bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of β-blocker use with survival and pulmonary function in patients with chronic obstructive pulmonary and cardiovascular disease: a systematic review and meta-analysis
Authors: Yang Yan-Li , Xiang Zi-Jian , Yang Jing-Hua , Wang Wen-Jie , Xu Zhi-Chun , Xiang Ruo-Lan
Published: September 2020

Aims

The aim of this study was to clarify the effect of β-blockers (BBs) on respiratory function and survival in patients with chronic obstructive pulmonary disease with cardiovascular disease (CVD), as well as the difference between the effects of cardioselective and noncardioselective BBs.

Methods and results

We searched for relevant literature in four electronic databases, namely, PubMed, EMBASE, Cochrane Library, and Web of Science, and compared the differences in various survival indicators between patients with chronic obstructive pulmonary disease taking BBs and those not taking BBs. Forty-nine studies were included, with a total sample size of 670 594. Among these, 12 studies were randomized controlled trials (RCTs; seven crossover and five parallel RCTs) and 37 studies were observational (including four post hoc analyses of data from RCTs). The hazard ratios (HRs) of chronic obstructive pulmonary disease exacerbation between patients with chronic obstructive pulmonary disease who were not treated with BBs and those who were treated with BBs, cardioselective BBs, and noncardioselective BBs were 0.77 [95% confidence interval (CI) 0.67, 0.89], 0.72 [95% CI 0.56, 0.94], and 0.98 [95% CI 0.71, 1.34, respectively] (HRs <1 indicate favouring BB therapy). The HRs of all-cause mortality between patients with chronic obstructive pulmonary disease who were not treated with BBs and those who were treated with BBs, cardioselective BBs, and noncardioselective BBs were 0.70 [95% CI 0.59, 0.83], 0.60 [95% CI 0.48, 0.76], and 0.74 [95% CI 0.60, 0.90], respectively (HRs <1 indicate favouring BB therapy). Patients with Chronic obstructive pulmonary disease treated with cardioselective BBs showed no difference in ventilation effect after the use of an agonist, in comparison with placebo. The difference in mean change in forced expiratory volume in 1 s was 0.06 [95% CI −0.02, 0.14].

Conclusion

The use of BBs in patients with chronic obstructive pulmonary disease is not only safe but also reduces their all-cause and in-hospital mortality. Cardioselective BBs may even reduce chronic obstructive pulmonary disease exacerbations. In addition, cardioselective BBs do not affect the action of bronchodilators. Importantly, BBs reduce the heart rate acceleration caused by bronchodilators. BBs should be prescribed freely when indicated in patients with chronic obstructive pulmonary disease and heart disease.
De Novo Gene Birth, Horizontal Gene Transfer, and Gene Duplication as Sources of New Gene Families Associated with the Origin of Symbiosis inAmanita
Authors: Wang Yen-Wen , Hess Jaqueline , Slot Jason C , Pringle Anne
Published: September 2020

By introducing novel capacities and functions, new genes and gene families may play a crucial role in ecological transitions. Mechanisms generating new gene families include de novo gene birth, horizontal gene transfer, and neofunctionalization following a duplication event. The ectomycorrhizal (ECM) symbiosis is a ubiquitous mutualism and the association has evolved repeatedly and independently many times among the fungi, but the evolutionary dynamics enabling its emergence remain elusive. We developed a phylogenetic workflow to first understand if gene families unique to ECM Amanita fungi and absent from closely related asymbiotic species are functionally relevant to the symbiosis, and then to systematically infer their origins. We identified 109 gene families unique to ECM Amanita species. Genes belonging to unique gene families are under strong purifying selection and are upregulated during symbiosis, compared with genes of conserved or orphan gene families. The origins of seven of the unique gene families are strongly supported as either de novo gene birth (two gene families), horizontal gene transfer (four), or gene duplication (one). An additional 34 families appear new because of their selective retention within symbiotic species. Among the 109 unique gene families, the most upregulated gene in symbiotic cultures encodes a 1-aminocyclopropane-1-carboxylate deaminase, an enzyme capable of downregulating the synthesis of the plant hormone ethylene, a common negative regulator of plant-microbial mutualisms.
A new solution approach to the Serre equations
Authors: Jang T S
Published: September 2020

This paper concerns constructing a semi-analytic solution procedure for integrating the fully non-linear Serre equations (or 1D Green–Naghdi equations for constant water depth). The validity of the solution procedure is checked by investigating a moving solitary wave for which the analytical solution is known. The semi-analytic procedure constructed in this study is confirmed to be good at observing non-linear wave phenomena of the collision of a sufficiently high-amplitude solitary wave with a vertical wall. The simulated results are in a good agreement with data of other authors. Further, the procedure simulates the non-linear interaction of four solitary waves, which enables us to investigate the repeated reflection of a single solitary wave between two vertical walls.
Birational Geometry of Blow-ups of Projective Spaces Along Points and Lines
Authors: He Zhuang , Yang Lei
Published: September 2020

Consider the blow-up $X$ of ${\mathbb{P}}^3$ at $6$ points in very general position and the $15$ lines through the $6$ points. We construct an infinite-order pseudo-automorphism $\phi _X$ on $X$. The effective cone of $X$ has infinitely many extremal rays and, hence, $X$ is not a Mori Dream Space. The threefold $X$ has a unique anticanonical section, which is a Jacobian K3 Kummer surface $S$ of Picard number 17. The restriction of $\phi _X$ on $S$ realizes one of Keum’s 192 infinite-order automorphisms. We show the blow-up of ${\mathbb{P}}^n$ ($n\geq 3$) at $(n+3)$ very general points and certain $9$ lines through them is not a Mori Dream Space. As an application, for $n\geq 7$, the blow-up of $\overline{M}_{0,n}$ at a very general point has infinitely many extremal effective divisors.
Selection for increased cranial capacity in small mammals during a century of urbanization
Authors: DePasquale C , Li X , Harold M , Mueller S , McLaren S , Mahan C
Published: September 2020

