bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of matrix hardness on the impact abrasive wear performance of ZTAp/steel architecture composite
Authors: Ma Wei , Lu Dehong , Tang Lu , Gong Wenhao , Yan Qinghua
Published: January 2021

The effect of the hardness of a steel matrix by heat treatment on the impact abrasive wear of ZTAp/40Cr steel architecture composites is investigated. Of these composites, the ZTA particles-reinforced 40Cr steel matrix composite and pure 40Cr steel formed a 3D network interpenetrating structure. The results show that the architecture composites with the martensite matrix demonstrate the best wear resistance, which is 32.76% higher than that with the troostite matrix and 163.60% higher than that with the pearlite matrix. Under the same Under the same quenching + 460 °C tempering conditions, the wear resistance of the architecture composites is 79.0% higher than that of the homogeneous composites. The wear mechanism analysis shows that the wear performance of composites depends on the interaction between the matrix and the reinforced particles. As the hardness of the composites matrix increases, the reinforcement particles are more strongly supported by the matrix. Conversely, the matrix is preferentially worn, and the ZTA particles are shed due to the lack of protection. The main wear mechanisms include micro-cutting, plastic fatigue wear, and particle crushing and spalling.
Bacterial cellulose growth on 3D acrylate-based microstructures fabricated by two-photon polymerization
Authors: Otuka Adriano J G , Domeneguetti Rafael R , Moraes Jonathas Q R , Balogh Debora T , Ribeiro Sidney J L , Mendonça Cleber R
Published: January 2021

Miniaturized environments have emerged as an excellent alternative to evaluate and understand biological mechanisms. These systems are able to simulate macroenvironments with high reproducibility, achieving many results in a short time of analysis. However, microenvironments require specific architectures that can be reached using laser micromachining techniques, such as two-photon polymerization (TPP). This technique has many advantages, allowing the production of environments without shape limitation and with special features. In this work, aided by the TPP technique, we produce different arrays of microstructures, fabricated using acrylate-based materials, in order to evaluate the growth and development of the Komagataeibacter xylinus bacteria, the micro-organism responsible for producing bacterial cellulose (BC), a natural polymer with several biological applications. BC grown in microenvironments presents similar features to those of biofilm formed in macroenvironments, maintaining their attractive properties. In addition, due to the high optical quality and mechanical resistance of the BC matrices, we use these films as flexible substrates in TPP experiments, obtaining promising results for tissue engineering studies.
A Pilot Study Evaluation of 3-Dimensional Imaging in Cosmetic Breast Augmentation: Results of a Single Surgeon 3.5-Year Retrospective Study Using the BREAST-Q Questionnaire
Authors: Hutchinson Lauren E , Castaldo Andrea D , Malone Cedar H , Sommer Nicole Z , Amalfi Ashley N
Published: January 2021

Background

Traditional methods of breast implant size selection provide limited ability to demonstrate postoperative outcomes. Three-dimensional (3D) imaging provides an opportunity for improved patient evaluation, surgical planning, and evaluation of postoperative breast appearance.

Objectives

The authors hypothesized that preoperative 3D imaging for patients undergoing breast augmentation would improve patient satisfaction and understanding of expected surgical outcomes.

Methods

A retrospective review of patients undergoing breast augmentation by a single surgeon over a 3.5-year period was performed. Patients presenting after the VECTRA was purchased had preoperative 3D imaging, while patients presenting before this did not. Eligible patients received a BREAST-Q questionnaire designed for postoperative evaluation of breast augmentation. They also received a second survey that evaluated expected vs actual breast outcomes.

Results

In total, 120 surveys were mailed and 61 patients (50.8%) returned the survey. The 3D imaged group had improved BREAST-Q scores regarding satisfaction with outcome, surgeon, and physical well-being compared with the group that did not. The imaged group also had higher size, shape, and overall breast correlation scores, confidence in implant size selection scores, and communication with surgeon scores. The differences between the 2 groups were not statistically significant.

Conclusions

Three-dimensional imaging is a valuable tool in breast surgery. Although this study showed improvement in patient satisfaction and predicted outcome scores in the 3D imaged group, the results were not statistically significant. With the majority of patients reporting that they would choose 3D imaging, it appears to instill confidence in patients regarding both surgeon and implant selection.

Level of Evidence: 4
Unsupervised and self-supervised deep learning approaches for biomedical text mining
Authors: Nadif Mohamed , Role François
Published: January 2021

Biomedical scientific literature is growing at a very rapid pace, which makes increasingly difficult for human experts to spot the most relevant results hidden in the papers. Automatized information extraction tools based on text mining techniques are therefore needed to assist them in this task. In the last few years, deep neural networks-based techniques have significantly contributed to advance the state-of-the-art in this research area. Although the contribution to this progress made by supervised methods is relatively well-known, this is less so for other kinds of learning, namely unsupervised and self-supervised learning. Unsupervised learning is a kind of learning that does not require the cost of creating labels, which is very useful in the exploratory stages of a biomedical study where agile techniques are needed to rapidly explore many paths. In particular, clustering techniques applied to biomedical text mining allow to gather large sets of documents into more manageable groups. Deep learning techniques have allowed to produce new clustering-friendly representations of the data. On the other hand, self-supervised learning is a kind of supervised learning where the labels do not have to be manually created by humans, but are automatically derived from relations found in the input texts. In combination with innovative network architectures (e.g. transformer-based architectures), self-supervised techniques have allowed to design increasingly effective vector-based word representations (word embeddings). We show in this survey how word representations obtained in this way have proven to successfully interact with common supervised modules (e.g. classification networks) to whose performance they greatly contribute.
Fur: Find unique genomic regions for diagnostic PCR
Authors: Haubold Bernhard , Klötzl Fabian , Hellberg Lars , Thompson Daniel , Cavalar Markus
Published: January 2021

