bluuebunny/crossref_metadata_2025 huggingface dataset:
An acoustic Lippmann-Schwinger inversion method: applications and comparison with the linear sampling method
Authors: Prunty Aaron C , Snieder Roel K
Published: December 2019

We introduce an imaging method based on solving the Lippmann-Schwinger equation of acoustic scattering theory. We compare and contrast the proposed Lippmann-Schwinger inversion with the well-established linear sampling method using numerical examples. We demonstrate that the two imaging methods are physically grounded in different but related wave propagation problems: Lippmann-Schwinger inversion seeks to reconstruct the space and time dependence of a scatterer based on the observed scattered field in a performed physical experiment, whereas the linear sampling method seeks to focus wave fields in a simulated virtual experiment by estimating the space and time dependence of an inverse source function that cancels the effects of the scatterer at a specified focusing point. In both cases, the medium in which the waves propagate is the same; however, neither method requires prior knowledge or assumptions on the physical properties of the unknown scatterer—only knowledge of the background medium is needed. We demonstrate that the linear sampling method is preferable to Lippmann-Schwinger inversion for target-oriented imaging applications, as Lippmann-Schwinger inversion gives nonphysical results when the chosen imaging domain does not contain the scatterer.
Environmental Issues and Social Work Education
Authors: Naranjo Nélida Ramírez
Published: December 2019

Environmental issues have been well-documented in recent years, paying particular attention to the anthropogenic climate change impact. To date, research addressing the relationship between environmental issues, environmental justice and sustainability within social work education has been scarce. The importance of these topics in education, especially in social work programmes must be well understood and research being generated on these subjects must increase. The primary goal of this article is to help increase the conversation and debates about environmental issues, environmental justice and sustainability within the social work academic community. Social work scholars must analyse and discuss opportunities and difficulties that are presented by the necessity to make the subjects mentioned, key concepts of the core curriculum and base for social work education. The secondary goal is to describe practical ways that environmental issues, environmental justice and sustainability content can be integrated into social work education to better equip professionals with the tools to assist in the continuously growing global environmental issues.
Cerambycid Communities and Their Associated Hymenopteran Parasitoids From Major Hardwood Trees in Delaware: Implications for Biocontrol of Invasive Longhorned Beetles
Authors: Golec Julian R , Aparicio Ellen , Wang Xingeng , Duan Jian J , Fuester Roger W , Tatman Daria , Kula Robert R
Published: December 2019

Cerambycidae provide important ecological services in forests yet cause economic damage when they infest living trees. Parasitoids can regulate woodborer populations, providing considerable control of pest cerambycids. Identifying parasitoids of native cerambycids may be useful in managing cerambycid outbreaks and aid in new-association biocontrol of exotic invasive cerambycids. We investigated Cerambycidae and associated hymenopteran parasitoid communities infesting Acer rubrum, Pinus virginiana, and Carya tomentosa from a forest in Delaware from 2005 to 2012. Cerambycid abundance, diversity, and richness, as well as parasitoid abundance, were measured by collecting trees in different conditions: felled, girdled, and naturally infested. Effect of edge or interior red maple on cerambycid abundance, diversity, and richness was examined. Over 14,500 cerambycids of 56 species and 38 genera were collected during the 7-yr period. Eleven species represented 95% of all cerambycids collected. Treatment only affected red maple, showing increased cerambycid richness and diversity from naturally infested trees. Cerambycid richness and diversity were two times greater on hickory than other species when combining girdled and felled treatments. Over 19,000 parasitic Hymenoptera of 12 families emerged from woodborer-infested wood with >70% of individuals belonging to Braconidae. Thirteen known species, and two unknown species, of Braconidae were identified from a subsample of 495 specimens; Ontsira mellipes (Ashmead) (Hymenoptera: Braconidae) and Rhoptrocentrus piceus Marshall (Hymenoptera: Braconidae) were the most abundant. This study provides fundamental information on native parasitoids associated with Cerambycidae, including cerambycid larval host associations. Parasitoids identified herein should be investigated for potential adaptation to invasive Cerambycidae to benefit invasive woodborer management.
Successful treatment with rivaroxaban of an extended deep vein thrombosis complicated by pulmonary embolism in a patient with familial antithrombin III deficiency: a case report
Authors: Appignani Marianna , Sciartilli Adolfo , Caputo Marcello , Di Girolamo Enrico
Published: December 2019

Background 

Patients with low levels of antithrombin III (AT III) are at an increased risk of developing arteriovenous thromboembolic disease.

Case summary 

We report a case of a 28-year-old woman who presented with a 1-week history of spontaneous right calf pain and swelling. A heterozygous AT III deficiency, phenotypically expressed as deep vein thrombosis, was reported in the patient’s mother and sister. Blood workup revealed residual AT III activity at 58% with normal protein C and protein S levels. Computed tomographic angiography (CTA) revealed subsegmental bilateral pulmonary embolism (PE) and deep vein thrombosis in the right leg extending into the inferior vena cava up to the confluence of the left renal vein. Placement of an inferior vena cava filter was not considered. Given the patient’s haemodynamic stability, anticoagulant therapy with 15 mg of rivaroxaban twice a day was initiated instead. Echocardiography after 10 days of treatment revealed complete resolution of the thrombus located in the inferior vena cava, while CTA revealed complete resolution of the PE.

