bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Stochasticity in the Origin of Epigenetic Variation in Animal Populations
Authors: Biwer C , Kawam B , Chapelle V , Silvestre F
Published: May 2020

Synopsis

Epigenetic mechanisms such as DNA methylation modulate gene expression in a complex fashion are consequently recognized as among the most important contributors to phenotypic variation in natural populations of plants, animals, and microorganisms. Interactions between genetics and epigenetics are multifaceted and epigenetic variation stands at the crossroad between genetic and environmental variance, which make these mechanisms prominent in the processes of adaptive evolution. DNA methylation patterns depend on the genotype and can be reshaped by environmental conditions, while transgenerational epigenetic inheritance has been reported in various species. On the other hand, DNA methylation can influence the genetic mutation rate and directly affect the evolutionary potential of a population. The origin of epigenetic variance can be attributed to genetic, environmental, or stochastic factors. Generally less investigated than the first two components, variation lacking any predictable order is nevertheless present in natural populations and stochastic epigenetic variation, also referred to spontaneous epimutations, can sustain phenotypic diversity. Here, potential sources of such stochastic epigenetic variability in animals are explored, with a focus on DNA methylation. To this day, quantifying the importance of stochasticity in epigenetic variability remains a challenge. However, comparisons between the mutation and the epimutation rates showed a high level of the latter, suggesting a significant role of spontaneous epimutations in adaptation. The implications of stochastic epigenetic variability are multifold: by affecting development and subsequently phenotype, random changes in epigenetic marks may provide additional phenotypic diversity, which can help natural populations when facing fluctuating environments. In isogenic lineages and asexually reproducing organisms, poor or absent genetic diversity can hence be tolerated. Further implication of stochastic epigenetic variability in adaptation is found in bottlenecked invasive species populations and populations using a bet-hedging strategy.
Getting Humans Off Monkeys’ Backs: Using Primate Acclimation as a Guide for Habitat Management Efforts
Authors: Thompson Cynthia L , Williams Susan H , Glander Kenneth E , Teaford Mark F , Vinyard Christopher J
Published: May 2020

Synopsis

Wild primates face grave conservation challenges, with habitat loss and climate change projected to cause mass extinctions in the coming decades. As large-bodied Neotropical primates, mantled howling monkeys (Alouatta palliata) are predicted to fare poorly under climate change, yet are also known for their resilience in a variety of environments, including highly disturbed habitats. We utilized ecophysiology research on this species to determine the morphological, physiological, and behavioral mechanisms howlers employ to overcome ecological challenges. Our data show that howlers at La Pacifica, Costa Rica are capable of modifying body size. Howlers displayed reduced mass in warmer, drier habitats, seasonal weight changes, frequent within-lifetime weight fluctuations, and gradual increases in body mass over the past four decades. These within-lifetime changes indicate a capacity to modify morphology in a way that can impact animals’ energetics and thermodynamics. Howlers are also able to consume foods with a wide variety of food material properties by altering oral processing during feeding. While this capability suggests some capacity to cope with the phenological shifts expected from climate change and increased habitat fragmentation, data on rates of dental microwear warn that these acclimations may also cost dental longevity. Lastly, we found that howlers are able to acclimate to changing thermal pressures. On shorter-term daily scales, howlers use behavioral mechanisms to thermoregulate, including timing activities to avoid heat stress and utilizing cool microhabitats. At the seasonal scale, animals employ hormonal pathways to influence heat production. These lines of evidence cumulatively indicate that howlers possess morphological, physiological, and behavioral mechanisms to acclimate to environmental challenges. As such, howlers’ plasticity may facilitate their resilience to climate change and habitat loss. While habitat loss in the tropics is unlikely to abate, our results point to a potential benefit of active management and selective cultivation to yield large, interconnected forest fragments with targeted phenology that provides both a complex physical structure and a diversity of food sources. These steps could assist howlers in using their natural acclimation potential to survive future conservation threats.
Genetic evidence that higher central adiposity causes gastro-oesophageal reflux disease: a Mendelian randomization study
Authors: Green Harry D , Beaumont Robin N , Wood Andrew R , Hamilton Benjamin , Jones Samuel E , Goodhand James R , Kennedy Nicholas A , Ahmad Tariq , Yaghootkar Hanieh , Weedon Michael N , Frayling Timothy M , Tyrrell Jessica
Published: May 2020

Background

Gastro-oesophageal reflux disease (GORD) is associated with multiple risk factors but determining causality is difficult. We used a genetic approach [Mendelian randomization (MR)] to identify potential causal modifiable risk factors for GORD.

Methods

We used data from 451 097 European participants in the UK Biobank and defined GORD using hospital-defined ICD10 and OPCS4 codes and self-report data (N = 41 024 GORD cases). We tested observational and MR-based associations between GORD and four adiposity measures [body mass index (BMI), waist–hip ratio (WHR), a metabolically favourable higher body-fat percentage and waist circumference], smoking status, smoking frequency and caffeine consumption.

Results

Observationally, all adiposity measures were associated with higher odds of GORD. Ever and current smoking were associated with higher odds of GORD. Coffee consumption was associated with lower odds of GORD but, among coffee drinkers, more caffeinated-coffee consumption was associated with higher odds of GORD. Using MR, we provide strong evidence that higher WHR and higher WHR adjusted for BMI lead to GORD. There was weak evidence that higher BMI, body-fat percentage, coffee drinking or smoking caused GORD, but only the observational effects for BMI and body-fat percentage could be excluded. This MR estimated effect for WHR equates to a 1.23-fold higher odds of GORD per 5-cm increase in waist circumference.

