bluuebunny/crossref_metadata_2025 huggingface dataset:
EOS-ESTM: a flexible climate model for habitable exoplanets
Authors: Biasiotti L , Simonetti P , Vladilo G , Silva L , Murante G , Ivanovski S , Maris M , Monai S , Bisesi E , von Hardenberg J , Provenzale A
Published: June 2022

Rocky planets with temperate conditions provide the best chance for discovering habitable worlds and life outside the Solar system. In the last decades, new instrumental facilities and large observational campaigns have been driven by the quest for habitable worlds. Climate models aimed at studying the habitability of rocky planets are essential tools to pay off these technological and observational endeavours. In this context, we present eos-estm, a fast and flexible model aimed at exploring the impact on habitability of multiple climate factors, including those unconstrained by observations. eos-estm is built on estm, a seasonal-latitudinal energy balance model featuring an advanced treatment of the meridional and vertical transport. The novel features of eos-estm include: (1) parametrizations for simulating the climate impact of oceans, land, ice, and clouds as a function of temperature and stellar zenith distance and (2) a procedure (eos) for calculating the radiative transfer in atmospheres with terrestrial and non-terrestrial compositions illuminated by solar- and non-solar-type stars. By feeding eos-estm with Earth’s stellar, orbital, and planetary parameters, we derive a reference model that satisfies a large number of observational constraints of the Earth’s climate system. Validation tests of non-terrestrial conditions yield predictions that are in line with comparable results obtained with a hierarchy of climate models. The application of eos-estm to planetary atmospheres in maximum greenhouse conditions demonstrates the possibility of tracking the snowball transition at the outer edge of the HZ for a variety of planetary parameters, paving the road for multiparametric studies of the HZ.
Modeling the kinematics of globular cluster systems
Authors: Chen Yingtian , Gnedin Oleg Y
Published: June 2022

Globular clusters (GCs) are old massive star clusters that serve as ‘fossils’ of galaxy formation. The advent of Gaia observatory has enabled detailed kinematics studies of the Galactic GCs and revolutionized our understanding of the connections between GC properties and galaxy assembly. However, lack of kinematic measurements of extragalactic GCs limits the sample size of GC systems that we can fully study. In this work, we present a model for GC formation and evolution, which includes positional and kinematic information of individual GCs by assigning them to particles in the Illustris TNG50-1 simulation based on age and location. We calibrate the three adjustable model parameters using observed properties of the Galactic and extragalactic GC systems, including the distributions of position, systemic velocity, velocity dispersion, anisotropy parameter, orbital actions, and metallicities. We also analyse the properties of GCs from different origins. In outer galaxy, ex situ clusters are more dominant than the clusters formed in situ. This leads to the GC metallicities decreasing outwards due to the increasing abundance of accreted, metal-poor clusters. We also find the ex-situ GCs to have greater velocity dispersions and orbital actions, in agreement with their accretion origin.
Are superthin galaxies low-surface-brightness galaxies seen edge-on? The star formation probe
Authors: Narayanan Ganesh , Banerjee Arunima
Published: June 2022

Superthin galaxies (STs) are edge-on disc galaxies with strikingly high planar-to-vertical axes ratios of ∼10–20 with no bulge component, and central surface brightness in the B band > 23 mag arcsec−2 comparable to low-surface-brightness galaxies (LSBs). Although STs and LSBs have similar dynamical, stellar, and atomic hydrogen (H i) masses on an average, it is tricky to conclude if they constitute the same galaxy population, given the edge-on and face-on orientations of the STs and the LSBs, respectively. We systematically study star formation rate (SFR) in a sample of STs and LSBs using SED fitting of photometric data in 10 bands including GALEX: FUV, NUV, SDSS: u,g,r,i,z and 2MASS: J, H, Ks using stellar population synthesis models employing the publicly available software magphys (Multi-Wavelength Analysis of Galaxy Physical Properties). The estimated median SFRs for LSBs and STs are $0.4^{+2.2}_{-0.3}$$ and $0.2^{+0.9}_{-0.2}\, {\rm M}_{\odot }{\rm yr}^{-1}$, respectively. Our calculations indicate that this deficit in the SFR of an ST can be attributed to inclination and opacity effects. Therefore, we conclude that STs and LSBs have equal intrinsic SFR over and above other physical properties, which possibly implies that STs are just LSBs seen in edge-on.
Priors on Lagrangian bias parameters from galaxy formation modelling
Authors: Zennaro Matteo , Angulo Raul E , Contreras Sergio , Pellejero-Ibáñez Marcos , Maion Francisco
Published: June 2022

We study the relations among the parameters of the hybrid Lagrangian bias expansion model, fitting biased auto and cross power spectra up to $k_{\rm max} = 0.7 \, h \, \mathrm{Mpc}^{-1}$. We consider ∼8000 halo and galaxy samples, with different halo masses, redshifts, galaxy number densities, and varying the parameters of the galaxy formation model. Galaxy samples are obtained through state-of-the-art extended subhalo abundance matching techniques and include both stellar mass and star formation rate selected galaxies. All of these synthetic galaxy samples are publicly available. We find that the hybrid Lagrangian bias model provides accurate fits to all of our halo and galaxy samples. The coevolution relations between galaxy bias parameters, although roughly compatible with those obtained for haloes, show systematic shifts and larger scatter. We explore possible sources of this difference in terms of dependence on halo occupation and assembly bias of each sample. The bias parameter relations displayed in this work can be used as a prior for future Bayesian analyses employing the hybrid Lagrangian bias expansion model.
Phenotyping and modeling of root hydraulic architecture reveal critical determinants of axial water transport
Authors: Boursiac Yann , Pradal Christophe , Bauget Fabrice , Lucas Mikaël , Delivorias Stathis , Godin Christophe , Maurel Christophe
Published: June 2022

