bluuebunny/crossref_metadata_2025 huggingface dataset:
Chattering of proxy-based sliding mode control in the presence of parasitic dynamics
Authors: Kikuuwe Ryo , Prieto Pablo J , López-Rentería J A
Published: February 2020

This paper reports an analysis on proxy-based sliding mode control (PSMC), which is a controller proposed by Kikuuwe & Fujimoto (2006, Proceedings of the 2006 IEEE International Conference on Robotics and Automation, pp. 25–30) originally for position control of robot manipulators. The describing function method is employed to investigate the chattering behavior of PSMC combined with a simple second-order plant with parasitic dynamics. The results show that PSMC is capable of achieving a lower tendency to chattering than the boundary-layer implementation of sliding mode control with the same sliding surface, without affecting the insensitivity to disturbance.
Construction of a Baculovirus Derivative to Produce Linearized Antheraea pernyi (Lepidoptera: Saturniidae) Multicapsid Nucleopolyhedrovirus Genomic DNA
Authors: Zhao Zhenjun , Ye Bo , Yue Dongmei , Li Peipei , Zhang Bo , Wang Linmei , Fan Qi
Published: February 2020

In the Antheraea pernyi multicapsid nucleopolyhedrovirus (AnpeNPV)-based expression vector system, the frequency of homologous recombination events between wild-type AnpeNPV DNA and the transfer vector is low, resulting in a small amount of recombinant virus. Previous reports have indicated that linearized baculovirus DNA can increase the proportion of recombinant virus relative to the total progeny. To improve the recombination efficiency, we constructed a linearized derivative of AnpeNPV, referred to as AnpeNPVPhEGFP-AvrII, in which egfp flanked by AvrII restriction sites was located at the polyhedrin locus and driven by the polyhedrin promoter. Linear AnpeNPV DNA was obtained by the treatment of AnpeNPVPhEGFP-AvrII genomic DNA with AvrII endonuclease. The infectivity and recombinogenic activity between the linearized and circular viral DNA were evaluated by quantitative real-time polymerase chain reactions. We demonstrated that the linearized AnpeNPV DNA produced only small numbers of infectious budded viruses, accounting for approximately 4.5% of the budded virus production of wild-type AnpeNPV DNA in A. pernyi pupae. However, the linearized AnpeNPV DNA substantially increased recombinant virus production after cotransfection with an appropriate transfer vector; relative abundance of the recombinant virus was approximately 5.5-fold higher than that of the wild-type AnpeNPV DNA in A. pernyi pupae. The linearization of AnpeNPV DNA will facilitate the purification of recombinant viruses using the AnpeNPV-based expression vector system and the construction of an AnpeNPV-based bacmid system.
Ruminations on Economic Decision Modeling of Managing Forest Resources with a Focus on Family Forest Landowners
Authors: Wagner John E
Published: February 2020

Abstract

The classic wealth maximization modeling of forest landowners may not be useful when examining the behavior of family forest landowners in particular. My challenge to the forestry community is to think more broadly with respect to the economic modeling of management decisions by these landowners. I would propose that forest structure (e.g., trees per unit area versus diameter class/distribution) versus time, as opposed to volume versus time, is a superior and practical approach to model forest dynamics given these landowners’ well-published preferences. I would also propose that a cost-minimization/least-cost model is also more consistent with their well-published preferences. These proposals, however, are not without their advantages and disadvantages that are examined briefly. Nonetheless, my conclusions are that scholarship based on a least-cost approach could provide insights that the classical wealth maximization modeling may not, given landownership trends.
WISE mid-infrared properties of compact active galactic nuclei selected from the high radio frequency AT20G survey
Authors: Chhetri R , Kimball A , Ekers R D , Mahony E K , Sadler E M , Jarrett T
Published: February 2020

Past studies of compact active galactic nuclei (AGNs), the dominant population at high radio frequencies, selected them using flat spectral index criteria. This biases the sample due to the steepening of AGN spectra at high radio frequencies. We improve upon this by selecting 3610 compact AGNs using their angular size information ($\lesssim$0.15 arcsec scale) from the Australia Telescope 20 GHz (AT20G) high-angular resolution catalogue. We cross-match these against the Wide-field Infrared Survey Explorer AllWISE catalogue and present a catalogue with 3300 (91 per cent) matches, 91 (3 per cent) rejects, and 219 (6 per cent) non-detections that are excellent high-redshift candidates. Of the matched compact AGNs, 92 per cent exhibit QSO mid-infrared colours (W1−W2 > 0.5). Therefore, our sample of high frequency compact sources has a very high rate of identification with mid-infrared QSOs. We find counterparts for 88 per cent of 387 compact steep-spectrum (CSS) sources in the AT20G survey, 82 ± 5 per cent of which exhibit QSO mid-infrared colours and have moderate redshifts (zmedian = 0.82), while those dominated by host galaxy colours in mid-infrared have lower redshifts (zmedian = 0.13). The latter classified into late- and early-type galaxies using their mid-infrared colours shows a majority (68 ± 4 per cent) have colours characteristic of late-type galaxies. Thus, we find that a larger fraction of these CSS sources are embedded in hosts with higher gas densities than average early-type galaxies. We compare mid-infrared colours of our AGNs against those reported for AGNs primarily selected using non-radio techniques. This shows that mid-infrared SED of high frequency selected compact radio AGN is comparatively less red, possibly due to contributions from their hosts.
Pushing point-spread function reconstruction to the next level: application to SPHERE/ZIMPOL
Authors: Beltramo-Martin O , Marasco A , Fusco T , Massari D , Milli J , Fiorentino G , Neichel B
Published: February 2020