Conclusions

These results provide strong evidence that a higher waist–hip ratio leads to GORD. Our study suggests that central fat distribution is crucial in causing GORD rather than overall weight.
Detection of heterogeneous vancomycin intermediate resistance in MRSA isolates from Latin America
Authors: Castro Betsy E , Berrio Maritza , Vargas Monica L , Carvajal Lina P , Millan Lina V , Rios Rafael , Hernandez Angie K , Rincon Sandra , Cubides Paola , Forero Erika , Dinh An , Seas Carlos , Munita Jose M , Arias Cesar A , Reyes Jinnethe , Diaz Lorena
Published: May 2020

Background

Vancomycin is a common first-line option for MRSA infections. The heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) phenotype is associated with therapeutic failure. However, hVISA isolates are usually reported as vancomycin susceptible by routine susceptibility testing procedures.

Objectives

To detect and characterize the hVISA phenotype in MRSA isolates causing infections in nine Latin American countries.

Methods

We evaluated a total of 1189 vancomycin-susceptible MRSA isolates recovered during 2006–08 and 2011–14. After an initial screening of hVISA using glycopeptide-supplemented agar strategies, the detection of hVISA was performed by Etest (GRD) and Macro-method (MET). Isolates deemed to be hVISA were subjected to population analysis profile/AUC (PAP/AUC) and WGS for further characterization. Finally, we interrogated alterations in predicted proteins associated with the development of the VISA phenotype in both hVISA and vancomycin-susceptible S. aureus (VSSA) genomes.

Results

A total of 39 MRSA isolates (3.3%) were classified as hVISA (1.4% and 5.6% in MRSA recovered from 2006–08 and 2011–14, respectively). Most of the hVISA strains (95%) belonged to clonal complex (CC) 5. Only 6/39 hVISA isolates were categorized as hVISA by PAP/AUC, with 6 other isolates close (0.87–0.89) to the cut-off (0.9). The majority of the 39 hVISA isolates exhibited the Leu-14→Ile (90%) and VraT Glu-156→Gly (90%) amino acid substitutions in WalK. Additionally, we identified 10 substitutions present only in hVISA isolates, involving WalK, VraS, RpoB and RpoC proteins.

Conclusions

The hVISA phenotype exhibits low frequency in Latin America. Amino acid substitutions in proteins involved in cell envelope homeostasis and RNA synthesis were commonly identified. Our results suggest that Etest-based methods are an important alternative for the detection of hVISA clinical isolates.
Vaginal bacterial community composition and concentrations of estradiol at the time of artificial insemination in Brangus heifers
Authors: Messman Riley D , Contreras-Correa Zully E , Paz Henry A , Perry George , Lemley Caleb O
Published: May 2020

The knowledge surrounding the bovine vaginal microbiota and its implications on fertility and reproductive traits remains incomplete. The objective of the current study was to characterize the bovine vaginal bacterial community and estradiol concentrations at the time of artificial insemination (AI). Brangus heifers (n = 78) underwent a 7-d Co-Synch + controlled internal drug release estrus synchronization protocol. At AI, a double-guarded uterine culture swab was used to sample the anterior vaginal tract. Immediately after swabbing the vaginal tract, blood samples were collected by coccygeal venipuncture to determine concentrations of estradiol. Heifers were retrospectively classified as pregnant (n = 29) vs. nonpregnant (n = 49) between 41 and 57 d post-AI. Additionally, heifers were classified into low (1.1 to 2.5 pg/mL; n = 21), medium (2.6 to 6.7 pg/mL; n = 30), and high (7.2 to 17.6 pg/mL; n = 27) concentration of estradiol. The vaginal bacterial community composition was determined through sequencing of the V4 region from the 16S rRNA gene using the Illumina Miseq platform. Alpha diversity was compared via ANOVA and beta diversity was compared via PERMANOVA. There were no differences in the Shannon diversity index (alpha diversity; P = 0.336) or Bray–Curtis dissimilarity (beta diversity; P = 0.744) of pregnant vs. nonpregnant heifers. Overall, bacterial community composition in heifers with high, medium, or low concentrations of estradiol did not differ (P = 0.512). While no overall compositional differences were observed, species-level differences were present within pregnancy status and estradiol concentration groups. The implications of these species-level differences are unknown, but these differences could alter the vaginal environment thereby influencing fertility and vaginal health. Therefore, species-level changes could provide better insight rather than overall microbial composition in relation to an animal’s reproductive health.
A Case Report of Heterotopic Ossification Caused by High-Voltage Electric Injury
Authors: Liu Shengli , Zheng Jiansheng , Zheng Qingyi
Published: May 2020

