bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermally driven disc winds as a mechanism for X-ray irradiation heating in black hole X-ray binaries: the case study of GX339–4
Authors: Tetarenko B E , Dubus G , Marcel G , Done C , Clavel M
Published: May 2020

X-ray irradiation heating of accretion discs in black hole X-ray binaries (BHXBs) plays a key role in regulating their outburst cycles. However, despite decades of theoretical and observational efforts, the physical mechanism(s) responsible for irradiating these discs remains largely unknown. We have built an observation-based methodology to estimate the strength of irradiation of BHXB discs by combining multiwavelength X-ray and optical/infrared (OIR) data throughout transient outbursts. We apply this to ∼15 yr of activity in the Galactic BHXB GX339–4. Our findings suggest that the irradiation heating required by the optical data is large in this system. Direct illumination of the outer disc does not produce sufficient irradiation, but this should also produce a thermal-radiative wind which adds to the irradiation heating by scattering flux down on to the disc. However, analytic estimates of X-ray illumination from scattering in the wind are still not sufficient to produce the observed heating, even in combination with direct illumination. Either the analytic thermal-radiative wind models are underestimating the effect of the wind, or there are additional scattering mechanisms at work, such as magnetically driven outflows, acting to increase the OIR flux. While wind-driven irradiation is likely a common feature among long-period BHXBs, fully understanding the driving mechanism(s) behind such a wind will require radiation hydrodynamic simulations.
Reducing Secondhand Smoke Exposure Among Nonsmoking Pregnant Women: A Systematic Review
Authors: Nwosu Chidiogo , Angus Kathryn , Cheeseman Hazel , Semple Sean
Published: May 2020

Introduction

Exposure to secondhand smoke (SHS) in pregnancy leads to an increased risk of stillbirths, congenital malformations, and low birth weight. There is a lack of evidence about how best to achieve reductions in SHS exposure among nonsmoking pregnant women. This work systematically reviews individual or household interventions to reduce pregnant women’s exposure to SHS.

Methods

MEDLINE, EMBASE, and CINAHL databases were searched from their dates of inception to April 17, 2019. Studies were included if: participants were nonsmoking pregnant women; involved an intervention to reduce SHS exposure or encourage partner quitting; and measured SHS exposure of pregnant women and/or recorded quit rates among partners. The UK National Institute for Health & Care Excellence (NICE) Quality Appraisal checklist was used to determine internal and external validity.

Results

Nine studies met the inclusion criteria. Educational interventions were primarily targeted at the pregnant woman to change her or others’ behavior, with only two studies involving the partner who smoked. Intervention delivery was mixed, spanning brief discussions through to more involving sessions with role play. The effective interventions involved multiple follow-ups. There was no standardized method of assessing exposure to SHS. Many of the included studies had moderate to high risk of bias.

Conclusion

There is mixed evidence for interventions aimed at reducing pregnant women’s exposure to SHS, though multi-component interventions seem to be more effective. The effectiveness of family-centered approaches involving creating smoke-free homes alongside partner smoking cessation, perhaps involving pharmacological support and/or financial incentives, should be explored.

Implications

• Measures to protect nonsmoking pregnant women from SHS tend to place the responsibility for “avoidance” on the woman.

• There is little work that seeks to involve the smoking partner or other smokers in protecting pregnant women from SHS.

• Interventions to create smoke-free homes and/or smoking partner cessation need to be developed: pharmacological and financial support should be explored.
Valence of Media Coverage About Electronic Cigarettes and Other Tobacco Products From 2014 to 2017: Evidence From Automated Content Analysis
Authors: Kim Kwanho , Gibson Laura A , Williams Sharon , Kim Yoonsang , Binns Steven , Emery Sherry L , Hornik Robert C
Published: May 2020

Introduction

As media exposure can influence people’s opinions and perceptions about vaping and smoking, analyzing the valence of media content about tobacco products (ie, overall attitude toward tobacco, cigars, electronic cigarettes, etc.) is an important issue. This study advances the field by analyzing a large amount of media content about multiple tobacco products across six different media sources.

Aims and Methods

From May 2014 to December 2017, we collected all English-language media items about tobacco products that U.S. young people might see from mass media and websites (long-form) and social media (Twitter and YouTube). We used supervised machine learning to develop validated algorithms to label the valence of these media items. Using the labeled results, we examined the impact of product type (e-cigarettes vs. other tobacco products), source (long-form vs. social media), and time (by month) on the valence of coverage.

Results

We obtained 152 886 long-form media texts (20% with more than a passing mention), nearly 86 million tweets, and 12 262 YouTube videos about tobacco products. Most long-form media content opposed, while most social media coverage supported, the use of e-cigarettes and other tobacco products. Over time, within-source valence proportions were stable, though in aggregate, the amount of media coverage against the use of tobacco products decreased.

Conclusions

This study describes the U.S. public communication environment about vaping and smoking for young people and offers a novel big data approach to analyzing media content. Results suggest that content has gradually become less negative toward the use of e-cigarettes and other tobacco products.

Implications

This study is the first to examine how the valence of media coverage differs for e-cigarettes versus other tobacco products, across several media sources, and over time using a large corpus of media items. Unlike prior studies, these data allow us to draw conclusions about relative support and opposition for these two categories of products in a variety of media coverage because the same coding scheme was used across products and media sources.
Compliance With FDA Nicotine Warning Statement Provisions in E-liquid Promotion Posts on Instagram
Authors: Laestadius Linnea I , Wahl Megan M , Vassey Julia , Cho Young Ik
Published: May 2020

Introduction

Effective August 2018, the U.S. Food and Drug Administration (FDA) required that nicotine addiction warnings be placed on ads for nicotine containing e-liquids. As per FDA comments, this provision pertains to visual ads communicated via social media, raising questions about compliance within the large e-liquid promotion community on Instagram.