Motivation

Unique marker sequences are highly sought after in molecular diagnostics. Nevertheless, there are only few programs available to search for marker sequences, compared to the many programs for similarity search. We therefore wrote the program Fur for Finding Unique genomic Regions.

Results

Fur takes as input a sample of target sequences and a sample of closely related neighbors. It returns the regions present in all targets and absent from all neighbors. The recently published program genmap can also be used for this purpose and we compared it to fur. When analyzing a sample of 33 genomes representing the major phylogroups of E.coli, fur was 40 times faster than genmap but used three times more memory. On the other hand, genmap yielded three times more markers, but they were less accurate when tested in silico on a sample of 237 E.coli genomes. We also designed phylogroup-specific PCR primers based on the markers proposed by genmap and fur, and tested them by analyzing their virtual amplicons in GenBank. Finally, we used fur to design primers specific to a Lactobacillus species, and found excellent sensitivity and specificity in vitro.

Availability and implementation

Fur sources and documentation are available from https://github.com/evolbioinf/fur. The compiled software is posted as a docker container at https://hub.docker.com/r/haubold/fox.

Supplementary information

Supplementary data are available at Bioinformatics online.
Epidemiological modeling in StochSS Live!
Authors: Jiang Richard , Jacob Bruno , Geiger Matthew , Matthew Sean , Rumsey Bryan , Singh Prashant , Wrede Fredrik , Yi Tau-Mu , Drawert Brian , Hellander Andreas , Petzold Linda
Published: January 2021

We present StochSS Live!, a web-based service for modeling, simulation and analysis of a wide range of mathematical, biological and biochemical systems. Using an epidemiological model of COVID-19, we demonstrate the power of StochSS Live! to enable researchers to quickly develop a deterministic or a discrete stochastic model, infer its parameters and analyze the results.

Availability and implementation

StochSS Live! is freely available at https://live.stochss.org/

Supplementary information

Supplementary data are available at Bioinformatics online.
Can plastid genome sequencing be used for species identification in Lauraceae?
Authors: Liu Zhi-Fang , Ma Hui , Ci Xiu-Qin , Li Lang , Song Yu , Liu Bing , Li Hsi-Wen , Wang Shu-Li , Qu Xiao-Jian , Hu Jian-Lin , Zhang Xiao-Yan , Conran John G , Twyford Alex D , Yang Jun-Bo , Hollingsworth Peter M , Li Jie
Published: January 2021

Using DNA barcoding for species identification remains challenging for many plant groups. New sequencing approaches such as complete plastid genome sequencing may provide some increased power and practical benefits for species identification beyond standard plant DNA barcodes. We undertook a case study comparing standard DNA barcoding to plastid genome sequencing for species discrimination in the ecologically and economically important family Lauraceae, using 191 plastid genomes for 131 species from 25 genera, representing the largest plastome data set for Lauraceae to date. We found that the plastome sequences were useful in correcting some identification errors and for finding new and cryptic species. However, plastome data overall were only able to discriminate c. 60% of the species in our sample, with this representing a modest improvement from 40 to 50% discrimination success with the standard plant DNA barcodes. Beyond species discrimination, the plastid genome sequences revealed complex relationships in the family, with 12/25 genera being non-monophyletic and with extensive incongruence relative to nuclear ribosomal DNA. These results highlight that although useful for improving phylogenetic resolution in the family and providing some species-level insights, plastome sequences only partially improve species discrimination, and this reinforces the need for large-scale nuclear data to improve discrimination among closely related species.
Visuomotor integration deficits are common to familial and sporadic preclinical Alzheimer’s disease
Authors: Lu Kirsty , Nicholas Jennifer M , Weston Philip S J , Stout Julie C , O’Regan Alison M , James Sarah-Naomi , Buchanan Sarah M , Lane Christopher A , Parker Thomas D , Keuss Sarah E , Keshavan Ashvini , Murray-Smith Heidi , Cash David M , Sudre Carole H , Malone Ian B , Coath William , Wong Andrew , Richards Marcus , Henley Susie M D , Fox Nick C , Schott Jonathan M , Crutch Sebastian J
Published: January 2021