Urbanization is a selective force that is known to drive changes in the population dynamics of wildlife. How animals adapt to changing environmental conditions is crucial to their survival in these environments. Relative brain size, or cranial capacity, is a known proxy of behavioral flexibility, and can be used to assess how well a species has adapted to a particular environment. We examined changes in cranial capacity in a time series of small mammal skulls collected from urban and rural populations in southwestern Pennsylvania. Skulls from urban populations were collected from Allegheny County, an area that experienced rapid urbanization over the past century, and skulls of rural populations from the Powdermill Nature Reserve of the Carnegie Museum, which has remained relatively unchanged forest over the same period. Our results show that Peromyscus leucopus and Microtus pennsylvanicus from urban populations had significantly greater cranial capacity than their rural counterparts, but the opposite was true for Eptesicus fuscus. We found no difference in relative cranial capacity across time in any of the small mammal species. Our results suggest that a larger cranial capacity is selected for in an urban environment and reinforces the hypothesis that behavioral flexibility is important for animals to adapt to novel environments.
Pulmonary herniation after minimally invasive cardiac surgery: review and implications from a series of 20 cases
Authors: Cetinkaya Ayse , Zeriouh Mohamed , Liakopoulos Oliver-Joannis , Hein Stefan , Siemons Tamor , Bramlage Peter , Schönburg Markus , Choi Yeong-Hoon , Richter Manfred
Published: September 2020

Minimally invasive cardiac surgery (MICS) via right lateral mini thoracotomy is the gold standard treatment approach for mitral and tricuspid valve disorders. Other selected procedures (e.g. transapical aortic valve implantation, MIDCAB) require a left lateral mini thoracotomy for surgical access. Advantages of MICS over complete sternotomy are well known, but access-related complications post MICS, such as pulmonary herniation, are often underestimated/overlooked. In males, a pulmonary herniation in the proximity of the former thoracotomy is often clinically visible, especially when the intrathoracic pressure rises (e.g. during coughing). In females, clinical symptoms may be hidden by the breast and patients often have unspecific complaints or occasional pain when coughing, making identification of a lung herniation more difficult. Chest computed tomography is the diagnostic tool of choice for pulmonary herniations. Using a series of 20 patients with pulmonary herniation post MICS, we report our findings in diagnosis and treatment of this condition.
Dissecting the role of a plant-specific Rab5 small GTPase NbRabF1 in Bamboo mosaic virus infection
Authors: Huang Ying-Ping , Hou Pei-Yu , Chen I-Hsuan , Hsu Yau-Huei , Tsai Ching-Hsiu , Cheng Chi-Ping
Published: September 2020

NbRabF1, a small GTPase from Nicotiana benthamiana and a homolog of Arabidopsis thaliana Ara6, plays a key role in regulating Bamboo mosaic virus (BaMV) movement by vesicle transport between endosomal membranes. Reducing the expression of NbRabF1 in N. benthamiana by virus-induced gene silencing decreased the accumulation of BaMV, and with smaller infection foci on inoculated leaves, but had no effect in protoplasts. Furthermore, transient expression of NbRabF1 increased the accumulation of BaMV in inoculated leaves. Thus, NbRabF1 may be involved in the cell-to-cell movement of BaMV. The potential acyl modification sites at the second and third amino acid positions of NbRabF1 were crucial for membrane targeting and BaMV accumulation. The localization of mutant forms of NbRabF1 with the GDP-bound (donor site) and GTP-bound (acceptor site) suggested that NbRabF1 might regulate vesicle trafficking between the Golgi apparatus and plasma membrane. Furthermore, GTPase activity could also be involved in BaMV cell-to-cell movement. Overall, in this study, we identified a small GTPase, NbRabF1, from N. benthamiana that interacts with its activation protein NbRabGAP1 and regulates vesicle transport from the Golgi apparatus to the plasma membrane. We suggest that the BaMV movement complex might move from cell to cell through this vesicle trafficking route.
Intermittent AGN episodes drive outflows with a large spread of observable loading factors
Authors: Zubovas Kastytis , Nardini Emanuele
Published: September 2020

The properties of large-scale galactic outflows, such as their kinetic energy and momentum rates, correlate with the luminosity of the active galactic nucleus (AGN). This is well explained by the wind-driven outflow model, where a fraction of the AGN luminosity drives the outflow. However, significant departures from these correlations have been observed in a number of galaxies. This may happen because AGN luminosity varies on a much shorter time-scale (∼104–105 yr) than outflow properties do (∼106 yr). We investigate the effect of AGN luminosity variations on outflow properties using 1D numerical simulations. This effect can explain the very weak outflow in PDS 456: if its nucleus is currently much brighter than the long-term average luminosity, the outflow has not had time to react to this luminosity change. Conversely, the outflow in Mrk 231 is consistent with being driven by an almost continuous AGN, while IRAS F11119+3257 represents an intermediate case between the two. Considering a population of AGN, we find that very low momentum loading factors $\dot{p}_{\rm out} \lt L_{\rm AGN}/c$ should be seen in a significant fraction of objects – up to $15{{\ \rm per\ cent}}$ depending on the properties of AGN variability and galaxy gas fraction. The predicted distribution of loading factors is consistent with the available observational data. We discuss how this model might help constrain the duty cycles of AGN during the period of outflow inflation, implications for multiphase, and spatially distinct outflows, and suggest ways of improving AGN prescriptions in numerical simulations.
Stellar scattering and the formation of exponential discs in self-gravitating systems
Authors: Wu Jian , Struck Curtis , D’Onghia Elena , Elmegreen Bruce G
Published: September 2020

