bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution of GA Metabolic Enzymes in Land Plants
Authors: Yoshida Hideki , Takehara Sayaka , Mori Masaki , Ordonio Reynante Lacsamana , Matsuoka Makoto
Published: September 2020

Gibberellins (GAs) play key roles in various developmental processes in land plants. We studied the evolutionary trends of GA metabolic enzymes through a comprehensive homology search and phylogenetic analyses from bryophytes to angiosperms. Our analyses suggest that, in the process of evolution, plants were able to acquire GA metabolic enzymes in a stepwise manner and that the enzymes had rapidly diversified in angiosperms. As a good example of their rapid diversification, we focused on the GA-deactivating enzyme, GA 2-oxidase (GA2ox). Although the establishment of a GA system first occurred in lycophytes, its inactivation system mediated by GA2oxs was established at a much later time: the rise of gymnosperms and the rise of angiosperms through C19-GA2ox and C20-GA2ox development, respectively, as supported by the results of our direct examination of their enzymatic activities in vitro. Based on these comprehensive studies of GA metabolic enzymes, we discuss here that angiosperms rapidly developed a sophisticated system to delicately control the level of active GAs by increasing their copy numbers for their survival under different challenging environments.
Does Collateral Value Affect Asset Prices? Evidence from a Natural Experiment in Texas
Authors: Zevelev Albert Alex
Published: September 2020

Does the ability to pledge an asset as collateral, after purchase, affect its price? This paper identifies the impact of collateral service flows on house prices, exploiting a plausibly exogenous constitutional amendment in Texas that legalized home equity loans in 1998. The law change increased Texas house prices 4 $\%$; this is price-based evidence that households are credit-constrained and value home equity loans to facilitate consumption smoothing. Prices rose more in locations with inelastic supply, higher prelaw house prices, higher income, and lower unemployment. These estimates reveal that richer households value the option to pledge their home as collateral more strongly.
Imbalance toward TFH 1 cells playing a role in aberrant B cell differentiation in systemic sclerosis
Authors: Ly Nhung Thi My , Ueda-Hayakawa Ikuko , Nguyen Chuyen Thi Hong , Huynh Trang Nguyen Mai , Kishimoto Izumi , Fujimoto Manabu , Okamoto Hiroyuki
Published: September 2020

Objective

SSc is a connective tissue disease with multisystem disorder induced by the inflammation and fibrosis following T and B cell abnormalities. Follicular helper CD4+ T (TFH) cells play a crucial role in the formation of germinal centres and specialize in interacting to aid B cell differentiation. We aimed to investigate TFH cells and their subsets to evaluate their involvement with B cell alteration in SSc.

Method

Circulating TFH cells (cTFH), B cells and their subsets were assessed by flow cytometry. The concentration of serum cytokines was measured by cytokine array assay. Immunohistochemistry and IF were performed to evaluate the migration of TFH cells in SSc skin lesions.

Results

The proportion of cTFH cells did not differ from controls, but their subsets were imbalanced in SSc patients. The frequency of TFH 1 was increased and correlated with ACA titre, serum IgM or CRP levels of patients, and cytokine concentrations of IL-21 and IL-6 that induce B cell differentiation in SSc. cTFH cells from SSc showed activated phenotype with expressing higher cytokine levels compared with controls. The frequency of TFH 17 was also increased, but was not correlated with a high level of Th17 cytokines in patients’ sera. Furthermore, infiltration of TFH cells was found in skin lesion of SSc patients.

Conclusion

We here describe an imbalance of cTFH toward TFH 1 that may induce B cell alteration through IL-21 and IL-6 pathways and promote inflammation, contributing to the pathogenesis of SSc disease.
Assessment of the Effect of Thermotherapy on ‘Candidatus Liberibacter asiaticus’ Viability in Woody Tissue of Citrus via Graft-Based Assays and RNA Assays
Authors: Thapa Naweena , Danyluk Michelle D. , Gerberich Kayla M. , Johnson Evan G. , Dewdney Megan M.
Published: September 2020

In 2019, citrus production in Florida declined by more than 70%, mostly because of Huanglongbing (HLB), which is caused by the bacterium ‘Candidatus Liberibacter asiaticus’ (CLas). Thermotherapy for HLB-affected trees was proposed as a short-term management solution to maintain field productivity. It was hypothesized that thermotherapy could eliminate HLB from affected branches; therefore, the study objectives were to show which time–temperature combinations eliminated CLas from woody tissues. Hardening, rounded Valencia twigs collected from HLB-affected field trees were treated in a steam chamber at different time–temperature combinations (50°C for 60 s; 55°C for 0, 30, 60, 90, and 120 s; 60°C for 30 s; and an untreated control). Three independent repetitions of 13 branches per treatment were grafted onto healthy rootstocks and tested to detect CLas after 6, 9, and 12 months. For the RNA-based CLas viability assay, three branches per treatment were treated and bark samples were peeled for RNA extraction and subsequent gene expression analyses. During the grafting study, at 12 months after grafting, a very low frequency of trees grafted with twigs treated at 55°C for 90 s and 55°C for 120 s had detectable CLas DNA. In the few individuals with CLas, titers were significantly lower (P ≤ 0.0001) and could have been remnants of degrading DNA. Additionally, there was a significant decrease (P ≤ 0.0001) in CLas 16S rRNA expression at 55°C for 90 s, 55°C for 120 s, and 60°C for 30 s (3.4-fold change, 3.4-fold change, and 2.3-fold change, respectively) in samples 5 days after treatment. Heat injury, not total CLas kill, could explain the limited changes in transcriptional activity; however, failed recovery and eventual death of CLas resulted in no CLas detection in most of the grafted trees treated with the highest temperatures or longest durations.
The Effect of Chemotherapy on Balance, Gait, and Falls Among Cancer Survivors: A Scoping Review
Authors: Wechsler Stephen , Wood Lisa
Published: September 2020

Background:

Evidence has mounted that cancer survivors demonstrate impaired balance, gait, and increased risk of falls following chemotherapy treatment. This relationship must be clearly defined in order to screen for functional impairments, intervene appropriately, effectively advise stakeholders, and plan for future research.

