bluuebunny/crossref_metadata_2025 huggingface dataset:
Trajectory Estimation of Flexible Needle Using PVA Tissue Material
Authors: Zhao Shijian , Gao Dedong , Zhao Mengxiao , Fu Jiajie
Published: October 2019

In order to determine the movement trajectory and characteristics of puncture needle in tissue, a series of puncture is selected for the puncture of PVA prosthesis. The image captured by CCD camera is preprocessed, and the starting coordinate point and target in the image are extracted. A fitting model based on least squares method is proposed to fit the radius of puncture needle. Comparing the simulation trajectory of forward kinematics and experimental trajectory, the experimental results show that the fitting model has a high success rate over 93% in the trajectory radius of the prosthesis puncture needle, and has a high success rate, stability and accuracy. It has a certain reference significance for the future path planning and guidance process.
An Implementation Method of SVPWM Modulation Algorithm
Authors: Chao Wang , Qiang Gao , Jing Tang
Published: October 2019

SVPWM algorithm is widely used in the field of power electronic frequency conversion power supply, motor frequency conversion control, power quality optimization and other technical fields. In this paper, the principle of SVPWM modulation is analyzed, in order to make the over-modulation algorithm more simplistic, the adverse effects on the system are smaller, and a phase and amplitude are used to change the modulation method to optimize the algorithm of the cross modulation II zone[1,2]. And using Matlab software to build SVPWM model for simulation verification. Explains the correctness of this method.
Modeling and Simulation Analysis of a Two-degree-of-Freedom Nonlinear Piezoelectric Energy Harvester
Authors: Jiang Junxiang , Liu Shaogang , Wu Junchao , Feng Lifeng
Published: October 2019

In order to improve energy harvesting efficiency, this paper shows the design of a two-degree-of-freedom (2-DOF) nonlinear piezoelectric energy harvester. The proposed harvest is realized by introducing magnetic attraction to a 2-DOF piezoelectric cantilever beam in order to broaden the energy harvesting bandwidth. Electromechanical equations describing this nonlinear system are presented. The simulation results confirmed the advantage of this new 2-DOF nonlinear harvester. Performance comparison shows that the 2-DOF nonlinear harvester has much higher energy harvesting efficiency than a conventional one-degree-of-freedom (1-DOF) nonlinear one.
Study on the Damping Problem in Circular Plates of Radial Phonon Crystals
Authors: Mu Di , Shu Haisheng , Su Yuqiang
Published: October 2019

In order to perfect the theoretical framework of the radial phonon crystal circular plate, a damping type radial circular plate is constructed. The localization factor of damping is solved by transfer matrix method, and the finite element simulation and experimental verification are carried out. Furthermore, the effect of elastic modulus on the bandgap is investigated from the perspective of its frequency nonlinearity. The results show that the damping effect of viscoelastic materials has a significant effect on the bandgap, which is mainly reflected in the fact that the cut-off frequency of bandgap moves to the high frequency with the increase of material loss factor, thus broadening the bandgap. The damping effect of damping alloy has no obvious influence on the bandgap characteristic, which is related to the inherent impedance characteristic of the alloy.
Zirconium-Based Cladding Coating Technique for Oxidation, Corrosion and Embrittlement Reduction at High-Temperature: An Overview
Authors: Sagiroun Mamoun I. A. , Xinrong Cao
Published: October 2019

Fukushima Daichii accident attracted attention to one important factor for nuclear reactors safety – overcoming the high hydrogen emissions under accident conditions. The coating on zirconium-based cladding is one of significant approach to protecting the cladding materials from corrosion, accelerated oxidation at high temperature, embrittlement and (oxygen and hydrogen) uptake at aggressive water-chemical environments inside the core of Light Water Reactors (LWR). This paper presents a compact review of the most common technologies used to apply coating on zr-based cladding superstrates. The paper also discusses the coating materials, substrate preparations and recent advances in deposition techniques.
Using Absorbent Paper Strips for the Collection of Cell-Free DNA in Patients with Periodontal Diseases
Authors: Thaweboon Boonyanit , Suwannagindra Sukhumchawee , Kerdvongbundit Varunee , Thaweboon Sroisiri
Published: October 2019

The cell-free DNA in gingival crevicular fluid (GCF) is a recent interesting diagnostic marker in patients with periodontal disease. The methods used to collect GCF are very important to get the proper specimen. There are several techniques used for sample collection, such as gingival washing or using a capillary tube, however, these methods are not practical to perform in the clinic since they need well-trained examiner. This study aimed to use absorbent paper strips to collect cell-free DNA fragment in GCF of patients as a diagnostic measure for periodontal diseases comparing to conventional washing technique. Thirty-nine periodontitis and 26 gingivitis teeth were selected from 26 patients according to clinical parameters. The GCF sample was randomly collected from each tooth by either paper strips or washing technique. Then, after one week, the collection of samples from the same tooth was repeated with another technique. The samples were centrifuged to get cell-free DNA in the supernatant and extracted by InstaGene Matrix. The concentration and purity of extracted DNA were determined by NanoDrop spectrophotometer. Three sets of specific primers to the human β-globin gene were used to evaluate the DNA fragment lengths, by amplifying 110 base pair (bp), 536 bp, and 2000 bp products in the polymerase chain reaction (PCR). The results showed no significant differences in the cell-free DNA fragment concentrations and the prevalence of PCR products between using absorbent paper strips and washing technique in either gingivitis or periodontitis groups. Therefore, with the ease and rapidity of the technique, using the absorbent paper strips for the quantitative and qualitative investigation of cell-free DNA fragment in patients with periodontal diseases instead of washing technique is recommended. Further studies are still required to confirm this finding in a large group of patients as well as in patients with other systemic health problems.
Finite Time Cascade Control Scheme for Tracking Control of an Underwater Exploring Robot
Authors: Liu Zhimin , Zhou Xiaozhong
Published: October 2019

