bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical parameters of active galactic nuclei derived from properties of the jet geometry transition region
Authors: Nokhrina E E , Kovalev Y Y , Pushkarev A B
Published: August 2020

We use the observed jet boundary transition from parabolic to conical shape, which was previously discovered to be a possible common property in active galactic nuclei, to estimate various parameters for black holes, jets and the ambient medium. We previously explained the geometry transition as a consequence of a change in the jet properties: a transition from a magnetically dominated to an equipartition regime. This interpretation allows us to estimate the black hole spin, the black hole mass and the ambient pressure amplitude, using the observed jet shape break position and the jet width at the transition point, for 11 active galactic nuclei. The black hole spin values obtained using our method are consistent with the lower estimates for sources with redshift z < 2 from spin evolution modelling. We find that the method of black hole mass determination based on the relationship between the broad-line region size and its luminosity may underestimate the masses of sources with large jet viewing angles. We propose a new method for the determination of the black hole mass, obtaining masses in the interval 108–1010 M⊙. The range of values of the ambient pressure amplitude points to the uniform medium conditions for the sources in our sample, with a tentative indication of higher pressure around Fanaroff–Riley II sources.
Amoeba Genome Reveals Dominant Host Contribution to Plastid Endosymbiosis
Authors: Lhee Duckhyun , Lee JunMo , Ettahi Khaoula , Cho Chung Hyun , Ha Ji-San , Chan Ya-Fan , Zelzion Udi , Stephens Timothy G , Price Dana C , Gabr Arwa , Nowack Eva C M , Bhattacharya Debashish , Yoon Hwan Su
Published: August 2020

Eukaryotic photosynthetic organelles, plastids, are the powerhouses of many aquatic and terrestrial ecosystems. The canonical plastid in algae and plants originated >1 Ga and therefore offers limited insights into the initial stages of organelle evolution. To address this issue, we focus here on the photosynthetic amoeba Paulinella micropora strain KR01 (hereafter, KR01) that underwent a more recent (∼124 Ma) primary endosymbiosis, resulting in a photosynthetic organelle termed the chromatophore. Analysis of genomic and transcriptomic data resulted in a high-quality draft assembly of size 707 Mb and 32,361 predicted gene models. A total of 291 chromatophore-targeted proteins were predicted in silico, 208 of which comprise the ancestral organelle proteome in photosynthetic Paulinella species with functions, among others, in nucleotide metabolism and oxidative stress response. Gene coexpression analysis identified networks containing known high light stress response genes as well as a variety of genes of unknown function (“dark” genes). We characterized diurnally rhythmic genes in this species and found that over 49% are dark. It was recently hypothesized that large double-stranded DNA viruses may have driven gene transfer to the nucleus in Paulinella and facilitated endosymbiosis. Our analyses do not support this idea, but rather suggest that these viruses in the KR01 and closely related P. micropora MYN1 genomes resulted from a more recent invasion.
Glutamate-Induced Electrical and Calcium Signals in the Moss Physcomitrella patens
Authors: Koselski Mateusz , Wasko Piotr , Derylo Kamil , Tchorzewski Marek , Trebacz Kazimierz
Published: August 2020

The mode of transmission of signals between plant cells is an important aspect of plant physiology. The main role in the generation of long-distance signals is played by changes in the membrane potential and cytoplasm calcium concentration, but the relationship between these responses evoked by the same stimuli in the same plant remains unknown. As one of the first plants that colonized land, the moss Physcomitrella patens is a suitable model organism for studying the evolution of signaling pathways in plants. Here, by the application of glutamate as a stimulus, we demonstrated that electrical but not calcium signals can be true carriers of information in long-distance signaling in Physcomitrella. The generation of electrical signals in a form of propagating transient depolarization seems to be dependent on the opening of calcium channels since the responses were reduced or totally blocked by calcium channel inhibitors. While the microelectrode measurements demonstrated the transmission of electric signals between leaf cells and juvenile cells (protonema), the fluorescence imaging of cytoplasmic calcium changes indicated that calcium response occurs only locally—at the site of glutamate application, and only in protonema cells. This study indicates different involvement of glutamate-induced electrical and calcium signals in cell-to-cell communication in these evolutionarily old terrestrial plants.
The Primacy of Duty and Its Efficacy in Combating COVID-19
Authors: Allinson Robert Elliott
Published: August 2020

Nyansa nye sika na w'akyekyere asie. (‘Wisdom, unlike money, cannot be kept in a safe’) (Appiagyei-Atua 2000).

