bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperative Indocyanine Green Angiography for Fat Necrosis Reduction in the Deep Inferior Epigastric Perforator (DIEP) Flap
Authors: Malagón-López Paloma , Vilà Jordi , Carrasco-López Cristian , García-Senosiain Oihane , Priego David , Julian Ibañez Juan F , Higueras-Suñe Carmen
Published: October 2018

Background

Fat necrosis is a frequent complication (up to 62.5%) of microsurgical breast reconstruction using the deep inferior epigastric perforator (DIEP) flap. This could have important clinical and psychological repercussions, deteriorating the results and increasing reconstruction costs.

Objectives

The aim of this study was to demonstrate the intraoperative use of indocyanine green angiography (ICGA) to reduce fat necrosis in DIEP flap.

Methods

Sixty-one patients who underwent unilateral DIEP flap procedures for breast reconstruction after oncological mastectomy were included (24 cases with intraoperative use of ICGA during surgery, 37 cases in the control group). The follow-up period was 1 year after surgery. The association between the use of ICGA and the incidence of fat necrosis in the first postoperative year, differences in fat necrosis grade (I-V), differences in fat necrosis requiring reoperation, quality of life, and patient satisfaction were analyzed.

Results

The incidence of fat necrosis was reduced from 59.5% (control group) to 29% (ICG-group) (P = 0.021) (relative risk = 0.49 [95% CI, 0.25-0.97]). The major difference was in grade II (27% vs 2.7%, P = 0.038). The number of second surgeries for fat necrosis treatment was also reduced (45.9% vs 20.8%, P = 0.046). The ICG group had higher scores on the BREAST-Q.

Conclusions

Intraoperative ICGA is a useful technique for reconstructive microsurgery that might improve patient satisfaction and reduce the incidence of fat necrosis by half as well as reduce its grade, especially in small fat necrosis cases; consequently, ICGA could reduce the number of secondary surgeries for treatment of fat necrosis.

Level of Evidence: 4
Measuring phylogenetic signal between categorical traits and phylogenies
Authors: Borges Rui , Machado João Paulo , Gomes Cidália , Rocha Ana Paula , Antunes Agostinho
Published: October 2018

Motivation

Determining whether a trait and phylogeny share some degree of phylogenetic signal is a flagship goal in evolutionary biology. Signatures of phylogenetic signal can assist the resolution of a broad range of evolutionary questions regarding the tempo and mode of phenotypic evolution. However, despite the considerable number of strategies to measure it, few and limited approaches exist for categorical traits. Here, we used the concept of Shannon entropy and propose the δ statistic for evaluating the degree of phylogenetic signal between a phylogeny and categorical traits.

Results

We validated δ as a measure of phylogenetic signal: the higher the δ-value the higher the degree of phylogenetic signal between a given tree and a trait. Based on simulated data we proposed a threshold-based classification test to pinpoint cases of phylogenetic signal. The assessment of the test’s specificity and sensitivity suggested that the δ approach should only be applied to 20 or more species. We have further tested the performance of δ in scenarios of branch length and topology uncertainty, unbiased and biased trait evolution and trait saturation. Our results showed that δ may be applied in a wide range of phylogenetic contexts. Finally, we investigated our method in 14 360 mammalian gene trees and found that olfactory receptor genes are significantly associated with the mammalian activity patterns, a result that is congruent with expectations and experiments from the literature. Our application shows that δ can successfully detect molecular signatures of phenotypic evolution. We conclude that δ represents a useful measure of phylogenetic signal since many phenotypes can only be measured in categories.

Availability and implementation

https://github.com/mrborges23/delta_statistic.

Supplementary information

Supplementary data are available at Bioinformatics online.
A framework for identifying dysregulated chromatin regulators as master regulators in human cancer
Authors: Ru Beibei , Sun Jianlong , Kang Qingzheng , Tong Yin , Zhang Jiangwen
Published: October 2018

Motivation

Chromatin regulators (CRs) are frequently dysregulated to reprogram the epigenetic landscape of the cancer genome. However, the underpinnings of the dysregulation of CRs and their downstream effectors remain to be elucidated.

Results

Here, we designed an integrated framework based on multi-omics data to identify candidate master regulatory CRs affected by genomic alterations across eight cancer types in The Cancer Genome Atlas. Most of them showed consistent activated or repressed (i.e. oncogenic or tumor-suppressive) roles in cancer initiation and progression. In order to further explore the insight mechanism of the dysregulated CRs, we developed an R package ModReg based on differential connectivity to identify CRs as modulators of transcription factors (TFs) involved in tumorigenesis. Our analysis revealed that the connectivity between TFs and their target genes (TGs) tended to be disrupted in the patients who had a high expression of oncogenic CRs or low-expression of tumor-suppressive CRs. As a proof-of-principle study, 14 (82.4%) of the top-ranked 17 driver CRs in liver cancer were able to be validated by literature mining or experiments including shRNA knockdown and dCas9-based epigenetic editing. Moreover, we confirmed that CR SIRT7 physically interacted with TF NFE2L2, and positively modulated the transcriptional program of NFE2L2 by affecting ∼64% of its TGs.

Availability and implementation

ModReg is freely accessible at http://cis.hku.hk/software/ModReg.tar.gz.