Point-spread function (PSF) reconstruction (PSF-R) is a well-established technique to determine the PSF reliably and accurately from adaptive optics (AO) control-loop data. We have successfully applied this technique to improve the precision of photometry and astrometry for observations of NGC 6121 obtained with the Spectro Polarimetric High-contrast Exoplanet REsearch (SPHERE)/Zurich IMaging POLarimeter (ZIMPOL), which will be presented in a forthcoming Letter. First, we present the methodology we followed to reconstruct the PSF by combining pupil-plane and focal-plane measurements using our PSF-R method PRIME (PSF Reconstruction and Identification for Multiple-source characterization Enhancement), with upgrades of both the model and best-fitting steps compared with previous articles. Secondly, we highlight that PRIME allows us to maintain the PSF fitting residual below 0.2 per cent over 2 hours of observation and using only 30 s of AO telemetry, which may have important consequences for telemetry storage for PSF-R purposes on future 30–40 m class telescopes. Finally, we deploy PRIME in a more realistic regime using faint stars, so as to identify the precision needed on the initial-guess parameters to ensure convergence towards the optimal solution.
The excitation of OH by H2 revisited – II. Hyperfine resolved rate coefficients
Authors: Kłos J , Dagdigian P J , Alexander M H , Faure A , Lique F
Published: February 2020

Observations of hyperfine resolved transitions of the hydroxyl radical (OH) are unique probes of the physical conditions in molecular clouds. In particular, hyperfine intensities can be used as an effective thermometer over a wide range of molecular densities. Accurate modelling of the OH emission spectra requires the calculation of collisional rate coefficients for the excitation of OH by H2, the most abundant collisional partner in the molecular clouds. Here, we determine hyperfine resolved rate coefficients for the excitation of OH by H2 using a recently developed highly accurate potential energy surface. State-to-state rate coefficients between the lower hyperfine levels were calculated using recoupling techniques for temperature ranging from 10 to 150 K. Significant differences were found with the earlier values currently used in astrophysical models, the new rate coefficients being larger than the previous ones. Finally, we compute the excitation of the OH radical in cold molecular clouds and star-forming regions. The new rate coefficients were found to increase the hyperfine intensities by a factor of ∼1–2. Consequently, we recommend using this new set of data in any astrophysical model of OH excitation.
An extended Pal 5 stream in Gaia DR2
Authors: Starkman Nathaniel , Bovy Jo , Webb Jeremy J
Published: February 2020

We present the results of a detailed search for members of the Pal 5 tidal tail system in Gaia Data Release 2 (DR2). Tidal tails provide a sensitive method for measuring the current and past gravitational potential of their host galaxy as well as for testing predictions for the abundance of dark matter subhaloes. The Pal 5 globular cluster and its associated tails are an excellent candidate for such analysis; however, only ∼23° of arc are currently known, with in particular the leading tail much shorter than the trailing. Using Gaia DR2 and its precise astrometry, we extend the known extent of the Pal 5 tail to ∼30°, 7° of which are newly detected along the leading arm. The detected leading and trailing arms are symmetric in length and remain near constant width. This detection constrains proposed models in which the Galactic bar truncates Pal 5’s leading arm. Follow-up spectroscopic observations are necessary to verify the candidate stream stars are consistent with the known tidal tails. If confirmed, this Pal 5 stream extension opens up new possibilities to constrain the Galactic potential.
Expanding a Music Therapy Business Using AMTA’s Aspirational Code of Ethics
Authors: Pizzi Meredith Roman
Published: February 2020

While all music therapists look to the Code of Ethics as a guiding document, music therapists who are self-employed or managing teams rely heavily on this document to create sound business and administrative policies. This article articulates how the 2019 Code of Ethics informs the music therapy entrepreneur or manager to make thoughtful, accountable, and ethical decisions, decreases confusion about specific business practices, and addresses significant concerns related to aspects of the previous AMTA Code of Ethics that were in conflict with federal anti-trust regulations in the United States, including the Sherman Anti-Trust Law. To address the legal and ethical issues inherent in expanding a service business, a discussion guided by the 2019 Code of Ethics and the Markkula Center for Applied Ethics (2009) model is provided as a way to think through potential ethical dilemmas when considering subcontracting music therapy services.
Structure specific recognition of telomeric repeats containing RNA by the RGG-box of hnRNPA1
Authors: Ghosh Meenakshi , Singh Mahavir
Published: February 2020

The telomere repeats containing RNA (TERRA) is transcribed from the C-rich strand of telomere DNA and comprises of UUAGGG nucleotides repeats in humans. The TERRA RNA repeats can exist in single stranded, RNA-DNA hybrid and G-quadruplex forms in the cell. Interaction of TERRA RNA with hnRNPA1 has been proposed to play critical roles in maintenance of telomere DNA. hnRNPA1 contains an N-terminal UP1 domain followed by an RGG-box containing C-terminal region. RGG-motifs are emerging as key protein motifs that recognize the higher order nucleic acid structures as well as are known to promote liquid-liquid phase separation of proteins. In this study, we have shown that the RGG-box of hnRNPA1 specifically recognizes the TERRA RNA G-quadruplexes that have loops in their topology, whereas it does not interact with the single-stranded RNA. Our results show that the N-terminal UP1 domain in the presence of the RGG-box destabilizes the loop containing TERRA RNA G-quadruplex efficiently compared to the RNA G-quadruplex that lacks loops, suggesting that unfolding of G-quadruplex structures by UP1 is structure dependent. Furthermore, we have compared the telomere DNA and TERRA RNA G-quadruplex binding by the RGG-box of hnRNPA1 and discussed its implications in telomere DNA maintenance.
The Highly Structured Physician Scientist Training Program (PSTP) for Medical Students at the University of Pittsburgh
Authors: Steinman Richard A. , Proulx Chelsea N. , Levine Arthur S.
Published: February 2020

