bluuebunny/crossref_metadata_2025 huggingface dataset:
Student profile in constructing concept of exponential through the problem posing
Authors: Cahyohadi H , Sunardi  , Irfan M
Published: March 2020

This study has the aim to describe the thinking process of students in constructing of exponential concept through problem posing. In this study constructivism through the problem posing in question is a process to assist students in developing mathematical concepts and principles with their own abilities through the process of obtaining information and also the information processing process for later making problems by students. This research type are descriptive research with a case study form using a qualitative approach. This research was conducted on the tenth grade Vocational students in the field of Computer and Network Engineering expertise with a total of ten students. The method of data collection well done through interviews, written tests, observations, and documentation. The data validation used by researchers was triangulation using the source triangulation type. The results of the study show that the construction of the exponential concept is influenced by the thinking of students process when they concept process through posing problem.
The analysis of learning materials implementation using inquiry based learning method to enhance student’s critical thinking skills in solving two dimensional problem
Authors: Wijaya A M Y , Hobri  , Prastiti T D , Dafik  , Suratno
Published: March 2020

Learning materials are the important thing that will support teaching and learning process at school. The existence of a good learning materials will help the students to understand the given subject matter. Mathematics is a subject matter which has a higher level of difficulty than other subjects. So teacher needs the right learning materials when delivering the material. a method that can be used to improve student’s understanding related to mathematics learning material, especially the subject of two dimensional is inquiry-based learning. This method emphasize the active participation of students to understand the material provided. Implementing this method in learning materials are expected to develop student’s critical thinking skills. Type of this research is mixed method research which combining qualitative and quantitative method. Quantitative methods are used to analyze the types of interval data on student learning outcomes while qualitative methods are used to analyze ordinal data types of student’s critical thinking skills. Respondents of this research consisted of one control class and one experimental class consisting of 30 students at 4th grade class in Sawaran Kulon 02 Lumajang Elementary School. Based on the experiment result, control class was obtained 65% of interpretation, 65% of analysis, 59% of evaluation and 52% of inference. Meanwhile, the experimental class was obtained 75% of interpretation, 75% of analysis, 69% of evaluation and 82% of inference. The t-test result of independent sample shows that there is a significant difference between control class and experimental class with a sig (2-tailed) value of 0.00 (p = <0.05). It can be concluded that the implementation of learning materials using inquiry-based learning method can improve the critical thinking of elementary school students.
Cognitive description of students in mathematics learning through lesson study
Authors: Susanto H A , Hidajat D , Hobri  , Jatmiko D D H
Published: March 2020

This research aimed at describing the students’ cognitive aspects in mathematics learning. The description of the students’ cognitive aspects in mathematics learning provided understanding to the lecturers as the preparation in planning the mathematics learning to support the maximum achievement of the students during the learning. In the first step, plan was the first activity with the Lesson Study team to discuss various preparations needed. The second step, namely do and the third step, see as the evaluation form of the conclusion through the lecturer expression model and findings of all observer in order to be improved and analyzed by the researchers. The results of the research revealed that the students’ cognitive aspects covering the students’ mental activities consisting of six levels, namely remembering, understanding, applying, analyzing, evaluating and creating. The results of this research were the initial references which needed to be raised in creating ideas, methods or procedures to solve problems.
An analysis of students’ difficulties in conjecturing process of block paving problems
Authors: Sutarto  , Dafik  , Hastuti I D , Surahmat
Published: March 2020

This study aimed to describe students’ difficulties in the conjecturing process of block paving problems. The subjects used in study were 32 of 8th grade students of Junior High School. The data were collected using Block Paving Problems (BPP) and interviews. Data collection procedures consisted of two stages. The first stage was the researchers had the student solved BPP while think aloud. The second stage is task-based interview to explore information needed to confirm from the results of think aloud. The result of study revealed that 1) difficulty in interpreting the pattern of,n, 2) The difficulty in finding and predicting the next pattern based on regularity, 3) The difficulty in finding and predicting the next pattern 4) The difficulty in Forming Pattern ofn.
The phosphorus legacy offers opportunities for agro-ecological transition (France 1850–2075)
Authors: Le Noë J , Roux N , Billen G , Gingrich S , Erb K -H. , Krausmann F , Thieu V , Silvestre M , Garnier J
Published: March 2020

Management of the non-renewable resource phosphorus (P) is critical to agricultural sustainability. The global P cycle is currently disturbed beyond planetary boundaries, mostly due to large excess P use in the agriculture of industrialized countries, while P is lacking in the Global South. The trajectories of P management and their effects on future sustainable agriculture were investigated for the case of France from 1850 to 2015 based on empirical data and simulations of two coupled biogeochemical models. Here we show that while French cropland soils have accumulated significant amounts of P, mainly sourced from former colonies or protectorates, P reserves in grassland soils have been depleted. Scenario calculations indicate that current P reserves may on average allow for another 60 years of agricultural production without mineral P application. In the light of a possible upcoming P scarcity, this time frame offers an opportunity for a transition towards regionally closed P loops and enhanced sustainability, allowing for fairer international distribution of P resources in the future.
Conductance and spectroscopic mapping of EDOT polymer films upon electrochemical doping
Authors: Wieland Matthias , Malacrida Claudia , Yu Qiulin , Schlewitz Claire , Scapinello Luca , Penoni Andrea , Ludwigs Sabine
Published: March 2020