Discussion 

Patients with AT III deficiency are likely to be heparin-resistant and will require higher heparin doses or the administration of AT III replacement therapy for the treatment of thrombosis, both of which are associated with an increased risk for haemorrhagic complications. Direct factor Xa inhibition by rivaroxaban provided an alternative mechanism for anticoagulation, which was found to be particularly useful in this patient with familial AT III deficiency, deep vein thrombosis, and PE.
Reduced form evidence on belief updating under asymmetric information—consumers’ response to wine expert opinions
Authors: Bonnet Céline , Hilger James , Villas-Boas Sofia B
Published: December 2019

We estimate the effect of quality labels on purchases through a retail field experiment. Utilising product-level panel scanner and product characteristic data for both labelled and unlabelled wines we estimate the average and heterogeneous effect on purchases. Consistent with earlier work, we find an average effect that is positively correlated with scores. We advance the consumer belief and product information literature on two fronts. First, higher scores matter more for lower priced products. Second, spillover effects impact sales of untreated wines; these effects can be positive or negative and are impacted by the average score and label converge within brand.
Assessing volume and variation of low-value care practices in the Netherlands
Authors: Kool Rudolf Bertijn , Verkerk Eva Wilhelmina , Meijs Jill , van Gorp Niels , Maessen Martijn , Westert Gert , Peul Wilco , van Dulmen Simone
Published: December 2019

Background

There have been contributions to quantify the volume of low-value care practices in the USA, Canada and Australia but we have no knowledge about the volume in Europe. The purpose of this study was to assess the volume and variation of Dutch low-value care practices.

Methods

We conducted a cross-sectional study with data of a Dutch healthcare insurance company from general practioners (GP’s) and hospitals in the Netherlands from 2016. We used all billing claims made by healthcare providers of 3.5 million Dutch inhabitants. We studied Choosing Wisely recommendations in order to select low-value care practices. We used the percentage low-value care practices per hospital and number of low-value care practices per GP as outcomes.

Results

We assessed the volume of low-back imaging by GPs, screening of patients over 75 years for colorectal cancer and diagnosing varices with Doppler or Plethysmography. We found that 0.4% (range 0–7%) of the eligible patients received low-value screening for colorectal cancer and 8.0% (range 0–88%) of eligible patients received low-value diagnosing of varices. About 52.4% of the GPs ordered X-rays and 11.2% ordered magnetic resonance imagings of the lumbosacral spine. Most healthcare providers did not provide the measured low-value care practices. However, 1 in 12 GPs ordered at least one low-back X-ray a week.

Conclusions

The three Choosing Wisely recommendations showed a lot of practice variation; many healthcare providers did not order these low-value diagnostic tests; a minor part did order a substantial amount, low-back spine radiology in particular. These healthcare providers should start reducing these activities.
Dietary Partitioning in Two Co-occurring Caecilian Species (Geotrypetes seraphini and Herpele squalostoma) in Central Africa
Authors: Kouete M T , Blackburn D C
Published: December 2019

Synopsis

Trophic interactions among fossorial vertebrates remain poorly explored in tropical ecosystems. While caecilian species can co-occur, whether and how sympatric species partition dietary or other resources are largely unknown. Based on specimens collected during field surveys in southern Cameroon, we conducted a dietary analysis of two co-occurring caecilian species, Geotrypetes seraphini and Herpele squalostoma. We find a negligible overlap in the adult diets of these two species. Earthworms dominated the diet of adult G. seraphini, whereas we found that mole crickets were the most frequent prey items in adult H. squalostoma. The dietary breadth of adult G. seraphini is smaller than that of H. squalostoma, which consumes a variety of hard-bodied prey including mole crickets, cockroaches, beetles, and crabs. Juvenile diets were similar between these species and mostly contained earthworms and ants. We did not detect significant ontogenetic dietary shifts in either species, though adults generally consumed a broader diversity of prey. As adults, G. seraphini and H. squalostoma may partition prey categories by consuming soft-bodied and hard-bodied prey, respectively. Because most caecilians are likely opportunistic predators, we expect that sympatric species partition dietary resources either by preference for different soil layers or ability to consume different prey categories.
Identification and Evaluation of Reference Genes for Normalization of Gene Expression in Developmental Stages, Sexes, and Tissues of Diaphania caesalis (Lepidoptera, Pyralidae)
Authors: Wang Zheng , Meng Qianqian , Zhu Xi , Sun Shiwei , Liu Aiqin , Gao Shengfeng , Gou Yafeng
Published: December 2019

Diaphania caesalis (Walker) is an important boring insect mainly distributed in subtropical and tropical areas and attacked tropical woody grain crops, such as starchy plants of Artocarpus. Quantitative real-time polymerase chain reaction (qRT-PCR) is a powerful approach for investigating target genes expression profiles at the transcriptional level. However, the identification and selection of internal reference genes, which is often overlooked, is the most vital step before the analysis of target gene expression by qRT-PCR. So far, the reliable internal reference genes under a certain condition of D. caesalis have not been investigated. Therefore, this study evaluated the expression stability of eight candidate reference genes including ACT, β-TUB, GAPDH, G6PDH, RPS3a, RPL13a, EF1α, and EIF4A in different developmental stages, tissues and sexes using geNorm, NormFinder and BestKeeper algorithms. To verify the stability of the recommended internal reference genes, the expression levels of DcaeOBP5 were analyzed under different treatment conditions. The results indicated that ACT, RPL13a, β-TUB, RPS3a, and EF1α were identified as the most stable reference genes for further studies on target gene expression involving different developmental stages of D. caesalis. And ACT and EIF4A were recommended as stable reference genes for different tissues. Furthermore, ACT, EF1α, and RPS3a were ranked as the best reference genes in different sexes based on three algorithms. Our research represents the critical first step to normalize qRT-PCR data and ensure the accuracy of expression of target genes involved in phylogenetic and physiological mechanism at the transcriptional level in D. caesalia.
Impact of forest fire on soil seed bank composition in Himalayan Chir pine forest
Authors: Konsam Bobbymoore , Phartyal Shyam S , Todaria Nagendra P
Published: December 2019