We show, using the N-body code gadget-2, that stellar scattering by massive clumps can produce exponential discs, and the effectiveness of the process depends on the mass of scattering centres, as well as the stability of the galactic disc. Heavy, dense scattering centres in a less stable disc generate an exponential profile quickly, with a time-scale shorter than 1 Gyr. The profile evolution due to scattering can make a near-exponential disc under various initial stellar distributions. This result supports analytic theories that predict the scattering processes always favour the zero entropy gradient solution to the Jeans/Poisson equations, whose profile is a near-exponential. Profile changes are accompanied by disc thickening, and a power-law increase in stellar velocity dispersion in both vertical and radial directions is also observed through the evolution. Close encounters between stars and clumps can produce abrupt changes in stellar orbits and shift stars radially. These events can make trajectories more eccentric, but many leave eccentricities little changed. On average, orbital eccentricities of stars increase moderately with time.
A new understanding of L4 and L5 axial orbits through the torus structure
Authors: Qi Yi , de Ruiter Anton
Published: September 2020

In this paper, through the critical isosurface of the pseudo-Hamiltonian of co-orbital motions in the torus space, we provide a new understanding of L4 and L5 axial orbits and their invariant manifolds in the circular restricted three-body problem. The contact points on the critical isosurface of the pseudo-Hamiltonian correspond to the locations of L4 and L5 axial orbits in the torus space, and provide a set of good initial guesses of L4 and L5 axial orbits for the multiple shooting method. Furthermore, we calculate and analyse orbital behaviours of L4 and L5 axial orbit families. Based on the topological structure of the critical isosurface of the pseudo-Hamiltonian, compound dynamical motions of invariant manifolds associated with L4 and L5 axial orbits are discussed. We present an approximate estimation for libration amplitudes of different co-orbital portions of invariant manifolds. Results obtained from numerical integration demonstrate the validity of our semi-analytical approach in the torus space..
The completed SDSS-IV extended Baryon Oscillation Spectroscopic Survey: BAO and RSD measurements from the anisotropic power spectrum of the quasar sample between redshift 0.8 and 2.2
Authors: Neveux Richard , Burtin Etienne , de Mattia Arnaud , Smith Alex , Ross Ashley J , Hou Jiamin , Bautista Julian , Brinkmann Jonathan , Chuang Chia-Hsun , Dawson Kyle S , Gil-Marín Héctor , W. Lyke Brad , de la Macorra Axel , du Mas des Bourboux Hélion , Mohammad Faizan G , Müller Eva-Maria , Myers Adam D , Newman Jeffrey A , Percival Will J , Rossi Graziano , Schneider Donald , Vivek M , Zarrouk Pauline , Zhao Cheng , Zhao Gong-Bo
Published: September 2020

We measure the clustering of quasars of the final data release (DR16) of eBOSS. The sample contains $343\, 708$ quasars between redshifts 0.8 ≤ z ≤ 2.2 over $4699\, \mathrm{deg}^2$. We calculate the Legendre multipoles (0,2,4) of the anisotropic power spectrum and perform a BAO and a Full-Shape (FS) analysis at the effective redshift zeff = 1.480. The errors include systematic errors that amount to 1/3 of the statistical error. The systematic errors comprise a modelling part studied using a blind N-body mock challenge and observational effects studied with approximate mocks to account for various types of redshift smearing and fibre collisions. For the BAO analysis, we measure the transverse comoving distance DM(zeff)/rdrag = 30.60 ± 0.90 and the Hubble distance DH(zeff)/rdrag = 13.34 ± 0.60. This agrees with the configuration space analysis, and the consensus yields: DM(zeff)/rdrag = 30.69 ± 0.80 and DH(zeff)/rdrag = 13.26 ± 0.55. In the FS analysis, we fit the power spectrum using a model based on Regularised Perturbation Theory, which includes redshift space distortions and the Alcock–Paczynski effect. The results are DM(zeff)/rdrag = 30.68 ± 0.90 and DH(zeff)/rdrag = 13.52 ± 0.51 and we constrain the linear growth rate of structure f(zeff)σ8(zeff) = 0.476 ± 0.047. Our results agree with the configuration space analysis. The consensus analysis of the eBOSS quasar sample yields: DM(zeff)/rdrag = 30.21 ± 0.79, DH(zeff)/rdrag = 3.23 ± 0.47, and f(zeff)σ8(zeff) = 0.462 ± 0.045 and is consistent with a flat ΛCDM cosmological model using Planck results.
SkyMapper colours of Seyfert galaxies and Changing-Look AGN
Authors: Wolf Christian , Golding Jacob , Hon Wei Jeat , Onken Christopher A
Published: September 2020