Aims and Methods

This study examines use of warnings on promotional Instagram posts before and after provisions took effect on August 10, 2018. Netlytic was used to gather a sample of 500 promotional #eliquid and #ejuice posts from: May 2017, October 2017, March 2018, August 2018, and September 2018. The 1500 prewarning and 1000 postwarning posts were coded using content analysis. Changes in products and marketing strategies were also considered. Post volume was tracked monthly between May 2017 and February 2020.

Results

In the prewarning period, nicotine warning statements were absent on all posts. Following August 10, 2018, FDA compliant warnings were present on 13.6% of posts. Among US-based posts, 36.4% used the warnings, with warnings more common on posts made by e-liquid brands (52.3%) and posts promoting e-liquids with nicotine (40.0%). Promotional strategies and products did not significantly change. The share of posts made by US Instagram users decreased by 11%, although total post volume continued to grow.

Conclusions

Many e-liquid promotion posts on Instagram remained noncompliant with nicotine warnings after FDA provisions took effect. The large volume of international users also limited the impact of FDA-mandated warnings on the social media environment.

Implications

Further guidance and enforcement are needed to ensure that US e-liquid marketers on visual social media platforms adhere to current provisions, particularly for individual social media users who are sponsored by industry. The inherently global span of social media also indicates the importance of a shared approach to marketing regulations. Further work is needed to assess enforcement strategies viable for the social media environment.
全谷物摄入对炎症影响的新进展
Authors: Sang Shengmin , Idehen Emmanuel , Zhao Yantao , Chu YiFang
Published: May 2020

尽管诸多研究显示全谷物(whole grain, WG)的摄入和某些疾病

风险降低之间相关联，但是其生物学机制尚未完全明确。越来越多的

研究证据表明，炎症可能是其中的一个重要中介。此外，还发现多种

影响WGs 调节炎症的作用机制，包括纤维、植物化学物质及肠道菌群

代谢物。这些物质中有些是直接发挥作用的，有些是通过肠道菌群将

生物活性物质转化为更有价值的代谢物来调节炎症信号通路发挥作用。

这篇综述介绍了WGs 对亚临床炎症标志物影响的新证据，重点强调

了膳食纤维、某些WGs 植物化学物质和肠道菌群在WGs 抗炎作用中

的作用。
Quantitative and Qualitative Analyses of Triacylglycerol Production in the Wild-Type Cyanobacterium Synechocystis sp. PCC 6803 and the Strain Expressing AtfA from Acinetobacter baylyi ADP1
Authors: Tanaka Motoki , Ishikawa Toshiki , Tamura So , Saito Yujiro , Kawai-Yamada Maki , Hihara Yukako
Published: May 2020

Although cyanobacteria do not possess wax ester synthase/acyl-CoA:diacylglycerol acyltransferase (WS/DGAT), the bacterial enzyme for triacylglycerol (TAG) production, there have been several studies reporting the accumulation of TAG-like compounds in cyanobacteria. In this study, we aimed to evaluate TAG productivity of the ΔrecJ::atfA strain of Synechocystis sp. PCC 6803 generated by inserting atfA encoding WS/DGAT from Acinetobacter baylyi ADP1 into recJ (sll1354), together with the wild type (WT) and the gene-disrupted strain of slr2103 having homology with eukaryotic DGAT2 gene family (Δ2103). Thin-layer chromatography (TLC) of neutral lipids or isolation of the neutral lipid-enriched fraction followed by gas chromatography or liquid chromatography–tandem mass spectrometry was employed for analyses. The ΔrecJ::atfA strain accumulated 0.508 nmol ml−1OD730−1 of TAG after a week of incubation at 100 μmol photons m−2 s−1. The saturated fatty acids C16:0 and C18:0 accounted for about 50% and 20% of the TAG fatty acids, respectively, suggesting that de novo-synthesized fatty acids were preferentially incorporated into TAG molecules. When the neutral lipid profile of the lipid extracts was examined by TLC, a spot located in a slightly lower position compared with the TAG standard was detected in WT but not in the Δ2103 strain. TAG accumulation levels of both strains was only 0.01–0.03 nmol ml−1OD730−1, but the fatty acid composition was substantially different from that of the background. These results suggest that trace amounts of TAG can be produced in Synechocystis cells by enzymes other than Slr2103, and major constituents of the TAG-like spot are unknown lipid species produced by Slr2103.
Petrologic Reconstruction of the Tieshan Magma Plumbing System: Implications for the Genesis of Magmatic-Hydrothermal Ore Deposits within Originally Water-Poor Magmatic Systems
Authors: Zhou Jin-Sheng , Wang Qiang , Wyman Derek A , Zhao Zhen-Hua
Published: May 2020