Aims

To explain how plant community copes with a recurring anthropogenic forest fire in Himalayan Chir pine forest, it is important to understand their postfire regeneration strategies. The primary aim of the study was to know: (i) how fire impact soil seed bank composition and (ii) how much soil seed bank composition differs with standing vegetation after the forest fire.

Methods

Soil samples were collected from burned and adjoining unburned sites in blocks using three layers down to 9 cm depth immediately after a forest fire and incubated in the net-house for seedling emergence. Same sites were revisited during late monsoon/early autumn season to know the species composition of standing vegetation recovered after a forest fire.

Important Findings

Soil contained viable seeds of >70 species. The average seed bank density was 8417 and 14 217 seeds/m2 in the burned and unburned site, respectively. In both sites, it decreased with increasing soil depth. Overall fire had no significant impact on seed density; however, taking individual layers into consideration, fire had a significant impact on seed density only in the uppermost soil layer. The species richness of soil seed bank and standing vegetation was 73 and 100, respectively (with 35 shared species), resulting in a similarity of about 40%. In contrast, >80% species in soil seed bank was found similar between burned and unburned sites. Further, there were no significant differences in species richness of standing vegetation in burned (87 spp.) and unburned (78 spp.) sites. Our results showed that fire had an insignificant impact on soil seed bank composition and restoration potential of a plant species from seeds. The understory herb and shrub plant community’s ability to form a fire-resistant viable soil seed bank and capable to recover in the postfire rainy season, explains how they reduce the risk of recurring fire damage in maintaining their population.
Acid and heat fastness in microsporidia: How acid fast are acid fast microsporidium?
Authors: Mittal Ruchi , Agarwal Sunil , Muduli Kalandi Ch , Sahu Srikant , Das Sujata
Published: December 2019

Microsporidia are obligate spore-forming microorganisms with strong resemblance to fungi and can affect almost every organ system in immunocompetent or immunocompromised individuals. Mixed infections are also reported in immunocompromised hosts. Microsporidial spores show marked morphological variations and the small and slender forms can resemble bacilli. Modified Zeihl Neelsen (ZN) stain, cold method demonstrates them as bright red in color, leaving several spores blue or incompletely stained; thus, they are reported as weakly or variably acid fast. Variability in staining results with ZN stain and considering the fact that Mycobacterium tuberculosis, the commoner bug in developing countries is identified by its resistance to stronger acids on ZN staining, authors wished to demonstrate acid and heat fastness in microsporidium using corneal tissue specimens. Microsporidial spores stained bright red in color with conventional ZN stain, demonstrated strong acid fastness, and interestingly the staining results improved on heating. Thus, the authors conclude that they are strongly acid and heat fast and care must be warranted so that they are not misdiagnosed as Mycobacterium or other acid-fast organisms. Careful observation of morphology, battery of special stains, and molecular diagnostics should be advocated for diagnostic confirmation. To the best of the authors’ knowledge, this is the first explicit report on acid and heat fastness on microsporidial spores.
Large-scale star formation in Auriga region
Authors: Pandey A K , Sharma Saurabh , Kobayashi N , Sarugaku Y , Ogura K
Published: December 2019

New observations in the VI bands along with archival data from the 2MASS and WISE surveys have been used to generate a catalogue of young stellar objects (YSOs) covering an area of about 6° × 6° in the Auriga region centred at l ∼ 173° and b ∼ 1.5°. The nature of the identified YSOs and their spatial distribution are used to study the star formation in the region. The distribution of YSOs along with that of the ionized and molecular gas reveals two ring-like structures stretching over an area of a few degrees each in extent. We name these structures as Auriga Bubbles 1 and 2. The centre of the Bubbles appears to be above the Galactic mid-plane. The majority of Class I YSOs are associated with the Bubbles, whereas the relatively older population, i.e. Class ii objects are rather randomly distributed. Using the minimum spanning tree analysis, we found 26 probable subclusters having five or more members. The subclusters are between ∼0.5 and ∼3 pc in size and are somewhat elongated. The star formation efficiency in most of the subcluster region varies between 5 ${{\ \rm per\ cent}}$ and 20 ${{\ \rm per\ cent}}$ indicating that the subclusters could be bound regions. The radii of these subclusters also support it.
Persistence of Immune Responses Through 36 Months in Healthy Adults After Vaccination With a Novel Staphylococcus aureus 4-Antigen Vaccine (SA4Ag)
Authors: Creech C Buddy , Frenck Robert W , Fiquet Anne , Feldman Robert , Kankam Martin K , Pathirana Sudam , Baber James , Radley David , Cooper David , Eiden Joseph , Gruber William C , Jansen Kathrin U , Anderson Annaliesa S , Gurtman Alejandra
Published: December 2019

Background

Staphylococcus aureus causes serious health care– and community-associated disease, requiring improved preventive measures such as vaccines. The investigational S. aureus 4-antigen vaccine (SA4Ag), comprising capsular polysaccharide serotypes 5 and 8 (CP5 and CP8) conjugated to CRM197, recombinant mutant clumping factor A (rmClfA), and recombinant manganese transporter protein C (rP305A or rMntC), was well tolerated, inducing robust functional immune responses to all 4 antigens through 12 months postvaccination. This is a serological extension study through 36 months postvaccination.