This case report described the diagnosis and treatment of a patient with ectopic bone injury due to high-pressure electric shock. A 24-year-old male patient suffered from burns that covered 50% of TBSA, including on limbs and torso, after coming into contact with 10-kV high-voltage electricity. A repeated Meek micrografting technique (MEEK) was applied for wound healing; skin grafts were cut into micrografts and expanded at a ratio of 1:4 to cover large areas after burn trauma. After the injury, right elbow redness, fever, pains, and joint movement disorder were reported by the patient, which might be attributed to excessive exercises and acute scarring. However, these symptoms were not treated immediately. Six months after the injury, his right elbow joint showed 90° locking and a restricted 5° movement capacity. X-ray examination revealed a new bone formation at the inner tibia shin. In addition, 3D CT showed the formation of right tibia, the ruler bone, and the skull of the humming bridge. Under general anesthesia, the right elbow joint was released, the medial collateral ligament was repaired, and the hinge external fixator was fixed. A large number of hyperplastic bone masses were found at the right elbow joint during surgery, specifically in the foot bone hawk’s beak nest. No complications after surgery were observed. X-ray examination in February showed disappearance of the bone bridge and normal relationship of the right elbow joint. This case study revealed that electric shock injury could lead to ectopic bone formation, and much attention should be paid on any changes that indicate aseptic inflammation, such as redness, swelling, fever, and pain during the treatment process. Finally, identification of the scar constriction phase could indicate surgical treatment in order to promote the limb rehabilitation process.
A general-purpose time-step criterion for simulations with gravity
Authors: Grudić Michael Y , Hopkins Philip F
Published: May 2020

We describe a new adaptive time-step criterion for integrating gravitational motion, which uses the tidal tensor to estimate the local dynamical time-scale and scales the time-step proportionally. This provides a better candidate for a truly general-purpose gravitational time-step criterion than the usual prescription derived from the gravitational acceleration, which does not respect the equivalence principle, breaks down when $\boldsymbol {a}=0$, and does not obey the same dimensional scaling as the true time-scale of orbital motion. We implement the tidal time-step criterion in the simulation code gizmo, and examine controlled tests of collisionless galaxy and star cluster models, as well as galaxy merger simulations. The tidal criterion estimates the dynamical time faithfully, and generally provides a more efficient time-stepping scheme compared to an acceleration criterion. Specifically, the tidal criterion achieves order-of-magnitude smaller energy errors for the same number of force evaluations in potentials with inner profiles shallower than ρ ∝ r−1 (i.e. where $\boldsymbol {a}\rightarrow 0$), such as star clusters and cored galaxies. For a given problem these advantages must be weighed against the additional overhead of computing the tidal tensor on-the-fly, but in many cases this overhead is small.
Searching for thermal inversion agents in the transmission spectrum of KELT-20b/MASCARA-2b: detection of neutral iron and ionised calcium H&K lines
Authors: Nugroho Stevanus K , Gibson Neale P , de Mooij Ernst J W , Watson Chris A , Kawahara Hajime , Merritt Stephanie
Published: May 2020

We analyse the transmission spectra of KELT-20b/MASCARA-2b to search for possible thermal inversion agents. The data consist of three transits obtained using HARPSN and one using CARMENES. We removed stellar and telluric lines before cross-correlating the residuals with spectroscopic templates produced using a 1D plane-parallel model, assuming an isothermal atmosphere and chemical equilibrium at solar metallicity. Using a likelihood-mapping method, we detect Fe i at > 13σ, Ca ii H$\&$K at > 6σ and confirm the previous detections of Fe ii, Ca ii IR Triplet, and Na i D. The detected signal of Fe i is shifted by −3.4 ± 0.4 km s−1 from the planetary rest frame, which indicates a strong day–night wind. Our likelihood-mapping technique also reveals that the absorption features of the detected species extend to different altitudes in the planet’s atmosphere. Assuming that the line lists are accurate, we do not detect other potential thermal inversion agents (NaH, MgH, AlO, SH, CaO, VO, FeH, and TiO) suggesting that non-chemical equilibrium mechanisms (e.g. a cold-trap) might have removed Ti- and V-bearing species from the upper atmosphere. Our results, therefore, show that KELT-20b/MASCARA-2b cannot possess an inversion layer caused by a TiO/VO-related mechanism. The presence of an inversion layer would therefore likely be caused by metal atoms such as Fe i and Fe ii. Finally, we report a double-peak structure in the Fe i signal in all of our data sets that could be a signature of atmospheric dynamics. However, further investigation is needed to robustly determine the origin of the signal.
Optical properties and dust temperatures in clumpy diffuse medium
Authors: Ostrovskii Andrei B , Parfenov S Yu , Vasyunin A I , Ivlev A V , Sokolova V A
Published: May 2020

In this study, we explore the impact of inhomogeneities in the spatial distribution of interstellar dust on spatial scales of ≤1 au caused by ion shadowing forces on the optical properties of diffuse interstellar medium (ISM) as well as on the dust temperature. We show that recently proposed possibility that interstellar dust grains in the diffuse ISM are grouped in spherical cloudlets (clumps) may significantly affect the observed optical properties of the diffuse ISM in comparison to that calculated under the commonly accepted assumption on the uniform dust/gas mixture if the size of clumps ≳0.1 au. We found that opacity of an arbitrary region of diffuse ISM quickly decreases with growth of dusty clumps. We also studied the dependence of opacity and dust temperature inside the dusty clumps on their size. We show that the clumps larger than 0.1 au are opaque for far-ultraviolet radiation. Dust temperature exhibits a gradient inside a clump, decreasing from the edge to the centre by several degrees for a clump of a size of 0.1 au and larger. We argue that dust temperatures and high opacity within clumps larger than 0.1 au may facilitate somewhat more efficient synthesis of molecules on surfaces of interstellar grains in the diffuse ISM than it was anticipated previously. On the other hand, the presence of clumps with sizes below 0.1 au makes small or negligible influence on the optical properties of the diffuse ISM in comparison to the case with uniform dust/gas mixture.
A molecular absorption line survey towards the AGN of Hydra-A
Authors: Rose Tom , Edge A C , Combes F , Hamer S , McNamara B R , Russell H , Gaspari M , Salomé P , Sarazin C , Tremblay G R , Baum S A , Bremer M N , Donahue M , Fabian A C , Ferland G , Nesvadba N , O’Dea C , Oonk J B R , Peck A B
Published: May 2020