We study the utility of broad-band colours in the SkyMapper Southern Survey for selecting Seyfert galaxies at low luminosity. We find that the u − v index, built from the ultraviolet u and violet v filters, separates normal galaxies, starburst galaxies, and type-1 active galactic nuclei (AGNs). This u − v index is not sensitive to age or metallicity in a stellar population but is instead a quenching-and-bursting indicator in galaxies and detects power-law continua in type-1 AGNs. Using over 25 000 galaxies at z < 0.1 from 6dFGS, we find a selection cut based on u − v and central u band brightness that identifies type-1 AGNs. By eyeballing 6dFGS spectra we classify new Seyfert galaxies of type 1 to 1.8. Our sample includes eight known Changing-Look AGNs (CLAGNs), two of which show such strong variability that they move across the selection cut during the 5 yr of SkyMapper observations in DR3, along mixing sequences of nuclear and host galaxy light. We identify 46 CLAGN candidates in our sample, one of which has been reported as a Type IIn supernova. We show that this transient persists for at least 5 yr and marks a flare in a Seyfert-1 period of a new CLAGN.
Data science and precision health care
Authors: Imoto Seiya , Hasegawa Takanori , Yamaguchi Rui
Published: September 2020

Precision health care plays a crucial role in an elderly society by providing personalized health care plans for improving an individual’s health conditions and preventing disease. To realize precision health care, data science is key; it allows for analyses of health-related big data. In this article, an actual analysis of time-series health check-up data is presented and as is a discussion of how personalized simulation models of health conditions are constructed and used to modify individual behavior. Future directions for precision health care based on the integration of genetic variations and the microbiome are also discussed.
Self-Reported Disability in Persons With HIV-Related Neuropathy Is Mediated by Pain Interference and Depression
Authors: Kietrys David M , Parrott James Scott , Galantino Mary Lou , Davis Tracy , Levin Todd , O’Brien Kelly K
Published: September 2020

Objective

The purpose of this study was to compare disability in people with HIV and peripheral neuropathy with those without neuropathy and explore how neuropathy and other relevant factors are associated with disability.

Methods

In this cross-sectional study, participants completed the Brief pain inventory, Beck Depression Inventory II, World Health Organization Disability Assessment Schedule (WHODAS 2.0), and a health and demographic questionnaire. Additional data were extracted from the medical record. A raw score of ≥1 on the Subjective Peripheral Neuropathy Screen questions about lower extremity numbness or paresthesia was used to identify peripheral neuropathy. Predictors of disability (as determined by association with World Health Organization Disability Assessment Schedule 2.0 scores) were evaluated bivariately and in a multivariable model. Path modeling was used to identify a parsimonious model to elucidate the mediated effects of peripheral neuropathy on disability.

Results

Participants with peripheral neuropathy had more depression symptoms, more pain (severity and interference), and higher disability scores compared with participants without neuropathy. The relationship between neuropathy and disability was mediated by pain interference and depression (standardized root mean residual = .056).

Conclusion

In this sample of people with HIV, those with lower extremity peripheral neuropathy reported more severe disability, worse pain, and more depression symptoms than those without neuropathy. The relationship between peripheral neuropathy and disability may be mediated though pain interference and depression.

Impact

Distal sensory polyneuropathy is a common comorbidity experienced by people living with HIV and frequently causes pain. This study can help providers direct care toward lessening disability experienced among people with HIV and peripheral neuropathy by targeting interventions for treatment of pain and depression.

Lay Summary

People living with HIV may experience disabling painful neuropathy. Treatment for pain and depression may help reduce the disability associated with painful neuropathy.
Housing, Mortgages, and Self-Control
Authors: Schlafmann Kathrin
Published: September 2020

Using a quantitative theoretical framework this paper analyzes how problems of self-control influence housing and mortgage decisions. The results show that people with stronger problems of self-control are less likely to become homeowners, even though houses serve as commitment for saving. The paper then investigates the welfare effects of regulating mortgage products if people differ in their degree of self-control. Holding house prices fixed, higher down payment requirements and restrictions on refinancing turn out to be beneficial to people with sufficiently strong problems of self-control, even though these policies restrict access to the commitment device.
Active support after natural disasters: a review of a microbiologist's role
Authors: Viswanathan Rajlakshmi , Chakrabarty Alok , Basu Sulagna
Published: September 2020

In the aftermath of a natural disaster, multispecialty rapid response teams are deployed to support health-related relief work. Microbiologists are often part of such teams, along with public health specialists, clinicians and entomologists, and can contribute to the response in multiple ways. The role of a microbiologist is critical not only for laboratory diagnosis of infectious diseases, but also for situational analysis and evaluation, planning, prevention and control. The task begins with risk assessment, specifically for identification of diseases epidemic and endemic to the area. Evaluation of existing laboratory setups and establishment of services where none exist is a priority, including facilitation of a tiered laboratory system. Training of laboratory staff at short notice in field settings, biosafety and biomedical waste management are niche areas where microbiologists can contribute. Emerging focus areas include establishment of modular laboratories, infection prevention and control in community evacuation centres and considerations for reopening of healthcare facilities closed due to extensive natural damage. A trained and efficient microbiologist will prove a valuable asset to provide timely and useful support for infectious disease diagnosis, prevention, control and management in the wake of natural disasters.
Dengue awareness, preventive behaviours andAedesbreeding opportunities among slums and slum-like pockets in Delhi, India: a formative assessment
Authors: Kusuma Yadlapalli S , Goswami Anil K , Babu Bontha V
Published: September 2020

Background

India is endemic for dengue. The present formative study reports awareness and practices of people regarding dengue and its prevention, personal protection behaviours and peoples’ exposure to dengue-related health promotion activities.

Methods

This is a cross-sectional study of 1194 households randomly selected from 20 slum clusters in Delhi. Data were collected from an adult member of the household through an interviewer-administered, pre-tested questionnaire. An observation checklist was used to identify potential breeding sources.