Supplementary information

Supplementary data are available at Bioinformatics online.
18β-glycyrrhetinic acid inhibited mitochondrial energy metabolism and gastric carcinogenesis through methylation-regulated TLR2 signaling pathway
Authors: Cao Donghui , Wu Yanhua , Jia Zhifang , Zhao Dan , Zhang Yangyu , Zhou Tianyu , Wu Menghui , Zhang Houjun , Tsukamoto Tetsuya , Oshima Masanobu , Jiang Jing , Cao Xueyuan
Published: October 2018

The natural phenolic substance, 18β-glycyrrhetinic acid (GRA), has shown enormous potential in the chemoprevention of cancers with rich resources and biological safety, but the GRA-regulated genetic and epigenetic profiles are unclear. Deregulated mitochondrial cellular energetics supporting higher adenosine triphosphate provisions relative to the uncontrolled proliferation of cancer cells is a cancer hallmark. The Toll-like receptor 2 (TLR2) signaling pathway has emerged as a key molecular component in gastric cancer (GC) cell proliferation and epithelial homeostasis. However, whether TLR2 influenced GC cell energy metabolism and whether the inhibition effects of GRA on GC relied on TLR2 signaling were not illustrated. In the present study, TLR2 mRNA and protein expression levels were elevated in gastric tumors in the K19-Wnt1/C2mE (Gan) mice model, GC cell lines and human GCs, and the overexpression of TLR2 was correlated with the high histological grade and was a poor prognostic factor in GC patients. Further gain and loss of function showed that TLR2 activation induced GC cell proliferation and promoted reactive oxygen species (ROS) generation, Ca2+ accumulation, oxidative phosphorylation and the electron transport chain, while blocking TLR2 inhibited mitochondrial function and energy metabolism. Furthermore, GRA pretreatment inhibited TLR2-activated GC cell proliferation, energy metabolism and carcinogenesis. In addition, expression of TLR2 was found to be downregulated by GRA through methylation regulation. Collectively, the results demonstrated that GRA inhibited gastric tumorigenesis through TLR2-accelerated energy metabolism, suggesting GRA as a promising therapeutic agency targeting TLR2 signaling in GC.
The Ambiguities of Belief and Belonging: Catholicism and the Church of the East in the Sixteenth Century
Authors: Parker Lucy
Published: October 2018

This article considers the emergence of the Chaldaean (East Syrian Catholic) Church in the 1550s, a topic of considerable relevance for scholars of eastern Christianity and of Counter-Reformation Catholicism alike. The Chaldaeans seem to present a paradox, in that they broke away from their existing Church and turned towards the papacy for support, yet continued to espouse their traditional beliefs and venerate their traditional saints, deemed heretical by Catholics. This paradox has often been attributed to the Chaldaeans’ ignorance of Catholicism, but this argument risks patronising the Chaldaeans and denying their agency. This article seeks to reconceptualise this problem, arguing that the apparent paradox largely disappears when viewed from an eastern Christian rather than a western Catholic perspective. First, an awareness of the highly tense political situation in Mesopotamia leads us to view some of the apparently contradictory Chaldaean writings as polemical and performative, rather than ignorant and confused. Secondly, it is necessary to appreciate the Chaldaeans’ own sense of religious belief and belonging, rather than trying to impose strict and exclusionary confessional boundaries upon them as if these were universal and unproblematic categories of analysis. Some of their leaders seem to have had an open-minded, perhaps even ecumenical, approach to other Christian churches. They adopted and adapted Catholicism selectively in view of their background and their particular priorities. As individual religious agents they had a greater range of possibilities than has usually been acknowledged. The article thus, from a new perspective, contributes to the scholarly ‘de-centring’ of Tridentine Catholicism.
Why are there gender inequalities in visual impairment?
Authors: Rius Ulldemolins Anna , Benach Joan , Guisasola Laura , Artazcoz Lucía
Published: October 2018

Background

In high-income countries, the prevalence of blindness and visual impairment is higher among women, regardless of age although the mechanisms that produce these gender inequalities are not well understood. The objectives of this study were to analyse gender inequalities in the prevalence of blindness and visual impairment, age of onset, diagnosed and undiagnosed status and related eye diseases among visually impaired individuals.

Methods

Data were obtained from the 2008 Spanish Survey on ‘Disability, Personal Autonomy and Dependency Situations’ (n = 213 626) participants 360 blind (160 men and 200 women), and 5560 with some visual impairment (2025 men and 3535 women). The prevalence of blindness and visual impairment, age of onset of visual impairment and diagnosed and undiagnosed eye diseases was calculated. Hierarchical multiple logistic regression models were fit to test gender differences.

Results

Women were more likely to report visual impairment (crude OR = 1.6 [95% CI: 1.56–1.74]). Prevalence of diagnosed cataract was higher among visually impaired women (crude OR = 1.4 [95% CI: 1.25–1.67]) whereas undiagnosed eye disease (crude OR = 0.7 [95% CI: 0.64–0.81]) or diagnosed glaucoma (aORsex = 0.8 [95% CI: 0.65–0.93]) were more frequent among visually impairment men. These associations were not explained by age or educational level.