In this paper, we discuss the curve trajectory tracking problem of an underactuated underwater robot in the horizontal plane. We use global diffeomorphism transformation method to transform the sixth-order dynamic tracking error model into a nonlinear cascaded system, by using the cascaded systems’ finite time stability theory, along with the back stepping technique to design the controller. Two discontinuous finite time controllers are designed for the two subsystems respectively. In the existing literature, finite time control is used for the first order nonholonomic system, we extended this method to two order nonholonomic system in this paper. The finite time controller can tune not only the gain, but also the fractional power, it is more convenience for engineering implementation. The results show the control laws can achieve the control objective with good performance for the horizontal trajectory tracking control.
The Method to Measure the Body’s Local Temperature: What Materials Should Be Used to Fix The iButton on the Skin
Authors: Xi Tianyu , Qin Huan , Lv Xiaowei , Wang Qiaochu
Published: October 2019

iButton, a wireless temperature system, is currently the most popular and inexpensive miniature temperature datalogger commercially available [1]. However, there is no any previous study to evaluate the effect of iButtons’ fixed material on the accuracy of thermal measure. This article carried an experiment to test the impacts of four different fixed materials on iButtons: transparent adhesive tape, Aluminum foil paper, black and white bandages. The result shows that transparent adhesive tape can reduce the influence of wind speed while Aluminum foil paper can prevent solar radiation effectively. As for bandages, the temperature of the black bandages group is higher than the white bandages group which indicated that black material can absorb more solar radiation. However, the function of bandages to reduce the impact of ambient heat is not obvious in this test, though it is existed.
Ultra-scaled MoS2 transistors and circuits fabricated without nanolithography
Authors: Ashokbhai Patel Kishan , Grady Ryan W , Smithe Kirby K H , Pop Eric , Sordan Roman
Published: October 2019

The future scaling of semiconductor devices can be continued only by the development of novel nanofabrication techniques and atomically thin transistor channels. Here we demonstrate ultra-scaled MoS2 field-effect transistors (FETs) realized by a shadow evaporation method which does not require nanofabrication. The method enables large-scale fabrication of MoS2 FETs with fully gated  ∼10 nm long channels. The realized ultra-scaled MoS2 FETs exhibit very small hysteresis of current–voltage characteristics, high drain currents up to  ∼560 A m−1, very good drain current saturation for such ultra-short devices, subthreshold swing of ∼120 mV dec−1, and drain current on/off ratio of ∼106 in air ambient. The fabricated ultra-scaled MoS2 FETs are also used to realize logic gates in n-type depletion-load technology. The inverters exhibit a voltage gain of  ∼50 at a power supply voltage of only 1.5 V and are capable of in/out signal matching.
Resource allocation trade-offs in a mast-seeding conifer: Piñon pine prioritizes reproduction over defense
Authors: Redmond Miranda D , Davis Thomas Seth , Ferrenberg Scott M , Wion Andreas P
Published: October 2019

The cost of plant reproduction or defense at the expense of other fitness traits is a central component of life history theory. Yet the three central resource allocation pathways of growth, reproduction, and defense have rarely been assessed simultaneously nor across individual to landscape scales. This information is critical towards identifying the physiological, environmental, and genetic mechanisms underpinning resource allocation. This study assessed trade-offs in resource allocation between tree growth, defense, and reproduction across scales among piñon pine (Pinusedulis), a widespread mast-seeding conifer of the southwestern USA. Time series (2004-2016) of tree growth (radial and primary shoot growth), defense (resin duct production; a key constitutive defense for this species), and cone production among individual trees from populations across a broad environmental gradient were used to investigate these trade-offs in resource allocation across three scales: individual, population, and landscape. We found evidence for a defense-reproduction trade-off among individuals whereby total resin duct area in annual xylem rings was lower during years of above average cone production. Despite variability in cone and resin duct production across trees within a population and across populations, there was no association between these fitness traits at either of those scales. There was no evidence of trade-offs between cone production and growth at any scales measured, whereas resin duct production and growth were positively related at all scales. Our study suggests that a strategic trade-off occurs whereby investment into defense is temporarily curtailed to favor reproduction, despite increased risk of exposure to natural enemies and the ability of piñon pine to simultaneously allocate carbon to growth and defense. Our study provides new insights into physiological expressions of growth, defense, and reproduction over time in this long-lived masting conifer and indicates the presence of trade-offs with direct importance for individual fitness and population dynamics under global change.
Professional Burnout in United States Plastic Surgery Residents: Is It a Legitimate Concern?
Authors: Coombs Demetrius M , Lanni Michael A , Fosnot Joshua , Patel Ashit , Korentager Richard , Lin Ines C , Djohan Risal
Published: October 2019

Background

Physician burnout is intimately associated with institutional losses, substance abuse, depression, suicidal ideation, medical errors, and lower patient satisfaction scores.