This paper deals with the electrochemical doping of different poly(ethylenedioxythiophene) (PEDOT)-based active layers performed in an organic electrochemical transistor configuration through the mapping of in situ conductance trends during electrochemical doping and dedoping. The experiments are complemented by UV/Vis/NIR in situ spectroelectrochemistry in the wavelength range from 400 to 1600 nm, which allow monitoring of the development of the neutral and charged redox species. Both electropolymerized EDOT-based layers and solution-processed chemically synthesized PEDOT films are characterized. In addition to pure electropolymerized PEDOT (e-PEDOT), tris(4-(2,3-dihydrothieno[3,4-b][1,4]dioxin-5-yl)phenyl) (TPA-EDOT3) is electrodeposited to generate highly branched networks of P(TPA-EDOT3). The solution-deposited PEDOT films contain poly(ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) with ratios of 1:2.5 and 1:6. Overall, we find that e-PEDOT and PEDOT:PSS(1:2.5) behave like classical conjugated polymers with a plateau-like conductance over a wide potential region. In contrast, PEDOT:PSS(1:6) and P(TPA-EDOT3) show rather bell-shaped conductance profiles. The mixed-valence conductivity model is used to interpret the experimental results in terms of the number of accessible redox states. We suggest that the bell-shaped conductance in the case of PEDOT:PSS(1:6) is caused by a high amount of PSS insulator that limits the inter-chain interaction between PEDOT moieties and in the case of P(TPA-EDOT3) by its distorted molecular architecture.
Amlodipine Improves Vessel Function and Remodeling in the Lewis Polycystic Kidney Rat Mesenteric Artery
Authors: Quek Ko Jin , Ameer Omar Z , Phillips Jacqueline K
Published: March 2020

BACKGROUND

Hypertension is a common comorbidity associated with chronic kidney disease (CKD). Treatment in these patients often involves L-type Ca2+ channel (LTCC) blockers. The effect of chronic LTCC-blockade treatment on resistance vasculature was investigated in a genetic hypertensive rat model of CKD, the Lewis Polycystic Kidney (LPK) rat.

METHODS

Mixed-sex LPK and Lewis control rats (total n = 38) were allocated to treated (amlodipine 20 mg/kg/day p.o. from 4 to 18 weeks) and vehicle groups. Following systolic blood pressure and renal function assessment, animals were euthanized and mesenteric vasculature was collected for functional and structural assessment using pressure myography and histology.

RESULTS

Amlodipine treatment reduced LPK rat blood pressure (untreated vs. treated: 185 ± 5 vs. 165 ± 9 mm Hg; P = 0.019), reduced plasma creatinine (untreated vs. treated: 197 ± 17 vs. 140 ± 16 µmol/l; P = 0.002), and improved some vascular structural parameters (internal and external diameters and wall–lumen ratios); however wall thickness was still increased in LPK relative to Lewis despite treatment (Lewis vs. LPK: 31 ± 2 vs. 41 ± 2 µm, P = 0.047). Treatment improved LPK rats’ endothelium dysfunction, and nitric oxide-dependent and endothelium-derived hyperpolarization vasorelaxation components, and downregulated prostanoid contributions. LTCC blockade had no effect on biomechanical properties of compliance and intrinsic stiffness, nor artery wall composition.

CONCLUSIONS

Our results indicate that blockade of LTCCs with amlodipine is effective in improving, to a certain extent, detrimental structural and functional vascular features of resistance arteries in CKD.
Test of Premorbid Functioning: You’re Doing It Wrong, but Does It Matter?
Authors: Shura Robert D , Ord Anna S , Martindale Sarah L , Miskey Holly M , Taber Katherine H
Published: March 2020

Objective

Clarify procedures to correctly score Test of Premorbid Functioning (TOPF) and assess the accuracy of TOPF scores in the estimation of premorbid intellectual functioning.

Method

In this cross-sectional study, post-9/11 veterans (N = 233, 84.12% male) completed the TOPF, the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), and performance validity measures.

Results

All TOPF scores were significantly correlated with WAIS-IV FSIQ scores (range r = 0.56–.73). The degree of discrepancy between TOPF scores and FSIQ varied with 10%–17% of TOPF scores deviating from FSIQ scores by one SD or more.

Conclusions

Proper TOPF scoring procedures are presented. The TOPF Actual and Predicted scores were related to FSIQ. However, a higher percentage of Actual and Predicted scores were discrepant from FSIQ compared with the other three TOPF estimates, arguing against their use as independent premorbid estimates. Use of the TOPF as was designed is recommended.
MeSHHeading2vec: a new method for representing MeSH headings as vectors based on graph embedding algorithm
Authors: Guo Zhen-Hao , You Zhu-Hong , Huang De-Shuang , Yi Hai-Cheng , Zheng Kai , Chen Zhan-Heng , Wang Yan-Bin
Published: March 2020