Conclusions

Strong gender inequalities were observed, with a higher prevalence of visual impairment and related cataracts among women, which could be related to gender inequalities in access to health care, and undiagnosed eye disease and related glaucoma among men, which could be related to their gender socialization resulting in less frequent and effectively use of health care services.
Comparing Estimates of Fall-Related Mortality Incidence Among Older Adults in the United States
Authors: Lohman Matthew C , Sonnega Amanda J , Nicklett Emily J , Estenson Lillian , Leggett Amanda N
Published: October 2018

Background

Falls are the leading cause of injury-related mortality among older adults in the United States, but incidence and risk factors for fall-related mortality remain poorly understood. This study compared fall-related mortality incidence rate estimates from a nationally representative cohort with those from a national vital record database and identified correlates of fall-related mortality.

Methods

Cause-of-death data from the National Death Index (NDI; 1999–2011) were linked with eight waves from the Health and Retirement Study (HRS), a representative cohort of U.S. older adults (N = 20,639). Weighted fall-related mortality incidence rates were calculated and compared with estimates from the Centers for Disease Control and Prevention (CDC) vital record data. Fall-related deaths were identified using International Classification of Diseases (Version 10) codes. Person-time at risk was calculated from HRS entry until death or censoring. Cox proportional hazards models were used to identify individual-level factors associated with fall-related deaths.

Results

The overall incidence rate of fall-related mortality was greater in HRS–NDI data (51.6 deaths per 100,000; 95% confidence interval: 42.04, 63.37) compared with CDC data (42.00 deaths per 100,000; 95% confidence interval: 41.80, 42.19). Estimated differences between the two data sources were greater for men and adults aged 85 years and older. Greater age, male gender, and self-reported fall history were identified as independent risk factors for fall-related mortality.

Conclusion

Incidence rates based on aggregate vital records may substantially underestimate the occurrence of and risk for fall-related mortality differentially in men, minorities, and relatively younger adults. Cohort-based estimates of individual fall-related mortality risk are important supplements to vital record estimates.
Imaging tissues and cells beyond the diffraction limit with structured illumination microscopy and Bayesian image reconstruction
Authors: Pospíšil Jakub , Lukeš Tomáš , Bendesky Justin , Fliegel Karel , Spendier Kathrin , Hagen Guy M
Published: October 2018

Background

Structured illumination microscopy (SIM) is a family of methods in optical fluorescence microscopy that can achieve both optical sectioning and super-resolution effects. SIM is a valuable method for high-resolution imaging of fixed cells or tissues labeled with conventional fluorophores, as well as for imaging the dynamics of live cells expressing fluorescent protein constructs. In SIM, one acquires a set of images with shifting illumination patterns. This set of images is subsequently treated with image analysis algorithms to produce an image with reduced out-of-focus light (optical sectioning) and/or with improved resolution (super-resolution).

Findings

Five complete, freely available SIM datasets are presented including raw and analyzed data. We report methods for image acquisition and analysis using open-source software along with examples of the resulting images when processed with different methods. We processed the data using established optical sectioning SIM and super-resolution SIM methods and with newer Bayesian restoration approaches that we are developing.

Conclusions

Various methods for SIM data acquisition and processing are actively being developed, but complete raw data from SIM experiments are not typically published. Publically available, high-quality raw data with examples of processed results will aid researchers when developing new methods in SIM. Biologists will also find interest in the high-resolution images of animal tissues and cells we acquired. All of the data were processed with SIMToolbox, an open-source and freely available software solution for SIM.
The Role of Cannabis in the Management of Inflammatory Bowel Disease: A Review of Clinical, Scientific, and Regulatory Information
Authors: Swaminath Arun , Berlin Eric P , Cheifetz Adam , Hoffenberg Ed , Kinnucan Jami , Wingate Laura , Buchanan Sarah , Zmeter Nada , Rubin David T
Published: October 2018

There is significant interest among patients and providers in using cannabis (marijuana) and its derivatives to treat a number of chronic illnesses, including inflammatory bowel disease. Despite the Schedule I classification of cannabis by the federal government, state governments have sought ways to make cannabis available for specific medical conditions, and some states have legalized cannabis outright. This white paper summarizes the preclinical data, clinical data, safety data, and the regulatory landscape as they apply to medical cannabis use in inflammatory bowel disease. Animal models of cannabinoid chemistry and physiology give evidence of anti-inflammatory, antidiarrheal, and nociceptive-limiting properties. Human studies have found benefit in controlling symptoms and improving quality of life, but no studies have established true disease modification given the absent improvement in biomarker profiles or endoscopic healing.

Finally, this review describes the legal, regulatory, and practical hurdles to studying the risks and benefits of medical cannabis in the United States.

10.1093/ibd/izy319_video1 izy319.video1 5852852028001
A fishing ground benthic ecosystem improved during the economic crisis
Authors: Tsikopoulou Irini , Smith Chris J , Papadopoulou Nadia K , Eleftheriadou Elena , Karakassis Ioannis
Published: October 2018

Fisheries have global socioeconomic and ecological effects. Long-term ecological studies could be beneficial to ecosystem approach management and biodiversity conservation, however, they are rare. In this study, the impacts of bottom trawling on a traditional fishing ground in the Eastern Mediterranean were addressed and an improvement in diversity metrics and ecological quality status were detected and ascribed to the Greek economic crisis. After 18 years, there was a modest increase in species richness, total abundance, and ecological status in the unaffected zone and more pronounced improvement in the trawled zone pointing at a possible link to a decrease in fishing effort. This upturn emphasized the strong link between financial activities and ecology. The present study underlines the multiple and variable effects of economy not only on countries and citizens but also on the environment and ecosystem conservation and management.
Planning and implementing sexual orientation and gender identity data collection in electronic health records
Authors: Grasso Chris , McDowell Michal J , Goldhammer Hilary , Keuroghlian Alex S
Published: October 2018