Purpose:

To conduct a scoping review to systematically map the current literature on the effect of chemotherapy on balance, gait, and falls among cancer survivors.

Methods:

Data Sources: Four databases were searched for studies. Study Selection: In total, 3769 abstracts were identified through literature searches. After screening and full-text review, 30 articles were included in this scoping review. Data Extraction: Data related to study design, temporality, sample characteristics, cancer/chemotherapy type(s), outcome measures, and relevant findings were extracted from full texts. Data Synthesis: Descriptive quantitative summaries were calculated and a narrative analysis was performed.

Discussion and Limitations:

The current body of literature is largely in agreement that chemotherapy negatively impacts static balance, dynamic balance, and gait and results in increased risk of falls throughout the survivorship continuum. The relationship between chemotherapy-induced peripheral neuropathy (CIPN) and these outcomes is evident. Males, non–breast cancer diagnoses, and causal pathways other than CIPN are underrepresented in the literature.

Conclusion:

This scoping review summarized the current body of literature related to the effect of chemotherapy on balance, gait, and falls. Clinical implications are proposed and suggestions made for future research to include more prospective studies with emphases on chemotherapy type and dosage, fewer sex-biased diagnoses, and to explore alternative causal pathways.
Safety and efficacy of cetuximab-containing chemotherapy after immune checkpoint inhibitors for patients with squamous cell carcinoma of the head and neck: a single-center retrospective study
Authors: Kurosaki Takashi , Mitani Seiichiro , Tanaka Kaoru , Suzuki Shinichiro , Kanemura Hiroaki , Haratani Koji , Fumita Soichi , Iwasa Tsutomu , Hayashi Hidetoshi , Yoshida Takeshi , Ishikawa Kazuki , Kitano Mutsukazu , Otsuki Naoki , Nishimura Yasumasa , Doi Katsumi , Nakagawa Kazuhiko
Published: September 2020

Immunotherapy has been shown to prolong survival in recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) in front-line use; however, subsequent systemic therapy has not been optimized. This study aimed to evaluate the safety and efficacy of cetuximab-containing chemotherapy after immunotherapy. We retrospectively analyzed patients with recurrent or metastatic SCCHN who underwent cetuximab-containing regimens after progression on immunotherapy. Of the 22 patients who met the inclusion criteria, 21 received paclitaxel and cetuximab, and 1 carboplatin and fluorouracil and cetuximab after immunotherapy. Nine patients achieved a partial response, 10 patients had stable disease as their best response on cetuximab-containing chemotherapy, yielding an overall response rate and disease control rate of 40.9 and 86.4%, respectively. The median progression-free survival was 5.2 months, and the median overall survival was 14.5 months. Ten patients developed grade 3–4 adverse events, including neutropenia (31.8%), acneiform rash (9.1%), anemia (4.5%), hypertransaminasemia (4.5%) and stomatitis (4.5%). The most frequent cetuximab-related toxicities across all grades were skin reactions (77.3%), hypomagnesemia (40.9%), stomatitis (27.3%), paronychia (13.6%) and keratitis (4.5%). There was no treatment-related death. Taken together, cetuximab-containing chemotherapy was effective and feasible even after immunotherapy.
Safe and Effective Chin Augmentation With the Hyaluronic Acid Injectable Filler, VYC-20L
Authors: Beer Kenneth , Kaufman-Janette Joely , Bank David , Biesman Brian , Dayan Steven , Kim William , Chawla Smita , Schumacher Andrew
Published: September 2020

BACKGROUND

VYC-20L is a hyaluronic acid soft tissue filler with lidocaine designed to restore facial volume.

OBJECTIVE

Evaluate the safety and effectiveness of VYC-20L in patients with chin retrusion.

MATERIALS AND METHODS

Adults with chin retrusion were randomized (3:1) to receive VYC-20L in the chin at study onset (treatment group) or 6 months later (control group). The primary effectiveness end point was ≥1-point improvement on the Allergan Chin Retrusion Scale (ACRS) from baseline at Month 6. Safety assessments included injection site responses (ISRs) and adverse events (AEs).

RESULTS

VYC-20L was administered to 192 participants (treatment group, n = 144; control group, n = 48). At Month 6, significantly more participants had an ACRS response in the treatment versus control group (56.3% vs 27.5%; p = .0019). Effectiveness was also demonstrated by the proportion of participants with improved/much improved Global Aesthetic Improvement Scale scores and responses on the FACE-Q Satisfaction with Chin questionnaire and FACE-Q Psychological Wellbeing module. Treatment benefit remained evident at Month 12. Most common ISRs were tenderness (81.1%) and firmness (75.1%). One participant (0.5%) discontinued the study due to 2 treatment-related serious AEs of facial cellulitis and injection site inflammation, both resolved without sequelae.