Most genetic models for magmatic-hydrothermal ore deposits are based on the prerequisite that the parental magmas associated with mineralization are enriched in water (> ∼4 wt %). However, it has been recognized that a number of magmatic-hydrothermal ore deposits also formed within tectono-magmatic settings that produce initially water-poor magmas such as Climax-type porphyry deposits. Here, we present a detailed reconstruction of the Tieshan magma plumbing system related to skarn-porphyry Cu–Fe–Au mineralization in the Edong district, in which primitive magmas typically show water-poor features. Applications of multiple thermodynamic calibrations on various magmatic units from the Tieshan and Tonglushan deposits provide a wealth of information regarding the structure and evolution of the transcrustal magmatic system. Petrographic observations and clinopyroxene-liquid thermobarometry calculations indicate that the Tieshan magmatic-hydrothermal system was fed by a deep crustal magma reservoir. An accurate picture of the evolution of H2O within the magma plumbing system is presented using the plagioclase-liquid hygrometer in combination with the amphibole hygrometer. Three critical stages during the evolution of water within the plumbing system have been recognized, associated with H2O contents of 0·8–1·7 wt %, 2·1–2·8 wt % and 3·2–4·6 wt %, respectively. The first enrichment of water in the magmas can be attributed to the separation and transfer of evolved melts from the deep magma reservoir to the shallow crust. Continuous cooling and solidification of the shallow magma body gave rise to the second enrichment of H2O in residual melts, leading to magmas that were fertile for the formation of ore deposits. The detailed chemical evolution of the magma plumbing system was investigated using mineral trace element compositions in combination with the partition coefficients predicted by the lattice strain model. The earliest equilibrium melts are characterized by high Sr contents (the average = 658 ± 64 ppm), suggesting that high Sr/Y signatures were likely derived from their magma sources or fractionation at deeper levels in initially water-poor environments. Variations of some particular geochemical fingerprints in equilibrium melts such as, Dy/Dy* and Eu/Eu*, also provide fundamental information on the evolution of the magma plumbing system. Our study confirms the critical role of a deep crustal magma reservoir on the formation of magmatic-hydrothermal ore deposits. The fertility of magmas with respect to ore deposit formation was enhanced by the extraction and transfer of evolved magmas from the deep reservoir to shallower levels, particularly due to the enrichment of magmatic water contents. In addition, the presence of a deep magma reservoir also sustains the incremental growth of shallow magma chambers, which provide ore-forming fluids.
Your presence soothes me: a neural process model of aversive emotion regulation via social buffering
Authors: Mulej Bratec Satja , Bertram Teresa , Starke Georg , Brandl Felix , Xie Xiyao , Sorg Christian
Published: May 2020

The reduction of aversive emotions by a conspecific’s presence—called social buffering—is a universal phenomenon in the mammalian world and a powerful form of human social emotion regulation. Animal and human studies on neural pathways underlying social buffering typically examined physiological reactions or regional brain activations. However, direct links between emotional and social stimuli, distinct neural processes and behavioural outcomes are still missing. Using data of 27 female participants, the current study delineated a large-scale process model of social buffering’s neural underpinnings, connecting changes in neural activity to emotional behaviour by means of voxel-wise multilevel mediation analysis. Our results confirmed that three processes underlie human social buffering: (i) social support-related reduction of activity in the orbitofrontal cortex, ventromedial and dorsolateral prefrontal cortices, anterior and mid-cingulate; (ii) downregulation of aversive emotion-induced brain activity in the superficial cortex-like amygdala and mediodorsal thalamus; and (iii) downregulation of reported aversive feelings. Results of the current study provide evidence for a distinct neural process model of aversive emotion regulation in humans by social buffering.
Meta-analysis and Meta-regression of Cognitive Behavioral Therapy for Psychosis (CBTp) Across Time: The Effectiveness of CBTp has Improved for Delusions
Authors: Sitko Katarzyna , Bewick Bridgette M , Owens David , Masterson Ciara
Published: May 2020

Published research shows small-to-medium effects of Cognitive Behavioral Therapy for Psychosis (CBTp) on reducing psychotic symptoms. Given the on-going development of CBTp interventions, the aim of this systematic review is to examine whether the effectiveness of CBTp has changed across time. MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for randomized controlled trials examining CBTp interventions targeting positive and/or negative symptoms vs treatment as usual. Four meta-analyses were carried out to examine the effectiveness of CBTp for: positive symptoms; delusions; hallucinations; and negative symptoms. Four meta-regressions examined whether the effectiveness of CBTp changed across time for these groups of symptoms. A total of 28 studies (n = 2698) yielded a pooled g of −0.24 (95% confidence interval [CI] −0.32, −0.16, P < .001) favoring CBTp for positive symptoms, with nonsignificant heterogeneity (Q = 26.87, P = .47; I2 =0%); 13 studies (n = 890) yielded a pooled g of −0.36 (95% CI −0.59, −0.13, P = .002) for delusions, with substantial heterogeneity (Q = 31.99, P = .001; I2 =62%); 16 studies (n = 849) yielded a pooled g of −0.26 (95% CI −0.42, −0.11, P < .001) for hallucinations, with nonsignificant heterogeneity (Q = 18.10, P = .26; I2 =17%); 19 studies (n = 1761) yielded a pooled g of −0.22 (95% CI −0.33, −0.12, P < .001) for negative symptoms, with nonsignificant heterogeneity (Q = 20.32, P = .32, I2 =11%). Meta-regressions indicated a significant effect of year on the effectiveness of CBTp only for delusions (F[1, 11] = 5.99, P = .032; R2 = 0.594); methodological quality did not effect this finding. Findings indicate small-to-medium effects of CBTp for psychotic symptoms, with increasing effectiveness across time for delusions.
Changes in dietary inflammatory potential predict changes in sleep quality metrics, but not sleep duration
Authors: Wirth Michael D , Jessup Angela , Turner-McGrievy Gabrielle , Shivappa Nitin , Hurley Thomas G , Hébert James R
Published: May 2020

Study Objectives

Non-pharmacological sleep interventions may improve sleep profiles without the side-effects observed with many pharmacological sleep aids. The objective of this research was to examine the association between sleep and inflammation and to examine how changes in dietary inflammatory potential influence changes in sleep.