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people experience significant health disparities across the life course and require health care that addresses their unique needs. Collecting information on the sexual orientation and gender identity (SO/GI) of patients and entering SO/GI data in electronic health records has been recommended by the Institute of Medicine, the Joint Commission, and the Health Resources and Services Administration as fundamental to improving access to and quality of care for LGBTQ people. Most healthcare organizations, however, have yet to implement a system to collect SO/GI data due to multiple barriers. This report addresses those concerns by presenting recommendations for planning and implementing high-quality SO/GI data collection in primary care and other health care practices based on current evidence and best practices developed by a federally qualified health center and leader in LGBTQ health care.
Acetylation of ACAP4 regulates CCL18-elicited breast cancer cell migration and invasion
Authors: Song Xiaoyu , Liu Wei , Yuan Xiao , Jiang Jiying , Wang Wanjuan , Mullen McKay , Zhao Xuannv , Zhang Yin , Liu Fusheng , Du Shihao , Rehman Adeel , Tian Ruijun , Li Jian , Frost Andra , Song Zhenwei , Green Hadiyah-Nicole , Henry Calmour , Liu Xing , Ding Xia , Wang Dongmei , Yao Xuebiao
Published: October 2018

Tumor metastasis represents the main causes of cancer-related death. Our recent study showed that chemokine CCL18 secreted from tumor-associated macrophages regulates breast tumor metastasis, but the underlying mechanisms remain less clear. Here, we show that ARF6 GTPase-activating protein ACAP4 regulates CCL18-elicited breast cancer cell migration via the acetyltransferase PCAF-mediated acetylation. CCL18 stimulation elicited breast cancer cell migration and invasion via PCAF-dependent acetylation. ACAP4 physically interacts with PCAF and is a cognate substrate of PCAF during CCL18 stimulation. The acetylation site of ACAP4 by PCAF was mapped to Lys311 by mass spectrometric analyses. Importantly, dynamic acetylation of ACAP4 is essential for CCL18-induced breast cancer cell migration and invasion, as overexpression of the persistent acetylation-mimicking or non-acetylatable ACAP4 mutant blocked CCL18-elicited cell migration and invasion. Mechanistically, the acetylation of ACAP4 at Lys311 reduced the lipid-binding activity of ACAP4 to ensure a robust and dynamic cycling of ARF6–ACAP4 complex with plasma membrane in response to CCL18 stimulation. Thus, these results present a previously undefined mechanism by which CCL18-elicited acetylation of the PH domain controls dynamic interaction between ACAP4 and plasma membrane during breast cancer cell migration and invasion.
Post-treatment Antiplatelet Therapy Reduces Risk for Delayed Cerebral Ischemia due to Aneurysmal Subarachnoid Hemorrhage
Authors: Darkwah Oppong Marvin , Gembruch Oliver , Pierscianek Daniela , Köhrmann Martin , Kleinschnitz Christoph , Deuschl Cornelius , Mönninghoff Christoph , Kaier Klaus , Forsting Michael , Sure Ulrich , Jabbarli Ramazan
Published: October 2018

BACKGROUND

Delayed cerebral ischemia (DCI) has a strong impact on outcome of patients with aneurysmal subarachnoid hemorrhage (SAH). Positive effect of antiplatelet therapy on DCI rates has been supposed upon smaller SAH series.

OBJECTIVE

To analyze the benefit/risk profile of antiplatelet use in SAH patients.

METHODS

This retrospective case–control study was based on institutional observational cohort with 994 SAH patients treated between January 2003 and June 2016. The individuals with postcoiling antiplatelet therapy (aspirin with/without clopidogrel) were compared to a control group without antiplatelet therapy. Occurrence of DCI, major/minor bleeding events in the follow-up computed tomography scans, and favorable outcome at 6 mo after SAH (modified Rankin scale < 3) were compared in both groups.

RESULTS

Of 580 patients in the final analysis, 329 patients received post-treatment antiplatelet medication. There were no significant differences between the compared groups with regard to basic outcome confounders. Aspirin use was independently associated with reduced DCI risk (P < .001, adjusted odds ratio = 0.41, 95% confidence interval 0.24-0.65) and favorable outcome (P = .02, adjusted odds ratio = 1.78, 95% confidence interval 1.06-2.98). Regarding bleeding complications, aspirin was associated only with minor bleeding events (P = .02 vs P = .51 for major bleeding events).

