, which contribute to epistemic injustice.
The clinical characteristics of melanoma with BRAF V600R mutation: a case series study
Authors: Malkhasyan Karen A. , Rooney Sydney L. , Snow Anthony N. , Swick Brian L. , Milhem Mohammed M. , Zakharia Yousef
Published: July 2019

Currently, several targeted therapy regimens are approved as first-line treatment in V600E/K-mutant advanced and metastatic melanoma. Patients with the third most common pathologic variant in the BRAF gene, V600R, were not included in BRAF/MEK inhibitors clinical trials, so there is lack of information about the clinical characteristics and predictive value of this mutation in systemic therapy of unresectable disease. We retrospectively reviewed clinical BRAF mutation testing results and the records of melanoma patients at the University of Iowa Hospitals and Clinics from 2011 to 2017. DNA from formalin-fixed, paraffin-embedded tumor specimens were sequenced using a next-generation sequencing panel or dye terminator sequencing covering exon 15 of the BRAF gene. The study protocol was approved by the University of Iowa Institutional Review Board. Nine patients (5.3% of 168 cases with BRAF mutation) were found to have the V600R mutation. We report our experience in treatment of seven patients with V600R-mutant melanoma, whose clinical records were available for review. Four patients in our cohort received BRAF inhibitors. Three patients demonstrated partial objective response to BRAF/MEK targeted therapy. V600R-mutant melanoma accounts for a significant number of cases even in single-institution practices. We believe that testing for BRAF-mutation status should include rare variants of this mutation. From our experience, the high rate of ulceration, male predominance and advanced age at diagnosis are features of melanoma with V600R mutation, which are similar to those reported for V600K mutation. We observed objective response to BRAF/MEK inhibitors in three cases with V600R variant.
Trends in the Incidence of Bowen Disease Based on a Single-Center Study in the Netherlands
Authors: Jansen Maud H.E. , Özhan-Hasan Hilal , Nelemans Patty J. , Winnepenninckx Veronique J. , Mosterd Klara
Published: July 2019

BACKGROUND

Incidence trends of nonmelanoma skin cancer show an increase. Few data have been published about the incidence of Bowen disease (BD). Three previous studies, conducted more than 15 years ago in North America, found large variation in incidence rates in Caucasians, and trends over longer periods have never been studied.

OBJECTIVE

To estimate the incidence of BD in a Caucasian population in Northern Europe (Maastricht, the Netherlands) between 2003 and 2013.

METHODS

Primary and histologically confirmed BD, diagnosed in Maastricht, the Netherlands, in the years 2003, 2008, and 2013, was retrieved from a pathology database. Age-standardized and sex-specific incidence rates per 100,000 inhabitants were calculated by using the age distribution of the European standard population of 2013.

RESULTS

A statistically significant increase in the annual age-standardized incidence rates per 100,000 people was found from 8.1 (95% confidence interval [CI] 3.7–12.5) in 2003 to 68.9 (95% CI 57.2–80.7) in 2013 (p < .001). For women, there was an increase from 7.7/100,000 (95% CI 2.0–13.4) in 2003 to 76.8/100,000 (95% CI 60.2–93.5) in 2013, respectively (p < .001). An increase from 8.8/100,000 (95% CI 1.8–15.9) in 2003 to 59.2/100,000 men (95% CI 42.8–75.6) in 2013 (p < .001) was found.

CONCLUSION

These findings suggest an increase in the annual age-standardized incidence rates in BD.
Validated Assessment Scales for Cellulite Dimples on the Buttocks and Thighs in Female Patients
Authors: Hexsel Doris , Fabi Sabrina Guillen , Sattler Gerhard , Bartsch Rolf , Butterwick Kimberly , Casabona Gabriela , Yen-Yu Chao Yates , Costa Joana , Eviatar Joseph , Geister Thorin L. , Goldie Kate , Grice Jenny , Kerscher Martina , Lorenc Paul , Lupo Mary , Peeters Wouter , Pooth Rainer , Waldorf Heidi A. , Yutskovskaya Yana , Kaminer Michael S.
Published: July 2019

BACKGROUND

New treatment methods for cellulite require globally accepted scales for aesthetic research and patient evaluation.

OBJECTIVE

To develop a set of grading scales for objective assessment of cellulite dimples on female buttocks and thighs and assess their reliability and validity.

MATERIALS AND METHODS

Two photonumeric grading scales were created and validated for dimples in the buttocks in female patients: Cellulite Dimples—At Rest, and Cellulite Dimples—Dynamic. Sixteen aesthetic experts rated photographs of 50 women in 2 validation sessions. Responses were analyzed to assess inter-rater and intra-rater reliability.

RESULTS

Overall inter-rater reliability and intra-rater reliability were both “almost perfect” (≥0.81, intraclass correlation efficient and weighted kappa) for the At Rest scale. For the Dynamic scale, inter-rater reliability and intra-rater reliability were “substantial” (0.61–0.80). There was a high correlation between the cellulite scales and body mass index, age, weight, and skin laxity assessments.

CONCLUSION

Consistent outcomes between raters and by individual raters at 2 time points confirm the reliability of the cellulite dimple grading scales for buttocks and thighs in female patients and suggest they will be a valuable tool for use in research and clinical practice.
PARACENTRAL ACUTE MIDDLE MACULOPATHY AFTER EPIRETINAL MEMBRANE REMOVAL
Authors: Ang Michael J. , Chen Judy J. , McDonald H. Richard
Published: July 2019

Purpose:

To describe a patient with newly developed paracentral acute middle maculopathy after uncomplicated epiretinal membrane removal.

Methods:

Retrospective chart review.

Results:

A 74-year-old white man underwent uncomplicated vitrectomy and epiretinal membrane removal in his left eye. One week later, the patient complained of a small paracentral visual field deficit and decreased visual acuity. Spectral domain optical coherence tomography revealed a characteristic hyperreflective band-like lesion at the level of the inner nuclear layer, consistent with paracentral acute middle maculopathy. The patient was closely followed and endorsed subjective improvement of his paracentral visual deficit at 3 months postoperatively.

Conclusion:

Paracentral acute middle maculopathy, although rare, may be encountered after epiretinal membrane removal.