Effectively representing Medical Subject Headings (MeSH) headings (terms) such as disease and drug as discriminative vectors could greatly improve the performance of downstream computational prediction models. However, these terms are often abstract and difficult to quantify. In this paper, we converted the MeSH tree structure into a relationship network and applied several graph embedding algorithms on it to represent these terms. Specifically, the relationship network consisting of nodes (MeSH headings) and edges (relationships), which can be constructed by the tree num. Then, five graph embedding algorithms including DeepWalk, LINE, SDNE, LAP and HOPE were implemented on the relationship network to represent MeSH headings as vectors. In order to evaluate the performance of the proposed methods, we carried out the node classification and relationship prediction tasks. The results show that the MeSH headings characterized by graph embedding algorithms can not only be treated as an independent carrier for representation, but also can be utilized as additional information to enhance the representation ability of vectors. Thus, it can serve as an input and continue to play a significant role in any computational models related to disease, drug, microbe, etc. Besides, our method holds great hope to inspire relevant researchers to study the representation of terms in this network perspective.
The thermal limits of cardiorespiratory performance in anadromous Arctic char (Salvelinus alpinus): a field-based investigation using a remote mobile laboratory
Authors: Gilbert Matthew J H , Harris Les N , Malley Brendan K , Schimnowski Adrian , Moore Jean-Sébastien , Farrell Anthony P
Published: March 2020

Despite immense concern over amplified warming in the Arctic, physiological research to address related conservation issues for valuable cold-adapted fish, such as the Arctic char (Salvelinus alpinus), is lacking. This crucial knowledge gap is largely attributable to the practical and logistical challenges of conducting sensitive physiological investigations in remote field settings. Here, we used an innovative, mobile aquatic-research laboratory to assess the effects of temperature on aerobic metabolism and maximum heart rate (fHmax) of upriver migrating Arctic char in the Kitikmeot region of Nunavut in the central Canadian Arctic. Absolute aerobic scope was unchanged at temperatures from 4 to 16°C, while fHmax increased with temperature (Q10 = 2.1), as expected. However, fHmax fell precipitously below 4°C and it began to plateau above ~ 16°C, reaching a maximum at ~ 19°C before declining and becoming arrhythmic at ~ 21°C. Furthermore, recovery from exhaustive exercise appeared to be critically impaired above 16°C. The broad thermal range (~4–16°C) for increasing fHmax and maintaining absolute aerobic scope matches river temperatures commonly encountered by migrating Arctic char in this region. Nevertheless, river temperatures can exceed 20°C during warm events and our results confirm that such temperatures would limit exercise performance and thus impair migration in this species. Thus, unless Arctic char can rapidly acclimatize or alter its migration timing or location, which are both open questions, these impairments would likely impact population persistence and reduce lifetime fitness. As such, future conservation efforts should work towards quantifying and accounting for the impacts of warming, variable river temperatures on migration and reproductive success.
Do cash transfers increase nutritional intakes? Experimental evidence from an unconditional cash transfer in Kenya
Authors: Aizawa Toshiaki
Published: March 2020

Malnutrition due to persistent food insecurity has been a serious public health issue in Kenya. An unconditional cash transfer programme, the Hunger Safety Net Programme (HSNP), was launched in 2009 in northern Kenya to reduce extreme poverty and to mitigate food insecurity. This study investigates the impact of the HSNP, on expenditure on food, types of food consumed and nutritional intake. Focusing on nutritional intake as well as spending and consumption is important because an unconditional cash transfer, which does not specify how the transferred money must be used, does not guarantee nutritional intake improvement. Converting food consumption data to caloric intake and nutrient content using food consumption databases, we calculate the intake of five macro-nutrients, seven vitamins and seven minerals and then estimate the impacts on nutritional intake 12 and 24 months after treatment exposure. This study finds the increased total expenditure on food items. Specifically, the beneficiary households increased their expenditure on milk and milk products and that on sugar after 12 months and expenditure on roots and tubers after 24 months. For consumption amounts, however, the HSNP did not show significant increases in all food categories except sugar. On the other hand, the HSNP improved the nutritional intakes of some macro- and micro-nutrients. The results show that beneficiary households substantially increased their intake of fat by 25.2% after 24 months and their intake of vitamin B12 by 36.6% and calcium by 34.9% after 12 months. The result does not yield sufficiently strong evidence that poorer households significantly enjoy greater improvements than other households.
The Euler–Maruyama scheme for SDEs with irregular drift: convergence rates via reduction to a quadrature problem
Authors: Neuenkirch Andreas , Szölgyenyi Michaela
Published: March 2020

We study the strong convergence order of the Euler–Maruyama (EM) scheme for scalar stochastic differential equations with additive noise and irregular drift. We provide a general framework for the error analysis by reducing it to a weighted quadrature problem for irregular functions of Brownian motion. Assuming Sobolev–Slobodeckij-type regularity of order $\kappa \in (0,1)$ for the nonsmooth part of the drift, our analysis of the quadrature problem yields the convergence order $\min \{3/4,(1+\kappa )/2\}-\epsilon$ for the equidistant EM scheme (for arbitrarily small $\epsilon>0$). The cut-off of the convergence order at $3/4$ can be overcome by using a suitable nonequidistant discretization, which yields the strong convergence order of $(1+\kappa )/2-\epsilon$ for the corresponding EM scheme.
A log-barrier Newton-CG method for bound constrained optimization with complexity guarantees
Authors: O’Neill Michael , Wright Stephen J
Published: March 2020