Methods

In 2 previous studies, healthy adults received SA4Ag, SA3Ag (without rMntC), or placebo; serology was also assessed at ~24 and ~36 months postvaccination. Functional immune responses (antibody responses that facilitate killing of S. aureus or neutralize S. aureus virulence mechanisms) were assessed with opsonophagocytic activity killing assays (CP5 or CP8) and a fibrinogen-binding inhibition assay (ClfA). A competitive Luminex immunoassay assessed ClfA and rMntC responses. Adverse events within 48 hours of blood draw were recorded.

Results

Four hundred forty subjects (18–64 years old, 255; 65–85 years old, 185) were enrolled. At 24 and 36 months postvaccination, subjects receiving SA4Ag had substantially higher geometric mean titers (GMTs) for CP5, CP8, and ClfA vs baseline; geometric mean fold rises (GMFRs) from baseline to month 36 were 2.7–8.1. For rMntC, 36-month GMTs declined from peak levels but remained above baseline for all SA4Ag groups; GMFRs from baseline to month 36 were 1.8 and 1.5 in the younger and older cohorts, respectively.

Conclusions

Persistent functional immune responses to S. aureus antigens were observed through 36 months in healthy adults.

ClinicalTrials.gov

NCT01643941 and NCT01364571.
Robotic Surgical Assistant Rehearsal: Combining 3-Dimensional-Printing Technology With Preoperative Stereotactic Planning for Placement of Stereoencephalography Electrodes
Authors: Bonda David J , Pruitt Rachel , Goldstein Todd , Varghese Anish , Shah Amar , Rodgers Shaun
Published: December 2019

BACKGROUND

The use of frameless stereotactic robotic technology has rapidly expanded since the Food and Drug Administration's approval of the Robotic Surgical Assistant (ROSA) in 2012. Although the use of the ROSA robot has greatly augmented stereotactic placement of intracerebral stereoelectroencephalography (sEEG) for the purposes of epileptogenic focus identification, the preoperative planning stages remain limited to computer software.

OBJECTIVE

To describe the use of a 3-dimensionally (3D)-printed patient model in the preoperative planning of ROSA-assisted depth electrode placement for epilepsy monitoring in a pediatric patient.

METHODS

An anatomically accurate 3D model was created and registered in a preoperative rehearsal session using the ROSA platform. After standard software-based electrode trajectory planning, sEEG electrodes were sequentially placed in the 3D model.

RESULTS

Utilization of the 3D-printed model enabled workflow optimization and increased staff familiarity with the logistics of the robotic technology as it relates to depth electrode placement. The rehearsal maneuvers enabled optimization of patient head positioning as well as identification of physical conflicts between 2 electrodes. This permitted revision of trajectory planning in anticipation of the actual case, thereby improving patient safety and decreasing operative time.

CONCLUSION

Use of a 3D-printed patient model enhanced presurgical positioning and trajectory planning in the placement of stereotactic sEEG electrodes for epilepsy monitoring in a pediatric patient. The ROSA rehearsal decreased operative time and increased efficiency of electrode placement.
Pamidronate as first-line treatment of hypercalcemia in neonatal subcutaneous fat necrosis: A case series
Authors: Chesover Alexander D , Harrington Jennifer , Mahmud Farid H
Published: December 2019

Background

Subcutaneous fat necrosis (SCFN) can be complicated by severe hypercalcemia, which is frequently asymptomatic. Nephrocalcinosis is associated with hypercalcemia and, in other clinical settings, has been linked to furosemide and glucocorticoid use. First-line bisphosphonate therapy treating hypercalcemia in neonatal SCFN is not well described.

Objectives

To describe the biochemical changes and risk of nephrocalcinosis in infants with hypercalcemia, secondary to neonatal SCFN, treated with initial pamidronate.

Methods

A retrospective chart review of five infants treated with initial pamidronate and without furosemide or glucocorticoids. Data were collected on the following: timing of presentation, therapeutic response, and presence of nephrocalcinosis.

Results

Hypercalcemia resolved after 2.8±1.7 days; this is compared to 7.6±2.8 days from previously reported cases utilising alternative therapies (P=0.012). There were no episodes of rebound hypercalcemia or hypocalcemia. Nephrocalcinosis was present in four of five cases. When including published cases, age at diagnosis was associated with presenting serum calcium (P=0.003) and nephrocalcinosis was associated with higher serum calcium (P=0.014) and time from SCFN to hypercalcemia diagnosis (P=0.002).