The University of Pittsburgh School of Medicine Physician Scientist Training Program (PSTP) is a 5-year medical student training program designed to prepare the next generation of MD-only physician–scientists engaging in preclinical research. This article provides an overview of the program, including the novel longitudinal structure and competency goals, which facilitate success and persistence in a laboratory-based physician–scientist career. The authors present data on 81 medical students accepted to the program from academic year 2007–2008 through 2018–2019. Extrinsic outcomes, such as publications, grant funding, and residency matching, indicate that PSTP trainees have actively generated research deliverables. A majority of eligible PSTP trainees have earned Howard Hughes Medical Institute Medical Research Fellow funding. PSTP students have produced a mean of 1.6 first-authored publications (median, 1.0) and a mean of 5.1 total publications (median, 4.0) while in medical school and have authored 0.9 publications per year as residents/fellows, excluding internship. Nearly 60% of PSTP students (26/46) have matched to top-10 National Institutes of Health-funded residency programs in their specialty (based on Blue Ridge Institute rankings). PSTP alumni are twice as likely as their classmates to match into research-heavy departments and to publish first-authored papers. Results of a 2018 program evaluation survey indicate that intrinsic outcomes, such as confidence in research skills, significantly correlate with extrinsic outcomes. The program continues to evolve to maximize both scientific agency and career navigation skills in participants. This medical student PSTP model has potential to expand the pool of physician–scientist researchers in preclinical research beyond the capacity of dedicated MD–PhD and postgraduate training programs.
Living in a World of Change: Bridging the Gap From Competency-Based Medical Education Theory to Practice in Canada
Authors: Dagnone Jeffrey Damon , Chan Ming-Ka , Meschino Diane , Bandiera Glen , den Rooyen Corry , Matlow Anne , McEwen Laura , Scheele Fedde , St. Croix Rhonda
Published: February 2020

Within graduate medical education, many educators are experiencing a climate of significant change. One transformation, competency-based medical education (CBME), is occurring simultaneously across much of the world, and implementation will require navigating numerous tensions and paradoxes. Successful transformation requires many types of power and is most likely to happen when the medical education community of professionals is engaged in designing, experimenting, acting, and sensemaking together.

In this complex climate, the craft of change facilitators and community leaders is needed more than ever. National top-down policies and structures, while important, are not sufficient. The operationalization of new advances is best done when local leaders are afforded room to shape their local context. An evidence-based approach to thinking about the transformative change associated with CBME needs to be adopted. In this age of entrustment, 3 priorities are paramount: (1) engage, entrust, and empower professionals with increasing shared ownership of the innovation; (2) better prepare education professionals in leadership and transformational change techniques in the complex system of medical education; and (3) leverage the wider community of practice to maximize local CBME customization. These recommendations, although based largely on the Canadian experience, are intended to inform CBME transformation in any context.
Effect on Opioids Requirement of Early Administration of Intranasal Ketamine for Acute Traumatic Pain
Authors: Bouida Wahid , Bel Haj Ali Khaoula , Ben Soltane Houda , Msolli Mohamed Amine , Boubaker Hamdi , Sekma Adel , Beltaief Kaouthar , Grissa Mohamed Habib , Methamem Mehdi , Boukef Riadh , Belguith Asma , Nouira Semir
Published: February 2020

Objectives:

To evaluate the efficacy and safety of early administration of low-dose intranasal ketamine on reducing the need for opioid and nonopioid analgesic agents in emergency department (ED) patients with acute moderate to severe acute limbs’ trauma pain.

Patients and Methods:

This is a double-blind, randomized, prospective, controlled study conducted in the ED. The included patients were randomly assigned to intranasal pulverization of ketamine or placebo. Protocol treatment was given at the triage. The primary outcome is the need for opioids during ED stay. Secondary outcome included the requirement of nonopioid analgesic agents and the percentage of patients discharged from the ED with a visual analog scale (VAS) <30. A combined outcome score including the 3 outcome items was constructed.

Results:

The authors included 1102 patients, 550 patients in the placebo group, and 552 in the intranasal ketamine group. The groups were similar regarding demographics, clinical characteristics, and baseline VAS. The need for opioids was decreased in the intranasal ketamine group compared with the placebo group (17.2% vs. 26.5%; P<0.001). The need for nonopioid analgesics was significantly lower in the intranasal ketamine group compared with the placebo group (31.1% vs. 39.6%; P=0.003). The percentage of patients discharged with a VAS score <30 was significantly higher in the intranasal ketamine group (P<0.001). The mean combined outcome score was 0.97 in the placebo group and 0.67 in the intranasal ketamine group (P<0.001).