We investigated whether subtle visuomotor deficits were detectable in familial and sporadic preclinical Alzheimer’s disease. A circle-tracing task—with direct and indirect visual feedback, and dual-task subtraction—was completed by 31 individuals at 50% risk of familial Alzheimer’s disease (19 presymptomatic mutation carriers; 12 non-carriers) and 390 cognitively normal older adults (members of the British 1946 Birth Cohort, all born during the same week; age range at assessment = 69–71 years), who also underwent β-amyloid-PET/MRI to derive amyloid status (positive/negative), whole-brain volume and white matter hyperintensity volume. We compared preclinical Alzheimer’s groups against controls cross-sectionally (mutation carriers versus non-carriers; amyloid-positive versus amyloid-negative) on speed and accuracy of circle-tracing and subtraction. Mutation carriers (mean 7 years before expected onset) and amyloid-positive older adults traced disproportionately less accurately than controls when visual feedback was indirect, and were slower at dual-task subtraction. In the older adults, the same pattern of associations was found when considering amyloid burden as a continuous variable (Standardized Uptake Value Ratio). The effect of amyloid was independent of white matter hyperintensity and brain volumes, which themselves were associated with different aspects of performance: greater white matter hyperintensity volume was also associated with disproportionately poorer tracing accuracy when visual feedback was indirect, whereas larger brain volume was associated with faster tracing and faster subtraction. Mutation carriers also showed evidence of poorer tracing accuracy when visual feedback was direct. This study provides the first evidence of visuomotor integration deficits common to familial and sporadic preclinical Alzheimer’s disease, which may precede the onset of clinical symptoms by several years.
Microbial intrusion and seasonal dynamics in the groundwater microbiome of a porous basaltic rock aquifer used as municipal water reservoir
Authors: Knobloch Stephen , Klonowski Alexandra Maria , Tómasdóttir Sigrún , Kristjánsson Bjarni Reyr , Guðmundsson Sverrir , Marteinsson Viggó Þór
Published: January 2021

Groundwater is a key resource for safe drinking water supply. Yet unconfined aquifers can be vulnerable to microbial contamination during extreme weather events that lead to surface runoff. The current study characterises the groundwater microbiome of a porous basaltic rock aquifer in South-West Iceland used for drinking water extraction and analyses the microbial community dynamics during surface runoff. The groundwater microbial community sampled from 12 wells across the extraction area contained over 745 prokaryotic genera and was phylogenetically similar between wells and most seasons, representing a diverse but homogenous ecosystem. The largest seasonal variation in the microbial community composition was detected during a period of concurrent snow melt and high precipitation leading to surface runoff. This period was characterised by an increased abundance of soil-associated taxa in the groundwater microbiome and specifically of taxa assigned to Aeromonas and Bacillus. A field experiment simulating high surface runoff around a groundwater well confirmed the increased abundance of surface soil microorganisms in the well water, indicating vulnerability of groundwater towards surface microbial intrusion during extreme weather events. As such events are likely to increase due to climate change, novel water management tools such as microbial community analysis could help ensure drinking water safety.
Taking Constitutionalization Seriously: European IP Law, Weak Fundamental Rights and the Network of Courts
Authors: Goldhammer Michael
Published: January 2021

A set of three recent decisions delivered by the CJEU – Spiegel Online,1 Pelham2 and Funke Medien3 – deepens the widespread interpretation of European IP law through the lenses of constitutionalization. While there is no unitary understanding of constitutionalization, many scholars associate it with the growing influence of fundamental rights on European IP law – both within and beyond the statutory body. In fact, the case law provides plenty of evidence on how the Charter of Fundamental Rights and proportionality – its central method – is deployed to steer the implementation of EU law by domestic courts. However, as the said decisions also show, there are still a lot of questions and frustration. While we have to acknowledge that the CJEU takes fundamental rights into account when interpreting IP law, some critics see deficits when the Court strictly rejects the idea of external limitations on exclusive copyrights. European fundamental rights are – obviously – not a trump card. This article aims to clarify some misleading aspirations by re-examining both the idea of constitutionalization and its impact on European IP law. It will argue that weak or evasive fundamental rights are not necessarily a sign of deficient constitutionalization, they might rather be the consequence thereof.
Current Topics in Marmoset Anesthesia and Analgesia
Authors: Goodroe Anna , Fitz Casey , Bakker Jaco
Published: January 2021

Anesthetic and analgesics are essential components of both clinical and research procedures completed in marmosets. A review of current anesthetic and analgesic regimens for marmosets has been complied to provide a concise reference for veterinarians and investigator teams. Published dose regimens for injectable and inhalant anesthetic drugs and analgesic drugs are included. Appropriate physiological monitoring is key to the success of the procedure and perianesthetic options are provided. Although recent publications have refined anesthesia and analgesia practices, our review demonstrates the continued need for evidence-based resources specific to marmosets.
Models for plasma kinetics during simultaneous therapeutic plasma exchange and extracorporeal membrane oxygenation
Authors: Puelz Charles , Danial Zach , Raval Jay S , Marinaro Jonathan L , Griffith Boyce E , Peskin Charles S
Published: January 2021