One critical factor that has contributed to the spread of the virus COVID-19 and resulting illnesses and deaths is both the conceptual and the ethical confusion between the prioritization of individual rights over social duties. The adherence to the belief in the priority of rights over duties has motivated some individuals to refrain from social distancing and, as a result, has placed themselves and other individuals at serious risk to health and life. My argument is that the ethical enjoinder of social duty possesses priority over the ethical value of individual rights especially in times of global crisis. I demonstrate this point by arguing that the concept of individual right is derivative from the concept of social duty and through the argument that the concept of social duty is more efficacious in addressing global threats to human life than is the concept of individual rights. What is needed is an in-depth revision of the moral ordering of rights and duties and a vision of the human being as inherently other directed with duties toward others. I shall examine two specific ethical systems, that of Confucian and African, Akan moral philosophy that exemplify such a revision of the moral order.
Understanding Willingness to Share Smartphone-Sensor Data
Authors: Struminskaya Bella , Toepoel Vera , Lugtig Peter , Haan Marieke , Luiten Annemieke , Schouten Barry
Published: August 2020

The growing smartphone penetration and the integration of smartphones into people’s everyday practices offer researchers opportunities to augment survey measurement with smartphone-sensor measurement or to replace self-reports. Potential benefits include lower measurement error, a widening of research questions, collection of in situ data, and a lowered respondent burden. However, privacy considerations and other concerns may lead to nonparticipation. To date, little is known about the mechanisms of willingness to share sensor data by the general population, and no evidence is available concerning the stability of willingness. The present study focuses on survey respondents’ willingness to share data collected using smartphone sensors (GPS, camera, and wearables) in a probability-based online panel of the general population of the Netherlands. A randomized experiment varied study sponsor, framing of the request, the emphasis on control over the data collection process, and assurance of privacy and confidentiality. Respondents were asked repeatedly about their willingness to share the data collected using smartphone sensors, with varying periods before the second request. Willingness to participate in sensor-based data collection varied by the type of sensor, study sponsor, order of the request, respondent’s familiarity with the device, previous experience with participating in research involving smartphone sensors, and privacy concerns. Willingness increased when respondents were asked repeatedly and varied by sensor and task. The timing of the repeated request, one month or six months after the initial request, did not have a significant effect on willingness.
Water insecurity and psychosocial distress: case study of the Detroit water shutoffs
Authors: Gaber Nadia , Silva Andrew , Lewis-Patrick Monica , Kutil Emily , Taylor Debra , Bouier Roslyn
Published: August 2020

Background

Water insecurity poses a significant global challenge to health and development. While the biophysical and economic impacts of inadequate water and sanitation are well documented, the complex emotional and social tolls of water insecurity are less understood— particularly in the global North. In this article, we advance understandings of the psychosocial dimensions of water insecurity in Detroit, MI, where an estimated 100 000 households have been disconnected from water and sanitation services since the city declared bankruptcy in 2013.

Methods

A community-based participatory research study was conducted among residents of a local food pantry. A culturally relevant measure of water insecurity was developed through ethnographic engagement, then administered alongside the Kessler Psychological Distress scale.

Results

Our models reveal a substantial, statistically significant effect of water insecurity on psychological distress. Additionally, financial stress in paying for water and sanitation produces significant distress, even independent of water supply status.

Conclusions

Curtailing water and sanitation access has complex, intersecting effects, including implications for community mental health. Rapidly rising utility rates across the USA, in the context of growing poverty, underscore the urgency of addressing this issue. The present study is the first we know of in the USA to examine the relationship between water insecurity and psychosocial distress.
‘Ac si ignis elementaris ibi arderet’: Richard Rolle’s Elemental Love
Authors: Abbott Jean
Published: August 2020

The ‘sensuous’ imagery of Richard Rolle’s Incendium Amoris is typically regarded as spiritual metaphor—albeit a very material-seeming one. However, the trio of spiritual sensations Rolle explores at length in this work (fervor, dulcor, and canor) has a more precise, systematic connection with the physical world via the theory of the four terrestrial elements—a cornerstone of medieval natural philosophy. Through his imagery and descriptions, as well as his own reported actions and reactions, Rolle sets up the burning of fervor as a spiritual mirror of physical fire, the breath of canor as air, and the flowing sweetness of dulcor as water. The fourth member of this elemental system, representing earth, is the human soul that experiences one or more of the other elements of God’s love. The resemblance between these spiritual and physical elements is so pervasive, and Incendium exploits it so effectively, that Rolle must carefully and repeatedly specify that they are not, in fact, the same thing. Describing the ineffable through these concrete natural phenomena offers a useful framework for understanding a complex spiritual concept; however, through the idea that elements can transform into one another, it also offers a way of conceptualizing how the devout soul may be fully enveloped in God’s elemental love.
“Whose streets? Our streets!”: Negotiations of Space and Violence in Protests
Authors: Nassauer Anne
Published: August 2020

This article suggests that focusing on situational, interactional space provides a fruitful addition to understanding protest dynamics and the emergence of violence in protests. It suggests connecting insights from social movement research and violence research to examine what happens spatially during a protest. Examining how space can be conceptualized situationally, the article then employs document and visual data, participant observation, and interviews in a qualitative analysis and cross-case comparison of protest marches. Situational space is studied in peaceful and violent marches during three social movements (Global Justice Movement, New Social Movements, 1960s student movement). Findings suggest that a clearly defined, transparent concept of situational space during protest marches can be useful in understanding the unfolding of protest events and that situational space is of particular relevance for the emergence of protest violence. Space is not only a common comfort zone, but for protests, territory also consists of implicit power relations. Thus, spatial incursions by police officers or protesters during protests into space assigned to the other group drastically change dynamics during protest marches, lead to mistrust and rising tensions, and form a crucial bedrock for violent eruptions.
Growth performance, organ weight, fecal scores, plasma, and ceca digesta microbial metabolites in growing pigs fed spent biomass of Pichia kudriavzevii
Authors: Kiarie Elijah G , Voth Conor , Wey Doug , Zhu Cuilan , Huber Lee-Anne , Squires E James
Published: August 2020