Conclusion:

Intranasal ketamine administered early in the triage was associated with a decrease in opioids and nonopioid analgesics need in patients with acute limb trauma-related pain.
Locking Screws With a Threaded Degradable Polymer Collar Reduce Construct Stiffness Over Time
Authors: Schultz Blake J. , Amin Nirav H. , Mattison Braden J. , Mir Hassan R. , Shah Anjan R. , Cerynik Douglas L.
Published: February 2020

Objectives:

The stiffness of locking plates provide increased stability for early fracture healing but may limit late interfragmentary motion (IFM) necessary for secondary bone healing. An ideal plating construct would provide early rigidity and late flexibility to optimize bone healing. A novel screw plate construct utilizing locking screws with a degradable polymer locking mechanism is a dynamic option.

Methods:

Conventional locked plating constructs (group A) were compared with locking screws with a threaded degradable polymer collar before (group B) and after polymer dissolution (group C). Monotonic axial compression, monotonic torsion, cyclic axial load to failure, and IFM at the near and far cortices were tested on synthetic bone models.

Results:

One-way analysis of variance and post hoc Tukey–Kramer testing demonstrated similar axial stiffness in group A (873 ± 146 N/mm) and B (694 ± 314 N/mm) but significantly less stiffness in group C (379 ± 59 N/mm; F(2,15) = 9.12, P = 0.003). Groups A and B also had similar IFM, but group C had significantly increased IFM at both the near (F(2, 15) = 48.66, P = 2.76E-07) and far (F(2, 15) = 11.78, P = 0.0008) cortices. In cyclic axial load to failure, group A (1593 ± 233 N) and B (1277 ± 141 N) were again similar, but group C was significantly less (912 ± 256 N; F(2, 15) = 15.00, P = 0.0003). All failures were above the 500-N threshold seen in typical weight-bearing restrictions for fracture care. Torsional stiffness demonstrated significant differences between all groups (F(2, 15) = 106.64, P = 1.4E-09).

Conclusions:

Use of locking plates with a degradable polymer collar show potential for in vitro construct dynamization. Future in vivo studies are warranted to assess performance under combined loading and the effects of decreasing construct stiffness during the course of bony healing.
The Effectiveness of Negative Pressure Wound Therapy Versus Conventional Dressing in the Treatment of Open Fractures: A Systematic Review and Meta-Analysis
Authors: Grant-Freemantle Marc C. , Ryan Éanna J. , Flynn Sean O. , Moloney Darren P. , Kelly Michael A. , Coveney Eamonn I. , O'Daly Brendan J. , Quinlan John F.
Published: February 2020

Objectives:

To compare the efficacy of negative pressure wound therapy (NPWT) versus conventional dressings (CD) in the management of open fractures.

Data Sources:

A systematic search of English articles in the PubMed/MEDLINE, Embase, and the Cochrane Library through April 2019 comparing NPWT versus CD in the management of open fractures.

Study Selection:

Inclusion criteria were articles in English language, comparing NPWT with CD in skeletally mature individuals who had sustained an open fracture at any anatomical site, reporting on rates of deep infection, flap frequency, flap failure, nonunion, amputation, length of hospital, or intensive care unit stay.

Data Extraction:

Two authors independently extracted data from selected studies, and the data collected were compared with verify agreement.

Data Synthesis:

Pooled odds ratios were calculated for dichotomous outcomes, whereas continuous data were analyzed using the standard weighted mean difference. A random or fixed effect model was used depending on the level of heterogeneity between the studies.

Conclusions:

NPWT results in decreased likelihood of deep infection and flap failure compared with CD in the management of open fractures not directly amenable to early closure.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
The NuVasive MAGEC Rod Urgent Field Safety Notice Concerning Locking Pin Fracture
Authors: Joyce Thomas J. , Smith Simon L. , Kandemir Goksu , Rushton Paul R. P. , Fender David , Bowey Andrew J. , Gibson Michael J.
Published: February 2020

Study Design.

Analysis of explanted MAGnetic Expansion Control (MAGEC) growing rods.

Objective.

The aim of this study was to quantify the rate of locking pin breakage in explanted MAGEC rods and compare with the manufacturer's data.

Summary of Background Data.

On June 25, 2019, NuVasive released an Urgent Field Safety Notice stating that MAGEC rods manufactured before March 26, 2015 had a higher than expected locking pin breakage rate of 5%. For rods made on or after that date, no pin breakages had occurred.

Methods.

From our independent explant database of 139 explanted MAGEC rods supplied from 10 UK spinal centers (Belfast, Bristol, Birmingham, Edinburgh, Exeter, Leeds, Newcastle, Nottingham, Oxford, and Sheffield) and one Danish center (Aarhus), we divided the rods into those manufactured before March 26, 2015, and those manufactured on or after that date. MAGEC rods were cut open to fully assess internal components including locking pins. From each of the two cohorts, 10 locking pins were selected at random and their diameters were measured using a micrometer.

Results.

One hundred and five explanted MAGEC rods were made before March 26, 2015 and could be disassembled to allow the locking pin to be examined. Fifty-nine percent (62/105) of these locking pins had fractured. For the MAGEC rods manufactured on or after March 26, 2015, 21% (6/29) were found to have fractured locking pins. Locking pins in MAGEC rods made on or after March 26, 2015 were of a stronger material and a larger diameter.

Conclusion.

Fifty-nine percent of the locking pins in MAGEC rods manufactured before March 26, 2015 had fractured, far greater than the 5% stated in the Urgent Field Safety Notice. Locking pin fracture still occurred in MAGEC rods manufactured on or after that date, in 21% of cases. This contrasted with the 0% reported by the manufacturer.