We describe an algorithm based on a logarithmic barrier function, Newton’s method and linear conjugate gradients that seeks an approximate minimizer of a smooth function over the non-negative orthant. We develop a bound on the complexity of the approach, stated in terms of the required accuracy and the cost of a single gradient evaluation of the objective function and/or a matrix-vector multiplication involving the Hessian of the objective. The approach can be implemented without explicit calculation or storage of the Hessian.
Levonadifloxacin, a recently approved benzoquinolizine fluoroquinolone, exhibits potent in vitro activity against contemporary Staphylococcus aureus isolates and Bengal Bay clone isolates collected from a large Indian tertiary care hospital
Authors: Bakthavatchalam Yamuna Devi , Shankar Abirami , Muniyasamy Rajeshwari , Peter John Victor , Marcus Zervos , Triplicane Dwarakanathan Hariharan , Gunasekaran Karthik , Iyadurai Ramya , Veeraraghavan Balaji
Published: March 2020

Objectives

Levonadifloxacin (WCK 771; IV) and its prodrug alalevonadifloxacin (WCK 2349; oral) are benzoquinolizine fluoroquinolones, recently approved in India for the treatment of acute bacterial skin and skin structure infections with concurrent bacteraemia and diabetic foot infections. Ahead of its market launch, the present study aimed to assess the in vitro activity of levonadifloxacin against contemporary Staphylococcus aureus isolates collected from a large tertiary care hospital in India. Additionally, levonadifloxacin activity was tested against hVISA and Bengal Bay clone MRSA isolates.

Methods

Non-duplicate S. aureus (n = 793) isolates collected at Christian Medical College hospital, Vellore, India during 2013–19 were included in the study. MRSA isolates were identified using a cefoxitin disc diffusion assay. MICs of levonadifloxacin and comparator antibiotics were determined using the broth microdilution method. Mutations in QRDRs were identified for selected levofloxacin-non-susceptible isolates. MLST profiling was undertaken to detect the Bengal Bay clone.

Results

Among the 793 isolates, 441 (55.6%) were MRSA and 626 (78.9%) were non-susceptible to levofloxacin. Levonadifloxacin showed MIC50 and MIC90 values of 0.25 and 0.5 mg/L, respectively, for all S. aureus, which included hVISA and Bengal Bay clone MRSA. The potency of levonadifloxacin was 16 times superior compared with levofloxacin.

Conclusions

The present study demonstrated potent activity of levonadifloxacin against contemporary S. aureus isolates, which included MRSA isolates, hVISA isolates, Bengal Bay clone isolates and a high proportion of quinolone-non-susceptible isolates. The potent activity of levonadifloxacin observed in this study supports its clinical use for the treatment of S. aureus infections.
Identification of Tree Genera Used in the Construction of Solid Wood-Packaging Materials That Arrived at U.S. Ports Infested With Live Wood-Boring Insects
Authors: Krishnankutty Sindhu , Nadel Hannah , Taylor Adam M , Wiemann Michael C , Wu Yunke , Lingafelter Steven W , Myers Scott W , Ray Ann M
Published: March 2020

Although international regulations have been successfully implemented to reduce the introduction and spread of plant pests through wood packaging material (WPM), wood-boring insects continue to be intercepted in WPM at U.S. ports of entry. Both hardwoods and softwoods are used in the construction of WPM for international trade; however, it is not clear if some types of wood pose higher risks than others for harboring wood borers. This study documented the taxonomic diversity of infested wood genera intercepted as a result of targeted WPM inspection at U.S. ports, and identified many of the wood-boring insects transported within them. The results of this study reveal associations among packaging woods, commodities, and shipment origins. The wood genera most frequently infested were Pinus Linnaeus (Pinales: Pinaceae), Picea Miller (Pinales: Pinaceae), and Populus Linnaeus (Malpighiales: Salicaceae), which were heavily represented as packaging for commodities such as stone, metal, vehicles, and machinery. In addition to these results, we summarized preferences by the wood borers to develop in living, stressed, dying, or dead hosts, the pest status of intercepted wood borers in their native and non-native ranges, and potential host range of intercepted wood borers to gauge potential for these taxa to become pests in North America. New possible host associations are reported for eight wood borer taxa. Taxonomy of host wood is presented as a new factor for consideration in pathway-level risk analysis of WPM, and the findings further reinforce the need for enhanced compliance with ISPM 15 to reduce entry of non-native wood-boring insects.
The Muslim Conquest of the City of al-Ubulla
Authors: Ramini Irsan , Al-Zuraiqi Heba
Published: March 2020

This paper discusses the dating of the Muslim conquest of the southern Iraqi port city of al-Ubulla. Arab historians give two conflicting accounts of the event: one puts it in the year 14 ah; the other in the year 16 ah. Modern scholars for their part have made no serious attempt to reconcile the two accounts. They have linked the disagreement with the traditional rivalry between Basran and Kufan historians and, generally, tended to prefer the latter account (16 ah). This paper takes a different approach to the issue. It rejects the interpretation of the disagreement given by modern scholars and, instead, reconciles the two accounts through close examination of other aspects of the Ubulla conquest. The argument conlcudes that the port city was conquered twice, once in the year 14 ah before the battle of al-Qādisiyya and then again in 16 ah after that battle. This conclusion puts us in a good position, first, to reconcile other disagreements on the sequence of events regarding the conquest of southern Iraq and, secondly, to draw some judgments as to the tribal identity of the Muslim troops who implemented that conquest and established the garrison city of Basra.
13-Hour progression of emphysematous hepatitis as depicted on repeat computerized tomography
Authors: Calderon Holly , Serfin Jennifer
Published: March 2020