Water uptake by roots is a key adaptation of plants to aerial life. Water uptake depends on root system architecture (RSA) and tissue hydraulic properties that, together, shape the root hydraulic architecture. This work investigates how the interplay between conductivities along radial (e.g. aquaporins) and axial (e.g. xylem vessels) pathways determines the water transport properties of highly branched RSAs as found in adult Arabidopsis (Arabidopsis thaliana) plants. A hydraulic model named HydroRoot was developed, based on multi-scale tree graph representations of RSAs. Root water flow was measured by the pressure chamber technique after successive cuts of a same root system from the tip toward the base. HydroRoot model inversion in corresponding RSAs allowed us to concomitantly determine radial and axial conductivities, providing evidence that the latter is often overestimated by classical evaluation based on the Hagen–Poiseuille law. Organizing principles of Arabidopsis primary and lateral root growth and branching were determined and used to apply the HydroRoot model to an extended set of simulated RSAs. Sensitivity analyses revealed that water transport can be co-limited by radial and axial conductances throughout the whole RSA. The number of roots that can be sectioned (intercepted) at a given distance from the base was defined as an accessible and informative indicator of RSA. The overall set of experimental and theoretical procedures was applied to plants mutated in ESKIMO1 and previously shown to have xylem collapse. This approach will be instrumental to dissect the root water transport phenotype of plants with intricate alterations in root growth or transport functions.
Early Initiation of Sub−Anesthetic Ketamine Infusion in Adults with Vaso-Occlusive Crises Is Associated with Greater Reduction in Sickle Cell Pain Intensity: A Single Center’s Experience
Authors: Kenney Martha O , Becerra Benjamin , Mallikarjunan Arvind , Shah Nirmish , Smith Wally R
Published: June 2022

Objectives

Recurrent, severely painful episodes, known as vaso-occlusive crises (VOCs) are the hallmark of sickle cell disease (SCD) and the primary reason for hospitalization. Opioids have been the gold standard for VOC treatment without significant improvement pain outcomes. To aid analgesia and combat opioid related adverse effects (ORAEs), some SCD clinicians have trialed infusions of sub-anesthetic ketamine along with opioids to treat VOCs. In this retrospective analysis, we compared adult SCD patients who received early vs late adjunctive sub-anesthetic ketamine infusions for VOCs.

Methods

We identified adult SCD patients (age 18–50 years) who presented to Duke University with a VOC and received sub-anesthetic ketamine infusions from July 2015 to June 2019. We assessed both daily opioid consumption (measured as oral morphine milligram equivalents (MME)) and self-reported 0–10 numeric pain ratings (NPR) at 1, 2, and 3 days after infusion initiation, as well as 1 day after discontinuation.

Results

A total of 56 patients were identified with a median age of 30 years. Compared to late administration, early infusion of sub-anesthetic ketamine was associated with a 24.5% (P = .0003) and 25.9% (P = .0006) reduction, respectively, in median NPR at 1 day and 2 days after infusion initiation but did not persist at 3 days following initiation of the infusion. A statistically significant reduction in MME was not observed.

Conclusions

In a nonrandomized study of sickle cell patients with VOCs, early sub-anesthetic ketamine infusion led to greater reduction in subjective pain intensity than late initiation of the infusion. Randomized studies should further explore whether early vs late ketamine infusion improves management of acute SCD pain.
L’ingénierie juridique et le droit des sûretés OHADA
Authors: Tchotchou Petche Kamga Camille , Nfoutcha Georges
Published: June 2022

Practice constantly formulates efficient guarantees, adapted to economic and financial transactions, so much so that it feeds and inspires the law of OHADA security. With this enrichment, OHADA's security law itself becomes an instrument of legal engineering from which the parties can combine security, arranging and enrichen them within the limits set by the OHADA legislator. It can thus be said that the Uniform Act on the organization of security is a veritable “Iceberg”. Its visible part highlights known safety features, while the submerged side contains a host of possibilities for the development of guarantee agreements. You just have to be creative and subtle in order to get the best out of OHADA's safety.
Molecular epidemiology of Porcine Parvovirus Type 1 (PPV1) and the reactivity of vaccine-induced antisera against historical and current PPV1 strains
Authors: Vereecke Nick , Kvisgaard Lise Kirstine , Baele Guy , Boone Carine , Kunze Marius , Larsen Lars Erik , Theuns Sebastiaan , Nauwynck Hans
Published: June 2022