Conclusions

This retrospective case series demonstrates that first-line pamidronate treatment was effective and safe in the resolution of hypercalcemia. Nephrocalcinosis was observed, despite the avoidance of furosemide and glucocorticoid therapy, and associated with greater disease severity and duration of hypercalcemia.
The falling asleep process in adolescents
Authors: de Zambotti Massimiliano , Goldstone Aimee , Forouzanfar Mohamad , Javitz Harold , Claudatos Stephanie , Colrain Ian M , Baker Fiona C
Published: December 2019

Study Objectives

To investigate the pre-sleep psychophysiological state and the arousal deactivation process across the sleep onset (SO) transition in adolescents.

Methods

Data were collected from a laboratory overnight recording in 102 healthy adolescents (48 girls, 12–20 years old). Measures included pre-sleep self-reported cognitive/somatic arousal, and cortical electroencephalographic (EEG) and electrocardiographic activity across the SO transition.

Results

Adolescent girls, compared with boys, reported higher pre-sleep cognitive activation (p = 0.025) and took longer to fall asleep (p < 0.05), as defined with polysomnography. Girls also showed a less smooth progression from wake-to-sleep compared with boys (p = 0.022). In both sexes, heart rate (HR) dropped at a rate of ~0.52 beats per minute in the 5 minutes preceding SO, and continued to drop, at a slower rate, during the 5 minutes following SO (p < 0.05). Older girls had a higher HR overall in the pre-sleep period and across SO, compared to younger girls and boys (p < 0.05). The EEG showed a progressive cortical synchronization, with increases in Delta relative power and reductions in Alpha, Sigma, Beta1, and Beta2 relative powers (p < 0.05) in the approach to sleep, in both sexes. Delta relative power was lower and Theta, Alpha, and Sigma relative powers were higher in older compared to younger adolescents at bedtime and across SO (p < 0.05).

Conclusions

Our findings show the dynamics of the cortical-cardiac de-arousing process across the SO transition in a non-clinical sample of healthy adolescents. Findings suggest a female-specific vulnerability to inefficient sleep initiation, which may contribute to their greater risk for developing insomnia.
Obstructive sleep apnea and CPAP therapy alter distinct transcriptional programs in subcutaneous fat tissue
Authors: Gharib Sina A , Hurley Amanda L , Rosen Michael J , Spilsbury James C , Schell Amy E , Mehra Reena , Patel Sanjay R
Published: December 2019

Obstructive sleep apnea (OSA) has been linked to dysregulated metabolic states, and treatment of sleep apnea may improve these conditions. Subcutaneous adipose tissue is a readily samplable fat depot that plays an important role in regulating metabolism. However, neither the pathophysiologic consequences of OSA nor the effects of continuous positive airway pressure (CPAP) in altering this compartment’s molecular pathways are understood. This study aimed to systematically identify subcutaneous adipose tissue transcriptional programs modulated in OSA and in response to its effective treatment with CPAP. Two subject groups were investigated: Study Group 1 was comprised of 10 OSA and 8 controls; Study Group 2 included 24 individuals with OSA studied at baseline and following CPAP. For each subject, genome-wide gene expression measurement of subcutaneous fat was performed. Differentially activated pathways elicited by OSA (Group 1) and in response to its treatment (Group 2) were determined using network and Gene Set Enrichment Analysis (GSEA). In Group 2, treatment of OSA with CPAP improved apnea-hypopnea index, daytime sleepiness, and blood pressure, but not anthropometric measures. In Group 1, GSEA revealed many up-regulated gene sets in OSA subjects, most of which were involved in immuno-inflammatory (e.g. interferon-γ signaling), transcription, and metabolic processes such as adipogenesis. Unexpectedly, CPAP therapy in Group 2 subjects was also associated with up-regulation of several immune pathways as well as cholesterol biosynthesis. Collectively, our findings demonstrate that OSA alters distinct inflammatory and metabolic programs in subcutaneous fat, but these transcriptional signatures are not reversed with short-term effective therapy.
Grain supplementation of calves as an alternative beef production system to pasture-finished steers in Chilean Patagonia: meat quality and fatty acid composition
Authors: Sales Francisco , Bravo-Lamas Leire , Realini Carolina E , Lira Raúl , Aldai Noelia , Morales Rodrigo
Published: December 2019

Beef production in Chilean Patagonia is based on steer finishing on pastures with low nutritive value. Grain supplementation for finishing calves on pasture arises as an attractive alternative to shorten the finishing phase and improve the production efficiency of the traditional system. The aim of this study was to compare meat quality and fatty acid (FA) composition of beef from steers and calves. Forty Angus cross steers were raised on pasture and slaughtered at 18 to 20 mo of age (448 ± 31.7 kg body weight). An additional group of 10 calves from similar genetics was weaned at 9 mo of age (303 ± 8.0 kg) and subsequently supplemented with 2.5 kg corn plus 1.0 kg commercial concentrate daily while on pasture during 47 d, until they reached slaughter weight (316 ± 13.9 kg). All animals were slaughtered on the same day and the Longissimus thoracis muscle was removed from each carcass for meat quality and FA profile analysis. Hot carcass weight from calves was lighter than steers (174 ± 7.9 vs. 224 ± 17.5 kg, P ≤ 0.001). Meat from calves was lighter (higher L*) and less red (lower a*). In addition, meat from calves showed lower level of yellow pigments in subcutaneous fat (lower b*) compared with meat from steers (P ≤ 0.001). Meat from calves was more tender than meat from steers (P ≤ 0.05), although both shear force values were low and within recommendations for high consumer acceptability. Meat from both production systems showed fat content and FA profiles within dietary recommendations for a healthy diet. However, meat from calves was leaner (1.10 ± 0.29 vs. 2.00 ± 0.72% fat, P ≤ 0.001). Meat from calves showed lower percentages of saturated (P ≤ 0.05) and monounsaturated (P ≤ 0.001) FAs and higher percentages of polyunsaturated and n-3 (P ≤ 0.001) FAs and conjugated linoleic acid (total and 9c,11t-18:2 isomer, P ≤ 0.001) than meat from steers. Grain supplementation of calves on pasture can reduce the finishing period by 8 to 10 mo at the expense of lighter carcasses with similar or improved meat quality characteristics compared with the traditional finishing of steers on pasture. Implementation of the alternative production system will depend mainly on feed costs and target carcass weights for specific markets.
Insights into basic science: what basic science can teach us about iron homeostasis in trauma patients
Authors: Bartnikas Thomas B. , Steinbicker Andrea U. , Enns Caroline A.
Published: December 2019