This paper focuses on the derivation and simulation of mathematical models describing new plasma fraction in blood for patients undergoing simultaneous extracorporeal membrane oxygenation and therapeutic plasma exchange. Models for plasma exchange with either veno-arterial or veno-venous extracorporeal membrane oxygenation are considered. Two classes of models are derived for each case, one in the form of an algebraic delay equation and another in the form of a system of delay differential equations. In special cases, our models reduce to single compartment ones for plasma exchange that have been validated with experimental data (Randerson et al., 1982, Artif. Organs, 6, 43–49). We also show that the algebraic differential equations are forward Euler discretizations of the delay differential equations, with timesteps equal to transit times through model compartments. Numerical simulations are performed to compare different model types, to investigate the impact of plasma device port switching on the efficiency of the exchange process, and to study the sensitivity of the models to their parameters.
Distribution and Temporal Dynamics of Plasmodium falciparum Chloroquine Resistance Transporter Mutations Associated With Piperaquine Resistance in Northern Cambodia
Authors: Shrestha Biraj , Shah Zalak , Morgan Andrew P , Saingam Piyaporn , Chaisatit Chaiyaporn , Chaorattanakawee Suwanna , Praditpol Chantida , Boonyalai Nonlawat , Lertsethtakarn Paphavee , Wojnarski Mariusz , Deutsch-Feldman Molly , Adams Matthew , Sea Darapiseth , Chann Soklyda , Tyner Stuart D , Lanteri Charlotte A , Spring Michele D , Saunders David L , Smith Philip L , Lon Chanthap , Gosi Panita , Sok Somethy , Satharath Prom , Rekol Huy , Lek Dysoley , Vesely Brian A , Lin Jessica T , Waters Norman C , Takala-Harrison Shannon
Published: January 2021

Background

Newly emerged mutations within the Plasmodium falciparum chloroquine resistance transporter (PfCRT) can confer piperaquine resistance in the absence of amplified plasmepsin II (pfpm2). In this study, we estimated the prevalence of co-circulating piperaquine resistance mutations in P. falciparum isolates collected in northern Cambodia from 2009 to 2017.

Methods

The sequence of pfcrt was determined for 410 P. falciparum isolates using PacBio amplicon sequencing or whole genome sequencing. Quantitative polymerase chain reaction was used to estimate pfpm2 and pfmdr1 copy number.

Results

Newly emerged PfCRT mutations increased in prevalence after the change to dihydroartemisinin-piperaquine in 2010, with >98% of parasites harboring these mutations by 2017. After 2014, the prevalence of PfCRT F145I declined, being outcompeted by parasites with less resistant, but more fit PfCRT alleles. After the change to artesunate-mefloquine, the prevalence of parasites with amplified pfpm2 decreased, with nearly half of piperaquine-resistant PfCRT mutants having single-copy pfpm2.

Conclusions

The large proportion of PfCRT mutants that lack pfpm2 amplification emphasizes the importance of including PfCRT mutations as part of molecular surveillance for piperaquine resistance in this region. Likewise, it is critical to monitor for amplified pfmdr1 in these PfCRT mutants, as increased mefloquine pressure could lead to mutants resistant to both drugs.
Matrix degradation and cell proliferation are coupled to promote invasion and escape from an engineered human breast microtumor
Authors: Rabie Emann M , Zhang Sherry X , Kourouklis Andreas P , Kilinc A Nihan , Simi Allison K , Radisky Derek C , Tien Joe , Nelson Celeste M
Published: January 2021

Metastasis, the leading cause of mortality in cancer patients, depends upon the ability of cancer cells to invade into the extracellular matrix that surrounds the primary tumor and to escape into the vasculature. To investigate the features of the microenvironment that regulate invasion and escape, we generated solid microtumors of MDA-MB-231 human breast carcinoma cells within gels of type I collagen. The microtumors were formed at defined distances adjacent to an empty cavity, which served as an artificial vessel into which the constituent tumor cells could escape. To define the relative contributions of matrix degradation and cell proliferation on invasion and escape, we used pharmacological approaches to block the activity of matrix metalloproteinases (MMPs) or to arrest the cell cycle. We found that blocking MMP activity prevents both invasion and escape of the breast cancer cells. Surprisingly, blocking proliferation increases the rate of invasion but has no effect on that of escape. We found that arresting the cell cycle increases the expression of MMPs, consistent with the increased rate of invasion. To gain additional insight into the role of cell proliferation in the invasion process, we generated microtumors from cells that express the fluorescent ubiquitination-based cell cycle indicator. We found that the cells that initiate invasions are preferentially quiescent, whereas cell proliferation is associated with the extension of invasions. These data suggest that matrix degradation and cell proliferation are coupled during the invasion and escape of human breast cancer cells and highlight the critical role of matrix proteolysis in governing tumor phenotype.
Biosynthesis of sulfonamide and sulfamate antibiotics in actinomycete
Authors: Awakawa Takayoshi , Barra Lena , Abe Ikuro
Published: January 2021

Sulfonamides and sulfamates are a group of organosulfur compounds that contain the signature sulfamoyl structural motif. These compounds were initially only known as synthetic antibacterial drugs but were later also discovered as natural products. Eight highly potent examples have been isolated from actinomycetes to date, illustrating the large biosynthetic repertoire of this bacterial genus. For the biosynthesis of these compounds, several distinct and unique biosynthetic machineries have been discovered, capable to generate the unique S–N bond. For the creation of novel, second generation natural products by biosynthetic engineering efforts, a detailed understanding of the underlying enzyme machinery toward potent structural motifs is crucial. In this review, we aim to summarize the current state of knowledge on sulfonamide and sulfamate biosynthesis. A detailed discussion for the secondary sulfamate ascamycin, the tertiary sulfonamide sulfadixiamycin A, and the secondary sulfonamide SB-203208 is provided and their bioactivities and mode of actions are discussed.
‘That would be dreadful’: The ethical, legal, and social challenges of sharing your Alzheimer’s disease biomarker and genetic testing results with others
Authors: Largent Emily A , Stites Shana D , Harkins Kristin , Karlawish Jason
Published: January 2021