Growth performance, liver and spleen weight, plasma, and ceca digesta metabolites and incidences of diarrhea were investigated in growing pigs fed spent biomass of Pichia kudriavzevii. Ninety six barrows (~25 kg, 4 pigs/pen) were fed 1 of 4 experimental diets (n = 6) for 7 weeks. The diets were control, corn-, and soybean meal-based diet or control plus 2.5%, 3.75%, or 5.0% P. kudriavzevii. Diets were formulated to be isocaloric and iso nitrogenous. Feed intake and body weight (BW) were recorded weekly for calculation of average daily gain (ADG), average daily feed intake (ADFI), and gain to feed ratio (G:F). Fecal scores were taken 3 d/wk to assess incidence and severity of diarrhea. One pig/pen close to pen average was bled for plasma metabolites on days 7 and 49 and subsequently euthanized for spleen and liver weight, ileal and cecum digesta samples for concentration of short-chain fatty acids (SCFA). The concentration of crude protein, crude fat, and non-fiber carbohydrates in P. kudriavzevii biomass was 36.4%, 9.6%, and 50.8% DM, respectively. Inclusion of P. kudriavzevii tended (P = 0.06) to linearly reduce ADG from days 8 through 49 resulting in a trend (P = 0.06) for linear reduction in the final BW. The final BW was 79.0, 79.2, 76.8, and 75.5 kg for the 0%, 2.5%, 3.75%, and 5.0% P. kudriavzevii, respectively. Diets had no effect (P > 0.10) on ADFI, G:F, spleen, and liver weight throughout the entire experiment. On day 7, there was cubic (P = 0.03) decrease and quadratic (P = 0.02) increase in plasma concentration of creatinine and urea N, respectively. However, there were no (P > 0.10) diet effects on plasma metabolites on day 49. There was a tendency (P = 0.08) for linear increase in cecum digesta concentration of acetic acid. There were no diet effects (P > 0.10) on fecal score in the first 4 wk of feeding. In conclusion, feeding P. kudriavzevii yeast tended to depress growth and stimulate cecum fermentation at higher dose and had no detrimental effects on organ weights or plasma metabolites in growing pigs.
Effectiveness of Mobile Phone-Based Support on Exclusive Breastfeeding and Infant Growth in Nigeria: A Randomized Controlled Trial
Authors: Ogaji Daprim S , Arthur Adaku O , George Innocent
Published: August 2020

Background

This study examined whether mobile phone-based support improve the rates, duration of exclusive breastfeeding (EBF) as well as infant growth patterns in Nigeria.

Methods

A 6-month prospective randomized controlled trial with 75 participants assigned to receive ‘usual care’ or ‘mobile phone-based support in addition to usual care’ EBF rates and duration as well as anthropometric measurements of infants before and after intervention were compared using proportions and mean differences.

Results

Attrition rates of 10.7% and 14.7% were observed in the intervention and control groups, respectively. Treatment groups were identical in all baseline characteristics and participants in the intervention group showed a slower rate of decline in the practice of EBF. The mean difference of 0.6 months (95% confidence interval: −0.22, 1.42) in EBF duration between intervention and control groups was not statistically significant (t = 1.45; p = 0.149). Similarly, the difference in the EBF rates at the 6th month for the intervention (55.2%) and control (46.8%) groups was not statistically significant (χ2 = 0.623; p = 0.430). Although the intervention group had significantly higher mean weight (p = 0.030) and length (p = 0.044) at the 6th month, the difference in the gain in weight and length of these infants over the period was only significant for the weight (p = 0.044). Although the incidence of adverse clinical nutritional status was more in the control group, these differences were not statistically significant.

Conclusion

Mobile phone-based intervention has positive effects on the rate and duration of EBF as well as the growth of young infants. Sustaining this simple and cheap technology will improve infant wellbeing especially in resource-constrained settings.
Anesthesia and the brain after concussion
Authors: Pasternak Jeffrey J. , Abcejo Arnoley S.
Published: August 2020

Purpose of review

To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations.

Recent findings

Acute concussion is associated with altered cerebral hemodynamics. These aberrations can persist despite resolution of signs and symptoms. Multiple repeated concussions can cause chronic traumatic encephalopathy, a disorder associated with pathologic findings similar to some organic dementias. Anesthetic utilization is common following concussion, especially soon after injury, a time when the brain may be most vulnerable to secondary injury.

Brain physiology may be abnormal following concussion and these abnormalities may persist despite resolutions of clinical manifestations. Those with recent concussion or chronic repeated concussion may be susceptible to secondary injury in the perioperative period. Clinicians should suspect concussion in any patient with recent trauma and strive to maintain cerebral homeostasis in the perianesthetic period.
Comparison of Clinical and Radiographic Outcomes of Laminoplasty, Anterior Decompression With Fusion, and Posterior Decompression With Fusion for Degenerative Cervical Myelopathy
Authors: Inose Hiroyuki , Yoshii Toshitaka , Kimura Atsushi , Takeshita Katsushi , Inoue Hirokazu , Maekawa Asato , Endo Kenji , Miyamoto Takuya , Furuya Takeo , Nakamura Akira , Mori Kanji , Kanbara Shunsuke , Imagama Shiro , Seki Shoji , Matsunaga Shunji , Okawa Atsushi
Published: August 2020

Study Design.