Objectives

By directly sampling all US plastic and reconstructive surgery residents, this study examined burnout, medical errors, and program-related factors.

Methods

Cross-sectional study of data collected from current US plastic and reconstructive surgery residents at Accreditation Council for Graduate Medical Education–accredited programs during the 2018 to 2019 academic year. Previously validated survey instruments included the Stanford Professional Fulfillment and Maslach Burnout Indices. Additional data included demographics, relationship status, program-specific factors, and admission of medical errors.

Results

A total of 146 subjects responded. Residents from each postgraduate year (PGY) in the first 6 years were well represented. Overall burnout rate was 57.5%, and on average, all residents experienced work exhaustion and interpersonal disengagement. No relation was found between burnout and age, gender, race, relationship status, or PGY. Burnout was significantly associated with respondents who feel they matched into the wrong program, would not recommend their program to students, do not feel involved in program decisions, reported increasing hours worked in the week prior, feel that they take too much call, reported making a major medical error that could have harmed a patient, or reported making a lab error.

Conclusions

This study directly examined burnout, self-reported medical errors, and program suitability in US plastic and reconstructive residents based on validated scales and suggests that burnout and some medical errors may be related to program-specific, modifiable factors, not limited to, but including, involvement in program-related decisions and call structure.
In utero exposure to persistent and nonpersistent endocrine-disrupting chemicals and anogenital distance. A systematic review of epidemiological studies†
Authors: Nelson William , Liu Ding-Yuan , Yang Yin , Zhong Zhao-Hui , Wang Ying-Xiong , Ding Yu-bin
Published: October 2019

Anti-androgenic endocrine-disrupting chemicals (EDCs) can cross the placenta to modify early offspring sexual dimorphic markers. These changes are linked to anogenital distance (AGD), which is an androgen-sensitive anthropometric parameter used as a biomarker of perineal growth and caudal migration of the genital tubercle. This review aimed to summarize strength of evidence for associations of in utero exposure to EDCs with AGD and to identify gaps and limitations in the literature so as to inform future research. We performed an electronic search of English literature in September 2019 in medical literature analysis and retrieval system online (MEDLINE), Web of Science and Toxline. We included epidemiological studies that examined in utero exposure to persistent and nonpersistent EDCs and considered AGD in offspring as an outcome. Our review contained 16 investigations examining exposure to persistent EDCs (nine studies) and nonpersistent EDCs (seven studies). Some individual studies reported an inverse association between exposure to bisphenol A (BPA), dioxins, perfluoroalkyl substances, and organochlorides and AGD in both male and female offspring. Meta-analysis of three studies found a small reduction of AGD in female offspring exposed to BPA. The number of studies per chemical is small, and number of subjects examined is limited; so, replication of these results is needed. To achieve more specificity and better replication of results, future studies should establish the association of nonpersistent EDCs using multiple urine samples, evaluate the cumulative impact of exposure to a mixture of anti-androgenic chemicals, and offer adequate consideration of more maternal- and children-related confounding factors.
Model-free approach to quantifying the proportion of treatment effect explained by a surrogate marker
Authors: Wang Xuan , Parast Layla , Tian Lu , Cai Tianxi
Published: October 2019

In randomized clinical trials, the primary outcome, $Y$, often requires long-term follow-up and/or is costly to measure. For such settings, it is desirable to use a surrogate marker, $S$, to infer the treatment effect on $Y$, $\Delta$. Identifying such an $S$ and quantifying the proportion of treatment effect on $Y$ explained by the effect on $S$ are thus of great importance. Most existing methods for quantifying the proportion of treatment effect are model based and may yield biased estimates under model misspecification. Recently proposed nonparametric methods require strong assumptions to ensure that the proportion of treatment effect is in the range $[0,1]$. Additionally, optimal use of $S$ to approximate $\Delta$ is especially important when $S$ relates to $Y$ nonlinearly. In this paper we identify an optimal transformation of $S$, $g_{\tiny {\rm{opt}}}(\cdot)$, such that the proportion of treatment effect explained can be inferred based on $g_{\tiny {\rm{opt}}}(S)$. In addition, we provide two novel model-free definitions of proportion of treatment effect explained and simple conditions for ensuring that it lies within $[0,1]$. We provide nonparametric estimation procedures and establish asymptotic properties of the proposed estimators. Simulation studies demonstrate that the proposed methods perform well in finite samples. We illustrate the proposed procedures using a randomized study of HIV patients.
Use of Procalcitonin and a Respiratory Polymerase Chain Reaction Panel to Reduce Antibiotic Use via an Electronic Medical Record Alert
Authors: Moradi Tony , Bennett Nicholas , Shemanski Shelby , Kennedy Kevin , Schlachter Andrew , Boyd Sarah
Published: October 2019

Background

Respiratory tract infections are often viral and but are frequently treated with antibiotics, providing a significant opportunity for antibiotic de-escalation in patients. We sought to determine whether an automated electronic medical record best practice alert (BPA) based on procalcitonin and respiratory polymerase chain reaction (PCR) results could help reduce inappropriate antibiotic use in patients with likely viral respiratory illness.