We present Atacama Large Millimetre/submillimetre Array observations of the brightest cluster galaxy Hydra-A, a nearby (z = 0.054) giant elliptical galaxy with powerful and extended radio jets. The observations reveal CO(1−0), CO(2–1), 13CO(2–1), CN(2–1), SiO(5–4), HCO+(1–0), HCO+(2–1), HCN(1–0), HCN(2–1), HNC(1–0), and H2CO(3–2) absorption lines against the galaxy’s bright and compact active galactic nucleus. These absorption features are due to at least 12 individual molecular clouds that lie close to the centre of the galaxy and have velocities of approximately −50 to +10 km s−1 relative to its recession velocity, where positive values correspond to inward motion. The absorption profiles are evidence of a clumpy interstellar medium within brightest cluster galaxies composed of clouds with similar column densities, velocity dispersions, and excitation temperatures to those found at radii of several kpc in the Milky Way. We also show potential variation in a ∼10 km s−1 wide section of the absorption profile over a 2 yr time-scale, most likely caused by relativistic motions in the hot spots of the continuum source that change the background illumination of the absorbing clouds.
Impact of UK Tobacco Control Policies on Inequalities in Youth Smoking Uptake: A Natural Experiment Study
Authors: Anyanwu Philip Emeka , Craig Peter , Katikireddi Srinivasa Vittal , Green Michael James
Published: May 2020

Introduction

UK countries implemented smoke-free public places legislation and increased the legal age for tobacco purchase from 16 to 18 years between 2006 and 2008. We evaluated the immediate and long-term impacts of these UK policy changes on youth smoking uptake and inequalities therein.

Aims and Methods

We studied 74 960 person-years of longitudinal data from 14 992 youths (aged 11–15 years) in annual UK household surveys between 1994 and 2016. Discrete-time event history analyses examined whether changes in rates of youth smoking transitions (initiation, experimentation, and escalation to daily smoking or quitting) or their inequalities (by parental education) were associated with policy implementation. Parallel analyses examined smoke-free legislation and the change in legal age. We interpret the results as a combined effect of the two pieces of legislation as their implementation dates were too close to identify separate effects. Models were adjusted for sex, age, UK country, historical year, tobacco taxation, and e-cigarette prevalence, with multiple imputation for missing data.

Results

For both policies, smoking initiation reduced following implementation (change in legal age odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.55 to 0.81; smoke-free legislation OR: 0.68; 95% CI: 0.56 to 0.82), while inequalities in initiation narrowed over subsequent years. The legal age change was associated with annual increases in progression from initiation to occasional smoking (OR: 1.26; 95% CI: 1.07 to 1.50) and a reduction in quitting following implementation (OR: 0.57; 95% CI: 0.35 to 0.94). Similar effects were observed for smoke-free legislation but CIs overlapped the null.

Conclusions

Policies such as these may be highly effective in preventing and reducing socioeconomic inequalities in youth smoking initiation.

Implications

UK implementation of smoke-free legislation and an increase in the legal age for tobacco purchase from 16 to 18 years were associated with an immediate reduction in smoking initiation and a narrowing of inequalities in initiation over subsequent years. While the policies were associated with reductions in the initiation, progression to occasional smoking increased and quitting decreased following the legislation.
Retention in Care and Viral Load Improvement After Discharge Among Hospitalized Out-of-Care People With HIV Infection: A Post Hoc Analysis of a Randomized Controlled Trial
Authors: English Kellee , May Sarah B , Davila Jessica A , Cully Jeffrey A , Dindo Lilian , Amico K Rivet , Kallen Michael A , Giordano Thomas P
Published: May 2020

Background

Understanding factors influencing retention in care (RIC) and viral load improvement (VLI) in people with HIV (PWH) who are out of care and hospitalized will assist in intervention development for this vulnerable population.

Methods

The study was a post hoc analysis of prospectively collected data. Hospitalized participants were enrolled if they were newly diagnosed with HIV during the hospitalization or out of HIV care. Participants completed surveys at baseline and 6 months postenrollment and laboratory studies of viral load (VL). Outcomes were RIC (2 completed visits, 1 within 30 days of discharge) and VLI (VL <400 or at least a 1-log10 decrease) 6 months after discharge. Univariate and multivariate regression analyses were conducted examining the contributions of predisposing, enabling, and need factors to outcomes.

Results

The study cohort included 417 participants enrolled between 2010 and 2013. The population was 73% male, 67% non-Hispanic black, 19% Hispanic, and 70% uninsured. Sixty-five percent had a baseline CD4 <200 cells/mm3, 79% had a VL >400 copies/mL or missing, and the population was generally poor with low educational attainment. After discharge from the hospital, 60% did not meet the definition for RIC, and 49% did not have VLI. Modifiable factors associated with the outcomes include drug use (including marijuana alone and other drugs), life instability (eg, housing, employment, and life chaos), and using avoidance coping strategies in coping with HIV.