Several large clinical trials are underway to discover therapies to delay or prevent the onset of dementia caused by Alzheimer’s disease (AD). A common feature of these trials is that they are testing therapies in people who do not yet have changes in memory or thinking—that is, who are cognitively unimpaired—but who have a biologically defined risk of developing dementia caused by AD. When these trials eventually succeed, it is reasonable to expect the widespread adoption of biomarker and genetic testing of cognitively unimpaired individuals into clinical practice, as well as treatment prescribed to individuals at heightened risk. Here, we report results from two qualitative studies that sought to understand with whom, why, and how individuals share their AD biomarker and genetic testing results, respectively. We found that sharing is common within the confines of close relationships. However, when sharing outside such relationships, people have multiple concerns, including stigma and discrimination. These concerns highlight the need for additional legal protections and policy changes in anticipation of the coming transformation of AD clinical care.
Recurrent intestinal obstruction due to gallstone ileus during same hospital admission: a case report and literature review
Authors: Alnahari Danah I , Almalki Sami A , Alabeidi Fahad A
Published: January 2021

Gallstone ileus (GSI) is an uncommon entity that causes obstruction of the intestinal lumen due to gallstones. It affects mainly the elderly with multiple comorbidities, leading to a high mortality rate. In this case, an 81-year-old woman was admitted due to GSI. She had a recurrence after 5 days of the index surgery. Recurrent intestinal obstruction due to GSI during the same hospitalization despite complete clearance of the small bowel from stones is rare. Through our case, we will discuss management along with a review of the current evidence.
The F-box protein MIO1/SLB1 regulates organ size and leaf movement in Medicago truncatula
Authors: Zhou Shaoli , Yang Tianquan , Mao Yawen , Liu Ye , Guo Shiqi , Wang Ruoruo , Fangyue Genwang , He Liangliang , Zhao Baolin , Bai Quanzi , Li Youhan , Zhang Xiaojia , Wang Dongfa , Wang Chaoqun , Wu Qing , Yang Yuanfan , Liu Yu , Tadege Million , Chen Jianghua
Published: January 2021

The size of leaf and seed organs, determined by the interplay of cell proliferation and expansion, is closely related to the final yield and quality of forage and crops. Yet the cellular and molecular mechanisms underlying organ size modulation remain poorly understood, especially in legumes. Here, MINI ORGAN1 (MIO1), which encodes an F-box protein SMALL LEAF AND BUSHY1 (SLB1) recently reported to control lateral branching in Medicago truncatula, was identified as a key regulator of organ size. We show that loss-of-function of MIO1/SLB1 severely reduced organ size. Conversely, plants overexpressing MIO1/SLB1 had enlarged organs. Cellular analysis revealed that MIO1/SLB1 controlled organ size mainly by modulating primary cell proliferation during the early stages of leaf development. Biochemical analysis revealed that MIO1/SLB1 could form part of SKP1/Cullin/F-box (SCF) E3 ubiquitin ligase complex, to target BIG SEEDS1 (BS1), a repressor of primary cell division, for degradation. Interestingly, we found that MIO1/SLB1 also played a key role in pulvinus development and leaf movement by modulating cell proliferation of the pulvinus as leaves developed. Our study not only demonstrates a conserved role of MIO1/SLB1 in the control of organ size in legumes, but also sheds light on the novel function of MIO1/SLB1 in leaf movement.
Epidemiology and Outcomes of Vancomycin-Resistant Enterococcus Infections in the U.S. Military Health System
Authors: Stagliano David R , Susi Apryl , Adams Daniel J , Nylund Cade M
Published: January 2021

Introduction

Vancomycin-resistant enterococci (VRE) are classified by the Centers for Diseases Control and Prevention as a serious antibiotic resistance threat. Our study aims to characterize the epidemiology, associated conditions, and outcomes of VRE infections among hospitalized patients in the U.S. military health system (MHS).

Materials and Methods

We performed a retrospective cohort study of patients with VRE infection using the MHS database. Cases included all patients admitted to a military treatment facility for ≥2 days from October 2008 to September 2015 with a clinical culture growing Enterococcus faecalis, Enterococcus faecium, or Enterococcus species (unspecified), reported as resistant to vancomycin. Co-morbid conditions and procedures associated with VRE infection were identified by multivariable conditional logistic regression. Patient case-mix adjusted outcomes including in-hospital mortality, length of stay, and hospitalization cost were evaluated by high-dimensional propensity score adjustment.

Results

During the seven-year study period and among 1,161,335 hospitalized patients within the MHS, we identified 577 (0.05%) patients with VRE infection. A majority of VRE infections were urinary tract infections (57.7%), followed by bloodstream (24.7%), other site/device-related (12.9%), respiratory (2.9%), and wound infections (1.8%). Risk factors for VRE infection included invasive gastrointestinal, pulmonary, and urologic procedures, indwelling devices, and exposure to 4th generation cephalosporins, but not to glycopeptides. Patients hospitalized with VRE infection had significantly higher hospitalization costs (attributable difference [AD] $135,534, P<0.001), prolonged hospital stays (AD 20.44 days, P<0.001, and higher in-hospital mortality (case-mix adjusted odds ratio 5.77; 95% confidence interval 4.59-7.25).