Methods

This multisite, pre–post, quasi-experimental study included patients 18 years and older with a procalcitonin level <0.25 ng/mL and a virus identified on respiratory PCR within 48 hours of each other, and 1 or more systemic antibiotics ordered. In the study group, a BPA alerted providers of the diagnostic results suggesting viral infection and prompted them to reassess the need for antibiotics. The primary outcome measured was total antibiotic-days of therapy.

Results

The BPA reduced inpatient antibiotic-days of therapy by a mean of 2.2 days compared with patients who met criteria but did not have the alert fire (8.0 vs 5.8 days, respectively, P < .001). The BPA also reduced the percentage of patients prescribed antibiotics on discharge (20% vs 47.8%, P < .001), whereas there was no difference in need for antibiotic escalation after initial discontinuation (7.6% vs 4.3%, P = .198).

Conclusions

The automated antimicrobial stewardship BPA effectively reduced antibiotic use and discharge prescribing rates when diagnostics suggested viral respiratory tract infection, without a higher rate for reinitiation of antibiotics after discontinuation.
An analysis of business English coursebooks from an ELF perspective
Authors: Si Jinghui
Published: October 2019

This study analysed a series of business English coursebooks published and used in the Chinese context from an English as a lingua franca (ELF) perspective. The analysis was conducted from four aspects: language ownership, language exposure, language activities, and cultural representations. These address four key issues in the debate over the practicality of ELF-informed materials. The findings show an orientation towards native English speakers as representatives of English users, a dominance of native-speaker Standard English in language exposure, a lack of ELF-informed activities, and a limited representation of Chinese culture. This article concludes that the coursebooks merely introduce ELF as a cultural and linguistic phenomenon. Despite some attempts to present the role of ELF in the global business community, there is a paucity of ELF exposure and ELF-informed activities. The implications of these findings for the selection and evaluation of ELF-informed materials are discussed.
Selection and Validation of Suitable Reference Genes for RT-qPCR Analysis in Apolygus lucorum (Hemiptera: Miridae)
Authors: Luo Jing , Wang Aoli , Cheng Yanxia , Rong Haoling , Guo Libin , Peng Yu , Xu Letian
Published: October 2019

Apolygus lucorum (Meyer-Dür) is a destructive pest to >280 plants. Major economic significance and pesticide resistance issues have created a need for integrated pest management (e.g., RNAi, entomopathogen-based bioinsecticides) for A. lucorum. To better develop these control strategies, large-scale genetic studies involving gene-expression analysis are required and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) is the most commonly used method. However, there have been no reports on appropriate reference genes in A. lucorum. Here, we evaluated nine widely utilized reference genes including EF1γ, RPL32, RPL27, SDH, TBP, ACT, ACT2, GAPDH, and βTUB for their expression stabilities in A. lucorum under five different conditions i.e., life stage, tissue, sex, dsRNA injection, and entomopathogen infection. Based on the gene stability ranking calculated by RefFinder, which integrates four algorithms (geNorm, delta Ct method, NormFinder, and BestKeeper), we recommend RPL27 and RPL32 as the most appropriate reference genes for molecular studies in different life stages and tissues; GAPDH and EF1γ for different sexes and entomopathogen infection studies; and RPL27 and EF1γ for RNAi studies. The results of this study will help improve the accuracy and reliability for normalizing the RT-qPCR data for further molecular analysis in A. lucorum.
Spatial Mixing between Calling Males of Two Closely Related, Sympatric Crickets Suggests Beneficial Heterospecific Interactions in a NonAdaptive Radiation
Authors: Xu Mingzi , Shaw Kerry L
Published: October 2019

Sympatry among closely related species occurs in both adaptive and nonadaptive radiations. Among closely related, sympatric species of a nonadaptive radiation, the lack of ecological differentiation brings species into continual contact where individuals are exposed to the risk of reproductive interference. Selection thus should cause divergence in multiple components mediating the reproductive boundary. Besides differentiation of reproductive signals per se, spatial segregation is a commonly proposed mechanism that can mitigate reproductive interference. Studying a pair of broadly sympatric, closely related cricket species from a nonadaptive radiation in Hawaii, we 1) quantified acoustic divergence of male songs and 2) tested alternative hypotheses of spatial distribution of calling males of the 2 species. Acoustic analyses of the recorded songs showed that, while the 2 species differed substantially in pulse rate, no spectral or fine temporal segregation of the pulse structure was evident, indicating the potential for acoustic masking. Moreover, we found that calling males of the 2 species are highly mixed both vertically and horizontally and showed the same preference for calling sites. More surprisingly, calling males were found to form mixed-species calling clusters where heterospecific males are closer to each other than conspecific males. Such an individual spacing pattern suggests low heterospecific aggression and/or high conspecific competition. Because females prefer higher sound intensity, heterospecific males may benefit, rather than interfere, with each other in attracting females. These findings offer a potential mechanism enabling species coexistence in sympatry.
Fifty Shades of the Harlequin Ladybird and a Sexually Transmitted Fungus
Authors: Fiedler Lukáš , Nedvěd Oldřich
Published: October 2019