Conclusions

Hospitalized out-of-care PWH in the United States are at high risk of poor re-engagement in care after discharge. Interventions for this population should focus on improving socioeconomic stability and coping with HIV and reducing drug use.
Assessing Molecular Point-of-Care Testing and Dried Blood Spot for Hepatitis C Virus Screening in People Who Inject Drugs
Authors: Chevaliez Stéphane , Wlassow Mélanie , Volant Johann , Roudot-Thoraval Françoise , Bachelard Antoine , Poiteau Lila , Trabut Jean-Baptiste , Hézode Christophe , Bourdel Anne , Dominguez Stéphanie
Published: May 2020

Background

Injecting drug use is a major driver of hepatitis C virus (HCV) spread worldwide, and the World Health Organization (WHO) has identified people who inject drugs (PWID) as a key population to target for HCV screening and care. Point-of-care (POC) hepatitis C tests and dried blood spot (DBS) sampling offer benefits for the management of patients with HCV infection by increasing HCV testing and linkage to care in different nonclinical settings. The aims of this prospective study were to evaluate the feasibility and the acceptability of use HCV ribonucleic acid (RNA) POC and fingerstick DBS testing in social-medical risk-reduction centers and to describe the cascade of care among PWID in France.

Methods

Between June 2018 and February 2019, 89 consecutive HCV-seropositive PWID attending 2 drug treatment services and 1 supervised consumption room in inner Paris were invited to participate in further evaluation, undergoing a clinical review with a liver assessment and blood tests including fingerstick capillary whole blood POC HCV RNA testing and fingerstick DBS sampling.

Results

Of the 89 participants enrolled, HCV RNA was detected in 34 (38.6%) participants. Fingerstick whole blood POC RNA testing and HCV RNA detection from DBS sample were feasible and acceptable among PWID with no major difference in terms of HCV RNA detection rate. Overall, 16 participants received pan-genotypic antiviral treatment. The proportion of PWID with sustained virologic response at 12 weeks was 81.2%, with data for 3 patients still pending.

Conclusions

One-step screening strategy based on the detection of HCV RNA would engage people in care for treatment scale-up and HCV elimination.
What are the social and scientific benefits of participating at academic conferences? Insights from a survey among doctoral students and postdocs in Germany
Authors: Hauss Kalle
Published: May 2020

Academic conferences are global phenomena. As the coronavirus pandemic continues, many conferences now are being postponed or canceled. Usually, they bring together a complex network of academic and nonacademic professionals to discuss and disseminate new knowledge. The practice of ‘conferencing’ also includes activities that go far beyond the exchange of information. Conferences constitute social spaces where researchers encounter other researchers, establish new contacts, maintain old contacts, hold exploratory talks, and initiate collaborations. Academic conferences therefore can yield a plenitude of scientific and societal impacts. In the past, much progress has been made in measuring the impact of financial investments in science. There is, however, no shared understanding of how to measure the impact of academic conferences. Against the background of the time and money that is spent on both visiting and organizing conferences, it is important to understand the ways in which conferences generate impact. The coronavirus pandemic also shows that it is important to implement digital technologies like tools for virtual conferencing. This article uses qualitative and quantitative data to examine the conference activities of young scholars from German universities and to study how they profit from attending conferences. It is shown that conferences play a significant role in the qualification process. However, in terms of information and networking benefits, postdocs compared with doctoral students seem to profit more.
A Comorbidity-based Screening Tool to Predict Severe Maternal Morbidity at the Time of Delivery
Authors: Easter S.R. , Bateman B.T. , Sweeney V.H. , Manganaro K. , Lassey S.C. , Gagne J.J. , Robinson J.N.
Published: May 2020

(Am J Obstet Gynecol. 2019;221:271.e1–271.e10)

An important strategy for improving maternal health is development of a tool that reliably identifies women at risk of severe maternal morbidity (SMM) and death. The obstetric comorbidity index (OB-CMI) summarizes the burden of maternal comorbidities and allows for the generation of a single numeric score to quantify risk assessment. While the OB-CMI was originally designed to address bias in research studies, the authors hypothesized it could be adapted for clinical use. The score is calculated from a 20-item list of comorbidities (eg, preeclampsia, multiple gestation, asthma, advanced maternal age). The comorbidities are weighted (eg, preeclampsia with severe features is 5 points, diabetes on insulin is 1 point). The points are summed for a total score. The aim of this study was to prospectively evaluate the performance of this comorbidity index as a screening tool to accurately identify laboring women at risk of SMM.
Oral Versus Intravenous Iron Therapy for Postpartum Anemia: A Systematic Review and Meta-analysis
Authors: Sultan P. , Bampoe S. , Shah R. , Guo N. , Estes J. , Stave C. , Goodnough L. , Halpern S. , Butwick A.
Published: May 2020

(Am J Obstet Gynecol. 2019;19.e2–29.e2)

Postpartum anemia is associated with fatigue, depression, and impaired cognition. Postpartum anemia affects up to 50% of women in well-resourced countries and up to 80% of women in developing countries, which can affect maternal-child bonding. However, adverse gastrointestinal reactions to oral iron treatments (ie, nausea, vomiting, and constipation) occur in up to 40% of patients, resulting in poor compliance and persistent anemia. Intravenous (IV) iron may be ideal for these patients, as it mitigates the absorption challenges and produces a more rapid increase in hemoglobin (Hb) concentration and iron stores. The disadvantages of IV iron include increased cost and the need for treatment at a hospital or outpatient facility. This study was an updated systematic review of all randomized trials comparing oral versus IV iron therapy to treat postpartum anemia. The primary outcome measure was postpartum Hb.
Managing acute cancer pain
Authors: Sears Robyn
Published: May 2020

Cancer-related pain is an ongoing concern for patients and families. Clinicians should include pain management or palliative care specialists who have advanced knowledge in pharmacotherapy and who have the ability to perform interventional procedures to help alleviate patients' pain and reduce opioid use. This article discusses available interventions for patients with cancer pain.
Can Headache Profile Predict Future Disability
Authors: Houle Mariève , Marchand Andrée-Anne , Descarreaux Martin
Published: May 2020

Objective:

The aim of this study was to determine if headache profile can predict future disability in patients with tension-type headache (TTH).