Conclusions

VRE infections carry a considerable burden for hospitalized patients given their impact on length of stay, hospitalization costs, and in-hospital mortality. Active surveillance and infection control efforts should target those identified as high-risk for VRE infection. Antimicrobial stewardship programs should focus on limiting exposure to 4th generation cephalosporins.
Enhancing Language Access: A Pilot Study to Examine the Importance of Understanding the Language Preference and Acculturalization Level in the Provision of Healthcare for Hispanics Veterans With Traumatic Brain Injury
Authors: Molina-Vicenty Irma L , Borrás-Fernandez Isabel C , Pope Charlene , Davis Boyd , Alemán-Del Toro Martha , Maldonado-Sánchez Irma , Arroyo Lillian , Jovet-Toledo Gerardo , Dismuke Clara E , Roque Alexandra , Díaz Yahaira , Resto Milagros , Rincones Alexandra , Soler-Llompart Cecilia , Acevedo Neishaliz-Díaz , Betances-Arroyo Gabriela S
Published: January 2021

Introduction

The purpose of this pilot study was to obtain preliminary data to culturally adapt the Veteran Health Administration Traumatic Brain Injury (TBI) assessment instruments for the Hispanic Veteran population. A qualitative analysis explored the cognitive processes used by Hispanic Veterans whose preferred language was Spanish to understand a specific set of screening questions within the Initial TBI Screening, the Comprehensive TBI Evaluation, the Neurobehavioral Symptom Inventory (NSI), and the La Trobe Communication Questionnaire (LTCQ).

Materials and Methods

A certified translator completed translation of the TBI instruments, an expert panel resolved inadequate expressions of the translations, and translated instruments were back translated. Male and female Hispanic Veterans with a positive TBI screening underwent a recorded administration of the TBI instruments, including LTCQ, followed by systematic debriefing using semi-structured cognitive interviews which then underwent qualitative analysis. The Marin’s Short Acculturation Scale for Hispanics, the Tropp’s Psychological Acculturation Scale, the English-Language Proficiency Test Series, and the TBI Demographic and Language Preference interview were administered to the subjects.

Results

Fifteen subjects were enrolled for the TBI instruments intervention; 11 of them completed all the additional procedures. The TBI instruments intervention seemed to produce very few variations, indicating adequate cultural equivalence. However, the LTCQ instrument showed suggested cultural variations, but did not suggest a lack of understanding or misinterpretation. The population studied displayed preferential connectedness to the Hispanic/Latino culture and to the Spanish language. The LTCQ indicated that subjects perceived themselves as having a worse execution in terms of communication skills than historical control and TBI groups. English-Language Proficiency Test Series found that most of the subject population did not demonstrate mastery of grade-appropriate basic social and academic vocabulary in English.

Conclusion

Current findings highlight the importance of using linguistically and culturally appropriate materials upon evaluating Hispanic Veterans with a suspected TBI who have Spanish as their primary or preferred language.
The Point Digit II: Mechanical Design and Testing of a Ratcheting Prosthetic Finger
Authors: Segil Jacob L , Pulver Ben , Huddle Stephen , Weir Richard F ff , Sliker Levin
Published: January 2021

Introduction

People with partial hand loss represent the largest population of upper limb amputees by a factor of 10. The available prosthetic componentry for people with digit loss provide various methods of control, kinematic designs, and functional abilities. Here, the Point Digit II is empirically tested and a discussion is provided comparing the Point Digit II with the existing commercially available prosthetic fingers.

Materials and Methods

Benchtop mechanical tests were performed using prototype Point Digit II prosthetic fingers. The battery of tests included a static load test, a static mounting tear-out test, a dynamic load test, and a dynamic cycle test. These tests were implemented to study the mechanisms within the digit and the ability of the device to withstand heavy-duty use once out in the field.

Results

The Point Digit II met or exceeded all geometric and mechanical specifications. The device can withstand over 300 lbs of force applied to the distal phalange and was cycled over 250,000 times without an adverse event representing 3 years of use. Multiple prototypes were utilized across all tests to confirm the ability to reproduce the device in a reliable manner.

Conclusions

The Point Digit II presents novel and exciting features to help those with partial hand amputation return to work and regain ability. The use of additive manufacturing, unique mechanism design, and clinically relevant design features provides both the patient and clinician with a prosthetic digit, which improves upon the existing devices available.
Soft Tissue Manipulation May Attenuate Inflammation, Modulate Pain, and Improve Gait in Conscious Rodents With Induced Low Back Pain
Authors: Loghmani M Terry , Tobin Carolyn , Quigley Colleen , Fennimore Alanna
Published: January 2021

Introduction

Low back pain (LBP) is common in warfighters. Noninvasive interventions are necessary to expedite return-to-function. Soft tissue manipulation, for example, massage, is a method used to treat LBP. Instrument-assisted soft tissue manipulation (IASTM) uses a rigid device to mobilize the tissue. This study explored the effects of IASTM on pain, function, and biomarkers.