The ectoparasitic fungus Hesperomyces virescens was studied on its invasive host, the harlequin ladybird Harmonia axyridis, in the Czech Republic. A primary aim was to examine the relationship between fungal infection and elytral coloration of the ladybird. Furthermore, the role of host sex and mating status of females were analyzed. Beetles (n = 1,102) were sampled during autumn migration, and then sexed, weighed, and screened for infection. Females were dissected for detection of sperm in their spermathecae. Ladybirds were sorted according to color form and absorbance spectrophotometry was used to quantify carotenoid contents in their elytra. In individuals of the nonmelanic succinea form, the degree of melanization was measured using digital photographs and putative age groups were estimated based on background color of elytra. Sexual differences in infection patterns indicated transmission during copulation: males were infected mostly on elytra and venter, and females had infection almost exclusively on elytra. Mated females had higher infection rate than virgins. There was no influence of genetic color form on the fungal infection. Putative age groups (visual sorting to yellow, orange, and red) correlated with fungal infection. Infected individuals had elevated elytral carotenoid levels in comparison to uninfected individuals, which could be explained by host age. Infection-free succinea beetles were extensively melanized because they emerged later in the season at lower temperatures which induced melanization. Overall, we highlight that H. axyridis is a multivoltine species whose age, if not taken into account in ecophysiological studies, might present a considerable confounding factor.
Stemming the Tide of Opioid Addiction—Dramatic Reductions in Postoperative Opioid Requirements Through Preoperative Education and a Standardized Analgesic Regimen
Authors: Sheldon Rowan R , Weiss Jessica B , Do Woo S , Forte Dominic M , Carter Preston L , Eckert Matthew J , Sohn Vance Y
Published: October 2019

Introduction

Surgery is a known gateway to opioid use that may result in long-term morbidity. Given the paucity of evidence regarding the appropriate amount of postoperative opioid analgesia and variable prescribing education, we investigated prescribing habits before and after institution of a multimodal postoperative pain management protocol.

Materials and Methods

Laparoscopic appendectomies, laparoscopic cholecystectomies, inguinal hernia repairs, and umbilical hernia repairs performed at a tertiary military medical center from 01 October 2016 until 30 September 2017 were examined. Prescriptions provided at discharge, oral morphine equivalents (OME), repeat prescriptions, and demographic data were obtained. A pain management regimen emphasizing nonopioid analgesics was then formulated and implemented with patient education about expected postoperative outcomes. After implementation, procedures performed from 01 November 2017 until 28 February 2018 were then examined and analyzed. Additionally, a patient satisfaction survey was provided focusing on efficacy of postoperative pain control.

Results

Preprotocol, 559 patients met inclusion criteria. About 97.5% were provided an opioid prescription, but prescriptions varied widely (256 OME, standard deviation [SD] 109). Acetaminophen was prescribed often (89.5%), but nonsteroidal anti-inflammatory drug (NSAID) prescriptions were rare (14.7%). About 6.1% of patients required repeat opioid prescriptions. After implementation, 181 patients met inclusion criteria. Initial opioid prescriptions decreased 69.8% (77 OME, SD 35; P < 0.001), while repeat opioid prescriptions remained statistically unchanged (2.79%; P = 0.122). Acetaminophen prescribing rose to 96.7% (P = 0.002), and NSAID utilization increased to 71.0% (P < 0.001). Postoperative survey data were obtained in 75 patients (41.9%). About 68% stated that they did not use all of the opioids prescribed and 81% endorsed excellent or good pain control throughout their postoperative course.

Conclusions

Appropriate preoperative counseling and utilization of nonopioid analgesics can dramatically reduce opioid use while maintaining high patient satisfaction. Patient-reported data suggest that even greater reductions may be possible.
Mental Health Diagnoses in Veterans Referred for Outpatient Geriatric Psychiatric Care at a Veterans Affairs Medical Center
Authors: Atkinson David M , Doane Bridget M , Thuras Paul D , Leskela Mitch R , Shiroma Paulo R
Published: October 2019

Introduction

Nearly half of the U.S. veterans are over 65 years of age. Older veterans are at higher risk for mental health (MH) conditions, which are associated with increased mortality and health care costs. Given the deficit of specialty-trained geriatric providers, we are conducting a Quality Improvement initiative to improve MH services for older veterans at Minneapolis Veterans Affairs Health Care System. Our first step is to understand the demographic and diagnostic characteristics of veterans referred for geriatric MH specialty treatment.

Materials and Method

We conducted a retrospective chart review of demographics and psychiatric diagnoses in veterans seen for outpatient geriatric MH intake between May 1, 2011 and April 30, 2016. We used chi-square and Spearman’s rho tests to examine age, diagnoses, and service-time era variables.

Results

1,059 veterans were evaluated, average age of 73.5 years. Depressive (47%), neurocognitive (42%), and anxiety disorders (22%) were the most common MH conditions. Vietnam veterans showed higher prevalence of depressive (56%), post-traumatic stress (11%), and alcohol use (10%) disorders. World War II veterans showed higher prevalence of neurocognitive disorders (71%). Neurocognitive disorder prevalence was significantly correlated with age.