Purpose of review

This review summarizes recent basic science studies on homeostasis of iron, an essential dietary nutrient and potentially toxic metal, and explores the relevance of these studies to our understanding of trauma and related severe, acute events.

Recent findings

Recent studies in experimental models of iron homeostasis have added to our understanding of how iron levels are regulated in the body and how iron levels and iron-dependent biological processes contribute to trauma and related events. Iron deficiency, a common nutritional disorder, can impair critical organ function and wound and injury repair. Iron excess, typically because of genetic defects, can cause toxicity to tissues and, like iron deficiency, impair wound and injury repair. Finally, pharmacologic inhibition of ferroptosis, a novel form of iron-dependent cell death, is beneficial in animal models of cardiac, hepatic, and intestinal injury and intracerebral hemorrhage, suggesting that ferroptosis inhibitors could serve as novel therapeutic agents for trauma and related events.

Perturbations in iron homeostasis can contribute significantly to an individual's predisposition to trauma and their ability to recover posttrauma, whereas pharmacologic targeting of ferroptosis may attenuate severity of trauma-induced organ dysfunction.
Comorbidities in gout and hyperuricemia: causality or epiphenomena?
Authors: Sumpter Nicholas A. , Saag Kenneth G. , Reynolds Richard J. , Merriman Tony R.
Published: December 2019

Purpose of review

To review advances in the understanding of potentially causal relationships between gout, hyperuricemia and comorbidities.

Recent findings

Observational studies reveal 4–5 comorbidity clusters in gout patients. There tend to be gout alone, gout with chronic kidney disease and gout with other metabolic comorbidities. However, heterogeneous study populations and confounding make inference difficult for causal relationships. Mendelian randomization leverages genetic information as an instrumental variable to indicate putatively causal relationships between traits of epidemiological interest. Thus far, Mendelian randomization has not indicated widespread causal relationships of serum urate for comorbid traits. However, BMI has a small causal effect on serum urate, which may partially explain the increased prevalence of metabolic syndrome and cardiovascular disease among those with gout and hyperuricemia. There is a lack of robust and sufficiently powered Mendelian randomization studies for many serum urate-associated traits, such as hypertension. No adequately powered studies have been completed for gout and its comorbidities.

Although observational studies indicate putative causal effects of serum urate on comorbidities, Mendelian randomization studies suggest that serum urate does not have a causal role on the various tested comorbidities. There remains work to be done in clarifying the causal role of gout per se on the same traits.
Management of Fasciotomy Incisions After Acute Compartment Syndrome: Is Delayed Primary Closure More Feasible in Children Compared With Adults?
Authors: Rademacher Emily , Miller Patricia E. , Jordan Eric , May Collin J. , Glotzbecker Michael P. , Bae Donald S. , Hedequist Daniel J. , Shore Benjamin J.
Published: December 2019

Background:

Recent adult literature has demonstrated that in the setting of acute compartment syndrome (ACS), if fasciotomy wounds are not closed after the first debridement, they are unlikely to be closed via delayed primary closure (DPC). The purpose of this study was to report the success of DPC through serial debridement in children with fasciotomy wounds secondary to ACS and to determine whether length of hospital stay is negatively affected by adopting a DPC strategy.

Methods:

We identified all patients treated with fasciotomy for ACS (aged 0 to18 y). Patient, injury, and treatment characteristics were summarized by fasciotomy treatment type. Patients were grouped as: primary closure, DPC, and flap or skin graft (F/SG). For patients who required additional debridements after initial fasciotomy, treatment success was defined as closure by DPC (without requiring F/SG). Multivariable logistic regression was used to determine factors associated with additional surgeries, complications, and treatment success.

Results:

A total of 82 children underwent fasciotomies for ACS. Fifteen (18%) patients were treated with primary closure at the time of their initial fasciotomy and were excluded from the remainder of the analysis, 48 (59%) patients underwent DPC, and 19 (23%) patients were treated with F/SG. The majority of delayed fasciotomy wounds were successfully closed by DPC (48/67, 72%) and the rate of successful closure remained consistent with each successive operative debridement. There were no differences across DPC and F/SG groups with respect to age, method of injury, or injury severity. Patients who underwent F/SG remained in the hospital for an average of 12 days compared with 8 days for those who underwent DPC (P<0.001).