Prospective multicenter study.

Objective.

The aim of this study was to compare the clinical and radiographic results of laminoplasty (LAMP), anterior decompression with fusion (ADF), and posterior decompression with fusion (PDF) for degenerative cervical myelopathy (DCM).

Summary of Background Data.

Although ADF, LAMP, and PDF have been performed for DCM, little is known about the difference in impact of these surgical treatments on clinical and radiographic outcomes.

Methods.

We prospectively enrolled patients who were scheduled for surgery for DCM and compared the clinical and radiographic results of ADF, LAMP, and PDF.

Results.

In total, 171 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy (C-JOA score), European Quality of Life-5 Dimensions (EQ-5D), and Neck Disability Index (NDI) scores improved in all groups postoperatively. However, no significant differences were found in C-JOA, EQ-5D, and NDI scores and recovery rate among the groups. Regarding radiographic parameters, although the operation had no effect on cervical lordosis (CL) and the C2–7 sagittal vertical axis (SVA) in the ADF group, they worsened in the LAMP and PDF group. Although there were no significant differences in any preoperative radiographic parameters within the ADF and LAMP group, CL was significantly lower and the C2–7 SVA was significantly higher in the nonrecovery group within the PDF group. Logistic regression analysis showed that preoperative lower CL was an independent risk factor for poor recovery in the PDF group.

Conclusion.

Although groups showed no significant differences in clinical outcomes, cervical alignment worsened after surgery in the LAMP and PDF groups. Within the PDF group, lower CL was an independent risk factor for poor recovery. Therefore, the indications for PDF in DCM patients with preoperative kyphotic alignment should be carefully considered.

Level of Evidence: 3
Validation of PROMIS Physical Function in MIS TLIF
Authors: Jenkins Nathaniel W. , Parrish James M. , Cha Elliot D.K. , Lynch Conor P. , Sayari Arash J. , Geoghegan Cara E. , Jadczak Caroline N. , Mohan Shruthi , Singh Kern
Published: August 2020

Study Design.

Retrospective cohort.

Objective.

We evaluate the correlation of the Patient-Reported Outcomes Measurement Information System for physical function (PROMIS-PF) with legacy patient-reported outcome measures (PROMs) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) up to 2 years postoperatively.

Summary of Background Data.

PROMIS-PF has not been validated past 6 months following MIS TLIF.

Methods.

A surgical registry was retrospectively reviewed for eligible MIS TLIFs between May 2015 and September 2017. Inclusion criteria were primary, one- or two-level MIS TLIFs for degenerative spinal pathology. Patients without preoperative or 2-year follow up PROMIS-PF surveys were excluded. Demographic, perioperative, and PROMs including Visual Analog Scale (VAS) back, VAS leg, Oswestry Disability Index (ODI), 12-Item Short Form (SF-12) physical component summary (PCS) scores, and PROMIS-PF at preoperative and postoperative timepoint (e.g., 6 weeks, 12 weeks, 6 months, 1 year, and 2 years). A paired t test evaluated PROM improvement from baseline. The relationship of PROMIS-PF with VAS back, VAS leg, SF-12 PCS, and ODI was evaluated with a Pearson correlation coefficient.

Results.

The 68-subject cohort was 41.2% female, with an average age of 52.9 years; 44.1% were obese, and the majority underwent one-level fusions (95.6%). Pain (VAS back, VAS leg) and disability metrics (ODI) demonstrated significant improvement at all timepoints following MIS TLIF when compared to baseline (all P < 0.001). Physical function (SF-12 PCS, PROMIS-PF) demonstrated significant postoperative improvement at 12 weeks, 6 months, 1 year, and 2 years (all P < 0.001). All evaluated timepoints, with the exception of preoperative VAS back scores, revealed strong PROMIS-PF correlations with VAS back, VAS leg, ODI, and SF-12 PCS.

Conclusion.

PROMIS-PF demonstrated a strong correlation with pain (VAS back, VAS leg), disability (ODI) and physical function (SF-12) at all postoperative follow-ups through 2 years. Our study provides longitudinal evidence for utilizing PROMIS-PF as a valid physical function measure among patients undergoing MIS TLIF.

Level of Evidence: 4.
Hounsfield Unit for Assessing Vertebral Bone Quality and Asymmetrical Vertebral Degeneration in Degenerative Lumbar Scoliosis
Authors: Wang Hui , Zou Da , Sun Zhuoran , Wang Longjie , Ding Wenyuan , Li Weishi
Published: August 2020

Study Design.

Retrospective analysis.

Objectives.

The aim of this study was to demonstrate the correlation between degenerative lumbar scoliosis (DLS) and osteoporosis based on Hounsfield unit (HU) measurement from computed tomography (CT) scans, and to investigate the asymmetrical vertebral degeneration in DLS.

Summary of Background Data.