Porcine Parvovirus Type 1 (PPV1) contributes to important losses in the swine industry worldwide. During a PPV1 infection, embryos and fetuses are targeted, resulting in stillbirth, mummification, embryonic death, and infertility (SMEDI syndrome). Even though vaccination is common in gilts and sows, strains mainly belonging to the 27a-like group have been spreading in Europe since early 2000s, resulting in SMEDI problems and requiring in-depth studies into the molecular epidemiology and vaccination efficacy of commercial vaccines. Here, we show that PPV1 has evolved since 1855 [1737, 1933] at a rate of 4.71 × 10−5 nucleotide substitutions per site per year. Extensive sequencing allowed evaluating and reassessing the current PPV1 VP1-based classifications, providing evidence for the existence of four relevant phylogenetic groups. While most European strains belong to the PPV1a (G1) or PPV1b (G2 or 27a-like) group, most Asian and American G2 strains and some European strains were divided into virulent PPV1c (e.g. NADL-8) and attenuated PPV1d (e.g. NADL-2) groups. The increase in the swine population, vaccination degree, and health management (vaccination and biosafety) influenced the spread of PPV1. The reactivity of anti-PPV1 antibodies from sows vaccinated with Porcilis© Parvo, Eryseng© Parvo, or ReproCyc© ParvoFLEX against different PPV1 field strains was the highest upon vaccination with ReproCyc© ParvoFLEX, followed by Eryseng© Parvo, and Porcilis© Parvo. Our findings contribute to the evaluation of the immunogenicity of existing vaccines and support the development of new vaccine candidates. Finally, the potential roles of cluster-specific hallmark amino acids in elevated pathogenicity and viral entry are discussed.
Early Physiologic Effects of Prone Positioning in COVID-19 Acute Respiratory Distress Syndrome
Authors: Zarantonello Francesco , Sella Nicolò , Pettenuzzo Tommaso , Andreatta Giulio , Calore Alvise , Dotto Denise , De Cassai Alessandro , Calabrese Fiorella , Boscolo Annalisa , Navalesi Paolo
Published: June 2022

Background

The mechanisms underlying oxygenation improvement after prone positioning in COVID-19 acute respiratory distress syndrome have not been fully elucidated yet. The authors hypothesized that the oxygenation increase with prone positioning is secondary to the improvement of ventilation-perfusion matching.

Methods

In a series of consecutive intubated COVID-19 acute respiratory distress syndrome patients receiving volume-controlled ventilation, the authors prospectively assessed the percent variation of ventilation-perfusion matching by electrical impedance tomography before and 90 min after the first cycle of prone positioning (primary endpoint). The authors also assessed changes in the distribution and homogeneity of lung ventilation and perfusion, lung overdistention and collapse, respiratory system compliance, driving pressure, optimal positive end-expiratory pressure, as assessed by electrical impedance tomography, and the ratio of partial pressure to fraction of inspired oxygen (Pao
2/Fio
2; secondary endpoints). Data are reported as medians [25th to 75th] or percentages.

Results

The authors enrolled 30 consecutive patients, all analyzed without missing data. Compared to the supine position, prone positioning overall improved ventilation-perfusion matching from 58% [43 to 69%] to 68% [56 to 75%] (P = 0.042), with a median difference of 8.0% (95% CI, 0.1 to 16.0%). Dorsal ventilation increased from 39% [31 to 43%] to 52% [44 to 62%] (P < 0.001), while dorsal perfusion did not significantly vary. Prone positioning also reduced lung overdistension from 9% [4 to 11%] to 4% [2 to 6%] (P = 0.025), while it did not significantly affect ventilation and perfusion homogeneity, lung collapse, static respiratory system compliance, driving pressure, and optimal positive end-expiratory pressure. Pao
2/Fio
2 overall improved from 141 [104 to 182] mmHg to 235 [164 to 267] mmHg (P = 0.019). However, 9 (30%) patients were nonresponders, experiencing an increase in Pao
2/Fio
2 less than 20% with respect to baseline.

Conclusions

In COVID-19 acute respiratory distress syndrome patients, prone positioning overall produced an early increase in ventilation-perfusion matching and dorsal ventilation. These effects were, however, heterogeneous among patients.

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The Effect of Aromatherapy on Blood Pressure and Stress Responses by Inhalation and Foot Massage in Patients With Essential Hypertension
Authors: Can Çiçek Saadet , Demir Şeyma , Yılmaz Dilek , Açıkgöz Aynur , Yıldız Sedat , Yis Özgür Mehmet
Published: June 2022

A 3-arm, parallel group, randomized clinical trial examines the effect of aromatherapy through inhalation and foot massage on blood pressure and stress response in patients with essential hypertension. Lavender oil reduced blood pressure, heart rate, serum cortisol, and subjective anxiety in hypertensive patients.
Role of corneal biopsy in the management of infectious keratitis
Authors: Hudson Julia , Al-khersan Hasenin , Carletti Piero , Miller Darlene , Dubovy Sander R. , Amescua Guillermo
Published: June 2022

Purpose of review

The aim of this study was to review the existing literature and investigate the role of microbiologic culture and histopathologic examination of corneal biopsies in the management of infectious keratitis.

Recent findings

Corneal biopsy continues to be a significantly useful tool in the diagnosis and tailored management of infectious keratitis. Several techniques can be employed for tissue collection, handling and processing to optimize diagnostic yield and maximize safety, including emerging femtosecond laser-assisted biopsy.

Corneal opacities represent a significant cause of global blindness, and infectious keratitis is the most common cause. Organism identification in progressive infectious keratitis is essential for proper management. However, microbiological culture alone has a high rate of false-negative results. Records from the Bascom Palmer Eye Institute were retrospectively searched for patients between 1 January 2015, and 31 December 2019, who underwent corneal biopsy, therapeutic keratoplasty or endothelial graft removal for infectious keratitis and had specimens bisected and submitted for evaluation with both microbiologic culture and histopathologic examination. Detection of bacteria, fungus and mycobacteria was not statistically different between culture and histopathology. Microbiology and histopathology are complementary methods for the identification of causative microorganisms in corneal specimens with presumed infectious keratitis.
The Laterality of Age-Related Hearing Loss and Depression
Authors: Chern Alexander , Irace Alexandria L. , Golub Justin S.
Published: June 2022

Objective

There is a known association between hearing loss (HL) and depressive symptoms. The objective was to establish if there is a stronger association with the left or right ear.