Methods

The Inflammation Management Intervention Study (IMAGINE), which was a dietary intervention designed to lower inflammation, provided access to 24-h dietary recalls (24HR), objectively measured sleep using SensewearTM armbands, and a range of self-reported demographics, health histories, lifestyle behaviors, psychosocial metrics, anthropometric measurements, and inflammatory biomarkers. Dietary Inflammatory Index® (DII®) scores were calculated from three unannounced 24HR-derived estimated intakes of whole foods and micro and macronutrients over a 2-week period at baseline and post-intervention (i.e. month 3). Statistical analyses primarily utilized linear regression.

Results

At baseline, for every 1-min increase in sleep onset latency, tumor necrosis factor-α increased by 0.015 pg/mL (±0.008, p = 0.05). Every one-percentage increase in sleep efficiency was associated with decreased C-reactive protein (CRP) of −0.088 mg/L (±0.032, p = 0.01). Every 1-min increase in wake-after-sleep-onset (WASO) increased both CRP and interleukin-6. Compared to participants with pro-inflammatory DII changes over 3 months, those with anti-inflammatory changes decreased WASO (0 vs. −25 min, respectively, p < 0.01) and improved sleep efficiency (−2.1% vs. +2.6%, respectively, p = 0.04).

Conclusions

Non-pharmacological treatments, such as anti-inflammatory diets, may improve sleep in some adults. Future research involving dietary treatments to improve sleep should not only focus on the general population, but also in those commonly experiencing co-morbid sleep complaints.

Clinical Trial Information

NCT02382458.
Diagnostic Guide for Cucurbit Downy Mildew
Authors: Salcedo Andres , Hausbeck Mary , Pigg Stacey , Quesada-Ocampo Lina M.
Published: May 2020

Cucurbit downy mildew caused by the oomycete Pseudoperonospora cubensis is the most devastating foliar disease on cultivated cucurbitaceous crops. Failure of host resistance in cucumber and previously effective fungicides has occurred in the last few years in the United States and Europe, making accurate and early diagnosis critical for timely disease management. The objective of this diagnostic guide is to describe the current taxonomy, host, geographic range, symptoms, and signs as well as effective techniques for pathogen identification, evaluation, isolation, and storage for P. cubensis.
Sequencing Herbarium Specimens of a Common Detrimental Plant Disease (Powdery Mildew)
Authors: Bradshaw Michael , Tobin Patrick C.
Published: May 2020

Powdery mildew (Erysiphaceae) is a detrimental plant disease that occurs on a variety of economically important crops. Powdery mildew consists of over 873 species of fungal pathogens that affect over 10,000 plant species. Genetic identification of powdery mildew is accomplished using the internal transcribed spacer (ITS) and large subunit (LSU) regions of the nuclear ribosomal RNA gene cluster. The ITS and LSU regions of powdery mildews can be useful in ecological, epidemiological, phylogenetic, and taxonomic investigations. However, sequencing these regions is not without its challenges. For example, powdery mildew sequences are often contaminated with plant and/or fungal DNA. Also, there tends to be a limited amount and older specimens’ DNA can fragment over time. The success of sequencing powdery mildew often depends on the primers used for running polymerase chain reaction (PCR). The primers need to be broad enough that they match the majority of powdery mildew DNA yet specific enough that they do not align with other organisms. A review of the taxonomy and phylogeny of the powdery mildews is presented with an emphasis on sequencing the ITS + LSU genomic regions. Additionally, we introduce a new nested primer protocol for sequencing powdery mildew herbarium samples that includes six new powdery mildew-specific primers. The new sequencing protocol presented allows specimens up to 130 years old to be sequenced consistently. Sequencing herbarium specimens can be extremely useful for addressing many ecological, epidemiological, phylogenetic, and taxonomic problems in multiple plant pathogenic systems including the powdery mildews.
Innovation During COVID-19: Improving Addiction Treatment Access
Authors: Samuels Elizabeth A. , Clark Seth A. , Wunsch Caroline , Jordison Keeler Lee Ann , Reddy Neha , Vanjani Rahul , Wightman Rachel S.
Published: May 2020

During the COVID-19 pandemic, many addiction treatment and harm reduction organizations have had to reduce their hours and services for people with substance use disorders, placing these individuals at increased risk of death. In order to address restricted treatment access during COVID-19, guidance from the Substance Abuse Mental Health Services Administration, the US Drug Enforcement Administration, and the US Department of Health and Human Services has allowed for use of audio-only telehealth encounters for buprenorphine induction without requiring an in-person evaluation or video interface. This has enabled innovations in order to try to meet the needs of the most vulnerable among us during the current pandemic. In this new regulatory environment, we established the Rhode Island Buprenorphine Hotline, a phone hotline which functions as a “tele-bridge” clinic where people with moderate to severe opioid use disorder can be linked with a DATA 2000 waivered provider who can provide an initial assessment and, if appropriate, prescribe buprenorphine for unobserved induction and linkage to outpatient treatment. In this correspondence we briefly share our experience developing this common sense approach to addressing the complex problem of access to treatment only now permissible due to regulatory changes during COVID-19.
The Effectiveness of Ego-state Therapy in Reducing Trypanophobia
Authors: Daharnis Daharnis , Ifdil Ifdil , Amalianita Berru , Zola Nilma , Putri Yola E.
Published: May 2020