Materials and Methods:

Eighty-three individuals with TTH were recruited. To be included in the study participants needed to fulfill the International Headache Society classification’s criteria for episodic or chronic TTH form and to be at least 18 years old. Baseline clinical outcomes (headache and neck-related disability, kinesiophobia, self-efficacy, and anxiety) and physical outcomes (neck extensors muscles maximum voluntary contraction) were collected for all participants. A prospective data collection of headache characteristics (intensity and frequency) was conducted using daily SMS or e-mail over a 1-month period. Headache-related disability was assessed at the 3-month follow-up and was used as the disability criterion for TTH.

Results:

Correlations showed that the number of years with headache (r=0.53, P<0.001), self-reported neck pain intensity (r=0.29, P=0.025), headache frequency (r=0.60, P<0.001) and intensity (r=0.54, P<0.001), anxiety (r=0.28; P=0.031), as well as neck-related disability (r=0.64, P<0.001) were correlated to headache-related disability assessed at 3 months. Multiple regression showed that these determinants can be used to predict headache disability (R
2=0.583). Headache frequency (β=0.284) was the best individual predictor.

Discussion:

Results showed that TTH frequency and intensity and the presence of concomitant infrequent migraine are predictors of future disability over a 3-month period. Further studies are needed to evaluate the contribution of other potential physical outcomes on headache-related disability.
Foot orthoses use for pediatric flexible flatfoot: comparative evaluation of quality of life for children and parents
Authors: Camurcu Yalkin , Ucpunar Hanifi , Karakose Resit , Ozcan Seckin , Sahin Vedat
Published: May 2020

This study aimed to comparatively evaluate the quality of life scores of patients with pediatric flexible flatfoot (PFF) according to the use of foot orthoses. We also aimed to compare quality of life scores of children and their parents. Nonobese children aged between 5 and 10 years old who were diagnosed as PFF according to physical and radiological examinations were included in this cross-sectional comparative study. All children and their parents completed the Turkish translation of Oxford ankle foot questionnaire (OxAFQ) which contains four domains (physical, school and play, emotional, and footwear). Patients were grouped according to the use of foot orthoses (group I: no foot orthoses group and group II: foot orthoses group). Comparison of OxAFQ scores demonstrated no significant differences between the two groups. However, the mean emotional scores of parents were significantly lower in group II (P = 0.007). In group I, the mean emotional score of children was significantly lower compared to their parents’ scores (P = 0.001). In group II, the mean physical score of children was significantly lower compared to their parents’ scores (P = 0.003). According to our results, we observed no significant difference in terms of quality of life scores between children using foot orthoses and not using foot orthoses. However, we observed significantly lower emotional scores in parents whose children were using foot orthoses. We recommend that physicians should be aware of low physical scores in children with PFF and should inform parents about this situation rather than considering foot orthoses to relieve parents’ concern about foot deformity.
Relapsing Bickerstaff Brainstem Encephalitis After Autologous Stem Cell Transplant
Authors: Malhotra Ashwin , Latov Norman
Published: May 2020

Bickerstaff brainstem encephalitis, widely considered to be associated with Miller Fisher and Guillain–Barré syndromes, is a rare disease state defined by the triad of ophthalmoplegia, ataxia, and decreased consciousness. The presence of central nervous system involvement, commonly in the form of impaired arousal, solidifies it as a unique entity. We present a case of this rare syndrome after autologous stem cell transplant.
BAG3 Myopathy Presenting With Prominent Neuropathic Phenotype and No Cardiac or Respiratory Involvement: A Case Report and Literature Review
Authors: Malatesta Lindsay , Arya Kapil , Gokden Murat , Stefans Vikki , Veerapandiyan Aravindhan
Published: May 2020

Bcl-2–associated athanogene 3 (BAG3) myopathy is a rare myofibrillar myopathy characterized by toe walking and clumsiness in the first decade with rapid progression to cardiomyopathy and restrictive lung disease in the second decade. Most patients (18 patients) have the c.626C >T (p.Pro209Leu) mutation. We describe BAG3 myopathy due to p.Pro209Leu in a 13-year-old girl with initial prominent neuropathic phenotype and no cardiac or respiratory involvement. Parents reported toe walking and clumsiness since 3 years old. Examination at the age of 13 years showed findings suggestive of Charcot–Marie–Tooth disease. Nerve conduction studies revealed demyelinating polyneuropathy. Next-generation sequencing panel for inherited neuropathies was unrevealing. Whole exome sequencing identified a de novo mutation in BAG3. Muscle biopsy confirmed myofibrillar myopathy. No cardiac involvement or symptoms of respiratory involvement at the age of 14 years. This case emphasizes the phenotypic variability of BAG3 myopathy and the importance of thorough electrophysiological examination and muscle pathology for establishing a precise diagnosis.
ACR–ASTRO Practice Parameter for Image-guided Radiation Therapy (IGRT)
Authors: Luh Join Y. , Albuquerque Kevin V. , Cheng Cheewai , Ermoian Ralph P. , Nabavizadeh Nima , Parsai Homayon , Roeske John C. , Weiss Stephanie E. , Wynn Raymond B. , Yu Yan , Rosenthal Seth A. , Hartford Alan
Published: May 2020

Aim/Objectives/Background:

The American College of Radiology (ACR) and the American Society for Radiation Oncology (ASTRO) have jointly developed the following practice parameter for image-guided radiation therapy (IGRT). IGRT is radiation therapy that employs imaging to maximize accuracy and precision throughout the entire process of treatment delivery with the goal of optimizing accuracy and reliability of radiation therapy to the target, while minimizing dose to normal tissues.