Methods

Sprague-Dawley rats (n = 44) were randomized to groups (n = 6/grp): (A) cage control; (B) 3 days (3d) postinjury (inj), untreated; (C) 3d inj, < 30-minute post-IASTM treatment; (D) 3d inj, 2 hours (2h) post-IASTM; (E) 14 days (14d) inj, untreated; (F) 14d inj, < 30-minute post-IASTM; and (G) 14d inj, 2h post-IASTM. Researchers induced unilateral LBP in Sprague-Dawley rats using complete Freund’s adjuvant injection. Conscious rodents received IASTM for 5 min/session once at 3 days or 3×/week × 2weeks (6× total) over 14 days. Biomarker plasma levels were determined in all groups, while behavioral outcomes were assessed in two groups, D and G, at three time points: before injury, pre-, and post-IASTM treatment. Circulating mesenchymal stem cell levels were assessed using flow cytometry and cytokine plasma levels assayed.

Results

The back pressure pain threshold (PPT) lowered bilaterally at 3 days postinjury (P < .05), suggesting increased pain sensitivity. IASTM treatment lowered PPT more on the injured side (15.8%; P < 0.05). At 14 days, back PPT remained lower but similar side to side. At 3 days, paw PPT increased 34.6% in the contralateral rear limb following treatment (P < .01). Grip strength did not vary significantly. Gait coupling patterns improved significantly (P < .05). Circulating mesenchymal stem cell levels altered significantly postinjury but not with treatment. Neuropeptide Y plasma levels increased significantly at 3 days, 2h post-IASTM (53.2%) (P < .05). Interleukin-6 and tumor necrosis factor-alpha did not vary significantly. At 14 days, regulated on activation, normal T cell expressed and secreted decreased significantly <30-minute post-IASTM (96.1%, P < .002), while IL-10 trended upward at 2h (53.1%; P = .86).

Conclusions

LBP increased pain sensitivity and diminished function. IASTM treatment increased pain sensitization acutely in the back but significantly reduced pain sensitivity in the contralateral rear paw. Findings suggest IASTM may positively influence pain modulation and inflammation while improving gait patterns. Soft tissue manipulation may be beneficial as a conservative treatment option for LBP.
The Effect of Gelatin Molecular Weight on Tendon Lubrication Utilizing an Extrasynovialized Turkey Flexor Tendon Model
Authors: Forthofer, BS Michael J , Arnold, MS Katherine M , Reisdorf, BS Ramona L , Amadio, MD Peter C , Zhao, MD Chunfeng
Published: January 2021

Introduction

Flexor tendon injuries are common hand injuries among the military population often resulting in functional impairment. Flexor tendon gliding friction has been linked to adhesion formation, especially with the use of extrasynovial grafts. Carbodiimide-derivatized hyaluronic acid with gelatin (cd-HA-gelatin) can reduce gliding friction of the tendon graft; however, the effects of gelatin molecular weight (MW) have not been studied. The turkey model has been shown to better match humans, but extrasynovial tendons are unavailable. The purpose of this study was to (1) manually roughen turkey flexor digitorum profundus (FDP) tendons to simulate extrasynovial tendons and (2) investigate the effects of gelatin MW on tendon friction.

Materials and Methods

The third digit of (n = 48) turkeys were dissected with the proximal pulley, and FDP tendon and the flexor superficialis tendon were preserved. Digits were randomly assigned into four groups: one saline control and three cd-HA-gelatin-treated groups of varying gelatin MW. Flexor digitorum profundus tendon friction was measured at its original condition, serving as a baseline. Tendons were roughened using a custom rig, and tendon friction was measured again. All four groups received treatment and gliding friction was measured every 100 cycles to a total of 1,000 cycles.

Results

Tendon friction significantly increased (P < 0.05) after roughening. Friction in the saline control group increased steadily over repeated cycles, whereas friction of all gelatin-treated tendons decreased significantly compared with the saline control group (P < 0.05), maintaining low friction to 1,000 cycles representing human tendons. There was no significant difference found between gelatin-treated groups.

Conclusions

We have developed a method to roughen synovial FDP tendons to create extrasynovial-like tendons for lubrication material evaluations. Cd-HA-gelatin effectively reduces tendon friction in this model. Our data suggest medium or low MW gelatin may provide a better reduction in friction compared with high MW gelatin.
Decision Support for Tactical Combat Casualty Care Using Machine Learning to Detect Shock
Authors: Nemeth Christopher , Amos-Binks Adam , Burris Christie , Keeney Natalie , Pinevich Yuliya , Pickering Brian W , Rule Gregory , Laufersweiler Dawn , Herasevich Vitaly , Sun Mei G
Published: January 2021

Introduction

The emergence of more complex Prolonged Field Care in austere settings and the need to assist inexperienced providers’ ability to treat patients create an urgent need for effective tools to support care. We report on a project to develop a phone-/tablet-based decision support system for prehospital tactical combat casualty care that collects physiologic and other clinical data and uses machine learning to detect and differentiate shock manifestation.

Materials and Methods

Software interface development methods included literature review, rapid prototyping, and subject matter expert design requirements reviews. Machine learning algorithm methods included development of a model trained on publicly available Medical Information Mart for Intensive Care data, then on de-identified data from Mayo Clinic Intensive Care Unit.