A phobia is an excessive fear of something or a phenomenon. Phobias can be considered to hinder the lives of people who suffer from them, and one of them is trypanophobia, an extreme fear of medical procedures involving injections or hypodermic needles. The symptoms of trypanophobia can greatly disrupt a person’s quality of life, both physically and psychologically. Phobia sufferers cannot heal themselves and so they must be assisted by therapists who are competent in their field. One of the therapeutic techniques that can help cure phobia sufferers is ego-state therapy. This therapy enables the respondents’ underlying states to be allocated to all ego states that contribute to trypanophobia and to be expressed, released, and empowered. The research objective here is to analyze the effectiveness of ego-state therapy in reducing trypanophobia. This research uses single-subject design A-B-A-B with 9 medical patients acting as respondents. The instruments used are observation, interview, and the Depression Anxiety Stress Scale Modification Inventory. Data obtained were analyzed used the Wilcoxon signed-rank test. The results of the study found that ego-state therapy can reduce trypanophobia. On the basis of this finding, this therapy can be one alternative treatment in the reduction of trypanophobia.
Hemiarthroplasty for Femoral Neck Fractures: Does Surgeon Subspecialty Affect Perioperative Outcomes?
Authors: Schumaier Adam P. , Andrews Erickson G. , Yue Ruixian A. , Lake Samuel S. , Evans Hardy T. , Scarberry Nathaniel W. , Kelley Todd C. , Archdeacon Michael T. , Le Theodore T.
Published: May 2020

Objectives:

To determine if surgeon subspecialty training affects perioperative outcomes for displaced femoral neck fractures treated with hemiarthroplasty.

Design:

Retrospective comparative study.

Setting:

One health system with 2 hospitals (Level I and Level III trauma centers).

Patient and Participants:

Patients who were treated with hemiarthroplasty for displaced femoral neck fractures between October 2012 and September 2017.

Outcome Measures:

Leg length discrepancy, femoral offset, estimated blood loss (EBL), incidence of blood transfusion, time to surgery, operative time, and length of stay. Data were analyzed based on the treating surgeon's subspecialty training [arthroplasty (A), trauma (T), other (O)]. Hierarchical regression was used to compare the groups and control for confounding variables.

Results:

A total of 292 patients who received hemiarthroplasty for displaced femoral neck fractures were included (A = 158; T = 73; O = 61). Surgeon subspecialty had a statistically significant effect on operative time, with arthroplasty surgeons completing the procedure 9.6 minutes faster than trauma surgeons and 17.7 minutes faster than other surgeons (P < 0.01; ΔR2 = 0.03). Surgeon subspecialty did not significantly affect other outcomes, including leg length discrepancy (P = 0.26), femoral offset (P = 0.37), EBL (P = 0.10), incidence of transfusion (P = 0.67), time to surgery (P = 0.10), or length of stay (P = 0.67).

Conclusions:

This study demonstrates that arthroplasty-trained surgeons perform hemiarthroplasty slightly faster than other subspecialists, but subspecialty training does not affect other perioperative outcomes, including leg length discrepancy, femoral offset, EBL, transfusion rate, time to surgery, or length of stay. This suggests that hemiarthroplasty can be adequately performed by various subspecialists, and deferring treatment to an arthroplasty surgeon might not have a clinically significant benefit in the perioperative period.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assessing Anticoagulation Management and Shared Decision-Making Documentation From Providers Participating in the SUPPORT-AF II Study
Authors: Hoque Laboni , Amroze Azraa , Gilvaz Vinit , Abraham Sonu , Lal Amos , Mishra Ajay , Crawford Sybil , Mazor Kathleen , McManus David D. , Kapoor Alok
Published: May 2020

Background:

A previously tested intervention featured educational outreach with modified academic detailing (AD) to increase anticoagulation use in patients with atrial fibrillation. Currently, this study compares providers receiving and not receiving AD in terms of inclusion of AD educational topics and shared decision-making elements in documentation.

Methods:

Physicians reviewed themes discussed with providers during AD and evaluated charts for evidence of shared decision-making. Frequencies of documentation of individual items for providers receiving AD versus non-AD providers were compared. To understand baseline documentation practices of AD providers, encounters of AD providers before their AD participation were randomly selected.

Results:

There were 113 eligible encounters in the four months after AD—36 from AD providers and 77 from non-AD providers. Thirty-five encounters were identified from AD providers before participating in the intervention. Providers infrequently documented many reviewed items (% documenting): anticoagulation mentioned (44%), multiple options for anticoagulation (5%), CHA2DS2-VASc score (11%), bleeding risk factors (2%). Compared with non-AD providers, AD providers had statistically significant higher percentages for the following items: mention of anticoagulation (64% versus 35%), stroke risk (11% versus 0%), anticoagulation benefits (8% versus 0%), and patient involvement (17% versus 0%). There was no improvement, however, for AD providers compared with baseline documentation percentages.

Discussion:

Providers infrequently documented important items in anticoagulation management and shared decision-making. AD participation did not improve documentation. Improving adoption of AD educational items may require more prolonged interaction with providers. Improving shared decision-making may require an intervention more focused on it and its documentation.
Chemo-immunotherapy combination after PD-1 inhibitor failure improves clinical outcomes in metastatic melanoma patients
Authors: Vera Aguilera Jesus , Paludo Jonas , McWilliams Robert R. , Zhang Henan , Li Ying , Kumar Anagha B. , Failing Jarrett , Kottschade Lisa A. , Block Matthew S. , Markovic Svetomir N. , Dong Haidong , Dronca Roxana S. , Yan Yiyi
Published: May 2020