Results

People were aware that dengue is transmitted through mosquitoes and sources of breeding (clean, stagnant water -60.1%, domestic water containers -18.7%, coolers -15.0%). Each house had at least one potential source of mosquito breeding. Using mosquito repellents (83.3%) was the most common personal protection behaviour. Peoples’ participation is limited in the mosquito prevention and health promotion activities carried out by the local municipality. Still, participation resulted in positive behavioural change.

Conclusions

While people were aware of dengue transmission, preventive measures against mosquito breeding were not satisfactory. People could not relate their existing knowledge on dengue to their household surroundings, and their awareness had not been translated to behavioural change. Community participation is limited, but is significant in the prevention and control of dengue.
Covid-19 and Otologic/Neurotologic Practices: Suggestions to Improve the Safety of Surgery and Consultations
Authors: Ayache Stephane , Schmerber Sebastien
Published: September 2020

Since the beginning of 2020, the world has been confronted by the Covid-19 pandemic. The lock-down aims to limit the circulation of the virus and thus avoid overwhelming healthcare systems. Healthcare workers have had to adapt by postponing consultation and surgical activities. Otolaryngologists are particularly exposed to infection from the upper airway where the virus is highly concentrated. Literature has previously reported other human coronaviruses in the middle ear and mastoid, suggesting a risk of infection to staff during ear surgery where aerosolizing procedures are usually used. The aim of this article is to propose a strategy for planning consultations and surgeries for ear and lateral skull base diseases, in the context of the current active evolution of the pandemic and of the future gradual recovery to normal practice.
The Effect of Centers for Medicare and Medicaid’s Inpatient Psychiatric Facility Quality Reporting Program on the Use of Restraint and Seclusion
Authors: Shields Morgan C. , Busch Alisa B.
Published: September 2020

Background:

Patients in inpatient psychiatry settings are uniquely vulnerable to harm. As sources of harm, research and policy efforts have specifically focused on minimizing and eliminating restraint and seclusion. The Centers for Medicare and Medicaid’s Inpatient Psychiatric Facility Quality Reporting (IPFQR) program attempts to systematically measure and reduce restraint and seclusion. We evaluated facilities’ response to the IPFQR program and differences by ownership, hypothesizing that facilities reporting these measures for the first time will show a greater reduction and that ownership will moderate this effect.

Methods:

Using a difference-in-differences design and exploiting variation among facilities that previously reported on these measures to The Joint Commission, we examined the effect of the IPFQR public reporting program on the use and duration of restraint and seclusion from the end of 2012 through 2017.

Results:

There were a total of 9705 observations of facilities among 1841 unique facilities. Results suggest the IPFQR program reduced duration of restraint by 48.96% [95% confidence interval (95% CI), 16.69%–68.73%] and seclusion by 53.54% (95% CI, 19.71%–73.12%). There was no change in odds of zero restraint and, among for-profits only, a decrease of 36.89% (95% CI, 9.32%–56.07%) in the odds of zero seclusion.

Conclusions:

This is the first examination of the effect of the IPFQR program on restraint and seclusion, suggesting the program was successful in reducing their use. We did not find support for ownership moderating this effect. Additional research is needed to understand mechanisms of response and the impact of the program on nontargeted aspects of quality.
Practice Patterns of Physicians and Nurse Practitioners in Primary Care
Authors: Neprash Hannah T. , Smith Laura Barrie , Sheridan Bethany , Hempstead Katherine , Kozhimannil Katy B.
Published: September 2020

Background:

Primary care practices increasingly include nurse practitioners (NPs), in addition to physicians. Little is known about how the patient mix and clinical activities of colocated physicians and NPs compare.

Objectives:

To describe the clinical activities of NPs, compared with physicians.

Research Design:

We used claims and electronic health record data from athenahealth Inc., on primary care practices in 2017 and a cross-sectional analysis with practice fixed effects.

Subjects:

Patients receiving treatment from physicians and NPs within primary care practices.

Measures:

First, we measured patient characteristics (payer, age, sex, race, chronic condition count) and visit characteristics (new patient, scheduled duration, same-day visit, after-hours visit). Second, we measured procedures performed and diagnoses recorded during each visit. Finally, we measured daily quantity (visit volume, minutes scheduled for patient care, total work relative value units billed) of care.

Results:

Relative to physicians, NPs treated younger and healthier patients. NPs also had a larger share of patients who were female, non-White, and covered by Medicaid, commercial insurance, or no insurance. NPs scheduled longer appointments and treated more patients on a same-day or after-hours basis. On average, “overlapping” services—those performed by NPs and physicians within the same practice—represented 92% of all service volume. The small share of services performed exclusively by physicians reflected greater clinical intensity. On a daily basis, NPs provided fewer and less intense visits than physicians within the same practice.

Conclusions:

Our findings suggest considerable overlap between the clinical activities of colocated NPs and physicians, with some differentiation based on intensity of services provided.
Prevalence and Factors Associated With HIV and Sexually Transmitted Infections Among Female Sex Workers in Bamako, Mali
Authors: Tounkara Fatoumata Korika , Téguété Ibrahima , Guédou Fernand A. , Keita Bintou , Alary Michel
Published: September 2020

Background

We aimed to (1) estimate the prevalence of HIV and other sexually transmitted infections (STIs) among female sex workers (FSWs) in Bamako, Mali, and (2) identify factors associated with STIs including HIV infection in this population.