Results

The project team interviewed 17 Army, Air Force, and Navy medical subject matter experts during design requirements review sessions. They had an average of 17 years of service in military medicine and an average of 4 deployments apiece and all had performed tactical combat casualty care on live patients during deployment. Comments provided requirements for shock identification and management in prehospital settings, including support for indication of shock probability and shock differentiation. The machine learning algorithm based on logistic regression performed best among other algorithms we tested and was able to predict shock onset 90 minutes before it occurred with better than 75% accuracy in the test dataset.

Conclusions

We expect the Trauma Triage, Treatment, and Training Decision Support system will augment a medic’s ability to make informed decisions based on salient patient data and to diagnose multiple types of shock through remotely trained, field deployed ML models.
Operationalizing the Deployment of Low-Titer O-Positive Whole Blood Within a Regional Trauma System
Authors: Schaefer Randall , Long Tasia , Wampler David , Summers Rena , Epley Eric , Waltman Elizabeth , Eastridge Brian , Jenkins Donald
Published: January 2021

Introduction

The implementation of a low-titer O+ whole blood (LTOWB) resuscitation algorithm, particularly in the prehospital environment, has several inherent challenges, including cost, limited and inconsistent supply, and the logistics of cold-chain management. The Southwest Texas Regional Advisory Council has implemented the nation’s first multidisciplinary, multi-institutional regional LTOWB program. This research effort was to illustrate the successful deployment of LTOWB within a regional trauma system.

Materials and Methods

A deliberate systems approach to the deployment of LTOWB was used. Tenets of this program included the active management of blood donor sources and blood supply levels to minimize wastage as a result of expiration, maximize product utilization, the use of prehospital transfusion triggers, and efforts to decrease program costs prehospital agencies. A novel LTOWB rotation system was established using the concept of a “rotation site” and “rotation center.” Standardized transfusion criteria, a regional approved equipment list, a regional Prehospital Blood Product Transfusion Record, and a robust multilevel communication plan serves as the framework for the program. The San Antonio Whole Blood Consortium was developed to create a consensus driven forum to manage and guide the program.

Results

From January 2018 to October 2019, LTOWB has been placed at 18 helicopter emergency medical services (HEMS) bases, 12 ground emergency medical service (EMS) agencies, 1 level I trauma center, and 1 level IV trauma center. A total of 450 patients have received a prehospital LTOWB transfusion. Program wide, the wastage rate of LTOWB due to expiration is between 1% and 2%. No complications related to prehospital LTOWB administration have been identified.

Discussion

This work demonstrates a novel model for the development of a trauma system LTOWB program. The program’s implementation augments remote damage control resuscitation strategies and requires the integration and collaboration of a multidisciplinary stakeholder team to optimize efficiency, performance, and safety of the program.
Pars Plana Vitrectomy following Traumatic Ocular Injury and Initial Globe Repair: A Retrospective Analysis of Clinical Outcomes
Authors: Phillips Hunter H , Blegen IV Halward J , Anthony Christopher , Davies Brett W , Wedel Marissa L , Reed Donovan S
Published: January 2021

Introduction

Penetrating and perforating ocular trauma are often devastating and may lead to complete visual loss in the traumatized eye and subsequent compromise of the fellow eye. A significant proportion of traumatic injuries are complex, often requiring vitreoretinal intervention to preserve vision. A retrospective analysis at a level 1 trauma center was performed to evaluate the time course, incidence, and outcomes following pars plana vitrectomy (PPV) after traumatic ocular injury and initial globe repair.

Materials and Methods

Eyes that underwent open globe repair following ocular trauma at Brooke Army Medical Center, between January 1, 2014 and December 30, 2016 were analyzed. Specific factors evaluated include mechanism of injury, defect size and complexity, ocular trauma score, zone of injury, associated orbital trauma, and time from injury to surgical intervention. A subset analysis was conducted specifically on eyes requiring subsequent PPV for vision preservation because of vitreoretinal disease. Surgical outcomes, time to secondary intervention, and complication rates were then assessed.

Results

In total, 70 eyes requiring open globe repair were examined, with 43 having undergone PPV. Average and median time to vitrectomy were 18.8 and 8 days, respectively. Eyes that underwent PPV were more likely to have an afferent papillary defect, vitreous hemorrhage, intraocular foreign body, and retinal detachment at the time of initial injury (although the latter two factors were not statistically significant), and were more likely to receive penetrating keratoplasty. Proliferative vitreoretinopathy occurred in 37.2% of eyes that underwent PPV, versus 3.7% of those that did not (P = 0.0013). Timing of PPV (i.e., before or after 14 days) had no statistically significant effect on the rate of PVR (Table I). Eyes that underwent PPV showed an improvement of visual acuity from average 2.5 logMAR following initial injury to 1.5 logMAR 6 months after PPV, equivalent to 18.7 Early Treatment Diabetic Retinopathy Study (ETDRS) letters gained, versus 37.7 ETDRS letters gained in eyes without PPV. Among PPV eyes, early repair (<14 days) was associated with greater improvement in visual acuity.

Conclusion

Overall, patients requiring PPV following open globe repair generally had more severe injuries and worse 6-month postoperative visual acuity. Patients who underwent more expedited vitrectomy showed greater improvement in visual acuity as measured by ETDRS letters gained.