Level of Evidence: 4
A Long-Term Follow-up, Multicenter, Comparative Study of the Radiologic, and Clinical Results Between a CaO-SiO2-P2O5-B2O3 Bioactive Glass Ceramics (BGS-7) Intervertebral Spacer and Titanium Cage in 1-Level Posterior Lumbar Interbody Fusion
Authors: Lee Jae Hyup , Kim Sun Ki , Kang Sung Shik , Han Seung Jung , Lee Choon-Ki , Chang Bong-Soon
Published: February 2020

Study Design:

This is a prospective, stratified randomized, multicenter, 4-year follow-up study.

Objective:

The authors aimed to evaluate the long-term clinical efficacy and safety of CaO-SiO2-P2O5-B2O3 glass ceramics (BGS-7) spacers in 1-level posterior lumbar interbody fusion (PLIF) at a 4-year follow-up.

Summary of Background Data:

According to 1-year follow-up results, BGS-7 spacer showed similar fusion rates and clinical outcomes compared with titanium cage. A long-term follow-up study beyond 2 years is necessary to investigate the status of intervertebral bone graft volumes. Moreover, longer follow-up is mandatory to also evaluate the safety and efficacy of BGS-7 spacers, because they remain in the intervertebral space for a long time.

Materials and Methods:

In this prospective, randomized, multicenter, 4-year follow-up study, we evaluated 62 of the 74 patients who underwent 1-level PLIF. During 1-level PLIF, titanium cages filled with autologous local bone were inserted into the control group patients and BGS-7 spacers were inserted to the experimental group patients. Bone fusion was evaluated by plain radiography and thin-section computed tomography. Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), Short Form-36 Health Survey (SF-36), and evaluation of safety were conducted after 48 months.

Results:

Computed tomography scan showed a bone fusion rate of 90.6% in the BGS-7 spacer group and 93.3% in the control group, with no significant differences between groups. The BGS-7 spacer group showed a significantly larger area directly fused to the endplate than the control group (P<0.001). The BGS-7 spacer group showed a significant increase in the fused area compared with the titanium group at 1- and 4-year follow-up. The ODI, SF-36, back pain, and lower limb pain in both groups showed significant improvement after surgery, and no significant differences were observed between the groups. Both groups showed no additional adverse events.

Conclusions:

The 4-year follow-up study showed similar fusion rates and clinical outcomes in both the BGS-7 spacer and autologous bone with a titanium cage in 1-level PLIF. However, the BGS-7 spacer implants showed a larger area of fusion with the endplates than that of autologous bone with a titanium cage. Therefore, the results demonstrated that the BGS-7 spacer can be considered as a novel intervertebral spacer to achieve successful spinal fusion without safety concerns for long-term use.
Extracorporeal Membrane Oxygenation in Pregnancy: An Analysis of the Extracorporeal Life Support Organization Registry
Authors: Ramanathan Kollengode , Tan Chuen Seng , Rycus Peter , Anders Marc , Lorusso Roberto , Zhang John J. Y. , MacLaren Graeme
Published: February 2020

Objectives:

We examined data from the International Registry of the Extracorporeal Life Support Organization to identify risk factors for mortality in pregnant and peripartum patients receiving extracorporeal membrane oxygenation.

Design:

Retrospective analysis.

Setting:

International Registry of Extracorporeal Life Support Organization.

Patients:

We collected de-identified data on all peripartum patients who needed extracorporeal membrane oxygenation between 1997 and 2017 using International Classification of Diseases, 9th and 10th Edition criteria.

Interventions:

Our primary outcome measure was in-hospital mortality. We also collected data on demographics, preextracorporeal membrane oxygenation ventilator, hemodynamic and biochemical parameters, extracorporeal membrane oxygenation mode, duration, and complications. Initial bivariate analysis assessed potential associations between survival and various preextracorporeal membrane oxygenation as well as extracorporeal membrane oxygenation-related factors. Variables with p values of less than 0.1 were considered for logistic regression analysis which identified predictors of mortality.

Measurements and Main Results:

There were 280 peripartum patients who received extracorporeal membrane oxygenation. Overall maternal survival was 70%, with observed mortality for these patients decreasing over the 21-year time period. Multivariate regression identified extracorporeal cardiopulmonary resuscitation (odds ratio, 3.674; 95% CI, 1.425–9.473; overall p = 0.025), duration of extracorporeal membrane oxygenation (< 66 hr: odds ratio, 1; 66–128 hr: odds ratio, 0.281; 95% CI, 0.101–0.777; p = 0.014; 128–232 hr: odds ratio, 0.474; 95% CI, 0.191–1.174; p = 0.107; and > 232 hr: odds ratio, 1.084; 95% CI, 0.429–2.737; p = 0.864; overall p = 0.017), and renal complications on extracorporeal membrane oxygenation (odds ratio, 2.346; 95% CI, 1.203–4.572; p = 0.012) as significant risk factors for mortality. There was no statistically significant difference in mortality between venovenous versus venoarterial versus mixed group extracorporeal membrane oxygenation (23.9 vs 34.4 vs 29.4%; p = 0.2) or between pulmonary versus cardiac indications (1.634; 95% CI, 0.797–3.352; p = 0.18) for extracorporeal membrane oxygenation.