Study Design

Cross-sectional analysis of an ongoing prospective epidemiologic cohort study

Setting

Hispanic Community Health Study (US, multicentered).

Patients

Five thousand three hundred and twenty-eight adults 2:50 years old.

Interventions

None.

Main Outcome Measures

The main outcome was depressive symptoms, measured by the 10-Item Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and defined continuously and binarily. Subjects with CESD-10 2: 10 were categorized as having clinically significant depressive symptoms (CSDS). Linear and logistic regressions were performed to assess the association between depressive symptoms and hearing in each ear, controlling for hearing aid use, age, sex, educational level, study site, geographic background, cardiovascular disease, and antidepressant use.

Results

Mean age was 58.5 ± 6.3 years. Mean pure-tone average (PTA) was 20.3 ± 11.7 dB (range = 0 – 125) in the right ear and 20.3 ± 12.4 dB (range = -2.5 to 120) in the left. Multivariable regression adjusting for covariates demonstrated significant associations between depressive symptoms and HL in both the left and right ear. For every 20-dB worsening in right ear PTA, there was 0.89-point increase in CESD-10 (95% confidence interval = 0.59 – 1.2), and odds of CSDS increased 1.31 times (1.17 – 1.46). For every 20-dB worsening in left ear PTA, there was a 0.85-point increase in CESD-10 (0.55 – 1.14), and odds of CSDS increased 1.34 times (1.20 – 1.49).

Conclusions

Worsening hearing in the right and left ears individually was associated with increased depressive symptoms and odds of CSDS. No ear laterality was demonstrated.
Prognostic Factors Influencing the Tinnitus Improvement After Idiopathic Sudden Sensorineural Hearing Loss Treatment
Authors: Li Jiahong , Qiu Zeheng , Qiu Yihong , Li Lingwei , Zheng Yiqing , Zhao Fei , Huang Xiayin , Liang Maojin , Li Yunjie , Cai Yuexin , Ou Yongkang
Published: June 2022

Purpose

Logistic regression analysis was used to explore the factors that influence tinnitus improvement after idiopathic sudden sensorineural hearing loss (ISSNHL) treatment.

Materials and Methods

In this retrospective study, 137 ISSNHL patients with tinnitus were recruited at the Sun Yatsen Memorial Hospital of Sun Yat-sen University, China. They underwent audiological examinations, vestibular assessments, tinnitus examinations, a Tinnitus Handicap Inventory (THI) assessment and ISSNHL treatments. Logistic regression analysis was performed to investigate factors that affected tinnitus improvement.

Results

Participants were divided into an effective group (73 patients) and noneffective group (64 patients) according to THI scores before and after treatment. The effective group had better averaged hearing threshold than the noneffective group (effective group vs. noneffective group: 74.47 vs. 87.66 dB HL; t = 3.03, p < 0.05). Additionally, before intervention there were significant difference in profound audiogram configuration (effective group vs. noneffective group: 17.81% vs. 46.88%, x
2 = 23.63; p < 0.001), mid tinnitus pitch (effective group vs. noneffective group: 19.18% vs. 35.94%, x
2 = 6.58; p = 0.037) and mean THI scores (effective group vs. noneffective group: 57.07 ± 22.27 vs. 36.78 ± 24.41, t = –5.09, p < 0.001) between the effective and noneffective tinnitus groups. Logistic regression analysis showed that audiogram configurations (profound audiogram: OR = 0.10, 95% CI 0.01–0.72, p = 0.022), tinnitus pitch (mid tinnitus pitch: OR = 0.16, 95% CI 0.05–0.57, p = 0.004) and THI scores (OR = 1.05, 95% CI 1.03–1.07, p < 0.001) were independent factors associated with tinnitus improvement.

Conclusion

Audiogram configuration, tinnitus pitch, and THI scores before intervention appear to be predictive of the effectiveness of acute tinnitus improvement following ISSNHL treatment.
The Relation of Cochlear Implant Electrode Array Type and Position on Continued Hearing Preservation
Authors: Perkins Elizabeth L. , Labadie Robert F. , O’Malley Matthew , Bennett Marc , Noble Jack H. , Haynes David S. , Gifford Rene´
Published: June 2022

Objective

To analyze the relationship of electrode array (EA) type and position on hearing preservation longevity following cochlear implantation.

Study Design

Retrospective chart review.

Setting

Tertiary referral center.

Patients

Adult cochlear implant recipients between 2013 and 2019 with hearing preserved postoperatively and postoperative CT scans.

Interventions

CT scan analysis of EA position. Stepwise regression to determine influence of EA position, EA type, and patient demographics on postoperative low frequency hearing.

Main Outcome Measures

Low frequency pure tone average (LFPTA), LFPTA shift, angular insertion depth, base insertion depth, scalar position, mean perimodiolar distance.

Results

Of 792 cochlear implant recipients, 121 had preoperative LFPTA <80 dB HL with 60 of the 121 (49.6%) implanted with straight, 32 (26.4%) with precurved, styletted, and 29 (24.0%) implanted precurved, nonstyletted EA. Mean follow up was 28.6 months (range 1–103). There was no statistically significant difference in activation, 6- and 12-month, and last follow-up LFPTA (125, 250, and 500 Hz) shift based on EA type (straight p = 0.302, precurved, styletted p = 0.52, precurved, nonstyletted p = 0.77). Preoperative LFPTA and age of implantation were significant predictors of LFPTA shift at activation, accounting for 30.8% of variance (F[2, 113] = 26.603, p < 0.0001). LFPTA shift at activation, scalar position, and base insertion depth were significant predictors of variability and accounted for 39.1% of variance in LFPTA shift at 6 months (F[3, 87] = 20.269, p < 0.0001). Only LFPTA shift at 12 months was found to be a significant predictor of LFPTA shift at last follow up, accounting for 41.0% of variance (F[1, 48] = 32.653, p < 0.0001).