The correlation between DLS and osteoporosis measured by dual-energy x-ray absorptiometry (DEXA) is debated, since T-scores measured by DEXA scan can be overestimated due to abdominal vessel wall calcification, degenerative bony spurs, and facet hypertrophy. The reliability and accuracy of HU to determine osteoporosis are shown in many reports, but it has never been used to assess the vertebral bone quality for DLS patients.

Methods.

Nighty-five DLS patients were retrospectively reviewed. Regions of interest for HU were measured on three coronal images of the lumbar vertebrae. HU measurement of the whole vertebrae from L1 to L5 was obtained, then HU measurement within concave and convex sides were obtained separately in L5, upper and lower end vertebrae, apex vertebrae, neutral vertebrae, stable vertebrae.

Results.

HU value presented a gradually increasing trend from L1 to L5. No correlation was detected between Cobb angle and mean HU value of the 5 lumbar vertebrae, or between Cobb angle and HU value of every lumbar vertebrae separately. HU value was higher within concavity than that within convexity of the same vertebrae both in major and compensatory curve. Asymmetric HU ratio in apex vertebrae positively correlated with Cobb angle. Stable vertebrae were the first proximal vertebrae that present opposite orientation of asymmetric HU ratio from the other lumbar vertebrae.

Conclusion.

Progression of degenerative scoliosis presents no correlation with osteoporosis based on HU measurement but could increase the asymmetrical vertebral degeneration, especially in apex vertebrae. Distraction of the pedicle screws at concave side, instead of compression of pedicle screws at convex side, should be a priority to correct lumbosacral curve.

Level of Evidence: 3
Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis
Authors: Alanay Ahmet , Yucekul Altug , Abul Kadir , Ergene Gokhan , Senay Sahin , Ay Binnaz , Cebeci Barbaros Omer , Yalinay Dikmen Pinar , Zulemyan Tais , Yavuz Yasemin , Yilgor Caglar
Published: August 2020

Study Design.

Retrospective analysis of prospectively collected data.

Objective.

To report the follow-up curve behaviors in different Sanders staging groups.

Summary of Background Data.

Vertebral body tethering (VBT) is a growth modulation technique that allows gradual spontaneous follow-up curve correction as the patient grows. There is a lack of scientific evidence regarding appropriate patient selection and timing of implantation.

Methods.

Patients were grouped into five as: Sanders 1, 2, 3, 4–5, and 6–7. Data were collected preoperatively, at the day before discharge, and at each follow-up. Outcome measures were pulmonary and mechanical complications, readmission, and reoperation rates. Demographic, perioperative, clinical, radiographic, and complication data were compared using Fisher–Freeman–Halton exact tests for categorical variables and Kruskal-Wallis tests for the continuous variables.

Results.

Thirty-one (29 F, 2 M) consecutive patients with a minimum of 12 months of follow-up were included. The mean age at surgery was 12.1 (10–14). The mean follow-up was 27.1 (12–62) months. The mean preoperative main thoracic curve magnitude was 47° ± 7.6°. For all curves, preoperative and first erect curve magnitudes, bending flexibility, and operative correction percentages were similar between groups (for all comparisons, P > 0.05). The median height gained during follow-up was different between groups (P < 0.001), which was reflected into median curve correction during follow-up. Total curve correction percentage was different between groups (P = 0.009). Four (12.9%) patients had pulmonary and six (19.4%) had mechanical complications. One (3.2%) patient required readmission and two (6.5%) required reoperation. Occurrence of pulmonary complications was similar in Sanders groups (P = 0.804), while mechanical complications and overcorrection was significantly higher in Sanders 2 patients (P = 0.002 and P = 0.018).

Conclusion.

Follow-up curve behavior after VBT is different in patients having different Sanders stages. Sanders 2 patients experienced more overcorrection, thus timing and/or correction should be adjusted, since Sanders 3, 4, and 5 patients displayed a lesser risk of mechanical complications.

Level of Evidence: 3.
Fragility Analysis of Statistically Significant Outcomes of Randomized Control Trials in Spine Surgery
Authors: Muthu Sathish , Ramakrishnan Eswar
Published: August 2020

Study Design.

Systematic review.

Objectives.

The aim of this study was to assess the robustness of statistically significant outcomes from randomized control trials (RCTs) in spine surgery using Fragility Index (FI) which is a novel metric measuring the number of events upon which statistical significance of the outcome depends.

Summary of Background Data.

Many trials in Spine surgery were characterized by fewer outcome events along with small sample size. FI helps us identify the robustness of the results from such studies with statistically significant dichotomous outcomes.

Methods.

We conducted independent and in duplicate, a systematic review of published RCTs in spine surgery from PubMed Central, Embase, and Cochrane Database. RCTs with 1:1 prospective study design and reporting statistically significant dichotomous primary or secondary outcomes were included. FI was calculated for each RCT and its correlation with various factors was analyzed.

Results.

Seventy trials met inclusion criteria with a median sample size of 133 (interquartile range [IQR]: 80–218) and median reported events per trial was 38 (IQR: 13–94). The median FI score was 2 (IQR: 0–5), which means if we switch two patients from nonevent to event, the statistical significance of the outcome is lost. The FI score was less than the number of patients lost to follow-up in 28 of 70 trials. The FI score was found to positively correlated with sample size (r = 0.431, P = 0.001), total number of outcome events (r = 0.305, P = 0.01) while negatively correlated with P value (r = −0.392, P = 0.001). Funding, journal impact-factor, risk of bias domains, and year of publication did not have a significant correlation.