CONCLUSION

VYC-20L significantly improved an ACRS response and was generally safe and well tolerated.
Enhanced Otolith Function Despite Severe Labyrinthine Damage in a Case of Pneumolabyrinth and Pneumocephalus Due to Otogenic Meningitis Associated With Superior Canal Dehiscence
Authors: Castellucci Andrea , Botti Cecilia , Renna Luigi , Delmonte Silvia , Moratti Claudio , Pascarella Rosario , Bianchin Giovanni , Ghidini Angelo
Published: September 2020

Objective:

To describe a rare case of pneumolabyrinth (PNL) and pneumocephalus (PNC) due to otogenic meningitis in a patient with superior canal dehiscence (SCD) resulting in profound sensorineural hearing loss (SNHL), semicircular canals impairment but preservation of SCD-related enhanced otolith function.

Patient:

A 65-year-old woman with otogenic meningitis.

Intervention:

Temporal bone high-resolution computed tomography (CT) scans, brain-magnetic resonance imaging, audiometry, bedside examination, video-head impulse test, and vestibular-evoked myogenic potentials (VEMPs).

Main outcome measures:

Enhanced otolith function despite canal and cochlear loss.

Results:

The patient developed right profound SNHL and acute labyrinthitis. Imaging showed middle ear inflammatory tissue, right PNL and PNC despite lack of bony fractures. Bilateral SCD and tegmen dehiscence were detected. The patient underwent mastoidectomy, drainage of effusion, and surgical repair of tegmen dehiscence. Exploratory tympanotomy was uneventful. She was treated with intravenous antibiotics and dexamethasone for 3 weeks with improvement of general condition. At 3-weeks follow-up, right profound SNHL persisted with global hypofunction for ipsilateral semicircular canals and selective impairment for left superior canal activity at video-head impulse test. Surprisingly, both cervical and ocular-VEMPs exhibited bilaterally abnormal amplitudes and reduced thresholds, consistently with preserved SCD-related macular hypersensitivity to sounds even on the affected side.

Conclusions:

This case report exhibits a unique clinical scenario as it offers interesting insights concerning PNL aetiology despite lack of either bony fractures or barotrauma and PNC likely conveyed intracranially by SCD. Moreover, it provides an unusual pattern of functional dissociation among inner-ear receptors showing enhanced otolith function despite severe labyrinthine damage.
On the Intracochlear Location of Straight Electrode Arrays After Cochlear Implantation: How Lateral Are Lateral Wall Electrodes?
Authors: Salcher Rolf , Boruchov Aaron , Timm Max , Steffens Melanie , Giesemann Anja , Lenarz Thomas , Warnecke Athanasia
Published: September 2020

Objective:

Cochlear implants are the gold standard for patients with severe sensorineural hearing loss. A focused electrical stimulation of individual spiral ganglion neurons has not been achieved yet because the scala tympani is a fluid-filled compartment and does not offer a matrix for neuritic outgrowth. Coating of the electrode contacts with swelling hydrogels could fill that gap between the electrode array and the medial wall of the cochlea. Therefore, the exact position of the electrode array within the scala tympani has to be known.

Study Design:

Retrospective analysis of patient data sets.

Setting:

Tertiary referral center. A total of 95 patients with cochlear implants from one manufacturer were included in this study. The lateral wall, the modiolar wall, and the cochlear implant electrode were segmented using OsiriX MD. For repositioning and reconstructing the respective contours and measuring distances, files were analyzed in MATLAB. The distances from the edge of each electrode contact to the cochlear walls showed no significant differences. But between the different contacts within each patient, there were significant differences. Around 180 degree insertion, electrodes start to get in contact with the lateral wall. The tip of the electrode array was always facing toward the modiolar wall independent of the length of the electrode. We established a method to analyze the position of electrodes within the cochlea.
Exploring the Impact of Religion and Spirituality on Mental Health and Coping in a Group of Canadian Psychiatric Outpatients
Authors: Adams G. Camelia , Wrath Andrew J. , Le Thuy , Adams Stephen , De Souza Dawn , Baetz Marilyn , Koenig Harold G.
Published: September 2020

Research has shown that religious/spiritual (R/S) beliefs can impact mental health. In addition, individual attachment impacts R/S views and mental health. Still, clinical studies are lacking. This study explores the presence of R/S beliefs and attachment insecurity in psychiatric outpatients and the implication for mental health. Ninety psychiatric outpatients reported their R/S beliefs and were categorized into two groups: religious/spiritual (+R/S) or nonreligious/spiritual (−R/S). The groups were compared on attachment, psychiatric symptoms, religious coping, and life satisfaction. Multivariate linear regression was also performed. The +R/S group had significantly higher religious coping and lower attachment insecurity, depression severity, and social anxiety. Attachment insecurity was associated with negative religious coping. Higher attachment avoidance was associated with lower life satisfaction and higher social anxiety. Many patients in psychiatric care hold R/S views and use religious coping. Their R/S beliefs and attachment characteristics might influence each other and impact their mental illness.
Affiliate Faculty in Nursing Clinical Education
Authors: Luckenbach Alyson , Nelson-Brantley Heather , Ireland-Hoffmann Ginger
Published: September 2020

Background

Academic-practice relationships can be integral in advancing high-quality education for prelicensure nursing students. In a midwestern city, the academic health center and school of nursing developed the affiliate faculty model, a viable and sustainable model for clinical education.