Conclusions

Patients had excellent long-term residual hearing regardless of EA type. Age, preoperative acoustic hearing, and base insertion depth may predict short term preservation, while 12-month outcomes significantly predicted long-term hearing preservation.
The Importance of a Preinsertion Integrity Device Test of Cochlear Implants
Authors: Körtje Monika , Stöver Timo , Leinung Martin , Baumann Uwe
Published: June 2022

Objectives

The surgery of a cochlear implant is a complex interdisciplinary procedure with high quality standards to ensure patients safety and implant durability. An integrity test of the device prior to insertion is an additional tool to improve quality standards by detecting potentially malfunctioning implants without burdening the patient.

Methods

At the Department of Otorhinolaryngology, University Hospital Frankfurt a. M. (Germany) since 2010 an integrity device test (“pre-insertion telemetry”) has been performed prior to the implantation of a cochlear implant. The preinsertion telemetry measures the electrical impedances of the implant electrode contacts in conductive saline solution and thereby confirms regular bidirectional data transmission and electrode integrity. In the case of irregular results with suspected implant malfunction, the device was discarded during surgery and returned to the manufacturer for further technical review. Data and test results of the preinsertion telemetry and from rejected implants (manufacturers’ reports) between January 2010 and December 2020 were analyzed.

Results

From 2010 to 2020, 1,926 cochlear implants from three manufacturers were implanted at our institution. All implants had fully functioning bidirectional data transmission. 15 implants had irregular preinsertion telemetry results (electrode circuit failures) and were rejected during surgery. In 13 cases, the manufacturer confirmed implant malfunction. In the last 5 years, only one implant with irregular preinsertion telemetry was detected.

Conclusion

Preinsertion telemetry is strongly recommended as a quick and reliable integrity test of the device to confirm the functionality of a cochlear implant.
The Feasibility and Treatment Results of Transcanal Endoscopic Myringoplasty
Authors: Furukawa Takatoshi , Ito Tsukasa , Kubota Toshinori , Futai Kazunori , Matsui Hirooki , Kakehata Seiji
Published: June 2022

Objective

We reported on transcanal endoscopic myringoplasty in 25 cases preliminarily in 2014. Now our number of transcanal endoscopic myringoplasty reached to 209 ears and allowed us to adequately investigate the visibility, necessity of canalplasty, treatment results, and multivariate analysis.

Study Design

A prospective case series.

Setting

Tertiary referral center.

Patients

Transcanal endoscopic myringoplasty was performed on 209 ears in 201 patients between 2011 and 2019 and followed up over 1 year.

Methods

Preoperative endoscopic and microscopic views for the same patient were compared. We examined success rates at 1 year after surgery according to operation type, perforation size, operation side, gender, cause of perforation, and age, and also examined hearing results. Logistic regression analysis was performed to investigate the basic demographic and clinical characteristics of the patients associated with perforation closure.

Results

The anterior edge of the preoperative perforation was not visible under microscopy in 14.4% of patients. In contrast, endoscopic views revealed the entire tympanic membrane in one field. However, canalplasty was required in 2.4% of tympanic procedures due to difficulty of manipulation. The overall closure rate for perforations was 90.4%. Logistic regression analysis revealed that age > 11 was the only significant factor associated with perforation closure. The average reduction in air–bone gap was 12.1 dB.

Conclusion

The endoscopic myringoplasty produced better visualization, the same or better closure rates, and the same or lower complication rates as compared with traditional microscopic techniques.
Efficacy and Safety of Endoscopic Primary Prophylaxis of Bleeding in Children With High-Risk Gastroesophageal Varices
Authors: Ackermann Oanez , Darmellah-Remil Amaria , Bernard Olivier , Boytchev Isabelle , Staiti Giuseppe , Gonzalès Emmanuel , Jacquemin Emmanuel , Duché Mathieu
Published: June 2022

Objectives:

Primary prophylaxis of bleeding is debated in children with gastroesophageal varices; one of the reasons is the limited number of studies concerning its efficacy and safety. We report our experience with endoscopic primary prophylaxis.

Methods:

From 2006 to 2019, 145 children (median age, 3.5 years; cirrhosis, n = 116) with high-risk gastroesophageal varices underwent primary prophylaxis (banding, n = 114; sclerotherapy n = 31, primarily in smaller children).

Results:

We observed the eradication of varices in 93% of children after a mean of 6 months, at least one recurrence of varices in 45% after eradication, and gastrointestinal bleeding in 17% of children. Irrespective of the cause of portal hypertension, grade 3 esophageal varices, presence of gastric varices along the cardia and a lower composite score of endoscopic severity were associated with a worse probability of eradication, a longer time to eradication and a lower risk of a first recurrence and of bleeding following the procedure, respectively. Ten-year probabilities of overall survival and of bleeding-free survival were 95% and 75%, respectively.