Conclusions:

On analysis of this multicenter database, pregnant and peripartum patients with refractory cardiac or respiratory failure supported on extracorporeal membrane oxygenation had survival rates of 70%. We identified preextracorporeal membrane oxygenation as well as extracorporeal membrane oxygenation-related factors that are associated with mortality.
The Anticancer Efficacy of Immune Checkpoint Inhibitors According to Patients’ Age: A Systematic Review and Meta-Analysis
Authors: Ciccarese Chiara , Iacovelli Roberto , Bria Emilio , Palazzo Antonella , Maiorano Brigida Anna , Mosillo Claudia , Carbone Carmine , Piro Geny , Tortora Giampaolo
Published: February 2020

Limited prospective data about the activity of immune checkpoint inhibitors (ICIs) are available for elderly patients. The aim of our analysis was to determine the relative efficacy of ICIs versus available standard therapies [standard of care (SOC)] in subgroups defined by patients’ age. Searching the MEDLINE/PubMed, Cochrane Library, and American Society of Clinical Oncology (ASCO) Meeting abstracts randomized clinical trials were identified. Data extraction was conduced according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The measured outcome was overall survival (OS). Twenty-nine randomized clinical trials (18,839 patients) were selected. As for the distribution of patients by age, all but 3 of the selected studies considered young the patients younger than 65 years (n=10,832) and elderly those with 65 years and older (n=7723); 7 studies identified a third subgroup of very elderly patients aged 75 years and above (n=421). In elderly and very elderly patients ICIs significantly reduced the risk of death by 23% compared with SOC [hazard ratio (HR), 0.77; P<0.00001)]. On the contrary, a lack of a survival advantage of immunotherapy was observed in the subgroup of very elderly patients (HR, 0.85; P=0.39). When comparing the efficacy of ICIs between the 2 subpopulations (elderly vs. young), no significant difference in OS was observed (HR, 0.76; P=0.66). ICIs prolonged OS compared with SOC in both elderly and young patients affected by lung cancer, melanoma, and renal carcinoma, regardless of the age. In conclusion, ICIs (as monotherapy or combinations) significantly improved OS compared with SOC in both young and elderly patients with advanced cancers, regardless of the tumor type. The magnitude of this benefit is debated in patients aged 75 years and above.
Pharmacologic Treatment of Neurobehavioral Sequelae Following Traumatic Brain Injury
Authors: Traeger Jessica , Hoffman Brian , Misencik Jennifer , Hoffer Alan , Makii Jason
Published: February 2020

Traumatic brain injury (TBI) is a leading cause of disability in the United States. With decreasing mortality rates, a higher number of patients are impacted by long-term neuropsychiatric sequelae, such as cognitive deficits, depression, anxiety, and sleep-wake disorders. These sequelae are primarily driven by the disruption of key neurotransmitter homeostasis including dopamine, norepinephrine, serotonin, and acetylcholine. Neurostimulants are centrally acting medications used to assist in restoring these neurotransmitter abnormalities and are pharmacologic options to ameliorate symptoms in post-TBI patients. Examples of neurostimulants include amantadine, selective serotonin reuptake inhibitors, tricyclic antidepressants, central stimulants (ie, methylphenidate), modafinil, and donepezil. Large, well-powered studies have not been performed to validate their use in patients with TBI, leaving uncertainty for these agents' place in therapy. Current practice is driven by consideration of patient-specific factors to select the most appropriate agent. This review provides clinicians with a summary of the available literature on neurostimulants following TBI to guide appropriate usage to help improve patients' symptoms and optimize safety.
Refusal of Radiation Results in Inferior Survival in Endometrial Cancer
Authors: Parsons Matthew W. , Francis Samual , Maurer Kathryn A. , Grant Jon , Gaffney David K.
Published: February 2020

Objective:

We sought to understand factors associated with refusal of adjuvant radiotherapy in endometrial cancer and its impact on outcomes.

Methods:

Data from the National Cancer Database for patients who underwent surgery for nonmetastatic endometrial cancer between 2004 and 2015 were pooled. The Pearson χ2 test and multivariate logistic regression analyses were used to assess demographic, clinical, and treatment factors. Inverse probability of treatment weighting was used to account for differences in baseline characteristics. Kaplan-Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling were used to analyze overall survival (OS).

Results:

We identified 4739 of 80,803 patients (5.9%) who refused radiotherapy. Factors associated with refusal were: no insurance (relative risk [RR]=1.66, P<0.01), Medicare (RR=1.42, P<0.01), living >50 miles from treatment (RR=1.34, P<0.01), Charlson-Deyo Comorbidity Scores of 1 (RR=1.16, P<0.01) or ≥2 RR=1.38, P<0.01), age above 60 years (RR=1.28, P<0.01), International Federation of Gynecology and Obstetrics (FIGO) stages IIIA (RR=1.63, P<0.01) and IIIC (RR=1.65, P<0.01) disease, papillary (RR=1.69, P<0.01) and clear cell histology (RR=1.64, P<0.01). Factors associated with radiation therapy receipt included: Hispanic race (RR=0.61, P<0.01), income >$63,000 (RR=0.89, P=0.044), undergoing chemotherapy (RR=0.17, P<0.01), FIGO stages IB (RR=0.81, P<0.01) and II (RR=0.70, P<0.01) disease, and lymphadenectomy (RR=0.79, P<0.01). After weighting, 5-year OS was significantly lower with refusal (74.3% vs. 79.7%, P<0.01). This survival decrement was maintained across FIGO stages.