CONCLUSION

Regular administration of aspirin might have a positive impact on DCI risk and outcome of SAH patients, without increasing the risk for clinically relevant bleeding events. In our SAH cohort, dual antiplatelet therapy showed no additional benefit on DCI risk, but increased the likelihood of major bleeding events.
Tropical Humid Forest Biome
Authors: Queenborough Simon A.
Published: October 2018

Tropical forests, largely restricted between 23.5° south and north of the equator, are famous for both their high biological diversity and high rates of deforestation. The tropical forest biome covers about 22 million km2 of the world’s terrestrial surface (see Matthews, et al. 2000; Food and Agriculture Organization of the United Nations 2010, both cited under General Overviews). Tropical forests are characterized by a multilayered, angiosperm-dominated canopy, with high species richness and varied life forms (including herbs, shrubs, epiphytes, lianas, and trees). Rainfall seasonality is the primary driver of the four main types of forest physiognomy, along with temperature: Closed canopy rain forest, moist deciduous forest, dry forest and savanna, and upland or montane forest. In this bibliography, we focus mostly on tropical rain forest and tropical humid forest—forest that receives substantial rainfall with or without a dry season—where most research has been conducted. Abundant tree families in the Neotropics include Fabaceae, Arecaceae, and Lecythidaceae, whereas Dipterocarpaceae, Euphorbiaceae, and Meliaceae are abundant in the Paleotropics; dominance by a single species is rare. Tropical forests are estimated to contain at least half of all known plant species. This diversity has led to the intense study of the evolution of diversity, mechanisms of species coexistence, and plant–animal interactions. Tropical forests are usually highly productive and have long been populated by people. However, more recent conversion of tropical forests to arable land and pastures have led to the loss of 0.45 percent per year of tropical forest cover, which has stark implications for forest fragmentation, biodiversity, and climate change (see Ramankutty, et al. 2008, cited under Tropical Forest Extent and Loss; Food and Agriculture Organization of the United Nations 2010, cited under General Overviews; Malhi, et al. 2014 and Lewis, et al. 2015, both cited under Tropical Forest Extent and Loss).
Febrile Neutropenia and Long-term Risk of Infection Among Patients Treated With Chemotherapy for Malignant Diseases
Authors: Nordvig Josefine , Aagaard Theis , Daugaard Gedske , Brown Peter , Sengeløv Henrik , Lundgren Jens , Helleberg Marie
Published: October 2018

Background

Febrile neutropenia (FN) is a common complication to chemotherapy, associated with increased short-term morbidity and mortality. However, the long-term outcomes after FN are poorly elucidated. We examined the long-term risk of infection and mortality rates in cancer patients with and without FN.

Methods

Patients aged >16 years treated with firstline chemotherapy were followed from 180 days after initiating chemotherapy until first infection, a new treatment with chemotherapy, death, or end of follow-up. Risk factors for infections were analyzed by competing risks regression, with death or another treatment with chemotherapy as competing events. Adjusted incidence rate ratios (aIRRs) of infection and death were analyzed using Poisson regression. In analyses of mortality, infection was included as a time-updated variable.

Results

We included 7190 patients with a median follow-up (interquartile range) of 0.58 (0.20–1.71) year. A total of 1370 patients had an infection during follow-up. The aIRRs of infection were 1.86 (95% confidence interval [CI], 1.56–2.22) and 2.19 (95% CI, 1.54–3.11) for patients with 1 or >1 episode of FN compared with those without FN. Mortality rate ratios were 7.52 (95% CI, 6.67–8.48) <1 month after, 4.24 (95% CI, 3.80–4.75) 1–3 months after, 2.33 (95% CI, 1.63–3.35) 3–6 months after, and 1.09 (95% CI, 0.93–1.29) >6 months after an infection, compared with the time before infection.

Conclusions

FN during chemotherapy is associated with a long-term increased risk of infection. Mortality rates are substantially increased for 6 months following an infection.
Does Social Exclusion Alter Sensory and Pain Thresholds in Children and Adolescents with Functional Abdominal Pain? – Results from a Preliminary Study
Authors: Gulewitsch Marco Daniel , Jusyte Aiste , Weimer Katja , Schönenberg Michael
Published: October 2018

Objective

Functional abdominal pain (AP) is a prevalent issue in childhood and adolescence. The contribution of psychosocial factors in the development and maintenance of this health problem is rather unclear, and experimental studies about underlying mechanisms are lacking. This study investigates whether experimentally induced social exclusion decreases sensory and pain thresholds in children suffering from AP.

Subjects

Twenty children/adolescents with AP and 22 healthy controls.

Methods

Children/adolescents participated in the Cyberball paradigm, which affects an experience of social exclusion. Thermal sensory and pain thresholds were measured before and after Cyberball.

Results

Children/adolescents with AP showed a divergent reaction regarding their sensory threshold after social exclusion: The control group exhibited a tendency toward a decreased sensory threshold whereas the AP group remained stable. Concerning the pain threshold, no effect of social exclusion could be identified. The increase of both thresholds (“numbing”) after Cyberball was positively correlated with symptoms of mental health issues.

Conclusions

This is the first study to investigate changes in sensory and pain thresholds following painful social interactions in a sample of children/adolescents with a chronic pain condition. Results suggest that AP and control children differ in their reaction of sensory thresholds, which might indicate an altered processing of social exclusion. Replication and further methodological improvements are needed.
Preventive Fungicidal Control of Cytospora leucostoma in Peach Orchards in Colorado
Authors: Miller S. T. , Otto K. L. , Sterle D. , Minas I. S. , Stewart J. E.
Published: October 2018