Purpose

This study explores the efficacy of the affiliate faculty model as reported by prelicensure nursing students and affiliate faculty over a 7-year period.

Methods

This study used a cross-sectional, descriptive survey design. An electronic survey using a mixed-methods approach was administered to nursing students and affiliate faculty.

Results

Seventy-two students and 25 affiliate faculty participated, agreeing that affiliate faculty prepared students to provide safe care and connect classroom to clinical. Themes included knowledge of the health system, support at the bedside, enjoyment of teaching, and creating “light bulb moments.”

Conclusions

The affiliate faculty model strengthens academic-practice partnerships while addressing the nursing faculty shortage.
Characterization of 2 Neisseria gonorrhoeae Strains With High-Level Azithromycin Resistance Isolated in 2015 and 2018 in Japan
Authors: Shimuta Ken , Lee Kenichi , Yasuda Mitsuru , Furubayashi Keiichi , Uchida Chiaki , Nakayama Shu-ichi , Takahashi Hideyuki , Ohnishi Makoto
Published: September 2020

We identified and characterized the first 2 Neisseria gonorrhoeae strains with high-level azithromycin resistance isolated in Japan. These were in the clade of ceftriaxone- and azithromycin-resistant strains isolated in Australia and the United Kingdom. The multilocus sequence typing, N. gonorrhoeae multiantigen sequence typing, and N. gonorrhoeae sequence typing for antimicrobial resistance types of these strains were found in gonococci from eastern Asia.
The General Public’s Support Toward Governmental Provision of Free/Subsidized HIV Preexposure Prophylaxis to At-Risk Chinese People: A Population-Based Study
Authors: Luo Sitong , Wang Zixin , Lau Joseph Tak-Fai
Published: September 2020

Background

Given its high cost, governmental financing is essential for promoting HIV preexposure prophylaxis (PrEP). The study investigated levels and associated factors of the general public's support toward governmental provision of free or subsidized PrEP to Chinese people at high risk of HIV.

Methods

A population-based random telephone survey was conducted among 300 residents in Hong Kong, China, from June to July, 2019. Descriptive analyses and logistic regression were performed.

Results

The prevalence rates of supportive attitude for free and subsidized PrEP were 30.0% and 30.3%, respectively; opinions were split, as similar proportions showed oppositional attitude. Those who were older, had less education, did not have a full-time job, or reported a lower household income were less likely to support free or subsidized PrEP. Stigmatizing attitudes against homosexuals (adjusted odds ratio [AOR], 0.81; 95% CI, 0.73–0.89) and perceived negative societal impacts of free PrEP (AOR, 0.78; 95% CI, 0.70–0.87) were negatively associated with the support for free PrEP. Compassion to others (AOR, 1.10; 95% CI, 1.01–1.21), perceived positive societal impacts of free PrEP (AOR, 1.86; 95% CI, 1.43–2.44), and the belief that the positive impacts would overweigh the negative impacts (AOR, 26.97; 95% CI, 10.66–68.24) were positively associated with the support for free PrEP. Similar associations were observed for the support toward subsidized PrEP.

Conclusions

The Hong Kong general public's support for government financial assistance of PrEP for people at high risk of HIV was low. Preexposure prophylaxis advocacy campaigns are warranted and suggested to incorporate components that address the associated factors.
Hepatoid Teratoma, Hepatoid Yolk Sac Tumor, and Hepatocellular Carcinoma
Authors: Al-Obaidy Khaleel I. , Williamson Sean R. , Shelman Nathan , Idrees Muhammad T. , Ulbright Thomas M.
Published: September 2020

Rare hepatoid teratomas (HTs) in testicular germ cell tumor patients mimic hepatoid yolk sac tumor (HYST) and hepatocellular carcinoma (HCC). We compared the features of 2 metastatic HTs, 12 HYSTs, and 16 HCCs. The mean ages were 36, 40, and 62.5 years, respectively. The HTs formed sheets of hepatocyte-like cells with macrovesicular fat arranged in vague lobules with intervening fibrous bands containing biliary ductule–like structures and abortive portal triads. HTs lacked basement membrane deposits, with hepatoid cells staining for glypican-3, arginase, and HepPar-1 (2/2), whereas stains for CK19 (2/2) and CK7 (1/2) highlighted ductules and for villin hepatoid cells and ductules (1/2). SALL4 and CDX2 stains were negative (0/2). HYSTs formed nests, trabeculae, cords, and occasional gland-like structures, and most (10/12; 83%) produced intercellular basement membrane. No Mallory-Denk bodies were seen. Stains for SALL4 (100%), glypican-3 (100%), CK19 (88%), CDX2 (88%), and villin (75%) were positive, whereas those for HepPar-1 highlighted rare tumor cells (70%) and for arginase were mostly negative (26%). All HCCs lacked basement membrane deposits, with Mallory-Denk bodies occurring in 50%. Stains for HepPar-1 (100%) and arginase (94%) were positive, glypican-3 infrequent (19%), and SALL4, CK19, villin, and CDX2 negative. In summary, HTs are distinguished from HYST by the formation of ductules and abortive portal tracts, lack of basement membrane deposits, more consistent staining for arginase and HepPar-1, and negativity for SALL4 and CDX2. Contrasting features of HCCs with HYSTs include negativity for SALL4, CK19, and CDX2, frequent Mallory-Denk bodies, and absence of basement membrane deposits.
Digital Analysis of Cranial Sutures Computed Tomography Data in Adolescents
Authors: Du Shanshan , Zhang Chen , Bi Hongsen , Yang Xin , Lv Yi , Zhi Juan , Zhao Zhenmin , Wang Junchen
Published: September 2020

To investigate the degree of fusion in sutures of the skull, the authors analyzed cranial computed tomography (CT) data using digital technologies to obtain the density values of coronal, sagittal, and lambdoid sutures in Chinese Han adolescents.