Emphysematous hepatitis is a rare, rapidly progressive and often fatal condition, which occurs predominantly in patients with uncontrolled diabetes mellitus. It results in the replacement of liver parenchyma by a collection of gas. Emphysematous infections of other abdominal and pelvic organs have long been established, but relatively little is known about the equivalent emphysematous infection of the liver with very few examples in the published literature. A review of the literature shows variability regarding timing of presentation and implicated organisms. To date, computerized tomography imaging has been purported to be diagnostic and vital to early management, as it clearly shows the characteristic appearance of air bubbles within the liver parenchyma. We report a case with inconclusive initial radiographic findings.
Transcription factor Tcf4 is the preferred heterodimerization partner for Olig2 in oligodendrocytes and required for differentiation
Authors: Wedel Miriam , Fröb Franziska , Elsesser Olga , Wittmann Marie-Theres , Lie D Chichung , Reis André , Wegner Michael
Published: March 2020

Development of oligodendrocytes and myelin formation in the vertebrate central nervous system is under control of several basic helix-loop-helix transcription factors such as Olig2, Ascl1, Hes5 and the Id proteins. The class I basic helix-loop-helix proteins Tcf3, Tcf4 and Tcf12 represent potential heterodimerization partners and functional modulators for all, but have not been investigated in oligodendrocytes so far. Using mouse mutants, organotypic slice and primary cell cultures we here show that Tcf4 is required in a cell-autonomous manner for proper terminal differentiation and myelination in vivo and ex vivo. Partial compensation is provided by the paralogous Tcf3, but not Tcf12. On the mechanistic level Tcf4 was identified as the preferred heterodimerization partner of the central regulator of oligodendrocyte development Olig2. Both genetic studies in the mouse as well as functional studies on enhancer regions of myelin genes confirmed the relevance of this physical interaction for oligodendrocyte differentiation. Considering that alterations in TCF4 are associated with syndromic and non-syndromic forms of intellectual disability, schizophrenia and autism in humans, our findings point to the possibility of an oligodendroglial contribution to these disorders.
Standardized Urine-Based Tuberculosis (TB) Screening With TB-Lipoarabinomannan and Xpert MTB/RIF Ultra in Ugandan Adults With Advanced Human Immunodeficiency Virus Disease and Suspected Meningitis
Authors: Cresswell Fiona V , Ellis Jayne , Kagimu Enock , Bangdiwala Ananta S , Okirwoth Michael , Mugumya Gerald , Rutakingirwa Morris , Kasibante John , Quinn Carson M , Ssebambulidde Kenneth , Rhein Joshua , Nuwagira Edwin , Tugume Lillian , Martyn Emily , Skipper Caleb P , Muzoora Conrad , Grint Daniel , Meya David B , Bahr Nathan C , Elliott Alison M , Boulware David R
Published: March 2020

Background

Diagnosis of extrapulmonary tuberculosis (TB) remains challenging. We sought to determine the prevalence of disseminated TB by testing urine with TB-lipoarabinomannan (TB-LAM) lateral flow assay and Xpert MTB/RIF Ultra (Ultra) in hospitalized adults.

Methods

We prospectively enrolled human immunodeficiency virus (HIV)-positive adults with suspected meningitis in Uganda during 2018–2020. Participants underwent standardized urine-based TB screening. Urine (60 mcL) was tested with TB-LAM (Alere), and remaining urine was centrifuged with the cell pellet resuspended in 2 mL of urine for Xpert Ultra testing.

Results

We enrolled 348 HIV-positive inpatients with median CD4 of 37 cells/mcL (interquartile range, 13–102 cells/mcL). Overall, 26% (90 of 348; 95% confidence interval [CI], 21%–30%) had evidence of disseminated TB by either urine assay. Of 243 participants with both urine TB-LAM and Ultra results, 20% (48 of 243) were TB-LAM-positive, 12% (29 of 243) were Ultra-positive, and 6% (14 of 243) were positive by both assays. In definite and probable TB meningitis, 37% (14 of 38) were TB-LAM-positive and 41% (15 of 37) were Ultra-positive. In cryptococcal meningitis, 22% (40 of 183) were TB-LAM-positive and 4.4% (6 of 135) were Ultra-positive. Mortality trended higher in those with evidence of disseminated TB by either assay (odds ratio = 1.44; 95% CI, 0.83–2.49; P = .19) and was 6-fold higher in those with definite TB meningitis who were urine Ultra-positive (odds ratio = 5.67; 95% CI, 1.13–28.5; P = .04).