Conclusion.

Statistically significant dichotomous outcomes reported in spine surgery RCTs are more often fragile and outcomes of the patients lost to follow-up could have changed the significance of results and hence it needs caution before transcending their results into clinical application. The addition of FI in routine reporting of RCTs would guide readers on the robustness of the statistical significance of outcomes. RCTs with FI ≥5 without any patient lost to follow-up can be considered to have clinically robust results.

Level of Evidence: 1
Timing of resumption of immune checkpoint inhibitor therapy after successful control of immune-related adverse events in seven advanced non-small cell lung cancer patients
Authors: Kashiwabara Kosuke , Fujii Shinji , Tsumura Shinsuke , Sakamoto Kazuhiko
Published: August 2020

Among advanced non-small cell lung cancer (NSCLC) patients in whom grade 2/3 immune-related adverse events (irAEs) that had developed during the initial immune checkpoint inhibitor (ICI) therapy had been successfully controlled, we experienced three patients in whom ICI therapy was resumed at the diagnosis of progressive disease (PD group, n = 3) and four patients in whom it was resumed immediately after successful control of irAEs (non-PD group, n = 4). The tumor response rate, disease control rate to the resumed ICI and progression-free survival from the resumption of ICI therapy were 0%, 0% and 2 months in the PD group and 25%, 75% and 4.8 months in the non-PD group. In advanced NSCLC patients in whom resumption of discontinued ICI therapy was planned, the ICI therapy should be resumed immediately after successful control of irAEs, rather than at the diagnosis of PD.
Detection of PIK3CA E545A mutation in circulating tumor DNA of a patient affected by uterine carcinosarcoma
Authors: Fantappiè Giulia , Malentacchi Francesca , Turrini Irene , Sorbi Flavia , Castiglione Francesca , Vergoni Federica , Ammatuna Carlo , Antonuzzo Lorenzo , Fambrini Massimiliano , Noci Ivo , Pillozzi Serena
Published: August 2020

Uterine carcinosarcomas are biphasic neoplasms consisting of mixed epithelial and mesenchymal elements, representing less than 5% of all uterine malignancies. Carcinosarcomas are rare, although the most common cause of uterine cancer-specific death. Few information is available on the pathogenesis, and molecular characterization is poorly investigated. Consequently, the treatment has not changed over the last years and is far too being tailored, consisting of surgery and traditional chemotherapy and radiotherapy. Molecular characterization of liquid biopsy by circulating tumor DNA (ctDNA)/circulating cell-free DNA (ccfDNA) evaluation in a patient with uterine carcinosarcoma. Here, we describe a case report of an 83-year-old woman with carcinosarcomas, stage T3aN0M0. Cancer cells did not express estrogen nor progesterone receptors, while p53 and p16 were positive. Molecular characterization of ccfDNA and of ctDNA was performed by quantitative PCR, amplification-refractory mutation system technology. The presence of phosphatidylInositol-4,5-bisphosphate 3-Kinase catalytic subunit alpha p.E545A mutation was detected in plasma. This approach may suggest the use of liquid biopsy and the development of specific targeted therapy for precision personalized medicine even in rare carcinosarcomas.
Novel DNA-based T-Cell Activator Promotes Rapid T-Cell Activation and Expansion
Authors: Keskar Vandana , Sood Anup , Loghin Evelina , Kovacs Ernest , Duthie R. Scott , Liu Shutong , Park Jee Hyun , Chadwick Chrystal , Smith Reginald , Brown Martin , Stroncek David F. , Highfill Steven L.
Published: August 2020

Autologous chimeric antigen receptor engineered T-cell therapies are beginning to dramatically change the outlook for patients with several hematological malignancies. Yet methods to activate and expand these cells are limited, often pose challenges to automation, and have biological limitations impacting the output of the injectable dose. This study describes the development of a novel, highly flexible, soluble DNA-based T-cell activation and expansion platform which alleviates the limitations of current technologies and provides rapid T-cell activation and expansion.
Reconstruction of Full Thickness Defects on the Scalp With Artificial Dermal Regeneration Template: Analysis of Long-Term Results in 68 Cases
Authors: Benecke Johannes , Koenen Wolfgang , Mager Lisa , Weina Kasia , Klemke Claus-Detlev , Felcht Moritz , Faulhaber Jörg
Published: August 2020

BACKGROUND

Artificial skin substitute templates have been shown to be a reliable solution for the reconstruction of large scalp defects with exposed skull bone, but there is a lack of long-term data.

OBJECTIVE

The aim of this retrospective study was to investigate the long-term outcome of the procedure in a large cohort of 68 cases.

MATERIALS AND METHODS

In total, 58 patients with 68 full thickness scalp defects with exposed skull bone, were included. Mean follow-up time was 24 (±19) months.

RESULTS

The mean size of the defects was 63 (±54) cm2. During the follow-up period, no local recurrences occurred. Complications were observed in 13% of the cases including template necrosis (4%), infections (4%), ulcerations (3%), and autograft necrosis (2%). During the final follow-up, 26 patients had died due to internal diseases not associated with the surgery. Cosmetic results were rated good by the patients and an independent observer.