Methods:

The ACR–ASTRO Practice Parameter for IGRT was revised according to the process described on the ACR website (“The Process for Developing ACR Practice Parameters and Technical Standards,” www.acr.org/ClinicalResources/Practice-Parametersand-Technical-Standards) by the Committee on Practice Parameters of the ACR Commission on Radiation Oncology in collaboration with the ASTRO. Both societies then reviewed and approved the document.

Results:

This practice parameter is developed to serve as a tool in the appropriate application of IGRT in the care of patients with conditions where radiation therapy is indicated. It addresses clinical implementation of IGRT including personnel qualifications, quality assurance standards, indications, and suggested documentation.

Conclusions:

This practice parameter is a tool to guide clinical use of IGRT and does not make recommendations on site-specific IGRT directives. It focuses on the best practices and principles to consider when using IGRT effectively, especially with the significant increase in imaging data that is now available with IGRT. The clinical benefit and medical necessity of the imaging modality and frequency of IGRT should be assessed for each patient.
Dislocation rates of perineural catheters placed either perpendicular or parallel to the femoral nerve
Authors: Kalimeris Konstantinos , Rupnik Barbara , Allenspach Kathrin , Fucentese Sandro F. , Götschi Tobias , Aguirre José , Eichenberger Urs
Published: May 2020

BACKGROUND

Ultrasound has increased the efficacy of femoral nerve catheters but their postoperative dislocation still remains a common problem. Although catheter placement parallel to the nerve seems to reduce dislocation rates in other nerves and plexuses, the possible advantage for femoral nerve catheter placement remains unclear.

OBJECTIVE

To compare the dislocation rates of femoral catheters when placed perpendicular or parallel to the femoral nerve.

DESIGN

Randomised controlled study.

SETTING

University orthopaedic hospital. Duration of study: October 2018 to June 2019.

PATIENTS

Eighty patients scheduled for major knee surgery with femoral catheter were enrolled and randomly allocated in two groups. Data from 78 patients could be analysed.

INTERVENTIONS

The femoral nerve catheters was placed perpendicular to the nerve in Group 1 (n=40), whereas in Group 2 (n=38) parallel to it. For Group 1 the short-axis view of the nerve and an in-plane puncture was used. For Group 2 we used the short-axis view of the nerve and an out-of-plane puncture technique combined with rotation of the transducer to the long-axis view with the needle in-plane.

MAIN OUTCOME MEASURES

Primary outcome was the catheter dislocation rate in the first 48 h. Secondary outcomes were pain scores and sensory blockade.

RESULTS

There was no statistically significant difference between the two techniques regarding dislocation of the catheters at 24 or 48 h (at 48 h, Group 1: 15%, Group 2: 2.6%, P = 0.109). Also pain scores, sensory blockade and rescue doses of ropivacaine did not differ between the groups. However, in Group 2 the technique took longer.

CONCLUSION

Rotating the ultrasound probe to the long-axis in-plane view enabled examination of the catheter position when it was placed parallel to the nerve. The parallel placement of the catheter required more time, but did not significantly improve dislocation rate, pain scores or sensory blockade.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT03693755.
Feasibility of Dried Blood Spots in Children with Behavioral Problems
Authors: Kloosterboer Sanne M. , van Eijk Estelle , van Dijk Monique , Dieleman Gwen C. , Hillegers Manon H. J. , van Gelder Teun , Koch Birgit C. , Dierckx Bram
Published: May 2020

Background:

Minimally invasive sampling methods are important to facilitate therapeutic drug monitoring and pharmacokinetic research in children with behavioral problems. This study assessed the feasibility and pain of dried blood spot (DBS) sampling in this population.

Methods:

Repeated DBS sampling was performed in children with autism spectrum disorder (ASD) and severe behavioral problems using antipsychotic drugs, aged between 6 and 18 years. The child, guardian, and DBS performer assessed pain using the numeric rating scale (NRS-11) or 5-face Faces Pain Scale. The influence of age, sex, and the fingerprick performer on the child's pain intensity was analyzed using linear mixed models.

Results:

Overall, 247 fingerpricks were performed in 70 children. Seven children refused all DBS sampling. The median (interquartile range) NRS-11 pain scores were 2 (3) rated by children, 3 (2.5) by guardians, and 2 (2) by fingerprick performers. The child's age and sex, and fingerprick performer had no significant influence on pain intensity.