In western Colorado, Cytospora leucostoma is ubiquitous in peach orchards and has developed into a major limiting factor of peach production. The pathogen is unable to invade healthy intact phloem tissue of the tree, but instead, it requires a wound as a mode of entry. Bark injuries caused by cold and pruning in commercial orchard systems provide infection courts that, in suitable environment conditions, can lead to many successful fungal infections. Preventive fungicide control is an integral component of management in tree fruit production. Eighteen fungicides were tested at selected label dose rates for C. leucostoma control. All treatments were initially tested in vitro in fungicide-amended media dishes. Successful treatments were then tested under controlled conditions on detached peach branch segments. Effective fungicides identified in the laboratory assays (thiophanate-methyl, captan, lime sulfur, and copper hydroxide) were further tested as spray applications in the field and as wound sealant applications in combination with latex paint and kaolin clay. Of the treatments evaluated, thiophanate-methyl, captan, 50% latex paint, thiophanate-methyl amended in 50% latex paint, captan amended in 50% latex paint, and lime sulfur were most effective in reducing C. leucostoma necrotic area. Copper hydroxide was ineffective in all field trials and in some instances, yielded larger necrotic areas than the nontreated positive control shoots.
Interaction BetweenDiaporthe rhusicolaandNeofusicoccum mediterraneumCausing Branch Dieback and Fruit Blight of English Walnut in California, and the Effect of Pruning Wounds on the Infection
Authors: Agustí-Brisach Carlos , Moral Juan , Felts Dan , Trapero Antonio , Michailides Themis J.
Published: October 2018

Botryosphaeriaceae and Diaporthaceae species are the causal agents of branch dieback of English walnut in California. In this study, the effects of the interaction between Neofusicoccum mediterraneum and Diaporthe rhusicola were evaluated in vitro by using mycelial plugs or spore suspensions and in vivo by inoculating shoots and epicarps (hulls) of walnut. Single inoculations of each species and different coinfection treatments were performed under laboratory or field conditions. The influence of shoot age and susceptibility of bark or pith tissues to N. mediterraneum and D. rhusicola infection after pruning was also evaluated. In in vitro experiments, spore germination of D. rhusicola was significantly (P < 0.0001) reduced in the presence of N. mediterraneum spores. When D. rhusicola was inoculated at 4 days before N. mediterraneum, a delay in lesion development in shoots and hulls was observed compared with the other two interaction treatments. One- to 2-year-old shoots were more susceptible to infection and colonization by N. mediterraneum than 3- to 4-year-old shoots. In young shoots, inoculation in the pith tissue resulted in longer lesions than those observed on shoots inoculated in the bark. No significant differences were observed between the development of internal or external necrosis and the age of the shoots, or the susceptibility of bark and pith to D. rhusicola infection. This information is essential to better understanding the complex situation of this walnut disease toward developing control management strategies.
Low Benefits from Fungicide Use on Hard Red Wheat in Low-Disease Environments
Authors: Friskop Andrew , Yellareddygari Shashi , Gudmestad Neil C. , Fuller Kate Binzen , Burrows Mary
Published: October 2018

The use of fungicides on hard red wheat in the northern Great Plains increased in part owing to inexpensive fungicide options and several years of foliar disease epidemics. In some instances, fungicides are used in the absence of disease, prompting questions on the perceived value of these applications. This study analyzed yield data from 46 fungicide trials conducted in low-disease environments from 2007 to 2014 on hard red spring wheat and hard red winter wheat. Data were sorted and organized to determine yield response attributed to fungicide application timing (Feekes 2–3 or Feekes 9) and fungicide mode of action. Fungicide modes of action included quinone outside inhibitors (QoIs), demethylation inhibitors (DMIs), succinate dehydrogenase inhibitors (SDHIs), and blends (mixtures of QoI, DMI, or SDHI). A meta-analysis indicated a significant yield response of 101.6 kg/ha for a Feekes 9 application and 69.3 kg/ha for applications that used a QoI. Economic analyses indicated that when a midpoint value for both wheat price and application cost were used, less than one-third of the trials had a profitable net return when a Feekes 9 application was used. The infrequent positive yield responses associated with foliar fungicides in low-disease environments should prompt growers to evaluate disease risk prior to making an application for foliar diseases.
Building Bridges: The Journey of Alabama's Health Action Coalition
Authors: Ratcliffe Carol J. , Cheshire Michelle H. , Buckner Ellen B. , Dawson Martha A. , Berry Shaina R. , McDaniel Gretchen S. , Ladner Kathleen A.
Published: October 2018

AIM

The Alabama Health Action Coalition is a state coalition whose purpose is to enable access to high-quality, safe, and patient-centered health care for all Alabamians by leading change in nursing and health care.

BACKGROUND

The Alabama Health Action Coalition has four focus areas: advancing nursing education, improving nursing workforce data, promoting diversity among nursing and health care professionals, and fostering a culture of health.

METHOD

From 2012 to 2014, the Advancing Education Taskforce and Health Workforce Committee initiated processes to maximize resources, track changes in workforce data, and provide support for goal achievement.

RESULTS

Outcomes included an increase in the number of nurses with a BSN and higher degrees from 35 percent to 50 percent, nearing national averages.

CONCLUSION

Tracking of trends continues with 2016 data. This growth is particularly important in a state with a large, underserved population and high percentage of rural areas.
Chief Nursing Officer Survey: BSN and Higher Degree Initiatives in North Carolina
Authors: Schuler Mary E. , (Polly) Johnson Mary P. , Stallings Karen D. , Li Yin
Published: October 2018

AIM

The purpose of this study was to determine gap areas where North Carolina should implement strategies to promote the Institute of Medicine’s recommendation of an 80 percent bachelor of science workforce.

BACKGROUND

The North Carolina Action Coalition sought information about the nursing BSN and higher degree workforce and about human resource policies/strategies that promote BSN and higher degree education.