Conclusions:

In the setting of ACS, pediatric fasciotomy wounds that are not closed after the first postfasciotomy debridement still have a high likelihood of being closed through DPC with serial surgical debridement. In children, persisting with DPC strategy for fasciotomy closure after ACS is more successful than it is in adults.

Level of Evidence:

Level III.
APL Lasso Suspensionplasty for Trapeziectomy
Authors: Sivakumar Brahman S. , Graham David J.
Published: December 2019

Base of thumb arthritis is a common pathology, with late-stage disease often treated by trapeziectomy and a form of ligament reconstruction or suspension. No therapeutic option for suspension or ligament reconstruction has proven to be superior to others, with risks inherent to all. Here, the authors describe a novel technique utilizing an accessory slip of abductor pollicis longus looped around the second metacarpal base to suspend the metacarpal and prevent subsidence after trapeziectomy. This technique aims to mitigate some of the risks seen in other methods, while providing similar biomechanical strength. Early clinical results are also presented.
Clinical Documentation for Intensivists: The Impact of Diagnosis Documentation
Authors: Sanderson Amy L. , Burns Jeffrey P.
Published: December 2019

Objectives:

The aim of this review is to describe the interaction of clinical documentation with patient care, measures of patient acuity, quality metrics, research database accuracy, and healthcare reimbursement in order to highlight potential areas of improvement for intensivists.

Data Sources:

An online search of PubMed was undertaken as well as review of resources published by the American Academy of Pediatrics, the Society of Critical Care Medicine, the American Medical Association, and the Association of Clinical Documentation Improvement Specialists.

Study Selection:

Selected publications included those that described coding, medical record documentation, healthcare reimbursement, quality metrics, administrative databases, Clinical Documentation Improvement programs, medical scribe programs, and various payment models.

Data Extraction:

Relevant information was extracted to highlight the impact of diagnosis documentation on patient care, perceived patient severity of illness, quality metrics, and healthcare reimbursement. Query data from our hospital’s Clinical Documentation Improvement program were reviewed to highlight areas of improvement within our own Division of Critical Care Medicine. Additionally, interventions to improve clinical documentation were incorporated into this review.

Data Synthesis:

Available data in the literature indicate that documentation of precise diagnoses in the medical record has a positive impact on quality metrics, accuracy of administrative databases, hospital reimbursement, and perceived patient complexity. However, there is insufficient data to make conclusions regarding documentation of specific diagnoses and effects on patient care. Administrative responsibilities associated with documentation have been increasing, especially with the introduction of electronic medical records.

Conclusions:

Documentation of specific diagnoses in the medical record is important in the broad context of our existing medical system but there is an associated burden in doing so. Widespread implementation of electronic medical record systems has inadvertently led to clinician dissatisfaction and burnout. Research is needed to further evaluate the impact of documentation on patient care as well as steps to decrease the associated burden.
Association Between Consecutive Days Worked by Intensivists and Outcomes for Critically Ill Patients
Authors: Gershengorn Hayley B. , Pilcher David V. , Litton Edward , Anstey Matthew , Garland Allan , Wunsch Hannah
Published: December 2019

Objective:

To evaluate the association between consecutive days worked by intensivists and ICU patient outcomes.

Design:

Retrospective cohort study linked with survey data.

Setting:

Australia and New Zealand ICUs.

Patients:

Adults (16+ yr old) admitted to ICU in the Australia New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Registries (July 1, 2016, to June 30, 2018).

Interventions:

None.

Measurements and Main Results:

We linked data on staffing schedules for each unit from the Critical Care Resources Registry 2016–2017 annual survey with patient-level data from the Adult Patient Database. The a priori chosen primary outcome was ICU length of stay. Secondary outcomes included hospital length of stay, ICU readmissions, and mortality (ICU and hospital). We used multilevel multivariable regression modeling to assess the association between days of consecutive intensivist service and patient outcomes; the predicted probability of death was included as a covariate and individual ICU as a random effect. The cohort included 225,034 patients in 109 ICUs. Intensivists were scheduled for seven or more consecutive days in 43 (39.4%) ICUs; 27 (24.7%) scheduled intensivists for 5 days, 22 (20.1%) for 4 days, seven (6.4%) for 3 days, four (3.7%) for 2 days, and six (5.5%) for less than or equal to 1 day. Compared with care by intensivists working 7+ consecutive days (adjusted ICU length of stay = 2.85 d), care by an intensivist working 3 or fewer consecutive days was associated with shorter ICU length of stay (3 consecutive days: 0.46 d fewer, p = 0.010; 2 consecutive days: 0.77 d fewer, p < 0.001; ≤ 1 consecutive days: 0.68 d fewer, p < 0.001). Shorter schedules of consecutive intensivist days worked were also associated with trends toward shorter hospital length of stay without increases in ICU readmissions or hospital mortality.

Conclusions:

Care by intensivists working fewer consecutive days is associated with reduced ICU length of stay without negatively impacting mortality.
Relative Hypoglycemia in Diabetic Patients With Critical Illness
Authors: Kwan Timothy N. , Zwakman-Hessels Lara , Marhoon Nada , Robbins Ray , Mårtensson Johan , Ekinci Elif , Bellomo Rinaldo
Published: December 2019

Objectives:

Relative hypoglycemia is a decrease in glucose greater than or equal to 30% below prehospital admission levels (estimated by hemoglobin A1C) but not to absolute hypoglycemia levels. It is a recognized pathophysiologic phenomenon in ambulant poorly controlled diabetic patients but remains unexamined during critical illness. We examined the frequency, characteristics, and outcome associations of relative hypoglycemia in diabetic patients with critical illness.