Methods

We analyzed baseline data from a prospective observational cohort study on cervical cancer screening, human papillomavirus, and HIV infections among FSWs 18 years or older recruited in Bamako. Multivariable log-binomial regression was used to estimate the adjusted prevalence ratios (APRs) with 95% confidence interval (95% CI) for HIV infection and STIs versus associated factors.

Results

Among 353 women participating in the study, mean age was 26.8 (±7.6) years. HIV prevalence was 20.4%, whereas 35.1% of the FSWs had at least one STI. Factors significantly associated with HIV were older age (P < 0.0001, test for trend), duration of sex work ≥6 years (APR, 1.92; 95% CI, 1.22–3.02), uneducated status (APR, 2.24; 95% CI, 1.16–4.34), less than 10 clients in the last 7 days (APR, 1.55; 95% CI, 1.02–2.34), and gonococcal (APR, 1.85; 95% CI, 1.21–2.82) and chlamydial (APR, 2.58; 95% CI, 1.44–4.62) infections. Younger age (P = 0.018, test for trend), having ≥10 clients in the last week (APR, 1.47; 95% CI, 1.11–1.94), and HIV infection (APR, 2.00; 95% CI, 1.49–2.69) were significantly associated with STIs.

Conclusions

HIV and curable STI prevalence are high among FSWs in Bamako. There is thus a need to enhance the efficiency of interventions toward FSWs in Mali to reduce the burden of HIV and STIs among them and prevent HIV spread to the general population.
Regionalization of trauma care by operative experience: Does the volume of emergent laparotomy matter?
Authors: Tang Andrew , Chehab Mohamad , Ditillo Michael , Asmar Samer , Khurrum Muhammad , Douglas Molly , Bible Letitia , Kulvatunyou Narong , Joseph Bellal
Published: September 2020

INTRODUCTION

The volume-outcome relationship led to the regionalization of trauma care. The relationship between trauma centers’ injury-specific laparotomy volume and outcomes has not been explored. The aim of our study was to examine the relationship between a trauma center’s injury-specific laparotomy volume and outcomes in blunt and penetrating trauma patients.

METHODS

We performed a (2017) analysis of the Trauma Quality Improvement Program database. We included adult (age, ≥18 years) blunt and penetrating trauma patients who required emergent laparotomies for hemorrhage control. Trauma centers were stratified based on their blunt and penetrating laparotomy volumes: high volume (HV), ≥25 cases per year; medium volume (MV), 13 to 24 cases per year; and low volume (LV), ≤12 cases per year. Multivariate regression analysis was performed to explore predictors of in-hospital mortality.

RESULTS

A total of 8,588 patients underwent emergent laparotomy for either blunt (4,936; 57.5%) or penetrating injuries (3,652; 42.5%). Overall, mean ± SD age was 40 ± 17 years, abdomen Abbreviated Injury Scale was 3 (2–4), and Injury Severity Score was 26 (17–35). For American College of Surgeons (ACS) level I centers, 50% were HV; 29%, MV; and 21%, LV. For ACS level II centers, 7% were HV; 23%, MV; and 70%, LV. For ACS level III centers, 100% were LV. On multivariate regression analysis, admission of blunt and penetrating trauma patients to HV blunt and HV penetrating centers, respectively, was independently associated with improved in-hospital mortality. High-volume blunt centers had a significantly lower time to laparotomy (72 [41–144] minutes) versus MV (81 [49–145] minutes) and LV (94 [56–158] minutes) centers (p < 0.001). The same trend was observed for HV penetrating trauma centers (35 [24–52] minutes) versus MV (46 [33–63] minutes) and LV (51 [38–69] minutes) centers (p < 0.001).

CONCLUSION

Blunt and penetrating injury patients requiring emergent laparotomy had higher survival when admitted to trauma centers with HV operative experience for their particular mechanism of injury. The regionalization of trauma care should be based on a thorough evaluation of trauma centers’ injury-specific operative experience.

LEVEL OF EVIDENCE

Prognostic, Level III; Therapeutic/Care management, Level IV.
The critical threshold value of systolic blood pressure for aortic occlusion in trauma patients in profound hemorrhagic shock
Authors: Ordoñez Carlos A. , Rodríguez Fernando , Orlas Claudia P. , Parra Michael W. , Caicedo Yaset , Guzmán Mónica , Serna José J. , Salcedo Alexander , Zogg Cheryl K. , Herrera-Escobar Juan P. , Meléndez Juan J. , Angamarca Edison , Serna Carlos A. , Martínez Diana , García Alberto F. , Brenner Megan
Published: September 2020

BACKGROUND

This study aimed to determine the critical threshold of systolic blood pressure (SBP) for aortic occlusion (AO) in severely injured patients with profound hemorrhagic shock.

METHODS

All adult patients (>15 years) undergoing AO via resuscitative endovascular balloon occlusion of the aorta (REBOA) or thoracotomy with aortic cross clamping (TACC) between 2014 and 2018 at level I trauma center were included. Patients who required cardiopulmonary resuscitation in the prehospital setting were excluded. A logistic regression analysis based on mechanism of injury, age, Injury Severity Score, REBOA/TACC, and SBP on admission was done.

RESULTS

A total of 107 patients underwent AO. In 57, TACC was performed, and in 50, REBOA was performed. Sixty patients who underwent AO developed traumatic cardiac arrest (TCA), and 47 did not (no TCA). Penetrating trauma was more prevalent in the TCA group (TCA, 90% vs. no TCA, 74%; p < 0.05) but did not modify 24-hour mortality (odds ratio, 0.51; 95% confidence interval, 0.13–2.00; p = 0.337). Overall, 24-hour mortality was 47% (50) and 52% (56) for 28-day mortality. When the SBP reached 60 mm Hg, the predicted mortality at 24 hours was more than 50% and a SBP lower than 70 mm Hg was also associated with an increased of probability of cardiac arrest.