Management of PD-1 blockade resistance in metastatic melanoma (MM) remains challenging. Immunotherapy or chemotherapy alone provides limited benefit in this setting. Chemo-immunotherapy (CIT) has demonstrated favorable efficacy and safety profiles in lung cancer. Our pre-clinical study showed that in MM patients who have failed PD-1 blockade, the addition of chemotherapy increases CX3CR1+ therapy-responsive CD8+ T-cells with enhanced anti-tumor activity, resulting in improved clinical response. Here, we examined the clinical outcomes of CIT in MM patients after PD-1 blockade failure and the treatment-related changes in CX3CR1+ therapy-responsive CD8+ T-cells. We reviewed MM patients seen between January 2012 and June 2018 who failed anti-PD-1-based therapy and received subsequent CIT, immune checkpoint inhibitors (ICI) or chemotherapy alone. Overall survival (OS), objective response rate (ORR), event-free survival (EFS), and toxicities were assessed. Among 60 patients, 33 received CIT upon disease progression on PD-1 blockade. At a median follow-up of 3.9 years, the CIT group had a median OS of 3.5 years [95% confidence interval (CI) 1.7–NR] vs. 1.8 years (95% CI 0.9–2; P = 0.002) for those who received subsequent ICI (n = 9) or chemotherapy alone (n = 18), with ORR of 59% vs. 15% (P = 0.0003), respectively. The median EFS was 7.6 months (95% CI 6–10) following CIT vs. 3.4 months (95% CI 2.8–4.1; P = 0.0005) following ICI or chemotherapy alone. Therapy-responsive CX3CR1+CD8+ T-cells showed dynamic increase with successful CIT. CIT showed favorable clinical outcomes and acceptable safety profile in PD-1 blockade-resistant patients. CX3CR1+CD8+ therapy-responsive T-cells can be potentially used for monitoring disease response to CIT.
Survival estimation of melanoma patients with brain metastasis using the Melanoma-molGPA score: external validation from a French cohort
Authors: Dalmasso Céline , Pagès Cécile , Chaltiel Léonor , Brun Aurore , Sibaud Vincent , Boulinguez Serge , Chira Ciprian , Moyal Elizabeth , Lubrano Vincent , Meyer Nicolas , Modesto Anouchka
Published: May 2020

While immunotherapies and targeted therapies such as BRAF inhibitors have improved the prognosis, BM is still associated with poor outcome and a short survival. Metastatic melanoma patients are a heterogeneous subgroup with variable prognosis. As several prospective clinical trials have addressed the question of optimal therapy for these patients, an accurate validated selection tool is needed. Melanoma molecular graded prognostic assessment (Melanoma-molGPA) is a new prognostic score for BM melanoma patients. We decided to perform an external validation of this score. All consecutive patients treated between May 2014 and December 2017 for a newly diagnosed locally advanced or metastatic melanoma with available status for BRAF mutation were identified. Melanoma mol-GPA was applied in each patient with BM and correlated to overall survival. One hundred patients were included. Median follow-up was 27.8 months. Distribution for the Melanoma-molGPA groups GPA 0–1, GPA 1.5–2, GPA 2.5–3 and GPA 3.5–4 were as follows: 23, 51, 24 and 2.0%, respectively. Subgroups GPA 2.5–3 and 3.5–4 were combined. Median overall survival for groups GPA 0–1, 1.5–2 and 2.5–4.0 was 4.2, 6.9 and 18.4 months, respectively, P = 0.0032. Our study is the most recent, and with the largest cohort, to validate the Melanoma-molGPA score as an accurate and reproducible score for estimating overall survival. As several prospective clinical trials are addressing the issue of optimal therapy including the impact of local treatment for these patients, the Melanoma-molGPA is a useful tool in BM melanoma patients.
Utilization and impact of immunotherapy in stage IV melanoma using the National Cancer Database
Authors: Conic Rosalynn R.Z. , Knackstedt Rebecca , Sussman Tamara A. , Rambhia Sagar , Damiani Giovanni , Funchain Pauline , Ko Jennifer , Gastman Brian R.
Published: May 2020

To evaluate factors affecting the utilization of immunotherapy and to stratify results based on the approval of ipilimumab in 2011 and PD-1 inhibitors in 2014, an analysis of available data from the National Cancer Database (NCDB) was performed. Stage IV melanoma patients were identified. Effects of immunotherapy on overall survival (OS) were assessed using Kaplan–Meier curves and Cox proportional hazards model. A total of 19 233 patients were analyzed and 1998 received immunotherapy. Between 2011 and 2013, and in 2014, 18.6 and 28.9% of patients received immunotherapy, respectively. Patients who received immunotherapy from 2011 to 2013 had a 33% (95% CI, 30–35%) 3-year OS compared to 23% (95% CI, 21–24%). In 2014, 3-year OS was 37% (95% CI, 32–43%) for those who received immunotherapy compared to 22% (95% CI, 18–26%) for those who did not (P < 0.0001). This is the first analysis of a large cancer database for melanoma patients with stratification based on utilization and availability of immunotherapy. Immunotherapy increased yearly and improved OS. With combination immunotherapy now more widely employed, it is expected these results will continue to improve. This is the first analysis of a large cancer database for melanoma patients with stratification based on utilization and availability of immunotherapy demonstrating that immunotherapy increased yearly and improved OS.
Incidence of venous thromboembolism among postmenopausal women prescribed ospemifene, selective estrogen receptor modulators for noncancer indications, or untreated vulvar and vaginal atrophy
Authors: Nordstrom Beth L. , Cai Bin , De Gregorio Fabio , Dhalwani Nafeesa , Fraeman Kathy H. , Yoshida Yuki , Gibbs Trevor
Published: May 2020

Objective:

Ospemifene is a nonsteroidal selective estrogen receptor modulator (SERM) for the treatment of moderate symptomatic vulvar and vaginal atrophy (VVA) due to menopause. A postauthorization safety study is currently examining the incidence of venous thromboembolism (VTE) among postmenopausal women receiving ospemifene or other SERM (raloxifene, bazedoxifene, or tamoxifen, for noncancer indications), or with untreated VVA.