The authors selected 80 patients who had undergone maxillofacial surgery. They were divided by age into a 9- to 12-year-old group and a 13 to 15-year-old group. The grayscale value of the cranial CT suture was segmented and measured using Mimics 20.0 software. The Mimics software measurement data were imported into SPSS 21.0 for data comparison and analysis.

The mean grayscale value of coronal sutures was 1203.25 and the standard deviation was 220.48, while the mean grayscale value of sagittal sutures was 1113.76 and the standard deviation was 197.83. The mean grayscale value of lambdoid sutures was 1106.37, and the standard deviation was 200.01. The grayscale values of coronal sutures were higher than those of sagittal sutures or lambdoid sutures. Further paired sample t tests were performed on the 3 types of cranial sutures. The differences between coronal and sagittal sutures and between coronal and lambdoid sutures were both substantial with statistical significance. Nevertheless, the difference between sagittal and lambdoid sutures was not significant. Further, an independent sample t-test, showed the grayscale values of coronal, sagittal and lambdoid sutures in the 9–12-year)ear-old group were significantly lower than those in the 13 to 15-year-old group (P < 0.001).

Through digital technologies, the research findings are more precise and accurate, which is of great significance to research on maxillofacial and associated anatomy.
Trust the FAST: Confirmation that the FAST examination is highly specific for intra-abdominal hemorrhage in over 1,200 patients with pelvic fractures
Authors: Schwed Alexander C. , Wagenaar Amy , Reppert Amy E. , Gore Amy V. , Pieracci Fredric M. , Platnick Kenneth B. , Lawless Ryan A. , Campion Eric M. , Coleman Jamie J. , Cohen Mitchell J. , Moore Ernest E. , Burlew Clay Cothren
Published: September 2020

BACKGROUND

Use of the focused assessment with sonography for trauma (FAST) examination in patients with pelvic fractures has been reported as unreliable. We hypothesized that FAST is a reliable method for detecting clinically significant intra-abdominal hemorrhage in patients with pelvic fractures.

METHODS

All patients with pelvic fractures over a 10-year period were reviewed at a Level I trauma center. The predictive ability of FAST was assessed by calculating the sensitivity, specificity, positive predictive value and negative predictive value against the criterion standard of either computed tomography (CT) or laparotomy findings. The FAST examination was considered “false negative” if findings at laparotomy indicated traumatic intra-abdominal hemorrhage. Likewise, the FAST examination was considered “false positive” if either CT or findings at laparotomy indicated no intra-abdominal hemorrhage. Hemodynamic instability scores were calculated for all patients.

RESULTS

There were 1,456 patients with pelvic fractures and an initial FAST reviewed; 1,219 (83.7%) underwent FAST and either CT or operative exploration. Median age was 43 years (interquartile range, 26–56 years) and mean Injury Severity Score was 18.5 ± 12.3. The sensitivity and specificity for FAST in this group of patients with pelvic fracture was 85.4% and 98.1%, respectively. The positive predictive value and negative predictive value were 78.4% and 98.8%, respectively. Of 21 patients with a false-positive FAST, 15 (71.4%) were confirmed with a negative CT scan, and 6 (28.6%) underwent laparotomy without findings of intra-abdominal hemorrhage. Of 13 patients with a false-negative FAST, all were identified with positive findings at the time of laparotomy. The specificity of the FAST examination remained high regardless of hemodynamic instability score grade.

CONCLUSION

The false positive rate of FAST examination for intra-abdominal hemorrhage is 1.1%. These data suggest that a positive FAST in this clinical scenario should be considered to represent intra-abdominal fluid. This series contradicts prior reports that FAST is unreliable in patients with pelvic fracture.

LEVEL OF EVIDENCE

Diagnostic, level III.
Dwarf mongoose alarm calls: investigating a complex non-human animal call
Authors: Collier Katie , Radford Andrew N. , Stoll Sabine , Watson Stuart K. , Manser Marta B. , Bickel Balthasar , Townsend Simon W.
Published: September 2020

Communication plays a vital role in the social lives of many species and varies greatly in complexity. One possible way to increase communicative complexity is by combining signals into longer sequences, which has been proposed as a mechanism allowing species with a limited repertoire to increase their communicative output. In mammals, most studies on combinatoriality have focused on vocal communication in non-human primates. Here, we investigated a potential combination of alarm calls in the dwarf mongoose (Helogale parvula), a non-primate mammal. Acoustic analyses and playback experiments with a wild population suggest: (i) that dwarf mongooses produce a complex call type (T3) which, at least at the surface level, seems to comprise units that are not functionally different to two meaningful alarm calls (aerial and terrestrial); and (ii) that this T3call functions as a general alarm, produced in response to a wide range of threats. Using a novel approach, we further explored multiple interpretations of the T3call based on the information content of the apparent comprising calls and how they are combined. We also considered an alternative, non-combinatorial interpretation that frames T3as the origin, rather than the product, of the individual alarm calls. This study complements previous knowledge of vocal combinatoriality in non-primate mammals and introduces an approach that could facilitate comparisons between different animal and human communication systems.
Fatigue resistant jaw muscles facilitate long-lasting courtship behaviour in the southern alligator lizard (Elgaria multicarinata)
Authors: Nguyen Allyn , Balaban Jordan P. , Azizi Emanuel , Talmadge Robert J. , Lappin A. Kristopher
Published: September 2020