Conclusions:

We identified characteristics associated with radiation refusal, including socioeconomic barriers, advanced disease stage, and histology. Refusal of radiotherapy conferred decreased OS across FIGO stages.
Nasal Valve Insufficiency in Dermatologic Surgery
Authors: Barbosa Naiara S. , Baum Christian L. , Arpey Christopher J.
Published: February 2020

BACKGROUND

Few publications have addressed nasal valve (NV) insufficiency as a complication of Mohs micrographic surgery.

OBJECTIVE

To comprehensively review the literature and further characterize the causes, prevalence, evaluation, and management of NV insufficiency as it relates to cutaneous oncology.

MATERIALS AND METHODS

A PubMed search was completed to identify articles related to the NV in the context of Mohs micrographic surgery, cutaneous oncology, and reconstruction.

RESULTS

Nasal valve insufficiency may occur during tumor removal and/or reconstruction. Defect size larger than 1 cm; location on the ala, sidewall, or alar crease; lack of structural support; and poorly planned flaps are the main risk factors for NV insufficiency. Several surgical techniques have been described to avoid and correct this complication.

CONCLUSION

Nasal valve insufficiency may be an underrecognized and underreported complication of Mohs micrographic surgery. Nasal valve insufficiency may be identified with relatively simple tests. Knowledge of NV anatomy and preoperative function assessment is essential. Recognition of this potential complication and awareness of its prevention and management may decrease morbidity in patients undergoing cutaneous surgery.
Peripapillary and Macular Vessel Density Measurement by Optical Coherence Tomography Angiography in Pseudoexfoliation and Primary Open-angle Glaucoma
Authors: Jo Youn Hye , Sung Kyung Rim , Shin Joong Won
Published: February 2020

Precis:

Pseudoexfoliation glaucoma eyes had a similar level of peripapillary and superficial macular vessel densities compared with primary open-angle glaucoma eyes matched for age and glaucoma severity when assessed by optical coherence tomography angiography (OCT-A).

Purpose:

To compare vessel density (VD) measured by OCT-A between primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) in the peripapillary and macular areas.

Materials and Methods:

The circumpapillary (cpVD), parafoveal (pfVD), and perifoveal vessel densities (perifVD) were obtained using OCT-A (AngioVue/RTVue-XR) in 98 eyes from 98 subjects [age, visual acuity, visual field (VF) mean deviation (MD) matched 49 POAG and 49 PXG eyes]. Global and 8 sectoral VDs in the peripapillary capillary layer were compared. In the macula, the superficial and deep layers of the pfVD and perifVD were analyzed globally and in 4 quadrants. Univariate and multivariate linear regression models were built using cpVD, pfVD, and perifVD as dependent variables and covariates [age, intraocular pressure (IOP), axial length, signal strength index (SSI), and retinal nerve fiber layer (RNFL) thickness] were considered independent variables.

Results:

In the peripapillary region, none of the VDs differed between groups both before and after adjustment. When we adjusted superficial and deep layer macular VDs for age, IOP, SSI, axial length, and RNFL thickness, all of which could affect measurements, the 2 groups did not differ in any sector. The cpVD in POAG eyes significantly correlated with VF MD and RNFL thickness, whereas IOP, VF MD, and RNFL thickness affected cpVD in PXG. The macular VD in the deep layer was associated with only SSI in both groups.

Conclusions:

Age-matched and glaucoma severity-matched PXG and POAG did not significantly differ in cpVD or in most of the superficial macular VD parameters.
Determining Factors That Influence Nurses' Perceptions of Quality Implementations Conducted in Hospitals in Turkey
Authors: GÜR Emel , EKICI Dilek
Published: February 2020

Background

Quality management program implementations in health services are team endeavors that involve all health service personnel. Because they are direct providers of care, nurses are best able to evaluate the influence of quality management program implementations on the health services and quality of care provided by hospitals.

Purpose

The aim of this study was to develop an instrument to determine how nurses perceive the implementation of quality management programs in hospitals. Furthermore, the nurses' perceptions of the influence of these implementations on the quality of patient care and their job satisfaction were examined.

Methods

A descriptive, comparative, cross-sectional online survey was conducted using a convenience sample (N = 388) of practicing nurses working at public and university hospitals where quality management programs were implemented. Nurses' perceptions of the implementations were analyzed using confirmatory factor analysis, whereas the influence of nurses' perceptions of quality management implementations on patient care and job satisfaction was measured using structural equation modeling approaches.

Results

This study revealed that the instrument is valid and reliable for the measurement of participant perceptions of quality management program implementations. Nurses' perceptions were generally negative, and they exhibited negative attitudes toward the implementation of quality management in the institutions where they work. However, the quality management program implementations had little influence on perceptions of the quality of patient care. Participant job satisfaction was lower than average, and the quality management program implementations conducted in the hospitals negatively affected job satisfaction. On the other hand, participants who worked at university hospitals perceived quality management program implementations more affirmatively; patient care quality and job satisfaction were viewed more positively as well.

Conclusions/Implications for Practice

Because nurses do not participate effectively in quality management program implementations, they perceive these efforts as unnecessary and the responsibility of the quality control department. It is very important to ensure that all care-service providers participate to effectively implement quality management programs in hospitals and to encourage the adoption of a culture of patient safety in all institutions.
The Use of the Gradual Yielding Mechanism During Downhill Walking in Persons With Transfemoral Amputation—A Case Study
Authors: Alexander Nathalie , Strutzenberger Gerda , Schwameder Hermann
Published: February 2020

Introduction

To avoid collapsing of the prosthetic knee during loading, some prostheses contain a yielding mechanism, which can also be used for a safe downhill gait. The aim of this case study was to investigate 1) the influence of downhill gradient on the utilization of yielding mechanisms during gait in individuals with UTA, 2) whether the yielding gait is linked to altered spatiotemporal parameters, and 3) if prosthetic ankle components influence the selection of the yielding mechanism.