METHOD

An electronic survey was used to query 120 acute care hospital chief nursing officers over a four-year period and 100 public health chief nursing officers over a two-year period.

RESULTS

A majority of acute care and a minority of public health institutions had policies promoting BSN education. Barriers included lack of tuition reimbursement, scheduling/staffing issues, lack of local universities, and a perceived lack of value for nurses. A minority of respondents reported an 80 percent BSN workforce.

CONCLUSION

Strategies are needed statewide to support nursing academic progression.
Pathways to BSN Education: Teamwork in Ohio
Authors: Sharpnack Patricia A. , Drennen Carol , Bowles Wendy , Koffel Chris , Salvador Diane , Didion Judy
Published: October 2018

AIM

The Ohio Action Coalition was formed to address the key recommendations of the Institute of Medicine’s Future of Nursing report.

BACKGROUND

The Future of Nursing Campaign for Action is a national initiative to guide implementation of the recommendations in the Future of Nursing report.

METHOD

Through statewide meetings, leaders from nursing education and practice adopted a statewide competency model. Regional teams provided detailed regional gap analyses using the Ohio Nurse Competency Model and address the Institute of Medicine’s foundational pillar that nurses should achieve higher levels of education.

RESULTS

Communication among baccalaureate and community colleges and nursing practice has increased statewide as a result of this collaborative project. The teams are committed to exploring ways to standardize and develop adaptable seamless academic progression models for implementation across communities.

CONCLUSION

Ultimately, the goal is to positively impact the academic preparation of the Ohio nursing workforce.
Online Machine Learning Audiometry
Authors: Barbour Dennis L. , Howard Rebecca T. , Song Xinyu D. , Metzger Nikki , Sukesan Kiron A. , DiLorenzo James C. , Snyder Braham R. D. , Chen Jeff Y. , Degen Eleanor A. , Buchbinder Jenna M. , Heisey Katherine L.
Published: October 2018

Objectives:

A confluence of recent developments in cloud computing, real-time web audio and machine learning psychometric function estimation has made wide dissemination of sophisticated turn-key audiometric assessments possible. The authors have combined these capabilities into an online (i.e., web-based) pure-tone audiogram estimator intended to empower researchers and clinicians with advanced hearing tests without the need for custom programming or special hardware. The objective of this study was to assess the accuracy and reliability of this new online machine learning audiogram method relative to a commonly used hearing threshold estimation technique also implemented online for the first time in the same platform.

Design:

The authors performed air conduction pure-tone audiometry on 21 participants between the ages of 19 and 79 years (mean 41, SD 21) exhibiting a wide range of hearing abilities. For each ear, two repetitions of online machine learning audiogram estimation and two repetitions of online modified Hughson-Westlake ascending-descending audiogram estimation were acquired by an audiologist using the online software tools. The estimated hearing thresholds of these two techniques were compared at standard audiogram frequencies (i.e., 0.25, 0.5, 1, 2, 4, 8 kHz).

Results:

The two threshold estimation methods delivered very similar threshold estimates at standard audiogram frequencies. Specifically, the mean absolute difference between threshold estimates was 3.24 ± 5.15 dB. The mean absolute differences between repeated measurements of the online machine learning procedure and between repeated measurements of the Hughson-Westlake procedure were 2.85 ± 6.57 dB and 1.88 ± 3.56 dB, respectively. The machine learning method generated estimates of both threshold and spread (i.e., the inverse of psychometric slope) continuously across the entire frequency range tested from fewer samples on average than the modified Hughson-Westlake procedure required to estimate six discrete thresholds.

Conclusions:

Online machine learning audiogram estimation in its current form provides all the information of conventional threshold audiometry with similar accuracy and reliability in less time. More importantly, however, this method provides additional audiogram details not provided by other methods. This standardized platform can be readily extended to bone conduction, masking, spectrotemporal modulation, speech perception, etc., unifying audiometric testing into a single comprehensive procedure efficient enough to become part of the standard audiologic workup.
A Pediatric Medial Epicondyle Fracture Cadaveric Study Comparing Standard AP Radiographic View With the Distal Humerus Axial View
Authors: Cao Jue , Smetana Brandon S. , Carry Patrick , Peck Kathryn M. , Merrell Gregory A.
Published: October 2018

Background:

Controversy exists with regard to the amount of fracture displacement that warrants surgical fixation of medial epicondyle fractures. Inaccurate determination of degree of displacement on plain radiographs may account for the disputed management. Recently, a novel distal humerus axial radiograph technique has been developed to improve the accuracy of radiographs. The purposes of the study are 2-fold; to identify the anatomic orientation of the medial elbow epicondyle physis in children and to compare the accuracy of determining fracture displacement between axial radiographs and standard anterior-posterior (AP) radiographs in a cadaveric medial epicondyle fracture model.

Methods:

Twelve pediatric elbow computed tomographic scans and 19 pediatric elbow magnetic resonance imaging scans were analyzed for the orientation of the medial elbow physis. After determining the correct orientation, 15 adult cadaveric medial epicondyle fracture models were created at displacements of 2, 5, 10 mm, and maximum displacement with elbow at 90 degrees of flexion. A linear mixed model regression analysis was used to compare displacement based on the axial versus the AP radiographic methods.