Design:

Retrospective cohort study.

Setting:

ICU of a tertiary hospital.

Patients:

One-thousand five-hundred ninety-two critically ill diabetic patients between January 2013 and December 2017.

Interventions:

None.

Measurements and Main Results:

The median age of patients was 67 years (interquartile range, 60–75 yr). The median Acute Physiology and Chronic Health Evaluation III score was 53 (interquartile range, 40–68). Thirty-four percent of patients with diabetes experienced relative hypoglycemia (exposure) during their ICU admission. Such patients had higher glycemic lability, hemoglobin A1C levels, and Acute Physiology and Chronic Health Evaluation III scores. The hazard ratio for 28-day mortality of diabetic patients, censored at hospital discharge, for patients with relative hypoglycemia was 1.9 (95% CI, 1.3–2.8) and was essentially unchanged after adjustment for episodes of absolute hypoglycemia. After an episode of relative hypoglycemia, the hazard ratio for subsequent absolute hypoglycemia in the ICU was 3.5 (95% CI, 2.3–5.3).

Conclusions:

In ICU patients with diabetes, relative hypoglycemia is common, increases with higher hemoglobin A1C levels, and is a modifiable risk factor for both mortality and subsequent absolute hypoglycemia. These findings provide the rationale for future interventional studies to explore new blood glucose management strategies and to substantiate the clinical relevance of relative hypoglycemia.
Immune checkpoint inhibitors in melanoma in the metastatic, neoadjuvant, and adjuvant setting
Authors: Herrscher Hugo , Robert Caroline
Published: December 2019

Purpose of review

Immune checkpoint inhibitors (ICI) are now standards of care in metastatic melanoma. We highlight here the dramatic improvement that these drugs brought in the history of melanoma care.

Recent findings

The monoclonal antibody directed against cytotoxic T-lymphocyte-associated protein 4, ipilimumab, was approved in 2011. Antiprogramed death cell protein 1 antibodies, nivolumab and pembrolizumab, were developed afterward and approved in 2014, demonstrating an improved efficacy/safety ratio as compared with ipilimumab. The association of ipilimumab and nivolumab now appears as the most efficient immunotherapy but the toxicity of this regimen is a limitation. These drugs have also been evaluated in the adjuvant setting for patients with stage III or IV resected melanoma where they have shown a significant benefit in terms of relapse-free survival.

ICI-based immunotherapy radically modified melanoma management and now appear as the most efficient treatment for patients with metastatic melanoma with characterized by long-lasting cancer remissions, and a distinct spectrum of immune-related adverse events. Their efficacy is now also established in the adjuvant setting and they are now actively evaluated as neoadjuvant treatment with promising early results.

Intensive translational work is ongoing to identify predictive biomarkers of efficacy and toxicity to improve ICI benefit/risk ratio.
Increased Risk of Acute Myelogenous Leukemia After Early Onset but Not Late-Onset Colorectal Cancer
Authors: Lehrer Steven , Rheinstein Peter H.
Published: December 2019

Background:

Early onset colorectal cancer in persons younger than 50 years is increasingly common. Clinical and molecular characterizations reveal a distinctive disease. Thirty percent of patients have mutations of hereditary cancer syndromes, especially Lynch syndrome. A recent analysis, testing germline DNA for mutations in 25 cancer susceptibility genes, showed that some patients younger than 50 years had mutations of high-penetrance colorectal cancer genes such as APC (adenopolyposis coli). Others had mutations in high-penetrance or moderate-penetrance genes not traditionally associated with colorectal cancer, such as ATM (ataxia telangiectasia mutated), whereas still others had low penetrance colorectal cancer genes. In the current study, we examined the incidence of second cancers following early onset (age less than 50 y) colorectal cancer.

Methods:

The initial study population was assembled using records from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. The SEER*Stat MP-SIR (multiple primary-standardized incidence ratio) tool was used to calculate SIRs and excess risk for second primary malignancies. The SIR is expressed as the ratio of observed-to-expected (O/E) cases. We used The Cancer Genome Atlas (TCGA) and AACR Project Genie for genetic analysis. The data were accessed with the online Xena Browser and cBioportal.

Results:

Acute myelogenous leukemia (AML) O/E ratios were significantly >1 in patients aged less than 50 years, at 12 to 59 months after colorectal cancer. In patients aged 50 years and older, O/E ratios were equal to 1 or quite close at 12 to 59 months after colorectal cancer. Alterations in 3 AML genes, CEBPA-AS1, MLLT1, and MLLT6, affected the prognosis of colorectal cancer patients less than 50 years but not older than 50 years. One AML gene, FLT3, had the highest copy number alteration frequency of any gene in 1438 colorectal patients 18 to 48 years of age. Genetic alterations of FLT3/TP53 were mutually exclusive. Genetic alterations of FLT3/JAK2 and JAK2/CTNNB1 were co-occurrent.

Conclusion:

These observations suggest that early onset colorectal cancer and AML may be related diseases.