Conclusions

In hospitalized Ugandans with advanced HIV disease and suspected meningitis, systematic screening with urine TB-LAM and Ultra found a high prevalence of urine TB test positivity (26%). In those with TB meningitis, urine tests were positive in over one third. There was little concordance between Ultra and TB-LAM, which warrants further investigation.
Dynamic human and avatar facial expressions elicit differential brain responses
Authors: Kegel Lorena C , Brugger Peter , Frühholz Sascha , Grunwald Thomas , Hilfiker Peter , Kohnen Oona , Loertscher Miriam L , Mersch Dieter , Rey Anton , Sollfrank Teresa , Steiger Bettina K , Sternagel Joerg , Weber Michel , Jokeit Hennric
Published: March 2020

Computer-generated characters, so-called avatars, are widely used in advertising, entertainment, human–computer interaction or as research tools to investigate human emotion perception. However, brain responses to avatar and human faces have scarcely been studied to date. As such, it remains unclear whether dynamic facial expressions of avatars evoke different brain responses than dynamic facial expressions of humans. In this study, we designed anthropomorphic avatars animated with motion tracking and tested whether the human brain processes fearful and neutral expressions in human and avatar faces differently. Our fMRI results showed that fearful human expressions evoked stronger responses than fearful avatar expressions in the ventral anterior and posterior cingulate gyrus, the anterior insula, the anterior and posterior superior temporal sulcus, and the inferior frontal gyrus. Fearful expressions in human and avatar faces evoked similar responses in the amygdala. We did not find different responses to neutral human and avatar expressions. Our results highlight differences, but also similarities in the processing of fearful human expressions and fearful avatar expressions even if they are designed to be highly anthropomorphic and animated with motion tracking. This has important consequences for research using dynamic avatars, especially when processes are investigated that involve cortical and subcortical regions.
Coronavirus Disease 2019 (COVID-19) and Pregnancy
Authors: Rasmussen Sonja A. , Jamieson Denise J.
Published: March 2020

As the world confronts coronavirus disease 2019 (COVID-19), an illness caused by yet another emerging pathogen (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]), obstetric care providers are asking what this means for pregnant women. The global spread has been swift, and many key questions remain. The case-fatality rate for persons cared for in the United States and whether asymptomatic persons transmit the virus are examples of questions that need to be answered to inform public health control measures. There are also unanswered questions specific to pregnant women, such as whether pregnant women are more severely affected and whether intrauterine transmission occurs. Although guidelines for pregnant women from the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention have been rapidly developed based on the best available evidence, additional information is critically needed to inform key decisions, such as whether pregnant health care workers should receive special consideration, whether to temporarily separate infected mothers and their newborns, and whether it is safe for infected women to breastfeed. Some current recommendations are well supported, based largely on what we know from seasonal influenza: patients should avoid contact with ill persons, avoid touching their face, cover coughs and sneezes, wash hands frequently, disinfect contaminated surfaces, and stay home when sick. Prenatal clinics should ensure all pregnant women and their visitors are screened for fever and respiratory symptoms, and symptomatic women should be isolated from well women and required to wear a mask. As the situation with COVID-19 rapidly unfolds, it is critical that obstetricians keep up to date.
Postoperative Single-shot Epidural Fentanyl and Bupivacaine for Postoperative Analgesia After Lumbar Decompression
Authors: Alican Mannuel Feliciano B. , Ver Mario R. , Ramos Miguel Rafael D. , Mamaril Lulu Joan C.
Published: March 2020

Study Design.

Randomized clinical trial.

Objective.

To evaluate the efficacy of the postoperative single-shot bolus of epidural Fentanyl and Bupivicaine in providing pain relief postlumbar decompression surgery.

Summary of Background Data.

Despite lumbar decompression's success in alleviating symptoms of sciatica, radiculopathy, and neurogenic claudication, transient back and buttock pain has been a common complaint postoperatively. Providing good postoperative pain alleviation predicts patient's quality of recovery.

Methods.

We performed a randomized, double-blinded, clinical trial. Forty-five patients scheduled for lumbar decompression for a year's period who were randomly assigned to receive a postoperative bolus of 10-mL solution of 50 mcg of Fentanyl, 0.125% Bupivacaine, and 0.9% saline solution via an intraoperatively placed epidural catheter immediately after wound closure, before dressing application. Facial pain scale scores (from 0 to 10) were measured at three time points after surgery (fully awake at recovery room, transfer to ward, first postoperative day). Postoperative need for oral analgesics, time to independent ambulation, associated adverse events, and time to hospital discharge were also evaluated.

Results.

Pain scores were noted to be significantly lower at all time points in the epidural group (P < 0.001). In turn, they also received less on-demand oral pain medications than those in the control group (P = 0.000). The mean time to ambulation was 0.09 days in the epidural group and 0.91 days in the decompression-alone group (P = 0.000). Criteria for hospital discharge were usually met on Day 0 in the epidural and Day 1 in the control group (P = 0.000). Within the study period, only one infection was noted in the epidural group which necessitated additional lumbar spine surgery (4.3%). No adverse events or complications related to Fentanyl use were observed.

Conclusions.

A postoperative bolus of Fentanyl and Bupivacaine is effective in reducing early postoperative pain without the related complications of opiod administration.

Level of Evidence: 2
Machine Learning for Predictive Modeling of 90-day Readmission, Major Medical Complication, and Discharge to a Facility in Patients Undergoing Long Segment Posterior Lumbar Spine Fusion
Authors: Jain Deeptee , Durand Wesley , Burch Shane , Daniels Alan , Berven Sigurd
Published: March 2020

Study Design.

Retrospective case control study.

Objective.

To develop predictive models for postoperative outcomes after long segment lumbar posterior spine fusion (LSLPSF).

Summary of Background Data.

Surgery for adult spinal deformity is effective for treating spine-related disability; however, it has high complication and readmission rates.

Methods.