The southern alligator lizard (Elgaria multicarinata) exhibits a courtship behaviour during which the male firmly grips the female's head in his jaws for many hours at a time. This extreme behaviour counters the conventional wisdom that reptilian muscle is incapable of powering high-endurance behaviours. We conductedin situexperiments in which the jaw-adductor muscles of lizards were stimulated directly while bite force was measured simultaneously. Fatigue tests were performed by stimulating the muscles with a series of tetanic trains. Our results show that a substantial sustained force gradually develops during the fatigue test. This sustained force persists after peak tetanic forces have declined to a fraction of their initial magnitude. The observed sustained force duringin situfatigue tests is consistent with the courtship behaviour of these lizards and probably reflects physiological specialization. The results of molecular analysis reveal that the jaw muscles contain masticatory and tonic myosin fibres. We propose that the presence of tonic fibres may explain the unusual sustained force properties during mate-holding behaviour. The characterization of muscle properties that facilitate extreme performance during specialized behaviours may reveal general mechanisms of muscle function, especially when done in light of convergently evolved systems exhibiting similar performance characteristics.
Fast saccadic eye-movements in humans suggest that numerosity perception is automatic and direct
Authors: Castaldi Elisa , Burr David , Turi Marco , Binda Paola
Published: September 2020

Fast saccades are rapid automatic oculomotor responses to salient and ecologically important visual stimuli such as animals and faces. Discriminating the number of friends, foe, or prey may also have an evolutionary advantage. In this study, participants were asked to saccade rapidly towards the more numerous of two arrays. Participants could discriminate numerosities with high accuracy and great speed, as fast as 190 ms. Intermediate numerosities were more likely to elicit fast saccades than very low or very high numerosities. Reaction-times for vocal responses (collected in a separate experiment) were slower, did not depend on numerical range, and correlated only with the slow not the fast saccades, pointing to different systems. The short saccadic reaction-times we observe are surprising given that discrimination using numerosity estimation is thought to require a relatively complex neural circuit, with several relays of information through the parietal and prefrontal cortex. Our results suggest that fast numerosity-driven saccades may be generated on a single feed-forward pass of information recruiting a primitive system that cuts through the cortical hierarchy and rapidly transforms the numerosity information into a saccade command.
Analysis of external quality assessment samples revealed crucial performance differences between commercial RT-PCR assays for SARS-CoV-2 detection when taking extraction methods and real-time-PCR instruments into account
Authors: Malecki Monika , Luesebrink Jessica , Wendel Andreas , Mattner Frauke
Published: September 2020

In limelight of the ongoing pandemic SARS-CoV-2 testing is critical for the diagnosis of infected patients, contact-tracing and mitigating the transmission. Diagnostic laboratories are expected to provide appropriate testing with maximum accuracy. Real-time reverse transcriptase PCR (RT-PCR) is the diagnostic standard yet many commercial diagnostic kits have become available. However, only a handful of studies have reviewed their performance in clinical settings. The aim of this study was to compare the performance of the overall analytical matrix including the extraction kit (BD MAX, Promega, Qiagen), the PCR instrument (Agilent Mx3005P, BD MAX, Qiagen Rotor-Gene, Roche Cobas z 480) and the RT-PCR assay (Altona Diagnostics, CerTest Biotec, R-Biopharm AG) using predefined samples from proficiency testing organizers.

The greatest difference of the Ct values between the matrices was 9 cycles. One borderline sample could not be detected by 3 out of 12 analytical matrices and yielded a false negative result. We therefore conclude that diagnostic laboratories should take the complete analytical matrix in addition to the performance values published by the manufacturer for a respective RT-PCR kit into account. With limited resources laboratories have to validate a wide range of kits to determine appropriate analytical matrices for detecting SARS-CoV-2 reliably. The interpretation of clinical results has to be adapted accordingly.
Resuming assisted reproduction services during COVID-19 Pandemic: An Indian experience
Authors: Jirge Padma Rekha , Patwardhan Sadhana , Paranjape Dilip , Jirge Shishir Narendra , Bhomkar Deepali Atul , Chougule Shruti Mahesh , Salpekar Anita , Modi Deepak
Published: September 2020

Purpose

The pandemic of COVID-19 has affected many countries; and medical services including assisted reproductive treatment (ART) have been hampered. The purpose of the study was to assess the preparedness of ART clinics and staff to resume services; patients’ reasons to initiate treatment and key performance indicators (KPIs) of ART labs during pandemic.

Methods

Semi-descriptive report of two private in-vitro fertilization (IVF) clinics in Maharashtra, India, when COVID-19 testing for asymptomatic people was unavailable. Time required for replenishing laboratory supplies, and staff preparedness to function under ‘new norms’ of pandemic was documented. Infection mitigation measures at workplace and triaging strategy were evaluated. KPIs of the clinics were evaluated.