Conclusions:

Endoscopic primary prophylaxis of variceal bleeding is reasonably effective and safe in children with high-risk gastroesophageal varices. Worse results are observed in children with more advanced endoscopic features. This pleads for endoscopic screening in children with portal hypertension and early detection of varices warranting primary prophylaxis.
Perceived Need and Acceptance of a Future Chlamydia Vaccine Among Health Care Providers
Authors: Footman Alison , Kanney Nita , Niccolai Linda M. , Zimet Gregory D. , Overton Edgar Turner , Davies Susan L. , Van Der Pol Barbara
Published: June 2022

Background

Chlamydia vaccination is a potentially important strategy to prevent infections and reduce the global burden of disease. Ideally, chlamydia immunization programs would require vaccinating adolescents before they engage in sexual activity. Communication by health care providers (HCPs) has been shown to have an impact on vaccine acceptance. Therefore, it is imperative to understand their opinions on chlamydia vaccines and factors that would promote strong vaccine recommendations to patients to promote uptake.

Methods

Semi-structured interviews with adolescent HCPs were conducted and focused on perceived need for chlamydia vaccine. Additional topics included vaccine characteristics, such as efficacy, cost, and booster vaccines, and potential vaccine recommendation strategies.

Results

From January to July 2021, 22 interviews were completed. Health care providers discussed how chlamydia vaccines are needed, especially in settings with high prevalence rates. Health care providers thought a chlamydia vaccine would need to be very efficacious in preventing infections and related sequalae and cost-effective. However, there were concerns about low completion rates if this vaccine required multiple doses or boosters. In addition, vaccine misinformation was prevalent among HCPs regarding potential benefits of vaccination.

Conclusions

Health care providers' perceptions that an adolescent chlamydia vaccine would be beneficial offers great promise for future promotion. However, there is need for targeted education programs about chlamydia and the benefits of vaccination for HCPs. These programs will be especially important in order for HCPs to effectively communicate about the benefits of vaccination to parents and adolescents provide strong vaccine recommendations.
Molecular Characterization of IDH Wild-type Diffuse Astrocytomas: The Potential of cIMPACT-NOW Guidelines
Authors: Kumari Kalpana , Dandapath Iman , Singh Jyotsna , Rai Hitesh I.S. , Kaur Kavneet , Jha Prerana , Malik Nargis , Chosdol Kunzang , Mallick Supriya , Garg Ajay , Suri Ashish , Sharma Mehar C. , Sarkar Chitra , Suri Vaishali
Published: June 2022

IDH wild-type (wt) grade 2/3 astrocytomas are a heterogenous group of tumors with disparate clinical and molecular profiles. cIMPACT-NOW recommendations incorporated in the new 2021 World Health Organization (WHO) Classification of Central Nervous System (CNS) Tumors urge minimal molecular criteria to identify a subset that has an aggressive clinical course similar to IDH-wt glioblastomas (GBMs). This paper describes the use of a panel of molecular markers to reclassify IDH-wt grade 2/3 diffuse astrocytic gliomas (DAGs) and study median overall survival concerning for to IDH-wt GBMs in the Indian cohort. IDH-wt astrocytic gliomas (grades 2, 3, and 4) confirmed by IDHR132H immunohistochemistry and IDH1/2 gene sequencing, 1p/19q non–codeleted with no H3F3A mutations were included. TERT promoter mutation by Sanger sequencing, epidermal growth factor receptor amplification, and whole chromosome 7 gain and chromosome 10 loss by fluorescence in situ hybridization was assessed and findings correlated with clinical and demographic profiles. The molecular profile of 53 IDH-wt DAGs (grade 2: 31, grade 3: 22) was analyzed. Eleven cases (grade 2: 8, grade 3: 3) (20.75%) were reclassified as IDH-wt GBMs, WHO grade 4 (TERT promoter mutation in 17%, epidermal growth factor receptor amplification in 5.5%, and whole chromosome 7 gain and chromosome 10 loss in 2%). Molecular GBMs were predominantly frontal (54.5%) with a mean age of 36 years and median overall survival equivalent to IDH-wt GBMs (18 vs. 19 mo; P=0.235). Among grade 2/3 DAGs not harboring these alterations, significantly better survival was observed for grade 2 versus grade 3 DAGs (25 vs. 16 mo; P=0.002). Through the incorporation of a panel of molecular markers, a subset of IDH-wt grade 2 DAGs can be stratified into molecular grade 4 tumors with prognostic and therapeutic implications. However, IDH-wt grade 3 DAGs behave like GBMs irrespective of molecular profile.
Comparison of State Board Disciplinary Actions in Board-Certified Versus Non-Board-Certified Physical Medicine and Rehabilitation Physicians
Authors: Robinson Lawrence R. , Raddatz Mikaela M.
Published: June 2022

Objectives

Our goals were to estimate how many physicians who were enrolled in a physical medicine and rehabilitation residency program are licensed to practice medicine without American Board of Physical Medicine and Rehabilitation board certification and to compare risk of state medical board disciplinary action with those who are board certified.

Design

We matched physicians who completed training in physical medicine and rehabilitation before 2019 with the Federation of State Medical Boards database. We compared certified versus noncertified physicians registered with Federation of State Medical Boards and frequencies of disciplinary action.

Results

There were 14,729 physicians with matched American Board of Physical Medicine and Rehabilitation and Federation of State Medical Boards data. Of these, 13,707 (93.1%) had attained initial American Board of Physical Medicine and Rehabilitation certification and 1022 (6.9%) had not. Certification status predicted a disciplinary action (odds ratio = 2.76; 95% confidence interval = 2.202–3.463; P < 0.001). Compared with the board-certified physicians, those who never passed part I (attempted once or more) were 4.68 times more likely to have a disciplinary action (P < 0.001), and those who passed part I with multiple attempts but failed part II (1 or more times) were 3.26 times more likely to have a disciplinary action (P = 0.013).