Patients who underwent LSLPSF (three or more levels) were identified in State Inpatient Database. Data was queried for discharge-to-facility (DTF), 90-day readmission, and 90-day major medical complications, and demographic, comorbid, and surgical data. Data was partitioned into training and testing sets. Multivariate logistic regression, random forest, and elastic net regression were performed on the training set. Models were applied to the testing set to generate AUCs. AUCs between models were compared using the method by DeLong et al.

Results.

37,852 patients were analyzed. The DTF, 90-day readmission, and 90-day major medical complication rates were 35.4%, 19.0%, and 13.0% respectively. For DTF, the logistic regression AUC was 0.77 versus 0.75 for random forest and 0.76 for elastic net (P < 0.05 for all comparisons). For 90-day readmission, the logistic regression AUC was 0.65, versus 0.63 for both random forest and elastic net (P < 0.05 for all comparisons). For 90-day major medical complications, the logistic regression AUC was 0.70, versus 0.69 for random forest and 0.68 for elastic net (P < 0.05 for all comparisons).

Conclusion.

This study created comprehensive models to predict discharge to facility, 90-day readmissions, and 90-day major medical complications after LSLPSF. This information can be used to guide decision making between the surgeon and patient, as well as inform value-based payment models.

Level of Evidence: 3
Hepatitis C Virus Infection as a Predictor of Complications and Increased Costs Following Primary Lumbar Fusion Surgery
Authors: Donnally Chester J. , Patel Parthik D. , Canseco Jose A. , Shenoy Kartik , Divi Srikanth N. , Goz Vadim , Arain Abdul R. , Vaccaro Alexander R.
Published: March 2020

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to identify whether hepatitis C virus (HCV) diagnosis influences in-hospital lengths of stay (LOS), postoperative complications, readmission rates, or costs following primary posterior lumbar fusions in an elective setting.

Summary of Background Data.

Although joint arthroplasty literature has shown increased complication rates and costs for patients seropositive with HCV without liver disease compared to those without HCV, this comorbidity has not been explored in the spine literature. To our knowledge, this is the first publication in the lumbar spine literature to solely focus on HCV as the disease burden.

Methods.

A national database was queried for patients who underwent primary lumbar spine fusion for degenerative lumbar pathology with Medicare insurance from 2005 to 2014. The 90-day postoperative complication rates, readmission rates, and treatment costs were queried. To limit confounding, HCV patients were matched with a control cohort of non-HCV patients using patient demographics, treatment modality, and comorbid conditions, and then analyzed by multivariate logistic regression. Patients with active liver disease were excluded to better isolate HCV as the comorbidity.

Results.

A cohort of 28,841 patients were included in the final analysis. Postoperatively, compared to those without HCV infection, those with HCV had significantly higher odds of blood transfusions (odds ratio [OR]: 3.06), pneumonia (OR: 2.49), respiratory failure (OR: 2.49), urinary tract infections (OR: 1.89), wound-/implant-related infections (OR: 1.74), cerebrovascular events (OR: 1.70), or any postoperative complication within 90 days (OR: 2.93; all P < 0.0001). Furthermore, HCV positive patients had higher day of surgery costs ($28,713.26 vs. $25,448.26, P < 0.0001) and 90-day costs ($33,447.39 vs. $29,016.77, P < 0.0001). There was not a significant difference for patients with HCV infection compared to those without in regard to hospital LOS (10 days vs. 8 days, P = 0.332) and rates of a 90-day readmission (0.37% vs. 0.22%; OR: 1.70, 95% confidence interval: 1.00–2.90, P: 0.050).

Conclusion.

In patients undergoing primary lumbar fusion, a seropositivity for HCV without liver disease is associated with higher costs and complication rates, including higher rates of blood transfusion requirements and pneumonia-related complications. This data shed new light on elective spine surgery in HCV patients and may influence the risks and benefits considerations for surgeons considering lumbar fusion in this population.

Level of Evidence: 3.
Lower Satisfaction After Adult Spinal Deformity Surgery in Japan Than in the United States Despite Similar SRS-22 Pain and Function Scores
Authors: Yagi Mitsuru , Ames Christopher P. , Hosogane Naobumi , Smith Justin S. , Shaffrey Christopher I. , Schwab Frank , Lafage Virginie , Bess Shay , Matsumoto Morio , Watanabe Kota
Published: March 2020

Study Design.

A multicenter retrospective case series.

Objective.

The purpose of this study was to compare the clinical outcomes of a surgical treatment for adult spinal deformity (ASD) in the United States (US) with those in Japan (JP) in a matched cohort.

Summary of Background Data.

Surgical outcomes of thoracic-lumbar-sacral (TLS) spinal fusions in adult spinal deformity ASD patients who live in Asian countries are poorly understood.

Methods.

A total of 300 surgically treated ASDs of age more than 50 years with the lowest instrumented vertebra at the pelvis and a minimum follow-up of 2 years (2y) were consecutively included. Patients were propensity-score matched for age, sex, levels fused, and 2y postop sagittal spinal alignment. Demographic, surgical, and radiographic parameters were compared between the US and JP groups.

Results.