CONCLUSION

Systolic blood pressure of 60 mm Hg appears to be the optimal value upon which AO must be performed immediately to prevent the probability of death (>50%). However, values of SBP less than 70 mm Hg also increase the probability of cardiac arrest.

LEVEL OF EVIDENCE

Therapeutic study, level IV.
Inhibitor binding influences the protonation states of histidines in SARS-CoV-2 main protease
Authors: Pavlova Anna , Lynch Diane L. , Daidone Isabella , Zanetti-Polzi Laura , Smith Micholas Dean , Chipot Chris , Kneller Daniel W. , Kovalevsky Andrey , Coates Leighton , Golosov Andrei A. , Dickson Callum J. , Velez-Vega Camilo , Duca José S. , Vermaas Josh V. , Pang Yui Tik , Acharya Atanu , Parks Jerry M. , Smith Jeremy C. , Gumbart James C.
Published: September 2020

The main protease (Mpro) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an attractive target for antiviral therapeutics. Recently, many high-resolution apo and inhibitor-bound structures of Mpro, a cysteine protease, have been determined, facilitating structure-based drug design. Mproplays a central role in the viral life cycle by catalyzing the cleavage of SARS-CoV-2 polyproteins. In addition to the catalytic dyad His41-Cys145, Mprocontains multiple histidines including His163, His164, and His172. The protonation states of these histidines and the catalytic nu-cleophile Cys145 have been debated in previous studies of SARS-CoV Mpro, but have yet to be investigated for SARS-CoV-2. In this work we have used molecular dynamics simulations to determine the structural stability of SARS-CoV-2 Mproas a function of the protonation assignments for these residues. We simulated both the apo and inhibitor-bound enzyme and found that the conformational stability of the binding site, bound inhibitors, and the hydrogen bond networks of Mproare highly sensitive to these assignments. Additionally, the two inhibitors studied, the peptidomimetic N3 and anα-ketoamide, display distinct His41/His164 protonation-state-dependent stabilities. While the apo and the N3-bound systems favored Nδ(HD) and Nϵ(HE) protonation of His41 and His164, respectively, theα-ketoamide was not stably bound in this state. Our results illustrate the importance of using appropriate histidine protonation states to accurately model the structure and dynamics of SARS-CoV-2 Mproin both the apo and inhibitor-bound states, a necessary prerequisite for drug-design efforts.
Epitope - based peptide vaccine against glycoprotein GPC precursor ofLujo virususing immunoinformatics approaches
Authors: Mohammed Arwa A. , Elkhalifa Mayada E. , Elamin Khadija E. , Mohammed Rawan A. , Ibrahim Musab E. , Dirar Amina I. , Migdar Sara H. , Hamid Maha A. , Elawad Emeirii H. , Abdelsalam Salam O. , Hassan Mohamed A.
Published: September 2020

Background

Lujo virus(LUJV) is a highly fatal human pathogen belonging to theArenaviridaefamily.Lujo viruscauses viral hemorrhagic fever (VHF). AnIn silicomolecular docking was performed on the GPC domain ofLujo virusin complex with the first CUB domain of neuropilin-2.

The aimof this study is to predict effective epitope-based vaccine against glycoprotein GPC precursor ofLujo virususing immunoinformatics approaches.

Methods and Materials

glycoprotein GPC precursor ofLujo virusSequence was retrieved from NCBI. Different prediction tools were used to analyze the nominee’s epitopes in BepiPred-2.0: Sequential B-Cell Epitope Predictor for B-cell, T-cell MHC class II & I. Then the proposed peptides were docked using Autodock 4.0 software program.

Results and Conclusions

The proposed and promising peptides FWYLNHTKL and YMFSVTLCI shows a very strong binding affinity to MHC class I & II alleles with high population coverage for the world, South Africa and Sudan. This indicates a strong potential to formulate a new vaccine, especially with the peptide YMFSVTLCI which is likely to be the first proposed epitope-based vaccine against glycoprotein GPC ofLujo virus. This study recommends an in-vivo assessment for the most promising peptides especially FWYLNHTKL, YMFSVTLCI and LPCPKPHRLR.
Foraging strategies under extreme events: Contrasting adaptations by benthic macrofauna to drastic biogeochemical disturbance
Authors: Wang Yiming V. , Lebrato Mario , Tseng Li-Chun , Larsen Thomas , Smith-Sánchez Nicolás , Lee Pei-Wen , Molinero Juan-Carlos , Hwang Jiang-Shiou , Chan Tin-Yam , Garbe-Schönberg Dieter
Published: September 2020

Extreme events caused by global change are increasingly affecting the ocean’s biogeochemical cycling and ecosystem functioning, but it is challenging to observe how food webs respond to rapid habitat disturbances. Benthic communities are particularly vulnerable because their habitats are easily affected by extreme events. Here, we examined how benthic macrofauna responded to a “near shutdown” of shallow marine hydrothermal vents, triggered by M5.8 earthquake and C5 typhoon events. Despite reduced vent fluxes, we shows that the endemic vent crab Xenograpsus testudinatus continued to rely on chemosynthetic sulfur bacteria rather than photosynthetic sources. We posit this obligate nutritional dependence caused a population decline of vent crabs. In contrast, the non-endemic mollusks exhibited much greater dietary plasticity with no detectable impact on the population. Our study based on naturally occurring extreme events exemplifies how specialist species in marine system are particularly vulnerable to the unprecedented evolutionary and environmental pressures exerted by human activities worldwide.
Deletion of Stim1 in hypothalamic arcuate nucleus Kiss1 neurons potentiates synchronous GCaMP activity and protects against diet-induced obesity
Authors: Qiu Jian , Stincic Todd L. , Bosch Martha A. , Connors Ashley M. , Petrie Stefanie Kaech , Rønnekleiv Oline K. , Kelly Martin J.
Published: September 2020