Conclusions

Absence of American Board of Physical Medicine and Rehabilitation certification is noted in approximately 7% of physicians who undertook physical medicine and rehabilitation residency training and obtained medical licensure. These individuals are at higher risk for state medical board disciplinary action.
Why Do Physical Medicine and Rehabilitation Physicians Lose American Board of Physical Medicine and Rehabilitation Board Certification?
Authors: Kinney Carolyn L. , Johns Jeffery S. , Sabharwal Sunil , Raddatz Mikaela M. , Driscoll Sherilyn W.
Published: June 2022

Objective

Physicians can lose board certification through revocation related to professionalism violations or expiration due to failure to complete continuing certification requirements. The purpose of this study was to analyze the causes of board certification loss for physicians with board certification through the American Board of Physical Medicine and Rehabilitation.

Design

This retrospective cohort study analyzed the certification status of 5541 American Board of Physical Medicine and Rehabilitation diplomates between 1993 and 2019 to determine reasons for certification loss. A focused analysis of diplomates with expired certificates in 2019 was conducted to further examine reasons for certificate expiration.

Results

Of 5541 physicians, 496 (9%) had certification expiration due to failure to meet continuing certification requirements and 60 (1%) had certification revocation due to disciplinary actions, without regaining certification across the study years. A focused analysis of physicians with expired certificates in 2019 revealed that the majority had failed to complete multiple components of continuing certification. Practice improvement was the single most common incomplete requirement. Failure to pass the knowledge assessment was an uncommon cause for certification loss.

Conclusions

Certification expiration through failure to complete all continuing certification requirements, versus revocation, is responsible for most instances of board certification loss. Practice improvement was the most common incomplete requirement.
Improving Patient Safety and Quality in Physical Medicine and Rehabilitation Through Participation in the American Board of Physical Medicine and Rehabilitation Continuing Certification Program
Authors: Sliwa James A. , Driscoll Sherilyn Whately , Robinson Lawrence R. , Walker Michelle L. , Garrison Christopher J. , Kinney Carolyn L.
Published: June 2022

The American Board of Medical Specialties Continuing Certification Program’s Improvement in Medical Practice Standard requires physicians to participate in practice improvement activities. Despite this universal requirement, there has been no assessment of this requirement or its potential impact on patient care. Because of its continuing certification oversight structure, the American Board of Physical Medicine and Rehabilitation is in a unique position to provide this assessment. Review of quality improvement projects submitted to the American Board of Physical Medicine and Rehabilitation for continuing certification compliance revealed that most diplomates (70.1%) used available topic-specific options. These projects are designed to be directive and easy to use for physicians with limited quality improvement experience. Examples of topic-directed project potential impact on patient care include preventing wrong-site injections through implementing a preprocedure timeout or decreasing opioid prescribing risk through implementation of an opioid risk assessment tool. Thirty percent of submissions described improvement efforts in other areas of practice. These projects were directed toward areas of patient care including safety, communication/education, satisfaction, processes, and outcomes. This study demonstrates the efforts of physiatrists to improve care and the potential impact of these efforts on patient care and safety through participation in continuing certification.
In vitro activity of fidaxomicin against nontuberculosis mycobacteria
Authors: Sun Qing , Liao Xinlei , Wang Chenqian , Jiang Guanglu , Yang Jing , Zhao Jianhong , Huang Hairong , Wang Guirong , Li Hao
Published: June 2022

Introduction. Nontuberculous mycobacteria (NTM) infections are increasing worldwide and are relatively resistant to many of the first- and second-line drugs to treat tuberculosis. Macrolide antibiotics, such as clarithromycin and azithromycin, are the key drugs for treating NTM infections. Fidaxomicin is a macrolide antibiotic that is widely used in treating Clostridium difficle (C.difficile) infections, and has high in vitro activity against

Mycobacterium tuberculosis

especially multidrug-resistant tuberculosis (MDR-TB) and has no cross-resistance with rifampicin.

Hypothesis. Fidaxomicin may have in vitro activity against NTM strains.

Aim. To find that whether the macrolide antibiotic fidaxomicin has in vitro activity against NTM strains.

Methodology. Fidaxomicin used in this study was firstly tested on

C. difficile

reference strains and has shown to be effective and workable. And then 28 rapidly growing mycobacteria (RGM), 12 slowly growing mycobacteria (SGM) reference strains and 103 NTM clinical isolates were tested by the microplate-based AlamarBlue assay (MABA) method to determine the MICs. Fidaxomicin, rifampicin and clarithromycin were tested against M. abcessus complex subspecies 14

M

.

abscessus

and 5

M

.

massiliense

strains for inducible resistance determination.

Results. In total, 21 out of 28 RGM and 9 of 12 SGM reference strains have the MICs of fidaxomicin at or below 1 µg ml−1. Fidaxomicin also showed low MIC values for some clinical isolates including

M. abscessus

complex,

M. avium

complex,

M. fortuitum

,

M. kansasii

and

M. parascrofulaceum

. Fidaxomicin also has no inducible macrolide resistance in

M. abscessus

complex in comparison with clarithromycin.

Conclusion. Fidaxomicin has high in vitro activity against most of the NTM reference strains and some prevalent NTM clinical isolates. This promising finding warrants further investigation on the actions of fidaxomicn in vivo and as a potential antibiotic for NTM treatment.
Contribution of prenatal exposure to ambient temperature extremes and severe maternal morbidity: A retrospective Southern birth cohort
Authors: Runkle Jennifer D. , Sugg Maggie M. , Stevens Scott E.
Published: June 2022

BACKGROUND

Health disparities have persisted in severe maternal morbidity (SMM), an event in which a woman nearly dies from a complication during pregnancy, with limited data on environmental risk factors.