Materials and Methods

Two participants with transfemoral amputation (UFT1 and UFT2) walked overground at various slopes (from 0° to −15°) with their habitual knee device using an articulating and a rigid prosthetic ankle component. Kinematic and kinetic data were recorded at self-selected walking speed.

Results

UTF1 switched to the gradual yielding mechanism at −6° and UTF2 at −12°. UTF2 walked with the yielding mechanism with a decreased speed, step, and stride length. The use of an articulating compared with a rigid ankle component did not influence the yielding pattern.

Conclusions

First, the gradient at which the UTFs first used the yielding mechanism was found to be individual. Second, the yielding mechanism induced different alterations in spatiotemporal parameters to the participant walking at higher speed when not using the yielding mechanism. Third, using an articulating prosthetic ankle component did not alter the yielding gait pattern in two individuals with unilateral transfemoral amputation. The individual differences highlight the need for individual setups taking the different components of the prosthetic limb into account.
Hip Joint Cartilage Defects in Professional Ballet Dancers: A 5-year Longitudinal Study
Authors: Mayes Susan , Smith Peter , Stuart Debbie , Semciw Adam , Cook Jill
Published: February 2020

Objective:

A causal link between ballet, hip pain, and pathology has not been established. Change in ballet dancers' hip pain and cartilage defect scores were investigated over 5 years.

Design:

Longitudinal.

Setting:

Professional ballet company.

Participants:

Twenty-one professional ballet dancers (52% men).

Independent Variables:

Baseline and follow-up Copenhagen Hip and Groin Outcome Score (HAGOS—pain subscale); incidence of hip-related pain and levels of dance participation collected daily over 5 years; bony morphology measured on baseline 3T magnetic resonance imaging (MRI).

Main Outcome Measure:

Change in cartilage defect score on MRI between baseline and 5-year follow-up.

Results:

Cartilage scores did not increase in 19 (90%) dancers. There was one new cartilage defect and one progressed in severity. At follow-up, all 6 dancers with cartilage defects were men. Group HAGOS pain scores were high 97.5 (7.5) and not related to cartilage defects (P = 0.12). Five (83%) dancers with baseline cartilage defects reported HAGOS pain scores <100 at follow-up. There were no time-loss hip injuries over 5 years. Two (33%) dancers with cartilage defects recorded hip-related pain (one reported minor training modification). Femoral neck-shaft angles (NSAs) were lower in men with cartilage defects [129.3 degrees (3.4 degrees)] compared with those without cartilage defects [138.4 degrees (4.5 degrees); P = 0.004].

Conclusions:

Elite level ballet did not negatively affect cartilage health over 5 years. Cartilage defects were related to low femoral NSAs. Most cartilage defects did not progress and there was minimal impact on dance participation and pain levels. Longer follow-up is required to determine the long-term sequelae for those with cartilage defects.

Level of Evidence:

1b.
Initial high-dose corticosteroids and renal impairment are risk factors for early severe infections in elderly patients with antineutrophil cytoplasmic autoantibody-associated vasculitis
Authors: Waki Daisuke , Nishimura Keisuke , Tokumasu Hironobu , Kadoba Keiichiro , Mukoyama Hiroki , Saito Rintaro , Murabe Hiroyuki , Yokota Toshihiko
Published: February 2020

Recent large observational studies of antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) show that severe infection is a major cause of death and that the majority of infections occur during the early phase of initiating remission-induction therapy. Many risk factors for severe infection have been suggested, but these have been inconsistent. Nevertheless, infectious risk factors in elderly patients with AAV have not been adequately investigated in previous studies.

In this retrospective observational study, we examined potential predictors of severe infection within 90 days (early severe infections) after remission-induction therapy in patients with AAV aged 65 years or older. We included 167 consecutive elderly patients with AAV admitted to our hospital. Data from medical history and remission-induction therapy were analyzed for predictive risk factors associated with early severe infections. The relationship between initial doses of corticosteroids and cumulative incidence of severe infections was also analyzed. A multivariate analysis of risk factors for early severe infections was performed using logistic regression analysis. The Kaplan–Meier method was used to estimate the overall survival, and the log-rank test was used to evaluate the differences between patients with and without early severe infections. Gray method was used to compare the cumulative incidence of severe infections in patients who did and did not receive initial high-dose corticosteroids.

Logistic regression analysis showed that initial high-dose corticosteroid administration (prednisolone ≥0.8 mg/kg/d) (odds ratio [OR] 3.86, P = .030) and serum creatinine levels at diagnosis ≥1.5 mg/dL (OR 5.13, P 
= .003) were independent predictors of early severe infection although administration of cyclophosphamide or rituximab was not. The cumulative incidence of severe infections was also significantly higher in patients who received initial high-dose corticosteroids (P = .042), and patients with early severe infections exhibited a high mortality rate within 6 months (P < .001).

Our findings suggest that initial high-dose corticosteroids and renal impairment at diagnosis are associated with a higher risk of early severe infections and early death in elderly patients with AAV.