Kisspeptin (Kiss1) neurons are essential for reproduction, but their role in the control of energy balance and other homeostatic functions remains unclear. High frequency firing of hypothalamic arcuate Kiss1 (Kiss1ARH) neurons releases kisspeptin into the median eminence, and neurokinin B (NKB) and dynorphin onto neighboring Kiss1ARHneurons to generate a slow excitatory postsynaptic potential (EPSP) mediated by TRPC5 channels that entrains intermittent, synchronous firing of Kiss1ARHneurons. High frequency optogenetic stimulation of Kiss1ARHneurons releases glutamate to excite the anorexigenic proopiomelanocortin (POMC) neurons and inhibit the orexigenic neuropeptide Y/agouti-related peptide (AgRP) neurons via metabotropic glutamate receptors. At the molecular level, the endoplasmic reticulum calcium-sensing protein stromal interaction molecule 1 (STIM1) is critically involved in the regulation of neuronal Ca2+signaling and neuronal excitability through its interaction with plasma membrane calcium (e.g., TRPC) channels. 17β-estradiol (E2) downregulatesStim1mRNA expression in female arcuate neurons. Therefore, we hypothesized that deletion ofStim1in Kiss1ARHneurons would increase neuronal excitability and their synchronous firing, which ultimately would affect energy homeostasis. Using optogenetics in combination with whole-cell recording and GCaMP6 imaging in slices, we discovered that the deletion ofStim1in Kiss1 neurons significantly increased the amplitude of the slow EPSP and augmented synchronous [Ca2+]i oscillations in Kiss1ARHneurons. Deletion ofStim1in Kiss1ARHneurons amplified the actions of NKB and protected ovariectomized female mice from developing obesity and glucose intolerance with high-fat dieting. Therefore, STIM1 appears to play a critical role in regulating synchronous firing of Kiss1ARHneurons, which ultimately affects energy homeostasis.

Significance Statement

Hypothalamic arcuate kisspeptin (Kiss1ARH) neurons are essential for stimulating the pulsatile release of gonadotropin releasing hormone (GnRH) and maintaining fertility. However, Kiss1ARHneurons appear to be a key player in coordinating energy balance with reproduction. The regulation of calcium channels and hence calcium signaling is critically dependent on the endoplasmic reticulum calcium-sensing protein stromal interaction molecule 1 (STIM1), which interacts with the plasma membrane calcium channels. We have conditionally deletedStim1in Kiss1ARHneurons and found that it significantly increased the excitability of Kiss1ARHneurons and protected ovariectomized female mice from developing obesity and glucose intolerance with high-fat dieting.
ImmunoCluster: A computational framework for the non-specialist to profile cellular heterogeneity in cytometry datasets
Authors: Opzoomer James W. , Timms Jessica , Blighe Kevin , Mourikis Thanos P. , Chapuis Nicolas , Bekoe Richard , Kareemaghay Sedigeh , Nocerino Paola , Apollonio Benedetta , Ramsay Alan G. , Tavassoli Mahvash , Harrison Claire , Ciccarelli Francesca , Parker Peter , Fontenay Michaela , Barber Paul R. , Arnold James N. , Kordasti Shahram
Published: September 2020

High dimensional cytometry is an innovative tool for immune monitoring in health and disease, it has provided novel insight into the underlying biology as well as biomarkers for a variety of diseases. However, the analysis of multiparametric “big data” usually requires specialist computational knowledge. Here we describeImmunoCluster (https://github.com/kordastilab/ImmunoCluster)an R package for immune profiling cellular heterogeneity in high dimensional liquid and imaging mass cytometry, and flow cytometry data, designed to facilitate computational analysis by a non-specialist. The analysis framework implemented withinImmunoClusteris readily scalable to millions of cells and provides a variety of visualization and analytical approaches, as well as a rich array of plotting tools that can be tailored to users’ needs. The protocol consists of three core computational stages: 1, data import and quality control, 2, dimensionality reduction and unsupervised clustering; and 3, annotation and differential testing, all contained within an R-based open-source framework.
Physiological System Dysregulation in Gene Expression Correlates Negatively with Age
Authors: Dufour Frédérik , Jacques Pierre-Étienne , Cohen Alan A.
Published: September 2020

We attempted to identify gene expression systems that dysregulate with age in human peripheral blood samples across five public datasets. Dysregulation of gene ontology (GO)-defined systems was measured using the Mahalanobis distance (DM), a measure of multivariant aberrance. We expected many weak positive DM-age correlations, indicating loss of homeostatic control. Out of the 5180 GO terms tested, we found 230 systems that replicated in at least three datasets. Surprisingly, all 230 systems showed negative DM-age correlations, in contrast to findings with clinical biomarkers. These systems were mostly metabolic functions related to small molecules and nitrogen compounds, transport functions, biosynthetic processes and response to stress functions. These results suggest a loss of responsiveness in these gene expression systems during the aging process, and contrast to some previous literature showing increased gene expression heterogeneity with age.