Results

30% of the patients consulted through telemedicine accepted or were eligible to initiate treatment upon clinic resumption. Lack of safe transport and financial constraints prevented majority from undergoing IVF, and only 9% delayed treatment due to fear of pandemic. With adequate training, staff compliance to meet new demands could be achieved within a week, but supply of consumables was a major constraint. 52 cycles of IVF were performed including fresh cycles and frozen embryo transfers with satisfactory KPIs even during pandemic. Conscious sedation and analgesia during oocyte retrieval was associated with reduced procedure time and no intervention for airway maintenance, compared to general anaesthesia. Self reported pain scores by patients ranged from nil to mild on a graphic rating scale.

Conclusion

This study provides a practical insight and will aid in forming guidelines for resumption of IVF services during pandemic.
Puerto Rico Health System Resilience After Hurricane Maria: Implications for Disaster Preparedness in the COVID-19 Era
Authors: Rios Christopher C. , Ling Emilia J , Rivera-Gutierrez Ralph , Sanchez Juan Gonzalez , Bruce Janine , Barry Michele , de Jesus Perez Vinicio
Published: September 2020

Background

Every year, Puerto Rico faces a hurricane season fraught with potentially catastrophic structural, emotional and health consequences. In 2017, Puerto Rico was hit by Hurricane Maria, the largest natural disaster to ever affect the island. Several studies have estimated the excess morbidity and mortality following Hurricane Maria in Puerto Rico, yet no study has comprehensively examined the underlying health system weaknesses contributing to the deleterious health outcomes.

Methods

A qualitative case study was conducted to assess the ability of the UPR health system to provide patient care in response to Hurricane Maria. An established five key resilience framework and inductive analysis was used to identify factors that affected health system resilience. Thirteen Emergency Medicine Physicians, Family Medicine Physicians, and Hospital Administrators in a University of Puerto Rico (UPR) Community Hospital were interviewed as part of our study.

Results

Of the five key resiliency components, three domains were notably weak with respect to UPR’s resiliency. Prior to the Hurricane, key personnel at the UPR hospital wereunawareof the limited capacity of back-up generators at hospitals and were ill-prepared to transfer ICU patients to appropriate hospitals. Post Hurricane, the hospital facedself-regulationchallenges when triaging the provision of Hurricane-related emergency services with delivering core health services, in particular for patients with chronic conditions. Finally, during and after the Hurricane,integrationof patient care coordination between the UPR hospital ambulances, neighboring hospitals, and national and state government was suboptimal. The two remaining resiliency factors, addressingdiverseneeds and systemadaptivenessin a time of crisis, were seen as strengths.

Conclusions

Hurricane Maria exposed weaknesses in the Puerto Rican health system, notably the lack of awareness about the limited capacity of backup generators, poor patient care coordination, and interruption of medical care for patients with chronic conditions. As in other countries, the current COVID epidemic is taxing the capacity of the Puerto Rico health system, which could increase the likelihood of another health system collapse should another hurricane hit the island. Therefore, a resilience framework is a useful tool to help health systems identify areas of improvement in preparation for possible natural disasters.
Genome-wide association studies reveal novel locus with sex-/therapy-specific fracture risk effects in childhood cancer survivors
Authors: Im Cindy , Li Nan , Moon Wonjong , Liu Qi , Morton Lindsay M. , Leisenring Wendy M. , Howell Rebecca M. , Chow Eric J. , Sklar Charles A. , Wilson Carmen L. , Wang Zhaoming , Sapkota Yadav , Chemaitilly Wassim , Ness Kirsten K. , Hudson Melissa M. , Robison Leslie L. , Bhatia Smita , Armstrong Gregory T. , Yasui Yutaka
Published: September 2020

Survivors of childhood cancer treated with radiation therapy (RT) and osteotoxic chemotherapies are at increased risk for fractures. However, research focusing on how genetic and clinical susceptibility factors jointly contribute to fracture risk among long-term (≥5 years) survivors of childhood cancer has been limited. To address this gap, we conducted genome-wide association studies of fracture risk in 2,453 participants from the Childhood Cancer Survivor Study (CCSS) using Cox regression models and prioritized sex- and treatment-stratified genetic associations. Replication analyses were conducted in an independent survivor sample from the St. Jude Lifetime Cohort Study (SJLIFE). We identified a genome-wide significant (P<5⨯10−8) fracture risk locus, 16p13.3 (HAGHL), among female CCSS survivors (N=1,289) with strong evidence of sex-specific effects (Psex-heterogeneity<7⨯10−6). We found rs1406815 showed the strongest association with fracture risk after replication (HRmeta-analysis per risk allele=1.43, P=8.2⨯10−9; N=1,935 women). While the association between rs1406815 and fracture risk was weak among female survivors who did not receive radiation therapy (RT) (HRCCSS=1.22, P=0.11), the association strength increased with greater RT doses to the head or neck (HRCCSS=1.88, P=2.4⨯10−10 in those with any head/neck RT; HRCCSS=3.79, P=9.1⨯10−7 in those treated with >36 Gray). In silico bioinformatics analyses suggest these fracture risk alleles regulate HAGHL gene expression and related bone resorption pathways, and are plausibly moderated by head/neck RT. Genetic risk profiles integrating this locus may help identify young female survivors who would benefit from targeted interventions to reduce fracture risk.
Analyzing How Changes in the Health Status of Healthcare Workers Affects Epidemic Outcomes
Authors: Phadke I. , McKee A. , Conway J.M. , Shea K.
Published: September 2020