Conclusions:

DBS sampling could be performed in most children with ASD and severe behavioral problems. However, 1 in 5 children refused one or more DBS fingerpricks owing to distress. Most expressed minimal pain (NRS < 4). Repeated sampling with DBS is feasible in children with ASD and severe behavioral problems.
Ultra HD Liposuction: Enhancing Abdominal Etching Using Ultrasound-Guided Rectus Abdominis Fat Transfer (UGRAFT)
Authors: Viaro Mauricio S. S. , Danilla Stefan , Cansanção Alvaro Luiz , Viaro Paloma Salomone
Published: May 2020

Background:

High-definition (HD) liposuction has allowed surgeons to sculpt the abdomen, enhancing abdominal etching. To create a more athletic abdomen, fat grafting has been used subcutaneously, and rectus abdominis fat grafting has been performed in patients undergoing lipoabdominoplasty. With the objective of increasing muscle volume to obtain a natural-looking abdomen in patients who are not suitable for abdominoplasty, we propose the use of ultrasound-guided rectus abdominis fat grafting (UGRAFT) in association with HD liposuction.

Patients:

A prospective study with 10 consecutive patients undergoing UGRAFT was conducted. After HD liposuction, UGRAFT was performed from an incision in the umbilical region, using a blunt 2.5-mm cannula assisted by ultrasound. Fat injection was done closer to the anterior rectus sheath in the lower and middle muscle bellies.

Results:

UGRAFT was performed in 10 patients. The mean age was 34.8 years (range, 24–51 years). The mean body mass index was 23.83 kg/m2 (range, 20.58–28.39 kg/m2). The mean volume of fat injected per “pack” was 34 cm3 (range, 20–40 cm3). UGRAFT added a mean time of 20 minutes (range, 15–30 minutes) to HD liposuction. Comparing the rectus abdominis muscle thickness pre-UGRAFT and post-UGRAFT, average muscle thickness increase was 5.1 mm (55.7% ± 37%), with P < 0.0001.

Conclusion:

UGRAFT showed to be helpful for obtaining muscle expansion and a more natural abdominal contour, avoiding that unnatural appearance that HD liposuction may provide in patients who gain weight or have skin laxity.
Transfeminine Gender Confirmation Surgery with Penile Inversion Vaginoplasty: An Initial Experience
Authors: Loree John T. , Burke Mark S. , Rippe Bridgett , Clarke Sarah , Moore Samuel H. , Loree Thom R.
Published: May 2020

Background:

To detail the early experience with and results of a transfeminine (TF) genital reconstruction at an established plastic surgery practice in Western New York.

Methods:

Between June 2016 and June 2019, 30 patients underwent penile inversion vaginoplasty for TF gender reassignment. All patients fulfilled World Professional Association for Transgender Health and NY State criteria for reassignment surgery. All surgeries were carried out at a large, government-owned tertiary care center.

Results:

There were 30 patients in this retrospective study, with a mean age of 37 years (SD 5.4) and a mean body mass index of 27.3 kg/m2 (SD 3.2 kg/m2). Nineteen patients never smoked, 4 were former smokers, and 7 were current smokers. Primary surgery was an orchiectomy and modified single-stage penile inversion vaginoplasty. Mean operative time was 6.0 hours. Mean initial hospital stay was 8.2 days. Three of the 30 (10%) patients required transfusion. There were 6 (20%) complications. Three complications (10%) required reoperation: 1 patient for wound dehiscence on postoperative day 7, 1 for rectal perforation identified on postoperative day 10, and 1 for urethrovaginal fistula. All complications were addressed without sequalae. Twenty of the 30 (66%) patients have undergone revision surgery. Indications for revision were prolapse correction/deepening, labiaplasty, clitoral hood construction/revision, meatal asymmetry, urinary fistula repair, and posterior vaginal flap revision. Twenty-one of 28 (75%) revisions were outpatient surgeries. There were no complications from these procedures. Overall satisfaction via survey was 92% (24 respondents).

Conclusions:

TF gender reassignment is a novel, challenging set of procedures for the specialty of plastic surgery. With appropriate consideration and technique, penile inversion vaginoplasty is a safe, effective means of achieving this goal.
Uterovaginal Anomalies: A Guide for the Generalist Obstetrician-Gynecologist
Authors: DEBIEC KATHERINE E. , AMIES OELSCHLAGER ANNE-MARIE E.
Published: May 2020

Congenital gynecologic anomalies result from interruption of embryologic development of the female reproductive tract. The anomalies may be hymenal, vaginal, cervical, or uterine. The impact of these anomalies is variable: some are asymptomatic, incidental findings that require no intervention, others require simple surgical management, while some complex anomalies may require a multidisciplinary approach with extensive surgical expertise for optimal outcomes. Uterovaginal anomalies may occur in isolation or in association with other malformations, such as renal anomalies. The origin, presentation, evaluation and treatment of these conditions are reviewed here.
Three Perspectives on a Successful Succession
Authors: Lancaster Tim , Hibbs Scott , Holland Brad
Published: May 2020

Leadership succession does not need to be extremely difficult. However, it does require time, a carefully planned process, well-defined roles, and the intent of all parties to achieve a successful transition—along with the trust to make these various aspects come together. In a CEO succession, the work does not begin at the time of an announced retirement or departure but rather well in advance. The outgoing CEO must want to make the upcoming transition as smooth as possible for everyone involved. The organization must already be committed to the ongoing education of its board, medical staff, and administrators so that all stakeholders are well prepared to execute the transition. Candidates for the CEO role in transition also must be confident in the knowledge of their own needs as well as the needs of the organization. When everyone’s best interests come together to create a good fit, the succession can be successful.

In this article, the leadership transition at one healthcare system is recounted from the perspectives of three principal players: the outgoing president and CEO, the chair of the board of trustees search committee, and the incoming president and CEO.