CONCLUSION

The use of a dermal regeneration template for the reconstruction of large, full thickness defects of the scalp with exposed skull bone is a reliable method regarding the complication rate, safety of the procedure, and cosmetic outcome. Limitations of this study are the retrospective and single center design.
Nonsurgical Treatment of Postpartum Lower Abdominal Skin and Soft-Tissue Laxity Using Microfocused Ultrasound With Visualization
Authors: Lin Frank G.
Published: August 2020

BACKGROUND

Microfocused ultrasound with visualization (MFU-V) is a well-established treatment modality for skin tightening. There is a paucity of evidence for its use in body treatments, such as the lower abdomen.

OBJECTIVE

To investigate the effectiveness and safety of MFU-V in treating lower abdominal skin and soft-tissue laxity in postpartum women.

METHODS

The lower abdomen of 20 female patients between 6 and 24 months postpartum are treated with MFU-V using 1.5-, 3.0-, and 4.5-mm transducers. Data are prospectively collected and analyzed at 3 and 6 months using subject-reported and investigator-reported outcome measures. One additional patient underwent planned abdominoplasty 6 weeks after MFU-V treatment with tissue assessed intraoperatively and histologically.

RESULTS

There was a mean improvement of 1.0 and 1.3 grades at 6 months using the investigator-reported and patient-reported skin laxity scale, respectively (p < .001). Patient-reported outcomes and satisfaction survey showed consistent improvement at 6 months. Histological examination of pretreated tissue showed increased total collagen, increased number and thickness of fibrous septae, and no change in fat cells within pretreated tissue compared with the control. No significant adverse events were recorded.

CONCLUSION

MFU-V is an effective and safe treatment modality for lower abdominal skin laxity in postpartum patients.
Canthal Rotation Flap: Analysis of Flap Mechanics
Authors: Syed Zain U. , Madden Nichelle , Donnelly Heidi B.
Published: August 2020

BACKGROUND

Surgical defects of the medial canthus lack reconstructive options that are reproducible, precise, and uncomplicated. The canthal rotation flap is a simple rotation flap that respects the geometry of this anatomic location.

OBJECTIVE

To describe the authors' experience with reconstructive planning, flap mechanics, and geometric analysis of the medial canthus to achieve the best cosmetic outcome when using the canthal rotation flap.

METHODS

A retrospective review of 16 cases performed at Dayton Skin Care Specialists and Skin Care Specialty Physicians between 2016 and 2018 was completed with a blinded visual analog score (VAS).

RESULTS

Sixteen patients with Mohs defects in the medial canthus were reconstructed using the canthal rotation flap. Defect diameters ranged from 0.8 to 2.7 cm. Patient ages ranged from 17 to 88 years. The mean flap dimensions were 4.8 cm by 2.15 cm. No major complications were noted. The VAS scar rating at 2 to 5 months follow-up was available for 10 of 16 patients; the mean VAS was 2.1.

CONCLUSION

The canthal rotation flap is a reliable, single stage repair for small defects of the medial canthus that is optimized for the unique geometry of the medial canthus. This repair technique adds to the paucity of reconstructive options for the medial canthus.
Simulation-based teaching and models for caesarean sections: a systematic review to evaluate the tools for the ‘See One, Practice Many, Do One’ slogan
Authors: Sultana Nabiha , Betran Ana Pilar , Khan Khalid S. , Sobhy Soha
Published: August 2020

Purpose of review

Caesarean sections are the most commonly performed procedure globally. Simulation-based training for caesarean sections can provide healthcare practitioners a safe and controlled environment to develop this life-saving skill. We systematically reviewed the use of simulation-based training for caesarean section and its effectiveness. Embase, Pubmed, Scopus and Web of Science were searched from inception to June 2019, without language restriction, for studies that included methods of simulation for caesarean section. Studies were selected and data extracted in duplicate. Synthesis analysed common themes on simulation-based training strategies.

Recent findings

There were 19 relevant studies including the following simulation-based methods: simulators (high and low fidelity), scenario-based drills training, e-learning and combinations. A common theme was simulation for rare events such as perimortem caesarean, impacted foetal head and uterine rupture. Combination studies appeared to provide a more comprehensive training experience. Studies rarely adequately assessed the educational or clinical effectiveness of the simulation methods.

There are different types of simulator models and manikins available for caesarean section training. Simulation-based training may improve technical skills and nontechnical skills, in a risk-free environment. More research is needed into simulation training effectiveness and its efficient incorporation into practice for improving outcomes.
What Chaplains Wish Nurses Knew
Authors: Taylor Elizabeth Johnston , Trippon Myrna
Published: August 2020