Results:

The medial epicondyle physis was found to be a posterior structure angled distally at ~36 degrees (range, 10.7 to 49.6) and angled posteriorly at 45 degrees (range, 32.2 to 59). The AP radiograph significantly underestimated displacement relative to the axial radiograph at 5 mm [mean difference, −1.6; 95% confidence interval (CI), −2.9 to −0.3], at 10 mm (mean difference, −4.5; 95% CI, −5.8 to −3.2 mm), and at maximal displacement (mean, 15 mm; range, 13 to 20 mm) (mean difference, −7.1; 95% CI, −8.3 to −5.8).

Conclusions:

The medial epicondyle physis of the distal humerus is a posterior structure angled distally and posteriorly. When displacement was >5 mm, the distal humerus axial radiograph technique was significantly more accurate than the AP radiograph technique at determining actual fracture displacement in our adult cadaveric fracture models. Therefore, we recommend clinicians to include the axial radiograph view during the evaluation of patients with medial epicondyle fractures.

Clinical Relevance:

This study provides further insight into the location and orientation of the medial humeral epicondyle physis, and further supports the improved accuracy of the distal humerus axial radiograph at detecting displacement in medial epicondyle fractures.
Orthopaedic Care for Children: Who Provides It? How Has It Changed Over the Past Decade? Analysis of the Database of the American Board of Orthopaedic Surgery
Authors: Hosseinzadeh Pooya , Obey Mitchel R. , Nielsen Ena , Andras Lindsay , Kiebzak Gary M. , Mignemi Megan , Sawyer Jeffrey R. , Albanese Stephen , Flynn John M.
Published: October 2018

Background:

The field of orthopaedic surgery has subspecialized over the past decade with an increasing number of graduates of orthopaedic residency programs entering fellowship training. The number of graduates from pediatric orthopaedic fellowships has also increased over the past decade. We hypothesize as the number of pediatric orthopaedic fellowship graduates has increased, the proportion of orthopaedic cases completed by pediatric surgeons in comparison with adult surgeons has also increased. We have used the database of the American Board of Orthopaedic Surgery (ABOS) to analyze the trends in who is providing the orthopaedic care for children.

Methods:

Procedure logs of applicants for ABOS part II certification from 2004 to 2014 were collected and pediatric cases were used for this study. Applicants were divided into pediatric orthopaedic surgeons and adult orthopaedic surgeons based on the self-declared subspecialty for part II examination. CPT codes were used to place the cases into different categories. Descriptive and statistical analysis were performed to evaluate the change in the practice of pediatric orthopaedics over the past decade.

Results:

ABOS part II applicants performed 102,424 pediatric cases during this period. In total, 66,745 (65%) cases were performed by nonpediatric surgeons and 35,679 cases (35%) by pediatric surgeons. In total, 82% of the pediatric cases were done by adult surgeons in 2004 which decreased to 69% in 2009 and to 53% in 2014 (r=0.8232, P=0.0019). In pediatric sports medicine, pediatric orthopaedic surgeons performed 7% of the cases in 2004 which increased to 14% in 2009 and to 28% in 2014 (300% increase from 2004). Pediatric surgeons also increased their share of pediatric trauma cases. In total, 12% of lower extremity trauma cases were attended by pediatric surgeons in 2004 compared with 47% in 2014 (235% increase from 2004). In upper extremity trauma, pediatric surgeons increased their share of the cases from 12% in 2004 to 43% in 2014 (175% increase from 2004).

Conclusions:

Over the past decade, pediatric orthopaedic specialists are caring for an increasing share of pediatric cases. Pediatric trauma, pediatric spine, and pediatric sports medicine have seen the greatest increase in the percentage of cases performed by pediatric orthopaedic surgeons.

Level of Evidence:

Level III.
Progestin enhances vasoconstrictor responses in postmenopausal women receiving estrogen replacement therapy
Authors: Sullivan Jay M. , Shala Bashar A. , Miller Leslie A. , Lerner Jody L. , McBrayer John D.
Published: October 2018

Clinical and experimental evidence suggests that the cardioprotective effect of estrogen replacement is due to effects both on scrum lipids and on blood vessels. Current practice includes the use of a progestin in combination with estrogen if the patient still has her uterus: however, little is known about the effects of combination therapy on vascular reactivity. We therefore studied the effects of estrogen alone and with added progestin on forearm vascular resistance at rest, during reactive hyperemia, and after cold pressor stimulation using plethysmography in six healthy, postmenopausal women. Measurements were made before therapy: after giving conjugated estrogen i.v.; followed by a daily oral dose of 0.625 mg for 21 days; and sequentially after the addition of 10 mg of medroxyprogesterone acetate (MPA) for 10 days. Mean blood pressure did not change significantly. After 21 days of estrogen therapy, forearm blood flow, resting vascular resistance, and resistance after cold pressor stimulation did not change significantly. However, after addition of MPA, resting forearm vascular resistance rose significantly from baseline: 25.7 ± 2.7 U (SE) versus 38.3 ± 2.5 (p = 0.004). In addition, forearm vascular resistance rose to a higher level after cold pressor stimulus during combination therapy (32.3 ± 5.9 vs. 58.4 ± 5.7; p = 0.0057) than after estrogen replacement alone (32.3 ± 5.9 vs. 37.7 ± 5.3; p = NS). We conclude that combination hormone replacement therapy results in higher resting vascular resistance and increased pressor responsiveness than does estrogen replacement therapy alone.