During a disease outbreak, healthcare workers (HCWs) are essential to treat infected individuals. However, these HCWs are themselves susceptible to contracting the disease. As more HCWs get infected, fewer are available to provide care for others, and the overall quality of care available to infected individuals declines. This depletion of HCWs may contribute to the epidemic’s severity. To examine this issue, we explicitly model declining quality of care in four differential equation-based SIR-type models with vaccination. We assume that vaccination, recovery, and survival rates are affected by quality of care delivered. We show that explicitly modelling healthcare workers and accounting for declining quality of care significantly alters model-predicted disease outcomes, specifically case counts and mortality. Models neglecting the decline of quality of care resulting from infection of HCWs may significantly under-estimate cases and mortality. These models may be useful to inform health policy that may differ for healthcare workers and the general population. Models accounting for declining quality of care may therefore improve the management interventions considered to mitigate the effects of a future outbreak.
Validation of the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in healthcare professionals
Authors: Moser Carolina M. , Tietbohl-Santos Bárbara , Arenas Daniel Luccas , Xavier Aurora , Ornell Felipe , Borges Rogerio Boff , Hauck Simone
Published: September 2020

The objective of this study was the validation of the Brazilian Portuguese version of The Copenhagen Burnout Inventory (CBI). The study sample consisted of 1.256 Brazilian health professionals. Data were collected during one month (May-2020 to June-2020) through an online self-administered questionnaire, including the CBI and the Patient Health Questionnaire 9 (PHQ-9) to evaluate depressive symptoms. All consistency measures showed values > 0.90. The split-half correlation values with Spearman-Brown reliability were higher than 0.8. The parallel analysis suggested two factors: the items of CBI’s personal burnout (PB) and work-related burnout (WB) sub-dimensions that were associated with factor 1 (personal and work-related fatigue and exhaustion) and the items of CBI’s client-related burnout (CB) sub-dimension were associated with factor 2 (exhaustion that emerges while working with people). The correlation between the PHQ-9 score and factor 1 was 0.76 (0.73; 0.79) and with factor 2, 0.49 (0.43; 0.55). Our study provides a valid and reliable Brazilian Portuguese version of CBI, encouraging the expansion of the burnout research field in our country.
Monitoring SARS-CoV-2 circulation and diversity through community wastewater sequencing
Authors: Izquierdo-Lara Ray , Elsinga Goffe , Heijnen Leo , Oude Munnink Bas B. , Schapendonk Claudia M. E. , Nieuwenhuijse David , Kon Matthijs , Lu Lu , Aarestrup Frank M. , Lycett Samantha , Medema Gertjan , Koopmans Marion P.G. , de Graaf Miranda
Published: September 2020

The current SARS-CoV-2 pandemic has rapidly become a major global health problem for which public health surveillance is crucial to monitor virus spread. Given the presence of viral RNA in feces in around 40% of infected persons, wastewater-based epidemiology has been proposed as an addition to disease-based surveillance to assess the spread of the virus at the community level. Here we have explored the possibility of using next-generation sequencing (NGS) of sewage samples to evaluate the diversity of SARS-CoV-2 at the community level from routine wastewater testing, and compared these results with the virus diversity in patients from the Netherlands and Belgium. Phylogenetic analysis revealed the presence of viruses belonging to the most prevalent clades (19A, 20A and 20B) in both countries. Clades 19B and 20C were not identified, while they were present in clinical samples during the same period. Low frequency variant (LFV) analysis showed that some known LFVs can be associated with particular clusters within a clade, different to those of their consensus sequences, suggesting the presence of at least 2 clades within a single sewage sample. Additionally, combining genome consensus and LFV analyses we found a total of 57 unique mutations in the SARS-CoV-2 genome which have not been described before. In conclusion, this work illustrates how NGS analysis of wastewater can be used to approximate the diversity of SARS-CoV-2 viruses circulating in a community.
Norwich COVID-19 Testing Initiative: feasibility project evaluation
Authors: Gillam T Berger , Cole J , Gharbi K , Hitchcock M , Edwards D , Brabbs T , Lipscombe J , Davidson R , Rushworth S , Steel N
Published: September 2020

Background

There is a high prevalence of COVID-19 in university-age students, who are returning to university campuses. There is little evidence regarding the feasibility of universal, asymptomatic testing to control outbreaks in this population. This study aimed to pilot mass COVID-19 testing on a university research park, to assess the feasibility and acceptability of scaling up to all staff and students.

Methods

This was a cross-sectional feasibility study on a university research park in the East of England. Staff and students (5,625) on the research park were eligible to participate. Polymerase chain reaction (PCR) testing was offered to all participants. Participants were offered 4 swabs, which they self-administered over a two-week period. Outcome measures included: uptake; drop-out rate; positivity rates; participant acceptability measures; laboratory processing measures.

Results

798/1053 (76%) of those who registered provided at least one swab and of these, 687 (86%) provided all four. 681/687 (99%) had all negative results. 6 participants had one inconclusive result. There were no positive results. 458/798 (57%) participants responded to a post-testing questionnaire. 446/458 (97.5%) of those who responded agreed that they would be interested in repeat testing in the future.

Conclusions

Repeated self-testing is feasible and acceptable to a university population.