Conclusions

Prevalence and comorbidity of major MH conditions is high in veterans referred for geriatric MH services. Future work will examine challenges faced by non-specialty providers in caring for older veterans, with the goal of developing targeted educational and clinical interventions to better address aging veterans’ MH needs.
High genetic connectivity in a gastropod with long-lived planktonic larvae
Authors: Crocetta Fabio , Caputi Luigi , Paz-Sedano Sofia , Tanduo Valentina , Vazzana Angelo , Oliverio Marco
Published: October 2019

Genetic connectivity plays a crucial role in shaping the geographic structure of species. Our aim in this study was to explore the pattern of genetic connectivity in Bursa scrobilator, an iconic marine caenogastropod with long-lived pelagic larvae. Our study was based on the analysis of DNA sequence data for the 658-bp barcoding fragment of the mitochondrial cytochrome c oxidase subunit I (COI) gene. This is the largest DNA sequence dataset assembled to date for B. scrobilator. These data confirm that the two recently described subspecies B. scrobilator scrobilator (Linnaeus, 1758), from the Mediterranean and Macaronesia, and B. s. coriacea (Reeve, 1844), from West Africa, constitute two evolutionarily significant units (ESUs). We found that for the nominal subspecies, the variation in morphology (shell, radula and gross anatomy) and DNA sequences was not geographically structured, and this agrees with what we would expect in a species with high connectivity at the larval stage. The divergence between the two subspecies cannot be easily explained by isolation by distance, and we would argue that one or more extrinsic factors may have played a role in isolating the two ESUs and maintaining that isolation.
Histone lysine demethylase KDM4B regulates the alternative splicing of the androgen receptor in response to androgen deprivation
Authors: Duan Lingling , Chen Zhenhua , Lu Jun , Liang Yanping , Wang Ming , Roggero Carlos M , Zhang Qing-Jun , Gao Jason , Fang Yong , Cao Jiazheng , Lu Jian , Zhao Hongwei , Dang Andrew , Pong Rey-Chen , Hernandez Elizabeth , Chang Chun-Mien , Hoang David T , Ahn Jung-Mo , Xiao Guanghua , Wang Rui-tao , Yu Kai-jiang , Kapur Payal , Rizo Josep , Hsieh Jer-Tsong , Luo Junhang , Liu Zhi-Ping
Published: October 2019

Alternative splicing is emerging as an oncogenic mechanism. In prostate cancer, generation of constitutively active forms of androgen receptor (AR) variants including AR-V7 plays an important role in progression of castration-resistant prostate cancer (CRPC). AR-V7 is generated by alternative splicing that results in inclusion of cryptic exon CE3 and translation of truncated AR protein that lacks the ligand binding domain. Whether AR-V7 can be a driver for CRPC remains controversial as the oncogenic mechanism of AR-V7 activation remains elusive. Here, we found that KDM4B promotes AR-V7 and identified a novel regulatory mechanism. KDM4B is phosphorylated by protein kinase A under conditions that promote castration-resistance, eliciting its binding to the splicing factor SF3B3. KDM4B binds RNA specifically near the 5′-CE3, upregulates the chromatin accessibility, and couples the spliceosome to the chromatin. Our data suggest that KDM4B can function as a signal responsive trans-acting splicing factor and scaffold that recruits and stabilizes the spliceosome near the alternative exon, thus promoting its inclusion. Genome-wide profiling of KDM4B-regulated genes also identified additional alternative splicing events implicated in tumorigenesis. Our study defines KDM4B-regulated alternative splicing as a pivotal mechanism for generating AR-V7 and a contributing factor for CRPC, providing insight for mechanistic targeting of CRPC.
Survival of diffuse astrocytic glioma, IDH1/2 wildtype, with molecular features of glioblastoma, WHO grade IV: a confirmation of the cIMPACT-NOW criteria
Authors: Tesileanu C Mircea S , Dirven Linda , Wijnenga Maarten M J , Koekkoek Johan A F , Vincent Arnaud J P E , Dubbink Hendrikus J , Atmodimedjo Peggy N , Kros Johan M , van Duinen Sjoerd G , Smits Marion , Taphoorn Martin J B , French Pim J , van den Bent Martin J
Published: October 2019

Background

The Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) has recommended that isocitrate dehydrogenase 1 and 2 wildtype (IDH1/2wt) diffuse lower-grade gliomas (LGGs) World Health Organization (WHO) grade II or III that present with (i) a telomerase reverse transcriptase promoter mutation (pTERTmt), and/or (ii) gain of chromosome 7 combined with loss of chromosome 10, and/or (iii) epidermal growth factor receptor (EGFR) amplification should be reclassified as diffuse astrocytic glioma, IDH1/2 wildtype, with molecular features of glioblastoma, WHO grade IV (IDH1/2wt astrocytomas WHO IV). This paper describes the overall survival (OS) of IDH1/2wt astrocytoma WHO IV patients, and more in detail patients with tumors with pTERTmt only.

Methods

In this retrospective multicenter study, we compared the OS of 71 IDH1/2wt astrocytomas WHO IV patients, with radiological characteristics of LGGs, with the OS of 197 IDH1/2wt glioblastoma patients. Moreover, we compared the OS of 22 pTERTmt only astrocytoma patients with the OS of the IDH1/2wt glioblastoma patients.

Results

Median OS was similar for IDH1/2wt astrocytoma WHO IV patients (23.8 mo) and IDH1/2wt glioblastoma patients (19.2 mo) (Cox proportional hazards model: hazard ratio [HR] 1.27, 95% CI: 0.85–1.88, P = 0.242). OS was also similar in patients with IDH1/2wt astrocytomas WHO IV, pTERTmt only, and IDH1/2wt glioblastomas (HR 1.15, 95% CI: 0.64–2.10, P = 0.641).