A total of 186 patients were matched by propensity score and were almost identical within these parameters: age (US vs. JP: 66 ± 8 vs. 65 ± 7 yr), sex (females: 90% vs. 89%), levels fused (10 ± 3 vs. 10 ± 2), 2y C7 sagittal vertical axis (C7SVA) (5 ± 5 vs. 5 ± 4 cm), 2y Pelvic incidence minus lumbar lordosis (9 ± 15° vs. 9 ± 15°), and 2y pelvic tilt (PT) (25 ± 10° vs. 24 ± 10°). Oswestry Disability Index (ODI) scores and Scoliosis Research Society patient questionnaire ((SRS-22) function and pain scores were similar at 2y between the US and JP groups (ODI: 27 ± 19% vs. 28 ± 14%, P = 0.72; SRS-22 function: 3.6 ± 0.9 vs. 3.6 ± 0.7, P = 0.54; SRS-22 pain: 3.6 ± 1.0 vs. 3.8 ± 0.8, P = 0.11). However, significantly lower satisfaction was observed in JP than in the US (SRS-22 satisfaction: 4.3 ± 0.9 vs. 4.0 ± 0.8, P < 0.01).

Conclusion.

Surgical treatment for ASD was similarly effective in patients in the US and in JP. However, satisfaction scores were lower in JP compared with the US. Differences in lifestyle and cultural expectations may impact patient satisfaction following ASD surgery.

Level of Evidence: 3
Systematic Review of Outcomes Following 10-Year Mark of Spine Patient Outcomes Research Trial (SPORT) for Degenerative Spondylolisthesis
Authors: Oster Brittany A. , Kikanloo Sina Rashidi , Levine Nicole L. , Lian Jayson , Cho Woojin
Published: March 2020

Study Design.

We performed a comprehensive search of PubMed, MEDLINE, and EMBASE for all English language studies of all levels of evidence pertaining to Spine Patient Outcomes Research Trial (SPORT), in accordance with Preferred Reported Items for Systematic Reviews and Meta-analyses guidelines.

Objective.

We aim to summarize the 10-year clinical outcomes of SPORT and its numerous follow-up studies for degenerative spondylolisthesis.

Summary of Background Data.

The SPORT was a landmark randomized control trial including approximately 2500 patients at 13 clinics across the country. SPORT compared surgical and nonoperative management of the three most common spinal pathologies.

Methods.

Keywords used in the literature search included SPORT, spine patient outcomes research trial, degenerative spondylolisthesis, and surgical outcomes.

Results.

The intent-to-treat analysis failed to show a significant difference between patients treated surgically as compared to those treated nonoperatively. However, as-treated analysis revealed statically greater improvements at 6 weeks, 2 years, and 4 years in patients treated surgically. Secondary outcomes such as low back pain, leg pain, stenosis bothersome scales, overall satisfaction with current symptoms, and self-rated progress were also significantly improved in surgical patients. Regardless of the initial grade of listhesis, disk height, or mobility, patients who had surgical treatment improved more in terms of Oswestry Disability Index, bodily pain, physical function, and low back pain bothersomeness scales. Risk of reoperation increased with age, having two or three moderate or severe stenotic levels, pain predominantly localized to the back, no physical therapy, the absence of neurogenic claudication, and greater leg pain scores. Risk of reoperation was not significantly affected by type of surgery performed, smoking, diabetes, obesity, longer duration of symptoms, or workman's compensation.

Conclusion.

Although intent-to-treat analysis failed to show significant differences in patients treated surgically, results of the as-treated analysis determined statically greater improvements in those patients with spondylolisthesis who were treated surgically as compared to those treated nonoperatively.

Level of Evidence: 2
Lordosis Recreation With PLIF Surgery—What Is the Influence on Adjacent Segment Lordosis?
Authors: Kamalanathan Viknesh , Kieffer Will K.M. , Zhu Mark , Baker Joseph F. , Robertson Peter A.
Published: March 2020

Study Design.

Retrospective cohort.

Objective.

We aimed to assess the changes in adjacent segmental lordosis (SL) across the intervertebral disc space following single level posterior lumbar interbody fusion (PLIF).

Summary of Background Data.

Adjacent segment degeneration is well documented following fusion surgery as are the spinopelvic parameters. What isn’t known is the effect of fusion surgery on the adjacent SL of the lumbar spine following PLIF.

Methods.

Preoperative and 1-year postoperative erect lateral radiographs were analyzed for lordotic angulation of all lumbar segments and pelvic incidence (PI) in patients undergoing L4/5 or L5/S1 PLIF.

Results.

Fourty seven PLIFs achieved a mean of 7° increase in SL at L4/5 (P < 0.05) and 11° at L5/S1 (P < 0.05). In L5/S1 PLIF the lordosis gain was associated with lordosis reduction at adjacent segments 3° at L4/5 (P < 0.05); 1° at L3/4 (P < 0.05), 0° at L2/3(NS); 0° at L1/2(NS), and modest gain in overall lordosis (3°). At L4/5 PLIF the global lordosis increased by 5°, but less so at the adjacent discs (L5/S1 = 1°; L3/4 ≤ 1°; L2/3 ≤ –1°, and; L1/2 = <–1°). 19% of cases had a PI–LL > 10° preoperatively, reducing to 4° postoperatively.

Conclusion.

SL increased significantly at the PLIF level. At L5/S1 minimal overall lordosis change occurred however there was reduction in lordosis at adjacent levels representing reduced adjacent segment “compensation.” Conversely L4/5 PLIF showed minimal change at adjacent levels but greater overall lordosis increase. Lumbar lordosis (LL) assessment requires monosegmental assessment as well as overall measure of the LL. PLIF surgery changes both LL and SL at adjacent levels.

Level of Evidence: 3