Methods:

This interim analysis used the US MarketScan Commercial and Medicare Supplemental claims database from 2013 to 2017 to identify incident VTE. The incidence rate and 95% confidence interval of VTE during the first continuous course of treatment (or continuous untreated time for the untreated cohort) were calculated for each cohort overall and by age group, with sensitivity analyses examining incidence in the short term (up to 90 days) and long term (all available follow-up, regardless of treatment changes).

Results:

Analyses included 8,188 ospemifene users, 11,777 other SERM users, and 220,242 women with untreated VVA. The incidence per 1,000 person-years and 95% confidence interval of VTE were 3.7 (1.7-7.1) for ospemifene, 11.5 (8.9-14.6) for other SERM, and 11.3 (10.8-11.7) for untreated VVA. Stratification by age and altering the time frame for analysis produced results with similar patterns to the primary analysis.

Conclusions:

This interim analysis of an ongoing study suggests a favorable safety profile for ospemifene with respect to VTE. Comparative analyses with covariate adjustment will be performed when data accrual is complete.
William H. G. Logan and His Bow
Authors: Manrique Monica , Bryant Justin R. , Benitez Elizabeth , Mantilla-Rivas Esperanza , Rogers Gary F. , Oh Albert K.
Published: May 2020

The Logan Bow is an external device comprising a curved bow-shaped metal bar, with spikes attached to its cross bars, and is widely used as part of a cleft lip management to maintain postoperative apposition and to avoid excessive strain after cheiloplasty for a cleft lip. Since its first description by William Hoffman Gardiner Logan, in the early 20th century, no significant modifications have been made to its original design. Even though this external device continues to be commonly used by cleft care providers, there is a paucity of objective evidence regarding its potential benefits and adverse effects even after almost 100 years since its original description. The goal of the current historical manuscript is to provide the reader an engaging study on the life of the man who invented this device, W. H. G. Logan, his initial description of the bow that bears his name, and how this external device is being used.
Stretching and Strength Training to Improve Postural Ergonomics and Endurance in the Operating Room
Authors: Winters James N. , Sommer Nicole Z. , Romanelli Michael R. , Marschik Chad , Hulcher Leah , Cutler Brigitte J.
Published: May 2020

Background:

Plastic surgeons report the highest prevalence of chronic musculoskeletal pain and fatigue among surgical subspecialties. Musculoskeletal pain impacts daily life, career longevity, and economic burden secondary to occupational injury. Poor postural awareness and ergonomic set up in the operating room represent the most common etiology.

Methods:

A literature review was performed to highlight the ergonomic set-up, postural pitfalls, occupational injuries, and musculoskeletal pain in the operating room. An institutional survey was administered among resident and attending surgeons regarding musculoskeletal pain, posture, ergonomic education, and future improvements. Literature results, survey data, and intraoperative photographs were analyzed in collaboration with physical therapists and personal trainers.

Results:

Survey results demonstrated that 97% of resident and attending respondents experienced musculoskeletal pain and 83% reported a lack of education in posture and ergonomics. The main postural pitfalls included head forward and flexed positioning, abduction and internal arm rotation, and kyphosis of the thoracic spine. The collaborators developed instructional videos to assess posture and biomechanics and demonstrate targeted stretching and strength exercises to address specific neck, back, and shoulder pain.

Conclusions:

Poor posture is unavoidable in the operating room at times. These educational videos should be utilized for self-motivated and prophylactic conditioning outside of the operating room to maintain physical well-being throughout a career in plastic surgery. Future focus should be aimed at implementing dedicated ergonomic education and physical wellness programs early in surgical resident training.
COMPARATIVE EFFECTIVENESS OF PROTON BEAM VERSUS PHOTODYNAMIC THERAPY TO SPARE THE VISION IN CIRCUMSCRIBED CHOROIDAL HEMANGIOMA
Authors: Mathis Thibaud , Maschi Célia , Mosci Carlo , Espensen Charlotte A. , Rosier Laurence , Favard Catherine , Tick Sarah , Remignon Charles-Henry , Ligorio Paolo , Bonin Nicolas , Gambrelle Joël , Nguyen Anh-Minh , Faber Carsten , Meyer Laurent , Mouriaux Frederic , Herault Joël , Baillif Stéphanie , Kiilgaard Jens-Folke , Kodjikian Laurent , Caujolle Jean-Pierre , Salleron Julia , Thariat Juliette
Published: May 2020

Purpose:

The aim of this study was to compare the functional and anatomical effectiveness of photodynamic therapy (PDT) versus proton beam therapy (PBT) in a real-life setting for the treatment of circumscribed choroidal hemangioma.

Methods:

A total of 191 patients with a diagnosis of circumscribed choroidal hemangioma and treated by PBT or PDT were included for analyses.

Results:

The 119 patients (62.3%) treated by PDT were compared with the 72 patients treated by PBT. The final best-corrected visual acuity did not differ significantly between the two groups (P = 0.932) and final thickness was lower in the PBT compared with the PDT group (P = 0.001). None of the patients treated by PBT needed second-line therapy. In comparison, 53 patients (44.5%) initially treated by PDT required at least one other therapy and were associated with worse final best-corrected visual acuity (P = 0.037). In multivariate analysis, only an initial thickness greater than 3 mm remained significant (P = 0.01) to predict PDT failure with an estimated odds ratio of 2.72, 95% confidence interval (1.25–5.89).