Conclusions

The presented data confirm the cIMPACT-NOW recommendation and we propose that IDH1/2wt astrocytomas WHO IV in the absence of other qualifying mutations should be classified as IDH1/2wt glioblastomas.
De novoassembly of a Tibetan genome and identification of novel structural variants associated with high-altitude adaptation
Authors:   Ouzhuluobu, He Yaoxi , Lou Haiyi , Cui Chaoying , Deng Lian , Gao Yang , Zheng Wangshan , Guo Yongbo , Wang Xiaoji , Ning Zhilin , Li Jun , Li Bin , Bai Caijuan ,   Baimakangzhuo,   Gonggalanzi,   Dejiquzong,   Bianba,   Duojizhuoma, Liu Shiming , Wu Tianyi , Xu Shuhua , Qi Xuebin , Su Bing
Published: October 2019

Structural variants (SVs) may play important roles in human adaptation to extreme environments such as high altitude but have been under-investigated. Here, combining long-read sequencing with multiple scaffolding techniques, we assembled a high-quality Tibetan genome (ZF1), with a contig N50 length of 24.57 mega-base pairs (Mb) and a scaffold N50 length of 58.80 Mb. The ZF1 assembly filled 80 remaining N-gaps (0.25 Mb in total length) in the reference human genome (GRCh38). Markedly, we detected 17 900 SVs, among which the ZF1-specific SVs are enriched in GTPase activity that is required for activation of the hypoxic pathway. Further population analysis uncovered a 163-bp intronic deletion in the MKL1 gene showing large divergence between highland Tibetans and lowland Han Chinese. This deletion is significantly associated with lower systolic pulmonary arterial pressure, one of the key adaptive physiological traits in Tibetans. Moreover, with the use of the high-quality de novo assembly, we observed a much higher rate of genome-wide archaic hominid (Altai Neanderthal and Denisovan) shared non-reference sequences in ZF1 (1.32%–1.53%) compared to other East Asian genomes (0.70%–0.98%), reflecting a unique genomic composition of Tibetans. One such archaic hominid shared sequence—a 662-bp intronic insertion in the SCUBE2 gene—is enriched and associated with better lung function (the FEV1/FVC ratio) in Tibetans. Collectively, we generated the first high-resolution Tibetan reference genome, and the identified SVs may serve as valuable resources for future evolutionary and medical studies.
Authority and the Future of Consent in Population-Level Biomedical Research
Authors: Sheehan Mark , Thompson Rachel , Fistein Jon , Davies Jim , Dunn Michael , Parker Michael , Savulescu Julian , Woods Kerrie
Published: October 2019

Population-level biomedical research has become crucial to the health system’s ability to improve the health of the population. This form of research raises a number of well-documented ethical concerns, perhaps the most significant of which is the inability of the researcher to obtain fully informed specific consent from participants. Two proposed technical solutions to this problem of consent in large-scale biomedical research that have become increasingly popular are meta-consent and dynamic consent. We critically examine the ethical and practical credentials of these proposals and find them lacking. We suggest that the consent problem is not solved by adopting a technology driven approach grounded in a notion of ‘specific’ consent but by taking seriously the role of research governance in combination with broader conceptions of consent. In our view, these approaches misconstrue the rightful location of authority in the way in which population-level biomedical research activities are structured and organized. We conclude by showing how and why the authority for determining the nature and shape of choice making about participation ought not to lie with individual participants, but rather with the researchers and the research governance process, and that this necessarily leads to the endorsement of a fully articulated broad consent approach.
The perspective of people with axial spondyloarthritis regarding physiotherapy: room for the implementation of a more active approach
Authors: Osthoff Anne-Kathrin Rausch , van der Giesen Florus , Meichtry André , Walker Beatrice , van Gaalen Floris A , Goekoop-Ruiterman Yvonne P M , Peeters Andreas J , Niedermann Karin , Vliet Vlieland Theodora P M
Published: October 2019

Objectives

Physiotherapy is recommended in the management of people with axial Spondyloarthritis (axSpA), with new insights into its preferred content and dosage evolving. This study aimed to describe the use and preferences regarding individual and group physiotherapy among people with axSpA.

Methods

A cross-sectional survey was conducted among people with axSpA living in the Netherlands (NL) and Switzerland (CH).

Results

713 people with axSpA participated (56.7% male, median age 55 years, median ASAS-Hi-score 4.2). Response rates were 45% (n = 206) in NL and 29% in CH (n = 507). 83.3% of participants were or had been using physiotherapy. Individual therapy only was or had been used by 36.7%, a combination of individual plus land- and water-based group therapy was or had been used by 29.1% and group therapy only by 5.3%. Only less than half participants attending individual therapy reported active therapy (like aerobic, muscle strength, flexibility exercises). Although the majority (75.9%) was not aware of the increased cardiovascular risk, participants showed an interest in cardiovascular training, either individually or in a supervised setting. If supervised, a majority, in CH (75.0%) more than in NL (55.7%), prefers supervision by a specialized physiotherapist.