This report presents qualitative data from a larger study that sought to examine chaplain perspectives on collaboration and nurse-provided spiritual care. This cross-sectional, descriptive study used online survey methods to distribute an investigator-designed questionnaire to a convenience sample of members of the Association of Professional Chaplains (N = 298). Findings were generated by written responses to 3 open questions that were thematically analyzed, as well as 1 quantitative item. Over half of these chaplains reported they did experience nurse “gatekeeping” at least occasionally. Themes from qualitative data revealed chaplains perceive nurses: lack understanding about the role and abilities of chaplains, sometimes overstep their role or impede the work of chaplains, and allow personal “baggage” to influence their collaboration with chaplains. Likewise, however, respondents respected nurses and were eager to collaborate. Naming these challenges to nurse-chaplain collaboration allows nurses and chaplains to begin to address them.
An Exploratory Study of a 3-Minute Mindfulness Intervention on Compassion Fatigue in Nurses
Authors: Owens Rebecca A. , Alfes Celeste , Evans Susan , Wyka Katarzyna , Fitzpatrick Joyce J.
Published: August 2020

This study shows that breathing mindfully for 3 minutes over a period of 4 weeks, positively affects compassion fatigue in nurses. A nonrandomized, pre/postintervention study was conducted using a 3-minute attentional breathing intervention. Thirty-two nurses participated over 4 weeks. The intervention demonstrated statistically significant reductions in compassion fatigue measures.
A Qualitative Study of the Experiences of Complementary and Alternative Medicine of Patients With IBS-C
Authors: Parlar Kılıc Serap , Kılıç Nermin , Sevinç Sibel , Demirel Cihat
Published: August 2020

The aim of this study was to examine the complementary and alternative medicine (CAM) experiences of patients with constipation irritable bowel syndrome (IBS-C). This qualitative study consisted of a total of 30 patients, who were admitted to a university hospital in Turkey. Data were collected using a descriptive questionnaire and a semistructured interview. Data analysis identified 5 main themes: (1) constipation-related difficulties experienced due to IBS, (2) the feeling that the CAM use is natural and useful, (3) the effect of the environmental stimuli in preferring the use of CAM, (4) the feeling that CAM is not negative and relieves, and (5) suggesting the CAM use. In conclusion, it was determined that all the patients with constipation IBS used various CAM methods. It may be recommended to raise the awareness of the patients by health care professionals about the CAM methods that may be useful.
Recommendations for Pregnancy in Rare Inherited Anemias
Authors: Taher Ali T. , Iolascon Achille , Matar Charbel F. , Bou‐Fakhredin Rayan , de Franceschi Lucia , Cappellini Maria Domenica , Barcellini Wilma , Russo Roberta , Andolfo Immacolata , Tyan Paul , Gulbis Beatrice , Aydinok Yesim , Anagnou Nicholas P. , Bencaiova Gabriela Amstad , Tamary Hannah , Martinez Patricia Aguilar , Forni Gianluca , Vindigni Raffaele ,   EHA Scientific Working Group on “Red Cells, Iron”
Published: August 2020

Rare inherited anemias are a subset of anemias caused by a genetic defect along one of the several stages of erythropoiesis or in different cellular components that affect red blood cell integrity, and thus its lifespan. Due to their low prevalence, several complications on growth and development, and multi‐organ system damage are not yet well defined. Moreover, during the last decade there has been a lack of proper understanding of the impact of rare anemias on maternal and fetal outcomes. In addition, there are no clear‐cut guidelines outlining the pathophysiological trends and management options unique to this special population. Here, we present on behalf of the European Hematology Association, evidence‐ and consensus‐based guidelines, established by an international group of experts in different fields, including hematologists, gynecologists, general practitioners, medical geneticists, and experts in rare inherited anemias from various European countries for standardized and appropriate choice of therapeutic interventions for the management of pregnancy in rare inherited anemias, including Diamond‐Blackfan Anemia, Congenital Dyserythropoietic Anemias, Thalassemia, Sickle Cell Disease, Enzyme deficiency and Red cell membrane disorders.
Rehabilitation Program Using Short Prostheses after Bilateral Transfemoral Amputation: A Case Report
Authors: Strelec Juliana , Akeju Oluropo A. , Gras Laura Z.
Published: August 2020

Introduction

Individuals with bilateral lower-limb (LL) amputations require more energy when using bilateral prostheses compared with those who have unilateral LL amputations. A short prosthesis is often used to determine whether someone will be functional using a more advanced prosthesis long term.

Patient Information

This case report describes physical therapy interventions for a 72-year-old male subject in subacute rehabilitation after a bilateral transfemoral amputation secondary to peripheral artery disease (PAD). At initial examination, the patient was dependent for all transfers and unable to sit unsupported.

Intervention

The interventions were done in three phases. Phase 1 focused on trunk strengthening, postural control, sitting and standing balance, and standing tolerance using short prostheses on a tilt table. Phase 2 progressed to dynamic standing activities using a tilt table and LiteGait with the goal to increase standing tolerance. Phase 3 focused on transfers and gait with assistance from the LiteGait and a platform walker.

Outcomes

After 8 weeks of rehabilitation, the patient achieved all short-term goals (STGs) and made 75% progress toward meeting his long-term goals. His Functional Balance Grades Scale (FBGS) score increased from poor to fair, whereas his Functional Independence Measure (FIM) scores for transfers and ambulation increased from 3 to 4 and 0 to 1, respectively.

Discussion

There is limited information in the literature on progressing exercise programs in individuals with bilateral transfemoral amputation. Physical therapists may wish to consider the interventions described in this case report when designing programs for individuals with bilateral transfemoral amputation.