Conclusion:

Photodynamic therapy and PBT provide similar anatomical and functional outcomes for circumscribed choroidal hemangioma ≤3 mm, although multiple sessions are sometimes required for PDT. For tumors >3 mm, PBT seems preferable because it can treat the tumor in only 1 session with better functional and anatomical outcomes.
PHOTORECEPTOR OUTER SEGMENT IS EXPANDED IN THE FELLOW EYE OF PATIENTS WITH UNILATERAL CENTRAL SEROUS CHORIORETINOPATHY
Authors: Borrelli Enrico , Battista Marco , Gelormini Francesco , Gabela Maria C. , Pennisi Flavia , Quarta Alberto , Pezzella Mario , Sacconi Riccardo , Querques Lea , Bandello Francesco , Querques Giuseppe
Published: May 2020

Purpose:

To quantitatively evaluate the photoreceptor structural changes in the fellow unaffected eyes of patients with unilateral central serous chorioretinopathy (CSC).

Methods:

This is a retrospective cross-sectional study. We analyzed data from patients with diagnosis of unilateral CSC, as based on clinical examination and multimodal imaging, who had structural optical coherence tomography obtained. An additional group of age-matched healthy patients was included for comparison. Main outcome measures were as follows: (1) the foveal photoreceptor outer segment lateral surface and (2) the foveal choroidal thickness.

Results:

One hundred and sixty fellow unaffected eyes of 160 unilateral CSC patients and 50 age-matched controls (50 eyes) were included. The mean ± SD age was 51.6 ± 11.1 years (range 28–80 years) in the unilateral CSC group and 52.8 ± 10.8 years (range 31–74 years) in the control group (P = 0.511). The foveal photoreceptor outer segment lateral surface was significantly increased in the unaffected eyes with CSC in the fellow eye (0.068 ± 0.007 mm2) as compared with control eyes (0.060 ± 0.005 mm2, P < 0.0001). The mean ± SD foveal choroidal thickness was 368.0 ± 105.7 µm in the unilateral CSC group and 302.9 ± 92.2 µm in control patients (P < 0.0001). In the Pearson correlation test, the photoreceptor outer segment lateral surface correlated with the choroidal thickness in the CSC group (R = 0.166, P = 0.016) but not in the control group (R = −0.025, P = 0.864).

Conclusion:

Our results corroborate the hypothesis that retinal and choroidal changes affect both eyes of patients with acute/history of unilateral disease. These structural changes could be intended as an imaging evidence of reduced photoreceptor outer segment turnover secondary to retinal pigment epithelium and choroid dysfunction.
EXTENDED FIELD IMAGING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FOR THE STUDY OF RETINAL AND CHOROIDAL CHANGES AFTER RADIATION THERAPY FOR CHOROIDAL MELANOMA
Authors: Preziosa Chiara , Corvi Federico , Staurenghi Giovanni , Pellegrini Marco
Published: May 2020

Purpose:

Radiation retinopathy is a common side effect of ocular radiotherapy with no long-term effective therapy. Optical coherence tomography angiography (OCTA) and wide-field fluorescein angiography (FA) are widely used for the study of radiation maculopathy and peripheral nonperfusion, respectively. We investigated the role of extended field imaging (EFI-OCTA) for the study of retinal and choroidal alterations after radiotherapy for choroidal melanoma.

Methods:

Cross-sectional observational study of 20 eyes of 20 patients diagnosed with radiation retinopathy. All patients underwent a complete imaging evaluation including FA and indocyanine green angiography (ICGA) with 55° and 102° lens (Spectralis Heidelberg Engineering, Heidelberg, Germany). Optical coherence tomography angiography imaging was performed with the Zeiss PlexElite 9000 Swept Source OCTA (Carl Zeiss Meditec, Dublin, CA) using a 12 × 12-mm volume scan pattern centered on the fovea and a +20.00-diopter lens specifically designed to obtain EFI examination. The imaging methods were then compared in terms of visible field of view, extension of nonperfused areas, and vessel density.

Results:

The mean extension ratio of EFI-OCTA compared to OCTA without EFI, FA/ICGA 55° and FA/ICGA 102° was, respectively, 1.98 ± 0.02, 1.21 ± 0.01 and 0.36 ± 0.003. The mean extension of retinal and choroidal nonperfused areas evaluated by EFI-OCTA (63.03 ± 48.21 and 38.63 ± 30.83 mm2) were significantly higher than with OCTA without EFI (40.40 ± 34.87 and 24.26 ± 21.82 mm2, P < 0.001) but lower than with FA/ICGA 102° (140.7 ± 69.23 and 108.3 ± 69.51 mm2, P < 0.001). No significant differences were found between mean extension of retinal and choroidal ischemic areas measured with EFI-OCTA and FA/ICGA 55° (69.64 ± 51.92 and 47.23 ± 33.59 mm2). The mean vessel density of EFI-OCTA (retina and choroid segmentation) was significantly different compared to OCTA without EFI (P < 0.05). Retinal vessel density was negatively correlated to retinal extension of nonperfused areas (r = −0.5, P = 0.02), and choroidal vessel density was negatively correlated to choroidal nonperfused areas (r = −0.6, P = 0.003) measured with EFI-OCTA.

Conclusion:

In our series, EFI-OCTA captured larger areas than OCTA without EFI and FA/ICGA with 55° lens. EFI-OCTA images showed a good definition of retinal and choroidal vascular changes after radiotherapy, suggesting a possible role of this safe and noninvasive imaging technique in the follow-up of patients with radiation retinopathy.