Conclusion

The majority of people with axSpA uses or used physiotherapy, more often in an individual than in a group setting. The content of individual therapy should be more active; in both therapy settings aerobic exercises should be promoted. Especially, enabling people with axSpA to perform exercises independently would meet their needs and might enhance their daily physical activity.
Foucault on the Wards: Rediscovering Reflection as a Social Pediatrician in Training
Authors: Maynard Kevin
Published: October 2019

The author states that as a second-year medical student with a liberal arts degree, it was often difficult for him to reconcile his former liberal arts education with the current demands of his training. Although the medical curriculum increasingly acknowledges the importance of a biopsychosocial model, the prioritization of knowledge remains the same: know your biological, pharmacological, and anatomical facts. However, the author’s experience with a social pediatrics research summer studentship moved him beyond this basic sciences mindset and provided a practical framework for the application of his liberal arts training. The experience was twofold: he worked on a research project while simultaneously shadowing a pediatrician twice a week. His project applied a Foucauldian critical discourse analysis (CDA) to an archive of texts that sought to better characterize the term social pediatrics. The author concludes that the thought-changing reflection, mentorship, and concrete clinical experiences made possible by the summer studentship expanded his worldview.

The author discusses the complementary relationship between CDA, clinical experience, and self-reflection in the developing clinician. The purpose of his essay is threefold. First, by drawing on concepts from Descartes’ Meditations and Plato’s allegory of the cave, he establishes educational continuity between his liberal arts and medical training. Second, using clinical examples, he explores the practicality of discourse analysis and how skills regarding empathy and bias awareness are transferrable to the wards. Last, he highlights the importance of cognitive dissonance and transformative learning in the maturing physician.
Comparison of Continuing Medical Education at U.S. Medical Schools and Other Accredited Organizations: A 20-Year Analysis
Authors: Rayburn William F. , Regnier Kate , McMahon Graham T.
Published: October 2019

Purpose

To describe a long-term overview of accredited continuing medical education (CME) at M.D.-granting medical schools in the United States.

Method

Self-reported data about type, duration, and numbers of learner participants of accredited CME activities and income for CME units from each medical school were compiled annually by the Accreditation Council for Continuing Medical Education (ACCME) between 1998 and 2017. Comparisons were made with data from all other ACCME-accredited organizations.

Results

Between 1998 and 2017, medical schools represented 18%–19% of all ACCME-accredited organizations. CME activities, hours of instruction, learner participants, and income increased gradually until reaching the highest levels between 2008 and 2011 before remaining constant. In 2017, each school generated a median of 132 activities (interquartile range [IQR]: 66–266), of which 44% were courses and 31% were regularly scheduled series (RSS), and a median of 29,824 learner interactions (IQR: 8,464–46,255). Total income rose gradually until 2010 before declining. In 2017, each school reported a median annual income of $1.0 million (IQR: $0.2 million – $2.9 million) from CME activities, comprising 44% from registration fees, 39% from commercial support, and 14% from advertising and exhibits. Compared with other accredited organization types, medical schools generally developed more RSS activities and proportionally fewer interprofessional and online activities.

Conclusions

While medical schools represent less than 20% of all ACCME-accredited organizations, their role is pivotal and their influence far-reaching. For medical schools to fulfill their responsibility as education leaders, they need to prioritize support for CME offices and faculty development and implement new approaches to teaching and learning.
Perceptions of Ethical Decision-Making Climate Among Clinicians Working in European and U.S. ICUs: Differences Between Nurses and Physicians*
Authors: Jensen Hanne Irene , Hebsgaard Stine , Hansen Tina Charlotte Bitsch , Johnsen Rikke Frank Aagaard , Hartog Christiane S. , Soultati Ioanna , Szucs Orsolya , Wilson Michael E. , van den Bulcke Bo , Benoit Dominique D. , Piers Ruth
Published: October 2019

Objectives:

To examine perceptions of nurses and physicians in regard to ethical decision-making climate in the ICU and to test the hypothesis that the worse the ethical decision-making climate, the greater the discordance between nurses’ and physicians’ rating of ethical decision-making climate with physicians hypothesized to rate the climate better than the nurses.

Design:

Prospective observational study.

Setting:

A total of 68 adult ICUs in 13 European countries and the United States.

Subjects:

ICU physicians and nurses.

Interventions:

None.

Measurements and Main Results:

Perceptions of ethical decision-making climate among clinicians were measured in April-May 2014, using a 35-items self-assessment questionnaire that evaluated seven factors (empowering leadership by physicians, interdisciplinary reflection, not avoiding end-of-life decisions, mutual respect within the interdisciplinary team, involvement of nurses in end-of-life care and decision-making, active decision-making by physicians, and ethical awareness). A total of 2,275 nurses and 717 physicians participated (response rate of 63%). Using cluster analysis, ICUs were categorized according to four ethical decision-making climates: good, average with nurses’ involvement at end-of-life, average without nurses’ involvement at end-of-life, and poor. Overall, physicians rated ethical decision-making climate more positively than nurses (p < 0.001 for all seven factors). Physicians had more positive perceptions of ethical decision-making climate than nurses in all 13 participating countries and in each individual participating ICU. Compared to ICUs with good or average ethical decision-making climates, ICUs with poor ethical decision-making climates had the greatest discordance between physicians and nurses. Although nurse/physician differences were found in all seven factors of ethical decision-making climate measurement, the factors with greatest discordance were regarding physician leadership, interdisciplinary reflection, and not avoiding end-of-life decisions.

Conclusions:

Physicians consistently perceived ICU ethical decision-making climate more positively than nurses. ICUs with poor ethical decision-making climates had the largest discrepancies.