OBJECTIVE

To examine the association between prenatal exposure to high and low ambient temperatures and SMM during critical windows of pregnancy for a birth cohort in the Southeastern United States.

METHODS

This retrospective, population-based birth cohort included hospital deliveries from 1999 to 2017 (570,660 women, 921,444 deliveries). Daily average temperatures at the county- scale were merged with delivery discharge records and days of exposure to very hot and very cold were estimated over the following critical windows: preconception, and first, second, and third trimesters (T1-T3). Generalized estimating equations with multivariable Poisson models examined the association between temperature extremes and SMM for each critical window.

RESULTS

Women exposed to a low compared to a high number of cold days during the first and third trimesters were 1.11 (CI: 1.03, 1.20) and 1.30 (CI: 1.20, 1.42) times more likely to experience SMM, respectively. Compared to the no exposure group, women exposed to a high number of very hot temperatures during preconception were 1.09 (95%CI:1.02,1.18) more likely to experience SMM. Sustained exposure to a high or moderate-intensity heat wave during the summer months was associated with a 45% or 39% increase in SMM risk during T2, respectively. Pregnant populations residing in rural locations were more sensitive to cold exposure in T3. Women exposed to a high number of very hot days in T2 compared to no exposure were 20% more likely to experience preterm SMM.

SIGNIFICANCE

Findings suggest that maternal exposure to hot or cold temperature extremes around the time or during pregnancy may be a contributing environmental risk factor for SMM. More attention should be focused on prenatal counseling in pregnant populations around the risk of thermal extremes.

Impact Statement

This is the first study to examine the association between severe maternal morbidity and ambient cold and hot temperature extremes. Results revealed an increase in SMM risk for pregnant individuals following unseasonably cold exposure during the first and third trimesters and exposure to hotter than average temperatures in the second trimester. Our findings suggest that maternal exposure to ambient temperature extremes is a modifiable risk factor for SMM. This study considered contextual social and environmental factors associated with increased SMM risks, such as residential segregation (a proxy for structural racism), residential poverty, and rural compared to urban differences.
Machine Learning-Based Risk Stratification for Gestational Diabetes Management
Authors: Yang Jenny , Clifton David , Hirst Jane , Kavvoura Foteini , Farah George , Mackillop Lucy , Lu Huiqi
Published: June 2022

Gestational diabetes mellitus (GDM) is often diagnosed during the last trimester of pregnancy, leaving only a short timeframe for intervention. However, appropriate assessment, management, and treatment have been shown to reduce the complications of GDM. This study introduces a machine learning-based stratification system for identifying patients at risk of exhibiting high blood glucose levels, based on daily blood glucose measurements and electronic health record (EHR) data from GDM patients. We internally trained and validated our model on a cohort of 1,148 pregnancies at Oxford University Hospitals NHS Foundation Trust (OUH), and performed external validation on 709 patients from Royal Berkshire Hospital NHS Foundation Trust (RBH). We trained linear and non-linear tree-based regression models to predict the proportion of high-readings (readings above the UK’s National Institute for Health and Care Excellence [NICE] guideline) a patient may exhibit in upcoming days, and found that XGBoost achieved the highest performance during internal validation (0.021 [CI 0.019-0.023], 0.482 [0.442-0.516], and 0.112 [0.109-0.116], for MSE, R2, MAE, respectively). The model also performed similarly during external validation, suggesting that our method is generalizable across different cohorts of GDM patients.
TMbed – Transmembrane proteins predicted through Language Model embeddings
Authors: Bernhofer Michael , Rost Burkhard
Published: June 2022

Background

Despite the immense importance of transmembrane proteins (TMP) for molecular biology and medicine, experimental 3D structures for TMPs remain about 4-5 times underrepresented compared to non-TMPs. Today’s top methods such as AlphaFold2 accurately predict 3D structures for many TMPs, but annotating transmembrane regions remains a limiting step for proteome-wide predictions.

Results

Here, we present TMbed, a novel method inputting embeddings from protein Language Models (pLMs, here ProtT5), to predict for each residue one of four classes: transmembrane helix (TMH), transmembrane strand (TMB), signal peptide, or other. TMbed completes predictions for entire proteomes within hours on a single consumer-grade desktop machine at performance levels similar or better than methods, which are using evolutionary information from multiple sequence alignments (MSAs) of protein families. On the per-protein level, TMbed correctly identified 94±8% of the beta barrel TMPs (53 of 57) and 98±1% of the alpha helical TMPs (557 of 571) in a non-redundant data set, at false positive rates well below 1% (erred on 30 of 5654 non-membrane proteins). On the per-segment level, TMbed correctly placed, on average, 9 of 10 transmembrane segments within five residues of the experimental observation. Our method can handle sequences of up to 4200 residues on standard graphics cards used in desktop PCs (e.g., NVIDIA GeForce RTX 3060).

Conclusions

Based on embeddings from pLMs and two novel filters (Gaussian and Viterbi), TMbed predicts alpha helical and beta barrel TMPs at least as accurately as any other method but at lower false positive rates. Given the few false positives and its outstanding speed, TMbed might be ideal to sieve through millions of 3D structures soon to be predicted, e.g., by AlphaFold2.

Availability

Our code, method, and data sets are freely available in the GitHub repository, https://github.com/BernhoferM/TMbed.